Department Of Orthopaedics Research Articles

The Appeal of the Adult and Elderly Population to the State Dental Clinic

The main form of providing dental care to the population remains the provision of access assistance. Its proper organization makes it possible to increase the volume and, to a certain extent, the quality of dental care to the population. The aim of the work was to determine the volume of visits of the adult and elderly population to the GBU RO «SP» in Rostov-on-Don in the period from 2021 to 2023. Materials and methods. The study was conducted on the basis of the GBU RO «Dental Clinic» in Rostov-on-Don. A retrospective analysis of patient attendance at the medical surgical and orthopedic departments of the polyclinic was conducted based on the results of annual reports of medical organizations. Results. The number of visits by the elderly population aged 60 years and above in the study period 2021–2023 is on average 26 %, the ratio of primary visits to repeated visits is on average within 1:2.7. The share of preferential visits decreased by 2.4 % compared to 2021. Conclusions. Public dental clinics are competitive with private medical institutions.

Establishment and validation of the prediction model for postoperative delirium risk factors in older patients after total knee arthroplasty: A retrospective study.

This study aimed to establish an effective predictive model for postoperative delirium (POD) risk assessment after total knee arthroplasty (TKA) in older patients. The clinical data of 446 older patients undergoing TKA in the Orthopedics Department of our University from January to December 2022 were retrospectively analyzed, and the POD risk prediction model of older patients after TKA was established. Finally, 446 patients were included, which were divided into training group (n = 313) and verification group (n = 133). Logistic regression method was used to select meaningful predictors. The prediction model was constructed with nomographs, and the model was evaluated with correction curve and receiver operating characteristic curve. The logistic regression analysis showed that age, educational level, American Society of Anesthesiologists grade, accompaniment of chronic obstructive pulmonary disease, accompaniment of cerebral stroke, postoperative hypoxemia, long operation time, and postoperative pain were independent risk factors for POD after TKA (P < .05). The nomogram prediction model established. The area under receiver operating characteristic curve of the model group and the validation group were 0.954 and 0.931, respectively. The calibration curve of the prediction model has a high consistency between the 2 groups. The occurrence of POD was associated with age, educational level, American Society of Anesthesiologists grade, accompaniment of chronic obstructive pulmonary disease, accompaniment of cerebral stroke, postoperative hypoxemia, long operation time, and postoperative pain in TKA patients.

Comparison between Intra-Articular Steroid Injection and Supra-Scapular Nerve Block in the Management of Frozen Shoulder.

To compare the efficacy of intra-articular steroid injection with ultrasound-guided supra-scapular nerve block in the management of frozen shoulder in terms of shoulder pain and disability index score and range of motion. This randomized controlled trial was conducted in orthopedic department, PIMS, Islamabad from 1st January, 2020 to 30th June, 2020. A total of 72 patients were randomly equally (n=36 each) allocated to Group-A (intra-articular steroid injection) and Group-B (supra-scapular nerve block). Adults above 18 years of both genders having diffuse shoulder pain were included. Cases of shoulder pain localized because of bicipital tendinitis, rotator cuff tear, pain due to acute trauma and those with osteoarthritis were excluded. Data was analyzed in SPSS version 22.0. Patients average age was 60.1 ± 6.29 in IASI and 58.0 ± 5.83 years in SSNB Group-And there were 19 (52.8%) males in IASI group compared to 15 (41.7%) in SSNB. At three weeks mean pain was significantly less in SSNB (57.1 ± 9.53 vs 49.4 ± 9.02) compared to IASI group (p-value, <0.001). The mean disability index was significantly low in SSNB (51.5 ± 5.10 vs 63.9 ± 5.14) versus IASI group (p-value, <0.001). At one week, three weeks and six weeks, mean external rotation was better in SSNB than IASI group (p-value, <0.001). The mean abduction was also better in SSNB group. Ultrasound guided supra-scapular nerve block is better than intra-articular steroid injection in managing frozen shoulder.

