Day 1 :
Northwestern University, USA
Time : 10:00 - 10:30
Todd A. Kuiken received his MD and Ph.D. in biomedical engineering from Northwestern (1990) and his residency in PM&R at the Rehabilitation Institute of Chicago (1995). He is a Professor in the Depts. of PM&R, Biomedical Engineering and Surgery of Northwestern University.
Dr. Kuiken currently is the Director of the Center for Bionic Medicine (CBM). This is a large multidisciplinary team that is focused on translational research in the areas of rehabilitation engineering and surgery. Key projects have include the development of Targeted Muscle Reinnervation, Pattern Recognition Control for powered prosthetic arms, the development of novel robotic arm and leg prostheses and unique wheelchair designs.
Providing adequate control of a powered artificial arm is difficult, especially with high levels of amputation where the need is greatest. We have developed a new technique to create a bi-directional neural interface for artificial limbs called ‘targeted muscle reinnervation’ (TMR). With TMR, it is possible to take the residual nerves in an amputated limb and transfer them to spare muscle and skin in or near the limb. The nerves grow into this muscle and then the surface EMG over this muscle can be used as an additional control signal. For example, if the median nerve reinnervates a small region of surface muscle, then when the amputee thinks ‘close hand’ this muscle will contract and the myoelectric signal can be used to close the powered hand. Since physiologically appropriate neural pathways are used, the control is intuitive, thus easier and faster for the amputee. Similarly, sensory nerves can be transferred to the residual nerves so that skin of the chest or arm is reinnervated-targeted sensory reinnervation (TSR). Then when the amputee is touched on this reinnervated skin, it feels like he or she is being touched in the missing arm or hand. TSR can provide a pathway for true sensory feedback of light touch, graded pressure, sharp/dull and thermal feedback. Research is presented showing how the skin of residual limbs has been reinnervated by hand afferents and our early attempts to provide closed loop feedback. TMR also is proving to be a very successful treatment for painful neuromas and it is likely an effective treatment to prevent neuromas. Essentially when a cut nerve or cut off neuroma are transferred to a small section of denervated muscle (by cutting a local motor point for example), the regenerating nerve now has a volume of muscle to grow into and many functional connections are formed. Thus the nerve is treated in a physiologically appropriate manner, more like a primary nerve repair. Compelling animal model data and a thorough review of neuroma pain in TMR patients will be presented.
LifePharm Global Network, USA
Keynote: Pilot study showed C-reactive protein was significantly reduced in subjects with progressive osteoarthritis consuming a proprietary dietary supplement for 4 weeks
Time : 10:30 - 11:00
Edward Andujar has received his Medical degree from Harvard Medical School and did his Residency at Temple University Hospital in Philadelphia, PA. He had a general practice for 20 years. With the growth of the dietary supplement industry and his interest in the field, he joined LifePharm Global in 2011 as a Research Scientist. He designs protocols with clinical physicians to investigate safety and efficacy of various dietary supplements. His preliminary work of investigating Laminine® and other dietary supplements appears in the Physician’s Desk Reference. He is devoted to educating consumers and other health care professionals in the clinical efficacy of nutritional supplements and their potential benefits.
Statement of the Problem: Osteoarthritis (OA) is a major cause of disability. It causes pain due to inflamed knee joints, involves cartilage degeneration and loss of collagen fibers. Current therapies have little influence on disease progression and are associated with adverse side effects. There is merit for use of safe compounds derived from natural sources for the treatment of OA. Increased serum levels of C-reactive protein (CRP) are observed in patients with OA. A low-level increase in CRP occurs in early disease and is predictive of progressive loss of joint space. CRP levels at presentation may help physicians identify individuals at risk of progression who may be suitable for intervention.
Methodology & Theoretical Orientation: Five subjects experiencing joint stiffness and pain were recruited by the physician. They signed voluntary informed consent for routine blood sampling and supplement ingredients. Subjects consumed one supplement (Laminine®, LifePharm Inc. Lake Forest, CA) in the morning and one in the evening for 4 weeks. Subjects were not asked to modify behaviors or medical regimens.
Findings: A t test for related samples was performed comparing baseline and 4 week final CRP values (p=0.02562). A sign test (p=0.03125) and Wilcoxon matched-pairs signed-ranks test (p=0.03125) were performed to confirm results as sample size was small.
Conclusion & Significance: This pilot study indicated the supplement supported a reduction in CRP in subjects with mild to moderate OA symptoms. The supplement contains proprietary fertilized chicken egg extract, fish and pea proteins. Recent human skin fibroblast experiments showed the unprocessed egg used in Laminine®, contained active Platelet Derived Growth Factor, Transforming Growth Factor β-1, Lysyl oxidase, Fibroblast Growth Factor 2 and chondroitin. When the proprietary egg was added to the cells there was highly significant up-regulation of collagen, elastin and fibronectin production compared to controls. These receptors and mechanisms are also found in connective tissues. Results warrant further studies.
