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Acta Scientific Orthopaedics

Journal Papers (75) Details Call for Paper Manuscript submission Publication Ethics Contact Authors' Guide Line
1 New Study: Spine Surgeons Take Care of Your Necks! , Ken Hansraj
Indian spine surgeons J Naresh-Babu, Viswanadha Arun-Kumar and DGS Ragu of the Mallika Spine Centre, Andhra Pradesh per-formed an observational study whose purpose was to analyze the surgeon's neck postures while performing lumbar spinal surger-ies.
2 Acute Median Nerve Compression by a Fragment of Hamate Bone , Martín Ulloa Cerezales and Uxía Blanco Sampedro
Acute median nerve symptoms are not commonly seen. Less frequent is the association with hamate fractures, which usually produce ulnar nerve symptoms. We report a case of a patient with an hamate fracture and acute median nerve injury. On surgical intervention, a bone fragment, directly responsible for the symptoms, was found inside the carpal tunnel
3 Gradual Correction of Proximal Tibial Biplanar Deformities Using Truelok Hexapod System , Saleh Alsaifi, Ahmed Abdelaziz, Sameeh Elashry and Mohamed Mosad
At thirteen-years-old boy who sustained an open physeal injury of the left proximal tibia at four year of age presented to our lower limb deformity clinic complaining from deformity of the left knee and limb length discrepancy. Clinical and radiographic assessment revealed apparent shortening of the left lower limb due to a biplanar deformity of left proximal tibia. The deformity was quantified as a 25° varus and 20° procurvatum deformity. The patient underwent treatment in the form of gradual deformity correction and 20 mm over-lengthening with a TL-Hex circular external fixator, along with complete epiphysiodesis of the proximal tibial and fibular physis. Treatment was completed over-six months including correction and consolidation and he returned to full activity one month after frame removal with 20 mm shoe raise to right lower limb. Normal clinical and radiological alignment of the left lower limb was achieved with good knee and ankle range of motion.
4 Perioperative Medication Management for Spinal Surgery , Nicholas S Venuti, Sangili Chandran, Connor Willis-Hong and Vivek Mohan
Background: Perioperative medication management of spinal surgery patients is essential to minimize risk of complications and expedite patient recovery. Commonly prescribed medication regimens such as anticoagulants (e.g. aspirin, clopidogrel), nonsteroidal anti-inflammatory drugs (e.g. ibuprofen, naproxen) and immunosuppressants (e.g. methotrexate, cyclosporine) may predispose patients to excessive hemorrhaging, wound dehiscence, and surgical infections among other intra-operative and post-operative complications. Through an understanding of medication mechanisms, recommended use and disuse protocol, and how these medications pertain to individual circumstances, physicians are optimally informed to prepare patients for elective spinal surgery. Study Design: Review of literature.Methods: Numerous searches were conducted utilizing PubMed. The searches were filtered to be written in English and within twenty years.Results: After review of relevant literature, different precautions must be taken depending on the type of medication (anti-coagulant, anti-platelet, non-steroidal anti- inflammatory drugs, immunosuppressants) and the individual perioperative health conditions. Patients on blood thinning regimens may need to discontinue use of prescribed medication as early as 10 days to 12 hours pre-operatively and may resume consumption as early as 12 hours post-operatively depending on the medication and perioperative health condition of the patient. Patients on nonsteroidal anti-inflammatory drugs (NSAIDs) may need to discontinue use as early as eight days to 12 hours pre-operatively and may not resume consumption of NSAIDs for up to three months post-operatively depending on medication and the patient’s perioperative health condition. Patients on immunosuppressant regimens may need to discontinue use as early as two months to eight hours pre-operatively and may resume post-operative consumption as early as one week or when the operative wounds have completely healed depending on the medication and the patient’s perioperative health condition.Conclusion: Due to the invasive nature of spinal surgery, and the potential effect of various medications that can affect surgical outcomes, it is imperative that providers review patient medications for proper management during the perioperative period. In the future, additional research for new classes of drugs and medications where literature is currently scarce will help to reduce hospital admission lengths, complications post-operation and even death
5 Metastatic Follicular Thyroid Carcinoma to the Dorsal Spine Presenting as Early Manifestation: Case Report , Romit Agrawal, Ayush Sharma, Vijay Singh, Nilesh Mangale and Ajay Jaiswal
Follicular thyroid carcinoma (FTC) patients are rarely present with spinal metastasis as an early manifestation. Here we present a 56 year old non ambulatory female with paraparesis of both lower limbs which was progressed over last 3 months. Spinal MRI and CT scan revealed D7 thoracic spine intramedullary lesion probably of thyroid origin which was confirmed on USG and FNAC later on. The aim of surgery was decompression of spinal cord and histological evaluation of the tumour. Surgery in the form of spinal mass excision and posterior spinal decompression and fixation two levels above and below was done and then adjuvant chemotherapy was given. Hence patients presenting with spinal tumour must always be screened for thyroid carcinoma as a differential diagnosis. Prognosis is quite well in such patients post decompression
