1
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Saw A, Bari S, Robertson NP. Novel biomarkers and neuroimaging techniques in Parkinson's disease. J Neurol 2024; 271:1056-1058. [PMID: 38231269 PMCID: PMC10827888 DOI: 10.1007/s00415-024-12187-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 01/18/2024]
Affiliation(s)
- A Saw
- Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - S Bari
- Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - Neil P Robertson
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK.
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Peh W, Saw A. Artificial Intelligence: Impact and Challenges to Authors, Journals and Medical Publishing. Malays Orthop J 2023; 17:1-4. [PMID: 38107365 PMCID: PMC10723007 DOI: 10.5704/moj.2311.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 12/19/2023] Open
Abstract
Artificial intelligence (AI)-assisted technologies are here to stay and cannot be ignored. These tools are able to generate highly-realistic human-like text and perform a wide range of useful language tasks with a wide range of applications. They have the potential to expedite innovation in health care and can aid in promoting equity and diversity in research by overcoming language barriers. When using these AI tools, authors must take responsibility for the output and originality of their work, as publishers expect all content to be generated by human authors unless there is a declaration to the contrary. Authors must disclose how AI tools have been used, and ensure appropriate attribution of all the text, images, and audio-visual material. The responsible use of AI language models and transparent reporting of how these tools were used in the creation of information and publication are vital to promote and protect the credibility and integrity of medical research, and trust in medical knowledge. Educating postgraduate and undergraduate students, researchers and authors on the applications and best usage of AI-assisted technologies, together with the importance of critical thinking, integrity and strict adherence to ethical principles, are key steps that need to be undertaken.
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Affiliation(s)
- Wcg Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - A Saw
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
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Pritchard G, Deshmukh P, Beerworth K, Saw A, Sims K. Incidence and management of shoulder injuries in female cricket. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Beerworth K, Saw A, Pritchard G, Deshmukh P. Understanding the true burden of shoulder problems in female cricket. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lau CF, Malek S, Gunalan R, Chee WH, Saw A, Aziz F. Paediatric upper limb fracture healing time prediction using a machine learning approach. All Life 2022. [DOI: 10.1080/26895293.2022.2064923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Chia Fong Lau
- Bioinformatics, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Sorayya Malek
- Bioinformatics, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Roshan Gunalan
- Department of Orthopaedics/ NOCERAL, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - WH Chee
- Department of Orthopaedics/ NOCERAL, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - A Saw
- Department of Orthopaedics/ NOCERAL, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Firdaus Aziz
- Bioinformatics, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
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Chung WH, Mihara Y, Toyat SS, Chiu CK, Hasan MS, Saw A, Chan C, Kwan MK. Pre-operative Halo-Pelvic Traction for Neurofibromatosis Patients with Severe Proximal Thoracic Spinal Deformity: Indications and Early Treatment Outcome. Malays Orthop J 2021; 15:99-107. [PMID: 34966502 PMCID: PMC8667250 DOI: 10.5704/moj.2111.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: To report the indications and early treatment outcomes of pre-operative halo-pelvic traction in patients with neurofibromatosis associated with severe proximal thoracic (PT) spinal deformity. Materials and methods: We reviewed four patients with neurofibromatosis with severe PT spinal deformity. Case 1, a 16-year-old male presented with severe PT kyphoscoliosis (scoliosis: 89°, kyphosis: 124°) and thoracic myelopathy. Case 2 was a 14-year-old, skeletally immature male who presented with a PT lordoscoliosis (scoliosis: 85°). Case 3, a 13-year-old male, presented with severe PT kyphoscoliosis (scoliosis: 100°, kyphosis: 95°). Case 4, a 35-year-old gentleman, presented with severe PT kyphoscoliosis (scoliosis: 113°, kyphosis: 103°) and thoracic myelopathy. All patients underwent pre-operative halo-pelvic traction. After a period of traction, all patients underwent posterior spinal fusion (PSF) with autologous bone grafts (local and fibula bone grafts) and recombinant human bone morphogenetic protein-2 (rhBMP-2). Results: Both patients with thoracic myelopathy regained near normal neurological status after halo-pelvic traction. Following traction, the scoliosis correction rate (CR) ranged from 18.0% to 38.9%, while the kyphosis CR ranged from 14.6% to 37.1%. Following PSF, the scoliosis CR ranged from 24.0% to 58.8%, while the kyphosis CR ranged from 29.1% to 47.4%. The total distraction ranged from 50-70mm. Duration of distraction ranged from 26-95 days. The most common complication encountered during halo-pelvic traction was pin-related e.g. pin tract infection, pin loosening and migration, osteomyelitis, and halo-pelvic strut breakage. No patients had cranial nerve palsies or neurological worsening. Conclusion: Pre-operative correction of severe PT spinal deformities could be performed safely and effectively with the halo-pelvic device prior to definitive surgery.
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Affiliation(s)
- W H Chung
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Y Mihara
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia.,Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu-shi, Japan
| | - S S Toyat
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - C K Chiu
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - M S Hasan
- Department of Anaesthesiology, University of Malaya, Kuala Lumpur, Malaysia
| | - A Saw
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Cyw Chan
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - M K Kwan
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
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Lucente A, Saw A, Sims K, Saw R, Kountouris A, Crowther R. Characteristics of elite cricket fast bowlers who do and do not sustain a lumbar bone stress injury: Multifactorial analysis over 4 years. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Predatory journals and conferences have little or no peer review. Their raison d'être is for making money through the article processing charges and the conference registration fees. Without a critical evaluation, predatory journals publishing flawed results and conclusions would cloud the existing scientific literature. Predatory conferences are the offshoots of predatory publishing. The conferences are not organised by learned societies, but by profit-making event organisers. There is a need for awareness among researchers and clinicians regarding predatory publishing. The scourge of predatory publishing and conferencing should be more often highlighted during scientific meetings and publication courses.
