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Acta Scientific Orthopaedics

Journal Papers (32) Details Call for Paper Manuscript submission Publication Ethics Contact Authors' Guide Line
1 New Study: Spine Surgeons Take Care of Your Necks! , Ken Hansraj
Indian spine surgeons J Naresh-Babu, Viswanadha Arun-Kumar and DGS Ragu of the Mallika Spine Centre, Andhra Pradesh per-formed an observational study whose purpose was to analyze the surgeon's neck postures while performing lumbar spinal surger-ies.
2 Acute Median Nerve Compression by a Fragment of Hamate Bone , Martín Ulloa Cerezales and Uxía Blanco Sampedro
Acute median nerve symptoms are not commonly seen. Less frequent is the association with hamate fractures, which usually produce ulnar nerve symptoms. We report a case of a patient with an hamate fracture and acute median nerve injury. On surgical intervention, a bone fragment, directly responsible for the symptoms, was found inside the carpal tunnel
3 Gradual Correction of Proximal Tibial Biplanar Deformities Using Truelok Hexapod System , Saleh Alsaifi, Ahmed Abdelaziz, Sameeh Elashry and Mohamed Mosad
At thirteen-years-old boy who sustained an open physeal injury of the left proximal tibia at four year of age presented to our lower limb deformity clinic complaining from deformity of the left knee and limb length discrepancy. Clinical and radiographic assessment revealed apparent shortening of the left lower limb due to a biplanar deformity of left proximal tibia. The deformity was quantified as a 25° varus and 20° procurvatum deformity. The patient underwent treatment in the form of gradual deformity correction and 20 mm over-lengthening with a TL-Hex circular external fixator, along with complete epiphysiodesis of the proximal tibial and fibular physis. Treatment was completed over-six months including correction and consolidation and he returned to full activity one month after frame removal with 20 mm shoe raise to right lower limb. Normal clinical and radiological alignment of the left lower limb was achieved with good knee and ankle range of motion.
4 Perioperative Medication Management for Spinal Surgery , Nicholas S Venuti, Sangili Chandran, Connor Willis-Hong and Vivek Mohan
Background: Perioperative medication management of spinal surgery patients is essential to minimize risk of complications and expedite patient recovery. Commonly prescribed medication regimens such as anticoagulants (e.g. aspirin, clopidogrel), nonsteroidal anti-inflammatory drugs (e.g. ibuprofen, naproxen) and immunosuppressants (e.g. methotrexate, cyclosporine) may predispose patients to excessive hemorrhaging, wound dehiscence, and surgical infections among other intra-operative and post-operative complications. Through an understanding of medication mechanisms, recommended use and disuse protocol, and how these medications pertain to individual circumstances, physicians are optimally informed to prepare patients for elective spinal surgery. Study Design: Review of literature.Methods: Numerous searches were conducted utilizing PubMed. The searches were filtered to be written in English and within twenty years.Results: After review of relevant literature, different precautions must be taken depending on the type of medication (anti-coagulant, anti-platelet, non-steroidal anti- inflammatory drugs, immunosuppressants) and the individual perioperative health conditions. Patients on blood thinning regimens may need to discontinue use of prescribed medication as early as 10 days to 12 hours pre-operatively and may resume consumption as early as 12 hours post-operatively depending on the medication and perioperative health condition of the patient. Patients on nonsteroidal anti-inflammatory drugs (NSAIDs) may need to discontinue use as early as eight days to 12 hours pre-operatively and may not resume consumption of NSAIDs for up to three months post-operatively depending on medication and the patient’s perioperative health condition. Patients on immunosuppressant regimens may need to discontinue use as early as two months to eight hours pre-operatively and may resume post-operative consumption as early as one week or when the operative wounds have completely healed depending on the medication and the patient’s perioperative health condition.Conclusion: Due to the invasive nature of spinal surgery, and the potential effect of various medications that can affect surgical outcomes, it is imperative that providers review patient medications for proper management during the perioperative period. In the future, additional research for new classes of drugs and medications where literature is currently scarce will help to reduce hospital admission lengths, complications post-operation and even death
5 Metastatic Follicular Thyroid Carcinoma to the Dorsal Spine Presenting as Early Manifestation: Case Report , Romit Agrawal, Ayush Sharma, Vijay Singh, Nilesh Mangale and Ajay Jaiswal
Follicular thyroid carcinoma (FTC) patients are rarely present with spinal metastasis as an early manifestation. Here we present a 56 year old non ambulatory female with paraparesis of both lower limbs which was progressed over last 3 months. Spinal MRI and CT scan revealed D7 thoracic spine intramedullary lesion probably of thyroid origin which was confirmed on USG and FNAC later on. The aim of surgery was decompression of spinal cord and histological evaluation of the tumour. Surgery in the form of spinal mass excision and posterior spinal decompression and fixation two levels above and below was done and then adjuvant chemotherapy was given. Hence patients presenting with spinal tumour must always be screened for thyroid carcinoma as a differential diagnosis. Prognosis is quite well in such patients post decompression