6 Revisiting Characters of Human Immune Orchestra in Light of Immuno-Suppression by Corona Virus , SS Jha
Basic understanding of immunology is relevant today in the light of consciousness raised by the worldwide pandemic of SARS-COV-2 responsible for Novel COVID-19.Immune system is evolved to protect from universe of foreign pathogens. During the course of evolution, depending on species, there has been diversification and high sophistication to permit the organism to adapt to its environment. The human immunity has two interdependent arms, “innate” and “adaptive” immune systems
7 Rehabilitation Program after Post-Traumatic Reconstruction of the Anterior Cruciate Ligament (With a Clinical Case Report) , Ivet Koleva and Borislav Yoshinov
The Anterior Cruciate Ligament (ACL) is an important stabilizer of the knee, providing almost 85% of the joint stability to forward force (especially in some aggressive twisting and jumping sports, as skiing and basketball). The common orthopedic surgical intervention is the reconstruction, performed as soon as possible after the traumatic injury.After the orthopedic surgery, a period of rehabilitation must begin and the consultation with a medical doctor - specialist in Physical and Rehabilitation Medicine (PRM) is required. The goal of current article is to suggest a complex PRM-algorithm of care of these patients, based on detailed literature review and on our own clinical practice
8 Percutaneous or Open Release is the Most Effective Surgical Technique in Diabetic Recurrent Trigger Finger in Short and Long Term Outcomes? A Clinical Review , Grigorios Kastanis, Pantouvaki A, Spyrantis M, Christoforidis C and Velivasakis G
Introduction: Stenosing Tenosynovitis is a common disorder among patients with diabetes mellitus. The definitive treatment is release of the A1 pulley (open or percutaneous). The aim of this study is to compare functional outcomes and complication rates of these two methods (open versus percutaneous release) for recurrent trigger finger in patients with diabetes mellitus.Materials and Methods: 114 patients with diabetes mellitus and an average age of 48 years (range 28 - 64 yrs old) were treated for recurrent trigger finger. The modified Quinnell grading system was used as a selection criterion for the classification of trigger digit. The patients were divided in two groups randomly. Group A included 52 patients who were treated with open release of A1 pulley and group B included 62 patients who were treated with percutaneous release using the tip of an 18-gauge or knife (Ophthalmic Corneal/Scleral knife 19 Gauge).Results: The median follow-up was 12 months (range from 10 - 14 months). The results were based on the Visual Analogue Scale (VAS), Quick Dash and Gilberts and Wereldasma Questionnaire. At 3 months, the results seemed to be better in group B, while there was no statistical difference at six months and at one year postoperatively. Conclusion: Both surgical methods (open and percutaneous release) in long-term follow-up postoperatively, resulted in similar therapeutic efficacy. The advantages of percutaneous release over the classic open method in short-term outcomes are: 1) low cost, 2) less complication rates and 3) immediate functional recovery.
9 Effectiveness of 6 Weeks Plyometric Training Protocol on Vertical Jump Ability among High School Amateur Male Volleyball Players-A Randomized Control Trial , Chaitanya D Sahasrabudhe, Siddhi Tendulkar and Sucheta Golhar
Volleyball is one of the most played games in Indian School going population. Vertical jump height is an essential part in volleyball which can be achieved by strengthening the lower leg musculature. Thus the 6 weeks plyometric training protocol is added to see its results on the strength of lower leg musculature among high school amateur male volleyball players. The subjects (n = 40; age = 10 - 16 years; mean = 12 ± 1.00 years) jumping reach Height (mean) = 169.00 ± 1.00 cm) were divided equally into 2 groups called as group A (Experimental) and group B (Control) respectively by simple random sampling method. Group A received the 6 weeks plyometric training protocol and conventional training while group B received only conventional training. Sargent jump test was used to assess the jump heights pre and post at the end of 6 weeks. Unpaired t-test was used to compare the results between the groups. Group A showed significant increase in the difference between the jumping and standing reach heights at the end of 6 weeks (mean difference in the height = 34.25 cm; p-value < 0.05) than in Group B (mean difference in the height = 25.15 cm; p-value < 0.05) at the end of 6 weeks. Also, there is significant improvement in Jumping reach height in Group A (pre = 188.05 cm; post = 203.00 cm) than in Group B (pre = 187.20 cm; post = 195.15 cm). Group A showed 43.65% (mean = 34.25 cm; SD = 7.59) increase while Group B achieved 31.61% (mean = 25.15 cm; SD = 3.73) increase with their initial vertical jump height Both the training protocols are effective in improving vertical jump height but the 6 weeks plyometric training protocol is more effective in improving vertical jump than the conventional training among high school amateur male volleyball players
10 Re-Igniting Our Body and Mind to Surpass Future Challenges , Julie Rammal
The human body and mind is incredibly intelligent and pow-erful. Our body, mind, organs and everything within us speaks its own language, records its own data, and to boost health, energy, and positive emotion one must unblock stagnant energy in body, mind or soul or the system may fail, collapse or become diseased
11 Outcomes of Outpatient Percutaneous Release of Trigger Finger , Jayesh Vaza, Pathik Vala, Rutvik Shah and Kuldeep Parmar.
