Arabic translation, cultural adaptation, and validation of the Bristol Impact of Hypermobility questionnaire.

BACKGROUND: The Bristol Impact of Hypermobility questionnaire (BIoH) is the first condition-specific patient reported outcome measure for people with hypermobility-related conditions. The BIoH original version is in English, which limits its use for patients who speak other languages. The study aimed to translate and culturally adapt the BIoH into Arabic and determine its concurrent validity, reliability, internal consistency and smallest detectable change. METHODS: Forward-backward translation and cross-sectional designs were used. The Ethics Committee of Kuwait Ministry of Health approved the study. Spearman correlation coefficient, intraclass correlation coefficient (ICC), and Cronbach's α were used for statistical analysis. Patients with hypermobility spectrum disorders (HSD) were included, diagnosed using the 2017 classification framework. RESULTS: 55 HSD patients were included, aged 26.0 (18.0) years old; median (IQR), and 85.5% were women. The BIoH showed very good concurrent validity when correlated with the SF-12 total and physical component scores; r = -0.743 and - 0.740, respectively (p < 0.05). Good correlation was identified between the BIoH and the SF-12 mental component score; r = -0.496 (p < 0.05). The BIoH demonstrated excellent test-retest reliability; ICC = 0.934 (0.749-0.983 95% CI) (p < 0.05), and high internal consistency (Cronbach's α = 0.933). The smallest detectable change was 30.90 points, representing 19.8% of the mean baseline score. CONCLUSIONS: The study successfully translated the BIoH into Arabic and demonstrated high psychometric properties. The translated score can help Arabic patients with HSD in their clinical evaluation process. Future research needs to determine the responsiveness of the Arabic version and translate the BIoH to other languages.

The concomitant diagnosis of fibromyalgia and connective tissue disorders: A systematic review.

BACKGROUND: Anecdotally, fibromyalgia syndrome (FMS) and connective tissue disorders (hypermobile Ehlers-Danlos Syndrome (hEDS), Hypermobility Spectrum disorders (HSD) and Generalized Joint Hypermobility (GJH)) manifest overlap in their diagnostic approach and symptomatic features. Understanding this overlap is important for accurate diagnosis and the success of subsequent management. This study therefore aimed to identify the prevalence of concomitant diagnosis of FMS and hEDS/HSD/GJH in adults and their shared symptomatic manifestations using a systematic review. METHODS: MEDLINE (via EBSCO host) was systematically searched. Observational research (case-control or single group) studies were considered for inclusion, where adults screened for hEDS/HSD/GJH and FMS were compared in terms of diagnostic prevalence, and musculoskeletal and non-musculoskeletal manifestations. Studies on pediatric populations were excluded. The quality of the included studies was assessed using the National Institute of Health Quality Assessment of Case-Control Studies and Jonna Briggs Critical Appraisal checklist for prevalence studies. The review was registered prospectively in PROSPERO (CRD42020216283). FINDINGS: The review included eleven studies: nine case-control studies and two single group studies. The prevalence of concomitant diagnosis of hEDS/HSD and FMS ranged from 68%-88.9% and from 8.0 to 64.2% for GJH and FMS. The prevalence and severity of a range of objective and patient-reported features were similar between hEDS/HSD and FMS, including joint pain (duration, persistence, SF-36-pain component score); joint swelling; muscle weakness; neurological problems; multidimensional pain inventory-activity; dysautonomia and total autonomic symptoms burden (including orthostatic intolerance, reflex syncope, vasomotor, gastrointestinal, diarrhea, constipation and pupillomotor domains); function; and quality of life. Shared symptomatic features between GJH and FMS were mean pain level, tender points count, total myalgia score and psychological impact. INTERPRETATION: There may be overlapping symptomatology and diagnostic prevalence of FMS and hEDS/HSD/GJH. Clinicians should consider both diagnoses to ensure appropriate diagnosis and management.

The epidemiology of traumatic musculoskeletal injuries in Kuwait: Prevalence and associated risk factors.

