Displaying publications 1 - 20 of 108 in total

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  1. Thangaraju S, Tauber M, Habermeyer P, Martetschläger F
    Knee Surg Sports Traumatol Arthrosc, 2019 Dec;27(12):3797-3802.
    PMID: 30900030 DOI: 10.1007/s00167-019-05482-7
    PURPOSE: Arthroscopic-assisted stabilization surgery for acute acromioclavicular joint (ACJ) disruption shows excellent and reliable clinical outcomes. However, characteristic complications such as fracture of the clavicle and coracoid have been reported to occur during the early post-operative period. The main goal of this study was to highlight the occurrence of fractures as a late post-operative complication. The secondary goals were to describe possible fracture morphologies and treatment outcomes.

    METHOD: Patient records from a single surgery centre were searched for all patients presenting with late fracture complication following arthroscopically assisted acromioclavicular stabilization. Medical reports including the operative notes and pre- and post-operative X-rays were reviewed. A telephone interview was conducted with each patient to access the American Shoulder and Elbow Surgeons shoulder score.

    RESULTS: A total of four patients presented with late fracture complication following arthroscopic-assisted ACJ stabilization surgery. All patients were males and presented following trauma at a median duration of 19.5 months after the index surgery. Fracture morphology differed between patients; the treatment was conservative in three patients, while one patient underwent osteosynthesis.

    CONCLUSION: Traumatic peri-implant fractures can occur, even 2 years after arthroscopically assisted ACJ reconstruction. This needs to be considered when planning for surgical intervention in acute ACJ disruption, especially in a high-risk population.

    LEVEL OF EVIDENCE: Therapeutic study, Level IV.

    Matched MeSH terms: Shoulder
  2. Brun SP
    Aust J Gen Pract, 2019 11;48(11):757-761.
    PMID: 31722459 DOI: 10.31128/AJGP-07-19-4992
    BACKGROUND: Shoulder pain and stiffness affects at least one-quarter of the Australian population, with the primary care physician seeing 95% of these patients. Idiopathic frozen shoulder affects >250,000 Australians, making it a significant burden on both the individual and society. The primary care physician plays a major part in recognising the condition and formulating an evidence-based management plan in conjunction with the physiotherapist.

    OBJECTIVE: This article provides the reader with an understanding of the natural history, pathophysiology, phases and clinical features of idiopathic frozen shoulder. It also outlines patients at risk of developing idiopathic frozen shoulder and addresses an evidence-based conservative approach to the management of this condition.

    DISCUSSION: The primary care physician plays a pivotal part in the identification and management of idiopathic frozen shoulder, with the vast majority of patients responding to conservative management. A shared care approach with a skilled physiotherapist is essential.

    Matched MeSH terms: Shoulder Joint; Shoulder Pain
  3. Collin P, Hervé A, Walch G, Boileau P, Muniandy M, Chelli M
    J Shoulder Elbow Surg, 2019 Oct;28(10):2023-2030.
    PMID: 31405717 DOI: 10.1016/j.jse.2019.03.002
    BACKGROUND: Results of anatomic shoulder arthroplasty for glenohumeral osteoarthritis with severe glenoid retroversion are unpredictable with a high rate of glenoid loosening. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative, with good early results. We sought to confirm this at longer follow-up (minimum 5 years). The study hypothesis was that early results would endure over time.

    METHODS: We retrospectively reviewed all RSAs performed in 7 centers from 1998 to 2010. The inclusion criteria were primary glenohumeral osteoarthritis with B1, B2, B3, or C glenoid. Forty-nine shoulders in 45 patients fulfilled the criteria. Bone grafting was performed in 16 cases. Clinical outcomes were evaluated with the Constant score (CS) and shoulder range of motion.

    RESULTS: The mean total CS increased from 30 preoperatively to 68 points (P < .001) with significant improvements in all the subsections of the CS and range of motion. Scapular notching was observed in 20 shoulders (43%), grade 1 in 5 (11%), grade 2 in 7 (15%), grade 3 in 5 (11%), and grade 4 in 3 (6%). The glenoid bone graft healed in all the shoulders. Partial inferior lysis of the bone graft was present in 8 cases (50%). Scapular notching and glenoid bone graft resorption had no influence on the CS (P = .147 and P = .798).