Nursing Leadership in a Post-Pandemic Elective Orthopaedic Theatre Department: A Detailed Thematic Analysis of an Open-Ended Qualitative Survey.

The COVID-19 pandemic has impacted nursing theatre staff, departmental activity, and delivery of services to patients. This work-based project aimed to investigate the challenges of nursing leadership in an elective orthopaedic department at current times. The study collected qualitative data exploring theatre staff's expectations from leadership, offering insight on how the pandemic has influenced the way of working and exploring how the future in this unit may look. The answers from 20 practitioners to an anonymised open-ended survey were examined using thematic analysis. The participants described a leader as a good communicator who focuses on empowering others and supporting the team, identified by the majority as a senior team member. From the findings, three topics were identified: immediate changes, delayed changes, and pre-existing conditions. The answers painted a reality that is complex and multifaceted, where numerous variables play a part in the physical and mental health of each candidate, impacting their performance as well as their work/life balance. Overall, the strongest subjects recurring in the findings were the need for nursing leadership to focus on supporting staff with training opportunities, to actively plan for a reduction in staffing shortages, and to be constantly mindful of staff well-being. This study pointed out that the need for constant communication with their staff, building honest relationships, and being a reliable leader, focused on empowering others and supporting the team were important factors for the nursing management during the COVID-19 pandemic and post-COVID-19 era.

Does the Extent of Tear Influence Pseudoparesis in Patients With Isolated Subscapularis Tears?

Surgeons tend to associate pseudoparesis with massive rotator cuff tears. However, little is known about the degree to which isolated subscapularis tears might be associated with pseudoparesis of the shoulder. Is the extent of subscapularis tears associated with pseudoparesis? A retrospective analysis identified all patients with subscapularis tears from 2010 to 2021 in the longitudinally maintained shoulder arthroscopy archive of one university hospital's shoulder section of the orthopaedic department. After exclusion, 106 of 152 patients with isolated subscapularis tears who underwent arthroscopic surgery were included in the study. Sixty percent of the patients were women, and the mean ± SD age was 52 ± 11 years. Patients who were scheduled for arthroscopic surgery were divided into two groups according to the presence or absence of pseudoparesis preoperatively. Pseudoparesis was considered to be active forward elevation > 45º but < 90º, which is a simple and reproducible measurement that can be taken using a goniometer, and demonstrated complete passive forward elevation. Pseudoparesis was present in 41% (43 of 106) of patients with an isolated subscapularis tear. Data on tear severity (according to Lafosse type, noted during arthroscopy), integrity of the subscapularis tendon (noted during arthroscopy), fatty degeneration (using the Goutallier grading system on MRI), arthroscopic findings of biceps disorder, superior labrum anterior to posterior (SLAP) lesions, and pain severity (measured by VAS score) were recorded. We used logistic regression analysis to examine the relationship between pseudoparesis and disruption of the tendinous part of the subscapularis. After accounting for potentially confounding factors such as biceps disorders and muscle atrophy, we found that pseudoparesis was associated with decreased tear severity according to the Lafosse classification (adjusted OR 0.2 [95% CI 0.1 to 0.7]; p = 0.01) and with disruption of the tendinous portion of the subscapularis (adjusted OR 21 [4 to 128]; p = 0.001). Patients with less severe tears (Lafosse type I) have lower odds of experiencing pseudoparesis compared with those with more severe tears (Lafosse types II, III, and IV), and patients with disruption of the tendinous portion of the subscapularis have substantially higher odds of pseudoparesis compared with those with an intact tendinous portion. No association was found between pseudoparesis and subscapularis fatty degeneration, biceps disorder, or SLAP lesions. This study provides initial evidence suggesting that isolated subscapularis tears are associated with pseudoparesis. The main finding of this study is that isolated subscapularis tears that involve the tendon extending to the inferior part of the subscapularis have higher odds of being found with pseudoparesis. These findings highlight the importance of maintaining the integrity of the superior tendinous part of the subscapularis for active forward elevation > 90°. Level III, therapeutic study.

