6^th Annual Surgeons & Orthopedics Conference & Expo September 12-14, 2016 Atlanta, Georgia USA

Biography:

Xiaosong Chen is currently working in the Department of Plastic Surgery, Union Hospital of Fujian Medical University, China.

Abstract:

Objective: This study is to identify whether miR-26a is a target gene of bile acid receptor TGR5 in BAT in spontaneous and diet-induced obesity animal models, thus providing a potential link between TGR5 and miR-26a expression.

Methods: We used spontaneous and diet-induced obesity mice to be determined whether TGR5 is the only receptor required to mediate the effect of OA on obesity. Mouse body weights were monitored during the entire process. Histological examination and metabolic measurementswere also performed.

Results: TGR5 partially mediated the effect of OA on obesity and glucose regulation.TGR5 activation increased the expression of miR-26a.TGR5 activation up-regulated miR-26a expression in macrophages.JNK pathway was downstream of TGR5 in miR-26a induction.TGR5 responsible DNA sequences were in the proximal regions of miR-26a promoter.

Conclusion: These findings suggest the activation of TGR5 by OA can modulate the expression of miR-26a through a JNK-dependent pathway for the treatment of obesity-associated metabolic diseases.  

Biography:

Abstract:

Background: Botulinum toxin is a proven and widely used treatment for numerous conditions characterized by excessive muscular contractions. Recent studies have assessed the analgesic effect of Botulinum toxin in joint pain and started to unravel its mechanisms.

Literature-search-methodology: We searched the international literature via the Medline database using the term “intraarticular botulinum toxin injection” combined with any of the following terms: “knee”, “ankle”, “shoulder”, “osteoarthritis”, “adhesive capsulitis of the shoulder”.

Results: Of 16 selected articles about intraarticular botulinum toxin injections, 7 were randomized con-trolled trials done in patients with osteoarthritis, adhesive capsulitis of the shoulder, or chronic pain after joint replacement surgery. Proof of anti-nociceptive effects was obtained in some of these indications and the safety and tolerance profile was satisfactory. The studies are heterogeneous. The comparator was usually a glucocorticoid or a placebo; a single study used hyaluronic acid. Pain intensity was the primary outcome measure.

Discussion & Conclusion: The number of randomized trials and sample sizes are too small to provide a satisfactory level of scientific evidence or statistical power. Unanswered issues include the effective dosage and the optimal dilution and injection modalities of botulinum toxin.

Biography:

Jirko Kühnisch has received his PhD in Biochemistry from Free University Berlin. Throughout his PhD and Post-doctoral studies, he concentrated on molecular mechanisms and therapeutic approaches of monogenic diseases of the skeleton (e.g. Neurofibromatosis Type 1). He is currently at the ECRC/MDC and focuses on mechanisms and therapies in cardiomyopathy. He has published more than 20 papers in reputed research journals. 

Abstract:

Patients with Neurofibromatosis Type 1 (NF1) develop subcutaneous benign tumors and dysfunction of multiple organs. About 30% of NF1 patients are affected by skeletal signs such as osteopenia, kyphoscoliosis, tibia bowing, or pseudarthrosis of the tibia. NF1 is caused by autosomal dominant mutation of the NF1 gene encoding the protein neurofibromin a regulator of the MAPK/ERK pathway. During the last decade we and others elucidated for the NF1 associated skeletal phenotype the molecular mechanisms, structural defects and explored therapeutic approaches by using tissue specific knockout mice and patient samples. In Nf1-Prx1 and Nf1-Col1 mice we demonstrated that loss of neurofibromin leads to multiscale defects in cortical bone i) increased marco-porosity, ii) increased micro-porosity (osteocyte lacunae), iii) diminished mineralization, and iv) reduced organic matrix maturation. This overall weakens the mechanical strength of bone tissue in long bones significantly. In NF1 patients this may result in fractures and pseudarthrosis. Inhibition of the MAPK/ERK pathway with Lovastatin, Trametinib, PD0325901 and Selumetinib normalized bone healing in neurofibromin knockout mouse models. Downregulation of the MAPK/ERK pathway restored normal osteoblast differentiation/function and sufficiently prevented accumulation of fibroblasts within the bone fracture site. In a recent breakthrough study, Asfotase-a,  replacing alkaline phosphatase (ALP) function specifically in bone tissue, was used to restore normal bone mass in Nf1-Osx1 knock-out mice. In summary, neurofibromin controls development of the skeletal system by regulating the MAPK/ERK pathway in chondrocytes, pre-osteoblasts, osteoblasts, and osteocytes. Therapeutic approaches normalizing MAPK/ERK and ALP activity promise future therapeutic inventions for NF1 patients. 

Biography:

Margaret WisÅ‚owska is the Head of the Department of Internal Medicine and Rheumatology at Szpital Kliniczny MSW, Poland. She is a Specialist in Internal Medicine, Rheumatology, Rehabilitation Medicine and Hypertension. She is the author of over 200 scientific papers and books. She has participated in numerous scientific meetings and is a Promoter of 12 PhD thesis. She took trainings at Guy and St. Thoma’s Hospitals in London, Charity Hospital in Berlin and Rheumatology Institutes in Prague and Moscow. In 2003, she started the Department of Internal Medicine and Rheumatology; and in 2010 the Clinic of Internal Medicine and Rheumatology Szpital Kliniczny MSW, Poland. She is a Professor at the Warsaw Medical University, Poland.

Abstract:

Sjogren syndrome [SS] is an inflammatory autoimmune disease affecting primarily the exocrine glands. Lymphocytic infiltrates replace functional epithelium leading to decreased exocrine secretions (exocrinopathy). Characteristic autoantibodies, anti-Ro (SS-A) and anti-La (SS-B) are produced. Mucosal dryness manifests as xerophthalmia (keratoconjunctivitis sicca), xerostomia, xerotrachea and vaginal dryness. The periepithelial extraglandular manifestations are the results of lymphocytic invasion in epithelial tissues of the lungs, kidneys and the liver. The extraepithelial manifestations, such as skin vasculitis, peripheral neuropathy and glomerulonephritis with low C4 levels, are associated with increased morbidity and high risk for lymphoma. Clinical manifestations include glandular involvement such as ocular involvement and oropharyngeal involvement; and extraglandular manifestations such as arthritis, skin involvement (purpura, annular erythema and Raynaud’s phenomenon); pulmonary involvement (bronchial abnormalities and parenchymal changes), gastrointestinal and hepatobiliary features; neuromuscular involvement (mononeuritis multiplex, polyneuropathy); and renal involvement (renal tubular acidosis, glomerulonephritis). Minor salivary gland biopsy from the inferior lip is a cornerstone for the diagnosis of SS. In microscopic examination, the focal score in an area of 4 mm² of focal aggregates of at least 50 lymphocytes is sufficient for diagnosis. Another possibility to recognize SS is with an ocular staining score of 3 or greater. IgG4 positive multiorgan lymphoproliferative syndrome like Mikulicz disease (MD) is characterized by high serum levels of IgG4 and tissue biopsies showing an infiltration of IgG4+ plasma cells coupled with fibrosis or sclerosis. Compared with SS, MD does not show the same female predominance and is associated with a lower frequency of dry eyes and dry mouth, arthralgia, and serum antinuclear antibody (ANA) test positivity.

Biography:

Dr Fizza Hassan is a Final Year Student at Karachi Medical and Dental College, affiliated with Karachi University. She has been a keen researcher since High School and took part in many scientific projects at city level. She has attended several national and international seminars and conferences. She has taken part in many researches successfully published in international journals and many are ongoing. She is looking forward to a bright future in medical career. 

Abstract:

Background:

Road traffic injuries are an emerging universal public health concern. Globally, RTIs contribute for over 1.2 million deaths and more than 50 million hospitalizations. Abbasi Shaheed hospital, being one of the apex tertiary level hospitals in one of the major cities of the Pakistan, data generated from this source, could be widely applicable to urban population.

Methods:

This was a retrospective hospital based study of road traffic injuries and the sampling technique was non-probability convenient sampling. Data was collected from November 2014 till November 2015 and was analyzed using SPSS version 20. Binary logistic regression analysis was used to access the predictors for road traffic collisions with a p value of less than 0.05 to be statistically significant. Continuous variable of age was presented as mean ± SD and categorical variables of type of vehicle, distraction, helmet status, and seat belt status, type of collision, injury site, injury type, respiratory rate, systolic BP and neurological status were presented as frequency or (%).

Inclusion Criteria:

All patients admitted in the emergency department with presenting complain of bone fractures (greenstick, transverse, oblique, simple, compound, stress/hairline, buckled/torus, compression, segmental, comminuted), bone dislocation and trauma exposing bone due to road traffic accidents including motorcyclists, vehicle drivers and passengers.

