Spinal Accessory Nerve Injury following Spinal Adjustment: Case Report and Literature Review of the Outcome of Accessory Nerve Pathology as Result of Blunt Trauma (Spinal Accessory Nerve Palsy after Spinal Adjustment).

Spinal accessory nerve palsy (SANP) is rare and is commonly presented following iatrogenic injury. Their diagnosis is often missed on initial presentation. Injury following blunt trauma is rare, with few cases reported in literature describing blunt-associated SANP and their treatment and recovery. We present and discuss a case of SANP following an aggressive soft tissue adjustment by an uncertified individual that has been responsive to nonsurgical measures over 18 months. We also reviewed the related literature on similar cases that were presented as result of direct pressure on the nerve from soft tissue manipulation or heavy lifting and their outcome following treatment. Chiropractic is generally a safe complimentary medicine and must only be practiced by trained personnel. We found that blunt-caused SANP injuries should initially be treated conservatively as they are likely to respond and recover unlike when presented following invasive trauma accordingly to what we found in literature.

Dynamic Compression Plating Versus Antegrade Intramedullary Nailing for the Treatment of OTA/AO 12-A Fractures: A Retrospective Cohort Study.

BACKGROUND: Fractures of the humerus diaphysis are common and often result from motor vehicle accidents (MVAs). Treatment methods range from nonoperative approaches to various operative techniques, including antegrade intramedullary nailing (AIMN) and dynamic compression plate (DCP) fixation. This study aimed to compare the cost effectiveness and outcomes of plating and nailing for humerus diaphyseal fractures. METHODS:  A retrospective cohort study involving 59 cases of humerus diaphyseal OTA/AO 12-A fractures was conducted at King Saud Medical City (KSMC), a level I trauma center located in the center region in Riyadh, Saudi Arabia. Patients treated with AIMN, anterolateral plating, or posterior plating were included. Data on demographics, clinical parameters, radiographic healing, and costs were collected and analyzed. RESULTS: The average surgical duration was shorter in the AIMN group compared to the anterolateral and posterior plating groups but with no statistical significance (P > 0.05). The average length of stay (LOS) was shorter, and the change in hemoglobin levels was lower in the AIMN group when compared to other groups but without a statistically significant difference (P > 0.05). The average cost of AIMN was significantly higher than that of anterolateral and posterior plating groups (P < 0.0001). CONCLUSION:  While both nailing and plating procedures are options for treating OTA/AO 12-A fractures, AIMN carries a higher overall procedural cost. The practice of drain placement in our study population is likely the cause of the increased LOS in the plating groups. Relative additional analgesic requirements were associated with AIMN. Surgeons should consider meticulous hemostasis to avoid drain placement, which can decrease LOS, thus possibly decreasing unnecessary treatment costs of humerus shaft fractures.

Outcome of a conservatively treated large Pipkin I fracture dislocation: a case report.

Pipkin I fracture dislocation is a rare injury. They commonly present following high mechanism trauma with possible devastating complications regardless of the treatment option. Treatment consensus depends on fracture reduction, size, site, and displacement. Surgical management is reserved for large fragments. We present a 42-year-old female presented with multiple chest injuries and left sided Pipkin I fracture dislocation Two days following the trauma. The fracture was found to be vertical in nature and was managed by closed reduction and a period of bed rest and skeletal traction. She was followed over a 3-year period and showed satisfactory results. We believe that the vertical nature of the fracture and maintenance of the anatomic reduction led to her successful outcome.

Bilateral simultaneous quadriceps ruptures in an elite bodybuilder: A case report of treatment success.

Tendon injuries in weightlifters is known to be associated with steroid use. Bilateral simultaneous quadriceps tendon rupture (BSQTR) is extremely rare with few cases reported in literature in young athletes. Unlike patellar tendon ruptures, they are more common in older age individuals. These injuries can jeopardize an athlete's career. In this paper, we report a very rare case of BSQTR in an elite bodybuilder who sustained a high mechanism trauma while squatting heavyweights. He sustained bilateral anterior cruciate ligament (ACL) injury and a left ankle fracture. All injuries were treated surgically except for the left ACL as it was asymptomatic on follow-up. The challenge in this case was to treat his injuries and to regain his baseline functional status in the shortest period of time. Following treatment, the patient had a satisfactory clinical outcome with focused rehabilitation. Despite the devastating trauma, the patient was able to progress throughout the treatment plan and has regained his baseline functional status in less than 18 months and has resumed his competitive bodybuilding career. From the available literature, this is the first case to be reported with such combined injuries that was treated and showed a satisfactory outcome in a short period of time.

