Malaysian Orthopaedic Journal最新文献

{"title":"Morphometric Analysis of the Tibial Tunnel after Primary and Revision Anterior Cruciate Ligament Reconstruction.","authors":"E Veizi, N Cay, B S Sezgin, A Sahin, A Firat, M Bozkurt","doi":"10.5704/MOJ.2503.009","DOIUrl":"https://doi.org/10.5704/MOJ.2503.009","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior cruciate ligament (ACL) reconstruction is a commonly performed surgical procedure. The objectives of this retrospective comparative study are (1) to evaluate the obliquity, size and the intra-articular aperture shape of the tibial tunnel in patients operated with an anteromedial portal technique, and (2) to determine their possible relation with revision surgery.</p><p><strong>Material and methods: </strong>Patients operated for a primary ACL reconstruction between 2014 and 2018 were eligible. All patients of primary and revision ACL fulfilling the inclusion criteria were assessed for presence of a knee CT scan within one month of surgery and at least three years of follow-up. Several radiological parameters were measured for the study, among which: Tunnel height, Coronal tunnel angle, Maximal tunnel width and Sagittal tunnel inclination. Multivariate analyses were performed to identify parameters correlated with revision.</p><p><strong>Results: </strong>Mean age of the primary group was 30.5±8.4 versus 29.4±8.0 of the revision group. The majority of patients were males in both groups (n=33, 76.7% and n=38, 95.0%, respectively). A longer diameter of the intra-articular ellipse (p=0.005) and an increased mid-tunnel to TT distance on the axial plane (p=0.006) were significantly correlated with revision. A ROC curve analysis determined a cut-off value of 27.9mm from the tubercle was an optimal entry point.</p><p><strong>Conclusion: </strong>A greater distance between the mid-point of the tibial tunnel entrance and the centre of the tibial tubercle is linked to a higher risk of revision. An elongated elliptic shape in the antero-posterior plane also correlates with revision risk.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"66-76"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053404","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":"Chimeric Free Fibula Osteocutaneus Flap and Massive Allograft for Refractory Post-traumatic Osteomyelitis Femur Defect: A Case Report.","authors":"H Y Lam, A S Halim, W A Wan-Sulaiman","doi":"10.5704/MOJ.2503.017","DOIUrl":"https://doi.org/10.5704/MOJ.2503.017","url":null,"abstract":"<p><p>Surgical management of femur osteomyelitis remains challenging. The burden of this chronic disease invariably results in composite bony and soft tissue defects that can interfere with bony stability. Therefore, reconstructive surgery is integral to functional limb salvage and limb preservatives. To the best of our knowledge, we are the first to report the limb salvaging method and important planning considerations for a case of chronic refractory osteomyelitis. We presented a case of a 31-year-old female with chronic post-traumatic osteomyelitis of the right femur. This intractable disease results in frequent remission of infection and non-union of the midshaft fracture. Surgical management with the implant, external fixation, and cement spacer failed due to infection. This rendered vascularised bone graft with massive allograft the only option. We described the anatomical aberrant during the harvest of free fibula flap and modified chimeric fibula flap to overcome the soft tissue defect complicated with severe fibrotic tissue with a background of an obese patient. She had undergone emergency hematoma evacuation 20 hours after the surgery. Otherwise, the flap survived well, and the patient started to have partial weight bearing. Chimeric fibula osteocutaneous free flap is a useful armament to provide a complex 3-dimensional spatial arrangement in a case of chronic osteomyelitis with huge bony and soft tissue defects.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"127-130"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050692","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":"A Prospective, Randomised Controlled Trial Comparing the use of the Proximal Femoral Nail - Antirotation and Dynamic Hip Screw for Stable Intertrochanteric Femur Fractures-Stable Trochanteric Fractures Intramedullary versus Extramedullary (STRIVE) Study.","authors":"Q Y Yeo, Krp Pillay, M Tan, Thi Chua, Bke Kwek","doi":"10.5704/MOJ.2503.011","DOIUrl":"https://doi.org/10.5704/MOJ.2503.011","url":null,"abstract":"<p><strong>Introduction: </strong>Intramedullary nailing in the management of hip fractures is gaining in popularity. Our study aims to determine if there are any clinical and radiological differences between the Proximal Femoral Nail Antirotation II (PFNA II) and the Dynamic Hip Screw (DHS) in the management of stable intertrochanteric (IT) femur fractures. <b>Materials and methods:</b> This is a single blinded prospective randomised controlled trial of 33 patients, aged above 60, comparing the use of the PFNA II and the DHS for the treatment of stable IT femur fractures in a single tertiary centre with an established ortho-geriatric co-managed hip fracture care pathway.