MyMedR

Fulltext A Computer Navigation System Analysis of the Accuracy of the Extramedullary (Tibial) Alignment Technique in Total Knee Arthroplasty (TKA)

Chee, E.K., Ewe, T.W.

Malays Orthop J, 2010;4(2):0-0.

MyJurnal

In total knee arthroplasty, mechanical alignment guides have improved the accuracy of implant alignment, but errors are not uncommon. In the present study, an image-free computer-assisted navigation system was used to analyse the accuracy of an extramedullary (tibial) alignment system, which is based on predetermined, fixed anatomical landmarks. Comparisons were made between two surgeons, with different levels of competency in order to determine if experience affected the accuracy of extramedullary tibial jig placement, in either the coronal and sagittal planes or both planes. The results showed that the accuracy of the extramedullary tibial alignment system, in the coronal plane (in up to 80-87% of cases) was much better than for posterior slope, and sagittal plane. Surgeon experience was not a significant factor.

Fulltext Bipolar Hemiarthroplasty in Elderly Patients Presenting WithDisplaced Intracapsular Femoral Neck Fractures ..

Krishnan, H., Yoon, T.R., Park, K.S.

Malays Orthop J, 2010;4(1):26-31.

MyJurnal

This retrospective study was undertaken to analyze perioperative parameters, functional outcomes and complications of cemented versus uncemented bipolar hemiarthroplasty in elderly patients presenting with displaced intracapsular femoral neck fracture. The authors reviewed 17 patients that underwent cemented bipolar hemiarthroplasty and 21 patients that underwent uncemented bipolar hemiarthroplasty. The mean follow-up duration in the cemented and uncemented group was 29.9 and 30.5 months respectively. Intraoperative and postoperative blood loss was higher in the cemented group. On the last follow-up the mean HHS was 74.7 in the cemented group and 84.2 in the uncemented group. No statistically significant difference was evident in the pain score. In summary, bipolar hemiarthroplasty was found to be a good option for displaced intracapsular femoral neck fractures, and overall outcome was marginally better in the uncemented group in terms of postoperative of blood loss and functional outcome at last follow up.

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 15Â°. 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.

Fulltext Cortical Blindness In Fat Embolism Syndrome Following Fracture Manipulative Procedure

Shahrulazua, A., Ariff, M.S., Aziz, M.A.

Malays Orthop J, 2010;4(1):35-38.

MyJurnal

Fat embolism syndrome is a well-recognised sequela of long bone trauma as well as intramedullary orthopaedic procedures. However, it has rarely been described following manipulation, reduction of fracture, and application of external fixator. Furthermore, bilateral ocular blindness is seldom the first manifestation; instead respiratory and other cerebral symptoms being most common. We describe a case with this rare presentation in a patient who underwent a trial of closed reduction, then open reduction of a femur fracture, followed by external fixation performed at day 47 post-initial trauma.

Fulltext Giant cell tumour of tendon sheath masquerading as trigger finger

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.

Fulltext Necrotising Fasciitis of the Lower Limb caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus

Chan, C.K., Merican, A.M., Nawar, A.M., Hanifah, Y.A., Thong, K.L.

Malays Orthop J, 2010;4(3):36-38.

MyJurnal

Necrotising fasciitis caused by Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a new entity. Although it is recognised worldwide, there have been no reported cases to date in Malaysia. We report a case of necrotising fasciitis of the left lower limb in an otherwise healthy 20-year-old man. He presented with septic shock and despite the paucity of clinical signs in the limb, the infection was aggressive. Methicillin-Resistant Staphylococcus aureus (MRSA) was isolated from the deep fascia of the leg. Panton-Valentine leucocidin gene (PVL), which is a stable genetic marker for CA-MRSA strain, was positive in this case. This case of community acquired MRSA necrotising fasciitis is of concern and may herald the emergence of this resistant organism in Malaysia. Vigilant surveillance and microbiological monitoring is needed to follow this CA-MRSA trend.

Fulltext Tandem Spinal Stenosis

Zulkefli, A., Ramanathan, R.

Malays Orthop J, 2010;4(1):46-49.

