Displaying publications 61 - 80 of 597 in total

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  1. Soh E, Muhamad-Ariffin MH, Baharudin A
    Malays Orthop J, 2020 Mar;14(1):88-91.
    PMID: 32296489 DOI: 10.5704/MOJ.2003.015
    Treatment of severe spinal deformities associated with neurofibromatosis has proven to be challenging. An 11-year-old girl, with neurofibromatosis and severe cervicothoracic kyphoscoliosis, was initially treated with posterior instrumentation and fusion. Implant failure developed within a year, requiring an anterior stabilisation and fusion with a non-vascularised fibular strut graft for better stability and increased likelihood of achieving union. The posterior instrumentation was removed due to its prominence and wound breakdown. Following the removal of the posterior implant, the fibular graft fractured. The patient was maintained on a cervical collar until union was achieved. Posterior spinal fusion alone in severe spinal deformities in neurofibromatosis has a high risk of failure. A combined anterior and posterior fusion may increase the chance of success, with better stability and union rate.
  2. Ariffin, M. H., Selvyn Lloyd, Rhani, S. A., Kamalnizat, Baharudin, A.
    Malays Orthop J, 2014;8(2):40-42.
    MyJurnal
    The management of post-radiation wound breakdown over the posterior cervico thoracic region can be a challenging task for a surgeon. The aim of the treatment is to produce a well vascularized and a low tensile flap which will close a large defect. We describe the use of the lower trapezius flap to reconstruct the wound breakdown and to obtain stable tissue coverage in a patient with post- radiation necrosis. This flap minimizes the disruption of the scapula-thoracic function while preserving the range of movement over the shoulder. From the literature review, it was noted that the dorsal scapular artery (DSA) and transverse cervical artery (TCA) aid in the blood supply to the trapezius muscle and prevent local necrosis during rotation of the flap. The trapezius flap is widely accepted because of the minor donor site morbidity, large arc of rotation and adequate blood supply.
  3. Abd-Rasid AF, Bajuri MY
    Malays Orthop J, 2020 Jul;14(2):130-133.
    PMID: 32983388 DOI: 10.5704/MOJ.2007.011
    Peroneal tendon tear is a relatively common cause of lateral ankle pain but often missed due to mixed presentation or low index of suspicion. Left untreated, peroneal injuries can lead to persistent ankle pain, instability and ultimately substantial functional disabilities. An isolated peroneus longus tear is rare with the lowest incidence rate compared to isolated peroneus brevis tear and mixed tear of both peroneal tendon. This is a case report of a 49-year-old lady with a chronic left ankle pain who ultimately underwent surgery for an isolated peroneus longus tear.
  4. Narayanan VL, Balasubramanian N
    Malays Orthop J, 2018 Jul;12(2):20-24.
    PMID: 30112124 DOI: 10.5704/MOJ.1807.004
    Introduction: Proximal humerus fracture fixation using plate osteosynthesis depends on the quality of the bone, design of the fixation devices and intra-operative soft tissue dissection. This study evaluates the functional outcome of minimally invasive percutaneous plate osteosynthesis using locking compression plate in proximal humerus fracture treatment. Materials and Methods: The study was conducted on 30 patients with complex proximal humerus fractures treated by minimally invasive percutaneous plate osteosynthesis using locking compression plate (PHILOS). There were 21 males and 9 females. The average age of our study group was 58.8 years. All the patients were evaluated at six weeks, three months, four months, six months and 12 months following surgery. Results: All patients had fracture union at an average of 13.2 weeks. The mean DASH score at the follow-up was 8.69 (2.5 to 17.16), the average range of flexion was 143.83 degrees (100 to 170 degrees) and abduction was 121.49 degrees (90 to 160 degrees). We had superficial infection in three patients which resolved with a short course of antibiotics. There was excellent outcome in 26 patients, good and fair in two patients each. Conclusion: Proximal humerus fractures treated with minimally invasive percutaneous plate osteosynthesis using locking compression plate with minimal soft tissue dissection, provides good functional outcome and early return of shoulder function.
  5. Krishna A, Garg S, Gupta S, Bansal H
    Malays Orthop J, 2021 Jul;15(2):143-150.
    PMID: 34429835 DOI: 10.5704/MOJ.2107.021
    Introduction: To evaluate the trends of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) in the first three weeks after uncomplicated total hip (THR) and total knee (TKR) arthroplasty/replacement in the Indian population and to compare it with available literature.

