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Background: Worldwide millions of people undergo joint replacement surgery to decrease the morbidity. The main indication for these surgeries is loss of function and pain. Similarly, knee replacement is done when degeneration and destruction of the knee create disability and decrease function of the knee. There are a number of implant types available but the use of an all-polyethylene tibial component in primary total knee replacement remains an att ractive option, considering the durability and lower cost. Objective: The objective of the study was to evaluate the pre-operative and post-operative range of motion (ROM) After total knee replacement at 6th, 12th and 48th weeks follow up using all poly implants. Material and Method: It is a prospective case series in which 111 subjects with total knee replacement in whom all poly implants were used and were assessed for range of motion at knee using simple goniometry examination at regular intervals were included. All data were analyzed using SPSS 17.0 version. Results: On goniometry examination, ROM at 6 weeks averaged 700 and at 12 weeks averaged 1,000 and on last follow up was 1,100. Conclusion: Total knee replacement with all poly implants has excellent results in terms of range of the motion of the knee. [ABSTRACT FROM AUTHOR]

Introduction: Spinal stenosis causing lower back pain and radiculopathy and it is the most common cause of patient admission at Spine centre as compared to other spine pathologies. Most common complaint in the Spine outpatient department or hospital admissions Different modalities have been applied with time for its management. Among them Epidural steroid injection is also. Objectives: "To Compare three doses of epidural steroid injection with single dose of epidural steroid injection for Lumbar Radicular pain in spinal stenosis patients." Study Design: Prospective study. Setting: Ghurki Trust Teaching Hospital, Lahore, Pakistan. Period: Jan 2016 to Dec 2016. Materials and Methods: 95 patients with lumbar radicular pain due to spinal stenosis were randomly allocated into 2 groups. In Group A, 42 patients were given 120 mg of Depo-medrol (40 mg per day for 3 days) along with local anesthesia and in group B, 43 patients were given 40 mg of Depo-medrol with local anesthesia as a single dose. Both Group A and Group B were matched in terms of age and gender. On visual analogue scoring, pain was assessed after 2 weeks, 3 months and 6 months. Results: In Group A (3 doses of depomedrol) VAS improvement at 2 weeks, 3 months and 6 months were more than group B (single dose of depomedrol) which was statistically significant (p < 0.05). There were no major complications like epidural hematoma or abscess formation in both groups. The overall minor complications like flushing, transient hyperglycemia and headache due to CSF hypotension were more in Group A than Group B but statistics shows no significant difference. All the adverse events resolved within few days without any significant morbidity and subsequent hospitalizations. Conclusion: Epidural steroid injection is excellent modality in the treatment of lower back pain with radiculopathy. Moreover 3 doses have greater effect in relieving pain as compared to single dose. There is no increase risk of complications by increasing dose. [ABSTRACT FROM AUTHOR]

Background: Cranio-femoral traction could gradually modernize the coronal and sagittal deformity and restore the trunk wastefulness through the elongation of the spine. The aim of this prospective study was to determine the outcome of two staged surgery in patients having severe spinal deformities in scoliosis i.e. anterior-spinal release followed by cranio-femoral traction for 5 to 7 days followed by posterior release and instrumentation in the management. Materials and Methods: This study was conducted in Orthopaedics and Spine Centre of Ghurki Trust Teaching Hospital, Pakistan from 1st April 2010 to 31st July 2014 on 17 patients. The patients with idiopathic and congenital scoliotic deformity were included in the study.All patients underwent anterior release followed by Cranio-femoral traction for 5 to 9 days and then followed by posterior release and spinal instrumentation. The difference of curves was measured from pre-operative, traction and post-operative scoliotic series x-rays. The data were analyzed through SPSS 17.0 Soft ware. Results: There were 17 patients, among them 8 were boys and 9 were females with an average age of 14.2 years ( range 10-16 years). The average total cranio-femoral traction interval were 7 days (range 5-9 days ). There were 14 idiopathic and remaining congenital scoliosis patients. The average pre-operative thoracic and lumbar scoliosis were 106.5° (range 92°-142°) and 87° (range 77°-110°), respectively. The post-operative magnitude curve was 50.6°(range 47.5° to 56°). The difference in magnitude of curve was statistically significant. One of our patient got bad chest in the interval of two stages and we postponed herand operate her for her second stage after one month when she was recovered from her chest infection and was excluded from our results. There was no neurological complication in any of our patient. One of our patient got superficial wound infection which responded to oral antibiotics and resolved. Conclusion: In this study we found that two staged surgery for stiffand larger curves in scoliosis deformities is a excellent, safe, cost effective and less complicative method. [ABSTRACT FROM AUTHOR]

Introduction: Th ese are aggressive bone tumor that arises adjacent to the sub-chondral bone of major joints. Th e areas of bone most oft en involved are the distal femur, proximal tibia, proximal humerus, and distal radius. Treatments ranging from surgical curett age to wide resection. Objective: To determine the frequency of the diff erent bones involved and diff erent surgical procedures as well as outcome in patients suff ering from Giant cell tumour. Materials & Methodology: Th e data of 108 patients between 2004-2016 who have biopsy proven Giant cell tumour and were followed for at least 1 year were analyzed retrospectively in the Department of Orthopaedic and spine surgery of Ghurki trust teaching hospital, Lahore. Th ere were 58 males and 50 females with a mean age of 28.66±11.23. Outcome of surgeries were determined in terms of Musculo skeletal Tumor Society (MSTS) score. Th e data was analyzed using SPSS 17.0 version. Results: It is most common between 21- 40 years i.e. 68(63.0%). Th e most of the patients presented with both pain and swelling i.e. 46(42.6%) and the commonest site were proximal tibia 32(29.63%) followed by distal femur 20(18.52%). Th e commonest surgical procedure performed were curett age and bone cementation i.e. 36(33.33%), followed by wide excision of bone±cementation and usage of implant i.e. 34(31.5%). Curett age and bone graft ing were done in 14(13%) patients, 10(9.3%) patients underwent above knee amputation, 6(5.55%) patients underwent custom made arthroplasties, 8(7.40%) patients underwent disarticulation. Th e recurrence were more in curett age and bone graft . Th e mean MSTS score was 25.7 out of 30 (standard deviation, 3.3; range, 16-30) Conclusion: Giant cell tumour can occur at any age, most commonly in 3rd & 4th decade and any bone can be involved but mostly proximal tibia and distal femur. Th e choice of surgical treatment varies among individuals which depends on the extent of bone destruction, risk of tumor recurrence and type of bone involved. [ABSTRACT FROM AUTHOR]

