Orthopaedic Outpatient Department Research Articles

A Study of Prescribing Patterns for Non-Steroidal Anti-Inflammatory Drugs in a Tertiary Care Teaching Hospital

Analgesics, including nonsteroidal anti-inflammatory drugs, are a commonly prescribed group of drugs in clinical practice for the management of pain and inflammation. This study was carried out to evaluate the prescribing pattern for nonsteroidal anti-inflammatory drugs in the tertiary care teaching hospital. A prospective cross sectional study was conducted in the orthopaedic department of a tertiary care teaching hospital from February to December 2017. The institutional ethical committee approved the study. Patients of both genders were included in the study. Patients treated with at least one nonsteroidal anti-inflammatory drug in the outpatient department of orthopaedics were included. The prescription was compared with World Health Organization drug prescribing indicators to compare selective and nonselective nonsteroidal anti-inflammatory drugs associated with the treatment also concurrent prescription of gastro protective agents. The data collected was analysed by descriptive statistics. Chi-Square test was used to compare the difference between the two groups. A p value of <0.05 was considered significant. Out of 500 prescriptions included in the study, the total number of drugs prescribed was 1098, of which were nonsteroidal anti-inflammatory drugs. Based on the World Health Organization’s drug use indicators, the average number of drugs per encounter was 2.19 % and the average number of nonsteroidal antiinflammatory drugs per encounter was 1.38 %. Out of all the nonsteroidal anti-inflammatory drugs prescribed, 428 (62.20 %) were from National List of Essential Medicine India 2015 and 678 (98.5 %) nonsteroidal anti-inflammatory drugs were prescribed by generic name. Among the study population, only 40 % of patients were prescribed Proton Pump Inhibitors along with nonsteroidal anti-inflammatory drugs. Proton Pump Inhibitors are effective in ulcer prophylaxis in their standard dose. The present study concluded that among cyclooxygenase-1 inhibitors, Diclofenac was the most commonly prescribed nonsteroidal anti-inflammatory drugs from the national list of essential medicine. The most frequently prescribed cyclooxygenase-2 inhibitor in this study was Etoricoxib. The percentage of analgesic prescribed by generic name was excellent. However, the average number of drugs per prescription deviated from the World Health Organization’s rational drug use indicator. The use of gastro protective agents needs to be rationalised with nonsteroidal anti-inflammatory drugsy

The dervan upper limb dermatome syndrome pilot study of high incidence of cervical disc disease in patients presenting with primary shoulder pain &amp; restriction of movements

Introduction: Shoulder pain is among the most common complaints in the orthopedic outpatient department. It can be due to local pathology or a referred pain from cervical disc degeneration. Frequently, neck and shoulder pathologies may co-exist causing a dilemma regarding treatment approach. Although there are many studies published in literature, we think ours is the first published Indian study to make the observation of concomitant cervical disc degeneration in patients with ipsilateral shoulder pain.Materials & Methods: 39 patients with shoulder pain without any history of trauma, attended the OPD of Walawalkar hospital, Dervan. Of the 3 patients 32 agreed to be part of this pilot study. They underwent x rays & MRI of the shoulder as well as cervical spine.Results: All patients who presented in the orthopaedicopd with complaints of atraumatic shoulder pain, showed varying degrees of cervical disc disease. The commonest affected cervical spine pathological segment was C5-C6 i.e 92 % with two patients having C6-C7 disc disease i.e 8 %.Grading of disc disease was 78.1 % grade 28, 6 patients had grade 3 disc disease, 18.75 %, and only 1 patient had a grade 1 disease with typical signs of chemical radiculopathy with shoulder pain & restriction.X Ray of shoulder showed normal acromiohumeral distance of more than 7 mm in more than 70 % of patients and less than 2 mm in only 1 patient who also incidentally had grade 3 disc disease.MRI of shoulder showed 78 % patients with grade 2 or less of Goutallier grading [9] and all patients of Grade 3 disc disease having grade 3 Goutallier grading and a positive Tangent sign [10]. (18.75 %)This may open another vista in investigation of degenerative rotator cuff disease mimicking grading and severity of cervical disc disease although that is not the primary objective of this paper. We aimed to bring to light the concomitant cervical spine pathology in patients presenting with shoulder pain in this original research. Conclusion: This study found an unusually high rate of coexistent shoulder and cervical spine pathologies. Almost all patients had some form of cervical disc disease and on deeper questioning related signs and symptoms of cervical spondylosis concurrently or a few weeks ago. It undermines the need for investigating this important contributor, the cervical spine, to clinically diagnose the enigma of shoulder pain.

