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Al-Naseem AO, Al-Muhannadi A, Ramadhan M, Alfadhli A, Marwan Y, Shafafy R, Abd-El-Barr MM. Robot-assisted pedicle screw insertion versus navigation-based and freehand techniques for posterior spinal fusion in scoliosis: a systematic review and meta-analysis. Spine Deform 2024:10.1007/s43390-024-00879-y. [PMID: 38619784 DOI: 10.1007/s43390-024-00879-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE The role of robotics in spine surgery remains controversial, especially for scoliosis correction surgery. This study aims to assess the safety and efficacy of robotic-assisted (RA) surgery specifically for scoliosis surgery by comparing RA to both navigation systems (NS) and conventional freehand techniques (CF). METHODS As per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a systematic review and meta-analysis were conducted via an electronic search of the following databases: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). All papers comparing RA to either NS or CF for posterior spinal fusion in scoliosis were included. Fixed and random effects models of analysis were utilised based on analysis heterogeneity. RESULTS 10 observational studies were included in total. RA had significantly greater odds of accurate pedicle screw placement relative to both NS (OR = 2.02, CI = 1.52-2.67, p < 0.00001) and CF (OR = 3.06, CI = 1.79-5.23, p < 0.00001). The downside of RA was the significantly greater operation duration relative to NS (MD = 10.74, CI = 3.52-17.97, p = 0.004) and CF (MD = 40.27, CI = 20.90, p < 0.0001). Perioperative outcomes including estimated blood loss, radiation exposure, length of hospital stay, cobb angle correction rate, postoperative SRS score, VAS pain score, JOA score, as well as rates of neurological injury and revision surgery, were comparable between the groups (p > 0.05). CONCLUSION RA offers significantly greater pedicle screw placement accuracy relative to NS and CF, however, surgery can take longer. In terms of perioperative outcomes, all three techniques are comparable.
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Affiliation(s)
| | | | | | | | - Yousef Marwan
- Department of Surgery, College of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait.
| | - Roozbeh Shafafy
- Division of Surgery & Interventional Science, University College London, London, UK.
- Department of Spinal Surgery, Royal National Orthopaedic Hospital NHS Foundation Trust, Stanmore, UK.
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Division of Spine, Duke University Medical Centre, Durham, USA.
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Marwan Y, Turner J, Senan R, Muir R, Barron E, Hadland Y, Moulder E, Sharma H. Circular external fixation for revision of failed tibia internal fixation. Eur J Orthop Surg Traumatol 2024; 34:353-361. [PMID: 37530905 DOI: 10.1007/s00590-023-03660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The management of failed tibial fracture fixation remains a challenge for orthopaedic surgeons. This study investigate the utility and outcomes of circular external fixation in the management of failed internal fixation of tibial fractures. METHODS Retrospective review of a prospectively collected database of a complex limb reconstruction unit at a major trauma centre was done during December 2022. Patients with failed internal fixation of tibial fracture who underwent revision surgery with circular external fixation frame were included. RESULTS 20 patients with a mean age of 47.8 ± 16.5 years (range: 15-69) were included. Fourteen (70.0%) patients had failed plate and screws fixations, and the remaining six (30.0%) failed intramedullary nail fixation. The most common indication for revision surgery was development of early postoperative surgical site infection (5 patients; 25.0%). The mean duration of frame treatment was 199.5 ± 80.1 days (range = 49-364), while the mean follow-up duration following frame removal was 3.2 ± 1.8 years (range = 2-8). The overall union rate in this series was 100%; and all infected cases had complete resolution from infection. The total number of complications was 11, however, only two complications required surgical intervention. The most common complications reported were pin site infection (6; 30.0%) and limb length discrepancy of 2 cm (2; 10.0%). CONCLUSIONS Circular external fixation is a reliable surgical option in the treatment of failed internal fixation of tibia fractures. This technique can provide limb salvage in complex infected and noninfected cases with a high union rate and minimal major complications.
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Affiliation(s)
- Yousef Marwan
- Department of Surgery, College of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait.
| | - Jeffrey Turner
- Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, UK
| | - Rahul Senan
- Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, UK
| | - Ross Muir
- Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, UK
| | - Elizabeth Barron
- Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, UK
| | - Yvonne Hadland
- Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, UK
| | - Elizabeth Moulder
- Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, UK
| | - Hemant Sharma
- Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, UK
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Algarni N, Al-Amoodi M, Marwan Y, Bokhari R, Addar A, Alshammari A, Alaseem A, Albishi W, Alshaygy I, Alabdullatif F. Unilateral laminotomy with bilateral spinal canal decompression: systematic review of outcomes and complications. BMC Musculoskelet Disord 2023; 24:904. [PMID: 37990183 PMCID: PMC10662450 DOI: 10.1186/s12891-023-07033-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Unilateral laminotomy with bilateral spinal canal decompression has gained popularity recently. AIM To systematically review the literature of unilateral laminotomy with bilateral spinal canal decompression for lumbar spinal stenosis (LSS) aiming to assess outcomes and complications of the different techniques described in literature. METHODS On August 7, 2022, Pubmed and EMBASE were searched by 2 reviewers independently, and all the relevant studies published up to date were considered based on predetermined inclusion and exclusion criteria. The subject headings "unilateral laminotomy", "bilateral decompression" and their related key terms were used. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles. RESULTS A total of seven studies including 371 patients were included. The mean age of the patients was 69.0 years (range: 55-83 years). The follow up duration ranged from 1 to 3 years. Rate of postoperative pain and functional improvement was favorable based on VAS, JOA, JOABPEQ, RMDW, ODI and SF-36, for example improved from a range of 4.2-7.5 preoperatively on the VAS score to a range of 1.4-3.0 postoperatively at the final follow up. Insufficient decompression was noted in 3% of the reported cases. The overall complication rate was reported at 18-20%, with dural tear at 3.6-9% and hematoma at 0-4%. CONCLUSION Unilateral laminotomy with bilateral decompression has favorable short- and mid-term pain and functional outcomes with low recurrence and complication rates. This, however, needs to be further confirmed in larger, long-term follow-up, prospective, comparative studies between open, and minimally invasive techniques.
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Affiliation(s)
- Nizar Algarni
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Al-Amoodi
- Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada
| | - Yousef Marwan
- Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Rakan Bokhari
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah Addar
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alshammari
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Abdulrahman Alaseem
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Alshaygy
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Alabdullatif
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Al Badi H, Lorange JP, Alzeedi M, Marwan Y, Bernstein M, Hamdy RC. Distal Femur Anterior Hemiepiphysiodesis for Fixed Knee Flexion Deformity in Neuromuscular Patients: A Systematic Review. JBJS Rev 2023; 11:01874474-202306000-00003. [PMID: 37276266 DOI: 10.2106/jbjs.rvw.23.00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND In the past decade, distal femur anterior hemiepiphysiodesis for fixed knee flexion deformity has gained popularity. In this study, we aim to systematically review the literature on this technique as a treatment for fixed knee flexion deformity in patients with neuromuscular disorders. METHODS A systematic review was performed in the following databases: PubMed, Embase, and Medline. The inclusion criteria included anterior hemiepiphysiodesis of the distal femur for patients with neuromuscular disorders and fixed knee flexion deformities. RESULTS Our search yielded 419 titles. A total of 12 articles were qualified for final review based on the inclusion and exclusion criteria. The total number of patients was 279, with 483 knees corrected. The male to female ratio was 2.1:1, and the mean age of the patients was 11.3 ± 1.4 years (range 4-17 years). The mean preoperative flexion deformity was 23.1° ± 10.0° (range 10°-90°). The mean residual flexion deformity at the final follow-up was 8.6° ± 9.0° (range 0°-32.5°), which corresponds to a statistically significant decrease compared with the preoperative deformity (p < 0.05). CONCLUSION Anterior hemiepiphysiodesis for fixed knee flexion deformity provides favourable outcomes with low complication rates in patients with neuromuscular disorders. Future studies should focus on comparing the long-term outcomes of the different metal implants used for these operations. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hamid Al Badi
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Justin-Pierre Lorange
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Muadh Alzeedi
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yousef Marwan
- Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Mitchell Bernstein
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Reggie C Hamdy
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Bozzo I, Kooner P, Nelson R, Marwan Y, Paruthikunnan S, Laverdière C, Boily M, Martineau PA. Contribution of the Bony Bankart in Calculating Glenoid Bone Loss. Orthop J Sports Med 2023; 11:23259671231168879. [PMID: 37223075 PMCID: PMC10201139 DOI: 10.1177/23259671231168879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 05/25/2023] Open
Abstract
Background Determining the magnitude of glenoid bone loss in patients with anterior shoulder instability is an important step in guiding management. Most calculations to estimate the bone loss do not include the bony Bankart fragment. However, if it can be reduced and adequately fixed, the estimation of bone loss may be decreased. Purpose To derive a simple equation to calculate the surface area of the bony fragment in Bankart fractures. Study Design Case series; Level of evidence, 4. Methods A total of 26 patients suspected of having clinically significant bone loss underwent computed tomography imaging preoperatively, and the percentage of glenoid bone loss (%BL) was approximated with imaging software using a freehand region of interest area measurement with and without the inclusion of the bony Bankart fragment. By assuming this bony fragment as a hemi-ellipse with height, H, and thickness, d, we represented the surface are of the bony piece (Abonefragment=πHd4), and subtracted it from the overall %BL. They compared this value with the one found using imaging software. Results Without the inclusion of the bony Bankart, the overall %BL by the standard true-fit circle measured using imaging software was 23.8% ± 9.7%. When including the bony Bankart, the glenoid %BL measured using imaging software was found to be 12.1% ± 8.5%. The %BL calculated by our equation with the bony Bankart included was 10% ± 11.1%. There was no statistically significant difference between the %BL values measured using the equation and the imaging software (P = .46). Conclusion Using a simple equation that approximates the bony Bankart fragment as a hemiellipse allowed for estimation of the glenoid bone loss, assuming that the fragment can be reduced and adequately fixed. This method may serve as a helpful tool in preoperative planning when there are considerations for incorporating the bony fragment in the repair.
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Affiliation(s)
- Isabella Bozzo
- Faculty of Medicine, McGill University,
Montréal, Québec, Canada
| | - Paul Kooner
- Division of Orthopaedic Surgery, McGill
University Health Centre, Montréal, Québec, Canada
| | - Ralph Nelson
- Department of Diagnostic Radiology,
McGill University Health Centre, Montréal, Québec, Canada
| | - Yousef Marwan
- Department of Surgery, Faculty of
Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | | | - Carl Laverdière
- Division of Orthopaedic Surgery, McGill
University Health Centre, Montréal, Québec, Canada
| | - Mathieu Boily
- Department of Diagnostic Radiology,
McGill University Health Centre, Montréal, Québec, Canada
| | - Paul A. Martineau
- Division of Orthopaedic Surgery, McGill
University Health Centre, Montréal, Québec, Canada
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Marwan Y, Muir R, Barron E, Hadland Y, Moulder E, Sharma H. Circular external fixation for knee fusion in complex indications. Eur J Orthop Surg Traumatol 2023:10.1007/s00590-023-03493-2. [PMID: 36774409 PMCID: PMC9922099 DOI: 10.1007/s00590-023-03493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/05/2023] [Indexed: 02/13/2023]
Abstract
PURPOSE Reconstructive surgery for complex knee problems is limited and challenging. The aim of this study is to report the technique, outcomes and complications of circular external fixation for knee fusion in complex indications. METHODS Retrospective review of a prospectively collected database of a complex limb reconstruction unit was done during December 2022. Patients with complex knee problems who underwent knee fusion with circular external fixator were included. RESULTS Fourteen patients met the inclusion criteria. The mean age of the patients was 63 ± 16.8 years. Deep infection was the indication for surgery in 11 patients (78.5%), of which 10 cases were related to previously failed revision arthroplasty. The mean duration of treatment in frame was 13 ± 4.1 months, while the mean follow-up duration following frame removal was 7.1 ± 4.2 years. Fusion was achieved in 13 patients (92.9%). The most common complication was pin site infection (6; 42.9%), of which three (21.4%) required pin/wire revision. One (7.1%) patient had fracture at the fusion site following frame removal that was treated with reapplication of the frame. CONCLUSION Knee fusion using circular external fixation is a reliable surgical option for complex knee problems especially in infected failed revision total knee replacements.
