Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 10th Global Orthopedicians Annual Meeting Kuala Lumpur, Malaysia.

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Day 1 :

Orthopedicians 2017 International Conference Keynote Speaker Neil P Sheth photo
Biography:

Neil Sheth is Assistant Professor of Orthopaedic Surgery at the University of Pennsylvania. He is also the Pennsylvania Hospital Site Director for the Adult Reconstruction Hip and Knee Fellowship. Dr. Sheth obtained his undergraduate degree in Biomedical Engineering with a minor in Finance at the University of Pennsylvania. He then spent 2 years on Wall Street as a Financial Analyst in Solomon Smith Barney's Healthcare Investment banking division prior to attending medical school at the Albany Medical College. Following medical school, he completed a 6 year Orthopaedic Surgery residency at the Hospital of the University of Pennsylvania. Following residency, he completed an adult hip and knee reconstruction fellowship at Rush University as well as a 3-month mini-fellowship at the Endo Klinik in Hamburg, Germany focusing on peri-prosthetic infection. Sheth has now returned to join the faculty at the University of Pennsylvania and focuses his research on acetabular bone loss pertaining to revision total hip arthroplasty, peri-prosthetic infection and the role of orthopaedic surgery in global health. He is currently leading a team to build an orthopaedic center of excellence in Moshi, Tanzania.

Abstract:

As the number of primary total hip arthroplasty (THA) procedures performed continues to rise, the burden of revision THA procedures is also expected to increase. With patients undergoing THA at younger ages and living longer, revision patients are presenting with greater bone loss at the time of revision surgery. The proper evaluation and treatment of acetabular bone loss at the time of revision surgery is complex and is further complicated in the face of a chronic pelvic discontinuity. Identifying Proper pre-operative patient assessment in conjunction with detailed pre-operative planning is essential for obtaining favorable clinical results. Appropriate radiographs are critical in assessing acetabular bone loss, and specific classification schemes can identify bone loss patterns and guide available treatment options. The presentation reviews the surgical decision making and clinical results of different surgical options for the treatment of acetabular bone loss, and introduces a novel technique for the treatment of a chronic pelvic discontinuity.

Keynote Forum

Ayman Al-Bedri

National University of Malaysia Medical Center, Malaysia

Keynote: The fifty shades of low back pain

Time : 10:15-11:00

Orthopedicians 2017 International Conference Keynote Speaker Ayman Al-Bedri photo
Biography:

Dr. Ayman Al-Bedri is a pioneer trainer and a board member in Exercise Is Medicine Malaysia (EIMM). My advanced training in family medicine give me the opportunity to deal directly with chronic disease patient and offering then exercise prescription. I assisted in training many general practitioner, physiotherapist and exercise profession during the process of acquiring their EIMM certificates.  Currently I am heading the exercise prescription clinic in the National University of Malaysia Medical Center. 

Abstract:

Low back pain (LBP) is a medical condition that can be encountered in both general and specialist practice. In several studies, the prevalence of low back pain varies between 10-63% (mean ± 37%) with no sex difference. Studies in Malaysia showed similar results with the prevalence of low back pain was found to be around 12-60 % (higher in population at risk). Low back pain (LBP) is a complex multidimensional phenomenon. For some individuals, LBP can be a recurrent and incurable condition while for others can be chronic leading to disability and distress. LBP can be classified into acute or chronic depends on the duration of the pain. LBP can be divided into vertebral, non-vertebral and non-specific pain. The hallmark of treating a patient with low back pain is to understand the symptoms and accurately interprets the physical signs. Only then a proper treatment can be initiated. That can be achieved through careful history and physical examination. The main aim of history and physical examination is to differentiate the serious spinal pathology “Red Flags”, “Yellow flags” and benign musculoskeletal pain.

The management of LBP depends on the condition that causes the pain.  The current exercise guidelines recommend staying active and avoid bed rest. It is important to avoid exercise immediately after acute episodes and during the exacerbation of the pain.  There is no preference for a kind of exercise over another. The FITT module suggests a tailored individual prescription rather than a fix exercise module.

Keynote Forum

James Stoxen

Team Doctors Chiropractic Center , USA

Keynote: The earliest detection intervention and prevention of thoracic outlet syndrome

Time : 11:20-12:05

Orthopedicians 2017 International Conference Keynote Speaker James Stoxen photo
Biography:

Team Doctors® president, Dr James Stoxen DC, FSSEMM (Hon) has been inducted into the
prestigious National Fitness Hall of Fame, the Personal Trainers Hall of Fame and appointed to the Advisory Board for the American Board of Anti-Aging Health Practitioners.  He developed the new advanced model of biomechanics, the integrated spring-mass model and the approach to the earliest detection, intervention and prevention of age related diseases.  In 2015, Dr Stoxen was presented with an honorary fellowship award by a member of the Royal Family, the Sultan of Pahang, at the World Congress of Sports and Exercise Medicine in Kuala Lumpur Malaysia for his distinguished research and contributions to the advancement of Sports and Exercise Medicine on an International level.He is a sought after speaker internationally lecturing at over 50 medical conferences on treatment, training and progressive preventive approaches.

