Characteristics of Elderly Hip Fracture Patients in Jordan: A Multicenter Epidemiological Study.

Background: Elderly hip fractures represent a global health care burden. Several reports expected a massive increase in the incidence of hip fractures by the next few decades. Knowing the epidemiology of hip fractures is crucial for planning health care policies. The purpose of this study is to provide a nationwide epidemiological overview of hip fractures in Jordan and to report the perioperative outcomes that may help to improve the delivered healthcare. . Methods: We conducted a retrospective study at 2 university hospitals and 2 major governmental hospitals in Jordan. We reviewed the records for all patients (age >55 years) who were diagnosed with hip fractures over a 3 years duration (2019-2021). We documented the patient's characteristics and the perioperative data (including preoperative, intraoperative, and postoperative details including the 1-year mortality). . Results: The total number of included patients was 1268; more than half (53.7%) were females. The mean age is 75 years (SD 9.7). The most common fracture type was trochanteric (66.2%) . 7% of patients had a prior contralateral hip fracture . The average time from admission to surgery was 2.96 days (SD 2.63). The surgery was done within 48 hours for 56.7% of patients. Approximately, one-third of all patients (34.5%) received a blood transfusion. The average length of hospital stay is 7.44 days (SD 5). The overall rate of postoperative thromboembolic events, readmission within 1 month, and revision for the same surgery are 2.4% , 10.7% , and 3% respectively. The 1-month, 6-month, and 12-month mortality rates are 4.5%, 9.1%, and 12.8% respectively. Conclusion: The annual incidence of elderly hip fractures in Jordan is approximately 96 per 100,000 individuals. The 1-year mortality rate of hip fractures in Jordan is 12.8% . Both findings are in the lower range of nearby Arab countries.

Translation and cross-cultural adaptation of the low back pain treatment belief questionnaire and its clinimetric properties.

BACKGROUND: The Low Back Pain Treatment Beliefs Questionnaire (LBP-TBQ) was developed to systematically measure patients' preferences about common treatments for low back pain (LBP). However, the questionnaire is not available in the Arabic language. OBJECTIVE: To translate and cross-culturally adapt the LBP-TBQ to the Arabic language and assess its clinimetric properties. METHODS: The LBP-TBQ was translated into Arabic version according to published guidelines. In pilot testing, the face and content validity of the translated questionnaire was assessed. Two hundred and fifty patients with LBP completed the translated LBP-TBQ for five common LBP treatments. In addition, a subgroup of 51 participants completed the questionnaire on two consecutive occasions to examine the test-retest reliability. RESULTS: Confirmatory factor analysis results showed that the Arabic version of LBP-TBQ has three factors: (1) "credibility", (2) "effectiveness and fitness", and (3) "concerns", and this 3-factors model had the best fit for the data for all the five treatments. Cronbach's α of the total items ranged from 0.812 to 0.899, while the sub-scores ranged from 0.557 to 0.837, indicating moderate to high internal consistency. The ICC(2,1) ranged from 0.626 to 0.909, which shows acceptable to good test-retest reliability. Correlation with other LBP questionnaires was < 0.3, demonstrating acceptable discriminant validity. Finally, the questionnaire showed acceptable criterion validity for all the subscales and the general questionnaire. CONCLUSIONS: The Arabic version of LBP-TBQ is reliable, valid, and appropriate to use in clinical and research settings.

Physiotherapists' knowledge, perception, and attitude regarding COVID-19 and infection control: An online cross-sectional survey in Jordan.

BACKGROUND: The COVID-19 pandemic highlighted the importance of knowledge and awareness of healthcare practitioners regarding infection control. OBJECTIVE: To explore Jordanian physiotherapists' knowledge and perception of COVID-19, awareness about protection measures, and attitude towards infection prevention. METHODS: A cross-sectional online survey was used. Data were collected from licensed physiotherapists currently living in Jordan. A structured survey was used to collect the data consisting of five parts: 1) General information about the physiotherapists including sociodemographic, academic training, and employment setting, 2) General knowledge about COVID-19, 3) Infection protection in the workplace, 4) Perception of COVID-19, and 5) Attitude towards COVID-19 in daily life and during work. RESULTS: A total of 147 physiotherapists completed the survey with a mean age of 30.56 (7.70) and years of experience of 7.28 (7.21). The mean of the total knowledge score was 17.18 (2.32)/ 26. There was a significant difference in the total knowledge score between COVID-19 trained physiotherapists and untrained (t = 2.895, p = 0.004). About 70.8% of the physiotherapists perceived COVID-19 as a very dangerous disease, 69.4% considered physiotherapy a high-risk profession, and 41% perceived COVID-19 does not require any special treatment. Approximately 85% of physiotherapists avoided going to crowded places and wore a mask when leaving home. 75-86.6% of physiotherapists would consider appropriate protective measures during their work. CONCLUSIONS: Physiotherapists showed suboptimal knowledge, perception, and attitude towards COVID-19. There is a need for training courses to increase physiotherapists' knowledge about COVID-19 and improve their perception and attitude towards COVID-19.

