Displaying publications 1 - 20 of 28 in total

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  1. Lye JX, Kow RY, Ismail R, Khalid KA
    J Hand Surg Asian Pac Vol, 2021 Jun;26(2):166-179.
    PMID: 33928864 DOI: 10.1142/S2424835521500156
    Background: The Michigan Hand Outcomes Questionnaire (MHQ), a self-reported questionnaire for patients with hand disorders, has been widely used globally. It has been cross-culturally adapted into different languages across all continents. Aims of this study were to translate the MHQ into Malay language and to evaluate its reliability and validity compared with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in a Malay-speaking population. Methods: The MHQ was cross-culturally adapted into a Malay version based on the guidelines. A pre-testing involving thirty patients with hand disorders was performed to assess whether it was comprehensible to the target population. One hundred patients with hand disorders were recruited in this study to answer the MHQ and DASH questionnaires. The MHQ was tested twice with an interval of two weeks in between. Statistical analysis was performed to assess the reproducibility and internal consistency via the test-retest method and Cronbach's alpha calculation, respectively. The association between MHQ and DASH questionnaire was assessed with Spearman's correlation calculation. Results: In the pre-testing, twenty-six patients (86.7%) understood all the questions in the Malay version of MHQ. The test-retest analysis showed a good reliability across the duration of two weeks with the intraclass correlation coefficient of all subscales ranging from 0.925 to 0.984. Cronbach's alpha values of the Malay version MHQ ranged from 0.82 to 0.97, indicating a good internal consistency. Spearman's correlation factor of the MHQ in comparison with DASH showed a fair to moderately strong correlation with the values ranging from 0.513 to 0.757. Conclusions: The Malay version of MHQ was successfully translated and culturally-adapted with excellent reliability (reproducibility and internal consistency) and good construct validity.
  2. Kow RY, Che-Ahmad A, Ayeop MAS, Ahmad MW, Yusof S
    J Orthop Surg (Hong Kong), 2021 11 11;29(3):23094990211043987.
    PMID: 34753329 DOI: 10.1177/23094990211043987
    BACKGROUND: Strayer's gastrocnemius recession is a common technique in treating ankle equinus of gastrocnemius origin. Nevertheless, this technique is associated with a few flaws. We aim to introduce a novel technique of isolated gastrocnemius recession and perform a cadaveric study to evaluate its safety and at the same time compare this novel technique with the existing Strayer procedure biomechanically.

    METHODS: Eight fresh cadaveric models of gastrocnemius tightness were established by isolated traction of the gastrocnemius muscles. Gastrocnemius recession was performed on all eight models with Strayer method and the novel method randomized equally. The safety of both the techniques was evaluated by identifying any iatrogenic injury to the surrounding structures. The lengthening and improvement of the ankle dorsiflexion was measured and compared between the two techniques.

    RESULTS: There was no iatrogenic sural nerve or saphenous vein injury in all eight models. There was no significant difference between the two techniques in terms of lengthening (24.25 mm vs 21.00 mm; p = 0.838) and improvement of ankle dorsiflexion (26.5° vs 26°; p = .829).

    CONCLUSIONS: Both Strayer technique and the novel technique of gastrocnemius recession lengthened the gastrocnemius and improved the ankle dorsiflexion in this cadaver trial. Both procedures were safe with proper techniques, and there was no significant difference in efficacy between them.

    LEVEL OF EVIDENCE: Level II, randomized controlled trial.

  3. Kow RY, Mustapha Zakaria Z, Khan ESKM, Low C
    J Orthop Case Rep, 2019 3 28;8(6):65-67.
    PMID: 30915298 DOI: 10.13107/jocr.2250-0685.1262
    Introduction: Fracture of the ulnar coronoid process is uncommon. It is commonly associated with posterior dislocation of the elbow, but it may also present as an isolated fracture. In general, all ulnar coronoid process fractures with elbow joint instability and large fracture fragments are fixed surgically. We report two cases of the rare isolated Regan-Morrey type III ulnar coronoid process fractures and their outcomes.

