Orthopedic Research Online Journal

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EISSN : 2576-8875
Current Publisher: Crimson Publishers (10.31031)
Total articles ≅ 142
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Orthopedic Research Online Journal; doi:10.31031/oproj

Abstract:
Orthopedic Research Online Journal is an international peer review journal, which aims at promoting the exchange and propagation of knowledge on problems related to orthopedics and their disorders
Mittal Rl
Orthopedic Research Online Journal, Volume 7, pp 689-697; doi:10.31031/oproj.2020.07.000655

Abstract:
Mittal RL* Consultant- Mittal Ortho Centre, 97 New Lal Bagh Colony, Patiala (Punjab) 147001, INDIA Emeritus Professor Orthopaedics, GOMCO Patiala *Corresponding author: Mittal RL, Emeritus Professor, Orthopaedic Department, Government Medical College Patiala, India Submission: May 12, 2020;Published: May 26, 2020 DOI: 10.31031/OPROJ.2020.07.000655 ISSN: 2576-8875 Volume7 Issue1 Background: Author published a comprehensive research article on trimorphic extreme clubfoot deformities [1], offering, all-inclusive, triple/ quadruple surgical techniques, a far reaching solution, which received tremendous Global attention. This generic name (trimorphic extreme clubfoot deformities) was given, by the author, to scores of brand names in literature, reporting 95% failures post-surgeries with contemporary techniques. “Each Clubfoot Is Different” an important discovery therein, was prominently considered, for grading of results, rather than the prevalent assessment criteria of Pirani’s or Demiglio’s etc. Additional thoughts on this were recorded in author’s invited BOOK on CLUBFOOT, published by Taylor and Francis (Informa group London U.K), ISBN: 9781138083738, released on 29th November, 2018 IOACON at Coimbatore (India). Author also performed, here, a Hat Trick, in clubfoot research, getting third best IOA original research award i.e. Diamond jubilee also; Golden and Silver awards bagged earlier in 2013 and 1988 respectively. During last about two years, as per its name, this research made significant headway with countless new features. Therefore, this has been christened as “Mother of all clubfoot discoveries/inventions”, with its deep seated roots and incredible unity in diversity in its All-inclusive, corrective, 4-in-1, surgical concept. Being so and with its unending future research potential, it needs to be free from the lockdown of Journal and BOOK, to spread awareness for the welfare of poor clubfoot community in LMICs, having more than 80% global population. Methods: Recently concieved new features are: Firstly, formulating a comprehensive classification under numerous broad headings: Limitless variations in deformity start at birth; get modified with age, patient’s weight, weight bearing, physical activity, treatments, early/ delayed complications, radiological variations etc. Secondly, the landmark, revelation in Rediscovery of Octopus Clubfoot, DOI: 10.31031/OPROJ.2019.06.000627 and stamping its surgical correction as all-inclusive, branded, surgical concept; A Unity in Diversity. This was proved earlier by actually showcasing innumerable diverse deformities with gratifying results in author’s International Orthopaedics as well as BOOK publications. This has been further strengthened with more new cases in this article (Table 1). Thirdly, many newer surgical steps have been added in the surgical corrections of these cases in the appropriate section in this article. Results and Conclusion: This MASTERSTROKE article, a GRASSROOTS DISCOVERY, needs to spread awareness for an impactful message, giving a far better deal to poor Clubfoot community of LMICs, at lesser cost, with longer, good looking, better functioning feet, on long term, without any bony fusion and improving the patient’s psycho-physico-socio-economics, helping indirectly their countries economy. The research in this entity is unending, each being different, therefore increasing awareness highly important. This will increase the demand for these surgeries and thereby a need for learning these comprehensive techniques through available internet channels and setting things going. Keywords: Mother of clubfoot innovations; “Each clubfoot is different”; Extreme clubfoot deformities; Fusion 4-in-1 surgical concept; Octopus clubfoot rediscovered; Unity in diversity; Triple/ Quadruple surgical skin expansion; Cosmetic/Plastic surgery in clubfoot; Rozy feet Abbreviations: AGMC: Arthrogryposis Multiplex Congenita; CCBs: Congenital Constriction Bands; CPC: Conjoint Posterior Capsule, DALYs: Disability Adjusted Life Years; DL: Dorsolateral; DOLAR: DOrso-Lateral Rotation; EQ: Equinus; FDP: Flexor Digitorumlongus; FHL: Flexor Halluces Longus; GBD: Global Burden of Disease; IOA: Indian Orthopaedic Association; IOACON: IOA Conference; IT: Intertarsal; ITC: Interosseoustalocalcanean; OA: Osteoarthritis; PMPDLR: Posteromedial Plantar Dorsal Lateral Release; TMT: Tarsometarsal “Each Clubfoot is Different” is the Mother of all Clubfoot inventions/ discoveries. It is like a ROSARY of countless beads, unified by its, 4-in-1, surgical concept. Author published in 2018, an original research article [1], Doi.10.1007/s00264-017-3741-6, receiving tremendous positive Global response. This research had been carried out in trimorphic deformities (a new name), with its equally matchless, infallible, surgical solution. To recapitulate 2018 article briefly, clubfoot remained unsolved, in spite of vast literature, with high prevalence rate of 95% failures, in neglected deformities with scores of brand names and no acceptable surgical solution [2-4]. Author researched this grey area in, need based, three phases, clustering all such brand names as trimorphic extreme deformities (three hierarchic grades), with an aim to improve upon contemporary surgical techniques. Posteromedial 3D skin contractures, in increasing severity, were discovered as the reasons for universal failures, which were corrected by all-inclusive, innovative, graded, expansion of fascio-cutaneous chamber for increasingly severe/ rigid deformities. First phase, in two stages, was the longest and continued for 25-30 years, including years of building a strong foundation of critical analysis of prevalent failures in literature. 1st stage was study of patho-anatomy, in 15 clubfeet of stillborn foetuses, published 1981 [5], discovering skin contracture as primary cause, reinforced by years of clinical...