Objectives: To determine the outcome of pelvic support osteotomy with Ilizarov method in patients undergoing Girdle stone procedure in terms of pain relief and limb length discrepancy. Study Design: Descriptive case series. Setting: Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital/Lahore Medical & Dental College, Lahore. Duration of Study: Six months (19-11-09 to 18-05-10) for sample collection and follow up for next one year after the procedure. Materials and Methods: Forty five patients having hip joint problems were included. The radiographs would include plain radiographs of the pelvis in neutral and single limb standing position and the femur of involved side to assess the pelvic obliquity. Surgery was performed in the supine position under spinal anesthesia. A proximal femoral osteotomy was performed at the level of ischial tuberosity. The other distal femoral osteotomy was performed to lengthen and adjust the mechanical axis. Both these osteotomies were then stabilized with Ilizarov external fixator. The standard rate of distraction is 1 mm/day for lengthening. Results: There were 30 male patients and 15 were female patients with male to female ratio was 2:1. The mean ± SD between the ages was 23.69±7.80 years. Among all patients, 43 patients had pain relief and 41 patients of limb length discrepancy. Conclusion: By using the Ilizarov technique, we could prevent the valgus effects created by the valgus extension osteotomy while achieving lengthening of the femur through the distal osteotomy in the femur. It is an excellent technique for those patients who are not fit for total hip replacement. [ABSTRACT FROM AUTHOR]

Introduction: Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Tuberculosis of spine is one of the major causes of spinal deformity and paraplegia. Treatment of tuberculosis infection of spine is crucial. Surgical decompression and stabilization is considered in patients to prevent/ treat complications arising as a result of the disease or where conservative treatment fails such as chemotherapy. Objective: Th e objective of this study was to determine the outcome of anterior decompression and stabilization with cage in spinal tuberculosis patients not responding to anti-tuberculosis chemotherapy for 4-6 weeks Material and methods: Th is descriptive case series on 105 patients were done at Department of Orthopedics, Ghurki Hospital Lahore from 1st Jan. to 31st Dec. 2016. All the patients fulfi lling the inclusion criteria underwent neural decompression with subtotal or complete corpectomy of the involved vertebrae by same team of surgeons. All patients were followed for at least 6 months aft er surgery to determine their kyphotic angle, neurological defi cit and functional outcome. All collected data was analyzed using SPSS version 20. Results: Th e mean age of patients in this study was 38.16±9.58 years .Th ere were 44 (41.9%) male and 61 (58.1%) female patients in our study. Th e average value for Kyphotic angle pre-operation was 59.38±8.28 and mean value post-operation was 22.89±15.44. Out of total subjects, 99 (94.4%) patients achieved correction in Kyphotic angle, improvement in neurological defi cit was seen in 96 (91.4%) patients while there were 8 (7.6%) patients who restored normal function, 57 (54.3%) restored functional outcome to grade-I, 9 (27.6%) to grade-II and 11 (10.5%) to grade-III. Conclusion: We conclude that spinal tuberculosis can be managed with cage along with anterior decompression and stabilization. As we found good outcome (in terms of kyphotic angle correction, improvement in neurological defi cit and good functional outcome) in our patients. [ABSTRACT FROM AUTHOR]

Backgrobund: The primary aim of using tourniquet during surgery is to keep the surgical fi eld clean. However the total amount of blood loss by using or not using tourniquet is still controversial. Objective: To compare the mean amount of blood loss in total knee arthroplasty patients with and without tourniquet. Materials and Methods: It was a randomized controlled trial in the Department of Orthopaedic from July 2015 to June 2016. 120 patients were randomly allocated in tourniquet and nontourniquet group. All operations were performed under spinal anaesthesia by one surgeon. Th ose in group A were had TKA under tourniquet aft er the leg has been exsanguinated. The tourniquet pressure was twice the systolic blood pressure. Patients in group B were not had tourniquet applied to the leg. Mean amount of blood loss was calculated per-operatively using the number of sponges soaked and the volume of blood in suction bott le. Post-operative blood loss was calculated by the volume of blood in drains measured on daily basis for initial 48 hrs. Results: The mean ages of the patients were 68.40±6.55 in group A and 67.43±5.95 in group B. The mean blood loss of patients in group A was 307.33±36.03 mL while in group B, 425.67±21.04 mL. Statistically the diff erence between the two groups is significant (P<0.05). Conclusion: The use of a tourniquet during total knee arthroplasty was eff ective for reducing blood loss. [ABSTRACT FROM AUTHOR]

