Malaysian Orthopaedic Journal最新文献

Introduction: There is paucity of research regarding the incidence of hamstring injuries and its inherent causes within youth Malaysian football contexts. We aim to investigate the incidence of hamstring injuries among youth footballers and analyse the risk between intrinsic risk variables (anthropometric and hip strength) and the risk of hamstring strain injuries (HSI).

Material and methods: This was a prospective cohort study involving 72 youth Malaysian professional footballers from a single prestigious club. This study was conducted during the 2023 Malaysian football league. Pre-season medical evaluations encompassed demographic information, anthropometric measurements, and isometric strength examinations of the hamstrings, quadriceps, hip abductors, and hip adductors. Injury surveillance was conducted during the season.

Results: The incidence of HSI in this study was 0.331 injuries per 1000 H, with incidence of injury during match higher 2.79 injuries per 1000 H compared to training 0.216 injuries per 1000 H. There was no hamstring injuries reported in U20. Forty-one (56.9%) has hamstring to quadriceps (H:Q) ratio <0.6 and forty-six (63.9%) has hip abductor to adductor ratio <0.8. The binary logistic regression analysis revealed increasing age (OR: 1.227, CI: 0.98 - 5.03), increased body mass index (OR: 1.79, CI: 0.415 - 7.77), increased body fat mass (OR: 1.39, CI: 0.33 - 5.89), and low H:Q ratio (OR: 4.274, CI: 0.347 - 58.1), increase the risk of HSI.

Conclusion: Injury prevention programs in youth footballers should incorporate these modifiable risk factors into account to reduce the risk of hamstring injuries.

Deep-space infection of the hand can be associated with a varying degree of morbidity. Management will always start with an incision and drainage of the affected hand, followed by appropriate intravenous antibiotic therapy and mobilisation of the joint post-operatively. In order to achieve a good outcome, wound bed preparation is vital as the first stage of wound healing. Ovine Tendon Collagen (OTC) can be a new alternative source of collagen that can be used as a bio scaffold for skin defect coverage.

A 31-year-old man presented with abscesses of the left iliacus muscle, adductor muscles and left hip septic arthritis. Following surgical debridement and antibiotics, he remained infection free at 3 years. We present the radiographic evolution of the changes in his left hip . Despite destruction of the hip during initial follow-up, there was remoulding of the proximal femur with changes of avascular necrosis over a 3-year period with good hip function. Hip septic arthritis may result alarming radiographic changes during initial follow-up. Some patients may continue to improve clinically and radiographically in the short term.

Introduction: Knee osteoarthritis is a degenerative joint disease attributed to failure in joint repair process. Key aspect of the diagnosis relies on thorough history, along with physical examination and radiology findings. The conventional weight-bearing plain radiograph remains the key modality to determine the severity of the condition and helps to plan the surgery. Nevertheless, not all patients can undergo weight-bearing plain radiographs, especially those who are wheelchair-bound or have severe deformities. The purpose of this study is to investigate whether a weight-bearing plain radiograph of the knee is essential in all patients with knee osteoarthritis.

Materials and methods: A prospective cohort study on patients with knee osteoarthritis receiving treatment in a single tertiary hospital was conducted. All patients consented to participate in this study. Patients were assessed functionally with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and radiologically with plain radiographs. Patients were subjected to undergo both supine and standing plain radiographs of the knee in the same setting for comparison purposes where measurement is done following patient functional outcome and radiological measurement for the patient.

Results: Our study shows that reduction in joint space is more obvious in weight-bearing radiographs, however in severe or higher-grade osteoarthritis, a supine radiograph is adequate to diagnose knee osteoarthritis.

Conclusion: Standing radiograph of the knee is preferred to a supine knee radiograph wherever possible due to the additional value it brings, however, in certain patient conditions, a supine radiograph is still acceptable.

Introduction: Proximal humerus fractures (PHFs) are associated with morbidity/functional impairment. Rehabilitation adherence is crucial to regain independent function yet is often hindered by pain. This pilot study aims to analyse the safety and efficacy of ambulatory catheter-based interscalene blocks (CISBs) as analgesia in post-surgical PHF patients and summarise learning points to guide further implementation/study of ambulatory CISB.

