Hamza M. Alrabai

Background: Total hip arthroplasty (THA) is an effective treatment for degenerative hip disease. ‏ ‏However Obesity may increase preoperative risk and postoperative complications this study aimed to evaluate association between preoperative obesity and post operative complication following THA. Questions/Purposes: This study aimed to determine whether preoperative obesity is associated with postoperative complication after THA and whether complication rates vary according to BMI category. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed/MEDLINE, the Cochrane Library and Google Scholar were searched for study published between 2015 and 2025 adult patient undergoing primary THA were included. Study quality was assessed using the Newcastle-Ottawa Scale, and pooled odds ratios (OR) were collected using a random-effect model. Thirteen studies with sample size ranging from 39 to 131,576 THA patient were included. Results: Obese patient had higher rates of post-operative complication compared with non-obese patient. Meta-analysis showed increased risk of infection (OR 0.39), dislocation (OR 0.63), and revision surgery (OR 0.60). No significant difference was observed in postoperative mortality (OR 0.58) or thromboembolic events (OR 0.69). Conclusion: Obesity is associated with increased risk of several postoperative complication following THA, particularly infection, dislocation, and revision surgery. However, mortality and thromboembolic event do not appear to be significantly affected.

The Relationship of Poor Posture While Using Electronic Devices and Periscapular Shoulder Pain - Article abstract #950269

Piriformis syndrome (PS) is a sciatic nerve entrapment condition caused by compression by the piriformis muscle, often presenting with symptoms that mimic lumbar radiculopathy and gluteal and buttock pain. This narrative review explores its diagnostic challenges and highlights the role of advanced imaging techniques in improving diagnostic accuracy. Literature suggests that PS may account for 5% to 8% of low back pain cases, frequently manifesting as buttock pain exacerbated by sitting or hip motion. Traditional imaging often fails to detect PS due to nonspecific findings, but magnetic resonance neurography can reveal sciatic nerve inflammation. A multimodal approach combining clinical assessment with targeted imaging enhances diagnostic precision and guides effective management of PS.

Introduction: Smoking tobacco negatively affects fracture healing, increasing the risk of delayed union, malunion, and nonunion, as well as healthcare expenses. Although smoking is common in Saudi Arabia, the literature on public awareness of the negative impact of smoking on fractures is...

Background: Limb deformity describes a condition where a limb has an abnormal shape or length, resulting from an acquired or a congenital case. This condition can impair the normal function of patients’ lives, leading to adverse psychological impacts. The limb deformity-modified Scoliosis Research Society (LD-SRS) score is a frequently used tool to assess quality of life. This observational study aimed to investigate the quality of life of patients with debilitating limb deformities in Saudi Arabia using the LD-SRS score. Methods: This is an observational analytical cross-sectional study conducted at the orthopedic clinic at King Saud University Medical City between March and May 2024. Patients diagnosed with any type of limb deformity (of different ages) were included in this study. Patients completed the LD-SRS score in the clinic and were divided into two groups based on whether they had undergone surgery for limb deformity. Results: This study included 152 participants, with the majority of participants in the 13–18-year age group and predominantly male (59.87%). Most participants were assessed before treatment, with significant differences observed in total scores based on the examination time (p < 0.001). Post-surgery scores showed marked improvement, with the overall total mean score for the surgery group being significantly higher than that of the non-surgery group (p < 0.001). Domain-specific scores revealed higher satisfaction in self-image/appearance for the surgery group, while the non-surgery group had lower scores in function/activity and mental health domains. No significant differences were found across age, gender, side of the body affected, or affected site. Conclusions: Preoperative patients had lower QoL scores as a whole group compared to those who had undergone surgery. The longer the duration postoperatively, the better the QoL score; those measured at three months had better QoL than preoperative patients, and those assessed at one and two years scored even higher. Self-image/appearance was a key factor, with the surgery group scoring higher in this domain than the non-surgery group. Future research should explore broader patient perspectives, including those related to mental and social well-being.

Background: In this study, we aimed to measure normal elbow radiographic angles in the Saudi population and compare the normal range of elbow angles between Saudi males and females, as well as those previously measured in other populations. Methods: Anteroposterior and lateral plain radiographs of 304 normal elbows from 153 females and 151 males from the Saudi population, aged > 18 years, were assessed. Radiographs, 174 right elbows, and 130 left elbows were studied retrospectively, between 2018 and 2023 in our institute. Only normal elbow radiographs with acceptable quality were included. The standard radiographic elbow measurements were collected. Data analysis was conducted with Student’s t -test for parametric data and Wilcoxon Mann–Whitney U test for nonparametric data. Two certified orthopedic surgeons performed the measurements independently. Interobserver and intraobserver errors were measured. Results: All the radiographic elbow measurements in Saudis did not show any significant sexual dimorphism or difference between sides. The radiographic angles obtained on the anteroposterior view appeared more reliable than lateral view angles. Unlike carrying angle (CA), measurements of radiographic elbow angles in Saudis were inconsistent with previously published values. Conclusions: The elbow radiographic anatomical parameters of the Saudi population were not consistent with previously published values except for CA. The presence of a significant impact of geographical or racial variation on elbow radiographic anatomy requires additional investigations.

