Displaying publications 41 - 60 of 106 in total

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  1. Fulltext Fat Embolism Syndrome - A Qualitative Review of its Incidence, Presentation, Pathogenesis and Management
    Timon C, Keady C, Murphy CG
    Malays Orthop J, 2021 Mar;15(1):1-11.
    PMID: 33880141 DOI: 10.5704/MOJ.2103.001
    Fat Embolism Syndrome (FES) is a poorly defined clinical phenomenon which has been attributed to fat emboli entering the circulation. It is common, and its clinical presentation may be either subtle or dramatic and life threatening. This is a review of the history, causes, pathophysiology, presentation, diagnosis and management of FES. FES mostly occurs secondary to orthopaedic trauma; it is less frequently associated with other traumatic and atraumatic conditions. There is no single test for diagnosing FES. Diagnosis of FES is often missed due to its subclinical presentation and/or confounding injuries in more severely injured patients. FES is most frequently diagnosed using the Gurd and Wilson criteria, like its rivals it is not clinically validated. Although FES is a multi-system condition, its effects in the lung, brain, cardiovascular system and skin cause most morbidity. FES is mostly a self-limiting condition and treatment is supportive in nature. Many treatments have been trialled, most notably corticosteroids and heparin, however no validated treatment has been established.
    Matched MeSH terms: Orthopedics
  2. Fulltext Coordinating a Postgraduate Orthopaedic Exam During the COVID-19 Pandemic
    Mohamed-Haflah NH, Abdullah S, Abdul-Rani R
    Malays Orthop J, 2021 Mar;15(1):16-20.
    PMID: 33880143 DOI: 10.5704/MOJ.2103.003
    The Coronavirus (COVID-19) pandemic and institution of the Movement Control Order (MCO) had resulted in the cancellation of a major orthopaedic exam in April 2020. The exam is known as the Malaysian Orthopaedic Specialist Committee (OSC) Part I Examinations. It is similar to the British Royal Colleges of Surgeons Membership (MRCS) exams and held twice annually in April and October. There are up to 200 candidates involved. With implementation of new guidelines and standard operating procedures (SOP), the OSC Part I exam was successfully held by Universiti Kebangsaan Malaysia (UKM) from 5th-9th October 2020. Here we highlight the challenges we faced whilst coordinating a major exam at a national level during the COVID-19 pandemic with recommendations for future exams.
    Matched MeSH terms: Orthopedics
  3. Fulltext Systemic Absorption of Gentamicin Irrigation in JointReplacement Surgery: A cause of concern
    Lee, K.H., Ng, A.B.Y., Tan, T.B., Mossinac, K., To, B.C. Se
    Malays Orthop J, 2008;2(2):11-15.
    MyJurnal
    Gentamicin, whether administered either intravenously, incorporated into bone cement or for local intra-operative irrigation, is a commonly used antibiotic in orthopaedic practice. The former two have been well studied, however the literature on the therapeutic efficacy and safety of gentamicin irrigation is sparse. The objective of this study was to assess systemic absorption of gentamicin irrigation in joint replacement surgery. This was a non-randomised, prospective study. Ninety-eight patients (group A) who underwent total joint replacement and 40 patients (group B) who underwent hemi-arthroplasty were treated traoperatively with gentamicin irrigation. Serum gentamicin levels were assayed at 4 hours and 24 hours post-surgery. Sixteen of 98 patients in group A (16%) and 12 out of 40 patients in group B (30%) were found to have serum gentamicin level above 2mcg/ml at 4 hours post-surgery. We conclude that intra-articular gentamicin irrigation is systemically absorbed at substantial levels.
    Matched MeSH terms: Orthopedics
  4. Fulltext The Role of Real Time Ultrasound in Differentiatingbetween Osteomyelitis and Tumour in Long Bones
    George, J., Teo, S.C., Adan, M.
    Malays Orthop J, 2008;2(1):33-37.
    MyJurnal
    Aim: This study was designed to evaluate the use of ultrasound in diagnosis of infection and tumour of long bones. Methodology: Patients referred from the orthopaedic unit with doubt regarding long bone clinical and/or radiological signs which could be tumour or infection were enrolled in this study. Analysis of ultrasound characteristics included presence of pericortical fluid over normal cortex well away from the primary lesion, wavy contour sign (fluid tracking in and out muscle planes), subperiosteal fluid and soft tissue mass displacing adjacent muscle planes. Results: Fourteen out of 15 patients with confirmed osteomyelitis were diagnosed by ultrasound examination. Ultrasound as a diagnostic tool has a sensitivity of 93% and specificity of 100%. The most accurate indicator was pericortical fluid noted up to several centimetres from the long bone abnormality seen on plain x-rays. Conclusion: Ultrasound is a safe, fast, cost-effective imaging modality that can play an important role in diagnosis of osteomyelitis as it then serves as a tool for ultrasound guided aspiration.
