Background: Clubfoot is a childhood congenital abnormality that can lead to disabilities, which c... more Background: Clubfoot is a childhood congenital abnormality that can lead to disabilities, which can last a lifetime if untreated. There are several types of interventions to treat this condition. However, these interventions depend on the age of presentation and result in good outcomes if started early. This study aimed to investigate the level of public awareness about clubfoot in the Al-Qassim region in Saudi Arabia. Method: This observational cross-sectional study was conducted on a population living in the Al-Qassim region in 2020. The study was conducted using a structured, validated questionnaire that was available online. The chi-square test and t-test were used to analyze the data. All the analyses were conducted using SPSS (version 21). Results: This study included 7085 individuals from the Al-Qassim region. The level of public awareness was as follows 15.6% had poor knowledge, 43.8% had fair knowledge, and 40.6% had high knowledge. The most common sources of knowledge were...
Background: The outcomes of revision subtalar arthrodesis have received relatively little focus i... more Background: The outcomes of revision subtalar arthrodesis have received relatively little focus in research compared with primary subtalar arthrodesis outcomes. This study aimed to assess the midterm clinical and radiologic results of subtalar joint revision arthrodesis and to analyze the risk factors that might influence the outcome of this procedure. Methods: We performed a retrospective review of 20 patients after subtalar joint revision arthrodesis for malunion, using interposition of iliac crest bone graft. The mean age was 55.75 years and the average follow-up lasted for 48.93 months. Eighty-five percent of the patients had at least 1 risk factor identified prior to revision. Patients’ satisfaction and functional outcomes were evaluated with the American Orthopaedic Foot & Ankle Society Scale (AOFAS), the Foot and Ankle Outcome Score (FAOS), the Foot Function Index (FFI), and dynamic pedobarography. Results: A fusion rate of 80% was recorded whereas 20% of the cases ended with...
Aim: The aim of this study was to determine the prevalence of low back pain (LBP) and to identify... more Aim: The aim of this study was to determine the prevalence of low back pain (LBP) and to identify risk factors associated with LBP among medical students. Materials and Methods: A cross-sectional study was conducted among 2021 medical students from four medical colleges in Saudi Arabia during the academic year 2019–2020. A self-administered questionnaire was conducted and included three sections: demographic data, risk factors of LBP, and prevalence of LBP (during lifetime, past 12 months, and past 7 days). Data were analyzed using SPSS. Results: A total of 2021 medical students responded to our survey. The participants were 57.1% female and 42.9% male. Most of the students' ages (76.3%) ranged from 20 to 24 years. Medical students younger than 20 and older than 24 were 21.8% and 1.9%, respectively. The prevalence of LBP was 80.7% at any time, 67.6% in the past 12 months, and 38.2% in the past 7 days. Females were found to have higher prevalence of LBP than males (P < 0.0001)...
Summary: Disruption of the knee extensor mechanism is an unfavorable situation because efficient ... more Summary: Disruption of the knee extensor mechanism is an unfavorable situation because efficient mobilization requires a functioning knee extensor apparatus. The purpose of this retrospective study was to report our technique of sartorius muscle transfer for restoration of extension mechanism function and the outcomes of five patients. Patients with ruptured knee extensor mechanism secondary to trauma or knee arthroplasty-related issues were studied retrospectively. In all patients, sartorius muscle was transferred to restore the quadriceps tension deficit. Increase in the knee active range of motion, increase in the extensor mechanism power by one grade on Medical Research Council scale, and improvement in the extension lag were observed in all patients. The sartorius muscle transfer can be a reliable option to restore the knee extensor mechanism in chronic quadriceps tendon injuries. Our initial results are promising and showed improvement of the extensor mechanism muscle power, i...
Background: The outcomes of revision subtalar arthrodesis have received relatively little focus i... more Background: The outcomes of revision subtalar arthrodesis have received relatively little focus in research compared with primary subtalar arthrodesis outcomes. This study aimed to assess the midterm clinical and radiologic results of subtalar joint revision arthrodesis and to analyze the risk factors that might influence the outcome of this procedure. Methods: We performed a retrospective review of 20 patients after subtalar joint revision arthrodesis for malunion, using interposition of iliac crest bone graft. The mean age was 55.75 years and the average follow-up lasted for 48.93 months. Eighty-five percent of the patients had at least 1 risk factor identified prior to revision. Patients’ satisfaction and functional outcomes were evaluated with the American Orthopaedic Foot & Ankle Society Scale (AOFAS), the Foot and Ankle Outcome Score (FAOS), the Foot Function Index (FFI), and dynamic pedobarography. Results: A fusion rate of 80% was recorded whereas 20% of the cases ended with...
