Jagar Omar Doski | University of Duhok (original) (raw)

Papers by Jagar Omar Doski

Research paper thumbnail of Current Lines and Angles Used in Paediatric Foot Radiograph: A Scoping Review of Literature

PubMed, Apr 30, 2024

Objective: This article aimed to review the main currently described lines and angles and gather ... more Objective: This article aimed to review the main currently described lines and angles and gather them in a single article and arrange them in a systematic way to facilitate the process of assessment of the pediatric foot for deformities. Methods: The review was a scoping literature review. Electronic database websites such as PubMed, Europe PMC, Cochrane Library, and Google Scholar in addition to some books on anatomy and human movements biomechanics, diagnostic radiology, and orthopedics were searched for relevant articles for the topic of the present review. No statistical analysis was applied in this review. Results: Data from thirty articles included in this review were arranged into different subheadings. In the anteroposterior view (AP), assessment of the hindfoot deviation was by the AP talo-calcaneal angle (Kite's angle); the forefoot and midfoot for abduction and adduction alignment was by the AP talo-first metatarsal angle, the talo-second metatarsal angle, the calcaneo-second metatarsal angle, the calcaneofifth metatarsal angle; the forefoot and midfoot rotation was by observing the normal proximal convergence of the metatarsal bones axes. In the lateral view, assessment of the hindfoot sagittal plane alignment was by the lateral tibio-calcaneal angle; hindfoot varus or valgus deviation by the lateral talo-calcaneal angle; talus bone alignment by talar declination angle and the tibio-talar angle; calcaneal bone alignment by the calcaneal inclination angle and the tibio-calcaneal angle, the midfoot and forefoot sagittal plane alignment for the plantar arch by the lateral talo-first metatarsal -Meary's- angle, the calcaneal inclination angle, and the lateral calcaneofirst metatarsal -Hibbs- angle; forefoot and midfoot rotational alignment by observing the overlap shadows of the metatarsals' shafts and drawing their axes. Conclusion: Drawing certain lines and angles with a systematic approach to assess different regions of the foot in the radiographic films of children can facilitate the process of assessment of the foot (as a whole) for deformities.

Research paper thumbnail of Terms Used to Describe Abnormalities of Joint Kinematics: An Overview

Kufa medical journal, Jun 15, 2024

Research paper thumbnail of Robert Jones bandage versus cast in the treatment of distal radius fracture in children: A randomized controlled trial

Chinese journal of traumatology, Apr 1, 2023

Research paper thumbnail of An Upgrade of the International Hip Dysplasia Institute Classification for Developmental Dysplasia of the Hip

Clinics in Orthopedic Surgery, 2022

Developmental dysplasia of the hip (DDH) is a common pediatric orthopedic disorder with an incide... more Developmental dysplasia of the hip (DDH) is a common pediatric orthopedic disorder with an incidence of 1.5-2.5 per 1,000 live births. 1) In early infancy, the physical examination cannot diagnose all cases of DDH; therefore, imaging either by ultrasound or radiography became popular worldwide for screening, confirming clinical suspicion, and classifying the severity of the condition. 2-4) Ultrasound is the preferred modality for diagnosing DDH in infants less than 6 months old, but the skills to perform a valuable ultrasound may not be available everywhere. 5) A majority of orthopedic surgeons use pelvic radiographic films to diagnose DDH in children over 3 months of age. 6) The International Hip Dysplasia Institute (IHDI) classification, which uses the midpoint of the proximal femoral metaphysis as a reference landmark to determine the location of the hip, can be applied to children of all ages and is considered more reliable than the Tönnis method, which depends on the relative position of the ossified capital femoral nucleus to Perkin's line and Hilgenreiner's line, even when the capital femoral epiphysis is ossified. 2,7,8) However, this classification depends mainly on the lateralization and displacement of the proximal femur and neglects the acetabulum. Moreover, grade 1 is a little bit confusing and it may be difficult to decide whether the hip with this grade is normal or abnormal as acetabular dysplasia alone without displacement of the proximal femur is also considered as a type of DDH. This study aimed to upgrade the IHDI classification by including the state of the acetabulum (normal or dysplastic) to classify the hips. The authors hypothesized that the inclusion of the acetabular state will resolve confusion about the grade 1 hips (whether normal or abnormal).

Research paper thumbnail of Characterization of a novel dormant, drug resistant, stem cell subpopulation in acute lymphoblastic leukemia

European Journal of Cancer, 2016

Research paper thumbnail of Accelerated versus conventional Ponseti protocol for the treatment of idiopathic talipes equinovarus deformity: A short term follow up in Iraq

Zanco Journal of Medical Sciences, 2021

Background and objective: The accelerated protocol of Ponseti method was suggested to shorten the... more Background and objective: The accelerated protocol of Ponseti method was suggested to shorten the period of treatment of the conventional one for the cases of talipes equinovarus deformity. This study aimed to compare the accelerated protocol of Ponseti method in the treatment of clubfoot deformity with the conventional one. Methods: A prospective comparative study was conducted for infants less than six months with congenital talipes equinovarus deformity. The patients were randomized to either Group 1 (casts changed every week, conventional protocol of Ponseti method) or Group 2 (twice weekly, accelerated one). Pirani score was used to assess the severity of the deformity at presentation, at time of last cast removal, and at the last follow up visit (6th months). Results: The patients included were 48 cases with 79 feet. Group 1 (39 clubfeet) had a mean Pirani score of 5.6 (± 1.15) at presentation, which dropped to 0.47 (± 0.41) when the last cast was removed. In Group 2 (40 clubf...

