Osteoporosis and its complications are a major health concern in Saudi Arabia, and the prevalence of osteoporosis is on the rise. The aim of this study was to estimate the direct healthcare cost for patients with osteoporosis. A retrospective study was carried out among adult patients with osteoporosis in a teaching hospital in Saudi Arabia. A bottom-up approach was conducted to estimate the healthcare resources used and the total direct medical cost for the treatment of osteoporosis and related fractures. The study included 511 osteoporosis patients, 93% of whom were female. The average (SD) age was 68.5 years (10.2). The total mean direct medical costs for patients without fractures were USD 975.77 per person per year (PPPY), and for those with osteoporotic fractures, the total direct costs were USD 9716.26 PPPY, of which 56% of the costs were attributable to surgery procedures. Prior to fractures, the main cost components were medication, representing 61%, and physician visits, representing 18%. The findings of this study indicated the economic impact of osteoporosis and related fractures. With the aging population in Saudi Arabia, the burden of disease could increase significantly, which highlights the need for effective prevention strategies to minimize the economic burden of osteoporosis.

Background and Objectives: Multiple hyaluronic acid (HA) products were approved and marketed to manage osteoarthritis (OA). Although these products are widely prescribed by orthopedic surgeons to manage OA, especially knee OA, the therapeutic value of these products is highly uncertain. Few studies with significant limitations in their designs have indicated positive outcomes among OA patients treated with HA; however, their results were inconclusive. Thus, we aimed to explore the therapeutic value of different HA products in alleviating knee OA pain and improving patients’ physical function from the orthopedic surgeons’ perspective. Materials and Methods: This was a questionnaire-based cross-sectional study in which practicing orthopedic surgeons in two countries (e.g., Saudi Arabia and Jordan) were invited to participate. The 10-item, newly developed questionnaire inquired about the respondents’ sociodemographic characteristics (e.g., age, gender, country, years of experience), and their opinions regarding the efficacy of HA products in the management of OA (e.g., efficacy in improving mobility and alleviating pain). Results: Out of the 200 orthopedic surgeons who were invited to participate, 122 (61%) filled out the questionnaire. Most of the respondents were from Saudi Arabia (58%), aged 35 to 55 years (68%), had at least 10 years of experience (69%), and male (98%). About 80% of the respondents reported prescribing HA, such as Hyalgan^®, Orthovisc^®, Hyalubrix^®, and Crespine Gel^®. About 66% of the respondents believed that HA was moderately to highly effective in managing knee OA, and 34% believed that HA was either ineffective or mildly effective. Pain at the site of injection (44.3%) and rash or local skin reactions (22.1%) were the most commonly reported adverse events. Conclusions: The variations in the formulation of different HA brands (e.g., molecular weight and cross-linking) did not seem to offer any therapeutic advantage. HA might have value in the management of knee OA; however, its value is highly uncertain and necessitates more well-designed studies to further examine its therapeutic value.

Background: Musculoskeletal pain is one of the most complex and debilitating types of pain. Although different pharmacologic treatments are available, very few studies have explored the predictors for opioid analgesics prescription to manage this type of pain. Objective: The aim of this study was to explore the predictors for opioid prescription in patients with acute musculoskeletal pain in Saudi Arabia. Methods: This was a single-center, retrospective chart review of adult patients (≥ 18 yrs.) with an acute nociceptive musculoskeletal pain at a university-affiliated medical center in Riyadh, Saudi Arabia. Cancer patients and those with chronic neuropathic pain were excluded. Patients’ age, gender, number of comorbidities, duration of pain management, number of clinic visits for pain, and Numeric Pain Rating Scale (NPRS) scores at rest and with normal activities were collected. Multiple logistic regression was conducted to examine the relationship between the type of musculoskeletal pain and the prescription of opioid analgesics controlling for NPRS score on activity, age, gender, number of comorbidities, duration of pain treatment, and number of clinic visits for pain. Results: The mean age of the 227 patients, who met the inclusion criteria, was 39 years and 68% of them were male. Sixty-three percent of the patients were prescribed opioid analgesics, and 61% of them had shoulder pain, 29% had back pain, and 10% had lower extremity pain (eg, hip, thigh, lower leg, knee, ankle, and foot pain). Tramadol was the most commonly prescribed opioid analgesic (82%), followed by codeine (13%). Ninety-seven percent of patients who were prescribed non-opioid analgesics had shoulder pain. Patients with shoulder pain had lower odds of receiving opioid analgesics (OR=0.019, P< 0.0001, 95% CI=0.004– 0.081) in comparison to their counterparts who had lower extremity or back pains. Moreover, the higher the pain score on activity was, the higher odds of receiving opioid analgesics (OR=1.317, P< 0.0001, 95% CI=1.029– 1.685). Conclusion: Future studies should explore the impact of different opioid prescribing policies to improve the quality of patient care and reduce the unnecessary prescribing of opioids for patients with non-cancer musculoskeletal pain.

Introduction: Chondrosarcoma is the second most common primary malignancy of bone that can occur in multiple locations in the skeleton. It has been rarely reported in the proximal radius. While surgical resection is the primary treatment modality for individuals with localized disease, reconstruction can be challenging in the elbow joint due to its complex anatomy. 3D printing technology can be used in such complex cases to restore the normal anatomy after resection. Case presentation: We present a case of mesenchymal chondrosarcoma in a 33-year-old male occurring in the proximal radius, restricting his elbow motion. That was resected and reconstructed using 3D modeling. Restoring a functional range of motion without instability. Discussion: Many surgical options for chondrosarcoma presented over the years including en bloc resection, resection with or without reconstruction, or amputation. Usage of 3D modeling in the orthopedic surgery field is relatively new and it can be used in pre-operative planning and shortens surgical time. 3D printing in our case helped in obtaining a full range of motion (flexion, extension, pronation, and supination) for the patient. Conclusion: It's important to reconstruct elbow joint support structure and function after resection of such a large malignant tumor in young patients. We used 3D printed implant to maintain a functional limb and it was an excellent alternative treatment. Highlights:

Tibial plateau fractures are quite common among lower limb fractures. Several fracture classifications exist including Schatzker classification, in which tibial plateau fractures are divided into six types where each increasing numerical category indicates increasing severity of the injury and worsening prognosis. Arthroscopic-assisted techniques using a lateral or medial metaphyseal window have shown results comparable to open internal fixation methods with multiple advantages. We present a case of a medically and surgically free 40-year-old lady who presented to our emergency department complaining of left knee pain following a fall from the stairs. Clinically there was significant swelling and tenderness over the lateral aspect of the left proximal tibia, radiographs showed a Schatzker type III tibial plateau fracture, confirmed by computed tomography (CT). A combined intraoperative arthroscopic- and fluoroscopic-guided reduction of the articular depression through a lateral cortical window was achieved and the fracture was fixed using a minimally invasive fixation technique. The postoperative course was uneventful. The patient had recovered full range of motion and the wounds were barely visible. One-year X-ray showed healed fracture without any evidence of displacement or subsidence.