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Journal of Orthopaedics And Bone Disorders

ISSN(p): | ISSN(e):2577-297X
Journal Papers (102) Details
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Indexed Journal

1 Excellent Short-term Results of Articular Surface Replacement XL Total Hip Arthroplasty , Zhao ZS* and Sun JY
Symptoms of pain, loosening and squeaking were historically reported as the main revision reasons for articular surface replacement XL (ASR XL) total hip arthroplasty. A total of 42 cementless primary total hip arthroplasties using ultra large-diameter femoral head and mono block acetabular component were performed in our institution. These consecutive 42 arthroplasties were retrospectively reviewed and the results were recorded and analysed. After an average 3-year follow-up period (range, 2.5-3.6 years), 42 primary replacements in 39 patients could be reviewed fully. Mean age at surgery was 51.9 years (range, 20-92 years). Pain was noted in 4 hips and squeaking was noted in 1 hip. According to Harris rating system, clinical results were graded excellent and good in 93% of hips and fair in 7%. Radiologically, the cup abduction angle of the acetabular components for all symptomatic hips was in acceptable realm. There has been no osteolysis or asceptic loosening on both sides of the hip. The failure rate of ASR XL total hip arthroplasty was 2% at early follow-up. The controversial ASR XL acetabular component could yield excellent clinical results in some circumstances.
2 Application and Failure Experience of Intramedullary Nail and Locking Plate in the Treatment of Femoral Subtrochanteric Fracture , Qiang Z*, Liangjun J, Hang L and Zhijun P
Background: The experience of intramedullary nail and locking plate in femoral subtrochanteric fracture were retrospectively analysed. Methods: The operation time, bleeding, hospitalization, fracture healing time, Harris function score and postoperative complications were summarized between two groups. Results: The operation time, bleeding, hospitalization, fracture healing time and Harris function score all made no significant differences between two groups. Three cases in nail group and two cases in plate group suffered fixation failure. Conclusion: Intramedullary nail must focus on fracture reduction and recovery of femoral medial support, whereas locking plate must strictly abide the MIPO technology.
3 Prognostic Factors of Cervical Cord Injury , Madougou S*, Lawson E1, Alihonou T, Chigblo P, Gbedinhessi C , Gandaho H, Hode L, and Hans-Moevi Akué A
Aim: Identify prognostic factors of management of cervical spinal cord injury in a low income country. Patients and method: This was a retrospective descriptive study which took place over 4 years and half, from 1st January 2010 to 30 June 2014. A correlation with statistical test has been searched between different variables: sex and clinical evolution, age and clinical evolution, injury circumstances and neurological achievement, admission delay and clinical evolution, operative delay and clinical evolution, tetraplegia and clinical evolution, sphincter disorders and clinical evolution. Epi-info version 3. 5. 1. has been used for statistical tests. Results: Women had clinical improvement in 72.7% and men in 56.5% with a statistically not significant difference (p=0.6053). Patients under 49 years old had a clinical improvement in more than 50% while patients of 50-59 years old have all presented an improvement with a statistically not significant difference (p=0.3665). 4 patients among 7 (57.1%) with a neurological improvement were victims of a public highway accident and 3 patients (42.9%) of work accident with a statistically not significant difference (p=0.4567). A clinical improvement was obtained in more than 50% of patients whatever is the admission delay with a statistically not significant difference (p= 0.4321). Clinical improvement concerned 15 patients (75%) among 20 patients with surgical management after 48 hours with a statistically significant difference (0.0029). 53.8% of patients with incomplete tetraplegia had a clinically improvement with a statistically significant difference (p=0.0378). Clinical improvement was achieved in 68.8% of patients without sphincter disorders against 48% in patients with sphincter disorders. Difference was statistically significant (p=0.0083) Conclusion: At the end of this study, there is a significant clinical improvement in patients with surgical management after 48 years, in patients with incomplete tetraplegia and patients without sphincter disorders.
4 Augmentative Locking Compression Plate Fixation for the Management of Subtrochanteric Non-Union after Intramedullary Nail Failure , Alfonso QL*
Subtrochanteric and inter trochanteric femoral non-unions in the case, situation of failed metalwork poses a challenging clinical problem. A small series of inter trochanteric with subtrochanteric extension non-unions presenting intramedullary nail failure, solved by removal of the broken nail, new intramedullary nailing, Judet decortications, autologous bone grafting and LCP augmentation plate, is reported. The surgical technique is described in this small clinical series, one case with an unexpected infection.
5 A Worsening Trend - Possum and NHFS in Patients with a Fractured Neck of Femur , Kapur B*, Shumon S and Platt 
With an aging population, an increasing number of patients are presenting with a fractured neck of femur (NOF) and concurrent multiple co-morbidities. Two scoring systems developed to predict morbidity; mortality and long-term outcomes are the Physiological and Operative Severity Score for enumeration of Mortality and morbidity score (POSSUM) and the Nottingham Hip Fracture Score (NHFS). Our study set out to identify the developing trends in patients presenting with a fractured NOF using the POSSUM score and NHFS. Data was retrospectively collected on all 139 patients operated on with a fractured neck of femur June and December 2011 and 2014. The results demonstrated a significant increase in both the POSSUM score and the NHFS between 2011 and 2014 (mean POSSUM score 35.39 vs. 40.19 respectively, P <0.001, 95% CI -6.94 to -2.65 and the mean NHFS 3.63 vs. 5.19 respectively, P <0.001, 95% CI -2.01 to -1.12). Our study demonstrated that patients presenting with a fractured NOF have worse physiological year on year. We believe that more research needs to be done to predict and prevent fractured NOF.
6 Smith-Petersen Osteotomy for the Treatment of Anderson Lesion with Kyphosis in Ankylosing Spondylitis:A Case Report and Literature Review , Liu C, Zhao Q, Wang L, Wang H and Xu H*
Andersson lesion (AL) is an uncommon manifestation of ankylosing spondylitis (AS) first described by Andersson in 1937. Few data are available on Anderson lesion in AS because of the lack of proper diagnostic criteria and the differences in the extent of spinal survey undertaken. Multiple types of surgery have been applied in the treatment for AL. However, the most effective and safe surgical procedure for AS-related symptomatic kyphosis is still controversial. We reported a case of surgical strategy with Smith-Petersen osteotomy (SPO) for AL-complicating with AS patient presenting severe kyphosis. The patient acquired excellent clinical results and returned to work without any physical complaints. The Smith-Petersen osteotomy (SPO) surgery may offer a useful choice for AL-complicating AS patients with severe kyphosis deformity
7 Radiodiagnostic Dilemmas of Telangiectic Osteosarcoma – A Case Report , Kumar P*, Bhattacharyya TD and Bhuyan N
The telangiectic osteosarcoma (TGS), an extremely lytic and hemorrhagic variant of the osteosarcoma, presents in the same age group and location as a classical osteosarcoma but has a radiographic appearance almost identical to that of an aggressive aneurismal bone cyst, making diagnosis more complex. Here we are reporting a rare case of biopsy proven telangiectic osteosarcoma in distal tibia of a 12 years old boy, who was misdiagnosed clinically as a case of aneurismal bone cyst
8 Single Stage Instead of Two-Stage Bilateral Total Knee Arthroplasty to Avoid Leg Length Discrepancy in Severe Varus Knee Deformity- Propose a Mathematical Model to Support the Hypothesis , Wong TH*
Single total knee arthroplasty (TKA) may be beneficial for its one admission, one anesthesia, cost reduction and faster recovery including shorter rehabilitation. However, controversial opinion against the idea for its higher complication rate, such as deep vein thrombosis and more blood loss. Limited discussion upon the point of leg length discrepancy (LLD) as a result of one side TKA in severe varus knee deformity. In this entity, single stage TKA may gain its significant beneficial effect to avoid LLD
9 Do Hip Joint Positioning Affects the Maximal Voluntary Contraction of Gluteus Maximus, Gluteus Medius, TFL and Sartorius Muscles? , Bernard J * , Beldame J , Lecuyer M, Poirier T, Brunel H, Guiffault P, Van Driessche S, Matsoukis J and Billuart F
Background: Functional and clinical benefits from mini invasive total hip arthroplasty (THA) are widely known. Although it relieves pain and improves quality of life, literature reveals that gait and posturographic parameters of patients undergoing THA do not reach those of the general population. An electromyography study of the hip muscles involved in the surgery (Gluteus Maximus, Gluteus Medius, TFL, Sartorius) could provide some information. But the literature in the field of electromyography assessment of muscles shows discordant methodologies. Purpose: The aim of this study was to develop a methodology to assess the maximal voluntary contraction (MVC) of Gluteus Maximus, Gluteus Medius, TFL, Sartorius muscle as a reference for normalization. Methods: 30 young asymptomatic subjects participated in the study. Each realized 8 maximal voluntary contractions of the hip muscles in various joint positions on 3 sessions. Results: Statistical analysis showed no difference between the 3 sessions, and between the hip positions for hip abductors as well as for hip flexors to assess the MVC. Conclusion: A single session and 1 test is enough to assess the MVC of hip abductors as well as for hip flexors.
10 Pediatric Monteggia Equivalent Type I Fracture , Kim WS*, Lee YS, and Eun DC
Monteggia fracture is a term used to describe a proximal ulna fracture accompanied by radial head dislocation. However in pediatrics, the incidence is rare and misdiagnosis as both of them alone occurs often. In our case, 6-year-old boy was visited to the emergency medical care center because of pain in his right elbow which had broke out after slipping down from a 70cm-high-block. On intial simple radiography, we noted an elbow sprain, that proved to be a misdiagnosis later and, we applied a long arm splint. After discharge, pain was lasted especially at the moment of supination and pronation of the wrist joint, so that led revisit. At the radiologic studies, ulnar bow sign was shown, and pediatric Monteggia equivalent type I fracture was diagnosed. On the result of the diagnosis, open reduction was performed after trying C-arm intensifier assisted closed reduction. The patient is followed up at outpatient clinic. There is no complication on range of motion or change on the morphology. Therefore, bewaring of not over looking Monteggia fracture on patient of ulnar fracture or radial head dislocation on pediatrics.
11 Compressive Mass of the Thearloop Revealing an Intramuscular Lipoma of the Short Abductor of the Thumb (A Case Report) , Rabhi I *, Marzouki A, Lahrach K and Boutayeb F
The lipoma of the thear louse is a rare lesion, which is often expressed by a tumor syndrome and signs of compression of the branches of the median nerve. Magnetic resonance imaging is the exam of choice to study the local extension of the tumor. The main differential diagnoses are median nerve lipofibroma and low grade liposarcoma.
12 The Treatment of Open Debridement to the Glenohumeral Joint Osteoarthritis , Niu F* , Gao Y, Lai W, Fu Q, Yin L1, Liu H, Tian T and Gao Y
Aim: To explore the effect of open debridement to the glenohumeral joint osteoarthritis. Methods:Open debridement was applied to treat 16 cases of glenohumeral joint osteoarthritis from March 2014 to June 2015. Results: Evaluation according to the Constant score was 68.95±16.78 compared with 32.35±14.78 before operation. Conclusion: Open debridement of shoulder joint was effective to the patients of glenohumeral joint osteoarthritis who can’t pay the fee of shoulder joint arthroplasty.
13 Interest of Open Surgical Treatment in Trigger Fingers Resistant to Corticosteroid Injections (About 20 Cases) , Naam A*, Marzouki A, Abdulrazak S, Alami BE, Lahrach K and Boutayeb F
Background: The aim of this study is to draw up the epidemiological profile of our patients, to estimate our results of the open resection of A-1 pulley and to show the interest of the surgical treatment in trigger fingers which are resistant to corticosteroid injections. Methods: It is a retrospective study made through the analysis of 20 exploitable files among several cases of trigger fingers, between January 2003 and October 2015. We included in our study patients aged of more than 18 years old, having symptoms dating of 6 months at least, and who have already benefited from at least one corticosteroid injection. Results: All our patients benefited initially from one or two injections. The use of surgery was indicated in the persistence of symptoms. The criteria of evaluation included the size of the skin incision, the pain, the residual symptoms, the satisfaction and the complications. The opening of the pulley A1 was done in all the patient cases, coupled with the premature active and passive mobilization, this was successful in all cases with satisfying Quick DASH score achieved after 3 months and 6 months postoperatively. Conclusion: The resection of A-1 pulley gives good results with an unimportant rate of complications and the surgical indication seems to be accepted when the symptoms persist after medical treatment by corticosteroid injection.
14 Non Union of Fracture of the Neck of Femur in Young Adult , Goel SC* and Gupta A
Non union is the most common complication of fracture neck of femur. Fracture of the neck of the femur has multiple factors leading to difficulties in union. Both biological and mechanical parameters contribute to the development of union complications. On biological side the lack of cambium layer of the periosteum of femoral neck and the presence of synovial fluid at the fracture site inhibit fracture union. Poor bone quality also plays a part. Mechanical parameters include the amount of vertical inclination of the fracture line, quality of reduction, stability of fixation and integrity of the posterior cortex [1]. These mechanical factors lead to an unstable fracture. Poor implant placement after fixtion contributes further to nonunion.
15 Ancient Non-union of the Radius Treated According to Watson Jones , Essekkal M*, Admi M, Marzouki A and Boutayeb F
Large boned efects in the forearm pose a challenging reconstruction problem, especially when the condition has become chronic. The Watson Jones technique is a relatively simple procedure that sacrifices pronationsupination, but allows the forearm to be used in everyday life.
16 Pain Management Techniques in Hip and Knee Arthroplasty: A Review of Literature , Diwakar M*
Adequate control of postoperative pain following hip and knee arthroplasty can be a challenging task [1,2]. Previous studies have shown that over 50% of patients undergoing surgery report postoperative pain as a major concern [3] .Inadequate control of pain may result in patient dissatisfaction, impaired patient rehabilitation, and prolonged hospitalizations [3]. The negative influence of postoperative pain on rehabilitation is particularly concerning for patients undergoing joint replacement. Functional recovery and return of muscle strength is dependent on the ability of these patients to comply with rehabilitation. The drawbacks of inadequate rehabilitation are especially cumbersome in hip and knee surgeries, since faster mobilization leads to quicker discharge from the hospital. Furthermore, studies have shown that recovery from knee arthroplasty is prolonged up to 50 days postoperatively, far greater than recovery from hip replacement [4]. Pain control is especially important for knee arthroplasty patients to allow recovery of range of motion and muscle strength for ambulation [5].
