Orthopaedic Outpatient Department Research Articles

Reliability of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries: A Cross-Sectional Study with Interobserver Analysis

Introduction: Anterior cruciate ligament (ACL) injuries are known to have a high rate of occurrence among athletes. The growing prevalence of these injuries demands research in this field to determine clinically reliable diagnostic techniques. Aims: The goal of this study was to compare the diagnostic accuracy of the lever sign test with other frequently used manual tests, such as the anterior drawer and Lachman test, and to evaluate the sensitivity and specificity of the lever sign test in the diagnosis of ACL injuries. Study Design: The study was conducted for a period of 1 year, from November 2021 to November 2022, among 100 patients presenting to orthopedic outpatient department in a tertiary care center with complaints of acute knee pain after a trauma to the knee. Materials and Methods: A thorough history, physical examination, and three manual tests for diagnosing an ACL tear were performed by an intern, orthopedic resident, and consultant after obtaining consent. Arthroscopy of the injured knee was taken as the reference standard. Results: Of 100 patients, 53 were surgical and 67 were nonsurgical; the mean patient age was 33 years (range, 16 + 6.38 years). The overall accuracy of the lever sign test was 83% (85% sensitivity and 81% specificity); the accuracy was almost similar at arrival and under anesthesia (at arrival 86%, under anesthesia 80%), when performed by interns, postgraduates, and consultants. Conclusion: The lever sign test is easier to perform, equally efficacious, and reliable in diagnosing ACL injuries when compared to the other conventionally used manual tests.

Navigating Patient Flow: Assessing the Bottlenecks in Out-Patient Services in a Tertiary Care Hospital in India

Abstract Introduction: Patient flow in hospital outpatient departments (OPDs) is affected by bottlenecks arising from patient load and service capacity mismatch. We evaluated OPD service bottlenecks at a medical college in India by measuring patient flow and service delivery rates and examined possible associations between the service rate and sociodemographic variables. Methods: Two hundred and fifty-two eligible patients in the queue were selected by systematic random sampling from general medicine, respiratory medicine, general surgery, and orthopedic OPDs. Structured interview schedules and checklists were used to gather required information. Waiting times and service delivery rates were compared statistically. Results: Most patients were newly registered (63.89%) and visited the institute directly (87.30%). Surgery had the highest number of doctors. In all OPDs, patient flow exceeded the doctor service rate; the orthopedic OPD had the longest waiting time to see a doctor (85.71% of total time). Patients attending the surgery OPD had the least waiting time and maximum consultation time (25.62% and 65.88% of the total time, respectively). Waiting and consultation times varied significantly between the OPDs. In respiratory medicine, patients took a significantly longer time to consult (P = 0.032). Conclusions: The study recommends facilitating properly scheduled consultation times, rearrangement of infrastructure, and a larger healthcare workforce in OPDs.

Evaluation of the Tensor Fascia Lata Muscle Pedicle Bone Grafting Technique in the Management of Avascular Necrosis of the Femoral Head: An Observational Clinical Study.

