Publications by authors named "Saad M AlQahtani"

19 Publications

  • Page 1 of 1

Effectiveness of radiographs and computed tomography in evaluating primary elbow osteoarthritis.

J Shoulder Elbow Surg 2021 Apr 20. Epub 2021 Apr 20.

The Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada. Electronic address:

Background: Preoperative radiographic assessment of osteophyte and loose body locations is critical in planning an arthroscopic débridement for primary elbow osteoarthritis. The purpose of this study was to evaluate the effectiveness of radiographs and computed tomography (CT) in localizing osteophytes and loose bodies.

Methods: A consecutive series of 36 patients with primary elbow osteoarthritis was investigated with radiographs and multiaxial 2-dimensional CT prior to elbow arthroscopy. The location of osteophytes and loose bodies was assessed in 9 anatomic locations by 2 fellowship-trained upper extremity surgeons. The diagnostic effectiveness of both imaging modalities was evaluated by calculating the sensitivity and specificity and compared to the gold standard of elbow arthroscopy. Inter- and intrarater percentage agreement between the observations was calculated using Kappa score.

Results: The mean sensitivity for detecting osteophytes in the 9 different anatomic locations was 46% with radiographs and 98% with CT, whereas the mean specificity was 66% and 21% for radiographs and CT, respectively. The mean sensitivity and specificity for loose body detection with radiography were 49% and 89%, respectively, whereas CT had a mean sensitivity of 98% and specificity of 47%. The overall inter-rater percentage agreement between the surgeons in detecting osteophytes and loose bodies on radiographs was 80% and 85%, respectively, whereas on CT it was 95% for detecting osteophytes and 91% for loose bodies.

Conclusion: CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis. The lower specificity of CT may be due to this imaging modality's ability to detect small osteophytes and loose bodies that may not be readily identified during elbow arthroscopy. Radiographs have an inferior inter-rater percentage agreement compared with CT. CT is a valuable preoperative investigation to assist surgeons in identifying the location of osteophytes and loose bodies in patients undergoing surgery for primary elbow osteoarthritis.
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http://dx.doi.org/10.1016/j.jse.2021.04.001DOI Listing
April 2021

Gingival Recession after Surgical Endodontic Treatment and Quality of Life: A Systematic Review and Meta-analysis.

Oral Health Prev Dent 2021 Jan;19(1):235-243

Purpose: This systematic review addressed flap designs in endodontic surgery which can have an impact on the Oral Health Related Quality of Life (OHRQoL).

Materials And Methods: Four electronic databases were searched (PubMed, Cochrane Library, Web of Science, and Scopus) to identify all studies up to November 2019 that investigated the effect of flap designs on gingival recession and quality of life among healthy adults.

Results: The initial search identified 2701 references. Ten studies were included in this systematic review; two were randomised clinical trials and eight were non-randomised clinical trials. Studies showed that sulcular incision increases the risk of gingival recession and decreases OHRQoL. Two studies were included in the meta-analysis in relation to gingival recession. The pooled results demonstrated that submarginal incision showed a decreased weighted mean difference in gingival recession by 0.31 mm (95% CI: 0.12 - 0.51) (p = 0.002) compared to sulcular incision.

Conclusion: Sulcular incision flap unfavourably affect the level of gingiva and OHRQoL. All nonrandomised studies had a statistically significant bias and the sample sizes in all studies were relatively small. More gingival recession and lower OHRQoL were associated with sulcular incision. Additional investigations are warranted to provide more evidence.
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http://dx.doi.org/10.3290/j.ohpd.b1176847DOI Listing
January 2021

Thyroid hemiagenesis with primary hyperparathyroidism or papillary thyroid carcinoma: A report of two cases and literature review.

Clin Case Rep 2021 Mar 27;9(3):1615-1620. Epub 2021 Jan 27.

Department of Surgery King Salman Armed Forces Hospital in the North-Western Region Tabuk Saudi Arabia.

The combination of TH and PHPT or PTC is extremely rare. A better comprehension of the normal anatomy of the thyroid gland and its variations, congenital anomalies, and related pathologies is essential for safe surgical intervention.
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http://dx.doi.org/10.1002/ccr3.3856DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981713PMC
March 2021

A subareolar breast abscess in a man: A case report and literature review.

Authors:
Saad M Alqahtani

J Taibah Univ Med Sci 2020 Dec 28;15(6):557-560. Epub 2020 Jul 28.

