Ahmed Al Ghaithi

Case: A 20-year-old man carried a 33-cm diaphyseal femoral defect after childhood osteosarcoma and three failed reconstructions — distraction osteogenesis, autografting and the induced-membrane (Masquelet) technique. As a final limb-salvage attempt, a patient-specific 3D-printed polycaprolactone–tricalcium phosphate (PCL-TCP) scaffold was implanted over an intramedullary nail and bioactivated with iliac-crest bone marrow aspirate, followed at nine months by reamer-irrigator-aspirator autograft. Biopsy at that second procedure confirmed new osteoid and thick-walled vessels at the scaffold interface, yet radiographic consolidation never followed. Four weeks later Staphylococcus haemolyticus infection supervened, and after serial debridement the scaffold was explanted. At four years the limb is preserved and the patient walks independently with a mild limp and a radiographically fused knee. Conclusion: Histological osteogenesis without radiographic union indicates a construct that was biologically alive but biologically outpaced. Three determinants — a defect roughly twice the length at which scaffold-guided regeneration has succeeded, a scarred and hypovascular host bed, and a staged bioactivation protocol whose repeated open re-entries were themselves the infective exposure — argue that defect length, host vascularity and cumulative infection risk, rather than scaffold chemistry alone, should govern candidate selection for this technology.

Background Carpal tunnel syndrome is a neuropathic compressive condition caused by median nerve compression as it travels into the wrist through the carpal tunnel. Validated patient-reported outcome measures such as the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the Mayo Wrist Score are commonly used to assess outcomes following carpal tunnel release; however, limitations remain in interpreting whether observed score changes are clinically meaningful from the patient’s perspective. The primary objective of this study was to determine the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for the Mayo Wrist Score after isolated carpal tunnel release, and secondarily to contextualize postoperative QuickDASH change using previously reported clinically meaningful thresholds. Methodology This prospective study included adult patients undergoing isolated carpal tunnel release at two tertiary hospitals. QuickDASH and Mayo Wrist Scores were recorded preoperatively and at the six-month follow-up. MCID and SCB were calculated using anchor-based and distribution-based methods, with receiver operating characteristic curve analysis primarily applied to the Mayo Wrist Score. Results A total of 92 patients were enrolled, of whom 73 completed the six-month follow-up. The anchor-based MCID for the Mayo Wrist Score was 11.5 points (area under the curve (AUC) = 0.77), while the SCB threshold was 13.5 points (AUC = 0.91). Significant postoperative improvements were observed in both QuickDASH and Mayo Wrist Scores. Conclusions Establishing MCID and SCB values for the Mayo Wrist Score and contextualizing change in the QuickDASH score provides a clinically meaningful framework for interpreting patient-reported outcomes following carpal tunnel release.

Objectives: Osteomyelitis, characterised by bone inflammation due to microbial infection, presents significant healthcare challenges. While the protective role of biofilm in bacterial immunity and persistence is well-documented, its direct impact on bone degradation in osteomyelitis remains inadequately characterised. This study aimed to comprehensively examine the direct effects of biofilm-forming pathogens on human bone, providing new insights into the mechanisms of bone destruction associated with osteomyelitis. Methods: Bone sections were collected from patients undergoing total knee replacement surgery at Sultan Qaboos University Hospital, Muscat, Oman, between January 2021 and December 2022. The samples were then inoculated with Staphylococcus aureus to simulate in vitro bone infection. Raman spectroscopy and scanning electron microscopy (SEM) were employed to analyse the bacterial interaction with bone tissue. Results: Biofilm-forming pathogens directly contributed to bone degradation, as evidenced by SEM images showing marked trabecular destruction. Raman analysis showed a significant increase in the carbonate-to-phosphate ratio in inoculated samples (61.9%) compared to controls (47%). Additionally, mineral content decreased in inoculated samples, and the carbonate-to-amide I ratio reduced by 47% in inoculated samples and by 80% in controls. The inoculated samples exhibited an 82% shift in collagen cross-linking compared to a 72% shift in controls. Conclusions: This research enhances the comprehension of the mechanisms underlying bone destruction in osteomyelitis and underscores the intricate role of biofilm in disease progression. These findings highlight the importance of biofilm in bone degradation and its potential implications for infection management.

Objectives: Despite the numerous advances in management strategies, treating osteomyelitis in individuals with sickle cell disease (SCD) remains a significant challenge, leading to severe long-term consequences. This study aimed to assess the key factors potentially linked to a complex progression of osteomyelitis in patients diagnosed with SCD. Methods: A cohort of 34 patients was identified and their progress was monitored over a span of 12 months during a 10-year period (2010–2020). The variables under investigation encompassed demographic and clinical traits, laboratory analyses and imaging data, as well as the treatment strategies employed. Results: The risk prediction model pinpointed 5 factors (severity of SCD, involvement of lower limbs, presence of bacteraemia, magnetic resonance image [MRI] findings and utilisation of surgical debridement) that exhibited an area under the curve (AUC) exceeding 0.7. Causative organisms were identified in 9 out of the total 34 patients (26.47%). A total of 17 patients displayed a severe course of SCD (AUC = 7.88), with MRI being highlighted as a valuable contributing factor (AUC = 7.88). Furthermore, 13 patients (38.2%) underwent surgical debridement, a procedure that yielded a statistically significant P value of 0.012 and an AUC of 0.714. Conclusion: Osteomyelitis within the context of severe SCD, particularly when accompanied by lower extremity infection, bacteraemia, positive MRI findings and the need for surgical debridement, emerges as a cluster of risk factors predisposing individuals to osteomyelitis relapse and a more complex disease course.

