Ibrahim Alshaygy

Lymphomas are a heterogeneous group of aggressive lymphoid malignancies characterized by frequent extranodal involvement. Musculoskeletal manifestations, although uncommon, represent a clinically significant and under-recognized presentation that often mimics primary bone tumors, soft tissue sarcomas, and infectious conditions, leading to diagnostic delays and inappropriate initial management. This narrative review synthesizes current evidence on the clinical presentation, imaging characteristics, pathology, and biological basis of musculoskeletal T-cell lymphomas, with particular emphasis on implications for orthopedic practice. A structured literature search was conducted across major databases from 2000 to the present, and evidence was integrated across clinical, radiologic, pathologic, and therapeutic domains. Musculoskeletal involvement most commonly presents with localized bone pain, soft tissue masses, or pathological fractures, with imaging features such as diffuse marrow infiltration, soft tissue extension, and relatively preserved cortical bone serving as important diagnostic clues. Definitive diagnosis relies on tissue biopsy with comprehensive immunophenotypic and molecular characterization. Emerging insights into the tumor microenvironment highlight its role in disease progression and therapeutic response, offering potential avenues for targeted treatment strategies. Management is subtype-specific and centers on systemic therapy, with selective roles for radiotherapy and orthopedic intervention in cases of structural compromise. Early recognition through integrated clinical, imaging, and pathological assessment, combined with multidisciplinary collaboration, is essential to optimize outcomes in this rare but challenging disease entity.

Sarcoma awareness among healthcare practitioners in our institution was limited, prompting an evaluation of their ability to recognize early presentations and initiate appropriate work-up for soft tissue and bone sarcomas. A structured survey assessed familiarity with key clinical features, recommended investigations, and perceived contributors to diagnostic delay. Overall awareness was modest, but higher among healthcare practitioners with prior sarcoma exposure, oncology-focused training, longer experience, or heavier patient loads; female practitioners and oncology nurses also scored higher. Confidence in identifying red-flag symptoms was strongly linked to familiarity with guideline-based practice. Despite these strengths, notable gaps persisted across specialties and training levels, indicating that exposure alone is insufficient. Targeted education, improved recognition of early warning signs, and clearer referral pathways are needed to reduce diagnostic delays and support timely management of suspected sarcomas.

Background and Clinical Significance: Malignant transformation of giant cell tumor of bone (GCTB) is a rare but clinically significant event, most commonly associated with radiotherapy, denosumab therapy, or recurrent disease. Secondary malignant transformation occurring in the absence of recognized risk factors is exceptionally uncommon. We report a rare case of high-grade sarcomatous transformation of proximal humeral GCTB after a prolonged latency period without prior radiotherapy, denosumab exposure, or documented recurrence; Case Presentation: A 27-year-old female initially presented with right shoulder pain and was diagnosed with proximal humeral GCTB. She underwent intralesional curettage and bone grafting, with histopathological confirmation of benign GCTB. Nine years later, she developed progressive shoulder pain, functional limitation, and systemic symptoms. Imaging demonstrated an aggressive lytic lesion with cortical destruction and soft-tissue extension involving the proximal humerus. Repeat curettage and histopathological evaluation revealed high-grade spindle cell sarcoma consistent with malignant transformation of GCTB. The patient received neoadjuvant chemotherapy followed by wide resection and endoprosthetic reconstruction of the proximal humerus, with additional adjuvant chemotherapy postoperatively. At two-year follow-up, she remained disease-free with excellent functional recovery and satisfactory quality of life; Conclusions: This case highlights the potential for delayed malignant transformation of GCTB even in the absence of established predisposing factors. Clinicians should maintain long-term vigilance in patients treated for GCTB, particularly when new pain, functional decline, or aggressive radiologic features develop years after initial treatment. Early recognition and multidisciplinary management are essential to optimize oncologic and functional outcomes.

