Malaysian Orthopaedic Journal最新文献

Introduction: Distal end radius fractures are common upper extremity fractures often requiring surgical intervention for instability. This study compares the functional and radiological outcomes of fixed angle versus variable angle volar locking compression plates in managing these fractures.

Materials and methods: A prospective randomized study was conducted at AIIMS, Raipur, from July 2020 to December 2022. Patients aged 18-60 years with complete intra-articular distal end radius fractures (AO Type 23C1, 23C2, 23C3) were included. Sixty-four patients were randomized into two groups: one receiving fixed angle plates (Group 1) and the other variable angle plates (Group 2). Functional outcomes were assessed using the Mayo wrist score, and radiological outcomes were evaluated with the Sarmiento modification of Lindstrom's criteria. Statistical analysis was performed using IBM SPSS 22.0, with p-values <0.05 considered significant.

Results: At 3 months, the variable angle group had significantly higher Mayo wrist scores (63.12 ± 11.81) compared to the fixed angle group (48.75 ± 11.90, p=0.005). This trend continued at 6 months (75.93 ± 9.16 vs. 64.37 ± 14.59, p=0.025) and 1 year (91.87 ± 7.27 vs. 81.25 ± 16.17, p=0.044). Radiologically, the variable angle group demonstrated better volar tilt restoration at all follow-up points (p<0.001 at 3 months, p=0.001 at 6 months, p=0.004 at 1 year). Complication rates were similar between groups.

Conclusion: Variable angle volar locking compression plates offer superior functional outcomes and better volar tilt restoration compared to fixed angle plates for unstable distal end radius fractures. Both types exhibited similar complication rates.

Introduction: The purpose of this study was to evaluate clinical and biochemical efficacy of autologous intraarticular (IA) platelet rich plasma (PRP) compared to saline and to measure effectiveness of single and multiple doses given at monthly intervals for Kellgren-Lawrence (K-L) grade II, III knee osteoarthritis (KOA).

Material and methods: A total of 130 patients were randomised into 4 groups; PRP-1 (n=36), PRP-2 (n=34), PRP-3 (n=32) and saline (NS) (n=28), after approval from institute ethics committee (reference number: TMU/IEC/20-21/091) and was conducted in accordance with Helsinki declaration. Groups PRP-1, PRP-2, PRP-3 received single, double and triple injections of PRP whereas NS group received single saline (0.9%) injection. Assessment of outcome scores (visual analogue scale [VAS] and Western Ontario and McMaster Universities Arthritis Index [WOMAC]) was done at baseline and three, six, nine months post intervention. Serum collagen 2-1 (Coll2-1) estimation at baseline and nine months post-therapy was used for biochemical assessment.

Results: Improvement in VAS and WOMAC was statistically significant and clinically meaningful (Minimal clinically important change [MCIC]; >12% of baseline and ≥2cm difference in mean for WOMAC and VAS, respectively) for groups PRP-1, PRP-2 and PRP-3 in comparison to saline (P<0.05), at every follow-up. PRP groups also exhibited a significant decrease in serum Coll2-1 at 9 months (P<0.05). On comparison among the PRP groups, multiple doses (groups PRP-2 and PRP-3) produced significantly better clinical results than single dose (group PRP-1) (P<0.05), whereas the difference in Coll2-1 levels was significant for group PRP-1 vs PRP-3 only (P<0.05).

Conclusion: PRP results in clinically significant amelioration of functional and pain scores as well as significant reduction in serum levels of Coll2-1 in K-L grade II, III KOA over nine months. These benefits can be accentuated by multiple doses given one month apart.