Osteonecrosis of the hip is defined as necrosis of the bone tissue due to some form of vascular insult, subsequently leading to the collapse of the femoral head and secondary osteoarthritis, which leads to pain and impaired joint function. This disease is widely known to affect middle-aged groups; however, in the Indian population, even younger people are more commonly affected. The disease has a debilitating effect on the activities of daily living (ADL) and the productivity of individuals and has financial consequences. With the increased utilization of magnetic resonance imaging (MRI) in society, the disease is diagnosed in its early stages. Hip-preserving surgery like tensor fascia lata (TFL) muscle pedicle iliac bone grafting should be given a chance to preserve the native femoral head. At a tertiary care teaching hospital in Gorakhpur, India, an observational clinical study was carried out. This study comprised 40 patients, ages 18-50 years, with femoral head osteonecrosis (stages II and III of the Ficat-Arlet staging system), who came to our institute's orthopedic outpatient department. Patients were treated with multiple drillings, curettage, and cheilectomy of the femoral head, in addition to TFL muscle pedicle bone grafting. The Harris hip score (HHS) was utilized to assess the clinical results, and the radiological assessment focused on signs of revascularization. In our study, the most prevalent age group was 20-30 years (67.5%), with a male predominance (85%). Among our cohort of 40 patients, the HHS indicated excellent outcomes (90-100) in 14 cases (35%), good outcomes (80-89) in 19 cases (47.5%), fair outcomes (70-79) in six cases (15%), and poor outcomes (<70) in one case (2.5%), at the time of the final follow-up. The final follow-up period varied from one to 10 years. TFL muscle pedicle bone grafting procedure provides excellent clinical and radiological outcomes, especially in young patients in whom femoral head-preserving surgery is preferred over total hip arthroplasty. This procedure is effective in both early and advanced stages of femoral head osteonecrosis, provided there are no arthritic changes. It reduces symptoms and improves functional outcomes.

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.

A Study on Prescription Pattern of Drugs in Orthopaedics Inpatient Department of Navodaya Medical College Hospital and Research Centre in Raichur

Background: Periodic evaluation of drug utilization pattern is necessary to promote rational drug use by. In orthopaedics practice, the prescribing pattern needs to be regularly monitored since many of the drugs prescribed carry untoward adverse effects. In this backdrop, the present study was conducted to explore the prescribing pattern in orthopaedics outpatient department (OPD) of Navodaya medical college hospital and research centre in Raichur. Methods: This is a prospective observational study conducted for 3 months, in Navodaya medical college hospital and research centre in Raichur, a 1000 bedded tertiary care rural based, teaching hospital. Total 100 patients were included in this study. Results: Total 1216 drugs were prescribed in 100 prescriptions. Average number of drugs per prescription was 7.34. Average duration of prescription was 9 days. Percentage of drugs prescribed by generic name was 29.7%. Percentage of encounter with an Antibiotic prescribed was 60.23% i.e. out of 100 prescriptions antibiotics were prescribed in 60. Percentage of encounter with an Injection prescribed was 60% which means out of 100 prescriptions, injectables were prescribed in 60. Percentage of drugs prescribed from National Essential Medicine List was 52.63%. Percentage of drugs prescribed from WHO model List was 32.46%. Diclofenac (14.25%) was most commonly prescribed drug. Incidence of polypharmacy was quite high in context of Analgesics. Almost 19% of prescriptions had 3 drugs. Orally prescribed Analgesics were 62.4%, Injectables 34% and Topical 3.6%. Conclusion: The study provides an insight into the prescribing pattern in orthopaedics in-patients. It highlights the importance of emphasizing rational drug prescribing and toward improving awareness of the physicians and medical students to the WHO recommended standards on prescribing indicators.

Knowledge, Attitudes, Practices, and Awareness Levels Among Indian Postmenopausal Women About Osteoporosis and Its Relationship With Sociodemographic Factors: A Cross-Sectional Study From Northern India.

Background Osteoporosis is a silent disease and can be prevented by providing correct and appropriate information to the individuals at risk. Therefore, we aim to find out the levels of knowledge, attitudes, and behaviors of postmenopausal women, the highest-risk group. Methods Between May 2021 and December 2023, a cross-sectional study was done in the Military Hospital in Ambala, India, in 1326 postmenopausal women of age between 45 and 70 years who visited the outpatient department of orthopedics and who previously had a measure of bone mineral density (BMD) or estimation of BMD. All patients participating in the study received a questionnaire that assessed the level of knowledge, attitudes, and behaviors related to osteoporosis. The Osteoporosis Knowledge Assessment Tool (OKAT) was used to assess these parameters. Results The mean age was 60±3.1 years. The mean score for osteoporosis awareness was 6/20 points. A total of 983 (73.13%) had no knowledge about osteoporosis, and 221 (16.66%) had higher knowledge. Knowledge about osteoporosis was low with a mean knowledge score of 7.44±3.16 and a median of 7.2.It was found that those who graduated had some knowledge regarding osteoporosis with the help of either a hospital staff or a family member who had a history of osteoporosis. Conclusions Even among postmenopausal women who know they are at risk and should have BMD, knowledge, attitudes, and behaviors about osteoporosis were found to be quite low. In addition, education and mass communications are needed to increase awareness among women of this age about improving bone health.