Materials and methods: This pilot study selected PHF patients who were >18yo, surgically treated and received ambulatory CISB (CISB ≥72 hours). Data was derived from clinical documentation (anaesthetist/surgeon/therapist reviews). Clinical outcomes (e.g. range of motion, Quick Disability of Arm/Shoulder/Hand (qDASH) scores), dynamic/resting pain scores and incidence of CISB-related complications were collected.

Results: Twelve patients were selected with mean ambulatory CISB duration of 9.5 days. All patients improved clinically, with means improvements of +64.6° and +61.9° for passive flexion and abduction, and reduction of 29.8 in qDASH after 3 months. Two patients experienced neurological complications (phrenic nerve palsy; medial forearm numbness) while six patients experienced catheter-based complications (dislodgment, erythema). All complications were self-limiting, resolving with removal of catheter.

Conclusion: Ambulatory CISB can minimise pain and facilitate rehabilitation for PHF patients. Learning points include (1) complications are predictable and incidence/physiological impact on patients can be minimised via appropriate patient selection, (2) standardised protocols (e.g. tunnelling of catheters) help maximise utility of ambulatory CISB while minimising complications, (3) regular monitoring/anticipation of complications facilitate early detection and prompt management. These learning points, combined with existing literature, can be adapted to future applications of ambulatory CISB to better study its safety and efficacy.

Introduction: Congenital pseudarthrosis of the tibia (CPT) is challenging to treat. The main issues following surgery are non-union, refracture, limb deformity and length discrepancy. We evaluated the surgical outcome of children operated in our centre.

Materials and methods: A retrospective study of the outcome of primary bone union, refracture and success rate. Patients who had reached skeletal maturity were further evaluated for Johnston grading, residual limb deformity and limb length discrepancy (LLD).

Results: Twelve patients (13 tibiae) were reviewed with an average follow-up of 14.5 years (range 3.1-24.0 years). Nine (69.2%) tibiae underwent intramedullary (IM) rodding; two (15.4%) were stabilised with the Ilizarov external fixator (IEF) + IM rod; and two other (15.4%) tibiae with the IEF only. Primary union was achieved in 5 (38.5%) tibiae, but refractures occurred in two tibiae (40%), lowering the overall success rate to 23.1%. Fixation with IM rodding alone led to a low primary union rate (22.2%) but combining it with IEF avoided refracture. Seven (53.8%) tibiae reached skeletal maturity and had a union at 12.6 years (7.5-17.4 years), after an average of 3 surgical procedures. Four (57.1%) were Johnston Grade I, and 3 (42.9%) were Grade II. Four (57.1%) tibiae had residual tibial valgus, two (28.6%) tibial varus, four (57.1%) procurvatum and one (14.3%) recurvatum. The average LLD was 3.9cm (2-10cm).

Conclusion: Intramedullary rodding alone is ineffective for producing a bony union but combining it with IEF minimise the refracture rate. The chances of union increased with age, but residual deformity and shortening are an ongoing challenge.

Introduction: This study aimed to study the usefulness of CTX II levels to identify normal population with patients of knee osteoarthritis, and its utility in identifying the severity of disease in primary knee osteoarthritis (KOA).

Materials and methods: This research recruited 80 cases of KOA and 80 healthy adults (160 subjects). Patients with primary knee osteoarthritis were graded according to the KL grading system, and serum CTX II (sCTX II) value were analysed. The age, gender, and BMI of the subjects were recorded.

Results: The sCTX-II value in cases (719.87 ± 256.1pg/ml) was more than in controls (419.26 ± 208.18pg/ml, p<0.001). The sCTX-II value in case group was significantly higher in males (812.67 ± 289.24) than in females (680.11 ± 236.59, p=0.03). In the control group, males (426.13 ± 221.06) and females (398.66 ± 166.92) had similar values (p=0.60). sCTX II level was higher with higher age, but this difference is significant in the case group only (p=0.003). Multivariate analysis revealed that the sCTX II level was only dependent on the severity of the disease. Analysis of the ROC curve reveals a cut-off value of sCTX II as 557.5pg/ml among cases and controls, 407.5pg/ml between KL grade 0-I, as 528.5pg/ml between KL grade I-II, as 681.1pg/ml between KL grade II-III, and as 866.4pg/ml between KL grade III-IV.

