MyMedR

Fulltext A Novel Technique for Fixation of Non-union Unicondylar Hoffa's Fracture: A Case Report

Harna B, Dutt DD, Sabat D

Malays Orthop J, 2020 Nov;14(3):174-176.

PMID: 33403081 DOI: 10.5704/MOJ.2011.028

Hoffa fractures are rare and difficult fractures to manage. Hoffa fracture involves a coronal plane fracture of posterior femoral condyle. Non-union in Hoffa fracture is further difficult to manage. The surgical management for such nonunion includes open reduction with recon/LCP plate or screw fixation with bone grafting. The problem with plates is the difficulty in contouring the plates according to the shape of posterior femoral condyles. We describe a new technique with 2 L shaped neutralisation plates placed in a circular fashion. This technique provides a more rigid construct and gives better holding strength of screws in Hoffa fragment. This enhances union and mobilisation can be started early.

Fulltext A Palmar Lipoma with Median and Ulnar Nerve Compressive Symptoms

Azwa, N., Shalimar, A., Jamari, S.

Malays Orthop J, 2007;1(2):33-35.

MyJurnal

Although lipoma is common in the upper limbs, it rarely occurs in the palm, and usually does not compress the surrounding structures. Here, we report a patient presenting with compressive neuropathy of the ulna and median nerves secondary to a palmar lipoma. Surgical excision led to full neurological recovery.

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 A Prospective Observational Clinical and Radiological Study of a Modular Bridging External Fixator for Unstable Distal Radius Fractures

Maccagnano G, Noia G, Vicenti G, Coviello M, Pesce V, Moretti B

Malays Orthop J, 2021 Nov;15(3):108-114.

PMID: 34966503 DOI: 10.5704/MOJ.2111.016

Introduction: Distal Radius Fractures (DRFs), with a reported annual incidence of 600,000, are common injuries treated by trauma surgeons. This prospective observational study aims to assess the efficacy of a modular external fixation system in the treatment of unstable distal radius fractures at 12-months follow-up.

Materials and methods: Between December 2014 and December 2016, 35 patients (female: 21, male:14; mean age: 62.5), with unstable DRFs, treated with modular external fixation system, were selected for this prospective observational study. All the patients underwent clinical and radiological reviews at follow-up.

Results: At 12-month follow-up, a mean DASH score of 15.73 and a mean PRWE score 20.10 were recorded. Mean radial inclination was 19.92°; mean ulnar variance was 1.12 mm and mean palmar inclination was 9.76°.

Conclusion: Modular external fixator system revealed clinically and radiologically effective in the treatment of unstable and comminuted DRFs. Additional K-wires should be used to complement the fracture fixation, when there is unacceptable fragment reduction only with external fixator.

A Randomised Controlled Trial Comparing Ketamine versus Fentanyl for Procedural Sedation in the Emergency Department for Adults with Isolated Extremity Injury

Srinivasarangan M, Jagadeesh S, Bheemanna A, Sivasankar A, Patil A, Basavaraju B, et al.

Malays Orthop J, 2024 Mar;18(1):116-124.

PMID: 38638669 DOI: 10.5704/MOJ.2403.015

INTRODUCTION: Alleviating pain and anxiety of patients during procedures is an essential skill for an Emergency Physician (EP). Several sedatives and dissociative agents are used for PSA (Procedural Sedation and Analgesia). In this study, we aimed to compare two drugs that is, ketamine and fentanyl for procedural sedation in adults with isolated limb injuries in the Emergency Department (ED).

MATERIALS AND METHODS: In this prospective, randomised controlled interventional trial, patients aged between 18 to 65 years with isolated extremity injury requiring PSA in the ED were recruited. A total of 200 subjects were included in the study and randomly allocated to either the fentanyl (n=100) or the ketamine (n=100) group. Patients were blinded to the intervention and subsequently premedicated with Midazolam. Following this, they received either ketamine or fentanyl based on the group they were allocated to. Vital signs, including but not limited to the level of sedation, were measured at predetermined time intervals. A Modified Aldrete Score of >8 was used as a criterion for disposition from the ED. Data were collected in a pre-designed proforma. We aimed to compare the effectiveness as well as ascertain the safety profile of the two drugs for PSA in the ED.

