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Fulltext A Palmar Lipoma with Median and Ulnar Nerve Compressive Symptoms

Azwa, N., Shalimar, A., Jamari, S.

Malays Orthop J, 2007;1(2):33-35.
MyJurnal

Although lipoma is common in the upper limbs, it rarely occurs in the palm, and usually does not compress the surrounding structures. Here, we report a patient presenting with compressive neuropathy of the ulna and median nerves secondary to a palmar lipoma. Surgical excision led to full neurological recovery.
Fulltext Cavernous lymphangioma of the digits: a rare cause of macrodactyly

Leong, J.F., Levin, K.B., Rajkumar V., Abdullah, S., Jamari, S.

Medicine & Health, 2019;14(2):261-265.
MyJurnal

Cavernous lymphangioma is a congenital malformation of lymphatic system causing dilated lymphatic sinuses that involve the skin and subcutaneous tissues. This was an interesting case of dystrophic macrodactyly of the left ring and little finger in a 18-month-old girl who presented with swollen and sausage like fingers deformity which turned out to be an isolated cavernous lymphangioma. This tumor, although rare to occur in the extremeties, must be differentiated from other congenital vascular lesions of the hand that include arteriovenous malformations and hemangiomas. Diagnosis should be solely based on histopathological analysis of the excised tissue mass. Surgical excision is usually necessary for satisfactory functional and cosmetic outcome
Fulltext Adhesions as an uncommon complication of k-wiring in paediatric phalangeal fractures

Nanchappan S., Parminder G.S., Nur Azuatul, A.K., Tan, J.A., Ahmad Suparno, B., Jamari, S., et al.

Medicine & Health, 2019;14(1):203-208.
MyJurnal

Paediatric hand fractures are common and prompt management is mandatory to achieve a good functional outcome. However many fail to realize that treating a fracture does not only involve bones but the soft tissues, as well. K-wiring itself can be difficult with multiple attempts inadvertently injuring the flexor or extensor tendons and resulting in adhesions. We highlight this possible complication of K-wiring which we believe is under reported due to the perception that K-wiring is a simple procedure. We present a case of a 9-year-old child, who sustained a closed displaced fracture of the base of the proximal phalanx (Salter Harris type 2) of the left index finger. He underwent percutaneous K-wiring but was complicated with severe adhesions of the flexor digitorum profundus (FDP) and flexor digitorum superficialis tendons (FDS). He was unable to flex the proximal and distal interphalangeal joints of the affected finger. We subsequently performed tendon adhesiolysis twice together with A2 pulley reconstruction, to restore movement of the finger. K-wiring of the fingers are not just simple bony procedures but also involve soft tissue components which can be prone to adhesions.
Fulltext Anatomical variations of the lumbrical muscles causing carpal tunnel syndrome

Benny, E., Parminder, G.S., Nur Azuatul, A.K., Tan, J.A., Ahmad Suparno, B., JamarI, S., et al.

Medicine & Health, 2019;14(1):197-202.
MyJurnal

Many anatomical variations exist in and around the carpal tunnel. However, symptomatic anomalies causing carpal tunnel syndrome is rare. Additionally, carpal tunnel surgery is considered a simple operation commonly done by junior surgeons who are usually unaware of variations resulting in unfavorable surgical outcomes. We highlight a case of lumbrical muscle variation causing carpal tunnel syndrome. A 73-year-old male presented with numbness and pain of both hands associated with abnormal fullness over both wrists and distal forearms. Initially the right hand was numb and subsequently a year later, the left hand became numb. Physical examination was positive for Durkan, Phalen and Tinel signs at the carpal tunnel. Magnetic Resonance Imaging (MRI) showed abnormal muscle tissues in the carpal tunnel. During the carpal tunnel release and exploratory surgery, we noted an abnormally proximal origin of the lumbrical muscles in the forearm rather than the typical palmar origin. He also had lumbrical muscle hypertrophy in the left side. These two factors resulted in overcrowding within the carpal tunnel. Post-operatively the patient recovered well with pain relief and gradual improvement of his numbness. Variations in the anatomy of the lumbrical muscles is not uncommon and may result in carpal tunnel syndrome. Hence, carpal tunnel release surgeries may not be as straight forward as expected and surgeons should be aware of this possibility.
Fulltext Complete Brachial Plexus Injury - An Amputation Dilemma. A Case Report