MyJurnal

A 42 years old gentleman presented with predominant low back pain associated with bilateral lower limb neurological deficit leading to an initial diagnosis of lumbar stenosis. Further history taking and examination revealed upper limb neurological deficit, and the lower limbs actually presented with upper motor neuron instead of lower motor neuron signs. Imaging studies confirmed the clinical findings with presence of both cervical and lumbar spinal stenosis. Twostage decompression procedures were performed at 6 monthintervals starting with cervical decompression. Postoperative improvement was noted on follow-up. This case highlights the importance of accurate diagnosis of cervical pathology for patients presenting with or referred for predominantly lumbar symptomology

Fulltext Chondrosarcoma of T2 vertebrae treated by combined anterior and posterior Approach: a case report

Norazian, K., Saw, L.B., Chan, C.Y.W., Amin, R., Kwan, M.K.

Malays Orthop J, 2010;4(3):22-25.

MyJurnal

Chondrosarcoma of the spine is rare; it presents predominantly in very young males and presentation with neurological deficit is uncommon. Treatment of this type of tumour is mainly through surgery as adjuvant therapy is ineffective. En bloc resection of tumours in the spine are difficult although it remains the recommended treatment for chondrosarcoma. We report here presentation of a female with paresis (Frankel C) whom was diagnosed with a large chondrosarcoma of the T2 vertebra extending to the right upper thoracic cavity. The patient underwent radical xcision through an anterior and posterior approach to the spine.

Fulltext Nonunion of Lateral Humeral Condylar Fracture in A Child with Cubitus Varus

Sulaiman, A.R., Munajat, I., Mohd, E.F., Sharifudin, M.A.

Malays Orthop J, 2010;4(3):29-31.

MyJurnal

Patients with cubitus varus deformity secondary to malunited supracondylar fracture are at risk for lateral humeral condylar (LHC) fracture. This report describes a child presenting with preexisting malunion of supracondylar fracture presenting along with nonunion of a LHC fracture following a recent injury. The patient underwent resection osteotomy of the metaphyseal proximal fragment of the fracture surface, reduction of the displaced LHC fragment and screw fixation. This procedure corrected the cubitus varus and treated the nonunion of the lateral condyle thus avoiding a supracondylar osteotomy procedure. Treatment resulted in solid union, good range of motion and no avascular necrosis.

Fulltext The Use of PROSTALAC in Two-stage Reimplantation of Septic Total Knee and Hip Arthroplasty

Wam, B.L., Chee, E.K., Ewe, T.W.

Malays Orthop J, 2010;4(3):11-15.

MyJurnal

The PROSTALAC (PROSThesis Antibiotic Loaded Acrylic Cement) functional spacer is made with antibiotic-loaded acrylic cement. We use it as an interim spacer in two-stage exchange arthroplasty in cases of infected total knee or total hip replacement. PROSTALAC allows continuous rehabilitation between stages as it maintains good alignment and stability of the joint with a reasonable range of movement. It also helps to maintain the soft-tissue planes, thereby facilitating the second-stage procedure. We report here early outcomes of the use of PROSTALAC in 5 patients - 3 in total knee replacements, 1 in a total hip replacement and 1 in a bipolar hemiarthroplasty.

Fulltext Myositis Ossificans in a 4-year-old Child

Boo, H.W., Vasanthie, B., Zulkifli, O.

Malays Orthop J, 2010;4(3):19-21.

MyJurnal

Sprengelâ€™s shoulder and myositis ossificans (MO) are rarely seen concomitantly. This report is about a rare case in a 4 year-old girl who presented with right shoulder deformity and pain associated with right proximal arm swelling.

Fulltext Giant epidermoid cyst of the thigh

Mohamed Haflah N, Mohd Kassim A, Hassan Shukur M

Malays Orthop J, 2011 Nov;5(3):17-9.

PMID: 25279030 MyJurnal DOI: 10.5704/MOJ.1111.001

Epidermoid cyst is a common benign cutaneous swelling frequently encountered in surgical practice. It usually presents as a painless lump frequently occurring in hairbearing areas of the body particularly the scalp, scrotum, neck, shoulder and back. Giant epidermoid cysts commonly occur in hairy areas such as the scalp. We present here the case of a rare occurrence of a giant epidermoid cyst in the less hairy area of the right upper thigh mimicking a soft tissue sarcoma. Steps are highlighted for the management of this unusual cyst.