Muhammad Inam, Mian Amjad Ali, Muhammad Shabir, Ihsanullah, Javed Iqbal
Orthopedic Research Online Journal, Volume 7, pp 685-688; doi:10.31031/oproj.2020.07.000654

Abstract:
Muhammad Inam1*, Ihsanullah2, Javed Iqbal3, Mian Amjad Ali1 and Muhammad Shabir1 1Department of Orthopedic and Trauma Medical Teaching Institute Lady Reading, Hospital Peshawar Pakistan, Pakisthan 2Medical Officer, Hospital Daggar Bunir Khyber Pakhtoonkhwa, Pakisthan 3Medical Officer, Hospital Shabqadar Charsadda, Pakistan *Corresponding author: Muhammad Inam, Department of Orthopedic and Trauma Medical Teaching Institute Lady Reading, Pakistan Submission: April 23, 2020;Published: April 29, 2020 DOI: 10.31031/OPROJ.2020.07.000654 ISSN: 2576-8875 Volume7 Issue1 Objective: The objective of this study is to evaluate the early results of total hip arthroplasty in osteoarthritis of the hip. Material and Method: This case series study was conducted in the Department of Orthopedic and Trauma, Medical Teaching Institute Lady Reading Hospital Peshawar from March 2017 to February 2018 on 39 consecutive patient of age 55 and above with primary osteoarthritis of the hip. In all these patient cemented arthroplasty of Surgival manufacturer was done through direct lateral approach and patients were mobilized on first post operative day. Patients were followed up on three months, six months and one year duration. Results: A total of fifty four patients were included in the study but at final follow up only thirty nine has been seen. So we analyzed only those thirty nine patients for any complication. Out of thirty nine patients, 13(33.3%) were female and 26(66.7%) were male. Mean age of the patients were 63.05( Deviation 4.359) with minimum 55 years and maximum 70 years. We have lost 15 patients to follow up. The remaining thirty nine has dislocation in 1(2.6%), peri prosthetic fracture in 1(2.6%) and infection in 2(5.1%) patients. Two (5.1%) patients has severe pain and 3(7.7%) were not satisfied post operatively. Conclusion: Total hip arthroplasty has best results in primary osteoarthritis of the hip in old age provided that the patient follows the post operative protocol for hip arthroplasty. Keywords: Arthroplasty; Acetabulam; Activity of daily living; Hip; Osteoarthritis; Pain; Satisfaction Where there is osteoarthritis there is arthroplasty. Not every patient need arthroplasty in osteoarthritis but most patients will need it in some stage of life [1]. Arthroplasty is now in vogue in Pakistan for osteoarthritis of hip and knee joints [2]. Before this hip has to be fused in adult to reduce pain but the patient would then be unable to flex or extend the hip and many of them has not tolerated the procedure [3]. Fusion of the hip is a cumbersome procedure that a young adult may not cope with it and most of time it fails. When the fusion fails then pain is unbearable to the patient and avoid using the limb that causes weakness of the whole limb and may prone to fracture [4]. Fracture of acetabulam also was a big challenge for the surgeon as it may develop osteoarthritis or may developed osteonecrosis of the head of the femur [5]. Hip dysplasia in young adults has deformed hip joint with dislocation [5]. The only solution for all such conditions is joint replacement. It may be a part of the joint (hemiarthroplasty) or total joint replacement [6]. Hemiarthroplasty is not used now days as compared to total arthroplasty. Arthroplasty of hip may cement or none cemented. In most of the world the orthopedic surgeons use no cemented arthroplasty for any age but in our part of the world surgeons prefer cemented arthroplasty for old age and none cemented for younger age [7]. Sometime hybrid arthroplasty is used in young age. Still controversies exist for cemented, no cemented or hybrid arthroplasty of hip but it is the most commonly used surgery for osteoarthritis of the hip [8]. Intra operative complication of cemented arthroplasty is the bone cement syndrome which may leads to loss of life of the patient [9]. To avoid the bone cement syndrome, surgeons nowadays use the noncemented arthroplasty irrespective of age. Non cemented arthroplasty has higher cost rate and the manufacturer may have a role to play with the surgeons [10]. However the benefits of arthroplasty either cemented or noncemented may not be overlooked for the management of osteoarthritis of the hip; either primary or secondary osteoarthritis [5]. The objective of this study is to evaluate the early results of total hip arthroplasty in osteoarthritis of the hip. This case series study was conducted in the Department of Orthopedic and Trauma, Medical Teaching Institute Lady Reading Hospital Peshawar from March 2017 to February 2018 on 39 consecutive patient of age 55 and above with primary osteoarthritis of the hip. In all these patient cemented arthroplasty of surgical manufacturer was done. All those patients of either gender that have primary osteoarthritis of hip, diagnosed clinically and confirmed by radiograph of the hip taken in anteroposterior and lateral projection. Then patients were counseled about the procedure and postoperative protocol for dialy living activities. Those patients who were willing to be put in the study were included in the study with written informed consent. All the co morbid conditions were optimized and then the patients were operated. Patient were admitted well before surgery and after optimizing the conditions of the patients and counseling for post operative care, were put on operation list on the top and either spinal or general anesthesia were given to the patient. Hip was operated with direct lateral approach and cemented arthroplasty was done. After closure, a pillow was put to the outer side of limb to avoid external rotation and hip flexion for 24 hours, and prophylactic intravenous antibiotics were given for five days. Vancomycin 2 grams and Cefoperazone+sulbactum 2 grams were given intra operatively 20 minutes before giving incision. The same antibiotics were given for first twenty four hours and then the vancomycin was stopped. Anterioposterior and lateral radiograph was taken to see the position...