Orthopedic clinics under the coronavirus disease-2019 (COVID-19) pandemic: Time to revisit the safety measures

Coronavirus disease-2019 (COVID-19) pandemic has changed the seen in each and every field of the globe and is true for orthopedic clinics as well. As the second surge of COVID-19 pandemic is fading away, number of patients in orthopedic clinics of hospitals, nursing homes, and even private chambers is increasing day by day. Very soon we will see a sudden surge of patients in orthopedic OPD (outpatient department) as the cold cases have been differed for the last one and half years. Visiting/handling the increasing number of patients in the same space of consulting and waiting area will be a challenge and it is quite possible that we may commit a mistake by compromising the protective guidelines, as we did during the beginning of this year. However, the first surge was fading away, which resulted into the entry of second surge of COVID pandemic. Therefore, it is time to revisit the situation in terms of safety measures while attending the patients in orthopedic clinic.

Prevention of Quadriceps Inhibition is The Key to Achieve Movement of The Knee Joint After Total Knee Replacement and Lower End of Femur Surgery

Background: Knee stiffness and weakness of quadriceps is common after surgeries around knee and even after total knee replacement. Swelling and inflammation in the early phases after surgery may contribute to stiffness and arthrogenic muscle inhibition. Aggressive physiotherapy to regain range of motion and early isometric and isotonic exercises are indicated for prevention of complications. Material and method: This were a descriptive, cross-sectional study which included hundred patients (without any limit of age range) attending the orthopaedic physical therapy outpatient department of Positron Hospital were selected for this study. The subjects were assessed for quadriceps inhibition and knee range of motion. The patients were assessed one week, six weeks and 12 weeks post surgery. The patients underwent supervised physiotherapy till 6 weeks and were put on home exercise program for next 6 weeks. Results: The quadriceps inhibition in initial phase was about 25% and quadriceps inhibition in recovery phase remained only 5%. There was zero flexion deficit in 30%, 59% and 76% of patients in first week, sixth week and twelfth week respectively. Mean of flexion deficit in hundred patients were 15% in first week, 6.5% flexion deficit remained in sixth week and only 2.9%flexion deficit left in twelfth week. Conclusion: Quadriceps inhibition was seen in 25% patients. Quadriceps inhibition was not associated with gender or age. There was moderate to strong correlation between flexion deficit and quadriceps inhibition

Spina Ventosa: An often Missed Diagnosis.

Rare and varied presentations of tuberculosis make it difficult for treating clinicians to arrive at the diagnosis. An adolescent female presented to the orthopedic outpatient department with slowly increasing swelling over the dorsum of the hand near the base of the third digit for 5 months. With multiple consultations, she was being treated with antibiotics as a case of abscess. On examination, the swelling was soft bulging with whitish watery discharge. Plain radiography revealed periosteal elevation with bony destruction of the proximal phalanx. Magnetic resonance imaging revealed signal intensity changes with collection suggestive of infection. Blood investigations were within the normal limits, except slightly raised erythrocyte sedimentation rate. A differential diagnosis of chronic osteomyelitis was performed. Since the swelling was growing with the overlying skin likely to give way, it was treated with incision and drainage. Cytology with Gram's and auramine staining helped in confirming the diagnosis of spina ventosa. Biopsy is the gold standard for diagnosis, and antitubercular therapy forms the mainstay of treatment.