Introduction: Trigger finger is caused by stenosing tenosynovitis, resulting in painful catching of the involved flexor tendon as the patient flexes and extends the digit. Treatments include Nonsteroidal anti-inflammatory drugs (NSAIDs), splinting, corticosteroid injection, open and percutaneous release. Aim of the Study: The aim of this study was to evaluate the results of percutaneous trigger finger release using 18G hypodermic needle. Materials and Methods: A prospective study of 80 patients for treatment of trigger finger by percutaneous release by 18G needle was conducted at L.G Medical college and hospital, Ahmedabad, Gujarat between 1st January 2019 to 31st December 2019. Written Consent was obtained for Surgery. Patients were followed up in opd on 1st week, 1 month, 3rd month, 6th month, 12th month and evaluated for complications and re-occurrence of symptoms. Results: A total of 80 patients with trigger fingers were included in this study, out of which 10 patients did not follow up on time. Successful release was achieved in 68/70 (97.14%) patients. There was no patient who experienced any issues like nerve injury, wound complications, decreased sensation and tendon bowstringing. Conclusion: Our review showed that this technique for release of trigger finger is less costly technique with more patient oriented, less complications and better recovery rate. This is a day care procedure
12 Objective Assessment of Tendinopathy by Ultrasound Elastography , Rajul Rastogi, Neha, Vijai Pratap and GL Meena.
Tendinopathy refers to an inflammatory condition of tendon usually secondary to overuse. In the tendons, edema leads to internal softening with consequent decrease in echogenicity and elasticity hence the tendon will appear hypoechoic on B-mode, gray-scale ultrasonography while appearing brighter on ultrasound elastography than its normal counterpart tendon.Ultrasound Elastography is a recent noninvasive technique that allows evaluation of the elasticity of human tissues. Acoustic radiation forced impulse is a special form of ultrasound elastography wherein an acoustic radiation impulse is sent to the human tissues and the strength of returning echo indicates the elasticity of tissues. The latter can be depicted in shades of gray or different colors. If the image is coded with shades of gray, harder tissues will appear black while softer tissues will show varying shades of gray. However, in color-coded maps red or blue is indicated for hard tissue and blue or red respectively indicating soft tissue. Majority of the studies in the recent literature focusses on ultrasound elastography of evaluation of larger tendons especially the Achilles tendon, rotator cuff, quadriceps tendon, etc. while very few studies have focused on smaller tendons of the human body. Hence, this study primarily focusses on objectively evaluating the role of ultrasound elastography in assessment of tendinopathy at wrist joint.
13 Re-Igniting Our Body and Mind to Surpass Future Challenges , Julie Rammal
The human body and mind is incredibly intelligent and pow-erful. Our body, mind, organs and everything within us speaks its own language, records its own data, and to boost health, energy, and positive emotion one must unblock stagnant energy in body, mind or soul or the system may fail, collapse or become diseased.
14 Popliteal Schwannoma Simulating Vascular Tumor: An Uncommon Case , Daoudi Samih, Affes Hassene,Bouaziz Anis, Kamoun Khaled Anis and Jenzri Mourad.
Schwannomas are benign tumors arising from the Schwann cells on the peripheral nerve sheath. This tumor affects specially adults between 20 and 50 years-old. Malignant transformation is rare and uncommon. The most common clinical presentation of sciatic nerve schwannoma is a painful palpable mass with paresthesia. We present the case of a 57 years old man with a schwannoma of the sciatic nerve. The imaging findings were suggestive of the diagnosis. The tumor was excised without neural damage and no neurological deficit was noted postoperatively.
15 Short-Term Functional Outcomes of Primary Total Hip Arthroplasty Using A Modified Minimally Invasive Antero Lateral Approach , F Maturana, G Hernández, I López and P Dobbs.
