Introduction: Dermatomyositis is a rare idiopathic inflammatory myopathy with distinctive cutaneous manifestations. This study aims to determine the demographic characteristics, clinical features and associated malignancies in patients with dermatomyositis. Materials & Methods: Dermatomyositis is a rare idiopathic inflammatory myopathy with distinctive cutaneous manifestations. This study aims to determine the demographic characteristics, clinical features and associated malignancies in patients with dermatomyositis. Results: Forty-three cases were identified, with female to male ratio of 1.26:1. Mean age of onset was 47.8 +18.0 years. Malay and Chinese patients made up the bulk of the patients, contributing 53.5% and 44.2% respectively. Photosensitive rash was the commonest clinical presentation, occurring in 55.8% of the patients, followed by Gottron’s papules (46.5%), heliotrope rash (44.2%), alopecia (23.3%) and calcinosis (9.3%). Median Creatinine Kinase level was 293IU/L (interquartile range 89-1166), Lactate Dehydrogenase 641IU/L (interquartile range 459-986) and Aspartate Transaminase 70.5IU/L (interquartile range 41.5-156.25). Concomitant malignancies occurred in 14 patients (32.5%), the commonest being nasopharyngeal carcinoma (6 patients), followed by gastrointestinal tumours (3 patients), breast cancer (2 patients) and lymphoproliferative disorders (2 patients) and lung cancer (1 patient). Of these 14 patients, malignancies were detected in 10 patients within the first year, and 2 patients within the second year after diagnosis of DM. Two patients had malignancies diagnosed within 6 months prior to the diagnosis of DM. Malignancy accounts for 64.7% of the 17 mortalities recorded. The proportion of Malay patients with paraneoplastic dermatomyositis with respect to the total number of Malay new clinic attendees over the past 13 years is 7 in 10,000 persons whereas in Chinese patients, the proportion is 15 in 10,000 persons. Conclusion: Malignancy is found in about a third of all patients, with Chinese predisposition seen. This could explain why nasopharyngeal carcinoma is most prevalent in our centre.

children with femur fractures. This study compares the outcomes of spica cast application, in terms of quality of fracture reduction and hospital charges when performed in operating theatre versus outpatient clinics at a local institution. Materials and Methods: A total of 93 paediatric patients, aged between 2 months to 8 years, who underwent spica casting for an isolated femur fracture between January 2008 and March 2019, were identified retrospectively. They were separated into inpatient or outpatient cohort based on the location of spica cast application. Five patients with metaphyseal fractures and four with un-displaced fractures were excluded. There were 13 and 71 patients in the outpatient and inpatient cohort respectively who underwent spica casting for their diaphyseal and displaced femur fractures. Variables between cohorts were compared. Results: There were no significant differences in gender, fracture pattern, and mechanism of injury between cohorts. Spica casting as inpatients delayed the time from assessment to casting (23.55 ± 29.67h vs. 6.75 ± 4.27h, p<0.05), increased average hospital stay (41.2 ± 31.1h vs. 19.2 ± 15.0h, p<0.05) and average hospital charges (US$1857.14 vs US$775.49, p<0.05). Excluding the un-displaced fractures, there were no significant differences in the period of cast immobilisation and median follow-up length. Both cohorts had a similar proportion of unacceptable reduction and revision casting rate. Conclusion: Both cohorts presented similar spica casting outcomes of fracture reduction and follow-up period. With spica cast application in operating theatre reporting higher hospital charges and prolonged hospital stay, the outpatient clinic should always be considered for hip spica application.

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 1997- 2015. 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 nonunion. 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.