Displaying publications 41 - 60 of 196 in total

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  1. Accuracy and reliability of virtual femur measurement from CT scan
    Ismail NA, Abdullah N, Mohamad Noor MH, Lai PS, Shafie MS, Nor FM
    J Forensic Leg Med, 2019 Apr;63:11-17.
    PMID: 30825771 DOI: 10.1016/j.jflm.2019.02.010
    BACKGROUND: In the application of scientific human skeletal variation in medico-legal matters, virtual anthropology is the current technique performed to examine skeleton and its body parts. Hence, this study was conducted to assess the accuracy and reliability of virtual femur measurement through intra and inter-observer error analysis, and comparison was made between the virtual and conventional methods.

    METHODS: A total of 15 femora were examined with four parameters i.e. maximum length of femur (FeMl), diameter of femoral head (FeHd), transverse diameter of midshaft (FeMd) and condylar breadth (FeCb). Osteometric board and vernier calipers were employed for the conventional method, while CT reconstructed images and Osirix MD software was utilised for the virtual method.

    RESULTS: Results exhibited that there were no significant differences in the measurements by conventional and virtual methods. There were also no significant differences in the measurements by the intra or inter-observer error analyses. The intraclass correlation coefficients (ICC) were more than 0.95 by both intra and inter-observer error analyses. Technical error of measurement had displayed values within the acceptable ranges (rTEM <0.08 for intra-observer, <2.25 for inter-observer), and coefficient of reliability (R) indicated small measurement errors (R > 0.95 for intra-observer, R > 0.92 for inter-observer). By parameters, FeMl showed the highest R value (0.99) with the least error in different methods and observers (rTEM = 0.02-0.41%). Bland and Altman plots revealed points scattered close to zero indicating perfect agreement by both virtual and conventional methods. The mean differences for FeMl, FeHd, FeMd and FeCb measurements were 0.01 cm, -0.01 cm, 0.02 cm and 0.01 cm, respectively.

    CONCLUSION: This brought to suggest that bone measurement by virtual method was highly accurate and reliable as in the conventional method. It is recommended for implementation in the future anthropological studies especially in countries with limited skeletal collection.