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Affiliation(s)
- S Ibrahim
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - A Saw
- Department of Orthopaedic Surgery (NOCERAL), University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Lee BYP, Mazelan A, Gunalan R, Albaker MZA, Saw A. Ponseti method of treating clubfoot - Is there difference if treatment is started before or after one month of age? Med J Malaysia 2020; 75:510-513. [PMID: 32918418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Most of the authors currently agree that congenital talipes equinovarus (CTEV) or idiopathic clubfoot can be effectively treated with the Ponseti method instead of extensive soft tissue surgery. This study was conducted to investigate whether there is a difference in the outcome between starting treatment before one month of age or after that age. METHODS This is a retrospective study on babies with CTEV treated in University Malaya Medical Centre from 2013 to 2017. The 54 babies (35 boys and 19 girls) were divided into two cohorts, Group 1 that had treatment before the age of one month, and Group 2 that had treatment after one month old. The number of cast changes, rate of full correction, and rate of relapse after treatment were compared between the two groups. RESULTS Of the 54 babies, with 77 CTEV treated during the period, our outcome showed that the mean number of cast change was 5.9 for Group 1 and 5.7 for Group 2. The difference was not statistically significant. All the affected feet (100%) achieved full correction. One foot in the Group 1 relapsed, while three feet in Group 2 relapsed, but the difference was also not statistically significant. All of the relapsed feet were successfully treated with repeated Ponseti method. CONCLUSIONS Treating CTEV using Ponseti method starting after one month was not associated with more casting change of higher rate of relapse.
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Affiliation(s)
- B Y P Lee
- University Malaya Medical Centre (NOCERAL), Department of Orthopaedic Surgery, Kuala Lumpur, Malaysia
| | - A Mazelan
- University Malaya Medical Centre (NOCERAL), Department of Orthopaedic Surgery, Kuala Lumpur, Malaysia
| | - R Gunalan
- University Malaya Medical Centre (NOCERAL), Department of Orthopaedic Surgery, Kuala Lumpur, Malaysia
| | - M Z A Albaker
- University Malaya Medical Centre (NOCERAL), Department of Orthopaedic Surgery, Kuala Lumpur, Malaysia
| | - A Saw
- University Malaya Medical Centre (NOCERAL), Department of Orthopaedic Surgery, Kuala Lumpur, Malaysia.
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Tay K, Kamarul T, Lok WY, Mansor M, Li X, Wong J, Saw A. COVID-19 in Singapore and Malaysia: Rising to the Challenges of Orthopaedic Practice in an Evolving Pandemic. Malays Orthop J 2020; 14. [PMID: 32313613 PMCID: PMC7169474 DOI: 10.5704/moj.2007.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/06/2020] [Indexed: 11/05/2022] Open
Abstract
With the increasing number of COVID-19 cases and related deaths worldwide, we decided to share the development of this condition in Singapore and Malaysia. First few cases were diagnosed in the two countries at the end of January 2020, and the numbers have surged to thousands by end of March 2020. We will focus on strategies adopted by the government and also the Orthopaedic community of the two countries up till the beginning of April 2020. We hope that by sharing of relevant information and knowledge on how we are managing the COVID-19 condition, we can help other communities, and health care workers to more effectively overcome this pandemic.
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Affiliation(s)
- K Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - T Kamarul
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - W Y Lok
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - M Mansor
- Department of Anaesthesiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - X Li
- Department of Obstetrics and Gynaecology, KK Women's and Children Hospital, Singapore
| | - J Wong
- Division of Anaesthesiology, Singapore General Hospital, Singapore
| | - A Saw
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Inge P, Orchard J, Kountouris A, Saw A, Sims K, Saw R. Injuries to elite female cricketers in australia over a 4 year period: a comparison to male injury patterns. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Goh S, Saw A, Kountouris A, Orchard J, Saw R. Neurocognitive changes associated with concussion in elite cricket players are distinct from changes due to post-match fatigue. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Cadaveric dissection is an integral component of medical education. There had been concerns about negative impact on medical students exposed to deceased donors before their clinical years, but most studies reported overall positive outcome following this form of teaching. Due to reducing number of body donations in most parts of the world, many institutions are adopting alternative models especially for the teaching of gross anatomy. A new body donation programme that incorporate humanistic values in the procurement process was initiated by Tsu Chi University of Taiwan in 1996. Early observations following teaching with the so-called “silent mentors” noted less negative emotional impact on the students. With increasing number of body donation following the initiation of the silent mentor programme as reported in some regions, we will be able to continue the time-honoured cadaveric dissection for anatomy teaching, at the same time promoting humanistic values on junior doctors.
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Affiliation(s)
- A Saw
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Malek S, Gunalan R, Kedija S, Lau C, Mosleh MA, Milow P, Lee S, Saw A. Random forest and Self Organizing Maps application for analysis of pediatric fracture healing time of the lower limb. Neurocomputing 2018. [DOI: 10.1016/j.neucom.2017.05.094] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Sims K, Kountouris A, Orchard J, Beakley D, Saw A. The relationship between cricket fast bowling workload and lumbar stress fracture. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.09.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bitar KM, Ferdhany ME, Ashraf EI, Saw A. Physical and Clinical Evaluation of Hip Spica Cast applied with Three-slab Technique using Fibreglass Material. Malays Orthop J 2017; 10:17-20. [PMID: 28553442 PMCID: PMC5333678 DOI: 10.5704/moj.1611.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Hip spica casting is an important component of treatment for developmental dysplasia of the hip (DDH) and popular treatment method for femur fractures in children. Breakage at the hip region is a relatively common problem of this cast. We have developed a three-slab technique of hip spica application using fibreglass as the cast material. The purpose of this review was to evaluate the physical durability of the spica cast and skin complications with its use. Methodology: A retrospective review of children with various conditions requiring hip spica immobilisation which was applied using our method. Study duration was from 1st of January 2014 until 31st December 2015. Our main outcomes were cast breakage and skin complications. For children with hip instability, the first cast would be changed after one month, and the second cast about two months later. Results: Twenty-one children were included, with an average age of 2.2 years. The most common indication for spica immobilisation was developmental dysplasia of the hip. One child had skin irritation after spica application. No spica breakage was noted. Conclusion: This study showed that the three-slab method of hip spica cast application using fibreglass material was durable and safe with low risk of skin complications.
