Displaying publications 81 - 100 of 576 in total

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  1. Kamarul T, Razif A, Elina R, Azura M, Chan KY
    Malays Orthop J, 2007;1(2):11-16.
    MyJurnal
    A study to determine average knee laxity in the Malaysian population and how it affects daily living was conducted at the University Malaya Medical Centre between January and April 2004. Fifty two male and 76 female subjects were recruited for this study, all of whom were healthy volunteers with no ambulatory problems. Side to side knee laxity testing was performed using a KT-1000 arthrometer. Significant differences in knee laxity were noted among different races and between sexes. For instance, overall, Chinese and female study participants had higher knee laxity: (left knee, 2.17 mm (SD=1.30) and right knee was 2.88 mm (SD= 1.51)). On average, the difference between knees was 0.70 ± 1.26 mm (less than 1 mm) which is a smaller variation than reported in previous studies which suggested 3 mm. Despite finding knee laxity ranging from 0 to 8mm, no correlations were found between Lysholm, IKDC and Tegner knee outcome scores and the degree of knee laxity. No other predictors such as height, weight and age correlated with levels of knee laxity. We therefore conclude that knee laxity is a common occurrence in the normal population and is therefore not suitable as a sole predictor of knee function and should not be used as the only criteria for surgical intervention.
    Study site: Orthopedic clinic, Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
  2. Kwan M, Chan C, Ng W, Merican A, Chung W, Chan S
    Malays Orthop J, 2013 Jul;7(2):12-7.
    PMID: 25722819 MyJurnal DOI: 10.5704/MOJ.1307.008
    There are reported cases of cortical reaction over the tension side of the normal femoral shafts in patients on long term treatment with alendronate, leading to subsequent femoral shaft fractures. We performed a retrospective review of patients with low-energy femoral shaft fracture on alendronate, admitted to our institution during the period 2004 to May 2009. The presence of radiological changes of cortical hypertrophy with or without Looser's zone over the tension side of the femoral bone (normal limb) was determined and correlated with clinical symptoms. Thirteen patients were identified. Average duration of alendronate use was 6.5 ± 3.3 years (ranges, two to 10 years). These radiological changes were noted in four patients. Average duration of alendronate usage in these four patients was 6.5 ± 2.4 years (ranges, 5 to10 years). Prodromal thigh pain was present in a patient, who had cortical hypertrophy with the presence of a Looser's zone traversing the cortex on the femoral shaft. One patient had Looser's zone limited at the lateral hypertrophied cortex without prodromal pain. The interobserver kappa coefficient was 0.96. A femoral radiograph should be performed in all patients who are on long-term alendronate therapy who present with thigh pain. We propose a new grading system based on our observation of the radiological features in these four cases. This new grading of the radiological spectrum of femoral shaft cortical pathology has the potential to stratify the risk of low energy femoral fracture for patients treated with long-term alendronate therapy.
  3. Pan K, Chan W
    Malays Orthop J, 2013 Nov;7(3):21-3.
    PMID: 25674303 MyJurnal DOI: 10.5704/MOJ.1311.003
    Fractures of the femoral shaft treated with interlocking nails will ultimately result in breakage of the nail if the bone does not unite. Further management requires removal of the broken nail which may be a difficult process for the distal segment. If we can identify the symptoms just before the nail breaks, an exchange nailing becomes much easier. We present a patient with fibromatosis who underwent repeated surgery as well as radiotherapy at the age of 16. Six years later, she had a pathological fracture of the upper third of the femur for which an interlocking nail was inserted. The femur did not unite and the nail subsequently broke. Over a period of 12 years, three nails broke and had to be replaced. Two to 3 months before each breakage, the patient experienced the same set of symptoms for each episode. Knowing that her fracture was not going to heal will now alert us to do an exchange nailing before the nail broke again. It is well known that where there is evidence of non-union, pre-emptive treatment is necessary before implant failure.

    KEY WORDS: Femur nonunion, interlocking nail, symptoms before breakage of nail.

  4. Zulkarnaen M, Pan K, Shanmugam P, Ibrahim Z, Chan W
    Malays Orthop J, 2012 Mar;6(1):49-52.
    PMID: 25279044 MyJurnal DOI: 10.5704/MOJ.1203.003
    ABSTRACT: Synovial sarcoma is primarily a soft tissue malignancy that most often affects adolescents and young adults. It very rarely presents as a primary bone tumour and has only been reported in nine other cases to date. We report a case of primary synovial sarcoma arising from the proximal femur in a 57-year-old man.

    KEY WORDS: Synovial sarcoma, primary bone tumour.

