Complementary Medicine a Costly Risk in Management of Chronic Knee Osteoarthritis? A Case Report

@#Knee osteoarthritis is the commonest cause of knee pain in the elderly. It is characterized by unresolved pain, limitation of motion and reduced quality of life. Total knee arthroplasty (TKA) is a safe and effective method in treating chronic knee osteoarthritis. We report a rare case of a seventy-seven-year-old Chinese female with multiple comorbidities and bilateral degenerative osteoarthritis who had sought services of traditional and complementary medicine (TCM) for pain relief. The patient experienced unresolved pain and superficial skin scars following the unregulated procedure. This paper aims to outline the importance of awareness among surgeons regarding the unregulated practice of TCM that may exacerbate chronic osteoarthritis, joint synovitis, influence the surgical approach for future procedures with the presence of scars and prosthetic joint infection risk.

Hypoxic-Mediated Oxidative Stress Condition and Hydroxyapatite-Inducing Osteogenic Differentiation of Human Mesenchymal Stem Cells: A Mathematical Modeling Study.

Avascular necrosis (AVN) of the bones remains a major clinical challenge. Fractures in the talus, the scaphoid, and the neck of the femur are especially challenging to heal due to the low blood vessel network and the lack of collateral blood supply. These fractures are associated with high rates of nonunion and increased infections that require repeated operations. Conventional treatments by autografting or allografting bone replacement and synthetic bone implants have limitations, including the invasiveness of operative procedures, tissue supply insufficiency, and the risk of host rejection. The advancement in tissue engineering has revealed the potential of stem cells as restorative agents for bone injuries. The administration of mesenchymal stem cells (MSCs) into the talus, the scaphoid, and the neck of the femur could produce enhanced osteogenesis via the manipulation of MSC culture conditions. In this study, we used hydroxyapatite as the nanomaterial, and hypoxic milieu to enhance MSC differentiation capacity into the osteogenic lineage, allowing for more rapid and efficient bone cell replacement treatment. Our results demonstrate 1% oxygen and 12.5 µg/mL of hydroxyapatite (HAP) as the optimal conditions to incorporate the osteogenic medium for the osteogenic induction of MSCs. We also established a proof of concept that the addition of HAP and hypoxic conditions could augment the osteoinductive capacity of MSCs. We also developed an accurate mathematical model to support future bone cell replacement therapy.

A peculiar case of Morel-Lavelle lesion of upper limb

@#594Med J Malaysia Vol 75 No 5 September 2020SUMMARYMorel-Lavallee lesions (MLL) are post-traumatic, closedinternal degloving injuries that can result in severecomplications if not diagnosed early. It is conventionallyseen in cases of the high energy injuries of the pelvis andlower limb. The accumulation of extravasated blood,secondary to fracture and soft tissue damage may causeinternal degloving injury, skin necrosis, soft tissue damageand acute osteomyelitis. We report here the clinical andradiological features in a 32-year-old male referred from theemergency department of a tertiary hospital who hadsustained high energy motor vehicle accident. Onexamination, there was a fluctuant, mobile, non-tendersubcutaneous mass over the distal arm with suspicion ofinternal degloving injury. Plain radiographs showed nofractures. Ultrasound showed a fluid collection with thepresence of septations and echogenic debris within thecollection. Extravasation was noted between subcutaneoustissue layer and fascia at the posterolateral aspect of thearm. Wound debridement under general anaesthesia wascarried out. Intraoperative findings reported a significantamount of thick serous fluid with necrotic debris. Unhealthyskin and fat layers were debrided. Underlying muscles werefound to be healthy. The results of the intraoperative fluidculture and sensitivity showed no growth. Negative pressurevacuum dressing was carried out. After five cycles ofvacuum dressing, the wound showed signs of healing withan improved range of motion of the elbow. Orthopaedicsurgeons need to be vigilant of the possibility of MLL in theupper limb as a differential diagnosis in the management ofhigh energy trauma.

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