11^th World Congress on Rheumatology, Orthopedics & Sports Medicine July 18-19, 2018 Sydney, Australia

Biography:

Abstract:

Insight into the pathogenesis of autologous platelet plasma (APP). The regenerative and therapeutic benefits as a treatment of acute injuries, tendinopathy and fasciopathy, pain and osteoarthitis as well as chronic inflammations (acne, psoriasis).

Introduction:

The therapeutic effect of autologous platelet plasma (APP) as a natural stimulation of tissue regeneration processes is based on the principle of oxygenation. The inflamed chronic tissues are characterized by a deficient angiogenesis process caused by an excessive production of angiogenesis inhibitors or by an insufficient production of blood vessel growth factors.

The stimulus of angiogenesis in physiological or pathological states is the deficiency of oxygen (hypoxia or ischemia), the activator of angiogenesis transcription factors — hypoxia induced factor-1 (HIF-1), — induces the expression of many angiogenic

factors, and the main regulator of angiogenesis — the vascular endothelial growth factor (VEGF) and its receptors. VEGF selectively stimulates proliferation and migration of endothelial cells, increases vessel permeability by helping the leakage of plasma proteins into the perivascular space which is necessary for the migration of endothelial cells induces the expression of endothelial NO-synthase and the formation of NO which enhances vasodilatation and stimulates the expression of proteases that destroy the connection between the endothelial cells and the extracellular matrix — a process necessary for the cell migration.

Fibroblast growth factor (FGF) stimulates proliferation and differentiation of the stromal cells of mesodermal origin of fibroblasts, osteoblasts, chondroblasts, myeloblasts, endothelial cells. The administration of autologous platelet plasma with high concentration of platelets in a given zone produces a concentration of platelets which is several hundred times bigger than it is natural in cases of injury and inflammation. The stimulation of chemotaxis and proliferation and differentiation of the cells in the tissues, and, therefore, the initiation of regeneration processes.

The using of  autologous platelet plasma (APP) for rehabilitation of musculoskeletal system has proved extremely positive. The effect of the autologous platelet plasma is significant and reduce the dosage of non-steroidal anti-inflammatory drugs, is an effective substitute of longterm glucocorticoids and hyaluronic acid therefore the therapy of arthrosis allows to avoid endoprosthesis replacement. The rehabilitation of muscles, ligaments and bone tissue after traumas progresses much more rapidly (up to 30% faster) when complemented by APP treatment.

The indications are Osteoarthritis (the most oft them are knee, shoulder, elbow, and also the other joints); Osteoarthrosis (OA); Periarthritis; Tendon irritation (eg tennis elbow, golfer's elbow, achilles tendon irritation, patellar tendinopathy); Partial rupture or rupture of ligaments and tendons (Achilles tendon tear, ankle ligament tear, cruciate ligament tear, internal ligament tear, rotator cuff rupture, etc.) and muscle injuries; many tender points in paravertebral back or tension headache.

Evaluation of effectiveness of treatment for autologous platelet plasma (APP) with and without patients with osteoarthrosis; parameters "Pain”, “Stiffness”, “Functional limitation", normalized WOMAC index scores, timed 20 meter walk test before and after

Degenerative arthritis disease (gonathritis and coxarthritis) and the intervertebral spinal cord symptomatology are one oft the major hearth problem for the patients in the working age (30-60 years). Every third working person (between 30-60 years) suffers from joint diseases.

The autologous platelet plasma (APP) with or without ozone therapie can reduce the time of convelescense, allowing patients quick recovery and restart their work. The comfort ist better also post therapeutic in this form of therapie

Biography:

Michael Maguire is an Orthopedic Surgeon with subspecialty interest in Upper Limb Surgery and has extensive experience in ultrasound guided interventions having utilized this technology for over 10 years in clinical practice

Abstract:

Background & Aim: Ultrasound technology is increasingly being adopted by doctors to assist in the diagnosis and treatment of musculoskeletal conditions. Initially, interventions were simply image guided therapeutic injections, then procedures, using commonly available needles, such as fenestration and hydro-dissection arose. Finally, ultrasound guided surgery, using specialized surgical tools arrived. As an orthopedic surgeon performing endoscopic carpal tunnel release and performing ultrasound guided interventions the author was interested in transitioning to an ultra-minimally invasive carpal tunnel procedure.

Method: A systematic review of the literature was performed using the major medical databases and relevant research articles were retrieved and reviewed. Extensive cadaveric and clinical research exists which revealed a variety of promising techniques utilizing differing instrumentation. In this paper the literature will be discussed and the most promising techniques explained.