    Case Report: Case Report 1: Mrs P, a 27-year-old right-hand dominant female, was involved in a motor vehicle accident (MVA) and sustained an isolated Regan-Morrey type III ulnar coronoid process fracture. In view of the large coronoid process fragment causing elbow joint instability, she underwent an open reduction and internal fixation when the elbow swelling had subsided. An anterior approach was used to identify the fracture fragment and it was fixed with two half-threaded cancellous lag screws with washers to achieve an anatomical reduction. Postoperatively, she recovered with excellent outcome based on the Mayo elbow performance score (MEPS).Case Report 2: Mr M, a 23-year-old right-hand dominant gentleman, was involved in a MVA and sustained an isolated Regan-Morrey type III ulnar coronoid process fracture. During examination under general anesthesia, passive range of the movement of his right elbow was noted to be <90°due to the impaction of the fracture fragment. An open reduction through an anterior approach was performed and Kirschner wires were inserted to fix the coronoid process fracture. Kirschner wires were opted for the ease of post-operative removal as the patient was not keen to have a retained implant after recovery. He recovered with good outcome based on the MEPS.

    Conclusion: Isolated fracture of the ulnar coronoid process is rare. Open reduction and internal fixation is mandatory for patients with coronoid process fracture and unstable elbow joint to achieve good functional outcomes.

  4. Kow RY, Yuen JC, Ahmad Alwi AA, Abas MF, Low CL
    JBJS Case Connect, 2019 6 25;9(2):e0163.
    PMID: 31233428 DOI: 10.2106/JBJS.CC.18.00163
    CASE: A 17-year-old male sustained an open fracture of the right medial malleolus (MM) with significant bone and soft tissue loss following a motor-vehicle accident. Following serial wound debridement, his ankle was effectively reconstructed with MM antiglide plate stabilization, iliac autogenous bone graft, and a free radial forearm soft tissue flap.

    CONCLUSIONS: Open MM fracture with bone and soft tissue loss is rare. It is feasible to treat this injury with a novel surgical reconstruction technique involving autogenous bicortical iliac bone graft and radial forearm free flap.

  5. Kow, Ren Yi, Dhiauddin Hai Ismail, Jamaluddin Shafie, Ruben Jaya Kumar, Nor Hafliza Md Salleh, Low, Chooi Leng
    MyJurnal
    Marjolin’s ulcer is a malignant cutaneous ulcer
    that undergoes transformation from a previously
    traumatized or chronically inflammed skin.1 Causes
    leading to ulcerations can be burn injury, trauma,
    chronic osteomyelitis and varicose ulcers.2 It is named
    after a French surgeon, Jean Nicolas Marjolin, who
    first described the condition in patients who developed
    malignant ulcers from burn scars.3 We report a case of
    a chronic non-healing foot ulcer that has become a
    Marjolin’s ulcer after 12 years. (Copied from article).
  6. Kow, Ren Yi, Hazwan Ab Wahid, Ed Simor Khan Mor Japar Khan, Colin Komahen, Low, Chooi Leng, Ruben Jaya Kumar
    MyJurnal
    Cervical spine injury is commonly associated with
    road-traffic accidents. The true incidence of cervical
    spine injuries is unknown due to under-reporting of
    such injuries. Cervical spine injury is associated with
    high morbidity and mortality if it is missed. With the
    advancement of imaging modalities, the number of
    missed cervical injuries has reduced. Nevertheless, some
    clinicians are dependent solely on imaging tools to rule
    out cervical spine injury in a trauma victim. We report
    two cases of “near miss” C6 fracture to highlight the
    importance of a detailed clinical history and clinical
    examination with imaging as an adjunct to rule out
    cervical injury.
  7. Kow, Ren Yi, Aziah Abdul Aziz, Muhammad Firdaus Abas, Low, Chooi Leng, Akmal Azim Ahmad Alwi
    MyJurnal
    The human foot serves as an important part to support
    the body weight and accounts for the majority of our
    movements. A mangled limb involves injury to at least
    three out of four systems, namely the soft tissues, nerves,
    blood supply and bone. While amputation is indicated in
    some cases of mangled limb, with proper planning, limb
    salvaging surgical management is also a viable option.
