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Malaysian Orthopaedic Journal

1997  to  Present  ISSN: 1985-2533

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Precontoured Clavicular Locking Plate with Broad Lateral End: A Newly Designed Plate for Lateral Third Clavicle Fractures

Kapil-Mani KC ; Acharya P ; Arun S

Malaysian Orthopaedic Journal.2018;12(1):15-20. doi:10.5704/MOJ.1803.003

Introduction: Various treatment modalities are available butno consensus has been reached for optimal treatment oflateral third clavicle fractures. Precontoured locking plateswith broad lateral end for multiple screws fixation is a newlydesigned plate for lateral third clavicle fractures. Theobjective of our study was to analyse the functionaloutcomes as well as complications of this technique in asignificant number of cases with long follow-up duration.Materials and Methods: Forty-six patients with distal thirdclavicle fractures were treated by precontoured clavicularlocking plate with broad lateral end. Functional outcomeswere assessed on the basis of Constant-Murley ShoulderOutcome Score and University of California, Los Angeles(UCLA) Shoulder Rating Score, active shoulder range ofmotion, time for fracture union and coraco-claviculardistance.Results: The mean Constant-Murley score was 92.56±4.47(range: 79-98) for injured side and 96.22±2.23 (range: 90-100) for normal side with p-Value 0.56. Mean coracoclaviculardistance at final follow-up was 10.52±1.13 mm(range 9.7 to 11.7 mm) in injured side and 10.25±0.98 mm(range 9.6 to 11.2 mm) in normal side. Mean UCLAShoulder Rating Score was 32.55±2.12 (range: 27-34) forinjured side and 33.46±1.88 (range: 31- 35) on normal sidewith p value 0.58. No major complications that necessitatedrevision of surgery occurred in our study.Conclusion: This newly designed plate seemed extremelyuseful in successful union of lateral third clavicle fractures,with reduced rate of complications like fixation failures,iatrogenic rotator cuff injury, AC joint osteoarthritis andsub-acromial bursitis, with good functional out

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The Relationship amongst Intervertebral Disc Vertical Diameter, Lateral Foramen Diameter and Nerve Root Impingement in Lumbar Vertebra

Yusof MI ; Hassan MN ; Abdullah MS

Malaysian Orthopaedic Journal.2018;12(1):21-25. doi:10.5704/MOJ.1803.004

Introduction: The vertical diameter of the foramen isdependent upon the vertical diameter of the correspondingintervertebral disc. A decrease in disc vertical diameter hasdirect anatomic consequences to the foraminal diameter andarea available for the nerve root passing through it. Thisstudy is to establish the relationship amongst theintervertebral disc vertical diameter, lateral foramendiameters and nerve root compression in the lumbarvertebra.Materials and Methods: Measurements of the studyparameters were performed using sagittal MRI images. Theparameters studied were: intervertebral disc verticaldiameter (DVD), foraminal vertical diameter (FVD),foraminal transverse diameter (FTD) and nerve root diameter(NRD) of both sides. The relationship between the measuredparameters were then analyzed.Results: A total of 62 MRI images were available for thisstudy. Statistical analysis showed moderate to strongcorrelation between DVD and FVD at all the lumbar levelsexcept at left L23 and L5S1 and right L3L4 and L4L5.Correlation between DVD and FTD were not significant atall lumbar levels. Regression analysis showed that a decreaseof 1mm of DVD was associated with 1.3, 1.7, 3.3, 3.3 and1.3mm reduction of FVD at L1L2, L2L3, L3L4, L4L5 andL5S1 respectively.Conclusion: Reduction of DVD was associated withreduction of FVD. However, FVD was relatively wide forthe nerve root even with complete loss of DVD. FTD wasmuch narrower than the FVD making it more likely to causenerve root compression at the exit foramina. Theseanatomical details should be given consideration in treatingpatients with lateral canal stenosis.

