Displaying publications 1 - 20 of 58 in total

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  1. Saw, A., Manimaran, S., Faizal S., Bulgiba, A.M.
    Malays Orthop J, 2008;2(1):44-48.
    MyJurnal
    Bone lengthening with distraction osteogenesis involves prolonged application of an external fixator frame. Qualitative and quantitative evaluation of callus has been described using various imaging modalities but there is no simple reliable and readily available method. This study aims to investigate the use of a densitometer to analyze plain radiographic images and correlate them with the rate of new bone formation as represented by the bone healing index. A total of 34 bone lengthening procedures in 29 patients were retrospectively reviewed. We used an X-Rite 301 densitometer to measure densities of new callus on plain radiographs taken at 4 and 8 weeks after surgery. Patients aged below 16y had significantly lower BHIs indicating faster bone healing and shorter duration of treatment. The ratio of radiographic densities between centre and edge of the new bone measured from plain radiographs taken at 8 weeks correlated positively with the eventual BHI of the patient. This method provides a simple and easy way to predict the rate of bone healing at an early stage of treatment and may also allow remedial action to be taken for those with poor progress in bone formation.
  2. Sallehuddin, A., Saw, A., George, J., Sengupta, S.
    Malays Orthop J, 2008;2(1):12-16.
    MyJurnal
    Purpose: To evaluate the usefulness of ultrasound guidance in percutaneous needle biopsy for musculoskeletal tumours.
    Methods: Forty-five consecutive patients underwent ultrasound-guided needle biopsy. An additional group of 50 patients who underwent needle biopsy without ultrasound guidance was retrospectively selected as historical control. The sample was considered adequate when a diagnosis can be made, and diagnostic when the diagnosis is similar to the final report based on the excised tumour.
    Results: Adequacy of the biopsy samples was 84% in ultrasound-guided group as compared 76% in the group with no ultrasound guidance. Diagnostic accuracy was 64% in the ultrasound-guided group and 52% in the group without ultrasound guidance. Both of these differences were not statistically significant.
    Conclusions: Ultrasound guidance did not provide a significant advantage in the biopsy of musculoskeletal tumours. Diagnostic accuracy seems to improve with the use of larger 14 gauge biopsy needle but further evaluation is necessary.
  3. Gooi SG, Wang CS, Saw A, Zulkiflee O
    Malays Orthop J, 2017 Mar;11(1):79-81.
    PMID: 28435583 MyJurnal DOI: 10.5704/MOJ.1703.015
    Missed Monteggia fracture leading to chronic radial head dislocation is a known complication. The surgical treatment options remain challenging. The aim of treatment is to reduce the radial head and to maintain the stability of the elbow in all ranges of motion. A few surgical techniques have been described with complications. We report the case of a 13 years old boy with chronic radial head dislocation as a result of an unrecognised Monteggia fracture-dislocation for eight years. We successfully reduced the radial head and corrected the cubital valgus from 45 degrees to 10 degrees with a proximal ulna osteotomy and gradual distraction with 2-pin Monotube external fixator. The correction was uneventful with good functional outcome.
  4. Kwan MK, Penafort R, Saw A
    Med J Malaysia, 2004 Dec;59 Suppl F:39-41.
    PMID: 15941159
    Joint stiffness is one of the complications of limb procedure. It developes as a result of failure of knee flexors to lengthen in tandem with the bone, especially when there is inadequate physical therapy to provide active and passive mobilization of the affected joint. We are reporting four patients who developed fixed flexion contracture of their knees during bone lengthening procedure for the tibia with Ilizarov external fixator. Three of them were treated for congenital pseudoarthrosis and one was for fibular hemimelia. None of them were able to visit the physiotherapist even on a weekly basis. A splint was constructed from components of Ilizarov external fixator and applied on to the existing frame to passively extend the affected knee. Patients and their family members were taught to perform this exercise regularly and eventually near complete correction were achieved. With this result, we would like to recommend the use of this "Passive Knee Extension Splint" to avoid knee flexion Contracture during limb lengthening procedures with Ilizarov external fixators.
  5. Ling HT, Kwan MK, Saw A, Choon DS
    Med J Malaysia, 2006 Aug;61(3):380-2.
    PMID: 17240598 MyJurnal
    The incidence of wound related complication following total knee arthroplasty is as high as 10%-20%. To perform total knee arthroplasty in a knee with extensive scarring around the knee can be a challenging task. We report a case of 55-year-old diabetic woman, who had total knee arthroplasty, performed two years after she had recovered from necrotizing fasciitis around the right knee. Understanding the vascular anatomy around the knee is of paramount importance in the planning of skin incision to ensure fewer wound related complications.
  6. Saw, A.
    Malays Orthop J, 2007;1(2):1-2.
    MyJurnal
    Musculoskeletal tumour is much less common compared to tumours of epithelial origin. Most of these tumours are benign, with only about 1% malignant in nature. A general orthopaedic surgeon may only come across a malignant primary bone or soft tissue tumour a few times in his entire medical career. The current recommendation is for these conditions to be investigated and treated in centres with musculoskeletal oncology service. Careful clinical evaluation with appropriate plain radiography can provide adequate information for definitive diagnosis and treatment for most cases, especially the benign tumours. For some other cases, further investigations will be necessary. Magnetic resonance imaging (MRI) can provide excellent details on anatomical location of a tumour and delineate vital structures that may have been distorted by the lesion. For primary malignant tumours, computerized tomography scanning is still the gold standard for evaluation of pulmonary metastasis, and bone scan can allow early detection of distant metastasis to other bones. Whole body MRI has recently been recommended for tumour staging but the potential benefit for musculoskeletal tumour is not that convincing. PET may be very helpful for follow up detection of tumour recurrence but its role in diagnosis and staging of musculoskeletal tumours is still being evaluated...
  7. Ibrahim S, Saw A
    Malays Orthop J, 2020 Jul;14(2):1-6.
    PMID: 32983372 DOI: 10.5704/MOJ.2007.003
    Predatory journals and conferences have little or no peer review. Their raison d'être is for making money through the article processing charges and the conference registration fees. Without a critical evaluation, predatory journals publishing flawed results and conclusions would cloud the existing scientific literature. Predatory conferences are the offshoots of predatory publishing. The conferences are not organised by learned societies, but by profit-making event organisers. There is a need for awareness among researchers and clinicians regarding predatory publishing. The scourge of predatory publishing and conferencing should be more often highlighted during scientific meetings and publication courses.
  8. Sharaf I, Saw A, Hyzan Y, Sivananthan KS
    Med J Malaysia, 2005 Jul;60 Suppl C:3-7.
    PMID: 16381273
    The tsunami which occurred off the west coast of North Sumatra on December 26, 2004 devastated the coastal areas of North Sumatra, South-West Thailand, South-East India and Sri Lanka killing more than a quarter of a million people. The destruction was enormous with many coastal villages destroyed. The other countries affected were Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Kenya, Tanzania and the Seychelles. In January 2005, volunteers went in weekly rotation to Banda Aceh in collaboration with Global Peace Mission. These were Dr Hyzan Yusof, Dr Suryasmi Duski, Dr Sharaf Ibrahim, Dr Saw Aik, Dr Kamariah Nor and Dr Nor Azlin. In Banda Aceh, the surgical procedures that we could do were limited to external fixation of open fractures and debriding infected wounds at the Indonesian Red Crescent field hospital. In February, a team comprising Dato Dr K S Sivananthan, Dr T Kumar and Dr S Vasan spent a week in Sri Lanka. In Sri Lanka, Dato Sivananthan and his team were able to perform elective orthopaedic operations in Dr Poonambalam Memorial Hospital. We appealed for national and international aid and received support from local hospitals and the orthopaedic industry. International aid bound for Banda Aceh arrived in Kuala Lumpur from the Philippine Orthopaedic Association, the Chiba Children's Hospital in Japan and the Chinese Orthopaedic Association. The COA donated 1.5 tons of orthopaedic equipments. A special handing over ceremony from the COA to the Indonesian Orthopaedic Association was held in Putrajaya in March. Malaysia Airlines flew in the donated equipment to Kuala Lumpur while the onward flight to Aceh was provided by the Royal Malaysian Air Force. In April, Dr Saw Aik and Dr Yong Su Mei joined the Tsu-Chi International Medical Association for volunteer services on Batam Island, Indonesia. The MOA acknowledges the many individuals and organizations, both governmental and non-governmental, for their contributions in the humanitarian efforts.
  9. Saw A, Lau CP
    J Orthop Surg (Hong Kong), 2003 Dec;11(2):141-7.
    PMID: 14676338
    To evaluate outcome following supracondylar nailing for distal femur fractures.
  10. Tan WJ, Kwan MK, Deepak AS, Saw A, Peng BC, Jalalullah W
    Med J Malaysia, 2006 Dec;61 Suppl B:18-22.
    PMID: 17600988
    Fracture of the femur is most commonly treated with interlocking nailing. We conducted this study to describe and analyze the size of femoral interlocking nails used in our local population. This is a retrospective study on reamed intramedullary interlocking nailing procedures performed between 1st July 1998 and 30th June 2003. Demographic data, the diameter and length of femoral nails used were obtained from patient's medical record. A total of 267 procedures were included. The most common diameter used was 10 mm (56.9%), followed by 11 mm (27.0%) and 12 mm (13.1%). Only 2.6% of the nails were less than 10 mm in diameter. The most common nail length was 38 cm (31.1%), followed by 36 cm (24.9%) and 40 cm (19.5%). The longest nail used was 46 cm while the shortest 32 cm. The most commonly used femoral nails were of 10 mm diameter with the length ranging from 36 to 40 cm, which is smaller than those reported in the English literature. Nails with diameter smaller than 10 mm were required in 2.6% of patients.
  11. Kwan MK, Ng ES, Penafort R, Saw A, Sengupta S
    Med J Malaysia, 2005 Jul;60 Suppl C:66-71.
    PMID: 16381287 MyJurnal
    Bone defect following en bloc resection of primary bone tumor around the knee can be reconstructed by allograft or prothesis or combination of both. Resection-arthrodesis is an alternative option for young vigorous patients facing circumstances of financial constrain or limited supply of allograft. This study was undertaken to determine the outcome and complications associated with resection-arthrodesis of 22 primary bone tumors (13 giant cell tumors and 9 osteosarcomas) around the knee treated between 1990 and 2003 at the University Malaya Medical Center. The mean follow-up was 6 years (range 1-13 years). hree patients with osteosarcoma died of lung metastasis, 3 required above knee amputation and 2 defaulted follow-up. Local complications of the procedure include infection in 8 cases (36.4%), non-union 7 (31.8%) and mal-union. Of 14 patients who returned for final evaluation, 79.8% had satisfactory outcomes according to the Musculoskeletal Tumor Society grading system. In conclusion, resection-arthrodesis of the knee is a viable treatment option for selected patients with primary bone tumor around the knee, and good functional outcome can be expected in the presence of short-term local complications.
  12. Saw A, Phang ZH
    J Orthop Surg (Hong Kong), 2020 1 4;28(1):2309499019889902.
    PMID: 31898473 DOI: 10.1177/2309499019889902
  13. Saw A, Chua YP, Hossain G, Sengupta S
    J Orthop Surg (Hong Kong), 2012 Aug;20(2):181-4.
    PMID: 22933675
    To assess the monthly rates of infection of individual pin sites in 7 patients during distraction osteogenesis.
  14. Wong LP, Tan SL, Alias H, Sia TE, Saw A
    Omega (Westport), 2023 Mar;86(4):1176-1189.
    PMID: 33818157 DOI: 10.1177/00302228211000952
    The COVID-19 pandemic has put a hold on the Silent Mentor Programme (SMP); this pause has not only caused unprecedented challenges for the delivery of medical education but has forced changes in the programme ceremony sessions. We aimed to describe the psychological impact and experiences of family members of silent mentors during the COVID-19 pandemic using qualitative interviews. Many expressed feelings of remorse and unrest about the unprecedented delay of the SMP. The delay increased negative emotions particularly among some elderly family members; however, there was no prominent negative effect on their functional health and well-being. Several participants relayed the belief that the soul cannot rest until the body receives a proper burial while some worried about the deterioration of the physical condition of the mentors. In conclusion, findings provide insights into the importance of not overlooking the mental health implications of delaying the SMP in future outbreaks or crises.
  15. Md Galam, H., Md Saimul, I., Kazi Enamul, H., Md Ashraful, I., Asma, Mamun, Kamruzzaman, M., et al.
    Malays J Nutr, 2014;20(1):71-81.
    MyJurnal
    Introduction: The high prevalence of underweight among children is a serious health concern in Bangladesh. Nutritional status influences students' academic performance directly or indirectly. This study aimed to determine factors that affect the academic performance of students in primary schools. Methods: Data were collected from several schools and madrasahs in Chapainawabganj district, Bangladesh using multistage stratified sampling with proportional allocation technique. Results: The prevalence of underweight children was 32.3%, with 43.0% of them being girls and 21.4% boys. Multiple logistic regression analysis demonstrated that normal weight children were more likely (p
  16. Chua YP, Tan WJ, Yahya TS, Saw A
    Singapore Med J, 2013 Nov;54(11):630-3.
    PMID: 24276099
    INTRODUCTION: Foot pain is a common problem, especially in women, and studies have shown that it is related to footwear. This study was conducted to establish the prevalence of nontraumatic foot pain and its contributing factors in young working Malaysian women in an urban setting.

    METHODS: The survey was conducted on a group of working women (age range 21-40 years) selected using convenience sampling. Data on foot problems was collected through an investigator-directed questionnaire and during clinical inspection of the foot.

    RESULTS: A total of 400 women, with a mean age of 29.4 years, were recruited. Half (n = 200) of the women had experienced recurrent nontraumatic foot pain in the past one year. Subjective assessments of foot pain using the Numeric Intensity Scale gave an average score of 4.89 ± 1.78 (range 2-10), with most episodes occurring at the heel. There was no statistically significant association between foot pain and age, ethnicity or body mass index. However, there was a higher incidence of foot pain in women wearing high-heeled footwear than those wearing non-high-heeled footwear (p = 0.027, odds ratio 1.591).

    CONCLUSION: Nontraumatic foot pain is common among young working women in our society. More than half (68.4%) of the women with foot pain in our study attributed the pain to footwear. Wearing high-heeled shoes to work was a significant contributing factor. Increased public awareness on the importance of proper footwear may help to reduce the prevalence of nontraumatic foot pain in working women.
  17. Islam MA, Mamun A, Hossain MM, Bharati P, Saw A, Lestrel PE, et al.
    PLoS One, 2019;14(4):e0215733.
    PMID: 31022237 DOI: 10.1371/journal.pone.0215733
    BACKGROUND: Early initiation of breastfeeding (EIBF) is associated with better health of the mothers and reduced risk of neonatal mortality. The objective of this study was to determine the prevalence of EIBF and associated factors among Bangladeshi mothers.

    METHODS: The data was extracted from the Bangladesh Demographic and Health Survey (BDHS)-2014. A total of 4,092 married non-pregnant Bangladeshi mothers who had at least one child aged 2 years or younger were included in this study. A two-level logistic regression model was used to remove the clustering effect for finding the impact of socio-economic and demographic factors on EIBF.

    RESULTS: The prevalence of EIBF among Bangladeshi mothers was 51.4% (urban: 47.1% and rural: 53.4%). A two -level logistic regression model showed that mothers living in the Sylhet division (p<0.01) and rural environment (p<0.05) were more likely to practice EIBF. Mothers who were obese or overweight (p<0.01), had secondary (p<0.05) or higher education (p<0.01) were less likely to provide early breastfeeding to their newborn babies compared to their counterparts. Those who delivered by caesarian-section (p<0.01) were less likely to perform EIBF while those who attended an antenatal care clinic more than 3 times (p<0.05) were more likely to do so.

    CONCLUSIONS: About half of the Bangladeshi mothers did not start breast-feeding within one hour after birth. This study identified several geographical and socio-demographic factors that were associated with EIBF, and hope that this information will help the government to focus their resources to promote early breastfeeding.

  18. Mahumud RA, Hossain MG, Sarker AR, Islam MN, Hossain MR, Saw A, et al.
    PMID: 29386920 DOI: 10.2147/OAJC.S76070
    Introduction: Contraceptive discontinuation is a worldwide incident that may be connected with low incentive to avoid pregnancy. Contraceptive discontinuation highly contributes to unplanned pregnancy and unwanted births.

    Objectives: The objective of this study was to observe the prevalence of discontinuation and switching of contraceptive methods among Bangladeshi married women. In addition, the sociodemographic factors associated with contraceptive discontinuation and switching were assessed.

    Methods: Secondary cross-sectional data was used in this study. A total of 16,273 married Bangladeshi women of reproductive age (15-49 years) were considered in the present study, from the Bangladesh Demographic and Health Survey, 2011. Logistic regression models were used to determine the relationships between key sociodemographic factors and user status.

    Results: The prevalence of discontinuation and switching of contraceptive method among women were 38.4% and 15.4%, respectively. The logistic regression model demonstrated that women in early reproductive years (25-29 years and 30-34 years) significantly more often (odds ratio [OR] =0.84 and 0.71, respectively) discontinued use of contraceptives. Significantly higher rates of discontinuation were pronounced among women who used the pill (OR =0.72) and injectable contraception users (OR =0.60), had small family size (OR =0.49), lived in a rural community (OR =1.65), and who were less educated (OR =1.55).

    Conclusion: Contraceptive discontinuation may reflect an association among less education, currently married, and smaller family size. Awareness of contraceptive methods can decrease the burden of unplanned pregnancies and thus progresses the family planning program.
  19. Chung WH, Mihara Y, Toyat SS, Chiu CK, Hasan MS, Saw A, et al.
    Malays Orthop J, 2021 Nov;15(3):99-107.
    PMID: 34966502 DOI: 10.5704/MOJ.2111.015
    Introduction: To report the indications and early treatment outcomes of pre-operative halo-pelvic traction in patients with neurofibromatosis associated with severe proximal thoracic (PT) spinal deformity.

    Materials and methods: We reviewed four patients with neurofibromatosis with severe PT spinal deformity. Case 1, a 16-year-old male presented with severe PT kyphoscoliosis (scoliosis: 89°, kyphosis: 124°) and thoracic myelopathy. Case 2 was a 14-year-old, skeletally immature male who presented with a PT lordoscoliosis (scoliosis: 85°). Case 3, a 13-year-old male, presented with severe PT kyphoscoliosis (scoliosis: 100°, kyphosis: 95°). Case 4, a 35-year-old gentleman, presented with severe PT kyphoscoliosis (scoliosis: 113°, kyphosis: 103°) and thoracic myelopathy. All patients underwent pre-operative halo-pelvic traction. After a period of traction, all patients underwent posterior spinal fusion (PSF) with autologous bone grafts (local and fibula bone grafts) and recombinant human bone morphogenetic protein-2 (rhBMP-2).

    Results: Both patients with thoracic myelopathy regained near normal neurological status after halo-pelvic traction. Following traction, the scoliosis correction rate (CR) ranged from 18.0% to 38.9%, while the kyphosis CR ranged from 14.6% to 37.1%. Following PSF, the scoliosis CR ranged from 24.0% to 58.8%, while the kyphosis CR ranged from 29.1% to 47.4%. The total distraction ranged from 50-70mm. Duration of distraction ranged from 26-95 days. The most common complication encountered during halo-pelvic traction was pin-related e.g. pin tract infection, pin loosening and migration, osteomyelitis, and halo-pelvic strut breakage. No patients had cranial nerve palsies or neurological worsening.

    Conclusion: Pre-operative correction of severe PT spinal deformities could be performed safely and effectively with the halo-pelvic device prior to definitive surgery.

  20. Lee BYP, Mazelan A, Gunalan R, Albaker MZA, Saw A
    Med J Malaysia, 2020 09;75(5):510-513.
    PMID: 32918418
    INTRODUCTION: Most of the authors currently agree that congenital talipes equinovarus (CTEV) or idiopathic clubfoot can be effectively treated with the Ponseti method instead of extensive soft tissue surgery. This study was conducted to investigate whether there is a difference in the outcome between starting treatment before one month of age or after that age.

    METHODS: This is a retrospective study on babies with CTEV treated in University Malaya Medical Centre from 2013 to 2017. The 54 babies (35 boys and 19 girls) were divided into two cohorts, Group 1 that had treatment before the age of one month, and Group 2 that had treatment after one month old. The number of cast changes, rate of full correction, and rate of relapse after treatment were compared between the two groups.

    RESULTS: Of the 54 babies, with 77 CTEV treated during the period, our outcome showed that the mean number of cast change was 5.9 for Group 1 and 5.7 for Group 2. The difference was not statistically significant. All the affected feet (100%) achieved full correction. One foot in the Group 1 relapsed, while three feet in Group 2 relapsed, but the difference was also not statistically significant. All of the relapsed feet were successfully treated with repeated Ponseti method.

    CONCLUSIONS: Treating CTEV using Ponseti method starting after one month was not associated with more casting change of higher rate of relapse.

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