</p><p><strong>Results: </strong>Of the 33 patients enrolled, 18 patients were treated with the DHS and the rest with the PFNA II. The two groups had similar demographic profiles and pre-operative radiological parameters. There was no statistical difference between the two groups in terms of intra-operative bleeding, post-operative pain score and total surgical time. The median Harris Hip and Parker Mobility Scores for the DHS group were non-inferior compared to the PFNA II group. Surgical time, blood loss, post-op radiological parameters and functional outcomes including time to ambulation were similar in both groups.</p><p><strong>Conclusion: </strong>We recommend the use of the DHS for stable IT fracture patterns in view of its cost savings and equivalent functional and radiological outcomes.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"86-95"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017042","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 Scores Post Medial Unicompartmental Knee Arthroplasty: A Comparison of the MAKO Robotic Arm versus the Oxford Conventional Approach.","authors":"Cmp Tan, Ssw Shih, V Ravichandra, Esh Quah, R Kunnasegaran","doi":"10.5704/MOJ.2503.002","DOIUrl":"https://doi.org/10.5704/MOJ.2503.002","url":null,"abstract":"<p><strong>Introduction: </strong>Unicompartmental knee arthroplasty (UKA) has significant advantages over total knee arthroplasty (TKA). However, due to its need for precise positioning and soft tissue balancing, UKA failures and revision rates may be higher than that of TKA. Robotic-assisted UKA offers more accurate implant positioning, soft tissue balancing, improved lower limb alignment, and a reduction in surgical error. There are few studies studying functional outcomes post robotic-assisted UKA. The aim of this study was to compare the functional outcomes between robotic-assisted and conventional medial UKA.</p><p><strong>Material and methods: </strong>A retrospective review was done of 159 patients; 110 patients underwent conventional UKA while 49 patients underwent robotic-assisted UKA. Outcome measures included the Oxford Knee Score (OKS), Knee Society Score (KSS), Visual Analogue Score (VAS) for pain, and range of motion (ROM) at three months, one-year and two years post-UKA.</p><p><strong>Results: </strong>Pre-operative patient demographics and outcome scores were not significantly different between both groups. ROM was significantly greater in the MAKO compared to the Oxford group at 3 months (p=0.039), 1 year (0.053) and 2 years (0.001) post-operation. While OKS, KSS and VAS scores improved for both groups, there were no significant differences in the final outcome measures. None of the patients experienced a mechanical failure, infection, or revision post-surgery. One patient each in the Oxford and MAKO group suffered a periprosthetic fracture.</p><p><strong>Conclusion: </strong>Both robotic-assisted MAKO UKA and conventional Oxford UKA showed good clinical outcomes. Robotic-assisted MAKO UKA had superior ROM outcomes compared to conventional Oxford UKA up to two years post-surgery.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"3-10"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029543","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":"Effectiveness of Silent Mentor Program (SMP) Workshop on Enhancing Confidence in Surgical Skills.","authors":"L P Wong, H Alias, S L Tan, S L Khaing, T E Sia, A Saw","doi":"10.5704/MOJ.2503.006","DOIUrl":"https://doi.org/10.5704/MOJ.2503.006","url":null,"abstract":"<p><strong>Introduction: </strong>Simulation-based surgical skills workshops using 'Silent Mentors' are employed in numerous surgical training programs worldwide, yet empirical evidence on their effectiveness remains limited. The objective of this study was to investigate whether participation in the surgical skills workshop within the Silent Mentor Program (SMP) resulted in an improvement in the surgical skills of the workshop attendees.