Day 1 :
Ayr University Hospital, UK
Time : 09:30-10:00
Thisara C Weerasuriya pursued his MBBS and MS in Sri Lianka, MRCS in England and FEBOT in Switzerland. He is currently working as a specialist in Trauma and Orthopaedics at University Hospital of Ayr in The UK.
A 65 year male with a high BMI, underwent an uncomplicated left total hip replacement. He insisted on going home on the 2nd post-operative day and dislocated his hip at home twice and the hip was reduced under anaesthesia twice. During mobilization he developed a pulmonary embolus necessitating thrombolytic therapy. Th is caused a haematoma which led to sciatic nerve palsy and his hip dislocated a third time. He had a posterior lip augmentation device fi tted and developed a likely wound infection subsequently. A 65 year old male with a BMI of 42 was admitted to the elective unit of the hospital for a routine total hip replacement using cement. He had osteoarthritis of his left hip which was disturbing him in his daily routine and was keeping him awake in the night. His walking distance was limited to 100 yards due to pain. He had to rely on a walking stick to help him mobilize this short distance. He was on a maximum dose of Co-Codamol and Diclofenac Sodium for pain relief, which according to him was of limited benefi t . He had to discontinue Tramadol due to constipation. Th e patient was also under treatment for type two diabetes and hypertension. He had surgery previously for retinal detachment and also has issues with sleep apnoea. Th e gentleman concerned walked with an antalgic gait. All hip movements were accompanied with an audible crepitus. The radiographs of the pelvis showed gross osteoarthritis of the left hip with narrowing of joint space, peri-articular sclerosis and osteophyte formation. Th e patient opted for a total hip replacement of the left hip has he felt that he had no other option. Following the relocation of the left hip the patient went home. He was not fi tted with an abduction brace due to anatomical constraints. Five days later he dislocated the hip once more. Two days post-reduction the patient developed sudden onset hypotension and hypoxia. A pulmonary embolus was considered and a CT pulmonary angiogram demonstrated a saddle thrombus of the pulmonary vasculature. Th rombolytic therapy led to the formation of a haematoma posteriorly at the left hip which caused pressure on the sciatic nerve causing a drop foot. He dislocated his left hip for the third time. A device was operatively fi tted on to the left hip. During surgery it was noted that his sciatic nerve was in continuity. Th e patient was re-admitted to hospital with a wound haematoma necessitating debridement and re-suture. He was treated with a course of antibiotics. However with recent research showing that obesity does not seriously alter the outcome following joint arthroplasty. More surgeons are off ering hip and knee arthroplasty to obese patients and patients may be less conscientious in making an eff ort to reduce weight. High BMI adds additional challenges to the operative procedure itself. In conclusion joint replacement should be off ered to patients with perhaps increased awareness of the full list of complications possible being clarifi ed at the very outset. Motivation to lose weight should be encouraged for the actual arthroplasty
Professor, Royal Military College of Canada, Canada
Keynote: Indexes derived from the end systolic pressure volume applied to the study of heart failure
Time : 10:00-10:30
Rachad Mounir Shoucri has completed his PhD in Theoretical Physics in 1975 at Laval University, Canada. After graduation he has worked for five years at the Institut de Cardiologie de Quebec where he has developed his current interest in mathematical physiology. Since 1981 he is with the Department of Mathematics and Computer Sciences, Royal Military College of Canada.
Based on the theory of large elastic deformation of the myocardium, a mathematical expression was derived for the non linear end systolic pressure volume relation (ESPVR). A rich collection of new indexes derived from the parameters describing the non linear ESPVR can be used to assess the ventricular function and the state of the myocardium. In particular relations obtained between ejection fraction (EF) and the new indexes derived from the non linear ESPVR give new insight into the problem of heart failure with normal or preserved ejection fraction (HFpEF) and can be used for prognostic, diagnostic and monitoring purposes. The figure shows how a relation between percentage occurrence of heart failure (HF) and EF (left side) has been extended to derive a relation between percentage occurrence of HF and SWR/SW (right side; SW=Stroke work, SWR=SWx-SW=Stroke work reserve, SWx is the maximum possible SW calculated from the area under the ESPVR). Five clinical groups are presented in the figure: Normal group (*), aortic stenosis (o), aortic valvular regurgitation (+), mitral valvular regurgitation (^), miscellaneous cardiomyopathies (x). Notice that the normal group (*) in both cases appear near the bottom of both curves with EF≈0.67 and SWR/SW≈0.34. Similar relations can be obtained for other indexes derived from the ESPVR, which show the strong potential use that can be made of the ESPVR for clinical applications.
