Day 3 :
- Bone Disorders, Osteoarthritis and Outpatient Orthopedic Disorders
Sports orthopedics, Medical Devices and Instruments in Orthopedics & Rheumatology
Session Introduction
Ruixin Zhang
University of Maryland, USA
Title: Electroacupuncture and laser acupuncture alleviate knee osteoarthritis pain in rats
Time : 09:00-09:25
Biography:
Ruixin Zhang has completed his Ph.D from Shanxi Medical University in China and postdoctoral studies from National Institutes of Health and Yale University. He has been serving as an editorial board member for seven professional journals. He is an assistant professor in Center for Integrative Medicine , School of Medicine, University of Maryland
Abstract:
Treatment of knee osteoarthritis (OA) pain remains serious challenges. Mechanisms of OA pain have been studied in rodent models. The aim of this study was to investigate effects and mechanisms of electroacupuncture and laser acupuncture on OA-caused pain in an OA rodent model produced by monosodium iodoacetate (MIA). MIA (3 mg/50 µl /rat) was injected into the knee joint cavity in male and female rats. Electroacupuncture, 10Hz, 2 mA, and 0.4 ms pulse width for 30 min, was applied bilaterally at the acupoint GB30 once a day on days 2-9 post-MIA injection. Laser acupuncture was conducted on acupoint Dubi (ST 35) for 5 min per treatment, once a day on days 1-7. Pain was measured with a battery of tests. Functional magnetic resonance imaging (fMRI) was used to study the effect of electroacupuncture on brain network connectivity during the resting state after electroacupuncture treatments. Electroacupuncture treatment increased body weight bearing in ipsilateral hind limb in male and female rats. It inhibited mechanically and thermally evoked pain, and improved rat motion distance and speed. Electroacupuncture -treated rats showed conditioned place preference to the electroacupuncture-paired chamber. fMRI data shows an increased anterior cingulate cortex (ACC)/motor/sensory (M1/S1) connectivity in MIA-injected rats but not in naive or electroacupuncture-treated rats. This suggests that MIA-induced pain affects connectivity between the nucleus accumbens and ACC/motor/sensory cortex and that electroacupuncture modulates OA-induced brain activity. The 200 mW laser treatment significantly improved body weight bearing in the ipsilateral hind limb. Electroacupuncture and laser acupuncture may alleviate knee OA pain.
Michael Yelland
Griffith University, Australia
Title: Randomized clinical trial of prolotherapy injections and an exercise program used singly and in combination for refractory tennis elbow
Time : 09:25-09:50
Biography:
Michael Yelland is the Associate Professor of Primary Health Care at Griffith University and a general and musculoskeletal Medicine Practitioner in Brisbane. His teaching, research and clinical interests focus on evidence-based diagnosis and treatment of musculoskeletal pain. These include tendon disorders and spinal pain. He has conducted RCTs comparing prolotherapy injections and exercises in the treatment of chronic painful musculoskeletal conditions, including low back pain, Achilles tendinosis and tennis elbow. He has also conducted three series of single patient placebo-controlled trials of medications for osteoarthritis and neuropathic pain. He is the President of the Australian Association of Musculoskeletal Medicine.
Abstract:
Lateral epicondylosis (LE, \"tennis elbow\") is a common, debilitating and expensive tendinopathy of the lateral elbow resistant to many treatments. Two treatment programs addressing the pathology of LE with preliminary evidence of efficacy are hypertonic glucose+lignocaine injections (prolotherapy, PrT) and an elbow joint mobilization and concentric/eccentric exercise guided by a physiotherapist (P/E). This presentation compares the clinical and disease modifying effectiveness, cost-effectiveness and acceptability of prolotherapy (PrT) injections with a physiotherapy/exercise (P/E) program used singly and in combination. It describes a three-arm RCT in which adults with moderate to severe LE were randomly assigned to PrT, P/E or PrT + P/E, with 40/group. Primary outcomes of their patient-rated tennis elbow evaluation score and global improvement were followed up at 6, 12, 26 and 52 weeks along with pain severity, recurrence, objective biomechanical measures and costs. Structural and biomechanical changes were followed with serial ultrasounds. Recruitment of 120 participants from 204 clinical assessments was completed in June 2014 with completion of 52 week follow-up due in June 2015. Follow-up rates to date have ranged from 82% to 90%. Baseline characteristics for each group were similar. Blinded analysis of results will be completed by August 2015. This trial should provide valuable evidence to inform practitioners in their choice of the most appropriate treatment of their patients with refractory LE, potentially providing substantial benefits to patients, industry and society. The correlation of clinical, biomechanical and ultrasound outcomes will inform the mechanisms of action of these treatments.
Rui Shi
Medical School of Southeast University, China
Title: The presence of stem cells in potential stem cell niches of the inter-vertebral disc region: An in vitro study on rats
Time : 09:50-10:15
Biography:
Rui Shi completed his MD from Southeast University and is currently pursuing PhD at Medical School of Southeast University
Abstract:
The potential of stem cell niches (SCNs) in the inter-vertebral disc (IVD) region, which may be of great significance in the regeneration process, was recently proposed. To the best of our knowledge, no previous in vitro study has examined the characteristics of stem cells derived from the potential SCN of IVD (ISN). Therefore, increasing knowledge on ISN-derived stem cells (ISN-SCs) may provide a greater understanding of IVD degeneration and regeneration processes. We aimed to demonstrate the existence of ISN-SCs and to investigate their characteristics in vitro. Sprague-Dawley rats (male, 4-weeks-old) were used in this study. ISN tissues were separated by ophthalmic surgical instruments under a dissecting microscope according to the anatomical areas. Cells isolated from the ISN tissues were cultured and expanded in vitro. Passage 4 (P4) populations were used for further analysis with respect to colony-forming ability, cellular immune phenotype, cell cycle, stem cell-related gene expression, and proliferation and multi-potential differentiation capacities. In general, the ISN-SCs met the minimal criteria for the definition of multi-potent mesenchymal stromal cells (MSCs), including adherence to plastic, specific surface antigen expression and multi-potent differentiation potential. The ISN-SCs also expressed stem cell-related genes that were comparable to those of bone marrow mesenchymal stem cells (BMSCs), and had colony-forming and self-renewal abilities. To the best of our knowledge, this is the first in vitro study aimed towards determining the existence and characteristics of ISN-SCs, which belong to the MSC family according to our data. This finding may be of great significance for additional studies that investigate the migration of ISN-SCs into the IVD, and may provide a new perspective on different biological approaches for IVD self-regeneration.
