Musculoskeletal tumour is much less common compared to tumours of epithelial origin. Most of these tumours are benign, with only about 1% malignant in nature. A general orthopaedic surgeon may only come across a malignant primary bone or soft tissue tumour a few times in his entire medical career. The current recommendation is for these conditions to be investigated and treated in centres with musculoskeletal oncology service. Careful clinical evaluation with appropriate plain radiography can provide adequate information for definitive diagnosis and treatment for most cases, especially the benign tumours. For some other cases, further investigations will be necessary. Magnetic resonance imaging (MRI) can provide excellent details on anatomical location of a tumour and delineate vital structures that may have been distorted by the lesion. For primary malignant tumours, computerized tomography scanning is still the gold standard for evaluation of pulmonary metastasis, and bone scan can allow early detection of distant metastasis to other bones. Whole body MRI has recently been recommended for tumour staging but the potential benefit for musculoskeletal tumour is not that convincing. PET may be very helpful for follow up detection of tumour recurrence but its role in diagnosis and staging of musculoskeletal tumours is still being evaluated...
For more than two decades extracorporeal shock wave lithotripsy has emerged as the standard therapy for calculi in the kidney and urinary tract, and biliary system. Application of extracorporeal shock waves in orthopaedics involves treatment of recalcitrant chronic pain of plantar fasciitis, tennis elbow and calcifying tendonitis of the shoulder. This review explores current evidence-based issues related to its potential use as a treatment option for some musculoskeletal conditions.
Cadaveric dissection is an integral component of medical education. There had been concerns about negative impact on medical students exposed to deceased donors before their clinical years, but most studies reported overall positive outcome following this form of teaching. Due to reducing number of body donations in most parts of the world, many institutions are adopting alternative models especially for the teaching of gross anatomy. A new body donation programme that incorporate humanistic values in the procurement process was initiated by Tsu Chi University of Taiwan in 1996. Early observations following teaching with the so-called "silent mentors" noted less negative emotional impact on the students. With increasing number of body donation following the initiation of the silent mentor programme as reported in some regions, we will be able to continue the time-honoured cadaveric dissection for anatomy teaching, at the same time promoting humanistic values on junior doctors.
This study involved evaluation of the elbows of 50 children between 4 to 14 years of age. Clinical examination for elbow flexion, extension, range of motion and carrying angle were performed, followed by ultrasonographic examination to determine position of the ulnar nerve in relation to the medial epicondyle upon elbow flexion and extension. Thirty-one elbows showed anterior displacement of the ulnar nerve, of which 14 were due to subluxation and 17 to dislocation. We found that anterior translation of ulnar nerve is present in the elbows up to 31% of children, especially those with increased range of elbow motion.
Predatory journals and conferences have little or no peer review. Their raison d'être is for making money through the article processing charges and the conference registration fees. Without a critical evaluation, predatory journals publishing flawed results and conclusions would cloud the existing scientific literature. Predatory conferences are the offshoots of predatory publishing. The conferences are not organised by learned societies, but by profit-making event organisers. There is a need for awareness among researchers and clinicians regarding predatory publishing. The scourge of predatory publishing and conferencing should be more often highlighted during scientific meetings and publication courses.
Bone lengthening with distraction osteogenesis involves prolonged application of an external fixator frame. Qualitative and quantitative evaluation of callus has been described using various imaging modalities but there is no simple reliable and readily available method. This study aims to investigate the use of a densitometer to analyze plain radiographic images and correlate them with the rate of new bone formation as represented by the bone healing index. A total of 34 bone lengthening procedures in 29 patients were retrospectively reviewed. We used an X-Rite 301 densitometer to measure densities of new callus on plain radiographs taken at 4 and 8 weeks after surgery. Patients aged below 16y had significantly lower BHIs indicating faster bone healing and shorter duration of treatment. The ratio of radiographic densities between centre and edge of the new bone measured from plain radiographs taken at 8 weeks correlated positively with the eventual BHI of the patient. This method provides a simple and easy way to predict the rate of bone healing at an early stage of treatment and may also allow remedial action to be taken for those with poor progress in bone formation.
Purpose: To evaluate the usefulness of ultrasound guidance in percutaneous needle biopsy for musculoskeletal tumours.
Methods: Forty-five consecutive patients underwent ultrasound-guided needle biopsy. An additional group of 50 patients who underwent needle biopsy without ultrasound guidance was retrospectively selected as historical control. The sample was considered adequate when a diagnosis can be made, and diagnostic when the diagnosis is similar to the final report based on the excised tumour.
Results: Adequacy of the biopsy samples was 84% in ultrasound-guided group as compared 76% in the group with no ultrasound guidance. Diagnostic accuracy was 64% in the ultrasound-guided group and 52% in the group without ultrasound guidance. Both of these differences were not statistically significant.
Conclusions: Ultrasound guidance did not provide a significant advantage in the biopsy of musculoskeletal tumours. Diagnostic accuracy seems to improve with the use of larger 14 gauge biopsy needle but further evaluation is necessary.
