Patients suffering from cancer will be extensively categorized for gene mutations and other genetic aberrations, and their treatment will uniquely be based on molecular profiling instead of their cancer being initiated or detected in the body. This approach is part of what is called precision medicine (PM). The better molecular understanding of cancer that we are gaining and applying toward the development of new therapies will be applicable to cancer prevention and screening. The field of PM in oncology or precision oncology (PO) is an appropriate choice to begin the initiative of PM. The integration of genomic information from tumors with clinical information, including treatment response and patient outcomes, will create a helpful resource to enhance anticancer therapeutics that are more effective and less toxic than the traditional treatments. Sarcomas are a heterogeneous group of tumors that display a remarkable heterogeneity, with more than 50 subtypes identified so far. Enhancements in the high throughput genomic sequencing have contributed to the discovery of genomic events associated with these heterogeneous tumors and the underlying biology, have opened up paths to discover molecular targeted therapeutics, and improve the clinical decision-making processes. This review will focus on how the integration of the PO approach will affect the drug development in sarcomas and strategies for optimizing finding of novel diagnostic, prognostic, and predictive biomarkers in addition to developing more-effective personalized therapeutic approaches for patients with sarcoma.

Objective: Through the journey of getting our research article published, we thought about submitting it to the Bone and Joint Journal as one of the Q1 orthopedic journals, but before doing so, we thought about the chances of being rejected. Hence, we decided to find out how often research articles have been published from our geographical area (Arab countries). The aim of this study was to detect the contribution of Arab countries' research work in this journal. Methods: We examined all the publications by this journal over 5 years starting from January 2014 to December 2018, to find how many publications came from the Arab countries. Results: We found that among the examined 1161 articles, only 6 articles had an author or more from an Arab country. However, only one article was totally from an Arab country, and the remaining five had an author affiliated to an Arabic institution. Conclusions: There is an obvious deficiency of publications coming from Arab countries in the Bone and Joint journal as an example of the Q1 orthopedic journals. We believe that a strategy for improving the research quality as well as quantity coming from our area should be discussed and adopted by national orthopedic associations.

Objective: The objective of this study was to access the effect of athletes' attitudes, beliefs, and knowledge on doping and dietary supplementation in Saudi sports clubs so that the Saudi Arabian Anti-Doping Committee (SAADC) might be better prepared to address these issues with athletes. Methods: A cross-sectional prevalence type of study was conducted in Saudi sports clubs in six cities: Almadinah Almunawwarah, Jeddah, Abha, Tabuk, Dammam, and Riyadh. Athletes aged between 20 and 35 years were randomly selected by a systematic random sampling technique. We used a questionnaire that consisted of 55 questions divided into four categories: use of doping and dietary supplements, reason for consumption of doping and dietary supplements, personal beliefs about doping and dietary supplements, and behavior. Results: Of the 650 athletes surveyed, 155 were excluded due to incomplete data. The total number of completed questionnaires was 445 (68.5%). The survey results showed a high number of athletes reported that the main purpose of physical activity was for the health (n = 292; 65.6%), followed by to increase muscle size (n = 282; 63.5%), and weight loss (n = 100; 22.4%). Of the participants, 294 (66.1%) did not take dietary supplements, while 151 (33.9%) took supplements. Data also indicated that the highest percentage of respondents (n = 376; 84.5%) did not use doping, yet a small percentage (n = 33; 7.4%) still use doping. Conclusion: A majority of Saudi athletes in sports clubs indicated that the reason for their use of doping products and dietary supplements was to improve their health, increase muscle size, and improve their performance.