    Matched MeSH terms: Femur/anatomy & histology*
  2. Finite element study of functionally graded porous femoral stems incorporating body-centered cubic structure
    Alkhatib SE, Tarlochan F, Mehboob H, Singh R, Kadirgama K, Harun WSBW
    Artif Organs, 2019 Jul;43(7):E152-E164.
    PMID: 30805945 DOI: 10.1111/aor.13444
    The mismatch between stiffness of the femoral dense stem and host bone causes complications to patients, such as aseptic loosening and bone resorption. Three-dimensional finite-element models of homogeneous porous (HGP) and functionally graded porous (FGP) stems incorporating body-centered cubic (BCC) structures are proposed in this article as an alternative to the dense stems. The relationship between the porosity and strut thickness of the BCC structure was developed to construct the finite-element models. Three levels of porosities (20%, 50%, and 80%) were modeled in HGP and FGP stems. The porosity of the stems was decreased distally according to the sigmoid function (n = 0.1, n = 1 and n = 10) with 3 grading exponents. The results showed that FGP stems transferred 120%-170% higher stresses to the femur (Gruen zone 7) as compared to the solid stem. Conversely, the stresses in HGP and FGP stems were 12%-34% lower than the dense stem. The highest micromotions (105-147 µm) were observed for stems of 80% overall porosity, and the lowest (42-46 µm) was for stems of 20% overall porosity. Finally, FGP stems with a grading exponent of n = 10 resulted in an 11%-28% reduction in micromotions.
    Matched MeSH terms: Femur/anatomy & histology*
  3. Fulltext Incarcerated Cannulated Cancellous Screw Removal during Total Hip Arthroplasty with a Novel Trick: A Case Report
    Tomar L, Govil G, Dhawan P
    Malays Orthop J, 2021 Mar;15(1):128-131.
    PMID: 33880160 DOI: 10.5704/MOJ.2103.020
    Salvage total hip arthroplasty (THA) may be required to manage femoral neck fracture implant failures, avascular necrosis and secondary hip arthritis. Cannulated cancellous screws can become stripped or incarcerated during the initial implantation and pose hardware removal issues. We present a novel technique for safe screw removal in a 62-year-old female patient with a painful right hip. She had undergone cancellous screw fixation for a fracture of the neck of femur ten years ago. There was avascular necrosis with screw cut out leading to secondary hip arthritis necessitating THA. Intra-operatively cannulated cancellous screw along the inferior femoral neck region was incarcerated. After posterior dislocation of the head, the neck was osteotomised, and the screw threads were exposed for possible extraction. However, the thickened femoral neck region with solid cortical bone prevented the screw disengagement in either direction. The screw along the femoral trochanter region was cut with a Harrington cutter and the remaining screw disengaged with careful removal of bony spicules and controlled anticlockwise rotations, to remove the screw in around fifteen minutes. Arthroplasty could be completed uneventfully thereafter. We could remove the screw while avoiding an iatrogenic fracture along the calcar region and excessive bone loss along the screw track. The femoral canal remained uncompromised. The anticipation of a difficult implant removal with a thorough understanding of the devices and techniques, is an invaluable asset to the operating surgeon. With a simple tool and novel technique in a difficult situation, we can save on operating time and minimise complications.
    Matched MeSH terms: Femur; Femur Neck
  4. Biomechanical analysis of three different types of fixators for anterior cruciate ligament reconstruction via finite element method: a patient-specific study
    Zainal Abidin NA, Abdul Wahab AH, Abdul Rahim RA, Abdul Kadir MR, Ramlee MH
    Med Biol Eng Comput, 2021 Sep;59(9):1945-1960.
    PMID: 34392448 DOI: 10.1007/s11517-021-02419-6