Achilles tendon (AT) is the strongest human tendon. AT disorders are common among athletes. AT pa... more Achilles tendon (AT) is the strongest human tendon. AT disorders are common among athletes. AT pathologies vary from tendinopathy to frank rupture. Diagnosis is made clinically. Imaging modalities are used adjunctively. Management of AT rupture in athletes is challenging to surgeons due to worldwide growing popularity of sports and potential social and financial impact of AT injury to an athlete. Hence, new surgical techniques aim at attaining quick recovery with good outcome, finding similar results with both open and percutaneous techniques when accompanying these with functional rehabilitation protocols. Non-operative strategies include shoe wear modification, physiotherapy and extracorporeal shock wave therapy. Surgical interventions vary based on the AT pathology nature and extent. Direct repair can work for small-sized defects. V-Y gastrocnemius advancement could approximate the tendon edges for repair within 2–8 cm original gap. Gastrocnemius turndown can bridge tendon loss &...
Objectives: Although calcaneal fractures are relatively uncommon, they are among injuries that ma... more Objectives: Although calcaneal fractures are relatively uncommon, they are among injuries that may lead to short- and long-term morbidity regardless of the treatment. The Saudi Arabian literature showed a shortage of studies that analyzed the epidemiology of this fracture. This study aimed to analyze the epidemiology and characteristics of patients with calcaneus fractures. Methods: A retrospective study of all patients with calcaneal fractures admitted to King Fahd Hospital in Almadinah Almunawwarah City, Saudi Arabia, over a 4-year-period (January 2016–December 2019). Data such as age, gender, trauma mechanism, laterality of fracture, and associated injuries, were extracted from patients' medical files and analyzed using appropriate statistical tests. Results: The study analyzed data of 130 patients with calcaneal fractures (156 calcaneal fractures). Male patients (86.2%) were more commonly affected than females, at a ratio of 6.2:1. Ninety-three (71.5%) of the cases resulted from low-energy falls and road traffic accidents (RTA). Low-energy falls and falling from a height as injury mechanisms were higher in female patients, while RTA was more frequent in males. Bilateral fractures were found in 20% of cases, with a significantly higher rate in male patients. The associated skeletal injuries were more frequent in females than male patients (66.7% vs. 43.8%), while associated nonskeletal injuries were only found in 15 male patients, particularly those aged <40 years. Conclusion: Calcaneal fractures have a high rate of associated skeletal and nonskeletal injuries indicating the seriousness of these fractures. More research using data from multi-centers is warranted.
Objectives: The present study aimed to identify barriers in conducting or completing research by ... more Objectives: The present study aimed to identify barriers in conducting or completing research by orthopedic surgeons in Saudi Arabia. Methods: A short structured, validated online survey was distributed to all orthopedic surgeons registered as members of the Saudi Orthopedic Association (SOA) through e-mail. The survey consisted of demographic data of the survey participants, data related to their research, and six-barrier items based on a five-point Likert scale. The collected data were analyzed using appropriate statistical methods, and the level of statistical significance was defined as P ≤ 0.05. Results: Out of 1252 SOA local members, 152 participants responded to the survey with a response rate of 12.1%. Abandoning orthopedic research activities among the studied 152 participants was significantly related to insufficient time to conduct research, and limited access to funding (P < 0.0001). The long duration (>12 months) of research completion was significantly related to almost all studied barrier items. The most important predictors, using regression analyses, were insufficient time and fund support for abandoning research projects, while confidence in conducting research and support by a mentor were the most important predictors for taking a long time for research completion. Conclusion: A considerable amount of orthopedic research in Saudi Arabia is abandoned or taking a long time to complete because of barriers. Addressing and solving these barriers might help to improve the research activity among the Saudi orthopedic community.
