1.One stage Versus Two stage Reduction of MalunitedFemoral Fracture with Shortening
Sulaiman AR ; Eskandar H ; Faisham WI
Malaysian Orthopaedic Journal 2007;1(1):18-21
Reduction of a malunited femoral diaphyseal fracture can be achieved by osteotomy and immediate internal fixation or gradual skeletal traction followed by delayed internal fixation. We retrospectively reviewed 27 patients with malunited and shortened femur. Nine patients with mean shortening of 4.7 cm (2.5 10.0) underwent acute one stage reduction and gained 2.5 to 5.0 cm length. Eighteen patients with mean shortening of 5.3 cm (3.5 to 9.0) underwent twostage reduction and gained 2.0 to 5.0 cm length. Ther
2.The Effectiveness of Intravenous Morphine Infusion as Preemptive Analgesia in Preventing Phantom Limb Pain Following Lower Limb Amputation
Kc Chong ; Sulaiman Ar ; Yusof Mi
Malaysian Orthopaedic Journal 2010;4(3):3-6
Phantom limb pain may reduce ambulation and mobility in amputees, resulting in diminished quality of life. We conducted a prospective study to compare the perioperative analgesic use of intravenous morphine infusion in 27 patients (Group A) and intramuscular diclofenac sodium in 28 patients (Group B) in patients undergoing lower limb amputation. All patients underwent amputation under spinal anaesthesia and reported a Modified Verbal Numerical Pain Score of less than two prior to the procedure. Presence of phantom pain was assessed on the first, second, third and seventh day as well as at the third month and sixth month post-operatively. Twelve (44 %) patients from group A and 21 patients (75 %) from group B developed phantom limb pain following amputation, a statistically significant difference between groups (p<0.05). We conclude that intravenous morphine infusion is more effective than intramuscular diclofenac sodium in preventing the occurrence of phantom limb pain following amputation.
3.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.
4.Developmental Dysplasia of Hip Screening Using Ortolani and Barlow Testing on Breech Delivered Neonates
AR Sulaiman ; Zakaria Yusof ; I Munajat ; NAA Lee ; Nik Zaki
Malaysian Orthopaedic Journal 2011;5(3):13-16
Introduction: We conducted this study to compare the
specificity and sensitivity of the Ortolani and Barlow tests performed by dedicated examiners, and to ascertain the incidence of developmental dysplasia of the hip (DDH) in breech babies. Methods: A dedicated examiner underwent
specific training and testing by a paediatric orthopaedic
surgeon. Routine examiners were medical officers who had
basic training in medical school and were briefly trained by their superiors. The dedicated examiner examined 170
babies. Thirty babies including 5 babies with positive tests (according to the dedicated examiner) were examined by a blinded routine examiner. Results of Ortolani and Barlow tests on 30 babies were compared with ultrasound
examination by blinded radiologist. Results: Five babies had positive Ortolani and Barlow tests. The routine examiner did not detect positive Ortolani and Barlow tests. Conclusion: The incidence of positive Ortolani and Barlow tests among breech babies was 2.8%. Result of Ortolani and Barlow tests by dedicated hip screener were better than results performed by routine examiner.
5.Clinical Measurement of the Tibio-femoral Angle in Malay Children
Mohd-Karim MI ; Sulaiman AR ; Munajat I ; Syurahbil AH
Malaysian Orthopaedic Journal 2015;9(2):9-12
Background: This study was conducted to find out the age
when tibiofemoral angle starts to be in valgus and reaches
maximum angle. The differences of the angles between
genders were also studied.
Methodology: This cross sectional study on tibiofemoral
angle was conducted among 160 normal healthy children
using clinical measurement method. The children between 2
18 months to 6 years old were assigned to 5 specific age
groups of 32 children with equal sex distribution.
Result: This study had shown a good inter-observer
reliability of tibiofemoral angle measurement with intraclass
correlation coefficient (ICC) of 0.87 with narrow
margin of 95% confident interval (95% CI: 0.73, 0.94). The
mean tibiofemoral angle for children at 2 , 3 , 4 , 5 and 6
years old were 2.25o (SD=0.53), 8.73o (SD=0.95), 7.53o
(SD=1.40), 7.27o (SD=1.14) and 6.72o (SD=0.98)
respectively. The age when they achieved maximum valgus
tibiofemoral angle was 3 years old. The maximum mean
(SD) tibiofemoral angle for boys, girls and all children were
8.91o (SD=1.17) , 8.56o (SD=0.62) and 8.73o (SD=0.95)
respectively. The mean tibiofemoral angle showed no
statistically significant difference between girls and boys
except for the 5-year-old group, in which the mean TF angle
for girls was 7.560 (SD=0.95) and for the boys was 6.970
(SD=1.26) with p-value of 0.037.
Conclusion: Measurement of tibiofemoral angle using the
clinical method had a very good inter-observer reliability.
The tibiofemoral angle in Malay population was valgus since
the age of 2 years with maximum angle of 8.730 (SD=0.95)
achieved at the age of 3 years.
6.A Modified Technique of Fixation for Proximal Femoral Valgus Osteotomy in Abnormal Bone: A Report of Two Cases
Logheswaren S, Mbbs, Sulaiman Ar, Ms Orth, Munajat I, Ms Orth
Malaysian Orthopaedic Journal 2017;11(2):82-84
The ideal size of intramedullary device to fix corrective
osteotomy of proximal femur in abnormal bone in children
and small patients may not be easily available. We report the
successful use of Rush rod in combination with multiple
Kirschner wires to fix the corrective osteotomy of coxa vara
and shepherd crook deformity in two patients with
osteogenesis imperfecta and fibrous dysplasia. The union
was achieved on time, neck shaft angle and rotation were
maintained.
7.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.
8.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.
9.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.
10.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.