    Materials and methods: A total of 90 patients were enrolled for this prospective study, of which 30 were unilateral THR, 30 were unilateral TKR (U/L TKR) and 30 were simultaneous bilateral TKR (B/L TKR). Serum CRP and ESR were measured on the day before surgery and post-operatively on day 1st, 2nd, 3rd, 7th, 12th, and at the end of 3rd week.

    Results: CRP showed a peak at day 2nd with normalisation to pre-operative value by the end of 3rd week. While ESR showed a peak on day 3rd and continued to remain elevated even at end of 3rd week post-operatively. Both mean CRP and ESR values were higher in THR patients followed by in B/L TKR and then in U/L TKR patients.

    Conclusion: CRP persists to be the best acute phase reactant in the early post-operative phase with a relatively typical pattern as compared to ESR. CRP values peak at post-operative day 2nd and then show a gradual decline. However, its normalisation to pre-operative baseline values may vary among different groups of population.

  6. Soni A, Gupta RK, Raghav M, Masih GD, Bansal P
    Malays Orthop J, 2021 Jul;15(2):12-17.
    PMID: 34429817 DOI: 10.5704/MOJ.2107.003
    Introduction: Bone-patellar tendon-bone (BPTB) and semitendinosus-gracilis (STG) are the commonest grafts used for ACL reconstruction. However even after having been debated for years, there is no consensus about the ideal graft. Moreover, the literature is deficient about STG graft with preserved tibial insertion (STGPI) which preserves the proprioception. Our aim is to compare the outcome of BPTB, free STG and STGPI grafts after ACL reconstruction in professional sports persons. We compared the outcome in terms of mechanical stability, functional outcome, return to sports activity and degenerative changes.

    Material and Methods: Professional sports persons aged between 16-50 years operated for ACL tear using BPTB, free STG and STGPI grafts with minimum follow-up of two years were identified from hospital records. Patients with associated knee injuries were excluded. Patients, divided in three groups according to graft used, were compared in terms of mechanical stability (arthrometric examination KT-1000 score), functional outcome (Lysholm Score), return to sports activity (Tegner score and difference in thigh circumference) and degenerative changes (KL grading).

    Results: BPTB graft group was found to be better than free STG and STGPI graft groups in terms of KT-1000 score. There was no statistically significant difference among the groups in terms of Lysholm score, Tegner score, difference in thigh circumference and KL grading.

    Conclusion: BPTB graft is better than free STG and STGPI grafts in terms of knee stability. When compared for patient reported outcome, return to sports activity, osteoarthritic changes and graft failure there is no significant difference among the three types of grafts.

  7. Iqbal MA, Khan I, Rehman S, Beg M
    Malays Orthop J, 2022 Nov;16(3):70-75.
    PMID: 36589368 DOI: 10.5704/MOJ.2211.012
    INTRODUCTION: The ulnar nerve palsy is a distressing injury, resulting in clawing of hand. The cause of clawing is due to paralysis of the interosseous muscles in the presence of functioning long extensor and long flexors of fingers. Various methods have been proposed to correct this deformity which include both static and dynamic procedures. In this study, we share our experience with flexor digitorum superficialis tendon transfer using Zancolli's modification for anti-claw correction.

