Patient specific technology is slowly gaining popularity and clinical adoption. In this study we designed, simulated and 3D printed a knee implant. Patient CT scan data was imported into ImageSim software from VOLMO (UK). ImageSim has number of features to smooth and filter the data; filtered data was exported as STL model of full knee.  The full knee STL model was then imported into TSV tools available in ImageSim for CAD functionality. Resection of Femur and tibia was done in TSV environment.  Re-sected knee model was imported in Solid works software and new components for femur, tibia and polymer insert were designed and exported back into TSV.  All the new components and original resected bones were assembled and positioned.  New assembled model were remeshed and then volume meshed.  Contacts, material properties and boundary conditions were assigned before final model was exported into Ansys for finite element analysis.  Static analysis for a full gait cycle was carried out in Ansys and the results obtained will be presented in the conference

Background: Many people struggle with hamstring (HM) stretches. They are a muscle group that tightens up quickly and depending on your posture can be overworked. The hamstrings run through the back of each thigh. Tightness in this muscle limits motion in the pelvis which can increase stress across the low back and corrupt correct posture and can cause the onset of knee or back pain. Hamstring stretching exercises are a necessary part of training in any sport and are useful in the maintenance of good posture. I observe after treating of many surgeons in our hospital a relation between tightness of HM and back pain especially after OT work.

Methods: Ten participants from different surgical departments (plastic surgery department, orthopaedic Dept. etc.) were asked to do Hamstring Muscle Tightness test. They were chosen from AlQassimi hospital, Sharjah, UAE. They were assigned to one group and practiced a program of Stretching Program of Hamstring Muscles daily for 2 weeks. All participants had been evaluated to measure Hamstring Muscle Tightness test and all participants with positive Hamstring Muscle Tightness test were enrolled in this study. All participants were asked to do Visual analogue scale test. All data were registered in data collection sheets. All measurements were done before and after the study program.

Results: After completion of the study, a significant improvement was observed in in measurement of back pain on visual analogue scale (P < 0.05), when compared to pre-program measurement.

Conclusion: Stretching exercises Program of Hamstring Muscles could improve Low Back Pain among Surgeon in Operation Theatre. Stretching Program of Hamstring Muscles is good methods that improve Low Back Pain among Surgeon

Clavicle fracture account for 2.6% of all fractures. >75% of these are midshaft fracture. Overlapping in multiple fragment fracture result in shortening of the shoulder girdle at the fracture site which leads to poor cosmetic and functional result. Classification of Clavicle Fractures: Group I: Middle third- Most common (80% of clavicle fractures), Group II: Distal third- 10-15% of clavicle injuries, Group III: Medial third-Least common (approx. 5%). Rockwood & Green's Fractures in Adults- As anyone who has treated this injury is aware, discussion of universal healing rates after clavicular fracture is overly optimistic. Recently, investigators have discovered that union after midshaft clavicle fracture is not as universal as once thought. Moreover, certain types of clavicular fractures have declared themselves to be problematic. Finally, there has been newfound interest in the treatment of problem fractures and nonunion. Recent data based on detailed classification suggests that incidence of nonunion in displaced clavicle fractures is between 10-15% Brinker MR, Edwards TB, and O’Connor DP. The risk of nonunion following nonoperative treatment of a clavicular fracture is estimated. Malunion with shortening & rotational deformity can be debilitating for the patients and challenging for the surgeon as it does not remodel in adults.

Purpose: We assessed the long-term results of periacetabular osteotomy (PAO) to determine the clinical and radiological outcomes for patients who developed osteoarthritis secondary to hip dysplasia. We separately evaluated the effect of PAO in patients who later underwent conversion to total hip arthroplasty (THA).

Methods: Forty patients were treated with PAO by a single surgeon in the same center from 1999 to 2006. Nine patients (10 hips) were lost to follow-up. The remaining 31 patients (37 hips) were retrospectively reviewed at an average follow-up time of 14 years.

Hips were evaluated by using the modified Harris hip score and the Tönnis radiological classification. The central edge angle was also recorded before and after PAO, as well as prior to THA.  In cases where patients were converted to THA, the inclination and anteversion measures were recorded.