    Special consideration to the skeletal stabilization, control
    of infection, vascular status and soft tissue coverage is
    paramount to the success of limb salvaging surgery. We
    present a case of mangled limb which was successfully
    treated with limb salvaging surgical management. Initial
    debridement, Kirschner wires insertion and cross ankle
    external fixation were used for skeletal stabilization. An
    antibiotic spacer was inserted for local antibiotic and to
    maintain the length left due to the loss of medial and
    intermediate cuneiform bones. The anterior tibialis
    artery and its venae comitantes were utilized for free
    vascularized fibular graft to provide bony reconstruction
    as well as soft tissue coverage for the mangled foot.
  8. Hazwan Ab. Wahid, Kow, Ren Yi, Khan, Ed Simor, Komahen, Colin
    MyJurnal
    The occurrence of atlantoaxial rotatory subluxation is fairly uncommon; however, it is
    more common to be encountered in the paediatric population, typically seen after a
    retropharyngeal inflammation or after a minor trauma. Ligamentous laxity, shallower
    and more horizontally oriented facet joints especially at the C1-2 joint making them
    prone to have atlantoaxial subluxation or dislocation. (Copied from article).
  9. Kow Ren Yi, Ed Simor Khan Mor Japar Khan, Fauziana Abd Jabar, Fauziana Abd Jabar, Low Chooi Leng
    IIUM Medical Journal Malaysia, 2019;18(102):69-0.
    MyJurnal
    Majority of the traumatic spine injuries are located at the thoracolumbar region. They can be compression fractures, burst fractures, flexionextension injuries (Chance fractures), dislocations, or any of the combination. Surgery is indicated for patients with thoracolumbar injury classification scoring (TLICS) of 4 or more. Traditionally, surgical approaches for thoracolumbar spinal injuries involve open surgery, instrumentation with/without decompression. In our previous study, open surgery for traumatic thoracolumbar injuries and history of blood transfusion have been found to be associated with higher risk of deep surgical site infection requiring surgical debridement. With the advent of modern implants and equipments, minimally invasive surgery (MIS) has been made possible for spine surgeries. We report our two-year experience in utilizing MIS to treat traumatic thoracolumbar spinal injuries. Materials and method: Patients who underwent spinal surgeries at Hospital Tengku Ampuan Afzan, Kuantan from July 2017 to July 2019 were screened for suitability to be included in this study. Only patients who underwent spinal minimally invasive surgeries have been included in this study. Patients who underwent open spinal surgeries were excluded. Results: A total of 8 patients were included in this study. There were 3 burst fractures and 5 chance fractures. All patients underwent a minimum of 4-level posterior spinal instrumented fusion with MIS techniques and 2 patients had laminectomy at the injured level for decompression. All but one patient did not require blood transfusion and there was no incidence of surgical site infection among these patients. Conclusion: Minimally invasive surgery (MIS) is a better option compared to open surgery in treating traumatic thoracolumbar spinal injuries. By minimizing the surgical incision, we are able to reduce blood loss and avoid deep surgical site infection.
  10. Kow Ren Yi, Ed Simor Khan Mor Japar Khan, Mohd Jumaidi Md Hashim, Anas Nazhar, Low Chooi Leng
    IIUM Medical Journal Malaysia, 2019;18(102):61-0.
    MyJurnal
    Solat or prayer, as one of the five pillars of Islam, and it is associated with bio-psycho-social benefits in Muslim patients. Â Many Muslim patients neglected solat while being hospitalized as they are unaware of the convenience (rukhsoh) available for them. Ibadah Friendly Hospital Courses have been conducted in different states of Malaysia to impart knowledge to the hospital staff who can in turn educate their patients. This study aims to construct a content-validated assessment tool and to assess the effectiveness of a state-level Hospital Mesra Ibadah course. Materials and methods: A self-administered questionnaire was constructed and content-validated by a panel of three experts (two religious teachers and one consultant spine surgeon). All 15 questions achieved item-level content validity index (I-CVI) of 1.00 after two rounds of validation. The questionnaires were distributed to participants of a state-level Hospital Mesra Ibadah course to compare the participants’ pre-course test score and post-course test score. Results: A total of 88 participants (48.9%) were included in this study. There was a significant difference in the pre-course test mean score and post-course test mean score among the participants. There was also a significant reduction of unsure answer after the course. There was no significant association found between the gender, place of working and occupations with the pre-post test score difference. Conclusion: This study demonstrates that the Hospital Mesra Ibadah course is effective in imparting as well as consolidating the knowledge among participants, hence it should be routinely organized to benefit more participants.
