MyMedR

Fulltext A Biomechanical Comparison between Taylor's Spatial Frame and Ilizarov External Fixator

Tan B, Shanmugam R, Gunalan R, Chua Y, Hossain G, Saw A

Malays Orthop J, 2014 Jul;8(2):35-9.

PMID: 25279090 DOI: 10.5704/MOJ.1407.012

Taylor's spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF.

Fulltext A New Approach to Body Donation for Medical Education: The Silent Mentor Programme

Saw A

Malays Orthop J, 2018 Jul;12(2):68-72.

PMID: 30112135 MyJurnal DOI: 10.5704/MOJ.1807.015

Cadaveric dissection is an integral component of medical education. There had been concerns about negative impact on medical students exposed to deceased donors before their clinical years, but most studies reported overall positive outcome following this form of teaching. Due to reducing number of body donations in most parts of the world, many institutions are adopting alternative models especially for the teaching of gross anatomy. A new body donation programme that incorporate humanistic values in the procurement process was initiated by Tsu Chi University of Taiwan in 1996. Early observations following teaching with the so-called "silent mentors" noted less negative emotional impact on the students. With increasing number of body donation following the initiation of the silent mentor programme as reported in some regions, we will be able to continue the time-honoured cadaveric dissection for anatomy teaching, at the same time promoting humanistic values on junior doctors.

Fulltext A biomechanical comparison between Taylor’s spatial frame and ilizarov external fixator

Tan, B. B., Shanmugam, R., Chua, Y. P., Hossain, G., Saw, A.

Malays Orthop J, 2014;8(2):35-39.

MyJurnal

Taylor’s spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF.

Fulltext A simple practical protocol for care of metal-skin interface of external fixation

Saw A, Chan CK, Penafort R, Sengupta S

Med J Malaysia, 2006 Feb;61 Suppl A:62-5.

PMID: 17042233

Patients treated with external fixation for limb reconsturciton or fracture stabilization equire regular and prolongedperiod of pin-tract care involving frequent visits to clinic and dressing traditionally carried out by trained nurses or medical assistants. A simple method of do-it-yourself dressing was introduced in our institution and this study was undertaken to evaluate the effectiveness of the protocol. Sixty patients (40 trauma-related problems and 20 congenital or developmental disorders) were enrolled into the study. Following application of external fixation, the patients and/or their caretakers were taught on how to do pin-site dressing using normal saline or drinking water as cleansing solution on daily basis. Patients were discharged on the second or third post-operative day and were followed-up every two weeks for an average 182 days (range 66 to 379 days) with special attention on identifying pin-tract infection. A simple grading system for pin-tract infections was proposed. Of 40 patients with trauma-related problems. 65% were post-traumatic infections. There were 788 metal-skin interfaces (239 half-pin fixations and 549 tensioned wire fixations. A total 143 metal-skin interface infections (18.1%) involving half-pin sites (41.3%) and tensioned wire sites (58.7%) was noted. Majority were grade I infections (79.7%), 18.8% grade II and only 1.4% grade III. Most infections (81%)were caused by Staphylococcus aureus. Grade I infections were successfully treated with frequent dressing, grade II by adjunctive oral antibiotic but grade III infections required removal of fixator. All eventually healed. Do yourself non-sterile dressing of metal-skin interfaces is a cost-effective method of pin-site care with a low infection rate. The infections were sucessfully treated using guidelines according to the proposed classification of pin-tract infections.

Fulltext Aberrant left brachiocephalic vein is a contraindication for anterior cervicothoracic approach

Ong EKS, Wong TS, Chung WH, Chiu CK, Saw A, Hasan MS, et al.

J Orthop Surg (Hong Kong), 2019 10 17;27(3):2309499019879213.

