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Fulltext Kimura's Disease with Atypical Musculoskeletal Presentation

Hafiz A., Yusuf, A., Rosmaliza, I., Premchandran, N., Kalavathy, R.

Malays Orthop J, 2010;4(2):44-47.
MyJurnal

We would like to highlight an unusual clinical presentation of Kimura's disease, a rare, benign, idiopathic condition, usually seen as swelling and lesions of the head and neck region and commonly affecting young men of Asian descent. It is rare for this disorder to present with lesions on other parts of the body, especially the lower limbs. We report a 27-year-old man who presented with a large mass located at the inguinal region and extending down to the upper thigh. Due to the large size of the mass (28 x 18 cm), our provisional diagnosis was a soft tissue sarcoma. Open biopsy showed that the lesion was benign.
Remodelling of Humeral Fracture in a Child with Osteopetrosis Tarda following Conservative Management - A 7-year Follow-up: A Case Report

Erkus S, Turgut A, Kose O, Kalenderer O

Malays Orthop J, 2019 Jul;13(2):42-44.
PMID: 31467651 DOI: 10.5704/MOJ.1907.008

Osteopetrosis (OP) is a rare hereditary sclerosing bone dysplasia characterised by generalised hard and brittle bone secondary to defective osteoclastic function. Osteopetrotic bone is brittle, thus these subjects are prone to frequent fractures, particularly of the long bones. Due to defective osteoclastic function, remodeling is also defective in OP. This report is a case of humeral fracture in a 9 years old girl who was followed seven years. The fracture had remodeled totally similar to healthy bone at the final follow-up. Conservative treatment should be kept in mind in the management of fractures in children with OP, and fractures within acceptable angulations and/or translations should be treated conservatively without hesitation.
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.
Fulltext A comparison between subvastus and midvastus approaches for staged bilateral total knee arthroplasty:a prospective, randomised study

Masjudin T, Kamari Zh

Malays Orthop J, 2012 Nov;6(3):31-6.
PMID: 25279053 DOI: 10.5704/MOJ.1207.0018

This prospective randomised study was undertaken to compare surgical parameters as well as clinical and radiological outcomes of subvastus (SV) to midvastus (MV) approaches in staged bilateral total knee arthroplasty (TKA). Twenty-three patients, aged 55-76 years, who underwent staged bilateral TKAs, were followed up for 6 months. The SV approach was used on one knee and MV approach on the other. We found similar lateral retinacular release rates and patellar resurfacing rates between the two approaches .The SV approached knees had a more significant blood loss and increased operative time compared to the MV approached knees but they achieved significantly earlier active straightleg raises (SLR) postoperatively (p<0.05 for all). The average postoperative pain, flexion, and Knee Society scores were comparable for both approaches. TKA via SV vs. MV approaches provides comparable satisfactory short-term clinical and radiological outcomes, even though there was slightly more difficulty, more blood loss and longer operative times with the SV approach.
Fulltext A comparison between subvastus and midvastus approaches for staged bilateral total knee arthroplasty: a prospective, randomised study

Masjudin, T., Kamari, Z.H.

Malays Orthop J, 2012;6(2):31-36.
MyJurnal

This prospective randomised study was undertaken to compare surgical parameters as well as clinical and radiological outcomes of subvastus (SV) to midvastus (MV) approaches in staged bilateral total knee arthroplasty (TKA). Twenty-three patients, aged 55–76 years, who underwent staged bilateral TKAs, were followed up for 6 months. The SV approach was used on one knee and MV approach on the other. We found similar lateral retinacular release rates and patellar resurfacing rates between the two approaches .The SV approached knees had a more significant blood loss and increased operative time compared to the MV approached knees but they achieved significantly earlier active straightleg raises (SLR) postoperatively (p
Fulltext A Preliminary Study of Human Amniotic Membrane as a Potential Chondrocyte Carrier

Boo, L., Sofiah, S., Selvaratnam, L., Tai, C.C., Pingguan-Murphy, B., Kamarul, T.

