Chronic Complex elbow fracture dislocation: Restoration of elbow function with ORIF and radial head replacement, a case report with long term follow up.

INTRODUCTION: The dislocation of the elbow joint to the posterior or postero-lateral region accompanied by fractures in the radial head or neck and coronoid process of the Ulna is known as a terrible triad injury of the elbow (TTI). IMPORTANCE: This injury presents as unique challenge for orthopedic surgeons due to elbow instability and stiffness, making the surgical intervention more difficult than usual. CASE PRESENTATION: A 47-year-old man suffered from polytrauma, including a pelvis fracture, a left humerus shaft fracture, and left ulna shaft fracture. An open reduction and internal fixation were administered as a treatment option. However, during a follow-up examination four months later, a missed fracture dislocation of the right elbow was discovered. CLINICAL DISCUSSION: The complex surgery required open reduction of the chronic dislocated joint, release of the triceps, resection of the radial head, replacement, bone grafting of the coronoid, reconstruction of the coronoid, and application of a spanning external fixation. The injury was complex, consisting of coronoid fractures, olecranon, a proximal third of the Ulna, and radial head malunion with heterotrophic ossification around the elbow joint. CONCLUSION: After seven years, our patient had a full range of motion in elbow flexion with 20-25 lags in extension. The Mayo Elbow Performance Score (MEPS) was 100 and Disabilities of Arm, Shoulder and Hand (DASH) score was 0.

Comparison of Postoperative Pain and Function in Robotic Total Knee Arthroplasty and Conventional Total Knee Arthroplasty Amongst Patients at King Fahad Medical City in Riyadh, Saudi Arabia.

Background Total knee arthroplasty (TKA) is the definitive surgical treatment for end-stage osteoarthritis and has been proven to relieve pain and improve function. With the rise in demand and the number of TKA procedures every year, more studies have been conducted on robotic TKA. Objective The objective of this study is to compare the postoperative pain between robotic and conventional TKA and the postoperative functional level between robotic and conventional TKA. Method This is a quantitative, observational, prospective study conducted from February 2022 to August 2022 amongst patients in the orthopaedic department of King Fahad Medical City, Riyadh, Saudi Arabia, who have undergone primary TKA for end-stage osteoarthritis using robotic TKA and conventional TKA. After applying the exclusion and inclusion criteria, a total of 26 patients (12 robotic and 14 conventional) were included in the study. The patients were assessed at three time points: two weeks, six weeks, and three months post-op. They were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and the visual analogue scores (VAS) used to assess pain. Result A total of 26 patients were included in this research. The patients were divided into two groups: 12 robotic TKA patients and 14 conventional TKA patients. In this study, while comparing patients who underwent robotic TKA with those who underwent conventional TKA, no statistical significance was found regarding pain and function at all stages postoperatively. Conclusion There was no short-term difference between robotic and conventional TKA regarding pain and function. There is a need for further extensive research on robotic TKA in terms of cost-effectiveness, complications, implant survivorship, and long-term outcomes.

One-Year Mortality Rates Following Fragility Femoral Fractures in Patients Presenting to King Saud Medical City in Riyadh, Saudi Arabia: A Retrospective Study.

OBJECTIVE: The objective is to investigate one-year mortality rates following femur osteoporotic fractures, and to investigate factors that are associated with higher mortality rates. DESIGN: A retrospective study was conducted from 2010 to 2021 (11 years) of all patients who presented to King Saud Medical City, Saudi Arabia, and had a fragility fracture of the proximal or distal femur. PATIENTS: One hundred eight patients who sustained a proximal or distal femoral fracture, as a result of low-energy trauma, were included. RESULTS: The majority of our cohort (77.8%) had proximal femoral fractures, whereas only 22.2% had a distal femoral fracture. 55.6% were less than 75 years old, and 44.4% were 75 years or older. All patients had fallen from standing height. Hypertension and diabetes were the most common comorbidities among our cohort at 49.1% and 47.2%, respectively, but neither showed a statistically significant increase in the risk of mortality. When assessing the overall mortality, 21.3% of our patients had passed away. Although this finding was not statistically significant, mortality rates were found to be higher in patients with proximal femoral fractures compared to distal femoral fractures (25% vs. 8.3%, respectively, p=0.095). Patients with a normal bone mass density (BMD) had higher mortality rates as opposed to those with abnormal BMD (p=0.001). CONCLUSIONS: Mortality rates are higher in proximal femoral fractures compared to distal femoral fractures. In addition, within our study cohort, patients with normal BMD had higher mortality rates. We recommend prospective studies that compare mortality rates between proximal and distal femoral fractures in patients with osteoporosis, as these studies would provide more accurate data. We also recommend having BMD measured in those patients to avoid further fractures in this patient population.