6 Revisiting Characters of Human Immune Orchestra in Light of Immuno-Suppression by Corona Virus , SS Jha
Basic understanding of immunology is relevant today in the light of consciousness raised by the worldwide pandemic of SARS-COV-2 responsible for Novel COVID-19.Immune system is evolved to protect from universe of foreign pathogens. During the course of evolution, depending on species, there has been diversification and high sophistication to permit the organism to adapt to its environment. The human immunity has two interdependent arms, “innate” and “adaptive” immune systems
7 Rehabilitation Program after Post-Traumatic Reconstruction of the Anterior Cruciate Ligament (With a Clinical Case Report) , Ivet Koleva and Borislav Yoshinov
The Anterior Cruciate Ligament (ACL) is an important stabilizer of the knee, providing almost 85% of the joint stability to forward force (especially in some aggressive twisting and jumping sports, as skiing and basketball). The common orthopedic surgical intervention is the reconstruction, performed as soon as possible after the traumatic injury.After the orthopedic surgery, a period of rehabilitation must begin and the consultation with a medical doctor - specialist in Physical and Rehabilitation Medicine (PRM) is required. The goal of current article is to suggest a complex PRM-algorithm of care of these patients, based on detailed literature review and on our own clinical practice
8 Percutaneous or Open Release is the Most Effective Surgical Technique in Diabetic Recurrent Trigger Finger in Short and Long Term Outcomes? A Clinical Review , Grigorios Kastanis, Pantouvaki A, Spyrantis M, Christoforidis C and Velivasakis G
Introduction: Stenosing Tenosynovitis is a common disorder among patients with diabetes mellitus. The definitive treatment is release of the A1 pulley (open or percutaneous). The aim of this study is to compare functional outcomes and complication rates of these two methods (open versus percutaneous release) for recurrent trigger finger in patients with diabetes mellitus.Materials and Methods: 114 patients with diabetes mellitus and an average age of 48 years (range 28 - 64 yrs old) were treated for recurrent trigger finger. The modified Quinnell grading system was used as a selection criterion for the classification of trigger digit. The patients were divided in two groups randomly. Group A included 52 patients who were treated with open release of A1 pulley and group B included 62 patients who were treated with percutaneous release using the tip of an 18-gauge or knife (Ophthalmic Corneal/Scleral knife 19 Gauge).Results: The median follow-up was 12 months (range from 10 - 14 months). The results were based on the Visual Analogue Scale (VAS), Quick Dash and Gilberts and Wereldasma Questionnaire. At 3 months, the results seemed to be better in group B, while there was no statistical difference at six months and at one year postoperatively. Conclusion: Both surgical methods (open and percutaneous release) in long-term follow-up postoperatively, resulted in similar therapeutic efficacy. The advantages of percutaneous release over the classic open method in short-term outcomes are: 1) low cost, 2) less complication rates and 3) immediate functional recovery.
9 Effectiveness of 6 Weeks Plyometric Training Protocol on Vertical Jump Ability among High School Amateur Male Volleyball Players-A Randomized Control Trial , Chaitanya D Sahasrabudhe, Siddhi Tendulkar and Sucheta Golhar
Volleyball is one of the most played games in Indian School going population. Vertical jump height is an essential part in volleyball which can be achieved by strengthening the lower leg musculature. Thus the 6 weeks plyometric training protocol is added to see its results on the strength of lower leg musculature among high school amateur male volleyball players. The subjects (n = 40; age = 10 - 16 years; mean = 12 ± 1.00 years) jumping reach Height (mean) = 169.00 ± 1.00 cm) were divided equally into 2 groups called as group A (Experimental) and group B (Control) respectively by simple random sampling method. Group A received the 6 weeks plyometric training protocol and conventional training while group B received only conventional training. Sargent jump test was used to assess the jump heights pre and post at the end of 6 weeks. Unpaired t-test was used to compare the results between the groups. Group A showed significant increase in the difference between the jumping and standing reach heights at the end of 6 weeks (mean difference in the height = 34.25 cm; p-value < 0.05) than in Group B (mean difference in the height = 25.15 cm; p-value < 0.05) at the end of 6 weeks. Also, there is significant improvement in Jumping reach height in Group A (pre = 188.05 cm; post = 203.00 cm) than in Group B (pre = 187.20 cm; post = 195.15 cm). Group A showed 43.65% (mean = 34.25 cm; SD = 7.59) increase while Group B achieved 31.61% (mean = 25.15 cm; SD = 3.73) increase with their initial vertical jump height Both the training protocols are effective in improving vertical jump height but the 6 weeks plyometric training protocol is more effective in improving vertical jump than the conventional training among high school amateur male volleyball players
10 Re-Igniting Our Body and Mind to Surpass Future Challenges , Julie Rammal
The human body and mind is incredibly intelligent and pow-erful. Our body, mind, organs and everything within us speaks its own language, records its own data, and to boost health, energy, and positive emotion one must unblock stagnant energy in body, mind or soul or the system may fail, collapse or become diseased
11 Outcomes of Outpatient Percutaneous Release of Trigger Finger , Jayesh Vaza, Pathik Vala, Rutvik Shah and Kuldeep Parmar.
