Displaying publications 41 - 60 of 97 in total

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  1. A biomechanical study comparing plate fixation using unicortical and bicortical screws in transverse metacarpal fracture models subjected to cyclic loading
    Afshar R, Fong TS, Latifi MH, Kanthan SR, Kamarul T
    J Hand Surg Eur Vol, 2012 Jun;37(5):396-401.
    PMID: 22019989 DOI: 10.1177/1753193411424557
    The use of bicortical screws to fix metacarpal fractures has been suggested to provide no added biomechanical advantage over unicortical screw fixation. However, this was only demonstrated in static loading regimes, which may not be representative of biological conditions. The present study was done to determine whether similar outcomes are obtained when cyclic loading is applied. Transverse midshaft osteotomies were created in 20 metacarpals harvested from three cadavers. Fractures were stabilised using 2.0 mm mini fragment plates fixed with either bicortical or unicortical screw fixation. These fixations were tested to failure with a three-point bending cyclic loading protocol using an electromechanical microtester and a 1 kN load cell. The mean load to failure was 370 N (SD 116) for unicortical fixation and 450 N (SD 135) for bicortical fixation. Significant differences between these two constructs were observed. A biomechanical advantage was found when using bicortical screws in metacarpal fracture plating.
    Matched MeSH terms: Fracture Fixation, Internal/instrumentation*
  2. Fulltext Size of interlocking nails used in the treatment of diaphyseal femoral fractures
    Tan WJ, Kwan MK, Deepak AS, Saw A, Peng BC, Jalalullah W
    Med J Malaysia, 2006 Dec;61 Suppl B:18-22.
    PMID: 17600988
    Fracture of the femur is most commonly treated with interlocking nailing. We conducted this study to describe and analyze the size of femoral interlocking nails used in our local population. This is a retrospective study on reamed intramedullary interlocking nailing procedures performed between 1st July 1998 and 30th June 2003. Demographic data, the diameter and length of femoral nails used were obtained from patient's medical record. A total of 267 procedures were included. The most common diameter used was 10 mm (56.9%), followed by 11 mm (27.0%) and 12 mm (13.1%). Only 2.6% of the nails were less than 10 mm in diameter. The most common nail length was 38 cm (31.1%), followed by 36 cm (24.9%) and 40 cm (19.5%). The longest nail used was 46 cm while the shortest 32 cm. The most commonly used femoral nails were of 10 mm diameter with the length ranging from 36 to 40 cm, which is smaller than those reported in the English literature. Nails with diameter smaller than 10 mm were required in 2.6% of patients.
    Matched MeSH terms: Fracture Fixation, Internal/instrumentation*
  3. 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: Fracture Fixation, Internal/instrumentation*
  4. Fulltext Outcome of infection following internal fixation of closed fractures
    Nazri MY, Halim YA
    Med J Malaysia, 2004 Dec;59(5):665-9.
    PMID: 15889570
    A retrospective study was done in 30 patients with infected closed fractures treated initially by open reduction and internal fixation. Nineteen fractures involved the femur, 8 the tibia, 2 the radius and 1 the ulna. Twenty-five were diaphyseal and 5 metaphyseal. Twenty-two fractures had initially been treated with plating and 8 with intramedullary nailing. Thirteen patients presented in the acute phase and 17 in the subacute phase of infection. Twenty-two patients presented with low grade infection and 8 with florid infection. The commonest organism isolated was Staphylococcus aureus (80%), of which fifty four percent was resistant to Methicillin (MRSA). This study showed that 77% of infected fractures with a stable implant united even in the presence of infection.
    Matched MeSH terms: Fracture Fixation, Internal/adverse effects*
  5. Fulltext Displaced supracondylar fracture of humerus in children--comparative study of the result of closed and open reduction
    Yusof A, Razak M, Lim A
    Med J Malaysia, 1998 Sep;53 Suppl A:52-8.