PMID: 31615339 DOI: 10.1177/2309499019879213

Aberrant left brachiocephalic vein is a rare condition. Its occurrence in patients requiring anterior cervicothoracic approach for severe kyphoscoliosis has not been described. A 16-year-old male with neurofibromatosis and severe upper thoracic kyphoscoliosis presented to us with curve progression. Halo gravity traction was attempted but failed to achieve significant correction. Subsequently, he underwent halo-pelvic traction and later Posterior Spinal Fusion (PSF) from C2 to T10. Second-stage anterior cervicothoracic approach with anterior fibula strut grafting was planned; however, preoperative computed tomography angiography revealed an aberrant left brachiocephalic vein with an anomalous retrotracheal and retroesophageal course, directly anterior to the T5/T6 vertebrae (planned anchor site for fibula strut graft) before draining into superior vena cava. Therefore, surgery was abandoned due to the risks associated with this anomaly. Aberrant left brachiocephalic vein is rare, the presence of which could be a contraindication for anterior cervicothoracic approach. Assessment of the anterior neurovascular structures is crucial in preoperative planning.

An Exploration of Death Anxiety of Family Members of Silent Mentor Body Donation Program

Wong LP, Alias H, Tan SL, Sia TE, Saw A

Omega (Westport), 2022 Oct 10.

PMID: 36217612 DOI: 10.1177/00302228221132902

Background: This study assesses the level of death anxiety among the family members of the Silent Mentor Programme (SMP) and determines whether their participation in various ceremonies during the training session impacted their death anxiety. Methods: The revised Collett-Lester Fear of Death Scale (CL-FODS) was administered to the study participants before the opening ceremony and after the sending-off ceremony of the programme. Results: All the four subscales that measure fear of one's own death, fear of the process of one's own dying, fear of the death of others and fear of the process of others dying in the CL-FODS showed significant reduction after the sending-off ceremony compared with before the opening ceremony. Younger family members reported significantly higher mean total death anxiety scores compared to the older members. Conclusion: The SMP not only nurtures doctors with humanity but also helps the family members to cope with grief and loss.

Fulltext Anterior Displacement of Ulnar Nerve at the Elbow inChildren Based on Ultrasonography

Shamsul, H., Saw, A., John, G.

Malays Orthop J, 2007;1(1):29-33.

MyJurnal

This study involved evaluation of the elbows of 50 children between 4 to 14 years of age. Clinical examination for elbow flexion, extension, range of motion and carrying angle were performed, followed by ultrasonographic examination to determine position of the ulnar nerve in relation to the medial epicondyle upon elbow flexion and extension. Thirty-one elbows showed anterior displacement of the ulnar nerve, of which 14 were due to subluxation and 17 to dislocation. We found that anterior translation of ulnar nerve is present in the elbows up to 31% of children, especially those with increased range of elbow motion.

Fulltext Antimicrobial gauze as a dressing reduces pin site infection: a randomized controlled trial

Lee CK, Chua YP, Saw A

Clin Orthop Relat Res, 2012 Feb;470(2):610-5.

PMID: 21842299 DOI: 10.1007/s11999-011-1990-z

Pin site infection is a common problem in external fixation. Plain gauze wetted with normal saline is commonly used for a pin site dressing owing to the simplicity and low cost. Evidence to support adding an antimicrobial agent in the dressing material is lacking.

Fulltext Automatic top loader washing machine related injury. A report of four cases with serious injury

Kwan MK, Saw A, Sara Ahmad T

Med J Malaysia, 2005 Mar;60(1):112-4.

PMID: 16250295 MyJurnal

We are reporting four cases of serious washing machine related injury that presented within a period of 5 months. All patients were young children with the mean age of 9 year-old and three had their dominant hand injured. The washing machines involved were the automatic top loader type and all injuries occurred during the spinning phase. Serious automatic washing machine injury is not uncommon in Malaysia. We feel that there is a need to improve the safety features especially during the spinning phase. The operating instructions and safety precautions on the washing machine should be displayed in different languages that can be understood well. Parents should also aware of the potential risks of this seemingly benign household appliance.

Fulltext Bone Overgrowth after Fracture of the Femoral Shaft inChildren

Yong, S.M., Saw, A., Sengupta, S., Bulgib A.M.

Malays Orthop J, 2007;1(1):8-11.

