1.Clinical Measurement of the Tibio-femoral Angle in Malay Children
Mohd-Karim MI ; Sulaiman AR ; Munajat I ; Syurahbil AH
Malaysian Orthopaedic Journal 2015;9(2):9-12
Background: This study was conducted to find out the age
when tibiofemoral angle starts to be in valgus and reaches
maximum angle. The differences of the angles between
genders were also studied.
Methodology: This cross sectional study on tibiofemoral
angle was conducted among 160 normal healthy children
using clinical measurement method. The children between 2
18 months to 6 years old were assigned to 5 specific age
groups of 32 children with equal sex distribution.
Result: This study had shown a good inter-observer
reliability of tibiofemoral angle measurement with intraclass
correlation coefficient (ICC) of 0.87 with narrow
margin of 95% confident interval (95% CI: 0.73, 0.94). The
mean tibiofemoral angle for children at 2 , 3 , 4 , 5 and 6
years old were 2.25o (SD=0.53), 8.73o (SD=0.95), 7.53o
(SD=1.40), 7.27o (SD=1.14) and 6.72o (SD=0.98)
respectively. The age when they achieved maximum valgus
tibiofemoral angle was 3 years old. The maximum mean
(SD) tibiofemoral angle for boys, girls and all children were
8.91o (SD=1.17) , 8.56o (SD=0.62) and 8.73o (SD=0.95)
respectively. The mean tibiofemoral angle showed no
statistically significant difference between girls and boys
except for the 5-year-old group, in which the mean TF angle
for girls was 7.560 (SD=0.95) and for the boys was 6.970
(SD=1.26) with p-value of 0.037.
Conclusion: Measurement of tibiofemoral angle using the
clinical method had a very good inter-observer reliability.
The tibiofemoral angle in Malay population was valgus since
the age of 2 years with maximum angle of 8.730 (SD=0.95)
achieved at the age of 3 years.
2.The Rubber Stopper: A Simple and Inexpensive Technique to Prevent Pin Tract Infection following Kirschner Wiring of Supracondylar Fractures of Humerus in Children
Santy JE ; Kamal J ; Abdul-Rashid AH ; Ibrahim S
Malaysian Orthopaedic Journal 2015;9(2):13-16
Percutaneous pinning after closed reduction is commonly
used to treat supracondylar fractures of the humerus in
children. Minor pin tract infections frequently occur. The
aim of this study was to prevent pin tract infections using a
rubber stopper to reduce irritation of the skin against the
Kirschner (K) wire following percutaneous pinning.
Between July 2011 and June 2012, seventeen children with
closed supracondylar fracture of the humerus of Gartland
types 2 and 3 were treated with this technique. All patients
were treated with closed reduction and percutaneous pinning
and followed up prospectively. Only one patient, who was a
hyperactive child, developed pin tract infection due to
softening of the plaster slab. We found using the rubber
stopper to be a simple and inexpensive method to reduce pin
tract infections following percutaneous pinning.
Bone Wires
3.Prevalence of Vitamin D Deficiency in Patients Presenting with an Orthopaedic Trauma at a Tertiary Centre in South India - Implications and Protocols for Replacement Therapy
Cherian VM ; Gouse M ; Albert S ; Jayasankar V
Malaysian Orthopaedic Journal 2015;9(2):21-25
Vitamin D has been the focus of much scientific literature in
recent years owing to various studies showing its association
with a wide variety of pathological conditions 1,2
. Sun
exposure, diet and fortified supplementation account for a
bulk of Vitamin D intake in humans. Activation of vitamin D
is sequential and requires sun exposure for conversion of 7-
dehydrocholesterol to Vitamin D3. Further metabolism in
the liver converts Vitamin D3 to 25 –hydroxyvitamin D3.