Role of Tranexamic Acid in Controlling Blood Loss in Hemiarthroplasty of the Hip: A Prospective and Observational Study.

Tranexamic acid, an antifibrinolytic drug, is well-established for its efficacy in reducing intraoperative and postoperative blood loss in major orthopedic surgeries, particularly total knee replacement (TKR) and spine surgeries. However, there is limited research on the role of tranexamic acid in hemiarthroplasty of the hip. This study aims to investigate the efficacy of tranexamic acid in controlling blood loss in hemiarthroplasty of the hip. The primary objective was to analyze the pre- and postoperative changes in hemoglobin levels among patients undergoing hemiarthroplasty of the hip with and without intravenous tranexamic acid administration. A prospective observational study was conducted at the Department of Orthopedics of Government Medical College, Kannur, and St. Joseph's Hospital, Karuvanchal, Kannur. Patients undergoing hemiarthroplasty of the hip with 1 gm of intravenous tranexamic acid were compared with those without tranexamic acid. The sample size was calculated to be 33 in each group. Data were collected using a standardized proforma, entered into an Excel sheet (Redmond, USA), and analyzed using IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. The study comprised mainly elderly females with a mean age of 74.84 ± 8 years. There was a significant reduction in postoperative hemoglobin drop, requirement for postoperative blood transfusion, and total drain output for the initial three postoperative days among patients who received intravenous tranexamic acid. Preoperative administration of intravenous tranexamic acid significantly reduced postoperative hemoglobin drop and the need for postoperative blood transfusion in patients undergoing hemiarthroplasty of the hip. This highlights the efficacy and safety of tranexamic acid in controlling blood loss in this surgical setting.

Patient perspectives on the role of orthopedic nurse practitioners: a cross-sectional study

BackgroundThe inclusion of nurse practitioners (NPs) specializing in orthopedics shows potential for improving the quality of care for orthopedic patients. A critical aspect of assessing the feasibility and acceptance of introducing NPs into orthopedic settings involves understanding patients’ perspectives on this role. This study aims to explore the receptiveness of orthopedic patients to treatment by orthopedic Nurse Practitioners (NPs). Additionally, it investigates potential associations between patients’ willingness to engage with NPs, their familiarity with the NPs role, perceptions of nursing, and satisfaction with orthopedic nursing care.MethodsThis cross-sectional study involved patients admitted to an orthopedic department in a central Israeli hospital between January and February 2023. Data was collected using a questionnaire consisting of five sections, validated by content experts. Statistical analyses, performed using SPSS, included descriptive statistics, independent samples t-tests, Pearson correlations, and linear regression.ResultsOrthopedic patient participants demonstrated a moderate willingness to undergo treatment by orthopedic NPs, with over two-thirds expressing strong openness. Patients displayed a high willingness for NPs to engage in various clinical tasks, albeit showing lesser enthusiasm for medication management and preoperative evaluation. Positive attitudes towards nurses and familiarity with the NP’s role emerged as significant predictors of patient receptiveness to NPs’ treatment.ConclusionPatient acceptance of orthopedic NPs varies across different aspects of care. While there is overall willingness to receive care from NPs, these nuanced preferences should be considered when implementing NPs in orthopedic settings. Awareness and positive perceptions play crucial roles in shaping patients’ willingness to receive care from these NPs.Trial registrationThe research doesn’t report the results of a health care intervention.

Comparison of Twin Screw Derotation Type Versus Single Helical Blade Type Cephalomedullary Nail in the Management of Unstable Intertrochanteric Fractures.