17 Sub-Talar Dislocation Neglected (About a Case) , Elbardai M*, Admi M, Essekal M and Boutayeb F
The sub talar or peri-astragalian dislocation is a loss of the anatomical relations between the astragales, calcaneum and scaphoid. The congruity of the tibioperoneo-astragales joint is maintained. It is a rare lesion that accounts for 1% of all dislocations. Internal variety is by far the most frequent
18 Simultaneous Dislocation of the Interphalangeal and Carpometacarpal Joints of the Thumb , Elbardai M*, Admi M, Essekal M and Boutayeb F
It is rare to encounter cases of simultaneous dislocations of two joints of a finger. We report a case of simultaneous dislocation of the interphalangeal and carpo-metacarpal of an inch with a normal metacarpophalangeal joint.
19 Neglected Humeral Fracture Revealing Bone Hydatic Cyst , El bardai M*, Essekkal M, Mamai O, Marzouki A and Boutayeb F
Bone hydatidosisis rare, his diagnose is often late because of its insidious evolution. CT scan and IRM provide a diagnostic and a preoperative extension assessment. Treatment is based on the association: surgery, hypertonic serum and albendazole. Here, we describe a unique case of one bone hydatic cyst for a patient who had been suffering from Neglected humeral fracture.
20 Bilateral Ischiofemoral Impingement: A Case Report and Literature Review , Chao DONG, Andrej M Nowakowski and Andreas H Krieg*
Background: Ischiofemoral Impingement (IFI) is rare disease and more common in females than in males. It is characterized by hip and groin pain with abnormalities of the quadratus femoris muscle. The narrowing of ischiofemoral space (IFS) and quadratus femrois space (QFS) are the main causes. It is easy to be missed diagnosis in daily clinical works. Case Report: We report the case of a 16 years old girl without trauma, pain in the right hip region only under loading. In MRI there exist an obvious narrowing IFS and QFS with edema in quadratus femoris muscle. The measurement of the neck-shaft angles is also greater than normal. Conclusions: IFS should be paid more attention when the hip or groin pain occurred. MRI is the best methods for the diagnosis of the IFI. The main treatments include conservative treatment, operation treatment and steroid injection but no ideal one. Further study should be taken to find a better treatment of IFI.
21 Outcomes and Complications of Intertrochanteric Fractures Treated with Trochanteric Fixation Nail: A Study of 138 Patients , Singh AK* , Narsaria N and Gupta RK
Background: The aim of this prospective study was to evaluate outcomes and complications of patients with intertrochanteric fractures treated with trochanteric fixation nail. Materials and Methods: 138 patients with intertrochanteric fractures were treated with trochanteric fixation nail from June 2011 to May 2014. There were 80 male patients and 58 females. There were 70 cases of AO type 31-A1 fractures, 32 fractures were type 31-A2 and 36 cases were type 31-A3. Union time, union rate, time to weight bearing, complications was recorded. The overall patient outcomes were summarized based on the Harris Hip Scoring system. Results: Average time needed to do TFN fixation was 48.2 ± 10.2 minutes (range 39-74 minutes). Per-operative blood loss was 150 ± 74 ml (range 80-300 ml). Of the 138 patients, 125 patients achieved union uneventfully. The mean union time was 4.4 ± 1.3 months (range 3-7months). Nonunion occurred in 13 cases. Conclusions: For intertrochanteric fractures fixation, trochanteric fixation nail is an effective implant in providing early mobilisation and weight bearing with comparable complication rate.
22 Primary Subcutaneous Hydatid Cyst Of The Elbow: An Exceptional Location , Admi M*, Elbardai M, Marzouki A and Boutayeb F
Hydatid disease in humans is an endemic zoonotic infestation caused by the larval form of Echinococcus species. The most commonly afflicted organs are the liver and lungs, but any tissue other than hair, nails and teeth may be involved. However the involvement of soft parts is exceptionnal, especially subcutaneous location.
23 Bone Involvement in Classic and Agressive Kaposi Sarcoma , Admi M*, Hassani I, Jellali A, Elhassani A, Lahrach K and Boutayeb F
Kaposi sarcoma (KS) is an endothelial proliferation described for the first time by moritz kaposi in 1872. It is commonly associated with human herpes virus 8 (HHV8) and human immunodeficiency virus (HIV). Skin and mucous membranes are the most common sites. Osseous involvement in kaposi sarcoma is rare and occurs either by direct spread of mucocutaneous lesions or through dissemination. There are 4 different variants of KS including : African (endemic) KS, classic KS, acquired immune deficiency syndrome (AIDS)-related (epidemic) KS, and transplantation (or immunosuppression)-associated KS.
24 Clinical Efficacy of Platelet-Rich Plasma on Allograft Transplantation after Core Decompression for Osteonecrosis of the Femoral Head , Baek S and Chung SH*
Purpose: This study explored the outcomes and clinical use of autologous, platelet-rich plasma (PRP) infusion after allograft bone transplantation for osteonecrosis of the femoral head (ONFH) by comparing the time to bone fusion and clinical symptoms. Method and Materials: From January 2008 to June 2015, 36 patients with a follow-up of at least 12 months were enrolled. 18 who underwent autologous PRP infusion after allograft bone transplantation were compared with 18 who underwent allograft bone transplantation only. Changes in pain and activities of daily living were assessed by a visual analog scale (VAS), the Harris Hip Score (HHS) and the time to bone fusion respectively, to evaluate differences between the two groups. Results: The VAS scores of patients who underwent autologous, PRP infusion was significantly improved compared to patients who did not undergo autologous, PRP infusion at post-operative 3 months(From 7.44 to 3.28 in PRP/ From 7.06 to 5.67 without PRP), but not at post-operative 12 months(From 7.44 to 6.95 / From 7.06 to 7.00). The HHS which showed no significant difference between groups(75 / 76). The mean time to bone fusion was 3.0 months (range, 1.5 to 5.7 months) in PRP group and 5.5 months (4.0 to 8.0 months) in without PRP group. Conclusion: Autologous, PRP infusion after allograft bone transplantation of core decompression for ONFH can promote bone fusion and initially produces effective pain control. However, the natural progression of disease, including femoral epiphyseal depression or osteonecrosis of the femoral head, is unlikely to be affected.
25 Does Lumbar Spondylosis Save the Spine From steoporosis? A Cross Sectional Study on 104 Postmenopausal Women , Omidi-Kashani F, Mirfeizi Z, Ariamanesh AS, Hasani M1, Parsa A and Madani MEM
Objective: Osteoporosis (OP) and osteoarthritis (OA) are two musculoskeletal disorders commonly affect older population. We aim to investigate the possible relationship may be present between OA and OP in the area of lumbar spine. Methods: This cross-sectional study was carried out on postmenopausal female patients complaining of chronic low back pain (LBP) more than three months who were referred to our orthopedic clinic. At first, demographic data were collected. Bone Mineral Density (BMD) in the lumbar region was calculated and the patients were divided into three categories: normal, osteopenia and osteoporosis. The severity of OA was divided into five grades (from 0 to 4) based on Kellgren / Lawrence (KL) system. Body mass index (BMI) was also calculated. Finally the data entered into computer and statistical analysis was performed to achieve the desired goals. The correlation between age, BMI, and lumbar T score with grade of OA was evaluated using spearman test. Results: The test results showed that grade of OA is significantly correlated with age and BMI. There was a significant positive correlation between grade of OA and lumbar T score. Lumbar T score had a significant negative correlation with age and a significant positive correlation with BMI. Conclusions: This study showed that the grades of lumbar OA and lumbar T score in postmenopausal women are in positive significant correlation. In other words, there was a significant and negative correlation between the grade of OA and OP.
26 Isolated Palmaire Luxation of the Base of the Fifth Metacarpian in a Boxer , Rabhi I *, Marzouki A, Lahrach K and Boutayeb F
The post-traumatic dislocation of the fifth finger is a rare lesion. In the absence of treatment, this lesion results in joint degeneration and instability. This lesion is usually unstable, treated by open, Closed. We report the case of a carpalmetacarpal dislocation isolated palmar pure in a boxer, clinically the patient presented a disturbance of rotation of 15° with a shortening of 5 mm. The standard radio graphy showed a palmar dislocation of the base of the 5th Metacarpal with a diastasis between the 4th and 5th metacarpal. The patient was treated with a parallel insertion of the M5M4M3 after reduction of the dislocation with closed focus and immobilization plastered for 45 days.
27 Outcomes and Complications of Nonunion of Humeral Shaft Fractures Treated with Locked Compression Plate: A Prospective Study , Singh AK*, Singh V and Chaurasia RK
Background: Management of nonunion of humeral shaft fractures are difficult. This study was conducted to evaluate outcomes and complications of these cases treated with locking compression plate (LCP) and autogenous bone grafting. Materials and Methods: Twenty-four patients of non-union of humeral diaphyseal fractures were included in this study. Fracture ends were freshened, reduced, fixed with locking compression plate and auto iliac bone grafting was done in all the cases. Clinico-radiological assessments were done for each case at each follow-up visit. Time to fracture union, union rate, functional outcome and complication such as infection, malunion, delayed union, implant failure and joint stiffness were recorded. Modified Constant and Murley Scoring was used to assess functional outcome of the fracture fixation. Results: The mean fracture union time was 16.4 ± 5.8 weeks (range 10–48 weeks). This study had 100% union rate. After assessing modified Constant and Murley scoring, 10 cases had excellent functional outcome, 9 had good and 5 had fair functional outcome. The mean Constant and Murley score was 18.74 in the preoperative period (range 0-34) and 81.20 (range 38-98) at the time of final followup. The range of motion at shoulder joint was excellent in 20 and moderate in 4 cases, and the range of motion at the elbow joint was excellent in 22 and moderate in 2 cases. Conclusion: This study concludes that LCP is a good implant to treat cases of non-union of humeral shaft fractures with good functional outcomes and acceptable rate of complications.
28 Monteggia Equivalents: Report of a New Variant of Type ISalter Harris Type One Injury to Proximal Radius Physis and Olecronon Fracture , Jangir R*
Introduction: Monteggia fracture dislocation in a child is relatively uncommon injury consisting approximately 1.5%– 3% of the elbow injuries in the childhood. Case Presentation: A unique case of a type 1 Monteggia fracture equivalent Fracture of olecronon with Salter-Harris type I physeal injury to proximal radius physis with in a child is reported. We describe the management of this unique fracture and discuss mechanism of injury. Conclusion: This case is a rare combination of injuries. Early recognition and prompt surgical intervention can lead to a satisfactory outcome even in these complex injuries. Fracture of olecronon with Salter-Harris type I physeal injury to proximal radius physis should be included in the current type I Monteggia equivalents. Key Message: The universal principle of examining one joint above and below and including both joints when taking radiographs for suspected long bone fractures must always be followed.
29 Tranexamic Acid in Total Knee Replacement Reduces Wound Complication and Transfusion Rates; An Observational Study , Harry S*
Background and Aims Tranexamic Acid (TXA) has been shown to reduce transfusion rates in Total Knee Replacement (TKR) without complication. We undertook a cohort study investigating TXA use with TKR, wound complication and transfusion rate. We added intravenous TXA to our standardised TKR protocol for 6 months of a 12-month study period, with no other changes during this time. Methods All patients undergoing primary TKR over the 12-month study period were identified. Notes and online records were reviewed to collate details including demographics, wound complication, blood transfusion, length of stay, and haemoglobin levels. All study patients received a Columbus navigated TKR, and routine thromboembolic and antibiotic prophylaxis. Results 124 patients were included, 72 receiving TXA. A significant change in wound complication was noted; 15% of patients (n=11) of the TXA group had a wound complication, with 40% of patients (n=21) in the control group (p = 0.003). All four patients requiring a blood transfusion were in the control group (p = 0.029). There was no diagnosed pulmonary embolusor mortality. Conclusion In our unit we have demonstrated a significantly lower transfusion rate, wound complication rate and length of stay, without any significant increase in thromboembolic disease with the use of TXA in TKR.
30 Carpo-Metacarpal Dorsal Dislocation of the Fourth and Fifth Fingers in a Skier (A Case Report) , Rabhi I*, Marzouki A, Lahrach K and Boutayeb F
The carpometacarpal dislocations are rare injuries. The authors report two cases of dorsal carpometacarpal joint dislocations of the ulnar two fingers, treated by closed reduction and fixation with percutaneous Kirschner-wires. A plaster splint with the wrist in neutral position was applied for six weeks. Active physiotherapy of the fingers was started from four weeks after surgery, with a satisfactory result.
31 Transient Synovitis of Hip Joint in Childhood , Gharaibeh A*, Lacko M, Ahmed AWA and Vaško G
Objective: Transient synovitis the most common cause of acute hip pain in children aged 4-8 years. The aim of the study is to determine the prevalence of hip joint pain in childhood based on a retrospective analysis. Methodology: This is retrospective study. We’ve analysed patient records with certain diagnosis during 2012 at the UNLP Paediatrics Orthopaedic and trauma Clinics in Kosice, Slovakia. We’ve examined 5523 paediatric patients. 73 patients found with hip pain. Outcomes were measured and analysed over one year. Data analysis of the results was processed using the statistical functions of Microsoft Excel. Results: During 2012, at the paediatric Orthopedic Clinic in Košice, we examined a total number of 5523 patients with various musculoskeletal problems. 73 patients during one year hip joint pain was found. In 37 cases (51%) were transient synovitis of hip diagnosed, in 13 cases (18%) a soft tissue injury to the hip joint was found, in 9 cases (12%) Legg- Calve-Perthes disease was diagnosed, in 8 patients (11%) septic arthritis of the hip was found, in 5 patients (7%) fracture of the proximal part of Femur was detected and one patient was diagnosed as malignant Tumour (1%). 46 patients were treated as outpatient and 27 patients were hospitalized. Conclusion: Transient synovitis of the hip joint is the most common cause of hemorrhage and sore throat in childhood, with occurrence between the 3rd and 6th year of age. The patient recovers usually between 7 to 10 days. Treatment of choice is resting and administration of non-steroidal anti-inflammatory drugs. Antibiotics are not indicated.