    Matched MeSH terms: Orthopedics
  5. Fulltext Giant sacral chondrosarcoma in an elderly male: a case report
    Chan, H. Z., Wang, C. S., Azuhairy, A., Hau, A., Zulkiflee, O.
    Malays Orthop J, 2014;8(1):79-81.
    MyJurnal
    Primary sacral tumours are rare, therefore experience of managing their associated complications are very limited. Effective surgical treatment of pelvic chondrosarcoma remains a major challenge for orthopaedic surgeons, due to the complex anatomic structure of the pelvis, the lack of defined compartment borders, the close vicinity to vital structures, and the risk of jeopardizing pelvic structural stability. We report a rare case of a giant sacral chondrosarcoma (100cm x 80cm) in an elderly male who successfully underwent tumour resection with good functional outcome and recovery. Long term follow up is essential in view of the possibility of local tumour recurrence.
    Matched MeSH terms: Orthopedics
  6. Fulltext Kajian analisa kos pembekal perkhidmatan kesihatan bagi rawatan diabetic foot wad ortopedik Pusat Perubatan Universiti Kebangsaan Malaysia dalam tahun 2006
    Amin, S.A., Ali, M., Aniza, I., Rizal, A.M., Saperi, S., Amrizal, M., et al.
    Malaysian Journal of Community Health, 2009;15(1):32-38.
    MyJurnal
    Introduction : Diabetes mellitus is recognized as a major public health problem worldwide. The burden of diabetes to society are morbidity, mortality and extensive usage of health care services.
    Methodology : This study aimed to determine the provider’s cost in treating diabetic foot patient per day in orthopaedic ward, Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in year 2006. Result : A total of 54 patients fulfilled the inclusion and exclusion criteria, only 29 were eligible for analysis. The cost of health care providers derived from cost calculation on capital and recurrent costs. Results showed that the average cost for treating diabetic foot patient per day is RM 634.57. Recurrent costs contributed 75.3% of the total diabetic foot treatment and Intensive Care Unit costs was the biggest percentage (40.5%).
    Discussion : The results were comparable with findings by Case-Mix Unit of UKMMC. Treatment cost of diabetic foot is substantial and therefore avoidance of this complication must be emphasized to all diabetic patients.
    Matched MeSH terms: Orthopedics
  7. Osteomyelitis in childhood -the natural history documented by radiographs
    Singh, H.
    Malaysian Journal of Paediatrics and Child Health, 2000;12(1):74-76.
    MyJurnal
    It is very rare indeed in the practice of children's orthopaedics today in Malaysia that the natural history of long bone osteomyelitis is seen. A case is presented where a shoulder abscess in a 3-year-old child developed into septic arthritis of the shoulder and subsequently chronic osteomyelitis of the adjacent humerus. The parents refused active surgical debridement and sequestrectomies. Three years later the child had regenerated a new humerus over the sequestra. Radiographs are presented illustrating the entire natural history of osteomyelitis with the regeneration of a new humerus.
    Matched MeSH terms: Orthopedics
  8. Fulltext Review Article: Stem Cell Therapy in Orthopaedic Surgery:Current Status and Ethical Considerations
    Hui,J.H.P., Azura M., Lee, E.H.
    Malays Orthop J, 2009;3(1):4-12.
    MyJurnal
    Regenerative medicine using stem cell therapy has sparked much interest in this 21st century not only because of the controversies that surround the ethics involving pluripotent stem cells but their potential for use in the clinic. The ability of stem cells to repair and regenerate new tissues and organs holds tremendous promise for the treatment of many serious diseases and injuries. This review provides a brief summary of the current status of research in stem cells with special emphasis on where we are in terms of the possible clinical application of stem cell therapy in orthopaedic surgery. We look at the available evidence and examine the ethical issues and considerations associated with the clinical use of stem cells.
    Matched MeSH terms: Orthopedics
  9. Fulltext Tissue Diagnosis for Musculoskeletal Tumours
    Saw, A.