Findings: The most promising technique is that described by Rojo-Manaute et al. This group have performed the most comprehensive research to date, comprising firstly a cadaveric technique study, then a clinical pilot study and finally a prospective randomized controlled trial comparing ultrasound guided, Ultra-minimally invasive Carpal Tunnel Release (UCTR) to Mini-Open carpal tunnel release. The authors concluded that Ultra-Minimally Invasive CTR produced less postoperative morbidity and earlier return of function compared to Mini Open CTR. Both procedures offered similar neurologic recovery for the treatment of carpal tunnel syndrome. This was the first randomized controlled trial to compare a true UCTR to any other established surgical treatment for CTS and is the best Level 1 Evidence in support of ultrasound guided carpal tunnel release.

Conclusion & Significance: Based on the available evidence ultrasound guided carpal tunnel release has enough evidence to support its use as a treatment for carpal tunnel syndrome.

Biography:

Hussain Al-Ramadani works as an Orthopedic Registrar at Wagga Wagga Rural Referral Hospital, Australia.

Abstract:

Background: The ability to mobilize without assistance is integral to maintaining independence. Patients treated with tibiotalocalcaneal arthrodesis are often kept non-weightbearing post-operatively. Our hypothesis is that a dynamically locked hindfoot arthrodesis nail and immediate weight-bearing does not compromise union rates or time to union.

Methods: All patients who underwent hindfoot fusion nails from 2009-2017 treated with 2 different intramedullary nails (23 static in 20 patients vs 11 dynamic locking in 11 patients) were retrospectively reviewed.  Post-operative radiographs were analyzed for union and time to union, and post-operative notes were reviewed for complications and revision surgery.

Results: 11 patients with a dynamically locked hindfoot nail were allowed to commence full weight-bearing from day 1 post-operatively, whereas 20 patients (23 nails) were treated with a statically locked nail and kept non-weightbearing for 12 weeks. Indications for surgery were grouped into: arthritis, inability to maintain fracture position, and neuro-muscular pathology. 90% of patients in the early weightbearing group progressed uneventfully to union and did not require any further surgery, compared with 83% in the non-weightbearing group.

Conclusion: Primary ankle and subtalar arthritis has a significant impact on weight-bearing. We believe that the use of a dynamically locked hindfoot arthrodesis nail allows immediate and simple mobilization post-operatively in a patient population who is unable to sustain non-weightbearing. This minimizes complications, does not compromise the end goal of union, and potentially reduces hospital stay.

Biography:

Abstract:

Introduction: Several options continue to evolve for treating the common olecranon fractures. The reported high percentage of skin and implant related complications for these subcutaneous fractures raised the question about the need for a mini-invasive line of treatment that improves the results and minimizes the complications.

Objectives: Prospective evaluation of the new line of treatment, crossing screws, versus the standard technique, tension band wiring (TBW) in treatment of isolated non-comminuted olecranon fractures.

Methods: A prospective study of 22 patients with Mayo type IIA olecranon fractures was conducted to evaluate the 2 techniques. They were divided into 2 groups. Group I included 11 patients treated by crossing screws and group II included 11 patients were treated by TBW. Compression by the transcortical partially threaded screws applied in a crossing manner offers a stable fixation without soft tissue compromise that allows faster fracture healing and carry no danger for the skin. The patients were evaluated for operation time, quality of reduction, fracture healing, implant position, elbow range of motion, stability of fixation, and presence of complications. The functional evaluation was based on the Mayo elbow performance score (MEPS).

Results: All the fractures united in both groups in accepted position except one in group II. No secondary procedure to achieve union was required only in that case. No fixation failure or implant migration problems were encountered in group I, but, 2 cases in group I. Faster radiographic union was encountered in group I. 29.2 (6-12) weeks. One case in group I versus 2 in group II got superficial infection. No vascular or nerve complications were found. At a mean follow-up of 12.6 months (range 12-18 months), the elbow range of motion (ROM) and forearm rotation in group I were comparable to the intact side except  5 degrees extension deficit in 2 patients versus 2 patients with extension deficit 10 degrees, and 2 patients with 5 degrees extension deficit. Using the MEPS, group I patients (100%) had a good to excellent results with a mean score of 94.3 (80-100), one patient had implant removal. In group II, the mean score was 91.6 (75-95), with 6 cases had implant removal.

Conclusions: Percutaneous or mini-open transcortical crossing screws for isolated non-comminuted olecranon fractures offered a cheap, simple and efficient mini-invasive stable fixation that allows early rehabilitation with excellent results and minimal complications. Their results were superior to the standard TBW. A multicenter comparative study is recommended before standardization of the technique.