Browse publications by year: 2000

  1. Fulltext Profile of a menopause clinic in an urban population in Malaysia
    Damodaran P, Subramaniam R, Omar SZ, Nadkarni P, Paramsothy M
    Singapore Med J, 2000 Sep;41(9):431-5.
    PMID: 11193115
    The object of this study is to determine the status of an urban Malaysian woman in her menopause age group with reference to her menopausal symptoms, lipid profile, breast, pelvis and bone. One hundred and sixty four women attending the Menopause Clinic of University Hospital, Kuala Lumpur who had not previously been on hormone replacement therapy were studied. Forty nine women were perimenopausal, 74 women were in early menopause (within 5 years of menopause) and 41 women were in late menopause (after 5 years of menopause). The most common symptoms were hot flushes (56%) and generalised tiredness (49%). Eighty four percent (84%) of women had high cholesterol levels. Serum triglycerides were highest in the late menopause group. There were 2 cases of intraductal carcinoma diagnosed on routine mammography, with 8 cases of fibrocystic breast disease and 7 cases of suspicious breast lumps. Routine ultrasound (pelvic and abdominal) revealed two women with ovarian cysts, 6 women with an endometrial thickness of more than 5 mm and 8 women with uterine fibroids. Eighty five women (51.8%) had mild osteoporosis while four women had moderate osteoporosis on dual photon measurements for bone mineral density. Menopause clinics should aim at investigating a woman in her menopause as a whole. Vasomotor symptoms were common in the urban Malaysian menopausal woman. There was a high incidence of lipid abnormalities. Routine mammography, pelvic ultrasound examinations and bone mineral density tests detected significant pathology and abnormalities.
    Study site: Menopause Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    MeSH terms: Aged; Breast Diseases/radiography; Cross-Sectional Studies; Female; Health Status; Hospitals, University; Humans; Lipids/blood; Malaysia; Mammography; Menopause*; Middle Aged; Osteoporosis/epidemiology; Outpatient Clinics, Hospital; Pelvis/ultrasonography; Bone Density; Incidence; Hormone Replacement Therapy
  2. Fulltext Gradual reduction of supracondylar fracture of the humerus in children reporting late with a swollen elbow
    Devnani AS
    Singapore Med J, 2000 Sep;41(9):436-40.
    PMID: 11193116
    AIM: To study the outcome of gradual reduction by skin traction of supracondylar fracture of the humerus in children with swollen elbow, who seek treatment two days or longer after the injury.
    METHOD: Fifteen children aged between 4 and 11 years (average 7 years 11 months), who had initially consulted a traditional practitioner, reported between 2 and 21 days (average 7.5) after the injury were treated by skin traction with the elbow kept straight and the forearm in position of comfort.
    RESULTS: The average duration of stay in hospital was 14 days. All fractures healed; there was no incidence of myositis ossificans or neurovascular deficit. All patients had functional range of movements at the elbow within 6 months. Five patients developed cubitus varus deformity greater than 5 degrees, they were classified as poor result. Four out of these 5 patients had sought treatment after a delay of 7 days or longer. There were 9 good (60%), 1 fair (7%) and 5 poor (33%) results.
    CONCLUSION: Gradual reduction by skin traction is safe. It is possible to achieve satisfactory reduction if the delay is up to 7 days. The results with regards to deformity and function were comparable with those obtained following open or closed Kirschner wire fixation.
    MeSH terms: Child; Child, Preschool; Elbow/injuries; Elbow/pathology; Female; Fracture Fixation/methods*; Humans; Humeral Fractures/pathology; Humeral Fractures/therapy*; Immobilization*; Male; Traction/methods*; Range of Motion, Articular; Treatment Outcome
  3. Emergence of Nipah virus in Malaysia
    Uppal PK
    Ann N Y Acad Sci, 2000;916:354-7.