Neglected severe rigid kyphoscoliosis can lead to rapid curve progression, presenting a challenge for surgical correction and carrying higher risks of mortality, morbidity, and neurological injury, potentially resulting in permanent paralysis. Halo-pelvic traction (HPT) has been reported to be effective in improving curve flexibility, assisting the surgical correction process, and reducing the likelihood of neurological complications. We report the case of a 15-year-old girl with mosaic Turner syndrome and severe kyphoscoliosis, who experienced progressive curve progression (from 41° to 158°) over a span of 6 years. Preoperative halo gravity traction (HGT) was unsuccessful. To address this deformity, HPT was performed with CT-based navigation for pelvic pin insertion, considering her relatively small pelvis and pelvic obliquity. This technique allowed for precise pin placement, reducing the risk of injury to major arteries, nerves, and abdominal/pelvic organs, while enabling the creation of a more versatile halo-pelvic frame designed to enhance patient comfort and mobility. The patient underwent weekly distraction using HPT for 4 weeks, during which her coronal Cobb angle reduced from 158° to 103° and her kyphotic angle decreased from 90° to 64°. With this notable improvement in the primary spinal curvature, we proceeded with posterior spinal fusion. Notably, this approach obviated the need for vertebral column resection. As a result, we achieved a correction rate of 53.8% in the coronal Cobb angle and 55.6% in the kyphotic angle without neurological injury.

Introduction: The purpose of this study is to assess the outcomes of patients that underwent single-stage revision ACL reconstruction (ACLR) with peroneus longus tendon (PLT), augmented with lateral extra-articular tenodesis (LET) using the modified Lemaire technique.

Material and methods: All the 18 patients underwent arthroscopic single-stage revision ACLR using autologous PLT with an additional modified Limier LET procedure. Patients were thoroughly assessed pre- and post-operatively by the Lachman test, the pivot shift test, and the side-to-side difference by the Rolimeter. Functional evaluation was done with the help of the Lysholm score, the IKDC subjective score, Tegner score, VAS score, MARX activity rating scale and The American Orthopaedic Foot and Ankle Society (AOFAS) score. Post-operatively, patient satisfaction, return to sport, and physical activity were also recorded. SPSS ver. 22.0 software was used. Wilcoxon test, paired and unpaired t-tests were used to compare variables. Statistical significance was determined by a two-sided p-value <0.05.

Results: Regarding subjective evaluations; post-operative residual laxity, and return to sport and physical activity, all of the patients demonstrated excellent results. Post-operatively, there was significant improvement in the anterior knee laxity. According to the Marx Activity Rating Scale, the extent of sports engagement was significantly increased at 18 months following surgery (p<0.001). According to the AOFAS score (p=0.38), there were no documented significant donor site morbidities.

Conclusion: Single-stage revision ACLR using PLT with an additional modified Lemaire LET procedure results in a significant reduction in residual knee laxity with good clinical outcomes and a high return to play and physical activity.

Introduction: Periprosthetic joint infection combined with periprosthetic fracture rarely occurs simultaneously. Once all components of the periprosthetic joint infection were removed, antibiotic spacers were placed. Moreover, periprosthetic fractures require fixing. We use a long femoral stem spacer molded intra-operatively via a self-design metal mold as a novel treatment method for the periprosthetic fracture combined with infection.

Material and methods: The study reviewed 12 patients who underwent two-stage revision arthroplasty with long femoral stem spacers over 6 years. During a minimum of two years of follow-up, the outcomes were evaluated, including reinfection rates, reimplantation rates, and re-operation rates, as well as the success rate based on the MSIS criteria.

Results: Twelve patients underwent two-stage revision with a long femoral stem spacer between stages. A mean follow-up period of 9.58 months followed infection (range 2 to 28 months). In 11 patients (91.67%), the infection was eradicated. There was one patient (8.33%) who required a second 2-stage revision and subsequently cleared their infection. The long femoral stem spacer was repeated in three patients (25%). After eradicating the infection, 9 patients (75%) underwent 2nd stage revision, on average 8.56 months after the first stage. At an average of 27.92 months (range 8 - 65 months) post-operatively, three (25%) long femoral stem spacers remained in place.

Conclusion: Using long femoral stem spacers, both periprosthetic joint infections and periprosthetic fractures can be treated simultaneously. In the cases with multiple organisms, we mixed one pack of bone cement with 2g of Vancomycin and 2g of Meropenem, resulting in satisfactory results.

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.

Introduction: 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.

Material and methods: 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.

Results: 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).

Conclusion: 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.