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Fulltext An Unusual Case of Chronic Partial Quadriceps Tear in a Child: A Case Report

Yeak RDK, Yap YY, Nizlan NM

JNMA J Nepal Med Assoc, 2020 Dec 31;58(232):1083-1085.
PMID: 34506395 DOI: 10.31729/jnma.5224

Quadriceps tendon rupture usually occurs in adults and is rare in children. A six-year-old boy was playing at home and had a fall. He was unable to extend his right knee but there was no gap felt over the patella tendon or quadriceps. He was first seen by a family doctor and presented late to the surgeon three months after the injury. Radiographs and ultrasound were performed. The magnetic resonance imaging confirmed the findings of partial quadriceps tear. The patient was put in a cylinder case with the knee in extension for two months. Six months post-injury, he regained full range of motion without any complications. We present an unusual case of partial quadriceps tear in an otherwise healthy six-year-old boy that was treated successfully despite a delayed presentation. Besides a high index of suspicion, magnetic resonance imaging is a good modality to detect partial quadriceps tear in children.
A Rare Case of Posterior Interosseous Nerve Palsy Post-venepuncture

Yeak RDK, Yap YY, Nasir NM

J Coll Physicians Surg Pak, 2021 Nov;31(11):1357-1358.
PMID: 34689498 DOI: 10.29271/jcpsp.2021.11.1357

Wrist drop post-venepuncture is uncommon. There has been reported cases of direct injury to the radial nerve during venepuncture but to our knowledge, there has never been a case of posterior interosseous nerve (PIN) injury. A 34-year female, right hand dominant homemaker, with a newly diagnosed diabetes mellitus, was admitted for diabetic ketoacidosis. There was difficult access with multiple attempts in her blood taking over the antebrachial fossa and forearm. Thereafter, she was unable to fully extend her wrist, fingers and thumb with an intact sensation. The electrophysiological study was suggestive of demyelinating right radial neuropathy at the elbow. Despite the transient blood taking session, patient developed neuropraxia, which only resolved after four months. We wish to report this case of unusual presentation of a PIN palsy post- routine venepuncture, which can result in high morbidity to a patient. Key Words: Posterior interosseous nerve syndrome, venepuncture, neuropraxia, wrist drop.
Non-Hodgkin's Lymphoma: An Unusual Cause of Shoulder Pain

Yeak RDK, Yap YY, Nizlan NM

Cureus, 2023 Mar;15(3):e36501.
PMID: 37090410 DOI: 10.7759/cureus.36501

Shoulder pain is a common complaint seen in the orthopedic clinic. Here, we report a rare case of primary extranodal ileocecal with exceedingly rare right shoulder deltoid non-Hodgkin's lymphoma (NHL). A 67-year-old female presented with abdominal swelling for four months associated with loss of appetite, loss of weight, and night sweats. Abdominal contrast-enhanced CT and cecal biopsy confirmed the diagnosis of ileocecal NHL. A right hemicolectomy was performed, and the patient completed six cycles of chemotherapy. The patient developed right shoulder pain with swelling three months later and was diagnosed with a relapse ileocecal lymphoma with dissemination to the right deltoid muscle after a repeat positron emission tomography scan. Clinicians need to consider NHL as a differential diagnosis in evaluating shoulder pain or swelling even though it is exceedingly rare. A partial or non-response to chemotherapy with dissemination to skeletal muscle carries a poor prognosis.
Fulltext The Successful Resolution of Bilateral Recurrent Shoulder Dislocation With the Bilateral Shoulder Open Latarjet Procedure: A Case Report

Kanesen K, Yeak RDK, Abdul Kahar J, Mohd Nasir MN

Cureus, 2023 Dec;15(12):e50569.
PMID: 38222191 DOI: 10.7759/cureus.50569

Recurrent shoulder dislocation is a common orthopedic condition, but bilateral involvement is rare and presents unique challenges in management. The Latarjet procedure is an effective surgical technique that addresses instability by creating a bony block on the anterior glenoid rim. This case highlights the successful management of bilateral recurrent shoulder dislocation using the bilateral shoulder open Latarjet procedure and emphasizes the importance of early intervention in such cases.
Meniscal Allograft Transplantation After Anterior Cruciate Ligament Reconstruction Can Improve Knee Stability: A Comparison of Medial and Lateral Procedures

Yoon KH, Lee HW, Park SY, Yeak RDK, Kim JS, Park JY

Am J Sports Med, 2020 08;48(10):2370-2375.
PMID: 32692971 DOI: 10.1177/0363546520938771

BACKGROUND: The purpose of this study was to evaluate the clinical score and stability after meniscal allograft transplantation (MAT) after a previous anterior cruciate ligament (ACL) reconstruction.
HYPOTHESIS: Medial MAT would improve anteroposterior stability, and lateral MAT would improve rotational stability.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHOD: We retrospectively investigated 31 cases of MAT after a previous total or nearly total meniscectomy and ACL reconstruction between November 2008 and June 2017. Cases were divided into medial (16 cases) and lateral (15 cases) MAT groups. The patients were assessed preoperatively and at the 2-year follow-up.
RESULTS: In the medial MAT group, the International Knee Documentation Committee, Lysholm, Lysholm instability, and Tegner scores improved significantly at the 2-year follow-up, and there were also significant improvements in the anterior drawer, Lachman, and pivot-shift tests. In the lateral MAT group, the Lysholm and Tegner scores improved significantly at the 2-year follow-up, as had the anterior drawer and Lachman tests but not the pivot-shift test. The medial MAT group showed significant improvement in side-to-side difference on Telos stress radiographs, from 6.5 mm (preoperatively) to 3.6 mm (2-year follow-up) (P = .001), while the lateral MAT group showed no significant change. There was no progression of arthritis in either group.
CONCLUSION: Medial MAT improved not only anteroposterior stability but also rotational stability in the meniscus-deficient ACL-reconstructed knee. Lateral MAT showed improvements in the anterior drawer and Lachman tests but not in the pivot-shift test or side-to-side difference on Telos stress radiographs in meniscus-deficient ACL-reconstructed knees. Instability and pain are indications for MAT in meniscus-deficient ACL-reconstructed knees.
A Reshaping Recovery: The Reverse Shoulder Arthroplasty Triumphs in Salvaging Chronic Four-Part Proximal Humerus Fractures

Kee HT, Yeak RDK, Ahmad Hanif KA, Seri Masran SM, Che-Hamzah F

Cureus, 2023 Dec;15(12):e50363.
PMID: 38213375 DOI: 10.7759/cureus.50363

The aging population is witnessing a steady increase in the incidence of displaced proximal humerus fractures, particularly among elderly patients. Such fractures pose a significant challenge to orthopedic surgeons, given the complex interplay of factors involved, including fracture displacement, comminution, compromised bone quality, and the presence of concurrent medical comorbidities. While open reduction internal fixation (ORIF) remains a viable treatment option for these fractures, it is a technically demanding procedure associated with a high incidence of complications. Recently, reverse total shoulder arthroplasty (RTSA) with tuberosity repair has gained popularity as a successful approach for addressing such fractures. The present case report details a unique and complex case of a chronic four-part proximal humerus fracture, complicated by avascular necrosis of the humeral head, fracture non-union, and hardware penetration. The patient was successfully treated through a reverse shoulder arthroplasty procedure, highlighting the effectiveness of this surgical approach in such challenging scenarios. The advantages of RTSA in this context include the potential to address avascular necrosis, non-union, and hardware complications, as seen in our patient. Additionally, the procedure can restore functional independence and improve the overall quality of life in these challenging cases.