Research paper thumbnail of Effect of Walking of the Child Independently on the Developmental Dysplasia of the Hip

Journal of Sulaimani Medical College, 2015

Background In developmental dysplasia of the hip a number of pathological changes develop, some o... more Background In developmental dysplasia of the hip a number of pathological changes develop, some of them perhaps reflecting a primary dysplasia of the acetabulum and/or the proximal femur, but most of them from adaptation to persistent instability and abnormal joint loading. After weight-bearing commences, these changes are intensified. Most children begin to walk independently near their 1st year birthday; some do not walk until 18 months of age. At this age group, the classical treatment of a dislocated hip is closed reduction with spica cast then abduction splint. Redislocation is one of the commonest complications of the treatment of developmental dysplasia of the hip. Aim Is to assess the effect of independent walking of the child on the treatment of a missed dislocated hip whether it increases the risk of failure of the treatment by re-displacement of the hip or not! Patients and Methods This study included those children who had missed dislocation or subluxation of the hip and they were at the expected period for the beginning of walking independently ( age 12-18 months ). They were 87 patients with 131 dislocated or subluxated hips. The patient had been divided into five groups: Group 1: still not walking independently, Group 2: walking independently for less than 1 month, Group 3: walking for 1-2 months, Group 4: walking for 2-3 months, and Group 5: walking for more than 3 months. Results Most of the patients of Group 1 had bilateral DDH ( 63.3% ) and also in Group 5 ( 80% ), while in Group 2, 3, and 4 the DDH was more common in one side ( 75%, 71.4%, and 72.7% respectively ). From the total number of patients who had been included in this study, 21 hips out of 131 showed signs of re-displacement with an incidence of failure of 16 %. There were 3 hips of Group 1, 1 hip of Group 2, 4 hips of Group 3, 6 hips of Group 4, and 7 hips of Group 5. Conclusion Walking of the child independently is associated with an increased risk of failure of closed reduction for patients having developmental dysplasia of the hip between age 12-18 months especially after 2 months of walking.

Research paper thumbnail of Is there an association between the familial form of generalized joint hypermobility and developmental dysplasia of the hip in children?

Medical Journal of Babylon, 2021

Background and Objectives: This study aimed to examine the association between the familial gener... more Background and Objectives: This study aimed to examine the association between the familial generalized joint hypermobility (GJH) and developmental dysplasia of the hip (DDH) in children. Materials and Methods: All infants and children included in this case (with DDH)–control study were examined for features of GJH by the revised Beighton’s Test Scale (BTS), provided that they had no teratogenic or pathological causes of DDH or GJH. Results: Two hundred and eight participants were included in this study: 101 (48.6%) cases and 107 (51.4%) controls; age mean 16.57 [standard deviation (SD) 18.1] months; 61.1% (127) females and 38.9% (81) males. The odds ratio was 2.1 (95% confidence interval 1.197–3.679). The cases had a higher value of BTS score (mean = 4.7, SD = 3.015) when compared with the controls (mean = 3.42, SD = 3.448). The difference was statistically significant, but the correlation coefficient (r) between the study groups and BTS scores was weak (r = 0.194, P = 0.005). The ...

Research paper thumbnail of Reliability of international hip dysplasia institute classification for the developmental dysplasia of the hip among different medical personnel in Iraq

journal article, 2020

Background: The international hip dysplasia institute (IHDI) classification is a new method for q... more Background: The international hip dysplasia institute (IHDI) classification is a new method for quantifying the severity of the developmental dysplasia of the hip (DDH). Objectives: This study aimed to compare the reliability of this classification between different medical personnel such as pediatricians, general practitioners, and family doctors in addition to orthopedic surgeons and radiologists. Methods: Hundred pelvic radiographic films (with 200 hips) were randomly selected from the files of children already diagnosed and treated as DDH cases. These films were analyzed by 12 independent observers of four different specialties: three orthopedic surgeons (Ortho Group), three radiologists (Radio Group), three pediatricians (Pediat Group), and three general practitioners (GP Group). Results: The average measures (Cronbach's alpha) for the intraclass correlation coefficient (ICC) for absolute agreement between all observers was 0.874 (with 95% confidence intervals between 0.780...

Research paper thumbnail of Clinical Analysis of Anterior Dislocation of the Shoulder by Spaso Technique

article , 2015

Background and objective: There are various methods for reduction of anterior shoulder dislocatio... more Background and objective: There are various methods for reduction of anterior shoulder dislocation, most of them are either technically difficult or need general anesthesia. The Spaso technique, a relatively new one, emerges as a reliable, simple and safe method. The aim of this study is to evaluate this method of reduction for shoulder dislocation in Duhok city hospitals and clinics. Patients and methods 42 patients with anterior shoulder dislocation treated by this method and those who failed then treated by other methods. Results 36 cases (85.7%) out of 42 were reduced successfully by this method without complications, most of them (31 case = 73.8%) done with analgesia and only 5 case (11.9%) need general anesthesia. All cases of recurrent shoulder dislocation (23 case) were reduced by this method, and most of those with first time shoulder dislocation (13 out of 19) were also successfully reduced by this method. Conclusion the Spaso technique is a successful method for reduction of anterior shoulder dislocation in Duhok city hospitals and clinics specially for cases of recurrent attacks.

Research paper thumbnail of Is There an Association Between the Familial Form of Generalized Joint Hypermobility and Developmental Dysplasia of the Hip in Children

article , 2021

Background and objectives This study aimed to examine the association between the familial Genera... more Background and objectives This study aimed to examine the association between the familial Generalized Joint Hypermobility (GJH) and Developmental Dysplasia of the Hip (DDH) in children.
Methods All the infants and children included in this case (with DDH) – control study, were examined for features of GJH by the revised Beighton’s Test Scale (BTS) provided that they had no teratogenic or pathological causes of DDH or GJH.
Results Two hundred and eight participants were included in this study, 101 (48.6%) cases, 107 (51.4%) controls; age mean 16.57 (Standard Deviation ‘SD’ 18.1) months; 61.1% (127) females and 38.9% (81) males. The Odds Ratio (OR) was 2.1 (95% Confidence Interval 1.197 – 3.679). The cases had a higher value of BTS’s score (mean = 4.7, SD = 3.015) compared to the controls (mean = 3.42, SD = 3.448). The difference was statistically significant but the Correlation Coefficient (r) between the study groups and BTS’s scores was weak (r = 0.194, P = 0.005). The correlation gained slight improvement by justification of the age to obtain homogeneity between the groups (r = 0.276, P < 0.001), but deteriorate and lost its significance when the sex was controlled as a confounder (r = 0.121, P = 0.082). There was a gradual increase of the mean BTS’s score from grade one to grade four of DDH but without a statistically significant value (r = 0,132, P = 0.128).
Conclusion The familial GJH has a weak - positive - correlation with DDH but can’t be considered as a possible risk factor for it.