Background: Tibia is the most commonly fractured bone because of its structure and position. Tibial fractures are increasing with time to time and hence the morbidity and mortality are increasing despite proper public health efforts. There is a lack of national epidemiological data on the characteristics of patients with tibial shaft fractures. Therefore, epidemiological assessment is crucial for fracture. The purpose of this study was to provide upto- date information about patients baseline demographics, distribution of fracture classification, trauma mechanism and to formulate the preventive measures. Study Design: Retrospective study. Setting: Emergency or OPD at Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital, Lahore. Period: 1st January 2011 to 31st December 2015. Material and methods: Any type of diaphyseal tibial fracture. The data were taken from hospital database and include clinical, epidemiological and radiological records. The results were analyzed using SPSS 20. Results: A total of 2120 patients were included in the study. 1980(93.4%) were male and 140 (6.6%) were females. Male to females ratio were 14.14:1 with mean age of 33.28 ± 21.02. Between 0-20 years, 519(24.5%) of patients were admitted, 1021(48.2%) of patients were between 21-40 years, 467(22.0%) were between 41-60 years and only 113(5.33%) were above 60 years. Type A2 in 444(20.9%) were the most common pattern of fracture found. The traumas were most common in months of May, June and July and Motorbike accidents were the main cause. The mid shaft of tibia is the most commonly fractured i-e 1038 (49.0%) followed by distal part i-e 611(28.8%) and the least is the proximal i-e 471(22.22%). Conclusion: This study shows AO-type 4A2 was the most common fracture type, representing 20.9% of all tibial shaft fractures. The individuals between 21-40 years were mostly affected and the motorbike accidents were found the main cause for such traumas. [ABSTRACT FROM AUTHOR]

Background: Tuberculous spondylitis being endemic in developing countries including Pakistan has considerable socio-economic and orthopaedic concern. In spite of all the advances regarding diagnosis, treatment and total control of many diseases, this slow but grave disease still affects considerable number of cases and makes them disabled and even paralyzed. The objective of the study was to determine the neurological outcome in terms of Frankel Scale after anterior decompression and stabilization with titanium mesh cage in thoracolumbar caries spine. Methodology: The case series (descriptive) study was conducted in Orthopaedic ward of Ghurki Trust Teaching Hospital/Lahore Medical & Dental College, Lahore from 1st Jan. 2015 to 31st Dec. to 2015. In this randomized controlled trial of 150 patients who were admitt ed either through OPD or through emergency. Data was collected by using non-probability consective sampling technique. Patient was prepared for surgery. A locally made fixed interbody Titanium Mesh Cage, with packed bone graft, was placed. A Boston brace was applied for at least 6 months to provide external support to spine. The neurological outcome was assessed in terms of Frankel Scale post-operatively at the end of one month, 6 months and 12 months. Results: In our study, out of 150 cases, 42% (n=63) were between 15-30 years of age while 58% (n=87) were between 31-60 years of age, mean+sd was calculated as 32.85±8.35 years, 45.33% (n=68) were male and 54.67% (n=82) were females. Frequency of neurological outcome regarding improvement was recorded as 52% (n=78). Conclusion: We concluded that the neurological outcome in terms of Frankel Scale after anterior decompression and stabilization with titanium mesh cage in thoracolumbar caries spine is good and this technique may be used in future in our population. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the functional and radiological outcome of metaphyseal core decompression of distal radius for treating Keinbock's disease. Study Design: Descriptive case series. Place and Duration: Orthopaedic A Unit Lady Reading Hospital Peshawar and Ghurki Trust Teaching Hospital, Lahore and District Headquater Hospital Temargarah Lower Dir from January 2014 to June 2016. Material and Methods: Patients of all ages and both gender with pain and restricted wrist motion and radiologically diagnosed Lichtman's stage I, II and III (A) were included in the study. Metaphyseal core decompression of distal radius was performed in the included subjects and patients were followed fortnightly for two months and then monthly for at least one year. At each visit pain was assessed with Visual Analogue Scale (VAS), wrist flexion and extension measured with goniometer and Stahl index with x ray wrist. Results: A total of eleven patients including 9(81.8%) males and 2(18.1%) females with \mean age 31.2 years (range 24 to 42 years) were included in the study. Lichtman's stage I patients were 2(18.1%), stage II were 6(54.5%) while stage III (A) patients were 3(27.2%).Post operatively complete pain relief was achieved (VAS 0) for all stage I and II and most stage III (A) patients (90.9%, n=10) while mild pain (VAS 1) was reported in one (9%) patient of stage III (A) disease at final visit. Normal wrist flexion and extension was achieved in all stage I and II and most of stage III (A) patients (90.9%). Only one (9 %) patient of stage III (A) could not achieve adequate wrist mobility at last follow up. Pre and post op Stahl index remained the same for all stages. No complication was reported. Conclusion: Metaphyseal core decompression of distal radius results in excellent functional outcome in majority patients and should be the treatment of choice for early Keinbock's disease (stage I'II and III (A). [ABSTRACT FROM AUTHOR]

The present experimental work was conducted in the Farm of Nubaria Agricultural Research Station for the two successive winter seasons of 2011/2012 and 2012/2013 on onion crop to study the correlation coefficients among the characters of total yield, marketable yield, average bulb weight, days to maturity, plant height, number of leaves per plant, percentage of single bulbs, percentage of double bulbs, percentage of bolters, total soluble solids (TSS %) and storage ability of bulbs. Results showed that correlation coefficients among characters were positive with days to maturity, plant height, number of leaves per plant, percentage of double bulbs, total soluble solids (TSS %) and storage ability of bulbs in both seasons while the correlation coefficients among characters were negative among total yield with percentage of bolters, marketable yield with storage ability of bulbs, percentage of single bulbs with percentage of bolters and percentage of bolters with total soluble solids (TSS %) in the first season. Also, in the second season, the correlation coefficients among characters were found to be negative among marketable yield with percentage of bolters, average bulb weight with storage ability of bulbs and percentage of single bulbs with both percentage of double bulbs and percentage of bolters. [ABSTRACT FROM AUTHOR]

