Gluteal compartment syndrome secondary to prolonged immobilization following carbon monoxide poisoning associated with leukoencephalopathy: A case report.

Introduction: Gluteal compartment syndrome (GCS) is a rare diagnosis that results mostly from a non-traumatic etiology. We describe a case of a gluteal compartment syndrome, complicated with sciatic nerve palsy. Case presentation: This paper reported a case of gluteal compartment syndrome caused by prolonged immobilization due to carbon monoxide poisoning. The case was complicated with sciatic nerve palsy and a sequala of leukoencephalopathy. Discussion and conclusion: This case report highlighted the importance of having a high suspicion for gluteal compartment syndrome in patients with history of lying down with prolonged immobilization. The diagnosis can be made solely on clinical examination and a fasciotomy must be performed with no delay.

Optimizing percutaneous reduction and fixation with guidewire modification in pelvic and acetabular fractures: surgical technique and case series.

BACKGROUND: Minimally invasive percutaneous screw fixation for pelvic ring and acetabular fractures has become increasingly popular due to its numerous benefits. However, the precise placement of the screw remains a critical challenge, necessitating a modification of the current techniques. This paper introduces a refined technique employing a modified guidewire to enhance the precision and efficiency of percutaneous fixation in pelvic and acetabular fractures. METHODS: This study details the surgical techniques implemented for correcting guidewire misdirection in percutaneous screw fixation and includes a retrospective analysis of patients treated with this modified approach over a three-year period. RESULTS: In this study, 25 patients with pelvic ring and acetabular fractures underwent percutaneous screw fixation. The cohort, predominantly male (23 out of 25), had an average age of 38 years. The majority of injuries were due to traffic accidents (18 out of 25). Types of injuries included pelvic ring (6 cases), acetabular fractures (8 cases), and combined injuries (11 cases). Various screw types, including antegrade and retrograde anterior column screws, retrograde posterior column screws, and lateral compression screws, were used, tailored to each case. Over an average follow-up of 18 months, there were no additional procedures or complications, such as neurovascular injury or hardware failure, indicating successful outcomes in all cases. CONCLUSIONS: This study introduces a simple yet effective method to address guidewire misdirection during percutaneous fixation for pelvic and acetabular fractures, offering enhanced precision and potentially better patient outcomes. Further research with a larger patient cohort is required for a more comprehensive understanding of its efficacy compared to traditional methods. LEVEL OF EVIDENCE: IV. Therapeutic Study (Surgical technique and Cases-series).

Incidence, risk factors, and prognosis of sciatic nerve injury in acetabular fractures: a retrospective cross-sectional study.

PURPOSE: This study aimed to investigate the incidence, risk factors of the sciatic nerve injury in patients with acetabulum fractures and assess its prognosis. METHODS: A retrospective cross-sectional review was conducted on 273 patients with acetabulum fractures who were treated between January 1st, 2017, and December 30th, 2019. The medical records and radiographs of these patients were analyzed. RESULTS: The overall nerve injury rate was 7.7% (21 of 273 cases), with 3.1% (8 of 273 cases) occurring because of the initial injury and 12.8% (13 of 101 cases) as post-operative complications. Among those with nerve injuries, 95.2% (20 of 21 cases) were males and the average age of the patients was 31.5 (SD 9.5) years. The most common mechanism of injury was motor vehicle collisions with 55.7% (152 of 273 cases), and the most common fracture pattern associated with nerve injury was posterior column and posterior wall fracture with 31.6% (6 of 21 cases). Hip dislocation was found in 16.5% (14 of 21 cases) of patients with nerve injury. The Kocher Langenbeck approach was the most common approach used for patients with post-operative nerve injury, and the prone position was significantly associated with sciatic nerve injury during the operation. Of all patients with nerve injury, 52% (11 of 21 cases) had fully recovered, 29% (6 of 21 cases) had partially recovered, and 19% (4 of 21 cases) had no improvement. The average follow-up was 15 months. CONCLUSION: This study emphasizes the incidence of sciatic nerve injuries in individuals with acetabulum fractures and highlights key risk factors, including hip dislocation, posterior column, and posterior wall fractures. It is noteworthy that the Kocher Langenbeck approach and the prone position may contribute to iatrogenic nerve injuries. Encouragingly, over half of the patients who suffered nerve injuries achieved full recovery, while nearly one-third experienced partial recovery. These findings underscore the vital significance of recognizing and addressing these risk factors in clinical practice.