Fulltext Developmental dysplasia of hip screening using ortolani and barlow testing on breech delivered neonates

Sulaiman A, Yusof Z, Munajat I, Lee N, Zaki N

Malays Orthop J, 2011 Nov;5(3):13-6.

PMID: 25279029 MyJurnal DOI: 10.5704/MOJ.1111.008

Fulltext The great mimic again? A case of tuberculosis knee

Teo Sh, Teh K, Azura L, Ng Y

Malays Orthop J, 2011 Nov;5(3):32-4.

PMID: 25279034 MyJurnal DOI: 10.5704/MOJ.1111.005

Tuberculosis (TB), once a disease confined to undeveloped or developing nations is currently in resurgence due to pandemic human immunodeficiency virus infection and immigration from endemic areas. TB is also known as the 'great mimicker'. Extra-pulmonary tuberculosis affecting the knee is rare in all forms of TB (0.1-0.3%). Here, we report a case of isolated highly erosive TB knee in a previously fit Burmese migrant worker. He presented with after a history of fall into a drain. The patient also reported pain and swelling over his left knee for the previous three years. He had been treated for a bacterial infection of the knee in another hospital but defaulted due to financial constraints. Arthrotomy of the knee was performed including washout. Diagnosis of TB of the knee was made based on the synovial fluid and tissue culture. Treatment with antituberculosis drugs was then initiated.

Fulltext Langerhans cell histiocytosis with extensive spinal and thyroid gland involvement presenting with quadriparesis: an unusual case in an adult patient

Mohd Ariff S, Joehaimey J, Ahmad Sabri O, Zulmi W

Malays Orthop J, 2011 Nov;5(3):28-31.

PMID: 25279033 MyJurnal DOI: 10.5704/MOJ.1111.004

Langerhans cell histiocytosis of the spine frequently presents as a solitary lesion and rarely results in neurological deficit. Involvement of thyroid tissue is also rare, even in multifocal disease presentations. We present an unusual variant of Langerhans cell histiocytosis in a 37-year-old man presenting with profound quadriparesis and incidental thyroid involvement. MR imaging and skeletal radiographs revealed widespread involvement of the spine. The patient underwent surgical resection of the tumour and stabilization of the spine. Diagnosis was confirmed by histological and immunohistochemistry analysis. Langerhans cell histiocytosis should be included in the differential diagnosis of radiolucent lesions of the spine in adults.

Fulltext Two-stage surgery for a large cervical dumbbell tumour in neurofibromatosis 1: a case report

Mohd Ariff S, Joehaimey J, Ahmad Sabri O, Abdul Halim Y

Malays Orthop J, 2011 Nov;5(3):24-7.

PMID: 25279032 MyJurnal DOI: 10.5704/MOJ.1111.003

Spinal neurofibromas occur sporadically and typically occur in association with neurofibromatosis 1. Patients afflicted with neurofibromatosis 1 usually present with involvement of several nerve roots. This report describes the case of a 14- year-old child with a large intraspinal, but extradural tumour with paraspinal extension, dumbbell neurofibroma of the cervical region extending from the C2 to C4 vertebrae. The lesions were readily detected by MR imaging and were successfully resected in a two-stage surgery. The time interval between the first and second surgery was one month. We provide a brief review of the literature regarding various surgical approaches, emphasising the utility of anterior and posterior approaches.

Fulltext A technique of distal clavicle fracture fixation using the tightrope procedure

Soh C, Sivapathasundaram N, Parthiban R, Ramanand A

Malays Orthop J, 2011 Nov;5(3):20-3.

PMID: 25279031 MyJurnal DOI: 10.5704/MOJ.1111.002

We present here a technique of fracture stabilization using the Tightrope procedure in a patient with a widely displaced Neer type IIB distal clavicle fracture. The Tightrope system, typically used for stabilization of acromioclavicular joint dislocation, has not been widely described for distal clavicle fractures. The patient achieved satisfactory results after surgery; we feel that this technique is appealing as it is simple, reproducible and avoids the complications associated with extensive metalwork. This technique may also appeal to the arthroscopic surgeon.

