Analysis of pattern of anti-osteoarthritic drugs in a tertiary care hospital of central India – A drug utilization study

Background: Osteoarthritis (OA) is the most common kind of arthritis and symptomatic OA is recognized as a significant cause of disability and participation limitation in middle-aged and older persons. Aims and Objectives: The present study was done to evaluate drug utilization pattern of drugs used in treatment of OA at tertiary care center in central India. Materials and Methods: The present study was observational and prospective research carried out at NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, a tertiary care hospital. The necessary information was collected from the orthopedics department. The investigation lasted 6 months, from July 2022 to December 2022. The present research included 108 patients diagnosed with OA. Results: The research included a total of 104 patients comprising of 58 females and 44 men. The majority of the patients were found to be 60 years old or older, with OA impacting their knee joint considerably (45%). NSAIDs were the most regularly given class of medicines in OA which was prescribed to 81% of the patients. Combined treatment of NSAIDs, calcium, and Vitamin D3. It was found that 52% of patients were adhering to OA medication. Conclusion: The patient’s uncontrolled pain was brought on by medicines, a low-calcium diet, increased stress, obesity, and advanced age, as well as a lack of knowledge about the challenges associated with OA.

La chirurgie ambulatoire en orthopédie et traumatologie: expériences du Centre Hospitalier Universitaire Morafeno Toamasina / mbulatory surgery in orthopedics and traumatology: experiences of the University Hospital Morafeno Toamasin

Introduction : Plus qu'un défi ou un enjeu, la chirurgie ambulatoire, constitue pour les pays en voies de développement une opportunité d'accroître l'accès aux soins. Elle est un concept d'organisation centrée sur le malade, basée sur la sélection des patients et des actes chirurgicaux afin d'assurer une qualité et une sécurité maximale de soins. Objectifs : Partager les résultats de notre expérience sur la chirurgie ambulatoire en orthopédie traumatologie et de déterminer les difficultés rencontrées lors de sa mise en place. Matériels et Méthodes: Il s'agit d'une étude prospective, descriptive et observationnelle allant de janvier 2018 au janvier 2019 (12 mois) réalisée au CHU Morafeno Toamasina. Résultats: Au total, 108 patients ont été retenus. Les interventions réglées étaient réalisées chez 82,40% des patients contre 17,59% d'urgences traumatologiques. L'âge moyen des patients était de 32 ans ± 8,6 ans avec une prédominance masculine (sex ratio:3,9) . Le type d'intervention réalisé était dominé par les ablations de matériels d'ostéosynthèses avec un taux de 25,92%, suivies des tentatives de réduction orthopédique de fractures dans 22,22 % des cas. Le type d'anesthésie la plus pratiquée était l'anesthésie locorégionale (52,77%). Les évènements en postopératoire étaient dominés par l'insomnie (4,62%), la céphalée (2,77 %), les nausées et vomissements (5,55%) et les hématomes (3,70%). Soixante-douze virgule deux pour cent des patients déclaraient satisfaits de leur prise en charge. Conclusion: Le développement extensif de la chirurgie ambulatoire est basé sur la sélection des patients à qui l'on propose ce type de prise en charge. Elle présente un enjeu majeur en matière de restructuration et d'amélioration de l'offre de soins en chirurgie orthopédique et traumatologie

Clubfoot Deformity Treatment with Ilizarov Apparatus in the Paediatric Population without Corrective Osteotomies and Soft Tissue Release: A Cross-Sectional Study

@#Introduction: Neglected Club Foot deformity is not an uncommon limb anomaly encountered by orthopaedic surgeons. Many treatment methods have been proposed. Ilizarov apparatus is one of the techniques used to correct this deformity. Materials and methods: In this cross-sectional study 47 patients (56 feet) between the ages of 5 and 10 years with clubfoot deformity were treated using the Ilizarov external fixator. Age, sex, type of deformity, and radiographic parameters were measured on foot radiographs. Also, the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Dimeglio classification were recorded for each patient before and after treatment. Results: The treatment was unilateral in 38 patients and bilateral in 9 patients. 39 patients (69.6%) were male, and 17 patients (30.4%) were female with a mean age of 7.86 ± 1.4 years. Plantar angles of ankle flexion and ankle flexion curve increased from 20.12±6.52 and -16.51±8.36 to 25.89±6.44 and 6.19±6.42, respectively. There was also an improvement in the talocalcaneal and tibiocalcaneal angles. Also, the angle between the first metatarsus and the talus in the front and side views improved (P<0.00). Additionally, the mean AOFAS score and Dimeglio classification significantly improved. Three cases were complicated with distal tibial physeal separation that were treated with additional open surgeries. Conclusion: Ilizarov technique without osteotomies and soft tissue release could be considered a less invasive and successful method of treatment for neglected clubfoot deformity in patient five to ten years old that are not good candidate for Ponseti method.

