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  Most popular articles (Since January 12, 2017)

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Failed carpal tunnel surgery: A guide to management
Martin Van, Rajive M Jose, Dominic Power
January-March 2019, 3(1):30-39
Revision surgery constitutes up to 2.7% of cases of carpal tunnel surgery in the UK. Failed carpal tunnel surgery can present as deterioration, recurrence or persistence of symptoms after surgical decompression. The causes of failed carpal tunnel decompression can often be categorised into four groups; poor surgery, poor nerve, poor diagnosis or poor luck. This situation calls for a structured review of the clinical history, examination, previous investigations and subsequently devising a management plan. We reviewed relevant articles on PubMed, Medline, Embase and Ovid, and we provided a structured approach to failed carpal tunnel surgery based on the current evidence. There are several options for revision carpal tunnel surgery that can be implemented to protect the median nerve, including local flaps, collagen and synthetic polymer wraps. A majority of patients experience improvement in symptoms after revision surgery.
  15,687 554 -
A review article of medial tibial stress syndrome
Saud M Alfayez, Mohammed L Ahmed, Abdulaziz Z Alomar
July-September 2017, 1(1):2-5
Medial tibial stress syndrome (MTSS), which also known as “shin splints,” is leg pain due to repetitive stresses. It is common among athletes, especially runners. It is estimated that up to 35% of all athletes have MTSS. As a consequence, the athletes spend less time in training and some of them refrain from exercises because of the exercise-induced pain, which adversely affects their career. The exact cause is still unclear. Some studies in the literature have suggested that the underlying mechanism is microdamage due to repetitive stresses. Risk factors include female gender, increased range of hip external rotation in males, navicular bone drop, increased body mass index, and training intensity. Patients usually complain of bilateral pain mainly in the anterior and/or medial side of their distal leg. Pain is aggravated by activity and relieved by rest. The examination may reveal swelling and tenderness, especially in the tibial posteromedial aspect along with other suggestive signs. Imaging modalities including radiographs, computed tomography, magnetic resonance imaging, and bone scintigraphy can be utilized to rule out other causes of similar presentation. Prevention is by repetitive stress avoidance, shock absorbing insoles, appropriate treatment of other stress-induced injuries, and screening for anatomical abnormalities. It is mostly treated conservatively with rest, ice and pain control. Athletes can keep training by doing different exercises that do not cause recurrent stresses. Surgery, which is rarely performed, is a treatment option in recalcitrant cases.
  10,359 1,323 -
A systematized approach to radiographic assessment of commonly seen genetic bone diseases in children: A pictorial review
Tamer A El-Sobky, Rabah M Shawky, Hossam M Sakr, Solaf M Elsayed, Nermine S Elsayed, Shaimaa G Ragheb, Radwa Gamal
October-December 2017, 1(2):25-32
Genetic skeletal dysplasias or osteochondrodysplasias constitute a large group of hereditable disorders with generalized skeletal involvement that can cause significant morbidity and mortality. Although most genetic skeletal dysplasias have been well identified clinically, the overlap between dysplasia subtypes may create diagnostic challenges. The plain radiographic presentation of genetic skeletal dysplasias may closely mimic rheumatologic, hematologic, and Perthes disease. Accurate review of the plain radiographic and clinical data may allow to prioritize and conduct gene sequencing tests efficiently. Bone imaging plays a distinctive role in diagnosis. We reviewed the radiologic profile of patients with some commonly seen skeletal dysplasias; achondroplasia, multiple epiphyseal dysplasia, pseudoachondroplasia, spondyloepiphyseal dysplasia tarda, osteogenesis imperfecta, mucopolysaccharidosis, and spondylometaphyseal and spondyloepimetaphyseal dysplasia. We proposed a specific radiographic approach to the differential diagnosis of commonly seen osteochondrodysplasias. The pictorial essay demonstrates that careful plain radiographic evaluation can be a very beneficial tool to the diagnostic process of osteochondrodysplasias.
