A review of scaphoid fracture, treatment outcomes, and consequences.

PURPOSE: Scaphoid fractures are the most common carpal fracture and can lead to severe complications like carpal collapse and osteoarthritis. This study reviewed scaphoid fracture patterns, outcomes, and consequences in conservative and surgical management. METHODS: Sixty-four patients with scaphoid fracture who attended the hand clinic at King Hussein Medical City from January 2022 to December 2022 were included and reviewed regarding the anatomical fracture site, the associated injury, the treatment modality (conservative versus surgical), the healing time, and fracture sequelae such as nonunion and scaphoid nonunion advanced collapse. RESULTS: Most patients were males (62 patients, 96.9%), and most (47, 73.4%) fell within 25 to 40 years. Scaphoid waist fracture was the most common location (40, 52.5%). Most patients (47, 73.4%) received conservative treatment and 17 (26.6%) were fixed acutely. However, nonunion complicated 53 fractures (82.8%). Notably, there were no differences in the union rate or time between cases of scaphoid nonunion treated with vascularized or nonvascularized grafts. Furthermore, there were no variations in union rates among genders, extremities, age, fracture locations, or among smokers. However, a higher union rate was noted in office workers and those who received conservative treatment. CONCLUSION: Nonunions were higher in our study than in the literature, as our department is a referral center for established nonunion cases. For conservative treatment, we recommend aggressive management and follow-up with a clinical and CT scan at three months and early referral of non-united fractures to the hand clinic to avoid the advanced collapse of the scaphoid.

Outcomes of distal biceps repair at two-year follow-up.

PURPOSE: This single-centre study aimed to review the postoperative outcomes of distal biceps avulsion repair using a single incision with the endo-button technique. METHODS: A retrospective cohort study was performed of a single surgeon series of distal biceps repairs performed consecutively from September 2016 to September 2020. At two years, outcome measures included Oxford Elbow Score (OES), range of movement (ROM), complications and ongoing issues. RESULTS: Forty-five distal biceps tendon repairs were performed on 43 patients with a mean follow-up of 3.2 years (1.1-5.3). The average OES was 46 (11-48), and 90% of patients recovered a comparable range of movement to the contralateral side. Two patients developed re-rupture (4%) on days 0 and 9 of surgery, but there were no late re-ruptures of the repair. CONCLUSION: Short-term outcomes from distal biceps tendon repair show low complication rates, high patient satisfaction and good functional outcomes. The results would support acute surgical treatment of active, working-age, patients with distal biceps tendon ruptures.

Clinical and Functional Results of Lateral Ulnar Collateral Ligament Repair for Posterolateral Rotatory Instability of the Elbow.

Background Posterolateral rotatory instability of the elbow arises from damage to the lateral ulnar collateral ligament (LUCL). While various methods exist for reconstructing or repairing the LUCL's attachment to the humerus, the most effective approach remains debatable. This study aims to assess the outcomes of directly repairing the LUCL when the injury occurs at the humeral attachment. Methodology This retrospective study, conducted at the Royal Berkshire Foundation Trust NHS hospital in Reading, UK, assessed outcomes through a review of 15 patients who underwent direct repair of the lateral ulnar collateral ligament between 2017 and 2022, evaluating a range of motion, the Mayo Elbow Performance Score, and the Nestor grading system. Results This study included nine males and six females, with an average age of 38.8 years. Most LUCL injuries arose from elbow dislocation (46.7%). The average follow-up period for patients was 26 months. At the final assessment, the mean Mayo Elbow Performance Score reached 99. According to the Nestor grading system, 12 patients achieved excellent results, and three had good outcomes. On average, there was an 11.3° loss of final extension and 5° of final flexion, yet achieving a comparable pronation-supination arch to the contralateral side. Conclusion Direct repair of the LUCL for elbow posterolateral rotary instability yielded excellent outcomes, obviating ligament reconstruction. Recognized as minimally invasive, it accelerates recovery, minimizes trauma, and offers a cost-effective procedure for managing instability.

Self-Assisted Finger Stiffness Splint (SFSS).

