Malaysian Orthopaedic Journal最新文献

Introduction: Football is the most popular sport and is widely played around the globe, with approximately 400 million players in 208 countries. Lower extremity injuries showed the highest incidence, with ankle injuries being the most prevalent after hip and knee injuries. The purpose of this study was to describe the characteristics of the players who reported previous ankle injuries during pre-competition medical assessment (PCMA) during the 2022 seasons of the Malaysian professional club. In addition, the study also investigated the effect of previous injuries on current ankle function.

Materials and methods: This was a retrospective cross-sectional study using secondary data from the preseason PCMA data from a professional club that competed in Malaysia. The ankle range of motion, anterior drawer test, and functional ankle assessments including the Biodex athlete single leg stability test and ankle joint muscle strength were performed during the PCMA.

Results: A total of 45 footballers reported previous history of ankle injuries to the left (n=9), right (n=20), or both ankles (n=16). Footballers with prior ankle injuries exhibited significantly less ankle inversion (p = 0.008) and a larger proportion of positive ADT tests in the injured ankle (x²(1, N=90) =7.76, p=0.005) compared to the non-injured side. there was no significant difference in other ankle range of motion, ankle stability index, or ankle muscular strength between previously injured and uninjured ankles.

Conclusions: During preseason screening, half of the footballers in this study reported previous history of ankle injury, putting them at risk of having future ankle injuries. Aside from inversion and the anterior drawer test, no significant differences in range of motion, stability index, or muscle strength were discovered. However, as injury causation is multifactorial, preventive measures should be taken to reduce the risk of injury.

Genuine infrapopliteal aneurysms are quite rare, in contrast to pseudoaneurysms. The aetiology of pseudoaneurysms related to external fixation is attributed to various theories, including direct vascular damage due to misplaced pins or wires, overshooting or misguidance during osteotomy, distraction at the corticotomy site during an Ilizarov procedure, and continuous abrasion of the vessel caused by a wire inserted in close proximity to an artery. Arteriography proves valuable in documenting lesions and assessing deeper pseudoaneurysms, particularly when contemplating reconstruction; it plays a crucial role in guiding management decisions. For significant tears and symptomatic aneurysms, resection and reconstruction are the gold standard treatment.

Tibial tuberosity avulsion fracture is a rare injury, and bilateral occurrence is more uncommon. Periosteal sleeve fracture is a unique fracture pattern which was first described in the lower pole of patella in children. We are reporting a rare case of bilateral tibial tuberosity sleeve fracture in a teenage boy which occurred while sprinting. The patient underwent open reduction, pull through suture fixation of the bilateral tibial tuberosity and screw fixation of left tibial tuberosity. Post-operative rehabilitation included gradual increment of range of motion with hinged brace and quadriceps muscle strengthening. Close follow-up was done to monitor the progression of his recovery. At six months follow-up, the patient recovered well. Both knees had full range of motion with an intact extensor mechanism.

Introduction: Clavicle fractures in adults are increasingly being treated by surgical fixation following reports of symptomatic non-union, malunion and poor functional outcome with conservative treatment. This has led to a similar trend in the management of clavicle fractures in adolescents. This study aims to evaluate the outcome and complications of non-operatively treated clavicle fractures in adolescents.

Materials and methods: This is a retrospective, single institution study on adolescents aged 13-17 years who sustained a closed, isolated clavicle fracture, between 19972015. Clinical records were reviewed for demographic information, injury mode, time to radiographic fracture union, time to re-attainment of full shoulder range of motion (ROM), and time to return to full activities and sports. Complications and fracture-related issues were recorded. Radiographs were analysed for fracture location, displacement and shortening.

Results: A total of 115 patients (98 males, 17 females; mean age:13.9 ± 0.89 years) were included for study. 101 (88%) sustained a middle-third fracture while the remainder sustained a lateral-third fracture. A total of 96 (95%) of the middle-third fractures were displaced, and 12 (86%) of the lateral-third fractures were displaced. All displaced fractures in this study had shortening. Sports-related injuries and falls accounted for 68 (59%) and 34 (30%) of the cases respectively. Overall, the mean time to radiographic fracture union was 7.8 ± 4.35 weeks; there were no cases of non-union. Full shoulder ROM was re-attained in 6.6 ± 3.61 weeks, and full activities and sports was resumed in 11.4 ± 4.69 weeks. There were 5 cases of re-fracture and a single case of intermittent fracture site pain.

Conclusion: Clavicle fractures in adolescents can and should be treated non-operatively in the first instance with the expectation of good outcomes in terms of time for fracture union, reattainment of shoulder full range of motion, and return to activities. Surgical stabilisation should be reserved for cases for which there is an absolute indication.

Introduction: Previous studies on the degree of leg length discrepancy that causes limb biomechanical problems did not differentiate between adults and children. We conducted this study to determine the effects of simulated leg length discrepancy on vertical ground reaction force in children and adults to enable decision-making for intervention in patients with leg length discrepancy for different age groups or heights.

Materials and methods: This cross-sectional study involved male volunteers of children 150cm and adults with 170cm in height. Vertical ground reaction force was measured using a gait analysis study. The first measurement was taken without any leg length discrepancy as a baseline. Subsequently, different amounts of leg length discrepancy were simulated on the left leg with shoe lifts of 2, 3, and 4cm. The measurements were repeated on each volunteer with similar shoe lifts on the right leg. Therefore, 14 volunteers provided simulations of 28 leg length discrepancies for each group. The first and second peaks of vertical ground reaction force were separately analysed. The vertical GRF of a simulated leg length discrepancy was compared with the baseline. Repeated measurement of analysis of variance (ANOVA) within each group was done.