32 Complications after De Quervain’s Disease Surgery , Federico A*
Surgical treatment of De Quervain improves symptoms, obtains good and quickly results with a local anesthesia procedure. Allows almost early return to work with few restrictions. It can provide complete pain and functional recovery and may offer a long-term solution. But it has a relative large number of complications, according to a review of the literature into 9 to 24 % of the cases. On this study we analyse the surgery complications in a randomized series of 20 patients treated by the same surgeon and with the same surgical technique (transverse skin incision and tenolysis). In conclusions the surgery of De Quervain’s disease is a simple, safety and reliable technique but with a lot complications, particular the sensory branch of the radial nerve damage.
33 Dry Arthroscopy of the Shoulder: A Technical Tip for the Beginner to Shoulder Arthroscopy , Aydin N*, Kocaoglu B, Tok O and Guven O
Backround: Most of the shoulder pathologies can be treated by shoulder arthroscopy. The major problem for the surgeon who has just started the shoulder arthroscopy is the difficulty of finding the joint in the first attempt. This results with uncontrolled fluid leakage to the surrounding soft tissues. Especially in obese patients this condition prolonges the operation duration. To prevent this, the following procedure is recommended. Methods: The technique can be summarized as follows: i. after entering from the posterior portal; the arthroscope is placed on to the three way canula, however the joint is not filled with fluid. ii. An injector is used to inject air from the canula. iii. Pumping the air makes the joint more visible and after dry dioagnostic arthroscopy the fluid can be pumped. Results: This technique enables the surgeon to fill the joint after being sure that the canula is in the joint to prevent unconrolled fluid extravasation. By this procedure the natural view of the joint can also be seen. A diagnostic arthroscopy can easily been done. Discussion and conclusion: We recommend this technique in the first 10 shoulder arthroscopy of the new starter surgeon. It is suggested to apply classical procedures after gaining considerable experience. But the technique can be used for dry diagnostic shoulder arthroscopy also by an experienced surgeon. Level of Evidence: Level V
34 Internal Fixation of Sacroiliac Joint via Posterior Approach in Management of Posterior Pelvic Injuries , Tarek A* and Osama A
Object: Sacroiliac dislocation frequently poses a complex problem for the surgical management and stabilization because of the anatomical and biomechanical factors of this transition zone between the spine and pelvis. The authors had used a modification of the Galveston technique, originally described by Allen and Ferguson in the treatment of scoliosis, to achieve rigid spinal-pelvic fixation in patient’s sacroiliac dislocation with vertical and rotational shear. Methods: Twelve patients who had required spinal-pelvic fixation secondary to sacroiliac dislocation and instability fixation was achieved by intraoperative placement of S1 pedicle screws and contoured titanium rods bilaterally into the ilium. Results: During the follow-up period of18 to 36 months (average 26 months), Postoperative posterior fracture reduction was excellent in 9 patients (75%), good in 2 (17%) and fair in 1 patient (8%) (7). Conclusion: The combined use of S1 pedicle screws and the Galveston technique provided immediate stability and sufficient reduction of sacroiliac dislocation
35 Arthritis Research in India: A Scientometric Assessment of Publications Output during 2007-16 , Gupta BM*, Ahmed KKM and Gupta R
The paper examines 3064 Indian publications on arthritis research, as covered in Scopus database during 2007-16, experiencing an annual average growth rate of 7.12% and qualitative citation impact averaged to 8.92 citations per paper. India’s share in global output was 3.54% during 2007-16, which increased from 2.96% to 4.09% from 2007-11 to 2012-16. Top 12 most productive countries in arthritis research accounted for 83.27% global publication share during 2007-16, which increased to 82.67% to 83.82% from 2007-11 to 2012-16. The top 12 most productive countries in arthritis research individually contributed global share from 2.69% to 26.29% with largest global publication share coming from USA (26.29), U.K. (10.02% share), Germany, Japan, Italy and France (from 5.16% to 6.72%), Netherlands, China and Canada (from 4.37% to 4.81%), Spain, India and Australia (from 2.69% to 3.77%) during 2007-16.The international collaborative share of India’s publications in arthritis research was 10.77% during 2007-16, which increased from 10.38% to 11.04% from 2007-11 to 2012-16. Medicine, among subjects contributed the highest publications share (66.09%) in India’s output followed by pharmacology, toxicology & pharmaceutics (33.09%), biochemistry, genetics & molecular biology (17.43%), immunology & microbiology (10.18%) and chemistry (3.36%) during 2007-16. Rheumatoid arthritis, among different types of arthritis, contributed the largest share of 49.35%, followed by adjuvant arthritis (10.70%), tuberculosis arthritis (8.39%), osteoarthritis (7.96%), bacterial arthritis (7.83%), lupus arthritis (7.64%), juvenile arthritis (7.60%), psoriatic arthritis (3.85%), hand arthritis (2.84%), polyarthritis (2.81%), gout arthritis (2.74%) and septic arthritis (2.20%) during 2007-16. The top 15 most productive organizations and authors together contributed 27.02% and 13.71% respectively as their share of global publication output and 44.76% and 17.36% respectively as their share of global citation output during 2007-16. Among the total journal output of 3021 papers (98.06% of total output), the top 15 journals contributed 27.61% share to the global journal output during 2007-16 which decreased from 27.94% to 27.38% from 2007-11 and 2012-16. Of the total arthritisresearch output, the top 25highly cited publications registered citations from 100 to 1112 and they together received 6410 citations, with 256.4 citations per paper. These 25 highly cited papers were published in 22 journals, of which 4 papers were published in The Lancet and 1 paper each in other journals
36 Unrecognised Inflammatory Arthritis with Joint Destruction , Evija S*, Helena M, Janis A and Dace V
Rheumatoid arthritis (RA) is the most common and serious form of inflammatory arthritis. Untreated it results in joint destruction and functional impairment. A clinical evaluation remains the cornerstone for evaluating early arthritis; determining whether arthritis is present or not, differentiating between the inflammatory or non-inflammatory disease, and deciding on the aetiology of the arthropathy [1]. Articular symptoms may be the presenting manifestations of many infectious, inflammatory or malignant conditions. There are certain difficulties in making an accurate diagnosis of rheumatoid arthritis in its early stages, a principal problem being the fact that its most defining feature is chronicity, which, by definition, takes time to identify [2]. After 2010 the ACR – EULAR RA classification criteria for RA have been implemented (This criteria set has been approved by the American College of Rheumatology (ACR) Board of Directors and the European League Against Rheumatism (EULAR) Executive Committee), identifying patients with a relatively short period of symptoms who would benefit from early diagnosis, has become more easier, giving practical value towards the commencement of early effective treatment, thus preventing the adverse sequelae of the disease [3].
37 Percutaneous Transforaminal Endoscopic Decompression for Lumbar Foraminal Stenosis , Yung-Ha W*, Heung-Tae J, In-Bo K, Woo-Seong S and DongWook J
Background: Several different techniques exist to address the pain and disability caused by isolated nerve root impingement. Failure to adequately decompress the lumbar foramen may lead to failed back surgery syndrome. However, aggressive treatment often causes spinal instability or may require fusion for satisfactory results. We describe a novel technique for decompression of the lumbar nerve root and demonstrate its effectiveness in relief of radicular symptoms. Materials & Methods: Percutaneous transforaminal endoscopic decompression was performed by removal of the herniated disc in patients with lumbar foraminal stenosis. 91 patients underwent the procedure from 2003 to 2015. Those who demonstrated neurogenic claudication without spinal instability or central canal stenosis and failed conservative management were eligible for the procedure. These patients were followed for an average of 39 months to evaluate outcomes. Results: The results were excellent in 50 patients, good in 39, and fair in 2. There were no surgery-related complications. Lateral lumbar spine flexion–extension radiography was performed in all patients at various times ranging from 3 to 48 months after the surgery, and no evidence of postoperative spinal instability was found. Conclusions: Percutaneous transforaminal endoscopic decompression is an effective means to decompress the lumbar nerve root foramen without causing spinal instability.
38 Total Hip Arthroplasty in Patient with Sickled Cell Trait Ss: The Cases of 14 Patients , Kinkpe CVA*, Niane MM1, Porgo A, Bonkian G2 Gueye AB, Daffe M, Kesenge J, Traore MM, Ndoye GF and Sy MM
Osteo-articular complications of sickle cell disease are multiple but mostly dominated by epiphyseal aseptic necrosis. Conservative at the beginning, the surgical treatment becomes radical in the last stage with the performance of a total hip arthroplasty (THA). We report the case of total hip arthroplastyin a patient with sickle cell traitSSat Ordre de Malte Hospital (CHOM) in Dakar, focusing on the peri-operative complications encountered in this particular case in order to prevent them or to treat them if necessary. This is a retrospective, mono-centric study including 15 total hip arthroplasty (THA) performed in 14 SS sickle cell patients over a 66-month period. The postero-lateral Moore mini open approach was used exclusively. The clinical evaluation was based on the Aubigné Postel-Merle (PMA) and Harris (HHS) scores and the radiographic score on the Ficat and Arlet classification. The corticodiaphyseal index as well as the Noble flare index channel made it possible to appreciate the medullary congestion and the shape of the femur. All together, THA in Sickle Cell Disease represented 7.57% of all hip prosthetic activity during the period. The average age of patients (10 women and 4 men) was 29.06 years (18-50). The overall functional result was good and very good in 77% of cases. We observed 4 femoral fissures, an early vesicular lithiasis infection with psoas syndrome and acetabular loosening in the same patient and one death at 5 days postoperatively.
39 A Case of Pott’s Disease under the Occipital Area , Kinkpe CVA*, Niane MM, Gueye AB, Lamah L, Traore MM, Ndoye GF, Coulibaly NF and Diop AN
Pott's disease of the cervico-occipital hinge is an exceptional and serious condition due to the risk of bulbo-medullary compression. The authors present a case of sub-occipital tuberculosis in a 19-year-old patient with progressive and sequential tetraplegia. The MRI which guided our diagnosis showed lytic images at the top of the tooth with an abscess overhanging it and compressing the bulb. The positive diagnosis was confirmed by tuberculin intradermoreaction and Genexpert. As an emergency, we have administered a bolus of corticosteroid and then anti-tuberculous chemotherapy for 9 months. Subsequently we made a posterior lacing C1-C2. The evolution was favorable with the disappearance of the neurological disorders. This type of lesion requires an accurate diagnosis for appropriate care.
40 Mosaicplasty in Osteochondritis Dissecans of Femoral Condyles about 8 cases , Niane MM1*, Kinkpe CVA Kesenge J Gueye AB Daffe M Porgo A and Bonkian G
Introduction: Osteochondritis dissecans of the femoral condyles is a subchondral bone necrosis, rare, more or less extended. The osteochondral fragmentation that results from it is responsible for very invalid pain and joint dysfunction. The aim of this work is to evaluate the clinical, radiological and evolutionary aspects of patients operated for osteochondritis dissecans of the femoral condyles by the technique of mosaicplasty at Order of Malta’s Hospital Center in Dakar CHOM. Patients and method: This is a retrospective, single-center study over a period of 67 months, involving 8 patients (6 men and 2 women). The average age was 25 years and the average BMI 22.93. Standard radiography has been performed in all our patients. 2 patients had MRI and 1 patientdid a CT. The collected data were the time of care, the IKDC score, the ICRS score and the Hughston / SFA score. The following characteristics of the lesion - the surface and the location - were also studied. Intraoperatively, the number and diameter of the pads, the location of the donor site and the associated operative procedures were recorded. At last follow-up, patients were assessed according to the Hughston functional and radiological scores, and IKDC. All the patients were immobilized for 6 weeks and benefited from the re-education sessions. Results: At an average follow-up of 36.5 months, the subjective results of the patients were very satisfactory in 62.5% of the cases and the clinical results according to the IKDC were excellent. Healing of osteochondral lesions was achieved in all our patients and 75% were in stage IV according to the radiological Hughston score.
41 Early Coverage of Gustilo Type 3b Fractures in Lower 1/3rd Leg Defects , Shree H*
Gustilo 3b injury accounts for a big bulk of cases which are reconstructed in any tertiary care centre with a joint effort of Plastic Surgeons and the orthopaedics team. Once the patient is stabilised, the plastic surgery team looks into the severity of soft tissue injury. The qualitative and quantitative defect is assessed under anaesthesia. Necessary radiological investigations are done and the orthopedician is consulted upon to plan the bony fixation.
42 The Functional Outcome of Four-in-One Technique: Dorsal Closing-Wedge & Shortening Osteotomy, Debridement, Micro-Fracture in the Treatment of Freiberg’s Disease , Balasubramanian B*, Maripuri SN, Kotecha A, Brahmabhat P, Kanakaraj K and Nathdwarawala Y
Introduction: Osteochondritis dissecans of the femoral condyles is a subchondral bone necrosis, rare, more or less extended. The osteochondral fragmentation that results from it is responsible for very invalid pain and joint dysfunction. The aim of this work is to evaluate the clinical, radiological and evolutionary aspects of patients operated for osteochondritis dissecans of the femoral condyles by the technique of mosaicplasty at Order of Malta’s Hospital Center in Dakar CHOM. Patients and Method: This is a retrospective, single-center study over a period of 67 months, involving 8 patients (6 men and 2 women). The average age was 25 years and the average BMI 22.93. Standard radiography has been performed in all our patients. 2 patients had MRI and 1 patient did a CT. The collected data were the time of care, the IKDC score, the ICRS score and the Hughston / SFA score. The following characteristics of the lesion - the surface and the location - were also studied. Intraoperatively, the number and diameter of the pads, the location of the donor site and the associated operative procedures were recorded. At last follow-up, patients were assessed according to the Hughston functional and radiological scores, and IKDC. All the patients were immobilized for 6 weeks and benefited from the re-education sessions. Results: At an average follow-up of 36.5 months, the subjective results of the patients were very satisfactory in 62.5% of the cases and the clinical results according to the IKDC were excellent. Healing of osteochondral lesions was achieved in all our patients and 75% were in stage IV according to the radiological Hughston score.