Comprehensive–Comparative study of fracture distal end radius with plating and K-Wire fixation

Introduction: Distal end radius fracture is a common fracture seen in the routine orthopedic outpatient department. The optimal management of distal radius fractures remains controversial. Aim: The aim of the study is to compare the functional outcomes folloing volar plating and K-ire fixation of the distal end radius fractures and to compare hich method produced better result. The functional outcome in terms of range of movements, pain, and grip strength of the patients as assessed at 6 months in both groups by demerit score system of Gartland and Werley. Material and Methods: The ORIF group as treated ith volar plating and CRIF group ith k ires. The functional outcome as measured using Gartland and Werley system. Results: Functional outcome as per Gartland and Werley as 95% excellent-to-good results in the plating group as compared to 75% in the K-ire fixation group. Conclusion: The study emphasizes that open reduction and internal fixation ith volar plating has excellent functional outcome hen compared to K-ire fixation in distal radius fractures. When considering the cost, K-ire fixation is preferred over volar plating.

Clinical observation on the treatment of periarthritis of shoulder by the combination of lijin manipulation and hot compress powder

Objective: To observe the clinical effect of Lijin Manipulation combined with Hot Fu Powder in treating periarthritis of shoulder. Methods: Seventy-two patients with periarthritis of shoulder were selected from the orthopaedic outpatient department of the Affiliated Hospital of Shaanxi University of Chinese Medicine, 36 cases in each group. The treatment group was treated with lijin manipulation combined with hot compress powder, while the control group was treated with massage combined with hot compress powder. The course of treatment was 2 weeks. Clinical efficacy, visual analogue scale (VAS) score, Melle score of shoulder function and shoulder motion score were compared before and after treatment, as well as between treatment group and control group in the same group. RESULTS: The clinical efficacy of treatment group was higher than that of control group (P<0.05).After treatment, visual pain score (VAS) and shoulder joint function Melle score in both groups were lower than before treatment (P<0.05), and the decrease in the treatment group was more obvious than that in the control group, the difference was statistically significant (P<0.05).The range of motion of shoulder joint in the treatment group and the control group was higher than before treatment, and the difference was statistically significant (P<0.05). The range of motion in the treatment group was improved more obviously than that in the control group, and the difference was statistically significant (P<0.05).Conclusion: The therapeutic effect of toning tendons manipulation combined with hot compress powder in the treatment of periarthritis of shoulder is obviously better than that of massage combined with hot compress powder. It can better reduce the pain of patients and improve the function and range of motion of shoulder joint, which is worthy of our promotion and application in clinical work.

Clinical Profile of Patients Presenting with Low Back Pain to Out Patient Department of a Tertiary Level Hospital

Introduction Low back pain is experienced by most of the people at some point of life. In our setting, there are very limited data on low back pain. This study aims to elaborate demographic and clinical profile of patients presenting to outpatient department of Orthopedics, in Tribhuvan University Teaching Hospital with complaints of low back pain.&#x0D; MethodsA descriptive cross-sectional observational study was carried out in 150 patients who presented with complaints of lower back pain in outpatient department of Orthopedics of TU Teaching Hospital from May to November 2019. The demographics including age, gender, occupation, and clinical data- duration of symptoms, body mass index, VAS score and radiculopathy along with Body Mass Index of each patient were recorded in a proforma separately.&#x0D; ResultsOut of total 150 patients, male: female ratio was 1:1.9. The average age of patients was 42.1 years The average height, weight and body mass index of patients were 157 cm, 61.81kg and 24.83kg/m2 respectively. The mean visual analogue score of patients was 5.41. Occupationally, predominant number of patients were housewives (41.3%). Seventy nine patients (52.7%) had low back pain alone. Seventy one patients (47.3%) had low back pain associated with radicular symptoms, out of which 74.6% had unilateral radiculopathy.&#x0D; ConclusionLow back pain is most commonly seen in fourth decade of life. More females as compared to males are affected with low back pain. The radiculopathy associated with low backache is mostly unilateral.