Background: Minimally invasive surgery (MIS) has had a progressive development in recent years, due to its advantages in terms of: reducing the rates of complications, infection, surgical time and bleeding. Total hip arthroplasty (THA) has not been exempt from this current. Since of the first descriptions in 90 ́, several different techniques has been described to achieve smaller incisions and better results in primary THA, however, there is not enough statistical evidence to widely recommend MIS-THA, defined as an incision < 8 cm. Materials and Methods: We retrospective reviewed a cohort of 173 THA, 55 men and 118 women, between January 2016 and October 2019, in an advanced trauma hospital, all performed by the same surgeon. An independent team, blinded to the primary diagnosis, performed a standardized clinical and radiological evaluation at 2, 6 and 12 weeks. Results: The average length of the incision was 71 mm (48 - 84 mm). The average surgical time was 68 minutes (42 - 175). Hematocrit decreased by an average of 3.8% (2.2 - 8.1%). Average blood loss was 335 ml (120 - 950 ml). Preoperative Harris Hip Score was 67 (45 - 76) and postoperatively at 12 weeks of 92 (82 - 97). Three cases of perioperative complications where reported: 1 case of calcar fracture with extended approach (84 mm) and cerclage fixation, 1 case of prosthetic dislocation and 1 postoperative periprosthetic fracture Vancouver B2. No cases of neurovascular injury, infection or misalignment of components were reported. Conclusion: These results with a locally developed technique, achieved satisfactory clinical and radiological outcomes, with minimum incisions up to 48 mm, with an average reduction of 50% to the standard approach (13 - 15 cm).
16 Effect of Subcutaneous Fat of Quadriceps Muscle on Q-Angle - A Cross-Sectional Study , Jagruti K Patel, Maldikar Pragna Satish, Patel Harsh Vinodbhai and Vaidya Nikita Rakeshkumar.
Background: Q-angle is an important indicator of the biomechanical function for the lower extremity. The increased value of Q-angle is suggestive of risk factors for many knee disorders. The fat is considered as basic compound of body which is necessary for certain anatomical and physiological functions. The accumulation of excess body fat affects the musculoskeletal system. Purpose: This study was conducted to determine the co-relation between the Q-angle and subcutaneous fat of the Quadriceps muscle and also determine the normal value of Q-angle and normal value of the Skinfold thickness of the Quadriceps Muscle. Procedure: A cross-sectional study was conducted among 109 individuals, having no history of knee injury or pain. There were 59 females and 50 males participated in the study. The Q-angle was measured in standing position with the help of universal goniometer and the Quadriceps muscle was kept relaxed. The measurement of the skinfold thickness was taken by normal plastic skin calliper. Results: The study showed that mean value of the Q-angle for females and males on the right side was 16.9 ± 1.85 and 13.87 ± 1.95 whereas on left side it was obtained 16.9 ± 1.85 and 13.96 ± 2.01. The study also obtained the mean value of the subcutaneous fat of quadriceps for females and males on right side 14.0 ± 5.16 and 11.22 ± 5.30 whereas on left side it was obtained 13.9 ± 5.15 and 11.54 ± 5.37. The study also obtained positive co-relation among the Q-angle and Quadriceps fat. (p = 0.001). Conclusion: The study concluded that there was a positive co-relation among the Q-angle and subcutaneous fat of the Quadriceps muscle.
17 Diet, Exercise and Thinking Positive Way Will Keep Cancer at Bay , Maithili Athavale
The word cancer itself imprints more fear than death. Under-standing the root cause of the disease and modulating one’s life-style can help a person to take control of this disease.
18 The Relationship between Foot Anthropometry and Vertical Jump Performance Using My Jump 2 App in Normal Population - A Cross Sectional Study , Vandana Patel, Dhara A Jiyani, Arika S Jadav, Rani B Kamti and Shruti S Motirupawala.
Background:Vertical jump is a motor task which requires the interaction of nervous and musculoskeletal system. Variability in musculoskeletal structure has the potential to influence locomotor function. This study examined acute anthropometric measure in relation to vertical jump performance. Purpose:The purpose of this study was to find the relation between foot anthropometry and vertical jump performance.Procedure:The purpose and the procedure of the research were explained to the subjects and on the basis of inclusion and exclusion criteria, the subjects who were willing to participate in the research were selected. Total n=100 subjects were explained about how to perform vertical jump. After obtaining their anthropometric values, the subjects performed three trials of vertical jump and the average of performance parameters were recorded using ios based My Jump 2 app and was recorded as the final value. Results:Data collected were entered and analyzed by SPSS version 16.0 for windows (IBM). Descriptive statistics was used to anal-yse baseline characteristics for all parameters of subjects. Mean score of all the parameters of subjects were taken and were analysed using Pearson’s method of correlation. There is negative correlation between weight of the subject, jump height, foot length, toe length, heel length, navicular height and BMI. Positive correlation was found between vertical jump height and ROM of dorsi flexion and plantar flexion as well as calf girth. Conclusion:There is correlation between different parameters of foot anthropometry and vertical jump performance in normal individuals.
