Spontaneous Idiopathic Bilateral Sagittal Band Rupture: A Case Report.

Introduction: Extensor tendon subluxation or dislocation resulting from sagittal band rupture can be associated with snapping, catching, locking, pain, and swelling of the finger. Several etiologies were reported in the literature, with frequent mention of a traumatic rupture caused by a direct blow at the level of the metacarpophalangeal joint (MCPJ). The other causes of sagittal band injuries are degenerative disease, congenital infection, and rheumatoid arthritis. To our knowledge, we report the first case of spontaneous idiopathic bilateral sagittal band rupture. Case Report: We, herein, present the case of a seronegative 29-year-old female who presented with pain and swelling in the dominant hand for 4 days. Conclusion: Upon examination, she was found to have bilateral dislocation of the extensor tendons at the level of the (MCPJ) of the third and fourth digits. Any underlying cause was excluded, and the diagnosis was confirmed with a dynamic ultrasound study.

Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) Of the Second Proximal Phalanx Encasing the Flexor Tendon of the Foot: A Case Report.

Introduction: Bizarre Parosteal Osteochondromatous Proliferation (BPOP) is a rare benign lesion commonly referred to as Nora's lesion. It typically affects adults in their 20s-30s. Due to its aggressive local invasion, it can be confused with some malignant tumors, including chondrosarcoma. Nora's lesion can be diagnosed radiographically, and its diagnosis is confirmed with an excisional biopsy. Case Report: A 40-year-old Bahraini male complained of swelling over the metatarsal head of the second digit, increasing in size over a year. He also complained of a reduced range of motion of the second toe and a pins-and-needles sensation affecting the entire toe. Plain X-ray, computed tomography, and magnetic resonance imaging were done, showing findings suggestive of bizarre parosteal osteochondromatous. The lesion was encasing the flexor tendon of the second digit. He was treated with surgical excision, and histopathology confirmed the diagnosis of BPOP. Conclusion: We report on a rare presentation of BPOP in the second proximal phalanx of a male in his 40 s. The patient underwent a wide local excision, and the diagnosis was confirmed with histopathology.

Cemented Versus Uncemented Total Hip Arthroplasty in Sickle Cell Disease Patients: A Retrospective Study.

Background and objective Sickle cell disease (SCD) can predispose patients to avascular necrosis (AVN) of the femoral head, resulting in severe disabling pain. Total hip arthroplasty (THA) is the leading treatment choice for end-stage arthritis caused by AVN. In this study, we aimed to compare complications associated with implant fixation with and without cement. Materials and methods We retrospectively analyzed 95 total hip implants in which 26 patients had staged bilateral THA. These surgeries were performed by four senior arthroplasty consultants between 2007 and 2018. Data were collected from the surgical logbook, physical files, and the electronic patient database (I-Seha, National Health Information System, Ministry of Health, Kingdom of Bahrain). Results The study included 95 hip implants in 69 patients. Forty-five (47%) were in males, and 50 (53%) were in females. Of these, 22 implants underwent revision (23%), two implants had periprosthetic infections (0.2%), two implants had periprosthetic fractures (0.2%), and 18 implants had implant loosening. We found that cemented THA was significantly associated with the development of implant loosening (p<0.001), small particle disease (p<0.001), and a higher revision rate (p<0.001). Conclusion We found that cemented THA in SCD patients led to a higher rate of aseptic implant loosening, mainly caused by osteolysis. Based on our findings, we recommend uncemented THA in SCD patients.

Vertebral Osteomyelitis Secondary to a Retroperitoneal Abscess in an Adolescent Male: A Case Report.

Pyogenic vertebral osteomyelitis (PVO) is included in a spectrum of spine infections called spondylodiscitis. It is commonly caused by hematogenous seeding. The annual incidence of spondylodiscitis is 2.4 per 100,000 person-years and the incidence triples for people over seventy. We report a case of a previously healthy 14-year-old male with a rare presentation of vertebral osteomyelitis associated with a large retroperitoneal abscess of unknown origin, manifested with flank pain, back pain, and fever, and treated with antibiotics with good short-term outcomes. We concluded that vertebral osteomyelitis in adolescent patients could manifest with back or flank pain. Moreover, it can occur as an extraperitoneal manifestation of a retroperitoneal abscess.

Hemoglobin Drop and the Need for Transfusion in Primary Knee Arthroplasty.

Background Blood loss is still a serious adverse effect of total knee replacement (TKR), resulting in Hemoglobin drop and a higher need for blood transfusions. Multiple modalities are used to reduce intra-operative blood loss and hemoglobin drop for this procedure, such as placing a drain intraoperatively and Tranexamic acid (TXA) administration. This study aimed to investigate factors associated with hemoglobin loss and blood transfusion increased demand. Patients and methods We retrospectively looked at 223 patients who underwent primary unilateral or staged bilateral knee arthroplasty by a single surgeon from January 2013 until April 2018 in Salmaniya Medical Complex (SMC), Bahrain. We looked into patients' demographics such as age, gender, preoperative hemoglobin and hematocrit, postoperative hemoglobin and hematocrit, drain insertion intra-operatively, and the administration of Intravenous tranexamic acid intra-operatively. Eighty-three patients had a drain inserted intra-operatively, and sixty-nine patients received intra-venous Tranexamic acid during the procedure. Results Out of 223 patients, 152 patients were included after applying exclusion criteria. The mean hemoglobin (Hb) loss in patients who had a drain inserted was 2.186 g/dL, while patients who received tranexamic acid had a mean of 1.609 g/dL. Multivariable regression analysis revealed that increased blood transfusion requirements postoperatively were significantly associated with reduced pre-operative Hemoglobin levels (p-value .004). Univariable analysis of the hemoglobin drop showed that the use of TXA would reduce Hb loss while a drain would increase Hb drop (p-value .003 and .002, respectively). Moreover, univariable analysis of blood transfusion requirements showed reduced pre-operative Hb, and placing a drain would increase blood transfusion demand (p-value <.001, .044 respectively), while administration of tranexamic acid would reduce blood transfusion demand (p-value 0.05). Conclusion Reducing the need for blood transfusion following primary total knee arthroplasty can be achieved by maintaining preoperative hemoglobin levels, administering tranexamic acid intra-operatively, and avoiding placing an intra-articular drain.