Introduction: Trigger finger is caused by stenosing tenosynovitis, resulting in painful catching of the involved flexor tendon as the patient flexes and extends the digit. Treatments include Nonsteroidal anti-inflammatory drugs (NSAIDs), splinting, corticosteroid injection, open and percutaneous release. Aim of the Study: The aim of this study was to evaluate the results of percutaneous trigger finger release using 18G hypodermic needle. Materials and Methods: A prospective study of 80 patients for treatment of trigger finger by percutaneous release by 18G needle was conducted at L.G Medical college and hospital, Ahmedabad, Gujarat between 1st January 2019 to 31st December 2019. Written Consent was obtained for Surgery. Patients were followed up in opd on 1st week, 1 month, 3rd month, 6th month, 12th month and evaluated for complications and re-occurrence of symptoms. Results: A total of 80 patients with trigger fingers were included in this study, out of which 10 patients did not follow up on time. Successful release was achieved in 68/70 (97.14%) patients. There was no patient who experienced any issues like nerve injury, wound complications, decreased sensation and tendon bowstringing. Conclusion: Our review showed that this technique for release of trigger finger is less costly technique with more patient oriented, less complications and better recovery rate. This is a day care procedure
12 Objective Assessment of Tendinopathy by Ultrasound Elastography , Rajul Rastogi, Neha, Vijai Pratap and GL Meena.
Tendinopathy refers to an inflammatory condition of tendon usually secondary to overuse. In the tendons, edema leads to internal softening with consequent decrease in echogenicity and elasticity hence the tendon will appear hypoechoic on B-mode, gray-scale ultrasonography while appearing brighter on ultrasound elastography than its normal counterpart tendon.Ultrasound Elastography is a recent noninvasive technique that allows evaluation of the elasticity of human tissues. Acoustic radiation forced impulse is a special form of ultrasound elastography wherein an acoustic radiation impulse is sent to the human tissues and the strength of returning echo indicates the elasticity of tissues. The latter can be depicted in shades of gray or different colors. If the image is coded with shades of gray, harder tissues will appear black while softer tissues will show varying shades of gray. However, in color-coded maps red or blue is indicated for hard tissue and blue or red respectively indicating soft tissue. Majority of the studies in the recent literature focusses on ultrasound elastography of evaluation of larger tendons especially the Achilles tendon, rotator cuff, quadriceps tendon, etc. while very few studies have focused on smaller tendons of the human body. Hence, this study primarily focusses on objectively evaluating the role of ultrasound elastography in assessment of tendinopathy at wrist joint.
13 Re-Igniting Our Body and Mind to Surpass Future Challenges , Julie Rammal
The human body and mind is incredibly intelligent and pow-erful. Our body, mind, organs and everything within us speaks its own language, records its own data, and to boost health, energy, and positive emotion one must unblock stagnant energy in body, mind or soul or the system may fail, collapse or become diseased.
14 Popliteal Schwannoma Simulating Vascular Tumor: An Uncommon Case , Daoudi Samih, Affes Hassene,Bouaziz Anis, Kamoun Khaled Anis and Jenzri Mourad.
Schwannomas are benign tumors arising from the Schwann cells on the peripheral nerve sheath. This tumor affects specially adults between 20 and 50 years-old. Malignant transformation is rare and uncommon. The most common clinical presentation of sciatic nerve schwannoma is a painful palpable mass with paresthesia. We present the case of a 57 years old man with a schwannoma of the sciatic nerve. The imaging findings were suggestive of the diagnosis. The tumor was excised without neural damage and no neurological deficit was noted postoperatively.
15 Short-Term Functional Outcomes of Primary Total Hip Arthroplasty Using A Modified Minimally Invasive Antero Lateral Approach , F Maturana, G Hernández, I López and P Dobbs.
