MyMedR

Fulltext Bone cement implantation syndrome

Razuin R, Effat O, Shahidan MN, Shama DV, Miswan MF

Malays J Pathol, 2013 Jun;35(1):87-90.

Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, cardiac arrhythmias, increased pulmonary vascular resistance and cardiac arrest. It is a known cause of morbidity and mortality in patients undergoing cemented orthopaedic surgeries. The rarity of the condition as well as absence of a proper definition has contributed to under-reporting of cases. We report a 59-year-old woman who sustained fracture of the neck of her left femur and underwent an elective hybrid total hip replacement surgery. She collapsed during surgery and was revived only to succumb to death twelve hours later. Post mortem findings showed multiorgan disseminated microembolization of bone marrow and amorphous cement material.

Fulltext Outcome of surgically treated Lisfranc injury: a review of 34 cases

Miswan MF, Singh VA, Yasin NF

Ulus Travma Acil Cerrahi Derg, 2011 Nov;17(6):504-8.

PMID: 22290002 DOI: 10.5505/tjtes.2011.04809

We reviewed cases with Lisfranc injuries who presented to our center in order to study the adequacy of the treatment method and their final functional outcome.

Fulltext Salmonella spondylodiscitis of the thoracic vertebrae mimicking spine tuberculosis

Muhamad Effendi F, Ibrahim MI, Mohd Miswan MF

BMJ Case Rep, 2016 Jul 05;2016.

PMID: 27381996 DOI: 10.1136/bcr-2016-215909

Extraintestinal Salmonella infection involving the thoracic spine is very rare. It commonly presents with non-specific chronic back pain and can occur with no gastrointestinal manifestation. Blood test results and imaging findings are often indistinguishable from more common chronic spine infections such as spine tuberculosis. Culture studies remain the key to establishing a definitive diagnosis and subsequently successful treatment. We report a case in which a patient presented with symptoms and signs suggestive of spine tuberculosis, yet the culture examination revealed otherwise.

Fulltext Chronic heel pain: It could be tuberculosis

Muhamad Effendi F, Ibrahim MI, Rozali KN, Miswan MF

Malays Fam Physician, 2016;11(2-3):20-23.

PMID: 28461854 MyJurnal

INTRODUCTION: Heel pain is a common presentation at a primary care setting. The majority of these cases are benign and self limiting in nature. Common differential diagnoses include plantar fasciitis and peroneal muscle sprains. However, certain conditions-if undetected early-may cause significant morbidity to the patient. A high index of suspicion and early referral for further investigations are needed to prevent long-term morbidities.

METHODS: A clinical review of a patient with chronic left heel pain was performed. Blood parameters and imaging investigations indicated chronic infection of the calcaneum. Histopathological examination was highly suggestive of tuberculosis.

RESULT: The patient responded well to antituberculous therapy. She was pain free and showed no signs of recurrence at final follow-up.

CONCLUSION: Here, we report a case of chronic heel pain, which was later diagnosed as tuberculosis of the calcaneum and successfully treated with antituberculous therapy.

The unusual traumatic locked young knee

Mohd Miswan MF, Latiff Alsagoff S, Muhamad Effendi F, Ibrahim MI

Malays Fam Physician, 2019;14(2):26-28.

PMID: 31827732

Locked knee is an orthopaedic condition requiring urgent treatment. Although the condition can be diagnosed via history, physical examination and imaging studies, the cause of the mechanical obstruction may only be apparent during arthroscopic examination of the knee joint. It is known that imaging plays a role in evaluating the integrity of intra-articular structures, however in some atypical cases, imaging cannot identify the definitive cause of locked knee. Here we report on two cases of locked knee, due to uncommon conditions which were unobservable via normal imaging studies.

Fulltext Soft-Tissue Loop for Medial Patellofemoral Ligament Reconstruction

Miswan MF, Al-Fayyadh MZ, Seow Hui T, Mohamed Ali MR, Ng WM

Arthrosc Tech, 2016 Apr;5(2):e321-7.

