The frequency of os acromiale in 751 shoulder MRI of Saudi population.

Background: Os acromiale (OA) is an uncommon pathology with a variable prevalence rate among different populations. Objectives: The aim of this study was to report the frequency of OA utilizing shoulder MRI of patients with shoulder pathology. Methods: It was a retrospective study. After obtaining our IRB approval, we gathered all shoulder and upper arm MRIs from the radiology department and evaluated them. Results: The prevalence of OA was found to be 3.32%. The mean age of the affected patients was 50.87 years (25-81). Conclusion: The rate of OA in patients presenting with shoulder pain is 3.32% in Saudi Arabia, which correlates with what has been previously reported in the literature.

Acromioclavicular joint separation: Controversies and treatment algorithm.

In this article, we present an uptodate outline of acromioclavicular (AC) joint separation. A clear understanding of acromioclavicular joint injury in terms of the mechanism of injury, clinical picture, diagnostic imaging, and most updated surgical techniques used for the treatment can provide the best care for those patients. This article describes updated treatment strategies for AC separation, including type III AC separation which is known most controversial. Finally, we present a proposed treatment algorithm that can aid in the treatment of AC separation from the most updated evidence.

Open Reduction at 15 Months of Left Hip Dislocation in a Male Infant Diagnosed with Arthrogryposis.

BACKGROUND Arthrogryposis is a congenital condition of multiple contractures of joints associated with hip dislocation. The outcome of open reduction of hip dislocation in arthrogryposis patients is debatable. Open reduction of arthrogryposis is challenging for shallow acetabulum and extensive adhesions and fibrosis. For this reason, a careful extensive release must be carried out to achieve the open reduction of the hip in arthrogryposis patients. The literature lacks surgical recommendations for open reduction of the hip in arthrogryposis patients and how to deal with cases of the extruded bone segment during open reduction. CASE REPORT The patient presented in the first few weeks of life with bilateral clubfoot and left hip dislocation. Clinical diagnosis of arthrogryposis was made after referral to a genetics specialist. The hip was clinically irreducible. The patient underwent open reduction and femoral shortening using the Smith Peterson approach at the age of 15 months, with accidental extrusion of the proximal femur, which was retained immediately. The clinical outcome showed a painless, good range of motion. Radiographically, features of avascular necrosis and healed osteotomy site were evident. CONCLUSIONS A difficult hip reduction was expected in this arthrogryposis patient, which required careful dissection of surrounding fibrosis and appropriate femoral shortening. Careful dissection should be carried out during open reduction to avoid jeopardization of femoral head vascularity or even complete devitalization of the proximal femur.

Prevalence and classification of accessory navicular bone: a medical record review.

BACKGROUND: The accessory navicular bone (ANB) is one of the most common accessory bones in the foot. Certain pathologies, such as posterior tibial tendon insufficiency are associated with ANB, and should be differentiated from midfoot and hindfoot fractures such as navicular tuberosity avulsion fractures. There are few studies addressing the prevalence and types of ANB in Saudi Arabia. OBJECTIVES: Determine the prevalence and morphological variations of ANB and its relation with age and sex in patients visiting foot and ankle clinics. DESIGN: Medical record review SETTING: Orthopedic foot and ankle clinic at a university hospital. PATIENTS AND METHODS: The presence of ANB was retrospectively analyzed in radiographs from patients who presented to the orthopedic foot and ankle at our university hospital from February 2010 to December 2020. The patients were stratified according to sex, age, and diagnosis. For each ANB, recorded information included site, size, classification, subtypes, and symptomatology. Purposive sampling was used to select the patients for the study (non-probability sampling). MAIN OUTCOME MEASURES: Prevalence of ANB in patients attending a foot and ankle clinic. SAMPLE SIZE: 117 patients and 194 feet. RESULTS: ANB was analyzed in 1006 radiographs from 503 patients. ANB was detected in 117 (23.3%) patients and 194 (19.3%) feet Prevalence was significantly higher in females (67.5%) than in males (32.5%) (Z=5.359, P<.001). The ages ranged from 19 to 86 years, with a mean age of 48.26 (14.5) years. The most common site was bilateral (77 patients, 65.8 %). Type I was the most common type, with a prevalence of 42.1%. There were no significant differences in types in relation to sex, but all types and subtypes differed significantly from each other. CONCLUSION: ANB was common among patients presenting to the foot and ankle clinic, with an overall prevalence of 23.3%. It should be considered among the differential diagnosis in chronic foot pain, and should be differentiated from midfoot and hindfoot fractures. Further studies with a larger, randomized sample are needed, for more accuracy and to confirm the reported results. LIMITATIONS: Retrospective chart review, non-probability sampling, and use of plain radiographs. CONFLICT OF INTEREST: None.