19 Is TSG-6 the Most Important Biomolecule in the Setting of Orthopedic Surgical Immunobiologics? Scientific Concepts and Case Report with Cartigram® Imaging , Austin Yeargan III, Caroline Yeargan, Bailey E Montgomery, Katie Whitney and Thos Evans.
Bone marrow concentrates for knee arthritis have received much attention over the last decade as a viable treatment for osteoarthritic knee pain and disability. In spite of the availability of these bone marrow concentrates, few authors have suggested a gold standard treatment protocol. We first introduced our signaling cell procedure to orthopedic surgery in 2006. The procedure has undergone multiple iterations since that time. In this article, we introduce our seventh-generation technique for signaling cell treatment in the setting of osteoarthritis of the knee and discuss the role of tumor necrosis factor stimulated gene six protein in our signaling cell product. We identified TSG-6 as an important chondroprotective biomolecule that is critical for the assembly and maintenance of the cartilage extracellular matrix. TSG-6 is an inflammation-induced protein that is produced at pathological sites, like synovial joints during arthritic degeneration. TSG-6 protects against joint damage through anti-plasmin activity and de-activation of serine protease during inflammation. TSG6 also limits neutrophil migration and has an anabolic, immunomodulatory effect in synovial joints. Modern signaling cell techniques are unable to capture or concentrate TSG-6 due to its small molecular size, that is coincident with the undesirable pro-inflammatory molecules. These molecules are on the order of 30 kD in comparison with anti-inflammatory molecules that typically are greater than 600 kD in size. Hyaluronic acid typically has a molecular weight of 3000 - 4000 kD and is bound by one of the domains of TSG-6, causing biological activation of the complex. We combine our cell concentration product and a commercially prepared hyaluronic acid to formulate a growth factor concentrate that is activated as a scaffold for signaling cells we harvest from autologous bone marrow aspirate taken at the anterior gluteal pillar during immunobiologic procedures. We believe that by concentrating TSG-6 and including it as a component of our signaling cell transplant procedures, a biologically superior injectate is able to be assembled that may favor cellular and tissue anabolism. In addition, we harvest autologous clotting proteins (Thrombin/factor 2) to lock the product in the subchondral bone after micro core of the stiff, subchondral bone using a commercially available device.
20 Early Controlled Mobilization Following Extensor Pollicis Longus Repair: A Case Report , Shrikant J Chinchalkar and Laura Yurkowski.
Adhesion formation causing the loss of tendon excursion after a digital extrinsic extensor tendon injury near or within the exten-sor retinaculum is common. Extensor pollicis longus (EPL) injuries, repairs and management near the extensor retinaculum have been limitedly described both surgically and post-operatively. When considering necessary tendon gliding and tendon excursions at, distal or proximal to the extensor retinaculum, the size and location of EPL laceration is important in the rehabilitation and patient outcome. The patient in this case study was treated by means of a dynamic hinge orthotic with an out trigger for the thumb and hinge for the wrist. Post-operative rehabilitation management consisted of a controlled mobilization program and was progressed accord-ing to the stages of healing and the principles of EPL tendon gliding resistance with respect to the wrist position. Full thumb flexion and extension combined with wrist motion and full grip and pinch strength was attained.
21 Post Operative Pleural Effusion and its PT Management- A Case Study , Gurman Kaur and Satish Kumar Anumula
In patients with dilated cardiomyopathy and end stage heart failure heart transplantation is the definitive treatment strategy. Post-operative pulmonary complications are very common in any solid organ transplant surgery. In maximum of heart transplant surgeries pleural effusion is very common due to which the patient require prolong hospital stay and mechanical ventilation. This case study shows the severe right ventricular dysfunction who was underwent a heart transplant surgery. The past medical history reveals pulmonary embolism, hemicolectomy (cancer) and some risk factors including smoking. During the post-operative recovery period the patient received immunosuppressive treatment with prednisone, cyclosporine, mycophenolate. Their was reduced air entry in both lungs and the respiratory rate was 20 cpm. Physiotherapy goals for the patient is to improve cardiopulmonary function, prevent further cardiopulmonary complication and improve fatigability and cardiopulmonary endurance. The patient physiotherapy treatment for twice a day for minimum of 40 ins per session which included ambulation, limb mobilisation and respiratory exercises. This study concluded that positive airway pressure as a treatment approach was safe, feasible and easy during sub-intensive care setting while treating patients with post-operative pleural effusion.