European Journal of Orthopaedic Surgery & Traumatology
Gastrocnemius flaps provide reliable reconstructive solutions to soft-tissue loss of the knee and... more Gastrocnemius flaps provide reliable reconstructive solutions to soft-tissue loss of the knee and proximal tibia following orthopedic procedures. While this technique has been used and studied, little is known about its prophylactic application. Single-stage and delayed approaches were compared with respect to the timing of débridement, complications, and relationship between microorganisms and complications. Gastrocnemius flaps for soft-tissue defects of the knee joint were retrospectively reviewed. Success of the flap procedure was defined as a healed soft-tissue envelope, no evidence of infection, a good blood supply to the flap, and adherence of the flap to its bed. Independent sample t test was used to compare the corresponding parameters (level of statistical significance was 0.05). Of 43 flaps (43 patients), 18 were performed during a single-stage procedure along with the orthopedic procedure and 25 were delayed. Success of the single-stage (100%) and delayed flaps (88%) was not significantly different (p = 0.083). Complication rate did not differ significantly for single-stage (11%) and delayed flaps (24%) (p = 0.272). We were unable to establish a relationship between complications and microorganisms. Results indicate both approaches are reliable. Single-stage gastrocnemius flaps may eliminate the need for a second surgery. Level III (Therapeutic, Retrospective cohort)
Objectives: There is a rapid advancement in surgical techniques requiring real-time visualization... more Objectives: There is a rapid advancement in surgical techniques requiring real-time visualization and intraoperative X-ray utilization, leading to a higher radiation exposure among operating room (OR) staff. Taking preventive measures and reducing the unnecessary radiation exposure for the patient and the OR staff is essential. The study aimed to assess the compliance with using radiation protection equipment, as well as assessing the level of knowledge about radiation exposure among the orthopedic OR staff. Methods: This is a cross-sectional study that was conducted in Saudi Arabia. A 19-Item questionnaire that was developed and validated by Jentzsch et al. was sent to the emails of all the registered members of the Saudi Orthopedic Association, orthopedic physicians, OR nurses, and radiology technicians were included in the study. A Correlation procedure was performed to determine the relationship between knowledge and compliance scores. Results: We recruited 242 orthopedic OR per...
Growth modulation has become a mainstream treatment for frontal plane angular lower extremity def... more Growth modulation has become a mainstream treatment for frontal plane angular lower extremity deformities in children. Few articles address the effect of growth modulation on sagittal deformity. Our aim is to compare two anterior distal femoral growth modulation techniques for fixed knee flexion contracture. Electronic medical records were reviewed for patients who underwent anterior femoral growth modulation for fixed flexion contracture. Patients were excluded if adequate preoperative/postoperative radiographs were unavailable. A cohort was subdivided based on surgical technique: screws alone versus dual tension-band plates. Complications were recorded; radiographs were evaluated preoperatively and at hardware removal. Posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA), and anterior cortical line (ACL) angle were evaluated. Of 35 patients identified, 20 patients (29 knees) were included. Thirteen knees were treated with dual anterior tension-band plates; 16 knees had transphyseal screws. Sagittal alignment improved in both groups. Statistically significant PDFA changes were observed in the tension-band plate group (P = 0.0095); a trend was noted toward improvement in ACL angle (P = 0.08). PPTA did not change. No changes reached significance in the transphyseal screw group (PDFA: P = 0.181, ACL: P = 0.64). Tension-band plate migration was noted in one (7.7%) of 13 knees, and transphyseal screw migration in nine (56.3%) of 16 knees (P < 0.01). Anterior distal femoral growth modulation improves sagittal alignment without significant remodeling at the proximal tibia. Hardware migration occurred more often with transphyseal screws (P < 0.01). We recommend dual anterior tension-band plating over placement of paired screws for sagittal growth modulation to treat knee flexion contracture.
INTRODUCTION/PURPOSE Osteochondral lesion of the talus (OCLT) is defined as a defect on the artic... more INTRODUCTION/PURPOSE Osteochondral lesion of the talus (OCLT) is defined as a defect on the articular surface of the talus with/without subchondral bone involvement. Several surgical techniques are described in literature to treat OCLT. Particulated Juvenile Cartilage Allograft Transplantation (PJCAT) is a new emerging technique that has the potential of restoring the native cartilage. However, available data on PJCAT in treating OCLT is confined to a small number of studies with heterogeneous population. The aim of this study is to systematically review the literature on clinical and radiological outcomes of PJCAT in treating OCLT. METHODS A systematic search of Medline database was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Number of patients and demographic data included age, gender and body mass index (BMI) were extracted. The level of evidence of each included study was identified. When feasible, mechanism of injury, lesion size and average follow up were recorded. The American Orthopedic Foot and Ankle Society Score (AOFAS), and Foot and Ankle Outcome Score (FAOS) were obtained to assess the functional outcomes. Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was selected to evaluate the radiological outcomes. RESULTS A total of 10 studies were eligible for this review involving 132 patients. Postoperative AOFAS scores were available for 44 patients who underwent PJCAT with an average of 86.14 at 25.5 months follow up. FAOS scores have been reported in 3 studies for 81 patients. The average preoperative score was 47.35 which has been improved to 62.88 at follow up of 23.6 months. MOCART was evaluated in 42 feet after the mean follow up of 18.2 months. The repair tissue was characterized by variable features; however, certain peculiarities were observed with higher frequency including infill hypertrophy, incomplete border zone integration, deep surface disruption, structure inhomogeneity, patches of hyperintense signals, damage of subchondral lamina and subchondral bone, adhesions and absence of effusion. CONCLUSION PJCAT seems to be a promising modality of treatment for OLT in terms of functional outcomes. Fair attempts of defect filling can be confirmed with MRI. Nevertheless, heterogeneous picture of regenerate cartilaginous tissue and lack of repair in subchondral bone and subchondral lamina are not in favor with claims of full restoration of lost normal hyaline articular cartilage.
