Autologous injection of platelet rich plasma (PRP) stimulates healing process in degenerated tendons. The purpose of this study is to compare the functional outcome of lateral epicondylitis treated with PRP and steroid injection.

Tennis elbow patients who failed conservative medical therapy were included and were allocated randomly steroid group (n=70) and PRP group (n=63). Data were collected before procedure, at 4, 8, 12 weeks, 1 year and 2 years after procedure. The main outcome measures were visual analogue score, Mayo elbow performance score, DASH score and hand grip strength.

Successful treatment was defined as more than a 25% reduction in visual analogue score or DASH score and more than 75 score in Mayo elbow performance score. We observed that 35 of the 70 patients (50%) in corticosteroid group and 47 of the 63 patients (75%) in PRP group were successful, which was significantly different (p<.001), according to DASH score 37 of the 70 patients (53%) and 47 of the 63 patients (75%) in the PRP group were successful which was also significantly different (P = .005), Mayo elbow performance score was successful in 36 of the 70 patients (51%) in corticosteroid group and 49 of the 63 patients (78%) in PRP group. The improvement in hand grip strength of hand from 24.7kg (mean) 26kg in corticosteroid group and 23.5kg (mean) to 32.9kg (mean) in PRP group.

PRP injection for chronic lateral epicondylitis reduces pain, improve functionality and hand grip strength when compared to steroid injection.

Aim: To study the effect of traction on the compartment pressures during intramedullary nailing of closed tibial shaft fractures. Methods:Thirty consecutive patients with Tscherne C1 fractures were randomised into two groups. Sixteen patients underwent intramedullary nailing of the tibia with traction and fourteen patients without traction. Compartment pressures were measured before the application of traction or commencement of the procedure and at the end of the procedure with a Stryker¨intracompartmental pressure monitor system. Results:The data collected was analysed using paired student t-test. There was no statistically signiþcant difference (p> 0.05) in the preoperative mean compartment pressures for both groups. The mean postoperative measurements were higher in all the four compartments in the traction group (p< 0.05). None of the pressures reached the critical level Conclusions:These results show that traction increases compartment pressures signiþcantly. The group considered did not have compartment syndrome possibly due to lower pressures. With greater pre operative compartment pressures, it can reach a critical level on traction necessitating decompression. We advocate the procedure be done without traction.

The aim of this study was to evaluate the effect of traction on the compartment pressures during intramedullary nailing of closed tibial shaft fractures.

The study design was a randomised prospective trial. The period of the study was Sept ’99 to Dec 2000. 30 consecutive patients with Tscherne C1 fractures were randomised into two groups.16 patients underwent intramedullary nailing of the tibia with traction and 14 patients without traction. Compartment pressures were measured before the application of traction or commencement of the procedure and at the end of the procedure. The method described by Gulli and Templeman was used to measure all the four compartments of the injured limb. The pressures were measured with a Stryker® pressure monitor. The absolute and differential compartment pressures were recorded. All patients were followed up for the duration of at least 8 months and until fracture union.

The data collected was analysed using paired student t-test. There was no statistically significant difference (p> 0.05) in the preoperative mean compartment pressures for both groups when all the four compartments were measured individually. The mean postoperative measurements were higher (range 9–10 mmHg) in all four compartments in the traction group. This was statistically significant (p< 0.05). None of the pressures reached the critical level as they were more than 30 mmHg below the diastolic pressure (differential pressure).

These results show that traction increases compartment pressures during intramedullary nailing of tibial shaft fractures. The group considered did not have compartment syndrome possibly due to less soft tissue injury. With greater soft tissue injury and greater preoperative compartment pressures, compartment pressures can reach a critical level necessitating decompression.

We conclude that intramedullary nailing without traction reduces the chances of significant increase in compartment pressures and advocate the procedure be done without traction.

Introduction: Compartment syndrome is a well recognised complication of tibial diaphyseal fractures. The sequelae of late treatment can be devastating to both patient and surgeon. The aim of this study was to identify the incident, outcome and possible risk factors of compartment syndrome treated in a regional trauma unit.

Patients and Methods: A total of six hundred and twenty three tibial diaphyseal fractures were managed over a four year period (1995–1999). Two hundred and forty three of these were treated using a reamed intramedullary nail. One hundred and ninety four of these were closed and forty nine were open. AO radiological classification and Tscherne soft tissue classification were used to grade severity of injury. The mechanism of injury was recorded for all tibial fractures. Patients who were diagnosed with compartment syndrome were clinically and radiologically evaluated.

Results: Compartment syndrome was diagnosed in seventeen cases with an average follow up of twenty eight months (range 8–48 months). This represented a rate of compartment syndrome of 2.7% of all tibial fractures but 6.9% of cases treated with a reamed tibial nail. The average age of patients was twenty four years (range 18–42 years). Fractures were closed in twelve cases and open in 5. Results in this group were good in ten cases, fair in four cases and poor in three cases (Edwards Classification). Six patients developed complications following fasciotomy including drop foot, equinus contracture, muscle weakness and MRSA infection. In patients with complications, the interval between onset of symptoms and decompression was greater than ten hours. All patients who developed compartment syndrome had been treated using a reamed intramedullary nail.

Discussion: There was a statistically significant association between the use of intramedullary reaming and development of compartment syndrome (p< .05). We recognised a hitherto undescribed trend of compartment syndrome following reamed intramedullary nailing of tibial fractures sustained during sport activity. This may relate to higher initial compartment pressure in this group at the time of fracture. Increased awareness may avoid the consequences of late treatment of compartment syndrome.