Browse publications by year: 2019

Fulltext A rare but treatable cause of recurrent chest pain - Ictal chest pain

Khoo CS, Lee D, Park KM, In Lee B, Kim SE

BMC Neurol, 2019 Dec 30;19(1):348.
PMID: 31888520 DOI: 10.1186/s12883-019-1575-0

BACKGROUND: Chest pain as the primary manifestation of epilepsy is extremely rare and has only been reported once to date.
CASE PRESENTATION: We herein describe a 47-year-old woman with recurrent chest pain for 3 years. The cause of her chest pain remained elusive despite extensive investigations including comprehensive cardiac work-up. She was referred to the neurology clinic for one episode of confusion. Video-electroencephalographic monitoring detected unequivocal ictal changes during her habitual chest pain events. She has remained chest pain (seizure) free with a single antiseizure drug.
CONCLUSIONS: This case underlines the importance of epilepsy as a rare yet treatable cause of recurrent chest pain. Further studies are required to determine the pathophysiology of ictal chest pain.

MeSH terms: Anticonvulsants/therapeutic use; Chest Pain/complications*; Chest Pain/drug therapy*; Electroencephalography; Epilepsy/complications*; Epilepsy/drug therapy; Female; Humans; Middle Aged; Monitoring, Physiologic
Fulltext Modelling excess mortality among breast cancer patients in the North East Region of Peninsular Malaysia, 2007-2011: a population-based study

Hanis TM, Yaacob NM, Hairon SM, Abdullah S, Nordin N, Abdullah NH, et al.

BMC Public Health, 2019 Dec 30;19(1):1754.
PMID: 31888561 DOI: 10.1186/s12889-019-8113-2

BACKGROUND: Measurement of breast cancer burden and identification of its influencing factors help in the development of public health policy and strategy against the disease. This study aimed to examine the variability of the excess mortality of female breast cancer patients in the North East Region of Peninsular Malaysia.
METHODS: This retrospective cohort study was conducted using breast cancer data from the Kelantan Cancer Registry between 2007 and 2011, and Kelantan general population mortality data. The breast cancer cases were followed up for 5 years until 2016. Out of 598 cases, 549 cases met the study criteria and were included in the analysis. Modelling of excess mortality was conducted using Poisson regression.
RESULTS: Excess mortality of breast cancer varied according to age group (50 years old and below vs above 50 years old, Adj. EHR: 1.47; 95% CI: 1.31, 4.09; P = 0.004), ethnicity (Malay vs non-Malay, Adj. EHR: 2.31; 95% CI: 1.11, 1.96; P = 0.008), and stage (stage III and IV vs. stage I and II, Adj. EHR: 5.75; 95% CI: 4.24, 7.81; P

MeSH terms: Breast Neoplasms/mortality*; Breast Neoplasms/therapy; Female; Humans; Malaysia/epidemiology; Middle Aged; Registries; Retrospective Studies; Models, Statistical
Fulltext Comment on: Prevalence of growth and endocrine disorders in Malaysian children with transfusion-dependent thalassaemia

Sookaromdee P, Wiwanitkit V

Singapore Med J, 2019 12;60(12):657.
PMID: 31889203 DOI: 10.11622/smedj.2019163
MeSH terms: Child; Humans; Thalassemia*; Prevalence
Fulltext Subacromial Impingement Syndrome of the Shoulder: A Musculoskeletal Disorder or a Medical Myth?

