12^th International Conference on
Osteoporosis, Arthritis and Musculoskeletal Disorders

Biography:

My name is Mr. Louai Abdeh and I am a Trauma & Orthopedics Core Surgical Trainee at the Manchester Royal Infirmary. As a medical student and junior doctor, I have taken an active role in many clinical governance and research projects, and I have presented at a number of conferences including the ASiT International Conference 2018, Barts and London National Undergraduate Surgical Conference and Warwick Undergraduate Regional Medical Conference. I have also completed a Master of Research in Tissue Engineering for Regenerative Medicine, and I received a distinction grade for my dissertation “The Role of Macrophages and Mast Cells in Fibroblast to Myofibroblast Differentiation- An insight into the Relationship between Inflammatory Cells and Fibrosis”. 

Abstract:

Introduction: Anterior Cruciate Ligament (ACL) ruptures are career-threatening injuries for athletes. A common question asked by athletes following ACL repair is the time frame for return to sport.  This difficult decision is influenced by many elements, but a key factor is the type of sport that the athlete participates in. A review of current literature was conducted to compare the average return to play time of athletes competing in different sports.

Methods: A literature search yielded 646 papers from the earliest possible entry to November 2018. However only 21 Studies, from 6 different sports, evaluated the average return to play time of professional athletes following an ACL injury. This review also examined the factors which influenced the athletes’ return to play time.

Results: The average return to play time in soccer athletes varied from 5.5 to 12 months depending on the league and country of participation, whilst the average return to play time ranged from 10.7 to 12.4 months for American football players. In comparison, the average return to play time for other sports was 9.8 months for hockey, 11.6 months for basketball, 12 months for alpine skiers and 13.6 months for baseball. Factors influencing athletes’ return to play time included tailored rehabilitation, referral to experienced surgeons and time of season at which the athlete was injured.

Conclusion: Return to sport following ACL injury was influenced by many factors including the sport that athletes participated in. Additionally, the return to play time varied within the same sport when leagues from different countries were analysed; supporting the theory that the return to sports time is multifactorial. Due to the relative scarcity of studies involving elite athletes, we suggest that more high-quality studies are required to improve our understanding and ability to facilitate athletes’ successful return to sport following an ACL injury.

Biography:

Mr Ali is currently undergoing their training in Trauma and Orthopaedics Surgery in North West region, UK. Through-out his undergraduate and postgraduate career, Mr Ali had been involved in extensive research and is author to several international publications and monographs. Authors unique and robust work on role of NSAID use on bone healing provides a cornerstone for future research to highlight effects of NSAID use on fracture healing and spinal fusion. This extensive project will be of interest to a wide variety of readers including medical practitioners, orthopaedic surgeons, and emergency medicine doctors while considering use of NSAIDs for pain management in patients with fractures.

Abstract:

This unique meta-analysis aims to determine whether non-steroidal anti-inflammatory drugs (NSAID) use is significantly associated with poor bone healing outcomes within clinical settings and to further highlight whether such association is more significant for non-union or delayed union of fractures. It will further explore bone healing outcomes in relation to the type, route, dosage and duration of NSAID exposure and aims to demonstrate modifying evidence effects of patients’ age, smoking status, diabetes, site of fracture and length of follow-up to diagnosis on bone healing outcomes. MedLine, Embase and Cochrane electronic databases were searched electronically, and search period included January 1975 to December 2017. Observational studies and randomised trials involving effects of NSAID exposure on fracture healing and spinal fusion were considered for non-union and delayed bone union. Meta-analysis was performed in compliance with QUORUM and PRISMA guidelines. In the initial analysis of pooled data from 15 studies including randomised trials and cohort studies, results suggested significant risk of poor bone healing in patients with NSAID use (OR = 2.45, 95% CI 1.57-3.82, p < 0.0001). Meta-regression further suggested significant poor outcomes in relation to oral route (OR = 4.34, 95% CI 2.50-7.55, p < 0.00001), extended duration of NSAID exposure (OR = 2.64, 95% CI 1.41-4.91, p = 0.002) and across all bone types (OR = 2.71, 95% CI 1.74-4.22, p < 0.0001). Smoking was a significant confounder associated with poor bone healing (OR = 2.55, 95% CI 2.12-3.07, p < 0.00001). The current synthesis incorporates high-quality randomized controlled trials and retrospective cohort studies; however, it lacks decent quality prospective cohort studies due to their non-existence within available literature. This highlights the need for further high-quality randomized controlled trials or prospective cohort studies assessing NSAID exposure on bone healing that will also provide basis for more extensive meta-analysis in future.

