Displaying publications 1 - 20 of 362 in total

  1. 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.
  2. 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.

  3. 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.
  4. Tawonsawatruk T, Mulpruek P, Hamilton D, Wajanavisit W, Tan S
    Malays Orthop J, 2014 Mar;8(1):37-40.
    PMID: 25347522 DOI: 10.5704/MOJ.1403.016
    It has been reported that oestrogen receptor alpha (ER-α) polymorphisms are associated with knee osteoarthritis (OA). In this study, we assessed whether there was any association between the codon 594 (G>A) polymorphism in ER-α and radiographic features of OA or patient function. Radiographs, WOMAC score and patient reported time of symptom onset were assessed in 194 patients presenting for total knee replacement at Ramathibodi hospital over a one year period. ESR-1 genotyping was assessed. There were 107 (55.15%) patients with common homozygote (GG), 78 (40.20%) patients with heterozygote (GA) and nine (4.65%) patients with rare homozygote (AA). There was poor correlation (r = <0.2) between group difference in the radiographic parameters, time of onset of symptom , or in WOMAC scores. This polymorphism is not associated with the clinical features of knee osteoarthritis. The role of this polymorphism is unlikely then to be used as a biological marker predicting the progression of knee OA.
  5. Chan H, Wang C, Azuhairy A, Hau A, Zulkiflee O
    Malays Orthop J, 2014 Mar;8(1):79-81.
    PMID: 25347391 DOI: 10.5704/MOJ.1403.007
    Primary sacral tumours are rare, therefore experience of managing their associated complications are very limited. Effective surgical treatment of pelvic chondrosarcoma remains a major challenge for orthopaedic surgeons, due to the complex anatomic structure of the pelvis, the lack of defined compartment borders, the close vicinity to vital structures, and the risk of jeopardizing pelvic structural stability. We report a rare case of a giant sacral chondrosarcoma (100cm x 80cm) in an elderly male who successfully underwent tumour resection with good functional outcome and recovery. Long term follow up is essential in view of the possibility of local tumour recurrence.
  6. Jagdish K, Paiman M, Nawfar A, Yusof M, Zulmi W, Azman W, et al.
    Malays Orthop J, 2014 Mar;8(1):14-20.
    PMID: 25279079 MyJurnal DOI: 10.5704/MOJ.1403.012
    A seven years retrospective study was performed in 45 consecutive vascular injuries in the extremities to investigate the pattern of injuries, managements and outcomes. Motor-vehicle accidents were the leading cause of injuries (80%), followed by industrial injuries (11.1%) and iatrogenic injuries (4.4%). Popliteal and brachial artery injuries were commonly involved (20%). Fifteen (33.3%) patients had fractures, dislocation or fracture dislocation around the knee joint and 6 (13.3%) patients had soft tissue injuries without fracture. Traumatic arterial transection accounted for 34 (75.6%) cases, followed by laceration in 7 (15.6%) and 9 (6.7%) contusions. Associated nerve injuries were seen in 8 (17.8 %) patients using intra-operative findings as the gold standard, both conventional angiogram (CA) and computerized tomography angiogram (CTA) had 100% specificity and 100% sensitivity in determining the site of arterial injuries. The mean ischemic time was 25.31 hours (4 - 278 hours). Thirty-three (73.3 %) patients were treated more than 6 hours after injury and 6 patients underwent revascularization after 24 hours; all had good collateral circulation without distal pulses or evidence of ischemic neurological deficit. The mean ischemic time in 39 patients who underwent revascularization within 24 hours was 13.2 hours. Delayed amputation was performed in 5 patients (11.1%). Of the 6 patients who underwent delayed revascularization, one patient had early amputation, one -had delayed amputation following infection and multiple flap procedures while the rest of the patients' limbs survived. Joint stiffness was noted in 10 patients (22.2%) involving the knee joint, elbow and shoulder in two patients each. Infection was also noted in 5 patients (11.1%) with two of them were due to infected implants. Other complications encountered included nonunion (2 patients, 4.4%), delayed union (1 patient, 2.2%),limb length discrepancy (1 patient, 2.2%), hematoma (1 patient, 2.2%) and leaking anastomosis in one patient (2.2%). Volkmann's ischemic contracture occurred in 3 (6.7%) patients. There was no complication noted in 8 (17.8%) patients Three patients (6.7%) died of whom two were not due to vascular causes. We conclude that early detection and revascularization of traumatic vascular injuries is important but delayed revascularization also produced acceptable results.
  7. Ariffin M, Lloyd S, Rhani S, Kamalnizat, Baharudin A
    Malays Orthop J, 2014 Jul;8(2):40-2.
