594Med J Malaysia Vol 75 No 5 September 2020SUMMARYMorel-Lavallee lesions (MLL) are post-traumatic, closedinternal degloving injuries that can result in severecomplications if not diagnosed early. It is conventionallyseen in cases of the high energy injuries of the pelvis andlower limb. The accumulation of extravasated blood,secondary to fracture and soft tissue damage may causeinternal degloving injury, skin necrosis, soft tissue damageand acute osteomyelitis. We report here the clinical andradiological features in a 32-year-old male referred from theemergency department of a tertiary hospital who hadsustained high energy motor vehicle accident. Onexamination, there was a fluctuant, mobile, non-tendersubcutaneous mass over the distal arm with suspicion ofinternal degloving injury. Plain radiographs showed nofractures. Ultrasound showed a fluid collection with thepresence of septations and echogenic debris within thecollection. Extravasation was noted between subcutaneoustissue layer and fascia at the posterolateral aspect of thearm. Wound debridement under general anaesthesia wascarried out. Intraoperative findings reported a significantamount of thick serous fluid with necrotic debris. Unhealthyskin and fat layers were debrided. Underlying muscles werefound to be healthy. The results of the intraoperative fluidculture and sensitivity showed no growth. Negative pressurevacuum dressing was carried out. After five cycles ofvacuum dressing, the wound showed signs of healing withan improved range of motion of the elbow. Orthopaedicsurgeons need to be vigilant of the possibility of MLL in theupper limb as a differential diagnosis in the management ofhigh energy trauma.

Intramedullary nailing is the preferred method of closed shaft fracture fixation of long bones. One of the most dreaded complications to occur following internal fixation of a lower limb fracture is pseudo- or false aneurysm which can lead to the loss of the limb due to acute ischemia. This diagnosis is made by contrast angiogram of the limb. Pointers to the diagnosis include absent distal limb pulsation as well as other signs of acute ischemia post trauma or surgery. We present a case of development of pseudo-aneurysm in an elderly patient following open reduction and internal fixation of a femoral fracture. This case report outlines a prompt multidisciplinary approach of management in a rare case of pseudoaneurysm post fixation of long bone.

A 68-year-old female presented with a 1-month history of lower back pain with right-sided radiculopathy and numbness. She was diagnosed with lumbar spondylosis and treated conservatively with analgesia and physiotherapy. Imaging showed multiple susuk, a metal alloy, in the lower back region and other regions of the body. The patient had undergone traditional medicine consultation 10 years earlier when the susuk was inserted in the lower back as talisman. The practice of the insertion of susuk is popular in rural East Malaysia and Indonesia. These foreign bodies act as possible causes of chronic inflammation and granuloma formation. In addition, the localised heighten peril upon imaging. This report suggests that the insertion of multiple susuk as talisman carries risk to safety of patients when imaging, and this practice complicates the management of musculoskeletal disorders

Knee osteoarthritis is the commonest cause of knee pain in the elderly. It is characterized by unresolved pain, limitation of motion and reduced quality of life. Total knee arthroplasty (TKA) is a safe and effective method in treating chronic knee osteoarthritis. We report a rare case of a seventy-seven-year-old Chinese female with multiple comorbidities and bilateral degenerative osteoarthritis who had sought services of traditional and complementary medicine (TCM) for pain relief. The patient experienced unresolved pain and superficial skin scars following the unregulated procedure. This paper aims to outline the importance of awareness among surgeons regarding the unregulated practice of TCM that may exacerbate chronic osteoarthritis, joint synovitis, influence the surgical approach for future procedures with the presence of scars and prosthetic joint infection risk.