Ramon B Gustilo, Rupesh Man Sherchan, Arlan Troncillo
Orthopedic Research Online Journal, Volume 7, pp 674-684; doi:10.31031/oproj.2020.07.000653

Abstract:
Rupesh Man Sherchan, Arlan Troncillo and Ramon B Gustilo* Gustilo Clinic Ambulatory Surgery Center, Manapla, Negros Occidental, Philippines *Corresponding author: Ramon B Gustilo, Gustilo Clinic Ambulatory Surgery Center, Manapla, Negros Occidental, Philippines Submission: February 06, 2020;Published: April 03, 2020 DOI: 10.31031/OPROJ.2020.07.000653 ISSN: 2576-8875 Volume7 Issue1 The use of Mechanical Axis Finder (MAF) is reliable in achieving the correct mechanical axis in (93.3%) out of 100 consecutive Axis Knee System Surgeries. Correct mechanical Axis is defined as 0 degrees(- neutral) + - 3 degrees. The rest (6.7%) fell 4-7 degrees of varus or 8-9 degrees valgus. Post-operative scanograms (hip-knee-ankle) were obtained in all 100 knees, 2-3 months after surgery. Patello-femoral tracking based on patella lateral displacements on Laurin patellar x-ray view, eighty nine percent exhibited normal or minimal lateral displacement. There was no patellar dislocation. All bone preparations of both femur and tibia were performed using extramedullary method. The preoperative knee society pain score improved from 49.59 to 88.95 at 2-3 months follow up. The patient satisfaction rate, average score was 87.8%. Complications consisted of 2 infection, 2 aseptic femoral loosening requiring revision and two knee stiffness. With the use of the Axis Knee System, the cost of TKA in the Philippines is markedly reduced by 100-200%. Proper alignment of the knee is considered to be one of the most determinant factors in determining the long-term outcomes after total knee arthroplasty, and correct mechanical axis alignment decrease both the mechanical and shear stresses placed on the bearing surfaces, as well as the bone/prosthesis interfaces [1-3]. In addition, proper alignment aids to balance the forces transmitted through the soft-tissue envelope, which is crucial for suitable functioning of the joint. Furthermore, when total knee arthroplasties are poorly aligned this can result in decreased implant survivorship, as well as being implicated as a cause for increased wear, poor functional outcomes, and early failure leading to component loosening. Total Knee Replacement is the most common joint replacement done and most expensive as well worldwide. Axis Total Knee System is a joint venture between the Department of Science and Technology (DOST) Philippines to provide affordable and quality total knee systems for Asians and in particular for the Philippines. Mechanical Axis Finder (MAF) Principle: Mechanical Axis Finder (MAF) is an extra-medullary device use to determine mechanical axis to the femur of each patient. Any point on the knee will trace a sphere centered on the femoral head when the knee is moved to different positions. Three points on a sphere will define a circle on the sphere. A reference line drawn through the center of the circle and perpendicular to the circle will pass through the center of the sphere. The MAF is a device that records the positions of 3 points in space. The three points identified by the MAF are used to locate the center of the femoral head. The position of the second pin is compensated so that it is perpendicular to the mechanical axis. The 2 pins are collinear with the mechanical axis when viewed in the coronal plane. This is both a retrospective and continual prospective study. Retrospective study group from January 2015 to December 2018 consists of 49 patients, (69 knees) with standard knee X-ray pre-op and Hip-Knee-Ankle scanogram post-op after 2 months. The prospective study group starting from January 2019 onwards consists of 21 patients, (31 knees) with both pre-op and post-op HKA scanogram. From 2015 to 2019 a total of 70 patient with 100 arthritic knees underwent total knee replacement using Axis Knee System with Femoral Mechanical Axis Finder. Patients with previous corrective osteotomies in femur or tibia were excluded from this study. All patients in this study were classified into 4 categories (A, B, C, D) upon registration depending on their ability to pay. ‘A’ are completely private patients with Phil-health, HMO Insurances and able to pay any hospital and professional charges. ‘B’ has Phil-health, HMO Insurances, and relatives. ‘C’ has Phil-health with relatives helping and ‘D’ completely indigent patient- no Phil-health, no other sources of income. Percentages of distribution based on their ability to pay A (45pats)-64%, B (11pats)-16%, C (14pats)-20%, D-0%. All patient were from Gustilo Clinic Ambulatory Surgery Center. Patient data were gathered from Gustilo Mobile Medical Record System (GMMR). Surgery was done by main surgeon Dr. Ramon B Gustilo and his assistant fellow Surgeons in training. Preoperatively, in all patients AP pelvis, AP/Lat (0, 20deg) standing and Laurin view knee x-rays were taken and was archived in PACS. For the prospective study group patient additional HKA scanogram was taken compulsorily. Patient is made to stand on the platform, equal weight bearing on both legs with patella at the center and facing forward. Using Quantum Medical Imaging X-ray machine and Fujifilm CR system, X-ray plate 40x 14 inch. X-ray beam is projected from a distance of 79inch at 70-75KVP (varies to the patient thickness), 150/200MA, 20-40MAS. Image is processed in Fujifilm CR system and archived in K-PACS which is accessible at the orthopedic clinic. Immediate after surgery postop x-ray of the knees were taken at the recovery room and standing HKA scanogram were taken 2 months after. Then patients were followed up every 6 months, 1 year and 2 yearly. Using Hip- knee -ankle scanogram radiograph, corrected mechanical axis alignment was measured. Using lateral knee X-ray femoral and tibial component alignment was measured and using the skyline view the patellar tracking was measured. The femoral mechanical axis angle (FMA), Mechanical axis deviation angle (MAD) and the distance of Mechanical axis deviation...
