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Fulltext Is A New Combination of Tendon Transfers For Radial Nerve Palsy (RNP) Needed?

Ramdhan I, Nawfar S, Paiman M

Malays Orthop J, 2014 Mar;8(1):75-8.
PMID: 25347622 MyJurnal DOI: 10.5704/MOJ.1403.006

Radial nerve palsy following traumatic humeral diaphyseal fractures occurs uncommonly. Most recover with good outcome. However the cases with poor outcome or recovery will have tendon transfers to regain the lost functions. Various tendon transfer methods and choices are available in literatures citing acceptable to good results. We report a case of radial nerve transection secondary to a closed traumatic diaphyseal fracture of the humerus which did not improve despite the repair. As many conventional technique produce asynergistic muscle action with secondary post-transfer deformity, thus we had resorted to tendon transfer procedure using an unconventional donor and recipient tendons yielding good results. This new combination of tendon transfers was invented involves better dynamic correlation of synergistic muscles action and produces good outcome and hand function.
Fulltext Minimally Invasive Plate Osteosynthesis with Conventional Compression Plate for Diaphyseal Tibia Fracture

Anuar-Ramdhan IM, Azahari IM, Med Orth M

Malays Orthop J, 2014 Nov;8(3):33-6.
PMID: 26401234 MyJurnal DOI: 10.5704/MOJ.1411.008

The diaphyseal tibia fracture is best treated with intramedullary nail but in some cases where the nail is not applicable, plate fixation will be the next option of fixation. The extensile anterior approach is normally used for conventional compression plate fixation in tibia shaft fractures. The extensive surgical dissection may devitalizes the bony fragments and interfere with the fracture union as well as soft tissue healing. Minimally Invasive Plate Osteosynthesis (MIPO) provides good preservation of blood supply and fracture hematoma at the fracture site thus promotes biological bone healing. The use of indirect reduction techniques and small skin incisions to introduce the plate is technically demanding and requires fluoroscopy exposures throughout the surgery, being some of its drawbacks. We recommend MIPO for conventional compression plate fixation in tibial shaft fractures in view of the reduced surgical trauma to the surrounding soft tissue and good functional outcome.
Fulltext 'Does the National Antibiotic Guideline- 2008 remain applicable for treating diabetic foot infection?' A new evidence-based regional study on culture and sensitivity patterns in Terengganu population

Balakrishnan S, Shahid Nj, Fairuz T, Ramdhan I

Malays Orthop J, 2014 Mar;8(1):42-4.
PMID: 25347049 DOI: 10.5704/MOJ.1403.017

Diabetic foot infections make up a significant number of orthopaedic ward admissions. The recommended choice of empirical antibiotics used in Malaysia for diabetic foot infections is based on the National Antibiotic Guidelines 2008. The pattern of bacteriology and the effectiveness of the treatment of diabetic foot infections based on this guideline were analyzed through a retrospective study in our hospital. Data over a period of one year (May 2012- April 2013) was analyzed, and 96 patients were included in this study. Polymicrobial growth (58%) was mainly isolated, followed with an almost equal percentage of gram-negative (22%) and gram-positive organisms (20%). The empirical antibiotics based on the national antibiotic guidelines were used as definitive antibiotics in 85% of the cases. Although there was slight variation in the pattern of organisms as compared to other studies conducted in this country, the high rate of positive clinical response proved that the antibiotic guideline was still effective in diabetic foot infection treatment.
KEY WORDS: Diabetic foot infections, National Antibiotic Guidelines, Culture and Sensitivity.
Fulltext Comparative study between coaptive film versus suture for wound closure after long bone fracture fixation

Anuar Ramdhan I, Zulmi W, Hidayah A, Kamel M, Fadhil M, Anwar Hau M

Malays Orthop J, 2013 Mar;7(1):52-5.
PMID: 25722808 MyJurnal DOI: 10.5704/MOJ.1303.017

Coaptive film (i.e., Steri-Strips™) is an adhesive tape used to replace sutures in wound closure. The use of coaptive film for wound closure after long bone fracture fixation has not been well documented in the literature.
Fulltext Knowledge and practice of diabetic foot care in an inpatient setting at a tertiary medical center

Muhammad-Lutfi AR, Zaraihah MR, Anuar-Ramdhan IM

Malays Orthop J, 2014 Nov;8(3):22-6.
PMID: 26401231 MyJurnal DOI: 10.5704/MOJ.1411.005