Conversion to its active form 1,25 dihydroxyvitamin D3
(Calcitriol) occurs in the kidneys 2
. The importance of
Vitamin D in calcium metabolism and bone health is well
known and documented. Controversies exist regarding the
true prevalence of hypovitaminosis, however in developing
countries the prevalence of vitamin D deficiency in all age
groups is probably higher 3
. Adding to this the burden and
morbidity of skeletal trauma, persistent deficiency may have
a deleterious effect in the injured 4, 5
. Vitamin D, with its
positive effect on bone health does play a role in the biology
of fracture repair and remodelling 6
. The role of Vitamin D
replacement as sole biological effectors in fracture repair
may be difficult to quantify and confounded by other
variables at play in bone healing. Studies looking at vitamin
D levels in orthopaedic patients have also shown significant
levels of deficiency and have put forward recommendations
for evaluation and supplementation
Vitamin D Deficiency
4.Posterior Cruciate Ligament Tibial Avulsion treated with Open Reduction and Internal Fixation
Malaysian Orthopaedic Journal 2015;9(2):26-32
The optimal treatment for thoracolumbar fractures (TLF)
without neurological deficit remains controversial. Majority
of the systematic reviews and meta-analyses have evaluated
open operative approaches but have yet to compare the
outcomes of minimally invasive percutaneous pedicle
fixation (MIPPF) versus non-operative treatment. A
retrospective cohort study was performed to compare clinical
and radiological outcomes between MIPPF and conservative
groups for TLF AO Type A1 to Type B2 during a 2-year
follow-up period. Pre-operative plain and CT films were
evaluated and decision made for short segment (non-fusion)
MIPPF. Patients who refused operation were treated
conservatively with three months of body cast, brace, or
corset. MIPPF group showed earlier Visual Analog Score
(VAS) improvement at six months post-injury (0 vs 6.0- p<
0.001), as well as better functional and radiological
outcomes (p<0.050) at final follow-up. Progressions of
regional kyphosis (RK) were noted in both groups but there
was no significant difference within and between them
(p>0.050). MIPPF as a method of internal bracing can be
pursued in the treatment of TLF, with larger future cohorts
and RCTs being called for to support and explore new
findings.
5.Femoral Neck Anteversion and Neck Shaft Angles: Determination and their Clinical Implications in Fetuses of Different Gestational Ages
Souza AD ; Ankolekar VH ; Padmashali S ; Das A ; Souza ASD ; Hosapatna M
Malaysian Orthopaedic Journal 2015;9(2):33-36
Precise anatomical assessment of femoral neck anteversion
(FNA) and the neck shaft angles (NSA) would be essential in
diagnosing the pathological conditions involving hip joint
and its ligaments. The present study was undertaken on 48
fetal femurs to calculate the NSA and FNA in fetuses
digitally.
End on images of upper end of the femurs were taken for the
estimation of FNA and a photograph in a perpendicular plane
was taken to calculate the NSA. Microsoft Paint software
was used to mark the points and Image J software was used
to calculate the angles digitally.
The FNA ranged from 17.08º to 33.97 º on right and 17.32 º
to 45.08 º on left. The NSA ranged from 139.33 º to 124.91 º
on right and 143.98 º to 123.8 º on left. Unpaired t test
showed the FNA and NSA of femur did not vary
significantly during the third trimester.
Bone Development
;
Femur
6.Does the Quality of Life in Operated Patients with Adolescent Idiopathic Scoliosis correspond with the Radiographic Parameters?
Hisam MA ; Siti NS ; Jou NP ; Ghaneshinee S ; Shaharuddin AR ; Azmi B ; Mohd KFMM
Malaysian Orthopaedic Journal 2015;9(2):37-40
Objectives: Traditionally, scoliosis surgery is aimed at
attaining a fused, balanced and painless spine. With
improvement in surgical and instrumentation techniques,
spine surgeons strive to achieve higher degree of Cobb’s
angle and rib hump correction with the idea of greater
patient satisfaction. The aim of this study was to determine
the patients’ satisfaction using SRS-22 questionnaire and
their correlations with the radiographic changes.
Materials and methods: A prospective study was conducted
in a tertiary referral centre using the Scoliosis Research
Society-22 (SRS-22) questionnaire during the patients’
annual follow up, between February to April 2014. Thirtyseven
patients who met the inclusion criteria were enrolled.
Results: The mean pre-operative Cobb’s angles were 57.8o ±
12.7o and mean post-operative angle of 20.0o ± 10.4o,
resulting in average correction of 65.9 ± 14.4%. Mean preoperative
rib hump was 61.1 ± 15.4 mm with mean postoperative
rib hump of 15.8 ± 17.8 mm, resulting in average
reduction of 77.7 ± 23.7%. Mean of post-operative total SRS
score was 4.1 ± 0.5. Using Spearman rank correlation, the
percentage of Cobb’s angle correction versus the SRS-22
score showed correlation of 0.17 (P=0.33) while the
percentage of rib hump reduction versus SRS-22 score
showed a correlation of 0.11 (P=0.53).