43 Patient Satisfaction after Primary Knee Arthroplasty in Indian Scenario , Pal CP* and Yajuvendra KS
Introduction: Arthritis is one of the leading causes of disability in India and Osteoarthritis (OA) is the most common type of arthritis found in Indian population. Total knee arthroplasty reliably reduces pain and improves health-related quality of life. Dissatisfaction still remains in some patients even after excellent results. The purpose of this study was to assess muscle strength, range of motion (ROM), and functional performance of patients prospectively from before to after TKA. Research method: This was a prospective cohort study of twenty three patients undergoing TKA, evaluated at 2 weeks preoperatively, as well as at 1, 3, and 6 months postoperatively. Patients were evaluated by WOMAC score and a question for satisfaction: How much satisfied he/she is with his arthroplasty? Answer was asked in dissatisfied, neutral, satisfied at follow up at 6 months. Results: The mean WOMAC score was better after 6 months postoperatively from preoperatively. Out of twenty three, 78.26% (18) were satisfied, 17.40 % (4) were neutral and 4.34(1) was dissatisfied. Discussion: TKA has been shown to be safe and effective in addressing end-stage osteoarthritis of the knee. But not all patients are satisfied after this procedure. Various studies have noted that only 82–89% patients express satisfaction. According to our study patient satisfaction after primary total knee arthroplasty was 78.26% and a significant improvement in WOMAC score
44 Arthroscopic Sutures of the External and Internal Meniscus at Ordre De Malte Hospital in Dakar: The Case of 13 Patients , Kinkpe CVA*, Niane MM, Bonkian G, Gueye AB, Daffe M, Porgo A,Traore MM and Kesenge J
Introduction: The management of traumatic lesions of the menisci is an up to date topic. The treatment has for long remained mutilating and the evolution towards osteoarthritis inevitable. In the light of the original work, important progress has been noted, which now allows conservative arthroscopic treatment in about 20% of cases. The scarcity of data in the West African literature on this topic and the need for a retrospective look at such a treatment which has been practiced at Ordre de Malte Hospital since 2012, motivate this study. Material and Method: This is a retrospective study from 2012 to 2015. A series of 13 meniscal sutures or 10.5% of 124 lesions explored and treated arthroscopically. This exclusive male series whose mean age is 28 years (20 - 49) was followed with a average follow-up of 38 months (23 - 62). Results: The average consultation time was 2 years and for 11 times (85%) the lesion had occurred following an accident during sport, of a contact + / pivot type . The lesions being found 11 times on the right, 9 times on the medial meniscus, 10 times on the posterior segment, and 9 times on the average segment. It was a bucket handle in 9 cases including 4 dislocated cases. The suture was performed "from outside to inside" and was made stable with an average of 2 points with Prolene 2/0. In 3 cases, this suture was associated with ACL DIDT Ligamentoplasty. We noted as complications: a case of intraoperative failure that led to partial regulation, an early superficial infection of the operative site and a thromboembolic event that had evolved well under treatment. At the last follow-up, 11 patients were satisfied or very satisfied compared to 2 disappointed. The average Lysholm score was 94.7 / 100 with 12 good or excellent results; the IKS score was 100% in all patients and the average knee IKS was 95.6 / 100. IKDC clinical evaluation of 10 patients seen at last follow-up reported 07 patients ranked "A" and 03 ranked "B". Anatomically, the MRI and the Arthro-CT foundevidence of partial scarring. 9 patients resumed sport, and 4 of them claimed to have achieved their previous performance. Conclusion: The functional results encourage the continuation of this activity with equipment enabling internal reparations.
45 Osteoporosis Research in India: A Scientometric Assessment of Publications Output During 2007-16 , Gupta BM, Mueen Ahmad KK and Ritu G*
The paper examines 1001 Indian publications on osteoporosis research, as covered in Scopus database during 2007-16, registering an annual average growth rate of 12.50%, qualitative citation impact averaged to 1097 citations per paper and international collaborative publication share of 12.59%. The top 17 most productive countries individually contributed global share from 1.80% to 26.97%, with largest global publication share coming from USA (26.97%), followed by U.K. (8.43%), China and Germany (6.72% and 6.23%), etc. Together, the 17 most productive countries accounted for 91.46% share of global publication output during 2007-16. Medicine, among subjects, accounted for the highest publications share (70.23%), followed by biochemistry, genetics & molecular biology (26.37%) and pharmacology, toxicology & pharmaceutics (23.88%) during 2007-16. The top 15 most productive organizations and authors together contributed 38.26% and 27.17% respectively as their share of global publication output and 43.01% and 51.07% respectively as their share of global citation output during 2007-16. Among the total journal output of 976 papers, the top 15 journals contributed 26.23% share to the Indian journal output during 2007-16.
46 Outcome of Intra-Articular Fractures of the Distal End of the Radius Managed Using Volar Variable Angle Locking Plate , Gupta RK, Arora S*, Gogna P, Govil V, Garg A and Neogi AK
Background: Distal radius fractures are one of the most common fractures of human skeleton. Despite advances in management of these fractures a consensus regarding the best treatment protocol is still lacking. Methods: This prospective study involved 20 patients (13 males; 7 females) who presented with fractures of distal end radius. There were three B3 (29%), six C1 (35.5%) & eleven C2 (9.7%) fractures according to AO classification system. The mean age was 36.39 years and the mean follow up was 2.4 years. At the time of final evaluation outcome was assessed as per Gartland and Werley scoring system. Statistical assessment was done using Chi-square test and p values were obtained at final follow up. Results: All fractures healed within a mean period of 10 weeks ranging from 8 to 14 weeks. At the time of final follow up pronation were 81.380, supination 86.340 degrees, palmar flexion 58.030, dorsiflexion 61.930, radial deviation 19.210& ulnar deviation 31.320. Radiological parameters as measured at final evaluation were: volar tilt 5.76 degrees, radial inclination 19.10 degrees & ulnar variance -0.42 mm. As per Gartland and Werley score, 85% had excellent outcome, 5% good, 5% fair and 5% had poor outcome. Two patients had complications, one complained of screw impingement for which implant removal was done at 12 months after surgery while other patient developed Sudeck’s osteodystrophy which was managed conservatively. Conclusion: Variable angle locking plate is a reliable implant associated with good outcome in intra-articular fractures of the distal end of the radius
47 A Prospective Diagnostic Study Evaluating the Prevalence of Vitamin D Deficiency and Insufficiency in a Cohort of Orthopaedic Trauma Patients , Sourabh C*
Vitamin D deficiency is very common in both developed and developing countries. This study was conducted to estimate the prevalence of vitamin D deficiency and insufficiency in orthopedic trauma patients and subsequently make recommendations about vitamin D supplementation in them. A prospective diagnostic study was conducted including orthopedic trauma patients within the age range of 21-50 years, between January 1, 2014 and June 30, 2017. All the patients were subjected to estimation of blood 25-hydroxyvitamin D levels. Vitamin D deficiency was defined as a 25- hydroxyvitamin D level less than 20 ng/mL and insufficiency was defined as a level between 20 and 30 ng/ml. 613 patients were tested for blood 25-hydroxyvitamin D levels. It was observed that vitamin D deficiency and insufficiency had an overall prevalence of 45.5% and 35.4%, respectively, in the orthopedic trauma patients. Overall deficiency prevalence in males and females was 44.3% and 47%, respectively. Most commonly affected patients belonged to age groups >36 years, while younger patients had lower prevalence of deficiency or insufficiency. Vitamin D deficiency and insufficiency were highly prevalent in this large population of orthopedic trauma patients. Vitamin D is an essential component of calcium metabolism and subsequently its adequate levels are important for bone healing. Establishing the prevalence of vitamin D deficiency and insufficiency can help in making adequate supplementation of vitamin D in orthopedic trauma patients.
48 Humeral Neck Fractures in Association with Traumatic Shoulder Dislocation , Sherif MA, Ahmed NM and Ramy AD*
Purpose: To evaluate the clinical and radiological outcomes of the open surgical management of concomitant neck humeral fractures and anterior glenohumeral dislocation with greater tuberosity fractures. Materials and methods: Twenty eight anterior shoulder dislocations with greater tuberosity fracture in 28 patients were reviewed retrospectively. Out of them, 9 patients were found to have associated humeral neck fractures (OTA/AO 11-B3). Management of these patients consisted of open reduction and prophylactic fixation of the surgical neck fractures with proximal humeral plate. Results: Radiographic analysis included fracture reduction, stability of the fixation construct, and achievement of bony union and assessment of the femoral head avascular necrosis occurrence. Clinical outcomes were assessed by the shoulder range of motion, the presence of persistent shoulder pain and the occurrence of any post-operative complication that would necessitate intervention or deviation from the ordinary follow up. After a mean follow up of 19 months post-operative; all the patients achieved bony union of the fracture with good clinical outcomes. None of the cases developed humeral head avascular necrosis. Satisfactory clinical results have been obtained in all of the nine cases. Conclusions: Early recognition of associated humeral neck fractures in patients with anterior shoulder dislocation and greater tuberosity fracture can minimize the incidence of iatrogenic fracture displacement. ORIF may offer a reasonable treatment option for such cases with lower incidence of complications.
49 A Balance between Art and Principle in Management Complex Femur Fracture , Gunaseelan P* and Hishamuddin S
Complex fractures of proximal and distal femur often difficult to treat. Plating of segmental femoral shaft fractures is also an option, particularly when associated with peritrochanteric fractures, but associated complications. Although technically difficult, intramedullary nailing has been recommended by several studies and has demonstrated good results. The purpose of this review was to analyse our results with the interlocked nailing of complex fractures of the femur.
50 Ankylosing Pelvitrochanteric Heterotopic Ossification in a Patient with Spinal Tuberculosis , Gunaseelan P*, Aishah N and Hishamuddin S
Heterotopic ossification (HO) is defined as the presence of lamellar bone at locations where bone normally does not exist. This syndrome is most commonly seen following neurological disorders such as traumatic brain or spinal cord injury, or following joint surgery or severe burns. Patients with neurogenic HO develop lesions around larger joints. The hip is the most common location, followed by the knees and elbows but complete ankylosis is a rare presentation. Radiation therapy, surgical resection, biphosphonates and various non-steroidal anti-inflammatory drugs (NSAIDs) have been reported and advocated as efficacious methods for management of HO. We report a case of ankylosing pelvitrochanteric HO in a patient with spinal tuberculosis (TB) treated successfully with surgical excision, postoperative radiation therapy and indomethacin.
51 Medial Epicondyle Fractures of Humerus in Children at the University Teaching Hospital of Yopougon , Claude MJ*, Baptiste YX, Thierry OK, Atafi D, Bertin K, Ossenou O, Anoma DS and Ruffin D
The purpose of this study is to evaluate the results of surgical treatment of medial epicondyle fractures in children. Patients and Methods: A retrospective study of 17 children was performed in the Pediatric Surgery Department at the Yopougon Hospital and University Center between January 2004 and December 2014. Children aged 3 to 15 years treated surgically for a fracture of medial epicondyle and had regular postoperative follow-up of more than three months were included. The average age was 11 years old. Fractures were divided according to the Marion and Faysse classification: stage II (n = 5), stage III (n = 3), stage IV (n = 9). We evaluated postoperative complications and sequelae. The evaluation of the functional results was based on the criteria of Hardacre. Results: The functional results were studied with a mean follow-up of 8 months. We found 70% good and very good results, 18% average results and 12% poor results. Postoperative complications were observed n = 3 (17.6%) of the cases. It was an operative wound infection n = 2 (11.7%), iatrogenic nerve damage n = 1 (5.9%). Sequelae were represented n = 3 (17.6%). This was an n = 2 elbow mobility deficit (11.7%) and the epitrochlear n = 1 protrusion (5.9%). Conclusion: Medial epicondyle fracture outcomes are associated with a relatively low rate of complications. It is important to stress the importance of prolonged surveillance because of the functional and morphological sequelae that they may cause.
52 Low Incidence of Secondary Hemorrhage after Single Level Lumbar Decompression , Wigram M and Winking M*
Secondary hemorrhage is a complication which can develop after spine surgery. To prevent progressive neurological deficit caused by an expanding hematoma, drains are inserted to build an outflow for the trickling blood. Minimally invasive spine surgery reduces local tissue damage and associated complications. In a prospective follow up study 882 patients receiving lumbar single level decompression surgery were assessed for a postoperative hemorrhage. Patients undergoing single level decompression for degenerative spinal stenosis and / or lumbar disk herniation were included. Three out of 882 patients (0.34%) developed a secondary hemorrhage with the indication for revision surgery. Second surgery was done on the same day in one case and after 5 and 8 days in the two other patients, respectively. In all patients persisting sciatic pain was the main indication. Increasing neurological deficit was observed in one patient immediately after surgery. Secondary hemorrhage is a rare complication after minimally invasive lumbar spine surgery. Even without inserting any drainage system the rate for compression related neurological deficit is very low
53 Anomalous Origin and Course of the Posterior Circumflex Humeral Artery: Clinical Interest in Shoulder Arthroscopy and Open Procedures , Miguel-Pérez M*, Rosa M Mirapeix, Albert Pérez-Bellmunt, Roberto Seijas, Laura Cuni, Mónica Buxeda and Andrés Combalia
The posterior circumflex humeral artery usually cross the quadrilateral space with the axillary nerve but there are variations as this case, that artery runs down this space. We study this artery and its relations in order to advice to injury it during surgical and invasive procedures such as shoulder arthroscopy and also prevent vascular repercussions. An embryological and clinical explanation is also considered.
54 ACL Reconstruction: “Technical Advancement Leading to Improved Patient Outcome and Return to Sports in Athletes” , Rajat J*
Years ago Anterior cruciate Ligament (ACL) was a career ending injury in Elite athletes, with advances in technology, surgical procedure, and rehabilitation an Elite athlte has an excellent chance of returning to high qulality sports participation.