    PMID: 10968183
    The displaced supracondylar fracture of the humerus in children (Gartland type 3) is a most challenging injury to treat. There is controversy regarding the initial treatment either closed manipulation and splint immobilization or open reduction and internal fixation. This is a retrospective study comparing two groups of patients with displaced supracondylar fracture of the humerus (Gattland 3) treated in the Orthopaedic Unit, Universiti Kebangsaan Malaysia. The first group, 13 patients treated with closed reduction and splint immobilization and a second group, 15 patients treated with open reduction and internal fixation as initial definitive treatment. The results showed a high failure rate of closed reduction and splint immobilization. This was due to difficulty in reduction, loss of reduction post operatively or during follow-up. Open reduction and internal fixation was more advantages with reduced hospitalization time, fewer complications, more stable fixation and better anatomical reduction with minimal complications for type 3 supracondylar fracture of humerus. We would recommend that all Gartland 3 supracondylar fracture of the humerus be treated with open reduction and two K-wire fixation.
    Matched MeSH terms: Fracture Fixation, Internal*
  6. Fulltext Functional outcome of open reduction and internal fixation of pelvic ring injuries
    Tee SS, Hyzan Y, Razak M
    Med J Malaysia, 2000 Sep;55 Suppl C:49-58.
    PMID: 11200045
    Between January 1996 and August 1998, 15 patients with pelvic ring injuries were treated by open reduction and internal fixation. Fractures types included Tile A1 (7%), B1 (33%), C1 (53%) and C3 (7%). The patients were observed for an average of 1 year (range: 5 to 21 months). Thirteen patients (87%) who were operated within 3 weeks after injury had their pelvic disruption healed. One patient with Tile C1 and non-union of the fracture dislocation of sacroiliac joint was operated 11 months after injury and developed implant failure and non-union of the fracture dislocation of sacroiliac joint. Another patient with Tile C1 injury with transforamina sacral fracture was fixed anteriorly only and developed non-union of the sacral fracture and redisplacement of pelvic disruption. Both of them had a poor functional outcome. A 40 points pelvic outcome grading scale (Cole et al 1996) based on physical examination, pain, radiographic analysis and activity/work status was used. Six patients (40%) (1 Tile A1, 5 Tile B1) had an excellent functional outcome. Seven patients (47%) (6 Tile C1, 1 Tile C3) had a good functional outcome.
    Matched MeSH terms: Fracture Fixation, Internal*
  7. Fulltext Supracondylar-condylar fractures of the femur
    Teh PH, Krishnamoorty S
    Med J Malaysia, 1986 Sep;41(3):205-12.
    PMID: 3670136
    A retrospective study of 34 patients with supracondylar-condylar fractures of the femur admitted to the Alexandra Hospital, Singapore, from January 1979 to December 1983 was carried out. These fractures were surgically treated by AO principles and fixation, and the surgery performed mainly by the two authors. Using strict criteria adopted from Schatzker of Toronto, 1 it was found that 62% of patients had excellent/ good results. The importance of treating supracondylar-condylar fractures by AO principles and fixation is emphasised.
    Matched MeSH terms: Fracture Fixation, Internal/methods*
  8. Fulltext Screw osteosynthesis in the treatment of fracture lateral humeral condyle in children
    Baharuddin M, Sharaf I
    Med J Malaysia, 2001 Dec;56 Suppl D:45-7.
    PMID: 14569766
    We reviewed the results of screw osteosynthesis for the treatment of fracture lateral condylar physis in twenty children whose average age was six years old (range, two to ten years) at the time of operation from January 1998 till December 2000. The average interval between the injury and the operation was three and half days (range, one day to two weeks). The average duration of follow up was one year (range, one year to two years). Osteosynthesis was revised in two patients due to anterior placement of screw and rotated distal fracture fragment. Osseous union was achieved in all twenty patients. The result was rated excellent in nineteen patients and good in one patient.
    Matched MeSH terms: Fracture Fixation, Internal/adverse effects*
  9. A Case of Non-Union of Ulna Fracture Managed with Tibial Strut Cortico-Cancellous Bone Grafting in a Paediatric Patient
    Looi CSK, S A R, Gill RS
    J Hand Surg Asian Pac Vol, 2017 Sep;22(3):396-402.
    PMID: 28774257 DOI: 10.1142/S0218810417720327
    Forearm fractures in children complicated with non-union are uncommon. Various methods have previously been reported to manage this condition. Well documented techniques would include iliac crest grafting, cancellous insert grafting, ulnar segment grafting, cortical tibial grafting, vascularized fibular grafting and bone transport by ring fixation. The authors present a case of a child with an atrophic non-union of the ulna who was successfully treated with a cortico-cancellous tibial strut bone graft.
