Scientific Program

Day 1 :

  • Orthopaedics | Arthroscopy | Osteoporosis Types
Location: London,UK
Speaker
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.

 

Speaker
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.

 

Speaker
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.

 

  • Prevention and Treatment of Osteoporosis

Session Introduction

Anthony Cavazos

University of Michigan,United States

Title: Harnessing the Power of Peptides in Treating Osteoporosis and its sequelae
Speaker
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.

 

  • Osteoporosis Types

Session Introduction

Ravichandran subbaraj

NMC DAY SURGERY CENTRE, United Arab Emirates.

Title: Serum homocysteine levels and the risk of Osteoporosis.
Speaker
Biography:

Dr. Ravichandran Subbaraj completed his MBBS, Diploma in Anesthesiology and then his Maser Degree in Orthopedics in 2005 from Madurai Medical College, India. Furthermore, he also completed his Advanced Revision Arthroplasty Training at John Flynn Hospital, Brisbane, Australia and a Fellowship in Adult Joint Reconstruction at University of Göttingen, Paderborn, Germany.He has over 10 years’ experience in Orthopedics and has worked in various intuitions such as, as Professor and Chief Surgeon of Arthroplasty in the Department of Orthopedics at the Mahatma Gandhi Medical College and Research Institute, Pondicherry, India as well as a Consultant Orthopedic Surgeon at Apollo Hospital, Chennai, India and has been the author and reviewer of more than 20 publications in both international and national journals of repute.Dr. Ravichandran Subbaraj keen areas of interest are Complex, Primary as well as Revision Knee and Hip Replacements, Trauma Management, Arthroscopy, Sports Medicine as well as management of Osteoporosis and Vitamin D deficiency and Stem Cell Therapy for Cartilage Regeneration.Dr. Ravichandran Subbaraj is a member of Indian Orthopedic Association and held various administrative posts in National Orthopedic Associations.Dr. Ravichandran Subbaraj converse with his patients in English, Tamil, Malayalam, Telugu and can understand basic Hindi. 

 

Abstract:

Osteoporosis is a major health problem which has devastating health consequences through its association
with osteoporotic fractures. Prevention of osteoporosis by identifying the risk factors is a major challenge in the field of
medicine. Elevated homocysteine level in blood can be a potential risk factor for the development of osteoporosis. We
aim to study if a person with high circulating level of homocysteine has a decreased Bone Mineral Density (BMD), thus
establishing an association between homocysteine and the risk of developing osteoporosis. Method: Patients between the
age group of 40-70 years attending BMD camps between July 2015 and December 2015 were included in the study. All
of them underwent BMD test and blood samples were sent to the laboratory for estimation of serum homocysteine levels.
The results were collected and analyzed to see if there was any association between serum homocysteine levels and
osteoporosis. Results: Out of the 58 males and 20 females with normal BMD, none had elevated serum homocysteine.
21 out of the 58 males and 47 out of the 82 females with osteopenia had elevated serum homocysteine. Of the 27 males
with osteoporosis, 25 had elevated serum homocysteine while among the 125 females with osteoporosis, all 125 had
elevated serum homocysteine levels. Conclusion: From our study we concluded that people with high circulating level
of homocysteine had a decreased Bone Mineral Density (BMD), thus establishing an association between homocysteine
and the risk of developing osteoporosis.

  • Osteoarthritis

Session Introduction

Michael Borsky

knee surgery and knee traumatology etzelclinic, Switzerland

Title: Autologous-Conditioned-Plasma (ACP) Therapy in severe knee osteoarthritis
Speaker
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.

 

 

  • Arthroscopy

Session Introduction

Ayman Sorial

Harrogate and District NHS Foundation Trust, UK

Title: Acute presentations of crystal arthropathy; a retrospective cohort review
Speaker
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.

 

  • Epidemiology of Fractures|Orthopaedics
Speaker
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.

 

Speaker
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.