Epidemiology of proximal femur fractures in the young population of Qatar.

PURPOSE: To review the epidemiological characteristics of proximal femur fractures in the young population (< 60 years) of Qatar between 2017 and 2019. METHODS: All patient treated for proximal femur fractures at Hamad General Hospital (HGH), a level one trauma center, were retrospectively reviewed between Jan 2017 and Dec 2019. All adults (18-60 years) with proximal femur fracture (femur head, femur neck, intertrochanteric and subtrochanteric fractures) were included with no restriction to the AO/OTA classification or fractures subtypes. Excluded cases were pathological fractures, cases with insufficient documentation or no radiographs. RESULTS: A total of 203 patients with a mean age of 40.07 ± 11.76 years were included, of who 89.9% were males. The incidence of proximal femur fracture was 3.12/100,000/year. Fall from height (48.1%) followed by road traffic accidents (26.9%) were common cause of injury. The most common fracture type was intertrochanteric fracture (36.1%) followed by femur neck fractures (33.7%). CONCLUSION: This study provides the initial insights into the proximal femur fractures in the young population of Qatar. This is the first study to investigate of the epidemiology of such fractures in this particular patient group. Contrary to the existing literature on older age groups, the majority of the injuries were observed in males. Falls from height followed by road traffic accidents were the primary mechanisms leading to these fractures. Improved understanding of the profile of these injuries can aid in their prevention by implementing more effective safety measures.

The outcomes of total hip arthroplasty in developmental dysplasia of hip versus osteoarthritis: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aimed to compare the outcomes of total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) and those with osteoarthritis (OA). METHODS: Four databases were searched from inception till February 2023 for original studies that compared the outcomes of THA in DDH and OA. The primary outcome was the revision rate; the secondary outcomes were dislocation and failure modes (i.e. aseptic loosening, PJI, instability, and periprosthetic fractures), hospital stay and costs. This review was conducted as per PRISMA guidelines, and the risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS: A total of 9 observational studies with 575,255 THA (469,224 hips) were included, with a mean age of 50.6 years and 62.1 years for DDH and OA groups, respectively. There was a statistically significant difference in revision rate between DDH and OA patients in favour of OA (OR, 1.66; 95% CI 1.11-2.48; p-value, 0.0251). However, dislocation rate (OR, 1.78, 95% CI 0.58-5.51; p-value, 0.200), aseptic loosening (OR, 1.69; 95% CI 0.26-10.84; p-value, 0.346) and PJI (OR, 0.76; 95% CI 0.56-1.03; p-value, 0.063) were comparable across both groups. CONCLUSION: A higher revision rate following total hip arthroplasty was associated with DDH compared with osteoarthritis. However, both groups had similar dislocation rates, aseptic loosening and PJI. Consideration of confounding factors, such as patient age and activity level, is crucial when interpreting these findings. LEVEL OF EVIDENCE : III. TRIAL REGISTRATION: PROSPERO registration: CRD42023396192.

Reliability of artificial intelligence in predicting total knee arthroplasty component sizes: a systematic review.

PURPOSE: This systematic review aimed to investigate the reliability of AI predictive models of intraoperative implant sizing in total knee arthroplasty (TKA). METHODS: Four databases were searched from inception till July 2023 for original studies that studied the reliability of AI prediction in TKA. The primary outcome was the accuracy ± 1 size. This review was conducted per PRISMA guidelines, and the risk of bias was assessed using the MINORS criteria. RESULTS: A total of four observational studies comprised of at least 34,547 patients were included in this review. A mean MINORS score of 11 out of 16 was assigned to the review. All included studies were published between 2021 and 2022, with a total of nine different AI algorithms reported. Among these AI models, the accuracy of TKA femoral component sizing prediction ranged from 88.3 to 99.7% within a deviation of one size, while tibial component sizing exhibited an accuracy ranging from 90 to 99.9% ± 1 size. CONCLUSION: This study demonstrated the potential of AI as a valuable complement for planning TKA, exhibiting a satisfactory level of reliability in predicting TKA implant sizes. This predictive accuracy is comparable to that of the manual and digital templating techniques currently documented in the literature. However, future research is imperative to assess the impact of AI on patient care and cost-effectiveness. LEVEL OF EVIDENCE III: PROSPERO registration number: CRD42023446868.

Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: Robotic knee arthroplasty procedures have emerged as a new trend, garnering attention from orthopedic surgeons globally. It has been hypothesized that the use of robotics enhances the accuracy of prosthesis positioning and alignment restoration. The objective of this study was to provide a high-level, evidence-based comparison between robotic total knee replacements and conventional methods, focusing on radiological and functional outcomes. METHODS: We searched five databases from their inception until June 1, 2022, specifically targeting randomized controlled trials (RCTs) that compared the outcomes of robotic and conventional total knee replacements. We were interested in outcomes such as knee range of motion, clinical and function knee society scores, the Western Ontario and McMaster University score (WOMAC), the Hospital of Special Surgery score, complications, and radiological alignment. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. We assessed the risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS: Our search returned seven RCTs suitable for our analysis, which included a total of 1942 knees; 974 of these knees were implanted using robotic arms while the remaining 968 utilized jig-based knee systems. Our findings indicated that robotic knees had significantly better post-operative anatomical (OR - 0.82; 95% CI, - 1.027 to - 0.58, p value < 0.00001) and mechanical restoration (OR - 0.95; 95% CI, - 1.49 to - 0.41, p value < 0.0006). While knee range of motion (OR - 2.23; 95% CI - 4.89-0.43, p value 0.1) and femoral prosthesis position (OR - 0.98; 95% CI, - 2.03-0.08, p value 0.07) also favored robotic knees, these differences did not reach statistical significance. Both clinical and functional outcomes, as well as the rate of complications, were found to be statistically similar between the groups undergoing robotic and traditional knee replacement surgeries. CONCLUSION: This meta-analysis indicates that robotic total knee replacements offer superior post-operative anatomical and mechanical alignment compared to conventional total knee replacements. Despite this, clinical and functional outcomes, as well as complication rates, were similar between the two. These findings should be considered in light of potential confounding factors. More randomized controlled trials with the latest robotic systems are needed to confirm any superior functional and clinical outcomes from robotic-assisted surgeries. LEVEL OF EVIDENCE: I.

Recurrent Instability after the Latarjet Procedure.

The Latarjet procedure is a favored approach for managing chronic and recurrent dislocation, especially in the presence of bone loss. Although generally yielding excellent results, the procedure carries a 15 to 30% complication rate. Although recurrent instability is a major concern, various complications such as infection, nerve injuries, and hardware impingement can also necessitate revision after a Latarjet procedure. Strategies for addressing this issue include glenoid bone grafting, using autogenous bone grafts from the iliac crest or distal clavicle, and allografts, with fresh lateral distal tibial allografts offering advantages because of their osteochondral nature. In addition, soft-tissue procedures offer another solution for recurrent instability, suitable for patients lacking substantial bone loss or those experiencing multidirectional instability. This review aims to provide a comprehensive overview of the causes and management strategies for recurrent instability following a failed Latarjet procedure.

Clinical and Radiological Outcomes of Scaphocapitate Fusion in Kienböck Disease: A Systematic Review and Meta-Analysis.

Purpose: To report the functional and radiological outcomes of scaphocapitate (SC) arthrodesis in the treatment of Kienböck disease. Methods: This meta-analysis was conducted with adherence to PRISMA guidelines. Google Scholar, PubMed, Cochrane and Virtual Health Library were searched from inception until November 2022. All original studies that investigated the outcomes of scaphocapitate fusion in Kienböck disease were included. Exclusion criteria were arthroscopically performed fusions, concomitant radial shortening, traumatic or other etiologies of lunate avascular necrosis, and studies published in languages other than English. Outcomes of interest were pre- and post-operative wrist range of motion, VAS score, functional scores, radiological outcomes, surgical technique, complication rate and reoperation rate. Results: The total number of included participants was 203 from 11 articles. The results showed no significant differences pre- and post-operatively in terms of wrist flexion, extension and ulnar deviation. However, there was a significant reduction in radial deviation after the surgery (WMD -2.30; 95% CI, -4.26 to -0.33). Moreover, a significant increase was noticed in grip strength in Kg (WMD 13.29; 95% CI, 3.21-23.37) and mmHg post-operatively (WMD 23.75; 95% CI, 17.56-29.94). In addition, the models demonstrated significant decrease in carpal height (WMD -0.01; 95% CI, -0.02 to 0.00), scapholunate angle (WMD -12.11; 95% CI, -20.46 to -3.77) and radioscaphoid angle after the surgery (WMD -12.09; 95% CI, -15.51 to -8.67). The pooled overall rate of complication and reoperation rates were 24% (95% CI, 6%-47%) and 14% (95% CI, 3%-31%), respectively. Conclusions: Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease. This procedure is associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength. Further studies with larger sample sizes and reduced heterogeneity are needed for a better evaluation of the results. Clinical relevance: Scaphocapitate arthrodesis is a recommended surgery for Kienböck disease with satisfactory functional and radiological outcomes. However, patients should be counseled on the possible complications and reoperation rate.