Department of Surgery, College of Medicine, Majmaah University, Majmaah, KSA.

Subareolar breast abscesses (SBAs) in men are extremely rare. To date, only 15 men with SBA have been reported in the English literature. We present a case of SBA in a 28-year-old man who visited our surgical clinic with a painful swelling in his right breast for 10 days. Physical examination showed a tender, hot mass in the right subareolar area with erythema. Ultrasound of the right breast showed radiological features of a breast abscess. Fine-needle aspiration yielded brownish yellow pus. Based on these findings, a diagnosis of right SBA was established. This is the first documented case of SBA in men from the KSA. Additionally, this case report sheds light on the current clinical and therapeutic approaches to managing cases of SBA in men.
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http://dx.doi.org/10.1016/j.jtumed.2020.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7715457PMC
December 2020

Post-Thyroidectomy Complications and Risk Factors in Tabuk, Saudi Arabia: A Retrospective Cohort Study.

Cureus 2020 Oct 8;12(10):e10852. Epub 2020 Oct 8.

Department of Surgery, King Salman Armed Forces Hospital in North-Western Region, Tabuk, SAU.

Background Thyroid surgery is one of the most commonly performed procedures internationally. There were no studies conducted in Tabuk, Saudi Arabia, on post-thyroidectomy complications and their risk factors. Objective The aim of this study was to assess post-thyroidectomy complications and determine the risk factors of such complications. Methods This retrospective study included all cases that underwent thyroidectomy at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia, from January 2012 to December 2017. Patients with preoperative hypoparathyroidism, chronic kidney disease, or history of dysphonia were excluded. Data were collected from medical records. Results The study showed 182 patients who underwent thyroidectomy operation between January 2012 and December 2017. Temporary hypocalcemia was developed in 116 patients (63.7%) while it persisted in three (1.6%). Change of voice was reported in five patients (2.7%) while two (1.1%) lost a high-pitched voice. Seroma, hematoma, and tracheal injury were documented in 1.6%, 1.1%, and 0.5%, respectively. Multivariate analysis showed that total thyroidectomy was the most significant (four times) risk factor for the development of hypocalcemia as compared to other surgical procedures. Conclusion Hypocalcemia was the most frequent post-thyroidectomy complication, whereas voice changes, seroma, hematoma, and tracheal injury are rare complications. Additionally, total thyroidectomy has the highest risk of postoperative hypocalcemia.
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http://dx.doi.org/10.7759/cureus.10852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652027PMC
October 2020

Salivary Osteocalcin as Potential Diagnostic Marker of Periodontal Bone Destruction among Smokers.

Biomolecules 2020 03 1;10(3). Epub 2020 Mar 1.

Department of Clinical Biochemistry, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia.

The objective of the study was to assess the levels and diagnostic accuracy of salivary osteocalcin (OC), osteonectin (ON), and deoxypyridinoline-containing degradation fragment of the C-terminal telopeptide region of type I collagen (CTX) in adult smokers with periodontal bone destruction. Towards this, ninety systemically healthy patients (groups I: healthy, II: periodontitis with non-smokers, and III: periodontitis with current smokers) were included in the study. The results showed a positive correlation (weak to moderate) was observed for OC, ON, and CTX with probing pocket depth (PPD; r = 0.40, 0.32, and 0.36) and alveolar bone loss (BL; r = 0.58, 0.38, and 0.51) ( < 0.01). Smoker periodontitis was best discriminated from healthy controls using 15.25 ng/mL of OC (AUC: 0.870; 95% CI: 0.757-0.943; YI (Youden Index): 0.693; < 0.0001). However, with a cut-off of BL at 33.33%, 19.24 ng/mL of salivary OC gave the best discrimination (AUC: 0.809; 95% CI: 0.686-0.900; Se: 80.0%; Sp: 73.47%, and YI: 0.534). A 16.45 ng/mL amount of OC gave excellent discrimination (AUC: 0.811; 95% CI: 0.688-0.901; Se: 92.31%; Sp: 65.22%, and YI: 0.575) among healthy and smoker periodontitis when PD at 6mm was considered as cut-off. Conclusion: The best discrimination between healthy controls and smoker periodontitis was obtained at 15.25 ng/mL of salivary OC.
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http://dx.doi.org/10.3390/biom10030380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175335PMC
March 2020

Subhepatic Appendicitis in an 11-year-old Boy: A Case Report.

