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.
33 Facts of Rheumatoid Arthritis (RA) , Chaitany Patel, Vaibhavi Parmar and Dipal Patel.
The most common type of autoimmune arthritis is called Rheu-matoid arthritis. Mainly caused by when the immune system is not working properly. Rheumatoid arthritis symptom pain and swell-ing in the wrist and small joints of the hand and feet.
34 A Tendinopathy of the Distal Quadriceps Femoris in a Professional Pitcher Treated with a Neutrophil-Reduced Platelet-Rich Plasma: A Case Report , Mamoru Yoshida
An enthesopathy developed at the distal quadriceps femoris in a professional pitcher was quite rare. We treated the enthesopathy unrecovered with a preceding 3 months conservative therapy by using a neutrophil-reduced platelet-rich plasma (PRP). The patient was 27 years old, a right overhand pitcher. The pain occurred in his left knee during the acceleration phase of pitching motion. A Pow-er Doppler analysis showed an abnormal hypervascularity area and the magnetic resonance (MR) revealed an enthesopathy with a partial tear at the distal insertion site of the quadriceps femoris tendon. The PRP therapy was performed twice separated by a three weeks interval. Concentrations of platelets or neutrophils in PRP were adjusted to be optimal for the treatment of the tendinopathy. He returned to his previous sport activity level at 11 weeks without symptoms. The hypervascularity region disappeared on Power Doppler images and the partial tear observed on MR scans also receded. A rare quadriceps femoris tendinopathy in baseball pitcher was recovered with a therapy using PRP containing optimal concentrations of platelets or neutrophils.
35 Traumatic Musculotendinous Avulsion of the Flexor Pollicis Longus Tendon: Current Concepts in Strategic Management , Kastanis G, Klonos G, Magarakis G, Kapsetakis P, Spyrantis M and Pantouvaki A.
Avulsion amputation injury of the digits of the hand is an uncommon and grave lesion when appeared in the emergency depart-ment. Replantation of an amputated digit constitutes a challenge for hand surgeon. This trauma presents a particularly difficult problem to manage because of simultaneous damage of the skin, vessels, nerve and tendons while different surgical techniques have been proposed in international bibliography for the reconstruction of this lesion with a variety of functional results. We report a case after a traffic accident presented with a delay of four hours with an amputation avulsion injury of left thumb in interphalangeal joint with avulsion of flexor pollicis longus from musculotendinous junction and concomitant tear of extensor pollicis longus. The aim of this study is to analyze the current concepts of therapeutic management of this type of lesions.
36 Improvement of Functional Outcome Via Supercharged End-to-Side Anterior Interosseous to Ulnar Motor Nerve Transfer: A Case Series , Dylan J Parker, Robert Teixeira and Paul A Sibley.
Anterior interosseous to ulnar motor nerve transfer offers a viable solution in the management of high ulnar nerve injuries. Fol-lowing clinical observation, we sought to determine if supercharged anterior interosseus nerve (AIN) to ulnar motor nerve transfer confers a clinically significant improvement in functional outcome as measured by the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Our objective was to track the functional outcomes compared to baseline following supercharged AIN to ulnar motor nerve transfer in patients with high ulnar nerve injuries. A case series comprising a retrospective cohort included all patients who underwent an anterior interosseous to ulnar motor nerve transfer within a one-year time interval. Functional outcomes were as-sessed via the preoperative to postoperative change in outcome measures including DASH scores, hand strength and active range of motion. Sixteen patients were included in the final review (81.25% male, 18.75% female, mean age 54.81 ± 16.26 years) with a mean follow-up of 2.06 ± 0.892 months. Postoperative DASH scores for all combined injury etiologies, compressive etiologies, and trau-matic etiologies decreased an average of 41.99%, 29.38% and 88.23% respectively. Grip strength, 3-point pinch strength, and lateral pinch strength increased an average of 41.37%, 16.38% and 55.84% respectively. Ulnar deviation and radial deviation increased an average of 46.38% and 31.58% respectively. Our findings demonstrate that end-to-side AIN to ulnar motor nerve transfer for ulnar nerve injuries may be a powerful adjunct to traditional management of above elbow nerve injuries.
37 Optimization Design of a Carbon Fibre Prosthetic Foot for Amputee , Huy-Tuan Pham, Thanh-Vu Phan and Van-Trinh Mai.
Compliant prosthetic foot is a popular term for all passive prosthesis that are currently preferable by amputee due to their advan-tage of energy saving, light weight, simple structure and easier usage over the powered counterparts. The key characteristic of this device replies on the elastic deformation of the structure to support its functions. In order to fulfil this property, design and material of the devices are the two most concerns. This paper describes an optimization design method for a prosthetic foot made from carbon fibre. Finite element analyses are carried out to evaluate the mechanical behaviours of the design obtained by the optimization proce-dure. Prototypes of the device are also fabricated and tested. The characteristics of the optimum prosthetic foot predicted by theory are not only quantitatively verified by experiments but also qualitatively surveyed by trials from the amputee. Results show that the fabricated prototype is capable of bending and compression to store elastic energy and release it to assist in forward propulsion of the body. These characteristics make it more versatile and reduce the impact force on residual limbs.
38 A Review of Surgical Indications for Scoliosis in Duchenne Muscular Dystrophy , Phong Truong, Kristina Kuklova and Natalie Brush.
The purpose of this article is to review the literature related to indications for scoliosis surgery in patients with Duchenne Mus-cular Dystrophy. Although the physiology behind spinal deformities in Duchenne Muscular Dystrophy is still unclear, the most recent theory supports the idea of progressive loss of ambulation, poor mobility, and muscle weakness, all leading up to a collapse of the spine. Scoliosis treatment varies from more conservative options, such as physiotherapy and long term glucocorticoids, to surgical intervention of spinal fusion. Duchenne Muscular Dystrophy is a degenerative generalized condition with complications that affect not only the musculoskeletal system, but respiratory and cardiovascular as well. Surgical intervention is essential for improvement of overall quality of life, especially in patients with rapidly declining forced vital capacity, heart failure with left ventricular ejection frac-tion less than 55% and increasing Cobb angle of more than 35 degrees-or 20 degrees in patients at high risk for rapid deterioration.
39 Transcultural Adaptation and Validation of the Arabic Version of the Compliance Questionnaire for Rheumatology , Nelly Raymond Ziadé, Ghada Abi Karam, Nelly Salloum and Marouan Zoghbi.
Background: To date, the Compliance Questionnaire for Rheumatology (CQR) is the only self-reported adherence measure created for and validated in Chronic Inflammatory Rheumatic Diseases (CIRDs). However, it has not been validated in Arabic. Aim: To translate, culturally adapt, and validate the CQR in Arabic.Methods: Cross-sectional study, with a longitudinal component to test reliability, using the WHO guidelines: forward and back-translation, cognitive debriefing, and final validation with CIRDs patients (rheumatoid arthritis, spondyloarthritis, connective tissue disease, and Behcet’s disease). Results: The CQR was translated and back-translated by two independent translators, and a cognitive debriefing was performed with 30 patients. For the final validation, 102 patients were included and found that the questionnaire was easy to complete (average time 4.8 minutes). The CQR was significantly associated with self-reported adherence. Test-retest reliability was high (ICC 0.94 (95% CI 0.85 to 0.98)), internal consistency was acceptable (Cronbach α of 0.704). The mean CQR score was 85.4% and was statistically associated with age. Implications: The CQR was validated in Arabic and can be a useful tool in future clinical and research settings in the Arab world.
40 A Narrative Review of Body Mass Index in Pediatrics and its Relationship with Stability of Slipped Capital Femoral Epiphysis , Phong Truong, Long Truong, Kristina Kuklova, Natalie Brush, Luke Vincent and Jonathan Schneider.
Purpose: To present a narrative review of the literature related to body mass index of children and adolescents and whether it re-lates to stability in slipped capital femoral epiphysis. Method: A review of literature was conducted. Using the MEDLINE database and Google Scholar search engine, publications in the English language were queried in regards to body mass index in children as well as any effects of body mass index on stability of slips in slipped capital femoral epiphysis. Results: Being overweight or obese is a risk factor for having slipped capital femoral epiphysis in adolescence; however, underweight or normal weight adolescent children have higher risk of unstable slips when compared to their overweight or obese peers. Perhaps bony changes in obese children play a protective role in decreasing risk of unstable slips. Epiphyseal cupping is a process in which the superior aspect of the capital femoral physis extends laterally towards the metaphysis. However, there has been no correlation shown between obesity and increased epiphyseal cupping. Conclusion: This calls for more research related to possible structural changes in the proximal femur of obese adolescents that may play a role in protecting against unstable slips in slipped capital femoral epiphysis.
41 Pressure Exerted Using a Pelvic Binder , Krunal Soni, Mehool Acharya and Arpit Jariwala.
Background: Pelvic Circumferential Compression Device (PCCDs) aids in temporary stabilisation of pelvic injuries, in a decrease of pelvic volume and thereby assisting in haemostasis. It is known that if PCCDs are applied for extended duration, damage to tissue can occur. This research helps to quantify the pressure exerted by two different PCCD (SAM Sling® and T-POD®) at four locations (anterior, right, left and sacral) in healthy volunteers. Methods: SAM sling® and T-POD® were applied randomly on healthy volunteers and mean pressures was measured at locations (an-terior, right, left and sacral) by pressure cuffs. Results: A significant variation was noted in the pressure exerted by both PCCDs at the four locations. Pressures exerted at anterior locations were less than tissue damaging pressure of 9.3 kPa for both SAM Sling® and T-POD®. For volunteers with higher BMI the pressure exerted at right and left greater trochanter was greater than the tissue damaging pressure of 9.3 kPa for both SAM Sling®and T-POD®. However, the SAM-Sling® produced higher mean pressures on the left location as compared to the right location while T-POD® produced higher mean pressures on the right location as compared to the left location. This can be attributed to the different closing mechanism of both the PCCDs. Pressure exerted at the sacral location was always greater than the tissue damaging pressure of 9.3 kPa for both the PCCDs. Conclusion: The results of this study in healthy volunteers presented that application of PCCD is associated with the development of high mean pressure at the right greater trochanter, left greater trochanter and sacral region and may lead to formation of pressure sores. However further research with a higher number of volunteers and testing of the results of this study in acute clinical scenario is needed to ascertain these findings from the current study.
42 Immediate Effect of Self Stretching and Foam Roller Release on Tensor Fascia Lata Tightness: A Randomized Controlled Trial , Khushali Choksi, Dhvani Champaneri and Arti Patel.
Background of the Study: Tensor fascia lata muscle is commonly seen to be tight in normal healthy subjects and leads to Myofascial restriction. It causes range of motion restriction of hip and knee joint, pain at lumbopelvic area and knee pain.Aims of the Study:The aim of the study was to evaluate the immediate effect of self stretching and foam roller release in subjects with TFL tightness. Study Design: Randomized Controlled Trial. Methodology: 90 subjects with TFL tightness were randomly allocated using chits for the study in three different groups with 30 subjects in each group. The outcome measure taken was OBER TEST; hip adduction range of motion. Pre and post treatment outcome measure was taken by Therapist 1. The instruction for intervention was given by therapist 2 for Group A (self stretching) and was performed for three repetitions with 30 seconds hold and Group B (foam rolling) and was performed for two minutes. Group C was control group who did not receive any kind of intervention. Result: There was statistical significant difference within foam roller and self stretching group. Using Post hoc analysis, there was significant difference between foam roller-control group and self stretching-control group (p value 0.000).There was no significant difference between foam roller and self stretching group (p value 0.422). Conclusion: There was statistical significant difference within self stretching and foam roller release group but when all three groups were compared simultaneously, self stretching and foam roller release group were equally effective in reducing the tightness of ten-sor fascia lata.
43 Clinical Results of Flexible Coracoclavicular Fixation with Fiber Tape in Acromioclavicular Dislocation. A Retrospective Study , José Tomás Echeverría Ubilla, Maximiliano Rosenkranz Caroca and Felipe Cichero Zamorano.
Background: The injury to the acromioclavicular joint is very common in the young athlete population. Treatment, depending on the type of injury, can be conservative or surgical. There are multiple surgical options described in the literature for these injuries and there is no consensus regarding the best surgical technique. The objective of this study is to describe the clinical results of the surgical management of acromioclavicular dislocations with the use of a double loop of subcoracoid Fiber Tape. Methods: We retrospectively reviewed the cases of acromioclavicular dislocations that required surgery (Rockwood types IIIb, IV, V and VI) between 2014 and 2017, operated by the same surgical team in the same center. In all cases, the surgical technique included the fixation with double loop of subcoracoid Fiber Tape. All patients were assessed radiographically and clinically using The Constant Score and The Disabilities of the Arm, Shoulder and Hand Score at six months follow-up. All patients underwent the same rehabilita-tion protocol. Results: A sample of 124 patients with acromioclavicular dislocation treated with open surgery was obtained. The average age was 35 years. The mean post-operative Constant score was 93. The mean post-operative Disabilities of the Arm, Shoulder and Hand Score was 6.2. There were 3 cases of minimal loss of range of motion, 21 cases of slight loss of radiological reduction, and 4 cases of mild pain at 6 months of follow-up, but all without clinical repercussion in their activities of daily life. There was 1 case of complete loss of reduction (handled in another rehabilitation center). All the patients returned to their usual activities, including work and sports. Conclusion: The postoperative results were satisfactory, and the complication rate was low with this technique. The fixation with double loop of subcoracoid fiber tape is a valid surgical option for the management of acromioclavicular dislocations.
44 Isolated Acute Rotator Cuff Muscle Injury in Professional Baseball Players: 2 Case Reports , Mamoru Yoshida and Hiroki Funasaki.
Isolated acute injuries of scapulohumeral muscles are relatively rare in sports compared with general muscle injuries or com-pared with throwing-related disorders in shoulders. We had two retrospective cases of an isolated acute muscle injury to the sub-scapularis muscle developed in the pitching motion and to the infraspinatus muscle developed in the batting motion in professional baseball players during regular season games. Both cases were conservatively treated and successfully returned to play at their previous activity levels. We proposed that isolated acute injuries of rotator cuff muscles are relatively specific to professional baseball players, since there are few reports in non-professional players or in athletes in other kinds of sports.
45 New Findings to Consider in the Sacroiliac Joint and Low Back Pain in the Differential Diagnosis , Sergio Marcucci
The sacroiliac joint (SIJ) is an anatomical structure, which is surrounded by an important network of ligaments and also has been referred to as an important source of low back pain (LBP). Worldwide low back pain (LBP) and its associated costs represent an important issue [1]. The SIJ posterior ligament is capable of re-ferred pain in the lower limb, and back. Thus, the SIJ complex is an anatomical structure that requires a specific manual physical examination during the diagnosis’s potential origins for SIJ or LBP.
46 Work-Related Musculoskeletal Disorders Among Physiotherapists in Hellenic Armed Forces Hospitals , MS Stamou, G Papathanasiou, D Bakalidou, M Papadopoulou, E Bontioti, E Kontaxaki and S Zepou.
First reports go back to the 17th century when Ramazzini related for the first time this profession to musculoskeletal disorders. Focus on research and solution to this has been made only recently as it has become a problem with high costs due to lost labor hours and increased prevalence among the practicians. The financial cost to the general population is high, both directly utilizing money spent and indirectly in the shape of lost manpower hours due to illness. The purpose of this pilot perspective study was to examine the levels of musculoskeletal pain in physiotherapists working in the Hellenic Armed Forces hospitals and research the risk factors. A three-page questionnaire consisting of close-ended questions was used. The collection of data was carried out by personal inter-views using the PAPI method and took place from May of 2016 through January of 2017. Questionnaires were given to thirty-seven physiotherapists giving a response rate 54%. 85% of the participants reported pain in at least one anatomical range of their body during last year, with the most commonly affected were the upper and lower back, knees and neck.The study presents a statistically important correlation. Fitness and stress have an impact on musculoskeletal pain level as it was identified in this study. Understand-ing work risk factors which lead to occupational musculoskeletal injuries may help to take precautions and improve the quality of the healthcare system.
47 Effect of Neural Mobilization Techniques and Nerve Mobilization Exercise on Ulnar Nerve Entrapment Post Supracondylar Humeral Fracture. A Case Report , Ishfaq Bashir Bhat
Introduction: The purpose of this case report is to describe the role of ulnar nerve mobilization techniques on post humeral fracture entrapment of ulnar nerve in and around the healing fracture. Ulnar nerve entrapment is the second most of entrapment neuropathy in upper limb. Ulnar nerve can get entrapped in callus in supracondylar fracture. Case Description:A 22‐year‐old male student presented to physical therapy, progressing well following supracondylar humeral frac‐ture, sustained 8 weeks prior. During the treatment, the patient reported restricted range of motion and function, with pain. Based on signs and symptoms the patient was having ulnar nerve entrapment. Results/Outcome: After two weeks of manual therapy (ulnar nerve gliding techniques), and a detailed home exercise program (nerve mobilization exercises and ROM), the patient returned to his normal. There was significant improvement in pain (VAS) and the post treatment McGowan score improved from grade 1 to grade 0. There was improvement in patient’s functions the patient specific functional scale (PSF) score improved from 6 to 1. Conclusion: This case report describes the effect of neural mobilization techniques in improving ulnar nerve entrapment post supra‐condylar fracture of humerus. The case report demonstrates improvements and maintaining functional mobility. Based on this report the further research is warranted in this area.
48 Simple Technique for Repair of Avulsed Distal Biceps Tendon through One Approach. Case Series and Literature Review , Ahmed Refaat Khamis
Introduction: Acute disruption of the distal biceps tendon is a rare injury that occurs due to eccentric contraction force on the elbow. Several techniques for reattachment of the avulsed tendon were described in the literature but no one had proved utmost efficiency over the other techniques. The purpose of this study is to evaluate the results of a simple technique for reattaching the tendon. Methods: This is a retrospective evaluation of the use of a combined simple two fixation methods through a single anterior approach in 9 patients aiming to avoid the possible difficulties and complications reported with the other techniques. Results: Were evaluated with the Mayo elbow score and showed 6 excellent cases (66.6%), 2 good (22.2%) and one fair (11.1%). Good and comparable results to the other fixation techniques were also obtained with minimal complications. Conclusion: The described simple combined fixation of avulsed distal biceps tendon by two anchors and trans-osseous tunnel through one anterior approach is an easy reproducible technique with minimal complications.
49 Research in a Tertiary Care Centre - SWOT Analysis , TR Ashok
Research being considered as major criteria nowadays for institutional upgradation and promotion for teaching faculties of health and allied health sciences amongst tertiary care centres throughout the country. MCI regulations from the recent past of 2018 with elimination of predatory journals and emphasis on indexing status of journals with UGC-CARE consortium throwed a light on index-ing agencies on publications, type of articles and guidelines of authorship but still persistence of confusion exists among teachers till date on publishing an article. Teaching places utilise this area of confusion thereby keeping the faculties under immense pressure and burden towards their growth in career.
50 Analysis of Functional Outcome in Proximal Humerus Plating (PHILOS) in Displaced Proximal Humerus Fracture , Dhruv Pandya and Krunal Soni.
Background: Fractures of proximal humerus are common and debilitating injuries increasing seen in the elderly population [1]. Neer classification remains most widely used today [7]. Optimal treatment of three- or four-part fractures of proximal part of the humerus in elderly patients is controversial. However, recent advances in fracture fixation technology has led to development of fixed angle locked plates (PHILOS) that maintain angular stability under load [18]. Methods: This retrospective study included 41 patients aged > 18 years with fractures of the proximal humerus, including two-, three-, and four-part fractures, treated by open reduction and internal fixation with PHILOS plating. Patients were functionally evalu-ated based on subjective (35 points) and objective (65 points) parameters as per the Neer scoring system. Results: All these operated patients were followed up for 12 - 18 months. Functional outcome based on the Neer scoring system showed 32 patients had good outcome scores (78%) which include excellent and satisfactory result, whereas 9 patients had poor outcome scores (22%) which include unsatisfactory and failure results, out of which 4 patients had avascular necrosis and were treated with Shoulder Hemiarthroplasty, 4 patients presented with varus malunion and treated with Osteotomy and revision plating and 1 patient underwent implant removal and physiotherapy. Conclusion: Proximal humerus locking plate is a preferred option for management of in all types of Neer’s fracture types of proximal humerus and fracture dislocation of proximal humerus. The present study concludes that it is a promising implant working by a dual mechanism i.e. a buttressing effect laterally and inferomedial support by locking screws, which prevent varus displacement of proxi-mal fragment and thus it provides a good functional outcome in proximal humerus fractures.However, complications are not uncommon with PHILOS plates. And therefore, a thorough understanding of fracture morphology using pre-operative planning with 3D CT scan, sound surgical techniques and proper plate positioning is necessary to achieve good functional outcomes.
51 Significance of Co-existing Distal Radio-Ulnar Joint Injuries in the Surgical Management of Distal Radius Malunion , Nikil Sanaba Paramesh and Abhishek M Matapathi.
Background: Distal radius malunion is a major complication of distal radius fractures, reported in about 33% of cases. Corrective osteotomy to restore normal anatomy usually provides improved function and significant pain relief. We report the outcomes in a case-series with special attention to the potential influence of the initial management. Material and Methods: This single-centre retrospective study included 15 patients, which included 11 males and 4 females, with a mean age of 32 years (range, 14-55 years). They were from different socio-economic and professional backgrounds. There were 10 extra-articular fractures, including 7 with volar angulation, 3 anterior marginal fractures, and 2 intra-articular T-shaped fractures; the dominant side was involved in 13/15 patients. Initial fracture management was with Kapandji intra-focal pinning in 3 patients, anterior plate in 3 patients, and non-operative reduction in 9 patients. The malunion was anterior in 13 patients, including 3 with intra-articular malunion, and posterior in 2 patients. Corrective osteotomy of the radius was performed in all 15 patients between 2018 June and 2019 July. Mean time from fracture to osteotomy was 145 days (range, 45-180 days). The defect was filled using an iliac bone graft in all patients. No procedures on the distal radio-ulnar joint were performed during the corrective osteotomy surgery. 2 patients among these underwent revision surgery on distal ulna on a later date. Results:All 15 patients were evaluated 12 months after the corrective osteotomy. They showed gains in ranges not only of flexion/extension, but also of pronation/supination. All patients reported improved wrist function. The flexion/extension arc increased by 44° (+24° of flexion and +20° of extension) and the pronation/supination arc by 30° (+15° of pronation and +15° of supination). Mean visual analogue scale score for pain was 1.5 (range, 0-3). Complications recorded within 12 months after corrective oste-otomy were complex regional pain syndrome type I (n = 1), radio-carpal osteoarthritis (n = 2), and restricted supination due to incongruity of the distal radio-ulnar joint surfaces (n = 2). This last abnormality should therefore receive careful attention during the management of distal radius malunion. Discussion: In our case-series study, 2 (13.33%) patients required revision surgery for persistent loss of supination. Here we found that the reason was failure to perform an additional procedure on the distal radio-ulnar joint despite finding joint congruity on post-operative x-ray. Hence, it can be concluded that outcome of corrective osteotomy for distal radius malunion significantly depends on distal radio-ulnar joint congruity.
52 High Rate of Radiological Failure Despite Excellent Clinical Results of Minimally Invasive Acromio-Clavicular Joint Reconstruction (MINAR) , Marc Banerjee, Carolin Spüntrup, Bertil Bouillon, Ann-Kathrin Singer, Rolf Lefering, Arasch Wafaisade and Maurice Balke.
Introduction:Hook plates and arthroscopic flip button techniques are currently the most commonly used procedures for AC-joint reconstruction. Minimally invasive AC-joint reconstruction (MINAR), a mini open flip button technique was introduced as an alterna-tive to the arthroscopic technique as it is a straight forward procedure and no experience in arthroscopy is needed. Methods: Between 2011 and 2015, 53 patients with acute AC-joint separations Type Rockwood III, IV and V were stabilized by MINAR. 45 were available for follow-up. In 15 patients a 1m m polyester suture was used, in the remaining 30 patients a No. 5 Fiber-wire. All patients had a follow-up examination at a minimum one year after surgery. The Constant score (CS), the American Shoulder Elbow score (ASES) and the subjective shoulder value (SSV) were evaluated. All patients had a calibrated bilateral stress view of the AC-joints and a bilateral axial view. The coraco-clavicular (cc) distance was measured on the injured and contralateral side. Further-more, the width of the clavicular tunnel was measured and compared with the initial diameter (4.5 mm). Results: The mean age of the patients was 37.6 years (range 17 - 64), patients were operated after an average of 7.2 (range 1 - 20) days after trauma. After a mean of 25.3 months (range 12 - 53 months) the mean absolute CS was 96.6 (range 87 - 100), the mean ASES 98.0 (range 60 - 100) and the mean SSV was 92.3 (range 60 - 100). The cc-distance was 10.0 mm on the injured side and 8.1 mm on the uninjured side (p < 0.001). Only 14 patients (31.1%) had a perfect reduction in the vertical plane defined as a cc-distance on the injured side of ± 10% compared to the contralateral side. 20% of the patients with polyester suture and 56.7% of patients with Fiberwire had a widening of the clavicular tunnel with an average tunnel of 3.5 mm and 5.0 mm, p = 0.016. Conclusion: Despite excellent clinical results and an average side-to-side difference of the cc-distance comparable to other tech-niques MINAR failed to restore the AC joint anatomically in the vertical plane. Therefor a modification of the originally described technique is advisable.
53 What Next in Shoulder! , Nithin Sunku
Today the scenario has changed extensively post COVID pan-demic. So now everywhere digital E conference, webinars and group meetings (zoom and other apps) have literally reduced the barrier and increased learning through online platforms. Also, the clinical practice has been modified and tailor made in each institu-tion.
54 Aceclofenac in Osteoarthritis - NSAID with Novel Mechanism of Action , Dilip Shah, Ananda K Pal, Gurinder Bedi, Anu Grover, Amarjit Singh, Indranil Purkait, Apurva Jawdekar and Anil Pareek.
Osteoarthritis (OA) is the most common form of arthritis, affecting millions of people worldwide. It is an inflammatory, degenera-tive and progressive disease which worsens over time, resulting in joint pain, swelling and stiffness. As the disease progresses, pain and stiffness become severe making daily tasks difficult, thereby affecting the quality of life. The treatment of osteoarthritis mainly focuses on management of inflammation to control the symptoms as complete reversal of the disease is not practical. Non-steroidal anti-inflammatory drugs (NSAIDs) are most commonly used and are mainstay drugs in the symptomatic treatment of osteoarthritis. Various NSAIDs are currently available in the market and looking into the co-morbidities associated with OA, there is a need for well tolerated NSAID with proven efficacy and safety. Aceclofenac, although was a late entry in crowded NSAID market, but, now is a well established drug in management of OA pain. It predominantly inhibits the inflammatory COX-2 enzyme, and due to less inhibitory action on gastroprotective COX-1 enzyme, it can be categorized as a preferential COX-2 inhibitor. Besides prostaglandin synthesis, it also inhibits synthesis of other inflammatory mediators like interleukins, tumour necrosis factor, nitric oxide and matrix metallopro-teinases. This makes its efficacy similar or superior to other NSAIDs. Its efficacy has been evaluated in international studies as well as in Indian patient setting, where it has shown significant decrease in pain and severity of symptoms and improvement of functional capacity in osteoarthritis patients. Additionally, aceclofenac has a unique chondroprotective action and hence exerts a stimulatory effect on cartilage matrix synthesis. Due to preferential COX-2 inhibition, it is well-tolerated amongst the available NSAIDs, with a lower incidence of gastrointestinal and other NSAID related side effects. Good tolerability profile of aceclofenac results in decreased withdrawal rate and greater compliance of the treatment. Aceclofenac is the preferred drug for chronic therapy of osteoarthritis as long term studies highlighting the efficacy and tolerability of the drug are available. This review mainly focuses on the efficacy of aceclofenac, and also briefly mentions its safety in osteoarthritis management.
55 “Double Bundle - Single Tunnel” Hamstring Graft Fixation in Femur , Rajkovic Stanislav, Vukomanovic Boris and Jeremic Danilo.
Purpose: An original technique of introducing hamstring graft into the femoral tunnel and its’ fixation which forms an anatomic double bundle anterior cruciate ligament (ACL). Materials and Methods: Hamstring tendon graft is prepared with a “head”, “body” and two “tails”. The femoral tunnel is drilled at the Resident’s and Bifurcation ridge junction through the anteromedial portal and subtunnels are prepared. The graft is introduced into the knee - “body” in the femoral tunnel, “tails” in one subtunnel and “head” in the other. Fixation is done by an absorbable in-terference screw. The “head” and the “tails” are twisted inside the tibial tunnel. Fixation in the tibial tunnel is done by an absorbable interference screw. Discussion and Conclusion: This technique eliminates “bungee” and “windshield wiper” effect, anatomic position of the graft is achieved and risk of “blow out” effect and graft damage during screw insertion is significantly reduced.
56 Psychometric Properties of the Gujarati Version of the Tampa Scale for Kinesiophobia in Chronic Neck Pain in Diamond Workers of South Gujarat Region , Hetvi Jaimin Shukla, Minesh Pragneshbhai Kapadia, Shafiya Ismailbhai Tai, Ruchi Rameshbhai Patel and Reshma Mansukhbhai Savaliya.
Background: The Tampa Scale for Kinesiophobia, an instrument for measuring fear of movement, has been confirmed as pain impor-tant predictor for the persistence of pain -related disability. The aim of this study to analyze the psychometric properties of Gujarati version Tampa Scale for Kinesiophobia (TSK-G) in chronic neck pain in diamond workers. Methods: A total 300 subjects with chronic neck pain were included in this study according to inclusion criteria. After gaining cross cultural adaptations, reliability was assessed with Cronbach’s alpha, inter and intra rater reliability, analyzed by intra- class correla-tion coefficient. And Neck disability index were used for construct validity and for face validity, this scale was given to more than 20 orthopedicians and physiotherapists.
57 Addressing Fear Avoidance and Self-efficacy Beliefs to Reduce Disability in Patients with Non-specific Low Back Pain: From Theory to Application. , George A Koumantakis.
A considerable proportion of patients with non-specific low back pain (nsLBP) report continued symptoms for an extended pe-riod of time. In many cases no structural lesion can be identified. Biopsychosocial models attempt to identify the contribution of sev-eral psychosocial factors contributing to the development and maintenance of chronic disability in these patients. The fear avoidance model postulates that patients may respond to pain with an avoidance behavior, reducing the level of their activities, resulting in a vicious cycle of prolonged disability, disuse and further pain experience. The aim of this mini-review is to present some of the most relevant evidence on the interrelationship of fear avoidance as well as self-efficacy beliefs with disability in patients with nsLBP and physical therapy-related methods targeting disability improvement through fear amelioration techniques. It is concluded that fear is a contributing factor leading to greater levels of disability in individuals suffering an acute episode and is also influencing patient disability further in the subacute and chronic stage of symptoms, also affecting LBP recurrence rate. Results of some studies indicate that there may be additional cognitive factors, like self-efficacy, influencing the outcome of therapy, mainly for those experiencing acute back pain symptoms. Further investigations should take into account and examine the joint contribution of such psychological factors in order to imple-ment effective and targeted therapy interventions for patients with back pain.
58 The Effects of Leukocyte-Poor Platelet Rich Plasma for the Symptomatic Knee Osteoarthritis: A Single Centre Experience. , Andrea Farneti, Michela Giustozzi, Marta Micheli, Enrico Sebastiani, Michele Berloco, Luca Pennacchi, Carlo Farneti1 and Fabio Perrone.
Purpose: Platelet-rich plasma (PRP) is routinely used in the symptomatic treatment of knee osteoarthritis (OA) despite limited evi-dence. The aim of this study was to evaluate the efficacy of injective protocol of leukocyte-poor-PRP for the symptomatic treatment of knee OA. Methods: A retrospective study of 213 patients (a total of 326 knees treated) with symptomatic knee OA were analysed; each patient underwent a cycle of three infiltrations with intra-articular PRP and was re-evaluated at 3, 6 and 12 months with clinical examination or phone contact. The Visual Analog Scale (VAS) and International Knee Documentation Committee Subjective Knee Form (IKDC) were used to assess efficacy. Results: Mean age was 68.1 ± 9.7 years and 59.6% were female. Mean VAS score before treatment was 6.5 ± 1.4 (range from 2 to 10), 1.6 ± 1.6 at 3 months, 1.4 ± 1.5 at 6 months and 1.7 ± 1.7 at 12 months. A significant reduction was observed between the VAS score pre-treatment and the VAS score at 3 months (p < 0.001), 6 months (p < 0.001) or 12 months (p < 0.001). The IKDC score was 41.7 ± 9.2 before treatment and was 67.3 ± 14.1 at 12 months (p < 0.001). A better symptomatic relief was observed in patients with early knee OA (stage 1 and 2 of Kellgren-Lawrence classification). Conclusions: This study suggests that leukocyte-poor-PRP injections are effective in reducing pain symptoms and improving func-tional outcomes in patients with knee OA at short-term follow-up.
59 A Prospective Study on the Efficacy of Closed Suction Drains in Fractures of the Hip Treated by Dynamic Hip Screw , Shareef S M Nada, Dalia A E Abuzeid and Hashim A Ahmed.
Background: The use of closed suction drains in orthopedics has been a subject of controversy over the years. The drain has a com-mon and effective role in general surgery but its use in orthopedics has yet to be justified. This study aims to elucidate the effect of closed suction drainage on the outcome of the extracapsular fractures of the neck of femur treated by DHS. Methods: 160 patients were included in the study. A non-randomized prospective cohort study design was used. There were two groups of 80 involved, which were all the patients undergoing DHS surgery in KTH from the period of Feb-June 2016. One group received a drain while the other did not, and the 2 groups were homogeneous in every respect other than the use of the drain. All the patients were followed up until 2 weeks postoperatively and appropriate statistical analysis methods were used. Results: The mean age was 61 ± 2.8. 51% of the fractures were intertrochanteric. The drains were removed after 72 hours in 63% of the drained group. 10% of the entire sample developed wound infections. Statistically significant postoperative complications were found in the drained group when compared to the non-drained group with a RR of 2 (95% CI) especially for respiratory complica-tions. Discussion: This is the first study of its kind in Sudan. Compared to other studies which showed no statistically significant difference in the use or nonuse of drains, this study showed that the use of closed suction drains is twice more likely to result in a postoperative complication than the nonuse of a drain. Also, drains should be removed within 24 hours as recommended by Chandretaya., et al. Based on these findings, the use of post-operative surgical drains in DHS should be limited by Orthopedic surgeons in Sudan.
60 Surgical Treatment in Fractures of the Lateral Humeral Condyle in Children: When and Which Surgery. , Sudhir Shankar Babhulkar, Sushrut Babhulkar and Amol Yashwantrao Patil.
Background: To optimize the treatment for lateral condyle humerus fracture and define surgical indications. Material and Methods: 36 patients evaluated with an average follow up of 3 years. All 36 patients had fresh injuries. Internal rota-tion view with antero-posterior and lateral view is essential. Arthrography, ultrasound or MRI may be required. Type I injury treated partly conservatively and mostly by percutaneous fixation in situ. Type II by closed reduction and fixation after confirming the intact cartilaginous hinge by arthrography and Type III by open reduction. Result: Type I had excellent results. In type II 8 had excellent and 10 patients had good results. Out of 8 Type III fresh cases 2 had excellent and 5 had good results, 1patient had fair outcome. Conclusion: Type I injury should be treated by percutaneous fixation to avoid chances of displacement. Type II injuries after confirm-ing the intact cartilaginous hinge can be dealt without open reduction. Type III injury requires open reduction and perfect anatomical fixation. Prognosis of type III injury should be informed in advance to parents. Follow up for loss of carrying angle and development of ulnar neuritis is necessary.
61 Bilateral Tibial Tubercle Fracture in Adolescence: A Case Report and Review of the Literature , Panagiotis Poulios, Athanasios Serlis, Livio Di Mascio, Adrian Carlos, Alexandros Vris and Georgios Konstantopoulos.
Background: Fractures of the tibial tubercle are relatively uncommon injuries. Bilateral tibial tubercle fractures are substantially rare; particularly the high-grade patterns. These types of fractures occasionally involve the growth plate, extend through the articular surface and have a reasonable good prognosis despite their bilateral nature. The available literature body is supporting the surgical fixation of these injuries, while there are no reports for conservative management. In this manuscript, we report satisfactory out-comes with conservative management and close follow-up.Case Summary:In this article, we report an Ogden type IVA simultaneous bilateral tibial tuberc le fractures in a 12-year-old boy after a reported ground-level fall during sporting activity. These injuries were managed conservatively with close follow-up and repeat imaging. Clinical and radiological results were excellent at the final review. Conclusion: The bilateral tibial tubercle fractures are a rare injury in the paediatric population. The majority of the reported cases in the literature support surgical fixation as the choice of treatment. In this case, we report satisfactory outcomes with conservative management and close follow-up, and we review the relevant literature.
62 Titanium and Cobalt Neurotoxicity due to Catastrophic Failure of a Metal/Polyethylene Total Hip Arthroplasty (THA)-Case Report and Literature Review , Ioannis C Vossinakis and Evangelia Bachlava.
Cobalt metallosis from failed total hip arthroplasty (THA) has been implicated in brain toxicity with, sometimes, severe neuro-logical symptoms. We present a case of a destroyed metal on polyethylene THA, in a male patient that resulted in extreme metallosis from Titanium and Cobalt within 5 years and presented with severe neurological impairment. A literature review revealed that little is known regarding titanium toxicity from orthopaedic implants. We discuss the case and the literature aiming to raise awareness for this rare and potentially serious complication.
63 Neglected Unstable Slipped Capital Femoral Epiphysis: A Case Report , Sawamura K, Mishima K, Matsushita M, Kamiya Y and Kitoh H.
Delay in diagnosis is a serious issue in stable type of slipped capital femoral epiphysis (SCFE), but it is rare in unstable SCFE due to its intense and severe clinical symptoms. We present a girl with an unstable SCFE who had not been diagnosed for one month after the acute onset of the disease. She was treated with percutaneous pinning to fix an unintentionally reduced femoral epiphysis after prolonged skeletal traction in a flexed position of the hip. Although moderate deformity of the proximal femur with an anterolateral metaphyseal bump was remained after physeal fixation, it was successfully remodeled during residual growth. She had spherical femoral head with no evidence of avascular necrosis and showed favorable clinical outcome within acceptable limb length discrep-ancy at skeletal maturity.
64 Herbal Plaster for Bone Disease Treatments , Jin-Yu Che and Da-Yong Lu
Bone disease is a human health-problem all over the world. Generally, bone disease recovery is different between Western countries and China. In China, herbal plaster is widely used for bone disease treatments and recovery. This editorial provides main themes of medical recovery alleviated by herbal plasters in China.
65 Open Wedge High Tibial Osteotomy Distal to the Tibial Tuberosity, is it a Superior Alternative? Review of the Literature , Sarmad Rashed Khalil Sulaiman, Naif Mohammed Al Junaid, Meshal Yousef Koshok and Rayan Mohammed Taher Al Arabi.
Open wedge high tibial osteotomy is a successful surgical procedure for the medial compartment knee osteoarthritis. It is a highly useful method in correcting the deformity and reducing the pain for better function, therefore, potentially delaying the need for knee arthroplasty. However, changes in the patellofemoral biomechanics due to patella infera could raise unusual patellofemoral contact pressures that generate patellofemoral osteoarthritis. Furthermore, the conversion of high tibial osteotomy to total knee replace-ment is a technical challenge. Open wedge osteotomy distal to the tibial tuberosity does not compromise the patellofemoral biome-chanics; therefore, could be a preferable alternative. The current literature review aims to answer the question: Is the open wedge osteotomy distal to the tibial tuberosity a superior alternative to the conventional high tibial osteotomy? There will be an evaluation of the open wedge osteotomy distal to the tibial tuberosity in comparison with the traditional open wedge osteotomy proximal to the tibial tuberosity in terms of alteration in, pa-tellar height, patellar tilt, patellar shift, posterior tibial slope, patellofemoral arthrosis, tibial tuberosity fracture, nonunion rate, the influence on subsequent total knee replacement.
66 Bilateral Fracture of 5th Metatarsal , José María Busto Villarreal, Karen Rubí Martínez Vega, Gabriela Murguia Canovas and Aldo Isaac Vazquez Godinez.
5th metatarsal stress fractures are frequently encountered in professional football. Approximately five to six percent of fractures encountered in the primary care setting are metatarsal fractures. In adults, meta-tarsal fractures peak in the second to fifth decades of life. The most frequent fracture seen is the fifth metatarsal, accounting for 68% of metatarsal fractures. Proximal fifth metatarsal fractures are divided into three zones. Zone one, zone two and zone three fractures account for 93%, four percent and three percent of proximal fifth metatarsal fractures, respectively [1]. Radiographic imaging for a suspected metatarsal fracture includes three standard radiographic views of the foot: Lateral, antero-posterior, and a 45 degree oblique. Acute stress fractures are typically not detected on the standard three views of the foot. It is sug-gested that repeated radiographs are made at 10 to 14d after the initial onset of symptoms. At this time a radiolucent reabsorption gap around the fracture confirms the diagnosis. In the case of more complex midfoot trauma, a CT scan is recommended to rule out the Lisfranc fracture dislocation [2]. Displaced zone two fractures require operative management. Less consensus exists on acute nondisplaced Jones fractures (zone two). There are many studies that advocate for early intramedullary screw fixation for acute Jones fractures in the active population. Acute Jones fractures treated operatively resulted in quicker return to sport and clinical healing in competitive athletes [1]. The therapeutic management of this fracture remains controversial. Someauthors have mentioned the difficulty of treating Jones fractures which very of-ten progress to non-union linked to the precariousness of the vascularization [4]. There is concern that early return to play following intra-medullary screw fixation may lead to an increased risk of delayed union. However, intramedullary screw fixation of 5th metatarsal stress fractures leads to a predictable time of return to play and a low rate of non-union [3]. The fracture of its base described by Sir Robert Jones in 1896 is the source of etiological, prognostic and therapeutic confusion. This frequent fracture of the foot has been often studied in the military, athletes and the European population but not mexican poblation [5,6].
67 Radiation-Induced Brachial Plexopathy. Two Case Revision , Julio Cesar Sánchez Hernández, Pedro Vicente Fuentes Escobar, Laura Valentina Greco Bermúdez, Pedro Tomas Jerez Garcia and Maria Fernanda Sánchez de la Fuente.
Introduction: The brachial plexus is a complex anatomical structure formed by the lower cervical and upper thoracic nerve roots. In case of suspected brachial plexopathy, nerve conduction and electromyography studies are often used to locate the lesion and assess its severity. Clinical Case: There are two clinical cases, the first of a 70-year-old male patient with a history of a squamous oropharynx adenocar-cinoma with cervical lymph node metastasis, treated by surgery, chemotherapy and radiotherapy, and the second case, a 70-year-old woman undergoing a radical right mastectomy following breast cancer, treated with chemotherapy, radiotherapy and hormonother-apy. In both cases, patients developed a late-onset brachial plexopathy in relation to the treatment. Radiotherapy-induced brachial plexopathy has been described as a rare complication. It is usually debuted with paresthesias rather than pain and usually associates amyotrophy. Radiation-induced plexopathies appear to affect the upper and middle trunk of the brachial plexus in greater proportion, being unusual to affect the lower trunk.
68 Brachial Plexus Injury Secondary to Prolonged Prone Position in COVID-19 Pneumonia: Case Report. , Rafael Poniachik, Maximiliano Rosenkranz, Warner Larrondo, Juan Castellaro, Gonzalo Diaz and Felipe Cichero.
Introduction:Peripheral neuropathy that compromises the brachial plexus have multiple causes. The prone position used in the management of patients with acute distress respiratory syndrome secondary to COVID-19 infection could cause injury to the brachial plexus. Case Report:We report the case of a 62 year-old man who presented severe shoulder dysfunction after been managed for 7 days in prone position while receiving invasive mechanical ventilation in an intensive care unit. The patient was managed with neurorehabilitation, oral vitamin B complex and pregabalin with progressive but slow progress. Discussion: The SARS-CoV-2 infection physiopathology on the peripheral nerve system is still not fully understood. Patients in the intensive care unit are susceptible to develop injuries to the brachial plexus mostly caused by the position of upper extremities. Prolonged use of prone position in patients with acute distress respiratory syndrome managed with invasive mechanical ventilation could cause injury to the brachial plexus. We stress the importance of actively looking for these injuries and take all the measures to prevent them.
69 Profunda Femoris Artery Avulsion Injury After A Primary Hip Arthroplasty. A Rare Complication and Literature Review. , Kastanis G, Magarakis G, Kapsetakis P, Christoforidis C, Chaniotakis K and Pantouvaki A.
Total Hip Replacement (THR) is one of the most successful medical procedures used, due to the increasing need for orthopaedic reconstructive surgery of an aging population. Iatrogenic arterial complication during total hip replacement is extremely rare but when appeared, leads to a serious cause of morbidity and mortality. We present a case of 83 year-old female patient who was selected for a primary total hip arthroplasty and on the second postoperative day the hemoglobin level started to decrease without evidence of obvious bleeding, pulsatile mass or lower limb ischemia. The CT/Angiography revealed an injury of Profunda Femoris artery and the hemorrhage stopped after arterial embolization. This case displays the necessity of suspicion and prompt diagnosis of vascular complication after a THR which is a limb threatening injury and leads to ischemia with all that entails.
70 Simultaneous Bilateral Femoral Neck and Proximal Humeral Fractures - Floating Members: A Case Report. , Anderson Freitas, Maxwell Oliveira, Silvio L Macedo Neto, Helio I Costa, Diogo R Souto, Laís Maria Pinto Almeida, Fabrício Reichert Barin and Vincenzo Giordano.
The first reports of simultaneous bilateral fractures of the femoral neck (BSFNF) and bilateral fractures and dislocations of the proximal humerus (BSPHFD), occurred in descriptions of complications in the treatment of psychiatric patients undergoing electro-convulsive therapy or by the use of drugs that induced seizures, since these caused strong muscle contractions, triggering, in some situations, simultaneous fractures. These injuries are also seen in patients with osteometabolic diseases and in cases of accidents with electrocution. In the literature, few cases of BSFNF or BSPH were observed and their association was not found The authors will report the case of a 66-year-old man weighing 154 Pounds (70 kg) with four simultaneous injuries, BSFNF and BSFNF after an episode of seizure, describing what could be the first case of non-traumatic dissociation of all four members, so that we could call floating members. The description of this case may guide future discussions about the need to perform diagnostic imaging of several joints in pa-tients that are brought to the hospital after an episode of seizure, so that we can track more effectively the possibility of multiple fractures, as happened with the patient reported here.
71 Comparison Between Capsular and Transossous Suture Techniques for Treatment of Triangular Fibrous Cartilage Complex Injuries with Distal Radio-Ulnar Joint Instability. , Ryosuke Kakinoki, Ryosuke Ikeguchi, Souichi Ohta, Haruhiko Nishichi, Hiroki Tanaka, Kazuhiro Ohtani and Masao Akagi.
We use the capsular suture (CS) and trans-osseous suture (OS) techniques to treat patients with triangular fibrous cartilage com-plex (TFCC) injury associated with distal radio-ulnar joint (DRUJ) instability. The purpose of this study was to compare the outcomes between the two techniques with a minimum of 2 years of follow-up and to identify whether any pre-operative assessment factors correlated with post-operative Disability of the Arm, Shoulder and Hand (DASH) scores. This study included 46 patients with TFCC injury with manually reducible DRUJ instability. Arthroscopic CS (n = 26) or OS (n = 20) was performed. Arcs of the wrist extension-flexion and radio-ulnar deviation, forearm supination-pronation, grip strength, DRUJ instability, and DASH and visual analogue scale scores for wrist pain were assessed pre-operatively and at the final follow-up. Spear-man’s correlation coefficients were calculated between the pre-operative assessments and the DASH scores at the final follow-up. The CS and OS techniques provided good stability of the DRUJ, increase in grip strength, and decrease in wrist pain and DASH scores. The results did not differ significantly between the CS and OS groups. Only the pre-operative DASH score correlated with the DASH score at the final follow-up. The results did not differ significantly between the CS and OS techniques performed on manually reducible TFCC injuries. Patients with a higher pre-operative DASH score were more likely to have a higher DASH score at the final follow-up.
72 BOAST 4 Guidelines - Literature Review and Recommendations. , Athanasios Serlis, Panagiotis Poulios, Grigoris Bolgouras, Panagiotis Konstantinou and Georgios Konstantopoulos.
Open fractures constitute serious injuries which range from small puncture wounds trauma to high energy traumatic injuries. The British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons have established evidence-based instructions for the assessment and management of open fractures in the pre-hospital and hospital setting. BOAST 4 (British Orthopaedic Association Standards for Trauma 4) guidelines have introduced nineteen instructions which are aiming to address the problems that arise in the management of open fractures. Additionally, these guidelines provide detailed guidance to the clinicians regarding the decision-making process and raise awareness for the most common complications in order to enhance patients’ care and safety. This article aims to review the evidence of BOAST 4 guidelines and suggest modifications based on the current literature.
73 Brachial Plexus Continuous Block in Management of Stiff Post Arthroscopy Shoulders. , Munawar Shah, Danial Shah, Kishen Parekh, Muhammad Sufyan and Tadas Kananavichius.
Introduction:After shoulder subacromial decompression (SAD) and Acromioclavicular joint (ACJ) excision when the patient for whatever reason does not mobilize shoulder according to a postoperative protocol becomes stiff and as the pain increases the stiff-ness worsens and end up in a vicious cycle.We are presenting our use of continuous brachial plexus block in stiff shoulders following surgery with an acceptable outcome. Method: A retrospective study was conducted in Walsall Manor Hospital of the patient undergoing Continuous Brachial plexus Block from January 2014 to December 2018 in patients with secondary frozen shoulder following simple post-arthroscopy Sub-acromial decompression (SAD) +/- acromioclavicular joint (ACJ) excision. Patients underwent Physiotherapy and were then followed up in the clinic at 8 weeks. About 90% were discharged at this stage. However, about 6 weeks further physiotherapy was offered to the strugglers. The Resistant cases were included after being filtered out for disc disease and Local anesthetic complications. All people fulfilling the criteria were listed for continuous brachial plexus block with a catheter for 48 hours along with physiotherapy. Patients followed and reviewed at 6/52 6/12 and 1 year. Constant score (1) was calculated at admission and 1 year follow up. Data analyzed using SPSS 20.0. Results: 401 shoulder arthroscopy for subacromial decompression and acromioclavicular joint decompression were carried out in a period of 5 years. At 14 weeks follow up post-surgery 28 patients were still struggling with pain and stiffness. Cervical disc disease of C5/C6 has been diagnosed in 5 patients and excluded from the study. Of the 23 patients ended up with being listed for Continu-ous Brachial plexus block. At 1-year post-block facilitated aggressive physiotherapy (for initial 48 hours) patients had remarkably improved clinical and functional outcomes. Conclusion: We report that in resistant cases after simple arthroscopy posterior capsule tightness is a cause and a continuous bra-chial plexus block is an ideal treatment with satisfactory results.
74 Management of Acute Native Joint Bacterial Arthritis in Adults in 2020 - A Short Narrative, Practical State-of-the-Art Review. , Alexandre Ansorge, Farah Selman and Ilker Uçkay.
Native joint bacterial arthritis is a common infection among adults and children. A solely conservative management, without any articular drainage/lavage, increases the risk of recurrence. In contrast, the type of initial lavage/drainage can be surgical (arthrotomy or arthroscopy) or non-surgical (iterative arthrocenteses). Up to date, no superiority has been shown for any of these approaches in relation to recurrence risk and postinfectious mechanical damage. Furthermore, an initial synovectomy, or the number of iterative drainages does not influence outcome in most cases. Nowadays, an antibiotic regimen of three to four weeks, with early oral therapy, is standard in most settings of the world. In arthritis cases involving the hand and wrist, a shorter systemic antibiotic treatment such as two weeks is sufficient. The outcome of infection is impacted by of mechanical sequelae in up to 40% of cases. These sequels are predominantly joint stiffness and/or osteoarthritis, which are difficult to treat.
75 Alveolar Ridge Preservation in Mandibular Molars Using Mixture of Autogenous Bone and Anorganic Bovine Bone (ABB) Versus Anorganic Bovine Bone Alone Versus Absorbent Gelatin Sponge (Randomized Clinical Trial). , Dina Mohammed Alesawy, Nevien Abd El-Latif Askar, Mohamed Atef Abdel-Rasoul and Hatem Abdel-Fattah Amer.
Purpose: Radiographic and Histomorphometric assessment of Autogenous and Anorganic bovine bone graft mixture (Auto/ABB) vs Anorganic Bovine Bone (ABB) vs Absorbable gelatin sponge in alveolar socket preservation. Materials and Methods: 30 patients, 1/group required extraction of mandibular molar tooth. Immediate and 6 months post grafting CBCT radiographs. Crestal flaps, followed by core biopsy. Histomorphometric analysis of mean bone/area and residual percent and radiographical evaluation of bone loss. Results: Auto/ABB loss buccally 2.64 ± 1.48 mm, lingually 1.59 ± 0.86 mm, width 1.63 ± 0.97mm. Mean bone area percent 42.34% residual material percent 32.19%. The ABB loss buccally 1.62mm, lingually 0.48mm and width 1.55mm. Bone area percent was 48.42% and residual percent of 20.87%. The AGS recorded a buccal loss of 1.29mm, lingual 1.44mm and horizontal 0.89mm. The Bone area percent 58.88% and a residual of 20.36%. Conclusion: The Auto/ABB loss was highest in all the radiographical dimensions with the least bone area percent and the highest residual material present giving rise to questioning its effectiveness in socket preservation. ABB had the significant least amount of lingual loss of bone. The AGS showed promising results with the bone area percent recorded the most and the least residual material percent.
76 Total Hip Arthroplasty Challenge in Abnormal Spinopelvic Motion , Mohamed Solyman Kabil
Total hip arthroplasty (THA) late dislocation is a main challenge. It is still an area of a research gap. Defining the late dislocation period is also a point of controversy, Charnely., et al. define the period as more than five years, other authors define it as 1 to 2 years after primary THA. A dynamic coordinated continuous motion of the spine, pelvis, and hip creates the spinopelvic balance; during standing, the pelvis is tilted anteriorly, lumbar spine is lordotic, and hip is in extension, sagittal balance is reached by locating the trunk on the pelvis and the acetabulum over the femoral head. Changing to sitting, the hip joint does not flex to 90 obut the following spinoplevic motions occur to accommodate and provides the biologic acetabular opening ; The pelvis is tilted posteriorely by 20 o, lumbar spine loses some lordosis, and the acetaulum tilted posteriorely. Aging and spine diseases alter this normal spinopelvic balance. Different classifications are described for the abnormal spinopelvic motion.
77 Surface Marking a Helpful Technique in the Approach of Acromioclavicular Joint During Shoulder Arthroscopy , Munawar Shah, Usama Bin Saeed, Mohammed Sufyan, Danial Shah and Kishen Parekh.
Background: The aim of study is to evaluate the effectiveness of surface marking in determining working portal for acromioclavicu-lar joint pathology during shoulder arthroscopy. Method: This prospective study was conducted in Walsall Manor Hospital from January 2015 to December 2017 during which 47 patient of shoulder arthroscopy was admitted with diagnosis of acromioclavicular joint pathology. Surface marking of acromiocla-vicular joint was done in every patient with the technique described below before starting shoulder arthroscopy, which later used for making ACJ portal. Result: Out of 47 patient we were able to reach acromioclavicular joint in 45 patients with help of surface marking before shoulder arthroscopy which results in decrease in intraoperative time and complications in shoulder arthroscopy. Conclusion: Surface marking of acromioclavicular joint by described technique is helpful in making acromioclavicular joint decom-pression portal during shoulder arthroscopy.
78 Atraumatic Rupture of the Distal Median Nerve , Liam Bibo, Alex O’Beirne and Matthew Lawson-Smith.
Carpal tunnel syndrome (CTS) is the most common compressive neuropathy affecting the upper extremity. We present a rare case of atraumatic rupture of the median nerve in a patient with electrophysiology proven severe left distal median nerve neuropathy secondary to CTS.
79 Outcomes and Complications After Elbow Hemiarthroplasty for Complex Distal Humerus Fractures and Post Traumatic Arthritis. Review of the Literature , Georgios Konstantopoulos, Athanasios Serlis, Panagiotis Poulios and Konstantinos Perpirakis.
Distal humerus fractures remain a challenge for the orthopaedic surgeon. In most of the cases the choice of treatment is surgi-cal, and depending on the patient characteristics this would include ORIF, Total elbow replacement and elbow hemiarthroplasty. Although EHA is commonly used to deal with elbow fractures, to our knowledge there is one study that elbow hemiarthroplasty was used in young patients with post traumatic arthritis. The aim of this article is to review the functional outcomes and the complications after elbow hemiarthroplasty for acute distal humerus fractures and treatment of post traumatic arthritis.
80 Social Media as an Alternative to Peer Reviewed Journal Publications , L Prakash.
Medical professionals are under great pressure to write academic articles and get them published in reputed journals. As publi-cations contribute significantly to the career prospects, promotions, and academic growth, a paradoxical situation exists in medical publishing, where instead of the author being paid for his articles he is expected to pay the publisher to get published. Social media has these days emerged as a reasonably attractive alternative to peer reviewed journals, and many medical profes-sionals have taken to sharing their ideas across these platforms as an alternative to peer reviewed academic publications. The pres-ent article discusses the changing trend and the pros and cons of this approach.
81 Alveolar Ridge Preservation in Mandibular Molars Using Mixture of Anorganic Bovine Bone (ABB) and Autogenous Particulate Vs Mixture of Injectable Platelets Rich Fibrin, ABB and Autogenous Particulates (Sticky Bone) (A Randomized Clinical Trial) , Mohamed Darwish Elsayed Darwish, Nevien Abd El-Latif Askar, Mohamed Atef Abdel-Rasoul and Hatem Abdel-Fattah Amer.
The aim of the study was a Radiographic and Histological assessment using a Mixture of Anorganic Bovine Bone (ABB) And Au-togenous Particulate bone vs a Mixture of Injectable Platelets Rich Fibers, ABB and Autogenous Particulates bone (sticky bone) In socket preservation. The study question was "does socket preservation of the Alveolar Ridge in the lower posterior regions yield better quality and quantity of bone using a Mixture of Anorganic Bovine Bone(ABB) And Autogenous Particulate bone or a Mixture of Injectable Platelets Rich Fibrin, ABB And Autogenous Particulates bones (sticky bone)?". Methodology:Radiologic assessment using CBCT after extraction and socket preservation and CBCT before dental implants as well as histologic assessment of core biopsy sample. Result: Sticky bone showed a statistically significant higher mean value of bone area percent compared to a mixture of ABB and Autogenous bone. Sticky bone is better than the mixture of ABB and Autogenous particulate bone in regards to the amount of bone formation. Conclusion: The results are increased predictability in preserving the socket from collapse which in turn will result in a more suc-cessful prosthetically driven dental implant placement surgery.
