Research Article

Skor Patient Rated Wrist Examination (PRWE) dan Radius Union Scoring System (RUSS) lebih baik dengan pemberian Platelet Rich Plasma pada kasus fraktur distal radius dengan terapi konservatif

I Gusti Ngurah Pramartha Wijaya Putra , I Ketut Siki Kawiyana, I Wayan Suryanto Dusak, Putu Astawa, I Ketut Suyasa, Ketut Gede Mulyadi Ridia, I Gede Eka Wiratnaya

I Gusti Ngurah Pramartha Wijaya Putra
Residen, Departemen Orthopaedi dan Traumatologi Fakultas Kedokteran Universitas Udayana – Rumah Sakit Umum Pusat Sanglah Denpasar, Bali, Indonesia. Email: ign.paramartha.wijayaputra@gmail.com

I Ketut Siki Kawiyana
Konsultan, Departemen Orthopaedi dan Traumatologi Fakultas Kedokteran Universitas Udayana – Rumah Sakit Umum Pusat Sanglah Denpasar, Bali, Indonesia

I Wayan Suryanto Dusak
Konsultan, Departemen Orthopaedi dan Traumatologi Fakultas Kedokteran Universitas Udayana – Rumah Sakit Umum Pusat Sanglah Denpasar, Bali, Indonesia

Putu Astawa
Konsultan, Departemen Orthopaedi dan Traumatologi Fakultas Kedokteran Universitas Udayana – Rumah Sakit Umum Pusat Sanglah Denpasar, Bali, Indonesia

I Ketut Suyasa
Konsultan, Departemen Orthopaedi dan Traumatologi Fakultas Kedokteran Universitas Udayana – Rumah Sakit Umum Pusat Sanglah Denpasar, Bali, Indonesia

Ketut Gede Mulyadi Ridia
Konsultan, Departemen Orthopaedi dan Traumatologi Fakultas Kedokteran Universitas Udayana – Rumah Sakit Umum Pusat Sanglah Denpasar, Bali, Indonesia

I Gede Eka Wiratnaya
Konsultan, Departemen Orthopaedi dan Traumatologi Fakultas Kedokteran Universitas Udayana – Rumah Sakit Umum Pusat Sanglah Denpasar, Bali, Indonesia
Online First: December 01, 2020 | Cite this Article
Putra, I., Kawiyana, I., Dusak, I., Astawa, P., Suyasa, I., Ridia, K., Wiratnaya, I. 2020. Skor Patient Rated Wrist Examination (PRWE) dan Radius Union Scoring System (RUSS) lebih baik dengan pemberian Platelet Rich Plasma pada kasus fraktur distal radius dengan terapi konservatif. Intisari Sains Medis 11(3): 1108-1112. DOI:10.15562/ism.v11i3.776


Introduction: Platelet Rich Plasma (PRP) is one of the supporting therapies that can increase the rate of tissue regeneration. In orthopedics, PRP is generally considered a therapy to accelerate bone regeneration, especially when combined with bone allografts. This study was conducted to determine whether the administration of platelet rich plasma (PRP) in conservative therapy of distal radius fractures resulted in a functional outcome (Patient Related Wrist Examination / PRWE score) and increased callus formation (Radius Union Scoring System / RUSS score) was better when compared to conservative therapy without PRP administration.

Methods: A total of 22 patients with distal radius fracture were divided into two groups, the intervention group who underwent closed reduction, immobilization with short arm cast and PRP injection at the fracture site, and the control group who received a placebo injection of 0.9% NaCl. After 8 weeks, the evaluation was carried out with the PRWE form and radiologic examination to assess RUSS. The research data were then analyzed to determine the difference in mean scores between groups.

Results: The mean PRWE score was lower in the conservative + PRP treatment group (73.18 ± 5.96) than in the control group (79.55 ± 3.30), p value = 0.007. In addition, the mean RUSS score was higher in the conservative + PRP treatment group (5.27 ± 1.10) than in the control group (4.00 ± 1.18),  p value = 0.017.

Conclusion: Administration of PRP in conservative therapy of distal radius fractures resulted in a lower PRWE score and a higher RUSS score at 8 weeks. It can be used as a basis for administering PRP in adjunct therapy to conservative therapy of distal radius fractures.

 

Pendahuluan: Platelet Rich Plasma (PRP) merupakan salah satu terapi penunjang yang dapat meningkatkan kecepatan regenerasi jaringan. Dalam bidang orthopaedi, PRP umumnya dianggap sebagai terapi untuk mempercepat regenerasi tulang, terutama ketika dikombinasikan dengan allografts tulang. Penelitian ini dilakukan untuk menentukan apakah pemberian platelet rich plasma (PRP) pada terapi konservatif fraktur distal radius menghasilkan luaran fungsional (skor Patient Related Wrist Examination / PRWE) dan peningkatan pembentukan kalus (skor Radius Union Scoring System / RUSS) yang lebih baik apabila dibandingkan dengan terapi konservaif tanpa pemberian PRP.

