Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac (up to 80%) and spinal joints (up to 54%) are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single- or multi-focal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging (MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications (antibiotics) and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.

Background and Purpose. The Salter innominate osteotomy has been an effective method to treat the developmental dysplasia of hip (DDH) over the past decades; however, several postoperative complications and deficiencies were reported. In this study, we evaluated outcome of a newly modified Salter osteotomy in patients presenting with DDH. Methods. We reviewed retrospectively 76 patients (90 hips) with DDH aged ≥ 18 months, who underwent open reduction and a modified osteotomy by a single surgeon. The distal osteotomy segment of pelvis was shifted anterolaterally in the amount of osteotomy cross-section, but not downwards. The mean age at surgery was 2 years and 11 months (1.5 to 16 years). Femoral shortening was conducted when necessary. The duration of operation varied between 60 and 90 minutes. The mean follow-up was 4 years and one month (range 15 months to 7 years and 9 months). All patients were followed up both clinically (based on the modified MacKay criteria) and radiologically (based on the modified Severin criteria). Results. Clinically, 94.5% of hips had excellent and good results at final follow-up, and only 5.5% had a fair condition. Radiographically, at the final follow-up 77.8% of hips were grade IA (excellent), 12.2% were grade IB, 6.7% were grade II, and 3.3% were grade III (fair). The preoperative mean acetabular index was 47.85° (41° to 59), which decreased to 17.16° (13° to 22°) immediately after the surgery (p<0.0001) and progressed to 11.24° (7° to 19°) at the final follow-up (p<0.0001). The mean initial postoperative center-edge angle was 30.3° (25° to 42°) significantly improved to 39.1 (31° to 56°) at the final follow-up (p<0.0001). Avascular necrosis of femoral head occurred in 4.4% of hips (4 patients). Conclusion. The results show that our modified Salter osteotomy is safe and associated with significant benefit for the management of patients suffering from DDH.

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BACKGROUND Hip fracture is a major health concern with high rates of mortality and disability. The purpose of this study was to conduct a systematic review and meta-analysis on the incidence of hip fracture in the Eastern Mediterranean Region (EMR). METHODS We searched the databases of PubMed, Scopus, Web of Science and Index Medicus for the EMR for observational studies reporting the incidence of fracture in the EMR countries, which were published from inception to September 2018 with no language restriction. Study selection and data extraction were conducted independently by two reviewers. RESULTS After applying inclusion and exclusion criteria, 10 articles were finally included in this study. The overall pooled crude incidence rate of hip fracture in the EMR was estimated to be 107.4 per 100,000 population/year (95% confidence interval [CI]: 83-131.8). Analysis also showed that the overall pooled age-standardized rate was 174.4 per 100,000 population/year (95% CI: 103.9-244.9). Lebanon had the highest crude incidence rate (140.1 per 100,000 population/year), and Kuwait had the lowest rate (21.9 per 100,000 population/year). Age-standardized rate for males was 121.3 per 100,000/year (95% CI: 80.8-161.7) and for females was 227.4 per 100,000/year (95% CI: 129-325.9). The overall crude incidence for traumatic fracture was estimated to be 79.2 per 100,000/year (95% CI: 21.8-136.6). CONCLUSIONS A considerable incidence rate was seen for hip fractures. There were also significant variations in the incidence of different countries of the EMR. Implementing preventive measures against fractures is needed in the region.