Choong C, Shalimar A, Jamari S

Malays Orthop J, 2015 Nov;9(3):52-54.
PMID: 28611911 MyJurnal DOI: 10.5704/MOJ.1511.017

Brachial plexus injuries with intact yet flail limb presents with problems of persistent neuropathic pain and recurrent shoulder dislocations, that render the flail limb a damn nuisance. As treating surgeons, we are faced with the dilemma of offering treatment options, bearing in mind the patient's functional status and expectations. We present a case of a 55-year old housewife with complete brachial plexus injury begging for surgical amputation of her flail limb, 6 years post-injury. Here we discuss the outcome of transhumeral amputation and the possibility of offering early rather than delayed amputations in this group of patients.
Fulltext A 2-Year Demographic Study of Domestic Paediatric Hand Injuries Requiring Surgical Intervention in An Urban Hospital

Shalimar, A., Jamari, S., Abdul Halim, A.R., Roohi, S.A., Naicker, A.S., Sharaf, I.

Malays Orthop J, 2007;1(1):34-38.
MyJurnal

Domestic paediatric hand injuries make up the bulk of overall paediatric hand injuries. This is a retrospective study of domestic paediatric hand injuries admitted into an urban hospital that required surgical intervention. The most common injuries sustained were tendon injuries (24%), total amputations (20%) and lacerations wounds (16%). Accordingly the most common surgical interventions were tendon repairs (28%), toilet suturing (24%) and refashioning (20%). Parents and care providers need to be more vigilant and careful when supervising children including ensuring the safe storage of dangerous items. Sharp items may require additional safety features and warning labels.
Splinting after Carpal Tunnel Release: Does it really Matter?

Shalimar A, Nor-Hazla MH, Arifaizad A, Jamari S

Malays Orthop J, 2015 Jul;9(2):41-46.
PMID: 28435609 MyJurnal DOI: 10.5704/MOJ.1507.011

Splinting of the wrist after carpal tunnel release (CTR) has been practised by many surgeons especially in North America. The main reason was to prevent possible adverse events of bowstringing of flexor tendons and the median nerve, pillar pain, entrapment of the median nerve in scar tissue and wound dehiscence. Studies on the effect of splinting after standard CTR have had dismal results. The duration of splinting in standard CTR has been either too long (for 2-4 weeks) or too short (48 hours only). The aim of our study was to compare the effects of post-operative splinting for a duration of one week with no splinting.
METHODS: All 30 of our patients underwent a standardized limited open CTR by a designated surgeon. Post operatively, they were randomized into a splinted (n=16) and a nonsplinted (n=14) group. The splint was kept for a week. Patients were reviewed at regular intervals of one week, two months and six months. At each follow up, these patients were clinically assessed for the following outcome measures: VAS (visual analogue score), 2PD (two-point discrimination), pinch grip, grip, Abductor Pollicis Brevis (APB)) power and completion of the Boston questionnaire.
RESULTS: All patients presented with significant improvement in the postoperative evaluation in the analyzed parameters within each group. However, there was no significant difference between the two groups for any of the outcome measurements at sequential and at final follow-up.
CONCLUSION: We conclude that wrist splinting in the immediate post-operative period has no advantage when compared with the unsplinted wrist after a limited open carpal tunnel release.
Fulltext Biomechanical properties of bone cement with addition of cefuroxime antibiotic