    PMID: 25279091 DOI: 10.5704/MOJ.1407.001
    The management of post-radiation wound breakdown over the posterior cervico thoracic region can be a challenging task for a surgeon. The aim of the treatment is to produce a well vascularized and a low tensile flap which will close a large defect. We describe the use of the lower trapezius flap to reconstruct the wound breakdown and to obtain stable tissue coverage in a patient with postradiation necrosis. This flap minimizes the disruption of the scapula-thoracic function while preserving the range of movement over the shoulder. From the literature review, it was noted that the dorsal scapular artery (DSA) and transverse cervical artery (TCA) aid in the blood supply to the trapezius muscle and prevent local necrosis during rotation of the flap. The trapezius flap is widely accepted because of the minor donor site morbidity, large arc of rotation and adequate blood supply.
  8. 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.
  9. Khoo C, Haseeb A, Ajit Singh V
    Malays Orthop J, 2014 Jul;8(2):14-21.
    PMID: 25279087 DOI: 10.5704/MOJ.1407.010
    Cannulated screw fixation is a widely accepted surgical method for management of fractures of the neck of femur especially in patients with poor premorbid conditions, minimally displaced fractures and those from a younger age group. A five year retrospective study was carried out in 53 consecutive patients between 2006 to 2010 to determine the pattern of injuries, management, outcomes and the associated predictive factors.All the patients underwent cannulated screw fixation, with 37 (69.8%) having had surgery within 24 hours and the remaining 16 (30.2%) 24 hours after the initial injury. All patients were followed up to union of fractures and complications thereafter if any. Good outcome was observed in 43 (81.1%) patients leaving only 10 (18.9%) patients with a poor outcome, of whom nine developed avascular necrosis (90%) and one non-union (10%). We found no significant relationship between the incidence of avascular necrosis and age of patient, fracture displacement, numbers of cannulated screws used, fracture reduction acceptability and anatomical location of the fracture. The time interval from injury to surgery and the presence of posterior comminution did seem to influence the rate of avascular necrosis but due to the small number of patients, was not statistically significant.We conclude that cannulated screw fixation is a viable option of treatment for fractures of the neck of femur.
  10. Saturveithan C, Arieff A, Premganesh G, Sivapathasundaram N
    Malays Orthop J, 2014 Jul;8(2):52-4.
    PMID: 25279095 MyJurnal DOI: 10.5704/MOJ.1407.005
    A one year old boy was admitted with left shoulder pain with reduced range of motion of five days' duration associated. Inflammatory markers were raised and radiograph of the left shoulder revealed widening of the metaphysis of the proximal humerus. Empirically, he was started on intravenous C-penicillin and cloxacillin after initial joint aspiration yielded only synovial fluid with negative culture. Subsequent MRI revealed acute osteomyelitis of the proximal left humerus with concurrent septic arthritis of the shoulder joint. Cultures from the arthrotomy washout grew Salmonella sp, sensitive to ampicillin. He recovered following six weeks of intravenous unasyn ( ampicillin and sulbactum). This rare case of salmonella osteomyelitis in a non-sickle cell disease patient was diagnosed with serial laboratory and radiological studies and was successfully treated with adequate duration of antibiotics and operative intervention.
  11. Chang C, Chan H, Lim S, Khoo E, Zulkiflee O
    Malays Orthop J, 2014 Jul;8(2):49-51.
    PMID: 25279094 MyJurnal DOI: 10.5704/MOJ.1407.004
    Postoperative wound infection in an instrumented spine patient is often disastrous. Management includes implant removal leading to spine instability. Negative pressure wound therapy (NPWT) applied to the spine surgical wound is one of the wound care technique with successful results. We report a case of a man who sustained Chance fracture of Lumbar 1 (L1) vertebra treated with long segment posterior instrumentation, who unfortunately developed Extended-spectrum beta-lactamase (ESBL) positive E. coli infection one month after the operation. After careful debridement of the wound, the implant became exposed. Three cycles of NPWT were applied and the wound healed with granulation tissue completely covering the implant, and thus negating the need to remove the implant. In conclusion, the NPWT is a good alternative in postoperative wound management especially in an instrumented spine patient.
  12. Aizah N, Su Y, Shaifulnizam C, MRos M
    Malays Orthop J, 2014 Jul;8(2):66-8.
