This was a prospective study to evaluate the effect of multilevel vertebral augmentation in addition to conventional therapy in multiple myeloma patients. We treated 27 patients, whom were recently diagnosed to have multiple myeloma by two ways of treatment. Thirteen patients (group I) were treated with conventional therapy and 14 patients (group II) with adding vertebroplasty and kyphoplasty. Patients were evaluated pre-treatment and at half, one, two and 3-years post-treatment by using Oswestry Disability Index (ODI), the Stanford Score (SS) and the Spinal Instability Neoplastic Score (SINS). Mean values of ODI, SS and SINS were 31.9 (63.8%), 4.3 and 13.8 for group I and 33.2 (66.4%), 4.6 and 12.8 for group II before starting treatment. Group II showed improvement better than group I at all follow-up intervals with best results at first 6 months. P-values at the end of the study were ODI = 0.047, SS = 0.180 and SINS = 0.002. Mortality rates were equal of both groups (four patients of each group). Adding vertebral augmentation to conventional therapy improves multiple myeloma patients’ quality of life, but didn’t affect the mortality rate.

Background: Spontaneous rupture of extensor pollicis longus (EPL) tendon is a rare condition often found in patients actively having regular extensive use of hands and fingers especially the thumb. In this article, we report 7 cases of spontaneous rupture of EPL tendon and investigate the associated factors and treatment outcome. Methods: Retrospectively, the databases for the 7 cases were retrieved and studied. These cases represent all cases of spontaneous rupture of EPL in our institution. Demographic data, clinical presentation, any history of trauma or steroid injection, laboratory and clinical findings suggestive for rheumatoid arthritis, co-morbidities and imaging findings were obtained. In addition, the operative technique and findings were retrieved. Moreover, histopathological studies and follow-up assessment were included. Results: Six males and one female were included. The mean age was 45.2 years. No prior history of trauma, rheumatological disease or steroid use was detected in any patient. All patients experienced prodromal pain in the radial side. Clinical examination was the most effective diagnostic measure. Magnetic resonance imaging (MRI) was used to confirm the diagnosis and to look for other abnormalities that may predispose to rupture. Five patients underwent extensor indicis proprius to EPL tendon transfer employing Pulvertaft weave technique and one patient underwent primary repair as there was a little gap in the tendon ends. In this study, one patient refused any treatment. All patients achieved a favorable outcome at the last follow-up. Conclusion: Diagnosis of spontaneous ruptures of EPL tendon can be confirmed through clinical examination and MRI for patients with restricted thumb movement even with the absence of any identifiable predisposing risk factor. During surgery, detailed attention must be drawn towards the tendon ends which can have unusual gaps and bone abnormalities.

Background: Elderly hip fractures represent a global health care burden. Several reports expected a massive increase in the incidence of hip fractures by the next few decades. Knowing the epidemiology of hip fractures is crucial for planning health care policies. The purpose of this study is to provide a nationwide epidemiological overview of hip ‎fractures in Jordan and to report the perioperative outcomes that may help to improve the delivered healthcare. ‎. Methods: We conducted ‎ a retrospective study at 2 university hospitals and 2 major ‎governmental hospitals in Jordan.‎ We reviewed the records for all patients (age > 55 years) who were diagnosed with hip fractures ‎over a 3 years duration (2019– 2021). ‎We documented the patient’s characteristics and the perioperative data (including preoperative, intraoperative, and postoperative details including the 1-year mortality).‎ Results: The total number of included patients was 1268; more than half (53.7%) were females.‎ The mean age is ‎ 75 years (SD 9.7). ‎ The most common fracture type was trochanteric (66.2%)‎. ‎ 7% of patients had a prior contralateral hip fracture‎. The average time from admission to surgery was 2.96 days (SD 2.63). The surgery was done within 48 ‎hours for ‎ 56.7%‎ of patients.‎ Approximately, one-third of all patients (34.5%) received a blood transfusion.‎ The average length of hospital stay is 7.44 days (SD 5). The overall rate of postoperative thromboembolic events, readmission within 1 month, and revision ‎for the same surgery are 2.4%‎, 10.7%‎, and 3% respectively.‎ The 1-month, 6-month, and 12-month mortality rates are 4.5%, 9.1%, and 12.8% respectively. Conclusion: The annual incidence of elderly hip fractures in Jordan is approximately 96 per 100,000 individuals. The 1-year mortality rate of hip fractures in Jordan ‎is ‎ 12.8%‎.‎ Both findings are ‎in the lower range of nearby Arab countries.

Combined proximal humerus fracture and glenohumeral dislocation in the pediatric population is extremely rare, with only few reports of such cases been reported. We review all cases of combined proximal humerus fracture and glenohumeral dislocation in the pediatric population and present a case of left proximal humerus fracture dislocation in a healthy 5-year-old girl. A 5-year-old girl fell from 2 m height and landed on her left shoulder where she started to complain from severe left shoulder pain, inability to move her left shoulder and bruising. She was diagnosed at our facility to have left proximal humerus fracture combined with glenohumeral dislocation and was treated with open reduction, K-wires fixation and immobilization in a shoulder cast. Traumatic proximal humeral fracture associated with glenohumeral dislocation is a rare presentation in pediatric age group. This type of fracture is usually managed by closed reduction and casting, with a minority being managed with open reduction. Indications for surgical intervention are open fractures, severely displaced fractures, fractures that are associated with neurovascular compromise, or irreducible fracture due to soft tissue obstacles. A high index of suspicion is required to diagnose such injuries along with appropriate radiographic evaluation. We recommend open reduction with K-wires fixation for irreducible combined proximal humeral fracture and glenohumeral dislocation.

Spontaneous Full Recovery of High Radial Nerve Palsy Following Closed Reduction and Percutaneous Pinning of Gartland IV Supracondylar Fracture: A Case Report - Article abstract #930277