Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the value of TAD was evaluated to verify its usefulness.
Methods: This is a retrospective study of 33 consecutive patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any fixation-related failure or complication.
Results: Fifty two percent of patients did not achieved the recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration.
Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of intertrochanteric fracture.
KEYWORDS: Intertrochanteric fracture, dynamic hip screw, tip-apex distance, screw cut-out
Clinically, it is sometimes diffi cult to distinguish an infection of the spine from a metastasis. Spinal tuberculosis is common according to its endemic region and adenocarcinoma of the lung is also rising in the incidence worldwide. Similar presentations, with unknown primary, clinical fi ndings and hematological investigations rarely conclude a true diagnosis. Radiologically, the hallmark of spinal infection is erosion of adjacent vertebral endplates and narrowing of the disc space with or without a paravertebral shadow. Metastasis typically does not involve the disc space with erosion of the adjacent vertebral endplates. It usually presents as a lytic/sclerotic lesion in the vertebral body or “winkle owl” sign. These distinguishing features of infection versus metastasis are not certainties. Biopsy is mandatory whenever in doubt or patient is not responded with provisional treatment. The author presents a case with so-called radiological features of spinal tuberculosis infection, which turns out to be a metastatic adenocarcinoma of the lung.
We report a case of a previously healthy 53-year-old man who developed an intra-operative catastrophic event occurring in association with the use of hydrogen peroxide for wound irrigation following surgical debridement of a chronic osteomyelitis lesion of the humerus. It is our intention to highlight this potentially fatal consequence of hydrogen peroxide irrigation as part of bone debridement procedure. This case will serve as a reminder to orthopaedic surgeons who frequently use hydrogen peroxide in their surgical practice.
INTRODUCTION: The understanding of the skin's vascular anatomy has improved in the last decade. It has lead to technique modification such as the staged procedure in performing sural flaps and improvement in the flap survival rate. The aim of this study was to evaluate the acute vascular complications (flap necrosis or congestion) of 29 patients who underwent distal base sural flap for coverage of wound around the ankle.
METHODS: Twenty-four males and five females with a mean age of 37.1 years old underwent sural flap surgery to cover wounds at around the ankle. There were 12 cases of open fracture, five infected fractures, four spoke injuries, four degloving injuries and four diabetic foot ulcers. Twentythree cases were done as a single stage procedure while six as a two-stage procedure. The flaps were tunnelled under the skin in three cases.
RESULTS: Twenty one flaps healed uneventfully, seven acute vascular complications occur in a single stage group: five developed partial necrosis, one had congestion with epidermolysis, and one had complete flap necrosis. Complications were treated by dressing or skin grafting and only one required a repeat flap surgery.
CONCLUSIONS: Acute vascular complications may be minimised when sural flap is done in stages for elderly, diabetic, smokers and/or patients with large wound around the ankle. Even if the flap appears necrotic, the underlying structure may still be covered as the fasciosubcutaneous layer of the flap may still survive.
Honey dressing has been used to promote wound healing for years but scanty scientific studies did not provide enough evidences to justify it benefits in the treatment of diabetic foot ulcers. We conducted a prospective study to compare the effect of honey dressing for Wagner's grade-II diabetic foot ulcers with controlled dressing group (povidone iodine followed by normal saline). Surgical debridement and appropriate antibiotics were prescribed in all patients. There were 30 patients age between 31 to 65-years-old (mean of 52.1 years). The mean healing time in the standard dressing group was 15.4 days (range 9-36 days) compared to 14.4 days (range 7-26 days) in the honey group (p < 0.005). In conclusion, ulcer healing was not significantly different in both study groups. Honey dressing is a safe alternative dressing for Wagner grade-II diabetic foot ulcers.