Combined effects of psychological and life style factors on pain intensity and/or disability in patients with chronic low back pain: A cross-sectional study

IntroductionChronic Lower Back Pain (CLBP) is a frequently encountered health issue in primary care settings, leading to global disability and imposing a considerable economic burden.ObjectivesThis study aimed to: (1) compare socio-demographic, health, lifestyle (sleep, physical activity) and psychological factors (depression, anxiety) between people with and without CLBP; and (2) quantify the correlations between these psychological and lifestyle factors, and clinical outcomes (intensity of CLBP and CLBP-related disability) in people with CLBP after considering other confounders.MethodsA cross-sectional study was undertaken at the neurosurgery and orthopedic outpatient department of Heraklion University Hospital between 2019-2021. Two hundred fifty three volunteers with CLBP and 116 without CLBP provided sociodemographic information, daily habits, medical history, subjective sleep/ sleep complaints, low back pain intensity and disability using a10-point numeric Visual Analogue Scale pain rating scale and Quebec Back Pain Disability Scale, as well as questions assessing impact of pain on mobility, self-care, routine activities and psychological status, respectively. Participants also completed the Zung Self-Rating Scale (SDS) for self-assessment of depression and Self-rating anxiety scale (SAS). Associations among CLBP, demographics, psychosocial or sleep disorders parameters and clinical outcomes were analyzed using multivariate models.ResultsPeople with CLBP exhibited a substantially greater prevalence of depressive, insomnia and obstructive sleep apnea (OSA) symptoms than controls (p &lt; 0.05). CLBP diagnosis was independently correlated with female gender, older age, as well as worse physical and mental health outcomes measured by (i) higher level of sleep symptoms such as sleepiness, OSA and insomnia symptoms and (ii) higher prevalence of physician-diagnosed depression, and moderate to severe depressive symptoms. The level of functional disability for CBLP patients (based on Quebec score) was independently associated with age, physician diagnosed depression, lower educational status, moderate to severe depressive symptoms and OSA symptoms. The combination of moderate to severe depressive symptoms with OSA or insomnia symptoms was the most important predictive factor for functional disability for CBLP patients (OR 13.686, 95% CI 4.581-40.885; p&lt;0.001).ConclusionsDepressive symptoms and subjective sleep disorders appear to relate to greater CLBP-intensity and/or CLBP-related disability in people with CLBP. To achieve the desired outcomes when treating patients with chronic CLBP, it is essential to employ a holistic approach, involving assessment and management of their psychological comorbidities, and sleep issues, that may improve quality of life in these patients.Disclosure of InterestNone Declared

Comparison of the Latarjet Procedure With the Modified Putti-Platt Surgery for Recurrent Anterior Shoulder Dislocation With Respect to Functional Outcome.

Introduction Shoulder dislocation is the most common injury encountered in orthopedic outpatient department. The choice of procedure depends on the expertise of surgeons.The objective of this study was tocompare the Latarjet procedure with the modified Putti-Platt surgery for recurrent anterior shoulder dislocation in terms of functional outcomes. Materials and methods A quasi-experimental study evaluated 60 patients with recurrent anterior shoulder instability. Patients were assigned to either Latarjet or modifiedPutti-Platt surgery. Functional outcomes were assessed at sixmonths using the Constant-Murley shoulder score. Results This study encompassed 60 patients (mean age:23.93±5.88 years) undergoing shoulder procedures.Functional outcomes exhibited a majority of 55% excellent, 35% good, 6.7% fair, and 3.3% poor outcomes. No significant differences in functional outcomes were found between the procedures. Conclusion Both procedures may be viable options for recurrent shoulder instability. The choice may depend on patient factors and surgeon preference. Further research is needed to refine techniques and identify ideal candidates.

