World Congress on Orthopedics, Rheumatology, and Musculoskeletal Diseases
Title: Reuse of implants in a peri-implant fracture of both forearm bones in an adolescent: a case report
Fractures of both forearm bones in adolescents are common. Many of these fractures are surgically fixed with internal fixation. However, among the complications that can occur are peri-implant fractures, which are somewhat infrequent. They are due mainly to high-energy injuries. Therefore, not much information about them is found in the literature.
Reusing implants is not a frequent or well-documented practice, and it is carried out only when the necessary resources are unavailable, particularly in developing countries.
We are reporting a 16-year-old male patient who suffered a peri-implant fracture distal to plates that were placed three years earlier in both left forearm bones. The material was removed successfully and reused, achieving an adequate reduction and fixation with one DCP plate for the radius and one reconstruction plate for the ulna. The patient recovered successfully. This case report aimed to understand the lack of resources in a developing country and a possible solution for this problem in this type of scenario.
Felipe Aguilar was born on May 16, 1991, in Chihuahua, Mexico. From a young age, he showed a keen interest in a career in medicine and later became interested in the area of orthopedics. He continued his studies in the spine specialty where he is currently enrolled at the University of Chihuahua Mexico.
Title: Incidence of deranged thyroid levels in women aged 25 years and above with lower back pain
Introduction: Low back pain (LBP) disorder amounts to 57% of disability overall overburdening individuals, healthcare and society. Though various aetiologies and literatures are available but treating LBP has met with only patchy success. This has led to calls for a more in-depth study to understand the origin and progression of the condition in early stage i.e., young age for better target intervention. In adolescent, overall prevalence of LBP is higher in females than males. As we know deranged levels of thyroid leads to body changes causing tiredness, fatigue, reducing quality of life due to generalized pain referable to muscles or joints that often resolves or improves on thyroid medication which may be one of the aetiology for LBP. Little research has been done on the relationship between LBP and deranged thyroid level i.e., hypothyroidism.
Thus, the objective of this study is to find the incidence of deranged thyroid levels using TSH screening in women (25 years and above) with LBP.
Methods: A prospective cohort was conducted after ethical approval of the esteemed institution from 2021 to 2022. After taking consent and explaining objective of study, we randomly screened 852 females of age 25 years, of which 426 females had complains of LBP of more than 3 weeks.
Results: Our study found, out of 852 Female subjects screened, 426 had LBP of which 66.9% had high TSH levels. There was no substantial association between age and deranged thyroid (high TSH). There was statistical correlation between high TSH and LBP with p value of 0.00001 and strong negative correlation was seen.
Conclusion: Low back pain in females of age 25 years and above may be a consequence of deranged thyroid levels i.e. elevated TSH levels (hypothyroidism). Therefore this will help in diagnosing, treating and subsequently preventing LBP by screening TSH Levels.
Department of Orthopaedics, D. Y. Patil School of Medicine & Hospital
Title: 17 years experience of surgical management of Thoracic Outlet Syndrome at a District General Hospital
Introduction: Thoracic outlet syndrome (TOS) is caused by compression of the neurovascular structures passing through the thoracic inlet. It is categorised into three subtypes: neurogenic TOS (NTOS), venous TOS (VTOS) and arterial TOS (ATOS). This study evaluates the outcomes of patients undergoing First Rib Resection (FRR) for Thoracic Outlet Syndrome (TOS) during a period of 17 years at a single District General Hospital (DGH).
Methods: Retrospective review of patient notes of individuals treated with FRR from August 2004 through to August 2021.
Results: A total of 62 FRR were performed on 51 individual patients. Indications for FRR included 42 neurogenic TOS (68%), 6 venous TOS (10%) and 14 arterial TOS (23%). 34 patients (64%) were female and the mean age at time of surgery was 39 years old (range 27 to 64 years). 11 patients (21%) underwent bilateral FRR and 7 cases of cervical ribs were observed. The mean time from initial symptoms to diagnosis was 18 months (2 to 60 months). Overall, outcomes after surgery were positive across all subtypes of TOS. Based on the Derkash’s classification; 52 (84%) reported excellent/good, 8 (13%) reported fair and 2 (3%) reported poor resolution of symptoms at 6 month follow up. Complications included 4 (9%) pneumothorax, 2 (4%) wound infections, 2 (4%) seromas, 1 (2%) haemothorax, 3 (5%) phrenic nerve complications and 1 (2%) chronic pain.
Conclusions: This series exemplifies the diagnostic difficulty associated with TOS with patients often waiting prolonged periods of time before definitive treatment. FRR for TOS can be performed safely and effectively in a DGH environment with excellent patient clinical outcomes.