    CONCLUSION: RSA for the treatment of primary glenohumeral osteoarthritis in patients with posterior glenoid deficiency and humeral subluxation without rotator cuff insufficiency resulted in excellent clinical outcomes at a minimum of 5 years of follow-up.

    Matched MeSH terms: Shoulder Dislocation/complications; Shoulder Dislocation/surgery*; Shoulder Joint/physiopathology; Shoulder Joint/surgery*; Arthroplasty, Replacement, Shoulder/adverse effects; Arthroplasty, Replacement, Shoulder/methods*
  4. Tamadon A, Pons DJ, Clucas D, Sued K
    Materials (Basel), 2019 Oct 01;12(19).
    PMID: 31581446 DOI: 10.3390/ma12193215
    One of the difficulties with bobbin friction stir welding (BFSW) has been the visualisation of microstructure, particularly grain boundaries, and this is especially problematic for materials with fine grain structure, such as AA6082-T6 aluminium as here. Welds of this material were examined using optical microscopy (OM) and electron backscatter diffraction (EBSD). Results show that the grain structures that form depend on a complex set of factors. The motion of the pin and shoulder features transports material around the weld, which induces shear. The shear deformation around the pin is non-uniform with a thermal and strain gradient across the weld, and hence the dynamic recrystallisation (DRX) processes are also variable, giving a range of observed polycrystalline and grain boundary structures. Partial DRX was observed at both hourglass boundaries, and full DRX at mid-stirring zone. The grain boundary mapping showed the formation of low-angle grain boundaries (LAGBs) at regions of high shear as a consequence of thermomechanical nature of the process.
    Matched MeSH terms: Shoulder
  5. Anderson PA, Morgan SL, Kreuger D, Zapalowski C, Tanner B, Jeray KJ, et al.
    J Clin Densitom, 2019 Aug 16.
    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: Shoulder
  6. Lui SK, Koh MM
    Med. J. Malaysia, 2019 Aug;74(4):333-334.
    PMID: 31424044
    Although post-stroke shoulder pain is a common medical complication among the stroke population, pseudotumor deltoideus which is non-malignant is rarely seen. This case report demonstrates a thorough history, physical examination followed by the relevant investigations are essential when managing a common post-stroke complication. We postulate that pseudotumor deltoideus is likely a pre-existing asymptomatic variant in our patient before the stroke and has presented symptomatically after the stroke due to the associated neurological and musculoskeletal impairments. As post-stroke shoulder pain is associated with unfavourable outcomes, it is important to recognise the underlying causes of post-stroke shoulder pain early and institute prompt appropriate treatment.
    Matched MeSH terms: Shoulder; Shoulder Pain
  7. Kwan MK, Chiu CK, Goh SH, Ng SJ, Tan PH, Chian XH, et al.
    Clin Spine Surg, 2019 Jul;32(6):256-262.
    PMID: 30640749 DOI: 10.1097/BSD.0000000000000769
    STUDY DESIGN: Retrospective study.

    OBJECTIVE: This study looked into whether crossbar can reliably measure Upper Instrumend Vertebra (UIV) tilt angle intraoperatively and accurately predict the UIV tilt angle postoperatively and at final follow-up.

    SUMMARY OF BACKGROUND DATA: Postoperative shoulder imbalance is a common cause of poor cosmetic appearance leading to patient dissatisfaction. There were no reports describing the technique or method in measuring the UIV tilt angle intraoperatively. Therefore, this study was designed to look into the reliability and accuracy of the usage of intraoperative crossbar in measuring the UIV tilt angle intraoperatively.

    METHODS: Lenke 1 and 2 Adolescent Idiopathic Scoliosis patients who underwent instrumented Posterior Spinal Fusion using pedicle screw constructs with minimum follow-up of 24 months were recruited for this study. After surgical correction, intraoperative UIV tilt angle was measured using a crossbar. Immediate postoperative and final follow up UIV tilt angle was measured on the standing anteroposterior radiographs.