A rare diagnosis has no certainty, but still they occur: A case report

Pain and swelling are among the most frequently encountered complaints in an orthopedics outpatient department (OPD) relatively less common in a pediatric OPD. A high level of suspicion is required to diagnose bone diseases. Common conditions such as rickets, septic arthritis, and tuberculosis must be ruled out. Treatment such as antibiotics, anti-inflammatory drugs, or steroids may mask an underlying serious condition in which if left untreated can cause significant morbidity and mortality to the person. Here, we discuss a case of a young infant 11 months of age who had symptoms suggestive of septic arthritis and was later found to have Brodie’s abscess which is a type of subacute osteomyelitis on further evaluation which is usually mistaken as a tumor. This age at presentation is rare.

Chondromyxoid Fibroma of the Metatarsal Head: A Rare Case Report

Chondromyxoid Fibroma (CMF) is an uncommon non malignant cartilage tumour with a greater predilection for the legs, with about a quarter of cases involving the metatarsals. It accounts for less than 0.5% of all bone tumours and mostly occurs in patients aged 10 to 30 years old. Patients typically present with complaints of pain and swelling in the affected region. Radiologically, a lytic lesion with well-defined margins is observed in the metaphysis. The present case is about an 11-year-old male who presented to the Orthopaedic Outpatient Department (OPD) with a history of pain and swelling over his left foot. Upon examination, a discrete swelling was noted over the lateral aspect of the foot, extending from the head to the shaft of the 4th metatarsal. Upon palpation, the swelling was found to be tender and firm in consistency, accompanied by restricted foot movement. Initially, a giant cell tumour of the 4th metatarsal bone in the left foot was suspected based on radiography. However, histopathological examination led to the diagnosis of CMF. The lesion was curetted, and a below-knee Plaster of Paris (POP) was applied for one month. No recurrence of the lesion has been observed after five months of follow-up.

A Cross-sectional Study to Estimate the Proportion and Ascertain Risk Factors for Osteoarthritis Knee among Women above 45 Years of Age Attending a Tertiary Care Hospital.

With aging, women face various health issues, the most common of which are musculoskeletal disorders. Osteoarthritis accounts for 15% of all musculoskeletal disorders in patients above the age of 45 years but receives little attention. This study aims to estimate the proportion of women above 45 years suffering from Osteoarthritis (OA) knee and to ascertain its risk determinants. A cross-sectional study was conducted among 380 women above 45 years of age attending the Orthopedic outpatient department of a tertiary care hospital over a period of 18 months. American College of Rheumatology clinicoradiological criteria were used for the diagnosis of OA knee. A predesigned case record form was used to collect information on sociodemographic profile and other risk factors. Data were analyzed using SPSS version 16.0. Our study found the overall proportion of OA knee to be 69.2%. The Chi-square test was used to find the association of various factors with OA knee. On logistic regression, diabetes mellitus, hypertension, menopause, and increased body mass index were found to be significant for OA Knee. The study concludes the possibility of prevention of disabilities by early screening for OA Knee in those with risk factors as a part of wellness clinics.

Investigating artificial intelligence models for predicting joint pain from serum biochemistry.

The study used machine learning models to predict the clinical outcome with various attributes or when the models chose features based on their algorithms. Patients who presented to an orthopedic outpatient department with joint swelling or myalgia were included in the study. A proforma collected clinical information on age, gender, uric acid, C-reactive protein, and complete blood count/liver function test/renal function test parameters. Machine learning decision models (Random Forest and Gradient Boosted) were evaluated with the selected features/attributes. To categorize input data into outputs of indications of joint discomfort, multilayer perceptron and radial basis function-neural networks were used. The random forest decision model outperformed with 97% accuracy and minimum errors to anticipate joint pain from input attributes. For predicted classifications, the multilayer perceptron fared better with an accuracy of 98% as compared to the radial basis function. Multilayer perceptron achieved the following normalized relevance: 100% (uric acid), 10.3% (creatinine), 9.8% (AST), 5.4% (lymphocytes), and 5% (C-reactive protein) for having joint pain. Uric acid has the highest normalized relevance for predicting joint pain. The earliest artificial intelligence-based detection of joint pain will aid in the prevention of more serious orthopedic complications.

