Chronic Exertional Compartment Syndrome in Athletes: An Overview of the Current Literature.

Chronic exertional compartment syndrome is an incapacitating condition that primarily affects athletes and individuals with high activity levels. The exact etiology of the condition is unknown to date, but multiple factors play a role in its occurrence. The clinical presentation includes pain, tightness, muscle weakness, paresthesia, and cramps. Common tools utilized during the diagnostic approach include intramuscular compartment pressure measurement, advanced imaging to exclude other disorder entities, near-infrared spectrometry, and shear wave elastography, with the clinical diagnosis being the gold standard. Management includes both conservative and surgical options. Conservative treatment includes gait re-training and botulinum toxin injections. Further, the operative treatment has variable approaches and may be combined with conservative modalities. This article reviews the literature on chronic exertional compartment syndrome and elucidates future recommendations.

Chin Reduction Made Simpler.

Deformities of the chin, including both macrogenia or microgenia, can alter facial aesthetics and harmony. Various reliable approaches to correct chin abnormalities are present. Nonetheless, in this article, we propose our surgical approach to reduce the chin with a 5-mm cutting burr, without the need for osteotomy. The ultimate goal of this new procedure is to provide optimum outcomes, ensure maximum safety, reduce the complication risk, and present a simple and fast option for chin reduction.

Representation of women in orthopaedic surgery: perception of barriers among undergraduate medical students in Saudi Arabia.

BACKGROUND: While female participation has improved in several surgical specialties over time globally, no such increase has been observed in orthopaedic surgery over the past decades. The potential barriers to female participation are likely present from the beginning of medical education. Therefore, this study assessed the apparent lag in equal representation among men and women in orthopaedic surgery in the Kingdom of Saudi Arabia. METHODS: This cross-sectional study used a questionnaire survey to investigate medical students' and interns' perceptions of women participating in orthopaedic surgery, their subspeciality preferences, and barriers preventing them from pursuing an orthopaedic career. The responses were analysed to understand general perceptions, gender-based differences, impact of clinical experiential learning, and exposure to orthopaedic surgery. RESULTS: Approximately 565 medical students (49% females, 51% males) participated in the survey. Only 17% of students (11% females, 23% males) considered orthopaedic surgery as their future career option. While 31% of female and 17% of male students disagreed with the concept of female-appropriate orthopaedic subspecialties, most of the remaining male and female students perceived paediatric orthopaedics as a female-appropriate subspecialty. Concerning equal representation of women, gender bias and lack of a strong physique were the most frequently selected barriers by female and male students, respectively. Patient preference for male orthopaedicians, gender discrimination, social and family commitments, and need for physical strength were all perceived as barriers for women in orthopaedics. Overall, clinical experience and orthopaedic exposure did not significantly improve the likelihood of female students in choosing orthopaedic surgery as a career. CONCLUSIONS: The bias against women in orthopaedic careers is prevalent among medical students early in their academic years. Clinical experience and exposure to orthopaedic surgery should be improved to make a significant impact on female participation in orthopaedic careers. Career building efforts in terms of improved career opportunities, career counselling, flexible working hours, social and family related adjustments and implementation of mentorship/research/fellowship programmes for females are needed to reduce gender discrimination and improve female orthopaedic participation. Furthermore, process improvements may yield greater flexibility for women pursuing the challenging field while accommodating other barriers faced by women in orthopaedic surgery.

Factors Influencing Sports Medicine as a Career Choice Among Orthopaedic Trainees in Saudi Arabia.

Background: Sports medicine is one of the most popular orthopaedic specialties, with more fellowship applicants than in any other subspecialty of orthopaedics. Purpose: To investigate the factors influencing orthopaedic trainees to complete their fellowships and subsequently subspecialize in sports medicine in Saudi Arabia, as well as to compare the motivational factors of trainees planning to pursue sports medicine versus other orthopaedic specialties. Study Design: Cross-sectional study. Methods: An online anonymous questionnaire was distributed to 400 orthopaedic surgical trainees from 44 training centers (residency and fellowship training programs) across Saudi Arabia. The questionnaire identified trainees planning to select sports medicine as their career and the most influential factors affecting their choice; items exploring the influential factors were answered on a 5-point Likert-type scale. A comparison of responses was performed with candidates aiming to pursue other orthopaedic specialties. The chi-square or Fisher exact test was used to compare demographic parameters and the percentage of "agree" and "strongly agree" responses between trainees opting for sports medicine fellowships and those choosing other fellowships. Results: Of the 400 potential participants, 250 orthopaedic trainees (response rate, 63%) completed the survey (201 [80%] male and 49 [20%] female). Sports medicine was the most coveted specialty among trainees, with 70 (28%) participants opting for it as their career choice. The most prominent factors for the decision included disease prognosis and surgical outcomes (90%), personal interest (87%), experience during residency training (83%), type of surgical skills (81%), disease pathology and patient population (77%), expected workload and lifestyle (73%), role model or mentor (70%), and patient volume and variety of cases (67%). Significant differences compared with trainees who preferred other orthopaedic specialties included role model/mentor impact (70% vs 54%), expected rate of income (60% vs 47%), and private sector job opportunities (64% vs 45%) (P = .025, .034, and .020, respectively). Conclusion: Study findings indicated that a significant percentage of orthopaedic trainees in Saudi Arabia choose to specialize in sports medicine. Role model/mentorship, private sector job opportunities, and expected rate of income were the most influential when compared with the motivations of trainees not choosing sports medicine.