Women in Orthopaedics: A Perspective from Malaysian Female Orthopaedic Surgeons

@#Introduction: The awareness of under-representation of female surgeons in orthopaedics has been increasing in this decade. We aim to investigate the reasons why female surgeons chose orthopaedic, the barriers that possibly hinder female surgeons into orthopaedics and analyse the obstacles that they encountered in their career in Malaysian context. Materials and methods: A total of 101 registered female orthopaedic surgeons registered with the Malaysian Medical Council, during the period 1980 to 2020, were contacted for a cross-sectional survey, consisting of thirty-four questions on their experience in the orthopaedic career. Eighty-two responses were received (81.2%). Questions in this survey consisted of four sections: (1) demographic details, (2) current clinical practice environment, (3) orthopaedics training experience, and (4) career experience. Results: A total of 49% of respondents had subspeciality training, highest in paediatric orthopaedic (30%). Enjoyment of manual tasks (64.6%) and professional satisfaction (64.6%) were the top reasons for choosing orthopaedic as a career. Primary barriers to orthopaedic were physical strength required (56.0%) and public gender bias (52.4%). Twenty-eight percent reported gender discrimination in career opportunities while 60% reported similar in daily work. Thirty-three percent reported verbal and 11% physical sexual harassment in their career. Forty-four percent of respondents reported benefits as female orthopaedic surgeon in their work. Conclusion: The reasons for Malaysian female orthopaedic surgeons to choose orthopaedic as their career and the barriers perceived to hinder other females from choosing orthopaedics were similar to reports worldwide with no exception to gender discrimination and sexual harassment. The support given by male colleagues to married female surgeons marked a unique phenomenon in Malaysian culture.

Smart Phone Chat Apps for Teaching and Assessment in Orthopaedic Residency Training

@#Introduction: Smart Phone Chat Apps (SPCA) is an integral part of people’s daily routine including orthopaedic education. SPCA facilitates efficient communication and learner-based management especially now as remote flexible learning is becoming the new norm in this COVID-19 pandemic medical training. The study described the use of a chat app (Viber) as experienced by residents and consultants in the Section of Adult Orthopaedics of the institution of the principal author. It described the mode and dynamics of the chat discussion amongst its participants, its perceived usefulness in teaching and learning specifically its relevance and applicability, its potential as a supplementary assessment tool, as well as its perceived effects. Materials and methods: This is a phenomenological study and strictly adhered to data privacy. The principal author conducted a participant observation of residents’ threemonth clinical rotation at the study site. Mobile phone screenshots of the chat interactions and focus group discussions with consultants and residents were done. Residents were also requested to complete a questionnaire. All qualitative data were iteratively content analysed and emerging themes were summarised using NViVO-12. Frequencies and percentage distribution were used to analyse quantitative data. Results: Respondents included eleven senior, four junior residents, and nine consultants. Results show that SPCA is a useful, applicable, and relevant teaching and assessment tool. Influxes of multiple ideas per case were discussed realtime as the chat exchanges and interactions helped in the planning of the surgical management and eventual decisionmaking. SPCA also served as an effective surgical case log and online library, as well as an efficient, rapid, economical mode of information dissemination. The residents reported that it helped in developing their emotional maturity through self-reflection and self-criticism in the performance of their cases. The consultants concurred and added that they too were updated professionally in certain fields in orthopaedics. Conclusion: The SPCA is a helpful, relevant, and acceptable adjunct teaching and learning tool for clinical teaching and can be, to a certain extent, a supplementary formative assessment tool of the resident’s communication skills, work ethics, initiative, and diligence.

The fruits of innovation and transformation will blossom and bear fruit on the land of China / 中华骨科杂志

In the new journey of building a modern socialist country in an all-round way, China is gradually entering the ranks of innovative countries. The national emphasis on scientific and technological innovation and transformation and the policy guidance have inspired the unprecedented enthusiasm and confidence of Chinese orthopaedic surgeons for innovation and transformation. After decades of unremitting efforts of orthopaedics predecessors, Chinese orthopaedics, as the new force of scientific and technological innovation, has been developing towards the direction of digitalization, personalized, minimally invasive, precise and intelligent, but some problems have also been exposed. We should strengthen the main position of independent innovation of orthopedics new technology, materials and instruments, implement the strategy of combining "import" with China's specific national conditions, and use Chinese and western, strive to solve the problem of transformation of scientific research results, accelerate the process of localization replacement, so that the innovation transformation results in the land of China.

