Malcolm Hooper is an International Executive Director serving on both the International Hyperbaric Medical Foundation (IHMF) and the International Hyperbaric Medical Association (IHMA). He is a regular speaker at international symposiums on the topic of Hyperbaric Oxygen Therapy applications in the modern era.
The Final Frontier – Repair and Functional Restoration Almost 20 to 30 per cent of the body’s consumption of oxygen occurs within 3 to 5 per cent of the body mass – the brain and spinal cord structures. These structures are extremely sensitive to oxygen deficiency and benefit from oxygen repletion. The final frontier in the treatment of degenerative neurovascular disorders is focused on ‘repair and functional restoration’. This involves the use of neural growth factors to promote axonal sprouting, activation of idling and non-functional neurons whilst promoting neovascularization (new capillary formation) of the damaged (penumbra) areas. Cells in a chronic hypoxic state overexpress pro-inflammatory cytokines including IL1, Il6, IL7, IL8, IL17, TNFa, MMP9, S100B. The smoldering ‘cytokine storm’ differs for each individual. Over expression of proinflammatory cytokines inhibit neuroplasticity and neurogenesis and promote secondary apoptotic cascades. The extent of both primary and secondary neurovascular deterioration can be significantly diminished with HBOT, which ‘expands the therapeutic window’. “Hyperbaric Oxygen Therapy creates a ‘fertile neurovascular platform’ for emerging stem cell, immunotherapies and nanotechnology techniques. The impact and success of these and future procedures are dependent on the integrity of the underlying supporting neurovascular bed.” A (Hooper 2005) .The benefit of HBOT in rehabilitation is well documented. Hyperbaric tissue oxygenation results in increased blood flow by fostering the formation of ‘new capillary dynamics’ (neovascularization) into the damaged regions of the body. Hyperbaric tissue oxygenation accelerates neuroplasticity, activating damaged and dormant nerve cells (penumbra state).Increased Oxygenation significantly accelerates the rate of healing, stabilization and repair through numerous immune modulating effects, providing up regulation of anti-inflammatory cytokines, including: Granulocyte Macrophage Colony Stimulating Factor (GM-CSF), Interleukin-3 (IL3), Interleukin-4 (IL4), Interleukin10 (IL10), Interleukin-13 (IL13), Interleukin-21 (IL21), Brain Derived Neural Growth Factors (BDNF, GDNF), Vascular Growth Factors (VEGF), TGFβ Signaling and IGF1.From the American Journal Physiology, Heart and Circulatory Physiology (2005): Stem Cell Mobilization by Hyperbaric Oxygenation reports a single two hour exposure to HBOT at 2 ATA doubles circulating CD34+ progenitor stem cells (primordial cells targeted to salvage and restore damaged structures). At approximately 40 hours of HBOT, CD34+ cells increase eight-fold (800 percent). LOKOMAT Robotic Gait Assisted Walking is a sophisticated exoskeleton technique where the patient is fitted with a harness, suspended from the wheel chair and strapped into the exoskeleton.
Safwat Mohammed El Hoseny is a Head of Wound Management Committee in Alqasimi & Alkuwait hospitals in Sharjah UAE and Leader of Remote Wound Care in all MOH in UAE. He received Doctoral Degree (MD) in plastic surgery from Ain Shams University, Faculty of Medicine Egypt in the 2008. He has completed MBBCH with honor Ain Shams University, Faculty of Medicine - Egypt. He is a recipient of many awards and grants for his valuable contributions and discoveries in major area of research. He is the Member of Emirates Medical Association He is committed to highest standards of excellence and it proves through his/her authorship of many books.
The dressings serve to help close chronic wounds and thereby to reduce pain and prevent the loss of fluid, heat, protein, electrolytes and restore the function. Also the advanced scaffold and growth factors dressing as epidermal growth factor (Heberprot) can prepare it for surgical or closure of difficult wounds . The recovery process will depend on the material of the dressing patient’s age and any pre-existing medical conditions. Patient selection, timely reconstruction and optimal procedure are the criteria for lower limb reconstructive surgery.
