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   Table of Contents - Current issue
April-June 2020
Volume 4 | Issue 2
Page Nos. 63-114

Online since Friday, April 3, 2020

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Before scoliosis surgery look at the eyes and face of the child p. 63
Mustafa A Salih
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Isolated congenital vertical talus: Genetics and genomics p. 66
Yasir N Khan, Sulman Basit
Congenital vertical talus (CVT) is a distinct orthopedic condition where the bone structure and number are normal in the affected foot, but the orientation of the bones is not correct. The abnormal orientation of the bones in the affected foot is believed to be due to muscle imbalance. There are a shortening and dorsal displacement of the peroneal tendons and tibialis posterior tendon, resulting in the clinical appearance of a severe rigid flatfoot. The underlying etiology of the CVT is unknown, and limited studies have been performed to decipher the genetics of CVT. The purpose of this review is to highlight the key research articles within the CVT genetics and genomics fields that were published previously. Herein, we reviewed the current literature and discussed the genetic studies carried out in families and patients with an isolated form of CVT. It is believed that CVT segregates in an autosomal dominant fashion. Most of the studies used a candidate gene approach to identify CVT causative variants. Variants in growth differentiation factor 5, HOXD10, teashirt zinc finger homeobox 1, and skeletal muscle contractile genes have been associated with CVT. An unbiased and hypothesis-free approach of whole-exome sequencing is much needed to unwire the genetic network underlying distal hind limb development and to improve our understanding of the gene regulatory mechanism in this musculoskeletal disorder. Moreover, this review focuses on highlighting the importance of the identification of the genetics of CVT and its implications in early clinical diagnosis and management of patients.
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Management of subtrochanteric fractures of femur: A narrative review p. 72
Jamal Ashraf, Arvind Kumar, Rizwan Khan, Samarth Mittal
Subtrochanteric fractures constitute complex proximal femoral fractures. These fractures are often associated with complications related to fracture union, loss of reduction, and implant failure. Reduction and stable fixation have been implicated as the major predictors for favorable outcomes. This narrative review briefly discusses various aspects of the management of subtrochanteric fractures along with various technical tips, which are helpful in achieving a satisfactory reduction of these fractures.
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Open versus Minimally invasive transforaminal lumbar interbody fusion: Intermediate outcomes in overweight and obese patients p. 82
Mohammed A Khashab, Muath M Alswat, Basil S Alsofiani, Osamah A Algamedi, Mahdi F Shulan
Objectives: To compare the intermediate results between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open approach in obese and overweight patients. Methods: A retrospective cohort study was conducted in which all cases of obese (body mass index [BMI] ≥30) and overweight (BMI ≥25) patients who had TLIF done in KAMC-NGHA, Jeddah, from January 2009 to December 2018 were reviewed. Patients were divided into two groups, namely MIS-TLIF and OPEN-TLIF and were compared in operative time, blood loss, length of hospitalization (LOH), decrease in hemoglobin, time before ambulation (TBA), and postoperative medium-term function using the Oswestry Disability Index (ODI). Results: Sixty-three MIS-TLIF and 41 Open-TLIF patients were included in the study. BMI for the open group was 31.5 kg/m2 and 33.2 kg/m2 for the MIS group. Blood loss was 175 ml for MIS-TLIF and 414.89 ml for OPEN-TLIF (P = 0.004). LOH was 4.60 days for MIS-TLIF and 8.29 days for OPEN-TLIF (P = 0.018). TBA was 1.86 days for MIS-TLIF and 3.60 days for OPEN-TLIF (P = 0.022). Operative time was 3.96 h for MIS-TLIF and 4.47 h for OPEN-TLIF (P = 0.56). The decrease in hemoglobin was 1.13 g/dl for MIS-TLIF and 1.61 g/dl for OPEN-TLIF (P = 0.435). ODI score was 25.57 points for MIS-TLIF and 19.67 points for OPEN-TLIF (P = 0.767). Conclusion: The results in MIS-TLIF are comparable with OPEN-TLIF in terms of functional outcomes. The advantages of MIS-TLIF are lesser blood loss, shorter hospital stay, and early mobilization; therefore, it is an attractive alternative for OPEN-TLIF in obese and overweight patients. However, large randomized studies are still needed.
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Osteoarthritis patients' preoperative perceptions about total knee replacement p. 87
Wazzan S Aljuhani, Abdullah N Al-Qahtani, Fayez S Alharbi
Objectives: Many patients with knee osteoarthritis refuse to undergo total knee replacement (TKR) and would rather tolerate the symptoms. This study aimed to collect information that described patients' perceptions of TKR and to identify factors that influenced decision-making about TKR and other available treatment options. Methods: This descriptive cross-sectional study was conducted in a hospital's orthopedic outpatient clinic. The study began in 2018 and used a self-administered questionnaire that comprised 16 questions and four domains, namely, activity expectations, current difficulties, expected complications, and general health. The questionnaire was completed by patients who had been advised to undergo TKR, who were aged ≥30 years, and who could read and understand Arabic. Patients with histories of orthopedic surgery were excluded. Results: A total of 362 patients participated in the study. The level of education was significantly associated with activity expectations (P < 0.025) and current difficulties (P < 0.012) negatively. The body mass index (BMI) was significantly associated with current difficulties (P < 0.002) and general health (P < 0.001). Age, gender, and marital status were not associated with the questionnaire's domains. Conclusion: The BMI and the level of education affected patients' perceptions of TKR. Low levels of expectation in relation to surgery impact upon patients' decision-making processes and could affect their quality of life.
