Publications by authors named "Faisham W"

33 Publications

Assessment of Extra-Cortical Bone Bridge Interface in Cemented Mega Endoprosthesis for Limb Salvage Surgery.

Malays Orthop J 2021 Mar;15(1):93-99

Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Introduction: Mega endoprosthesis replacement for resection of primary malignant bone tumour requires immediate and long-term stability, particularly in the young and active patient. Extracortical bone bridge interface (EBBI) is a technique whereby autograft is wrapped around the interface junction of bone and porous-coated implant to induce and enhance bone formation for biological incorporation. This procedure increases the mean torsional stiffness and the mean maximum torque, which eventually improves the implant's long-term survival.

Material And Methods: The extracortical bone bridge interface's radiological parameter was evaluated at the prosthesis bone junction two years after surgery utilising a picture archiving and communication system (PACS). The radiograph's anteroposterior and lateral view was analysed for both thickness and length in all four cortices. The analysis was done in SPSS Version 24 using One-Way ANOVA and independent T-Test. Results were presented as mean and standard deviation and considered significant when the p-value was < 0.05.

Results: The mean average thickness was 2.2293mm (SD 1.829), and the mean average length was 31.95% (SD 24.55). We observed that the thickness and length of EBBI were superior in the young patient or patients with giant cell tumour that did not receive chemotherapy, compared to patients treated for osteosarcoma. The distal femur also had better EBBI compared to the proximal tibia. However, the final multivariable statistical analysis showed no significant difference in all variables. EBBI thickness was significantly and positively correlated with EBBI Length (p<0.001). We conclude that, for each 1mm increase in EBBI thickness, the length will increase by 0.06% on average. About 17.2% of patients out of the 29 showed no radiological evidence of EBBI.

Conclusion: From our study, there were no factors that significantly contributed to the formation and incorporation of EBBI.
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http://dx.doi.org/10.5704/MOJ.2103.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043634PMC
March 2021

Iliac Telangiectatic Osteosarcoma - A Rare Presentation and Diagnostic Pitfall: A Case Report.

Malays Orthop J 2020 Nov;14(3):198-201

Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Telangiectatic osteosarcoma is a rare variant of osteosarcoma and can be easily misdiagnosed as aneurysmal bone cyst. We report an atypical case of iliac telangiectatic osteosarcoma in a young healthy female, who presents with painful slow growing expansile lytic septate lesion in the left hemipelvis, which is initially treated as aneurysmal bone cyst. The diagnosis of aneurysmal bone cyst is made after histopathological examination of core needle biopsy. Her condition became unstable and massive bleeding is noted at the lesion site after sclerosant injection. She undergoes emergency hemipelvectomy and eventually the biopsy turns up to be telangiectatic osteosarcoma. Our case highlights that core needle biopsy is not useful in making diagnosis for iliac telangiectatic carcinoma. Hence, an open biopsy should be carried out in our case. This case also emphasises on careful evaluation for malignancy which is mandatory because bleeding from pelvis after an unsuitable treatment can be grave, to the extent that major amputation hemipelvectomy is an option. Even though telangiectatic osteosarcoma has the same prognosis and treatment with conventional osteosarcoma, the outcome of delayed treatment for telangiectatic osteosarcoma is not good due to the dilemma in establishing an early correct diagnosis.
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http://dx.doi.org/10.5704/MOJ.2011.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751993PMC
November 2020

Combined Techniques of Non-invasive Tc-Besilesomab/Tc-Sulfur Colloid with Hybrid SPECT/CT Imaging in Characterising Cellulitis from Symptomatic Perimegaprosthetic Infection: A Case Report.