Objectives: Epidemiological explorations of traumatic injuries are essential to provide benchmarks for future planning to address multidimensional challenges. The study aimed to describe the epidemiology of traumatic musculoskeletal injuries in Kuwait, including their prevalence and associated risk factors. Methods: The Orthopedic Admission Database of a level II trauma center in Kuwait was retrospectively reviewed from January 2018 to February 2020. Traumatic fractures of the spine and upper and lower limbs were explored. Results: The study included 564 patients with 788 traumatic injuries who were 33.0 (23.0) years of age (median and interquartile range): 78.0% were male, and 43% were Kuwaitis. Spinal fractures were the most prevalent injury, at 21.7%, followed by tibial fractures, at 11.3%, and ankle fractures, at 10.2%. Road traffic accidents were the leading mechanism of injury, at 37.9%, followed by falling over and falling from height, at 29.3% and 16.8%, respectively. Risk factors included injury mechanism, nationality, and age (p < 0.05). Road traffic accidents were at risk for sustaining spinal, scapular, clavicle, humeral, pelvic, hip, tibial, and fibular fractures; those for falling over were radial, ulnar, femoral, and patellar fractures; and those for falling from height were foot and ankle fractures. Kuwaitis were found to be at risk of spinal, humeral, pelvic and femoral fractures, whereas non-Kuwaitis were found to be at risk of scapular, shoulder, elbow, ulnar, radial, hip, patellar, tibial, fibular, foot, and ankle fractures. The age range of 19-49 years was associated with the highest risk for all fracture sites. Conclusion: Epidemiological characteristics of traumatic injuries in Kuwait have been determined to guide preventive strategies and healthcare planning.

Open fracture dislocation of the calcaneocuboid and naviculocuneiform joints: A case report.

Combined fracture and dislocation of the calcaneocuboid (CC) and naviculocuneiform (NC) joints is a very rare injury; therefore, it is under-reported. We present a case of rare open fracture and dislocation of the CC and NC joints by discussing the diagnosis, evaluation, management and prognosis.

The epidemiology of spinal fractures in a level 2 trauma center in Kuwait.

OBJECTIVES: Spinal fractures are a public health issue with high morbidity and mortality, and significant social and economic impact. The burden of disease can be minimized through effective management and preventive strategies based on basic epidemiological figures. Therefore, this study aimed to establish the epidemiological figures for traumatic injuries of the spine, including prevalence and associated risk factors in Kuwait, one of the high-income countries in the Middle East region. METHODS: Using a retrospective design, the Orthopedic Admission Database of level II trauma center was reviewed from January 2018 to February 2020 for traumatic spinal fractures. RESULTS: The study included 564 patients with 788 fractures, and from this sample, 162 patients sustained vertebral fractures at 181 different vertebral anatomical areas, resulting in 28.72% prevalence rate for spinal fractures; the mean age was 37.10 (SD = 18.25) years old; 79.2% were men, and 57.8% were Kuwaitis. The most prevalent mechanism of injury was road traffic accidents at 54.5%, and the lumbar spine was the most prevalent fracture site, followed by the thoracic spine at 47.5% and 31.5%, respectively. The mortality rate associated with spinal fractures is 42.10% from trauma cases admitted to the intensive care unit. Patients' sex, nationality, fracture anatomical site, and the mechanism of injury were identified as risk factors (p < 0.05). CONCLUSION: The established epidemiological figures for spinal fractures can be used to direct management and preventive strategies and assist health care planning and delivery. LEVEL OF EVIDENCE: III.

Surgical interventions of Freiberg's disease: A systematic review.

BACKGROUND: Freiberg's disease is an osteonecrosis of the metatarsal head bone. Numerous surgical interventions can be provided; however, the literature is limited in systematic reviews discussing the various options. The study aimed to systematically review the quantity and quality of literatures exploring the surgical interventions. METHODS: Fifty articles were found to be relevant for assessing the efficacy of common surgical interventions. The articles were assigned a level of evidence (I-V) to assess their quality. Next, the studies were reviewed to provide a grade of recommendation (A-C, I). RESULTS: Two studies were found at level III that explored osteotomy and autologous transplantation; the other studies were level IV-V. There is poor evidence (grade C) in supporting of joint sparing and joint sacrificing for Freiberg's disease. CONCLUSION: Poor evidence exists to support the surgical interventions for Freiberg's disease, higher quality trials are needed to support the increasing application of these surgical techniques. LEVEL OF EVIDENCE: Level IV, Systematic review.

The effect of Mulligan's mobilization with movement following total knee arthroplasty: Protocol of a single-blind randomized controlled trial.