  7,674 1,051 -
The stages of rehabilitation following motor nerve transfer surgery
Joshua L Hill, Lewis C Turner, Richard D Jones, Devanshi T Jimulia, Caroline Miller, Dominic M Power
January-March 2019, 3(1):60-68
Nerve transfer surgery is a reliable technique for restoration of motor function for paralysis resulting from peripheral nerve injury. The donor motor branch or fascicle is selected in proximity to the denervated target, and a tension-free end-to-end nerve coaptation is performed allowing rapid neurotisation and functional restoration. To date, a standardised rehabilitation protocol does not exist. The Birmingham Protocol was developed to enhance communication between surgeons and physiotherapists and to improve patients' understanding of the recovery process. It is a six-phase continuous rehabilitation programme designed to improve the outcomes following motor nerve transfer surgery. The programme was developed in a regional peripheral nerve injury service and has been evaluated over 10 years in >500 motor nerve transfer procedures. The programme is simple to understand and implement, allowing patient engagement and standardisation of treatment by non-specialist physiotherapists in rehabilitation units remote from the regional centre. The phases are described with expected timelines for progression for motor nerve transfers at different sites. Core outcome measures are defined to facilitate multicentre research. It is hoped that this protocol will serve as a framework that can be applied in other centres both in the UK and the international community.
  4,848 410 -
Early complications of anterior cervical discectomy and fusion: A case series
Ghazwan A Hasan, Hayder Q Raheem, Luay M Al-Naser, Reda A Sheta
July-September 2018, 2(3):121-125
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.
  4,801 383 2
Prevalence of femoral shaft fractures and associated injuries among adults after road traffic accidents in a Saudi Arabian trauma center
Abdullah M Sonbol, Abdulmalek A Almulla, Bandar M Hetaimish, Wael S Taha, Tafani S Mohmmedthani, Thabat A Alfraidi, Yousef A Alrashidi
April-June 2018, 2(2):62-65
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.
  4,370 450 -
External fixation versus open reduction and internal fixation of pilon fractures: A systematic review and meta-analysis
Manaf H Younis, Osama Aldahamsheh, Lukman Thalib, Talal Ibrahim
April-June 2018, 2(2):41-50
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.
  4,119 467 1
A new radiological classification system for developmental dysplasia of the hip in pediatric patients aged 6-months and older
Abak A Ahmad, Khalid I Khoshhal, Kazi Kabiruddin, Tarief Al-Akhras, Munzir A Izzeldin, Mubashir M Wani
October-December 2017, 1(2):39-43
Objectives: Developmental dysplasia of the hip (DDH) describes a wide spectrum of abnormal hip development and maturation defects. Till date, there have been many classifications proposed to describe the severity of the disease based on individual hip joint pathology and radiological appearance. None of these classifications has taken patients with the bilateral hip disease into consideration. A new radiological classification system based on plain pelvic radiographs has been presented, combining all the pathological possibilities in both unilateral and bilateral cases and its reliability was assessed in patients aged 6-months and older. Methods: The plain anteroposterior pelvic radiographs of 120 DDH patients were classified according to the suggested classification system by five orthopedic surgeons. Inter- and intra-observer reliability was assessed to determine the reliability and validity of the new classification system. Results: Intraobserver differences were on an average 0, and interobserver differences were negligible. The intra- and inter-observer reliability was >97%. Conclusions: The classification system developed and tested in this study is highly reliable. Our system represents a complete classification than the systems already existing. This system of classification if applied in clinical practice will help in better describing and comparing the outcome in patients with bilateral disease instead of just focusing on the outcome of individual hip joints.
  3,890 408 -
Prevalence of ankle injuries in physical education and sports classes among saudi high school male students in Riyadh, Saudi Arabia
Mohammad A Almalki, Nasser A Alowaime, Abdullah M Alanazi, Ahmed K Alanazi, Nawaf N Alamri, Mohammed A Alaqil, Emad M Masuadi, Nader S Alkenani
January-March 2018, 2(1):16-20
Objective: Physical education and sports classes are mandatory for male high school students in Saudi Arabia. Nevertheless, participation in sports activities increases the risk of injury. This study aims at assessing risk factors and estimating the prevalence of ankle injuries in physical education and sports classes among high school male students in Riyadh, Saudi Arabia. Methods: A cross-sectional study was conducted, using a data collection sheet about demographic and clinical characteristics of students and Foot and Ankle Disability Index to measure the degree of disability. Schools were chosen by cluster sampling of the four regions of Riyadh city. Three schools from each region were selected by simple random sampling. In each school, one section randomly selected from each grade, and eleven students were selected from each section by simple random sampling. Results: The prevalence of ankle injuries of the included participants (n = 399) at the study time, last month, last 6 months, last 12 months, and high school time were 14%, 21.1%, 30.3%, 31.7%, and 34.7%, respectively. Conclusions: One-third of students had an ankle injury during the high school time; only one-fifth needed treatment.