Application of WeChat group combined with PBL teaching model in the practice of pediatric orthopaedics / 中华医学教育探索杂志

Objective:To study the application of establishing WeChat group combined with PBL teaching mode in the practice of pediatric orthopaedics.Methods:The study was conducted among 36 postgraduates of "5+3" pediatrics and 22 postgraduates of orthopedic surgery of Batch 2012 who had practice in Department of Orthopaedics, Children's Hospital of Chongqing Medical University from September 2018 to August 2019, and they were randomized into control group and experimental group, with 29 students in each group. The control group was taught by traditional PBL mode, while the experimental group was taught by WeChat group combined with PBL mode. At the time of leaving the department, the two groups were assessed by theoretical knowledge, practical operation and questionnaire satisfaction, thus evaluating the teaching effects. The SPSS 23.0 was used to conduct t test and chi-square test. Results:The average scores of theoretical knowledge test (91.28±2.89) and practical operation test (87.44±2.94) in the experimental group were significantly higher than those in the control group (87.39±3.53) and (79.06±3.84), with statistically significant differences ( P<0.05). In the survey of teaching satisfaction, the experimental group[96.55%(27/29)] was significantly higher than the control group[61.90%(21/29)], with statistically significant differences ( P<0.05). Conclusion:The establishment of WeChat group and the combination of PBL teaching model can significantly improve the teaching effect and students' satisfaction in the practice of pediatric orthopaedics, which is worthy of further promotion and application.

Manejo de fracturas abiertas de tibia en Cuba / Management of Open Tibial Fractures in Cuba

Introducción: Las fracturas abiertas de tibia son un subconjunto de la carga de traumatismos en América Latina. Se examinaron cuestiones relacionadas con el tratamiento potencialmente críticas en Cuba, país con recursos limitados, pero con un programa nacional de salud estandarizado, coherencia en educación y similitudes de programas de posgrado. Objetivos: Describir los patrones de tratamiento de la fractura abierta de tibia en Cuba, y comparar las características del manejo agudo y tardío en siete provincias del país. Métodos: Se encuestaron 67 cirujanos ortopédicos para evaluar cuatro aspectos en el tratamiento de la fractura abierta: profilaxis antibiótica, irrigación y desbridamiento, estabilización y tratamiento de heridas. Se utilizó el método de muestreo por conveniencia para identificar a los cirujanos y el análisis se realizó mediante la prueba exacta de Fisher (p < 0,05). Resultados: Se administraron antibióticos posoperatorios durante más de 72 horas para las fracturas GA-I/II (49 por ciento) y las fracturas GA-III (70 por ciento). Los cirujanos de La Habana (n= 32) utilizaron con más frecuencia la fijación interna primaria para las fracturas GA-I/II, que los cirujanos en las restantes provincias (n= 35) (64,3 porciento vs. 30,3 por ciento, p= 0,008). Los cirujanos de otras provincias realizaron cierre primario en el momento de la fijación definitiva de fracturas GA-I /II con más frecuencia que los de La Habana (62,9 por ciento vs. 32,3 por ciento, p= 0,013). Para fracturas GA-III, la mayoría de los cirujanos habaneros (88,6 %), al igual que los de las restantes provincias (96,8 por ciento) prefirieron realizar cierre diferido.Conclusiones: El tratamiento de fracturas abiertas de tibia en Cuba es generalmente consistente con otros países de América Latina. Se describen las características del manejo de fracturas abiertas de tibia en Cuba y se comparan las diferencias en los métodos de estabilización y tratamiento de heridas entre provincias, lo cual resulta útil para evaluar si son resultado de diferencias en la práctica quirúrgica, o en la disponibilidad de recursos. Esto representa una ayuda al abordar las formas de optimizar la atención al paciente, a través de la capacitación especializada y la asignación de los recursos(AU)