Dhillon KS

Malays Orthop J, 2019 Nov;13(3):1-7.
PMID: 31890103 DOI: 10.5704/MOJ.1911.001

Subacromial impingement syndrome (SAIS) is a commonly diagnosed disorder of the shoulder. Though this disorder has been known for a long time, it remains a poorly understood entity. Over the years several hypotheses have been put forward to describe the pathogenesis of SAIS but no clear explanation has been found. Two mechanisms, the extrinsic and intrinsic mechanism, have been described for the impingement syndrome. The intrinsic mechanism theories which deny the existence of impingement are gaining popularity in recent years. The various shoulder tests used to diagnose SAIS have low specificity with an average of about 50%. Meta-analysis shows that neither the Neer sign nor the Hawkins sign has diagnostic utility for impingement syndrome. Several randomised controlled trials have shown that the outcome of treatment of SAIS by surgery is no better than conservative treatment. Physiotherapy alone can provide good outcome which is comparable to that achieved with surgery without the costs and complications associated with surgery. Since decompression with surgery does not provide any additional benefits as compared to conservative treatment for patients with SAIS, the impingement theory has become antiquated and surgical treatment should have no role in the treatment of such patients. There are calls by some practitioners to abandon the term impingement syndrome and rename it as anterolateral shoulder pain syndrome. It appears that SAIS is a medical myth. There are others who called SAIS as a clinical illusion.
Fulltext Is Platelet-rich Plasma Injection more Effective than Steroid Injection in the Treatment of Chronic Plantar Fasciitis in Achieving Long-term Relief?

Soraganvi P, Nagakiran KV, Raghavendra-Raju RP, Anilkumar D, Wooly S, Basti BD, et al.

Malays Orthop J, 2019 Nov;13(3):8-14.
PMID: 31890104 DOI: 10.5704/MOJ.1911.002

Introduction: Plantar fasciitis is characterised by pain in the heel, which is aggravated on weight bearing after prolonged rest. Many modalities of treatment are commonly used in the management of plantar fasciitis including steroid injection. Many studies show that steroid injection provides pain relief in the short term but not long lasting. Recent reports show autologous platelet-rich plasma (PRP) injection promotes healing, resulting in better pain relief in the short as well as long term. The present study was undertaken to compare the effects of local injection of platelet-rich plasma and Corticosteroid in the treatment of chronic plantar fasciitis. Materials and methods: Patients with the clinical diagnosis of chronic plantar fasciitis (heel pain of more than six weeks) after failed conservative treatment and plantar fascia thickness more than 4mm were included in the study. Patients with previous surgery for plantar fasciitis, active bilateral plantar fasciitis, vascular insufficiency or neuropathy related to heel pain, hypothyroidism and diabetes mellitus were excluded from the study. In this prospective double-blind study, 60 patients who fulfilled the criteria were divided randomly into two groups. Patients in Group A received PRP injection and those in Group B received steroid injection. Patients were assessed with visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score. Assessment was done before injection, at six weeks, three months and six months follow-up after injection. Plantar fascia thickness was assessed before the intervention and six months after treatment using sonography. Results: Mean VAS in Group A decreased from 7.14 before injection to 1.41 after injection and in Group B decreased from 7.21 before injection to 1.93 after injection, at final follow-up. Mean AOFAS score in Group A improved from 54 to 90.03 and in Group B from 55.63 to 74.67 at six months' follow-up. The improvements observed in VAS and AOFAS were statistically significant. At the end of six months' follow-up, plantar fascia thickness had reduced in both groups (5.78mm to 3.35mm in Group A and 5.6 to 3.75 in Group B) and the difference was statistically significant. Conclusion: Local injection of platelet-rich plasma is an effective treatment option for chronic plantar fasciitis when compared with steroid injection with long lasting beneficial effect.

MeSH terms: Adrenal Cortex Hormones; Ankle; Diabetes Mellitus; Double-Blind Method; Follow-Up Studies; Heel; Humans; Injections; Pain; Prospective Studies; United States; Weight-Bearing; Treatment Outcome; Fasciitis, Plantar; Platelet-Rich Plasma; Visual Analog Scale; Conservative Treatment
Fulltext Prevalence of Osteoporosis in Patients with Distal Radius Fracture from Low-Energy Trauma