  3,833 404 1
Seat belt usage and distracted driving behaviors in Saudi Arabia: Health-care providers versus nonhealth-care providers
Ayman H Jawadi, Laura I Alolayan, Thuraya S Alsumai, Mohammad H Aljawadi, Winnie Philip, Nesrin A Alharthy, Mohammed AlMutairi
July-September 2017, 1(1):10-15
Introduction: Motor vehicle accidents (MVAs) and noncompliance to seat belt have been a continuing safety issue in Saudi Arabia for decades. The aim of this study is to determine the prevalence of seat belt use and distracted driving behaviors among health-care providers in Saudi Arabia and its comparison with nonhealth-care providers. Methods: This is a cross-sectional survey. Data were collected through an online questionnaire distributed among Saudi health-care providers in Saudi Arabia through E-mails and social media using a snowball sampling approach. The data were statistically analyzed. Results: Of 695 respondents, 356 (51.2%) were health-care providers and 339 (48.8%) were nonhealth-care providers. Seat belt wearing rates were 43% among health-care providers and 13.3% among nonhealth-care providers. Most common distracting driving behavior was cell phone usage while driving in both groups (98.6% vs. 86.5%). Conclusion: The present study revealed a statistically significant difference in compliance to seat belt usage by health-care providers compared to nonhealth-care providers. We believe that this is due to a better exposure and knowledge about the consequences of the MVA cases, as well as a high awareness about traffic rules. No statistically significant difference was observed in regard to distracted driving behavior between both groups. We would like to strongly recommend the need of various levels of awareness campaigns regarding the importance of wearing seat belt and avoiding distractive driving behavior in Saudi Arabia.
  3,628 387 1
The surgical management of traumatic neuromas
Tom Challoner, Amit Nijran, Dominic M Power
January-March 2019, 3(1):22-29
Following injury to a peripheral nerve, a neuroma may form and cause severe debilitating neuropathic pain. End neuromas are the result of an amputation or are found at the proximal stump in a complete nerve transection or rupture. Neuromas-in-continuity follows traction or compression injury and may complicate repair of a nerve transection or rupture. Symptomatic neuromas should be assessed and treated by a peripheral nerve surgeon working within a multi-professional team. The objectives of the initial treatment should encompass pain management, psychological support and physical therapies with the aim of restoration of normal nerve response thresholds to afferent stimuli and optimisation of the perineuroma environment. Surgical intervention should be reserved for non-responders and in cases where reconstruction of nerve function is deemed essential for useful functional recovery and pain resolution.
  3,702 286 2
Tibialis anterior muscle herniation repaired with trevira tube: A surgical technique and review of literature
Hatim A Al Rehaili, Abdullah M Al Ghamdi, Wazzan S Al Juhani
October-December 2019, 3(4):357-362
Muscle herniation is an outpouching of the muscle tissue through the fascia covering it. Although it is considered a rare condition, some reports had been published with the concern of misdiagnosis. Lower limbs are considered the most common area of muscle herniation and tibialis anterior muscle is the commonest. Patients usually seek medical advice for pain, cosmetic purposes, or even a worrisome swelling. It can be constitutional in origin or acquired secondary to trauma. Clinical diagnosis is the mainstay for muscle herniation confirmed by imaging (magnetic resonance imaging and ultrasound). The majority are asymptomatic and surgical treatment is reserved for the symptomatic patients using a variety of methods. In our report, we present a case of traumatic tibialis anterior muscle herniation, repaired with trevira tube (polyethylene mesh graft). The patient was satisfied during 9 months of follow-up without immediate nor late complications.
  3,566 120 -
Incidence and predictors of surgical site infections following foot and ankle surgery
Nader S Al-Kenani, Abdulaziz S Alsultan, Mariam A Alosfoor, Manal I Bahkali, Omar A Al-Mohrej
July-September 2017, 1(1):6-9
Objectives: Surgical site infections (SSIs) have a significant impact on morbidity, mortality, and health-care expenditures. Therefore, the aims of the current study were to examine the incidence of SSI among patients who had foot and ankle surgery at large hospital in Riyadh and to identify predictors of SSIs. Methods: This is a retrospective cohort study. This is a consecutive study of patients underwent foot and ankle surgery between 2010 and 2014. The association between variables and infection status was analyzed using a logistic regression model. Results: The study included 295 patients. The incidence of SSI was 3.42%. The age and the type of surgery were significant predictors of SSI. Conclusions: Proper postoperative monitoring for high-risk patients may facilitate reduction of SSIs following foot and ankle surgery and improves health outcomes.