Below- versus above-elbow cast treatment of displaced distal forearm fractures in children: A systematic review and meta-analysis of randomized controlled trials.

Objectives: Distal forearm fractures are the most common pediatric fractures. This study aimed to investigate the effectiveness of below-elbow cast treatment for displaced distal forearm fractures in children compared to above-elbow cast through meta-analysis of randomized controlled trials. Methods: Several databases from January 1, 2000 until October 1, 2021 were searched for randomized controlled trials that assessed below versus above-elbow cast treatment of displaced distal forearm fractures in pediatric patients. The main meta-analysis comparison was based on the relative risk of loss of fracture reduction between children undergoing below versus above-elbow cast treatment. Other outcome measures including re-manipulation and cast-related complications were also investigated. Results: Nine studies were eligible of the 156 articles identified, with a total of 1049 children. Analysis was undertaken for all included studies with a sensitivity analysis conducted for studies with high quality. In the sensitivity analysis, the relative risks of loss of fracture reduction (relative risk = 0.6, 95% confidence interval = 0.38, 0.96) and re-manipulation (relative risk = 0.3, 95% confidence interval = 0.19, 0.48) between the below and above-elbow cast groups were in favor of below-elbow cast and statistically significant. Cast-related complications were in favor of below-elbow cast but did not attain statistical significance (relative risk = 0.45, 95% confidence interval = 0.05, 3.99). Loss of fracture reduction was noted in 28.9% of patients treated with above-elbow cast and 21.5% in below-elbow cast. Re-manipulation was attempted in 48.1% versus 53.8% of children who lost fracture reduction in the below-elbow cast and above-elbow cast groups, respectively. Conclusion: Below-elbow cast treatment was favored, with statistical significance, in terms of loss of fracture reduction and re-manipulation, and was not associated with a higher risk of cast-related complications. The accumulative evidence currently does not support above-elbow cast treatment and below-elbow cast treatment should be the mainstay for displaced distal forearm fractures in children. Level of evidence: Level I, meta-analysis of therapeutic level I studies.

Trauma and orthopaedic surgery response at the world's largest sporting event: an analysis of the FIFA World Cup Qatar 2022.

PURPOSE: The purpose of this study is to analyse the impact of the FIFA World Cup Qatar 2022 on the Orthopaedic Surgery department at Hamad Medical Corporation and its response to the challenges posed by the world's largest sporting event. METHODS: A retrospective analysis was conducted on the epidemiology, crisis management plan, and training program adaptations at the Orthopaedic Surgery department during the World Cup. Descriptive analysis of the number and types of surgeries performed, patient demographics, and the disaster preparedness plan were performed. RESULTS: During the tournament period (November-December 2022), 706 patients (4.22% football fans) were operated on, with an average age of 44 ± 17 years. Most patients were males, 67%. Of the 706 patients, 60.33% were emergency cases, 38.24% were elective, 1.27% were limb-saving, and one life-saving procedure was performed, comparable to pre-tournament numbers. The patients were of 77 different nationalities, reflecting the diverse background of Qatar's population and the international fanbase of the tournament. CONCLUSIONS: This analysis provides valuable insights for future mega sporting events and highlights the importance of crisis management and training program adaptation for optimal patient care and resident training advancement. The findings demonstrate the crucial role of the Orthopaedic Surgery Department in responding to the challenges posed by large-scale events.

All-polyethylene versus metal-backed tibial components in total knee arthroplasty: a meta-analysis of randomized controlled trials.