Voluntary elbow extension is essential for optimal upper limb positioning required for daily livi... more Voluntary elbow extension is essential for optimal upper limb positioning required for daily living activities, particularly above-shoulder maneuvers. The authors present a case of traumatic brachial plexus injury in which paralysis of the musculature selectively supplied by the posterior cord was based on magnetic resonance imaging and nerve conduction studies. An attempt at a radial nerve graft at another center was not effective. Ipsilateral hand function improved after multiple local tendon transfers were performed. Restoration of active elbow extension was not possible using the posterior deltoid or the latissimus dorsi because they were denervated by the primary trauma and so the trapezius muscle was used as a donor muscle unit to restore voluntary elbow extension. The patient resumed biking 6 weeks after the transfer procedure. At 2-year follow-up, full active elbow extension was regained, elbow extension power scored 4 of 5, and the patient reported that he could ride his bicycle for 70 miles.
This study was aimed to review the short-term results of endoscopic percutaneous longitudinal ten... more This study was aimed to review the short-term results of endoscopic percutaneous longitudinal tenotomy for noninsertional Achilles tendinopathy using the Centerline Endoscopic Carpal Tunnel Release instrument (Arthrex). This method simplifies the operation technique, allows a good endoscopic visualisation of the Achilles tendon with very promising results. We performed multiple percutaneous longitudinal tenotomies under local anesthesia in 24 patients (25 tendons) with Achilles tendinopathy or peritendinitis that had failed conservative treatment between January 2013 and September 2016. All ambulatory procedures consisted of paratenon release and longitudinal tenotomies. The results were reviewed in 22 patients (23 tendons) at an average follow-up period of 22.5 months (range 10-36 months). Patients' satisfaction and functional outcomes were evaluated using the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, the pain visual analog scale (VAS), and the f...
Reconstruction of segmental bone defects requires a large commitment both on the part of the pati... more Reconstruction of segmental bone defects requires a large commitment both on the part of the patient and the physician. Investing in preoperative evaluation and optimization is the only logical way to pursue such an endeavor. Unfortunately, detailed studies regarding segmental bone defects and preoperative factors are relatively lacking owing to the relatively low incidence of the problem. Fortunately, other orthopaedic pathologies (arthritis, ligamentous injuries about the knee) have high prevalence and consistency, allowing detailed analysis of preoperative factors. We review this literature, and that directly involving segmental bone defects when available, to guide surgeons planning segmental bone defect reconstruction.
Knee complaints and their accompanying functional impairments are frequent problems encountered b... more Knee complaints and their accompanying functional impairments are frequent problems encountered by healthcare practitioners worldwide. Plenty of functional scoring systems were developed and validated to give a relative estimation about the knee function. Despite the wide geographic distribution of Arabic language in the Middle East and North Africa, it is rare to find a validated knee function scale in Arabic. The present study is aimed to translate, validate, and culturally adjust the Knee Outcome Survey: Activities of Daily Living Scale (KOS-ADLS) into Arabic language for future use among Arabic-speaking patients. Permission for translation was obtained from the copyrights holder. Two different teams of high-level clinical and linguistic expertise conducted translation process blindly. Forward-backward translation technique was implemented to ensure preservation of the main conceptual content. Main study consisted of 280 subjects. Reliability was examined by test-retest pilot study. Visual Analogue Scale (VAS), Get Up and Go (GUG) Test, Ascending/Descending Stairs (A/D Stairs), and Subjective Assessment of Function (SAF) were conducted concurrently to show the validity of Arabic KOS-ADLS statistically in relation to these scales. Final translated version showed no significant discrepancies. Minor adaptive adjustment was required to fit Arabian cultural background. Internal consistency was favourable (Cronbach&#39;s alpha 0.90). Patients&#39; scoring on Arabic KOS-ADLS appeared relatively consistent with their scoring on VAS, GUG, A/D Stairs, and SAF. A significant linear relationship was demonstrated between SAF and total KOS-ADLS scores on regression analysis (adj. R = 0.548). Arabic KOS-ADLS, as its English counterpart, was found to be a simple, valid, and useful instrument for knee function evaluation. Arabic version of KOS-ADLS represents a promising candidate for unconditional use among Arabic-speaking patients with knee complaints.