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Affiliation(s)
- K M Bitar
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Petaling Jaya, Malaysia
| | - M E Ferdhany
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Petaling Jaya, Malaysia
| | - E I Ashraf
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Petaling Jaya, Malaysia
| | - A Saw
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Petaling Jaya, Malaysia
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Gooi SG, Wang CS, Saw A, Zulkiflee O. Ulnar Osteotomy with 2-Pin Unilateral Gradual Distraction for Treatment of Chronic Monteggia Fracture: A Case Report. Malays Orthop J 2017; 11:79-81. [PMID: 28435583 PMCID: PMC5393123 DOI: 10.5704/moj.1703.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Missed Monteggia fracture leading to chronic radial head dislocation is a known complication. The surgical treatment options remain challenging. The aim of treatment is to reduce the radial head and to maintain the stability of the elbow in all ranges of motion. A few surgical techniques have been described with complications. We report the case of a 13 years old boy with chronic radial head dislocation as a result of an unrecognised Monteggia fracture-dislocation for eight years. We successfully reduced the radial head and corrected the cubital valgus from 45 degrees to 10 degrees with a proximal ulna osteotomy and gradual distraction with 2-pin Monotube external fixator. The correction was uneventful with good functional outcome.
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Affiliation(s)
- S G Gooi
- Department of Orthopaedics, Pulau Pinang Hospital, Georgetown, Malaysia
| | - C S Wang
- Department of Orthopaedics, Pulau Pinang Hospital, Georgetown, Malaysia
| | - A Saw
- National Orthopaedic Center of Excellence for Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - O Zulkiflee
- Department of Orthopaedics, Pulau Pinang Hospital, Georgetown, Malaysia
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Gunalan R, Mazelan A, Lee Y, Saw A. Pattern of Presentation and Outcome of Short-term Treatment for Idiopathic Clubfoot / CTEV with Ponseti Method. Malays Orthop J 2016; 10:21-25. [PMID: 28553443 PMCID: PMC5333679 DOI: 10.5704/moj.1611.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Congenital Talipes Equinovarus (CTEV) is a common congenital foot deformity that is associated with long term disability. Treatment with Ponseti method has been successful especially for children who present early. We conducted this study to investigate the age of presentation of children and report the early outcome. Materials: This is a retrospective study from a single institution. We included 31 patients with 45 idiopathic clubfeet and investigated problems and success rate at the end of serial casting. Results: Mean age at presentation was 4.9 months. The mean number of casting was 6 and mean duration of casting was 2.7 months. The initial success rate of 91.1%, with four feet (8.8%) diagnosed as resistant clubfoot and eventually required soft tissue surgery. With mean follow up of 14.1 months, four other feet (8.8%) developed relapse but were treated with repeat Ponseti method. Conclusion: Many CTEV patients present late for treatment. However, the Ponseti method remained effective with high initial success rate of 91.1%. Relapsed CTEV can still be treated successfully with repeat casting using the Ponseti method.
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Affiliation(s)
- R Gunalan
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Petaling Jaya, Malaysia
| | - A Mazelan
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Petaling Jaya, Malaysia
| | - Ypb Lee
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Petaling Jaya, Malaysia
| | - A Saw
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Petaling Jaya, Malaysia
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Saw A, Main L, Robertson S, Gastin P. Effects of a newly implemented self-report measure on athlete self-regulation. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Corticotomy is an essential procedure for deformity correction and there are many techniques described. However there is no proper classification of the fracture pattern resulting from corticotomies to enable any studies to be conducted. We performed a retrospective study of corticotomy fracture patterns in 44 patients (34 tibias and 10 femurs) performed for various indications. We identified four distinct fracture patterns, Type I through IV classification based on the fracture propagation following percutaneous corticotomy. Type I transverse fracture, Type II transverse fracture with a winglet, Type III presence of butterfly fragment and Type IV fracture propagation to a fixation point. No significant correlation was noted between the fracture pattern and the underlying pathology or region of corticotomy.
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Affiliation(s)
- M Luvan
- Department of Orthopaedic Surgery, Pulau Pinang Hospital, Georgetown, Malaysia
| | - S R Kanthan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - G Roshan
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - A Saw
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Tan B, Shanmugam R, Gunalan R, Chua Y, Hossain G, Saw A. A Biomechanical Comparison between Taylor's Spatial Frame and Ilizarov External Fixator. Malays Orthop J 2014; 8:35-9. [PMID: 25279090 PMCID: PMC4181081 DOI: 10.5704/moj.1407.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ABSTRACT Taylor's spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF. KEY WORDS Taylor's Spatial Frame, Ilizarov External Fixator, Biomechanical properties.