82 How COVID-19 Pandemic Influenced Non-formal Education Digital Transformation – SLAOTI Experience , Pia Stefano, Juan Carlos Ocampo, Ricardo Mosquera, Ricardo Trevisan, Alfonso Meza and Jamil Soni.
Background: Recent COVID-19 pandemic has generated exceptional changes in medical education. Processes carried out by differ-ent educational entities are important to be reported since they allow to improve teaching methods and thus professional quality. The main objective of this article was to report the experience and relevant data in our adaptation of non-formal education through digital transformation in pediatric orthopaedic field. Methods: Webinars were broadcasted and uploaded to SLAOTI official website and its YouTube channel. Through YouTube Analytics tool, metrics were extracted regarding: webinars length, views, electronic display device and spread of access link; channel subscrib-ers; digital and geographical visit origin and viewers age and gender since the channel creation on April 15th to July 29th 2020. Results: We evaluated 34 webinars. Average webinars length was 29 min with a Q&A section of 29 min. Mobile phone was the most used display device and WhatsApp was the main social network used for access link spread. The channel had 13404 views and 884 subscribers. From total viewers almost 80% were less than 44 years and 82,1% were male. Geographical visit origin showed that Mexico, Argentina and Venezuela were the countries with more visits and that an external link were the most used digital origin to access webinars. Conclusions: Collaborative streaming platforms and social networks are useful in keeping non-formal educational exchange and in maintaining community communication and collaboration in pandemic times. In addition, some of them provides data that allows for continuously improving educational processes.
83 Perspective of Making Self-training Habit from Psychological Consideration and Practice , Makoto Takasugi, Akito Moriyasu, Hiroshi Bando, Hiroya Hanabusa and Mitsuru Murakami.
Authors and collaborators have continued clinical practice and research on rehabilitation and self-training, in which various prob-lems were found. Protocol: The author himself tried home self-training exercise of push-up for 2 months, which was successfully achieved. Results: Positive changes were 94 to 96.5cm in chest circumference, and 45 to 100 times in continuous push-up, respectively. Discussion: From the viewpoint of sport psychology, close relationship among motivation, self-efficacy and performance has been observed. Self-efficacy can influence one’s beliefs concerning accomplishing and continuing the task, activities and effort. This report will hopefully become the reference for future practice and research development.
84 Movement Restricting Heterotopic Ossification After Free Functioning Gracilis Muscle Transfer to the Elbow: A Case Report , Sanjog Sharma, Vybhav Deraje and Rajendra S Gujjalanavar.
We report a case of development of a movement restricting heterotopic ossification after a free functioning gracilis muscle trans-fer performed for elbow flexion in a patient with pan brachial plexus palsy. We also present the management of the case including the repair of the brachial artery which was thinned out by the lesion. To the best of our knowledge, this is the first case in literature which reports heterotopic ossification after a free functioning muscle transfer.
85 Patellar Pseudoarthrosis With Intact Knee Function - A Case Report , Sameer Panchal, Sangeet Gawhale, Nadir Z Shah3 and Sujith BS.
Case Report: 65 year old male, tailor by occupation sustained transverse fracture of patella following trauma due to fall and was referred to our centre. Open reduction and internal fixation were performed and patient was mobilized post operatively as per the routine protocol. Patient regained full movements in two months and was back to his normal job in three months. However, Implant removal was done two years later after the index surgery in view of discharging sinus. His patellar fracture has not healed with obvi-ous fracture gap but he is able carry activities of daily living, climbing stairs with weights and has some knee pain. Conclusion: Despite of patellar non-union of four years, patient has full active knee range of motion and no extensor lag and is able to do all heavy activities. Managing non-union of patella is an orthopedic challenge but the real question arises does all the patients with non-union patella requires some form of intervention.
86 Systematic Review of Post Covid Myalgia Literature , Manjiri Ranade, Prakash Deshmukh, Sweety Purushottham and Prasad Kasliwal.
Since the end of 2019, the whole world has been suffering through the pandemic of the new Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2). Pain is a most common symptom during Novel Coronavirus Disease 2019 (COVID-19). According to the World Health Organization, patients suffering from COVID-19 show symptoms of muscle pain (myalgia) and/or joint pain (arthral-gia), sore throat and headache. We present a narrative review of musculoskeletal manifestation and available treatment options. Our aim is to update the pain physicians and physicians working with COVID-19 Patients about possible pathogenesis of myalgia and best proposed treatment available. Research data for this article is based on literature search which has been referenced in the text. There was no preliminary data. A search of PubMed and Google Scholar was done. We found 15 scientific papers on the related topics. Based on the review we infer that in addition to the cytokine storm experienced by many COVID-19 patients, certain additional factors such as severity of COVID-19 infection contributes to post covid myalgia and fatigue.
87 Covid 19 and Orthopedic Manifestations - A Quick Primer , Ashish Anand, Raviraj A and Bianca E Bullie-Thompson.
Coronavirus -2019-Covid 19 pandemic as declared by the world health organization in April 2020 and has caused widespread dam-age across nations which is reminiscent of the Spanish flu. United States leads the tally with more than 8 million patients affected by the disease and closely followed by India which is touching at about 5 million cases.
88 Nonunion of Spinous Process Fracture Revealed by Interscapular Crepitus: A Case Report , W Bouaicha, M Jlidi, S Daas, M Kharrat, MA Sbai and A Khorbi.
Fractures of the spinous process are relatively common injuries especially in the cervical spine. Those involving the thoracic and lumbar spine are rarely reported in literature due to very little clinical relevance and cases re-quiring surgical treatment are even rarer. In this article we report the case of a symptomatic non union of a fractured spinous process of T3 treated with surgical excision of the non united fragment with good clinical results.
89 Traumatic Posterior Sternoclavicular Joint Dislocation in a 20 Year Old Male: A Case Report , Leanne McKeown PA-C and Mitesh K Patel MD.
Sternoclavicular posterior joint dislocations are rare and typically occur from a high-energy injury. The author reports the case of a 20-year-old male who sustained a left sternoclavicular posterior dislocation after wrestling with his brother. He presented with persistent left shoulder pain and swelling at an Orthopaedic Specialty Urgent care after discharge from an emergency room with a sling and soft collar. Standard chest radiographs were normal. Chest CT scan demonstrated posterior dislocation of the occipital head with sharp posterior edge impinging on the proximal aortic arch's anterior wall. The patient underwent a sternoclavicular joint ORIF with suture anchor repair. After four months, the patient reports a resolution of pain and mobility. The patient's injury was initially undiagnosed, emphasizing the importance of recognizing this rare event and obtaining a CT scan for early diagnosis.
90 Epidural and Psoas Abscess, as a Rare Complication of Fournier ́s Gangrene , Mónica Belén Martínez-Mardones, Dan Hartmann Schatloff, Scar-leth Jara Carrasco, Valentina Garlaschi and Anamaría Pacheco Frez.
Introduction: Due to the low incidence and variable presentation of both, Psoas abscess and epidural abscess, there are often delays in the diagnosis and treatment of this condition. Fournier's gangrene has a low incidence (0.02%) and even less as an etiology of these complications, presenting a not insignificant mortality (7 - 10%). Clinical Case: A 56-year-old male, obese and chronic alcoholic. At admission, in Glasgow 11, with diagnosis of diabetic ketoacidosis and an increase volume in perianal zone. The CT scan shows a collection 13 x 5 cm, with no other findings. Enter intensive care and need for vasoactive drugs. Being in the 5th surgery, he presents fever, and during the epidural puncture evidence of purulent liquid appears. Cytochemical analysis does not correspond to cephalo-rachis fluid and CT scan shows multiple collections in spine muscula-ture (larger diameter at L3-L4 level 8.4 x 5.3 cm). Magnetic resonance imaging is required, showing an extensive epidural phlegmon from T8 to S2 and both psoas, without neurological deficit. It is performed ATB management of vertebral abscesses, continue peri-neal surgical management, until complete perianal closure and resolution of abscess. Discussion: Epidural and psoas abscesses are uncommon, difficult to suspect and even less diagnosed pathologies, associated with Fournier's gangrene. With the presentation of this clinical case, we want to show these pathologies as possible complications of a Fournier, since in the international literature they are not widely described within the complications associated with this one.
91 Acute Unstable Posterior Shoulder Dislocation Treated by Modified McLaughlin Procedure: A Case Report , W Bouaicha, M Jlidi, S Daas, K Charfi, MA Sbai and A Khorbi.
Posterior shoulder fracture-dislocation is a rare injury accounting for only 0.9% of all shoulder fracture-dislocations. The size of the associated “Reverse Hill-Sachs lesion (RHSL)” dictates the treatment options. Several surgical techniques have been described for the treatment of this condition based on the chronicity of the injury and the size of the RHSL. This article describes the use of a modified Mc Laughlin procedure in the treatment of an acute unstable posterior shoulder fracture dislocation in a 47-year old male. The surgical technique consists in transferring the subscapularis tendon after osteotomy of its lesser tubercle insertion into the anterior bony defect. This transfer is secured with screw fixation and transosseous suturing. Post operative rehabilitation included 4 weeks of immobilization followed by 6-weeks progressive physiotherapy. This technique yielded a pain-free and stable shoulder with good joint congruency.
92 The Relationship Between Previous Injuries and Acromiohumeral Distancing in Adolescent Athletes , Ahmed Abd-Elkhalek Mansour, El-Saeed Tamer Mohamed and Abdelazeim Faten Hassan.
Background: Following injury, there were strength, proprioception, and kinematics that lead to overall changes in function and mo-tor control. The researchers in this study aimed to investigate the correlation between the previous knees, back and shoulder injuries to acromio-humeral distance measurement (AHD) in adolescent athletes. Methods: Thirty-nine rowers were recruited during the national championship of indoor rowing with mean age 16.35 ± 1.39 years. AHD at 0° and 90° abduction from the scapular plane of both shoulders was measured pre-and post- rowing by ultrasound and a his-tory of previous injuries was taken. The correlation was investigated between number of previous injuries from different categories and mean difference of AHD. Results: At angle 0 abduction in either right or left shoulder, there was a weak association (Eta = 0.135) between previous injuries and AHD also the previous injuries had an effect of 1.8% on AHD but at angle 90, the effect was higher in both left and right shoulder (6.8% and 5.1% respectively). Conclusion: Even with a weak correlation founded between previous injuries and AHD, a percent of effect was founded for previous injuries which may be clinically important.
93 Tibial Insertion of Patellar Tendon: Arthroscopic Approach , Marco Martins Lages and Max Rogerio Freitas Ramos.
Osgood-Schlatter's disease is responsible for a significant portion pain in adolescent knee. Conservative treatment is successful in more than 90% of cases. In unresolved cases, surgery is recommended for tendon debridement and resection of the remaining ossicle. Arthroscopy is a valid surgical procedure in these cases.
94 Perforation of Secondary Meckel’s Diverticulum due to Abdominal Trauma by a Car Accident , Mónica Belén Martínez-Mardones, Scarleth Jara Carrasco, Dan Hartmann Schatloff, María Teresa König Jottar and Anamaria Pacheco Frez.
Introduction:Meckel's diverticulum corresponds to the most frequent congenital malformation of the digestive system. Generally, it corresponds to the accidental finding during imaging or surgical procedures. Among its complications, there are hemorrhage and perforation. The resolution is surgical and can vary between diverticulectomy versus intestinal resection. Case Reports:Hereafter, a Meckel's diverticulum perforation case is presented, associated with abdominal blunt trauma, by a car accident in a 26 year old man. Discussion: The relevance of this case is based on the infrequent presentation; and while the final conduct (surgical) does not change, it will help to keep in mind other differential diagnosis considering the described findings and the correct surgical resolution of it.
95 Comparative Study of the Results after Surgical Treatment of Transtrochanteric Hip Fractures Using a Cephalomedullary Device with and without the Use of the Orthopedic Traction Table , Edir Soccol Junior, Mauro G Rodrigues, Vinicius C Guarienti, Neri Machado Jr, Fabio A Cavali, Fernando Soccol and Vanessa Marcolina.
Objectives: to analyze the differences in the post-surgical result in the quality of fracture reduction in which the orthopedic traction table was used as a technique for intramedullary osteosynthesis. Methods: The present study consists of a comparative quantitative study using secondary data from medical records of 79 patients who suffered a transtrochanteric fracture and underwent surgical treatment with and without the use of a traction table. Measure-ment data of the tip-apex distance (TAD) was collected on the immediate postoperative radiography, presence of the cut-out, analysis of loss of reduction, evaluation of possible failure in the synthesis material and analysis of fracture consolidation, and post-surgical complications. The Mann-Whitney U test and the Fisher Exact test were used to compare the traction table's use and non-use, adopt-ing p < 0.05. Results: There was a greater proportion of women with this type of fracture (75.9%). Complications related to surgery occurred in 7.9% of cases. No significant difference was found for TAD (p = 0.39), consolidation indicators (p = 0.52) and fracture-related post-surgical complications (p = 0.05) between the use and non-use of the traction table. Conclusion: No significant difference was seen for TAD, consolidation, and the occurrence of post-surgical complications related to fracture between the use or not of a traction table to perform the surgical procedure.
96 Evaluation of Infraspinatus Tendon Delamination Using Radial-Sequence Magnetic Resonance ImagingEvaluation of Infraspinatus Tendon Delamination Using Radial-Sequence Magnetic Resonance Imaging , Hiroshi Negi, Shin Yokoya, Ryosuke Matsushita, Norimasa Matsubara, Yuji Akiyama and Nobuo Adachi.
Objective:Magnetic resonance imaging (MRI) is used to diagnose rotator cuff tears; however, it is difficult to assess the delamination of the posterosuperior part of the insertion of the infraspinatus tendon on the axial, sagittal, and coronal views of conventional MRI. Therefore, in this study, we determined the accuracy of radial-sequence MRI for diagnosing the delamination of the posterosuperior part of the infraspinatus tendon. Materials and Methods: In this retrospective study, the records of 126 rotator cuff tears in 126 patients (aged 65.5 ± 9.7 years; 79 males; 47 females) who underwent arthroscopic repair between June 2012 and March 2016 at our institution were considered. The intraoperative findings of the posterosuperior side of the infraspinatus tendon were compared with the preoperative conventional and radial-sequence MRI findings. The sensitivity and specificity of the two MRI methods were calculated, and their inter- and intrao-bserver reliability measured by independent orthopaedic surgeons were calculated using the kappa statistic (κ). Results: Intraoperatively, delamination of the infraspinatus tendon was noted in 32 shoulders. Conventional MRI had 40.1% sensitiv-ity and 78.7% specificity. Radial-sequence MRI had 75% sensitivity and 94.7% specificity. The interobserver reliability and intrao-bserver reliability for radial-sequence MRI were both κ = 0.767, corresponding to a high reproducibility, whereas for conventional MRI, these values were κ = 0.3 and 0.588, respectively, corresponding to a lower reproducibility. Conclusion: Radial-sequence MRI shows higher accuracy and reproducibility for the diagnosis of delamination of the posterosuperi-or side of the infraspinatus tendon than conventional MRI. It is a useful tool to evaluate the delamination of the infraspinatus tendon.
97 Early Outcomes with a New-generation Humeral Nail: An Institutional Experience , Jade Nicolette Chee, Bryan Dehao Wang, Andy Kuei Siong Yeo, Thomas Chung Liang Kuo and Charles Kon Kam King.
Introduction:The majority of humeral fractures are treated conservatively, while displaced and unstable fractures require surgery. We evaluated our institutional outcome of humeral nailing using a new-generation nailing system. Our surgical technique and opera-tive nuances are described.We analyzed a cohort of 14 patients with 6 months follow-ups. Radiographic classification (AO/OTA Classification) was per-formed. Clinical outcome was prospectively charted using American Shoulder and Elbow Surgeons shoulder score (ASES), Oxford and Constant scores. Our secondary outcome was the complication rate of surgery using this new-generation nailing system. Results: Over one year, 26 patients underwent surgery with complete follow-up data available in 14 patients (nine females). The mean age was 52.4 years old (range, 19-85 years). There were 36% A-type fractures, 14% B-type fractures, 21% C-type fractures, and 29% shaft fractures. The mean post-operative Constant score was 52.1 (range, 24-100, SD ± 24.4), Oxford score was 33.7 (range, 6-47, SD ± 12.7) and ASES was 66.1 (range, 11.6 to 98.0, SD ± 24.9). Radiographically, all fractures united by 3-months. The complica-tion rate was 14.3% (n = 2/14). Conclusion: Our findings show that this new method of nailing was versatile for both simple and complex fractures. In osteoporotic patients, this technique yielded good functional results with minimal complication rates.
98 Difficulties in the Management and Prognosis of Cervical Spine Trauma in a Regional Neurosurgery Unit in a Developing Country: The Example of Senegal , Faye Mohameth, Barry Louncény Fatoumata, Sy El Hadji Cheikh Ndiaye, Djasde Donald, Roger Ilunga Mulumba, Ndongo Mouhamadou Moustapha, Diop Abdoulaye, Cisse Yakhya, Mualaba Célèbre and BA Momar Code.
Introduction: Traumatic injuries of the cervical spine are frequent and are complicated in 15 to 30% of spinal cord injuries. The prognosis depends on the initial spinal cord injuries and the speed of management. We report our experience in order to evaluate our results and to reveal the difficulties of managing these injuries in our work context. Materials and methods: over a period of 5 years from January 2015 to December 2019, we retrospectively studied 107 cases of cervical spine trauma in the neurosurgery unit of the regional hospital of Thiès (Senegal). Results: The mean age was 35.7 years with a sex ratio of 12.3. The frequency was 67.7% of all vertebro-medullary traumas. The etiologies were dominated by road accidents (69.2%) with only 10.28% of medicalized transport and an average admission time of 50.28 hours. Neurological signs were present in 77 patients (71.9%) with an ASIA A score in 35.5% of cases and an ASIA B in 18.7% of cases. Dislocations were the dominant lesions (60.7%). Surgery was performed in 75 patients (70%) with complete improvement of motor deficit in 7 cases. The average delay was 34 months. Conclusion: This study shows the difficulties of management in our context of patients suffering from cervical spine trauma, due to the failure of the emergency management system and the absence of specialized rehabilitation structures for follow-up care.
99 A Prospective Study of Closed Comminuted Osteoporotic Metacarpal Shaft Fractures Treated with Locking Mini Plates in a Tertiary Care Hospital , Venkataramana Rao M, Manjunath J, Kore Aditya Basawaraj, Sachin S Nimbargi, Pavan Patil and Druva V.
Background:Fractures of hand bones are the most common fractures encountered and management of the same differs across the world. Multiple factors are responsible for the variability in management. Less expensive methods of hand fractures treatment are followed in developing countries. Fractures of the hand bones accounts between 20% -30% of all visits to the emergency room following trauma due to assault, road traffic accidents etc. Methods: A prospective study was carried out from October 2018 to October 2020 in department of orthopaedics, SS institute of medical sciences, Davangere, Karnataka, India. A total of 30 cases with metacarpal fractures were treated surgically with locking mini plate and screws and were followed up at the end of 1, 2, 4 and 6 months and evaluated with ASSH-TAF score. Results: This study compraises of 30 patients. 7 patients had multiple metacarpal fractures (23% cases). In 19 patients (63%) right hand was involved. 23 out of 30 patients were males (77%). 100% results achieved in patients who underwent open reduction and internal fixation with locking compression plate for unstable metacarpal fracture. Conclusions: Locking compression plates are a satisfactory method for treating comminuted, unstable and osteoporotic metacarpal and phalangeal fractures where alternative methods of fixation are least effective, plating provides the rigid stable fixation which sustains load without non success allowed early mobilization and gained good practical outcome in contrast to other methods.
100 Post-Covid 19 Chronic Fatigue Syndrome - A Rising Concern , Varsha Chorsiya.
The whole world was threatened with the advent of the COVID 19 infection. The persons who got infected with SARS-CoV-2 and witness sign and symptoms in long term even after recover are in-terchangeable known as “COVID long haulers,” “long COVID,” and “Post COVID Syndrome”. The COVID 19 patient presents with spec-trum of symptoms ranging from simple fever, cough, sore throat, breathlessness, anosmia, ageusia to an extent and to complex progression to pneumonia, acute respiratory distress syndrome (ARDS) and multi organ dysfunction [1]. These symptoms are tak-en into consideration of examination and are treated accordingly.
101 Are People Who Received Steroid Therapy Prone to Osteonecrosis of Femoral Head? A Systematic Review , Wing Yi Pao, Suzanne Sut Ying Chan H, Zhao Min Liu and Ying Man Law.
The aim of this systematic review is to analyze the risk of developing osteonecrosis of femoral head (ONFH) for people received steroids therapy. Steroid has been considered as a risk factor of developing ONFH. However, there is no known systematic review that specifically focus on understanding steroid usage and the risk of developing ONFH. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. Six electronic databases were searched: Cochrane, PubMed-MEDLINE, EMBASE, AMED, CINAHL and CJN. After eliminating duplicated articles and applying the inclusion criteria, five articles were selected for qualitative and the quantitative analysis: two case-control studies and three small sample cohort studies. The cohort studies indicate relative risk of the pooled data is 6.77 with 95% CI (0.39, 118.36). The case-control studies show a pooled odd ratio is 7.05 with 95% CI (2.19, 22.67). In general, findings shown to support that a higher risk of developing ONFH in people with steroid usage when compared with people without steroid usage. There are small number of related studies and their methodological quality is generally low. The risk of ONFH with steroids and the related dose-response relationship remain inconclusive from clinical studies. The unique clinical values of steroids should not be overlook due to the reference of the uncertain and unconfirmed research reports. Steroids remain its important values for certain patients; such as the infected with CO-VID-19 in the pandemic. Clinicians should administer steroids with cautions with careful assessment and monitoring to the patients. Whilst the possible risks and dose-response relationship cannot be confirmed from the related evidence, pharmological and non-pharmological adjuvant therapies should be prescribed together with steroids to minimize the potential risks of steroids therapy. Robust research is still needed to determine the suitable dosage and safe guidelines for using steroids to obtain the best therapeutic effects of it for the benefits of the patients in need.
102 Bone Disease Treatment Study, Major Pathways , Jin-Yu Che and Da-Yong Lu.
Bone disease treatment is very important worldwide. At present, drug development, surgery and instrument are major pathways for therapeutics. Until now, several pathways are widely used in the clinic. This editorial provides biomedical information and path-ways for bone disease treatments.
103 Effect of 8.4% Soda-Bicarbonate Steam Inhalation on the Course of Disease in Mild to Moderate Cases of Covid-19. , Kshitij Mody.
Background: A prospective, randomized open label parallel group trial was carried out to evaluate the effect of 8.4% soda-bicarbon-ate steam inhalation on the course of covid-19 infection in mild to moderate confirmed cases of covid-19. Methods: 30 patients were enrolled and compared with 30 patients in a control group, giving a total sample size of 60 patients. Ran-domisation was achieved by sealed envelope technique. The 30 patients in the SB group received SB inhalation in addition to all other therapeutic measures as part of covid-19 treatment protocol. The control group was treated according to same treatment protocol, but without SB inhalation therapy. Clinical symptoms and lab markers were recorded on Day 1 and Day 5 of patients’ stay at hospital. Results: Patients receiving 8.4% SB inhalation as part of their treatment showed faster improvement in symptomatology and quicker normalization of inflammatory lab markers. Conclusion: The results of this study show a highly significant improvement in the clinical picture of covid-19 affected patients treated with inhalations of steam impregnated with 8.4% sodium bicarbonate.
104 Charcot’s Arthropathy of Bilateral Hip Joints: Natural Evolution More than 30 Years after Hip Fracture , Rogelio Rey Nande and Carolina Rey Pinella.
This article describes the exceptionality of the pathology, and a case of a man with Charcot’s Arthropathy of his two hip joints, and probably his ankle, that started after hip fractures, with more than 30 years of evolution since his positive diagnoses and acceptable clinical evolution without chirurgical treatment.
105 Peripheral Blood Cytokines Levels and Post-Surgical Pain with Coated or Uncoated TKAs after 5 Years Follow-Up , Raffaele Iorio, Edoardo Viglietta, Daniele Mazza, Fabio Marzilli, Piergiorgio Drogo, Gerardo Salerno, Vincenzo Visco, Fabio Conteduca and Andrea Ferretti.
Purpose: Twenty per cent of patients are estimated to be unsatisfied after total knee arthroplasty. Existence of an immune response against the implant has been recently investigated. This study aims to assess the cytokine patterns expressed in vivo in 5 years follow-up patients comparing uncoated and coated TKAs and correlating cytokines levels with post-surgical pain and clinical satisfaction. Methods: Fifty-eight TKA patients were retrospectively evaluated at a 5 years follow-up. Patients were divided in two groups accord-ing to the type of the implant. Thirty patients received a standard uncoated TKA and 28 subjects were treated with a titanium nitride (TiN) ceramic coated TKA. In each group, 10 patients were enrolled because they complained a post-surgical pain > 3 at the Numeri-cal Rating Scale (NRS) and were thus considered clinically unsatisfied. Peripheral blood samples were obtained and levels of inflam-matory cytokines IL-4, IL-5, IL-6, Inf-γ and TNF-α were analysed with a Luminex Magpix platform. Cytokines level was expressed as median fluorescent intensity (MFI). Results: Comparison of the two groups showed significant higher TNF-α expression in the uncoated TKA group (P = 0.027). In both groups, a statistically higher IL-6 and TNF-α levels were found in patients with post-surgical pain > 3. Both for IL-6 and TNF-α, this difference was more significant in the uncoated (P = 0.0007 and P = 0.0045) than in the coated group (P = 0.044 and P = 0.049). Conclusion: It is difficult to properly demonstrate an immunological response against the implant in TKA patients. In our study, higher cytokines expression was found with standard uncoated implants and in painful-unsatisfied patients. Further evidences, are needed to establish if an immune mechanism may be responsible for cases of unexplained poor functioning TKAs.
106 Bone Disease Treatments, Importance of Technical Supports , Da-Yong Lu and Jin-Yu Che.
Bone disease is common human diseases worldwide. At present, drug and surgery development is achieved in low rates. However, technical progress for bone disease treatment grows rapidly and greatly helps other types of bone-disease treatment in the clinic. This editorial provides general information of bone disease treatment and the importance of technical developments in this areas and discipline.
107 Implications of the Sacroiliac Joint Posterior Ligaments and Cluneal Nerves in the Differential Diagnosis of Low Back and Pelvic Pain. , Sergio Marcucci.
The sacroiliac joints (SIJs) are known to be a critical cause of low back pain (LBP) and contained between two bony structures, iliac bones, the iliac, and sacral bone. The SIJ is surrounded by an extensive network of ligaments. Besides, thirty-five muscles are fixing on the SIJs, from the lower limb, pelvis, and trunk. The SIJs are involved in essential costs related to impairment for people affected by LBP and SIJs pain.
108 Septic Arthritis of the Sacroiliac Joint: Case Report and Evolution 10 Years after Treatment. , Edir Soccol Junior, Mauro Grinfelder, Caroline Rafaela Solano, Maria Eduarda Oro Dilly, Willian Gustavo Tasca, Rubia M Alves, Lilian C Meneguzzo, Neri Machado Junior, Fabio Cavali, Fernando Soccol, Haiana Cavalheiro and Ronan Bertinatto.
Introduction: Case report of septic arthritis of the left sacroiliac joint, which after a difficult diagnosis it obtained effective treatment. The report compares image exams after 10 years of follow-up. Objective: To present a case report about an 18-year-old youngster, male, with difficult diagnosis of the septic arthritis of the left sacroiliac joint condition, as well as the adopted therapy. Methodology: The information present in this paper was taken from the anamnesis and the physical exams of the patient, medi-cal and photographic records review of the diagnostic methods and the therapy adopted in the treatment; it has been performed a literature review. Conclusion: This report seeks to call the colleagues attention to a rare disease of difficult diagnosis, which needs aggressive and well directed treatment in order to avoid severe sequelae of lower members or even death.
109 Technique for Digital Block Prior to Hallux Procedures , Faith Schick, Mitesh K Patel, Homyar Karnjia, and Nicholas Taweel.
Background: Obtaining digital anesthesia is commonly performed to facilitate procedures on the hallux. Typically, when performing a blockade of the hallux a technique utilizing multiple injection points is employed. Methods: This technique report describes a simple approach to achieving anesthesia by means of a single subcutaneous injection beginning at the hallux interphalangeal joint. Anesthesia is obtained utilizing approximately 3cc lidocaine 1%. A 27-gauge needle is used for administering the injection. Conclusion: This technique offers a useful tool for physicians to perform a fast-acting injection during times when a patient is under stress or pain.
110 Novel In-Frame FLNB Deletion in Familiar Larsen Syndrome. A Case Report , Christodoulou Michael, Kontogeorgakos Vasileios, Flinger Ioannis, Kitsiou Sophia and Frysira Helen.
A case of a novel in-frame FLNB deletion in familiar Larsen syndrome of a newborn, with a clinical appearance of dislocated bi-lateral hip joints, knee joints, elbows and equinovarus foot deformities. Patient underwent both conservative treatment and surgical treatment in sequence of severity as indicated, while in parallel genetic counseling with subsequent DNA testing revealed the familiar extent of the syndrome and a novel mutation first reported today. Patient follow up is presented until adulthood giving a great insight to the impact of the treatment chosen at presentation.
111 Role of PhysioErgo Training during Work from Home , Varsha Chorsiya.
With the advent of neo normal during COVID 19 era, the work from home (WFH) has become a part of life. Many companies and institutions have adopted this model during lockdown to continue with the work and to break the chain of SARS-CoV-2 infection. Even after the lockdown is over, the companies and the institution either continuing with the work from home policy or adopted an hybrid work model where only some days employees might have to re-port the office. In Indian scenario the homes are not adapted to suit for WFH culture and missing the proper workstation setup. Moreover, it has been seen that apart from workstation issue, the time of work during WFH has increased as compared from work from office. These cumulatively is putting the stress on the human body causing musculoskeletal disorders (including pain at differ-ent regions), eye strain, indigestion etc. Even though we were ear-lier also living in the digital world, but during COVID 19 era there was a complete paradigm shift towards the digitally guided virtual world.
112 Total Hip Replacement After Childhood Osteotomy: A Cohort Study , Meilyn Muskus, Camilo Cabezas, Omar Herrera and Hugo Rodriguez.
Aim: Developmental hip dysplasia is a common disease and if not treated, it may cause secondary hip osteoarthrosis, and this may ul-timately lead to total hip replacement in adulthood. Hence, multiple childhood osteotomies have been developed over time to prevent such incidence. The purpose of this study is to determine whether an osteotomy around the hip can delay the total hip replacement surgery and as a second objective evaluate the degree of technical difficulty involved in an arthroplasty, with and without previous osteotomy, in patients with developmental hip dysplasia. Materials and Methods: This retrospective cohort study involved patients with a history of dysplasia and total hip replacement done between February 2007 and January 2017, comparing patients who underwent osteotomies around the hip (n = 54) and those who did not (n = 135). However, patients diagnosed with Crowe III/IV requiring subtrochanteric ostectomy at the time of the re-placement were excluded. The technical difficulty of the procedure was evaluated considering the surgical time and intraoperative bleeding as outcomes. Results:Overall, 189 hip arthroplasties were analyzed in 173 patients with a history of developmental hip dysplasia, of which 54 had osteotomy around the hip. The average age at which the arthroplasty was performed in patients without previous osteotomy was 55.1 years (p < 0.001) compared to patients with previous osteotomy that was 42.2 years (p < 0.001). The surgical time and intraop-erative bleeding were higher in the group of patients with previous osteotomy and it was possible to demonstrate that this medical history increased the risk of having a prolonged surgical time (5.46 times; p < 0.001) and an increased risk of higher intraoperative bleeding (6.08 times; p < 0.001). Conclusion: Patients with osteotomies around the hip required hip arthroplasty surgery earlier and having a previous osteotomy made the overall procedure longer in surgical time and increased intraoperative bleeding.
113 Percutaneous Screw Fixation of Adolescent Skier’s Thumb. A Case Report and Review of the Literature , Chatziravdeli Vasilik, Tsatlidou Maria, Vazakidis Polychronis, Abouhamdan Mahdi and Mpeletsiotis Anastasios.
Adolescent skier’s thumb is a common injury in this high activity level age group, that involves a Salter Harris (SH) III avulsion fracture with the ulnar collateral ligament (UCL) attached to it. Optimal fracture stabilisation therefore affects joint stability. Opera-tive treatment for large, displaced fragments involves open reduction with the use of Kirchner wires, screws, bone anchors or pull out sutures in order to achieve anatomic restoration of the epiphyseal fracture with respect to the physis. Our case report involves percutaneous reduction of an SH III fracture of the proximal phalanx of the thumb in an adolescent with the joystick technique and cannulated compression screw fixation without crossing the physis. This method provided stable fixation and allowed for early com-mencement of range of motion exercises and early return to previous activities. The radiographic evidence after 18 months demon-strated fracture consolidation with no malalignment and no residual thumb instability. The best treatment strategy should be based on fracture characteristics, joint stability and patient’s activity level and preferences. It is our suggestion that percutaneous screw fixation by closed means should be attempted for reducible fragments prior to open reduction techniques, to avoid disturbing local anatomy and prevent scarring.
114 Osteopetrosis: Case Report , Edir Soccol Junior, Mauro Grinfelder, Caroline Rafaela Solano, Maria Eduarda Oro Dilly, Willian Gustavo Tasca, Rubia M Alves, Lilian C Meneguzzo, Neri Machado Junior, Fabio Cavali1, Fernando Soccol, Haiana Cavalheiro and Ronan Bertinatto.
Introduction: Case report of osteopetrosis with bilateral diaphyseal femoral fracture, with therapeutic approach. Objective: To present a report about a 33-year-old youngster, carrying osteopetrosis, who was admitted in emergency service with bilateral diaphyseal femoral fracture, and the adopted therapy. Methodology: The information present in this paper was taken from the anamnesis and the physical exams of the patient, medi-cal and photographic records review of the diagnostic methods and the therapy adopted in the treatment; it has been performed a literature review. Conclusion: The report seeks to call the colleagues attention to a rare and difficult to handle disease which needs surgical treatment of high technical difficulty, whose planning must be discerning, especially in the fixing mechanism choice. Besides that, the rehabilita-tion must be gradual and circumspect, considering the high number of pseudoarthrosis cases.
115 The Extrinsic and Intrinsic Factors Predisposing to ACL Injuries in Female Athletes - Sports Medicine Implications in 2021 , Alexander Mitrichev, Rami Shenouda and Mark Daniel Wilson.
Anterior cruciate ligament (ACL) injury is one the most common knee injuries in the young and middle age population. Large numbers of studies have examined the anatomy, biomechanics, management and rehabilitation of ACL injuries in the general popu-lation and athletes. Contemporary medical technology has facilitated new treatment paradigms and lead to the exponential growth in knowledge in this fundamental area of knee surgery and sports medicine. The objective of this narrative review was to identify studies that examined certain intrinsic and extrinsic factors contributing to ACL injury risk in female athletes. Participation in sports by females is increasing globally and the burden of disease in relation to ACL injuries is expected to increase in association with these increased participation rates. There is a paucity of literature that clearly delineates the intrinsic and extrinsic risk factors for ACL injury among different popula-tions, especially higher-level female athletes. To facilitate the best possible care for knee injured patients, it is essential to understand the key factors that may underpin different injury patterns, especially in the context of dramatically increased participation in high risk sports, including Australian Rules Football, rugby union and rugby league, basketball, netball, soccer and skiing; focusing on those identifiable risk factors that have a female predilection will be the focus of this review and an attempt has been made to broadly review the most pertinent scientific literature.
116 Inertia to Integrate Orthobiologics into Orthopaedic Practise: Are We Asking the Right Question? , Madhan Jeyaraman and Sathish Muthu.
One of the most ironic realities of orthopedic regenerative medicine practice is that, before being able to consider any treatment methods involving regenerative medicine, we frequently ask for high-quality evidence [1].If we look closer, we must only consider only procedures with level 1 evidence from either randomized controlled trials (RCTs) or reviews of similar RCTs favoring their use in our orthopedic practice. However, one must realize that for a treatment method to reach such a high level of evidence, it needs to be embraced in the first hand considering the ingenuity and potential behind its usage from the preclinical and in-vitro studies backing their use. Moreover, these procedures need to travel a long way until it acquires a high-level research funding to generate sufficient high-quality evidence to grab its place in routine practice.
117 Surgical Treatment of the Consequences in the Wrist of Rheumatoid Arthritis , Maylin Naples Perez, Nelson Juan Cabrera Viltre, Mario de Jesús Bernal González, Leopoldo Alvarez Placeres and Yaima Rizo Fiallo .
Introduction: The consequences of lesions caused by Rheumatoid Arthritis on the wrist are responsible for important deformities and functional limitations, which make them taxed for surgical action, that sometimes con be complex. Objectives: The objective of this work was to evaluate the results of the different surgical techniques used in this study.Method:A prospective longitudinal intervention study was carried out. The sample was made up of 17 patients (24 wrists) with this diagnosis, attended by the Superior Member Service, External Minifibers and Microsurgery of the International Orthopaedic Scien-tific Complex “Frank País” in the period from January 2014 to March 2018. The evaluation of the results was carried out according to the Cooney Score, the Allien and Machle Score as well as the complications that presented the patients. Results: In the preoperative period the evaluation of an 83.3% of the studied patients total was Bad, 16.7% of them was Regular and none of them was Good. Six months after the postoperative period the 41,7% of the patients was evaluated as Good, the 58,3% as Regular and none as Bad. Only three patients presented complications, one of them with superficial wound sepsis and the other two cases presented paresthesia on the back of the wrist. Conclusion: The surgical techniques used in the current study as a treatment for the consequences of Rheumatoid Arthritis on the wrist showed encouraging results.
118 Timing and Outcome of Surgical Treatment in Supracondylar Humeral Fractures in Pediatric Patients, Khartoum, Sudan , Khalid Abdelsalam Mohamed Tahir, Ashraf EJ Ibrahim and Hassan Mohammed Hassan Elbahri.
Introduction:This study aims to evaluate the timing of close surgical treatment in supracondylar humeral fractures in pediatric patients and to know the radiological outcome of its management, through measuring the mean delay per hour and assessing post-surgical radiological outcome for reduction. Materials and Methods: A cross- sectional hospitals-based study carried out in Khartoum state, through randomized cluster sam-pling, both data sheets and pre/post-surgical images were filled and collected. A well-constructed criterion was developed to assess the radiological outcome. Results: With a sample size of 41cases, we found that the mean delay from trauma to surgery was 99 hours (SE, 13), equivalent to 4.13 days. The reduction outcome criterion was significant when comparing it with the surgeon level P value of 0.015, but when comparing it with the delay more than 32 hours and Gartland classification; both weren’t significant with P values of 0.383 and 0.501 respectively. Conclusion: These results are refuting the current concepts about the impossible reduction after a delay more than 32 hours and filled the current gap of knowledge about the outcome of supracondylar humeral fractures with delayed presentation.
119 The New Normal the Recovery Plan to Create Capacity , Asim Saleemi, Danial Shah, Kishen Parekh, Muhammad Umair Asim, Anthony Burgess and Munawar Shah.
Introduction:The COVID-19 pandemic has led to a cessation of non-urgent elective surgery and a reduction in trauma surgery. The disease results from inflection by a novel coronavirus first detected in China in 2019 (SARS-CoV-2). Its detection and transmission has led to an international emergency response. As part of recovery Green Areas are being developed to implicate a recovery plan affected Trauma and Orthopaedic Surgery. Methods: The NHS, along with the British Orthopaedic Association (BOA) like the rest of the world produced a BOAST guideline to help guide management of orthopaedic patients during the pandemic. Patients requiring surgery in this pandemic were sub grouped into 5 distinct categories [1]. There are plans afloat to think beyond the peak of this pandemic and divert attention to the Planned Surgery. Plans have to be put in place on the basis of COVID-19 being endemic. Until we better understand these, in order to ensure patient safety, it will be vital to establish COVID free ‘green’ pathways. These arrangements will require changes in service delivery that will extend beyond individual hospitals or Trusts. There is high-quality local data on deferred surgery and pre-existing waiting lists to enable an accurate assessment of the surgical workload by specialty. (Prioritising the forgotten few) SOP has been developed for Green zones. To create capacity all minor procedures that can be done safely under local anaesthesia or no anaesthesia were relocated to a local GP minor surgery services. Result: The planned surgery is being done in a local independent sector (Green Covid Free) as an extension of our facilities as per NHS England Guidelines. We also have relocated our local anaesthetic procedures to a GP service minor Surgery. Infrastructure for green pathways/Local anaesthesia was developed locally. SOP was formulated and questionnaire was developed.Initially all injections were transferred to this facility than carpal tunnel release were added and finally ultrasound guided injections were carried out in place of x-ray guided injections. We used PRP instead of steroid were indicated and did use some steroids in guid-ance with Protocols. We did over 300 injections as illustrated in the 2 charts below predominantly us guided shoulder injections and over 50 carpal tunnel releases to create capacity for planned surgery. Conclusion: We report that green areas created at a local GP practice with robust SOP and protocols is a viable option and possible the new normal future.
120 Outcome of Percutaneous Osseointegrated Prostheses for Patients with Transfemoral Amputation at 5-Year Follow-Up , Carlos Rojas, Jose Laso, Diego Valiente, Rodrigo Olivieri and Nicolas Gaggero.
Introduction: Patients with transfemoral amputation (TFA) often experience problems related to the use of socket-suspended pros-theses. The clinical development of osseointegrated percutaneous prostheses (OPP) for patients with a TFA started in 1990. The main objective was to compare the clinical outcomes of transfemoral amputees before and 5 years after osseointegration. We aim to find a clinical difference in favor of osseointegrated prosthesis use compared to traditional prosthesis. Methods: 21 consecutive patients with 21 TFAs who received an OPP between 2009 and 2015 and followed for at least five years were included. All the amputations were secondary to trauma. A two-stage surgical procedure was used to introduce a percutaneous implant to which an external amputation prosthesis was attached. Outcome assessment included the use of two self-report question-naires, the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA), and the Short-Form (SF)-36. Results: The cumulative survival at five years’ follow-up was 81%. Q-TFA showed improved prosthetic use, mobility, global situation, and fewer problems (p < 0.001). SF-36 ́s physical function score was also improved (p < 0.001). Superficial infection and abutment fracture were the most frequent complications. The implant was removed in four patients. Conclusion: Osseointegrated percutaneous implants constitute a novel form of treatment for patients with TFA. The high cumulative survival rate at five years combined with enhanced prosthetic use and mobility, fewer problems and improved quality of life, sup-porting using this type of prostheses.
121 Single-Stage Computer-Assisted Total Knee Arthroplasty for Arthritic Knee with Supracondylar Distal Femoral Fractures , Ashish Singh, Purushotam Kumar, Sushil Singh, Kartheek Telagareddy and RN Singh.
Total knee arthroplasty (TKA) can be an alternative to treat supracondylar distal femoral fractures in elderly patients with a pre-existing osteoarthritis. The present case series of 3 patients evaluates a single-stage treatment technique by TKA for the distal femoral fractures and arthritic knee. It was further assisted for increased accuracy by an image-free navigation system. All the three patients were treated by TKA with a less constrained approach using a Stryker Scorpio NRG cruciate-retaining total knee replace-ment prosthesis after internal fixation of the femoral fracture and guided by Orthomap precision navigation system. The 6-week and 3-month radiographic evaluation revealed proper positioning, prosthesis maintenance, lower extremity alignment and good fracture union. The clinical evaluation using the mean knee society score improved from 46.6 at six weeks to 85.3 at three months with an improved range of motion of the knee joint. A new term, “Pre-prosthetic fracture”, can be considered for such fractures around the knee occurring in combination with arthritis and suitably managed with single-stage total knee arthroplasty.
122 Delay in Joint Replacement Arthroplasty due to Covid Pandemic Leading to Increased Orthopaedic Morbidity and Poor Outcomes td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;} , Vineet Trivedi
As the global community is still reeling under the continued pressure of covid pandemic the ramifications which it lays out for the Orthopaedic patients are poorly understood and grossly un-derreported.
123 The Influence of Prone Position on Hemodynamic Function in Patients with Vertebrogenic Pathology , Lyzohub Mykola, Kotulskii Ihor, Lyzohub Kseniia, Moskalenko Nataliia and Pishchik Victoriia.
Introduction: A significant amount of surgeries, especially orthopedic, are provided in prone position. This position is accompanied by some physiologic changes, that may lead to complications during anesthesia and surgery. Postural hemodynamic reactions are well-known but their dependencies on anthropometrics are still not fully studied. Aim: To study the influence of body mass index (BMI) and age on hemodynamics of patients after turning them from supine to prone position. Materials and Methods: We examined 200 people with vertebrogenic pathology 18 - 75 yo; 118 male and 82 female. In group A there were people with BMI ≤ 25 kg/m2 and in group B - people with BMI > 25 kg/m2. Hemodynamics (blood pressure, peripheral vascular resistance, stroke volume) were examined by impedance thoracic rheography in supine position, in prone position 5 min after turning and in prone position 20 min after turning. Results: It was shown that turning of the patient into prone position leads to statistically significant hemodynamic changes (P < 0.05). Peripheral vascular resistance increased by 13,4 ± 3,4% and stroke volume index (SVI) decreased by 14.8 ± 3.5%. These changes were mostly dependent from BMI. In patients with normal BMI, SVI decreased by 11,0 ± 3,0% 5 min after turning and in 20 min it returned to normal range. In obese patients SVI decreased by 18,3 ± 3,9% after turning and it did not return to normal range in 20 min. Conclusion: Compensatory reactions of cardio-vascular system after turning to prone position depend on age and BMI. Dependence on BMI is more significant and anesthesiologist should be aware of these changes when planning anesthesia in prone position.
124 Minimally Invasive Osteosynthesis in the Treatment of Associated Pelvic Trauma , Vladimir Kusturov and Anna Kusturova.
Introduction: Associated injuries of the pelvic ring and the organs of the pelvic cavity are a complex problem in emergency surgery. The difficulties are explained by the fact that these lesions develop as a result of severe trauma, accompanied by significant injury of the organs and tissues within this area and traumatic shock development, that require the active participation of a multidisciplinary team, such as traumatologist, urologist, surgeon and anesthesiologist reanimatologist. Aim: To determine the particularities of minimally invasive external osteosynthesis in the treatment of pelvic fractures with associ-ated urinary tract injuries. Materials and Methods: Prospective study included the analysis of treatment outcomes in 59 trauma patients with fractures of the pelvic ring and urinary organs lesions. There were 55 males and 4 females, including a pregnant woman in the third trimester of pregnancy. Mean patient age was 41,34 ± 2,66 years (p < 0,05). At hospitalization, 52 patients were diagnosed with shock. 47 patients suffered traffic accident, 9 - fall from height and 3 - massive wall collapse. According to the AO/ASIF classification pelvic fractures, type A were identified in 6.77% (n = 4) cases, type B - in 31 (55.93%) patients, type C - in 22 (37.3%) patients, all of them being hemodynamic unstable. Urinary organs were damaged in all 59 cases. Urinary bladder contusion was diagnosed in 21 (35,59%) patients, bladder wall lesions - in 30.58% (n = 38), urethral ruptures - in 18.64% (n = 11), in 7 cases bladder rupture was associated with kidney injury. Long tubular bone fractures were found in 54.23% (n = 32) cases. Associated chest trauma - in 35 patients, cra-niocerebral trauma - in 27 patients, abdominal organ injuries - in 10 patients. The severity of lesions according to ISS scale ranged from 17 to 51 points (mean 35,03 ± 14,97).The initial management of the patients with pelvic fractures included antishock measures - bleeding stopping, perfusion and transfu-sion therapy, pelvic ring stabilization. Results: In this study the main tactical aspects in trauma patient care were identified, such as patient stabilization, preliminary fixa-tion of the pelvic ring with an external device, urinary bladder repair and drainage and control over pathological accumulation of urine in the pelvic cavity. Conclusion: The sequence of urgent treatment measures in trauma patients with pelvic injuries associated with urinary tract lesion was identified; in addition, the problems that require further investigations and may improve the clinical outcomes were determined. Preventive treatment outcomes in these patients indicated that adequate and early surgical correction of the pelvic ring with an ex-ternal fixation device and urinary bladder repair is possible in almost all cases. Realization of this goal requires special equipment, qualified and properly trained personnel.
125 A Rare Case of Acute Simultaneous Bilateral Quadriceps Tendon Rupture - From Diagnosis to Treatment and Review of the Literature. , João Brito Barroso, João Pedro Campos, Andreia Moreira, João Quelhas, José Machado, Pedro Santos and Nuno Camelo Barbosa.
Acute simultaneous bilateral quadriceps tendon ruptures are rare. In the majority of the cases they are related to major trauma in patients with well-estabilished predisposing factors to tendinopathy and rupture. We describe a case of bilateral quadriceps ten-don rupture sustained after minimal trauma in a patient with no history of systemic diseases. We discuss the etiology and possible risk factors of acute tendon rupture, its treatment and rehabilitation and report a literature review of bilateral quadriceps tendon ruptures.
126 Improvement of the Effectiveness of Treatment Patients with Tuberculosis Spondylitis. , GG Holka, VV Vesnin, VV Burlaka, AO Oliinyk and OG Fadieiev.
The protocols of clinical and radiological examination, analysis of treatment of 60 patients with active tuberculous spondylitis have become the clinical material of this study. The main group included patients (n = 30) with TS of the thoracic and lumbar vertebrae operated with the use of a sliding titanium cage for ventral intercostal spondylodesis. The comparison group includes patients (n = 30) using traditional approaches to the surgical treatment of the TS. The comparative study of the effectiveness of treatment of patients of the main and control group with TS showed that the use of the proposed technique in patients of the main group made it possible to significantly improve the results of treatment.Tuberculosis spondylitis (TS) in the structure of bone-joint tuberculosis in adults occupies a leading position and reaches 40 - 61.5% and it presents the great medical and social problem [2,4,8].
127 Severe Hyperuricemia, Hepatic Steatosis and Dyslipidemia in Younger Patients with Tophaceous Gout. , Zheng Wuyan, Chen Jianchun, Lv Wanping, Tan Wei and Oshmianska Nataliia.
Introduction: Despite gout being widely known as the disease of old age, recent studies showed the rising problem of hyperuricae-mia in children and young adults. Our aim was to analyze the factors influencing tophi formation in goutpatients younger than 45 years old with major functional impairment of the joint. Subjects and Methods: This study retrospectively analyzed medical records of 280 male patients between 18 and 80 years old (in-cluding 108 patients aged below 45) who were admitted in 2019-2020 with complains for major functional impairment of the joints and/or massive joint transformation and diagnosed with gout. The frequency of renal and hepatic disorders, presence of hepatic steatosis was assessed as well as lipid profile. Results: Younger patients with disabling tophaceous gout have significantly higher serum uric acid compared to those aged above 60 and higher rate of hepatic steatosis, significantly higher triglycerides (2.62 ± 2.49 mmol/L compared to 1.75 ± 1.02) and higher total cholesterol. There was a trend for lower HDL cholesterol and higher LDL cholesterol (r = 0.116 and -0.119 respectively). Fre-quency of hypertriglyceridemia in younger gout patients was 39.81%, which is significantly higher compared to patients older than 60 (17.31%). Conclusion: We found thatyoung patients with tophaceous gouthavesignificantlyhigher levels of hyperuricemia compared to patients older than 60. Rate of hepatic steatosis and dyslipidemia was also higher in younger patients, which may contribute to the development of metabolic syndrome and lead to tophi formation and major functional impairment of the joints in the very young age.
128 Plateau Tibial Fractures are Associated with High Rates of Major Ligaments Ruptures. , Manuel Mosquera, Juan Ricardo Gil, Juan Manuel Mosquera, David Portilla, Andrés Felipe Vence and Yessica Paola González F.
Summary: Tibial Plateau fractures are injuries that usually result from high energy trauma, especially those involving motorcycle accidents. The association of meniscal and ligament injuries in this type of fracture is described in the literature, especially grade IV, V and VI, according to the Schatzker classification. Purpose: To know the frequency of injuries of the major ligaments in patients with tibial plateau fracture according to the Schatzker classification and to present a sub-group of patients intervened due to anterior and/or posterior instability, describing the type of lesion, its location, the treatment used and the short-term follow-up. Materials and Methods: We reviewed the medical records of the patients who were diagnosed with tibial plateau fracture from January 2014 to January 2018, analyzing the type of fracture according to Schatzker and those who presented secondary ligament instability diagnosed after the consolidation of the fracture. Results: A total of 302 patients with tibial plateau fractures were presented, of which 63 (20.8%) had involvement of one or more of the major ligaments. The lesions occurred in all types of fracture primarily in type II, V and VI. The most frequent ligament torn was the Anterior Cruciate Ligament (ACL) in 52 patients (17.2%), with the type II fracture causing the most injury. Of the 63 patients with instability, for administrative reasons only 13 patients (20%) were operated, 11 of whom had ACL injury. 91% of the ligament injuries found at the time of surgery preserved a large part of their remnant’s fibers with elongation. Conclusion: Tibial plateau fractures have a high association of lesions in the major ligaments, presenting in this study in one per five patients.
129 Analysis of Combined Pelvic Ring and Acetabulum Fractures for their Optimal Management. , Senthil Kumar Selvarajan, Inder Gill, Nikil Shah, Vineet Trivedi, Ahmed Galhoum and Tanya Tradoff.
Background: Pelvic fractures carry a huge burden on the current health care system and it has a high morbidity and mortality. The survivors carry a huge burden of complications which can have a lifetime implication, it is therefore imperative to understand the fracture pattern and plan for appropriate care which could be a key in optimal care of these critically injured patient. The classical classification system used for these fractures need to be adapted according to the mechanism of injury and severity of trauma which should also guide in decision making process. Methods: In this retrospective study all pelvic trauma patients who attended Salford royal NHS foundation from 2015 to 2018 were retrieved then the patterns of fractures and mechanism of injury were analysed and correlated. Results: Combined pelvic ring and acetabular fractures [5] can be sub-categorised into three groups according to mechanism of injury and fracture patterns: • Type 1: Road traffic collision causes fracture involving anteroposterior compression (APC) 1, 2, 3 along with Anterior wall (AW), Anterior Column (AC), associated both columns (ABC) variety, lateral compression fractures are rare in RTC, hemody-namic stability is dependent of grade of APC than acetabular fracture pattern and treatment can vary from non-operative to complex surgeries. • Type 2: Jumpers commonly sustain lateral compression (LC) and ABC pattern and have high Injury severity score (ISS) when compared to RTC, majority of them are hemodynamically unstable and require blood products and more often end up in a broad spectrum of pelvic surgery. Mortality rate is high, and we found nearly 30% of them die within 24 hours in our study. • Type 3: Cyclers and pedestrians have an equal incidence of type 1 and type 2 fractures and rarely presents with a combina-tion of type 1 and 2. ISS, blood transfusion and mortality are like type 1 and type 2 combined fractures and treatment must be designed after a thorough understanding of fracture types. Often require complex surgery.
130 To Investigate the Extent of the Level of Physical Activity Participation and Lifestyle Choice having a Significant Influence on Body Image Perception and Awareness in University Students Aged 18 - 21. , Lewis Bridges and Dr Stephen Pack.
Introduction:Body image refers to the perception of physical appearance and the external factors which may create low body con-fidence. The aim of this study was to investigate the extent of the level of physical activity participation and lifestyle choice having an influence on body image perception and awareness in University students aged 18 - 21, which is believed to dictate one’s variation in behaviour and attitude. Methods: Forty participants were recruited through random opportunistic sampling and were placed into Competitive Active (Uni-versity team), Social Active (non-competitive), Casual Active (exercise at home/gym) and Sedentary test groups. The Body Aware-ness Questionnaire, Body Consciousness Questionnaire and Social Physique Anxiety Scale were given on one occasion as part of a descriptive cross-sectional study. Results: Trends were expected with consistent findings supporting the inclusion age, showing body image presentation can be indicative of an initial external judgement. Social and Casual groups do not have the outcome achievement goal (Competitive) but are self-motivated to better performance, or to socialise/compete with friends. There were no statistically significant differences between group means for each questionnaire (p > 0.05). Conclusion: The level of physical activity and lifestyle choice does have a moderate influence on body image perception and aware-ness, in both independent and social scenarios. Sedentary people create a negative impression of themselves over time and psycho-logically adjust to their physical appearance.
131 Delaying and Resuming Hip and Knee Arthroplasty Surgery during Covid-19 Outbreak: A Systematic Review for Solving this Challenge. , Abolfazl Bagherifard, Abolfazl Bagherifard, Mehdi Mohammadpour, Mohamadreza Heidarikhoo, Milad Bahari, Sajad Fakoor and Masoud Hasanikhah.
Purpose:Given that major orthopedic surgeries can be associated with worsening outcomes, it is not yet clear whether such surger-ies should be a priority or postponed as much as possible in Covid-19 outbreak. The present review study tries to provide a reliable and acceptable answer to this question by comprehensively evaluating the available evidence, and finally, to provide a good summary of the results of the studies with the approach to hip and knee arthroplasty surgery. Methods: Five databases including PubMed, Web of knowledge, Google scholar, EMBASE and SCOPUS were searched using the rel-evant keywords by two blinded researchers. The risk bias in eligible studies was assessed by two authors based on the nine-star Newcastle-Ottawa Scale scoring system. Results:Fourteen articles were eligible for the final analysis that published between August and October 2020. With respect to early or delayed hip and knee arthroplasty surgery, we are faced with the triangle of delaying the procedure, the early or delayed patients’ discharge after surgery and rescheduling the procedure as soon as possible that patient safety, patient prioritization, patient per-spective and financial challenges are in the center of gravity of this triangle. Conclusion: In fact, the decision to perform surgery or delay it should be made with non- individualized and multidimensional viewpoint. Level of Evidence: Level III.
132 Using Free Double Barrel Vascularized Fibular Grafting in Complex Nonunion with Extensive Bone Loss in Distal Humeral Fractures. , Saab Mufleh Al Mestirihi, Yousef Marzouq Khair, Ayman Mustafa Burghol, Sherif Mamdouh AMR, Sana’a Haddadin and Silvana De Giorgi.
Distal humeral fractures are not very common. 3% of these fractures may need further surgical management [22]. Nonunion of fractures of the distal humerus is a challenging issue for orthopedic surgeons. Management could be either by using non vascular-ized or vascularized bone grafts, or by using a double barrel vascularized graft from the fibula. In our study we used a double barrel vascularized fibular graft for treatment this kind of nonunion. We used this procedure with different ways of fixation (either using external fixation, k wires with screws, plates) in different patients. Double barrel vascularized fibular grafting is a good option for treatment of fracture nonunion with a gap of 6 cm or more. It adds stability to the medial and lateral columns and enhances bone healing at the fracture site.