Niempoog S, Sukkarnkosol S, Boontanapibul K

Malays Orthop J, 2019 Nov;13(3):15-20.
PMID: 31890105 DOI: 10.5704/MOJ.1911.003

Introduction: Osteoporosis is a devastating problem leading to significant morbidity and mortality. Patients with osteoporosis usually present with fractures from low-energy trauma and falls, commonly of the distal radius, which may precede more severe fractures like fracture of the neck of femur, but data from Thailand are limited. The objective of our study was to determine the prevalence of osteoporosis in patients with distal radius fracture from low-energy trauma. Materials and Methods: This was a descriptive retrospective study, performed at Thammasat University Hospital in Thailand, from January 2011 to June 2017. Patients aged more than 50 years with distal radial fractures from low-energy trauma with available bone mineral density (BMD) result were included. Patients with known secondary causes of osteoporosis were excluded. Patients were grouped by age, sex, and BMD status (normal, osteopenic and osteoporotic). Results: One hundred out of 351 patients with distal radial fractures had bone mineral density data but only 79 (73 females) met the inclusion criteria. Most patients were aged 60-69 years old (n=31, 42.5%). 47 (59.5%) patients were osteoporotic, 23 (29.1%) osteopenic, and 9 (11.4%) were normal. Seven (6 osteoporotic) patients suffered a more severe fracture subsequently. No deaths were recorded. Conclusion: Our study found a high rate of osteoporosis mostly in females, consistent with published literature. Assessing BMD is crucial in middle age and elderly patients with fractures to better manage osteoporosis and prevent more severe fractures in the future.
Fulltext Modified Unipolar Hemiarthroplasty for the Treatment of Metastatic Lesions of Proximal Femur with Pathological Fractures: Case Series of Six Patients

Lim CY, Mat-Hassan S, Awang M, Md-Ariff MF, Hau-Abdullah MA

Malays Orthop J, 2019 Nov;13(3):21-27.
PMID: 31890106 DOI: 10.5704/MOJ.1911.004

Introduction: Proximal femur resection and endoprosthetic reconstruction is the preferred treatment for extensive bony destruction and pathological fractures. Due to the relatively high cost of endoprosthesis, we adopted the modified unipolar hemiarthroplasty (MUH) for reconstruction when the mode of treatment was for palliation. Materials and Methods: This is a retrospective case study of six patients, who had bone and multi-organs metastases with extensive proximal femur involvement with pathologic fractures who underwent resection and MUH reconstruction during the period 2013 to 2017. All patients were classified as Group B / C based on Scandinavian Sarcoma Group survival scoring, with estimated survival of maximum six months. The basic MUH construct consisted of Austin-Moore prosthesis which was secured to a Küntscher nail using cerclage wire and cemented into the femoral canal. Subsequently, the whole length of the prosthesis which remained outside the canal was coated with cement. Results: The mean age was 61.8 years. The mean survival was 3.9 months, post-operation. There was no implant failure during patients' life span; however, a third of the patients developed infection. Wheel chair ambulation was started immediately post-operation for all patients, and two patients progressed to walking frame ambulation. The total cost of each construct was below US$490 in comparison to long-stem hemiarthroplasty (roughly US$ 1700). Conclusion: Our aim was to alleviate pain, facilitate rehabilitation, ease nursing care and improve quality of life for metastatic bone disease patients until end of life. MUH for the treatment of pathological fracture in proximal femoral metastases is a feasible palliative surgical modality in resource-limited settings.

MeSH terms: Artificial Limbs; Bone Diseases; Femur; Fractures, Spontaneous; Hip Prosthesis; Humans; Longevity; Middle Aged; Palliative Care; Quality of Life; Retrospective Studies; Sarcoma; Terminal Care; Wheelchairs; Walking; Pain Management; Hemiarthroplasty
Fulltext Factors Related to Early Recurrence of Idiopathic Clubfoot Post the Ponseti Method