    MATERIALS AND METHODS: It was a retrospective case series study. A record of 53 patients was included in the study, during a period between June 2013 to July 2017 with ulnar nerve palsy. The procedure done was flexor digitorum superficialis tendon transfer as dynamic anti-claw procedure. The follow-up period was three months. The outcomes assessed were grip strength by using sphygmomanometer and active range of motion of fingers assessed by fingers tips touching the palm.

    RESULT: Fifty-three patients were included out of them, there were fifty males and three females. The mean age was 28±10 years. All patients underwent flexor digitorum superficialis transfer for ulnar claw hand. A total of 84.9% patients have good grip strength and 83% showed good active range of motion.

    CONCLUSION: Flexor digitorum superficialis tendon transfer is found to be effective, reliable and reproducible technique in ulnar nerve palsy where patient need grip strength, good range of motion and acceptable hand function for daily routine work.

  8. Duarte-Silva M, Guerra-Pinto F, Camelo-Barbosa N, Beja-da-Costa P
    Malays Orthop J, 2019 Jul;13(2):38-41.
    PMID: 31467650 DOI: 10.5704/MOJ.1907.007
    Meniscectomy is the most common surgery in orthopaedics. The absence of meniscal tissue might be related to irreversible damage to the articular cartilage. Meniscal replacement is a tissue-engineering technique for post-meniscectomy syndrome. Its success depends on the implant integration which was vastly proven in animal model studies. Histological evidence is hard to obtain in humans due to ethical issues. We report a clinical case in which a collagen scaffold meniscal implant was harvested six months after implantation due to mechanical failure. Histological analysis was performed revealing vascularisation not only of the peripheral attachment of the implant but also on the anterior horn. These morphologic findings demonstrate that this implant allows the colonisation by precursor cells and vessels, leading to the formation of a fully functional tissue. This present report is one of the few independent reports of scaffold biological integration in the literature.
  9. Asma A, Onal C, Eroglu ON, Berk RH
    Malays Orthop J, 2022 Nov;16(3):120-127.
    PMID: 36589374 DOI: 10.5704/MOJ.2211.018
    INTRODUCTION: The instantaneous centre of rotation (ICR) is the centre of motion with zero velocity where a rigid body moves in a particular plane. ICR, as a dynamic measurement, gives more accurate results in terms of quality and quantity of the vertebral motions compared to range of motion (ROM). We aimed to determine the effect of thoracic instrumentation on cervical movement of adolescent idiopathic scoliosis (AIS) patients who had undergone thoracic level instrumentation by measuring pre-operative and post-operative ICR change in a pilot study.

    MATERIALS AND METHODS: A total of 25 AIS patients were included in this study. C4-C5 and C6-C7 segmental ICR were determined by pre-operative and post-operative cervical flexion-extension radiographs. In addition, cervical sagittal parameters and global sagittal parameters were investigated.

    RESULTS: There was no statistically significant change in ICR location post-operatively in both x and y coordinates at C4-C5 segment (p: 0.326 and p: 0.946, respectively) and C6-C7 segment (p: 0.209, p: 0.086, respectively). There was a positive correlation between LCL and C4-C5 ICR y coordinate (r: 0.481), but not with C6-C7 ICR y coordinate (r: -0.2, p: 0.398). T5-T12 kyphosis decreased (p: 0.002) and T1 pelvic angle (0.003), SVA (0.02) and sacral slope (0.049) increased significantly post-operatively. T1S was correlated with LCL (r: 0.595, p: 0.002), T5-T12 kyphosis (r: 0.423, p: 0.035), SVA (r: 0.658, p<0.001) and C2-C7 SVA (r: 0.416, p: 0.039).

    CONCLUSION: The ICR for cervical region was not changed post-operatively in AIS patients with thoracic instrumentation. There was no relationship found between the development of post-operative cervical kyphosis or lordosis and ICR, which represents the quality and quantity of intervertebral motion. The T1 vertebra plays a key role for cervical, thoracic, and global parameters interaction.