    RESULTS: A total of 100 patients were included into this study. The reliability of the intraoperative crossbar to measure the optimal UIV tilt angle intraoperatively was determined by repeated measurements by assessors and measurement by different assessors. We found that the intra observer and inter observer reliability was very good with intraclass correlation coefficient values of >0.9. The accuracy of the intraoperative crossbar to measure the optimal UIV tilt angle intraoperatively was determined by comparing this measurement with the postoperative UIV tilt angle. We found that there was no significant difference (P>0.05) between intraoperative, immediate postoperative, and follow-up UIV tilt angle.

    CONCLUSIONS: The crossbar can be used to measure the intraoperative UIV tilt angle consistently and was able to predict the postoperative UIV tilt angle. It was a cheap, simple, reliable, and accurate instrument to measure the intraoperative UIV tilt angle.

    Matched MeSH terms: Shoulder
  8. Dabirrahmani D, Bokor D, Tarento T, Ahmad S, Appleyard R
    J Biomech Eng, 2019 Jun 08.
    PMID: 31175841 DOI: 10.1115/1.4043969
    As the use of glenoid suture anchors in arthroscopic and open reconstruction, for instability after Bankart lesions of the shoulder, increases, an emerging problem has been the incidence of glenoid rim fractures through suture drill holes. Very little is known regarding the effect of the Hill-Sachs lesion on the glenoid's susceptibility to fracture and how drill hole location can further affect this. This study used finite element modelling techniques to investigate the risk of fracture of the glenoid rim in relation to variable sized Hill-Sachs defects impacting on the anterior glenoid edge with suture anchor holes placed in varying positions. The distribution of Von Mises (VM) stresses and the Factor of Safety (FOS) for each of the configurations were calculated. The greatest peak in von Mises (VM) stresses was generated when the glenoid was loaded with a small Hill-Sachs lesion. The VM stresses were lessened and the FOS increased (reducing likelihood of failure) with increasing size of the Hill-Sachs lesion. Placement of the suture drill holes at 2mm from the glenoid rim showed the highest risk of failure; and when combined with a medium sized Hill-Sachs lesion, which matched the central line of the drill holes, a potentially clinically significant configuration was presented. The results of this study are useful in assisting the surgeon in understanding the interaction between the Hill-Sachs lesion size and the placement of suture anchors with the purpose of minimising the risk of subsequent rim fracture with new injury.
    Matched MeSH terms: Shoulder; Shoulder Joint
  9. Abdul Rahim MF, Shaharudin S
    J Taibah Univ Med Sci, 2018 Dec;13(6):572-575.
    PMID: 31435380 DOI: 10.1016/j.jtumed.2018.08.001
    Objectives: This study aimed to determine isokinetic profiles of rotator cuff muscle strength and power in adolescent state-level weightlifters.

    Methods: Nineteen young state-level weightlifters performed concentric strength tests of the upper limbs using an isokinetic dynamometer. Peak torque/body weight was measured for each weightlifter in dominant and non-dominant limbs.

    Results: Peak torque/body weight was significantly different in external rotation (p  0.05). Time to peak torque in external rotation was less in the dominant than in the non-dominant limb. However, opposite results were obtained in external rotation, whereby time to peak torque was longer in the dominant limb compared to the non-dominant limb. Similarly, no significant difference was found between dominant and non-dominant limbs in terms of average power (p > 0.05).

    Conclusions: The findings of this study may help in establishing potential imbalance in variables of muscular contractions between dominant and non-dominant limbs of weightlifters. This may help to maximise performance and minimise potential shoulder injury.