  3,212 407 -
Gulf cooperation council female residents in orthopedics: Influences, barriers, and mental pressures: A cross-sectional study
Abdulmuhsen N Alshammari, Mohammed O Shafiq, Mohammad A Altayeb, Aliaa F Khaja, Khaled M Ghabban, Khalid I Khoshhal
April-June 2018, 2(2):51-56
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.
  3,308 303 5
Rice bodies: An uncommon incidental finding inside a bursa over a hip implant
Ganesh S Dharmshaktu, Binit Singh, Tanuja Pangtey
July-September 2017, 1(1):19-22
Osteosynthesis in orthopedic surgery involves placement of various implants inside the body as a means of fracture fixation. Certain implants have the propensity to become loose due to physiological cyclic loading or other biomechanical issues. A prominent implant often develops surrounding bursitis with or without an external wound. Removal of a prominent implant is done for clinical improvement with or without revision surgeries. A rare incidental finding of multiple rice bodies inside a bursa over an implant prominence is a rare event and has been described here with relevant details. The preoperative clinicoradiological features did not show any feature suggesting their presence, and no associated infective pathology including bacterial, mycobacterial, or fungal was identified in further investigations. A handful of cases associated with implant-related issues have been reported so far, and this case adds value to the existing literature with its rarity and learning potential.
  3,317 289 -
Study of outcome of 300 cases of arthroscopic anterior cruciate ligament reconstruction with quadrupled hamstrings tendon graft using anterior cruciate ligament tightrope for femoral fixation
Sanjay K Rai, Rohit Varma, Sunit S Wani
January-March 2018, 2(1):26-30
Objective: The aim of treatment of tear of the anterior cruciate ligament (ACL) in any military soldiers is to restore normal/near normal stability and function of the knee, preventing further damage to other knee structures and quick return to duty. We studied the functional outcome of arthroscopic-guided ACL reconstruction using quadrupled hamstring tendon graft (QHTG) and femoral side graft fixation using ACL TightRope and also to evaluate its complications. Methods: In this prospective study, evaluation parameters Lachman test, pivot test, and hamstring strength were assessed pre- and post-operatively at 3, 6, 12, 18, and 36 months. Lysholm test was assessed postoperatively. Results: A total of 300 male soldiers with a mean age of 26.5 years were evaluated. Injury due to military training, sports, fall, and road traffic accident was a common cause. Preoperatively, all patients had a positive pivot and anterior drawer tests, 4+ score of Lachman test, and 4/5 muscle strength with restriction of movement to <10°. Mean ± standard deviation Lysholm score at 3, 6, and 12 months were 81.19 ± 10.21, 83.86 ± 12.44, and 89.17 ± 8.32, respectively. At the 3rd month, negative Lachman test was seen in 83.6% (251/300) of patients, 13.6% (41/300) had 1+ laxity, and 2.6% (8/300) patients had 2+ laxity. None had positive pivot shift test. At 3 and 12 months, 91.3% (274/300) and 100% (300/300) had a grade of 5/5 power in hamstring muscles. Fifteen cases developed postoperative complications such as infection and graft failure. Conclusion: Autologous ipsilateral QHTG is a near anatomical and good choice for ACL reconstruction and is associated with fewer complications.
  3,291 298 1
Primary subacute osteomyelitis of the talus in a child
Abdulmuhsen N Alshammari, Mohammad H Alotaibi, Mohamed A Abouelnaga, Abdullah M Almohammadi
January-March 2018, 2(1):34-37
Primary subacute osteomyelitis of the talus is very rare in healthy children, and the diagnosis can be delayed or even missed, because of its uncommon presentation. Only a few cases of primary subacute osteomyelitis of the talus have been reported in the literature. In this article, we report a case of primary subacute osteomyelitis of the talus in a child and describe its symptoms, signs, radiographic appearance, and the outcome of the surgical management along with a short course of antibiotics coverage. We present this rare case report and its management to increase the awareness for the possibility of this pathology, and to avoid misdiagnosis.