Background: Clubfoot is a childhood congenital abnormality that can lead to disabilities, which c... more Background: Clubfoot is a childhood congenital abnormality that can lead to disabilities, which can last a lifetime if untreated. There are several types of interventions to treat this condition. However, these interventions depend on the age of presentation and result in good outcomes if started early. This study aimed to investigate the level of public awareness about clubfoot in the Al-Qassim region in Saudi Arabia. Method: This observational cross-sectional study was conducted on a population living in the Al-Qassim region in 2020. The study was conducted using a structured, validated questionnaire that was available online. The chi-square test and t-test were used to analyze the data. All the analyses were conducted using SPSS (version 21). Results: This study included 7085 individuals from the Al-Qassim region. The level of public awareness was as follows 15.6% had poor knowledge, 43.8% had fair knowledge, and 40.6% had high knowledge. The most common sources of knowledge were...
Background: The outcomes of revision subtalar arthrodesis have received relatively little focus i... more Background: The outcomes of revision subtalar arthrodesis have received relatively little focus in research compared with primary subtalar arthrodesis outcomes. This study aimed to assess the midterm clinical and radiologic results of subtalar joint revision arthrodesis and to analyze the risk factors that might influence the outcome of this procedure. Methods: We performed a retrospective review of 20 patients after subtalar joint revision arthrodesis for malunion, using interposition of iliac crest bone graft. The mean age was 55.75 years and the average follow-up lasted for 48.93 months. Eighty-five percent of the patients had at least 1 risk factor identified prior to revision. Patients’ satisfaction and functional outcomes were evaluated with the American Orthopaedic Foot & Ankle Society Scale (AOFAS), the Foot and Ankle Outcome Score (FAOS), the Foot Function Index (FFI), and dynamic pedobarography. Results: A fusion rate of 80% was recorded whereas 20% of the cases ended with...
Aim: The aim of this study was to determine the prevalence of low back pain (LBP) and to identify... more Aim: The aim of this study was to determine the prevalence of low back pain (LBP) and to identify risk factors associated with LBP among medical students. Materials and Methods: A cross-sectional study was conducted among 2021 medical students from four medical colleges in Saudi Arabia during the academic year 2019–2020. A self-administered questionnaire was conducted and included three sections: demographic data, risk factors of LBP, and prevalence of LBP (during lifetime, past 12 months, and past 7 days). Data were analyzed using SPSS. Results: A total of 2021 medical students responded to our survey. The participants were 57.1% female and 42.9% male. Most of the students' ages (76.3%) ranged from 20 to 24 years. Medical students younger than 20 and older than 24 were 21.8% and 1.9%, respectively. The prevalence of LBP was 80.7% at any time, 67.6% in the past 12 months, and 38.2% in the past 7 days. Females were found to have higher prevalence of LBP than males (P < 0.0001)...
Summary: Disruption of the knee extensor mechanism is an unfavorable situation because efficient ... more Summary: Disruption of the knee extensor mechanism is an unfavorable situation because efficient mobilization requires a functioning knee extensor apparatus. The purpose of this retrospective study was to report our technique of sartorius muscle transfer for restoration of extension mechanism function and the outcomes of five patients. Patients with ruptured knee extensor mechanism secondary to trauma or knee arthroplasty-related issues were studied retrospectively. In all patients, sartorius muscle was transferred to restore the quadriceps tension deficit. Increase in the knee active range of motion, increase in the extensor mechanism power by one grade on Medical Research Council scale, and improvement in the extension lag were observed in all patients. The sartorius muscle transfer can be a reliable option to restore the knee extensor mechanism in chronic quadriceps tendon injuries. Our initial results are promising and showed improvement of the extensor mechanism muscle power, i...
Background: The outcomes of revision subtalar arthrodesis have received relatively little focus i... more Background: The outcomes of revision subtalar arthrodesis have received relatively little focus in research compared with primary subtalar arthrodesis outcomes. This study aimed to assess the midterm clinical and radiologic results of subtalar joint revision arthrodesis and to analyze the risk factors that might influence the outcome of this procedure. Methods: We performed a retrospective review of 20 patients after subtalar joint revision arthrodesis for malunion, using interposition of iliac crest bone graft. The mean age was 55.75 years and the average follow-up lasted for 48.93 months. Eighty-five percent of the patients had at least 1 risk factor identified prior to revision. Patients’ satisfaction and functional outcomes were evaluated with the American Orthopaedic Foot & Ankle Society Scale (AOFAS), the Foot and Ankle Outcome Score (FAOS), the Foot Function Index (FFI), and dynamic pedobarography. Results: A fusion rate of 80% was recorded whereas 20% of the cases ended with...