    Matched MeSH terms: Shoulder Joint; Shoulder Injuries
  10. Ganasegeran K, Abdulrahman SA, Al-Dubai SAR, Tham SW, Perumal M
    J Relig Health, 2018 Nov 08.
    PMID: 30406891 DOI: 10.1007/s10943-018-0730-z
    Evidence-based practices that rely upon pain relieving medications and interventional strategies for symptom alleviation in chronic pain survivors have shown modest benefits. The recent emphasis of spiritual care as a new dimension of treatment strategy incorporated within the biopsychosocial model has inspired new hopes to mediate mental and physical health for illness coping. This study aimed to explore the factors associated with spirituality needs among chronic pain patients in a general hospital in Malaysia. An analytical cross-sectional study was conducted among 117 chronic pain patients in a general hospital in Malaysia. Clinical features and assessments were evaluated by an experienced pain physician and retrieved from patient medical records. An interviewer-administered questionnaire that consisted of items on socio-demographics, the validated 19-items spiritual needs questionnaire and the visual analog scale was utilized. Multivariate linear regression analysis was conducted to identify the factors associated with spiritual needs in chronic pain patients. Patients had higher actively giving score as compared to other spirituality need domains. Central neuropathic pain (β = 1.691, p = 0.040) predicted existential. Renal problems (β = 5.061, p = 0.019) highly predicted religiosity; followed by head pain (β = 3.774, p = 0.036), central neuropathic pain (β = 2.730, p = 0.022), heart problems (β = 1.935, p = 0.041), income (β = 0.001, p = 0.003), living arrangement (β = - 3.045, p = 0.022), face (β = - 3.223, p = 0.005) and abdominal (β = - 4.745, p = 0.0001) pains. Predictors of inner peace include renal problems (β = 3.752, p = 0.021), shoulder pain (β = 1.436, p = 0.038) and pain duration (β = - 0.012, p = 0.027). Predictors of actively giving were renal problems (β = 3.803, p = 0.001), central neuropathic pain (β = 1.448, p = 0.017), heart problems (β = 1.004, p = 0.042), income (β = 0.001, p = 0.0001), age (β = - 0.046, p = 0.004) and abdominal pain (β = - 2.617, p = 0.0001). Chronic pain patients had higher actively giving score compared to other spirituality needs. Their spirituality needs were significantly influenced by pain type, duration and site, co-existing medical conditions and socio-demographics.
    Matched MeSH terms: Shoulder Pain
  11. Kongcharoensombat W, Wattananon P
    Malays Orthop J, 2018 Nov;12(3):1-5.
    PMID: 30555639 DOI: 10.5704/MOJ.1811.001
    Introduction: The anterolateral acromion approach of the shoulder is popular for minimally invasive plate osteosynthesis (MIPO) technique. However, there are literatures describing the specific risks of injury of the axillary nerve using this approach. Nevertheless, most of the studies were done with Caucasian cadavers. So, the purpose of this study was to evaluate the risk of iatrogenic axillary nerve injury from using the anterolateral shoulder approach and further investigate the location of the axillary nerve, associated with its location and arm length in the Asian population that have shorter arm length compared to the Caucasian population. Materials and Methods: Seventy-nine shoulders in fourty-two embalmed cadavers were evaluated. The bony landmarks were drawn, and a vertical straight incision was made 5cm from tip of the acromion (anterolateral approach), to the bone. The iatrogenic nerve injury status and the distance between the anterolateral edge of the acromion to the axillary nerve was measured and recorded. Results: In ten of the seventy-nine shoulders, the axillary nerve were iatrogenically injured. The average anterior distance was 6.4cm and the average arm length was 30.2cm. The anterior distance and arm length ratio was 0.2. Conclusion: Our results demonstrated that the recommended safe zone at 5cm from tip of acromion was not suitable with Asian population due to shorter arm length, compared to Caucasian population. The location of axillary nerve could be predicted by 20% of the total arm-length.
    Matched MeSH terms: Shoulder
  12. Chiu CK, Chan CYW, Tan PH, Goh SH, Ng SJ, Chian XH, et al.
    Spine, 2018 Oct 07.
    PMID: 31593064 DOI: 10.1097/BRS.0000000000003275
    STUDY DESIGN: Retrospective study.

    OBJECTIVE: The primary objective of this study was to assess the conformity of the radiological neck and shoulder balance parameters throughout a follow-up period of more than 2 years.

    SUMMARY OF BACKGROUND DATA: Postoperative shoulder and neck imbalance are undesirable features among Adolescent Idiopathic Scoliosis (AIS) patients who underwent Posterior Spinal Fusion (PSF). There are many clinical and radiological parameters used to assess this clinical outcome. However, we do not know whether these radiological parameters conform throughout the entire follow-up period.