  10. Belgaid V, Courtin C, Desmarchelier R, Fessy M, Besse JL
    Malays Orthop J, 2020 Nov;14(3):82-89.
    PMID: 33403066 DOI: 10.5704/MOJ.2011.013
    Introduction: Diabetic foot ulcer is the main aetiology for non-traumatic amputation, which is a major public health care concern. A multidisciplinary approach in the management of this pathology has been shown to improve the surgical outcome. However, there are little data available on the tools we can use to pursue this multidisciplinary approach. The main goal of this cross-sectional study was to find out whether the implementation of a specific management pathway could improve the treatment outcome in the treatment of diabetic foot.

    Materials and Methods: From 2012 to 2014, we consecutively recruited patients with diabetic foot referred to Orthopaedic surgery department of our university for surgical opinion. A specific diabetic foot pathway was introduced in 2013. One group of patients who were treated with previous method were evaluated retrospectively. Another group of patients who were treated after implementation of the pathway were evaluated prospectively. We compared treatment outcome between the two groups.

    Results: We included 51 patients. Amputation rate was similar both the groups: 74% in the retrospective group not using the new pathway versus 73% in a prospective group that used the new pathway. Revision surgery was 39% in the retrospective group and 14% in the prospective group (p=0.05).

    Conclusion: We recommend the use of this simple and cost-effective pathway to guide the interdisciplinary management of diabetic foot. A prospective study with more subjects would provide a better overview of this management pathway.

  11. Agrawal S, Chabra T, Pandey S, Bhardwaj P
    Malays Orthop J, 2019 Mar;13(1):20-24.
    PMID: 31001379 DOI: 10.5704/MOJ.1903.003
    Introduction: Carpal collapse of wrist occurs in disorders like rheumatoid arthritis and Kienbock's disease. Three techniques have been described to measure carpal collapse. First, the carpal height ratio (CHR), measured by dividing carpal height by 3rd metacarpal length. Second, the revised carpal height ratio (RCH ratio), measured by dividing carpal height by length of capitate. Third, capitate radius distance (CR index), measured by shortest distance between distal edge of radius and the proximal edge of capitate. The index publications describe good reliability of all these but which method out of the three is best in terms of intra- and inter-observer variability is not known. The purpose of this study was to find out which method had the least inter- and intra-observer variability for determining carpal collapse. Materials and Methods: Fifty normal wrist postero-anterior radiographs were studied by three assessors who measured CHR, RCH ratio and CR index separately. The measurements were repeated after one month by all the three observers. The results were then statistically analysed. Results: The p-value was <0.001 in all the three assessors in CR index meaning that the intra-observer variability was least in CR index. For the inter-observer variability intra class coefficient of 0.9 indicated that the CR index has the least variability. Conclusion: CR index is the most reproducible method to measure carpal collapse. The method which provides accurate measurement of carpal collapse will allow better staging of carpal disorders.

    Study site: Grande Hospital, Nepal
  12. Nema S, Vyas G, Sirsikar A, Bhoj PK
    Malays Orthop J, 2012 Jun;6(SupplA):41-2.
    PMID: 25279074 MyJurnal DOI: 10.5704/MOJ.1211.010
    We present here a unique case of humeroradial synostosis. These anomalies are due to longitudinal failure of differentiation. Approximately 150 cases of humeroradial synostosis have been reported worldwide, the majority of which are familial in nature or associated with syndromes. The case presented here involves an infant aged 1½ months, born with bilateral humeroradial synostosis without familial or syndromic association. To the best of our knowledge, no such case has been reported in Asia.
  13. Pande K, Aung TT, Leong JF, Bickle I
    Malays Orthop J, 2017 Mar;11(1):77-78.
    PMID: 28435582 DOI: 10.5704/MOJ.1703.012
    Transient osteoporosis of the hip (TOH) is a benign, selflimiting condition characterised by acute onset groin pain in adults. Early diagnosis is important to differentiate it from progressive conditions such as osteonecrosis. We report on a middle-aged male who presented with right groin pain without any prior trauma. The diagnosis of transient osteoporosis of hip was confirmed by Magnetic Resonance Imaging (MRI) and he was successfully treated with a course of Alendronate sodium, anti-inflammatory analgesics and a period of non-weight bearing ambulation.
  14. Deslivia MF, Savio SD, Wiratnaya I, Astawa P, Sandiwidayat KS, Bimantara NG
    Malays Orthop J, 2023 Mar;17(1):98-110.
    PMID: 37064619 DOI: 10.5704/MOJ.2303.012
    INTRODUCTION: Anti-osteoclastic mechanism of Bisphosphonate (BP) is crucial to treat Giant Cell Tumour of the Bone (GCTB), however no established guidelines of its use have been published. This systematic review and meta-analysis is the first to summarise recent clinical studies on the subject.