OBJECTIVES: The design of tibial trays for total knee arthroplasty (TKA) has been a topic of research for several decades. Although all-polyethylene trays were developed to address issues such as osteolysis and to enhance the longevity of the prosthesis, as well as knee range of motion, metal-backed designs have remained the most commonly used type of prosthesis. This meta-analysis aimed to compare the clinical, radiological, and survival outcomes of both designs. METHODS: Five databases were searched from inception until October 1, 2020, for randomized controlled trials (RCTs) that compared the outcomes of all-polyethylene and metal-backed tibial components in TKA. The outcomes of interest included range of motion, knee society score, stairs climbing scores, radiostereographic analysis, survivorship and complication. This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was assessed using the Newcastle-Ottawa tool. RESULTS: A total of 14 RCTs with 1367 TKA were included with a mean age of - years and - years for all-polyethylene and metal-backed tibial components groups, respectively. All-polyethylene group demonstrated statistically significant differences in five-year survivorship (OR 0.27; 95% CI 0.10-0.75; p value 0.01) and stairs climbing score (OR - 2.07; 95% CI - 3.27-0.87; p value 0.0007) when compared to the metal-backed group. The metal-backed design was significantly more radiographically stable in anterior-posterior, varus-valgus, and internal-external rotations at the 2-year follow-up compared to all-polyethylene tibias (OR - 0.09; 95% CI - 0.16 to - 0.02; p value 0.02) as per the pooled radiostereographic analysis. However, ten-year survivorship (OR 0.92; 95% CI 0.53-1.60; p value 0.78), range of motion (OR - 0.57; 95% CI - 2.00-0.85, p value 0.43), knee society scores (OR 1.38; 95% CI - 0.47-3.23, p value 0.14), and complications (OR 0.83; 95% CI 0.5-1.39, p value 0.48) were comparable between both groups. CONCLUSIONS: While this meta-analysis suggests that all-polyethylene tibial components in total knee arthroplasty may offer advantages over metal-backed components in terms of five-year survivorship, and stairs climbing score, this finding should be considered in the context of potential confounding factors. Nonetheless, based on the results, the all-polyethylene implant should be considered a viable choice for primary knee replacement. LEVEL OF EVIDENCE: I.

Epidemiology of proximal humerus fractures in Qatar.

OBJECTIVE: This study aimed to investigate the epidemiological characteristics and treatment options of proximal humerus fractures at a level one trauma center and to compare our data with the current literature. METHODS: A retrospective review was conducted on all patients diagnosed and treated for proximal humerus fractures at Hamad General Hospital, a level one trauma center, between January 2018 and December 2019. Age, gender, mechanism of injury, fracture classification, mode of treatment, implant type, length of hospital stay, associated injuries and complications were analyzed. RESULTS: A total of 190 patients with a mean age of 52.4 years were included; 56.8% were males. The incidence of proximal humerus fracture was 4.1/100,000 per year. Falling from a standing height was the most common cause of injury (50.5%). Additionally, Neer's two-part fracture was found to be the most common type (n = 132, 69%). Forty-one patients (21.3%) had other associated injuries. Most fractures were treated nonoperatively with an arm sling (n = 138, 72.6%). CONCLUSION: In summary, the incidence of proximal humerus fractures during the two-year study period was found to be 4.1 per 100,000 persons per year. Our results showed a lower incidence of proximal humerus fractures with a predominance of males and younger patients in Qatar's population compared to females and older patients in the developed countries. Our results may contribute to the development of effective strategies for preventing and treating proximal humerus fractures, and can provide important data for further high-level clinical research. LEVEL OF EVIDENCE: IV.

Complications of conventional percutaneous sacroiliac screw fixation of traumatic pelvic ring injuries: a systematic review and meta-analysis.

