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Professor Gavriil Abramovich Ilizarov was born on June 15, 1921 in the town of Bialowiez in the Bialystok Voivodeship of the Polish Republic. Gavriil was able to go to school only at the age of 11, but his level of education allowed him to pass the exams for the elementary grades, and he was enrolled immediately in the fourth grade. He graduated from the eight-year school with excellent marks and in 1938 continued his studies at the medical faculty in the city of Buinaksk, Dagestan ASSR. In 1939, Gavriil Abramovich entered the Crimean State Medical Institute, after graduating from which in 1944 he worked as a doctor in Polovinskaya and then Kosulinskaya district hospitals of the Kurgan region. At this time, Ilizarov came up with a brilliant idea for the treatment of complex fractures of long tubular bones with the fixation of their fragments with a special metal controlled device instead of blind and static plaster immobilization. In 1955, G. A. Ilizarov was appointed head of the Traumatological and Orthopedic department of the Kurgan Regional Hospital for the Disabled of the Great Patriotic War, where he began to apply his invention. The first official scientific recognition of G. A. Ilizarov received his dissertation «Transosseous compression osteosynthesis by the author’s apparatus (experimental and clinical study)» in September 1968 in Perm. In 1966, on the basis of the 2nd city hospital of Kurgan, the problem laboratory of the Sverdlovsk Research Institute of Traumatology and Orthopedics was organized, the head of which was Gavriil Abramovich, and in 1969 the laboratory was transformed into a branch of the Leningrad Research Institute of Traumatology and Orthopedics named after R. L. Vreden and its director was appointed G. A. Ilizarov. Since 1982, the triumphant introduction of the Ilizarov method into the practice of leading foreign countries began, and the press gave the author the enthusiastic title of «Michelangelo in orthopedics». Gavriil Abramovich successfully engaged in public activities, was elected deputy of the district and regional Councils of Workers‘ Deputies, deputy of the Supreme Soviet of the RSFSR, People’s Deputy of the USSR. For his great achievements in medical science and outstanding services to the national and world health care, G. A. Ilizarov was awarded the highest state awards, academic and honorary titles of the USSR and many foreign countries. Academician Gavriil Abramovich Ilizarov died suddenly of heart failure on July 24, 1992 in Kurgan and was buried in the central alley of the new Riabkovskое cemetery in Kurgan.

Aim: This study aimed to know the prescribing pattern of baclofen in the outpatient setting in Al-Kharj. Methodology: This retrospective study was conducted to know the prescribing pattern of baclofen in the outpatient setting in Al-Kharj in 2018. The data were collected and analyzed using Excel and represented as frequencies and percentages. Results: From January to June 2018, about 30.43% of the prescriptions were prescribed by orthopedic department, 28.99% were prescribed by emergency department and about 78.26% of the prescriptions were prescribed by residents. More than 76% of the prescriptions were prescribed by residents in the second phase of the study between July/2018 to December/2018. Moreover, about 40.71% of the prescriptions were prescribed by emergency department and about 26.43% were prescribed by orthopedic department. Conclusion: Baclofen use is uncommon in our regionin contrast to the global increase in the use of baclofen. It is important to increase the awareness of health care providers about the appropriate use of baclofen and they should educate the patients about its correct use.

Leprosy, commonly known as Hansen's disease, is a chronic infectious illness caused by the bacteria Myobacterium leprae. The presence of the musculoskeletal system is the third most common symptom. Acute onset of arthritis is documented secondary to Hansen’s disease. Septic arthritis is a joint infection that causes excruciating pain, it typically manifests as a single hot, swollen, and extremely painful joint. The main aim of physical therapy is to recover from functional impairment as a result of Hansen's disease and to tailor lifestyle changes to help the patient regain functional independence. In this case study, updated physiotherapy rehabilitation of septic arthritis following borderline Tuberculoid Hansen's disease has been demonstrated to be important in restoring range of motion (ROM), muscular strength, and pain alleviation. A male with 46 year of age presented to the orthopedic department with the symptoms of pain and swelling of the knee of the right side since 1 month without any history of fall or twisting injury. He was advised for the investigations of x-ray and MRI and arthrocentesis of right knee was done during which pus was found and aspirated. He was diagnosed with septic arthritis of right knee joint. Patient was operated with diagnostic arthroscopy of right knee where debridement was done. Patient then was referred to physiotherapy department with the complaints of pain and stiffness over right knee joint, with restricted range of motion. He was known case of Hansen’s disease. He was started with physiotherapy rehabilitation protocol for 6 weeks where cryotherapy, TENS, passive ROM, active assisted and active ROM exercises were given. Focus was also made on improving strength. In this case study physiotherapy rehabilitation protocol used had significantly reduce the pain, increased ROM, muscle strength and endurance which considerably help the patient in restoring his functional independence at home and work place.

Background: All femoral or tibial fractures regardless of associated injuries, intramedullary nailing (IMN) has its more advantages in rapid rehabilitation, good effects on the child and his family and strong fixation. Objective: To assess the role of elastic stable IMN in union of diaphyseal fractures of long bones in children. Patients and Methods: A prospective and retrospective analytical study on ten children with isolated femoral or tibial fractures who were admitted to Orthopedic Department, Zagazig University Hospitals. They were divided equally into group I that included 5 patients with femoral shaft fracture managed with IMN and group II, which included 5 patients with tibial shaft fracture managed with IMN. Their mean age was 4.7 years old. Results: When the groups compared, the spica cast group was found to have a shorter duration of hospital stay compared to elastic nail group. The knee range of motion of the spica cast group was found to be better compared to the elastic nailing group. The elastic nailing group was found to have started walking earlier both with and without support. Patients with intramedullary nailing started to walk with aid after one month and independently after 2 weeks. Patients with spica cast started to walk with aid after 2 months and independently after 12 weeks. Conclusion: None of the available treatment tools to fix diaphyseal long bones fractures in preschool children is perfect because each method has its own set of complications. However, constitute the motive for developing new techniques or changing the design of currently available devices.

