Cross-cultural Adaptation and Validation of the Harris Hip Score for Arabic-Speaking Patients Abdulraheem A. Altalib, Sulaiman A. Almousa, Mohammad M. Alzahrani, Bandar A. Alzahrani, Ahmed K. Alsenan, Hashem A. Alkhamis Saudi Journal of Medicine and Medical Sciences, 2026 Background: The English language Harris Hip Score (HHS) is widely adopted tool that measures the health of the hip joint through pain, function, and disabilities domains. The aim of this study is to translate the HHS into Arabic (HHS-A) and then assess its validity and reliability. Methodology: The HHS-A underwent cross-cultural adaptation involving forward- and backtranslation following recommended guidelines, and then a pilot testing. Validity was assessed by comparing it with the Arabic SF-36 for convergent and divergent validity. Internal consistency was measured using Cronbach’s alpha, and test–retest reliability was evaluated with through a subgroup analysis of 20 participants using intraclass correlation coefficients (ICC) and minimal detectable change (MDC). Results: A total of 149 consecutive patients were enrolled in the study. The mean adjusted total HHS-A score was 45.02 (±17.95), and were 17.15 and 27.87 for pain and function domains, respectively. The pain domain of HHS-A showed strong correlations with physical function (PF) ( r = 0.686, P < 0.001) and the physical component summary (PCS) score ( r = 0.662, P < 0.001) of the SF-36, while the function domain showed strong correlation with PF ( r = 0.742, P < 0.001), and moderate correlation with the physical component summary PCS ( r = 0.588, P < 0.001), indicating good convergent validity. A weak correlation was observed between pain domain and the function domain with mental health ( r = 0.320, P < 0.001; r = 0.230, P < 0.01, respectively), indicating divergent validity. Both total and function domain demonstrated good internal consistency (Cronbach’s alpha: 0.83 and 0.81, respectively). The ICC of the pain and function domains was 0.986 and 0.982, respectively, and the MDC was 3.01 and 3.56 points, respectively. Conclusion: The Arabic version of the Harris Hip Score is found to be a valid and reliable instrument for assessing hip pathologies within Arabic-speaking populations.
Validity of the Arabic version of AAOS-foot and ankle outcomes questionnaire in patients with traumatic foot and ankle injuries Sulaiman A AlMousa, Mohammad M Alzahrani, Bandar A Alzahrani, Ahmed K Alsenan, Abdulraheem A Altalib, Hashem Abdulkarim Alkhamis World Journal of Orthopedics, 2025 BACKGROUND Arabic-speaking patients are underrepresented in orthopedic clinical studies, particularly in foot and ankle trauma research. The lack of validated Arabic language tools hinders their inclusion, creating a need for culturally and linguistically adapted instruments. The American Academy of Orthopedic Surgeons Foot and Ankle Outcomes Questionnaire (AAOS-FAOQ) is a widely used tool but has not been adapted for Arabic-speaking patients. AIM To translate, cross-culturally adapt, and validate the AAOS-FAOQ for Arabic-speaking patients with traumatic foot and ankle injuries. METHODS The cross-cultural adaptation followed established guidelines, involving forward and backward translations, expert review, and pre-testing. The final Arabic version was administered alongside the Arabic Short-Form 36 (SF-36) to 100 patients for validity testing. Reliability was assessed through test-retest methods with 20 patients completing the questionnaire twice within 48 hours. Pearson correlation coefficients measured convergent and divergent validity with SF-36 subscales, while Cronbach's alpha and intraclass correlation coefficients (ICC) determined internal consistency and reliability. RESULTS Out of 100 patients, 92 completed the first set of questionnaires. The Arabic AAOS-FAOQ showed strong correlations with the SF-36 subscales, particularly in physical function and bodily pain (r > 0.6). Test-retest reliability was robust, with ICCs of 0.69 and 0.66 for the Global Foot and Ankle Scale and Shoe Comfort Scale, respectively. Cronbach's alpha for internal consistency ranged from 0.7 to 0.9. CONCLUSION The Arabic version of the AAOS-FAOQ demonstrated validity and reliability for use in Arabic-speaking patients with traumatic foot and ankle injuries. This adaptation will enhance the inclusion of this population in orthopedic clinical studies, improving the generalizability of research findings and patient care.
