Bone and skeletal muscle are the main components of the musculoskeletal system that functions as one unit to give the body shape, support, and movement. The maintenance of adequate bone health depends on a multitude of factors on the top of genetics, including nutritional factors, especially calcium, Vitamin D, and proteins, in addition to regular physical activity, particularly weight-bearing exercises and parathyroid hormone. These factors are most effective in building peak bone mass and strength during childhood and adolescence and these effects are maintained into adult life and beyond. This review will discuss how exercise and the main nutritional components perform their function in maintaining bone health, bone mineral density, and strength.

Objectives: Crouch gait in cerebral palsy (CP) is characterized by excessive knee flexion throughout stance. Single-event multilevel orthopedic surgery is the standard of care to improve gait and function through correcting lever arm deformities in children with CP. A limited number of prospective studies on single-event multilevel orthopedic surgery for crouching CP children are available. We intended to evaluate the effectiveness of single-event multilevel surgery (SEMLS) regarding functional mobility, energy consumption during gait, and the mental, attitudinal, and lifestyle status of CP children with crouch gait on the short term. Methods: Thirty-four limbs in 18 children with bilateral spastic and crouching CP were enrolled prospectively and subjected to SEMLS. The mean age was 12 years (range, 5.5–18). Outcome measures included clinical couch examination parameters, walking speed, physiological cost index (PCI), functional mobility scale (FMS), and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). In addition, we used instrumented three-dimensional gait analysis as an outcome measure for some participants. Results: At a mean follow-up of 16 months (range, 12–22), the couch examination parameters, FMS at 5, 50, and 500 m, walking speed, PCI, and WHODAS 2.0 score showed a highly statistically significant improvement (P < 0.01). Conclusions: SEMLS for CP children and adolescents with crouch gait is effective for improving function, independence, energy consumption, and quality of life on the short term.

Objectives: Legg–Calvé–Perthes Disease (LCPD) is a juvenile hip disorder in which interruption to the blood supply of the femoral head causes osteonecrosis. Previous studies reported an association between attention deficit hyperactivity disorder (ADHD) and LCPD. This study aimed to assess the relationship between ADHD and LCPD disease in a tertiary hospital in Riyadh city, Saudi Arabia. Methods: This is a case–control study that included 50 case subjects (LCPD group) and 100 controls. Both groups underwent clinical assessment by the 5^th edition of the Diagnostic and Statistical Manual of Mental Disorders criteria to diagnose ADHD and to compare the proportions in both groups. Results: The age range of the study population was 4–19 years. In the case group, we collected the data from 11 females and 39 males. The age ranged from 4 to 19 years (mean 9 years). While in the control group, we collected the data from 47 females and 53 males. The age range was 4–15 years (mean 8 years). In both groups, 34 children (22.7%) were diagnosed with ADHD, 15 (30%) in the case group and 19 (19%) in the control group. There was no significant difference in ADHD incidence between the case group and the control group (P = 0.1293, odds ratio = 1.827). LCPD has a significant male predominance (78%). Conclusions: We found that the prevalence of ADHD in LCPD is high (30%), which is comparable to the reported literature but as ADHD was higher than the reported literature in the control group (19%) the difference was statistically insignificant.

Objectives: Musculoskeletal disorders are an occupational hazard between physicians. Physicians whose practice involves physical undertakings, such as surgeons, are prone to musculoskeletal pain, which can lead to decreased productivity. This study aimed to compare surgical and nonsurgical specialties musculoskeletal pain prevalence, as well as assess whether certain factors contribute to their pain. Methods: A cross-sectional study that utilized a self-administered questionnaire handed out to 140 conveniently selected surgical and nonsurgical residents at King Abdulaziz Medical City, Riyadh. The questionnaire included a demographics section and a section inquiring about nine anatomical areas derived from the Nordic Musculoskeletal Questionnaire. Results: The mean age was 27 years old, and 79% were male. Surgical residents comprised 39% (n = 55) of the participants. Of all the residents, 82.9% (n = 116) suffered from a musculoskeletal complaint, with the majority involving the lower back (53%). Surgical residents were more likely to take time off work (16% vs. 4%) and attributed their pain to their profession (38% vs. 15%). Lower back pain was related positively to body mass index (P = 0.04). Multivariate logistical regression revealed that being a surgeon (odds ratio [OR] = 5.08 and confidence interval [CI] = 0.27–94.14) and spending time doing interventional procedures (10 h; OR = 0.97 and CI = 0.05–18.61) are predisposing factors to musculoskeletal pain. Conclusion: Ergonomic changes are needed to enhance productivity and decrease time off work. Surgical residents need to be aware of the risk of experiencing musculoskeletal pain and be educated on ways to avoid or cope with their pain.

Osteochondromas are characteristically benign cartilaginous neoplasms and are one of the most frequent benign tumors, usually targeting the axial skeleton. We came across an unusual presentation of this lesion, whereby the location of the osteochondroma is unique to the literature, and the morphological features are classified as rare. This study reviewed a case of a resected osteochondroma in a clavicle, which reoccurred a year later as chondrosarcoma. The decision was made to resect the malignant transformation. Due to the critical location of the lesion, the clavicle was left in a position where it was suspended. To protect the anatomical surroundings from the suspended clavicle, a pectoralis major flap was sutured to the sternocleidomastoid muscle. The patient has been symptom free for the past 2 years, and functional abilities have been preserved.

Caffey's disease or infantile cortical hyperostosis is a rare condition that affects infants and is mostly a self-limiting condition. It presents as an acute inflammatory process of the periosteum and the surrounding soft tissues. Affected infants present with irritability and fever. In many cases, the diagnosis gets delayed because of the rarity of the condition and the fact that it mimics a wide range of diseases that are more common and more serious including acute osteomyelitis, bone tumors, scurvy, hypervitaminosis A, infantile malignant osteopetrosis, and child abuse. This case is reported to get the awareness of the physicians about the disease, its existence in our population, presentation, and important differential diagnoses and management and to show the important role of magnetic resonance imaging in the management.