Abstract:

The use of hand held devices (HHD) such as mobile phones, game controls, tablets, portable media players and personal digital assistants have increased dramatically in past decade.  This drastic change has led to new batch of difficult to treat, Musculoskeletal Disorders of the Upper Extremities such as myofascial pain syndrome of neck and upper back and thoracic outlet syndrome. 

This month over 60,000 people have used thoracic outlet syndrome to search for more information on this condition according to Google.  This compares equally to the number of searches for neck pain. 

The thoracic outlet anatomy and how the bundle passes through the passageway is complex for even musculoskeletal experts.  So for doctors trained in other specialties there can be an inadequate understanding about nature and cause of thoracic outlet syndrome.

A syndrome rather than a disease, the Mayo Clinic, Cleveland Clinic and the National Institute of Neurological Disorders And Stroke, plus top 10 ranked hospitals for neurology and neurosurgery agree persistent compression of nerves, arteries and veins traveling through the thoracic outlet is what leads to thoracic outlet syndrome.
I will discuss the three models of human movement, the inverted pendulum model, the spring-mass model and the integrated spring-mass model (ISMM).  The (ISMM), which integrates the spring suspension systems of the foot and shoulder region as well as the torsion spring of the spine and the mass, the head.  I will discuss my clinical findings show compressive disorders like TOS and herniated discs are merely an over control of tension on the human spring mechanism leading to these syndromes.
I will give brief review of the symptoms and their patterns, the common orthopedic tests, and diagnostic tests, the 16 different common conservative therapies and the 10 reasons for when surgery is medically necessary.  I will discuss an alternative treatment for this disorder based on the integrated spring mass model.

  • Sessions: Fractures | Orthopedic Surgery | Bone Disorders | General Orthopedics | Sports Medicine| Arthroscopy & Arthroplasty
Speaker
Biography:

Professor Doctor Joao Manuel D. A. Rollo has a degree in Materials Engineering, Master’s degree and PhD in Sciences, is currently a Professor at the University of Sao Paulo (USP) in Brazil.

Abstract:

Osteoporosis is an osteometabolic disease characterized by the loss of bone mass and an increase in fracture risk. The evaluation of microarchitecture resistance of the trabecular bone may contribute in determining the risk and preventing fractures associated to osteoporosis. A total of 90 human trabecular vertebrae were dried (dehydrated), distributed proportionally by the regions T12, L1 and L4 in a total of 30 vertebrae segments extracted from individuals (human cadavers of Brazilian nationality) and classified through a bone quality index (BQI) as normal, osteopenic and osteoporotic bones through the ultrasonometry of the calcaneous bone. The nanoindentation technique allowed the evaluation of the elastic module (E) and nanohardness (H) in one single trabecula in the respective groups. The results obtained from the groups do not show any meaningful differences when analyzed by the ANOVA Test (p = 0.682 for E and H) or in multiple comparisons by Turkey Kramer HSD (p = 0.915 between normal / osteopenic, p = 0.932 between normal / osteoporotic and p = 0.999 between osteopenic / osteoporotic for E, and p= 0.939 between normal / osteopenic, p = 0.690 between normal / osteoporotic and p = 0.878 between osteopenic / osteoporotic for H) and the Spearman Test did not show any correlation between the BQI and E and H. Therefore, it was not possible to classify the quality of the microarchitechture in the trabeculae of human vertebrae through the mechanical properties of the bone matrix in one single trabecula in order to evaluate the bone quality and fracture risk associated to osteoporosis.

Speaker
Biography:

Mohammed K M Ali is a Junior Clinical Fellow of Trauma and Orthopaedics at Royal Derby Hospital, UK

Abstract:

Aim: The aim of the study was to evaluate the management approach in treating ulnar shaft fractures

Method: We retrospectively reviewed patients’ clinical notes, physiotherapy letters and radiographs.

Patients: Our study included 46 patients with isolated ulnar shaft fractures between September 2010 and December 2015 with a mean follow-up of 36 months. This included 10 females and 36 males, with a mean age of 34 years.

Main Outcome Measurements:  Measures include radiographic healing, post-operative range of motion, complications and patient satisfaction.

Results: Six patients were treated non-operatively, four were fixed using RECON plates and 36 patients had DCP fixation. All the surgeries were carried out ASAP with average wait of two days. Mobilisation was commenced immediately after the surgeries non weight bearing. Thirty six patients had no complications post-operatively with good outcome and average of four visits follow-up. One patient complained of metal work irritation, one patient had a delayed union and two patients went into nonunion which required revision. No stiffness was reported in all these cases. Those who were treated non-operatively had mean follow-up of nine visits and three patients (out of six) developed non-union and required fixation.