    PMID: 11193645
    A pig-borne virus causing viral encephalitis amongst human beings in Malaysia was detected in 1997 by the Ministry of Health. Initially, the disease was considered to be Japanese encephalitis. Subsequently, it was thought to be a Hendra-like viral encephalitis, but on 10th April, 1999 the Minister of Health announced this mysterious and deadly virus to be a new virus named Nipah virus. The virus was characterized at CDC, Atlanta, Georgia. The gene sequencing of the enveloped virus revealed that one of the genes had 21% difference in the nucleotide sequence with about 8% difference in the amino acid sequence from Hendra virus isolated from horses in Australia in 1994. The virus was named after the village Nipah. In all, the Ministry of Health declared 101 human casualties, and 900,000 pigs were culled by April, 1999. The worst affected area in Malaysia was Negri Sembilan. The symptoms, incubation period in human being and pigs, animal to human transmission, threat of disease to other livestock, and control program adopted in Malaysia is described.
    MeSH terms: Animals; Australia; Centers for Disease Control and Prevention (U.S.); Horse Diseases/transmission; Horse Diseases/virology; Horses; Humans; Malaysia/epidemiology; Swine; Swine Diseases/transmission; Swine Diseases/virology; United States; Zoonoses/transmission; Zoonoses/virology; Incidence; Paramyxoviridae Infections/epidemiology*; Paramyxoviridae Infections/transmission; Paramyxoviridae Infections/veterinary*
  4. Chronic hepatitis B virus infection in Asian countries
    Merican I, Guan R, Amarapuka D, Alexander MJ, Chutaputti A, Chien RN, et al.
    J Gastroenterol Hepatol, 2000 Dec;15(12):1356-61.
    PMID: 11197043
    Of the estimated 50 million new cases of hepatitis B virus (HBV) infection diagnosed annually, 5-10% of adults and up to 90% of infants will become chronically infected, 75% of these in Asia where hepatitis B is the leading cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC). In Indonesia, 4.6% of the population was positive for HBsAg in 1994 and of these, 21% were positive for HBeAg and 73% for anti-HBe; 44% and 45% of Indonesian patients with cirrhosis and HCC, respectively, were HBsAg positive. In the Philippines, there appear to be two types of age-specific HBsAg prevalence, suggesting different modes of transmission. In Thailand, 8-10% of males and 6-8% of females are HBsAg positive, with HBsAg also found in 30% of patients with cirrhosis and 50-75% of those with HCC. In Taiwan, 75-80% of patients with chronic liver disease are HBsAg positive, and HBsAg is found in 34% and 72% of patients with cirrhosis and HCC, respectively. In China, 73% of patients with chronic hepatitis and 78% and 71% of those with cirrhosis and HCC, respectively, are HBsAg positive. In Singapore, the prevalence of HBsAg has dropped since the introduction of HBV vaccination and the HBsAg seroprevalence of unvaccinated individuals over 5 years of age is 4.5%. In Malaysia, 5.24% of healthy volunteers, with a mean age of 34 years, were positive for HBsAg in 1997. In the highly endemic countries in Asia, the majority of infections are contracted postnatally or perinatally. Three phases of chronic HBV infection are recognized: phase 1 patients are HBeAg positive with high levels of virus in the serum and minimal hepatic inflammation; phase 2 patients have intermittent or continuous hepatitis of varying degrees of severity; phase 3 is the inactive phase during which viral concentrations are low and there is minimal inflammatory activity in the liver. In general, patients who clear HBeAg have a better prognosis than patients who remain HBeAg-positive for prolonged periods of time. The outcome after anti-HBe seroconversion depends on the degree of pre-existing liver damage and any subsequent HBV reactivation. Without pre-existing cirrhosis, there may be only slight fibrosis or mild chronic hepatitis, but with pre-existing cirrhosis, further complications may ensue. HBsAg-negative chronic hepatitis B is a phase of chronic HBV infection during which a mutation arises resulting in the inability of the virus to produce HBeAg. Such patients tend to have more severe liver disease and run a more rapidly progressive course. The annual probability of developing cirrhosis varies from 0.1 to 1.0% depending on the duration of HBV replication, the severity of disease and the presence of concomitant infections or drugs. The annual incidence of hepatic decompensation in HBV-related cirrhosis varies from 2 to 10% and in these patients the 5-year survival rate drops dramatically to 14-35%. The annual risk of developing HCC in patients with cirrhosis varies between 1 and 6%; the overall reported annual detection rate of HCC in surveillance studies, which included individuals with chronic hepatitis B and cirrhosis, is 0.8-4.1%. Chronic hepatitis B is not a static disease and the natural history of the disease is affected by both viral and host factors. The prognosis is poor with decompensated cirrhosis and effective treatment options are limited. Prevention of HBV infection thorough vaccination is still, therefore, the best strategy for decreasing the incidence of hepatitis B-associated cirrhosis and HCC.
