Melorheostosis is a rare skeletal dysplasia of uncertain etiology that predominantly affects the long bones; involvement of the hand and wrist is uncommon, with an incidence of 0.9–1/million. Although the condition classically demonstrates a “dripping candle wax” appearance on radiographs, atypical presentations may mimic other sclerotic bone disorders, creating diagnostic challenges. We report the case of a 35-year-old female who presented with pain and deformity in the right hand for 2 years. Clinical examination revealed tenderness over the thumb and index finger, with a restricted range of motion (ROM) and decreased grip strength. Radiographs demonstrated eccentric cortical thickening with a characteristic dripping-candle-wax appearance. Computed tomography and magnetic resonance imaging of the hand and wrist supported the diagnosis of melorheostosis. Bone scintigraphy showed increased tracer uptake around the thumb and index finger. Bone biopsy from the index finger revealed non-specific histopathological findings, including dead bone with adjacent fibrous tissue and fragments of mature lamellar bone. The patient was treated conservatively with intravenous zoledronic acid (4 mg diluted in 100 mL of normal saline) administered once monthly for 3 consecutive months, along with nonsteroidal anti-inflammatory drugs and physiotherapy, and showed relief of pain and no improvement in ROM at 20-month follow-up. This case highlights the diagnostic importance of multimodality imaging and emphasizes the role of a multidisciplinary approach in distinguishing melorheostosis from other sclerotic bone disorders.
To synthesize the available evidence on surgical strategies for foot drop secondary to common peroneal nerve (CPN) injury and evaluate functional outcomes across different reconstructive techniques. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. MEDLINE, Embase, and LILACS were searched from inception through April 11, 2026, without language restrictions. Observational studies and relevant case series evaluating surgical interventions for foot drop were included. Risk of bias was assessed using the risk of bias in non-randomized studies of interventions and the Joanna Briggs Institute checklist. A random-effects meta-analysis of proportions was performed for tendon-transfer studies. Nineteen studies met the eligibility criteria. Surgical interventions included neurolysis and nerve repair procedures, nerve transfer techniques, tendon transfer procedures, and combined surgical strategies. Tendon-transfer studies generally reported favorable functional outcomes, with approximately 70– 90% of patients achieving functional recovery. Neurolysis, nerve repair, and nerve transfer procedures showed more variable results across studies. Meta-analysis of seven tendon-transfer studies ( n = 139) demonstrated a pooled functional dorsiflexion rate of 76.4% (95% confidence interval, 67.2–83.7) with low statistical heterogeneity (I 2 = 11.6%). The certainty of evidence ranged from low to very low across intervention categories. Surgical management of foot drop secondary to CPN injury appears to be associated with meaningful functional improvement. Tendon-transfer procedures were associated with favorable and relatively consistent outcomes in the available literature; however, the predominance of observational studies and methodological limitations preclude definitive comparative conclusions regarding the superiority of any surgical strategy. Further well- designed prospective studies with standardized outcome measures are needed to strengthen the evidence base.
Objectives: Managing incomplete anterior cruciate ligament (ACL) injuries is difficult due to the ongoing debate on whether conservative management or surgical reconstruction is the best option. Augmentation surgery is an emerging technique that may help preserve the ligament’s proprioception and biological healing. This study aimed to examine the clinical and functional outcomes of ACL augmentation surgery in patients with symptomatic partial ligament injuries over 1 year. Methods: Between 2023 and 2024, a prospective analysis was conducted on 37 patients who underwent arthroscopically confirmed ACL augmentation for partial tears. The primary outcome measure was the International Knee Documentation Committee (IKDC) score. Secondary outcomes included Lysholm scores and IKDC clinical stability tests. Clinical and functional evaluations were performed preoperatively and at several standardized postoperative intervals. Notably, 9 patients (24.3%) required concomitant surgery for additional intra-articular pathologies identified during the procedure. Results: One-year post-operative follow-up, 91.9% of the patients satisfied the IKDC criteria for success and 94.6% of the patients achieved the Lysholm criteria. Mean IKDC score was 83.1 preoperatively, 73.8 at 6 months postoperatively, and 80.5 at 1 year postoperatively ( p = 0.078). Lysholm scores were 96.7% preoperatively, 89.2% at 6 months postoperatively, and 96.4% 1 year postoperatively ( p = 0.856). A significantly higher score was achieved at the 1-year follow-up than at the 6-month follow-up, indicating high satisfaction. Almost two-thirds of patients achieved excellent functional recovery, with 48.6% of patients achieving the maximum IKDC score. Conclusion: With ACL augmentation for partial tears, at 1-year follow-up, the selected patients experienced favorable functional improvements. The technique not only restored knee stability but also preserved patients’ knee function. Longer follow-up studies are needed to determine whether these results are sustainable.