Awareness about total knee replacement among Saudi population.

Introduction: The purpose of this study is to identify the knowledge of the general population about knee osteoarthritis and its surgical interventions in the management of knee osteoarthritis. Knee osteoarthritis is a prevalent disease. A lack of knowledge about the nature of the disease may delay seeking medical advice until the advanced stage of the disease. Methods: This cross-sectional study was conducted among 486 participants (≥18 years) who were sampled randomly from an osteoarthritis awareness campaign located within a shopping facility located in Riyadh in 2020. Data were collected via a structured questionnaire, which included six domains; demographic information, causes, symptoms, treatment, complications, and general questions. Data for this study were analyzed by using the Statistical Package for Social Studies (SPSS 22; IBM Corp., New York, NY, USA). Continuous variables were expressed as mean ± standard deviation and categorical variables were expressed as percentages. The t-test and one-way Analysis of Variance (ANOVA) were used for continuous variables. Univariate and multivariate logistic regression were used to assess the associated factors with a low level of knowledge. A P value of <0.05 was considered statistically significant. Results: Most of the participants in our study were males (56.8%) and Saudi nationals (89.7%). (83.74%). Consider that surgical intervention is the best treatment when non-surgical options do not work. The mean questionnaire score for the 486 participants was found to be 20.85 ± 5.29 out of 35 points. In comparing the male to female total scores, we found the mean female total score to be statistically significant and higher than that of the males with a P value of 0.036. Furthermore, we found that the non-Saudis had a total score higher than the Saudis with a P value of 0.016. On the other hand, the difference in the total scores between the city and rural area residents and different educational levels were statistically insignificant. Conclusions: Our results demonstrate that the majority of the community has satisfactory awareness about the treatment options of knee osteoarthritis. It also demonstrates the domains that require more effort for increased public awareness of knee osteoarthritis.

Minimally Invasive Excision of Ventral Osteochondroma of the Scapula: A Case Report.

Introduction: Osteochondromas are the most common benign lesions of the bone. They usually affect flat bones such as the scapula. Case Report: We report a case of a left-handed 22-year-old male with no previous medical history, who came to the orthopedic outpatient clinic complaining of pain in the right shoulder, snapping, poor cosmetic look, and limited range of motion. Magnetic resonance imaging revealed an osteochondroma of the scapula. The tumor was surgically excised using a muscle splitting technique in line with the muscle fibers. Histopathological evaluation of the excised tumor confirmed the diagnosis of an osteochondroma. Conclusion: Surgical excision of the osteochondroma using muscle splitting in line with the muscle fibers gave good results in terms of patient satisfaction and cosmetic appearance. Delayed diagnosis and management may increase the risk of symptoms such as snapping or winging of the scapula.

The Effect of Delayed Closed Reduction of Supracondylar Fracture on Perioperative Complications.

