14^th International Conference on Orthopedics, Arthroplasty and Rheumatology September 21-22, 2020 Rome, Italy

Biography:

Aleksandra Nikolic is affiliated to the University Medical Center Ljubljana, Department of Traumatology, Slovenia.

Abstract:

Introduction

We present a case of two patients with distal humerus fracture (DHF), treated conservatively with an above elbow backslab (AEB). After 1 month of immobilization, followed by physiotherapy, both achieved good bone healing with negligible functional loss.

Case presentation

Two 79 year old patients, one male with rheumatoid arthritis, after STEMI, LCX stenting and bilateral total hip replacement followed by removal of the left prosthesis due to inflammation, and one female with arterial hypertension, diabetes type 2, after aortic valve replacement with warfarin treatment, suffered a metaphyseal comminutive fracture of the right distal humerus and left humerus lateral epicondylus fracture, respectively, both without distal neurocirculatory deficits.

In both patients, the broken limb was realigned and an AEB applied for 1 month, followed by physiotherapy. Upon followup, both were able to utilize the arm in all daily activities, with completely unhindered pronation/supination. In the male, the final achieved range of elbow movement was +10/120°, with good secondary bone healing in a satisfactory position on x-ray. In the female, no elbow movement obstruction persisted, x-ray showing a healed radial epicondylus in a slight dislocation.

Discussion

Examination of literature clearly shows a tendency towards a surgical approach to DHF treatment due to poorer joint movement results after conservative “bag of bones” treatment. On the other hand, there are numerous reports of perioperative complications in DHF patients with significant comorbidities. In the presented two cases, based on x-ray imaging analysis and clinical presentation, taking the patient’s comorbidities into consideration, a surgical approach was omitted in favor of immobilization with an AEB.

Conclusions

In spite of conservative treatment of DHF being a generally unfavored approach, it is useful for select low demand patients with significant comorbidities, and can achieve a favorable end result.

Biography:

Aleksandra Nikolic is affiliated to the University Medical Center Ljubljana, Department of Traumatology, Slovenia.

Abstract:

Background

Anterior hip approach became very popular in the last years among orthopaedic surgeons. The approach is minimally invasive and there are many articles which confirm that postoperative rehabilitation period is shorter and less painful when we perform a planned total hip arthroplasty. In theory should be the anterior approach advantages especially beneficial for treating elderly patients with femoral neck fractures. Is it really so much better than anterolateral approach when we perform a hip hemiarthroplasty?

Objectives

We did a clinical trial to check if the anterior approach is really a better tool in the hands of orthopaedic-trauma surgeons who used anterolateral approach before.

Study Design & Methods

Inclusion criteria for our study were patients over 75 years of age with femoral neck fractures which were treated with hip hemiarthroplasty. All stems were cemented. In group A there were 34 patients with mean age 80 years. The prosthesis was inserted through anterolateral hip approach. In group B there were 31 patients with mean age 78 years. The prosthesis was inserted through anterior hip approach. We compared operation times, blood loss during operation, need for transfusion, postoperative pain, hospitalisation period and functional recovery between the two groups.

Results

Group A: mean operation time 90 minutes. Blood loss during operation: 320 ml. Transfusion post OP: 1.1 unit. Pain on day 1 post OP: VAS 6, on day 7: VAS 4. Hospitalisation period 19 days. Functional recovery: none of the patients could walk without support upon dismissal from hospital.

Group B: mean operation time 75 minutes. Blood loss during operation: 290 ml. Transfusion post OP: 0.25 unit. Pain on day 1 post OP: VAS 3, on day 7: VAS 1. Hospitalisation period 19 days. Functional recovery: 28% of patients could walk without support upon dismissal from hospital.

Conclusions

Anterior hip approach proved to be a slightly better tool for treating elderly with femoral neck fractures in comparison to anterolateral hip approach. Its main advantages are lesser blood loss and minor postoperative pain which allows quicker start of physiotherapy. Minimal need for transfusion can be an important economic factor, as well.

Biography:

Aleksandra Nikolic is affiliated to the University Medical Center Ljubljana, Department of Traumatology, Slovenia.

Abstract:

Introduction

We demonstrate our protocol for treatment of heterotopic ossification (HO) after osteosynthesis of complex elbow fractures (CEF) by presenting a case of a patient with fracture dislocation of the distal humerus in whom very good end results were achieved.

Case presentation

A 72 year old female with idiopathic osteoporosis suffered fracture dislocation of distal humerus a FDHBCL without distal neurocirculatory deficits. Initial treatment included limb reposition and above elbow backslab immobilization. After 2 weeks, osteosynthesis was performed with no complications. With postoperative rehabilitation (criotherapy, assisted and active elbow movement exercises) elbow range of movement (ERM) reached +45/90°. 7 months after the injury, despite ongoing physiotherapy, ERM had deteriorated to +30/90° with normal pronation/supination. On x-ray and CT-scan, a large heterotopic ossification was protruding anteriorly into the fossa coronoidea, with a smaller ossification seen on the ulnar side. The initial radial condylus fracture was healed, with osteosynthetic material in a satisfactory position. 4 months later, removal of osteosynthetic material and heterotopic ossification was performed, reaching a full ERM intraoperatively. In the morning before the operation, the ossification was subjected to prophylactic radiotherapy (total dose 7Gy). Postoperatively, the patient received indometacin 25mg 3 times a day for the duration of 4 weeks. With ongoing intensive physiotherapy, a ERM of 0/140° was reached at 9 months post re-operation. X-ray findings were clear of heterotopic ossifications, with a satisfactory anatomical presentation.