55 Mortality and Morbidity Associated with Periprosthetic Fracture after Total Knee Replacement , Faimali M, Karuppiah SV*, Hassan S, Swamy G, Badhe N and Geutjens G
Background: Periprosthetic fractures following total knee arthroplasty are a devastating consequence of an otherwise successful procedure. With an ageing population and extension of total knee arthroplasty to older patients, the rate of these fractures will continue to rise. The purpose of this study was to observe the mortality and morbidity associated with surgical treatment after periprosthetic fracture of total knee replacement. Methods: We retrospectively identified all patients that were admitted to two institutes with a periprosthetic fracture of total knee arthroplasty over a period of five years. Forty five patients underwent operative stabilization (23males and 22 females): by retrograde nailing (n=9), plate fixation (n=32) and 4 revision total knee arthroplasties. Results: Of the 45 patients, there were 20 fractures united within one year of surgery (average 4.8 range 2 to 11months), there was 3 required further surgery for non union (1 following plating and 2 following retrograde nailing). 9 patients died within 6 months of surgery (7 with 4 weeks of surgery). Conclusion: There is a high mortality associated with periprosthetic surgery in the elderly. There was a higher non union rate with retrograde nailing then plating in this group of patients.
56 “Cubital Tunnel Syndrome Due to Ganglion Associated with Ulnar Neuropathy”: A Case Report , Tarun C*, Dheenadhayalan J and Rajasekaran S 
We report a case of ulnar neuropathy by a ganglion in the cubital tunnel. A 52 year old male presented in our OPD with tingling and numbness over medial side of left hand and left 4th and 5th fingers since 2 months which increased on prolonged flexion and during night time. On clinical examination there was wasting of both ulnar forearm and hypothenar muscles with thickening of ulnar nerve and tenderness at medial aspect of elbow and decreased hand grip .CARD test and EGAWA test positive and FROMENT sign present. X-ray of left elbow (AP and Lateral View) showed osteophytes at ulno-humeral joint. During surgery a 2-cm diameter ganglion arising from ulno-humeral joint compressing the ulnar nerve was identified. Ganglion cyst excised and ulnar nerve was transposed anteriorly. Biopsy of the material confirmed it as a ganglion. Patient recovered satisfactorily 3 months after the surgery
57 Prevalence of Low Back Pain in Pregnant Women and the Associated Risk Factors , Gharaibeh A*, Al Wadiya A, Qdhah E, Khadrawi M, Abu Slaih A and Qaoud Y
Objective: This study aimed to compare and analyse prevalence of low back pain during pregnancy. We looked into the risk factors, impact on everyday life and estimate the severity of the problem in major maternity and childhood centers in Jordan. Design: This is a cross-sectional study that was performed on pregnant women attending prenatal care and various maternity and childhood centers. They have been asked to fill a structured and authored questioner about lower back pain. Results: The study was conducted on 408 pregnant women. These women attended the three largest maternity and childhood centers in Jordan. 310 pregnant women had lower back pain (76%) and 98 pregnant women (24%) (P<0.01) had no pain. Higher age, post term date, high BMI and long working hours are statistically significant criteria for the back pain symptoms in pregnant women. Conclusions: The results show that lower back pain during pregnancy is a common problem in this population. Low back pain causes sleep disturbances and mood swings in pregnant women.
58 Lateral Condyle Fracture Dislocation of the Elbow Joint in an Adult: A Rare Case Report , Sanjay A* and Vijayvargiya M
Fracture dislocation of the humeral condyle is very rare in adults. There are only two published studies in the world literature demonstratingsuch injury. Plan of management for this injury is still not well defined. We report a case of fracture dislocation of lateral humeral condyle with gross comminution of the condyle, in a 64 year old lady. The severity of the comminution rendered the recreation of the normal anatomy difficult and non-reconstructable. Therefore, to replicate normal anatomy, an en-bloc iliac bone graft was used, which was refashionedto fill the defect. To our knowledge, this is the first reported case in the literature demonstrating use of a refashioned iliac graft in a case of Fracture-dislocation of elbow in an adult patient.
59 omparison between the Effect of Clindamycin after Open Reduction Internal Fixation in Jaws and in Limbs , Gharaibeh M, Al wadiya A and Gharaibeh A*
Clindamycin is one of the most important antibiotics used against bone infections, in this study we tried to reveal if there is difference between clindamycin effect after open reduction internal fixation (ORIF) in upper and lower jaw operations and the clindamycin effect in open reduction internal fixation (ORIF) of the upper and lower limb bones operations, and to know if the presence of anaerobic bacteria in the oral cavity make any difference of this drug effect comparing with elsewhere bones. We prepared retrospective study about 260 in-patients during the last 10 years, 130 of them after open reduction internal fixation in limb bones and 130 patients after open reduction and internal fixation ORIF in maxillofacial region, given I.V. Clindamycin. There is no significant difference in the effectiveness of clindamycin in the presence of anaerobic bacteria or not, and clindamycin is the drug of choice in prevention against bone infections after open reduction surgery in the orthopedic and maxillofacial purposes which is agreeing with other studies.
60 Intermuscular Hydatid Cyst Isolated from the Arm , Talal G*, Saudi F, Ouazzani N, Fekhaoui MR, Boufetal M, Reda-Allah B and Saleh Berrada M
Hydatid disease is an infestation caused by Echinococcus granulosus, which is still widespread in temperate zone countries. The muscoloskeletal localisation is extremely rare and represents a major challenge for surgeons because there are few cases reported in the literaturel. We report a case of a 30-year-old man with no medical antecedants, living in a rural area with a primary hydatid cyst located in the intermuscular space front of the arm.
61 Outcome Measures in Spine Surgery: How Far Can we Go Building Evidence? , Relvas H*, Fernandes O and Oliveira R
There is an imperative need to alleviate the actual and predictably harder burden of spine disorders and particularly the share due to chronic nonspecific low back pain, both at the individual and community-based viewpoint. Studies on global health trends charge a relevant part of the onus to the proposed invasive procedures, raising concern over its inappropriately high and growing use, counteracting clinical guidelines recommendation of a prudent selection of patients, based on clear-cut indications. Part of this gap between evidence and practice stands from questionable assumptions regarding the usefulness of surgery. Uncertainty on relative benefits and harms in the face of increased risk of adverse events, or the higher costs and health care resources involved, results in controversial decision-making to plan the intervention. Improvement of knowledge about these questions can be provided by the inclusion in the research agenda of comprehensive and standardized evaluation of outcomes after spine surgery. Such a protocol procedure would enable future systematic reviews to perform a consistent meta-analysis of data from trials, mandatory for high-quality evidence gathering. Outcome evaluation requires both subjective and objective assessments. This review aims to clarify the role of outcome measures in support of the need to build reliable information on the effectiveness of surgical treatment of spinal disorders.
62 Treatment of Ankylosis in Children Associated with Osteogenic Distraction: Literature Review and Case Report , Michelle FF, Ian Luna PB, João LC* and Andrea DD
Introduction: Temporomandibular joint ankylosis is defined as a bone or fibrous adhesion of the anatomical joint and its components in the glenoid fossa, and it is accompanied by limited mouth opening, causing difficulties in chewing, speaking and oral hygiene, which may influence mandibular growth. This condition in children may or may not be associated with a disease, syndrome or trauma. Method: To review the literature on the treatment of ATM ankylosis associated with micrognathia in children with osteogenic distraction, and to report two clinical cases of children with unilateral or bilateral ankylosis with mandibular micrognathia. Methods: To present a broad research on the etiology, risk factors and complications of this condition as the options of treatments for the ankylosis of TMJ in children by Buccomaxillofacial Surgery treated with gap arthroplasty surgery without interposition of materials, with the installation of osteogenic distractors for the correction of mandibular deformities. Results: The cases presented here continue to be treated and monitored since their development is not yet complete, but the procedures performed are successful without presenting recurrences so far. Conclusions: Osteogenic distraction is one of the treatments that can treat ankylosis in children with success. However, the successful treatment of children with TMJ ankylosis with dentofacial deformities is slow and prolonged, and the earlier it is initiated, the greater the success of treatment completion, always depending on the joint work of a multidisciplinary team, as well as family support and patient collaboration.
63 Trace Elements in Young Field Hockey Players and Fencers , Rylova NV*, Zholinsky AV and Sereda AP
Active physical exercises are associated with high body mineral demand that can cause mineral disbalances with diverse negative health outcomes. The purpose of this study is to examine the impact of sport-related factors on mineral composition in young athletes. Saliva and hair samples were chosen for the analysis as reflecting immediate and more permanent mineral status, respectively. The samples were analyzed by spectral methods with inductively coupled plasma for eight essential minerals: calcium (Ca), chromium (Cr), iron (Fe), potassium (K), magnesium (Mg), selenium (Se), and zinc (Zn). The results from athletes were compared to ones from the control group of adolescent non-athletes. Different minerals demonstrated sampling specific distribution. Sport type specificity of mineral content was found. These findings can help in the process of mineral status data standardization and in training process to correct the sport-associated mineral disbalances.
64 Pubic Osteomyelitis after Treatment for Prostate Cancer A Case Report and Review of the Literature , Els Van Nieuwenhuyse*, Bart Kerens and Paul Vanderschot
Osteomyelitis pubis is a known, rare complication related with the treatment of prostate cancer. It can occur after surgery, radiotherapy and after ultrasound therapy. The latency between the treatment modality and the onset of the osteomyelitis is different for all treatment options. Symptoms are mostly subtle and non-specific, causing a delay in the diagnosis. For the diagnostic work-up, clinical examination, laboratory tests and medical imaging are necessary. The irrevocable diagnosis will be made by culture of a bone aspirate. Treatments consist of antibiotic therapy and surgery. The medical condition of the patient and the location of the infection determine the type and extent of the surgical modality
65 Post-Traumatic Hip with Obturator Dislocation: Case Report and Review of the Literature , Mehdi Omar K*, Amine A, Mounir R, Allah Bassir R, Boufettal M, Kharmaz M, My Omar L, Ouadghiri M, Ahmed El Bardouni, Mahfoud M and Saleh Berrada M
Introduction: Traumatic dislocation of the coxofemoral joint is defined as the permanent posterior or anterior displacement of the femoral head out of the acetabular cavity. It is generally the consequence of a violent trauma, most often an accident on the public road. our case it is a post-traumatic hip obturator dislocation, managed in our department. Clinical case and results: 16 years old patient, with no particular history, victim of a road accident, causing a closed trauma to his left hip, right ankle and left wrist. It presents with a vicious attitude: left lower limb in flexion, abduction, external rotation. An X-ray requested objective obturator dislocation with a small bone fragment of the head. A bone reconstruction CT was completed in favour of obturator dislocation with head fracture type 1 according to Pipkin's classification. Patient sent directly to the block, he benefits from a reduction under sedation according to Boehler's maneuver, control by scopy, then immoblisation by zimmer splint after testing the stability of dislocation. Patient is hospitalized in our ward for monitoring then follow-up in consultation. Results were satisfactory, removal of the zimmer splint at the 6th week. Total support was possible at week 12, with complete mobility, patient reviewed afterworld without clinico-radiological signs of aseptic necrosis of the femoral-head. Conclusion: The fracture-luxation of the femoral head is a serious lesion. It is necessary to think about it in front of each dislocation not to ignore the associated fracture which still darkens the prognosis.
66 Effect of Biofield Energy Treatment on Bone Cell Proliferation and Differentiation for the Assessment of its Potential to Improve Bone Health , Trivedi D1, Trivedi MK, Alice Branton, Nayak G and Jana S*
The bone health is an important part of healthy-life and longevity in general. The present study was investigated to see the effect of the Biofield Energy Healing (The Trivedi Effect®) on the human bone osteosarcoma cells - MG-63 (ATCC® CRL-1427™) for the assessment of bone cell proliferation and differentiation in vitro. The study parameters were assessed using cell viability by MTT, collagen synthesis, and alkaline phosphatase (ALP) on bone health using ELISA-based assay. The cell viability assay data showed significant response in all the tested groups; while in the Biofield Energy Treated group supplemented with 10% charcoal-dextran treated fetal bovine serum (CD-FBS) (G3) showed better response (increased 63%) in terms of cells proliferation compared to the untreated cell group (G1). The level of ALP was increased by 32% in the G3 group compared to the untreated cells group (G1). Additionally, the level of collagen synthesis was increased by 27% in the G3 group compared to the G1 group. The overall results demonstrated that the Biofield Energy Treatment has the potential for bone mineralization and bone growth as evident via increased levels of collagen and ALP. Therefore, the Biofield Energy Healing (The Trivedi Effect®) Treatment might be useful as a bone health promoter for various bone-related disorders like low bone density, osteogenesis imperfecta, and osteoporosis.
67 Rheumatic Diseases and Musculoskeletal Disorders in Kyrgyz Republic , Nazgul A Omurzakova*
At present, the musculoskeletal disorders (MSDs) and rheumatic diseases (RD) concern to one of the most prevalent pathologies in a modern society. These diseases essentially reduce quality of a life, lead to a significant expenditure of resources on public health services and negatively influence national economy of countries
68 Assessment of Surgical Treatment and Long-Term Follow-up Results of Extremity Liposarcomas: A Single Center Experience , Kaya V, Yilmaz S, Atalay IB* and Gungor BS
Background: The aim of this study was to determine the clinical and histological features, management strategy, treatment outcomes, and mortality rates of patients who underwent surgery due to extremity liposarcoma (LPS) in our center. Methods: The study included patients whom underwent surgery due to extremity LPS in a tertiary oncology center, between January 2002 and December 2014. The data were obtained from the hospital records. Age, gender, lesion localization, tumor size, histopathological analyses, surgical techniques, adjuvant treatments, local recurrence rates, and mortality were noted. Results: A total of 103 patients (54 males, 49 females) with a mean age of 52.4 years (min-max 19-80 years) were included. The mean follow up period was 57.7 months. Swelling was the most common symptom (97%). The thigh and gluteal region were the most commonly involved localizations. Mxyoid/round cell and well-differentiated LPSs were the two most commonly seen subtypes (57.2% and 17.6%, respectively). Extremity salvage surgery was performed in 96 (93.2%) cases. Adjuvant treatment was applied to 99 (96.1%) patients. Infection, drop foot, or hematoma was seen in 17 patients. Recurrence was seen in 18 patients (17.4), and mean recurrence time was 17 months. The recurrence rate was higher in myxoid/round shaped LPSs. The 5 and 10-year survival rates were 94.1% and 87.3%, respectively. Conclusion: When planning the management, factors such as surgical margin, tumor grade, age of the patient, size of the tumor, histopathological type, and localization should be considered. It should be noted once again that bone and soft tissue tumors should be treated in specialized institutions with experienced and adequate staff and equipment
69 Rheumatic Fever Arthritis , Hasina C*
On the occasion of the World Arthritis Awareness Month from 12th-27th October 2018, it is an honor for me to share my experience regarding rheumatic fever arthritis. Rheumatic fever (RF) is a multisystem disease which post-streptococcal sequelae of pharyngitis.It is an autoimmune reaction to the M-proteins in the cell wall of few strains of the organism. It may attack the connective tissue of various systems of the body. 
