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.

Case: A 25-year-old man presented with progressive pain and swelling of the left foot for 4 years. The images showed a contrast-enhanced mixed lesion (osteolytic and blastic) of the first metatarsal bone with surrounding soft-tissue edema. The differential diagnoses favored chronic osteomyelitis or neoplasia, most likely benign. Histopathology confirmed the diagnosis of osteoblastoma as immature bone trabeculae rimmed by osteoblasts appeared. Then, the patient was successfully treated with wide surgical excision of the first metatarsal bone and reconstruction using a nonvascularized fibular autograft. After 3 years of follow-up, the graft was well incorporated and no recurrence was encountered. Conclusion: Osteoblastoma is rare in metatarsals; only 12 cases have been reported. It may have similar clinical and radiological picture to osteomyelitis. Wide surgical excision followed by fibular autograft reconstruction is an effective treatment option.

Background:Radiographic measurements are used for screening of developmental dysplasia of the hip (DDH) in children. The ability to detect acetabular dysplasia requires validated radiographic outcome measures. The acetabular index (AI) measurement has been shown to be a reliable measure worldwide. This study aims to test the reliability of the AI measurement in a DDH screening population by orthopaedic junior and senior residents. Methods:The review examined 470 radiographs taken during 4 yr (2016)(2017)(2018)(2019) in a university hospital. AI measurement was performed by two surgeons, four senior residents, and four junior residents at three different times. The intraobserver and interobserver reliability for each group was assessed. Results:The intraobserver reliability intraclass correlation coefficient (ICC) for the AI measurement performed by seniors was excellent at 0.98 (confidence interval [CI] 0.98 to 0.99) for the right side and 0.99 (CI 0.98 to 0.99) for left side. Indistinguishably, the ICC for AI measurement performed by orthopaedic juniors for right and left side was excellent at 0.96 (CI 0.95 to 0.97) and 0.95 (CI 0.95 to 0.96), respectively. The overall ICCs for interobserver reliability for the AI measurement between professors, seniors, and juniors for right and left side was between good and excellent at 0.89 (CI 0.87 to 0.90) and 0.89 (CI 0.87 to 0.91), respectively. Conclusions:Orthopaedic juniors are less reliable in terms of intraobserver and interobserver variability in detecting DDH in screening program in comparison with seniors using AI measurement in a pediatric orthopaedic clinic.

‫اﻟﺜﻮرﻳﻮم‬ ‫اﺳﺘﺨﻼص‬5-n 4 n − ABSTRACT: Solvent extraction of Thorium (VI) ion from perchlorate solution using didodecylphosphoric acid, DDPA, in chloroform diluent was studied. The effects of stripping hydrochloric acid concentration, stripping time, extraction time, DDPA concentration, pH, ionic strength, supporting electrolyte and temperature on the extraction processes have been studied. From the distribution coefficient values at different temperatures, the enthalpy, the free energy and the entropy changes associated with the extraction processes were determined. The composition of the complex formed was established to be Th(ClO 4 ) 4-n R n (HR) 5-n where, n=1 or 2 and (HR) 2 represents the dimer of DDPA.

Introduction: patellar tendon rupture is usually traumatic in origin; however, spontaneous or atraumatic rupture is uncommon and often signify underlying pathological processes involving the tendon substance. One of these pathological processes is primary hyperparathyroidism. Case presentation: In this case report we present a unique case of a patient not diagnosed previously with hyperparathyroidism. The patient's initial presentation was atraumatic knee pain and knee extension weakness, imaging studies showed complete avulsion of the patellar tendon from its tibial footprint. Another clinical finding was an index finger swelling, which, after laboratory and imaging studies of the parathyroid gland, turned out to be brown tumor of undiagnosed primary hyperparathyroidism. The patient underwent excision of the parathyroid adenoma, and repair of the patellar tendon using semitendinosus tendon graft and intraosseous tibial anchors at the footprint. Patient regained pain-free and good movement of her knee. Conclusion: Atraumatic patellar tendon rupture, especially in the absence of renal impairments should raise the suspicion of pathological process involving the tendon substance, this should alert the orthopedic surgeon to look for secondary causes of degeneration of the tendon substance, of which hyperparathyroidism is an important differential diagnosis.