The intertrochanteric fracture is a frequently occurring fracture, often attributed to osteoporosis in older populations. Recently, there has been a proposal to perform early surgical fixation on elderly patients to facilitate early rehabilitation. This approach has been shown to have a beneficial effect in lowering comorbidities. The study aims to compare the efficacy of the twin screw derotation type cephalomedullary nail with that of the single helical blade type cephalomedullary nail in the management of unstable intertrochanteric fractures. The research sample included patients from the orthopedic outpatient and emergency departments of Adesh Medical College and Hospital,Ambala Cantt, India, who were scheduled for surgery for unstable intertrochanteric femur fractures. The patients were categorized into two groups according to the kind of implant they were given: either a twin screw derotation cephalomedullary nail or a single helical blade cephalomedullary nail. The functional result was evaluated by comparing the modified Harris hip score (HHS). Patients with unstable intertrochanteric fractures, including reverse oblique fractures and fractures with posteromedial comminution, as well as patients who provided consent, were included in this study. Thirteen individuals received treatment with proximal femoral nail antirotation (PFNA2), whereas 19 individuals received treatment with proximal femoral nail (PFN). The mean age in the PFNA2 group was 69.51, whereas the mean age in the PFN group was 70.804. There were three patients in the PFNA2 group and five patients in the PFN group who had a tip apex distance of more than 25 mm. According to the Cleveland index, nine patients in the PFNA2 group and eight patients in the PFN group had an implant location that was not optimum. Four patients in the PFNA2 group and seven patients in the PFN group had a neck shaft angle difference of more than 10° between their undamaged and operated sides. The mean HHS was 74.55 for the PFNA2 group and 69.88 for the PFN group. The PFNA2 group exhibited four problems, whereas the PFN group had five issues. The study found that both implants offer similar functional outcomes, with adherence to specific radiological parameters optimizing results. While both face similar challenges with osteoporosis, there was no notable distinction between them. Notably, the PFNA2 group showed superior outcomes in perioperative morbidity.

Prevalence and Associated Factors of Nonunion in Open Tibial Shaft Fracture among Patients Treated with External Fixation in Tibebe Ghion Specialized Hospital

Background: The definitive treatment of open tibial shaft fractures remains challenging and nonunion after treatment of open tibial shaft fractures with external fixation complicates a significant proportion of cases. There are varying rates of occurrence of nonunion and the prevalence is not well known in Ethiopia. The objective of the study is to assess the prevalence and associated factors of nonunion in open tibial shaft fractures treated with EX FIX in TGSH. Methods: The study was conducted using a cross-sectional study in patients with open tibial shaft fractures who were admitted and treated with external fixation in the Tibebe Ghion Specialized Hospital orthopedics department from January 1, 2019, to January 29, 2021. The study involved 75 patients, which was the total number of cases in the study period and fulfilled the inclusion criteria. Bivariate and multiple variable logistic regression analyses were used to analyze the association between variables. The degree of association between variables was determined at the p-value of &lt;0.05. Results: The overall prevalence of nonunion in open tibial shaft fractures treated with external fixation in TGSH was 21.3%. The severity of the injury, presence of wound infection, and treatment factors affect the occurrence of nonunion. It occurs in 9 of 19 (47.4%) Gustilo-Anderson grade IIIB fractures and 6 of 48 (12.5%) Gustilo-Anderson grade IIIA fractures. A delay in soft tissue covering of Gustilo-Anderson grade IIIB fracture of 15 days or more increases the nonunion rate to 72.7%. Nonunion occurred in 41.7% of cases with SSI and 11.8% of cases without SSI. Gustilo-Anderson grade (AOR=4.85, CI 95%: 1.31-18.01), surgical site infection (AOR=4.12, CI 95%: 1.11-15.26), and time until coverage of bone of Gustilo-Anderson grade IIIB fracture (AOR=18.23, CI 95%: 1.17-284.8) have statistically significant association with nonunion. Conclusion and Recommendation: External fixation use for definitive treatment of open tibial fractures should be disfavored as the prevalence of nonunion in open tibial shaft fractures treated with EX FIX is higher than other previous studies done in European and Asian countries. Gustilo-Anderson grade of injury, surgical site infection, and time from injury to bone coverage of Gustilo-Anderson grade IIIB fractures were found to be statistically significantly associated with the occurrence of nonunion. Therefore, attention should be given to early soft tissue reconstruction of exposed bones to establish a favorable environment for bone healing and to make treatment with internal fixations possible. Better management of wounds to minimize surgical site infections is required for better healing of open tibial shaft fractures. Prospective studies are also recommended on the issue.