Malays Orthop J, 2009;3(2):16-23.
MyJurnal

Purpose:To investigate the feasibilty of using processed human amniotic membrane (HAM) to support the attachment and proliferation of chondrocytes in vitro which it turn can be utilised as a cell delivery vehicle in tissue engineering applications. Methods: Fresh HAM obtained from patients undergoing routine elective ceasarean sections was harvested., processed and dried using either freez drying (FD) or air drying (AD) methods prior to sterilisation by gamma irradiation. Isolated, processed and characterised rabbit autologous chondrolytes were seeded on processsed HAM and cultured for up to three weeks. Cell attachment and proliferation were examined qualitatively using inverted brightfield microcospy. Results: Processed HAM appeared to allow cell attachment when implanted with chrondocytes. Although cells seeded on AD and FD HAM did not appear to attach as strongly as those seeded on glycerol preserved intact human amniotic membrane, these cells to be proliferated in cell culture conditions. Conclusion: Prelimanary results show that processed HAM chondrocyte attachment and proliferation.
Fulltext Near-miss Thoracic Spine Solitary Plasmacytoma with Neurological Deficit during Pregnancy: A Case Report

Teh KH, Thilak J, Lim HS, Yahaya AA, Kamarul-Bahrin ZA

Malays Orthop J, 2022 Nov;16(3):139-142.
PMID: 36589377 DOI: 10.5704/MOJ.2211.022

Solitary plasmacytoma (SPC) account for only 5% of plasma cell neoplasms, and the literature hardly reports spinal SPC with a neurological deficit. Furthermore, spinal surgical intervention during pregnancy is rarely encountered and often requires multidisciplinary collaboration and management. The objective of this case report is to highlight this near-miss diagnosis and spinal surgical intervention during pregnancy. A 31-year-old woman with 24 weeks gestation presented with sudden paralysis and incontinence, with an underlying history of chronic backpain over a two-month period. Initially, she was treated for musculoskeletal back pain by obstetric colleagues during an antenatal visit, and no radiograph was performed. A non-contrasted spinal MRI was eventually requested when she started to show bilateral lower limb weakness, numbness and incontinence. The MRI highlighted thoracic vertebrae T11 vertebra plana with kyphotic deformity and a paraspinal soft tissue mass compressing the spinal cord causing spinal cord oedema. Our initial working diagnosis was spinal tuberculosis (TB), considering TB is highly endemic in Malaysia. However, TB workup was negative, and we proceeded with spinal surgery and transpedicular biopsy. Neurology improved significantly after surgery. Eventually, serum protein electrophoresis reported plasma dyscrasia, and HPE confirmed plasmacytoma. The patient was referred to a haematologist for steroidal and chemotherapy treatment.
Fulltext Transtubular Transoral Surgery for Excision of a Dystrophic Os Odontoideum: A Case Report

Ariffin MH, Ashfaq MM, Kang E

Malays Orthop J, 2016 Mar;10(1):50-52.
PMID: 28435547 MyJurnal DOI: 10.5704/MOJ.1603.009

Transoral approach to the cervico-medullary junction is a well-established procedure. However oropharyngeal complications in the form of soft tissue morbidity postoperatively do occur. We report a case of a teenage boy with traumatic quadriparesis secondary to compression of the cervico-medullary junction by an os odontoideum. Decompression was done via transoral approach through a tubular retractor system, hence obviating the need for the splitting or separate retraction of the soft palate and minimised the damage and violation of surrounding soft tissues. His neurological status improved and he was able to ambulate with support on fourth post-operative day with no soft tissue morbidity in the oral cavity. To our knowledge this is the first case reported using this technique. We conclude that adoption of this method would improve the traditional transoral approach and reduce the oropharyngeal complications.
Fulltext Unstable Non-isthmic Spondylolisthesis Following Unilateral Biportal Endoscopy Assisted Unilateral Laminotomy for Bilateral Decompression: A Case Report

Son IS, Han SY, Chung HJ, Hong JE, Kang MS

Malays Orthop J, 2021 Nov;15(3):147-151.
PMID: 34966512 DOI: 10.5704/MOJ.2111.025

Lumbar decompressive laminectomy is a standard treatment for degenerative lumbar spinal stenosis, but in some cases, can lead to iatrogenic spondylolysis and delayed segmental instability. Iatrogenic spondylolysis occurs in most cases in pars interarticularis, but rare cases have also been reported, pediculolysis in pedicle and laminolysis in lamina. Minimally invasive spine surgery (MIS) is known to have a low risk of developing these iatrogenic spondylolyses, and unilateral biportal endoscopy is the MIS that has been drawing attention. We present a case of a 72-year-old female who was diagnosed with L4-5 unstable non-isthmic spondylolisthesis and severe right central disc extrusion 10 weeks after UBE assisted unilateral laminotomy for bilateral decompression (ULBD) at the consecutive segments of L3-4 and L4-5. Pre-operative imaging studies revealed severe central stenosis without spondylolisthesis at L3-L4 and L4-L5 along with L4-L5 facet tropism. She was managed by anterior lumbar interbody fusion and cement augmented pedicle screw fixation, which resulted in the complete resolution of her clinical and neurologic symptoms.
Fulltext Olecranon Osteotomy Approach for Complex AO-13C Fractures of Distal Humerus: A Prospective Analysis of 24 Cases