Exclusion Criteria:

Bones history of osteoporosis, osteoarthritis, osteomyelitis, rheumatoid arthritis and fracture of a previous fracture bone

Results:

Mean age was 26.83 ± 1.5 SD. Male drivers were 68% among which 70% were motor cyclists. The vehicle of collision was motor cycle in 32% of cases; the source of distraction was vehicle in 3.8% and sign board in 1.3% of cases. Head on collision was 14%, rear end 24% and side swipe was 20%. Musculoskeletal injury was 38.5% and fractures were 36% and lower limb was 23% involved among cases. Systolic BP was >89 in 94%, 76-89 in 5% of cases. Regarding neurological status 94% were alert and 5% responded to verbal stimuli.  The following variables were significantly (p<0.05) associated with road traffic injuries. Regression analysis showed that Colliding vehicle was (OR 1.34, 95% CI 1.15-1.55) and distraction was (OR 1.47, 95% CI 1.38-1.97) statistically significant.  

Conclusion:

Road traffic crashes comprise a major public health dilemma in our setting and contribute significantly to unacceptably high morbidity and mortality. The citizens should be familiar with proper first aid training. Paramedics should be vigilant at all times to correctly respond to a patient’s needs. Medical teams at trauma centers must be proficient in their procedures. Trauma centers should be well equipped to reduce morbidity and mortality. 

Biography:

Dr. Kapil Mani K.C. is currently working in Civil Service Hospital, Department of Orthopedics Minbhavan, Kathmandu as an Orthopedic Registrar since Second July 2011. After 2013 he is acting as an assistant professor as well as orthopedic and joint replacement surgeon. 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: Open reduction and internal fixation is an ideal treatment for displaced unstable lateral condyle fractures. Very few studies have focused on the closed reduction and percutaneous pinning (CRPP) of displaced lateral condyle fractures in children. We prospectively studied the CRPP for minimally displaced as well as displaced lateral condyle fracture except completely rotated fractures to evaluate the functional and radiological outcomes.

Methods: We classified the fractures according to the Song et al classification system based on the pattern and displacement of fractures. We included the stage II, III and IV of lateral condyle fractures excluding Stage I and V. Twenty-three patients were finally enrolled in the study. Fractures were reduced under C arm by varus and longitudinal traction force and fixed with 2 or 3 parallel K wires. Functional outcomes were evaluated according to the Hardacre et al scores.

Results: The Average age of patient in our study was 7.91±2.44 years with 15 (65.22%) of male and 8 (34.78%) of female. There were 13 (50.52%) fractures in left side and 10 (43.48%) in right side, 9 (39.13%) of fractures caused by fall from height. Time to unite the fracture was 6.21±1.08 weeks and total duration of hospital stay was 1.65±0.57 days. There were 22 (95.65%) of excellent and 1 (4.35%) of good results according to the Hardacre et al scores.

Conclusion: Closed reduction and percutaneous pinning can be tried successfully in minimally displaced unstable as well as displaced unstable lateral condyle fractures with excellent functional outcomes provided the good assessment of pattern and displacement of fractures by internal oblique views.

Biography:

Gabriel Enenche Ochube bagged his PhD from Ahamadu Bello University, Zaria as an equine orthopedic surgeon. He was Director of clinics at Gombe state Veterinary hospital where he worked for 2 decades as an equine practitioner. During the period under review he held various posts. He has many publications and currently is a lecturer in the same university where he teaches both undergraduate & post-graduate courses in equine orthopedic surgery.

Abstract:

The use of Aphanizomenonflos-Aquac (stem enhance®) to hasten fracture healing in six clinical cases of compound, mid shaft metacarpal, and metatarsal fractures managed by closed reduction using fiber glass cast and three experimental cases of compound mid shaft metacarpal and metatarsal fractures managed by internal reduction using bone plates and cancellous screws was evaluated for sixteen weeks in Adult African donkeys with average age of eight years. Nine donkeys were used for the study; five were treated with AFA, while four were controls that were not given AFA. Animals in the study groups were administered orally 2 capsules of Aphanizomenonflos-Aquac(AFA) (5mg 7/52) daily each for the first two weeks of a month and for 3 consecutive months. However, the control was not given AFA. Both groups were managed clinically using the same post operative parameters. Hematological parameters (PCV, WBC, Total protein, Hemoglobin concentration, total white blood count), calcium and phosphorus serum assay, stem cell estimation (count) were carried out for both groups and results obtained were analyzed statistically. Although hematological values did not alter significantly (P>0.05) for both groups, stem cell count and total protein were significant (P<0.05) in the AFA treated groups. Post operative radiographs were taken at 0, 4, 8, 12 and 16 weeks, at 4 weeks 100% (n=9) of the treated groups had appreciable level of callus being formed, between 8 to 12 weeks, 6 study donkeys (66%) had their fracture line disappearing and bone remodeling had commenced. Both study and control group were subjected to locomotive assessment test 16 weeks post surgery. The study group exhibited good stance, normal gait and absence of pain while the control walked with a limp and there was obvious pain. Although post surgical complication like wound dehiscence and infection occurred in 20% (n=2) of the cases managed without stem enhance, a success rate of 87% was achieved during the entire procedure. The use of AFA significantly (P<0.05) reduced the average healing time to 13±0.5 weeks as against the control that had 27±0.8 weeks as average, although healing time differed slightly based on the method of reduction employed. AFA produced a superior healing quality as evidenced by the post operative gait and absence of infection in the study group, therefore facilitating the early return of the study group to active physical exercise. It is concluded that Aphanizomenonflos-Aquac (AFA) should be used when treating cases of fracture as it has the ability to hasten fracture healing.

Biography:

Dr. Stephen Yusuf is a register in orthopaedic unit of the Department of surgery of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi State, Nigeria. He studied medicine and surgery in Ahmadu Bello University Teaching Hospital Zaria, Kaduna State, Nigeria. Graduated in 2012, did his internship at ATBUTH-Bauchi. After which, he served for a year in the Nigerian Department of state services (DSS) Hospital Abeokuta. He has co-published several studies in the journal of abstract of the West African college of surgeons along with his head of Department (Head of surgery). 

Abstract:

Osteochdroma is a benign tumor of the bone that occurs during childhood or adolescence. It forms on the surface of bones near the growth plate and compose of bony portion with a cartilaginous cap. Asymptomatic growths are managed conservatively. Excision is done in cases of pain, discomfort or for cosmetic reasons. The aim was to conduct a case by case review of cases of Osteochondroma managed at our institution.

Between November 2015 and April 2016 3 cases were managed in our facility, 2 of the patients were females (ages 9 and 10) while the third patient is a male, 30years. Duration of symptoms prior to presentation ranges from 2-9years. There was a case of multiple exostoses (both shoulders, ribs and the distal tibia) while the remaining two have solitary exostosis (pelvis and distal radius). All patients were evaluated using plain radiographs and computed tomographic scan was done for the case located within the pelvis. The indication for excision range from pain and discomfort to difficulty in ambulation. All patients had excision based on the indication at evaluation. Follow up period was 3months to 8 months. There was significant improvements in the symptoms prior to excision and there was no case of recurrence after excision. All patients were satisfied with the procedure. Excision of symptomatic cases of solitary or multiple exostoses is the mainstay of management of this benign bone tumour. 

Biography:

Ogechi Nwoko was born and raised in Los Angeles, California. She received her Bachelors in Biology with a double minor in Math and Physics from Xavier University of Louisiana. She is currently a second year medical student at Morehouse School of Medicine, with aspirations of becoming an Orthopaedic Surgeon. Ogechi is an Nth Dimensions Scholar. She participated in the Orthopaedic Summer Research Internship at the National Sports Medicine Institute in Lansdowne, Virginia in 2016. 

Abstract:

Introduction: Despite the growing demand for arthroscopic procedures, arthroscopic Bankart repair has yet to surpass its open alternative as the technique of choice for anterior shoulder stabilization. Anterior shoulder instability is a complex medical issue because of its tendency to result in recurrent subluxation of the humerus, transforming an injury from acute to chronic. Many variables of this arthroscopic technique have been measured to assess their influence on patient outcomes. Systematic reviews have been conducted to assess how patients positioned in Beach Chair versus Lateral Decubitus affect the rate of postsurgical recurrent instability.  However in this systematic review, these parameters were examined using only Level I and II randomized clinical studies. Secondarily, we will also assess the most commonly used patient reported outcome measures for shoulder instability.

Methods: A systematic review was performed using multiple medical databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were used: Pubmed, EMBASE, and Cochrane Central Register of Contolled Trials. The search terms “arthroscopic” “Shoulder stabilization” Bankart repair” and “Bankart Lesion” generated a total of 376 studies. All English language Level I and Level II randomized controlled trials regarding Arthroscopic Bankart Repairs written from 1997 to 2016 were included. Studies detailing open Bankart repairs, revision repairs, cadaver studies and biomechanical laboratory studies were all excluded. Studies containing evidences levels of III and below were also excluded. These parameters resulted in the exclusion of 354 studies. Studies were subsequently analyzed by two independent reviewers and an additional 13 studied were then excluded resulting in a total of 9 studies included in the systematic review. 

