Malaysian Orthopaedic Journal最新文献

Introduction: Young active patients with significant pain from knee osteoarthritis are a challenging group of patients to treat. For patients with symptomatic osteoarthritis involving both medial and lateral compartments, total knee arthroplasty (TKA) would traditionally be their only surgical option. Knee joint distraction (KJD) is a novel procedure in Asia that offers a joint preserving alternative for this cohort of patients. This study aims to evaluate patients with knee osteoarthritis treated with knee joint distraction (KJD).

Material and methods: Patients were included in this study if they had medial and lateral knee pain refractory to conservative treatment for more than 6 months, aged less than 50 and radiographs confirmed osteoarthritic changes in both the medial and lateral tibio-femoral compartments. An external fixator was placed in the distal femur and proximal tibia, and the knee joint was progressively distracted over a period of 3 days, to a total distance of 5mm. After six weeks, the external fixator is removed. Manipulation under anaesthesia was performed for patients who experienced stiffness post external fixator removal to achieved desired range of motion.

Results: A total of three patients underwent KJD from 2020 to 2021. The patients' age ranged from 44 to 49 years. The mean pre-operative Oxford Knee Score (OKS) was 37.6. At final follow-up at 2 years, the mean post-operative OKS was 17.6. All patients managed to attain the minimal clinically important difference in the OKS.

Conclusion: In young patients with symptomatic bicompartmental knee osteoarthritis, KJD can be considered before doing a total knee replacement.

Introduction: Late-onset Legg-Calvé-Perthes disease, which is diagnosed in children older than 8 years old, is considered to have a poorer outcome. The outcome depends on the severity of the disease, the age at presentation, and the method of treatment. This study aims to evaluate the effectiveness of containment using femoral varus osteotomy (FVO) in late-onset Legg-Calvé-Perthes disease patients.

Material and methods: We reviewed seven patients with Legg-Calvé-Perthes disease aged nine and older (four Herring B and three Herring C) who had containable hip included two cases of pseudo hinged abduction. All patients went through FVO at the subtrochanteric level, with the varus adjustment guided by an image intensifier to ensure hip containment in a neutral position, and the site was then fixed with a plate. The outcomes were assessed based on Stulberg classification of radiograph at skeletal maturity with a mean follow-up of 9.99 years.

Results: All seven patients that went through FVO were between nine to eleven years old. Among the four Herring B patients, one had Stulberg I, one had Stulberg II, and two had Stulberg III. All three Herring C patients had Stulberg III.

Conclusion: Femoral varus osteotomy produces a reasonable outcome in patients of nine years and older, including those with pseudo-hinge abduction.

Introduction: Knee osteoarthritis (OA) is a degenerative joint condition with significant global prevalence, often resulting from inflammatory joint processes, trauma, occupational stress, and obesity. While total knee arthroplasty (TKA) effectively alleviates pain and restores function, its limited lifespan and increased revision risk in younger patients necessitate alternative joint-preserving strategies. Emerging evidence highlights the potential of approaches such as Knee Joint Distraction (KJD), High Tibial Osteotomy (HTO), platelet-rich plasma therapy, and radiofrequency ablation in managing knee OA. These non-invasive and joint-preserving interventions have demonstrated efficacy in reducing OA-related pain and improving patient outcomes.

Material and methods: This study evaluated four comparative studies focusing on KJD vs HTO and TKA in the treatment of severe knee OA. Patient-reported outcomes were assessed using validated tools, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), Intermittent and Constant Osteoarthritis Pain (ICOAP) score, Visual Analog Scale (VAS) for pain, EuroQol-5 Dimensions (EQ-5D), and Short Form-36 (SF-36). Structural outcomes were quantified via Joint Space Width (JSW), an indicator of cartilage preservation. Data were analysed using Review Manager (RevMan) version 5, with Cochrane's Q test applied to evaluate heterogeneity. Results were summarised using Forest plots, and statistical significance was set at p < 0.05.

Results: Statistical analysis revealed significant differences between KJD vs. HTO and TKA across all measured outcomes. HTO and TKA demonstrated superior improvements in WOMAC, KOOS, ICOAP, VAS, EQ-5D, SF-36, and JSW. Despite these statistically significant differences, the mean values were comparable, suggesting KJD's non-inferiority as a joint-preserving alternative. The efficacy of non-invasive modalities in alleviating knee OA symptoms further strengthens the argument for exploring less invasive, cost-effective options for managing this condition.

