1.The Outcomes of Salvage Surgery for Vascular Injury in The Extremities: A Special Consideration For Delayed Revascularization
Jagdish Krishnan ; M Paiman ; AS Nawfar ; MI Yusof ; W Zulmi ; WS Azman ; AS Halim ; AZ Mat Saad ; MD Shafei ; WI Faisham
Malaysian Orthopaedic Journal 2014;8(1):14-20
A seven years retrospective study was performed in 45
consecutive vascular injuries in the extremities to investigate
the pattern of injuries, managements and outcomes.
Motor-vehicle accidents were the leading cause of injuries
(80%), followed by industrial injuries (11.1%) and iatrogenic
injuries (4.4%). Popliteal and brachial artery injuries were
commonly involved (20%). Fifteen (33.3%) patients had
fractures, dislocation or fracture dislocation around the knee
joint and 6 (13.3%) patients had soft tissue injuries without
fracture. Traumatic arterial transection accounted for 34
(75.6%) cases, followed by laceration in 7 (15.6%) and 9
(6.7%) contusions. Associated nerve injuries were seen in 8
(17.8 %) patients using intra-operative findings as the gold
standard, both conventional angiogram (CA) and
computerized tomography angiogram (CTA) had 100%
specificity and 100% sensitivity in determining the site of
arterial injuries.
The mean ischemic time was 25.31 hours (4 - 278 hours).
Thirty-three (73.3 %) patients were treated more than 6
hours after injury and 6 patients underwent revascularization
after 24 hours; all had good collateral circulation without
distal pulses or evidence of ischemic neurological deficit.
The mean ischemic time in 39 patients who underwent
revascularization within 24 hours was 13.2 hours. Delayed
amputation was performed in 5 patients (11.1%). Of the 6
patients who underwent delayed revascularization, one
patient had early amputation, one -had delayed amputation
following infection and multiple flap procedures while the
rest of the patients’ limbs survived. Joint stiffness was noted
in 10 patients (22.2%) involving the knee joint, elbow and
shoulder in two patients each. Infection was also noted in 5
patients (11.1%) with two of them were due to infected
implants. Other complications encountered included nonunion
(2 patients, 4.4%), delayed union (1 patient, 2.2%),limb length discrepancy (1 patient, 2.2%), hematoma (1
patient, 2.2%) and leaking anastomosis in one patient
(2.2%). Volkmann’s ischemic contracture occurred in 3
(6.7%) patients. There was no complication noted in 8
(17.8%) patients Three patients (6.7%) died of whom two
were not due to vascular causes. We conclude that early
detection and revascularization of traumatic vascular injuries
is important but delayed revascularization also produced
acceptable results
Extremities
2.Acromion Morphology of Patients with Rotator Cuff Disease in Standard AP Shoulder Radiograph in Hospital Sultanah Bahiyah and Hospital Kuala Lumpur
Leong YC ; Yeoh CW ; Azman MI ; Juhari MS ; Siti HT
Malaysian Orthopaedic Journal 2022;16(No.3):50-54
Introduction: Rotator cuff pathology is commonly
attributed to acromion morphology that is demonstrable in
standard AP shoulder radiographs by measuring the critical
shoulder angle (CSA), the lateral acromial angle (LAA), and
the acromial index (AI). However, these parameters vary
among races and countries. Therefore, our study aimed to get
the local data on acromion morphology in patients with
rotator cuff disease.
Materials and methods: MRI shoulder reports between
January 2012 and June 2018 were reviewed. The study group
consisted of 47 patients with rotator cuff injury with a partial
or complete tear, and a control group of 37 patients with
tendinitis or osteoarthritis and intact rotator cuffs. The CSA,
LAA, and AI of both groups were measured on the
anteroposterior shoulder radiograph. The risk factors for
both groups and the acromion morphology were recorded.
Results: The CSA for the rotator cuff tear and the control
group was 39.08° and 38.28°, LAA was 72.57 ° and 73.51°,
and AI was 0.79 and 0.75. The acromion morphology
differed in terms of gender, and only LAA was different
among the different ethnic groups. There was a negative
correlation between age and CSA, age and AI, LAA and
CSA, LAA and AI, but a positive correlation between AI and
CSA.
Conclusion: The CSA for rotator cuff tear patients in our
population was 39.08°, LAA was 72.57°, and AI was 0.79.
The acromion morphology was significantly influenced by
age and gender.