Background: The paradigm of revision surgery has been evolving constantly. There is a wide range of surgical options for successful reconstruction. Objective: This study aimed to evaluate the results of reconstruction techniques in acetabular deficiency. Patients and methods: A prospective interventional designincluded patients with acetabular deficiency who were admitted to Orthopedic Department at Zagazig University Hospitals. We had 10 patients with acetabular deficiency (Three were classified as Paprosky IIIA; one of them was AAOS IIB and two were AAOS III, Two were classified as Paprosky IIIB and AAOS III, Two were classified as Paprosky IIA and AAOS IIA; one was Paprosoky IIB and AAOS IIB and Two patients were classified as Paprosky IIC; one of them was AAOS IIB and the other was AAOS III). The evaluation and follow up of patients depended mainly on the Harris hip score, which evaluates the patient clinically preoperatively and postoperatively. Results: All the patients reached full weight bearing between 7 and 9 weeks after surgery. Revision total hip replacement (THR) was the treatment of choice for patients with severe groin pain and apparent acetabular deficiency. Restoration of the normal center of rotation was essential for the joint biomechanics and survival of the prosthesis. Conclusion: There was no method of reconstruction of acetabulum superior to another method; each method had specific indication, which differs according to the percentage of acetabular coverage and bone stock. Patients with mild to moderate acetabular deficiency (Paprosky I, IIA and IIB) were managed by using acetabular augmentation graft or small acetabular component with medialization. Keywords

Objectives: The aim of this study was to provide the pattern of orthopedic trauma catered at our center during the lockdown to stop the spread of SARS-CoV-2 and compare it during the same period in the preceding year. Methods: A retrospective study of all trauma patients operated during partial and total lockdown during March– July 2020, was conducted at the orthopedic department of King Fahd Hospital of the University, Al-Khobar. The data collected were age, gender, reason for hospital admission, date of injury and presentation, length of stay, and treatment provided. The exposure and transmission of the COVID-19 to healthy orthopedic staff were recorded. Results: During the lockdown, there were 71 admissions compared to 110 the year before, with a drop of 39 (35.4%) patients. The drop in the number of women and children was statistically significant (P < 0.05 and < 0.001, respectively). The majority of injuries were sustained from domestic accidents and road crashes. There was a significant increase in fractures of the vertebral column and distal radius (P < 0.002 and < 0.05, respectively). In the pre-COVID-19 period, the average time to discharge was 18.90 ± 12.74 days and the average time to discharge in COVID-19 period was 4.28 ± 3.52 days. Four orthopedic staffs were exposed to COVID-19-positive patients and one of the surgeons became positive. Conclusion: The COVID-19 pandemic decreased orthopedic trauma admissions by 35% during the lockdown period and early surgery and discharge of the patients was possible due to proper planning.

Objectives: Clubfoot is a burden affecting 150,000 newborns worldwide every year. This study looked at the prevalence of clubfoot at King Saud Medical City (KSMC) and examined the risk factors associated with clubfoot in Saudi Arabia. Methods: Data were collected through the medical system (Medisys) and the database of the orthopedic department intern at KSMC to determine the prevalence of clubfoot using the births recorded from 2015 to 2019 and reviewing their medical files. The epidemiological description of Saudi clubfoot patients was attained by collecting a sample of 100 patients from the clubfoot clinic database. Results: A total of 18,515 births at KSMC from 2015 to 2019 were evaluated. It was found that 42 patients were affected by clubfoot resulting in a birth prevalence of 2.3/1000 (0.23%) among Saudis at KSMC. Out of 100 clubfoot patients, 93% had no maternal history of chronic disease, while 31% of the cases were a product of consanguineous marriages. About 15% of the patients had an associated developmental dysplasia of the hip. Conclusion: This study estimates the prevalence of clubfoot in one major medical center in Saudi Arabia to be 2.3/1000. The findings support the data reported in the literature that males are more affected by clubfoot than females, with twice the likelihood that males will be affected by clubfoot. This study will provide an initial look at clubfoot in Saudi Arabia, which can build a base for future studies.

Objective: To determine the incidence of surgical site infection among patients with hip fracture and undergo a surgical procedure for management. And to spotlight on the risk factors which may lead to surgical site infection among them. Also, to look for other complications following the surgery. Methods: This is a descriptive, correlational cross-sectional study design. The study was conducted at Orthopedic Department, Mohammad Medical College and Hospital Mirpurkhas, Pakistan for one-year duration from March 2019 to March 2020. All patients had hip fracture and received management at the department of orthopedic. All patients were adults and older than 20 years of age. Data was analyzed using SPSS program. Results: The study included 103 patients who had hip fractures. The most frequent age group was 40-50 years. Patients had a mix of modifiable and non-modifiable risk factors for developing surgical site infection. The incidence rate of surgical site infection in this study was 3.2%. It was correlated to having hypertension and diabetes as complications. Conclusion: This study aimed to spotlight on the SSI following hip surgeries and to look for complications and risk factors. We noticed that the SSI rate among the study populations is almost similar as the worldwide range. This is due to the agreed protocol for managing patients. However, there is a need for log-term follow up for our patient to discover the cases of delayed SSI.