Research paper thumbnail of Accelerated versus conventional Ponseti protocol for the treatment of idiopathic talipes equinovarus deformity: A short term follow up in Iraq

article, 2021

Background and Objectives The accelerated protocol of Ponseti method was suggested to shorten th... more Background and Objectives The accelerated protocol of Ponseti method was suggested to shorten the period of treatment of the conventional one for the cases of Talipes Equinovarus deformity. The aim of this study was to compare the accelerated protocol of Ponseti method in treatment of clubfoot deformity with the conventional one.
Methods A prospective comparative study done for Infants less than 6 months with congenital talipes equinovarus deformity. The patients were randomized to either Group 1 (casts changed every week, conventional protocol of Ponseti method) or Group 2 (twice weekly, accelerated one). Pirani score was used to assess the severity of the deformity at presentation, at time of last cast removal and at last follow up visit (6th months).
Results The patients included were 48 cases with 79 feet. The Group 1 (39 clubfeet) had a mean Pirani score of 5.6 (± 1.15) at presentation which dropped to 0.47 (± 0.41) when last cast removed and in Group 2 (40 clubfeet) it dropped from 5.57 (± 0.83) to 0.77 (± 0.01). The result of each treatment protocol was significant but the difference between them was not significant. Five cases (3 patients, age more than 3 months) of Group 2 needed 8 casts to reach an acceptable position of correction. The difference between the mean number of casts applied in Group 1 (5.09) and Group 2 (5.82) was statistically not significant, but between the mean number of days spent in cast was significant. The complications occurred in 12 out of 79 feet, with no statistically significant difference between both groups.
Conclusion The accelerated protocol of the Ponseti method for the treatment of clubfoot deformity is as effective as and as safe as the conventional one. It shortens the time required to complete the treatment program. Those who present lately (beyond the age of 3 months) may require an additional number of casts.

Research paper thumbnail of Limited Mid Palmar Versus Extended Incision in Surgical Treatment of Carpal Tunnel Syndrome: Clinical Analysis

article, 2020

Background and Objectives There is different methods and incisions to release the transverse car... more Background and Objectives There is different methods and incisions to release the transverse carpal ligament in carpal tunnel syndrome. The purpose of this study was to compare the surgical outcome of the conventional extended incision with the limited mid palmar one.
Methods The study was a prospective comparative one. Patients with carpal tunnel syndrome were divided into 2 groups: Group 1 was patients operated by the conventional extended incision, Group 2 with limited mid palmar incision.
Results The patients included were 79 with 89 hands. The age mean was 41 years. The Group 1 included 47 and Group 2 included 42 hands. The differences between both groups were statistically significant regarding the operative data (the incision length and the operative time) and in the post-operative data (the duration of analgesia needed, the date of starting to use the hand in daily life activities and return to work). But the date of improvement of the sensory symptoms from the fingers showed no significant differences. The sum of the overall complications occurred for the cases of Group 2 was about third of that occurred for Group 1. The highly significant difference was in the scar tenderness at the third month of post-operative period.
Conclusion The limited mid palmar incision to release the entrapment of median nerve in carpal tunnel syndrome offers a shorter operative time, less analgesia needed post-operatively, less complication rate, less scar tenderness, an earlier use of the hand in the daily life activities and return to the work in a shorter period.

Research paper thumbnail of Effect of Walking of the Child Independently on the Developmental Dysplasia of the Hip

article, 2015

Background In developmental dysplasia of the hip a number of pathological changes develop, some... more Background In developmental dysplasia of the hip a number of pathological changes develop, some of them perhaps reflecting a primary dysplasia of the acetabulum and/or the proximal femur, but most of them from adaptation to persistent instability and abnormal joint loading. After weight-bearing commences, these changes are intensified. Most children begin to walk independently near their 1st year birthday; some do not walk until 18 months of age. At this age group, the classical treatment of a dislocated hip is closed reduction with spica cast then abduction splint. Redislocation is one of the commonest complications of the treatment of developmental dysplasia of the hip.
Aim Is to assess the effect of independent walking of the child on the treatment of a missed dislocated hip whether it increases the risk of failure of the treatment by re-displacement of the hip or not!
Patients and Methods This study included those children who had missed dislocation or subluxation of the hip and they were at the expected period for the beginning of walking independently ( age 12-18 months ). They were 87 patients with 131 dislocated or subluxated hips. The patient had been divided into five groups: Group 1: still not walking independently, Group 2: walking independently for less than 1 month, Group 3: walking for 1-2 months, Group 4: walking for 2-3 months, and Group 5: walking for more than 3 months.

Results Most of the patients of Group 1 had bilateral DDH ( 63.3% ) and also in Group 5 ( 80% ), while in Group 2, 3, and 4 the DDH was more common in one side ( 75%, 71.4%, and 72.7% respectively ). From the total number of patients who had been included in this study, 21 hips out of 131 showed signs of re-displacement with an incidence of failure of 16 %. There were 3 hips of Group 1, 1 hip of Group 2, 4 hips of Group 3, 6 hips of Group 4, and 7 hips of Group 5.
Conclusion Walking of the child independently is associated with an increased risk of failure of closed reduction for patients having developmental dysplasia of the hip between age 12-18 months especially after 2 months of walking.