Reconstruction of the Anterior Cruciate Ligament Using the Over-The-Top Technique Combined with a Lateral Plasty: A Case Report of 3 Patients

The over-the-top technique with lateral plasty is a technique that allows anterior cruciate ligament reconstruction and lateral plasty using a graft consisting of semitendinosus and gracilis that remain attached at the tibial level. This technique uses only the tibial tunnel without the femoral tunnel. We report on a series of 3 patients operated on for anterior knee instability following an anterior cruciate ligament injury in the orthopaedic department of the Delafontaine Hospital in Saint Denis, France, and discuss the results with a review of the literature.

Physiotherapists’ Use of Outcome Measure Tools in the Assessment of Neuro-Musculoskeletal Injuries for Short-Term Functional Rehabilitation Domains to Minimize Impairments and Disability following Commercial Motorcycle Road-Related Accident, Eldoret, Kenya

Bed immobilization remains a core intervention to stabilize neuro-musculoskeletal injuries following commercial motorcycle-related road traffic accidents. Despite timely operative and conservative management, most patients remain handicapped, requiring short- and long-term physical therapy. That calls for physiotherapists to assess and make use of outcome measure tools to determine the level of impairments and disability and make informed decisions when developing management goals. The objective of the study was to determine short-term functional rehabilitation domains, the use of outcome measure tools, and physiotherapy interventions used to minimize impairments and disability following a commercial motorcycle road-related accident in Eldoret, Kenya. Biopsychosocial theory guided the study. A prospective cohort study was adopted. Purposive sampling was used for the selection of 79 participants for 6 months between March 2021 and July 2021 in level 5 hospitals in Eldoret, Kenya. The target population included post-operative patients in both male and female orthopedics wards, physiotherapists, and social workers in the orthopedic department of Moi Teaching and Referral Hospital. The study population was 150 patients. A self-administered, structured questionnaire was used. The data collected was entered and analyzed with SPSS 20. The findings of this study revealed that forty-four percent (44%) of total participants were bedridden for fracture immobilization and spinal cord injuries for more than 3 days before and after orthopedic and neurological surgery. The majority (100%) of the participants had been referred for physiotherapy rehabilitation. All 100 participants were assessed with different outcome measure tools for neuro-musculoskeletal injuries to determine the level of physical function. Forty-three percent (43%) had lost functional abilities of the upper extremity (19 males, 15 females). Fifty-one-point nine percent (51.9%) had lost physical function due to lower extremity fractures (39% (26 males, 15 females) and 24% (15 males, 4 females) with spinal cord injuries. Four participants (5%) reported lost days to school, and 94.9% reported lost days to income-generating activities (27 females, 48 males). The majority (100%) of the participants pre- and post-operatively were assessed with standardized outcome measure tools that remain significant for prompt best evidence-based physiotherapy practices. Pain (100%) and impaired physical functions (100%) were the main rehabilitation domains that posed the biggest challenge to patients’ post-trauma. Multicomponent physiotherapy interventions ranging from stretching, strengthening, breathing exercises, bed positioning, mobility and transfers, balance and coordination, and gait training tailored to patients’ physical function levels, prevention of muscle atrophy and strength, and joint stiffness were core. This study recommended short-term physiotherapy rehabilitation on early bed mobilization and ambulation for patients, which remains core for the restoration of physical functional levels and a return formula to socioeconomic status.

Misdiagnosis of Lumbar Septic Spondylitis as Lumbar Tuberculosis: A Case Report and Literature Review

Pyogenic spondylitis (PS) is relatively rare. Its clinical symptoms, laboratory tests, and early imaging findings lack distinct features, making it easily misdiagnosed as tuberculous spondylitis (TS). In February 2022, the Department of Orthopedics at Hebei Provincial People’s Hospital admitted a patient with PS. This paper presents the case details and reviews the relevant literature.