Biography:

Mrs. Hayat are currently undergoing their training in Trauma and Orthopaedics Surgery in North West region, UK. Mrs. Hayat completed her masters in Orthopaedics and Trauma Science and thrives to contribute to ongoing research in the subject. Authors unique and robust work on role of NSAID use on bone healing provides a cornerstone for future research to highlight effects of NSAID use on fracture healing and spinal fusion. This extensive project will be of interest to a wide variety of readers including medical practitioners, orthopaedic surgeons, and emergency medicine doctors while considering use of NSAIDs for pain management in patients with fractures.

Abstract:

This unique meta-analysis aims to determine whether non-steroidal anti-inflammatory drugs (NSAID) use is significantly associated with poor bone healing outcomes within clinical settings and to further highlight whether such association is more significant for non-union or delayed union of fractures. It will further explore bone healing outcomes in relation to the type, route, dosage and duration of NSAID exposure and aims to demonstrate modifying evidence effects of patients’ age, smoking status, diabetes, site of fracture and length of follow-up to diagnosis on bone healing outcomes. MedLine, Embase and Cochrane electronic databases were searched electronically, and search period included January 1975 to December 2017. Observational studies and randomised trials involving effects of NSAID exposure on fracture healing and spinal fusion were considered for non-union and delayed bone union. Meta-analysis was performed in compliance with QUORUM and PRISMA guidelines. In the initial analysis of pooled data from 15 studies including randomised trials and cohort studies, results suggested significant risk of poor bone healing in patients with NSAID use (OR = 2.45, 95% CI 1.57-3.82, p < 0.0001). Meta-regression further suggested significant poor outcomes in relation to oral route (OR = 4.34, 95% CI 2.50-7.55, p < 0.00001), extended duration of NSAID exposure (OR = 2.64, 95% CI 1.41-4.91, p = 0.002) and across all bone types (OR = 2.71, 95% CI 1.74-4.22, p < 0.0001). Smoking was a significant confounder associated with poor bone healing (OR = 2.55, 95% CI 2.12-3.07, p < 0.00001). The current synthesis incorporates high-quality randomized controlled trials and retrospective cohort studies; however, it lacks decent quality prospective cohort studies due to their non-existence within available literature. This highlights the need for further high-quality randomized controlled trials or prospective cohort studies assessing NSAID exposure on bone healing that will also provide basis for more extensive meta-analysis in future.

Biography:

Wagih El Masri WEM trained in the speciality of spinal injuries at Stoke Mandeville, Oxford, Guys Hospitals & the USA between 1971 and 1983 . To date he personally treated 10,000 patients with traumatic Spinal Injuries acute, subacute, rehabilitation phases as well as in the long term. He is the author of the concept of “Physiological Instability of the Injured Spinal Cord ”and an advocate for the evidence based Active Physiological Conservative Management of the patient. He lectured worldwide in developed and developing countries, contributed to the literature with over 140 publications including the Prognostic Indicators of Neurological Recovery, the long term incidence of Post Traumatic Syringomyelia and the increased incidence of Bladder Cancer in SCI patients. He held the offices of President of the International Spinal Cord Society & Chairman of the British Association of Spinal Cord Injury Specialist

Abstract:

The management of traumatic spinal cord injury (TSCI) has been controversial for the last two centuries. Better visualisation by CT and MRI together with improved instrumentation & increased safety of anaesthetic 35 years ago resulted in a change of practice from Active Physiological Conservative Management (APCM) of the spinal cord injury together with all its medical and non-medical effects to resources being directed to a focused surgical management of the injured spine with fragmentation of management of other effects of cord damage. This was based on the Assumptions that surgical Decompression and Stabilisation will result in better neurological recovery, prevention of neurological deterioration, earlier mobilisation and completion of Rehabilitation, shorter hospitalisation and reduced cost of management. Unfortunately those who advocate Surgical Intervention are basing the same principles of Management to the Neurologically Intact and the Neurologically Impaired patient whose Physiology is impaired, whose Spinal Cord is Patho-Physiologically Unstable and who are at risk of neurological deterioration by Surgery and by Early Mobilisation. Furthermore to date there is no evidence that: Neurological Outcomes, Duration of Rehabilitation, Period of Hospitalisation or Cost of Management are improved by surgical intervention on the spine of patient with cord injury and the opposite is likely to be true. A Spinal Cord Injury (SCI) results in a multi-system impairment and malfunction, paralysis, sensory loss and a potential wide range of medical and non-medical complications. The injured spinal cord is Physiologically Unstable and can be further damaged by non-mechanical complications. Hypoxia, hypertension, hypotension, sepsis, hypothermia, fluid overload can easily occur causing more neurological damage. Patients require scrupulous simultaneous attention of all effects of paralysis to ensure: maximum neurological recovery, prevent complications including long term pain, achievement of maximum range of movement of the spine essential for independence in the wheelchair to minimise cost of support in the community, ensure safe and convenient functioning of all body systems, ensure long term maintenance of health to minimise readmission with complications and enable the patient to actively contribute to the society. The prognostic indicators of neurological recovery based on the initial sensory sparing without intervention will be demonstrated and discussed. The irrelevance of traumatic Biomechanical Instability, Spinal Canal Encroachment and Cord Compression on prognosis of neurological recovery in patients with sensory sparing on presentation will be demonstrated. The possible disadvantages, complications and hazard of Surgical Stabilisation, Surgical Decompression and Early Mobilisation will be discussed . The Outcomes of APCM will be demonstrated. The importance of future research with relevant outcomes to target will be highlighted . The full text can be accessed and shared free of charge from the following website address: http://journals.sagepub.com/eprint/V9qda2SDWRT7fEMYttqF/full

Biography:

Dr Cavazos, or as his patients address him, “DrC”, has been practicing medicine for over 30 years. He graduated with honors from the University of Michigan Medical School and completed a family medicine residency outside Pittsburgh, PA. After residency he practiced Emergency Medicine in Ohio for nearly 10 years. Despite the hustle and bustle of the ER pace, his patients were always treated with respect and compassion. DrC then moved to New Jersey & worked in various urgent care settings. But he was frustrated with the state of patient care as it only focused on symptom control; not the core issue. He then began studying vitamin, hormone, integrative and regenerative medicine. DrC opened his own practice, DrC360, nearly four years ago and is only looking forward to growth and excitement!

Abstract:

Osteoporosis is estimated to negatively impact 200 million people worldwide. It is a “silent” disease in that it doesn’t manifest itself until one suffers its endpoint, a fracture. One in three women over the age of 50 years and one in five men will experience an osteoporotic fracture in their lifetime. Medical research and literature has been lukewarm regarding secretagogues usage in osteoporosis protocols. One of these peptides, namely, sermorelin has been widely studied since its birth in the early 1990’s. It upregulates human growth hormone in 70% of patients which leads to increasing bone mineral content. Newer peptides such as ipamorelin also are efficacious in building bone mass, but are not commonly utilized by medical providers. On the other hand, anabolic agents such as teriparatide and abaloparatide have seemed to be the new darlings on the block but long term side effects are unknown. It is the conclusion of this author that secretagogues are underutilized by the medical establishment and have much benefit to offer the osteoporotic patient.

Biography:

Dr. Yuan has his expertise in orthopeadics and especially osteoporosis. He is joint Ph.D. student in Harvard Medical School now. He concentrates on correlation between bone marrow environment, including mesenchymal stem cells and hematopoietic stem cells, and bone homeostasis. Given the clinical observation that hematopoietic disorders increase risk of complications such as osteoporosis, his work proposes hematopoietic cell autophagy is essential for maintenance of osteogenesis.