Research paper thumbnail of Reflex Sympathetic Dystrophy: Recognition of Some Risk Factors

article, 2015

Background Reflex sympathetic dystrophy occurs most often in the extremities after an injury. It ... more Background Reflex sympathetic dystrophy occurs most often in the extremities after an injury. It causes the limb to undergo chronic pain, swelling, redness, tenderness, and stiffness with patchy rarefaction. The diagnosis is mainly clinical and delays in diagnosis end with a poor prognosis. Therefore predicting this problem is important by noticing the risk factors. The aim of this study is to highlight some risk factors for the development of this disorder.
Patients and methods The study included those patients who sustained trauma to their extremities or underwent surgery. Children and those with clear nerve injury were excluded from the study. Those who did not show the clinical features of RSD were included in group 1 and we considered them as a control group, while those who had RSD features were included in group 2.
Results The total number of patients was 143 cases. In Group 1 the male to female ratio was 3:2, the average age was 36 years. 65 of them had trauma to their upper limb and 31 to the lower limb. Most of them had no psychological symptoms. In Group 2 the male to female ratio was 1:4 and the average age was 53 years. 27 with upper limb trauma and 20 with lower limb. All the patients of this group had clear psychological disturbance and 45 ( 95.7% ) of them had pre-morbid stressful personalities.
Conclusion age ( middle ), gender ( female ), and stressful personality are risk factors to develop RSD if such a person sustained trauma or did a surgical procedure. The extremity involved and the type of injury seem to have no role in the development of RSD.

Research paper thumbnail of Reliability of International Hip Dysplasia Institute Classification for the Developmental Dysplasia of the Hip Among Different Medical Personnel in Iraq

article , 2020

Background: The international hip dysplasia institute (IHDI) classification is a new method for q... more Background: The international hip dysplasia institute (IHDI) classification is a new method for quantifying the severity of the developmental dysplasia of the hip (DDH). Objectives: This study aimed to compare the reliability of this classification between different medical personnel such as pediatricians, general practitioners, and family doctors in addition to orthopedic surgeons and radiologists.
Methods: Hundred pelvic radiographic films (with 200 hips) were randomly selected from the files of children already diagnosed and treated as DDH cases. These
films were analyzed by 12 independent observers of four different specialties: three orthopedic surgeons (Ortho Group), three radiologists (Radio Group), three pediatricians (Pediat Group), and three general practitioners (GP Group).
Results: The average measure (Cronbach’s alpha) for the intraclass correlation coefficient (ICC) for absolute agreement between all observers was 0.874 (with 95% confidence intervals between 0.780 and 0.925). This was considered as having a good level of reliability and agreement between all observers. The ICC for
agreement between the observers of the radio group showed the highest score (0.904) while that between those of GP Group had the lowest
one (0.826). However, during the comparison between the mean score of each group with that of the other groups by the one‑way ANOVA
method, there was no statistically significant difference between all groups (P values were 0.563, 0.415, 0.399, and 0.291 respectively).
Conclusion: The IHDI classification method for cases of DDH has a good level of reliability among different medical personnel regardless
of their specialties.

Research paper thumbnail of Relapse Of Clubfoot Deformity After Correction: Effect Of Type Of Splint In Unilateral Cases

article, 2012

Background Talipes equinovarus is the most common type of clubfoot deformity. Diagnosis is mainly... more Background Talipes equinovarus is the most common type of clubfoot deformity. Diagnosis is mainly clinical. The aim of treatment is to produce and maintain a plantigrade supple foot that functions well. The treatment is usually started by the conservative method by serial manipulations and casting but may need surgical correction. After complete correction of the deformity, there is a significant risk of relapse, which can be prevented by using different types of splints for 3-4 years. The classical splint is Denis Browne Brace in which both feet are held together in an external rotation position. But the non-compliance to this splint makes adherence to it difficult.
Aim To study the incidence of relapse after using different types of splints after correction of clubfoot deformity.
Patients and Methods This retrospective study included 48 patients with unilateral clubfoot who wear a splint in their foot after their deformity had been corrected. Twenty-six cases wear unilateral ankle-foot orthosis while 22 cases wear foot abduction brace. They had been followed for about 1.3-3 years.
Results In this study the incidence of relapse in patients with unilateral clubfoot was 35.4%. Thirteen (50%) out of 26 cases who used unilateral Ankle Foot Orthosis developed relapse, while 4 (18.2%) out of 22 cases who wear the Foot Abduction Brace developed relapse. The results were statistically significant.
Conclusion The use of a Foot Abduction Brace is associated with a low risk of relapse because it maintains the foot in an external rotation position and causes stretching of posteromedial soft tissue structures while unilateral Ankle Foot Orthosis can't hold this position.

Research paper thumbnail of Adductor Tenotomy Versus Preliminary Traction For Prevention of Complications of Closed Reduction of The Developmental Dysplasia of The Hip

article , 2019

Objectives closed reduction and spica cast application in the treatment of developmental dysplasi... more Objectives closed reduction and spica cast application in the treatment of developmental dysplasia of the hip especially before walking age has a risk of complication specially avascular necrosis and re-displacement of the femoral head out of the acetabular socket. Different measures were tried to improve the outcome of the treatment. The present study aimed to evaluate the effect of two of these methods (preliminary traction and adductor tenotomy).
Methods The outcome were retrospectively reviewed after one year from completing the program of treatment. The patients were divided into 2 groups: group 1 was those for whom adductor tenotomy before casting, while group 2 was those for whom preliminary traction did for 3 weeks before casting.
Results The total number of cases was 223 with 357 affected hips. The complications occur in 142 hips (39.8%), 30% developed avascular necrosis, and 9.8% end with re-displacement. In group 1, those who developed complications were 113 out of 287 (39.3%). While in group 2, 29 out of 70 hips (41.4%) developed complications. There was no statistically significant difference between the two groups in relation to success and complication rates as the p-value was 0.753.
Conclusion In conclusion, a single measure (either adductor tenotomy or only preliminary traction) is not promising to decrease the complications rates. A combination of different measures may overcome a percent of these complications. There is no clear superiority of either approach; adductor tenotomy or preliminary traction, however adductor tenotomy is preferred.