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Affiliation(s)
- Yousef Marwan
- Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait.
| | - Ross Muir
- grid.9481.40000 0004 0412 8669Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, HU3 2JZ UK
| | - Elizabeth Barron
- grid.9481.40000 0004 0412 8669Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, HU3 2JZ UK
| | - Yvonne Hadland
- grid.9481.40000 0004 0412 8669Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, HU3 2JZ UK
| | - Elizabeth Moulder
- grid.9481.40000 0004 0412 8669Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, HU3 2JZ UK
| | - Hemant Sharma
- grid.9481.40000 0004 0412 8669Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, HU3 2JZ UK
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Chergui S, Al-Ali H, Marwan Y, Abu Dalu K, Dahan-Oliel N, Hamdy RC. Talectomy for arthrogrypotic foot deformities: A systematic review. Foot Ankle Surg 2023; 29:15-21. [PMID: 36266132 DOI: 10.1016/j.fas.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthrogryposis multiplex congenita (AMC) is one of the most common congenital joint contracture syndromes. Talectomy has been proposed for severe foot deformities in AMC, but the literature is limited. The purpose of this systematic review is to evaluate the indications, outcomes and complications of talectomy in arthrogrypotic foot deformities. METHODS The articles were found through Embase and Medline. Screening was conducted by two independent investigators with disagreements resolved by a third reviewer. Relevant data regarding demographics, outcomes and complications were collected. RESULTS Of 232 feet, 71.98 % and 62.22 % had clinical and radiographic improvements respectively. Amongst 122 patients, 92.62 % could ambulate following surgery. Recurrent deformities and revision surgery were seen in 16.81 % and 13.36 % of cases respectively. CONCLUSIONS Talectomy is a valid surgical option for severe arthrogrypotic foot deformities with favorable post-operative outcomes and low complication rate.
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Affiliation(s)
- Sami Chergui
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Hussain Al-Ali
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yousef Marwan
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Khaled Abu Dalu
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Noémi Dahan-Oliel
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Shriners Hospital for Children, Montreal, Quebec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Reggie C Hamdy
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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AlZeedi M, Park JP, Marwan Y, Abu-Dalu KM, Hamdy R, Janelle C. Growth Modulation for the Treatment of Juvenile Hallux Valgus: A Systematic Review of Literature. Strategies Trauma Limb Reconstr 2023; 18:51-55. [PMID: 38033921 PMCID: PMC10682558 DOI: 10.5005/jp-journals-10080-1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 04/20/2023] [Indexed: 12/02/2023] Open
Abstract
Background Juvenile hallux valgus (JHV) is a forefoot deformity that causes pain and functional limitation. Treatment poses a challenge in terms of the optimal technique and timing of intervention. A systematic review of the literature on the use of growth modulation in treating JHV was conducted. Materials and methods The literature review was performed using PubMed and EMBASE searches for articles investigating growth modulation in the treatment of JHV published before December 1st, 2021. Seven articles were included in the final review that matched the inclusion and exclusion criteria. The primary outcomes included the degree of correction of hallux valgus angle and intermetatarsal angle. A qualitative assessment of the articles was done due to the heterogeneity of the growth modulation methods used in these articles. Results A total of 135 feet from 78 patients were included from the reviewed articles. Growth modulation methods included temporary screw lateral hemiepiphysiodesis of the first metatarsal, lateral drilling hemiepiphysiodesis of the first metatarsal, and a trephine plug removal of the lateral epiphysis followed by cancellous bone graft insertion. The degree of correction of the hallux valgus and intermetatarsal angles were found to be statistically significant in all studies, regardless of the technique. Conclusion Growth modulation for JHV by lateral hemiepiphysiodesis using minimally invasive techniques produced favourable radiologic outcomes with some evidence of clinical improvement. Larger, prospective and comparative studies with objective clinical outcome measures may further consolidate this surgical approach as a mean to treating this deformity. How to cite this article AlZeedi M, Park JP, Marwan Y, et al. Growth Modulation for the Treatment of Juvenile Hallux Valgus: A Systematic Review of Literature. Strategies Trauma Limb Reconstr 2023;18(1):51-55.
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Affiliation(s)
- Muadh AlZeedi
- Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - J Patrick Park
- Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yousef Marwan
- Department of Surgery, College of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
| | - Khaled Mousa Abu-Dalu
- Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Reggie Hamdy
- Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Chantal Janelle
- Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Lorange JP, Alamiri N, Marwan Y, Alshammari A, Hamdy RC, Bernstein M. Humerus Lengthening with a Motorized Intramedullary Nail: A Systematic Review of Outcomes and Complications. Strategies Trauma Limb Reconstr 2022; 17:165-171. [PMID: 36756294 PMCID: PMC9886034 DOI: 10.5005/jp-journals-10080-1568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/10/2022] [Indexed: 01/01/2023] Open
Abstract
Aim In the past decade, internal limb lengthening nails have gained popularity. In this study, we aim to systematically review the literature on humerus limb lengthening with a motorized intramedullary nail (MIN). We intend to assess the outcome and complications of this technique. Materials and methods A systematic review was performed in the following databases: PubMed, Embase, Web of Science, and the Journal of Limb Lengthening and Reconstruction. The inclusion criteria included limb lengthening of the humerus using an intramedullary nail, clinical studies, all levels of evidence, and no restriction to the date of publication. Results Our search yielded 239 journal articles. A total of nine articles remained relevant based on the inclusion and exclusion criteria. The total number of patients was 20, with 22 segments lengthened. The mean age of the patients was 20.8-year-old [standard deviation (SD), 12.0; range, 13-51]. The mean gained length was 5.7 cm (SD, 0.9; range, 5-7.5) with a mean distraction protocol of 0.82 mm/day (SD, 0.2; range, 0.6-1). The average duration of lengthening was 71.6 days (SD, 12.8; range, 50-93), and the mean duration of consolidation was 192.3 days (SD, 40.5; range, 120-228). Reported complications included a range of motion (ROM) limitation, hardware failure, and hypertrophic bone regeneration. Conclusion Humeral lengthening with an MIN provides favourable outcomes with low complication rates. Future high-level studies should focus on comparing long-term outcomes of humeral lengthening utilising internal and external fixation techniques. Clinical significance Humeral lengthening using MIN can be used safely. Each surgical approach and type of nail have different risks and benefits. These should be carefully discussed when planning the surgery. How to cite this article Lorange JP, Alamiri N, Marwan Y, et al. Humerus Lengthening with a Motorized Intramedullary Nail: A Systematic Review of Outcomes and Complications. Strategies Trauma Limb Reconstr 2022;17(3):165-171.
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Affiliation(s)
- Justin-Pierre Lorange
- Department of Pediatric Orthopedic Surgery, Limb Deformity Unit, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nawaf Alamiri
- Department of Pediatric Orthopedic Surgery, Limb Deformity Unit, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yousef Marwan
- Department of Pediatric Orthopedic Surgery, Limb Deformity Unit, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Abdullah Alshammari
- Department of Pediatric Orthopedic Surgery, Limb Deformity Unit, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Reggie Charles Hamdy
- Department of Pediatric Orthopedic Surgery, Limb Deformity Unit, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mitchell Bernstein
- Department of Pediatric Orthopedic Surgery, Limb Deformity Unit, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Marwan Y, Dalu KA, Bernstein M, Hamdy RC. Metatarsal Gradual Lengthening for Brachymetatarsia Using a Mini-rail External Fixator System. Strategies Trauma Limb Reconstr 2022; 17:184-188. [PMID: 36756291 PMCID: PMC9886031 DOI: 10.5005/jp-journals-10080-1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/17/2022] [Indexed: 01/01/2023] Open
Abstract
Aim To describe the surgical technique for gradual lengthening of the metatarsal using the Orthofix MiniRail System (Orthofix Medical Inc., Lewisville, TX, USA). Background Brachymetatarsia refers to the shortening of the metatarsal bone. When indicated, metatarsal lengthening is performed to treat this deformity. Technique A dorsal approach to the short metatarsal is performed, protecting the neurovascular structures and the extensor tendons. The most proximal wire or screw is inserted first, followed by the most distal wire or screw. The distal wire or screw should not be inserted in the metatarsal head. The middle wires or screws are inserted thereafter. All wires or screws should be placed perpendicular to the anatomic axis of the bone. Once the MiniRail lengthener is assembled, a 1.6 mm K-wire is inserted from the tip of the toe into the metatarsal head, blocking the motion of the metatarsophalangeal joint and avoiding joint subluxation during lengthening. The osteotomy is then performed perpendicular to the metatarsal shaft, in between the middle two wires and screws. Conclusion The surgical technique for gradual lengthening of the metatarsal using the Orthofix MiniRail System was described in detail with accompanying step-by-step intraoperative clinical and fluoroscopic images. Clinical significance This surgical technique of metatarsal lengthening is simple and effective. An understanding of the surgical technique of gradual lengthening of the metatarsal bone is important when treating shorting deformities of more than 1 cm. How to cite this article Marwan Y, Abu Dalu K, Bernstein M, et al. Metatarsal Gradual Lengthening for Brachymetatarsia Using a Mini-rail External Fixator System. Strategies Trauma Limb Reconstr 2022;17(3):184-188.
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Affiliation(s)
- Yousef Marwan
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Khaled Abu Dalu
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mitchell Bernstein
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Reggie C Hamdy
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Lorange JP, Bakhsh D, Laverdière C, Marwan Y, Berry GK. Management of Patella Fracture Nonunion and Large Bone Defect After Bone-Patellar Tendon-Bone Autograft: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00035. [PMID: 36049034 DOI: 10.2106/jbjs.cc.22.00251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 32-year-old patient was diagnosed with a vertical patella fracture nonunion after a bone-patellar tendon-bone (BTB) anterior cruciate ligament reconstruction. In addition, a 1 × 2 × 1 cm patellar bone defect was noticed at the graft harvesting site. The patient was treated surgically with open reduction and internal fixation and iliac crest bone autograft which resulted in fracture union. CONCLUSION Many intraoperative and postoperative risk factors for iatrogenic patella fracture when harvesting BTB autograft were identified. Surgeons should be aware of technical skills needed to prevent this complication and should treat the fracture appropriately to avoid nonunion and optimize the outcome.