22 Reconstruction of Bone Defects after Tumor Resection Using Present Methods (Mini-Review). Bone Reconstruction Algorithm , Evgeniya Anastasieva and IA Kirilova.
The replacement of large bone defects after segmental bone resections in patients with bone tumors is an actual problem in orthopedics. The main difficulty it causes especially in cases of disturbance of normal biomechanics. Especially when the “gold standard” of reconstruction with bone autograft is not possible, because of the defect, which can be so extensive that any autograft stock will be not enough. Therefore, allografts based on demineralized bone with optimal properties for osteoregeneration can become the necessary alternative for bone replacement. Nowadays composite materials is possible to be programmed to have the specific properties by changing its compound. After concluding the results of the literature analysis, we revealed that the allograft in combination with additional components is comparable by its effectiveness with autograft. As an additional component to improve osteoregeneration mesenchymal stem cells of both bone marrow and adipose tissue can be used. However, it is noteworthy that the analyzed studies did not reveal the influence of stem cells on the tumor recurrence. So, the authors tell about necessity of further researches. Some authors still prefer traditional methods of bone traction despite obtaining own satisfactory results of defects reconstruction with allografts. Such opinion is based on proven effectiveness of the method, structural stability of construction during treatment period and ability to adjust the process of bone regeneration at any stage. Our goal was to analyze publications over the recent 10 years, which report about results of experiments and clinical studies with performing massive bone reconstruction after bone tumor resection using auto- and allografts, or other technique. Based on the literature analysis we have updated our previous algorithm for graft selection in replacement of large bone defects after segmental bone resections.
23 Could the Yeargan Autologous Subchondral Nanoplastytm and Mechanical Axis Deviation Protocol (NAMAD®) Halt Molecular Progression and Reverse the Clinical Symptoms of Knee Osteoarthritis? Clinical and Scientific Concepts with Case Presentation Including T2 Wetmap Cartigram® sequencing , Austin Yeargan III, Bailey Montgomery, Matt Murphy, Katie Whitney, Peter Millett and Thos Evans.
Osteoarthritis causes a heavy disease burden globally and treatments are continually evolving. We introduced an autologous cell therapy protocol in 2006 that has continued to demonstrate promise clinically and on advanced imaging studies. In this report, we detail applicable scientific concepts, our surgical technique and present a case report for illustration.
24 Forearm Support Band Versus Wrist Splint in Treatment of Lateral Epicondylitis , Hamza M Shaheen, Nadia Fayaz, Lilian Albert Zaky and Ayman Mansour.
Objective this study was done to assess the therapeutic efficacy of forearm support band and wrist splint in minimizing severity of pain and improving hand grip strength with lateral epicondylitis cases, and determine which one of these two common splints is more effective to reduce pain intensity and improve grip strength. Method:Thirty male and female patients with tennis elbow were selected from orthopedic Department at National instate of neu-rolocomotor system. All patients were randomly assigned into two groups. The group (A) (n = 15, mean age: 44.8 ± 6.87 years) received forearm support band for four weeks, while the group (B) (n = 15, mean age: 42.86 ± 6.34 years) received wrist splint. All patients received exercises (12 sessions, 3 sessions per week) over a four weeks period. They were evaluated using visual analog scale to determine the pain intensity, and handheld dynamometer to determine hand grip strength in both groups. Results: The results of the current study revealed that forearm support band or wrist splint combination with exercises for four weeks in patients with tennis elbow resulted in significant increase in hand grip strength in the post-treatment, associated with a sig-nificant decrease in pain intensity in the post-treatment in both groups. In addition, it revealed that there was significant difference between forearm support and wrist splint as regard to pain reduction which wrist splint allows a greater degree of pain relief than the forearm support band for patients with lateral epicondylitis, while there was no difference as regard to grip strength improve-ment between both groups. Conclusion:It was concluded that forearm support band or wrist splint (cock-up splint) combined with exercises were effective in improving pain intensity and increasing hand grip strength in patient with tennis elbow, and wrist splint allows a greater degree of pain relief than the forearm support band.
25 A Case Report of Nail Patella Syndrome and Knee Pain , Gupta Sunny, Patel Mitesh, Chhipa Irfan, Barrientos Steven and Grzywinski Matthew.
