Over the past few decades, various forms of platelet concentrates have evolved with significant clinical utility. The newer generation products, including leukocyte-platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF), have shown superior biological properties in musculoskeletal regeneration than the first-generation concentrates, such as platelet-rich plasma (PRP) and plasma rich in growth factors. These newer platelet concentrates have a complete matrix of physiological fibrin that acts as a scaffold with a three-dimensional (3D) architecture. Further, it facilitates intercellular signaling and migration, thereby promoting angiogenic, chondrogenic, and osteogenic activities. A-PRF with higher leukocyte inclusion possesses antimicrobial activity than the first generations. Due to the presence of enormous amounts of growth factors and anti-inflammatory cytokines that are released, A-PRF has the potential to replicate the various physiological and immunological factors of wound healing. In addition, there are more neutrophils, monocytes, and macrophages, all of which secrete essential chemotactic molecules. As a result, both L-PRF and A-PRF are used in the management of musculoskeletal conditions, such as chondral injuries, tendinopathies, tissue regeneration, and other sports-related injuries. In addition to this, its applications have been expanded to include the fields of reconstructive cosmetic surgery, wound healing in diabetic patients, and maxillofacial surgeries.

Musculoskeletal disorders encompass a wide range of conditions that impact the bones, joints, muscles, and connective tissues within the body. Despite the ongoing debate on toxicity and administration, ozone demonstrated promise in managing several musculoskeletal disorders, modulating pain and inflammation. A literature search was conducted. The research design, methods, findings, and conclusions of the studies were then examined to evaluate the physiological effects, clinical application, controversies, and safety of the application of ozone in musculoskeletal medicine. Ozone application demonstrates considerable therapeutic applications in the management of musculoskeletal disorders, including fractures, osteoarthritis, and chronic pain syndromes. Despite these advantages, studies have raised concerns regarding its potential toxicity and emphasized the importance of adhering to stringent administration protocols to ensure safety. Additionally, heterogeneities in patient reactions and hazards from oxidizing agents were observed. Given its anti-inflammatory and analgesic qualities, ozone therapy holds potential in the management of several musculoskeletal disorders. Additional high-quality research with long follow-up is required to refine indications, efficacy and safety profile. Finally, for wider clinical acceptability and utilization, the development of international recommendations is essential.

Objetivo Comparar a eficácia dos protocolos de reabilitação acelerada precoce e de reabilitação conservadora retardada após reconstrução artroscópica do ligamento cruzado anterior, em termos da escala do International Knee Documentation Committee (IKDC), da dor (segundo a Escala Visual Analógica), da frouxidão e da rigidez no pós-operatório de um ano para determinar o melhor desfecho. Materiais e Métodos Um total de 80 participantes foram divididos em dois grupos (grupo da acelerada precoce e grupo da conservadora retardada), que foram analisados pelos testes do Qui-quadrado de Pearson e da soma dos postos de Wilcoxon. Resultados A frouxidão do joelho no pós-operatório de 1 ano foi significativamente mais alta (p = 0,039) no grupo da acelerada precoce do que no grupo da conservadora retardada. Em termos de dor pós-operatória (pela Escala Visual Analógica) e pontuações no IKDC, ambos os grupos apresentaram resultados similares. A amplitude de movimento pós-operatória foi melhor no grupo da acelerada precoce, mas isso não foi estatisticamente significativo (p = 0,36). Conclusão O protocolo de reabilitação acelerada precoce foi associado com uma frouxidão significativa do joelho em um ano de pós-operatório em comparação com o protocolo de reabilitação conservadora retardada. ^* Trabalho desenvolvido no Departamento de Trauma e Emergência, AIIMS, Bhubaneswar, Índia. Received: 15 July 2021 Accepted: 24 September 2021 Article published online: 30 June 2022 © 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Elastic intramedullary nailing or titanium elastic nail (TEN) is an alternative method for the treatment of various pediatric long bone fractures. Titanium nails are preferred over plaster cast and stainless steel nails for children older than six years. Our series included 30 paediatric long bone fractures who were managed with TEN. The mean age was 9.3 years and the mean follow-up period was 28 months. A mean time of 10 weeks was recorded for the union of all fractures. The occurrence of superficial infection in three cases healed with antibiotics and minor debridement. Limb length discrepancy was seen in three cases of femur fracture, which was functionally insignificant, but it may be a potential problem needing close follow-up until skeletal maturity is attained. An elastic intramedullary nail or TEN in long bone fractures in children is a safe and minimally invasive technique that achieves stable reduction, especially in long spiral fractures till union. We attained successful union and good results in all our 30 cases with long bone fractures in children. A few complications of hardware prominence were resolved with implant removal. Long-term studies with a comparison to casting techniques in paediatric long bone fractures are required.

Regarding medico-legal malpractice suits, lawyers and insurers focus on informed consent documentation. Unfortunately, there is no standard protocol for obtaining informed consent for platelet-rich plasma (PRP) injections. The objective of the present study was to create a pre-designed, evidence-based informed consent form specifically for PRP injections. The current evidence on the medico-legal implications of PRP injections was accessed, as well as informed consent in general and specifically informed consent in PRP injections. Additionally, we interviewed orthopaedic surgeons and patients who had undergone PRP injections in the past year using a semi-structured approach. A legally valid and evidence-based informed consent form for PRP injections ensures rights, encouraging open communication and transparency between the patient and surgeon. Moreover, if a lawsuit arose, informed consent would be a critical document in surgeons' defence and would withstand scrutiny from lawyers and the judiciary. An evidence-based informed consent form for PRP injections was elaborated and reviewed by a legal expert to ensure adherence to legal proprieties. The final form of the informed consent for PRP injection was administered for one year and validated at our institution.

A 58-year-aged man, clerical by job, presented to our outpatient department with painful swelling (Visual Analogue Score of 4/10) over the anterior aspect of the right knee just inferior to the patella for almost a year (figure 1A). He had a history of minor trauma to the knee. On examination, the lump was solitary, slightly tender and roughly measured 5×5 cm with slight discoloration of the overlying skin. Extremes knee flexion and extension aggravated the pain. The blood investigations, including a complete blood count, acute phase reactants, were within the normal limit. The serum uric acid and autoimmune markers such as the antinuclear antibody, rheumatoid factor, and the anti-citric citrullinated peptide were also unremarkable. Radiological investigations included an X-ray of the knees where the soft tissue swelling could be appreciated without any calcification or ossification (figure 1B). A MRI revealed a well-defined, subcutaneous, elliptical mass in the midline, which was superficial to the tibial tuberosity. The mass was hypointense on T1-weighted but hyperintense on T2-weighted and fat-suppressed images associated with surrounding subcutaneous oedema (figure 2A–C). The patient was counselled for an excisional biopsy. Under local anaesthesia, a midline incision was made and the mass was removed in toto and sent for histopathological examination (figure 2D). The macroscopic examination revealed a soft to firm yellowish mass without any haemorrhage, necrosis or gritty sensation on cutting. Microscopic examination revealed chronic inflammation tissue covered with fibrinous debris (figure 2E).