    MeSH terms: Asia; DNA, Viral/physiology; Hepatitis B virus/genetics; Hepatitis B virus/physiology; Carcinoma, Hepatocellular/virology; Humans; Liver Neoplasms/virology; Virus Activation; Virus Replication; Prevalence; Hepatitis B, Chronic/complications; Hepatitis B, Chronic/epidemiology*; Hepatitis B, Chronic/physiopathology; Hepatitis B, Chronic/virology
  5. Evaluation of miniature manometric techniques for the measurement of esophageal body pressure waves
    Shanmuganathan G, Ritz MA, Holloway RH, Di Matteo AC, Omari TI
    J Gastroenterol Hepatol, 2000 Dec;15(12):1362-9.
    PMID: 11197044
    BACKGROUND AND AIMS: Perfused miniature manometric assemblies with lumina of 0.4-0.5 mm i.d. have been developed. Reduced luminal size offers the advantages of reduced assembly bulk and increased assembly complexity with greater numbers of lumina and lower manometric infusion volumes because of a slower perfusion rate. This study investigated the recording fidelity of miniature manometric assemblies in the measurement of esophageal peristalsis.

    METHODS: Four miniature manometric assemblies, each containing manometric lumina of either 0.4 or 0.5 mm i.d., were evaluated at 100 and 180 cm lengths. The fidelity of miniature manometric luminal recordings were evaluated in vivo during esophageal peristalsis by using a simultaneous comparison with the standard lumina and an intraluminal strain gauge.

    RESULTS: During esophageal peristalsis, miniature manometric lumina recorded the peak amplitude of pressure waves, with an accuracy at perfusion rates of 0.04 mL/min (0.4 mm, i.d.) and 0.15 mL/min (0.5 mm, i.d.).

    CONCLUSION: Miniature manometric assemblies of lengths that are practical for use in humans are suitable for recording esophageal peristalsis.

    MeSH terms: Adult; Esophagus/physiology*; Female; Humans; Male; Manometry/methods*; Manometry/standards*; Miniaturization*; Peristalsis/physiology*; Pressure
  6. Communal peeing: a new mode of flood control in ants
    Maschwitz U, Moog J
    Naturwissenschaften, 2000 Dec;87(12):563-5.
    PMID: 11198200
    The behavioral response of the obligate bamboo-nesting ant Cataulacus muticus to nest flooding was studied in a perhumid tropical rainforest in Malaysia and in the laboratory. The hollow internodes of giant bamboo, in which C. muticus exclusively nests, are prone to flooding by heavy rains. The ants showed a two-graded response to flooding. During heavy rain workers block the nest entrances with their heads to reduce water influx. However, rainwater may still intrude into the nest chamber. The ants respond by drinking the water, leaving the nest and excreting water droplets on the outer stem surface. This cooperative 'peeing' behavior is a new survival mechanism adaptive to the ants' nesting ecology. Laboratory experiments conducted with two other Cataulacus species, C. catuvolcus colonizing small dead twigs and C. horridus inhabiting rotten wood, did not reveal any form of water-bailing behavior.
    MeSH terms: Animals; Ants/physiology*; Disasters*; Poaceae; Malaysia; Social Behavior*; Tropical Climate; Urination
  7. Fulltext Supracondylar fractures of the humerus in children
    Sengupta S
    Med J Malaysia, 2000 Sep;55 Suppl C:1.
    PMID: 11200034
    MeSH terms: Child; Child, Preschool; Humans; Humeral Fractures/complications*; Humeral Fractures/epidemiology*; Malaysia; Wounds and Injuries/complications; Wounds and Injuries/epidemiology; Incidence; Peripheral Nerve Injuries*
  8. Fulltext X-linked hypophosphatemic rickets--a report of 2 cases and review of literature
    Yong SM, Aik S
    Med J Malaysia, 2000 Sep;55 Suppl C:101-4.