    METHODS: This was a retrospective study done in a single academic institution. Inclusion criteria were patients with scoliosis who underwent posterior instrumented spinal fusion with pedicle screw fixation and attended all scheduled follow-ups for at least 24 months postoperatively. Radiological shoulder parameters were measured from both preoperative antero-posterior (AP) and postoperative AP radiographs. Lateral shoulder parameters were: Radiographic Shoulder Height (RSH), Clavicle angle (Cla-A), Clavicle-Rib Intersection Difference (CRID) and Coracoid Height Difference (CHD). Medial shoulder and neck parameters were: T1 tilt and Cervical Axis (CA).

    RESULTS: The radiographs of 50 patients who had surgery done from November 2013 to November 2015 were analyzed. Mean age of this cohort was 16.3 ± 7.0 years. There were 38 (76%) female patients and 12 (24%) male patients. Mean final follow-up was 38.6 ± 5.8 months. When conformity assessment of the radiological parameter using the interclass coefficient correlation (ICC) was done, we found that all parameters had significant correlation (p shoulder and neck balance parameters studied were conformed and suitable to be used to assess the patient postoperatively. Amongst these radiological parameters, T1 tilt followed by CA recorded to be the most reliable parameters over time.

    LEVEL OF EVIDENCE: 4.

    Matched MeSH terms: Shoulder
  13. Labao HC, Faller EM, Bacayo MFD
    Ann Glob Health, 2018 08 31;84(3):474-480.
    PMID: 30835403 DOI: 10.29024/aogh.2331
    BACKGROUND AND PURPOSE: Musculoskeletal disorders (MSDs) are alarmingly high among migrant workers in Malaysia. MSDs are the most prevalent occupational-related conditions in most parts of the world affecting function, productivity and overall health-related quality of life. Therefore, this study aims to determine the profile of Filipino migrant workers in Malaysia and their various musculoskeletal complaints.

    METHOD: This study utilized a quantitative, nonexperimental, cross-sectional research design. A total of 60 subjects were randomly selected after passing the study's sampling criteria. The Nordic Musculoskeletal Questionnaire (NMQ) was to used to determine common MSDs affecting the various regions in the body. The Demographic Pofile Sheet was provided to gather a subject's demographic characteristics.

    RESULTS: Filipino migrant workers mostly complain of pain in the low back area (60%) and shoulder pain (60%), followed by pain in the upper back (48.3%) and neck pain (45%) in the last 12 months. Household workers accounting for 73.3% of the subjects commonly complain of pain in the hips/thighs (78.9%), while workers in the service industry commonly complain of knee pain (39.1%).

    CONCLUSIONS: Results imply that Filipino migrant workers have a higher prevalence of shoulder and lower back pain in the last 12 months. Household workers are more susceptible to hip/thigh pain. Interventions focusing on ergonomics policy implementation, education on posture and lifting techniques and physical function is recommended. Further studies should consider the psychological and psychosocial aspects of migrant employment, which are known risk factors for MSDs.