Malcolm R. Hooper is an International Executive Director serving on both the International Hyperbaric Medical Foundation (IHMF) and the International Hyperbaric Medical Association (IHMA). He is a regular speaker at international symposiums on the topic of Hyperbaric Oxygen Therapy applications in the modern era
Almost 20 to 30 per cent of the body’s consumption of oxygen occurs within 3 to 5 per cent of the body mass – the brain and spinal cord structures. These structures are extremely sensitive to oxygen deficiency and benefit from oxygen repletion. The final frontier in the treatment of degenerative neurovascular disorders is focused on ‘repair and functional restoration’. This involves the use of neural growth factors to promote axonal sprouting, activation of idling and non-functional neurons whilst promoting neovascularisation (new capillary formation) of the damaged (penumbra) areas. Cells in a chronic hypoxic state overexpress pro-inflammatory cytokines including IL1, Il6, IL7, IL8, IL17, TNFa, MMP9, S100B. The smoldering ‘cytokine storm’ differs for each individual. Over expression of proinflammatory cytokines inhibit neuroplasticity and neurogenesis and promote secondary apoptotic cascades. The extent of both primary and secondary neurovascular deterioration can be significantly diminished with HBOT, which ‘expands the therapeutic window’. “Hyperbaric Oxygen Therapy creates a ‘fertile neurovascular platform’ for emerging stem cell, immunotherapies and nanotechnology techniques. The impact and success of these and future procedures are dependent on the integrity of the underlying supporting neurovascular bed.” (Hooper 2005). The benefits of HBOT in rehabilitation is well documented. Hyperbaric tissue oxygenation results in increased blood flow by fostering the formation of ‘new capillary dynamics’ (neovascularization) into the damaged regions of the body. Hyperbaric tissue oxygenation accelerates neuroplasticity, activating damaged and dormant nerve cells (penumbra state). Increased Oxygenation significantly accelerates the rate of healing, stabilization and repair through numerous immune modulating effects, providing upregulation of anti-inflammatory cytokines, including: Granulocyte Macrophage Colony Stimulating Factor (GM-CSF), Interleukin-3 (IL3), Interleukin-4 (IL4), Interleukin10 (IL10), Interleukin-13 (IL13), Interleukin-21 (IL21), Brain Derived Neural Growth Factors (BDNF, GDNF), Vascular Growth Factors (VEGF), TGFβ Signaling and IGF1.From the American Journal Physiology, Heart and Circulatory Physiology (2005): Stem Cell Mobilization by Hyperbaric Oxygenation reports a single two hour exposure to HBOT at 2 ATA doubles circulating CD34+ progenitor stem cells (primordial cells targeted to salvage and restore damaged structures). At approximately 40 hours of HBOT, CD34+ cells increase eight-fold (800 percent). LOKOMAT Robotic Gait Assisted Walking is a sophisticated exoskeleton technique where the patient is fitted with a harness, suspended from the wheel chair and strapped into the exoskeleton. The LOKOMAT kinetic settings can be varied and specifically adjusted throughout the training session to “match the specific requirements of the individual”. Some patients have high level spasticity and others have a complete loss of tone. Robotic assisted training can be constantly adjusted to provide numerous accurate repetitions necessary to restore activity, especially walking function for neurologic patients. Improving a patient to the point that he or she no longer needs a wheelchair to move leads to reducing the economic burden associated wheel chair-associated complications that include pressure ulcers, circulatory disorders, osteoporosis and attendant care. LOKOMAT provides excellent opportunity to ‘best-fit’ a patient’s specific capabilities and capacity to re-train function. LOKOMAT Gait Training not only improves the gait in neurological patients, it also positively effects cardiovascular performance and reductions in spasticity, bone loss and associated bladder or bowel complications
Ash Harkara has completed his PhD from University Pune and Postdoctoral studies from school of EE, University of Leeds, UK. He is a founder director of VOLMO LTD. He has been presented papers in number of conferences and published papers in reputed journals.
Patient specific technology is slowly gaining popularity and clinical adoption. In this study we designed, simulated and 3D printed a knee implant. Patient CT scan data was imported into ImageSim software from VOLMO (UK). ImageSim has number of features to smooth and filter the data; filtered data was exported as STL model of full knee. The full knee STL model was then imported into TSV tools available in ImageSim for CAD functionality. Resection of Femur and tibia was done in TSV environment. Re-sected knee model was imported in Solid works software and new components for femur, tibia and polymer insert were designed and exported back into TSV. All the new components and original resected bones were assembled and positioned. New assembled model were remeshed and then volume meshed. Contacts, material properties and boundary conditions were assigned before final model was exported into Ansys for finite element analysis. Static analysis for a full gait cycle was carried out in Ansys and the results obtained will be presented in the conference
Mohamed Abdulsattar has completed his PhD from Cairo University, Egypt. He is the Consultant Physical Therapist in Ahmed Maher teaching hospital, Egypt. He has published his papers in reputed journals and has been won a safety and health Award in 30th International conference of ideas UK in UK 2016.
Background: Many people struggle with hamstring (HM) stretches. They are a muscle group that tightens up quickly and depending on your posture can be overworked. The hamstrings run through the back of each thigh. Tightness in this muscle limits motion in the pelvis which can increase stress across the low back and corrupt correct posture and can cause the onset of knee or back pain. Hamstring stretching exercises are a necessary part of training in any sport and are useful in the maintenance of good posture. I observe after treating of many surgeons in our hospital a relation between tightness of HM and back pain especially after OT work.