Tameside Hospital NHS Foundation Trust, UK
Keynote: An exceptional comparative study of different treatment modalities (including ultrasound bone stimulator) of the not uncommon tibia shaft & the rare fi bula shaft fractures non-union in the same individual from a sport injury
Time : 10:00-10:30
Francis Yu-Sing Chan is a Consultant Orthopaedic Surgeon in Manchester UK and the Lead Appraiser of the Tameside Hospital NHS Foundation Trust on doctors revalidation. He completed his medical school in Queen’s University of Belfast and graduated with MB, BCh, BAO (with distinction) and BSc (with 1st class honours). He completed the basic surgical training in Northern Ireland. He completed the Higher Surgical Training in Trauma & Orthopaedic Surgery in Manchester (Clinical Lecturer of the Manchester University and Specialist Registrar). He completed the world renowned Kurgan Ilizarov Fellowship in 2003 and the AO International Trauma Fellowship in 2005. Between 2009 and 2012, He was the Clinical Director of Department of Orthopaedics at Tameside General Hospital. In addition to a busy clinical practice, He am actively involved in education. He have over 40 presentations in local and international meetings and over 40 publications in journals and book chapter. He is UK MRCS &FRCS(Tr&Orth) examiner. He is the Chairman of the Greater Manchester East Research & Ethics Committee of the UK NHS Health Research Authority. He works as the teaching faculty of the MCh(Orth) Programmes of both the Dundee University and the Edge Hill University. In 2016, He was granted with the Fellowship of the European Federation of Orthopaedics and Traumatology for recognition of my clinical and academic achievement.
Introduction: While simultaneous tibia & fi bula shaft fractures are not uncommon in both routine trauma & sport related trauma (with seventy fi ve per cents of tibia fractures have associated fi bula fractures), tibia fractures have long been regarded as the main injury and surgeons attention 'and surgical treatments are as a result focused on the tibia fractures. With the abundant soft tissues attachments to the fi bula, the traditional wisdom informs us that fi bular non-union is uncommon. Once the tibia fractures have been stabilised, the fi bula fracture would commonly united usually prior to the tibia fractures union. In the residual small number of fi bula non-union, persistent symptoms from the non-union is even rare. Th us, very little was known or published on symptomatic fibula fractures non-union following the associated tibia fracture union is achieved. In the limited literature available, while there was reported use of surgery or other non-invasive methods in the treatment of symptomatic fi bular non-union, there has been no reported use of non-invasive ultrasound bone stimulator. In this study, we reported the use of ultrasound bone stimulator in this rare symptomatic non-union. Objective: 1. To report a rare symptomatic fibula fracture non-union following tibia fracture union in a keen sports woman. 2. Th e first documented assessment of the eff ectiveness of Ultrasound Bone Stimulator in the treatment of the rare symptomatic fibula non-union. Results: On completion of the 20 weeks period of ultrasound bone stimulator treatment, the patient's right leg symptoms have completely resolved and she has returned to skiing and water skiing without further symptoms. The fibular fracture was also confi rmed to be united radiological. Conclusions: With its abundant soft tissues attachment, it has long been claimed that fibula fracture has the ideal environment for union to occur. Hence, fi bula fracture non-union is rare. In previous study of 440 patients who sustained both tibia and fi bula fractures, the reported incidence of (symptomatic and asymptomatic) radiological fi bula non-union is less than 1% and symptomatic fibula non-union is less than 0.25%. In this study, the symptomatic fi bula fracture non-union following the tibia fracture union constitutes a rare clinical situation. Review of the literature has shown treatments with electrical stimulation, and/ or surgical interventions (e.g. resection of distal fragment, internal fi xation with/ without bone graft etc.). In this study, we reported the fi rst successful use of ultrasound bone stimulator in its treatment.