OBJECTIVES: The objective of this review was to present a thorough overview of the complications associated with conventional percutaneous sacroiliac screw fixation to identify areas for improvement in surgical technique and patient selection. METHODS: PubMed/Medline, Web of Science, Embase, Ovid, Cochrane library, and Google Scholar were systematically searched for original human studies reporting on complications of conventional percutaneous sacroiliac fixation in traumatic pelvic ring injuries from January 1, 2000, to April 30, 2022. The main meta-analysis was based on the random effect model to pool all complications reported in the included studies. The results were reported as weighted proportions with 95% confidence intervals. This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS: A total of 56 studies with 3644 screws (2871 procedures) met the inclusion criteria, with a mean age of 40.5 years. The most frequently reported complications were screw malposition with a weighted proportion of 6% (95% CI: 5-9%) and involved 189 out of 3644 screws, persistent pain following the procedure with a weighted proportion of 3% (95% CI: 2-4%) and affected 98 out of 2871 patients, and nerve injury, which had a weighted proportion of 2% (95% CI: 1-3%) and was observed in 41 out of 2871 procedures. The L5 and S1 nerve roots were more frequently affected. Revision surgery was required for 184 out of 2871 patients with a weighted proportion of 5% (95% CI: 3-7%). The primary reason for the revision was persistent pain after the initial procedure, which affected 74 out of 184 patients, with a weighted proportion of 2.0% (95% CI: 1.2-2.8%). CONCLUSIONS: This study showed that screw malposition, the need for revision surgery, persistent pain, and nerve injuries were the most frequent complications following conventional percutaneous sacroiliac screw fixation. However, these results must be interpreted in context due to confounding factors, including the lack of high-quality studies and the absence of uniformity in defining some complications across studies.

The role of cerclage wiring in the management of subtrochanteric and reverse oblique intertrochanteric fractures: a meta-analysis of comparative studies.

PURPOSE: Subtrochanteric and reverse oblique intertrochanteric fractures are challenging and often difficult to reduce. While intramedullary nailing (IMN) is considered the standard treatment, achieving anatomic reduction prior to fixation is essential. This study aimed to assess the impact of cerclage wiring with IMN on the outcomes and complication rate in treating subtrochanteric and reverse oblique intertrochanteric fractures. METHODS: This meta-analysis was conducted in line with PRISMA guidelines. The primary outcome was the time to union. The secondary outcomes were operative time, blood loss, quality of reduction, reduction alignment (if in varus), complications and reoperations. PubMed, Cochrane, Web of Science and Google Scholar were searched till July 2021. Articles that compared intramedullary nailing (IMN) versus intramedullary nailing and cerclage wiring (IMN-C) in the treatment of subtrochanteric and reverse oblique intertrochanteric fractures were included. The risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS: This meta-analysis included 415 patients with subtrochanteric and reverse oblique intertrochanteric fracture from six comparative studies. Our findings showed that IMN-C was significantly associated with higher mean duration of surgery and blood loss. However, IMN-C had significantly lower mean time to union compared to IMN alone. In addition, IMN-C had lower pooled prevalence of varus reduction and overall complications. CONCLUSION: This study showed that the use of cerclage wiring is associated with lower time to union, lower prevalence of varus reduction and overall complications. Therefore, cerclage wiring augmentation is a safe technique with low complication rate and may be advised whenever open reduction is needed in the management of subtrochanteric and reverse oblique intertrochanteric fractures.

Higher sensitivity and accuracy of synovial next-generation sequencing in comparison to culture in diagnosing periprosthetic joint infection: a systematic review and meta-analysis.

PURPOSE: The purpose of this meta-analysis was to compare the diagnostic parameters of synovial next-generation sequencing (NGS) and cultures in diagnosing periprosthetic joint infections (PJI). METHODS: PubMed, Web of Science, Cochrane, and Google Scholar were searched from inception until 8 Jan 2022 for literature investigating the role of NGS in comparison to culture in the diagnosis of PJI. The studies were included if they investigated the diagnostic value of culture and NGS in diagnosing PJIs against the Musculoskeletal Infection Society (MSIS) criteria. Diagnostic parameters, such as sensitivity, specificity, positive predictive value, negative predictive value, positive-likelihood ratio, negative-likelihood ratio, accuracy, and area under the curve (AUC), were calculated for the included studies to evaluate the performance of NGS in comparison to culture in PJI diagnosis. RESULTS: The total number of the included patients was 341 from seven articles. The pooled sensitivity, specificity, and diagnostic odds ratio of NGS were 94% (95% CI 91-97%), 89% (95% CI 82-95%), and 138.5 (95% CI 49.1-390.5), respectively. NGS has positive- and negative-likelihood ratios of 7.9 (95% CI 3.99-15.6) and 0.1 (95% CI 0.0-0.1), respectively. On the other hand, the pooled sensitivity, specificity, and diagnostic odds ratio of culture were 70% (95% CI 61-79%), 94% (95% CI 88-98%), and 28.0 (95% CI 12.6-62.2), respectively. The SROC curve for NGS showed that the accuracy (AUC) was 91.9%, and that the positive and negative predictive values were 8.6 (95% CI 5.0-19.5) and 0.1 (95% CI 0.0-0.1), respectively. While, culture SROC curve demonstrated that the accuracy (AUC) was 80.5% and the positive- and negative-likelihood ratio were 12.1 (95% CI 4.5-49.6) and 0.3 (95% CI 0.2-0.4). CONCLUSIONS: NGS has a potential role in diagnosing hip and knee PJIs due to its high sensitivity, specificity, and accuracy. However, the sensitivity and specificity reported by the studies varied according to the time of synovial sampling (preoperative, postoperative, or mixed).

