Objectives: Pilon fractures are challenging to treat and associated with complications such as skin necrosis and superficial and deep infections that can potentially lead to amputation. This meta-analysis aimed to compare the postoperative outcomes following open reduction and internal fixation (ORIF) versus external fixation for pilon fractures. Methods: We searched several databases from January 1990 to July 2017, for any observational or experimental studies that evaluated the postoperative outcomes of pilon fractures. We pooled the effect sizes using fixed-effect models that compared the postoperative outcomes of ORIF versus external fixation. Descriptive and qualitative data were also extracted. Results: Of the 485 articles identified, 13 were eligible for the meta-analysis, with a total of 683 pilon fractures in 679 patients. The pooled estimate for major infection in external fixation of pilon fractures showed comparable events compared to those who underwent ORIF (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 0.56–1.96, I²= 42.2%). External fixation was also found to be associated with higher events for minor infection (OR = 2.83, 95% CI: 1.63; 4.93, I²= 0.00%), delayed union (OR = 2.42, 95% CI: 1.02; 5.72, I²= 0.00%), nonunion (OR = 1.58, 95% CI: 0.79; 3.18, I²= 0.00%), malunion (OR = 3.14, 95% CI: 1.65; 5.97, I²= 0.00%), and posttraumatic arthritis (OR = 2.55, 95% CI: 1.40; 4.63, I²= 0.00%). These results did not change even after doing sensitivity analysis comparing limited internal fixation with external fixation, uniplanar external fixation, and circular external fixator, to ORIF. Conclusions: External fixation was associated with the same chance of having adverse events that required additional procedure(s) or intravenous antibiotics compared to ORIF in pilon fractures, but the difference in bone healing complication was much more observed. ORIF allows accurate articular reduction with comparable infection rates and lower bone healing complications.

Objectives: There is insufficient data about female orthopedic residents in the Gulf Cooperation Council (GCC) region. This study was performed to survey what influences females to take up orthopedics, and the barriers, mental pressures, and obstacles they face while a resident in training. Methods: This is a cross-sectional study, which was conducted using an online self-reported validated questionnaire. Our population consisted of 569 orthopedic trainees who met our inclusion criteria, and we received 254 anonymous responses (44.6%). Results: The response rate was 78.7% for females (37 out of 47 total females who were sent the questionnaire) and 41.6% for males (217 out of 522 total number of males). The gender distribution of those who responded was 14.6% (n=37) females and 85.4% (n=217) of males. Around half of the females (48.6%) in the study decided to join orthopedic programs during their undergraduate studies. The majority of female residents (75.7%) agreed that orthopedics is physically tiring and 89.2% of them agreed that there are gender intolerances. The need to increase the number of female residents was another notion shared by 86.5% of them. On the contrary, 62.2% of the male responders disagreed to the need of increasing the female orthopedic residents and 34% were with the opinion that female residents are not fit to cover on-call duties. Conclusion: Gender intolerances exist in the GCC orthopedic programs. This might discourage female physicians from pursuing orthopedic careers. All of the concerns raised by the residents are adjustable and attainable, such as offering maternity leaves, encouraging positive behavioral changes in male surgeons, and providing equal opportunities for applicants to orthopedic boards' acceptance.

Objectives: Total knee arthroplasty (TKA) has dramatically improved the quality of life of patients with end-stage arthritis, improving both their physical activity and functioning level. There are sufficient data illustrating the postoperative complications of patients with diabetes undergoing TKA. However, no satisfactory data exist illustrating the relationship of TKA on the glycosylated hemoglobin (HbA1c) levels in patients with type II diabetes postoperatively, which is the aim of this study. Methods: This retrospective cohort chart review study was conducted in King Abdulaziz Medical City, Riyadh, Saudi Arabia, where 308 individuals were included after applying the inclusion/exclusion criteria. The primary outcome was to establish if any association exists between type II diabetic patients and postoperative drop in HbA1c levels compared with nondiabetic patients. Results: The overall mean age was 65.5 years, and 67% of the total sample were patients with diabetes. Furthermore, 76% of the whole sample underwent unilateral knee surgery. The overall mean for pre- and post-HbA1c were 7.08 and 7.04, respectively. Conclusions: In our sample, there were more diabetic patients needing TKA than nondiabetic. It was also noticed that diabetic patients have a higher chance of undergoing bilateral TKA than unilateral when compared to nondiabetic patients, with both results being statistically significant. In addition, postoperative HbA1c level was significantly reduced in diabetic patients who underwent bilateral TKA when compared to diabetic patients who underwent unilateral TKA.