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Affiliation(s)
| | - Dena Bakhsh
- Division of Orthopaedics, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Carl Laverdière
- Division of Orthopaedics, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Yousef Marwan
- Division of Orthopaedics, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Gregory K Berry
- Division of Orthopaedics, Department of Surgery, McGill University, Montreal, Quebec, Canada
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12
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Park JP, Marwan Y, Alfayez SM, Burman ML, Martineau PA. Arthroscopic management of synovial chondromatosis of the shoulder: a systematic review of literature. Shoulder Elbow 2022; 14:5-15. [PMID: 35845621 PMCID: PMC9284258 DOI: 10.1177/1758573220977205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Synovial chondromatosis (SC) of the shoulder is rare, with limited literature on its management. This systematic review of literature aimed to characterize common arthroscopic techniques for the treatment of shoulder SC and patient outcomes. We hypothesized that arthroscopy is an effective operative modality for the management of shoulder SC. METHODS PubMed and Embase databases were searched for articles on arthroscopic management of shoulder SC, published before 6 August 2020. All articles meeting inclusion criteria received an independent full-text review by two authors. RESULTS An initial search found 64 articles. Following duplicate removal and title, abstract, and full-text reviews, 27 articles (48 patients) remained eligible. The mean age of patients was 33.0 years, with 2:1 male-to-female ratio. The mean follow-up was 41.8 months. SC was found to affect various intra- and extra-articular locations of the shoulder. Overall, arthroscopic treatment of shoulder SC was successful in 70.8%. Treatment failure was common in SC involving the bicipital tendon sheath. Disease recurrence was seen in 14.7%. CONCLUSION Literature on arthroscopic management of shoulder SC is limited, and significant heterogeneity in arthroscopic techniques was observed. Although arthroscopic management of shoulder SC is effective, further optimization is necessary to minimize treatment failure and disease recurrence.
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Affiliation(s)
- J Patrick Park
- J Patrick Park, McGill University Health Center,
Montreal General Hospital, 1650 Cedar avenue, B5.159 Montreal, Quebec H3G 1A4, Canada.
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13
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AlFarii H, Marwan Y, Algarni N, Addar A, Hamdy R, Janelle C. Temporary Screw Lateral Hemiepiphysiodesis of the First Metatarsal for Juvenile Hallux Valgus Deformity: A Case Series of 23 Feet. J Foot Ankle Surg 2022; 61:88-92. [PMID: 34266723 DOI: 10.1053/j.jfas.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 03/13/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
Juvenile hallux valgus (JHV) can limit the quality of life of the affected children. This study aims to evaluate the outcomes of temporary screw lateral hemiepiphysiodesis of the base of the first metatarsal. A chart review of patients who underwent temporary screw lateral hemiepiphysiodesis of the first metatarsal at a tertiary care pediatric orthopedic center was done. A total of 23 feet of 14 patients were included. The mean age of the patients was 10.6 ± 1.8 years, while the bone age was 11.1 ± 1.8 years. The mean follow-up duration was 24.7 ± 13.4 months (range: 12-60 months). The hallux valgus angle (HVA) improved from a mean of 30.9° ± 6.7° to a mean of 27.6° ± 8.2° (p = .001), while the intermetatarsal angle (IMA) improved from a mean of 14.6° ± 2.3° to a mean of 12.5° ± 3.0° (p < .001). Revision surgery was done for 5 (21.7%) feet of 3 patients for symptomatic uncorrected deformity (4 feet) or screw migration due to bone growth (1 foot). The mean HVA correction was 5.00° ± 3.7° in patients with bone age of 12 years or less compared to 1.50° ± 4.6° in patients with bone age of more than 12 years (p = .060). The radiological outcomes of temporary screw lateral hemiepiphysiodesis of the first metatarsal for JHV deformity correction are promising, especially in children with lesser bone age. The procedure was technically simple to perform and had minor complications.
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Affiliation(s)
- Humaid AlFarii
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Yousef Marwan
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nizar Algarni
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
| | - Abdullah Addar
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
| | - ReggieC Hamdy
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
| | - Chantal Janelle
- Division of Orthopaedic Surgery, Shriners Hospital for Children, McGill University Health Centre, Montreal, Quebec, Canada
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14
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Addar A, Marwan Y, Algarni N, Algarni N, Berry GK, Benaroch T. Tarsal coalition: Systematic review of arthroscopic management. Foot (Edinb) 2021; 49:101864. [PMID: 34597922 DOI: 10.1016/j.foot.2021.101864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 07/08/2021] [Accepted: 09/19/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The standard of care in the treatment of symptomatic tarsal coalitions is open surgery. However, certain limitations exist with open surgery, which include limited visualization leading to an incomplete resection and possible recurrence of the tarsal coalition. Arthroscopic tarsal coalition resection (TCR) is an alternative that is gaining traction, primarily as the safety profile of posterior ankle and subtalar arthroscopy is more well understood. This study provides a systematic review of the outcomes of arthroscopic TCR. METHODS PubMed and Embase were searched independently by 2 reviewers for relevant articles based on predetermined criteria. The subject heading "tarsal coalition" and its related key terms were used. RESULTS A total of 416 studies were revealed by the initial search, out of which only 6 met our predetermined inclusion criteria. A total of 42 patients (average age: 17.6 years) were treated with arthroscopic TCR. Thirty-three (78.6%) and 9 (21.4%) patients had talocalcaneal and calcaneonavicular coalitions, respectively. The follow-up period ranged from 6 to 60 months (mean: 26 months), and no recurrence of the tarsal coalition was detected (0.0%). Complications occurred in two (4.8%) patients only, with one developing complex regional pain syndrome (CRPS), and another patient developing hyperesthesia on the medial aspect of the calcaneus. CONCLUSION Arthroscopic TCR is a feasible and effective surgery for both CNC and TCC with minimal complications and no disease recurrence at an average of 26 months follow-up. Future high-level of evidence studies are needed to compare the outcomes of open versus arthroscopic TCR.
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Affiliation(s)
- Abdullah Addar
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Nizar Algarni
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nabil Algarni
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gregory K Berry
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Thierry Benaroch
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Sivakumaran T, Jaffer R, Marwan Y, Hart A, Radu A, Burman M, Martineau PA, Powell T. Reliability of Anatomic Bony Landmark Localization of the ACL Femoral Footprint Using 3D MRI. Orthop J Sports Med 2021; 9:23259671211042603. [PMID: 34692880 PMCID: PMC8532227 DOI: 10.1177/23259671211042603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Nonanatomic placement of anterior cruciate ligament (ACL) grafts is a leading cause of ACL graft failure. Three-dimensional (3D) magnetic resonance imaging (MRI) femoral footprint localization could enhance planning for an ACL graft's position. Purpose: To determine the intra- and interobserver reliability of measurements of the ACL femoral footprint position and size obtained from 3D MRI scans. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 41 patients with complete ACL tears were recruited between November 2014 and May 2016. Preoperatively, a coronal-oblique proton-density fast spin echo 3D acquisition of the contralateral uninjured knee was obtained along the plane of the ACL using a 1.5T MRI scanner. ACL footprint parameters were obtained independently by 2 musculoskeletal radiologists (observers A and B). The distal and anterior positions of the center of the footprint were measured relative to the apex of the deep cartilage at the posteromedial aspect of the lateral femoral condyle, and the surface area of the ACL femoral footprint was approximated from multiplanar reformatted images. After 1 month, the measurements were repeated. Intraclass correlation coefficients (ICCs) were calculated to assess for intra- and interobserver reliability. Bland-Altman plots were produced to screen for potential systematic bias in measurement and to calculate limits of agreement. Results: The ICCs for intraobserver reliability of the ACL femoral distal and anterior footprint coordinates were 0.75 and 0.78, respectively, for observer A. For observer B, they were 0.75 and 0.74, respectively. The ICCs for interobserver reliability were 0.75 and 0.85 for the distal and anterior coordinates, respectively. Bland-Altman plots demonstrated no significant systematic bias. For surface area measurements, the intraobserver ICCs were 0.37 and 0.62 for observers A and B, respectively. The interobserver reliability was 0.60. Observer B consistently measured the footprints as slightly larger versus observer A (1.19 ± 0.27 vs 1 ± 0.22 cm2, respectively; P < .001). Conclusion: Locating the center of the anatomic footprint of the ACL with 3D MRI showed substantial intra- and interobserver agreement. Interobserver agreement for the femoral footprint surface area was fair to moderate.
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Affiliation(s)
- Thiru Sivakumaran
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rehana Jaffer
- McGill University Health Sciences Centre, McGill University, Montreal, Quebec, Canada
| | - Yousef Marwan
- McGill University Health Sciences Centre, McGill University, Montreal, Quebec, Canada
| | - Adam Hart
- McGill University Health Sciences Centre, McGill University, Montreal, Quebec, Canada
| | - Arnold Radu
- McGill University Health Sciences Centre, McGill University, Montreal, Quebec, Canada
| | - Mark Burman
- McGill University Health Sciences Centre, McGill University, Montreal, Quebec, Canada
| | - Paul A Martineau
- McGill University Health Sciences Centre, McGill University, Montreal, Quebec, Canada
| | - Tom Powell
- McGill University Health Sciences Centre, McGill University, Montreal, Quebec, Canada
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Tamimi I, Ballesteros J, Lara AP, Tat J, Alaqueel M, Schupbach J, Marwan Y, Urdiales C, Gomez-de-Gabriel JM, Burman M, Martineau PA. A Prediction Model for Primary Anterior Cruciate Ligament Injury Using Artificial Intelligence. Orthop J Sports Med 2021; 9:23259671211027543. [PMID: 34568504 PMCID: PMC8461131 DOI: 10.1177/23259671211027543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Supervised machine learning models in artificial intelligence (AI) have been increasingly used to predict different types of events. However, their use in orthopaedic surgery has been limited. Hypothesis It was hypothesized that supervised learning techniques could be used to build a mathematical model to predict primary anterior cruciate ligament (ACL) injuries using a set of morphological features of the knee. Study Design Cross-sectional study; Level of evidence, 3. Methods Included were 50 adults who had undergone primary ACL reconstruction between 2008 and 2015. All patients were between 18 and 40 years of age at the time of surgery. Patients with a previous ACL injury, multiligament knee injury, previous ACL reconstruction, history of ACL revision surgery, complete meniscectomy, infection, missing data, and associated fracture were excluded. We also identified 50 sex-matched controls who had not sustained an ACL injury. For all participants, we used the preoperative magnetic resonance images to measure the anteroposterior lengths of the medial and lateral tibial plateaus as well as the lateral and medial bone slope (LBS and MBS), lateral and medial meniscal height (LMH and MMH), and lateral and medial meniscal slope (LMS and MMS). The AI predictor was created using Matlab R2019b. A Gaussian naïve Bayes model was selected to create the predictor. Results Patients in the ACL injury group had a significantly increased posterior LBS (7.0° ± 4.7° vs 3.9° ± 5.4°; P = .008) and LMS (-1.7° ± 4.8° vs -4.0° ± 4.2°; P = .002) and a lower MMH (5.5 ± 0.1 vs 6.1 ± 0.1 mm; P = .006) and LMH (6.9 ± 0.1 vs 7.6 ± 0.1 mm; P = .001). The AI model selected LBS and MBS as the best possible predictive combination, achieving 70% validation accuracy and 92% testing accuracy. Conclusion A prediction model for primary ACL injury, created using machine learning techniques, achieved a >90% testing accuracy. Compared with patients who did not sustain an ACL injury, patients with torn ACLs had an increased posterior LBS and LMS and a lower MMH and LMH.