Nail-Patella Syndrome (NPS), also known as Fong’s Disease, Turner-Keiser Syndrome or Hereditary Onychoosteodysplasia (HOOD), is a rare hereditary condition affecting 1 in 50,000 individuals. The condition is associated with mutations in the LMX1B gene and is inherited in an autosomal dominant pattern. Patients with this syndrome may have several musculoskeletal abnormali-ties including hypoplastic or absent patellae, underdeveloped elbows, and iliac horns. The joint abnormalities associated with this condition predispose patients to osteoarthritis (OA) and easy joint dislocation. Other common findings include nail abnormalities (absent or hypoplastic nails, nail ridges, and nail discoloration), renal dysfunction, glaucoma, irritable bowel syndrome, rash, and neuropathy. Here, we describe the case of a patient with known NPS presenting with bilateral knee pain.
26 Integration of Real - Time Ultrasonography Imaging (RUSI) for Physiotherapists in India , Shivani Chowdhury
X Rays, MRIs are images of body structures when the patient is still or not moving. On the contrary, pain is a disturbing sensation many a times caused by an external or internal stimuli. The Inter-national Association for the Study of Pain defines pain as “an un-pleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.
27 Clinical Presentation of Joint Hypermobility Syndrome of the Knee in Jordanian Military Personnel , Moh’d Rami AlAhmar, Kreem Al Rashdan, Deifallah Al Sharari, Awni Al Hdead, Zaid Al Dhamsheh and Ibrahim Amayreh.
Objective: To describe the findings of clinical presentation, complication, radiographic and laboratory of the knee among Jordanian military personnel diagnosed to have hyper mobile syndrome. Methods: A prospective cohort descriptive study carried out at Royal Rehab Centre in King Hussein Medical Centre, over a period of 2 year (from May 2016 to May 2018). One hundred and twenty military patients complaining of knee problem who attended the rehabilitation clinic and diagnosed with hypermobility were enrolled in this study. Their age, sex, presenting features, clinical profile, laboratory and radiological parameters were studied. Results: (102 males, and 18 females with M: F ratio 5.7:1), their mean age was 25.6 (range: 17-35 years), mean duration of symptoms 10.3 months. The most common presenting complain was bilateral knee pain (72 patients, 60%) followed by unilateral knee pain (35 patients, 29%), while pain and swelling were noted in 10 patients (8%) and joint locking was observed in 3 patients (2.5%).The commonest radiographic abnormality was premature osteoarthritis seen in 30 patients (25%) followed by ligament injury observed in 5 patients (4%), while bone bruising and contusion were documented in 3 patients (2.5%), stress fracture was reported in 2 patients (1.7%). Rheumatoid factor and anti-nuclear antibody were found to be positive in 7 patients (5.8%) and 5 patients (4%) respectively. Conclusion: While most people with hypermobile joints remain asymptomatic a small number may have a wide range of musculo-skeletal symptoms.Hypermobility of the knee can predispose early osteoarthritis in this age group of military personnel moreover due to repetitive stress and prolonged standing in static posture, ligament or tendon injury, bone contusion and stress fracture may occur.
28 Locked Platting for Distal Femur Fractures, Is it a Good Option? , Maged Mohamed Mostafa, Ahsan Javaid Butt, Ahmed Refaat Khamis, Atul Bandi3 and Adeel Nawab Ditta.
Distal femoral fractures are among the challenging injuries to be rigidly fixed. Different implants for internal fixation have been used with varying degrees of success. The aim of this study is to review the results of using the distal femoral locked plate (DFLP) in treatment of different fracture patterns of the distal femur.Methods: A retrospective study was performed between 2012 and 2018 on 41 patients with distal femur fractures treated by distal femoral locked plate (DFLP) in King Hamad University Hospital (KHUH) of Bahrain. Pritchett rating system was used to assess the functional outcome of those patients. Results: total 41 patients were enrolled in the study. There were 13 males and 28 females. The age ranged between 18 and 94 years with an average of 62.9 years. Thirty four patients were followed up till complete union. The average follow up period was 17.2 months. Functional outcome was excellent in 15 patients, good in 10, fair in 4 and poor in 5 cases. Conclusion: distal femoral locked plate (DFLP) is a reliable implant which offers successful results upon using in treatment of various patterns of distal femur fractures.
29 Extremities Fracture and Associated Factors among Adult Patients in Debre Markos Referral Hospital, East Gojjam Zone, Northern Ethiopia: A Hospital Based Cross-Sectional Study , Yoseph Merkeb Alamneh, Getachew Chane, Mengistu Ayele2 and Asfaw Gerbi.