Results: 9 studies (4 BC position, 5 LD position) met the inclusion criteria. A total of 734 shoulders included, with 553 surgeries were performed in beach chair position while 181 were performed in lateral decubitus. The average age of patients was 26.4 (range 15 – 50). Average overall recurrent instability rates for the beach chair group was 5.1% compared to 4.4% for the lateral decubitus group. Functional outcomes were also measured. Both positions had nearly identical postsurgical ROWE and CONSTANT scores.

Conclusion:

In conclusion lateral decubitus and beach chair position are both viable options for improving instability. Available evidence does not allow definitive conclusions, further research is needed.  Failure definitions need to be standardized and universal functional outcome measures should be adopted for consistency. A survival regression should also be performed in order to further understand failure rates.

Biography:

Stephanie Jones is a 2^nd year medical student at Morehouse School of Medicine. She received her Bachelor of Arts in Psychology from Duke University in 2014. She is the president of the Bonnie Simpson Mason Orthopaedic Surgery Interest Group at Morehouse School of Medicine and a scholar in the Nth Dimensions Program. She has presented her research at the National Sports Medicine Foundation conference in Lansdowne, Virginia and the National Medical Association conference in Los Angles California. Following completion of her Doctor of Medicine degree, she will apply to residency programs in Orthopaedic Surgery and complete a fellowship in Sports Medicine. 

Abstract:

Introduction: Few clinically-based, outcomes studies have been designed to understand the implications of knee flexion angle at the time of graft tensioning during anterior cruciate ligament (ACL) reconstruction. Knee positioning at the time of graft tensioning is of importance due to the risk of complications associated with over-tensioning or under-tensioning of the ACL graft. There is currently no consensus regarding ideal knee positioning during graft tensioning. Some orthopaedic surgeons report a preference for graft tensioning anywhere between 0° of knee flexion and 30° of knee flexion. The study was designed to systematically review the highest level of clinical evidence regarding the outcomes and complications of graft tensioning at 0° of knee flexion and 30° of knee flexion for single-bundle ACL reconstruction with hamstring autograft.

Methods: Following PRISMA guidelines, a systematic review of the PubMed, EMBASE, and Cochrane Library databases was conducted. The following search terms were used: “anterior cruciate ligament reconstruction,” “hamstring autograft,” “outcomes”, and “complications. 501 studies were initially identified. Inclusion criteria were English-language, human subjects, Level I and Level II studies in which a single-bundle hamstring autograft technique was performed for ACL reconstruction and an explicit statement was made of the knee flexion angle at the time of graft tensioning as either 0° of knee flexion or 30° of knee flexion. Exclusion criteria were non-English language, non-human subject, Level III and Level IV studies in which a non-hamstring autograft and non-single bundle technique was performed for ACL Reconstruction. Following strict application of the above criteria and removal of duplicate studies across databases, 491 of the identified studies were excluded. Ten studies were deemed eligible for systematic review. The eligible studies were assessed for bias and methodological quality. Relevant data was extracted, and the studies were analyzed by two independent reviewers on the basis of knee flexion angle at the time of graft tensioning, post-operative functional outcomes, and graft failure. Descriptive statistics were generated in order to conduct a quantitative assessment of the relationship between functional outcomes of ACL reconstruction and knee flexion angle at the time of graft tensioning for ACL reconstruction. Post-operative data was analyzed in three categories: (1) objective functional outcomes, (2) subjective functional outcomes, and (3) graft failure. Objective functional outcomes were assessed using the KT-1000 Arthrometer. KT-1000 Arthrometer was measured by side-to-side difference with normal defined as <3 mm. Subjective functional outcomes were measured using the International Knee Documenting Committee (IKDC) Score, the Lysholm Knee Score, and the Tegner Activity Scale. Graft failure was defined as re-rupture of the ACL graft requiring subsequent revision procedure.

Results: Ten studies were subjected to systematic review. Data from 448 subjects was analyzed. The average post-operative KT-1000 Arthrometer for graft tensioning at 0° of knee flexion was 2.2 mm while 30° of knee flexion was 1.4 mm. The average -post-operative IKDC Subjective Score was 87.0 for graft tensioning at 0° of knee flexion and 81.7 for graft tensioning at 30° of knee flexion. The average post-operative Lysholm Knee Score was 91.7 for the 0° of knee flexion group and was 82.0 for the 30° of knee flexion group. The average post-operative Tegner Activity Scale Scores for the 0° of knee flexion group and the 30° of knee flexion group were 5.3 and 5.2, respectively. The reported graft failure rate for the 0° of knee flexion group was 2.1% while the reported graft failure rate for the 30° of knee flexion group was 3.4%.

Conclusions: The results of the study are supported by previously reported data from biomechanical cadaver models. There is a lack of high-quality, randomized controlled trials which decreases the ability to infer the true effectiveness of one knee flexion angle at graft tensioning over another. Further subgroup analysis needs to be performed to address the influence of additional variables such as surgical technique (i.e. anteromedial portal vs. transtibial femoral drilling approach) on post-operative outcomes following ACL reconstruction.

Biography:

Amer Al-Ani is a Specialist Orthopedic Surgeon and has completed his PhD in the Department of Clinical Science Intervention and Technology (CLINTEC) with the title “Hip fracture in young and old subjects: Aspects on risk factors and outcome” from Karolinska Institute, Stockholm, Sweden. He is an active Researcher at the Stockholm Hip Fracture Group. He has published more than 9 papers in reputed journals.

Abstract:

Background: Reduced bone mineral density (BMD) together with muscle wasting and dysfunction, i.e. sarcopenia, emerge as risk factors for hip fracture. The aim of this study was to examine body composition, BMD and their relationship to trauma mechanisms in young and middle-aged patients with femoral neck fracture.

Materials & Methods: In this study 185 patients with femoral neck fracture aged 20-69 were included. BMD, body composition, including fat-free mass index (FFMI) were determined by dual-X-ray absorptiometry (DXA) and trauma mechanisms were registered.

Results: 90% of the whole study population had a femoral neck BMD below the mean age. In the young patients (<50 years) 27% had a Z-score of BMD ≤ -2 SD. More than half of the middle-aged patients (50-69 years) had osteopenia, i.e. T-score -1 to -2.5, and 35% had osteoporosis, i.e. T-score<-2.5, at the femoral neck. Patients with low-energy trauma, sport injury or high-energy trauma had a median standardized BMD of 0.702, 0.740 vs. 0.803 g/cm2 (P=0.03), and a median FFMI 15.9, 17.7 vs. 17.5 kg/m2 (P<0.001), respectively. FFMI<10^th percentile of an age- and gender matched reference population was observed in one third.

Conclusions: A majority had low BMD at the femoral neck and one third had reduced FFMI (i.e. sarcopenia). Patients with fracture following low-energy trauma had significantly lower femoral neck BMD and FFMI than patients with other trauma mechanisms. DXA examination of both BMD and body composition could be of value especially in those with low energy trauma. 

Biography:

Aparanji Poosarla has been awarded PhD in the year 2005 for working on immunosuppressive compounds in Biochemistry Department, Andhra University, Andhra Pradesh and presently working as Asst. Professor in Department of Biochemistry, Andhra University. To her credit she has published several research papers in reputed national and international journals. More than 20 research papers were presented in various national and international conferences. In addition, CSIR, DST and Immunology Foundation supported financially for presenting her research paper in Asian Congress on Autoimmunity in Singapore in 2009. She has received bursary award for attending FIMSA at New Delhi during 2012. She has been awarded CSIR Pool Scientist, DST young Scientist-New Delhi in 2013.

Abstract:

Introduction: Rheumatoid arthritis is characterized by the chronic inflammation of the synovial membrane of joints resulting cell interactions induce proinflammatory cytokine production which in turn activates the release of proteases leading to bone and cartilage destruction.

Purpose of the study: Modulation of inflammatory cytokines by marine sponge products represents a possible approach to the pharmaceutical prevention and treatment of Rheumatoid arthritis. New treatments could use the effects of Th17 cells on the function of regulatory T cells. IL-17, TNF- α, IL-6 and IL-1 not only promote inflammation but also inhibit regulatory T cell functions. IL-17 appears a novel target in T cell-mediated inflammatory disease, playing a role upstream in the pathologic process. Use of IL-17 inhibitors could be a way to control first inflammation but also to restore regulatory T cell functions.