Singh R, Singh H, Kanodia N

Malays Orthop J, 2019 Mar;13(1):30-35.
PMID: 31001381 DOI: 10.5704/MOJ.1903.005

Introduction: Olecranon osteotomy is well described approach for complex intra-articular distal humeral fractures. In this study, we investigated the usefulness and complications of olecranon osteotomy approach for such fractures. We hypothesise that outcome is comparable in young adults and middle age group and also functional outcome is independent of fracture subtype following surgical fixation. Materials and Methods: Between December 2012 and September 2015, twenty-four adult patients (male: 15, female: 9) having mean age of 41.4 years with closed intra-articular fracture (AO-13C) were surgically managed using olecranon osteotomy approach and were followed-up for a mean of 28.5 months (range: 22-35 months). Functional outcome was measured using Mayo Elbow Performance Score (MEPS) and complications were observed. Statistical analysis was done using Student t-test and Kruskal Wallis test. Results: All fractures united by the end of three months. Mean elbow flexion achieved was 123°, mean extension lag was 9° and mean active arc of motion was 114°. Mean MEPS was 87 (excellent: 8, good: 14, fair: 1 and poor: 1). Post-operative transient ulnar nerve palsy was noted in two cases, heterotopic ossification (HO) was in one case, infection in two cases, implant prominence in five and elbow stiffness in three cases. Motion arc was higher in young adults and MEPS was comparable in both age group. Functional outcome was also dependent on fracture subtype. Conclusion: The olecranon osteotomy approach for distal humerus fractures had good functional outcome with fewer complications. Joint congruity and fixation could easily be assessed intraoperatively.
Fulltext Influence of Infraspinatus and Subscapularis Pathologies on Supraspinatus Muscle Atrophy - A Retrospective Cohort Study

Altan E, Nayman A, Yildirim A, Ozbaydar MU, Ciftci S, Karahan M

Malays Orthop J, 2020 Jul;14(2):23-27.
PMID: 32983374 DOI: 10.5704/MOJ.2007.007

Introduction: Many factors could affect the supraspinatus (SSP) muscle after tendon rupture. We aimed to determine how infraspinatus and subscapularis tendon problems affect supraspinatus muscle atrophy associated with tears, in a retrospective cohort study conducted in a tertiary-level centre.
Material and Methods: Fifty-eight patients with a full-thickness SSP tendon tear who fulfilled the inclusion criteria were enrolled in the study. They were evaluated for tear retraction, fatty degeneration, and other rotator cuff tendon pathologies. Supraspinatus muscle was assessed using the Goutallier classification, and its average area was also measured. Accompanying lesions of the subscapularis and infraspinatus tendons and degree of supraspinatus muscle atrophy were evaluated using magnetic resonance imaging.
Results: Our results showed that supraspinatus tendon tears ranged between 3mm and 41mm, and the estimated average cross-sectional area of the SSP muscle was 247.6mm2. Any degree of infraspinatus tendon pathology, ranging from tendinosis to full-thickness tears, was significantly correlated with the SSP muscle area (P < 0.05). The subscapularis tendon pathologies did not show a similar correlation. The interobserver and intraobserver reliabilities of the measurements were graded as excellent.
Conclusion: Impairment of any of the rotator cuff muscles may affect the other muscles inversely. Our study showed that all infraspinatus tendon pathologies and partial subscapularis tears affect and alter the SSP muscle belly. We suggest early intervention for supraspinatus tears to avoid further fatty degeneration, as muscle atrophy and fatty degeneration progress in combination with the accompanying lesions.
Fulltext Management of osteonecrosis of the hip complicated with fracture: a case report

Chua Y, Wazir N, Chiu C, Kareem B

Malays Orthop J, 2012 Jun;6(SupplA):43-5.
PMID: 25279075 MyJurnal DOI: 10.5704/MOJ.1211.011

A 47-year-old gentleman, with underlying seborrhoeic dermatitis that was treated with steroid therapy, and hepatitis B, presented with pain in his right hip. He was diagnosed with stage 2 osteonecrosis of the right hip (Ficat and Arlet classification). Core decompression and bone grafting was performed but recovery was complicated by a surgical site infection. Wound debridement, removal of bone graft and clearance of the bone tunnel were carried out. The patient was allowed to bear weight after surgery. Twelve days later, he developed right hip pain and radiographs showed fractured femur neck; the patient then underwent a two-stage total hip replacement (THR).
Fulltext Inferior Healing Rate in Isolated Meniscal Repair than that in Meniscal Repair with Concomitant ACL Reconstruction Evaluated with MRI