Limpaphayom N, Sailohit P

Malays Orthop J, 2019 Nov;13(3):28-33.
PMID: 31890107 DOI: 10.5704/MOJ.1911.005

Introduction: Idiopathic clubfoot or congenital talipes equinovarus (CTEV) is managed by the Ponseti method worldwide; however, the recurrence of the deformity is a challenging problem. The purpose was to review the factors associated with early recurrence of CTEV post the Ponseti method. Materials and Methods: During 2011-2016, 34 infants with 52 CTEV, who underwent the Ponseti method and a minimum follow-up period of six months, were reviewed. Twenty-two infants (65%) were male, and 18 infants (53%) had bilateral CTEV. Recurrence of CTEV was defined as a reappearance of at least one of the four components of the deformity. The association between recurrence and factors, including age, gender, bilaterality, family geography, type of principal caregiver, severity at presentation, centre where the Ponseti method was initiated, compliance to foot abduction brace (FAB), practice of stretching exercise, type of FAB, and complications of casting, were evaluated using univariate logistic regression analysis. Results: The median age at initiation of the treatment was 3.4 (IQR; 2.1-12.6) weeks. A median of six (range; 3-12) casts were required. Tenotomy was performed in 32/34 (94%) of cases. Recurrence occurred in 14/52 feet (27%) at an average follow-up period of 2.3±1.1 years. Non-compliance to FAB protocol began at an average age of 11.2±6.5 months, and significantly increased the risk of recurrence during the weaning phase [OR (95%CI)=8.4 (1.2-92.4), p=0.03]. Other factors were not associated with the recurrence. Conclusion: Non-compliance to FAB occurred early during the treatment and related to a risk of recurrence of CTEV. Physicians should encourage the parents and/or guardians to follow the protocol to decrease the risk of recurrence.

MeSH terms: Braces; Clubfoot; Follow-Up Studies; Geography; Humans; Infant; Infant, Newborn; Male; Patient Compliance; Weaning; Logistic Models; Caregivers; Tenotomy; Foot Orthoses; Talipes
Fulltext Arthrofibrosis Following Anterior Cruciate Ligament Reconstruction

Rushdi I, Sharifudin S, Shukur A

Malays Orthop J, 2019 Nov;13(3):34-38.
PMID: 31890108 DOI: 10.5704/MOJ.1911.006

Introduction: Anterior cruciate ligament (ACL) tear is a frequent injury and its reconstruction is among the most commonly performed orthopaedic surgical procedures. ACL reconstruction generally yields good results. However, its recovery can be hampered by the development of postoperative complications. The aim of this study was to review complications following arthroscopic ACL reconstruction done in Hospital Raja Permaisuri Bainun, Ipoh and Hospital Teluk Intan, Perak with the emphasis on arthrofibrosis. Arthrofibrosis is defined as a loss of 15 degrees extension or more, with or without flexion loss compared to the contralateral knee. Materials and Methods: The study is based on a series of retrospective cases, on which medical records of 200 patients who underwent ACL reconstruction surgeries between March 2007 and December 2014 were reviewed. Follow-up treatment records were available for 166 patients (83%). The data was analysed to identify the risk factors for developing complications with an emphasis on arthrofibrosis. Results: Eight patients (5%) developed arthrofibrosis in the post-operative period. Early surgical intervention, preoperative limited range of motion and female gender are the risk factors correlate with arthrofibrosis. However, the type of graft used and meniscal procedure do not have a significant correlation with the development of arthrofibrosis. Other complications encountered are local infections, hypertrophic scar and chronic regional pain syndromes. Conclusion: The 5% incidence of arthrofibrosis following an ACL reconstruction in our centres can be reduced with proper preventive measures which include thorough preoperative evaluation, proper patient selection, restoration of ROM prior to surgery and proper timing of surgery.

MeSH terms: Animals; Female; Follow-Up Studies; Humans; Knee Joint; Medical Records; Retrospective Studies; Risk Factors; Syndrome; Incidence; Range of Motion, Articular; Anterior Cruciate Ligament; Cicatrix, Hypertrophic; Patient Selection; Anterior Cruciate Ligament Reconstruction; Anterior Cruciate Ligament Injuries; Meniscus
Fulltext The Feasibility of Long-Segment Fluoroscopy-guided Percutaneous Thoracic Spine Pedicle Screw Fixation, and the Outcome at Two-year Follow-up