This work was carried out on 18 genotypes of barely (16 out of them are landraces and two are commercial cultivars). These genotypes were cultivated at the farm of Nubaria Agricultural Research Station for the two successive seasons of 2012/2013 and 2013/2014 and evolutional of some characters were significant differ between genotypes with respect of the green yield character. The data showed that the commercial varieties are higher than that of the landraces. Plant height (cm) showed that genotype 1 and 11 were higher than that of the commercial varieties in both seasons. Also the genotype 12 was found to be higher. No. of days to heading (days) in one season: Genotypes 2, 11 and 13 were proven to be higher compared with the commercial varieties. But in the second season genotypes 11 and 13 were higher compared with that of the commercial varieties. Grain yield (g m-2) in one season: No. 3&16 were found to be higher landraces genotypes compared with the commercial cultivars but its less than commercial cultivars. But in the second season were genotypes 3, 5and 13 higher compared with the remaining landraces but it's lower than the commercial the commercial varieties. Spike length (cm) was genotype 2 hieher compared with landraces genotypes in both seasons. No. plants per m2 in one season: Genotype 4 and 5 were proven to be higher compared with that of the commercial varieties. But in the second season were 5 and 7 higher compared with that of landraces genotypes. Weight of 1000 grains (g) in one season: No. 1 and 4 proved to be higher compared with that of commercial ones. But in the second season were 1 and 4 hieher compared with landraces genotypes. Correlation between no. of days to heading (days) was significant with spike length (cm) and negative significant with grain yield but 1000 grains (g) during the first season of 2012/2013, but in the second season 2013/2014 it was significant with spike length (cm) and negative high significant with 1000 grains. [ABSTRACT FROM AUTHOR]

This work was carried out at the Farm of Faculty of Agriculture, Alexandria University. This work was carried out using 16 land races of Barley and 7 characters for plant growth as well as investigation of karyotype were carried out. The obtained data indicated that there are significant differences between the tested land races and fourteen chromosomes were detected in karyotype for each land race. This work recommends the use of these data for the selection and breeding program. [ABSTRACT FROM AUTHOR]

This work was carried out to evaluate some agronomic traits in eleven different genotypes. In order to achieve such a purpose 11 different genotypes were kindly obtained from Field Crops Research Institute and cultivated at two different successive seasons and some agronomic traits were evaluated. These agronomic traits are Plant height, Ear height, Days to mid silking, Grain yield/plant, Ear diameter, Kernel depth, No. of rows/ear, No. of kernels/row, Shelling% and 100-kernel weight. The obtained result showed that differential gene expression was obtained and such a result might be used in breeding program and selection. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy and safety of aceclofenac in the treatment of osteoarthritis. Study design: Randomized double blind Phase IV trial. Place and Duration of study: This study was conducted in the department of Orthopaedics & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore. The duration was eight weeks. Methodology: A total of 90 subjects, fulfilling the inclusion criteria and willing to give free informed consent were enrolled in this trial. All these subjects were randomized into two treatment groups (A & B). Subjects either received Aceclofenac 100 mg twice daily or Diclofenac 75 mg twice daily for 08 weeks. During the screening visit, information on their demographic characteristics, medical history and previous and current medications were collected. A thorough physical examination and necessary laboratory investigations were carried out before drug administration and after the completion of treatment (end of week 8). Clinical examination was done at baseline visit, randomization and 2, 4 and 8 weeks. Gastrointestinal (GI) safety was assessed using adverse drug reaction (ADR) reports. WOMAC questionnaire was used to see improvement in activities of daily living and pain was assessed using visual analogue scale (VAS). All data was collected in the case report form (CRF). Statistical evaluation was performed at the end of the trial and results were analyzed using SPSS. Results: 70 subjects completed the study while 20 were lost in follow-up. There were 28 males and 34 females in the study with mean age of 56 years. There was a significant decrease in WOMAC and VAS scores in both groups. In group A (Diclofenac group) VAS decreased from 7.107 to 2.538 (p= 0.000) and WOMAC decreased from 32.75 to 7.38 (p=0.000). In group B (Aceclofenac group), VAS decreased from 7.912 to 6.0 (p=0.001) while WOMAC decreased from 37.29 to 21.50 (p=0.000) showing the efficacy of both drugs. There was also significant decrease in the disease severity in both groups at the end of treatment. But the safety profile of (Diclofenac) group A was not significant (p=0.767) as compared to (Aceclofenac) group B (p=0.022). Conclusions: Aceclofenac is efficacious and safe drug for the treatment of osteoarthritis in adults as compared to Diclofenac. [ABSTRACT FROM AUTHOR]

Background: Available evidence suggests that Transcranial electric motor evoked potentials and somatosensory evoked potential is safe methods to check the integrity of the spinal cord during spine deformity correction surgery. We compare the efficacy of Transcranial electric motor evoked potentials and somatosensory evoked potential to detect the nerve injury during Scoliosis surgery. Objectives: To demonstrate the advantages of combined motor and sensory evoked potential monitoring during scoliosis surgery. Methods: We analyzed records of 65 (48 female and 17 male) Scoliosis surgery cases of Transcranial electric motor evoked potential and Somatosensory evoked potential. The mean age was 15.6 years. Patients who showed significant (at least 55%) of unilateral or bilateral amplitude loss, for at least five to ten minutes during the intervention in scoliosis surgery under total intravenous anesthesia, will be included. Results: From 65 patients during surgery seventeen patients have a significant or complete drop of baseline amplitude on transcranial electric motor evoked potentials. Thirteen patients have the complete return of baseline amplitude by surgeon intraoperative intervention, whereas four patients have a reversal of motor response after 8 hours post-operatively. Transcranial electric motor evoked potential monitoring was 100% specific and 100% sensitive, whereas Somatosensory evoked potential was 100% specific and 85% sensitive. Conclusions: SSEPs and MEPs, in combination give accurate and quick information of nerve or spinal cord insult intraoperatively. [ABSTRACT FROM AUTHOR]