Abstract:

Statement of the Problem: Disorders of hematopoiesis affect skeletal system. Osteoporosis is a major risk of complications in hematopoietic disease such as hematopoietic malignancy, anemia, b-thalassemia and hematopoietic stem cell transplantation. We examine the correlation between hematopoietic system and bone homeostasis.

Findings: In clinical, we found positive correlation between red blood cell count and femur neck bone mineral density (BMD) in 4964 healthy samples. Then femur-derived bone marrow of 30 patients was obtained from young normal BMD (BMD>-1.0, age<40y) or aged osteoporosis (BMD<-2.5, age>60y) during total hip replacement surgery. Human hematopoietic stem progenitor cells (CD34+CD45+) LC3 protein was inhibited in aged osteoporosis patients associated with descending autophagy gene expression, with Atg7, Atg5, Atg12, LC3b, Lam2a, P62 involved.

To verify the clinical observation, deletion of Atg7 gene in hematopoietic system mice (Atg7f/f;Vav-iCre) were established, which led to autophagy dysfunction specifically in hematopoietic system. Atg7 null in hematopoietic system caused decreased BMD, low bone formation rate and weak bone biomechanical strength properties. Scanning electron microscope as well as H＆E and Masson staining depicted trabecular microstructure destruction. However, there was no size difference in skeleton Alcian blue and Alizarin red S staining. Immunofluorescence of cortical bone revealed abnormal osteocyte size and number in Atg7f/f;Vav-iCre mice, accompanied by osteocyte DNA damaged and increased ROS level. Bone homeostasis related gene expression, including SP7, RUNX2, BMP2, BMP6, CTSK, TRAP5, was inhibited in Atg7f/f;Vav-iCre mice. Integrative proteomics functional enrichment showed Atg7f/f;Vav-iCre mice bone tissue skeletal systme morphogenesis and development were down-regulated, with extracelluar matrix (ECM) pathway by KEGG analysis, which confirmed by collagen1 immunohistochemistry staining.

Conclusion & Significance: These findings suggest that deterioration of autophagy in hematopoietic system undermines osteogenesis, which are apparently caused by aberrant alteration in the ECM pathway, extending new potential cause and potential therapy of osteoporosis.

Biography:

Dr Borsky is practicing surgery for 30 years. Graduated from the University of Zurich he spent most of his residency in institutions around the city of Zurich, including the Zurich University Hospital. At last head of surgical department in a country hospital in the larger Zurich area he founded together with another colleague in the year 2000 the “etzelclinic”, a surgical and orthopaedic unit. In the meantime the “etzelclinic” accommodates 8 surgeons, each team dealing only with one joint. Dr Borsky was from the beginning pushing the “orthobiology” treatments additionally to the surgical treatments of knee diseases, especially in knee osteoarthritis, being amongst the first in Switzerland offering intraarticular PRP preparations.

Abstract:

Knee osteoarthritis is a major problem in the European population from a medical as well as from an economical point of view. Surgical treatment implicates a long absence from work. Alternative treatments postponing major surgery to the age of retirement from work would be beneficial. Methods and Material: Patients with severe knee osteoarthritis qualifying for knee replacement but not yet ready for major surgery are treated by four intraarticular injections of ACP (double syringe system, Arthrex). Injections are performed once a week. Lequesne and VAS score before and four weeks after treatment are evaluated. Two years after treatment patients are contacted via telephone. Those not having had a knee replacement in the meantime and not requiring pain killers in daily living are considered as mid term success. Results: As far 168 patients were treated, 71 men and 97 women aged 64.2 +/- 10.9 years. 24 (14.3%) showed no effect. Lequesne score was 11.6 +/- 4.0 before and 3.9 +/- 2.7 (p<0.001) after treatment. Regarding the Lequesne classes 107 patients were classified to the extremely severe and severe group before treatment whereas after treatment 153 patients were classified as mild or moderate (p<0.001). Consequently, the VAS score dropped from 6.4 +/- 1.9 before to 2.2 +/- 1.5 after treatment (p<0.001). Two years after treatment 139 patients were contacted (no one lost for follow up). 93 (66.9%) of them being classified as mid term success (no knee replacement, no necessity of pain killers). Conclusion: Intraarticular ACP therapy shows excellent short term results reducing significantly the Lequesne score and class as well as the VAS pain score. Furthermore the majority of the patients does not require major surgery for another two years, thus often postponing the time of surgery to the age of retirement and avoiding higher costs from incapacity to work.

