A Prospective Multicenter Randomized Controlled Trial to Evaluate the Efficacy of Chitosan Hydrogel Paste in Comparison to Commercial Hydroactive Gel as a Wound Bed Preparation.

Background This clinical trial aimed to evaluate the clinical efficacy of chitosan derivative hydrogel paste (CDHP) as a wound bed preparation for wounds with cavities. Methods This study enrolled 287 patients, with 143 patients randomized into the CDHP group (treatment) and 144 patients randomized into the commercial hydroactive gel (CHG) group (control). The granulation tissue, necrotic tissue, patient comfort, clinical signs, symptoms, and patient convenience during the application and removal of the dressing were assessed. Results The study was completed by 111 and 105 patients from the treatment and control groups, respectively. Both groups showed an increasing mean percentage of wound granulation over time when the initial wound size and comorbidity were adjusted (F(10,198) = 4.61; p < 0.001), but no significant difference was found between the groups (F(1,207) = 0.043; p = 0.953). The adjusted mean percentage of necrotic tissue of both groups showed a significant decrease over time (F(10,235) = 5.65; p <0.001), but no significant differences were found between the groups (F (1,244) = 0.487; p = 0.486). Conclusion CDHP is equivalent to CHG and is an alternative in wound management and wound bed preparation for wounds with cavities.

The outcome of type 1 pelvic resection and reconstruction with pedicle screw-rod system without bone grafting in malignant pelvic tumour: A case series and short term review.

INTRODUCTION: There is no consensus regarding the reconstruction method for type 1 resections around the pelvis. Various methods are currently used, such as resection without reconstruction, bone graft (autologous, recycled, allograft) with simple fixation, and pedicle screw-rod fixation with or without bone grafting. We aim to study the outcome of pedicle screw-rod reconstruction without bone grafting in type 1 pelvic resections involving sacroiliac joint to show that pedicle screw-rod construct alone is stable and has low risk of failure. MATERIAL AND METHODS: This is a retrospective review of eight patients who underwent type 1 resection of malignant pelvic tumours and reconstruction with a pedicle screw-rod system between 2011 and 2018. All patients who underwent type 1 resection and reconstruction with pedicle screw without bone grafting were included into this study. We reported their clinical (complication and radiological outcome), oncological (local recurrence and metastasis), and functional outcome based on Musculoskeletal Tumour Society Score (MSTS) and The Toronto Extremity Salvage Score (TESS) at their last follow-up. RESULTS: Eight patients were recruited into the study. The mean follow-up period was 58.5 months (range: 40 - 121 months). There were three postoperative complications in three different patients: superficial infection, surgical hernia with ipsilateral femoral avascular necrosis (AVN), and femoral nerve injury. At the end of the study period, one patient passed away due to disease progression, one patient was alive with disease, and the rest were disease-free. Mean MSTS score during last follow-up was 77.1% (range: 66.7% - 93.3%), while mean TESS score was 75.6% range (63.3% - 80.2%). There were no cases of implant failure. CONCLUSION: Type 1 pelvic reconstruction with a pedicle screw-rod system is stable without a concurrent biological reconstruction, and it is feasible, with few complications, and an excellent functional outcome.

Fracture Risk Factor in Post-Menopausal Women with Deterioration of Bone Density.

Background: Most of the aged women experience the deterioration of bone due to the gradual decrease in bone mineral density (BMD). According to different studies, a continuous progressive decline in bone density results in risks of fractures. Aims: The study aimed to identify the fracture risk factors among post-menopausal women with the deterioration of bone density. Settings and Design: Cross-sectional study design was used, and was conducted clinic at Hospital Tengku Ampuan Afzan (HTAA) Kuantan, Pahang, Malaysia. Methods: In total, 116 post-menopausal women were selected as a sample from a public hospital in Malaysia. An assessment checklist on fracture risks; including age, menopause year, BMD, serum calcium level, balance and gait score, body mass index (BMI) was used to collect data. Descriptive statistics and Pearson correlation were used to analyze data. Results: Findings showed that 87.1% participants confidently performed daily activities. Normal TUG score was revealed for 76.7%, and Fall Free Prevention Questionnaire (FFPQ) findings show that no risk of falling prevailed. Pearson correlation showed negative weak correlation between BMD with the age of respondents, year of menopause and TUG (r = -.373), (r = -. 284) and (r = -.237). Moderate correlation was found between BMD in BMI status (r = .343) and weak correlation was found between BMD and ABC scale (r = .200). Conclusions: The study emphasized on instigation of the intervention to improve population literacy related to menopause and bone density deficiency.