Shoaib Khan
University Hospital of North Tees, UK
Title: Radiological evaluation of the rate of interbody fusion using posterior/transformainal interbody fusion with a missed screw technique
Time : 10:35-11:00
Biography:
Shoaib Khan has completed his M.B.B.S from Dow Medical College, Karachi, Pakistan in 2005 and his M.R.C.S from Royal College of Surgeons of Edinburgh, UK in 2013. He is working as a Research Fellow for Spine in University Hospital of North Tees, Stockton on Tees, United Kingdom
Abstract:
Abstract: Objective: Posterior or Transforminal Interbody fusion has been performed for about 7 decades to treat degenerative lumbar spine disease. The aim of our study is to evaluate the rate of interbody fusion using posterior or lumbar interbody fusion with a missed screw technique. In our study, Interbody fusion was performed at two levels with no intervening screw at the middle vertebral pedicle. Methods: The study involved retrospective radiological analysis of PLIF/TLIF performed at two levels with a missed screw technique in Forty patients. The radiographs were assessed independently bya Consultant Radiologist and a Spinal Surgeon both commenting on fusion rate using Brantigan-Steffee fusion criteria. The criteria include a denser and more mature bone fusion area than originally achieved at the time of operation, no interspace between the cage and the vertebral body, and mature bony trabeculae bridging the fusion area. The procedures were performed by one Spinal surgeon. Results: In our study of 40 patients, we had 24 males and 16 females with an average age of 44.7 years in both groups. The main indication of performing Interbody fusion was degenerative lumbar spine disease. Fusion procedures were performed over a period of 3 years and 6 months from July 2009 to Jan 2013 with an average follow up of 19.8 months. Radiographs as independently reviewed by Radiologist and Spinal surgeon revealed that 29 patients were fused at both levels, one level was fused in 3 patients (L4/5 in 2 patients and L5/S1 in 1 patient), two patients did not have adequate follow to comment on fusion and non fusion was found in six patients Conclusion: Our study concluded that it may not be necessary to insert a screw at the middle vertebral pedicle while performing PLIF/TLIF at two levels.
Jignesh Bhagabhai Patel
Sarvoday College of Physiotherapy, India
Title: Short-term effects of kinesio taping on dynamic knee valgus in asymptomatic collegiate athletes- a randomized double-blinded sham controlled trial
Time : 11:00-11:25
Biography:
Jignesh patel completed his Master of physiotherapy (M P T, Musculoskeletal Disorders & Sports) from Srinivas College of Physiotherapy in 2014, Mangalore-India. Presently he is working as Assistant Professor at Sarvoday College of Physiotherapy, Kalol-Gandhinagar and as Clinical Physiotherapist at Stavya Spine Hospital and Research institute, Ahmedabad- Gujarat-India
Abstract:
Objectives: To determine the short-term effectiveness of Kinesio taping (KT) on dynamic knee valgus in asymptomatic collegiate athletes. Methods: Design: A randomized double blinded sham-controlled trial. Setting: Srinivas college of Physiotherapy and Research centre, Mangalore, India. Participants: Total 40 athletes (28 males and 12 females). Main Outcome Measure: Drop Jump test. Results: There was a high significance difference found (p<0.001) between the group with mean difference of 3.07 (CI 1.78 to 4.36) DKV for males and 5.5 (CI 4.21 to 6.79) for females. However 3rd day mean difference between the group was not as great as immediately after taping that is 0.28 (CI -1.01 to 1.57) for males and 2.17 (CI 0.88 to 3.46) for females. There was a high significance difference found (p<0.001) on 1st day after (immediate effect) the Kinesio taping group with mean difference of 6 (CI 5.5-5.9) and 3rd day with mean difference of 3 (CI 2.9-3.8). Conclusion: There was reduction in dynamic knee valgus angle as well as improving muscle strength immediately after Kinesio taping. However, there was no significant difference between and within groups on 3rd day
Luthfi Dharmawan
Padjadjaran University
Title: Decreased levels of serum chondroitin sulfate and pain numeric rating scale in patients with knee osteoarthritis after isotonic quadriceps strengthening exercise
Time : 11:25-11:50
Biography:
Luthfi D has completed his MD from Padjadjaran University. He is currently pursuing Physical Medicine and is a rehabilitation resident at the same University.