    Matched MeSH terms: Shoulder; Shoulder Pain
  14. Arinima P, Ishak A
    Korean J Fam Med, 2018 Jul;39(4):266-269.
    PMID: 29972896 DOI: 10.4082/kjfm.17.0117
    A 16-year-old Malay boy presented to Kota Bharu Health Care Centre, Kelantan, with left shoulder pain after sustaining a fall. On further history taking, it was noted that the pain preceded the fall by 1 month. The early changes of osteosarcoma were visible on an X-ray during the initial presentation; however, this was missed by the primary care doctors. Three months later, the patient presented with persistent pain in the left shoulder and was diagnosed with osteosarcoma.
    Matched MeSH terms: Shoulder; Shoulder Pain
  15. Narayanan VL, Balasubramanian N
    Malays Orthop J, 2018 Jul;12(2):20-24.
    PMID: 30112124 DOI: 10.5704/MOJ.1807.004
    Introduction: Proximal humerus fracture fixation using plate osteosynthesis depends on the quality of the bone, design of the fixation devices and intra-operative soft tissue dissection. This study evaluates the functional outcome of minimally invasive percutaneous plate osteosynthesis using locking compression plate in proximal humerus fracture treatment. Materials and Methods: The study was conducted on 30 patients with complex proximal humerus fractures treated by minimally invasive percutaneous plate osteosynthesis using locking compression plate (PHILOS). There were 21 males and 9 females. The average age of our study group was 58.8 years. All the patients were evaluated at six weeks, three months, four months, six months and 12 months following surgery. Results: All patients had fracture union at an average of 13.2 weeks. The mean DASH score at the follow-up was 8.69 (2.5 to 17.16), the average range of flexion was 143.83 degrees (100 to 170 degrees) and abduction was 121.49 degrees (90 to 160 degrees). We had superficial infection in three patients which resolved with a short course of antibiotics. There was excellent outcome in 26 patients, good and fair in two patients each. Conclusion: Proximal humerus fractures treated with minimally invasive percutaneous plate osteosynthesis using locking compression plate with minimal soft tissue dissection, provides good functional outcome and early return of shoulder function.
    Matched MeSH terms: Shoulder; Shoulder Fractures
  16. Ganeshan M, Bujang MA, Soelar SA, Karalasingam SD, Suharjono H, Jeganathan R
    J Obstet Gynaecol India, 2018 Jun;68(3):173-178.
    PMID: 29895995 DOI: 10.1007/s13224-017-1000-9
    Aims: The aim of this study is to compare obstetric outcomes between overweight and class 1 obesity among pregnant women in their first pregnancy based on WHO's BMI cut-offs and the potential public health action points identified by WHO expert consultations specific for high-risk population such as Asians.

    Methods: This is a retrospective cohort review of data obtained from the Malaysian National Obstetrics and Gynaecology Registry between the year 2010 and year 2012. All women in their first pregnancy with a booking BMI in their first trimester were included in this study. The association between BMI classifications as defined by the WHO cut-offs and the potential public health action points identified by WHO expert consultations towards adverse obstetric outcomes was compared.

    Results: A total of 88,837 pregnant women were included in this study. We noted that the risk of adverse obstetric outcomes was significantly higher using the public health action points identified by WHO expert consultations even among the overweight group as the risk of stillbirths was (OR 1.2; 95% CI 1.0,1.4), shoulder dystocia (OR 1.9; 95% CI 1.2,2.9), foetal macrosomia (OR 1.8; 95% CI 1.6,2.0), caesarean section (OR 1.9; 95% CI 1.8,2.0) and assisted conception (OR 1.9; 95% CI 1.6,2.1).

    Conclusion: A specifically lower BMI references based on the potential public health action points for BMI classifications were a more sensitive predictor of adverse obstetric outcomes, and we recommend the use of these references in pregnancy especially among Asian population.

    Matched MeSH terms: Shoulder
  17. Ho W, Lin Seow L, Musawi A
    J Clin Transl Res, 2018 May 28;4(1):70-74.
    PMID: 30873496
    Background: The purpose of the present study was to investigate the effect of different viscosities of polyvinyl siloxane (PVS) impression materials on the accuracy of the stone die produced.

    Methods: A three-unit bridge master model was fabricated using cold-cure acrylic resin. Four combinations of different viscosities of PVS impression materials - regular body (monophase) alone, light body with regular body, light body with heavy body, and light body with putty - were used to make an impression of the master model. Ten impressions from each group were taken and Type IV gypsum stone was used to generate the dies. The dies were measured at the inter-abutment distance, occlusogingival length, and shoulder width with a measuring microscope and were compared with the master model using one-way analysis of variance and Tukey (honest significant difference) test.

    Results: Differences were found for inter-abutment distance between the master model and the light body with regular body and light body with putty dies (both P < 0.02). A difference was found for shoulder width between the master model and the regular body alone die (P = 0.01). No differences were found for occlusogingival distance (all P > 0.08).

    Conclusion: Results suggested inter-abutment distance was most accurate when using a PVS light body combination. Occlusogingival length was accurate using any of the studied PVS combinations, and shoulder width was more accurate when using the regular body PVS.

    Relevance for patients: These results should be considered when choosing the viscosity of the PVS to use for producing impressions of high accuracy and fabricating a well-fitting fixed prosthesis.