Methods & Materials: In our laboratory we have screened compounds purified from marine sponge collected at Andaman and Nicobar islands for anti-collagen antibody response and anti-proliferative activity using radiolabelled thymidine. We estimated the levels of IL-17, TNF-α, IL-1β and IL-6, IL-12, IFN-ϒ from T cell culture supernatants of in vitro and in vivo compounds treated arthritic C57/black mice. In addition we also observed the IL-4 levels in the above treated mice.

Results: Cytokines have been found to inhibit TH17 differentiation through various mechanisms. Both IFN- ϒ and IL-4 were recognized as suppressors of TH17 development.

Conclusion: Altered balance between immunosuppressive T_reg and inflammatory Th17 cells appears to be major component in disease pathogenesis.

Biography:

Ahmed S Ahmed went to veterinary school at Cairo University, from which he got his Bachelor, Masters and subsequently PhD in 1977. He was a Professor at the Surgery department of Cairo University, then the Head of the department and currently is an Emeritus Professor. He obtained Post-doctoral studies from Cornell University. 

Abstract:

Denervation of the Coxo-Femoral Joint (CFJ) is a recently introduced surgical technique for the treatment of Canine Hip Displasia (CHD). Synovitis was induced by injecting sodium urate under ultrasonographic guidance in right CFJ in 6 dogs at 2 occasions, one week before surgical denervation and two weeks post denervation. Dogs were then examined for signs of pain, lameness and range of motion of both CFJs. In this study, restriction of CFJ motion and pain were the most important clinical signs after induction of synovitis. Restriction of joint motion was manifested clinically by decreased joint flexion, extension and abduction. A decrease in limb forces of the affected limb and an increase in limb forces in the contra lateral pelvic limb were noticed, while no compensatory loading of the forelimbs was detected. In the present study, selective denervation of the canine CFJ did not result in the prevention of gait abnormalities induced by sodium urate crystals. No significant differences were found when comparing kinetic and kinematic parameters measured following injection, before and after denervation. Thus, the hypothesis that selective denervation of the canine CFJ will prevent CFJ pain from sodium urate crystals induced synovitis was not accepted.

Biography:

Vaibhav G Patel has completed his DNB Orthopaedics from National Board of Examinations, New Delhi, India. He is a Senior Resident at GMERS (Govt. Medical College and Research Centre). He has published 1 paper in reputed journal and presented a case report at SICOT, Jaipur. 

Abstract:

Intertrochanteric fractures constitute more than 50% hip fractures in elder people.
The incidence of fragility intertrochanteric fractures is increasing as the life span is increasing and as the number of high velocity road traffic accidents are increasing. Dynamic hip screw has been gold standard for the treatment of intertrochanteric fractures and has stood the test of time, against which proximal femoral nail; the newer intramedullary device has been designed keeping in mind, the theoretical advantages of placing the implant in the anatomical axis. 45 cases were recruited for the study during the study period of April 2013 to March 2014 and were divided into two groups for undergoing surgery with proximal femoral nail (PFN) for one group and dynamic hip screw (DHS) for the other group by randomization. Short term functional outcome was analyzed using the Harris hip scoring system.

Biography:

Praveen Kumar Pandey has completed his MS Orthopedics from GGSIPU University and became Specialist in department of orthopedics at Government Hospital, Daman & Diu. He has published more than 15 articles in reputed journals and has been serving as a Potential Reviewer of various reputed journals (AOTT, BJMMR, JCDR, Open Journal of Orthopedics etc.).

Abstract:

Advent of Plaster of Paris (POP) many years ago is a novel invention for the field of orthopedics. There are varied and multiple usage of plaster of Paris in day to day orthopedics practice. The first recorded use of plaster in a medical situation was in the 9^th century A.D. in the Arabic world. More modern use is credited to Antonius Mathyson, a Dutch medical officer, who initiated the use of plaster impregnated bandages for the treatment of musculoskeletal injuries in 1852. Classical technique of applying plaster splints for musculoskeletal injuries includes application of cotton roll of adequate thickness followed by putting wet POP splint made of adequate layers & thickness for proper strength and wrapped over by bandage to keep it in position after proper molding. But in this technique we all are facing some problems i.e. drainage of more amount of POP material in dip water, spilling of wet POP material all over the floor, frequent reapplication of POP splints in same patient due to breakage and loosening of splint, difficulty in on and off application of splint for intermittent exercises etc. These problems can be avoided by using readymade POP splints which are easily available in medical store but are very costly. Because of these problems we made some efficient and cheap modifications in this classical technique which includes : a) wrapping the POP splint of adequate thickness with two layers of starch bandage with 50% overlapping before wetting, b) addition of a layer of foam sponge before application of second layer of bandage around dry POP splint when required mostly in pediatric population as their skin is more prone to burns due to exothermic reaction after wetting POP and c) addition of a separate layer of cotton roll of same length and width as of POP splint on both surfaces along the axis of POP splint for easy on and off application in case intermittent exercises required. This slight and easy modification in POP splint application has various advantages mentioned below which we found in our day to day practice: Easy to apply, less drainage of POP material from splints while wetting in dip water, less spillage of POP material on floor as starch bandage holds the POP material in splints well, finally molded splint with smooth edges, easy to remove and reapply when POP splints are required on and off for intermittent mobilization to prevent stiffness and found to have very good strength compared to classical technique of POP splint application in terms of breakage point at the last follow up. This technique is very beneficial for developing countries as this is very easy to make and apply and cheap as well as comfortable for the patients.

Biography:

Abstract:

INTRODUCTION

The femur shaft is one of the most commonly fractured long bones occur in children. A relatively infrequent complication is Non union which can result in shortening, angular malalignment or rotational deformities. The factors that cause non-union may be considered as those inherent in the fracture, patient (host) factors and surgical (treatment) factors. Unstable fixation, excessive iatrogenic stripping of the periosteum, infection, malnutrition, chronic alcoholism and injudicious interventions by traditional bonesetters are other risk factors.

Non union with severe angulation following surgery of the midshaft femur fractures presents with a twin problem of cosmetic and functional derangements. It is a challenge to the Surgeon, especially in the presence of a precarious soft tissue envelop from poorly managed concomitant open injuries. Deep soft tissue scarring are other sources of management challenge for the Surgeon.

CASE REPORT

A 13-year old Indian boy presented to us with a 1-year history of severe deformity of his midshaft right thigh and difficulty in walking. He was involved in a trauma at a construction building site when a heavy block of stone fell on his right thigh. He sustained an open injury to his right thigh and was treated with (rush) nailing for his midshaft femur fracture of right femur.

On examination, he had a short limb of right lower limb with an anterior angular deformity of the right thigh. There was a surgical scar of about 15cm and a non surgical scar of 7 cm present over anterior aspect the right thigh. Gross muscle wasting of 2cm noted on thigh component. 

Clinically there was no abnormal mobility and non-united fracture of the midshaft femur with anterior angulations of the thigh measuring 90 degrees. There was a limb length discrepancy of 12 cm on right side.

INVESTIGATIONS

Radiograph of right thing in AP & Lateral view which showed feature of non-union fracture of right femur with fracture gap, sclerosis of fracture ends, rounding of fracture end, obliteration of medullary cavity and osteoporosis of fracture fragments

TREATMENT

The first stage conservative management comprised of upper Tibial skeletal traction using 5 kg weight gradually increasing to 9kg  where the limb were kept on bohler braun splint for 4 weeks.

The operative stage: An open reduction, implant removal, freshening of sclerosed ends and internal fixation with inter locking nailing.

At 16 weeks post operatively, there was clinico-radiologic evidence of union and the patient was allowed for progressing on weight bearing as tolerated.

Biography:

Head of department de chirurgie orthopédique et traumatologie, groupe hospitalier du Havre.
 

Abstract:

Reverse shoulder arthroplasty (RSA) is increasingly being used to revise anatomical total shoulder arthroplasty cases. This procedure’s high complication rate has been reduced by the availability of modular shoulder system, which allows the humeral component to be preserved during the conversion. This case report describes the revision of an anatomical shoulder implant inserted in 1998.  Polyethylene wear and resulting metal-on-metal contact had caused metallosis. Since the existing humeral implant was not compatible with standard conversion products, the manufacturer provided a custom humeral adapter that allowed the humerla stem to be preserved. This approach greatly simplified the surgical procedure and resulted in good anatomical and clinical outcomes after 9 months of follow-up.

Biography:

Dr. Thomas Gross leads the nation in hip resurfacing. He began performing metal-on-metal total hip resurfacing arthroplasty (HRA) in 1999. With the retirement of Dr. Harlan Amstutz, he now has the longest track record of performing this operation in the United States. He has performed over 3500 HRA, which is the fourth largest series in the world.

Dr. Gross’ published track record is one of the best in the world. In unselected patient series of hip resurfacing, he has published 10-year implant survivorship of 93% with the Corin Hybrid system, 97% 10-year implant survivorship with the Biomet Hybrid system, and most recently 98% 8-year survivorship with the uncemented Biomet system in peer reviewed scientific journals. 