133 Effect of Sublingual Piroxicam on Hypoxia in Cytokine Storm Induced Covid 19 Pneumonia - Descriptive Study of Clinicians’ Experiences in 2003 Consecutive Cases. , L Prakash, Arvind Diwaker Jain, Shabir Dhar and Sajid Jamal.
Pulmonary compromise and rapidly diminishing serum oxygen levels (SpO2), affects a significant number of patients suffering from Covid 19, and often necessities hospitalisation and administration of oxygen! Cytokine storm has been identified as one of the principal causes of this diminution of oxygen concentrations. Anti-inflammatory agents are known to assist in control of cytokine storms, and the current study is an observation of 2003 Covid 19 patients, who were administered 20 mg sublingual cuboidal crystals of Piroxicam daily for five days. 134 participating clinicians shared their experience with the molecule. It was observed that Piroxi-cam was capable of controlling cytokine storm, and rapidly improving oxygen saturation in over 90% of patients and the effect of a single tablet was sustained for over 24 hours.
134 Blood Flow Restriction Effects on Amateur Soccer Player: More than Just Strength and Mass Gains? , Besozzi Lorenzo.
Objective: To investigate effects of blood flow restriction (BFR) in pain modulation beyond other well-established effects on muscle gains after anterior cruciate ligament (ACL) surgery in a soccer player. Design: Case study examining BFR training in a clinical rehabilitation setting. Methods: BFR was utilized in a strength training protocol of the lower limbs after ACL surgery. Pain values on a visual analogue scale (VAS) were collected before and after the strength protocol's execution. The cross-sectional area of the thigh and isometric mean and peak force output during a squat were measured before the protocol execution. Results: Minimal clinical important difference (MCID) of 20 mm on a 1 - 100 mm VAS was reported in both pre- and post-training values between the first data collection (T0) and the last one (T3). No improvements were reported in CSA values on the injured limb between T0-T3. Inconsistent values were reported in the isometric squat test: an increase of both mean and peak from T0 were reported in T1 and T2. Both values then decreased again in T3, below T0 values. Conclusion: BFR may play an essential role in pain modulation after ACL surgery.
135 Thumb Opposition Strength in Healthy Adults- A Baseline Study. , Charles Andrew R Chu-Santos and Precious Grace B Handog.
Background:The thumb is considered the central component of hand function and involves for 40% to 50% of the hand’s useful-ness. Thumb opposition is the hallmark of human hand functionand is the most important motion of the hand. Currently there is no quantitative baseline data for thumb opposition strength using a standardized measure and tool. Thus, this study aims to provide the baseline reference using the Jamar B & L Pinch Gauge Dynamometer. Methods: Purposive sampling was done for recruitment. The maximal strength among three trials for each stage of Kapandji that was designated (Stage 5, 6, 9) was recorded and used in the data. Results: With 388 individuals included in the study, it was noted that the mean thumb opposition strength in stage 5 right is 4.14 to 4.42 kg, Left 3.79 to 4.04 kg. Stage 6 right 2.80 to 3.02 kg, Left 2.48 to 2.67kg. Stage 9 right 3.23 to 3.40kg, left 3.17 to 3.34 kg. There was significant difference between the 3 designated stages of Kapandji (Stage 5, 6, 9). Generally, males have higher strength than females and that hand dominance has no significant correlation. Age has a positive correlation with thumb opposition strength. BMI and Dash score showed no significant correlation except on Stage 5 left and Stage 6 right. Conclusion: Baseline reference for thumb opposition strength in the local setting in the Philippines is of significance considering that this function of the thumb is vital and it is involved in several conditions. This data will be of great importance as a quantitative measure for therapeutic assessment and that it can be used as a screening measure for susceptible individuals.
136 Cyclic 1 Minute Versus 20 Minutes Hamstrings Stretch for Spastic Cerebral Palsy. , Ahmed F Attia, Hala R Elhabashy2 and Faten H Abdelaziem.
Background: Children with cerebral palsy suffer from a wide range of complications which may be neurological, muscular or skel-etal. Muscle tightness is a common musculoskeletal complication in cerebral palsy. Stretching exercises are one of the used methods to decrease muscle tightness but there is a lack of agreement on the effective time of single stretching session. Objectives: To compare between 1-minute and 20-minutes stretching of hamstring. Patients and Methods: This study was conducted on 20 children with diplegic cerebral palsy classified into 2 equal groups (group A and B). The cyclic 1-minute stretch was applied for group A and 20-minutes positional stretch was applied for group B. Their age ranged from 7 to 10 years, their degree of spasticity ranged from 1 to 2 according to modified Ashworth scale with degree of popliteal angle ranged from 30 to 45 degrees and level II or III according to gross motor function classification system. Nexus 10 by (Mind Media) was used as Surface electromyography device to monitor hamstring activity. Popliteal angle was measured by Digital inclinometer. Result: Motor unit amplitude during stretch of group A increased significantly more than motor unit amplitude of group B (p < 0.001). No difference between motor unit amplitude of group A and motor unit amplitude of group B post stretch (p > 0.05). Conclusion: The stretching exercise for hamstrings in children with diplegia has no significant effect on decreasing motor unit am-plitude and muscle tension after one session of stretching. If we used stretching exercises on daily basis as a method of controlling hamstrings tightness, it is better to use the 20-minutes positional stretch than the cyclic 1-minute stretch.
137 Bone Metastasis Treatments, Major Therapeutic Frontiers , Da-Yong Lu and Bin Xu.
Cancer is the secondary leading disease-induced human mor-tality worldwide. 60 - 90% cancer mortality is caused by neoplasm metastasis [1-4]. Currently, anticancer drugs are the foremost therapeutic selection because a lot of diversity of tumor origins and drug responses. Several pathways can improve these thera-peutic responses and benefiting for bone metastasis treatment.
138 The Immediate Effect of Dynamic Stretching and Foam Rolling on Hamstring Flexibility and Vertical Jump in College Students , Pratibha Yogeshwar and Ishfaq Bashir Bhat.
Background: Hamstring muscle makes the posterior compartment of thigh and hamstring is the most common muscle which gets injured easily and main reason is tightness of hamstring muscles. The purpose of study was to assess the effect of foam roller and dynamic on hamstring flexibility and jump performance and to compare the effects of foam rolling and dynamic stretching on ham-string flexibility. Methods: Thirty college students were selected for the study and allocated into two groups then group A was treated with foam roll-ing and group B was asked to perform dynamic stretching and the effect measured using active knee extension test (AKE) and active straight leg raise (ASLR) and vertical jump test. Student t test (two tailed, independent) has been used to find the significance of study Parameters on continuous scale between two groups (Inter group analysis) on metric parameters. For assessing the homogeneity of variance Leven`s test was used. A t-test was used to compare the means of two groups. Results: The results showed that there was significant difference in AKE test in both groups (P ≤ 0.01) there was significant improve-ment in ASLR and vertical jump in foam rolling Group and dynamic stretching group. The results show that there was improvement in AKE, ASLR and vertical jump in both groups. Conclusion: By this study we conclude that the acute effects of dynamic stretching and foam rolling is to increases the flexibility of hamstring muscle and improvement in the vertical jump performance. But there is no significant difference when we compare the foam rolling with dynamic stretching.
139 Irreducible Radial Head in Monteggia Fracture Dislocation; Is there an Alternative to Open Reduction? , Amr A Abdelgawad, Aaron J Wey, Rami Khalifa, Saad Shoulah and Ahmed M Thabet.
Monteggia fracture dislocation include ulnar fracture and radial head dislocation. In most cases of Monteggia fracture dislocation, the radial head will reduce spontaneously with reduction of the ulnar fracture. In some cases, the radial head will not reduce with ulnar fracture reduction and these cases were classically reduced by open reduction which often resulted in elbow stiffness. We propose a new method for indirect radial head reduction by manipulation of the ulnar fracture. Two cases of irreducible radial head were successfully treated with this maneuver without the need for open reduction.
140 The Influence of Hamstring Extensibility on a Clinical Test for Lumbar Spine Mobility (Schober) , Ana Clara Castilho Meraio, Gladson Ricardo Flor Bertolini and Dérrick Patrick Artioli.
Introduction: Low back pain is usually the result of dysfunctions and/or alterations in lumbar biomechanics. It is represented as a set of painful manifestations that can affect the lumbar, lumbosacral, and/or sacroiliac region, with the quadrant of discomfort being the region from the costal margin to the inferior gluteal fold, with or without complaints for the lower limb. Objective: To determine if the hamstrings muscles can affect the interpretation of the analysis of two tests involving lumbar mobility (Schober and 3rd finger to the ground). Methodology: A pilot study was conducted with 42 volunteer students studying at the Lusíada University Center where BMI, ab-dominal circumference, 90-90º flexometer, Schober test and 3rd finger to ground test were evaluated. Results: 42 participants, when the variables were analyzed and correlated, all showed a weak inverse correlation or weak correla-tion, not being possible to confirm the proposal of the study. Conclusion: Retraction of the hamstrings probably affects lumbar mobility, but the relations found were weak to corroborate such a statement, possibly because the population studied was young and healthy.
141 Post-Exercise Hypotension - A Narrative Review , Bimal Raj, Rijo Oommen Iype, Tulasiram Bommasamudram and Shifra Fernandes.
Post-exercise hypotension (PEH) is a condition wherein there is a drop in blood pressure (BP) after a simple exercise bout. PEH could be used as an effective strategy to regulate blood pressure at rest, particularly among people with hypertension. This literature review attempts to investigate the significance of PEH induced via aerobic and resistance training in hypertensive, pre-hypertensive, and normotensive individuals. The articles chosen for this review addressed active adult and the older population who were either normotensive, pre-hypertensive, or hypertensive and engaged in aerobic exercise or resistance exercise. Since the research studies have used different prescriptions and protocols for the aerobic and resistance training, which leads to certain disagreements about the intensity and duration of the workouts to be prescribed. Aerobic training appears to encourage a greater and longer decrease in BP rates as compared to resistance training. Also, high intensity or moderate intensity training both can reduce the risk of cardio-metabolic disorder.
142 Metacarpophalangeal Arthroplasty in Rheumatoid Hand: Our Experience of the Neuflex® Prostheses. , Arnaldo Sousa, Margarida Areias, João Rosa, Marta Santos-Silva, Alexandre Pereira and César Silva.
Background: The metacarpophalangeal joint (MCP) is the most important joint for the finger function. The rheumatoid destruction of these joints causes severe deformity and functional loss.MCP arthroplasty in rheumatoid arthritis patients is aimed at restoring function, improving range of motion, decreasing pain, cor-recting deformity and improving the aesthetic appearance of the hand.Objectives: The objective of this study was to evaluate the results of NeuFlex® MCP prostheses in patients with rheumatoid hands, done in an institution over a 12 year period. Study Design and Methods: We evaluated 96 NeuFlex® MCP prostheses performed at our institution in rheumatoid arthritis pa-tients between January 2007 and December 2018 and analyzed clinical and radiological results using scales and algorithms of pain, mobility, function and satisfaction. Results: Of the 36 patients evaluated, the majority (28) were women and 14 were operated bilaterally. The average follow-up of these patients was 8.3 years. Pain was the main reason for surgery, followed by deformity and functional loss.Pain relief was observed using the visual analogue scale, averaging 5.3 points and an improvement in the range of mobility of 26º. There were 9 complications that needed revision: 6 implant dislocations and 3 fractures.Overall satisfaction was positive for all patients, with improved deformity and activities of daily and professional life. Conclusion: Neuflex® MCP arthroplasty has been shown to be an effective treatment in rheumatoid patients, with excellent results in pain relief, aesthetic and functional improvement.
143 The “EVE” Procedure - Vascularized Serratus and Rib Free Flap for First Metacarpal Reconstruction- A Case Report. Is it a Reliable Option for Metacarpal Bones Reconstruction? , Veronica Romanescu, V Bloanca and Z Crainiceanu.
A 45-year-old right hand dominant male presented to our de-partment with a circular saw trauma at his right hand, with com-plex bone and soft tissue defect of the first metacarpal ray (Fig-ure 1a-1c) following a work related accident in 2015. During the trauma, the patient hit the ground and presented also symptoms of brachial plexus closed injury treated conservatory with good re-sults. The patient was stable as his general condition was planned for the surgery of the thumb in the same night.
144 Posteromedial Dislocation of the Elbow with Lateral Condyle Fracture in a Six-Year-Old Boy. , Ahmad Khaled Almigdad, Ghandi Almanasir, Fahed Alsarhan, Mohammad Alsaideh and Khaled Bani Melhem.
Traumatic elbow dislocation is a rare injury in children and usually occurs at older ages. Elbow dislocation is classified based on the proximal radio-ulnar joint position in relation to the distal humerus. Most elbow dislocations in children are posterolateral and might be associated with medial humeral condyle fracture. Posteromedial dislocation is extremely rare. This article describes a six-year-old boy with posteromedial dislocation of the elbow associated with a displaced fracture of the lateral humeral condyle. Dislocation is closely reduced at the emergency room, and the lateral condyle fracture is subsequently fixed at the operating room by Kirschner wires through a lateral approach. A long arm cast was applied for four weeks then physiotherapy was initiated. The child was followed at 3 and 6 months to evaluate the outcome.
145 Case Report: Rare Peroneocalcaneus Internus Muscle (PCI) Etiology of Tarsal Tunnel Syndrome. , Paul E Sullivan, Michael P Bernstein, Eileen L Sullivan Pharm, Lucian M Feraru, Jonathan S Engelhardt and Mitesh K Patel.
Tarsal tunnel syndrome (TTS) can have many causes, which include direct nerve compression from cyst formation in the tarsal canal, direct trauma to the posterior tibial nerve or medial ankle impingement, fluid or tenosynovitis along the posterior tibial, flexor digitorum longus, or flexor hallucis longus tendons, varicose veins causing compression of the tibial nerve, hypertrophy of the abdu-ctor hallucis muscle belly causing compression at the level of the porta pedis, excessive pronation with arch collapse, and accessory muscles in the posterior leg. This case reports enlightens how complicated a patient presenting with heel pain can turn out to be. The article reviews tarsal tunnel syndrome and its release. It also highlights the importance of preoperative Magnetic Resonance Image (MRI) and Electromyography/Nerve Conduction Velocity (EMG/NCV) to adequately assess the cause of tarsal tunnel. The authors show the benefits of early post-op weight bearing, the ability to perform the Tarsal Tunnel Release using local anesthesia with seda-tion, using a high ankle tourniquet in higher-risk patients, release of the nerve proximally, especially when preoperative Valleix sign exists, as well as the use of Lyrica to decrease post-operative nerve pain.Finally, the authors show the best stepwise approach to attack this condition and obtain the most successful surgical treatment. Level of Evidence: Level V: Case Reports.
146 Probable Criteria of Symptomatic Pediatric Flatfoot and Findings: Case-Control Study. , Anastasiia Vladimirovna Sertakova, Musa Khamzatovich Timaev, Sergey Alekseevich Kurkin, Magomed Machrailovich Dokhov\, Sergey Anatolievich Rubashkin, Ksenia Pavlovna Zvereva, Vladimir Andreevich Gerasimov and Nina Yurievna Agafonova.
Introduction: Pediatric flatfoot (PFF) is a multifactorial group of foot diseases with varied disability in anatomy and function. Flat-foot can be flexible and rigid. We aim to select significant basic criteria for symptomatic flatfoot assessment. Patients and Methods: To analyse the PFF criteria significance, the following were selected: clinical examination indicators and functional tests; OAFQuestionnairepro for QoL; 18 paired radiological indicators for both feet and 13 biomechanical spatio-temporal parameters, centre of mass and gravity, ground-reaction forces. Investigation was performed on 228 feet in 114 patients (75 boys, 39 girls, average age: 9,5 ± 0,9 years, aged 7 - 14 years) diagnosed with symptomatic flatfoot, confirmed by statistically significant criteria of instrumental examination methods selected in our study. Results: The most significant radiological criteria in diagnosing PFF were talo-horizontal angle (Ñ€ = 0,0002), medial longitudinal arch angle (Ñ€ = 0,03) and medial longitudinal arch height (Ñ€ = 0,05). The calcaneal pitch angle is included with p = 0.67, L, mm and V, mm/sec. with about 0.29, however, in their presence the proportion of correctly predicted cases increases, which is explained by the clinical significance of these indicators and the “tuning” of the mathematical model. Valid biomechanical indicators: stance phase, swing period in gait cycle, centre of mass and gravity parameters (p < 0,05). ENMG demonstrated significant changes in M-responses and F-waves, F/M ratio from the gastrocnemius muscle, reciprocity coefficients of the gastrocnemius and tibial muscles different from that of healthy children 4 - 5 times.
147 Current Concepts in Rehabilitation of Plantar Fasciitis. , Monica Chhabra and Karan Bir Singh.
Plantar Fasciitis is the most common cause of heel pain treated mostly conservatively and physical therapy significantly contrib-utes to alleviate the symptoms using both exercise therapy and electrotherapeutic modalities. attributes to 8% of all running related sports injuries, 15% of all reported foot complaints and 7% of all the reported complaints of tenderness of heel in patients above 65 years. An understanding of the fasciitis’ pathomechanics and a comprehensive knowledge of these modalities, their mechanism of action, and the evidence of their efficacy can help in swift and accurate clinical decision making, helping the patients and the health-care system alike.
148 Surgical Management of Acute Tendinous Mallet Finger: Our Experience. , Massimo Massarella, Eleonora Piccirilli and Domenico Sergio Poggi.
Introduction: Mallet finger often occurs often a traumatic event that causes the lesion of the extensor tendon with its rupture at the base of the distal phalanx in the so called zone I. It is important to treat the lesion after the acute injury in order to avoid chronic deformities. Aim: The aim of our study was to demonstrate the effectiveness of surgical treatment in treatment of acute tendinous mallet finger.Materials and Methods: In our study, we evaluated a series of 51 patients aged 30 to 65 admitted for acute tendinous mallet finger after sport trauma or manual activities. They all underwent open surgery with an internal absorbable tendon suture and temporary DIPJ arthrodesis with Kirschner wire removed after for 6 weeks. Results:We showed excellent results for 30 patients (60%) and good results for 21 patients (40%). No pain, no recurrence of defor-mity or stiffness was detected is 84% of patients. There was an high satisfaction rate of treated patients. Conclusion: In our experience, our surgical technique for the treatment of acute tendinous mallet finger is a safe and effective meth-od that provides positive functional results with a good restoration of tendon strength with very few postoperative complications.
149 Subcutaneous Calcaneal Bursitis - A Commonly Forgotten Differential Diagnosis. , Pedro Henrique de Oliveira Alvarenga, Mayara Oliveira da Silva, Márcio Luís Duarte and Lucas Ribeiro dos Santos.
The bursa is a fluid-filled synovial bag that can be profound or on the surface and serves as a pad to diminish friction among structures like tendons, bone, or skin. The bursa positioned in the subcutaneous tissue between the bone and the skin nearby is the superficial bursa. Adventitious or non-native bursa develops secondary to chronic microtrauma and shearing forces exerted on the subcutaneous tissue.We report a 40 years-old woman who complains about pain in the posterior region of the ankle for four months. A physical examination refers to pain on palpation of the posterior region of the ankle, and with the dorsiflexion of the ankle, but without limitation of movement. It presents slight edema in the region without alteration of the skin color. At ultrasonography she presents fluid in the subcutaneous calcaneal bursa with a normal calcaneus tendon, characterizing subcutaneous calcaneal bursitis.
150 Sustainable Development of Persons with Disabilities (Divyangjan) through Clinical Health Care by Prosthetics and Orthotics Professionals. , Tapas Priyaranjan Behera and Markanda Chndra Dash.
Sustainable development is a unique concept that human so- cieties must live and progress with fulfilling their needs without compromising the ability of future generation's necessity.
151 Clinico-Radiological Outcome of Low Profile Pre-Contoured Anatomical Locking Plates Fixation in Displaced Intraarticular Calcaneum Fracture. , Neetin P Mahajan, Lalkar Laxman Gadod, Mrugank Narvekar, Ishan Gajbe, Swapnil Bhalerao and Kartik Pande.
Background: Calcaneal fractures are one of the most difficult fractures to be treated by the orthopedic surgeons. Calcaneal fractures (CFs) account for more than 60% of tarsal bone fractures and around 2% of all fractures. This can be a debilitating fracture and is most common in those who are economically active. Methods: Twenty-four patients with a history of fall from height, and having closed intra-articular joint depression type of calca-neum fractures, included in the study, after obtaining proper valid written informed consent. CT scan of the calcaneum was also done in all patients to further delineate the type and pattern of fractures, and fracture was classified by the Sanders classification system. Functional outcome was measured with the American Orthopaedic Foot and Ankle Society (AOFAS) score 10 and the Maryland Foot Score which includes pain, function and alignment. Radiological outcome was assessed by the angle of Bohler and assessing union of fracture. Results: The mean AOFAS score at 9 months was 78.87 ± 9.86. According to the AOFAS score, at 9 months, 16 (66.67%) patients had good outcome, 5 (20.83%) patients had fair outcome and 3 (12.5%) patients had poor outcome. Conclusion: ORIF of closed type II, III and IV sanders calcaneal fractures have superior radiographic and functional outcomes ORIF has to be undertaken only when swelling and fracture blisters are completely resolved. ORIF with bone graft insertion of displaced intra-articular calcaneum fractures is an effective method for treatment as it enables anatomical reduction of fracture and articular surface, restoration of Bohler’s angle, and early union by the bone graft.
152 Comparative Study of Active Release Technique and Myofascial Release Technique in Treatment of Patients with Non-Specific Low Back Pain. , Hamza M Shaheen, Karim Ghuiba, Alaa Abu Sakour, Ameer Tayseer and Sayel Abu Daowd.
Aim: To compare between the efficacy of Active release technique and Myofascial Release Technique on pain and range of motion in patients with non-specific low back pain. Subjects and Methods: 20 patients with low back pain who were randomly assigned to one of two groups that received Active release technique (n = 10; mean age, 33.3 years) or Myofascial Release Technique (n = 10; mean age, 28.4 years). Both groups were received their programs for one week; 7 sessions per week. Main Measures: VAS, ROM, and functional disability. An assessment was made for each group at the initial visit (before initiation of treatment) and at end of the program. Results: There was a significant difference between group (A) and (B) in pain level where P-value was (< 0.005), and there was a sig-nificant difference between group (A) and (B) in ROM where the P-value was (< 0.005) and there was a significant difference between group (A) and (B) in LBDI where the P-value was (< 0.005). Conclusion: There was a significant difference between active release technique and myofascial release technique as regard to pain reduction, improvement ROM and functional disability. Which active release technique allows a greater degree of pain relief and al-lows a greater improvement in ROM and function disability than the myofascial release technique for patients with low back pain.
153 Pincer Grasp Pain- A New Sign in CRPS-1: A Case Series. , Prakash Deshmukh, Helee Khetan, Manjiri Ranade and Kailash Kothari.
Background and Aims: Chronic regional pain syndrome (CRPS) has always been a diagnosis of exclusion. As there are no specific tests to confirm the diagnosis of CRPS, other causes of chronic pain such as nerve root compression, discopathy, muscular causes have to be definitively ruled out. This can cause a significant delay in the treatment of such patients who then have to suffer through the pain for a longer duration of time. During our practice, we have encountered several patients with confirmed CRPS of the upper limb who have all shown a common ‘sign’ which resolves upon treating the CRPS. This case series aims to describe the findings of these patients and also to provide a hypothesis for the mechanism behind the sign. Methods: 4 patients who were diagnosed with CRPS of the upper limb were asked to perform the clinical test. The test involved pinching a piece of paper between their forefinger and thumb (pincer grasp, or OK sign) of the affected limb, and the end point was pain around the shoulder joint of the same limb. The test was repeated on the normal side with no elicitation of pain. The patients underwent T2-T3 sympathetic block with immediate relief of symptoms. They were asked to repeat the test on the affected limb after the procedure. Result: All patients reported an immediate relief in their symptoms after the procedure. On repeating the pincer-grasp on the af-fected limb, there was no pain around the shoulder. Conclusion: The pincer-grasp pain reflex looks to be a promising sign that may help in diagnosing CRPS, which may in turn reduce the time to treatment in these patients. Although more data has to be collected, preferably pooled, to document this sign in more patients, using this in clinical practice will be beneficial to patients. There need to be more studies to define it further.
154 A Disruptive Approach to the Correction of Severe Valgus Deformities in Total Knee Arthroplasty , Arlan H Troncillo, Jose Rodrigo G Cervero, Antonio A Rivera and Ramon B Gustilo.
A new surgical technique is presented for severe valgus deformity requiring total knee arthroplasty. Before any bone cuts are made, soft tissue releases are done to get the correct mechanical alignment that is balanced and stable in extension and flexion. Femoral mechanical axis is then determined using an extra-medullary Mechanical Axis Finder (MAF) which was shown to be 93.3% accurate in determining the femoral mechanical axis in a pilot study [28]. Eight knees with severe valgus deformity were identified from a total of 100 total knee arthroplasties performed from 2015 - 2019. Severe valgus was defined as a tibiofemoral angle (TFA) of 20 degrees or more on standing antero-posterior (AP) x-rays at full extension or scanogram view (standing full-length X-ray of the lower extremity from the hip to the knee, ankle joint). Pre-operative and post-operative measurements of the TFA and mechanical axis deviation (MAD) angle; knee society score (KSSC) for pain and function; and the final range of motion of knees were recorded and analyzed. The mean age was 63.75 (+/- 11.01) years old. The mean pre-operative tibiofemoral valgus angle was 26.87 (+/- 5.94) degrees and the mean post-operative tibiofemoral valgus angle was 6.75 (+/- 2.05) degrees. The mean value of Mechanical Axis Deviation (MAD) improved from 20.87° (+/- 5.94) preoperatively to 1.37° (+/- 2.26) valgus post-operatively. KSS pain mean scores improved from 45.12 (+/- 10.19) pre-operatively to 95.63 (+/- 1.99) at two months and two years post-operatively. KSS functional mean scores also improved from 93.1 (+/- 3.14) pre-operatively to 97.1 (+/- 1.81) post-operatively. The new surgical procedure used is reliable in correcting a severe valgus knee. It achieves good soft tissue balance in both flexion and extension and correcting mechanical alignment with component stability. Level of evidence: Level IV.
155 Preoperative Discharge Assessment Tool (PDAT): Predicting Disposition After Lumbar Spine Fusion. , Taryn E LeRoy, Andrew Mason, David Tybor, Jonna Capecci, Louis Jenis and Ashley Rogerson.
Background: Various forms of scoring tools have been utilized to predict discharge disposition after joint arthroplasty surgery but there is limited data following spine surgery. The aim of this study was to develop a Risk Assessment and Predictor Tool (RAPT) for patients undergoing lumbar fusion surgery to preoperatively assess patient disposition and coordinate discharge after lumbar spine fusion surgery. Methods: Retrospective review of 300 patients undergoing lumbar spine fusion surgery at a single center from January 1, 2014 - De-cember 31, 2014. Patient demographics, intraoperative, and postoperative data were collected. Patients discharged to an inpatient rehabilitation facility or skilled nursing facility were compared to those discharged home to determine which variables were signifi-cantly different between the groups. Variables with the highest predictive accuracy were used to develop the Preoperative Discharge Assessment Tool (PDAT). Results: A total of 300 patients were analyzed of which 227 (76%) were discharged directly home and 73 (24%) were discharged to a rehab facility. The mean and standard deviation (SD) length of stay (LOS) was 3 ± 1 days for all patients. Variables included in the final scoring tool were American Society of Anesthesiologists physical status classification (ASA) classification, number of levels fused, home living situation, and preoperative assistive device (AD) use. Overall predictive accuracy of the PDAT was 85.5%. Fifteen patients preferred to be discharged to rehab and 14 (93.3%) of those patients were ultimately discharged to rehab. These patients were older (67.9 vs 58.5 years) and more often lived alone (46.2% vs 7.0%). Conclusion: Patients that were discharged to rehab shared similar characteristics to those in previously published reports in arthro-plasty and spine literature. Patients discharged to inpatient rehab were more likely to be older, have higher a higher body mass index (BMI), live alone, and undergo larger operations. Higher estimated blood loss (EBL), longer surgical time, and more levels fused, were all associated with discharge to rehab. Our scoring tool (PDAT) uses preoperative living situation, assistive device (AD) use, number of levels fused, and ASA classification to preoperatively predict discharge destination. It has similar predictive properties to the RAPT, which is currently used in patients undergoing hip or knee arthroplasty. Patient preference for a discharge to rehab should be taken into consideration as well.
156 Polymorphism of Pro and Anti-Inflammatory Cytokine Genes in Children with Legg-Calve-Perthes Disease. , Shabaldin NA, Shabaldin AV, Tsepokina AV, Shabaldina EV and Rovda Yu I.
Introduction: The pathogenesis of Perthes disease is being actively studied. One of the possible mechanisms that cause osteode-struction in the early stages of Perthes disease is the predominance of the biological activity of pro-inflammatory cytokines. The association of polymorphic variants of cytokine genes may be of particular importance in this case. Aim: Search for associations of Perthes disease with polymorphic variants of pro-inflammatory and anti-inflammatory cytokine genes. Materials and Methods: Polymorphic variants of pro-inflammatory and anti-inflammatory cytokine genes were studied: IL10 (rs1800896), IL13 (RS20541), IL18 (RS187238), IL18 (RS5744292), IL1A (RS1800587), IL1Rn (POL_GF_58), IL1Rn (RS4251961), IL1β (RS16944), IL1β (RS1143634), IL4 (POL_GF_99), IL4 (rs2243250), IL6 (rs1800796), IL6 (rs1800795), INFG (rs2430561), TGFB (rs1800469), TNFα (rs1800629). The main group consisted of 25 children with 2,3 stages of Perthes disease according to the Reint-berg classification, the control group consisted of 40 conditionally healthy children. Results: The highest predictor coefficient was found for the polymorphic variant of the IL10 gene (rs1800896). The second in predic-tor significance was the mutant homozygous IL6 genotype (rs1800796). The third significant predictor of BLCP was the homozygous mutant genotype INFG (rs2430561). The protective genotype was located in the polymorphic region of the TNFA gene (rs1800629). Based on the logistic regression, an equation was obtained for calculating the risk of LCPD formation based on genetic predictors with potentiating and protective properties. Conclusion: The potentiating genotypes for the risk of LCPD formation were IL6 (rs1800796), INFG (rs2430561) and IL10 (rs1800896). The genotype of the protective risk of the formation of LCPD - TNFα (rs1800629) was identified. It was shown that the combination of genotypes of pro-inflammatory and anti-inflammatory cytokines (IL6 (rs1800796), INFG (rs2430561), IL10 (rs1800896), TNFα (rs1800629), TGFB (rs1800469) and IL1β (rs16944)) make the most significant contribution to the determina-tion of LCPD in children.
157 Muscle Recovery Strategies Applied to Soccer Players: A Narrative Review. , Fellipe Lima Oliveira, Wanderson Divino Nilo dos Santos, Rodrigo dos Santos Guimarães, Naiany Pereira Silva and Vitor Alves Marques.
Post-exercise recovery in sports is important, for the athelete a good recovery is essential for better performance in training and games. The aim of the study was to analyze which muscle recovery is most used after soccer game. The study is a narrative review, in which five studies were selected. Inclusion criteria were articles in English and Portuguese, articles from 2009 to 2021 were selected. Exclusion criteria were articles that are not English and in Portuguese, articles before 2009, review studies, dissertations, guidelines and animal studies. The databases udes to search for the studies were Pubmed, Lilacs and Google Scholoar. The descriptors were: soc-cer and recovery; soccer players and muscle recovery; soccer players and recovery; soccer and recovery; soccer players and rest. The study had a total five articles Where four of them had cryotherapy, two of them being favorable to itself as the best method, passive recovery and the two had better results for it and a massage study. According to the analysis of the studies, active recovery was more effective when compared to cryotherapy and passive recovery. Sports massage has not had significant results, but when recovery periods are short and other methods are not possible.
158 A Case Report of a Patient with Severe Knee Instability, Treated with Hinge Knee Prosthesis. , Fezollari L, Caushi Gj, Asoc Ruci V, Selmani E, Cami E, Gega A, Biba G, Vellku F, Sejdini K, Memini S and Bassi G.
A patient who is 59 years old, female with marked knee instability by 8 months after the onset of knee trauma. The patient is un-able to walk normally, walking only with knee support. After a careful clinical and radiological examination special knee prosthesis (hinge prosthesis) was recommended.
159 Arthroscopic Assisted Open Reduction and Internal Fixation of Ankle Fractures: Fundaments of a Growing Trend. , Guilherme França
Ankle fractures are one of the most common in the lower limb representing 9% of all fractures. Open reduction and internal fixa- tion is the treatment of choice of unstable ankle fractures which is frequently regarded as technically simple and one of the first procedures usually performed by residents during their training. Despite this apparent simplicity, it’s known that even considering anatomically reduced fractures, good or excellent outcomes are not achieved in approximately 20% of patients.
160 Management of Non-Healing Ulcers by Autologous Platelet Rich Fibrin (PRF). , Kartavya Chaudhari, Parvez Ahmad Ganie, Nilesh Kumar Agrawal, Rashmi Jain, Madhan Jeyaraman and Manish Khanna.
Introduction: Chronic non-healing ulcer is defined as a persistent defect in the skin for the period of more than six weeks and does not exhibit any tendency to heal following three or more months. Non-healing ulcers are enfeebling and leads to dwindling of qual-ity life of a patient. Venous diseases, arterial diseases, and neuropathy are some of the common causes of these non-healing ulcers. The underlying pathology for chronic ulceration is multifactorial which calls for a patient’s systematic evaluation for the purpose of ascertaining etiology and optimization of the treatment. The therapeutic use of autologous platelet rich fibrin (PRF) represents a newer regenerative avenue to stimulate and accelerate complex wound healing. In this article, we aimed to treat the non-healing ulcers with platelet rich fibrin gel. Materials and Methods: A total of 23 cases of non-healing ulcers were treated with autologous platelet rich fibrin gel once a week for 6 weeks. The pain reduction by VAS score, the mean area (cm2) and the mean volume (cm3) of the ulcer were analyzed at the end of 6 months. Results: By the end of 4 months, almost 100% improvisation in the ulcer area and its volume was seen in 17 (73.91%) and 21 (91.30%) of the ulcers respectively. The mean VAS score for ulcer showed a declining trend from 9.01 ± 0.09 to 2.19 ± 1.32 at the end of 6 months. The reduction of pain in the ulcer was due to the anti-inflammatory property of platelet rich fibrin matrix. Conclusion: Platelet rich fibrin gel provides biological treatment for non- healing ulcers by decreasing the morbidity and improving the functional quality of life.
161 Functional Outcomes of Surgical Treatment of the Fifth Diaphyseal Metatarsal Fractures (Dancer’s Fractures). A Case-Series and a Literature Review. , Grigorios Kastanis, Kapsetakis P, Magarakis G, Stavrakakis MI and Pantouvaki A.
Introduction: Fifth metatarsal fractures represent a significant proportion of injuries, while fractures of the distal diaphyses (dancer fractures) comprise 20% of all fifth metatarsal fractures. Conservative treatment is the preferred method for managing these frac- tures. The aim of this study is to present our functional outcomes of patients, in long term (one year), who underwent surgical treat-ment with low profile plates and to analyze the time of fracture union, the complications and final patient satisfaction. Material and Method: A retrospective study was performed from January 2015 to November 2019 with forty one patients under-gone surgical treatment with low profile locking plates 2,3 mm or screws for an unstable (spiral or oblique) fracture of distal di-aphyses of 5th metatarsal. The data collected, consisted of patient demographics, radiographic healing times, fracture characteristics, complications and final patients’ satisfaction (AOFAS Ankle-Hindfoot scale). Fractures were classified into two types according to the anatomical location: Type I which is a long oblique fracture that begins distal to lateral surface of metatarsal neck and extends into diaphysis (23 cases 56,1%), and type II which is when the fracture line starts at the distal-lateral metaphysis and extends proximal as spiral pattern (18 cases 43,9%). Results: Twelve men and twenty nine females were assessed post-surgically with a mean follow-up of 16,2 months. Time to union in all fractures was 7,2 ± 2,9 weeks more specifically in type I the union (6,1 ± 1,1) was more quick than type II (7,9 ± 1,3). Complications encountered were in three cases a delay union, in four cases infection and one with malunion. At final examination the AOFAS Ankle -Hindfoot scale was for the type I, 91,5 (range 89 - 93) and for the type II, 89,7 (range 85 - 91). None of the patients presented at last examination with metatarsalgia and the implants were not removed in any patient. Conclusion: Based on our results we postulate that open reduction and internal fixation of Dancer fractures offer high incidence of union, low rate of complications and should be considered as the ideal management for patients who need rapid reintegration into their previous activities.
162 Profile of the Patient with Fracture of Proximal Femur in a Regional Trauma Service. , Edir Soccol Junior, Mauro Remulo Grinfelder Brunel Rodrigues, Laura Maria Voss Spricigo, Neri Machado Junior, Fabio Cavali, Fernando Soccol4, Haiana Cavalheiro4 and Ronan Bertinatto.
With the increase in the elderly population, there is an increasing concern about health problems in this age group. Studies reveal that the mortality of elderly people with fractures of the proximal femur varies from 14% to 36%, with osteoporosis as the main con-tributor. The mechanism of fracture of the proximal third of the femur most reported in the literature is falling from their own height, with risk factors being the female gender, presence of chronic diseases, history of falls and environments with inadequate surfaces. In order to describe and analyze the epidemiological profile of the patient diagnosed with a proximal femur fracture, an analysis of medical records was made, at a regional reference service for orthopedic trauma, of patients whose main diagnosis was a fracture of the proximal femur during the period of March 2018 to March 2020. The variables analyzed were sex, age, fracture topography, fracture mechanism, associated comorbidities, level of ambulation (pre and postoperative) and chosen treatment. With a sample of 197 patients, 131 were female and 66 were male, with an average age of 76 years. The most prevalent comorbidity was Systemic Arterial Hypertension. The topography most found was Transtrochanteric Tronzo 3B. In the preoperative phase, most patients were community walkers without assistance, and in the postoperative phase, home walkers with assistance predominated. The most used treatment was the Cephalomedullary Nail. Based on this, the present study made it possible to add knowledge about the epidemiol- ogy of proximal femur fracture, informing health professionals about the profile of the patient susceptible to this trauma, enabling the establishment of interventional actions to avoid fracture or minimize its risks.
163 Is the Quality of Life, Functionality and Podiatric Evaluation of Adolescents with Clubfoot Treated by Ponseti Method Worse than that of Other Adolescents? , Ey Batlle Ana Maria, Moral Benitez Helena, Vinyals Rodriguez Marta, Perez Palma Laura and Míguez Gonzalez Paula.
Introduction: The Congenital talipes equinovarus (CTEV), also known as clubfoot has an incidence of 1 or 2 per 1.000 live births in Europe. Nowadays, the predominant treatment is Ponseti Method, which includes manipulation and casting. Objective: To analyses and compare with a control group, the quality of life, function and podiatric measures of the patient with CTEV treated with the Ponseti Method 18 years after treatment. Materials and Methods: A comparative study of 12 adolescent CTEV patients (19 feet) and a Control. Inclusion criteria in CTEV group: Having being treated with Ponseti method, no surgical releases and more than 18 y.o. Laaveg - Ponseti score and SF - 36 are used for quality of life and functionality. The maximum pronation test, the supination resistance test, Lunge’s test and FPI used as podiatric assessment. Results: Everyone got an evaluation between excellent and good in the Laaveg - Ponseti test. In the SF - 36 questionnaire the results obtained were similar between the groups. but the podiatric evaluation was clearly different. Only 4 from the 12 CTEV patients had been treated by a podiatrist. Discussion: The study shows similar results between both groups, Concerning the Laaveg - Ponseti test both groups display similar results and in the SF - 36 test the results showed a slight improvement in the Clubfoot group, however the results are not statistically significant. The podiatric evaluation results are different between both groups. Despite function of clubfeet after Ponseti Method in adolescents is very good we can detect mild structural changes with podiatric tests. Conclusion: In terms on functionality and quality of life there are no significative differences between clubfeet and control cases but podiatric evaluation shows statistical differences between both groups. Level of Evidence: II Or 2b (Oxford Level of evidence).
164 Bone Cancer and Metastasis Trials, Drug Treatment. , Da-Yong Lu and Bin Xu.
Bone cancer and metastasis is difficult to be managed. In the early stage, amputation is widely practiced in the clinic. To avoid this devastating event, drug treatment should be strengthened. Several factors or associations should be noticed for therapeutic promo-tion and paradigms. This editorial discusses drug development and clinical treatment for bone cancer and metastasis.
165 Management of Fractures of Metacarpals and Phalanges of Hand with Mini External Fixator. , Shivaraj B, Shiva Kumar Bingi, Parvez Ahmad Ganie, Aquib Suheil Pasha and Madhan Jeyaraman.
Introduction: Metacarpal and phalangeal fractures are more common injuries in hand, either closed or open. These injuries are encountered every day. Most of the fractures are treated conservatively, but for unstable fractures, open fractures, comminuted fractures operative treatment is indicated. This study was undertaken to evaluate the functional outcome of closed or open metacarpal and phalangeal fractures treated with a mini-external fixator. Materials and Methods: From July 2016 to June 2019, a total of 40 cases of metacarpal and phalangeal fractures of the hand were treated with a mini-external fixator. All patients were screened using inclusion and exclusion criteria. Follow up was done till 12 months to evaluate the fracture union and range of movements by DASH score. Results: The mean soft tissue healing was 2.56 weeks. The mean fracture healing was 14.45 weeks. The results were found excellent in 55%, good in 22.5% cases, fair in 15% cases, whereas poor results were seen in 7.5% of fractures. Conclusion: External fixation is an adequate alternative treatment for unstable phalangeal and metacarpal fractures which are open or accompanied by severe soft-tissue injuries.
166 Neuromuscular Re-Education Using Surface Electromyography Biofeedback. , Magdalini Stamou.
This paper investigates the role of Surface Electromyography Biofeedback in neuromuscular re-education. It references the theo-retical basis of biofeedback action, the physiological mechanism of the peripheral motor neuron, recruitment and modification of central stimulation and brain plasticity. This paper includes an analysis of the technical characteristics of surface electromyography as well as of the advantages and disadvantages of these applications.
167 Role of Neurophysiological Studies in Prediction of Prognosis of Obstetrical Brachial Plexus Palsy OBPP. , Mohammed Elkhatim, Musaab Mohamed Abdalla and Elhadi Abdelrahim.
Background: Obstetric brachial Plexus Palsy (OBPP) almost always involves traction of the C5 and C6; nerve roots Resulting in weakness of shoulder function and elbow flexion. Additional involvement of C7, C8 and T1 roots affects elbow extension wrist and hand function. lifelong functional impairment occur in20 to 30% of cases. Mild lesion cannot be distinguished reliably from severe lesions in the prenatal period: only time reveals Whether or not spontaneous recovery will occur. Early identification of severe cases facilitates early referral to specialized centres. where the need for reconstructive nerve surgery can be assessed. Neurophysiologic studies are useful tools for early prognostic assessment of OBPPs. This research will give us data about the role of neurophysiologic studies in prediction of mode of treatment of OBPPs. Patients and Methods: Case series descriptive retrospective study done in patients with (OBPP) presented to Pediatric Orthopedics Department at Soba University Hospital and underwent surgical correction during the period between (January 2013 and December 2014) and have pre-operative neurophysiologic studies. Results: In this study we assessed 28 child with obstetrical brachial plexus palsy operated At pediatric orthopedic department, Soba University Hospital from January 2013 to December 2014 twelve male (42.9%) and 16 female (57.1%). Three (10.7%) were below 1 year of age, 20 (71.4%) were between (1 - 10 years). 5 (17.9%) were more than 10 years. Seventeenth (60.7%) with right shoulder affected and 11 children (39.3%) with left shoulder affected. One Child weight less than 2.5 kg (3.6%) while 7 child 25% fell between 2.5 and 4kg, and 20 (71.4%) children were above 4 kg. 4 (14.3%) children had neurophysiologic studies performed before 3 months of age, while the remaining children were all had the neurophysiologic studies after three months of age. The neurophysiologic stud- ies finding showed neuropraxia in 7 (25.0%), axonotmesis in 14 (50.0%) and neurotmesis in 7 (25.0%). Conclusion: In conclusion, we observed that none of our patients had electromyogram done before surgery. While it is recom-mended to be done at 1 month as the best time to give accurate prediction of future prognosis. when done within 48 hours following birth it helps to discover the etiology, and it has important medico legal implications. We also found that it is not helpful to rely on the neurophysiological studies alone in prediction of mode of treatment of OBPP.
168 The Incidence of Knee Stiffness Fallowing Femur Shaft Fracture. , Musaab Mohamed Abdalla, Mohammed Elkhatim and Elhadi Abdelrahim.
Knee stiffness is one of most common complications following femur shaft fractures, in this this study we evaluate 67 patients with femur shaft fractures for Knee stiffness. Patients with hip fractures intraarticular distal femur fractures, pathological fractures and those who has Knee stiffness before trauma are excluded. We found incidence of knee stiffness is 64.7%, 44 patients had Knee stiffness ranging from mild to moderate and severe.
169 Acetabular Component Position Highly Variable in Early Practice. , Caitlin Barrett, Jillian Glasser, Brooke Barrow, Dioscaris Garcia and Valentin Antoci.
One factor in choosing an orthopedic fellowship is to increase practice with standard procedures, such as acetabular cup place-ment. The purpose of this study is to see how adult reconstruction fellowship affects surgical accuracy in practice. This retrospective review compares anteversion/abduction measurements and outcomes of 50 THAs done during fellowship to 50 THAs performed in clinical practice. Abduction and anteversion in fellowship averaged 46.14° and 23.9°, compared to 45.16° and 29.86° in practice. There was no significant difference in complications between groups. These results suggest that fellowship training decreases but does not eliminate the learning curve for acetabular cup placement.
170 Knowledge, Attitude and Practice of Surgical Residents Handling Possible Carriers of Hepatitis B, C or HIV Viruses. , Shareef S M Nada, Mohammedalfatih Abdalgadir, Kamaleldin E I Sabir, Dalia A E Abuzeid and Muhammad F Azzedin.
Background: Surgical residents have the greatest risk of exposure to blood-borne pathogens while learning a new surgical skill. However, this risk could be decreased by adherence to standard precautions (SPs) and by better knowledge and effective practice after exposure. Objectives: To determine the level of Knowledge and attitudes towards HIV/AIDS, hepatitis B and hepatitis C as well as practices among the rotating surgical residents when they exposed to different types of infection transmission from the patients. Methodology: KAP Survey: the questionnaire was handed to 63 previously identified surgical residents (by Simple random selection). Questionnaires were filled between April 2nd 2018 and June 2nd 2019. Results: The incidence of sharp objects injuries was found to be 84.1%. 74.6% of respondents claimed that they followed SPs. Gen-eral surgery trainees showed better knowledge and attitude in the emergency room (ER) than orthopedics residents (p = 0.04) but overall, this is below the expected level. While 60.3% of respondents are not vaccinated against Hepatitis B virus (HBV), 23% of them attended a training course in bio-safety. 41% did not read a book or even an article about infection control while 23% have neither enough knowledge nor safe practice at operating theaters. Regarding immunoglobulins and booster vaccine time of administration 70% of trainees lack the knowledge about proper timing for taking immunoglobulins against HBV. 49% answered that they will take a booster vaccine. 51% do not know when to test them-selves if injured by a known Hepatitis C virus (HCV) patient. 31.4% answered by testing themselves properly if injured by a known Human Immunodeficiency Virus (HIV) patient. The timing of receiving post exposure prophylaxis (PEP) after exposure was known only to 11.8% of the candidates. Among three trainees (6%) injured by known positive Hepatitis B Surface Antigen (HBsAg) patients only one of them was vacci-nated. Two trainees did the advanced measures but one trainee, who was not vaccinated, did only the simple measures by removing the gloves and washing the wound. No one was injured by a known patient with HCV or HIV.
171 Giant Lipoma Infiltrating the Thigh with Vascular Distress: A Case Report. , Papa Amadou Ba, Yves Girineza Ndabereye, Cheikh Coundoul, Abdoulaye Lindor Diop, Madior Diouf, René André Macodou Ndiaye and Coumba Diouf Niang.
Solitary lipoma is a frequent soft tissue tumor of multiple locations; indication for surgery when it is painful, unsightly and causes a functional gene. Benign mesenchymal tumor, it is said to be giant when its size is greater than 10 cm and/or weighs more than 1000g. It rarely degenerates into liposarcoma. We report the case of a giant infiltrating lipoma of the right thigh with vascular damage in a 62-year-old patient. The clinical picture was marked by a recurrent mass in the right thigh for about 16 years, painless, causing a significant functional gene. The preoperative radiological assessments (ultrasound and MRI) and the biopsy were in favor of the diagnosis and the indication for resection was retained.
172 Energy Cost of Water Running in Shallow and Deep Water. , Monica Tiberi, Sabrina Demarie and Marcello Faina.
Water running is distinguished in two different form, shallow water running and suspended deep water running. Shallow water running is defined as running in water at the hip or breast depth with contact with the bottom of the pool while deep water running is intended as running without contact with the floor supported by a flotation device. They have been prescribed by physician and coaches as an alternative to land-based running as a rehabilitative treatment, as well as supplement to land based training regiments. However, higher metabolic responses have been reported for shallow water with respect to deep water running. Aim of the study was to assess individualized relative exercise intensity of water running at different stride frequency for young active female at the same water level (xiphoid level) once with ground contact in shallow water and once suspended in deep water by a buoyancy belt. In the present study running performed in deep and shallow water induced a similar metabolic expenditure at all exercise intensity. In conclusion, to exercise at a mainly aerobic intensity young active females should run in water at a stride frequency of about 50 cpm, which elicits more or less 35% of both HRmax and VO2max. While for a mixed aerobic/anaerobic intensity water running should be performed at ~ 60 cpm, where HR corresponds to 50% of HRmax and VO2 to 41/44% of VO2max.
173 Benign Bone Tumors, An Overview. , Bola Adel Alfy Hakim.
Benign bone tumors often weaken bone and make patients vulnerable to pathological fractures. Benign lytic bone lesions such as Simple Bone Cyst (SBC), Non-Ossifying Fibroma (NOF) and Fibrous Dysplasia (FD), etc. commonly affect the young people. These lesions, which are usually asymptomatic, are stabilized or usually disappear after skeletal maturaty. Therefore, Surgical op- tion is generally now not required until the size of the lesion is prone to pathological fractures, in which case curettage and graft- ing are the widespread treatment.
174 Surgical Management of Intertrochanteric Fractures in Adults by Trochanteric Fixation Nail (TFN). , Mallikarjuna Reddy, Raghukumar J, Prajwal GS, Vijaykumar K and Rajendra Pranav Prasad.
Background: Intertrochanteric femoral fractures are of more interest globally. Understanding biomechanics of these fractures and the development of implants had led to the various treatment modalities for these patients. The primary goal of surgical management is to provide the anatomical restoration of the normal abductor-lever-arm mechanism of the hip joint. Rigid intramedullary nailing has been suggested as a treatment option in these patients with intertrochanteric fractures due to the perceived advantages of stable fixation with higher union and low complication rates. Objective: To prospectively review, collate and evaluate the functional outcome, advantages, union rate and complications of inter-trochanteric fractures in adults using trochanteric fixation nail. Materials and Methods: A prospective cohort study with 43 adult patients with intertrochanteric fractures were treated with tro-chanteric fixation nailing in JJM Medical College, Davangere between 2018 to 2020. The fractures included in the study were clas-sified according to Boyd and Griffin classification. All the cases were followed at regular intervals as per our study protocol. The functional outcome were assessed with Modified Harris’ Hip Score. Results: In our study, we managed 43 intertrochanteric fractures by trochanteric fixation nailing. The mean radiological union of trochanteric fractures were 12.74±3.12 weeks. The functional assessment were made with Modified Harris Hip scores which were excellent in 23 cases (53.48.48%), good in 14 cases (32.55%), fair in 4 cases (9.30%) and poor in 2 cases (4.65%). No case of helical blade cut out, Z effect and reverse Z effect were reported in our study.   Conclusion: The load sharing device, trochanteric fixation nail (TFN), decrease the patient related morbidity during intra and post-operative period in intertrochanteric fractures and improve the functional status of the patients.
175 Application of Fascia of Temporal Muscle and Cartilage of Auricular Tragus in Myringoplasty in Children. , Ivan Baljosevic, Slavisa Antic and Stefan Popovic.
Introduction: Perforation of tympanic membrane in children may be cause of recurrent midlle ear infection and loss of hearing. Objective: The aim of this study is to analyze application of different reconstructive materials in surgical technique-miringoplasty. Methods: We performed 88 myringoplasty in 76 children during the period of July 2010. and July 2018. Age, gender, size and site of perforation, status of the contra lateral ear, underlying cause of the perforations, surgical technique, preoperative and postoperative hearing levels and postoperative complications were recorded. In performing myringoplasty we used fascia of temporal muscle and cartilage of auricular tragus. Results: In 43 (48%) patients we used fascia of temporal muscle and in 45 (52%) cartilage of auricular tragus. Graft success was defined as an intact eardrum at 12 months postoperatively and an improvement in perception of air-bone gap of 10 dB, which we re-corded in 73 (83%) cases. Reperforations were noted in 12 (13%) patients, in 8/43 (18,6%) cases where we used temporal fascia and in 4/45 (9,3%) cases with tragal cartilage. Retraction of tympanic membrane was recorded in 3/43 (4%) cases with temporal fascia. Conclusion: Myringoplasty is a reasonably successful method with good functional results for the pediatric patients. Risk factors for surgical success were size of perforation and pathological conditions of contra lateral ear. Tragal cartilages give better results in cases with bilateral perforations because possibility of retractions and reperforations is smaller.
176 To Assess the Fibular Grafting in Gap Nonunion and Bony Defects Created by Trauma or Tumour Excision. , Rajendra Kumar Shakunt, Brijesh Sharma, Sushil Kumar Saini, Sabeel Ahmad, Ashwani Sadana and CP Pal.
Introduction: Treating a large bone defects is really challenging for orthopaedician. The bone defect created by tumour excision, bone loss as sequelae to infection and trauma. Various methods popularly cancellous Bone graft, free fibular graft, and bone trans-port with the help of LRS (Limb Reconstruction System) and external fixator technique used to fill the defect. Fibula is very common bone to use for filling a defect created after bone resection either after tumor or in bony nonunion. The treatment of these bone gaps has evolved significantly during the past two decades. This study aims to assess the role of fibular grafting (nonvascularized) in gap non-union and bony defect created after tumour resection as a treatment modality in terms of financial burden, hospital stay as well as technically demanding. Method: This was a prospective study conducted at S.N Medical College, Agra from April 2018 to May 2021. In this period of three years we analysed hospital records to find out the cases treated by fibular strut grafts. Among 30 cases 20 were taken those fulfilling the inclusion criteria, in which there were 15 tumours and 5 post traumatic shortening. Results: This study had 65% (13/20) stable, pain free limb movements, resumed over a period of one year without any assisted device. 7 patients who did not gain normal functions, in which 3 cases had fair result, and 4 got failed. Conclusion: Overall experiences with non-vascularized fibular graft for reconstructing bony defects are promising, more handy and universal.
177 Effects of a Structured Training Plan in Technical-Tactical Exercises on Unforced Errors in Competition in Table Tennis Athletes. , Juan Camilo Soto Jaramillo.
Table Tennis is a sport characterized by the high speed of play at which it is practiced, the constant decision-making process that athletes are faced with and the high levels of technical precision that they must possess when developing on a rather small playing surface. If you add to these aspects the fact that the points of tension and the situations that destabilize the athletes are presented in a recurrent way in the competitions, you haven enough arguments to understand why the tennis players make a lot of unforced errors in the matches. The present research exercise was framed in a methodological proposal that generated statistically significant results (p < 0.002) on the reduction of unforced errors in competition in a group of table tennis players.
178 Vaccine Administration Leading to Subacromial Bursitis. , Ravin Pate, Irfan Chhipa, Mitesh Patel and Sunny Gupta.
Shoulder injury related to vaccine administration (SIRVA) describes the condition of injury to the shoulder joint after incorrect or inaccurate placement of intramuscular injections intended for the deltoid muscle. Vaccine placement inherently carry multiple risks given the vasculature, neural intervention and anatomy of the shoulder joint. We present a patient that presented with a chief complaint of left shoulder pain occurring for two months. This patient failed conservative management with non-steroidal anti-inflammatory drugs and oral steroids which were recommended by his primary care physician. He was ultimately referred to orthopedics given his lack of improvement and persistence of pain with active range of motion and overhead movements. After significant work up including history taking, physical examination and imaging this patient was diagnosed with SIRVA. This patient was treated successfully with subacromial cortisone injection with complete resolution of his symptomatology. Our aim with this case is to urge clinicians to maintain a high index of suspicion for SIRVA in individuals presenting for acute shoulder pain. It is important to consider recent administration of vaccines through a thorough history and physical exam in order to accurately diagnose SIRVA in patients. This is especially true with the increased prevalence of vaccinations against COVID-19 which we will see in the upcoming months.
179 The "Standard of Beauty" and "Ideal Body" of the Descents of the Licensing Course in Physical Education. , Leite Marcelo Alencar.
The work aims to understand how the students of the Physical Education Degree Course perceive the affect of the ideas of what the Beauty Standard and the Ideal Body are. It is a field study and has a qualitative character. Electronic means were used to apply a questionnaire, containing closed and open questions, as a way to collect information. It was concluded that the need for fitting into a Beauty Standard and following an idea of an exemplary Ideal Body is rooted in the thinking of students as academics and future Physical Education teachers.
180 Isolated Lunotriquetral Interosseous Ligament Tear - An Uncommon Lesion. , Marco Antonio Alves Braun, Thaís Amanda Frank de Almeida Alves, Márcio Luís Duarte and Lucas Ribeiro dos Santos.
An injury of the interosseous lunotriquetral ligament is an infrequently recognized cause of pain in the ulnar side of the wrist. A partial or complete tear of it occurs by many mechanisms including traumas, sports activities, and degenerative disorders. The patient will experience ulnar-sided pain, point tenderness, painful snap, loss of strength and stability. The gold-standard test to confirm its diagnosis is arthroscopy, despite many others that may help in the investigation and exclusion of other causes that lead to the same symptoms. Treatment can be conservative or need surgery. Surgical intervention has as objective the stabilization of the lunotriquetral joint. However, its consequences have high complication rates and need of re-operation.
