Displaying publications 21 - 40 of 105 in total

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  1. 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
  2. Saad-Ilyas M, Zehra U, Khan UU, Mohammad I, Muhammad R, Aziz A
    Malays Orthop J, 2021 Mar;15(1):72-78.
    PMID: 33880151 DOI: 10.5704/MOJ.2103.011
    Introduction: The study aimed to target the current practices of the orthopaedic community in outpatient (OPD), emergency (ER) and surgical services (OT) during COVID-19.

    Material and method: This study surveyed 303 orthopaedic surgeons from all over Pakistan. The survey had 30 questions targeting the setup of outpatient, emergency and operation services in orthopaedic departments of different hospitals in Pakistan.

    Result: A total of 302 surgeons were included from 53 cities all over Pakistan. Between 35-48% of the respondents reported lack of availability of standard operating procedures in OPD, ER and in OT. Majority of the respondents noted that their OPD and surgical practice had been affected to some degree and 69% of the surgeons were only doing trauma surgery. This trend was higher in younger consultants of less than 45 years of age (p<0.001). Almost two-third of the surgeons, mostly senior (p=0.03) were using surgical masks as the only protective measure during various practices of OPD, ER and OT, while most of the setups were not assessing patients even for signs and symptoms of COVID. Almost 89% of the orthopaedic community is facing definite to mild stress during this pandemic and this has significantly affected the senior surgeons (p=0.01).

    Conclusion: Our study highlighted that COVID-19 has resulted in marked changes to the practices of the majority of Pakistani orthopaedic surgeons. Despite a sharp upsurge in the number of cases and mortality due to COVID-19, guidelines were still lacking at most of the settings and a substantial percentage of the orthopaedic community were not following adequate safety measures while attending to patients.

    Matched MeSH terms: Orthopedics
  3. Jain VK, Upadhyaya GK, Iyengar KP, Patralekh MK, Lal H, Vaishya R
    Malays Orthop J, 2021 Mar;15(1):55-62.
    PMID: 33880149 DOI: 10.5704/MOJ.2103.009
    Introduction: The social lockdown measures imposed to contain the COVID-19 pandemic, have had profound effects on the healthcare systems across the world and India has been no exception to it. The study was aimed to evaluate the impact of COVID-19 on orthopaedic practice in India during the lockdown period and assess the preparedness of orthopaedic surgeons for resuming clinical practice after the initial lockdown was lifted.

    Materials and Methods: An online survey of 35 questions was conducted to evaluate impact on (i) general orthopaedic practice (ii) hospital protocols (iii) out-patient practice (iv) surgical practice (v) personal protective equipment (PPE) use and (vi) post-lockdown preparedness.

    Results: A total number of 588 practising orthopaedic surgeons from India completed the survey. Majority (88.3%) found severe impact (>50%) on trauma surgery and non-trauma surgery with significant reduction in out -patient attendance compared to corresponding time in 2019. There were significant changes made in individual hospital protocols (91.7 %). Appropriate required PPE was available in majority of the hospitals (74.3%). No remodelling or upgrading of the existing operating theatre infrastructure was done by most surgeons (89.5%).

    Conclusion: This pan India survey of orthopaedic surgeons has indicated that COVID-19 has had a profound impact on their outpatient and surgical trauma and non-trauma practice, due to the lockdown and resulted in significant changes to hospital protocols. Preparedness to resume clinical and surgical practice was associated with anxiety in two-thirds of the respondents. Majority of the orthopaedic practitioners felt that they would continue to conduct pre-operative COVID-19 screening and use PPE even after the lockdown is over.

