Orthopedic Surgery

Campomelic dysplasia is a rare form of congenital dwarfism associated with potentially fatal respiratory insufficiency. There are several types of campomelic dysplasia; however, it is characterized by the presence of anteriorly bowed tibias with cutaneous dimpling, anterolaterally bowed femurs, thoracic kyphoscoliosis, hypoplastic scapulas, and absence or delayed ossification of thoracic pedicles. With improving treatment of respiratory insufficiency, the survival rate of affected infants has increased, thereby necessitating treatment of the musculoskeletal malformations to prevent additional morbidity. In an attempt to increase awareness of the presentation of infants with campomelic dysplasia and to emphasize the difficulties of treating associated developmental dislocation of the hip early, the current authors report the case of a 2-year-old girl with campomelic dysplasia who was treated for dislocation of the right hip. The postoperative course of this child was complicated seriously by several apneic episodes secondary to tracheobronchial malacia for which she required admission to the pediatric intensive care unit.

Since 1980, 64 children with pelvic osteomyelitis (40 boys) were treated at a major pediatric referral center. The average age was 11 years and 6 months. The presenting complaints included pain in 61 children, fever in 30, and altered weight-bearing in 31. The erythrocyte sedimentation rate was elevated in 56 and there was leukocytosis in 19. The most commonly affected sites were the ilium in 21 and the acetabulum in 20, followed by the pubis in 11 and the ischium in 10. Culture results were negative in 32 and positive for Staphylococcus aureus in 26. Treatment consisted of intravenous antibiotics in 62 and irrigation and debridement in five children, all of whom presented since 1990. The infection resolved in 62 children and persisted in two. Three developed complications, including fusion of the sacroiliac joint in one, deformity of the acetabulum in one, and one child with an underlying protein C deficiency developed thromboembolism. Recent patients have demonstrated increased se...

The modern educators have minimized didactic teaching by lectures, as outdated spoon feeding that dampens creative thinking and keeps the student away from reflective practice and lifelong learning. There are diverse ways for delivering medical curriculum ranging from teacher-centered and isolated blocks to the student-centered and integrated curriculum. This study aims to review the existing undergraduate curriculum of the College of Medicine at Taibah University (CMTU) Almadinah Almunawwarah Saudi Arabia (SA) and outlines the guidelines for a change in the existing curriculum in terms of Student-centered, Problem-based, Integrated, Community-oriented, Elective driven and Systematic (SPICES) model. Study Design: Cross sectional study. Place and Duration of Study: CMTU, between September 2010 and August 2011. Methodology: CMTU started with the traditional curriculum and recently, there are wellstructured modifications taken as initial steps towards a more integrated and systematic curriculum. The curricula of preclinical and clinical disciplines were analyzed in terms of 420 SPICES model; course contents, organization of the course, delivery of the course contents, teaching strategies, learning styles of the students, and integration among different courses. Results: The undergraduate medical curriculum of CMTU stands on the right-side, which does not correspond to the desired left-sided paradigm on the SPICES model.

Abstract
Objectives
This study aims to assess the value of certain radiographic features of the pelvis associated with developmental dysplasia of the hip (DDH), in predicting the method of treatment; whether conservative or operative, in patients between 12 and 24 months of age where both options are valid.
Methods
A retrospective review of the radiographs and the clinical files of children diagnosed with DDH during their second year of life (mean age 18.2 months), including only children who had a follow up of clinically and radiologically for a minimum of 5 years. The initial plain AP pelvic radiograph before commencing any treatment was used to measure 12 different measurements and 2 ratios. Each radiograph was studied individually and blindly, without knowing to which group of patients it belonged.
Results
A total of 72 dislocated hips in 54 patients were studied. The mean, standard deviation and P. values of age and radiographic measurements were calculated. Patients were divided into 2 groups according to the treatment modality used whether conservative or operative then they were compared. The measurement of the width of the femoral head ossific nucleus was significantly higher in the conservative group. The measurements of lateralization, superior migration of the femoral head and the acetabular angle were found to be significantly higher in the operative group.
Conclusion
Study results suggest the possibility of using specific radiographic measurements in patients with DDH during the second year of life to determine the most feasible way of management.
Key words: DDH, Radiographic predictors, Width of the femoral ossific nucleus, Acetabular angle, Lateralization, Superior migration.