PREVALENCE OF GENERALIZED LIGAMENT LAXITY IN ADULT INDIAN POPULATION: A CROSS-SECTIONAL STUDY AND REVIEW OF LITERATURE

Objective: Generalized ligament laxity (GLL) is defined as increased range of motion across multiple joints in an individual. Its prevalence has been reported to be between 5% and 15%. Although there has been implication of increased prevalence in Indian population, there are relatively few studies related to the prevalence of GLL in adult Indian population. There is also a dearth of literature on, which specialty outpatient department (OPD), these patients commonly present to, with their complaints. The objective of this study was to assess the prevalence of GLL in adult Indian population. Methods: 5400 patients were selected from various OPDs of a tertiary care hospital after informed consent. After stratification for age and sex, Beighton’s score assessment was done. Results: Using the Beighton’s score of four or more, to assess the prevalence of generalized ligament laxity, a total of 735 (13.61%) participants had GLL in the entire study population of 5400. Significantly higher number of patients were found to have GLL from the sample recruited from orthopedic OPD (p=0.013) as compared to other OPDs. The highest Beighton’s score was 8/9, recorded in a 29-year female in the orthopedic OPD. It was observed that in all OPDs, the mean Beighton’s scores were higher in female than in male participants in each subgroup; also, there was a decline in mean scores with increase in age in all OPDs which can be inferred as a decrease in GLL with age. Conclusion: This study is the largest Indian study to investigate the prevalence of GLL in the adult population in India. The study found that there was a significant prevalence of GLL in the adult population especially in females compared to males in all ages, though prevalence of GLL reduced with age. This study has implications of prevention of injuries in people with GLL. Although orthopedic surgeons generally primarily manage the people with GLL, they do not have a high index of suspicion toward the same. Identifying these individuals and making a diagnosis regarding the same is problematic but doing so will help these individuals live a pain-free life.

Vertebral changes in the lumbar spine of adults presenting with chronic low back pain at a Referral Hospital in western Kenya

Background: Chronic low back pain is a common musculoskeletal symptom affecting the lower part of the spine. It is described as pain and discomfort around the lumbar region lasting for more than twelve weeks. The symptoms of chronic low back pain might range from a dull ache to a stubbing or shooting sensation. This nature of pain may be localized around the axial region or radiate to the lower limbs affecting the patients’ daily activities. The aim of this study, therefore, was to evaluate vertebral changes in the lumbar spine of adults presenting with chronic low back pain at Kakamega County General and Referral Hospital.&#x0D; Methods: This was a cross-sectional quantitative descriptive study whereby; patients’ data was collected during patients’ presentation at orthopedic outpatient clinic and MRI department. Purposive sampling of lumbar spine Magnetic resonance imaging scans was used to obtain data. A total of 144 patients were selected using the Yamane Taro formula. Anatomical vertebral changes of the lumbar spine were assessed from the selected MRIs to evaluate the structural causes of chronic low back pain. Descriptive statistics such as frequency and percentage were used in analyzing the data.&#x0D; Results: It was noted that osteophytes were the most pathological changes causing chronic low back pain while fractures were the least common. Osteophytic changes in the vertebra and desiccation of the intervertebral discs can predispose one to chronic lower back pain.&#x0D; Conclusion: The study recommends early screening and treatment of lower back pain to avert its sequelae.

The Spectrum of Shoulder Pathologies on Magnetic Resonance Imaging: A Pictorial Review.

