Malaysian Orthopaedic Journal最新文献

{"title":"Early Intervention in Post-operative Infectious Spondylodiscitis: Outcome of Aggressive Transforaminal Lumbar Interbody Fusion.","authors":"A Krishnan, B R Dave, D Degulmadi, S Mayi, R Rai, P Bang, M Dave, V Chauhan, S Bali, P Charde, A Anil, P Krishnan","doi":"10.5704/MOJ.2411.003","DOIUrl":"10.5704/MOJ.2411.003","url":null,"abstract":"<p><strong>Introduction: </strong>Conservative and surgical approach timeline in post-operative spondylodiscitis (POS) following lumbar disc herniation (LDH) surgery is ill defined, and patients have a protracted recovery phase with social, psychological, and financial implications.</p><p><strong>Material and methods: </strong>Retrospective analysis of patients operated by transforaminal lumbar interbody fusion (TLIF) in POS was done. Confirmed clinico-radiological diagnosed POS cases, not responding within three to four weeks were included. Normalisation of CRP and radiological stable reconstruction was assessed for objective clearance of POS and bony union.</p><p><strong>Results: </strong>Ninety-five patients were included in the study with minimum follow-up period of two years. The mean age was 51.63±13.63 years. There were organisms cultured in 55 patients (57.89%). The ODI improvement of the patients was noted to improve from 88.71±5.3 to 20.80±9.7 (8 weeks) and was incremental at 2 years follow-up (10.12±6.41) and maintained further at final follow-up at 9±4.3. Bony union achieved in all with stable reconstruction. The resumption of activities of daily living (ADL) was quick (15.90±8.20 days) and job (3.67±1.31 months) was achieved in all the patients. In poor outcomes, two patients didn't respond, and one patient died due to uncontrolled infection.</p><p><strong>Conclusion: </strong>Early diagnosis and intervention is the key to effective management of POS. Utilisation of aggressive TLIF yields faster ADL resumption.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"18 3","pages":"16-26"},"PeriodicalIF":0.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of Metacarpals of Two Rays with Double Barrel Osteocutaneous Fibular Flap in a Hand Injury with Composite Tissue Loss: A Case Report.","authors":"J K Mishra, S A Sahu, A Sindhuja, B K Kar, A Saha","doi":"10.5704/MOJ.2411.010","DOIUrl":"10.5704/MOJ.2411.010","url":null,"abstract":"<p><p>Free fibula flap has been a workhorse for head, neck, and extremity long bone defects. We discuss the reconstruction challenge in an unusual hand injury case involving the loss of multiple metacarpals and soft tissue with surprising preservation of finger vascularity. The reconstructive goals were addressed with a microvascular osteocutaneous fibula flap transfer with multiple osteotomies to create spitting images of metacarpals and soft tissue defects restored with the skin paddle. The outcome, in terms of functional gain, was sufficient for managing day-to-day activities. We share our experience in reconstructing this unique presentation of a complex hand injury.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"18 3","pages":"71-74"},"PeriodicalIF":0.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"APAME 2024 - Sydney Declaration on Predatory or Pseudo Journals and Publishers.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"18 3","pages":"1"},"PeriodicalIF":0.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibula Pro-tibia or Tibial Pro-fibula Dilemma: Order Defines Meaning.","authors":"R Y Kow, C L Low, N Mohd-Yusof","doi":"10.5704/MOJ.2411.014","DOIUrl":"10.5704/MOJ.2411.014","url":null,"abstract":"","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"18 3","pages":"88-89"},"PeriodicalIF":0.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional and Radiological Outcome of Anterior Plate Stabilisation of the Sacroiliac Joint in Unstable Pelvic Injury.","authors":"M H Din, A M Aziz, Y Sahran, M A Mohamed-Saat, N S Abdul-Ghani, W I Faisham, A T Musa","doi":"10.5704/MOJ.2411.007","DOIUrl":"10.5704/MOJ.2411.007","url":null,"abstract":"<p><strong>Introduction: </strong>Sacroiliac joint disruption, resulting from high energy trauma can cause significant morbidity if no proper treatment given. Many techniques can be used to stabilise pelvic ring injuries. We studied the functional and radiological outcome following open reduction and anterior fixation of the sacroiliac joint and agreement between both outcomes.</p><p><strong>Material and methods: </strong>This retrospective study involved 15 patients with unstable pelvic injuries requiring surgical intervention from January 2015 to December 2020 who undergone anterior stabilisation of the sacroiliac joint. Radiological outcome assessments were done postoperatively by using Lindahl criteria. The complete functional outcome was assessed at least six months postoperatively when patients were able to weight bear by using Majeed system. Descriptive statistical analysis was performed using IBM SPSS Statistics Version 27.</p><p><strong>Results: </strong>The participants consist of 73.3% male and 26.7% female patients. A total of 66.7% of patients had a Tile type B pelvic ring injury, and the remaining 33.3% had a Tile type C pelvic ring injury. Based on the Majeed system, 73.3% of patients had excellent functional outcomes, and based on Lindahl criteria; there were 60% of patients who had excellent radiological outcome. However, there was no significant agreement between functional and radiological outcomes.