Objectives: This study evaluated whether bovine hydroxyapatite (BHA) combined with propolis, with or without glutaraldehyde (GTA) crosslinking, enhances bone healing in a rat femoral small-sized defect model. Methods: Forty-eight male Wistar rats were allocated into four groups: small-sized defect only, BHA, BHA plus propolis, and BHA plus propolis with GTA. Four specimens from each group were collected on days 3, 14, and 35 after intervention. Bone healing was assessed macroscopically and histologically using osteoblast and osteoclast categories and callus formation based on Allen’s histological score. Outcome assessment was performed using blinded observers, and group comparisons were analyzed separately at each time point. Results: Scaffold-treated groups showed earlier macroscopic defect filling and greater callus formation than the defect-only group. Osteoblast activity differed significantly among groups on day 14, with the BHA-propolis group showing higher osteoblast activity than BHA alone. On day 35, propolis-containing groups showed lower osteoclast activity and histological features consistent with later-phase healing. Callus formation differed significantly among groups on days 3 and 14 but was present in all groups by day 35. No clear statistically significant difference was observed between BHA plus propolis and BHA plus propolis with GTA. Conclusion: BHA combined with propolis supported early bone-healing activity in a rat femoral small-sized defect model. GTA crosslinking did not provide a measurable additional histological advantage. These findings should not be interpreted as evidence of critical-size defect or non-union repair.
Objectives: Anterior cruciate ligament reconstruction (ACLR) restores knee stability, but its long-term effect on preventing post-traumatic osteoarthritis (OA) remains unclear. This study evaluated the midterm risk of radiographic knee OA after ACLR by comparing the operated knee with its preoperative status and the contralateral knee, in association with meniscal status, age, and surgical delay. Methods: Retrospective cross-sectional study of 108 patients (mean age 30.7 years; mean follow-up 7.1 years) who underwent hamstring ACLR. The operated knee was compared with its preoperative status and the contralateral knee using the Kellgren–Lawrence (KL) grading system. Clinical assessment included Lysholm score, kinesiophobia scale, and objective laxity testing; independent predictors were identified using multivariable ordinal logistic regression. Results: Moderate-to-severe OA (KL grades 3–4) was present in 25.9% of operated knees at midterm follow-up, vs. none preoperatively and 3.7% of contralateral knees (interobserver κ = 0.986). Partial meniscectomy showed the highest severity, with 75% developing KL grades 3–4. Age, follow-up duration, knee laxity, and meniscectomy were independent predictors of OA grade on multivariable analysis; surgical delay was associated with OA severity univariately but not after adjustment. OA grade correlated negatively with Lysholm score (r = –0.594, p < 0.001) and positively with kinesiophobia (r = 0.421, p = 0.002) and laxity (r = 0.354, p = 0.009). Conclusion: ACLR does not fully prevent post-traumatic OA: About one-quarter of patients developed moderate-to-severe radiographic changes at midterm follow-up despite an OA-free preoperative baseline. Advanced age, follow-up duration, knee laxity, and meniscectomy are independent risk factors; surgical delay shows a univariate association.
