Background: This study compared the practice of elderly hip fractures management at Jordan University Hospital against the practice recommended by American Academy of Orthopaedic Surgeons (AAOS). Methods: Medical records between Oct 1, 2017, and Oct 31, 2018, were reviewed retrospectively. Inclusion criteria included patients over the age of 65 yr who were admitted from the emergency department. Patients excluded from the study were involved in motor vehicle accidents, had pathological fractures, or were transferred from other hospitals. One hundred and thirteen patients were included. Results: All patients received venous thromboembolism prophylaxis, and none had preoperative traction. Surgery was done within 48 hr in 83% (94/113) of patients. All patients with unstable femoral neck fractures underwent arthroplasty. Sliding hip screws were used in 93.5% (29/31) of stable intertrochanteric fractures, but cephalomedullary devices were used in 86.7% of unstable fractures (46 patients). Rehabilitation was done for a majority of patients. Unfortunately, preoperative regional analgesia was not used at all. Bipolar heads were used in a majority of hemiarthroplasty cases. A blood transfusion threshold of no higher than 8 g/dL was only followed in 16 cases. Only 23.9% of patients continued physical therapy at home. Fewer than one-third of the patients underwent nutritional assessment or support. Only 15 patients received a secondary mode of analgesia postoperatively. Vitamin D and calcium were prescribed for less than 50% of patients. Only 10.6% were evaluated for osteoporosis after fracture. Conclusions: Compliance with AAOS guidelines is reasonable, and it can be increased by following recommendations regarding: preoperative analgesia, femoral head type, blood transfusion threshold, home physical therapy, nutritional assessment, pain management, vitamin D and calcium supplementation, and osteoporosis treatment. Level of Evidence: Level III.

To propose a novel, accurate, and easy to perform test replacing the manual muscle testing. Our target is to develop a valuable tool for identification of patients with neurological motor impairment precisely, rapidly, and easily. Methods: We have randomly selected patients presenting to the clinic complaining of back pain with or without lower limb symptoms. These patients were asked to walk on their heels and on their toes. Being unable to walk on heels and/or toes, the patient is considered to have positive test result (abnormal finding). After that, a full and thorough neurological examination was performed on every patient by an orthopedic resident doctor. We looked specifically to the correlation between the ability to do toe-heel walking with the results of the detailed neurological examination. Results: Toe-heel walking test was able to detect all patients with weakness in their lower limb musculature. The results from the current investigation indicate a very high Pearson correlation of 0.95 (p ¼ 0.001) between the toe-heel test and manual muscle testing. Conclusion: Toe-heel walking test is superior to detailed neurological examination in identification of patients with weakness, sphincter problem, and/or positive straight leg raising test. This test is both simple and rapidly performed test, which can be easily done by any health-care provider. Owing to its ease, this test is not restricted to medical doctors, but it could be accurately performed by any health-care provider such as nurses and physiotherapists. This will enable us to decrease the referral to the specialty clinic and to decrease the overall cost.

Background: Subtrochanteric fractures account for around 7% to 34% of all femur fractures. Cephalo-medullary nailing is the gold standard in the repair of subtrochanteric femur fractures. Case presentation: We present a case of a medically free 21-year-old man, who was admitted with right thigh deformity and inability to bear weight after a motor vehicle accident. Standard pelvis and right femur radiographs showed a subtrochanteric femur with deformity forces of the fracture fragments. The patient was operated with cephalo-medullary nailing using a lowman bone holder. The fracture remained stable after cephalo-medullary fixation. The patient was discharged and was advised to continue follow up. Conclusion: Fixation of femur subtrochanteric fracture with cephalo-medullary nailing technique using a Lowman clamp showed excellent clinical and radiographic results and low complication rate.

Objective: This study aimed to compare two methods of wound skin closure—staples versus vertical mattress nylon sutures—in patients undergoing primary total hip (THR) and total knee replacements (TKR). The comparison was for wound complications as a primary outcome, and satisfaction of patient and nurse as secondary outcomes. Method: A prospective cohort study was conducted at an academic teaching hospital. All the patients who were admitted for either primary THR or TKR from September 2018 to September 2019 were included. Revision surgeries, patients >85 years of age, and those who were on steroid therapy were excluded. Patients were divided into two groups (staples and sutures) to compare the two methods of wound closure. Patients in each group were assessed for characteristics such as age, sex, weight, height, comorbidities, smoking status, postoperative wound complications, reoperation and patient/nurse satisfaction. Results: A total of 100 patients met the inclusion criteria. In the staples group (n=50), 26 patients underwent THR while 24 patients underwent TKR. In the sutures group (n=50), 23 patients underwent THR and 27 patients underwent TKR. Overall, there was no significant difference between the two groups (staples versus sutures) in terms of wound complications (p=0.401), patient satisfaction (p=0.357) and nurse satisfaction (p=0.513). Further analysis compared THR and TKR subgroups (THR staples versus THR sutures and TKR staples versus TKR sutures). The results showed no significant difference between the staples and sutures subgroups of THR and TKR in terms of wound complications, patient satisfaction and nurse satisfaction. Conclusion: In THR and TKR, there was no significant difference between either vertical mattress nylon sutures or staples primary skin closure in terms of wound complications and patient satisfaction in this study. The decision on wound closure method should be based on the availability of resources in the institution/country.