Entrapped long head of biceps tendon in pediatric proximal humerus fracture dislocation: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Combined proximal humerus fracture and glenohumeral dislocation in the pediatric population is extremely rare, with only few reports of such cases been reported. We review all cases of combined proximal humerus fracture and glenohumeral dislocation in the pediatric population and present a case of left proximal humerus fracture dislocation in a healthy 5-year-old girl. CASE PRESENTATION: A 5-year-old girl fell from 2 m height and landed on her left shoulder where she started to complain from severe left shoulder pain, inability to move her left shoulder and bruising. She was diagnosed at our facility to have left proximal humerus fracture combined with glenohumeral dislocation and was treated with open reduction, K-wires fixation and immobilization in a shoulder cast. CLINICAL DISCUSSION: Traumatic proximal humeral fracture associated with glenohumeral dislocation is a rare presentation in pediatric age group. This type of fracture is usually managed by closed reduction and casting, with a minority being managed with open reduction. Indications for surgical intervention are open fractures, severely displaced fractures, fractures that are associated with neurovascular compromise, or irreducible fracture due to soft tissue obstacles. CONCLUSIONS: A high index of suspicion is required to diagnose such injuries along with appropriate radiographic evaluation. We recommend open reduction with K-wires fixation for irreducible combined proximal humeral fracture and glenohumeral dislocation.

Spontaneous Rupture of Extensor Pollicis Longus Tendon: Clinical and Occupational Implications, Treatment Approaches and Prognostic Outcome in Non-Rheumatoid Arthritis Patients: A Retrospective Study.

BACKGROUND: Spontaneous rupture of extensor pollicis longus (EPL) tendon is a rare condition often found in patients actively having regular extensive use of hands and fingers especially the thumb. In this article, we report 7 cases of spontaneous rupture of EPL tendon and investigate the associated factors and treatment outcome. METHODS: Retrospectively, the databases for the 7 cases were retrieved and studied. These cases represent all cases of spontaneous rupture of EPL in our institution. Demographic data, clinical presentation, any history of trauma or steroid injection, laboratory and clinical findings suggestive for rheumatoid arthritis, co-morbidities and imaging findings were obtained. In addition, the operative technique and findings were retrieved. Moreover, histopathological studies and follow-up assessment were included. RESULTS: Six males and one female were included. The mean age was 45.2 years. No prior history of trauma, rheumatological disease or steroid use was detected in any patient. All patients experienced prodromal pain in the radial side. Clinical examination was the most effective diagnostic measure. Magnetic resonance imaging (MRI) was used to confirm the diagnosis and to look for other abnormalities that may predispose to rupture. Five patients underwent extensor indicis proprius to EPL tendon transfer employing Pulvertaft weave technique and one patient underwent primary repair as there was a little gap in the tendon ends. In this study, one patient refused any treatment. All patients achieved a favorable outcome at the last follow-up. CONCLUSION: Diagnosis of spontaneous ruptures of EPL tendon can be confirmed through clinical examination and MRI for patients with restricted thumb movement even with the absence of any identifiable predisposing risk factor. During surgery, detailed attention must be drawn towards the tendon ends which can have unusual gaps and bone abnormalities.

Transient Osteoporosis of the Hip: Risk and Therapy.

