Objectives: The survey was conducted to gain a current understanding of how economic evaluations affect surgeon practice and determine their role in hospital purchasing decisions. Methods: A total of 589 surgeons completed a survey on their experience with health economics and hospital purchasing decisions. Demographics and survey results were analyzed both qualitatively and quantitatively. Statistical testing was performed through Chi-square analysis. Results: Of all respondents, 89% and 83% were affected by economic topics at the department level and personally, respectively, within the year before the survey. Fifty-eight percent had discussed device costs with their Finance Department and 32% stopped using their preferred implant for financial reasons. Forty percent indicated that their hospital included both the medical and Financial Departments in purchasing decisions, while 14% and 13% reported that these decisions involve the finance department only and the individual surgeon only, respectively. Fifty-five percent reported that a mixture of both financial/economic and medical/patient information is used when purchasing devices. Fifty-one percent stated that they “always” or “very often” consider the implant cost preoperatively, compared to 18% who responded with “rarely” or “never.” Conclusions: The rise of health economics has impacted surgeon practice; however, these individuals seldom receive training in the area. Interventions that improve knowledge of costs and economic evaluations among these decision-makers must be implemented in a manner that is accessible and well understood.

Objectives: Orthopedic residency training program in Saudi Arabia is one of the relatively new programs that are being expanded to accommodate a growing need. This program has not been studied systematically before. As such, assessing orthopedic trainees' needs and evaluating the program from the trainees' perspective are essential components to ensure optimal training. The purpose of this study was to assess Saudi orthopedic trainees' perceptions of the content and adequacy of their current training and its impact on knowledge and skills acquisition. Methods: Electronic questionnaire surveys were sent to all postgraduate orthopedic trainees in Saudi Arabia. A 36-items questionnaire was constructed and piloted. A 5-point Likert scale was used to obtain trainees' rating of six main areas of training. Results: Seventy-four out of 104 trainees responded to the survey (71%). Sixty-five percent of trainees rated their satisfaction with the current program as neutral (46%) or satisfactory (20%) and 34% were dissatisfied. A perceived lack of rotation-specific learning objectives (63%), suboptimal technical skills training and practice opportunities including exposure as the primary surgeon (80%), and lack of feedback (80%) were some of the main concerns expressed by trainees. Conclusions: This study highlights several areas for improvement in the current program to address trainees' learning needs and optimize surgical competency. The observed large percentage of trainees' dissatisfaction seems to be predominantly related to the lack of surgical exposure; a parameter that could be improved. In addition, research to address the training needs of orthopedic educators and program directors' perspective is required.

Objectives: Anterior cervical discectomy and fusion (ACDF) is a common procedure in cervical degenerative disorders and cervical trauma patients. However, this procedure and approach are associated with peri- and post-operative complications. This study aims to report peri- and early postoperative complications occurred during ACDF and also tries to find any relation between dysphagia and plating, smoking, or age. Methods: This is a multicentric prospective study conducted on 165 patients; 116 males (70.3%) and 49 females (29.7%); their age range was 33—61 years (mean age, 42.5 years). The study started from January 2013 to February 2017. The follow-up was for 6 weeks, and we evaluated the clinical and radiographic signs of complications. Results: Fifty-seven patients (34.5%) had transient dysphagia and two patients (1.2%) each had a dural tear, surgical-site infection, and postoperative hematoma. One patient (0.6%) each had an esophageal injury, slippage of the cage, Brown—Sequard syndrome, acute implant extrusion, and Horner syndrome. No patient had a recurrent laryngeal nerve injury. The risk factors for dysphagia include female sex, multilevel surgery, plating, and smoking, most of the dysphagic symptoms were mild in severity and lasted <6 weeks. Conclusion: Not all complications of ACDF require surgical intervention, and most of them could be treated nonoperatively with careful follow-up. Our results are comparable with what was reviewed in the literature. The incidence of complications is increased with more than one-level fusion and in multiple comorbid disorders (including diabetes mellitus and smoking). Most of the postoperative dysphagic symptoms are mild and last <6 weeks.

Objectives: Hallux valgus is one of the common causes of foot pain and deformity in the adult and adolescent population with multiple possible causes. Surgical correction with the opening proximal wedge osteotomy using low-profile plate system (LPS) fixation has been gaining popularity in the recent literature. This study report results from a case series of feet with hallux valgus corrected utilizing open proximal wedge osteotomy using LPS fixation. Methods: This was a retrospective case series of 12 consecutive patients (14 feet). All surgeries were done by a single orthopedic surgeon. A proximal wedge osteotomy using Arthrex opening wedge LPS fixation was done to all patients. Follow-up was 3 years minimum except for four patients who were lost to follow. Patient subjective satisfaction, radiographic assessment, and physical examination were reported. Results: The overall satisfaction was at 100% of followed patients. Shoe wear and foot shape were improved in 11 feet, and 12 had postoperative pain improvement. Mean preoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA) were at 30.07° and 12.36°, respectively. Postoperatively, the mean HVA and IMA improved to 13.36° and 6°, respectively (P < 0.001). All followed patients showed complete healing. Conclusion: The opening proximal wedge osteotomy with a LPS fixation has a high overall satisfaction by patients and is preferred by surgeons, which stems from its straightforward technique, which makes the technique an attractive option for correcting the hallux valgus deformity.

Macrodystrophia lipomatosa (ML) is a rare nonhereditary congenital/developmental disorder. It can manifest in limb overgrowth and disfigurement. In consequence, considerable esthetic and functional implications can develop. To overcome such problems, debulking surgery and digit amputation have been practiced. The diagnosis of ML is largely based on accurate clinical assessment and supplementary imaging modalities. The differential diagnosis of an overgrown limb(s) including ML offers numerous challenges in terms of overlapping clinical features and diversity of prognosis of the involved disorders. This study aims to describe the clinical and radiologic characteristics of two girls with ML of the foot. In particular, we intend to explore the role of magnetic resonance imaging (MRI) in clarifying the pathology and supporting the diagnosis. This study demonstrates that accurate history taking and clinical examination provide a valuable key to the diagnosis of foot ML. We used MRI effectively to delineate the characteristics of ML and confirm the diagnosis. Review of the differential diagnosis suggests a potential and important role for magnetic resonance imaging in the differential diagnosis of overgrowth disorders.