    Malays Orthop J, 2007;1(2):1-2.
    MyJurnal
    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...
    Matched MeSH terms: Orthopedics
  10. Fulltext Transformation of surgical training through national transformation 2050 (TN50): a National agenda
    Razman, J.
    Journal of Surgical Academia, 2017;7(1):1-3.
    MyJurnal
    Surgical training worldwide has been reformed from
    the since 19th century until the present era. It started as
    a trade which eventually was transformed into a
    profession that acquires skills and knowledge. The
    apprenticeship model was introduced amongst the
    Western surgeons as the standard approached for
    surgical training. The surgery was learned through
    direct observation without any formal and structured
    education. William S Halstead had introduced the new
    approach of training the surgeons in America
    following his landmark lecture at Yale University in
    1904 (1). His principle was based on direct the
    German Surgical training which emphasized on basic
    sciences in the curriculum and Sir William Ossler
    concepts of bedside rounds. This has lead to the
    development of Halsted principals of surgical training
    which included intense and repetitive exposure in
    managing surgical patients under the supervision of
    skilled surgeons, acquiring the knowledge of scientific
    basis of surgical diseases and as the surgical trainee
    received enhanced responsibility and independence
    with each advancing year (2). Since then, Halsted
    principle of surgical training has become the
    foundation of most established surgical training
    worldwide. The principles have been expanded and
    upgraded and since then six cores competencies have
    been identified for the surgical residents to achieve
    and master during the training course (3). There were
    medical knowledge, patient care, interpersonal and
    communication skills, professionalism, practice-based
    learning and improvement and system based practice.
    From the Malaysia perspective, surgical training was
    done through the overseas Royal colleges after the
    independence in 1957. The local programme started in
    1982 through the initiative of local universities that
    initially offered surgical training programme in
    General surgery, Orthopedics and otorhinolaryngology
    (4). Since then through the collaborations of Ministry
    of Health and other professional bodies various
    surgical training programme has been established to
    provide training opportunities which will eventually
    serving the nation. The subcommittee of the National
    Conjoint Board for General Surgery was the
    consultative body to oversee and manage the
    implementation of the surgical training. Since the
    establishment, the subcommittee was responsible in
    streamlined the training curriculum for all the
    universities that offered the course, centralized and
    standardized the intake of the trainees, coordinating
    the national exit examination and advising new
    application for graduate training in general surgery.
    The important milestone of the subcommittee was the
    task given to develop the national surgical
    postgraduate curriculum for the doctors who are
    interested in becoming a surgeon in the country. The
    curriculum is being developed to create a pathway for
    surgical training from the internship until subspecialty
    training. The development encompasses the
    governance, the curriculum development, the training
    process and learning outcome according to the latest
    evidence based on post graduate training. The
    programme should be the foundation in producing well
    trained surgeons towards 2050 through TN50.
    Matched MeSH terms: Orthopedics
  11. Fulltext An approach for developing integrated undergraduate medical curriculum
    Akram A, Rizwan F, Sattar K, Hadi JIS, Meo SA
    Pak J Med Sci, 2018 9 8;34(4):804-810.
    PMID: 30190732 DOI: 10.12669/pjms.344.14565
    Background and Objectives: Medical schools are to develop integrated medical curricula because the term 'integrated curriculum' has grown up and flourished globally and it has become mandatory to align the medical education with the global concept in Pakistan. This paper aims to present a guideline to design an undergraduate integrated medical curriculum.

    Methods: Various themes are used to develop integrated curriculum which are basic medical science, simulation skills, clinical science, personality development, research, entrepreneurship and pre specialization. Each theme is subdivided, termed a module and its contents primarily focus on particular aspect.

    Results: Knowledge, skill and attitude, embodied in themes or modules, are planted in specific way that they have horizontal as well as vertical integration. There is no boundary of various traditional disciplines in template of five years curriculum. For example, diagnosis is a theme which carries contents from medicine, surgery, orthopedics etc.

    Conclusion: The blueprint introduced in this paper would help medical educators to draft integrated medical curricula for those institutions which intend to switch their medical programs from traditional to integrated one.

    Matched MeSH terms: Orthopedics
  12. Fulltext Incidence of phlebitis among adult patients with peripheral intravenous catheter in an east coast hospital Malaysia
    Azlina Daud, Fatimah Mohamad, Siti Noorkhairina Sowtali
    International Journal of Care Scholars, 2018;1(2):5-8.