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Commentary on: Osteoarthritis patients' preoperative perceptions about total knee replacement p. 93
Ahmed S Al Zubaidy
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Pattern and extent of traumatic epiphyseal injuries at Almadinah Almunawwarah p. 95
Zahid Mahmood Akhtar, Sultan Hatem Farsi, Hanan Helmi Almahdi, Abbas Zahid, Seraj Munir Wali, Asim Fayez Mohabbat, Abdulrahman Khalid Mansi, Mohammad Mahroos Alghabban, Ossama Hassan Alrehaili
Objectives: Epiphyseal plate is responsible for bone growth; hence, its preservation is vital for normal bone growth to occur. This study aimed to present the pattern of traumatic epiphyseal injury in a single regional hospital and list the most common causes of these injuries. Methods: This is a retrospective study, with a 1-year duration, started from October 30, 2017, using the hospital database of all admitted fracture cases for data collection at King Fahad Hospital, Almadinah Almunawwarah city, Saudi Arabia. Radiographs of all cases were reviewed. Epiphyseal injuries cases were included and classified using Salter–Harris (SH) classification. Results: The 1-year prevalence of epiphyseal injury in this project was 7.8% out of 770 fractures. Falls were the most commonly incurred type of injury. Humerus was the most common fractured bone (48.3%), followed by radius (10%). Type II SH fracture was the most frequent type observed. Fractured bones and type were significantly related to the mechanism of injury, whereas gender and type of fracture were significantly related to the age group in years. Conclusion: The 1-year prevalence of epiphyseal injuries in this study is moderately low. Falls were the most frequent mechanism of injury, and the humerus was the most commonly fractured bone, whereas SH Type II fracture was the most common morphology.
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Sciatic notch dumbbell tumor resection: A surgical technique and report of two cases p. 100
Wazzan S Aljuhani, Amal A Alamri, Abdulrahman H Bobseit
Intrapelvic and extrapelvic sciatic notch dumbbell tumors (SNDTs) are rare soft-tissue tumors that are difficult to remove. This study aimed to report the surgical technique and evaluate the clinical findings of SNDTs. We performed a retrospective review of the clinical outcomes and primary features of two consecutive cases of SNDTs. Both patients with SNDTs had different clinical presentations and prognoses and underwent surgeries with the same technique. We performed complete surgical resection of the tumor in one patient with greater trochanteric osteotomy and pelvic osteotomy in both patients. We achieved satisfactory results in both cases by implementing the utilitarian approach and pelvic osteotomy through the greater sciatic notch to surgically resect the tumors. This technique was chosen to provide a maximum benefit to the patients.
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Surgical management of a lumbar spine posterior element aneurysmal bone cyst in a child p. 105
Abdulaziz M Bayounis, Samir O Alsayegh, Turki S Almugren
The estimated annual incidence of aneurysmal bone cysts (ABCs) is 1.4 cases/100,000 people. Around 8%–30% of ABCs are located in the spine, which represents approximately 15% of all spinal tumors. Although ABCs are benign tumors, they can be locally aggressive and cause destruction of their hosting bones and pathological fractures. In spine ABC cases, compression of the spinal cord or instability of the spine might occur, and an urgent decision must be taken. We present a case of an 11-year-old boy who was found to have a second lumbar (L2) vertebral ABC and failed two sessions of sclerotherapy with a progression of the cyst that led to spinal compression. The decision was taken for surgical intervention with bone grafting and posterior instrumentation (L2–3) as there was instability due to facet destruction. We present a good outcome for surgical excision and short-segment fixation with a fusion of lumbar spine ABC in a patient who failed sclerotherapy in terms of cord decompression and a lower chance of recurrence.
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Managing severe flexion deformity of the lower femur in a young child p. 109
Mamoun K Kremli, Ameera K Elrafi, Manar M Zainab, Mayas W Sabhan
A severe flexion deformity of the knee that prevented a 2-year-old-child from walking caused by a 90° flexion of the lower right femur is presented. It was managed surgically by a large closed-trapezoid wedge extension-shortening osteotomy resulting in gaining the ability to walk. This case report represents a dilemma of diagnosis and management and discusses a well-planned trapezoid excision shortening osteotomy to save the neurovascular structures.
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Case of Leg Pain p. 113
Nizar A Al-Nakshabandi
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