  5. Kunnasegaran R, Chan YH
    Malays Orthop J, 2017 Mar;11(1):64-67.
    PMID: 28435578 DOI: 10.5704/MOJ.1703.007
    The treatment of fractures in osteopetrosis can be complicated and difficult. We describe the use of an industrial grade tungsten carbide drill bit in the treatment of one of these complex fractures. An industrial grade tungsten carbide drill bit was used to fashion a medullary canal in the surgical treatment of a left peri-implant fracture of the neck of femur in a patient with osteopetrosis. The patient was successfully treated with a hemiarthroplasty with good functional outcomes. A tungsten carbide drill bit serves as an effective and safe option in the treatment of osteopetrotic femoral neck fractures.
  6. Zaidi, M., Azuhairy, Chan, C.K.,
    Malays Orthop J, 2008;2(1):8-11.
    MyJurnal
    This study evaluates the outcome of anterior cruciate ligament (ACL) reconstruction with arthroscopy using the bone–patella tendon-bone method. We performed this procedure in 24 patients with the average age of 33.1 years (range: 17-51 years ) between 2004 and 2006. Sixteen of the 24 patients were available for evaluation using the Lysholm Knee Score and International Knee Documentation Committee (IKDC) system. Based on the Lysholm score, there was a statistically significant improvement in knee function when comparing pre- and post-surgical scores (p
  7. Pan, K.L., Chan, W.H.
    Malays Orthop J, 2010;4(2):51-53.
    MyJurnal
    Giant cell tumours of bone are best treated by extended curettage and filling in of the defect with cement or bone graft. In more advanced stages, when there is extensive loss of cortical bone cover, containment of the filling material is not possible and resection and reconstruction is required. We report a case of a recurrent giant cell tumour of the distal tibia in a 21-year-old female with extensive cortical bone loss in which polypropylene surgical mesh was used to contain the bone cement, thus avoiding a resection.
  8. Kongcharoensombat W, Charoensri P
    Malays Orthop J, 2023 Jul;17(2):57-61.
    PMID: 37583531 DOI: 10.5704/MOJ.2307.009
    INTRODUCTION: The infrapatellar branch of saphenous nerve (IPBSN) has anatomic variations and prone to injury during surgery around the medial side of the knee. High tibial osteotomy is one of the procedures that may be risky to the IPBSN. This research was aimed to establish which skin incision (vertical vs oblique) is less likely to damage to the IPBSN and also to study the anatomy of the IPBSN, with the institutional review board reference (No. LH611054, date 10/1/2020). The primary outcomes are aimed to establish which skin incision (vertical vs oblique) is less damaging to the IPBSN. The secondary outcome is to study about the anatomy of the IPBSN.

    MATERIALS AND METHODS: Twenty-two fresh cadavers (forty-four knees) were dissected by randomisation under the block of four technique, and two different incisions were performed for each knee. Exploration was performed from the skin incision to the IPBSN around the incision zone. If the discontinuity of the nerve was found, it was classified as IPBSN injury. The anatomic measurement was performed. The IPBSN injury between two groups were analysed with the chi-square test.

    RESULTS: The risk of IPBSN injury in the oblique group was 2 from 22 knees (9.1%), and 12 knees from 22 knees (54.5%) in the vertical group (P=0.001). Most common number of branch(es) found, is one branch, the horizontal distance ranged from 2.6cm to 8.5cm (average 5.7±1.6), the vertical distance ranged from 4.4cm to 12.6cm (average 7.6±1.9) and the declination angle ranged from 6° to 87° (average 34.7±24.3).

    CONCLUSION: The risk of the IPBSN injury in oblique skin incision may be less than the vertical incision in the medial opening wedge HTO.

  9. Singh VK, Rathore KS, Khan G, Rahim A, Rashid A, Chauhan S
    Malays Orthop J, 2020 Nov;14(3):151-154.
    PMID: 33403076 DOI: 10.5704/MOJ.2011.023
    Introduction: Fluorosis has been associated with an increased risk of degenerative changes in the knee. Multiple studies have found an association between arthritis and elevated fluoride levels. We aim to delineate if elevated fluoride level has any direct correlation with the degree of radiological grading and clinical symptoms in knee arthritis.

    Materials and Methods: A cross-sectional study of 80 knee arthritis patients was conducted from February 2017 to April 2018. Serum fluoride levels were measured and patient's pain scores, WOMAC scores and radiological grading were correlated with the elevated fluoride levels.

    Results: In our study, 30 out of 80 patients had increased serum fluoride level. Statistically significant differences were noted in VAS score, WOMAC score and Kellgren and Lawrence radiological grades between patients with normal serum fluoride level and those with elevated fluoride level.

    Conclusion: There is an increased risk of knee arthritis in patients with elevated blood fluoride levels and patients with increased fluoride levels are associated with more severe symptoms and radiographic disease.