Clinical Profile of Patients Presenting with Low Back Pain to Out Patient Department of a Tertiary Level Hospital

Introduction: Low back pain is experienced by most of the people at some point of life. In our setting, there are very limited data on low back pain. This study aims to elaborate demographic and clinical profile of patients presenting to outpatient department of Orthopedics, in Tribhuvan University Teaching Hospital with complaints of low back pain. Methods: A descriptive cross-sectional observational study was carried out in 150 patients who presented with complaints of lower back pain in outpatient department of Orthopedics of TU Teaching Hospital from May to November 2019. The demographics including age, gender, occupation, and clinical data- duration of symptoms, body mass index, VAS score and radiculopathy along with Body Mass Index of each patient were recorded in a proforma separately. Results: Out of total 150 patients, male: female ratio was 1:1.9. The average age of patients was 42.1 years. The average height, weight and body mass index of patients were 157 cm, 61.81kg and 24.83kg/m2 respectively. The mean visual analogue score of patients was 5.41. Occupationally, predominant number of patients were housewives (41.3%). Seventy nine patients (52.7%) had low back pain alone. Seventy one patients (47.3%) had low back pain associated with radicular symptoms, out of which 74.6% had unilateral radiculopathy. Conclusion: Low back pain is most commonly seen in fourth decade of life. More females as compared to males are affected with low back pain. The radiculopathy associated with low backache is mostly unilateral.

Effects of eldecalcitol alone or a bone resorption inhibitor with eldecalcitol on bone mineral density, muscle mass, and exercise capacity for postmenopausal women with distal radius fractures

BackgroundDistal radius fractures are often the first fractures experienced by adults with osteoporosis, and such fractures provide an opportunity for treatment to prevent a domino effect of future fractures. Most of these fractures result from falls, which may be related to the individual's limb muscle mass, strength, and exercise capacity. Active vitamin D3 positively affects muscle and bone mass. However, the effect of a bone resorption inhibitor is unknown. This study aimed to determine the effects of eldecalcitol alone or a bone resorption inhibitor with eldecalcitol on bone mass, limb muscle mass, and exercise capacity of osteoporotic patients with distal radius fractures and to identify the preventive effects against future fractures. MethodsParticipants were postmenopausal women(n = 99) with distal radius fractures who visited the orthopedics outpatient department in a city general hospital from April 2015 to October 2017. Bone mass, limb muscle mass, skeletal muscle mass index, and muscle strength (grip strength and quadriceps muscle strength), walking speed, 2-step results, and timed up and go tests results were evaluated before and after 1 year of treatment. The instances of fall recurrence and refracture were investigated using a questionnaire. ResultsEighty-five patients completed follow-up assessments for 1 year. After treatment, bone mass and bone mineral density were significantly improved in the lumbar spine and total proximal femur compared to before treatment. Furthermore, skeletal muscle mass index, grip strength on the unaffected side, quadriceps muscle strength, walking speed and 2-step test results after 1 year of treatment were significantly improved. Nineteen and 4 patients experienced fall recurrence and refracture, respectively. ConclusionsEldecalcitol alone or a bone resorption inhibitor with eldecalcitol improved bone mass and bone mineral density, and maintained skeletal muscle mass index, muscle strength, and exercise capacity of osteoporotic patients with distal radius fractures.

A Study of normal variation in lumbosacral angle in asymptomatic patients attending orthopaedic out-patient department of a medical college hospital, Telangana

Introduction: The Lumbosacral angle (LSA), is the angle formed between a line across the plane of the superior margin of the sacrum and a horizontal line. Various literature and studies around the world shows wide normal variation in LS angle, ranging from 320 to 440. Abnormal variation in LS angle is commonly associated with low back pain. Hence research involving study of normal variation of LSA in different ethnic population plays a significant role. In Indian scenario very few studies are available, especially from rural population, to know up to what extent, variation in LS angle is normal. Hence, the present study attempts to study the normal variation in LSA in rural population of Telangana. Materials and Methods: A descriptive study of normal LSA variability, involving 100 asymptomatic subjects between the age group of 20-60 years was carried out in orthopedic department of Medical College hospital, Telangana. Ferguson’s technique was employed for calculation of LSA. Results: In this study variation of LSA ranges from 280 to 600. Overall average LSA was 340.Females have greater average LSA as compared to males. Conclusion: Results of the present study show variability when compared to other similar studies, which further strengthen the fact that normal variation in LSA differs among different region and races; hence results of the present study will be a useful tool to health care providers for treating different spinal disorders of rural Telangana population. Keywords: Lumbosacral angle (LSA), Ferguson technique, Lumbar lordosis, LSA Variation, Spinal maturity.