Achilles tendon (AT) is the strongest human tendon. AT disorders are common among athletes. AT pa... more Achilles tendon (AT) is the strongest human tendon. AT disorders are common among athletes. AT pathologies vary from tendinopathy to frank rupture. Diagnosis is made clinically. Imaging modalities are used adjunctively. Management of AT rupture in athletes is challenging to surgeons due to worldwide growing popularity of sports and potential social and financial impact of AT injury to an athlete. Hence, new surgical techniques aim at attaining quick recovery with good outcome, finding similar results with both open and percutaneous techniques when accompanying these with functional rehabilitation protocols. Non-operative strategies include shoe wear modification, physiotherapy and extracorporeal shock wave therapy. Surgical interventions vary based on the AT pathology nature and extent. Direct repair can work for small-sized defects. V-Y gastrocnemius advancement could approximate the tendon edges for repair within 2–8 cm original gap. Gastrocnemius turndown can bridge tendon loss &...
Objectives: Although calcaneal fractures are relatively uncommon, they are among injuries that ma... more Objectives: Although calcaneal fractures are relatively uncommon, they are among injuries that may lead to short- and long-term morbidity regardless of the treatment. The Saudi Arabian literature showed a shortage of studies that analyzed the epidemiology of this fracture. This study aimed to analyze the epidemiology and characteristics of patients with calcaneus fractures. Methods: A retrospective study of all patients with calcaneal fractures admitted to King Fahd Hospital in Almadinah Almunawwarah City, Saudi Arabia, over a 4-year-period (January 2016–December 2019). Data such as age, gender, trauma mechanism, laterality of fracture, and associated injuries, were extracted from patients' medical files and analyzed using appropriate statistical tests. Results: The study analyzed data of 130 patients with calcaneal fractures (156 calcaneal fractures). Male patients (86.2%) were more commonly affected than females, at a ratio of 6.2:1. Ninety-three (71.5%) of the cases resulted from low-energy falls and road traffic accidents (RTA). Low-energy falls and falling from a height as injury mechanisms were higher in female patients, while RTA was more frequent in males. Bilateral fractures were found in 20% of cases, with a significantly higher rate in male patients. The associated skeletal injuries were more frequent in females than male patients (66.7% vs. 43.8%), while associated nonskeletal injuries were only found in 15 male patients, particularly those aged <40 years. Conclusion: Calcaneal fractures have a high rate of associated skeletal and nonskeletal injuries indicating the seriousness of these fractures. More research using data from multi-centers is warranted.
Objectives: The present study aimed to identify barriers in conducting or completing research by ... more Objectives: The present study aimed to identify barriers in conducting or completing research by orthopedic surgeons in Saudi Arabia. Methods: A short structured, validated online survey was distributed to all orthopedic surgeons registered as members of the Saudi Orthopedic Association (SOA) through e-mail. The survey consisted of demographic data of the survey participants, data related to their research, and six-barrier items based on a five-point Likert scale. The collected data were analyzed using appropriate statistical methods, and the level of statistical significance was defined as P ≤ 0.05. Results: Out of 1252 SOA local members, 152 participants responded to the survey with a response rate of 12.1%. Abandoning orthopedic research activities among the studied 152 participants was significantly related to insufficient time to conduct research, and limited access to funding (P < 0.0001). The long duration (>12 months) of research completion was significantly related to almost all studied barrier items. The most important predictors, using regression analyses, were insufficient time and fund support for abandoning research projects, while confidence in conducting research and support by a mentor were the most important predictors for taking a long time for research completion. Conclusion: A considerable amount of orthopedic research in Saudi Arabia is abandoned or taking a long time to complete because of barriers. Addressing and solving these barriers might help to improve the research activity among the Saudi orthopedic community.