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Affiliation(s)
- Iskandar Tamimi
- Knee Division, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Almudena Perez Lara
- Department of Radiology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jimmy Tat
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Motaz Alaqueel
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Justin Schupbach
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Cristina Urdiales
- Electronics Technology Department, Escuela de Ingeniería Telecomunicación, University of Malaga, Málaga, Spain
| | | | - Mark Burman
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Paul Andre Martineau
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada
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Abstract
BACKGROUND The subtalar joint has a complex anatomic function that includes inversion and eversion of the hindfoot, assisting in walking on uneven surfaces. Arthritis is the most common pathological condition affecting this joint and can require fusion. The surgery can be performed open or with arthroscopic assistance. This systematic review assesses articles written on the safety and efficacy of isolated arthroscopic subtalar fusion. METHODS Using MEDLINE and Embase, we systematically reviewed articles published before May 21, 2020. RESULTS Of 395 articles, 17 on a total of 395 patients (409 operations) were included in the review. The average duration of follow-up was 40.0 months (range, 3 to 105 months). Radiographic evidence of union was reported for 95.8% of cases at an average of 11.9 weeks (range, 6 to 56 weeks) postoperatively. Delayed union was reported in 1.0% of patients and nonunion, in 4.3% of patients. In the articles reporting patient satisfaction, including pain relief, 95.4% of patients had positive outcomes. Postoperative complications were reported in 64 patients (16.2%), including 37 (9.4%) with symptomatic implants, 11 (2.8%) with dysesthesia or neuropathic pain, and 3 (0.8%) with postoperative infection. CONCLUSIONS Arthroscopic subtalar fusion is a safe and effective alternative to open subtalar arthrodesis, with high patient satisfaction rates, high union rates at similar follow-up intervals, and low complication rates. The aim of future research should be to determine the ideal cases for this approach as well as the most efficient arthroscopic surgical technique and postoperative rehabilitation to optimize function and union as seen on radiographs. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Allison Loewen
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Susan M Ge
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gregory K Berry
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Loewen A, Ge SM, Marwan Y, Burman M, Martineau PA. Arthroscopic Management for Bipartite Patella: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211022248. [PMID: 34409114 PMCID: PMC8366165 DOI: 10.1177/23259671211022248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Bipartite patella is a rare congenital condition that becomes painful following direct trauma or an overuse injury. If it remains painful despite nonoperative treatment, surgery may be warranted. The current gold standard is open fragment excision or lateral release; however, arthroscopic management is also possible. Purpose: To investigate the safety and efficacy of arthroscopic treatment of painful bipartite patella. Study Design: Systematic review; Level of evidence, 4. Methods: Using Medline and Embase, we systematically reviewed the literature as of March 8, 2020, using the subject headings “bipartite patella” and “arthroscopy” and related key terms. All levels of evidence involving human studies in English were included. Articles were excluded if only the abstract was published or the study was related to nonsurgical treatment or nonrelated diagnoses. Data related to journal/article information, demographic/clinical data, arthroscopic technique, length of follow-up, treatment outcomes, and complications were extracted. Results: Eleven articles with 43 patients were included in the review. Most patients (n = 34; 79%) underwent arthroscopic lateral release, while 16% (n = 7) had arthroscopic excision of the accessory fragment and 5% (n = 2) had arthroscopic excision and release. All patients except for one, who experienced postoperative trauma, were pain-free after arthroscopic treatment and were able to return to sports after a mean 2.6 months. Conclusion: This review demonstrated that arthroscopic management of painful bipartite patella is a safe and effective alternative to open surgical excision or release. However, all articles were case studies or small case series, owing to the rarity of the condition. In the future, higher-level studies comparing arthroscopic techniques and postoperative rehabilitation programs should be performed.
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Affiliation(s)
- Allison Loewen
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Susan M Ge
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Mark Burman
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Paul A Martineau
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Marwan Y, Addar A, Algarni N, Algarni N, Burman M, Martineau PA. Endoscopic fasciotomy for chronic exertional compartment syndrome of the forearm: Systematic review of outcomes and complications. World J Orthop 2021; 12:320-328. [PMID: 34055589 PMCID: PMC8152436 DOI: 10.5312/wjo.v12.i5.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/18/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic fasciotomy of the forearm for chronic exertional compartment syndrome (CECS) has gained popularity recently.
AIM To systematically review the literature of endoscopic fasciotomy for CECS of the forearm, aiming to assess the outcomes and complications of the different endoscopic fasciotomy techniques described in the literature.
METHODS On January 18, 2021, PubMed and EMBASE were searched by 3 reviewers independently, and all relevant studies published up to that date were considered based on predetermined inclusion/exclusion criteria. The subject headings “endoscopic fasciotomy” and “compartment syndrome” and their related key terms were used. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.
RESULTS A total of seven studies including 183 patients (355 forearms) were included. The mean age of the patients was 31.2 years (range: 15-42 years). The postoperative follow-up duration ranged from 6 wk to 4.9 years. All patients were able to return to sport activities between postoperative weeks 1 to 8. Recurrence of the compartment syndrome occurred in three patients, giving a rate of 1.6% per patient and 0.8% per forearm. The overall complication rate was 8.7% per patient, and 4.5% per forearm. The most common reported complication was hematoma (7 forearms; 2.0%).
CONCLUSION Endoscopic fasciotomy for CECS of the forearm has favorable short- and mid-term outcomes with very low recurrence and complication rates. This, however, needs to be confirmed in larger, long-term follow-up, prospective, comparative studies between open, mini-open and endoscopic fasciotomy techniques.
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Affiliation(s)
- Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal H3G-1A4, Quebec, Canada
| | - Abdullah Addar
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal H3G-1A4, Quebec, Canada
| | - Nizar Algarni
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal H3G-1A4, Quebec, Canada
| | - Nabil Algarni
- Department of Orthopaedic Surgery, King Fahad Medical City, Riyadh 00966, Saudi Arabia
| | - Mark Burman
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal H3G-1A4, Quebec, Canada
| | - Paul A Martineau
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal H3G-1A4, Quebec, Canada
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20
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Hamido F, Habiba AA, Marwan Y, Soliman ASI, Elkhadrawe TA, Morsy MG, Shoaeb W, Nagi A. Correction to: Anterolateral ligament reconstruction improves the clinical and functional outcomes of anterior cruciate ligament reconstruction in athletes. Knee Surg Sports Traumatol Arthrosc 2021; 29:1181-1182. [PMID: 32816102 DOI: 10.1007/s00167-020-06177-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Fawzy Hamido
- Division of Sports Medicine, Al-Razi Orthopaedic Hospital, Ministry of Health, Kuwait, Kuwait. .,Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Safat, P.O. Box 24923, 13110, Kuwait, Kuwait.
| | - Abdelrahman A Habiba
- Division of Sports Medicine, Al-Razi Orthopaedic Hospital, Ministry of Health, Kuwait, Kuwait
| | - Yousef Marwan
- Division of Sports Medicine, Al-Razi Orthopaedic Hospital, Ministry of Health, Kuwait, Kuwait.,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait, Kuwait
| | - Aymen S I Soliman
- Department of Orthopaedic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tarek A Elkhadrawe
- Department of Orthopaedic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed G Morsy
- Department of Orthopaedic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Wael Shoaeb
- Division of Sports Medicine, Al-Razi Orthopaedic Hospital, Ministry of Health, Kuwait, Kuwait
| | - Ahmed Nagi
- Division of Sports Medicine, Al-Razi Orthopaedic Hospital, Ministry of Health, Kuwait, Kuwait
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Marwan Y, Luo L, Toobaie A, Benaroch T, Snell L. Operating Room Educational Environment in Canada: Perceptions of Surgical Residents. J Surg Educ 2021; 78:60-68. [PMID: 32741693 DOI: 10.1016/j.jsurg.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/18/2020] [Accepted: 07/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The educational experience in operating rooms (OR) plays a central role in the transformation of a trainee into a surgeon. As Canadian residency programs transition to competency-based medical education, and since most surgical competencies are attained in the OR, we investigated the perceptions of Canadian surgical residents about their OR learning environment. DESIGN Cross-sectional, national survey. SETTING An online questionnaire, including the validated 40-item operating room educational environment measure (OREEM) inventory, was sent to residency programs of all surgical specialties in Canada. The OREEM assesses the trainees' perceptions of the "trainer and training," "learning opportunities," "atmosphere in the operating room," "supervision, workload, and support," Each individual item was rated using a 5-point Likert scale ranging from "strongly disagree" (scores 1) to "strongly agree" (scores 5). The mean score of each individual item was measured, and the mean scores of each subscale and an overall score of the questions were also measured. PARTICIPANTS Surgical residents in Canada. RESULTS Four hundred thirty residents were included for final analysis. The overall mean OREEM score was 3.72 ± 0.4. "Atmosphere in the OR" was the subscale with the highest mean score (3.87 ± 0.5), while "supervision, workload, and support" had the lowest subscale mean score (3.49 ± 0.5). The overall OREEM mean score for junior and senior residents was 3.67 ± 0.4 and 3.80 ± 0.4, respectively (p = 0.001). No significant differences were seen in the mean OREEM score between males and females or different surgical programs. Nevertheless, general surgery had the lowest "supervision, workload, and support" subscale score (3.27 ± 0.5; p < 0.001). CONCLUSIONS The overall educational environment in OR may be considered satisfactory as perceived by Canadian surgical residents; however, several areas for potential improvement are identified and suggestions for optimizing the learning environment are described.
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Affiliation(s)
- Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Lucy Luo
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Asra Toobaie
- Division of Orthopaedic Surgery, Western University, London, Ontario, Canada
| | - Thierry Benaroch
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Linda Snell
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
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Al Farii H, Doyle-Kelly C, Marwan Y, Volesky M, Turcotte R. Arthroscopic Management of Synovial Chondromatosis of the Ankle Joint: A Systematic Review of the Literature. JBJS Rev 2020; 8:e2000045. [PMID: 33151646 DOI: 10.2106/jbjs.rvw.20.00045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Synovial chondromatosis (SC) of the ankle is a rare disorder in which metaplastic proliferation of synovia, tendon sheaths, and/or bursae leads to the formation of loose cartilaginous bodies within the joint space. While SC itself is a benign condition, its sequelae can be chronic and debilitating if left untreated, or if there is postoperative recurrence. Arthritic degeneration and malignant transformation to chondrosarcoma are among the more serious complications in the natural history of the disease; the latter occurs in approximately 5% of cases. We performed a systematic review of the literature on the arthroscopic management of ankle SC in order to better understand recurrence patterns and suggest an alternative approach to open arthrotomy. METHODS Using predetermined inclusion and exclusion criteria, the PubMed and Embase databases were searched for relevant articles related to arthroscopic surgical management of patients with confirmed SC of the ankle. Article selection and data abstraction were performed in 3 steps by 3 independent reviewers. RESULTS The initial search retrieved 116 articles, of which 15 were included. Those studies included 22 patients (14 to 63 years of age; 77% male) who were followed for a mean of 27 months (range, 8 weeks to 12 years) postoperatively. The cases represented a mix of primary and secondary SC etiologies, and almost entirely stage-III disease. Arthroscopic synovectomy with excision of loose bodies was a consistent feature of treatment, and bursectomy, debridement of osteochondral lesions or involved tendons, and osteophyte resection were performed as indicated. All but 1 case employed an anterior approach including anteromedial and anterolateral portals, and in several cases a 4-portal technique was used, which was subsequently proposed as a necessary approach for the definitive treatment of ankle SC. On the basis of the available data, complication and recurrence rates following arthroscopic management were very low. CONCLUSIONS A growing pool of evidence is emerging to suggest favorable outcomes for arthroscopic treatment of SC of the ankle joint. However, more data on patient and surgical variables, as well as comparative studies with longer follow-up, are needed in order to draw definitive conclusions. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Humaid Al Farii
- 1Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
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Abstract
Aims To systematically review the outcomes and complications of cosmetic stature lengthening. Methods PubMed and Embase were searched on 10 November 2019 by three reviewers independently, and all relevant studies in English published up to that date were considered based on predetermined inclusion/exclusion criteria. The search was done using “cosmetic lengthening” and “stature lengthening” as key terms. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles. Results A total of 11 studies including 795 patients were included. The techniques used in the majority of the patients were classic 3- or 4-ring Ilizarov fixator (267 patients; 33.6%) and lengthening over nail (LON) (253 patients; 31.8%), while implantable lengthening nail (ILN) was used in the smallest number of patients (63 patients; 7.9%). Mean end lengthening achieved was 6.7 cm (SD 0.6; 1.5 to 13.0), and the mean follow-up duration was 4.9 years (SD 2.1; 41 days to 7 years). Overall, the mean number of problems, obstacles, and complications per patient was 0.78 (SD 0.5), 0.94 (SD 1.0), and 0.15 (SD 0.2), respectively. The most common problem and obstacle was ankle equinus deformity, while the most common complications were deformation of the regenerate after end of treatment and subtalar joint stiffness/deformity. Conclusion Cosmetic stature lengthening provides favourable height gain, patient satisfaction, and functional outcomes, with low rate of major complications. Clear indications, contraindications, and guidelines for cosmetic stature lengthening are needed. Cite this article: Bone Joint Res 2020;9(7):341–350.