KSS Vascular Trainee, Clinical Research Fellow
Title: A novel therapeutic target for arthritis pain
Background: Arthritis-associated chronic pain is a major concern for all patients and is often exacerbated due to comorbidities (for example, obesity). We have reported a novel granulocyte macrophage-colony stimulating factor (GM-CSF)/CCL17 axis in monocytes/macrophages. Given that there are reported encouraging clinical data on anti-GM-CSF monoclonal antibody (mAb) therapy in rheumatoid arthritis and osteoarthritis (OA) pain and disease, we therefore proposed that the chemokine, CCL17, could be a novel therapeutic target in different types of arthritis by examining its relevance in mouse models of (i) inflammatory arthritis, (ii) OA and (iii) obesity-exacerbated OA.
Methods: To study the relevance of CCL17 in arthritis, we used the following mouse models: (i) for inflammatory arthritis, zymosan-induced arthritis and antigen-induced arthritis models; (ii) for OA, the destabilization of medial meniscus (DMM)-induced OA, monosodium iodoacetate (MIA)-induced OA and collagenase-induced OA (CiOA) models; (iii) for obesity-exacerbated OA, an eight-week 60% high-fat diet protocol was used prior to the induction of an OA model. These models were either induced in CCL17 gene-deficient (Ccl17E/E) mice with wild-type (WT) mice as a control group or in WT mice treated with an anti-CCL17 mAb therapeutic protocol (i.e. following the onset of pain). We assessed the development of pain-like behaviour and joint pathology using the static weight bearing method and histological analysis, respectively.
Results: For inflammatory arthritis, in comparison to WT mice, Ccl17E/E mice were protected from developing pain-like behaviour and joint pathology, while, interestingly, the degree of joint inflammation was similar to that seen in WT mice. Therapeutic blockade of CCL17 showed efficacy in ameliorating pain-like behaviour and joint pathology. For both OA and obesity-exacerbated OA, similar to inflammatory arthritis, we again found a similar dependence on CCL17 for pain-like behaviour and joint pathology using Ccl17E/E mice. We also consistently found therapeutic efficacy of anti-CCL17 mAb therapy in the OA models.
Conclusions: In contrast to the well-recognized chemotactic role of CCL17 (e.g. preferential Th2 cell chemotaxis), these data reveal a novel, non-chemotactic and algesic role of CCL17 in arthritis-associated pain and disease, and suggest that it could be a therapeutic target in different types of arthritis.
Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria 3050 Australia
Title: Intraarticular Co-Injections for Knee Osteoarthritis: An Evaluation of Effectiveness through A Systematic Review
Background: Knee osteoarthritis is a prevalent degenerative condition that leads to discomfort and influences elderly function causing huge burden. Intraarticular injections are commonly used to improve pain and function in individuals with knee osteoarthritis. Co- intraarticular injections, involving the simultaneous administration of different substances, have emerged as a potential recently-introduced management option.
Objective: This systematic review aims to assess the efficacy of intraarticular co-injections in the management of knee osteoarthritis.
Methods: A thorough search of electronic databases such as PubMed, Embase, and Cochrane was conducted to identify relevant studies investigating the effectiveness of intraarticular co-injections in patients with knee osteoarthritis. Studies meeting the inclusion criteria were selected, followed by data extraction and quality assessment.
Results: A total of 16 studies met the eligibility criteria for this systematic review. The combinations of corticosteroids, hyaluronic acid, platelet-rich plasma, and Ozon were detected. The results from the included studies indicated that intraarticular co- injections may offer enhanced pain relief and functional improvement compared to single injections or non-invasive treatments for knee osteoarthritis. However, there were inconsistencies in the findings across studies, and the optimal combination of substances for dual injections remains uncertain.
Conclusion: Intraarticular co-injections are a promising choice for managing knee osteoarthritis, showing potential efficacy in alleviating pain and improving function in affected individuals. Further research is necessary to determine the most effective combination of substances for combined injections and to establish the long-term efficacy of this treatment approach.
Dr. Nastaran Maghbouli is an assistant professor specializing in physical medicine and rehabilitation. She obtained her medical degree from Tehran university of medical sciences and completed her residency training at its top hospital. With her research experience in the field.
Orthopedics Conference, conducted yearly, brings together renowned specialists, researchers, and practitioners in the field of orthopedics. Presentations, workshops, and networking sessions provide opportunities for attendees to exchange knowledge. Topics include advances in orthopedic surgery, rehabilitation procedures, and prosthetic inventions. The meeting promotes collaboration and breakthroughs in orthopedic treatment.