Adiele Dube
Orthopedic Research Online Journal, Volume 7, pp 672-673; doi:10.31031/oproj.2020.07.000652

Abstract:
Adiele Dube1* and Mdziniso Ntombiyenkosi J2 1Department of Health Education, Southern Africa Nazarene University, Eswatini 2Department of Physiotherapy, Mbabane Government Hospital, Eswatini *Corresponding author: Adiele Dube, Department of Health Education, Southern Africa Nazarene University, Eswatini Submission: March 05, 2020;Published: March 13, 2020 DOI: 10.31031/OPROJ.2020.07.000652 ISSN: 2576-8875 Volume7 Issue1 Musculoskeletal injuries, predominantly the hamstring, lower back and neck pain, are a challenge to amateur, professional and elite athletes across a wide range of sporting codes. Contact sports pose a high risk to the lower back and neck pain. Professionals such as sports medicine physicians, physiotherapists, athletic trainers and clinical researchers are concerned with these injuries. This is due to their high prevalence, high risk of recurrence, high pain and disability as well as high costs for treatment and rehabilitation. There is scant literature on injuries affecting Southern African sport population, however, researches carried among Eastern, Central and Western Europe reveal that in footballers the most prevalent muscle injury, with a high recurrence within a year after initial injury is the hamstring; rated between 12%–33% [1]. Disability-adjusted life years (DALYs) resulting from low back pain has also increased by 54% [2] reaching as high as 84% [3] between 1995 and 2017, where injured population are prone to experience more than one episode. Platforms such as PubMed, Web of Science, Google Scholar, CrossRef and Lancet series, have published a number of researches on hamstring, lower back and neck pain. To date, no studies relating hamstring have specified how injury risk should be assessed when clinicians are faced with the return-to-play (RTP) decision after injury [1]. Similarly, the patho-anatomy of LBP is unclear often due to the uniqueness of most LBP-conditional abnormalities; therefore, the use of imaging appends very little hence be much less used [2]. The diversity in definitions and methodologies of RTP among sports medicine physicians and clinicians contributes significant differences in the results and conclusions obtained from sports injury research [4]. Basing on this, numerous stakeholders in sports injury and rehabilitation use varied methodologies based on their personal and institutional reasons to why RTP of hamstring and LBP should be accelerated or delayed [5]. With increasing literature, it is imperative to understand pain cognitions and central pain-modulating mechanisms so as to deal with LBP persistent disability and provide clarity on who is to be consulted and who is responsible for the RTP decision [1]. Globally, there are discrepancies and gaps between clinical practice and research, regarding the association of the extent of musculoskeletal injuries with time needed to recover, return to play or competition and specific measurements or parameters showing prognostic value. There is limited existence of use of consensually recommended first-line treatments, and inappropriately high use of imaging, rest, opioids, spinal injections and surgery [2]. Although not considered in few previous reports, the importance of neuromuscular coordination and the quality of interplay, between the different hamstring muscle bellies, among other factors, should be a key determinant within the intrinsic injury risk [6]. Although not yet studied and validated in clinical practice, the recent Delphi study may help sports medicine clinicians faced with the problem of when an athlete should RTP after a hamstring injury [1]. Musculoskeletal Injury and Disorders’ (MIDs) unremittingly high incidence and recurrence rates indicate that the principal and underlying risk has not yet been fully identified. Despite that the causes of lower back pain are rarely addressed, at the moment low back pain is treated mainly with analgesics. Effective management of hamstring injury and acute back pain in the primary care setting can be the most important factors to help predict the time needed to RTP [6] and progression to chronic back pain [2]. Alternative treatments include physical therapy, rehabilitation and spinal manipulation; however, a broader recognition of multi-morbidity is necessary for assessment and treatment of MIDs, particularly in those with persistent problems. Literature have shown that rehabilitation through use of bio-psychosocial approach compared to biomedical (symptom focused) approach yield positive results in improving functionality when maintained under a healthier life-style [2,7,8]. Therefore, sports medicine physicians’ physiotherapists, performance coaches, athletic trainers, clinical researchers and sports scientists should not only focus on pain symptoms and function, but also recognise accompanying problems such as pain-related fear, inactivity, anxiety, sleep disturbance, depression and related psychological stress. It can be acknowledged that though clinical practice, research and policy-making often represent different worlds, they are always dependent upon each other. Multiple evidence-based guidelines for the management of hamstring grade 1 to grade 4, acute and chronic back pains are readily available to guide providers, and therefore, adherence to such recommendations is important. Eswatini and Zimbabwe through their Ministries of Sports, Culture & Youth/Arts should improve their relationship and collaboration with the Ministries of Health (and Child Care) so that athletes’ treatment becomes payable, accessible, effective and evidence-based. Treatment, RTP and prevention of recurrence through guidelines and standards are paramount, and policymakers should look at effectiveness, cost-effectiveness, necessity, feasibility, education and funding. Recommendations for future RTP after musculoskeletal injuries decision should be considered as a multi-disciplinary decision. Athletic teams with limited access...
