Distal femoral anterior cortical perforation is a rare complication of intramedullary nailing for proximal femur fractures. Awareness and intraoperative preventive measures are key to minimizing the risk of this complication. We report a case of a patient who experienced an anterior cortical breach of the distal femur during routine antegrade nailing for an intertrochanteric fracture, which was attributed to a sclerotic lesion in the distal femur. Additionally, we describe the management of this complication, along with an analysis of risk factors and effective prevention strategies.

Patient experience and satisfaction are the keystones in evaluating the effectiveness of clinical care in musculoskeletal medicine. Although all orthopedic settings work on the same principles of providing safe and quality health care, community hospitals represent a unique environment. There may be key differences with regard to patient experience between these settings. Accessibility to care, choices of provider, personalized care, availability of and access to resources, cultural and social variances, and waiting times are a few of the many elements that may impact patient experience and satisfaction. This narrative review aims to explore the core differences in these settings and how they can reflect on patient experience and satisfaction.

We present a case of asymptomatic non-union of distal clavicle fracture in an older adult who experienced late-onset skin dehiscence and a secondarily open fracture. We adopted a simplified surgical approach involving resection of the protruding medial clavicular fragment instead of fixation of the non-union. This approach led to the rapid healing of soft tissues while maintaining an ulcer-free status and adequate shoulder function at the one-year follow-up. Skin necrosis, a frequent complication of acute distal clavicle fractures, may also occur in non-union. In a low-demand elderly patient, a conservative surgical approach involving local non-union spur resection yielded favorable outcomes.

A thorough exploration of traumatic wound is critical to accurately assess the severity of the injury. When it comes to glass-related injuries, the diagnosis of a glass foreign body is often prioritized over identifying any underlying damage. The authors report a case of peroneus longus tendon rupture caused by plate-glass accident that was misdiagnosed in the emergency department (ED) as a superficial laceration.

Introduction Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) are two well-accepted modes of surgical treatments for intertrochanteric (IT) hip fractures. While studies have extensively explored the efficacy of one over the other in unstable fractures, the comparison is sparsely available for stable fractures. The main aim of this study is to compare DHS or PFN corrective surgeries in cases of stable IT fractures operated at the Hamad General Hospital, Doha, Qatar, between 2016 and 2018. Methods We conducted a retrospective data review of all stable IT fractures operated at the Hamad General Hospital, Doha, Qatar, between 2016 and 2018. Data were extracted from electronic medical CERNER records, including demographics, clinical notes, operative reports, radiographs, and imaging reports. Data review was followed by prospective data collection via phone about the current post-operative functional status of all cases. Data analysis was done on SPSS v.23. Study was approved by Medical Research Center (MRC) and Institutional Review Board (IRB) at Hamad Medical Corporation (HMC). Study Protocol ID: MRC-01-19-108 Results Out of 62 stable IT fractures operated at our center during the study period, 42 underwent DHS correction, while 20 had PFN. The mean age of the studied cohort was 66.56 years (± 15.95). Males were twice more than females. The mean duration of surgery was 83.73 minutes for DHS and 120.25 minutes for PFN. This difference was statistically significant (p < 0.001). Differences in intraoperative blood loss, duration between fracture and surgery, and length of hospital stay were all statistically insignificant. Patients who underwent PFN showed a higher frequency of return to ambulation (assisted and unassisted), while the number of patients with DHS was less for the functional outcome. Similarly, more post-PFN radiographs displayed union than post-DHS radiographs (55% and 38%, respectively). This difference was statistically insignificant. Conclusion Our study showed promising results for stable IT fractures treated with PFN. However, more data and prospective observational studies are required to establish more statistically significant results.

Intra-articular injections are widely used for diagnostic and therapeutic purposes of joint pathologies throughout the body. These injections can be performed blind by utilizing anatomical landmarks or with the use of imaging modalities to directly visualize the joint space during injections. This review of the literature aims to comprehensively identify differences in the accuracy of intra-articular injections via palpation vs. image guidance in the most commonly injected joints in the upper and lower extremities. To our knowledge, there are no such comprehensive reviews available. A narrative literature review was performed using PubMed and Google Scholar databases to identify studies focusing on the accuracy of blind or image-guided intra-articular injections for each joint. A total of 75 articles was included in this review, with blind and image-guided strategies being discussed for the most commonly injected joints of the upper and lower extremities. Varying ranges of accuracy with blind and image-guided modalities were found throughout the literature, though an improvement in accuracy was seen in nearly all joints when using image guidance. Differences are pronounced, particularly in deep joints such as the hip or in the small joints such as those in the hand or foot. Image guidance is a useful adjunct for most intra-articular injections, if available. Though there is an increase in accuracy in nearly all joints, minor differences in accuracy seen in large, easily accessed joints, such as the knee, may not warrant image guidance.

