Search

Background: Large benign bone tumors can cause bone defects that significantly affect the stability of a limb after resection. The reconstruction of large skeletal defects in children presents a unique challenge to the orthopedic surgeon due to the significant remaining growth potential, the desire for biologic preservation of the joint surface, and the need for a long-term viable reconstruction in patients expected to survive for decades. The use of a fibular strut graft has been shown to provide biologic reconstruction that successfully addresses these issues in the pediatric population. This study aims to evaluate the results of benign and tumor like lesions treated by non-vascularized autologous fibular strut graft and supplementary fixation. Methods: This retrospective study was conducted between January 2002 and December 2017 at Jinnah Postgraduate Medical Centre, Karachi, Pakistan. The study included all patients under 13 years of age with benign and tumor-like lesions of bone undergoing surgical procedures requiring bone grafts. The surgical procedures performed were simple excision, curettage, and stabilization, and marginal resection with reconstruction with autologous fibula bone grafting±cancellous bone grafting. Further stabilization was achieved with intramedullary or compression plate and screw fixation. Clinical and radiological follow-up was done until skeletal maturity. Results: There were 480 cases of benign and tumor-like lesions of bone operated in the study period, with an average age of 7.8 years (range 4–13 years). The most common lesion operated was aneurysmal bone cysts (38.54 %), followed by fibrous dysplasia (28.75 %), and non-ossified fibromas (9.37 %). All patients could walk with partial weight-bearing four weeks postoperative, and full weight-bearing was permitted after a mean of 8 weeks. Graft union was attained in 468 (97.5 %) patients at a mean of 2 months while 12 (2.5 %) required repeated surgery. No recurrence of the pathology, pain, graft fracture or limitation in range of motion was noted. Conclusions: This study showed that primary bone tumors were mainly benign, settled predominantly in the lower extremities mostly in the femur with a male preponderance. In the pediatric patient, the described technique is an effective and reliable treatment method for large benign bone tumors requiring resection. However, great diameter discrepancy of the donor and recipient site and a thin periosteum can be a limiting factor for its application. We conclude that non vascularized autologous fibular strut graft with internal fixation is a safe and effective method of treatment for benign cystic lesions in children.

Purpose: The purpose of this literature review is to examine the current evidence regarding the timing of surgical intervention for acetabular fractures and to explore the outcomes of early versus late surgical management. Additionally, this review aims to evaluate the experiences of low-resource settings in managing acetabular fractures. Method: A systematic literature search was conducted using electronic databases to identify relevant studies published between 2010 and 2022. Inclusion criteria consisted of studies that assessed the timing of surgical intervention for acetabular fractures and reported on outcomes such as pain, functional outcomes, and radiographic healing. A total of 22 studies were included in this review. Literature Review: The literature review revealed conflicting evidence regarding the optimal timing of surgical intervention for acetabular fractures. Some studies suggested that early intervention leads to improved outcomes in terms of pain relief, functional outcomes, and radiographic healing. However, other studies found no significant differences in outcomes between early and delayed surgical management. The experience of low-resource settings also showed comparable outcomes to those of high-income settings, although studies in these settings were limited. Results: The results of this literature review suggest that the timing of surgical intervention for acetabular fractures remains controversial. While some studies suggest that early intervention may result in better outcomes, others found no significant differences in outcomes between early and delayed surgery. Furthermore, the experience of low-resource settings suggests that successful outcomes can be achieved despite limited resources. However, further studies in these settings are needed to better understand the challenges and limitations of managing acetabular fractures in low-resource settings.

Background: Femoral neck fractures are challenging injuries that can lead to non-union and avascular necrosis (AVN), particularly in cases of delayed presentation. Muscle pedicle bone grafting has been suggested as a potential approach to supplement blood supply to the fracture site. The objective of this study was to evaluate the efficacy of Meyer's procedure in the treatment of ununited femoral neck fractures with grade I and II AVN, which involves internal fixation and quadratus femoris-based muscle pedicle bone grafting. Methods: Five patients with delayed presentation of femoral neck fractures with grade I and II AVN were included in this retrospective study. The surgical approach for all patients was Meyer's procedure, consisting of open reduction and internal fixation followed by a muscle pedicle graft and cancellous bone graft. Fixation was done with parallel cannulated screws or non-cannulated cancellous screws. In all cases, the quadratus femoris muscle pedicle graft was utilized. The average follow-up duration was three years. Results: All five patients achieved radiological union and reported excellent functional outcomes, including the ability to perform activities such as squatting and sitting cross-legged. According to the Salvatti and Wilson hip rating system, three cases had excellent results, one had good results, and one had fair results. Two cases had coxa vara, and one case had temporary loss of scrotal sensation as complications. Avascular necrosis and transient foot drop were not observed in any cases. Using the modified Harris hip score, all cases achieved good or excellent outcomes, with an average follow-up period of 130 weeks and radiological union occurring at an average of 6.5 months. Conclusion: Meyer's procedure provides stable internal fixation and enhanced blood supply to promote union in ununited femoral neck fractures with grade I and II AVN. This technique can achieve good or excellent functional outcomes and may represent a viable treatment option for patients with these types of fractures. However, further research is needed to confirm these findings and optimize treatment strategies.

