Study to Determine the Outcomes of Closed Tibial Shaft Fractures Treated with Reamed Inter Locking Nails

Aim: The aim of the study is to evaluate the results of treatment of a closed reamed interlocking in the treatment of closed fractures of the tibial shaft. Study design: A Descriptive observational study Venue and Duration: This study was conducted in the Orthopedic department of Ayub Teaching Hospital, Abbottabad for six months duration i.e from September 2020 to February 2021. Patients and methods: The study included 43 patients over 19 years of age. The patients were taken to the emergency and Orthopedic department for surgery of Ayub Teaching Hospital, Abbottabad for six months duration i.e from September 2020 to February 2021. Written approvals were granted from all selectees. Detailed history was asked and each patient was assessed clinically and radiographically. The reamed intramedullary nailing performed according to the protocol. Patients were followed for 1 year and assessed for infection, union, knee and ankle range of motion, and implant problems. 3 patients were excluded from follow-up, and the study was held in 40 patients. Results: All fractures were having complete union without the need for bone grafting. Simple fractures have union at mean of 14 weeks, comminuted and segmented fractures have union for longer than five weeks, and a mean duration of 18.5 weeks. Superficial infection at the screw site occurred in two patients, and the drainage was done, antibiotics were given and distal screw were removed, respectively. While all patients had a full range of knee motion, 37 patients had a full range of ankle movement. The other three patients had a 15-to-20-degree dorsiflexion loss at the ankle joint. No nail fracture, proximal screw end fracture in one patients and distal screw fracture in two patients were observed. Conclusion: We came to the conclusion that closed intramedullary nailing in the case of a closed shaft fracture of the tibia is a safe and satisfactory technique with a high rate of union and a relatively low complication rate and early return to activity. Keywords: Fracture, Internal, Fixation, Interlocking nail.

Result of high Fibular Osteotomy (HFO) in Osteoarthritis knee

To assess the effectiveness of high fibular osteotomy (HFO) in improving function and reducing pain among patients diagnosed with osteoarthritis knee admitted in the orthopedic department of Dibba Hospital Fujairah, United Arab Emirates. This is a descriptive, correlational cross-sectional study design. The study was conducted at the Orthopedic department Dibba Hospital Fujairah, United Arab Emirates, during the period from March 2019 to March 2020. All patients had knee osteoarthritis and were managed using HFO. All patients were adults and older than 18 years of age. Data was analyzed using the SPSS program. Ethical approval was gained from the hospital as well as from patients. The mean age of the patients was 32.5 ± 8.3 years. The study included 100 participants, among them, 28 were females, and 72 were males. There was a statistically significant relationship between knee injury and osteoarthritis outcome score and Lysholm. Also, knee x-rays images demonstrated clinical improvements among most of the patients. According to previous results, HFO and mesenchymal cell induced chondrogenesis (MCIC)should be considered for treating of medial compartment osteoarthritis, especially in patients with varus deformity.

Postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer: a case report

Background Pulmonary tumor thrombotic microangiopathy (PTTM) is a condition that involves the development of pulmonary hypertension due to the presence of microscopic tumor emboli of the peripheral pulmonary arteries. Here, we report a case of rapidly exacerbating PTTM associated with gastric cancer that was identified postmortem through pathological autopsy. Case presentation A 52-year-old Asian woman who experienced anterior chest pain while coughing visited the orthopedic department of the Gifu University Hospital. She was diagnosed as having multiple osteolytic bone metastases throughout her body and was subsequently scheduled to undergo combined positron emission tomography and computed tomography (CT) to search for a primary lesion. However, 4 days after her visit to the orthopedic department, she was unable to stand up and thus visited the emergency department. At the time of admission, physical examination results revealed that she had a percutaneous oxygen saturation level of 90% (on room air) and cyanosis and that she was in a state of hemodynamic shock. Laboratory test results revealed elevated levels of fibrin degradation products and D-dimer in her blood. Chest CT results were normal. She was admitted to the hospital’s general ward for follow-up but soon entered a gradually worsening state of shock and respiratory failure. Electrocardiography revealed findings associated with right heart strain; however, contrast-enhanced CT did not reveal the presence of pulmonary embolism. She was admitted to the intensive care unit and was treated for pulmonary hypertension; however, 45 h after her arrival at the hospital, she died of respiratory failure. A pathological autopsy revealed the presence of gastric cancer, tumor microemboli, and fibrous intimal thickening of the peripheral arteries of both lungs; thus, a diagnosis of PTTM was made. Conclusions In patients with carcinoma of unknown primary site and pulmonary hypertension with pulmonary embolism ruled out by CT, emergency physicians and intensivists must consider the possibility of PTTM, which represents an oncologic emergency, and initiate chemotherapy administration as soon as possible.

Effect of Educational Program on Nurses' Knowledge, Practices and Patients' Outcomes Post Total Knee Arthroplasty

Context: Total knee arthroplasty (TKA) is a surgical procedure in which the damaged parts of the patient's kneecap, thighbone, and shinbone are replaced with artificial parts. Aim: This study aimed to evaluate the effect of an educational program on nurses' knowledge, practices, and patients' outcomes post total knee arthroplasty. Methods: A quasi-experimental design was utilized in the orthopedic department and outpatient orthopedic clinic affiliated to Benha University Hospital from the beginning of July 2020 to the end of June 2021. A convenience sample of all available nurses (50) working in the orthopedic department. A purposive sample of 64 adult patients from both genders was divided into (32) control and (32) study groups. Three tools were used: The nurses' knowledge assessment questionnaire, nurses' practice observational checklist, and patient’ outcomes assessment sheet. Results: The present study revealed that 58% of nurses age was from 40 to less than 60 years old, 92% were females, 66% had secondary nursing education, 28 % of studied nurses had total satisfactory knowledge pre-program implementation, which reached 80%, 58 %, respectively immediately after and in follow up of program implementation. 22% of studied nurses had a competent level of practice scores pre-program implementation, which improved to 82%, 74 %, respectively, immediately after and in follow up of program implementation. There were highly statistically significant differences between study and control group patients regarding the frequency of most of the general and local complication and lower extremity function scale after two weeks and one month post-surgery at p-value<0.00. Conclusion: Implementing the educational program had statistically significantly improved the knowledge and practices of the studied nurses that could reflect positively on patient condition. The study recommended a continuous educational program for all nurses working in the orthopedic departments. Further study to search the correlation between the nurses' performance and the patient outcomes is recommended.