Abstract:

A recent report from the Nordic Arthroplasty Register showed patients under 50-years old receiving traditional total hip arthroplasty present only 83% 10-year implant survivorship in 14,600 cases. These poor clinical results do not meet the National Institute for Health and Care Excellence of Great Britain’s guideline of 95% 10-year implant survivorship. The purpose of this study is two-fold: First, we evaluate the ability of metal-on-metal hip resurfacing arthroplasty to meet these strict standards in young patients. Next, we compare outcomes between younger and older patient cohorts to evaluate the validity of the long-standing hypothesis that young patients are at higher risk for revisions and complications. From January 2001 to August 2013, a single surgeon performed 1285 metal-on-metal HRA in patients younger than 50-years old.

Approximately 40% of patients reported a UCLA activity level of 9 or 10 postoperatively, equal to regular participation in impact sports. There were 48 (3.7%) failures. Kaplan-Meier survivorship was 96.5% at 10 years and 96.3% at 12 years for the entire group, which did not vary from older patient 12-year implant survivorship at 97% (log-rank and Wilcoxon p=0.2). While a disparity exists in overall implant survivorship between young men and women (98% vs. 93%, respectively, p<0.0001), this margin was considerably smaller in the uncemented Recap™ group, which had an 8-year survivorship of 99% in men and 97.3% in women (p=0.01). Hip resurfacing arthroplasty in young patients exceeds the National Institute for Health and Care Excellence’s criteria for 10-year implant survivorship. As resurfacing technology and experience advance, results continually improve. We allow our resurfacing patients to participate in unrestricted activity, with 40% choosing to engage in high impact sports postoperatively, while total hip patients are typically more restricted. In sum, hip resurfacing in young patients provides excellent survival and superior functional results compared to total hip arthroplasty.

Biography:

Abstract:

The surgical care of the traumatology in Kisangani (Democratic Republic of the Congo “DRC”) comes up against constraints medical-economic and cultural which often end in delayed care. The purpose of this study was to determine the deadlines of care, the operating deadlines and to correlate them in the postoperative complications. The Functional and radiographic results of the fractures of leg were also evaluated. Our hypothesis was that the rate of complications is significantly higher in case of the delayed care (coverage). This retrospective study was realized in Kisangani University Hospital from 1996 to 2009. 76 leg fractures or tibial pilon treated by internal or external fixation closed or open hearth were analyzed. Functional and radiographic results were evaluated at 12 months minimum. The care of the patient loads was late. The average time of admission at the hospital was of 19±18.28 days (extreme from 1 to 90 days) with a significant difference of the complications according to the time of admission (p<0.05). The operating time after admission was 9.5±8.51 days (Extremes of1 to 30 days) with a significant difference complications according to the operative time (p<0.05) at the expense of late operated patients (infections and nonunion). The time of admission or the operating time after admission does not influence the operating results functional (p>0.05). These results are consistent with those reported in the literature. The delay of surgery is a partner to the increase of postoperative complications (infection and nonunion) and hospital stay. A delay of more than an operative 48 hours must be avoided, but not for the medically unstable patients who require medical stabilization period. Level of evidence - Level IV: retrospective - historical series.

Biography:

Jorge Uriel Carmona Ramirez, professor of the Faculty of Agricultural Sciences at the University of Caldas, was appointed to support the Chamber of the National Intersectoral Commission for Quality Assurance in Higher Education (cognacs) in the area of agriculture, forestry, fisheries and veterinary medicine.

Award:

- High Quality re-accredited by the Ministry of National Education (until 2018).

- Certification of quality Icontec and IQNet.

Abstract:

Introduction: There are scarce data about the knowledge of differential effects of platelet rich (PRG) supernatants on normal equine cartilage explants. We believe that these substances should only be used in osteoarthritic cartilage, because they could induce inflammation in normal joint tissues.

Aims: The aims were: (1) to evaluate the effects at 48 and 96 h of two concentrations (25 and 50%) of leukocyte- and platelet-rich gel (L-PRG) and pure platelet rich gel (P-PRG) supernatants on the production/degradation in normal equine cartilage explants (CEs) of platelet-derived growth factor isoform BB, transforming growth factor beta-1, tumour necrosis factor alpha, interleukin (IL) 4 (IL-4), and IL-1 receptor antagonist (IL-1ra); and (2) to study possible correlations of these molecules with their respective PRG supernatant treatments.

Methods: CEs from six horses were cultured for 96 h with L-PRG and P-PRG supernatants at 25 and 50% concentrations, respectively. CE culture media were changed each 48 h and used for determination, by ELISA, of the molecules. L-PRG and P-PRG supernatants at 25 and 50%

Results: Concentrations influenced the molecular anti-inflammatory profile of CE groups cultured with these substances. 50% L-PRG supernatant produced the best regulatory effects when compared to the CE control group and the CE group treated with the other PRG supernatant concentrations.

Conclusions: PRG supernatants induced pro-inflammatory and possibly regulatory effects in normal CEs; situation that is different for the same tissues challenged with LPS, where these substances induce a more dramatic anti-inflammatory effect.

Biography:

Rachel W Li was a Surgeon and Senior Liver Disease Specialist leading a number of Clinical Trials in Anti-inflammatory Drugs before she completed her PhD at Southern Cross University, Australia. She gained her Post-doctoral experiences in Molecular Pharmacology from the University of Hawaii, USA. She joined the Trauma and Orthopaedic Research Unit (TORU) at the Australian National University Medical School and established TORU Laboratory with a focus on Osteoimmunology.

Abstract:

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovial inflammation in multiple joints with hyperplasia of the synovial intimal lining layer, influx of inflammatory cells and angiogenesis, eventually resulting in the destruction of cartilage and bone. The early process of angiogenesis is recognized as a fundamental process in pannus formation. Given that angiogenesis is one of the earliest manifestations in RA, the ability to determine a marker for angiogenesis and demonstrate its specificity in RA would aid in disease diagnosis. Despite the diagnostic contribution of currently used RA markers and rheumatoid factors, about one-third of RA patients remain seronegative. Heparanase (HPSE) activity is implicated in promotion of angiogenesis in the synovium and RA progression. The action of heparanase is involved in multiple regulatory events related, among other effects, to augmented bioavailability of growth factors and cytokines at sites of inflammation, allowing extravasation of immune cells into nonvascular spaces and releasing inflammatory mediators that regulate angiogenesis. We reported a highly significant increase of HPSE activity and expression in synovial fluid and synovial tissue of RA patients, and the increase of the heparanase activity positively correlates with angiogenic gene expression. We have further obtained preliminary evidence from which we postulate that the involvement of HPSE in gene regulation in the development of pannus in RA may be reflected in the patients’ blood, which makes heparanase a potential predictor of RA progression and a novel therapeutic target in RA.

Biography:

Abstract:

Background: In a developing country like ours  patients with compound fracture often reach a tertiary care center after the described "golden period" window of internal fixation that has been standardized as 6 hours according to literature due to various factors. There are very few studies describing the result of internal fixation in delayed golden period "6-24"hours.

Material & Methods: This is prospective study carried out from feb2010 to Jan 2012. All cases of compound fractures Type I, II Type IIIA and IIIB were included .These were operated after the golden period but before 24 hours of injury. The study includes a total of 40 patients. There were 36 males and 4 females. Age ranged from 12 years to 58 years with the mean age of 28 years. Gustilo – Anderson classification was used to   classify the fractures. Follow up period was of 36 months (mean 26.3 months). Exclusion criteria were parents with head injury, type IIIC compound fractures and those with associated spinal injury. The purpose of following study is to assess the infection rates, union, implant failure and need for additional procedures after internal fixation was done in compound fracture in "delayed golden period” that is 6-24 hours after adequate debridement of the wound and appropriate antibiotic coverage.

Results: Mechanism of injury was road traffic accident in 33 patients, fall from height in 7 patients. Out of 40 fractures 14 were type I 12 were type II, 14were type III compound fractures.17 patients presented within 6-12 hours, 23 presented from 12-24 hours. The patients were taken for debridement and fixation after 16.7 HOURS (MEAN) hours of injury. Average infection rate was 9.2% (Type 1 - 7.14% (1/14), Type 2- 8.33% (1/12), Type 3 - 14.2% (2/14)) which was comparable or less then in literature .Non union was seen in 5 patients. 3 were managed with bone grafting while 2 were managed with exchange nail. There was no incidence of implant failure. Functional evaluation was done according to the Kattenjian criteria. Good to excellent results were seen in 70 percent of patients.

Conclusion: There are definitive advantages of internal fixation in open fracture provided infection can be prevented by careful and radical debridement along with judicious use of antibiotics. 