Introduction: Open tibia fractures are a significant subset of the overall trauma burden in Latin America. Latin American countries vary in their access to orthopaedic care resources, and country-specific orthopaedic recommendations are necessary. Cuba, a country with limited resources, has a standardized national health program, consistencies in education, and similarities across post-graduate training programs. This study aimed to identify management preferences for open tibia factures in Cuba. Objectives: To describe the treatment of open tibial fractures in Cuba, and to compare the characteristics of acute and delayed management across seven Cuban provinces. Methods: Sixty-seven orthopaedic surgeons were surveyed to evaluate four aspects of open fracture management, regarding antibiotic prophylaxis, irrigation and debridement, stabilization, and wound management. The convenience sampling method was used to identify surgeons and the analysis was performed using Fisher's exact test (p <0.05). Results: Postoperative antibiotics were administered for more than 72 hours for GA-I / II fractures (49 pecent) and GA-III fractures (70 percent). Surgeons in Havana (n = 32) used primary internal fixation for GA-I / II fractures more frequently than surgeons in the remaining provinces (n = 35) (64.3 pecent vs. 30.3 percent p = 0.008). Surgeons from other provinces performed primary closure at the time of definitive fixation of GA-I / II fractures more frequently than those from Havana (62.9 percent vs. 32.3 percent, p = 0.013). For GA-III fractures, the majority of Havana surgeons (88.6 percent), as well as those of the remaining provinces (96.8 percent) preferred to perform deferred closure. Conclusions: The treatment of open tibial fractures in Cuba is generally consistent with other Latin American countries. The characteristics of the management of open tibial fractures in Cuba are described and differences in wound stabilization and treatment methods between provinces are compared, which is useful to assess whether they are the result of differences in surgical practice, or in availability of resources. This is helpful in addressing ways to optimize patient care through specialized training and resource allocation(AU)

Osteogénesis por distracción en pseudoartrosis infectada de tibia. A propósito de un caso / Distraction osteogenesis in infected pseudoarthrosis of the tibia. A clinical case

Los defectos óseos post-traumáticos (DOPT), son por definición una entidad en donde existe pérdida de stock óseo en huesos largos, secundario a trauma de alta energía, infecciones o iatrogenia. Se define como defecto óseo critico a aquel que no es capaz de sanar en forma espontánea, o a aquel que en longitud supera 2 veces el diámetro diafisario del hueso afectado. Son una causa importante de menoscabo en la calidad de vida del que la padece debido a la importante pérdida de funcionalidad osteomuscular. Existe una variedad de técnicas que buscan tratar esta entidad, siendo el injerto de peroné vascularizado, la inducción de membrana y la osteogénesis por distracción las alternativas comúnmente usadas. El objetivo de este reporte es exponer una experiencia local con la técnica de osteogénesis por distracción en un paciente con defecto óseo critico producto de una fractura expuesta de tibia.

Post-traumatic osseous defects are, by definition, a condition in which there is loss of bone stock in the long bones secondary to high energy trauma, infections or iatrogenesis. Critical osseous defect is defined as that which cannot heal spontaneously, or where its length is more than twice the diaphyseal diameter of the affected bone. It is an important cause of impairment in the quality of life of the sufferer due to the significant loss of musculoskeletal functionality. There are a variety of techniques used to treat this, vascularised fibula grafting, membrane induction and distraction osteogenesis being the commonly used alternatives. The objective of this report is to relate local experience of distraction osteogenesis in a patient with a critical osseous defect, product of an exposed tibia fracture.

Fat Embolism Syndrome – A Qualitative Review of its Incidence, Presentation, Pathogenesis and Management

@#Fat Embolism Syndrome (FES) is a poorly defined clinical phenomenon which has been attributed to fat emboli entering the circulation. It is common, and its clinical presentation may be either subtle or dramatic and life threatening. This is a review of the history, causes, pathophysiology, presentation, diagnosis and management of FES. FES mostly occurs secondary to orthopaedic trauma; it is less frequently associated with other traumatic and atraumatic conditions. There is no single test for diagnosing FES. Diagnosis of FES is often missed due to its subclinical presentation and/or confounding injuries in more severely injured patients. FES is most frequently diagnosed using the Gurd and Wilson criteria, like its rivals it is not clinically validated. Although FES is a multi-system condition, its effects in the lung, brain, cardiovascular system and skin cause most morbidity. FES is mostly a self-limiting condition and treatment is supportive in nature. Many treatments have been trialled, most notably corticosteroids and heparin, however no validated treatment has been established.