    Matched MeSH terms: Orthopedics
  4. Muhammad Hanif Ramlee
    MyJurnal
    Most orthopaedic cases that involved with bone fracture are normally treated with medical implants. To be noticed that some precautions in terms of biomechanical and biomaterial properties are necessary for a successful post-sur- gery process. The biomechanical evaluation of implants could be carried out using computing and engineering technologies. However, in the computer simulation, some assumptions are needed as the limitations on computer resources and data input. This review focuses on the current method of developing the finite element model for patients with specific values of material properties for lower limb part such as hip, knee and ankle joint. Previous literature was reviewed from which keywords and search engines were identified. In this review, inclusion and exclusion criteria were used to limit the literature search. We reviewed the state-of-the-art in this area and provide recommendations for future research. In conclusion, the previous published reports illustrated different methods to develop numerical models.
    Matched MeSH terms: Orthopedics
  5. Adlin Dasima, A.K., Karis, M.
    MyJurnal
    Ambulatory surgery has now becoming increasingly popular and it is generally well accepted. Major complications following ambulatory surgery are very rare but certain postoperative symptoms can be very unpleasant and distressing to the patients. Follow-up phone calls regarding their well being at home following the surgery may give us the clue and allow us to identify certain problems that can be sorted out immediately or as a reference for a better service in future. The present study was carried out to determine the prevalence of common postoperative symptoms and their subsequent effects within 24 hours after ambulatory surgery by follow-up phone calls. We prospectively studied 199 ASA I and II patients, but only 187 patients were analyzed. Patients had undergone general surgery, orthopaedic, urology, gynaecology or ear, nose and throat (ENT) surgery. Pain was scored based on Numerical Rating Scale (NRS). Majority of patients (70.8%) had only mild pain prior to discharge home. At 24 hours postoperatively, pain was the commonest symptom reported (92.5%) followed by sleepiness (72.2%), dizziness (49.7%), sore throat (17.1%), nausea and vomiting (7.5%) and headache (7%). Sleep was mildly affected in nearly 50% of the patients. Fifty seven percent of patients did not need assistance in performing daily activities during the 24 hours, post surgery. Majority of patients were satisfied (81.3%) with ambulatory surgery. In conclusion, pain was the commonest postoperative symptom encountered following the surgery. Sleep was mildly affected by the postoperative symptoms. Most of the patients did not need assistance in performing their daily activities following surgery. All patients were able to return to at least more than 50% of their normal daily activities at 24 hours after the surgery. Overall satisfaction towards ambulatory surgery was good.
    Matched MeSH terms: Orthopedics
  6. Ong, T.K., Chee, E.K., Wong, C.L., Thevarajan, K.
    Malays Orthop J, 2008;2(2):40-42.
    MyJurnal
    In comminuted patellar fractures, a combination of cerclage wiring and tension band fixation is said to provide good mechanical stability. This is a retrospective review of four patients treated with this method. All fractures described herein were classified as 45-C3 (based on Orthopaedic Trauma Association classification) and were fixed with a 1.25mm cerclage wire and tension band wire proximally looped through the quadriceps tendon and distally through the patellar ligament in a figure-of-eight configuration. The average follow-up period was 10 months. The Activity of Daily Living Scale (ADLS) of the Knee Outcome Survey was used to assess symptoms and functional capability of the knee. In all the cases, fracture union was achieved at an average of 11 weeks. The average ADLS score was good (92.5 %). Full range of knee motion was achieved by end of the third postoperative month. None of the patients had complications, such as infection and implant failure.
    Matched MeSH terms: Orthopedics
  7. Obaid, Kadhim Jawad, Sood, Suneet
    Medical Health Reviews, 2009;2009(1):59-73.
    MyJurnal
    Robotic surgery is a technique that uses mechanical, computercontrolled arms to conduct surgical operations. It carries the advantages of minimal access associated with laparoscopic surgery, and of precision associated with open surgery. It is also feasible to conduct robotic surgery with the surgeon far away, by “telerobotics”. The robot is more versatile than the human arm, and less susceptible to tremors. The view is excellent, and it is possible to conduct more intricate procedures than are possible with the human hand. Robotics has been in use for over seven years, and the initial experience shows that the success rate is over 90%, with only about 10% of cases needing to be converted to open surgery. Blood loss is low, and tumour margins in cancer surgery are satisfactory. Surgeons have used robotics for procedures in urology, gastrointestinal surgery, gynecology, cardiac surgery, neurosurgery, orthopedics, and other specialties. Presently, robotics suffers from two major disadvantages: one, that it is very expensive, and two, that robotic procedures take significantly longer than do open or laparoscopic procedures.
