Malaysian Orthopaedic Journal最新文献

{"title":"Pre-operative Factors Predicting Mortality in Six Months and Functional Recovery in Elderly Patients with Hip Fractures.","authors":"N H Nam,&nbsp;N D Minh,&nbsp;T X Hai,&nbsp;C T Sinh,&nbsp;C B Loi,&nbsp;L T Anh","doi":"10.5704/MOJ.2303.002","DOIUrl":"https://doi.org/10.5704/MOJ.2303.002","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to determine on-admission and perioperative factors predicting six-month mortality and functional recovery in Vietnamese patients with hip fracture.</p><p><strong>Materials and methods: </strong>Between April 2020 and July 2021, 118 patients participated in this prospective study. Patients' data were collected from medical records. Harris hip score (HHS) was used to evaluate the functional recovery six months after fractures. The obtained data were analysed using a univariate and multivariate model.</p><p><strong>Results: </strong>The mean age of the participants was 79.5±9.4 years and 68.6% of the patients were female. The six-month mortality rate was 5.9% and independently associated with age (odds ratio (OR): 3.512, 95% confidence interval (CI) 1.538 - 8.019; P<0.001, patients aged >80 years vs those aged ≤80 years) and hypoproteinemia (OR: 2.859, 95% CI: 1.001 - 8.166, P=0.049). Among 111 survivors there were 66 (59.5%) of patients with a good functional recovery. Patients aged >80 years had a higher risk of poor functional outcome (OR: 3.167, 95% CI: 1.386 - 7.235, P: 0.006) compared to those aged ≤ 80 years. No significant correlations between other clinical (gender, body mass index, comorbidities, type of fractures or surgery, time until surgery) or laboratory parameters (anaemia, hyperglycemia, marked elevation of C reactive protein level, electrolyte abnormalities, elevated urea) and mortality or functional outcome were found.</p><p><strong>Conclusion: </strong>Advanced age is the most important factor affecting both mortality and functional outcome while hypoproteinemia is associated with a higher risk of mortality in elderly patients with hip fractures.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"17 1","pages":"10-17"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9317241","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":"Improving the Accuracy of Corrective Osteotomy for Congenital Radio Ulnar Synostosis using the Axis of Rotation of the Forearm as a Guide.","authors":"S Gandhi,&nbsp;T R Dalei,&nbsp;S K Nema,&nbsp;A Rathod,&nbsp;M Jagadevan","doi":"10.5704/MOJ.2303.006","DOIUrl":"https://doi.org/10.5704/MOJ.2303.006","url":null,"abstract":"<p><strong>Introduction: </strong>Despite several techniques for corrective osteotomy in congenital radioulnar synostosis (CRUS) the published literature lacks a guide for radiographic planning and rationale for the site and level of the osteotomy. The primary objective of this study is to report a technique of radiographically controlled corrective osteotomy using the axis of rotation of the forearm in CRUS.</p><p><strong>Materials and methods: </strong>Children with CRUS underwent corrective osteotomy based on radiographic planning; the extent of rotational correction and functional outcomes were assessed at a mean of 27 months after the operation.</p><p><strong>Results: </strong>Seven forearms in six children of an average of 6.25 years were assessed for correction and functional outcomes. The average pre-operative pronation deformity was 71.5°. The average correction achieved was 64°. At follow-up, there were five excellent and two good functional outcomes. All children could perform daily tasks besides eating with hand and personal hygiene.</p><p><strong>Conclusion: </strong>Radiographic determination of the osteotomy sites by the method described is effective, consistent, and reproducible in achieving optimal functional outcomes in congenital radioulnar synostosis.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"17 1","pages":"40-44"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9317242","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":"Intra-articular Steroid alone vs Hydrodilatation with intra-articular Steroid in Frozen Shoulder - A Randomised Control Trial.","authors":"S Swaroop,&nbsp;P Gupta,&nbsp;S Patnaik,&nbsp;S S Reddy","doi":"10.5704/MOJ.2303.005","DOIUrl":"https://doi.org/10.5704/MOJ.2303.005","url":null,"abstract":"<p><strong>Introduction: </strong>Various non-operative treatment modalities have been advocated for a frozen shoulder. In the present study we compared the efficacy of single intra-articular steroid injection vs hydrodilatation with intra-articular steroids for frozen shoulder (FS) in the frozen phase.