Scientific Program

Day 1

KEYNOTE SPEAKERS
  • Surgical Pain Management by In-vivo Endoscopic Visualization of Pain Generators in the Lumbar Spine

    Desert Institute for Spine Care
    USA
    Biography

    Dr Yeung specializes in diagnosing and treating the patho-anatomy of back pain and sciatica from painful degenerative conditions of the lumbar spine, particularly discogenic pain from toxic annular tears, disc herniations, lumbar spondylosis and foraminal stenosis. His over 10,000 endscopic procedures since 1991 are effective in relieving both back and leg pain, by visualizing, decompressing, and ablating the pain generator with an endoscope. He is the developer of the Yeung Endoscopic Spine System, and has interest in developing a robotic and image guidance system to facilitate his technique for spine surgeons in training.

    Abstract

    Introduction: There is a crisis of affordability in spine care delivery. Interventional pain management, often the first line of invasive treatment only provides temporary relief that depend on natural healing to mitigate pain. Visualizing the patho-anatomy with an endoscope targeting the patho-anatomy, however, has opened the door for surgical decompression and ablation of the pain generators. Endoscopic Spine Surgery is effective using mobile cannulas to target the pain source. When a surgeon combines interventional techniques with endoscopic visualization, bringing effective steps for surgical pain management. Materials and Method: Endoscopic foraminal surgery (The YESS?) technique, is featured. 1. Intra-operative evocative chromo-discography is performed to confirm discogenic pain. 2. Intradiscal therapy and visualizing the hidden zone of Mac Nab identifies 90% of pain generators. 3. Endoscopic foraminoplasty decompresses the lateral recess and visualizes the exiting and traversing nerve in the axilla containing the dorsal root ganglion (DRG). 4. Dorsal visualized rhizotomy denervates the facet joint. 10,000 surgical cases illustrate the painful conditions most suitable for foraminal endoscopic surgery. Results: The transforaminal endoscopic technique will allow surgical access to the lumbar spine for treatment of a wide spectrum of painful degenerative conditions. There are conditions where the endoscopic foraminal approach has advantages over traditional surgical approaches.1. Discitis 2. Far lateral foraminal and extraforaminal HNP, even at L5-S1, 3. Upper lumbar HNP 4. Lateral foraminal stenosis. 5. Discogenic pain from toxic annular tears. Conclusions: New surgical skills by spine surgeons incorporating endoscopic spine surgery is needed. The techniques focusing on intradiscal therapy, disc augmentation, biologics, annular modulation, and neuromodulation are all well suited for the endoscopic foraminal approach. This will open the door to for true minimally invasive access to the lumbar spine without affecting and destabilizing the dorsal muscle column. Formal training or mentorship will bring make this technology mainstream.

  • Interventions for treating osteoarthritis in the temporomandibular joint Addis Ababa Ethiopia

    Royal Specialized dental center
    Ethiopia
    Biography

    ROBERA CHALA ABEEBE was born in December 15, 1986 in Ethiopia country Oromiya Region west Shoa zone Gindaberet district. He studied my High school at Gindaberet Senior secondary school . Then he had studied Doctor of Dental Medicine (DMD) at Jimma University from one of the best higher University and pioneer for Dental doctor Medicine in Ethiopia by passing very high competition to enter the dental School. Then he had graduated in 2011 from Jimma University by DMD degree. Then he applied at MYUNGSUNG CHRISTIAN MEDICAL CENTER to one of the best Medical center in Africa for my further training to upgrade myself in more skillful and advanced way. The first two years by regular and practical training ,he had took these training by Clinical General Dentistry which includes Endodontic& Operative, Prosthodontic, Periodontal therapy & Minor oral surgery given to me by south Korean Dentists from 2012 up to 2014. Soon he had finished my first training there; He had started soon Orthodontic Specialty training for two years. He is also an instructor teaching dental and oral health for medical student at MYUNGSUNG MEDICAL COLLEGE. He had received the assistance Professor rank at this college which seen by special committee of college.

