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Fulltext Autologous chondrocyte implantation for knee focal cartilage defects: 3 years' follow-up at the University Malaya Medical Centre

Abbas AA, Mohamad JA, Lydia AL, Selvaratnam L, Razif A, Ab-Rahim S, et al.

JUMMEC, 2014;17(1):8-13.
MyJurnal

Autologous chondrocyte implantation (ACI) is a widely accepted procedure for the treatment of large, fullthickness chondral defects involving various joints, but its use in developing countries is limited because of high cost and failure rates due to limited resources and support systems. Five patients (age

Matched MeSH terms: Orthopedic Procedures
Fulltext Fat embolism in right internal jugular vein: incidental ultrasound finding during internal jugular vein cannulation

Adi O, Fong CP, Azil A, Wahab SFA

Ultrasound J, 2019 Feb 25;11(1):1.
PMID: 31359296 DOI: 10.1186/s13089-019-0116-9

BACKGROUND: We report a case study of fat embolism seen on ultrasound at right internal jugular vein during central venous cannulation in a patient diagnosed with fat embolism syndrome. This case demonstrates the importance of ultrasound for evaluation of trauma cases with suspicion of fat embolism.
CASE PRESENTATION: A 23-year-old trauma patient with closed fracture of left femoral shaft and left humerus presented to our emergency department (ED). 11 h after admission to ED, patient became confused, hypoxic and hypotensive. He was then intubated for respiratory failure and mechanically ventilated. Transesophageal ultrasound revealed hyperdynamic heart, dilated right ventricle with no regional wall abnormalities and no major aorta injuries. Whole-body computed tomography was normal. During central venous cannulation of right internal jugular vein (IJV), we found free floating mobile hyperechoic spots, located at the anterior part of the vein. A diagnosis of fat embolism syndrome later was made based on the clinical presentation of long bone fractures and fat globulin in the blood. Despite aggressive fluid resuscitation, patient was a non-responder and needed vasopressor infusion for persistent shock. Blood aspirated during cannulation from the IJV revealed a fat globule. Patient underwent uneventful orthopedic procedures and was discharged well on day 5 of admission.
CONCLUSIONS: Point-of-care ultrasound findings of fat embolism in central vein can facilitate and increase the suspicion of fat embolism syndrome.

Matched MeSH terms: Orthopedic Procedures
Levobupivacaine for postoperative epidural analgesia in orthopaedic surgery

Afaf AA, Liu CY, Joanna OS

Clin Ter, 2013;164(2):91-5.
PMID: 23698199 DOI: 10.7417/CT.2013.1524

Levobupivacaine is the S(-)enantiomer of bupivacaine, a long acting amino-ester local anaesthetic agent. Cocktail mixture of levobupivacaine and fentanyl infusion is commonly given via epidural for post-operative analgesia. The concentration of levobupivacaine for optimal pain relief with least side effects remained uncertain.

Matched MeSH terms: Orthopedic Procedures*
Fulltext Venous thromboembolism prevention protocol for adapting prophylaxis recommendations to the potential risk post total knee replacement: a randomized controlled trial

Alameri MA, Syed Sulaiman SA, Ashour AM, Al-Saati MF

Pharm Pract (Granada), 2020 09 22;18(3):2025.
PMID: 33029262 DOI: 10.18549/PharmPract.2020.3.2025

Background: Total knee replacement (TKR) is a major orthopedic surgery that is considered high risk for the development of venous thromboembolism (VTE).
Objective: The aim of this study is to evaluate the clinical outcomes that resulted from the use of a new proposed VTE risk stratification protocol for selecting a suitable extended VTE prophylaxis for post TKR surgery patients administered in conjunction with patient education programs.
Method: A randomized controlled trial was conducted in two medical centers in Saudi Arabia. A total of 242 patients were enrolled in the study, 121 patients in each group. The experimental group (A) was assessed by using the proposed VTE risk stratification protocol and also took part in patient education programs about TKR and its complications. The control group (B) was assessed by using the 2005 Caprini risk assessment tool and no education programs were given to this group. Both groups were followed for 35 days post operation.
Results: The mean age of the participants was 65.86 (SD 8.67) and the majority of them were female 137 (56.6%). The mean body mass index of the study sample was 32.46 (SD 5.51). There were no significant differences between the two groups except for surgery type; the proportion of bilateral TKR in group A was higher than in group B (69/121 (28.5%) vs. 40/121(16.5%), p<0.05). There were no confirmed pulmonary embolism cases in the study sample and diagnosis of deep-vein thrombosis was confirmed in 12/242 (5.0%) of patients: 1/121 (0.8%) in group A and 11/121 (9.1%) in group B (p<0.05). The readmission rate for all patients was 2.5% (6/242), all of whom were in group B (p<0.05).
Conclusion: The proposed VTE risk stratification protocol that was applied in conjunction with patient education programs reduced VTE complications and readmission events, post TKR surgery. Trial Registration: ClinicalTrials.gov: Identifier: NCT04031859.

Matched MeSH terms: Orthopedic Procedures
Use of Bone Health Evaluation in Orthopedic Surgery: 2019 ISCD Official Position

Anderson PA, Morgan SL, Krueger D, Zapalowski C, Tanner B, Jeray KJ, et al.

J Clin Densitom, 2019 08 16;22(4):517-543.
PMID: 31519473 DOI: 10.1016/j.jocd.2019.07.013

This position development conference (PDC) Task Force examined the assessment of bone status in orthopedic surgery patients. Key questions included which orthopedic surgery patients should be evaluated for poor bone health prior to surgery and which subsets of patients are at high risk for poor bone health and adverse outcomes. Second, the reliability and validity of using bone densitometry techniques and measurement of specific geometries around the hip and knee before and after arthroplasty was determined. Finally, the use of computed tomography (CT) attenuation coefficients (Hounsfield units) to estimate bone quality at anatomic locations where orthopedic surgery is performed including femur, tibia, shoulder, wrist, and ankle were reviewed. The literature review identified 665 articles of which 198 met inclusion exclusion criteria and were selected based on reporting of methodology, reliability, or validity results. We recommend that the orthopedic surgeon be aware of established ISCD guidelines for determining who should have additional screening for osteoporosis. Patients with inflammatory arthritis, chronic corticosteroid use, chronic renal disease, and those with history of fracture after age 50 are at high risk of osteoporosis and adverse events from surgery and should have dual energy X-ray absorptiometry (DXA) screening before surgery. In addition to standard DXA, bone mineral density (BMD) measurement along the femur and proximal tibia is reliable and valid around implants and can provide valuable information regarding bone remodeling and identification of loosening. Attention to positioning, selection of regions of interest, and use of special techniques and software is required. Plain radiographs and CT provide simple, reliable methods to classify the shape of the proximal femur and to predict osteoporosis; these include the Dorr Classification, Cortical Index, and critical thickness. Correlation of these indices to central BMD is moderate to good. Many patients undergoing orthopedic surgery have had preoperative CT which can be utilized to assess regional quality of bone. The simplest method available on most picture archiving and communications systems is to simply measure a regions of interest and determine the mean Hounsfield units. This method has excellent reliability throughout the skeleton and has moderate correlation to DXA based on BMD. The prediction of outcome and correlation to mechanical strength of fixation of a screw or implant is unknown.

Matched MeSH terms: Orthopedic Procedures/methods*
Fulltext A Review of Guidelines to Resuming Elective Orthopaedic Surgeries Amid COVID-19 Pandemic: Deriving a Simple Traffic Light Model

Attia AK, Omar UF, Kaliya-Perumal AK

Malays Orthop J, 2020 Nov;14(3):10-15.
PMID: 33403057 DOI: 10.5704/MOJ.2011.003

The COVID-19 pandemic has affected most healthcare systems around the world. Routine care operations such as outpatient clinics and elective surgery remain badly hit. This situation cannot continue for long as it puts patients at a higher risk for complications due to delayed management. Hence, it is essential to resume routine, especially elective surgery. Regarding orthopaedic practice, various authors and organisations have come out with guidelines to resume elective surgeries. However, clear consensus and common strategies need be derived. With this motive, we conducted a review of the literature for guidelines to resume elective orthopaedic surgery amid COVID-19 pandemic and shortlisted scholarly publications and information from regional organisations. We have summarised the information and derived an organised algorithm considering the guidelines provided by various sources. In this extraordinary time, guidelines come in as a relief for every surgeon who is in a dilemma whether to resume electives or not. Putting safety first, these guidelines or suitable versions should be followed at all levels wherever possible to avoid the lack of trained manpower in the event of staff morbidity.

Matched MeSH terms: Orthopedic Procedures
Fulltext Comparison of biocompatibility and biodegradability of Poly(Lactic-co-Glycolic Acid) (PLGA) combined with Autologous Fibrin versus PLGA for intra-articular screw fixation; an Invivo study with New Zealand white rabbits the microradiograph outcome

Balakrishnan, Theenesh, Ahmad Hafiz Zulkifli, Munirah Sha'ban, Nurul Hafiza Mohd Jan, Mohd Zulfadzli Ibrahim, Noorhidayah Md Nazir

International Medical Journal Malaysia, 2017;16(11):30-30.
MyJurnal

The great potential of biodegradable polymers in orthopaedic surgery is
gradually being recognized. PLGA is one of the common polymers used. However, long
term outcomes, with regards to PLGA, are still not well documented. Hence, we
attempted to study the outcome of PLGA and also its combination with fibrin. (Copied from article).

Matched MeSH terms: Orthopedic Procedures
Fulltext The rate of glove perforations in orthopaedic procedures: single versus double gloving. A prospective study

Chan KY, Singh VA, Oun BH, To BH

Med J Malaysia, 2006 Dec;61 Suppl B:3-7.
PMID: 17605178

Glove perforation during surgery has always been a matter of concern as it increases the infection rate and the risk of transmission of blood borne diseases. To determine the common causes, the site and the awareness of glove perforations in orthopaedic surgery, a prospective study was conducted to assess the rate of glove perforation during 130 consecutive orthopaedic operations. All gloves worn by the surgical team were assessed after the surgery using the water-loading test. A total of 1452 gloves were tested, and the rate of perforation was 3.58%. Most of these perforations (61.5%) were unnoticed. The main surgeons had the most perforations (76.9%), followed by first assistants (13.5%) and second assistants (9.6%). Most perforations occurred at the non-dominant hand. The commonest site of perforation was the index finger followed by the thumb. Shearing force with instruments accounted for 45% of the noticed perforations. Majority of these occurred during nailing procedures (33%) and internal fixation without the use of wires (19%). Our rate of glove perforation is similar to other series. Most of them went unnoticed and were mainly due to shearing injuries rather than perforation by sharps. Therefore, there is an increased risk of contamination and break in asepsis during surgery.

Matched MeSH terms: Orthopedic Procedures/instrumentation*
Fulltext Preliminary in Vivo evaluation of bone healing in critical size bone defects implanted with an injectable calcium phospate bone cement (Osteopaste)

Che Nor Zarida Che Seman, Zamzuri Zakaria, Zunariah Buyong, Mohd Shukrimi Awang, Ahmad Razali Md Ralib @ Md Raghib

International Medical Journal Malaysia, 2017;16(11):23-23.
MyJurnal

A novel injectable calcium phosphate bone cement (osteopaste) has been
developed. Its potential application in orthopaedics as a filler of bone defects has been
studied. The biomaterial was composed of tetra-calcium phosphate (TTCP) and tricalcium
phosphate (TCP) powder. The aim of the present study was to evaluate the
healing process of osteopaste in rabbit tibia.(Copied from article).

Matched MeSH terms: Orthopedic Procedures
Fulltext Revision surgery for developmental dysplasia of the hip

Chidambaram S, Abd Halim AR, Yeap JK, Ibrahim S

Med J Malaysia, 2005 Jul;60 Suppl C:91-8.
PMID: 16381291

Revision surgery following failed open reduction for developmental dysplasia of the hip (DDH) is technically demanding. We reviewed 12 patients in our institution that required a revision surgery between January 1994 and December 2003. The aims of this study are to identify the causes of redislocation after the primary open reduction and to determine the clinical and radiological outcome after the revision surgery. The mean age at presentation for DDH was 31 months (range 1-84) and the mean age at primary open reduction surgery was 38 months (range 15-84) and the mean age at revision surgery was 69 months (range 21-180). The mean follow-up period after revision surgery was 20 months (range 3-84). All the revision surgery was performed via an anterior Smith Peterson approach. The most common cause for redislocation was inadequate exposure and failure to release the obstructing soft tissues around the hip. The bony factors for redislocation included failure to perform a femoral shortening and excessive derotation of an anteverted femoral head combined with a Salter osteotomy. Three cases with posterior acetabular wall deficiency needed immobilization of the hip in extension as the hip tended to dislocate in flexion. Six patients had limb length discrepancy ranging from 1 cm to 4 cm and 50% developed avascular necrosis. Only 2 patients were asymptomatic and the majority had a limp and limitation of motion. All were pain free except one. In view of the technically demanding surgery and poor results after revision, the surgeon should recognize the pathology and ensure that the primary procedure achieves a stable and concentric reduction.

Matched MeSH terms: Orthopedic Procedures*
Fulltext Closed reduction of traumatic bilateral anterior hip dislocations with sedation: a case report and review of the literature

Chiu CK, Ng TS, Wazir NN, Bhurhanudeen KA

Ulus Travma Acil Cerrahi Derg, 2015 Jan;21(1):63-7.
PMID: 25779715 DOI: 10.5505/tjtes.2015.27475

A rare case of bilateral anterior hip dislocation reduced under sedation was reported in this study. A 47-year-old man was knocked down by a car and sustained bilateral anterior hip dislocation which was reduced successfully with sedation using titrated dose of intravenous Midazolam in combination with Pethidine. A modified Lefkowitz maneuver using the manipulator's thigh as a fulcrum was used. Patient started weight bearing in the second month after injury and was walking without any hip pain at the twenty-fourth month follow-up. Thirteen case reports describing bilateral anterior hip dislocations were found while reviewing the literature and it was noticed that only one author had reported the usage of intravenous sedation (Propofol) for the reduction procedure. However, no author reported the use of Lefkowitz maneuver for this purpose. Consequently, reduction of a bilateral anterior hip dislocation is possible with sedation using a modified Lefkowitz maneuver.

Matched MeSH terms: Orthopedic Procedures/methods
Cervical myelopathy caused by an exostosis of the posterior arch of C1

Chooi YS, Siow YS, Chong CS

J Bone Joint Surg Br, 2005 Feb;87(2):257-9.
PMID: 15736753

We report a case of vertebral osteochondroma of C1 causing cord compression and myelopathy in a patient with hereditary multiple exostosis. We highlight the importance of early diagnosis and the appropriate surgery in order to obtain a satisfactory outcome.

Matched MeSH terms: Orthopedic Procedures/methods
Deep Infections after Endoprosthetic Replacement Operations in Orthopedic Oncology Patients

Dhanoa A, Ajit Singh V, Elbahri H

Surg Infect (Larchmt), 2015 Jun;16(3):323-32.
PMID: 26046246 DOI: 10.1089/sur.2014.049

Numerous studies have described various complications after endoprosthetic reconstructive operations. However, there are limited reports that focus specifically on deep infections (e.g., deep incisional surgical site infections), which remain one of the most dreaded complications of these operations, with rates ranging from 10% to 17%. Thus, this study was undertaken to determine the deep infection rates and to analyze possible risk factors, clinico-pathologic characteristics, and treatment modalities of endoprosthetic infections.

Matched MeSH terms: Orthopedic Procedures/adverse effects*
Integration and Vascular Ingrowth of a Collagen Meniscal Implant: A Case Report

Duarte-Silva M, Guerra-Pinto F, Camelo-Barbosa N, Beja-da-Costa P

Malays Orthop J, 2019 Jul;13(2):38-41.
PMID: 31467650 DOI: 10.5704/MOJ.1907.007

Meniscectomy is the most common surgery in orthopaedics. The absence of meniscal tissue might be related to irreversible damage to the articular cartilage. Meniscal replacement is a tissue-engineering technique for post-meniscectomy syndrome. Its success depends on the implant integration which was vastly proven in animal model studies. Histological evidence is hard to obtain in humans due to ethical issues. We report a clinical case in which a collagen scaffold meniscal implant was harvested six months after implantation due to mechanical failure. Histological analysis was performed revealing vascularisation not only of the peripheral attachment of the implant but also on the anterior horn. These morphologic findings demonstrate that this implant allows the colonisation by precursor cells and vessels, leading to the formation of a fully functional tissue. This present report is one of the few independent reports of scaffold biological integration in the literature.

Matched MeSH terms: Orthopedic Procedures
Effective nutritional status screening in orthopaedic oncology patients and post-operative complications

Eu CW, Ajit Singh V, Yasin NF

J Orthop Surg (Hong Kong), 2019 5 16;27(2):2309499019847232.
PMID: 31084248 DOI: 10.1177/2309499019847232

PURPOSE: This study aims to determine the prevalence of malnutrition among orthopaedic oncology patients with malignant tumour during preoperative period.
METHODS: This is a prospective observational study involving patients from the orthopaedic oncology unit who were undergoing surgery. They were assessed with Patient Generated Subjective Global Assessment (PG-SGA), Malnutrition Screening Tool (MST) and 3-minute Nutritional Screening (3MinNS) questionnaires. Anthropometric data such as body mass index, mid upper arm circumference (MUAC) and blood parameters such as serum albumin, total lymphocyte count and haemoglobin were also investigated. Patients were then followed up for 3 months. Post-operative complications were divided into infectious and non-infectious groups. Length of stay and unplanned readmission were also documented.
RESULTS: Prevalence of malnutrition ranged from 13.3% to 45.8% under different nutritional assessment methods. Patients who were determined as malnourished were significantly associated with both infectious and non-infectious post-operative complications ( p < 0.001). PG-SGA and 3MinNS values were also significant in univariate and multivariate analysis, respectively. Low serum albumin (<35 g/L) was associated with post-operative infectious complications, especially surgical site infection ( p < 0.001), prolonged hospital stay ( p = 0.009) and unplanned readmission ( p = 0.017). 3MinNS and Charlson Comorbidity Index were predictive of non-infectious complications, whereas serum albumin and the presence of metastasis were predictive of infectious complications.
CONCLUSION: This pilot study of patients with soft tissue and bone sarcoma of upper and lower limbs showed that malnutrition is a significant independent factor related to infectious and non-infectious complications which leads to unplanned readmission and prolonged length of stay. Periodic screening using the PG-SGA or 3MinNS questionnaires, MUAC and evaluation of serum albumin levels is recommended during clinic session and pre-surgery assessment rounds to identify those predisposed to malnutrition and help in reducing incidence of post-operative complications.

Matched MeSH terms: Orthopedic Procedures/adverse effects*
Fulltext Pulmonary metastases of giant cell tumour of the bone

Faisham WI, Zulmi W, Saim AHM, Biswal BM

Med J Malaysia, 2004 Dec;59 Suppl F:78-81.
PMID: 15941172

The clinical presentation and behaviour of giant cell tumour of bone vary. The progression of the disease and metastasis are unpredictable, but the overall prognosis is good. Six patients with pulmonary metastases of giant cell tumour have been treated at our institution since 1998. This represents 15% of all patients treated for giant cell tumour of the bone. Early detection and treatment of this tumour is important as complete resection of this tumour have favourable prognosis. Multiple lung nodules which preclude resection may remain dormant and asymptomatic with systemic chemotherapy.

Matched MeSH terms: Orthopedic Procedures/methods
Fulltext Intertrochanteric fracture fixation with dynamic hip screw: is tip-apex distance measurement useful for predicting fixation failure?

Goh, K.L., Zamzuri, Z., Mohd Ariff, S., Mohamed Azril, M.A.

International Medical Journal Malaysia, 2016;15(1):31-34.
MyJurnal

Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the value of TAD was evaluated to verify its usefulness.
Methods: This is a retrospective study of 33 consecutive patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any fixation-related failure or complication.
Results: Fifty two percent of patients did not achieved the recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration.
Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of intertrochanteric fracture.
KEYWORDS: Intertrochanteric fracture, dynamic hip screw, tip-apex distance, screw cut-out

Matched MeSH terms: Orthopedic Procedures
Fulltext Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation and analgesia in the emergency department

Jamal SM, Fathil SM, Nidzwani MM, Ismail AK, Yatim FM

Med J Malaysia, 2011 Aug;66(3):231-3.
PMID: 22111446

The study compared the effectiveness of ketamine and midazolam/fentanyl as procedural sedation and analgesia agents for reduction of fractures and dislocated joints. Forty-one adult patients were enrolled by convenience sampling. They were randomized to receive ketamine or midazolam/fentanyl. Depth of sedation, pain score, procedural outcome and memory of the procedure were documented. The ketamine group had deeper sedation, but there was no statistical difference in other variables between the two groups. Three patients in the midazolam/fentanyl group had oxygen desaturation. More adverse effects were associated with ketamine. Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation.

Matched MeSH terms: Orthopedic Procedures/adverse effects
Hip dislocation in Down syndrome

Jamil K, Abdul Rashid AH, Ibrahim S

J Pediatr Orthop B, 2014 Mar;23(2):204.
PMID: 24447939 DOI: 10.1097/01.bpb.0000434259.00524.7f
Matched MeSH terms: Orthopedic Procedures/methods*
Fulltext Acromio-Clavicular Joint Dislocation Types IV to VI: Does the Outcome with the modified Weaver-Dunn Procedure Justify the Treatment?

Kapil-Mani KC, Niroula A

Malays Orthop J, 2018 Jul;12(2):31-36.
PMID: 30112126 DOI: 10.5704/MOJ.1807.006

Introduction: The optimal surgical treatment for acromioclavicular joint (ACJ) injuries remains controversial. The modified Weaver-Dunn (WD) procedure is one of the frequently used techniques. Recently when it was compared with anatomical autogenous tendon graft reconstruction procedures, the results were inferior. However, these anatomical procedures are technically more demanding with small margin of error and they have tendency for postoperative pain because of extra donor site incision. Materials and Methods: Forty patients with type IV to VI ACJ dislocations were treated by modified WD procedure using non-absorbable synthetic suture passed through the base of coracoid process for augmentation of transferred coraco-acromial (CA) ligament. Functional outcome was assessed using the Oxford Shoulder Score, Nottingham Clavicular Score and Visual Analog Score (VAS) at the final follow-up after surgery. Results: The mean pre-operative Oxford Shoulder Score improved from 25.22±2.64 (range 20 to 30) to 44.75±1.99 (range 40 to 48) and mean pre-operative Nottingham Shoulder Score improved from 49.25±4.91 (range 39 to 58) to 87.27±4.39 (range 79 to 96) at last follow-up after surgery with p-value <0.001. Thirty-five (87.5%) patients had excellent outcomes, four (10%) patients had good outcomes and one (2.5%) patient had fair outcome. Thirty-eight (95%) patients had no pain while two (5%) had moderate pain based on VAS score. Conclusion: Modified Weaver-Dunn is a simple well established technique for grade IV to VI ACJ dislocation. We cannot consider this procedure as old and outdated on the argument that the long term functional outcomes are not suboptimal.

Matched MeSH terms: Orthopedic Procedures

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