Outcomes of the Treatment of Humeral Shaft Fractures by Closed Reduction and Internal Fixation With Multiple Intramedullary Kirschner Wires (K-wires).

Background Humeral shaft fractures are common orthopedic injuries, and their treatment options vary based on fracture characteristics. One surgical method involves closed reduction and internal fixation (CRIF) with multiple intramedullary (IM) Kirschner wires (K-wires), which remains less explored, especially in adults. This study aims to investigate the outcomes of the treatment of humeral shaft fractures by closed reduction and internal fixation with multiple flexible intramedullary K-wires. Materials and methods We conducted a retrospective study at King Abdulaziz Medical City, Riyadh, Saudi Arabia, focusing on patients with traumatic humeral shaft fractures who underwent flexible intramedullary K-wire fixation. We analyzed nine patient records for demographic information, fracture location, type, mechanism of injury, intra-operative and post-operative factors, and complications. Results Fractures mostly affected the middle third of the humerus (55.6%) and were primarily transverse or oblique (77.8%). Motor vehicle accidents were the leading cause of injury (66.7%). Intra-operative time was 125 minutes on average, with minimal blood loss (78 mL). No participants required intra-operative blood transfusion. Complications following IM K-wire fixation were absent in all cases. Three patients had not yet undergone instrumental removal, and most reported mild or no pain during the final follow-up. All participants achieved a full range of motion for their elbows. All participants achieved complete radiological and clinical union (healing) of their fractures. Conclusion The use of multiple intramedullary K-wires for the treatment of humeral shaft fractures in this study demonstrated positive outcomes with low complication rates. This approach provides an effective option for managing these fractures, particularly in cases where surgical indications favor it.

How Ready are Pediatricians and Family Physicians in Saudi Arabia to Perform Clinical Screening of Developmental Dysplasia of the Hip?

Background: Developmental dysplasia of the hip (DDH) is one of the most common hip pathologies in pediatric age group and late diagnosis remains a major concern in Saudi Arabia. Objective: The aim of this study is to examine the ability of Saudi Arabian pediatricians and family physicians to conduct clinical screening for (DDH) by estimating their clinical knowledge and skills and analyzing the gaps therein to determine whether there is potential to launch a national screening protocol for DDH in Saudi Arabia. Methods: This is a multicenter cross-sectional study from three major regions in Saudi Arabia (Central, Eastern and Western provinces). The assessed aspects are risk factors, age of screening, incidence in Saudi Arabia, physical signs and diagnostic markers, and treatment, along with their 'clinical knowledge and skills' score. Results: Half of the participants were pediatricians, while the rest were family physicians. More than a third of the participants were considered to have adequate knowledge, ie, above the mean score. Dimensions with the most significant knowledge gaps included the incidence of DDH in Saudi Arabia, adverse effects of swaddling, and the management of a high-risk infants presenting with a negative physical examination. Additionally, there were relatively low rates of awareness regarding positive risk factors as well as a generally poor ability to identify physical signs. Clinical knowledge and skill levels were significantly lower among family physicians. Conclusion: Pediatricians and family physicians in Saudi Arabia still need further training to improve their clinical skills for DDH screening. The proper administration of training programs could eventually enable the gradual implementation of a national systematic screening program.

Effect of type of disease-modifying antirheumatic drugs on depression and anxiety of patients with rheumatoid arthritis in Saudi Arabia: a cross-sectional study.

Background: Rheumatoid arthritis (RA) can cause depression and anxiety. This study evaluated the factors associated with depression and anxiety in patients with RA and examined the effect of conventional and biologic disease-modifying antirheumatic drugs (DMARDs). Methods: This cross-sectional study was conducted in a regional hospital in Riyadh between March and November 2022 and included 213 patients with RA. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS) and data about patients' DMARDs use was obtained from the hospital's medical records. Results: Based on the HADS scores, 35 (16.4%) and 49 (23%) patients with RA had depression and anxiety, respectively. There was a significant association between the level of depression and anxiety and the use of leflunomide and tocilizumab among patients with RA (p = 0.006 and p = 0.009, respectively). Patients with RA who took leflunomide had significantly higher scores for anxiety (ß = 0.158, value of p = 0.037) when compared to patients who did not take leflunomide. Patients with RA who took etanercept showed a significantly lower depression score even after adjusting for confounders, including sociodemographic, clinical, and lifestyle factors (ß = -0.189, p = 0.043). Conclusion: The present study highlighted the prevalence of psychiatric disorders among patients with RA and the level of depression and anxiety may differ between patients with RA depending on the type of DMARDs used. We recommend patients with RA be screened regularly for depression and anxiety to avoid further extra-articular systemic complications associated with RA.

