Most prognostic factor related to development of traumatic osteonecrosis of femoral head following hip dislocation. Time to relocation or severity of injury?

Femoral head osteonecrosis following hip dislocations has been reported to be directly related to the timing of reduction. Reduction within six hours of injury was reported to lower the risk to 10%. Most previous reports concluded no good results were achieved if reduction is delayed beyond twenty-four hours. In this study, factors which are implicated in the development of traumatic osteonecrosis of femoral head were evaluated. Thirty-eight patients with simple posterior hip dislocation admitted to a single tertiary centre were evaluated. All patients were treated with closed manual reduction. Plain radiograph of the hip was done to screen for occurrence of osteonecrosis of the femoral head. The duration of injury until the last x-ray done must be more than four months post injury. The mean age was 25 years (range 14 to 48 years). Majorities were males (92.1%) and motorcyclists (71.0%). 15.7% had associated femoral head fracture, while 31.6% had posterior acetabular fracture. Time to relocation for 42.1% of cases was less than six hours, with 28.9% of cases were reduced after twelve hours. Mean duration from the onset of injury until last x-ray done was 41 months (range 4 to 99 months). No case of avascular necrosis of the femoral head was reported. All of the hips had good to excellent functional and radiographic outcome. The findings were not consistent with previous reports concluding no good results achieved if reduction is delayed beyond 24 hours. This supports the claim that the severity of injury sustained rather than delay in treatment is the more important factor influencing the occurrence of femoral head osteonecrosis

Clinical factors affecting minor amputation in diabetic foot diseases at Tengku Ampuan Afzan Hospital, Kuantan

Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease. A cross-sectional study enrolling patients admitted to orthopaedic wards of a single tertiary hospital for diabetic foot disease was conducted. Patients who had undergone major amputation or with medical condition above the ankle joint were not included. Clinical data were collected by measurement of ankle brachial systolic index and Semmes-Weinstein 5.07 gauge monofilament test with foot clinical evaluation using King’s classification respectively. The total number of patients included was 138, with mean age of 59.7 years (range 29 to 94 years old). Fifty patients (36.2%) had minor amputations. Poor compliance to diabetic treatment, King’s classification stage 5, low measures of ankle brachial systolic index, sensory neuropathy, high serum C-Reactive protein and high serum creatinine are significant predictive factors for minor amputation (P < 0.05). Identifying these risk factors may help in prevention of minor amputation and subsequently reduce limb loss in diabetic foot

Paediatric cause of back pain in young adult. A case report

Eosinophilic granuloma is a non-neoplastic lesion commonly occurs in paediatric age group, arising from clonal proliferation of Langerhans-type histiocytes. Vertebral involvement has been frequently reported in approximately 10-15% of cases, but involvement of the spinal cord and roots remains a rare occurrence. Patients may present with progressive back pain, with or without neurologic symptoms. We describe an additional case of Langerhans cell histiocytosis (LCH) of the spine in a young adult presented with a progressive back pain with quadriparesis

Langerhans cell histiocytosis with extensive spinal and thyroid gland involvement presenting with quadriparesis: an unusual case in an adult patient

Langerhans cell histiocytosis of the spine frequently presents as a solitary lesion and rarely results in neurological deficit. Involvement of thyroid tissue is also rare, even in multifocal disease presentations. We present an unusual variant of Langerhans cell histiocytosis in a 37-year-old man presenting with profound quadriparesis and incidental thyroid involvement. MR imaging and skeletal radiographs revealed widespread involvement of the spine. The patient underwent surgical resection of the tumour and stabilization of the spine. Diagnosis was confirmed by histological and immunohistochemistry analysis. Langerhans cell histiocytosis should be included in the differential diagnosis of radiolucent lesions of the spine in adults

Preoperative physiotherapy and short-term functional outcomes of primary total knee arthroplasty

Physiotherapy is an important part of rehabilitation following arthroplasty, but the impact of preoperative physiotherapy on functional outcomes is still being studied. This randomised controlled trial evaluated the effect of preoperative physiotherapy on the short-term functional outcomes of primary total knee arthroplasty (TKA). 50 patients with primary knee osteoarthritis who underwent unilateral primary TKA were randomised into two groups: the physiotherapy group (n = 24), whose patients performed physical exercises for six weeks immediately prior to surgery, and the nonphysiotherapy group (n = 26). All patients went through a similar physiotherapy regime in the postoperative rehabilitation period. Functional outcome assessment using the algofunctional Knee Injury and Osteoarthritis Outcome Score (KOOS) scale and range of motion (ROM) evaluation was performed preoperatively, and postoperatively at six weeks and three months. Both groups showed a signi cant difference in all algofunctional KOOS subscales (p 0.05). Signi cant differences were observed in the time-versus-treatment analysis between groups for the symptoms (p = 0.003) and activities of daily living (p = 0.025) subscales. No signi cant difference in ROM was found when comparing preoperative measurements and those at three months following surgery, as well as in time-versus- treatment analysis (p = 0.928). Six-week preoperative physiotherapy showed no signi cant impact on short-term functional outcomes (KOOS subscales) and ROM of the knee following primary TKA

