• We are available for your help 24/7
  • Email: info@isindexing.com, submission@isindexing.com



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 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.
138 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
139 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.
140 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
141 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
142 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
143 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
144 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.
145 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
146 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
147 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
148 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.
149 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.
150 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.
151 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).
152 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.
153 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.
154 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.
155 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.
156 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.
157 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.
158 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.
159 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.
160 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.
161 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.
162 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”.
163 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.
164 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.
165 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.
166 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.
167 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.
168 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.
169 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.
170 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.
171 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.
172 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.
173 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.
174 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.
175 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.
176 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.
177 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.
178 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.
179 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.
180 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.
181 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.
182 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.
183 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.
184 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.
185 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.
186 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.
187 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.
188 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.
189 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.
190 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.
191 “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.
192 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.
193 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.
194 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.
195 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.
196 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.
197 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.
198 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.
199 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.
200 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.
201 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.
202 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].
203 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.
204 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.
205 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.
206 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.
207 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.
208 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.
209 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.
210 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.
211 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.
212 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.
213 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.
214 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.
215 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.
216 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.
217 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.
218 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.
219 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.
220 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.
221 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.
222 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.
223 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.
224 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.
225 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.
226 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.
227 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.
228 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.
229 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.
230 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.
231 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.
232 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.
233 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.
234 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.
235 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.
236 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.
237 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.
238 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.
239 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.
240 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.
241 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.
242 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.
243 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.
244 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.
245 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.
246 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.
247 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.
248 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.
249 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.
250 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.
251 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.
252 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.
253 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.
254 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.
255 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.
256 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.
257 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.
258 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.
259 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.
260 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.
261 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.
262 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].
263 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.
264 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.
265 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.
266 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.
267 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.
268 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.
269 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.
270 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.
271 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.
272 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.
273 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.
274 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.
275 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.
276 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.
277 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.
278 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.
279 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.
280 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.
281 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.
282 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.
283 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.
284 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.
285 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.
286 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.
287 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.
288 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.
289 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.
290 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.
291 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.
292 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.
293 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.
294 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.
295 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.
296 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.
297 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.
298 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.
299 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).
300 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.
301 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.
302 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.
303 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.
304 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.
305 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.
306 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.
307 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.
308 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.
309 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.
310 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.
311 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.
312 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.
313 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.
314 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.
315 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.
316 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.
317 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).
318 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.
319 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.
320 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.
321 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.
322 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).
323 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.
324 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).
325 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.
326 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.
327 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.