Background: Retrograde intramedullary nailing is commonly performed to stabilize distal femoral shaft fractures which may lead to iatrogenic injuries of the knee articular cartilage. The limited regenerative capability of cartilage may further be hindered by intake of non-steroidal anti-inflammatory drugs (NSAIDs) which are usually advised for injuries of the musculoskeletal system. The current study was designed to evaluate the histological changes in the femoral articular cartilage of knee joint after retrograde femoral nailing of rats., Methods: Retrograde intramedullary nailing was performed in 36 adult male Wistar rats, divided into three groups of 12 each. Groups 1 and 2 were given nonselective and selective COX 2 inhibitors, respectively, while the third group was taken as control. Half of the animals from each group were sacrificed at the second week, and remainder on the seventh week, and samples of the femoral articular cartilage were assessed for cartilage regeneration according to the modified Mankin scoring on histology while BMP-2 expression was evaluated on immunohistochemistry., Results: Mean modified Mankin scores for cartilage degradation were increased in animals taking NSAIDs at the second and seventh weeks of healing (P = 0.02, P < 0.001 respectively). There was a significant decrease in chondrocytes at the second week (P = 0.001), along with the loss of proteoglycan content in these animals at both time points (P = 0.001). The BMP-2 expression was significantly enhanced in the control group at the second (P = 0.001) and seventh weeks (P = 0.001)., Conclusion: The results reveal that intake of NSAIDs hinders the process of cartilage healing by reducing the number of chondrocytes and loss of proteoglycan content and decreased expression of BMP-2., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Study Design: A 2-year follow-up study., Purpose: To evaluate the effectiveness of modified halo-pelvic Ilizarov distraction assembly in the management of patients with severe kyphoscoliosis., Overview of Literature: Severe and rigid scoliosis curves are always a challenge for operating surgeons. Preoperative correction through halo-pelvic devices successfully minimizes the severity of the curve; however, cumbersome complications are also reported with its use. Modified assembly could be safe for these cases., Methods: Patients with severe kyphoscoliosis having coronal Cobb angle >90° were applied with modified halo-pelvic Ilizarov distraction assembly preoperatively. The modified assembly consisted of a pelvic component and halo ring, and distraction was given at the rate of 2-3 mm/day for 6-12 weeks. Complete clinical assessments along with pulmonary function tests were performed, and scoliosis series X-ray images were assessed for coronal and sagittal Cobb angle and other spinopelvic parameters before applying the assembly and during 2 years of follow-up., Results: Thirty-four patients (age, 9-27 years; male/female ratio of 18:16) were included. The coronal and sagittal Cobb angles were 116°±16.2° and 84°±28.3°, respectively. Correction rates obtained through modified halo-pelvic assembly were nearly 52% (p=0.001) in coronal and 40% (p=0.001) in sagittal Cobb angles, with improvement in height (p=0.001). Apical vertebral translation and coronal balance were also improved significantly (p=0.001). Further improvements in all the parameters were obtained after definitive surgery, with improvements in the forced expiratory volume in 1 second (p =0.002) and forced vital capacity (p=0.001)., Conclusions: Our modified halo-pelvic Ilizarov distraction assembly can achieve good correction in severe spinal deformities without significant risk to neurology, has fewer complications, and promotes good patient compliance.

Adjacent segment degeneration is commonly observed in patients after fusion surgery. Among the associated risk factors is the preoperative presence of adjacent disc degeneration (ADD). The risk factors and other spine phenotypes associated with preoperative ADD is critical to understand the pathological process and better prognosis postsurgery. Current study aims to assess and compare the magnetic resonance imaging (MRI) spinal phenotype of herniated level with and without ADD. Preoperative T2W sagittal lumbar MRI images of 155 lumbar disc herniated patients were analyzed for the presence of ADD (Pfirrmann grade III and above). The herniated disc level was assessed for the presence and absence of vertebral endplate (VEP) defects, Modic changes, and high intensity zone (HIZ). Mean age of patients was 38 ± 2 years, almost 62% were males. ADD was found in 57%, VEP defects were seen in 62% of the herniated level, 24.5% showed Modic changes, 3.8% showed spondylolishthesis, and 15.5% revealed HIZ. Age and other demographic factors did not have any significant effect on the presence of ADD, the patients with extruded and sequestered discs had more ADD (p = 0.02). VEP defects were significantly higher in levels with ADD (p = 0.02). Patients with ADD had significantly VEP defect scores (p = 0.01), Modic score (p = 0.002), HIZ score (0.02), and posterior bulge score (p < 0.001). Findings suggest that affected levels with VEP defects and severe grade of disc herniation have the greater likelihood of having ADD. Once developed this ADD may also affect the other spinal levels, and also can affect postoperative prognosis., (© 2023 Orthopaedic Research Society.)