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Affiliation(s)
- Bb Tan
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur
| | - R Shanmugam
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur
| | - R Gunalan
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur
| | - Yp Chua
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur
| | - G Hossain
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur
| | - A Saw
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur
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Saw A, Ng KH. Open Access Publishing in Medicine. Malays Orthop J 2014. [DOI: 10.5704/moj.1403.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Asim AM, Noor Fadzilah R, Rukmanikanthan S, Saw A. Pattern of distal radius fracture in malaysian children. Med J Malaysia 2012; 67:483-486. [PMID: 23770863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The distal radius is the most common fracture site in children, but local information on the fracture pattern, mechanism of injury and socio-demographic characteristics of the fracture is lacking. MATERIAL METHODS We interviewed 126 children and their family members who were under follow up for this fracture in a single institution over a period of 2 years. Radiological images were reviewed to ensure that only those with fracture in the distal one third of the forearm were included. RESULTS The overall incidence of this fracture increased with age, and male dominance was noted starting from schooling age. Most fractures occurred at home (38.8%), and 52.3% of all fractures were due to low energy falls. Sports injuries were mainly due to playing football, and road accidents due to riding bicycles. There were 49 (38.8%) children with incomplete fractures, and 19 (15.0%) with physeal plate fractures. CONCLUSION Male dominance for distal radius fracture occurred at a comparatively younger age in our population. Preventive measures should focus on home environment since this is the most common place for fracture to occur. Special attention should be paid to boys after the school going age.
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Affiliation(s)
- A M Asim
- University Malaya Medical Centre, Department of Orthopaedic Surgery, 59100 Kuala Lumpur, Malaysia.
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Saw A. Malaysian Orthopaedic Journal: The First Five Years. Malays Orthop J 2012. [DOI: 10.5704/moj.1207.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Lee CK, Chua YP, Saw A. Antimicrobial gauze as a dressing reduces pin site infection: a randomized controlled trial. Clin Orthop Relat Res 2012; 470:610-5. [PMID: 21842299 PMCID: PMC3254747 DOI: 10.1007/s11999-011-1990-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 07/08/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pin site infection is a common problem in external fixation. Plain gauze wetted with normal saline is commonly used for a pin site dressing owing to the simplicity and low cost. Evidence to support adding an antimicrobial agent in the dressing material is lacking. QUESTIONS/PURPOSES We compared the rate of pin tract infection using plain gauze and gauze impregnated with polyhexamethylene biguanide in patients undergoing limb lengthening procedures. PATIENTS AND METHODS We included 38 patients (40 limbs) undergoing limb lengthening or deformity correction using an external fixator between July 2009 and June 2010. There were 23 male patients and 15 female patients, with a mean age of 26.3 years (range, 5-68 years). The patients were randomized into two groups: a polyhexamethylene biguanide group (22 limbs) and a control group (18 limbs). The metal-skin interfaces were assessed by a researcher blinded to the type of gauze at 2, 4, 8, and 12 weeks after surgery for the pin site infection based on a predetermined grading system. There were a total of 483 metal-skin interfaces, with 1932 total observations. Infection rates were compared using the chi square test and relative risk with 95% confidence interval. RESULTS The infection rate was lower (χ(2) [1, n = 1932] = 23.00) and the risk for infection was lower (relative risk, 0.228; 95% confidence interval, 0.118, 0.443) for the polyhexamethylene biguanide group (n = 1068; 1.0%) than for the control group (n = 864; 4.5%). CONCLUSIONS Use of polyhexamethylene biguanide-impregnated gauze can reduce the risk of pin tract infection in external fixation. LEVEL OF EVIDENCE Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- C K Lee
- Department of Orthopaedic Surgery, University Malaya Medical Centre, 50603 Kuala Lumpur, Malaysia.
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Hossain MG, Saw A, Ohtsuki F, Lestrel PE, Kamarul T. Change in facial shape in two cohorts of Japanese adult female students twenty years apart. Singapore Med J 2011; 52:818-823. [PMID: 22173252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Secular changes in the head and body dimensions of the Japanese population were recorded during the last century, but studies on Japanese adult facial shape were poorly documented. This study aimed to document the secular changes in facial shape and their association with craniofacial measures of Japanese adult female students. METHODS Data were collected from 1998-2001 and 1975-1979 from institutions in Tokyo and Kyoto. The prosopic index (PI) was derived from morphological facial height (n-gn) and bizygomatic breadth (zy-zy). Multiple regression analysis was used to determine the association between PI (facial form) and craniofacial measures. RESULTS Larger mean values for morphological facial height (n-gn) and for PI, but smaller values for bizygomatic breadth (zy-zy) and bigonial breadth (go-go) were observed in the current sample compared to their predecessors 21 years ago. The most prevalent facial shapes were mesoprosopic (30.53 percent) and euryprosopic (45.14 percent) for the current and previous series, respectively. There was a significant positive relationship between the PI and head length (g-op) (p less than 0.01), head breadth (eu-eu) (p less than 0.01) and head height (v-po) (p less than 0.05), and a negative relationship between the PI and head circumference (g-g) (p less than 0.01) and minimum frontal breadth (ft-ft) (p less than 0.01). CONCLUSION Our results suggest that a narrowing of facial shape has been occurring for approximately 21 years in adult Japanese females. The best predictor variables for PI were head length, head circumference, head breadth, minimum frontal breadth and head height.