The existing literature have demonstrated a considerable amount of existing studies that merely interest on scientific perspectives by examining the physical environmental changes rather than conducting social-based studies that allow for the comparison of adaptation ability between mainland and island small-scale fishermen. Therefore, the current research attempts to fill this gap by investigating the adaptation level of mainland and island small-scale fishermen towards climate changes for the purpose of further identifying any significant differences regarding their adaptation aspects. The primary aim of the current research is to conduct a comparative study with the purpose of assessing the environmental change adaptation ability between the mainland and the islander small-scale fishermen. In the context of the current research, a quantitative approach was employed by selecting a total of 600 samples through several levels of cluster sampling. The instrument for the study was developed based on the 16 adaptation variables that were suggested within the adaptation framework proposed by the International Union for Conservation of Nature and Natural Resources. The data were analysed using SPSS, whereby to achieve the study's main objective, inferential analysis which refers to the independent t test was performed to examine any possible significant difference that might exist. In regard to this matter, various significant differences between the islander and the mainland fishermen managed to be detected in 10 adaptation aspects out of the 16 adaptation variables which include the capacity to adapt to change (monetary and emotional adaptability); the level of interest in adapting to change; the ability to plan, learn, and reorganize; and attachment to occupation. Accordingly, a number of recommendations were discussed at the end of this study which is hoped to assist the involved and relevant parties in arranging better adjustment approaches for small-scale fishermen in Malaysia.
Wireless Sensor Technologies (WST) is entering a new phase. Recent advances offer vast opportunities for research and development. On top of that, this is the consequence of the decreasing costs of ownership, the increase of smaller sensing devices in engineering and the achievements in radio frequency technology and digital circuits. The aim of this research was to combine the Wireless Sensor Network with ZigBee technology. It is expected to develop Haze Smart Greenhouse to control the temperature and humidity via remote automation. In addition, a GUI interface will be built to ease in controlling and managing the prototype through computer via wired and wireless technology. This Haze Smart Greenhouse prototype will be proposed to be developed and tested with operational via remote automation.
We report a case of a 14-year-old Malay male who fell at school and sustained bilateral olecranon fractures. He had undergone an open reduction and tension band wiring to stabilize the fracture. Three months after the surgery, the movement of both his elbows was satisfactory.
Introduction: This is a cross-sectional study of 37 patients with AO type C (complete intra-articular) fractures of the distal radius, evaluating the functional, anatomical, and patient rated outcomes one year after primary fixation with a volar locking plate.
Methods: Functional outcomes were assessed based on the grip strength, and the range of motion of forearm and wrist. Anatomical outcomes were assessed based on the radial inclination, radial height, volar tilt, and articular step or gap. Patient rated outcome was measured with a Disability of arm, shoulder and hand (DASH) questionnaire.
Results: One year after surgery, 24 (64%) patients achieved good and excellent anatomical results, and DASH scores were acceptable in 73% of patients. Most of the patients had achieved 80% of their grip strength. The mean DASH score of 12.3 was comparable with other studies. Grip strength, radial inclination and volar tilt had a significant correlation with the DASH score.
Conclusion: Volar locking plates can be used to achieve optimal reduction in all three parameters in the treatment of AO type C fractures of the distal radius. Versatile fracture fragment reduction and angular stability enable rehabilitation hence obtaining good functional outcomes.
Nasopharyngeal carcinoma (NPC) is a malignant neoplasm arising from the mucosal epithelium of the
nasopharynx, mainly within the lateral nasopharyngeal recess or Fossa of Rosenmuller. Distant metastasis to the cervical spine is the least common site in the vertebral system. This is a case of a 37-year-old lady with stage IV C nasopharyngeal carcinoma with local extension to the cervical spine who presented with right upper limb weakness.
Posterior interosseus artery flap is commonly used as a pedicle flap to cover soft tissue defect in the dorsum of the hand. It is not able to cover a soft tissue defect beyond the level of proximal phalang unless it is used as a free flap. We illustrate 2 cases in which large soft tissue defect in the finger was able to close by using a contralateral posterior interosseous flap. This technique is a reliable alternative method for closing large soft tissue defect in the fingers.
In Malaysia, futsal is a popular sport played by individuals across all ages and genders. Despite its popularity, information on futsal related injury in Malaysia is not available. The purpose of this study is to examine the injury incidence and injury patterns among amateur men and women futsal players in Malaysia.
Climate change in Asia is affecting farmers' daily routines. Much of the focus surrounding climate change has targeted the economic and environmental repercussions on farming. Few systematic reviews have been carried out on the social impacts of climate change among farmers in Asia. The present article set out to analyse the existing literature on Asian farmers' adaptation practices towards the impacts of climate change. Guided by the PRISMA Statement (Preferred Reporting Items for Systematic reviews and Meta-Analyses) review method, a systematic review of the Scopus and Web of Science databases identified 38 related studies. Further review of these articles resulted in six main themes - crop management, irrigation and water management, farm management, financial management, physical infrastructure management and social activities. These six themes further produced a total of 35 sub-themes. Several recommendations are highlighted related to conducting more qualitative studies, to have specific and a standard systematic review method for guide research synthesis in context of climate change adaptation and to practice complimentary searching techniques such as citation tracking, reference searching, snowballing and contacting experts.