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Outcome of Primary Cemented Bipolar Hemiarthroplasty compared with Dynamic Hip Screw in Elderly Patients with Unstable Intertrochanteric Fracture

Gashi YN ; Elhadi AS ; Elbushra IM

Malaysian Orthopaedic Journal.2018;12(1):36-41. doi:10.5704/MOJ.1803.007

Introduction: Although the treatment of choice for unstableintertrochanteric fractures in elderly patients has beeninternal fixation for a long time, several studies have shownmechanical and technical failures. Primary cemented bipolar(PCB) hemiarthroplasty has been proposed as an alternativewith some advantages concerning earlier mobilization andminimal postoperative complications.Materials and Methods: This is a prospective cohorthospital-based study conducted at three tertiary hospitalsover a period of two years. A total of 98 patients wereenrolled in the study, 38 patients treated with Dynamic HipScrew (DHS) and 60 patients treated with PCBhemiarthroplasty. Intraoperative events (e.g. duration ofsurgery and blood loss), hospital stay, weight bearing, HarrisHip score and post-operative complications were used aspredictors of final outcome. Mean follow-up was 13.66±5.9months in hemiarthroplasty group and 11.8±2.7 months atinternal fixation group.Results: The two groups were comparable in age, sex,comorbidity, mode of trauma, and classification of fracture.Early mobilisation was significantly better inhemiarthroplasty (p<0.001) where 93.3% of patients startedpartial weight bearing on postoperative Day 1, while in theDHS group, 73.7% of patients started partial weight bearingafter two weeks postoperatively. At the final follow-up, themortality rate did not differ between the two groups, butgeneral and mechanical complications were more commonin the DHS group. The mean Harris Hip score was better inthe hemiarthroplasty group (91.14 vs 74.11).Conclusion: Primary cemented bipolar hemiarthroplasty is asafe and valid option in treating unstable intertrochantericfracture. Although it has been shown to have someadvantages over DHS in certain circumstances, lack ofrandomization and difficulties in standardization of patientsand treating surgeon raise a need for more studies withbigger sample size and proper randomizatio

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Bilateral Proximal Femur Fractures in a Patient with Renal Tubular Acidosis: A Case Report

Charl SS ; Shahrul-Hisham S ; Mohamad-Sha S

Malaysian Orthopaedic Journal.2018;12(1):42-44. doi:10.5704/MOJ.1803.009

The diagnosis of pathological fractures is on the rise. Themorbidity involved does not only burden the patient and theirfamilies but it has a great toll on the healthcare system aswell. Early identification of the patient at risk is aninvaluable tool to cut cost and improve the patient’s qualityof life. Multiple renal pathologies have been highlighted inrelation to the risk of pathological fractures; however,complications in renal tubular acidosis have been rarelydocumented. Nevertheless, prompt action with adequate andrelevant patient education ultimately can reduce theassociated morbidity. We present a case of poor control ofthe disease and its debilitating pathological fracturecomplications.

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Surgical Fixation of a Comminuted Inter-Trochanteric Fracture in a Patient with Bilateral Below Knee Amputation

Lee BH ; Ho SW ; Kau CY

Malaysian Orthopaedic Journal.2018;12(1):54-56. doi:10.5704/MOJ.1803.013

Surgical fixation of hip fractures in patients with below kneeamputation is challenging due to the difficulty in obtainingoptimal traction for reduction of the fracture. Surgeons mayface difficulty in positioning such patients on the tractiontable due to the absence of the foot and distal lower limb.There are several techniques described to overcome thistechnical difficulty. In this case report, we present a case ofa 64-year old gentleman with bilateral below kneeamputation presenting with a comminuted rightintertrochanteric fracture. We highlight a simple andeffective method of applying skin traction to obtain adequatereduction for hip fracture fixation.

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Concomitant Traumatic Peroneal Tendon Dislocation and Medial Malleolus Fracture: A Case Report

Vosoughi AR ; Erfani MA

Malaysian Orthopaedic Journal.2018;12(1):57-59. doi:10.5704/MOJ.1803.014

Peroneal tendon dislocation in association with medialmalleolus fracture is a very rare traumatic injury to the ankle.A 19-year old male patient was referred after injury sustainedin a motorcycle accident with car, with concomitanttraumatic peroneal tendon dislocation and medial malleolusfracture. The possible mechanism of this unusual injurycould have been sudden external rotation force to thepronated foot in full dorsiflexed position of the ankle.Diagnosis of peroneal tendon subluxation or dislocationshould be carefully evaluated in patients with single medialmalleolus fracture.Key Words:peroneal tendon subluxation; medial malleolus fracture;ankle; superior peroneal retinaculum

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Bilateral Clavicle Fractures: A Case Report

Bajuri MY ; Boon HW

Malaysian Orthopaedic Journal.2018;12(1):60-62. doi:10.5704/MOJ.1803.015

Bilateral clavicle fractures are not frequently seen. To treatthese injuries surgically or non-surgically is still a debatableissue. Implant option for surgical management is also indoubt. We would like to share our experience in treating apatient with bilateral clavicle fracture surgically. He hadexcellent outcomes in terms of function and radiology.Surgical option for bilateral clavicle fractures promisesexcellent outcome in terms of early rehabilitation and returnin function.