Conclusion: In this study, the average total SRS-22 score
was 4.1 ± 0.5 (range, 3.1-4.9) post-operatively indicating
very high satisfaction rate overall. Despite attempts at
greater curve correction and rib hump reduction, there is no
direct correlation between patient satisfaction and
radiographic parameters.
Scoliosis
;
Spinal Diseases
7.Outcome Determining Factors for displaced Intra-articular Calcaneal Fractures treated operatively
Nawfar SA ; Chan KL ; Idham HM ; Izani IM ; Nahulan T
Malaysian Orthopaedic Journal 2015;9(3):8-16
Introduction: Calcaneal fractures are caused by high energy
trauma and mostly are intra-articular fractures. Nondisplaced
intra-articular calcaneal fracture (IACF) can be
treated non-operatively. However, displaced intra-articular
need to be reduced and fixed anatomically to facilitate early
ankle rehabilitation and minimize functional impairment.
This study was done to find out the outcome of the IACF
patients who underwent operative treatment.
Methods: 62 patients with IACF were selected in this study
and had been followed up from June 2009 to May 2013.
They were placed into two groups; the operative treated and
non-operative treated groups. Bilateral ankle lateral view
plain radiographs were taken for comparison of the Bohler
and Gissane angles. Both groups of patients were assessed
by the Maryland Foot Score (MFS) and the SF-36v2 general
health survey questionnaire. The ability of the patients to
perform activity of daily living (ADL) and /or return to work
(RTW) was assessed as well.
Results: The operative treatment group of displaced IACF
patients achieved no significant better scores in the mean
MFS and SF-36v2 mean scores as compared to non operated
cases. There was no difference in RTW between the 2
groups, but earlier ADL was recorded in the operated group.
However, this study had found 5 associated factors which
causes major effect to the patients’ outcome to treatment.
Conclusions: The patient’s compliance with post-operative
rehabilitation regimen were found to be significantly related
with the outcomes.
fractures
8.The Current Role of Stem Cells in Orthopaedic Surgery
Maniar HH ; Tawari AA ; Suk M ; Horwitz DS
Malaysian Orthopaedic Journal 2015;9(3):1-7
Basic science and experimental research on stem cells has
increased exponentially in the last decade. Our present
knowledge about stem cell biology is better than ever before.
This new paradigm shift in research has been reflected in the
field of orthopaedic surgery. Various experimental models
have suggested a potential application of stem cells for
different orthopaedic conditions, and early clinical results of
stem cell use have been encouraging. These cells can be
easily isolated, processed and made available for clinical use.
From healing of bone defects caused by trauma, tumor or
infection to cartilage defects, nerve, tendon and ligament
healing, stem cell use has the potential to revolutionize
orthopaedic practice. The purpose of this article is to orient a
general orthopaedic surgeon towards the current use and
clinical applications of stem cell based therapy in
orthopaedics and to provide a complete overview of the
clinical advances in this field.
Stem Cells
9.Functional Outcome With Percutaneous Ilio-sacral Screw Fixation For Posterior Pelvic Ring Injuries In Patients Involved In Heavy Manual Laboring
Abhishek SM ; Prashanth ; Azhar AL ; Vijay GB ; Harshal K
Malaysian Orthopaedic Journal 2015;9(3):23-27
Introduction: Unstable posterior pelvic ring injuries are best
treated with operative methods due to better post-op
functional score. Our patient cohort was involved in heavy
manual laboring frequently required ground level work in
their activities of daily living. There are very few outcome
studies dealing exclusively with such patients.
Materials & Methods: Forty one patients who were treated
with percutaneous sacroiliac screw fixation under
fluoroscopic guidance and were followed-up for at least one
year were analyzed retrospectively for functional outcome
using the Majeed score.
Results: Twenty one (51.22%) and thirteen (31.70%) patients
were found to be in excellent and good categories
respectively and majority of the patients (thirty/73.17%)
were able to return to their original occupation with or
without minor adjustments.
Conclusion: Percutaneous ilio-sacral screw fixation for
posterior pelvic unstable injuries is an acceptable mode of
treatment in patients involved in heavy manual laboring.
laboring
Pelvic Infection
10.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