Objective: To evaluate the functional and radiological outcome of the distal femur fracture treated with a retrograde locking nail. Methods: This is a descriptive study conducted at the Orthopedic department Dibba Hospital Fujairah, United Arab Emirates for one-year duration from March 2019 to March 2020. All patients who met the inclusion criteria were treated with femoral retrograde nailing technique. The postoperative functional score was assessed according to Schatzker and Lambert criteria, which were rated excellent, good, and poor. Radiological union was assessed by X-rays. Results: There were 103 patients with a mean age of 35.20 ± 10.66 (range, 20 to 50 years). There were 78 men (75.72%) and 25 women (24.27%). Most of the fractures (68.9%, n = 71) were caused by car accidents. Fracture of the right side occurred in 70 (67.96%) patients, and the left side fracture in 33 (32.03%) patients. Excellent results were obtained in 75 (72.81%) patients and good results were obtained in 28 patients (28.20%). The nonunion has been documented in one patient. Conclusion: Excellent and good functional and radiological results were obtained in patients with distal femur treated with retrograde locking nails. For some distal femoral fractures, we recommend the use of a retrograde locking nail.

Background: Diaphyseal fractures of the femur (DFF) are common long-bone injuries in children and adolescents. DFF represent 1.5% of fractures in childhood. Objective: This study aimed to evaluate the clinical, functional and radiological outcome of femoral shaft fractures, which are managed by elastic stable intramedullary nailing (ESIN) in pediatric age 6-10 years. Patients and Methods: A prospective clinical randomized trial study was conducted on18 children underwent elastic stable intramedullary nailing (ESIN) for treating femoral shaft fractures at Orthopedic department, Zagazig University Hospitals during the period from April to December 2020. Plain X- rays of the femur Antero-posterior (AP) & Lateral (Lat.) views (from hip to the knee joint) was taken. Results: The time to surgery was 1.39 ± 1.12 days ranging from 1 to 6 days, the time till full union was 9.4 ± 1.76 weeks ranging from 7 to 12 weeks, more than half of the studied group (55.5%) ranged from 7 to 9 weeks and the time of full weight bearing was 9.6 ± 1.7 weeks ranging from 7 to 12 weeks, half of the studied group (50.0%) ranged from 7 to 9 weeks. So, the final outcome was 83.3% had excellent functional outcome, 11.1% of them had satisfactory functional outcome and 5.6% had poor functional outcome. 88.8% didn’t have any complications, 5.6% of them had irritation and 5.6% had superficial infection. Conclusion: ESIN is the choice treatment for transverse and short oblique shaft fractures in patients aging from 6 to 10 years old.

Background Authorship trends in medical journals were studied in many disciplines, mostly in western countries' journals. We aimed at studying the authorship trends in the Egyptian Orthopaedic Journal as an example of a specialized Egyptian medical journal. Results A total of 397 articles were eligible for analysis. The mean number of authors per article was 2 ± 1 (range from 1 to 6), 161 (40.6%) articles were single authorship. The degree of the first author was reported in 305 (76.6%), the first author carried an M.D. degree in 302 (99%) articles, and in three (1%), the first author carried a master’s degree. No authors with a bachelor's degree were reported. Forty-two institutions contributed to the publications, 14 (33.3%) international and 28 (66.7%) Egyptian national institutions. In 368 (92.7%) articles, all the authors were from the same institution, and 29 (7.3%) articles were published as a cooperation between different institutions with a mean 1.1 ± 0.3 institution per article. International contribution to the journal was found in 21 (5.3%) articles. The orthopedic department from Cairo university was the most contributing department to the journal publications. Conclusions The old trend of single authorship prevails in the journal publications with a notable deficiency in young researchers’ contribution to the journal and low incidence of international contribution and poor national institution cooperation.

Background The purpose of this study is to describe a Level 1 Trauma Center’s orthopedic response to the COVID-19 pandemic, and to compare outcomes of acute fracture patients pre-COVID versus during the COVID-19 pandemic. Methods All inpatient fracture cases performed over a 5-month period were identified and retrospective chart review performed. Patients were divided into pre- and COVID-era groups based on when surgery was performed relative to March 16, 2020 (the date elective operations were ceased), and groups were statistically compared. Patients with a COVID test result were further sub-divided into COVID negative and positive groups, and statistically compared. Statistical analysis was performed using independent t-test for continuous variables and chi-square analysis for categorical variables. Results One hundred and nineteen patients were identified, 38% females with average age of 58 years. Average length of stay was 7 days with average time from injury to surgery of 3 days and average time from admission to surgery of 1.3 days. Overall in-hospital complication rate was 29.4%, and 30-day mortality and readmission rates were 2.5% and 5%, respectively. Sixty-nine patients comprised the pre-COVID group, and 50 in the COVID-era group. There was no significant difference with respect to length of stay, time from injury to surgery, time from admission to surgery, need for post-operative ICU stay, in-hospital complication rate, 30-day mortality rate and 30-day readmission rate. Thirty-four patients had COVID testing, with 24 negative and 10 positive. COVID-positive patients had longer time from injury to surgery (8.5 days vs. 2 days, p = 0.003) and longer time from admission to surgery (2.7 days vs. 1.2 days, p = 0.034). While more COVID-positive patients required ICU admission post-operatively (60% vs. 21%, p = 0.036), there was no difference in overall complication rate. Conclusions Orthopedic care of acute fracture patients was not affected by a global pandemic. The response of our Level 1 Trauma Center’s orthopedic department can guide other hospitals if and when new surges in COVID cases arise, in order to prevent compromising appropriate orthopedic care. Level of evidence Prognostic III.

A 66-year-old female patient was admitted to the orthopedic department due to a left femoral neck fracture. She received perioperative oral management prior to femoral head replacement. Laboratory blood tests indicated an elevated D-dimer level, which suggested the presence of a venous malformation. Computed tomography, magnetic resonance imaging, and short TI inversion recovery indicated the presence of multiple phleboliths medial to the right mandibular ramus. No swelling, redness, or salivary colic pain was observed. Owing to the absence of clinical symptoms, the patient elected to undergo observation of the lesion, as opposed to surgical treatment.