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Affiliation(s)
- Yousef Marwan
- Division of Orthopaedic Surgery, MGill University Health Centre, Montreal, Canada
| | - Dan Cohen
- Division of Orthopaedic Surgery, MGill University Health Centre, Montreal, Canada
| | - Mohammed Alotaibi
- Division of Orthopaedic Surgery, MGill University Health Centre, Montreal, Canada
| | - Abdullah Addar
- Division of Orthopaedic Surgery, MGill University Health Centre, Montreal, Canada
| | - Mitchell Bernstein
- Division of Orthopaedic Surgery, MGill University Health Centre; Shriners Hospital for Children, Montreal, Canada
| | - Reggie Hamdy
- Division of Orthopaedic Surgery, MGill University Health Centre; Shriners Hospital for Children, Montreal, Canada
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Marwan Y, Böttcher J, Laverdière C, Jaffer R, Burman M, Boily M, Martineau PA. Three-Dimensional Magnetic Resonance Imaging for Guiding Tibial and Femoral Tunnel Position in Anterior Cruciate Ligament Reconstruction: A Cadaveric Study. Orthop J Sports Med 2020; 8:2325967120909913. [PMID: 32284939 PMCID: PMC7137122 DOI: 10.1177/2325967120909913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Femoral and tibial tunnel malposition for anterior cruciate ligament (ACL) reconstruction (ACLR) is correlated with higher failure rate. Regardless of the surgical technique used to create ACL tunnels, significant mismatches between the native and reconstructed footprints exist. Purpose: To compare the position of tunnels created by a standard technique with the ones created based on preoperative 3-dimensional magnetic resonance imaging (3D MRI) measurements of the ACL anatomic footprint. Study Design: Controlled laboratory study. Methods: Using 3D MRI, the native ACL footprints were identified. Tunnels were created on 16 knees (8 cadavers) arthroscopically. On one knee of a matched pair, the tunnels were created based on 3D MRI measurements that were provided to the surgeon (roadmapped technique), while on the contralateral knee, the tunnels were created based on a standard anatomic ACLR technique. The technique was randomly assigned per set of knees. Postoperatively, the positions of the tunnels were measured using 3D MRI. Results: On the tibial side, the median distance between the center of the native and reconstructed ACL footprints in relation to the root of the anterior horn of the lateral meniscus medially was 1.7 ± 2.2 mm and 1.9 ± 2.8 mm for the standard and roadmapped techniques, respectively (P = .442), while the median anteroposterior distance was 3.4 ± 2.4 mm and 2.5 ± 2.5 mm for the standard and roadmapped techniques, respectively (P = .161). On the femoral side, the median distance in relation to the apex of the deep cartilage (ADC) distally was 0.9 ± 2.8 mm and 1.3 ± 2.1 mm for the standard and roadmapped techniques, respectively (P = .195), while the median distance anteriorly from the ADC was 1.2 ± 1.3 mm and 4.6 ± 4.5 mm for the standard and roadmapped techniques, respectively (P = .007). Conclusion: Providing precise radiological measurements of the ACL footprints does not improve the surgeon’s ability to position the tunnels. Future studies should continue to attempt to provide tools to improve the tunnel position in ACLR. Clinical Relevance: This cadaveric study indicates that despite the use of 3D MRI in understanding the ACL anatomy, re-creating the native ACL footprints remains a challenge.
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Affiliation(s)
- Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Jens Böttcher
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Carl Laverdière
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Rehana Jaffer
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Mark Burman
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Mathieu Boily
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Paul A Martineau
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Affiliation(s)
- Jumanah Karim
- Department of PediatricsMcGill University Health Centre Montreal Quebec Canada
| | - Yousef Marwan
- Division of Orthopaedic SurgeryMcGill University Health Centre Montreal Quebec Canada
- Department of SurgeryFaculty of MedicineHealth Sciences CentreKuwait University Kuwait City Kuwait
| | - Ahmed Dawas
- Department of MedicineMcGill University Health Centre Montreal Quebec Canada
| | - Ali Esmaeel
- Department of SurgeryFaculty of MedicineHealth Sciences CentreKuwait University Kuwait City Kuwait
| | - Linda Snell
- Department of MedicineMcGill University Health Centre Montreal Quebec Canada
- Centre for Medical EducationMcGill University Montreal Quebec Canada
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Ge SM, Marwan Y, Addar A, Algarni N, Chaytor R, Turcotte RE. Arthroscopic Management of Osteoid Osteoma of the Ankle Joint: A Systematic Review of the Literature. J Foot Ankle Surg 2019; 58:550-554. [PMID: 30910487 DOI: 10.1053/j.jfas.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Indexed: 02/07/2023]
Abstract
Osteoid osteomas (OOs) are rare benign bone tumors that may occur in various joints including the ankle. These tumors are generally removed via open surgical excision or radiofrequency ablation. However, when they occur intra-articularly, these treatments are more difficult to perform because of more difficult access and the increased risk of damaging articular cartilage. Therefore, some have advocated for the use of arthroscopy to treat these cases. This systematic review aims to investigate the safety and efficacy of arthroscopic treatment for intra-articular OO of the ankle. Using Medline and Embase, we systematically reviewed the literature as of May 31, 2017. All articles published on and before that date were reviewed by 2 independent reviewers. Seventeen articles containing a total of 27 cases were included in the review. Most reported cases were in the talar neck, followed by the distal tibia. Of all the cases, only 2 recurrences were reported (in the same patient), and no complications were reported. Therefore, these cases demonstrate arthroscopic excision of intra-articular OO of the ankle as a safe and effective alternative to open surgical excision and radiofrequency ablation, with a success rate of 96%. However, all articles found were case studies or small case series owing to the rarity of this disease. In the future, analyses of case series with larger case collections should be performed.
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Affiliation(s)
- Susan M Ge
- Resident, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada.
| | - Yousef Marwan
- Resident, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Abdullah Addar
- Resident, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Nizar Algarni
- Resident, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Ruth Chaytor
- Assistant Professor of Surgery, McGill University, Montreal, Canada; Staff Orthopaedic Surgeon and Chief of the Foot and Ankle Clinical Teaching Unit, Jewish General Hospital, Montreal, Canada
| | - Robert E Turcotte
- Professor of Surgery, McGill University, Montreal, Canada; Staff Orthopaedic Surgeon and Chief of Surgical Oncology, McGill University Health Centre, Montreal, Canada
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Addar A, Marwan Y, Algarni N, Berry G. Assessment of "YouTube" Content for Distal Radius Fracture Immobilization. J Surg Educ 2017; 74:799-804. [PMID: 28359680 DOI: 10.1016/j.jsurg.2017.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/26/2017] [Accepted: 03/06/2017] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Distal radius fractures (DRFs) are the most common orthopedic fractures, with >70% of cases treated by closed immobilization using a short arm cast or a sugar tong splint. However, inadequate immobilization is a risk factor for loss of reduction requiring repeat reduction or surgical treatment. Therefore, education of clinical skills for appropriate immobilization of DRFs is important. With the increasing use of web-based information by medical learners, our aim was to assess the quality and quantity of videos regarding closed immobilization of DRFs on YouTube. DESIGN Retrospective review of YouTube videos on distal radius fracture immobilization using specific search terms. SETTING Identified videos were analyzed for their educational value, quality of the technical skill demonstrated, and overall metrics. Educational value was scored on a 5-point scale, with "1" indicative of low quality and "5" of high quality. PARTICIPANTS Not applicable. RESULTS Among the 68,366 videos identified, 16 met our inclusion criteria of being in English; performed by a health care professional or institution; and with casting being the major theme of the educational information provided. Of these 16 videos, 6 had an educational value score of 4 or 5, with the remaining 10 having a score ≤3. Although immobilization was demonstrated by cast technician specialized in orthopedics, skills were also performed by orthopedic attendants, urgent care physicians, orthopedic residents, and nurse practitioners. The credentials of the performer in 3 videos were not identified. CONCLUSION There is a need to promote high-quality educational videos produced by established medical school faculty members on open, web-based, portals.
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Affiliation(s)
- Abdullah Addar
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nizar Algarni
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gregory Berry
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Marwan Y, Makhdom AM, Berry G. Locking Screw Migration to the Palm Four Years Following Surgical Implantation of Distal Radius Locking Plate. J Hand Surg Asian Pac Vol 2017; 22:363-365. [PMID: 28774236 DOI: 10.1142/s0218810417720248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hardware-related complications are rare in patients with distal radius fractures who were surgically fixed with volar-locking plates. In this report, we present a case of locking screw loosening and migration to the palm four years following the treatment of type 23-C1 distal radius fracture with a volar locking-plate. This complication occurred without evidence of trauma, infection, non-union or plate breakage. Orthopaedic surgeons should be aware of such rare complication and add it to the list of potential postoperative complications when counseling their patients preoperatively.