Research paper thumbnail of Current Lines and Angles Used in Paediatric Foot Radiograph: A Scoping Review of Literature

PubMed, Apr 30, 2024

Objective: This article aimed to review the main currently described lines and angles and gather ... more Objective: This article aimed to review the main currently described lines and angles and gather them in a single article and arrange them in a systematic way to facilitate the process of assessment of the pediatric foot for deformities. Methods: The review was a scoping literature review. Electronic database websites such as PubMed, Europe PMC, Cochrane Library, and Google Scholar in addition to some books on anatomy and human movements biomechanics, diagnostic radiology, and orthopedics were searched for relevant articles for the topic of the present review. No statistical analysis was applied in this review. Results: Data from thirty articles included in this review were arranged into different subheadings. In the anteroposterior view (AP), assessment of the hindfoot deviation was by the AP talo-calcaneal angle (Kite's angle); the forefoot and midfoot for abduction and adduction alignment was by the AP talo-first metatarsal angle, the talo-second metatarsal angle, the calcaneo-second metatarsal angle, the calcaneofifth metatarsal angle; the forefoot and midfoot rotation was by observing the normal proximal convergence of the metatarsal bones axes. In the lateral view, assessment of the hindfoot sagittal plane alignment was by the lateral tibio-calcaneal angle; hindfoot varus or valgus deviation by the lateral talo-calcaneal angle; talus bone alignment by talar declination angle and the tibio-talar angle; calcaneal bone alignment by the calcaneal inclination angle and the tibio-calcaneal angle, the midfoot and forefoot sagittal plane alignment for the plantar arch by the lateral talo-first metatarsal -Meary's- angle, the calcaneal inclination angle, and the lateral calcaneofirst metatarsal -Hibbs- angle; forefoot and midfoot rotational alignment by observing the overlap shadows of the metatarsals' shafts and drawing their axes. Conclusion: Drawing certain lines and angles with a systematic approach to assess different regions of the foot in the radiographic films of children can facilitate the process of assessment of the foot (as a whole) for deformities.

Research paper thumbnail of Terms Used to Describe Abnormalities of Joint Kinematics: An Overview

Kufa medical journal, Jun 15, 2024

Research paper thumbnail of Robert Jones bandage versus cast in the treatment of distal radius fracture in children: A randomized controlled trial

Chinese journal of traumatology, Apr 1, 2023

Research paper thumbnail of An Upgrade of the International Hip Dysplasia Institute Classification for Developmental Dysplasia of the Hip

Clinics in Orthopedic Surgery, 2022

Developmental dysplasia of the hip (DDH) is a common pediatric orthopedic disorder with an incide... more Developmental dysplasia of the hip (DDH) is a common pediatric orthopedic disorder with an incidence of 1.5-2.5 per 1,000 live births. 1) In early infancy, the physical examination cannot diagnose all cases of DDH; therefore, imaging either by ultrasound or radiography became popular worldwide for screening, confirming clinical suspicion, and classifying the severity of the condition. 2-4) Ultrasound is the preferred modality for diagnosing DDH in infants less than 6 months old, but the skills to perform a valuable ultrasound may not be available everywhere. 5) A majority of orthopedic surgeons use pelvic radiographic films to diagnose DDH in children over 3 months of age. 6) The International Hip Dysplasia Institute (IHDI) classification, which uses the midpoint of the proximal femoral metaphysis as a reference landmark to determine the location of the hip, can be applied to children of all ages and is considered more reliable than the Tönnis method, which depends on the relative position of the ossified capital femoral nucleus to Perkin's line and Hilgenreiner's line, even when the capital femoral epiphysis is ossified. 2,7,8) However, this classification depends mainly on the lateralization and displacement of the proximal femur and neglects the acetabulum. Moreover, grade 1 is a little bit confusing and it may be difficult to decide whether the hip with this grade is normal or abnormal as acetabular dysplasia alone without displacement of the proximal femur is also considered as a type of DDH. This study aimed to upgrade the IHDI classification by including the state of the acetabulum (normal or dysplastic) to classify the hips. The authors hypothesized that the inclusion of the acetabular state will resolve confusion about the grade 1 hips (whether normal or abnormal).

Research paper thumbnail of Characterization of a novel dormant, drug resistant, stem cell subpopulation in acute lymphoblastic leukemia

European Journal of Cancer, 2016

Research paper thumbnail of Accelerated versus conventional Ponseti protocol for the treatment of idiopathic talipes equinovarus deformity: A short term follow up in Iraq

Zanco Journal of Medical Sciences, 2021

Background and objective: The accelerated protocol of Ponseti method was suggested to shorten the... more Background and objective: The accelerated protocol of Ponseti method was suggested to shorten the period of treatment of the conventional one for the cases of talipes equinovarus deformity. This study aimed to compare the accelerated protocol of Ponseti method in the treatment of clubfoot deformity with the conventional one. Methods: A prospective comparative study was conducted for infants less than six months with congenital talipes equinovarus deformity. The patients were randomized to either Group 1 (casts changed every week, conventional protocol of Ponseti method) or Group 2 (twice weekly, accelerated one). Pirani score was used to assess the severity of the deformity at presentation, at time of last cast removal, and at the last follow up visit (6th months). Results: The patients included were 48 cases with 79 feet. Group 1 (39 clubfeet) had a mean Pirani score of 5.6 (± 1.15) at presentation, which dropped to 0.47 (± 0.41) when the last cast was removed. In Group 2 (40 clubf...