Finger stiffness may arise from injuries, surgeries, or hand-related medical conditions, impacting hand function and overall well-being in daily life. Rehabilitation and hand therapy play a crucial role in restoring optimal range of motion, strength, and functionality. This article introduces the Self-Assisted Finger Stiffness Splint (SFSS), a dynamic splint designed for active finger movement applicable in post-trauma or postoperative rehabilitation. SFSS empowers patients to perform self-administered stretching exercises, expediting recovery and improving compliance. Its versatility extends to postoperative rehabilitation, covering cases like tenolysis of extensor tendons or rehabilitation after fracture healing. While particularly effective for proximal interphalangeal joint (PIPJ) and metacarpophalangeal joint (MCPJ) stiffness, SFSS remains valuable for managing isolated finger stiffness and proves beneficial in addressing multiple-digit stiffness.

Pseudo-Volkmann Contracture: A Case Report.

Pseudo-Volkmann contracture, also known as entrapment of the flexor muscles, occurs due to mechanical entrapment of the flexor myotendinous units in the fracture or adhesions after both bone forearm fractures. It differs from Volkmann contracture in that there is no ischemia or compartment syndrome, and there is an absence of muscle fibrosis intra-operatively. Patients with pseudo-Volkmann contracture typically present with an inability to extend the fingers passively or actively when the wrist is in extension. However, finger extension is possible when the wrist is flexed. We present the case of a 16-year-old female who developed pseudo-Volkmann contracture subsequent to sustaining a both bone forearm fracture at the age of 4. Despite early recognition of finger flexion issues, the diagnosis was delayed until the age of 16 due to parental reassurance. Consequently, further medical consultation was not sought as the child exhibited satisfactory functional abilities. Understanding these complications is crucial for administering appropriate treatment and mitigating the risk of long-term issues such as flexion contracture.

Reduction of Operative Time, Intraoperative Radiographs, and Anterior Knee Pain With the Lateral Parapatellar Approach for Tibial Shaft Fracture Nailing: A Case Series.

Background Tibia fracture is a common indication for operative intervention in orthopedics. Usage of Intramedullary nailing provides a minimally invasive technique with good results. Positioning, operative time, and radiation exposure are major points in such cases. This study described the semi-extended lateral parapatellar intramedullary technique as a technique that helps achieve and maintain reduction, simplifies nail insertion, and decreases fluoroscopy and operative time. Methodology This prospective case series study included nine patients with tibial shaft fractures operated at Royal Rehabilitation Center from April to October 2023 by intramedullary nailing and extra-articular lateral parapatellar insertion technique using the semi-extended knee position. Duration of surgery, intraoperative radiation exposure, and anterior knee pain score were assessed for all patients. Results The average duration of surgery was 63.78 ± 5.3 minutes, and the average intraoperative imaging was 94 (85-103). The average union time was 18 ±2 weeks. The mean Kujala score was 90.9% ± 2.3% six months after the surgery. All patients regained a comparable range of motion in their knees and ankles. One patient reported minimal pain at the pin site but did not require any analgesia. Conclusion The lateral parapatellar approach for tibial shaft fracture nailing has the advantage of reducing operative time, the number of intraoperative radiographs, and lower postoperative anterior knee pain. Additionally, this approach did not cause patellar instability.

Chronic Exertional Compartment Syndrome in Athletes: An Overview of the Current Literature.

Chronic exertional compartment syndrome is an incapacitating condition that primarily affects athletes and individuals with high activity levels. The exact etiology of the condition is unknown to date, but multiple factors play a role in its occurrence. The clinical presentation includes pain, tightness, muscle weakness, paresthesia, and cramps. Common tools utilized during the diagnostic approach include intramuscular compartment pressure measurement, advanced imaging to exclude other disorder entities, near-infrared spectrometry, and shear wave elastography, with the clinical diagnosis being the gold standard. Management includes both conservative and surgical options. Conservative treatment includes gait re-training and botulinum toxin injections. Further, the operative treatment has variable approaches and may be combined with conservative modalities. This article reviews the literature on chronic exertional compartment syndrome and elucidates future recommendations.

Efficacy and Safety of Hyaluronic Acid and Platelet-Rich Plasma Combination Therapy Versus Platelet-Rich Plasma Alone in Treating Knee Osteoarthritis: A Systematic Review.