    PMID: 25279099 MyJurnal DOI: 10.5704/MOJ.1407.015
    Extruded bone is a rare complication of high energy open fractures, and there is only a handful of literature on reimplantation of the extruded segment. No clear guidelines exist regarding timing of reimplantation, stabilization of extruded bone segments, and also bone disinfection and sterilization techniques. Previous reports describe sterilization using thermal or chemical methods. We present a case of successful reimplantation of an extruded metaphyseal segment of femur after gamma sterilization in a fourteen- year old boy.
  13. Chan H, Ooi C, Lim M, Ong E, Zulkiflee O
    Malays Orthop J, 2014 Jul;8(2):59-62.
    PMID: 25279097 MyJurnal DOI: 10.5704/MOJ.1407.007
    Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders(1). Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS) and University of California Los Angeles Score (UCLA).
  14. Choong C, Chan H, Azuhairy A, Hau MA, Zulkiflee O
    Malays Orthop J, 2014 Jul;8(2):55-8.
    PMID: 25279096 DOI: 10.5704/MOJ.1407.006
    Conventional chondrosarcomas rarely metastasize and it is extremely unusual to see multicentric- behaviour in malignant cartilage tumour. We report a 40 year old lady with presentation of two non-contiguous metachronous foci of low to intermediate grade of chondrosarcoma over left pelvic bone and right scalp respectively in the absence of pulmonary or visceral metastasis.
  15. Bhardwaj A, Sivapathasundaram N, Yusof M, Minghat A, Swe K, Sinha N
    Malays Orthop J, 2014 Jul;8(2):6-13.
    PMID: 25279086 DOI: 10.5704/MOJ.1407.009
    Background :Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and general public health. Orthopaedic surgeons may be more prone to NSIs due to the prevalence of bone spikes in the operative field and the use of sharp orthopaedic instruments such as drills, saws and wires. A hospital-based cross sectional study was conducted in the orthopedic wards of Melaka General Hospital. The prevalence of NSIs was 32 (20.9%) and majority of it occurred during assisting in operation theatre 13(37.4%). Among them six (18.8%) were specialist, 12(37.5%) medical officer, 10 (31.2%) house officer and four staff nurses (12.5%). Among the respondents 142 (92.8%) had been immunized against Hepatitis B and 148 (96.7%) participants had knowledge regarding universal precaution. The incidence of NSI among health care workers at orthopaedics ward was not any higher in comparison with the similar studies and it was found out that the prevalence was more in junior doctors compared with specialist and staff nurses and it was statistically significant.
  16. Ho JP, Ahmad Faizal A, Sivapathasundaram N
    Malays Orthop J, 2013 Nov;7(3):30-2.
    PMID: 25674306 MyJurnal DOI: 10.5704/MOJ.1311.012
    We present a case of chronic acromioclavicular joint dislocation (Rockwood type 5) in which the choice of acromioclavicular reconstruction using autogenous semitendinosus tendon graft was made due to its superiority in anatomical reconstruction of the coracoclavicular ligaments, and the impact of postoperative rehabilitation on the recovery of this patient. We also discuss the rationale behind this.
  17. Chua C, Yeap E, Yazid M
    Malays Orthop J, 2013 Nov;7(3):27-9.
    PMID: 25674305 MyJurnal DOI: 10.5704/MOJ.1311.011
    Subtalar coalition is an uncommon condition that usually manifests in early adolescence(1). Frequently, this condition is missed. Delayed diagnosis may result in osteoarthritis requiring triple arthrodesis. Here, we report two patients with subtalar coalition. The first patient is a 12 year old boy who presented with right ankle pain for one year and was treated with excision of the coalition and bone wax insertion at the excision site. We followed up the patient for two years and the result was excellent with full range of movement of his right ankle and subtalar joint attained within two months. He returned to athletic activity by six months and was discharged with no complications after two years. The second patient is a 15 year old girl who presented with bilateral ankle pain and swelling for three years and was treated with excision of the coalition and subtalar interpositional arthroplasty bilaterally. She defaulted follow up after seven months as she was very satisfied with the result. We wish to highlight this condition which may be misdiagnosed as flexible flat foot or ankle sprain.
  18. 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.

  19. Wang C, Bea K, Zulkiflee O
    Malays Orthop J, 2013 Nov;7(3):18-20.
    PMID: 25674302 MyJurnal DOI: 10.5704/MOJ.1311.002
    Clavicle fracture is commonly treated conservatively. However uncommon complication can arise causing impingement. We report a patient who sustained distal clavicle fracture and was treated conservatively. However he developed persistent shoulder pain that affected his daily life. Shoulder impingement was diagnosed and arthroscopic subacromioclavicular decompression was done. Following early physiotherapy the early recovery was good with full range of motion of the shoulder.
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