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. The distribution of postoperative orthopedic infection and their susceptibility pattern to antibiotics vary regionally and change over time. The incidence of methicillin-resistant Staphylococcus aureus infection is rising worldwide. Therefore, knowledge of the frequency of the causative microorganisms and their susceptibility to antibiotics are necessary for an improved therapeutic outcome. This study aims to study the frequency and distribution of postoperative orthopedic infection and their resistance pattern to antibiotics. Methods. The study utilized a retrospective design that took place over a period of 5 years from 2016 and 2020 at a tertiary care hospital. The bacterial culture testing was performed by a recommended method. Descriptive statistics were used to analyze the data. Results. A total of 158 patients (100 males and 58 females) with positive cultures of postoperative orthopedic infection were included. The most common infective organism was Staphylococcus aureus, 64 patients (38.1%); coagulase-negative staphylococci, 40 patients (23.8%); Klebsiella species, 14 patients (8.3%); and Enterococcus species, Escherichia coli, and Pseudomonas aeruginosa in 10 patients (6%). Data also showed that gram-positive bacteria were detected in 118 patients (70.8%), while gram-negative microorganisms were found in 50 patients (29.8%). Among Staphylococcus aureus, 79.7% were MRSA, and vancomycin was the most effective antibiotic in staphylococcus infections. The antibiotics with the greatest sensitivity to gram-positive bacteria were vancomycin, linezolid, tigecycline, moxifloxacin, and nitrofurantoin, while the antibiotics for gram-negative bacteria with greater sensitivity were tigecycline, amikacin, ertapenem, imipenem, and cefotaxime. Conclusion. Staphylococcus aureus is the most common postoperative orthopedic infection, which was predominantly MRSA with vancomycin being the most effective antibiotic. In addition, the results showed a high resistance pattern to the commonly used antibiotics, leaving few choices. Antibiotic agents should be carefully selected according to specific drug sensitivity through routine monitoring of drug resistance patterns and to help formulate hospital antibiotic policy.

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.

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