70 Prevalence of Calcaneal Fractures in Our Hospital in Central Europe , Gharaibeh A*, Gharaibeh M, Al wadiya A, Stolfa S and Lacko M
Objective: To analyse the epidemiology of patients suffering calcaneal fractures. Methods: This is a retrospective study of patients with calcaneal fractures hospitalized in the teaching department of Orthopaedics and Traumatology and in central between 2014 and 2018. Results: The work presented retrospective study to evaluate the Incidence of calcaneal fractures in NSP UNLP hospital. We retrospectively studied 15787 patients with bony fractures in our hospital and trauma clinic in emergency department from 1.1.2014 to 31.12.2018, from our records, 156 patients had calcaneal fracture (1%). Conclusion: The research revealed a rare incidence of calcaneus fracture, affecting men 4 times more than women due to nature of work and daily activities. Calcaneal fracture is common cause of disability. The results of this study are expected to contribute to providing an information base that helps planners and decision makers in developing appropriate strategies to deal with safety at work site.
71 Polyostotic Fibrous Dysplasia in a Child with Bone Fractures and Neuropsychiatric Symptoms, Case Report , Hala A Al Shaikh*
Fibrous dysplasia of the bone in children is a rare, genetic, heterogeneous disorder, associated with extra-skeletal manifestations in the McCune Albright Syndrome. It results from a post-zygotic activating mutation in the (GNAS) gene coding for (Gs alfa) protein. This leads to replacement of the lamellar bone with under-mineralized fibrous tissue, presenting clinically with limping, pain, and pathological fractures. Objective: To demonstrate the clinical course, challenges and treatment of a child with polyostotic fibrous dysplasia presenting with limping, extra skeletal manifestations, neuropsychiatric symptoms and bone fractures. Method: The clinical information and lab results were obtained directly from the mother and the computerized medical records at the treating hospitals. Genetic analysis was done at Washington University School of Medicine, USA. Informed publication consent was obtained from the parents. Results: The child presented at the age of 3years with limping and was found to have polyostotic fibrous dysplasia and café au lait spot. Later on, he developed neurological symptoms. He had bone fractures in the proximal femur, requiring surgical intervention. Bone pain and frequency of fractures improved after Zoledronate injections. Blood genetic analysis of the GNAS-gene was negative. Conclusion: Polyostotic fibrous dysplasia is a rare cause of limping and recurrent pathological fractures in children. Medical treatment with Biphosphanate injections can positively affect the clinical course of the disease. A negative blood genetic analysis of the GNAS gene does not exclude the McCune Albright Syndrome, and indicates analysis from the affected tissue. Neuropsychiatric symptoms may manifest with fibrous dysplasia without any endocrine involvement.
72 Giant Cell Tumors of the Tendon Sheath of the First Finger , Boufettal M, Grimi T*, Bassir RA, Kharmaz M, Lamrani MO, Mahfoud M, Bardouni A, Bjijou Y and Berrada MS
Giant cell tumors of the tendon sheath of the hand present a very rare entity, only two percent of all reported Giant cell tumors are found in the hand, several hypotheses were formulated about the etiological factors of these tumors, but still there is not a common opinion on etiology, prognostic factors and recurrence rate. We report a rare case of giant cell tumour of the tendon sheath the second finger in 55-year-old women, which was treated with extended curettage. After one year of follow-up, the patient was asymptomatic with complete functional recovery and no signs of recurrence.
73 Bilateral Anterior Fracture-Dislocation of Shoulder Following Electrocution: About a Rare Case and Review of the Literature , Badreddine D*, Mohamed B, Malika A, Adil L, Reda O, Mansour T and Abdeloihab J
Bilateral anterior dislocation of the shoulders associated with a bilateral fracture of the greater tuberosity is an extremely rare lesion. We reported a case of bilateral dislocation of the shoulder following an electrocution received and operated on in the Traumatology Orthopaedics I department of the Mohamed V Military Training Hospital in Rabat. The diagnosis was clinical as confirmed by radiological investigations; the patient received surgical treatment after failure of orthopaedic treatment, a bloody reduction in dislocation and osteosynthesis of the greater tuberosity of both shoulders. An evolution was marked by a satisfactory functional recovery of both shoulders. Even clinical examination can help to suspect dislocation, but x-rays are mandatory for an accurate and early diagnosis. Surgery is recommended for unreduced dislocations or displaced fractures; orthopaedic treatment is indicated in non-displaced fractures subsequent functional rehabilitation allows results after surgical and non-surgical treatment
74 Allied Disorders and Complications of Rheumatoid Arthritis - A Statistical Comorbidity Study of 234 Autopsy Patients , Bely M* and Apathy A
Objective: The incidence of co-morbidities is higher in rheumatoid arthritis (RA) than in the general population. Associated diseases accompanying RA may modify the clinical course and symptoms of RA and may influence the prevalence and mortality of complications related to the basic diseases and vica versa. The aim of this study was to determine statistically the possible effect of certain allied disorders: type 2 diabetes mellitus (DM), atherosclerosis (Ath), hypertension (HT), tuberculosis (Tb) with miliary dissemination (mTb), and malignant tumours (mTu) on the prevalence and mortality of RA related complications: systemic autoimmune vasculitis (AV), AA amyloidosis (AAa), lethal cardiac insufficiency (CI) caused by endo-, myo- or pancarditis, with or without interstitial pneumonitis, furthermore lethal septic infection (SI) combined with septic vasculitis (SV) or purulent arthritis (PA) Patients and Methods: Twohundred thirty four (234) non- selected autopsy patients with RA were studied. RA was confirmed clinically according to the criteria of the American College of Rheumatology (ACR). The presence of DM, Ath, HT, Tb, mTb, or mTu was determined and analyzed retrospectively, reviewing the clinical and pathological reports. The prevalence and mortality of AV, AAa, CI, SI, SV and PA was determined at autopsy and confirmed by a detailed review of extensive histological material. Demographics of different patient cohorts were compared with the Student (Welch) tprobe. The link between Ath, HT, DM, Tb, mTb, or mTu and AV, AAa, CI, SI, SV or PA was analyzed by Pearson's chisquared (χ2) test. Results: RA associated with DM in 41 (17.52%), with severe Ath in 107 (45.72%), with HT in 41 (17.52%), with with Tb in 28 (11.96%), including active disseminated mTb in 9 (3.85%), and with mTu in 27 (11.54%) of 234 patients. RA was complicated by AV in 43 (18.38 %), by AAa in 48 (20.51%), by CI in 15 (6.41%), and by lethal SI in 33 (14.10%) of 234 patients. SI was combined with PA in 15 (6.41% of 234; 45.45% of 33) or with SV in 7 (2.99% of 234; 21.21% of 33) patients; PA or SV did not occur without generalized SI. The relationship between Ath and AV, AV (lethal), AAa, AAa(lethal), CI, SI, PA or SV was consequently inverse and mostly significant. There was a positive and significant correlation between Tb or mTb and AV, furthermore between mTb and mortality of AV. Discussion and Conclusions: The consequently inverse and (in most cases) significant correlation between atherosclerosis and autoimmune vasculitis, amyloidosis or sepsis shows that the prevalence or mortality of AV, AAa and SI was not influenced by Ath. RA patients with Ath may represent a special group, characterized by lower incidence of SV, AAa, SI, CI, and carry a better prognosis. Ath is basically an age-dependent phenomenon, characteristically present in RA patients with advanced age, while AV, AAa (with or without lethal outcome) and SI are complications of RA, and characterize severe forms of disease, mostly in younger patients and with an earlier onset (without pronounced atherosclerosis). The positive and significant correlation between Tb or mTb and AV suggest a positive influence of Tb or mTb on the prevalence of vasculitis, e.g. the presence of Tb or endogenous exacerbation and miliary dissemination of Tb may promote the AV. The significant connection between mTb and mortality of AV indicates an increased risk of lethal outcome.
75 Upper Limb Non-Traumatic Affections in a Rural Tertiary Health Care Center , NS Dhaniwala*
Introduction: Non-traumatic upper limb disorders are not uncommon. These may range from non-specific myalgia & fibro-fasciitis to specific disorders of joints and bones of the upper limb bones. Frequent key board use is also becoming a new etiologic factor. Material & Methods: The present prospective study was done in rural tertiary health care facility on admitted cases having upper limb non-traumatic disorders. Their pre -treatment functional status was assessed using 20 items Upper Extremity Function Index (UEFI) developed by Stanford PW et al. The data was analyzed to find the frequency of various disorders. Observations & Results: Out of total 41 cases, male female ratio was 2.7:1. The maximum patients 19 (46.34%) were in the age group 02 to 20 years and the least 02 (4.87%) > than 60 years. The maximum cases, 20 (48.78%) were of bone tumors, benign in 16 cases and malignant in 04 cases. Other pathologies noted were, rotator cuff injury, tuberculosis, peri-arthritis shoulder, tennis elbow, nerve involvement, avascular necrosis of Lunate, inflammatory arthritis and De Quervain’s disease. As per the Upper Extremity Functional Index, the scores ranged from 0 to 80. The minimum scores were seen in patients having gross neurological deficit in upper limb.
76 The Computer Assisted Rehabilitation Environment (CAREN): A Commentary , Abdelmegeed M*
The Computer Assisted Rehabilitation Environment (CAREN) is a virtual reality (VR)-based system that was developed by the Dutch company Motek Medical (Motekforce Link, Amsterdam, Netherlands) and has been used by clinicians for evaluation and treatment of various musculoskeletal, neurological, vestibular conditions
77 Does the Overhead Squat Assessment is needed as a Movement Screening Method in Health Care Practice , Senthil P*
Globally, the incidence of musculoskeletal dysfunction and its related movement impairment have been extremely raised in varying population. If this movement impairment is not identified earlier with proper musculoskeletal screening, it will leads to recurrent complaint of musculoskeletal system and thereby muscle fatigue and lesser productivity. There are many movement screening methods which has been practiced in the health sector. But the overhead squat assessment is the simple and time-effective key assessments for an indication of gross movement quality.
78 Patellar Sleeve Fracture: What You Need to Know About , Rafik Y* and Tobenna JO
The patella develops as an aggregation of the deeper three –fifths of the quadriceps substance. The patella is thus an intramuscular element which has secondarily acquired a free articular surface [
79 Bisphosphonates in Postmenopausal Women with Osteoporosis to Prevent Future Fractures , Bashir I* and Rahman Z
Postmenopausal women who have osteoporosis are at increased risk of future fractures. Bisphosphonates are drugs that are used to treat osteoporosis by acting on the osteoclasts to inhibit bone resorption. Several studies have shown that bisphosphonates can maintain or even increase bone mineral density in osteoporosis patients. This review study analyzed the literature on clinical experiments with bisphosphonate therapy in postmenopausal women to determine if these drugs are efficacious in preventing future fractures. Four out of five studies found that women treated with bisphosphonates were at decreased risk of future fractures, and six of six studies found that bisphosphonate therapy increases bone mineral density relative to placebo control. Although further work is warranted to understand the level of bone mineral density increase that is associated with fracture prevention, this study implies that bisphosphonate therapy can be used to help prevent future fractures in postmenopausal osteoporotic women. The study is significant in that it helps to underscore the efficacy of bisphosphonate therapy in postmenopausal women, and it may be generalizable to other populations with osteoposrosis who are at increased risk of fractures.
80 Posterıor Interosseous Nerve Syndrome Caused by Intramuscular Lipoma: A Rare Case of Radial Neuropathy , Atalay IB*, Yapar A, Öztürk R, Seyhoglu CandGüngör BS
Lipomas are common benign soft tissue neoplasms that occur usually in subcutaneous tissue. In rare instances they can occur in the deep soft tissue such as intramuscular and parosteal sites. When an intramuscular lipoma occurring in the proximal forearm or adjacent to the proximal radius they can compress the posterior interosseous branch of radial nerve and cause paralysis of posterior interosseous nerve. In this report we describe an unusual case of a 55-year-old man with posterior interosseous nerve syndrome caused by quite small intramuscular lipoma.
81 Kahler's Disease Revealed by a Fracture of the Humeral Diaphysis , Dehayni B*, Amarir M, Zaddoug O, El Nouali, Benchakroune M, Zine A, Tanane M and Jaafar A
Kahler's disease or multiple myeloma is a malignant hematological pathology, characterized by the malignant proliferation of plasma cells. Reporting a case of a humeral shaft fracture in a non-traumatic context that revealed Kahler's disease during paraclinical investigations. Management involves histological confirmation of the pathology, osteosynthesis of the fracture by static centromedullary nailing, with medical treatment made of biphosphonate combined with a chemotherapy protocol targeting the disease. The management of a pathological fracture is a diagnostic emergency, but never an operating emergency. A diagnosis of certainty must be made before any intervention.
82 Prevalence of Paediatric Fractures in Teaching Department of Orthopaedics and Musculoskeletal Trauma in Eastern Slovakia during the Year 2018 , Gharaibeh A* and Al Wadyia A
Objective: To determine the prevalence of different fractures among paediatric age 0-19 years in teaching department of orthopaedics and musculoskeletal trauma during one year. Methods: We retrospectively evaluated all children younger than twenty years who presented to our institution with a new fractures or fractures combined with dislocations within the calendar year 2018. The main outcome measures were the annual fracture and dislocation incidence in our population in central Europe. Results: There were 783 paediatric patients with fractures or dislocations. 181 (26%) were with forearm fractures, 161 (23%) ankle and foot fractures, 145 (21%) hand fractures, 75 (11%) shoulder fractures, 32 (34%)elbow dislocations, 27 (28%) patellar dislocations (25), and (2) knee dislocation. Conclusion: Distal radius fractures and dislocated elbows are the most common fractures and dislocations among childhood (0-19 years) in our University Hospital.
