Displaying publications 41 - 60 of 105 in total

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  1. 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
  2. Faria G, Virani S, Tadros BJ, Dhinsa BS, Reddy G, Relwani J
    Malays Orthop J, 2021 Mar;15(1):100-104.
    PMID: 33880155 DOI: 10.5704/MOJ.2103.015
    Introduction: COVID-19 has had a significant impact on the entire health system. The trauma and orthopaedic service has been compelled to alter working practices to respond proactively and definitively to the crisis. The aim of this study is to summarise the impact of this outbreak on the trauma and orthopaedic workload and outline the response of the department.

    Materials and Methods: We retrospectively collected data comparing patient numbers pre-COVID-19, and prospectively during the early COVID-19 pandemic. We have collected the numbers and nature of outpatient orthopaedic attendances to fracture clinics and elective services, inpatient admissions and the number of fracture neck of femur operations performed.

    Results: The number of outpatient attendances for a musculoskeletal complaint to Accident and Emergency and the number of virtual fracture clinic reviews reduced by almost 50% during COVID-19. The number of face-to-face fracture clinic follow-ups decreased by around 67%, with a five-fold increase in telephone consultations. Inpatient admissions decreased by 33%, but the average number of fracture neck of femur operations performed has increased by 20% during COVID-19 compared to pre-COVID-19 levels.

    Conclusion: We have noted a decrease in some aspects of the trauma and orthopaedic outpatient workload, such as leisure and occupational-related injuries but an increase in others, such as fracture neck of femurs. Many injuries have significantly reduced in numbers and we consider that a model could be developed for treating these injuries away from the acute hospital site entirely, thereby allowing the acute team to focus more appropriate major trauma injuries.

    Matched MeSH terms: Orthopedics
  3. Lee, K.H., Ng, A.B.Y., Tan, T.B., Mossinac, K., To, B.C. Se
    Malays Orthop J, 2008;2(2):11-15.
    MyJurnal
    Gentamicin, whether administered either intravenously, incorporated into bone cement or for local intra-operative irrigation, is a commonly used antibiotic in orthopaedic practice. The former two have been well studied, however the literature on the therapeutic efficacy and safety of gentamicin irrigation is sparse. The objective of this study was to assess systemic absorption of gentamicin irrigation in joint replacement surgery. This was a non-randomised, prospective study. Ninety-eight patients (group A) who underwent total joint replacement and 40 patients (group B) who underwent hemi-arthroplasty were treated traoperatively with gentamicin irrigation. Serum gentamicin levels were assayed at 4 hours and 24 hours post-surgery. Sixteen of 98 patients in group A (16%) and 12 out of 40 patients in group B (30%) were found to have serum gentamicin level above 2mcg/ml at 4 hours post-surgery. We conclude that intra-articular gentamicin irrigation is systemically absorbed at substantial levels.
    Matched MeSH terms: Orthopedics
  4. 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
  5. Suhail,A., Gunalan, Sabarul, A ., Shahril, Y., Salasawati, H., Masbah, O.
    Malays Orthop J, 2008;2(2):1-5.
    MyJurnal
    Infection after joint replacement surgery is problematic and difficult to treat. The utility of antibiotic laden bone cement for reduction of risk of infection in primary and revision joint replacement surgery has already been established in many studies. In this study, we examined the efficacy of bone cement containing cefuroxime, employing a modified in vitro Kirby-Bauer susceptibility model for investigation of 13 strains of organisms that are found in orthopaedic infections. Organisms investigated were broad spectrum and effective for Gram-positive, Gram-negative, aerobic organisms and anaerobes. Simplex P with added cefuroxime was effective against 8 out of 13 strains. Cefuroxime is stable during exothermic polymerisation of the cement, and is released from the cement at concentrations high enough to inhibit the growth of most organisms encountered after joint arthroplasty.