Introduction The diagnosis of Acute lymphoblastic leukemia (ALL) is delayed due to vague presentation and normal hematological investigations. Objective The objectives were to identify the frequency of ALL cases presented to the orthopedic department and with normal hematological investigations. Material and methods 250 consecutive ALL cases were retrospectively evaluated to identify cases with musculoskeletal manifestations, and laboratory investigations. Results Twenty-two patients (4- vertebral compression fractures, 12- joint pain, 6- bone pain), presented primarily to the orthopedic department. Six patients had a normal peripheral smear. Conclusion The primary physician should maintain a high index of suspicion despite a normal peripheral smear.

Ollier disease is a rare congenital disease in which multiple enchondromas occur. The tumors can transform to malignant chondrosarcomas of various histologic grades. The patient we described has been treated in our orthopedic department six times, always being referred on account of new lesions. The tumors were excised with margins of healthy tissue. Each tumor was subjected to a histological examination to determine its type and grade. Chondroid tumors should be diagnosed carefully, because the treatment depends on their histologic features. If surgery is performed, removal of the tumor with a margin of healthy tissue is crucial for the patient’s well-being and good prognosis.

Most studies on acute Achilles tendon rupture (AATR) and its treatment contain only a small number of patients, and due to selection criteria, older patients and those with comorbidities are typically excluded. Therefore, little is known about true complication rates in an unselected population reflecting the situation in an ordinary orthopedic department. Patient files of 639 consecutive Achilles tendon repairs in 631 patients with AATR between February 1998 and December 2005 were reviewed, and all complications from the day of surgery until December 2011 were identified using the hospital’s patient records and the Swedish national registry. Twenty-five (3.9%) re-operations were done, out of which 22 were due to a re-rupture. Fifty-one (8.6%) cases were of deep vein thrombosis (DVT), no difference between patients given versus patients not given thromboprophylaxis. Nineteen (3.0%) cases were of surgical site infection (SSI), all of which resolved upon oral antibiotics. Surgical repair of acute Achilles tendon rupture was associated with a low risk for re-operations, but the risk for deep vein thrombosis was considerable, despite the use of prophylaxis.

Background: The external fixation device had been the gold standard for treatment of many types of fractures that cannot be treated by traction or cast. Orthopedic nurses increasingly play integral roles in all aspects of orthopedic care. The study aimed to assess nurses' performance regarding orthopedic patients with external fixation at Zagazig University Hospital. Research design: A descriptive design was used. Tools of data collection: A self-administered questionnaire and observational checklist were used to collect data. Study subjects: convenient sample of 55 nurses working at orthopedic department at Zagazig university hospitals. Results: Studied nurses’ age ranged between 28 - 58 years and all of studied nurses were females. The majority of studied nurses had a diploma degree in nursing science and hadn’t attended previous training about caring of the orthopedic patient with external fixation. About three quarter of studied nurses had unsatisfactory total knowledge and Almost half of studied nurses had inadequate total practice regarding care of patient with external fixation. The majority of the studied nurses’ performance was affected by environmental factors. A statistically significant relation was found between factors affecting nurses’ performance and their demographic characteristics at nursing qualification. Also there was a statistical relation between nurses’ total knowledge regarding external fixation and nurses total practice at care of patients’ positioning. Conclusion: Nurses had unsatisfactory level of knowledge and inadequate practice regarding care of orthopedic patient with external fixation and nurses reported that their performance was affected by environmental occupational, administrative, and psychological factors. Recommendation: Educational programs should be held periodically for such group of nurses to provide clear idea about the proper care of patient with external fixation, external fixation complications, pin site care, dressing and the factors affecting these performance.

Background: Pulmonary embolism is the third commonest cause of cardiovascular death after coronary artery disease and stroke .Preventing thrombus formation is a major nursing role. Therefore, the best management of pulmonary embolism is through prevention of risk factors. Aim: Assess nurses' performance regarding preventive measures of pulmonary embolism. Subjects and Method: A descriptive research design was used. Setting: The study was conducted in surgical department, orthopedic department and intensive care unit at Port-Said general hospital, Port-Fouad general hospital, and Elzohour hospital. Subjects: A convenient sample of 90 nurses were participate in the study Tools: Data were collected using three tools, Nurses' Knowledge questionnaire, observational check list for nurses' practice and Nurses 'attitude scale. Results: The result of study indicated that 71.1% of studied nurses had unsatisfactory knowledge, 62.2% had unsatisfactory practice and 74.4% had positive attitude regarding preventive measures of pulmonary embolism Conclusion:. The studied nurses had unsatisfactory level of knowledge and practice, but, remarkable positive attitude was observed regard the preventative measures of pulmonary embolism. Also there was statistical significant correlation between nurses' knowledge and practice .Recommendations: There are obvious needs for conducted an in service educational and training programs to improve nurses' performance regarding preventive measures of pulmonary embolism.

Background and objective: Patients affected by fibular hemimelia primarily presented clinically as foot deformities and limb length discrepancies. Surgical restoration of normal limb alignment and length has been reached by using Ilizarov technique. This study aimed to determine the outcome of using Ilizarov procedure in the management of lower limb discrepancy cases in Erbil. Methods: This study is a review of fibular hemimelia cases managed at the orthopedic department of Erbil Teaching Hospital between November 2014 and June 2018. Fibular hemimelia patients complaining from lower limb shortening of 3–11 cm were included in this study. All patients were examined pre and post application of Ilizarov procedure to determine the range of lower limb motion by using the lower extremity functional scale. Ilizarov operative technique was used for the correction of deformities and restoration of normal limb length and alignment. Results: Eight fibular hemimelia patients, including three males, were enrolled in the study with a mean (±SD) age of 7.37 ± 4.13 years (range from 3 to 16 years). They had a mean limb shortening of 6.06 ± 2.36 cm. A wide range of residual deformities and congenital anomalies was reported among fibular hemimelia cases. A number of residual deformities and complications were associated with Ilizarov technique affecting the knee joint, proximal tibia, and ankle joint. Improvement in the lower extremity functional scale from quite a bit and moderate difficulty to a little bit of difficulty (P