Cureus 2019 Dec 28;11(12):e6489. Epub 2019 Dec 28.

Department of Surgery, King Khalid General Hospital, Majmaah, SAU.

Appendicitis is a common surgical emergency. When present in an abnormal subhepatic location, it can pose a challenge in its diagnosis and management. Subhepatic appendicitis is a rare phenomenon, especially in the pediatric age group. Herein, we present a rare case of subhepatic appendicitis in an 11-year-old boy with delayed presentation but managed successfully.
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http://dx.doi.org/10.7759/cureus.6489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984176PMC
December 2019

Strategies of enhancing bone regenerate formation in distraction osteogenesis.

Connect Tissue Res 2018 01 8;59(1):1-11. Epub 2017 Mar 8.

a Division of Orthopaedic Surgery , Shriners Hospital for Children, Montreal Children's Hospital, McGill University , Montreal , Canada.

Distraction osteogenesis (DO) is a commonly used technique in multiple orthopedic sub-specialties, including trauma, oncology and pediatrics. This technique aims to produce new bone formation in the distraction gap in a controlled manner. The issue with this technique has been the high risk of complications, one of which is poor regenerate formation during the distraction process. Although several factors (including patient and operative factors) and techniques (including surgical, mechanical and pharmacological) have been described to ensure successful regenerate formation during the process of DO, these factors are sometimes difficult to control clinically. Our aim from this review is to highlight the different factors that affect DO, modalities to assess the regenerate and review treatment options for poor regenerate in the distraction gap. In addition, we propose a management protocol derived from the available literature that can be used to facilitate the management of inadequate regenerate formation.
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http://dx.doi.org/10.1080/03008207.2017.1288725DOI Listing
January 2018

Outcomes following long head of biceps tendon tenodesis.

Curr Rev Musculoskelet Med 2016 Dec;9(4):378-387

Division of Orthopedic Surgery, Department of Surgery, Queen's University, Kingston General Hospital, Watkins 3, 76 Stuart Street, Kingston, Ontario, Canada, K7L 2V7.

Lesions of the proximal long head of the biceps tendon (LHB) have been considered as a major cause of shoulder pain and dysfunction. The role of the LHB in causing pain has been a source of controversy for many years, and extensive literature is available discussing anatomy, function, pathology, and most importantly appropriate treatment. Despite this, there is a lack of consensus in the literature regarding the management of biceps-related pathology. Biceps tenotomy and tenodesis are common surgical treatment options when dealing with LHB-related pathology. In this review, a brief discussion on surgical options is provided while focusing on the different options for biceps tenodesis including outcomes and complications.
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http://dx.doi.org/10.1007/s12178-016-9362-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127942PMC
December 2016

Musculoskeletal disorders among orthopedic pediatric surgeons: an overlooked entity.

J Child Orthop 2016 Oct 18;10(5):461-466. Epub 2016 Aug 18.

Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 2000 Drummond, Apt.1203, Montreal, QC H3G 2X1 Canada.

Introduction: Forceful and repetitive maneuvers constitute the majority of pediatric orthopedic surgical tasks, thus subjecting surgeons to the risk of musculoskeletal (MSK) injuries during their years in practice. The aim of this study was to assess the prevalence, characteristics and impact of MSK disorders among pediatric orthopedic surgeons.

Methods: A modified version of the physical discomfort survey was sent to surgeons who were members of the Pediatric Orthopedic Society of North America (POSNA) via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher's exact test. p values of <0.05 were considered statistically significant.

Results: Of the 402 respondents, 67 % reported that they had sustained a work-related MSK injury, of which the most common diagnoses were low back pain (28.6 %) and lateral elbow epicondylitis (15.4 %). Among those which reported an injury, 26 % required surgical treatment and 31 % needed time off work as a direct result of their injury. The number of work-related injuries incurred by a surgeon increased significantly with increasing age (p < 0.001), working in a non-academic institute (p < 0.05), working in more than one institute (p < 0.05), and being in active practice for >21 years (p < 0.05). The need to undergo treatment or take time off due to the injury was associated with increased number of injuries (p < 0.001). In addition, surgeons were more likely to require time off work when they were >56 years of age (p < 0.001), had been in practice for >21 years (p < 0.001), required surgical management of their disorder (p < 0.001), and had experienced an exacerbation of a previous disorder (p < 0.001).

