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Use of a New External Fixator for the Correction of Fixed Flexion Deformity of the Fingers

Siow YS, Ahmad TS, Goh SY

Hand Surg, 1999 Dec;4(2):167-174.
PMID: 11089175

Three patients with severe fixed flexion deformity of the fingers caused by trauma were reported. As an alternative treatment, a new mini external fixator was used to correct the deformities. The use of this device has made treatment of contractures simpler and more predictable. Gradual distraction and straightening was applied to loosen and extend the joints, followed by a period of mobilisation while still on the device. In all the three patients, this experimental device and approach led to improvement of the fixed flexion deformities. With use of this device, surgical release may not be necessary.
Fulltext Diffusion weighted MR imaging in acute vertebral compression fractures: differentiation between malignant and benign causes

Bhugaloo A, Abdullah B, Siow Y, Ng Kh

Biomed Imaging Interv J, 2006 Apr;2(2):e12.
PMID: 21614224 MyJurnal DOI: 10.2349/biij.2.2.e12

The primary objective of this study was to evaluate the specificity and sensitivity of diffusion weighted MR imaging (DWI) in the differentiation and characterisation between benign and malignant vertebral compression fractures compared with conventional T1 WI, T2 WI and fat suppressed contrast enhanced T1 WI in the Malaysian population.
Cervical myelopathy caused by an exostosis of the posterior arch of C1

Chooi YS, Siow YS, Chong CS

J Bone Joint Surg Br, 2005 Feb;87(2):257-9.
PMID: 15736753

We report a case of vertebral osteochondroma of C1 causing cord compression and myelopathy in a patient with hereditary multiple exostosis. We highlight the importance of early diagnosis and the appropriate surgery in order to obtain a satisfactory outcome.
Fulltext Trends in post osteoporotic hip fracture care from 2010 to 2014 in a private hospital in Malaysia

Yeap SS, Nur Fazirah MFR, Nur Aisyah C, Zahari Sham SY, Samsudin IN, C Thambiah S, et al.

Osteoporos Sarcopenia, 2017 Jun;3(2):112-116.
PMID: 30775514 DOI: 10.1016/j.afos.2017.05.001

OBJECTIVE: Following an osteoporotic fracture, pharmacological treatment is recommended to increase bone mineral density and prevent future fractures. However, the rate of starting treatment after an osteoporotic hip fracture remains low. The objective of this study was to survey the treatment rate following a low-trauma hip fracture at a tertiary private hospital in Malaysia over a period of 5 years.
METHODS: The computerised hospital discharge records were searched using the terms "hip," "femur," "femoral," "trochanteric," "fracture," or "total hip replacement" for all patients over the age of 50, admitted between 2010 and 2014. The medical charts were obtained and manually searched for demographic data and treatment information. Hip operations done for non-low-trauma-related fracture and arthritis were excluded.
RESULTS: Three hundred seventy patients over the age of 50 years were admitted with a hip fracture, of which 258 (69.7%) were low trauma, presumed osteoporotic, hip fractures. The median age was 79.0 years (interquartile range [IQR], 12.0). Following a hip fracture, 36.8% (95 of 258) of the patients received treatment, but out of these, 24.2% (23 of 95) were on calcium/vitamin D only. The median duration of treatment was 1 month (IQR, 2.5). In 2010, 56.7% of the patients received treatment, significantly more than subsequent years 2011-2014, where approximately only 30% received treatment.
CONCLUSIONS: Following a low-trauma hip fracture, approximately 72% of patients were not started on active antiosteoporosis therapy. Of those who were, the median duration of treatment was 1 month. This represents a missed opportunity for the prevention of future fractures.
A summary of the Malaysian Clinical Practice Guidelines on the management of postmenopausal osteoporosis, 2022

Ong TIW, Lim LL, Chan SP, Chee WSS, Ch'ng ASH, Chong EGM, et al.

Osteoporos Sarcopenia, 2023 Jun;9(2):60-69.
PMID: 37496985 DOI: 10.1016/j.afos.2023.06.002

OBJECTIVES: The aim of these Clinical Practice Guidelines is to provide evidence-based recommendations to assist healthcare providers in the screening, diagnosis and management of patients with postmenopausal osteoporosis (OP).
METHODS: A list of key clinical questions on the assessment, diagnosis and treatment of OP was formulated. A literature search using the PubMed, Medline, Cochrane Databases of Systematic Reviews, and OVID electronic databases identified all relevant articles on OP based on the key clinical questions, from 2014 onwards, to update from the 2015 edition. The articles were graded using the SIGN50 format. For each statement, studies with the highest level of evidence were used to frame the recommendation.
RESULTS: This article summarizes the diagnostic and treatment pathways for postmenopausal OP. Risk stratification of patients with OP encompasses clinical risk factors, bone mineral density measurements and FRAX risk estimates. Non-pharmacological measures including adequate calcium and vitamin D, regular exercise and falls prevention are recommended. Pharmacological measures depend on patients' fracture risk status. Very high-risk individuals are recommended for treatment with an anabolic agent, if available, followed by an anti-resorptive agent. Alternatively, parenteral anti-resorptive agents can be used. High-risk individuals should be treated with anti-resorptive agents. In low-risk individuals, menopausal hormone replacement or selective estrogen receptor modulators can be used, if indicated. Patients should be assessed regularly to monitor treatment response and treatment adjusted, as appropriate.
CONCLUSIONS: The pathways for the management of postmenopausal OP in Malaysia have been updated. Incorporation of fracture risk stratification can guide appropriate treatment.