OBJECTIVE: The aim of this study was to investigate the impact of occupation in patients with transient osteoporosis of the hip (TOH). The study also compares two different types of management for this condition: conservative treatment and surgical drilling. METHODS: This was a retrospective case series study. The medical records for patients diagnosed with TOH at our institution within the period 2012-2017 were retrieved. General demographic data, clinical features, and diagnostic modalities were obtained. In addition, management procedures and their associated prognostic factors were acquired. The effectiveness of these procedures was assessed by the number of days of sick leave, the time needed for full recovery and the number of recurrences of TOH. Also, pain responses at 24 hrs, 48 hrs, and at 1 week were estimated subjectively through a "pain score" out of 10, and objectively through the degree of improvement in daily activity. The patients had a regular follow-up at 4- to 6-week intervals. RESULTS: In total, 15 cases of TOH, 14 men and one woman, were enrolled in the study. The mean age of the patients was 41 years (range 26-59 years). Out of the 15 cases, nine were healthcare professionals (eight physicians and one nurse). Ten patients underwent hip drilling for core decompression and five patients were treated conservatively. The time needed for full recovery was 5.8 weeks for those who underwent drilling, and 48.3 weeks for three patients receiving conservative treatment. The other two patients who were treated conservatively had not achieved full or near-full recovery at the time of reporting this study. CONCLUSION: Physicians may be at increased risk of developing TOH. Further studies should be conducted to examine the role of this occupation as a risk factor. In addition, hip drilling should be considered as an effective treatment modality, especially in those patients who seek a faster recovery.

Avascular necrosis of the femoral head after single steroid intra-articular injection.

Femoral head avascular bone necrosis (AVN) is the loss of blood supply to the bone tissue of femoral head that results in cellular death. This condition causes a significant limitation in patient daily life activities and has a poor functional outcome. Long-term steroid intake was established as a cause of AVN. However, few cases reported femoral head AVN post-single steroid intra-articular injection. We review all cases of AVN that results from single intra-articular steroid injection and present a case of femoral head AVN developed in a 78-year-old male. The patient, who was not known to have any medical illness, presented complaining of mild left hip pain for 4 months with long distant ambulation and weight standing. He was diagnosed to have left hip joint osteoarthritis for which he received intra-articular steroid injection 2 months prior visiting our orthopedics center. MRI of the pelvis revealed AVN of the femoral head. He underwent total hip arthroplasty. The pathological examination confirmed the diagnosis of AVN. To best of our knowledge, this is the fifth case of AVN of femoral head AVN after single intra-articular steroid injection. We reviewed all cases of AVN of femoral head after single steroid injection. Intra-articular steroid injection can cause femoral head AVN, and the patient receiving these injections should be aware about this rare but significant complication that results in poor functional outcome and significant morbidity.

Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual Features.

OBJECTIVES: Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor. It has several challenging features. The aim of this study is to identify challenges in the diagnosis and treatment of ABC especially in patients with unusual features. METHODS: This retrospective study involved medical record review of primary ABC patients with one or more of the following features: unusual clinical presentation with a mass or a pathological fracture especially at an unusual age, rare locations, radiological findings suggesting other diagnoses especially sarcoma, and a nondiagnostic histopathology of biopsy samples. RESULTS: 25 patients (17 males and 8 females) were included. Most patients were either younger than 10 or older than 20 years. 10 patients presented with a mass or a pathological fracture. Unusual locations include the scapula, the olecranon, the hamate, the calcaneus, and the first metatarsal bone. Extension into the epiphysis occurred in 2 patients with proximal fibula and olecranon ABCs. Two separate synchronous cysts existed in the proximal epiphysis and middiaphysis of one humerus. Radiological imaging suggested other primary diagnoses in 8 patients. Core needle biopsy was diagnostic in only 2 of 7 patients. The main treatment was intralesional resection/curettage with bone grafting. Wide resection was performed in 4 patients. Recurrence rate was 28%. Recurrence risk factors included the following: age less than 10 years, male gender, and proximal femur location. Late recurrence occurred in 3/7 patients. One patient with asymptomatic radiological recurrence showed subsequent spontaneous resolution one year later. CONCLUSIONS: This study presented multiple unusual features of ABC including: unusual age, rare locations, and nondiagnostic radiological and histopathological findings. These features can complicate the diagnosis and management. Given these features, especially with pathological fractures, a well-planned incision, the use of frozen section examination, and the application of either external fixation or plate osteosynthesis for fracture fixation can be recommended.

Idiopathic Spinal Epidural Lipomatosis in the Lumbar Spine.