Background: Minimally invasive surgery (MIS) has had a progressive development in recent years, due to its advantages in terms of: reducing the rates of complications, infection, surgical time and bleeding. Total hip arthroplasty (THA) has not been exempt from this current. Since of the first descriptions in 90 ́, several different techniques has been described to achieve smaller incisions and better results in primary THA, however, there is not enough statistical evidence to widely recommend MIS-THA, defined as an incision < 8 cm. Materials and Methods: We retrospective reviewed a cohort of 173 THA, 55 men and 118 women, between January 2016 and October 2019, in an advanced trauma hospital, all performed by the same surgeon. An independent team, blinded to the primary diagnosis, performed a standardized clinical and radiological evaluation at 2, 6 and 12 weeks. Results: The average length of the incision was 71 mm (48 - 84 mm). The average surgical time was 68 minutes (42 - 175). Hematocrit decreased by an average of 3.8% (2.2 - 8.1%). Average blood loss was 335 ml (120 - 950 ml). Preoperative Harris Hip Score was 67 (45 - 76) and postoperatively at 12 weeks of 92 (82 - 97). Three cases of perioperative complications where reported: 1 case of calcar fracture with extended approach (84 mm) and cerclage fixation, 1 case of prosthetic dislocation and 1 postoperative periprosthetic fracture Vancouver B2. No cases of neurovascular injury, infection or misalignment of components were reported. Conclusion: These results with a locally developed technique, achieved satisfactory clinical and radiological outcomes, with minimum incisions up to 48 mm, with an average reduction of 50% to the standard approach (13 - 15 cm).
16 Effect of Subcutaneous Fat of Quadriceps Muscle on Q-Angle - A Cross-Sectional Study , Jagruti K Patel, Maldikar Pragna Satish, Patel Harsh Vinodbhai and Vaidya Nikita Rakeshkumar.
Background: Q-angle is an important indicator of the biomechanical function for the lower extremity. The increased value of Q-angle is suggestive of risk factors for many knee disorders. The fat is considered as basic compound of body which is necessary for certain anatomical and physiological functions. The accumulation of excess body fat affects the musculoskeletal system. Purpose: This study was conducted to determine the co-relation between the Q-angle and subcutaneous fat of the Quadriceps muscle and also determine the normal value of Q-angle and normal value of the Skinfold thickness of the Quadriceps Muscle. Procedure: A cross-sectional study was conducted among 109 individuals, having no history of knee injury or pain. There were 59 females and 50 males participated in the study. The Q-angle was measured in standing position with the help of universal goniometer and the Quadriceps muscle was kept relaxed. The measurement of the skinfold thickness was taken by normal plastic skin calliper. Results: The study showed that mean value of the Q-angle for females and males on the right side was 16.9 ± 1.85 and 13.87 ± 1.95 whereas on left side it was obtained 16.9 ± 1.85 and 13.96 ± 2.01. The study also obtained the mean value of the subcutaneous fat of quadriceps for females and males on right side 14.0 ± 5.16 and 11.22 ± 5.30 whereas on left side it was obtained 13.9 ± 5.15 and 11.54 ± 5.37. The study also obtained positive co-relation among the Q-angle and Quadriceps fat. (p = 0.001). Conclusion: The study concluded that there was a positive co-relation among the Q-angle and subcutaneous fat of the Quadriceps muscle.
17 Diet, Exercise and Thinking Positive Way Will Keep Cancer at Bay , Maithili Athavale
The word cancer itself imprints more fear than death. Under-standing the root cause of the disease and modulating one’s life-style can help a person to take control of this disease.
18 The Relationship between Foot Anthropometry and Vertical Jump Performance Using My Jump 2 App in Normal Population - A Cross Sectional Study , Vandana Patel, Dhara A Jiyani, Arika S Jadav, Rani B Kamti and Shruti S Motirupawala.
Background:Vertical jump is a motor task which requires the interaction of nervous and musculoskeletal system. Variability in musculoskeletal structure has the potential to influence locomotor function. This study examined acute anthropometric measure in relation to vertical jump performance. Purpose:The purpose of this study was to find the relation between foot anthropometry and vertical jump performance.Procedure:The purpose and the procedure of the research were explained to the subjects and on the basis of inclusion and exclusion criteria, the subjects who were willing to participate in the research were selected. Total n=100 subjects were explained about how to perform vertical jump. After obtaining their anthropometric values, the subjects performed three trials of vertical jump and the average of performance parameters were recorded using ios based My Jump 2 app and was recorded as the final value. Results:Data collected were entered and analyzed by SPSS version 16.0 for windows (IBM). Descriptive statistics was used to anal-yse baseline characteristics for all parameters of subjects. Mean score of all the parameters of subjects were taken and were analysed using Pearson’s method of correlation. There is negative correlation between weight of the subject, jump height, foot length, toe length, heel length, navicular height and BMI. Positive correlation was found between vertical jump height and ROM of dorsi flexion and plantar flexion as well as calf girth. Conclusion:There is correlation between different parameters of foot anthropometry and vertical jump performance in normal individuals.