Purpose: Improper utilization of surgical antimicrobial prophylaxis frequently leads to increased risks of morbidity and mortality.This study aims to understand the common causative organism of postoperative orthopedic infection and document the surgical antimicrobial prophylaxis protocol across various institutions in to order to strengthen surgical antimicrobial prophylaxis practice and provide higher-quality surgical care., Methods: This multicentric multinational retrospective study, includes 24 countries from five different regions (Asia Pacific, South Eastern Africa, Western Africa, Latin America, and Middle East). Patients who developed orthopedic surgical site infection between January 2021 and December 2022 were included. Demographic details, bacterial profile of surgical site infection, and antibiotic sensitivity pattern were documented., Results: 2038 patients from 24 countries were included. Among them 69.7 % were male patients and 64.1 % were between 20 and 60 years. 70.3 % patients underwent trauma surgery and instrumentation was used in 93.5 %. Ceftriaxone was the most common preferred in 53.4 %. Early SSI was seen in 55.2 % and deep SSI in 59.7 %. Western Africa (76 %) and Asia-Pacific (52.8 %) reported a higher number of gram-negative infections whereas gram-positive organisms were predominant in other regions. Most common gram positive organism was Staphylococcus aureus (35 %) and gram-negative was Klebsiella (17.2 %). Majority of the organisms showed variable sensitivity to broad-spectrum antibiotics., Conclusion: Our study strongly proves that every institution has to analyse their surgical site infection microbiological profile and antibiotic sensitivity of the organisms and plan their surgical antimicrobial prophylaxis accordingly. This will help to decrease the rate of surgical site infection, prevent the emergence of multidrug resistance and reduce the economic burden of treatment., (© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Background: In osteoarthritic knee, flexion deformity is caused by synovial inflammation, posterior femoral and tibial osteophytes tenting onto the capsule, ligamentous contracture and hamstring shortening. This study aimed to evaluate the safe zone of joint line elevation for the treatment of flexion knee contracture preventing mid-flexion instability in total knee replacement., Methods: 51 knees with varus osteoarthritis undergoing TKA were evaluated. 39 knees with flexion contracture < 15°and 12 knees with flexion contracture >15°. 2-mm joint line elevation was performed in just 4 knees with >15° flexion contracture. The extension and flexion gaps were measured with traditional spacer block. Stability in coronal plane (varus & valgus stress) was assessed at 0,30,60 & 90 degrees. Sampling Technique was non probability consecutive. SPSS 23 was used for statistical analysis., Results: The study comprises 51 patients undergoing total knee replacement (TKA) for osteoarthritis, with a notable gender distribution (84.3% women, 15.7% men) and a mean age of 60.24±8.54 years. Of these, 41.2% had both knees affected, and joint elevation was performed in 23.5% with flexion contracture >15°. No instability was found in cases with joint line elevation. Flexion contracture analysis revealed asymmetry across sides, yet no statistically significant differences. Detailed comparisons show variability in flexion contracture and range of motion, emphasizing the complexity of side-specific outcomes. The study underscores the importance of tailored evaluation and intervention for flexion contracture >15° to optimize postoperative results., Conclusion: This study has shown that in patients with varus osteoarthritis of the knee and flexion contracture > 15°, a 2-mm joint line elevation is safe to treat knee flexion contracture and is not associated with mid-flexion laxity. Level of evidence IV Cross sectional study.

Background: : A host of different methodologies have been implemented in the management of distal humerus fractures, including conservative measures and surgical fixation with a variety of plates. This study was conducted to evaluate the functional outcome of open reduction and internal fixation of extra articular distal humerus fractures with distal humerus locking compression plate., Methods: This is a retrospective cohort study of patients with close extra articular distal humerus fractures who underwent open reduction and internal fixation with a distal humerus locking compression plate at Ghurki Trust Teaching Hospital from July 2017 to December 2019. Various demographic indicators were used for data analysis and radiological union was assessed in serial follow-ups. Functional outcome was evaluated using the Mayo Performance Elbow Score at the final follow-up., Results: Thirty-one patients presented with extra-articular fracture of humerus (N=31) with average age 33.5±9.90 years. The average follow-up period was 13.8 months. Radiological union was achieved in 14.8 weeks (range 12-20 weeks). Out of 31 patients, 28 had excellent results with mean Mayo Elbow Performance Score of 94.8. Two patients (6.5%) had radial nerve palsy post-operatively., Conclusion: This study shows that open reduction and internal fixation of extra-articular distal humerus fractures with distal humerus locking compression plates allows for stable fixation, good functional outcome, and low complication rates.

Study Design: Cross-sectional comparative., Purpose: To characterize the scores of disc degeneration, inflammation, and nerve density in herniated disc samples and associate findings with the presence of vertebral endplate (VEP) changes on magnetic resonance imaging (MRI)., Overview of Literature: Considering the role of disc composition in spontaneous regression and persistence of pain during conservative management, it is important to identify the influencing factors. VEP changes are highly associated with disc degeneration, but their correlation with herniated disc composition has not yet been reported., Methods: Fifty-one discs were obtained from patients undergoing surgery for herniated disc. Their ages ranged from 19-65 years, and 31/51 were male. Pre-surgical T1 and T2 weighted lumbar-spine MRIs were analyzed to observe Pfirrmann grade, VEP defects, herniation type, Modic changes, and high-intensity zones (HIZ) at the affected level. Five-micron thick sections were stained with hematoxylin and eosin, Alcian blue periodic acid-Schiff stain; examined for histological degeneration scores (HDS; 0-15), inflammation (0 [absence]-3 [severe]), and presence of cartilaginous endplate (CEP). Three-micron thick sections were stained with protein-gene-product 9.5 and expression was counted/mm2. Data was analyzed, and p<0.05 was considered to indicate statistical significance., Results: VEP defects, Modic changes, and HIZ were respectively observed in 30/51, 16/51, and 6/51 of the samples. CEP was observed in 26/51 samples and in 23/51 with endplate defects. Discs with adjacent VEP defects showed increased HDS (p<0.001) and inflammation (p<0.001). Discs with adjacent Modic changes also revealed increased HDS (p=0.01). Histological sections with CEP showed increased HDS (p<0.001) and inflammation (p<0.001), and nerve density was significantly positively correlated with HDS (r=0.27, p=0.02)., Conclusions: VEP changes can modulate degeneration and inflammation of herniated discs. Presence of these changes is highly predictive of the occurrence of CEP in herniated discs, which leads to slow resorption and persistent clinical symptoms.