Orthopaedic Practices and Surgeries during COVID-19 in Pakistan - A Survey Based Study

@#Introduction: The study aimed to target the current practices of the orthopaedic community in outpatient (OPD), emergency (ER) and surgical services (OT) during COVID19. Material and method: This study surveyed 303 orthopaedic surgeons from all over Pakistan. The survey had 30 questions targeting the setup of outpatient, emergency and operation services in orthopaedic departments of different hospitals in Pakistan. Result: A total of 302 surgeons were included from 53 cities all over Pakistan. Between 35-48% of the respondents reported lack of availability of standard operating procedures in OPD, ER and in OT. Majority of the respondents noted that their OPD and surgical practice had been affected to some degree and 69% of the surgeons were only doing trauma surgery. This trend was higher in younger consultants of less than 45 years of age (p<0.001). Almost two-third of the surgeons, mostly senior (p=0.03) were using surgical masks as the only protective measure during various practices of OPD, ER and OT, while most of the setups were not assessing patients even for signs and symptoms of COVID. Almost 89% of the orthopaedic community is facing definite to mild stress during this pandemic and this has significantly affected the senior surgeons (p=0.01). Conclusion: Our study highlighted that COVID-19 has resulted in marked changes to the practices of the majority of Pakistani orthopaedic surgeons. Despite a sharp upsurge in the number of cases and mortality due to COVID-19, guidelines were still lacking at most of the settings and a substantial percentage of the orthopaedic community were not following adequate safety measures while attending to patients.

Impact of COVID-19 on Clinical Practices during Lockdown: A pan India Survey of Orthopaedic Surgeons

@#Introduction: The social lockdown measures imposed to contain the COVID-19 pandemic, have had profound effects on the healthcare systems across the world and India has been no exception to it. The study was aimed to evaluate the impact of COVID-19 on orthopaedic practice in India during the lockdown period and assess the preparedness of orthopaedic surgeons for resuming clinical practice after the initial lockdown was lifted. Materials and Methods: An online survey of 35 questions was conducted to evaluate impact on (i) general orthopaedic practice (ii) hospital protocols (iii) out-patient practice (iv) surgical practice (v) personal protective equipment (PPE) use and (vi) post-lockdown preparedness. Results: A total number of 588 practising orthopaedic surgeons from India completed the survey. Majority (88.3%) found severe impact (>50%) on trauma surgery and nontrauma surgery with significant reduction in out -patient attendance compared to corresponding time in 2019. There were significant changes made in individual hospital protocols (91.7 %). Appropriate required PPE was available in majority of the hospitals (74.3%). No remodelling or upgrading of the existing operating theatre infrastructure was done by most surgeons (89.5%). Conclusion: This pan India survey of orthopaedic surgeons has indicated that COVID-19 has had a profound impact on their outpatient and surgical trauma and non-trauma practice, due to the lockdown and resulted in significant changes to hospital protocols. Preparedness to resume clinical and surgical practice was associated with anxiety in two-thirds of the respondents. Majority of the orthopaedic practitioners felt that they would continue to conduct pre-operative COVID-19 screening and use PPE even after the lockdown is over.

Distraction index measurement on the dog's hip joint using a dedicated software / [Medição do índice de distração da anca do cão usando um software especial]

The aim of this study was to test the accuracy of a new automated computer software tool for the assessment of passive hip laxity. The hip laxity was estimated using the dedicated computer software by two blinded evaluators, one previously trained and one without specific training for distraction index measurement, in two independent sessions using 230 hip joints from 115 dogs that underwent screening for passive hip laxity using the distraction view. Previously, all of these radiographs were sent to PennHIP Analysis Center for an official distraction index record. The measurement repeatability of the two sessions was adequate for both evaluators. The reproducibility of the official distraction index measurement, mean distraction index±standard deviation 0.44±0.15, was adequate (P>0.05) for the trained evaluator, 0.44±0.15, and non-adequate (P<0.05), for the non-trained evaluator 0.47±0.17. The distraction index measurement tool proposed can be used with confidence for hip laxity evaluation by trained evaluators, as it provided good repeatability and reproducibility of official reports. The simplicity of the process described leads to a less time-consuming and more affordable procedure.(AU)