Malays Orthop J 2020 Nov;14(3):188-193

Department of Nuclear Medicine, Radiotherapy and Oncology, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Megaprosthesis is used to restore the form and function of massive skeletal defects, but it is accompanied by risks of failure, mainly due to perimegaprosthetic infection (PMI). In practice, the diagnosis of infected megaprosthesis among patients with a high index of clinical suspicion, elevated serological markers, and multiple negative or inconclusive imaging can be very challenging and poses a diagnostic conundrum to many orthopaedic surgeons. We present the case of a symptomatic 26-year-old female with large B-cell lymphoma who developed cellulitis with suspected complication of PMI 15 months post-implantation. The combination of advanced nuclear medicine imaging strategies, i.e., Tc-besilesomab/Tc-sulfur colloid scintigraphy with hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) scanning helps to characterise and delineate both infections. Invasive procedures such as joint aspiration and biopsy were avoided, and the patient was successfully treated with antibiotics. Hence, we report a case where advanced imaging modalities were decisive in the investigation of PMI.
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http://dx.doi.org/10.5704/MOJ.2011.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752015PMC
November 2020

A Single Posterolateral Scapular Approach to Drain Post-Traumatic Intramuscular Scapular and Axillary Abscess in an Adolescent: A Case Report.

Malays Orthop J 2019 Jul;13(2):56-58

Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Scapular abscess is a rare clinical diagnosis. This is a report of an atypical case of extensive intramuscular scapular abscess involving the anterior and posterior aspects of the scapula with extension into the axillary region following minor trauma in a young healthy adolescent, describing a single posterolateral approach to the scapula to evacuate the abscess. Following surgical drainage and antibiotic treatment, patient recovered without any complication.
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http://dx.doi.org/10.5704/MOJ.1907.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702981PMC
July 2019

Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion.

Malays Orthop J 2018 Nov;12(3):19-23

Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Restoration of a functional hand is the ultimate goal following a distal radius tumour resection. The early outcomes of mobile wrist reconstruction are satisfactory; however, long-term results are unpredictable due to late wrist instability and degenerative arthritis. Our aim is to compare mobile wrist reconstruction with wrist fusion (pan-carpal fusion) in our cohort of patients. A retrospective cohort study was performed for functional outcomes of all patients who underwent resection for distal radius tumour and treated with either fusion or reconstruction of the wrist in a single institution from years 2000-2013 with a minimum of three years follow-up. Eleven patients were included in the study, six of whom had wrist reconstruction with proximal fibula graft and the remaining five wrist fusion, with a mean follow-up of 6.3 years. The mean Musculoskeletal Tumour Society (MSTS) score was 82.78%, ranging from 70% to 93.3%. Average grip strength compared to the normal contralateral hand was 60.0% for total wrist fusion, which was better than wrist reconstruction with 58.07%. There was no difference in the functional outcome between fusion and mobile reconstruction in our study. Osteoarthritis changes and subluxation of the wrist joint were the most common findings in the long-term follow-up for this group. There was no difference in the functional outcome of the long-term follow-up between the two groups.
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http://dx.doi.org/10.5704/MOJ.1811.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287129PMC
November 2018

Immediate Revascularization of A Traumatic Limb Vascular Injury associated with Major Pelvic Injuries.

Malays Orthop J 2015 Nov;9(3):61-64

Department of Orthopaedic Surgery, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

High velocity pelvic injury with limb vascular injury poses difficulties as immediate surgery for limb reperfusion is indicated. However immediate vascular intervention deviates from conventional principles of damage control following major injuries. We present two cases of this rare combination of injuries. In both cases, early limb revascularization is possible despite presented with multiple injuries and pelvic fracture.
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http://dx.doi.org/10.5704/MOJ.1511.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393139PMC
November 2015

Prognostic factors and survival rate of osteosarcoma: A single-institution study.

Asia Pac J Clin Oncol 2017 Apr 13;13(2):e104-e110. Epub 2015 Apr 13.

Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Aim: Osteosarcoma is a highly malignant primary bone tumor. The study aim to evaluate the prognostic factors influencing the survival rate in our center.

Methods: This was a retrospective cohort study of all patients treated between January 2005 and December 2010.

