1.Giant Solitary Forearm Exostosis in A Child
Malaysian Orthopaedic Journal 2009;3(1):81-84
Forearm deformity secondary to giant solitary ulna exostosis is rare. We describe a rare presentation of symptomatic solitary giant exostosis involving the entire distal ulna resulting in ulnar bowing of the forearm in a five year old boy. The tumour was completely resected and the defect was reconstructed with an allograft wrapped with a free autogenous periosteal tubular sleeve to deliver fresh
pluripotential cells for better incorporation and integration. The distal ulna physes was preserved. An osteotomy was performed on the radius to correct the deformity. One year after surgery, the deformity remains corrected with normal bone length and excellent hand function. There is no evidence of local recurrence and the allograft has fully incorporated.
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2.Management of Extensive Surgical Wounds of the Extremity after Tumour Resections Using Two Simultaneous Composite Flaps: Two Case Reports
Faizal A1 ; Ahmad SH2 ; Zulmi W
Journal of Surgical Academia 2011;1(1):42-45
Tumour surgery for locally extensive malignant neoplasms of the extremity will sometimes result in extensive composite soft tissue defect. Local flaps are usually inadequate to cover these large defects. More than one tissue flap might be required to cover any exposed neurovascular structures, bone or prosthesis. We present two cases where two composite flaps were simultaneously used to cover extensive surgical defects after ablative tumour resections in the extremity. These resulted in uncomplicated wound healing and limb salvage.
3.Langerhans Cell Histiocytosis with Extensive Spinal and Thyroid Gland Involvement Presenting with Quadriparesis: An Unusual Case in an Adult Patient
Mohd Ariff S ; Joehaimey J ; Ahmad Sabri O ; Zulmi W
Malaysian Orthopaedic Journal 2011;5(3):28-31
Langerhans cell histiocytosis of the spine frequently presents as a solitary lesion and rarely results in neurological deficit.
Involvement of thyroid tissue is also rare, even in multifocal disease presentations. We present an unusual variant of Langerhans cell histiocytosis in a 37-year-old man presenting with profound quadriparesis and incidental
thyroid involvement. MR imaging and skeletal radiographs
revealed widespread involvement of the spine. The patient
underwent surgical resection of the tumour and stabilization of the spine. Diagnosis was confirmed by histological and immunohistochemistry analysis. Langerhans cell histiocytosis should be included in the differential diagnosis of radiolucent lesions of the spine in adults.
4.Outcome of Skeletal Reconstructive Surgery for Metastatic Bone Tumours in the Femur
Mohamed-Haflah NH ; Kassim Y ; Zuchri I ; Zulmi W
Malaysian Orthopaedic Journal 2017;11(1):28-34
Introduction: The role of surgery in skeletal metastasis is to
reduce morbidity and improve the quality of life in
terminally ill patients. We report our experience with patients
who underwent skeletal reconstructive surgery for metastatic
bone tumour of the femur.
Materials and Methods: Twenty nine operations for
skeletal metastasis of the femur performed in our centre
between 2009 and 2015 were included in this study. We
evaluated the choice of implant, complications, survival rate
and functional outcome. Fourteen patients were still alive at
the time of this report for assessment of functional outcome
using Musculoskeletal Tumour Society (MSTS) form.
Results: Plating osteosynthesis with augmented-bone
cement was the most common surgical procedure (17
patients) performed followed by arthroplasty (10 patients)
and intramedullary nailing (2 patients) There were a total of
five complications which were implant failures (2 patients),
surgical site infection (2 patients), and site infection
mortality (1 patient). The median survival rate was eight
months. For the functional outcome, the mean MSTS score
was 66%.
Conclusion: Patients with skeletal metastasis may have
prolonged survival and should undergo skeletal
reconstruction to reduce morbidity and improve quality of
life. The surgical construct should be stable and outlast the
patient to avoid further surgery.