The Algorithm for Territorial Distribution of Public Emergency Rooms in Megapolis (by the Example of Moscow)

Background. The lack of a system for evaluating the feasibility of new trauma and orthopedic departments in outpatient clinics under construction creating is one of the main reasons for the imbalance in their territorial location. Therefore, one of the most urgent modern tasks in the megalopolis healthcare organization — is to develop a system for effective regulation of the trauma and orthopedic outpatient departments network construction. The purpose of the study is to improve the effectiveness of outpatient trauma and orthopedic care for megalopolis residents. Materials and Methods. In the research process, theoretical (formalization, synthesis, deduction) and empirical (observation, comparison, modeling, measurement) methods were used. A total of 67 emergency trauma outpatient departments in Moscow were sampled and data on their attendance for April 2019 were collected. Results. Creation of a mathematical model of the network of outpatient primary trauma care and a basic algorithm for estimating the average time from the moment a patient received injuries to the time of primary care in one of the emergency outpatient trauma units of the medical organizations of the capital, which can be used by the executive bodies of the healthcare organization cities in solving administrative and economic problems. Conclusion. The developed specialized mathematical algorithm for assessing the existing effectiveness of the already existing emergency outpatient trauma units network and the distribution of new units allows you to create an “ideal” model for the location of these deparments in a megapolis. In the future, this model can be developed taking into account the development of the transport network, the financing of emergency rooms, etc.

Orthopaedic Services during Nationwide COVID-19 Lockdown: Dhulikhel Hospital, Kathmandu University Hospital Experience and Review

Background The Nepal government issued a nationwide lockdown due to COVID-19 from 24 March to 21 July 2020. This halted elective medical services in our hospital. A number of modifications in the orthopaedic practices at our department were made. &#x0D; Objective This article discusses the impact on orthopaedic load at the Department of Orthopaedics and Trauma, Dhulikhel Hospital, Kathmandu University Hospital during the lockdown. &#x0D; Method This is a longitudinal observational study done during the nation-wide lockdown including all the patients who presented to the hospital requiring orthopaedic consultation. For comparison purposes, the patient numbers from the same date in previous year (2019) were retrieved. &#x0D; Result We received no COVID-19 cases requiring orthopaedics consultation. A total of 1828 patients were seen in the Orthopaedic Outpatient Department, 1077 trauma patients in the Emergency Department, 216 patients were admitted and 210 orthopaedics procedures were performed at the operation theatre. There was 82.21% decrease in OPD patients and 56% less surgeries in OT compared to the same duration of last year.&#x0D; Conclusion There was a great reduction in the patient numbers visiting the hospital, which reflected in decreased number of admission and surgery. A greater part of our work during the lockdown was trauma.

Efficacy of rtsa-byugs vs diclofenac gel in relieving knee pain of patients with osteoarthritis of the knee

PurposeRtsa-byugs, a massage oil from Bhutan, is a traditional herbal formula known for its anti-inflammatory properties and used in osteoarthritis treatment. This study investigates the efficacy of rtsa-byugs vs diclofenacgel in relieving knee pain in osteoarthritis patients.Design/methodology/approachA single-blind, randomized controlled trial was conducted amongst osteoarthritis knee patients at an orthopedic outpatient department of Thammasat University Hospital. Participants were randomly allocated to the rtsa-byugs (N = 31) or the Diclofenac gel (N = 31) group. Primary outcomes were assessed by the knee injury and osteoarthritis outcome scores (KOOS), visual analog scale (VAS) and goniometer at day 0, 1, 3, 7.Findings62 participants completed the study. The result of the KOOS scores demonstrated a significant improvement of symptoms at the end of the study in both treatment groups. Improvement of symptoms, pain, daily life living, sport and recreational score and quality of life assessment showed a significant difference from baseline (p &lt; 0.001) within both groups. The quality of life score for the rtsa-byugs group increased significantly on day 3 and 7. The VAS score in both groups decreased with a significant difference from baseline to day 7. The mean value of extension of angle measurement was decreased in day 7, and the mean of flexion score increased in both groups when compared with the baseline.Research limitations/implicationsThe duration of the study was very limited and included a small sample consisting of men and women.Originality/valueRtsa-byugs is safe and effective in relieving pain from osteoarthritis of the knee and can be used as an alternative treatment for knee osteoarthritis.

