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Objective The main objective of this study is to design a custom-made weight-drop impactor device to produce a consistent spinal cord contusion model in rats in order to examine the efficacy of potential therapies for post-traumatic spinal cord injuries (SCIs). Methods Adult female Sprague-Dawley rats (n = 24, 11 weeks old) were randomly divided equally into two groups: sham and injured. The consistent injury pattern was produced by a 10 g stainless steel rod dropped from a height of 30 mm to cause (0.75 mm) intended displacement to the dorsal surface of spinal cord. The neurological functional outcomes were assessed at different time intervals using the following standardized neurobehavioral tests: Basso, Beattie, and Bresnahan (BBB) scores, BBB open-field locomotion test, Louisville Swim Scale (LSS), and CatWalk gait analysis system. Results Hind limb functional parameters between the two groups using BBB scores and LSS were significantly different (p < 0.05). There were significant differences (p < 0.05) between the SCI group and the sham group for the hind limb functional parameters using the CatWalk gait analysis. Conclusion We developed an inexpensive custom-made SCI device that yields a precise adjustment of the height and displacement of the impact relative to the spinal cord surface.

Purpose To measure the morphometric variables of the superior pubic ramus in a sub-set of an Arab population to establish a safe pubic screw fixation technique. Methods Cross sectional retrospective analysis of computed tomography (CT) pelvis images for 231 participants. The morphometric analysis included; pubic ramus axis length, insertion angles orientation, distance from the exit point to the pubic symphysis, distance from the entry point to acetabular joint surface and assessment of the narrowest pubic ramus diameter at three anatomical zones: para-symphyseal, mid-pubic and supra-acetabular areas. Pubic rami diameter correlation with age and sex was also analyzed. Results A total of 231 participants were included (55% male, 45% female). The mean screw length was between (104–127 mm) and it is significantly higher in males than females. The narrowest canal diameter was found at the para symphyseal area in both sexes were; 7.35mm in males and 4.75 mm in females. In females, all canal diameters at the three measured regions were significantly smaller than male’s diameters. The mediolateral insertion angle was significantly higher in females than males (49.4° vs. 41.8°, respectively), whereas the cephalic-caudal angle was significantly higher in males than females (49.9° vs. 42.1° respectively). The mean distance from the lateral ilium entry point to joint articular surface was higher in males (23.5 mm) than females (19.9 mm).The symphysis pubis to tubercle exit point was significantly higher in females than males (24.2 mm vs 16.6 mm respectively). Pearson’s correlation analysis revealed a statistically significant positive correlation between age and the pubic ramus diameter at the three measured regions in all age groups. Conclusion The results from this study suggest that percutaneous pubic rami screw fixation using the standard 6.5 or 7.3mm cannulated screw system may potentially be unsafe in female Arab patients. Thus, a closer evaluation in this subset of patients may require the alternative solid non-cannulated screws (3.5- 4.5mm) or plate fixation options. Further, female patients may have a higher risk of acetabular joint penetration, while males have a potentially higher risk of pudendal nerve injury

Purpose To assess the analgesic efficacy of the circumferential periosteal block (CPB) and compare it with the conventional fracture hematoma block (HB). Methods This study was a prospective single-center randomized controlled trial performed in a national orthopedic hospital. Fifty patients with displaced distal radius (with or without concomitant ulna) fractures requiring reduction were randomized to receive either CPB or HB prior to the reduction. Pain was sequentially measured using the visual analogue scale (VAS) across three stages; before administration of local anesthesia (baseline), during administration (injection) and during manipulation and immobilization (manipulation). Further, the effect of demographic factors on the severity of pain was analyzed in multivariate regression. Finally, complications and end outcomes were compared across both techniques. Results Patients receiving CPB experienced significantly less pain scores during manipulation (VAS = 0.64) compared with HB (VAS = 2.44) (p = P = 0.55) and injection (P = 0.40) stages. Conclusion The CPB provides a superior analgesic effect over the conventional HB with no documented complications in either technique. Level of evidence Therapeutic Level II.