European Journal of Orthopaedic Surgery & Traumatology
Gastrocnemius flaps provide reliable reconstructive solutions to soft-tissue loss of the knee and... more Gastrocnemius flaps provide reliable reconstructive solutions to soft-tissue loss of the knee and proximal tibia following orthopedic procedures. While this technique has been used and studied, little is known about its prophylactic application. Single-stage and delayed approaches were compared with respect to the timing of débridement, complications, and relationship between microorganisms and complications. Gastrocnemius flaps for soft-tissue defects of the knee joint were retrospectively reviewed. Success of the flap procedure was defined as a healed soft-tissue envelope, no evidence of infection, a good blood supply to the flap, and adherence of the flap to its bed. Independent sample t test was used to compare the corresponding parameters (level of statistical significance was 0.05). Of 43 flaps (43 patients), 18 were performed during a single-stage procedure along with the orthopedic procedure and 25 were delayed. Success of the single-stage (100%) and delayed flaps (88%) was not significantly different (p = 0.083). Complication rate did not differ significantly for single-stage (11%) and delayed flaps (24%) (p = 0.272). We were unable to establish a relationship between complications and microorganisms. Results indicate both approaches are reliable. Single-stage gastrocnemius flaps may eliminate the need for a second surgery. Level III (Therapeutic, Retrospective cohort)
Objectives: There is a rapid advancement in surgical techniques requiring real-time visualization... more Objectives: There is a rapid advancement in surgical techniques requiring real-time visualization and intraoperative X-ray utilization, leading to a higher radiation exposure among operating room (OR) staff. Taking preventive measures and reducing the unnecessary radiation exposure for the patient and the OR staff is essential. The study aimed to assess the compliance with using radiation protection equipment, as well as assessing the level of knowledge about radiation exposure among the orthopedic OR staff. Methods: This is a cross-sectional study that was conducted in Saudi Arabia. A 19-Item questionnaire that was developed and validated by Jentzsch et al. was sent to the emails of all the registered members of the Saudi Orthopedic Association, orthopedic physicians, OR nurses, and radiology technicians were included in the study. A Correlation procedure was performed to determine the relationship between knowledge and compliance scores. Results: We recruited 242 orthopedic OR per...
Growth modulation has become a mainstream treatment for frontal plane angular lower extremity def... more Growth modulation has become a mainstream treatment for frontal plane angular lower extremity deformities in children. Few articles address the effect of growth modulation on sagittal deformity. Our aim is to compare two anterior distal femoral growth modulation techniques for fixed knee flexion contracture. Electronic medical records were reviewed for patients who underwent anterior femoral growth modulation for fixed flexion contracture. Patients were excluded if adequate preoperative/postoperative radiographs were unavailable. A cohort was subdivided based on surgical technique: screws alone versus dual tension-band plates. Complications were recorded; radiographs were evaluated preoperatively and at hardware removal. Posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA), and anterior cortical line (ACL) angle were evaluated. Of 35 patients identified, 20 patients (29 knees) were included. Thirteen knees were treated with dual anterior tension-band plates; 16 knees had transphyseal screws. Sagittal alignment improved in both groups. Statistically significant PDFA changes were observed in the tension-band plate group (P = 0.0095); a trend was noted toward improvement in ACL angle (P = 0.08). PPTA did not change. No changes reached significance in the transphyseal screw group (PDFA: P = 0.181, ACL: P = 0.64). Tension-band plate migration was noted in one (7.7%) of 13 knees, and transphyseal screw migration in nine (56.3%) of 16 knees (P < 0.01). Anterior distal femoral growth modulation improves sagittal alignment without significant remodeling at the proximal tibia. Hardware migration occurred more often with transphyseal screws (P < 0.01). We recommend dual anterior tension-band plating over placement of paired screws for sagittal growth modulation to treat knee flexion contracture.
INTRODUCTION/PURPOSE Osteochondral lesion of the talus (OCLT) is defined as a defect on the artic... more INTRODUCTION/PURPOSE Osteochondral lesion of the talus (OCLT) is defined as a defect on the articular surface of the talus with/without subchondral bone involvement. Several surgical techniques are described in literature to treat OCLT. Particulated Juvenile Cartilage Allograft Transplantation (PJCAT) is a new emerging technique that has the potential of restoring the native cartilage. However, available data on PJCAT in treating OCLT is confined to a small number of studies with heterogeneous population. The aim of this study is to systematically review the literature on clinical and radiological outcomes of PJCAT in treating OCLT. METHODS A systematic search of Medline database was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Number of patients and demographic data included age, gender and body mass index (BMI) were extracted. The level of evidence of each included study was identified. When feasible, mechanism of injury, lesion size and average follow up were recorded. The American Orthopedic Foot and Ankle Society Score (AOFAS), and Foot and Ankle Outcome Score (FAOS) were obtained to assess the functional outcomes. Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was selected to evaluate the radiological outcomes. RESULTS A total of 10 studies were eligible for this review involving 132 patients. Postoperative AOFAS scores were available for 44 patients who underwent PJCAT with an average of 86.14 at 25.5 months follow up. FAOS scores have been reported in 3 studies for 81 patients. The average preoperative score was 47.35 which has been improved to 62.88 at follow up of 23.6 months. MOCART was evaluated in 42 feet after the mean follow up of 18.2 months. The repair tissue was characterized by variable features; however, certain peculiarities were observed with higher frequency including infill hypertrophy, incomplete border zone integration, deep surface disruption, structure inhomogeneity, patches of hyperintense signals, damage of subchondral lamina and subchondral bone, adhesions and absence of effusion. CONCLUSION PJCAT seems to be a promising modality of treatment for OLT in terms of functional outcomes. Fair attempts of defect filling can be confirmed with MRI. Nevertheless, heterogeneous picture of regenerate cartilaginous tissue and lack of repair in subchondral bone and subchondral lamina are not in favor with claims of full restoration of lost normal hyaline articular cartilage.
