MyMedR

Fulltext Tuberculosis of the skull mimicking multiple myeloma

Pan KL, Zulkarnaen M

Med J Malaysia, 2014 Aug;69(4):197-8.

There is a resurgence of tuberculosis globally but lesions affecting the skull are rare. Cases reported are of single, focal lesions as seen on plain x-rays. We report a 34 yearold patient with tuberculosis of the skull where multiple punched out lesions are seen, mimicking that of multiple myeloma.

Fulltext Symptoms indicating imminent breakage of a femoral interlocking nail: a case report

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.

Fulltext A simple method for removal of the distal segment of a broken femoral intramedullary nail: a case report

Pan K, Reuben P

Malays Orthop J, 2012 Nov;6(3):66-8.

PMID: 25279064 MyJurnal DOI: 10.5704/MOJ.1207.011

We report a method for removing the distal segment of a broken locked intramedullary nail secondary to nonunion of the femur following radiotherapy for fibromatosis. A Kirschner wire with one tip fashioned into a hook was used to remove the distal segment without opening with the nonunion site. Details of the procedure are described.

Fulltext A modified method of traction for young children with congenital dislocation of the hip as a preliminary to reduction

Pan KL, Rasit H

Med J Malaysia, 2004 Dec;59 Suppl F:47-8.

PMID: 15941161

Many authors agree that preliminary traction prior to closed or open reduction for congenital dislocation of the hip is helpful. Different ways of traction have been used and each of them has its own advantages and disadvantages. One of the problems in the very young child is the difficulty in maintaining a suitable traction that is biomechanically effective. We found that using a rocker bed made the traction more "user friendly" for the child, the parent and the doctors.

Fulltext Osteopoikilosis--a case report

Pan KL, Ibrahim S

Med J Malaysia, 2000 Sep;55 Suppl C:107-8.

PMID: 11200037

Osteopoikilosis is a rare, inheritable, sclerosing bone dysplasia; sometimes mistaken for osteoblastic bone metastases. We report a case in a 25 year-old lady.

Fulltext Tuberculosis of the distal end of the radius mimicking a giant-cell tumour

Pan KL, Ibrahim S

Med J Malaysia, 2000 Sep;55 Suppl C:105-6.

PMID: 11200036

We report a case of a lady presenting with a lesion in the distal radius with classical radiological features of a giant-cell tumour. These tumours are often resected without preliminary histological confirmation. A biopsy done in this patient showed it to be tuberculosis.

Fulltext Delayed repair of rupture of the biceps femoris tendon--a case report

Pan KL, Ting F

Med J Malaysia, 2000 Sep;55(3):368-70.

PMID: 11200719

A rare case of an isolated rupture of the biceps femoris tendon at its insertion to the femoral head is presented. Delayed surgical repair has not been previously reported. In this patient, a successful repair was carried out four months after the injury.

Fulltext Conservative management of femoral shaft fractures in children

Moses T, Pan KL, Razak M

Med J Malaysia, 1998 Sep;53 Suppl A:22-6.

PMID: 10968179

Thirty-two children with femoral shaft fractures were treated conservatively with initial skin traction followed by an additional period in a spica cast. After 12 to 20 months of follow up, none had any pain and all of them were attending school without problems. Shortening of more than 2 cm occurred in 6 (19%) of the 32 patients. The most important factor associated with shortening was an overlap of more than 2 cm of shortening of the fracture ends at the time of cast fitting. The average compensatory overgrowth at final assessment was 7 mm. Angular deformity did not pose a problem. This is a safe, simple and practical method to treat childhood femoral shaft fractures.

Fulltext Intraarticular fractures of the distal radius in young adults--a review of the outcome of treatment

Pan KL, Masbah O, Ali M

Med J Malaysia, 2001 Jun;56 Suppl C:19-25.

PMID: 11814243

A retrospective review of 30 intraarticular fractures of the distal radius in 27 patients was done. Only young adults aged between 18 and 40 were included. Road traffic accidents accounted for 25 of the cases (23 motorcyclists). Fourteen fractures were treated by closed reduction and a plaster cast. Sixteen fractures were treated by open reduction with internal fixation using a buttress plate or multiple Kirschner wires. At a mean follow-up of 17 months, 63% of the wrists had a satisfactory result and 37% unsatisfactory result. The main adverse factor was intraarticular congruity. The grip strength on the injured side averaged 56% of that of the uninjured side and the pinch strength averaged 73%. Most of the patients were able to return to their former occupation in an average of four months.