Purpose: To investigate the orthopedic injuries sustained while driving and using social media on cellular phones from an orthopedic resident's perspective. Methods: A total of 118 patients who presented with a history of road traffic accident secondary to social media usage and suffered from fractures were included in this cross-sectional study. These patients were reported from October 2018 to April 2019. We collected the data including the type of collision, type of social media usage during driving, location of injury, wearing of safety equipment's such as helmet and seat belt during driving. Results: The mean age of patients was (34.86 ± 12.73) (range 15–71) years. The common types of accident on the basis of collision of vehicles were: car versus motorbike 45 (38.1%), motorbike versus motorbike 28 (23.7%), and motorbike versus pedestrian 22 (18.6%). Most of the accidents (61, 51.7%) occurred due to mistake of motor-bikers. Out of them, 44 (37.3%) occurred on traffic signals, followed by 29 (24.6%) while driving on main roads. The common timing of accident was normal hours with frequency of 44 (37.3%), followed by 39 (33.1%) at late night. According to fracture type, closed injuries were 98 (83.1%) and open fractures were 20 (16.9%). The most common fracture was clavicular fracture (21, 22.5%) followed by soft tissue injury in 19 (16.1%) patients. The most common social media application usage during driving was Facebook 43 (36.4%), followed by Whatsapp 24 (20.3%), Google 19 (16.1%), and Instagram 15 (12.7%). Conclusion: This study provides evidence that social media usage while driving put the drivers and other road users' lives at high risk. The most common social media addiction while driving is Facebook and Whatsapp. So there is a need to make strict rules and penalties for using cell phone during driving so as to save the lives of drivers and other people using road.

Purpose: This literature review aims to assess the impact of malnutrition on the Ponseti method, a widely used non-surgical approach for treating clubfoot, and to evaluate the importance of nutritional status in achieving successful outcomes. Methods: A systematic search was conducted on PubMed, Embase, and Scopus databases using the keywords ''malnutrition,'' ''Ponseti method,'' ''clubfoot,'' ''non-surgical treatment,'' ''surgical outcomes,'' and ''nutritional status.'' Studies published between 2010 and 2023 were considered for inclusion. A total of 12 relevant articles were reviewed. Results: Malnutrition is a significant risk factor for poor outcomes in clubfoot patients treated with the Ponseti method. Malnourished patients are more likely to experience delayed wound healing, increased infection risk, impaired cognitive function, and decreased bone density, all of which can negatively impact the success of the treatment. Malnourished children also have a higher relapse rate and require a longer duration of treatment compared to well-nourished patients. Improving nutritional status through appropriate measures is crucial for achieving a successful outcome. Vitamin D deficiency is a prevalent issue in clubfoot patients, and addressing this through supplementation has been shown to improve success rates. Conclusions: The results of this review highlight the importance of assessing nutritional status in clubfoot patients undergoing the Ponseti method. Addressing malnutrition and optimizing nutritional status can prevent complications, reduce treatment duration, and increase the success rate of the treatment. Clinicians should routinely evaluate and manage the nutritional status of clubfoot patients to ensure the best possible outcomes.

Background: Opioid use disorder (OUD) is a global public health concern. The standard of care for OUD involves treatment using medications such as buprenorphine, methadone, or naltrexone. No known review exists to assess the contextual factors associated with medication for opioid use disorder (MOUD) in the Arab World. This systematic review serves as an implementation science study to address this research gap and improve the uptake of MOUD in the Arab World., Methods: Systematic searches of Medline, PsycINFO, and EMBASE, and a citation analysis, were used to identify peer-reviewed articles with original data on MOUD in the Arab World. Quality assessment was conducted using the CASP appraisal tools, and main findings were extracted and coded according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework., Results: 652 research articles were identified, and 10 met inclusion criteria for final review. Four studies considered health-systems aspects of MOUD administration, such as cost-effectiveness, the motivations for and impact of national MOUD policies, the types of social, political, and scientific advocacy that led to the adoption of MOUD in Arab countries, and the challenges limiting its wide-scale adoption in the Arab World. Six papers considered MOUD at individual and group patient levels by evaluating patient quality of life, addiction severity, patient satisfaction, and patient perspectives on opioid agonist therapy., Conclusion: Despite financial and geographic barriers that limit access to MOUD in the Arab World, this review found MOUD to be cost-effective and associated with positive health outcomes for OUD patients in the Arab World. MOUD can be successfully established and scaled to the national level in the Arab context, and strong coalitions of health practitioners can lobby to establish MOUD programs in Arab countries. Still, the relative novelty of MOUD in this context precludes an abundance of research to address its long-term delivery in the Arab World., Competing Interests: Declarations of Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Daniel Bromberg is supported by F31 DA054861 from the National Institute on Drug Abuse, as well as the Global Health Equity Scholars Program funded by Fogarty International Center (D43 TW010540) and the National Institute of Mental Health (T32 MH020031)., (Copyright © 2022. Published by Elsevier B.V.)