Digital injuries are among the most common presentations to the emergency department. In order to sufficiently examine and manage these injuries, adequate, prompt, and predictable anesthesia is essential. In this trial, we aim to primarily compare the degree of pain and anesthesia onset time between the two-injection dorsal block technique (TD) and the single-injection volar subcutaneous block (SV) technique. Further, we describe the temporal and anatomical effects of both techniques for an accurate delineation of the anesthetized regions.This is a single-center prospective randomized controlled trial involving patients presenting with isolated wounds to the fingers requiring primary repair under local anesthesia. Patients were randomized to either the SV or TD blocks. The primary outcome was procedure-related pain (Numerical Rating Scale). Further, we assessed the extent of anesthesia along with the anesthesia onset time.A total of 100 patients were included in the final analysis, 50 on each arm of the study. The median pain score during injection was significantly higher in patients who received TD block than patients who received SV block (median [interquartile range] = 4 [2.25, 5.00] vs. 3.00 [2.00, 4.00], respectively,The single-injection volar subcutaneous blocks are less painful with a similar anesthesia onset time. Injuries presenting in the proximal dorsal region may benefit from the two-injection dorsal blocks, given the anatomical differences and timely anesthesia of the region.

Introduction COVID-19 has led to intricate global challenges, among these, the impact on emergency and elective orthopedic services. Patients with COVID-19 often complain of musculoskeletal symptoms. The subsequent orthopedic consultations require careful assessment of possible inpatient trauma and to rule out any injuries that require active management. Methods A retrospective cross-sectional analysis involving 13,580 admitted patients in a national quarantine center between March 2020 and April 2021. All patients with orthopedic consultations were included in the study, and were assessed by orthopedic surgeons in person. Patients were further evaluated for age, sex, presence of trauma, cause for consultation, diagnosis and management. Results Seventy-five orthopedic consultations were included, 44% females and 56% males. Of the 75 consultations, 29 (38%) were related to a history of inpatient trauma. Of the 29 cases, 11 sustained fractures of the distal radius, proximal humerus, femoral neck, clavicle and ankle. Four of which were treated operatively. Discussion and conclusion Inpatient orthopedic consultations must be assessed carefully to avoid misdiagnoses. Elderly or frail patients are more likely to both; sustain trauma and fractures. Potential limitations of tele-orthopedics may be apparent here, especially in the presence of technological incompetence and high likelihood of fractures.

Introduction Proximal humerus fractures are common amongst the elderly and osteoporotic cohorts. Common treatment methods include proximal locking plates. In this case, we describe an iatrogenic fracture of the proximal humeral shaft during screw insertion under power. Similar cases have not been described previously in open reduction and internal fixation of a proximal humerus fracture. Further, we focus particularly on precautionary measures that aim to avoid such complications that may lead to considerable morbidity. Case presentation We describe a case of a 65 year old osteoporotic female who underwent open reduction internal fixation of a proximal humerus fracture complicated by an unusual iatrogenic humeral fracture at the level of insertion of the distal screw, likely secondary to inserting the proximal locking screws under power. Conclusion In this case, we explore the possible factors leading to the fracture and precautionary measures to avoid them. The rate of iatrogenic intraoperative fractures are likely underreported and have not been described in open reduction and internal fixation of an existing fracture. The underlying factors that may predispose to such complications have not been previously described in similar cases. This case serves as a warning of an unanticipated complication and describes the potential biomechanical factors involved., Highlights • Proximal humerus fractures are common in the elderly and osteoporotic cohorts. • Iatrogenic fractures intraoperatively during open reduction internal fixation have not been reported in orthopedic trauma. • Care should be taken to avoid excessive energy/torque at screw sites while using electric drivers. • The biomechanical precautions during fixation should be visited and more extensively described to avoid similar incidents.