O objetivo deste estudo foi testar a viabilidade de uma nova ferramenta de software informático para avaliação da lassitude articular passiva da articulação coxofemoral. A lassitude articular da articulação coxofemoral foi estimada usando-se um programa informático especial, desenvolvido para o efeito, por dois avaliadores, um com treino prévio e outro não treinado, na medição do índice de distração, em duas sessões independentes, utilizando-se 230 articulações coxofemorais de 115 cães, as quais efetuaram o rastreio de displasia coxofemoral realizando a projeção de distração da articulação coxofemoral. Previamente, todas as radiografias foram enviadas para o PennHIP Analysis Center, para se obter uma medida oficial do índice de distração. A repetibilidade das medições das duas sessões foi adequada para ambos os avaliadores. A reprodutibilidade do índice de distração oficial, média±desvio-padrão 0,44±0,15, foi adequada (P>0,05) para o avaliador treinado, 0,44±0,15, e não adequada (P>0,05) para o avaliador não treinado, 0,47±0,17. A ferramenta de medição do índice de distração proposta pode ser usada com segurança na medição do índice de distração por avaliadores treinados, uma vez que mostra uma adequada repetibilidade e reprodutibilidade das medições oficiais do índice de distração. A simplicidade do processo apresentado torna-o menos demorado e mais econômico.(AU)

Porous Lattice Structure of Femoral Stem for Total Hip Arthroplasty / Estructura de Diseño Poroso por Latice de Vástago Femoral para Artroplastia Total de Cadera

Abstract Total Hip Arthroplasty (THA) is one of the surgical procedures carried out satisfactorily in procedures for osteoarthritis and trauma lesions. ATC surgery reduces pain and improves the quality of life of young patients. Therefore, it is of great importance to improve the properties of hip implants, since current implants do not match their lifespan with the life expectancy of a young patient. This is because the solid prostheses that currently exist have a higher Young's modulus, and therefore are too rigid compared to the bone tissue. On the other hand, the cyclic and continuous loads to which the hip joint is subjected in daily activities, can cause loosening and consequent implant loss The present work proposes an implant manufactured with a porous lattice structure, which aims to reduce stiffness, allow bone growth and a more effective mechanical load transfer. Three computational models subjected to static charges were evaluated and compared: 1) healthy femur, 2) implanted femur with a commercial prosthesis, and 3) implanted femur with a prosthesis with lattice structure. For the computational analysis it was decided to perform a static analysis of a person standing on the left foot; a load equivalent to the body weight was applied on the head of the femur, balancing the reaction forces in the system of forces (contact force, body weight, and abductor muscle).. The results were shown in terms of displacement, compression and deformation. The model implanted with a prosthesis with a lattice design presented a slight decrease in displacement, and a decrease in compression and deformation values, which indicated that the proposed design has a better distribution and transport of the loads through its structure.

Resumen La artroplastia total de cadera (ATC) es uno de los tratamientos quirúrgicos llevados a cabo de manera satisfactoria en procedimientos para la osteoartritis y lesiones de trauma. La ATC reduce el dolor y mejora la calidad de vida de los pacientes. Por lo tanto, es de gran importancia mejorar las propiedades de los implantes de cadera, ya que los implantes actuales tienen un tiempo de vida útil y deben cumplir con las expectativas de rehabilitación para los pacientes. Esto se debe a que las prótesis sólidas que existen actualmente tienen un módulo de Young más elevado, y por lo tanto son demasiado rígidas a comparación del tejido óseo. Por otro lado, las cargas cíclicas y continuas a las que se ve sometida la articulación de la cadera en actividades diarias, pueden ser causa del aflojamiento y consecuente pérdida del implante. El presente trabajo propone un implante fabricado con una estructura porosa tipo látice, el cual tiene como objetivos reducir la rigidez, permitir crecimiento óseo y una transferencia de cargas mecánicas más efectiva. Se evaluaron y compararon tres modelos computacionales sometidos a cargas estáticas: 1) fémur sano, 2) fémur implantado con una prótesis comercial, y 3) fémur implantado con una prótesis con estructura látice. Para el modelo computacional se optó por hacer un análisis estático de una persona parada sobre el pie izquierdo; donde se aplicó una carga equivalente del peso corporal sobre la cabeza del fémur, equilibrando las fuerzas de reacción en el sistema de fuerzas (fuerza de contacto, peso corporal, y músculo abductor). Los resultados fueron mostrados en términos de desplazamiento, compresión y deformación. El modelo implantado con una prótesis con un diseño tipo látice presentó una ligera disminución de desplazamiento, y disminución en los valores de compresión y deformación, lo que indicó que el diseño propuesto posee una mejor distribución y transporte de las cargas a través de su estructura.