Introduction: Calcaneus is one of the most commonly fractured tarsal bones. The use of computed tomography (CT) has enabled more accurate fracture configuration and classification of fractures. The outcomes of operative versus nonoperative treatment of these fractures have been extensively debated with variable results. Significant complications following intra-articular fractures have been reported in the literature despite management by experienced surgeons. This article will discuss the treatment of calcaneus fractures by open reduction and internal fixation in a prone position with a calcaneal traction pin, and assess the outcomes following this novel technique. Methods: Fifty-three patients with 58 acute displaced intra-articular calcaneal closed fractures (Sanders type II and III), presented to one tertiary center, were treated by open reduction and internal fixation in a distracted prone position through an extensile lateral approach by a single surgeon and assessed for postoperative wound and soft tissue complications. The primary outcome measure was postoperative wound complications. Secondary outcome measures were postoperative ankle and subtalar range of motion and return to work. Radiological assessment of anatomical reduction by measuring preoperative and postoperative Bohler's angle, Gissane angle, and posterior facet joint depression was conducted. A comparison was made with paired sample t-test with a confidence interval of 95%. Results: Fifty-three patients with 58 calcaneus fractures were treated surgically. Three cases (5.6%) developed postoperative wound infection, of which only one needed surgical intervention. The reoperation rate was 5.6% in our study. Half of the patients (50%) were able to be followed up long-term, and the radiographs showed significant restoration of Bohler's angle and posterior facet joint depression in 24 patients. Return to full duties was achieved in an average of 5.6 months for 16 of 22 patients, who were available for follow-up questions with regard to return-to-work status. Conclusion: Operative treatment of calcaneus fracture by open reduction and internal fixation in the novel distracted prone position technique has shown a low rate of the wound and soft tissue complications and can be considered as an alternative approach in treating these fractures.

Diabetic Charcot arthropathy of the ankle, due to the presence of multiplanar deformities, and associated medical comorbidities, poses a challenge for treating physicians. The situation becomes more complicated when accompanied by ulceration and osteomyelitis, leaving limited salvage options. We present a case of advanced Charcot ankle arthropathy with osteomyelitis and ulcerated hindfoot. It was managed by talectomy and antibiotic-impregnated cement beads, followed by hindfoot arthrodesis using a retrograde intramedullary nail six weeks later. This two-stage reconstruction approach resulted in an ulcer-free, stable, plantigrade foot at one-year postoperative follow-up.

Background: Study was conducted to determine whether operative treatment for intraarticular calcaneus fractures results in improvement of post-operative Bohler’s angle (BA) and if the pre and postoperative measurements of BA can be used as prognostic factor for clinical outcome. Methods: This retrospective study was conducted at orthopedic department in Hamad General Hospital, Doha, Qatar. The fractures were classified according to BA (Class A: > 16°; Class B: 0 - 15°; Class C: < 0°). The pre and immediate postoperative radiographs were assessed. Minimum follow up period for assessing clinical outcome was restricted to one year. Patients were telephonically followed up and assessed using the Foot Function Index and American Orthopedic Foot and Ankle Society Ankle Hind Foot Score by two independent observers. Result and Discussion: 131 intra-articular calcaneus fractures were operated from 117 patients during the study period. Of these, 100 fractures from 96 patients were followed up. Kappa value for inter-observer reliability was 0.6258 (preoperative) and 0.6478 (postoperative). The Cohen kappa coefficient for intra- observer reproducibility was 0.6141 (preoperative) versus 0.6672 (postoperative) measurement of BA. Quantitative analysis was done using the paired t-test. The mean improvement in BA was found to be 13.14 for class A, 20.24 for class B, and 44.75 in class C. The mean AOFAS score for class A, B and C was found to be 46.38, 40.98, and 26.23 respectively. Likewise, the mean FFI was 25.66, 31.42, and 57.63 for class A, B and C respectively. Conclusion: There was statistically significant improvement in BA among all classes. We conclude that surgical fixation is indicated if the preliminary angle is 0-25° and it results in good radiologic and functional outcome and grading system of BA can be predictably used as a prognostic indicator.

A multiple-ligament knee injury (MLKI) is a devastating injury most commonly due to an acute knee dislocation [1-3]. This high energy injury leads to disruption of the major stabilizing ligaments. Sequela of these injuries included compromised knee stability and pain [4].

Although olecranon fractures are not uncommon in the geriatric population, there has been a considerable difference of opinion between surgical and nonsurgical treatments. Surgical treatment is usually deferred in the elderly, even for displaced olecranon fractures, because of inherent risks associated with poor bone quality and soft tissues, which often necessitate further surgeries. However, nonoperative treatment frequently results in an inability to regain full extension strength of the elbow, which can be disabling in select older adults with higher functional demands. We present an active older adult with a displaced olecranon fracture, who achieved a satisfactory result after open reduction and internal fixation (ORIF) using a low-profile locking plate.