Tamburrelli FC, Perna A, Proietti L, Zirio G, Santagada DA, Genitiempo M

Malays Orthop J, 2019 Nov;13(3):39-44.
PMID: 31890109 DOI: 10.5704/MOJ.1911.007

Introduction: Posterior percutaneous instrumentation may represent a challenge when multiple levels need to be instrumentated, especially when including the upper thoracic spine. The aim of the present study was to evaluate the technical feasibility and the long-term outcome of such long constructs in different surgical conditions. Materials and Methods: This investigation was a retrospective cohort study which included patients who underwent thoraco-lumbar percutaneous fixations. We collected clinical, surgical and radiological data, with a minimum follow-up of 24 months. Health-related quality-of-life, residual pain, instrumentation placement, and complications were studied. Results: A total of 18 procedures were enrolled, in which 182 screws were implanted, (170 positioned in thoracic and 12 in lumbar pedicles, respectively). No surgical complications or hardware failure occurred in our series, 6 out of 182 (3,2%) screws had a partial pedicle breach, without neurological impairment or need for surgical revision. Conclusion: According to our results, a fully posterior percutaneous approach for long thoraco-lumbar spine instrumentation can be considered safe and reproducible, although an adequate training is strictly required.

MeSH terms: Bone Screws; Feasibility Studies; Follow-Up Studies; Humans; Lumbosacral Region; Pain; Quality of Life; Radiography; Reoperation; Retrospective Studies; Spine
Fulltext Predictive Factors of Major Lower Extremity Amputations in Diabetic Foot Infections: A Cross-sectional Study at District Hospital in Malaysia

Kow RY, Low CL, Ruben JK, Zaharul-Azri MZ, Lim BC

Malays Orthop J, 2019 Nov;13(3):45-52.
PMID: 31890110 DOI: 10.5704/MOJ.1911.008

Introduction: Diabetic foot infection, a complication which can lead to lower limb amputation, is a major source of morbidity and mortality in Malaysia. The objective of this study was to determine the predictive factors of major lower limb amputation among patients with diabetes mellitus in a cluster of three district hospitals in Pahang, Malaysia. Materials and Methods: This cross-sectional study involved 170 patients who had undergone surgical interventions for diabetic foot infections at three district hospitals from 1st of September 2014 to 31st December 2015. The predictors for major amputation of lower limb were determined using simple logistic regression (LR) and forward LR multiple logistic regression. Results: A total of 21 patients had undergone major amputations of lower limb (15 transtibial and 6 transfemoral). The following factors were associated with major amputation of lower limb; longer duration of disease, age ≥ 60 years, patients from Bentong Hospital, presence of hypertension, presence of fever, history of multiple limb-salvaging surgeries, monomicrobial culture, necrotising fasciitis, anemia and leukocytosis. Upon forward LR multiple logistic regression, only duration of disease, history of more than three previous limb-salvaging surgeries and total white blood cell count ≥15X109/L were found to be significant as predictive factors of major amputation of lower limb. Conclusion: Among the factors analysed in this study, a longer duration of disease, raised total white blood cell count and history of more than three limb-salvaging surgeries were identified as predictors for major amputation of lower limb in diabetic foot infections using stepwise logistic regression analysis.

MeSH terms: Amputation; Anemia; Cross-Sectional Studies; Diabetes Mellitus; Hospitals, District; Humans; Hypertension; Leukocyte Count; Leukocytosis; Malaysia; Logistic Models; Diabetic Foot; Fasciitis, Necrotizing; Limb Salvage; Lower Extremity
Fulltext Demographics of Patients Undergoing Carpal Tunnel Release in an Urban Tertiary Hospital in Malaysia