Genesis and Symptom Interval of Osteosarcoma Following High-Energy Trauma.

We report three cases of femoral fracture, which subsequently developed osteosarcoma within the course of illness. The first patient presented with a spiral fracture treated with an interlocking femoral nail. He presented five months later with a painful knee swelling and was diagnosed with osteosarcoma. He was asymptomatic despite initial radiographs showed osteolysis at the distal metaphysis. The fracture united well and no evidence of marrow or soft tissue contamination. The second patient had a distal femoral fracture and underwent plate stabilization. Osteosarcoma developed at the united fracture site three years later. Both survived six to seven years without evidence of disease following the standard treatment protocol. The third patient had a closed distal third fracture treated with dynamic compression plating. He presented with an osteoblastic lesion in the proximal femur three years later. There was no initial radiological evidence of osteosarcoma one year before the clinical manifestation of the disease.

Correlation Study Between Clinical Special Tests for Myelopathy and Static MRI Parameters in Patients of Malaysian Population Treated for Cervical Dysfunction.

INTRODUCTION: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction. Magnetic resonance imaging (MRI) remains the imaging modality of choice, but its findings are not completely specific for clinically significant CSM. This cross-sectional study aims to determine the pathoanatomy of CSM in patients and analyze the correlations between clinical key symptoms, myelopathic signs, and MRI findings. METHODS: Patients with CSM aged 30 to 80 years old with no previous cervical spine disease or injuries were recruited. Clinical parameters include myelopathic hand signs and other clinical-specific tests. The MRI findings were analyzed for level of compression, underlying degenerative pathology, and parameters for cord compression. RESULTS: Thirty patients were recruited. The most common myelopathic signs observed were positive Hoffmann's sign and the presence of reverse brachioradialis reflex. All patients had either degenerative or prolapse disc changes on MRI. There was a positive correlation between the clinical key features with MRI parameters for canal and cord diameter. The transverse cord diameter, cord compression ratio, and approximate cord area were the only independent variables related to almost all the positive clinical specific tests. All three have a moderate to strong correlation with the clinical findings. CONCLUSION: The MRI parameters such as canal and cord size of the cervical spine are an objective reflection of compression on the spinal cord. Correlations observed indicate cord compression that plays a major role in the pathophysiology of CSM. These measurements are sensitive indicators of canal stenosis and play a significant role in predicting the severity and outcome of CSM.

Knowledge and Attitudes of Maintaining Bone Health among Post-Menopausal Women in Malaysia.

INTRODUCTION: Public awareness of osteoporosis is low among women in the developing countries. Health education was shown to be effective in improving knowledge and awareness on maintaining bone health. This study aims to identify the level of knowledge and attitudes among post-menopausal women in Malaysia on achieving bone health throughout the menopausal transition period. METHODS: A total of 116 post-menopausal female patients of orthopedic menopause clinic were recruited using a purposive sampling approach. Data on osteoporosis awareness and knowledge were collected using validated structured questionnaires Osteoporosis Prevention and Awareness Tool and Osteoporosis Attitude Knowledge Test. The chi-square test was used to determine the association between post-menopausal women's socio-demographic characteristics and their knowledge and attitude towards maintaining bone health. RESULTS: Participants' age ranged between 49 and 82 years (61.84, SD=7.87). The knowledge of osteoporosis varied significantly by age (p=0.014) and education (p=0.001) among the studied population. No significant diffrences were found for participants' attitude towards bone health. CONCLUSION: This study showed that the age and education levels have significantly different knowledge of bone health.