  11. Kow Ren Yi, Saiful Azlan Kamisan, Goh Kian Liang, Asmah Hanim Hamdan, Ahmad Razali Md Ralib@Md Raghib
    IIUM Medical Journal Malaysia, 2019;18(102):60-0.
    MyJurnal
    Sacral chordomas are rare, low-grade and slow growing malignant bone tumours arising from the sacral bone. They are locally aggressive with the tendency to metastasize to the lungs. Surgical resection remains the mainstay of treatment of sacral chordomas. However, most patients presented late with large tumours and intra-abdominal extension making en bloc resection highly challenging. Besides that, surgical resection poses risk of injury to the surrounding structures such as major blood vessels, bladder, ureters and rectum due to their proximity to the tumour. Therefore, multidisciplinary team approach is vital in ancipitating possible complications and preventing surgical morbidity. We present a case of advanced sacral chordoma which has been successfully resected with the assistance of pre-operative selective arterial embolization as a pre-emptive therapy. Case report: A 58-year-old lady presented with a large sacral chordoma (17.17 cm x 27.3 cm x 30.5 cm) with sacral erosion, infiltration to gluteus maximus, medius and minimus muscles and lung metastasis. A decision to perform a surgical resection was made to alleviate the pain secondary to sacral nerve compression. Anticipating massive bleeding intra-operatively, pre-operative arterial embolization was performed involving one branch of right internal iliac artery as well as five branches of left internal and external iliac arteries using endovascular coils. The tumour was resected with partial sacrectomy from S2 and below. Intra-operatively, 6 pints of packed cells were transfused with estimated blood loss of 4 litres. The patient recovered well after the surgery. She was pain-free post-operatively with no lower limb neurological deficit. Conclusion: Surgical resection remains the treatment of choice for sacral chordoma. Pre-operative selective arterial embolization can reduce intra-operative bleeding and avoid a potentially convoluted surgery.
  12. Khan ES, Kow RY, Arifin KBBM, Komahen C, Low CL, Lim BC
    Cureus, 2019 Apr 03;11(4):e4377.
    PMID: 31218142 DOI: 10.7759/cureus.4377
    Introduction Surgical site infection (SSI) is the most common healthcare-related infection in surgical patients. Patients who have undergone spinal surgeries and have contracted postoperative SSI face increased morbidity and mortality, which invariably leads to additional burden on the healthcare system and higher costs. The risk factors for the increase in SSI in patients who have undergone spinal surgery have been investigated in numerous studies but no studies have been performed in Malaysia. The aim of this pilot study is to determine the incidence and factors associated with deep SSIs in patients that have undergone spinal surgeries. Methods This retrospective study includes all patients who underwent spinal surgeries at Tengku Ampuan Afzan Hospital, Kuantan, from 1 January 2016 to 31 December 2017. Patients with an active spinal infection, polytrauma, and open fractures were excluded from this study. Patient characteristics and laboratory investigations were extracted to determine the risk factors for deep SSI events. Associations between SSI and risk factors were analyzed with SPSS V21.0 (IBM, Armonk, NY). Results The univariate analysis indicated that fracture dislocation at the thoraco-lumbar junction (p=0.008) and a history of preoperative blood product transfusion (p=0.003) were associated with deep SSI. Other factors such as age (p=0.162), gender (p=0.262), body mass index (p=0.215), smoking status (0.272), number of vertebrae involved in the surgery (p=0.837), spinal cord involvement (p=0.259), postoperative hemoglobin reduction (p=0.816), and preoperative white blood cell count (p=0.278) were not associated with deep SSI. Conclusions This pilot study highlights the factors associated with deep SSI in spinal surgeries. A larger study is needed to further confirm these findings.