Biography:

Praveen Kumar Pandey has completed his MS Orthopedics from GGSIPU University and became Specialist in department of orthopedics at Government Hospital, Daman & Diu. He has published more than 15 articles in reputed journals and has been serving as a Potential Reviewer of various reputed journals (AOTT, BJMMR, JCDR, Open Journal of Orthopedics etc.).

Abstract:

Background: Ceramic bearings are widely used in total hip arthroplasty (THR) along with metal and polyethylene bearings. There were several studies in past few years evaluating the advantage of one over the other. The young population with high activity levels has an increased risk of wear debris production at bearing surface and subsequent implant failure. Recently, interest and use of a ceramics with high wear resistance has been growing. Early reports on ceramic on ceramic THR have demonstrated excellent clinical and radiological results.

Purpose: To evaluate clinical, functional and radiological outcomes of cement-less ceramic on ceramic primary total Hip Replacement (THR) in young patients (<50 years age) with diagnosis of avascular necrosis femoral head.

Study Design: Single-centre, prospective comparative study of prospectively collected outcomes, with a minimum of 12 month follow-up.

Patient Sample: 30 patients who underwent cement-less ceramic on ceramic primary THR in young patients (< 50 years age) for avascular necrosis of femoral head.

Outcome Measures: For clinical evaluation, Harris hip scores were measured pre-operatively and post-operatively at predefined intervals. For radiological evaluation, Post- operative radiographs were checked for alignment of femoral stem, loosening of stem, presence of heterotopic ossification, loosening of acetabular component at predefined regular intervals.

Method: This study included 30 patients, who underwent cement-less ceramic on ceramic primary THR in young patients (< 50 years age) for avascular necrosis of femoral head between July 2013 and April 2015 with a minimum of 12 month follow-up.

Results: The mean Harris hip score in our study increased from 32.73 pre-operatively to 87.8 post-operatively at the latest follow up with 90% hips having good-excellent results. This improvement was statistically significant (p<0.005). On evaluation of alignment of femoral stem 27 stems were central (90%) and 3 stems found to be in valgus (10%) and none to be in varus position. There was no significant correlation between stem alignment and clinical outcome based on Harris hip score. Not a single case of focal osteolysis, stem loosening or heterotopic ossification was seen in our study till latest follow-up. None of the major complication was noticed during evaluation of our cases except minor chronic hip pain in one patient which did not restricted his daily living activities.

Conclusion: In our study, we found better results of ceramic on ceramic THR for younger patients (<50 years age) comparable to previous studies with no serious complication found in any patient. Based on our study, we recommend ceramic on ceramic THR for younger patients in the age group of less than 50 years of age. We need a study of large sample size with long term follow up to further confirm the findings of our study.

Biography:

Abstract:

Introduction: Although total knee replacement (TKR) is a common procedure, it may lead to complications such as infections or the need of blood transfusion following the surgery. Previous studies based on data from developed countries found that the incidence rate of blood transfusion following TKR is between 8-18% and identified several risk factors associated with increased risk of blood transfusion. However, data in this area is still limited in Saudi Arabia. Therefore, this study aims to examine the incidence and predictors of blood transfusion following TKR at a large trauma center in Saudi Arabia.

Aim & Objectives: 1. To estimate the incidence rate of blood transfusion following primary TKR at National Guard Hospital in Riyadh, Saudi Arabia. 2. Determine the key predictors of blood transfusion following TKR.

Methods: A retrospective study on 462 cases of adult patients who underwent primary TKR from 2010-2015 at National Guard Hospital (NGH) in Riyadh, Saudi Arabia. Data pertaining to baseline clinical and demographic characteristics, co-morbidities, preoperative hemoglobin (Hb) level, American Society of Anesthesiologist (ASA) score, blood loss and surgery related data, and whether the subject has received blood transfusion were extracted from medical charts. Descriptive statistics were compared by blood transfusion status. To determine the predictors of blood transfusion, all statistical tests were declared significant at a level of 0.05 or less. Significant variables were further included in the logistic regression model.

Results: The overall incidence rate of blood transfusion following TKR surgery was 35.3%. The incidence rate of blood transfusion following unilateral TKR and bilateral TKR, were 27.72% and 73.68%, respectively. The multivariate regression analysis identified bilateral surgery, low preoperative Hb level, and high amount of blood loss as key predictors of blood transfusion.

Discussion: To our knowledge, this is the first study to estimate the incidence rate of blood transfusion following TKR and its predictors in Saudi Arabia. The main findings in study were as follows: (1) The study suggests that the incidence rate of blood transfusion is high. This is particularly true when compared to published literatures where the rates are at least 50% less than our estimate. One important factor leading to such high incidence is the inclusion of subjects with bilateral TKR. (2) However, looking at the rates of unilateral TKR in our study, it suggests that we are 1.5 times higher than the other studies. (3) Our findings suggest that bilateral surgery is associated with a high incidence rate of blood transfusion. It is difficult to judge the magnitude of our findings in the light of lack of similar studies. (4) The predictors of blood transfusion following TKR were low preoperative Hb level, high amount of blood loss, and bilateral TKR.

Conclusion: The estimated rates for blood transfusion presented in this study are much higher than any previously published study. Bilateral surgery, low preoperative Hb level, and high amount of blood loss found to be key predictors of blood transfusion. Quality improvement programs may use these findings to guide initiatives aimed to improve surgery outcomes and reduce patients’ complications.

Biography:

Abstract:

Background: Several methods are available for fixing the femoral side of a hamstring auto graft in ACL reconstruction and the best method is unclear. Biomechanical studies have shown varying results with regard to fixation failure. There are 2 fixation types for ACL grafts in femoral tunnel: aperture fixation and non-aperture fixation. Aperture fixation describes graft fixation at the opening of the bone tunnel, typically with an interference screw. Suspensory fixation describes graft fixation that is remote from the intra-articular space (i.e., at the femoral or tibial cortices) using endobutton or tight rope. Our study compares the results following two methods.

Material & Methods: A total of 60 patients were undertaken in the study and institutional review board approval was taken along with patient’s consent. They were divided into two groups randomly. The ACL reconstruction was done in two groups using endobutton in 30 and interference screw in another 30.The tibial site was fixed with interference screw in all the cases. Our primary outcome measure was comparison of lysholm II score and tibial translation while secondary outcome was surgery time, tourniquet time, Lachman test, pivot shift, range of motion, Quadriceps control.

Results: At 6 months follow up 60 patients completed clinical evaluation. The primary outcome measure Tibial translation using rolimeter (KT-1000) was 3.6±1.2mm (tight rope) and 2.9±1.12mm (interference screw). P=0.027 is considered to be statistically significant. The post op lysholm II score was 96.5±6.42 (IS group) and 95.9± 8.6, P-value equals 0.77 this difference is not statistically significant. There was no significant complication in either group in addition no difference was found in two groups in secondary outcomes.

Conclusions: Our study concludes that while there is significant difference in tibial translation the lysholm II scoring and secondary outcomes showed no significant difference in the two groups.

Biography:

Amer Al-Ani is a Specialist Orthopedic Surgeon and has completed his PhD in the Department of Clinical Science Intervention and Technology (CLINTEC) with the title “Hip fracture in young and old subjects: Aspects on risk factors and outcome” from Karolinska Institute, Stockholm, Sweden. He is an active Researcher at the Stockholm Hip Fracture Group. He has published more than 9 papers in reputed journals.

Abstract:

Background & Purpose: Prospective studies on patient related outcome in patient <70 with a femoral neck fracture (FNF) are few. We aimed to investigate functional outcome and health-related quality of life (HRQoL) in 20-69 years old patients with a FNF treated with internal fixation.

Patients & Methods: 182 patients, 20-69 years with a FNF treated with internal fixation were prospectively included in a multicenter study. Follow up included radiographic and clinical examination at 4, 12 and 24 months. Collected data were on hip function using Harris hip score (HHS), HRQoL (EQ-5D and SF-36), fracture healing and re-operations.

Results: At 24 months, HHS was good or excellent in 73% of the patients with displaced fractures and 85% of the patients with non-displaced fracture (p=0.15). Of the patients with displaced fracture (n=120), 23% had a non-union (NU) and 15% had an avascular necrosis (AVN) with a 28% re-operation rate. None of the patients with non-displaced fracture (n=50) had an NU, 12% had a radiographic AVN and 8% needed a re-operation. The mean EQ-5D_index in patients with displaced fracture decreased from 0.81 to 0.59 at 4 months, 0.63 at 12 months and 0.65 at 24 months (p<0.001). The corresponding values for patients with non-displaced fracture were 0.88, 0.69, 0.75 and 0.74 respectively (p<0.001). The mean SF-36 total score in patients with displaced fracture decreased from 76 to 55 at 4 months, 63 at 12 months and 0.65 at 24 months (p<0.001). The corresponding values for patients with non-displaced fracture were 80, 67, 74 and 0.76 respectively (p<0.001).