Cervical ossification of the posterior longitudinal ligament and its post surgical outcome analysis

Background: Ossification of the posterior longitudinal ligament (OPLL) is a complex multi-factorial disease process having both metabolic and biomechanical factors. The objective of this study was to assess the surgical out come and post operative functional improvement in patients with cervical OPLL at a tertiary care centre.Methods: This prospective observational study included 35 patients undergoing surgery for cervical OPLL in the department of neurosurgery, Care hospitals Hyderabad from October 2015 to October 2016 with follow up at 3months and 6 months.Results: Total 35 patients who underwent surgery, majority (77.15%) were males and (22.85%) were female. The age of the patients was between 30 to 70 years. The most common type of OPLL was found to be segmental and mixed type. Nurick grade improved by 1.12 in anterior approach vs 0.66 in posterior approach. Recovery rates observed in anterior approach is 57.72% while in posterior surgical approach it is 48.87%. No complication was observed in this study.Conclusions: OPLL is more common in males as compared to females. The average age of presentation is sixth decade. Younger patients have better outcomes. The most common variant of OPLL is segmental.  The recovery rate achieved from anterior approach are better than those from the posterior approach. Improvement in NURICKS score is more in anterior surgical group than in posterior surgical group. No complications seen in this study. No mortality seen in this study.

Treatment of a femoral septic nonunion in a dog with interlocking nail stabilization associated to corticospongious bone autograft and greater omentum flap: case report / Tratamento de não união séptica femoral em cão com estabilização com haste intramedular bloqueada associada a autoenxerto de osso corticoesponjoso e retalho do omento maior: relato de caso

Chronic septic bone nonunion requires a well-designed therapeutic planning, demanding a multimodal treatment to achieve bone consolidation and elimination of infection. A successful case of an association of the major omentum flap with surgical stabilization with an interlocking nail for treatment of a femoral septic nonunion in dog is reported. The patient had partial functional return of the limb 30 days after surgery, negative bacterial culture with radiographic signs of bone healing and total functional return of the limb at 90th days after the surgical procedure.(AU)

Não uniões ósseas associadas à osteomielite crônica necessitam de um planejamento terapêutico muito bem realizado, demandando tratamento multimodal para conseguir atingir a consolidação óssea e eliminar a infecção. Relatou-se um caso de sucesso do uso da associação de retalho do omento maior com estabilização cirúrgica com haste intramedular bloqueada para tratamento de uma não união séptica de fêmur em cão. O paciente apresentou retorno funcional parcial do membro com 30 dias após a cirurgia, cultura bacteriana estéril com sinais radiográficos de consolidação óssea e retorno funcional total do membro aos 90 dias de pós-operatório.(AU)

Roadmap Out of COVID-19

@#The recent coronavirus disease (COVID-19) was declared as a public health emergency by the World Health Organisation on 30th January 2020, and has now affected more than 100 countries. Healthcare institutions and governments worldwide have raced to contain the disease, albeit to varying degrees of success. Containment strategies adopted range from complete lockdowns to remaining open with public advisories regarding social distancing. However, general principles adopted by most countries remain the same, mainly to avoid gatherings in large numbers and limit social interactions to curb the spread of disease. In Singapore, this disease had a very different progression. The first wave of the disease started with the confirmation of the first COVID-19 positive patient in Singapore on 23rd January 2020. Initially, the daily number of confirmed cases were low and manageable. With a rise in unlinked cases, the Disease Outbreak Response System Condition (DORSCON) status was raised from yellow to orange. New cluster outbreaks in foreign worker dormitories led to the rampant spread of disease, with daily spikes of COVID-19 cases. As of 7th June 2020, we have a total of 37,910 confirmed cases of COVID-19 infections, the highest in Southeast Asia, 12,999 active cases and a manageable mortality count of 25 deaths. This details our unique method for dealing with a pandemic, including a brief demographic of trauma patients during this period. We were able to conserve sufficient resources to ensure that our essential services can still continue. Moving on, we have to ensure the continued protection of our population, especially the vulnerable groups such as the elderly and the immunocompromised, as we reopen.

