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The Use of PROSTALAC In Two-stage Reimplantation 0f Septic Total Knee And Hip Arthroplasty

Malaysian Orthopaedic Journal.2010;4(3):11-15.

The PROSTALAC (PROSThesis Antibiotic Loaded Acrylic Cement) functional spacer is made with antibiotic-loaded acrylic cement. We use it as an interim spacer in two-stage exchange arthroplasty in cases of infected total knee or total hip replacement. PROSTALAC allows continuous rehabilitation between stages as it maintains good alignment and stability of the joint with a reasonable range of movement. It also helps to maintain the soft-tissue planes, thereby facilitating the second-stage procedure. We report here early outcomes of the use of PROSTALAC in 5 patients - 3 in total knee replacements, 1 in a total hip replacement and 1 in a bipolar hemiarthroplasty.

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Outcome of Traumatic Fractures of the Intracapsular Neck of the Femur Treated with Total Hip Arthroplasty in Patients Aged Above 60 Years

Yazid Dm ; Cy Lim ; S Chopra

Malaysian Orthopaedic Journal.2010;4(3):7-10.

This study was undertaken to investigate the outcome of traumatic intracapsular neck of femur fractures treated with total hip arthroplasty (THA). Patients aged ? 60 years who underwent THA for traumatic intracapsular neck of femur fractures from January 2005 to March 2009 were included in the study. Telephone or personal interviews were conducted. There were 49 patients identified within the study period. The mean age was 74.12 years. Most patients were females (81.6%), with a male: female ratio of 1: 4.4. In total, 29 patients were available for outcome scoring. The one-month mortality rate was 4.1%, and the one-year mortality rate was 20.5%. Of the 29 patients 82.8% obtained a Zukerman Functional Outcome Score of good (80 ?100) and 13.8% obtained a score of fair (60 ?80). THA for the treatment of traumatic neck of femur fractures in elderly is a good option with 96.6% of patients obtaining a satisfactory functional outcome, with acceptable morbidity and mortality statistics.

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The Effectiveness of Intravenous Morphine Infusion as Preemptive Analgesia in Preventing Phantom Limb Pain Following Lower Limb Amputation

Kc Chong ; Sulaiman Ar ; Yusof Mi

Malaysian Orthopaedic Journal.2010;4(3):3-6.

Phantom limb pain may reduce ambulation and mobility in amputees, resulting in diminished quality of life. We conducted a prospective study to compare the perioperative analgesic use of intravenous morphine infusion in 27 patients (Group A) and intramuscular diclofenac sodium in 28 patients (Group B) in patients undergoing lower limb amputation. All patients underwent amputation under spinal anaesthesia and reported a Modified Verbal Numerical Pain Score of less than two prior to the procedure. Presence of phantom pain was assessed on the first, second, third and seventh day as well as at the third month and sixth month post-operatively. Twelve (44 %) patients from group A and 21 patients (75 %) from group B developed phantom limb pain following amputation, a statistically significant difference between groups (p<0.05). We conclude that intravenous morphine infusion is more effective than intramuscular diclofenac sodium in preventing the occurrence of phantom limb pain following amputation.

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Necrotising fasciitis of the Lower limb caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus

Ck Chan ; Am Merican ; Nawar Ariffin

Malaysian Orthopaedic Journal.2010;4(3):36-38.

Necrotising fasciitis caused by Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a new entity. Although it is recognised worldwide, there have been no reported cases to date in Malaysia. We report a case of necrotising fasciitis of the left lower limb in an otherwise healthy 20-year-old man. He presented with septic shock and despite the paucity of clinical signs in the limb, the infection was aggressive. Methicillin-Resistant Staphylococcus aureus (MRSA) was isolated from the deep fascia of the leg. Panton-Valentine leucocidin gene (PVL), which is a stable genetic marker for CA-MRSA strain, was positive in this case. This case of community acquired MRSA necrotising fasciitis is of concern and may herald the emergence of this resistant organism in Malaysia. Vigilant surveillance and microbiological monitoring is needed to follow this CA-MRSA trend.

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Giant Cell Tumour of the Tendon Sheath Masquerading as Trigger Finger

Rahimawati N ; Roohi Sa ; As Naicker

Malaysian Orthopaedic Journal.2010;4(3):32-35.

We report a case of a 59-year-old female who presented in the general orthopaedic clinic with triggering of her right middle finger. She did not respond to conventional treatment methods; subsequently she underwent surgical open release under local anaesthesia. Five months postoperatively, the patient presented with signs and symptoms of acute flexor tenosynovitis, and was thought to have a postoperative infection. Re-examination by a hand surgeon raised the possibility of a different aetiology. Based on clinical findings and response to initial treatment, giant cell tumour of the flexor tendon sheath was suspected and later confirmed following surgical biopsy. A high index of suspicion and knowledge of the variegated presentations of giant cell tumour in the hand are beneficial in these types of cases.

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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.

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Delayed presentation of an unusual transpharyngeal penetrating neck injury by a wooden stick: a case report

Samit Grover ; M Chaudhry

Malaysian Orthopaedic Journal.2010;4(3):26-28.

Penetrating neck trauma is a horrifying injury. Patients may present with sudden death, or life threatening injuries such as catastrophic haemorrhage, major vessel injury, injuries to the respiratory or digestive tract, neurological deficits, or bony injuries of the cervical spine. Other less life threatening symptoms may be associated with such injuries. We present here a case report of a 2-year-old child who sustained a transpharyngeal penetrating neck injury that occurred while playing with a wooden stick. He presented one month later with an abscess in the posterior triangle of the neck.

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Chondrosarcoma of the T2 Vertebra Using a Combined Anterior and Posterior Approach: A Case Report

Mun Keong Kwan ; Norazian Kamisan ; Lim Beng Saw

Malaysian Orthopaedic Journal.2010;4(3):22-25.

Chondrosarcoma of the spine is rare; it presents predominantly in very young males and presentation with neurological deficit is uncommon. Treatment of this type of tumour is mainly through surgery as adjuvant therapy is ineffective. En bloc resection of tumours in the spine are difficult although it remains the recommended treatment for chondrosarcoma. We report here presentation of a female with paresis (Frankel C) whot was diagnosed with a large chondrosarcoma of the T2 vertebra extending to the right upper thoracic cavity. The patient underwent radical excision through an anterior and posterior approach to the spine.

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Myositis Ossificans in a 4-year-old child

Huck Wee Boon ; Vasanthie B

Malaysian Orthopaedic Journal.2010;4(3):19-21.

Sprengel’s shoulder and myositis ossificans (MO) are rarely seen concomitantly. This report is about a rare case in a 4 year-old girl who presented with right shoulder deformity and pain associated with right proximal arm swelling.

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Ipsilateral acute Monteggia lesion and malunion of Galeazzi fracture in an adult. A case report

Essoh Sié ; Aka Kacou ; Bada Sérv

Malaysian Orthopaedic Journal.2010;4(3):16-18.

Presentation of Monteggia and Galeazzi fractures in the same limb is a rare injury. We report an unusual case in which an acute Monteggia fracture was associated with a malunited Galeazzi fracture in an adult patient. The mechanism of this complex injury is discussed.

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