Research paper thumbnail of Effect of Walking of the Child Independently on the Developmental Dysplasia of the Hip

Journal of Sulaimani Medical College, 2015

Background In developmental dysplasia of the hip a number of pathological changes develop, some o... more Background In developmental dysplasia of the hip a number of pathological changes develop, some of them perhaps reflecting a primary dysplasia of the acetabulum and/or the proximal femur, but most of them from adaptation to persistent instability and abnormal joint loading. After weight-bearing commences, these changes are intensified. Most children begin to walk independently near their 1st year birthday; some do not walk until 18 months of age. At this age group, the classical treatment of a dislocated hip is closed reduction with spica cast then abduction splint. Redislocation is one of the commonest complications of the treatment of developmental dysplasia of the hip. Aim Is to assess the effect of independent walking of the child on the treatment of a missed dislocated hip whether it increases the risk of failure of the treatment by re-displacement of the hip or not! Patients and Methods This study included those children who had missed dislocation or subluxation of the hip and they were at the expected period for the beginning of walking independently ( age 12-18 months ). They were 87 patients with 131 dislocated or subluxated hips. The patient had been divided into five groups: Group 1: still not walking independently, Group 2: walking independently for less than 1 month, Group 3: walking for 1-2 months, Group 4: walking for 2-3 months, and Group 5: walking for more than 3 months. Results Most of the patients of Group 1 had bilateral DDH ( 63.3% ) and also in Group 5 ( 80% ), while in Group 2, 3, and 4 the DDH was more common in one side ( 75%, 71.4%, and 72.7% respectively ). From the total number of patients who had been included in this study, 21 hips out of 131 showed signs of re-displacement with an incidence of failure of 16 %. There were 3 hips of Group 1, 1 hip of Group 2, 4 hips of Group 3, 6 hips of Group 4, and 7 hips of Group 5. Conclusion Walking of the child independently is associated with an increased risk of failure of closed reduction for patients having developmental dysplasia of the hip between age 12-18 months especially after 2 months of walking.

Research paper thumbnail of Is there an association between the familial form of generalized joint hypermobility and developmental dysplasia of the hip in children?

Medical Journal of Babylon, 2021

Background and Objectives: This study aimed to examine the association between the familial gener... more Background and Objectives: This study aimed to examine the association between the familial generalized joint hypermobility (GJH) and developmental dysplasia of the hip (DDH) in children. Materials and Methods: All infants and children included in this case (with DDH)–control study were examined for features of GJH by the revised Beighton’s Test Scale (BTS), provided that they had no teratogenic or pathological causes of DDH or GJH. Results: Two hundred and eight participants were included in this study: 101 (48.6%) cases and 107 (51.4%) controls; age mean 16.57 [standard deviation (SD) 18.1] months; 61.1% (127) females and 38.9% (81) males. The odds ratio was 2.1 (95% confidence interval 1.197–3.679). The cases had a higher value of BTS score (mean = 4.7, SD = 3.015) when compared with the controls (mean = 3.42, SD = 3.448). The difference was statistically significant, but the correlation coefficient (r) between the study groups and BTS scores was weak (r = 0.194, P = 0.005). The ...

Research paper thumbnail of Reliability of international hip dysplasia institute classification for the developmental dysplasia of the hip among different medical personnel in Iraq

journal article, 2020

Background: The international hip dysplasia institute (IHDI) classification is a new method for q... more Background: The international hip dysplasia institute (IHDI) classification is a new method for quantifying the severity of the developmental dysplasia of the hip (DDH). Objectives: This study aimed to compare the reliability of this classification between different medical personnel such as pediatricians, general practitioners, and family doctors in addition to orthopedic surgeons and radiologists. Methods: Hundred pelvic radiographic films (with 200 hips) were randomly selected from the files of children already diagnosed and treated as DDH cases. These films were analyzed by 12 independent observers of four different specialties: three orthopedic surgeons (Ortho Group), three radiologists (Radio Group), three pediatricians (Pediat Group), and three general practitioners (GP Group). Results: The average measures (Cronbach's alpha) for the intraclass correlation coefficient (ICC) for absolute agreement between all observers was 0.874 (with 95% confidence intervals between 0.780...

Research paper thumbnail of Clinical Analysis of Anterior Dislocation of the Shoulder by Spaso Technique

article , 2015

Background and objective: There are various methods for reduction of anterior shoulder dislocatio... more Background and objective: There are various methods for reduction of anterior shoulder dislocation, most of them are either technically difficult or need general anesthesia. The Spaso technique, a relatively new one, emerges as a reliable, simple and safe method. The aim of this study is to evaluate this method of reduction for shoulder dislocation in Duhok city hospitals and clinics. Patients and methods 42 patients with anterior shoulder dislocation treated by this method and those who failed then treated by other methods. Results 36 cases (85.7%) out of 42 were reduced successfully by this method without complications, most of them (31 case = 73.8%) done with analgesia and only 5 case (11.9%) need general anesthesia. All cases of recurrent shoulder dislocation (23 case) were reduced by this method, and most of those with first time shoulder dislocation (13 out of 19) were also successfully reduced by this method. Conclusion the Spaso technique is a successful method for reduction of anterior shoulder dislocation in Duhok city hospitals and clinics specially for cases of recurrent attacks.

Research paper thumbnail of Is There an Association Between the Familial Form of Generalized Joint Hypermobility and Developmental Dysplasia of the Hip in Children

article , 2021

Background and objectives This study aimed to examine the association between the familial Genera... more Background and objectives This study aimed to examine the association between the familial Generalized Joint Hypermobility (GJH) and Developmental Dysplasia of the Hip (DDH) in children.
Methods All the infants and children included in this case (with DDH) – control study, were examined for features of GJH by the revised Beighton’s Test Scale (BTS) provided that they had no teratogenic or pathological causes of DDH or GJH.
Results Two hundred and eight participants were included in this study, 101 (48.6%) cases, 107 (51.4%) controls; age mean 16.57 (Standard Deviation ‘SD’ 18.1) months; 61.1% (127) females and 38.9% (81) males. The Odds Ratio (OR) was 2.1 (95% Confidence Interval 1.197 – 3.679). The cases had a higher value of BTS’s score (mean = 4.7, SD = 3.015) compared to the controls (mean = 3.42, SD = 3.448). The difference was statistically significant but the Correlation Coefficient (r) between the study groups and BTS’s scores was weak (r = 0.194, P = 0.005). The correlation gained slight improvement by justification of the age to obtain homogeneity between the groups (r = 0.276, P < 0.001), but deteriorate and lost its significance when the sex was controlled as a confounder (r = 0.121, P = 0.082). There was a gradual increase of the mean BTS’s score from grade one to grade four of DDH but without a statistically significant value (r = 0,132, P = 0.128).
Conclusion The familial GJH has a weak - positive - correlation with DDH but can’t be considered as a possible risk factor for it.