CONTEXT. Estimation of osteoporotic hip fracture incidence and Romanian FRAX model were based on nationally reported hospital ICD 10 coding admissions of all hip fractures (without a validation process). OBJECTIVE. We aimed to calculate, based on individual hospital charts analysis, the incidence of osteoporotic hip fracture in the main urban area of Romania and compare it with data reported to the National Institute of Public Health (NIPH). DESIGN. We retrospectively analyzed the charts of all patients (>40 years old) admitted for hip fracture in a 12-month period in hospitals with an Orthopedic Department in Bucharest and surrounding Ilfov County (11.8% of Romania population). SUBJECTS AND METHODS. All ICD 10 fracture and event/fall codes were validated against the charts. We calculated the age and sex adjusted incidence of osteoporotic hip fracture and used the national reported hip fracture data base for comparison. RESULTS. There were 2203 hip fractures of which 1997 (90.65%) were fragility fractures. The crude incidence of low-energy hip fractures was 171/100,000 (225/100,000 in women, 103/100,000 in men). The incidence rose with age to a maximum rate of 1902/100,000 in women >85 years. The NIPH-reported incidence of hip fracture was 181/100,000 for the region of interest and 176/100,000 at the national level. CONCLUSION. The incidence of osteoporotic hip fracture was lower than the incidence based on hip fractures reported codes in the national database, but the incidence of fragility fractures calculated by our group was higher than the incidence reported in previous national studies. Nationwide studies are warranted.

Background: The clinical use of ankle arthroscopy for diagnosis and treatment of foot and ankle disorders has increased over the last few decades, it may seem novel to those unfamiliar to this technique. The recent advances in the equipment as well as sound knowledge of the anatomy of the portals required for safe scope insertion have made a possible number of diagnostic and therapeutic procedures. Aim: to give a good, efficient and radical minimal invasive solution to the chronic post traumatic ankle pain, Also we can perform an arthroscopic assisted ankle arthrodesis. Methods: This study was conducted on 25 patients with post traumatic ankle pain. They were being collected from the orthopedic department of Benha University and orthopedic department of Railway hospital. Results: Majority of cases were males by 72%, Mean ± SD of age was 37.52 ± 11.87 and majority of cases had right side lesion by 72%. There was highly statistically significant difference between preoperative and postoperative regarding diagnosis score with better score postoperative. 80% of cases had no complications, 4% had Subchonfrs sclerosis, 4% had RSD well early, and 4% had Fair mild pain + mild swelling. Conclusion: Arthroscopic management of post-traumatic ankle pain was indicated if the history and clinical examination are suggestive, arthroscopy proved to be effective for confirming the diagnosis and for treatment.

Background: Researchers studying parent-adolescent relationships are increasingly investigating the significance of parenting influencing adolescent development and how experiences in the family and other contexts interact with genetic factors to influence behavioral and developmental outcomes. Methods: The study was conducted on two samples. The first (the control sample) consisted of 50 adolescents from the admitted cases in the orthopedic department at Al-Hussein University Hospital and Sayed Galal University Hospital Cairo, Egypt. Their ages ranged from 12 to 18 years. They were subject to the conditions of inclusion in the sample. And the second (cases) consists of 50 adolescents who suffer from conduct disorder according to DSM5 (Diagnostic and Statistical Manual of Mental Disorders 5th Edition) and Mini International Neuropsychiatric Interview (MINI) Kid. Results: By conducting more statistical analyses on the questionnaire results, We note that there are statistically significant differences between the conduct disorder variable and the types of domestic violence (physical - verbal - social - economic - the threat of violence) for all members of the sample. The results showed statistically significant between the conduct disorder variable and the total degree of domestic violence among all sample members. Conclusion: Adolescents are exposed to all typed domestic violence (physical, verbal, social, economic, the threat of violence), and there are statically significant results between the conduct disorder and domestic violence.

Genu varum of the knee is a predisposing factor for osteoarthritis of the medial femoro-tibial compartment. High tibial osteotomy is the surgery of choice for such patients. Patello-femoral abnormalities have a negative effect on the prognosis of high tibial osteotomy. The aim of this study is to assess the changes in patellar height after medial open wedge high tibial osteotomy.Our study was performed in kafr el sheikh university hospital, orthopedic department during the period 2018-2019 on 30 patients.All patients were subjected to thorough clinical and radiological examination and follow up of all patients with Modified Hospital for Special Surgery knee scoring scale (modified HSS), was utilized and compared with its pre-operative valuesThere was significant decrease of patellar height from preoperatively postoperatively; this difference was statistically highly significant.The conclusion was that the High tibial osteotomy using the medial opening wedge technique causes reduction in patellar height due to relative joint line elevation and obliquity and it may be almost inevitable after this type of osteotomy.