Limb amputation is a major public health concern, with profound physical, psychological, and socioeconomic consequences. Although largely preventable, the prevalence of amputation continues to rise, particularly in regions with high rates of diabetes and vascular diseases. Despite this, national-level data evaluating demographic trends, clinical characteristics, and the associated costs of amputations remain limited. This study aimed to provide a comprehensive decade-long retrospective analysis to assess the epidemiological patterns and economic burden of amputations. A retrospective review was conducted of all limb amputations performed at a tertiary care center in Saudi Arabia from 2015 to 2024. Patient demographics, etiology, amputation level, surgical specialty, and admission type were extracted. Surgical costs were analyzed in terms of total expenditure and per-patient costs using hospital financial records. Statistical analyses included descriptive statistics and comparative cost assessments across the subgroups. Regression analysis was used to assess the relationship between length of hospital stay and cost. A total of 769 amputations were performed on 647 patients, resulting in a total direct cost of $32.39 million and an average cost of $50,062.30 per patient. Diabetic complications were the leading cause (67.7%), associated with a total cost of $24 million and an average per-patient cost of $54,886.60. Emergency amputations (72%) incurred significantly higher per-patient costs than elective procedures ($52,947.70 vs $42,648.78, P < .05). Lower-limb amputations were more common, and among lower-limb procedures, above-knee amputations had the highest per-patient cost ($62,038.45 per patient). This study highlights the substantial financial burden of limb amputation in Saudi Arabia, with diabetic complications being the predominant cause. The findings highlight the urgent need for enhanced preventive strategies, particularly diabetic foot care and early intervention programs, to reduce the incidence and economic burden of amputation.

Background/Objectives: Sacral giant cell tumor of bone (GCTB) is a rare, mostly benign but locally aggressive neoplasm that carries significant diagnostic and treatment challenges due to its anatomic complexity, proximity to sacral nerve roots as well as the blood vessels, and potential impact on bowel, bladder, sexual, and lumbopelvic function and stability. This narrative review aimed to synthesize current evidence on the epidemiology, clinical presentation, diagnostic evaluation, classification, management strategies, outcomes, and surveillance of sacral GCTB. Methods: A focused literature search of PubMed/MEDLINE and Google Scholar was conducted for studies published between January 2000 and January 2026, with additional manual review of reference lists. Given the rarity of the tumor and the observed heterogeneity in study designs, treatment strategies, and outcomes, the evidence was synthesized narratively. Results: Sacral GCTB mainly affects young adults with an indolent nature, often presenting late with progressive low back or buttock pain, radiculopathy, or neurological deficits. Magnetic resonance imaging is the preferred modality for determining local extent, whereas histopathologic biopsy and molecular testing remain essential for definitive diagnosis. Conventional grading systems, such as Enneking and Campanacci, have limited value in sacral disease, as anatomical extent and anticipated neurological morbidity are more relevant for treatment planning. Surgery remains the cornerstone for resectable disease, yet management plans should balance local tumor control against preservation of sacral nerve roots and mechanical stability. Denosumab, selective arterial embolization, and radiotherapy may play important roles in selected unresectable or high-morbidity cases. Local recurrence remains a major concern, and long-term surveillance is recommended because tumor relapse, treatment-related morbidity, and distant metastasis may occur late. Conclusions: Current evidence supports a multidisciplinary, individualized approach to sacral GCTB, guided by tumor extent, expected neurological morbidity, and patient-centered functional outcomes. Prospective multicenter studies are needed to refine treatment algorithms and improve risk stratification.