    Abstract

    The temporomandibular joint (TMJ) or jaw joint is located in front of the ear on either side of the face. However, it is the only joint that the dentists and maxillofacial surgeons predominantly have to deal with. As with many of the other joints, the TMJ can be affected by osteoarthritis (OA). This is characterized by progressive destruction of the internal surfaces of the joint which can result in debilitating pain and joint noises. Several disorders other than OA may affect the TMJ and the correct diagnosis is important such that it can be matched with appropriate therapy. A range of therapeutic options are available for TMJ OA, which include non?surgical modalities such as control of contributory factors, occlusal appliances, cold or warm packs applied to the joint, pharmacological interventions as well as physiotherapy. Surgical treatment options include intra?articular injections, arthrocentesis (lavage of the joint) as well as attempts at repair or replacement of portions of the TMJ. This review found weak evidence indicating that intra?articular injections of sodium hyaluronate (a natural constituent of cartilage) and betamethasone (an anti?inflammatory steroid) had equivalent effectiveness in reducing pain and discomfort. Occlusal appliances when compared with diclofenac sodium (a non?steroid anti?inflammatory drug) showed a similar pain reduction, as did a comparison between the food supplement glucosamine and ibuprofen (a non?steroid anti?inflammatory). Future studies should aim to provide reliable information about which therapeutic modality is likely to be more effective for the reduction of pain and other symptoms (e.g. joint sounds) of TMJ OA. Moreover, because the limited evidence available only covers a restricted number of interventions, comparisons with other therapeutic modalities should be encouraged. One of the authors' concerns was the large number of trials which included mixed groups of participants diagnosed with TMJ OA, in addition to other disorders of the TMJ, which could not be considered in this review. Background: Osteoarthritis (OA) is the most common form of arthritis of the temporomandibular joint (TMJ), and can often lead to severe pain in the orofacial region. Management options for TMJ OA include reassurance, occlusal appliances, physical therapy, medication in addition to several surgical modalities.

Spine Disorders and Spine Injuries
Osteoarthritis
Speaker
  • HOW EARLIEST THE MANIPULATION AND CASTING CAN AVOID SURGICAL INTERVENTION IN IDIOPATHIC CONGENITAL KNEE DISLOCATION.
    Speaker
    Anisuddin Bhatti
    J.S.Medical University
    Pakistan
    Biography

    Presently working as, (i) Professor & HOD, Department of Orthopaedic, Trauma & Reconstructive Surgery, Jinnah Postgraduate Medical Centre J.S.Medical University, Karachi. (2) Focal person Ponseti International Pakistan working for Clubfoot disability prevention & Eradication from Pakistan by year 2025. (3) Vice President Paediatric Orthopaedic Society, Pakistan. Remained: a) Executive Director (2015-2017), Jinnah Postgraduate Medical Centre, Karachi, Pakistan. b) President Pakistan Orthopaedic Association-POA (2012

    Abstract

    OBJECTIVE: To know, the earliest age to avoid surgical intervention in Congenital Dislocated Knee. METHODS: This Prospective study was carried at JPMC Karachi, Pakistan from January 2013 to December2016.The patients with Idiopathic, Type II & III Congenital Knee Dislocations, in newborn to three months were managed by serial manipulation and Casting with and without per cutaneous quadriceps Tenotomy. RESULTS: At 25.17 months follow-up 22 patients (31 Knees) out of 23 patients, behaved Excellent to good .Average 4 casts required, to achieve >1200 flexion, stable knees in 95.65% Knees. The number of casts increased from 3 in age group of one day to 5 casts in age group over one month, including 15.6% Per Cutaneous Tenotomies. CONCLUSION: The duration from birth to start of treatment is directly proportional to functional outcome. The CDK is easy to reduce without significant manipulation time, when treatment is started within 24 hours of birth. Manipulation takes more time and number of cast as age of initiating treatment increases from hour to four weeks. After four weeks age CDK often require an addition procedure of PCQT

Arthritis
Speaker
  • What causes Rheumatoid arthritis
    Speaker
    Brook Demissie
    St Peter Specialized hospital, Addis Ababa, Ethiopia
    Ethiopia
    Biography

    Dr Brook Demissie is a medical doctor at St Peter Specialized hospital, Addis Ababa, Ethiopia. He was medical director at Delgi Hospital, Gondar, Ethiopia where he worked for a year and 10 months after which he transferred to his current place. He finished medical school at Addis Ababa University, Medical Faculty. Brook worked at Delgi hospital in chronic disease patient’s follow up outpatient department and followed many chronic disease patients including patients with hypertension, Rheumatoid Arthritis, and others.