Experience in prevention and control of COVID-19 in tramatological and microsurgical wards / 中华创伤骨科杂志

Objective@#To report our experience in the prevention and control of COVID-19 in the tramatological and microsurgical wards.@*Methods@#A retrospective study was conducted of the COVID-19 infections in the 51 medical staff and patients from 31 December, 2019 to 14 February, 2020 at Department of Traumatology and Microsurgery, Zhongnan Hospital. The prevention and control measures were upgraded after 20 January, 2020 to address the serious epidemic situation, including preventive disinfection, terminal disinfection and personnel disinfection in wards, management of emergency patients, inpatients and patients suspected of COVID-19 infection, and training, management and psychological intervention of medical staff. The outcomes resulting from different prevention and control measures before and after 20 January, 2020 were compared.@*Results@#From 31 December, 2019 to 20 January, 2020, there were altogether 3 cases of definite COVID-19 infection and 2 ones of suspected COVID-19 infection at the department. One doctor, one technician and one nurse were diagnosed as definite COVID-19 infection while one nurse and one patient as suspected COVID-19 infection. The 4 medical staff members infected were cured and discharged before 14 February, 2020 but unfortunately the one patient infected died. After the prevention and control measures for COVID-19 infection had been upgraded since 20 January, 2020, 12 out of the 29 emergency patients at our wards had fever (body temperature ≥37.3℃) but none COVID-19 infection. All the 47 medical staff on duty at the department got trained and none of them was infected by COVID-19 or suffered from mental disorder.@*Conclusion@#In the epidemic of COVID-19, as our prevention and control measures for COVID-19 infection were adjusted and upgraded in response to the changing epidemic situation, they eliminated nosocomial infection scientifically and effectively and ensured life safety of the medical staff and patients at the department.

Strategies suggested for emergency diagnosis and treatment of traumatic orthopedicsin the epidemic periodof Corona Virus Disease 2019 / 中华创伤骨科杂志

Objective@#To suggest strategies for emergency diagnosis and treatment of trauma orthopedics in the epidemic period of Corona Virus Disease 2019(COVID-19).@*Methods@#In the epidemic of COVID-19 from January 21 to February 15, 2020, 128 patients with orthopaedic trauma sought emergency treatment at Department of Orthopedic Surgery, The People’s Hospital of Wuhan University. They were 71 males and 57 females with an average age of 48.7 years (from 5 to 88 years).Of them, 107 cases were treated at the outpatient department and 21 hospitalized. Emergency operations were carried out for 4 cases and selective operationsfor 17 cases. COVID-19 infections were recorded in the patients and medical staff as well. Measures taken and experiences learned were summarized since the epidemicoutbreak of COVID-19.@*Results@#Of the 107 cases treated at the outpatient department, 3 had a definite diagnosis of COVID-19 and 3 a suspected diagnosis of COVID-19. Of the 4 cases undergoing emergency surgery, one was suspected of having COVID-19. Of the 17 cases undergoing selective surgery, one was diagnosed definitely as COVID-19and 2 were suspected of COVID-19. Two nurses were diagnosed definitely as having mildCOVID-19.One doctor and one nurse were suspected of COVID-19. Since the COVID-19 infections in medical staff occurred all before the preventive and control measures for COVID-19 had been implemented,is was not ruled out that their infections might have come from communities.@*Conclusions@#It is particularly important for medical institutions of all levels to maintain safe and effective routine services while doing well in COVID-19 prevention. In the epidemic of COVID-19, front-line medical staff in emergency traumatic orthopedics is faced with great challenges in the process of diagnosing and treating patients. High-quality and safe medical services can be provided as long as nosocomial COVID-19infection is effectively controlled by rigid screening of patientsnewly admitted, classified management of inpatients, optimal management of inpatient wards, standard preventive measures in perioperative period, a perfect system for medical protection, and medical education for patients and their carers.

Management highlights for patients with orthopedic trauma during the epidemic of Corona Virus Disease 2019 / 中华创伤骨科杂志

Although the epidemic outbreak of Corona Virus Disease 2019 (COVID-19) restricted freecoming and going of people, it was inevitable that fracture patients, elderly ones with low-energy fracture in part ICU lar, sought medical attention. In this special situation, itwas crucial for trauma orthopaedists to do well in prevention and control of COVID-19 infection and in perioperative management of their patients as well while they went on with routine diagnosis and treatment. It was also of great significance for prognosis of the patients and prevention and control of the epidemic that orthopaedic surgeons chose proper surgical and anesthesia methods. In the process of diagnosis, treatment, nursing and rehabilitation, medical staff too was challenged by how to prevent themselves from infection and how to eliminate cluster COVID-19 transmission. This paper, from the perspectives of orthopedic surgeons, nurses and patients, expounds briefly on the management of patients with orthopedic trauma during the epidemic period of COVID-19 in a mode of multidisciplinary comprehensive interventions.