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BACKGROUND AND OBJECTIVE: Sickle cell disease (SCD) is quite common in eastern Saudi Arabia and Avascular necrosis of femoral head (ANFH) occurs in 30% of the young patients leading to early joint arthroplasty. This study was conducted to assess the benefits of injection of osteoblasts in the avascular lesions of the head of femur. PATIENTS AND METHODS: A preset technique was used, 10 CC of bone marrow aspiration was performed under local anesthesia and aseptic technique. Osteoblasts were separated from the bone marrow cells. The avascular area was drilled and 10 million osteoblasts were transplanted at the lesion site. Patients were seen in the out patient clinic after two weeks for removal of the suture and addressed the questionnaire and examined for the range of movement. The follow up MRI was performed at 4 months. RESULTS: The average age was 20.2±3.9 years. The mean hemoglobin S was 81.6±4.8 percent. Quality of Life Score for Chronic Hip Disease was assessed and found at 8.6 (1 being the severe limitation and 10 being normal), whereas Harris hip score improved from 41.7±5.1 to 88.93±3.6 (p < 0.001). MRI of pre and post osteoblast implantation showed robust new bone formation and disappearance of the avascular lesions. CONCLUSIONS: The short term results were good and we believe the injection of osteoblast in the avascular lesion of head of femur is a less invasive procedure devoid of any untoward complications and merits such treatment in large patient group with longer follow up.
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BACKGROUND: Reconstruction of the anterior cruciate ligament (ACL) involves use of semintendinosis and gracilis tendons graft that is transplanted into bone tunnels at the femoral and tibial insertion sites and the sites and the bone tendon interface is a weak link in the early healing period due to slow rate of healing. We hypothesized that an addition of bone growth factor like Sadat-Habdan mesenchymal stimulating peptide (SHMSP) could enhance bone tendon healing rate so that re-rupture of the tendon does not take place. METHODOLOGY: Twenty skeletally mature rabbits underwent ACL reconstruction of the right knee. In 10 of the rabbits at the site of the tendon-graft 5 mg/kg body weight of SHMSP was put in the bone tunnel. In 10 other animals, nothing was added. At eight and 12 weeks 5 animals from each group were sacrificed. The tendon-graft site was harvested and sent for histopathological examination to assess the healing at the tendon-bone graft to the tibial tunnel. RESULTS: There were no deaths in both the groups. One rabbit of the control group developed an infection. In all the animals of the study group from 4 weeks onward showed bone formation, wherein the control group only granulation tissue was observed. By 8 weeks in the study group, the canal was totally obliterated with the new bone formation which extended onto the periosteal area. In the control, there was minimal change in the formation of the new bone formation. CONCLUSION: Addition of a growth factor like SHMSP would enhance the osteo-integration of the tendon-graft in the bony tunnel after ACL reconstruction in vivo.
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UNLABELLED: The current study reassesses the prevalence of fragility fractures and lifetime costs in the Eastern Province of Saudi Arabia. Forty-two percent (391) of the fractures were at the neck of the femur, and 38.6 % (354) were inter-trochanteric fractures. The overall incidence was assessed to be 7528 (1,300,336 population 55 years or older) with the direct cost of SR564.75 million ($150.60 million). A National Fracture Registry and osteoporosis awareness programs are recommended. PURPOSE: Proximal femur fragility fractures are reported to be increasing worldwide due to increased life expectancy. The current study is carried out to assess the incidence of such fractures in the Eastern Province of Saudi Arabia and to assess the costs incurred in managing them annually. Finally, by extrapolating the data, the study can calculate the overall economic burden in Saudi Arabia. METHODS: The data of fragility proximal femur fractures was collected from 24 of 28 hospitals in the Eastern Province. The data included age, sex, mode of injury, type of fracture, prescribed drug (and its cost), and length of hospital stay. Population statistics were obtained from the Department of Statistics of the Saudi Arabian government Web site. RESULTS: Twenty-four hospitals (85 %) participated in the study. A total of 780 fractures were sustained by 681 patients. Length of stay in the hospital averaged 23.28 ± 13.08 days. The projected fracture rate from all the hospitals would be 917 (an incidence of 5.81/1000), with a total cost of SR68.77 million. Further extrapolation showed that the overall incidence could be 7528 (1,300,336 population 55 years or older) with the direct cost of SR564.75 million ($150.60 million). CONCLUSIONS: Osteoporosis-related femoral fractures in Saudi Arabia are significant causes of morbidity besides incurring economic burden. We believe that a National Fracture Registry needs to be established, and osteoporosis awareness programs should be instituted in every part of Saudi Arabia so that these patients can be diagnosed early and treated appropriately to reduce both the number of fractures and the economic burden of the fractures.
Asunto(s)
Fracturas del Cuello Femoral/economía , Costos de la Atención en Salud/tendencias , Osteoporosis/economía , Fracturas Osteoporóticas/economía , Adulto , Anciano , Femenino , Fracturas del Cuello Femoral/epidemiología , Fracturas del Cuello Femoral/etiología , Predicción , Fracturas de Cadera/economía , Fracturas de Cadera/epidemiología , Fracturas de Cadera/etiología , Humanos , Incidencia , Tiempo de Internación , Masculino , Persona de Mediana Edad , Osteoporosis/complicaciones , Osteoporosis/epidemiología , Fracturas Osteoporóticas/epidemiología , Prevalencia , Sistema de Registros , Arabia Saudita/epidemiologíaRESUMEN
Surgical site infection (SSI) is disastrous in orthopedic practice as it is difficult to rid the bone and joint of the infection. This study was aimed to assess the prevalence of SSI in orthopedic practice and to identify risk factors associated with surgical site infections. All patients admitted to the orthopedic male and female wards between January 2006 and December 2011 were included in the study group. The data, which were collected from the medical charts and from the QuadraMed patient filing system, included age, sex, date of admission, type of admission (elective versus emergency), and classification of fractures. Analyses were made to find out the association between infection and risk factors, the χ (2) test was used. The strength of association of the single event with the variables was estimated using Relative Risk, with a 95% confidence interval and P < 0.05. A total of 79 of 3096 patients (2.55%) were included: 60 males and 19 females with the average age of 38.13 ± 19.1 years. Fifty-three patients were admitted directly to the orthopedic wards, 14 were transferred from the surgical intensive care unit, and 12 from other surgical wards. The most common infective organism was Staphylococcus species including Methicillin Resistant Staphylococcus aureus (MRSA), 23 patients (29.11%); Acinetobacter species, 17 patients (21.5%); Pseudomonas species, 15 patients (18.9%); and Enterococcus species, 14 patients (17.7%). Fifty-two (65.8%) had emergency procedures, and in 57 patients trauma surgery was performed. Three (3.78%) patients died as a result of uncontrolled septicemia. SSI was found to be common in our practice. Emergency surgical procedures carried the greatest risk with Staphylococcus species and Acinetobacter species being the most common infecting organisms. Proper measures need to be undertaken to control infection rates by every available method; antibiotics alone may not be sufficient to win this war.