Abstract
Osteoporosis has long been considered a health problem unique to postmenopausal women and elderly. It is being increasingly recognized that osteoporosis could affect children as a primary problem and as secondary to various diseases, and medications. The present review discusses the current definition of osteoporosis in children, its causes, types and risk factors for low bone mineral density, in addition to prevention and treatment strategies that can help optimize bone health in children.
Key words: Bone mineral density, Children, Fragility fractures, Osteopenia, Osteoporosis, Primary osteoporosis, Secondary osteoporosis.

Background: Pyomyositis is a rare condition in immune competent patients and is usually seen in tropical countries.
Pyomyositis of obturator muscles in particular is an extremely rare condition, which causes hip pain and mimics
septic arthritis.
Case Report: This is a case report of a 9-year-old boy without an underlying disease or a compromised immune system, who
presented with knee pain that progressed to hip pain and inability to bear weight. He was diagnosed initially
with septic arthritis of the hip and underwent unnecessary hip exploration surgery. Magnetic resonance imaging
scan was performed postoperatively and showed pyomyositis of obturator internus and obturator externus
muscles. He was managed medically and had a good outcome.
Conclusions: A greater awareness of this emergency condition is necessary to prevent misdiagnosis, unnecessary surgical
intervention, and to avoid the devastating possible complications of delayed diagnosis.
Key words: obturator externus • obturator internus • obturator pyomyositis • primary pyomyositis •
septic arthritis

A variety of osteotomies have been proposed to correct
post-traumatic cubitus varus deformity. Each one of them
has advantages and disadvantages or limitations. A new
technique for correcting post-traumatic cubitus varus with
closed wedge counter shift osteotomy of the distal
humerus is described and the preliminary results in six
cases are reported. Five patients showed excellent results
and one patient showed good result. We believe that the
described technique is an alternative to the other
procedures for the treatment of post-traumatic cubitus
varus with minimal internal rotation and hyperextension
deformities. It has the advantages of being a simple,
safe, inherently stable, technically sound procedure, and

Although numerous studies have been performed on
congenital trigger thumb (CTT), the pathogenesis is still
unknown. Cytocontractile proteins and myofibroblasts
are present during soft-tissue contraction, and they
may have a role in CTT. The aim of the study is to clarify
the immunohistochemical and the electron microscopy
characteristics of the first annular (A-1) pulley in CTT.
The specimens from the A-1 pulleys were collected from
22 children with CTT. Electron microscopy was used to
study the last five specimens. Immunohistochemistry
staining demonstrated that all specimens stained
positively for vimentin and for a-smooth muscle actin,
and stained negatively for desmin. Electron microscopy
showed fibroblasts in collagenous matrix, which contain
vimentin-like material and associated at the surface
with elastin-like tubular matrix filaments and elastin
fibers. In two specimens, a few cells showed markers
of myofibroblastic differentiation. The presence of the
cytocontractile proteins and myofibroblasts suggests
proliferation of fibrous tissues during either the
intrauterine or extrauterine phase of developmentand may account for the presence of congenital stenosis at
the level of the A-1 pulley. We believe that CTT may be
developmental; if the process started in the intrauterine
phase it might present as a fixed flexion contracture and
will show mature fibroblasts. If the process started in the
extrauterine phase, it might present as triggering first and
will show myofibroblastic changes, then with the
maturation of the fibrous tissue, result in a fixed flexion
contracture.

Summary: The functional outcome of Sofield procedures
done in the upper limb of five patients with severe osteogenesis
imperfecta was studied. Fourteen procedures were done. Mean
follow-up was more than 10 years. Function of the upper limb
improved in all patients. No patient lost function. Key Words:
Function–Intramedullary rod—Osteogenesis imperfecta—
Sofield—Upper limb.

Summary: In patients with neurofibromatosis, rib displacement
into the spinal canal is a rare cause of paraplegia. We
report a patient with paraplegia caused by rib displacement
whose signs and symptoms began after posterior in situ fusion
for dysplastic scoliosis. There was complete recovery after anterior
decompression and resection of the rib. Key Words:
Neurofibromatosis—Paraplegia—Rib displacement—
Scoliosis.