Femur
5.Resection of Thumb Metacarpal Ewing Sarcoma and Primary Reconstruction with Non-Vascularized Osteoarticular Metatarsal Autograft
Ariff MS ; Faisham WI ; Krishnan J ; Zulmi W
The International Medical Journal Malaysia 2015;14(1):103-107
Ewing sarcoma is a primary bone malignancy that rarely occurs in the hand. Resection and reconstruction will
usually result in reduced or loss of thumb function. We describe a case of successful transplantation of nonvascularized
osteoarticular second metatarsal autograft following wide resection of Ewing sarcoma of first
metacarpal in an 11-year-old girl. The capsule of the graft’s metatarso-phalangeal joint was repaired to achieve
mobility of the joint. This enabled preservation of thumb function by a relatively simple surgical technique.
Detailed surgical procedures and excellence function after 2 years following surgery are described.
6.Non-Operative Treatment Versus Steroid Injections in the Management of Unicameral Bone Cysts
WI Faisham ; AH Nawaz ; AM Ezane ; W Zulmi ; S Ibrahim ; AR Abdul Halim
Malaysian Orthopaedic Journal 2011;5(2):11-14
The cases of nine patients with unicameral bone cysts were
reviewed from two orthopaedic centres. In one hospital, five patients received serial steroid injections, and at the other hospital four patients were treated conservatively following fractures. In the steroid injection group, three cases were in
the proximal femur and two in the proximal humerus. The
five steroid injection patients showed radiological evidence of cyst healing within six months of treatment. Subsequently four of the patients showed a satisfactory radiological outcome after a year and complete resolution after 2 years. In the conservative group, all four cases were in the proximal humerus. Persistent cystic lesions were observed in all four patients and two was complicated by another fracture within six months.
7.Early Functional Outcome of Resection and Endoprosthesis Replacement for Primary Tumor around the Knee
AR Sharil ; AH Nawaz ; MZ Nor Azman ; W Zulmi ; WI Faisham
Malaysian Orthopaedic Journal 2013;7(1):30-35
We evaluated functional outcomes for patients who
underwent surgery for resection and endoprosthesis
replacement for primary tumours around the knee. We used
the Musculoskeletal Tumour Society Scoring System
(MSTS) for functional evaluations to compare differences
between distal femur (DF) and proximal tibia (PT)
placements. The study sample included 34 cases of distal
femur and 20 cases of proximal tibia endoprosthesis
replacement. Primary tumours were classified as follows: 33
osteosarcoma, 20 stage III giant cell tumour (GCT) and one
case of mesenchymal chondrosarcoma. The mean MSTS
score for both DF and PT endoprosthesis together was 21.13
(70.43%), and The MSTS scores for DF was 21.94 (73.13%)
and PT was 19.75 (65.83%) Infection developed in 7 cases
and 5 of which were PT endoprosthesis cases. Three deep
infections required early, two-stage revision and resulted in poor MSTS scores. We conclude that endoprosthesis
replacement for primary bone tumours had early good to
excellent functional outcome. There were no differences in
functional outcomes when comparing distal femur
endoprostheses with proximal tibia endoprostheses.
8.Comparative Study Between Coaptive Film Versus Suture For Wound Closure After Long Bone Fracture Fixation
IM Anuar Ramdhan ; W Zulmi ; AN Hidayah ; MJM Kamel ; MSM Fadhil ; ; M Anwar Hau
Malaysian Orthopaedic Journal 2013;7(1):52-55
Background: Coaptive film (i.e., Steri-StripsTM) is an
adhesive tape used to replace sutures in wound closure. The
use of coaptive film for wound closure after long bone
fracture fixation has not been well documented in the
literature. Methods: The aim of this prospective, randomized controlled trial comparing coaptive film with sutures for wound closure after long bone fracture fixation was skin closure time, incidence of wound complications and scar width at 12 week follow-up. Forty-five patients underwent femur fracture fixation (22 patients’ wound closed with sutures, 23 with coaptive film). Results: The mean time for skin closure using coaptive film was 171.13 seconds compared to 437.27 seconds using suture. The mean wound
lengths in the coaptive film group and suture group were
187.65 mm and 196.73 mm, respectively. One patient in each
group had wound complications. Conclusion: Coaptive film
is a time-saving procedure for skin closure following long
bone fracture fixation. There is no difference in the incidence of wound complications and scar width between these two methods of skin closure.