19 Is TSG-6 the Most Important Biomolecule in the Setting of Orthopedic Surgical Immunobiologics? Scientific Concepts and Case Report with Cartigram® Imaging , Austin Yeargan III, Caroline Yeargan, Bailey E Montgomery, Katie Whitney and Thos Evans.
Bone marrow concentrates for knee arthritis have received much attention over the last decade as a viable treatment for osteoarthritic knee pain and disability. In spite of the availability of these bone marrow concentrates, few authors have suggested a gold standard treatment protocol. We first introduced our signaling cell procedure to orthopedic surgery in 2006. The procedure has undergone multiple iterations since that time. In this article, we introduce our seventh-generation technique for signaling cell treatment in the setting of osteoarthritis of the knee and discuss the role of tumor necrosis factor stimulated gene six protein in our signaling cell product. We identified TSG-6 as an important chondroprotective biomolecule that is critical for the assembly and maintenance of the cartilage extracellular matrix. TSG-6 is an inflammation-induced protein that is produced at pathological sites, like synovial joints during arthritic degeneration. TSG-6 protects against joint damage through anti-plasmin activity and de-activation of serine protease during inflammation. TSG6 also limits neutrophil migration and has an anabolic, immunomodulatory effect in synovial joints. Modern signaling cell techniques are unable to capture or concentrate TSG-6 due to its small molecular size, that is coincident with the undesirable pro-inflammatory molecules. These molecules are on the order of 30 kD in comparison with anti-inflammatory molecules that typically are greater than 600 kD in size. Hyaluronic acid typically has a molecular weight of 3000 - 4000 kD and is bound by one of the domains of TSG-6, causing biological activation of the complex. We combine our cell concentration product and a commercially prepared hyaluronic acid to formulate a growth factor concentrate that is activated as a scaffold for signaling cells we harvest from autologous bone marrow aspirate taken at the anterior gluteal pillar during immunobiologic procedures. We believe that by concentrating TSG-6 and including it as a component of our signaling cell transplant procedures, a biologically superior injectate is able to be assembled that may favor cellular and tissue anabolism. In addition, we harvest autologous clotting proteins (Thrombin/factor 2) to lock the product in the subchondral bone after micro core of the stiff, subchondral bone using a commercially available device.
20 Early Controlled Mobilization Following Extensor Pollicis Longus Repair: A Case Report , Shrikant J Chinchalkar and Laura Yurkowski.
Adhesion formation causing the loss of tendon excursion after a digital extrinsic extensor tendon injury near or within the exten-sor retinaculum is common. Extensor pollicis longus (EPL) injuries, repairs and management near the extensor retinaculum have been limitedly described both surgically and post-operatively. When considering necessary tendon gliding and tendon excursions at, distal or proximal to the extensor retinaculum, the size and location of EPL laceration is important in the rehabilitation and patient outcome. The patient in this case study was treated by means of a dynamic hinge orthotic with an out trigger for the thumb and hinge for the wrist. Post-operative rehabilitation management consisted of a controlled mobilization program and was progressed accord-ing to the stages of healing and the principles of EPL tendon gliding resistance with respect to the wrist position. Full thumb flexion and extension combined with wrist motion and full grip and pinch strength was attained.
21 Post Operative Pleural Effusion and its PT Management- A Case Study , Gurman Kaur and Satish Kumar Anumula
In patients with dilated cardiomyopathy and end stage heart failure heart transplantation is the definitive treatment strategy. Post-operative pulmonary complications are very common in any solid organ transplant surgery. In maximum of heart transplant surgeries pleural effusion is very common due to which the patient require prolong hospital stay and mechanical ventilation. This case study shows the severe right ventricular dysfunction who was underwent a heart transplant surgery. The past medical history reveals pulmonary embolism, hemicolectomy (cancer) and some risk factors including smoking. During the post-operative recovery period the patient received immunosuppressive treatment with prednisone, cyclosporine, mycophenolate. Their was reduced air entry in both lungs and the respiratory rate was 20 cpm. Physiotherapy goals for the patient is to improve cardiopulmonary function, prevent further cardiopulmonary complication and improve fatigability and cardiopulmonary endurance. The patient physiotherapy treatment for twice a day for minimum of 40 ins per session which included ambulation, limb mobilisation and respiratory exercises. This study concluded that positive airway pressure as a treatment approach was safe, feasible and easy during sub-intensive care setting while treating patients with post-operative pleural effusion.