BACKGROUND: Mulligan's mobilization with movement (MWM) aims to enhance the kinematics of the joint. Kinematic impairment of the knee joint is significant following total knee arthroplasty (TKA), which could be managed with Mulligan's MWM. This article describes the study protocol for a single-blind randomized controlled trial investigating the effectiveness of Mulligan's MWM following TKA. METHODS: A single-blind randomized controlled trial design will be employed to compare two groups: an intervention and control group. Each group will attend a standard post-operative rehabilitation program. The intervention group will additionally receive articular mobilization using a Mulligan's MWM approach. A blinded examiner will assess participants at four points: pre-operation, 3 weeks post-operation (when the intervention starts), 6 weeks post-operation (when the intervention ends), and at 6 months as a long-term follow-up. The two groups will be compared on the basis of knee range of motion (standard goniometry), knee joint pain (Visual Analogue Scales), walking speed using (15-metre walk test), functional mobility (timed up and go test) and participation (Western Ontario and McMaster Universities Osteoarthritis Index questionnaire). A blinded examiner will measure knee joint alignment using a computed tomography scanogram pre-operatively and at 3 months post operation. Mixed model ANOVA will be used to identify any group differences. Ethical approval has been secured from the ethical committee of Kuwait Ministry of Health, and the trial is registered in the ISRCTN registry (ref:13028992). DISCUSSION: The study findings could inform the optimization of post-operative rehabilitation of patients following TKA.

Cross-cultural adaptation and validation of an Arabic version of the American Orthopedics Foot and Ankle Score (AOFAS).

BACKGROUND: The evaluation process is essential to optimize the management of patients with foot and ankle pathologies and disorders. This study aimed to translate and culturally adapt the four scoring systems of the American Orthopedics Foot and ankle Score (AOFAS) into Arabic and explore its psychometric properties. METHODS: A multicenter observational design was used, following the forward-backward translation method. One hundred and twenty patients with foot and ankle problems were included. Construct validity and test-retest reliability were analyzed using Intra-class correlation coefficients; internal consistency was analyzed with Cronbach's alpha, and the responsiveness was analyzed using a paired-sample test. RESULTS: The validity ranged from 0.303 to 0.542 and from 0.018 to 0.753 when correlated to the SF-12 physical and mental component scores, respectively. Test-retest reliability ranged from 0.727 to 0.974; from 0.826 to 0.983 for internal consistency and from 0.001 to 0.182 for sensitivity. CONCLUSION: The AOFAS's four systems were successfully translated and culturally adapted into Arabic with sufficient psychometric properties. LEVEL OF CLINICAL EVIDENCE: II.

Preliminary Experience With Polyvinyl Alcohol Hydrogel Implant for Pathology of the Second Metatarsal Head.

BACKGROUND: There is no consensus regarding which surgical technique is most beneficial for pathology of the second metatarsophalangeal joint. We report the use of polyvinyl alcohol hydrogel synthetic cartilage implant hemiarthroplasty for pathology of the second metatarsal head that has failed nonoperative treatment and present 5 cases with a minimum 15 months of follow-up. METHODS: The technique for synthetic cartilage hemiarthroplasty of the second metatarsal head is described. The postoperative protocol included weightbearing as tolerated for 2 weeks and moderate limitations in activities of daily living to respect wound healing, followed by physiotherapy for range of motion exercises. Charts for patients who underwent this procedure between 2015 and 2017 were retrospectively reviewed. Outcome measures collected postoperatively included a pain visual analog scale, Short-Form 36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, and Foot and Ankle Ability Measure (FAAM) Sports and Activities of Daily Living (ADL) current level of function percentages. RESULTS: At 15 to 38 months of follow-up, patients reported little to no pain and good range of motion, with no complications. Mean outcome measure scores were 89 for FAAM ADL, 75 for FAAM Sports, 44.4 for SF-36 PCS, and 52.1 for SF-36 MCS. CONCLUSION: This preliminary study of synthetic cartilage hemiarthroplasty for treatment of joint-destructive conditions of the second metatarsal head demonstrated good outcomes and no complications in 5 cases at a mean 25 months of follow-up. Large prospective cohort studies are needed to prove the efficacy and safety of this new surgical technique for the treatment of pathology of the second metatarsal head. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Percutaneous Ankle Reconstruction of Lateral Ligaments.

Chronic ankle instability following ankle sprains causes pain and functional problems such as recurrent giving way. Within the 3 ligaments of the lateral ligament complex, 80% of patients tear the anterior talofibular ligament (ATFL), whereas the other 20% of patients tear the ATFL and calcaneofibular ligament (CFL). Rarely, the posterior talofibular ligament is involved. An incidence of 10% to 30% of patients will fail conservative treatment and result in chronic ankle instability that may require surgical treatment. To date, numerous open surgical procedures for anatomic repair or reconstruction of ATFL and/or CFL provide good clinical results.