</p><p><strong>Materials and methods: </strong>This was a prospective, randomised control trial (RCT) done at a tertiary care centre. A total of 108 participants were randomised into two groups-one group received intra-articular steroid with hydrodilatation (HDS) and other group received intra-articular steroid injection only (S). Shoulder Pain and Disability Index (SPADI) scores were taken, and statistical analysis was done to measure the outcome at two weeks, six weeks and three-month intervals after the injection.</p><p><strong>Result: </strong>There was significant improvement in symptoms at each interval for both the groups (p=0.0). There was no statistically significant difference in the SPADI score between the two groups at two weeks post injection, however at six weeks (p=0.04) and 3 months (p=0.001) significant difference in the SPADI score was demonstrated with better scores in group S. The mean duration of analgesia required in group HDS was 5.17 days (S.D.=1.73) and for group S was 4.28 days (S.D.=1.01), with a statistical significance (p=0.002).</p><p><strong>Conclusion: </strong>Better clinical results were obtained at six weeks and three months with the group receiving corticosteroid only and also had a lesser requirement of analgesia post-intervention. Thus, intra-articular steroid injection only seems to be a more desirable method of management during the frozen phase of FS than that of hydrodilatation with intra-articular steroid injection.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"17 1","pages":"34-39"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9310023","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":"Concomitant Ulnar Styloid Fractures in Distal Radius Osteosynthesis Does Not Impact Radiographic Outcomes, Ulnar Sided Symptoms and Patient Outcomes.","authors":"K C Wong,&nbsp;Mwf Wu,&nbsp;Qjj Zai,&nbsp;M K Wong,&nbsp;T S Howe,&nbsp;Sbj Koh,&nbsp;H Soeharno","doi":"10.5704/MOJ.2303.017","DOIUrl":"https://doi.org/10.5704/MOJ.2303.017","url":null,"abstract":"<p><strong>Introduction: </strong>Current literature reports varied significance of ulnar styloid fractures (USF) associated with distal radius fractures. Our study assesses the role of ulnar styloid fractures and fragment size in surgically managed distal radius fractures.</p><p><strong>Materials and methods: </strong>We reviewed patients who underwent surgical fixation of distal radius fractures between January 2004 to June 2006. Patients were divided into those with (Group 1) and without (Group 0) USFs. Post-operative radiographic parameters, clinical outcomes and overall wrist function were analysed. Outcomes included ulnar-sided wrist pain, extensor carpi ulnaris (ECU) tendinitis, triangular fibrocartilage complex (TFCC) grind test, distal radioulnar joint (DRUJ) instability and pain. Overall wrist function was assessed with range of motion and Disabilities of the Arm, Shoulder and Hand (DASH) score.</p><p><strong>Results: </strong>Our study cohort included 31 males and 23 females, and 38.9% of these patients had concomitant USFs. There was no difference in terms of demographic data and fracture configuration between groups. Radiographic parameters were similar, except for palmar tilt, which was significantly higher in Group 1 (4.6º vs 9.4º, p=0.047). At 24 months, there were no differences in clinical outcomes and overall wrist function. A sub-group analysis showed that mean USF fragment size was larger in patients with a positive TFCC grind test (3.9mm vs 7.3mm, p=0.033).</p><p><strong>Conclusion: </strong>The presence of USFs in surgically managed distal radius fractures does not compromise clinical and functional outcome. Similarly, the size of USFs does not impact clinical and functional outcome but is associated with the presence of a positive TFCC grind test.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"17 1","pages":"142-148"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9310024","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":"Women in Orthopaedics: A Perspective from Malaysian Female Orthopaedic Surgeons.","authors":"S K Liew,&nbsp;J A Lee,&nbsp;F Tamam,&nbsp;I I Ismail,&nbsp;F Mohamed-Saaid,&nbsp;P C Chye","doi":"10.5704/MOJ.2303.009","DOIUrl":"https://doi.org/10.5704/MOJ.2303.009","url":null,"abstract":"<p><strong>Introduction: </strong>The awareness of under-representation of female surgeons in orthopaedics has been increasing in this decade. We aim to investigate the reasons why female surgeons chose orthopaedic, the barriers that possibly hinder female surgeons into orthopaedics and analyse the obstacles that they encountered in their career in Malaysian context.