  10. Sirithiantong T, Sukhapanon T, Cheewatanakornkul R
    Malays Orthop J, 2022 Nov;16(3):6-10.
    PMID: 36589373 DOI: 10.5704/MOJ.2211.002
    INTRODUCTION: Plain anteroposterior radiograph of the hip plays an important role in diagnosing hip pathology. However, one of the most common mistakes is image distortion because the hip is externally rotated due to natural femoral neck anteversion. Thus, the lower extremities should be internally rotated by 15°-20°. The researchers developed a hip internal rotation assistive device and compared it with conventional radiograph positioning.

    MATERIALS AND METHODS: A hip internal rotation assistive device was designed. This study consisted of 20 volunteers without clinical hip pathology. The volunteers were informed to do a hip radiograph twice to compare the efficacy of the developed device with a conventional positioning. The thickness of the lesser trochanter (TLT) was measured and interpreted by an orthopedist and a radiologist. Statistical significance and inter- and intra-observer reliabilities were analysed.

    RESULTS: According to the orthopaedist's measurement, the mean TLT distance was 4.42 + 3.2mm and 4.97 + 3.16mm for the conventional technique and assistive device, respectively, without statistical significance between both groups (p = 0.05). Consistent with the musculoskeletal radiologist, the mean TLT distance was 4.00 + 2.06mm for the conventional technique and 3.92 + 2.27mm for the assistive device, without statistical significance between both groups (p = 0.56). Intra-observer reliability was 0.900 and 0.898 for the orthopaedist and the radiologist, respectively. Interobserver reliability of the assistive device and conventional technique were 0.800 and 0.588, respectively.

    CONCLUSION: The efficacy of the developed device was similar to that of the conventional technique. Inter/intra-observer reliabilities were at a good agreement level in both methods. The developed device would also be useful in clinical applications, especially in decreasing unnecessary radiation exposure of medical personnel.

  11. Ng, W.M., Ong, T.C., Kwan, M.K., Cheok, C.Y.
    Malays Orthop J, 2008;2(1):49-51.
    MyJurnal
    We report here a rare presentation of an extra-nodal non-Hodgkin's lymphoma. Both clinical presentation radiological findings were suggestive of psoas abscess. Surgical debridement was performed and histopathological examination of the tissue sample revealed the diagnosis of non-Hodgkin's lymphoma. It is therefore important to note that non-Hodgkin's lymphoma can mimic psoas abscess and that psoas lesion with vertebral involvement does not necessarily indicate infection. It is always advisable to obtain needle biopsy to establish diagnosis before embarking on surgical intervention. The practice to send any suspicious tissue obtained intra-operatively for histopathological examination is also warranted.
  12. Boo HC, Yeo SJ, Chong HC
    Malays Orthop J, 2020 Mar;14(1):55-60.
    PMID: 32296483 DOI: 10.5704/MOJ.2003.009
    Introduction: Stiffness after Total Knee Arthroplasty (TKA) is a complication that decreases patient satisfaction. Patients in an Asian population have potentially different requirements of knee range of motion. The authors have encountered patients who complain of subjective stiffness post TKA who do not have a severely restricting range of motion (ROM). Some patients have persistent subjective stiffness and undergone Manipulation Under Anaesthesia (MUA). We look at their functional outcomes post MUA.

    Materials and Methods: This is a retrospective study, including 48 patients from a single institution who underwent MUA for stiffness, separated into objective and subjective knee stiffness. Patients with subjective knee stiffness who underwent MUA had failed conservative management. ROM, Oxford Knee Scores (OKS), Knee Society Scores (KSS) and Short Form 36 (SF36) scores were compared at two years post MUA.

    Results: The demographics of the two patient groups were similar. The time interval between index TKA and MUA was higher in the subjective knee stiffness group. Pre-MUA OKS, KS Function Score, KSS and SF36 scores were similar in both patient subgroups. There was no significant difference in the OKS, KSS or SF36 at two year follow-up. The proportion of patients in each group who achieved the Minimum Clinically Important Difference (MCID) improvement in the scores was also similar.

    Conclusions: Patients with subjective knee stiffness can achieve similar functional outcome improvements in Oxford and Knee Society Scores with MUA at two years follow-up.

