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The World Association Against Infection in Orthopedics And Trauma (W.A.I.O.T.) Study Group on Bone And Joint Infection Definitions Metal hypersensitivity (MHS) has been investigated by several authors as a possible reason for painful total joint arthroplasty, with controversial results. Periprosthetic joint infection (PJI) is another possible source of unexplained pain and implant failure that may be difficult to diagnose if not properly investigated. We performed this critical review to assess whether the current literature on MHS includes an adequate diagnostic workup to discern metal allergy from PJI. The results of this review highlight the importance of assessing patients for PJI before making a diagnosis of MHS and emphasize that the methods currently used to exclude PJI are substantially inadequate. Therefore, well-designed clinical trials with adequate diagnostic protocols and definitions of PJI that can differentiate MHS from low-grade PJI are needed. [ Orthopedics . 2022;45(2):e73-e78.].

Pemberton's osteotomy has been recognized as a standard technique for the treatment of acetabular dysplasia. The aim of this article is to describe the surgical technique of a double-level pelvic osteotomy. To the authors' knowledge, this technique has never been reported. The osteotomy was performed in a case of severe pan-acetabular dysplasia where a single, classic Pemberton's osteotomy was not sufficient to provide adequate coverage. The described osteotomy provided sufficient acetabular coverage and overcame the persistent acetabular dysplasia. [Orthopedics. 2016; 39(4):e806-e809.]., (Copyright 2016, SLACK Incorporated.)

A total 12 consecutive children with secondary deformities following total obstetric brachial plexus palsy were included in this retrospective study. In all patients, the main complaints were two socially disabling hand postures: the "beggar's" hand and/or the "unshakable" hand. All children had a supinated forearm with no active pronation and were teased by their friends, who called them "beggars." When the impairment was severe and involved the right hand and wrist, children also complained that they were not able to shake hands. The management approach to these children was described, with the main aim of surgery being the correction of the abnormal posture. Other simultaneous tendon transfers were also performed to improve hand function if there were suitable musculotendinous units. Successful reconstruction was accomplished in all patients. Preoperatively, some children refused to go to school because of teasing, and most did not want to interact socially. After surgery, all children attended school regularly, and parents reported much better social interaction. However, the functional gain was never enough to dramatically improve the daily use of the limb. The contralateral normal limb remained the dominant one for all daily activities, including writing and eating.

Objective: Our aim was to study the significance of persistently absent radial pulse, with monophasic doppler flow after close reduction percutaneous pinning of displaced supracondylar fracture of humerus, and the need of early exploration of brachial artery in such cases., Methods: Between July 1992 and 1999, 86 children with Grade III supracondylar fracture of humerus were treated at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia The history, physical examination, vascular status of limb before and after close reduction percutaneous pinning of fracture were recorded. All children having persistently absent radial pulse and monophasic flow doppler signals after close reduction percutaneous pinning under went exploration of brachial artery., Results: Of the 86 children with Grade III supracondylar fracture of humerus, 6 had persistently absent radial pulse with monophasic flow doppler signals after close reduction percutaneous pinning. Five children had one warm pink well perfused hand and one cold pale poorly perfused hand. All 6 under went exploration of brachial artery and were found to have entrapped artery at the fracture site. There was an immediate return of radial pulse with triphasic Doppler flow on release of brachial artery., Conclusion: Persistently absent radial pulse with objectivity, obtained by doppler ultrasound in the form of absent or monophasic flow in radial artery, is a reliable indicator of vascular compromise. Surgical exploration of brachial artery by a competent surgeon is to be carried out to avoid early and late complication, of pulseless limb in children with displaced supracondylar fracture of humerus.

Objective: To study the patterns of scoliosis seen in a major Spinal Unit in Saudi Arabia., Methods: Medical records of 192 Saudi patients with scoliosis seen between 1992 and 1997 at the Spinal Unit of the Riyadh Medical Complex (which is a major spinal unit in the Kingdom) were studied and analyzed and epidemiological data was collected., Results: Fifty nine percent of all cases of scoliosis were idiopathic, 7% were secondary to poliomyelitis and 17% were congenital scoliosis. The mean age of discovery of idiopathic scoliosis was 12.5 years and at presentation was 16 years. The mean Cobb`s angle at presentation was 58o. Adolescent type constituted 74% of idiopathic curves with a male to female ratio of 1:3.8. Thoracic curves were the most common followed by the double major curves. Half of the curves were right sided. Infantile idiopathic scoliosis constituted 8% with male to female ratio of 4:1 and here left thoracic curves formed 50%. The juvenile type constituted the remaining 18% with male to female ratio of 1:1.5., Conclusion: The pattern of scoliosis in our study is comparable in many aspects with other studies carried out elsewhere, with the exception of delay in patients age at referral. We believe that our data could reflect a possible pattern of the epidemiology of scoliosis in Saudi Arabia, given the fact that there is no National Registry. To avoid delay in management, community education will help in the early detection of cases.

Objective: To study the patterns of scoliosis seen in a major Spinal Unit in Saudi Arabia., Methods: Medical records of 192 Saudi patients with scoliosis seen between 1992 and 1997 at the Spinal Unit of the Riyadh Medical Complex (which is a major spinal unit in the Kingdom) were studied and analyzed and epidemiological data was collected., Results: Fifty nine percent of all cases of scoliosis were idiopathic, 7% were secondary to poliomyelitis and 17% were congenital scoliosis. The mean age of discovery of idiopathic scoliosis was 12.5 years and at presentation was 16 years. The mean Cobb's angle at presentation was 58 degrees C. Adolescent type constituted 74% of idiopathic curves with a male to female ratio of 1:3.8. Thoracic curves were the most common followed by the double major curves. Half of the curves were right sided. Infantile idiopathic scoliosis constituted 8% with male to female ratio of 4:1 and here left thoracic curves formed 50%. The juvenile type constituted the remaining 18% with male to female ratio of 1:1.5., Conclusion: The pattern of scoliosis in our study is comparable in many aspects with other studies carried out elsewhere, with the exception of delay in patients age at referral. We believe that our data could reflect a possible pattern of the epidemiology of scoliosis in Saudi Arabia, given the fact that there is no National Registry. To avoid delay in management, community education will help in the early detection of cases.