    Matched MeSH terms: Orthopedics
  8. 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
  9. Rahimawati N, Roohi SA, Naicker AS, Zanariah O
    Malays Orthop J, 2010;4(3):32-35.
    MyJurnal
    We report a case of a 59-year-old female who presented in the general orthopaedic clinic with triggering of her right middle finger. She did not respond to conventional treatment methods; subsequently she underwent surgical open release under local anaesthesia. Five months postoperatively, the patient presented with signs and symptoms of acute flexor tenosynovitis, and was thought to have a postoperative infection. Re-examination by a hand surgeon raised the possibility of a different aetiology. Based on clinical findings and response to initial treatment, giant cell tumour of the flexor tendon sheath was suspected and later confirmed following surgical biopsy. A high index of suspicion and knowledge of the variegated presentations of giant cell tumour in the hand are beneficial in these types of cases.
    Matched MeSH terms: Orthopedics
  10. Bhardwaj, A., Sivapathasundaram, N., Yusof, M. F., Minghat, A. H., Swe, K. M. M., Sinha, N. K.
    Malays Orthop J, 2014;8(2):6-13.
    MyJurnal
    Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and general public health. Orthopaedic surgeons may be more prone to NSIs due to the prevalence of bone spikes in the operative field and the use of sharp orthopaedic instruments such as drills, saws and wires. A hospital-based cross sectional study was conducted in the orthopedic wards of Melaka General Hospital. The prevalence of NSIs was 32 (20.9%) and majority of it occurred during assisting in operation theatre 13(37.4%). Among them six (18.8%) were specialist, 12(37.5%) medical officer, 10 (31.2%) house officer and four staff nurses (12.5%). Among the respondents 142 (92.8%) had been immunized against Hepatitis B and 148 (96.7%) participants had knowledge regarding universal precaution. The incidence of NSI among health care workers at orthopaedics ward was not any higher in comparison with the similar studies and it was found out that the prevalence was more in junior doctors compared with specialist and staff nurses and it was statistically significant.
    Matched MeSH terms: Orthopedics
  11. Nadia, M.N., Samsul Johari, M.A., Muhammad, M., Raha, A.R., Nurlia, Y.
    MyJurnal
    This study aimed to compare dexmedetomidine and propofol, in terms of haemodynamic parameters, respiratory rates and offset times, when used for sedation in patients undergoing elective orthopaedic and surgical procedures under regional anaesthesia. This was a prospective, randomised, single-blind study where 88 patients were recruited. Patients were randomised into two groups to receive either dexmedetomidine or propofol infusion. Central neuraxial blockade (spinal, epidural or combined spinal epidural) was performed. After ensuring an adequate block and stable haemodynamic parameters, dexmedetomidine was infused 15 minutes later at 0.4 μg/kg/hr, and propofol, at a target concentration of 2.5 μg/ml. Both drugs were titrated to achieve a bispectral index score of 70 before surgery commenced. Sedation level was monitored using the bispectral index score and assessed by the Observer Assessment of Alertness Scale score. Drug infusion was adjusted to maintain bispectral index scores ranging between 70-80 during surgery. Both groups showed reductions in mean arterial pressure and heart rate from baseline readings throughout the infusion time. However there was no significant reduction in the first 15 minutes from baseline (p > 0.05). Haemodynamic parameters and respiratory rate between both groups were not significantly different (p > 0.05). No patient demonstrated significant respiratory depression or SpO2 ≤ 95%. Offset times were also not significantly different between both groups (p = 0.594). There were no significant differences in haemodynamic parameters, respiratory rates and offset times between dexmedetomidine and propofol used for sedation in patients undergoing elective orthopaedic and surgical procedures under regional anaesthesia.
    Matched MeSH terms: Orthopedics
  12. Harjeet, S., Suhail, A., Shahril, Y., Masbah, O., Subanesh, S.
    Malays Orthop J, 2009;3(1):24-27.
    MyJurnal
    Fracture of the femoral neck is one of the most common types of osteoporotic fractures. Hemiarthroplasty continues to be a good option despite current calls for total hip arthroplasty in this subset of patients. The hemiarthroplasty is less expensive and easier to perform, and can be adequately carried out in smaller hospitals with basic orthopaedic facilities staffed by general orthopaedists. Functional demands of the elderly among Asians are often less compared to similar subsets of Western population on which most comparative hip studies are based. This study was undertaken to investigate the outcome for femoral neck fractures treated with conventional hemiarthroplasty. The authors hope to provide information based on local data as a reference for our doctors and patients.
    Matched MeSH terms: Orthopedics
  13. Choy, Hew Hei, Khalib Abdul Latiff, Mohd Rohaizat Hassan, Hasanain Faisal Ghazi