Results: The mean age of the PAO patients was 36.9 years (range 16–49).  The average surgical time for PAO was 4 hours 37 minutes (SD 42 mins), and the average estimated blood loss during surgery was 557 mL (SD 186). The ASA score median was 1.  The mean Harris hip score at follow-up was 83 (SD 24) and ranged from 26 to 113. The median Tönnis classification of osteoarthritis based on radiographic changes was 2.

The center edge angle improved significantly, from a mean of 15.6 (SD 10.5) preoperatively to a mean of 32.8 (SD 3.3) at follow-up.   Eighteen of the 37 hips were converted to THA.  The mean central edge angle prior to THA was 12.7 (SD 9.2).  The mean inclination in these cases was 44.9 (SD 6.8), and the mean anteversion was 17.5 (SD 5.2). Nine patients experienced complications. Eight of these patients developed moderate to severe pain secondary to greater trochanteric bursitis. One patient from the bursitis group developed non-union pelvic osteotomy, and another developed hip impingement secondary to prominent PAO hardware (screws). Two patients in the converted THA group had a revision. One had a septic loosening of the acetabular and femoral components, and the other experienced femoral periprosthetic fracture secondary to excessive femoral anteversion.

Conclusion: Periacetabular osteotomy is a useful and predictable procedure in young patients with symptomatic hip dysplasia. The procedure can improve pain relief and femoral head coverage and slow the progression to THA conversion.  Furthermore, the PAO procedure did not affect the THA component position in our patient population, but there were variable results with regard to functional activity and pain levels compared to older aged patients who undergo total hip arthroplasty.

Patients with Diabetic Charcot Neuroarthropathy are at high risk for ulcerations and major lower extremity amputations. Osseous reconstruction is an important component in ulcer healing and prevention, however despite such efforts, major lower extremity amputations remain a serious post-reconstruction concern. The aim of this study was to identify risk factors for major lower extremity amputation in patients who underwent osseous Charcot reconstruction. A retrospective review was performed on 331 patients with the diagnosis of Charcot Neuroarthropathy in the foot and ankle treated over a 16-year period. Two hundred eighty five patients were included after exclusion of those without Diabetes. Demographic data, anatomical wound location, surgical interventions, wound healing status, and the level of eventual amputation were recorded. Multivariate logistic regression and Fischer Test were used for analysis.  All patients had Diabetes, neuropathy, Charcot Neuroarthropathy, and required osseous reconstruction.  Risk factors and their respective odds ratios are as follows: Postoperative non-union [OR 8.5 (95% CI 2.2-33.5), 0.0023]; development of new site of Charcot [OR 8.2 (95% CI 1.1-62.9), 0.0440]; Peripheral arterial disease [OR 4.3 ( 95% CI 1.7-11.0), 0.0020]; renal disease [OR 3.7 (95% CI 1.6-8.8), 0.0025]; postoperative delayed healing [OR 2.6 (95% CI 1.1-6.5), 0.0371]; postoperative osteomyelitis [OR 2.4 (95% CI 1.0-5.9), 0.0473];  elevated HbA1c; [OR 1.2 (95% CI 1.0-1.4), 0.0053].  Independent risk factors found to be statistically significant for major lower extremity amputation in Diabetic Charcot Neuroarthropathy in the setting of osseous reconstruction must be mitigated for long term prevention of major amputations.

Introduction: Synovial chondromatosis is an uncommon, idiopathic, generally benign condition, mostly monoarticular, most commonly involving the synovial membranes of large joints, most commonly the knee joint, with preponderance in males of 4th to 6th decade. Presence of multiple cartilaginous nodules and loose bodies in the synovium or cavity are characteristic. Histopathology is confirmatory. Removal of loose bodies and complete synovectomy is the mainstay of treatment.

Case Report:

Here we present a case of 38 year old male with swollen stiff right knee joint for 2 years, presenting with sudden locking sensation. After clinical and radiological assessment, diagnostic arthroscopy was planned which was converted into an open synovectomy, in lieu of large loose bodies, histopathological examination of which confirmed the diagnosis.