RESULTS: There was no significant difference between the two groups when age, gender, mechanism of injury and comorbidities were compared. We found that there was no statistically significant difference between the two groups when blood pressure, respiratory rate and depth of sedation were compared. In both groups, there was a significant decrease in pain on the Numerical Rating Scale (NRS) following drug administration from 8 to 3 (p<0.001). Patients in the fentanyl group had an increased incidence of transient oxygen desaturation (p<0.001). Vomiting was more common in the ketamine group (p<0.001).

CONCLUSION: PSA is a safe and efficacious procedure for patients undergoing painful procedures in ED. Patients in both the groups maintained hemodynamic stability throughout the procedure. From our study, we were able to conclude that both ketamine and fentanyl are similar in efficacy for PSA in the ED for adults with isolated limb injuries. In addition, no significant cardiovascular adverse events were noted in either group in our study.

A Rare Case of Giant Cell Tumour of Bilateral Achilles Tendon Sheath - Reconstruction with Dual Tendon Transfer: A Case Report

Samal P, Mohapatra NC, Mishra J, Mylarappa A, Das P

Malays Orthop J, 2020 Mar;14(1):84-87.

PMID: 32296488 DOI: 10.5704/MOJ.2003.014

Giant cell tumour of tendon sheath is a benign soft tissue lesion most commonly found in the flexor aspect of hand and wrist. However, it is uncommon in foot and ankle and rare in bilateral achilles tendon. We report a case of 17-year-old female who presented with progressive enlargement of bilateral achilles tendon for six months. MRI findings showed that most of the tumour had intermediate to low signal intensity. Histopathology confirmed the diagnosis of giant cell tumour of tendon sheath. To help the patient regain the strength of the achilles tendon and walking abilities, a large area of tendon tumour was excised, followed by reconstruction with transfer of the peroneus brevis (PB) and posterior tibial (PT) tendon autograft. At two years follow-up, functional result was satisfactory.

A Rare Case of a Distal Humerus Pathological Fracture from Klebsiella Pneumoniae Osteomyelitis: A Case Report

Chan MF, Kwek E

Malays Orthop J, 2020 Mar;14(1):81-83.

PMID: 32296487 DOI: 10.5704/MOJ.2003.013

Klebsiella pneumoniae is one of the leading causative organisms in pyogenic liver disease. It can cause disseminated infections, but rarely to bone, and rarely in healthy hosts. We report an unusual case of a distal humerus fracture from osteomyelitis secondary to dissemination in a non-immuno-compromised patient. The patient was surgically managed with external fixation and insertion of anti-biotic beads, in conjunction with medical therapy via culture direct antibiotics. This report highlights the diagnostic approach and treatment options for these atypical cases.

Fulltext A Rare Incidence of Breakage of tip of Micropituitary Forceps during Percutaneous Discectomy - How to Remove it: A Case Report

Sureisen M, Tan BB, Teo YY, Wong CC

Malays Orthop J, 2015 Nov;9(3):58-60.

PMID: 28611913 MyJurnal DOI: 10.5704/MOJ.1511.009

Breakage of the tip of the micropituitary forceps during spine surgery is a rare occurrence. Retrieval of the broken tip could be a challenge in minimally invasive surgeries due to limitation of access and retrieval instruments. We describe our experience in handling such a situation during percutaneous radiofrequency discectomy. The removal was attempted, without converting into open surgery, by utilising percutaneous endoscopic lumbar discectomy working cannula and guided by image intensifier. We were able to remove the fragment without any significant morbidity to the patient. This technique for removal has not been reported previously in the literature.

Fulltext A Rare Infection Following Snakebite

Cheong, C.Y., Lee, C.K., Zuki Z.

Malays Orthop J, 2010;4(1):-.

MyJurnal

Snakebite is very common especially in Asia. We report a rare case of Providencia rettgeri infection following snakebite on the foot. This patient was treated with early and aggressive wound debridement, daily wound dressing during hospitalization and then skin coverage with split skin graft. No anti-venom was given administered. Appropriate intravenous antibiotics were given to the patient while hospitalized and oral antibiotic were prescribed upon discharge. The outcome of this treatment was successful.

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 Review of Surgically Treated Distal Radius Fractures in a University Hospital

Bahar-Moni AS, Wong SK, Mohd-Shariff N, Sapuan J, Abdullah S

Malays Orthop J, 2021 Nov;15(3):52-57.