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Affiliation(s)
- M G Hossain
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur 50603, Malaysia
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Chua YP, Kwan MK, Ng WM, Saw A. Use of the Tip-Apex Distance in predicting Dynamic Hip Screw Cut Out in Intertrochanteric Fracture of the Femur in Asian Population. Malays Orthop J 2011. [DOI: 10.5704/moj.1107.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Saw A, Sallehuddin AY, Chuah UC, Ismail MS, Yoga R, Hossain MG. Comparison of fracture patterns between rural and urban populations in a developing country. Singapore Med J 2010; 51:702-708. [PMID: 20938610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The pattern of fracture, including the anatomical location and age distribution, may differ among urban and rural populations due to various factors such as the inhabitants' occupation and living environment. METHODS This was a retrospective multicentre study involving two urban and three rural hospitals in Malaysia. The demographic data and anatomical location of fracture of patients admitted in 2007 were collected for analysis. RESULTS A total of 7,973 patients were admitted for fractures between January and December 2007. The femur was the commonest fracture site that required admission in the urban population (21.9 percent), followed by the tibia-fibula (18.7 percent), while the radius-ulna was the commonest site among the rural population (22.0 percent), followed by the tibia-fibula (19.4 percent). The rates of head and pelvic fractures were comparatively higher in the urban population, while hand fractures were more common in the rural population. The higher rate of femur fracture in the urban group, especially among the elderly, may be due to the higher incidence of osteoporosis or a higher proportion of older people in the population. CONCLUSION The anatomical locations of common fractures differed between the urban and rural populations. A higher rate of upper limb fractures was observed in the rural areas, while femur fractures in the elderly was the main cause of fracture admission in the urban areas. The relatively high rate of hand fractures in the rural areas, especially among children and young adults, may require further investigation.
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Affiliation(s)
- A Saw
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Lembah Pantai, Kuala Lumpur 59100, Malaysia.
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Abstract
PURPOSE To compare infection rates associated with 2 dressing solutions for metal-skin interfaces. METHODS 60 patients who underwent distraction osteogenesis with external fixators were equally randomised into 2 dressing solution groups (diluted povidone-iodine vs. saline). Fixations were attained using either rigid stainless steel 5-mm diameter half pins or smooth stainless steel 1.8-mm diameter wires. Half-pin fixation had one metal-skin interface, whereas wire fixation had 2 interfaces. Patients were followed up every 2 weeks for 6 months. RESULTS Of all 788 metal-skin interfaces, 143 (18%) were infected: 72 (19%) of 371 in the diluted povidone-iodine group and 71 (17%) of 417 in the saline group. Dressing solution and patient age did not significantly affect infection rates. Half-pin fixation was more likely to become infected than wire fixation (25% vs 15%). CONCLUSION Saline is as effective as diluted povidone-iodine as a dressing solution for metal-skin interfaces of external fixators. Saline is recommended in view of its easy availability and lower costs.
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Affiliation(s)
- C K Chan
- Department of Orthopaedic Surgery, Hospital Kuching, Malaysia
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Saw A, Manimaran S, Faizal S, Bulgiba AM. Use of Radiographic Densitometry to Predict the Bone Healing Index in Distraction Osteogenesis. Malays Orthop J 2008. [DOI: 10.5704/moj.0804.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Sallehuddin A, Saw A, George J, Sengupta S. Ultrasound-guided Percutaneous Trucut Needle Biopsy for Musculoskeletal Tumours. Malays Orthop J 2008. [DOI: 10.5704/moj.0804.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Yong SM, Saw A, Sengupta S, Bulgiba AM. Bone Overgrowth after Fracture of the Femoral Shaft in Children. Malays Orthop J 2007. [DOI: 10.5704/moj.0705.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tan WJ, Kwan MK, Deepak AS, Saw A, Peng BC, Jalalullah W. Size of interlocking nails used in the treatment of diaphyseal femoral fractures. Med J Malaysia 2006; 61 Suppl B:18-22. [PMID: 17600988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Fracture of the femur is most commonly treated with interlocking nailing. We conducted this study to describe and analyze the size of femoral interlocking nails used in our local population. This is a retrospective study on reamed intramedullary interlocking nailing procedures performed between 1st July 1998 and 30th June 2003. Demographic data, the diameter and length of femoral nails used were obtained from patient's medical record. A total of 267 procedures were included. The most common diameter used was 10 mm (56.9%), followed by 11 mm (27.0%) and 12 mm (13.1%). Only 2.6% of the nails were less than 10 mm in diameter. The most common nail length was 38 cm (31.1%), followed by 36 cm (24.9%) and 40 cm (19.5%). The longest nail used was 46 cm while the shortest 32 cm. The most commonly used femoral nails were of 10 mm diameter with the length ranging from 36 to 40 cm, which is smaller than those reported in the English literature. Nails with diameter smaller than 10 mm were required in 2.6% of patients.
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Affiliation(s)
- W J Tan
- Department of Orthopaedic Surgery, University Malaya Medical Centre, 50603 Kuala Lumpur, Malaysia
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Ling HT, Kwan MK, Saw A, Choon DSK. Total knee replacement subsequent to severe necrotising fasciitis of the lower limb. Med J Malaysia 2006; 61:380-2. [PMID: 17240598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The incidence of wound related complication following total knee arthroplasty is as high as 10%-20%. To perform total knee arthroplasty in a knee with extensive scarring around the knee can be a challenging task. We report a case of 55-year-old diabetic woman, who had total knee arthroplasty, performed two years after she had recovered from necrotizing fasciitis around the right knee. Understanding the vascular anatomy around the knee is of paramount importance in the planning of skin incision to ensure fewer wound related complications.
