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Fulltext Determining the effectiveness of the different preparation protocols for platelet-rich plasma (PRP) in yielding higher concentrations of platelets

Kavitha, G., Sangeetha, V.N., Shani, S., Murali, M.R., Raja, E.A., Rukmanikanthan, S., et al.

JUMMEC, 2011;14(2):1-6.
MyJurnal

INTRODUCTION: Despite the various methods described in producing platelet-rich plasma (PRP), it is well established that this biological product in its many preparations have been proven to enhance wound healing. However, very little have been known about the efficacy of these methods hence there is a lack of evidence in the superiority of one method over another. Thus, a study was conducted to compare these different protocols to determine which produces the highest concentration of platelets.
METHODS: Peripheral blood was obtained from 24 healthy volunteers. Four different protocols using similar 2 step centrifugation methods of preparing PRP were applied to an equal number of samples in this study. Platelet counts were performed on whole blood (without processing), PRP preparations and platelet-poor plasma (PPP).
RESULTS: All protocols produced higher amounts of platelet concentrates in PRP preparations than plasma. However, centrifugation at 150g for 10 minutes followed by another at 450g at 10 minutes produces significantly higher amount of platelets concentration (p<0.05)
CONCLUSION: Optimizing the protocols to produce PRP appears to be important in obtaining a maximal yield of platelet concentrate. Here the protocol described has shown to provide significant concentration yield over all others.
Keywords: platelet-rich-plasma, growth factors, centrifugal forces
Fulltext Pattern of distal radius fracture in Malaysian children

Asim AM, Noor Fadzilah R, Rukmanikanthan S, Saw A

Med J Malaysia, 2012 Oct;67(5):483-6.
PMID: 23770863 MyJurnal

INTRODUCTION: The distal radius is the most common fracture site in children, but local information on the fracture pattern, mechanism of injury and socio-demographic characteristics of the fracture is lacking.

MATERIAL METHODS: We interviewed 126 children and their family members who were under follow up for this fracture in a single institution over a period of 2 years. Radiological images were reviewed to ensure that only those with fracture in the distal one third of the forearm were included.

RESULTS: The overall incidence of this fracture increased with age, and male dominance was noted starting from schooling age. Most fractures occurred at home (38.8%), and 52.3% of all fractures were due to low energy falls. Sports injuries were mainly due to playing football, and road accidents due to riding bicycles. There were 49 (38.8%) children with incomplete fractures, and 19 (15.0%) with physeal plate fractures.

CONCLUSION: Male dominance for distal radius fracture occurred at a comparatively younger age in our population. Preventive measures should focus on home environment since this is the most common place for fracture to occur. Special attention should be paid to boys after the school going age.
Fulltext Distal radius morphometry in the Malaysian population

Chan CYW, Vivek AS, Leong WH, Rukmanikanthan S

Malays Orthop J, 2008;2(2):27-30.
MyJurnal

The goal of treatment in distal radius fracture is to restore the anatomy of the distal radius, however the criteria currently used to evaluate the quality of eduction are based on Western based published figures. This goal of this study was to investigate whether there are variations in the morphology of the distal radius among the multiracial population of Malaysia. Consecutive normal wrist radiographs of patients who presented to the accident and emergency unit in three major hospitals in Malaysia were measured. The palmar tilt of the distal radius averaged 12.6o Â± 3.55o, and the radial inclination averaged 25.1o Â± 3.42o. The ulnar variance averaged â€“ 0.1 Â± 1.31mm, 38.4% of the patients had neutral ulnar variance, 28.8% have negative ulnar variance and 32.9% have positive ulnar variance. Our results indicate that distal radius morphometric parameters in the Malaysian population are comparable to Western figures.
Fulltext Prospects of implant with locking plate in fixation of subtrochanteric fracture: experimental demonstration of its potential benefits on synthetic femur model with supportive hierarchical nonlinear hyperelastic finite element analysis

Latifi MH, Ganthel K, Rukmanikanthan S, Mansor A, Kamarul T, Bilgen M

Biomed Eng Online, 2012;11:23.
PMID: 22545650 DOI: 10.1186/1475-925X-11-23

Effective fixation of fracture requires careful selection of a suitable implant to provide stability and durability. Implant with a feature of locking plate (LP) has been used widely for treating distal fractures in femur because of its favourable clinical outcome, but its potential in fixing proximal fractures in the subtrochancteric region has yet to be explored. Therefore, this comparative study was undertaken to demonstrate the merits of the LP implant in treating the subtrochancteric fracture by comparing its performance limits against those obtained with the more traditional implants; angle blade plate (ABP) and dynamic condylar screw plate (DCSP).
The Safety and Strength of a Novel Medial, Partial Nonthreaded Pedicle Screw: A Cadaveric and Biomechanical Investigation

Kwan MK, Chan CY, Saw LB, Rukmanikanthan S, Lenke LG

Clin Spine Surg, 2017 04;30(3):E297-E304.
PMID: 28323715 DOI: 10.1097/BSD.0b013e3182aab29d

STUDY DESIGN: Cadaveric and biomechanical study.
OBJECTIVE: The aim of this study was to assess the safety and pullout strength of medial, partial nonthreaded thoracic pedicle screws compared with conventional screws.
SUMMARY OF BACKGROUND DATA: The perforation rate of the pedicle screws has been reported as high as 41%. Nerve injury and irritation can result from the compression of malpositioned screw on neural structures.
METHODS: Ten fresh cadavers were studied. Screws, 5.0 and 6.0 mm, were inserted from T1 to T6 and T7 to T12, respectively. Pedicle perforations and fractures were recorded upon screw insertion and final positioning (nonthreaded portion facing medially) after a wide laminectomy. Pullout strength of novel and conventional screws were then tested using an Instron machine in an artificial bone substitute.
RESULTS: A total of 240 thoracic pedicle screws were inserted. Of them, 88.8% (213 screws) were fully contained during screw insertion. There were 5.0% (12 screws) grade 1 medial perforations and 6.2% (15 screws) grade 1 lateral perforations during screw insertion. Upon final positioning, 93.8% (225 screws) were fully contained. All grade 1 medial perforations, which occurred during insertion, were converted to grade 0. No dural or nerve root injuries occurred. Pedicle split fractures were noted in 6.7% (16 screws). The use of medial, partial nonthreaded screws reduced the overall perforation rate from 11.2% to 6.2%. The mean pullout load for the 5 mm fully threaded screw versus medial, partial nonthreaded was 1419.3±106.1 N (1275.8-1538.8 N) and 1336.6±44.2 N (1293.0-1405.1 N) respectively, whereas 6 mm pullout load averaged 2126.0±134.8 N (1986.3-2338.3 N) and 2036.5±210.0 N (1818.4-2355.9 N). The difference was not statistically significant.
CONCLUSIONS: The use of medial, partial nonthreaded pedicle screws reduced the medial perforation rate from 5.0% to 0%; however, the pullout strength was not significantly reduced. The use of this novel screw can potentially reduce the incidence of nerve injury or irritation after medial pedicle perforations.