Fulltext Glomus tumour: a retrospective review of 15 years experience in a single institution

Fazwi R, Chandran PA, Ahmad TS

Malays Orthop J, 2011 Nov;5(3):8-12.

PMID: 25279028 MyJurnal DOI: 10.5704/MOJ.1111.007

ABSTRACT: Glomus tumours (GT), neoplasms of the glomus body comprise 4.5% of upper limb tumours. Seventy-five per cent of these occur in the hand, and most are subungual (50%). We performed a literature review and retrospective search of histopathologically confirmed GT seen from 1995 to 2009. Fifteen patients were identified, with an average age of 49.6 years. Eight were in the hand, 2 in the upper limb, 2 lower limb and 3 in the ear. Eighty-six per cent presented with pain and 50% underwent radiological investigation. Most diagnoses followed biopsy findings. Surgical excision resulted in a recurrence rate of 13%. The average time to diagnosis was 3.3 years. The average duration of symptoms was 7 to 11 years with an average of 2 to 3 consultations prediagnosis. MRI remains the most useful imaging modality (82 to 90% sensitivity). Excision biopsy is the most common treatment. Greater awareness is needed for quicker diagnosis.

KEY WORDS: Glomus Tumour, Presentation, Imaging, Recurrence.

Fulltext Factors predicting late collapse of distal radius fractures

Myderrizi N

Malays Orthop J, 2011 Nov;5(3):3-7.

PMID: 25279027 DOI: 10.5704/MOJ.1111.006

BACKGROUND: Although fractures of the distal radius are a common clinical presentation, many factors affect instability of these injuries. The aim of this study was to assess the influence of age, sex, distal radial ulnar joint injury (DRUJ), ulnar styloid fracture, and dorsal displacement in late collapse of distal radius fractures.

METHODS: Three hundred twenty-nine patient fractures were measured for dorsal tilt, radial inclination and ulnar variance after reduction and 2 months later. Reduction loss was analysed statistically against variables like DRUJ involvement, ulnar styloid fractures, age, sex, and AO classification.

RESULTS: After two months there was loss of reduction in 171(51.9%) cases. Loss of reduction was related to age, AO classification, involvement of DRUJ, ulnar styloid fractures and initial displacement.

CONCLUSIONS: Factors such as age, associated DRUJ injury, ulnar styloid fracture are predictive of loss of reduction. Knowing these predictor factors, can aid in decision regarding treatment methods.

KEY WORDS: Distal Radius Fracture, Radial Tilt, Ulnar Variance, Volar Tilt, Ulnar Styloid Fracture, DRUJ.

Fulltext Treatment of Developmental Dysplasia of the Hip: Short and Mid-term Outcome

Malays Orthop J, 2011;5(1):17-20.

MyJurnal

Objective: To review the presentation and outcome of developmental dysplasia of the hip (DDH) cases in the last 6 years. Methodology:We retrospectively reviewed the presentation as well as short and mid-term outcome of 17children (18 hips) with DDH seen and treated from 2004 to 2010. Treatment was either splinting with Pavlik harness,closed or open reduction depending on age at presentation and the individual needs of each patient. Results:Theaverage age at presentation was 31.1 months, and the male to female ratio was 1:4.6. Six patients (35%) presented early(less than 6 months old) while 7 patients (41%) presented between 6 -24 months. In these 2 groups splinting or closed reduction under anaesthesia was initially utilized for treatment depending on age, and open reduction was use dafter failure of closed reduction and for those presented late.Average age at the time of closed reduction was 11 months,and 6 years for those underwent open reduction. The average period of follow up for all patients was 29.4 months. The final outcome was successful in 12 hips (66%) in 11 patients.Ten of these presented at less than 2 years old, in the other 6 hips in which there was failure, 50% presented after 3 years of age. Conclusion:Late presentation of DDH is still common in Malaysia, which necessitates more complex management and more frequent occurrences of unfavourable results.

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