    MATERIALS AND METHODS: A systematic search was performed based on PRISMA guidelines for clinical trials of BP administration in GCTB. Baseline data including BP regimen, dose and timing was summarised. The primary outcomes assessed were recurrence rate, metastases, survival rate, functional outcome, clinical outcome, radiological outcome, and adverse effect.

    RESULTS: We identified 8 articles from 2008-2020. Most studies administer 4mg of Zoledronic acid post-operatively, with five studies mentioning pre-operative administration and six studies describing post-operative administration. There was a total of 181 GCTB cases analysed in this study. The BP group presented lower recurrence rate than control group (three studies; Odds Ratio [OR] 0.15; 95% Confidence Interval [CI], 0.05 - 0.43; p<0.05; heterogeneity, I2=0%). As for survival rate, BP group is comparable to control group (two studies; OR 1.67; 95% CI, 0.06 - 48.46; p=0.77; heterogeneity, I2=65%).

    CONCLUSION: Bisphosphonate therapy offers satisfactory recurrence rate, functional outcome, clinical outcome, radiological outcome, survival rate and metastases rate in patients with GCTB, with minimal adverse effects. Pre- and post-operative administration of bisphosphonates in combination might be the most beneficial in minimalising the recurrence rate.

  15. Bajuri MY, Boon HW
    Malays Orthop J, 2018 Mar;12(1):60-62.
    PMID: 29725518 MyJurnal DOI: 10.5704/MOJ.1803.015
    Bilateral clavicle fractures are not frequently seen. To treat these injuries surgically or non-surgically is still a debatable issue. Implant option for surgical management is also in doubt. We would like to share our experience in treating a patient with bilateral clavicle fracture surgically. He had excellent outcomes in terms of function and radiology. Surgical option for bilateral clavicle fractures promises excellent outcome in terms of early rehabilitation and return in function.
  16. Kampitak W, Tanavalee A, Ngarmukos S, Amarase C, Songthamwat B, Boonshua A
    Malays Orthop J, 2018 Mar;12(1):7-14.
    PMID: 29725506 DOI: 10.5704/MOJ.1803.002
    Introduction: Total knee arthroplasty (TKA) is associated with intense postoperative pain for which effective analgesia is essential to facilitate early postoperative recovery. Adductor canal block (ACB) and local infiltration analgesia (LIA) have become increasingly involved in postoperative pain management after TKA. We aimed to compare their efficacy and outcomes in patients undergoing TKA. Materials and Methods: Sixty patients undergoing unilateral TKA were randomized to receive either postoperative single-injection ACB (Group A) or LIA (Group L) during the operation. All patients received spinal anaesthesia. Primary outcome was total morphine consumption over postoperative 24 hours. Visual analog pain scale, time to first and total dosage of rescue analgesia, performance-based evaluations [timed-up and go (TUG) test, quadriceps strength], side-effects, length of hospital stay and patient satisfaction were measured. Results: Fifty-seven patients were available for analysis. Median total morphine consumption over 24 and 48 postoperative hours of Group A were significantly less than Group L (6/10 mg vs 13/25 mg, p, 0.008 and 0.001, respectively). Similarly, Group A had significantly lower VAS at postoperative 6, 12 and 18 hours, VAS at ambulation on postoperative (POD) 1-3, better TUG tests on POD 2 and during POD 3 than those of Group L. However, quadriceps strength and patient satisfaction were not different between both groups. Conclusion: Patients undergoing TKA with single-injection ACB required less postoperative opioids than those with LIA. Furthermore, multimodal analgesia using ACB provided better postoperative analgesia, as well as performance-based activities, than those with LIA.