    Complication rates of anterior cruciate ligament reconstruction (ACL-R) were reported to be around 15% although it is a common arthroscopic procedure with good outcomes. Breakage and migration of fixators are still possible even months after surgery. A fixator with optimum stability can minimise those two complications. Factors that affect the stability of a fixator are its configuration, material, and design. Thus, this paper aims to analyse the biomechanical effects of different types of fixators (cross-pin, interference screw, and cortical button) towards the stability of the knee joint after ACL-R. In this study, finite element modelling and analyses of a knee joint attached with double semitendinosus graft and fixators were carried out. Mimics and 3-Matic softwares were used in the development of the knee joint models. Meanwhile, the graft and fixators were designed by using SolidWorks software. Once the meshes of all models were finished in 3-Matic, simulation of the configurations was done using MSC Marc Mentat software. A 100-N anterior tibial load was applied onto the tibia to simulate the anterior drawer test. Based on the findings, cross-pin was found to have optimum stability in terms of stress and strain at the femoral fixation site for better treatment of ACL-R.
    Matched MeSH terms: Femur/surgery
  5. Two Late Pleistocene human femora from Trinil, Indonesia: Implications for body size and behavior in Southeast Asia
    Ruff CB, Sylvester AD, Rahmawati NT, Suriyanto RA, Storm P, Aubert M, et al.
    J Hum Evol, 2022 Nov;172:103252.
    PMID: 36162353 DOI: 10.1016/j.jhevol.2022.103252
    Late Pleistocene hominin postcranial specimens from Southeast Asia are relatively rare. Here we describe and place into temporal and geographic context two partial femora from the site of Trinil, Indonesia, which are dated stratigraphically and via Uranium-series direct dating to ca. 37-32 ka. The specimens, designated Trinil 9 and 10, include most of the diaphysis, with Trinil 9 being much better preserved. Microcomputed tomography is used to determine cross-sectional diaphyseal properties, with an emphasis on midshaft anteroposterior to mediolateral bending rigidity (Ix/Iy), which has been shown to relate to both body shape and activity level in modern humans. The body mass of Trinil 9 is estimated from cortical area and reconstructed length using new equations based on a Pleistocene reference sample. Comparisons are carried out with a large sample of Pleistocene and Holocene East Asian, African, and European/West Asian femora. Our results show that Trinil 9 has a high Ix/Iy ratio, most consistent with a relatively narrow-bodied male from a mobile hunting-gathering population. It has an estimated body mass of 55.4 kg and a stature of 156 cm, which are small relative to Late Pleistocene males worldwide, but larger than the penecontemporaneous Deep Skull femur from Niah Cave, Malaysia, which is very likely female. This suggests the presence of small-bodied active hunter-gatherers in Southeast Asia during the later Late Pleistocene. Trinil 9 also contrasts strongly in morphology with earlier partial femora from Trinil dating to the late Early-early Middle Pleistocene (Femora II-V), and to a lesser extent with the well-known complete Femur I, most likely dating to the terminal Middle-early Late Pleistocene. Temporal changes in morphology among femoral specimens from Trinil parallel those observed in Homo throughout the Old World during the Pleistocene and document these differences within a single site.
    Matched MeSH terms: Femur/anatomy & histology
  6. Fulltext Symptoms indicating imminent breakage of a femoral interlocking nail: a case report
    Pan K, Chan W
    Malays Orthop J, 2013 Nov;7(3):21-3.
    PMID: 25674303 MyJurnal DOI: 10.5704/MOJ.1311.003
    Fractures of the femoral shaft treated with interlocking nails will ultimately result in breakage of the nail if the bone does not unite. Further management requires removal of the broken nail which may be a difficult process for the distal segment. If we can identify the symptoms just before the nail breaks, an exchange nailing becomes much easier. We present a patient with fibromatosis who underwent repeated surgery as well as radiotherapy at the age of 16. Six years later, she had a pathological fracture of the upper third of the femur for which an interlocking nail was inserted. The femur did not unite and the nail subsequently broke. Over a period of 12 years, three nails broke and had to be replaced. Two to 3 months before each breakage, the patient experienced the same set of symptoms for each episode. Knowing that her fracture was not going to heal will now alert us to do an exchange nailing before the nail broke again. It is well known that where there is evidence of non-union, pre-emptive treatment is necessary before implant failure.