  13. Tai, C.C., Tan, S.H., Misnan, N.A., Nam, H.Y., Choon, S.K.
    Malays Orthop J, 2008;2(1):38-43.
    MyJurnal
    The safety of simultaneous bilateral total knee arthroplasty (TKA) remains controversial. The objective of the current study was to investigate perioperative morbidity and mortality rates within 30 days of simultaneous bilateral TKA. A detailed analysis of medical, surgical and anaesthesia records of 183 consecutive patients who underwent total knee arthroplasty between 2002 and 2006 was performed. The mean age of the patients was 67.6 years old. More than 80% had one or more co-morbidities, but none of them had ASA score greater than class 2. The mean hospital stay was 10 days, and the mean surgical time 156 minutes. Less than half of the patients (42.6%) required blood transfusion. The rate of perimorbidity was 15.3 % and there was no mortality in this series. We believe that simultaneous bilateral total knee arthroplasty is a safe and cost effective option for our patients, provided that patients are selected and informed appropriately.
  14. Tai, C.C., Abbas, A.A., Varaprasad, M., Choon, S.K.
    Malays Orthop J, 2007;1(1):22-25.
    MyJurnal
    We report on the medium term outcome of five patients (ten hips) who underwent one stage bilateral total hip arthroplasty. Both Harris Hip Scores and Oxford Hip Scores improved postoperatively as did range of motion. There was no radiographic evidence of loosening in any hip arthroplasty involved in this study, however one revision surgery was needed due to periprosthetic fracture. There were no increased medical complications. Based on our limited experience, we believe that one stage bilateral total hip arthroplasty is safe in selected patients.
  15. Wazir,N.N., Ravindran, T., Mukundala, V.V., Choon, S.K.
    Malays Orthop J, 2007;1(2):21-23.
    MyJurnal
    In 1977, a female patient, aged 31y, presented with histiocytosis X in the right pelvis and was treated with radiotherapy. She presented again in 1999 at the age of 53y with a similar problem at the same location this time also involving the acetabulum. The affected right hip was treated with cemented total hip replacement. Two years postoperatively, the patient was pain free with no evidence of local recurrence or loosening of implant, thus demonstrating that total hip replacement is a viable treatment option for histiocytosis involving the hip.
  16. Choong, L.T.
    Malays Orthop J, 2009;3(1):68-71.
    MyJurnal
    Selective cervical nerve root injection using a mixture of corticosteroid and lignocaine is a treatment option for managing cervical radiculopathic pain. The procedure is usually performed under image guided fluoroscopy or Computerized Tomograhy. Ultrasound-guided cervical nerve root block does not expose the patients and personnel to radiation. During injection, the fluid is mostly visualized in a real-time fashion. This retrospective study reviewed the effectiveness of ultrasound in guiding cervical peri-radicular injection for pain relief in patients with recalcitrant cervical radiculopathy. There were no complications reported in this series.
  17. Yazid DM, Lim CY, Chopra S
    Malays Orthop J, 2010;4(3):7-10.
    MyJurnal
    This study was undertaken to investigate the outcome of traumatic intracapsular neck of femur fractures treated with total hip arthroplasty (THA). Patients aged >=60 years who underwent THA for traumatic intracapsular neck of femur fractures from January 2005 to March 2009 were included in the study. Telephone or personal interviews were conducted. There were 49 patients identified within the study period. The mean age was 74.12 years. Most patients were females 81.6%), with a male: female ratio of 1: 4.4. In total, 29 patients were available for outcome scoring. The one-month mortality rate was 4.1%, and the one-year mortality rate was 20.5%. Of the 29 patients 82.8% obtained a Zukerman Functional Outcome Score of good (80 – 100) and 13.8% obtained a score of fair (60 – 80). THA for the treatment of traumatic neck of femur fractures in elderly is a good option with 96.6% of patients obtaining a satisfactory functional outcome, with acceptable morbidity and mortality statistics.
  18. Lee WC, Chua T
    Malays Orthop J, 2021 Mar;15(1):138-140.
    PMID: 33880163 DOI: 10.5704/MOJ.2103.023
    Atypical femoral fractures (AFF) have low union rates. The use of teriparatide has been advocated for the post-operative healing of AFF, but the evidence is limited to case reports and some series due to its low incidence. We present a case series of four female patients to support the use of teriparatide after the surgical fixation of their AFF. Three of the patients had a complete AFF and one had an incomplete fracture. Their mean age was 70 (52 - 87) years, mean body mass index 24.6 (18.3 - 29.3), mean bone mineral density T-score of -2.3 (-4.8/-1.0), with a prior history of anti-resorptive therapy with bisphosphonates and denosumab. Teriparatide was started at an average of 8 (2-18) days post-fixation, with 20mcg daily for six months. Immediate full weight-bearing was permitted in three patients, while one was non-weight bearing for two months. The mean time to union was 12 (10 - 14) weeks. No side effects were observed over a mean follow-up of 58 (50 - 72) weeks. The use of teriparatide facilitated the quick union of AFF after surgical fixation. It appeared to be safe and promoted fracture healing in AFF.
  19. 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.


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