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Affiliation(s)
- Yousef Marwan
- * Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada.,† Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Asim M Makhdom
- * Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada.,‡ Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Gregory Berry
- * Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Marwan Y, Waly F, Algarni N, Addar A, Saran N, Snell L. The Role of Letters of Recommendation in the Selection Process of Surgical Residents in Canada: A National Survey of Program Directors. J Surg Educ 2017; 74:762-767. [PMID: 28126378 DOI: 10.1016/j.jsurg.2017.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/06/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Letters of recommendation (LOR) provide valuable information that help in selecting new residents. In this study, we aim to investigate the perceptions of surgical residency program directors (PDs) in Canada on the elements that can affect the strength and value of LOR. DESIGN Cross-sectional; survey. SETTING A national survey was conducted using an online questionnaire consisting of 2 main sections to collect data from PDs from all surgical subspecialties. The first section included basic background questions about the participant, such as the specialty and experience in selecting resident candidates, whereas the second section was about the elements and characteristics of LOR. Participants were asked to rate the importance of 34 different variables using a Likert scale. PARTICIPANTS Surgical PDs in Canada. RESULTS Of 122 PDs, 65 (53.3%) participated in the survey. Work ethic (57; 87.7%), interpersonal skills (52; 80.0%), and teamwork (49; 75.4%) were considered very important parts of the LOR by more than three-quarters of the PDs. Thirty-three (50.8%) PDs reported that a familiar author of LOR would always affect their impression regarding the letter. Additionally, 57 (87.7%) and 35 (53.8%) directors thought that LOR are important in evaluating the candidates and can help in predicting the residents' performance during their residency training. CONCLUSIONS LOR are important for the selection of new surgical residents in Canada. Information about the candidate's work ethic, interpersonal skills, and teamwork is essential for a good LOR. Familiarity of PDs with authors of LOR could increase the value of the letter.
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Affiliation(s)
- Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.
| | - Feras Waly
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, University of Tabuk, Tabuk, Saudi Arabia
| | - Nizar Algarni
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Addar
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Neil Saran
- Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Linda Snell
- Centre for Medical Education, McGill University, Montreal, Quebec, Canada
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Ibrahim SA, Shohdy EM, Marwan Y, Ramadan SA, Almisfer AK, Mohammad MW, Abdulsattar WS, Khirat S. Anatomic Reconstruction of the Anterior Cruciate Ligament of the Knee With or Without Reconstruction of the Anterolateral Ligament: A Randomized Clinical Trial. Am J Sports Med 2017; 45:1558-1566. [PMID: 28293966 DOI: 10.1177/0363546517691517] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotational instability of the knee remains an issue after anterior cruciate ligament (ACL) reconstruction. Hypothesis/Purpose: The purpose was to evaluate the subjective and objective outcomes of combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. The hypothesis was that favorable outcomes can be achieved with this surgical procedure compared with isolated anatomic reconstruction of the ACL. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS One hundred ten patients with a unilateral ACL injury and high-grade pivot shift were randomly assigned to undergo either combined ACL and ALL reconstruction (group A) or isolated ACL reconstruction (group B). Preoperative and postoperative evaluations of the patients were conducted by obtaining history details, recording physical examination findings, measuring knee laxity using the KT-1000 arthrometer, and using validated outcome scores for the knee. P < .05 was considered as the cut-off level of statistical significance. The Fisher exact and Mann-Whitney U tests were used to assess statistical significance. RESULTS At a mean follow-up of 27 months, 53 and 50 patients in groups A and B, respectively, were available for analysis. No statistically different outcomes were found between the 2 groups except for the KT-1000 arthrometer values. The median KT-1000 arthrometer result for combined ACL and ALL reconstruction was 1.3 mm, while the median result for isolated ACL reconstruction was 1.8 mm ( P < .001). None of the patients (n = 0; 0.0%) who underwent combined ACL and ALL reconstruction had anterior translation of greater than 5 mm at maximum pulling strength compared with their normal knees at final follow-up. On the other hand, 3 (6.0%) patients who underwent isolated ACL reconstruction had anterior translation of more than 5 mm. No serious complications were found in both groups. CONCLUSION Combined ACL and ALL reconstruction was found to be effective in improving subjective and objective outcomes. Nevertheless, these findings were not significantly superior to isolated ACL reconstruction except for the instrumented knee laxity testing results. This might indicate that ALL reconstruction should not be performed routinely for patients undergoing ACL reconstruction.
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Affiliation(s)
- Samir Abdulrazik Ibrahim
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Emad Mureed Shohdy
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Yousef Marwan
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Sami Abdulghaffar Ramadan
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Abdulrahman Khalid Almisfer
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Mohammad Wagdy Mohammad
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Wael Shoabe Abdulsattar
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Shiref Khirat
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
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Azeem MA, Marwan Y, Morshidy AE, Esmaeel A, Zakaria Y. A New Classification Scheme for Closed Avulsion Injuries of the Flexor Digitorum Profundus Tendon. J Hand Surg Asian Pac Vol 2017; 22:46-52. [PMID: 28205464 DOI: 10.1142/s0218810417500083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Closed avulsion injury of the flexor digitorum profundus (FDP) tendon is a relatively common condition of the hand. Its present classification system seems to be deficient in including all possible patterns of injury, leading to improper selection of the best treatment method for the injury. We aim to provide a new classification scheme for this injury. METHODS We developed a new classification scheme based on the possible pattern of FDP tendon injury. It consisted of three main types, and 10 sub-types. This was used to classify the injury of 34 patients, and help in choosing the best management approach. All patients underwent surgical treatment of their injury. The distal interphalangeal (DIP) joint extension deficit and total active motion (TAM) of the proximal interphalangeal (PIP) and DIP joints were considered as the main outcomes. Five orthopaedic surgeons used the new classification system for our cases, and the inter-rater reproducibility was tested with Fleiss' kappa. RESULTS The multi-rater kappa for the classification was excellent. At the final follow-up visit 24 months following surgery, the mean loss of extension of the DIP joint was 13.76° ± 13.53° (range 0° to 45°), while the mean TAM was 148.88° ± 22.64° (range 94° to 172°). Based on the TAM score, 21 (61.76%), 8 (23.53%) and 5 (14.71%) patients had excellent, good and fair results, respectively. None of our patients had poor results. CONCLUSIONS Our new classification scheme of FDP tendon avulsion appeared to be comprehensive and useful in guiding the surgeon for the best treatment option. Nevertheless, this should be confirmed by using it for larger number of patients with different patterns of injury.
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Affiliation(s)
- Mokhtar Abdul Azeem
- * Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.,† Division of Hand and Microsurgery, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.,‡ Department of Orthopaedic Surgery, Al-Azhar University Hospitals, Cairo, Egypt
| | - Yousef Marwan
- * Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.,§ Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ahmed El Morshidy
- § Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ali Esmaeel
- * Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.,∥ Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Yehia Zakaria
- * Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.,¶ Department of Plastic Surgery, Al-Babtain Hospital, Kuwait City, Kuwait.,** Department of Plastic Surgery, Zagazig University, Zagazig, Egypt
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Marwan Y, Dahrab B, Esmaeel A, Ibrahim SA, Al-Failakawi J. Extracorporeal shock wave therapy for the treatment of coccydynia: a series of 23 cases. Eur J Orthop Surg Traumatol 2017; 27:591-598. [DOI: 10.1007/s00590-016-1896-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/23/2016] [Indexed: 11/25/2022]
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Al-Saeed O, Marwan Y, Kombar OR, Samir A, Sheikh M. The feasibility of transpedicular screw fixation of the subaxial cervical spine in the Arab population: a computed tomography-based morphometric study. J Orthop Traumatol 2016; 17:231-8. [PMID: 26868419 PMCID: PMC4999373 DOI: 10.1007/s10195-016-0396-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 01/26/2016] [Indexed: 11/26/2022] Open
Abstract
Background Transpedicular screw fixation of the cervical spine provides excellent biomechanical stability. The feasibility of inserting a 3.5-mm screw in the pedicle requires a minimum pedicle diameter of 4.5 mm. This diameter allows at least 0.5 mm bony bridge medially and laterally in order to avoid pedicle violation which can result in neurovascular complications. We aim to evaluate the feasibility of this technique in Arab people since no data are available about this population. Materials and methods This cross-sectional study involved a retrospective review of computed tomography scans of normal cervical spines of 99 Arab adults. Ten morphometric measurements were obtained. Data were analyzed using a p value of ≤0.05 as the cut-off level of statistical significance. Results Our sample included 63 (63.6 %) males and 36 (36.4 %) females, with a mean age of 35.5 ± 16.5 years. The morphometric parameters of C3–C7 spine pedicles were larger in males than in females. The outer pedicle width (OPW) was <4.5 mm in >25 % of all subjects at C3–C6 vertebrae. Statistically significant differences in the OPW between males and females were noted at C3 (p = 0.032) and C6 (p = 0.004). Conclusions Inserting pedicle screws in the subaxial cervical spine is feasible among the majority of Arab people. Level of evidence Level 3.
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Affiliation(s)
- Osama Al-Saeed
- Department of Radiology, Faculty of Medicine, Health Sciences Center, Kuwait University, PO Box 24923, Safat, 13110, Kuwait City, Kuwait.
- Department of Radiology, Al-Amiri Hospital, Kuwait City, Kuwait.
| | - Yousef Marwan
- Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Osama Rabie Kombar
- Department of Radiology, Al-Amiri Hospital, Kuwait City, Kuwait
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Ahmed Samir
- Department of Radiology, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Mehraj Sheikh
- Department of Radiology, Faculty of Medicine, Health Sciences Center, Kuwait University, PO Box 24923, Safat, 13110, Kuwait City, Kuwait
- Department of Radiology, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
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Sadeq H, Karim J, Marwan Y, AlSaleem T. Neuroimaging Evaluation for First Attack of Unprovoked Nonfebrile Seizure in Pediatrics: When to Order? Med Princ Pract 2016; 25:56-60. [PMID: 26488747 PMCID: PMC5588324 DOI: 10.1159/000441847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 10/20/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the value of neuroimaging studies in evaluating pediatric patients presenting with a first attack of nonfebrile seizure. METHOD We reviewed the medical records of pediatric patients aged 28 days to 12 years who were admitted between 1 January and 31 December 2013 with a first attack of unprovoked, afebrile seizure. These patients had undergone neuroimaging studies. The exclusion criterion was patients with known predisposing conditions for seizure. The computed tomography (CT) scan and magnetic resonance imaging (MRI) results were either normal or abnormal, and the abnormal ones were further classified into clinically insignificant or significant. Descriptive analysis was performed to summarize the data. RESULT Fifty children were identified with a mean age of 5.2 ± 3.8 years. Of the 50 subjects, 29 (58.0%) were males and 21 (42.0%) were females. Sixteen patients (32.0%) had abnormal neuroimaging studies (CT scan, MRI or both); however, only 1 was considered to have a clinically significant abnormality, later diagnosed as Moyamoya disease. CONCLUSION In this study, the neuroimaging studies were found not to be useful in evaluating pediatric patients presenting with a first attack of unprovoked, nonfebrile seizures.
