Female ; Hearing Loss, Noise-Induced ; diagnosis ; Humans ; Leisure Activities ; Male ; Music ; Noise ; adverse effects

INTRODUCTIONWe conducted a biomechanical study comparing cerclage wiring using a power tool with the traditional manual method.

MATERIALS AND METHODSOur study consisted of 4 experimental arms based on the method of fixation and diameter of wires. The 4 arms were: 1) power tool method using 0.8 mm cerclage wires, 2) power tool method using 1.0 mm cerclage wires, 3) conventional manual method using 0.8 mm cerclage wires, and 4) conventional manual method using 1.0 mm cerclage wires. Synthetic femur bones were employed in our study. Six specimens were prepared for each arm. Each specimen was cut lengthwise and pressure sensors were placed in between. For the power tool method, while maintaining tension, wires were coiled using the Colibri power tool until just before secondary coiling occurred. For the conventional manual method, each specimen was compressed by plier twisting for 10 rounds, while maintaining tension. Cerclaging and data recording was done thrice for each specimen, giving a total of 18 readings per arm. Peak and steady-state forces were recorded.

RESULTSThere was no significant difference between the peak forces recorded between the power drill and manual methods. The steady-state forces achieved using the power tool method were significantly higher than that achieved in the manual fixation method (0.8 mm wires: 54.89N vs 27.26N, P = 0.037; 1.0 mm wires: 71.59N vs 39.66N, P = 0.025).

CONCLUSIONThe power tool method achieved a superior steady-state force of compression across the fracture site for both 0.8 mm and 1 mm wires.

Biomechanical Phenomena ; Bone Wires ; Femur ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Models, Anatomic

INTRODUCTIONThe fabella, a sesamoid bone sometimes found in the lateral head of the gastrocnemius muscle, often articulates directly with the lateral femoral condyle. This study aimed to determine the incidence of fabellae in an Asian population and to characterise the radiological features of the fabella.

METHODSElectronic radiographs and magnetic resonance imaging films of 80 consecutive patients who underwent knee arthroscopy between May 2005 and October 2009 were reviewed to determine the presence and characteristics of the fabella.

RESULTSThe incidence of fabellae was 31.25% in our study cohort. The median length, thickness, width and distance of the fabella from the lateral femoral condyle were 7.06 mm, 4.89 mm, 6.12 mm and 33.19 mm, respectively. The fabella was consistently bony and located in the lateral head of the gastrocnemius, with 52% of the fabellae having an articulating facet. Fabellae in men were found to be larger than in women, although the difference was not statistically significant. The presence of an articulating groove was associated with increased size of the fabella, but not with the distance between the fabella and its insertion onto the lateral head of the gastrocnemius.

CONCLUSIONThe incidence of fabellae in our population was lower than that in regional studies. They were consistently bony and not all had articulating grooves on the lateral femoral condyle. We found that the larger the fabella, the higher the chances of it having an articulating groove. By defining the radiological characteristics of the fabella, we provide objective parameters to help differentiate the fabella from other loose bodies or calcifications in the knee.

Adolescent ; Adult ; Arthroscopy ; Asia ; Cohort Studies ; Female ; Humans ; Incidence ; Knee Joint ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle, Skeletal ; diagnostic imaging ; pathology ; Radiography ; Sesamoid Bones ; diagnostic imaging ; pathology ; Sex Factors ; Young Adult

INTRODUCTIONWe evaluated if there was significant stress in caregivers of elderly patients with osteoporotic hip fractures and determine any contributory factors.

MATERIALS AND METHODSA prospective cohort study was performed from June 2005 to June 2006 in a single tertiary hospital. Patients admitted during this period and their primary caregivers were interviewed on admission and at 6 months. Information on patient's demographics, comorbidities, functional and mental status, placement post-discharge and financial strain were noted. Caregiver stress was measured using the caregiver strain index (CSI). Relationships between key variables were analysed to derive possible correlations.

RESULTSThe study comprised caregivers of 76 patients with a mean age of 77 years (range, 50 to 95; SD, 11). Within 1 week of admission, 45 of the 76 caregivers (59.2%) were significantly stressed based on the CSI while at 6 months, 30 of the caregivers (50%) were significantly stressed. The mean CSI within 1 week of admission and at 6 months post-admission was 7.18 and 6.25 respectively (P = 0.042). The most significant contributory factor to stress was financial strain (P = 0.01) attributable to medical bills, rehabilitation costs and transport expenses.

CONCLUSIONThere is a significant amount of stress that is experienced by caregivers of elderly patients with hip fractures which commences from admission of the patient and it remains high at 6-months post-fracture. Financial strain has been found to be the only significant cause on both univariate and multivariate analysis. Adequate resources should be available to caregivers of patients with osteoporotic hip fractures.

Aged ; Aged, 80 and over ; Caregivers ; economics ; psychology ; Cost of Illness ; Female ; Hip Fractures ; etiology ; rehabilitation ; Humans ; Male ; Middle Aged ; Osteoporosis ; complications ; Prospective Studies ; Stress, Psychological

INTRODUCTION: Multisystem inflammatory syndrome in children (MIS-C) is a rare inflammatory syndrome with multisystem involvement affecting children exposed to COVID-19. This condition is rarely reported in East Asia and was not detected in Singapore until 2021. We present 12 cases of MIS-C diagnosed in KK Women's and Children's Hospital (KKH) from October 2021 to December 2021. METHOD: We conducted an observational study on cases fulfilling the Singapore Ministry of Health criteria for MIS-C from January 2020 to December 2021 in KKH. Medical records were reviewed to obtain information on clinical presentation, disease course, treatment received and outcomes. RESULTS: In the 12 cases detected, the median age was 7.50 years (interquartile range 4.00-9.25); 8 were male. All patients had mucocutaneous symptoms similar to Kawasaki disease. Other commonly involved systems were: haematological (coagulopathy 100%, lymphopaenia 91.70% and thrombocytopaenia 75.00%), gastrointestinal (75.00%) and cardiovascular (83.30%). Six patients (50.00%) had shock and were admitted to the intensive care unit. The majority of patients received treatment within 2 days of hospitalisation with intravenous immunoglobulin (IVIg) and steroids. All survived; the majority had normal echocardiograms and no long-term organ sequelae at 6 months post-discharge. CONCLUSION MIS-C emerged in Singapore as the incidence of COVID-19 in the community increased in 2021. The clinical presentation of our patients is similar to earlier reports, with some significant differences from Kawasaki disease. Multidisciplinary management, timely diagnosis, and early initiation of treatment with IVIg and steroids likely contributed to comparatively good outcomes. Our cases highlight the need for continued awareness of MIS-C among physicians, and surveillance of its incidence, short- and long-term outcomes.
Child ; Humans ; Female ; Male ; COVID-19/epidemiology* ; Mucocutaneous Lymph Node Syndrome ; Immunoglobulins, Intravenous/therapeutic use* ; Aftercare ; Singapore/epidemiology* ; Patient Discharge