Methods: Ten participants from different surgical departments (plastic surgery department, orthopaedic Dept. etc.) were asked to do Hamstring Muscle Tightness test. They were chosen from AlQassimi hospital, Sharjah, UAE. They were assigned to one group and practiced a program of Stretching Program of Hamstring Muscles daily for 2 weeks. All participants had been evaluated to measure Hamstring Muscle Tightness test and all participants with positive Hamstring Muscle Tightness test were enrolled in this study. All participants were asked to do Visual analogue scale test. All data were registered in data collection sheets. All measurements were done before and after the study program.
Results: After completion of the study, a significant improvement was observed in in measurement of back pain on visual analogue scale (P < 0.05), when compared to pre-program measurement.
Conclusion: Stretching exercises Program of Hamstring Muscles could improve Low Back Pain among Surgeon in Operation Theatre. Stretching Program of Hamstring Muscles is good methods that improve Low Back Pain among Surgeon
Gaurav Kumar Maddheshiya has completed DNB Orthopedic Surgery and he is a specialist in Orthopedic Field in the institution of National institute of medical science, Jaipur. He has been awarded and certified by different National and International journals. His field of interest includes Pain Management and fluid therapy
Clavicle fracture account for 2.6% of all fractures. >75% of these are midshaft fracture. Overlapping in multiple fragment fracture result in shortening of the shoulder girdle at the fracture site which leads to poor cosmetic and functional result. Classification of Clavicle Fractures: Group I: Middle third- Most common (80% of clavicle fractures), Group II: Distal third- 10-15% of clavicle injuries, Group III: Medial third-Least common (approx. 5%). Rockwood & Green's Fractures in Adults- As anyone who has treated this injury is aware, discussion of universal healing rates after clavicular fracture is overly optimistic. Recently, investigators have discovered that union after midshaft clavicle fracture is not as universal as once thought. Moreover, certain types of clavicular fractures have declared themselves to be problematic. Finally, there has been newfound interest in the treatment of problem fractures and nonunion. Recent data based on detailed classification suggests that incidence of nonunion in displaced clavicle fractures is between 10-15% Brinker MR, Edwards TB, and O’Connor DP. The risk of nonunion following nonoperative treatment of a clavicular fracture is estimated. Malunion with shortening & rotational deformity can be debilitating for the patients and challenging for the surgeon as it does not remodel in adults.
Purpose: We assessed the long-term results of periacetabular osteotomy (PAO) to determine the clinical and radiological outcomes for patients who developed osteoarthritis secondary to hip dysplasia. We separately evaluated the effect of PAO in patients who later underwent conversion to total hip arthroplasty (THA).
Methods: Forty patients were treated with PAO by a single surgeon in the same center from 1999 to 2006. Nine patients (10 hips) were lost to follow-up. The remaining 31 patients (37 hips) were retrospectively reviewed at an average follow-up time of 14 years.
Hips were evaluated by using the modified Harris hip score and the Tönnis radiological classification. The central edge angle was also recorded before and after PAO, as well as prior to THA. In cases where patients were converted to THA, the inclination and anteversion measures were recorded.
Results: The mean age of the PAO patients was 36.9 years (range 16–49). The average surgical time for PAO was 4 hours 37 minutes (SD 42 mins), and the average estimated blood loss during surgery was 557 mL (SD 186). The ASA score median was 1. The mean Harris hip score at follow-up was 83 (SD 24) and ranged from 26 to 113. The median Tönnis classification of osteoarthritis based on radiographic changes was 2.
The center edge angle improved significantly, from a mean of 15.6 (SD 10.5) preoperatively to a mean of 32.8 (SD 3.3) at follow-up. Eighteen of the 37 hips were converted to THA. The mean central edge angle prior to THA was 12.7 (SD 9.2). The mean inclination in these cases was 44.9 (SD 6.8), and the mean anteversion was 17.5 (SD 5.2). Nine patients experienced complications. Eight of these patients developed moderate to severe pain secondary to greater trochanteric bursitis. One patient from the bursitis group developed non-union pelvic osteotomy, and another developed hip impingement secondary to prominent PAO hardware (screws). Two patients in the converted THA group had a revision. One had a septic loosening of the acetabular and femoral components, and the other experienced femoral periprosthetic fracture secondary to excessive femoral anteversion.