Distraction osteogenesis using motorized nails have shown promising results. These high-priced nails are regularly removed following successful lengthening sessions. The internal lengthening mechanism inside such nails is presumably intact and perhaps capable of running additional lengthening. Motorized nails are relatively weaker than conventional nails. This case report presented a broken re-activated PRECICE nail which has not been previously reported. A 21-year-old male patient with right short tibia. He has completed an uneventful lengthening session using tibial PRECICE® nail. A residual length discrepancy persisted despite 4 cm length gain. Attempt of re-lengthening was conducted utilizing the pre-implanted PRECICE® nail. The re-lengthening session run smoothly throughout distraction phase. Late in the consolidation phase, partial nail breakage occurred. The patient acknowledged intermittent gentle weightbearing against the physician's recommendations. The broken nail was removed on emergency basis. Cast immobilization with non-weightbearing continued until achievement of full consolidation clinically and radiographically. Most of commercially available lengthening motorized nails are considered less rigid compared to conventional nails and hence more susceptible to deformation and metal failure. However, nail breakage has been reported in both conventional and lengthening nails. Re-activation of PRECICE nail for additional lengthening session could carry higher risk of breakage. Possibility of nail breakage may be higher in re-activated PRECICE® nails relative to newly implanted PRECICE® nails. More studies are required to evaluate behavior of re-activated lengthening nails. Defective lengthening nails must not be re-activated. The patient compliance is essential for successful re-activation of lengthening nails.

Introduction: Impact of COVID-19 pandemic on the orthopedic residency programs was substantial worldwide. Orthopedic residency programs eventually survived such a hardship with implementation of certain measures. The impact of COVID-19 pandemic on the orthopedic trainees was variable relative to the country in which orthopedic residency program is based. This study aimed to assess the experience of the orthopedic residents during COVID-19 pandemic in Saudi Arabia and consequences on mental health, academic performance, and clinical training. Methods: A cross-sectional study was conducted from June 2021 to August 2021. An online survey was sent to the orthopedic residents in Saudi Arabia. The questionnaire was arranged into four sections pertaining to demographic data, academic activity, mental health, and clinical activity. Results: One-hundred forty-four orthopedic residents participated with mean age of 28.7 ± 5.67 years. Males were 108 (75%) and females were 36 (25%). Fifty-four (37.5%) residents worked in COVID-19 isolation unit. One-hundred twenty residents (83.3%) treated COVID-19 patients. Thirty residents (20.8%) had positive COVID-19 tests. Eighty-four (58.3%) residents were quarantined. Overall online education was difficult (41%). Half of the participants faced online difficulties in technicality, maintaining attention, and interaction with audience and examiners. Prospective research conduction was difficult (71.4%). More than 50% of residents experienced difficulties with isolation, quarantine, socialization, and anxiety of disease transmission. Physical examination was difficult for 50% of trainees. No shortage of PPE supply was reported. Getting hands-on surgical training was very difficult (47.8%). Conclusion: COVID-19 pandemic had an adverse impact on Saudi orthopedic residents in terms of academic performance, mental wellbeing, and clinical training. After all, adequate level of orthopedic training quality was maintained. In crises, collaborative efforts are needed to minimize undesirable consequences on the trainees’ competency level. Residency program decision makers should utilize all available strategies to optimize the training environment to achieve the required competency level.

Background: Magnetic intramedullary lengthening nails (MILNs) have gained popularity in recent years for the treatment of limb-lengthening discrepancies. We sought to catalog mechanical failures and their prevention and management in a large, single-institution series. We specifically assessed the rate of mechanical failures, the types of failures observed, and management strategies. Methods: We retrospectively reviewed 377 patients (420 limbs) who underwent limb lengthening with early (P1) or later (P2) MILN iterations with ≥12-month follow-up. Mechanical failure was defined as mechanical breakage of the instrumentation or nail and/or failure of the internal lengthening mechanism. Failure assessment was arranged by lengthening phases and was sorted with a complication classification system. All lengthening and alignment parameters were assessed radiographically. Results: Mechanical failure was observed in 40 nails (9.5%), most of which (63%) were corrected with an additional surgical procedure. The mechanical failure rate was 11.3% in P1 nails and 9% in P2 nails. Two nails failed the intraoperative distraction test, and 1 nail was found to have a broken washer during the insertion phase. Sixteen nails had mechanical failures in the lengthening phase. Some nails (8 of 16) required nail replacement surgery. Thirteen nails failed during the consolidation phase; 7 of these cases were managed by replacement with either a functional MILN or a conventional intramedullary nail. Eight failures happened during the extraction phase and were managed intraoperatively. Conclusions: A 9.5% overall rate of mechanical failure of MILNs was observed in this large series. Resolution was achieved with an additional surgery in most cases. Nail distraction and weight-bearing compliance should be closely monitored during the lengthening and consolidation phases. Nail removal can be difficult and requires a careful study of radiographs for locking-screw bone overgrowth and backup removal equipment. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.