Postmortem Diagnosis of Pulmonary Tumor Thrombotic Microangiopathy with Rapid Exacerbation in a Patient with Gastric Cancer: A Case Report

Background: Pulmonary tumor thrombotic microangiopathy (PTTM) is a condition that involves the development of pulmonary hypertension due to the presence of microscopic tumor emboli of the peripheral pulmonary arteries. Here, we report a case of rapidly exacerbating PTTM associated with gastric cancer that was identified postmortem through pathological autopsy.Case presentation: A 52-year-old Asian woman who experienced anterior chest pain while coughing visited the orthopedic department of the Gifu University Hospital. She was diagnosed as having multiple osteolytic bone metastases throughout her body and was subsequently scheduled to undergo combined positron emission tomography and computed tomography (CT) to search for a primary lesion. However, 4 days after her visit to the orthopedic department, she was unable to stand up and thus visited the emergency department. At the time of admission, physical examination results revealed that she had a percutaneous oxygen saturation level of 90% (on room air) and cyanosis, and that she was in a state of hemodynamic shock. Laboratory test results revealed elevated levels of fibrin degradation products and D-dimer in her blood. Chest CT results were normal. She was admitted to the hospital’s general ward for follow-up but soon entered a gradually worsening state of shock and respiratory failure. Electrocardiography revealed findings associated with right heart strain; however, contrast-enhanced CT did not reveal the presence of pulmonary embolism. She was admitted to the intensive care unit and was treated for pulmonary hypertension; however, 45 h after her arrival at the hospital, she died of respiratory failure. A pathological autopsy revealed the presence of gastric cancer, tumor microemboli, and fibrous intimal thickening of the peripheral arteries of both lungs; thus, a diagnosis of PTTM was made. Conclusions: In patients with carcinoma of unknown primary site and pulmonary hypertension with pulmonary embolism ruled out by CT, emergency physicians and intensivists must consider the possibility of PTTM, which represents an oncologic emergency, and initiate chemotherapy administration as soon as possible.

Tuberculous spondylitis

Tuberculous spondylitis in the Orthopedic Department of the Charit Surgical Polyclinic in Berlin, according to the study of Bergmann'a (Arch. F. Orthop. U. Unf-Chir., 1923, XXII), during the time from 1912 to 1922 was established 342 times, which is 23% in relation to all bone-tuberculosis patients.

Study to determine the Results of Femoral Shaft Fractures among Children managed with Immediate Hip Spica Cast

This prospective descriptive study aims to assess the importance of the immediate hip spica in a fracture of the femoral shaft in children at the Orthopedic Department of Liaqat University of Medica and Health science Jamshoro, Pakistan, for a one-year duration from June 2019 to June 2020. All children 1 to 5 years of age with femoral fractures who were admitted to the Orthopedic department within seven days of injury were included in the study. A total of 35 children, 24 (68.6%) boys and 11 (31.42%) girls, with a mean age of 3.8 years, were treated with an immediate hip spica cast. Their ages ranged from 1 to 5 years. The time of immobilization of the Spica cast ranged from 4 to 6 weeks (mean 5.4 weeks). In the second week, seven (22.85%) children had spica wetting, and breakage and reinforcement of spica was done, and 5 (14.28%) children had a spica wedging, and casting was applied to fix the angulation. No extension or hypertrophy was observed in the fractured limb. We concluded that immediate hip spica casting is a safe, inexpensive and definitive treatment of femoral shaft fractures in children aged 1-5 years.

Orthopedic Department of Education Center and Service Provide During Coronavirus Disease-2019 Pandemic: An Experience from Single-Center Hospital

BACKGROUND: In the global pandemic of the 2019 coronavirus disease (COVID-19), many countries have reported a decrease in visits to hospitals, and health-care systems around the world are reshaping health protocols. Health service and education in orthopedics are also affected although not at the frontline in dealing COVID-19. METHODS: The data from this study collected from several official databases, including the Indonesian Ministry of Health, Central Java provincial government, general hospital, and orthopedic surgery cases. RESULTS: Pandemic COVID-19 started in March 2020 in Indonesia. Surakarta has become one of the epicenters. Health services in the orthopedic department also experienced a decrease cases on all divisions (outpatient clinics, emergency rooms, and inpatients). Mann–Whitney non-parametric comparative test showed significance result in p value operation of orthopedic cases and inpatients (p = 0.016 and p = 0.016; p < 0.05), meanwhile, outpatient visits did not show significance result with p = 0.0509 (p > 0.05). The decrease in the number of cases being treated in the orthopedic service also has an impact on education and training programs. The digital era is one of the choices in the field of education. However, digital resources cannot substitute for direct patient exposure. CONCLUSION: The average number of orthopedic patients during the pandemic period from January to December 2020 decreased compared to visits in the same period in 2019 so that orthopedic services at tertiary and academic referral hospitals experienced a significant decrease in cases. The education and services department must adapt to the policy on educational activities for residents and medical students. The education department and hospital institutions restructured and reorganized resident doctors to continue providing services. The digital era is an option that supports the education process during a pandemic.