Abdulrahman D Algarni

Comparative Study of Hamstring and Quadriceps Strengthening Treatments in the Management of Knee Osteoarthritis

[Purpose] Osteoarthritis (OA) of the knee is the most common form of joint disease. It is one of the major causes of impaired function that reduces quality of life (QOL) worldwide. The purpose of this study was to compare exercise treatments for hamstring and quadriceps strength in the management of knee osteoarthritis. [Subjects and Methods] Forty patients with OA knee, aged 50–65 years were divided into 2 groups. The first group (57.65±4.78 years) received hot packs and performed strengthening exercises for the quadriceps and hamstring, and stretching exercises for the hamstring. The second group (58.15±5.11 years) received hot packs and performed strengthening exercises for only the quadriceps, and stretching exercise for the hamstring. Outcome measures were the WOMAC (Western Ontario and McMaster Universities OA index questionnaire), Visual Analogue Scale (VAS) assessment of pain, the Fifty-Foot Walk Test (FWS), and Handheld dynamometry. [Results] There was a significant difference between the groups. The first group showed a more significant result than the second group. [Conclusion] Strengthening of the hamstrings in addition to strengthening of the quadriceps was shown to be beneficial for improving subjective knee pain, range of motion and decreasing the limitation of functional performance of patients with knee osteoarthritis.

Delayed Horner's syndrome following ultrasound- guided interscalene brachial plexus block

We describe a case of Horners syndrome that occurred shortly after post-operative bolus administration of interscalene brachial plexus analgesia.

Effect of Forward and Backward Locomotion Training on Anaerobic Performance and Anthropometrical Composition

[Purpose] Forward walking (FW) and backward walking (BW) on a treadmill is a common tool for lower extremity rehabilitation in the clinical setting. The purpose of this study was to evaluate the effects on anaerobic performance and anthropometrical adaptations during FW and BW on a treadmill. [Subjects and Methods] A convenience sample of thirty healthy male subjects with a mean age of 20.93 ± 2.54 years participated in this study. Subjects were divided into 2 groups, a Forward Walking Group (FWG) (n=15) and a Backward Walking Group (BWG) (n=15), which performed FW and BW on a treadmill at 10° inclination, respectively. The training consisted of three sessions per week for 6 weeks. Study outcomes such as anaerobic performance and anthropometrical body composition were measured at pre- and post-intervention. [Results] Both FW and BW improved anaerobic performance significantly, and the BW group showed better performance than FW. However, changes in anthropometrical body composition were found to be not significant after six weeks of intervention in both the FW and BW groups. [Conclusions] BW training in rehabilitation can be considered more effective than FW at improving anaerobic performance. We also conclude that six weeks of FW and BW training is insufficient for eliciting changes in the body composition.

The Prevalence of and Factors Associated with Neck, Shoulder, and Low-Back Pains among Medical Students at University Hospitals in Central Saudi Arabia

Aim The study aim was to determine the prevalence of neck, shoulder, and low-back pains and to explore the factors associated with musculoskeletal pain (MSP) among medical students at university hospitals in central Saudi Arabia. Method This cross-sectional study was conducted at a government institution using an online self-administered, modified version of the Standardised Nordic Questionnaire in the English language. Results A total of 469 students responded to our survey. The prevalence of MSP in at least one body site at any time, in the past week, and in the past year was 85.3%, 54.4%, and 81.9%, respectively. Factors significantly associated with MSP in at least one body site at any time were being in the clinical year (P = 0.032), history of trauma (P  =  0.036), history of depressive symptoms (P < 0.001), and history of psychosomatic symptoms (P < 0.001). On multivariable regression analysis, factors associated with MSP were history of trauma (P = 0.016) and depressive (P = 0.002) or psychosomatic symptoms (P = 0.004). Conclusion MSP among Saudi medical students is high, particularly among those in the clinical years and those with history of trauma and with depressive or psychosomatic symptoms. Medical institutions should be aware of this serious health issue and preventive measures are warranted.