Conclusion: Periacetabular osteotomy is a useful and predictable procedure in young patients with symptomatic hip dysplasia. The procedure can improve pain relief and femoral head coverage and slow the progression to THA conversion. Furthermore, the PAO procedure did not affect the THA component position in our patient population, but there were variable results with regard to functional activity and pain levels compared to older aged patients who undergo total hip arthroplasty.
Tammer Elmarsafi has completed his MBBCh from Cairo, Egypt, and his DPM degree from Washington, DC USA. He completed a fellowship in Diabetic Limb Salvage at MedStar Georgetown University Hospital and is currently an Attending Surgeon at a level one academic trauma center in Washington, DC. He has multiple publications related to Limb Salvage
Patients with Diabetic Charcot Neuroarthropathy are at high risk for ulcerations and major lower extremity amputations. Osseous reconstruction is an important component in ulcer healing and prevention, however despite such efforts, major lower extremity amputations remain a serious post-reconstruction concern. The aim of this study was to identify risk factors for major lower extremity amputation in patients who underwent osseous Charcot reconstruction. A retrospective review was performed on 331 patients with the diagnosis of Charcot Neuroarthropathy in the foot and ankle treated over a 16-year period. Two hundred eighty five patients were included after exclusion of those without Diabetes. Demographic data, anatomical wound location, surgical interventions, wound healing status, and the level of eventual amputation were recorded. Multivariate logistic regression and Fischer Test were used for analysis. All patients had Diabetes, neuropathy, Charcot Neuroarthropathy, and required osseous reconstruction. Risk factors and their respective odds ratios are as follows: Postoperative non-union [OR 8.5 (95% CI 2.2-33.5), 0.0023]; development of new site of Charcot [OR 8.2 (95% CI 1.1-62.9), 0.0440]; Peripheral arterial disease [OR 4.3 ( 95% CI 1.7-11.0), 0.0020]; renal disease [OR 3.7 (95% CI 1.6-8.8), 0.0025]; postoperative delayed healing [OR 2.6 (95% CI 1.1-6.5), 0.0371]; postoperative osteomyelitis [OR 2.4 (95% CI 1.0-5.9), 0.0473]; elevated HbA1c; [OR 1.2 (95% CI 1.0-1.4), 0.0053]. Independent risk factors found to be statistically significant for major lower extremity amputation in Diabetic Charcot Neuroarthropathy in the setting of osseous reconstruction must be mitigated for long term prevention of major amputations.
Ajay Trivedi is a third year orthopedic resident in NHL Municipal Medical College and Shree Vadilal Sarabhai General Hospital, Ellisbridge, Ahmedabad, Gujarat, India. He is from Ahmedabad and went to Nutan Vidhyavihar Higher secondary school. He has completed MBBS (medicine and surgery bachelor) from B J Medical College, Civil Hospital, Ahmedabad under Gujarat University in the year 2016 and took admission in the aforementioned institute (NHL MMC) for postgraduate degree course of master of surgeon in orthopedics and traumatology
Introduction: Synovial chondromatosis is an uncommon, idiopathic, generally benign condition, mostly monoarticular, most commonly involving the synovial membranes of large joints, most commonly the knee joint, with preponderance in males of 4th to 6th decade. Presence of multiple cartilaginous nodules and loose bodies in the synovium or cavity are characteristic. Histopathology is confirmatory. Removal of loose bodies and complete synovectomy is the mainstay of treatment.
Here we present a case of 38 year old male with swollen stiff right knee joint for 2 years, presenting with sudden locking sensation. After clinical and radiological assessment, diagnostic arthroscopy was planned which was converted into an open synovectomy, in lieu of large loose bodies, histopathological examination of which confirmed the diagnosis.
Conclusion: Primary synovial chondromatosis is an uncommon, highly destructive and aggressive disease. Histopathology is confirmatory. Removal of loose bodies with stripping of and complete excision of the synovium remain the mainstay of treatment.
Aditya Malik is currently working as a Senior Resident in the Department of Orthopaedics at Safdarjung and VMMC hospital, New Delhi. He completed his MBBS and MS in Orthopaedic surgery from Institute of Medical Sciences, Benaras Hindu University (Currently AIIMS BHU). He has other publications to his name along with extensive experience in Trauma surgery. This research was a part of his Thesis for his MS orthopedics
Biofilms are aggregates of microorganisms embedded within the self-produced matrix of extracellular substances. Biofilms are of serious concern especially related to artificial devices. The bacteria in biofilm state become 10 to 100 times more resistant to antibiotics usually due to poor penetration. Orthopedic implants related infections are often associated with biofilm formation and mostly due to Staphylococcus aureus.
Objective: As bacteriophages are known to penetrate the biofilm and are able to lyse the bacteria which are multidrug resistant, in the present study we decided to look into the effect of bacteriophage therapy in vivo on biofilms formed on stainless steel K-wires by methicillin-resistant S. aureus (MRSA).