Voluntary elbow extension is essential for optimal upper limb positioning required for daily livi... more Voluntary elbow extension is essential for optimal upper limb positioning required for daily living activities, particularly above-shoulder maneuvers. The authors present a case of traumatic brachial plexus injury in which paralysis of the musculature selectively supplied by the posterior cord was based on magnetic resonance imaging and nerve conduction studies. An attempt at a radial nerve graft at another center was not effective. Ipsilateral hand function improved after multiple local tendon transfers were performed. Restoration of active elbow extension was not possible using the posterior deltoid or the latissimus dorsi because they were denervated by the primary trauma and so the trapezius muscle was used as a donor muscle unit to restore voluntary elbow extension. The patient resumed biking 6 weeks after the transfer procedure. At 2-year follow-up, full active elbow extension was regained, elbow extension power scored 4 of 5, and the patient reported that he could ride his bicycle for 70 miles.
This study was aimed to review the short-term results of endoscopic percutaneous longitudinal ten... more This study was aimed to review the short-term results of endoscopic percutaneous longitudinal tenotomy for noninsertional Achilles tendinopathy using the Centerline Endoscopic Carpal Tunnel Release instrument (Arthrex). This method simplifies the operation technique, allows a good endoscopic visualisation of the Achilles tendon with very promising results. We performed multiple percutaneous longitudinal tenotomies under local anesthesia in 24 patients (25 tendons) with Achilles tendinopathy or peritendinitis that had failed conservative treatment between January 2013 and September 2016. All ambulatory procedures consisted of paratenon release and longitudinal tenotomies. The results were reviewed in 22 patients (23 tendons) at an average follow-up period of 22.5 months (range 10-36 months). Patients' satisfaction and functional outcomes were evaluated using the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, the pain visual analog scale (VAS), and the f...
Reconstruction of segmental bone defects requires a large commitment both on the part of the pati... more Reconstruction of segmental bone defects requires a large commitment both on the part of the patient and the physician. Investing in preoperative evaluation and optimization is the only logical way to pursue such an endeavor. Unfortunately, detailed studies regarding segmental bone defects and preoperative factors are relatively lacking owing to the relatively low incidence of the problem. Fortunately, other orthopaedic pathologies (arthritis, ligamentous injuries about the knee) have high prevalence and consistency, allowing detailed analysis of preoperative factors. We review this literature, and that directly involving segmental bone defects when available, to guide surgeons planning segmental bone defect reconstruction.
Knee complaints and their accompanying functional impairments are frequent problems encountered b... more Knee complaints and their accompanying functional impairments are frequent problems encountered by healthcare practitioners worldwide. Plenty of functional scoring systems were developed and validated to give a relative estimation about the knee function. Despite the wide geographic distribution of Arabic language in the Middle East and North Africa, it is rare to find a validated knee function scale in Arabic. The present study is aimed to translate, validate, and culturally adjust the Knee Outcome Survey: Activities of Daily Living Scale (KOS-ADLS) into Arabic language for future use among Arabic-speaking patients. Permission for translation was obtained from the copyrights holder. Two different teams of high-level clinical and linguistic expertise conducted translation process blindly. Forward-backward translation technique was implemented to ensure preservation of the main conceptual content. Main study consisted of 280 subjects. Reliability was examined by test-retest pilot study. Visual Analogue Scale (VAS), Get Up and Go (GUG) Test, Ascending/Descending Stairs (A/D Stairs), and Subjective Assessment of Function (SAF) were conducted concurrently to show the validity of Arabic KOS-ADLS statistically in relation to these scales. Final translated version showed no significant discrepancies. Minor adaptive adjustment was required to fit Arabian cultural background. Internal consistency was favourable (Cronbach&#39;s alpha 0.90). Patients&#39; scoring on Arabic KOS-ADLS appeared relatively consistent with their scoring on VAS, GUG, A/D Stairs, and SAF. A significant linear relationship was demonstrated between SAF and total KOS-ADLS scores on regression analysis (adj. R = 0.548). Arabic KOS-ADLS, as its English counterpart, was found to be a simple, valid, and useful instrument for knee function evaluation. Arabic version of KOS-ADLS represents a promising candidate for unconditional use among Arabic-speaking patients with knee complaints.
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Papers by Hamza Alrabai