Background: Lateral humeral condyle fracture is the second most common intra-articular fracture in pediatric elbow. Objectives: The present study aimed to analyze the differences between X-ray and magnetic resonance imaging (MRI) in the evaluation of the stability of pediatric lateral humeral condyle fracture and the degree of fracture displacement. Methods: A total of 78 patients with acute elbow trauma were selected and hospitalized in our orthopedic department from July 2018-July 2019. All patients were examined with X-ray and MRI. The sensitivity and specificity of X-ray and MRI in the diagnosis of lateral humeral condyle fracture and the integrity of the trochlear cartilage chain fracture were calculated. The X-ray and MRI were examined respectively to check the value of lateral and posterior fracture space of lateral humeral condyle fracture. Results: Callus repair was observed according to the observation of fracture line during operation or the follow-up imaging examination of conservative treatment. It was confirmed that out of 78 patients with elbow joint trauma, 72 cases were diagnosed with the fracture of lateral condyle of humerus, and the other 6 patients were cured without fracture signs. The sensitivity of MRI in the diagnosis of pediatric lateral condylar fracture was 100%, which was significantly higher than that of X-ray (88.89%) (P

As the world grapples with the COVID-19 pandemic, we as health care professionals thrive to continue to help our patients, and as orthopedic surgeons, this goal is ever more challenging. As part of a major academic tertiary medical center in New York City, the orthopedic department at New York University (NYU) Langone Health has evolved and adapted to meet the challenges of the COVID pandemic. In our report, we will detail the different aspects and actions taken by NYU Langone Health as well as NYU Langone Orthopedic Hospital and the orthopedic department in particular. Among the steps taken, the department has reconfigured its staff's assignments to help both with the institution's efforts and our patients' needs from reassigning operating room nurses to medical COVID floors to having attending surgeons cover urgent care locations. We have reorganized our residency and fellowship rotations and assignments as well as adapting our educational programs to online learning. While constantly evolving to meet the institution's and our patient demands, our leadership starts planning for the return to a new "normal".

BACKGROUND Orthopedic infections are difficult to manage. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most dangerous and harmful bacteria and is difficult to eradicate because of its changing strains as well as sensitivity to different antibiotics. The main aim of this study was to determine the prevalence of pathogens, especially MRSA, associated with orthopedic wounds and their sensitivity to different antibiotics. METHODS A prospective study was conducted from September 2015 to August 2016. Pus samples of 1,350 patients who presented at the out-patient department or admitted with a wound infection after an orthopedic intervention were taken with the help of culture swab and were sent for culture and sensitivity according to hospital protocol. Data analyses were made using the SPSS software, version 17 (IBM). RESULTS Adults aged between 15 and 30 years were most affected, with 444 (32.9%) cases. Of the patients, 268 (19.9%) had negative cultures. Among the patients with positive cultures, the gram-positive cocci and gram-negative rods were 497 (36.8%) and 377 (27.9%), respectively. The most common pathogen was MRSA (240; 17.8%), followed by Escherichia coli and methicillin-sensitive S. aureus. CONCLUSIONS Multiple pathogens are involved in patients having an orthopedic surgical intervention. The high occurrence of MRSA and E. coli has an increasing economic burden on patients because of these pathogens high resistance to antibiotics. Thus, proper preventive measures should be done to decrease the occurrence of such infections as well as their associated morbidity.

Introduction: Proximal femoral fractures account for a large number of hospitalization cases among the elderly patients. The proximal femoral fractures pattern based on intra-articular or extra-articular could affect the treatment options and induce several complications. The aim of this study is to evaluate the relationship between the severity of osteoporosis and pattern of proximal femoral fractures among elderly patients. Methods: In this cross-sectional study, 83 patients over than 65 years old were enrolled from 2014 to 2018 in the orthopedic department of Urmia University of Medical Sciences, Urmia, Iran. Bone mineral density (BMD) was determined by dual energy x-ray absorptiometry (DXA) at the time of hospitalization. Vitamin D level was also measured. Finally, the mortality rate was determined in 12-month follow-up after the operation. Results: In this study, 83 patients with proximal femoral fractures including 60 cases (72.3%) with extra-articular fractures and 23 cases (27.7%) with intra-articular fractures were investigated. The mean vitamin D level of these two groups [patients with intra-articular fracture (34.4 ± 24.7 nmol/l) and extra-articular fracture (11.3 ± 5.4 nmol/l)] was significantly different (P = 0.020). A significant difference was also observed in the bone densities (based on T-score) of these two groups (P < 0.001). The patients’ mortality rate was significantly different and it was higher in patients with extra-articular fracture (23.0%) compared to those with intra-articular fracture (17.3%) (P = 0.020). Conclusion: In the case of elderly patients, the hip bone density and vitamin D levels play a decisive role in predicting the pattern of proximal femoral fractures. It was also associated with increased mortality among the elderly patients.

The study aimed to gain knowledge about low back pain (LBP) in nurses working in the orthopedic departments of tertiary hospitals in Sichuan province, China. We used a cross-sectional survey to examine the prevalence of LBP among 797 inpatient nurses who had worked for 1 year in an orthopedic department in one of 29 hospitals (Grade 3A) in Sichuan province. The survey included a questionnaire to determine the prevalence of LBP and factors related to LBP, a screening graph of LBP symptoms, the Roland Morris Disability Questionnaire (RMDQ), and the Fear Avoidance Beliefs Questionnaire (FABQ) for LBP. The 1-year period prevalence of LBP in the nursing population was 66.8% and the point prevalence was 51.3%. Among the 523 nurses who had experienced LBP, the mean total number of days that LBP had been experienced during the past year was 20.2 ± 16.3 days (range = 1-90 days). The annual number of episodes of LBP was 5.7 ± 4.5 times/year (range = 1-20 times/year). More than half the orthopedic nurses (51.1%) planned to quit, and 5.8% thought of leaving their job due to LBP. These study findings indicate that nurses in this region experience a burden of LBP similar to those in other regions in the world.