Isono M, Koga H, Nakagawa Y, Nakamura T, Sekiya I, Katagiri H

Malays Orthop J, 2023 Mar;17(1):61-69.
PMID: 37064625 DOI: 10.5704/MOJ.2303.008

INTRODUCTION: Isolated meniscal repair has been suggested as one of the contributing factors in unhealed meniscal repair. The purpose of this study was to compare the healing rate between isolated meniscal repair and meniscal repair with concomitant anterior cruciate ligament reconstruction (ACLR) using a standardised assessment method after propensity score matching.
MATERIALS AND METHODS: Accuracy of the Crues' grading system for meniscal healing was validated using second-look arthroscopy as the reference standard in 17 patients. Propensity score matching (one-to-one) was performed between 26 patients who underwent isolated meniscal repair and 98 patients who underwent meniscal repair with concomitant ACLR. Patients were matched for sex, age, side and zone of the meniscal repair, and number of sutures. Healing rates at one year which were evaluated with magnetic resonance imaging (MRI) were compared between the two groups.
RESULTS: The sensitivity and specificity of the Crues' grading system on multiple plane MRI for meniscal healing were 100% and 83.3%, respectively. Both the isolated meniscal repair group and the meniscal repair with concomitant ACLR group included 21 patients after propensity score matching. Baseline characteristics did not differ significantly between the two groups. The healing rate was significantly lower in the isolated meniscal repairs group (14.3%) than in the meniscal repair concomitant with ACLR group (47.6%, P=0.04).
CONCLUSION: The healing rate for isolated meniscal repair using a standardised MRI assessment method was inferior to that of meniscal repair with concomitant ACLR after propensity score matching.
Retrospective Comparative Analysis of Clinical and Functional Outcome After Arthroscopic Bankart Repair using All-Suture Anchor and Metal Anchor

Jain V, Gupta H, Mehta N, Joshi D, Ajay, Kataria H

Malays Orthop J, 2024 Mar;18(1):11-18.
PMID: 38638665 DOI: 10.5704/MOJ.2403.002

INTRODUCTION: Both knotted all suture anchors and metal anchors are used for arthroscopic Bankart repair. We retrospectively evaluated and compared clinical and functional outcomes after arthroscopic Bankart repair using the knotted all-suture anchors and knotted metal anchors.
MATERIALS AND METHODS: In a retrospective cohort analysis, patients who underwent arthroscopic Bankart repair without any concomitant additional lesion repair using either all-suture anchors or metal anchors, between January 2015 and May 2018 were identified. Their pre- and post-operative functional and clinical outcomes were compared using Rowe and WOSI scores. The recurrence rate in the two groups was also compared.
RESULTS: A total of 41 patients in all suture anchors group and 47 in the metal anchors group were identified as per inclusion and exclusion criteria. The demographic profile of both groups was comparable. There was no significant difference in clinical and functional outcome between the two suture anchor groups as per Rowe (pre-operative 40.13+6.51 vs 38.09+6.24 and post-operative 2 years 93.28+7.09 vs 92.55+9.2) and WOSI (pre-operative 943.05+216.64 vs 977.55+165.46 and post-operative 2 years 278.21+227.56 vs 270.94+186.25) scores. There was a significant improvement in both the groups between preoperative and post-operative ROWE and WOSI scores at 6 months and 2 years follow-up as compared to pre-operative scores (p<0.001). Re-dislocation rates were also comparable (4.8% vs 6.3%).
CONCLUSION: All-suture anchors showed comparable clinical and functional results as the metal anchors for arthroscopic Bankart repair at two-year follow-up.
Fulltext Surgical Fixation of a Comminuted Inter-Trochanteric Fracture in a Patient with Bilateral Below Knee Amputation

Lee BH, Ho SW, Kau CY

Malays Orthop J, 2018 Mar;12(1):54-56.
PMID: 29725516 DOI: 10.5704/MOJ.1803.013

Surgical fixation of hip fractures in patients with below knee amputation is challenging due to the difficulty in obtaining optimal traction for reduction of the fracture. Surgeons may face difficulty in positioning such patients on the traction table due to the absence of the foot and distal lower limb. There are several techniques described to overcome this technical difficulty. In this case report, we present a case of a 64-year old gentleman with bilateral below knee amputation presenting with a comminuted right intertrochanteric fracture. We highlight a simple and effective method of applying skin traction to obtain adequate reduction for hip fracture fixation.
Fulltext Giant Cell Tumour Around Knee Managed by Curettage and Zoledronic Acid with Structural Support by Fibula Cortical Struts