Conclusion: sCTX II values are dependent only on the severity of the disease. sCTX II level estimation is an excellent diagnostic tool for identifying the normal population with knee osteoarthritis patients and has a clinical significance in identifying KOA cases of KL grade I and II.

Hamartomas are benign masses of disorganised tissue native to specific anatomical sites, with a potential for malignant transformation. While they can manifest in various organs, cases involving the hands are exceptionally rare. Hamartomas in the hand have been documented sparingly. To date, there have been no cases of hamartomas in the fingers, hence contributing to the limited body of literature. This case report discusses a hamartoma in the right little finger of an 80-year-old male with a history of a slowly growing painless mass over the course of 5 years. Examination revealed a 1x1 mass with benign features over the proximal interphalangeal joint (PIPJ). A plain radiograph was unremarkable. An excision biopsy was done, and histopathological examination (HPE) revealed a diagnosis of hamartoma. Post-operatively, his wound healed accordingly, and normal function of the finger was achieved.

Introduction: Recent advances in orthopaedic research focus on improving bone healing and grafting. Osteopaste, a synthetic bone cement made from tetra-calcium phosphate (TTCP) and tri-calcium phosphate (TCP) has been developed to overcome limitations of traditional bone grafts. This study evaluates the radiographic density and new bone formation to bridge the critical size defect of Osteopaste compared to two other synthetic grafts, JectOS (calcium phosphate) and MIIG-X3 (calcium sulfate) at 6, 12, and 24 weeks.

Materials and methods: A critical size defect measuring approximately 4.5mm (width) x 9.0mm (length) was surgically created at the proximal tibial metaphysis and implanted with Osteopaste, JectOS, or MIIG-X3. Following cement implantation, surrounding soft tissues were repositioned and sutured with bioabsorbable surgical suture. Bone defect healing and cement density were qualitatively and quantitatively evaluated using plain radiographs and computed tomography (CT) scans at 6, 12, and 24 weeks.

Results: The Osteopaste group showed radiographic density levels between those of JectOS and MIIG-X3. JectOS had the highest density, while Osteopaste was higher than MIIG-X3. In the Osteopaste group, new bone formation bridged the critical size defect by 12 weeks, but no bridging occurred in the other two groups at any time point. Statistical analysis showed significant differences in mean density among the groups at 6, 12, and 24 weeks (P<0.0001).

Conclusion: Osteopaste effectively promotes new bone formation. Its performance falls between that of JectOS, which has the highest density, and MIIG-X3. These results suggest that Osteopaste could be a useful alternative for bone grafting.

Introduction: We have devised an algorithm to assist classifying acetabulum fractures using plain radiographs. This study aimed to test if the accuracy and reliability of fracture classification increases using our algorithm in resident doctors.

Materials and methods: Seventy-two residents of eight tertiary care institutes took part in our survey. These residents were divided into three groups, Groups A, B, and C, with 31, 20, and 21 residents, respectively. Two different Collections (1 and 2) containing radiographs of twenty patients each, with known classification from CT and intra-operative findings, were prepared. Collection 1 radiographs were given to Group A and B, and Collection 2 radiographs were given to Group C. Group A residents were asked to classify the fractures using our algorithm, and Group B and C residents were asked to classify the fractures according to their understanding. Intra-observer and interobserver reliability were estimated.

Results: A total of 1411 unique responses were made. The accuracy of group A, B, and C residents was 53.8%, 34.9% and 28.3%, respectively (p-value 0.001). The interobserver reliability for fracture classification was fair with an algorithm (κ = 0.32) and slight without an algorithm. The intra-observer reliability among five observers was moderate (κ = 0.43).

Conclusion: Our algorithm improves the accuracy and reliability for classifying acetabular fractures according to the Judet-Letournel classification for resident doctors with two to four years of experience.