    Matched MeSH terms: Orthopedics
  6. George, J., Teo, S.C., Adan, M.
    Malays Orthop J, 2008;2(1):33-37.
    MyJurnal
    Aim: This study was designed to evaluate the use of ultrasound in diagnosis of infection and tumour of long bones. Methodology: Patients referred from the orthopaedic unit with doubt regarding long bone clinical and/or radiological signs which could be tumour or infection were enrolled in this study. Analysis of ultrasound characteristics included presence of pericortical fluid over normal cortex well away from the primary lesion, wavy contour sign (fluid tracking in and out muscle planes), subperiosteal fluid and soft tissue mass displacing adjacent muscle planes. Results: Fourteen out of 15 patients with confirmed osteomyelitis were diagnosed by ultrasound examination. Ultrasound as a diagnostic tool has a sensitivity of 93% and specificity of 100%. The most accurate indicator was pericortical fluid noted up to several centimetres from the long bone abnormality seen on plain x-rays. Conclusion: Ultrasound is a safe, fast, cost-effective imaging modality that can play an important role in diagnosis of osteomyelitis as it then serves as a tool for ultrasound guided aspiration.
    Matched MeSH terms: Orthopedics
  7. 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.


    Matched MeSH terms: Orthopedics
  8. Pan, K.L., Zolqarnain A., Ong, G.B.
    Malays Orthop J, 2009;3(2):55-57.
    MyJurnal
    Osteosarcoma occurring in the humerus is often confined to the proximal part, in which case, reconstruction after excision is less daunting. When the tumour spreads down the medullary cavity distally, a total humeral replacement is often required. This is costly and beyond the means of the average patient in a developing country. An amputation is often the procedure of first resort. We report a 13-year-old boy with osteosarcoma originating from the left proximal humerus, with involvement of the marrow reaching down to the distal diaphyseal-metaphyseal junction, leaving only 6 cm of the distal humerus intact after wide resection. Reconstruction of the defect was done with a composite cement-autoclaved autograft fixed to the remaining humerus with a plate. At 40 months of follow-up, the patient is well with normal function of the elbow, wrist and hand. Salvaging the limb despite near total involvement of the humerus by high grade osteosarcoma is possible using material available in the average orthopaedic operating room.
    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. Chan, H. Z., Wang, C. S., Azuhairy, A., Hau, A., Zulkiflee, O.
    Malays Orthop J, 2014;8(1):79-81.
    MyJurnal
    Primary sacral tumours are rare, therefore experience of managing their associated complications are very limited. Effective surgical treatment of pelvic chondrosarcoma remains a major challenge for orthopaedic surgeons, due to the complex anatomic structure of the pelvis, the lack of defined compartment borders, the close vicinity to vital structures, and the risk of jeopardizing pelvic structural stability. We report a rare case of a giant sacral chondrosarcoma (100cm x 80cm) in an elderly male who successfully underwent tumour resection with good functional outcome and recovery. Long term follow up is essential in view of the possibility of local tumour recurrence.
    Matched MeSH terms: Orthopedics
  12. Sara Ahmad, T.
    Malays Orthop J, 2011;5(3):35-37.
    MyJurnal
    The Mahmood Merican Award is an annual award for the best original scientific or clinical study submitted by young trainees in orthopaedic surgery in Malaysia, for presentation during the annual scientific meeting of the Malaysian Orthopaedic Association (MOA). This award was initiated in 1997 to encourage high standard of research and scientific presentations among young trainees.A cash prize of RM 1,000 was donated by Dato Dr Mahmood Merican. All Award finalists will represent MOA as ambassadors to regional orthopaedic association meetings, a duty that will be fully sponsored by MOA.
    Matched MeSH terms: Orthopedics
  13. Dhillon KS
    Malays Orthop J, 2015;9(1):47-59.
    MyJurnal
    Conflicts of interest in medicine has created deep concerns about the integrity of medicine and raised doubts about the trustworthiness of the medical professional. New stories of conflict of interest in medicine have become a commonplace. The interactions between the medical professional and the biomedical device as well as the pharmaceutical industry has become so pervasive that the primary interest of the medical professional in protecting and promoting the welfare of the patient has been compromised. The professional judgement and actions have been influenced by secondary interests, the major fungible and quantifiable being financial interest. The industry influence not only affects the way we practice orthopaedics but also affects medical education and peer review publications. Peer review publications have been shown to exaggerate benefits of the industry products while at the same time