</p><p><strong>Conclusion: </strong>Definitive fixation of the sacroiliac joint by anterior plate stabilisation provided an excellent functional and radiological outcome mainly due to good anatomical reduction and mechanical stability. However, further study may be needed to evaluate the correlation between functional and radiological outcomes and compare the various method of fixation with a larger sample size.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"18 3","pages":"51-58"},"PeriodicalIF":0.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rotator Cuff Tears and Mid-Term Shoulder Outcomes after Intramedullary Nail Fixation for Humeral Shaft Fracture: A Minimum Five-year Follow-up Study.","authors":"R Furuhata, A Tanji, S Nakamura, T Urabe","doi":"10.5704/MOJ.2411.008","DOIUrl":"10.5704/MOJ.2411.008","url":null,"abstract":"<p><strong>Introduction: </strong>Antegrade intramedullary nail fixation for humeral shaft fractures yields satisfactory union rates. However, one of the related concerns is damage to the rotator cuff during nail insertion, which may affect long-term outcomes. The effect of a rotator cuff lesion on mid- and long-term shoulder outcomes remains unknown. This study aimed to investigate the incidence of rotator cuff tears 5 years or more after intramedullary nailing for humeral shaft fractures and to determine the impact of post-operative rotator cuff tears on mid-term outcomes.</p><p><strong>Material and methods: </strong>We retrospectively identified 27 patients who underwent antegrade intramedullary nail fixation for traumatic humeral shaft fractures and received follow-up for at least 5 years post-operatively. The patients were divided into two groups: those without tears and those with partial or complete tears, diagnosed using ultrasonography. We compared the functional and radiological shoulder outcomes between the two groups.</p><p><strong>Results: </strong>Of the 27 patients, 10 had partial or complete supraspinatus tears with a mean follow-up of 7.5 years postoperatively. The incidence of acromial spurs was significantly higher in patients with partial or complete tears than in those without tears (P<0.001). There were no significant differences in the age and sex-adjusted Constant score, or the American Shoulder and Elbow Surgeon score between the two groups.</p><p><strong>Conclusion: </strong>Our results revealed that 37% of patients developed partial or complete supraspinatus tendon tears in the mid-term. Post-operative rotator cuff tears were significantly associated with the formation of acromial spurs; however, they had no significant effect on mid-term shoulder functional outcomes.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"18 3","pages":"59-65"},"PeriodicalIF":0.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Bracing in a Femur Non-union Following Fracture Related Infection: A Case Report.","authors":"K Nazirul-Mubin, M Y Nazri, S Ahmad-Fadzli","doi":"10.5704/MOJ.2411.011","DOIUrl":"10.5704/MOJ.2411.011","url":null,"abstract":"<p><p>Non-union refers to a disruption in the process of fracture repair, which can be identified through sequential clinical and radiographic assessments. The distinction between septic and aseptic non-union is essential because the treatment strategies are fundamentally different. Non-unions are most often treated surgically as it helps to provide both mechanical stability and good biological environment to promote bone healing. However, there is also the option of managing it conservatively by proper immobilisation using functional brace which is an alternative for surgical procedures and widely reported in tibia non-union cases. To date, there has been no reported case of femur non-union successfully treated with a functional brace. This case report details the success of treatment using a functional brace in a mentally disabled gentleman who sustained a femur non-union following a fracture related infection.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"18 3","pages":"75-79"},"PeriodicalIF":0.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcome of Single-Stage Posterior Decompression and Stabilisation for Spine Metastasis.","authors":"C S Wang, Z Atan","doi":"10.5704/MOJ.2411.005","DOIUrl":"10.5704/MOJ.2411.005","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical treatment for indicated spinal metastases cases is an option to improve patients' outcomes. Local data in analysing the potential of patients' improvement after surgical treatment are limited. We intend to review the clinical outcomes of surgeries performed for cancer patients who were diagnosed with spinal metastases. We aim to identify factors associated with improved spinal pain, neurological deficit and patient survival.</p><p><strong>Material and methods: </strong>The medical records of 51 patients who were diagnosed with thoracolumbar spinal metastatic tumour and underwent palliative single-stage posterior approach spinal surgery between June 2015 and June 2022 were recruited retrospectively. Patient demographic data, pre-operative and post-operative pain scores, neurological assessment and survival duration were collected from the medical records. Radiological findings were studied using respective imaging and reports.