181 Post-operative Myelopathy (Paraplegia), Unusual Causes to Consider - Case Reports. , Forshing Lui, Ning Zhong, John Geraghty, Zoe Robinow and Kathleen Barnett.
Post-operative paraparesis due to spinal cord pathology (myelopathy) is an uncommon yet devastating complication related to surgery or anesthesia. Direct causes are either related to the spinal column or the procedure such as spinal fractures, spondylosis, rheumatoid and other spondyloarthropathies, spinal osteomyelitis, discitis, epidural abscess, and spinal tumors. These causes of post-operative paraparesis are more obvious and often anticipated pre-operatively. We reported two uncommon causes which needs to be considered with a high index of suspicion. These are spinal cord infarction related to aortic manipulations or interventions, intraoperative hypotension, use of vasoconstrictors with the anesthetics, or epidural anesthesia. The typical clinical presentation is acute (wake up from surgery and anesthesia) onset severe paraparesis due to an acute ischemic myelopathy. The diagnostic MRI findings are vertebral body infarction in addition to the abnormal spinal cord signal. The other rare yet important cause is functional vitamin B12 deficiency induced by use of nitrous oxide anesthesia. The diagnostic findings are high plasma methylmalonate level and the classical MRI findings of abnormal signals in the dorsal columns (the inverted V sign).
182 The Influence of Deformity and Limited Joint Mobility on Foot Ulceration in Type 2 Diabetes. , Josephine Debattista, Alfred Gatt and Cynthia Formosa.
Aim: To investigate the influence of foot deformities on diabetes foot ulcer development. Methods: Two groups of n = 50 participants were recruited; Group A with current and/or history of foot ulceration, Group B matched for main confounding variables, without ulcers. A comprehensive clinical and biomechanical examination was performed to record foot deformities, together with foot joint range of motion. Results: 68% of ulcers in Group A were located in the toes, with the apex of the 2nd toe being the commonest site of ulceration (26%), whilst 32% of the ulcers were located under the 1st (20%) and 5th (12%) metatarsophalangeal joints. Group A exhibited significantly more foot deformities than Group B, including hammer, claw and mallet toe deformities, limitation in joint mobility at the joints, in-cluding the ankle, subtalar, midtarsal, first ray and first metatarsophalangeal joint. Prominent metatarsophalangeal joints were also more common in Group A (60 - 66%; p < 0.001). Conclusion: Toe deformities, which may often be considered as insignificant in clinical practice, are an important aspect that need to be managed well in patients living with diabetes mellitus in order to try to prevent the onset of ulceration. Methods to improve joint motion should also be advised to patients at risk.
183 Modified Bell Tawse Technique for Correction of Pediatric Isolated Radial Head Dislocation without Ulnar Bowing. , Joana Monteiro Pereira, Ana Esteves, Pedro Ribeiro, Francisco Bernardes, Tiago Costa and Pedro Barreira.
Chronic radial head dislocation is a rare and potentially devastating injury in pediatric population, resulting in long term function and movement impairment. Early recognition and management are essential to restore elbow flexion and more important pronation and supination. The treatment of chronic radial head dislocations in children can be challenging and currently there is no consensus on the opti-mal treatment. The authors describe a case of a 6-year-old boy who suffered a fall onto his outstretched left arm, with 6 weeks evolution, and sustained a left radial head fracture with anterior dislocation, without ulnar deformity. A Boyd and Speed approach was made, and a modified Bell Tawse procedure was performed using a lateral slip of the triceps tendon, passed around the radial neck and fixed with a suture anchor into ulna. This versatile approach allowed access to all the structures, minimizing the risk of surgical scarring, with excellent functional and imagiologic results, without long-term major complications. To our knowledge, there are no reported cases regarding an annular ligament reconstruction using a modified Bell Tawse proce-dure with suture anchor. Level of evidence IV.
184 Low Back Pain: Oswestry Low-back Pain Disability and Body Mechanic Practices Among the School Teachers in Tabuk, Saudi Arabia. , Mathar Mohideen.
Background: Low back pain (LBP) considered to be one of the most common problem among all musculoskeletal conditions, which is very much related with the occupational functioning. Worldwide trend in back pain is escalating. Constant use of “Head -Down” posture, poor posture and improper technique of lifting carrying among the teachers are the common causes that need to be focused in preventing and managing back pain. Safe working practice to be ensured in managing LBP.  Methods: A descriptive cross- sectional study was conducted among the school teachers from the selected schools in Tabuk to iden-tify the low back pain disability level and body mechanic practices by using structured self -administrated questionnaire. Result: 66.8% of the study participants had reported back pain. In that majority of the teachers had reported mild and moderate level of back pain, these teachers were able to continue their work. This study had identified significant association with medical ill-ness and previous surgery related to Oswestry Disability Index (ODI) LBP Disability. Only 35.2% of the teachers had good practices of body mechanics in prevention of back pain. This study also revealed that female gender, marital status and work experience had significantly associated with practices of body mechanics. Conclusion: This study recommends on enhancing the educational activities about body mechanic practices in preventing the LBP.
185 Evaluation of Results from Rehabilitation of Patients with Pertrochanteric Fracture Treated Surgically. , Mitrevska B, Koevska V and Grkova-Miskovska E.
Introduction: Adult population generally is more sensitive and exposed to various injuries, which means increased opportunity for the emergence of various kinds of geriatric trauma. By increasing average length of life, solving fractures of the upper end of the femur is a major problem for the modern surgery. Aim of the Study: Aim is to evaluate the effects of treatment and physical rehabilitation with kinesiotherapy and magnetic therapy versus kinesiotherapy and therapy with interference currents of patients with surgically treated pertrochanteric fracture with DHS- type KYLE I, II, according to the protocol results monitoring. Materials and Methods: The study represents a prospective randomized clinical trial implemented at the Institute for Physical Medicine and Rehabilitation - Skopje. Include two cohorts, with 90 participants with pertrochanteric fracture treated surgically with DHS- type KYLE I, II. Respondents are divided into two groups: Examined group - 45 patients, treated with kinesiotherapy and magnetic therapy and control group - 45 patients treated with kinesiotherapy and therapy with interference currents. Respondents were followed for one year, during which were performed three examinations, the first control on the day of discharge of the hospital, than after 6 and 12 months, from the first review which is input for selected patients who meet the criteria for inclusion in research. Results: For p > 0.05, there is no statistically significant difference between the groups in terms of the gender of the respondents (Pearson Chi-square = 0.6527, df = 1, p = 0.4191. For p <0.05, a significant difference was found between the respondents from the two groups in terms of the status of formed callus (Pearson Chi-square = 10,181, df = 1, p = 0,0014). It is recognized that, kinesio-therapy and magnetic therapy and kinesiotherapy and interference currents, for p < 0,05, increase Harris hip score (improve the condition of patients) in three time combinations. On physical examination after discharge, 6 and 12 months, Harris hip score for the group treated with magnetic therapy is significantly higher compared with the same in the group treated with interference currents, Conclusion: In the postoperative rehabilitation of pertrochanteric fractures, with dynamic fixation implant-DHS, therapy of choice is kinesiotherapy and magnetic therapy. It resulted with improvement in the functional status, the stimulation of osteogenesis and quality of life in elderly patients.
186 Do Not Forget Proximal Hamstring Avulsions. , Diego Edwards, Miguel Carrasco and Consuelo Carrasco.
Proximal hamstring avulsions (PHA) are rare lesions that can cause permanent functional alterations and a very high risk of re-tear (12% to 31%) . They are present in 9 - 12% of all lesions in this muscle group  and most often occur in athletes who require rapid acceleration (running, hurdling) or “ballistic" movements (skiing, skating, weight lifting).
187 Intimacy Lemurrian Sexual Yoga Practices for Couples. , Acharyar Sennimalai Kalimuthu.
For each and every creature on earth, sex is mental food. Also, sex is essential and inevitable for human and other living creatures for production of their respective beings. The two main factors for the divorce of married couple is opinion of differences and sexual dissatisfaction. There are hundreds of sexual techniques to attain pleasure, joy and ecstasy. In this work, the author proposes the Le-murrian yoga methods for prolonged happiness of both married couple and lovers.
188 Association of Neck Disability and Upper Extremity Musculoskeletal Discomfort in Text Neck Syndrome among Adults. , Bhavna Anand, Sara Nishat, Natasha Khanna, Shubhi Kulshrestha1 and Sukriti Raj.
Background: Text neck syndrome is a terminology used to describe a repetitive stress injury which occurs when individuals keep their head and neck flexed downwards. This syndrome is known to occur during activities like texting, typing when the neck is bent for extended periods and leads to excessive amount of pain. The aim is to check the association of neck disability and upper extremity musculoskeletal discomfort in text neck syndrome among adults age group 18 - 45 years using smartphones and other electronic devices more than 5 hours a day for more than a year. Methods: 113 participants took part in survey out of which 22 were excluded as they didn’t fulfil the criteria of inclusion. Data was collected from 91 participants and two standard questionnaires - Neck Disability Index and Upper Extremity Functional Index- 15 were used for data collection. Data was interpreted using Microsoft excel and correlation was found using Pearson coefficient. Results: There was slightly positive association between neck disability and upper extremity discomfort and out of 91 participants, 80 had some characteristic of neck disability. The present study shows prevalence of neck disability due to text neck syndrome to be around 28.17% in the 18 - 45 age group by using NDI scale. Most affected age group was 21 years. Conclusion: The study shows weak positive association between neck disability and upper extremity musculoskeletal discomfort in text neck among adults with r value (0.343).
189 Impact of Smartphone Addiction on Craniovertebral Angle in Healthy Adults. , Bhavna Anand, Vinayak Singhal, Shubhi Kulshrestha and Sukriti Raj.
The craniovertebral angle is measurable, linear measure of the curvature of the neck. Smartphone addiction can alter this angle and cause headaches, pain in one’s neck and shoulders, and even difficulty breathing. The concept of smartphone addiction and its effect on craniovertebral angle has gained increased attention in the recent years. There are many well-known studies that have shown how the use of smartphones can lead to the development of neck, shoulder and back pain as well as other health issues. The study is of cross-sectional design where 30 participants were selected and correlation between smartphone addiction and craniovertebral angle was seen. The aim was to explore how smartphone addiction can affect craniovertebral angle.
190 Clinical and Imaging Improvement After the Atlasprofilax Method in a Patient with Cervicobrachial Syndrome and Temporomandibular Joint Disorders. A Case Report. , José G León, Lluís Manent, Kathleen Lewis and Orlando Angulo.
A 30-year-old woman with chronic shoulder pain, cervicobrachial syndrome with functional motor loss and paresthesia, car-pal tunnel syndrome, tension-type headache, and temporomandibular disorders was referred for a computed tomography scan to evaluate a possible atlantoaxial rotatory subluxation and asymmetry of the lateral atlantodental interval prior to the application of the Atlasprofilax method. The same tomographic study was performed after the application of this method. Normalization of the at-lantoaxial rotatory subluxation and lateral atlantodental interval was observed post-treatment, as well as substantial improvement in the patient’s symptoms. Normalization of previous midline deviation and better alignment of C3-C4 spinous processes was also visualized after the application of the treatment. We also discuss the probable relationship, relevance, and implications of clinical or subclinical atlantoaxial rotatory subluxations and lateral atlantodental interval. In addition, we consider the fascia and suboccipital muscles that could be underlying abnormalities at the craniocervical junction and affecting proximal or distal regions. The effective-ness of the Atlasprofilax method as an innovative, safe, and non-invasive approach is preliminarily postulated and recommended to be the subject of further consideration and clinical studies.
191 Multicentric Musculoskeletal Hydatid Cysts - A Rare Case Report. , Prem James Charles, Harshvardhan and Selvaraj Periyasamy.
Hydatid disease is one of most common parasitic diseases affecting humans. Though no organ is exception, the hydatid cysts pref-erably develop in the liver and the lungs. Though the musculoskeletal involvement is known to be rare, it should be considered in the differential diagnosis of soft tissue tumors. We report an unusual case of musculoskeletal hydatid disease presenting in multiple locations over a period of four years dura-tion in a 34-year-old male patient. The disease manifested with painful swellings, initially on the lateral aspect of right hip, then on the left hip and later in the left shoulder region. They were treated by incision and drainage/surgical excision in combination with anti-helminthic medication. Final functional outcomes were found satisfactory.
192 Fight with Covid-19 Pandemic is Still on! However, Hopes are High that the Worst is Already Behind us! , Krunal Soni
India just witnessed a proud achievement of crossing billionvaccinations which has been the biggest collective event orches -trated successfully by any single country, in a record time frame in the history of mankind.
193 Case Report on Ulna Diamelia (Mirror Hand) at St. Luke Catholic Hospital, Woliso , Biniamtadesse, Ararso Gonfa, Teshome Eshetu and Habtewold Mulat
Introduction: Congenital deformity reported in mirror hand is rare in literature, usually ulna is doubled and faces each other or fol-lows each other. The etiology suggested is probably failure of differentiation of part of the ray than its pure duplication.Presentation of Case: We present a case of mirror hand (ulna diamelia) in 1-hour old female born from gravid seven, Para four, abor-tion two mother at term with birth weight 2.5 kilogram with normal APGAR score.Discussion: Duplication of ulna is an extremely rare anomaly. The radial sided ulna is almost always hypo plastic and short and thehand is deviated to radial side and the limb is shorter than the contra lateral side, according to international federation society ofsurgery of the hand it is classified as duplication
194 Physical Therapy Interventions and Outcomes in a Patient with Transfemoral Amputation Following Sound Side Total Knee Arthroplasty: A Case Report , Scott Love, Jenna Yent, Clair V Kean, Nicole A Liotta, Debra Gray and M Jason Highsmith
Abstract Background: Following a transfemoral amputation (TFA), osteoarthritis (OA) on the sound limb may occur secondary to overuse. Potential causative factors include gait abnormalities, increased knee load, and performing hopping activities without a prosthesis. Unilateral TFA patients may require a total knee arthroplasty (TKA) to improve function. Case Description and Methods: A 56-year-old male with a TFA who was diagnosed with left knee OA and was classified as a limited community ambulator underwent a TKA to restore function. The purpose of this case report is to determine the benefits of standard physical therapy (PT) augmented by a high intensity, whole-body strengthening program. PT examinations, interventions, and out - comes were analyzed from one-week pre-TKA to one-year post-TKA. Multiple outcome measures were utilized to assess progress including the Single Leg Stance Test (SLST), Four Square Step Test (FSST), Timed Up and Go Test (TUG), and Six Minute Walk Test (6MWT). Findings: Patient achieved functional independence, normalized gait, lower extremity strength, and lower extremity active range of motion (AROM) goals. Outcomes and Conclusion: The results of the TUG and FSST from the patient equaled those of non-amputees. The standard PTprotocols post-TKA contributed to the patient’s success, while the high intensity, whole-body strengthening program contributed to patient’s achievements. Clinical Relevance Statement: This case study suggests rehabilitation interventions in a relatively healthy unilateral TFA with sound limb TKA may be appropriate at a higher level of intensity, than typically prescribed, to regain functional independence.
195 Management of Shepherd’s Crook Deformity by Proximal Femoral Osteotomy without Bone Graft - A Case Report , Avijit Basak, Kunal Mondal, Pinaki Das, Raunak Agarwal and Subhasish Manna
Abstract Introduction: Fibrous dysplasia is a benign condition of the skeletal system. In this disorder there is fibro-osseous proliferation with intervening areas of normal or immature bone in the intramedullary region. This is a case report reflecting management a case of unilateral shepherd’s crook deformity at right proximal femur with microfractures causing functional restrictions. Case Report: A 19-year-old female presented with pain and shortening of right lower limb. Radiographs and histopathology sug- gestive of fibrous dysplasia. On the right side, we did a valgus close wedged osteotomy in the subtrochanteric region and fixed with dynamic condylar screw supported by 95-degree barrel plate without introducing any bone graft. Patient was followed up for 1 year and ends up with a better functional outcome evaluated by Harris hip score and Oxford hip score. Conclusion: Lateral close wedged osteotomy is effective method to correct the shepherd’s crook deformity if properly executed. Hence using an extramedullary device without bone graft can be the choice of treatment in such cases
196 The Influence of Pain Self-efficacy on Physiotherapy Outcomes for Patients with Shoulder Pain: A Systematic Review , Aws Obaid, Ahmad Alhamed and Alaa Khushhal
Abstract Background: Shoulder pain is a very complex and common condition among population, and the mechanisms involved in its per- petuation remain unclear. Pain self-efficacy appear to play a role in the outcomes of treatment in people with shoulder pain. The purpose of this systematic review is to investigate the impact of pain self-efficacy on physiotherapy outcomes (pain intensity and disability) in patients with shoulder pain. Objectives: To identify the impact of pain self-efficacy on physiotherapy outcomes in patients with shoulder pain. Methods: A systematic search performed on the following databases PubMed, the Physiotherapy Evidence Database (PEDro), Scopus (Elsevier), Science of Direct, (CINAHL) and Psychology database (ProQuest). Longitudinal studies with quantitative designs analyz- ing the role of psychological factors and pain self- efficacy on treatment outcomes included. The quality assessment of the included studies evaluated using National Heart, Lung, and Blood Institute’s Quality Assessment Tool for Observation Cohort and Cross-Sec- tional Studies. Results: Two studies were selected for this systematic review. From 1030 patients 71 putative prognostic factors were collected, main findings were higher patient expectation of recovery as a result of physiotherapy (β=-12.43, 95% CI -8.20 to -16.67), higher pain self-efficacy (β=-0.36, 95% CI -0.50 to -0.22), lower pain severity at rest (β=-1.89, 95% CI -1.26 to -2.51). The results of secondary analysis showed that patient expectancy is related to the patient recovery as the patients who expected to recover with the physiotherapy had better results than those who did not expect to recover with the physiotherapy. Conclusion: The available evidence suggests that there is a relationship between high levels of pain self-efficacy, and low levels of pain intensity and disability in patients with shoulder pain.
197 Low Back Pain and Functional Lumbar Segmental Instability , Simone Molinelli
Abstract Introduction: Low back pain (LBP) is usually defined as pain and discomfort, localized below the costal margin and above the infe- rior gluteal fold, with or without referred leg pain. This pain is a common musculoskeletal disorder affecting 80% of people some time in their lives. Low back pain is defined chronic (Chronic Low Back Pain) if the problem persisted for at least three months. Many studies show that specific causes for LBP are un- common, less than 15% of all low back pain. While other studies show that a relevant fraction of a specific low back pain it would in fact be caused by a functional instability. It’s estimated between 15 and 30% of all CLBP. Anatomophysiology: Panjabi, described the stabilizing system of the spine as divided into three subsystems: 1) The spinal column 2) The spinal muscles and 3) The neural control unit; spine stability depends on the complex interplay of these three systems. Disturb in one or more of these three stabilizing mechanisms lead to spinal segments moving outside of their normal range of motion (the neutral zone), causing tissue injury and initiating LBP. There are many important myofascial structure involved in this functional instability: the abdominal muscle, the spinal multifidus, the transversus abdominis muscle, and the pelvic floor. Clinical Presentation and Tests for Functional Instability: The patients with functional lumbar segmental instability have a char- acteristic clinical presentation and there many tests useful in identifying this kind of dysfunction. Conclusion: Many tests, like: prone instability test, passive lumbar test, instability catch sign, painful catch sign, prone Instability test, albeit with considerable differences between them, show a fair degree of reliability in identifying patients with low back pain due to functional lumbar segmental instability.
198 Infusion Media. When? What and How Much? , Bocharov SN, Bocharova YuS, Mankov AV, Golub IE and Sorokina LV
Abstract Topicality: The key link in the perioperative period of treatment of patients with various pathologies and, especially, all kinds of shock states, is infusion-transfusion therapy, the effectiveness of which depends on the functional state of transcapillary metabolism, determined by the value of oncotic plasma pressure - a derivative of the concentration of Total Protein, and not albumin!. The traditional method of correction of hypovolemia/blood loss of any genesis and any volume remains hypervolemic hemodilution, accompanied by excessive administration of crystalloid(Na containing) and artificial colloidal solutions, at the same time, neither the sector of their stay is taken into account, nor the volemic coefficient, nor the features of their clinical manifestation are taken into account and ted. Work: Development of a program for replenishing hypovolemia/hemorrhage, based on the principle of normalization of transcapil- lary metabolism and the justification of infusion solutions used to correct it. Material and Methods: Based on the analysis of infusion media used in the 30-year period of perioperative treatment of surgical and trauma patients, development and justification of the principles of the program of replenishment of blood loss/hypovolemia, based on the normalization of transcapillary metabolism. Criteria for the effectiveness of treatment, an algorithm for correcting blood loss/hypovolemia are formulated and substantiated. According to the results of a comparative analyzes obtained when performing hemihepathecomy confirmed the high clinical effectiveness of the method of blood loss correction based on the normalization of transcapillary metabolism. This method was used and improved by techniques: preoperative blood procurement and postoperative return of drainage blood in the 20-year period of treatment of trauma patients. Conclusion: According to the results of the performed studies, high clinical efficacy has been proven and undeniable advantage, which was as follows: patients who underwent hemihepatectomy were discharged with recovery, and 20 years of experience in the practical use of this program in trauma patients confirmed the absolute effectiveness of and security.
199 Broken Tip of Meniscal Repair Instrument, Removed from the Back of the Knee 15 Months Postoperatively , Ioannis C Vossinakis and Christos I Vosinakis
Abstract Arthroscopic knee surgery is considered to be safe. A recent large study reported a 1.1% risk of complications, although earlier reports had significantly higher numbers, up to 8%. Complications are more common with ACL reconstruction, meniscal repair and meniscectomy. One of the most common complications is the breakage of arthroscopic instruments into the joint. Most of them are identified and dealt with intraoperatively, sometimes with the aid of fluoroscopy. In some occasions, however, the breakage is not noticed during surgery and the broken instrument part is seen in postoperative radiographs. Some authors recommend immediate removal of foreign bodies, especially sharp ones, while others tend to leave those in place if they are asymptomatic. We present a bro- ken tip of an all-inside meniscal repair instrument that remained undetected during surgery, and was eventually removed 15 months postoperatively, when it became symptomatic. To our knowledge, such a case has not been previously reported in the literature.
200 Tele-physio in Covid-19 , Dr. Shakti Mishra(PT)
The importance of using virtual physiotherapy services amongpeople. Survey have shown the 30% more use of online physio-therapy sessions among people during pandemic times [1].As we all are very much aware of the present scenario prevail-ing all over the globe, people have found a new way of living life with all the necessary activities performed digitally in everyday basis. So, when it comes to taking physiotherapy sessions, it has also become a new norm to ask for expert advice through tele-phonic or video consultation as well.Physiotherapy is a field of medicine that requires physical hands on involvement with the client and therapist. But, there are also many techniques that can be done by the client himself by demonstrations and self-help with help of the therapist.
201 Preliminary Scoring Template of a Modified Landing Error Scoring System , Ivana Hanzlíková, Jim Richards and Kim Hébert-Losier
Background: The Landing Error Scoring System (LESS) identifies participants displaying potentially high-risk movement patterns during a double-leg jump-landing (DLJL) task. However, the DLJL has been criticized for not reflecting injury-prone situations in sport. The biomechanics and perceived difficulty of a rotated single-leg jump-landing (SLJLrot) task have shown stronger associations with sport-specific cutting maneuvers than DLJL. Therefore, the SLJLrot may be a better suited task than the DLJL to assess landing “errors”. Objectives: Present a preliminary scoring template of a modified LESS applied to a SLJLrot task. Design: Cross-sectional study. Methods: Whole-body motion was recorded for 42 young active participants (25 males and 17 females) using a three-dimensional infrared camera system during DLJL and SLJLrot tasks. Ankle, knee, hip, and trunk angles corresponding to the original LESS items were extracted for dominant and non-dominant legs from both tasks. Based on the differences in kinematic values between tasks, original LESS thresholds, and current scientific evidence, the original LESS items from the DLJL were modified to suit the SLJLrot task. Results: A preliminary scoring template of a modified LESS applied to a SLJLrot task was developed, including operational definitions of errors and relevant thresholds. The preliminary template consists of 13 items. The minimum and maximum scores are 0 and 12errors, respectively, with higher scores indicating poorer landing biomechanics. Conclusions: The modified LESS may be an appropriate clinical screening tool for assessing sport-related non-contact lower extrem- ity injury risk in athletes. The proposed template and thresholds require further scientific validation.
202 Osteoarticular Maneuvers and Exercises for the Relief of Pain and Restoration of Knee Mobility , Carlos Eduardo Adolfo De Lima, Carlos Hélber Soares Rodrigues De Lima, Guilherme De Souza Farias, Lucas Henrique Gomes Da Silva, Dérrick Patrick Artioli and Gladson Ricardo Flor Bertolini
Injuries involving the knee occupy the third place in the list of those insured by social security in Brazil, among these cases, osteoarthrosis is often one of its causes, being more common in the female gender with onset around 40 - 50 years [1]. Besides osteoarthritis, postoperative (arthroplasties, ligament reconstruction, and meniscectomies) and impairments that have conservative treatment as the choice (femur-patellar syndrome, tendinopathies, meniscal and ligament injuries, and fractures) commonly are causes of pain, joint stiffness, and progressive loss of function [2-6]. In cases of radical treatment, there is an obvious need for early mobilization; however, cases of conservative treatment involving prolonged immobilization or rest also lead to joint complaints. For these cases, joint mobilization techniques such as Maitland’s, Mulligan’s, and McKenzie’s concepts may help relieve pain and stiffness. It is through activation of peripheral (gating theory) and central (descending inhibitory pathway) analgesic pathways, in addition to the temporary increase of space between the joint surfaces, that patients with knee involvement benefit
203 Intermediate Term Results of Total Hip Arthroplasty with Uncemented Acetabular Components for Patients with a Prior Acetabular Fracture , Konigsberg , Nordin, Lackner, Hartman and Garvin
Background: Acetabulum fractures can lead to post-traumatic arthritis necessitating total hip arthroplasty (THA). Some studies have shown higher rates of failure in patients undergoing THA after acetabular fracture as compared to primary THA. Likewise, studies have shown uncemented acetabular fixation has shown improved outcomes in primary THA. Study Objective: This study evaluates outcomes of uncemented acetabular fixation in THA for post-traumatic arthritis following an acetabular fracture. Furthermore, there are comparisons of outcomes between highly cross-linked polyethylene (HXLPE) with conventional polyethylene as well as evaluation of outcomes utilizing different femoral head components. Methods: 78 total hip arthroplasties (77 patients) for post-traumatic arthritis after acetabulum fracture were performed at our in stitution from 1991-2015. Routine follow-up was performed (range 6 weeks to 23 years). After institutional review board approval, patients were asked to return for clinical and radiographic evaluation. Patients who were unable to return to clinic were contacted by mail and telephone. At the time of this study, twenty-three patients were known to have died. Fifty-eight patients (59 hips) had a minimum of 2 year follow up available. Results: Of the 78 arthroplasties performed, 8 (10.2%) underwent revision surgery (3 for instability, 1 for loosening, 1 for wear and trunnionosis, 1 for femoral fracture, 1 for infection, and 1 for persistent pain). Of the 58 patients with a minimum of 2-year follow-up available, the mean follow-up period was 10.2 years (2-25). 6 of the 59 (10.2%) arthroplasties has been revised. The mean Harris Hip Score was 79.6 (33-100). There were 50 HXLPE liners, 8 conventional polyethylene and 1 ceramic liner. These showed no clinical or radiographic difference at any follow up period. There was 1 revision for polyethylene wear at 16 years postoperatively in a patient with a conventional liner.
204 A Review of the Effectiveness of Arthroereisis Implant in Adults with Acquired Flatfoot Deformity , Paolo Ceccarini1, Rosario Petruccelli1, Marco Corzani, Lorenzo Maria Di Giacomo, Giuseppe Rinonapoli, Pierluigi Antinolfi and  Auro Caraffa
The role of arthroereisis in adult flatfoot has been debated for years. Arthroereisis procedures were originally designed for thetreatment of pediatric deformities, that is: correction of the flat foot while preserving foot function, subtalar joint locking deviceinto the sinus tarsi or tarsal canal. The purpose of this study was to review the literature on arthroereisis implants in adults. The literature was reviewed from 2003 to 2019. 13 articles were included in the study. Most were level 4 evidence. Over all outcomeswere good, but the overall study quality was poor. The authors recommend further studies in the topic. Methods: In January 2020 atopical review of the PubMed/MEDLINE, EMBASE database was conducted. This review identified 13 studies focusing on the use ofarthroereisis in adults with flatfoot, for a total of 456 feet in 431 patients, with a mean age of 46.3 years and median follow-up of 35months. Results:: The current evidence for the treatment is limited to retrospective case series. The clinical results are encouragingbut the removal of the implant remains controversial. Conclusion: The degree of recommendation in adults is level IV. There is no consensus related to what kind of implant should be indicated. Finally, to definitively validate the success of arthroereisis procedure prospective and comparative studies are indispensable.
205 Rehabilitation of the Stomatognathic System in Patients with Hemiglosectomy. A Case Report , Montes González Jesús, Peso Florencia, Valenzuela María Eva, Rimoldi Candela, Felice Agostina and Provassi Paula
Introduction: Head and neck cancer includes tumors of the oral cavity, pharynx and larynx, with oral cancer being the eighth most common in the world. The tongue is one of the most common sites of carcinoma oral. The primary treatment of choice for this pathology is surgical by hemiglosectomy. This type of surgery affects the stomatognathic system which ensures the vital functions of swallowing, chewing and communication. As for the rehabilitation treatment, the literature proposes exercises to improve the musculature and mobility of the tongue and the floor of the mouth as well as the jaw. The objective of this study is to describe the evolution of a patient with hemiglosectomia without indication of prosthesis or reconstruction, after having carried out a rehabilitation plan of the stomatognathic system in the external office of higA Pedro Fiorito de Avellaneda. Case Description: Male patient of 32 years with diagnosis of left hemiglosectomy secondary to oral carcinoma. At the initial evaluation, it presents alterations for masticatory and lingual movements and decreased cervical and scar mobility. As for their quality of life and stab altered. There are 2 sessions per week of 1 hour duration with various exercises of elongation, muscle energy, trigger points, active and passive exercises among others. Upon re-evaluation, the patient achieves improvement in terms of the mobility of the altered structures and their quality of life. Conclusion: The present work describes the evolution of a patient with hemiglosectomy after performing kinetic treatment of the stomatognathic system in the external office of higA Pedro Fiorito de Avellaneda
206 Chemotherapy Treatment and Muscle Performance in Women with Breast Cancer , Vitor Alves Marques1
Cancer has been considered a public health problem nearly all over the world, especially in developmental countries. In 2020, approximately 2.26 million of new cases of breast cancer were detected, representing 11.7% of all cancer types diagnosed in women.One of the existing forms of treatment is chemotherapy. Chemotherapy treatmen lasts around six months. There are two types of medications: Anthracycline is used every 21 days and has the function change in flow and transport of cell membrane ions; promote oxygen free radical formation; it has breaking DNA strands and adverse effects are risk of cardiovascular disease. The Taxanes is used once a week and has the function: suppress or inhibit cell growth; they are mitosis inhibitors and adverse effects are nausea, diarrhea and skin rashes. Quality of life is related to subjective parameters that are usually linked to health conditions and with factors that can affect the subject capacity of living a full life.
207 Assessment of the Outcome of Acetabulum Fractures by Open Reduction and Internal Fixation , Vipin Tyagi, Amit Dwivedi, Rahul Kakran, Shriya Garg and Robium Naorem
Introduction: Acetabular fractures are one of the most challenging and complex injuries encountered by the orthopedic surgeons. Because the acetabulum involves a major weight bearing joint in the lower limb, these fractures are of great clinical importance. The main aim in such fracture management is the proper anatomical reduction for the good functioning of the hip joint. Aims and Objective: In this study, our aim is to assess the outcome of the acetabular fractures operated by open reduction and internal fixation with plating. Method: In this retrospective study, we included 30 patients with acetabular injuries who needed surgical intervention as per the indications. The patients were selected according to the inclusion and exclusion criteria. The patients were operated between November 2019 to December 2020 at Yashoda Superspeciality Hospital, Nehru Nagar, Ghaziabad. Result: Follow up of the patients was done at 6, 8 and 12 weeks and 6 and 12 months. The patients were assessed according to the Modified Harris Hip Score. Out of the 30 patients included in this study, 26 patients had excellent result, 3 patients had good result and 1 patient had fair result who developed stitch line infection which was treated with antibiotics. Conclusion: All the patients operated had successful outcome with weight bearing, mobilization, and return to normal life and activities of daily living. Ilioinguinal, stoppa approach and KL approach have good outcome and the choice depends on the operating surgeon and the configuration of fracture.
208 COVID-19 and Hip Fracture Surgical Outcomes: 2020-2022 , Ray Marks
The novel corona virus known as COVID-19 has strongly impacted the delivery of health services, plus the effects of these. Those older adults who are living in the community with one or more chronic health conditions and who sustain a hip fracture, a very debilitating injury in its own right, appear especially vulnerable in this regard in the event they are COVID positive. Reviewed here in narrative form are some recent peer reviewed COVID-19 studies and their most recent findings that appear relevant to examine in light of the ongoing COVID-19 pandemic that continues to target the frail and vulnerable older adult, among others.
209 Anatomical Study of Foramen Ovale and Foramen Spinosum in the Norma Basalis with Clinical Correlation , Varalakshmi KL, Jyothi Nayak and Sangeeta M
Background: The greater wing of sphenoid bone in norma basalis shows two important foramina: foramen ovale and foramen spinosum. Anatomical study of foramen ovale is of great diagnostic importance in trigeminal rhizotomy and transfacial fine needle aspiration techniques. Foramen spinosum is an important foramen used for neurosurgical procedures of infratemporal and middle cranial fossa. Materials and Methods: A total 90 dry adult human skulls obtained from MVJ Medical College and Research Hospital were used for the study. The anteroposterior diameter (length) and mediolateral diameter (transverse) of both foramen ovale and foramen spinosum were measured. The shape of foramen ovale and spinosum were noted and data obtained were analyzed statistically. Results: The mean length of foramen ovale on right side was 7.07 mm and on the left side was 7.09 mm. The mean breadth on right side was 4.81 mm and on the left side was 5.52 mm. Oval shape was the most predominant type on both sides The mean length of foramen spinosum on right side was 2.66 mm and on the left side was 2.58 mm. The mean breadth on right side was 1.42 mm and on the left side was 1.64 mm. Round shape of foramen spinosum was common on both sides. Conclusion: The findings of present study will be of great value for neurosurgeons, radiologists and neurologists for planning and management of surgeries of middle cranial fossa and infratemporal fossa.
210 Effectiveness of Active Release Technique Versus Myofascial Release in Patients with Trapezitis - Mini-Review , Manashi Dey and Shilpi Pal
Neck is a very common region for the cause of the neck pain due to upper trapezius muscle. Majority of people for example about 2/3rd of people experience this neck pain at some points of time in their lives. Prevalence is highest in mid age and women are more commonly affected than the men category. In different studies, neck pain prevalence varies widely with a mean point prevalence of 13% (range 5.9% - 38.7%) and for mean lifetime prevalence of 50% (range 14.2% - 71.0%). Prolonged constrained work position with ley neck or neck-forward bending may imply a risk factor for poor ergonomic habit. Maintaining poor posture for long period of time or sitting in chair in bad posture results in muscle fatigue/fatigues, discomfort or sudden pain eruption. Even-though, if there is no alternation in soft tissues structurally; more significantly prolonged exposure to high static muscle and joint may eventually leads to pathological changes and further leading to permanent disability. This study helps us to identify the effectiveness of the two techniques i.e. Myofascial Release and Active Release therapy/techniques. Active Release Therapy (ART) and Myofascial Release (MFR) are soft tissue manipulation techniques practiced by physiotherapists for reducing muscle spasm and pain.
211 Clubfoot Associated with Nail-patella Syndrome. Evolution and Treatment with Ponseti Method , Ey Batlle Ana Maria, Vinyals Rodriguez Marta and Míguez Gonzalez Paula
Introduction: The incidence with clubfoot, is about 1 to 7/1000 newborns bat its association with Nail Patella Syndrome has never been reported and there are no series of homogeneous treatment of clubfoot associated with this syndrome. Nail-Patella Syndrome is an hereditary onycho-osteodysplasia which has an incidence rate estimated at 1/45.000 newborns. Patients may have hypoplastic or absent patella, dysplastic elbows and iliac exostoses. There may also be renal and ophthalmic alterations. Objective: To evaluate function and quality of life in patient with clubfoot associated with Nail-Patella Syndrome treated by Ponseti Technique, and to describe its results. Materials and Methods: Retrospective study of 4 patients (n = 8 feet) treated by Ponseti Technique. The cases were evaluated with detailed medical history, physical examination, total number of casts made for the foot correction, associated complications, description of associated onychopathies, initial correction obtained (Pirani Score), percentage of percutaneous Achilles tenotomy performed, recurrence rate of relapses, tolerance of abduction braces and morphology and foot function. For statistical analysis Chi-square test have been used. Chi-square tests were used in comparison with categorical variables, and expressed as numbers and percentages. Results: Follow up 4-14y. All cases required between 3-4 casts. All cases required percutaneous Achilles tenotomy. No patient has suffered signs of deformity relapse. According to Laaveg-Ponseti scale, the functional results obtained are 98.6/100. No patient presents residual deformity or complication of any note. Functionally, all 8 feet are painless. Conclusions: Ponseti Technique is a good method for treatment of clubfoot associated with Nail-Patella Syndrome. It obtains excellent results without any need for additional aggressive surgical treatment.
212 Fatty Embolism (Pathogenesis, Treatment)   , Bocharov SN, Mankov AV, Bocharova YuS, Morikov DD, Sorokina LV and Golub IE
Despite the historical antiquity of fat embolism syndrome, its treatment remains a subject of de-bate and one of the significant medical problems, since none of the theories has a key link in its development, by influencing which one can effectively prevent and treat ittreated. In this regard, the aim of the work was to develop the pathogenesis of fat embolism syndrome and determine an effective, pathogenetically based, method of its treatment. Material and Methods: In the main 85 patients who were performed: determination of the presence of fatty globules at various stages of underwent total hip arthroplasty (TETS), the following treatment; dynamics of lipid metabolism markers; cholesterol level; dynamics of bio-chemical criteria that made it possible to formulate the pathogenesis of fat embolism and determine the key link in its development. In 194 patients, studies were performed to determine the most effective method of prevention and treatment with various drug substrates. Outcomes: In 79% of cases, during the performance of TETS operations, patients develop fatty hyperglobulemia. Based on the re- sults of the studies performed, a scheme of pathogenesis of the syndrome of fat embolism/hyperglobulemia was formulated, the key link of which is the insufficiency of a hepatocyte (liver failure), acting on which it is possible to successfully stop its development. Medicinal substrates of prevention and treatment were: the traditionally prescribed solution of Essentiale H (Lipostabil); 5% alcohol solution in 5% glucose solution and pathogenetically based hepato protector “Hepasol A”. Conclusion: According to the results of the studies performed, it was established that the key link in the formation of fatty globulemia is the functional insufficiency of the hepatocyte. The use of a 5% solution of ethyl alcohol diluted in a 5% glucose solution is al-most identical in clinical effectiveness to the amino acid hepato protector, but with strict adherence to the technology of its use (calculated dosage of 0.5 g/kg of body weight is administered during the day)! Traditionally prescribed and used solution “Essentiale H” has neither clinical nor laboratory significance.
213 Effectiveness of Pelvic Floor Exercises Along with Faradic Stimulation on Bladder Retention and Quality of Life in Post-operative Case of Cauda Equina Syndrome. Case Report , Shiwani Nitin Redij, Apoorva Ambolkar and Gaurish Kenkre
Cauda equina neurological condition caused by compression of the cauda equina, mainly secondarily to massive prolapsed intervertebral disc. Approximately 45% of cases of Cauda equine syndrome (CES) are due to herniated lumbar disc. CES is a rare but devastating condition [1]. The presentation of CES can be acute or chronic but maximum of patients present with sever back pain and radiculopathy. About 62% of patients report a recent and/or old episode of trauma [2]. Symptoms of CES are low back pain, unilateral or bilateral sci- atica, sensory loss of the saddle area, motor deficit and/or loss of reflexes of the lower limbs, micturition dysfunction, defecation complaints, and/or sexual dysfunction [1]. In CES with retention there is damage below the micturition reflex center which affects some or all of the nerves in this region, depending on the type of lesions [3]. If all nerve roots are affected, the condition of a contractile detrusor and sphincter occur.
214 Effect of Knee Extensors Strengthening Versus Hip Posterolateral Musculature Strengthening with Ankle Dorsi Flexors in Patellofemoral Pain , Shweta Suryvanshi and Nikhil Kumar Rana
Background: Patellofemoral Pain Syndrome (PFPS) is an umbrella term used for pain arising from the patellofemoral joint itself, or adjacent soft tissues. The knee consists of two major joints tibiofemoral and patellofemoral commonly affected as patellofemoral joint pain with lower extremity dysfunction that physiotherapists and sports specialist rehabilitate. Mostly the anterior knee pain was caused by joint stress at the patella. This may be occured by chondromalacia patella or malalignment of the femur during recreational activities. Rehabilitation mainly focus on relieving pain maintaining the momentum positioning of the patella on femur and may incorporate quadriceps reinforcement, coxa and back extensor muscle strength training knee flexors and stretching exercise of iliotibial band, patellar glide, taping on patella, external aids for lower base, and pelvis manual therapy intervention. Objective: Main aim: 1. To analyze the outcome of quadriceps muscle build up versus abductors and extensors group of muscle with dorsiflexors muscle of ankle joint training on betterment of genus activity and having ache in runner’s knee pain patient. Another aim: 2. To decide the potency of genus quadriceps muscle reinforce training on measure of functional activity and having stress pain for subjects with anterior knee pain condition.  
215 Relationship Between Body Composition and Body Mass Index in Obese Women   , Mohamed Ridha Guedjati, Khaoula Lachekhab and Abdelaziz Adjali
Objective: The aim of our work is to study the links between anthropometric parameters and body composition obtained by bioelectric impedancemetry in case of obese women of peri- menopausal age. Method and Materials: 154 obese women were classified according to their degree of obesity according to WHO criteria. The analysis of body composition was performed by impedancemetry. Pearson’s (r) and Spearman’s (r2) correlations were calculated to check the relationships between age, weight, BMI, as well as total and segmental body fat composition. Results: 154 women of mean age 40.20 ± 13.13 years, obese, mean BMI 38.66 ± 6.56 Kg/m 2 participated in our study. Impedance reduced an average total fat mass% (TFM%) of 45.39 ± 5.67%. BMI is strongly correlated with TFM% (r = 0.73; r2 = 0.82; p ≥ 0.05). For obesity stages 1-2, weight is correlated with BMI (r-r2 > 0.40; p ≤ 0.001). Likewise, a strong correlation exists between weight and TFM in Kg (r2 = 0.82; p ≥ 0.05). For a BMI ≥ 35 Kg/m2, weight is inversely correlated with age [r2 ≥ (-0.36); p ≤ 0.003]. The FM of the trunk (Kg) is correlated with the weight for obesity grade 3 (r = 0.49; p = 0.0002) and whatever the stage of obesity at the BMI (r ≥ 0.32; p ≤ 0.02). Conclusion: The use of bioelectrical impedancemetry in the diagnostic management of obese people is quite useful. This tool gives us better information on the location and distribution of fatty tissue .
216 Evaluation of Various Modalities of Surgical Treatment of Distal End Radius Fractures in a Tertiary Hospital in Bangalore , Yogesh, Anil Chowdary, Ambreesh, Arvind JD, Yashwant and Sneha
The fracture of the distal radius is the most common fracture encountered in daily practice. Besides, these fractures are also reported in elderly osteoporotic patients. If these fractures are not assessed properly and not treated on time, angulation, shortening and articular incongruity may lead to permanent deformity and loss of function. The degree of disability is highly correlates with degree of residual deformity in elderly patients. There is no consensus with regards to the optimal management of these fractures and lack of scientific evidence to allow definitive conclusions concerning the main aspects of managing distal radius fractures. In this context of the research gap, the present study was undertaken to compare the functional  outcome of treatment fracture distal end radius with various surgical modalities i.e. closed reduction and percutaneous K-wire fixation under C-arm guidance with post opcast immobilization, Ligament taxis and stabilization with external fixator, Open reduction and internal fixation with Dynamic Compression Plates, Locking Compression Plates and Buttress Locking Compression Plate. The Mean age of patients was 37.21 years. 48 (82.75%) males and 6 (10.34%) females were considered for the study. Left side was involved in 28 cases (48.27%), right in 22 cases (37.93%), 4 (6.89%) patients had both wrist fractures. Using AO classification, study shows better outcome with plating or k wiring for A2 type of fractures, K wiring or Ex Fix for type A3, Plating for B1, B2, B3, C1 type, External fixation for C2 type, Plating or Ex fix+ k wiring + Plating is preferred for C3 type. The functional outcome after fixation of distal radius fractures depends on patient’s age, fracture anatomy, displacement, reducibility, stability and articular incongruity of fractures. They are related more to the quality of anatomical reduction than to the method of immobilization. Volar locking plates are safe and effective option for unstable fracture types.
217 Extended Use of Smartphone Technology Cause Repetitive Upper Limb and Related Stress-strain Injuries and it’s Impact on Home-isolation Covid-19 (Pandemic) Affected Population: Short Communication , Manashi Dey
COVID-19 pandemic has resulted in a devastating threat to humans primarily in terms of lifestyle, economy and health and, majorly affecting the mental health, posture, associated pains mainly upper body pain, low back pain or joint pains and accompanied with lethargy and high amount of exhaustion. Population, who were mild-moderate affected were asked to be bed rest with prophylactic treatment and on home-isolation, if affected severely, were admitted to hospital setting for antibiotic therapy. Set of people who were into home-isolation, however, due western society lifestyle behaviors like physical inactivity and sedentariness made them more inclined towards cellular technology. Due to this pandemic or otherwise this “smart-cellular technology” has made a strong hold in ourselves. The usage of smartphone technology has increased drastically during the national lockdown to keep themselves updated in terms of health information, education, socialization, banking solution, household remedies. With this usage of smartphone technologies came up “Text Claw”, Blackberry Thumb or WhatsAppitis or “prolonged-phone-posture” leading to neck, elbow, wrist or finger referred or primary pain areas, further damaging any particular nerve or leading to syndrome like conditions. The usage of smartphone technology is greatly aggravated by the containment measures imposed to control the expansion of the pandemic.
218 Acupuncture for Bone Disease Treatments, Modern Approaches   , Jin-Yu Che and Da-Yong Lu
Human bone diseases ask for high-quality surgery, and effective food and drug treatments [1-16]. High levels of disease diagnosis, interventions and therapeutics call for excellent therapy for a lot of patients. Acupuncture is very important for bone disease treatments in China [16,17]. Acupuncture can support almost all areas of these bone treatments and recovery. This editorial provides new acupuncture approaches in modern medicine. Acupuncture History Acupuncture has a long history in China (> 2000 years) [18]. It was never interrupted across the history in China. It was as long as herbal medicine. Therapeutic Perfection Acupuncture is different from modern medicine and medical tradition of other countries. It can be very useful for human bone disease recovery and treatments. Entering into new era, we should promote acupuncture study and clinical application in a systematic way. Treatment schedules and protocols (temperature, treatment duration, electric-supportive and others) need to be  customized [19-21] and cooperative ways (personalized medicine)
219 Assistive Technology and Environmental Modifications to Enhance Abilities and Function , Anu Arora
Modern Technology in varying levels of sophistication can be utilized to assist and enhance human functioning in day-to-day tasks. The essence of a truly egalitarian society lies in its inclusivity, and the recent advances in technology, are not just making life easier for the able bodied, but are also providing crucial assistance for persons with varying level of disabilities to enhance their function at individual level and constructive participation at the community level. Assistive products and technology refer to an umbrella term for both assistive products/devices and related services: instrument, equipment, or technology adapted or especially designed for improving the functioning of a person with a disability such that it compensates for absent or impaired abilities. Assistive Technology (AT) enables the subjects to accomplish not just their activities of daily living (ADLs) but also tasks of occupations and roles. AT can assist in: Self-maintenance, Self-advancement and Selfenhancement. Basic ADLs can be assisted by ATs such as electric toothbrushes and electric shavers, which can increase competency with personal care tasks.
220 Investigation of the Surface Properties of Glass-ceramic Materials During their Binding with Albumin   , Andrii Sherehii, Vasyl Stoyka, Jurii Meklesh, Ivan Pushkash, Mikhail Vasilinec, Oksana Savvova and Vitalii Kochmar
The study of the interaction between physicochemical and hemocompatible characteristics of biomaterials is extremely important in the field of creating medical devices that contact with blood, including implants. It is known that the adsorption of proteins is the first stage of blood interaction with a foreign surface. The aim of the study is to observe the influence of surface structure of bioactive glass materials on their ability to bind to albumin. Materials and Methods: The production of the test material took place in accordance to standardized instructions in the conditions of a certified laboratory as part of the at the Department of Ceramics, Refractory Materials, Glass and Enamels Technology of the National Technical University “Kharkiv Polytechnic Institute”. The surface energy of solid bodies cannot be evaluated directly by the value of the surface tension parameter, as there is no movement of molecules on their surface. The wetting edge angle was measured statically and calculated by the sediment drop method. Toxicity of implants based on developed materials was assessed at the Sytenko Institute of Spine and Joint Pathology, “National Academy of Medical Sciences of Ukraine” on the basis of dynamics study of content in raw materials of blood of the common protein, urea and activity of enzyme alanin-aminotransferase (ALT). The ALT was determined by the kinetic method, the total protein content - biuret method, urea content - enzymatic method. Statistical analysis of the obtained indicators was performed using software packages Microsoft Excel and Statsoft Statistica 6.0.
221 NJR Data Impact on a Outlier District General Hospital Learning from Failures   , Vineet Trivedi, Nayani Punati, Shuhong Biswas, Mareeta Oorloff, Timnit Tekie and Ashwin Unnithan
NJR has been collecting data since April 2003 - data submission for NHS organisations has been mandatory since April 2011. The largest orthopaedic device registry in the world with over 3 million records which feed into Model Hospital and GIRFT Improvement support programmes. Methods: NJR has been able to present joint replacement data up to 15 years of follow up, offering hospitals, surgeons and patients’ invaluable opportunities to understand the factors that influence outcome and longevity of joint replacement procedures. NJR data creates the ability to drive forward change, influence best practice, undertake important research and maximise patient safety. NJR data collection and processing are fully compliant with GDPR and Common Law Duty of Confidentiality [1-7]. Result: Our hospital has been an underperforming unit since 2009 as per the NJR data for Knee Revision surgery both TKR and Uni compartmental we have used the service which NJR has offered since 2015 and we have been able to successfully able to turn things around, we are well within the curve of successful units, we would like to share our journey and progress and would like to thank NJR for their  ontinued support.
222 24-year Old Female Athlete with Ischiofemoral Impingement Treated Successfully with Ultrasound-guided Injection: A Case Report + Literature Review , Anaïs De Vroey, Thomas Mathieu and Gaëtane Stassijns
We report a case of a 24-year old female with Ischiofemoral impingement (IF). This pathology is a rare cause of groin or buttock pain due to the impingement of the quadratus femoris muscle between the lesser trochanter and the ischial tuberosity of the femur. A review of the literature identified 33 studies of IF. The diagnosis is dependent of imaging and clinical features. Treatment relies on conservative measures and infiltrations. If these measures fail, surgery should be considered. IF is clearly an underdiagnosed problem, the authors conclude that it is important to recognize and treat this pathology.
223 Effect of Early Intervention in an Infant with Erb’s Palsy   , Mythili Kasthurirengan
Erb’s palsy is a type of weakness or paralysis of muscles of upper limb due to traction injury to brachial plexus mostly during birth. Severity of symptom is based on level of injury. It is also sometimes called brachial plexus palsy. The mode of injury is mostly traction of head and neck at the side when the shoulders are passing through the birth canal during labor in head first delivery. But can also occur due to forceps delivery injury or vacuum extraction injury, breech presentation or when pulling the arm forcefully after birth. In case of mild and moderate level injury this condition improves in time, but some kids can have permanent complications if left untreated. Here an infant with of Erb’s palsy during birth and effect of early intervention on that infant is presented. The location of injury is the point where C5 and C6 form the upper trunk which is also known as Erb’s point. The nerves affected are, supra scapular nerve (C5, 6), axillary nerve (C5, 6) and musculocutaneous nerve (C5, 6, 7). Muscles affected are from proximal supraspinatus, infraspinatus, serratus anterior, deltoid, biceps and brachialis. Thus this condition affects shoulder external rotation, abduction flexion and elbow flexion and supination. Due to opposite muscle pulling the arm will end up in adduction, internal rotation elbow extension and forearm pronation. This position is classically known as waiters tip position or policeman tip hand. It is important to understand the anatomy for diagnosis and proper management. With proper intervention many children can attain normal or near normal functions by 6 to 7 months of age but the injury can take up to 2 years to recover full.
224 The Role of Martial Arts Means for the Therapeutic Recuperation Programs   , Polevaia-Secăreanu Angela
Background: The contemporary lifestyle evolution is followed by a progressive abandon of physical activities in day by day life, this fact leads to an epidemics of obesity and increase of chronic diseases such as cardiovascular and locomotor diseases. Methods: The study was established on the basis of an retrospective analysis of the special literature and scientific documents which represent the experimental data made by various medical clinics worldwide on various population. Results: The conducted retrospective analysis of the musculoskeletal system in school and student age in different countries has shown that during the study period there is a dynamics of increasing detection of disorders of posture, hearing, vision. Also, a nu- mber of characteristic disorders of the musculoskeletal system have been identified, where in the first place are various kinds of morphofunctional disorders of the spine, scoliosis of I-II degrees and osteochondrosis in the initial stage and other pathologies. Furthermore, types of interventions that have been tested in different medical clinics have been analysed, most of them with minimal or no outcome. According to the data on the application of martial arts tools, the therapeutic effect of Pilates, Yoga, Qigong, Wushu and Tai Chi tools has been highlighted. Of all the martial arts systems presented by the authors, Tai Chi reported a particularly mul- tilateral effect. Conclusion: The present study can lead to the conclusion that the martial arts means and Tai Chi in particular represent an universal method of restorative physical education. Tai Chi gymnastics brings to normal all body vital processes, it is recommended not only for disease prophylaxis but also for the treatment of some cardiovascular system, digestive tract, locomotor apparatus diseases.
225 Could Use of Autologous Interleukin-1 Receptor Antagonist Fasten the Return to Sport Time after Sustained Medial Collateral Ligament Injury? Case Series Report , Bartłomiej Kacprzak and Natalia Siuba-Jarosz
The medial collateral ligament (MCL) is the most common knee ligament to be injured during knee trauma. In this paper, we present the conservative treatment of 5 elite football players who sustained MCL injury between May 2020 and October 2021. To help to fasten the injured ligament to grow biological treatment using Orthokine was administered. Patients underwent supervised rehabilitation from the first day after diagnosis, with the according protocol. After 2-3 weeks, MRI was performed. MRI for all patients showed gradual resolution of ligament oedema, ligament remodeling and reabsorption of the fluid All of the football players in this cohort returned to play within a relatively short period, which suggests that the rehabilitation regimen was good and in helped to RTP faster than what previous studies have reported after isolated MCL injuries. The results may suggest that use of an autologous interleukin-1 receptor antagonist can be a factor that can shorten RTP time.
226 The Use of EOS Imaging to Assess Curve Magnitude Changes in Adolescent Idiopathic Scoliosis Undertaking Brace Management , Gatehouse SC, Izatt MT1, Labrom RD, Askin GN, Grant CA, Pivonka P and Little JP
This study aimed to investigate the use of EOS (bi-planer) imaging and SterEOS reconstruction software to study the efficacy of spinal bracing in adolescent idiopathic scoliosis (AIS). EOS images of scoliosis patients being treated with bracing were obtained both in and out of their brace. These images were processed using SterEOS software to allow 3D representation, which was then compared to traditional coronal 2D parameters. Over a 12-month period 29 patients were recruited for participation. Of these participants, 25 had a single episode of EOS imaging out of and in their brace. Additionally, 19 of the 25 participants had further episodes of EOS imaging within the study period, separated by mean 144+/-44 days. This allowed a total of 44 EOS single scan episodes for parameter analysis out of, and in the brace. Longitudinal analysis was also performed on the 19 patients who had sequential scans. Participants were mean 13.8 ± 1.1 years old at the first scan. Coronal 2D parameters, specifically Cobb Angle measurement, were accurately reproducible with SterEOS 3D measurements. Across all EOS scans (n = 44) the mean major coronal curve measurement was 42.3 ± 13.3° out of brace and 37.2 ± 13.8° in the brace. This produced a mean correction of 4.6 ± 4.4° (p < 0.05). The correction achieved in this cohort with bracing appeared more modest than those reported in previous studies using traditional 2D coronal curve measurements [1-3]. The mean axial vertebral rotation (AVR) was 10.6 ± 7.1° out of the brace and 9.6 ± 6.8° in the brace, with a mean correction of 1.4 ± 5.3°(p = 0.14). The current study results suggested no significant change in axial vertebral rotation with brace treatment. Notably, in 17 of the 44 AVR measured, the differences were negative. That is, the AVR worsened in the brace. There was a significant moderate correlation between 3D coronal Cobb angle measured and AVR measured out of the brace for all curves. However, the change in Cobb and change in AVR with bracing did not correlate.
227 Hamstring Weakness: A Sequel of Cerebrovascular Accident   , Binuyo Overcomer and Adejimi Olaolu
Cerebrovascular accident (CVA), commonly known as stroke is a condition that results from infarction of neurons in the brain due to vascular compromise. It is a highly prevalent disease, a leading cause of death and long-term disability. The most frequent sign after stroke is muscle weakness which leads to loss of functions in the upper or lower limb. The most frequently affected muscle groups are the extensors of the upper limb and flexors of the lower limb. The muscle group of interest is the hamstring muscle group. The mechanism of muscle weakness in stroke can be neural or structural. The hamstring muscles are the muscles responsible for knee flexion. Knee flexion in humans is essential to the performance of major lower-limb functions which include walking, transfers, standing, stair climbing and so on. Physiotherapy management is indicated as a major part in the rehabilitation of post-stroke paresis (muscle weakness). There are several physiotherapy modalities employed in the management of paresis including passive exercises, mirror therapy, electrical stimulation, mental practice, functional electrical stimulation, task specific training among others. In Conclusion, at different levels of hamstring muscle power (Oxford muscle grading) among stroke survivors, there are effective physiotherapy management techniques to address that. The goal is to improve the muscle strength with associated increase in functional level and ultimately increase in societal participation for community integration.