    PMID: 11200035
    We report two cases of x-linked dominant hypophosphatemic rickets involving a man and his daughter. The family tree consists of 44 members with 13 of them having short stature and bowing of the lower limbs. The study of this family tree strongly suggests an x-linked dominant inheritance.
    MeSH terms: Adult; Aged; Bone Nails; Female; Femur/surgery; Humans; Hypophosphatemia, Familial/genetics*; Hypophosphatemia, Familial/pathology; Hypophosphatemia, Familial/radiography*; Hypophosphatemia, Familial/surgery; Male; Osteotomy; Pedigree
  9. Fulltext Tuberculosis of the distal end of the radius mimicking a giant-cell tumour
    Pan KL, Ibrahim S
    Med J Malaysia, 2000 Sep;55 Suppl C:105-6.
    PMID: 11200036
    We report a case of a lady presenting with a lesion in the distal radius with classical radiological features of a giant-cell tumour. These tumours are often resected without preliminary histological confirmation. A biopsy done in this patient showed it to be tuberculosis.
    MeSH terms: Antitubercular Agents/therapeutic use; Biopsy; Bone Neoplasms/radiography*; Diagnosis, Differential; Female; Giant Cell Tumors/radiography*; Humans; Middle Aged; Radius/microbiology*; Radius/pathology; Radius/radiography*; Tuberculosis, Osteoarticular/drug therapy; Tuberculosis, Osteoarticular/pathology; Tuberculosis, Osteoarticular/radiography*
  10. Fulltext Osteopoikilosis--a case report
    Pan KL, Ibrahim S
    Med J Malaysia, 2000 Sep;55 Suppl C:107-8.
    PMID: 11200037
    Osteopoikilosis is a rare, inheritable, sclerosing bone dysplasia; sometimes mistaken for osteoblastic bone metastases. We report a case in a 25 year-old lady.
    MeSH terms: Adult; Analgesics/therapeutic use; Back Pain/drug therapy; Back Pain/etiology; Female; Humans; Osteopoikilosis/complications; Osteopoikilosis/radiography*
  11. Fulltext Thoracolumbar fracture--dislocation results of surgical treatment
    Razak M, Mahmud M, Mokhtar SA, Omar A
    Med J Malaysia, 2000 Sep;55 Suppl C:14-7.
    PMID: 11200038
    Fifteen cases of unstable fracture-dislocation of the thoracolumbar spine have been treated by open reduction, short segment transpedicular fixation and fusion in Universiti Unit, Kuala Lumpur Hospital from January 1994 until December 1997. Twelve male and three female patients were injured; their age ranged from 18 to 45 years. Five fracture-dislocations occurred in the lower thoracic spine (T8 to T11), eight at the thoracolumbar junction (T12 to L2) and two in the lumbar spine (L3 to L5). All the patients had neurological deficit. Seven patients with incomplete or cauda equina lesions regained some neural function, while all eight with complete lesions remained unchanged. Ten of the fifteen cases were grossly unstable and translated beyond 50% of the width of the spinal column. At the time of follow up (more than one year in all patients), no loss of reduction or of fixation was noted in any patient. Solid fusion was achieved in all patients. The advantages of this method of treatment include stable fixation, with maintenance of sagittal and coronal spinal alignments, to allow early rehabilitation.
    MeSH terms: Adult; Dislocations/surgery*; Female; Fracture Fixation; Humans; Lumbar Vertebrae/injuries*; Male; Spinal Diseases/surgery*; Spinal Fusion; Thoracic Vertebrae/injuries*; Spinal Fractures/surgery*; Treatment Outcome
  12. Fulltext Spinal infection--an overview and the results of treatment
    Razak M, Kamari ZH, Roohi S
    Med J Malaysia, 2000 Sep;55 Suppl C:18-28.