Rare genetic diseases present with a broad spectrum of clinical manifestations, frequently affecting multiple organ systems or causing isolated, severe physical impairments. These disorders represent a profound public health and socioeconomic burden due to prolonged diagnostic delays, suboptimal clinical management, and the lack of targeted therapeutic options. While early detection remains paramount to establishing effective clinical care, rehabilitation protocols, and orthopedic interventions, the molecular etiologies of numerous musculoskeletal, neurodevelopmental, and immunological rare conditions remain completely unknown. Key drivers of this diagnostic gap include fragmented healthcare access, high costs of advanced genomic technologies, and a lack of integrated research pipelines capable of translating variants of uncertain significance into confirmed disease-causing genes. Identifying and functionally validating these genetic factors is essential for expanding the known Mendeliome, discovering novel diagnostic biomarkers, and revealing targetable pathways for future therapeutics. In this review, using an implementation model, we evaluate the global and regional burdens of undiagnosed rare genetic diseases and outline a strategic, multi-omics functional workflow tailored to address complex, hidden variants in the highly consanguineous population of Saudi Arabia.
Objectives: Repair of critical-sized bone defects requires porous scaffolds that balance mechanical support with vascular and tissue ingrowth, yet current designs rely largely on empirical parameter tuning. This work asks whether porosity can serve as a practical first-order structural indicator for interpreting early-stage scaffolds in orthopedic settings. Methods: In a concept-oriented narrative synthesis, six representative datasets from three material systems (calcium silicate, borate glass, and polylactic acid) were selected against predefined criteria. Compressive strength was normalized within each system and interpreted descriptively without curve fitting or predictive modeling. Results: Across the representative datasets, increasing porosity was consistently associated with a reduction in normalized compressive strength, despite differences in material composition. The shared direction of this trend across material systems is the principal observation. Because only two porosity levels were available per material system, the relationship is presented as descriptive rather than predictive. Conclusion: Porosity may act as a useful first-order indicator linking transport accessibility with mechanical performance. Given the limited illustrative data, the proposed framework remains conceptual and requires experimental, computational, or clinical validation before any clinical application.
Objectives: Achilles tendinopathy is a common overuse trauma in active populations; there are limited epidemiological studies that are based on informal and community-based sporting groups. The objective of the study was to determine the prevalence of Achilles tendinopathy among amateur street players and to assess its relationship with demographic and anthropometric factors. Methods: A cross-sectional observational study involving 298 amateur street players (18–35 years) was conducted. Convenience sampling was applied to recruit participants. The evaluation of Achilles tendinopathy was done through a patient-reported outcome measure. The anthropometric data and demographic characteristics were measured in accordance with standard procedures. Prevalence was estimated using descriptive statistics, and Chi-square tests were used to test the associations between Achilles tendinopathy and categorical factors. Results: Approximately one-quarter of the study population (26.5%) had Achilles tendinopathy. A higher percentage of Achilles tendinopathy was reported in males and among those who were classified as overweight and obese. Its unilateral involvement was more typical, and the right ankle was the most frequently affected. There were significant relationships between Achilles tendinopathy and body mass index (BMI), as well as the side of the ankle involvement ( p < 0.001). Conclusion: Achilles tendinopathy is a significant musculoskeletal issue among amateur players on the street and is associated with higher BMI and unilateral involvement. These results indicate the need for targeted preventive measures and early screening programs among informal athletes.
Atypical ulnar fractures are rare and typically associated with prolonged antiresorptive therapy. We report an 84-year-old female with severe osteoporosis who presented with a transverse proximal ulnar fracture after minor trauma. The patient had no history of long-term antiresorptive therapy and had received only a single denosumab injection 3 years prior. The patient habitually bore weight through the forearms during ambulation. Imaging demonstrated a transverse fracture with cortical thickening and sclerotic margins, consistent with an atypical pattern. Histopathological examination revealed dead bone fragments with the absence of osteocytes, indicating locally suppressed bone turnover. The patient underwent curettage, rigid plate fixation, and allogeneic cancellous bone grafting, with radiographic union achieved at 7 weeks. This case demonstrates that chronic mechanical loading on osteoporotic bone can contribute to the development of atypical ulnar fracture, even in the absence of prolonged antiresorptive therapy.