</p><p><strong>Materials and methods: </strong>A total of 101 registered female orthopaedic surgeons registered with the Malaysian Medical Council, during the period 1980 to 2020, were contacted for a cross-sectional survey, consisting of thirty-four questions on their experience in the orthopaedic career. Eighty-two responses were received (81.2%). Questions in this survey consisted of four sections: (1) demographic details, (2) current clinical practice environment, (3) orthopaedics training experience, and (4) career experience.</p><p><strong>Results: </strong>A total of 49% of respondents had subspeciality training, highest in paediatric orthopaedic (30%). Enjoyment of manual tasks (64.6%) and professional satisfaction (64.6%) were the top reasons for choosing orthopaedic as a career. Primary barriers to orthopaedic were physical strength required (56.0%) and public gender bias (52.4%). Twenty-eight percent reported gender discrimination in career opportunities while 60% reported similar in daily work. Thirty-three percent reported verbal and 11% physical sexual harassment in their career. Forty-four percent of respondents reported benefits as female orthopaedic surgeon in their work.</p><p><strong>Conclusion: </strong>The reasons for Malaysian female orthopaedic surgeons to choose orthopaedic as their career and the barriers perceived to hinder other females from choosing orthopaedics were similar to reports worldwide with no exception to gender discrimination and sexual harassment. The support given by male colleagues to married female surgeons marked a unique phenomenon in Malaysian culture.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"17 1","pages":"70-78"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9321865","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":"Patients Related Outcome Measures in Hand Surgery: What Perspective for Children's Assessment?","authors":"G Taccardo,&nbsp;D Vigliarolo","doi":"10.5704/MOJ.2303.024","DOIUrl":"https://doi.org/10.5704/MOJ.2303.024","url":null,"abstract":"","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"17 1","pages":"193-194"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9317421","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":"Reduction of Displaced Acetabular Fracture with Central Hip Dislocation using Vector Traction: A Case Report.","authors":"Rhy Wong,&nbsp;S M Lim,&nbsp;Gmhj Pang","doi":"10.5704/MOJ.2303.022","DOIUrl":"https://doi.org/10.5704/MOJ.2303.022","url":null,"abstract":"<p><p>Fracture-dislocations of the hip is the result of high-energy trauma which necessitates urgent reduction. Closed reduction is usually attempted first and if failed, open reduction is indicated and may require more than one surgical approach. However, there is also the option of managing it with vector traction. This case report details the treatment of a middle-aged gentleman who sustained a left hip central dislocation which was gradually reduced with vector traction prior to surgery and in doing so, diminished the risk of him developing several potentially debilitating complications known to be associated with surgical fixation of such injuries.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"17 1","pages":"184-187"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9321868","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":"Distal Tibia Fractures: is the Tibia First Technique a Rational Approach?","authors":"G Touloupakis,&nbsp;M Messori,&nbsp;A Gilli,&nbsp;E Theodorakis,&nbsp;S Ghirardelli,&nbsp;G Antonini","doi":"10.5704/MOJ.2303.020","DOIUrl":"https://doi.org/10.5704/MOJ.2303.020","url":null,"abstract":"<p><strong>Introduction: </strong>In this retrospective case-series study we discuss the clinical and radiographic outcomes obtained following the \"tibia-first concept\" in the treatment of distal tibia fractures, both in patients with fibular comminution and in cases with a simple fibula fracture.</p><p><strong>Materials and methods: </strong>We analysed a consecutive series of 64 patients who presented at our emergency department with a distal articular tibial and fibular fracture from January 2015 to September 2020. A total of 22 patients met the inclusion and exclusion criteria and were included in the study. Clinical and radiographic examination were performed at each follow-up. To quantify pain and functional disability, the Foot and Ankle Outcome Score (FAOS) and the American Orthopaedic Foot and Ankle Society's ankle-hindfoot scale (AOFAS) were applied.