Objectives: We aimed to determine the prevalence of venous thromboembolism (VTE) in patients with acetabular or hip fractures and the relationship between hemoglobin and VTE. Methods: The records of patients diagnosed with acetabular or hip fractures between 2009 and 2015 were reviewed. A 1:4 case–control study was conducted to determine the relationship between VTE and hemoglobin. In the “case” group, convenience sampling was used, including all the patients diagnosed with deep-vein thrombosis (DVT) or pulmonary embolism (PE). In the control group (n = 80), convenience sampling with age and gender matching was used. The prevalence of VTE was determined from the number of cases identified from 2009 to 2015 divided by the number of patients diagnosed with acetabular or hip fractures over the same period. Results: During the study period, 995 patients presented with acetabular or hip fractures. Four hundred and four patients had acetabular fractures, 20 (5%) of whom developed VTE, 11 (2.7%) were diagnosed with DVT alone, 7 (1.7%) with PE alone, and 2 (0.5%) with both DVT and PE. The prevalence of VTE following hip fracture was 3%, and the prevalence of DVT, PE, and both was 1.7%, 1%, and 0.5%, respectively. The mean hemoglobin concentration at admission was 11.7 ± 2.5 g/dl in patients with VTE and 12.3 ± 2.3 g/dl in controls (P = 0.45). Conclusion: The prevalence of VTE in patients with acetabular fracture was 5% and 3% with hip fracture. The present study showed no association between hemoglobin concentration at admission and VTE.

Objectives: Congenital talipes equinovarus (CTEV) is characterized by midfoot cavus, forefoot adducts, hindfoot varus, and equinus. The condition leads to difficulty in walking. CTEV is one of the most common congenital birth defects and an incidence of 1–2/1000 newborns has been reported. The etiology of the CTEV is not completely understood. Multiple etiological factors, both environmental and genetic, have been implicated in the pathogenesis of CTEV. Genetic factors associated with the development of CTEV include mutations in genes related to limb patterning and development of muscle and blood vessels. The present study aims to screen four genes to detect the mutation underlying CTEV in families from Pakistan. Methods: Peripheral blood samples were collected from ten individuals from two Pakistani families with CTEV segregating in an autosomal recessive manner. Genomic DNA was isolated, followed by primer designing and Sanger sequencing of four known genes associated with the isolated form of CTEV (TBX4, PITX1, HOXD12, and HOXD9). Results: Clinical diagnoses of the affected individuals were made by consultant orthopedics. Sequencing analyses revealed that the four candidate genes screened here are not responsible for the CTEV phenotype in both families. Conclusion: Failure to detect sequence variant in four known genes associated with the isolated form of CTEV lead us to the conclusion that TBX4, PITX1, HOXD12, and HOXD9 mutations are not responsible for CTEV in both families. Therefore, genome-wide studies, including whole-genome single nucleotide polymorphism genotyping and whole-exome sequencing, are required to identify the underlying genetic defects in these families.

Objectives: Clubfoot deformity occurs in approximately one in 1000 newborns. In patients with neuromuscular disease, the clubfoot deformity differs markedly from that in idiopathic clubfoot with respect to its severity and higher rate of complications. We aimed to compare the effectiveness of the Ponseti serial casting technique in treating idiopathic and neuromuscular clubfoot. Methods: We performed a retrospective study of patients with clubfoot identified from a pediatric orthopedic clinic database, who were treated at our hospital from 2004 to 2018. The follow-up period for patients in both groups ranged from 8 to 12 years. The information obtained included age at presentation and number of casts required for deformity correction. We measured the severity of the clubfoot using the modified Pirani score before and after Ponseti treatment. Results: The initial number of participants was 117; upon applying our inclusion and exclusion criteria, only 39 patients from the idiopathic group and 10 from the neuromuscular disease-associated clubfoot group were included. The average age in weeks of the participants in the idiopathic group and the neuromuscular disease-associated clubfoot group at diagnosis was 1.79 and 1.80, respectively. Both groups had a similar mean modified Pirani score before and after the Ponseti treatment. Conclusions: Ponseti casting is an effective primary modality of management for clubfoot associated with neuromuscular diseases, as it is in idiopathic clubfoot, to achieve functional pain-free feet and reduce the number of surgical interventions needed.