Fulltext Late reconstruction of the patellar tendon

Pan KL, Masbah O, Razak M

Med J Malaysia, 2001 Jun;56 Suppl C:73-5.

PMID: 11814255

A case of late reconstruction of the patellar tendon is reported. Besides partial loss of the tendon, the patient also had loss of the distal third of the patella. A rolled strip of fascia lata was used to reconstruct the tendon with tunnels through the patella. At the tenth month of follow-up, the result was deemed successful.

Fulltext Rare combination of seven fractures in the same forearm and wrist

Pan KL, Masbah O, Razak M

Med J Malaysia, 2000 Jun;55(2):268-70.

PMID: 19839159

A rare combination of a segmental ulnar fracture with fracture dislocation of the head of the radius and intraarticular fracture of the distal radius concomitant with an ipsilateral scaphoid, lunate and coronoid process fractures is presented. The mechanism of injury could possibly be a tremendous impact on the outstretched hand with a dorsiflexed wrist, fracturing the carpal bones and the distal radius. Transmitted axial forces on the ulna in a pronating forearm resulted in the other fractures. To the best of our knowledge, no such case has been reported. Open reduction with screw fixation of the scaphoid, plating of the proximal ulna and Kirschner wiring of the distal radius and radial head dislocation were done.

Fulltext Squamous cell carcinoma involving the tibia treated by reimplantation of autoclaved resected bone

Pan KL, Mourougayah V, Jayamalar T

Med J Malaysia, 2003 Dec;58(5):783-5.

PMID: 15190672

We present an elderly patient with a squamous cell carcinoma over the subcutaneous aspect of the leg involving the tibia. En bloc resection of the tumour together with a 10 centimetre segment of the tibia was done. The resected bone was autoclaved, replaced in its original position and stabilized with bone cement and a locked nail. This allowed early ambulation with minimal cost.

Fulltext Moulded cement-prosthesis for osteosarcoma of the proximal humerus

Pan KL, Ong GB, Potukuchi AP

Med J Malaysia, 2006 Dec;61 Suppl B:55-7.

PMID: 17600994

We report a case of an 11-year-old boy with osteosarcoma of the proximal humerus treated with wide excision and reconstruction with a cement spacer-prosthesis. After seven years of follow-up, the patient is now almost a young adult. We present his current physical and functional status, which seems to defray the initial doubts regarding long-term problems when we chose this method of reconstruction.

Fulltext The pattern of femoral diaphyseal fractures in children admitted in Sarawak General Hospital

Rasit AH, Mohammad AW, Pan KL

Med J Malaysia, 2006 Feb;61 Suppl A:79-82.

PMID: 17042236

Trend towards changing the face of management for pediatric femoral fractures tends to advocate operative treatment. This study was undertaken to review our current practice in the wake of recent progress in the management of pediatric femoral fractures. Fifty patients with femoral diaphyseal fracture treated in Sarawak General Hospital were reviewed retrospectively after an average follow-up of 2.6 years. There were 36 boys and 14 girls, with a mean age of 6.2 years (range five months to 14 years). Children under six years of age constituted the majority of the patients. Half of the fractures were caused by road traffic accident. Nine patients had associated injuries. The most common site of fracture was at the middle third (N=31). The treatment regimens were delayed hip spica (DHS) in 16, immediate hip spica (IHS) in 24, plate osteosynthesis (PO) in five, titanium elastic nailing (TEN) in five, and external fixation (EF) in one. The minimum hospital stay was two days, and the maximum 33 days (mean, 9.7 days). Malunion was the commonest complication. Conservative treatment is the preferred option for children under six years of age. It is cost-effective with minimal complication. The other treatment options are reserved for specific indication in older children. Diaphyseal fractures of the femur in children can be adequately managed non-operatively.

Fulltext Delay in treatment of primary malignant and aggressive musculoskeletal tumours

Pan KL, Zolqarnain A, Chia YY

Med J Malaysia, 2006 Feb;61 Suppl A:53-6.