</p><p><strong>Results: </strong>The overall mean age was 52.8 years, and the mean follow-up was 13.18 months. Multiple scales data from the FAOS were as follows: pain score 80.70; symptoms score 81.69; activities of daily living score 87.22; quality of life 76.05. The mean AOFAS ankle-hindfoot score was 74.36.</p><p><strong>Conclusions: </strong>Even though the principles of Rüedi and Allgöwer are still valid, in specific circumstances, the tibia-first concept could be considered as a valid option for the treatment of these demanding fractures. If a good reduction is obtained intra-operatively by ligamentotaxis, we recommend fixing the tibia first, avoiding surgical stress on tissues derived from a previous fibular fixation.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"17 1","pages":"172-179"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9317424","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":"The Effect of Pre-operative use of Antiplatelets and Anticoagulants on Time to Surgery in Hip Fracture Patients.","authors":"N S Shamsuri,&nbsp;C Y Yeap,&nbsp;Kms Low,&nbsp;T Kaur-Dhaliwal,&nbsp;H Hashim,&nbsp;A Y Wan-Sim,&nbsp;S D Chandrakumara,&nbsp;Ksa Yeo,&nbsp;K S Goh","doi":"10.5704/MOJ.2303.018","DOIUrl":"https://doi.org/10.5704/MOJ.2303.018","url":null,"abstract":"<p><strong>Introduction: </strong>Hip fractures are a major health concern resulting in significant morbidity worldwide. They are the leading cause of fall-related injuries amongst the elderly with high risk of death, and numbers are expected to rise with the growing elderly population. Expedited surgical repair has been proven to improve patient outcomes, however there are often multiple barriers to early surgery especially in the elderly. The use of antiplatelets and anticoagulation is a significant contributory factor to surgical delay.</p><p><strong>Materials and methods: </strong>We conducted a retrospective, single centre study on hip fracture patients admitted to an acute care orthogeriatric unit over a 12-month period, aimed at determining the impact of pre-operative use of antiplatelets and anticoagulants on time to surgery (TTS) and its impact on one-year mortality rates.</p><p><strong>Results: </strong>Amongst 404 eligible patients, 102 were on antiplatelets, 23 on anticoagulants and 279 were neither on antiplatelets or anticoagulants. Our study showed that patients taking clopidogrel (p<0.001) and DOACs (p=0.001) were more likely to have delayed surgery compared to those who were not on these agents. In addition, all patients on warfarin experienced surgical delay. Warfarin group also had highest mortality rates compared to other group and 10 times more likely to die within a year (p=0.001).</p><p><strong>Conclusion: </strong>The results from this study are consistent with existing literature, suggesting that the use of clopidogrel and anticoagulants have a negative impact on TTS in hip fracture patients. Strategies should be developed for patients on these medications to enhance their TTS.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"17 1","pages":"149-159"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9321862","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":"The Osseous Pathology of Purpura Fulminans in a Two-Year-Old Child: A Case Report.","authors":"S Mohd-Razali,&nbsp;K Ahmad-Affandi,&nbsp;S Ibrahim,&nbsp;A H Abdul-Rashid,&nbsp;N Abdul-Shukor","doi":"10.5704/MOJ.2303.021","DOIUrl":"https://doi.org/10.5704/MOJ.2303.021","url":null,"abstract":"<p><p>Purpura fulminans (PF) is a severe clinical manifestation of <i>Neisseria meningitides</i> infection that is associated with high mortality rates in children. Survivors are frequently left with debilitating musculoskeletal sequelae. There is a paucity of reports on the musculoskeletal pathology of purpura fulminans. We report on a 2-year-old boy with purpura fulminans due to meningococcemia. The child developed distal gangrene in both the upper and lower limbs. Amputations were done for both lower limbs. Histological examination of the amputated specimens showed an inflammatory process and features of osteonecrosis. The latest follow-up at the age of 6 years showed a right knee valgus due to asymmetrical growth arrest of the proximal tibia. PF and its complications are challenging to treat and may require a multidisciplinary approach to improve patient's functional ability.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"17 1","pages":"180-183"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9317237","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}