Background Supracondylar fracture is one of the most frequent pediatric traumas and surgically managed fractures. Multiple factors can contribute to delaying surgical management of supracondylar fracture, which is thought to lead to difficult reduction and more complications. Surgical treatment during the nighttime shift (from 20:00-8:00) might increase the complication rate including vascular injury, nerve injury, and the need to convert closed reduction to open due to multiple reasons including nontrained staff, exhausted on-call team, and other reasons. Objectives We are looking into the effect of delaying surgical intervention 24 hours from the trauma to the surgical intervention and the impact of daytime or night-time surgeries on perioperative complications. Methods A retrospective cohort study was conducted on all patients who presented with supracondylar fracture Gartland type 2 or 3 who required surgical intervention (63 patients) from 2018-2021 in an academic institute. All patients presented with unilateral injury. Patients were divided into an early surgical group where the surgery was done within the first 24 hours from the trauma and a delayed surgical group if performed after 24 hours. Additionally, patients were classified based on the time of the day surgery was performed into daytime or nighttime surgeries. The complication rate was compared between the groups. Results Most of the patients were male, and the mean age was 4.52 ± 2.28 years. No significant difference was found between the early and delayed groups in the complication rate. Nerve and vascular injury were statistically higher for cases operated at nighttime. Conclusion Delayed surgical treatment of supracondylar fracture doesn't affect the complication rate, whereas closed reduction of supracondylar fractures that were performed during nighttime duty was shown to lead to a higher rate of vascular and nerve injuries.

Bilateral scapular osteochondroma in Multiple Hereditary Exostosis patient presented with bilateral shoulder pain treated with arthroscopic and open excision: Case report.

INTRODUCTION AND IMPORTANCE: Multiple etiologies for snapping shoulder syndrome have been described in the existing literature. Scapular osteochondroma is considered as a rare etiology and bilateral scapular osteochondroma have rarely been reported to date. Patient can present with discomfort, pain and crepitation. Multiple surgical methods were described and the patient underwent two different surgical methods with preferable outcome for arthroscopic side. CASE PRESENTATION: 24 year-old male who is known case of Multiple Hereditary Exostosis (MHE) since childhood presented with bilateral shoulder pain and snapping scapula. Computed tomography demonstrated bilateral ventral scapular osteochondromas. One side treated with open excision and other side with arthroscopic excision. CLINICAL DISCUSSION: Patient exhibited resolution of symptoms, restoration of function on both sides, but he reported cosmetic preference over arthroscopic side and faster recovery from surgery as well in terms of pain resolution and rehabilitation. CONCLUSION: Osteochondroma should by one of differential diagnoses for snapping shoulder syndrome. Despite arthroscopic excision is technically demanding, it carries better outcome compared to open excision.

Prevalence of low back pain among health sciences students.

AIM: To determine the prevalence of low back pain (LBP) among health sciences students and to identify the associated factors. METHODS: Cross-sectional study was conducted among 1163 students from five health sciences colleges during the academic year 2016-2017. Self-administered questionnaire was conducted and included 4 sections: demographic characteristics, risk factors, Nordic musculoskeletal questionnaire and Oswestry disability questionnaire. Data were analyzed using SPSS. RESULTS: Mean age was 20.74 ± (1.59 years). 70.9% of students were female. Lifetime prevalence of LBP was 56.6%, 12-month prevalence 48.8%, and point prevalence 21.2%. Dentistry students had highest lifetime prevalence of LBP (67.6%) with significant p value (<0.001). Male were found to have higher lifetime prevalence compared to female (p ≤ 0.001). Spending more than 10 h on computer or tablet was significantly associated with LBP (OR 2.19; 95% CI 1.30-3.70; p = 0.003). Feeling discomfort on bed was associated with LBP (OR 1.81; 95% CI 1.38-2.38; p ≤ 0.001). Uncomfortable college furniture was associated with LBP (OR 1.40; 95% CI 1.09-1.79; p = 0.008). Using heavy backpack was found to be associated with LBP (OR 1.49; 95% CI 1.01-2.03; p = 0.011). Most of students LBP (90.3%) found to cause minimal disability on Oswestry scale. CONCLUSION: This study has shown high prevalence of LBP among future healthcare provider. These risk factors should be well established to minimize the prevalence of LBP among future health sciences students. Dentistry students at higher risk of developing LBP compared to other students.