    MyJurnal
    Objective: This study aims to determine the incidence rate of phlebitis among patients with peripheral intravenous catheter. Methods: An observational study was conducted in one of the hospitals in East Coast Malaysia. There were 321 data collected among patients who had peripheral intravenous catheter in medical, gynecology and orthopedic wards. The incidence of phlebitis was evaluated using modified Visual Infusion Phlebitis score checklist. Results: The incidence of phlebitis, was found out to be 36.1% (n=116/321). Most patients who developed phlebitis had visual infusion phlebitis, with a score of two (34.9%) and the rest developed phlebitis with a score of three (1.2%). Conclusion: This high incidence of phlebitis indicated a worrying outcome. Therefore, the study findings suggested that a specific guideline on post insertion management of peripheral intravenous catheter should be revised which may help in reducing more incidence of phlebitis, subsequently reduce infection in ward, and provide more safety environment in hospital and reducing cost in managing infection control.
    Matched MeSH terms: Orthopedics
  13. Fulltext Brachial Artery Injury in a Child following Closed Elbow Dislocation: Case Report of a Rare Injury
    Vickash K, Amer A, Naeem A, Falak S
    Malays Orthop J, 2016 Nov;10(3):36-38.
    PMID: 28553446 DOI: 10.5704/MOJ.1611.001
    Elbow dislocation, though a common orthopaedic emergency is rare with brachial artery injury and is even more uncommon in the paediatric age group. We present the case of a child who sustained trauma resulting in closed elbow dislocation with brachial artery injury. Elbow dislocation with brachial artery injury can present with palpable distal pulses and good capillary refill because of rich collaterals at the elbow. But this patient presented with signs of frank ischemia distally, and was managed with ipsilateral reverse cephalic vein graft. He had good volume pulses at one year follow-up. Patients with such presentation should have careful clinical and radiological assessment to exclude complicated elbow dislocation.
    Matched MeSH terms: Orthopedics
  14. Controversies in orthopaedic oncology
    Jeys LM, Thorkildsen J, Kurisunkal V, Puri A, Ruggieri P, Houdek MT, et al.
    Bone Joint J, 2024 May 01;106-B(5):425-429.
    PMID: 38689572 DOI: 10.1302/0301-620X.106B5.BJJ-2023-1381
    Chondrosarcoma is the second most common surgically treated primary bone sarcoma. Despite a large number of scientific papers in the literature, there is still significant controversy about diagnostics, treatment of the primary tumour, subtypes, and complications. Therefore, consensus on its day-to-day treatment decisions is needed. In January 2024, the Birmingham Orthopaedic Oncology Meeting (BOOM) attempted to gain global consensus from 300 delegates from over 50 countries. The meeting focused on these critical areas and aimed to generate consensus statements based on evidence amalgamation and expert opinion from diverse geographical regions. In parallel, periprosthetic joint infection (PJI) in oncological reconstructions poses unique challenges due to factors such as adjuvant treatments, large exposures, and the complexity of surgery. The meeting debated two-stage revisions, antibiotic prophylaxis, managing acute PJI in patients undergoing chemotherapy, and defining the best strategies for wound management and allograft reconstruction. The objectives of the meeting extended beyond resolving immediate controversies. It sought to foster global collaboration among specialists attending the meeting, and to encourage future research projects to address unsolved dilemmas. By highlighting areas of disagreement and promoting collaborative research endeavours, this initiative aims to enhance treatment standards and potentially improve outcomes for patients globally. This paper sets out some of the controversies and questions that were debated in the meeting.
    Matched MeSH terms: Orthopedics
  15. The incidence of post-operative deep vein thrombosis in general surgical patients of hospital universiti sains malaysia
    Tun M, Shuaib IL, Muhamad M, Mat Sain AH, Ressang AS
    Malays J Med Sci, 2004 Jan;11(1):75-80.
    PMID: 22977363
    The incidence of deep vein thrombosis is believed to be rare in Asians. During recent years, a few reports have appeared with high incidence in orthopaedic patients comparable to Western studies. This study was carried out to find out the incidence of post-operative deep vein thrombosis (DVT) after major surgical procedures in general surgical patients in an Asian population. In a prospective study of 45 consecutive Asian patients after major general surgery, colour-flow duplex scan of the legs as an initial screening was done twice within two weeks. Mean age of the patients was 54 years 5 months and 87% of patients were included in the moderate and high risk group for deep vein thrombosis. Ascending venography was used to confirm deep vein thrombosis on patients with equivocal or positive results from colour flow duplex scan. One patient showed positive evidence of post-operative deep vein thrombosis on colour flow duplex scan which was further confirmed by ascending venography; giving an incidence of 2.2%. The incidence of post-operative deep vein thrombosis in general surgical patients is lower than the Western studies.