Objectives: Car accidents (CAs) are considered as one of the leading causes of mortality worldwide. They cause various ramifications on individuals and society, with fractures being a major one. Because of poor local epidemiological data, economic burden, and the enormity of the outcomes of CA, the aim of this study was to provide vital statistics about the most frequent sites of fractures due to CA. Methods: This is a retrospective cross-sectional study conducted in King Abdulaziz Medical City, Riyadh, Saudi Arabia. It included individuals who were admitted to the hospital with fractures from CA. The study looked for bone fractures related to CA, the length of hospital stay, the age, and the gender of each individual. The data included all patients aged ≥15 years who were admitted to inpatient departments from January 2011 to December 2015. Results: A total of 1396 individuals were included, of which 86% were male. The median age of injured patients was 26 years. The median length of hospital stay was 10 days. The most common fracture found was in the acetabulum (10%). The most common region to be fractured was the skull (n = 376, 27%). Males were more predisposed to fractures in the acetabulum (11%) and the base of the skull (10%). Females were more prone to develop fractures in the pubis (10%) and the malar and maxillary bones (9%). Conclusions: The study showed that the young population has the highest number of fractures after CA, and these fractures are common in the acetabulum and skull.

We report a case of two-stage leg lengthening of the tibia through the normal tibial bone followed by a 2^nd stage lengthening through the consolidated regenerate bone using Ilizarov external fixator. A 10-year-old boy presented with multiple fractures, including a Gustilo IIIC open tibial fracture with neurovascular injury and 11 cm bone defect. Surgical debridement and acute shortening using a triangular external fixator were performed. After wounds healing, this was replaced by an Ilizarov circular frame, with a proximal tibial osteotomy performed to start distraction osteogenesis. Leg lengthening of 5.9 cm was achieved after 10.5 months of total external fixator time. Fourteen months after first frame removal, a 2^nd stage leg lengthening was performed with an Ilizarov circular frame through an osteotomy of the consolidated regenerate bone in the proximal tibia to achieve further 6.1 cm leg lengthening after 6.2 months of total external fixator time. The second leg lengthening stage united faster than the first stage with reduced external fixator time and index. The patient had a good functional outcome assessed by the Association for the Study and Application of the Methods of Ilizarov criteria at 6 months' follow-up. A literature review was performed for a proposed research question about the treatment of such cases shows that this method is an acceptable way of treatment. To the best of our knowledge, there are no cases reported in English literature that reports a 2^nd stage leg lengthening of the tibia through the consolidated regenerate bone after a first stage leg-lengthening for treatment of open tibial fracture with bone loss.

Surgical management of joint dislocation in a patient with hemophilia with an unremarkable medical history and a negative family history of hereditary diseases or hematological disorders is quite challenging. Due to its rare representation, the diagnosis can be delayed or even missed; therefore, frequent evaluations are necessary for early diagnosis and treatment. The treatment of such patients should be carried out on a comprehensive basis by a multidisciplinary team. No cases of joint dislocation secondary to hemophilia have been reported in the available English literature. In this report, we present a case of recurrent radial head dislocation following an open reduction and internal fixation of Monteggia fracture–dislocation in a patient with undiagnosed hemophilia. We describe its symptoms, signs, and investigations along with the surgical management. We present this case report and its management to increase the awareness of the possibility of this pathology and to avoid future misdiagnoses.

Rosai–Dorfman disease (RDD) is an uncommon proliferative histiocytic disorder whose etiology remains unknown. It is equally identified by the nomenclature sinus histiocytosis with massive lymphadenopathy. The major causes appear to be autoimmune dysregulation or proliferation of the histiocytes secondary to infection. The current diagnosis of this disorder is based on cytological and histological characteristics, with positive CD68 and S100 markers, and emperipolesis as the key diagnostic factor. We present the case of a 37-year-old man with multiple soft tissue masses in the left thigh, scalp, and back whose histological features were consistent with soft tissue RDD, which is an unusual presentation of this relatively rare disease.