Role of post-operative X-rays in distal-radius fractures among pediatric patients Ammar K Alomran, Bandar A Alzahrani, Dana S Alamoud, Layan S Alsultan, Meshail M AlSaud, Raneem G Althobaiti, Badriah S Alruwaili World Journal of Orthopedics, 2025 BACKGROUND In pediatric age group patients (< 18 years old) treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period -particularly in uncomplicated cases - appears to provide limited additional benefit. AIM To determine the necessary number of follow-up X-rays to use resources efficiently. METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017. The data in the study included patients who had distal radius fractures and underwent fixation surgery (n = 88). RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation, the only significant difference is the closed reduction fixation method. Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method. Open reduction, internal fixation, and other fixation methods (close reduction and internal fixation, debridement, or epiphysiodesis) have higher odds of having two or more X-rays compared to patients who did not receive these methods; however, these odds are not statistically significant. CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.
Accuracy of artificial intelligence in prediction of osteoporotic fractures in comparison with dual-energy X-ray absorptiometry and the Fracture Risk Assessment Tool: A systematic review Mir Sadat-Ali, Bandar A Alzahrani, Turki S Alqahtani, Musaad A Alotaibi, Abdallah M Alhalafi, Ahmed A Alsousi, Abdullah M Alasiri World Journal of Orthopedics, 2025 BACKGROUND Osteoporotic fractures, whether due to postmenopausal or senile causes, impose a significant financial burden on developing countries and diminish quality of life. Recent advancements in artificial intelligence (AI) algorithms have demonstrated immense potential in predicting osteoporotic fractures. AIM To assess and compare the efficacy of AI models against dual-energy X-ray absorptiometry (DXA) and the Fracture Risk Assessment Tool (FRAX) in predicting fragility fractures. METHODS We conducted a literature search in English using electronic databases, including PubMed, Web of Science, and Scopus, for studies published until May 2024. The keywords employed were fragility fractures, osteoporosis, AI, deep learning, machine learning, and convolutional neural network. The inclusion criteria for selecting publications were based on studies involving patients with proximal femur and vertebral column fractures due to osteoporosis, utilizing AI algorithms, and analyzing the site of fracture and accuracy for predicting fracture risk using SPSS version 29 (Chicago, IL, United States). RESULTS We identified 156 publications for analysis. After applying our inclusion criteria, 24489 patients were analyzed from 13 studies. The mean area under the receiver operating characteristic curve was 0.925 ± 0.69. The mean sensitivity was 68.3% ± 15.3%, specificity was 85.5% ± 13.4%, and positive predictive value was 86.5% ± 6.3%. DXA showed a sensitivity of 37.0% and 74.0%, while FRAX demonstrated a sensitivity of 45.7% and 84.7%. The P value for sensitivity between DXA and AI was < 0.0001, while for FRAX it was < 0.0001 and 0.2. CONCLUSION This review found that AI is a valuable tool to analyze and identify patients who will suffer from fragility fractures before they occur, demonstrating superiority over DXA and FRAX. Further studies are necessary to be conducted across various centers with diverse population groups, larger datasets, and a longer duration of follow-up to enhance the predictive performance of the AI models before their universal application.
