Osteochondromas are bone lesions composed of medullary and cartilaginous bone covered by a cap of hyaline cartilage. The presence of medullary and cortical bone with the continuity of the tumor is pathognomonic for osteochondroma and aid in establishing the diagnosis. We report a case of a two-year-old girl who presented to our clinic following her mother noticing a palpable, growing, and painful mass on her left scapula. There was no limitation in the range of motion. A clear-cut mass was seen on the dorsal aspect and palpated measuring around 2.5x3 cm. Surgical excision of the mass followed by histologic examination confirmed osteochondroma. Upon follow-up, the patient had no pain and had a full range of left shoulder motion without discomfort or pain. In conclusion, scapular exostoses are very rare and more so when they present dorsally. Symptomatic lesions can be managed effectively with surgical excision of exostosis.

Background: Mental health disorders are common in Saudi Arabia with a 34% lifetime prevalence. Cognitive behavioral therapy (CBT), a type of psychotherapy, is an evidence-based intervention for the majority of mental disorders. Although the demand for CBT is increasing, unfortunately, there are few therapists available to meet this demand and the therapy is expensive. Computerized cognitive behavioral therapy (cCBT) is a new modality that can help fill this gap. Objective: We aimed to measure the knowledge of cCBT among mental health care professionals in Saudi Arabia, and to evaluate their attitudes and preferences toward cCBT. Methods: This quantitative observational cross-sectional study used a convenience sample, selecting mental health care professionals working in the tertiary hospitals of Saudi Arabia. The participants received a self-administered electronic questionnaire through data collectors measuring their demographics, knowledge, and attitudes about cCBT, and their beliefs about the efficacy of using computers in therapy. Results: Among the 121 participating mental health care professionals, the mean age was 36.55 years and 60.3% were women. Most of the participants expressed uncertainty and demonstrated a lack of knowledge regarding cCBT. However, the majority of participants indicated a positive attitude toward using computers in therapy. Participants agreed with the principles of cCBT, believed in its efficacy, and were generally confident in using computers. Among the notable results, participants having a clinical license and with cCBT experience had more knowledge of cCBT. The overall attitude toward cCBT was not affected by demographic or work-related factors. Conclusions: Mental health care professionals in Saudi Arabia need more education and training regarding cCBT; however, their attitude toward its use and their comfort in using computers in general show great promise. Further research is needed to assess the acceptance of cCBT by patients in Saudi Arabia, in addition to clinical trials measuring its effectiveness in the Saudi population.

Medical research is a crucial indicator of a nation's reputation and development. However, there are concerns about the limited orthopedic research in Kingdom of Saudi Arabia (KSA). Therefore, this study conducted bibliometric analysis to investigate orthopedic research output from KSA. PubMed database for orthopedic articles, with a minimum of one KSA-affiliated orthopedic author published from the year 2000 onwards, was searched. This excluded duplicate articles, corrections, letters, editorials, commentaries, and brief communications. The titles of the included articles, publication years, first and corresponding authors' primary affiliations and countries, countries and institutes of research, and total citations were noted. Thereafter, year-wise research contribution, top contributing and collaborating nations, top contributing affiliations, study types, levels of evidence, journal distribution, their impact factor, h-index and quartile-related information, and citation trends were analyzed. The search strategy yielded 1047 eligible articles. An increasing trend in research contributions in recent years was observed, with the least number of articles (8) contributed in 2005 and the most (140) in 2023. The research was conducted in KSA for most articles (83.48%). Authors from Canada collaborated in 3.44% of the articles. King Saud University was the top contributing institution (17.38% of all articles). There were 66 (6.30%) basic science studies and 873 (83.3%) clinical studies. Among non-basic science studies, 84.51% had level IV evidence. Overall, 73.83% of articles had either first/corresponding or both authorships from KSA-affiliated orthopedic authors. The eligible articles were published in 303 journals, with a mean impact factor of 3.04 (range 0.4-51.1, 165 journals) and a mean h-index of 59.2 (range 1-367, 277 journals). Overall, 31.23% of articles with quartile information available were published in first-quartile journals. The orthopedic research productivity in KSA is limited. However, there has been an increasing trend in orthopedic research in recent years. Nevertheless, the quality of clinical research, particularly the level of evidence, needs improvement. Therefore, further efforts should be made to strengthen research opportunities and encourage research participation among orthopedic and medical institutes.

A 32-year-old male was brought to our emergency department following trauma due to fall of heavy object (tree) on his back. After Advanced Trauma Life Support (ATLS) protocol implementation, the patient was noted to have a complete perianal tear and loss of power in L3-S1 measuring 1/5 complete loss of sensation below the level of L2. Imaging showed spinopelvic dissociation with cauda equina syndrome. Spinopelvic fixation and fusion with rigid fixation done. The patient regained normal function following extensive physiotherapy. This paper concludes that good and prompt surgical intervention facilitated neurological recovery following decompression.