</p><p><strong>Material and methods: </strong>Participants in the SMP at Universiti Malaya during the period from May 15, 2022, to September 24, 2023, were included in the study. Participants self-evaluated their surgical skill confidence levels in four fundamental surgical skills (chest tube insertion, central venous line insertion, endotracheal intubation, and skin suturing). The pre-workshop confidence scores were assessed and compared with immediate post-workshop scores.</p><p><strong>Results: </strong>The findings demonstrated that after the training, participants exhibited higher confidence in all four fundamental surgical skills. Skin suturing demonstrated the highest total confidence score post-workshop, with a median of 21 and an interquartile range (IQR) of 18-24. Endotracheal intubation and chest tube insertion followed closely, both with a median of 19. Conversely, central line insertion displayed the lowest total confidence score, registering a median of 18 (IQR=16-21). No statistically significant differences were observed in the confidence level scores for chest tube insertion, central line insertion, and endotracheal intubation between pre- and post-workshop assessments across all demographic characteristics.</p><p><strong>Conclusion: </strong>In conclusion, utilizing silent mentors in surgical skills training enhances proficiency in all four fundamental surgical skills, with skin suturing demonstrating particularly noteworthy improvements. The consistent confidence levels across demographic factors suggest the workshop's effectiveness across a broad spectrum of participants.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"39-48"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014481","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":"Treatment of Pathologic Proximal Femur Fractures Using the Improvised Megaprosthesis: Combination of the Hip Prosthesis and Intramedullary Nail.","authors":"D K Carolino, A R Tud","doi":"10.5704/MOJ.2503.012","DOIUrl":"https://doi.org/10.5704/MOJ.2503.012","url":null,"abstract":"<p><strong>Introduction: </strong>The proximal femur is the most common long bone affected by metastatic disease. Pathologic fractures in this area are frequent, secondary to weight-bearing and deforming forces. Long-stem endoprosthetic replacement is often used to replace and bypass segments affected by metastases. However, implant cost remains prohibitive for patients in low-resource settings. An improvised megaprosthesis using a hip implant combined with Kuntscher nail provides an economic option.</p><p><strong>Material and methods: </strong>This is a case series of three patients diagnosed with pathologic fracture of the hip secondary to metastatic bone disease who underwent proximal femoral resection with reconstruction using an improvised endoprosthesis in a single tertiary hospital. Outcomes determined include total blood loss, total surgical time, length of hospital stay, latest functional score using the Musculoskeletal Tumour Society (MSTS) score, and pain scale using the numerical rating scale (NRS).</p><p><strong>Results: </strong>For case 1, a 42-year-old female with metastatic breast carcinoma, currently alive with disease and able to perform activities of daily living (ADLs) with minimal assistance; for case 2, a 77-year-old male diagnosed with prostatic carcinoma, able to ambulate with assistive device before expiring 2 years post-surgery; and for case 3, a 57-year-old female with metastatic breast carcinoma, able to resume unassisted ADLs at 3 months post-surgery before refusing systemic treatment in her second year of surveillance monitoring.</p><p><strong>Conclusion: </strong>An improvised megaprosthesis is a cost-effective implant option in low-resource settings, which may help decrease complications related to immobilisation for patients undergoing palliative surgery for metastatic bone disease.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"96-101"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053371","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":"Can Pre-operative MRI Predict the Need for Salter's Osteotomy in DDH Children Undergoing Open Reduction?","authors":"K C Vatsyan, K Rangasamy, N R Gopinathan, P Sudesh, A Shinha, A K Salaria","doi":"10.5704/MOJ.2503.010","DOIUrl":"https://doi.org/10.5704/MOJ.2503.010","url":null,"abstract":"<p><strong>Introduction: </strong>MRI having the multiplanar capability is a good choice for pre-operative planning in developmental dysplasia of hip (DDH). Although few previous studies utilised MRI to quantify dysplasia, predict outcomes, and the procedure required, there are no defined pre-operative conclusive criteria on when to do Salter's osteotomy?