1.A Case Series of Bosworth Fracture-Dislocations and Review of 129 Reported Cases
Fang C ; Tang ZH ; Yeoh CS ; Tan GM
Malaysian Orthopaedic Journal 2022;16(No.3):76-85
Introduction: Bosworth fracture dislocations of the ankle
are rare injuries of the ankle caused by extreme external
rotation of the supinated foot where the proximal fibula
fracture fragment is posteriorly dislocated and entrapped
behind the posterior-lateral ridge of the tibia. This case series
aims to document three such cases treated in our institution
over a nine year period. We also provide a review of 129
cases in the existing literature.
Materials and methods: Medical records and relevant
radiographs for each patient were analysed and collected
from the time of presentation till the point of latest followup. During each clinic visit, all physical exam findings as
well as all complications were recorded. The American Foot
and Ankle Society (AOFAS) Hindfoot score was also
tabulated for each patient at the point of latest review.
Results: Closed reduction was unsuccessful in all three
patients, and all required open reduction. One patient had an
uncomplicated recovery whilst the remaining two suffered
significant soft tissue complications. One patient suffered
severe soft tissue swelling preventing primary closure at the
time of surgery, whilst another suffered post-operative
wound dehiscence and infection. Eventually all fractures
healed, and all three patients obtained satisfactory AOFAS
scores.
Conclusion: The diagnosis of Bosworth fracture
dislocations of the ankle is often delayed or missed, due to its
rare occurrence. Closed reduction is often unsuccessful, and
early open reduction is required to avoid poor clinical
outcomes due to severe soft tissue damage or even
compartment syndrome.
2.Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore.
Ei Zune THE ; Mei Yen NG ; Geelyn JL NG ; Bernadette GC ER ; Amy ML QUEK ; Prakash PALIWAL ; Leonard L YEO ; Bernard CHAN ; Vijay K SHARMA ; Hock Luen TEOH ; Eric YH KHOO ; Raymond CS SEET
Annals of the Academy of Medicine, Singapore 2021;50(1):16-25
INTRODUCTION:
Diabetes increases the risk of ischaemic stroke especially among Asians. This study aims to investigate contemporaneous long-term cardiovascular outcomes of ischaemic stroke patients with diabetes in a multi-ethnic Asian cohort.
METHODS:
Consecutive patients with ischaemic stroke were recruited from the National University Hospital, Singapore. Data on age, gender, ethnicity, risk factors (including diabetes status and body mass index [BMI]), stroke severity and mechanisms were collected. These patients were followed up until the day of the first cardiovascular event or July 2016, whichever was earlier. The primary endpoint was the time from enrolment to the first occurrence of a composite of cerebrovascular and coronary artery events.
RESULTS:
Between July 2011 and December 2013, 720 patients (mean age 60.6 years, 71% men, 43% with diabetes, median National Institute Health Stroke Severity scale 2) were enrolled and followed up. A total of 175 cardiovascular events occurred during a median follow-up of 3.25 years (6.90 events per 1,000 person-month), comprising 133 cerebrovascular and 42 coronary artery events. The adjusted hazard ratio of diabetes was 1.50 (95% CI 1.08-2.10). In a multivariable Cox proportional hazards model, Malay and Indian ethnicities, BMI <23kg/m2 and a prior diagnosis of diabetes were identified as independent predictors of recurrent cardiovascular events.
CONCLUSION
Our study provides quantitative data on the event rates of ischaemic stroke patients with diabetes. These findings provide insights on stroke predictors in a multi-ethnic Asian population, which may have implications in the design of future interventional studies.
3.Modified French Osteotomy for Humeroradial Synostosis in a Child with Multiple Synostoses Syndrome: A Case Report
Sahdi H ; Rasit AH ; Khoo CS ; Bojeng A ; Nur-Alyana BA
Malaysian Orthopaedic Journal 2019;13(2):52-55
Congenital humeroradial synostosis can occur as an isolated clinical entity or as part of a syndrome. Bilateral elbow fixed flexion deformity is very incapacitating and challenging to treat. Here we present the case of a boy with fixed flexion deformity of both elbows due bilateral humeroradial synostosis. Other characteristic features of multiple synostoses syndrome were also present in this child, his elder brother and mother. We elected to improve the position of the right elbow by adapting the modified French osteotomy described by Bellemore et al.