Forty children treated non-operatively for fractures of the femoral shaft were reviewed with regard to differences in limb length after treatment. Follow up duration ranged from two to seven years. The average femoral overgrowth was 0.85cm (range 0 - 2.5cm) and was influenced by age at the time of fracture. We were not able to find any association between the quantity of overgrowth and race, gender, level or configuration of the fracture.
To conduct a prospective randomised controlled study to compare the stability and risk of nerve injury between fractures treated by medial-lateral pin fixation and those treated by 2-lateral pin fixation.
Taylor’s spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF.
We are reporting four cases of serious washing machine related injury that presented within a period of 5 months. All patients were young children with the mean age of 9 year-old and three had their dominant hand injured. The washing machines involved were the automatic top loader type and all injuries occurred during the spinning phase. Serious automatic washing machine injury is not uncommon in Malaysia. We feel that there is a need to improve the safety features especially during the spinning phase. The operating instructions and safety precautions on the washing machine should be displayed in different languages that can be understood well. Parents should also aware of the potential risks of this seemingly benign household appliance.
Joint stiffness is one of the complications of limb procedure. It developes as a result of failure of knee flexors to lengthen in tandem with the bone, especially when there is inadequate physical therapy to provide active and passive mobilization of the affected joint. We are reporting four patients who developed fixed flexion contracture of their knees during bone lengthening procedure for the tibia with Ilizarov external fixator. Three of them were treated for congenital pseudoarthrosis and one was for fibular hemimelia. None of them were able to visit the physiotherapist even on a weekly basis. A splint was constructed from components of Ilizarov external fixator and applied on to the existing frame to passively extend the affected knee. Patients and their family members were taught to perform this exercise regularly and eventually near complete correction were achieved. With this result, we would like to recommend the use of this "Passive Knee Extension Splint" to avoid knee flexion Contracture during limb lengthening procedures with Ilizarov external fixators.
Introduction: The high prevalence of underweight among children is a serious health concern in Bangladesh. Nutritional status influences students' academic performance directly or indirectly. This study aimed to determine factors that affect the academic performance of students in primary schools. Methods: Data were collected from several schools and madrasahs in Chapainawabganj district, Bangladesh using multistage stratified sampling with proportional allocation technique. Results: The prevalence of underweight children was 32.3%, with 43.0% of them being girls and 21.4% boys. Multiple logistic regression analysis demonstrated that normal weight children were more likely (p
Introduction: Congenital Talipes Equinovarus (CTEV) is a common congenital foot deformity that is associated with long term disability. Treatment with Ponseti method has been successful especially for children who present early. We conducted this study to investigate the age of presentation of children and report the early outcome. Materials: This is a retrospective study from a single institution. We included 31 patients with 45 idiopathic clubfeet and investigated problems and success rate at the end of serial casting. Results: Mean age at presentation was 4.9 months. The mean number of casting was 6 and mean duration of casting was 2.7 months. The initial success rate of 91.1%, with four feet (8.8%) diagnosed as resistant clubfoot and eventually required soft tissue surgery. With mean follow up of 14.1 months, four other feet (8.8%) developed relapse but were treated with repeat Ponseti method. Conclusion: Many CTEV patients present late for treatment. However, the Ponseti method remained effective with high initial success rate of 91.1%. Relapsed CTEV can still be treated successfully with repeat casting using the Ponseti method.
Acupuncture is used for some conditions as an alternative to medication or surgical intervention. Several complications had been reported, and they are generally due to physical injury by the needle or transmission of diseases. We report a case of life-threatening necrotising fasciitis that developed after acupuncture treatment for osteoarthritis of the knee in a 55-year-old diabetic woman. She presented with multiple discharging sinuses over the right knee. As the patient did not respond to intravenous antibiotics, extensive debridement was performed. She made a good recovery. Since many old diabetic patients with degenerative joint diseases may consider this mode of treatment, guidelines on cleanliness and sterility of this procedure should be developed and practiced.
INTRODUCTION: The distal radius is the most common fracture site in children, but local information on the fracture pattern, mechanism of injury and socio-demographic characteristics of the fracture is lacking.
MATERIAL METHODS: We interviewed 126 children and their family members who were under follow up for this fracture in a single institution over a period of 2 years. Radiological images were reviewed to ensure that only those with fracture in the distal one third of the forearm were included.
RESULTS: The overall incidence of this fracture increased with age, and male dominance was noted starting from schooling age. Most fractures occurred at home (38.8%), and 52.3% of all fractures were due to low energy falls. Sports injuries were mainly due to playing football, and road accidents due to riding bicycles. There were 49 (38.8%) children with incomplete fractures, and 19 (15.0%) with physeal plate fractures.
CONCLUSION: Male dominance for distal radius fracture occurred at a comparatively younger age in our population. Preventive measures should focus on home environment since this is the most common place for fracture to occur. Special attention should be paid to boys after the school going age.