1.Early Vessels Exploration of Pink Pulseless Hand in Gartland III Supracondylar Fracture Humerus in Children: Facts and Controversies
Tunku-Naziha TZ ; Wan-Yuhana WMS ; Hadizie D ; Muhammad-Paiman ; Abdul-Nawfar S, M ; Wan-Azman WS ; Arman-Z MS ; Abdul-Razak S ; Rhendra-Hardy MZ ; Wan-Faisham WI
Malaysian Orthopaedic Journal 2017;11(1):12-17
The management of pink pulseless limbs in supracondylar
fractures has remained controversial, especially with regards
to the indication for exploration in a clinically well-perfused
hand. We reviewed a series of seven patients who underwent
surgical exploration of the brachial artery following
supracondylar fracture. All patients had a non-palpable radial
artery, which was confirmed by Doppler ultrasound. CT
angiography revealed complete blockage of the artery with
good collateral and distal run-off. Two patients were more
complicated with peripheral nerve injuries, one median
nerve and one ulnar nerve. Only one patient had persistent
arterial constriction which required reverse saphenous graft.
The brachial arteries were found to be compressed by
fracture fragments, but were in continuity. The vessels were
patent after the release of obstruction and the stabilization of
the fracture. There was no transection of major nerves. The
radial pulse was persistently present after 12 weeks, and the
nerve activity returned to full function.
Humerus
;
Fractures, Bone
2.Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion
Choo CY ; Mat-Saad AM ; Wan-Azman WS ; Wan Z ; Nor-Azman MZ ; Yahaya S ; Faisham WI
Malaysian Orthopaedic Journal 2018;12(3):19-23
Introduction: Restoration of a functional hand is the ultimate goal following a distal radius tumour resection. The early outcomes of mobile wrist reconstruction are satisfactory; however, long-term results are unpredictable due to late wrist instability and degenerative arthritis. Our aim is to compare mobile wrist reconstruction with wrist fusion (pan-carpal fusion) in our cohort of patients. Materials and Methods: A retrospective cohort study was performed for functional outcomes of all patients who underwent resection for distal radius tumour and treated with either fusion or reconstruction of the wrist in a single institution from years 2000-2013 with a minimum of three years follow-up. Results: Eleven patients were included in the study, six of whom had wrist reconstruction with proximal fibula graft and the remaining five wrist fusion, with a mean follow-up of 6.3 years. The mean Musculoskeletal Tumour Society (MSTS) score was 82.78%, ranging from 70% to 93.3%. Average grip strength compared to the normal contralateral hand was 60.0% for total wrist fusion, which was better than wrist reconstruction with 58.07%. There was no difference in the functional outcome between fusion and mobile reconstruction in our study. Osteoarthritis changes and subluxation of the wrist joint were the most common findings in the long-term follow-up for this group. Conclusion: There was no difference in the functional outcome of the long-term follow-up between the two groups.