Objectives: Synovial fluid (SF) analysis is crucial for diagnosing various joint diseases. This research delved into using Raman spectroscopy (RS) as a primary method for molecular profiling of SF and identifying significant biomarkers. The findings from this research have the potential to expand the utility of RS in diagnosing a diverse range of joint conditions. Methods: The SF samples were collected from patients undergoing knee joint surgeries and analyzed using RS coupled with a video microsampling system. Various strategies were implemented to minimize background fluorescence interference, a common challenge in biofluid RS analysis. Results: The spectral characteristics of fresh and overnight dry SF samples were compared revealing a reduction in background fluorescence in the dried samples. However, certain important signals were found to be absent due to overlap between Raman bands. The analysis showed distinct spectral features associated with hyaluronic acid, glycosaminoglycans, collagen, and proteins, highlighting their potential as biomarkers for joint diseases. Conclusion: Our study highlights the effectiveness of RS as a promising non-invasive method for analyzing SF. We have pinpointed specific biomarkers critical for joint health and disease paving the way for RS to potentially revolutionize the diagnosis and monitoring of joint pathologies. Despite the focus on osteoarthritis, the implications of this research extend to other complex joint diseases necessitating further investigation to enhance diagnostic precision and patient care.

Objectives: Posterior tibial slope (PTS) is an important factor in restoring joint biomechanics after total knee arthroplasty (TKA). Given ethnic variation and the lack of recorded values for PTS, this study aimed to report PTS in a cohort of Omani patients (Arab ethnicity). Methods: This retrospective study included all Omani patients who underwent TKA in a specialized center between May 2017 and March 2020. Patients with revision TKA, extra-articular deformity, and tibial defects necessitating bony build-up and traumatic indications were excluded. Data collected include age, gender, and pre-and post-operative PTS. Results: A total of 128 patients were included in the study, 94 (73.4%) were female and 34 (26.6%) were male. The mean age of the patients was 65.16 years, standard deviation (SD) 8.47 (Maximum 87–Minimum 43). The mean pre-operative PTS was 10.6° (SD 3.65), whereas most current TKA designs aim for a 5–6° posterior slope. We found no correlation between PTS value and age or gender (P > 0.05). Conclusion: Given the higher PTS angle found in this study, which is consistent with those reported in the literature for Asian and Arab populations. This study indicates the importance of examining PTS variation within the population served. The proximal tibia shape and cutting angle can be varied to avoid any discrepancy in PTS after implantation.

Nemaline myopathy is a rare genetic disorder caused by a mutation in genes encoding skeletal muscle proteins resulting in generalized hypotonia. It can be associated with neonatal multiple long bone fractures. We present a female neonate who had bilateral humerus and left femur fractures. Due to fetal distress, her delivery was at 37 weeks gestation by emergency cesarean section. The child was splinted and followed up for 8 weeks. She had a good union of fractured bones, callus formation, and no deformity. Muscle biopsy showed nemaline myopathy. Other biochemical and genetic tests were normal. The aim of this case report was to describe the presentation of multiple long bone fractures in neonates as an obstetric complication. Therefore, identifying the potential risk factors and planning the mode of delivery in future pregnancies, is critical in their management.

Isolation of the causal microorganisms in osteomyelitis presents a major challenge for treating clinicians. Several methods have been proposed to rapidly and accurately identify microorganisms. There has been an increasing interest in using Raman spectroscopy in the field of microbial detection and characterisation. This paper explores the use of Raman spectroscopy identification as one of the most difficult-to-isolate microorganisms causing osteomyelitis. Fresh healthy human bone samples were collected from patients undergoing a total knee replacement. These samples were then inoculated with fresh overnight Pseudomonas aeruginosa (PAO) cultures. Bacteria growth and bone ultrastructural changes were monitored over a period of 6 weeks. The experiment demonstrated ultrastructural bony destruction caused by osteolytic PAO secretions. Raman-specific spectral signatures related to the cellular membranes of PAO structures were spotted indicating survival of bacteria on the bone surface. This study showed the promising ability of Raman spectroscopy to identify the presence of bacteria on the surface of inoculated bone samples over time. It was able to detect the osteolytic activity of the bacteria as well as ultrastructure specific to PAO virulence. This method may have a role as an aid to existing diagnostic methods for fast and accurate bacterial identification in bone infection. Al Ghaithi A, Al Bimani A, Al Maskari S. Investigating the Growth of Pseudomonas aeruginosa and Its Influence on Osteolysis in Human Bone: An In Vitro Study. Strategies Trauma Limb Reconstr 2021;16(3):127–131.