  13. Raj JJ, Kow RY, Ramalingam S, Low CL
    Cureus, 2021 Jul;13(7):e16155.
    PMID: 34367767 DOI: 10.7759/cureus.16155
    Secondary hyperparathyroidism is a complication arising from untreated end-stage renal disease (ESRD). It can invariably lead to osteoporosis and subsequently cause pathological neck of femur (NOF) fracture. Despite being young, osteosynthesis in neck of femur fractures of these patients often leads to nonunion and implant failure due to severely osteoporotic bone. We present our experience in managing three young patients with ESRD and secondary hyperthyroidism who sustained NOF fractures. All three patients were successfully treated and showed no complication at one year post-operation. Based on our experience and literature review, we propose a simple algorithm to guide the management of these patients.
  14. Kow RY, Nik Abdul Adel NA, Abdul Razak AH, Low CL, Awang MS
    Cureus, 2021 Jul;13(7):e16289.
    PMID: 34405060 DOI: 10.7759/cureus.16289
    Ascorbic acid (vitamin C) is an essential micronutrient that the human's body cannot synthesize endogenously. Scurvy, a disease of ascorbic acid deficiency, can manifest in a myriad of presentations. Due to its rarity in the modern world, scurvy is considered as a disease of the past. We present a paediatric case of scurvy with musculoskeletal manifestations as a result of picky eating behavior.  We report a previously healthy nine-year-old boy who presented with unexplained progressive bilateral lower limb generalized weakness and pain for two months. All initial biochemical and radiological investigations were unremarkable. Upon further history taking, he had severe picky eating behavior which raised the suspicion of scurvy. The diagnosis was confirmed with a serum ascorbic acid test. After ascorbic acid supplementation, his symptoms resolved immediately. Further food behavioral modification counselling to his family members helped to change his diet in a lasting way. As a result, he had no recurrence of symptoms. This case highlights the importance of having a high index of suspicion for an uncommon disease and emphasizes the need for a detailed dietary history upon patient's presentation.
  15. Kow RY, Low CL, Siron Baharom KN, Sheikh Said SNB
    Cureus, 2021 Jun;13(6):e15758.
    PMID: 34290935 DOI: 10.7759/cureus.15758
    Introduction After detailed anatomical delineation of the anterolateral ligament (ALL) of the knee, there is a surge in research on this anatomical structure. Owing to the anatomical variation and lack of experience in the identification of this structure, magnetic resonance (MR) evaluation of the ALL produces mixed results. It was aimed to evaluate the ALL using the routinely performed MR imaging of the knee and to determine any associated factors with ALL injuries. Materials and methods Thirty-six MR images of the knee from 31 patients from January 1, 2017, to June 30, 2017, are evaluated. MR sequences performed include T1-weighted, T2-weighted, proton density (PD), and PD fat saturation (FS). All MR images were double-read by two authors and approved by a consultant radiologist with more than 20 years of radiological experience. The ALL was divided into three portions: femoral, meniscal, and tibial, and the ALL was considered fully visualized when all three portions were seen on MR images. Results At least a portion of the ALL was visualized in 27 scans (75%), and it was fully visualized in 20 scans (55.6%). The femoral portion was the most commonly identified (75%), followed by the meniscal portion (69.4%) and the tibial portion (58.3%). ALLs were best visualized on coronal view in PD FS with the lateral inferior genicular artery as a guide to locate the bifurcation of the meniscal and tibial components. Conclusion The ALL can be visualized in routine 1.5-T MR imaging, either full delineation (55.6%) or partially visualized (75%). It is best characterized via a PD-weighted sequence with fat saturation on the coronal plane. The ALL injury was associated with an anterior cruciate ligament (ACL) injury.
  16. Jaya Raj J, Kow RY, Ganthel Annamalai K, Kunasingh DE, Panicker GK, Lim BC, et al.
    Cureus, 2021 Sep;13(9):e18110.