Background: Extremities’ fractures, particularly when left untreated, are a common sequelae of injuries and a major cause of mor-bidity and mortality; but the burden and distribution of traumatic fractures in low- and middle-income countries is poorly under-stood. The increasing the prevalence of extremity fracture can be attributed to modernization, industrialization and increased rate of bone fracture in the society. Extremities fracture is the leading cause of functional disability and death in different age groups in both sex. It may result from road traffic accidents, falls, gunshot, machines, attacks as well as sports. The epidemiology of fracture in Ethiopia provides little knowledge about its distribution and associated factors needed for prevention. Thus, this study aimed to investigate extremities fracture and associated factors in Debre Markos referral Hospital.Hypermobility of the knee can predispose early osteoarthritis in this age group of military personnel moreover due to repetitive stress and prolonged standing in static posture, ligament or tendon injury, bone contusion and stress fracture may occur. Methods: Hospital based cross-sectional study was conducted from April to June 2018 at Debre Markos referral hospital, Northern Ethiopia. A total of 422 patients were included in this study. Data were collected using a structured questionnaire by trained data collectors. The collected data were coded, entered into epi data 3.1, and exported to STATA version 14 for statistical analysis. Simple logistic Regression analysis and Multiple logistic regression analyses was employed to identify factors associated with extremity frac-ture and factors which had a p-value of ≤ 0.25 in Simple Logistic Regression analysis was included in Multiple Logistics Regression analysis. P-values of less than or equal to 0.05 was considered statistically significant. Result: Among the total 422 adult patients who visited the emergency department, 144 (34.12%) patients experienced extremity fractures in Debre Markos Referral Hospital. Ninety-two (63.9%) were males and 52(36.1%) were females and their age range from 26 to 77 years. Residency, sex, age, behavioral factors such as using alcohol and fighting, vehicle type, types of occupation and medical illness were identified as the key risk factors of extremities fracture. Conclusion and Recommendation: The prevalence of extremities fracture were high at study area and socio-demographic charac-teristics, behavioral factors and co-morbidities were found to be significantly associated with extremity fracture. Therefore, efforts should be scaled up to develop effective preventive measures and enforced against fractures of extremities.
30 Scoliosis and Osteopathy , René Zweedijk, Christophe Tylleman and Peter Schwind.
Scoliosis is a frequently seen problem in the osteopathic practice. There are different types of scoliosis. The most disabling form is the Adolescent Idiopathic Scoliosis (AIS). Humans are chaotic, complex adaptive systems. The consequence is that many different factors can cause AIS and that the onset can be sudden and quick. In this article we study the etiology of AIS by using the 2012 SOPE model of 5 of osteopathy. AIS has mechanical, neurological, respiratory, circulatory, metabolic and bio-psychosocial aspects. It also means that the osteopath should see every patient as unique and analyze all factors that are putative causal in the onset of AIS. Some treatment options are shown based on recent scientific insights.
31 Rehabilitation as an Essential Element in the Clinical Practice of Orthopaedics and Traumatology , Ivet B Koleva and Borislav Yoshinov.
The World Report on Disability defines the goals of rehabilitation: prevention of the loss of function; slowing the rate of loss of function; improvement or restoration of function; compensation for lost function; maintenance of current function. Orthopedic reha-bilitation is part of the rehabilitation sciences, needed frequently in clinical practice. Our opinion is that rehabilitation is an essential element in the patients’ management of Orthopedics and Traumatology. In this article, we present basic theoretical knowledge, necessary for a successful orthopedic rehabilitation, and we cite practical skills of rehabilitation in patients with the most frequent orthopedic conditions, including after orthopedic surgery. We explain our own proposal for OT rehabilitation algorithms, with the goal to stimulate the functionality of our patients and to assure their inde-pendence in activities of daily living, respectively their autonomy.
32 Orthopaedics Procedures in Patients with Coronavirus Disease , Sebastião David Santos-Filho
Introduction: Orthopaedics’ surgeons may not be in the front line in the fight against the viral pandemic, but the way they practice has been affected substantially. The emergence of the COVID-19 pandemic has severely squeezed medical performs throughout the world, especially those of infectious syndrome specialists, emergency room personnel, anaesthetists, intensivists, virologists, epide-miologists and hygienists. At the same time, researchers have also been affected. Objective:This work pretends to show the procedures done by orthopaedics physicians in patients with coronavirus disease and to describe the reality fight by these healthy professionals. Methods: Articles searched in PubMed with key-words Orthopaedics and Coronavirus were founded accepting the following criteria: free full text, clinical trial, meta-analysis, review, in the last year, English language, and still in MEDLINE data. Results:The research was done on July 14th 2020 and it was founded 15 articles that comprises in the criteria cited above, but only 9 attend the goal of this article. Conclusion: The scientific reasons for the correctly use of surgeon’s procedures and the eligibly of those procedures that it was used in some cases were presented in this work. We hope that this work will be a guide for the orthopaedic professionals.
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.