1.Nonunion Of Lateral Humeral Condylar Fracture In A Child With Cubitus Varus
Sulaiman Ar ; Munajat I ; Mohd Ef
Malaysian Orthopaedic Journal 2010;4(3):17-20
Patients with cubitus varus deformity secondary to malunited supracondylar fracture are at risk for lateral humeral condylar (LHC) fracture. This report describes a child presenting with preexisting malunion of supracondylar fracture presenting along with nonunion of a LHC fracture following a recent injury. The patient underwent resection osteotomy of the metaphyseal proximal fragment of the fracture surface, reduction of the displaced LHC fragment and screw fixation. This procedure corrected the cubitus varus and treated the nonunion of the lateral condyle thus avoiding a supracondylar osteotomy procedure. Treatment resulted in solid union, good range of motion and no avascular necrosis.
2.Performance of Osteoporosis Self-assessment Tool for Asian (OSTA) for Primary Osteoporosis in Post-menopausal Malay Women
DAJ Muslim ; EF Mohd ; AY Sallehudin ; TMS Tengku Muzaffar ; AM Ezane
Malaysian Orthopaedic Journal 2012;6(1):35-39
The Osteoporosis Self-Assessment Tool for Asians (OSTA)
score has been developed to identify women at risk of
osteoporosis. It can be used as a screening tool for patients at risk who would benefit from bone mineral density measurement and treatment. It was developed based on data from eight countries including Malaysia. However, most subjects were of Chinese (59%). This study evaluated the performance of OSTA among 152 post-menopausal Malay
women. OSTA score calculation and DEXA scan were
performed. Our results showed that the OSTA score is a good
predictor of patients at risk of osteoporosis based on BMD
measurements at the proximal femur. Instrument sensitivity
was 87.5%, specificity was 95.8%, positive predictive value
(PPV) was 0.538, negative predictive value (NPV) was
0.993, and the area under the receiver operating
characteristic curve (ROC) was 0.895. We conclude that use
of the OSTA score in postmenopausal Malay women is
effective and has adequate sensitivity and specificity.
3.Submuscular Plate Stabilisation After Lengthening: Standard and Modified Techniques
Munajat I, MMed Ortho ; Sulaiman AR, MMed Ortho ; Mohd EF, MMed Ortho ; Zawawi MSF, PhD
Malaysian Orthopaedic Journal 2020;14(No.1):49-54
Introduction: Submuscular plating after lengthening shortened the period of external fixation in distraction osteogenesis of the femur. In the femur, where monolateral or ring fixators had been used for the distraction, plates, could be inserted laterally, anteriorly or medially. Specific technical modification of the plate insertion, however, would be necessary to accommodate the femoral varus angular correction created at the end of the distraction, in the pelvic support osteotomy lengthening. Material and Methods:We reviewed a series of eight cases with standard and modified techniques of plating after lengthening. The amount of lengthening, the period of distraction, the external fixator index and the associated complications were assessed. Results:The mean lengthening was 5cm, with a range of 3cm to 9cm. The external fixation index, the period of external fixators in days in relation to the length of distraction in cm, was between 18 days/cm to 58 days/cm. One patient with quadriceps contracture, underwent quadriceplasty to improve knee flexion. Three patients with transient knee stiffness had resolution with aggressive physiotherapy. One patient with transient hypoesthesia recovered spontaneously. None of the patients developed joint subluxation, deep infection, re-fracture or implant failures. Conclusion:Standard and modified techniques of plating after lengthening were safe and required only a short period of external fixation. The modified technique offered an easier way of plate insertion in a deformed bone.
4.Displaced Physeal and Metaphyseal Fractures of Distal Radius in Children. Can Wire Fixation Achieve Better Outcome at Skeletal Maturity than Cast Alone?