  17. Niempoog S, Sukkarnkosol S, Boontanapibul K
    Malays Orthop J, 2019 Nov;13(3):15-20.
    PMID: 31890105 DOI: 10.5704/MOJ.1911.003
    Introduction: Osteoporosis is a devastating problem leading to significant morbidity and mortality. Patients with osteoporosis usually present with fractures from low-energy trauma and falls, commonly of the distal radius, which may precede more severe fractures like fracture of the neck of femur, but data from Thailand are limited. The objective of our study was to determine the prevalence of osteoporosis in patients with distal radius fracture from low-energy trauma. Materials and Methods: This was a descriptive retrospective study, performed at Thammasat University Hospital in Thailand, from January 2011 to June 2017. Patients aged more than 50 years with distal radial fractures from low-energy trauma with available bone mineral density (BMD) result were included. Patients with known secondary causes of osteoporosis were excluded. Patients were grouped by age, sex, and BMD status (normal, osteopenic and osteoporotic). Results: One hundred out of 351 patients with distal radial fractures had bone mineral density data but only 79 (73 females) met the inclusion criteria. Most patients were aged 60-69 years old (n=31, 42.5%). 47 (59.5%) patients were osteoporotic, 23 (29.1%) osteopenic, and 9 (11.4%) were normal. Seven (6 osteoporotic) patients suffered a more severe fracture subsequently. No deaths were recorded. Conclusion: Our study found a high rate of osteoporosis mostly in females, consistent with published literature. Assessing BMD is crucial in middle age and elderly patients with fractures to better manage osteoporosis and prevent more severe fractures in the future.
  18. Yong, S.M., Saw, A., Sengupta, S., Bulgib A.M.
    Malays Orthop J, 2007;1(1):8-11.
    MyJurnal
    Forty children treated non-operatively for fractures of the femoral shaft were reviewed with regard to differences in limb length after treatment. Follow up duration ranged from two to seven years. The average femoral overgrowth was 0.85cm (range 0 - 2.5cm) and was influenced by age at the time of fracture. We were not able to find any association between the quantity of overgrowth and race, gender, level or configuration of the fracture.
  19. Saw, A., Manimaran, S., Faizal S., Bulgiba, A.M.
    Malays Orthop J, 2008;2(1):44-48.
    MyJurnal
    Bone lengthening with distraction osteogenesis involves prolonged application of an external fixator frame. Qualitative and quantitative evaluation of callus has been described using various imaging modalities but there is no simple reliable and readily available method. This study aims to investigate the use of a densitometer to analyze plain radiographic images and correlate them with the rate of new bone formation as represented by the bone healing index. A total of 34 bone lengthening procedures in 29 patients were retrospectively reviewed. We used an X-Rite 301 densitometer to measure densities of new callus on plain radiographs taken at 4 and 8 weeks after surgery. Patients aged below 16y had significantly lower BHIs indicating faster bone healing and shorter duration of treatment. The ratio of radiographic densities between centre and edge of the new bone measured from plain radiographs taken at 8 weeks correlated positively with the eventual BHI of the patient. This method provides a simple and easy way to predict the rate of bone healing at an early stage of treatment and may also allow remedial action to be taken for those with poor progress in bone formation.
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