Cost-Outcome Descriptive Study for Mobile App (UPSCALER) in the Rehabilitation of Anterior Cruciate Ligament (ACL) Injuries After Reconstructive Surgery.

Anterior cruciate ligament (ACL) injuries are a significant concern in athletes, often leading to long-term complications and reduced quality of life. Despite advancements in surgical techniques, outcomes following ACL reconstruction remain suboptimal, largely due to poor adherence to postoperative rehabilitation. This study introduces a novel postoperative rehabilitation approach utilizing a smartphone application, UPSCALER, developed by the Universiti Putra Malaysia Sports Injury and Arthroscopic Surgery Center of Excellence. The application delivers a validated accelerated rehabilitation protocol through instructional videos tailored to each patient's recovery phase. Results from the study demonstrate promising outcomes, including improvements in Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales post-rehabilitation, potentially attributed to increased adherence facilitated by the application's accessibility. Furthermore, the study explores the cost-effectiveness of this approach compared to conventional methods. In conclusion, smartphone application-guided rehabilitation shows promise in improving ACL reconstruction outcomes, warranting further research to validate its effectiveness and long-term impact on patient recovery and healthcare costs.

A Triad of Shoulder Injuries Following Cardioversion: A Case Report.

Transthoracic defibrillation and cardioversion are commonly used techniques to resuscitate a patient during acute cardiac arrhythmic events. There are numerous complications associated with these procedures. We report a previously unreported complication where a patient suffered from a supraspinatus tear after cardioversion for ventricular tachycardia. There are numerous complications associated with these procedures. We report a previously unreported complication where a middle-aged Chinese patient with no previous trauma history suffered from a supraspinatus tear after cardioversion for ventricular tachycardia.

A Rare Occurrence of Opportunistic Infection by Streptococcus mitis Due to Antibiotic-Induced Neutropenia in Prosthetic Joint Infection.

Prosthetic joint infection (PJI) is a devastating complication in arthroplasty surgery. Although the prevalence is less than 2%, its functional and financial implications are significant. Part of its treatment involves the usage of prolonged and high-dose systemic antibiotics. Ironically, this predisposes the patient to unwanted adverse effects caused by the drugs. We report a case of cefazolin-induced neutropenia that led to Streptococcus mitis (S. mitis) bacteraemia in a patient with Staphylococcus aureus PJI. There have been no previous reports on cefazolin-induced neutropenic bacteraemia complicating the treatment of PJI. This case report aims to create awareness among the attending physicians on the possibility of cefazolin-induced neutropenia, which led to bacteraemia from an opportunistic microorganism. The reversal was as simple as cessation of the antibiotic itself. However, if not recognized, it could be fatal.

High Sural Nerve Trifurcation: A Rare Anatomical Variation.

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

Discal Cyst, a Physical Risk: A Case Report on Endoscopic Resection.

Discal cysts are a rare diagnosis involving the formation of an intraspinal extradural cyst. They are a diagnostic challenge as it is difficult to differentiate discal cysts from other causes of back pain, neurological deficit, and radiculopathy. Due to its rarity, there is a lack of research-based evidence on the optimal management of the discal cyst. This case report aims to increase awareness of this diagnosis and to highlight a possible treatment option for this condition.

Necrotizing fasciitis, causative agents and management: a five-year retrospective study in two tertiary care hospitals in Central Malaysia.

PURPOSE: Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. The severity of the disease depends on the virulence of the organism and host immunity. There is a paucity of reports on the prevalence of NF causing pathogens and management. METHODS: Retrospective data of patients treated for NF were collected from two tertiary care hospitals in Central Malaysia between January 2014 and December 2018. RESULTS: A total of 469 NF patients were identified. More than half of the NF patients were males (n = 278; 59.28%). The highest number of cases was found among age groups between 30 and 79, with mean age of 56.17. The majority of the NF cases (n = 402; 85.72%) were monomicrobial. Streptococcus spp. (n = 89; 18.98%), Pseudomonas aeruginosa (n = 63; 13.44%) and Staphylococcus spp. (n = 61; 13.01%) were identified as the top three microorganisms isolated. Among the 469 NF cases, 173 (36.8%) were amputated or dead while 296 (63.1%) recovered. Proteus spp. (n = 19; 12.93%), Klebsiella pneumoniae (n = 18; 12.24%) and Escherichia coli (n = 14; 9.52%) were associated with all types of amputations. The most common antibiotic prescribed was unasyn (n = 284; 60.56%), followed by clindamycin (n = 56; 11.94%) and ceftazidime (n = 41; 8.74%). A total of 239 (61.8%) recovered while 148 (38.2%) were either amputated or dead when managed with the unasyn, clindamycin or ceftazidime. CONCLUSION: This study represents the largest NF cases series in Malaysia highlighting the causative agents and management.

Superficial Femoral Artery Thrombosis After Midshaft Femoral Fracture Fixation With an Intramedullary Nail: A Case Report

@#Intramedullary nailing is the preferred method of closed shaft fracture fixation of long bones. One of the most dreaded complications to occur following internal fixation of a lower limb fracture is pseudo- or false aneurysm which can lead to the loss of the limb due to acute ischemia. This diagnosis is made by contrast angiogram of the limb. Pointers to the diagnosis include absent distal limb pulsation as well as other signs of acute ischemia post trauma or surgery. We present a case of development of pseudo-aneurysm in an elderly patient following open reduction and internal fixation of a femoral fracture. This case report outlines a prompt multidisciplinary approach of management in a rare case of pseudoaneurysm post fixation of long bone.

The precarious use of charm needles susuk in treatment of low back pain by traditional medicine practitioners and its possible risk to patient safety

@#A 68-year-old female presented with a 1-month history of lower back pain with right-sided radiculopathy and numbness. She was diagnosed with lumbar spondylosis and treated conservatively with analgesia and physiotherapy. Imaging showed multiple susuk, a metal alloy, in the lower back region and other regions of the body. The patient had undergone traditional medicine consultation 10 years earlier when the susuk was inserted in the lower back as talisman. The practice of the insertion of susuk is popular in rural East Malaysia and Indonesia. These foreign bodies act as possible causes of chronic inflammation and granuloma formation. In addition, the localised heighten peril upon imaging. This report suggests that the insertion of multiple susuk as talisman carries risk to safety of patients when imaging, and this practice complicates the management of musculoskeletal disorders