Discussion & Conclusions

As proven by this case (and a few others which we also successfully treated using the same protocol), it is our opinion that the combination of arthrolysis with ossification removal, coupled with preoperative prophylactic radiotherapy and postoperative NSAID treatment, is an effective method of post-CEF HO removal and its subsequent prevention.

Biography:

Aleksandra Nikolic is affiliated to the University Medical Center Ljubljana, Department of Traumatology, Slovenia.

Abstract:

INTRODUCTION: The application of negative pressure to assist in wound healing was first described in the management of soft tissue injury in association with open fracture in 1992.  Soft tissue trauma with open fracture wounds still remains important indication for the use of NPWT. With the development of science and technology NPWT has transformed the management of complex open wounds and nowadays it is used as a preventative tool in reducing the incidence of surgical site infection (SSI) and dehiscence of the closed incision. It is also an important tool for the treatment of chronic wounds and chronic osteitis.

METHODS: Aim of our study was to demonstrate practical solutions for treatment of complex wounds in our department.

DISCUSSION: Treatment with NPWT is a relatively simple method but in clinical practice it is commonly used for handling complex patients. Such patients are challenging to treat with NPWT and inventive practical solutions are recommended.

CONCLUSION: NPWT does not replace adequate surgical treatment of soft tissue injuries and is used as a temporary solution until definitive treatment of the defect is performed. Technological advances within NPWT are currently seen to be heading in several directions.

Biography:

Mr Funbi Anthony Ayeni is a trained orthopaedic surgeon who completed his residency training in Nigeria in 2018 and has since commence further training in the United Kingdom. Funbi is working towards being a sports orthopaedic surgeon in the United Kingdom. His research work is towards sport medicine and has published an original research article on the use of platelet rich plasma in knee osteoarthritis.

Abstract:

Wide awake local anaesthesia no tourniquet (WALANT) is being employed beyond hand surgeries recently. COVID 19 shifted many orthopaedic practices with reliance on conservative treatment and deferment of elective procedures. WALANT techniques has a tendency to minimize the risk of aerosolized droplet contamination which is important in transmission of the disease. We studied the outcome of recalcitrant tennis elbow treated with either WALANT techniques or general anaesthesia.

Retrospective study of patient who underwent open release of recalcitrant tennis elbow with either WALANT or general anaesthesia with tourniquet. Outcome assessments were visual analogue score (VAS), quick disability of arm, shoulder and hand score (quick DASH) and the operative time.

46 patients were studied with average age of 49 years (SD=8.12), there was no difference in the mean of the quick DASH (GA 16.23±30.21, WALANT 0.00±0.00 p =0.07) and post-operative VAS (GA 2.61±3.17, WALANT 0.87± 1.80 p =0.17).  However, there was a significant difference in the operative time (GA 38.78±13.80, WALANT 19.88±8.24 p =0.00).

Both techniques have similar outcomes with respect to the quick DASH and VAS but procedures done with WALANT techniques are expedited with significant shorter duration. This study suggests WALANT technique might be relevant in surgical treatment of indicated patients during the COVID 19 pandemic and require wider acceptance in orthopaedic practice.

Biography:

Dr Kiran Madhvani completed his MBBS and BMedSci(Hons) at the University of Nottingham in 2017. After completing foundation training in the South Yorkshire deanery, he is now practising as a Junior Clinical Fellow in Trauma and Orthopaedics where he is undertaking research and audit projects in order to broaden his experience prior to entering Specialty Training.  

Abstract:

Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to establish local and contribute to national/international diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on the machines. A total of 603 procedures were studied. The median radiation dose for wrist fracture open fixation was 2.73cGycm², K-wiring procedures 2.36cGycm², small joint arthrodesis 1.20cGycm², small joint injections 0.58cGycm² and phalangeal fracture fixation 1.05cGycm². Wrist fracture fixation used higher radiation doses than phalangeal fracture fixation, arthrodeses and injections. Injections used significantly less radiation than the other procedures. There are significant differences in total radiation doses when comparing these procedures in hand and wrist surgery. Institutional audit data should be collected regularly and should be stratified by procedure type.

Biography:

Dr Ahmed Elzubier Ahmed has completed his MBBS at Barts and the London School of Medicine and Dentistry. He then went on to complete a BSc (Hons) in Sports and Exercise Medicine at Queen Mary University of London. He is currently working as a junior doctor with Oxford University Hospitals NHS Foundation Trust with ambitions for a career in Trauma and Orthopaedics.

Abstract:

Objective
To determine if there is a relationship between proximal radial length and radial head diameter.

Design
A pilot study.

Methods
20 plain AP radiographs of the elbow were selected for this study. Two measurements were made from each x-ray. The radial head diameter (RD); distance between the widest points of the superior aspect of the radial head and the radio-tuberosity distance (RTD); distance between the most superior point of the medial radial head to the midpoint of the bicipital tuberosity of the radius. Mean RD:RTD ratios and 95% confidence intervals were calculated for all patients. Patients were also stratified into various groups based on gender and age.

Results
The mean RD:RTD ratio for all participants was 0.65 with a relatively low standard deviation of 0.04. Indicating a similar relationship between the RD and the RTD for all participants. Moreover the 95% confidence interval for the mean RD:RTD ratio was calculated as 0.63-0.67.

Conclusion
The results of this study do show an apparent relationship between proximal radial length and radial head diameter. It is hoped that further research on the topic will lead to more accurate positioning and sizing of radial head replacements leading to better patient outcomes.