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  1. Wui NB, Ahmad Anuar MA, Abdul Wahid AM
    Malays J Med Sci, 2020 Jul;27(4):64-71.
    PMID: 32863746 MyJurnal DOI: 10.21315/mjms2020.27.4.6
    Background: The management of fractures around the knee in the elderly population can be challenging due to the complexity of the patients and the fracture characteristics. In this study, we aimed to investigate the short-term outcome of elderly patients who had fractures around the knee and who were treated with primary total knee arthroplasty. The study included patients who were at least 70 years old with poor bone quality and who presented with a fracture around the knee that would be difficult to treat with open reduction and internal fixation (ORIF) as well as patients who were at least 55 years old presenting with severe concomitant knee osteoarthritis.

    Methods: This is a cross-sectional study in which all the elderly patients who underwent early primary total knee replacement due to trauma around the knee at the Segamat Hospital between January 2015 and June 2019 were identified. Data were collected from clinical and operative notes. The clinical outcomes of these patients were evaluated by the range of motion of the knee and the Knee Society Score (KSS).

    Results: Ten patients were identified to have undergone this procedure. Six patients sustained supracondylar femur fractures, two patients had tibial plateau fractures and two patients had concurrent supracondylar femur and tibial plateau fractures. The mean follow-up duration was 22.3 ± 13.9 months, the mean knee score was 87.7 ± 10.0 and the mean functional knee score was 56 ± 41.9.

    Conclusion: In this cohort, good short-term outcomes close to pre-fracture condition was noted in patients who did not suffer from any complications during the post-operative period. Two patients who had surgical site infection had lower functional knee scores. Another two patients with lower knee scores experienced surgical site infection of the distal tibia and contralateral fixed flexion deformity of the knee. Early primary total knee replacement remains a viable option in treating fractures around the knee in the elderly. Infection, which in this study affected 20% of the patients, is the main deterring factor in performing this procedure.

  2. Abdul Wahab AH, Wui NB, Abdul Kadir MR, Ramlee MH
    Comput Biol Med, 2020 12;127:104062.
    PMID: 33096298 DOI: 10.1016/j.compbiomed.2020.104062
    External fixators have been widely used in treating open fractures and have produced excellent outcomes, as they could successfully heal bones. The stability of external fixators lies greatly in their construction. Factors that associated with the stability of the external fixators includes stress, displacement, and relative micromotion. Three-dimensional (3D) models of bone and external fixators were constructed by using 3D modelling software, namely Materialise and SolidWorks, respectively. Three different configurations of external fixators namely Model 1, Model 2, and Model 3 were analysed. Three load cases were simulated to assess the abovementioned factors at the bone, specifically at the fracture site and at the external fixator. Findings showed that the double-cross configuration (Model 3) was the most promising in axial, bending, and torsion load cases as compared to the other two configurations. The no-cross configuration (Model 1) had the highest risk of complication due to high stress, relative micromotion, and displacement in the bending and torsion load cases. On the other hand, the single-cross configuration (Model 2) had the highest risk of complication when applied with axial load. In conclusion, the double-cross locking construct (Model 3) showed the biggest potential to be a new option for medical surgeons in treating patients associated with bone fracture. This new double-cross locking construct showed superior biomechanical stability as compared to single-cross and no-cross configurations in the axial, bending, and torsion load cases.
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