Discussion And Conclusion: This study is the first of its kind to assess MSK injuries sustained by pediatric orthopedic surgeons. The high incidence of these disorders may place a financial and psychological burden on these surgeons and thus the healthcare system. These results should shed a light on awareness and the need for further studies to prevent and help decrease the incidence of these disorders not only in orthopedic surgeons but also in the surgical population in general.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5033786PMC
http://dx.doi.org/10.1007/s11832-016-0767-zDOI Listing
October 2016

Do not resuscitate: An expanding role for critical care response team.

Indian J Crit Care Med 2016 Mar;20(3):146-9

Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Background: Do not resuscitate (DNR) order is an important aspect of medical practice. Since the implementation of critical care response team (CCRT), frequently we have encountered with patients in the wards that should have been made DNR. Initiating DNR became an important part of CCRT activity. We were obliged to extended the role of CCRT - beyond managing seriously ill patients - in addressing the code status for patients after discussion with the managing teams.

Purpose: We compare the trend of initiation of DNR orders in the regular ward before and after implementing CCRT.

Methods: Our hospital is 1200 bed tertiary care center. CCRT has been launched in January 1, 2008. The CCRT is 24/7 service led by in-house North American certified intensivists. Cohort analysis of prospectively collected data of 5406 CCRT activation from January 1, 2008, to September 30, 2013. Data before implementation of CCRT was available for 299 patients from the period of June 1, 2007, to December 31, 2007. A comparison made between the two groups (before and after implementation of CCRT) for demographic data and percentage of patients in whom DNR order initiated.

Results: Before CCRT implementation, 299 patients were attended by Intensive Care Unit physician for regular consultation, 41.1% were females and 52.4% were males with mean of age 58.44 ± 18.47 standard deviation (SD). DNR was initiated in 2.7% of patients. After CCRT implementation, 5904 CCRT activations, 47.6% females and 52.4% males with mean of age 59.17 ± 20.07 SD DNR initiated in 468 (7.9%) of cases. There was 5.2% increase in DNR orders initiation and completion after CCRT introduced to our institute.
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http://dx.doi.org/10.4103/0972-5229.178177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810891PMC
March 2016

Prevalence of musculoskeletal disorders among orthopedic trauma surgeons: an OTA survey.

Can J Surg 2016 Feb;59(1):42-7

From the Department of Surgery, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Que. (AlQahtani, Alzahrani, Harvey); and the Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia (AlQahtani, Alzahrani).

Background: Occupational injuries and hazards have gained increased attention in the surgical community in general and in the orthopedic literature specifically. The aim of this study was to assess prevalence and characteristics of musculoskeletal disorders among orthopedic trauma surgeons and the impact of these injuries on the surgeons' practices.

Methods: We sent a modified version of the physical discomfort survey to surgeon members of the Orthopaedic Trauma Association (OTA) via email. Data were collected and descriptive statistics were analyzed.

Results: A total of 86 surgeons completed the survey during the period of data collection; 84.9% were men, more than half were 45 years or older and 40.6% were in practice for 10 years or more. More than 66% of respondents reported a musculoskeletal disorder that was related to work; the most common was low back pain (29.3%). The number of body regions involved and disorders diagnosed was associated with increasing age and number of years in practice (p = 0.033). Time off work owing to these disorders was associated with working in a private setting (p = 0.045) and working in more than 1 institute (p = 0.009).

Conclusion: To our knowledge, our study is the first to report a high percentage of orthopedic trauma surgeons sustaining occupational injuries some time in their careers. The high cost of management and rehabilitation of these injuries in addition to the related number of missed work days indicate the need for increased awareness and implementation of preventive measures.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734918PMC
http://dx.doi.org/10.1503/cjs.014415DOI Listing
February 2016

Adult Reconstructive Surgery: A High-Risk Profession for Work-Related Injuries.

J Arthroplasty 2016 06 21;31(6):1194-1198. Epub 2015 Dec 21.

Division of Orthopaedic Surgery, McGill University, Montreal, Canada.

Background: Adult reconstructive surgery is an orthopedic subspecialty characterized by surgical tasks that are physical, repetitive, and require some degree of stamina from the surgeon. This can result strain and/or injury of the surgeon's musculoskeletal system. This study investigates the prevalence of work-related injuries among arthroplasty surgeons.

Methods: A modified version of the physical discomfort survey was sent to surgeon members of the Hip Society, the International Hip Society, and the Canadian Orthopedic Arthroplasty via email. One hundred and eighty-three surgeons completed the survey.