Singaravadivelu V, Kavinkumar V

Malays Orthop J, 2020 Nov;14(3):42-49.
PMID: 33403061 DOI: 10.5704/MOJ.2011.008

Introduction: Giant cell tumour (GCT) of the bone is a benign tumour with a high tendency to recur after surgery. This study aimed to analyse prospectively the rate of local recurrence following management of giant cell tumours by curettage, using intravenous zoledronic acid as an adjuvant, and fibular struts to support the empty cavity after curettage.
Materials and Methods: This study was carried out in ten cases of biopsy-proven GCTs: five males and five females, in the age group between 18 and 39 years. All patients were given three doses of zoledronic acid, one pre-operative and two post-operative. Extended curettage was done three weeks after the pre-operative dose of zoledronate. The cavity was left empty in all the cases. Fibular struts were used to support the cavity from collapse. Patients were followed-up for post-operative local recurrence. The functional status of the patients was assessed during each visit using the Musculoskeletal Tumour Society (MSTS) score.
Results: There were no recurrences at a follow-up of two years. All patients had a stable knee and were able to bear weight fully. The average knee flexion was 75º. The average MSTS score of the study was 92%.
Conclusion: Extended curettage using hydrogen peroxide, systemic zoledronic acid adjuvant and leaving the cavity empty without using cancellous bone graft did not lead to a recurrence of GCT. Non-vascularised fibular strut provided adequate support while the cavity left empty after curettage did not collapse and there was good knee function.
Fulltext The Use of Dual Reconstruction Plates for Failed Fixation of Patellar Fracture after Total Knee Replacement: A Case Report

Sa-Ngasoongsong P, Chulsomlee K, Wongsak S, Suphachatwong C, Kawinwonggowit V

Malays Orthop J, 2016 Nov;10(3):52-55.
PMID: 28553451 DOI: 10.5704/MOJ.1611.012

Patellar fracture after total knee replacement (TKR) is one of the challenging problems in periprosthetic fracture. Open reduction with internal fixation (ORIF), as tension band wiring (TBW), usually required in cases with extensor mechanism disruption. However, many studies reported a high failure rate after using this technique. In this report, we presented an interesting case of periprosthetic patellar fracture after TKR with TBW failure that was successfully treated with double non-locking reconstruction plates fixation and TBW augmentation.
Fulltext A survey on common injuries in recreational badminton players

Muttalib, A., Zaidi, M., Khoo, C.

Malays Orthop J, 2009;3(2):8-11.
MyJurnal

The aim of this descriotive study is to determine the incidence of injuries among recreational badminton players. We evaluated 86 recreational badminton players in the city of Malacca; 35 were excluded for fitting the exclusion criteria. The average recreational badminton player was 36.13 years old and had been playing badminton for the past 17.84 years at a frequency of 2.11 times per week. 39.21% of the recreational badminton players complained of recent injuries in relation to playing badminton. Our data showed that the most common injury sustained by recreational badminton players was pain and stiffness at the shoulder joint. None of the injuries sustained by the players in our data were serious enough to warrant any form of surgical intervention. We conclude that badminton is a sport of relatively low risk and that the majority of related injuries were chronic overuse injuries.
Fulltext Necrotizing Fasciitis of the Lower Limb: A Prospective Study of Prognostic Factors Affecting Mortality

Chee, E.K., Kwan, M.K., Khoo, E.H.

Malays Orthop J, 2009;3(1):32-35.
MyJurnal

Necrotizing fasciitis is a life and limb threatening soft tissue infection with a high mortality rate. This study tries to identify the possible risk factors that contribute to mortality in patients with necrotizing fasciitis involving a lower limb. We prospectively reviewed 41 patients that presented with necrotizing fasciitis of the lower limb over a period of one year. Results show that the mortality rate for necrotizing fasciitis of the lower limb is quite high at 19.5%. Comparison among necrotizing fasciitis patients reveals that higher mortality rate is seen among those patients with advanced age and those presented with initial high pre-operative creatinine levels. Sex, pre-morbid diabetes mellitus, duration from initial symptoms to presentation for treatment and presence of streptococcus group A were not associated with an increased mortality rate. Neither were admission vital signs, subcutaneous gas on radiograph, prior antibiotic treatment on admission or clinical note of bullae formation.
Fulltext Bilateral traumatic hip dislocation in a child: a case report

Khoo, S,M.

Malays Orthop J, 2007;1(2):17-20.
MyJurnal

Traumatic hip dislocation in children is uncommon; when this condition is diagnosed in paediatric patients, it is most frequently seen as a unilateral posterior dislocation and is rarely associated with fracture. We report here a case involving a young girl who dislocated both hips in two separate incidents.

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