9.Outcome of Surgical Treatment of Pelvic Osteosarcoma: Hospital Universiti Sains Malaysia Experience
MS Ariff ; W Zulmi ; WI Faisham ; MZ Nor Azman ; AH Nawaz
Malaysian Orthopaedic Journal 2013;7(1):56-62
We reviewed the surgical treatment and outcomes of 13
patients with pelvic osteosarcoma treated in our centre in the past decade. The study sample included 9 males and 4
females with a mean age of 28.1 years. Four patients had
ileal lesions, five had acetabulum lesions, one had a
ischiopubis lesion, and three had involvement of the whole
hemipelvis. Seven patients presented with distant metastases at diagnosis. Limb salvage was performed in 6 patients and amputation in 7. In 60% of cases in the limb salvage surgery group, we attempted wide resection with positive microscopic margin compared to only 16.7% in the
amputation group. Local recurrence was higher in the limb
salvage group. Overall survival was 18 months for mean
follow up of 14.8 months. Median survival was 19 months in
the limb salvage group compared to 9 months in amputation
group. The outcome of surgical treatment of pelvic
osteosarcoma remains poor despite advancements in
musculoskeletal oncology treatment.
10.The Outcomes of Salvage Surgery for Vascular Injury in The Extremities: A Special Consideration For Delayed Revascularization
Jagdish Krishnan ; M Paiman ; AS Nawfar ; MI Yusof ; W Zulmi ; WS Azman ; AS Halim ; AZ Mat Saad ; MD Shafei ; WI Faisham
Malaysian Orthopaedic Journal 2014;8(1):14-20
A seven years retrospective study was performed in 45
consecutive vascular injuries in the extremities to investigate
the pattern of injuries, managements and outcomes.
Motor-vehicle accidents were the leading cause of injuries
(80%), followed by industrial injuries (11.1%) and iatrogenic
injuries (4.4%). Popliteal and brachial artery injuries were
commonly involved (20%). Fifteen (33.3%) patients had
fractures, dislocation or fracture dislocation around the knee
joint and 6 (13.3%) patients had soft tissue injuries without
fracture. Traumatic arterial transection accounted for 34
(75.6%) cases, followed by laceration in 7 (15.6%) and 9
(6.7%) contusions. Associated nerve injuries were seen in 8
(17.8 %) patients using intra-operative findings as the gold
standard, both conventional angiogram (CA) and
computerized tomography angiogram (CTA) had 100%
specificity and 100% sensitivity in determining the site of
arterial injuries.
The mean ischemic time was 25.31 hours (4 - 278 hours).
Thirty-three (73.3 %) patients were treated more than 6
hours after injury and 6 patients underwent revascularization
after 24 hours; all had good collateral circulation without
distal pulses or evidence of ischemic neurological deficit.
The mean ischemic time in 39 patients who underwent
revascularization within 24 hours was 13.2 hours. Delayed
amputation was performed in 5 patients (11.1%). Of the 6
patients who underwent delayed revascularization, one
patient had early amputation, one -had delayed amputation
following infection and multiple flap procedures while the
rest of the patients’ limbs survived. Joint stiffness was noted
in 10 patients (22.2%) involving the knee joint, elbow and
shoulder in two patients each. Infection was also noted in 5
patients (11.1%) with two of them were due to infected
implants. Other complications encountered included nonunion
(2 patients, 4.4%), delayed union (1 patient, 2.2%),limb length discrepancy (1 patient, 2.2%), hematoma (1
patient, 2.2%) and leaking anastomosis in one patient
(2.2%). Volkmann’s ischemic contracture occurred in 3
(6.7%) patients. There was no complication noted in 8
(17.8%) patients Three patients (6.7%) died of whom two
were not due to vascular causes. We conclude that early
detection and revascularization of traumatic vascular injuries
is important but delayed revascularization also produced
acceptable results
Extremities