Abstract:
Background: Osteoarthritis (OA) is degenerative joint disease that is characterized by loss of cartilage. Chondroitin sulfate (CS) is an important structural component of cartilage. It is responsible for pressure resistance. CS can slow the progression of cartilage destruction and may help to regenerate the joint structure, leading to reduce pain of the affected joint. CS synthesis stimulated by mechanical forces. The mechanical force recommended for knee OA patients is an isotonic strengthening exercise of quadriceps muscles. Objective: To analyze the prevalence ratio between serum CS level and pain level after quadriceps isotonic strengthening exercise. Method: This study recruited 36 participants with Knee OA grade 2 and 3. The participants’ assessed for pain and their blood was taken before and after intervention. Participants practiced quadriceps isotonic strengthening exercise 3 times a week for 8 weeks. Results: The serum CS level and pain level shows decrease after intervention. The prevalence ratio between CS level and pain level is 1,548 (95% CI, 0,765–3,131) but statistically not significant. Conclusion: CS is synthesized by chondrocyte to stimulate an anabolic process of the cartilage metabolism and can stimulate an anti-inflammatory action. Even though statistically not significant, the prevalence ratio showed that serum level CS can influence the pain level of the patients. Based on the result, isotonic quadriceps strengthening exercise have a positively effect to the joint in patients with OA.
Zewudu Tadese Shemelis
Addis Ababa University, Ethiopia
Title: Major current problems with orthopedic related disability in Ethiopia
Time : 11:50-12:15
Biography:
I have completed my Doctorate Degree age of 26 years from Jimma, university and post doctoral study from Addis Ababa University. Previous medical director and other time CEO of Abomsa Hospital. Currently, Assistant professor of Orthopedic and Traumatology, at Addis Ababa University, college of health science, Department of Orthopedics and Traumatology. Executive Committee of Ethiopian Society of Orthopedic and Traumatology. Board member of Efa Beri Disabilities’ Charity Organization (EBDCO).
Abstract:
Disability is one of the social problems prevalent in our country. According to the International Rehabilitation Review, about 10% of the world’s population has disabilities of which 80% found in developing countries. In accordance with developmental social welfare policy (1996) of the Federal Democratic Republic of Ethiopia, a total of 23 types of disabilities have been identified in a country. Studies carried out indicate that 85% of all disabled citizens live in the rural areas and with regard to this problem, children and elders are the most vulnerable segments of the society. According to the country’s profile, study on persons with disabilities carried out by Wa’el International Business and Development Consultant (2000) 1,488,892 disabled citizens are found in Ethiopia. Out of this, about 833,653 (56%) are found in Oromia National Regional State. Persons with disability in Ethiopia do not often have access to rehabilitative services; simply because the availability of these services are very much limited. Furthermore, background societal attitudes and prejudice against the victims perpetuate fatalism, that is, the victims and their loved ones would rather learn how to live with the problem accepting it as God’s will than seek remedy for it. The rehabilitative services that are available today for persons with disability in our country emphasize institutional care are costly and, therefore, greatly limited to the number of beneficiaries. Worse yet, the institutions are very few and urban–concentrated and thus exclude the majority of those who need these services.
Patience Odiehza
FunbellTra-Opedics, Nigeria
Title: Prospective evaluation of two diagnostic apprehension signs for poster lateral instability of the elbow
Time : 12:15-12:40
Biography:
Patience Odiehza grew up with her parents who happen to be Tra-opedicals, who used traditional herbs in healing broken bone. She started learning how to heal and stretch bone from them before she was contacted by Dr. Kenneth, who helped her understand the difference of herbs and drugs in the orthopaedics system
Abstract:
Posterolateral rotatory instability (PLRI) of the elbow occurs from attrition of the lateral ulnohumeral collateral ligament of the elbow after elbow dislocation. Diagnosis by physical examination can be difficult in the patient who is awake. The goals of this study were to define two active apprehension signs for the physical diagnosis of PLRI and to perform a prospective evaluation of the signs in a series of patients with PLRI. Eight patients with PLRI undergoing surgical reconstruction of the lateral ulnocollateral ligament of the elbow were prospectively included in this continuous case series. Preoperative evaluation consisted of physical examination with two active apprehension signs, the chair sign and the pushup sign, as well as the pivot-shift sign. Results were compared with repeat physical examination after reconstruction of the ligaments. Of 8 patients included in the series, 3 demonstrated a positive pivot-shift sign while awake, and all demonstrated a positive pivot-shift sign while under anesthesia. Seven patients demonstrated a positive chair sign, and seven demonstrated a positive pushup sign. At the 2-year follow-up evaluation, 7 patients remained stable and asymptomatic. The pushup sign, chair sign, and pivot-shift sign were negative in all 7 patients. The study demonstrated that both the pushup and chair signs are effective in aiding the diagnosis of PLRI. They are more sensitive than the pivot-shift sign in the patient who is awake and may be easily performed in the office environment.
Abdulkarim Ali
Midland Regional Hospital, UK
Title: The effect of orthopaedic surgery on the intrinsic properties of surgical gloves
Time : 12:40-13:05
Biography:
Ali Abdulkarim is working in Midland Regional Hospital, Tullomore, Ireland, UK. He has interest in bacterial contamination of diathermy tips, intrinsic properties of surgical gloves and total knee arthroplasty. He completed his studies from University of Limerick, Ireland, UK.