downplaying the risks. These conflicts of interest in orthopaedic surgery are particularly common in spinal and joint replacement surgery where joint replacement has been described as a ‘fashion trade’. The introduction of new products appears to be an uncontrolled experiment which has been hijacked by large corporations. This article explores the unhealthy pervasive interaction between the orthopaedic surgeon and the medical devices as well as the pharmaceutical industry. It highlights how the biomedical and the pharmaceutical industry dominate all aspects of the healthcare system. With its wealth and political clout, its influence is present everywhere, from the use of devices and drugs, research, publications, trials, education and even formulation of CGPs.
    Matched MeSH terms: Orthopedics
  14. 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
  15. Hui,J.H.P., Azura M., Lee, E.H.
    Malays Orthop J, 2009;3(1):4-12.
    MyJurnal
    Regenerative medicine using stem cell therapy has sparked much interest in this 21st century not only because of the controversies that surround the ethics involving pluripotent stem cells but their potential for use in the clinic. The ability of stem cells to repair and regenerate new tissues and organs holds tremendous promise for the treatment of many serious diseases and injuries. This review provides a brief summary of the current status of research in stem cells with special emphasis on where we are in terms of the possible clinical application of stem cell therapy in orthopaedic surgery. We look at the available evidence and examine the ethical issues and considerations associated with the clinical use of stem cells.
    Matched MeSH terms: Orthopedics
  16. Saw, A.
    Malays Orthop J, 2007;1(2):1-2.
    MyJurnal
    Musculoskeletal tumour is much less common compared to tumours of epithelial origin. Most of these tumours are benign, with only about 1% malignant in nature. A general orthopaedic surgeon may only come across a malignant primary bone or soft tissue tumour a few times in his entire medical career. The current recommendation is for these conditions to be investigated and treated in centres with musculoskeletal oncology service. Careful clinical evaluation with appropriate plain radiography can provide adequate information for definitive diagnosis and treatment for most cases, especially the benign tumours. For some other cases, further investigations will be necessary. Magnetic resonance imaging (MRI) can provide excellent details on anatomical location of a tumour and delineate vital structures that may have been distorted by the lesion. For primary malignant tumours, computerized tomography scanning is still the gold standard for evaluation of pulmonary metastasis, and bone scan can allow early detection of distant metastasis to other bones. Whole body MRI has recently been recommended for tumour staging but the potential benefit for musculoskeletal tumour is not that convincing. PET may be very helpful for follow up detection of tumour recurrence but its role in diagnosis and staging of musculoskeletal tumours is still being evaluated...
    Matched MeSH terms: Orthopedics
  17. Vickash K, Amer A, Naeem A, Falak S
    Malays Orthop J, 2016 Nov;10(3):36-38.
    PMID: 28553446 DOI: 10.5704/MOJ.1611.001
    Elbow dislocation, though a common orthopaedic emergency is rare with brachial artery injury and is even more uncommon in the paediatric age group. We present the case of a child who sustained trauma resulting in closed elbow dislocation with brachial artery injury. Elbow dislocation with brachial artery injury can present with palpable distal pulses and good capillary refill because of rich collaterals at the elbow. But this patient presented with signs of frank ischemia distally, and was managed with ipsilateral reverse cephalic vein graft. He had good volume pulses at one year follow-up. Patients with such presentation should have careful clinical and radiological assessment to exclude complicated elbow dislocation.
    Matched MeSH terms: Orthopedics
  18. 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
  19. Tay K, Kamarul T, Lok WY, Mansor M, Li X, Wong J, et al.
    Malays Orthop J, 2020 Jul;14(2).
    PMID: 32313613 DOI: 10.5704/MOJ.2007.001
    With the increasing number of COVID-19 cases and related deaths worldwide, we decided to share the development of this condition in Singapore and Malaysia. First few cases were diagnosed in the two countries at the end of January 2020, and the numbers have surged to thousands by end of March 2020. We will focus on strategies adopted by the government and also the Orthopaedic community of the two countries up till the beginning of April 2020. We hope that by sharing of relevant information and knowledge on how we are managing the COVID-19 condition, we can help other communities, and health care workers to more effectively overcome this pandemic.
    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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