Good knowledge and practice regarding diabetic foot care will reduce the risk of diabetic foot complications and ultimately amputation. This study is conducted to assess patients' knowledge and compliance of diabetic foot care. A cross sectional study performed on patients who were admitted to HSNZ from the 1st September 2013 to 30th April 2014 for diabetic foot infections. They were interviewed with a questionnaire of 15 'yes' or 'no' questions on foot care knowledge and practice. Score of 1 was given for each 'yes' answer. The level of knowledge and practice, whether good or poor, was determined based on the median score of each category. The result was tested using a chi-square test in SPSS version 17. A total of 157 patients were included in this study with a mean age of 56.33 years (31-77). There were 72 male (45.9%) and 85 female (54.1%) patients with the majority of them being Malays (154 patients, 98.1%). Majority of the patients (58%) had poor foot care knowledge while 97 patients (61.8%) had poor diabetic foot care practice as compared to the median score. Based on the chi square test of relatedness, there was no significant association between knowledge and practice with any of the variables. In conclusion, the majority of patients admitted for diabetic foot infections had poor knowledge and practice of diabetic foot care. Education regarding foot care strategies should be emphasized and empowered within the diabetic population.
Study site: Hospital Sultanah Nur Zahirah, Kuala Terengganu,Terengganu, Malaysia
Fulltext Cubitus Valgus with Tardy Ulnar Nerve Palsy - Is Anterior Transposition of the Ulnar Nerve Always Necessary? A Case Report

Anuar-Ramdhan IM, Remli R, Abdul-Rashid AH, Ibrahim S

Malays Orthop J, 2020 Jul;14(2):126-129.
PMID: 32983387 DOI: 10.5704/MOJ.2007.010

Tardy ulnar nerve palsy is a known complication of cubitus valgus. The options for treating the ulnar neuropathy include anterior nerve transposition or neurolysis. We report on an 11-year-old boy who had a tardy ulnar nerve palsy due to cubitus valgus resulting from a non-union of a lateral condyle fracture of the humerus. Anterior transposition of the ulnar nerve was not done after the closing wedge osteotomy of the distal humerus. The close wedge osteotomy relieved the tension on the nerve and not transposing the ulnar nerve anteriorly prevented an iatrogenic nerve injury. The patient had no restriction with activities of daily living at the six years follow-up although neurological recovery was incomplete.
Fulltext Economic impact of managing acute diabetic foot infection in a tertiary hospital in Malaysia

Lam AWC, Zaim MR, Helmy HH, Ramdhan IMA

Malays Orthop J, 2014;8(1):46-49.
MyJurnal

Diabetic foot disease is the leading cause of non-traumatic amputations of the lower limb, hence a major health care and socioeconomic burden. It has been found that most of the costs occur in the inpatient setting; therefore this study is to quantify the costs of managing inpatient diabetic foot infections (DFI). We treated 182 inpatients from May 2012 till April 2013 and analysed the cost of antibiotic usage, wound dressing, surgical procedure, admission and basic investigation costs. The total cost was ~ USD 11,000 (2013). This number, however, only reflects the cost for managing an acute infection. The price for follow-up care as an outpatient, rehabilitation and indirect costs (emotional suffering, reduced productivity) is estimated to be much more.
Study site: Diabetic Inpatient Registry, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
Fulltext Pigmented Villonodular Synovitis (PVNS) of the Knee mimicking Septic Arthritis in a Paediatric Patient: A Case Report

Indra F, Anuar-Ramdhan IM, Vick-Duin E, Awang-Ojep DN

Malays Orthop J, 2021 Nov;15(3):122-126.
PMID: 34966506 DOI: 10.5704/MOJ.2111.019

Pigmented villonodular synovitis (PVNS) is a benign but rare proliferative disorder of the synovium. It commonly occurs in the adult population and usually presents as a monoarticular disease. There are two types of PVNS, namely the localised and diffused type. The disease is often misdiagnosed due to its rarity especially in paediatric patients. Knee involvement in PVNS is the commonest form in children although other joints such as hip, foot, ankle, hip, sacroiliac joint and concurrent multiple joint involvements have also been reported. PVNS in paediatric patients is often misdiagnosed as septic arthritis, juvenile rheumatoid arthritis and bone sarcoma, and the diagnosis is usually often made late due to its vague presentation. The majority of PVNS cases are managed by surgery either via open or arthroscopic synovectomy except in a few paediatric patients as described in the literature. This case report of PVNS is of a knee in 11-year-old boy who was initially treated as septic arthritis. The synovium appearance mimicked the features of PVNS during a knee arthrotomy washout, and histopathological examination confirmed the diagnosis. The knee symptoms had significantly improved without additional surgery, and good functional knee motion was achieved, with no sign of recurrence, after two years of follow-up.