Abstract:
Introduction: Surgical gloves function as a mechanical barrier that reduces transmission of body fluids and pathogens from hospital personnel to patients and vice versa. The effectiveness of this barrier is dependent upon the integrity of the glove. Infectious agents have been shown to pass through unnoticed glove microperforations which have been correlated to the duration of wear. Varying factors may influence the integrity of the glove such as the material, duration of use, activities and fit. Studies have recommended changing gloves 90 minutes into a general surgical operation, however there are no known EBM recommendations in orthopaedic surgery. Objectives: The aim of our study was to determine whether the intrinsic properties of sterile surgical gloves can be compromised when exposed to common orthopaedic materials in the operating theatre. Methods: A total of 20 unused sterile surgical gloves (neoprene and latex) were exposed to cement over 30 sec, 1, 5, 12 minute intervals. Following each time point, the palmar surface and finger tips of each glove was analyzed under the scanning electron microscope (SEM), and were tested for changes in contact angle and tensile properties. Results: Exposure to cement caused a significant increase in both the neoprene and latex glove porosities at 12 min but no significant further changes at any later time points. The latex gloves had a greater increase in pore diameter than the neoprene gloves. Exposure to cement for 12 min duration significantly decreased the tensile strength of both latex and neoprene gloves. Conclusions: This study provides evidence that exposure to cement, a common orthopaedic material, can disrupt the intrinsic properties of the surgical gloves worn in the operating theatre. This can lead to micro or macro perforations putting both the patient and operating room personnel at risk of contamination
Kapil Mani K C
Civil Service Hospital, Nepal
Title: Total hip replacement for old displaced subcapital fracture neck of femur in elderly patients
Time : 13:05-13:30
Biography:
Kapil Mani K.C. is currently working in Civil Service Hospital of Nepal, Minbhavan, Kathmandu as an orthopedic surgeon since Second July 2011. He is actively involved to attend the patients in OPD and Emergency department as well as to perform the operations in routine and emergency basis every day. Besides he is involved in teaching and learning activities in the hospital.
Abstract:
Background: The management of displaced subcapital femoral neck fracture in elderly patients is controversial because of high rate of complications associated with internal fixations, hemiarthroplasty, and bipolar arthroplasty. To avoid some of these complications, we did primary total hip replacement for these elderly patients of age more than 65 years. There is high chance of nonunion of fracture with internal fixations, significantly increased wear of bone in hemiarthroplasty and even bipolar arthroplasty resulting difficult total hip replacement like revision arthroplasty. Because of less mobility of patients, replacing the total hip after 65 years for fracture neck of femur, the joint sustains for longer time, and there may not be the need of revision arthroplasty. Patients and Methods: A total of 12 total hip replacements was performed for displaced femoral neck fracture of elderly patients of age more than 65 years in Civil Service Hospital of Nepal and National Academy of Medical Sciences, Bir Hospital for past two and half years. All the patients were operated through modified Harding’s approach. Non-cemented arthroplasty was performed in 8 cases and cemented arthroplasty was performed in 4 cases. In case of cemented arthroplasty, both hybrid and reverse hybrid type were done. Patients were evaluated at 3 months and 1 year after surgery. Results: There were 8 male and 4 female patients of age range from 65 to 77 years. Seven patients were fracture in right side and 5 patients in left side. None of the patients died and developed medical complications after surgery till now. Similarly none of them developed wound problems and landed into the dislocation. Every patient was assessed using Harris Hip Scoring method. Nine of them had excellent and 3 patients had good results. Gait analysis was performed in all patients. We found normal speed and step length at 3 month and one year after surgery. Conclusion: Total hip replacement is one of the best management for displaced sub-capital fracture neck of femur for independently mobile, mentally competent, elderly patients of age more than 65 years with better rehabilitation potential and function of hip and very low revision rate. However, long term follow-up has to be awaited for final results.
Biography:
David Buzas MD has completed his Medical Education at Wayne State University School of Medicine. He is currently a second year Orthopaedic Surgery Resident at Wayne State University. He has had more than 20 published papers, podium or poster presentations
Abstract:
Purpose: To describe the epidemiology of concussions sustained during participation in 9 organized sports prior to participation in high school athletics. Methods: Over an 11-year span from January 2002 to December 2012, the authors reviewed the concussions sustained by athletes aged 4 to 13 years while playing basketball, baseball, football, gymnastics, hockey, lacrosse, soccer, softball, and wrestling, as evaluated in emergency departments (EDs) in the United States and captured by the National Electronic Injury Surveillance System (NEISS) database of the US Consumer Product Safety Commission. Study Design: Descriptive epidemiology study. Results: There were 4864 (national estimate [NE] = 117,845) youth athletes evaluated in NEISS EDs as sustaining concussions from 2002 to 2012. Except for the year 2007, concussion frequencies trended upward throughout the 11-year time frame as well as with increasing age. Loss of consciousness (LOC) occurred in 499 cases (NE, 12,129; 10%). Football had the highest frequency of concussions, with 2013 (NE, 51,220; 41%), followed by basketball, with 977 (NE, 22,099; 20%), and soccer, with 801 (NE, 18,916; 17%). The majority of concussions were treated in the outpatient setting, with 4444 (91.4%) patients being treated and released; 412 (9%) patients required admission and were found to have increased frequencies of LOC (n = 17; 18.0%) compared with LOC in the total group (n = 499, 10%). The total number of player-to-player injury mechanisms mirrored the total number of concussions by year, which increased throughout the 11-year span, except for the year 2007. Subgroup analysis of athletes aged 4 to 7 years demonstrated a difference in the mechanism of injury distribution, with a ball-to-head mechanism increase of 5% from 15% to 20% and a player-to–other object mechanism of injury increase by more than double to 13% compared with the entire cohort over the 11-year time frame. Conclusion: Within the 4- to 13-year age range, there were a significant number of young athletes who presented to EDs with concussion as a result of playing organized sports. The 4- to 7-year age group had a disproportionately higher player-to–other object mechanism of injury. Clinical Relevance: Younger children are more susceptible to long-term sequelae from head injuries, and therefore, improved systems of monitoring for these athletes are required to monitor the patterns of injury, identify risk factors, and develop evidence-based prevention programs.
Nathan J. Savage
University of Utah, USA
Title: The prognostic value of electrodiagnostic testing in patients with sciatica receiving physical therapy
Biography:
Savage has practiced as a Physical Therapist since 2000, currently managing an outpatient orthopaedic and sports medicine clinic in South Ogden, Utah. He is Board Certified in Orthopaedics and Clinical Electrophysiology. He received his Doctor of Philosophy degree in Rehabilitation Science from the University of Utah, Department of Physical Therapy where he currently serves as Clinical Faculty. Dr. Savage has published 3 original research papers in peer reviewed journals. Dr. Savage is passionate about his chosen field of Physical Therapy and finds great joy in helping his patients restore their full physical function and improve their quality of life.
