Background: There are many methods for evaluating a traumatized metacarp. Objectives: This study sought to evaluate the accuracy of the metacarpal Compression test for the diagnosis of metacarpal fracture. Methods: All patients with metacarpal trauma were tested via placement of axial load (Compression) on the metacarpal; induction or exacerbation of pain on each metacarp was recorded upon applying axial pressure. Then, an X-Ray imaging system was used to identify and record the presence of fracture. All data were entered into a 2x2 table, and then negative predictive value (NPV), positive predictive value (PPV), sensitivity and specificity of the test were calculated. Results: After careful physical examination and application of the axial pressure on the metacarpal bone, 16(23. 68%) patients did not experience any pain during axial loading (none had fracture). According to the statistical analyses of the data, the proposed method had a 69% specificity, 100% sensitivity, 86% PPV and 100% NPV. Conclusion: Our findings showed that axial loading applied on the metacarpal bone, when it leads to pain, is a good marker for fracture. On the other hand, patients with negative test results had no fracture on radiography, which emphasized 100% NPV of the test.

Physical examination is the most important procedure for examining traumatized patients and ruling out possible bone fractures. Edema, deformity, ecchymosis, tenderness on trauma location, and limited bone movement are among the signs of fracture. The diagnosis is documented by plain radiography. The number of false positive cases in this test increase in the presence of soft tissue injury along with bone damage. In this case, a great number of X-rays will be taken daily and many patients will be exposed to radiation, unnecessarily (1). The question to be fully answered is whether all cases of trauma and pain require radiographs or not? ...

Background: The risk of fractured vertebral increases in patients with rheumatoid arthritis as they are more likely to suffer from osteopenia, and osteoporosis. Objectives: This study aimed to investigating the rate and risk factors of vertebral fractures in patients with rheumatoid arthritis. Methods: We recruited 201 patients aged between 30 and 70 who attended the rheumatology department at Shahid Hemn Teaching Hospital in Sulaymaniyah, between January and September 2022. Medical records were reviewed for disease and treatment characteristics while also clinically evaluated by a rheumatologist. Spinal radiographs were assessed by two experienced radiologists blinded to patients’,clinical diagnosis and status. Compression fractures were classified by using the Genant semiquantitative method, and the type of fracture was classified as wedged fracture, biconcave fracture, or crushed fracture. Results: Of the 201 included participants, 151 were female, and 50 were male. The BMI of women was higher than men by nearly four points (P < 0. 001). Most women were also illiterate (68/151, 45. 0%) and unemployed (139/151, 92. 1%). Hypertension (28. 4%) and diabetes mellitus (14. 4%) were the most reported comorbidities. Women were more likely to have higher DAS28 scores while men had more vertebral fractures (P = 0. 003). The probability of fractures increased with age, male sex, and illiteracy compared to primary school, osteopenia, and osteoporosis through simple and multiple logistic regression models. Conclusion: With at least one fracture affects females and males at a rate of 27. 8% and 52. 0%, respectively. Also reported that age, male sex, illiteracy, osteopenia, and osteoporosis significantly increase the risk of fractures.

Background: In the patients with osteoporotic vertebral Compression fracture (OVCF) treated conservatively, significant progressionof the local kyphosis due to an impaired healing leads to reduction in the quality of life. Thus, it is of critical value to identifythe predictors of this major complication. Objectives: The current prospective cohort study aimed at evaluating the predictors of progression in the local kyphosis in a seriesof patients with acute OVCF undergoing conservative treatment. Methods: Eligible patients with OVCF were identified and local kyphosis progression was evaluated after four months of conservativetreatment. Demographic characteristics such as gender, age, and body mass index (BMI), as well as radiographic characteristicssuch as the location of fracture, bone mineral density (BMD), andserum25 (OH) vitaminDlevel were compared between the patientswith local kyphosis angle (LKA) progressed 30° (group A) and the patients with LKA remained < 30° (group B). Results: From a total of 60 patients with OVCF, LKA progressed  30° in 19 patients (31. 7%). The mean change of LKA was 16. 2°  7. 2° in group A and 1. 92°  2. 7° in group B (P < 0. 001). Higher age, lower BMI, and lower spinal BMD were significantly associatedwith LKA progression  30° (P = 0. 013, P < 0. 001, and P = 0. 037, respectively). The involvement of thoracolumbar junction (T11-L1)was more frequent in group A (P = 0. 049). Anterior cortical wall fracture was more frequent in group A as well (P = 0. 007). Afteradjustment of confounding factors, the association of LKA progression with the age, BMI, and the level of fractured vertebra stillremained significant. Conclusions: Significant progression of LKA following conservative treatment of OVCF is correlated with the level of fractured vertebra, BMI, and age of the patients. These factors could be used to select patients most benefit from conservative treatment.

Background: As a minimally invasive operation, kyphoplasty has become popular in the treatment of Osteoporotic Vertebral Compression fracture (OVCF). Objectives: This study aimed to evaluate how the timing of kyphoplasty affects the parameters of sagittal alignment in OVCF. Methods: In this prospective study, the patients with OVCF, who underwent kyphoplasty at our center, were recruited. Pre-and post-operative vertebral height, local and total kyphosis, coronal axis, sagittal vertebral axis, pelvic tilt, lumbar lordosis, sacral slope, and spino-cranial angle were evaluated and compared between acute OVCF (kyphoplasty performed within 1 month after injury) and chronic OVCF (kyphoplasty performed after 1 month from injury) patients. Results: Kyphoplasty was done for 18 acute and 28 chronic OVCF patients. All of the evaluated parameters, except spino-cranial angle, were significantly improved after the kyphoplasty. A significant difference was observed between the mean lumbar lordosis improvement of the two groups (P=0. 026). In particular, the Mean± SD lumbar lordosis improved 6. 1± 6. 6º in the acute patients and 0. 92± 7. 86º in the chronic group. No other significant difference was observed between the improvement of the spinopelvic parameters in the two groups. Conclusion: The timing of kyphoplasty impacts the improvement of spinopelvic parameters, as well as the reduction of pain and restoration of vertebral height.