22 Reconstruction of Bone Defects after Tumor Resection Using Present Methods (Mini-Review). Bone Reconstruction Algorithm , Evgeniya Anastasieva and IA Kirilova.
The replacement of large bone defects after segmental bone resections in patients with bone tumors is an actual problem in orthopedics. The main difficulty it causes especially in cases of disturbance of normal biomechanics. Especially when the “gold standard” of reconstruction with bone autograft is not possible, because of the defect, which can be so extensive that any autograft stock will be not enough. Therefore, allografts based on demineralized bone with optimal properties for osteoregeneration can become the necessary alternative for bone replacement. Nowadays composite materials is possible to be programmed to have the specific properties by changing its compound. After concluding the results of the literature analysis, we revealed that the allograft in combination with additional components is comparable by its effectiveness with autograft. As an additional component to improve osteoregeneration mesenchymal stem cells of both bone marrow and adipose tissue can be used. However, it is noteworthy that the analyzed studies did not reveal the influence of stem cells on the tumor recurrence. So, the authors tell about necessity of further researches. Some authors still prefer traditional methods of bone traction despite obtaining own satisfactory results of defects reconstruction with allografts. Such opinion is based on proven effectiveness of the method, structural stability of construction during treatment period and ability to adjust the process of bone regeneration at any stage. Our goal was to analyze publications over the recent 10 years, which report about results of experiments and clinical studies with performing massive bone reconstruction after bone tumor resection using auto- and allografts, or other technique. Based on the literature analysis we have updated our previous algorithm for graft selection in replacement of large bone defects after segmental bone resections.
23 Could the Yeargan Autologous Subchondral Nanoplastytm and Mechanical Axis Deviation Protocol (NAMAD®) Halt Molecular Progression and Reverse the Clinical Symptoms of Knee Osteoarthritis? Clinical and Scientific Concepts with Case Presentation Including T2 Wetmap Cartigram® sequencing , Austin Yeargan III, Bailey Montgomery, Matt Murphy, Katie Whitney, Peter Millett and Thos Evans.
Osteoarthritis causes a heavy disease burden globally and treatments are continually evolving. We introduced an autologous cell therapy protocol in 2006 that has continued to demonstrate promise clinically and on advanced imaging studies. In this report, we detail applicable scientific concepts, our surgical technique and present a case report for illustration.
24 Forearm Support Band Versus Wrist Splint in Treatment of Lateral Epicondylitis , Hamza M Shaheen, Nadia Fayaz, Lilian Albert Zaky and Ayman Mansour.
Objective this study was done to assess the therapeutic efficacy of forearm support band and wrist splint in minimizing severity of pain and improving hand grip strength with lateral epicondylitis cases, and determine which one of these two common splints is more effective to reduce pain intensity and improve grip strength. Method:Thirty male and female patients with tennis elbow were selected from orthopedic Department at National instate of neu-rolocomotor system. All patients were randomly assigned into two groups. The group (A) (n = 15, mean age: 44.8 ± 6.87 years) received forearm support band for four weeks, while the group (B) (n = 15, mean age: 42.86 ± 6.34 years) received wrist splint. All patients received exercises (12 sessions, 3 sessions per week) over a four weeks period. They were evaluated using visual analog scale to determine the pain intensity, and handheld dynamometer to determine hand grip strength in both groups. Results: The results of the current study revealed that forearm support band or wrist splint combination with exercises for four weeks in patients with tennis elbow resulted in significant increase in hand grip strength in the post-treatment, associated with a sig-nificant decrease in pain intensity in the post-treatment in both groups. In addition, it revealed that there was significant difference between forearm support and wrist splint as regard to pain reduction which wrist splint allows a greater degree of pain relief than the forearm support band for patients with lateral epicondylitis, while there was no difference as regard to grip strength improve-ment between both groups. Conclusion:It was concluded that forearm support band or wrist splint (cock-up splint) combined with exercises were effective in improving pain intensity and increasing hand grip strength in patient with tennis elbow, and wrist splint allows a greater degree of pain relief than the forearm support band.
25 A Case Report of Nail Patella Syndrome and Knee Pain , Gupta Sunny, Patel Mitesh, Chhipa Irfan, Barrientos Steven and Grzywinski Matthew.