Conclusion: Knee Joint Distraction emerges as a promising joint-preserving intervention, offering comparable pain relief and functional improvement to HTO and TKA in the management of severe knee OA. While HTO and TKA showed marginally superior outcomes, KJD remains a viable alternative for younger patients or those seeking to delay TKA. Incorporating adjunctive treatments such as platelet-rich plasma therapy or radiofrequency ablation may further enhance outcomes, paving the way for multimodal and individualised approaches to knee OA management.

Introduction: Musculoskeletal disorders (MSDs) are a critical occupational health issue, particularly among dental professionals, where repetitive tasks, prolonged postures, ergonomic challenges, and psychosocial stressors contribute to their high prevalence. Existing literature highlights musculoskeletal issues, but gaps remain in understanding their prevalence and causes among primary oral healthcare personnel in Malaysia.

Material and methods: A multistage sampling technique was used to recruit a representative sample of 330 respondents from Malaysian primary oral healthcare personnel in various job roles within government dentistry facilities. Nordic Musculoskeletal Questionnaires (NMQ) were distributed to investigate the prevalence of musculoskeletal issues among the participants.

Results: Of the participants, 53.4% of females and 46.6% of males reported experiencing work-related musculoskeletal disorders (WR-MSD). The neck was the most affected region, with a prevalence of 65.5%. Musculoskeletal disorders were more prevalent among individuals with longer years of service, with dental officers being the most affected type of designation.

Conclusion: This study highlights the high prevalence of musculoskeletal disorders (MSDs) among Malaysian primary oral healthcare personnel, emphasising the need for targeted ergonomic interventions and workplace practice improvements to enhance occupational health and well-being.

We present a case of an 18-month-old female child who attended the paediatric emergency department with mild dehydration, pyrexia and a healing chickenpox (varicella) rash. Her older brother recently recovered from chickenpox without complication and is believed to have been the source of her infection. Her classically self-limiting condition was initially treated supportively with oral fluids and benzydamine mouth spray, before two further presentations to the emergency department with worsening clinical deterioration, a protracted pyrexia and an exquisitely painful right shoulder prompted the search for an alternative diagnosis. This ordinarily fit and well, immunocompetent girl was subsequently diagnosed with septic arthritis of the right shoulder, complicated by concurrent varicella zoster virus infection. She was managed operatively with needle arthrocentesis, using a two-cannula technique to thoroughly wash out the infected glenohumeral joint. An intra-operative pus sample was sent for culture, subsequently growing Group A streptococcus pyogenes. Following washout, she received a course of intravenous antibiotics. There was immediate clinical recovery in the function of the right shoulder joint which continued into the post-operative period. Down-trending infection markers demonstrated a biochemical improvement, and she was discharged from hospital with a three-week course of oral antibiotics, making a full recovery. The rarity of upper limb involvement, along with the operative management technique of two needle arthrocentesis joint washout make this case an important contribution to the existing knowledge base and highlights the importance of considering this surgical emergency presenting in - what is usually - an overwhelmingly benign and self-limiting illness.

Introduction: Bladder exstrophy is an embryologic malformation characterised by a deficiency of the anterior midline, resulting in urogenital and skeletal complications. The aim of this article is to identify the factors influencing outcomes in patients with bladder exstrophy, a condition for which published literature remains limited.

Material and methods: A retrospective cohort study analysed medical records from 2011 to 2017. Patients with bladder exstrophy who underwent anterior and posterior innominate osteotomy were evaluated for clinical outcomes in an orthopaedic outpatient clinic. Anatomical outcomes were assessed by calculating the percentage of pubic approximation, while functional outcomes were measured using the PedsQL 4.0 and compared to typical peers.

Results: Nineteen children (median age 6 years) were included: 11 boys (57.9%) and 8 girls (42.1%). Among them, 17 had bladder exstrophy, 2 had cloacal exstrophy, 2 had epispadias, and 1 had hypospadias. Sixteen children (84.2%) had no other congenital anomalies. The median age at surgery was 6 months (range 1-71 months), with a median pubic approximation percentage of 78.5% (range 65- 98.1%). The mean PedsQL score post-operation was 97.2 ± 1.6. A significant correlation was found between age at operation, post-operative diastasis, pubic approximation percentage, and PedsQL score (p < 0.05).