Metode:  Sebanyak total 22 pasien dengan fraktur distal radius dibagi ke dalam dua kelompok, yakni kelompok intervensi yang menjalani reduksi tertutup, imobilisasi dengan short arm cast dan injeksi PRP di lokasi fraktur, serta kelompok kontrol yang mendapat injeksi plasebo berupa NaCl 0,9%. Setelah 8 minggu, evaluasi dilakukan dengan formulir PRWE dan pemeriksaan radiologik untuk menilai RUSS. Data penelitian kemudian dianalisis untuk mengetahui perbedaan rerata skor antar kelompok.

Hasil: Didapatkan rerata skor PRWE yang lebih rendah pada kelompok perlakuan konservatif + PRP (73,18 ± 5,96) dibanding pada kelompok kontrol (79,55 ± 3,30) dengan nilai p < 0,05. Selain itu, didapatkan pula rerata skor RUSS yang lebih tinggi pada kelompok perlakuan konservatif + PRP (5,27 ± 1,10) dibanding pada kelompok kontrol (4,00 ± 1,18) dengan nilai p < 0,05.

Simpulan: Pemberian PRP pada terapi konservatif fraktur distal radius menghasilkan skor PRWE yang lebih rendah dan skor RUSS yang lebih tinggi dalam waktu 8 minggu. Hal ini dapat digunakan sebagai dasar pemberian PRP dalam terapi tambahan pada terapi konservatif fraktur distal radius.

 

References

Handoll HHG, Huntley JS, Madhok R. External fixation versus conservative treatment for distal radial fractures in adults. Cochrane Database Syst Rev. 2007;3:CD006194.

Jaremko JL, Lambert RGW, Rowe BH, Johnson JA, Majumdar SR. Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment? Clin Radiol. 2007;62(1):65–72.

Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am. 2011;36(5):824-835.e2.

Huang S, Wang Z. Influence of platelet-rich plasma on proliferation and osteogenic differentiation of skeletal muscle satellite cells: An in vitro study. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology. 2010;110(4):453–62.

Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: From basic science to clinical applications. Vol. 37, American Journal of Sports Medicine. 2009. p. 2259–72.

Schnabel L V., Mohammed HO, Miller BJ, McDermott WG, Jacobson MS, Santangelo KS, et al. Platelet Rich Plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons. J Orthop Res. 2007;25(2):230–40.

Simman R, Hoffmann A, Bohinc RJ, Peterson WC, Russ AJ. Role of platelet-rich plasma in acceleration of bone fracture healing. Ann Plast Surg. 2008;61(3):337–44.

Ghaffarpasand F, Shahrezaei M, Dehghankhalili M. Effects of platelet rich plasma on healing rate of long bone nonunion fractures: A randomized double-blind placebo controlled clinical trial. Bull Emerg Trauma. 2016;4(3):134–40.

Namazi H, Mehbudi A. Investigating the effect of intra-articular PRP injection on pain and function improvement in patients with distal radius fracture. Orthop Traumatol Surg Res. 2016;102(1):47–52.

MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient Rating of Wrist Pain and Disability: A Reliable and Valid Measurement Tool. J Orthop Trauma. 1998;12(8):577–86.

Li W wu, Sabsovich I, Guo TZ, Zhao R, Kingery WS, Clark JD. The role of enhanced cutaneous IL-1? signaling in a rat tibia fracture model of complex regional pain syndrome. Pain. 2009;144(3):303–13.

Zhang J, Middleton KK, Fu FH, Im HJ, Wang JHC. HGF Mediates the Anti-inflammatory Effects of PRP on Injured Tendons. PLoS One. 2013;8(6):e67303.

Mammoto T, Jiang A, Jiang E, Mammoto A. Platelet rich plasma extract promotes angiogenesis through the angiopoietin1-Tie2 pathway. Microvasc Res. 2013;89(Sep):15–24.

Aghaloo TL, Moy PK, Freymiller EG. Evaluation of platelet-rich plasma in combination with freeze-dried bone in the rabbit cranium: A pilot study. Clin Oral Implants Res. 2005;16(2):250–7.

Kanthan SR, Kavitha G, Addi S, Choon DSK, Kamarul T. Platelet-rich plasma (PRP) enhances bone healing in non-united critical-sized defects: A preliminary study involving rabbit models. Injury. 2011;42(8):782–9.

Say F, Türkeli E, Bülbül M. PS9 Is platelet-rich plasma injection an effective choice in cases of delayed union or non-union? Acta Chir Orthop Traumatol Cech. 2014;81(5):340–5.


No Supplementary Material available for this article.
Article Views      : 159
PDF Downloads : 69