Fracture risk prediction in post-menopausal women with osteopenia and osteoporosis: preliminary findings

Objective: The study aims to identify the risk of obtaining a fracture among post-menopausal women with osteopenia and osteoporosis. Method: This work was a cross-sectional study involving a purposive sample of 87 post-menopausal women who attended the orthopedic and menopause clinics of Hospital Tengku Ampuan Afzan, Kuantan. The data were entered into the WHO fracture risk assessment tool (FRAX®) to predict major fracture and risk for hip fracture in 10 years' time. Results: The mean age of the respondents was 61.6 years (SD=7.9). Among the respondents, 50.6% had osteopenia and nearly half (48.3%) had osteoporosis. The mean number of menopausal years of the respondents was 11.9 (SD=8.5), ranging between 1 and 44 years. The FRAX findings indicated 9.7% major osteoporotic fracture probability and 3.5% hip fracture probability, which were denoted as high risk. A Pearson correlation coefficient was computed to assess the relationship between menopausal years and the FRAX major osteoporotic fracture probability. A significant positive correlation was found between the two, but the correlation was weak (r=0.581, n=87, p < 0.001). Conclusions: The present findings indicate that menopausal years have a positive correlation with the risk of obtaining a fracture

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A Rare Case of Monostotic Spinal Fibrous Dysplasia Mimicking Solitary Metastatic Lesion of Thyroid Carcinoma.

Monostotic fibrous dysplasia of the vertebra is a rare entity. A case of a 53-year-old lady who presented with an 8 months history of pain in the thoracic spine region with paraparesis is discussed. She had a history of papillary thyroid carcinoma and had undergone total thyroidectomy one year prior to her current problem. Magnetic resonance imaging revealed isolated osteolytic lesion over the posterior element of the T12 vertebra with narrowing of the spinal canal causing compression of the cord. The diagnosis of fibrous dysplasia was made histologically. Fibrous dysplasia rarely occurs in axial bones compared with peripheral bones. This case illustrates that osteolytic lesion of the vertebrae should be evaluated with detailed radiological and histopathological examination before an empirical diagnosis of spinal metastasis is made in an adult with a background history of primary malignancy well-known to spread to the bone.

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

INTRODUCTION: 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). METHODS: 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. RESULTS: Both groups showed a significant difference in all algofunctional KOOS subscales (p < 0.001). The mean score difference at six weeks and three months was not significant in the sports and recreational activities subscale for both groups (p > 0.05). Significant 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 significant 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). CONCLUSION: Six-week preoperative physiotherapy showed no significant impact on short-term functional outcomes (KOOS subscales) and ROM of the knee following primary TKA.

Relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae and age among adolescent idiopathic scoliosis patients.

INTRODUCTION: This retrospective review aimed to examine the relationship between preoperative pulmonary function and the Cobb angle, location of apical vertebrae and age in adolescent idiopathic scoliosis (AIS). To our knowledge, there have been no detailed analyses of preoperative pulmonary function in relation to these three factors in AIS. METHODS: A total of 38 patients with thoracic or thoracolumbar scoliosis were included. Curvature of spinal deformity was measured using the Cobb method. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were used to evaluate preoperative pulmonary function. Statistical methods were used to analyse the relationship between preoperative pulmonary function and the factors that may contribute to poor pulmonary function. RESULTS: The mean age of the patients was 16.68 ± 6.04 years. An inverse relationship was found between the degree of the Cobb angle and FVC as well as FEV1; however, the relationships were not statistically significant (p = 0.057 and p = 0.072, respectively). There was also a trend towards a significant negative correlation between the thoracic curve and FVC (p = 0.014). Patients with larger thoracic curves had lower pulmonary function. A one-year increase in age significantly decreased FVC by 1.092 units (p = 0.044). No significant relationship between age and preoperative FEV1 was found. The median FVC was significantly higher in patients with affected apical vertebrae located at levels L1-L3 than at T6-T8 or T9-T12 (p = 0.006). CONCLUSION: Lung function impairment was seen in more severe spinal deformities, proximally-located curvature and older patients.

Clinical Factors affecting Minor Amputation in Diabetic Foot Disease at Tengku Ampuan Afzan Hospital, Kuantan.

BACKGROUND: Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease. METHODS: 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. RESULTS: 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). CONCLUSION: Identifying these risk factors may help in prevention of minor amputation and subsequently reduce limb loss in diabetic foot.