Assessment of Vitamin D status in patients attending tertiary care hospital in Northern Andhra Pradesh with musculoskeletal pain

Introduction: vitamin D deficiency involve the musculoskeletal system leading toproximal muscle weakness, bone pain, and osteomalacia which is largely unrecognized by bothphysicians and patients.The prevalence of vitamin D (&lt;20ng/dl) deficiency among patients attending the orthopedic outpatient department in tertiary care hospital with complaints of non-specific symptoms of body pain and low back pain without any other co morbid condition is our study. Methodology: A cross sectional study was conducted among 468 adult patients above the age 20 yearsattending orthopedic department of a tertiary care hospital with non-specific complaints of general body pain/back pain/tiredness/weakness on working and walking with no other symptoms such as injury,fever, GIT problems or known medical illness and no relief of the pain symptoms with routine treatments with analgesics and rest and physiotherapy were screened for Vitamin D levels when other routine test such as complete blood count, ESR, BI, sugar, RFT were normal. Results: out of 468 patients tested, 386 (82.4%) of the study population had below normal vitamin D, of them 49.1% had deficiency, 33.3% had insufficiency and 17.5% had sufficient vitamin D level. The proportion of patients Vitamin D deficiency is higher in the age group 30-59 whereas insufficiency was higher in the age group 20-39 compared to other age group and it was found statically significant.

Outcome of Congenital Pseudoarthrosis Tibia Treated with Illizarov Fixator in Children

OBJECTIVES : To determine the outcome of congenital pseudoarthrosis tibia (CPT) managed with illizarov fixator. METHODS : This prospective cross-sectional study was done from 20 th March 2008 to 19 th March 2018. All patients presenting to the Orthopaedic out patient department (OPD) with pseudoarthrosis tibia belonging to either gender aged up to 12 years were included. All patients underwent excision of tapering ends and illizarov fixator application. Outcome was assessed in terms of complications. Data regarding age, gender, side, type of CPT and any complication was noted and analyzed using SPSS version 23. RESULTS : 16 patients were included in the study. 10 (62.5%) were males and 6 (37.5%) females. Mean age was 4 years. 10 (62.5%) patients were type-1 and 6 (37.5%) were type-2. Evidence of neurofibromatosis was seen in 9 (56.2%) patients. Most common complications were residual leg length discrepancy (LLD), mal-alignment and delayed consolidation which was seen in 8 (50%) patients. CONCLUSION : CPT is a periosteal disease with variable results. The study concludes that good results are achieved in 50% patients.

A Study on Vertebral Compression Fracture in Postmenopausal Women with Back Pain in Two Medical College Hospitals of Bangladesh

Background: To determine the prevalence and nature of the vertebral compression fracture in postmenopausal women suffering from back pain in the rural communities of Bangladesh.&#x0D; Materials and methods: Cross sectional study was conducted for the period January to December 2018 which included all postmenopausal women aged 55 years and above presented with back pain in the Obstetrics and Gynaecology and Orthopedic outpatient Departments of Jahurul Islam Medical College and North Bengal Medical College Hospitals. Vertebral fractures were diagnosed by X-Ray scanning of the spine based on predefined criteria.&#x0D; Results: Prevalence of vertebral compression fracture was 30.6%. Most of the subjects were highly active, of poor nutritional status and undergraduate. Majority (35.7%) of the patients belonged to 55-59 years group but prevalence was highest in 70-75 years of age. Maximum patients (48.1%) sustained fracture at only one vertebra. Highest number of fracture (61.1%) was found in the dorsolumbar region. Most of the fracture (44.8%) was of biconcave shape. Most of the wedge deformities were present from 12th thoracic and above and majority of the biconcave deformities were from 11th thoracic and below.&#x0D; Conclusion: Although the prevalence was low in comparison to other studies, it showed a great burden on our social life. The most important step in treating vertebral compression fractures is prevention and treatment of osteoporosis.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 49-53