Results: Overall, 66.1% of the arthroplasty surgeons reported that they had experienced a work-related injury. The most common injuries that occurred were low back pain (28%), lateral epicondylitis of the elbow (14%), shoulder tendonitis (14%), lumbar disc herniation (13%), and wrist arthritis (12%). Overall, 27% of surgeons took time off from work because of the injury. As the number of disorders diagnosed increased, there was a significant increase in the incidence of requiring time off work because of the disorder (P < .001) and also exacerbation of a previously diagnosed disorder (P < .01). Factors that significantly increased the risk of the surgeon requiring time off because of the disorder were age >55 years, practicing for more than >20 years, and performing >100 total hip arthroplasty procedures per year (P < .05). In addition, 31% of the orthopedic surgeons surveyed required surgery for their injury.

Conclusion: Although most studies concentrate on the importance of patient safety and thus the quality of the health care system, the surgeon's safety is also considered an integral part of this system's quality. This study highlights a high prevalence of musculoskeletal work-related injuries among arthroplasty surgeons and indicates the need for the identification of preventive measures directed toward improving the operative surgical environment and work ergonomics for the surgeons.
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http://dx.doi.org/10.1016/j.arth.2015.12.025DOI Listing
June 2016

Hip arthroscopy for the management of osteoid osteoma of the acetabulum: a systematic review of the literature and case report.

BMC Musculoskelet Disord 2015 Oct 24;16:318. Epub 2015 Oct 24.

Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada.

Background: Intra-articular osteoid osteoma (OO) causes irreversible joint damage. Its treatment of choice is radiofrequency ablation (RFA); however, some areas of the acetabulum are hard to access. Therefore, hip arthroscopy was used to treat this tumor. We aim to systematically review the literature with regards to arthroscopic management of acetabular OO, and to report a further case in which hip arthroscopy was used for treatment.

Methods: PubMed and EMBASE were searched for articles relevant to the arthroscopic management of acetabular OO on December 2, 2014. All articles published on and before that date were reviewed, and studies which met our pre-determined inclusion criteria were included. Articles screening and data abstraction were done by two reviewers independently. We also presented a 31-year-old man with acetabular OO who underwent hip arthroscopy for the management of his tumor after failing to respond to medications and computed tomography scan (CT)-guided RFA.

Results: The initial search revealed 14 studies, of which ten met our inclusion criteria. A total of ten patients underwent hip arthroscopy for the management of acetabular OO. Only two patients were females, and the patients' age ranged from 7 to 47 years. Two patients underwent arthroscopic guided-RFA of the lesion, while the rest underwent excision. The follow-up period ranged from 6 months to 2 years. Success rate was 100 %, and no recurrence was reported. Minor complications (transient impotence and perineal numbness) developed in one patient (10 %). Arthroscopic-guided RFA failed to eliminate the tumor in our additional case. A second trial of CT-guided RFA was successful in treating the patient's condition.

Conclusions: Hip arthroscopy is an effective and safe option for the management of acetabular OO, with success rate exceeding 90 %. Studies of higher level of evidence are required.
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http://dx.doi.org/10.1186/s12891-015-0779-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4620000PMC
October 2015

Symphysis pubis osteomyelitis with bilateral adductor muscles abscess.

Case Rep Orthop 2014 14;2014:982171. Epub 2014 Dec 14.

Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1529 Cedar Avenue, Montreal, QC, Canada H3G 1A6.

Osteomyelitis of the pubis symphysis is a rare condition. There have been various reports in the literature of inflammation and osteomyelitis as well as septic arthritis of pubic symphysis. However, due to the fact that these conditions are rare and that the usual presenting symptoms are very nonspecific, osteomyelitis of the pubic symphysis is often misdiagnosed, thus delaying definitive treatment. We present a case that to our knowledge is the first case in literature of osteomyelitis of the pubic symphysis in a 17-year-old boy with juvenile idiopathic arthritis (JIA), which was initially misdiagnosed and progressed to bilateral adductor abscesses. A high suspicion of such condition should be considered in a JIA patient who presents with symphysis or thigh pain.
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http://dx.doi.org/10.1155/2014/982171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4279146PMC
January 2015

Burn Management in Orthopaedic Trauma: A Critical Analysis Review.

JBJS Rev 2014 Oct;2(10)

1Division of Orthopaedic Surgery, McGill University Health Center, Montreal General Hospital, 1650 Cedar Avenue, Room B5.159.5, Montreal, Quebec, Canada H3G 1A4.