Mohd Fuad D, Masbah O, Shahril Y, Jamari S, Norhamdan MY, Sahrim SH

Med J Malaysia, 2006 Feb;61 Suppl A:27-9.
PMID: 17042225

Antibiotic-loaded bone cement has been used as prophylaxis against infection in total joint replacement surgery. Its effect on the mechanical strength of cement is a major concern as high dose of antibiotic was associated with a significant reduction in mechanical strength of bone cement. However, the cut-off antibiotic that weakens the mechanical strength of cement remains to be determined. This study was undertaken to observe the changes in the mechanical properties of bone cement with gradual increments of Cefuroxime antibiotic. Cefuroxime at different doses: 0, 1.5, 3.0 and 4.5gm were added to a packet of 40gm bone cement (Simplex P) and study samples were prepared by using third generation cementing technique. Mechanical impact, flexural and tensile strength were tested on each sample. Significant impact and tensile strength reduction were observed after addition of 4.5 gm of Cefuroxime. However, flexural strength was significantly reduced at a lower dose of 3.0 gm. The maximum dose of Cefuroxime to be safely added to 40mg Surgical Simplex P is 1.5gm when third generation cementing technique is used. Further study is needed to determine whether it is an effective dose as regards to microbiological parameters.
Epithelioid sarcoma and concurrent Volkman ischaemic contracture: a case report

Suria-Hayati MP, Siti-Aishah MA, Eshagroni A, Jamari S, Abdolvahab F, Yazmin Y, et al.

Clin Ter, 2012;163(3):215-7.
PMID: 22964694

Epithelioid sarcoma is a very infrequent soft tissue sarcoma involving predominantly distal extremities of adolescent and young adult. We hereby report a case of epithelioid sarcoma in a 34-year-old young adult who presented with 1-year history of a painful left upper limb associated subsequently with warm left forearm swelling and a Volkman contracture. He was treated as an inflamed soft tissue condition of the left upper limb. A computed tomography study showed presence of multiple hypodense lesions mainly in the flexor compartment of the left arm as well at the subcutaneous tissue, which measured 1 to 1.7 cm in diameter. Histological examination of the left upper limb mass showed nodular proliferation of epithelioid tumour cells and some with rhabdoid features surrounding a central zone of necrosis and was diagnosed as epithelioid sarcoma. Concurrent presence of epithelioid sarcoma and Volkman ischaemic contracture are rarely seen in clinical practice. The present case highlights the importance of the histology which can be confused with other types of sarcoma or chronic granuloma and even missed at times thereby causing diagnostic problems.
Role of high resolution ultrasound in ulnar nerve neuropathy

Radhika S, Lee YL, Low SF, Fazalina MF, Sharifah Majedah IA, Suraya A, et al.

Med J Malaysia, 2015 Jun;70(3):158-61.
PMID: 26248778 MyJurnal

AIM: This study was conducted to measure the cross sectional area (CSA) of the ulnar nerve (UN) in the cubital tunnel and to evaluate the role of high-resolution ultrasonography in the diagnosis of ulnar nerve neuropathy (UNN).
MATERIALS AND METHODS: This was a cross sectional study with 64 arms from 32 patients (34 neuropathic, 30 nonneuropathic). Diagnosis was confirmed by nerve conduction study and electromyography. The ulnar nerves were evaluated with 15MHz small footprint linear array transducer. The ulnar nerve CSA was measured at three levels with arm extended: at medial epicondyle (ME), 5cm proximal and 5cm distal to ME. Results from the neuropathic and nonneuropathic arms were compared. Independent T-tests and Pearson correlation tests were used. P value of less than 0.05 was considered significant.
RESULTS: Mean CSA values for the UN at levels 5cm proximal to ME, ME and 5cm distal to ME were 0.055, 0.109, 0.045 cm(2) respectively in the neuropathic group and 0.049, 0.075, 0.042 cm2 respectively in the non-neuropathic group. The CSA of the UN at the ME level was significantly larger in the neuropathic group, with p value of 0.005. However, there was no statistical difference between the groups at 5cm proximal and distal to the ME, with p values of 0.10 and 0.35 respectively.
CONCLUSION: There is significant difference in CSA values of the UN at ME between the neuropathic and non-neuropathic groups with mean CSA value above the predetermined 0.10cm(2) cut-off point. High-resolution ultrasonography is therefore useful to diagnose and follow up cases of elbow UNN.