Abstract:
Purpose: Investigate the prognostic value of electrodiagnostic testing in patients with sciatica receiving physical therapy. Methods: Electrodiagnostic testing was performed on 38 patients with sciatica participating in a randomized trial comparing different physical therapy interventions. Patients were grouped and analyzed according to the presence or absence of radiculopathy based on electrodiagnostic testing. Longitudinal data analysis was conducted using multilevel growth modeling with 10 waves of data collected from baseline through the treatment and post-treatment periods up to 6 months. The primary outcome measure was changes in low back pain-related disability assessed using the Roland and Morris disability questionnaire (RMDQ). Results: Patients with radiculopathy (n=19) had statistically significant and clinically meaningful improvements in RMDQ scores at every post-treatment follow-up occasion regardless of treatment received. The final multilevel growth model revealed improvements in RMDQ scores in patients with radiculopathy at the 6-week (-8.1, 95% CI, -12.6 to -2.6; P=.006) and 6-month (-4.1, 95% CI, -7.4 to -0.7; P=.020) follow-up occasions compared to patients without radiculopathy. Treatment group was not a significant predictive factor at any follow-up occasion. An interaction between electrodiagnostic status and time revealed faster weekly improvements in RMDQ scores in patients with radiculopathy at the 6-week (-0.72, 95% CI, -1.4 to -0.04; P=.040) through the 16-week (-0.30, 95% CI, -0.57 to -0.04; P=.028) follow-up occasions compared to patients without radiculopathy. Conclusions: The presence of lumbosacral radiculopathy identified with electrodiagnostic testing is a favorable prognostic factor for recovery in low back pain-related disability regardless of physical therapy treatment received.
Aser Adel Mansour
Dammam Medical Complex, Saudi Arabia
Title: Retrograde femoral nailing: Our experience
Biography:
Aser Adel Mansour Saleh is Orthopedic Surgeon in MOH Saudi Arabia, He was graduated from mansoura (Egypt) Medical School 1998 and completed his residency and master degree from Cairo medical School 2010. He joined MOH Saudi Arabia Dammam Medical complex from 2010 till now.
Abstract:
Introduction: Retrograde femoral nail is a technique that has recently been used with increasing frequency for the management of complex femoral shaft fractures. Purpose:The aim of this study was to investigate in a retrospective analysis the results of retrograde nailing in femoral shaft fractures with multiple other injuries. Methodology:Retrograde femoral nailing was used from 2002until 2012in Dammam Medical Complex for the treatment of complex femoral shaft fractures in 217 patients with . The preferred entry portal, the intercondylar notch, can be reached quickly and effectively by a variety of methods.The mean age of patients was 43,2 years (range 18: 65). Patients were followed till fracture healing . Result:Bony healing occurred in shaft fractures in 15,5 weeks on an average . Postoperative complications requiring re-intervention were seen in 6/48 (12, 5%) fractures. Infection 1 case (0.015).anterior knee pain 2 cases (0.03) Conclusion:our experience in DMC revealed that Retrograde locked intramedullary nailing represents a reliable fixation method for complex femoral shaft fractures .retrograde inserted nails offer a valuable alternative, especially when the proximal femoral approach is obstructed in polytrauma patients. Comminuted fracture shaft with big butterfly fragment and metaphyseal fractures better to be fixed by plates for more stability
Biography:
Dr Mohamed M H El-Sayed, Professor & Consultant of Pediatric Orthopedics & Limb Reconstructive Surgeries, Faculty of Medicine, Tanta University. Fellow of LMU - Deutschland, Fellow of UNT - USA, Member of EPOS, ASAMI, AAOS, IFPOS, EOA.
Abstract:
Introduction: The surgical management of neglected developmental dysplasia of the hip (DDH) in walking children has always been a challenge to orthopedic surgeons. Aim of the work: The aim of this study was to evaluate the short- to middle-term clinical and radiographic results of the management of DDH patients less than 6 years old. Patients and methods: Two of the most commonly used osteotomies, namely; Salter innominate osteotomy and the Dega acetabuloplasty, were used for all the selected cases. Special attention was paid to acetabular remodeling after concentric reduction, which was monitored by the acetabular index. That, in turn, was measured preoperatively, immediately postoperatively, every 6 months, and at the final follow-up examination. Results: The final overall clinical end results were favorable (excellent or good) in 93 hips (85.3 %). There was a marked improvement of the acetabular coverage during the follow-up period, which proved the good remodeling potential of the acetabulum for this particular age group after concentric reduction was achieved and maintained. Conclusion: Both osteotomy types were found to be adequate for the management of neglected walking DDH patients under the age of 6 years.
Biography:
Orthopedics specialist, Tameside General Hospital Fountain Street, Ashton-under-Lyne, United Kingdom
Abstract:
The two most commonly used implants for the fixation of intra-capsular fractures of the neck of the femur are the multiple parallel screw method and the sliding hip screw method. The sliding screw allowed for collapse of the bone at the fracture site and the multiple screw technique allowed for rotational stability. These two implants have been compared in their various features in six randomised trials using 772 participants. With sliding screws the incidence of fracture healing complications were lower (28% versus 33%). The sliding hip screw was associated with more wound healing complications probably due to the slightly longer time needed for the procedure. The Targon is a design which incorporates the advantageous features of both implants. This device provides the rotational stability and the lateral support. The implant is Magnetic Resonance Imaging compatible. Our series in a district general hospital involves 09 cases performed over a period of 10months. The average operating time is 45minutes and the average follow up period is 06 weeks. We found that removing the handle of the jig helps to manoeuvre the jig more easily especially in the case obese patients. We conclude from our limited experience that Targon device appears to be a promising implant in the treatment of intra-capsular fractures of the femur.