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Affiliation(s)
- H T Ling
- Department of Orthopaedic Surgery, University Malaya Medical Center, 50603 Kuala Lumpur
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Saw A, Chan CK, Penafort R, Sengupta S. A simple practical protocol for care of metal-skin interface of external fixation. Med J Malaysia 2006; 61 Suppl A:62-5. [PMID: 17042233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Patients treated with external fixation for limb reconsturciton or fracture stabilization equire regular and prolongedperiod of pin-tract care involving frequent visits to clinic and dressing traditionally carried out by trained nurses or medical assistants. A simple method of do-it-yourself dressing was introduced in our institution and this study was undertaken to evaluate the effectiveness of the protocol. Sixty patients (40 trauma-related problems and 20 congenital or developmental disorders) were enrolled into the study. Following application of external fixation, the patients and/or their caretakers were taught on how to do pin-site dressing using normal saline or drinking water as cleansing solution on daily basis. Patients were discharged on the second or third post-operative day and were followed-up every two weeks for an average 182 days (range 66 to 379 days) with special attention on identifying pin-tract infection. A simple grading system for pin-tract infections was proposed. Of 40 patients with trauma-related problems. 65% were post-traumatic infections. There were 788 metal-skin interfaces (239 half-pin fixations and 549 tensioned wire fixations. A total 143 metal-skin interface infections (18.1%) involving half-pin sites (41.3%) and tensioned wire sites (58.7%) was noted. Majority were grade I infections (79.7%), 18.8% grade II and only 1.4% grade III. Most infections (81%)were caused by Staphylococcus aureus. Grade I infections were successfully treated with frequent dressing, grade II by adjunctive oral antibiotic but grade III infections required removal of fixator. All eventually healed. Do yourself non-sterile dressing of metal-skin interfaces is a cost-effective method of pin-site care with a low infection rate. The infections were sucessfully treated using guidelines according to the proposed classification of pin-tract infections.
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Affiliation(s)
- A Saw
- Department of Orthopaedic Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia
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Kwan MK, Saw A, Chee EK, Lee CS, Lim CH, Zulkifle NA, Saarey NH, Mohamad Hussien MN. Necrotizing fasciitis of the lower limb: an outcome study of surgical treatment. Med J Malaysia 2006; 61 Suppl A:17-20. [PMID: 17042223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Necrotizing fasciitis is a limb- and life-threatening rapidly spreading infection affecting the deep fascia with secondary necrosis of the subcutaneous tissue. It requires immediate medical attention and emergency surgery to prevent morbidity and death. This study was undertaken to determine its co-morbidity and risk factors affecting the outcome of its surgical treatment. This is a retrospective review of 36 cases of necrotizing fasciitis of the lower limb treated in our center between 1998 and 2002. Only 19% of the cases were correctly diagnosed upon admission and 48.6% were initially diagnosed as 'cellulitis'. Diabetes mellitus was the most common co-morbid. Pseudomonas, Staphylococcus, Streptococcus and Enterobactericae were the common pathogens isolated. Ten patients (27.8%) had major amputation as part of radical debridement. The overall mortality rate was 36% with laboratory parameters: high serum urea and creatinine, and low haemoglobin levels were predictors for higher mortality. Poor white cell response which is common in diabetic patients and a delay in surgical debridement were. notable attributes to a higher mortality. Necrotizing fasciitis is a serious infection associated with significant morbidity and mortality. A poor white blood cell response, high serum urea and creatinine, and low haemoglobin level were the predictors for mortality. Early diagnosis and prompt treatment are of paramount importance in the treatment of this infection.
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Affiliation(s)
- M K Kwan
- Department of Orthopaedic Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Chua YP, Kwan MK, Saw A. Operative treatment of trochanteric fractures with dynamic hip screw--is perioperative blood transfusion needed? Med J Malaysia 2005; 60 Suppl C:78-82. [PMID: 16381289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The need for perioperative blood transfusion in elderly patients with trochanteric fracture scheduled for elective dynamic hip screw fixation has recently been questioned following reports on the association between allogeneic blood transfusion and post-operative infections. This retrospective study was undertaken to assess the amount of per operative blood loss and transfusion requirement in relation to pre-operative haemoglobin level in 198 patients with trochanteric fractures. The average per operative blood loss was 409 ml and it correlated well with the duration of the operation. More than half of the patients (52.5%) required blood transfusion and nearly three-quarters were anaemic prior to the surgery. Proactive pre-operative measures to optimize the patient's haemoglobin level and intra-operative minimization of blood loss are essential steps to obviate the need for perioperative allogeneic blood transfusion.
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Affiliation(s)
- Y P Chua
- Department of Orthopaedic Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia
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Sharaf I, Saw A, Hyzan Y, Sivananthan KS. The Malaysian Orthopaedic Association humanitarian mission to Indonesia and Sri Lanka. Med J Malaysia 2005; 60 Suppl C:3-7. [PMID: 16381273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The tsunami which occurred off the west coast of North Sumatra on December 26, 2004 devastated the coastal areas of North Sumatra, South-West Thailand, South-East India and Sri Lanka killing more than a quarter of a million people. The destruction was enormous with many coastal villages destroyed. The other countries affected were Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Kenya, Tanzania and the Seychelles. In January 2005, volunteers went in weekly rotation to Banda Aceh in collaboration with Global Peace Mission. These were Dr Hyzan Yusof, Dr Suryasmi Duski, Dr Sharaf Ibrahim, Dr Saw Aik, Dr Kamariah Nor and Dr Nor Azlin. In Banda Aceh, the surgical procedures that we could do were limited to external fixation of open fractures and debriding infected wounds at the Indonesian Red Crescent field hospital. In February, a team comprising Dato Dr K S Sivananthan, Dr T Kumar and Dr S Vasan spent a week in Sri Lanka. In Sri Lanka, Dato Sivananthan and his team were able to perform elective orthopaedic operations in Dr Poonambalam Memorial Hospital. We appealed for national and international aid and received support from local hospitals and the orthopaedic industry. International aid bound for Banda Aceh arrived in Kuala Lumpur from the Philippine Orthopaedic Association, the Chiba Children's Hospital in Japan and the Chinese Orthopaedic Association. The COA donated 1.5 tons of orthopaedic equipments. A special handing over ceremony from the COA to the Indonesian Orthopaedic Association was held in Putrajaya in March. Malaysia Airlines flew in the donated equipment to Kuala Lumpur while the onward flight to Aceh was provided by the Royal Malaysian Air Force. In April, Dr Saw Aik and Dr Yong Su Mei joined the Tsu-Chi International Medical Association for volunteer services on Batam Island, Indonesia. The MOA acknowledges the many individuals and organizations, both governmental and non-governmental, for their contributions in the humanitarian efforts.