    PMID: 11200039
    A retrospective review of thirty-eight patients (16 males and 22 females) with spinal infection between 1993 and 1998 revealed that the mean age was 39.9 years and the peak incidence was in the 5th decade of life. Infections in thirty-two patients (84.2%) were tuberculous in origin, 13.2% were pyogenic and 2.6% were fungal. Back pain was a symptom in 94.7% while 55.8% had neurological deficits, of which two-thirds were tuberculous in origin. Twenty-two patients (57.9%) had an impaired immune status secondary to pulmonary either tuberculosis, diabetes mellitus, intravenous drug abuse, prolonged steroid treatment, malnutrition, or advanced age. History of contact with tuberculous patients was elicited in 31.3%, extraskeletal tuberculosis was found in 28.1%, while Mantoux test was only positive in 53.1% of tuberculous patients. Majority of the cases (57.9%) involved lumbar vertebra. The histopathological examination was only positive in 22.2% from material taken via CT guided biopsy but 93.3% were found to be conclusive from open biopsy. 4 out of 5 patients who had a pyogenic infection were treated conservatively and produced a good result. There was no difference in outcome for tuberculosis patients treated with either the 3 drug or 4 drug regimen. Anterior decompression and bone grafting in tuberculous patients was superior in terms of a faster fusion rate, early pain relief and prevention of kvphotic deformity. The initial neurological deficit did not reflect the future prognosis of patients with spinal infection.
    MeSH terms: Adolescent; Adult; Aged; Bacterial Infections/complications; Bacterial Infections/diagnosis*; Bacterial Infections/epidemiology; Bacterial Infections/therapy*; Child; Child, Preschool; Female; Humans; Malaysia; Male; Middle Aged; Nervous System Diseases/etiology; Spinal Diseases/complications; Spinal Diseases/diagnosis*; Spinal Diseases/epidemiology; Spinal Diseases/therapy*; Incidence
  13. Fulltext HUKM instrumentation system in surgical treatment of adolescent idiopathic scoliosis--an early experience
    Razak MA, Fazir M, Ibrahim S
    Med J Malaysia, 2000 Sep;55 Suppl C:2-8.
    PMID: 11200040
    Between May 1992 through October 1998, twenty-two patients who had adolescent idiopathic scoliosis were treated using Universiti Kebangsaan Malaysia (UKM) spinal instrumentation and fusion. The minimum length of follow-up was 2 years with an average of 2.9 years. Nineteen patients were female and three patients were male. The mean age at the time of the operation was 16.2 years (range, 13 to 24 years). The average blood loss was 1,878 ml and the average operating time was 291 minutes. The mean pre-operative curve was 61.2 degrees, with a range of 40 degrees to 90 degrees. The average post-operative correction of the Cobb's angle was 53.5 per cent, with a range of 33 per cent to 81 per cent. Post-operative immobilization consisted of a maximum of six months in a body cast. There were no neurological injuries, no deep wound infections, and no evidence of pseudoarthroses. Only three complications occurred and these did not disturb the progress of the fusion. This technique safely achieves the objectives of scoliosis correction, and is cost-effective in the treatment of adolescent idiopathic scoliosis.
    MeSH terms: Adolescent; Equipment Failure; Female; Follow-Up Studies; Humans; Male; Scoliosis/surgery*; Treatment Outcome
  14. Fulltext Selective thoracic fusion of King II scoliosis with segmental spinal instrumentation
    Lim HH, Choon DSK
    Med J Malaysia, 2000 Sep;55 Suppl C:29-34.
    PMID: 11200041
    Segmental spinal instrumentation with Harrington rod secured to the spine by sublaminar wires was a popular method of scoliosis correction in 1980's. It was gradually replaced by newer rod-hook systems due to concern about neurological complications. However, correction of type II and III curves by selectively fusing the thoracic curves with these new instruments has resulted in poor results in some cases. The aim of this study is to review the result of selective thoracic fusion treated by segmental spinal instrumentation. Between January 1989 to October 1994, 31 patients with King II scoliosis were treated operatively in our unit. These consisted of 29 girls and 2 boys. The mean age of these patients were 11.3 years. The study population consisted of 21 Chinese, 5 Malays and 5 Indians. In one patient, the thoracic curve was convex to the left whilst the thoracic curves in the majority were to the right. The surgery was performed by three surgeons using harrington rods and posterior fusion with autograft. Anterior releases were also required in eight patients to increase flexibility. The curve correction obtained was an improvement from a average preoperative cobb's angle of 71.5 degrees to 39.5 degrees postoperatively. After an average follow-up period of 77.9 months, the correction deteriorated by 22% in the thoracic curve and 59% in the lumbar spine without disturbance to truncal balance. Only one sublaminar wire broke. However, no implant failure or removal has to be performed as yet. This technique appears useful in our institution with minimal morbidity.