MyJurnal

Forty children treated non-operatively for fractures of the femoral shaft were reviewed with regard to differences in limb length after treatment. Follow up duration ranged from two to seven years. The average femoral overgrowth was 0.85cm (range 0 - 2.5cm) and was influenced by age at the time of fracture. We were not able to find any association between the quantity of overgrowth and race, gender, level or configuration of the fracture.

Fulltext COVID-19 in Singapore and Malaysia: Rising to the Challenges of Orthopaedic Practice in an Evolving Pandemic

Tay K, Kamarul T, Lok WY, Mansor M, Li X, Wong J, et al.

Malays Orthop J, 2020 Jul;14(2).

PMID: 32313613 DOI: 10.5704/MOJ.2007.001

With the increasing number of COVID-19 cases and related deaths worldwide, we decided to share the development of this condition in Singapore and Malaysia. First few cases were diagnosed in the two countries at the end of January 2020, and the numbers have surged to thousands by end of March 2020. We will focus on strategies adopted by the government and also the Orthopaedic community of the two countries up till the beginning of April 2020. We hope that by sharing of relevant information and knowledge on how we are managing the COVID-19 condition, we can help other communities, and health care workers to more effectively overcome this pandemic.

Fulltext Change in angle of depressed medial tibial plateau following extra-articular mechanical realignment surgery in children with Blount's disease who presented late for treatment

Phang ZH, Albaker M, Gunalan R, Lee AYX, Saw A

Singapore Med J, 2021 Nov 08.

PMID: 34749494 DOI: 10.11622/smedj.2021189

INTRODUCTION: The aim of this study was to determine whether any change in degree of medial tibia plateau depression after extra-articular mechanical realignment surgery was observed in children with Blount's disease who presented late for treatment in their adolescent and young adulthood.

METHODS: We retrospectively reviewed the radiographic parameters of 22 patients (32 lower limbs) with Blount's disease who underwent gradual correction of deformity surgery using ring external fixator without surgical elevation of the depressed medial tibial plateau at a mean age of 15 (10-37) years. Preoperative and postoperative angles of depressed medial tibia plateau (ADMTP) of the same patient were compared for any significant change. Normally distributed data were analysed using Student's t-test when comparing two groups or one-way ANOVA when comparing more than two groups. Skewed data were analysed using Mann-Whitney test.

RESULTS: After extra-articular mechanical alignment surgery, statistically significant improvements in medial tibial plateau depression were seen in the Infantile (p = 0.03) and Juvenile (p = 0.04) Blount's subgroups. Change of ADMTP was greater in patients who were operated on at age < 17 years, before skeletal maturity (p = 0.001). The improvement was likely due to ossification of unossified cartilage at the posteromedial proximal tibia and remodelling potential of proximal tibia physis after mechanical realignment.

CONCLUSION: Improvement of medial tibia plateau depression is possible after mechanical realignment without surgical hemiplateau elevation in cases of Infantile and Juvenile Blount's disease that present late for treatment, especially when the operation is performed before age 17 years old.

Fulltext Change in facial shape in two cohorts of Japanese adult female students twenty years apart

Hossain MG, Saw A, Ohtsuki F, Lestrel PE, Kamarul T

Singapore Med J, 2011 Nov;52(11):818-23.

PMID: 22173252

Secular changes in the head and body dimensions of the Japanese population were recorded during the last century, but studies on Japanese adult facial shape were poorly documented. This study aimed to document the secular changes in facial shape and their association with craniofacial measures of Japanese adult female students.

Fulltext Comparing the mechanical strength of hip spica cast between a conventional and a new method of application

Wan KL, Shanmugam R, Lee KY, Saw A

J Child Orthop, 2016 Oct;10(5):387-94.

PMID: 27614766 DOI: 10.1007/s11832-016-0770-4

The current technique of hip spica application is mostly based on a publication by Kumar (J Pediatr Orthop 1(1):97-99, 1981). We modified the technique of hip spica application in order to reduce the rate of breakage across the hip joint and designed this study to compare the strength between hip spica applied according to Kumar's technique and the new technique.

Fulltext Comparison of fracture patterns between rural and urban populations in a developing country

Saw A, Sallehuddin AY, Chuah UC, Ismail MS, Yoga R, Hossain MG

Singapore Med J, 2010 Sep;51(9):702-8.