83 The Inadequate Treatments for Patients before and after Osteoporotic Hip Fracture , Wong TH*
Hip fracture will count for a significant problem in the aging group in the near future. Although the fracture is always being considered unexpected, either the fracture itself or the complication of the fracture treatments, patients and medical personnel should aware of the so call unexpected fractures and complications are really preventable and predictable with careful alertness
84 Back Pain, Causes, Symptoms and Physiotherapy , Karski Tomasz*, Karski Jacek, Karska Klaudia, Ramirez Claudia, Kedzierski Zbigniew and Menet Honorata
Every fourth woman and every sixth man in the world coming to the Orthopedic or Neurology Departments complain of spinal pains - information from WHO, Decade of Bones and Joints 2000-2010 (Lars Lidgren). According to our observations there are six main causes of such spinal disorders: 1. Lumbar Hyperlordosis causes by flexion contracture of hips and in result anterior tilt of the pelvis. Common in persons with Minimal Brain Dysfunction (MBD). Pain syndromes appear after overstress in some kinds of jobs or in sport. 2. Lumbar or thoracic-lumbar left convex “C” scoliosis in 2nd/A etiopathological group (epg) or ”S” scoliosis in 2nd/B epg in Lublin classification. Pain syndromes appear after overstress in some kinds of jobs or in sport. 3. Stiffness of the spine as clinical sign of “I” scoliosis in 3rd epg group in Lublin classification. 4. Spondylolisthesis or spodylolisis in sacral-lumbar or lumbar spine. 5. Urgent “nucleus prolapsed” (in German “Hexen Schuss”). 6. Extremely cooling of the back part of trunk during work or intensive walking in low temperature. In many of patients in clinical examination we see positive Laseguae test. Sometimes we see weakness of extensors of the feet or paresis of the foot. Our observations confirm that not surgery, but physiotherapy can be beneficial to the patients with spinal problems.
85 Overview on Auto inflammatory Bone Disorders: From Pathogenesis to Clinical Manifestations , Marino A*
hronic Recurrent Multifocal Osteomyelitis (CRMO) is a rare disease occurring in childhood. It is characterized by insidious onset and variable clinical manifestations that may mimic infections or malignancies [1]. Since CRMO may be neither multifocal nor recurrent, some authors suggest replacing it with the term chronic nonbacterial osteomyelitis (CNO) that includes different disorders with sterile bone inflammation [2]. Synovitis, acne, pustulosis, hyperostosis and osteitis syndrome (SAPHO) is the adult form of CRMO with prominent skin manifestations
86 Arthrotomy and Lavage of Neonatal Septic Arthritis - A Multicenteric Study , Madhan J*, Naveen J, Eswar R and Raam Mohan S
Background: Acute septic arthritis (SA) of childhood is a potentially devastating disease that may cause permanent disability or even death, especially in resource-limited settings. Septic arthritis is rare in developed countries, the annual incidence being 4 cases per 1,00,000 but is considerably more common in lower socioeconomic groups. Objective: To study about the septic arthritis in neonates using arthrotomy & lavage and the complications associated with septic arthritis. Materials and Methods: A total of 319 neonates with septic arthritis irrespective of the joint involved, admitted to NICU in School of Medical Sciences and Research, Madras Medical College and Mohan Kumaramangalam Medical College for a period of three consecutive years were taken up for the study. All suspected cases of neonatal septic arthritis were subjected for detailed clinical history, examination, hematological and radiological investigations were done. All suspected cases were started with empirical or culture specific IV antibiotics for 2 weeks. The neonates who responded to the treatment given within 48 – 72 hours were treated conservatively and excluded from our study. The neonates who did not respond to the antibiotics given were subjected for arthrotomy and lavage of the affected joint. The aspirated material was sent for culture and sensitivity for specific antibiotic treatment. The treatment was given with culture specific IV antibiotics for a minimum period of 2 weeks followed by oral antibiotics for a period of 2 weeks from the time symptoms subsides. All cases were followed up at a monthly interval to a minimum period of 1 year of their age. Results: A total of 512 septic arthritis cases were seen in infants of whom 319 cases were neonates during the three year study period. The most common organism causing neonatal septic arthritis in our study was Staphylococcus aureus in 116 cases (36.36%). No organism was cultured in 81 cases (25.39%). Viral or fungal or anaerobes or reactive arthritis might be responsible for this 25.39% cases. Concomitant osteomyelitis was found in 5 cases in hip % 1 casein knee. Tomsmith arthritis of hip was found in 2 cases. Mild joint stiffness were found in 7 cases in hip, 3 cases in knee, 1 case in shoulder and 1 case in ankle seen at follow up. After discharge gentle passive joint motion were advised. The missed cases from follow up were not included in the study. Conclusion: The sequelae of septic arthritis in neonates can be prevented by early diagnosis and early intervention with emergency lavage of any involved joint to reduce the rate of disability. The arthrotomy and lavage is the definitive treatment for neonatal septic arthritis which reduce the morbidity and mortality of the neonates.
87 The Effect of Infrapatellar Fat Pad Resection in Total Knee Replacement on Patella Tendon Length and Functional Outcomes after Five Years , Sheldon M*, Siamak S, Kieran B and Richard B
Background: It remains unclear whether infrapatellar fat pad (IPFP) excision leads to patella tendon shortening. Shortening of the tendon alters the biomechanics of the knee and can be problematic however current literature is divided regarding the effect of IPFP resection on patella length and functional outcomes following total knee replacement. Methods: Our aim was to identify any functional and radiographic differences incurred with IPFP resection. We conducted a retrospective study comparing resection and preservation of the infrapatellar fat pad between 2007-2009 using the Stryker Triathlon or Duracon implants between two independent consultant surgeons. 168 consecutive patients were recruited. Baseline demographics were similar between resection and preservation groups with a mean age of 68.5 (70 vs 67, p=0.17), BMI 31.71 (31.02 vs 32.4, p=0.84) and patella resurfacing 23.5 (24 vs 23, p=0.29). Results: Comparisons between the resection and preservation groups for the Insall-Salvati, Modified Insall-Salvati, Caton-deschamps and Blackburne-peel ratios preoperatively, at one year and five years postoperatively did not demonstrate any statistically significant differences. Knee society scores (KSS) preoperatively (45.36 vs 40.5, p=0.31) and at five years postoperatively (90.49 vs 85.31, p=0.2) were not statistically different. Similarly anterior knee pain scores (AKPS) demonstrated no statistical significance between groups preoperatively (50.6 vs 42.8, p=0.3) and at five years post operatively (69.4 vs 62.0, p=0.88). Conclusion: There is no statistical difference in radiological measures or functional scores (AKPS &KSS) at one or five years post-operatively between resection or preservation of the infrapatellar fat pad following total knee arthroplasty for primary osteoarthritis.
88 Slipped Capital Femoral Epiphysis (SCFE) Coxa Vara Adolescentium (CVA) , Gharaibeh A* and Al Wadyia A
Slipped femoral capital epiphysis is considered to be one of the most destructive conditions of hip joint during adolescence. The epiphysolysis of the femoral head was first defined in 1572 by the French surgeon Abrois Paré (1510 - 1590). The first authentic traumatic epiphysesolysis of the femoral head was described by Brousseau in 1867. It was in a 15-year-old boy with multiple injuries after trauma with heavy carriage. Death occurred in a few hours, and was discovered by post-mortem examination. Complete separation of epiphysis of the femur head was found. The first mention of a non-traumatic form of epiphysolysis occurred in a fourteen years old boy later. In 1881, Fiorani reported fifteen cases of distorted hip joint with impaired adduction in children. He described the deformity as a bend of the proximal part of the femur, which was based on rickets. With a high probability, some individuals were coxa vara adolescentium. The first complete description of the disease was given by E Müller (1888) in his work “About the bending of the femoral neck in the growth age” Coxa vara adolescentium (CVA), epiphysesolysis of femural head or slipped femoral capital epiphysis represents a serious hip disease in the pubescent age at which the femoral proximal growth plate loses its strength and influence mechanical forces, caused mainly by excessive body weight, the non-traumatic epiphysesolysis will occur. Symptoms like pain and twisting are initially vague, but they tend to escalate over time. The incidence of this disease is 0.1 per one million, affect male more than female 2:1,4 in the rapid growth period 10-16 years old. Childhood obesity is the common cause of Slipped femoral capital epiphysis, then endocrine disorders and Down syndrome. Slipped femoral capital epiphysis has three grades first up to 33 degrees of slippage, second grade from 34-50% of slippage and the third degree more than 50%.Slipped femoral capital epiphysis, represents a serious disease of the puberty in the pubescent age at which the femoral proximal growth plate loses its strength and influence mechanical forces, caused mainly by excessive body weight, will occur non-traumatic epiphysesolysis. Symptoms like pain and limping are initially vague, but they tend to escalate over time
89 Intra Osseous Arteriovenous Malformations of Hand and Foot: Treatment Outcome after Open Surgical Cementoplasty in 9 Patients , Claude Laurian*, Annouk Bisdorff, Veronique Marteau, Claudine Massoni, Claudine Pierre Cerceau and Emmanuel Houdart
Background: To evaluate the benefit of open surgical cementoplasty on the intra osseous nidus in the treatment of arteriovenous malformations (AVMs) on hand and forefoot. Methods: Over the period 2014-2017, 9 consecutive patients underwent open cementoplasty of bone for AVMs of hand and foot. Investigations included digital radiography, Doppler ultrasound, and CT scan with bone and vascular reconstructions. The main outcome end points of this study were: pain, residual AVMs identified by CT scan, and quality of life. Results: Over a period of 4 years, 65 patients with AVM on hand (38 pts.) or foot (27 pts.) were observed in our institution, 10 pts. (15%) of the cohort had bone involvement. Nine patients (4 F, 5 M) with a mean age of 30 years (range 10-50) were included in this study. On their hand (n=5), skeletal changes were at first metacarpal (2pts), in the proximal and middle phalanx (3 pts.). On their foot (n=4), changes were in the metatarsal (3 pts.), in proximal and distal phalanx (3 pts.). Nine patients had a targeted cementoplasty of the involved bone. On control CT scan, 9 patients had no residual intraosseous AV shunts, 4 had minor shunt around bone. Mean follow-up was 29 months (range 10-55 m). No morbidity, no delays of healing were observed. Disappearance of pain was the dominant impact in all the patients. Conclusion: Open surgical cementoplasty is a new option for AVMs bone lesions located in the digits and forefoot. The conclusions are restricted by the short period of follow-up.
90 Elderly Patients with Pertrochanteric Hip Fracture: In Hospital Care , Faour Martín O*, Valverde García JA, Sáez López, Martín Ferrero and Vega Castrillo A
Objective: To evaluate the improvement in the care of elderly patients hospitalized due to pertrochanteric hip fractures. Methods: A comparative study of two cohorts of patients admitted due to pertrochanteric hip fracture before (2010) and after the application of in hospital management protocols (2018). The intervention consisted in the implementation of multidisciplinary measures during hospitalization based on current scientific evidence. An evaluation of the clinical results was performed, as well as the health care impact. Results: The characteristics of patients admitted for hip fracture in 2010 (216 patients) and 2018 (205 patients) were similar in age, sex, Barthel index and the Charlson abbreviated index. In 2018 patients had more comorbidity. A significant reduction of preoperative stay and overall stay in the cohort of 2018 was achieved. Detection of delirium, malnutrition and anaemia was higher in 2018, and a reduced incidence of infection and a better functional efficiency was achieved in this period. Conclusion: The introduction of measures for the improvement of the pertrochanteric hip fracture management reduces hospitalization with consequent cost reduction. Unification of criteria among professionals may be an opportunity for better clinical results and reduction of complications.
91 Prevalence and Clinical Correlation of Vitamin D Inadequacy in Traumatic Hip Fracture among Elderly Patients , Tutaworn T, Phruetthiphat O* and Songpatanasilp T
Introduction: High prevalence of vitamin D deficiency has been described in more than 1 billion people around the world, especially in Middle-East and Asia. In Thailand, the largest study of vitamin D status in normal population (N=2641) identified overall 45.2 percent of vitamin D inadequacy in normal population. However, there was no study focusing on Vitamin D inadequacy in traumatic elderly patients. The purpose of this study is going to define the prevalence of vitamin D inadequacy in traumatic hip fracture among elderly patients and to identify a clinical correlation. Materials and Methods: A prospective study of elderly patients (more than 60 years old) with low energy trauma who underwent orthopaedic surgery at Phramongkutklao Hospital between the period of January 2016 and December 2016. All hip fracture patients underwent orthopedic surgery were collected for demographic data, comorbidities including Charlson Comorbidity Index. Primary outcome was to identify a prevalence of vitamin D inadequacy (<30 ng/ml) and vitamin D deficiency (<20 ng/ml) in hip fracture underwent orthopedic surgery. Secondary outcome was to define association of demographic data, comorbidity with vitamin D level. Additionally, comparison the ambulatory status and mechanical failure between normal vitamin D and vitamin D inadequacy Results: The serum 25(OH)D levels for this study was normally distributed, with a mean of 25.0±12.2 ng/ml in all patients, Prevalence of vitamin D inadequacy was 70.5 percent (n=103) and the prevalence of vitamin D deficiency was 37.7 percent (n=55). There was no significant difference of ambulatory status between vitamin D inadequacy and sufficient vitamin D groups (p=0.958). Additionally, there was not different in mechanical failure between groups (4.5% and 0%, p=1.000). Conclusion: Vitamin D inadequacy is so common in traumatic elderly patients. We should raise attentiveness among physician to determine vitamin D status. Public health strategy should add knowledge about diet, supplements or adequate sun exposure to elderly population. Vitamin D inadequacy did not affect the outcome including time to union and ambulatory status at 1 year follow up.