Mohammad Q Hassan
University of Alabama, USA
Title: A Network Connecting miR-23a cluster and HOXA Class Factors Regulate Osteogenesis
Biography:
Hassan graduated from the Indian Institute of Chemical Biology in 1996 and continued there as a faculty member for 3 years. In 2001 he joined the University of Massachusetts Medical School, USA. In 2011, he joined School of Dentistry at the University of Alabama as an Assistant Professor to start his independent research laboratory. The primary focus of his research is to study the in vivo biologic significance of microRNA in skeletogenesis. He have developed a high quality research projects in bone cell and molecular biology, the results of which have had a significant impact in biology and medicine.
Abstract:
Studies of HOXA class genes have indicated their importance in skeletogenesis, but their regulation by specific miRNA in bone formation and homeostasis are incompletely defined. MiRNA regulation contributes to every step of osteogenesis, including differentiation, skeletal patterning, and homeostasis. We recently identified miRNA-23a cluster as a potential repressor of osteoblast maturation by targeting Runx2 and Satb2. In our study there is very strong evidence that miR-23a cluster is likely to regulate osteogenesis. Here we have established a mechanism where miR-23a cluster silenced Hoxa5, Hoxa10 and Hoxa11-mediated gene activation, and also identified epigenetic changes associated with poor maturation and mineralization of osteoblasts. Among 11 HOXA class proteins, miR-23a cluster directly targeted Hoxa5, Hoxa10 and Hoxa11 and decreased their expression. HOXA5, HOXA10 and HOXA11 are all interacted physically and functionally with RUNX2, to regulate tissue-specific promoter activity. Overexpression of miR-23a cluster reduced while knockdown increased the recruitment of HOXA5, HOXA10 and HOXA11 to Runx2, Ocn, and Alp promoters and epigenetically control HOXA5 and HOXA11-facilitated chromatin remodeling. Targeted depletion of HoxA5 and HoxA11 by short hairpin RNA (shRNA) decreased expression of osteoblast-related genes while increased SIBLING protein osteopontin. Taken together, our results provide novel molecular evidence that miR-23a cluster and target HOXA5 and A11 functions in an miRNA-epigenetic regulatory network to control osteogenesis. Therefore, the analysis of this miR-23a cluster knockdown mouse model and supportive epigenetic changes by HOXA5, HOXA10 and HOXA11 will dramatically enrich our understanding of this newly recognized level of gene regulation in bone formation.
Maire-Clare Killen
University Hospital of North Tees, UK
Title: Venous thromboembolism following ankle arthroscopy
Biography:
Maire-Clare Killen graduated from the University of Manchester in 2010. She is about to commence orthopaedic speciality training in the Northern Deanery, starting in a foot and ankle rotation. Maire-Clare is currently undertaking an MSc, evaluating treatment of spontaneous osteonecrosis of the knee.
Abstract:
Background: The number of ankle arthroscopies being performed is increasing for both diagnosis and treatment of intra-articular pathology. Venous thromboembolism is an uncommon complication following ankle arthroscopy, but can have devastating outcomes. Publication of procedure-specific studies evaluating rates of post-operative thromboembolism is lacking, and current guidelines reflect this. Aim: To evaluate the incidence of thromboembolism in a consecutive series of patients undergoing diagnostic ankle arthroscopy, with intervention requiring immobilisation in a non-weight bearing cast post-operatively. Method: An analysis of consecutive patients undergoing diagnostic ankle arthroscopy with either ligament reconstruction or supra malleolar osteotomy by a single surgeon over a 12 month period. A retrospective review of the incidence of any complications was undertaken, with a particular focus on venous thromboembolism. Results: 104 patients underwent ankle arthroscopy during the 12 month period. All patients completed routine follow-up at 6 weeks, 3 months and 6 months. The overall complication rate was 3.8%. The incidence of venous thromboembolism in our series was 0.96%. Conclusion: Our incidence of venous thromboembolism with standard use of low molecular weight heparin in all patients is lower than previously published. Larger trials will aid in identifying whether chemoprophylaxis is required in all those undergoing ankle arthroscopy with post-operative immobilisation, or just patients with additional risk factors
Shu-Yuan Li
Chinese PLA General Hospital, China
Title: Ligament Structures in the Tarsal Sinus and Canal
Biography:
Shu-Yuan Li has completed her PhD at the age of 25 years from Peiking University and postdoctoral studies from Chinese PLA General Hospital. She is a Foot and Ankle surgeon at Beijing Tong’ren Hospital, Capital Medical University. She is a member of Chinese Orthopaedic Foot and Ankle Society, and works as academic secretary for Orthopaedic Foot and Ankle Society of Beijing City.
Abstract:
The concrete anatomy of the subtalar ligaments was studied in 32 fresh-frozen cadaver feet. The course of the inferior extensor retinaculum (IER) and other subtalar ligaments was carefully measured, photographed, and described. It was found that the IER inserted inside the tarsal sinus and canal by means of 3 roots: a lateral, an intermediate, and a medial one. These roots, along with the tarsal canal, divided the subtalar space into 3 parts. In front of the IER and inside the tarsal sinus, the thick cervical ligament (CL) lay at a 45-degree angle to the calcaneus. Behind the IER and inside the posterior capsule, in most cases (25 of 32 specimens), the posterior capsular ligament (PCaL) lay directly in front of the posterior talocalcaneal facet. Inside the tarsal canal, the fan-shaped medial root of the IER spread from outside upper lateral to lower medial, and the interosseous talocalcaneal ligament (ITCL) ran from upper medial to lower lateral; fibers of these 2 ligaments blended tightly together to form a V-shaped ligament complex. Just anterior to this complex in some cases (20 of 32 specimens), a short narrow upright ligament, the tarsal canal ligament (TCL), was located behind the middle talocalcaneal joint. This study shows that the CL is the primary ligament in the tarsal sinus and that the ITCL is a thin single band rather than a strong bilaminar ligament located inside the tarsal canal. Instead, the medial root of the IER is the primary ligamentous structure in the tarsal canal.