Orthopaedic Guidelines for the COVID-19 Post-Outbreak Period: Experience from Wuhan, People's Republic of China.

Currently, the coronavirus disease 2019 (COVID-19) crisis has rapidly spread worldwide. As the earliest outbreak area of the pandemic, Wuhan, People's Republic of China, is gradually recovering to its normal state under the effective control of government authorities. Outpatient services in major hospitals are now being restored. An accumulation of asymptomatic infections is a potential risk for medical personnel, especially when there is crowding in hospitals. As the biggest center for orthopaedic patients in Wuhan, our orthopaedic outpatient department admits >300 patients per day. Optimal guidelines on how to handle this huge number of patients during the post-outbreak stage of the COVID-19 pandemic, particularly with regard to potential asymptomatic infection, are urgently needed for orthopaedic surgeons. We have developed and proposed applicable guidelines to fill this knowledge gap, including the necessary protective strategies for medical personnel in orthopaedic outpatient and inpatient wards as well as during surgery. We also have provided mental health recommendations for health-care workers. To the best of our knowledge, these guidelines are the first of their kind for orthopaedic surgeons who are slowly reestablishing medical activity following the pandemic.

Challenges and response in the medical management of the orthopaedic department during the coronavirus disease 2019 pandemic: strategies in Wuhan, China.

Currently, COVID-19 has rapidly spread around the globe, there are already many nosocomial infections in medical staff. The purpose of this study is to provide some medical management experience from the orthopaedics department of Tongji Hospital in Wuhan, China, to provide reference for orthopaedists. This study is a summary of the orthopaedic medical management of Tongji Hospital. It systematically summarized the Chinese experience including orthopaedic outpatient and emergency department management, and orthopaedic surgery and preventive management during the pandemic. We described some challenges in the orthopaedic department during the epidemic and formulated a set of medical management procedures to find an balance between effective treatment and infection prevention. These experiences and strategies could help orthopedists to work safely and effectively, and prevent nosocomial infections during the global pandemic of COVID-19.

Factors Influencing Cervical Spondylosis

Background: Cervical spondylosis is a degenerative disorder of cervical spine prevalent in our population. The disease advances insidiously resulting in worsening with time. This study aims to highlight the factors influencing cervical spondylosis. Methods: The present case control study was conducted at orthopedic OPD (Out Patient Department) and Radiology department of the Patel hospital from September 2018 to February 2019 after acquiring ethical approval from Ethical Review Committee (ERC) of Bahria University Medical and Dental College and Patel Hospital. The study enrolled 88 cases suffering from cervical spondylosis based on history and clinical examination and 88 controls i.e., healthy attendants. The radiography of cervical spine was used to assess degenerative changes of cervical spine. They were asked basic history entailing age, gender, working hours, nature of job, use of computers, mobiles. The independent t-test was used for comparison between these variables, and Fischer exact test and Chi square test was employed to find association between them. Results: The study revealed a significant preponderance of females (56.8%) with shorter stature (159.14±8.88) in patients. There was a predilection for cases in outdoor workers (44.3%) and homemakers (43.2%) as well as increased working hours (73.9%). The mobile use had a significant impact (59.1%) on disease. Conclusion: Considering factors like Middle Ages, females, short stature, obesity, outdoor workers and house workers with increased working hours and use of mobiles for more than 4 hours can influence development of cervical spondylosis. One can intervene in the progression of disease by adopting healthy lifestyle to prevent it.