Nail-Patella Syndrome (NPS), also known as Fong’s Disease, Turner-Keiser Syndrome or Hereditary Onychoosteodysplasia (HOOD), is a rare hereditary condition affecting 1 in 50,000 individuals. The condition is associated with mutations in the LMX1B gene and is inherited in an autosomal dominant pattern. Patients with this syndrome may have several musculoskeletal abnormali-ties including hypoplastic or absent patellae, underdeveloped elbows, and iliac horns. The joint abnormalities associated with this condition predispose patients to osteoarthritis (OA) and easy joint dislocation. Other common findings include nail abnormalities (absent or hypoplastic nails, nail ridges, and nail discoloration), renal dysfunction, glaucoma, irritable bowel syndrome, rash, and neuropathy. Here, we describe the case of a patient with known NPS presenting with bilateral knee pain.
26 Integration of Real - Time Ultrasonography Imaging (RUSI) for Physiotherapists in India , Shivani Chowdhury
X Rays, MRIs are images of body structures when the patient is still or not moving. On the contrary, pain is a disturbing sensation many a times caused by an external or internal stimuli. The Inter-national Association for the Study of Pain defines pain as “an un-pleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.
27 Clinical Presentation of Joint Hypermobility Syndrome of the Knee in Jordanian Military Personnel , Moh’d Rami AlAhmar, Kreem Al Rashdan, Deifallah Al Sharari, Awni Al Hdead, Zaid Al Dhamsheh and Ibrahim Amayreh.
Objective: To describe the findings of clinical presentation, complication, radiographic and laboratory of the knee among Jordanian military personnel diagnosed to have hyper mobile syndrome. Methods: A prospective cohort descriptive study carried out at Royal Rehab Centre in King Hussein Medical Centre, over a period of 2 year (from May 2016 to May 2018). One hundred and twenty military patients complaining of knee problem who attended the rehabilitation clinic and diagnosed with hypermobility were enrolled in this study. Their age, sex, presenting features, clinical profile, laboratory and radiological parameters were studied. Results: (102 males, and 18 females with M: F ratio 5.7:1), their mean age was 25.6 (range: 17-35 years), mean duration of symptoms 10.3 months. The most common presenting complain was bilateral knee pain (72 patients, 60%) followed by unilateral knee pain (35 patients, 29%), while pain and swelling were noted in 10 patients (8%) and joint locking was observed in 3 patients (2.5%).The commonest radiographic abnormality was premature osteoarthritis seen in 30 patients (25%) followed by ligament injury observed in 5 patients (4%), while bone bruising and contusion were documented in 3 patients (2.5%), stress fracture was reported in 2 patients (1.7%). Rheumatoid factor and anti-nuclear antibody were found to be positive in 7 patients (5.8%) and 5 patients (4%) respectively. Conclusion: While most people with hypermobile joints remain asymptomatic a small number may have a wide range of musculo-skeletal symptoms.Hypermobility of the knee can predispose early osteoarthritis in this age group of military personnel moreover due to repetitive stress and prolonged standing in static posture, ligament or tendon injury, bone contusion and stress fracture may occur.
28 Locked Platting for Distal Femur Fractures, Is it a Good Option? , Maged Mohamed Mostafa, Ahsan Javaid Butt, Ahmed Refaat Khamis, Atul Bandi3 and Adeel Nawab Ditta.
Distal femoral fractures are among the challenging injuries to be rigidly fixed. Different implants for internal fixation have been used with varying degrees of success. The aim of this study is to review the results of using the distal femoral locked plate (DFLP) in treatment of different fracture patterns of the distal femur.Methods: A retrospective study was performed between 2012 and 2018 on 41 patients with distal femur fractures treated by distal femoral locked plate (DFLP) in King Hamad University Hospital (KHUH) of Bahrain. Pritchett rating system was used to assess the functional outcome of those patients. Results: total 41 patients were enrolled in the study. There were 13 males and 28 females. The age ranged between 18 and 94 years with an average of 62.9 years. Thirty four patients were followed up till complete union. The average follow up period was 17.2 months. Functional outcome was excellent in 15 patients, good in 10, fair in 4 and poor in 5 cases. Conclusion: distal femoral locked plate (DFLP) is a reliable implant which offers successful results upon using in treatment of various patterns of distal femur fractures.
29 Extremities Fracture and Associated Factors among Adult Patients in Debre Markos Referral Hospital, East Gojjam Zone, Northern Ethiopia: A Hospital Based Cross-Sectional Study , Yoseph Merkeb Alamneh, Getachew Chane, Mengistu Ayele2 and Asfaw Gerbi.
