Morphometric study of sacrum and its clinical implications in population in Bihar

The sacrum is a large triangular bone formed by fusion of five sacral vertebrae and wedged between two hip bones. Dimension of sacrum varies from region to region therefore morphometric study of sacrum in population of Bihar is important for proper fixation during orthopedic procedure in trauma patients. : The objectives of this study was to evaluate the morphometric parameters of sacrum so that a data can be generated from local population. M: The present study was done on 110 human sacra of known sex (62 male and 48 female) collected from department of Anatomy, IGIMS, Patna and also from other medical colleges of Bihar. Maximum length of sacrum, curved length of sacrum, maximum breadth of sacrum, antero-posterior diameter of the body of first sacral vertebra, transverse diameter of the body of first sacral vertebra and maximum length of articular surface of sacrum were measured. Mean value of sacral straight length were 104.55 cm in male and 94.66 cm in female, Curve length 112.03 cm in male and 103.98 cm in female, Width of sacrum 101.53 cm in male and 105.67 cm in female. Transverse diameter of body of 1st sacral vertebra were 46.53 cm and 40.85 cm in male and female respectively, antero-posterior diameter of body of 1st sacral vertebra were 29.89 cm and 27.73 cm in male and female respectively, Length of auricular surface were 56.08 cm and 54.77 cm respectively. Sacral index, curvature index, index of body of first sacral vertebra, corpora-basal index and auricular index were calculated. Morphometric study of sacrum in population of Bihar is important because dimension of sacrum varies from region to region and this is important for proper fixation during orthopedic procedure in trauma patients.

Apolipoprotein E impairs aged bone fracture healing

Bone fracture healing and osteoblast differentiation are impaired with advanced age. Using a combination of parabiosis and proteomic models, we identified apolipoprotein E (ApoE) to be an aging factor in bone regeneration. Circulating levels of ApoE increased with age in patients and in mice. ApoE impaired bone fracture healing by decreasing bone deposition in the fracture callus which subsequently decreased the mechanical strength of healed tissue. Osteoblasts serve as the sole bone forming cells within the body. In tissue culture models, ApoE treatment decreased osteoblast differentiation and activity which led to decreased matrix formation and mineralization. This inhibition of osteoblast differentiation relied on down-regulation of the Wnt/β-catenin pathway. In mouse models, aged bone repair was rejuvenated when we lowered circulating ApoE levels using a hepatotropic AAV-siRNA model – serving as a proof of concept that ApoE can be targeted to improve bone repair in an older population. While promising, knockdown of circulating ApoE in such a fashion is likely not translatable to patient care. Thus, current work in our laboratory is focused on developing treatment strategies that temporally decrease circulating ApoE levels and consequently improve bone healing after acute injury and/or surgical orthopedic procedure in the geriatric population.

A Framework for Time-Driven Activity-Based Costing for Orthopedic Procedure

This study used method of Time-Driven Activity-Based costing (TDABC) approach to examined cost reduction in healthcare sector, Knee Arthroplasty Department in Al-Emadi Hospital as case-study for delivering a primary knee arthroplasty consultation. The purpose of the study is to propose an optimization model that tends to determine significant and insignificant resources and cost uncertainties in a particular healthcare service. Then compare results of optimization model with current costing methods used in healthcare. Eight-steps of TDABC method are applied to obtain Capacity Cost Rate (CCR) of each human resource involved in care-delivery cycle. Data was collected from interviewing staff and patients, financial reports, and human resource reports. Multiple linear regression (MLR) model is used to test strength of relationship between time and cost variable. Optimization model applied to decrease uncertainties by using Least Square method. Optimized model showed that human resources are not fully utilized which leads to error in costing model. Seven human resources out of eight are significant to model. Accuracy of optimized model is equal to 3%, with RMSE equal to 6. Total cost of the optimized model equal $177,492.45 which is better simulate actual cost $180,048. The research value is about building a new statistical model using MLR analysis to predict behavior and data trend of main healthcare segmentation: Human Resource. Also, propose a generic optimization model that can be used for specific healthcare service costing.

Anesthesia for knee arthroscopy: which nerves should be blocked?