Subject: For in vivo study, MRSA biofilm containing K-wire were implanted at the proximal end of ulna of both the limbs of 12 rabbits.
Method: While the 6 rabbits of experimental group were given the local injection of the cocktail of 3 different bacteriophages, the 6 rabbits belonging to control group did not receive any kind of therapy. Rabbits of both groups were monitored up to 8 weeks. One K-wire was removed from each limb sequentially with the interval of 1 week and evaluated on the basis of clinical, radiological, microbiological, histopathological examinations.
Results: Control group rabbits usually showed either death or continuation of infection with the presence of biofilm. However, phage therapy group showed cure of the infection as removed k wire were found sterile.
Conclusions: Thus, our findings suggest definite role of bacteriophage therapy in the treatment of the biofilm formed on metal implants by MRSA
Kevin Ragothaman has completed his doctoral degree from Western University of Health Sciences and undergraduate at University of Washington. He is currently a 2nd year resident physician and surgeon at MedStar Washington Hospital Center and Georgetown University Hospital. He has published in reputed journals and has received poster awards from the Diabetic Limb Salvage Conference and the American College of Foot and Ankle Surgeons
Dipendra Pandey is a Connsultant Orthopaedics Surgeon working at government based national Trauma Centre at Kathmandu in Nepal. He completed his MS (Orthopaedics and Traumatology) from National Academy of Medical Sciences, Nepal. He was award with AOA Trauma Fellowship from NITOR, Bangladesh. Besides Trauma, he is much interested in the field of rheumatology and osteoporosis
Introduction: Non operative treatment for middle third clavicle fractures remained mainstay for until last two decades. But due to the prevalence of nonunion, symptomatic malunion and shortening for displaced fractures, trend has shifted towards operative management. Our study is aimed at prospectively evaluating the functional outcome of 120 patients treated with open reduction and plating with precontoured anatomical plate. This study estimates the functional outcome in terms of DASH score.
Methodology: 120 patients from 16 years to 60 years of age, with displaced (>2cm ) and/or shortened (>2cm) or comminuted middle third clavicular fractures were included in this prospective observational study conducted in Bir Hospital and National Trauma Center over four years period. Open reduction and internal fixation with precontoured anatomical plate was done. Postoperatively arm is held in a sling for about 3 weeks with intermittent pendulum exercise after one week or as soon as the pain is tolerable and range of motion started after four weeks of surgery. Patients were followed up on 2, 6, 12 and 24 weeks. Functional outcome was assessed using DASH score. Statistical analysis was done using SPSS 22.
Results: Mid clavicular fractures were more common among males and left side was commoner than right. Younger age group was more commonly affected. All fractures united in a mean radiological union period of 7.1 weeks. 6 cases developed pain, 23 had hardware prominence, 5 case developed superficial infection. DASH score was at significant negligible level by 24 weeks. 98% of patients returned to their work by 12 weeks.
Conclusion: Open reduction and internal fixation with pre-contoured anatomical plate in displaced middle third clavicular fractures is safe procedure that avoids complications associated with non-operative management and provides good functional outcome with early return to pre-injury activities
Jamil M. Al-Jamali, He is a Consultant Plastic surgeon and fellowship training in Craniomaxillofacial surgery Department in Freiburg University medical Centre - Germany, also head of Plastic, Reconstructive, Aesthetic and Hand surgery section in Mediclinic Welcare Hospital - Dubai. He has published several research papers and awarded by several courses and workshops. His Field of interest includes plastic, Reconstructive and Aesthetic Surgery
Decompression of carpal tunnel syndrome can be done by different methods including both open and endoscopic techniques. The endoscopic type of decompression can be used in many cases except those where other pathologies must be excluded or treated at the same time like performing synovectomy or removing other mass that cause median nerve compression. The need for minimal invasive approach is now more requested by the patients specially those need to go back to their jobs and sport activities earlier. Many systems are in the market to perform endoscopic decompression using either one port or two port methods. These need special instrumentations that are expensive and not everyone or every hospital can afford to supply. In this presentation, I will show a very simple way to perform a minimal invasive approach using 2.4 mm endoscope that is used for other purposes like ankle or wrist arthroscopy without the need for any costly systems and with using simple instruments.