    PMID: 34692321 DOI: 10.7759/cureus.18110
    Background and objective Femoral neck fractures are relatively rare in young adults, but they result in prolonged loss of function in these patients, thereby placing a huge burden on a country's healthcare and economy. Femoral neck fractures in young adults are normally treated with head salvage surgery. However, primary head replacement surgeries have been gaining traction recently to expedite the recovery of these patients. In this study, we aimed to investigate the outcomes in young patients with femoral neck fractures and factors associated with their complications. Patients and methods Patients with femoral neck fractures who underwent surgery in three tertiary hospitals [Hospital Tengku Ampuan Afzan (HTAA), Hospital Sultan Haji Ahmad Shah (HOSHAS), and Hospital Kuala Lipis] in Pahang state in Malaysia were reviewed and included in this study. The demographic profile of the patients, injury patterns, intervention details, functional outcomes, and complications were analyzed. The comparison between the sociodemographics, clinical assessment, and complication outcomes was analyzed using statistical software. Results The complications were associated with the mechanism of injury, capsulotomy, and type of fixation. A total of 46 patients were included in the study. Most of the patients were found to have severe displacement based on Garden and Pauwels classification. The majority of the patients underwent femoral head salvage surgeries. Almost half of the patients sustained complications and were unable to achieve weight-bearing status at six months postoperatively. Conclusion Despite a relatively short follow-up period in our study, femoral neck fractures in young adults were found to be associated with a high rate of complications. Primary head replacement surgeries should be considered in high-risk patients with femoral neck fractures.
  17. Zakaria Mohamad Z, A Rahim A, Kow RY, Karupiah RK, Zainal Abidin NA, Mohamad F
    Cureus, 2022 Jan;14(1):e20889.
    PMID: 35145794 DOI: 10.7759/cureus.20889
    Background Transpedicular biopsy of spinal lesions is imperative for the generation of a definite diagnosis. Thus far, literature comparing the accuracy and adequacy between fluoroscopy-guided and computed tomography (CT)-guided transpedicular biopsy of spinal lesions is scarce. We aim to compare the accuracy and adequacy of samples collected with the two techniques at the largest tertiary hospital in Malaysia. Materials and methods A total of 60 patients (37 patients with spinal infection and 23 patients with spinal tumour) underwent percutaneous transpedicular biopsy of spinal lesions from January 2013 to December 2017 at a tertiary centre. Demographic data, biopsy method (fluoroscopy-guided and CT-guided), diagnosis, adequacy, and accuracy of samples obtained were assessed. Results Among the 60 samples obtained, only two samples (3.3%) were deemed inadequate. There were 10 biopsy samples (16.7%) that were inaccurate. There was no statistical difference between fluoroscopy-guided and CT-guided transpedicular biopsy in terms of accuracy (p = 0.731) and adequacy (p = 0.492). Conclusions Fluoroscopy-guided and CT-guided transpedicular biopsy of spinal lesions offer similar accuracy and adequacy. Fluoroscopy-guided biopsy of the spinal lesion will be an option for spine surgeons when CT-guided biopsy is not available.
  18. Anwarali Khan MH, Kow RY, Ramalingam S, Ho JPY, Jaya Raj J, Ganthel Annamalai K, et al.
    Cureus, 2021 Oct;13(10):e18820.
    PMID: 34804677 DOI: 10.7759/cureus.18820
    Background and objective Periprosthetic joint infection (PJI) is one of the dreaded complications in patients after arthroplasty surgeries, owing to the risk of morbidity and arduous investigations and management associated with it. Nevertheless, as Malaysia is currently battling against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) pandemic head-on, the treatment for other non-life-threatening diseases including PJI has taken a backseat. In this study, we present a case series of 11 patients with PJI who were managed surgically at the largest tertiary hospital in Malaysia and we hope to shed some light on the difficulties we have encountered during this trying period. Patients and methods Patients with PJIs who underwent surgical intervention during the ongoing COVID-19 pandemic (March 1, 2020, to June 30, 2021) were reviewed and included in this study. The demographic profile of the patients, presenting complaints, prosthesis topography, biochemical investigative findings, surgical interventions, and short-term outcomes were summarized. Results A total of 11 patients were treated surgically at Hospital Kuala Lumpur for PJI. Among them, five patients are still awaiting their second-stage surgeries despite the completion of their antibiotic regimes, and they are fit for the procedure. Conclusion The COVID-19 pandemic has wreaked havoc on the treatment of patients with PJI. In a setting with scarce resources, surgeons should strongly consider single-stage revision surgeries for the treatment of patients with PJI.
  19. Nizam Siron K, Mat Lani MT, Low CL, Kow RY
    Cureus, 2021 Nov;13(11):e19254.
    PMID: 34900455 DOI: 10.7759/cureus.19254
    Introduction Shoulder impingement syndrome (SIS) is one of the common problems which lead to shoulder disabilities. This condition has been described as impingement to the rotator cuff by the anterior third of the acromion process and has been classified into three stages. Treatment option varies depending on the grade of the disease. Arthroscopic subacromial decompression (ASAD) has become more popular in recent years and has shown to have a good outcome. The purpose of this study is to evaluate the outcomes following ASAD in terms of the functional, clinical, and radiological parameters in treating SIS in the ageing population in Kuantan, Pahang, Malaysia. Materials and methods This was an observational study looking at the outcomes of patients with stage 2 and stage 3 (partial cuff tear) impingement syndrome who underwent ASAD in Hospital Tengku Ampuan Afzan and International Islamic University Malaysia Medical Centre from May 2018 to June 2019. The functional outcomes were evaluated using American Shoulder and Elbow Surgeons (ASES) score taken at pre-operative, six weeks, three months, and six months post-operation. Clinical outcomes were evaluated using Constant score (CS) taken at six months post-operation. Radiological outcomes were measured by comparing acromiohumeral distance pre- and post-operation on anteroposterior (AP) view radiograph of the affected shoulder. Results A total of 28 patients were selected for the study. On functional outcome, there was a significant effect of time on the ASES scoring system (p-value <0.05) from pre-operative to six months post-operation. On clinical outcome, the CS at six months showed 13 patients have excellent scores, 10 have good, and five have fair scores. There was a statistically significant difference in mean values of all categories (p-value <0.05). In terms of the radiological outcome, this study observed a significant increase in patients' subacromial space on X-ray from the pre-operative and post-operative treatment stages. In this study, we also observed that there was no significant difference in outcomes between partial and intact rotator cuff (RC) tears at six-month post-operation. Conclusion In this study, ASAD was found to be a beneficial intervention in the treatment of patients with shoulder impingement evidenced by the significant outcomes in terms of functional, clinical, and radiological parameters.
  20. Yuen JC, Kow RY, Jaya Raj J, Low CL
    Cureus, 2022 Dec;14(12):e32254.
    PMID: 36620812 DOI: 10.7759/cureus.32254
    Joint replacement surgeries have been performed to treat joint arthropathies with excellent outcomes. As the number of joint replacement surgeries surges, the incidence of periprosthetic joint infection (PJI) has also increased. Currently, two-stage revision surgery is the gold standard in the treatment of periprosthetic joint infection. Two-stage revision surgery involves joint washout, the removal of the primary implant, the insertion of a cement spacer, and subsequently the reimplantation of prosthesis after the infection has been eliminated. Custom-made articulating cement spacer has been used with success to improve the patient's ambulatory status and quality of life. Nevertheless, custom-made articulating cement spacer or commercialized cement mold is generally costly. By the modification of previous authors' techniques, we manage to fabricate reusable silicone molds, which can be used to create articulating cement spacers for both hip and knee joints. We share two case reports to illustrate how these fabricated silicone molds can be a cost-effective technique to create articulating cement spacers to manage periprosthetic joint infection in both hip and knee joints. Surgeons in resource-deprived countries can utilize this technique to create articulating cement spacers with minimal cost, but they need to discuss with their patients and check with the local regulatory board on the feasibility of this technique to create cement spacer that will be used in a patient.
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