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Affiliation(s)
- Hussain Sadeq
- Department of Pediatrics, Al-Adan Hospital, Kuwait City, Kuwait
- *Hussain Sadeq, Department of Pediatrics, Al-Adan Hospital, Kuwait City (Kuwait), E-Mail
| | - Jumanah Karim
- Department of Pediatrics, Al-Adan Hospital, Kuwait City, Kuwait
| | - Yousef Marwan
- Department of Orthopedic Surgery, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait
| | - Talal AlSaleem
- Department of Pediatrics, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
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Abd-Almageed E, Marwan Y, Esmaeel A, Mallur A, El-Alfy B. Hybrid External Fixation for Arbeitsgemeinschaft für Osteosynthesefragen (AO) 43-C Tibial Plafond Fractures. J Foot Ankle Surg 2015. [PMID: 26215549 DOI: 10.1053/j.jfas.2015.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 43-C tibial plafond/pilon fractures represent a challenge for the treating orthopedic surgeon. We assessed the outcomes of using hybrid external fixation for this fracture type. The present prospective cohort study was started in August 2009 and ended by July 2012. Thirty consecutive patients (mean age 37.4 ± 10.7 years) with a type C tibial plafond fracture who had presented to our tertiary care orthopedic hospital were included. Motor vehicle accidents and fall from height were the cause of the fracture in 14 (46.7%) and 13 (43.3%) patients, respectively. A type C3 fracture was present in 25 patients (83.3%), and type C1 and C2 fractures were present in 2 (6.7%) and 3 (10.0%) patients, respectively. Nine fractures (30.0%) were open. Hybrid external fixation was used for all fractures. All fractures were united; clinical healing was achieved by a mean of 18.1 ± 2.2 weeks postoperatively and radiologic healing at a mean of 18.9 ± 1.9 weeks. The fixator was removed at a mean of 20.4 ± 2.0 weeks postoperatively. At a mean follow-up point of 13.4 ± 2.6 months, the mean modified Mazur ankle score was 84.6 ± 10.4. It was not associated with wound classification (p = .256). The most commonly seen complication was ankle osteoarthritis (17 patients; 56.7%); however, it was mild in >50.0% of the affected patients. In conclusion, using hybrid external fixation for type C tibial plafond fractures resulted in good outcomes. However, this should be investigated further in studies with a higher level of evidence.
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Affiliation(s)
- Emad Abd-Almageed
- Orthopaedic Trauma Surgeon, Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Yousef Marwan
- Orthopaedic Resident, Division of Orthopaedic Trauma, Department of Orthopaedic Hospital, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.
| | - Ali Esmaeel
- Assistant Professor of Orthopaedic Surgery, Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, and Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Amarnath Mallur
- Orthopaedic Trauma Surgeon, Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Barakat El-Alfy
- Assistant Professor of Orthopaedic Surgery, Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, and Department of Orthopaedic Surgery, Mansoura University, Mansoura, Egypt
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Abstract
Closed avulsion of the flexor digitorum profundus (FDP) tendon is classified based on the impact of injury on the management plan. In this report, we present a case with unclassified pattern of FDP tendon avulsion. The injury involves an intra-articular fracture of the volar part of distal phalanx of the little finger resulting into two bony fragments, one attached to the retracted avulsed tendon and another separated and incarcerated at A4 pulley, and an intact dorsal cortex of the phalanx. Based on that, we recommend the development of a new classification scheme for this condition.
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Affiliation(s)
- Mokhtar Abdul Azeem
- * Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait.,† Division of Hand and Microsurgery, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.,‡ Department of Orthopaedic Surgery, Al-Azhar University Hospitals, Cairo, Egypt
| | - Yousef Marwan
- * Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait
| | - Ali Esmaeel
- * Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait.,‡ Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
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Karim J, Al-Halabi B, Marwan Y, Sadeq H, Dawas A, Al-Abdulrazzaq D. The educational environment of the undergraduate medical curriculum at Kuwait University. Adv Med Educ Pract 2015; 6:297-303. [PMID: 25897273 PMCID: PMC4396345 DOI: 10.2147/amep.s81729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Educational environment of an institution affects the quality of learning. We aim to assess the educational environment of the undergraduate curriculum of Faculty of Medicine, Kuwait University (FOMKU). METHODS A cross-sectional study was carried out during April 2014. The validated Dundee Ready Education Environment Measure (DREEM) questionnaire was e-mailed to 607 students. Mean scores of the main domains of the questionnaire, and for each item, were calculated, and their association with the students' background information was measured using Student's t-test (P-value of ≤0.05 was considered as the cut-off level of significance). RESULTS Of 607 students, 117 (19.3%) completed the questionnaire. The total mean score for DREEM was 108.7/200 (54.3%). The mean score for students' perception of teaching, perception of teachers, academic self-perception, perception of atmosphere, and social self-perception were 25.2/48 (52.5%), 24.6/44 (55.9%), 18.4/32 (57.5%), 26.2/48 (54.5%), and 14.3/28 (51.0%), respectively. The highest mean score for an item of DREEM questionnaire was for "my accommodation is pleasant" (3.48±0.75), while the lowest was for "there is a good support system for students who get stressed" (0.88±0.86). The total mean score was not significantly different between the two phases of the curriculum, or among males and females; however, few significant differences among the main domains and items were noted. CONCLUSION Based on the learners' perspectives, the educational environment of FOMKU, was suboptimal. Medical educators in Kuwait should improve this environment in order to advance the quality of the delivered curriculum.
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Affiliation(s)
- Jumanah Karim
- Department of Pediatrics, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Becher Al-Halabi
- Department of Surgery, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Yousef Marwan
- Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Hussain Sadeq
- Department of Pediatrics, Al-Adan Hospital, Kuwait City, Kuwait
| | - Ahmed Dawas
- Department of Pediatrics, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Dalia Al-Abdulrazzaq
- Department of Pediatrics, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
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Ibrahim SAR, Abdul Ghafar S, Marwan Y, Mahgoub AM, Al Misfer A, Farouk H, Wagdy M, Alherran H, Khirait S. Intratunnel versus extratunnel autologous hamstring double-bundle graft for anterior cruciate ligament reconstruction: a comparison of 2 femoral fixation procedures. Am J Sports Med 2015; 43:161-8. [PMID: 25349264 DOI: 10.1177/0363546514554189] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anatomic double-bundle anterior cruciate ligament (ACL) reconstruction provides excellent results for restoring normal kinematics to the knee. Nevertheless, strong evidence supporting an ideal method for fixation of the ACL graft is lacking. HYPOTHESIS Intratunnel femoral fixation of the ACL graft via a cross-pin fixation technique would provide better clinical and objective results than the extratunnel femoral fixation with cortical buttons. STUDY DESIGN Randomized clinical trial; Level of evidence, 2. METHODS Seventy patients with a unilateral ACL-deficient knee were randomly assigned to 1 of 2 femoral fixation groups. Group A (35 patients) was fixed with 2 bioabsorbable Rigidfix pins, 1 cross-pin per bundle, while group B (35 patients) was secured with 1 EndoButton cortical button per bundle. All femoral tunnels were created via an anteromedial portal, and a bioabsorbable Biointrafix interference screw was used for tibial fixation for both groups. The evaluation of the patients was performed by history details, clinical examination findings, measurement of the joint laxity by KT-1000 arthrometer, and use of validated patient outcome questionnaires. Statistical analysis was carried out with Fisher exact and Mann-Whitney U tests, with P<.05 considered the cutoff level of significance. RESULTS At a mean follow-up of 30 months, 34 and 32 patients of group A and B, respectively, were available for evaluation. There were no statistically significant differences between the treatment groups regarding the subjective and objective outcomes, except for KT-1000 arthrometer values. The median KT-1000 value of patients in the cross-pin fixation group was 1.30 mm, while the median value in the cortical button fixation group was 1.95 mm (P<.001). Four patients with ACL grafts that were fixed with cortical buttons demonstrated failure of stability via the instrumented knee laxity testing, while patients from the other group had no failures. CONCLUSION Intratunnel femoral fixation of the double-bundle ACL graft from the cross-pin fixation technique provided better instrumented knee laxity results than did the extratunnel femoral fixation with cortical buttons. Future larger studies comparing these 2 techniques should be conducted to ensure the availability of stronger evidence supporting the findings of this study.
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Affiliation(s)
- Samir Abdul Razik Ibrahim
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Sami Abdul Ghafar
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Yousef Marwan
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Abdelbary Mohamed Mahgoub
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Abdulrahman Al Misfer
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Hassan Farouk
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Mohammad Wagdy
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Hamad Alherran
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Sharif Khirait
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
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Al-Halabi B, Marwan Y, Hasan M, Alkhadhari S. Extracurricular research activities among senior medical students in Kuwait: experiences, attitudes, and barriers. Adv Med Educ Pract 2014; 5:95-101. [PMID: 24812535 PMCID: PMC4010614 DOI: 10.2147/amep.s61413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Research is the foundation of scientific advancement and improvement in quality of health care, which ensures the good health of the community. The aim of this study is to explore experiences, attitudes, and barriers of medical students in Kuwait University (KU) in regards to extracurricular research. METHODS A questionnaire about extracurricular research activities (ie, any research activity that is not part of the required undergraduate curriculum, such as publishing a paper, research elective, etc) was distributed to 175 senior medical students (years 6 and 7). Descriptive and chi-square analyses were used to analyze the responses, considering a P-value of <0.05 as the cut-off level for significance. The main outcome was defined as taking part in any of the extracurricular research activities. RESULTS Of the 150 participants (response rate = 85.7%), 26 (17.3%), 68 (45.3%), 52 (34.7%), and 17 (11.3%) had published their required medical school research, presented abstracts in conferences, conducted extracurricular research, and completed a research elective/course, respectively; 99 (66.0%) took part in any of these activities. Participants who read medical journals regularly (81; 54%) reported higher participation in extracurricular research activities than those who did not read journals (P=0.003). Improving the availability of mentors for students' extracurricular research was ranked by the participants as the most important factor to improve their participation in extracurricular research (4.05/5.00). CONCLUSION Despite the lack of adequate support, extracurricular research activities among medical students of KU were comparable to students from other countries. Barriers for these activities should be addressed by KU medical educators in order to enhance research activities among the students.
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Affiliation(s)
- Becher Al-Halabi
- Department of Surgery, Mubarak Al-Kabeer Hospital, Ministry of Health, Kuwait
| | - Yousef Marwan
- Department of Orthopaedic Surgery, Al-Razi Hospital, Al-Sabah Medical Area, Ministry of Health, Kuwait
| | - Mohammad Hasan
- Department of Radiation Oncology, Kuwait Cancer Control Center, Al-Sabah Medical Area, Ministry of Health, Kuwait
| | - Sulaiman Alkhadhari
- Department of Psychiatry, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait
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Marwan Y, Husain W, Alhajii W, Mogawer M. Extracorporeal shock wave therapy relieved pain in patients with coccydynia: a report of two cases. Spine J 2014; 14:e1-4. [PMID: 24094989 DOI: 10.1016/j.spinee.2013.07.438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 06/27/2013] [Accepted: 07/13/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Extracorporeal shock wave therapy (ECSWT) has been used widely for musculoskeletal conditions; however, no reports are available about its use for coccydynia. PURPOSE Study the effect of ECSWT in relieving pain of coccydynia. STUDY DESIGN Case report. METHODS Extracorporeal shock wave therapy was used for two male patients, Patients 1 and 2, who failed to respond completely to other conservative management of coccydynia. Numerical pain scale (NPS) and visual analogue scale (VAS) were used to assess the pain. Consent to publish the data was obtained from both the patients. RESULTS Before starting ECSWT, Patient 1 reported a pain intensity of 6/10 and 5.1/10 on NPS and VAS, respectively, whereas the intensity of pain in Patient 2 was 7/10 and 6.9/10 on NPS and VAS, respectively. Four weeks after ECSWT, Patient 1 reported complete relief of pain on NPS and VAS, whereas Patient 2 reported a pain intensity of 1/10 and 0.8/10 on NPS and VAS, respectively. The same intensity of pain was reported by both patients after 12 months of follow-up. CONCLUSIONS Extracorporeal shock wave therapy relieved pain of coccydynia in our patients.