Knee osteoarthritis (KOA) is a chronic degenerative disease of the joint characterized by biochemical and biomechanical alterations of articular cartilage, degradation of the joint edge, and subchondral bone hyperplasia. Nowadays, intra-articular hyaluronic acid (HA) or platelet-rich plasma (PRP) has become a popular treatment modality for treating KOA. Each treatment can be used independently or in combination. However, the efficacy and safety of combination treatment are still inconclusive, and there is a lack of high-quality level 1 studies that support using combination therapy over PRP alone. Consequently, we conducted a systematic review to examine the effectiveness and safety of combining HA and PRP therapy versus using PRP therapy alone in KOA patients. Based on the most up-to-date evidence, the dual approach of PRP and HA therapy yields outcomes similar to PRP therapy alone in the short term, up to 12 months. Nonetheless, when considering longer-term results, particularly in the 24-month follow-up, dual therapy holds the potential to produce superior outcomes compared to PRP alone therapy. Additionally, in terms of safety, dual therapy has been associated with slightly fewer adverse events.

Posteromedial elbow dislocation with irreducible medial condyle fracture in adult, a case report.

Elbow dislocation is a common elbow injury classified into simple or complex depending on the associated bony injuries. Posterolateral dislocation is the most common, while posteromedial elbow dislocation is rare. Elbow fracture-dislocation in adults usually has a typical pattern of associated fractures. However, medial condyle fracture is an uncommon pattern in the context of elbow dislocation in adults. The following report describes a thirty-two-year-old male who developed posteromedial elbow dislocation with an irreducible medial condyle fracture.

Pediatric Kienböck's Disease in an 11-Year-Old Boy: A Case Report.

Kienböck's disease is a rare condition in the pediatric age group, with little agreement on its natural history and the best treatment option. Typically, these patients present with vague wrist pain and a variable degree of joint motion restriction. Diagnosis is mainly based on clinical suspicion and MRI findings, as radiographs do not show significant changes in the early stages of the disease. Prognosis is better in children than in adults due to the good healing capacity in this age group. This study will report on an 11-year-old boy diagnosed with Kienböck's disease who underwent surgical treatment to temporarily offload the diseased lunate. Clinical and radiographic recovery was observed at the six-month follow-up.

A review of acetabular fracture patterns, etiologies, and management in Jordan.

OBJECTIVES: To review the epidemiology of acetabular fractures in Jordan and to provide a base to advance high-level clinical research in the future. METHODS: A total of 141 acetabular fractures admitted to King Hussein Medical City, Amman, Jordan, from July 2018 to December 2022 were reviewed retrospectively. Fractures were classified according to Judet and Letournel and were analyzed regarding age, gender, the cause of injury, fracture classification, mode of treatment, and associated nerve and other body part injuries. RESULTS: Males represented 84.4% of patients. The mean age was 42.52 (±17.655) years, and the age group from 20 to 39 represented 54.6% of patients. Road traffic accidents caused 56.7% of injuries, and 53.9% had other accompanying injuries. Posterior wall fractures were the most common (37.6%) patterns, and femoral head dislocation was reported in 28.4%. Posttraumatic and iatrogenic sciatic nerve injuries were reported in 7% of patients. The mean time from admission to surgery was 7.62 (±7.915) days; 66% of patients received surgical treatment, and 83.9% had a satisfactory reduction. CONCLUSION: Acetabular fractures are uncommon injuries, with road traffic accidents being the most common cause of injury. Posterior wall fracture was the most frequent pattern; most patients were males. Our results are comparable to the literature. However, we recommend future studies to measure the outcome of acetabular fracture management.

Impact of Social Distancing on Geriatric Hip Fractures Among Jordanian Population During COVID-19 Pandemic.