An 18-year-old man presented with complaints of pain and swelling around the left ankle region. Local examination revealed diffuse, hard, mildly tender swelling with ill-defined margins over the medial aspect of the left ankle joint just below the medial malleolus. Radiographic and computed tomographic assessment revealed osteolytic lesion with moderately defined margins. Provisional diagnosis of Campanacci grade 2 giant cell tumor was made, which was later confirmed on histopathology. Extended intralesional curettage and reconstruction with polymethylmethacrylate cement was done under spinal anesthesia. Full weight bearing was allowed at 4 weeks when the below knee back slab was removed. Radiographic assessment was done every 3 months during the first year of follow-up and then every 6 months. No evidence of recurrence of tumor, collapse of talus, or avascular necrosis was found during follow-up. Managing such rare form of bone tumors with extended intralesional curettage and bone cement is an appropriate treatment and gives good functional results. Level of Evidence: Level V.

A 19-year-old morbidly obese man presented with infected nonunion of femoral shaft fracture. Patient had history of 13 failed fixation surgeries, assessment revealed 3-centimetre limb-length discrepancy with 3-centimetre gap nonunion. Wound debridement, primary compression and external fixation using a customised Ilizarov external fixation assembly were planned. A four-ring customised assembly was applied. Partial weight bearing was allowed from first postoperative day on walker. Patient was kept on a monthly follow-up. After complete union at 10 months after surgery, frame was dynamised. After 6 months of dynamisation, frame was removed, at that time patient was full weight bearing. Knee was still stiff with a range of motion of 0°-20°, and there was 6 cm of limb length discrepancy, which was managed with a shoe raise. At 9 months after frame removal, patient is mobile with fully united bone. Ilizarov external fixator can be a good managing option in such difficult and complicated cases., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Tele-rehabilitation to explore current evidence on the effectiveness of tele-rehabilitation compared to face-to-face rehabilitation for patients after total hip replacement., Methods: The systematic review of clinical trials comprised search of Cochrane, Medline, Embase and PEDro databases from 2000 to date for English-language, human studies dealing with postoperative rehabilitation of total hip replacement patients. A thorough search was performed to retrieve articles missed through databases as well as unpublished grey literature. Methodological quality assessment was done using the Cochrane risk of bias tool, and the studies were critically appraised using the PEDro scale., Results: Of the 150 studies initially found on the databases, 11(7.3%) were subjected to detailed review; 4(36.4%) randomised trials, 3(27.3%) randomised controlled protocols, 3(27%) randomised pilot studies, and 1(9%) prospective cohort study. Overall, 8(72.7%) studies were of 'high' quality and 3(27.3%) fell under the category of 'fair'., Conclusions: Tele-rehabilitation group reported similar improvement in terms of activities of daily living and quality of life as did those exposed to traditional rehabilitation.

Prevalence, morphological and molecular characterization of Anisakid larvae in smoked herring fish (Clupea harengus) from five governorates that represent Northern, Middle, and Southern Egypt which include; Menofia, Alexandrina, Qaliubiya, Sohag, and Assiut were elucidated in this study, smoked herring fish samples were collected from local markets during 2020, 384 positive (42.7%) out of 815 examined samples, the highest prevalence was observed in middle and southern Egypt (Sohag (139/230, 60.43%), and Menofiya (123/215, 57.20%), they were found to be naturally infected with Anisakis simplex larvae as free in peritoneal cavity, Based on morphological, morphometric by SEM, and molecular analyses of ITS-2 ribosomal DNA targeted gene and phylogenic analysis, these nematodes were identified as third- stage larvae of Anisakis simplex., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Optimal implant density for posterior spinal fusion in adolescent idiopathic scoliosis (AIS) remains controversial. We aimed to examine radiographic outcomes of AIS cases treated with limited density pedicle screw constructs., Methods: This is a retrospective analysis of 96 patients (89 females and 7 males with mean age of 13.8 ± 4.4 years) with AIS who underwent posterior spinal instrumentation at Ghurki Trust Teaching Hospital between 2014 and 2016. Construct characteristics and radiographic measurements were compared preoperatively and at 2 year follow-up using paired t-test. Pearson's correlation coefficient between curve characteristics and metal density was calculated., Results: Preoperative coronal Cobb angle was 68.5 ± 6.9°. Flexibility of the curve was 47.5 ± 10.3% based on push-prone films. The mean number of vertebrae in the fusion was 10.7 ± 1.6. The implant density was 62%. The mean postoperative Cobb angle was 18.6 ± 4.2°, giving a mean correction of 72.5 ± 6.8%. Metal density was not correlated with preoperative coronal or sagittal radiographic variables; MT Cobb angle (r = 0.02, p = 0.847), MT curve flexibility (r = 0.129, p = 0.210), preoperative thoracic kyphosis (r = -0.119, p = 0.247) or lumbosacral lordosis (r = -0.048, p = 0.645). There was a significant correlation between the flexibility of the curve as assessed by push-prone radiographs with the percentage correction achieved (r = 0.368, p < 0.0001) as well as absolute correction in degrees (r = 0.643, p < 0.0001). No significant correlations were present between metal density and MT curve coronal correction rate/percentage (r = 0.086, p = 0.407) or postoperative Cobb angle (r = 0.098, p = 0.344)., Conclusion: Metal density does not influence the coronal and sagittal correction of AIS. Neither larger nor stiffer curves necessitate high metal density., Level of Evidence: IV., Competing Interests: Authors declare no conflict of interest., (© 2020 The Authors.)