    Matched MeSH terms: Fracture Fixation, Internal/methods*
  10. Use of Computed Tomography in Determining the Occurrence of Dorsal and Intra-articular Screw Penetration in Volar Locking Plate Osteosynthesis of Distal Radius Fracture
    Diong TW, Haflah NHM, Kassim AYM, Habshi SMIA, Shukur MH
    J Hand Surg Asian Pac Vol, 2018 Mar;23(1):26-32.
    PMID: 29409409 DOI: 10.1142/S2424835518500030
    BACKGROUND: The use of volar locking plate in distal radius fracture can lead to extensor tendon rupture due to dorsal screw penetration. The aim of our study was to investigate the occurrence of dorsal and intra-articular screw penetration using CT scan after volar distal radius osteosynthesis for distal radius fractures.

    METHODS: Thirty patients who underwent distal volar locking plate for distal radius fracture were included in a retrospective study. In all 30 patients no dorsal and intra-articular screw penetration were detected on standard AP and lateral views of a plain radiograph. CT scan of the operated wrist was performed to determine the number of intra-articular and dorsal screw penetrations. Clinical examination was performed to determine the wrist functions in comparison to the normal wrist.

    RESULTS: Nineteen wrists were noted to have screw penetration either dorsally or intraarticularly. The highest incidence is in the 2nd extensor compartment where 13 screws had penetrated with a mean of 2.46 mm. Six screws penetrated into the distal radial ulnar joint and five screws into the wrist joint with a mean of 2.83 mm and 2.6 mm, respectively. However, there was no incidence of tendon irritation or rupture.

    CONCLUSIONS: This study demonstrated a high incidence of dorsal and intra-articular screw penetration detected by CT scan which was not apparent in plain radiograph. We recommend that surgeons adhere to the principle of only near cortex fixation and downsizing the locking screw length by 2 mm.

    Matched MeSH terms: Fracture Fixation, Internal*
  11. Fulltext Simple approach to the management of aseptic non-union of the shaft of long bones
    Devnani AS
    Singapore Med J, 2001 Jan;42(1):20-5.
    PMID: 11361233
    Internal fixation with a plate in the management of non-union for shaft of long bones has been condemned but the review of the literature does not provide such unequivocal evidence. Also there are certain situations where it is either technically not feasible or contraindicated to do closed intramedullary nailing. This study was done to see the outcome of plate-fixation for the treatment of non-union of the shaft of long bones.
    Matched MeSH terms: Fracture Fixation, Internal/methods*
  12. Fulltext Femoral overgrowth following plate fixation of the fractured femur in children
    Sulaiman AR, Joehaimy J, Iskandar MA, Anwar Hau M, Ezane AM, Faisham WI
    Singapore Med J, 2006 Aug;47(8):684-7.
    PMID: 16865208
    The purpose of this study is to determine the overgrowth phenomenon of the affected femur following plate fixation of femoral fractures in children.
    Matched MeSH terms: Fracture Fixation, Internal/adverse effects*
  13. Plating of Distal Radius Fracture Using the Wide-Awake Anesthesia Technique
    Ahmad AA, Yi LM, Ahmad AR
    J Hand Surg Am, 2018 Nov;43(11):1045.e1-1045.e5.
    PMID: 29866390 DOI: 10.1016/j.jhsa.2018.03.033
    Fractures of the distal radius are one of the most common types of injuries encountered in hand surgery. Plate osteosynthesis is recommended for unstable fractures. Because distal radius fracture fixation is usually performed under general or regional anesthesia with the use of a tourniquet, this exposes patients, especially elderly people with extensive comorbidities, to adverse effects commonly associated with these forms of anesthesia. As such, many of these patients are unable to undergo surgery in a timely manner until they are deemed medically fit for surgery or anesthesia, and some may still be treated nonsurgically. Injecting local anesthetic of lidocaine and epinephrine into the surgical field and without using a tourniquet is known to be advantageous for various surgical procedures of the hand. However, this approach, also known as wide-awake local anesthesia no tourniquet (WALANT), has not been used in the fixation of fractures beyond the wrist. Using the WALANT approach as an alternative anesthetic for plating of distal radius fractures may enable patients who are normally denied surgery owing to their age or medical comorbidities to undergo plate fixation for the fractures. This article outlines the WALANT approach used for a single case of fixation of distal end radius fracture with a detailed description of the technique of administering local anesthesia.
