This is a prospective study of a series of 26 patients with closed unstable comminuted intra-articular fracture distal end of the radius treated with two different methods of treatment to compare their anatomical and functional results. The external fixation group consisted of 12 patients and internal fixation group consisted of 14 patients. The anatomical and functional assessments were performed at six months and one year. The anatomical results at six months and one year showed that the internal fixation group was effective in maintaining the reduction compared to the external fixation group. The radial height, volar tilt and radial inclination were well maintained. However, the functional results at six months and one year showedno differences between these two types of fixation. The complication rate was higher in external fixation group.
A retrospective study was conducted in 130 patients who underwent replantation or revascularization of 195 amputations in Hand and Microsurgery Unit Hospital Kuala Lumpur from 1990 to 1995. There were 130 patients with 195 amputations in the duration of 6 years study, which were mainly males (111 patients, 85.4%). The commonest age group involved was 19-25 years old (49 cases, 63.7%). There were 146 complete amputations replanted and 49 cases of incomplete amputations were revascularized. The commonest part involved was thumb and index finger (23% of cases each) and majority was caused by industrial accident (60.8%). However in pediatric age group home accident was the leading cause of the amputation (93.8%). The overall survival rate for the amputation was 65.6%. Revascularization had a better survival rate (77.6%) than replantation (61.6%). A clean cut wound and ischaemic time less than 12 hours gave better survival rate. However, there was no significant different chance of survival on distribution of injured parts and ischaemic time (< 12 hours).
From January 1994 to January 1998, 26 patients of unstable thoracolumbar burst fracture were treated by a short segment posterior instrumentation (pedicular screw plate/rod system), reduction and fusion in Kuala Lumpur and Universiti Kebangsaan Malaysia Hospital. Majority of them were young and in a productive age group (mean age were 30 year-old). The mean duration of follow-up was 24.4 months. The injuries were caused by fall from height (69%) and motor vehicle accident (31%). Most of the fracture occurred at 1st and 2nd lumbar vertebrae (24/26). Twelve of the patients did not have neurological deficits. Out of 14 patients with neurological deficits, 64.4% of them showed an improvement of at least one Frankel's grade. There was no defect correlation between canal compromise and neurological deficit. Kyphotic angle improved from 20 degrees to 7 degrees immediately after surgery. In the last follow-up average kyphotic angle was 9 degrees with average lost of 2 degrees. The average length of hospitalization following surgery was 24 days. A posterolateral bony fusion was achieved in all cases at an average of 3 months. Complication included 2 loosening and 3 misplacement of pedicle screw fixation. We concluded that short-segment fixation with posterolateral decompression and fusion is effective in the treatment of unstable thoracolumbar burst fracture.
We are reporting a case of a patient with a symptomatic intra-articular ganglion of the knee arising from infrapatellar fat pad. Plain radiograph and Magnetic Resonance (MR) images were correlated with arthroscopic examination and histological findings. The cyst was removed and post operatively patient regained full extension.
We attempted to compare the accuracy of our clinical examination and the usage of magnetic resonance imaging (MRI) in evaluating patients suspected of having internal derangement of the knee who were seen in our Orthopaedic clinic. This was done using the findings of arthroscopy as the 'gold standard'. The accuracy of MRI in detecting cruciate ligament tears was between 80-96% against 82-93% for clinical examination. MRI accuracy for meniscus injuries was 80-84% compared to 48-65% for clinical examination. We thus propose that MRI examination is an effective first-line investigation for patients with suspected internal knee derangement, especially menisci injuries; allowing arthroscopy to be reserved for patients in whom surgery is truly indicated.
Study site: Orthopedic clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)