Interpretation: Three-quarters of the patients with displaced femoral neck fracture were healed after one operation and reported good or excellent functional outcome at 24 months. However, they did not regain their pre-fracture level of HRQoL. 

Biography:

Ali Andalib has completed his MD from Isfahan Medical University and then Orthopedics surgery in Alzahra University hospital and Kashani university hospital. He is the Assistant Professor in orthopedics department of surgery. He is one of the members of orthopedics research committee department.

Abstract:

Introduction: Treatment of comminuted fractures of long bones has long been a problem in orthopedic surgery. Recently fixation without opening the fracture site known as MIPO (minimally invasive plate osteosynthesis) has been used. We performed this study to assess the result, and complications of this treatment for comminuted fractures of tibia and femur.

Method: 49 patients with femoral and tibial comminuted fractures were treated with minimal invasive plate osteosynthesis. After biological fixation, joint motion was started but avoided weight bearing until radiographic evidence of union was occurred.

Results: 32 femoral fractures and 17 tibial fractures were evaluated. In 48 patients, union was completed but in one patient with femoral fractures, there was nonunion. After bone graft and giving 9 months to heal, full union achieved. Mean union time in all patients in this study was 18.57±2.42 weeks. According to the t-test exam, all of the results were statistically significant (p=0.09)

Conclusion: according to the result of this study and comparing it with others, MIPO is safe, simple and effective method of fixation for comminuted fractures of long bones. It has a high rate of union with minimal complication. 

Biography:

Christoph Lutter currently works as a research fellow at the CVPath Institute in Washington D.C. His research focus is rock climbing related injuries of the upper extremities and the hand (such as UEDVT, pulley injuries, injuries of the carpal bones).

Abstract:

Objective: Sport climbers strain passive and active anatomical structures of their hands and fingers to the maximum during training or competition. This study was designed to investigate bone marrow edema in rock climbing athletes.

Design: Systematic detection, treatment and follow-up investigation of rock climbing athletes with bone marrow edema of the hand.

Setting: Primary-level orthopedic surgery and sports medicine division of a large academic medical center.

Patients: Thirty-one high-level climbers with diffuse pain in the hand and wrist joint caused by rock climbing were included in this study.

Interventions: The therapy consisted of consequent stress reduction and break from sporty activity.

Main outcome measures: Reduction of bone marrow edema in MRI and regain of pre-injury climbing level (UIAA metric scale).

Results: In 28 patients, the MRI revealed osseous edema due to overload at the respective area of interest, mainly in the distal radius, the distal ulna or the carpal bones, which could not be identified otherwise diagnosed as inflammations, tumors or injuries. We classified these edemas and fractures of hamate as due to overload. The edema resulted as a stress reaction to highly intensive training and climbing, with presumably high traction to the wrist area. The control MRIs demonstrated that - even with a consequent stress reduction - these edemas need three to four months to disappear completely.

Conclusion: Climbers with an unspecific, diffuse pain in the wrist and/or the fingers should be examined with MRI to detect or exclude the diagnosis of a bone marrow edema (BME). 

Biography:

Ketan Desai, MD, PhD is the CMO of Levolta Pharmaceuticals and the Inventor of the Lead Compound, Volt01. He was trained at Washington University in Saint Louis and Baylor College of Medicine. He has been in the Pharmaceutical Industry for 18 years and started his own companies in 2006. The companies include a Radiology Company and Levolta Pharmaceuticals. He is a consultant for hedge funds and venture capitals.

Abstract:

Osteoarthritis (OA) is the most common form of arthritis worldwide with rising incidence and prevalence in part due to ageing and obesity. In Western populations it is one of the most frequent causes of pain, loss of function, and disability in adults. In the US, Osteoarthritis affects 30% of the population with nearly 1 in 2 people expected to develop knee osteoarthritis by age 85. Over 40,000 total knee and hip replacement procedures were performed in 2013, the majority for OA, each costing between $15,000-$31,900. Despite its large disease burden, there are currently no approved disease-modifying drugs available which modify structural progression of OA. Conventional treatment of OA is mostly symptomatic and costly. Therefore, there is urgent need for a disease modifying osteoarthritis drug (DMOAD). Bisphosphonates have been evaluated as DMOAD. Zoledronic Acid (ZA) is the most potent bisphosphonate and is approved for prevention and treatment of osteoporosis, Paget’s disease and certain bone cancers. A phase 2 randomized controlled trial of ZA in OA of knee in Australia (ZAP study, zoledronic acid for knee pain) showed efficacy at six months of ZA in decreasing bone marrow lesions in OA by MRI. This study describes the ability of a new formulation of ZA, VOLT01 (US patent # 13/791,685, US, WO PCT/US14/22169), to treat OA. In comparison, to ZA, VOLT01 showed superior efficacy in controlling osteoarthritis pain. 

Biography:

Head of Department of Orthopedic Surgery and Traumatology, Le Havre Hospital Group.

Abstract:

Reverse shoulder arthroplasty (RSA) is increasingly being used to revise anatomical total shoulder arthroplasty cases. This procedure’s high complication rate has been reduced by the availability of modular shoulder system, which allows the humeral component to be preserved during the conversion. This case report describes the revision of an anatomical shoulder implant inserted in 1998.  Polyethylene wear and resulting metal-on-metal contact had caused metallosis. Since the existing humeral implant was not compatible with standard conversion products, the manufacturer provided a custom humeral adapter that allowed the humerla stem to be preserved. This approach greatly simplified the surgical procedure and resulted in good anatomical and clinical outcomes after 9 months of follow-up.

Biography:

Mohamed El Sayed is a working Professor at Tanta & Cairo Universities in Egypt. He is a reviewer for 4 international scientific journals, an Editorial Board Member of 3 international journals and published more than 28 international articles in the last 10 years.

Abstract:

Background: Although the standard treatment of clubfoot deformity is conservative by serial casting techniques, relapses are not uncommon. Management of relapsed clubfoot deformity in older children is an orthopedic challenge. There is a growing interest in management of such complex deformities using the Ilizarov technique.

Methods: In this study, the Ilizarov frame was used to correct severe relapsed clubfoot deformities in older children, whom underwent previous surgical interventions. 42 relapsed clubfeet were included. The Dimeglio classification was used for clinical assessment of the relapsed feet pre-operatively as well as post-operatively.

Results: After an average follow-up period of 4.6 years, and according to the Beatson and Pearson numerical assessment, favorable results (excellent or good) were found in 37 feet, while poor results took place in only five feet.

Conclusion: Based on the final clinical and radiographic results, the Ilizarov technique could be considered as a good management alternative for such severe deformities.

Biography:

Dr. Kapil Mani K.C. is currently working in Civil Service Hospital, Department of Orthopedics Minbhavan, Kathmandu as an Orthopedic Registrar since Second July 2011. After 2013 he is acting as an assistant professor as well as orthopedic and joint replacement surgeon. 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:

Nowadays total hip arthroplasty (THA) has been considered to be a gold standard treatment for both primary and secondary arthritis of hip joint. Its indications and practical application to the patients are beyond discussion. With development of recent advances and techniques, different kinds of complex primary and revision arthroplasty have been performed smoothly. Complex primary total hip arthroplasty has been indicated in different conditions like developmental dysplasia of hip (DDH), neurological diseases like meningocele, spastic hemiplegia and Parkinson’s disease, severe coxa vara, rheumatoid arthritis with significant acetabular protrusion, acetabular dysplasia, ankylosis due to heterotrophic ossification, arthrodesis of hip joint, congenital bowing of proximal femur, bone dystrophies like osteopetrosis, Paget’s disease and failed internal fixation of proximal femur. We performed different cases of complex primary total hip arthroplasty in our hospital out of which some cases were mentioned. There was one case of bilateral simultaneous hip arthroplasty in protrusion of acetabulum (Rheumatoid arthritis) with bone grafting, one case of failed internal fixation of intertrochanteric fracture by reconstruction of proximal femur, one case of DDH by reconstruction of acetabulum and proximal femur, one case of bilateral protrusio acetabulum with bone grafting and lateralization of hip joint and another case of severe acetabular dysplasia with acetabular reconstruction. All of them have good functional results without any undue complications. However, long term follow-up reports are to be awaited.

Biography:

Christoph Lutter currently works as a research fellow at the CV Path Institute in Washington D.C. His research focus is rock climbing related injuries of the upper extremities and the hand (such as UEDVT, pulley injuries, injuries of the carpal bones).

Abstract:

Purpose: Comprising two to four percent of all carpal fractures, hamate hook fractures are rare injuries. Climbing athletes seem to be affected more frequently than others as they strain their passive and active anatomical structures of their hands and fingers to maximum during training or competing. This stress is transmitted to the hook of the hamate by tightened flexor tendons, which create a high contact pressure to the ulnar margin of the carpal tunnel. Injuries of the hamate hook, caused by other than external impact but by contact pressure of the anatomical structures, are rare and occur during climbing nearly exclusively.