Early functional and radiological outcomes between plaster cast and fiberlass cast in stable thoracolumbar burst fracture

Introduction: Burst fracture results from compression failure of both the anterior and middle columns under substantial axial loads. Conservative treatment was a method of treatment for fractures without neurological deficit. This cross sectional study was designed to evaluate the functional and radiological outcome of patient with thoracolumbar burst fracture treated conservatively. Methods: 40 cases were recruited from January 2013 till December 2015. They were followed-up with minimum period of 1 year and evaluated for the functional (Oswetry Disbility Index) and radiological outcomes (kyphotic angle deformity and anterior body compression). Results: 20 patients were treated with body cast made form plaster of Paris and remaining 20 patients with fiberglass cast. In plaster of Paris group, mean kyphotic angle deformity at last follow up was 16.60 ± 2.95 with a mean improvement 4.45 degree and anterior body compression at last follow up was 30.35% ± 10.2 with mean improvement of 9.30%. In fiberglass group, mean kyphotic angle deformity at last follow up was 15.55 ± 3.38 with a mean improvement 7.25 degree and anterior body compression at last follow up was 25.90% ± 7.81 with mean improvement of 3.45%. The functional outcome showed Oswetry Disability Index (ODI) score in plaster of Paris group was 23.70 (SD = 7.82) and in fiberglass group was 18.50 (SD = 5.94). Conclusions: Application of body cast using a fiberglass material give better radiological outcome hence less pain, more functional and higher patient’s satisfaction as compared to plaster of Paris

Chronic tibial osteomyelitis in children. A case review at Hospital Tengku Ampuan Afzan, Kuantan

Osteomyelitis in children has various clinical manifestations causing diagnostic and therapeutic difficulties. Inappropriate treatment of acute osteomyelitis may lead to chronic, serious and complicated condition. Chronic osteomyelitis continues to be a major cause of morbidity and disability in children living in developing countries. We present three cases of tibial osteomyelitis that have different presentations and sequalae. Our intention is to alert our colleagues, particularly primary physicians, regarding the variety of presentation and the important of early diagnosis and treatment to reduce the risk of morbidity following osteomyelitis

A comparative study of Tualang honey spray versus film spray (OPSITE®) as post-long bone fracture fixation wound dressing

Introduction: Honey-based dressings have a potential benefit in treating wounds in implant-related surgery due to its anti-microbial activities and healing potentials. The aim of the study is to compare Tualang honey spray with film spray (Opsite®) as an alternative dressing material following long bone fracture fixations. This is a preliminary study in Malaysia that involves human subjects. Methodology: This is a randomized, controlled trial involving patients with closed diaphyseal fracture of tibia or femur treated with open reduction and internal fixation (plates or intramedullary devices) at a single tertiary centre. Forty patients were randomly divided into three groups according to the dressing material used; film spray (Opsite®) dressing (n=16), Tualang honey spray (n=13), and control group (n=11). Each group used a same wound protocol except for the control group in which involve application of non-adhesive film (Mepore) only. Dressing materials were applied immediately after surgery and on day three post-surgery. Wound assessment was done on day 14 and day 42 post-surgery. Outcomes evaluated include wound complications, and the effects on skin commensals. On day 42, infection rate (wound dehiscence) and scar formation were also evaluated. Results: There was a case of superficial surgical site infection from the Opsite® spray group. Acinobacter species was isolated from one of the patients under the control group. There was no statistically significant association between dressing methods used and wound healing. All wounds healed without any infection at the end of the study. Tualang honey spray have a significant influence in reducing the risk of hypertrophic scar formation and has similar wound outcomes as compared to Opsite® spray. Conclusion: Tualang honey spray is comparable to the widely used Opsite* spray as a safe alternative for dressing material. Contradict to some previous studies; it promotes good wound healing with a low risk of hypertrophic scar formation