228 A Literature Review on Importance of Speedendurance Assessment for Soccer Players   , Monika G, Amirtha varshini S, Priyanka R, M ManiKumar and J Muthukumaran
Background and Aim: Speedendurance is a key component to success in many sports which is especially vital to sports that have a large playing surface and is of great importance in soccer players at different competitive levels. For the estimation of sprint speedendurance applies a speedendurance test to obtain data on the efficiency of performance that is maximal for the soccer players. The aim of this literature review was to know the importance of speedendurance assessment for soccer players. Methods: Literature searches from 2010-2019 were collected in this study. Totally 7 articles are finalized on the bases of selection criteria. The articles selected were randomized controlled trials and systematic reviews which are published in English language. Results: The present review article shows the benefits and detail procedures of speedendurance assessment by means of 3 important tests for soccer players. Conclusion: The study concludes that speedendurance assessment is a great pre-season test for individuals and teams to perform, the article suggested that this speedendurance test has effect in assessing speedendurance performance among soccer players.
229 Cancer Bone Metastasis, Diagnostic Insights and Drug Selection   , Da-Yong Lu, Bin Xu and Jin-Yu Che
Cancer bone metastasis was common clinical events to many human cancer, such as breast, prostate and lung cancer. It is a devastating event that is difficult to therapeutic targeting and benefiting. Several reasons are major factors and drawback for disease management and therapeutic cure. To promote clinical treatment outcomes of bone metastasis, high-quality diagnosis and drug selection is indispensable. This editorial discusses bone cancer metastasis diagnosis and relevant therapeutics in the clinic.Cancer is the secondary leading cause of human mortality worldwide [1-4]. Cancer metastasis is one of frequent cancer metastasis events and mortality worldwide (90% cancer mortality) in the clinic, especially to categories of breast, prostate and lung cancer (general incidence >30%) [5-10]. To reduce the devastating pathogenesis and human mortality, high-quality disease diagnosis and clinical treatment is indispensable. This editorial discusses the landscape of bone cancer diagnosis and drug selection in the clinic.
230 Effectiveness of Stretching Exercise in the Treatment of Plantar Fasciitis-A Review of Literature , Shilpi Pal, Syeda Khanam and Priyali Priyadarsini
Plantar fasciitis is one of the most common cause of heel pain it is a Common musculoskeletal foot disorder involving pain and gait problems. It mainly occurs during the middle age of 40 and 60 years in general population with prevalence of 11-15% [3]. The causes of this disease is not clear but the most common theory say that it is due to repetitive micro trauma and chronic inflammation of the plantar fascia inserted on the medial tubercle of the calcaneus. The major contributing factors related to plantar fasciitis are Obesity, biomechanics of foot disturbances, poor foot wear, work related activity and over exertion. Overuse activity is the most common cause of injury such as running and jobs with prolong standing this will increases risk of micro trauma of the fascia. The normal presentation of plantar fasciitis includes gradual, insidious onset of inferior-medial heel pain of the insertion of the plantar fascia worse with rising morning or after prolonged weight bearing activities and exacerbated by climbing stairs or doing toes raises.
231 Prevalence and Causes of Injuries in a Number of Women's Sports , Konstantin Anatolyevich Bugaevsky
The article presents the results of a study aimed at identifying the main causes and types of injuries, both during training and during the competitive period, among female athletes of different age groups involved in a number of types of modern women’s sports. Injuries and injuries of the musculoskeletal system of athletes are considered, with the involvement of the bones, ligamentous- tendon and muscular apparatus of athletes in the traumatic process, primarily the girdle of the upper and lower extremities, the chest, various parts of the spine, as well as the soft tissues of the body. According to the results of the study, it was reliably established that among all types of sports injuries in athletes of the studied groups, sprains and dislocations prevail - 1108 cases, in 67.44% of female athletes, as well as soft tissue injuries of various parts of the body - 973 cases or 59.22% of all female athletes. There was also a history of bone fractures in various parts of the body, mainly in the upper and lower extremities - 25 cases, or 1.52% of all female athletes studied. Also, it was found that muscle pain of different localization was detected in 1525 (94.54%) of all athletes; joint pains of different localization (mainly in the knee, elbow, shoulder and ankle joints) - in 1478 (91.63%); pain in different parts of the spine (most often in the neck and lumbosacral) - in 1548 (95.97%) female athletes. According to extended interviews, the most common causes of injuries are etiological factors such as violation of basic safety requirements - in 1007 (61.29%); insufficient duration and volume of the warm-up, when performing the necessary set of exercises - in 804 (48.94%) athletes; lack of proper control on the part of the coach, when performing this or that technique/exercise 619 (37.68%) cases of injury to an female athlete. In addition, it was found that the greatest number of all types of injuries was recorded among young athletes with little sports experience.
232 Analysis and Assessment of Injuries Resulting from Electric Scooter - A Review Article , Abhishek Thanuja Jayadhar, Vineet Trivedi, Roshan Chirakka, Dheeraj Panchaksharam Selvarajan and Ashwin Unnithan
We have noted the changing patterns of injuries which are resulting from the usage of electric scooters, since its introduction since 2014 it has gained popularity both because of its ease and its low economic burden, this had led to a surge in its usage which range between 4 years to 74 years, this wide age group in usage have resulted in a varied patterns of injuries which we have evaluated and discussed in this paper we have noted that the Head injuries are commonest followed by Upper Limb injuries, the risk of serious intra-abdominal injuries are on a high as the speed of these vehicles have increased leading to an acceleration and deceleration pat- tern of trauma.We have noted that with increasing age group and with more patients on anticoagulant therapy the complexity of trauma increases, the higher risk of rib fracture, liver lacerations and splenic injuries are on an increase and it is a matter of concerns as most of these vehicles operate on the pavements which increases the risk of injury to the pedestrians infact there are studies which have documented the increasing number of susceptible pedestrians. We at our center at ASPH which is a tertiary frame unit for the region have been referred with patients around the region with an atypical tibial plateau fracture in younger age groups which we mostly see in high-speed road accidents, this has led to a higher number of circular frame surgeries in our unit.
233 Physical Activity at Home to Optimize the Physical and Mental Health of the Liceista Students , Lcdo Roberto Andrés Rojas Bajaña, MSc León López Luiggi Wladimir, Mgtr Giovanni David Álava Magallanes, Mgtr Luisana Isabel Plaza Criollo and MSc Luis Alberto Saltos Aldaz
This research paper presents the ways and means of implementing good body practices in times of Covid-19 in Ecuador, the same ones that the World Health Organization points out to keep the world population physically active. In addition, the purpose is to develop a proposal of activities and physical exercises through a Flipped Classroom methodology in the Physical Education sessions to optimize the physical and mental health of the students of the Naval Lyceum of Guayaquil. In this way, motor activities were applied within the weekly pedagogical file according to the physical possibilities, age and appropriate to the context “at home” of the students, where the use of educational and audiovisual technologies is combined in  synchronous sessions using Google Classroom and in synchronous sessions online by zoom to participate in motor actions online and in a directed way.
234 Barriers to Community Re-integration of patients with Spinal Cord Injuries , Sabah Thaver
Community (re-)integration (after/with (physical) impairment or disability) is acquiring/resuming age-/gender-/culture appropriate roles/statuses/activities, including independence/ interdependence in decision making, and productive behaviours performed as part of multi-varied relationships with family, friends, and others in natural community  settings”. This definition fits well with the International Classification of Functioning,Disability and Health (ICF). Spinal cord injury leads to changes in typical motor, sensory or autonomic functions. It is a high-cost debilitating condition that brings a considerable number of changes in the life of the affected patient and those around him/her and has a broad impact on medical, social, psychological, and economic conditions for those directly affected, their paid and unpaid caregivers, and the community they live in
235 Intramedullary Osteosynthesis of Clavicle Fractures , Nosivets DS
Clavicle fractures account for 3% of closed fractures of the tubular bones and are typical for persons of young working age. Fractures of the middle third account for 75%, lateral 20%, and medial 5% of all clavicle fractures. Most often, the treatment of these injuries requires open reduction and internal fixation with internal fixation, or much less often an external fixation device is used [1-3]. Intramedullary fixation of clavicle fractures has not found proper application due to the S-shape form of the medullary  canal and the migration of the intramedullary implant. Axial and rotational instability of the “bone-implant” system is also considered to be a traditional disadvantage of intramedullary osteosynthesis. The use of a cancellous screw for clavicle fractures in most cases eliminates these shortcomings. The aim is to present a method of intramedullary fixation of clavicle fractures with a cancellous screw.
236 Effect of Mirror Therapy on Lower Limb Functions and Balance in Hemiparetic Patients , Rucha Choudhari, Simran Vohra and Trupti Siddapur
Background: Leftover weakness of muscles leading to synergies and spasticity usually make stroke survivor to adapt an inactive way of living, which further restricts the individual’s routine activities. These initial neurological deficits results in balance alteration leading to risk of fall and abnormal gait. Neurological disorders based on ideal motor control models and on motor learning theories help in regaining functional movements of the affected lower limb. Attempt to reduce the influence and enhance functional outcomes after a stroke thus, pose a major challenge for rehabilitation experts. Its been recommended that the mirror therapy is an easy, economical and patient governed treatment approach which enhances hand function. Aim: To find out the effect of mirror therapy on lower limb functions and balance in patients with hemiparesis Materials and methods: 30 subjects (<70 years) with one episode of stroke having 1-2 grade of spasticity according to modified Ashworth scale were included in the study. Fugl Meyr Assessment for Lower Extremity and Berg Balance Scale were used to assess motor function and balance. Subjects were given conventional physiotherapy along with mirror therapy Results: results of the study showed improvement in lower limb function and balance Conclusion: from this study it can be concluded that mirror therapy can be used in conjunction with convention physiotherapy for stroke patients.
237 Tele-rehabilitation and its Efficacy in Knee Osteoarthritis - Pilot Study , Shilpi Pal and Manashi Dey
Osteoarthritis (OA) is one of the most common, chronic and degenerative musculoskeletal joint disease/condition spread worldwide. Characterized by degeneration of cartilage and its underlying bone. Progressively, there will be loss of articular cartilage and remodelling of the underlying bone. Associated with significant health and welfare costs. OA condition has a major cause of pain and joint stiffness in especially elderly group. The specific causes of OA are still unknown. The onset of the disease is gradual and usually begins after or in the 40s, favouring obesity, advancing age and female gender. At some point, everybody will be affected by primary osteoarthritis, if we all live long enough. Rapid evolution of the technology,  healthcare professionals began to adapt to this new evolution and then came into the practice of Tele-rehabilitation or Tele-consultation (telephone, skype or zoom) that involves the use of information and communication technology to deliver health-care services to people remotely in their home or other setup, outside the rehabilitation clinics, which is potentially associated with geographical isolation, reduced waiting and travel time and consequently reduced treatment expenses and flexibility. Services like therapeutic interventions, remotely monitoring the progress, patient education, consultation, training and people networking. With advancement of technology and high prevalence of OA, there is need to spread awareness about the disease, its prevention, and rehabilitation in the community.
238 Evidence Based Physiotherapeutic Concepts and Approaches on Improving Functional Hand and Arm Activities for Stroke Patient , Shubham Sharma, Neha Gupta, Shubhi Kulshrestha and Sukriti Raj
Background: Stroke is a neurological disease. Half of the stroke patients are left with disability. Most of the stroke patients are able to walk independently but more than 50% of the patient will not recover their hand functions. Upper extremity functional recovery is slower than lower limb functional recovery. Objective: There are several protocols which we are used to rehabilitate the upper limb after stroke, through this study we can find out the latest technique and the most effective technique at the present time. Search Strategy: Various articles have been studied to create this literature review. The database was probed from various journal sites such as PubMed, Science Direct, Research Gate, Cochrane and Google Scholar. The articles were identified with keywords such upper limb rehabilitation for stroke, PNF for upper limb stroke rehabilitation and Bobath therapy. Results: Total 10 studies were identified with different protocols to improve functional hand and arm activities for stroke patient. There are many concepts and approaches which are evolved during time and produce great output in the rehabilitation of upper limb. Concept used in postural control and integration of the task performance of the sensory information for the motor control and the perception will improve at the cortex level. Conclusions: Through all the studies, every concept and approach gives significant improvement on each other. The latest technologies like electrical stimulator are more focused from last 5 years while CIMT shows better results in comparison with other studies for the rehabilitation of the upper limb recovery.
239 Brief Visualization of Democracy and Human Rights in Ecuador from 1972-2020 , Lcdo Roberto Andrés Rojas Bajana, Mgtr Daniel Augusto Moreira Caceres, MSc July Elizabeth Fabre Cavanna, Lcda Yesenia Mariela Moran Chacon and MSc Roberto Arturo Rojas Vera
The following study aims to develop a brief analysis through a documentary, theoretical and descriptive study that manages to gather accurate content on democracy and human rights in Ecuador. The methodology used is mixed, quantitatively Google Drive digital surveys were used and in this way statistical data was obtained, qualitatively documentary research content is presented, the same one that compiles different texts from books, articles, scientific magazines, articles of newspapers, information from educational texts, among others, to process the information obtained, organize it and provide an analysis. Therefore, one of the main results is that political parties through the media influence society, they are also observed in question No. 14, if there is democracy today? where 58% said yes, while 42% said no. Finally, in conclusion, the presidential commands due to the economic crisis have taken measures that directly affect the Ecuadorian people such as: fraud, deception, administrative failures, economic crises, which have a greater impact on the most vulnerable sectors, due to this the population feels that equal rights do not exist as part of an equitable democracy.
240 Surgical Treatment Of Congenital Cholesteatoma of Middle Ear at Children , Ivan Baljošević, Ognjen Milicevic and Stefan Popovic
bjectives: Congenital cholesteatoma presents pathological lesion that develops behind intact membrane tympani. Objective of this paper is to present our experience in diagnostics and treatment of congenital cholesteatoma at children. Material and Methods: Our study represents a retrospective review of 17 children who underwent surgery for congenital cholesteatoma from 2012. to 2019. at the ORL Department, Mother and Child Health Care Institute, Belgrade, Serbia. All patients had congenital cholesteatoma present on one ear. Diagnoses were made from between 3 months to one year after presentation (an average of 6.3 months). Basic criteria in diagnosis of congenital cholesteatoma were presence of white mass behind the intact timpani membrane with no data on otorrhea, perforation of membrane timpani or surgical interventions. Staging of the cholesteatomas was based on the classification suggested by Potsic. Results: Congenital cholesteatoma confined to the middle ear cavity was present in 16 (94%) patients, the majority of whom had involvement of multiple quadrants (9 patients or 57%), in 4 (25%) cases CC was localized to the posterior quadrants, in 2 (12%) to the anterior quadrants and in one (6%) case to the anterosuperior and posterosuperior quadrants. One case involved congenital cholesteatoma confined to the mastoid cavity. Preoperative contralateral middle ear disease was absent in 12 (70%) cases, whereas secretory otitis media (SOM) was identified in the contralateral ear in 3 (18%) cases and adhesive otitis in 2 (12%) cases. The following surgical interventions were performed: tympanoplasty type I in 3 (17%) patients with congenital cholesteatoma localized to the anterior quadrants, radical modified tympanomastoidectomy (canal wall up) and tympanoplasty type II in 5 (30%) patients, canal wall down mastoidectomy and tympanoplasty type III in 8 (47%) and simple (cortical) mastoidectomy in 1 (6%) patient (where the cholesteatoma was confined to the mastoid cavity). All patients were followed up 24 ± 6,4 months postoperatively. Recurrent cholesteatoma was diagnosed in 2 (12%) patients, one in a patient who had CWU and one in a patient who had CWD mastoidectomy performed. In both cases a small aplastic poorly pneumatized mastoid was encountered during surgery and both patients had concomitant contralateral middle ear disease (SOM and adhesive otitis media respectively)
241 The Use of Allograft in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis , Kedar Padhye, Jonathan Howatt, Andrew Gilyan, Ron EL-Hawary and Benjamin Orlik
Posterior spinal instrumentation and fusion (PSIF), with bone grafting, is the most accepted surgical treatment in Adolescent Idio-pathic Scoliosis (AIS). Many different options are used as a bone graft, but the difference in the rate of infection and pseudoarthrosis has not been fully documented. This study aimed to compare the outcomes of the use of the allograft in adolescent idiopathic scoliosis (AIS) compared to no graft or autograft alone. A literature search was performed in PubMed, EMBASE, CINAHL, CENTRAL, and Web of Science, using the set inclusion/extrusion criteria. A meta-analysis was performed on select articles with RevMan TM (Review Manager 5) software. Six studies were included for each outcome. In total, the odds of getting a pseudoarthrosis if allograft was used were 1.1 (95% CI: 0.41, 3.09) times the odds of getting a pseudoarthrosis if allograft was not used, which was not statistically significant (p = 0.81). The odds of getting an infection if allograft was used were 1.2 (95% CI: 0.33, 4.72) times the odds of getting an infection if allograft was not used, which was not statistically significant (p = 0.74). There is limited evidence to either strongly support using, or not using allograft bone graft for posterior spinal fusion in cases of AIS when compared to the use of autograft alone or no graft.
242 A Correlational Study of Mechanical Low Back Pain on Medial Arches of Foot in School Teachers   , Priyali priyadarsini and Shilipi Pal
Background: Low back pain (LBP) is defined as pain and discomfort, localized posteriorly below the lower costal margin and above the inferior gluteal folds with or without leg pain. Low back pain is perceived as a familiar occupational problem having a high prevalence between musculoskeletal disorders among school teachers. In the whole lot of the data related to cacophonies, the biomechanical analysis and the exact reason or co-relationship of the incidences of low back pain with biomechanics of other associated structure is completely lost. This study has clearly emphasized on the area of biomechanics and alterations to the foot arches specifically to the medial arch and its co-relationship with the incidence of low back pain among school teachers. Objective: The objective of this study was to correlate the mechanical low back pain with the medial arch measurement in school teachers. Methodology: This study involves teachers from different schools of K.R. Puram. 100 number of subjects both male and female who were aged between 31- 50 years participated in this study. The selection was made on the basis of inclusion and exclusion criteria. Modified Oswestry Low back pain questionnaire was used to assess the low back pain and function, Pressure algometer (kg/cm2) was used to measure the back pain and Navicular Drop Test(mm) was used to measure the arches of foot. An informed consent was obtained from all of them before starting the study and the demographic data was obtained from them. Statistical analysis was done by SPSS software and the data was validated.
243 Relationship between Antibiotic duration and Superficial Surgical Site Infection in Arthroplasty surgery, Khartoum, Sudan , Khalid Abdelsalam Mohamed Tahir and Asma Abdelaal Abdalla Osman
The study aims to study the difference in using antimicrobial prophylaxis for different durations in joints replacement operations and developing superficial surgical site infection. A retrospective cohort study carried out in a well-equipped hospital, data collected from the record files of in-patient’s medical record unit and the outcome data was collected from consultant’s out- patient records and telephone calls. Total sample size was 101, incidence of superficial site infection from the cohort was found to be 6.9% overall, (8.89% and 5.36% among those who took the antimicrobial for 24 hours and a week respectively). No association was found between the different duration of antimicrobial prophylaxis and having superficial surgical site infections (The risk ratio was 1.66 {confidence interval =0.39 to 7.04}). These results are consistent with the international results and current knowledge about the duration of administration of anti- microbial prophylaxis in joints replacement operation and clean surgical operations in general, as the 24 Hours use duration is supported by most of current results.
244 Comparative Effect between Interferential Therapy and Isometric Exercises on Postural Neck Pain among Dentists , Syeda Khanam P, Avinash N, Addanki Premchand and Jibi Paul
Background and Objective: Mild to severe pain in the neck, is the common problem in the dental professionals, this affect their daily professional activities in their clinic. This study is indented to find the effect of neck isometric exercise over conversional exercise on functional abilities among the dental professionals. Method: Male and female dentist aged 27 to 40 were selected for this study based on selection criteria. Total 30 participants were in- cluded in this study. The conventional group A was treatment with Interferential therapy and experimental group B was treated with isometric strengthening exercise. Comparison was done between group A and b to find out the outcome of the study. The participants were treated five days in a week for four weeks. Neck pain and functional ability were measured using Visual Analogue Scale (VAS) and Neck Disability Index (NDI) scale to find the outcome before and after the treatment.Result: The study has observed significant difference between experimental and control group on VAS in Post treatment with P <0.001. There was significant difference between experimental and control group on NDI with P < 0.001.Conclusion: The study concluded that there is better reduction in pain among subjects who underwent isometric strengthening exercises.
245 Difficulties in the Diagnosis and Treatment of some Bone Tumors. Case Report   , Eliovigildo Merino Martínez, Alicia Tamayo Figueroa, Ragnar Calzado Calderon, Carlos González de Varon, Juan Carlos Álvarez Rodríguez and Ricardo Martínez Llizo
Bone tumors are a diagnostic challenge for orthopedists, radiologists, oncologists and pathologists dedicated to the study of these lesions, it is necessary to consider multiple factors (epidemiological, clinical, imaging and pathology) for an effective diagnosis and treatment. Three cases of patients are presented: the first 43-year-old female, the second 15-year-old male and the third 8-year-old male with symptoms of pain in the lower limbs associated with bone lesions, which were diagnosed as tumoral lesions, tumor of giant cells, metaphyseal fibrous defect and aneurysmal bone cyst, respectively, which did not receive the best treatment option, so it was necessary to carry out new procedures. Due to the complexity of managing these patients, we carry out this work and with it we expose the need for the existence of a multidisciplinary team prepared to take on the challenge of diagnosis and treatment of bone tumors.
246 Tens versus Plate Fixation on Pediatric Femoral Shaft Fracture. A Randomised Control Trial Study   , Bikash Neupane, Zhao Meng, Xu Sheng Kang, Niu Ju Wei, Prabha paudel, Sagar Panthi, Siddhartha Khanal, Jigyasu pradhan, Rishiswor Shrestha, Ripu Singh and Bibhuti Sharma
Background: Femur fractures are one of the most prevalent injuries in children. Femoral shaft fractures are the most common or thopedic injury that requires hospitalization, accounting for around 1.6 percent of all bone injuries in children. Treatment for femoral shaft fractures in children is determined by the patient's age and weight, as well as the type of fracture. Traction and hip Spica werethe usual treatments for all femoral shaft fractures that needed a lengthy stay in the hospital until recently. However, in recent de-cades there has been a shift toward increased use of surgery such as intramedullary nailing and plate fixation because of decrease impairment, increase convenience and decrease cost of care. There are increasing reports in literature that operative treatment moresatisfactory results than non-operative but the treatment of choice in children are still controversial.Aims and Objective: To compare the functional outcome in patients who underwent surgery for the femoral shaft fracture using the titanium elastic nail and the plate fixation.Methods: This is prospective and comparative study was carried out in the department of orthopedic surgery, unit IV and V TaiheHospital affiliated to Hubei University of Medicine, Shiyan, Hubei, China from April 2018 to February 2019. A total of 20 patients wereenrolled in this study and divided equally into 2 groups TENS and plate 10 patients on each group.Results: Out of 20 patients10 (50%) patients treated with Tens and 10 (50%) were treated with plates. Mean age of total patientswas 6.65 ± 2.110 years. road traffic accident is the main cause of injury in both group which comprises 5 (50%) patients in TENS group and 4 (40%) patients in plate group. Majority of the factures were in the middle third of the femoral shaft. The mean blood lossin TENS group was 16 ± 6.146 ml while in plates group 160 ± 45.947 ml. which shows significant between two groups with (p = 0.00< 0.005). The average operating time in TENS group was found to be 54 ± 14.298 minute while in case of plaiting group was 127 ±22.998 minute with (p = 0.000 < 0.05). Average time of union in TENS group was 8.10 ± 2.846 weeks and in plate group was 9.80 ±1.989 weeks. Which is insignificant with (p = 0.139 > 0.05). among total 17 (85%) patients had no complications, Superficial infec-tion found in 2 (10%) patients with plates group. and delayed union was found in 1 (5%) patient in with TENS group with (p = 0.217> 0.05). There is no significance difference found with respect to complication between both groups. The final outcome assessed byFlynn’s criteria, showed that 14 {7 (70%) were from TENS group and 7 (70%) from plate group} had excellent results. 6{3 (30%)from TENS group 3 (30%) from plate group} had satisfactory and None of them have poor result in both group. These differences were not found to be statistically significant (p = 1.000 > 0.05).
247 The Effects of Minimalist Shoes on the General Endurance in Long-Distance Recreational Runners , Chiara Modestini, Stephen Mizzi and Cynthia Formosa
Background: The difference in general endurance between running with a minimalist shoe versus structured footwear is a topic of debate amongst both runners and researchers. Studies investigating the effect of structured and minimalist footwear on general endurance are still lacking. Therefore, the purpose of this study was to explore the difference between running in minimal versus structured footwear on endurance amongst long distance recreational runners. Methods: Thirty healthy long distance recreational runners were recruited for this study. Treadmill running in two different shod conditions: ‘Trial 1’ with structured footwear and ‘Trial 2’ with minimalist footwear was conducted. The Bruce Treadmill Protocol was used to estimate the VO2 max of each athlete were the time taken to reach volitional exhaustion was recorded and interpreted via two equations depending on whether the participant was male or female. The results of the equations estimating the participants' VO2 max were compared between the two types of footwear. Results: The results of this study found a significant difference in general endurance when wearing minimalist footwear versus structured footwear (p = 0.038), indicating a higher efficiency when running with minimalist footwear. No significant difference was found in the mean Borg 6-20 RPE (Rate of Perceived Exertion rating scores) between structured and minimalist footwear (p = 0.32). However, although no significant difference was found, it is important to note that whilst all the participants wearing both structured and minimalist footwear reached stage 7 on the BTP protocol, in stages 8 and 9 the number of participants in minimalist footwear exceeded those in structured footwear implying better endurance when using minimalist footwear. Conclusion: This finding provides important information to the running community, clinicians and researchers alike with regards to the efficacy when using minimalist shoes in long distance running. Since physical exercise and sports are today being advocated as important elements to improve general health status and weight loss, with recreational running being picked up by many individuals, it is of utmost importance to provide recreational runners and their coaches with evidence-based information regarding potential implications when choosing the appropriate footwear for distance running.
248 Vitamin K, Osteoporosis, and Hip Fragility Fractures: A Review of Vitamin K Bone Impacts   , Ray Marks
Hip fragility fractures, which are very common injuries sustained by many older adults commonly lead to disabling hip joint os-teoarthritis, premature death, or reduced life quality. As such and given the failure of most hip fracture preventive strategies to date, it appears more might be done to consider incorporating additional strategies into those already in place. This mini review examines whether: 1) Vitamin K, an important dietary compound that can also be partially synthesized intrinsically is a potentially important bone building or modeling determinant whose presence might influence the onset and progression of osteoporosis a key determinant of fragility fractures and 2) whether any evidence points to its application as being desirable among vulnerable aging adults with low vitamin K status or at risk for fragility fractures for other reasons. Based on the bulk of available data housed in PUBMED, it appears that vitamin K and its derivatives do have some promising albeit unproven impacts on bone metabolism, and hence possibly on osteoporosis, a pathological feature often found to prevail in hip fragility fracture injuries. It also appears that in addition to ensuring aging at risk adults have adequate vitamin K intakes and serum levels, efforts to solidify this promising line of inquiry may prove highly fruitful in efforts to prevent or reduce the persistent global age-associated hip fracture burden and its immense associated human and socioeconomic costs and ramifications.
249 To Study the Effects of Assisted Cough Techniques and the Clinical Utility of a Peak Flow Meter to Measure Peak Cough Expiratory Flow in Persons with Spinal Cord Injury , Swati Goverdhan Jadhav and Ujwal Yeole
To study the effect of assisted cough techniques and the clinical utility of peak flow meter to measure peak expiratory flow in persons with spinal cord injury. Objective: To find out the effectiveness of ACT in SCI. Study Design: Convienent sampling  Methodology: The assisted cough technique applied by 3 methods. On 30 patient it was done.with the help of peak flow meter the expiratory values were recorded. Result: It shows that ACT is effective in Spinal cord injury patient. It reduces the respiratory complication. The comparison indicated that the thoracic spinal cord injury patients performed better than cervical. The mean value of post thoracic was 281.33. whereas the mean post value of cervical was 279.33 Thus from mean value the thoracic shows better result after ACT. Conclusion:• ACT appear to increase the PCEF of persons with cervical and thoracic SCI • Assisted cough technique is important and effective in spinal cord injury patient.• Thoracic patient shows better result than cervical patient. • An optimal ACT can be easily evaluated with peak flow meter
250 Description of Walant Technique on Achilles Surgery in Times of Covid-19 , Lucar Lopez Gustavo Adolfo, Guevara-Noriega Kerbi Alejandro, Villamizar Maria Angelica and Ballester-Alomar Manel
The WALANT technique, wide-awake local anesthesia no tourniquet has been applied in hand surgeries with good results. We describe the technique of WALANT anesthesia to be performed in the Achilles surgery (Achilles rupture, non insertional ten-dinopathy, insertional tendinopathy).Methods: The anesthesia procedure begins in the posterior part of the Achilles tendon in between the skin and the peritenon, wherethe skin incision is going to be. Another injection is done in the Kager space medial and lateralFinally we go more proximal and inject de solution in the posterior compartment fascia.It is important to perform the anesthesia procedure at least 30 minutes before de surgery.WALANT solution is injected based on lidocaine, epinephrine Sodium Bicarbonate and saline solution.No tourniquet is used during the surgery.Intraoperative dynamic check can be performed to confirm correct stability of the repair and this allow rapid recovery program.
251 Impact of Muscle Energy Technique on Hamstring Muscle Flexibility in Recreational Athletes , Dinesh Dharmalingam, Gladies Kamalam S, Vijay Selvan N and Monica Catherinre R
A simple mechanism of altered flexibility is extensibility [1]. Flexibility is the potential of the muscle to elongate and favor the continuity of joint movement [2]. The hamstrings become tight and this is identified when the knee extension ranges from 20° to 0° with 90° hip flexion are not attained [3]. Reduced ROM of knee causes postural deviations and also affects gait pattern of the individual as flexibility varies, as a leading factor for muscle strain injury [4]. Even among young, healthy individuals and in recreational athletes, hamstrings has the tendency to undergo tightness, making them prone for muscle tear [5,6]. MET is the technique applied by manual means and is ffectively proved for lengthening of a tightened muscle or contracture, improving joint range, facilitating the drainage of lymphatic fluid or blood by muscle stretch [7]. The explorations supporting and authenticating the utility of MET is restricted and the evidences that help the assumptions to clarify its effects are also limited. Adel Rashad Ahmed., et al. investigated to compare the effects of MET and dynamic extending on hamstrings adaptability in adults and confirmed that better improvement was seen in muscle energy technique as compared to dynamic stretching. These techniques are simple and easy to administer on subjects who lack muscle flexibility [8]
252 Which is a more Efficacy Method between Manual Therapy, Traction, or Laser in Low Back Pain without Neurological Deficiency? A Randomized Controlled Trial , Piotr Godek and Wojciech Rucinski    
Background: The conservative treatment of Low Back Pain (LBP) is the generally accepted standard of care at least in its initial phase. A myriad of modalities are offered but optimal management is still a matter of debate. Objective: Efficacy comparison of selected methods of conservative LBP treatment.  Introduction Methods: Ninety patients with LBP were allocated randomly to three groups each containing 30 participants with a different method of treatment. Manual therapy (MT), Traction Therapy (TT), or High-Intensity Laser (HIL) were implemented twice a week for five weeks. Assessment: Baseline (T0), 4 (T1), and 12 (T2) weeks after last intervention. Primary outcomes: Visual Analogue Scale (VAS, 0-10), Oswestry Disability Index (ODI, 0-50), Modified Laitinen Questionnaire (MLQ, 0-16). Secondary outcomes: Seat and reach test (SaR) and range of motion (ROM).Results: No significant statistical differences (SSD) between groups for primary outcomes at T1. At T2 noted SSD in ODI for HIL (12.27) versus MT and TT (6.87, 7.03 respectively), p = 0,002. In all groups, SaR and ROMs directions improved at T1, but during follow-up, only side-bending right was maintained. Conclusion: MT, TT, and HIL are comparable methods in terms of efficacy for LBP treatment.
253 Nasal Septum Metastasis of Renal Cell Carcinoma 7 Years After Nephrectomy: A Case Report , Vladan Milutinovic, Snezana Sankovic-Babic, Zorana Radin, Rade Kosanovic and Ivan Baljosevic
Introduction: Malignant tumors of the nose and paranasal cavities are rare tumors that account for less than 1% of body malignancies and 3-5% of malignancies of the head and neck. Metastatic tumors in the sinonasal region are extremely rare, but renal cell carcinoma (RCC) metastases are the most common in this region. The aim of this study was to present the clinical features, diagnostic and therapeutic options in this rare metastatic tumor growth of the nose, and the significance of the postoperative follow-up period of these patients. Case outline: A 70-year-old male patient was examined due to difficulty breathing in the nose on the left side with occasional bleeding. Clinical examination revealed a papillomatous growth in the left vestibule of the nose attached to the nasal septum. The presence of clear cell tumor proliferation was determined pathohistological and further immunohistochemical analysis was advised. Patient had nephrectomy performed due to adenocarcinoma of the kidney in 2011., after which he was not regularly followed. Further diagnostic procedures revealed a metastasis of renal cell carcinoma. After the surgical treatment was completed, the patient was treated with chemotherapy. Conclusion: In patients with observed unilateral growth in the sinonasal region, which occasionally bleeds and leads to nasal obstruction, with the obtained anamnestic data that their RCC has been previously confirmed or treated, it is important to think about metastatic tumor by differential diagnosis. In most patients, early detection of metastasis provides the possibility of surgical treatment and a more favorable response to systemic therapy.
254 An Interesting and Unusual Case of Recurrent Psoas Abscess , Saikat Sarkar
Psoas abscess (ilio psoas abscess) is a relatively rare clinical entity. Recurrent pyogenic psoas abscess is extremely rare and we have found three reported cases till date [1,4,6]. Psoas abscess may be primary or secondary. In India psoas abscess secondary to spinal tuberculosis is not uncommon. We present a case of primary, pyogenic, right sided psoas abscess in a 53 years male patient. In this case the large abscess was drained surgically and patient was treated with appropriate antibiotics. He was cured completely. After 4 months patient returned with fever, right flank pain and swelling almost like the 1st time. Repeat surgical drainage done and proper antibiotics were administered.Psoas abscess (ilio psoas abscess) is a relatively rare clinical entity. Recurrent pyogenic psoas abscess is extremely rare and we have found three reported cases till date [1,4,6]. Psoas abscess may be primary or secondary. In India psoas abscess secondary to spinal tuberculosis is not uncommon. We present a case of primary, pyogenic, right sided psoas abscess in a 53 years male patient. In this case the large abscess was drained surgically and patient was treated with appropriate antibiotics. He was cured completely. After 4 months patient returned with fever, right flank pain and swelling almost like the 1st time. Repeat surgical drainage done and proper antibiotics were administered.
255 Intertrochanteric Fractures - Unsolved Enigma , Dilip Shah
Intertrochanteric fractures of Femur are the commonest fractures. Varus collapse of the femoral neck and head Implants cutting out which makes revision surgery necessary. Uncontrolled shortening of the femoral neck Rigid distal tip Weakening of the hip abductor muscles making Revision surgery mandatory. Malrotation and Shortening of the neck and head Shaft fractures at the distal tip of the nail Leg length discrepancy, decreased strength, and impaired patient mobility leading to failure of procedure. Intertrochanteric fractures of Femur are fastest growing bone fractures in the world at present 1.6 million cases which will be 6.5 million in next 30 years. Almost half of the patients have to live with disability in spite of fracture healing. Aim of this article is to suggest best methods and choice of implants to get better outcome in the Intertrochanteric fractures of Femur. Understand Principles of treatment, Optimize Variables influencing patient and fracture outcome and introduce Recent Evidence based Newer Implants and will Suggest Surgical Tips and tricks to avoid common avoidable problems. In Hip fractures patient outcome predictors are UNCONTROLLED FACTORS: Pre-injury physical and cognitive status, Ability to be self-sufficient and self-dependent and SURGEON CONTROLLED FACTORS: How early patient can be ambulatory and minimise post operative complications.
256 Comparison of Immediate Effect of Muscle Energy Technique in Upper Trapezius and Activation of its Antagonist Muscle i.e., Middle and Lower Trapezius with Thoracic Extension in Patients with Upper Trapezius Spasm , Vimmi Bhandari
Background: The most common reason for neck pain is trapezitis. With digilization coming into picture in recent years, adaption of incorrect posture has been a common issue. Patients with trapezitis presents with over-activity of the trapezius and levator scapula and decreased strength of deep cervical flexors along with its antagonist muscles. Exercises have shown improvement in posture related musculoskeletal imbalances. Since M.E.T. have been used earlier for pain relief in trapezitis, the present study compares its effect with activation of its antagonist muscle which are lower trapezius and rhomboids with thoracic extension exercises. Aim: To compare the effect of M.E.T. and activation of lower trapezius and rhomboids with thoracic extension exercises in patients with upper trapezius spasm. Objectives: To assess the effectiveness of M.E.T. in patients with upper trapezius spasm. To determine the effectiveness of activation of lower trapezius and rhomboids with thoracic extension exercises in patients with upper trapezius spasm. Comparison of both groups. Method: A total of 60 individuals were taken which was calculated using the sample size formula, 30 in each group were selected as per the inclusion and exclusion criteria. Outcome measures- tenderness grading scale, NRPS on rest and activity, intensity of pain using pain algometer, cervical range of motion- lateral flexion and rotation, scapular positioning, upper trapezius length, tragus to wall length, neck disability index were assessed pre and post intervention of three days. Result: The intra-group comparison between group A and B showed statistically and clinically significant improvement in all outcome measures. The inter-group comparison of Group A and Group B showed that, group A had better improvement in the muscle length and ranges than group B. And group B show better improvement in scapular positioning and tragus to wall distance than group A. Conclusion: The study concluded that both the techniques were equally effective in pain relief in individuals with trapezitis. M.E.T. was effective in improving the cervical range of motion and its length as M.E.T. directly works on upper trapezius muscle. And activation of anagonist muscles with thoracic extension exercises was effective in improving the posture as it works on the postural group of muscles of scapula
257 Rotator Cuff Tendon Rupture: Radio-Surgical Correlation , Sbaihi S, Ben Othmen N, Jlidi M, Bouaicha W, Daas S, Lamouchi M² and BouzaidiK
Introduction: Rotator cuff tears are among the most frequent causes of pain and dysfunction of the shoulder. The role of imaging in such circumstances is therefore to identify the causative factors. Our aims evaluate the performance of ultrasound versus magnetic resonance imaging in rotator cuff tears by correlating data from each technique to intraoperative data. Methods: This was a retrospective study of 38 patients followed and operated for a rotator cuff tear. All patients were explored preoperatively by ultrasound then by an MRI of the shoulder in the medical imaging department of the same hospital. Results: The average age of the patients was 56 years with a discreet male predominance. The supraspinatus tendon was the most affected tendon. Ultrasound was as efficient as MRI in the detection of long head of the biceps dislocations with sensitivity and specificity of 100% and this was probably due to the reduced number of dislocations found 3 times per operative. Conclusion: our study confirmed the literature data concerning the performance of MRI in the detection of rotator cuff tears, its better sensitivity and specificity compared to ultrasound for the detection of small tears
258 Management of Traumatic Mallet Finger Deformaty in a Child , Rajiv Gupta
A case of mallet finger in a child is described. The epiphysis of the terminal phalanx was displaced dorsally with the extensor tendon attached to it, and was first diagnosed two weeks after injury. The treatment was by open reduction. Radiograph three years later showed that a satisfactory position of the epiphysis and normal growth of the terminal phalanx had occurred. Young children cannot give accurate histories and are usually different to examine when they have been injured. Careful examination of the fingers is necessary after the child has been pacified. The most common mechanism causing a mallet finger deformity is a sudden flexion force applied to the distal interphalangeal joint while the extensor tendon is under tension. In adults this usually ruptures the extensor tendon, but in children with a thick epiphyseal plate it may result in separation of the epiphyseal plate through the zone of calcifying cartilage. Rank & Wakefield observed that mallet finger deformity in children is due to forward angulation of the diaphysis on the epiphysis. Seymour described this angulation and advocated onservatie treatment.
259 Effectiveness of Shoulder Mobilization on Abduction in Dominant Versus Non-Dominant Periarthritic Shoulder , Rajani Cartor Medidi and Munaparthi Mounika
Background: Periarthritis Shoulder is common condition of the shoulder joint, affecting 2% of the general population. Periarthritis is characterized by initially painful and later progressively restricted active and passive range of motion of the shoulder joint. Mobilization is a passive manual therapy applied to joints and related soft tissues at varying speeds and amplitudes for therapeutic purposes. If Periarthritis shoulder has considerable effect on dominant versus non dominant shoulder, the dominant shoulder has more effects in decreasing pain and increasing movement than non-dominant shoulder. This is based on cerebral dominance, lateralization of pain and side to side symmetry. Aim: To determine the recent research evidence for the Effectiveness of Shoulder Mobilization on abduction in Dominant or Non dominant Periarthritic Shoulder. Method: this review includes simple randomized controlled trail (RCTS). Subjects with Periarthritis shoulder attending physiotherapy outpatient department at KGH and VAPMS College of physiotherapy would be included in this study. Results: present outcomes show that mobilization in dominant Periarthritic shoulder is effective in reducing pain and increasing range of motion (ROM) than non-dominant Periarthritic shoulder without adverse effects.
260 Myths, Problems and prospects in the Diagnostics and Treatment of Complex Pelvic Injuries , GV Lobanov
Pelvic injury in the structure of damage to the musculoskeletal system, of course, is the most disruptive to the patient’s quality of life. At the same time, according to the data of various authors and according to our research, a third of polytrauma is accompanied by unstable multi fragmentary destruction of the pelvis (up to 38%), with access to permanent disability in 19.1% of the victims. An analysis of current publications on various problems of pelvic injuries does not give the impression of assessing their adequacy or “simplicity” of the topic to which these studies are devoted, and the authors freely interpret the complex issues of diagnosis and treatment of these complex injuries. The widespread development of the Internet, with an avalanche of information falling, has led to the fact that experts began to read less. Today, a new relationship is being formed between scientific publishing and the Internet community. Internet content forces people to search for information in various sections, including narrowly specialized problems, which are often interpreted in an accessible language for all. This is faced by a practitioner in the case when the patient explains that “he read everything on the Internet, and now do as it was before - before the illness ...”. And the same doctor searches the Internet for “how to properly treat a patient’s illness.” The reliability of this information is questionable in terms of its objectivity and scientific validity, since the world medical community knows the facts of a commercial approach to the development of grants (Cochrane’s control). In such cases, there is a chance that scientifically significant results go away as an error in the study.
261 Actinomycosis of the Foot: A Rare Case Report , Prathibha Shamanna and Manjunatha Swamy SH
Mycetoma is a chronic granulomatous disease affecting the skin and subcutaneous tissue. It tends to have a chronic course either caused by true fungi or filamentous bacteria. Current case report is a rare case of Mycetoma involving the foot due to actinomyces species. A 35-year-old male presented with 1 year history of multiple swellings over the left foot with discharging sinuses. Patient was treated with Cotrimoxazole and Amikacin combination and later treated with Doxycycline and Amikacin combination. This case report emphasis the importance of multidisciplinary approach in diagnosis and management of chronic granulomatous disease.Case Report A 35-year-old male farmer presented to a tertiary care orthopaedic centre with severe disability secondary to multiple wounds in his left foot which progressed slowly involving the entire foot. As described by patient he noticed a small swelling which was around size of a small marble after injuring himself with a stick while working in the farm. He developed multiple swellings along with purulent discharge from multiple sites (Figure 1). Patient had no history of fever, diabetes, varicosity, tuberculosis, or any other chronic conditions. The patient was treated with several oral and injectable antibiotics in the past one year before presenting to us.
262 Actinomycosis of the Foot: A Rare Case Report , Prathibha Shamanna and Manjunatha Swamy SH
Mycetoma is a chronic granulomatous disease affecting the skin and subcutaneous tissue. It tends to have a chronic course either caused by true fungi or filamentous bacteria. Current case report is a rare case of Mycetoma involving the foot due to actinomyces species. A 35-year-old male presented with 1 year history of multiple swellings over the left foot with discharging sinuses. Patient was treated with Cotrimoxazole and Amikacin combination and later treated with Doxycycline and Amikacin combination. This case report emphasis the importance of multidisciplinary approach in diagnosis and management of chronic granulomatous disease.Case Report A 35-year-old male farmer presented to a tertiary care orthopaedic centre with severe disability secondary to multiple wounds in his left foot which progressed slowly involving the entire foot. As described by patient he noticed a small swelling which was around size of a small marble after injuring himself with a stick while working in the farm. He developed multiple swellings along with purulent discharge from multiple sites (Figure 1). Patient had no history of fever, diabetes, varicosity, tuberculosis, or any other chronic conditions. The patient was treated with several oral and injectable antibiotics in the past one year before presenting to us.
263 Nasal Septum Metastasis of Renal Cell Carcinoma 7 Years After Nephrectomy: A Case Report , Vladan Milutinovic, Snezana Sankovic-Babic, Zorana Radin, Rade Kosanovic and Ivan Baljosevic
Introduction: Malignant tumors of the nose and paranasal cavities are rare tumors that account for less than 1% of body malignancies and 3-5% of malignancies of the head and neck. Metastatic tumors in the sinonasal region are extremely rare, but renal cell carcinoma (RCC) metastases are the most common in this region. The aim of this study was to present the clinical features, diagnostic and therapeutic options in this rare metastatic tumor growth of the nose, and the significance of the postoperative follow-up period of these patients. Case outline: A 70-year-old male patient was examined due to difficulty breathing in the nose on the left side with occasional bleeding. Clinical examination revealed a papillomatous growth in the left vestibule of the nose attached to the nasal septum. The presence of clear cell tumor proliferation was determined pathohistological and further immunohistochemical analysis was advised. Patient had nephrectomy performed due to adenocarcinoma of the kidney in 2011., after which he was not regularly followed. Further diagnostic procedures revealed a metastasis of renal cell carcinoma. After the surgical treatment was completed, the patient was treated with chemotherapy. Conclusion: In patients with observed unilateral growth in the sinonasal region, which occasionally bleeds and leads to nasal obstruction, with the obtained anamnestic data that their RCC has been previously confirmed or treated, it is important to think about metastatic tumor by differential diagnosis. In most patients, early detection of metastasis provides the possibility of surgical treatment and a more favorable response to systemic therapy
264 Understanding Proximal Ulna Anatomy on Fluoroscopic Images , Sean M Mitchell, Anna Y Babushkina, Andrew S Chung and Scott G Edwards
Purpose: The three-dimensional anatomy of the proximal ulna can be difficult to interpret with standard intraoperative fluoroscopy. Without appropriate visualization, surgeons risk placing implants in suboptimal locations during fracture fixation of the proximal ulna. The purpose of this study was to delineate the borders of proximal ulnar anatomy, specifically, the trochlear ridge and the medial and lateral facets, and to provide measurements to assist surgeons with navigation of its complex anatomy. Methods: We analyzed ten fresh-frozen cadaveric elbows: five female and five male specimens, with diverse ages and heights. Utilizing novel reference points, the center of the trochlea and the intersection of the ulnar axis and a perpendicular plumb line from the coronoid tip, we recorded measurements to adjacent anatomical landmarks. Results: The distances from the center of the trochlea to the trochlear ridge, the medial facet, and lateral facet from the center of the trochlea as measured off of a custom reference line were 10.2 mm (95% confidence intervals 9.7 to 10.6 mm), 13.6 mm (95% CI; 12.4 to 14.8 mm), and 11.2 mm (95% CI; 10.9 to 11.5 mm), respectively. When evaluating our referencing technique, we found interobserver and intra-observer reliabilities to be dependable at 0.85 to 0.98 for all measurements, respectively. Conclusions: This cadaveric study provides simple radiographic parameters that should be considered when placing implants about the trochlear notch of the proximal ulna to avoid aberrant hardware placement.
265 The Effectiveness of Dry Needling on Total Elbow Arthroplasty to Improve Range of Motion, Upper Extremity Dexterity and Performance: Case Report , Mohammad E Tamboosi and Hashim T Alharthi
Background: Complications during elbow joint (EJ) injuries might indicate further surgeries such as Total Elbow Arthroplasty (TEA), which is rarely performed from an expert surgeons. Furthermore, there are many complications occur after TEA such as infection, implant loosening, instability, fracture, and component failure in the form of bushing wear. Additionally, the triceps complications occur after the surgery. Also, the Range of Motion (ROM) of the elbow extension will be limited. Yet, there is no evidence proof the effectiveness of DN on TEA. Objective: The current study aimed to investigate the effectiveness of DN for post TEA to Improve Range of Motion (ROM), Upper Extremity Dexterity and Functions. Case Description: This case is a male patient, 32-years old, post TEA, 6 months post operation. He had motor vehicle accident (MVA), fixed externally 6 years ago. Multiple irrigation and debridement were performed after the accident. Finally, the physician decided to perform TEA for him, referred to physiotherapy after the operation to start the rehabilitation program which included strengthening exercises and ROM exercises. Visited our clinic to continue the rehabilitation program. During the examination, the ROM was limited and the muscles, especially the triceps, were weak. Intervention: Patient continued the same rehabilitation program (ROM and muscles strengthening), DN was added to the intervention. He was seen for 3 times per week, for 8 weeks. DN was be applied once per week. Results: There was a significant improvement in Box and Blocks (BBT) and Disabilities of the Arm, Shoulder, and Hand (DASH), but there was no significant difference in ROM. Conclusion: Applying DN on post TEA demonstrate a significant improvement in dexterity and performance of EJ. Patient must continue rehabilitation program daily and the DN should be applied around the scar and on the TrPs for at least once every 2 weeks to observe the improvement.
266 Chronic Suppurative Otitis Media in Children , Ivan Baljosevic
Chronic suppurative otitis media (CSOM) in children is one of the most common chronic infections in childhood, even in children in developed industrial countries. Globally, CSOM occurs in 4.76% of the population (22% in children under 5 years old) with hearing impairment present in 30 children per 10,000 [1]. Chronic suppurative otitis media without cholesteatoma is a condition that occurs after attacks of acute otitis with perforation on the eardrum. According to the research of the authors [2], the development of this infection occurs in two ways. In the first, the eardrum is intact and bacteria enter the middle ear from the nasopharynx, by reflux of nasopharyngeal secretion. This happens especially when there is an infection of the nose, adenoids and paranasal cavities, which spreads through the Eustachian tube into the middle ear. Another way to develop a chronic infection is when bacteria (eg. Pseudomonas) that are in the water, during bathing and swimming, enter through the perforated eardrum and cause contamination of the middle ear space. The most commonly isolated bacteria are Pseudomonas aeruginosa (18-67%), Staphylococcus aureus (14-33%). Bacteroides spp. are isolated from anaerobic microorganisms. (1- 91%) and Fusobacterium spp. (4-15%) [3].
267 Association Between Work Related Musculoskeletal Pain and Quality of Sleep Among Work from Home Individuals , Bhavna Anand, Kshipra Gupta, S Gautam, Ruchika Kalra, Shubhi kulshrestha, Shubham Kumar and Sukriti Raj
Background: The entire world is witnessing the impact of covid-19 today. In response to the ongoing global pandemic, most of the organizations have adopted work from home culture. With this work from home culture, there is a significant increase in incidences of musculoskeletal discomforts experienced by the working population. Also, a larger population is struggling with poor sleep owing to the increased physical and mental stress imposed by the global pandemic. Hence, there is a need to identify the consequences of WFH culture and extent to which it has impacted the quality of sleep-in working population. Objective: The aim of the study is to check association between work related musculoskeletal pain and quality of sleep among work from home individuals. Method- Due to the pandemic, an online survey is conducted and consent from participants will be obtained. The survey questionnaire will be prepared using Microsoft forms and will be distributed through WhatsApp to concerned population. Two standard questionnaires used- Orebro musculoskeletal pain screening questionnaire and Pittsburg Sleep Quality Index. Questionnaire includes questions based on work related discomforts and sleep patterns during the pandemic time. 101 individuals participated in the survey study out of which only 90 participants met the inclusion criteria of the study. Results- The study revealed that 24.44% of the participants mentioned having pain and discomfort in neck and 23.33% of participants complained of pain in upper back followed by lower back (17.77%). Pain in shoulder, elbow, wrist and hand, knee, ankle and foot was mentioned by 10%, 2.22%, 10%, 4.44% and 2.22% participants respectively. The present study shows a weak correlation between the two outcome scales used and Pearson coefficient is found to be 0.250. Conclusion: Majority of participants have reported having musculoskeletal pain in at least one region of the body during covid-19 pandemic. Since the pandemic has not only caused mental stress but has also increased the instances of physical pain and discomfort, it has raised the concern and requires intervention at the earliest
268 Cross Border Surgical Treatment: Issues to Consider when Resumption of Travel Begins in a Post COVID 19 World , Harwant Singh
The COVID pandemic is coming to an end; and cross border travel for surgery will resume. The cross border surgical treatments seen in two main forms; medical tourism and outreach/teaching care. Both these cross border surgical treatments have inherent risks, such as increased costs, unexpected outcomes, and recovery from surgical injury and malpractice. The best method to minimise these risks are to have processes in place which protect the patient and the surgeon. These include a high standard of ethics, a patients’ charter, an appraisal of the risks inherent in both types of cross border surgical treatment, an informed consent of a high standard and a statement of continuity of care so that ambiguity is reduced. Also, with the advent of pandemic viruses such as covid 19, assurances that such infections are not inadvertently spread by poor screening procedures of surgeons who travel, or patients who travel. With the adoption of these suggestions it is hoped that the process of cross border surgical treatments can be formalised safely; with a very high standard of care for the patient and sufficient protection for the surgeon providing the care. n this post COVID modern age of an increasingly opened interconnected world, travel is allowed again. Many patients will travel across borders for surgical treatment; and many surgeons will travel across borders to deliver surgical treatment. This situation raises many issues about the care that is delivered, and it is appropriate to discuss the rights of the patients; and the protection of surgeons who deliver such care, the consents for surgery in such situations. Also to consider will be the COVID travel regulations set by various jurisdictions
269 Short Segment Versus Long Segment Pedicular Fixation of Thoracolumbar Burst Fracture. A Comparative Study , Said Hilmani, Yassin Haouas, Abderrazak Bertal, Abdessamad Naja and Abdelhakim Lakhdar
Introduction: Traumatic thoracolumbar (TL) burst fractures requiring stabilization are widespread among younger people. Surgical intervention can be divided into long and short fixation. Here, we report the results of 60 patients operated for TL burst fractures to determine whether one construct was better than the other. Material and Methods: Sixty patients, between 17 and 70 years old, had surgery for TL burst fractures over a 2 years period (2018 -2019). Patients who were neuorlogicaly intact in Group A received short fixation (32 patients), while Group B patients had long fixations (28 patients) performed. Their clinical and radiological outcomes were then assessed postoperatively at 3, 6 and 12 months. Results: The demographic data and clinical progression, anterior and posterior height vertebral, the sagittal index and Cobb Angles were similar for both groups. However, those undergoing long fixation exhibited better long-term outcomes (i.e., local kyphosis (GB: 15.10 vs. GA: 22.3; P = 0.003) and sagittal index of Farcy (GB: 16, 35 vs. 24.8; p = 0.011)). However, there was no significative difference Conclusion: Based on our small sample, we concluded that those patients undergoing long-fixation of TL burst fractures had the highest rates of kyphosis correction, and greatest incidence of maintaining correction over the long-term vs. short fixation patients.
270 High-Intensity Interval (HIIT) Training for Healthy Older People , Mohammad Kamrujjaman
The number of people aged 60 and up is increasing faster than any other age group in the world [3]. Reduced physical performance in elderly persons has been associated with a higher risk of death [1,2]. Neuromuscular deterioration, gait and balance difficulties, loss of mobility, and an increased risk of falls and fractures are all classic symptoms of ageing [1,3]. High-intensity interval training (HIIT) has been described as a promoted and encouraged for increasing indices of performance and various health markers in older persons [3]. It’s a challenging task to establish whether or not HIIT is a safe and well-tolerated training approach for healthy older people. It is needed to examine the effectiveness of HIIT on body composition, upper and lower body muscle strength, mobility and balance, mechanical efficiency as well as aerobic fitness, fear of falling, and functional capacity [1-5]. After considering these key aspects, it might be considered to assume that HIIT is the most effective training strategy for a healthy older adult.