Background: Bone and soft tissue sarcomas, while rare, making up less than 2% of adult cancers with an incidence below 5 per 100,000 annually, present a significant challenge due to their varied and often obscure pathology. Additionally, the absence of global sarcoma awareness contributes to delayed interventions, necessitating more-aggressive treatments and increasing mortality risks. Conversely, cancers such as breast and colon have seen improved outcomes through effective screening and early-management strategies. Methods: In this cross-sectional study, out of the total number of participants approached, using a preset questionnaire, by trained medical students to participate in this study, 626 met the inclusion criteria. The questionnaire started with an informed consent process followed by a set of questions regarding sociodemographic characteristics and lifestyle. Subsequently, the questionnaire delved into their understanding and awareness of bone and soft tissue sarcomas, focusing on risk factors, recognizable signs and symptoms, and tendencies regarding health-seeking behavior. Results: In this study with 626 participants, demographic insights showed a young cohort, with 43.5% between 21 and 30 years, and a male predominance of 60.1%. Risk factor awareness was moderate; genetics and smoking were recognized as primary risks for sarcomas. Participants showed limited awareness of sarcoma signs, symptoms, and management, with a substantial percentage unsure about the most at-risk age group, gender differences in risk, and recognizability of symptoms. Barriers to seeking medical care included a passive attitude towards healthcare, fear, and accessibility issues. Most participants had limited knowledge of sarcomas, with 58% unaware of risk factors and 72.3% of signs and symptoms. Conclusions: This study emphasizes the necessity for targeted interventions to bridge the knowledge gap and promote early detection practices, which could significantly impact the prognosis of sarcoma patients.

Background and Objectives: Diabetic foot disease is a major cause of lower-limb amputation and is associated with substantial morbidity and mortality. While amputation is often considered definitive treatment, postoperative outcomes and their predictors remain incompletely characterized. Materials and Methods: This retrospective cohort study included all patients who underwent diabetic foot amputation at a tertiary care center between January 2015 and August 2025. Demographic data, comorbidities, laboratory parameters, and amputation-related variables were collected. The primary outcome was postoperative complications. Secondary outcomes included readmission, re-amputation, ICU admission, length of stay, and mortality. Logistic regression was used to identify predictors of postoperative complications. Results: A total of 437 patients were included (mean age 62.0 ± 11.8 years; 65.7% male). Postoperative complications occurred in 52.1% of patients, most commonly infections (31.6%) and acute kidney injury (18.1%). Readmission occurred in 50.6%, re-amputation in 23.4%, ICU admission in 28.7%, and mortality in 17.8%. On multivariable analysis, preoperative serum albumin was the only independent predictor of postoperative complications (aOR 0.944, 95% CI: 0.913–0.976; p < 0.001). Conclusions: Postoperative complications following diabetic foot amputation are common and associated with significant healthcare utilization and mortality. Preoperative hypoalbuminemia was the only independent predictor of postoperative complications, supporting its utility as an integrated biomarker of systemic illness (including inflammatory burden/infection and hepatic synthetic function) for perioperative risk stratification.

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

Background: Complementary and alternative medicine (CAM) treatment practices are frequently utilized by patients alongside conventional modern medicine. CAM options are commonly practiced by orthopedic trauma patients and are usually driven by cultural and sometimes religious beliefs. This study aims to evaluate the prevalence, practices and influencing factors of CAM use among orthopedic patients. Methodology: An observational cross-sectional survey study was carried out at the Orthopedic Department fracture clinics in a tertiary trauma center in Riyadh, Saudi Arabia. Participants were recruited from orthopedic fracture clinics and requested to complete a questionnaire survey. Results: Among the 356 surveyed fracture patients, 49.4% reported using CAM. Of these CAM users, 20.5% patients used CAM for the first time after being diagnosed with fracture, while 79.5% of patients had previously utilized CAM and increased their usage after fracture diagnosis. CAM practices were significantly associated with older age, joint reconstructive fracture treatment, and reported disability/dependence. Fenugreek was the most commonly consumed type by 81% of CAM users. The key motivations for CAM use were the perception of enhancing the fracture healing process and maintaining good health. Notably, 61.5% of CAM users reported experiencing improvements in their physical health, while 9.0% of the users experienced adverse effects such as weight gain and joint pain. Conclusion: Our study shed a light on the high prevalence of CAM usage among fracture patients, with Fenugreek being the most popular. Potential influencing factors for CAM practices were investigated including demographic, socioeconomic as well as fracture-related factors. Despite its high prevalence, CAM use is often not discussed with the treating physicians, therefore, increased physician awareness and enhanced patient communication about CAM practices are essential. Further investigations are required to explore CAM adverse effects as well as impact on fracture healing and general health.