  3,224 288 -
Management of the scarred nerve using porcine submucosa extracellular matrix nerve wraps
Pieter Willem Jordaan, Okezika Uhiara, Dominic Power
January-March 2019, 3(1):128-133
Objectives: Scar tissue formation around the peripheral nerves causes nerve compression and ischemia, but it also causes adherence of nerves to the surrounding tissues, decreasing the nerve's ability to glide, and therefore, causing neurostenalgia – nerve pain with motion due to tether. Our unit has been using a porcine submucosal extracellular matrix (AxoGuard® AxoGen Inc., Alachua, FL, USA) nerve wrap to prevent nerve scarring. The aim of this study is to present a case series of our use of the AxoGuard® and early follow-up data. Methods: This study describes the use of AxoGuard® nerve protectors, including the indications, anatomic locations, and complications. After obtaining ethics approval from the Institutional Audit Review Board, a retrospective review was performed of all cases where AxoGuard® nerve protectors were used from June 2015 to July 2018. Results: Over a 3-year period, AxoGuard® nerve wraps were used in 71 cases. The indication for surgery was a scarred nerve after trauma surgery in 32 cases, scarring after primary nerve surgery in 19 cases, primary trauma in 9 cases, nerve scarring after elective nonnerve surgery in 5 cases, and nerve tumors in 5 cases. There have been no complications directly related to the use of the AxoGuard® nerve protector and no cases of postoperative infection. Conclusions: The AxoGuard® nerve protector has many clinical indications, an excellent safety profile with no reported complications directly related to the nerve wrap, and is effective in mitigating the effects of neurostenalgia following revision neurolysis.
  3,230 275 2
Whole exome sequencing analysis identifies a missense variant in COL1A2 gene which causes osteogenesis imperfecta Type IV in a family from Saudi Arabia
Yaser M Alkhiary, Anum Ramzan, Muhammad Ilyas, Ubaidullah Khan, Abdul Nasir, Muhammad I Khan, Habib Ahmad, Musharraf Jelani
October-December 2017, 1(2):33-38
Objectives: Molecular diagnosis of a large Saudi family presenting an autosomal dominant form of osteogenesis imperfecta (OI). Methods: Genetic analysis of the index patient was performed through 100× paired end whole exome sequencing (WES) covering 24,000 coding genes of the human genome. The causative variant was filtered out among the previously known 23 genes' panel reported for 17 subtypes of OI. The dominant segregation of the causative variant with the disease phenotype was confirmed by Sanger sequencing. Pathogenicity of the altered protein was predicted through SIFT, PolyPhen, and MutationTaster software. Results: A heterozygous variant (c.1801G>A; p. Gly601Ser) in exon 31 of collagen 1α2 was identified. In this study, WES was successfully applied to identify the molecular basis of OI in the proband. The rest of family members were confirmed through Sanger validation confirming the autosomal dominant mode of inheritance in large Saudi family. Conclusion: OI is a rare heterogeneous disorder of connective tissues with 17 overlapping subtypes, for which 23 genes are known. Our work adds to the growing list of disease-causing variants in COL1A2. Reporting the disease-causing variants is one of the best ways to share data for better and accurate variants interpretation. We tested that WES can be used as an efficient tool for the molecular diagnosis of this rare phenotype.
  3,176 327 2
Functional anatomy of the hand: prevalence of the linburg–Comstock anomaly in a young saudi population
Mohammed T Alzahrani, Mohammad A Almalki, Turki A Althunayan, Amjaad H Almohawis, Faisal FA Almehaid, Loung V Umedani
January-March 2018, 2(1):21-25
Objectives: Linburg–Comstock (LC) anomaly is a developmental defect, characterized by flexion of thumb causing flexion of the index finger with pain in the wrist and forearm due to a tendinous interconnection between the flexor pollicis longus and flexor digitorum profundus. Methods: We carried out a random cross-sectional study in 2016. Undergraduate students were recruited; we excluded those with inflammation, hand or forearm trauma or surgery. Data were analyzed descriptively and categorically using Microsoft Excel and SPSS-20. Results: The study included 331individuals; 164 (49.5%) were male, and 167 (50.5%) were female, out of which 130 (39%) had LC anomaly. The mean age was 23 years (standard deviation ± 5.3). LC anomaly was found bilaterally in 43 (12.9%), in the right hand in 51 (15.4%) and in the left hand in 35 (10.5%). It was found bilaterally in females in 17 (10.1%) participants, and in males in 26 (15.8%), P = 0.37. The right-hand dominance was found in 294 (89%) versus left-hand in 37 (11%). Conclusion: The prevalence of LC anomaly was 39%, which matches with the global prevalence, the males showed slightly more prevalence of bilateral LC anomaly. The right-hand dominance was found in 89% as opposed to 11% having left-hand dominance.