    Matched MeSH terms: Fracture Fixation, Internal/methods*
  14. Fulltext The pattern of femoral diaphyseal fractures in children admitted in Sarawak General Hospital
    Rasit AH, Mohammad AW, Pan KL
    Med J Malaysia, 2006 Feb;61 Suppl A:79-82.
    PMID: 17042236
    Trend towards changing the face of management for pediatric femoral fractures tends to advocate operative treatment. This study was undertaken to review our current practice in the wake of recent progress in the management of pediatric femoral fractures. Fifty patients with femoral diaphyseal fracture treated in Sarawak General Hospital were reviewed retrospectively after an average follow-up of 2.6 years. There were 36 boys and 14 girls, with a mean age of 6.2 years (range five months to 14 years). Children under six years of age constituted the majority of the patients. Half of the fractures were caused by road traffic accident. Nine patients had associated injuries. The most common site of fracture was at the middle third (N=31). The treatment regimens were delayed hip spica (DHS) in 16, immediate hip spica (IHS) in 24, plate osteosynthesis (PO) in five, titanium elastic nailing (TEN) in five, and external fixation (EF) in one. The minimum hospital stay was two days, and the maximum 33 days (mean, 9.7 days). Malunion was the commonest complication. Conservative treatment is the preferred option for children under six years of age. It is cost-effective with minimal complication. The other treatment options are reserved for specific indication in older children. Diaphyseal fractures of the femur in children can be adequately managed non-operatively.
    Matched MeSH terms: Fracture Fixation, Internal/adverse effects; Fracture Fixation, Internal/utilization
  15. Fulltext Plate osteosynthesis of the humerus shaft fracture an its association with radial nerve injury--a retrospective study in Melaka General Hospital
    Lim KE, Yap CK, Ong SC, Aminuddin
    Med J Malaysia, 2001 Jun;56 Suppl C:8-12.
    PMID: 11814257
    Over a seven-year period, 170 cases of humerus fractures were plated in Hospital Melaka. Of these, 131 cases were successfully traced for this study. Besides looking at fracture epidemiology, its relationship with radial nerve injury was examined. The incidence of post-traumatic wrist drop in closed and compound fractures were 14.9% and 35.3% respectively. In relation to the site of fracture, lower third fracture had the highest incidence of wrist drop (29%). The recovery from post-traumatic wrist drop was 83%. The average duration taken for recovery was 11.8 weeks. The incidence of post-operative wrist drop was high at 17.6% but all recovered during follow-up.
    Matched MeSH terms: Fracture Fixation, Internal/adverse effects*; Fracture Fixation, Internal/statistics & numerical data
  16. Comparison of two methods of percutaneous pin fixation in displaced supracondylar fractures of the humerus in children
    Foead A, Penafort R, Saw A, Sengupta S
    J Orthop Surg (Hong Kong), 2004 Jun;12(1):76-82.
    PMID: 15237126
    To conduct a prospective randomised controlled study to compare the stability and risk of nerve injury between fractures treated by medial-lateral pin fixation and those treated by 2-lateral pin fixation.
    Matched MeSH terms: Fracture Fixation, Internal/instrumentation*; Fracture Fixation, Internal/methods
  17. Fulltext The use of X-shaped cross-link in posterior spinal constructs improves stability in thoracolumbar burst fracture: a finite element analysis
    Alizadeh M, Kadir MR, Fadhli MM, Fallahiarezoodar A, Azmi B, Murali MR, et al.
    J Orthop Res, 2013 Sep;31(9):1447-54.