Results: In both groups, the second peak of vertical ground reaction force in the longer leg reduced gradually as the shoe lift increased sequentially from 2 to 3cm and then to 4cm. A discrepancy of 3cm and above was statistically significant to cause a reduction in the vertical GRF on the longer limb in both height groups.

Conclusion: The degree of leg length discrepancy that caused significant changes in second peak ground reaction force in children with 150 and adults with 170cm height population was similar at 3cm. Therefore, the cut-off point for intervention for both groups are similar with additional consideration of future growth in children.

A chronic expanding hematoma (CEH) is a rare clinicopathologic entity that may simulate the clinical and radiologic presentation of soft tissue sarcomas. Etiology has been attributed to repeated exudation and bleeding from capillaries in granulation tissue, resulting in a gradually enlarging mass. A 51-year-old male presented with a large thigh mass following a gunshot wound one year prior. Diagnostic imaging revealed a large complex mass with cystic areas overlying cortical erosions in the femoral diaphysis suggestive of osteomyelitis versus a primary aggressive new growth. Biopsy confirmed CEH and the absence of malignant cells. Hip disarticulation was performed after noting massive necrosis of the thigh compartments and neurovascular compromise. CEH is an important differential diagnosis to be considered in a patient with a slow-growing soft tissue mass and history of significant trauma. Its similar clinical presentation with a soft tissue sarcoma necessitates a high index of suspicion, diagnostic imaging, and biopsy prior to performing definitive surgery.

Introduction: Forearm fractures are common in children. The remodelling capacity of growing long bones in children makes these potentially forgiving injuries, recovering with good outcomes despite minimal intervention. Clinicians rely on radiological characteristics that vary with age to guide treatment decisions and minimise adverse sequelae. The purpose of this review was to consolidate the evidence base of radiological indications for intervention in paediatric mid-shaft forearm fractures.

Materials and methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed for this review. Citable research output reporting radiological criteria for mid-shaft forearm fractures in paediatric patients (age ≤16 years) was screened and analysed to ascertain acceptable radiological criteria for non-operative management.

Results: A total of 2,059 papers were initially identified; 14 were selected following screening. Sagittal angulation >15°, coronal angulation >10°, and/or >50% (or >1cm) translation were the most common radiological indications for intervention in children aged 0 to 10 years. For children over 10 years of age, the most common radiological indication for intervention was sagittal angulation >10°, coronal angulation >10°, and/or >50% (or >1cm) translation.

Conclusion: This study revealed a scarcity of high-quality evidence to guide management and significant variation in outcome reporting throughout the published literature. Since Noonan and Price's 1998 recommendations, there has been no significant evolution in the evidence-base guided threshold for intervention in paediatric mid-shaft forearm fractures. There remains a pressing need for a robust multicentre observational study using the patient-reported outcome measurement information system (PROMIS) to address this complex and controversial area of uncertainty in paediatric trauma management.

Introduction: Shoulder injury related to vaccine administration (SIRVA) is a group of pathologies defined by pain and stiffness after intramuscular administration of vaccine to the upper arm and has been reported after COVID-19 vaccination. We aim to discuss its pathophysiology, clinical presentation, treatment and outcomes.

Materials and methods: We retrospectively identified patients presenting with adhesive capsulitis within four weeks of administration of COVID-19 vaccine to the affected arm at our tertiary institution from March 2021 to December 2022.

Result: Based on the above criteria, we identified seven cases of adhesive capsulitis, comprising one male and six female patients, with average age of 60 years. We present initial symptoms, signs and the duration from when the vaccine was administered. We have highlighted our treatment strategies as well as the clinical and functional outcomes reported by these patients after treatment. We have reported improvement in both Visual Analogue Scale (VAS) and range of motion (ROM) in all our patients after non-surgical management which included physiotherapy and, in some cases, hydrodilatation.

Conclusion: SIRVA related adhesive capsulitis is rare and under-reported with limited information in current literature. This study highlights that adhesive capsulitis is a potential complication arising from improper COVID-19 vaccine administration and reinforces traditional wisdom of administering vaccinations on the non-dominant arm. Conservative treatment strategies appear to be effective, particularly hydrodilatation combined with physiotherapy, and patients are expected to have a good return of function.

Introduction: Total femur replacement is an option instead of amputation for extensive bone tumour or after revision surgery with a massive bone loss. Over a long period of time the patients may need revision surgery, and this might affect the functional outcome. We reviewed all consecutive total femur replacements done for primary and revision surgery of primary bone tumours in our centre to evaluate the long-term functional outcome and survival.

Materials and methods: All patients who had total femur resection and reconstruction with modular endoprosthesis replacement in our centre from June 1997 to May 2022 were reviewed. The respondents were surveyed through WhatsApp using google form which was translated into Bahasa Malaysia based on the Musculoskeletal Tumour Society Scoring System (MSTS). The data were presented as descriptive data on the final survival of the limb and prosthesis.

Results: Ten patients underwent total femur replacement. There were eight osteosarcoma, one giant cell tumour and one chondromyxoid fibroma. Three patients with osteosarcoma succumbed to pulmonary metastases; all had good early post-operative functional outcomes without local recurrence. Seven patients were available for long term evaluation of function with a mean follow-up of 17.6 years (ranged 10-25 years). Four patients with total femur replacement had good functional outcomes (60-80%) without revision with 10-25 years follow-up. Three patients experienced acetabulum erosion and chronic pain that required early hip replacements. Two of them were complicated with superior erosions and bone loss and subsequently were managed with massive reconstruction using cemented acetabulum cage reconstruction. The other has diabetes mellitus with chronic infection following revision of distal femur endoprosthesis to total femur replacement and subsequently underwent limited hemipelvectomy after 14 years.

Conclusion: Total femur replacement offers a good long term functional outcome and prosthesis survival and is a favourable option for limb salvage surgery.