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http://dx.doi.org/10.2106/JBJS.RVW.N.00010DOI Listing
October 2014

Level of evidence of clinical orthopedic surgery research in Saudi Arabia.

Saudi Med J 2013 Apr;34(4):395-400

Division of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada.

Objective: To evaluate the level of evidence (LOE) of Saudi clinical orthopedic research.

Methods: In July 2012, a list of Saudi orthopedic surgeons (N=93) affiliated with all major universities and hospitals in Saudi Arabia were obtained. PubMed and Embase searches were performed for all eligible studies over the last 2 decades (August 1991 to May 2012). The Oxford LOE scale was utilized to determine the LOE of these studies (Level V studies were excluded). The LOE trends were compared between the last 2 decades. In addition, the LOE of Saudi orthopedic studies was compared with North American studies.

Results: Of 251 articles, 159 met the inclusion criteria for the LOE evaluation. Most of the published studies are Level IV (86%). The average level of evidence was 3.75. There was no statistically significant difference when we compared the LOE trend between the last 2 decades. North American studies contained higher proportions of high-level studies when compared to Saudi studies (p<0.05).

Conclusion: Most of the published studies are low LOE. Academic staff, institutions, and training programs are required to develop research strategies to improve orthopedic research quality in Saudi Arabia.
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April 2013

What's new in acute compartment syndrome?

J Orthop Trauma 2012 Dec;26(12):699-702

Department of Surgery, Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada.

Acute compartment syndrome (ACS) after trauma is often the result of increased size of the damaged tissues after acute crush injury or from reperfusion of ischemic areas. It usually is not solely caused by accumulation of free blood or fluid in the compartment, although that can contribute in some cases. There is no reliable and reproducible test that confirms the diagnosis of ACS. A missed diagnosis or failure to cut the fascia to release pressure within a few hours can result in severe intractable pain, paralysis, and sensory deficits. Reduced blood circulation leads to oxygen and nutrient deprivation, muscle necrosis, and permanent disability. Currently, the diagnosis of ACS is made on the basis of physical examination and repeated needle sticks over a short time frame to measure intracompartmental pressures. Missed compartment syndromes continue to be one of most common causes of malpractice lawsuits. Existing technology for continuous pressure measurements are insensitive, particularly in the deep tissues and compartments, and their use is restricted to highly trained personnel. Newer concepts of the pathophysiology accompanied by new diagnostic and therapeutic modalities have recently been advanced. Among these are the concept of inflammatory mediators as markers and anti-inflammatories as medical adjunct therapy. New diagnostic modalities include near-infrared spectroscopy, ultrafiltration catheters, and radio-frequency identification implants. These all address current shortcomings in the diagnostic armamentarium that trauma surgeons can use. The strengths and weaknesses of these new concepts are discussed to allow the trauma surgeon to follow current evolution of the field.
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http://dx.doi.org/10.1097/BOT.0b013e31826df980DOI Listing
December 2012

Trauma profile at a tertiary intensive care unit in Saudi Arabia.

Ann Saudi Med 2012 Sep-Oct;32(5):498-501

National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia.

Background And Objectives: Trauma is a leading cause of death worldwide and in Saudi Arabia. This study describes the injury profiles and ICU outcomes of patients in a tertiary trauma care referral center in Riyadh, Saudi Arabia.

Design And Setting: A retrospective analysis of ICU data collected prospectively over 5 years in a 21-bed medical and surgical intensive care unit (ICU) in a tertiary care teaching hospital.

Patients And Methods: We collected ICU data on all patients admitted secondary to motor vehicle accidents (MVAs), excluding patients younger than 18 years, brain dead patients and readmissions. We collected data on age, gender, and Glasgow coma scale score at admission, injury severity scores, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and other data. Multivariate logistic regression was used to identify predictors of mortality.

Results: During the study period, of 1659 patients, MVA was the most common cause of injury (78.4%), followed by pedestrian accident (12.7%). ICU mortality included 221 patients (13.3%) during the study period. Severe head injury, age > 60 years, Glascow coma scale score, injury severity scores, APACHE II and international normalized ratio were independent predictors of mortality.

Conclusion: MVA is very common in our country and leads to significant mortality and morbidity. Public education and strict law enforcement are needed to reduce these adverse events.
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http://dx.doi.org/10.5144/0256-4947.2012.498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6080991PMC
November 2012