Malaysian Orthopaedic Journal最新文献

Introduction: 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.

Material and methods: 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.

Results: 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.

Conclusion: Early diagnosis and intervention is the key to effective management of POS. Utilisation of aggressive TLIF yields faster ADL resumption.

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.

Introduction: 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.

Material and methods: 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.

Results: 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.

Conclusion: 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.

Introduction: 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.

Material and methods: 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.

Results: 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.

Conclusion: 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.

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.

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.

Introduction: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

Fractures of the distal radius are the most common type of forearm fractures seen in children. The most serious outcome of physeal injuries is growth arrest, which can result in deformity and even significant differences in limb length. Therefore, we'd like to share our experience with treating a patient whose left radius stopped growing after she had a physeal injury in an accident. Case presentation: we encountered a 10-year-old girl, who was involved in a road traffic accident. She sustained closed fracture distal end left radius (Salter Harris 2). She sought medical assistance late, so osteoclasis, open reduction, and a k-wire on her left radius to fix the fracture, however it was complicated with growth arrest of left radius after the bone united. It was observed that her left radius was around 4cm shorter than her right. She had an osteotomy performed on her left radius and a LRS implanted. After six months post-surgery, there was no visible shortening of her left upper limb, and the radius had grown by around 4cm. There was no neurovascular impairment after left radius lengthening. After a year had passed after her operation, the patient said she had no complaints about her left upper limb. Despite the prevalence of the ilizarov method, the monorail external fixator, also known as LRS, is an option for bone lengthening of the radius. The LRS was utilised in our situation, and the results demonstrated its usefulness.