92 Simultaneous Bilateral Total Knee Arthroplasty Outcomes Analysed for Present Day Practice , Nithin S*
Commentary on an article by Michael-Alexander Malahias “Comparing the Safety and Outcome of Simultaneous and Staged Bilateral Total Knee Arthroplasty in Contemporary Practice: A Systematic Review of the Literature”
93 Increasing posterior condyle cut for high-flex knee prosthesis may injure popliteus tendon origin: a cadaveric study , Rit Apinyankul, Surachai Sae-Jung and Ong-art Phruetthiphat*
Background: High-flex total knee prosthesis designs were proposed to improve flexion in total knee replacement (TKA). One of high-flex features is increasing posterior condyle cut which put popliteal tendon in higher risk of injury and may result in gap changes. Methods: Thirty-six popliteal origin sites from eighteen fresh cadavers were measured distances between the posterior rim of popliteal tendon origin and posterior border of the lateral femoral condyle (distance A) using digital “Vernier caliper”. The mean distances were compared to posterior condyle thickness of different prosthesis designs. Results: The mean of distance A on the right knee was 9.59 ±1.66 mm (6.03-12.70) while the mean of distance A on the left knee was 9.13 ± 1.78 mm (5.80-11.07). Posterior condyle thickness of the femoral prostheses varies upon their design and size from 7.4 to 10 mm for standard model and from 8.2 to 12.5 mm for high-flex design. Possibilities of popliteal tendon injury during posterior condyle bone cut were 16.7% to 66.7% for standard model and 27.8% to 97.2% for the high-flex design. Conclusion: High-flex TKA prosthesis with thicker posterior condyle relates to higher possibility of popliteal tendon origin injury compared to standard one.
94 Relation between vitamin D deficiency and osteoarthritis , Gharaibeh A*, Kupershtein M, Gharaibeh M, Filip V, Sokol D, Lackova A, Folvarsky M, Beres M, Mitro I, Ivanecky S, Habinakova M, Naser Y, Cellar R, Schreierova D and Lacko M
Purpose of the Work: The main objective of our work is to determine the relationship between osteoarthritis and deficiency of vitamin D in our region in central Europe and to make a database for further researches, to be effective in investigating, controlling, and preventing OA and vitamin D deficiency in our population. Methodology: We perform a retrospective study in adult patients≥25years with osteoarthritis big joints from their health records, which were seen at the osteology clinic of University Hospital Louise Pasteur during the year 2018. The authors analyse the blood tests of Vitamin D level, calcium level, phosphorus level, B ALP, glomerular filtration rate (GFR) levels in the serum of these patients. Results: There were 47 patients with osteoarthritis. All of these patients had Vitamin D deficiency. The mean age of our group is 71 years. 12.8% (7) are male and 87.2% (41)are female. The mean of vitamin D is 24mmol/l (normal range 75-200 nmol/l), Calcium level with in normal range, Phosphorus level mean was within normal range and B ALP level within normal. Conclusion: Osteoarthritis increased by deficiency of vitamin D level in blood serum and increasing with age. Vitamin D is a fat-soluble vitamin that regulates calcium and phosphorus metabolism, maintenance of the normal skeletal and muscular systems. Most of the patients show OA in hip and knee and in advanced age 71 years. Vitamin D supplementation may be a safe method to treat and prevent OA.
95 Carpal Antelunar Dislocation and Fenton Syndrome: Extremely Rare Association , Mounir Y*, Aharram S, Amghar J, Abdelkrim D and Omar A
Mounir Y*, Aharram S, Amghar J, Abdelkrim D and Omar A
96 The Effectiveness of Thermal Mode of 448 KHz Capacitive Resistive Monopolar Radiofrequency in Continuous Wave in Patients with Chronic Rotator Cuff Tendinopathy: A Clinical Trial , Stasinopoulos D*, Constantinou A and Lamnisos D
The aim of the present clinical trial was to compare the clinical results of the use of an exercise program with those of an exercise program and thermal (thermia or hyperthermia) mode of 448 kHz Capacitive Resistive Monopolar Radiofrequency in continuous wave in patients with chronic rotator cuff tendinopathy. Patients were allocated to two groups by drawing lots. Pain, function and strength were measured. An exercise programme and thermal (thermia or hyperthermia) mode of 448 kHz Capacitive Resistive Monopolar Radiofrequency in continuous wave, had reduced the pain and improved function and strength in patients with chronic rotator cuff tendinopathy at the end of the treatment and at the follow-ups. Future well-designed randomised controlled clinical trials are needed to establish the effectiveness 448 kHz Capacitive Resistive Monopolar Radiofrequency in the management of chronic rotator cuff tendinopathy.
97 Postural Control at Hospital Discharge after Spine Surgery–The Influence of the Type of Surgery, Pain Level, Radiculopathy and Stance Parameters , Relvas H*, Diniz A, Fernandes O and Oliveira R
Information on postural control has gained recognition as an objective outcome measure after spine surgery. Insights on the patterns of posture and movement exhibited by patients using nonlinear tools can provide useful information on the structure of sway variability, adding value to the traditional quantification of its magnitude. The results should guide efficient therapeutic strategies to promote early recovery. To date, no clinical trial used this protocol at the time of hospital discharge. This study aims to analyse postural control under the acute effect of spine surgery. Thirty-seven patients submitted to decompressive or fusion spine surgery to treat degenerative pathologies or correct severe deformities were recruited (21 male, 16 female; mean age: 53,4 ± 18,1 y, range 14-80). Thirty-seven matching healthy volunteers included the control group. All participants performed a standard stabilometric test on a force platform for 180 seconds, patients being tested at the hospital on discharge day. Six more trials were randomly performed in different stance conditions: 1) eyes closed; 2) feet together; 3) performing a mental task; 4) on a high-density foam; 5) on a low-density foam; 6) holding a box. Values of sway range, mean velocity, elliptic area, and sample entropy, were extracted from centre-of-pressure displacement time-series and analysed using parametric statistical methods. Comparisons were made between control values and the effects of surgery, type of surgical procedure, level of back or leg pain, and residual radiculopathy. During the baseline task (eyes open) patients increased their total area of oscillation (p=0,016), mainly its range in the anteroposterior (AP) direction (p=0,010); the structure of that variability has less complexity and more regularity compared to control participants, showing lower sample entropy values (p=0,031 / AP direction). Differences were not significant in the mediolateral (ML) direction, and the mean velocity did not discriminate participants. Eyes closed condition, being on a highdensity foam, or holding a box, exhibited the most robust cumulative significance. Interactions between all the parameters (the type of surgery, level of pain, presence of radiculopathy) may reveal more significant determinants to the postural patterns adopted. However, present data should be interpreted cautiously, being necessary broader samples for each sub-group in future studies, the replication of these measures in later follow-ups, and consider the effects of rehabilitation programs tailored in concordance to the main findings.
98 Atypical Presentation of Sacrococcygeal Pilonidal Disease: Presentation and Surgical Management , Ahmed Al Wadiya*, Amr Abouelela, Abdallah Al Ghunimat, Neil Ashwood, Amit Kotecha and Ahmad Gharaibeh
Sacrococcygeal pilonidal disease presentation varies greatly between being asymptomatic, acute abscess and chronic sinus. Acute abscess constitutes almost half of the initial presentation of such disease. To our best knowledge, acute abscess presentation hasn’t been reported as a result of acute trauma in the literature. In this paper, we report a case of atypical presentation of sacrococcygeal pilonidal disease after a fall on the back a week earlier. Surgical management of the abscess, incidental finding of the pilonidal disease and lessons learned from such case is discussed in detail.
99 Management of Cauda Equina Syndrome: NHS Staff Perceptions in a DGH , Taylor G*, Tanagho A and Rutherford M
Objective: Cauda Equina Syndrome (CES) is a challenging condition to diagnose due to such variability in clinical features and poor correlation with MRI findings. It requires surgery within hours to avoid damage to the bowel, bladder, sexual organs and lower limbs. There are empirical studies exploring patients’ perspectives of having CES, however, there is no literature to review NHS staff perceptions of managing this neurosurgical emergency. The aim is to explore perceptions of senior clinical staff who commonly manage patients with suspected CES in secondary care within the Emergency Department (ED) and Trauma and Orthopaedics (T&O) to improve the management of CES. The main objective is to identify barriers to successful management and possible solutions to improve care. Methods: A self-administered non-validated questionnaire was designed to identify barriers experienced and potential solutions. In addition, a Nominal Group Technique (NGT) was used to gain a greater insight. The qualitative data obtained was analysed by thematic analysis. Results: The questionnaire generated a 73% response rate. Six senior clinicians attended the NGT with representation from the three clinical specialities; ED, T&O and Advanced Physiotherapy Practitioner (APP). The challenges and potential solutions were categorised into themes and subthemes. The barriers highlighted included; staff confidence in clinical diagnosis; fear of litigation and inter-professional relations; patient psychosocial factors, expectations and comorbidities; lack of agreed local pathway. The solutions raised include; staff training; standardising local/national pathway; access to daily Magnetic Resonance Imaging (MRI) slots. Conclusion: Patient safety and accurate diagnosis of CES is at the forefront of decision-making despite organisation barriers and limitations of existing pathways. A shift away from admission to expedite an urgent MRI requires a change to traditional clinical practice and expectations. In times of rising pressures and financial constraints, collaborative working is essential to implement and sustain the required changes highlighted in this study.
100 Current Status of Nerve Transfers: “Supercharge End-to-Side Transfer in Severe Cubital Syndrome” , Salmeron Martinez EJ*, Castellanos Moreno A and Ubeda Garcia FM
Supercharge end-to-side (SETS) technique has been increasingly implemented in the treatment of nerve pathologies. It was known for its use in ulnar injury, and although it seemed that its usefulness was more directed to injuries due to ulnar nerve section, with this work and based on all the literature available to date, the aim is to assess the possibilities of implementation based on the results of the articles published in compression-type injuries, especially those classified as severe that have little treatment available to improve their evolutionary course, and where their use to date was doubtful. A compilation is made of all the evidence to date of cubital tunnel syndrome, focused on treatments, and on the emergence of the SETS technique as a therapeutic option. The purpose of the study was to collect and review the indications, results, and complications of end-to-side axonal super feeding transfer of the interosseous nerve anterior to the ulnar nerve. Twenty-one articles that met the inclusion and exclusion criteria were finally reviewed, most of them retrospective (level of evidence IV) and some review or case series (level of evidence II/ III). The data has been pooled and analyzed focusing on the primary outcomes: intrinsic muscle recovery and complications. SETS is a successful procedure with low morbidity, which can restore the function of the intrinsic musculature in patients with severe proximal ulnar nerve compression injuries thanks to the anterior interosseous nerve (median branch) that serves as a donor. Although the technique has already begun to be introduced in the sketch of the treatment of the lesion, to implement it with assured success, prospective studies should be carried out that corroborate it with greater certainty than the articles published on the subject to date. Even so, it has been possible to verify as previous indications for performing supercharge: a normal donor nerve electromyogram (it will be performed in a pronator square), a preoperative electromyogram of the injured nerve that must have a reduced amplitude of compound muscle action potential (demonstrating axonal loss) and an electromyogram to know if the denervated motor endplates remain receptive to reinnervation (check they have spontaneous activity and this is shown by fibrillation potentials and / or acute positive waves).
101 Impact of COVID-19 on Pediatric and Adult Orthopaedics , Daniel S Hayes*, Elliott Holbert S, Alexander Holbert J, Mark AS and Michael S
Background: Social practices, hospital guidelines, and government regulations in response to COVID-19 have influenced orthopaedic practice volumes. The widespread cessation of non-essential surgeries has greatly decreased elective practices, but the extent to which trauma volumes diminish remains unknown. Access to common sites of orthopaedic injury was limited during this period, including organized sports, playgrounds, and travel. Methods: To examine the effect of COVID-19 in pediatric and adult practices, considering local responses to the pandemic, weather effects, and school activity. We retrospectively examined orthopaedic clinic changes for the first five months of the year in 2019 and 2020. An administrative database was used to obtain volume data for OR cases, OP visits, and OP clinic procedures. Temperature and precipitation records were collected for the same period. Results: All aspects of the adult practice greatly decreased in March, April, and May compared to the previous year. The largest decreases in OR cases occurred in April for adults, with a slight increase in May, but volumes remained decreased compared to the previous year. Pediatric and adult OP visits and OR cases dropped similarly in March and April. This trend continued into May for OP visits, but only pediatric OR visits increased in May. Conclusion: Practice trends from 2019 to 2020 established in January and February abruptly altered in the following months. Institutional cessation of elective procedures and government issued statewide stay-at-home orders greatly impacted orthopaedic volumes during this period. Decreased opportunity for social activity contributed to drops in pediatric and adult trauma. Proactive responses by local schools aided in a more rapid decline of pediatric trauma compared to adults in the month of March.
102 Rib-Based Anchors are Associated with Proximal Translational Deformity in Early Onset Spinal Deformity Patients undergoing Growth-Friendly Surgical Treatment , Connor D Burke, Brett J Goodloe, William R Barfield, Frederick J Hughes, James F Mooney and Robert F Murphy*
Objective/Background: No studies to date have evaluated the the effect of rib-based anchors on the translational relationship between the rib and spine. We hypothesized that there would be an increase in the translational distance between the rib anchor and anterior vertebral body in early onset spinal deformity patients managed with long-term rib-based anchors. Methods: All patients with EOSD from a single tertiary level institution treated with a growth-friendly technique surgery utilizing proximal rib-based anchors from 2006-2015 with a minimum of 2-year follow-up were included. Thoracic kyphosis and the translational distance from the rib anchor to the corresponding anterior vertebral body were measured. Results: Twenty-seven patients (13 female, 14 male) qualified for inclusion. Mean age at implantation of the index proximal rib-based construct was 5±1.9 years (range, 1-9). EOSD etiology was congenital: 3, neuromuscular: 17, syndromic: 3, and idiopathic: 4. Mean kyphosis improved from 31±33° preoperatively to 25±20° immediately post-operatively. No significant changes in kyphosis were noted over 1 and 2 year follow-up (p=0.3). Twenty-one (78%) patients demonstrated an increase in translational distance from the rib anchors to the adjacent anterior vertebral body. Immediately post-operatively, mean distance was 25±1 mm and increased at 1-year (26±1 mm) and significantly at 2-year (29±1 mm) follow-up (p=0.005). Conclusion: The use of long term rib-based anchors may lead to an increase in the distance between the rib utilized for proximal fixation and the associated vertebral body, generating what appears to be increased anterior translation of the spine. This translation, in conjunction with increased or increasing overall thoracic kyphosis, may be the source of unexpected obstacles at the time of future surgical procedures for revision or final fusion.