    Abstract

    Rheumatoid arthritis is a systemic inflammatory disorder affecting many organs (skin. joints, lung, and liver) but commonly affecting synovial fluid of joints. It affects 1% of the world population. It has no known causative factor despite the many possible theories. It is one of the causes of disability. In developed countries, because of DMRADS and ‘biologics’ the treatment option is expanded and the quality of life of these patients improved. On the other hand in developing countries, like Ethiopia, the options of treatment pause on only NSAIDs and steroids. NSAIDs and steroids may decrease the progression of the inflammatory response but do not halt the inflammatory process. In Ethiopia, especially in rural areas, a lot people are affected by this disease. In addition, though the disease usually affects those with age 40- 50yrs in Ethiopia we found many patients with the age of 20 – 30yrs. In Delgi Hospital, it is the 8th leading cause of hospital visit in outpatient departments in above 5yr patients and it accounts 6.59% of patients seen between March 30 and June 27, 2016G.C. Despite the above figure the treatment includes only NSAIDs and steroids. Most of these patients will subsequently have follow up in the hospital. The progression slows down but after 15-20 years they eventually develop permanent disability. Introducing DMRADs and ‘biologics’ in developing countries like Ethiopia may help reduce rate of disabilities thereby saving the working population which may contribute to saving the countries economy.

Bone Disorders
Speaker
  • Identification of high risk patients through effective recognition of early warning signs and reduces mortality and morbidity of orthopedic patients.
    Speaker
    Verasiya, S., Khowaja
    Aga Khan University Hospital
    Pakistan
    Biography

    Currently, she is working as a Clinical Nurse Instructor in musculoskeletal sports medicine service line (orthopedics) at Aga khan university hospital Karachi Pakistan. Previously she had an experience of Registered nurse in cardiac intensive care unit where she has to deal patient with medical surgical issues, pre and post cardiac surgeries and cardiac problems. She had an experience of Registered nurse in medical surgical nursing where she have got an opportunity to deal patient with chronic infectious disease and patient with different surgeries including orthopedics, trauma patients, general surgeries, ENT, plastic and neurosurgeries. She is a focused, competent and hardworking professional possess the ability to provide comprehensive nursing care to patients.

    Abstract

    The objective of this project is to identify high risk patients through effective recognition of early warning signs and reduce mortality and morbidity of orthopedic patient. Method: The project was conducted at The Aga Khan University Hospital from September 2016- June 2017. It was a multidisciplinary approach where a team of health care providers were involved to ensure identification of high risk patients and its interventions. The strategies employed for quality improvement were to give the awareness to nurses regarding the importance of risk assessment in every patient, reinforcement to do focused assessment to act on early warning signs. In addition to that in the daily rounds the priority of head nurses, nurse instructor, clinical nurse coordinator and team leader is to visit the high risk patients first. Multiple sessions were conducted on modified early warning signs and its action plan. Multiple mock drills and rhythm analysis sessions were conducted to ensure proper code management and resuscitation. Teachings were given regarding proper interpretation of clinical findings. During the weekend, the nurse team leader on coverage performs the role of checking the high risk patients. Result: Data was collected from January 2017 to June 2017 regarding high risk patients. A total of 34 patients were identified as high risk and managed accordingly. Out of which, 12 patients were recognized, managed and remained on the same ward bed. Whereas 19 patients, were managed

Day 2

KEYNOTE SPEAKERS
  • Radiofrequency ablation for treating chronic knee pain

    UW Health Pain Services
    USA
    Biography

    Dr. Alaa Abd-Elsayed graduated from medical school in 2000 and was hired as a member of the faculty at the public health department, where he finished his master's degree. He moved to the U.S. in 2008 and worked at the Cleveland Clinic as a research fellow in the department of anesthesiology. Between 2009 and 2013, Dr. Abd-Elsayed performed his anesthesiology residency at the University of Cincinnati. Later, he joined Cincinnati's program for pain fellowship and finally the UW School of Medicine and Public Health. He is an assistant professor in the UW Department of Anesthesiology. Dr. Abd-Elsayed also serves as medical director of the UW Pain Clinic and Pain Services Department. He has published more than 100 presentations, 80 peer-reviewed articles, 10 book chapters and several editorials. He is a member of the editorial board for a number of medical journals and regularly reviews content related to pain management.