271 Understanding the Relative Energy Deficiency in Sports (RED-S) , Jasrah Javed
The term RED-S first described by the International Olympic committee in the year 2014 [1] is the ‘Relative Energy Deficiency in Sports’ occurring as the consequences of altered physiological functioning causing abnormal metabolic rates, bone health changes, altered immunity and protein synthesis along with a compromised cardiovascular health and psychological health issues [2]. The condition of RED-S is believed to occur as a result of insufficient caloric intake and/or excessive energy expenditure. In simpler words Energy Expenditure > Energy Intake = Decreased Availability of Energy The concept and the term RED-S is an advancement of the ‘female athlete triad’ which was an earlier identified term used for the syndrome observed among female athletes with signs of low energy availability, menstrual dysfunction (amenorrhea/oligomenorrhea) and low bone mineral density [1]. The revision of the name emphasizes the occurrence of the condition is also seen in active men in sports [1].RED-S is considered as a serious and lifethreatening illness among athletes [3]. As the condition is found to be an inter-connection between three conditions, it is believed that if an athlete shows the signs of one element of the triad, it is likely for them to be suffering from the other two elements of the triad as well [4]
272 Regional Blockades in the Perioperative Period during the Reposition of the Inferior Orbital Rim Wall , Mishchenko OP, Mankov AV and Zabolotskii DV
Abstract The analgesic effect of the pterygopalatine blockade is successfully used as anesthesia in otolaryngology, with volumetric surgical interventions in the maxillofacial region and as an interventional method for the treatment of migraine, cluster and chronic facial pain, in the treatment of post-functional pain syndrome, postherpetic neuralgia. The purpose of this study is to evaluate the analgesic effect of the infra zygomatic access of performing a pterygopalatine block as a component of combined anesthesia during reconstructive surgery for fractures of the lower orbital edge. Research and Design: The study was carried out at Irkutsk Branch of S. Fyodorov “Eye microsurgery” Federal State Institution of Ministry of Health of the Russian Federation. 9 male patients with the fractures of the lower orbital edge were included. Material and Methods: Pterygopalatine blockade as a component of combined anesthesia was performed through a infrazygomatic access by the impegnation technique for pain management in reconstruction of the inferior orbital rim wall. A 25 mm needle with a 23G diameter was used to anesthetize the pterygopalatine ganglion and the maxillary nerve with solutions of local anesthetics (lidocaine 2% - 2 ml and ropivacaine 0.75% - 2 ml). The following parameters were evaluated: the adequacy of anesthesia, the duration of the analgesic effect of the pterygopalatine blockade by Verbal Rating Scale, the appointment of additional anesthesia, patient comfort, complications after the blockade. Results: Pterygopalatine blockade as component of a combined anesthesia was effective intraoperatively and didn’t cause hemodynamic changes during surgery. During a postoperative period, patients felt comfortable without pain. No additional anesthesia required. The length of the block varied from 4 to 6 hours. Such complications as hemorrhages, intravascular injection of anesthetic, trauma of neural structures were not noticed. Conclusion: Pterygopalatine block is a good alternative to both intra and post operative anesthesia in reposition of the inferior orbital rim wal
273 Effect of Gravitational Torque Deficiency in Human Body , Mythili kasthurirengan
Torque is the force which tend to rotate the body to which it is applied [1]. The object fixed on an axis will experience gravitational forces that will produce rotational forces (Torque). Gravitational torque is zero at center of mass in any object [2]. In human body also this applies the same where our bones and muscles act as a lever over the joint as axis. Our body is constantly exposed to these gravitational torque forces on all weight bearing joints. In which the gravitational force is creating a torque and pulling our body towards center of earth and our antigravity muscles produce a counter force to make our joints stable. Like any mass on earth in human body also gravitational torque is zero at center of gravity [3]. For example we will take knee joint. Center of gravity of knee joint is located on average 1.4 (+/-1.1) cm in front of the joint [4]. As the center of gravity of knee joint is placed anterior to knee joint it avoids the gravitational pull towards floor every time we stand up. But during certain activities where our center of gravity moves, like when we wear back pack or perform squatting, in which center of gravity on knee joint moves posteriorly it puts a great pressure on knee extensors to maintain balance [5]. In other words the gravitational torque need to be overcome by our antigravity muscles to maintain balance
274 Role of Medical College Teacher- Healer, Teacher, Researcher: What is Most Important? , Manika Agarwal and Sharat Agarwal
It is very honorable and prestigious position for a doctor, if he becomes a faculty in a medical college. Not only does he contribute to taking care of patients, but also takes pride in teaching medical students, who will be the future healers. Traditionally, the merit of a doctor was judged by the patients he had healed and by the value of the classes he had taken for the students, which earned him respect and fame. In the present time, a medical college doctor has to necessarily do some research which may be collecting data of a particular disease or conducting some new experimental studies. The knowledge gained is supposed to benefit the mankind, which is the aim of these projects. Research papers are written to disseminate information and knowledge gained through such projects or life experiences in dealing with difficult cases. These are to be appreciated if they fulfill the purpose of creating additional knowledge for the benefit of the mankind. However, if a worth of a faculty is judged by the research papers and projects instead of their ability to treat and teach, it may have its own adverse effects. Many faculties will devote more time to writing papers and research projects instead of treating patients and teaching students, as it makes them more worthy of an academic promotion. In a senior post sometimes, writing papers and projects may be deputed to juniors and the first name will be of senior faculty.
275 Treatment of Scaphoid Nonunion Advanced Collapse Stage III with Proximal Row Carpectomy and Resurfacing of Capitate with Pyrocarbon Implant - Results of 2-Year of Follow-Up , Paulo Cunha, Joni Nunes, Melanie Ribau, Guilherme Correia, Tiago Barbosa, Cesar Correia, Guilherme Franca, Elisabete Ribeiro, Juvenalia Ribeiro, Pedro Varanda and Luis Filipe Rodrigues
Objective: We intend to demonstrate the functional results of a patient with post-traumatic radiocarpal arthrosis due to a scaphoid nonunion advanced collapse who underwent surgical treatment with proximal row carpectomy and capitate resurfacing with pyrocarbon implant. Material and Methods: A 51-year-old male patient, working as a sculptor, presented to our consultation with a scaphoid nonunion advanced collapse due to a non-treated scaphoid fracture 20 years before. Clinically he had pain and radiocarpal instability. Radiographically, there was collapse of the scaphoid and lunate, advanced radiocarpal osteoarthritis and proximal migration of capitate. In 2018, he underwent proximal row carpectomy and capitate resurfacing with pyrocarbon implant through a dorsal approach. The patient was immobilized with a wrist cast for 4 weeks. physical rehabilitation started after remove of the cast. Unrestrained activities were allowed at 12 weeks after surgery. Every 6 months the patient was observed in our consultation. Results: After two and a half years of follow-up, the patient presents a presented a significant improvement on wrist pain, with an initial Visual Analogue Scale score of 9/10 and a current one of 3/10 and a satisfactory wrist mobility, with approximately 20º of extension and 30º of flexion, which allows the execution of his work activity. He refers, however, to a decrease in grip strength. On reassessment radiographs, there is a periprosthetic radiolucent line of 1mm, with progression of radiocarpal arthrosis. Conclusion: Post-traumatic radiocarpal arthrosis has a negative impact on patients' quality of life. There are several surgical treatment options varying from proximal row carpectomy, total wrist prosthesis, partial or total arthrodesis. In the present case, capitate resurfacing with pyrocarbon implant associated with proximal row carpectomy proved to be a good surgical option, with satisfactory results, especially in the reduction of pain, providing the patient wrist mobility compatible with the daily living activities.
276 Arthroscopic Repair of Hip Labrum Using a Technique of Single Perforation and Double Loop , Carlos Tobar, Jose Tomas Bravo, Gonzalo Escobar and Dante Parodi
Introduction: Labral injury repair has been a matter of interest in hip preservation surgery. Multiples fixations methods using anchors have been described. A single labral perforation avoids the loss of the sealing and decreases labral tear risk, whereas a double-loop technique avoids shearing the labrum. Nevertheless, it is still unclear what the best method is to perform the repair. Objective: We present a technique for fixation of double-loop labral repair, having a unique enter labral site and performed through a single gate, providing joint sealing, resistance to pull out, and lack of eversion or labrum stenosis. Surgical Technique: By classic anterolateral and a modified anterior portal, minimal capsulotomy is performed with the preservation of an interportal bridge. Superficial drilling of the acetabular rim is performed with a 5.5mm arthroscopic circular burr. Through an 8.5mm cannula, the anchor is placed in the acetabular rim. The suture pin is threaded with the strand, penetrating the labrum close to the chondrolabral junction or through it, creating a suture loop in the intra-articular space. The strand is released from the suture pin, which is removed, and re-entered through the intra-articular space, capturing the loop, and taking it to the extra-articular zone. The suture pin is re-inserted through the loop, and the strand is captured, which is slid through the loop and taken out of the cannula. The result is a double beam knot made with the working strand and the strand pole. The corresponding knots are made and slid according to the traditional technique. Conclusion: Double-loop and single perforation give the surgeon versatility and capability of fixation in a broad spectrum of labral injuries, allowing a resolution by an arthroscopic standard, recovering the joint seal without any further complication, only limited by the proper set of the anchor and the tightness of the knot
277 Ulnar Nerve Tuberculoma Mimicking as a Ulnar Nerve Schwannoma and Neurofibroma , Hirenkumar R Desai, Deepak H Kakade, Avani S Patel and Chandani Dangarosia
We report a very rare case of ulnar nerve tuberculoma. A 16-year-old male presented with swelling over ulnar aspect of Right Wrist and tingling sensation on Right hand. Three Years back patient had history of Injury at Wrist. Any Signs and Symptoms indicating Tuberculosis and Leprosy was not found. In order to removed lesion completely, Exploratory Surgery was performed. Histopathological examination of the specimen consisted with tuberculoma.Meningitis and tuberculomas are the main manifestations of tuberculosis involving the CNS. Tuberculomas of the brain and spinal cord are not uncommon. Tuberculoma involving a peripheral nerve is uncommon and only 5 cases are reported in the literature [1-5]. All of the 5 cases reported involved the ulnar nerve, imaging in the form of CT was performed in only 1 case 2, and all patients were managed surgically. In this paper, we report another case of ulnar nerve tuberculoma. Our case is the third case of ulnar nerve tuberculoma with MRI sequences that has been reported in the literature. The literature on this topic is also briefly reviewed with special emphasis on pathogenesis of this lesion. Case Report History and examination A 16-year-old patient presented with Complain of swelling over ulnar aspect of Right Wrist and tingling sensation on Right hand since 1 month. Past History of Injury at Wrist was present.
278 Markers of Synaptic Transmission: A Review , Bon EI and B Th Vihanga
Information is passed between neurons and stored for memory formation at synapses, which are the sites for brain communication. Reduced amounts of pre- and postsynaptic proteins cause synaptic degeneration, which is a widespread and early pathogenic event in neurodegenerative illnesses. Other neurodegenerative and neurodevelopmental illnesses, including Alzheimer's disease, reveal disrupted synaptic homeostasis as a pathogenic event, and are hence referred to as synaptopathies. Synaptic biomarkers for certain disorders would aid in deciphering the precise processes of synapse malfunction in various diseases, as well as the pathogenic impact of synaptic degeneration. We shall describe the primary pre- and postsynaptic indicators that are used to diagnose various neurological illnesses in this article. The biological mechanism through which a neuron communicates with a target cell across a synapse is known as synaptic transmission. Chemical synaptic transmission occurs when a neurotransmitter is released from a pre-synaptic neuron and binds to certain post-synaptic receptors. Electrical signals are transmitted across gap junctions in electrical synapse transmission [1]. The following stages are required for chemical synaptic transmission: In the presynaptic nerve terminal, the neurotransmitter is synthesized. The neurotransmitter is stored in secretory vesicles. Neurotransmitter release in the synaptic gap between pre- and post-synaptic neurons is regulated.
279 Demographic Characteristics, Anatomical Distribution and Presentation of Sudanese Patients with Giant Cell Tumor , Hassan Mohammed Hassan Elbahri, Ali Hamid Ali Osman, Hozifa Mohammed Ali Abd-Elmaged and Hassan EHM Ahmed
Introduction: Giant cell tumor of bone (GCTB) is a benign aggressive primary bone tumor. This study provides an overview of demographics, anatomical distribution, and clinical presentation of GCTB in Sudan. Material and Methods: This retrospective study was conducted on patients with a diagnosis of giant cell tumor of the bone that attended our institution. Demographic information, tumor location and clinical presentation were obtained from medical records of patients. Data were collected using data sheet and analyzed using statistical package for social science (SPSS version 26). Result: This study include 46 patients diagnosed with giant cell tumor of bone, 34 male (73.9%) and 12 female (26.1%), with their ages ranging from 17 - 57 years old, patients with age 30 or less are 31 (67.4%), age from 31 to 50 years are 12 (26.1%), and patients age more than 50 are 3 (6.5%), the mean age being 26.5 years old. The location of tumor was found to be commonly in proximal tibia 21 (45.7%) patients, followed by distal femur 18 (39.1%) patients, then distal tibia 3 (6.5%) patients, proximal fibula 1 (2.17%), patella 1 (2.17%) patient, calcaneum 1 (2.17%) patient and distal humerus 1 (2.17%) patient. All patients (100%) presented with pain that affect their life activity. Conclusion: This study demonstrates an overview of GCTB in Sudan. Male was predominating over female in this study which is opposing the previous studies. Age distribution show slightly difference from those data in literature. In our patients, the tumor location and clinical presentation was in line with previous study. Further studies are recommended to expand information about GCT in Sudan
280 Modern Technologies in the First Stage Treatment of Deep Periprosthetic Hip Joint Infection , Valeriy Murylev, Grigoriy Kukovenko, Pavel Elizarov, Alexey Muzychenkov, Alexander Zhuchkov, Semen Alekseev, Ivan Chizh, Michail Elizarov, Nursultan Stambekov, Alexander Rudnev and Nikolay Erochin
Purpose: To evaluate the functional results of using 3D spacers for IIIA and IIIB defects according to the classification system described by W.G. Paprosky during the first stage of deep hip periprosthetic joint infection (PJI) treatment. Patients and methods: From 2017 to 2020, 24 patients with hip PJI and IIIA and IIIB acetabular bone defects according to the W.G. Paprosky classification underwent first-stage revision arthroplasty. The patients were divided into 2 groups: group 1 received articulating spacers, and group 2 received 3D custom-made spacers. Function was evaluated by the Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analogue scale (VAS). Statistical analyses were performed using IBM SPSS Statistics version 22.0 for Windows. Student's t-test, Wilcoxon's signed-rank test (to compare parameters before and after surgery) and the Mann-Whitney rank-sum test were used. Results: In the first group, the average VAS score, HHS, and WOMAC score were 3.3 (± 1.4), 51.3 (± 9.4), and 42.9 (± 5.9), respectively; in the second group, the average VAS score, HHS, and WOMAC score were 1.3 (± 0.9), 69.7 (± 3.6), and 30.1 (± 2.4), respectively. The rating scale data showed a statistically significant improvement in the function of patients in the second group (p < 0.05). Conclusion: Custom-made 3D spacers used during the first stage of treatment for deep periprosthetic hip infections yielded larger improvements in function and quality of life than articulating spacers.
281 Pandemic Effect on Body Composition. Single-Center Analysis of 2.771 Cases , Fabrício Braga, Roberto Zagury, Cristiane Perroni and Victor Hugo Domecg
Background: The SARSCOV-2 pandemic has led to a dramatic increase in the levels of sedentary lifestyles and unhealthy dietary habits. A worsening in populational obesity levels and body composition (BC) is strongly awaited but has not yet been documented. Objective: To compare the BC profile measured by bioelectrical impedance analysis (BIA) between prepandemic (P1-03/15/2017 to 03/16/2020) and pandemic (P2-3/17/2020 to 3/10/2021) periods. Materials and Methods: BIA was grouped according to the time it was performed. Two comparisons were made: an independent sample comparison (ISC) and a paired sample comparison (PSC), considering patients with at least one BIA in P1 and P2. Age, height, sex, weight, body mass index (BMI), body fat mass (BFM), free fat mass (FFM), skeletal muscle mass (SMM), percentage of body fat (PBF), and visceral fat area (VFA) were compared. The statistical significance level was defined for a p value < 0.05. Results and Discussion: 3.358 BIA was performed, and 2.771 and 112 were selected for IS and PS, respectively. In ISC, despite an unchanged weight, BFM, FFM, PBF, and VFA increased, and SSM decreased on P2 (p < 0.015 for all). Using PBF as a dependent variable, a multivariate linear regression model showed P2 as an independent predictor (β = 0.38 95% CI 0.19 to 0.56). In the PSC, PBF also increased from P1 to P2 (p = 0.015). To our knowledge, this is the first documentation of worsening BC after the pandemic. Health authorities should be alert to this phenomenon and its clinical consequences in the future
282 Arthroscopic Minimally Invasive Surgery for Septic Arthritis of the First Metatarsophalangeal Joint: A Case Report , Michael A Thomas, Hinal K Patel and Jeffrey M Belancio
The first metatarsophalangeal joint and tibiotalar joint account for the majority of foot and ankle septic arthritis cases which have an incidence of about 3-7%. Typical treatment of the first metatarsophalangeal joint septic arthritis consists of serial needle aspirations with irrigation or an open arthrotomy approach. Both of these treatment options can have complications such as, articular cartilage damage or wound healing complications, respectively. This case study discusses a 70-year-old diabetic male patient, who is high risk for wound complications that had septic arthritis of the first metatarsophalangeal joint. Here an uncommon treatment option was performed utilizing a minimally invasive approach via arthroscopy for debridement of septic arthritis due to the patient’s comorbidities and to reduce postoperative complications. The patient was subsequently followed for 1-year post operatively and was noted to have complete range of motion restored to the first metatarsophalangeal joint, no recurring signs of infections and no pain. This report and technique guide shows how an arthroscopic approach for the treatment of septic arthritis in a small joint such as the first metatarsophalangeal joint, can be a viable treatment option especially as minimally invasive surgery is becoming more prevalent around the globe.
283 A Comparison of Functional Outcome Following Conservative or Operative Treatment of Intra-Articular Fractures of Calcaneum , Ashish Singh, Purushotam Kumar, Kartheek Telagareddy, Sushil Sing, Pankaj Kumar, Rabindra Narain Singh, Ashok Singh, Abhishek Kumar, Arun Jairaj, Rishabh Kumar Singh and Pravez Anwar
Aim: A comparative to study the functional outcome in Intra-articular Fractures of Calcaneum after Surgery and conservative management. Materials and Methods: A prospective short-term study was conducted to compare Functional outcome in Intra -Articular Fractures of Calcaneum after Surgery and conservative management from December 2015 to December 2017. All patients with intra-articular fractures of the Calcaneum that confirmed to the inclusion criteria were included in the study. Patients were investigated with plain radiography and CT scan. X-ray included Calcaneum lateral and axial views. Bohler’s angle was calculated and Geographic pattern of the fracture was studied and classified using Essex Lopresti classification. All patients were treated initially using a posterior slab and limb elevation before definitive management. Following which patients were treated conservatively which included below knee cast application. The Operative Treatment protocol included either Essex Lopresti Maneuver or Open reduction and internal Fixation with a reconstruction plate, depending upon the surgeon. All surgeries which were done aimed to restore the Bohler’s angle and were done by single surgeon patients were given a below knee cast after subsidence of swelling and were mobilized non weight bearing with axillary crutches or a walker for a period of 6 weeks and gradual weight bearing mobilization was allowed until Union. Bohler’s Angle was calculated post operatively and functional outcome was assessed at 12 weeks, 3 months, 6 months and 1year and 6 monthly respectively. The results were evaluated with the Ankle and Foot Society Scoring System and reviewed. SF 36 questionnaires were filled at the end of the study. Observation and Results: A total of 26 patients were reviewed. According to the AOFAS scale, 63.6% all patients developed good and fair results. The SF 36 Score this present study suggested better quality of life in the operated group (p = 0.011) which was statistically significant at the end of two years. Conclusion: All displaced intra- articular fractures of Calcaneum should be treated with anatomical reduction and restoration of the Bohler’s angle so to have a better and early functional outcome
284 Loss of Trial Femoral Head, A Rare Intraoperative Complication During Total Hip Arthroplasty: A Case Report and Literature Review   , Shubham Y Dakhode, Ketan Naik, Sahil Mhaisane and Subith S
The one of the most important step while performing total hip replacement is trial reduction of implant. While dislocating or reducing trail implant the femoral trial head may disengage and migrate into the deep tissue space of the pelvis. Such a complication can be very frustrating to the surgeon and sometimes to the patient also. 70-year-old male farmer presented with right neck femur fracture. The patient was planned for total hip replacement. The trial reduction was done and the hip relocated and checked for range and stability. On performing the dislocation maneuver the trial head disengaged and migrated into the surrounding soft tissue and could not be visualized in spite of multiple attempts. The Final head was attached and the final reduction performed and the patient was closed. The trial head couldn't be detected on the portable fluoroscopy machine and immediate radiographs. A CT on the 3rd post-operative day revealed that the trial head was lying next to the iliac bone, within the pelvis. A 3, 6 and 12 month follow up of the patient showed a normal clinical examination and patient was able to walk full weight bearing.Total hip replacement is a commonly performed surgery for various pathologies of the hip in elderly individuals. The one of the most important steps while performing total hip replacement is trial reduction of implant to check stability of hip joint and the leg length discrepancy [1].
285 Principles of Surgical Treatment of Gunshot Wounds of Extremities, Nosivets DS
The beginning of the 21st century is characterized by the emergence of a number of military local conflicts around the world. The peculiarities of combat trauma in modern conditions include a high frequency of blast and gunshot wounds of extremities, which account for up to 80% of all musculoskeletal injuries [1]. In general, a gunshot wound is tissue damage with a violation of the integrity of their cover, caused by a firearm and characterized by a zone of primary necrosis and changes resulting in the formation of areas of secondary necrosis in the surrounding tissues, as well as the inevitable primary risk of developing wound infection [1,2].
286 The Ethnic Factor as an Influence on the Wars of the Subsequent Process of Dissolution of Yugoslavia, Rojas Bajana Roberto Andres, Daniel Augusto Moreira Caceres, Valenzuela Moran Franklin Alejandro, Gonzales Fuentes Luis Alberto, Moran Chacon Mariela and Cumbicus Montoya Hugo
The present work shows a study on the disintegration of Yugoslavia and its effects, for this the purpose is to analyze the dissolution of Yugoslavia from the point of view of ethnicity, in this sense arises the question before: How did the ethnic factor influence the disintegration of Yugoslav? The methodology applied in this work is qualitative and documentary, whose results show and confirm that many of these dissolution factors are ethnic. Finally, as a conclusion it can be observed that in a very direct way, almost always the ethnic cause was linked to the different secessionist processes that took place between 1990-1999, the project of union of the South Slavs (Yugoslavia) was destined to fail since its first attempt at accession, at that time what motivated its union was to protect itself from its neighbors, the Imp. Austro-Hungarian and Germany, which were more socially developed.
287 Hazards of Radiotherapy in Head and Neck Cancers, LK Shankhdhar, Kshitij Shankhdhar and Smita Shankhdhar
Cancers of Head and neck are treated with combination of Radiotherapy and Chemotherapy. Although results of therapy are quite good but side effects of therapy are many and bothering so much so that many patients fail to complete the course. During counseling the Radio-oncologist explains all side effects for the sake of education but that creates a lot of scare and confusion in the mind of the patient. The consultant does not define clearly as to chronology of side effects. This article aims to present a firsthand account of various effects and side effects of therapy in chronological manner since the patient himself is a physician.
288 Midterm Clinical Outcome of Single-Stage Knee Articular Cartilage Repair Using Hyaluronic Acid-Based Scaffold Embedded with Bone Marrow Aspirate Concentrate (HA-BMAC) Combined with Microfracture, Prema Sivalingarajah, Siti Hawa Binti Tahir, Siva Thangaraju, Muhammad Hafiz Bin Daud, Duratul’ain Binti Mohamad Nazri and Charles Ang Poh Thean
Introduction: Single-stage knee articular cartilage repair using Hyaluronic Acid-based scaffold embedded with bone marrow aspirate concentrate combined with microfracture (HA-BMAC-microfracture) is a significant advancement in the treatment of chondral injury. Objectives: To investigate the midterm clinical outcome of knee cartilage repair treated with HA-BMAC-microfracture. Methods: Clinical outcomes were assessed via patient-reported scoring tools, namely the International Knee Documentation Committee (IKDC), subjective function score (Lysholm score), ability to return to sports and performing daily prayers in a normal manner. They were assessed preoperative, at short-term follow-up (1 year and 2 years postoperative), and at mid-term follow-up (4 years postoperative). Results: Twenty-four patients fulfilled the criteria, mean age 36.7 years. Mean IKDC score showed statistically significant (P value < 0.001) increase from preoperative to 1year postoperative (65.2), from preoperative to 2 years postoperative (62.6) and from preoperative to 4years postoperative (58.2). Lysholm score also showed statistically significant (P value < 0.001) increase from preoperative to 1 year postoperative (56.6), from preoperative to 2 years postoperative (54.9), and from preoperative to 4 years postoperative (46.5). On the ability to return to sports also showed statistically significant outcomes. From preoperative to 1 year postoperative (P value 0.031), to 2 years postoperative (P value 0.031) and to 4 years postoperative (P value 0.031). However, the proportion of return to sports from 1 year to 2 years postoperative (P = 1.00), to 4years post operative (P = 1.00) and from 2 years to 4 years postoperative (P = 1.00) was not statistically significant. Similarly, the proportion of individuals able to perform daily prayers in a normal manner also showed statistically significant improvement. From preoperative to 1 year postoperative (P value 0.021), to 2 years postoperative (P value 0.008), and to 4 years postoperative (P value 0.008). There was no significant difference in the proportion of prayer outcomes from 1 year to 2 years postoperative (P value 1.00), to 4 years postoperative (P value 1.00) and from 2 years to 4 years postoperative (P value 1.00). Conclusion: HA-BMAC-microfracture for the treatment of knee cartilage injury provides a good clinical outcome at short and mid- term follow up. Despite good clinical outcome, none of the patients were able to return to pre- injury level sports and all patients with patellofemoral lesion did not return to praying normally.
289 Demerit of Drug Therapy in Aged-People , Adam Abba Bukar
Drug therapy is by far the most common form of medical intervention for many acute and chronic conditions due to its effectiveness at preventing disease or slowing disease progression. Problems occur when multiple clinical guidelines are implemented which lead to the increased risk of adverse drug events and incidences where patient’s preferences are neglected.
290 Single Incision Approach and Cortical Button Fixation System for Distal Biceps Tendon Ruptures: Functional Outcomes and a Literature Review, Kastanis G, Kapsetakis P, Chaniotakis C, Stavrakakis I and Pantouvaki A
Introduction: Distal biceps brachii tendon detachment is an uncommon lesion which results from rapid elbow flexion against resistance and more often affects males between fourth and sixth decade of life. Among therapy options, surgical treatment leads to anatomic reinsertion of the tendon with better functional recovery. In literature, different methods have been proposed, regarding surgical treatment, with satisfactory outcomes. The aim of this study is to present the functional outcomes of our patients, in one year, who underwent surgical treatment with singe incision and cortical button implant and to analyze the complications and final patient satisfaction. Material and Methods: From 2018 until 2020 thirty-five male patients underwent surgical repair for traumatic distal biceps tendon rupture with an average age of 40,5 years old (range from 22 to 68). Clinical diagnoses for the rupture were confirmed with ultrasound in majority of patients, and MRI in eight cases. The most common cause of lesion is rapid elbow flexion against resistance. All patients were repaired with anterior single incision, and cortical button fixation system while the average time from injury to surgery was 12,5 days (from 4 to 45 days). After operation, a functional elbow brace was applied, and all patients followed specific rehabilitation protocol. Results: Mean time follow-up period was 18,9 months (range from 13 to 28 months). Results were evaluated according to complications, range of motion of elbow joint, Mayo Elbow Performance Score, Dash Score, EQ-5D-5L, and satisfaction of the patients. Major complications were paresthesia of posterior interosseous and lateral anterobrachial cutaneous nerves (17,1%). At the final reexamination the mean range of motion was flexion 135˚, extension -5˚, pronation 79˚ and supination 78˚, mean MEPS was 98,1 ± 8,4, mean Dash score was 8,5 ± 7,5, and the EQ-5D-5L was 93. The majority of patients was very satisfied (68,5%) and satisfied (25,8%) and only the 5,7% of cases was unsatisfied. Conclusion: Distal biceps brachii reattachment with single incision and fixation with cortical button is a successful surgical method according to the superiority of biomechanical stabilization between other fixation system and better functional outcomes. Neurological complication, if presented, recovers in a relatively short period of time (range from 3 to 6 months) while patients return soon to the previous level of activity. Because all the surgical procedures of reattachment of distal biceps tendon rupture, present a large number of neurological, the patient should be informed of these conditions.
291 Vitamin K and Osteoarthritis Associated Observations: “What’s New” in 2022, Ray Marks
Osteoarthritis, the most common joint disease experienced by many older adults and one that is increasing as societies age remains largely incurable and highly disabling. As such, and in light of the failure of most palliative pharmacologic strategies to date to reverse or mitigate this painful condition, it appears all avenues of potential progress added to those already being explored may yet prove fruitful. Based on emerging and quite promising data outlining a possible link between aspects of osteoarthritis joint damage and vitamin K serum deficits, this mini-review elected to examine the most current data in regard to whether: 1) Vitamin K, an important dietary compound is being shown to be a potentially valuable health determinant whose presence might influence the onset and progression of osteoarthritis through direct as well as indirect pathways, and 2) any evidence pointing to its possible supplementation as being desirable in this regard if indicated. Based on the bulk of available data housed in PUBMED as of June 25, 2022, it is concluded that a mediating or moderating role for vitamin K in the realm of osteoarthritis cannot be ignored. Future efforts to advance this line of inquiry from multiple perspectives may hence prove highly fruitful in efforts to prevent or reduce osteoarthritis disability and its immense personal and socioeconomic costs.
292 Sharing the Truth of Scoliosis Curve Progression Risk with Patients and Families Using a Colorized Natural History Graph Handout - A Quality Improvement Shared Decision-Making Case Report from a Pediatric and Adult Scoliosis Clinic, Lloyd A Hey, Kristina Stanson, Kirsten Darroch and Victoria Dorr
Peripheral odontogenic fibroma (POdF) is an odontogenic neoplasm of connective tissue. Due to the rarity of POdF, the lesion is not commonly reported in the literature. POdF is a benign, slow-growing, asymptomatic, nonulcerated gingival mass seen mainly in the anterior mandible. It is designated as the extraosseous counterpart of the central odontogenic fibroma (COF). POdF mainly consists of connective tissue with various amounts of epithelial nests. This entity should be added to armamentarium of the differantial diagnosis of soft tissue tumors like peripheral ossifying fibroma, peripheral ameloblastoma, pyogenic granuloma, and giant cell granuloma. Recurrence was reported in the literature. Surgical excision is the treatment of choice. Thus, the patient should be followed up regularly after the surgery.
293 Guideline ‘Nonspecific Complaints of Arm, Neck and/or Shoulder (CANS), Harald S Miedema and Anita Feleus
Complaints of the arm, neck and/or shoulder (CANS) are an important health problem. In the Netherlands, in any previous year about 33% of all adults reported to have CANS and more than 25% had CANS at the moment of inquiry. In addition, more than 10% of days lost to sickness absence is attributed to CANS. End 2012, a multidisciplinary guideline was published with recommendations for the diagnosis, treatment, care, and (work) participation of patients with nonspecific CANS. The purpose of this guideline is to improve the process of care and the multidisciplinary cooperation required, as well as to improve the communication with patients. The project started with a revision of the existing CANS model (dating from 2004). During this update, the list of disorders was extended to cover 36 specific diagnostic categories. In addition, a clinical pathway was developed that focuses on optimal timing of diagnostics and treatment, and on the multidisciplinary cooperation. The improved diagnostic process means that patients with specific CANS receive faster and better targeted treatment. Also, better understanding of treatment results leads to the choice of more effective treatments for patients with nonspecific CANS, so that more patients receive the most beneficial form of treatment.
294 Viral Activity Among Incidentally Detected Asymptomatic HBSAG Positive Patients in Khartoum State, Abdelsalam Mohamed Ahmed, Mohamed Kharief, Ayoub Mustafa Omar Ali, Musaab Mohamed Abdallah and Mohamed Alkhatem
One of the commonest modes of detection of hepatitis-B virus (HBV) infection is incidental detection. Incidentally detected asymptomatic HBsAg (IDAHS) positive patients represent a heterogeneous group with variable serological and clinical profile. The aim is to study the viral activity of IDAHS positive patients.
295 Treatment of Bilateral Preaxial Polydactyly with Second Digit Ray Amputation and Medial Cuneiform Open Wedge Osteotomy, Tolgay Satana and Fulya Doktorlar
Introduction: Congenital polydactyly is an autosomal dominant deformity inherited by one generation from anotherd the most commonly cited classification scheme by Wessel which, does not include this particular anomaly (tarsal coalition). In addition, there has been only reference to this type of polydactyly with coalition in hand in the literature. We could classify our case in main type VI but propose subdivision A- not tarsal coalition B-With tarsal coalition. Medial finger might be halluxs even if it is hypoplastic, may disrupt the plantigrade structure of the foot and cause ulcers in the plantar region caused by pressure changes. Tarsal coalitions are frequently seen in preaxial. Material and Method: The patient was admitted to the outpatient clinic with a complaint of inability to put on shoes. His both feet had six toes each. In his radiological examination, extra second digit sprouting from preaxial, arising from medial cuneiform and hallux varus deformity were found in medial. Duplicated thumbs are almost similar, medial thumb was smaller or hipoplastic. Medial finger decided to as Hallux after radiologic and functional investigation. The treatment is planed that second digit ray amputation and residual hallux varus deformation realigned to normal anatomic relationship with medial cuneiform open wedge osteotomy while the 1st intermatatarsal Linsfranc joint relation was restored. Supero-lateral part of medial cuneiform was continue second digit metatarsal bone than ray amputation extended to medial cuneiofrom. Open wedge osteotomy performed on medial cuneiform and first ray realigned, reduced to angel and linsfranc level metatarsal widening reduced. Moreover, soft tissue procedure was performed (transfer of the adductor and flexor attached tendon to the distal of the 1st metatarsus and with lateral capsuloraphy. (Plantar facia and protected foot incised only dorsally and plantar ragion as an intact. Foot incised only dorsally was fixed with one cortical screw and short leg was fixed in plaster for six weeks. At week six, plaster was removed. Conclusion: Treatment of congenital deformities like polydactyly at an early age may not always provide positive outcomes. A better clinical-radiological assessment should be made for such deformities. Moreover, They should be treated with a very good preoperative planning before reconstruction. It may be useful to wait for the adolescence period or completion of bone development in these cases like the one in our study.
296 Overview of ICF Categories Addressed within Outcome Measures Applied in Prognostic and Intervention Studies for Non-Specific Complaints of Arm, Neck and Shoulder, Harald S Miedema, Elin Koppelaar, Yvonne F Heerkens, Anita Feleus, Alex Burdorf and Bart W Koes
Background: Non-traumatic complaints of arm, neck and shoulder (CANS) are an important health issue. Although CANS may vary in clinical expression and underlying causes, data on sick leave and healthcare use show that, especially chronic CANS, has a major impact on functioning and health. There is a need for more insight into the physical, emotional and social challenges of patients with CANS. Aim: To present an overview of relevant outcomes regarding functions, activities and participation, in patients with complaints of arm, neck and shoulder (CANS) and their association with the International Classification of Functioning, Disability and Health (ICF). Design Linkage study, linking items of outcome measures to ICF-categories. Methods: A literature search was made for articles on prognostic and intervention studies, as part of the development of the Dutch multidisciplinary evidence-based guideline for non-specific CANS. Outcome measures of each article were extracted and categorized into those on physical health and mental health. All items of these measures were linked separately to the ICF following internationally developed linking rules. All ICF categories used in at least 5% of the studies are listed, following new recommendations for the development of ICF core sets. Additionally, the distribution of ICF categories across all ICF categories within the outcome measures is evaluated. Results: A total of 123 original studies were included. The ‘top 20’ of ICF categories related to physical health and mental health are listed, together with the cumulative percentage of all the applied ICF categories. Also reported are all ICF categories used in at least 5% of the studies, as well as the frequency of the total number of applied ICF categories. Conclusions: Aspects of function, activities and participation were identified in outcome measures used in studies on CANS and linked to the ICF, based on the literature included in the multidisciplinary guideline for non-specific CANS. Clinical Rehabilitation Impact: The results of this study can serve as a preparatory study for the development of an ICF core set for CANS, which can be applied in rehabilitation care for patients with (chronic) CANS.
297 Medical Statistics, Critical Thinking, New Technology in Treating Spine Pain; and the Role of Open Access Journals, Harwant Singh
Barak Obama, the 44th President of the United States said, ‘Change is never easy, but is always possible’ [1]. Closer to home, Mahatma Gandhi said, ‘An error does not become truth by reason of multiplied propagation, nor does truth become error because nobody sees it. Truth stands, even if there be no public support. It is self-sustained’ [2].
298 Interrater Reliability of the Clinical Examination of Muscular Scapular Stabilisation, Stefan ABT, Katja Ruegg, André Meichtry and Hannu Luomajoki
The objective of this study was the assessment of the interrater reliability of four tests of the resting scapula and five tests of muscular stabilisation of the scapula with a total of 65 subjects without using any quantitative measuring devices. A visual and palpatory examination of the resting scapula was made with regard to observation features such as acromion level in relation to the angulus superior, scapular winging, the shape of the margo medialis and the scapular tilt. The trapezius as a whole, the trapezius ascendens and serratus anterior muscles were tested with manual resistance for their scapular stabilisation capacity. The trapezius descendens was tested for active sufficiency. The shoulder shrug test with a wKappa coefficient of 1.0 (95% CI: 1.0) on the right, as well as the scapular tilt test with a wKappa coefficient of 0.65 (95% CI: 0.41-0.89) on the left and a wKappa coefficient of 0.64 (95% CI: 0.40-0.87) on the right, were the most reliable tests. The rest of the assessed tests showed poor to average congruence. Based on these results, an examination of the scapula has to be critically evaluated in daily clinical practice.
299 The Effectiveness of Lower Limb Plyometric Exercises on Vertical Jump Performance in Young Basketball Players: A Randomized Controlled Trial, Gerald Edwin Raj, Suriya and Priyadarshini
Background: Plyometrics is a well-known form of ballistic training, designed to improve performance of jump capabilities. It is an training that uses both the speed and force with various movements which improves muscle power. Vertical jump is raising his or her center of gravity in a vertical plane. Plyometric exercise training improves vertical jump height. In basketball a vertical leap is involving rapid and repeated muscle contraction and stretching. Aim: To determine the effect of plyometric exercises on vertical jump height in young basketball players and compare them with their untrained counterparts. Design: Randomized control trial with pre and post test. Methodology: 20 students who play basketball around age 14-17 years, who fulfilled the inclusion criteria were randomly divided into Group A (experimental group) and group B (control group). The untrained group was asked to perform the general warm up prior to the vertical jump. Cool down exercises. The experimental group was given plyometric exercises for 6-8 weeks and vertical jump height pre and post training were recorded and compared. Results: Vertical jump height improved significantly post plyometric in Group A compared to the control group. Statistically analysis was done using paired ‘t’ test, the results indicated that there was significant improvement in subjects who received plyometric training. Conclusion: Plyometric training brought significant changes in vertical jump height. This study concludes that plyometric training is effective in improving vertical jump height among young basketball players.
300 Aspects of Nonoperative Management of Shoulder Dislocation (Review) , Ehsan Ul Haq, Maryam Jamil, Shafqat Waseem Ch, Tauseef Ali Memon and Noor Afsheen
Background: Shoulder dislocation (SD) is the most common dislocation represent 45% of all major joint dislocations. Worldwide, the number of patients with SD not decreased. There are many non-operative methods of reduction of SD. The ways of treatment are widely discussed in scientific forums and in publications. The aim of this review is the analysis of literature data concerning the methods of reduction of SD. Results: Methods of non-operative techniques of SD have a long history, but today they have not lost their relevance. The widespread occurrence of SD is the reason of great number of reduction techniques available for SD. At the same time, recurrence of dislocation of the shoulder joint is observed in 50% of clinical cases, and often occurs in young patients. The disadvantages of methods for reduction the primary traumatic SD marked by many authors. The frequency of complications (habitual dislocation of the shoulder, instability of the shoulder joint, shoulder contractures), according to many authors, varies widely: from 15 to 95%. The review includes the main methods of non-operative reduction of dislocation of the shoulder joint, the frequency and structure of complications. Special focus have made to anesthesia during the reduction of the SD. In contrast to previously opinion, that it is necessary to use anesthesia during the reposition procedure, current data have demonstrated good results of SD without the use of intra-articular and other forms of anesthesia. The presented review allows to understand and to analyze current situation with treatment of SD.
301 A Rare Variant of Open Patella Fracture Treated with Medial Facetectomy, Akash Tiwari, Anu Ranjan and Madhav Khadilkar
Patella fractures are relatively uncommon, constituting about 0.5-1.5% of all skeletal fractures. Out of this, vertical Patella fractures make upto 12-17% with open Patella fractures representing 6-30% and the comminuted fractures aggregate to 30-35%. Aim of this case report was to present a unique coalition of these three conditions with 360° articular rotation in one patient as well as treatment modality and successful outcome. A 30 years old female presented to Emergency department with Open injury to Left Knee, Gustilo and Anderson Grade IIIA following motorcycle accident. The X-ray investigation was suggestive of central longitudinal split in Patella with comminuted Medial half and intact Lateral half was rotated 360°.The patient was treated with emergency wound debridement, Medial facetectomy and subsequent suturing of Quadriceps tendon and Medial Retinaculum to remnant Patella resulting in a normal Patellar tracking. With a stable knee, the patient had good range of motion and no extension lag by end of 3 months.
302 Outcomes of Open Proximal Tibia Fractures Managed by Primary Plating with Mippo Technique in Terms of Stability, Union and Complications, Ashutosh Verma, Atul Kumar Saroj, Shailesh Kumar, Subham Khandelwal, Gaurav Kumar Singh and Piyush Gautam
Background: Periarticular fracture of tibia management had main challenges because these are high energy fractures associated with soft tissue damage leading to increased chance of complex injuries. The purpose of this study, on patients of open proximal tibia fractures managed by primary plating with MIPPO technique, were to assess the functional outcome in terms of functional Stability, union, range of motion, early mobilization and complications. Methodology: In this study, 55 patients of open fracture of upper third tibia were managed by primary locking compression plate using MIPPO method. Cases were followed up at 4th week, 8th week, 14th week, 20th week, 26th week, 38th week and 50th week. At all visit cases were evaluated by using radiograph of knee and Knee-Society score. Results: More than 90% patients had an Excellent to good Knee Society Score (p ≤ 0.005) and Fracture united in less than 20 weeks duration.Conclusion: MIPPO has leverage over traditional plating by conserving periosteal blood supply. The patient compliance is good and it is cosmetically better than different types of fixators. Thus, Primary MIPPO using locking plates is an acceptable method of managing Compound proximal tibia fractures.
303 Eneslow Pedorthic Rocker Sole Biomechanical Design Criteria - 2022, Robert Schwartz
The rocker sole uses the concept of a rocking chair platform which controls joint motion and transfers impact forces. Modifications to the heel and sole of the shoe.To help control motion, relieve pain and improve comfort, balance, alignment, posture, and gait. While standing, and in gait: walking and running. Designed to help Control Foot Motion primarily in the sagittal plane Decrease Impact forces on Hip, Knee, Ankle, and Foot Improve Balance, Posture, alignment, and gait Caution: Rocker soles may increase demand on other connective tissue (joints, muscles, tendons, etc.). • For best guidance ask your ealthcare professional if Eneslow rocker soles may prove beneficial.
304 Pros and Cons of social media: A Double-Edged Sword , Dilip Shah
In this modern world age Robotic Surgery becoming norm, 5G about to arrive, you love social media, hate it but you cannot ignore it. Almost 5 billion people across the world are on social media. Social Media are the windows through which you can see the whole world and areas of your interest. One can make his presence felt through the social media aptly and easily. It’s up to you how to use social media like - Lamp post one can use it for illumination or use it for support like a drunkard uses it i.e., for support to maintain balance. Like our Mythological Gods Brahma can be used in creative manner or Siva as a destroyer in distracting or disheartening manner. In fact it is Frenemy, it can be friendly if used in positive manner and enemy if used in negative manner. We will go into the Pros and Cons of social media
305 Assessing Ground Reaction Forces and Degenerative Changes of Sound Limb in Unilateral Lower Extremity Amputees: A Systematic Review, Kira N Donnelly, Colin Davis, Nicole Liotta, Angela Perkins, Vibhor Agrawal, Jason Highsmith and Scott Love
Background: There is a rising number of individuals undergoing lower extremity amputation (LEA) and is associated with increased risk of comorbidities. Osteoarthritis (OA) and Degenerative Joint Disease (DJD) are conditions that cause reduction in an individual’s function, independence, and quality of life.Research Design: A search of multiple databases using terms associated with possible functional declines as evidenced by the International Classification of Functioning, Disability and Health (ICF), followed by assessment of evidence using the PEDro scoring method will be conducted. Multiple reviewers will screen, sort, rate and extract data from articles.Methods: A computer-aided literature search of PubMed, CINAHL, and Google Scholar was performed to identify studies published beginning in 2009 that investigated factors that contribute to degenerative changes in the contralateral limb of a unilateral LEA. Results: A total of 21 studies were selected from a total of 56 collected studies. Predictors of osteoarthritis (OA) following lower limb amputation include age, etiology, level of amputation, gender, Body Mass Index (BMI), comorbidity, pain, phantom pain, streng and OA. The impact of ground reaction forces on the sound limb varies between studies. In general, poor gait mechanics and resulting compensatory mechanisms are significant contributors to the occurrence of OA. Conclusion: There is a dearth of information relating to the prevention of degenerative changes in those with LEA and protocols for pain management and training pre- and post-joint replacement. The incidence of OA in the contralateral limb is still not fully understood. Further investigation into the biomechanics of compensatory mechanisms is necessary to fully understand the functional impact on the population. It is imperative to develop thorough physical therapy protocols for individuals in early onset of OA and those undergoing joint replacement due to degeneration.
306 Minimal Invasive Fibular Osteotomy for Uni (Medial) Compartmental Osteoarthrosis of Knee, Satya Kumar Koduru and Venkata Narasimha Rao V
Osteoarthrosis of knee is the most important and common reason for the disability in the elderly population. The major reasons for disability are pain and limitation of movements of the knee. Total knee replacement surgery, which aims to decrease the pain, improvement in joint function and movement, is the main surgical modality to treat this condition.in population minimal invasive fibular osteotomy is the new alternative in the young patients with arthritis of medial compartment. From October 2019 to December 2021, 50 patients who underwent minimal invasive fibular osteotomy at our institute were followed prospectively (n = 37; age range, 48-72 years; 28 females, 22 male) with follow-up at 6 weeks, 3months, 6months, 9months, 12months, and 24months post-operatively. Out of 50 patients who underwent minimal invasive fibular osteotomy, medial pain relief was observed in 45 patients with in one- or two-days post operatively remaining 5 had no change in pain. Results revealed elevation in mean visual analog score (from 5.76+/0.60 to 2.08+/-0.70) and an improvement in Mean medial joint space (1.30+/-0.33 to 4.50+/0.29) and improvement in mean functional knee score (54.24 to 74.56). Postoperative complications like paresthesias of foot in dorsum of foot in 2 patients, which recovered by 6 to 12 weeks, EHL weakness in 2 patients. Thus, we conclude that minimal invasive fibular Osteotomy is a simple, safe and pocket friendly, day care procedure that doesn’t require insertion of implants.
307 Complications Following Tonsilloadenoidectomy, Ivan Baljosevic, Mladen Novkovic, Vladan Subarevic, Katarina Stankovic, Aleksandra Bajec-Opancina and Stefan Popovic
Aim of study: The aim of this study is to present the incidence of complications following tonsilloadenoidectomy and to determine causative factors for complications.Methods: The study is a prospective analysis encompassing 200 children aged 2,5 to 10 years with a history of tonsilloadenoidectomy from October 2017 to April 2018. The results were determined using descriptive statistical methods. Results: 124 or 62% of treated patients were males and 76 or 38% females, 71 or 36% were children aged 2.5 to 4 years, 89 or 44% children aged 5 to 7 years and 40 or 20% children aged 8 to 10 years. Postoperative hemorrhage was classified as either primary (within 24h) seen in 3 patients or secondary (after 24h) seen in 8, with a total post-tonsillectomy hemorrhage rate of 11 (5,5%). Other complications included elevated body temperature seen in 16 (8%) cases, vomiting in 16 (8%), dehydration in 8 (4%), and diarrhea in 6 (3%). Conclusion: Bleeding following tonsilloadenoidectomy appears more often in children with a history of frequent tonsillopharyngitis prior to operation and vomiting and diarrhea were more frequent in children aged 2 to 4 years
308 Courrent Concepts: Adhesive Capsulitis of the Shoulder, Pulcinelli FM, Nannerini M, Emanuele G and Libutti E
Adhesive capsulitis is a condition characterised by the spontaneous onset of pain, and progressive movement restriction/limitation. The etiology of adhesive capsulitis of the shoulder is still unknown. Patients often complain about pain, especially overnight, and progressive reduction of range of motion. Conservative treatment can be performed b physioterapy, corticosteroid injection and capsular distension. When conservative treatment fails, surgical treatment is indicated, it is characterized by either open or arthroscopic treatment followed by manipulation. The aim of this article is to provide the literature and our experience results of the most used treatments
309 Prevalence of Nasal Carrying of Staphylococcus aureus in Patients Undergoing Total Hip Arthroplasty, Nicolas Rojas Veloso, Jonathan Torres Castro, Cristian Contreras Villalobos, Chu Long Yuan, Nicolas Pinto Santander, Giovanna Castillo, Tomas Amenabar Vial and Osvaldo Inostroza Farina
Introduction: Prosthetic joint infection (PJI) is one of the most dramatic complications in total hip arthroplasty (THA). Among risk factors, nasal colonization with Staphylococcus Aureus (SA) has been described, showing an increasing prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) The aim of this study is to determine the prevalence of S. Aureus, MRSA nasal colonization before THA and to learn the relation to Charlson comorbidity index (CCI). Methods: From a sample of patients from the community with osteoarthritis, we selected patients undergoing THA who met inclusion and exclusion criteria and were screened for nasal colonization of SA and antibiotic resistance, prior to surgery. A decolonization protocol with topic mupirocin and soapy chlorhexidine bathing was used in nasal carriers of SA. A new culture was performed two weeks after the treatment was completed. Finally, CCI was calculated.Results: 106 patients met the inclusion and exclusion criteria. 24.5% (26) of patients were positive to nasal colonization to SA, 1.8% of them were positive to MRSA and all completed treatment. No positive cultures were obtained in the two-week follow-up, no statistically significant difference in the CCI between both groups was revealed and no PJI was reported at 6-month follow-up.Discussion: In this study, the prevalence of nasal colonization S. Aureus and MRSA, was within the range reported in international literature. We suggest a universal detection of nasal carriage of SA in patients who will be undergoing a THA.
310 Posterior Transpedicular Intercorporeal Impaction Morselized Bone Graft for the Treatment of Pyogenic Thoracolumbar Spondylodiscitis a Prospective Cohort Study, Mohamed Fawzy Khattab, Tameem Mohamed Elkhateeb and Youssry Elhawary
Study Design: Prospective cohort study. Objectives: To assess the efficacy of transpedicular intercorporeal impaction morselized bone graft in management of pyogenic thoracolumbar spondylodiscitis. Methods: Patients were treated from 2013 to 2020. All patients underwent transpedicular anterior column debridement, intercorporeal fusion using morselized bone graft with posterior pedicle screw fixation. Kirkcaldy-Willis criteria and the Visual analogue scale for back pain were used. Neurological state was assessed by recording ASIA scale. Radiological fusion was assessed by the Brantigan and Stefee grading system. The local kyphosis angle was assessed preoperatively, postoperatively and at final follow up. The presence of any complications was reported. Results: 38 patients met our inclusion criteria. Patients mean age 55.26 ± 7.41 SD years and mean follow up 42.12 ± 11.35 SD months. Preoperative VAS for back pain significantly improved. Kirkcaldy-Willis functional outcome were excellent in 26 patients, good in 9 patients and fair in 3 patients. All neurologically affected patients showed improvement of their neurological status. Radiologically intercorporeal bony fusion grade 4 and 5. Preoperative local kyphotic angle significantly improved from mean 22.73° ± 4.85 SD to 4.53 ° ± 2.35 SD postoperatively and 5.75° ± 1.66 SD at final follow up. No recurrence of infection, implant failure nor graft resorption.Conclusion: Transpedicular debridement and impaction intercorporeal morselized bone graft is simple, safe, and cost-effective technique in treating thoracolumbar pyogenic spondylodiscitis. With good clinical and radiological outcomes
311 Description of WALANT Technique on Forefoot Surgery, Gustavo Lucar-Lopez, Guillem Paz Ramirez, Maria Fernanda Gomez Blanco, Manel Ballester-Alomar, Kerbi Alejandro Guevara-Noriega and MA Villamizar Avendano
Forefoot surgery usually requires tourniquet use and anaesthesia is performed using a popliteal or ankle anaesthetic block. Therefore, surgical departments require an anaesthesiologist to trust them with this procedure. The elective nature of forefoot surgery and the lack of anaesthesiologists resulting from the COVID 19 pandemic, has forced Foot and Ankle specialists to dig into other alternatives, in order to continue their surgical practice and to avoid the growth of the waiting list. The wide-awake local anaesthesia non-tourniquet, which was originally described for upper limb surgery, has recently been adjusted to Foot and Ankle surgery. It does not require sedation, nor regional or general anaesthesia and since the patient is wide-awake, they will be able to fully collaborate during the procedure. The use of lidocaine and adrenaline described on the WALANT technique allows us to obtain a local anaesthesia and vasoconstriction. This method permits the surgeon to move forward into surgery with a completely awake patient and no need of tourniquet giving the advantage of a full motor function assessment intraoperatively. WALANT has been proven to be a safe, effective and affordable technique when it comes to foot and ankle surgery. Having gone through a lack of anaesthesiologists, surgery rooms and hospital resources during SARS-CoV2, WALANT emerged and now represents an acceptable alternative to consider and continue to treat selected cases of foot and ankle surgeries
312 Patient Satisfaction in Forefoot Surgery Using Walant Technique, Gustavo Lucar-Lopez, Guillem Paz Ramirez, Maria Fernanda Gomez Blanco, Manel Ballester-Alomar, Kerbi Alejandro Guevara-Noriega and MA Villamizar Avendano
Several anesthetic techniques are used in foot and ankle surgery, WALANT technique is one of them that has several advantages: fast procedure, no ischemia or tourniquet needed, dynamic evaluation. Less preoperative test are needed and the total cost is reduced. It has very successful proven in upper extremity. We would like to evaluate the patient satisfaction of the WALANT technique in forefoot surgery.21 patients are included in the study. 66% of the patients had no pain and 19% had minimal pain during the surgery. 85% of the cases recommended or strongly recommended this technique for the forefoot surgery.Our results indicate that WALANT surgery is a safe with very good satisfaction indicators for the patients
313 Unicompartmental Knee Arthroplasty in the ACL Deficient Knee , Tuesday F Fisher
Unicompartmental osteoarthritis in young, active patients with concomitant ACL deficiency is controversial problem. Several different operative treatment options exist including unicompartmental knee arthroplasty, high tibial osteotomy (HTO), and total knee arthroplasty [1]. Total knee arthroplasty (TKA) has a very high success rate and is a comprehensive procedure that would address knee pain as well as instability related to ACL insufficiency [2,3]. However, contemporary literature benefits of UKA over TKA including preservation of bone stalk, physiologic knee kinematics, lower perioperative morbidity and accelerated rehabilitation [4-9]. TKA may also impart unacceptable activity restrictions in a physiologically young patient with specific physical demands. As an alternative, UKA and HTO have been used with or without concomitant ACL reconstruction. Early results for UKA have been most promising; however, controversy still remains as to its role in the treatment of this population.
314 Midterm Results of 2 Stage Revision for Periprosthetic Knee Infection. Comparison of Metal/Polyethylene and Metal/Cement Types of Spacers, Denis Vladimirovich Rimashevskiy, Ildar Fuatovich Ahtyamov, Erkin Dauir Kurmangalyev, Stanislav Vladimirovich Rangaev, Alexey Alexandrovich Belokobylov, Dan Zhadygerov, Bulat Iskakov, Marat Khudayergenov, Manarbek Aubakirov and Reinhard Schnettler
Background: Two stage revision for periprosthetic joint infection after total knee arthroplasty is the golden standard of treatment, but it has a large number of reinfections and outcomes of re-implantations are far from optimal. Many patients after spacer implantation are not being reimplanted during the first 6 months due to multiple reasons. Method: In this prospective study 160 patients (160 joints) who underwent two stage revision for septic knee arthroplasty were included. In all cases articulating spacers with primary metal femoral component and armed intramedullary spacers (dowels) were implanted. 4 patients were lost to follow-up within a year after the spacer implantation with confirmed infection sedation at the first follow up in 3 months after spacer implantation and were excluded from the study. Out of the rest 156 cases in 81 case liner of bone cement was used. In 75 cases we used polyethylene liner. Medical comorbidities, type of knee replacement (primary vs. revision), culture results, serum hemoglobin level, erythrocyte sedimentation rate, Knee Society Score, knee range of motion, were all recorded before the first spacer implantation, in 3 months and at the last follow-up in average 56.35±18.77 months after reimplantation or spacer with poly liner implantation. Results: After the first stage infection relapsed in 33% (N = 27) of the cases in cement liner group and in 8% (N = 6: 4 during the first 6 months after the 1st spacer implantation and 2 later) of cases in poly liner group. At the last follow-up control over infection with functioning articulating knee was achieved in 85% and 94.7% of cases, respectively. Clinical and functional results in poly liner group were significantly better than in cement liner group at all periods of follow-up (p ≤ 0,05). Conclusion: superior results of poly liner spacers over cement liner spacers made us completely abandon cement liner spacer technique and broaden the indications for so called temporary-permanent spacers with polyethylene liner in cases of infection in the knee with possibility to achieve knee stability with non-constrained spacer. Success of temporary-permanent spacers implantation may lead us towards wider use of one stage revisions in “high risk” deep infection after knee arthroplasty.
315 Total Knee Arthroplasty (TKA) in Ankylosed Knee with Fracture Supracondylar Femur, Ashish Singh, Purushotam, Sushil Singh, Pankaj Kumar and Rabin- dra Narain Singh
Total knee arthroplasty indication and contraindication in an ankylosed knee with supracondylar femur fracture are poorly defined in the literature. Many of reports in this situation is either a retrospective study or very less mention or no mention for indication of surgery with fixation of fracture and TKA in fused knee in single sitting.TKA in ankylosed knees is a challenging procedure, and if combined with a fracture it becomes bigger challenge. Here in this case report we present TKA in an ankylosed knee with a supracondylar fracture femur done in a single stage. This case imposed many challenges as bony fusion was one issue, muscle atrophy and a recent fracture was the other major concern. The patient was young and had desire that he could have some procedure done so he gains functional range of movement. The Knee Society Score (KSS) [1] increased from 35 improved to 90 and functional outcome reported is good. This case was a learning lesson in managing a primary complex TKA
316 Impact of Virtual Reality on Hand Grip Functional Activity in Stroke Patients, Velmurugan G, Gladies Kamalam S, Manivannan S, Dinesh Dhar- malingam and Mrudula J Pawar
Background: Stroke is common cause of motor disability. Recovery of hand function such as gipping activity is poor with few stroke survivors. Virtual reality therapy can provide enhanced feedback to promote hand functions in stroke conditions. Aim: This study is done to find out the effect of virtual reality on improving grip function of stroke patients. Methodology: 10 stroke patients with difficulty in gipping activities received virtual reality therapy for 4 weeks, 5 sessions/week. Hand dynamometer was used as outcome measure to measure the grip strength. Statistical tool: Independent t test was used.Conclusion: Significant difference in grip strength was seen after Virtual reality therapy at p < 0.01
317 Robotic Total Knee Arthroplasty in Post-Traumatic Osteoarthritis: A Report of Three Cases, Ashish Singh, Kartheek Telagareddy, Purushotam Kumar, Sushil Singh, Rabindra Narain Singh and Pankaj Kumar Singh
Background: The purpose of this case study is to present three cases in which the robotic assisted TKA device was used to correct a severe post traumatic osteoarthritis. Routine conventional TKA in complex PTOA can be challenging and difficult to execute precisely due to articular distorted anatomy. Patients and Methods: A single centre retrospective series collated the records of three patients (mean age, 46.3 years) who underwent TKR for post-traumatic osteoarthritis of the knee associated with intra-articular malunion. Mean trauma-to-TKR interval was 8.2 years (range 1 to 6.9 years). Patients were assessed clinically and radiologically at last follow-up, using the Knee Society score and WOMAC score at a mean of 16.3 months. Results: At a mean overall follow-up of 16.3 months (range 12 to 19 months), mean knee society score improved from 67 to 144.3 and WOMAC score 53.6 to 4.6. Mean flexion gain was 6◦: mean preoperative flexion, 103◦ (0◦ to 110◦), vs. 115◦ (0◦ to 115◦) at final follow-up. No complications were observed in this series.Conclusion: Robot-assisted surgery allows the surgeon to restore alignment even in patients with severe deformities. In this case series, we have illustrated how the robotic device corrected severe PTOA and flexion deformities in patients, which can be challenging in routine TKA.