  3,196 294 1
Managing the nerve gap: New tools in the peripheral nerve repair toolbox
Mohammad Nassimizadeh, Abdul K Nassimizadeh, Dominic Power
January-March 2019, 3(1):4-8
End-to-end repair of a peripheral nerve transection injury remains the gold standard. Delayed repair, nerve debridement and early functional mobilisation may all increase repair site tension, which impedes axon regeneration and must be avoided. Prompt diagnosis, referral to a specialist and exploration can minimise the nerve retraction, debridement and gap size, and societal benefit will be achieved through adopting a standardised approach to management. However, early exploration may provide challenges in defining the extent of the injury zone and therefore the adequacy of nerve debridement. Repair site tension can be reduced with 'sutureless' nerve approximation in a conduit, interposition of autologous graft or with interposed processed nerve allograft. Sutures can be avoided through interposition de-tensioning grafts and use of tissue glues. However, a large gap in a conduit will not support robust regeneration and grafts have two neurorrhaphy sites for axons to negotiate. Autologous graft has a donor site morbidity that may be unacceptable. An algorithm for peripheral nerve reconstruction should include the use of conduits and allograft as de-tensioning devices, avoiding the morbidity associated with autologous nerve grafting.
  3,141 341 1
The effect of exercise and nutrition on bone health
Abdel Galil M Abdel Gader
October-December 2018, 2(4):142-147
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.
  3,139 320 -
Assessment of the awareness among females in Saudi Arabia about the relationship of swaddling to developmental dysplasia of the hips
Hanan H Almahdi, Rana A Almukhlifi, Raha A Alahmadi, Bandar M Hetaimish
October-December 2017, 1(2):44-48
Objectives: With the wide use of swaddling, there is a concern that swaddling could potentially increase the risk of developmental dysplasia of the hips (DDH). A number of epidemiological studies from around the world have confirmed the association of improper swaddling with the lower limbs in adduction and extension with an increased risk of DDH, which is one of the common disorders in Saudi Arabia. This study aims to assess the prevalence of swaddling and the awareness of the females in Saudi Arabia about the correct method of swaddling and its relationship to DDH. Methods: This is a cross-sectional study, conducted using an online self-reported validated questionnaire. Results: The study involved 2631 adult females, 61% of them have children, out of which 91.3% used swaddling. Most of the ladies learnt how to swaddle from their family or friends while only 4% learnt from the health-care providers. More than 77% of the participants are not aware of the negative effects of swaddling on children's hips and around 63% did not know the correct swaddling method. 7% of them will use swaddling even if they know that it may harm their children. Conclusions: Awareness level among females in Saudi Arabia is suboptimal. Health-care providers should explain swaddling effects and demonstrate the technique for hip-friendly swaddling during ante- and post-natal care and in the media to reach all future mothers.
  2,914 317 -
Postgraduate orthopedic training in Saudi Arabia: A need assessment for change
Khalid H Alzahrani, Sohail Bajammal, Abdullah A Alghamdi, Wael Taha, Savithiri Ratnapalan
July-September 2018, 2(3):113-120
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.
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Burnout syndrome among orthopedic surgery residents in Saudi Arabia: A multicenter study
Khalid A Alsheikh, Faisal A Alhabradi, Faisal F Almalik, Abdulrahman A Alsalim, Faris E Ahmed, Ali A Alhandi
April-June 2019, 3(2):184-188
Objective: This study aimed to identify burnout syndrome prevalence among orthopedic surgery residents from different levels in different training centers of Saudi Arabia. Methods: A survey was sent to all orthopedic surgery residents in the Central, Western, and Eastern regions of Saudi Arabia in late September/early October 2018. The Maslach Burnout Inventory for Medical Personnel was used as a data collection tool. A three subscale questionnaire based on emotional exhaustion, depersonalization, and personal accomplishment determined the level of burnout syndrome. High, moderate, or low were the parameters reported after calculating the score of each subscale. Results: A total of 142 out of 301 residents completed the survey (response rate: 47.2%). The majority of the sample (90.1%, n = 128) were male. The sample had a mean of 6 on-call days per month, 2 clinic days per week, 2.3 operation days per week, and slept a mean of 5.5 h per night. More than two-thirds of the sample (68.3%) were not satisfied with their work-life balance. Around one-fifth (21.8%) of residents would not choose orthopedic surgery again as career choice and less than half of them (43%) would not choose medicine again for their graduate-level study. The results indicated that more than 56.3% of the sample scored positive for burnout syndrome. Conclusion: The study demonstrated that more than half of the studied orthopedic surgery residents in Saudi Arabia experienced burnout syndrome, which may have negative consequences for patient care, physician's efficacy, and the health-care system.
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