Conclusion: The clinical outcomes for bladder exstrophy patients were favourable, as indicated by pubic approximation percentage and PedsQL scores. Age at operation and post-operative diastasis significantly influenced both anatomical and functional outcomes.

Introduction: Patellar fractures were common and often challenging to manage, particularly in the elderly population. Achieving stable anatomic reduction and maintaining it throughout the perioperative period was crucial for restoring knee function, especially in patients with osteopenic bone.

Material and methods: This was a retrospective case series of geriatric patients who presented to our centre with closed transverse patellar fractures between 2022 and 2023. All fractures were classified as AO 34C1 under the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and were considered fragility fractures, having resulted from a fall from standing height. Only patients aged over 60 years were included. All underwent open reduction and internal fixation using cannulated screws with suture tape augmentation. The Knee Society Score (KSS) was evaluated at four months post-operatively, and patients were followed for complications for up to one year.

Results: Six cases met the inclusion criteria. The mean displacement was 19mm, and the average operative time was 45.17 minutes. The average time to radiographic union was 8.67 weeks. At a mean follow-up of 12.8 months, none of the patients required revision surgery or hardware removal. No patient reported issues related to implant prominence or pain during kneeling. The KSS at four months ranged from 87 to 97, with a mean score of 91.

Conclusion: Cannulated screw fixation with suture tape augmentation appeared to be a safe and effective method for treating transverse patellar fractures in the elderly population, offering stable fixation and favourable functional outcomes.

Introduction: Shoulder impingement syndrome (SIS) arises from inflammation and degeneration of structures in subacromial space, significantly affects daily functioning, and is a frequent reason for primary care consultations. Extrinsic factors include pathological anatomical variations in the acromion and thickening of coracoacromial ligament, along with Intrinsic factors resulting from aging, inadequate blood supply, genetic predisposition, occupation, or lifestyle-induced stress.

Materials and methods: This study, uniquely designed to assess the effectiveness of a consensus of clinical guidelines on the effectiveness of arthroscopic subacromial decompression (ASD) with intra-operative platelet-rich plasma (PRP) augmentation in SIS, analysed seventy-two patients. Their functional outcomes were determined using Visual Analogue Scale, Constant Shoulder Score, and UCLA Score.

Results: The findings revealed significant improvements across all outcome measures. The most striking was the substantial pain reduction, as evidenced by the mean VAS score decreasing from 5.88 pre-operatively to 1.08. This significant reduction in pain offers substantial hope and optimism for patients suffering from SIS. The constant scores increased from 38.04 to 82.71, with excellent or good results in 91.67% of the patients. The UCLA scores increased from 14.50 to 31.13, with 91.67% of patients having excellent or good results. Importantly, no significant complications were observed.

Conclusion: Arthroscopic subacromial decompression, augmented with PRP, is a safe and effective procedure in treating SIS, yielding significant improvements in clinical outcomes (pain and function) by the present study. The functional result is comparable for patients with intact and partial rotator cuff tears. This study's findings and safety profile reiterate the effectiveness of this procedure, instilling confidence in the practitioner regarding its application.

Necrotizing Fasciitis (NF) is a rare and potentially life-threatening infection affecting the skin and soft tissue. Its incidence is estimated at 4 cases per 100,000 people a year in the United States. Gram-positive cocci are the common causative organism. With a mortality rate of 25% to 35%, it should be diagnosed as soon as possible, and the treatment should be expedited. A 68-year-old woman presented with acute disturbed consciousness, accompanied by fever, swelling, and pain on the index finger of the right hand. She gave a history of a cut finger one day prior. Her index finger appeared pale and cold in touch with no capillary refill time and was insensate. Initially, she was diagnosed with a diabetic hand. With the disease progressivity combined with laboratory and ultrasonography results, she was diagnosed with NF, and emergency debridement and fasciotomy were done. NF is a lethal and fast progressing Skin and Soft Tissue Infections (SSTIs) that should be diagnosed early to reduce the mortality rate. A slower rate of infection does not exclude NF as a diagnosis because many factors can affect it, such as its aetiology, coexisting disease, or our empiric antibiotic. In treating NF, a blood culture should be done to identify its cause, and we should perform adequate surgical debridement with or without fasciotomy based on its manifestations.