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Lymphatic Filariasis Presenting as a Swelling over the Upper Arm: A Case Report

Sharma GM ; Bhardwaj AR ; Relwani NR ; Dubey S

Malaysian Orthopaedic Journal.2018;12(1):63-65. doi:10.5704/MOJ.1803.016

Filariasis continues to be one of the endemic problemsworldwide with 40% of the cases in India. We report a caseof lymphatic filariasis in a 32-year old female who presentedwith a non-tender swelling over left upper arm. Bloodsample showed no eosinophilia while the FNAC wasdiagnostic of W. bancrofti. Patient responded well with oraldiethylcarbamazine. High index of suspicion of filariasis isindicated when dealing with a swelling of unknown causeespecially in filariasis endemic areas.

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Multiple Scattered and Small Lesions of Lower Limbs: Idiopathic Calcinosis Cutis: A Case Report

Ferdaus-Kamudin NA ; Mohamed-Haflah NH

Malaysian Orthopaedic Journal.2018;12(1):66-68. doi:10.5704/MOJ.1803.008

Calcinosis cutis is a rare presentation and not many caseshave been reported especially of idiopathic type. We arereporting a case of idiopathic calcinosis cutis of lower limbsin a 33-year old female who presented to our clinic formultiple painless swellings over her lower limbs for the pastsix months, without any history of trauma or infection. Wehave decided to observe her condition on regular follow-upand conservative management.

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Do Age and Co-morbidy, Among other Factors, affect Length of Hospital Stay following Total Knee Arthroplasty

Komang-Agung IS ; Sindrawati O ; William PS

Malaysian Orthopaedic Journal.2018;12(2):25-30. doi:10.5704/MOJ.1807.005

Introduction: The only treatment for grade IV knee osteoarthritis is total knee arthroplasty (TKA) irrespective of the age of the patient.Most of the grade IV OA patient are elderly and most likely to have some comorbidities. Age and comorbidities are the major reasons for patient’s reluctance toundergo TKA. A clinical pathway with standard length of stay(LOS) could justify the patient’s hesitation for TKA. The aimof this study was to determine the factors, including age andcomorbidity, that affect the LOS of patients treated with TKA. MaterialsandMethods:This is a retrospective study ofTKA patients in Surabaya Orthopedics and TraumatologyHospital from January 2011 to July 2017. Preoperativecomorbidities were scored using Charlson ComorbidityIndex (CCI) and physical status by ASA (American Societyof Anesthesiologist), classification for age, sex, BMI, bloodloss, operation time, method of anaesthesia andpostoperative day of rehabilitation were recorded as factorspotentially affecting LOS. The discharge criteria for thepatients were ability to ambulate to the bathroom and cleanoperative wound with no complications. The data obtainedwere analysed statistically.Results:The average LOS was 5.58 days, ranging fromthree to eight days. There were no demographic factors thataffected the patients’ LOS. BMI, ASA, CCI, and blood lossdid not significantly affect LOS. Operation time wasbetween 90-140 minutes, and spinal anaesthesia showedsignificant longer LOS, but within the average.Conclusion:Age and comorbidity did not affect length of stay in TKA patients.

Country

Malaysia

Publisher

Malaysian Orthopaedic Association

ElectronicLinks

http://www.morthoj.org

Editor-in-chief

Azlina Amir Abbas University of Malaya, Kuala Lumpur, Malaysia

E-mail

morthoj@gmail.com

Abbreviation

Malaysian Orthopaedic Journal

Vernacular Journal Title

ISSN

1985-2533

EISSN

Year Approved

Current Indexing Status

Currently Indexed

Start Year

1997

Description

The Malaysian Orthopaedic Journal is a peer-reviewed journal that is published three times a year in both print and electronic online version. The purpose of this journal is to publish original research studies, evaluation of current practices and case reports in various subspecialties of orthopaedics and traumatology, as well as associated fields like basic science, biomedical engineering, rehabilitation medicine and nursing. It also provides a forum for exchange of ideas among researchers and promotes continuing medical education among medical and health care personnel in the region. The journal is currently indexed in Emcare, MyAIS and Google scholar. The Malaysian Orthopaedic Journal is the official journal of Malaysian Orthopaedic Association (MOA) and ASEAN Orthopaedic Association (AOA). It is distributed free of charge to members of the association. Complimentary copies are also sent to libraries of institutes of higher education in Malaysia and member countries of ASEAN Orthopaedic Association.

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