Conclusion: Primary synovial chondromatosis is an uncommon, highly destructive and aggressive disease. Histopathology is confirmatory. Removal of loose bodies with stripping of and complete excision of the synovium remain the mainstay of treatment.

Biofilms are aggregates of microorganisms embedded within the self-produced matrix of extracellular substances. Biofilms are of serious concern especially related to artificial devices. The bacteria in biofilm state become 10 to 100 times more resistant to antibiotics usually due to poor penetration. Orthopedic implants related infections are often associated with biofilm formation and mostly due to Staphylococcus aureus.

Objective: As bacteriophages are known to penetrate the biofilm and are able to lyse the bacteria which are multidrug resistant, in the present study we decided to look into the effect of bacteriophage therapy in vivo on biofilms formed on stainless steel K-wires by methicillin-resistant S. aureus (MRSA).

Subject: For in vivo study, MRSA biofilm containing K-wire were implanted at the proximal end of ulna of both the limbs of 12 rabbits.

Method: While the 6 rabbits of experimental group were given the local injection of the cocktail of 3 different bacteriophages, the 6 rabbits belonging to control group did not receive any kind of therapy. Rabbits of both groups were monitored up to 8 weeks. One K-wire was removed from each limb sequentially with the interval of 1 week and evaluated on the basis of clinical, radiological, microbiological, histopathological examinations.

Results: Control group rabbits usually showed either death or continuation of infection with the presence of biofilm. However, phage therapy group showed cure of the infection as removed k wire were found sterile.

Conclusions: Thus, our findings suggest definite role of bacteriophage therapy in the treatment of the biofilm formed on metal implants by MRSA

Introduction: Non operative treatment for middle third clavicle fractures remained mainstay for until last two decades. But due to the prevalence of nonunion, symptomatic malunion and shortening for displaced fractures, trend has shifted towards operative management. Our study is aimed at prospectively evaluating the functional outcome of 120 patients treated with open reduction and plating with precontoured anatomical plate. This study estimates the functional outcome in terms of DASH score.

Methodology: 120 patients  from 16 years to 60 years of age, with displaced (>2cm ) and/or shortened (>2cm) or comminuted  middle  third  clavicular  fractures  were  included  in  this  prospective  observational study conducted in Bir Hospital  and National Trauma Center over  four years period. Open  reduction  and  internal  fixation  with  precontoured  anatomical  plate  was  done. Postoperatively arm is held in a sling for about 3 weeks with intermittent pendulum exercise after one week or as soon as the pain is tolerable and range of motion started after four weeks of surgery.  Patients were followed up on 2, 6, 12 and 24 weeks. Functional outcome was assessed using DASH score. Statistical analysis was done using SPSS 22.

Results: Mid clavicular fractures were more  common among males and left side was commoner  than right. Younger age group was more commonly affected. All fractures united in a mean radiological union period of 7.1 weeks. 6 cases developed pain, 23 had hardware prominence, 5 case developed superficial infection. DASH score was at significant negligible level by 24 weeks. 98% of patients returned to their work by 12 weeks.

Conclusion: Open  reduction  and  internal  fixation  with  pre-contoured  anatomical  plate  in displaced  middle third  clavicular  fractures  is safe  procedure  that  avoids  complications  associated  with non-operative management and provides good functional outcome with early return to pre-injury activities

Decompression of carpal tunnel syndrome can be done by different methods including both open and endoscopic techniques. The endoscopic type of decompression can be used in many cases except those where other pathologies must be excluded or treated at the same time like performing synovectomy or removing other mass that cause median nerve compression. The need for minimal invasive approach is now more requested by the patients specially those need to go back to their jobs and sport activities earlier. Many systems are in the market to perform endoscopic decompression using either one port or two port methods. These need special instrumentations that are expensive and not everyone or every hospital can afford to supply. In this presentation, I will show a very simple way to perform a minimal invasive approach using 2.4 mm endoscope that is used for other purposes like ankle or wrist arthroscopy without the need for any costly systems and with using simple instruments.