Toxoplasma gondii is associated with physiological and psychiatric perturbations. The immune response is interrelated to the progress of anhedonia and despair symptoms of T. gondii-infected subjects. We recently reported that serum N-glycans were altered in mice displayed depressive-like behaviors. However, a novel biomarker that correlated to T. gondii infection and associated behaviors is demanded. Glycomics has been used to find affected glycoproteins during depression. The objective of this study is to investigate serum N-glycomics changes during infection with T. gondii in BALB/c mice, immunocompetent, or in severe combined immunodeficient mice, and after treatment with an immunostimulant; 1-methyl tryptophan. Glycans were examined through glycoblotting-protocol then investigated by MALDI-TOF/MS. Both depressive and sickness-related behaviors were significantly abundant (P ≤ 0.001 each), during acute T. gondii in immunocompetent mice, compared to controls. Only sickness symptoms were evident in immunodeficient mice infected with T. gondii, as associated with high expression level (P ≤ 0.001) of Peak # 15 (2 × Neu5Gc) compared to controls. The alteration of sialylated N-glycan expressions is important to detect the immune status of animals/humans against T. gondii. Moreover, 1-methyl tryptophan reduced depressive-like behavior (P ≤ 0.001) compared to controls. Therefore, sialylated N-glycan (Neu5Ac/Neu5Gc-terminal) is targeted to be used as a novel biomarker of sickness/depressive-like behaviors.

Competing Interests: Declaration of Competing Interest Authors disclose all relationships or conflict of interests that could have direct or potential influence or impart bias on the work.

Purpose: Spine-related disorders are a leading cause of global disability and are a burden on society and to public health. Currently, there is no comprehensive, evidence-based model of care for spine-related disorders, which includes back and neck pain, deformity, spine injury, neurological conditions, spinal diseases, and pathology, that could be applied in global health care settings. The purposes of this paper are to propose: (1) principles to transform the delivery of spine care; (2) an evidence-based model that could be applied globally; and (3) implementation suggestions., Methods: The Global Spine Care Initiative (GSCI) meetings and literature reviews were synthesized into a seed document and distributed to spine care experts. After three rounds of a modified Delphi process, all participants reached consensus on the final model of care and implementation steps., Results: Sixty-six experts representing 24 countries participated. The GSCI model of care has eight core principles: person-centered, people-centered, biopsychosocial, proactive, evidence-based, integrative, collaborative, and self-sustaining. The model of care includes a classification system and care pathway, levels of care, and a focus on the patient's journey. The six steps for implementation are initiation and preparation; assessment of the current situation; planning and designing solutions; implementation; assessment and evaluation of program; and sustain program and scale up., Conclusion: The GSCI proposes an evidence-based, practical, sustainable, and scalable model of care representing eight core principles with a six-step implementation plan. The aim of this model is to help transform spine care globally, especially in low- and middle-income countries and underserved communities. These slides can be retrieved under Electronic Supplementary Material.

Purpose: The purpose of this report is to describe the Global Spine Care Initiative (GSCI) contributors, disclosures, and methods for reporting transparency on the development of the recommendations., Methods: World Spine Care convened the GSCI to develop an evidence-based, practical, and sustainable healthcare model for spinal care. The initiative aims to improve the management, prevention, and public health for spine-related disorders worldwide; thus, global representation was essential. A series of meetings established the initiative's mission and goals. Electronic surveys collected contributorship and demographic information, and experiences with spinal conditions to better understand perceptions and potential biases that were contributing to the model of care., Results: Sixty-eight clinicians and scientists participated in the deliberations and are authors of one or more of the GSCI articles. Of these experts, 57 reported providing spine care in 34 countries, (i.e., low-, middle-, and high-income countries, as well as underserved communities in high-income countries.) The majority reported personally experiencing or having a close family member with one or more spinal concerns including: spine-related trauma or injury, spinal problems that required emergency or surgical intervention, spinal pain referred from non-spine sources, spinal deformity, spinal pathology or disease, neurological problems, and/or mild, moderate, or severe back or neck pain. There were no substantial reported conflicts of interest., Conclusion: The GSCI participants have broad professional experience and wide international distribution with no discipline dominating the deliberations. The GSCI believes this set of papers has the potential to inform and improve spine care globally. These slides can be retrieved under Electronic Supplementary Material.

Purpose: Spinal disorders, including back and neck pain, are major causes of disability, economic hardship, and morbidity, especially in underserved communities and low- and middle-income countries. Currently, there is no model of care to address this issue. This paper provides an overview of the papers from the Global Spine Care Initiative (GSCI), which was convened to develop an evidence-based, practical, and sustainable, spinal healthcare model for communities around the world with various levels of resources., Methods: Leading spine clinicians and scientists around the world were invited to participate. The interprofessional, international team consisted of 68 members from 24 countries, representing most disciplines that study or care for patients with spinal symptoms, including family physicians, spine surgeons, rheumatologists, chiropractors, physical therapists, epidemiologists, research methodologists, and other stakeholders., Results: Literature reviews on the burden of spinal disorders and six categories of evidence-based interventions for spinal disorders (assessment, public health, psychosocial, noninvasive, invasive, and the management of osteoporosis) were completed. In addition, participants developed a stratification system for surgical intervention, a classification system for spinal disorders, an evidence-based care pathway, and lists of resources and recommendations to implement the GSCI model of care., Conclusion: The GSCI proposes an evidence-based model that is consistent with recent calls for action to reduce the global burden of spinal disorders. The model requires testing to determine feasibility. If it proves to be implementable, this model holds great promise to reduce the tremendous global burden of spinal disorders. These slides can be retrieved under Electronic Supplementary Material.