Eimear Cronin, David Roberts, Kenneth Monaghan
Orthopedic Research Online Journal, Volume 7, pp 667-671; doi:10.31031/oproj.2020.07.000651

Abstract:
Eimear Cronin1,2,3*, David Roberts1,2 and Kenneth Monaghan1,2 1Clinical Health and Nutrition Centre (CHANCE), Institute of Technology (IT) Sligo, Ireland 2Neuroplasticity Research Group, Clinical Health and Nutrition Centre (CHANCE), Ireland 3HSE Physiotherapy Department, Ireland *Corresponding author: Eimear Cronin, Institute of Technology (IT) Sligo, Ireland Submission: February 21, 2020;Published: March 02, 2020 DOI: 10.31031/OPROJ.2020.07.000651 ISSN: 2576-8875 Volume7 Issue1 Neurological pilates; Neuropilates; Stroke; Rehabilitation Introduction to pilates Pilates as an exercise form was created by Joseph Pilates in the 1920s and is a programme of mind-body exercise focussing on strength, core stability, flexibility, muscle control, posture and breathing [1]. Joseph Pilates initially started using his exercises to rehabilitate bedridden world war 1 soldiers, often using the springs of the beds as resistance equipment [2]. In the late 1930s, the exercise method then became popular amongst the dance community benefitting them by improving performance and fitness and reducing time spent recovering from injuries [2]. The pilates method of exercise may have suited dancers above other forms of exercise due to the focus on alignment, core strength and flexibility and the aim of achieving neutral postures [3] and building long lean muscles as opposed increasing muscle bulk It also may have helped dancers to increase their kinaesthetic awareness, due to the mind-body nature of this exercise method, thereby enhancing their dancing. As an exercise form, pilates was initially introduced into rehabilitation by therapists specialising in dance medicine [2]. In more recent years, it has become an important and effective rehabilitation tool in wider patient groups, including those with musculoskeletal and rheumatological conditions, particularly for the purposes of reducing pain and disability [4]. The pilates method contains 6 key principles: centreing, concentration, control, precision, flow and breathing [5]. Pilates in the non-clinical population In a systematic review in 2011 of 16 randomised controlled trials including 727 participants overall, investigating the effects of pilates exercise in healthy individuals, strong evidence was found for improving flexibility and dynamic balance, while moderate evidence was found for improving muscular endurance [6]. It is worth noting, however, that control groups were inactive in 11 of these 16 randomised controlled trials and so placebo and hawthorne effects may have been relevant in the findings. The authors found contradictory results for strength, with pilates exercises improving hip, lower back and abdominal strength in 3 of the studies when compared with no exercise, but with no additional abdominal strength benefits found in one study when compared with a postural education group [7]. Differences in strength measurement, duration of intervention and level of supervision and instruction may account for these contradictory results between studies. In healthy children, a systematic review has shown that pilates appears to improve flexibility, strength and postural control [8] and in elderly populations, pilates has also been shown to have benefits with one systematic review of 10 studies demonstrating improvements in muscle strength, walking, activities of daily living, quality of life and dynamic balance [9]. Clinical pilates In clinical populations, the effects of pilates on low back pain has been examined in detail. A cochrane review of 10 trials, including 510 participants, showed low to moderate quality evidence that pilates reduces pain and disability in participants with non-specific low back pain when compared to minimal intervention. The authors, however, could not provide any conclusive evidence that pilates is superior to other forms of exercise [10]. Further systematic reviews have shown improvements in pain, range of motion and fatigue in women with breast cancer [11]. Pilates has also been shown to significantly reduce depressive and anxiety symptoms and feelings of fatigue in a systematic review of 8 studies. Sample sizes in the studies selected for inclusion in this latter review were small and the quality of the non-active control conditions was variable, therefore, further studies would be needed to clarify if pilates, as a mind-body connection enhancing exercise programme, would have superiority over a general exercise programme in improving mental health outcomes. Pilates has not only been studied and clinically used by therapists in populations with pain and movement loss, but also in populations with specific disabilities as a result of a neurological condition [12]. Neuropilates Neuropilates, that is, the practice pf clinical pilates in patients with a neurological condition, is theorised to have beneficial effects on strength, postural control, alignment, stability, balance, proprioception, coordination and gait in those with deficits due to a neurological condition through retraining low threshold activity of local muscles and decreasing over-active global muscles [13]. Most of the literature in this field centres around populations with Multiple Sclerosis. The evidence investigating pilates training in people with multiple sclerosis is conflicting with the largest of these studies, a multi-centre randomised control trial with 94 participants showing no significant improvements in 10-metre walk test scores after 12 weeks of pilates exercises compared with 12 weeks of relaxation [14]. However, two smaller randomised control trials demonstrated significant improvements in balance, mobility and strength [15,16]. A systematic review examining the effects of pilates in people with Parkinson’s Disease presented some preliminary evidence that the exercise form may have positive impacts on fitness, balance and particularly lower-body function in this patient cohort [17]. However, the authors emphasized the need for...
Roger Amisi Kitoko, Bonza Bomoloko, Pericles Lokangu Kalokola, Junior Mtoro, Gaspard Esiso Afelokoky, Didier Baonga Lembalemba, Victor Esafe Lolongi, Freddy Wami W’Ifongo
Orthopedic Research Online Journal, Volume 6, pp 663-666; doi:10.31031/oproj.2020.06.000650

Abstract:
Roger Amisi Kitoko*, Bonza Bomoloko, Pericles Lokangu Kalokola, Junior Mtoro, Gaspard Esiso Afelokoky, Didier Baonga Lembalemba, Victor Esafe Lolongi and Freddy Wami W’ifongo Department of Orthopedics and Traumatology, University of Kisangani, Democratic Republic of Congo *Corresponding author: Roger Amisi Kitoko, Department of Orthopedics and Traumatology, University Clinics of Kisangani, University of Kisangani, Kisangani, Democratic Republic of Congo Submission: February 08, 2020;Published: February 28, 2020 DOI: 10.31031/OPROJ.2020.06.000650 ISSN: 2576-8875 Volume6 Issue5 The aim of this paper is to report an exceptional case of bilateral scapular osteochondromas in an African- American adolescent patient affected by Multiple Hereditary Exostoses (MHE) coming to our observation for multiple bone swelling and deformities in the upper and lower limbs, progressively evolving for more than 10 years. A 17-year-old adolescent had not been able to consult medical training in time because of the precarious socio-economic conditions. He is the youngest of 8 children and was born to an active term pregnancy, complicated by heavy bleeding during the second trimester. The family history of multiple osteochondromas was unremarkable. Standard radiographs of the front thorax and the spine, pelvis, shoulder blades, revealed opaque bony growths in the two shoulder blades. The surgical excesses proposed with biopsy sampling of these exostoses were not carried out due to insufficient financial means. However, we explained to the patient the probable risk of malignancy of osteochondromas in adolescents and adults and asked him to strictly adhere to the appointment for clinical and radiological monitoring of his osteochondromas Keywords: Hereditary multiple exostosis; Bilateral scapular osteochondromas; African-American adolescent; DRC Multiple hereditary exostosis (MHE) is a rare disease. Its prevalence is estimated at least one in 50,000 peoples [1-3]. Most often located in the proximal humerus, distal femur and proximal tibia, cartilaginous exostoses come from metaphyseal regions of growing enchondral bones [2,4]. Osteochondromas increase in size throughout childhood and stop growing when skeletal maturity is reached. Although osteochondromas are often clinically asymptomatic, symptoms such as pain and orthopedic deformities, i.e. differences in bone length, forearm deformities and varus-valgus malposition of the knee usually lead at the diagnosis of HME during the first decade of life [1,2]. If the growth and clinical symptoms of osteochondromas reappear in adults, malignant transformation of generally benign growing tumors should be suspected. Malignant degeneration into chondrosarcoma is estimated at 8% of cases [5]. Regular monitoring of a diagnosed malignancy and surgical treatment of patients with MHE are necessary [5,6]. The aim of this paper is to report an exceptional case of bilateral scapular osteochondromas in an African-American adolescent patient affected by Multiple Hereditary Exostoses (MHE) coming to our observation for multiple bone swelling and deformities in the upper and lower limbs, progressively evolving for more than 10 years. In addition, nowadays in the literature, no case of bilateral scapular osteochondroma in an African American adolescent is described. We report the case of a congolese adolescent patient, affected by MHE with bilateral scapular osteochondromas. A 17-year-old Congolese adolescent suffering from hereditary multiple exostosis was referred to our hospital for multiple bone swellings and significant deformities in the upper and lower limbs progressively evolving for more than 10 years and a delay in weight-loss development. He had not consulted medical training in time because of the precarious socio- economic conditions. He is the youngest of 8 children and was born to an active term pregnancy, complicated by heavy bleeding during the second trimester. The family history of multiple osteochondromas was not present in the parents and grandparents. During physical examination, we noted significant weight loss and a delay in weight-loss development (the patient tall was 135cm and weighing 34kg), multiple and symmetrical, generalized, hard, painless and immobile bone swelling at the level of the pelvis, the dorsal column, the joints of the upper limbs (in particular the shoulders, elbows, wrists and hands in the form of bulky firm nodes) and lower (the hips, knees and ankles) and multiple significant deformations and symmetrical, in the form of curvature and shortening of the two forearms and wrists and hands. Upon close examination of both shoulders, we noted a slightly visible and clearly palpable bilateral swelling on both sides in the body of the scapula. The range of motion of the two shoulders was not impaired. The motor skills and sensitivity of the upper limbs were retained. Despite the absence of scapulothoracic pain, standard radiographs of the skeleton, especially of the chest, revealed bilateral osteochondromas at the level of the two shoulder blades without obvious signs of malignant degeneration (Figure 1 & 2). Interestingly, these X-rays did not detect any signs of malignancy. Specialized explorations including the CT, MRI or biopsy were not carried out due to the limited technical platform. Figure 1: Standard radiograph of the front two right and left humerus, two right and left shoulder blades, of the spine: bony outgrowth of the outer edge of the two shoulder blades, of the upper metaphysis of the two humerus, deformation of the right humeral shaft in varus, vertebral deformity in scoliosis. Figure 2: Standard frontal X-ray of the two bones of the forearms, wrists and hands: multiple and symmetrical bony growths of the proximal and distal metaphyses of the two bones of the two forearms and of the phalanges with curvatures of the two radiuses. In front of this clinical and radiological diagnosis of bilateral scapular osteochondromas,...
Ebeed Yasin, Mohamed Salman, Hesham Refae, Ahmed Zakaria Msc, Ahmed Abdellatif, Morsy Basiony, Faisal Adam, Ahmed Shawky
Orthopedic Research Online Journal, Volume 6, pp 659-662; doi:10.31031/oproj.2020.06.000649

Abstract:
Mohamed Salman MD1, Faisal Adam MD2, Hesham Refae MD1, Ahmed Shawky MD2, Ebeed Yasin MD1*, Ahmed Zakaria MSc1, Ahmed Abdellatif MD1, Morsy Basiony MD1 1Orthopaedic Department, Aswan University, Egypt 2Orthopaedic Department, Assiut University Hospital, Egypt *Corresponding author: Ebeed Yasin, Orthopaedic Department, Aswan University, Egypt Submission: February 24, 2020;Published: February 28, 2020 DOI: 10.31031/OPROJ.2020.06.000649 ISSN: 2576-8875 Volume6 Issue5 Background: Percutaneous method has increased in popularity in the traumatic spine field over recent 2 decades. The minimally invasive procedure has several advantages, including the diminished length of hospital stay, bleeding and early postoperative rehabilitation. Purpose: Evaluation the clinical and functional outcomes of Percutaneous Fixation of Thoracolumbar Fracture AO Type (A). Material: Forty patients 25 males and 15 females, Mean age 31.92±6. Fall from height was in 27 patients (67.5%) and Motor car accidents were in 13 patients (32.5%). According to the AO classification 37 patients (92.5%) were type A3 fracture and 3 patients (7.5%) had type A1 fracture. All patients were neurologically free according to the ASIA score. Methods: A prospective Cohort Study was carried out for forty patients with unstable thoracolumbar fracture AO Type A in Aswan and Assiut university hospitals for assessment of clinical and functional outcomes according to the Oswestry disability index. Results: Forty patients with AO type A thoracolumbar fracture underwent percutaneous fixation. Surgical interference time varied from 12 to 24 hours post-traumatic, with mean 18 hours, SD of ±54 hours. Follow up for 6 months up to one year radiological, clinical and neurological status were evaluated. At the end of follow up the Oswestry disability index and ASIA score were used in the evaluation of results. Conclusion: Percutaneous fixation is a minimally invasive, safe and reliable technique in treating cases of thoracolumbar spine fractures type A without Keywords: Spine; Fractures; Fracture fixation; Minimally invasive; Percutaneous Percutaneous fixation of the thoracolumbar spine was firstly described by Magerl by using the external fixator [1]. Mathews and Long in 1995 first performed and described the lumbar percutaneous pedicle fixation technique by using a plate system instead of longitudinal rods [2]. Lowery and Kulkarni in 2000 described a new system and the rod connectors were just under the fascia they noticed good results about 61% fusion rate within 8 months [3]. In all cases, the longitudinal connectors were placed either superficially, just beneath the skin or externally. This has several potential disadvantages 1st, the superficial plate may be irritating and needs removal. 2nd, using longer screws is required than that achieved using standard pedicle systems fixation producing a less effective biomechanical stabilization and lead to more potential for failure of the implant. In Comparison with old percutaneous techniques, many new systems allow the screw placement in a perfect anatomical position. This achieves the best biomechanical stable fixation and makes the hardware stable without harmful irritating effect to the skin and muscles of the back. The percutaneous technique allows the surgeon to achieve biomechanically stable spine fixation with minimal insult to the soft tissues for many spine problems including trauma, tumor, degenerative disease and deformity [4,5]. Our study entails a prospective Cohort Study with preliminary results of 40 patients with thoracolumbar fracture AO type A from June 2018 to November 2019 carried out in the orthopedic departments, Aswan and Assiut university hospitals with percutaneous fixation and follow up for 6 months up to one year. The study included patients with AO type A >30 kyphosis, >50% reduction of vertebral height and Surgical technique Figure 1: Illustrating: 1. The middle of the back. 2. Line parallel to the lateral edge of the pedicle. 3. Line 1cm lateral to the lateral edge of the pedicle; it’s the site of the skin incision. Figure 2: Illustrating skin incision in a patient undergoing percutaneous fixation with a screw at the fractured level Pedicle taping was done from lateral margin up to the medial margin as in AP view Figure 3. At this point, we must take a lateral view (Figure 4 & 5); it is very important step to make sure about the position of the tab cannula as it might be Figure 3: Figure 4: Figure 5: The seven mm Dilator was inserted into the Cannula and Until they lock on each other. Then pushing down until the dilator touches the bone. Then the dilator is removed, and we must keep the guidewire in place and must take care to avoid wire removal then Cannulated Self-Drilling Tap was advanced into the Cannula through the wire. We must control the tap cannula, the Self-Drilling Tap is advanced within the targeted pedicle by moving the Tap in a clockwise direction we must take care to avoid unplanned guide wire removal by avoiding advancement of the tap beyond guide wire and avoiding wire bending and breakage. Fluoroscopy used for measuring the depth of the tap and making sure that the wire is not passing the anterior cortex After the appropriate screw was chosen and loaded into polyaxial screwdriver the screw is advanced through the guidewire till the screw enter the pedicle then the wire was removed and the screw is advanced into the body but the screw head shouldn't touch the bone completely to preserve the polyaxial capability of the screw then the screwdriver was removed and the polyaxial movement of screw was tested by moving the screw extension. Fascia and skin closure. Our study entails a prospective Cohort Study with preliminary results of 40 patients with Dorsolumbar fracture AO type A from June 2018 to November 2019 carried out in the orthopedic departments, Aswan and Assiut university hospitals with percutaneous fixation and follow up for 6...
Tassilo König
Orthopedic Research Online Journal, Volume 6, pp 649-653; doi:10.31031/oproj.2020.06.000647

Abstract:
Tassilo König* Practice for Orthopaedics / Osteological Specialist Centre DVO, Germany *Corresponding author: Tassilo König, Practice for Orthopaedics / Osteological Specialist Centre DVO, Germany Submission: February 20, 2020;Published: February 27, 2020 DOI: 10.31031/OPROJ.2020.06.000647 ISSN: 2576-8875 Volume6 Issue5 After 10 years of therapy of osteoporosis with the monoclonal antibody Denosumab (Prolia°) we look back on the results. Can new fractures be prevented under Denosumab? How long do patients stay on therapy? The primary goal of osteoporosis therapy is to avoid fractures. Especially major fractures such as radius, femoral neck and vertebral body fractures are accompanied by functional losses, sometimes severe pain and reduced quality of life. Those affected with vertebral body fractures report the most severe pain, often requiring opioid therapy. Fractured osteoporosis patients have an increased risk of death. In 2010 Denosumab (DMAB) received approval in the EU. Initially approved for the treatment of osteoporosis in postmenopausal women with an increased risk of fractures and for the treatment of bone loss associated with hormone ablation in men with prostate cancer and an increased risk of fractures, the approval was later extended to osteoporosis induced by systemic cortisone therapy and osteoporosis in ankylosing spondylitis due to its proven efficacy. Denosumab (DMAB) is a fully human monoclonal antibody that inhibits bone resorption, thereby increasing bone mass and