Relationship between Utilization of Body Mechanics and exposure to Low Back Pain among Nurses working in Orthopedic Department

Relationship between Utilization of Body Mechanics and exposure to Low Back Pain among Nurses working in Orthopedic Department

Radiographic and complication evaluation of 2 different bioresorbable pins in hallux valgus corrective surgery.

Osteotomies to correct hallux valgus are usually secured using metal implants. Their main disadvantage is the need for a repeat surgery for removal of implanted material. Bioresorbable implants would make it possible to overcome this complication. Few studies analyse the results of using bioresorbable pins. The primary objective of this study is to compare hallux valgus correction radiographic results with the use of two types of bioresorbable pins. The secondary objectives are to screen for possible complications related to the use of these bioresorbable pins. This is a descriptive, retrospective, single-centre study carried out between May 2018 and May 2022 in the orthopaedic surgery department of the Centre Chirurgical Emile Gallé at the CHRU in Nancy (France). The study involved 105 hallux valgus (98 patients) operated on by open double metatarsal and phalangeal osteotomy. Osteotomies were stabilised with resorbable polylactic acid (PLLA) pins (Arthrex® TRIM-IT® drill pin) in 57 cases (53 patients), and with resorbable polylactic acid-polyglycolic acid copolymer (PGLA) pins (Bioretec® ActivaPins®) in 48 cases (45 patients). The efficacy of hallux valgus correction was analysed in terms of changes in preoperative and postoperative radiographic parameters at 1 and 6 months on a weight-bearing foot. Descriptive statistics were used to describe the demographic and radiological parameters of each group. The mean age was 59.7 years (range 25-81 years) in the PLLA group and 56 years (range 23-78 years) in the PGLA group. The mean preoperative HVA was 30° (range 15-63°) in the PLLA group and 30.8° (range 15-57°) in the PGLA group. The mean preoperative IMA was 14.4° (range 7-30°) in the PLLA group and 13.8° (range 7-20°) in the PGLA group. There was a statistically significant correction of hallux valgus in the PLLA (p=5.24 X 10-15 ) and PGLA (p=3.56 X 10-13 ) groups. The mean correction for the hallux valgus angle was 13° in the PLLA group and 12° in the PGLA group. There was no statistically significant difference in hallux valgus correction between the PLLA and PGLA groups, particularly in terms of hallux valgus severity. There was no radiological or clinical complication in the groups related to bioresorbable pins. The use of bioresorbable pins allows effective stabilisation of osteotomies to correct hallux valgus. There was no significant difference in correction between PLLA and PGLA implants, regardless of the severity of the hallux valgus. We did not observe any obvious clinical or radiological complications related to their use. The use of bioresorbable osteosynthesis material in forefoot surgery seems to offer interesting advantages, providing patients with safer and less invasive treatment solutions.

Place of rank ligand inhibitor in giant cell tumour of bone.

e23511 Background: Giant cell tumour of bone (GCTB) is a locally aggressive and osteolytic tumour.The peak incidence is during the third and fourth decades of life. The majority of tumours occur in the metaepiphyseal (end) region of the long bones. Surgical resection is the preferred treatment option, if possible but it is a tumor which always poses progressive problems. Denosumab is indicated in recurrent or unresectable GCTB. Methods: We report a series of 70 patients treated for GCT at the medical oncology department of the CPMC (Algiers) in collaboration with the orthopedics department of Mustapha University Hospital from January 2020 to December 2023. Results: 70 patients ( 50 women and 20 men). The sex ratio is 0.54 The average age is 22 years (11-54 years). Reason for consultation : - Pathological fracture: n = 10 - Pain: n = 30 - Functional impotence: n = 20 - Tumor mass: n = 5 - Concept of trauma: n = 5 Stage of the disease: -Localized: n = 29 -Recurrence: n = 30, -Recurrence + pulmonary metastases: n = 10, -Sarcomatous transformation: n = 1 Type of treatment: -Radiotherapy, n = 1 -Exercised biopsy: n = 10, -Curettage + cementoplasty: n = 50 -Exeresis with osteosynthesis material: n = 8, -Amputation : n = 1 Medical treatment: Denosumab: n = 45 The number of courses with denosumab was between 6 and 55 cycles. Denosumab was administered neoadjuvantly in 10 patients, in 20 patients with reccurence disease, 15 patients in the metastatic phase - In terms of toxicity, we noted moderate hypocalcemia in 3 patients. -Objective responses: 95% ORR, 5 complete radiological responses and 10 partial responses, 20 stable patients and 9 out of 10 patients who received neoadjuvant denosumab were able to operate.Progression Free Survival was 28 months. Conclusions: GCTs are aggressive tumors with intermediate malignancy that should not be underestimated. The treatment is essentially surgical. Denosumab is indicated for both neoadjuvant and adjuvant use, it allows obtaining a clear clinical and radiological improvement.