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Affiliation(s)
- I Sharaf
- Humanitarian Committee, Malaysian Orthopaedic Association, Kuala Lumpur, Malaysia
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Saw A. Extracorporeal shock wave therapy for musculoskeletal pathology--a literature review. Med J Malaysia 2005; 60 Suppl C:8-10. [PMID: 16381274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
For more than two decades extracorporeal shock wave lithotripsy has emerged as the standard therapy for calculi in the kidney and urinary tract, and biliary system. Application of extracorporeal shock waves in orthopaedics involves treatment of recalcitrant chronic pain of plantar fasciitis, tennis elbow and calcifying tendonitis of the shoulder. This review explores current evidence-based issues related to its potential use as a treatment option for some musculoskeletal conditions.
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Affiliation(s)
- A Saw
- Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Kwan MK, Ng ES, Penafort R, Saw A, Sengupta S. Resection arthrodesis for primary bone tumour about the knee. Med J Malaysia 2005; 60 Suppl C:66-71. [PMID: 16381287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Bone defect following en bloc resection of primary bone tumor around the knee can be reconstructed by allograft or prothesis or combination of both. Resection-arthrodesis is an alternative option for young vigorous patients facing circumstances of financial constrain or limited supply of allograft. This study was undertaken to determine the outcome and complications associated with resection-arthrodesis of 22 primary bone tumors (13 giant cell tumors and 9 osteosarcomas) around the knee treated between 1990 and 2003 at the University Malaya Medical Center. The mean follow-up was 6 years (range 1-13 years). hree patients with osteosarcoma died of lung metastasis, 3 required above knee amputation and 2 defaulted follow-up. Local complications of the procedure include infection in 8 cases (36.4%), non-union 7 (31.8%) and mal-union. Of 14 patients who returned for final evaluation, 79.8% had satisfactory outcomes according to the Musculoskeletal Tumor Society grading system. In conclusion, resection-arthrodesis of the knee is a viable treatment option for selected patients with primary bone tumor around the knee, and good functional outcome can be expected in the presence of short-term local complications.
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Affiliation(s)
- M K Kwan
- Department of Orthopaedic Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia
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Kwan MK, Saw A, Sara Ahmad T. Automatic top loader washing machine related injury. A report of four cases with serious injury. Med J Malaysia 2005; 60:112-4. [PMID: 16250295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We are reporting four cases of serious washing machine related injury that presented within a period of 5 months. All patients were young children with the mean age of 9 year-old and three had their dominant hand injured. The washing machines involved were the automatic top loader type and all injuries occurred during the spinning phase. Serious automatic washing machine injury is not uncommon in Malaysia. We feel that there is a need to improve the safety features especially during the spinning phase. The operating instructions and safety precautions on the washing machine should be displayed in different languages that can be understood well. Parents should also aware of the potential risks of this seemingly benign household appliance.
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Affiliation(s)
- M K Kwan
- Department of Orthopaedic Surgery, University Malaya Medical Center, 50603 Kuala Lumpur
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Kwan MK, Penafort R, Saw A. Treatment for flexion contracture of the knee during Ilizarov reconstruction of tibia with passive knee extension splint. Med J Malaysia 2004; 59 Suppl F:39-41. [PMID: 15941159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Joint stiffness is one of the complications of limb procedure. It developes as a result of failure of knee flexors to lengthen in tandem with the bone, especially when there is inadequate physical therapy to provide active and passive mobilization of the affected joint. We are reporting four patients who developed fixed flexion contracture of their knees during bone lengthening procedure for the tibia with Ilizarov external fixator. Three of them were treated for congenital pseudoarthrosis and one was for fibular hemimelia. None of them were able to visit the physiotherapist even on a weekly basis. A splint was constructed from components of Ilizarov external fixator and applied on to the existing frame to passively extend the affected knee. Patients and their family members were taught to perform this exercise regularly and eventually near complete correction were achieved. With this result, we would like to recommend the use of this "Passive Knee Extension Splint" to avoid knee flexion Contracture during limb lengthening procedures with Ilizarov external fixators.
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Affiliation(s)
- M K Kwan
- Department of Orthopaedic Surgery, University Malaya Medical Center, Kuala Lumpur
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Foead A, Penafort R, Saw A, Sengupta S. Comparison of two methods of percutaneous pin fixation in displaced supracondylar fractures of the humerus in children. J Orthop Surg (Hong Kong) 2004; 12:76-82. [PMID: 15237126 DOI: 10.1177/230949900401200114] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To conduct a prospective randomised controlled study to compare the stability and risk of nerve injury between fractures treated by medial-lateral pin fixation and those treated by 2-lateral pin fixation. METHODS Patients with displaced supracondylar fractures admitted between May 2000 and December 2001 were recruited into the study. They were randomised to treatment either with medial-lateral pin fixation (n=34) or with 2-lateral pin fixation (n=32). RESULTS 66 children with the mean age of 5.78 years were admitted during the study period. 11 of them were lost to follow-up. The mean follow-up period of the remaining 55 patients was 8.93 months. The difference in the carrying angle between injured and normal elbows was 3.57 degrees and 3.70 degrees in medial-lateral pin fixation and 2-lateral pin fixation, respectively. The extension and flexion loss was 7.14 degrees and 8.68 degrees respectively in medial-lateral pin fixation, and 7.11 degrees and 11.26 degrees respectively in 2-lateral pin fixation. The Baumann angle difference was 5.96 degrees in medial-lateral pin fixation, and 5.30 degrees in 2-lateral pin fixation. The difference in the medial epicondylar epiphyseal angle was 6.07 degrees in medial-lateral pin fixation and 6.92 degrees in 2-lateral pin fixation. Statistical analyses show that these differences are not significant. Five iatrogenic ulnar nerve injuries developed in the group treated by medial-lateral pin fixation, while 2 ulnar nerve and one radial nerve injuries were seen after 2-lateral pin fixation. Again the differences were not statistically significant. CONCLUSION Both methods of fixation were comparable in terms of stability, duration of bone healing, and risks of injury to the nerve.