Background: There were serious concerns about delivering the care and support to the elderly population in Jordan during the full lockdown period. In turn, this raised concerns about how this group of population will care for themselves and if this change in the situation will increase the risk of falls and related geriatric hip fractures. Hip fractures are a significant cause of morbidity and mortality in the geriatric population. Jordan has been affected by the coronavirus disease, COVID-19; pandemic like other parts of the world. The Jordanian authorities acted early to prevent the infection from spread, and lockdown along with social distancing measures were implemented early and enforced. Even though these measures successfully slowed the spread of the virus, some concerns were raised about the delivery of care by the family and caregivers to Jordanian geriatric population. Objective: We studied the effect of lockdown and social distancing in Jordan on hip fracture incidence among the geriatric population during the lockdown period. Methods: This retrospective observational study was conducted at two Jordanian Royal Medical Services (JRMS) hospitals, King Hussein Medical Center and Prince Rashid Hospital. Patients who were treated surgically for traumatic hip dislocation during lockdown (15th March to 30th April 2020) were compared with patients during the corresponding period in 2019 regarding the incidence of geriatric hip fractures. Results: The lockdown group included 102 trauma patients, 68 patients (66.7%) had geriatric hip fractures. On the other hand, the non-lockdown group included 144 patients, 45 (31.3%) had hip fractures. Thus, the proportion of patients with geriatric hip fractures in the lockdown group was significantly higher than the non-lockdown group (P=0.034). However, the geriatric hip fractures male to female ratio were the same in lockdown and non-lockdown groups (1:1.5). Conclusion: During the complete lockdown and social distancing due to COVID-19, the epidemiology of surgically treated fractures changed; there is a decrease in the total number of trauma patients and an increase in the proportion of geriatric hip fractures.

Bone Fracture Patterns and Distributions according to Trauma Energy.

Background: This study investigates the effect of injury mechanism and energy on fracture patterns and distributions. Also, it compares differences in bone fracture patterns based on injury mechanism, gender, and age. Methods: Three thousand and sixty-six admitted patients with bone fractures were reviewed retrospectively, and the fractures were analyzed regarding age, gender, and mechanism of injury. Fractures were located in eleven bones. However, the forearm, hand, leg, and foot were considered one bone, and the fracture was then subclassified according to the anatomic position within each bone. Trauma energy was classified according to the mechanism of injury where simple falls were considered low-energy injury while falling from a height, road traffic accidents, bullet, and industrial injuries were considered high energy. Results: Males represented most of the patients, and most injuries occurred in adults. However, the male patients were more prone to injuries than females across all age groups below fifty years, women above fifty years were more frequent, and a third of females' injuries occurred in the elderly. Simple falls represent two-thirds of the trauma mechanism, and falling from a height and road traffic accidents are the most common high-energy injuries and more prevalent in males. Scapular, clavicular, distal humerus, and shaft of long bones fractures were more prevalent in males. In contrast, females had a higher frequency of proximal humerus, proximal and distal femur, distal leg, and thoracic spine fractures. Industrial injuries are more frequent in males; thus, hand injuries are more frequent. Pathological fractures were higher in females, and spine and pelvic fractures were more associated with high-energy injuries. Conclusions: The trauma's energy determines the bone injury's extent and nature. Knowing the trauma mechanism is essential to expect the extent of injuries and construct preventive measures accordingly.

Hereditary Tyrosinemia Type 1 in Jordan: A Retrospective Study.

BACKGROUND: Hereditary tyrosinemia type 1 (HT1) is a recessively inherited inborn error of metabolism affecting the final step of tyrosine catabolism. The accumulation of tyrosine toxic metabolites leads to progressive hepatic, renal, and neurological manifestations. Treatment of HT1 consists of tyrosine-restricted diets and nitisinone. The untreated disease progresses into life-threatening liver failure with an increased risk of hepatocellular carcinoma. METHODS: From April 2010 to March 2021, eighteen patients were diagnosed with HT1 in the metabolic department at Queen Rania Al Abdullah Hospital for Children in Jordan. Patients were reviewed retrospectively regarding their clinical features, laboratory data, and sociodemographic history. RESULTS: The mean age of nine boys and nine girls was 6.03 years (SD ± 3.85). The mean age for symptom onset was 5.61 months (SD ± 6.02). However, the diagnosis was belated from the onset by 10.50 months (±10.42). Nitisinone treatment was delayed from diagnosis around 12.28 months (SD ± 25.36). Most of the patients (66.7%) had acute onset of the disease. Two children (11.1%) died due to hepatic complications. Positive family history was identified in 61.1% of patients, and a similar percentage were born to parents with consanguineous marriage. The most common presentation was abdominal pain, vomiting, and fever. Hepatomegaly and abdominal distention were the most common findings. Six patients' (42.9%) first presentation was rickets. CONCLUSION: HT1 diagnosis is usually delayed because it is not part of newborn screening and nonfamiliarity with the clinical features of the disease. Therefore, nationwide newborn screening should be expanded to include HT1.