    Abstract

    Chronic knee osteoarthritis (KOA) is a prevalent disease among the elderly. KOA does not only lead to pain but also it can cause limitation of movement, reduced physical activity and psychological disability. Common treatments used include non-steroidal anti-inflammatory medications which have limited efficacy but several side effects. Commonly used procedures include intra-articular steroid injection and hyaluronic acid injection which may fail to improve pain, may relief pain for short duration of time. In addition, steroids have several side effects especially if patient receive steroids on regular basis. Surgery is an option and can be successful, but patients who are not illegible for surgery, do not prefer to go through surgery or who already had joint replacement will need a modality that will provide long term pain relief. Articular branches to the knee joint are called genicular nerves. Genicular nerves radiofrequency ablation is a procedure with growing interest due to its efficacy, safety and feasible technical performance by ultrasound or fluoroscopy guidance.

Spine Disorders / Spine Injuries
Speaker
  • Revision of failed hip hemiarthroplasty.
    Speaker
    Elsayed Morsi
    Menoufia University
    Egypt
    Biography

    Professor. Elsayed Morsi is a hip and knee reconstructive orthopedic and sports surgeon at Menoufia university Hospital. He is considered as one of the best hip surgeons worldwide. He has been treating many famous athletes during his career. He was born in 1962 in Alexandria Egypt. He studied medicine and surgery at Faulty if Medicine, Alexandria University: and was graduated in 1986. He has master and doctorate degrees in orthopedic Surgery and traumatology in 1991 and 1997 respectively. He had two tears clinical research fellowship at Toronto University, Canada in the field of arthroplasty and reconstructive surgery.

    Abstract

    Background: Many types of failed hemiarthroplasties have been reported, but there is no classification of these failures. Patients and methods: Revisions of 217 cases of failed hemiarthroplasty were studied with an average follow-up of 6.2 years. Classification system based on site of problem, mode of failure, and type of revision, was introduced. Results: In most cases, the intra-operative assessment of failure correlated with the preoperative classification (99%). At the last follow-up, there were 15/217 re-revisions; giving a success rate of 93%. Conclusion: This classification helps in choosing the appropriate revision method, leading to acceptable results.

Bone Disorders
Speaker
  • IceBand® Knee Brace towards rapid rehabilitation in post operative Total Knee Replacements. A Prospective Trial.
    Speaker
    Mansoor Jafri
    Dr Gray’s Hospital
    Scotland
    Biography

    He is a surgeon in the Trauma & Orthopedics department of Dr Gray’s Hospital, Elgin, Scotland

    Abstract

    IceBand® is a Disposable Cooling Compression Brace made of “protective non-­woven fabrics”. It is available as a pair and uses pure water and “Phase Changing Element” technology providing longer lasting cooling effects to swollen and warm postoperative knees. This is safe, simple, and efficient way to faster rehabilitation and postoperative pain relief. The trial was compared against previously used “Cryo-­Cuffs” which were bulky, cools off quickly and required attachment to a water cooler, involving staff help. It required re-­chilling after first half hour and lasted for twenty minutes only. Cleaning required in order to be used for another subject thus risking infection transmission. In contrast, IceBand® provided cooling phase lasting more than sixty minutes, and re-­usable up to thirty times after repeated cooling of spare brace in freezer. It hardly required any staff involvement and the subjects were mobile independently as there was no attachment to the water cooler. Twelve random patients participated in trial. Each used both methods for half a day. Questionnaires were handed to patients asking parameters of user friendly, security, interference with mobility, pain relief, preference of method and complications if any. Each parameter was given a score and average calculated. All patients opted for IceBand® as it is comfortable for mobility, lighter, simple application, user friendly, longer lasting, re-­useable spare available to take home, and disposed as household waste. Pain relief scored 8.5 for IceBand® vs. 5.25 for cryo-­cuff. Mobility score 8.58 vs. 6-­ application ease 9.5 vs. 5.75 and overall score of 38.33 vs. 23.