Objectives: The hand is commonly utilized in various daily activities. Hand deformities can cause stiffness and reduced range of motion. Treatment options such as small-joint arthroplasty require precise implant placement and adjustment of implant size based on finger anatomical dimensions. This study aims to determine the dimensional characteristics of finger anatomy among Indonesian individuals, which are crucial for hand reconstruction, implantation, and prosthetic device implementation. Methods: This descriptive observational study used secondary data from hand examinations conducted at Dr. Saiful Anwar General Hospital from June 2023 to July 2023. The sample consisted of 384 patients. Morphological measurements were performed using the radiology information system application. Data were processed using Microsoft Excel and the Statistical Package for the Social Sciences. Results: The length of the proximal phalanx ranged from 29.79 to 43.63 mm, with an average of 37.08 mm. The middle phalanx had a length range of 17.05–25.80 mm, with a mean value of 22.17 mm, and the distal phalanx had a length range of 14.88–20.85 mm, with an average of 16.78 mm. The proximal, middle, and distal phalanges in this study were shorter than those reported in previous studies. Ethnicity, measurement techniques, age ranges, and hand positions during radiological examination may be contributing factors. Previously proposed fibonacci-based proportional assumptions did not adequately represent this dataset and are therefore interpreted as secondary exploratory observations rather than validated predictive relationships. Conclusion: The study found smaller finger anatomical morphology than in prior research, with no alignment or finger-proportion conformity. Morphological proportions can be determined using an approximation formula.
Objectives: In the surgical treatment of lumbar spondylolisthesis (LS) with posterior lumbar interbody fusion (PLIF), interbody fusion cages play a vital role in supporting the vertebral body, restoring disc height, facilitating fusion, and correcting sagittal alignment. The objective of this study was to detect the effect of cage implantation on sagittal parameters and functional outcomes in patients undergoing PLIF surgery for LS. Methods: This retrospective cohort study included 120 patients who had undergone open PLIF surgery. Radiological outcome was evaluated using plain radiographs postoperatively and at 6 weeks, 3 months, 6 months, and 2 years. Functional outcome was assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) pre- and postoperatively. Results: This study included 120 patients (mean age 49.9 ± 7.0 years; 60.8% female; all single-level procedures: L4–L5 in 45.8%, L3–L4 in 27.5%, L5–S1 in 21.7%, and L2–L3 in 5.0%). Degenerative LS accounted for 63.3% of cases and isthmic LS for 36.7%. Mean operative time was 100.1 ± 18.0 min and mean blood loss was 493.5 ± 72.0 mL. The overall complication rate was 6.7% (8/120), with a reoperation rate of 1.7% (2/120). Satisfactory fusion (Bridwell grades I–II) was achieved in 86.7% of cases. The mean pre-operative ODI was 69.9 ± 6.2% and decreased significantly to 22.7 ± 4.5% at 2 years ( p < 0.001; minimal clinically important difference met in 100%). The mean pre-operative VAS was 7.9 ± 0.6 and decreased significantly to 3.9 ± 0.5 ( p < 0.001). Lumbar lordosis (LL) improved from 37.7 ± 5.0° to 54.2 ± 4.2° and pelvic incidence–LL mismatch decreased from 21.1 ± 5.3° to 4.8 ± 2.6° (both p < 0.001). The mean pre-operative sacral slope was 24.73, which increased significantly to 35.9 postoperatively. The mean pre-operative pelvic tilt was 34.73, which significantly decreased postoperatively to 22.77. The mean pre-operative pelvic incidence was 59.1, which did not significantly decrease to 59.07 postoperatively. The mean pre-operative LL was 37.7°, which increased significantly postoperatively to 54.17. Conclusion: The use of a cage in PLIF significantly enhances mechanical stability, fusion success, and functional recovery in adult LS.
Objectives: High tibial osteotomy (HTO) is a well-established surgical technique primarily employed to correct knee varus deformity and treat medial compartment osteoarthritis in the knee. However, traditional plate designs used for HTO often encounter challenges, particularly when HTO is combined with anterior cruciate ligament reconstruction, where the traditional plate usually has limited bone space for graft fixation. Methods: This study evaluates the mechanical behavior of a novel HTO 7-plate implant through comprehensive finite element analysis. The investigation was conducted under two primary physiological loading conditions: Axial (tensile) and compression. The simulation meticulously analyzed key mechanical parameters, including displacement, strain, and von Mises stress, under varying applied forces of 250 N, 500 N, and 750 N. Results: The consistent results demonstrated that all calculated stress values remained significantly below the approximately 300 MPa yield strength of SS316L stainless steel. Conclusion: This study’s findings indicate that the novel implant design is mechanically safe and robust under the simulated physiological loading scenarios, suggesting its potential for reliable clinical application.
