1.Double Level Extension Distraction Thoracic Spine Injuries with Concomitant Double Level Sternal Fractures: A Case Report
Malaysian Orthopaedic Journal 2011;5(1):52-55
Extension distraction injury of the spine is rare. A majority of these cases occur in the cervical region and at an isolated level. Rare instances of this injury have been described in an ankylosed or fused spine. This case report describes a rare two level extension distraction thoracic spine injury in an otherwise healthy adult resulting from a motor vehicle accident.
Orthopaedic
2.Safety Issues and Neurological Improvement following C1 C2 Fusion using C1 Lateral Mass and C2 Pedicle Screw in Atlantoaxial Instability.
Malaysian Orthopaedic Journal 2010;4(2):17-22
The evolution of instrumentation methods for C1 C2 fusion from the use of posterior wiring methods to transarticular screws and C1 lateral mass with C2 pedicle screw construct have improved fusion rates to almost 100%. However, the C1 lateral mass and C2 pedicle screw technique is technically demanding. This is a prospective review of a series of ten patients who was planned for C1 C2 fusion using C1 lateral mass and C2 pedicle screw technique between January 2007 and June 2009. The procedure was converted
Orthopaedic
3.Comparison of Srs 24 And Srs 22 Scores in Thirty Eight Adolescent Idiopathic Scoliosis Patients Who Had Undergone Surgical Correction
Malaysian Orthopaedic Journal 2009;3(1):56-59
Adolescent idiopathic scoliosis is a spinal deformity that affects patients self image and confidence. Surgery is offered when the curvature is greater than 50 degrees based on the likelihood of curvature progression. Outcome measures for scoliosis correction can be described in terms of radiological improvement or improvement of health related quality of life scores. The Scoliosis Research Society 22 (SRS 22) and Scoliosis Research Society 24 (SRS 24) questionnaires are widely accepted and used to characterize clinical results. Therefore, this prospective study of 38 patients aims to investigate how the SRS 24 and SRS 22 questionnaires compare to each other in terms of scoring when the same group of patients is evaluated. The SRS 22 questionnaire tends to give an inflated value in the overall score, pain and self image domain compared to the SRS 24 questionnaire.
orthopaedic
4.Chance Fracture Secondary to a Healed Kyphotic Compression Osteoporotic Fracture
Malaysian Orthopaedic Journal 2009;3(2):44-46
Chance fracture is an unstable vertebral fracture, which usually results from a high velocity injury. An elderly lady with a previously healed osteoporotic fracture of the T12 and L1 vertebra which resulted in a severe kyphotic deformity subsequently sustained a Chance fracture of the adjacent L2 vertebrae after a minor fall. The previously fracture left her with a deformity which resulted in significant sagittal imbalance therefore predisposing her to this fracture. This case highlights the importance of aggressive treatment of osteoporotic fractures in order to prevent significant sagittal imbalance from resultant (i.e. kyphotic) deformity.
Orthopaedic
5.Distal Radius Morphometry in the Malaysian Population
Chan CYW ; Vivek AS ; Leong WH ; Rukmanikanthan S
Malaysian Orthopaedic Journal 2008;2(2):27-30
The goal of treatment in distal radius fracture is to restore the anatomy of the distal radius, however the criteria currently used to evaluate the quality of reduction are based on Western based published figures. This goal of this study was to investigate whether there are variations in the morphology
of the distal radius among the multiracial population of
Malaysia. Consecutive normal wrist radiographs of patients
who presented to the accident and emergency unit in three
major hospitals in Malaysia were measured. . The palmar tilt of the distal radius averaged 12.6o ± 3.55o, and the radial inclination averaged 25.1o ± 3.42o. The ulnar variance averaged – 0.1 ± 1.31mm, 38.4% of the patients had neutral ulnar variance, 28.8% have negative ulnar variance and 32.9% have positive ulnar variance. Our results indicate that distal radius morphometric parameters in the Malaysian population are comparable to Western figures.
6.Improved Accuracy and Safety of Intracorporeal Transpedicular Bone Grafting - using Contrast Impregnated Bone: A Case Report
Malaysian Orthopaedic Journal 2014;8(3):27-29
A method of transpedicular bone grafting using contrast
impregnated bone to improve the visualization of bone graft
on the image intensifier is reported. A - 36-year old man who
had sustained traumatic burst fracture of T12 vertebra, with
Load-Sharing Classification (LSC) score of 8, was treated
with posterior short segment fusion from T11 to L1 with
transpedicular bone graft of T12 vertebra. We were able to
correct the kyphotic end plate angle (EPA) from 19º to 1.4º.
Anterior bone graft augmentation was achieved with contrast
enhaced transpedicular bone grafts. At six months follow up,
CT scan showed good bony integration of the anterior
column with EPA of 4.5º and two years later, radiographs
showed EPA of 7.6 º.