Conclusion: High non-union and stiffness rates with non-operative management due to the nature of the injury and prolonged immobilization were observed. All the night stick fractures should be treated with open reduction and internal fixation regardless the degree of the displacement.

Level of Evidence: The level of the evidence was from Level IV, Case Series, and Treatment Study.

  • Networking & Lunch Break- 12:55-13:55

Session Introduction

Zenat Khired

Princess Nourah bint Abdulrahman university, Saudi Arabia

Title: Relationship between radiographic grading of knee osteoarthritis and functional limitation in elderly patients

Time : 13:55-14:20

Speaker
Biography:

Abstract:

Background:

The objective of this study is to find out the relationship between the  Kellgren and Lawrence system for knee Osteoarthritis (OA) and the functional limitation in the daily activities in the elderly patients using WOMAC Questionnaire.

 

Methods:

This study was a cross-sectional study. The subjects were 160 patients  (131  Females and 29 Males) who were diagnosed with knee OA at an orthopedic clinic using the Kellgren and the Lawrence system  with no history of knee joint surgery. Outcome indices were functional limitations in 17 living activities (descending stairs, Ascending stairs, Rising from sitting, Standing, Bending to floor, Walking on flat surface, Getting in/out of car, Going shopping, Putting on socks, Lying in bed, Taking off socks, Rising from bed, Getting in/out of bath, Sitting, Getting on/off toilet, Heavy domestic duties, Light domestic duties) obtained from a WOMAC questionnaire.

Results:

A significant correlation with p value <1 was seen between increase in knee OA stages in x-rays and the severity of limitation in physical function .

Speaker
Biography:

Abstract:

Fractures of the distal tibia can be challenging to treat because of the limited soft tissue, the subcutaneous location, and poor vascularity. Minimal invasive locked plate aims to reduce surgical soft tissue trauma and preserve periosteal blood supply. This study included 26 patients between 20 and 53 years (mean 34 years), with both open and closed distal tibia pilon fractures that were intraarticular or extra articular. All fractures were fixed using minimally invasive plate osteosynthesis under Image control using a precontoured locking compression plate – distal tibial plate. There were 11 AO 43 A, 7 AO 43 B, and 8 AO 43 C fractures including 18 closed and8 open fractures. Fracture union was achieved in 23 patients (88%), while 3 cases (12%) showed delayed union. Four cases suffered from late infection, and plate removal was necessary, whereas 6 cases had minor wound problems and responded to conservative treatment. Twenty two patients (85%) returned to their work within I year, however 17 patients ( 85%) had not returned to their preinjury sporting or leisure activities .Seven patients(27%) had angular deformities, all less than 7 degrees. The final ankle – hind foot score was 84.4 points. The conclusion is that short term results for treating distal pilon fractures using minimally invasive locked distal tibial plates to reduce surgical soft-tissue trauma and to help preserve periosteal blood supply and fracture hematoma appears encouraging, with union rates similar to that of ORIF techniques, but avoiding the usual associated drawbacks.

Ayman Al-Bedri

National University of Malaysia Medical Center, Malaysia

Title: Sweat out your rickety bone: Using FITT module in exercise prescription for patient with osteoporosis

Time : 14:45-15:10

Speaker
Biography:

Dr. Ayman Al-Bedri is a pioneer trainer and a board member in Exercise Is Medicine Malaysia (EIMM). My advanced training in family medicine give me the opportunity to deal directly with chronic disease patient and offering then exercise prescription. I assisted in training many general practitioner, physiotherapist and exercise profession during the process of acquiring their EIMM certificates.  Currently I am heading the exercise prescription clinic in the National University of Malaysia Medical Center. 

Abstract:

Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. With only one study available on hip fracture in Malaysia in 1997, the incidence of osteoporosis remains under-diagnosed and under-treated.  The incidence rate was about 140 per 100,000 for females and 65 per 100,000 for males making it as twice common in females compare to males.  The average hospital costs for a hip fracture event are estimated 6,000 USD, and in the public sector the patient would be responsible for approximately half of this cost. In general, patients remain in hospital for about 7 days.

As estrogen level is a key factor that determines the health of the skeleton, other factors play a role in maintaining bone health. Among those factors are the physical activity and nutrition. Physical activity plays a prominent role in primary and secondary prevention of osteoporosis. Physical activity may reduce the risk of osteoporotic fractures by enhancing the Bone Marrow Density (BMD) during growth and by slowing the bone loss with aging. Physical Activity can play indirect role in reducing the risk of falls by muscle strengthening and balancing.