Congenital Radioulnar Synostosis, a Report of 7 Cases and Review of Literature

Background: Congenital radio-ulnar synostosis is rare condition, characterized by limited pronation and supination. It is typically diagnosed in school-aged children. The forearm is mostly fixed in a hyperpronated position. Transverse derotational osteotomy at the site of synostosis is the intervention we propose. Patients and methods: This is a retrospective study including 7 cases of congenital radio-ulnar synostosis followed and treated at the pediatric orthopedic department of the children's Hospital of Rabat between January 2006 to February 2017. Results: The average age is about 32.5 months with a male predominance. Bilateral involvement presents 57.7% of cases. According to the Cleary and Omer classification, 42.8% of cases are classified as type IV, and 57.1% of cases are classified as type III. The average degree of preoperative fixed rotation of the forearm is 66° (from 0° to 85°). Only one patient presents a poly-malformative syndrome. Ten forearms underwent surgery, with transverse derotational osteotomy at the site of synostosis, without any postoperative complications.

Establishment of a functional Orthopaedic Department in a Nigerian Teaching Hospital: The problems, peculiarities and prospects

Establishing a functional orthopaedic department in a Nigerian teaching hospital faces challenges like staff attitude, equipment shortages, and regulatory hurdles. Solutions include infrastructure development, equipment procurement, and staff recruitment. Strategies for equipment shortages include capital investment and improved inventory management. Cultural competence training and community involvement address cultural factors impacting patient care. Quality control and innovation are crucial, necessitating audits and research collaborations. Ethical considerations, like patient consent, are paramount. Intramural Private Practice (IPP) integrates private and institutional healthcare, enhancing service delivery. Structured guidelines ensure operational integrity. Overall, a holistic approach focusing on staff management, quality, and patient-centred care is essential for a successful establishment. Keywords: orthopaedic department, challenges, solutions, cultural factors, quality control.

Self-locking tenotomy of the long head of the biceps: What is the benefit?

Tenotomy and tenodesis of the biceps are the surgical techniques used to treat pathology of the long biceps. Between the proponents of the two techniques, the superiority of one over the other is still debated. The Popeye sign is often cited to the disadvantage of tenotomy. The aim of our study is to report on our experience using a self-locking tenotomy and its impact on Popeye's sign, and to assess our functional results. This is a retrospective study of 53 shoulders treated for long biceps tendinopathy, isolated or associated with a rotator cuff tear. All patients underwent surgery at the AILE 4 orthopedic department of the Ibn Rochd University Hospital in Casablanca over a period of five years, and were reviewed at least six months later. A self-locking tenotomy was performed in all patients. The mean age at surgery was 58 years. Popeye's sign was observed in five patients and was well accepted in four patients. Constant-Murray scores improved significantly by an average of 25 points. Satisfaction was over 90%. Professional and sporting activities were resumed in all patients. We highlight the value of the self-locking tenotomy as a simple, rapid, reproducible, effective and low-cost arthroscopic technique, ensuring a tenodesis effect by reducing the rate of appearance of Popeye's sign.