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Affiliation(s)
- A Foead
- Department of Orthopaedic Surgery, University Malaya Medical Center, 50603 Kuala Lumpur, Malaysia
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Saw A, Kwan MK, Sengupta S. Necrotising fasciitis: a life-threatening complication of acupuncture in a patient with diabetes mellitus. Singapore Med J 2004; 45:180-2. [PMID: 15094988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Acupuncture is used for some conditions as an alternative to medication or surgical intervention. Several complications had been reported, and they are generally due to physical injury by the needle or transmission of diseases. We report a case of life-threatening necrotising fasciitis that developed after acupuncture treatment for osteoarthritis of the knee in a 55-year-old diabetic woman. She presented with multiple discharging sinuses over the right knee. As the patient did not respond to intravenous antibiotics, extensive debridement was performed. She made a good recovery. Since many old diabetic patients with degenerative joint diseases may consider this mode of treatment, guidelines on cleanliness and sterility of this procedure should be developed and practiced.
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MESH Headings
- Acupuncture Therapy/adverse effects
- Acupuncture Therapy/methods
- Anti-Bacterial Agents
- Combined Modality Therapy
- Critical Illness
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/diagnosis
- Drug Therapy, Combination
- Fasciitis, Necrotizing/diagnosis
- Fasciitis, Necrotizing/etiology
- Fasciitis, Necrotizing/microbiology
- Fasciitis, Necrotizing/therapy
- Female
- Follow-Up Studies
- Humans
- Lower Extremity
- Middle Aged
- Osteoarthritis, Knee/complications
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/therapy
- Pseudomonas Infections/diagnosis
- Pseudomonas Infections/etiology
- Pseudomonas Infections/therapy
- Risk Assessment
- Skin Transplantation
- Treatment Outcome
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Affiliation(s)
- A Saw
- Department of Orthopaedic Surgery, University of Malaya Medical Centre, Kuala Lumpur 59100, Malaysia.
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48
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Abstract
PURPOSE To evaluate outcome following supracondylar nailing for distal femur fractures. METHODS The clinical and radiological outcome for 13 patients treated between January 1995 and December 1998 at the University Malaya Medical Center was assessed. Patients were seen for follow-up for a mean duration of 20.2 months. RESULTS There were no cases of non-union or infection. Overall assessment of clinical outcome based on the criteria of Schatzker and Lambert was graded excellent in 6 patients, good in 3 patients, fair in 3 patients, and one graded as a failure. CONCLUSION Supracondylar nailing for fixation of supracondylar (Arbeitsgemeinschaft für Osteosynthesefragen [AO] type A) and less comminuted intercondylar (AO type C1 and C2) fractures is recommended by the authors.
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Affiliation(s)
- A Saw
- Department of Orthopaedic Surgery, University Malaya Medical Center, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
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49
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Abstract
PURPOSE To review cases of giant cell tumour of bone or osteoclastoma managed at the University Malaya Medical Center, University of Malaya, Kuala Lumpur, from January 1990 to December 1999. METHODS Medical records of all patients with musculoskeletal tumours were reviewed. Demographic data, clinical presentation, surgical management, and clinical outcomes were reviewed retrospectively. RESULTS Most of the 31 patients who were treated for giant cell tumour of bone presented late on the basis of the duration of their symptoms and radiological features. Five of the patients had been referred for local recurrences. 26 patients were treated for primary tumours: 18 needed wide excision, 7 curettage, and one amputation. The joint could not be preserved and arthrodesis was performed for 11 patients. Three (12%) of the 26 patients had local recurrence during a mean follow-up of 60 months, including one (6%) who had recurrence after wide excision and 2 (29%) after curettage. Pulmonary metastasis was noted in 4 cases, 2 of which were confirmed histologically. CONCLUSION Even in an advanced stage of disease, good clinical outcomes can be achieved with adequate excision and appropriate reconstruction. For lesions around the knee, autologous rotational grafting is a good alternative method of reconstruction.
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Affiliation(s)
- E S Ng
- Department of Orthopedic Surgery, University Malaya Medical Center, University of Malaya, Kuala Lumpur, Malaysia
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50
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Saw A, Mackie PS, Choong PF. Adamantinoma and meningioma occurring synchronously in a patient with breast cancer: a case report. Clin Orthop Relat Res 2001:400-3. [PMID: 11716414 DOI: 10.1097/00003086-200111000-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Screening mammography of a woman with no symptoms led to the diagnosis of carcinoma of the breast, an intracranial meningioma, and adamantinoma of the right tibia. This is the first reported case of three synchronous primary tumors of different tissue origins. Biopsy is essential for diagnosing or excluding primary tumor(s) in cases of suspected metastases occurring at a limited number of sites.
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Affiliation(s)
- A Saw
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Victoria, Australia
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