Patients present to the orthopedic outpatient department with complaints of shoulder pain on movement or restriction of movement in the shoulder joint and are referred for magnetic resonance imaging (MRI) of the shoulder joint. Almost all the patients have similar complaints but may have a wide range of pathology affecting the joint and causing pain. Rotator cuff tears or tendinopathy are the most common causes of shoulder pain. Ultrasound (USG) and MRI are the most commonly used imaging modalities for assessing rotator cuff pathologies. There is a wide range of pathologies affecting the shoulder joint, other than rotator cuff tendinopathies or tears, for which USG is less sensitive and specific in detecting accurate pathology. MRI is the choice of imaging for shoulder joint pathologies. We present a pictorial review discussing and depicting MRI features of a wide list of pathologies of the shoulder joint complex that should be kept in mind when the patient presents with shoulder pain.

Effectiveness of Dextrose Prolotherapy in Chronic Plantar Fasciitis: A Cross-Sectional Study

&#x0D; Introduction: Plantar fasciitis is a very common musculoskeletal condition encountered in the outpatient department of orthopedics. It's the most common cause of heel pain. Patients have pain on weight-bearing, which limits their activities. Usually, plantar fasciitis is diagnosed on the basis of history and clinical examination; however, X-ray and USG can be helpful in atypical presentations. Mostly, plantar fasciitis is managed conservatively, which includes stretching exercises, footwear modification, ultrasonics, and injections. Prolotherapy is a very cost-effective, and OPD-based procedure that has shown promising results in many tendinopathies. There are no other risks involved in this procedure, and patients can start light activities immediately after the injection.&#x0D; Objective: To evaluate the efficacy of dextrose prolotherapy in the treatment of chronic resistant plantar fasciitis (PF).&#x0D; Methodology: This prospective, cross-sectional study, was conducted from July 2021 to December 2021 at Birat Medical College and Teaching Hospital after taking permission from the Institutional Review Committee (IRC). Patient selection was done using inclusion and exclusion criteria. A total of 66 patients were included in the study, who received two prolotherapy injections in a gap of two weeks and were followed up after 12 weeks. Patient’s clinical (Visual Analogue Score for pain at rest and activities), functional (Foot Function Index), and ultrasonograhic (plantar fascia thickness) findings were noted pre- and post-test and were evaluated.&#x0D; Results: There were 66 adult patients included in the study, out of which 39 patients (59.1%) were female and 27 patients (40.1%) were male. Their age ranged from 26 to 68 years, with a mean age of 43.91 and a standard deviation (SD) of 10.225. The mean BMI was 25.758 with an SD 2.69 (range: 19.6-33.2). The clinical score (VAS-R and VAS-A), functional score (FFI), and ultrasonographic findings (PF thickness) yielded significant outcomes following prolotherapy.&#x0D; Conclusion: Prolotherapy is a safe, economical, and effective treatment module for plantar fasciitis that has shown significant improvement in pain, functional outcomes, and patient satisfaction.

Coexistence of Slipped Capital Femoral Epiphysis and multiple endocrine neoplasia type 2B (MEN2B) - a case report

Introduction: MEN 2B syndrome is distinguished by the occurrence of medullary thyroid cancer, pheochromocytoma, mucosal neuromas, marfanoid features, and skeletal anomalies, including kyphoscoliosis, joint laxity, pes cavus, and, in a smaller number of cases, slipped capital femoral epiphysis (SCFE).&#x0D; Case report: We describe a case report of a 15-years-old patient with the diagnosis of the MEN2B syndrome with a rare manifestation of Slipped Capital Femoral Epiphysis (SCFE). A 15-year-old female presented to the orthopedics out-patient department (OPD) with complaints of pain around the right hip and knee and walking with a limp for approximately four months. Additionally, the feeling of enlarged thyroid gland was reported. X-ray confirmed the presence of the SCFE, while thyroid biopsy revealed the presence of medullary thyroid cancer (MTC). Thus, the diagnosis of MEN2B was made.&#x0D; Conclusion: Slipped capital femoral epiphysis (SCFE) can occasionally be a manifestation of MEN 2B syndrome. It is important for physicians to be aware of this association, as it can contribute to the early detection of a potentially life-threatening condition.

