We report a case of chronic recurrent multifocal osteomyelitis in a 9-year-old girl. She presented with a 9-month history of gradually worsening pain and swelling in her left foot. Non-steroidal anti-inflammatory drugs were prescribed but the symptoms persisted. She underwent curettage through a small oval corticotomy window on the first metatarsal bone. The pain and swelling improved promptly and she was able to walk without pain 2 weeks later. Curettage enabled rapid symptomatic relief and induced remission, with little risk of complications.
A 56-year-old man became quadriplegic, bed bound, and carer-dependent secondary to cervical osteomyelitis. Three years later, he presented with generalised spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his hips and knees prevented ischial sitting. Injections of botulinum toxin type A to both hamstrings and gastrosoleuii controlled the flexor spasticity of his lower limbs and facilitated rehabilitation and wound healing through proper positioning, wound care, stretching, and weight-bearing exercises. A few weeks later, the patient could better position himself in bed (prone lying) and on his wheelchair (ischial sitting). His spasm-related pain lessened and his mobility and activities of daily living improved. The sacral pressure sore healed completely a few months later. The patient could sleep better, feed with set-up and adaptive aids, groom, dress, and transfer himself with minimal assistance. The effects of botulinum toxin extended beyond just spasticity reduction. His upper extremity function, mobility, and social well-being were all improved through better positioning.
Sacral tumours often present surgical resection and reconstruction challenges. Wide resections result in large sacral defects and neoadjuvant radiotherapy impairs wound healing. The wounds need to be covered with bulky, well-vascularised, healthy tissues. We present 2 cases where large sacral defects were reconstructed following tumour resection. Both defects were reconstructed with inferiorly based, transpelvic, pedicled vertical rectus abdominis myocutaneous flaps. This is a robust flap and carries a well-vascularised muscle bulk and skin paddle. The donor site is distant from the lesion site and is thus unaffected by both the resection and radiotherapy. This is a useful flap for reconstructing large sacral defects.
To evaluate the effect of autologous human serum (AHS) versus pooled human serum (PHS) versus foetal bovine serum (FBS) for growth of articular chondrocytes and formation of chondrocytefibrin constructs.
A Malaysian family with congenital insensitivity to pain with anhydrosis was diagnosed based on clinical symptoms of chronic ulcers, joint deformities, malunited fractures, anhydrosis, and learning disabilities. We detected a compound heterozygous mutation in exon 16: V709L from the mother and G718S from the father. Two novel mutations were identified: at amino acid 709, a change of G to C at nucleotide 2209 (approximately 2209G to C) causing a valine to leucine substitution (V709L), and at amino acid 718, a change of G to A at nucleotide 2236 (approximately 2236G to A) causing a glycine to serine substitution (G718S). Polymorphisms identified were at nucleotides approximately 2113G to C and approximately 2176T to C.
To measure the diameter of the odontoid process in a Malaysian population using computed tomographic (CT) scan and determine the feasibility of treating type-II odontoid fractures using 2 cortical screws.
We report a case of the Antley-Bixler syndrome in an 11-year-old girl. She presented with bilateral proximal femoral focal deficiency, right clubfoot, left radiohumeral synostosis, bilateral ear hypoplasia, cleft palate, tongue tie, missing teeth, congenital heart disease, a pelvic kidney with hydronephrosis, and mental retardation. Proximal femoral focal deficiency has never been reported before as a manifestation of Antley-Bixler syndrome. Her mother was exposed to radiation during an intravenous urogram done in the first trimester of pregnancy. Exposure to radiation has not been implicated as a cause of Antley-Bixler syndrome.
Infection following total knee arthroplasty can be devastating. Even with established treatment protocols, eradication of the infection may not be feasible. We report 2 patients who required above-knee amputation to eradicate recalcitrant infection.
To compare the results of Achilles tendon repair using a standard open procedure or a minimally invasive technique using a double-ended needle, and to determine whether the latter technique reduces the incidence of sural nerve injury and soft-tissue complications.
Resection and reconstruction using a vascularised fibular graft is a viable alternative treatment for congenital pseudarthrosis of the tibia, although distal junctional nonunion and residual deformity are known complications that are difficult to treat. We illustrate 2 cases in which bony union was achieved following a technique using fibular grafting and intramedullary nailing, without additional bone grafting. This technique was feasible because of hypertrophy of the fibular graft.
PURPOSE: To evaluate the short-term clinical and functional outcomes of total hip arthroplasty performed for physiologically active elderly patients with Garden type-3 or -4 femoral neck fracture.
METHODS: Records of 47 consecutive patients (40 female, 7 male) with type-3 or -4 femoral neck fracture (Garden classification) who underwent cemented total hip arthroplasty at our hospital during January 1999 to December 2002 were reviewed. Radiological and clinical (Harris functional hip score and Oxford hip score) assessments of 38 patients were measured with a mean follow-up period of 21 months (range, 4-48 months).
RESULTS: The mean age of the 47 patients was 75 years (range, 62-89 years). Records of 9 patients were excluded because of death, lost to follow-up, and development of deep infection that necessitated implant removal and excision arthroplasty. The mean Harris hip score of the 38 patients was 83 (range, 59-97), whereas the mean Oxford hip score was 25.2 (range, 14-33). Pain in the hips was absent in 30 patients, 6 had slight pain occasionally, and 2 patients had mild-to-moderate hip discomfort. No signs of aseptic loosening or change in implant position were noted on radiographic assessment. Two cases of dislocation were reduced by closed reduction. Two patients had deep wound infection and were treated with debridement, implant removal, and conversion to girdle stone.
CONCLUSION: This short-term study showed that total hip arthroplasty for femoral neck fracture had good postoperative results in functional hip and pain scores. More attention should be paid to coexisting medical illness (e.g. diabetes mellitus, hypertension, and ischaemic heart disease) and prevention of infection.