Cadaveric device-injected very high-viscosity cement during vertebroplasty

Introduction: Cement extravasation during vertebroplasty (VP) is the most commonly reported complication. Cement viscosity is considered the single most important predictor of the risk of extravasation. Certainly, injecting high-viscosity cement (HVC) is difficult to utilize in real practice. We invented a new device capable of injecting high-viscosity with ease and at a distance to avoid radiation. The aim of this study is to confirm the efficacy and safety of the new device on cadaveric vertebrae. Methodology: A 126 osteoporotic vertebral bodies were harvested from cadavers. Eighty vertebrae were included in the study. Computer-randomization software was used to allocate specimens over two main groups, Conventional VP and New Device. Both groups were further subdivided into two subgroups; high-viscosity and low-viscosity. A custom device was used on each vertebra to induce a compression fracture. Results: Injecting HVC was associated with a lower leakage volume compared with low-viscosity cement. HVC was associated with no leakage into the spinal canal. It was also associated with a low incidence of vascular extravasation (P < 0.001). The mean volume of cement leakage in the low-viscosity group was 0.23 and 0.15 cc, for the Conventional VP and New Device, respectively. In both groups, the most common site for leakage was the vertebral end plate, which was exhibited more in the low-viscosity group (71.5%) compared with the high-viscosity group (42.5%). The preset target amount of cement to be injected was reached in 99% of the time when injecting HVC with the New Device, compared with 62% using the Conventional VP. In both groups, there was no correlation between the amount of cement injected and the amount of leakage. Conclusion: The new device is capable of injecting HVC easily, with a lower incidence of cement leakage. It also minimized the risk of radiation exposure to the surgeon.

Clinical and Radiological Outcomes of Extracorporeal Shock Wave Therapy in Early-Stage Femoral Head Osteonecrosis

Objective Femoral head osteonecrosis is a progressive clinical condition with significant morbidity and long-term disability. Several treatment modalities including both surgical and nonsurgical options have been used with variable levels of success. High-energy extracorporeal shock wave therapy is a nonoperative treatment option that has been described for early-stage disease. We aimed to assess the functional and radiological outcomes of extracorporeal shockwave therapy (ESWT) in the treatment of osteonecrosis of the femoral head (ONFH). Methods Thirty-three hips of 21 patients were included in this study. Adult patients with ONFH of any etiology and in the precollapse stage were included. Clinical (visual analogue scale [VAS] and Harris hip score [HHS]) and radiological (plain radiographs and magnetic resonance imaging [MRI]) evaluations were performed before and after intervention. We used 3000–4500 pulses in a single session performed under general anesthesia. Results At an average of 8 months after ESWT, pain scores and HHS were significantly improved compared with the preintervention scores (p<0.001). The overall clinical outcomes were improved in 21 hips (63.3%), unchanged in 5 hips (15.15%), and worsened in 7 hips (21.2%). A trend toward a decrease in the size of the ONFH was observed although not of clinical significance (p=0.235). MRI revealed significant resolution of bone marrow edema (p<0.003). Regression was observed in 9 lesions (42.9%) and progression in 1 lesion (4.7%); no change was observed in the remaining 23 lesions (52.4%). Conclusion ESWT is a viable noninvasive treatment option for early-stage ONFH. It significantly improves clinical outcomes and may halt or delay the radiographic progression of the disease in the precollapse stage.

Analysis of the spinal nerve roots in relation to the adjacent vertebral bodies with respect to a posterolateral vertebral body replacement procedure

Objective: This study aims to improve the understanding of the anatomic variations along the thoracic and lumbar spine encountered during an all-posterior vertebrectomy, and reconstruction procedure. This information will help improve our understanding of human spine anatomy and will allow better planning for a vertebral body replacement (VBR) through either a transpedicular or costotransversectomy approach. Summary of Background Data: The major challenge to a total posterior approach vertebrectomy and VBR in the thoracolumbar spine lies in the preservation of important neural structures. Methods: This was a retrospective analysis. Hundred normal magnetic resonance imaging (MRI) spinal studies (T1–L5) on sagittal T2-weighted MRI images were studied to quantify: (1) mid-sagittal vertebral body (VB) dimensions (anterior, midline, and posterior VB height), (2) midline VB and associated intervertebral discs height, (3) mean distance between adjacent spinal nerve roots (DNN) and mean distance between the inferior endplate of the superior vertebrae to its respective spinal nerve root (DNE), and (4) posterior approach expansion ratio (PAER). Results: (1) The mean anterior VB height gradually increased craniocaudally from T1 to L5. The mean midline and posterior VB height showed a similar pattern up to L2. Mean posterior VB height was larger than the mean anterior VB height from T1 to L2, consistent with anterior wedging, and then measured less than the mean anterior VB height, indicating posterior wedging. (2) Midline VB and intervertebral disc height gradually increased from T1 to L4. (3) DNN and DNE were similar, whereby they gradually increased from T1 to L3. (5) Mean PAER varied between 1.69 (T12) and 2.27 (L5) depending on anatomic level. Conclusions: The dimensions of the thoracic and lumbar vertebrae and discs vary greatly. Thus, any attempt at carrying out a VBR from a posterior approach should take into account the specifications at each spinal level.

Anterior cruciate ligament reconstruction: Can optimal graft placement be achieved with a free-hand drilled transtibial technique?