Methods: We now diagnosed 12 athletes with diffuse pain in the wrist joint, which occurred during or after climbing. Radiographs and/or CT revealed fractures in the hamate bones in most of the patients; as other diagnoses such as inflammation, tumor or injuries could be largely excluded, we classified those fractures of hamate as due to overload. The therapy consisted of consequent stress reduction.

Results: Follow-up investigations showed satisfying healing tendencies and all athletes were free of symptoms after a time span of 10.7 ± 5.1 (6–24) weeks. Resection of the hamate hook was necessary in three patients. They all regained their pre-injury climbing level.

Conclusion: Climbers with an unspecific, diffuse pain in the wrist need to be examined with Radiograph and – if unclear – CT and/or MRI to detect or exclude the diagnosis of hamate fracture to avoid severe complications like ulnar nerve irritation and flexor tendon rupture.

Biography:

Cary Fletcher completed his MBBS degree at University of the West Indies in 2001 and went on to complete his Doctorate in Orthopaedics in 2012, also at The University of the West Indies. He is at present an Orthopedic surgeon at St. Ann’s Bay Regional Hospital where he functions as the academic coordinator of the Orthopaedic service. As coordinator, he functions to moderate presentations at all levels of medical staff including residents, interns and student nurses and hence ensure continuing up to date medical education. He serves as one of the senior surgeons on the service in which the majority of cases involve Orthopedic trauma. He is first author on seven publications.

Abstract:

Five patients are presented in this prospective observational study to describe injuries not previously described as a result of a water slide. Issues regarding surveillance, prevalence of water slide injuries and preventative strategies are discussed. Recent policy changes and possible future interventions are described.

Biography:

Abstract:

Background: Bilateral total knee arthroplasty as a simultaneous procedure is a subject of controversy and debated for many years. Simultaneous procedure has the definitive advantage of decreased anesthetic exposure to the patients, shorter hospital stay, shorter rehabilitation and physical therapy, convenient to family members and even cost effective. However this procedure threats the major complications like pulmonary embolism and cardiac problems. So our study aims to establish that whether simultaneous procedure is as safe as stage or unilateral procedures.

Methods: We reviewed 25 patients (50 knees) performed simultaneous bilateral exposure. All the patients were reviewed extensively before surgery with notification of associated comorbidities, demographic profiles, and blood loss during surgery, functional improvement of knee joints and major peri and postoperative complications.

Results: The average age of patients in our study was 69.36±5.49 year with 40% male and 60% female. Eighty percent of cases were ASA grade I and II with 24% of patients having hypertension, 20% diabetes mellitus, 16% COPD and 8% coronary artery disease. Average pre-operative hemoglobin was13.47±0.88 gm/dl, average post-operative hemoglobin was 9.82±0.54 gm/dl, mean blood loss in both knees was 1239.6±198.08 ml and average hospital stay was 8.72±1.59 days. Knee Society Score (KSS) was improved from 37±3.48 to 81.04±3.58 within one year and there were no major pulmonary, neurological and cardiac complications noted.

Conclusion: SBTKA seems safe, effective, less expensive and with no added major pulmonary and cardiac complications in properly selected patients. 

Biography:

Abstract:

Introduction: Platelet-rich plasma (PRP) preparations are a common treatment in equine osteoarthritis (OA). However, there are controversies regarding the ideal concentration of platelets and leukocytes in these biological substances necessary to induce an adequate anti-inflammatory and anabolic response in articular cartilage.

Aims & Methods: The aims were to study the influence of leukocyte- and platelet-rich gel (L-PRG) and pure platelet-rich gel (P-PRG) supernatants on the histological changes of cartilage, the degree of chondrocyte apoptosis, the production of hyaluronan (HA) and the gene expression of nuclear factor kappa beta (NFkb), matrix metalloproteinase 13 (MMP-13), a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS-4), collagen type I alpha 1 (COL1A1), COL2A1 and cartilage oligomeric matrix protein (COMP) in normal cartilage explants (CEs) challenged with lipopolysaccharide (LPS).

Results: Overall, 25 % L-PRG supernatant (followed in order of importance by, 50% P-PRG, 25% P-PRG and 50% L-PRG) represented the substance with the most important anti-inflammatory and anabolic effect. 25% P-PRG supernatant presented important anabolic effects, but it induced a more severe chondrocyte apoptosis than the other evaluated substances.

Conclusions: 25% L-PRG supernatant presented the best therapeutic profile. Our results demonstrate that the biological variability of PRP preparations makes their application rather challenging. Additional in vivo research is necessary to know the effect of PRP preparations at different concentrations.

Biography:

Olexandr Korchynskyi has completed his PhD from Institute of Biochemistry, Lviv Branch, Ukraine and Post-doctoral studies from Netherland Cancer Institute, Amsterdam, University of North Carolina at Chapel Hill, NC and University of California at San Diego, CA. He is a Senior Scientist and Group Leader at the Institute of Cell Biology, Lviv, Ukraine and an Associate Professor at the Dept. of Immunology, Rzeszow University, Poland. He has published more than 35 papers in reputed journals and books. 

Abstract:

Impaired bone homeostasis contributes to development of osteopenia, osteolysis and joint erosions during the rheumatoid arthritis (RA). On the other hand, bone morphogenetic proteins (BMP) and their intracellular mediators Smad proteins, are crucially important regulators of bone formation and regeneration. Using in-vitro tissue culture approaches we showed that activation of NF-κB pathway with proinflammatory cytokines IL-1β and TNFα inhibits osteogenic differentiation of pluripotent mesenchymal precursor cells through Smad7-independent inhibition of Smad1/5 transcriptional activity. Neither Smad1/5 phosphorylation by BMPR-Is, nor direct Smad1/5 binding to DNA into BMP target genes promoters are affected by the activation of NF-κB pathway with TNFα, or by the overexpression of NF-κB signaling components. Nevertheless, Smad1/5 transactivation and, consequently, transcription of BMP target genes is greatly reduced upon activation of NF-κB signaling with a requirement new protein synthesis. Furthermore, we found two distinct TNFα target genes that are novel potent inhibitors of BMP signaling. One of them, twist family BHLH transcription factor 1 (TWIST1) is a transcriptional target of NF-κB and has been implicated into repression of RUNX2 driven osteogenesis. Another one, KLF10/TIEG is induced by TNFα in NF-κB-independent manner. shRNA mediated knockdown of the expression of each of these BMP signaling repressors results in partial rescue of BMP-Smad-driven transcription from inhibition by TNFα. We generated crosses of BMP reporter mice with p65/RelA knockout mice and found that NF-κB (most likely, via TWIST1) controls the intensity and the duration of BMP signals in vivo already during the embryogenesis. Thus, our data demonstrate TIEG1 and TWIST1 as transcriptional repressors of BMP-Smad signaling and as the central candidates responsible for proinflammatory control of osteogenic program possibly also involved in the development of osteolysis and joint erosions during the RA. 

Biography:

Dr. Lu has completed his MD from China, and Dr.PH in Biostatistics from the University of North Carolina at Chapel Hill. He is an Assistant Professor of Medicine at Harvard Medical School, and Associate Professor (adjunct) at Albert Medical School of Brown University. He has published more than 90 papers in reputed journals and has been serving as an editorial board member of several international journals. 

Abstract:

The objective of this study was to examine the relationship between being overweight or obese and developing rheumatoid arthritis (RA) in two large prospective cohorts, the Nurses’ Health Study (NHS 1984-2014) and Nurses’ Health Study II (NHSII 1991-2013). We followed 76,597 women aged 30-55 years enrolled in NHS and 93,392 women aged 25-42 years in NHSII at baseline and free from RA or other connective tissue diseases, who provided lifestyle, environmental exposure and anthropometric information through biennial questionnaires. We used the pooled data from two large cohorts and assessed the association between time-varying Body Mass Index (BMI) in WHO categories of normal, overweight and obese (18.5–<25, 25.0–<30, ≥30.0 kg/m²) and incident RA meeting the 1987 American College of Rheumatology (ACR) criteria. We estimated HRs for overall RA and serologic subtypes with Cox regression models adjusted for potential confounders. During 4,832,369 person-years of follow-up, we validated 1220 incident cases of RA. There was a significant trend toward increased risk of all RA among overweight and obese women [HR (95% CI): 1.23 (1.08, 1.40) and 1.36 (1.17, 1.58), p for trend=0.001]. Among RA women aged 55 years or younger, this association appeared stronger [HR 1.48 (1.20, 1.81) for overweight and 1.76 (1.42, 2.20) for obese women (p trend <0.001)]. In conclusion, risks of RA were elevated among overweight and obese women, particularly among young or middle aged women. (228 words)