    MeSH terms: Adolescent; Adult; Female; Humans; Male; Orthopedic Fixation Devices*; Scoliosis/surgery*; Spinal Fusion*; Thoracic Vertebrae/surgery*; Treatment Outcome
  15. Fulltext Experience in snuffbox arteriovenous fistulae for hemodialysis
    Lee JK, Sara TT
    Med J Malaysia, 2000 Sep;55 Suppl C:35-8.
    PMID: 11200042
    Sixty-five patients with "Snuffbox" arteriovenous fistulae for hemodialysis were reviewed. The procedure was performed under local anaesthesia as an outpatient procedure. It was done as a "standby" procedure for 41.5% of patients with Chronic Ambulatory Peritoneal Dialysis. 58.5% of patients had the procedure done for primary hemodialysis. Patency was assessed as presence of an engorged vein and presence of thrill. This was assessed routinely at 4 to 6 weeks after the procedure. Patency rate was noted to be 83%. The commonest complication was thrombosis of the arteriovenous anastomosis. Some patients required repeated procedure at a more proximal site. Further study to determine the blood flow rate provided by the anastomosis, and comparison with other anatomical sites is necessary.
    MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care; Arteriovenous Shunt, Surgical*; Catheters, Indwelling*; Female; Renal Dialysis*; Humans; Male; Middle Aged; Vascular Patency
  16. Fulltext Supracondylar fractures of the humerus in children--an epidemiological study of 132 consecutive cases
    Chai KK, Aik S, Sengupta S
    Med J Malaysia, 2000 Sep;55 Suppl C:39-43.
    PMID: 11200043
    132 consecutive cases of supracondylar fractures of the humerus admitted between July, 1997 and February, 1999 were included in a prospective study. There were 93 boys and 39 girls. The age ranges from one to 14 years old. The non-dominant arm was more often injured. Ethnic Malay constituted the majority. Accidents mainly occurred at home with a peak between 4 pm and 8 pm. Majority was presented within 24 hours of injury. Type III fracture with distal fragment in extension predominated. Nerve injuries occurred in 9 cases in which median nerve was the most commonly affected. There was only one open fracture and it was complicated by absent radial pulse and median nerve injury.
    MeSH terms: Adolescent; Child; Child, Preschool; Female; Humans; Humeral Fractures/ethnology; Humeral Fractures/epidemiology*; Infant; Malaysia/epidemiology; Male; Prospective Studies; Wounds and Injuries/epidemiology; Incidence; Peripheral Nerve Injuries
  17. Fulltext The results of open reduction and pin fixation in displaced supracondylar fractures of the humerus in children
    Srivastava S
    Med J Malaysia, 2000 Sep;55 Suppl C:44-8.
    PMID: 11200044
    The treatment of displaced supracondylar fracture humerus (Gartland Type III) in children continues to be a challenging problem. We did a retrospective study of such fractures treated in Hospital Muar, over a 2 years period (from January 1998 to December 1999). A total of 42 cases with displaced supracondylar fractures, treated with open reduction and internal fixation were studied. All cases were operated using a posterior triceps splitting approach and crossed kirschner wires were used to stabilize the fracture site. An excellent outcome was seen in 34 patients (81%) and a good outcome in 7 patients (17%). The incidence of complications such as pin tract infection (14%), nerve injury (2%) was very low. None of the patients had vascular complications or myositis ossificans.
    MeSH terms: Bone Nails*; Child; Child, Preschool; Female; Fracture Fixation, Internal; Humans; Humeral Fractures/surgery*; Male; Postoperative Complications; Retrospective Studies
  18. Fulltext Functional outcome of open reduction and internal fixation of pelvic ring injuries
    Tee SS, Hyzan Y, Razak M
    Med J Malaysia, 2000 Sep;55 Suppl C:49-58.