Complications of Elbow Arthroscopic Surgery: A Systematic Review and Meta-analysis.

Background: Elbow arthroscopic surgery has been popularized and has made significant progress during the past 3 decades. The elbow joint is relatively small and is in close proximity to many neurovascular structures. These factors make elbow arthroscopic surgery technically demanding and liable to complications. Purpose: To evaluate the rate of complications after elbow arthroscopic surgery. Study Design: Systematic review; Level of evidence, 4. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis. PubMed, Web of Science, and Embase were searched up to July 2021. All clinical studies that reported complications after elbow arthroscopic surgery were included; a total of 1208 articles were initially found. Case reports, reviews, abstracts, imaging studies, technique studies, nonclinical studies, and those not reporting postoperative complications were excluded. Complication rates were pooled across studies and reported as percentages. Complications were expressed as weighted proportions with 95% CIs. Results: A total of 95 studies (14,289 elbows) were included in the meta-analysis. The overall weighted complication rate was 11.0% (95% CI, 8.8%-13.5%), with postoperative stiffness being the most commonly encountered complication (4.5% [95% CI, 2.1%-7.6%]; 158/8818 procedures). The second most encountered complication was the need for subsequent surgery with a weighted proportion of 4.1% (95% CI, 2.9%-5.6%; 177/8853 procedures) followed by nerve injury with a weighted proportion of 3.4% (95% CI, 2.6%-4.3%; 267/13,725 procedures). The ulnar nerve was the most commonly injured nerve (2.6% [95% CI, 1.9%-3.4%]; 123/6290 procedures). Conclusion: The results of this study showed that elbow arthroscopic surgery is a relatively safe procedure with low complication rates.

Acute irreducible volar distal radioulnar joint dislocation treated with open reduction through dual approaches: A case report and literature review.

Introduction: Acute dislocation of distal radioulnar joint (DRUJ) is a rare pathology. Most cases were managed with closed reduction, and few patients required open reduction through dorsal or volar approaches. We describe a patient who required open reduction using dual approaches. Case presentation: This paper reported a case of acute DRUJ volar dislocation that failed closed reduction. Open reduction was tried using a dorsal approach which failed to achieve joint reduction. A second volar approach to release volar joint capsule had only achieved joint reduction. Discussion and conclusion: This case report highlighted the importance of open reduction when treating acute DRUJ injuries that failed closed reduction. We strongly recommend that surgeons should be ready to utilize dual approaches for this injury and to appraise patients about this possibility.

Bilateral pelvic crescent fracture combined with left acetabular fracture: A case report.

INTRODUCTION: Crescent fracture-dislocations are subtype of lateral compression fractures of the pelvic ring, which usually occur following high-velocity impacts. Bilateral crescent fractures are rare entities, with a limited number of cases reported in the literature. Of those reported, none were combined with an acetabulum fracture. PRESENTATION OF CASE: The case involves a 49-year-old male, who presented to the trauma unit after a motor vehicle collision and sustained a bilateral crescent pelvic fracture combined with a left acetabulum fracture. The patient was resuscitated and managed initially according to the advanced trauma life support (ATLS) protocol then staged fixation of his pelvic and acetabulum fractures was carried out. CONCLUSION: Bilateral crescent fractures of the pelvis combined with acetabulum fractures constitute a rare injury. Given their rarity, a standard of care is lacking and has not been described yet. Staged surgical stabilization of such combined injuries is recommended, and may contribute to a better outcome.