PMID: 20938610

The pattern of fracture, including the anatomical location and age distribution, may differ among urban and rural populations due to various factors such as the inhabitants' occupation and living environment.

Comparison of two methods of percutaneous pin fixation in displaced supracondylar fractures of the humerus in children

Foead A, Penafort R, Saw A, Sengupta S

J Orthop Surg (Hong Kong), 2004 Jun;12(1):76-82.

PMID: 15237126

To conduct a prospective randomised controlled study to compare the stability and risk of nerve injury between fractures treated by medial-lateral pin fixation and those treated by 2-lateral pin fixation.

Fulltext Conduct of body donation and cadaveric dissection training during the COVID-19 pandemic: challenges, impacts and mitigation

Wong LP, Alias H, Tan SL, Saw A

Anat Sci Int, 2023 Sep;98(4):558-565.

PMID: 37072599 DOI: 10.1007/s12565-023-00723-9

The new coronavirus disease 2019 (COVID-19) has had a substantial impact on the Silent Mentor Programme (SMP), a programme in which members of the public may pledge their bodies to be used for medical training and research after their death. This study aimed to explore the conduct of body donations and simulation surgery training during the COVID-19 pandemic from the viewpoints of the committee members of the SMP and the next-of-kin of body donor pledgers. This study utilised a qualitative exploration method to seek an in-depth understanding of this phenomenon. In-depth individual interviews were carried out. Thematic analysis was used to identify patterns of themes. The COVID-19 polymerase chain reaction (RT-PCR) test is compulsory before accepting a body donation, and this resulted in the turning down of several donations. Being a donor is the final wish of pledgers and this turning down led to a negative emotional remorseful feeling in the next-of-kin of pledgers. From the perspective of students, it is feared that the conduct of the programme, particularly the home visit session being held online, has impeded teaching of humanistic values, compassion, and empathy, which is the prime philosophy of the programme. Previous to the pandemic, the programme ceremonies were well-attended, denoting the utmost respect and recognition of the mentors; however, travel restrictions due to the pandemic limiting in-person attendance resulted in ceremonies becoming less impactful. Continuous postponements of cadaveric dissection training also resulted in students missing training opportunities, hence potentially impairing their professional practice and humanistic values in the medical profession. Counselling interventions should be directed at easing the negative psychological impact on the next-of-kin of pledgers. As the COVID-19 pandemic may pose a significant impediment to achieving the educational outcomes of cadaveric dissection training, efforts to make up for these gaps are essential.

Fulltext Correction to: Factors influencing childhood anaemia in Bangladesh: a two level logistic regression analysis

Yusuf A, Mamun ASMA, Kamruzzaman M, Saw A, Abo El-Fetoh NM, Lestrel PE, et al.

BMC Pediatr, 2019 Jul 26;19(1):258.

PMID: 31349810 DOI: 10.1186/s12887-019-1607-3

Following publication of the original article [1], the authors reported that name that appeared in published online version is incorrect.

Fulltext Differentials in the prevalence of anemia among non-pregnant, ever-married women in Bangladesh: multilevel logistic regression analysis of data from the 2011 Bangladesh Demographic and Health Survey

Kamruzzaman M, Rabbani MG, Saw A, Sayem MA, Hossain MG

BMC Womens Health, 2015;15:54.

PMID: 26219633 DOI: 10.1186/s12905-015-0211-4

Anemia is one of the most common public health problems globally, and high prevalence has been reported among women of reproductive age, especially in developing countries. This study was conducted to evaluate differentials in the prevalence of anemia among non-pregnant, ever-married women of reproductive age in Bangladesh, and to examine associations with demographic, socioeconomic, and nutritional factors.

Diluted povidone-iodine versus saline for dressing metal-skin interfaces in external fixation

Chan CK, Saw A, Kwan MK, Karina R

J Orthop Surg (Hong Kong), 2009 Apr;17(1):19-22.

PMID: 19398787

To compare infection rates associated with 2 dressing solutions for metal-skin interfaces.

Displaying publications 1 - 20 of 58 in total