    PMID: 23640802 DOI: 10.1002/jor.22376
    Posterior instrumentation is a common fixation method used to treat thoracolumbar burst fractures. However, the role of different cross-link configurations in improving fixation stability in these fractures has not been established. A 3D finite element model of T11-L3 was used to investigate the biomechanical behavior of short (2 level) and long (4 level) segmental spine pedicle screw fixation with various cross-links to treat a hypothetical L1 vertebra burst fracture. Three types of cross-link configurations with an applied moment of 7.5 Nm and 200 N axial force were evaluated. The long construct was stiffer than the short construct irrespective of whether the cross-links were used (p < 0.05). The short constructs showed no significant differences between the cross-link configurations. The XL cross-link provided the highest stiffness and was 14.9% stiffer than the one without a cross-link. The long construct resulted in reduced stress to the adjacent vertebral bodies and screw necks, with 66.7% reduction in bending stress on L2 when the XL cross-link was used. Thus, the stability for L1 burst fracture fixation was best achieved by using long segmental posterior instrumentation constructs and an XL cross-link configuration. Cross-links did not improved stability when a short structure was used.
    Matched MeSH terms: Fracture Fixation, Internal/instrumentation*; Fracture Fixation, Internal/methods
  18. Nerve injuries in supracondylar fractures of the humerus in children: is nerve exploration indicated?
    Khademolhosseini M, Abd Rashid AH, Ibrahim S
    J Pediatr Orthop B, 2013 Mar;22(2):123-6.
    PMID: 23222035 DOI: 10.1097/BPB.0b013e32835b2e14
    A retrospective study of nerve injuries with displaced supracondylar fractures of the humerus in children younger than 12 years of age, treated in Hospital Universiti Kebangsaan Malaysia. Our objectives were to determine the incidence of primary and iatrogenic nerve injuries in supracondylar humerus fractures Gartland types II and III and to determine the outcome of nerve recovery. A total of 272 patients with displaced supracondylar humerus fractures who required admission to Hospital Universiti Kebangsaan Malaysia from January 2000 to December 2007 were reviewed. There were 182 boys (67%) and 90 girls (33%). The mean age was 6.0 years, ranging from 1 to 12 years. Of 272 supracondylar fractures, 79 were type II and 193 were type III. Fifty-one (19%) patients had closed reduction, 160 (59%) had closed reduction and percutaneous crossed Kirschner (K) wires, and 61 (22%) had open reduction and crossed K-wires. Associated nerve injuries involving the median, radial, and ulnar nerves were observed in 48 (18%) patients. Nerve injuries were observed in nine (3%) patients upon admission. Thirty-nine (14%) patients developed nerve injuries following treatment. Of these 39 patients, 34 had ulnar, three had radial, and two had median nerve injuries. Nerve exploration was performed in five patients (in four patients following debridement of open fracture and in one because of unacceptable postoperative radiographs, and they subsequently underwent open reduction and exploration). Except for these five patients, the K-wires were not removed earlier nor were the nerves surgically explored in others. The nerve injuries resolved clinically on an average time of 3.5 months (range from 3 weeks to 8 months). Our study found complete resolution of all patients with nerve injuries confirmed by clinical assessment. On the basis of our study, we believe that there is no indication to remove the K-wires immediately or to explore the nerve surgically following a mini-open technique, which reduces the risk of penetrating a nerve during pinning.
    Matched MeSH terms: Fracture Fixation, Internal/adverse effects*; Fracture Fixation, Internal/instrumentation*; Fracture Fixation, Internal/methods
  19. Letter to the Editor: Minimally invasive plate osteosynthesis for proximal humeral fractures
    Sinha N, Rao BS, Trivedy PD, Rao AS
    J Orthop Surg (Hong Kong), 2016 04;24(1):139.
    PMID: 27122535
    Matched MeSH terms: Fracture Fixation, Internal
  20. Fulltext The results of surgical treatment of tibial plateau fractures
    Ruslan GS, Razak M
    Med J Malaysia, 1998 Sep;53 Suppl A:35-41.
    PMID: 10968181
    Thirty-eight tibial plateau fractures were treated with open reduction and internal fixation. The fractures were classified into six groups (Hohl's 1991 Classification) and the clinical results were evaluated using the Rasmussen (1973) criteria. The average follow-up period was 2.07 years. Overall there was one excellent, thirty-four (34) good, three fair and no poor results. In three patients with less than a good score there were other associated ipsilateral injuries and delayed mobilisation of the knee joint. There was no direct association between the type of internal fixation and the end result.
    Matched MeSH terms: Fracture Fixation, Internal
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