Impact of Virtual Learning on Mothers With Children in Elementary School: A Psychosocial Viewpoint.

Background Measuring the impact of virtual learning (VL), specifically psychosocially, and its consequences have been poorly studied because VL has never been implemented in this way before worldwide. To our knowledge, no studies in Saudi Arabia have addressed this topic, with very limited available literature internationally. This study aims to evaluate the psychosocial effects of VL on mothers of children in elementary school and its relation to psychosocial factors. Methodology Using an anonymous online questionnaire posted on social media, a quantitative, observational, cross-sectional study was conducted from May through December 2021 in Riyadh, Kingdom of Saudi Arabia. A total of 460 mothers consented to complete the study questionnaire. The questionnaire consisted of a socioeconomic section and collected information on perceived stress via the Perceived Stress Scale (PSS-14). Results The overall PSS-14 score showed a moderate stress level. Our results showed that as age groups tended to rise, stress scores tended to decline. Diabetes was a significant variable contributing to high stress. Verbal abuse toward a child essentially reflects an increase in stress. Mothers with familial conflicts were more prone to high stress. Conclusions The consequences of VL on mothers and the whole family are alarming. Stress, verbal and physical abuse, and unhealthy family dynamics are strongly associated with such a way of learning. The impact of emotional and behavioral changes among this group of individuals needs to be further investigated.

Septic Arthritis Caused by Sphingomonas Paucimobilis in Immunocompetent Patient: Case Report and Literature Review.

Septic arthritis, also known as infectious arthritis, is inflammation of the joints due to a wide range of pathogens, such as bacterial, fungal, mycobacterial, viral, or/and other pathogens; however, some opportunistic pathogens tend to affect immunocompromised patients and rarely infect immunocompetent patients. For example, Sphingomonas paucimobilis is an opportunistic pathogen with a particular tropism toward bones and soft tissues that rarely causes infections in immunocompetent humans. We present a case of Sphingomonas paucimobilis causing septic arthritis in a 34-year-old man who is medically free and with no history of previous surgeries or any other comorbidities. He was treated successfully by both pharmacological treatment and surgical intervention. To our knowledge, there are only four cases published in the literature involving Sphingomonas paucimobilis as a causative organism of septic arthritis affecting immunocompetent patients.

Aggressive L3 vertebral hemangioma coexisting with adult thoracolumbar scoliosis: Case report.

Vertebral hemangiomas are benign vascular tumors that are commonly asymptomatic. A low percentage might become aggressive; however, they are not known to be associated with scoliosis. We present a case of a third lumbar vertebral lesion coexisting with a moderate thoracolumbar scoliosis. The patient's initial presentation was back pain with bilateral lower limb radiculopathy and neurogenic claudication. Diagnosis was established using CT and MRI, which showed classical findings of an aggressive vertebral hemangioma. The patient underwent Partial hemangioma excision and scoliosis correction, with satisfactory outcome at 1 year follow up.

Management of thoracic spine dislocation by total vertebrectomy and spine shortening: case report.

INTRODUCTION: The treatment of thoracic spine fracture-dislocations is now well established with the recent progress in spine surgery. Although most affected individuals have a degree of spinal cord injury (SCI), early surgical reduction, and stabilization of the unstable deformity allow an immediate program of rehabilitation. Vertebrectomy is considered as the last surgical technique reserved for the most persistent spinal deformities that cannot be brought to an acceptable correction with less invasive methods. CASE PRESENTATION: We present a case of a 19-year-old male with a sub-acute thoracic spine fracture-dislocation at the level of T7-T8 who underwent a posterior T8 vertebrectomy with reduction and instrumentation from T4 down to T1. The individual had excellent results during follow-ups regarding alignment, fusion, and rehab program. DISCUSSION: In this case, we present the good outcome of vertebrectomy and spine shortening in an individual with thoracic spine fracture-dislocation, and the advantages of posterior approach.