Hip joint biomechanical analysis of the acetabular anatomical reconstruction and nonanatomical reconstruction in total hip arthroplasty for Crowe type Ⅲ developmental dysplasia of the hip by finite element method

To analyze the hip joint biomechanics of the acetabular anatomical reconstruction and nonanatomical reconstruction in total hip arthroplasty (THA) for Crowe type Ⅲ developmental dysplasia of the hip (DDH) by finite element method, which provided theoretical foundation and experimental basis for the anatomical acetabular reconstruction during THA in clinical practice. One patient with left end-stage hip arthritis secondary to Crowe type Ⅲ DDH was selected in this study, who underwent total hip arthroplasty in the orthopedic department of the First Affiliated Hospital of Bengbu Medical College in April 2020. This patient was female, 57 years old. The preoperative and postoperative three dimentional CT scan of the patient's pelvis were performed. Fourteen acetabular cup models with different anteversion, inclination and rotation center height were established in Mimics and 3-Matic software. The boundary and load conditions were set in Abaqus software. The Von Mises and stress distribution of the hip joint were calculated and observed. In the Crowe type Ⅲ DDH THA, if the hip rotation center was restored anatomically and the acetabular cup's inclination was set as 40°, the cup's anteversion varied from 5° to 25°, the lowest Von Mises value of acetabular cup and polyethylene liner occured in 20°anteversioin;if the hip rotation center was restored anatomically and the acetabular cup's anteversion was set as 15°, the cup's inclination varied from 35° to 55°, the lowest Von Mises value of acetabular cup and polyethylene liner occured in 35° inclination;if the acetabular cup's anteversion and inclination were set as 15°and 40°respectively, the up migration of hip rotaion center varied from 0 mm to 20 mm, the lowest Von Mises value of acetabular cup and polyethylene liner occured in 10 mm up migration. In all fourteen models, the Von Mises value of the acetabulum, acetabulum cup and polyethylene liner were lowest when the acetabular cup's anteversion and inlcination were 15°, 35° respectively, as well as the rotation center was restored anatomically. In total hip arthroplasty for Crowe type Ⅲ DDH, the anatomical restoration of hip rotation center with 15° anteversion and 35° inclination of the acetabular cup are suggested, bone graft above the acetabular cup and additional screws are recommended simultaneously to further reduce the Von Mises of hip joint.

The Effects Of Surgical Arthroscopy And Intraarticular Medication On The Antioxidant System And Lipid Peroxidation In Knee Osteoarthritis

&lt;b&gt;Aim: &lt;/b&gt;This study aims to evaluate the effects of joint surgery through arthroscopy, intraarticular medication, and antioxidant therapy on the antioxidant system and lipid peroxidation in patients with knee osteoarthritis (KOA). The study examines the ability of high-molecular weight hyaluronan, sodium hyaluronate, and oral Vitamin E to modulate oxidative stress markers in the knee joint.&lt;br /&gt; &lt;b&gt;Methods and Materials: &lt;/b&gt;There were 60 patients diagnosed with KOA that were divided into four groups according to the type of treatment for this prospective study at the Department of Orthopaedics and Traumatology. Blood and synovial fluid samples collected before and after treatment were evaluated for superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), lipid peroxidation (malondialdehyde, MDA) catalase (CAT). SPSS software was used to perform statistical analysis where the significance level was set at p&amp;lt;0.05.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;Synovial fluid malondialdehyde levels that showed a decreased tendency among treated groups indicated a reduced state of antioxidant activity. However, no significant changes were observed in systemic oxidative stress markers. These findings show that localized antioxidant therapy within the knee can be effective in reducing oxidative stress, therefore, may have implications for nonsurgical treatment of KOA.&lt;br /&gt; &lt;b&gt;Conclusion: &lt;/b&gt;The results emphasize possible gains made from combining surgical arthroscopy together with antioxidant treatment in managing KOA. By reducing the level of oxidative stress within the knee joint, this combined method can provide a viable solution to improve symptoms and quality of life among KOA patients.