Abdulkarim Ali
Midland General Hospital, UK
Title: Can the sound of hammering objectively predict micro-fracture in bones? A study on animal bone
Biography:
Abdulkarim Ali is working in Midland regional hospital, Tullomore, Ireland, UK. He has a interest in Bacterial contamination of Diathermy tips, Intrinsic properties of surgical gloves and Total knee Arthroplasty. He completed his studies from University of Limerick, Ireland, UK
Abstract:
Introduction Many surgeons are familiar with the audible change in the sound pitch while hammering a rasp in a long bone during surgeries like Hip Arthroplasty. We have developed a hypothesis indicating that there is a relationship between that sound change and the development of micro-fracture and subsequently full fracture . Methods An experiment using porcine femur bone performed by attaching a bone conduction microphone to the distal part of the bone while hammering a rasps of different sizes through the medullary canal till the point where a fracture developed. The transduce sound resonances created in the bone during rasping are converted to an analogue electrical signals that were sent to a Zoom H4n handheld recording device which recorded the signal to a disk. The recorded signals subsequently were analysed using Matlab software and a spectrum analyzer using Fast Fourier Transforms (FFT). Results Our analysis of the sound frequency response (SFR) during hammering of a rasp in the medullary canal of a porcine bone proved that the (SFR) changes are influenced by the structural integrity of the Rasp-femur interface. The pitch of the resonance increases as the rasp approaches optimal tension and grip in cortical bone. The SFR graph shifted to the right between successive hammer blows as the fixation stiffness increased and that was reflected by increasing resonance frequencies, Once bone fracture developed this structure was compromised leading to a change in the pitch and duration of the resonance. When the tension decreased due to the fracture The SFR graph shifted to the left as the structure no longer has the capacity to resonate to the same extent.SFR analysis can detect accurately the rasping end point where the risk of fracture increases if hammering continued beyond it. Conclusion There is a relationship between hammering sound frequency response during rasping and internal stress in the bone which could be used as an objective method to predict and prevent the development of intraoperative micro-fracture through the identification of insertion end point.
Roy Bechtel
University of Maryland Medical Center, USA
Title: Mis and missed diagnosis at the knee – biomechanical meniscal dysfunction (BMD)
Biography:
Roy Bechtel, PhD, PT, is an Assistant Professor with research interests in four areas: 1) creation of a model of the pelvic joints which will allow insight into how these joints interact with spine and lower extremity function; 2) mechanical characterization of the ligaments of the sacroiliac joint and spine; 3) histological investigation of the sacroiliac ligaments to determine the presence, type and quantity of sensory receptors; and 4) investigation of the surface topology of the sacroiliac joints to define the role of surface interactions in guiding motion at these joints. Dr. Bechtel has supervised several Bachelor\'s level research projects, one of which resulted in submission of a paper for publication. Dr. Bechtel will train ARRTP doctoral students in use of the Instronâ„¢ mechanical testing system, histologic methods for identification of sensory receptors, data collection and analysis, and methods of computer modeling of biomechanical processes.
Abstract:
“What’s wrong with my knee Doc ?†Everyone is familiar with the three letter response – “IDK†which technically means Internal derangement of the knee, but many times also stands for “I don’t knowâ€Â. Biomechanical meniscal dysfunction (BMD) may result from a meniscal tear, osteoarthritis, connective tissue disease such as Ehlers-Danlos, or as a secondary effect of other biomechanical dysfunction, typically involving the sacroiliac joint, ankle or foot. The net result is a meniscus or fragment that ceases to move normally as the joint surfaces of the femur and tibia slide over it. This frequently causes non-specific knee pain, sometimes referred to the shin above the ankle on the affected side, which becomes tender to palpation. Because many different processes can be associated with BMD, it is frequently mis-diagnosed as osteoarthritis, or some other co-morbidity. Because a meniscal tear is not a pre-requisite, BMD may be missed by diagnostic tools with good validity and reliability, such as the Thessaly test. It will almost certainly be missed by tests with poorer supporting evidence, such as McMurray’s. In order to capture the vast majority of cases of BMD, a biomechanical test such as the retreating meniscus test should be employed. The retreating meniscus test relies on the examiner’s ability to palpate soft tissues. As the leg is turned passively in or out, the appropriate meniscus is palpated for movement. Failure to move away from the examiner’s finger (i.e. retreat) is a positive test. The test can be employed for an anteriorly-displaced as well as a posteriorly-displaced meniscus. In a series of cases, with diagnoses ranging from arthritis to trochanteric bursitis, we have shown that employing the retreating meniscus test is a simple and effective step to a useful diagnosis. Making the diagnosis of BMD then allows the practitioner to choose an appropriate treatment, which, in most cases, allows the symptoms to be resolved almost immediately, thereby reinforcing the diagnosis and creating happy patients. Due to the mobile nature of the meniscus, there can be recidivism, but these episodes are usually just as easy to resolve as the initial episode. Serial recidivism requires further discussion with the patient to elucidate possible mechanisms. Some of these may include improper biomechanics while running, but others may be as simple as deterring the patient from pushing their chair away from their desk by extending their knees while sitting. Recidivism involving meniscal tears may require surgical intervention.