Takatomo Mine has received his bachelor degree from Yamaguchi University School of Medicine. He obtained PhD in Medical Science degree at Yamaguchi University School of Medicine. He is currently an Associate Professor in the Department of Orthopedic Surgery, Yamaguchi University. He is the Director of Orthopedic Surgery & Rheumatology at Kanmon Medical Center, Yamaguchi and also a member of various associations: Japanese Orthopedic Association(1985), The Central Japan Association of Orthopedic Surgery & Traumatology(1985), International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine(2014), Japanese Society for Regenerative Medicine(2015), Japanese Society for Cartilage Metabolism(2017) and many other. He has published 35 articles in various International Journals in the field of Orthopedics
Some gait abnormalities persist for a long time after total knee arthroplasty. The goal of this analysis was to assess gait oscillation during gait and stair stepping in patients after TKA. Fifteen patients diagnosed with knee osteoarthritis were treated with unilateral TKA. For prosthesis, we used Bi-surface KU5 with cementation for all. We examined acceleration (anterior, TKA side and contralateral side direction) and gait barycentric factors (single-support phase and ratio of the center of gravity maximum values) between gait and stair stepping. Acceleration to the anterior direction in the sacral region and the dorsal vertebral region increased more at stair-up than at gait or stair-down. There was no significant difference between acceleration to TKA side direction or to contralateral direction at gait and stair-up and down. The single-support phase was close to 1. In comparison with the contralateral side, the load was equal on the TKA side at gait and stair stepping. In addition, it was more obvious during stair stepping than gait. The ratio of the center of gravity maximum values increased more at the sacral region than at the dorsal vertebral region. We considered that gait oscillation was less at the dorsal vertebral region than at the sacral region
Malcolm Hooper is an International Executive Director serving on both the International Hyperbaric Medical Foundation (IHMF) and the International Hyperbaric Medical Association (IHMA). He is a regular speaker at international symposiums on the topic of Hyperbaric Oxygen Therapy applications in the modern era
Malcolm Hooper has over 23 year’s experience in modern applications of Hyperbaric Oxygen Therapy. His patients include the international leadership and life coach Tony Robbins, and many other celebrities. There is a long list of world leading athletes who consult with Mal Hooper, all seeking that extra one per cent in recovery and performance. The majority of elite athletes are in a constant state of burn-out and with a growing ‘injury list’. High end athletes are confronted with a range of metabolic issues due to chronic mental fatigue, metabolic overload and constant international travel. When compared to sea level, international travel exposes the individual to prolonged in-flight “hypoxia” at “lower altitude pressures”. Preparation, performance, recovery, travel ... it’s an endless loop. As tissue Oxygenation diminishes, metabolic burden rises and the range of injuries increase dramatically. Tissues exposed to constant hypoxia and excessive inflammation rapidly become ‘energy poor’ acting like a “mitochondrial handbrake”. Simply stated, you’re done! Improvement requires more than replacing your coach or getting another mind therapist, and there is more to it than simply training harder or taking another supplement. Cytokine gene expression testing is at the forefront of “clinical” sports science. Pro-inflammatory and anti-inflammatory gene expressions are specific to the individual. Cells in a chronic hypoxic state overexpress pro-inflammatory cytokines including IL1, Il6, IL7, IL8, IL17, TNFa, MMP9, S100B. How do these markers affect the athlete? How do you manage an athlete or a “team” in a “cytokine storm”? Hyperbaric Oxygenation is breathing 100 per cent oxygen at pressures greater than normal. But are the benefits of Hyperbaric Oxygen Therapy (HBOT) boasted? What are the real effects impacting recovery and performance? Can HBOT have a ‘negative effect’ on a competing athlete? Are all pressures and protocols the same? What is normobaric oxygen? What is the difference between an “soft inflatable chamber” versus a solid chamber capable of deeper pressures? How does HBOT for an athlete compare to hospital HBOT for complex medical disorders? Typically, we breathe 21 per cent oxygen (or less in larger populated cities). Hyperbaric drives greater levels of enriched oxygen into the blood plasma enabling the correction of local and systemic effects of hypoxia. Hyperbaric acts as a 'catalyst' promoting immune modulation
Margaret Wislowska is the Head of The Department of Internal Medicine and Rheumatology CSK MSW is a specialist in internal medicine, rheumatology, rehabilitation medicine, hypertension, and the author of over 200 scientific papers and books. She has participated in numerous scientific meetings and is a promoter of 14 PhD theses. She took trainings at Guy and St. Thomas’ Hospitals in London, Charity Hospital in Berlin, Rheumatology Institutes in Prague and Moscow. In 2003, she started the Department of Internal Medicine and Rheumatology and in 2010 the Clinic of Internal Medicine and Rheumatology CSK MSW. She is the Professor at the Warsaw Medical University.