- Orthopedic Surgery | Orthopedic Trauma | Osteoarthritis | Orthopedic Degenerative Diseases
University of Miyazaki Hospital, Japan
Title: Morselized bone grafting in total hip arthroplasty with dysplastic hip: Effectiveness of Protrusio technique
Time : 11:30 - 12:00
Total hip arthroplasty is a standard treatment for patients with symptomatic osteoarthritis secondary to developmental dysplasia of the hip. Better long-terms survival has been observed among patients who have undergone anatomical hip reconstruction. However, as a result of deficient acetabular bone loss, autogenous bone grafting was performed to improve acetabular coverage. In acetabular reconstruction in patients with dysplasia at our institution, we routinely place the cup at the anatomical hip center or slightly high hip fixation aiming at cup-CE angle 0 degree. The purpose of this study was to evaluate the 5 to 11-year follow-up result of dysplastic hip with cementless cup without bulk bone or reconstruct ring. There were 101 primary THA. We examined the clinical and radiographic evaluation. Cup coverage and hip center were measured as cup-CE angle and horizontal and vertical distance. The minimum cup-CE angle was -2° (mean, 20.3°) and tended to be high hip center and many bone grafts. No cup revisions were required and there was no radiographic loosening. All cases use morselized bone only and no need for bulk bone. Low CE angle, even if lower than 0°, as long achieved good press-fit fixation, not only long-term results are obtained, remodeling of the bone can be expected.
University of Bergen, Norway
Title: Predicting outcome in frozen shoulder (shoulder capsulitis) in presence of comorbidity as measured with subjective health complaints and neuroticism
Time : 12:00 - 12:30
Satya Pal Sharma is a Family Physician with special interest in musculoskeletal disorders and in particular shoulder problems. He currently teaches medical students at University of Bergen and family physicians of musculoskeletal disorders. He is a PhD Student/Research Fellow at Institute of Global Public Health and Primary Care, University of Bergen along with his part- time work as Family Physician.
Statement of the Problem: Much has been focused on frozen shoulder and various treatment strategies both conservative and surgical and their outcome. Little is discussed about the comorbidities that may affect the treatment outcome in the condition.
Purpose of the Study: The objective of the study was to investigate whether subjective health complaints and neuroticism can predict treatment outcome in patients with frozen shoulder.
Methodology & Theoretical Orientation: Hundred and five (105) patients divided in two groups: Intervention group with 69 patients and control group with 36 patients, recruited in the main randomized controlled trial study, filled in three questionnaires; the Subjective Health Complaints (SHC) inventory, the Neuroticism (N) component of Eysenck Personality Questionnaire, revised short form (EPQ-R) and SPADI at inclusion, at 4 weeks and 8 weeks. Both total SHC score and subscales in SHC were tested.
Findings: There were no statistically significant differences in demography between the groups at baseline. Pseudoneurology subscale in SHC had significant predictive power p<0.001 in control group at baseline. Intervention group and shoulder pain duration exhibited statistical significant predictive power p<0.001 and p<0.005, respectively but not the control group in change in SPADI after 8 weeks (SPADI at baseline minus SPADI at 8 weeks). Total SHC score, SHC subscales other than pseudoneurology and Neuroticism were non predictive of outcome in frozen shoulder.
Conclusion & Significance: In broader picture, psychometric parameters as measured by Subjective Health Complaints and Neuroticism (N) component of Eysenck Personality Questionnaire, revised short form (EPQ-R) did not predict outcome in frozen shoulder measured by shoulder pain and disability index. One may conclude that in general psychometric parameters probably do not predict outcome in frozen shoulder may be because frozen shoulder is a distinct clinical condition.
Shahid Sayed Nazrul Islam Medical College, Bangladesh
Title: Diaphyseal fracture-nonunion of forearm bone treated by compression plating aided with autologous bone grafting: A study outcome
Time : 12:30 - 13:00
Md. Abul Kenan has completed his Master of Surgery in the field of Orthopedics from Dhaka University, Bangladesh in 2008. He entered as 1st class Government officer under Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh and still working without any interruption. Currently he is working as assistant professor & Head of the Department of Orthopedic Surgery at Shaheed Syed Nazrul Islam Medical College, Kishoreganj, Bangladesh.