Oslei de Matos
Federal Technological University of Parana, Brazil
Title: The effect of body mass index on bone mineral density in lumbar spine and hip in Osteopenia or Osteoporosis postmenopausal
Biography:
Oslei de Matos has completed his PhD in Education and Sports Science at the age of 41 years from Porto University and master degree in Physical Education and Physiotherapy studies from Pontifical Catholic University of Paraná in 1989 and 1995. Medical Gymnastic Specialist in Castelo Branco University of Rio de Janeiro in 1991. He is the director of Laboratory Biochemical and Densitometry, Researcher on women’s health with Osteoporosis, Fibromyalgia and Manager. He is Author of books on postural and physical education. Currently is Anatomy and Biomedical Professor in Graduate Program in Biomedical Engineering in Federal Technological University of Parana in Curitiba – Brazil.
Abstract:
The aim of this study was analyze the influence of body mass index (BMI) in bone mineral density (BMD) on the lumbar spine and hip in women with osteopenia or osteoporosis postmenopausal. This study demonstrated that both BMI and the FMI correlated with BMD of the hip and spine, but in the hip, these values were more significant. The conclusion is thus the total body mass exerts a greater influence on femoral BMD than lumbar spine, probably due to direct impact forces on the upper end of the hip and dissipation of forces through the physiological spinal curves vertebral. Despite the probable influence of total body mass as a protective factor in BMD, replacing the fat mass by muscle mass would present the same biomechanical effect with less impact on the overall organic health. Relation osteoporosis and osteoarthritis in postmenopausal women through assessment body composition by DXA and Postural evaluation. The importance of this assessment of these postural changes sets the likely commitment the bone structure and joint. The body components analyze define the questions multidisciplinary which should be used for the less articular overload with more effectiveness of the longitudinal forces above the bones. For an evaluation and prescription of more targeted therapies for bone health, it is essential to analyze the nutrition, absorption capacity and establishment of nutrients, and without proper nutrition and evaluation of clinical conditions, it is not possible to assess the real capacity fixing bone mineral. Thus, the fixing mineral medicines have no effect in BMD.
Anna Binkiewicz-Glinska
Medical University of Gdansk, Poland
Title: Arthrogryposis in infancy, multidisciplinary approach: Case report
Biography:
Dr Anna Binkiewicz-Glinska has completed medicine studies and her Ph.D from Medical University of Gdansk. She also graduated from University of Ottawa, faculty of economics. She is assistant professor at the Rehabilitation Department of Medical University of Gdansk. She has been publishing papers in reputed journals.
Abstract:
Background Arthrogryposis multiplex congenita is an etiopathogenetically heterogeneous disorder characterised by non-progressive multiple intra-articular contractures, which can be recognised at birth. The frequency is estimated at 1 in 3,000 newborns. Etiopathogenesis of arthrogryposis is multifactorial. Case presentation We report first 26 weeks of life of a boy with severe arthrogryposis. Owing to the integrated rehabilitation approach and orthopaedic treatment a visible improvement in the range of motion as well as the functionality of the child was achieved. This article proposes a cooperation of various specialists: paediatrician, orthopaedist, specialist of medical rehabilitation and physiotherapist. Conclusions Rehabilitation of a child with arthrogryposis should be early, comprehensive and multidisciplinary. Corrective treatment of knee and hip joints in infants with arthrogryposis should be preceded by the ultrasound control. There are no reports in the literature on the ultrasound imaging techniques which can be used prior to the planned orthopaedic and rehabilitative treatment in infants with arthrogryposis. The experience of our team indicates that such an approach allows to minimise the diagnostic errors and to maintain an effective treatment without the risk of joint destabilisation.
Vassilis Lykomitros
Greek National Liaison for Eurospine, Greece
Title: Laparoscopic anterior lumbar interbody fusion with large lordotic cage
Biography:
Dr. Lykomitros has completed his Medical School and Orthopaedic Residency at Athens University Orthop. Dept. KAT Hospital. He received the European Spinal Deformity Travelling Fellowship at 1998. He was Spinal Fellow at Hope Hospital, Manchester University Spinal Unit from Feb. 2000 to July 2001. Since then he works as an Orthopaedic Spinal Specialist Surgeon in Greece. He is also a member of the Patient Line Committee for Eurospine.He has published papers, written chapters in books and gave many lectures on various topics of spinal surgery.
Abstract:
We present our experience with the laparoscopic anterior lumbar fusion and demonstrate the technique with a single, large, lordotic cage, as a new and innovative method for 360 or 540 degree interbody fusions for demanding L5-S1 fusion cases. Materials-Methods: Twelve patients underwent laparoscopic ALIF between October 2010 and April 2014. Mean patient age was 49 years. Patient inclusion criteria were spondylolisthesis, trauma and failure of previous posterior fusion. In the spondylolisthesis and the revision cases, a 540 degree fusion was done, the first part an extended laminectomy and facetectomy with the patient in the prone position. The next part was the laparoscopic placement of a single ALIF type cage in the L5-S1 and in one case in the L4-L5 intervertebral spaces, and the final part of the operation, completing either a 360 or a 540 degree fusion was the posterior instrumentation implantation with graft placement. Mean operative time was 270 min. Results: Early, full mobilization was commenced in all patients. No major complication occurred during or after the surgery and within one year, solid fusion was documented in all twelve patients. A significant improvement in visual analog scale score and Oswestry disability index was documented in all patients. Conclusion: Laparoscopic lumbar interbody fusion when performed with a single, large, lordotic ALIF type cage, is an innovative technique, that in our experience led to excellent results, particularly in the demanding L5-S1 fusion cases and proved to be safe and comparable with the open fusion techniques.