Osteoarthritis (OA) which affects the whole joint: articular cartilage, subchondral bone, synovium, tendon and muscle, characterized by degeneration of articular cartilage, synovitis and alterations to peri-articular and subchondral bone. The repairing role is played by IGF-1 and TGF-beta, stimulating the biosynthesis of proteoglycans and collagen, and reducing the number of IL-1 receptors on chondrocytes, and in OA, bone morphogenetic bone protein (BMP)-7 decreased. Administration of BMP-7 to the joints reduces experimental degenerative disease in animals and is currently in human phase I trial. Research is being conducted on the regulation of cytokine production and metalloproteinases (MMPs), involved in the destruction of cartilage, on gene therapy involving the introduction of genes encoding proteins that improve cartilage synthesis into joints. Sprifermin (recombinant human fibroblast growth factor 18) is under development for the treatment of OA. Tanezumab is a monoclonal antibody against nerve growth factor; this drug is effective at relieving pain and improving function in OA patients. Beside analgetics and NSAIDs current concepts in pharmacological treatment of OA are follows: inducible nitric oxide synthase (iNOS) inhibitors, MMP inhibitors, proinflammatory cytokine blockers, regulators of apoptosis, regulators of mitochondrial function, nutraceuticals and herbal medicine. Techniques that cause multipotent adult mesenchymal stem cells (MSCs) to differentiate into cells of the chondrogenic lineage have led to experimental strategies to investigate whether MSCs instead of chondrocytes can be used for the regeneration of articular cartilage. These strategies include use of MSCs as progenitor cells to engineer cartilage implants that can be used to repair chondral and osteochondral lesions. MSCs could be used as producers of bioactive factors to initiate endogenous regenerative activities in the OA joint. Their activities might be further enhanced via targeted gene therapy. Delivery of MSCs might be achieved either by direct intra-articular injection or by implantation of engineered constructs derived from MSC-seeded scaffolds.
The human hand is a very important member in our daily life, it is necessary in any activity. However, loss as a result of trauma, accident or other cause can have a detrimental effect on the individual's personal, social, psychological and economic life. Therefore, the establishment of a robotic device to restore the important functions in the simulation of the functions of a biological standard is of interest. We have the honor to present a robotic device, which served to the patients, who lost upper limb, to have a bionic hand under the vocal or myo-electrical command, and which can reproduce the movements elementals of a biological hand. During the design and manufacture of the equipment, we tried to respect the biomechanical rules of the physiological principle. We will present the different stages of realization and manufacture of this robotic device, as well as a demonstration. The manufacture of the equipment passes through the main stages:
1. 3D modeling: it is the geometric design of all the pieces on a computer, but also to export these pieces in the form of a file accessible at any time.
2. 3D printing: it consists of converting a virtual computer file into a real object, via a 3D printer. All the printed parts are brought together to form all the equipment. 3. Motorization and implementation of the electronic circuit: we installed servo-engines (one responsible for the pronation / supination of the forearm and 5 for the mobilization of the fingers). These servo motors are connected to an electronic card with a programmable microprocessor. Amputation is a big problem; this bionic hand is an ultimate solution for these patients and allows them to recover their hand functions.
Intravesical bacillus Calmette-Guerin (BCG) instillation is a commonly used treatment for urothelial bladder carcinoma. Soft tissue manifestation of Mycobacterium tuberculosis (M. tuberculosis) following administration of BCG is exceedingly rare. Few cases of periprosthetic M. tuberculosis infections have been reported, however they have been isolated to the hip and knee. This case study presents a well-healed total ankle arthroplasty subsequently infected with M. tuberculosis resulting in a non-salvageable limb. It is important to also be cognizant of the treatment algorithm for infected total arthroplasties as there is some debate in the current literature as to when to explant the hardware. Here we will clearly define our treatment procedure to give insight on the future of management of infected arthroplasties
Gaurav Kumar Maddheshiya has completed DNB Orthopedic Surgery and he is a specialist in Orthopedic Field in the institution of National institute of medical science, Jaipur. He has been awarded and certified by different National and International journals. His field of interest includes Pain Management and fluid therapy
Burst fractures accounting for greater than 50% of all thoracolumbar trauma1. SSPF (Short Segment Pedicular Screw Fixation) is standard Method. Failure of SSPF can be attributed to inadequate fixation points on the vertebrae and insufficient anterior column support 2. In this study, we propose SSPF using longest possible screws in both pedicle of fractured vertebra. A long pedical screw in bilateral fractured vertebrae supports subcondral bone, superior endplate and allows more correction by cantilever forces created by distraction maneuver. This three point fixation which also prevents long term collapse and loss of kyphosis.