Knowledge, attitude, and practice of bariatric surgery among adult Saudi community, Saudi Arabia, 2019.

The prevalence of overweight and obesity is higher in developed countries than in developing countries of all ages (data from 2013). This study is aimed at assessing the knowledge and attitudes of people in Saudi Arabia toward bariatric surgery. To do this, the specific objectives sought to determine the satisfaction of people who underwent bariatric surgery and to determine the importance of bariatric surgery among the community. METHODS: The study is a cross-sectional, community-based study conducted among the Saudi adult population. The final sample size was 891 respondents from different regions of Saudi Arabia. Data collection was through online questionnaires that consisted of 26 questions to assess the perceived knowledge and attitudes toward obesity and bariatric surgery adopted from Abouhamda (2016). RESULTS: More than 70% of the study participants were aged between 18 and 25 years. There were more males than there were females 76.0% versus 24.0%, while most of the respondents were living single. The proportion of respondents across listed regions of Saudi Arabia significantly varied at a 5% level (P = 0.000). Sixty percent of the study respondents were within the normal weight range (BMI 18.5-25), 9% were marked as obese (BMI >30). Age group was not significantly associated with knowledge of quantization and perceived the knowledge that quantization can cause death (P > 0.05 in both cases). CONCLUSION: The knowledge about obesity in Saudi Arabia is generally good and most Saudis would rather take the approach of proper diet as opposed to surgery, with the bigger percentage being in the normal range (BMI 18.5-25).

Pelvic Aneurysmal Bone Cyst in an Adolescent: A Case Report and Literature Review.

An aneurysmal bone cyst (ABC) is a benign but locally aggressive lesion. The challenge in managing pelvic ABC arises from its relative inaccessibility and the presence of nearby neurovascular structures. In this report, we present the case of a 14-year-old female with pelvic ABC and describe the symptoms, signs, and radiographic appearance of the ABC, management, and good outcome of non-surgical management by selective trans-arterial embolization. Although challenging, non-surgical management of pelvic ABCs can result in a favorable outcome. In addition, we reviewed the literature regarding the treatment modalities of pelvic ABCs.

Work-related musculoskeletal disorders among clinical laboratory workers.

AIMS AND OBJECTIVES: The aim of this study was to estimate the prevalence and risk factors of work-related musculoskeletal disorders (WMSDs) among clinical laboratory workers. MATERIALS AND METHODS: This questionnaire-based cross-sectional study included the clinical laboratory departments of six governmental tertiary and secondary hospitals in Riyadh, Saudi Arabia. The selected instrument was a self-administered adapted standardized questionnaire. The sample comprised 306 laboratory workers, and the selected sampling technique was a non-random convenient method. RESULTS: The overall prevalence of WMSDs in any body region was 82% in the last 12 months; it was mainly linked to lower back pain (61%). In the logistic regression, age <30 years, working in specific laboratories and working in hematology/flow-cytometry laboratory divisions were all found to be significant risk factors (P < 0.05). CONCLUSION: Clinical laboratory workers are at a high risk for WMSDs; it is essential that we take preventative action to address this.

Knowledge of first aid skills among medical and nonmedical students in Saudi Arabia.

BACKGROUND: First aid is the first treatment a health care worker provides at the site of an accident to a patient who is injured or very sick before the ambulance arrives. First aid providers are those who have the skill and knowledge to deal with life-threatening conditions outside the facilitated environment of a hospital. This study aims to assess the knowledge of first aid among university students in Saudi Arabia. METHODOLOGY: An observational descriptive cross-sectional study was conducted from 17 August 2018 until 2 February 2019 on Saudi universities' students, including medical and nonmedical students and excluding postgraduate. The sample size was 384 students using a cluster sampling technique. The questionnaire was developed specifically for the purpose of this study after searching the literature and consulting an epidemiologist. It contains questions that assess the level of knowledge regarding first aid. It was subjected to a prop to test for validity and liability. Data were analyzed using (SPSS, version 22.0) and (P values of ≤ 0.05) considered significant. The consent was obtained before data collection. RESULT: Only 40.35% (157/389) of the total participants had basic life support (BLS) course in their college syllabus. Good knowledge was generally observed in both medical (61.2%) and nonmedical (53.2%) student participants. Medical students' knowledge regarding first aid was better than nonmedical students in all questions, whereas the results were not statistically significant. CONCLUSION: Medical students were more familiar with the knowledge of first aid than other colleges' students. Researches should investigate the willingness of medical students to apply their first aid knowledge when necessary using a health belief model.