This topic will shed the light on exercise prescription for osteoporosis using FITT principle. Weight-bearing aerobic activities are recommended together with other activities that involve jumping and resistance exercise.

Speaker
Biography:

James Stoxen DC, FSSEMM (Hon), Team Doctors® President, has been inducted into the
prestigious National Fitness Hall of Fame, the Personal Trainers Hall of Fame and appointed to the Advisory Board for the American Board of Anti-Aging Health Practitioners. He developed the new advanced model of biomechanics, the integrated spring-mass model and the approach to the earliest detection, intervention and prevention of age related diseases. In 2015, he was presented with an Honorary Fellowship award by the member of the Royal Family, the Sultan of Pahang, at the World Congress of Sports and Exercise Medicine in Kuala Lumpur Malaysia for his distinguished research and contributions to the advancement of Sports and Exercise Medicine at an international level. He is a sought after speaker internationally lecturing at over 50 medical conferences on treatment, training and progressive preventive approaches.

Abstract:

The team physician role is to provide treatment not only for the medical management of injuries and illnesses but also to provide for appropriate education and counseling regarding nutrition, strength and conditioning, and ergogenic aids maximize the athletes human performance in sport. Efficient, stress and strain free movement with efficiency is an essential aspect of survival for living things. Therefore understanding normal movement and how the human organism accomplishes normal movement is vitally important for physicians to understand so they can determine what is normal and what is abnormal movement. In this presentation I will reveal ways the physician can improve human performance of patients in sport by selecting the most advanced model of locomotion that better describes the biomechanics of locomotion, the integrated spring-mass model. This model integrates the upper half of the body onto the spring-mass model developed in 1989-90. It is advanced because it integrates the spine as a torsion spring, the discs as compression springs and the head as the non-spring 8-10 pound mass. In this model, the entire body is a giant torsion spring. This is to my knowledge the most advanced model and most accurate model of biomechanics today. If your goal is to provide clinical management of the athlete that is intended to insure or improve human performance you must know the earliest detection and intervention of the over modulation by examining for abnormal movement patterns with gait evaluation and through table examination for the changes in the muscles, tendons, and joints. By evaluating patients this way, a physician can fairly accurately predict where these compressive forces will be, thus predicting where compressive injuries will occur before the onset of symptoms.

  • Networking & Coffee Break -15:35-15:55
Speaker
Biography:

Abstract:

Objective: To compare the anaesthetic characteristics of prilocaine 1% and 1.5%   in terms of onset and offset time of sensorimotor block and methemoglobinemia levels, when used for ultrasound guided axillary brachial plexus blocks.

Methods: The prospective, randomised, double-blinded trial was conducted at the University Hospital Brussels on 60 patients (ASA I-III, age range 19–86) scheduled for ambulatory hand surgery. The axillary brachial plexus blocks were performed with ultrasound alone with selective injection of 5 ml of 1% prilocaine or 1.5% prilocaine around each nerve (20 ml in total). Onset time and duration of sensory and motor block were assessed, as well as peak methemoglobinemia levels 2 hours after injection.

Results: Mean onset time for sensory block in the 1% prilocaine group was 15 min for the median nerve and 12 min for ulnar and musculocutaneous nerve compared to 15 min for the median nerve and 9 min for ulnar and musculocutaneous nerve in the 1.5% group. Mean duration of sensory and motor block was 265 min and 247 min respectively for the 1% group versus 255 min and 245 min for the 1.5% group. The average methemoglobinemia level was 2.25% for the 1% group compared to 3.03% for the 1.5% group.

Conclusion: We conclude that there is no statistically significant difference between 1% and 1.5% prilocaine in terms of onset and offset times of the sensorimotor block. However significantly higher levels of methemoglobinemia were found in the 1.5% group.

Speaker
Biography:

Mohammed K M Ali is a Junior Clinical Fellow of Trauma and Orthopaedics at the Royal Derby Hospital, UK.

Abstract:

Purpose: Steroid injections are routinely done as non-operative management for foot and ankle conditions; however there is no strong evidence in the literature about the effectiveness of foot and ankle injections. The aim of our study was to assess the effectiveness of the foot and ankle injections.

Methods: We retrospectively studied the results of 64 foot and ankle injections done over a period of 12 months from July 2013 to June 2014. The most common indication for the injections was arthritis of the joint involved. 0.5% bupivacaine and 40 mg of kenolog was used for the injection. A visual analogue score was used to determine the efficacy of the injection.

Results: The mean follow up was 12 months. 84% patients had significant pain relief following the foot and ankle injection. 16% went on to have further procedures at six months. Most of the failed injections were ankle injections. Some went on to have further injection; some were listed for fusion and the others had an ankle arthroscopy. The ones who had good symptom relief were either discharged or given an open appointment.

Conclusions: Our study has demonstrated that intra-articular injections provide significant pain relief for foot and ankle conditions.