Bilateral brachial plexus injury (BBPI) is an exceptionally rare but profoundly disabling condition due to the absence of a compensatory upper limb. The available evidence is limited to isolated case reports and very small series, restricting the development of standardized diagnostic and management strategies. This scoping review was conducted to map the existing literature on BBPI, with a focus on etiologies, diagnostic approaches, management strategies, and outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, a comprehensive search of PubMed, Embase, Scopus, and Web of Science (from inception to September 2025) identified 13 publications encompassing 13 patients. Etiologies were broadly categorized into traumatic (7/13), non-traumatic (5/13), and obstetric (1/13) causes; the non-traumatic group included positional/iatrogenic, compressive, and toxic/immobilization mechanisms. Injuries were frequently asymmetric, with one limb demonstrating more severe structural damage. Management varied depending on etiology and severity; traumatic injuries more often underwent surgical reconstruction (neurolysis, nerve grafting, or nerve transfers), often with the goal of restoring elbow flexion, whereas non-traumatic injuries were generally managed conservatively with rehabilitation. Outcomes were heterogeneous: four patients achieved full-to-near-full recovery, five attained partial but functionally useful recovery, and four had poor outcomes. Overall, 9 of 13 patients regained at least one functionally useful limb; however, these descriptive proportions should be interpreted with caution, given the very small sample size. Based on limited case-level evidence, BBPI encompasses diverse mechanisms requiring individualized management strategies. Early recognition, careful differentiation from central causes, timely intervention in selected cases, and intensive multidisciplinary rehabilitation appear critical. Given the rarity and heterogeneity of BBPI, coordinated reporting and multicenter registries are necessary to refine prognostication and guide future reconstructive strategies.
Objectives: The objectives of the study are to compare the effects of muscle energy technique (MET) and positional release technique (PRT) on pain intensity, functional disability, and lumbar range of motion (ROM) in adults with mechanical low back pain (LBP). Methods: In this randomized controlled trial, 100 participants (26–40 years) with mechanical LBP were randomized to two groups: Group A – MET ( n = 50) and Group B – PRT ( n = 50). Both groups received 12 sessions over 2 weeks. Pain was assessed using the Numeric Pain Rating Scale (NPRS); disability using the Oswestry Disability Index (ODI); and lumbar ROM using the modified Schober test at baseline, post-intervention, and 15-day follow-up. Between-group comparisons were performed at each time point with statistical significance set at p < 0.05. Results: Both interventions improved all outcomes over time ( p < 0.001 within each group). At follow-up, MET showed lower NPRS (2.46 ± 0.71 vs. 3.74 ± 0.69), lower ODI (26.44 ± 6.24 vs. 31.34 ± 5.88), and greater lumbar ROM (6.74 ± 0.92 cm vs. 4.66 ± 0.85 cm) than PRT (all p < 0.001). Conclusion: MET and PRT both improved pain, disability, and lumbar mobility in mechanical LBP; however, MET produced superior between-group outcomes and may be considered better in rehabilitation protocols.
Objectives: The objectives of the study are to report the association between the severity of common extensor tendon (CET) injury and additional elbow abnormalities detected on magnetic resonance imaging (MRI) in patients with lateral epicondylitis. Methods: This is a retrospective cross-sectional study that included 144 patients with MRI-confirmed CET injury. Patients with prior elbow surgery, unavailable MRI, or age below 18 years were excluded. Tendon injuries were graded as mild, moderate, or severe. Ligament injuries (lateral ulnar collateral, radial collateral, and medial collateral), muscle injuries, bone injuries, and joint effusion were recorded as present or absent. Associations between tendon injury severity and concomitant abnormalities were analyzed. Results: Of 144 patients, 54.9% were female and 63.9% had right-sided involvement. Tendon injuries were mild in 55.6%, moderate in 36.1%, and severe in 8.3%. Concomitant findings included lateral ulnar collateral ligament injury (51.4%), radial collateral ligament injury (18.1%), medial collateral ligament injury (10.4%), muscle injury (9.7%), bone injury (10.4%), and joint effusion (28.5%). Tendon severity was significantly associated with lateral ulnar collateral ( p < 0.001), radial collateral ( p = 0.002), medial collateral ( p < 0.001) ligament injuries, and joint effusion ( p = 0.005). Conclusion: MRI demonstrated that lateral epicondylitis commonly coexists with ligament and joint abnormalities, and tendon injury severity correlates with ligament injury and joint effusion. Prospective studies are needed to evaluate long-term functional outcomes.