Syurahbil AH, MMed Ortho ; Munajat I, MMed Ortho ; Mohd EF, MMed Ortho ; Hadizie D, MMed Ortho ; Salim AA, MMed Ortho
Malaysian Orthopaedic Journal 2020;14(No.2):29-39
Introduction:Redisplacement following fracture reduction is a known sequela during the casting period in children treated for distal radius fracture. Kirschner wire pinning can be alternatively used to maintain the reduction during fracture healing. This study was conducted to compare the outcomes at skeletal maturity of distal radius fractures in children treated with a cast alone or together with a Kirschner wire transfixation. Materials and Methods: This was a retrospective study involving 57 children with metaphyseal and physeal fractures of the distal radius. There were 30 patients with metaphyseal fractures, 19 were casted, and 11 were wire transfixed. There were 27 patients with physeal fractures, 19 were treated with a cast alone, and the remaining eight underwent pinning with Kirschner wires. All were evaluated clinically, and radiologically, and their overall outcome assessed according to the scoring system, at or after skeletal maturity, at the mean follow up of 6.5 years (3.0 to 9.0 years). Results: In the metaphysis group, patients treated with wire fixation had a restriction in wrist palmar flexion (p=0.04) compared with patients treated with a cast. There was no radiological difference between cast and wire fixation in the metaphysis group. In the physis group, restriction of motion was found in both dorsiflexion (p=0.04) and palmar flexion (p=0.01) in patients treated with wire fixation. There was a statistically significant difference in radial inclination (p=0.01) and dorsal tilt (p=0.03) between cast and wire fixation in physis group with a more increased radial inclination in wire fixation and a more dorsal tilt in patients treated with a cast. All patients were pain-free except one (5.3%) in the physis group who had only mild pain. Overall outcomes at skeletal maturity were excellent and good in all patients. Grip strength showed no statistical difference in all groups. Complications of wire fixation included radial physeal arrests, pin site infection and numbness. Conclusion: Cast and wire fixation showed excellent and good outcomes at skeletal maturity in children with previous distal radius fracture involving both metaphysis and physis. We would recommend that children who are still having at least two years of growth remaining be treated with a cast alone following a reduction unless there is a persistent unacceptable reduction warranting a wire fixation. The site of the fracture and the type of treatment have no influence on the grip strength at skeletal maturity.
5.Treatment of Malrotation and Limb Length Discrepancy in Osteogenesis Imperfecta Patients: Report of Two Cases
Ibrahim MA ; Nik-Mohamed NAF ; Munajat I ; Sulaiman AR ; Mohd EF
Malaysian Orthopaedic Journal 2022;16(No.1):112-114
Malunion of recurrent fractures in Osteogenesis Imperfecta
(OI) patients causes limb length discrepancy and
malrotation. These cause added difficulty for OI patients to
ambulate. Lengthening with distraction osteogenesis using
an external fixator in OI patients is challenging. Acute
lengthening with autologous bone graft is a known method in
a normal bone but not a known procedure in OI patients. We
present two clinic cases of adolescent OI patients with limb
length discrepancy and externally rotated lower limb that
underwent acute lengthening and rotational correction using
a locked intramedullary nail and ipsilateral autologous iliac
bone graft. Both patients obtained union and improvement of
ambulatory capability without recurrence of fracture within
five years of follow-up. Acute lengthening by 2cm and
rotational correction with intramedullary nail improved the
gait efficiency in the OI patients. Harvesting large amounts
of the tricortical iliac bone graft, followed by controlled
weight-bearing is a safe procedure.
6.The Effects of Different Degrees of Leg Length Discrepancy on Vertical Ground Reaction Force in Children and Adults: Treatment Implications
Mohamed-Saaid F ; Sulaiman AR ; Munajat I ; Mohd EF ; Arifin WN ; Ghafar R
Malaysian Orthopaedic Journal 2023;17(No.3):66-72
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.
7.Treatment Of Nonunion In Osteogenesis Imperfecta Patient
Mohamad Nor NA ; Abdul Halim S ; Sulaiman AR ; Munajat I ; Mohd EF
Malaysian Orthopaedic Journal 2018;12(Supplement A):134-
8.Reconstruction of Secondary Type Congenital Hallux Varus with Modification of the Farmer Technique for Cover of Skin Defect: Report of Three Cases
Sulaiman AR ; Munajat I ; M-Yusuf H ; Nik-Jaffar NMS ; Zarullail NH ; Mohd EF ; Johari NA
Malaysian Orthopaedic Journal 2019;13(3):72-76
The reconstruction of hallux varus deformity involves the release of contracted medial structure and realignment of the phalange, leaving a significant skin defect which requires cover. Farmer described proximal based rotational skin flap from the first web space to cover the defect. This technique may compromise the circulation to the flap and risk to the lateral digital vessels. We modified his technique to address these issues. We report a successful reconstruction using the Farmer’s technique on one patient and a modified technique on three patients. We used the excess skin from the extra digit to cover the medial defect. We found this modified technique of skin cover safe without risk of injuring the neurovascular bundle. There was no recurrence of deformity at last foolow-up. All patients were able to wear normal shoes.