    Matched MeSH terms: Orthopedics
  16. Orthopaedic surgeons and the device industry: skeletons in the closet
    Poduval M
    Indian J Med Ethics, 2011 Apr-Jun;8(2):97-102.
    PMID: 22106619
    The relationship between orthopaedic surgeons and the device industry is one that is mutually beneficial and productive. However there are skeletons in the closet. The financial implications of this relationship have come under intense scrutiny. The sponsorships and the financial benefits of this symbiotic relationship have been found to cross the boundaries considered acceptable to ethical practice of the profession. In India, the ethical transgressions resulting from unhealthy associations between the orthopaedic surgeon and the industry have yet to be given due importance. Adequate rules and regulations are yet to be enforced and self-regulation is practically non-existent. It is essential to deal with the problem and potential implications that can arise from this kind of misconduct at the organisational level and enforce them for compliance.
    Matched MeSH terms: Orthopedics/ethics*
  17. Fulltext Radiation exposure to the surgeon during femoral interlocking nailing under fluoroscopic imaging
    Muzaffar TST, Imran Y, Iskandar MA, Zakaria A
    Med J Malaysia, 2005 Jul;60 Suppl C:26-9.
    PMID: 16381279
    Femoral interlocking nailing requires fluoroscopic assistance for insertion of the nail and distal screws. In this study, scattered radiation to the eye and hand of the operating surgeon was measured during the procedure. Thermo-luminescent dosimeter (TLD) was used to quantify the dose received by the surgeon. The mean radiation exposure time during the procedure was 3.89 minutes. The mean scattered radiation doses to the hand and eye were 0.27 mSv and 0.09 mSv per procedure respectively. These very low doses have made a surgeon very unlikely to receive more than the recommended annual dose limit set by the National Council on Radiological Protection.
    Matched MeSH terms: Orthopedics*
  18. Skills assessment for undergraduate orthopaedic education
    Harwant S, Pravin D, Teng EM
    Med J Malaysia, 2005 Aug;60 Suppl D:69-70.
    PMID: 16315628
    Matched MeSH terms: Orthopedics/education*
  19. Fulltext The incidence of post-operative wound infection in orthopaedic surgery
    Dhillon KS, Kok CS
    Med J Malaysia, 1995 Sep;50(3):237-40.
    PMID: 8926901
    With the increase in the number of orthopaedic surgeons and the aggressive marketing by manufacturing companies, high technology orthopaedic surgery is being more frequently carried out in Malaysia. Post-operative sepsis complicating this type of surgery can have disastrous consequences. No data is available in this country on the incidence of post-operative infection in Orthopaedic Surgery. The aim of this study was to determine the incidence of post-operative infection. A retrospective survey of 703 patients undergoing elective Orthopaedic Surgery in the year 1991 was carried out. We found an overall post-operative infection rate of 6.8% and a deep infection rate of 3.3%. This figure of 3.3% is higher than the internationally accepted figure of less than 2%. A need for ongoing surveillance and concerned effort to reduce the infection rate is stressed.
    Matched MeSH terms: Orthopedics/statistics & numerical data*
  20. Fulltext A new clinical test for radial tunnel syndrome--the Rule-of-Nine test: a cadaveric study
    Loh YC, Lam WL, Stanley JK, Soames RW
    J Orthop Surg (Hong Kong), 2004 Jun;12(1):83-6.
    PMID: 15237127 DOI: 10.1177/230949900401200115
    Radial tunnel syndrome refers to pain on the lateral aspect of the forearm as a result of compression of the posterior interosseous nerve within a tunnel with specific anatomical boundaries. Diagnosis of the condition is difficult because of its close association with lateral epicondylitis, which warrants different methods of treatment. Based on a cadaveric study, a new clinical test, the Rule-of-Nine test, is proposed to improve the diagnostic accuracy in radial tunnel syndrome. The test involves constructing 9 equal squares on the anterior aspect of the forearm and noting those squares where tenderness can be elicited.
    Matched MeSH terms: Orthopedics/methods*
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