Research paper thumbnail of Accelerated versus conventional Ponseti protocol for the treatment of idiopathic talipes equinovarus deformity: A short term follow up in Iraq

article, 2021

Background and Objectives The accelerated protocol of Ponseti method was suggested to shorten th... more Background and Objectives The accelerated protocol of Ponseti method was suggested to shorten the period of treatment of the conventional one for the cases of Talipes Equinovarus deformity. The aim of this study was to compare the accelerated protocol of Ponseti method in treatment of clubfoot deformity with the conventional one.
Methods A prospective comparative study done for Infants less than 6 months with congenital talipes equinovarus deformity. The patients were randomized to either Group 1 (casts changed every week, conventional protocol of Ponseti method) or Group 2 (twice weekly, accelerated one). Pirani score was used to assess the severity of the deformity at presentation, at time of last cast removal and at last follow up visit (6th months).
Results The patients included were 48 cases with 79 feet. The Group 1 (39 clubfeet) had a mean Pirani score of 5.6 (± 1.15) at presentation which dropped to 0.47 (± 0.41) when last cast removed and in Group 2 (40 clubfeet) it dropped from 5.57 (± 0.83) to 0.77 (± 0.01). The result of each treatment protocol was significant but the difference between them was not significant. Five cases (3 patients, age more than 3 months) of Group 2 needed 8 casts to reach an acceptable position of correction. The difference between the mean number of casts applied in Group 1 (5.09) and Group 2 (5.82) was statistically not significant, but between the mean number of days spent in cast was significant. The complications occurred in 12 out of 79 feet, with no statistically significant difference between both groups.
Conclusion The accelerated protocol of the Ponseti method for the treatment of clubfoot deformity is as effective as and as safe as the conventional one. It shortens the time required to complete the treatment program. Those who present lately (beyond the age of 3 months) may require an additional number of casts.

Research paper thumbnail of Limited Mid Palmar Versus Extended Incision in Surgical Treatment of Carpal Tunnel Syndrome: Clinical Analysis

article, 2020

Background and Objectives There is different methods and incisions to release the transverse car... more Background and Objectives There is different methods and incisions to release the transverse carpal ligament in carpal tunnel syndrome. The purpose of this study was to compare the surgical outcome of the conventional extended incision with the limited mid palmar one.
Methods The study was a prospective comparative one. Patients with carpal tunnel syndrome were divided into 2 groups: Group 1 was patients operated by the conventional extended incision, Group 2 with limited mid palmar incision.
Results The patients included were 79 with 89 hands. The age mean was 41 years. The Group 1 included 47 and Group 2 included 42 hands. The differences between both groups were statistically significant regarding the operative data (the incision length and the operative time) and in the post-operative data (the duration of analgesia needed, the date of starting to use the hand in daily life activities and return to work). But the date of improvement of the sensory symptoms from the fingers showed no significant differences. The sum of the overall complications occurred for the cases of Group 2 was about third of that occurred for Group 1. The highly significant difference was in the scar tenderness at the third month of post-operative period.
Conclusion The limited mid palmar incision to release the entrapment of median nerve in carpal tunnel syndrome offers a shorter operative time, less analgesia needed post-operatively, less complication rate, less scar tenderness, an earlier use of the hand in the daily life activities and return to the work in a shorter period.

Research paper thumbnail of Effect of Walking of the Child Independently on the Developmental Dysplasia of the Hip

article, 2015

Background In developmental dysplasia of the hip a number of pathological changes develop, some... more Background In developmental dysplasia of the hip a number of pathological changes develop, some of them perhaps reflecting a primary dysplasia of the acetabulum and/or the proximal femur, but most of them from adaptation to persistent instability and abnormal joint loading. After weight-bearing commences, these changes are intensified. Most children begin to walk independently near their 1st year birthday; some do not walk until 18 months of age. At this age group, the classical treatment of a dislocated hip is closed reduction with spica cast then abduction splint. Redislocation is one of the commonest complications of the treatment of developmental dysplasia of the hip.
Aim Is to assess the effect of independent walking of the child on the treatment of a missed dislocated hip whether it increases the risk of failure of the treatment by re-displacement of the hip or not!
Patients and Methods This study included those children who had missed dislocation or subluxation of the hip and they were at the expected period for the beginning of walking independently ( age 12-18 months ). They were 87 patients with 131 dislocated or subluxated hips. The patient had been divided into five groups: Group 1: still not walking independently, Group 2: walking independently for less than 1 month, Group 3: walking for 1-2 months, Group 4: walking for 2-3 months, and Group 5: walking for more than 3 months.

Results Most of the patients of Group 1 had bilateral DDH ( 63.3% ) and also in Group 5 ( 80% ), while in Group 2, 3, and 4 the DDH was more common in one side ( 75%, 71.4%, and 72.7% respectively ). From the total number of patients who had been included in this study, 21 hips out of 131 showed signs of re-displacement with an incidence of failure of 16 %. There were 3 hips of Group 1, 1 hip of Group 2, 4 hips of Group 3, 6 hips of Group 4, and 7 hips of Group 5.
Conclusion Walking of the child independently is associated with an increased risk of failure of closed reduction for patients having developmental dysplasia of the hip between age 12-18 months especially after 2 months of walking.