    MyJurnal
    The uprising needs of traditional & complementary medicine (T&CM) despite the availability of conventional medical (CVM) treatments has gained a serious concern to the authorities in hospital care delivery systems. It was about suffices the supply and demand for T&CM and its absence may interfere the quality of patient care. Malaysia was not exempted of this phenomenon. Moreover, its rich tropical biodiversity and multi-ethnical medical systems promoted T&CM usage. This research was aimed to determine the overall T& CM preferences, the preferred future patient care services (FPCS) and its socio-demographic and warding characteristics. Using a self-administered standardised questionnaire, instrumented by cross sectional study, a total 132 warded patients in a UKM Medical Center (UKMMC) were interviewed. T&CM preferences were the composite of seven domains. The finding revealed that the T&CM preference was 64.4%, dominated by older age (66.2%), women (68.2%), low education (66.0%), employed (66.7%), high income (67.5%) and married (66.0%). Oncology (81.3%) and orthopaedic (75.7%) ward patients were more in preference compared to other wards. When asked about the FPCS preference, about 80.3% expected integrative medicine services to be provided, whereas the remaining were still exclusively preferred modern medicine (15.2%) and alternative medicine (4.5%) respectively. As conclusion, this study has affirmed that there is a great need towards T&CM among hospitalized patients who are accessible to modern CVM.
    Matched MeSH terms: Orthopedics
  14. Omar M. Isa
    Medical Health Reviews, 2009;2009(2):47-58.
    MyJurnal
    The consequence of postoperative infections associated with orthopaedic or biomaterial-associated implants is devastating to both the patients and the surgeons. Bacterial microcolonies adhere to the surface of implants, forming biofilms and then detaching part of itself into free-floating planktonic forms may be the cause of recurrent and persistent infections. These bacteria are very resistant towards antibiotics and require a higher drug concentration than usual in order to eradicate them. Quorem-sensing is regarded as one mechanism of communication or integration between these microorganisms in the biofilm and may even be in the transfer of resistant genes. Disruption of this pathway is regarded as one method of inhibiting its growth and formation. Implant design, technique and stability of fixation as well as the surface characteristics, the material and its biocompatibility may also influence bacterial adhesion. It has been suggested that multi-prong strategies such as prevention and disruption of biofilm formation, parenteral antibiotics, use of antibiotic-impregnated construction materials and altering the intrinsic properties of the implant surface may help to eradicate this menace.
    Matched MeSH terms: Orthopedics
  15. Lim, W.K., Ling, H.T., R. Ramanathan
    MyJurnal
    Brush cutting is a commonly performed activity occupationally as well as recreationally in Malaysia. There are various occupational injuries reported related to brush cutting, for example foreign body penetration. There were 11 reported cases of foreign body penetrated in leg of brush cutting workers admitted to orthopaedic ward in Hospital Raja Permaisuri Bainun from the period of January till October 2009. Among the cases, 4 were surgically removed under local anaesthesia and 7 cases performed under general anesthesia. 2 cases reported foreign body penetrated into tibia bone. There were many contributing factors to the injury, which include lack of protective measures for workers, engineering property of brush cutting machine and education on handling of equipment. It is vital to study the factors separately in order to determine and recommend useful preventive measures. However, the actual numbers of cases are under reported and awareness of the problem is undermined.
    Matched MeSH terms: Orthopedics
  16. Chai WL, Phang YH, Chong HC
    MyJurnal
    Tumoral calcinosis is an uncommon condition which has been described to exist in primary and secondary forms. A lack of awareness of this entity can lead to unnecessary procedures and incorrect management. We report a case of a patient on peritoneal dialysis who presented with multiple painful joint swellings to the orthopaedic department. An initial diagnosis of septic arthritis was made, then revised to chronic tophaceous gout and referred to the rheumatology unit.
    Matched MeSH terms: Orthopedics
  17. Mohammad Arif Shahar, Mohd Faiz Idris, Che Anuar Che Mohamad, Zul Azlin Razali
    MyJurnal
