1.Nonunion Of Lateral Humeral Condylar Fracture In A Child With Cubitus Varus
Sulaiman Ar ; Munajat I ; Mohd Ef
Malaysian Orthopaedic Journal 2010;4(3):17-20
Patients with cubitus varus deformity secondary to malunited supracondylar fracture are at risk for lateral humeral condylar (LHC) fracture. This report describes a child presenting with preexisting malunion of supracondylar fracture presenting along with nonunion of a LHC fracture following a recent injury. The patient underwent resection osteotomy of the metaphyseal proximal fragment of the fracture surface, reduction of the displaced LHC fragment and screw fixation. This procedure corrected the cubitus varus and treated the nonunion of the lateral condyle thus avoiding a supracondylar osteotomy procedure. Treatment resulted in solid union, good range of motion and no avascular necrosis.
2.Developmental Dysplasia of Hip Screening Using Ortolani and Barlow Testing on Breech Delivered Neonates
AR Sulaiman ; Zakaria Yusof ; I Munajat ; NAA Lee ; Nik Zaki
Malaysian Orthopaedic Journal 2011;5(3):13-16
Introduction: We conducted this study to compare the
specificity and sensitivity of the Ortolani and Barlow tests performed by dedicated examiners, and to ascertain the incidence of developmental dysplasia of the hip (DDH) in breech babies. Methods: A dedicated examiner underwent
specific training and testing by a paediatric orthopaedic
surgeon. Routine examiners were medical officers who had
basic training in medical school and were briefly trained by their superiors. The dedicated examiner examined 170
babies. Thirty babies including 5 babies with positive tests (according to the dedicated examiner) were examined by a blinded routine examiner. Results of Ortolani and Barlow tests on 30 babies were compared with ultrasound
examination by blinded radiologist. Results: Five babies had positive Ortolani and Barlow tests. The routine examiner did not detect positive Ortolani and Barlow tests. Conclusion: The incidence of positive Ortolani and Barlow tests among breech babies was 2.8%. Result of Ortolani and Barlow tests by dedicated hip screener were better than results performed by routine examiner.
3.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.
4.A Modified Technique of Fixation for Proximal Femoral Valgus Osteotomy in Abnormal Bone: A Report of Two Cases
Logheswaren S, Mbbs, Sulaiman Ar, Ms Orth, Munajat I, Ms Orth
Malaysian Orthopaedic Journal 2017;11(2):82-84
The ideal size of intramedullary device to fix corrective
osteotomy of proximal femur in abnormal bone in children
and small patients may not be easily available. We report the
successful use of Rush rod in combination with multiple
Kirschner wires to fix the corrective osteotomy of coxa vara
and shepherd crook deformity in two patients with
osteogenesis imperfecta and fibrous dysplasia. The union
was achieved on time, neck shaft angle and rotation were
maintained.
5.Femoral Neck Non-union Treated using Compression Screw with or without Gluteus Medius Trochanteric Flap: A Case Series of Ten patients
Faisham WI ; Munajat I ; Salim AA
Malaysian Orthopaedic Journal 2021;15(No.3):137-142
Non-union is a challenging complication following a femoral
neck fracture. Inability to achieve anatomical reduction and
compression over the fracture leads to non-union. We
reported a 10-case series of femoral neck non-union treated
with sliding compression screw and anti-rotational screw
with or without gluteus medius local trochanteric flap. When
compression could not be achieved and a gap was present
over the non-union site, a gluteus medius trochanteric flap
was used to enhance the union. Surgeries were performed as
a single-stage procedure through the Watson Jones approach.
The initial implants were removed, followed by fracture
reduction, during which the varus deformity was corrected,
and the neck length was preserved as much as possible.
Patients were advised for strict non-weight bearing until the
presence of trabecular bone crossing the fracture on the
radiographs. Union was achieved at three months in all
cases. Patients undergoing surgery without trochanteric flap
had normal abduction strength, and the neck length was
maintained. All cases had no significant loss of function.
Patients with trochanteric myo-osseous flap had neck
shortening with weak abductors with MRC grade 4. Two out
of 10 cases developed avascular necrosis of the femoral head
before intervention. One case progressed to collapse of the
femoral head requiring implant removal. This and the
femoral neck shortening, caused this patient to have weak
abductors and a positive Trendelenburg gait. We observed
that delayed surgery leads to neck shortening and fracture
gap requiring trochanteric myo-osseous flap to achieve
union.
7.Submuscular Plate Stabilisation After Lengthening: Standard and Modified Techniques
Munajat I, MMed Ortho ; Sulaiman AR, MMed Ortho ; Mohd EF, MMed Ortho ; Zawawi MSF, PhD
Malaysian Orthopaedic Journal 2020;14(No.1):49-54
Introduction: Submuscular plating after lengthening shortened the period of external fixation in distraction osteogenesis of the femur. In the femur, where monolateral or ring fixators had been used for the distraction, plates, could be inserted laterally, anteriorly or medially. Specific technical modification of the plate insertion, however, would be necessary to accommodate the femoral varus angular correction created at the end of the distraction, in the pelvic support osteotomy lengthening. Material and Methods:We reviewed a series of eight cases with standard and modified techniques of plating after lengthening. The amount of lengthening, the period of distraction, the external fixator index and the associated complications were assessed. Results:The mean lengthening was 5cm, with a range of 3cm to 9cm. The external fixation index, the period of external fixators in days in relation to the length of distraction in cm, was between 18 days/cm to 58 days/cm. One patient with quadriceps contracture, underwent quadriceplasty to improve knee flexion. Three patients with transient knee stiffness had resolution with aggressive physiotherapy. One patient with transient hypoesthesia recovered spontaneously. None of the patients developed joint subluxation, deep infection, re-fracture or implant failures. Conclusion:Standard and modified techniques of plating after lengthening were safe and required only a short period of external fixation. The modified technique offered an easier way of plate insertion in a deformed bone.
