Platelet-rich plasma (PRP) is an autologous blood-derived product with an increased concentration of platelets in plasma, which are used to deliver supraphysiological levels of growth factors. Platelet-rich plasma has been used in many fields, including oral, maxillofacial, and plastic surgery. Its use in sports medicine has been increasing after recent evidence and media publicity suggest that it may augment the treatment of muscle strains, as well as tendon and ligament healing. Basic science and animal studies show promising results, but high-level clinical trials have yet to prove its efficacy. With increasing media coverage on the use of PRP in athletes, it is paramount that orthopedic surgeons and sports medicine physicians understand the various methods of preparation and administration, potential clinical applications, and available clinical results to best counsel patients on its advantages and disadvantages.
Displaced isolated greater tuberosity fractures are rare injuries that require operative treatment to optimize rotator cuff function and prevent painful subacromial impingement. A lack of consensus exists regarding ideal management of these injuries because of the paucity of literature on the subject.The outcomes of 17 patients treated with open (n=15) or arthroscopic (n=2) fixation at the authors' institution between 2001 and 2009 were retrospectively reviewed. Postoperative range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) score, and overall patient satisfaction were recorded at final follow-up. At a mean of 5.2 years (range 1.5-9.7 years), average postoperative active forward elevation was 150.3° (range, 60°-180°), ASES score was 82.9 (range, 46.7-100), and VAS score was 1.4 (range, 0-5). According to Neer's criteria, the overall outcome was excellent in 11 (65%) patients, satisfactory in 5 (29%) patients, and unsatisfactory in 1 (6%) patient. Final postoperative radiographs were available for 15 patients at a mean of 6.64 months. Radiographic union with near-anatomic position of the greater tuberosity was achieved in 13 (87%) of 15 patients. The presence of rotator cuff and rotator interval tears requiring repair, history of dislocation, age 60 years or older, and delayed time to surgery ≥ 10 days did not significantly (P>.05) influence the patients' final active forward elevation and ASES scores.Favorable patient outcomes can be achieved when fractures with >5 mm of displacement are treated with anatomic reduction and secure fixation. For a specific injury, the ideal surgical approach and method of fixation is dictated by patient characteristics and fracture pattern.
Patients are referred to hospital for dento-alveolar surgical procedures requiring supplemental corticosteroid administration. However, it has been reported that medically compromised patients who require routine dental treatment are being referred unnecessarily. This article reports a retrospective study undertaken at a Regional Maxillofacial Unit over a 24-month period, which reveals the referral pattern and management of patients specifically referred for outpatient dental treatment with corticosteroid supplementation. The paper highlights the dilemma confronting practitioners when reviewing the literature on corticosteroid supplementation and the confusion that still exists in both the primary and secondary care settings as to which patients should be prescribed supplemental corticosteroids. A simplified guide is proposed for the clinical management of these patients.
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