We calculated in-hospital, 30-day, and 1-year mortality rates and analyzed potential mortality risk factors in 2742 patients with low-trauma hip fractures. We found a high mortality rate at 30 days and 1 year after hip fracture. The high mortality can be explained by a very high number of conservatively treated fractures. Data on mortality after low-trauma hip fracture in Romania is scarce and comes from a single-hospital study. Our aim was to calculate mortality rates and risk factors in all patients admitted for low-trauma hip fracture in the largest university medical center of Romania. We retrospectively analyzed the charts of all patients (>40 years old) admitted for hip fracture in a 12-month period in hospitals with an Orthopedic Department in Bucharest, Romania, and surrounding Ilfov County and calculated the crude in-hospital, 30-day, and 1-year mortality rates after low-trauma hip fractures. A number of potential clinical risk factors for mortality were evaluated. We analyzed 2742 low-trauma hip fractures. The in-hospital, 30-day, and 1-year all-cause mortality rates were 4.26% (n=117), 9.59% (n=263), and 29.72% (n=815) respectively. Four hundred and fifty (16.41%) fractures were managed conservatively with a 1-year mortality HR of 3.05 (p

Shoulder hemiarthroplasty is a viable option in young patients with an intact rotator cuff in order to preserve the native glenoid. To avoid the dreaded and expected wear of the glenoid in very active shoulders, implants with humeral head coated with a high resistant and elastic material—pyrolytic carbon—are now an option. The authors present the first pyrocarbon coated arthroplasty performed at our Orthopedic Department in a patient with osteonecrosis of the humeral head. At three years of follow-up, the patient is pain free and without limitations in his daily work. The Constant score was applied preand postoperatively, and an improvement of 32 points was reported. Larger cohorts with long-term follow-up are required to confirm our promising results. info:eu-repo/semantics/publishedVersion

Background The causes of falls are heterogeneous and represent an interaction between patient and environmental factors. This study aimed to explore the characteristics of patients who fell in an in-patient orthopedic department and explore possible reasons for their falls. Methods A retrospective case-control study of adults in an orthopedic in-patient setting at a major hospital, who sustained a fall. Sociodemographic and medical characteristics of randomly sampled patients who fell (cases, n = 128) and their controls (n = 128) were compared. Results Fallers were younger, had less comorbidities, took less medications, and had a shorter length of stay than non-fallers. Moreover, fallers' reasons for hospitalization were not necessarily associated with limited mobility. Fall events occurred most frequently from the patient's bed, in the bathroom and during night shifts. Conclusions Our study portrays atypical fallers; that is, patients who had no obvious risk factors for falls and, thus, were not expected to fall. It appears that reduction in falls among high-risk patients may artificially create a population of atypical fallers. The patients may overestimate their abilities and avoid asking for assistance. Our findings suggest that emphasizing the importance of asking for assistance among both low-risk and high-risk patients as well as male and female patients should be an integral part of patient education in orthopedic departments.

Introduction: Here, we aim to compare the accuracy of the regression formula derived to predict genderusing data on measurements of foot and hand with the formula derived to predict gender using the lengthmeasurements data of the long bones (tibia and ulna).Methods: Patients attending the outpatient services at the Orthopedic Department, and between the agerange 18 to 50 years were recruited (n=1000; 500 males and 500 females). Subjects suffering from any kindof bone deformity were excluded. Vallois method was used to estimate the measurements of hand, foot,tibia, and ulna. Regression formulas were obtained from the hand, foot-long bones measurements; to predictgender, using multiple logistic regression.Results: Differences between male’s and female’s measurements of hand (P

Rotator cuff repair has become one of the most performed surgeries in an outpatient orthopedic department. It gained its reputation due to significant clinical improvement amongst patients. However, clinical outcomes proved to be different from rotator cuff healing, and expectations of both surgeons and patients may also vary due to the difference in their perception of the procedure. Failure can be defined by the patient as a worsening of the preoperative clinical status, a persistent pain, stiffness, and an inability to return to work. Whereas objectively, ultrasound and MRI are widely used to asses healing failure. This is why it is highly recommended that surgeons collect preoperative data and scores in order to obtain a better understanding and definition to the rotator cuff repair failure.

Background. Different trochanteric osteotomies have been developed to aid in surgical exposure and proper removal and placement of arthroplasty components. Objectives. The study aimed to measure functional outcomes of the modified trochanteric slide approach for both primary and revision hip arthroplasty with radiologic and clinical variables, identify preoperative indications for the approach and identify possible postoperative complications. Methods. We conducted a retrospective case series of patients who underwent the modified trochanteric slide approach for hip arthroplasty at the orthopedic department of a tertiary hospital from 2012 to 2016. We reviewed patient charts and radiographs. Descriptive statistics were used to analyze data. Results. Out of nine patients screened, seven were included. The average post-op hip range of motion was 42 degrees abduction and 98 degrees flexion. The union rate was 36% and the non-union rate was 7%. Conclusion. The modified osteotomy is still recommended for difficult primaries and revisions to aid in exposure and hip biomechanics post-operatively.

Background: The novel coronavirus disease-2019 (COVID-19) has become a significant worldwide problem since January 2019. Hospitals have spent most of their time and logistics on patients with COVID-19. During this crisis, many healthcare providers have been infected with the disease, and occasionally, some wards and operating rooms were shut down as a result. Here, we explain our experience with the healthcare staff involvement with COVID-19 in our hospital. Methods: As a referral tertiary center, Imam Khomeini Hospital (Tehran, Iran) has 4,200 health-care workers (HCWs). From February 20, 2020 to August 21, 2020, we investigated the hospital database for COVID-19 involvement among the staff. Results: During the study period, 973 (23%) hospital HCWs were detected with COVID-19, 378 (9%) of whom were involved between June 21 and July 21, 2020. In the orthopedic department, 20 of 43 (46%) HCWs were infected with COVID-19. Conclusion: We believe that the increase in the incidence of the disease and higher risk of exposure is a highly noticeable factor which should be addressed by the administrative health officials.