318 Outcome Of Decompression in Lumbar Stenosis Using Spinous Process Splitting Approach, Bharath R, Shaival C, Sharan P and Purushotam L
Aim of Study: The functional outcome following decompression surgery using the spinous process splitting approach, to assess the integrity of the paraspinal muscles after surgery and assess the fusion of the split spinous processes after they are sutured together Material and Methodology Preoperative plan: History was taken followed by clinical examination. Pre- operative scores were assessed Oswestry Disability Index(ODI), Japanese Orthopaedic Association(JOA) scoring system and Visual Analog Scale(VAS). Tests such as Tread mill test and electromyography studies of the involved segment were done. Radiographs of lumbosacral spine AP/lateral/flexion and extension views and MRI of spine were performed. Blood parameters CPK levels were done. Informed consent taken Surgical Procedure: With the patient prone, the level of decompression is marked. The spinous process is split longitudinally in the middle and divided at its base from the posterior arch, leaving the bilateral paraspinal muscles attached to the lateral aspects. Ample working space for laminectomy is obtained by retracting the split spinous process laterally together with its attached paraspinal muscles. After successful decompression the two halves of the spinous process is re-sutured using a suture. Post op protocol: Post operatively patients were evaluated for paraspinal muscle damage using CPK levels - 1hour and 48 hours post surgery. The patients were reviewed 1month, 3months and 6 months after surgery. The functional outcome was evaluated with Oswestry Disability Index, Japanese Orthopaedic Association scoring system, Visual Analogue Scale and a Tread-Mill test. At 3 months the patients underwent electromyogram of paraspinal muscles. This was followed by a limited section computer tomography scan at 6 months to assess the fusion of the spinous process. Results: Level of stenosis was most commonly seen at L3-L4 level. CPK levels compared to pre-operative, increased immediately during the post operative phase and started to decline by 48 hours. No change in the paraspinal muscles when compared between pre operative and 3 months post operative muscle status. Tread mill test showed the patient’s duration of walking improved with time after the procedure. The patients walked for a greater duration at their own speed when compared to a fixed speed of 1.2mph after the surgical procedure. The patients assessed for pain showed that VAS increased post operatively but reduced with time. The functional outcome assessed using JOA score and the impairment of disability measured using ODI showed improvement.Union rates were lesser in the above 50 age group though the functional outcomes were the same in whom spine was united and those with uniting spinous processes. Conclusions: The lumbar spinal canal splitting approach offers the advantages of a wider surgical working space. The damage to the muscles and ligaments are minimal. Insignificant denervation of muscles was present. Union rates were higher in younger age group. Decompression achieved by this method was good in both unilateral and bilateral stenosis when involving one level.
319 Simulation Fidelity in the Context of Surgical Training in Orthopaedics , Suddhajit Sen
Surgical training has evolved in the last two decades from the traditional master apprentice model to a method of deliberate practice through simulation based learning. Simulation based learning is an established form of training in the aviation industry. Efficient and effective transfer of clinical skills through training is the final goal of all training methods. This article aims to critically review and analyse the relationship between simulation fidelity and surgical skills transfer in Orthopaedics to present a pragmatic perspective
320 Ensuring Good Outcomes after Elective Spine Surgery, Harwant Singh
321 Ensuring Good Outcomes after Elective Spine Surgery, Harwant Singh
Elective surgery for degenerative spinal conditions has a very high litigation rate [1]. The most common cause of litigation is informed consent and wrong level of surgery. This is also because the patients’ expectations did not match the outcome of surgery [2]. It is the saddest situation that arises in clinical care as there is no malice on the part of the surgeon who provides the care. However, the doctor-patient relationship is destroyed after such an event.
322 Infracardiac Type Total Anomalous Pulmonary Venous Connection. A Clinical Case Presentation and Literature Review, José Alfredo Castro Ibañez, Rocío Gissel Cordero Suárez, Oscar Gustavo García Ruíz, Martha Alicia Hernández González and Marco Antonio Olvera Olvera
The Total anomalous connection of pulmonary veins (TAPVC) of the infracardiac type is a rare pathology whose diagnosis is achieved by transthoracic echocardiography (TTE). However, due to its limitations, thorax angiotomography (TAT) emerged as the preferred complementary modality due to its high resolution, as well as multiplanar and 3D reconstruction capabilities, which are essential for correct anatomical evaluation and surgical planning.We present the clinical case of a pediatric patient in whom TAT was performed in addition to a TTE study to determine the size, number, and connection of the pulmonary veins.
323 Impact of Smartphone Usage on Forward Neck Posture and Function in College-Going Students, Shubham Menaria, Tittu Thomas James, Pranali Gaonkar, Shubhi Saxena and Pradnya Dhargave
Objective: There is an increased usage of smartphones among college-going students, especially with an increase in online education system during the COVID pandemic. Long-term use of smartphones may lead to various health issues in an individual. The objective of this paper was to identify the impact of smartphone usage on the neck posture and disability in college-going students.Methodology: The study recruited 50 students between the age group of 21 to 25 years. The weekly usage of smartphone in hours was documented from usage-tracking apps. Forward neck posture of the individuals was assessed by measuring Cranio-Vertebral (CV) angle using Photogrammetry method, and the disability using Neck Disability Index (NDI). Pearson correlation analysis was done to statistically analyze the data.Results: The mean age of the study population was 23.3 ± 1.5 years and had 14 males and 36 females. There was a mean weekly smartphone usage of 36.45 ± 9.50 hours among the participants. The mean NDI score was 4.82 ± 3.76, depicting mild disability among participants. A moderately positive correlation was identified between the weekly smartphone usage and NDI score and was statistically significant (ρ = 0.309, p = 0.029). The mean CV angle was 46.62 ± 4.71 degrees. The CV angle had a strong correlation of -0.811 (p < 0.001) with the weekly smartphone usage, denoting an increased forward neck posture with increased smartphone usage.Conclusion: The study identified a mild disability in neck functions and an increased forward head posture in individuals who having increased weekly usage of smartphone. The results of the study call for actions in these patient population in order to prevent further worsening of situations by increasing awareness regarding the same.
324 A New Modification of the ‘Surgilig’ Technique for the Reconstruction of Chronic Acromioclavicular Dislocations , Michael- Alexander Malahias, Dimitrios Gerogiannis, Apostolos Stathellis, Stefania Kokkineli, Emmanouil Brilakis and Emmanouil Antonogiannakis
Background: The clinical outcomes of artificial ligament grafts for the treatment of chronic acromioclavicular joint (ACJ) dislocations have been controversial. We aimed to determine the clinical outcomes of ACJ reconstruction with a modified “Surgilig technique’ (Surgilig, LockDown, UK) for the treatment of patients suffering from chronic ACJ dislocations graded as Rockwood’s type III or higher.Materials and methods: Between January 2015 and May 2017, 13 patients with chronic ACJ dislocations were reconstructed with the use of a new modification of the ‘Surgilig technique’ including the additional use of six sutures (Ethibond No5).Results: At the final documented follow-up, no patient was re-operated, while the vast majority has returned to the same level of activities (76.9%) as before injury. In addition, 84.6% of the patients were very satisfied with their procedure, whereas an equal percentage (84.6%) would be willing to repeat the same operation again. The mean final postoperative American Shoulder and Elbow Surgeons (ASES) score was 97 (SD: 1.7, range: 89-100), while 92.3% of the patients were found free or almost free of pain (mean visual analogue scale: 0.25, range: 0-20/100). Conclusions: Late reconstruction of chronic Rockwood type ≥ III ACJ dislocations with the ‘Surgilig technique’ illustrated excellent clinical outcomes.
325 Hamstrings Graft Harvesting: Where Should be the Incision? Anatomical Landmarks Based on Magnetic Resonance Imaging, Alan Augusto Coelho, Júlio César Nather Júnior, Rodrigo Salim, Mauricio Kfuri Junior, Robinson Esteves Pires and Fabricio Fogagnolo
Objective: The objective of the present study was to standardize the surgical approach for hamstring graft harvesting, with location of the center of the incision based on anatomical parameters and using data from a selection of magnetic resonance images of the knee.Method: This study analyzed 40 magnetic resonance images of the knee (20 men and 20 women). The parameters measured were: longitudinal distance from the proximal border of the pes anserinus to the femorotibial joint in the coronal section (PA-JOINT); transverse distance from the lateral border of the pes anserinus to the medial border of the anterior tibial tuberosity in the axial section (PA-ATT); and ratio between the distance from the proximal border of the pes anserinus to the femorotibial joint (PA-JOINT) and the largest transverse width of the tibial plateau (WIDTH PLATEAU). Results: According to the analysis, the location of the center of the incision was estimated to be 4.0 cm distally to the femorotibial joint (PA-JOINT) and 2.5 cm medially to the anterior tibial tuberosity (PA-ATT). There was a strong intra-observer and regular inter-observer correlation for these measurements. Conclusion: With the precise determination of the incision center, it is possible to standardize an accurate and reproducible surgical approach for hamstring graft harvesting.
326 Glomus Tumour Around the Knee Joint A Case Report and Review of Literature, Farid Ghasemzadeh Mojaveri and Aaron Han
Introduction: Glomus tumours usually is seen in the extremities, especially subungual area of fingers and toes. Glomus tumours rarely occur around the knee joint and especially in young active people who are prone to different types of knee injuries it can easily be misdiagnosed as a case of internal knee derangement. Case report: In this case report we are presenting a young 33 years old Egyptian gentleman with a history of knee pain for the past 8 years who has done several MRIs and has done unsuccessful several physio therapies with suspicion of internal knee derangement recently even he was offered an arthroscopic knee surgery. A careful clinical and imaging study revealed a tiny soft tissue mass in anteromedial joint line with exquisite tenderness.Excision of the mass under local anaesthesia showed the typical purple mass and histology study confirmed the Glomus tumour. He remained completely pain free after the surgery.Discussion: There had been 39 case report of Glomus tumour around the knee joint so far in the literature we have discussed different locations and presentations of this tumour in this case report.Conclusion: Lack of experience and awareness about this mostly benign soft tissue tumour can lead to plenty unnecessary work ups and sometimes unnecessary surgeries.
327 Is it Really Necessary to Remove the Metal Plate When an Infectious Process in the Bone Does Not Resolve with Clinical Treatment?, Huang WL
Nosocomial osteomyelitis is a complication that needs immediate treatment and can often require the removal of the metallic implant, increasing expenses and prolonging recovery by the patient [1]. The most common bacteria responsible for two-thirds of infection in orthopedic implant infection is Staphylococcus aureus in osteomyelitis and septic arthritis [2]. The mechanism involved in this implant infection is related to bacterial adhesion in implant infection. The factors involved in this process depend on material surface properties, bacterial effects, and the existence of tissue and serum proteins [2]. There are some studies in the literature showing that implants that have porous or smooth surfaces have more propensity to have an infection and they need only 2.5 times fewer bacteria to induce infection, compared to polished surfaces [3]
328 Case of Multifocal Non-Hodgkins Lymphoma of Bones of Foot and Ankle , K Satyakumar and Venu Gopal Reddy P
We present a unique case of a 65 year old woman with complaints of multiple swellings around the left ankle. we performed preoperative work up with radiography, CT and MRI and because of diagnostic dilemma, we planned for excision biopsy and sent for histopathological examination which suggested large B cell lymphoma and was confirmed by Immunohistochemistry. The patient subsequently underwent chemotherapy and radiotherapy to the affected area
329 Atypical Femoral Stress Fracture with Uncommon Location and Mechanism of Injury: A Case Report , Kishan V Patel, Mitesh Patel, Sunny Gupta and Irfan Chhipa
Atypical femoral fractures (AFFs) typically present in patients predisposed to brittle bones or greater biomechanical stresses along the shaft of the femur. Risk factors include, Asian population, women, high body mass index, and users of bisphosphonates, glucocorticoids, and proton pump inhibitors. Most commonly the injury occurs in the proximal or middle portion, but few studies have documented distal femoral stress fractures. This case illustrates a patient presenting with right lower extremity pain for over a month and difficulty ambulating for a few days. He initially had a negative conservative work up when the pain started. The patient lacked high energy trauma history and other predisposing conditions. After imaging with both X-ray and MRI, he was diagnosed with an occult transverse stress fracture of the distal femoral diametaphysis. He was treated conservatively with non-weight bearing to the right lower extremity for 6 weeks. On follow up, his fracture healed well and clinically the patient was able to return to his daily activities. This report emphasizes a unique fracture mechanism and location to the limited evidence of AFFs. The case urges clinicians to consider ordering additional imaging for patients if the provider has a high clinical suspicion of fractures. A comprehensive history is warranted for the case of occult fractures as knowledge of risk factors can help diagnostic accuracy and improve patient care.
330 Comparative Study of Grip Strength Assessment in Tennis Player with and without Shoulder Pain , Chetna Rajput, Shweta Pachpute, Roopa Lokesh and MK Kishore
Background: Tennis deals with chronic shoulder injuries and also grip strength is important for muscle function, injury prevention and performance. There is positive correlation between grip strength and shoulder musculature. Hence this study finds and compares grip strength in tennis players with shoulder pain and without shoulder pain. Methodology: Ethical committee approval was taken. The subjects selected were in age group of 20-30yrs with experience of 2-5 years having chronic shoulder pain. 30 subjects were selected - 15 with shoulder pain and 15 without shoulder pain with mean age of was 23yrs with S.D.±3.6. With the help of Visual Analogue Scale the pain score was recorded. The testing position for grip strength assessment was taken using Jamar Hand Dynamometer according to American society of hand therapist. The participants seated with straight back with both feet flat on floor with the shoulder adducted and neutrally rotated. The elbow flexed at 90 degrees of flexion, the forearm in neutral, and the wrist between 0- and 30-degrees extension and 15 degrees ulnar deviation. The average of grip strength with pain and without pain was taken. The analysis of results was done and tabulated. Results: The study found that mean VAS was 3.8 and mean grip strength in shoulder pain was 29.88 and without shoulder pain was 37.4. Conclusion: This study found that there was decrease in grip strength in players with shoulder pain than players without pain.
331 “Correlation Between Pain and Disability in Cervical and Lumbar Spine in Two-Wheeler Riders” , Renukesh Shetty, Trupti Siddapur and Tushar Palekar
Background: India is a nation with crowded streets and limited parking spaces, making two wheelers as a preferred modes of commute in cities. Current design of motorbike in market is not equipped with back leaning postures support features for rider leading to musculoskeletal pain in the riders. Use of helmets causes discomfort in neck region; such pain and discomfort affect the quality of life leading to disability (QoL). Objectives: To find out the correlation between Pain and Disability in Cervical and Lumbar Spine in Two- Wheeler Riders Among Physiotherapy Profession based on Neck Disability Index (NDI), Oswestry Disability Index and Numeric Pain Rating Scale (NPRS). Method: 30 young adults with neck and low back pain between 20-30 years, Riding bike more than 1 year were assessed for pain and disability. Result: Data was analyzed by Pearson’s Correlation Coefficient suggesting strong positive correlation between Neck pain with Neck Disability (r = 0.53) and Low back pain with Low back Disability (r = 0.44) Conclusion: There is a significant positive correlation between pain and disability of cervical and lumbar spine
332 Interest of Drainage in Shoulder Arthroplasty: A Prospective Multicenter Study , Kevin Bargoin, Jean-Marc Glasson, Jacques-Emmanuel AYEL, Emmanuel BEAUDOUIN, Régis GUINAND5 and Anne Vidil
Objectives of the study: It is common to drain the operative wound to limit the occurrence of postoperative hematoma after shoulder prosthesis (TSA). The interest of drainage has been questioned in hip and knee replacement surgeries for the sake of blood saving. Rapid recovery protocols after surgeries are suitable for shoulder surgery and the usefulness of drainage is a determining factor. A prospective, multicenter controlled study was performed on shoulder prostheses with or without drainage to analyze blood loss, mean length of stay (SMD) and complications. Hypothesis: the drain increases the length of hospitalization and does not decrease the risk of complications. Material and Method: A continuous prospective study was carried out on 6 centres in France for a total of 139 TSA over a year divided into 2 groups, the first 6 months with drainage (AD: 80 TSA) and the following 6 months without drainage (SD: 59 TSA). The study compared the 2 groups with clinical scores in preoperative and at 6 months postoperatively (M6): Constant, SST, SSV and ASES. Blood loss was assessed on the evolution of hemoglobin (Hb) levels, the volume of the redon on the 1st and2nd day and any transfusions. SMD and postoperative complications were identified. The groups with and without drain are comparable in age, ASA score and types of prosthesis. Results: No significant difference on the constant (M6) AD scores: 62 points (pts), SD: 60 pts p = 0.37, ASES, SST, SSV nor on the rate of change in preoperative hemoglobin and J2 AD (-1.87g/dL) SD (-1.83g/dL). No significant difference on the SMD (3.9d – 4.1d) with extremes of 2 to 15 days. A difference in SMD is found depending on the etiology: fractures vs other causes (6.06days - 3.7 days) p = 0.015. Analysis of complications was less hematoma collected in the drain group AD 2.5%, SD 8.5%, not significant p = 0.13, 4 times in the group with drain vs 2 times in the group without drain. Discussion: Drainage did not increase blood loss, lack of drainage did not decrease SMD in our study. The main factor in increasing SMD is traumatic etiology with a SMD that is often greater than a week. Drainage does not influence the recovery rate. Systematic drainage is above all a matter of practice. Conclusion: Drainage does not appear to be essential for shoulder prostheses in patients who do not have a coagulation abnormality.
333 Aïnhum (Dactylolysis Spontanea), A Rare Mutilant Disease : A Case Report , Virginie VAN BOECKEL, Sebastien FIGIEL and Sandrine CAO
Aïnhum, also known as dactylosis spontanea, is a rare dermatological disease that most frequently affects men of African origin, characterized by a fibrous constrictive band that develops preferentially at the base of the 5th toe. The natural evolution of aïnhum can be described in four different stages, ranging from a simple fibrous band to self-amputation of the toe. The classic distinction is between "true" aïnhum of unknown cause, which would only affect people of African descent, and pseudo-aïnhum, which follows various causes. We present a case of aïnhum, at stage 2 of the pathology, treated with a Z-plasty on the 5th toe. The diagnosis is clinical, and the prognosis after early surgical treatment is favourable.
334 The Effect of Phonophoresis Versus Iontophoresis in Lateral Epicondylitis-RCT , Aher Ravindra Karbhari
Background: Lateral Epicondylitis is prevalent in 95% of non-tennis players and predominantly in women. Current literature supports the effectiveness of the Phonophoresis and Iontophoresis with Dexamethasone in treating lateral epicondylitis but studies regarding its safety and effectiveness are not done. The study is intended to find the superiority of Phonophoresis and Iontophoresis on lateral epicondylitis by using Dexamethasone. Aims and objectives: To find out the effect of Phonophoresis and Iontophoresis in patients with lateral epicondylitis. Materials and Methods: One year of Study was done at Krishna hospital in patients diagnosed with lateral epicondyltis. Patients assigned randomly into three Groups A, B and C (n = 3). Subjects were treated by Phonophoresis, Iontophoresis and ultrasound respectively for 2 weeks, and the outcome were measured and documented. Results: Significant improvement in pain relief was measured by VAS in Group A than B and C (p = 0.0332) and improved grip strength was better in Group B than Group A and C (p = 0.5745). Conclusion: Phonophoresis and Iontophoresis are effective in pain reduction and increased grip strength as proved statistically and clinically.
335 The Effect of Polyvinyl Alcohol Antimicrobial Foam Dressing with Two Organic Pigments vs. Silver Antimicrobial Foam on Exuding Venous Ulcerations: A Comparative Pilot Study , Isaac Matthias Buhagiar, Alfred Gatt, Nikolaos Papanas, Andrew Scicluna, Claudine Farrugia and Cynthia Formosa
Background: Treatment of venous ulcers often includes incorporation of dressings, for reduction of bio-load. Evidence is lacking with regards to which dressing is ideal for healing chronic venous wounds. This study aimed to compare the healing effect of polyvinyl alcohol (PVA) antimicrobial foam dressing impregnated with two organic pigments (gentian violet and methylene blue) vs. silver antimicrobial foam dressing. Research Design and Method: A quasi-experimental study was conducted. 28 participants were divided into two groups and treated with one of the antimicrobial foams. Patients reviewed weekly for 3 weeks. Wound healing was assessed using the Bates-Jensen Wound Assessment Tool. Results: Over a period of 3weeks, both the PVA antimicrobial foam with two organic pigments and the silver antimicrobial foam dressings were effective in reducing mean BJWAT scores and wound healing (p < 0.001). The former was significantly better at week 1 (p = 0.001) and 2 (p = 0.014) but not at week 3 (p = 0.881). Conclusion: PVA antimicrobial foam with two organic pigments showed some superiority over silver antimicrobial foam dressings in chronic venous ulcers. This should be considered when treating chronic venous ulcerations since the rate of healing was greater despite the extreme severity of ulcers at the start of the study.
336 Quadruple Disruption of the Superior Shoulder Suspensory Complex: Case Report and Review of the Literature , Ehab M Farhan and Saif S Aldhuhoori
The superior shoulder suspensory complex (SSSC) is an extremely important structure composed of a ring of bone and soft tissues at the superior aspect of the shoulder. Double disruption leads to instability of the construct and usually requires operative treatment. Triple disruption of the SSSC is extremely rare and is encountered in high-energy trauma cases often in association with other injuries. The authors experienced a case of quadruple disruption involving the acromion, glenoid, and segmental clavicle fracture. This type of SSSC disruption is unlikely to have been caused by a single impact and is rather caused by multiple impacts during one traumatic event.
337 Osteochondroma at an Unusual Site - A Case Report , Mithilesh Anil Nikam, Nitin S Patil and Priyambada Kumar
Introduction: Osteochondromas are the most common type of benign bone tumours, which usually present as a solitary nonhereditary lesion along the shaft of long bones. Osteochondromas are generally asymptomatic and at most times, the only significant complain is of a painless slow-growing mass over the involved bone. The scalloping effect and increased localised pressure due to the tumour are hypothesised to be the main aetiology of the pain. These tumours should be evaluated to rule out any malignant changes prior to surgical management. Complete surgical excision is the treatment of choice, so as to relieve pain caused by expanding nature of the tumour and prevent a pathological fracture through affected region. Case Report: We present a case of an Osteochondroma of the 4th metatarsal in a 16-year-old male, presenting with pain and swelling over the affected foot as the chief complaint. On physical examination, a solitary bony hard swelling was palpated in 4th web space of the foot MRI was done to rule out any malignant changes prior to surgical excision of the tumour. scan of the foot showed a cartilage capped bony outgrowth, arising from the distal 4th metatarsal along plantar as well as dorsal aspect and extending into the 4th webspace. The mass was excised en bloc. Conclusion: The osteochondroma in the metatarsal is rare but should be kept in mind as an unusual aetiology of a painful foot even at the young age group.
338 The Influence of Blood Flow on Skin Surface Temperature in the Lower-Limbs: A Research Article , Chiara Modestini, Tiziana Mifsud, Anabelle Mizzi, Owen Falzon and Stephen Mizzi
Background: Peripheral arterial disease (PAD) tends to be associated with lower foot skin temperatures, however it is dubious whether there is enough evidence to support this claim. Skin temperature monitoring, and its ability to be an independent diagnostic modality for PAD, particularly in diabetes, has gained remarkable interest in recent years, but its ability to detect and diagnose PAD is not yet clear. Methods: A systematic literature search was conducted in: Academic Search Ultimate, CINAHL, Cochrane Library, LISTA, and MEDLINE Complete until February 2022. Results: A total of nine studies were eligible for review. For the purpose of this review, the inclusion studies were grouped according to the type of investigation analysed: those investigating lower-limb thermal patterns in various populations and those investigating comparisons between various outcome measures to assess blood flow to the feet, including skin temperature measurement. Findings suggest that higher foot skin temperatures were found in PAD patients with Diabetes Mellitus (DM). Foot skin temperature measurements also showed a clear correlation with blood flow to the feet, evaluated by ABI. Conclusions: Variations in foot skin temperature play an important role in the diagnosis of PAD. Current evidence shows that the influence of blood flow on surface skin temperature is complex. The interpretation of thermography as a diagnostic modality for PAD and its severity needs to be considered within the context of the overall medical condition of the individual patient.
339 Metaphysiodiaphyseal Insufficiency Fracture of Tibia Failure of Biology and Mechanical Stability: A Case Report , Prahalad Kumar Singhi, Sivakumar Raju, Atmaram Gadgil and Somashekar V
Insufficiency fractures are seen when physiological stress given to pathological bone and needs to be differentiated from fatigue fracture. Management of these stress fractures depends on etiology, location and radiographic findings. Surgeon should address both biology and stability for satisfactory outcome. A 54-year-old postmenopausal woman, presented with knee pain diagnosed with tibial meta-diaphyseal insufficiency fracture, treated conservatively with cast, but lost to follow up, subsequently she developed malalignment for which she underwent open reduction deformity correction and fixation elsewhere with an anterolateral plate. Later she presented to us with deformity, broken plate and non-union. Dual plating with bone grafting was done to achieve desired outcome. Conclusion: An osteoporotic Insufficiency fracture if not appropriately evaluated and treated may end up in problems. So addressing both biology and stability is key.
340 Dextrose Prolotherapy - Mechanism of Action , Mark Wilson, Anna Topping, Stephan Praet
Introduction: Prolotherapy is an injection-based therapy used for multiple acute and chronic musculoskeletal pain drivers. The aim of this clinical discussion is to review the clinical considerations in the use of prolotherapy in sport and exercise medicine. We will also compare intervention options and provide valuable clinical pearls. Methodology: The focus of this clinical discussion is on the application of prolotherapy in clinical practice. Summary: it is hoped that this narrative review guides clinicians on possible uses of prolotherapy in clinical practice, based on the current evidence of efficacy, complications and risk profile. The integration of clinical experience, combined with a review of the best evidence in the field, may assist in clinical decision making.
341 Bone Pelvis and its Morphofunctional Features in Sexual Somatotypes in a Series of Female Athletic Sports , Konstantin Anatolyevich Bugaevsky
Based on the analysis and generalization of the literature sources, as well as the results of the pedagogical experiment, the article presents data on the morphofunctional features of the pelvis in young athletes who are engaged in athletic sports. The presence of an anatomically narrow pelvic in the large group of female athletes participating in the study, with the I-II degrees of its narrowing, as well as various variants of morphofunctional changes in the structure of the pelvis of the athletes, often combined.
342 Short Uncemented Femoral Stems in Total Hip Arthroplasty , Marco Aurélio Silvério Neves, Leandro Gregorut Lima, Gustavo Rocha Santos, Kelly Cristina Moutinho da Costa, Thais Cristina Rampazo and Barbara Fialho Carvalho Sampaio
Total hip arthroplasty with short stems has been increasingly used in the treatment of hip degenerative diseases. Total hip arthroplasty with short stems can preserve bone stock and are a good choice in young patients who will eventually undergo revision surgery. It is also a good choice when we use approaches for minimally invasive surgeries. In this study, we evaluated clinically and radiologically our cases of total hip arthroplasty with Proxima® short rods (DePuy). Patients were assessed clinically using the Harris Hip Score (HHS). We included in the study a total of 82 hips (77 patients) with mean age of 52 years at the time of surgery. These patients were followed for at least 5 years. There was a slight femoral deviation in Varo from the stem in two cases, with no asseptic loosening. We observed three cases with migration of the femoral component with consequent subsidence in the femoral canal, requiring revision. The metaphyseal stem has good results in most cases, but our experience with this implant demonstrates that it demands more technically from the surgeon and from the bone conditions of the patient.
343 A Comparative Study of Safety and Efficacy of Allopurinol and Febuxostat in Patients with Hyperuricemia , Valmiki Sai Kiran, Chinthaginjala Harish, Padwal Shradda, B Swathi, R Sandhya, YSN Murthy and Guruprasad
Objective: To Evaluate the comparative study of safety and Efficacy of Allopurinol and Febuxostat in patients with hyperuricemia. To report adverse effects of allopurinol and febuxostat. Evaluation of Laboratory investigations by Serum Uric Acid Test. Introduction: Hyperuricemia is defined by a rise in serum urate levels > 7.0mg/Dl. It is caused by a combination of a factors including nutrition, genetic predisposition and urate overproduction or underproduction. Uric acid is a by-product of protein metabolism. Allopurinol and Febuxostat is used to treat hyperuricemia patients (chronic gout) with a dose of 100-300 mg and 40-80 mg respectively. Methodology: Out of 200 patients with hyperuricemia were randomly assigned to allopurinol group (100) and febuxostat group (100) in that both males and females are equally randomized. The Duration of the study is 6 months and was designed as a prospective, comparative, observational and follow-up component. This study was carried out in patients suffering from hyperuricemia to evaluate the comparative study of safety and efficacy of Allopurinol and Febuxostat in the Department of Orthopaedics, Durgabai Deshmukh Hospital, 300 bedded multi-speciality hospital from January 2021. All statistical analysis are performed by using IBM SPSS windows V24. Descriptive statistics like mean, SD, are calculated for Age, height, weight, BMI, serum uric acid. ANCOVA was performed to compare mean values of uric acid. X2- test were used to study the association between the BMI category and drugs. Results: We found no statistically significant correlation between age, height, weight, or BMI and drugs in our study. Using the x2-test, we found no correlation between BMI category and drug in our study. In both groups, when gender is considered, there is a statistically significant difference between age and drugs for female patients, but not for male patients. Out of 200 patients in our study, 116 patients (61 men and 55 women) had adverse effects that were reported, and 84 patients (39 men and 45 women) had no adverse effects. Compared to other drugs allopurinol has more side effects. Conclusion: In our study, it is proved that febuxostat with a dose 40-80mg/day is shown to be be more efficacious and safer in reducing serum urate concentration than allopurinol 100-300mg/day. Allopurinol shows a major adverse effect as compared to febuxostat.
344 “Effect of Proprioceptive Neuromuscular Facilitation on Pain and Function in Patients with Osteoarthritis of Knee” , Rucha Choudhari, Samya Patel, Trupti Siddapur and Tushar Palekar
Background: Osteoarthritis of the knee is considered a major public health problem with impaired functions that reduces quality of life owing to musculoskeletal pain and disability and muscle weakness. Thus, effective modality for pain relief and also muscle strengthening is needed. To reduce such effects, proprioceptive neuromuscular facilitation can be used. Thus the aim of the study is to find out the effect of proprioceptive neuromuscular facilitation on pain and function in patients with Osteoarthritis of knee. Materials and Methods: 30 individuals between the age group of 55-70 years diagnosed with osteoarthritis of knee were included in the study. Pain and functional activities of the participants were assessed using Numeric Pain Rating Scale (NPRS) and Knee Injury and Osteoartritis Outcome Score (KOOS) on the first day and last day. Subjects received Proprioceptive Neuromuscular Facilitation (PNF) of lower limb along with conventional physiotherapy treatment for two weeks. Results: The results showed highly significant difference in the NPRS as well as KOOS scores (P < 0.001) pre and post treatment. Conclusion: The study concluded PNF can be considered as an adjunct therapy to conventional treatment for individuals with knee Osteoarthritis
345 Current Clinical Considerations in the Use of Dextrose Prolotherapy in Sport and Exercise Medicine, Mark Wilson, Anna Topping, Nirmala Perera and Stephan Praet
Introduction: Prolotherapy is an injection-based therapy used for multiple acute and chronic musculoskeletal pain drivers. The aim of this clinical discussion is to review the clinical considerations in the use of prolotherapy in sport and exercise medicine. We will also compare intervention options and provide valuable clinical pearls. Methodology: The focus of this clinical discussion is on the application of prolotherapy in clinical practice. Summary: it is hoped that this narrative review guides clinicians on possible uses of prolotherapy in clinical practice, based on the current evidence of efficacy, complications and risk profile. The integration of clinical experience, combined with a review of the best evidence in the field, may assist in clinical decision making.
346 SEMLS in Young Children with Cerebral Palsy - need of Orthopedic Surgery Reviewed, Mythili Kasthurirengan
By definition cerebral palsy is an umbrella term for group of disorders that affect movement, muscle tone, posture and coordination, caused by hypoxic injury to be developing brain [1]. Though it is a non-progressive neurological condition the effect of the condition varies according to the area of the brain affected and changing motor impairment syndromes based on development of brain [2]. It is the leading cause of motor and postural deformities in children. The primary motor disorders in children with CP are muscle tone abnormalities which lead to impairments in posture, movement, decreased strength, loss of selective motor control, balance and coordination. The secondary musculoskeletal problems are muscle contractures and bony deformities like scoliosis, pelvic obliquity, windswept hip deformity, hip subluxation/dislocation, excessive femoral anteversion, tibial torsion and ankle equinus which develop progressively in response to the primary deficits and causes further motor dysfunction and the need for orthopaedic surgery [3,4].
347 Association of Balance and Pelvic Tilt among the Individuals with Functional Lordosis- An Observational Study, Shyam Devidas Ganvir and Deepti Chandrasheel Thokal
Balance or the Postural Sway is defined as the movement of body in still or erect position [1]. Balance is the term frequently used by the health professionals working in a wide variety of clinical specialities [2]. The Centre of Gravity (COG) is the most common parameter which affect the balance, the COG is the balance point in your body at which your upper and lower body weight is balanced, and combined mass of body appears to be concentrated. The disorders in spinal posture are significantly seen at the young age group, the functional Lordosis is predominantly a most common feature in females of young generation, the important parameters used to assess the role of pelvis in sagittal alignment is the pelvic incidence [3]. The normal curvature of the lumbar spine is visible in sagittal plane, some factors such as Age, gender, weight, muscular strength, physical activity, lifestyle of individual shows great impact on spinal curvature [4].
348 Monocyte New Kid on Block, Danial Shah, Kishen Parekh and Munawar Shah
Biologics has come a long way from visco supplementation and microfracture to oral supplements and now Orthobiologics. They are now in clinical realityMonocytes is the new kid on the block. The function uses and method to harvest monocytes with charged gravity assisted selected filtration is discussed. This is in its early stages and more work needs to be done to look into long term outcomes. Literature is presented to better understand monocytes and process of harvesting.
349 Inveterated Knee Dislocation Treated with Rotating Hinged Knee Arthroplasty: A Case Report, Andrea Farneti and Fabio Luigi Perrone
Introduction: The purpose of this paper is to present a possible treatment in case of inveterated knee dislocation which presented in out Institution as a subtle case after a common knee sprain. The Case: A 74-year-old female patient with acute knee pain presented to our Institution in the Emergency Room, after a knee sprain occurred 48 hours before. Clinical assessment reported a knee swelling and limitation of the range of motion; no neurovascular complications were found. Knee X-ray was normal except for a lamellar bone detachment on medial condyle. The patient was treated conservatively with knee brace ad no weight-bearing; an MRI and clinical examination were prescribed after 3 weeks. Unfortunately the patient was not compliant and ignored medical prescription: she came back to outpatient clinic after 96 days without MRI with valgus knee and limping. An X-ray was executed and we observed a knee dislocation with disruption of both cruciate land collateral ligaments. In consideration of knee instability and the age of the patient we decided to treat this patient with a rotating hinge knee arthroplasty Results Patient came back home after 6 days after surgery with good range of motion and good control of pain. After 40 days knee R.O.M. was 0°-90° and a good muscle trophism was observed. Conclusions: Knee dislocation is a relatively rare but also a potentially serious injury for the patient. A diagnostic classification is essential for accurate diagnosis and treatment, which often requires multidisciplinary approach.
350 Verrucous Carcinoma in a Diabetic Foot Ulcer: A Case Report, Paul Sullivan, Michael Bernstein, Mujtaba Qureshi, Eileen L Sullivan and Mitesh Patel
Verrucous Carcinoma (VC) is a rare malignant lesion that is often misdiagnosed as a simple wart. It is a variant of squamous cell carcinoma most commonly found in the foot and is locally destructive with frequent invasion to deep tissue and bone. Treatment is typically wide surgical excision, including amputation when clinically indicated. This study presents a case of Verrucous Carcinoma found in the distal toe after a chronic diabetic ulceration that required amputation and repeat surgical excision.
351 Interlaminar Endoscopic Lumbar Discectomy - Results in First 50 Patients, M Srinivasan
Introduction: Posterior endoscopic discectomy is a time proven technique for the management of lumbar disc prolapse. Many endoscopic systems are being used for this technique. We report a study of first 50 patients operated by this endoscopic system (Destandau) in our centre. It is proved to be a safe technique and has a better learning curve. Materials and Methods: A total of 50 patients suffering from lumbar disc herniation were operated from Jan 2017 to Dec 2019. Patients requiring two level surgeries and associated lumbar canal stenosis were excluded from this study. Endoscopic discectomy was done through the endospine system, using a 15 mm incision. The results were evaluated using the modified Macnab’s criteria. The average follow up period was 24 months. Results: 80% patients had excellent results and 20% patients had good results. None of them had fair or poor results. The complications observed were minor dural tear in two patients, nerve root injury in one patient, facetal damage in one patient. 80% of patients were able to return to light work in 2 weeks time and normal physical activities in 6 weeks time.Conclusion: Posterior endoscopic discectomy is a safe and proven method of treating lumbar disc herniation. It allows early mobilization of patients and return to work. The technique is proved to have a better learning curve and familiar instrumentation for the conventional spine surgeon.
352 Surgical Anatomy of Bernese Periacetabular Osteotomy Modified Approach. A Cadaveric Study, Dante Parodi, Jose Tomas Bravo, Javiera Gonzalez, Diego Villegas and Carlos Tobar
Introduction: The Bernese periacetabular osteotomy (PAO) is one of the most widely used surgical techniques in hip dysplasia. Several modifications in the approach have been described in the literature. The iliocapsularis muscle is a valuable landmark in the PAO approach, owing to its constant presentation and being an element that may help protect neurovascular structures. Objective: This study aims to describe this surgical technique through an anatomical-cadaveric study performing a split incision of the Iliocapsularis muscle and show the clinical results regarding the care of the motor branch of the femoral nerve and the lateral femoral circumflex artery. Surgical technique: One cadaveric specimen was used for the cadaveric dissection. An oblique inguinal incision is performed. An anterior superior iliac spine osteotomy keeping the sartorius insertion intact is performed. The rectus femoris muscle is exposed, keeping its direct and reflex insertions intact. The iliocapsularis is dissected into two halves: a lateral one that remains in its position and a medial one that is rejected medially which protects the motor branch of the femoral nerve). Subsequent osteotomies described according to the original technique are carried out. Methods: Prospective Cohort of patients with hip dysplasia operated by the same surgeon using the current technique between June 2016 and July 2022. A directed physical examination was performed to evaluate the motor branch of the femoral nerve on the first postoperative day, and then during the follow-up period. Results: 88 Bernese periacetabular osteotomies, no patients were excluded. 63.4% females, 27.7 (15-49) years old, 47.5 months (3-75) follow-up. One femoral nerve neuropraxia was secondary to a hematoma, which resolved completely. One self-limited paresthesia was detected in the territory of the lateral femoral cutaneous nerve. Conclusion: Iliocapsularis split dissection provides adequate protection for the motor branch of the femoral nerve and the lateral femoral circumflex artery.
353 Traumatic Bilateral Hip Dislocation: A Case Report and Review of the Literature, Papa Amadou Ba and Abdoulaye Ba
Bilateral hip dislocations are rare compared to unilateral ones. They are usually seen following high velocity injury. This case report describes a 42-year-old male passenger who was involved in a road traffic accident and had high posterior dislocation of both hips associated with a symphysis pubis diastasis, a fracture of the acetabulum on the right and a fracture of the inferior pubic ramus on the left. The reduction must take place as early as possible and within a period not exceeding six hours.
354 Treatment of Holospinal Epidural Abscess with Selective Skip Laminectomies and Catheter Irrigation: A Case Report, Alexander Doederlein, George Beeton, Zachary Loeffelholz and Cezar Sandu
Case: A 60-year-male presented with fever, neck pain, and altered mental status. An MRI revealed an extensive epidural abscess running from the cervical to lumbar spine with multiple paraspinal musculature abscesses and a retropharyngeal/prevertebral abscess. Conclusion: The patient was treated with intravenous broad-spectrum antibiotics and surgical debridement. Skip laminectomies were performed at T4 and T10, and catheters were inserted at these entry points and ran along the length of the spine for irrigation/aspiration. This technique facilitated the reduction of infectious burden while maintaining spinal column stability.
355 Hallux Abducto Valgus: A Systematic Review on the Effectiveness of Conservative and Non-Operative Treatments of the 1st Ray and Hallux Abducto Valgus Progression, E Arvanitakis, C Formosa and A Gatt
Background: Hallux Abducto Valgus (HAV) is a very common, multifactorial, painful foot condition associated with a deformation of the big toe. Dysfunctions in the biomechanics of the first ray such as hypomobility or hypermobility have been suggested to play a key role in several foot conditions. Surgical interventions should be considered as a last option for patients presenting with hallux valgus. Many conservative, non-surgical treatments have proved inefficient, therefore there is scope for an innovative, non- surgical solution to reduce HV development and support proper foot function. Research Question: The purpose of this study is to determine the availability and efficacy of the current non- surgical treatment modalities through a systematic review and to perform a systematic literature search to identify studies which have analyzed the effect of non-surgical foot appliances on hallux valgus, the effect of hallux valgus appliances on foot function, including muscle action, 1st ray biomechanics, hallux valgus angle and plantar pressure distribution, the effect of hallux valgus applications on pain, deformity and disability, to perform a quality assessment to identify the rigor of the identified studies. Methods: The systematic review was conducted in PubMed in order to determine the availability and efficacy of present non-surgical treatment modalities for the control of the hallux valgus progression and for this investigation we used relevant search terms. We followed the Effective Public Health Practice Project Quality Assessment Tool recommendations for the assessment of risk of bias and the report was performed following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Eight studies were eligible for selection. Hallux Abducto Valgus was the pathology to be evaluated with the use of soft and semi-rigid orthoses, taping, custom-made foot orthoses, static and dynamic orthoses. In most studies the reduction of the level of pain and the prevention of HAV progression was the effect of the non-surgical treatment.
356 Hallux Abducto Valgus: A Systematic Review on the Effectiveness of Conservative and Non-Operative Treatments of the 1st Ray and Hallux Abducto Valgus Progression, E Arvanitakis, C Formosa and A Gatt
Background: Hallux Abducto Valgus (HAV) is a very common, multifactorial, painful foot condition associated with a deformation of the big toe. Dysfunctions in the biomechanics of the first ray such as hypomobility or hypermobility have been suggested to play a key role in several foot conditions. Surgical interventions should be considered as a last option for patients presenting with hallux valgus. Many conservative, non-surgical treatments have proved inefficient, therefore there is scope for an innovative, non- surgical solution to reduce HV development and support proper foot function. Research Question: The purpose of this study is to determine the availability and efficacy of the current non- surgical treatment modalities through a systematic review and to perform a systematic literature search to identify studies which have analyzed the effect of non-surgical foot appliances on hallux valgus, the effect of hallux valgus appliances on foot function, including muscle action, 1st ray biomechanics, hallux valgus angle and plantar pressure distribution, the effect of hallux valgus applications on pain, deformity and disability, to perform a quality assessment to identify the rigor of the identified studies. Methods: The systematic review was conducted in PubMed in order to determine the availability and efficacy of present non-surgical treatment modalities for the control of the hallux valgus progression and for this investigation we used relevant search terms. We followed the Effective Public Health Practice Project Quality Assessment Tool recommendations for the assessment of risk of bias and the report was performed following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Eight studies were eligible for selection. Hallux Abducto Valgus was the pathology to be evaluated with the use of soft and semi-rigid orthoses, taping, custom-made foot orthoses, static and dynamic orthoses. In most studies the reduction of the level of pain and the prevention of HAV progression was the effect of the non-surgical treatment.
357 Skeletal Manifestations of Sickle Cell Disease, Role of Plain Radiograph in Predicting the Diagnosis and Management , Ahmed M Abdelhai, Mohammed Hassan Babiker, Hassan Elbahri, Dafaalla Salih Altyar and Hozifa Mohammed Ali Abd-Elmaged
Introduction:The misdiagnosis of skeletal manifestation of sickle cell anaemia, Mostly bone Infraction as an infection, depending on the same clinical presentation and the x-ray findings. Methodology: This is a descriptive prospective multi-centric hospital-based study. conducted in Khartoum, the Capital of Sudan in several hospitals, the study included 50 patients with SCA with skeletal manifestation. Which presented to hospitals during the study period. Results: Sensitivity, specificity, positive predictive value and negative predictive value of final diagnosis (as osteomyelitis) were 46.7%, 90.9%, 87.5% and 94.7% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of final diagnosis (as bone infarction) were 72%, 53.3%, 94% and 88.9% respectively, which significantly indicates low reliability of using X-Ray in the diagnosis of skeletal manifestations among SCD patients (P < 0.05). Comparing between initial and final diagnoses realized the tendency to change from infection to infarction after initiation of treatment, which is mostly due to a lack of proper workup. Radio-leucency was the most common X-Ray finding among the studied patients, followed by osteoscelerosis, joint destruction osteopenia and bone collapse. Finally patients diagnosed with bone infarction, underwent bone debridement in their course of treatment before the definitive diagnosis as infarction and 82% of them were given a long course of antibiotics Conclusion: We Note the necessity of clinical assessment and x-ray imaging in SCD workup, further imaging and investigation have to be done before diagnosing the patient as osteomyelitis and proceeding with aggressive management. In addition to radioisotope imaging which provides useful information about acute osteomyelitis.
358 Geometric Modeling of the Knee Articular Surface with Neutral Boundary Alignment, Lorenzo Deveza and Ilwhan Park
Knee mechanics is reliant on surface geometry and ligament attachments. Herein, we propose an elliptical cam model representing the femoral articular surface to explain the contact characteristics between the tibiofemoral and the patellofemoral articulations. This occurs in conjunction with a smooth transition of MCL and LCL tension to patella tendon tension that enables knee flexion without a loss of stability. The model is developed based on the Neutral Boundary Alignment (NBA) approach and has the following implications: 1) the asymmetry of distal femoral and tibial condyles is closely linked to the position of the epicondyles; 2) the epicondyles play important roles in femoral rotation in concert with MCL and LCL; 3) these features adjust the elliptical cam model to establish the concurrent motion between the tibiofemoral and patellofemoral motion with respect to the center of ellipse that would help dictate unique knee motion. In the foregoing analysis, we evaluate MRI knee images to illustrate various measures of knee asymmetry between individuals. As will be demonstrated, the asymmetry between the condyles varies and is not related to varus/valgus angle. This may have implications for total knee replacement planning and future implant design.
359 Allowing Demarcation in a Case of Pedal Gangrene Secondary to Vasopressor Use, Tyson O Strom, Brennen L O’Dell, Rebecca A Burmeister and Michigan Medicine
Introduction: Limb salvage is often a topic of discussion in diabetic foot management, but certain cases of non-diabetes related foot complications also require limb salvage. The development of gangrene is one such disease. Gangrene can be caused by atherosclerotic disease such as peripheral arterial disease (PAD) or by the effects of vasopressor medications used in life saving measures. Treatment for gangrene is typically surgical intervention in the form of amputation. To preserve limb length and function a period of demarcation is usually employed before amputation. There is no specified time for complete demarcation so timing should be made on an individual patient basis. Case Presentation: The authors present a case of vasopressor induced bilateral lower extremity vast gangrene in a 40-year-old female who had a Type 1A aortic dissection and subsequent surgical repair. The patient had a complicated hospital course including septic shock requiring vasopressor medication for life saving efforts. The patient developed bilateral lower extremity vast gangrene secondary to vasopressor use. She underwent a left below knee amputation (BKA) at 14 weeks after admission. Decision was made to allow complete demarcation of right sided lower extremity tissues before any surgical intervention. At 6 months post-admission the patient underwent a right transmetatarsal amputation (TMA) with hallux rotational flap. The patient healed all surgical sites and is ambulating with a left leg prosthesis and right foot custom accommodative orthotic. Discussion: Current literature does not reveal a specified time to wait for demarcation before amputation in cases of lower extremity gangrene, as each patient presents a unique situation. Current literature does agree that higher level amputations correlate with increased disability and lower patient satisfaction and quality of life scores. Therefore, all efforts should be made to avoid high levels of amputation.Conclusion: In this unique case report, a patient who was initially presented with the option of bilateral BKAs was able to avoid the double major amputation and likely increased disability by choosing to allow a 6-month period of demarcation of soft tissues.
360 A Cracking Tale of Ceramic Component Fracture Revision: A Case Report and Literature Review, Elliott A Ayling, Mohammed Amer and Douglas Dunlop
Ceramic-on-ceramic (CoC) hip replacements present a significant issue upon fracture. Remnant ceramic particulates can become embedded in polyethylene, leading to wear of revision bearings causing significant metallosis. This article uses a case report and literature review to explore the limited evidence guiding revisions of ceramic component fracture. The literature search used pre-defined search terms to explore the databases of PubMed, Ovid MEDLINE, The Cochrane Library and Web of Science. The case report outlines a gentleman with significant metallosis following revision of a CoC fracture to a MoP. The remaining ceramic ‘sand’ can embed in polyethylene, resulting in wear of the opposing bearing surface. Good outcomes are reported for ceramic-on-polyethylene (CoP) and CoC revisions. Disastrous outcomes are seen with metal heads. This is consistent with our findings, where the serum cobalt and chromium soared and a metallosis soup developed. Improperly revised ceramic components can present a significant risk to patients. Metallic replacement for ceramic fracture is inappropriate due to the potential for runaway abrasive wear. A ceramic ball should be a prerequisite of any such revision. This is poorly documented in the literature, with a need for greater awareness.
361 Charcot Foot Arthropathy Secondary to Holocord Syringomyelia in a Skeletally Immature Patient - A Case Report , Salar Sobhi, Sheldon Moniz, Jordan Korol and Richard Carey-Smith
Charcot arthropathy, is progressive and destructive process of articular surfaces secondary to impaired nociception and proprioception of the involved joint, commonly seen in adults a long-standing history of diabetes mellitus. We report a case of a 4-year-old girl who presented to the Emergency Department complaining of right heel pain and antalgic gait. Physical examination was unremarkable, but an MRI of the right foot revealed a lytic and destructive process of the right calcaneus with associated fluid tracking. Given the absence of any biochemical evidence to favour infection, a full-body MRI subsequently revealed an Arnold-Chiari type I malformation with extensive holocord syringomyelia of the cervical and thoracic spine.
362 Mini Invasive Anterior Approach for the Reinsertion of Distal Biceps Tendon: Our Experience, Massimo Massarella, Eleonora Piccirilli and Domenico Sergio Poggi
Introduction: elbow injuries are not uncommon and distal ruptures of the biceps are rare when compared to proximal ones. They often occur in men during eccentric contraction of the biceps or after overload with flexed elbow. Usually, surgical treatment is the best choice, except in elderly patients or in patients who have a low functional demand. Aim: the aim of our work is to evaluate the mid-term results of a mini-invasive anterior approach for the reinsertion of distal biceps tendon using a resorbable anchor. Materials and methods: we collected data from 22 patients treated for total distal biceps tendon rupture from January 2019 to March 2021. We included all male patients, mean age 40 years (35-55) who underwent distal biceps tendon rupture after sport injuries. The tendon was repaired through a single anterior longitudinal mini open approach (3 cm incision) using a resorbable anchor (2.9mm) inserted into the bicep’s radial tuberosity. We used DASH test to evaluate patient satisfaction rate. The average follow-up of our study was 12 months. Results: twelve months after the surgical procedure, patients’ satisfaction was very good (mean score 82), and all the patients came back to their daily living activities in forty days. Conclusions: the mini-invasive single longitudinal anterior approach is a valid surgical option in distal biceps tendon rupture. This technique has a minimal aesthetic impact, and it allows a good functional outcome. On a functional point of view, the anchored tendon allows the complete range of motion of the elbow after five weeks. In four months, patients were completely back to their previous sport activities.
363 Effect of Prophylaxis for Deep Venous Thrombosis in Traumatic Spinal Cord Injury, Abhishek Tiwari, Akshay MK and Bhupender Khatri
Aim: Injuries to prevent DVT. Incidence of deep venous thrombosis in traumatic spinal injury patients and effect of prophylaxis for deep venous thrombosis in traumatic spinal cord injury patients in a tertiary care hospital in Indian setting. Objectives: To identify the risk factors for DVT in traumatic spinal cord injury patients in a tertiary care hospital in Indian. Conclusion: These results suggest that active measures for prevention are important beginning from the acute stage of injury and pharmacological thromboprophylaxis can be considered for all patients with acute spinal cord injury patients unless there is not ongoing bleeding or severe coagulopathy.
364 Role of Rivaroxaban and Apixaban in Hip Replacement , LB Gaikovaya, KN Zamyatina1, SA Saiganov, Maryam Jamil, Ehsan Ul Haq, AN Tkachenko, D Sh Mansurov and IL Urazovskaya
Introduction: Direct oral anticoagulants significantly reduce the risk of venous thromboembolic complications. However, in some cases in patients with latent hemostasis disorders, the use of drugs of this group (most often rivaroxaban and apixaban) may be accompanied by an increased risk of postoperative bleeding after hip arthroplasty. Materials and Methods: 38 patients were under observation, from the clinic of traumatology and orthopedics of the North-western State Medical University named after I.I. Mechnikov, Saint Petersburg, in connection with the planned hip replacement for osteoarthritis. The average age of patients was 58 ± 15 (33; 85) years. Depending upon the anticoagulant taken, patients were divided into 2 groups. The first group - 25 patients receiving rivaroxaban and the second - 13 patients - apixaban. All patients underwent laboratory tests before surgery (baseline), on the first day after surgery (while taking anticoagulant) and on the 7th day after surgery. The laboratory study included determination of hemostasis parameters (INR, APTT, Fibrinogen, D-dimer) on the STA Compact analyzer (Stago, France), biochemical parameters (total calcium, ionized calcium, serum iron, C-reactive protein) on the COBAS Integra 400plus analyzer and hematological parameters on the LH-500 analyzer (Beckman Coulter, USA). Results and Discussion: When evaluating biochemical parameters, patients in both groups had statistically significant decreases in total calcium, ionized calcium, serum iron after surgery compared with baseline data. At the same time, the concentration of C-reactive protein was significantly increased in both groups. Patients treated with rivaroxaban showed a statistically significant increase in INR (p < 0.05) in contrast to the group of patients treated with apixaban. After surgery, patients treated with rivaroxaban and apixaban showed a significant increase in fibrinogen and D-dimer concentrations.Conclusions: The use of direct oral anticoagulants after hip replacement is not accompanied by hemorrhagic complications. The evaluation of plasma concentrations of apixaban and rivaroxaban demonstrated the efficacy of anticoagulant effects of direct coagulation factor Xa inhibitors and proved the need for their use in the prevention of thrombotic complications in patients after hip arthroplasty.
365 Hardware (Implant) Removal rate in Surgical Treatment of a Consecutive Series of 230 Clavicle Fractures, Rafael Goecke, Pedro Lizama, Nazira Bernal, Orlando Callejas, Juan P Rieutord, Roberto Montegu, Cristian Aravena and Felipe Reinares
Background: Surgical treatment in clavicle fractures is becoming increasingly common. However, it is associated with complications and a significant number of reoperations, being implant removal the most frequent procedure. Our objective is to determine the implant removal rate, clinical outcomes and associated complications to surgical management in a hospital with a population subject to workers compensation. Methods: Retrospective study of clinical and radiologic outcomes in a consecutive series of 230 clavicle fractures surgically treated with an anatomical plate between January 2013 and February 2019 at a Level V trauma center. Patients with previous ipsilateral shoulder fractures, follow-up of less than 6 months, use of complementary osteosynthesis and a history of glenohumeral infection were excluded. We studied the implant removal rate, functional outcomes, time to bone union, return to work and complications. Results: 230 patients were analyzed with a mean age of 38.3 years (18-69 years). 91.7% of male gender and 90% located in middle third. Implant removal rate of 5.7% (13), due to symptomatic hardware (7), non-union (4), implant fracture (1) and refracture (1). Complication rate of 28.7% (78 in 66 patients), secondary to range of motion deficit (18.7%), perilesional hypoesthesia (3.9%) and chronic pain (3.5%), among others. An average time to bone union of 21 weeks and return to work of 27 weeks. Average range of motion at final follow up was 173º of anterior elevation, 169º of abduction and 81º of external rotation. Conclusions: The implant removal rate in our series was lower than that reported in the literature, while the clinical results and complications were similar to those described in other series.
366 Awareness about Physiotherapy among General Public - A Cross Sectional Survey Analysis, Shubham Menaria, Tittu Thomas James, Jarapla Srinivas Nayak, Shubhi Saxena and Pradnya Dhargave
Background and Objectives: Physiotherapy is a field of medicine which deals with maximizing human functioning by treating structural and functional impairments. Although there is an increased knowledge about physiotherapy among healthcare providers, there is still lack of awareness evident among the general public. It is found that the quack practitioners and fake courses utilize this gap for malpractice. This cross-sectional survey analysis tries to identify the level of awareness among physiotherapy in general public. Methods: People above 20 years of age and has the access to internet facility are provided with online survey questions. The answers were collected from them on the same day. The data collected from the online survey was collected and documented in spreadsheet. The data was analysed descriptively and analysed accordingly. Result: A total of 346 people participated the study. It was found that more than 60% of the respondents are aware of the profession and treatments provided by the therapists. There is a lack of awareness in the public regarding physiotherapy because 4.6% of the respondents consider it as massage therapy whereas 9.1% consider physiotherapists as yoga trainers. 70 participants responded that physiotherapists are eligible to prescribe medications. 10.2% of them are unaware of the preventive aspect of diseases with physiotherapy. Conclusion: We suggest the use of available resources including social media to increase the awareness among the general public, living in both in rural and urban areas. It is imperative to take measures by professional bodies to initiate the formation of a central regulatory body in controlling malpractice in this professional field.