PMID: 27354953 DOI: 10.1016/j.eats.2016.01.003

A patient with patellar instability frequently presents with anterior knee pain, patellar subluxation, or dislocation. Medial patellofemoral ligament (MPFL) has a key role for normal patella tracking and stability. Reconstruction of the MPFL using a hamstring graft is a commonly used procedure for the treatment of chronic lateral subluxation of patella. Anchor sutures and bony tunnels are used for the patellar attachment of the graft. This can be associated with complications such as patella fracture; besides, it does not produce an anatomical reconstruction for the native MPFL that can alter the direction of tension applied on the patella. To overcome these problems, a soft-tissue loop technique is used for MPFL reconstruction. During this procedure, a semitendinosus graft was passed through the prepatellar extensor retinaculum and secured with sutures. The free ends of the graft were then passed between the second and third layers of the medial patellofemoral retinaculum and fixed to a femoral tunnel on the medial femoral condyle with an interference screw. The desired amount of tension on the graft is achieved under direct vision of patella tracking arthroscopically. We found this method to be relatively safe and fast. It is more anatomical and can avoid the complications during the conventional bony procedures.

Fulltext Pulled/nursemaid's elbow

Mohd Miswan MF, Othman MS, Muhamad Effendi F, Ibrahim MI, Rozali KN

Malays Fam Physician, 2017;12(1):26-28.

PMID: 28503271

Nursemaid's elbow is a radial head subluxation caused by axial traction on the extended arm while the forearm is pronated, allowing for slippage of the radial head. A 2-year-old boy presented with pain, swelling and reduced range of movement of the right elbow for 4 days. The mother noted that the child was moving the right upper limb less often and there was tenderness over the right elbow. X-ray of the right elbow showed subluxation of the elbow joint with no obvious fracture. A trial of conservative management was decided upon and the patient was placed on a right elbow backslab with the right forearm in a supine position. On follow-up, there was no swelling, tenderness or neurological deficit noted. A repeate x-ray revealed normal findings.

Correlation between anatomy of the scapula and the incidence of rotator cuff tear and glenohumeral osteoarthritis via radiological study

Miswan MF, Saman MS, Hui TS, Al-Fayyadh MZ, Ali MR, Min NW

J Orthop Surg (Hong Kong), 2017 01;25(1):2309499017690317.

PMID: 28215115 DOI: 10.1177/2309499017690317

INTRODUCTION: We conducted a study to elucidate the correlation between the anatomy of the shoulder joint with the development of rotator cuff tear (RCT) and glenohumeral osteoarthritis (GHOA) by using acromioglenoid angle (AGA).

MATERIALS AND METHODS: The AGA is a new measured angle formed between the line from midglenoid to lateral end of the acromion with the line parallel to the glenoid surface. The AGA was measured in a group of 85 shoulders with RCT, 49 with GHOA and 103 non-RCT/GHOA control shoulders. The AGA was compared with other radiological parameters, such as, the critical shoulder angle (CSA), the acromion index (AI) and the acromiohumeral interval (AHI). Correlational and regression analysis were performed using SPSS 20.

RESULTS: The mean AGA was 50.9° (45.2-56.5°) in the control group, 53.3° (47.6-59.1°) in RCT group and 45.5° (37.7-53.2°) in OA group. Among patients with AGA > 51.5°, 61% were in the RCT group and among patients with AGA < 44.5°, 56% were in OA group. Pearson correlation analysis had shown significant correlation between AGA and CSA ( r = 0.925, p < 0.001). It was also significant of AHI in RCT group with mean 6.6 mm (4.7-8.5 mm) and significant AI in OA group with mean 0.68 (0.57-0.78) with p value < 0.001 respectively.

CONCLUSION: The AGA method of measurement is an excellent predictive parameter for diagnosing RCT and GHOA.

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