Research paper thumbnail of Reflex Sympathetic Dystrophy: Recognition of Some Risk Factors

article, 2015

Background Reflex sympathetic dystrophy occurs most often in the extremities after an injury. It ... more Background Reflex sympathetic dystrophy occurs most often in the extremities after an injury. It causes the limb to undergo chronic pain, swelling, redness, tenderness, and stiffness with patchy rarefaction. The diagnosis is mainly clinical and delays in diagnosis end with a poor prognosis. Therefore predicting this problem is important by noticing the risk factors. The aim of this study is to highlight some risk factors for the development of this disorder.
Patients and methods The study included those patients who sustained trauma to their extremities or underwent surgery. Children and those with clear nerve injury were excluded from the study. Those who did not show the clinical features of RSD were included in group 1 and we considered them as a control group, while those who had RSD features were included in group 2.
Results The total number of patients was 143 cases. In Group 1 the male to female ratio was 3:2, the average age was 36 years. 65 of them had trauma to their upper limb and 31 to the lower limb. Most of them had no psychological symptoms. In Group 2 the male to female ratio was 1:4 and the average age was 53 years. 27 with upper limb trauma and 20 with lower limb. All the patients of this group had clear psychological disturbance and 45 ( 95.7% ) of them had pre-morbid stressful personalities.
Conclusion age ( middle ), gender ( female ), and stressful personality are risk factors to develop RSD if such a person sustained trauma or did a surgical procedure. The extremity involved and the type of injury seem to have no role in the development of RSD.

Research paper thumbnail of Reliability of International Hip Dysplasia Institute Classification for the Developmental Dysplasia of the Hip Among Different Medical Personnel in Iraq

article , 2020

Background: The international hip dysplasia institute (IHDI) classification is a new method for q... more Background: The international hip dysplasia institute (IHDI) classification is a new method for quantifying the severity of the developmental dysplasia of the hip (DDH). Objectives: This study aimed to compare the reliability of this classification between different medical personnel such as pediatricians, general practitioners, and family doctors in addition to orthopedic surgeons and radiologists.
Methods: Hundred pelvic radiographic films (with 200 hips) were randomly selected from the files of children already diagnosed and treated as DDH cases. These
films were analyzed by 12 independent observers of four different specialties: three orthopedic surgeons (Ortho Group), three radiologists (Radio Group), three pediatricians (Pediat Group), and three general practitioners (GP Group).
Results: The average measure (Cronbach’s alpha) for the intraclass correlation coefficient (ICC) for absolute agreement between all observers was 0.874 (with 95% confidence intervals between 0.780 and 0.925). This was considered as having a good level of reliability and agreement between all observers. The ICC for
agreement between the observers of the radio group showed the highest score (0.904) while that between those of GP Group had the lowest
one (0.826). However, during the comparison between the mean score of each group with that of the other groups by the one‑way ANOVA
method, there was no statistically significant difference between all groups (P values were 0.563, 0.415, 0.399, and 0.291 respectively).
Conclusion: The IHDI classification method for cases of DDH has a good level of reliability among different medical personnel regardless
of their specialties.

Research paper thumbnail of Relapse Of Clubfoot Deformity After Correction: Effect Of Type Of Splint In Unilateral Cases

article, 2012

Background Talipes equinovarus is the most common type of clubfoot deformity. Diagnosis is mainly... more Background Talipes equinovarus is the most common type of clubfoot deformity. Diagnosis is mainly clinical. The aim of treatment is to produce and maintain a plantigrade supple foot that functions well. The treatment is usually started by the conservative method by serial manipulations and casting but may need surgical correction. After complete correction of the deformity, there is a significant risk of relapse, which can be prevented by using different types of splints for 3-4 years. The classical splint is Denis Browne Brace in which both feet are held together in an external rotation position. But the non-compliance to this splint makes adherence to it difficult.
Aim To study the incidence of relapse after using different types of splints after correction of clubfoot deformity.
Patients and Methods This retrospective study included 48 patients with unilateral clubfoot who wear a splint in their foot after their deformity had been corrected. Twenty-six cases wear unilateral ankle-foot orthosis while 22 cases wear foot abduction brace. They had been followed for about 1.3-3 years.
Results In this study the incidence of relapse in patients with unilateral clubfoot was 35.4%. Thirteen (50%) out of 26 cases who used unilateral Ankle Foot Orthosis developed relapse, while 4 (18.2%) out of 22 cases who wear the Foot Abduction Brace developed relapse. The results were statistically significant.
Conclusion The use of a Foot Abduction Brace is associated with a low risk of relapse because it maintains the foot in an external rotation position and causes stretching of posteromedial soft tissue structures while unilateral Ankle Foot Orthosis can't hold this position.

Research paper thumbnail of Adductor Tenotomy Versus Preliminary Traction For Prevention of Complications of Closed Reduction of The Developmental Dysplasia of The Hip

article , 2019

Objectives closed reduction and spica cast application in the treatment of developmental dysplasi... more Objectives closed reduction and spica cast application in the treatment of developmental dysplasia of the hip especially before walking age has a risk of complication specially avascular necrosis and re-displacement of the femoral head out of the acetabular socket. Different measures were tried to improve the outcome of the treatment. The present study aimed to evaluate the effect of two of these methods (preliminary traction and adductor tenotomy).
Methods The outcome were retrospectively reviewed after one year from completing the program of treatment. The patients were divided into 2 groups: group 1 was those for whom adductor tenotomy before casting, while group 2 was those for whom preliminary traction did for 3 weeks before casting.
Results The total number of cases was 223 with 357 affected hips. The complications occur in 142 hips (39.8%), 30% developed avascular necrosis, and 9.8% end with re-displacement. In group 1, those who developed complications were 113 out of 287 (39.3%). While in group 2, 29 out of 70 hips (41.4%) developed complications. There was no statistically significant difference between the two groups in relation to success and complication rates as the p-value was 0.753.
Conclusion In conclusion, a single measure (either adductor tenotomy or only preliminary traction) is not promising to decrease the complications rates. A combination of different measures may overcome a percent of these complications. There is no clear superiority of either approach; adductor tenotomy or preliminary traction, however adductor tenotomy is preferred.