Biography:

Mr Ayman Sorial. MBBCh. Hons. MSc. MD MRCS. FRCS. Consultant trauma and Orthopaedic surgeon (Egypt). Staff grade Trauma and Orthopaedic surgeon (UK). First RCS Fellow certificate awarded for Senior Hip Fellowship Harrogate and District NHS FT. Clinical Hip Fellowship Leeds Teaching Hospitals. Lower Limb Arthroplasty and Arthroscopy specialist.                                                                           

Abstract:

Background

Synovial fluid analysis is an indispensable investigation to attain a diagnosis in a patient with acute hot swollen joint. A delay in appropriate early management results in serious undesired consequences. The management of acute hot swollen joint would normally be conducted along BSR/ BOA guidelines¹. The management of pediatric hot swollen joints is normally conducted with reference to Kocker’s criteria for septic arthritis in children.

Methods

We have evaluated the pathway for acute hot swollen joints as an audit of practice against published guidelines; the time frame was set at an interval of three years allowing the capture of a larger series. This included any patient with a synovial fluid sample with a request for gram stain direct microscopy and culture. The study involved 562 synovial samples, for every sample data were collected to include; age at presentation, gender, time lapse between sample collection and reporting of results, other relevant results both hematological and biochemical. The synovial fluid samples were also examined for white cell content and prevalence of Polymorphs.

Results

The median age at presentation was 68 years, the audit identified areas for improvement e.g. Failure to report joint affected (1.78%), Failure to report side (6.35%). Adherence to all 6 points outlined in guidelines was 75.5%. In our review it was evident that crystal arthropathies accounted for 25% of cases presenting with acute onset arthropathy in adults, in this study Calcium pyrophosphate arthropathy was more prevalent than gouty arthritis. Acute presentations of Crystal arthropathy have been associated with a significant inflammatory reaction as evidenced by a high C-Reactive Protein (CRP) even if compared to septic arthritis.

The classic radiological findings associated with calcium pyrophosphate crystal arthropathy³ were not evident in all patients presenting with acute mono–arthropathy confirmed to be related to calcium pyrophosphate deposition. There were two cases of joint sepsis associated with crystal arthropathy.

Biography:

My name is Mr. Louai Abdeh and I am a Trauma & Orthopedics Core Surgical Trainee at the Manchester Royal Infirmary. As a medical student and junior doctor, I have taken an active role in many clinical governance and research projects, and I have presented at a number of conferences including the ASiT International Conference 2018, Barts and London National Undergraduate Surgical Conference and Warwick Undergraduate Regional Medical Conference. I have also completed a Master of Research in Tissue Engineering for Regenerative Medicine, and I received a distinction grade for my dissertation “The Role of Macrophages and Mast Cells in Fibroblast to Myofibroblast Differentiation- An insight into the Relationship between Inflammatory Cells and Fibrosis”. 

Abstract:

Background: Open fractures of long bones should be managed by an orthoplastic team, BOAST (2017).

Aim: To evaluate the impact of a trauma team with no plastic surgeons on the management of open fractures.

Methods: Retrospective service evaluation exercise looking at outcomes of open fractures managed at our centre over a 6-month period. Care provided was audited against BOAST guidelines on open fractures.

Results: 17 patients identified. All cases were initially managed by orthopaedic surgeons. Following initial debridement, 5 patients required plastics input for wound closure which was sought via online referral to another centre. Definitive wound closure within 72 hours, as advised by BOAST guidelines, occurred in none of the cases that required plastics input compared to 91% of cases where plastics were not required. Definitive fracture management within 72 hours occurred in only 40% of cases that required plastics input compared to 82% in cases that did not.  Infection was also recorded in 67% of cases with delayed wound closure compared to none in wounds that were closed within 72 hours.

Conclusion: Delayed wound closure is associated with increased infection and delayed fixation.  We suggest that these fractures are managed in centres with on-site access to plastics.