Nowadays knee arthroscopy is the most common orthopedic procedure. It is used to diagnose and treat various pathological conditions. Usually knee arthroscopy can be performed using spinal anesthesia. The article presents a successful experience of using a combined technique, which consist in a unilateral subarachnoid anesthesia with additional adductor canal block and blocks of the articular branches of the sciatic and obturator nerves.

The ability of comorbidity indices to predict mortality in an orthopedic setting: a systematic review

Background Several comorbidity indices have been created to estimate and adjust for the burden of comorbidity. The objective of this systematic review was to evaluate and compare the ability of different comorbidity indices to predict mortality in an orthopedic setting. Methods A systematic search was conducted in Embase, MEDLINE, and Cochrane Library. The search were constructed around two primary focal points: a comorbidity index and orthopedics. The last search were performed on 13 June 2019. Eligibility criteria were participants with orthopedic conditions or who underwent an orthopedic procedure, a comparison between comorbidity indices that used administrative data, and reported mortality as outcome. Two independent reviewers screened the studies using Covidence. The area under the curve (AUC) was chosen as the primary effect estimate. Results Of the 5338 studies identified, 16 met the eligibility criteria. The predictive ability of the different comorbidity indices ranged from poor (AUC < 0.70) to excellent (AUC ≥ 0.90). The majority of the included studies compared the Elixhauser Comorbidity Index (ECI) and the Charlson Comorbidity Index (CCI). In-hospital mortality was reported in eight studies reporting AUC values ranging from 0.70 to 0.92 for ECI and 0.68 to 0.89 for CCI. AUC values were generally lower for all other time points ranging from 0.67 to 0.78. For 1-year mortality the overall effect size ranging from 0.67 to 0.77 for ECI and 0.69 to 0.77 for CCI. Conclusion The results of this review indicate that the ECI and CCI can equally be used to adjust for comorbidities when analyzing mortality in an orthopedic setting. Trial registration The protocol for this systematic review was registered on PROSPERO, the International Prospective Register of Systematic Reviews on 13 June 2019 and can be accessed through record ID 133,871.

Effect of Enhanced Exercise Program on Pain and Physical Activity for Patients after Total Knee Arthroplasty

Context: Total knee arthroplasty (TKA) is considered the most effective orthopedic procedure for treating knee osteoarthritis. The need for knee replacement is predicted to increase six-fold between 2005 and 2030 to reflect an increasingly yet functionally demanding population. Aim: This study aimed to evaluate the effect of an enhanced exercise program on pain and physical activity after total knee arthroplasty. Methods: Quasi-experimental (pre/posttest) design was utilized in this study. The study was carried out in the orthopedic department, Benha University Hospital, and followed the patients through the orthopedic outpatient clinic from the beginning of May 2020 till the beginning of May 2021. A purposive sample of 64 patients was recruited to achieve the aim of this study. Four tools were used to collect the study data. These are the structured interview questionnaire to assess patients' knowledge regarding total knee arthroplasty, Barthel ADL index scale, Lysholm knee scoring scale, and Numeric Pain Rating Scale to assess the effect of the enhanced exercise program. Results: Showed that nearly two-thirds of the study sample was ≤60 years old, females, and married. The study also showed a statistically significant difference between pre-and post- enhanced exercise program in terms of total knowledge mean score among the study sample, as well as an increase in the total mean score in Barthel ADL index, decrease Lysholm knee scoring, and pain score after one month and after three months of enhanced program exercise implementation. Conclusion: Implementing an enhanced exercise program for patients with total knee arthroplasty effectively improved knowledge, increased physical activity (Barthel ADL index), decreased Lysholm knee scoring, and pain score. The present study recommended including an enhanced exercise program in the treatment plan for patients with total knee arthroplasty to improve patient's knowledge and practices. Also, repeating the study on a larger probability sample to achieve generalization of the findings.

New strategies of meniscal tears management: A review study

The incidence of meniscal tear injuries is rising, predominately due to the sporting activities of young adults. There are different methods in orthopedics of meniscal tear management. An Arthroscopic Partial Meniscectomy (APM) is the most practiced orthopedic procedure globally. However, recent literature reported serious concerns about its positive outcome. Meniscal repair is another recommended technique and growing rapidly due to its less incision requirement. Partial Meniscal implant is a modern management strategy with the excellent outcomes but still required further large-scale research. Concluding to the modern strategies of meniscus tear management “Save the meniscus!” is the emerging approach. This review critically analyzed the most adapted management strategies of meniscal tear and the emerging ones.