Bahar-Moni AS, Abdullah S, Fauzi H, Chee-Yuen SY, Abdul-Razak FZ, Sapuan J

Malays Orthop J, 2019 Nov;13(3):53-59.
PMID: 31890111 DOI: 10.5704/MOJ.1911.009

Introduction: Carpal tunnel syndrome (CTS) is the most commonly encountered neuropathy. The entrapment of the median nerve at the wrist can be corrected with a carpal tunnel release (CTR) procedure. The objective of this retrospective study was to determine the demographic, medical, and surgical characteristics of the patients with CTS who presented for CTR surgery in a tertiary hospital in Malaysia. Materials and Methods: Malaysians patients with CTS who had undergone a CTR during the period from 1st June 2017 to 31st December 2017 were enrolled into the study. Each patient had a minimum follow-up of three months. The demographic data of age, gender, race and occupation, and the comorbid illnesses and associated risk factors were recorded. The prevalence and occurrence of CTS in the dominant or non-dominant hand and the effectiveness of surgical intervention were also noted. Data was collected, analysed and stored in Microsoft Excel and SPSS 25. Results: There was a total of 76 cases of CTR surgeries done in 62 patients in the study. Eighty percent of the patients were female, and most of the patients belonged to the age group of 41-60 years. Malays constituted 74.2% of the patients, and 34% were housewives. Hypertension, dyslipidaemia and diabetes mellitus were the three major comorbidities. Cervical spondylosis was seen in one-fourth of the patients. Bilateral hand involvement was present in 54.8% of patients. 59.7% of CTR surgery was done on the dominant hand alone, 17.7 % CTR on the non-dominant hand alone and 22.6% CTR on both hands. Numbness and pain (50%) were the predominant presenting symptoms. The most positive signs were the Durkan test (77.6%), followed by the Tinel sign at the carpal tunnel and the Phalen's test. At follow-up, three months or more, after the surgery, 75% of the patients showed a satisfactory improvement. Conclusion: Patients, who had undergone CTR, had a higher prevalence of pre-morbid conditions, and a quarter of them presented with associated cervical spondylosis. The most common presentation was a combination of numbness and pain. Many obtained satisfactory improvement post-surgery and thus open surgery could be considered a reliable treatment for CTS.

MeSH terms: Adult; Carpal Tunnel Syndrome; Female; Follow-Up Studies; Hand; Humans; Hypesthesia; Malaysia; Median Nerve; Middle Aged; Morbidity; Pain; Retrospective Studies; Risk Factors; Wrist; Wrist Joint; Comorbidity; Prevalence; Tertiary Care Centers
Fulltext Comparison of Interobserver Reliability between Junior and Senior Resident in Assessment of Developmental Dysplasia of The Hip Severity using Tonnis and International Hip Dysplasia Institute Radiological Classification

Ismiarto YD, Agradi P, Helmi ZN

Malays Orthop J, 2019 Nov;13(3):60-65.
PMID: 31890112 DOI: 10.5704/MOJ.1911.010

Introduction: The radiographic classification for developmental dysplasia of hip to quantify the severity of disease consist of Tonnis and International Hip Dysplasia Institute (IHDI) classification. The Ossification center of the femoral head in DDH patient more than six months is still vague or eccentric, so the reliability of both classifications is still in question and especially is influenced by the experience of the observer. This study aims to test and compare interobserver reliability in evaluation of DDH patients using IHDI and Tonnis classification assessed by senior and junior orthopaedic residents which had different degree of experience. Materials and Methods: This study used retrospective analysis of pelvic supine AP view radiograph of DDH patients from 2014 to 2017. All three observer groups analysed the pelvis radiographs using Tonnis and IHDI classification. Inter and intra-observer reliability was measured by Cohen's and Fleiss Kappa method, respectively. Results: The Fleiss Kappa value for 15 radiographs of DDH patients assessed by senior residents using Tonnis and IHDI classification are 0.715 and 0.832 and result of Fleiss Kappa value assessed by junior residents are 0.577 and 0.845, respectively. Intra-observer reliability for Tonnis classification was lower in junior group compared to other two groups but showed almost perfect value in all groups for IHDI classification. Conclusion: Significantly different results were noted between junior and senior residents in assessing DDH severity, with higher diagnostic reliability in senior residents compared to junior residents. In general, junior resident has less clinical experiences in many aspects in comparison with the seniors.

MeSH terms: Femur Head; Hip Dislocation; Hip Dislocation, Congenital; Humans; Orthopedics; Osteogenesis; Pelvis; Radiography; Radiography, Abdominal; Retrospective Studies; Severity of Illness Index; Reproducibility of Results
Fulltext Axillary Artery Injury with Intact Radial Pulse following Fracture-Dislocation of Shoulder: A Case Report

Rajeev A, Timmons G

Malays Orthop J, 2019 Nov;13(3):66-68.
PMID: 31890113 DOI: 10.5704/MOJ.1911.011

The occurrence of axillary artery injury following proximal humerus fracture dislocation in elderly patient with low velocity fall is uncommon. The patient could have diverse clinical presentations in spite of intact peripheral pulses. We report the case of an 85-year-old lady who presented to our emergency department with greater tuberosity fracture of the humerus with dislocation of the right shoulder. After closed manipulative reduction of the dislocation, it was observed that the patient had brachial plexus palsy with intact radial pulse. An expanding swelling and bruise around the shoulder was noted and a steady drop in haemoglobin level. CT angiogram revealed avulsion of the posterior circumflex artery which was then treated successfully with stenting.