Impact of Preoperative Neuropraxia on Surgical Duration Following Pediatric Supracondylar Fracture of the Humerus: A Retrospective Cohort Study.

Background Supracondylar fractures of the humerus (SCFHs) are the most common type of elbow fracture in children. Because of the influence on functional outcome, neuropraxia is one of the most common concerns at presentation. The impact of preoperative neuropraxia on surgery duration is not extensively probed. The clinical implications of several other risk factors associated with preoperative neuropraxia at presentation may contribute to longer surgical duration of SCFH. Hypothesis Preoperative neuropraxia is likely to increase surgery duration in patients who sustained SCFH. Patients and Methods This is a retrospective cohort analysis. Sixty-six patients who sustained surgical pediatric supracondylar humerus fracture were included in the study. Baseline characteristics including age, gender, the type of fracture according to Gartland classification, mechanism of injury, patient weight, side of injury, and associated nerve injury were included in the study. Logistic regression analysis was performed using mean surgery duration as the main dependent variable and age, gender, fracture type according to the mechanism of injury, Gartland classification, injured arm, vascular status, time from presentation to surgery, weight, type of surgery, medial K-wire use, and afterhours surgery as the independent variables. A follow-up of 1 year was implemented. Result The overall preoperative neuropraxia rate was 9.1%. The mean surgery duration was 57.6 ± 5.6 minutes. The mean duration of closed reduction and percutaneous pinning surgeries was 48.5 ± 5.3 minutes, whereas the mean duration of open reduction and internal fixation (ORIF) surgeries was 129.3 ± 15.1 minutes. Preoperative neuropraxia was associated with an overall increase in the surgery duration ( p < 0.017). Bivariate binary regression analysis showed a significant correlation between the increase of surgery duration and flexion-type fracture (odds ratio = 11, p < 0.038) as well as ORIF (odds ratio = 26.2, p < 0.001). Conclusion Preoperative neuropraxia and flexion-type fractures convey a potential longer surgical duration in pediatric supracondylar fracture. Level of Evidence Prognostic III.

One-Year Mortality Rates Following Fragility Femoral Fractures in Patients Presenting to King Saud Medical City in Riyadh, Saudi Arabia: A Retrospective Study.

OBJECTIVE: The objective is to investigate one-year mortality rates following femur osteoporotic fractures, and to investigate factors that are associated with higher mortality rates. DESIGN: A retrospective study was conducted from 2010 to 2021 (11 years) of all patients who presented to King Saud Medical City, Saudi Arabia, and had a fragility fracture of the proximal or distal femur. PATIENTS: One hundred eight patients who sustained a proximal or distal femoral fracture, as a result of low-energy trauma, were included. RESULTS: The majority of our cohort (77.8%) had proximal femoral fractures, whereas only 22.2% had a distal femoral fracture. 55.6% were less than 75 years old, and 44.4% were 75 years or older. All patients had fallen from standing height. Hypertension and diabetes were the most common comorbidities among our cohort at 49.1% and 47.2%, respectively, but neither showed a statistically significant increase in the risk of mortality. When assessing the overall mortality, 21.3% of our patients had passed away. Although this finding was not statistically significant, mortality rates were found to be higher in patients with proximal femoral fractures compared to distal femoral fractures (25% vs. 8.3%, respectively, p=0.095). Patients with a normal bone mass density (BMD) had higher mortality rates as opposed to those with abnormal BMD (p=0.001). CONCLUSIONS: Mortality rates are higher in proximal femoral fractures compared to distal femoral fractures. In addition, within our study cohort, patients with normal BMD had higher mortality rates. We recommend prospective studies that compare mortality rates between proximal and distal femoral fractures in patients with osteoporosis, as these studies would provide more accurate data. We also recommend having BMD measured in those patients to avoid further fractures in this patient population.

Traumatic spinal injuries in Saudi Arabia: a retrospective single-centre medical record review.