    Matched MeSH terms: Shoulder
  18. Bajuri MY, Boon HW
    Malays Orthop J, 2018 Mar;12(1):60-62.
    PMID: 29725518 MyJurnal DOI: 10.5704/MOJ.1803.015
    Bilateral clavicle fractures are not frequently seen. To treat these injuries surgically or non-surgically is still a debatable issue. Implant option for surgical management is also in doubt. We would like to share our experience in treating a patient with bilateral clavicle fracture surgically. He had excellent outcomes in terms of function and radiology. Surgical option for bilateral clavicle fractures promises excellent outcome in terms of early rehabilitation and return in function.
    Matched MeSH terms: Shoulder Fractures
  19. Kurnaz R, Ikizler M, Ozbayburtlu M, Gunes T
    Malays Orthop J, 2018 Mar;12(1):51-53.
    PMID: 29725515 DOI: 10.5704/MOJ.1803.012
    Proximal humerus fracture is a common arm trauma and rarely occurs with vascular injury which however is a serious complication. In this case report, we present a long segment dissection of the axillary and brachial arteries as a rare complication due to fragmented proximal humerus fracture and shoulder dislocation. An 80-year old female patient was seen at the emergency department. Radiograph examination has revealed a fragmented proximal humerus fracture besides dislocation of the head of humerus towards the axillary area. On vascular examination, acute arterial occlusion such as absence of radial and ulnar pulses were observed in her left hand. The patient was immediately taken to the operating room. The dissection included the entire segment approximately 20cm between the distal subclavian artery and the distal brachial artery. This injured segment was removed and a 6mm Polytetrafluroethylene (PTFE) graft with rings was interpositoned between subclavian and brachial arteries. This case is a rarity because of such a significant complication after a small injury. Axillary artery injuries caused by humeral neck fractures are rare but should not be missed by the physician.
    Matched MeSH terms: Shoulder Dislocation; Shoulder Fractures
  20. Rusli R, Haque MM, Saifuzzaman M, King M
    Traffic Inj Prev, 2018;19(7):741-748.
    PMID: 29932734 DOI: 10.1080/15389588.2018.1482537
    OBJECTIVE: Traffic crashes along mountainous highways may lead to injuries and fatalities more often than along highways on plain topography; however, research focusing on the injury outcome of such crashes is relatively scant. The objective of this study was to investigate the factors affecting the likelihood that traffic crashes along rural mountainous highways result in injuries.

    METHOD: This study proposes a combination of decision tree and logistic regression techniques to model crash severity (injury vs. noninjury), because the combined approach allows the specification of nonlinearities and interactions in addition to main effects. Both a scobit model and a random parameters logit model, respectively accounting for an imbalance response variable and unobserved heterogeneities, are tested and compared. The study data set contains a total of 5 years of crash data (2008-2012) on selected mountainous highways in Malaysia. To enrich the data quality, an extensive field survey was conducted to collect detailed information on horizontal alignment, longitudinal grades, cross-section elements, and roadside features. In addition, weather condition data from the meteorology department were merged using the time stamp and proximity measures in AutoCAD-Geolocation.

    RESULTS: The random parameters logit model is found to outperform both the standard logit and scobit models, suggesting the importance of accounting for unobserved heterogeneity in crash severity models. Results suggest that proportion of segment lengths with simple curves, presence of horizontal curves along steep gradients, highway segments with unsealed shoulders, and highway segments with cliffs along both sides are positively associated with injury-producing crashes along rural mountainous highways. Interestingly, crashes during rainy conditions are associated with crashes that are less likely to involve injury. It is also found that the likelihood of injury-producing crashes decreases for rear-end collisions but increases for head-on collisions and crashes involving heavy vehicles. A higher order interaction suggests that single-vehicle crashes involving light and medium-sized vehicles are less severe along straight sections compared to road sections with horizontal curves. One the other hand, crash severity is higher when heavy vehicles are involved in crashes as single vehicles traveling along straight segments of rural mountainous highways.

    CONCLUSION: In addition to unobserved heterogeneity, it is important to account for higher order interactions to have a better understanding of factors that influence crash severity. A proper understanding of these factors will help develop targeted countermeasures to improve road safety along rural mountainous highways.

    Matched MeSH terms: Shoulder
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