Robot-assisted hysterectomy in a 41-year-old male: A rare case report.

Persistent Müllerian Duct Syndrome (PMDS) is regarded as a rare genetic disorder influencing internal sexual male development. PMDS is commonly diagnosed incidentally either during any pelvic surgery or examination of undescended testis. Currently, we have presented a case focusing on the phenotype individual who was presented to our institute with primary infertility as well as bilateral undescended testis, who underwent Robotic-assisted hysterectomy, left orchidectomy, and right orchiopexy.

Ileal volvulus secondary to cystic lymphangioma: A rare case report with a literature review.

Lymphangioma is a benign malformation of the lymphatic system. It usually affects the neck, head, and rarely, the abdomen. Volvulus is a serious condition, which occurs as a result of bowel twisting around itself or around the mesentery leading to severe consequences such as obstruction. The most common cause of volvulus in children is malrotation. We report a rare case of a 2-year-old boy who was brought by his parents to the emergency room with the complaint of constipation for 5 days and vomiting for the last 4 days. Examination and plain abdominal X-ray suggested intestinal obstruction. Furthermore, ultrasonography indicated the presence of a cyst and dilatation of the bowel. On exploratory laparotomy, an ileal volvulus caused by cystic lymphangioma developed on the mesenteric wall and associated with ileal and jejunal dilatation was observed. The diseased segments were resected in addition to 5cm before and after the cystic lymphangioma to prevent recurrence.

Surgical site infections after trauma laparotomy. An observational study from a major trauma center in Saudi Arabia.

OBJECTIVES: To determine the incidence of surgical site infection (SSI) after trauma laparotomy and evaluate variables on presentation to the emergency department (ED) associated with the development of SSI. Methods: A retrospective cohort study was undertaken of patients presenting directly from the scene who underwent trauma laparotomy between January 2016 and December 2017. The primary outcome variable was SSI, as defined by the Centers for Disease Control and Prevention guideline. A univariate assessment with demographics, vital signs, and acute management was reported. Results: A total of 70 patients were included for data analysis. Of these, 9 (12.9%; 95% confidence interval (CI): 6.9-22.7%) patients developed SSI, including 5 patients with bowel injury (small bowel; n=3, colonic injuries; n=2). Most cases were diagnosed after 7 days in the hospital. All patients developed superficial incisional (skin and subcutaneous tissue) SSI. No predetermined variables, including bowel injury (p=0.08) or duration of surgery (p=0.09), demonstrated a statistically significant association with the development of SSI. Conclusion: Rates of SSI after trauma laparotomy were similar to previous reports from other centers. Surgical site infection after trauma laparotomy was diagnosed at a delayed time point after surgery, and patient demographics, injury characteristics, and acute surgical management did not appear to be associated with subsequent diagnosis of SSI.

Depression Among First- and Fifth-Year Medical Students in Riyadh, Saudi Arabia.

BACKGROUND: Depression, which is characterized by persistent sadness, is a highly prevalent and serious medical disease that affects more than 300 million individuals worldwide. It is hypothesized that the onset of depressive symptoms in medical students occurs due to prolonged exposure to the stressful environment of medical colleges. Hence, we aimed to determine the presence of depressive symptoms and compare the level of depression between the first-year and fifth-year medical students in Riyadh city, Saudi Arabia. MATERIALS AND METHODS: This cross-sectional study was performed with convenient sampling from 2 medical colleges in Riyadh in the Kingdom of Saudi Arabia from October to November 2017. The English version of Beck's Depression Inventory questionnaire was used in this study. Statistical analysis was administered using SPSS via chi-square test, and P-value less than 0.05 was considered statistically significant. RESULTS: The questionnaire was answered by 241 participants. The age variable shows a bimodal distribution. The mean age of first-year and fifth-year students was 19±0.8 years and 23±2.1 years, respectively. Fifth-year students comprised 53.5% of the total sample, and male students accounted for 63.1% of the total sample. After analysis, the results show that male students scored higher than female students on the lower side of the scale in both years. Most of the first-year female students scored a higher level of depression compared with male students (P=0.001), whereas no difference between males and females (P=0.04) was found in the fifth-year students' data. CONCLUSION: Our study shows a new pattern of reported depressive symptoms among first-and fifth-year medical students. In addition, the study suggests that depression is more common in female medical students as compared with their male counterparts. For future studies, we recommend using randomized sampling in a cohort study including all levels of medical students to further investigate and confirm the findings.