    PMID: 11200045
    Between January 1996 and August 1998, 15 patients with pelvic ring injuries were treated by open reduction and internal fixation. Fractures types included Tile A1 (7%), B1 (33%), C1 (53%) and C3 (7%). The patients were observed for an average of 1 year (range: 5 to 21 months). Thirteen patients (87%) who were operated within 3 weeks after injury had their pelvic disruption healed. One patient with Tile C1 and non-union of the fracture dislocation of sacroiliac joint was operated 11 months after injury and developed implant failure and non-union of the fracture dislocation of sacroiliac joint. Another patient with Tile C1 injury with transforamina sacral fracture was fixed anteriorly only and developed non-union of the sacral fracture and redisplacement of pelvic disruption. Both of them had a poor functional outcome. A 40 points pelvic outcome grading scale (Cole et al 1996) based on physical examination, pain, radiographic analysis and activity/work status was used. Six patients (40%) (1 Tile A1, 5 Tile B1) had an excellent functional outcome. Seven patients (47%) (6 Tile C1, 1 Tile C3) had a good functional outcome.
    MeSH terms: Adolescent; Adult; Female; Fracture Fixation, Internal*; Humans; Male; Middle Aged; Pelvic Bones/injuries*; Postoperative Complications; Treatment Outcome; Fractures, Bone/surgery*
  19. Fulltext Clinical experience with reamed locked nails for close and open comminuted tibial diaphyseal fractures: a review of 50 consecutive cases
    Zainudin M, Razak M, Shukur SH
    Med J Malaysia, 2000 Sep;55 Suppl C:59-67.
    PMID: 11200046
    We present the results of our experience in treating comminuted tibial shaft fractures with reamed interlocking intramedullary nail from September 1993 to December 1995. In this retrospective study, there were fifty patients with an average follow-up of 14.3 months (range six to twenty-eight months). Ninety-eight percent of the fractures were due to motor-vehicle accident with majority of the patients being motorcyclist (96%). Thirty-eight fractures were closed and twelve were open (Gustilo grade I--8; grade II--4); 44% of them had additional fractures or other injuries. According to Winquist-Hansen classification of diaphyseal fracture comminution, there were 24% type I; 18% type II; 26% type III and 32% type IV. The union rate was 98%. There were 6 infections, 2 superficial and 4 deep. All these infections arose from closed fractures, which was possibly due to the long operative time. No patients with open fractures, which underwent delayed nailing, had infection. One of the patient had severe deep infection which required early nail removal before union. Anterior knee pain following nailing occurred in 6% of the patients. The average hospital stay after operation was 3.4 days. Ninety-four percent of the patients had excellent to good functional outcome after nailing. The mean time to regain full range of movement of knee and ankle was 8.4 weeks. Patients were allowed full weight bearing in the average time of 10.7 weeks and the mean time to return to work was 24.7 weeks.
    MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Bone Nails*; Equipment Design; Female; Fractures, Closed/surgery*; Fractures, Open/surgery*; Humans; Male; Middle Aged; Tibial Fractures/surgery*; Diaphyses/injuries*
  20. Fulltext Proximal third femoral shaft fractures in children: prevention of angular deformities using bilateral Thomas splints
    Kamal MH, Razak M, Ibrahim S, Lim A
    Med J Malaysia, 2000 Sep;55 Suppl C:68-73.
    PMID: 11200047
    This is a prospective study to look at the outcome of unilateral proximal third femoral shaft fractures in children treated with a bilateral Thomas splint in the Department of Orthopaedic Surgery Universiti Kebangsaan Malaysia between the period of January 1996 and June 1998. Eighteen children aged between 2 years and 12 years old with unilateral proximal third fractures of the femoral shaft were treated using a bilateral Thomas splint. Angular deformities were measured using a goniometer metric scale before and after Thomas splints. The percentage of varus tilt corrected ranged from 17% to 72% with an average correction of 29% from the initial deformity and the difference was statistically significant (p < 0.05). The percentage of posterior tilt corrected ranged from 19% to 60% with the average correction of 20% from the initial deformity. The difference was statistically significant (p < 0.05). From this study, we conclude that bilateral Thomas splints can give a better correction of angular deformity for proximal third femoral shaft fractures in children below twelve years of age.
    MeSH terms: Child; Child, Preschool; Female; Femoral Fractures/therapy*; Humans; Joint Diseases/prevention & control; Male; Prospective Studies; Splints*; Traction
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