Methodology: Pedicle screws were placed at one level above and below the fracture site. Fracture level screws were inserted at the same time with the other screws prior to compression/distraction, and were included into the lording distracting maneuver. Both the fractured pedicels were inserted and care is taken to insert longest possible screws so that they can support subchondral bone and superior end plate of fractured vertebrae. Kyphosis correction achieved by cantilever forces created by distraction and compression maneuver. Visualization Laminectomy performed for confirmation of indirect decompression achieved by distraction maneuver when indicated by the presence of compression over neural tissue in MRI. No Fusion was performed in all.
Kevin Ragothaman has completed his doctoral degree from Western University of Health Sciences and undergraduate at University of Washington. He is currently a 2nd year resident physician and surgeon at MedStar Washington Hospital Center and Georgetown University Hospital. He has published in reputed journals and has received poster awards from the Diabetic Limb Salvage Conference and the American College of Foot and Ankle Surgeons.
This is a case report of a 31 year old healthy male who presented to the trauma bay 2 hours after suffering lawn mower injury from the hallux to the medial cuneiform, resulting in laceration and open fracture. Cefazolin and tetanus ppd were administered upon arrival. Wound was irrigated with betadine-saline lavage upon arrival. Gentamicin and Penicillin G were administered within 1 hour. Neurovascular status and motor function were intact. Operative debridement and irrigation with 9L of saline were performed, along with screw fixation of the medial cuneiform fracture, excision of loose bone from the lateral distal phalanx, primary closure, and external fixation. The patient was discharged in 5 days with neurovascular status intact and no sign of infection. An epidemiologic study in the United States revealed that, of the diagnoses related to lawnmower injuries, 34.4% were fracture of phalanges, while 32.4% were traumatic amputation of toe (1). Prompt administration of intravenous antibiotics and surgical debridement with atraumatic technique is paramount to achieving a good outcome in these complex wounds. Primary closure of these wounds is controversial. A retrospective study of 8 lawn mower injuries to the foot that required surgical debridement has demonstrated the efficacy of primary closure, showing good functional outcome and no readmissions for further surgery (2). We investigate the use of primary closure with external fixation of pedal open fracture from lawn mower injury
The availability of viable soft tissue for skin coverage following a midfoot amputation from a polymicrobial infection often impedes the surgeon’s preference for primary closure. A drainage amputation with loss of viable tissue in the setting of polymicrobial infections tends to be the accepted procedure. This case reports describe a 57year-old woman who was originally scheduled for an elective outpatient procedure but upon arrival, was noted to have an ulcer that required subsequent debridement. The following day, the patient was noted to have gas gangrene in the plantar forefoot that ultimately led to a partial midfoot amputation. The preservation of viable soft tissue and bone at the initial amputation led to a successful skin closure that otherwise would have required wound vac therapy and graft application. In the setting of staged procedures for lower extremity amputations the authors have found that preserving all viable soft tissue and bone at the first operative room visit can lead to more successful limb salvage outcomes.
Ajay Trivedi is a third year orthopedic resident in NHL Municipal Medical College and Shree Vadilal Sarabhai General Hospital, Ellisbridge, Ahmedabad, Gujarat, India. He is from Ahmedabad and went to Nutan Vidhyavihar Higher secondary school. He has completed my graduation MBBS (medicine and surgery bachelor) from B J Medical College, Civil Hospital, Ahmedabad under Gujarat University in the year 2016 and took admission in the aforementioned institute (NHL MMC) for postgraduate degree course of master of surgeon in orthopedics and traumatology. He will be completing my masters by May-2019.
Peroneus brevis tendon tears are frequently overlooked or misdiagnosed. Longitudinal tears, often associated with ankle sprains are mostly situated the level of distal fibula. The most reliable diagnostic sign is persistent swelling & tenderness along the peroneal tendon sheath.. The pathophysiological mechanism is subluxation of tendon over the posterolateral edge of fibula, which produces multiple longitudinal splits. Treatment is primarily surgical & must address both split tendon & the subluxation that caused it. Debridement & repair are recommended for grade I tears, which have damage less than 50% of the cross sectional area. Excision of the damaged segment & tenodesis to peroneus longus are recommended for grade II tears, which have destruction of more than50% of the cross sectional area. Both the methods must be augmented by stabilization of etiological subluxation. We here present a case of 38 years old female with gradual onset, poorly localized pain behind left ankle which was radiologically suggestive of split Peroneus brevis tendon in retromalleolar groove & was confirmed intraoperatively, leading to release of inflammed tendon sheath, ethibond repair of tendon split & removal of a soft tissue mass attached to the tendon sheath beneath the retromalleolar groove, which was found out histopathologically to be fibrocollagenous & hyalinised tendon tissue with adipose tissue, with possibility of lipoma arborescence couldn’t be ruled out. On follow up after 2 months, patient did not have pain & full range of movements.