Overgrowth of epidural fat, known as spinal epidural lipomatosis (SEL), can cause symptomatic compression of the spinal cord, conus medullaris, or cauda equina. Suggested predisposing factors such as obesity, steroid use, and diabetes mellitus have been based on a few reported cases, many of which were not surgically confirmed. There is a paucity of epidemiological data in surgically confirmed cases for this disorder. The purpose of this independently reviewed, retrospective, matched cohort analysis was to compare the demographics and incidence of comorbidities of patients who underwent lumbar decompression for SEL vs degenerative stenosis without SEL. Two surgeons' databases were reviewed to identify patients older than 18 years who underwent decompression surgery for magnetic resonance imaging-verified, symptomatic lumbar SEL. A matched control group comprised an equal number of patients with degenerative stenosis (n=14). Demographic data, body mass index, symptom type/duration, comorbidities, complications, treatment history, and associated pathology were collected from medical records. Previously suggested risk factors, such as obesity, endocrinopathy, and epidural steroid injections, were not significantly different between the SEL and control groups. Furthermore, there were no differences in operative times, complications, or blood loss. The only noted difference between the 2 groups was the preoperative duration of symptoms, on average double in patients with SEL. This series represents the largest of its kind reported to date. Because symptom duration was the only difference noted, it is postulated to be the result of lack of awareness of SEL. Future prospective study in a larger group of patients is warranted. [Orthopedics. 2016; 39(3):163-168.].

What are the risks of prophylactic pinning to prevent contralateral slipped capital femoral epiphysis?

BACKGROUND: Two decision analyses on managing the contralateral, unaffected hip after unilateral slipped capital femoral epiphysis (SCFE) have failed to yield consistent recommendations. Missing from both, however, are sufficient data on the risks associated with prophylactic pinning using modern surgical techniques. QUESTIONS/PURPOSES: We determined the incidence and nature of complications after contemporary prophylactic fixation of the contralateral, unaffected hip in patients with a unilateral SCFE. METHODS: We retrospectively identified and reviewed 99 children (mean age, 11 years; range, 8-15 years) who underwent prophylactic pinning of the contralateral hip after treatment of a unilateral SCFE at four tertiary-care children's hospitals from 2001 to 2010. Complications on the prophylactic side, such as avascular necrosis (AVN), chondrolysis, fractures, implant pain, and need for further surgery, were recorded. Minimum followup was 12 months (median, 26 months; range, 12-110 months). RESULTS: On the prophylactic side, we found two cases of focal AVN (2%) and no cases of chondrolysis (0%). Two patients sustained periimplant femur fractures (2%). Three patients had symptomatic hardware (3%), two of whom required surgery for implant removal. In three patients (3%), growth occurred off the end of the prophylactic screw before physeal closure, but they did not require revision fixation. No patients developed a subsequent slip on the side of the prophylactic pinning. CONCLUSIONS: While prophylactic pinning prevents SCFE, it is not an entirely benign procedure. The possibility of developing complications such as AVN and periimplant fracture should be considered when determining the best management for the contralateral hip in patients who present with unilateral SCFE. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Outcomes of suture button repair of the distal tibiofibular syndesmosis.

BACKGROUND: Recently, a suture button device has been advocated as a simple and effective method of repairing the syndesmosis. Proponents of the device have cited earlier weightbearing and elimination of the need for device removal as potential advantages over metallic screws. However, the available reports generally have short followup. With longer followup, some concerns about the suture button device have surfaced. MATERIALS AND METHODS: We reviewed the clinical and radiographic results of 24 patients with acute injuries to the distal tibiofibular syndesmosis who were treated with suture button fixation. Average followup was 20 months. The primary outcomes measure was the AOFAS ankle hindfoot score. Secondary outcomes measures included a calibrated measurement of the tibiofibular clear space and tibiofibular overlap. RESULTS: The average AOFAS score was 94 points. Syndesmotic parameters returned to normal after surgery and remained normal throughout the followup period. One in four patients required removal of the suture endobutton device due to local irritation or lack of motion. Osteolysis of the bone and subsidence of the device into the bone was observed in four patients. Three patients developed heterotopic ossification within the syndesmotic ligament, one mild, one moderate, and one who had a nearly complete syndesmotic fusion. CONCLUSION: The suture button device is an effective way to repair the syndesmosis. In our series, the reduction of the syndesmosis was maintained throughout the followup period. However, reoperation for device removal was more common than anticipated. Osteolysis of the bone near the implant and subsidence of the device may occur.