Bone Transplantation
7.Halo-Pelvic Traction – An Optional Treatment For Severe Scoliosis
Chooi YJ ; Saw A ; Kanthan SR ; Chan CYW ; Kwan MK
Malaysian Orthopaedic Journal 2018;12(Supplement A):160-
8.The Clinical Effectiveness of School Screening Programme for Idiopathic Scoliosis in Malaysia
Deepak AS ; Ong JY ; Choon DSK ; Lee CK ; Chiu CK ; Chan CYW ; Kwan MK
Malaysian Orthopaedic Journal 2017;11(1):41-46
Introduction: There is no large population size study on
school screening for scoliosis in Malaysia. This study is
aimed to determine the prevalence rate and positive
predictive value (PPV) of screening programme for
adolescent idiopathic scoliosis.
Materials and Methods: A total of 8966 voluntary school
students aged 13-15 years old were recruited for scoliosis
screening. Screening was done by measuring the angle of
trunk rotation (ATR) on forward bending test (FBT) using a
scoliometer. ATR of 5 degrees or more was considered
positive. Positively screened students had standard
radiographs done for measurement of the Cobb angle. Cobb
angle of >10° was used to diagnose scoliosis. The percentage
of radiological assessment referral, prevalence rate and PPV
of scoliosis were then calculated.
Results: Percentage of radiological assessment referral
(ATR >5°) was 4.2% (182/4381) for male and 5.0%
(228/4585) for female. Only 38.0% of those with ATR >5°
presented for further radiological assessment. The adjusted
prevalence rate was 2.55% for Cobb angle >10°, 0.59% for
>20° and 0.12% for >40°. The PPV is 55.8% for Cobb angle
>10°, 12.8% for >20° and 2.6% for > 40°.
Conclusions: This is the largest study of school scoliosis
screening in Malaysia. The prevalence rate of scoliosis was
2.55%. The positive predictive value was 55.8%, which is
adequate to suggest that the school scoliosis screening
programme did play a role in early detection of scoliosis.
However, a cost effectiveness analysis will be needed to
firmly determine its efficacy.
9.Delayed Post-operative Spinal Epidural Haematoma after Posterior Spinal Surgery: Report of Two Cases
Chung WH ; Tan RL ; Chiu CK ; Kwan MK ; Chan CYW
Malaysian Orthopaedic Journal 2020;14(No.3):170-173
Delayed post-operative spinal epidural haematoma (DPSEH)
is diagnosed when the onset of symptoms is more than three
days from the index surgery. DPSEH is a rare but serious
complication of spinal surgery. Missed diagnosis will result
in irreversible neurological deficit which may lead to
permanent disabilities. We report two cases of DPSEH who
presented with worsening neurological deficit four days after
the index surgery. Magnetic resonance imaging (MRI)
showed the presence of an epidural haematoma compressing
the spinal cord. Surgical evacuation of haematoma were
performed for both patients. Both patients experienced
neurological improvement. Surgeons should have high
index of suspicion to identify delayed onset of spinal
epidural haematoma (SEH) and timely intervention should
be taken to avoid irreversible neurological damage.
10.Minimally Invasive versus Conventional Open Surgery for Fixation of Spinal Fracture in Ankylosed Spine
Chung WH ; Ng WL ; Chiu CK ; Chan CYW ; Kwan MK
Malaysian Orthopaedic Journal 2020;14(No.3):22-31
Introduction: This was a retrospective study aimed to
investigate the perioperative outcomes of long construct
minimally invasive spinal stabilisation (MISt) using
percutaneous pedicle screws (PPS) versus conventional open
spinal surgery in the treatment of spinal fracture in
ankylosing spondylitis (AS) and diffuse idiopathic skeletal
hyperostosis (DISH).
Material and Methods: Twenty-one patients with AS and
DISH who were surgically treated between 2009 and 2017
were recruited. Outcomes of interest included operative time,
intra-operative blood loss, complications, duration of
hospital stay and fracture union rate.
Results: Mean age was 69.2 ± 9.9 years. Seven patients had
AS and 14 patients had DISH. 17 patients sustained AO type
B3 fracture and 4 patients had type B1 fracture. Spinal
trauma among these patients mostly involved thoracic spine
(61.9%), followed by lumbar (28.6%) and cervical spine
(9.5%). MISt using PPS was performed in 14 patients
(66.7%) whereas open surgery in 7 patients (33.3%). Mean
number of instrumentation level was 7.9 ± 1.6. Mean
operative time in MISt and open group was 179.3 ± 42.3
minutes and 253.6 ± 98.7 minutes, respectively (p=0.028).
Mean intra-operative blood loss in MISt and open group was
185.7 ± 86.4ml and 885.7 ± 338.8ml, respectively (p<0.001).
Complications and union rate were comparable between both
groups.
Conclusion: MISt using PPS lowers the operative time and
reduces intra-operative blood loss in vertebral fractures in
ankylosed disorders. However, it does not reduce the
perioperative complication rate due to the premorbid status
of the patients. There was no significant difference in the
union rate between MISt and open surgery.