OBJECTIVES: To describe the patterns and outcomes of traumatic spinal injuries (TSIs) in a tertiary care trauma centre in Riyadh, Saudi Arabia. DESIGN: Retrospective medical record review. SETTING: Level 1 trauma centre for all patients presented from 1 February 2016 to 31 December 2018. PARTICIPANTS AND DATA: Records of patients presenting with any spinal trauma were reviewed, and the data obtained included age, gender, nationality (as Saudi and non-Saudi), date of presentation, site of fracture/injury, associated injuries, mechanism of injury, presence of neurological involvement and hospital mortality. MAIN OUTCOMES: Frequencies of different types of TSI across various subgroups. RESULTS: We identified 692 patients who presented with TSI throughout the study period. The mean age was 36.9 years. Males represented 83.2% (n=576) of the sample size, and the most common mechanism of injury was motor vehicle collision (MVC), accounting for 66.8% of cases (n=462), while fall-related injuries were seen in 31.6% of cases (n=219). A total of 454 (65.6%) of all patients were Saudi, and 332 (73.1%) of the TSIs in Saudis were due to MVC. Non-Saudi cases accounted for 238 (34.4%) of all patients, and 89 (37.4%) of the non-Saudi injuries were due to falls from height, and this association was statistically significant (p<0.001). CONCLUSION: TSI was not thoroughly examined in Saudi Arabia; therefore, this study is considered the first to be done in the Kingdom using a representative sample. The fact that non-Saudi patients had a higher proportion of falls as a mechanism of injury should be taken into consideration in terms of raising awareness and taking more safety precautions, as most construction workers tend to be expatriates.

Avulsion Fracture of the Tibial Tuberosity Combined with Lateral Tibial Plateau in an Adolescent.

Avulsion fractures of the tibial tuberosity are commonly sustained in adolescent males during sport activities which involve jumping and tackling. Tibial tuberosity avulsions combined with lateral tibial plateau in an adolescent are rare injuries. We received an unusual case of left Ogden type IIIB avulsion fracture of the tibial tuberosity with an articular involvement of the lateral tibial plateau (Salter Harris type IV) in a 14-year-old boy. The injury was sustained after jumping from three stairs where the boy predominantly landed on his left lower limb. Unlike other cases reported, since they were athletes and injuries were sustained during sport activities, our case is an obese individual who jumped off few stairs. The results following surgical treatment are excellent since the fracture united, and the articular surface was restored without the need of arthrotomy with gaining full range of motion. Therefore, displaying this case in the literature will be helpful since it is rare and was successfully treated differently from the previously reported cases.

Outcome of diaphyseal pediatric forearm fractures following non-surgical treatment in a Level I Trauma Center.

OBJECTIVES: Pediatric diaphyseal forearm fractures are common injuries of childhood. Conservative modality of treatments is usually preferred when they are possible. We identified factors that may affect closed reduction success or lead to redisplacement in forearm diaphyseal fractures in children. METHODS: This was a retrospective study from a level I trauma center on patients up to 18 years of age who presented with forearm diaphyseal fractures from January 1, 2007, to December 31, 2015. Cases were obtained from medical records. Data were collected and confirmed by plain films and medical files. RESULTS: We included 145 patients in this study. The majority (86.2%) were boys. Around 29% of trials of closed reduction failed, and the patients were subsequently treated surgically. Following trials of closed reduction, 82.4% of both bone cases were successfully reduced compared to 42.9% of radius shaft cases (P = 0.006). Redisplacement following non-surgical treatment in the first follow-up was found in 32% of both bone cases and 13.3% of radial shaft cases. All Galeazzi cases that were successfully treated with closed reduction presented with no redisplacement on follow-up. CONCLUSION: Immediate surgical management might be considered in older children, especially above 12 years of age since they have a higher failure rate of closed reduction than younger ones. Fracture site should be taken into account when following pediatric diaphyseal forearm fractures following conservative treatments as cases with both bone involvement have a high success rate of closed reduction and considerably high rate of redisplacement compared to others.

Patterns of paediatric forearm fractures at a level I trauma centre in KSA.

OBJECTIVES: The current literature does not clearly elaborate the pattern of paediatric forearm fractures. This study aims to identify patterns of paediatric forearm fractures in KSA. METHODS: This retrospective study was conducted in a level I trauma centre. The study population comprised patients up to 18 years of age who presented with forearm fractures between 2007 and 2015. The demographic data of the recruited patients were obtained from medical files, and fractures were identified using plain films. Mean and standard deviations were used for continuous variables, whereas frequencies and percentages were used for categorical variables. RESULTS: This study included 318 patients, ranging in age from 1.2 to 18 years (average: 10.42 ± 4.56 years). The majority were boys (80.8%) and 53.1% were <12 years of age. Girls were significantly more prevalent in the <12-year-old group than in the ≥12-year-old group (p < 0.001). A fall was the mechanism of injury in the majority of patients (82.1%) in the <12-year-old group compared with the ≥12-year-old group (p < 0.001). There was no statistically significant difference in fracture site between the two age groups. The distal forearm was the most common site fractured (47.8%), followed by the distal third of the forearm diaphysis (34.2%). CONCLUSION: Forearm fractures are commonly seen in school-age boys. The distal radius is the most commonly fractured site reported in this study. A fall was the most common mechanism of injury, and safety measures should be implemented in places where children frequently gather.