1.The Role of Nerve Exploration in Supracondylar Humerus Fracture in Children with Nerve Injury
Anuar RIM ; Gooi SG ; Zulkiflee O
Malaysian Orthopaedic Journal 2015;9(3):71-74
The supracondylar humerus fracture (SCHF) in children is
common and can be complicated with nerve injury either
primarily immediate post-trauma or secondarily posttreatment.
The concept of neurapraxic nerve injury makes
most surgeons choose to ‘watch and see’ the nerve recovery
before deciding second surgery if the nerve does not recover.
We report three cases of nerve injury in SCHF, all of which
underwent nerve exploration for different reasons. Early
reduction in the Casualty is important to release the nerve
tension before transferring the patient to the operation room.
If close reduction fails, we proceed to explore the nerve
together with open reduction of the fracture. In iatrogenic
nerve injury, we recommend nerve exploration to determine
the surgical procedure that is causing the injury. Primary
nerve exploration will allow early assessment of the injured
nerve and minimize subsequent surgery.
Radial Nerve
;
Ulnar Nerve
2.The Economic Impact of Managing Late Presentation of Developmental Dysplasia of Hip (DDH)
Anuar RIM ; Mohd-Hisyamudin HP ; Ahmad MH ; Zulkiflee O
Malaysian Orthopaedic Journal 2015;9(3):40-43
Delayed presentation of Developmental Dysplasia of Hip
(DDH) comes with challenges in treatment as well as high
surgical cost. Therefore the objective of this study is to
quantify the economic impact of management of late
presentation of DDH during a last 3-year period. We
conducted a retrospective study with analysis of DDH cases
managed between years 2012 to 2014. Early and late
presentations of DDH were identified and cost management
for both was estimated. Out of twenty-four DDH cases,
thirteen cases fulfilled the inclusion criteria. All were female
with majority of them presenting with unilateral DDH
predominantly of the left hip. Most patients presented after
age of six months and the principal complaint was abnormal
or limping gait. The grand total cost for managing DDH
during the three years period was USD 12,385.51, with 86%
of the amount having been used to manage late presentation
of DDH that was mostly contributed by the cost of surgery.
We concluded that delayed presentation of DDH contributes
heavily to high national expenditure. Early detection of
DDH cases with systematic neonatal screening may help to
minimize the incidence of the late presenting DDH and
subsequently reduce the economic burden to the
government.
Bone Diseases, Developmental