TENS in Femoral Shaft Fractures of Children

Background: Pediatric femoral shaft fractures are one of the common fractures that we encounter in the orthopedics outpatient department. These fractures have various treatment options ranging from traction and early hip spica casting to elastic titanium intramedullary nails [titanium elastic nailing system (TENS)] and reamed intramedullary nails. In this study, we are evaluating the functional outcome and results following the use of flexible intramedullary nails and conservative management for femoral shaft fractures in children.&#x0D; Methods: This was a prospective observational study which was carried out in a tertiary care hospital from October 2015 to May 2017 for two groups of children who sustained traumatic femoral shaft fractures. A total of 40 patients were taken into consideration with 20 patients each in two groups.&#x0D; Results: The male-to-female ratio was 2.6:1 in our study population. The overall post-operative complication rate was more in the TENS group. Besides, we found that the TENS group of patients had a less limb length discrepancy (LLD) (P = 0.004) and a lower degree of angular deformity (P = 0.36).&#x0D; Conclusion: TENS demonstrated advantages including sufficient axial stability, early mobilization, and more rapid return to function than spica cast treatment; however, it had the drawback of possible infection and pin site irritation. Overall, TENS offers a minimally invasive method for treatment of the femoral shaft fractures in children which stands superior to traditional spica casting.&#x0D;

The Charlotte Maxeke Johannesburg Academic Hospital Fire: Our Orthopaedic Surgery Disaster Management and Lessons Learnt

Purpose: This report aims to review the orthopaedic doctor's experiences and to provide insight for the formulation of response measures for similar incidents in the future.We further report on our orthopaedic surgery disaster management and lessons learnt&#x0D; Methodology: A retrospective review of orthopaedic patients who were admitted at Chris Hani Baragwanath academic hospital (CHBAH) from the 01 April to 30 April 2021, the month of the fire incident. Data were obtained from the hospital casualty, inpatient registers, and outpatient registers. Data were compared before and after the fire incident.&#x0D; Findings: Transfer was provided to 51 patients to CHBAH orthopaedic emergency unit. Forty-three (84.3%) were adult patients and eight (15.7%) were paediatric patients. There were fewer daily admissions to orthopaedic emergency unit in the last 15 days of the month of the disaster compared to the first 15 days, when the 51 cases from Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) were excluded (mean: 12.89 versus 13.26). The orthopaedic outpatient department doctor to patient ratio improved after the fire incident.&#x0D; Recommendation: The four phases’ disaster approach- preparedness, response, recovery and mitigation remain applicable to disaster management. Planning for emergencies the dedication of orthopaedic professionals and hospital employees can all contribute to the highest quality patient care.&#x0D;

ASSESSMENT OF HIP INSTABILITY IN HIGH RISK DELIVERIES IN NEWBORN BY CLINICAL EXAMINATION AND ULTRASONOGRAPHY

Background: Developmental dysplasia of hip (DDH) is one entity which occasionally comes across in orthopaedic or paediatric outpatient department. The knowledge of risk factors and awareness of the condition is must for every orthopaedic surgeon and paediatrician so that the diagnosis won’t be missed. An early diagnosis can alter the prognosis of the disease and prevent late disabilities. Material And Methods: Diagnosis of instability in the neonatal period can be easily assessed with the Barlow and Ortolani manoeuvres. Sonography is valuable in the first months of life. Graf et al established a method to evaluate the infant hip according to morphology. Result: It has been found that first born female with breech presentation has more chances of this hip instability as compare to male born with left side more affected assessed by clinically and graf et al method. Conclusion: Neonatal hip instability is common and a screening programme should be initiated to detect its incidence and prognosis can be better if diagnosed early.