    KEY WORDS: Femur nonunion, interlocking nail, symptoms before breakage of nail.

    Matched MeSH terms: Femur
  7. Long Term Follow-up of an Open Bicondylar Hoffa Fracture with a Disrupted Extensor Mechanism: A Case Report
    Joseph CM, Rama-Prasad YS, Boopalan P, Jepegnanam TS
    Malays Orthop J, 2019 Jul;13(2):59-62.
    PMID: 31467656 DOI: 10.5704/MOJ.1907.013
    This is the first report of a long-term follow-up of an open bicondylar Hoffa with patella fracture. It is interesting to note the radiological changes of osteoarthritis 15 years after global intra-articular injury of the distal femur. The good clinical outcome is possibly due to the integrity of the knee ligaments and reconstruction of the extensor mechanism in addition to stable anatomical reduction and fixation.
    Matched MeSH terms: Femur
  8. Fulltext Causative Factors for Femoral Pin Track Fractures inNavigated Total Knee Arthroplasty
    Ewe, T.W., Chee, E.K., Chooi, Y.S., Ng, W.M.
    Malays Orthop J, 2010;4(1):8-11.
    MyJurnal
    This retrospective radiographic analysis of 57 patients (62 knees) examined two possible factors involved in pin tract fractures of the femur due to navigated total knee arthroplasty (TKA): the angle of the tracker pin with respect to the lateral femoral cortex, and the distance between the tracker pin and the lateral joint line. Our findings demonstrate a relationship between postoperative pin tract induced stress fractures (3 patients), with pin tract angles exceeding 15°. Pin placement at a site more than 10cm from the lateral joint line, did not show any significant association with risk of fracture. These findings lead to enhanced understanding of the causative factors underlying pin track femoral fractures in TKAs.
    Matched MeSH terms: Femur
  9. Fulltext Cannulated screw fixation for femoral neck fractures: a 5-year experience in a single institution
    Khoo, C. C. H., Amber Haseeb, Vivek Ajit Singh
    Malays Orthop J, 2014;8(2):14-21.
    MyJurnal
    Cannulated screw fixation is a widely accepted surgical method for management of fractures of the neck of femur especially in patients with poor premorbid conditions, minimally displaced fractures and those from a younger age group. A five year retrospective study was carried out in 53 consecutive patients between 2006 to 2010 to determine the pattern of injuries, management, outcomes and the associated predictive factors.All the patients underwent cannulated screw fixation, with 37 (69.8%) having had surgery within 24 hours and the remaining 16 (30.2%) 24 hours after the initial injury. All patients were followed up to union of fractures and complications thereafter if any. Good outcome was observed in 43 (81.1%) patients leaving only 10 (18.9%) patients with a poor outcome, of whom nine developed avascular necrosis (90%) and one non-union (10%). We found no significant relationship between the incidence of avascular necrosis and age of patient, fracture displacement, numbers of cannulated screws used, fracture reduction acceptability and anatomical location of the fracture. The time interval from injury to surgery and the presence of posterior comminution did seem to influence the rate of avascular necrosis but due to the small number of patients, was not statistically significant.We conclude that cannulated screw fixation is a viable option of treatment for fractures of the neck of femur.
    Matched MeSH terms: Femur
  10. Pattern of Cortical Fracture following Corticotomy for Distraction Osteogenesis
    Luvan M, Kanthan SR, Roshan G, Saw A
    Malays Orthop J, 2015 Nov;9(3):35-39.
    PMID: 28611907 MyJurnal DOI: 10.5704/MOJ.1511.005