</p><p><strong>Material and methods: </strong>A prospective cohort study was conducted in unilateral idiopathic DDH cases those who underwent an open reduction in the age group of one to four years. Pre- and post-operative MRI was done to assess various acetabular and femoral parameters. Intra-operatively, osteotomy was planned. Based on stability assessment given by Zadeh <i>et al</i> Clinical follow-up assessment was done at three- and six-month post-op. Functional assessment using Modified McKay's criteria was done at six months follow-up.</p><p><strong>Results: </strong>Out of 15 cases, seven children underwent only open reduction (OR), whereas eight underwent OR with Salter's osteotomy. Based on pre-op acetabular index and anteversion, Salter's osteotomy should be done in 14 out of 15 cases, but intra-operative stability test precluded Salter's in 6 cases. Post-operative anterior sectoral angle and femoral head coverage percentage were better in OR with Salter's group than OR-only group, but not statistically significant. Functional assessment at final follow-up showed all OR with Salter's group cases were Grade I, whereas in OR-only group, 4 were Grade I and 3 were Grade II.</p><p><strong>Conclusion: </strong>Three-dimensional dynamic assessment using intra-operative stability test predicts the best possible interrelation between the articular surface of the femoral head and acetabulum and the need for osteotomy rather than preoperative MRI.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"77-85"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017091","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":"Type 1 Monteggia Equivalent Fracture with Ipsilateral Distal Radius Fracture: A Case Report.","authors":"Y S Gokceoglu, E Y Ozger","doi":"10.5704/MOJ.2503.016","DOIUrl":"https://doi.org/10.5704/MOJ.2503.016","url":null,"abstract":"<p><p>In this case report, we present a 13-years-old patient who sustained a Monteggia equivalent fracture along with an ipsilateral distal radius fracture following a fall on the elbow. Comminuted ulnar fracture was treated with open reduction and internal fixation with a bridging plate. After restoring the ulnar length, the radial neck fracture was successfully reduced. The distal radius fracture was managed conservatively. Our literature review shows that, the patient is one of the comparatively older patients treated with open reduction and internal fixation in this area and that a successful outcome was achieved with early mobilisation. This case underscores the need for further studies to determine the optimal treatment strategy in such cases.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"123-126"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020924","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":"Implant Choice of Internal Fixation for Stable Femoral Neck Fractures in Elderly: Cannulated Screw Fixation versus Helical Blade Cephalomedullary Nailing.","authors":"Y H Roh, J S Ahn, C M Lim, K W Nam","doi":"10.5704/MOJ.2503.013","DOIUrl":"https://doi.org/10.5704/MOJ.2503.013","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of femoral neck fractures (FNFs) in elderly patients is increasing as average lifespans and the prevalence of osteoporosis increase. The optimal treatment strategy remains unclear. We compared the outcomes of cephalomedullary nail (CMN) and cannulated screw (CTS) fixations used to treat stable FNFs in patients over 65 years of age.</p><p><strong>Material and methods: </strong>Among elderly patients with Garden type 1 and 2 FNFs treated between January 2010 and May 2018, 44 who were followed-up for more than 1 year were included. There were 28 cases in the CTS group and 16 cases in the CMN group, and the average age at the time of surgery was 76.3 years (range, 65-88 years). Radiological and functional variables were analysed to compare the results by fixation device.</p><p><strong>Results: </strong>There were no significant differences between the groups in terms of functional outcomes or bone union times. However, operation and fluoroscopy times were significantly shorter in the CMN group. The neck shaft varus angulation and the extent of device sliding were greater in the CTS group. Multivariate analysis showed that CTS use was independently associated with major complications.</p><p><strong>Conclusion: </strong>The CMN is a useful tool for treating stable FNFs in the elderly. It is simpler to use than conventional CTS fixation and is associated with fewer complications.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"102-112"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038196","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}