  • Stability of femoral neck osteosynthesis: Comparison of different cannulated screws configurations
    Speaker
    Xu Renjie
    Suzhou Municipal Hospital
    China
    Biography

    Dr. Xu Renjie is an associate chief physician in orthopaedic department of Suzhou Municipal Hospital. He graduated with a medical doctor degree from Peking University in 2009. After graduation, he worked in Suzhou Municipal Hospital, major in Trauma of Bone and Joint

    Abstract

    Objective: To compare the biomechanical characteristics of three cannulated screws in paralleled and non-paralleled (including crossed and divergent)configuration in treating femoral neck fractures, also to identify the association between bone mineral density and biomechanical characteristics in the femoral neck fractures using three cannulated screws. Methods: 36 femurs of human cadavers were divided into 3 groups (each group included 12 femurs). The bone mineral density of all the specimens were tested. Femoral neck fractures were simulated in all the specimens, followed by osteosynthesis using three cannulated screws in three kinds of configurations. Using load test and torsion test to evaluate the biomechanical characteristics. Axial load test included single progressive test, cyclic fatigue test and destructive test. Torsion test included single progressive test and destructive test. Multiple linear regression models were constructed to analyze the statistics. Results: Only when axial load was small (200N and 400N) in single progressive test the results showed no significant difference between crossed group and divergent group. After the adjustment for bone mineral density, other axial load tests showed paralleled group excelled divergent group, divergent group excelled crossed group. After the adjustment for bone mineral density, other torsion tests showed paralleled group excelled crossed group, crossed group excelled divergent group. After adjustment for configuration of cannulated screws, the greater the bone mineral density, the stronger the axial and anti-rotation strength. Conclusion: Both the configuration of cannulated screws and bone mineral density can affect the axial strength and anti-rotation strength. The configuration appears to be even more weighted than bone mineral density.

Arthritis
Speaker
  • Improving Outcomes with Data: Developing an Orthopaedic Trauma Registry in Pakistan
    Speaker
    Zehra Abdul Muhammad
    Aga Khan University Hospital
    Pakistan
    Biography

    Dr. Zehra did her Master in Medical and Pharmaceutical research from Vrije Unuversity of Brussels and conducted her basic research in the field of molecular biology. She has been involved with multidisciplinary research areas and has seven years’ experience working in clinical research setting. Recently she is working as a research associate at Aga Khan University Hospital, Karachi, Pakistan and she is committed to assist in providing highest quality of care to trauma victims and promote her city a center of excellence for trauma care and trauma research.

    Abstract

    Objective: To establish an orthopaedic trauma registry at Aga Khan University as a model system of objective, reliable assessment of injuries, recording of management and analysis of outcomes. Methods: Consensus was developed among all orthopaedic surgeons about the need for an orthopaedic trauma registry. Internationally validated injury-specific scoring scales enabling objective assessment of functional, clinical and radiological outcomes were selected. The study was approved by the Departmental Research Committee and Institutional Ethical Review Committee. After obtaining informed consent from eligible patients, data was collected from the patient’s medical records. Injury-specific outcomes were assessed at multiple time points and reports were generated about injuries, hospital care provided, and outcome. Results: Over a 19-month period, 350 patients were enrolled. There were 123 patients with upper limb injuries, 200 with lower limb injuries and 27 with poly trauma involving both upper and lower limbs. Road traffic accidents, falls and firearm injuries accounted for the top three commonest causes of orthopaedic trauma. Outcome assessment was completed in about one half, a third had stopped following up, while is ongoing in the remaining patients. Conclusion: Robust methods of trauma data capture and analysis are fundamental requirements for improvement in management outcomes in patients with orthopaedic trauma. Through the registry data a system of outcome monitoring and peer-review to enable early identification of complications and need for re-intervention can be developed. Registry data also permits comparison of outcomes with international benchmarks. We plan to expand the scope of the registry within the city, and across the country for a uniform, comprehensive system of data capturing, management and analysis, enabling evidence-based decisions. Six-monthly and annual reviews will enable exploration of possible areas for improvement in the infrastructure and process, thus improving the quality of orthopaedic trauma care, and outcomes.

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