In recent years, a considerable amount of studies published locally which focused on the influence of age on climate change ability. Accordingly, this has driven the present study to achieve its main objective which is to compare the adaptation ability between youth and older fishermen. The current research is quantitative in nature; hence, a survey was conducted on a total of 259 youth and older fishermen residing in different states of Malaysia, namely Pulau Pinang, Terengganu, Johor, and Kedah. The present study managed to conclude a unique and important result which stated that youth and older fishermen within the context of Malaysia have an equally strong adaptation ability. In regard to this matter, a number of recommendations were presented at the end of this paper with the hope that it can act as a basis for future scholars to conduct more climate change related studies.
This study proposes a set of GuFSyADD guidelines on steps for developing suggestions that enhance of its rigor in systematic literature review (SLR) for studies related to climate change adaptation. The prescribed guidelines are based on the following six steps, (1) guided by review of protocol/publication standard/established guidelines/related published articles, (2) formulation of review questions, (3) systematic searching strategies, (4) appraisal of quality, (5) data extraction and analysis, and (6) data demonstration. Essentially, this set of proposed guidelines enables researchers to develop an SLR pertaining to climate change adaptation in an organised, transparent, and replicable manner.
In civil engineering, many geotechnical and forensic projects employ polyurethane (PU) for ground improvement, and the results have shown to be effective in terms of time and cost savings. However, similar to many other chemical stabilisers, the use of PU for soil stabilisation may have environmental repercussions. Therefore, this paper utilised a toxicity characteristic leaching procedure (TCLP) to investigate the potential for ground contamination resulting from the application of PU for the stabilisation of marine clay. Furthermore, the hazardousness of PU during the stabilisation of marine clay was investigated by testing its reactivity, ignitability, corrosivity and physical properties. The results reveal that the quantity of heavy metals present in PU is far below the regulatory limits. The results further confirm that PU is odourless and non-corrosive and that it is non-cyanide and non-sulphide-bearing. However, PU is capable of igniting. Overall, the potential application of PU for ground improvement is promising due to its environmental friendliness.
Cyberbullying has emerged of late as a serious issue, especially among the most active internet users in Malaysia – youths. As the number of related studies is still lacking, the present study aims to determine the predictors of cyberbullying among youths in Malaysia. The study is quantitative in nature and in total had involved 400 youths aged between 18 to 40 years old. The findings suggest that predictors such as age, loneliness, self-esteem, and empathy yielded significant relationship with cyberbullying, while males were predominantly reported to perpetrate cyberbullying than females. Several recommendations were highlighted and hopefully, it can assist any concerned parties in developing concrete strategies to reduce cyberbullying cases among youths in Malaysia further.
This study sought to develop and validate an instrument measuring cyberbullying among
Malaysian youths. Exploratory factor analysis (EFA) was employed to determine the best
sub-factors and items for the instrument, while confirmatory factor analysis (CFA) was
performed to test and validate the measurement model. Results from EFA on 38 items
showed that the items were pooled into four sub-factors. Meanwhile, results from CFA
indicated that eight items had to be discarded in order to confirm that the model was fit.
Overall, the final version of the instrument consisted of four cyberbullying sub-factors,
namely, impersonation (13 items), cyberstalking and harassment (nine items), flaming (four
items), and elimination (four items).
A 15-year–old Malay male with congenital insensitivity to pain presented with recurrent septic arthritis of the left knee complicated by osteomylitis. Repeated arthrotomy and wound debridement was done, however, the condition was not resolved. Amputation was suggested as the best method of treatment to eradicate the infection.
This is a prospective study on infection following fixation of closed fractures done in Hospital Tengku Ampuan Afzan ,Kuantan from May 2003 to May 2005. There were 23 cases in this study. The mean age of patient was 32.9 years (range 15 to 77). Twenty one were males and 2 females. Twenty (87%) infections occurred in the lower limb and only 3(13%) occurred in the upper limbs. Twenty two patients (91%) had plating done for the fracture. Infection following internal fixation is commonly a deep seated (96%) and florid (78%) infection in which 70% occur after the surgical wound has healed. Staphylococcus aureus is the commonest organism isolated in which 43% are Methicillin resistant (MRSA). Overall infection caused by gram negative organisms is more common than gram positive organisms.