Management of a Femur Shaft Fracture With Nancy Nail in the Setting of Dystrophic Epidermolysis Bullosa: A Case Report.

Management of bone fractures must achieve both reduction and stability. However, dermatological conditions such as dystrophic epidermolysis bullosa can lead to catastrophic events when operating on the patient's bone fracture, possibly leading to wound infections and fracture nonunion. Here, we report the case of a 20-year-old female with dystrophic epidermolysis bullosa who had suffered from a femur fracture after a fall from the bed. The fracture management was challenging due to the severe condition; however, the use of the Nancy nail was efficient. Due to the rarity of the disease, modifications due to the challenges faced during the patient care approach were accomplished to prevent any harm to the patient. Even though the management was challenging, the outcome was good.

Outcomes of Woodward's Procedure for Sprengel's Shoulder Using Neurophysiological Monitoring of the Brachial Plexus Without Clavicular Osteotomy: A Retrospective Study.

Introduction For Sprengel deformity, a variety of operations are available, with Woodward's procedure being a favorable option with good outcomes. This study aims to assess the outcomes of Woodward's procedure with brachial plexus monitoring to prevent the possible complications of nerve injury and consequent deficits. Methods In our study, we included 18 patients with Sprengel deformity treated with Woodward's procedure using intraoperative neuromonitoring for the brachial plexus from 2013 to 2019 at our institute. For each patient, we collected information about age, gender, follow-up duration, affected shoulder side, and presence of an omovertebral bar. Also, preoperative and postoperative degrees of shoulder abduction, Cavendish grade of cosmetic appearance, Rigaults grade, and difference in scapular elevation along with postoperative complications were all measured to evaluate the outcomes. Results The mean duration of follow-up was 12 months. The average preoperative Cavendish grade was 3.1, which decreased to 1.3 on the final follow-up. The average preoperative Rigault grade was 2.5, which has decreased to an average of 1.8. The average increase in the degree of shoulder abduction postoperatively was 48.3°. The average preoperative difference in scapular height (mm) was 26.9, which decreased to an average of 12.2. Furthermore, the final outcome was not impacted by the absence or the existence of the omovertebral bar. Conclusion Woodward's procedure using intraoperative neuromonitoring without clavicle osteotomy for Sprengel's deformity successfully corrects the deformity and decreases the risk of iatrogenic brachial plexus injury.

Sprengel's Deformity With Congenital Scoliosis Successfully Treated With Combined Posterior Spinal Instrumented Fusion and Modified Woodward's Procedure in a 14-Year-Old Patient With MURCS Association.

Müllerian duct aplasia-renal agenesis-cervicothoracic somite dysplasia (MURCS) association is a rare syndrome. This unique condition consists of Müllerian duct aplasia, cervicothoracic somite dysplasia, and renal aplasia, and skeletal abnormalities manifesting in childhood. We report the case of a 14-year-old girl who presented to the orthopedic clinic with spinal deformity and Sprengel's shoulder complicated by a background of MURCS association. The treatment modalities of scoliosis include posterior spinal fusion and the vertical expandable prosthetic titanium rib. On the other hand, Sprengel's deformity is surgically managed by Woodward's procedure. The management plan for our patient involved correcting scoliosis by the posterior spinal fusion procedure and performing Woodward's procedure to correct Sprengel's deformity simultaneously. Simultaneous scoliosis correction with posterior spinal instrumented fusion and Sprengel's deformity correction with modified Woodward's procedure is a promising surgical technique that can lead to favorable outcomes.