8.Displaced Physeal and Metaphyseal Fractures of Distal Radius in Children. Can Wire Fixation Achieve Better Outcome at Skeletal Maturity than Cast Alone?
Syurahbil AH, MMed Ortho ; Munajat I, MMed Ortho ; Mohd EF, MMed Ortho ; Hadizie D, MMed Ortho ; Salim AA, MMed Ortho
Malaysian Orthopaedic Journal 2020;14(No.2):29-39
Introduction:Redisplacement following fracture reduction is a known sequela during the casting period in children treated for distal radius fracture. Kirschner wire pinning can be alternatively used to maintain the reduction during fracture healing. This study was conducted to compare the outcomes at skeletal maturity of distal radius fractures in children treated with a cast alone or together with a Kirschner wire transfixation. Materials and Methods: This was a retrospective study involving 57 children with metaphyseal and physeal fractures of the distal radius. There were 30 patients with metaphyseal fractures, 19 were casted, and 11 were wire transfixed. There were 27 patients with physeal fractures, 19 were treated with a cast alone, and the remaining eight underwent pinning with Kirschner wires. All were evaluated clinically, and radiologically, and their overall outcome assessed according to the scoring system, at or after skeletal maturity, at the mean follow up of 6.5 years (3.0 to 9.0 years). Results: In the metaphysis group, patients treated with wire fixation had a restriction in wrist palmar flexion (p=0.04) compared with patients treated with a cast. There was no radiological difference between cast and wire fixation in the metaphysis group. In the physis group, restriction of motion was found in both dorsiflexion (p=0.04) and palmar flexion (p=0.01) in patients treated with wire fixation. There was a statistically significant difference in radial inclination (p=0.01) and dorsal tilt (p=0.03) between cast and wire fixation in physis group with a more increased radial inclination in wire fixation and a more dorsal tilt in patients treated with a cast. All patients were pain-free except one (5.3%) in the physis group who had only mild pain. Overall outcomes at skeletal maturity were excellent and good in all patients. Grip strength showed no statistical difference in all groups. Complications of wire fixation included radial physeal arrests, pin site infection and numbness. Conclusion: Cast and wire fixation showed excellent and good outcomes at skeletal maturity in children with previous distal radius fracture involving both metaphysis and physis. We would recommend that children who are still having at least two years of growth remaining be treated with a cast alone following a reduction unless there is a persistent unacceptable reduction warranting a wire fixation. The site of the fracture and the type of treatment have no influence on the grip strength at skeletal maturity.
9.Treatment of Malrotation and Limb Length Discrepancy in Osteogenesis Imperfecta Patients: Report of Two Cases
Ibrahim MA ; Nik-Mohamed NAF ; Munajat I ; Sulaiman AR ; Mohd EF
Malaysian Orthopaedic Journal 2022;16(No.1):112-114
Malunion of recurrent fractures in Osteogenesis Imperfecta
(OI) patients causes limb length discrepancy and
malrotation. These cause added difficulty for OI patients to
ambulate. Lengthening with distraction osteogenesis using
an external fixator in OI patients is challenging. Acute
lengthening with autologous bone graft is a known method in
a normal bone but not a known procedure in OI patients. We
present two clinic cases of adolescent OI patients with limb
length discrepancy and externally rotated lower limb that
underwent acute lengthening and rotational correction using
a locked intramedullary nail and ipsilateral autologous iliac
bone graft. Both patients obtained union and improvement of
ambulatory capability without recurrence of fracture within
five years of follow-up. Acute lengthening by 2cm and
rotational correction with intramedullary nail improved the
gait efficiency in the OI patients. Harvesting large amounts
of the tricortical iliac bone graft, followed by controlled
weight-bearing is a safe procedure.
10.The Effects of Different Degrees of Leg Length Discrepancy on Vertical Ground Reaction Force in Children and Adults: Treatment Implications
Mohamed-Saaid F ; Sulaiman AR ; Munajat I ; Mohd EF ; Arifin WN ; Ghafar R
Malaysian Orthopaedic Journal 2023;17(No.3):66-72
Introduction: Previous studies on the degree of leg length
discrepancy that causes limb biomechanical problems did
not differentiate between adults and children. We conducted
this study to determine the effects of simulated leg length
discrepancy on vertical ground reaction force in children and
adults to enable decision-making for intervention in patients
with leg length discrepancy for different age groups or
heights.
Materials and methods: This cross-sectional study
involved male volunteers of children 150cm and adults with
170cm in height. Vertical ground reaction force was
measured using a gait analysis study. The first measurement
was taken without any leg length discrepancy as a baseline.
Subsequently, different amounts of leg length discrepancy
were simulated on the left leg with shoe lifts of 2, 3, and
4cm. The measurements were repeated on each volunteer
with similar shoe lifts on the right leg. Therefore, 14
volunteers provided simulations of 28 leg length
discrepancies for each group. The first and second peaks of
vertical ground reaction force were separately analysed. The
vertical GRF of a simulated leg length discrepancy was
compared with the baseline. Repeated measurement of
analysis of variance (ANOVA) within each group was done.
Results: In both groups, the second peak of vertical ground
reaction force in the longer leg reduced gradually as the shoe
lift increased sequentially from 2 to 3cm and then to 4cm. A
discrepancy of 3cm and above was statistically significant to
cause a reduction in the vertical GRF on the longer limb in
both height groups.
Conclusion: The degree of leg length discrepancy that
caused significant changes in second peak ground reaction
force in children with 150 and adults with 170cm height
population was similar at 3cm. Therefore, the cut-off point
for intervention for both groups are similar with additional
consideration of future growth in children.