Objective:To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department.Design:Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention.Setting:A 1,000-bed, tertiary-care, university hospital.Patients:Adult patients admitted to the orthopedics department between January 2015 and December 2018.Methods:During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed.Results:The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001).Conclusions:Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the largest global healthcare crisis of the last century since its emergence in December 2019. As more of the condition’s chronicity became evident and the government policies changed, the unlocking of the orthopedic wards seemed necessary. In this study, we decided to share our experience regarding the unlocking of our orthopedic ward in the largest tertiary referral hospital of Iran and to explain its negative and positive consequences. Methods: This observational study was done in Imam Khomeini Hospital Complex, Tehran, Iran, from April to August 2020. We extracted the data regarding the number of elective/trauma operations, emergency patients, and morning report sessions attendance from our registry database. The data were analyzed and plotted using Microsoft Excel 365. Results: The mean weekly number of orthopedic operations decreased from 50 for elective and 30 for trauma operations in January 2020 to almost zero for both in late March and early April 2020 [the first coronavirus disease 2019 (COVID-19) peak]. Following the department unlocking, the mean weekly elective and trauma operations returned to 50 and 20 by mid-June, respectively. The mean weekly orthopedic emergency visits followed the same order with decrease from 50 to almost zero in late March and increase to 70 in mid-June. However, by the beginning of the second wave, it decreased to almost 38 in early July and further to 28 in late July by the end of the second wave. Conclusion: The unlocking of the orthopedic department in a tertiary referral hospital during the COVID-19 pandemic is possible, provided that there is a set of protocols for patient care in the ward, emergency room (ER), operating room (OR), and clinic during the pandemic.

When a crisis such as that induced by COVID-19 pandemic creates impediments to the provision of in-person orthopedic care, telemedicine can be used as an alternative to provide many of these medical services. The creation and implementation of these services are challenging. This chapter reviews the experience of one orthopedic department during the COVID-19 pandemic and highlights the challenges encountered and the solutions implemented and provides the opportunity to reflect on some of the key insights and pearls obtained from the experience.

Delayed recognition of compartment syndrome can result in devastating consequences such as the need for amputation or even death. Nurses are at the frontline of patient care in the orthopedic department and it is essential that they have a high index of suspicion for compartment syndrome. In this publication we describe an easily replicable project to assess and improve the understanding of the condition by nurses on trauma wards. Our project involved a questionnaire to assess the ability of nurses to recognise the key clinical features of compartment syndrome. This initial questionnaire was followed by a one-week teaching programme within the department, after which the questionnaire was repeated. Our results demonstrate that nursing staff place a disproportionate emphasis on neurovascular compromise in recognising the condition. Only just over one half (11/21) could correctly identify 'pain out of proportion to the associated injury' as the key clinical feature. Unlike pain, neurovascular compromise is a late feature of compartment syndrome and overstating its importance may potentially contribute to delayed diagnosis. Our targeted educational week dramatically improved the number of correct responses. One month after the teaching week, 83% (19/23) of nurses correctly identified pain as the most important feature in compartment syndrome. We hope that improved knowledge of compartment syndrome by nurses will help to reduce delayed recognition and adverse outcomes.

Shuzhong Liu,1,* Xi Zhou,1,* An Song,2 Siyuan Yao,1 Muchuan Wang,1 Tong Niu,1 Chengao Gao,1 Zhen Huo,3 Yong Liu,1,* Yipeng Wang1,* 1Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 2Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People’s Republic of China; 3Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yong Liu; Yipeng WangDepartment of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Wangfujing, Beijing 100730, People’s Republic of ChinaEmail liuyong_pumch@163.com; ypwang_pumch@163.comObjective: Metastatic spinal differentiated thyroid carcinoma (MSDTC) is relatively rare in the clinic and often overlooked. The objective of the current study is to analyze the clinical characteristics and prognosis of patients with MSDTC who underwent surgical treatment to determine the prognostic factors that affect survival.Methods: This study retrospectively analyzed the clinical data and postoperative follow-up results of MSDTC patients who underwent spinal surgery at the Orthopedic Department of Peking Union Medical College Hospital from January 2010 to January 2020. Clinical data and survival time were analyzed by Kaplan–Meier analysis.Results: Eleven patients were included, and the average age was 58.3 years (range 37‒74). The average time from the initial surgery to the discovery of spinal metastasis was 42.9 months (range 0‒132), and the average follow-up time was 21.8 months (range 3‒80). Progression was identified in seven patients, and 10 patients (90.9%) died during the follow-up period. Kaplan–Meier analysis showed that extraosseous visceral metastasis (p=0.012), revised Tokuhashi score (p=0.035), Tomita score (p=0.038), and surgical method (p=0.028) were associated with overall survival (OS). In addition, skeletal visceral metastasis (p=0.017), revised Tokuhashi score (p=0.028), Tomita score (p=0.038), and surgical method (p=0.049) were associated with progression-free survival (PFS).Conclusion: Surgical treatment is an effective method for treating MSDTC and leads to pain relief, restored function and increased spinal stability. Based on our single-center experience, extraosseous visceral metastasis, revised Tokuhashi score, Tomita score, and surgical methods may be potential prognostic factors for OS whilst visceral metastasis, revised Tokuhashi score, Tomita score, and surgical methods may be potential prognostic factors for PFS.Keywords: adjuvant therapy, clinical features, differentiated thyroid carcinoma, postoperative survival, prognostic factors, spinal metastasis, surgical treatment

A 49-year-old woman presented to the orthopedic department with a chief complaint of severe low back pain for 2 years, with no neurologic deficiency on physical examination. Laboratory investigations revealed no abnormities. MRI (Figure 1, A and D) showed an intradural mass displacing the posterior spinal cord at the L3 level, leading to lumbar stenosis. Contrast-enhanced MRI (Figure 1, B and E) showed obvious marginal enhancement. CT (Figure 1, C and F) showed that the mass was calcified and the nerve root was compressed. The mass containing tophaceous deposits was removed surgically. As shown in the pathology slide (figure 2), the diagnosis was gouty tophus eventually, which is rarely presented in the spinal canal.1,2 The pain disappeared after the operation.