Objective: Anterior cruciate ligament (ACL) injuries are common among athletes and active individuals participating in sports. ACL reconstruction using the single-bundle technique can be performed through transtibial or anteromedial portals. The transtibial technique carries the theoretical risk of vertical placement of the femoral tunnel in the intercondylar notch. The aim of this study is to assess the efficacy of a free-hand drilled-transtibial technique in achieving optimal graft positioning. Materials and Methods: We analyzed a retrospective series of post-operative knee radiographs in 52 consecutive patients who underwent a single-bundle ACL reconstruction by a single surgeon using this transtibial method, from June 2009 to January 2010. Tunnel positioning was radiographically assessed by an independent single observer, who was not involved in the management of patients. The graft inclination angle, the coronal and the sagittal femoral and tibial tunnel placements were evaluated. Results: Post-operative radiographs of 40 patients (40 knees) were retrospectively evaluated for femoral and tibial tunnel positioning. In the coronal plane, the mean graft inclination angle was 21°, the femoral tunnel was positioned at a mean of 43% lateral to the lateral femoral condyle and the tibial tunnel at a mean of 46% lateral to the medial border of the medial tibial plateau. In the sagittal plane, the femoral tunnel was placed at 84% posteriorly across Blumensaat′s line and the tibial tunnel at a mean of 43% along the length of the tibial plateau. The results were consistent with optimal tunnel positioning according to anatomic and clinical studies. Conclusion: The transtibial technique described in this series can achieve optimal tunnel positioning for single-bundle ACL reconstruction.

Evaluation of the orthopedic residency training program in Saudi Arabia and comparison with a selected Canadian residency program

Objective The primary aim of the present study was to assess the quality of the Saudi Orthopedic Residency Program. Methodology As a comparator, a cross-sectional survey involving 76 Saudi residents from different training centers in Saudi Arabia namely; Riyadh, Jeddah, Medina, Abha, and Dammam and 15 Canadian. Results The results showed that Canadian residents read more peer-reviewed, scholarly articles compared with Saudi residents (P=0.002). The primary surgical role for residents was to hold retractors during surgery. The survey respondents strongly supported the ability to recommend removal of incompetent trainers. Saudi trainees were more apprehensive of examinations than Canadian trainees (P<0.0001). Most residents preferred studying multiple-choice questions before examinations. Saudi and Canadian participants considered their programs to be overcrowded. Unlike Canadian participants, Saudi trainees reported an inadequate level of training (P<0.0001). Conclusion Educational resources should be readily accessible and a mentorship system monitoring residents’ progress should be developed. The role of the resident must be clearly defined and resident feedback should not be ignored. Given the importance of mastering basic orthopedic operative skills for residents, meaningful remedial action should be taken with incompetent trainers.

Hybrid Fixation Utilizing a Custom Stem Extension for the Treatment of Periprosthetic Femoral Nonunions Around Well-Fixed Cylindrical Femoral Stems

Periprosthetic femoral nonunion associated with total hip arthroplasty is an infrequent complication1. However, the increasing worldwide incidence of periprosthetic fractures2 is expected to result in a higher number of complications, including fracture nonunion. A periprosthetic fracture around a well-fixed stem (e.g., Vancouver type B1)3 is a difficult complication to manage4, and it often requires both an arthroplasty and the skills of a trauma surgeon5. Nonunited fractures are even more challenging; they have a high rate of complications and relatively poor functional outcomes1. We present two cases of periprosthetic femoral nonunion around a stable cylindrical stem. The first nonunion occurred following an intraoperative periprosthetic fracture, and the second nonunion occurred following a postoperative fracture, after which a custom stem extension had been added to the conventional fixation method. After this combination of intramedullary and extramedullary or hybrid fixation, stability was achieved at the nonunion site, and healing was obtained in both patients. To our knowledge, the use of this type of custom-made porous-coated prosthesis has not been previously reported. The patients were informed that data concerning their cases would be submitted for publication, and they provided consent. Case 1. A sixty-six-year-old woman with a history of polymyalgia rheumatica (treated with corticosteroid therapy) and left hip osteoarthritis underwent simultaneous removal of previous fixation hardware and a cementless left total hip arthroplasty. The components included a Duraloc cup and a cylindrical-type Prodigy stem (DePuy Synthes, Warsaw, Indiana). During the procedure, the patient sustained a long spiral femoral fracture extending around and distal to the stem. Because the stem was stable, the fracture was reduced and fixed with a Dall-Miles cable and plate system and multiple lag screws. Six months postoperatively, radiographs showed a well-ingrown femoral stem; however, the fracture had failed to …