PMID: 34966495 DOI: 10.5704/MOJ.2111.008

Introduction: Distal radius fracture (DRF) is the most common orthopaedic injury with a reported incidence of 17.5%. It is commonly seen in young males and elderly females. Over the last two decades, there is an increasing tendency to treat DRF surgically by open reduction and internal fixation (ORIF) with plate and screws owing to improved device design, better fixation and operative technique. The purpose of this study was to evaluate the demographic characteristics, type and method of fixation, and outcome in all surgically treated DRF cases from 2014 to 2018 in a university hospital.

Materials and methods: A retrospective review of all surgically treated DRF cases with one year follow-up in a tertiary hospital in Malaysia was done. Patients who left the follow-up clinic before one-year post-surgery or before fracture union were excluded. A total of 82 patients with 88 DRF were finally included into the study and outcome in terms of union time and need of multiple surgeries were analysed along with the predictors.

Results: In this study, mean age of the patient was 46.2 years. Motor vehicle accident was the commonest cause of the fracture and AO Type C fracture was the commonest fracture type. Seventeen (19.3%) out of 88 fractures were compound fracture. Open reduction and internal fixation with volar plate was the most common surgical technique done in this series (93.2%). Three (3.5%) out of 88 fractures required multiple surgeries and eighty-three (94.3%) DRF cases were united before nine months of the surgery in this study. There was statistically significant association between clinical type of the fracture and the union time (p-value <0.05).

Conclusion: There was a 1.7:1 male-female ratio with AO-C fracture being the most common type of fracture. The most common method of fixation was ORIF with volar locked plate. Patients with closed fractures have a higher rate of union compared to open fractures at nine months.

A Safe Technique to Remove the Hip Spica

Mazelan A, Lam A, Albaker M

Malays Orthop J, 2020 Mar;14(1):102-103.

PMID: 32296494 DOI: 10.5704/MOJ.2003.020

A Simple Cable Method for Intraoperative Limb Alignment Assessment

Chan CK, Shanmugam R

Malays Orthop J, 2016 Mar;10(1):69-70.

PMID: 28435552

Fulltext A Simple External Fixator Construct for Assessment of Intra-operative Hip-Knee-Ankle Axis Alignment in Lower Limb Deformity Correction Surgery

Verma T, Chavali VH

Malays Orthop J, 2020 Jul;14(2):149-150.

PMID: 32983393 DOI: 10.5704/MOJ.2007.004

A Single Posterolateral Scapular Approach to Drain Post-Traumatic Intramuscular Scapular and Axillary Abscess in an Adolescent: A Case Report

Khaw YC, Faisham WI

Malays Orthop J, 2019 Jul;13(2):56-58.

PMID: 31467655 DOI: 10.5704/MOJ.1907.012

Scapular abscess is a rare clinical diagnosis. This is a report of an atypical case of extensive intramuscular scapular abscess involving the anterior and posterior aspects of the scapula with extension into the axillary region following minor trauma in a young healthy adolescent, describing a single posterolateral approach to the scapula to evacuate the abscess. Following surgical drainage and antibiotic treatment, patient recovered without any complication.

Fulltext A Study on the Absence of Palmaris Longus in a Multiracial Population

Roohi, S.A., Choon-Sian, L, Shalimar, A., Tan,G.H., Naicker, A.S.

Malays Orthop J, 2007;1(1):26-28.

MyJurnal

Palmaris longus is a dispensable muscle with a long tendon which is very useful in reconstructive surgery. It is absent 2.8 to 24% of the population depending on the race/ethnicity studied. Four hundred and fifty healthy subjects (equally distributed among Malaysia's 3 major ethnic groups) were clinically examined for the presence or absence of palmaris longus. This tendon was found to be absent unilaterally in 6.4% of study subjects, and bilaterally in 2.9% of study participants. Malays have a high prevalence of palmaris longus absence at 11.3% followed closely by Indians at 10.7% whilst Chinese had a low absence rate of 6.0%.

Fulltext A Technique for Removal of Forearm Dynamic Compression Plate with Stripped Screws: A Report of Three Cases

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.

Fulltext A biomechanical comparison between Taylor’s spatial frame and ilizarov external fixator

Tan, B. B., Shanmugam, R., Chua, Y. P., Hossain, G., Saw, A.

Malays Orthop J, 2014;8(2):35-39.

MyJurnal

Taylor’s spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF.

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 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.

Displaying publications 21 - 40 of 597 in total