We report a case of a 14-year-old Malay male who fell at school and sustained bilateral olecranon fractures. He had undergone an open reduction and tension band wiring to stabilize the fracture. Three months after the surgery, the movement of both his elbows was satisfactory.
Introduction: Tuberculosis (TB) of the elbow joint is uncommon. Prompt diagnosis and treatment are important to prevent joint destruction and preserve function. We present a case of TB synovitis of the elbow joint in a patient with active rheumatoid arthritis (RA). Case description: A 56-year-old woman with a known seropositive RA on metho-trexate and Leflunomide was seen in the outpatient rheumatology clinic as part of her monthly follow-up. She com-plained of persistent bilateral elbow pain and swelling, despite optimisation of her disease-modifying antirheumatic drugs (DMARD) and steroid therapy. The suspicion for another diagnosis for her elbow symptoms stems from the persistent pain and swelling amidst increased titration of methotrexate and prednisolone dosages. Ultrasound scan of her elbows revealed bilateral complex olecranon bursitis with active synovitis. The left elbow aspiration yielded cloudy yellowish synovial fluid and the sample was sent for fluid culture, acid-fast bacilli (AFB) stain, and GeneXpert. No AFB was seen but the GeneXpert test confirmed the presence of Mycobacterium Tuberculosis. Thus, a diagnosis of TB synovitis of the left elbow was made, and she was promptly started on anti-tubercular therapy (ATT) consisting of Rifampicin, Isoniazid, Ethambutol and Pyrazinamide with the aim to complete 9 months of ATT. Conclusion: The diagnosis of tuberculous synovitis is challenging. In the absence of constitutional or respiratory symptoms, joint TB is usually low on the initial differential diagnosis in patients presenting with joint pain and swelling. The diagnosis is made even more difficult in patients with concomitant rheumatoid arthritis. This case demonstrates the importance of a high index of suspicion for TB, particularly when evaluating patients in high TB prevalence area with an underlying immunosuppressive state.
Introduction: Olecranon osteotomy is well described approach for complex intra-articular distal humeral fractures. In this study, we investigated the usefulness and complications of olecranon osteotomy approach for such fractures. We hypothesise that outcome is comparable in young adults and middle age group and also functional outcome is independent of fracture subtype following surgical fixation. Materials and Methods: Between December 2012 and September 2015, twenty-four adult patients (male: 15, female: 9) having mean age of 41.4 years with closed intra-articular fracture (AO-13C) were surgically managed using olecranon osteotomy approach and were followed-up for a mean of 28.5 months (range: 22-35 months). Functional outcome was measured using Mayo Elbow Performance Score (MEPS) and complications were observed. Statistical analysis was done using Student t-test and Kruskal Wallis test. Results: All fractures united by the end of three months. Mean elbow flexion achieved was 123°, mean extension lag was 9° and mean active arc of motion was 114°. Mean MEPS was 87 (excellent: 8, good: 14, fair: 1 and poor: 1). Post-operative transient ulnar nerve palsy was noted in two cases, heterotopic ossification (HO) was in one case, infection in two cases, implant prominence in five and elbow stiffness in three cases. Motion arc was higher in young adults and MEPS was comparable in both age group. Functional outcome was also dependent on fracture subtype. Conclusion: The olecranon osteotomy approach for distal humerus fractures had good functional outcome with fewer complications. Joint congruity and fixation could easily be assessed intraoperatively.
Melioidosis is a zoonotic disease as a result of infection by Burkholderia pseudomallei. It is of significant public health
concern due to its ubiquitous nature with high morbidity and mortality in humans and animals. In cats, the disease is usually reported
with abscess formation in lung, liver and spleen, however, isolated articular melioidosis is rare. A 1-year-old, a female Domestic
Shorthair cat was presented to University Veterinary Hospital, Universiti Putra Malaysia (UVH-UPM) with swollen right elbow and
non weight bearing lameness of the right forelimb. Physical examination revealed pyrexia, soft tissue swelling and pain upon
palpation of the right elbow joint. Radiographs of the right forelimb revealed osteolysis at the distal third of the humerus and
proximal radius and ulna, cortical thinning at the olecranon and soft tissue swelling around the elbow joint. Bacterial culture of the
joint fluid revealed positive growth for Burkholderia pseudomallei. Unfortunately, the owner opted to euthanise the cat citing
personal reasons. Upon necropsy, there was presence of multiple caseous nodules within the right elbow joint cavity only and none
of the other limbs, lung, spleen and liver was affected. It is important for veterinarian to be aware of septic arthritis and osteomyelitis
form of melioidosis.