Malaysian Orthopaedic Journal最新文献

{"title":"Treatment of Capitellum and Trochlear Fracture using Headless Screw with Concomitant Olecranon Fracture Through Posterior Approach: A Case Report.","authors":"Nza Aishah, H A Noor","doi":"10.5704/MOJ.2503.015","DOIUrl":"https://doi.org/10.5704/MOJ.2503.015","url":null,"abstract":"<p><p>Articular fracture of distal humerus account for 2% of all adult elbow fracture. The coronal shear fracture combined with olecranon fracture require stable anatomical reduction and stabilisation for early rehabilitation and mobility. Numerous reports have described various approaches in tackling this type of fracture and method of fracture fixation. Here, we shared a case of a lady with traumatic coronal shear capitulum and trochlear comminuted fracture fixed using posterior elbow approach with fracture site open window technique in managing distal humerus articular fracture with ipsilateral olecranon fracture using headless screw and tension band wire. During last follow-up, fracture was united radiographically with congruent articular joint, patient able to return to her original function without limitation and no indications of avascular necrosis.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"119-122"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031811","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":"Prevalence of Blood Transfusion and Factors Influencing Blood Loss Following Primary Total Knee Replacement Surgery.","authors":"A N Sadagatullah, Maa Sahadun, M K Md-Isa, M F Yusof","doi":"10.5704/MOJ.2503.007","DOIUrl":"https://doi.org/10.5704/MOJ.2503.007","url":null,"abstract":"<p><strong>Introduction: </strong>Total knee replacement (TKR) is a highly effective treatment for end-stage knee osteoarthritis and has been proven to have excellent results in relieving pain as well as improving mobility of the patient. Although becoming more increasingly performed, it is still associated with considerable perioperative blood loss requiring allogenic blood transfusion. Allogenic blood transfusion (ABT) can be lifesaving in certain clinical situations but also comes with their own risks and side effects. The reported incidence of ABT and blood loss following TKR surgery varies widely in the literature. The objectives of this study were to look at the prevalence of ABT, factors leading to transfusion as well as increase in blood loss.</p><p><strong>Material and methods: </strong>A cross-sectional retrospective study was conducted involving 296 adult patients who underwent elective primary unilateral TKR surgery from January 2015 until December 2019 at Hospital Melaka. Medical records of these patients were reviewed, and relevant data were extracted for final analysis. Incidence of ABT, demographic data, use of antiplatelet/anticoagulant, tourniquet time, types of general anaesthesia, and pre- and post-operative haemoglobin count were recorded. These factors were analysed to look at the association with ABT as well as increase in blood loss.</p><p><strong>Results: </strong>Prevalence of ABT following primary unilateral TKR surgery were found to be 4.39% (95% confidence interval 2.04, 6.74). Pre-operative haemoglobin value was found to be the only significant variable associated with blood transfusion [P<0.001; Odds ratio (OR) = 0.35; 95% Confidence interval (CI) 0.22, 0.54]. Meanwhile, prolonged tourniquet time of >120 minutes was the only significant variable towards an increase in blood loss. Participants with tourniquet time >120 minutes has 2.67 times the odds to have blood loss >2 g/dL compared to participants with tourniquet time of less or equal to 120 minutes (95% CI=1.54, 4.64).</p><p><strong>Conclusion: </strong>The prevalence of ABT following primary unilateral TKR was lower in our centre compared to other reported studies. Pre-operative optimisation of anaemic patients with haematinics will help surgeons reduce the need for ABT.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"49-56"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003726","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":"Importance of Appropriate and Substantial Imaging and Pathological Information for Rare Conditions.","authors":"J Ichikawa, T Kawasaki, K Onohara","doi":"10.5704/MOJ.2503.018","DOIUrl":"https://doi.org/10.5704/MOJ.2503.018","url":null,"abstract":"","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"131-132"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020618","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 Outcomes of Delayed Revascularization in Lower Extremity Vascular Injury: A Retrospective Cohort Study.","authors":"K S Chai, W I Faisham, W A Wan-Sulaiman, M A Rosli, A Z Mat-Saad, M H Jusoh, M Paiman, A S Halim","doi":"10.5704/MOJ.2503.008","DOIUrl":"https://doi.org/10.5704/MOJ.2503.008","url":null,"abstract":"<p><strong>Introduction: </strong>There is no consensus yet whether delayed limb salvage procedures with an \"ischemic time\" of more than 6 hours are worthwhile, as these repairs are often complicated by reperfusion injury. Our study aims to determine the outcomes of delayed revascularization to validate our current treatment approach and assess areas for future improvement.</p><p><strong>Material and methods: </strong>We performed a retrospective cohort study on a highly selected group of patients who underwent delayed revascularization surgery for lower extremity traumatic vascular injuries in our institution from January 2008 to June 2018. Exclusion criteria include the presence of a terminal non-salvageable ischemic limb; defined as a gangrenous extremity evident by non-blanchable, mottled skin with complete limb paralysis, renal trauma, known renal impairment, and those with an ischemic time less than 6 hours. The demographic data, type and level of vascular, type of injuries, duration of ischemia, MESS score, and the need for secondary amputation were assessed. <b>Result:</b> Fifty-nine patients were identified and included in the analysis. Fifty patients (84.7%) were male, while 9 patients (15.3%) were female. The mean age was 28.1 years. The most injured vessel was the popliteal artery (n=41, 69.5%). The commonest injury pattern was contusion with thrombosis (n=31, 52.5%). Revascularizations were mainly achieved by interposition saphenous vein graft (n=40, 67.8%). The mean duration of delayed was 14.1 hours. A total of 83.1% of patients (n=49) had a Mangled Extremity Severity Scoring (MESS) of 7 and above. The limb salvage rate in this study was 89.8%, with only 6 patients (12.2%) requiring secondary amputations. Thirty-one patients developed rhabdomyolysis, with 6 cases (19.4%) requiring temporary inpatient renal replacement therapy (RRT). Out of the six, only one patient required lifelong RRT.</p><p><strong>Conclusion: </strong>Limb salvage in those with the duration of delayed of more than 6 hours should be attempted after careful assessment and a high rate of limb salvage, minimal renal complication and acceptable functional (mobility) outcomes can be achieved, despite the reperfusion injury that accompanies.</p>","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"57-65"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051529","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":"In Patients not Suitable for Generalised Anaesthesia, Surgery for Necrotising Fasciitis under Spinal Anaesthesia should be Considered.","authors":"J Finsterer, S Zarrouk","doi":"10.5704/MOJ.2503.019","DOIUrl":"https://doi.org/10.5704/MOJ.2503.019","url":null,"abstract":"","PeriodicalId":45241,"journal":{"name":"Malaysian Orthopaedic Journal","volume":"19 1","pages":"133-135"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031908","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":"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":"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}