BACKGROUND: Periprosthetic fractures around a total knee replacement (TKR) can be complex and difficult to manage, requiring the surgical expertise of the trauma and arthroplasty surgeon. There are a number of treatment modalities available, each with their own merits and limitations. As data on tumor prosthesis revision in periprosthetic fractures is sparse, this study aims to evaluate the results of revision using a tumor prosthesis and compare them with those of fixation using a locking plate in periprosthetic fractures after TKR. METHODS: This is a retrospective study of 15 patients who underwent either tumor prosthesis revision (n = 7) or locking plate fixation (n = 8) for supracondylar femoral periprosthetic fractures in our hospital from 2009 and 2014. The mean follow-up time for these patients was 44 months. This study's main outcome measures were pain relief, return to premorbid ambulatory function, and complications. RESULTS: The revision and fixation groups saw five versus three patients achieve pain relief (71.4% vs. 37.5%, p = 0.315), and two versus four patients return to their premorbid ambulatory function (28.6% vs. 50%, p = 0.608) at the follow-up, respectively. The mean time to weight-bearing in the revision group and fixation group was 2.9 days and 18.9 weeks, respectively (p = 0.001). There were eight complications seen in the revision group with none requiring reoperation; there were five complications seen in the fixation group, and two required reoperation. CONCLUSIONS: The results of revision TKR using a tumor prosthesis were comparable to those of fixation using a locking plate in periprosthetic fractures after TKR. Tumor prosthesis revision may be considered as a viable alternative to locking plate fixation when indicated.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Humans ; Outcome Assessment (Health Care) ; Periprosthetic Fractures* ; Prostheses and Implants* ; Reoperation ; Retrospective Studies ; Weight-Bearing

Few in vivo studies had previously been attempted in reaffirming the in vitro data in current literature. This study evaluated the ability of mesenchymal stem cells (MSCs) isolated from bone marrow, periosteum and fat to treat partial growth arrest in immature New Zealand white (NZW) rabbits. A physeal arrest model in an immature rabbit was created. The bony bridge was excised 3 weeks later, and MSCs from various sources were transferred into the physeal defect of different rabbits. Group I consisted of bone marrow-derived MSCs, Group II: periosteumderived MSCs, Group III: fat-derived MSCs. Contra-lateral tibiae, without undergoing operation, served as self-control. The animals were subsequently sacrificed, with radiological and histological analyses performed. All MSCs demonstrated chondrogenic and osteogenic differentiation potentials in vitro. In correction of varus angulation groups I and II exhibited superior results when compared to group III (P <0.05). The length discrepancies between operated and normal tibiae in groups I, II and III were significantly corrected when compared to the control group (P <0.01). In conclusion, bone marrow and periosteum derived stem cells provided better correction of physeal arrest in rabbits. The source of MSCs itself could influence the success in the treatment of growth arrest.
Animals ; Bone Diseases ; therapy ; Bone Regeneration ; Cell Culture Techniques ; methods ; Disease Models, Animal ; Growth Disorders ; therapy ; Mesenchymal Stem Cell Transplantation ; methods ; Mesenchymal Stromal Cells ; cytology ; Osteogenesis ; Rabbits ; Tibia ; growth & development ; injuries

INTRODUCTIONThis study aimed to characterise interpersonal violence victims admitted to a major trauma centre.

MATERIALS AND METHODSA retrospective cohort study of interpersonal violence victims who were admitted to our centre from 1 January 2001 to 31 December 2010 was conducted. Data were obtained from our trauma registry.

RESULTSInterpersonal violence victims constituted 444 (90.1% males and 9.9% females) out of a total of 8561 trauma admissions in the same time period. The average age was 36.6 years (range, 14 to 83 years). Majority were Chinese (53.4%) and Singaporeans (77.3%). The number of cases increased from 10 per year to 96 per year in the first 8 years, then decreased in the last 2 years (55 in year 2010). Time of injury was predominantly 0000 to 0559 hours (72.3%). Interpersonal violence mostly occurred in public spaces for both genders (88.7%). However, the number of females who were injured at home was significantly higher than males (P = 0.000). Blunt trauma (58.3%) was more common than penetrating trauma (41.7%). The average injury severity score (ISS) was 13.5 (range, 1 to 75); 34.9% of patients had major trauma (ISS >15). The average Glasgow coma scale (GCS) score was 13.5 (range, 3 to 15); 16.4% of patients had moderate-to-severe brain injury (GCS 3-8). Blunt trauma was significantly more likely to cause major trauma than penetrating trauma (P = 0.003). The sole case of firearm assault caused most morbi-mortality. Overall mortality was 4.5%. Major trauma (OR: 25.856; P = 0.002) and moderate-to-severe brain injury (OR: 7.495; P = 0.000) were independent risk factors of mortality.

CONCLUSIONThere has been no prior published data on interpersonal violence locally. This study is thus useful as preliminary data for future population-based studies. It also provides data for authorities to formulate preventive and intervention strategies.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Patient Admission ; statistics & numerical data ; Retrospective Studies ; Time Factors ; Trauma Centers ; Violence ; statistics & numerical data ; Young Adult

Lung cancer is the leading cause of cancer-related death around the world, being the top cause of cancer-related deaths among men and the second most common cause of cancer-related deaths among women in Singapore. Currently, no screening programme for lung cancer exists in Singapore. Since there is mounting evidence indicating a different epidemiology of lung cancer in Asian countries, including Singapore, compared to the rest of the world, a unique and adaptive approach must be taken for a screening programme to be successful at reducing mortality while maintaining cost-effectiveness and a favourable risk-benefit ratio. This review article promotes the use of low-dose computed tomography of the chest and explores the radiological challenges and future directions.