Meniscectomy is still a frequent orthopedic procedure: a pending need for education on the meniscus treatment possibilities

Purpose The purpose of this study was to evaluate the current status of education of polish surgeons in the subject of meniscus repair possibilities. The analysis of the possible correlations between the number of knee arthroscopy procedures performed by polish surgeons and their decision whether to remove or to repair the damaged meniscus has been performed. Methods Two-hundred and five registered orthopedic surgeons took part in surveys. The questionnaire contained the description of 20 patients with different types of meniscus damage and three questions concerning the experience in knee arthroscopy (two questions) and a choice of the treatment method (one question). Comparisons were made between knee arthroscopy experts (> 100 arthroscopies performed per year) and non-experts (≤ 100 cases). Results The questionnaire was completed by 194 knee surgeons from Poland with different levels in knee arthroscopy experience. For most cases, experts and non-experts agreed on the meniscus treatment method. Statistically significant differences in the recommended treatment between experts and non-experts were observed in 4 cases, where experts decided to repair the damage rather than to perform the meniscectomy. Conclusions Meniscectomy remains a frequent orthopedic procedure, despite meniscal sparing having been advocated for several decades now and despite the existence of meniscus repair technique which gives good clinical outcomes—augmentation of the damaged meniscus with a collagen membrane. Polish surgeons still need education on the meniscus treatment possibilities. Level of evidence V.

Knowledge and Attitude Among Various Dental Specialities Regarding Nasoalveolar Molding Procedure in Cleft Patients—A Cross-Sectional Study

Background: Nasoalveolar molding (NAM) is a presurgical orthopedic procedure, mainly focusing upon the aesthetic outcome of the treatment goal by reducing the number of reconstructive surgeries performed later for the purpose of esthetics. It was reported a very small proportion of pediatric dentists are providing presurgical intervention and the practice of NAM still side stepping among various dental practitioners. Objectives: The study was aimed to assess the knowledge and attitude among various dental specialties regarding NAM procedure in cleft patients. Materials and Methods: A questionnaire-based cross-sectional survey was carried out among 180 dental professionals (pedodontists, orthodontists, prosthodontists, oral surgeons). A total of 180 questionnaires were prepared, out of which 98 were filled through direct personal interview and 82 were circulated via Google forms. Results were analyzed using chi-square test, Mann-Whitney U test, and Kruskal-Wallis test. Results: There was statistically significant difference in the cumulative knowledge scores between specialty with P < .001; 99% of the participants think one should opt for NAM before cleft lip and palate surgery and 39% participants prefer pedodontists to carry out NAM procedure. Conclusion: Dental specialists in India have a positive attitude toward presurgical orthopedics. Majority of them agreed that there is great improvement in the aesthetic outcomes of surgeries after NAM intervention.

Fat Embolism Syndrome Mimicking a COVID-19 Infection

Fat embolism syndrome (FES) is a multiple organ disorder that can appear after pelvic and long bone fractures. The most common clinical finding is hypoxia, accompanied by diffuse petechiae, alveolar infiltrates, altered mental status, fever, polypnea, and tachycardia. We present a mild FES case on a 32-year-old man with no medical history admitted for an orthopedic procedure, following both tibia and fibulae fractures. Thirty hours postoperatively, he developed respiratory failure with altered mental status and needed admission in the intensive care unit. The chest radiography and later chest tomography raised the suspicion of a COVID-19 disease, even if our first suspicion was FES. After being carefully investigated in a dedicated COVID-19 ward and three negative RT-PCR SARS-CoV-2 tests, he returned to continue supportive treatment in the orthopedic intensive care ward. His evolution was favorable with discharge at ten days, without sequelae. In the context of the SARS CoV-2 pandemic, differential diagnosis has become an increasingly challenging process. Added to the variety of preexisting respiratory diseases and disorders, the COVID-19 infection, with its symptomatology so similar to multiple other pulmonary diseases, must not cloud our clinical judgement.