Interlocking intramedullary nail for forearm diaphyseal fractures in adults-A systematic review and meta-analysis of outcomes and complications.

PURPOSE: The purpose of this systematic review is to examine the outcomes, complications, and potential advantages of using anatomical interlocking intramedullary nails (IMN) in the treatment of radius and ulnar shaft diaphyseal fractures in adults. METHODS: Medline, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched between January 2000 and January 2023. Studies meeting criteria were observational or randomized controlled trials evaluating outcomes in IMN for adult diaphyseal forearm fractures. Standardized data extraction was performed and a quality assessment tool was used to evaluate individual study methodology. Descriptive statistics for interventions, functional outcomes, and complications were reported. Meta-analysis was performed for patient-reported outcome measures and operative time. RESULTS: A total of 29 studies involving 1268 patients were included with 764 (60%) undergoing IMN, 21% open reduction and internal fixation (ORIF), and 9% hybrid fixation. There was no significant difference between groups in DASH and Grace-Eversmann scores. Operative time was significantly shorter in IMN compared with ORIF. The DASH scores were: 13.1 ± 6.04 for IMN, 10.17 ± 3.98 for ORIF, and 15.5 ± 0.63 in hybrids. Mean operative time was 65.3 ± 28.7 in ORIF and 50.8 ± 17.7 in IMN. Complication rates were 16.7% in the IMN group, 14.9% in ORIF, and 6.3% in hybrid constructs. There were 11 cases of extensor pollicis rupture in the IMN group. Average IMN pronation and supination were 78.3° ± 7.9° and 73° ± 5.0°, respectively. Average ORIF pronation and supination was 82.15° ± 1.9° and 79.7° ± 4.5°, respectively. CONCLUSIONS: Similar functional outcomes and complication rates along with shorter operative times can be achieved with IMN compared with ORIF. The use of IMN is promising, however, higher quality evidence is required to assess appropriate indications, subtle differences in range of motion, implant-related complications, and cost-effectiveness. Trail Registration PROSPERO (International Prospective Register of Systematic Reviews) (ID: CRD42022362353).

Gender Differences in Prevalence of Sleepy Driving Among Young Drivers in Saudi Arabia.

Introduction: Sleepy driving is associated with Motor Vehicles Accidents (MVAs). In Saudi Arabia, previous studies have addressed this association among men only. Therefore, the aim of this study was to compare the prevalence of sleepy driving and associated factors between genders. Methods: In a cross-sectional study design, we offered a self-administered online questionnaire to 3272 participants from different regions of Saudi Arabia. The questionnaire included 46 questions covering sociodemographics, driving habits, sleeping habits, Epworth Sleepiness Scale, and Berlin questionnaire to assess the risk of sleep apnea. Univariable and multivariable logistic regression analyses were used to determine the significant factors associated with self-reported sleepy driving, defined as operating a motor vehicle while feeling sleepy in the preceding six months. Results: Of the 3272 invitees, 2958 (90%) completed the questionnaire, of which 1414 (48%) were women. The prevalence of sleepy driving in the preceding six months was 42% (men: 50% and women 32%, p<0.001). Specifically, participants reported the following: 12% had had to stop their vehicle due to sleepiness (men: 16.2% and women 7%, p<0.001), 12.4% reported near-miss accidents (men: 16.2% and women: 8.2%, p<0.001) and 4.2% reported an accident due to sleepiness (men: 4.3% and women: 4%, p=0.645). In multivariable analysis, being male, younger age, use of any type of medications, shift working, working more than 12 hours per day, driving duration of 3-5 hours per day, driving experience of more than 2 years, excessive daytime sleepiness and risk of having obstructive sleep apnea were all associated with increased likelihood of falling asleep while driving in the preceding 6 months. Conclusion: Sleepy driving and MVA are prevalent in both gender but was higher in men. Future public health initiatives should particularly focus on men, since men reported a greater likelihood of both sleep-related MVA and "near miss" events.

Successful nonoperative treatment of a closed posteromedial ankle dislocation without associated fractures - a case report.

Pure ankle dislocations occurring in the absence of malleolus fractures are extremely rare injuries. These injuries often present with high-energy trauma and ligamentous injury. Comprehensive research is not available due to the rarity of the injury. However, recent literature has supported treatment by nonoperative means. This case report aims to discuss a similar case and offer insight into the prognosis of such injuries. Case presentation: A previously healthy 26-year-old male was diagnosed with a closed posteromedial ankle dislocation without associated fractures. Reduction was performed under procedural sedation and confirmed with postreduction radiographs. The patient was immobilized and scheduled for serial follow-up in the outpatient department. Weight bearing was gradually introduced at 6 weeks along with physiotherapy. The American Orthopedic Foot and Ankle Score was 90 and 100 at 6 months and 1 year follow-up, respectively. Return to sports was possible at 1 year postinjury. Range of motion was normal apart from a 5-8° ankle dorsiflexion deficit. Radiographs, computed tomography, and MRI were unremarkable with longer term follow-up. Conclusion: Patients who sustain pure ankle dislocations with an intact distal tibiofibular syndesmosis can expect favorable outcomes with immobilization, splinting, and gradual rehabilitation, as evident by the high American Orthopedic Foot and Ankle Score and the time to return to sports. This case report serves to provide prognostic information and anticipate outcomes in patients with similar injuries.