PMID: 17042231

Patients with aggressive musculoskeletal tumours often arrive at specialised treatment centres late. Such a delay could mean disfavour for potentially curable or long-term disease-free outcome of limb preserving surgery. This study was undertaken to identify the underlying problem-related delay with a view to propose solution for solving it. We reviewed 30 patients to determine the periods of delay between onset of the first symptom and the definitive treatment. The delays were categorized as 'patient' delay, 'referral' delay and 'treatment' delay. There was 'patient' delay in 57% of patients (n=17), ranging from 1 to 18 months; 'referral' delay in 67% of patients (n=20) ranging from 1 to 19 months and 23% of patients (n=7) had treatment delay (average 23 days) at the treatment centre. The causes of late arrival are not solely patient-related but are multifactorial. Measures to minimize such delays include enhancing awareness only with high index of suspicion among primary care practitioners, creating a special lane specialized imaging studies and establishing a dedicated musculoskeletal tumour unit.

Fulltext Sleeve fracture of the patella in a child

Rasit AH, Sharaf I, Pan KL

Med J Malaysia, 2004 Dec;59 Suppl F:52-3.

PMID: 15941163

Sleeve fracture of the inferior pole of the patella is a rare and distinctive fracture in children with few published reports. These fractures are frequently misdiagnosed and neglected. We highlight a case of a neglected and misdiagnosed sleeve fracture of the patella in an eleven-year-old boy. This was initially diagnosed as an avulsion fracture of the tibial tubercle. A good outcome was achieved after open reduction and internal fixation.

Locked intramedullary nailing for complex non-union of the tibia

Pan KL, Shukur MH, Ghani MA

Injury, 1994 Dec;25(10):655-7.

PMID: 7829188

Ten patients with complex non-union of the tibia were treated by locked intramedullary nailing. These patients had scarred skin as a result of initial severe open fractures, multiple debridement or fasciotomies with external fixators and skin grafts applied. Seven of the patients also had previous osteomyelitis or pin track infections. Fully pain-free walking was achieved in all patients and radiological union in nine patients without the need for a bone graft. Four patients developed infection after nailing, of which three resolved with treatment.

Hip fracture incidence in Malaysia 1981-1989

Lee CM, Sidhu JS, Pan KL

Acta Orthop Scand, 1993 Apr;64(2):178-80.

PMID: 8498181 DOI: 10.3109/17453679308994565

The age-corrected incidence of hip fracture in the city of Kuala Lumpur and the surrounding districts has increased from 1981 to 0.7 per 1,000 population in 1989. Women dominated by a factor of 1.3. The mean age was 73 (50-103) years. The increased rate observed was attributed solely to trochanteric fractures among those 70 years and above. There were differences in the various parameters among the different races. The fracture incidence and woman/man ratio were substantially lower than has been reported from developed countries.

Fulltext Large volume osteosarcomas of the femur treated with total femoral replacement

Pan K, Chan W, Shanmugam P, Ong G, Kamaruddin F, Tan S

Malays Orthop J, 2014 Mar;8(1):32-6.

PMID: 25347294 MyJurnal DOI: 10.5704/MOJ.1403.015

Patients with extensive malignancies involving the femur often require total femoral replacement when their limbs can be salvaged. Reported series are small and involve heterogeneity of tumours. We present nine patients with osteosarcomas of the femur treated at our institution between 2003 and 2010 with a mean follow-up of 27 (6 to 56) months. Their ages ranged from 9 to 17 (mean 14 years). They had large volume tumours (mean 911 cm3) and presented late with a mean of 5.5 months from the onset of symptoms to definitive treatment. All patients underwent resection and total femur replacement. Six patients have died and two are alive with good function at the time of this report. One was lost to follow-up. These patients require a high level of treatment care and have a guarded prognosis.

Fulltext Non-bacterial chronic recurrent osteomyelitis of the clavicle

Pan K, Chan W, Ong G, Zulqarnaen M, Norlida D

Malays Orthop J, 2012 Mar;6(1):57-60.

PMID: 25279046 MyJurnal DOI: 10.5704/MOJ.1203.005

This report details the case of a 12-year-old girl with a painful, progressive swelling of the medial portion of the clavicle with no history of trauma or other constitutional symptoms. All laboratory investigations were normal except for an elevated erythrocyte sedimentation rate (ESR). Initial plain radiographs showed a destructive lesion with magnetic resonance imaging showing features of malignancy. Biopsies revealed osteomyelitis, but with negative bacterial cultures and no evidence of malignancy. Treatment with antibiotics did not result in a favourable response. Over time, the swelling increased in size with episodic exacerbations of pain. Follow-up radiographs showed sclerosis and hyperostosis. After five years, this was recognized as non-bacterial chronic recurrent osteomyelitis of the clavicle.

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