No definitive treatment guidelines exist for pediatric olecranon fractures. We describe a 14-year-old boy who sustained an olecranon fracture after a bicycle fall. Radiographs and computed tomography showed <2 mm of displacement and a step-off, findings indicating conservative care. However, the greater sigmoid notch (GSN) contour appeared abnormal, and magnetic resonance imaging revealed marked disruption. Surgical treatment was performed to restore the GSN arc. At 2 years, the patient had full, painless motion and symmetric olecranon morphology. Even in patients with <2 mm of displacement and minimal step-off, greater disruption of the sigmoid notch contour may occur. Thus, treatment planning should include careful evaluation of the GSN contour.
Objectives: Rotator cuff tears (RCTs) are among the most common shoulder disorders and affect function and quality of life. The size of the RCTs is classified as small, medium, large, and massive. Risk factors such as advanced age, diabetes, dyslipidemia, and hypertension have been associated with the development of RCTs. However, regional data from Saudi Arabia on the association between these factors and RCT severity remain limited. This study was conducted to address this gap by analyzing the association between RCT size and demographic characteristics. Methods: This retrospective study was conducted at a private hospital on adult patients with RCT who underwent arthroscopic repair by a single surgeon from 2019 to 2023. Dependent variables were analyzed to assess their association with RCT size. Results: A total of 555 patients who underwent arthroscopic rotator cuff repair were included. The mean age was 58 ± 10 years, and females comprised 60% of the cohort. Small tears were the most common (45%), followed by medium (34%), large (13%), and massive tears (8%). Increasing age was independently associated with larger tear sizes ( p < 0.001). Hypertension was associated with larger tear sizes on unadjusted analysis, but did not remain independently associated after adjustment in the multinomial logistic regression model. No significant associations were observed between tear size and sex, affected shoulder, diabetes, dyslipidemia, or biceps tendinitis. Conclusion: These findings highlight the clinical relevance of age as an independent factor associated with RCT severity, while hypertension may serve as a clinical marker associated with larger tear sizes, aiding in clinical risk stratification. Future multicenter studies including larger populations across Saudi Arabia are needed.
Objectives: Quadriceps neuromuscular dysfunction is a recognized sequela of anterior cruciate ligament reconstruction (ACLR) and may persist despite clinical recovery. Persistent activation deficits impair functional performance and elevate reinjury risk. This pilot study investigated quadriceps neuromuscular activation asymmetry after ACLR using a publicly available electromyographic (EMG) dataset, comparing activation symmetry between reconstructed and contralateral limbs and relative to healthy controls. Methods: In this pilot secondary observational analysis, surface EMG recordings from isokinetic knee extension were analyzed from a publicly available Dryad dataset. The dataset comprised 22 participants: 12 with prior ACLR and 10 healthy controls. Vastus lateralis EMG was recorded at 90°/s and 180°/s. Peak EMG amplitude and root-mean-square (RMS) activation were extracted per participant. Limb symmetry indices (LSIs) were calculated from involved and uninvolved limbs. Between-group comparisons used independent samples t -tests or nonparametric equivalents. Results: Individuals with ACLR demonstrated greater variability in quadriceps EMG activation patterns compared with healthy controls. LSI analysis revealed persistent neuromuscular asymmetry in reconstructed limbs, most pronounced during higher-velocity contractions. Healthy participants exhibited consistently balanced bilateral activation, whereas the ACLR group demonstrated substantially wider dispersion of symmetry values during isokinetic knee extension tasks. Conclusion: Quadriceps neuromuscular activation asymmetry persists after ACLR and is detectable using surface EMG during isokinetic testing, with velocity-dependent deficits most apparent at higher contraction speeds. These pilot findings provide effect size estimates to support the design of future adequately powered prospective studies.