    The Kulliyyah of Medicine of IIUM has pioneered the Islamization of Medicine in Malaysia since its establishment in year 1994. Therefore, it is timely to review publications on Islamization by the kulliyyah and also to propose a classification system in the field of researches to promote an organized, comprehensive, inclusive and relevant Islamization process. The aim is to review and classify publications on Islamization performed by the members of Kulliyyah of Medicine, International Islamic University Malaysia (IIUM). All researches and publications deposited in the IIUM Repository (IREP) under the Kulliyyah of Medicine between 1st of January 2000 and 31st of August 2016 were reviewed. Journal articles, posters and proceedings with Islamization themes were identified. These publications were classified based on common themes to either of the following; 1) "Islamic Principles and Related Rulings in Medicine"; 2) "Medical Treatment for Muslim Patients"; 3) "Islamic Input in Medical Practices"; 4) "Ruqyah and Tibb an-Nabawi in Contemporary Medicine". A total of 1616 items (journal articles, abstracts and proceedings) were reviewed. Sixty-one (3.8%) of them were related to Islamization. The major contributors to writings in Islamization are the Orthopaedics, Traumatology and Rehabilitation Department (10%) followed by the Internal Medicine Department (7.9%), from their total deposits in the IREP database. Majority (36.5%) of work were done in "Islamic Principles and Related Rulings in Medicine", which dwells in subjects such as euthanasia, autonomy and doctor-patient relationship followed by "Islamic Input in Medical Practice" (28.6%) which was related to topics in the medical curriculum such as Fiqh Ibadah for the sick. Twenty-three point eight percent (23.8%) of work were in the "Medical Treatment for Muslim Patients" which focuses on Ramadan and diabetes and joint problems and Solat. Minimal work (7.9%) was done in the "Ruqyah and Tibb an-Nabawi in Contemporary Medicine" category. Low number of publications on Islamization was deposited in the IREP database for the past 15 years. Based on the proposed classification system, majority of publications were on "Islamic Principles and Related Rulings in Medicine" and "Islamic Input in Medical Practice". More work is required on the theme of "Medical Treatment for Muslim Patients" and "Ruqyah and Tibb an-Nabawi in Contemporary Medicine".
    Matched MeSH terms: Orthopedics
  18. Nur Azida Che Lah, Muhamad Hellmy Hussin
    MyJurnal
    Titanium (Ti) and Ti-based alloys presence the most widely applied as advanced biomaterials
    in biomedical implant applications. Moreover, these alloys are known to be the most
    valuable metallic materials including spinal cord surgical treatment. It becomes an interest
    due to its advantages compared to others, including its bio compatibility and corrosion
    resistant. However, an issue arises when it comes for permanent implant application as
    the alloy has a possible toxic effect produced from chemical reaction between body fluid
    environments with alloys chemical compositions. It also relies on the performance of
    neighbouring bone tissue to integrate with the implant surface. Abnormalities usually
    happen when surrounding tissue shows poor responses and rejection of implants that would
    leads to body inflammation. These cause an increase in foreign body reaction leading to
    severe body tissue response and thus, loosening of the implant. Corrosion effects and
    biocompatibility behaviour of implantation usage also become one of the reasons of
    implant damage. Here, this paper reviews the importance of using Ti and Ti-based alloys
    in biomedical implantation, especially in orthopaedic spinal cord injury. It also reviews the
    basic aspects of corrosion effects that lead to implant mechanical damage, poor response
    of body rejection and biocompatibility behaviour of implantation usage.
    Matched MeSH terms: Orthopedics
  19. Tan K, Kwek E
    Malays Orthop J, 2020 Mar;14(1):24-27.
    PMID: 32296478 DOI: 10.5704/MOJ.2003.004
    Introduction: Orthopaedic surgeons are significantly predisposed to musculoskeletal injury, and these injuries can have negative effects on surgeon function and patient outcomes. While this phenomenon has been studied in the non-Asian population of surgeons, no study has been carried out in the local or regional Asian setting. The aim of this study was to determine the prevalence, characteristics and associations of occupational injuries in orthopaedic surgeons and residents, and to assess its functional impact.

    Materials and Methods: The Nordic Musculoskeletal Questionnaire was sent out to all orthopaedic consultants and residents at two institutions in Singapore, via an email link to an online survey. Separately, further questions on symptom description, severity and treatment were surveyed. Additional information like age, gender, height and weight were obtained as well.

    Results: A total of 87.5% respondents have at least one injury. Neck symptoms (66.1%) were the most prevalent, and back symptoms had the highest median severity score (4.5/10). The 74.1% of these injuries were reported as directly attributable to work. Age was found to be associated with an increase in the total number of anatomical areas affected (p = 0.016). A seated operating position was associated with more severe back pain (p = 0.040).

    Conclusion: There is a high prevalence of occupational injuries sustained in our population of orthopaedic surgeons. Neck symptoms, followed by back and wrist symptoms, were the predominant symptoms in our population. Targeted ergonomic interventions may be considered to prevent specific musculoskeletal injuries in our population of orthopaedic surgeons.

    Matched MeSH terms: Orthopedics
  20. 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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