MeSH terms: Aged; Aged, 80 and over; Angiography; Axillary Artery; Brachial Plexus; Contusions; Emergency Service, Hospital; Female; Hemoglobins; Humans; Humerus; Shoulder; Shoulder Fractures; Tomography, X-Ray Computed; Brachial Plexus Neuropathies; Fracture Dislocation
Fulltext Surgical Fixation and Inter-phalangeal Arthrodesis of Symptomatic Non-union of Fracture of a Lesser Toe Distal Phalanx: A Case Report

Foo GL, Wee L

Malays Orthop J, 2019 Nov;13(3):69-71.
PMID: 31890114 DOI: 10.5704/MOJ.1911.012

Distal phalanx fractures of the toes are common injuries. The majority of them are treated conservatively with good outcome. We present the case of a painful non-union fracture of the distal phalanx of the 4th toe in a 60-year-old female patient with symphalangism of the 4th and 5th toes. She underwent surgical fixation of the fracture with concomitant inter-phalangeal joint (IPJ) arthrodesis for better stability. A transverse dorsal incision was made just distal to the IPJ to allow preparation of both the fracture site and IPJ. Fibrous tissue at the fracture non-union site was removed and the opposing surfaces drilled with a 0.88mm K-wire. Cartilaginous tissue at the IPJ was removed and similarly drilled with the 0.88mm K-wire. Stabilisation was achieved with a percutaneous headless compression screw. Radiographic union was achieved and the patient had resolution of symptoms 16 weeks after the surgery. The patient continued to be symptom-free at one year follow-up. This is the first case report of a surgically treated symptomatic non-union of distal phalanx fracture of a lesser toe in the literature.

MeSH terms: Arthrodesis; Bone Screws; Bone Wires; Female; Follow-Up Studies; Humans; Middle Aged; Toes; Finger Phalanges; Fractures, Bone
Fulltext Reconstruction of Secondary Type Congenital Hallux Varus with Modification of the Farmer Technique for Cover of Skin Defect: Report of Three Cases

Sulaiman AR, Munajat I, M-Yusuf H, Nik-Jaffar N, Zarullail NH, Mohd EF, et al.

Malays Orthop J, 2019 Nov;13(3):72-76.
PMID: 31890115 DOI: 10.5704/MOJ.1911.013

The reconstruction of hallux varus deformity involves the release of contracted medial structure and realignment of the phalange, leaving a significant skin defect which requires cover. Farmer described proximal based rotational skin flap from the first web space to cover the defect. This technique may compromise the circulation to the flap and risk to the lateral digital vessels. We modified his technique to address these issues. We report a successful reconstruction using the Farmer's technique on one patient and a modified technique on three patients. We used the excess skin from the extra digit to cover the medial defect. We found this modified technique of skin cover safe without risk of injuring the neurovascular bundle. There was no recurrence of deformity at last foolow-up. All patients were able to wear normal shoes.

MeSH terms: Farmers; Humans; Shoes; Surgical Flaps; Skin Transplantation; Finger Phalanges; Hallux Varus
Fulltext Late Presentation of Paediatric Pink Pulseless Supracondylar Fracture of Humerus: A Case Report

Kow RY, Yuen JC, Low CL, Mohd-Daud KN

Malays Orthop J, 2019 Nov;13(3):77-79.
PMID: 31890116 DOI: 10.5704/MOJ.1911.014

Supracondylar humeral fracture is the most common elbow injury in children. It may be associated with a vascular injury in nearly 20% of the cases with a pink pulseless limb. We present a unique case of a paediatric pink pulseless supracondylar humeral fracture, seen late, on the 16th-day post-trauma. Open reduction, cross Kirschner wiring, and brachial artery exploration and repair were performed, and the patient recovered well. Early open reduction and exploration of the brachial artery with or without prior CT angiography was a safe approach in treating patients who presented at 16 days.