    Corticotomy is an essential procedure for deformity correction and there are many techniques described. However there is no proper classification of the fracture pattern resulting from corticotomies to enable any studies to be conducted. We performed a retrospective study of corticotomy fracture patterns in 44 patients (34 tibias and 10 femurs) performed for various indications. We identified four distinct fracture patterns, Type I through IV classification based on the fracture propagation following percutaneous corticotomy. Type I transverse fracture, Type II transverse fracture with a winglet, Type III presence of butterfly fragment and Type IV fracture propagation to a fixation point. No significant correlation was noted between the fracture pattern and the underlying pathology or region of corticotomy.
    Matched MeSH terms: Femur
  11. Fulltext Acetabulum Protrusion Following Ceramic Liner Fracture: A Case Report
    Aytekin K, Esenyel CZ
    Malays Orthop J, 2018 Mar;12(1):45-47.
    PMID: 29725513 DOI: 10.5704/MOJ.1803.010
    Hip arthroplasty is an extremely satisfying treatment method for coxarthrosis which is in increasing use throughout the world. However, loosening of the prosthesis is a significant complication and to overcome this, ceramic liners are increasingly being selected. If the survival of ceramic surfaces is prolonged, there is a risk of fracture of the ceramic materials. New ceramic materials developed to overcome this problem are more resistant. The case presented here is of a patient in whom liner fracture developed following ceramic-ceramic hip arthroplasty. The ceramic femoral head was observed to have protruded into the defect created in the acetabular component. Acetabular revision was applied to the patient.
    Matched MeSH terms: Femur Head
  12. A rare case of non-contact salter harris type 2 fracture of distal femur during a football match
    Razzi M, Nordin A
    Med J Malaysia, 2018 10;73(5):342-343.
    PMID: 30350822 MyJurnal
    Distal femoral physeal fractures in adolescents are often due to high velocity injuries. We present an unusual case of a non-contact distal femoral physeal fracture that occurred during a football match. A torsional force had been directed at the fracture site occurring at the growth plate causing a transverse fracture rather than a spiral fracture. It is important to be aware that such fractures can occur despite little or no evidence of contact. These type of injuries should also be treated as an emergency to reduce the risk of further complications.
    Matched MeSH terms: Femur
  13. Fulltext Use of an Industrial Tungsten Carbide Drill in the Treatment of a Complex Fracture in a Patient with Severe Osteopetrosis: A Case Report
    Kunnasegaran R, Chan YH
    Malays Orthop J, 2017 Mar;11(1):64-67.
    PMID: 28435578 DOI: 10.5704/MOJ.1703.007
    The treatment of fractures in osteopetrosis can be complicated and difficult. We describe the use of an industrial grade tungsten carbide drill bit in the treatment of one of these complex fractures. An industrial grade tungsten carbide drill bit was used to fashion a medullary canal in the surgical treatment of a left peri-implant fracture of the neck of femur in a patient with osteopetrosis. The patient was successfully treated with a hemiarthroplasty with good functional outcomes. A tungsten carbide drill bit serves as an effective and safe option in the treatment of osteopetrotic femoral neck fractures.
    Matched MeSH terms: Femur
  14. Submuscular Plate Stabilisation After Lengthening: Standard and Modified Techniques
    Munajat I, Sulaiman AR, Mohd EF, Zawawi M
    Malays Orthop J, 2020 Mar;14(1):49-54.
    PMID: 32296482 DOI: 10.5704/MOJ.2003.008
    Introduction: Submuscular plating after lengthening shortened the period of external fixation in distraction osteogenesis of the femur. In the femur, where monolateral or ring fixators had been used for the distraction, plates, could be inserted laterally, anteriorly or medially. Specific technical modification of the plate insertion, however, would be necessary to accommodate the femoral varus angular correction created at the end of the distraction, in the pelvic support osteotomy lengthening.