367 Vitamin D Supplementation: Still a Paradox!, Archisha Marya and Kirti Mohan Marya
The classic work of Francis Glisson, a Cambridge physician, ti-tled “De Rachitide” was published in Latin in 1650 and is still considered a treatise on rickets. Glisson was of the opinion that rickets was neither transmissible nor hereditary. His hypothesis regarding the association of age to the onset of rickets has remained time-tested [1]. A Scottish physician, Dr Palm, in 10 years of his stay in Japan noted that rickets was surprisingly absent and made a notable observation in 1890 on the incidence of rickets and its geographical distribution. Large towns and industrialised regions like Glasgow and Edinburgh in the UK had high prevalence of rickets alongside the coal mining regions of the country. Such cities were hazy and smoggy, and the air was filled with soot. Children in tropical coun- tries were exposed to filth, poor sanitation and unsafe water and yet they didn’t show symptoms of rickets, he noted. Other medical missions from areas in China, Mongolia, India, Morocco and Sri Lanka [erstwhile Ceylon] did not report rickets. Palm concluded that “the geography of rickets appears to involve the temperate latitudes of Europe: Germany, England, Holland, Belgium, France and northern Italy but southern Italy, southern Spain, Turkey and Greece with greater sunshine “enjoy a notable immunity from it” [2]. He suggested that exposure to abundant sunshine to toddlers in tropics was responsible for their protection against rickets. Palm recommended “systematic use of sun-baths as a preventive and therapeutic measure in rickets.” However, Palm’s observations and recommendations were ignored by the medical world [2].
368 An Outcome Analysis of Locking Versus Limited Contact Dynamic Compression Plate in Surgical Management of Shaft of Humerus Fracture - A Comparative, Longitudinal Study, Radha Krishna AM, Shivananda S, Jayaram BS and Vijay Bharadwaj
Background and Objectives: For managing humerus shaft fractures, limited contact dynamic compression plates (LC-DCP) were developed to limit contact between the bone and plate. Off late, a novel bio-friendly, locking compression plates (LCP) are hypothesized to be more suitable especially for osteoporotic bones. Current study was conducted to evaluate and compare clinical, functional and radiological outcomes and complications associated with them. Methodology: This comparative longitudinal study conducted for a period of 18 months among subjects with fracture of humerus shaft. Subjects were assessed for 6-month follow-up. Functional outcomes were measured by Constant and Murley scoring system and Pain by using VAS score. Statistical analyses were performed using SPSS software. P value < 0.05 was considered statistically significant. Result: W20 cases each managed by LCP and LCDCP respectively. Baseline details were statistically comparable (p > 0.05) between study groups. RTA was the commonest mode of injury. Commonest fracture pattern noted was transverse type (40%). Fracture union time was 18-24 weeks commonest among both study groups. Range of motion was 75% cases in both groups. Most patient had Constant and Murley Score between 71-85 indicating good outcome at final follow-up. 85% cases in both study groups had mild pain by VAS score at follow-up. Statistically all the patient outcome parameters were noted to be comparable between study groups (p > 0.05). Conclusion: The Results were statistically comparable between both study groups, indicating that results from both Plates are equivalent and can be adopted to manage shaft of humerus fractures. Both the Plates were noted to be safe.
369 Pelvic Osteotomies in Bladder Exstrophy: Surgical Technique and Case Follow-Up, Raul Quispe Suarez and Paola Castro Suarez
The Classic Bladder Exstrophy is part of the Exstrophy - Epispadias Complex; it is a rare condition in which there are anomalies in the formation of the genitourinary system, and in its more severe cases compromises the digestive system and the pelvic ring as well. Orthopedic treatment remains challenging and involves improving the pelvic ring continent and reducing the diastasis of the pubic symphysis through pelvic osteotomies. We present the case of an 08-month-old male karyotype patient with bladder exstrophy, omphalocele, imperforate anus, sacral anomaly and pelvic alteration, who underwent surgical management for genitourinary and pelvic ring reconstruction; We describe the surgical technique used, the evolution and post-surgical follow-up at 3 years.
370 Teres Ligament Ganglion in the Hip Joint. Case Report, Oscar Perez-Fernandez, Luis Perez-Carro, Luis Antonio Ruiz Villanueva, Jose Antonio Fernandez-Divar, Lorena Trueba-Sanchez and Gustavo Gutierrez Castanedo
Injuries to the round or teres ligament of the hip, also called the ligamentum capitis femoris, are being diagnosed more and more frequently. We report location of a round ligament ganglion in the hip joint that has not been previously published. Cystic lesions in the hip region are usually asymptomatic and can be found incidentally on medical imaging examinations such as computed tomography and magnetic resonance imaging and they can become symptomatic due to the compression they cause in the adjacent structures. Treatment depends on symptoms, loca- tion and size. We report a case of a patient with an anterior hip labral tear and an associated ganglion cyst arising from the round or teres ligament. As far as we know this is the first report of this ganglion location.
371 An Observational Study for Comparison of Glenohumeral Joint Mobility Amongst Indian Badminton Players and Volleyball Players, Vatsal Parikh and Medha Deo
Does one of the sports’ athletes have more mobility of shoulder joint as compared to other? There has been much research on what are the predisposing factors to shoulder injuries in overhead activities during sports but is one sport more prone to injury has yet to be found out. The results of the study can be used as a data to work upon the training regimen for the athletes to prevent injury and minimize the risk. It can also be used to find out the normative data of glenohumeral range of motion for the athletes who visit any healthcare professional for any intervention. Badminton is one of the most popular sports in the world, and it is included in the group of racquet sports. It can be practiced by anyone regardless of age or experience and is the fastest racquet game. Volleyball is a team sport in which two teams of six players are separated by a net. Each team tries to score points by grounding a ball on the other team’s court under organized rules. Players need to have good Glenohumeral mobility to excel in the game, irrespective of the position at which they play. With previous research it has been proved that the overhead sports injuries can involve poor mobility. A total of 50 (25 Male & 25 Female) players of volleyball & badminton each, playing for over 1 year, aged between 15-28 years, having no history of trauma or any other pathologies, were included in a cross-sectional observational study using convenience sampling. Players were screened for their glenohumeral range of motion using a universal goniometer and Apley’s Scratch test. Out of the overhead athletes, it has been observed that the badminton players have more mean external rotation in the dominant side as well as the non-dominant side, while volleyball players have more mean extension in non-dominant side than badminton players. However, clinically, there is no significant difference in mobility and flexibility amongst the two sports.
372 The Effect of Incentive Spirometer Verses Conventional Chest Physiotherapy on Pulmonary Complications in Coronary Artery Bypass Grafting Patients., Mrunal Mahesh Wable
Background: The purpose of this study was to identify the post pulmonary complication faced by the coronary artery bypass grafting patients. So that the most effective treatment is reviewed and selection of incentive spirometer exercise, conventional chest physiotherapy with early mobilization is chosen as the line of treatment. It may improve health status by improving the functional capacities and there by enhance the aerobic performance of an individual. The value of chest physiotherapy has recently been estab- lished and accepted but it is still unclear which treatment techniques are most effective. Early mobilization and breathing exercises are often the first choice of treatment, but evidence as to the optimal intensity, timing and choice of exercises is scarce. There are only limited published literatures on how the cardiac surgery patient should be exercised with incentive spirometer and mobilizes during the first postoperative period in hospital. Aim and objectives: To find the effectiveness of incentive spirometer and conventional chest physiotherapy on pulmonary complications in coronary artery bypass grafting patients. Material and Method: Intervention was given preoperatively and post operatively. Then the patient was divided into two groups are Group A Incentive spirometer, Group B Conventional chest physiotherapy. All the participants were receive the selected treatment for 2 session’s minimum pre operatively and 6 sessions post operatively. Material used are inch tape and pulmonary function test machine Result: chest expansion pre and postoperatively shows there is extremely significant difference in group A. chest expansion post-operatively shows there is very significant difference between group A and GroupB.FEV1/FVC there is very significant difference between Group A and Group B. Conclusion: Based on statistical analysis for results, the present study concluded that, incentive spirometer training was significantly effective compared with conventional chest physiotherapy on pulmonary complications in coronary artery bypass grafting patients.
373 Treatment of a Case of Intra-arterial Calcification of Popliteal Artery in a Young Boy, Gopala Krishna B.A
Introduction: ACDC is a rare autosomal recessive genetic disorder caused by mutation in the NT5E gene, which results in extensive calcification of vessels below the diaphragm, notably the large lower extremity arteries and small joints of hands and feet [3,4]. Also known as “calcification of joints and arteries” (CALJA) syndrome, the late-onset profound calcification spares arteries in the trunk and the coronary circulation. Case Report: We report the case of, an 11-year-old boy, who presented with abrupt and abnormal calcific deposits at various anatomical location with pain and limitation of the movements of the involved region. The symptoms were not controlled with standard anti-inflammatory medications with other supportive measures. The symptoms were significant enough to limit his activities of daily living. Conclusion: ACDC is a rare genetic disorder with limited knowledge to many practicing physicians and surgeons. The symptoms are debilitating depending on the anatomical region affected. Inadvertent usage of medication or intervention can lead to complications or undesired outcomes. Hence a detailed study of such cases with standard treatment recommendations are necessary. This case report shows a favourable outcome with the treatment approach that was instituted. However study of a reasonable number of similar cases can throw better light in understanding and managing such rare disorder.
374 Patellofemoral Arthroplasty: Early Demographic and Radiological Analysis for Less Complications and Better Results, MD. Julio C. Fernandes, MD. Pierre Ranger, Luis Fernando Jordao Dos Santos
Background: Isolated patellofemoral arthritis represents around 15 to 20% of all patients with knee pain. Patellofemoral Arthroplasty has become an interesting option for severe patellofemoral joint arthritis because of the good results obtained with new implants designs. Methods: This retrospective study has revised 117 medical records of patients submitted to patellofemoral joint arthroplasty between 2007 and 2017 at Sacre Coeur and Jean Talon Hospitals in Montreal - QC, Canada. Results: The study has shown patellofemoral arthrosis in 52,9% of cases, followed by trochlear dysplasia (41,8%) and these are the most important factor to guide patients to surgery specially in young women (2,3:1/F:M) around fifties (50,3 yo average). Patellofemoral arthroplasty is preceded by another surgical treatment in 24,6% of cases. Patellar malalignment is present in 86,3% of patients divided in lateral displacement (24,7%), tilt patellar lateral (41,1%) and patellar height (20,5%). Patellar overstuffing is the most frequent early complication observed in 12,8% of patients. Other clinical complications had the same rate for TKA and UKA. Conclusion: Patellofemoral Arthroplasty is a less aggressive option to treat isolated PF Arthrosis presenting the same rates of Total Knee Arthroplasty. Patellar alignment should be evaluated preoperatively and reestablished to reach good results.
375 Understanding the Basic Principles and Biomechanics of Patellar Modified Tension Band Wiring Surgery: are we on a Monotonous Path for Fixing Transverse Patellar Fractures?, Rohil Singh Kakkar
Fractures of patella constitute up to 1% of all skeletal injuries with 70-80% of these having a transverse fracture pattern in adults with the absolute indication for surgical treatment being an extensor mechanism disruption [1-4,7]. The aim of surgical treatment in patella fracture is anatomical reduction, restoration of articular congruity, preserving patellar bone stock, and repairing the extensor mechanism. The modified tension band wiring (TBW) technique, which converts the tensile forces generated by the knee extensor into compressive forces at the joint line, has been widely acknowledged as the optimum treatment for displaced transverse patellar fractures due to its biomechanical superiority and economical benefits [1-3,6,7].
376 Knee Joint Neural Pathways and their Osteoarthritis Pathogenic Linkage Implications, Ray Marks
Knee joint osteoarthritis, a widespread disabling disease with no known cause continues to produce considerable bouts of intractable pain as a result of multiple disease associated problems despite years of research. This paper examines some probable neural influences that may be involved or implicated in inducing and perpetuating knee joint osteoarthritis, a major chronically painful, disabling and debilitating health condition. Presented are data retrieved from several sources that discuss the nature of the knee joint nerves and their ramifications in various knee joint tissue, their proposed functional importance, and connections with the spinal cord, central nervous system and motor control pathways, as this affects joint biomechanics, pain production, joint instability at the knee, and possible knee joint pathology. As such, it is concluded that to reduce the risk of joint injury, as well as to improve the effectiveness of treatments designed to avert knee joint damage and ensuing osteoarthritis pain, a better understanding of the probable neural origin[s] of knee joint pathology and pain may permit the development of more precise as well as targeted noninvasive nerve sparing preventive and intervention strategies for mitigating disabling knee osteoarthritis.
377 Neuroimaging Semiotics of Non-greasy Compressing Factors in Patients with Persistent Compression of the Lumbar and Sacral Roots in Degenerative-dystrophic Lesions of the Spine, Mokhov Nikita Valeryevich, Danilov Valeriy Ivanovich, Padiryakov Viktor Nikolaevich and Bulgakov Evgeny Pavlovich
Compression of the lumbar and sacral roots in dystrophic pathology of the spine is polyfactorial. Among the factors of compression of these roots, the proportion of non-greasy compression options is high. This determines the need to optimize the diagnosis of patients with degenerative spinal lesions using modern methods of neuroimaging. Each non-gnaw factor of persistent compression of the lumbar and sacral roots has its own characteristic neuroimaging semiotics, the knowledge of which will allow to more accurately determine the indications for surgical treatment and the amount of surgical intervention. Patients with degenerative disease of spine have multifactorial compression of lumbar and sacral roots. Among the compression factors of the roots there is a high percentage of non-herniated factors. It is very important to optimize the diagnosis of patients with degenerative diseases of spine by using modern neuroimaging. Every non-herniated factor of resistant compression of lumbar and sacral roots has its own neuroimaging signs. It will determine the indications for surgical treatment and volume of surgical intervention more accurately.
378 Hip Arthroplasty Done for Osteoarthritis vs. Hip Fractures: A Comparison, Dheeraj Panchaksharam Selvarajan, Gaurav Gurung, Abhishek Thanuja Jayadhar and Ashwin Unnithan
Introduction: Osteoarthritis and femoral neck fractures are two important entities which are indications for hip arthroplasties and cause a significant burden to the healthcare system. It is imperative to compare the patient characteristics and operative complicaions in both these cohorts and whether existing NICE guidelines for patient selection is appropriate. Materials and Methods: 300 patients’ data from a district general hospital in Surrey, United Kingdom was retrospectively studied and analyzed. Results: From our study, it was clear that women suffered more hip fractures than men. Average length of hospital stay was higher in the group that received Hip Hemi-arthroplasty compared to the patients who received a Total Hip Arthroplasty (12.7 ± 9 vs 8.2 ± 3.9 days). Institutionalized patients were more likely to have HHA compared to those living in their own homes (p-value < .05). Patients who were selected for HHA had higher mortality rates (53%) during our follow up period compared to those selected for THA. The post-operative dislocation rates were comparable and not statistically significant. Conclusion: Careful patient selection for the type of arthroplasty through existing NICE guidelines has proved beneficial for patients in terms of length of hospital stay and post-operative morbidity and mortality. There is still a need for clearer follow-up guidelines for patients suffering from a hip fracture, which needs to be worked up in detail.
379 Complex Physeal Fracture of the Distal Tibia - Description of a New Fracture Pattern, Nuno Vieira da Silva, Susana Neto, Marta Cerqueira, Francisco Bernardes, Diogo Soares and Fernando Silva
Pediatric ankle fractures are the second most common physeal injuries. We report a singular case with a different fracture pattern. Although the surgical planning being not based only on the fracture pattern alone, it is mandatory to know the different fracture classifications and its mechanism influence on the treatment. This is the first time that this type of fracture has been described - an important warning about a new specific pattern, caused by a particular mechanism, with a new radiological translation and its own treatment requirements.Pediatric ankle fractures are the second most common physeal injuries, accounting for almost 40% of all physeal injuries and for 5% of all pediatric fractures.1 High-energy suprasyndesmotic fractures are associated with hard complications.2 Although the surgical planning being not based only on the frac- ture pattern alone, it is mandatory to know the different fracture classifications and its mechanism influence on the treatment.
380 The Diabetic Foot: Worldwide Crisis - Time to Act Now!, Cynthia Formosa
Every 20 seconds a limb is lost somewhere in the world due to diabetes! Moreover, every 1.2 seconds someone develops a diabetic foot ulceration. Every 7 seconds someone dies from diabetes. Lower-extremity complications of diabetes constitute a substantial burden for people with diabetes. Once healed, foot ulcerations frequently recur. This may suggest that current management of the diabetic foot is not effective, clearly demonstrating the need for the implementation of new and effective strategies aimed primarily at prevention of ulceration. The time to referral will determine the number of ulcerations and re-ulcerations or alternatively ulcer- free days – in other words Time is Tissue! [1]. We need to act now without further delay! The COVID-19 Pandemic has surely not helped this devastating situation and has proven to be a very challenging time for both patients and healthcare professionals. The total closure of Podiatric clinics and other medical services for at least a period of 4 months during the start of the pandemic, and the cancellation of elective surgeries at hospitals have led to a very high impact on the diabetic foot. Furthermore, when the medical services reopened for the public, the elderly and the vulnerable were still afraid or uncomfortable to attend to their much-needed clinical appointments, hence cancelling or delaying their appointments by months. This esulted in severe complications in the diabetic foot including severe cellulitis, callosities leading to pre-ulcerative lesions and extravasations, ulcerations, osteomyelitis, gangrene and an increase in amputations. A recent retrospective audit reported that 61.4% of amputees in Malta were not seen by a podiatrist [2]
381 Osteochondral Allograft Transplantation in the Knee of a Teenage Athlete: A Case Report, Bárbara Choupina, Inês Casais, João Dinis, Filipe Lima Santos, Paulo Jorge Carvalho and Rui Lemos
Introduction: Traumatic osteochondral lesions of the knee in young athletes can result in significant morbidity. The aim of our study was to describe the results of the use of an osteochondral allograft for the treatment of an extensive knee osteochondral lesion in a skeletally mature teenager. Methods: A 17 years old male presented with knee pain, stiffness and locking sensation after a knee trauma related to sports. Imaging studies revealed an osteochondral injury of the lateral femoral condyle with approximately 4x2 cm. The patient underwent surgical treatment, in which an osteochondral graft was used to repair the lesion and fixated with resorbable cannulated screws. An evaluation of range of motion, pain and knee function (IKDC Score) before the surgical procedure and at the end of 24 months of follow-up was performed. Results: Range of motion increased from 100º preoperatively to 120º; pain improved from a daily, constant pain with an intensity of 6 (VAS) preoperatively to a sporadic pain with an intensity of 1 (VAS). The preoperative IKDC score was 36.8 and increased to 92. Return to sports was allowed at 12 months. There were no complications resulting from the procedure. Conclusions: Although many studies are available on the efficacy of allografts in adults, little is published in children about the outcomes of allograft transplantation. In this case, the use of an osteochondral allograft allowed for the restoration of range of motion, excellent functional capability and pain relief in the affected knee.
382 The Quality of Life After a Total Hip Replacement Procedure: The Factors Attributed to a 24-Year Survival Case, Rajvinder S, Lopez J Mohan and G Ruslan Nazaruddin Simanjuntak
Total Hip Replacement (THR) is a restorative procedure aimed at managing hip-joint ailments that display little to no response to conventional medical therapy. The procedure has improved patients’ quality of life and overall survival. After conducting a comprehensive review of a case of a fortuitous left hip replacement procedure conducted on a senior 93-year-old male patient whose ability to hike was impaired by bilateral hip joint osteoarthritis, the success factors of this procedure were determined. After enduring a surgical excision of the femur’s head and proximal neck, his walking ability was restored. There were no physical activity-related complications. A comprehensive cross-sectional study showed that good surgical excision, effective cementing techniques, proper placement of implants, the young patient age at the time of THR, and the underlying cause for the surgery were the elements attributed to the procedure’s success. The THR procedure is the most commonly performed ortho- paedic practice, widely endorsed by healthcare practitioners due to its exceptionally long-term outcomes [1]. Since its inception, the procedure has been used to restore the functionality of the hips of patients suffering from Osteoarthritis. According to the National Joint Registry (2018), osteoarthritis-related complication has necessitated the most cases of total hip replacement, amounting to almost 90% of the surgeries in the UK, followed by the fractured neck of the femur accounting for 5% of surgeries, dysplasia and avascular necrosis for 2% of the surgeries, and inflammatory arthritis for 1% [2].
383 Case Report: Metal-on-Metal Total Hip Arthroplasty Associated with Pseudotumor, Andre Luiz Pellacani Franca, Edmar Simoes Silva Junior, Bruno Barreira Campagnoli, Filipe Aubin Nascimento, Julia Fardin de Oliveira Mariani and Bruna Couto Domingos
The development of pseudotumor associated with hip prostheses in metal-metal tribology is a rare complication that brings great morbidity, because it generates early loosening of these implants. The objective is to report a case that describes the treatment of pseudotumor alumour lesion and the release of the previous prosthesis, through the arthroplasty review procedure and discuss this unusual complication. It is related to the release of metallic debris and ions by corrosion of the prosthetic joint interface, especially in the metal-metal tribological pair. The patient underwent resection of the lesion, removal of the loose prosthesis and the hip revision arthroplasty procedure, with revision components in trabecular metal. The patient suffered two episodes of prosthetic dislocation in the postoperative period, being treated conservatively, through unscrupulous reduction. After such procedures there was a good evolution of the case, with no further recurrences.
384 Charcot Arthropathy of the Upper Extremity in Relation with Multiple Sclerosis or Syringomyelia. A Case Report of Two Rare Cases and Review of the Literature, F Hollman, EGJ Thijssen , CEP Van Munster , EMJ Cornips , JJC Arts and PZ Feczko
Background: Charcot arthropathy may occur in the upper extremities as a result of syringomyelia or even multiple sclerosis. However, due to late diagnosis, function of the affected joint is often lost. This article shows two cases of patients with Charcot arthropathy of the upper extremities. Case presentations: The first case describes a Charcot arthropathy of the elbow, thought to be a result of white matter lesions in multiple sclerosis. The second case describes a Charcot arthropathy of the shoulder as a result of syringomyelia. Both cases show the importance of a multidisciplinary approach in the diagnostic process of Charcot arthropathy, in which collaboration between at least an orthopaedic surgeon, neurologist, neurosurgeon and radiologist is recommended. Discussion and Conclusions: A multidisciplinary approach is essential for the treatment process in Charcot arthropathy. Not only for the completeness, but also for the duration of the diagnostic process. This is of great importance, since - as discussed above - early diagnosis of Charcot arthropathy may prevent further destruction of the affected joint and thus preserve function of the joint. Therefore, it is important to redirect patients to a multidisciplinary health care centre. It is recommended to focus treatment on preservation of joint function in addition to treatment of the underlying neurological cause.
385 Silent Elbow Joint Relocation - A Red Flag for Medial Collateral Ligament Instability Needing Repair, RM Vignesh Karthik
Background: This case report is to highlight the red flag for ligamentous injury in elbow dislocation cases which reduce into position without much effort. All cases of easily reducible elbow dislocations warrant a CT scan and dynamic examination using an image intensifier to identify the torn ligaments. This aids in early reconstruction of the torn ligaments and better rehabilitation. Patient and Method: An office going young lady sustained injury to her right elbow. She was diagnosed with posterior elbow dislocation which reduced into position with just a gentle push on the olecranon. She underwent dynamic radiological examination which revealed an unstable medial support with coronoid fracture. She was assessed for surgery and underwent open reduction and fixation of the coronoid fragment, followed by medial collateral ligament repair. Result: At 6 months follow up she has regained full range of movements with no instability. Conclusion: Easy reduction of dislocated elbow is a red flag for bony avulsion/ligamentous injury and warrants complete radiological workup including dynamic x rays. Prompt and early ligament reconstruction re-establishes the stability of the joint.
386 Favorable Outcome of Hand Compartment Syndrome Secondary to Extravasation of Intravenous Contrast Medium: A Case Report, Geletaw Tessema , Hailegebriel Degefu and Mengistu G Mengesha
Hand compartment syndrome due to extravasation of contrast medium is a rare condition. Most of the time, it results in minimal swelling and erythema. But injection site skin necrosis and compartment syndrome occur when the amount of the contrast is large in volume and extravasated into the soft tissue. This case report presents a 58 years old female patient for whom contrast medium was injected intravenously at the dorsum of the hand and ended up with compartment syndrome. She was treated by emergency fasciotomy for established compartment syndrome which resulted in full hand function.Currently, the use of contrast medium become common prac- tice due to its significant role in the advanced diagnostic accuracy of some pathologies. Associated with its’ utilization, there are reported complications including compartment syndrome due to the extravasation [1,2,11]. One of the well-recognized complications is extravasation into subcutaneous tissue causing edema and skin necrosis [3].
387 Ilium Osteochondroma in a Child: A Voluminous Rare Localization, Khaled Kamoun, Ahmed Mdaoukhi , Wajdi Arfa , Mohamed Amri , Zied Jlalia , Faten Farah and Mourad Jenzri
Osteochondroma is a benign bone tumor developing especially in long bone metaphysis in children. It can be involved in heredtary multiple exostoses disease (HME) or an isolated tumor. It rarely develops in spine and pelvis. We report a rare localization of a voluminous osteocnondroma developing from iliac crest in a five-year-old child initially followed for HME. In clinical exam this mass was hard, immobile but not adherent to the overlying skin. No hip joint stiffness was observed. X ray showed a pedenculated tumor with high-density and clear boundarie developing from ilium lateral fossa. This exam revealed also smaller asymptomatic exostoses in distal femur and proximal tibia. CT scan showed a “cauliflower like” tumor. The child complains from pain while lying in a right side and when wearing trousers. En-bloc excision was performed by direct approach. Histological study confirms diagnosis showing a cartilage cap and abundant cellular hyaline cartilage and chondrocytes. There was no recurrence at two years follow up and the child is regularly seen in outpatient department for the other osteochondroma locations.
388 Knee Arthroscopic Surgery in Iraq, Yahia Falih Mohammad
After a short period of a decrease in the number of infections with Covid-19 patients all over the world, we recovered and began in Iraq to discuss and evaluate the results and the future of our pre- vious work in the field of orthopedics in general and Arthroscopic surgery in particular. Where it became clear to us that there are many successes that have been achieved in this field despite its recent. We were able to a count many orthopedic surgeons who perform most of the surgeries for the knee view Arthroscopicly after they were referred to neighboring countries almost ten years ago, despite the limited capabilities available to us here in Iraq. Not long ago, we started using platelet-rich plasma (PRP) in the treatment of certain cases of Osteoarthritis of the knee joints and they noticed an improvement in the joints treated in this way, so I started using PRP in the treatment of partial rupture in the an- terior cruciate ligament (ACL) and the results were good through clinical follow-up for periods of more than three years. This is a remarkable progress in this field, especially as we avoided the patient with the anterior cruciate ligament reconstruction in such cases, and the player’s return to the courts at intervals that are considered record compared to those with persons with ACL reconstruction surgery.
389 Fracture of the volar lip of the lunate in the face of perilunate injury. Report of three cases and review of literature, Ana Carreño Delgado, Francisca Pacheco Donoso and Marco Antonio Ardilla Jimenez
Lunate fractures associated with perilunate dislocation are very rare. The diagnosis is often difficult as is the treatment itself. Up to 25% go on to be undiagnosed in the emergency room (ER) setting. We present 3 very different cases of perilunate dislocation with lunate volar lip fracture occurring in the different hospitals around the world (Spain, Colombia and Chile). All 3 were diagnosed in the ER, however the treatments differ. We aim to show the spectrum of treatment of these high energy lesions either acute or chronic and the outcomes of these. Perilunate dislocations and lunate fracture tend to occur mostly in young males due to a high energy trauma. The pathomecanics involves a load applied to the wrist while in dorsiflexion and ulnar deviation. According to Conway, an additional axial force produced by the capitate, is responsible for the lunate fracture [1].
390 The Effect of Instrument-Assisted Manual Therapy Technique on Brachial Hemodynamics and Pain, Tony Boucher and Andrew Gallucci
Purpose: To investigate the effect of instrument-assisted manual technique versus standard manual soft tissue mobilization on heart rate, blood pressure, brachial artery blood flow, and subjective pain. Subjects: Eleven males and nine females (age = 23.4 ± 2.7 years, height = 170.2 ± 8.2 cm, mass = 76.3 ± 18.1 kg) without pathology or cardiovascular impairment. Methods: Participants received either instrument-assisted manual technique or manual soft tissue mobilization to anterior brachial region, medial forearm flexor wad, and distal bicep tendon on two testing sessions separated by 4-7 days. Brachial heart rate (bpm) and blood pressure (mm Hg) were measured using an automated blood pressure monitor and brachial artery blood flow velocity (cm/sec) was measured via spectral Doppler ultrasonography prior to therapy application, immediately post, and every 5 minutes for 30 minutes. Pain was measured post each testing session. Data Analysis: A mixed design repeated measures multivariate analysis of variance compared heart rate, blood pressure, and blood velocity between the therapy applications across time. A mixed design repeated measures analysis of variance compared heart rate, blood pressure, and blood flow independently between therapy applications across time. Univariate analysis of variance compared pain between therapy applications. Results: No significant multivariate difference was shown between therapy applications for heart rate, blood pressure, and blood flow (p = 0.74). No significant univariate difference was found between therapy applications in analysis over time for heart rate (Graston:65.5 to 64.5 bpm, manual:66.7 to 62.5 bpm; p = 0.73), systolic blood pressure (Graston:115.6 to 117.8 mm Hg, Manual:114.1 to 117.9 mm Hg; p = 0.72), diastolic blood pressure (Graston:71 to 74.2 mm Hg, Manual:69.6 to 73.8 mm Hg; p = 0.98), or blood flow (Graston:20.6 to 20.1 cm/sec, Manual:20.1 to 19.8 cm/sec; p = 0.32). There was a significant decrease in heart rate (66.1 to 63.72 bpm; p = 0.001) over time regardless of therapy application. Pairwise comparison revealed time significance between baseline to immediate post, ten minutes, twenty minutes, and twenty-five minutes post. No difference was found for pain between applications (Graston:3.3cm, Manual:3.9cm; p = 0.32). Conclusion: Instrument-assisted manual techniques nor manual techniques differentially influence localized heart rate, blood pres- sure, or blood flow. Manual therapy, regardless of technique, does appear to reduce localized heart rate and stimulate equivalent subjective pain.
391 Incidence of Malignant Bone Tumors and Short-term Functional Outcome Of Amputation, Hassan Mohammed Hassan Elbahri, Osman Mohamed Mohamed Ahmed, Mohammed Mubarak Mohammed Ahmed, Dafaalla Abdelmoneim Dafaalla Salih and Hozifa Mohammed Ali Abd-Elmaged
Background: A malignant bone tumour is a neoplastic growth of tissue in bone which can be benign or malignant. Amputation is the removal part or all of a limb. When used to treat cancer, amputation removes the limb part with the tumour, some healthy tissue above it, and everything below it. The prognosis depends on the type of tumour. The outcome is expected to be good for people with benign tumours, although some types of benign tumours may eventually become malignant. Methods: Observational descriptive cross-sectional hospital-based study was conducted in Ibrahim Malik Teaching Hospital in Khartoum State in the period from January 2018 to September 2018. Data was collected using a datasheet. Data entered and analyzed using SPSS version 25.0. Results: This study covered 50 study participants, most of them (96%) were less than 40 years of age. Our study found that only (16%) of the study participants were fully aware of their disease while (40%) were not aware at all. Furthermore, there was a delay between the presentation and starting the treatment among most of them (90%) while (82%) had tried other traditional or non-for- mal methods of treatment. Concerning the type of tumour, most of the study participants (84%) were diagnosed with osteosarcoma, while a small proportion of them was diagnosed with Chondrosarcoma (6%), Ewing sarcoma (6%), and Admantinoma among only (4%). The study found that the total number of patients with primary bone sarcoma were 65 patient from January to June 2018(hospital records) so the incidence of amputation at that time was 76%. Regarding the management applied, all study participants were amputated, of which (56%) had chemotherapy and (12%) had radiotherapy. The analysis found that there is a significant association between the level of education and the delayed presentation (pvalue < 0/001). Conclusion: A high awareness of malignant bone tumours are essential to avoid diagnostic delays. Some might even be dangerous.
392 Correlation Between Clinical and Radiographic presentations in Patients with Insertional Achilles Tendinitis, 2019, Sami Nogdallah, Mohamed Alamin Ezeldin, Montaser Fatooh, Hozifa Mohammed Ali Abd-Elmaged, Alaa Mohammed Mohamed Khairy
Background: Disorders of the Achilles tendon can occur in adolescents and adults and include both traumatic and non-traumatic problems such as insertional tendinitis, intra-substance tendinopathy, complete rupture. Insertional tendinitis radiographically present as Huglund’s deformity, posterior calcaneal spur and retro-calcaneal calcification. Diagnosed based on history clinical examination to radiography. Objectives: to correlated between clinical and radiographically finding in patents with insertional Achilles tendonitis. Methodology: This study is a descriptive cross-sectional hospital-based study conducted in Khartoum state, Sudan. The study was total coverage, data collected questionnaire and patents’ X-rays were studied. Results: A total of 25 patients and 30 feet was studied most of them were within age group (41-60) representing 53.3% and 14 were female representing 46.7%. concerning the severity 12 case were severe (40%), 13 were moderate (43.3%) and 5 cases were mild in their presentation with 16.7% of total cases.8 cases(mild) had posterior calcaneal spur (26.7%), 10 cases (4 mild, 4 moderate and 2 sever) had patchy calcification (33.3%), 8cases (severe disease) had both spur and Huglund’s deformity and calcification. The rela- tion between the severity of the Insertional Achilles Tendinitis and the radiographic finding was found to be statistically significant (p-value less than 0.05). Conclusion and Recommendations: Our study concluded that there is significant correlation between radiographic and clinical presentation but this correlation is weak. Based on this finding X-rays alone is not valid method for diagnosis and severity determination of Achilles tendonitis. Our study was done on a short period so a recommendation to be done over long duration, in order to involve more cases. Also we recommend that the size and the length of posterior calcaneal prominence taking in consideration over is presence or absence. And the study group must be matched to the control group for more accurate and reliable results.
393 Equivalent Functional Outcomes of Rotator Cuff Repair in Patients Above 70yrs in an Appropriately Selected Cohort Can Be Achieved: An Observational Case-Control Comparative Study, Noam Rosen, Corey J Scholes, Piyush S Nashikkar, Dvir Ben Shabat, Andres E Rodriguez Borgonovo and Mark D Haber
Background: This study assessed the effects of increasing age in patients undergoing arthroscopic rotator cuff repair (RCR) on self-reported rehabilitation compliance, retear incidence and patient-reported outcomes (PROMs), with emphasis on patients older than 70 years of age deemed “repairable” using an appropriate protocol. Methods: A retrospective analysis of prospectively collected data was performed from patients undergoing primary arthroscopic RCR between Feb 2014 and May 2017, with >26 weeks follow-up. Demographics, PROMs, intraoperative parameters and follow-up ultrasounds were collected. Incidence of retear in patients above/below 70yrs was compared using binary logistic regression, and PROMs examined using multiple linear regression. Results: Significantly lower tendon and bone quality and fewer biceps tendon procedures were observed in patients >70yrs. Patients >70yrs had clinically equivalent postoperative PROMs despite significantly higher incidence of segmental retears (14% vs 6.9%) at 6 months. Increasing age was a risk factor for any retear, and full rehabilitation compliance was protective. Preoperative PROMs were strongest predictors of both postoperative and change scores. Discussion: Arthroscopic RCR provides comparable improvements in PROMs in older patients (>70yrs) deemed “repairable”, despite higher risk of segmental retear. Patient selection is important and age alone should not be the deciding factor regarding suitability for reconstruction.
394 Postural correction and manual therapy for chronic musculoskeletal diseases, Kapernaros Emmanouil, Komisopoulos Christos and Siaperas Panagiotis
The body posture control is a complex function of the human body that continuously controls and regulates balance. By studying the literature on the most commonly appearing musculoskeletal degenerative diseases, it appears that there is a common mechanism affecting the balance through the arthrogenic muscle 2inhibition. In order to manage this mechanism, we found that manual therapy and/or medical exercise are the interventions of choice, with the exercise having a range from simple movements through simple assessment, more specific with the guidance or help of a trainer, or neuromuscular reeducation through personalized assessment and guidance from a physical therapist. Objectives: We want to identify the best intervention between simple exercises or neuro- muscular reeducation after applying manual therapy techniques for musculoskeletal degenerative diseases. No comparison between these two methods after manual therapy application could be found in the literature despite the total indication for exercise after manual therapy techniques. Methods: 63 patients took part in the study. They all suffered from the 10 most commonly appearing musculoskeletal degenerative diseases. We tested VAS-pain, FABq for functionality, center of mass characteristics for balance and posture. Results: Both intervention groups showed improvement, with the neuromuscular reeducation group showing statistically significantly better results in all areas.
395 Three-Dimensional (3D) printing technology in Traumatology: is it the present or the future?, Diego Edwards, Sebastián Bianchi, Juan Pablo Casas-Cordero, Francisco Cornejo and Gerardo Zelaya
Three-dimensional printing (3D) is an additive manufacturing technique, which through digital models of a patient, obtained through different techniques such as computed tomography (CT), allows the manufacture of custom made and specific structures for each patient, in real size, by using plastic materials [1,2]. This is a growing technology, used nowadays in the field of engineering, architecture, entertainment, education, in addition to its use in a variety of health areas, which has had an explosive increase in the number of publications per year since 2013 that are found through electronic medical databases such as PUBMED and SCOPUS [3]. In this field, for example, we find the dental area, where the use of small and custommade implants is required [4]. Within the field of medicine, there is currently a great interest in various areas, such as regenerative medicine and tissue engineering with the bioprinting of organs, (heart, liver, kidney, etc) [5,6]. Undoubtedly, a specialty of medicine in which it is generating great interest is Traumatology and Orthopaedcis, through the printing of orthoses/prostheses, surgical instruments and anatomical models [7,8].
396 Efficacy of sCOMP in Diagnosing Knee Osteoarthritis, Sudhir Singh, Chetan Verma and Lal Shrikant Kaushik
Objective: The goal of this study was to establish the utility of serum Cartilage Oligomeric Matrix Protein (sCOMP) as a biomarker for differentiating between disease severity grades of knee osteoarthritis (KOA). Material and Method: Patients of osteoarthritis of knee were included as Cases (100 subjects) and normal adults were taken as Controls (50 subjects). Clinical, radiological and biochemical assessment was done by WOMAC score, knee radiograph and blood sample for sCOMP respectively. Results: Results show WOMAC Score was significantly higher in cases (49.97 ± 17.98) than in Controls (11.24 ± 06.07) (p < 0.001). Mean sCOMP level was significantly higher in Case group than in Control group (17.38 ± 4.99 U/L vs 1.16 ± 0.39 U/L; p = 0.001). sCOMP increases with increasing K-L grades except in grade III. In Case group sCOMP was 14.60 ± 6.47 U/L in K-L grade I; as 17.47 ± 4.99 U/L in K-L grade II; as 17.25 ± 4.63 U/L in K-L grade III and as 19.77 ± 4.65 U/L in K-L grade IV. One-way ANOVA of K-L Grade with sCOMP (F = 1.55, p = 0.02) and with WOMAC score (F = 20.18, p = 0.001) show significant association. Pearson Correlation and coefficient (r) value show that Age has moderate positive and significant co-relation with WOMAC Score (r = 0.43, p = 0.001), with KL grade (r = 0.40, p = 0.001) and weak positive and significant co-relation with sCOMP level (r = 0.24, p = 0.01). Interpretation and Conclusion: The receiver operative curve (ROC) analysis suggested a “Cut-off” value of sCOMP as 9.06 U/L (Sensitivity 99%; Specificity100%; Accuracy100%) between Control group and Case group with excellent discriminatory power (p = 0.001) but not for various subgroups of disease severity of KOA.
397 An audit of orthopaedic surgery notes: Where do we stand today?, Rohil Singh Kakkar
Every surgical specialty recognizes the significance of precise and comprehensive operation notes for ensuring patient care as well as for generating data for research and auditing purpose. Orthopaedic operative notes at the author’s institution were audited against guidelines published by the Royal College of Surgeons of England regarding standard of content, completion and legibility. An orthopedic specialty specific template for writing operative notes has been proposed. Also, It has been proposed that all surgical specialty registrar level doctors should undergo training for writing operative notes and aide memoires be placed in the OT complex. All surgical specialties recognize the value of accurate and thor- ough operation notes for safeguarding patient care as well as for generating data for research and auditing. The only documentation of surgery is operation notes. The operative findings and post operative plans they contain, serve not only as a vital means of communication between health professionals, but are also the only legal record of a surgery [1].
398 Nursemaid’s Elbow In A Newborn, João Costa, Joana Costa, Fernando Macedo, Miguel Rocha, João Lucas and João Luís Moura
Pulled elbow is characterized by a subluxation of the radial head, usually reported in children between 1 and 4 years of age. It is a condition that requires closed reduction, with an excellent prognosis as it allows pain free mobilization a few minutes after reduc- tion. As the injury mechanism is axial traction of the upper limb, this injury is usually associated with traction caused by adults on the child for which the nickname Nursemaid’s elbow was given. The authors describe a case of pulled elbow diagnosed in a newborn in which traction was applied to the upper limbs during delivery, treated using supination technique. Therefore, It’s the case of nursemaid’s elbow described at a youngest age. Pulled elbow, also called nursemaid’s elbow is a very common phenomenon in children aged 1 to 4 years, average age of 28,6 months [1]. It occurs due to a radial head subluxation caused by axial traction or a sudden pull of the extended pronated arm, but this mechanism is not universal.
399 Epidemology and Pathophysiology of Spinal Cord Injury and Potential Health Benefits of Omega 3 Fatty Acid, Rajeshwar Nath Srivastava, Zeenat Ara, Shah Waliullah, Alka Singh, Saloni Raj and Lavini Raj
Spinal cord injury is a life changing threatening neurological condition that completely changes subject’s life. In medical management recent advances has significantly improved diagnosis, stabilization, survival rate and well-being of SCI patients, but there has been very small progression in its treatment, and some such as Stem cell transplantation etc. is very cost effective that is not possible for everyone to afford, so now a days major focus is on nutraceutical supplementation as they are easy to administer and easy to afford, omega 3 fatty acid are important polyunsaturated fatty acids with some roles in normal cellular metabolism, they have Anti-inflammatory and antioxidant properties, and studies have proved its beneficial role in ameliorating inflammation in different diseases and thus plays role in improving neurological outcomes after neuronal injury, studies have shown that in SCI inflammatory events results in activating various inflammatory markers so PUFA 3 helps in suppressing their activity, for healthy adults, the daily recommended level of omega-3 fatty acid is 300 mg, Leukotriene-5, thromboxane-3, and prostaglandin-3 are derived from essential fatty acids, and are known to be therapeutically important in inflammatory conditions as well as for mental health. Omega 3 fatty acid helps in modulating multiple pathways that responsible for damage caused after secondary SCI, due to significant health benefits consumption of EPA and DHA is promoted as fatty fishes such as salmon, mullet, and mackerel are the best sources of EPA and DHA so more focus is on aquaculture industries, thus this review tries to cover all possible potential benefits of PUFA. Omega 3 fatty acid helps in modulating multiple pathways that responsible for damage caused after secondary SCI, due to significant health benefits consumption of EPA and DHA is promoted as fatty fishes such as salmon, mullet, and mackerel are the best sources of EPA and DHA so more focus is on aquaculture industries, thus this review tries to cover all possible potential benefits of PUFA.
400 Comparison of pre-surgery methods of intramedullary nail length measurement: determining the best estimation method in femur and tibia fractures, Zanderahimi F, Sadeghifar A.R, Aazami M, Sarhadi Zade A and Saied A.R
Introduction: Tibia and femur fractures are common in orthopedics. Their standarad treatment is intramedullary nailing. This study investigated the best pre-surgery method for estimating the intramedullary nail length. Methods: First, we assessed intra- and inter-observer reliabilities by examining healthy volunteers. Then, we measured the presurgery intramedullary nail length of 82 patients with tibia and 25 patients with femur shaft fractures. This size was compared with the suitable nail length used at operation. Results: Almost all of the examined methods had "good" inter- and intra-observer reliability. In patients with femur fractures, the greater patella method had the best intraclass correlation coefficient (0.876) and the lowest standard error of measurement (0.777). In tibia fractures, medial malleolus-tubercle method had the best intraclass correlation coefficient (0.860) and the lowest standard error of measurement (0.602). Bland–Altman plots were created for the findings of the second part of the study. For femur fractures, 64% of the pre-surgery measurements with greater patella method were more than the actual nail used at operation. These percentages were 93% and 100% in olecranon fifth finger and greater-epicondyle methods, respectively. For tibia fractures, 40.9% of medial malleolus-tubercle, 37.3% of olecranon-metacarp and 65.06% of radiogram methods’ measurements were more than the actual nail at operation. Conclusion: The medial malleolus-tuberosity method seems to be more accurate for tibia fractures. The greater patella method seems to be more accurate for femur fractures. However, we found no completely accurate method in the examined methods.
401 Didactic Strategies in Physical Education: Experiences and analysis due to the confinement of Covid-19, Luis Alberto Saltos Aldaz, Roberto Andres Rojas Bajana, Pena Perez Sally Lely and Penafiel Pena Dayse Johanna
This study addresses the importance of using adequate educational strategies for physical education sessions during confinement due to Covid-19. The purpose of this is to explain the teaching-learning processes and the didactic strategies in Physical Education (PE) at home through the Didactic Unit (UD) "Ludic Practices" with 8th year students from the Liceo Naval Guayaquil Educational Unit. Therefore, the methodology applied is the Flipped Classroom, which allows to unite pedagogy with technology, allowing active student learning, encouraging cooperation, creativity and problem solving. Accordingly, among the main results, it is observed that the majority of students liked the recording of a tutorial video and that 83.6% of the students enjoyed the development of self-built implements for alternative games. Finally, as the main conclusions, it was possible to avoid the risk of educational exclusion in most of the teaching-learning process, besides, alternative games with self-constructed material strengthened the teaching-learning processes and promoted educational inclusion.
402 Artificial Intelligence: Blessing or Curse?, Dilip Shah
Artificial intelligence (AI) is a term given by John McCarthy as a theory that computers could ultimately learn to do work recogniz- ing the methods with minimal to no involvement of human beings. AI in recent terms can be redefined as the application of innova- tions that can give machines the possibility to solve difficulties that requires human intellect. In 1976, Jerrold S. Maxmen wrote that AI would bring the era where the physicians are eliminated in this century. With the exponential advent of computers physicians would be eliminated and AI will over-rule. AI has progressed from being only theory to probable tool. AI has made it possible to have auto pilots and auto drivers without drivers for cars, doing shopping online without being personally present, virtual meetings on Zoom rather than physical meetings.
403 Segmental Scaphoid Fracture treated with One Headless Screw: A Case Report, Abdullah Almana Asiri , Ghazi Alqahtani and Hind Alraeh
Background: The scaphoid is the most frequently fractured carpal bone, accounting for 71% of all carpal bone fractures. Scaphoid fractures often occur in young and middle-aged adults, typically those aged 15-60 years, after a fall on an outstretched arm that results in acute dorsal flexion of the wrist. Early diagnosis of a scaphoid fracture is important because nonunions is more likely if treatment is delayed. Aim: To report a case presented with Segmental scaphoid fracture treated with one headless Screw. Results: A 38 Saudi female present as case of left-hand swelling and pain for 1 day ago. The pain localized at volar of left hand at wrist which started after falling down. Clinical examination revealed inception with swelling close injury but no change in color. palpation revealed soft distal compartment tenderness distal with intact movement and limit rom. The patients undergone X-ray at ER and diagnosed to have Segmental scaphoid fracture. Started by conservative treatment with long arm spica. After 1 month, treating team decided for surgical intervention through dorsal approach to scaphoid and fixation by headless screw
404 Diagnostic Dilemmas and Treatment Strategy for Paediatric Non-Traumatic Knee Effusion, Dhawal Bakhda 1 * and Kirti Raju
Knee effusion in paediatric age group is usually due to hemarthrosis following an injury. However, there are several non-traumatic causes of knee effusion found in the paediatric age group. Evaluation and treatment for non-traumatic effusion in knee requires special attention. This is desired basically to differentiate between infectious, post-infectious, rheumatologic, hematologic, vasculitis and malignant diseases. Despite knee swelling prevailing in ~27% of general population, there is lack of consensus on diagnosis and management of this condition among Indians. The present case highlights the importance of a definite diagnostic pyramid and multidisciplinary approach required for early diagnosis and treatment of non-traumatic knee effusion in an adolescent with underlying juvenile spondyloarthropathy
405 Functional Outcome Following Knotless Tendoachilles Repair and FHL Augmentation, Ramkinkar Jha MS, Raman Kant Aggarwal, Mohd Irfan Banday, Ashish Kumar Goyal and Saksham Tripathi
Introduction: The achilles tendon is the strongest and largest tendon of the human body and can be exposed to forces six to eight times body weight. The spontaneous ruptures of the achilles tendon are relatively common and are frequently missed. Materials and Methods: We present a prospective case series of 11 patients of spontaneous tendoachilles rupture treated with speed bridge technique and augmented with flexor hallucis longus tendon transfer from a period of January 2019 to April 2020 op- erated by a single orthopaedic surgeon. Results: The mean FAOS score before surgery was 56.5 ± 7.7 (42 -66) and improved to a mean score of 88.2 ± 5.7 (78-96) postoperatively. Conclusion: Speed bridge reconstruction technique combined with FHL transfer allows stable reconstruction and early mobilisa- tion of the patient with good to excellent results.
406 Is Using Sinus Tarsi Approach with Bone Block Susbstitute and Screws the Optimal Plan of Treatment of Articular Calcaneus Fracture?, TA Al-Sadek1 and A Al-Sadek
Objective: To evaluate the results of fixation of intra articular calcaneus fracture using sinus tarsi approach, bone block substitute, and screws fixation. Background: Minimal invasive techniques for treatment calcaneus fractures have been developed to overcome soft tissue complications associated with the traditional lateral approach. Sinus tarsi approach has the advantage of visualization of posterior facet of subtalar joint. Methods: All patients underwent preoperative calcaneal lateral and axial radiographs and CT scan of the injured foot. The injury type was graded according to the Sanders classification on the basis of the CT scan findings. Bohler and Gissane angles were measured as anatomical parameters before surgery. Sinus tarsi approach was done for all patients, in addition to use of percutaneous screws fixation and bone block graft substitute. Results: A total of 14 patients were included in our study. The mean age was 37.8years,at the end of follow up radiological evaluation was done by measuring ; Bohler angle and angle of Gissan. American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score was calculated at the end of follow-up for all the cases. Excellent results were found in7 patients, good results in 5 patients and fair results in only 2patients. There was statistically significant improvement of Bohler angle at the end of follow up. Conclusion: Treatment of intra articular calcaneal fractures using sinus tarsi approach with a bone block substitute and screws can provide satisfactory clinical outcomes
407 The 50 Most Cited Publications on Trigger Finger, Moses I Markowitz1, Michael G Rizzo1, David S Constantinescu, Joseph S Geller1, Rajan R Murgai1, Brandon Goldenberg1 and David L Chen
Trigger finger is a common cause of hand disability. There is no consensus as to the superiority of operative versus nonoperative treatment. Here, we perform a bibliometric analysis concerning the 50 most cited articles discussing trigger finger. We performed a search of the ISI Web of Knowledge database in November 2021. Keywords used were: “Trigger finger”, “Trigger digit”, “Flexor tendon entrapment”. The 50 most cited articles were evaluated. The mean number of citations was 58.7 (range 32-183, SD 31.3). All articles were published between 1954 to 2014. The majority were contributed by the Journal of Hand Surgery-American Volume (n = 7). The United States contributed the largest portion of the articles (n = 24). The most common level of evidence was Level IV (n =19), followed by Level I (n = 11). Twenty-six articles discussed treatment outcomes. The most influential orthopaedic literature on trigger finger evaluated clinical outcomes, took place in the United States, and were published in the Journal of Hand Surgery. There were a significantly greater percentage of level I articles than in alternative bibliometric analyses within the field of hand and upper extremity orthopedics. This allows physicians to apply study results more confidently to their clinical practice
408 Metal Hypersensitivity in Total Joint Arthroplasty, Keith Kotecki, John Walsh , Gary Ulrich , Jim Christensen and Ronald Hillock
Background: Failed total joint arthroplasty (TJA) is a multifactorial problem and one potential cause of failed TJA has been attributed to allergic reaction to the metallic components of the implants. The pathophysiology of implant function failure due to allergy has been postulated but is poorly understood. This review explores recent literature on the topic of metal hypersensitivity in TJA and human implantation in general to clarify the current state of understanding on this topic.Methods: A literature search was completed via PubMed for all articles published related to implant failure in TJA due to metallic allergic reaction. The information was then sorted for relevance on basic science as well as clinical outcomes attributed to metal al- lergy in TJA. Results: This review found that previous works attribute 5% of failed TJA to metal hypersensitivity reactions, no single test or finding has been found to be predictive of patients who will experience a failed TJA due to metal hypersensitivity, and there is no clear relationship between metal hypersensitivity and poor clinical outcomes in TJA although many theories have been presented. Discussion: While evidence-based evaluation and management is desired for metal hypersensitivity, no clear consensus exists. Even routine pre-implantation testing has not shown to be of benefit. Furthermore, no test or finding has been shown to be diagnostic of metal allergy as a cause of failed TJA after implantation. Based on review of the published literature, this review article finds no objective evidence of metal allergy as a cause of TJA failure and therefore cannot conclude that metal allergic reaction is a mode of failure in TJA
409 Osteoid Osteoma in the Proximal Humerus in a 52-Year-Old - A Case Report, Richard S Kirby , Sunny Gupta , Irfan Chhipa and Mitesh Patel
Introduction: Osteoid osteoma is a rare bone tumor with high prostaglandin expression that often presents in the second decade of life and is usually responsive to non-steroidal anti-inflammatory agents. Aim: We report an osteoid osteoma of the proximal humerus in a 52-year-old, an unusual location and in a patient who is older than most who get these tumors. Case Report: A 52-year-old man comes to the outpatient orthopedics office with R shoulder pain. After receiving a corticosteroid injection without relief of symptoms, further imaging studies revealed an osteoid osteoma in the proximal humerus which was unresponsive to non-steroidal anti-inflammatory therapy. He underwent radiofrequency ablation of the lesion and was symptom free after the procedure. Conclusion: Osteoid osteoma can appear in a wide variety of locations and in different age groups. Treatment with radiofrequency ablation is safe and effective
410 Treatment of Pathologic Fracture of Humerus with Internal Fixation, Abrasion of the Lytic Lesion and Cement Infusion; A Case Report and Literature Review, Velitsikakis P A1, Oikonomopoulos L1, Perisynakis N1, Staikos N2, Giovanidis G
Introduction: The skeleton is the most common target of metastatic disease, after lungs and liver. Humerus is the third most common location for a bone metastasis. Pathologic fractures occur as a response to the compromised physiology of the bones, which has as a result poor mechanical properties due to the underlying lesion. Methods and Materials: A 59year-old woman with diagnosed and under treatment lung cancer arrived at the outpatient orthopaedic clinic due to chronic pain (three weeks) and inability to lift her right arm. The onset of pain was gradual. Radiological tests showed a fracture in the proximal third of the humerus and a lytic lesion. Results: The patient was treated with internal fixation with a locking plate, broad abrasion and ablation of the lytic lesion and ce- ment infusion. The patient was mobilized without limitations, other than avoidance of loading, post-operatively. Conclusion: Pathological fractures are a common complication of bone metastases. Life expectancy in patients with bone metastases has been extended due to the progress in chemotherapy, radiotherapy, and other oncological therapies. At pathological fractures of the humeral shaft, the abrasion of the lytic lesion and the infusion of cement, after internal fixation, creates a more stable fixation of the fracture and gives the patient a better quality of life being able to use the arm. According to current bibliography, the use of PMMA limits the spread of cancer cells
411 Validity of Knee Arthroplasty in Osteoarthritis, Presnyakov EV , Tkachenko AN , Deev RV , Starchik DA , Balgley AG , Mansurov DSh , Maryam Jamil and Ehsan Ulhaq
Introduction and Materials and Methods: In the clinic of orthopedics and trauma North-western State Medical University named after I.I. Mechnikov from 01.01.2022 to 15.12.2022, a total of 187 total knee replacement (TKR) were done in patients with osteoarthritis. A random sample taken for histological studies from 30 patients aged 40 to 76 years (19 F, 11 M). Samples were prepared according to the standard protocol for bone tissue, the bone fragments tested were decalcified in electrolyte decalcification solution (Biovitrum, Russia). Histological processing, pouring, and microtomy with a section thickness of 5 μm were performed as per standard protocol. The preparations were stained with dyes (hematoxylin and eosin) and safranin O. Results: Only 48 (25.7%) patients before TKR were at least once had inpatient conservative or minimally invasive surgical treatment for osteoarthritis of the knee joint. 18 (9.6%) patients had intraoperative and postoperative complications. Among the 30 morphological studies performed, 3 (10%) patients grade I, 8 (26.7%) subjects grade II, and in 19 (63.3%) - grade III osteoarthritis of the knee joint was diagnosed. Conclusions: Among patients who underwent TKR, only one in four (48 people - 25.7%) was at least once had inpatient conservative or minimally invasive surgical treatment for OA. According to the morphological study, 11 (36.7%) clinical observations undergoing arthroplasty were verified as grade I-II OA. To form a strategy for the treatment of patients with osteoarthritis of knee joint, it is vital to develop an algorithm for teamwork between therapist, orthopedic surgeon, rheumatologist, rehabilitation medicine specialist, specialists in restorative medicine and healthcare organizers in the process
412 Comparative Study between Operative and Conservative Treatment of Un-Displaced Isolated Greater Tuberosity Fracture of the Humerus, TA Al-Sadek1* and AAl-Sadek
Background and Purpose: Fractures of the greater tuberosity of humerus account for one fifth of all fractures affecting the proximal ⅓ of humerus. Although a displacement of 3-5 mm in fractured greater tuberosity indicates surgical inter- vention, less displaced tuberosities can be managed nonoperatively in young athletes as well as more displacement in older groups. Surgical modalities include ORIF using plate and screws, fragment excision, and percutaneous fixation. Patients and Methods: We performed a prospective interventional study involved 20 patients with isolated greater tuberosity frac- tures of the humerus. Divided equally into 10 in each group, conservative and operative management. The follow-up images were assessed for radiographic healing. For the objective assessment, the DASH score was used. Results: We have twenty patients with un-displaced isolated greater tuberosity fracture; divided equally into ten in each group; conservative and operative. The mean age in conservative group 37.7 and in operative 36.9 with statistically non-significant difference. Male patients represented 60% and 70% within conservative and operative groups respectively. There is statistically non-significant difference between studied groups regarding range of motion. Four patient (40%) had anterior shoulder dislocation within operative group. The median DASH score of operative group 13.49, while it was 20.83 within conservative group. Conclusion: Un-displaced greater tuberosity fractures can be treated without surgery with good outcome; however there are indica- tions for surgical interventional with benefit of provides early return to life activity as it enhance early union