Background & Aim: The forearm fulfills an important role in the integrated function of the upper extremity. Fracture nonunion of forearm bone singly or both interfere with normal forearm function grossly. Nonunion of the forearm bone cause dysfunction of forearm as they effect interosseous membrane, elbow and wrist and limit the rotational movement of forearm that is pronation and supination, stiffness of the elbow and wrist due to long term immobilization. But treatment of fracture nonunion of forearm bone is still a therapeutic challenge and outcome is moderate at best. This study was design and carried out to assess the outcome of treatment of fracture nonunion of forearm bone by dynamic compression plating aided with autologous bone grafting from iliac crest.
Method: A prospective study was carried out from January 2010 to December 2015, where 20 cases of fracture nonunion of forearm bone (radius n=8, ulna n=6, both n=6) were treated in government/private hospitals situated in Kishoreganj of Bangladesh. Surgical procedure was performed following AO principle by dynamic compression plating aided with autologous bone grafting taken from iliac crest. Outcome was assessed by regular follow up, radiograph and functional outcome design by Anderson et al. Follow up time was 10 months to 24 months.
Results: Bony union was achieved within a median of 5 months and 18 patient achieved union within 4 months of revision surgery. According to the system of Anderson et al. 11 cases (55%) achieved excellent result, 4 cases (20%) had satisfactory and 5 cases (25%) had an unsatisfactory result. 1 patient developed infective nonunion.
Conclusion: This study showed that treatment of fracture nonunion of forearm bone using technique of compression plating osteosynthesis aided by autologous bone grafting represent an effective treatment option of this challenging condition.
Semalk Hospital, India
Title: An innovative method of closed reduction and percutaneous pinning for all types of fracture distal end radius by using 6 K-wires in 2 plains
Time : 13:00 - 13:30
Born in 1960 in Kollam Dist.,Kerala state in India. Completed medical graduation from Government Medical College,Trivandrum in the year 1986. Completed the post graduation in 1989 from the same institution under the guidance of Prof.Cheryan Thomas and Prof.T.C Joseph. He was married to Dr.Sakunthala in the year 1988.Started his orthopedic carrier as junior orthopedic surgeon at Semalk Hospital, Ottapalam in the year 1989.Mean while for 7 years from 1993 to 1999 he served for government sector and returned back to Semalk Hospital and continuing as the senior Orthopedic Surgeon. He had done more than 5000 orthopedic surgeries of various types concentrating mainly on trauma. From 1999 onwards he started his research work in various fractures of the ends of the long bones by closed reduction and percutaneous fixation with K-wires. Most of the works were done for fractures of distal end Radius, even though there were good number of cases of elbow and ankle. The mode and configuration of fixations were modified several times according to the results. At various stages of modifications of the configurations of the fixations he had presented more than 10 papers in various orthopedic conferences at national and international level.
Introduction: Distal End Radius (DER) is one of the most common fractures. Conventional mode of treatments is POP, ORIF and External Fixation. Presently percutaneous K-wire fixation is used as an add-on procedure to other methods.
Objective: The aim of this study is to find can we do CMR and per-cutaneous pinning alone for fracture DER as a new mode of treatment including comminuted and intra articular?
Materials & Method: It is a prospective study of 200 cases over a period of 4 years from 2011 to 2015. Patients aged ranged from 18 to 84 and grouped it into three groups. 109 patients in Group-1 (aged: 18-45), 65 patients in Group-2 (45-60) and Group-3 (>60) with 26 patients.
Procedure: Two triangles are created by crossing 6 K-wires in plains without skin incision by stabilizing the DRUJ. No wire protruding outside the skin, allows full range of finger movements & Radio-carpel movement from the 1st POP day onwards except supination and pronation. The chance of residual deformity is reduced by the scaffolding action of the crossed K-wires forming 2 triangles in 2 plains by encircling the compressed comminuted metaphysical fragments and by stabilizing the intra-articular fragments.
Results: The results are evaluated on the basis of Green and O’Brien score modified by Cooney by analyzing pain, functional status, range of movement and grip strength. Overall result comes to 92.5% with a split up of 96% for Group-1, 91% for Group-2 and 81% for group-3.
Conclusion: The new mode of closed reduction and percutaneous pinning alone can be used as a surgical mode of treatment for all types of fractures of distal end of Radius.
Discussion: Recent literature shows that specific technique is not as important as attaining anatomical reduction. Clinical outcome and biomechanical studies demonstrate that maintenance of palmar tilt (normal 11), ulnar variance (2 mm) and radial height (normally 12 mm) is the most important factor for obtaining good results. The 2 sets of K-wires crossing in the radial styloid and 2 transverse pins which stabilize the DRUJ prevent the radial inclination deformity, radial shortening and negative ulnar variance. The 2 transverse pins parallel to the articular surface and 2 proximal pins directing to lunar impacted fragments maintain the congruity of the radial articular surface. The 2 sets of 3 K-wires in 2 plains add strength and stability and maintain the normal palmar tilt and prevent metaphysial collapse. It can also hold the fragments of Barton's.