Prevalence and associated factors of clubfoot in the eastern province of Saudi Arabia: A hospital-based study Ammar K Alomran, Bandar A Alzahrani, Bader S Alanazi, Mohammed A Alharbi, Loay M Bojubara, Eman M Alyaseen World Journal of Orthopedics, 2024 BACKGROUND Clubfoot, or congenital talipes equinovarus, is a widely recognized cause of disability and congenital deformity worldwide, which significantly impacts the quality of life. Effective management of clubfoot requires long-term, multidisciplinary intervention. It is important to understand how common this condition is in order to assess its impact on the population. Unfortunately, few studies have investigated the prevalence of clubfoot in Saudi Arabia. AIM To determine the prevalence of clubfoot in Saudi Arabia via the patient population at King Fahad University Hospital (KFUH). METHODS This was a retrospective study conducted at one of the largest hospitals in the country and located in one of the most densely populated of the administrative regions. RESULTS Of the 7792 births between 2015 to 2023 that were included in the analysis, 42 patients were diagnosed with clubfoot, resulting in a prevalence of 5.3 per 1000 live births at KFUH. CONCLUSION The observed prevalence of clubfoot was significantly higher than both global and local estimates, indicating a substantial burden in the study population.
Patients’ awareness of their rights: an insight from a teaching hospital in Saudi Arabia Mohammed Madadin, Ritesh G. Menezes, Abdulaziz A Almazrua, Bandar A Alzahrani, Maha A. Alassaf, et al. Acta Biomedica, 2023 BACKGROUND AND AIM: Knowledge and awareness of patients' rights are essential to reach the highest quality of care. In 2006, the Saudi Arabian government formulated "The Patients' Bill of Rights" to ensure that healthcare delivery is at its highest standard. Despite their efforts, several studies revealed patients' lack of awareness. In this study, we aim to investigate the patients' awareness of their rights according to the policy of a teaching hospital in Saudi Arabia. METHODS: A cross-sectional study was conducted where the participants (n= 384) were in-patients and out-patients of a tertiary care teaching hospital in the Eastern Province of Saudi Arabia. Informed consent was obtained, and confidentiality was maintained. The questionnaire consisted of 23 questions. Data were analyzed using Statistical Package Social Software version 26. RESULTS: Most of the participants were males (70.1%), in-patients (63.3%), and Saudi nationals (84.5%) with a mean age of 32 years. The mean awareness score was satisfactory (>7/14). However, more than half of the participants were unaware of their right to know the risks and benefits of treatment (55.1%), to know the identity of their healthcare providers (61.9%), to deny participation in research (58%), and appoint a healthcare proxy (64.8%). CONCLUSIONS: The present study revealed the lack of awareness of certain aspects of patients' rights that require action in the means of hospital awareness campaigns and educational materials. Further research is required to generalize a consensus on the Saudi population's level of awareness and consequent steps to optimize the delivery of healthcare in the country.
Is Ponseti Casting Effective in Neuromuscular Clubfoot? A University Hospital Experience from Eastern Province in Saudi Arabia AmmarK Alomran, DalalA Bubshait, BandarA Alzahrani, AbdulazizA Almazrua, MohammedA Alyaqout Journal of Musculoskeletal Surgery and Research, 2020 Objectives: Clubfoot deformity occurs in approximately one in 1000 newborns. In patients with neuromuscular disease, the clubfoot deformity differs markedly from that in idiopathic clubfoot with respect to its severity and higher rate of complications. We aimed to compare the effectiveness of the Ponseti serial casting technique in treating idiopathic and neuromuscular clubfoot. Methods: We performed a retrospective study of patients with clubfoot identified from a pediatric orthopedic clinic database, who were treated at our hospital from 2004 to 2018. The follow-up period for patients in both groups ranged from 8 to 12 years. The information obtained included age at presentation and number of casts required for deformity correction. We measured the severity of the clubfoot using the modified Pirani score before and after Ponseti treatment. Results: The initial number of participants was 117; upon applying our inclusion and exclusion criteria, only 39 patients from the idiopathic group and 10 from the neuromuscular disease-associated clubfoot group were included. The average age in weeks of the participants in the idiopathic group and the neuromuscular disease-associated clubfoot group at diagnosis was 1.79 and 1.80, respectively. Both groups had a similar mean modified Pirani score before and after the Ponseti treatment. Conclusions: Ponseti casting is an effective primary modality of management for clubfoot associated with neuromuscular diseases, as it is in idiopathic clubfoot, to achieve functional pain-free feet and reduce the number of surgical interventions needed.