Background: Extremities’ fractures, particularly when left untreated, are a common sequelae of injuries and a major cause of mor-bidity and mortality; but the burden and distribution of traumatic fractures in low- and middle-income countries is poorly under-stood. The increasing the prevalence of extremity fracture can be attributed to modernization, industrialization and increased rate of bone fracture in the society. Extremities fracture is the leading cause of functional disability and death in different age groups in both sex. It may result from road traffic accidents, falls, gunshot, machines, attacks as well as sports. The epidemiology of fracture in Ethiopia provides little knowledge about its distribution and associated factors needed for prevention. Thus, this study aimed to investigate extremities fracture and associated factors in Debre Markos referral Hospital.Hypermobility of the knee can predispose early osteoarthritis in this age group of military personnel moreover due to repetitive stress and prolonged standing in static posture, ligament or tendon injury, bone contusion and stress fracture may occur. Methods: Hospital based cross-sectional study was conducted from April to June 2018 at Debre Markos referral hospital, Northern Ethiopia. A total of 422 patients were included in this study. Data were collected using a structured questionnaire by trained data collectors. The collected data were coded, entered into epi data 3.1, and exported to STATA version 14 for statistical analysis. Simple logistic Regression analysis and Multiple logistic regression analyses was employed to identify factors associated with extremity frac-ture and factors which had a p-value of ≤ 0.25 in Simple Logistic Regression analysis was included in Multiple Logistics Regression analysis. P-values of less than or equal to 0.05 was considered statistically significant. Result: Among the total 422 adult patients who visited the emergency department, 144 (34.12%) patients experienced extremity fractures in Debre Markos Referral Hospital. Ninety-two (63.9%) were males and 52(36.1%) were females and their age range from 26 to 77 years. Residency, sex, age, behavioral factors such as using alcohol and fighting, vehicle type, types of occupation and medical illness were identified as the key risk factors of extremities fracture. Conclusion and Recommendation: The prevalence of extremities fracture were high at study area and socio-demographic charac-teristics, behavioral factors and co-morbidities were found to be significantly associated with extremity fracture. Therefore, efforts should be scaled up to develop effective preventive measures and enforced against fractures of extremities.
30 Scoliosis and Osteopathy , René Zweedijk, Christophe Tylleman and Peter Schwind.
Scoliosis is a frequently seen problem in the osteopathic practice. There are different types of scoliosis. The most disabling form is the Adolescent Idiopathic Scoliosis (AIS). Humans are chaotic, complex adaptive systems. The consequence is that many different factors can cause AIS and that the onset can be sudden and quick. In this article we study the etiology of AIS by using the 2012 SOPE model of 5 of osteopathy. AIS has mechanical, neurological, respiratory, circulatory, metabolic and bio-psychosocial aspects. It also means that the osteopath should see every patient as unique and analyze all factors that are putative causal in the onset of AIS. Some treatment options are shown based on recent scientific insights.
31 Rehabilitation as an Essential Element in the Clinical Practice of Orthopaedics and Traumatology , Ivet B Koleva and Borislav Yoshinov.
The World Report on Disability defines the goals of rehabilitation: prevention of the loss of function; slowing the rate of loss of function; improvement or restoration of function; compensation for lost function; maintenance of current function. Orthopedic reha-bilitation is part of the rehabilitation sciences, needed frequently in clinical practice. Our opinion is that rehabilitation is an essential element in the patients’ management of Orthopedics and Traumatology. In this article, we present basic theoretical knowledge, necessary for a successful orthopedic rehabilitation, and we cite practical skills of rehabilitation in patients with the most frequent orthopedic conditions, including after orthopedic surgery. We explain our own proposal for OT rehabilitation algorithms, with the goal to stimulate the functionality of our patients and to assure their inde-pendence in activities of daily living, respectively their autonomy.
32 Orthopaedics Procedures in Patients with Coronavirus Disease , Sebastião David Santos-Filho
Introduction: Orthopaedics’ surgeons may not be in the front line in the fight against the viral pandemic, but the way they practice has been affected substantially. The emergence of the COVID-19 pandemic has severely squeezed medical performs throughout the world, especially those of infectious syndrome specialists, emergency room personnel, anaesthetists, intensivists, virologists, epide-miologists and hygienists. At the same time, researchers have also been affected. Objective:This work pretends to show the procedures done by orthopaedics physicians in patients with coronavirus disease and to describe the reality fight by these healthy professionals. Methods: Articles searched in PubMed with key-words Orthopaedics and Coronavirus were founded accepting the following criteria: free full text, clinical trial, meta-analysis, review, in the last year, English language, and still in MEDLINE data. Results:The research was done on July 14th 2020 and it was founded 15 articles that comprises in the criteria cited above, but only 9 attend the goal of this article. Conclusion: The scientific reasons for the correctly use of surgeon’s procedures and the eligibly of those procedures that it was used in some cases were presented in this work. We hope that this work will be a guide for the orthopaedic professionals.