</p><p><strong>Results: </strong>The mean age was 57.5 years, and the median survival was nine months after the surgical treatment. The post-operative pain improvements were statistically significant at two weeks (VAS improved from 5 to 2), and three months follow-up VAS was one (p<0.001 and p=0.009, respectively). At initial presentation, patients with a single-level spinal involvement had higher VAS compared to multiple spinal metastases (p=0.018). A total of 18 (35.3%) patients had improved one or more ASIA grades, of which eight (15.7%) of them had gain of ambulatory function (p<0.001). Twenty-seven (52.9%) patients were ambulatory post-operative. The slow growth type of primary carcinoma, post-operative ambulatory ability, and the absence of perioperative morbidity were factors associated with favourable survival duration (p=0.006, p<0.001 and p<0.001, respectively). Synchronous visceral metastases adversely affected the survival duration (p=0.008).</p><p><strong>Conclusion: </strong>Single-stage posterior decompression and stabilisation improved the clinical outcomes of spinal pain and neurological deficit in metastatic spinal tumours. Type of primary tumour, visceral metastasis, perioperative morbidity, and post-operative ambulatory status significantly impact post-operative survival duration.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"18 3","pages":"32-41"},"PeriodicalIF":0.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Elbow Arthroplasty as the Treatment of Choice for a Young Man with Neglected Terrible Triad of the Elbow Joint and Schizophrenia: A Case Report.","authors":"S D Savio, Kyw Artha, Iglnaa Wiguna","doi":"10.5704/MOJ.2411.009","DOIUrl":"10.5704/MOJ.2411.009","url":null,"abstract":"<p><p>In young patients, the use of total elbow arthroplasty (TEA) is rarely preferred due to its high rate of mechanical failure. Poor compliance and psychological problems encountered may lead to increased difficulty in management. A 38-year-old male complained stiffness and pain on his left elbow. History of trauma was present 10 months ago, when he fell down from a tree of 6m high. Immediate closed reduction and immobilisation with backslab was performed, but he was lost to follow-up due to Schizophrenia. In physical examination, we found varus and recurvatum deformity with inability to flex the elbow beyond 30° and perform pronation. Plain radiograph and CT scan confirmed the terrible triad of elbow with callus formation. Total elbow arthroplasty with soft tissue release was then performed, resulting in satisfactory range of motion at one year follow-up. The management of neglected terrible triad of the elbow is challenging not only due to the bony problems, but also contracted muscles and fibrotic joint. TEA previously has been described in cases of inflammatory arthritis and degenerative arthritis, less in post-traumatic conditions especially in young patients. Though there is still scarcity in literatures discussing the burden of psychiatric problems in arthroplasty patients, but the existing literatures proved the correlation between psychiatric comorbidity with higher rate of post-operative adverse events. Total elbow arthroplasty can be considered as a surgical treatment for a young patient with neglected fracture dislocation of elbow with satisfactory result; however close post-operative monitoring and routine physiotherapy exercise should always be performed.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"18 3","pages":"66-70"},"PeriodicalIF":0.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Pre-operative Correction of Vitamin D3 Deficiency in Controlling Post-operative Bone Pain after Unicompartmental Knee Arthroplasty.","authors":"A M Rajani, Ars Mittal, V U Kulkarni, K A Rajani, K A Rajani","doi":"10.5704/MOJ.2411.002","DOIUrl":"10.5704/MOJ.2411.002","url":null,"abstract":"<p><strong>Introduction: </strong>Hypovitaminosis D plays an important role in post-operative bone pain and muscle strength in arthroplasty surgeries. Its role in unicompartmental knee arthroplasty (UKA) has not been elucidated yet. The objective of this study was to determine the impact of hypovitaminosis D and its correction on post-operative bone pain after UKA.</p><p><strong>Materials and methods: </strong>A prospective cohort study involving 240 patients undergoing mobile-bearing medial UKA was conducted. Group A (na=80) received postoperative correction of Vitamin D3 Deficiency (VDD), Group B (nb=80) received pre-operative correction of VDD, while Group C (nc=80) had normal Vitamin D3 levels to begin with (≥30ng/ml). Correction was done by three doses of intramuscular injection of 600,000 IU Arachitol® (Vitamin D3) given at an interval of one week each. All groups were matched for demography and outcome measures. The level of bone pain by checking for tibial shin tenderness quantified by the visual analog scale (VAS) and evaluated pre-operatively, and at 2, 4, 6 and 12 weeks post-operatively.</p><p><strong>Results: </strong>Group B and C showed similar post-operative trends and remained significantly superior to Group A till the 6th-week follow-up. The biostatistical difference between Group A and the other two groups started decreasing after the completion of post-operative correction regime as noticed on the 6th-week follow-up. By 12 weeks post-operatively, all three groups had similar levels of bone pain.</p><p><strong>Conclusion: </strong>Vitamin D3 serves as an important preoperative investigation in patients undergoing UKA as it is a modifiable risk factor affecting post-operative bone pain. Its correction pre-operatively gives excellent post-operative pain control.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"18 3","pages":"7-15"},"PeriodicalIF":0.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}