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Great toe fusion is the standard of care for severe hallux rigidus and other great toe pathology requiring definitive surgical management. Great toe fusion has proven an effective surgical treatment when correctly performed on appropriate patients. This study aimed to prospectively assess the clinical results of great toe fusion surgery in isolation compared to great toe fusion surgery combined with concomitant procedures. Methods: All patients undergoing a 1st metatarsophalangeal joint fusion from January 1st 2017 through June 30th 2018 were prospectively studied. Patients completed the Foot and Ankle Outcome Score (FAOS) and Veterans RAND 12 (VR-12) patient- reported outcome measures (PROMs) on the day of surgery (T0) and 12 months post-surgery (T1). Surgeons were surveyed regarding surgical details and patient characteristics. 204 patients underwent a great toe fusion during the study period. There were 67 enrollment failures (2 patient refusals, 63 incomplete T0 patient surveys, 2 incomplete surgeon surveys). Of the 137 patients completing the initial PROMs at T0, 100 patients (73%) also completed the PROMs at T1. Within this study group, 54 patients underwent an isolated great toe fusion and 46 underwent one or more concomitant procedures including hammertoe correction (30); MTP joint capsulotomy (22); Weil osteotomy (19); bunionette (2); metatarsal head resection (3); and other (12). Results: The study group consisted of 80 females and 20 males with age = 63.3 +/-8.5 and BMI = 28.3 +/-6.0. Indications for surgery included: hallux rigidus (26%), hallux valgus (35%), hallux varus (7%), arthritic bunions (30%) and other (2%). Fixation constructs included: a plate and a lag screw (82%), a plate alone (15%), and lag screws alone (3%). Patients undergoing isolated great toe fusions and those undergoing concomitant procedures both improved at one year (Table 1). Multivariable analysis demonstrated that after controlling for confounding variables, patients undergoing an isolated great toe fusion when compared to those also undergoing a concomitant procedure had higher odds for improvement in: FAOS pain (odds Ratio = 0.34, p=0.011); FAOS QoL (Odds Ratio=0.38, p=0.022); and VR-12 PCS (Odds Ratio=0.58, p=0.162). Conclusion: A great toe fusion can lead to substantial improvement in pain, quality of life, and overall physical function. However, this study demonstrates that the addition of a concomitant procedure such as a claw toe correction or a Weil osteotomy leads to an inferior outcome with respect to pain and quality of life when compared to an isolated great toe fusion. [Table: see text]

Benign and malignant bone tumors around the knee can be encountered with concomitant orthopaedic disease. As such, it is important to recognize these oncologic processes that may impact or alter the routine treatment of more common orthopaedic processes. Frequently, these rare oncologic conditions are discovered only through the evaluation of acute injuries as in the setting of fractures or sports injuries. Other times, they are encountered when evaluating chronic entities, such as arthroplasty. This article aims to provide general guidelines and management strategies for benign bone tumors when they coincide with common orthopaedic conditions around the knee.

This study aimed to review the epidemiological aspects of acetabular fractures treated at Hamad Medical Corporation in Qatar. The study is the first orthopaedic trauma epidemiological study in Qatar and will provide a platform to advance high-level clinical research.

The purpose of this study was to assess the clinical, radiologic and functional outcome of treating comminuted intra-articular distal radius fractures with fragment specific fixation.

Chance type fractures, as defined by G Q Chance in 1948, is a flexion-distraction type injury of the spine. There is high suspicion of ligamentous injury on initial X-Rays and CT scan if there is anterior wedging exceeds 40 – 50%, inter-spinous distance widening of more than 20% or vertebral body translation. In case of ligamentous Injury, about half of all patients treated non-operatively will have poor outcomes. Intraoperative finding of ligamentous injury is the gold standard. Although MRI is considered a reliable diagnostic tool for detection of injury to posterior ligamentous complex but limited studies are available that evaluate the correlation statistically.

Road traffic injuries (RTI) are the leading cause of death in Qatar with one in eight deaths from all causes due to RTIs. Furthermore, motor vehicle crashes (MVC) are becoming a growing public health problem and the use of seatbelt is universally low throughout the nation. The aim of our study was to investigate and highlight potential socio-demographic risk factors that contribute to seatbelt non-compliance. A prospective cross-sectional survey of all adults admitted with orthopaedic injuries following a MVC was conducted. A physician-administered questionnaire was used to interview all patients. Univariate and multivariate logistic regression analysis was carried out to examine the association of various risk factors and seatbelt compliance. One hundred and seventy one patients were interviewed over a twelve-month period. Of the 171 patients, 103 patients (60%) (92 males, 11 females) were not wearing a seatbelt compared to 68 patients (59 males, 8 females) wearing a seatbelt. The mean age of the non-compliant patients was 32.8 years compared to 33.8 years of the compliant patients. Seatbelt compliance was associated with gender (OR: 11.3), nationality (ORs: 7.6 and 1.9), position in the car (OR: 14.2), education of the patient (ORs: 25.9 and 30.5), time of the injury (OR: 3.3), marital status (OR: 6.5), awareness of seatbelt campaign (OR: 5.9) and owner of a vehicle (OR: 11.2). The majority of non-compliant patients were single males from a Middle Eastern background that we involved in a MVC during the weekend. The majority of patients admitted with orthopaedic injuries following MVCs were not wearing seatbelts. The majority of non-compliant patients were driving 4WD vehicles and had crashes on main roads. A further national seatbelt campaign is required to promote the importance of seatbelt compliance amongst young male drivers with more stringent traffic penalties.