reducing the risk of fracture. The antibody binds to the soluble Receptor Activators of Nuclear Factor kappa-B-ligand (RANK- ligand) and thus prevents the activation of its receptor RANK, which controls the maturation of pre-osteoclasts and the function and viability of osteoclasts. This results in a rapid, long-lasting and reversible reduction of bone resorption. In contrast to the likewise anti-resorptive bisphosphonates, DMAB is not stored in the bone. Patients Between 2010-2019 95 women and 27 men were treated with DMAB in our practice and included in the retrospective on the course of DMAB therapy. The average age of the women was 78, that of the men 75 years. With an average duration of therapy of 3.2 years, this results in a total of about 400 patient years. The average age of our cohort (DMAB) corresponds to the data from the osteoporosis registry of Germany in that the average age of the women was 77.6 [1]. In Hadji [2] the patients had an average age of 70.6 years. Specific osteological pre-therapy and prevalent fractures 57.7% of our 122 DMAB patients received a specific osteological pre-therapy in addition to the basic supply of vitamin D and, if required, calcium. Of these, 66% were first line bisphosphonate (BP) patients (Figure 1 & 2). Figure 1: Figure 2: 84% of our patients who were adjusted to DMAB therapy were prevalently fractured but only 44% of these fractured cases received specific pre-therapy! This is still too low a proportion! Also, in the BEST study [3] only 45% of patients with osteoporosis and fracture received guideline-based therapy. There has not been much improvement so far. Of the 95 women who were recruited by us for DMAB, 64 had prevalent vertebral body fractures and 48 peripheral low-traumatic fractures (Figure 3). In Hadji [2] the rate of prevalent fractures was 50%. Figure 3: The 27 men in our group had 21 prevalent vertebral body fractures and 6 peripheral fractures prior to DMAB therapy (Figure 4). As expected, the frequency of multiple fractures increases with age. In women with DMAB indication, most prevalent fractures were grade 3 vertebral body fractures and multiple peripheral fractures (54%), while men had grade 3 or multiple fractures in 70% of cases. Figure 4: Bone density before DMAB therapy (DXA measurement) The DXA measurement of bone mineral content is still considered the gold standard. DXA -measurements have been carried out in our centre of excellence since 1992. The LSC for the spinal column measurement is 0.028g/cm², for femur total 0.033g/cm². According to the WHO definition, bone density measurements (DXA) indicate osteoporosis from a T-score of ≤-2.5 SD (standard deviation from the mean value of a 20-29 year old woman/men). In order to assess the therapy-relevant 10-year fracture risk, other clinical and anamnestic risk factors (pre-existing fractures, concomitant diseases, long-term drug therapy, femoral neck fracture in family, oral cortisone-therapy etc.) are considered in addition to bone densitometry. Depending on the individual 10-year fracture risk determined, specific osteological therapy is initiated even in less severe cases (T-score ≥ -2.5 SD). Figure 5: As expected, in the patients selected for DMAB therapy, men showed the higher initial BMD values for both the spine (+12%) and the hips (+4%) (Figure 5 & 6). The T-score median for women before DMAB therapy was -2.5 SD at the WS and -2.3 SD at the hip. For the men the mean T-score was -1.9 SD at the WS and -2.2 SD at the hip before DMAB therapy. Figure 6: Change of BMD under DMAB It has been shown that bone mineral content (BMD) increases differ depending on whether or not specific anti-resorptive therapy was given prior to DMAB therapy. In the case of no therapy before there was a stronger increase in bone mineral content than in patients who had received anti-resorptive pre-treatment. For patients under DMAB, the mean annual increase in BMD in the spinal column was 4.5% p.a. than in those undergoing anti-resorptive pre-treatment at 3.1% p.a. (delta +1.4%). At the total hip, the annual increases were 2.4% for the therapies and 1.6% for the specifically pretreated women. DMAB- therapy was associated with a continuous increase in BMD over the entire therapy period (Figure 7). The cumulative increase in our cohort was 27.2% for a 7-year period, higher than in the FREEDOM extension study [4]. The average 8-year gain in the extension study was 18.4% at...
Ebeed Yasin, Hesham Refae, Mahmoud Abdelgaliel Msc, Ahmed Abdellatif, Morsy Basiony, Mohamed Salman, Faisal Adam
Orthopedic Research Online Journal, Volume 6, pp 654-658; doi:10.31031/oproj.2020.06.000648

Abstract:
Ebeed yasin MD1*, Faisal Adam MD2, Hesham Refae MD1, Mahmoud Abdelgaliel MSc1, Ahmed Abdellatif MD1, Morsy Basiony MD1, Mohamed Salman MD1 1Orthopaedic Department, Aswan University, Egypt 2Orthopaedic Department, Assiut University Hospital, Egypt *Corresponding author: Ebeed Yasin, Aswan University, Egypt Submission: February 24, 2020;Published: February 27, 2020 DOI: 10.31031/OPROJ.2020.06.000648 ISSN: 2576-8875 Volume6 Issue5 Background: Comminuted tibial plateau fractures (CTPF) almost associated with intraarticular extension and various degree of soft tissue injury. Ilizarov fixator provides a rigid fixation for these fractures and allows immediate mobilization of the joints and early weight bearing. Purpose: evaluation of results of the Ilizarov ring fixator method in patients with CTPF regard to union, complication rates and final functional outcome. Methods: A prospective cohort study was carried out for patients with CTPF in Aswan University Hospital and Assiut University Hospital utilizing ilizarov ring external fixator. Material: Twenty consecutive patients with CTPF were classified according Schatzker's classification; 9 patients were type VI, 7 patients were type V and 4 patients were type IV, 17 open and 3 closed fractures.The mean age was 34.05 (ranged from 20-54) years, 16 male and 4 females. Results: All fractures united at a mean time 21 (ranged from 14 to 25) weeks. The ilizarov fixators were removed after mean of 5 (range from 13 to 29) weeks. The average follow up was 19 (range 15-24) months. The outcome was excellent in 12, good in 6 and fair in 2 according the rating system of Hospital for Special Surgery (HSS knee score). Five cases recorded malunion. The final knee range of motion ranged from 0ᵒ to 160ᵒ with mean 105ᵒ with cases of schatzker, type V and VI, while type IV fractures had 125ᵒ mean knee range. One case suffered from total stiff knee in 0ᵒ extension. Three cases with ligamentus laxity but without functional disability.There was a direct correlation (P
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