MeSH terms: Arm Injuries; Brachial Artery; Child; Elbow; Extremities; Humans; Humeral Fractures; Musculoskeletal Diseases; Vascular System Injuries; Open Fracture Reduction; Computed Tomography Angiography
Fulltext Aviator's Fracture - Bilateral Fracture-Dislocation of Talus in a 29-year-old Patient: A Case Report

Noia G, Silluzio N, Sircana G, Maccauro G, Ziranu A

Malays Orthop J, 2019 Nov;13(3):80-84.
PMID: 31890117 DOI: 10.5704/MOJ.1911.015

Bilateral fracture-dislocation of the talus is a rare occurrence. It represents 0.06% of the dislocations and 2% of the traumas of the talus. We report the case of a 29-year-old patient with an exposed bilateral fracture of the talus following a plane accident. On the right ankle, the patient had a fracture-dislocation Hawkin 3 Gustilo II, on the left ankle presented a Hawkin 4 Gustilo IIIB. The patient was treated within six hours from the trauma. We reduced the dislocation and performed an osteotomy of the tibial malleolus and osteosynthesis of the fracture with screws. The definitive stabilisation has been achieved in both limbs with an external fixator. We evaluated the patient at 1, 3, 6, 8, 12 and 18 months from treatment, with a radiograph and with SF-36 and Foot and Ankle Disability Index questionnaires. No infection was reported, radiographs showed a successful consolidation of the fracture in both limbs. At the one year follow-up, the patient was able to walk without aids and there were no signs of osteonecrosis on the MRI. The treatment of these lesions requires timely treatment, an anatomical reduction of the fracture and patient's collaboration. The use of external fixator with internal osteosynthesis represents a good therapeutic option in Hawkins 3 and 4 type fractures.

MeSH terms: Accidents; Adult; Ankle; Ankle Joint; Bone Screws; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Osteonecrosis; Osteotomy; Surveys and Questionnaires; Talus; External Fixators; Fracture Dislocation
Fulltext Intracranial Subdural Hematoma after Lumbar Spine Surgery: A Case Report

Zakaria AF, Tsuji M

Malays Orthop J, 2019 Nov;13(3):85-87.
PMID: 31890118 DOI: 10.5704/MOJ.1911.016

Intracranial subdural hematoma following lumbar surgery is a devastating but rare complication. It has been implicated due to intracranial hypotension secondary to persistent cerebrospinal fluid leakage. The resultant drop in intracranial pressure presumably causes traction and tearing of venous structures. Patients typically present with postural headaches. However, other symptoms of subdural hematoma, intracranial hypotension and cerebrospinal fluid leak must also be cautioned.

MeSH terms: Headache; Hematoma, Subdural; Humans; Hypotension; Intracranial Pressure; Traction; Intracranial Hypotension; Lacerations; Hematoma, Subdural, Intracranial; Cerebrospinal Fluid Leak
Fulltext Tuberculosis of the Left Wrist Joint and Spine

Sivasamy P, Bajuri MY, Ghani AW

Cureus, 2019 Nov 19;11(11):e6203.
PMID: 31890405 DOI: 10.7759/cureus.6203

The incidence of wrist tuberculosis is rare. Clinical features and radiographs are not conclusive in the beginning, happen to delay the achievement of the diagnosis, and thus result in poor treatment. We present a case report of wrist tuberculosis that had delayed diagnosis. Hence, the initiation of antituberculous treatment was delayed, as the initial investigations were not conclusive of tuberculous infection. The patient was treated surgically multiple times before tuberculosis was diagnosed. Antituberculous chemotherapy was started for the patient for one year until she became afebrile and infective markers returned to normal. However, the patient developed left wrist stiffness due to arthrofibrosis and bony destruction of the wrist joint.

MeSH terms: Female; Humans; Tuberculosis; Wrist; Wrist Joint; Incidence; Hand Joints; Delayed Diagnosis

External Links