Objectives: To identify the prevalence of femoral shaft fractures (FSFs) and to study the associated injuries among road traffic accident (RTA) adult victims in a Saudi trauma center. Methods: This was a retrospective chart review of all adult patients (above 16 years of age) who had FSFs and were admitted to King Fahad Hospital in Almadinah Almunawwarah, Saudi Arabia, over a 6-year period. Results: A total of 591 patients were included in the study with a male-to-female ratio of 3.6:1 and an average age of 33.2 ± 15.9 years. The associated head injuries are statistically significant. They are found to be more in male victims(27.5%) compared to female(15.3%). A highly significant percentage of associated tibial and patellar fractures were found among males, and a higher percentage of associated distal femoral fractures were found among female patients. Head injuries were more statistically significant among patients <30 years. Fractures of the neck of femur (6.9%) and tibia (15.5%) were more among patients aged from 30 to <60 years, while distal femoral fractures were more among patients of 60 years and more group (8.2%). Conclusions: The study showed a high prevalence of associated injuries with FSFs among RTA victims. These injuries were variable and could affect any part of the body; careful evaluation of these patients to determine these injuries and to adequately treat them alongside the FSF is important.

Objectives: Femoral shaft fractures (FSFs) comprise approximately 1.6% of all bony injuries in children. The aim of this paper is to elaborate on the prevalence of FSFs and injuries associated with them in children after road traffic accidents (RTA). Methods: A retrospective review study was conducted in a trauma center in Almadinah Almunawwarah, Saudi Arabia. It evaluated FSFs in children under 16 years of age admitted under the care of orthopedics from November 2011 to October 2016. The data were analyzed using the statistical analysis system software package. Results: Data of 206 patients have met the inclusion criteria. The prevalence of injuries associated with FSFs after RTAs in children was 29.1%, whereas isolated FSFs were 70.9%. The average age was 6.9 ± 4.1 (1–15) years. The majority of cases were males (75.9%). The nonskeletal injuries represented 27.6% of the total cases; of these injuries, head injuries comprised 16%, chest 6.7%, abdomen 2.9%, and pelvic injuries 2%. Conclusions: Findings indicate the high prevalence of injuries associated with FSFs secondary to RTAs in children who were treated in this trauma center. Trauma response teams should look for the common associated injuries and manage them early.

Objectives: We present the epidemiology of pediatric fractures requiring admission, to a referral hospital, in Oman and analysis, of the environmental factors associated with the injuries, with a view to developing preventive strategies. Methods: A retrospective cross-sectional study was conducted in Sohar Hospital between December 2012 and September 2014. We ascertained the circumstances of the injury from the patient records and telephonic interviews. We also determined the safety measures in place at the homes of the victims. Results: A total of 380 consecutive pediatric fractures requiring admission were studied. A majority of the fractures occurred in males (75%). The most common fracture was distal forearm (28%). Falls at or near-home was the predominant mechanism of injury (53%). We found variations in the activities before the falls. Most of the injuries occurred in the evening. Home design played a major role in the causation of the injuries. Conclusions: Pediatric fractures cause significant morbidity, and there is a need for educating the community about home child safety in Oman. Similar patterns may exist in other countries in the Gulf region and the rest of the Middle East.

Thirteen years long follow-up was carried out in our pediatric orthopedic clinic on an 18-year-old left-hand-dominant male who suffered from hereditary multiple osteochondromas affecting only his hands since he was 5 years of age. Progressive angular and rotational deformities were observed during his childhood resulting in disabilities affecting his schooling. Although successive conservative and surgical management were undertaken, the exostoses reappeared constantly and randomly. A great functional improvement was noticed following each surgical intervention resulting in the patient being left with absolutely no functional impairment and little cosmetic deformity in his adulthood.