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Affiliation(s)
- Yousef Marwan
- Department of Orthopaedic Surgery, Jaber Al-Ahmad Armed Forces Hospital, PO Box 24923, 13110 Safat, Kuwait.
| | - Wael Husain
- Department of Orthopaedic Surgery, Jaber Al-Ahmad Armed Forces Hospital, PO Box 24923, 13110 Safat, Kuwait
| | - Waleed Alhajii
- Department of Radiology, Jaber Al-Ahmad Armed Forces Hospital, Safat, Kuwait
| | - Magdy Mogawer
- Department of Radiology, Jaber Al-Ahmad Armed Forces Hospital, Safat, Kuwait
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AlMutar S, AlTourah L, Sadeq H, Karim J, Marwan Y. Medical and surgical ward rounds in teaching hospitals of Kuwait University: students' perceptions. Adv Med Educ Pract 2013; 4:189-93. [PMID: 24101889 PMCID: PMC3791545 DOI: 10.2147/amep.s52096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Teaching sessions for medical students during ward rounds are an essential component of bedside teaching, providing students with the opportunity to regard patients as actual people, and to observe their physical conditions directly, allowing a better understanding of illnesses to be developed. We aim to explore medical students' perceptions regarding medical and surgical ward rounds within the Faculty of Medicine at Kuwait University, and to evaluate whether this teaching activity is meeting the expectation of learners. METHODS A pretested questionnaire was used to collect data from 141 medical students during the 2012-2013 academic year. They were asked to provide their current and expected ratings about competencies that were supposed to be gained during ward rounds, on a scale from 1 (lowest) to 5 (highest). Mean scores were calculated, and the Student t-test was used to compare results. P < 0.05 was the cut-off level for significance. RESULTS Only 17 students (12.1%) declined to participate in the study. The students' current competency scores (for competencies taught within both disciplines - medical and surgical) were significantly lower than the scores indicating students' expectations (P < 0.001). The best-taught competency was bedside examination, in both medical (mean: 3.45) and surgical (mean: 3.05) ward rounds. However, medical ward rounds were better than surgical rounds in covering some competencies, especially the teaching of professional attitude and approach towards patients (P < 0.001). CONCLUSION Both medical and surgical ward rounds were deficient in meeting the students' expectations. Medical educators should utilize the available literature to improve the bedside teaching experience for their students.
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Affiliation(s)
| | | | - Hussain Sadeq
- Department of Pediatrics, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Jumanah Karim
- Department of Pediatrics, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Yousef Marwan
- Department of Orthopedic Surgery, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait
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Abstract
BACKGROUND In Kuwait, 21 residency training programs were offered in the year 2011; however, no data is available regarding the criteria of selecting residents for these programs. This study aims to provide information about the importance of these criteria. METHODS A self-administered questionnaire was used to collect data from members (e.g. chairmen, directors, assistants …etc.) of residency programs in Kuwait. A total of 108 members were invited to participate. They were asked to rate the importance level (scale from 1 to 5) of criteria that may affect the acceptance of an applicant to their residency programs. Average scores were calculated for each criterion. RESULTS Of the 108 members invited to participate, only 12 (11.1%) declined to participate. Interview performance was ranked as the most important criteria for selecting residents (average score: 4.63/5.00), followed by grade point average (average score: 3.78/5.00) and honors during medical school (average score: 3.67/5.00). On the other hand, receiving disciplinary action during medical school and failure in a required clerkship were considered as the most concerning among other criteria used to reject applicants (average scores: 3.83/5.00 and 3.54/5.00 respectively). Minor differences regarding the importance level of each criterion were noted across different programs. CONCLUSIONS This study provided general information about the criteria that are used to accept/reject applicants to residency programs in Kuwait. Future studies should be conducted to investigate each criterion individually, and to assess if these criteria are related to residents' success during their training.
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Affiliation(s)
- Yousef Marwan
- Department of Surgery and Centre for Medical Education, Faculty of Medicine, Health Sciences Center, Kuwait University, Al-Jabriya, Kuwait
| | - Adel Ayed
- Department of Surgery and Centre for Medical Education, Faculty of Medicine, Health Sciences Center, Kuwait University, Al-Jabriya, Kuwait
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Al-Fouzan R, Al-Ajlan S, Marwan Y, Al-Saleh M. Factors affecting future specialty choice among medical students in Kuwait. Med Educ Online 2012; 17:19587. [PMID: 23272649 PMCID: PMC3529360 DOI: 10.3402/meo.v17i0.19587] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/09/2012] [Accepted: 11/22/2012] [Indexed: 05/17/2023]
Abstract
BACKGROUND Choosing a medical specialty can be either a daunting and confusing experience for some medical students and junior doctors or a foregone conclusion to others. The aim of this study is to evaluate factors affecting future specialty choice among medical students in Kuwait University. METHODS A self-administered questionnaire was used to collect data from medical students registered in Kuwait University during the academic year 2011/2012. Chi-square test and logistic regression were used to test the association between deciding a future specialty and students' sociodemographic and academic factors. RESULTS Of the 422 students approached, 387 (91.7%) decided to participate. A total of 144 (37.2%) students made a decision regarding their choice of future medical specialty. Pediatrics, general surgery, and cardiology were the most desired specialties - 18 (12.5%), 17 (11.8%), and 16 (11.1%) students requested these specialties, respectively. Only 61 (42.4%) of those who selected a future specialty received advice regarding their choice. Looking for a good treatment outcome for patients (66; 45.8%) and a challenging specialty (58; 40.3%) were the most influencing incentives when selecting a future specialty. Students in the clinical phase of their study were 3.014 (95% CI: 1.498-6.065) more likely to report on their decision regarding a future specialty compared to students in the basic medical sciences phase (p=0.002). CONCLUSION A variety of factors appeared to inspire medical students in Kuwait to choose a future medical specialty. When identified, these factors can be used by mentors of medical students and directors of residency training programs to motivate students to choose specialties that are limited in Kuwait.
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Affiliation(s)
| | | | - Yousef Marwan
- Yousef Marwan, Department of Surgery, Faculty of Medicine, Health Science Center, Kuwait University, Al-Jabriya, Kuwait, Tel: +00965–94060660.
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Marwan Y, Al-Saddique M, Hassan A, Karim J, Al-Saleh M. Are medical students accepted by patients in teaching hospitals? Med Educ Online 2012; 17:17172. [PMID: 22509091 PMCID: PMC3326580 DOI: 10.3402/meo.v17i0.17172] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/18/2012] [Accepted: 03/20/2012] [Indexed: 05/18/2023]
Abstract
BACKGROUND Worldwide, patients are the cornerstone of bedside teaching of medical students. In this study, the authors aimed to assess patients' acceptability toward medical students in teaching hospitals of the Faculty of Medicine of Kuwait University. METHODS Ninehundred and ninety five patients were approached in 14 teaching hospitals; 932 patients agreed to participate (refusal rate is 6.3%). A self-administered questionnaire was used to collect data. RESULTS In general, higher acceptance of students by patients was found when there is no direct contact between the patient and the student (e.g., reading patients' files, presenting in outpatient clinic, observing doctors performing examination or procedures) compared to other situations (e.g., performing physical examination or procedures). Pediatrics patients showed higher acceptance of students compared to patients in other specialties, while Obstetrics/Gynecology patients showed the highest refusal of students. Gender of patients (especially females) and students appeared to affect the degree of acceptance of medical students by patients. Majority of the patients (436; 46.8%) believed that the presence of medical students in hospitals improves the quality of health care. CONCLUSION Patients are an important factor of bedside teaching. Clinical tutors must take advantage of patients who accept medical students. Clinical tutors and medical students should master essential communication skills to convince patients in accepting students, thus improving bedside teaching. Also, using simulation and standardization should be considered to address scenarios that most patients are unwilling to allow students to participate.
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Affiliation(s)
- Yousef Marwan
- Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Al-Jabriya, Kuwait.
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Karim J, Al-Saraji M, Al-Mousawi F, Al-Haddad Z, Al-Sharaf D, Marwan Y, Akhtar S. Knowledge and self-reported practice of universal precautions among Kuwait University medical students in their clinical years. Med Princ Pract 2012; 21:328-33. [PMID: 22248907 DOI: 10.1159/000335278] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 11/23/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This cross-sectional study aimed to assess the knowledge and practice of universal precautions among Faculty of Medicine, Kuwait University, medical students in their clinical years. SUBJECTS AND METHODS A self-administered questionnaire including 9 knowledge and 9 practice questions of universal precautions was used. A score was calculated for both knowledge and practice. These scores were dichotomized into less than median score (poor) and more than median score (good). 244 students were invited to participate. RESULTS Of the 244 students, 220 (90.2%) accepted to participate. Of the 9 knowledge questions about universal precautions, 7 were answered correctly by more than 60% (range 64.8-90.4) of the students. All questions regarding the practice of universal precautions were answered correctly by over 60% (range 61.8-96.4) of the students. The prevalence of poor knowledge was 38.2% (84/220) and poor practice was 27.7% (61/220). Grade point average was significantly (p = 0.008) associated with the knowledge status of the respondents; however, it was not significantly associated (p = 0.397) with practice of universal precautions. Furthermore, neither the knowledge status nor any of the sociodemographic variables were significantly associated with the practice of universal precautions. CONCLUSIONS A substantial number of students of the Faculty of Medicine, Kuwait University, in their clinical years appeared to have poor level of both knowledge and practice of universal precautions. Efforts are needed to optimize the level of knowledge and practice among students to minimize the risk of preventable infections.
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Affiliation(s)
- Jumanah Karim
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Health Sciences Center, Kuwait University, Al-Jabriya, Kuwait
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Marwan Y, Behbehani A, Al-Mousawi A, Mulla-Juma'a A, Sadeq H, Shah N. Sports injuries among professional male athletes in Kuwait: prevalence and associated factors. Med Princ Pract 2012; 21:171-7. [PMID: 22024622 DOI: 10.1159/000332442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 08/15/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To assess a 12-month period and the lifetime prevalence of sports injuries among male athletes according to type of sport, type of injury and its seriousness, and to examine the association of injuries with sociodemographic, lifestyle and preventive factors. SUBJECTS AND METHODS In this cross-sectional study, we approached 475 professional athletes participating in ball sports, aged 15 years and older, from 5 sports clubs in Kuwait. Of them, 452 responded. Four ball games--football (soccer), basketball, handball and volleyball--were included. Data were collected through a self-administered questionnaire. Bivariate and multivariate relationships between associated factors and experience of injury were tested by using χ(2) and logistic regression. RESULTS The overall 12-month and lifetime prevalence of sports injuries were 73.8 and 89.8%, respectively. Prevalence was highest among volleyball athletes (79%) and lowest among football (soccer) athletes (69%). Lower limbs (73.1%) were the most common site of injuries and joint injuries (43.6%) were the most common type. For the most recent injury, 138 (42%) of athletes took more than 10 days off practice. Compared to volleyball, football (soccer) and handball athletes were 2.9 times (95% CI: 1.3-6.3) and 3.4 times (95% CI: 1.5-7.8) more likely to take more than 10 days off practice. Athletes who sometimes wore protective gears were 3.1 times (95% CI: 1.7-5.8) more likely to report an injury compared with those who never wore protective gears (p < 0.001). CONCLUSIONS Sports injuries are highly prevalent among professional athletes in Kuwait. Future studies are needed to provide guidelines for interventions that may reduce such injuries.
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Affiliation(s)
- Yousef Marwan
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Health Sciences Centre, Kuwait University, Al-Jabriya, Kuwait.
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