Biography:

Dr Anood Al Shaali has graduated from the Royal College of Surgeons in Ireland. She has completed the Arab Board in Community Medicine in 2013. She is currently working as a Community Medicine Senior Specialist Registrar in the Elderly Care Unit, Dubai Health Authority.

Abstract:

Vertebral fractures are one of the most common fractures associated with low bone mineral density. However, two third to three fourth of patients with vertebral fractures are not clinically recognized. The objective of this study was to determine the prevalence of vertebral fractures in patients referred for bone densitometry and the most common site of fracture. The study was carried out in the osteoporosis clinic in Dubai Primary healthcare center. A total of 120 patients were examined using the dual energy x-ray absorptiometry. Of all the patients, 48.3% were osteoporotic and 40.9% were osteopoenic. The overall prevalence of vertebral fracture was 14.2%. The result showed that the prevalence of vertebral fracture was higher in female compared to male (15.7% and 9.7% respectively). It was found that patients aged 80 and above had the highest prevalence of vertebral fracture (54.5%). Undiagnosed vertebral fractures were common. Therefore, it is crucial to prevent vertebral fracture through early diagnosis and appropriate treatment of osteoporosis.

Biography:

Abstract:

Purpose

The sacroiliac joint (SIJ) can be a cause of low back pain and sciatica. The aim of this study was to assess and introduce a new physiotherapy manipulation intervention for SIJ-related back and leg pain.

Methods

As a double-blinded, randomized trial, we evaluated the short-term therapeutic efficacy of a new intervention therapy against the current traditional practice. In this study, 60 patients with SIJ-related leg and back pain were studied. Following the initial assessment of each patient with respect to their perception of pain and quality of life (QOL), the effect of the treatment was evaluated. Using the visual analogue scale (annexure 1), perception of pain was assessed before and after the 1^st, 2^nd and 5^th day (3^rdday) of treatment. The instrument used for evaluation of quality of life was SF-36 (annexure1). At the outset of the study, QOL status was determined using this instrument. After the course of treatment by the assigned treatment method, each patient was reassessed using the SF-36 at the 5^th week following a lapse of 4-week treatment free period. Except for having to drop out one patient for his failure to keep to the appointment, another 59 patients were treated successfully.

The results

The results show that the effect is highly significant at α = 0.001(CI 4.3+0.7) for pain reduction and α = 0.001(CI 1447.5+24.2) for QOL improvement. Of the 59 patients, 100% (n=30) have recovered from pain with the new treatment after the 3^rd visit, while the recovery rate among patients who received the traditional treatment is 6.8% (n=29) after the 3^rd visit.

Conclusion

In this double-blinded intervention study, the new manual therapy technique appeared to be the choice of treatment and more beneficial to the patients with back pain due to sacroiliac dysfunction than the traditional treatment. Further study to investigate its benefits with larger population should be encouraged.

Biography:

Aymen Mohmed Elbutran M. B. B. CH Al_Azhar University 2006 MSc Orthopedic Surgery and Limb Reconstruction surgery Benha University 2012. The Egyptian society for orthopedic and trauma surgery. Member of AO foundation. Presently working in Kom Hamada general Hospital.

Abstract:

By about age 35, people reach their peak bone mass. Women lose bone mass slowly after that point until a few years after menopause, when bone mass is lost very rapidly. For middle-aged and older women, healthy bones depend on the development, during younger years, of a strong bone structure and an adequate peak bone mass. There is tenuous evidence that moderate alcohol consumption may protect bone. But human and animal studies clearly indicate that chronic heavy drinking, particularly during adolescence and the young adult years, can dramatically compromise bone quality and may increase osteoporosis risk. Further, research indicates that the effects of heavy alcohol use on bone cannot be reversed, even if alcohol consumption is terminated. Research suggests that in addition to alcohol, other lifestyle factors—such as tobacco use, nutrition, weight-bearing exercise, increased body weight, and hormone replacement therapy—affect bone development and osteoporosis risk in women. However, there has been little examination of how alcohol interacts with these factors to influence bone health.

Biography:

Abstract: