Displaying publications 1 - 20 of 106 in total

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  1. Nazri Mohd Yusof
    MyJurnal
    Gastrocnemius flap is the workhorse for wound coverage in the proximal
    tibia. It can be perform by general orthopaedic surgeon because it is done without the
    need of microscopic instrumentation. Its coverage can be extended to cover the knee
    and midshaft of tibia when skin overlying it is included in the flap. (Copied from article).
    Matched MeSH terms: Orthopedics
  2. Singh A, Panda K, Mishra J, Dash A
    Malays Orthop J, 2020 Nov;14(3):129-136.
    PMID: 33403073 DOI: 10.5704/MOJ.2011.020
    Introduction: The incidence of compound fractures and severe soft tissue loss has increased manifolds due to high speed traffics. Negative Pressure Wound Therapy (NPWT) is a treatment modality for managing soft tissue aspect of such injuries. It reduces the need of flap coverage. However, many patients from developing countries cannot afford a conventional NPWT. We developed an indigenous low cost NPWT for our patients and supplemented it with Topical Pressurised Oxygen Therapy (TPOT). We conducted this study to compare its treatment outcome with the use of conventional NPWT.

    Materials and Methods: The study was conducted from 2018 to 2020 at a tertiary care teaching hospital. A total of 86 patients were treated with NPWT and their results were assessed for various parameters like reduction in wound size, discharge, infection, etc. We included patients with acute traumatic wounds as well as chronic infected wounds, and placed them in three treatment groups to receive either conventional NPWT, Indigenous NPWT and lastly NPWT with supplement TPOT.

    Results: We observed a significant reduction of wound size, discharge and infection control in all three groups. The efficacy of indigenous NPWT is at par with conventional NPWT. Only six patients who had several comorbidities required flap coverage while in another four patients we could not achieve desired result due to technical limitations.

    Conclusion: Indigenous NPWT with added TPOT is a very potent and cost effective method to control infection and rapid management of severe trauma seen in orthopaedic practice. It also decreases the dependency on plastic surgeons for management of such wounds.

    Matched MeSH terms: Orthopedics
  3. 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: Orthopedics
  4. Lee, C.K., Kwan, M.K., Chua, Y.P.
    Malays Orthop J, 2009;3(1):85-87.
    MyJurnal
    Removal of plates is a procedure commonly performed by orthopaedic surgeons and stripped screws are probably the most common problem encountered during this procedure. Stripped screws are caused by slippage between the screwdriver and the screw. Due to the inherent difficulty in removing such screws, surgeons should be knowledgeable in techniques for their removal and should be equipped with the proper instruments to expedite the procedure. There are few published articles about such techniques. This report describes a technique for removal of plates with stripped screws. The tip of a stripped screw is approached from the far cortex and then reamed with a trephine reamer in the direction of the screw until both cortices are cleared. The plate is then removed with stripped screws attached. All the removals utilizing this technique to date have been successful with no complications, and this method is safe, efficient and technically easy to learn.


    Matched MeSH terms: Orthopedics
  5. Ong T, Vindlacheruvu M
    Age Ageing, 2023 Jun 01;52(6).
    PMID: 37389557 DOI: 10.1093/ageing/afad110
    The National Institute for Health and Care Excellence released its second update on hip fracture management in early 2023. First published in 2011, the last update was in 2017. The scope of this recent update focussed on surgical implants for hip fracture. This included recommendation to offer total hip replacements instead of hemiarthroplasty for displaced intracapsular hip fractures, and a move away from Orthopaedic Device Evaluation Panel rated implants to a more standardised consistent choice. Other recommendations such as the importance of multidisciplinary orthogeriatric care, early surgery and prompt mobilisation remain. As the literature surrounding hip fracture management continue to grow, guidance such as this needs to continue updating itself to ensure patients with hip fracture receive the best possible care.
    Matched MeSH terms: Orthopedics*
  6. Loh YC, Lam WL, Stanley JK, Soames RW
    J Orthop Surg (Hong Kong), 2004 Jun;12(1):83-6.
    PMID: 15237127 DOI: 10.1177/230949900401200115
    Radial tunnel syndrome refers to pain on the lateral aspect of the forearm as a result of compression of the posterior interosseous nerve within a tunnel with specific anatomical boundaries. Diagnosis of the condition is difficult because of its close association with lateral epicondylitis, which warrants different methods of treatment. Based on a cadaveric study, a new clinical test, the Rule-of-Nine test, is proposed to improve the diagnostic accuracy in radial tunnel syndrome. The test involves constructing 9 equal squares on the anterior aspect of the forearm and noting those squares where tenderness can be elicited.
    Matched MeSH terms: Orthopedics/methods*
  7. Chua, S.K., Singh, Devinder K.A., Rajaratnam, B.S., Mokhtar, Sabarul A., Sridharan, R., Gan, K.B., et al.
    MyJurnal
    Older adults are at risk of osteoporotic fractures. Osteoporotic vertebral fractures are associated with a reduced cross-sectional area and muscle strength of the back extensor muscles, increased intramuscular fat infiltration and thoracic and lumbar curvature alterations. This study proposed a protocol to examine in more detail the contributions of altered spinal morphological, physical performance and biochemical markers to the risk of developing osteoporotic vertebral fractures. In this cross-sectional study, we plan to recruit 100 adults aged 50 years and above from an orthopaedic clinic, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia. The fracture prediction tool (FRAX) will be used to categorise high and low risk groups. Back muscle strength will be quantified using a load cell system. Thoracolumbar curvatures will be examined using an electromagnetic tracking system and intramuscular fat infiltration in the lumbar muscles will be measured using Magnetic Resonance Imaging. The Short Physical Performance Battery and JAMA dynamometer will quantify physical performance and the European Quality of Life Questionnaire will be used to assess self-perceived quality of life. Biochemical markers of serum C terminal telopeptide and N terminal propeptide of type I procollagen will be assessed using an enzyme-linked immunosorbent assays kit. A spine-specific model using regression analysis will be developed to predict osteoporotic vertebral fractures using the measured parameters in the present study.
    Matched MeSH terms: Orthopedics
  8. May Honey Ohn
    MyJurnal
    This systematic review was aimed to evaluate the effectiveness of technology-enhanced learning (TEL) used in medical teaching for undergraduate medical students. The objectives are to (a) identify various teaching modalities which are used to enhance TEL; (b) evaluate whether TEL is more effective than traditional learning (TL) in cognitive and affective learning domain outcome. The empirical studies were searched in the following databases: Google Scholar, MEDLINE, ERIC, ProQuest, Cochrane Library and Scopus. All papers published from 2008 to 2018 were included. From eligible studies, the study design, study field, study population, intervention methods, type of assessment and learning achievement were abstracted and summarized the information. The search results were independently reviewed by two authors. From a pool of 1384 articles, 43 eligible articles were identified, enrolling 7292 undergraduate medical students examining comparative study between TEL and traditional learning. The results showed that there was a high degree of heterogeneity seen amongst the included studies in terms of TEL modalities used. The majority of intervention studies favoured online resources, while the rest used various offline multimedia electronic devices, virtual simulations and blended modes. Overall findings showed promising data that TEL is better than TL with regards to knowledge gain and skill acquisition, as well as providing higher student satisfaction. In all, the findings present blended learning in a positive and promising light in time, particularly where systematic reviews on technology-enhanced learning in the field of the undergraduate medical programme have produced mixed result.REVIEW ARTICLEA Systematic Literature Review on Technology-Enhanced Learning in Medical EducationMay Honey Ohn1*, Bareth Ravindran2, Chan Zhi Wei3, Khin Maung Ohn4, Ng Pey Luen5Borneo Journal of Medical Sciences 14 (1) January, 2020: 3 – 171 Emergency Department, Sandwell & West Birmingham NHS Trust, United Kingdom2 Surgical Department, Hospital Tuanku Ja’afar Seremban, Kuala Lumpur, Malaysia3 Orthopaedics Department, Hospital Sungai Buloh, Kuala Lumpur, Malaysia4 Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia5 Radiology Department, Hospital Queen Elizabeth II, Sabah, Malaysia* Corresponding author’s email: mayhoney.ohn@gmail.com Received: 14 July 2019 Accepted: 5 November 2019Borneo Journal of Medical SciencesBJMSKeywords: blended learning, technology-enhanced learning, medical education, hybrid learning, undergraduate medical students
    Matched MeSH terms: Orthopedics
  9. Akram A, Rizwan F, Sattar K, Hadi JIS, Meo SA
    Pak J Med Sci, 2018 9 8;34(4):804-810.
    PMID: 30190732 DOI: 10.12669/pjms.344.14565
    Background and Objectives: Medical schools are to develop integrated medical curricula because the term 'integrated curriculum' has grown up and flourished globally and it has become mandatory to align the medical education with the global concept in Pakistan. This paper aims to present a guideline to design an undergraduate integrated medical curriculum.

    Methods: Various themes are used to develop integrated curriculum which are basic medical science, simulation skills, clinical science, personality development, research, entrepreneurship and pre specialization. Each theme is subdivided, termed a module and its contents primarily focus on particular aspect.

    Results: Knowledge, skill and attitude, embodied in themes or modules, are planted in specific way that they have horizontal as well as vertical integration. There is no boundary of various traditional disciplines in template of five years curriculum. For example, diagnosis is a theme which carries contents from medicine, surgery, orthopedics etc.

    Conclusion: The blueprint introduced in this paper would help medical educators to draft integrated medical curricula for those institutions which intend to switch their medical programs from traditional to integrated one.

    Matched MeSH terms: Orthopedics
  10. Roy KD, Sharma GM, Qureshi F, Wadia F
    Malays Orthop J, 2020 Nov;14(3):137-142.
    PMID: 33403074 DOI: 10.5704/MOJ.2011.021
    Introduction: A small proportion of patients presenting to the Emergency department (ED) of any hospital tend to take discharge against medical advice (DAMA) due to several patient related or hospital/service related reasons. Amongst these, orthopaedic patients are a special group due to their inability to mobilise independently due to injuries and have treatment needs which involve higher costs. The aim of the current study was to ascertain and analyse the reasons for orthopaedic walkouts at a tertiary care new private hospital.

    Materials and Methods: This retrospective telephonic structured interview-based study was carried out on all orthopaedic patients taking DAMA during a one-year period from July 2016 to June 2017. They were telephonically interviewed with a structured questionnaire. Hospital and ED records were analysed for demographic as well as temporal characteristics.

    Results: A total of 68 orthopaedic patients walked out of casualty against medical advice out of a total 775 (8.77%) orthopaedic patients presenting during the period as against 6.4% overall rate of DAMA for all specialties. The main reasons for DAMA were financial unaffordability of treatment (36.7%), preference for another orthopaedic surgeon (22%) and on advice of the patient's General Practitioner (16.1%).

    Conclusion: Unaffordability of treatment is a significant cause for walkouts amongst orthopaedic patients. Private hospitals need to recognise and implement processes by which these patients can be treated at affordable costs and with coverage either by medical insurance or robust charity programs. Patient education and awareness are important to encourage them to have insurance coverage.

    Matched MeSH terms: Orthopedics
  11. Ang HL, Mohamad Adam B, Tajuddin A, Isnoni I, Suzanna A, Anwar Hau M, et al.
    MyJurnal
    The incidence of hip fractures is increasing within the aging population.We determined the risk factors of in-hospital mortality following hip fracture across major hospitals in Malaysia. This is a retrospective cohort review from 18 hospitals across Malaysia in National Orthopaedic Registry of Malaysia (NORM) . We collected demographic data, prefracture co-morbidities, previous hip fracture, pre-fracture walking ability, fracture type and stability, mechanism of injury, type of management (operative or non-operative), operation types and grade of surgeon. Between 2008 and 2009, 685 patients were admitted with a hip fracture to 18 government hospitals with orthopaedic service. The overall in-hospital mortality was 2.2%. We found more in-hospital mortality in elderly patients and patients with eye and hearing problems as pre-fracture morbidity. In conclusion, patients who were elderly with multiple comorbidities especially those with eye and hearing impairment were had higher risk for immediate mortality
    Matched MeSH terms: Orthopedics
  12. Vickash K, Amer A, Naeem A, Falak S
    Malays Orthop J, 2016 Nov;10(3):36-38.
    PMID: 28553446 DOI: 10.5704/MOJ.1611.001
    Elbow dislocation, though a common orthopaedic emergency is rare with brachial artery injury and is even more uncommon in the paediatric age group. We present the case of a child who sustained trauma resulting in closed elbow dislocation with brachial artery injury. Elbow dislocation with brachial artery injury can present with palpable distal pulses and good capillary refill because of rich collaterals at the elbow. But this patient presented with signs of frank ischemia distally, and was managed with ipsilateral reverse cephalic vein graft. He had good volume pulses at one year follow-up. Patients with such presentation should have careful clinical and radiological assessment to exclude complicated elbow dislocation.
    Matched MeSH terms: Orthopedics
  13. Faria G, Virani S, Tadros BJ, Dhinsa BS, Reddy G, Relwani J
    Malays Orthop J, 2021 Mar;15(1):100-104.
    PMID: 33880155 DOI: 10.5704/MOJ.2103.015
    Introduction: COVID-19 has had a significant impact on the entire health system. The trauma and orthopaedic service has been compelled to alter working practices to respond proactively and definitively to the crisis. The aim of this study is to summarise the impact of this outbreak on the trauma and orthopaedic workload and outline the response of the department.

    Materials and Methods: We retrospectively collected data comparing patient numbers pre-COVID-19, and prospectively during the early COVID-19 pandemic. We have collected the numbers and nature of outpatient orthopaedic attendances to fracture clinics and elective services, inpatient admissions and the number of fracture neck of femur operations performed.

    Results: The number of outpatient attendances for a musculoskeletal complaint to Accident and Emergency and the number of virtual fracture clinic reviews reduced by almost 50% during COVID-19. The number of face-to-face fracture clinic follow-ups decreased by around 67%, with a five-fold increase in telephone consultations. Inpatient admissions decreased by 33%, but the average number of fracture neck of femur operations performed has increased by 20% during COVID-19 compared to pre-COVID-19 levels.

    Conclusion: We have noted a decrease in some aspects of the trauma and orthopaedic outpatient workload, such as leisure and occupational-related injuries but an increase in others, such as fracture neck of femurs. Many injuries have significantly reduced in numbers and we consider that a model could be developed for treating these injuries away from the acute hospital site entirely, thereby allowing the acute team to focus more appropriate major trauma injuries.

    Matched MeSH terms: Orthopedics
  14. Tay K, Kamarul T, Lok WY, Mansor M, Li X, Wong J, et al.
    Malays Orthop J, 2020 Jul;14(2).
    PMID: 32313613 DOI: 10.5704/MOJ.2007.001
    With the increasing number of COVID-19 cases and related deaths worldwide, we decided to share the development of this condition in Singapore and Malaysia. First few cases were diagnosed in the two countries at the end of January 2020, and the numbers have surged to thousands by end of March 2020. We will focus on strategies adopted by the government and also the Orthopaedic community of the two countries up till the beginning of April 2020. We hope that by sharing of relevant information and knowledge on how we are managing the COVID-19 condition, we can help other communities, and health care workers to more effectively overcome this pandemic.
    Matched MeSH terms: Orthopedics
  15. Harith H, Schmutz B, Malekani J, Schuetz MA, Yarlagadda PK
    Med Eng Phys, 2016 Mar;38(3):280-5.
    PMID: 26739124 DOI: 10.1016/j.medengphy.2015.11.012
    Anatomically precontoured plates are commonly used to treat periarticular fractures. A well-fitting plate can be used as a tool for anatomical reduction of the fractured bone. Recent studies highlighted that some plates fit poorly for many patients due to considerable shape variations between bones of the same anatomical site. While it is impossible to design one shape that fits all, it is also burdensome for the manufacturers and hospitals to produce, store and manage multiple plate shapes without the certainty of utilization by a patient population. In this study, we investigated the number of shapes required for maximum fit within a given dataset, and if they could be obtained by manually deforming the original plate. A distal medial tibial plate was automatically positioned on 45 individual tibiae, and the optimal deformation was determined iteratively using finite element analysis simulation. Within the studied dataset, we found that: (i) 89% fit could be achieved with four shapes, (ii) 100% fit was impossible through mechanical deformation, and (iii) the deformations required to obtain the four plate shapes were safe for the stainless steel plate for further clinical use. The proposed framework is easily transferable to other orthopaedic plates.
    Matched MeSH terms: Orthopedics
  16. Shahid Hassan
    MyJurnal
    Context: Community-based medical education (CBME) has become widely accepted as an important innovation in undergraduate medical education. In curriculum featuring CBME, students are acquainted with the community early in their studies however; the impact of this training can be judged best to see them practice the required aspects of CBME. Malaysia is a multiracial country with a very strong community dependant life style. Main national health problems have called for a change in health profession education from traditional hospital based health care to community-based delivery system. Three major university's medical schools that either practice community oriented or community based medical education in undergraduate medical curriculum are evaluated. Universiti Sains Malaysia (USM) has a community based medical education (CBME) curriculum as Community and Family Case Study (CFCS) compared to a community oriented education curriculum (COE) adopted by Universiti Malaya (UM) and Universiti Kebangsaan Malaysia (UKM). However, UM at the time of undertaking this study back in 2005 was though practicing COE has also later opted CBME as CFCS.

    Objective: To determine whether medical graduates from USM with a community-based medical education in its curriculum for more than 25 years are inspired to have stronger commitment towards community health as shown in their on-job practice of medicine compared to other graduates from UM and UKM, who have adopted community-oriented medical education program.

    Method: A questionnaire-based pilot study with 12 items (variables) was designed to obtain supervisor's opinion on commitment of interns towards the health of community they serve. The questionnaire was administered to a randomized group of 85 specialists supervising the internship training program in five major disciplines including internal medicine, surgery, orthopaedic, gynaecology and obstetrics and paediatric medicine. The data received from 62 respondents from five major disciplines was analyzed utilizing SPSS version 12.0.1.

    Result: The responses received from 62 supervisors on an inventory in which 9 out of 12 variables were directly related to community commitments of interns. It was shown that the USM graduates who were taught through a CBME curriculum have performed better than the graduates from UM and UKM who followed a COE curriculum. P-value (< 0.001) was highly significant and consistent with higher mean score in those variables.

    Conclusion: The graduates taught through a CBME curriculum performed better in community commitments towards patients care compared to graduates from COE curriculum.
    Matched MeSH terms: Orthopedics
  17. Raveendran K
    Family Practitioner, 1984;7:43-45.
    Matched MeSH terms: Orthopedics
  18. Md Nizar ND, Hassan SK, Mohamad Zaini RH, Hassan MH, Wan Hassan WMN, Mazlan MZ
    Malays J Med Sci, 2020 Dec;27(6):68-78.
    PMID: 33447135 DOI: 10.21315/mjms2020.27.6.7
    Background: Hypotension is a common complication following spinal anaesthesia. The administration of intravenous fluids prior to spinal anaesthesia, known as pre-loading, has been used to offset the hypotension effect; however, the ideal fluid for pre-loading is still a matter of debate. The objective of this study was to compare the effects of Gelaspan 4% and Volulyte 6% as pre-loading fluids.

    Methods: A total of 93 patients with American Society of Anaesthesiologists (ASA) physical status I or II having lower limb orthopaedic surgery under spinal anaesthesia were randomised into two groups that received either Volulyte (n = 47) or Gelaspan (n = 46). Before the spinal anaesthesia, these patients were pre-loaded with 500 mL of the fluid of their respective group. Blood samples were taken before pre-loading and again after spinal anaesthesia and sent for venous blood gas and electrolyte level measurement. Baseline and intraoperative records of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and the requirement of ephedrine to treat hypotension were also recorded.

    Results: Both fluids could not prevent significant reductions in SBP (P = 0.011), DBP (P = 0.002) and MAP (P = 0.001). There was also significant reduction in HR over time (P < 0.001). There was no significant difference in terms of ephedrine usage between both groups. Neither Volulyte 6% nor Gelaspan 4% caused significant changes in acid-base status.

    Conclusion: The use of 500 mL of either Gelaspan 4% or Volulyte 6% as pre-loading fluids did not significantly prevent the incidence of post-spinal anaesthesia hypotension following orthopaedic lower limb surgery; however, both were useful in the maintenance normal acid-base balance.

    Matched MeSH terms: Orthopedics
  19. 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.
    Matched MeSH terms: Orthopedics
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