Background: Thoracolumbar fractures are classified into four categories according to the mechanism of injury and fracture morphology into compression fracture, burst fracture, flexion-distraction injury, and fracture dislocation. Unfortunately, the management of spinal fracture has lacked standardization given the many unanswered yet relevant questions regarding the outcome. However, management is generally divided into surgical and nonsurgical treatment such as orthosis. We aim to compare the clinical and the radiological outcomes of operative spinal fractures in patients with thoracolumbar spinal orthoses (TLSO) and patients without TLSO. Up to our knowledge, there are no similar studies comparing such management approaches in Saudi Arabia. Methods: This is a retrospective cohort study conducted in King Saud Medical City which included patients over 18 years of age from the past 10 years who underwent spinal fixation with or without the use of orthotics and had at least 6 months follow-up. We have excluded any patients with degenerative diseases, spinal tuberculosis or spinal tumors. Our primary outcome was radiological outcomes and clinical outcomes among groups using orthotics postoperatively versus groups who didn’t use orthotics. Statistical analysis was done utilizing The Statistical Package for the Social Sciences (SPSS) IBM statistical computing program version 21 was used for the statistical data analysis and the alpha significance level was considered at 0.050 level. Results: The patients were divided into two groups, patients given TLSO postoperatively (group A) (53.1%) and patients not given TLSO postoperatively (group B) (46.9%). Most of the patients had a burst fracture and most (86.4%) had endured a single level spine fracture. Bivariate Pearson’s correlations test showed the patients mean perceived pain level [the visual analogue scale (VAS)] had correlated negatively and significantly with their emotional well-being (EM-WB) score, r=−0.132, P<0.05. Moreover, the patients self-rated pain level had correlated negatively and significantly with their satisfaction level with their comfort subscale score, r=−0.156, P<0.05. The patients mean measured kyphotic angle had correlated positively with their mean comfort level satisfaction, r=0.158, P<0.05. A non-parametric Mann-Whitney U test showed that the patients who used TLSO had perceived significantly greater general health (GH) score (mean GH score =77.44) compared to those who have not used TLSO (mean GH score =70.79), Z=2.38, P=0.02. Group A perceived significantly lower satisfaction with their social limitations (mean score =71.32) compared to group B (mean score =89.47) on average, Z=2.10, P=0.040. Group B (n=38) measured a significant decline in their pain level across the three time-point measured pain levels (P<0.001). Conclusions: Our study concludes that both groups have noticeable reductions in pain postoperatively and have shown decent results with regards to the Short Form 36 (SF-36) scores. However, further research is necessary to gain a comprehensive understanding of the varying effects of bracing versus non bracing long-term outcomes in upper thoracic and thoracolumbar fractures.

Background: Anatomic variations of the popliteal artery are critical to recognize during preoperative planning to avoid complications. The aberrant anterior tibial artery (AATA) arises higher than the usual site of the anterior tibial artery, and it passes between the posterior tibial cortex and anterior to the popliteus muscle. Purpose: To assess AATA prevalence, magnetic resonance imaging (MRI) landmarks, intraoperative vascular injuries, and surgeon acknowledgment of the AATA presence. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study was conducted in 2 stages. During the first stage, 787 knee MRIs were reviewed to detect the AATA prevalence. In the second stage, 10 board-certified knee and sports surgeons were invited to comment on 10 knee MRIs, 5 of which showed AATA variation. This assessment was performed 3 times: (1) at baseline; (2) immediately after an instructional orientation session; (3) 2 weeks after the orientation session. Results: The prevalence of the AATA was found to be 2.03%. MRI measurements revealed that the AATA was, on average, 5.69 mm from the tibial attachment of the posterior cruciate ligament (PCL) and 9.89 mm from the posterior horn of the lateral meniscus. The anatomic variation of the AATA was most consistently visualized at the level of the tibial attachment of the PCL in 81.25% of cases. Before instructional orientation, observer surgeons failed to identify the presence or absence of the AATA on all MRI images. However, after the orientation, all observers accurately identified the AATA in both positive and negative cases immediately and after 2 weeks, achieving 100% intraobserver reproducibility. Conclusion: Popliteal artery anatomic variations may often be overlooked in preoperative planning; a detailed understanding of these variations is crucial to prevent unfortunate intraoperative complications. None of the surgeons detected the AATA on the first encounter. This highlights the importance of education in improving the detection and diagnosis of the AATA.