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Fulltext A qualitative and quantitative investigation of the coracoid process of human scapula

Manal Fathi, Ezamin, A.R., Cheah, Pike See, Nizlan, Nasir M., Paisal Hussin, Rozi Mahmud, et al.

Malaysian Journal of Microscopy, 2016;12(1):40-47.
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Coracoid process (CP) bone quality and quantity are two important variables in many successful shoulder surgeries. The goal of this study was to determine the Bone Mineral Density (BMD) and morphometry of CP in Malaysian population using a non-invasive imaging data. Sixty-six (66) shoulders’ computed tomographic (CT) examinations of 132 potential sites were selected. BMD and morphometry of CP was evaluated using e-film. The present study found that there are significant (P
Fulltext Osteomyelitis post acromioclavicular joint reconstruction

Yeak RD, Daud H, Nizlan NM

Chin J Traumatol, 2019 Jun;22(3):182-185.
PMID: 31060897 DOI: 10.1016/j.cjtee.2019.03.004

Acromioclavicular joint (ACJ) injury is a common shoulder injury. There are various techniques of ACJ reconstruction. Superficial infection after ACJ reconstruction is not an uncommon complication. However, osteomyelitis post ACJ reconstruction has never been highlighted as a possible complication. Our patient is a 31-year-old male who sustained a Rockwood 5 ACJ dislocation and had anatomical ACJ reconstruction with autogenous gracilis and semitendinosus graft. Our technique involved the anatomical reconstruction of the ACJ and the coracoclavicular ligament with the usage of two bioscrews and the temporary stabilisation of the ACJ with two k-wires. As in any orthopaedic surgery, infection is often disastrous especially when the surgery involves implants. It can be disastrous with high morbidity to the patient as well as a costly complication to treat. Therefore, we wish to highlight this case as despite its rarity, osteomyelitis can be devastating to the patient and should be prevented if possible.
Fulltext The impact of COVID-19 pandemic on orthopaedic specialty in Malaysia: A cross-sectional survey

Teo SH, Abd Rahim MR, Nizlan NM

J Orthop Surg (Hong Kong), 2020 7 24;28(2):2309499020938877.
PMID: 32700619 DOI: 10.1177/2309499020938877

PURPOSE: This study aims to investigate further how the coronavirus disease 2019 (COVID-19) pandemic is affecting orthopaedic surgeon in Malaysia in terms of exposure, general perceptions of risk, and the impact on their current and future practice.
METHODS: Orthopaedic surgeons nationwide were invited through email and text messages to answer an online self-administered questionnaire collecting demographic information, COVID-19 exposure experience, perception of risk, and impact on orthopaedic practice.
RESULTS: Of the respondents, 4.7% and 14.0% were involved in frontline treatment for COVID-19 patients with non-orthopaedic and orthopaedic problem, respectively. Respondents working in Ministry of Health had highest percentage of involvement as frontliner, 7.8% (8/103) and 20.4% (21/103) for non-orthopaedic and orthopaedic related COVID-19 treatment, respectively (not significant). Their main concern was an infection of family members (125/235, 53.2%). Majority of respondents were still working (223/235, 94.9%), running outpatient clinics (168/223, 75.3%), and continued with their semi-emergency (190/223, 85.2%) and emergency surgeries (213/223, 95.5%). Of the surgeons, 11.2% (25/223) did not screen their patients for COVID-19 prior to elective surgeries, 30.9% (69/223) did not have any training on proper handling of personal protective equipment (PPE), 84.8% (189/223) make decision to manage more conservatively due to COVID-19 and 61.9% (138/223) had their income affected. Of the surgeons, 19.3% (43/223) started using telehealth facilities.
CONCLUSION: Direct exposure to treatment of COVID-19 patients among the respondent is low and the main concern was infecting their family member. There are still several surgeons who did not conduct preoperative COVID-19 screening and practice without proper PPE training.
Fulltext An Unusual Case of Chronic Partial Quadriceps Tear in a Child: A Case Report

Yeak RDK, Yap YY, Nizlan NM

JNMA J Nepal Med Assoc, 2020 Dec 31;58(232):1083-1085.
PMID: 34506395 DOI: 10.31729/jnma.5224

Quadriceps tendon rupture usually occurs in adults and is rare in children. A six-year-old boy was playing at home and had a fall. He was unable to extend his right knee but there was no gap felt over the patella tendon or quadriceps. He was first seen by a family doctor and presented late to the surgeon three months after the injury. Radiographs and ultrasound were performed. The magnetic resonance imaging confirmed the findings of partial quadriceps tear. The patient was put in a cylinder case with the knee in extension for two months. Six months post-injury, he regained full range of motion without any complications. We present an unusual case of partial quadriceps tear in an otherwise healthy six-year-old boy that was treated successfully despite a delayed presentation. Besides a high index of suspicion, magnetic resonance imaging is a good modality to detect partial quadriceps tear in children.
Non-Hodgkin's Lymphoma: An Unusual Cause of Shoulder Pain

Yeak RDK, Yap YY, Nizlan NM

Cureus, 2023 Mar;15(3):e36501.
PMID: 37090410 DOI: 10.7759/cureus.36501

Shoulder pain is a common complaint seen in the orthopedic clinic. Here, we report a rare case of primary extranodal ileocecal with exceedingly rare right shoulder deltoid non-Hodgkin's lymphoma (NHL). A 67-year-old female presented with abdominal swelling for four months associated with loss of appetite, loss of weight, and night sweats. Abdominal contrast-enhanced CT and cecal biopsy confirmed the diagnosis of ileocecal NHL. A right hemicolectomy was performed, and the patient completed six cycles of chemotherapy. The patient developed right shoulder pain with swelling three months later and was diagnosed with a relapse ileocecal lymphoma with dissemination to the right deltoid muscle after a repeat positron emission tomography scan. Clinicians need to consider NHL as a differential diagnosis in evaluating shoulder pain or swelling even though it is exceedingly rare. A partial or non-response to chemotherapy with dissemination to skeletal muscle carries a poor prognosis.
High Sural Nerve Trifurcation: A Rare Anatomical Variation

Tan EK, Alias A, Yeak R, Jaafar MS, Nizlan NM

Cureus, 2022 Oct;14(10):e30606.
PMID: 36426341 DOI: 10.7759/cureus.30606

The sural nerve is a commonly encountered anatomical structure in foot and ankle surgeries. Knowledge of its location and course is imperative in performing surgeries within its vicinity to avoid neurological deficits. We herein report a rare anatomical variation of the sural nerve where it trifurcates above the level of the lateral malleolus that was discovered in a patient who underwent internal fixation for a trimalleolar ankle fracture with ipsilateral navicular fracture. This study aimed to raise awareness on a unique anatomical variation of the sural nerve in order to reduce the risk of iatrogenic injury.