    Material and Methods: We reviewed a series of eight cases with standard and modified techniques of plating after lengthening. The amount of lengthening, the period of distraction, the external fixator index and the associated complications were assessed.

    Results: The mean lengthening was 5cm, with a range of 3cm to 9cm. The external fixation index, the period of external fixators in days in relation to the length of distraction in cm, was between 18 days/cm to 58 days/cm. One patient with quadriceps contracture, underwent quadriceplasty to improve knee flexion. Three patients with transient knee stiffness had resolution with aggressive physiotherapy. One patient with transient hypoesthesia recovered spontaneously. None of the patients developed joint subluxation, deep infection, re-fracture or implant failures.

    Conclusion: Standard and modified techniques of plating after lengthening were safe and required only a short period of external fixation. The modified technique offered an easier way of plate insertion in a deformed bone.

    Matched MeSH terms: Femur
  15. Fulltext Design and development of potential tissue engineering scaffolds from structurally different longitudinal parts of a bovine-femur
    Pramanik S, Pingguan-Murphy B, Cho J, Abu Osman NA
    Sci Rep, 2014 Jul 28;4:5843.
    PMID: 25068570 DOI: 10.1038/srep05843
    The complex architecture of the cortical part of the bovine-femur was examined to develop potential tissue engineering (TE) scaffolds. Weight-change and X-ray diffraction (XRD) results show that significant phase transformation and morphology conversion of the bone occur at 500-750°C and 750-900°C, respectively. Another breakthrough finding was achieved by determining a sintering condition for the nucleation of hydroxyapatite crystal from bovine bone via XRD technique. Scanning electron microscopy results of morphological growth suggests that the concentration of polymer fibrils increases (or decreases, in case of apatite crystals) from the distal to proximal end of the femur. Energy-dispersive analysis of X-ray, Fourier transform infrared, micro-computer tomography, and mechanical studies of the actual composition also strongly support our microscopic results and firmly indicate the functionally graded material properties of bovine-femur. Bones sintered at 900 and 1000°C show potential properties for soft and hard TE applications, respectively.
    Matched MeSH terms: Femur/anatomy & histology; Femur/ultrastructure*
  16. Design of new generation femoral prostheses using functionally graded materials: a finite element analysis
    Oshkour AA, Abu Osman NA, Yau YH, Tarlochan F, Abas WA
    Proc Inst Mech Eng H, 2013 Jan;227(1):3-17.
    PMID: 23516951
    This study aimed to develop a three-dimensional finite element model of a functionally graded femoral prosthesis. The model consisted of a femoral prosthesis created from functionally graded materials (FGMs), cement, and femur. The hip prosthesis was composed of FGMs made of titanium alloy, chrome-cobalt, and hydroxyapatite at volume fraction gradient exponents of 0, 1, and 5, respectively. The stress was measured on the femoral prosthesis, cement, and femur. Stress on the neck of the femoral prosthesis was not sensitive to the properties of the constituent material. However, stress on the stem and cement decreased proportionally as the volume fraction gradient exponent of the FGM increased. Meanwhile, stress became uniform on the cement mantle layer. In addition, stress on the femur in the proximal part increased and a high surface area of the femoral part was involved in absorbing the stress. As such, the stress-shielding area decreased. The results obtained in this study are significant in the design and longevity of new prosthetic devices because FGMs offer the potential to achieve stress distribution that more closely resembles that of the natural bone in the femur.
    Matched MeSH terms: Femur/physiology*; Femur/surgery*
  17. The absorbed dose in femur exposed to diagnostic radiography
    Salehi Z, Yusoff AL
    Radiat Prot Dosimetry, 2013;154(3):396-9.
    PMID: 23012482 DOI: 10.1093/rpd/ncs239
    A femur phantom made of wax and a real human bone was used to study the dose during radiographical procedures. The depth dose inside the phantom was determined using DOSXYZnrc, a Monte Carlo simulation software. The results were verified with measurements using TLD-100H. It was found that for 2.5 mm aluminium filtered 84-kVp X-rays, the radiation dose in the bone reached 57 % higher than the surface dose, i.e. 3.23 mGy as opposed to 2.06 mGy at the surface. The use of real bone introduces variations in the bone density in the DOSXYZnrc model, resulting in a lower attenuation effect than expected from solid bone tissues.
    Matched MeSH terms: Femur/physiology*; Femur/radiography*
  18. Fulltext Prospects of implant with locking plate in fixation of subtrochanteric fracture: experimental demonstration of its potential benefits on synthetic femur model with supportive hierarchical nonlinear hyperelastic finite element analysis
    Latifi MH, Ganthel K, Rukmanikanthan S, Mansor A, Kamarul T, Bilgen M
    Biomed Eng Online, 2012;11:23.
    PMID: 22545650 DOI: 10.1186/1475-925X-11-23
    Effective fixation of fracture requires careful selection of a suitable implant to provide stability and durability. Implant with a feature of locking plate (LP) has been used widely for treating distal fractures in femur because of its favourable clinical outcome, but its potential in fixing proximal fractures in the subtrochancteric region has yet to be explored. Therefore, this comparative study was undertaken to demonstrate the merits of the LP implant in treating the subtrochancteric fracture by comparing its performance limits against those obtained with the more traditional implants; angle blade plate (ABP) and dynamic condylar screw plate (DCSP).
    Matched MeSH terms: Femur/injuries*; Femur/surgery
  19. Fulltext Distraction osteogenesis over intramedullary nail: a report of two cases
    Sulaiman AR, Munajat I, Liau KM, Salehuddin AY, Shukrimi A
    Med J Malaysia, 2006 Dec;61 Suppl B:48-50.
    PMID: 17600992
    Distraction osteogeneis over intramedullary nail has a benefit of decreasing the time for external fixation thus reducing the rate of associated complications. However, risk of panosteomyelitis is still the major worry. We are reporting two patients who underwent the procedure. The first case was a 13-year-old girl requiring 6 cm of femoral lengthening and the second case was a 17-year-old girl who required 5 cm of tibial lengthening. The healing index was 19.5 days/cm and 14.8 days/cm respectively, compared favorably to 30 days/cm with traditional method of distraction osteogenesis. There were mild pin tract infections and joint stiffness which responded to non-operative treatment.
    Matched MeSH terms: Femur/radiography; Femur/surgery*
  20. Failure analysis of stainless steel femur fixation plate
    Hussain PB, Mohammad M
    Med J Malaysia, 2004 May;59 Suppl B:180-1.
    PMID: 15468877
    Failure analysis was performed to investigate the failure of the femur fixation plate which was previously fixed on the femur of a girl. Radiography, metallography, fractography and mechanical testing were conducted in this study. The results show that the failure was due to the formation of notches on the femur plate. These notches act as stress raisers from where the cracks start to propagate. Finally fracture occurred on the femur plate and subsequently, the plate failed.
    Matched MeSH terms: Femur/radiography; Femur/surgery*
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