Results: We included 163 patients with an age range of 6-59 years (median = 19). The median follow-up was 47 months (range 36-84). The overall survival in patients who completed chemotherapy and surgery (n = 117) was 72% at 2 years and 44% at 5 years. Histologically, 99 (85%) had osteoblastic, 6 (5%) had chondroblastic and 3 (2.5%) had telangiectatic osteosarcoma. Limb salvage surgery was performed in 80 (49%) and 41 (25%) underwent amputation. However, 46 patients (28%) underwent no surgical intervention and incomplete chemotherapy. In total, 38/79 patients had a good chemotherapy response. There was a significantly better survival rate for limb salvage versus amputation. Independent prognostic factors for survival are compliance to treatment and presence of lung metastasis.

Conclusion: The overall survival of osteosarcoma patients was influenced by the presence of pulmonary metastases and compliance to treatment. Histological subtype, different chemotherapy regimens and histological necrosis after chemotherapy did not significantly influence survival. The patients who did not complete treatment had significantly poorer survival.
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http://dx.doi.org/10.1111/ajco.12346DOI Listing
April 2017

Correlation of psychosocial factor with functional outcome: one year after hip fracture surgery.

Malays Orthop J 2014 Mar;8(1):21-5

Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Abstract:

Objective: This study investigated the correlation of 8 domains of psychosocial factors with functional outcome one year after hip fracture surgery. A prospective cohort study of patients who had unilateral hip fracture surgery was included. A total of 89 subjects were interviewed between 3rd to 7th day after the hip surgery using the short length Multi-level Assessment Instrument and followed up after 1 year. The functional outcomes were measured through the Harris Hip Score. All of the psychosocial factors have little to no correlation on the functional recovery of the patient but the cognitive domain had a fair correlation in Harris Hip Score (r=0.46) and is significant (p-value<0.0001) The study did not find strong correlation between psychosocial factors and functional outcome one year after unilateral hip surgery. Although statistics have shown little effect on psychosocial factors to functional outcome, it may still be prudent to consider every aspect that may contribute to the whole wellbeing of our patients, which includes their psychosocial background.

Key Words: Psychosocial Factors; Hip Fracture Outcome; Biopsychosocial; Hip Surgery; Psychosocial Background.
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http://dx.doi.org/10.5704/MOJ.1403.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093552PMC
March 2014

The outcomes of salvage surgery for vascular injury in the extremities: a special consideration for delayed revascularization.

Malays Orthop J 2014 Mar;8(1):14-20

Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Abstract: A seven years retrospective study was performed in 45 consecutive vascular injuries in the extremities to investigate the pattern of injuries, managements and outcomes. Motor-vehicle accidents were the leading cause of injuries (80%), followed by industrial injuries (11.1%) and iatrogenic injuries (4.4%). Popliteal and brachial artery injuries were commonly involved (20%). Fifteen (33.3%) patients had fractures, dislocation or fracture dislocation around the knee joint and 6 (13.3%) patients had soft tissue injuries without fracture. Traumatic arterial transection accounted for 34 (75.6%) cases, followed by laceration in 7 (15.6%) and 9 (6.7%) contusions. Associated nerve injuries were seen in 8 (17.8 %) patients using intra-operative findings as the gold standard, both conventional angiogram (CA) and computerized tomography angiogram (CTA) had 100% specificity and 100% sensitivity in determining the site of arterial injuries. The mean ischemic time was 25.31 hours (4 - 278 hours). Thirty-three (73.3 %) patients were treated more than 6 hours after injury and 6 patients underwent revascularization after 24 hours; all had good collateral circulation without distal pulses or evidence of ischemic neurological deficit. The mean ischemic time in 39 patients who underwent revascularization within 24 hours was 13.2 hours. Delayed amputation was performed in 5 patients (11.1%). Of the 6 patients who underwent delayed revascularization, one patient had early amputation, one -had delayed amputation following infection and multiple flap procedures while the rest of the patients' limbs survived. Joint stiffness was noted in 10 patients (22.2%) involving the knee joint, elbow and shoulder in two patients each. Infection was also noted in 5 patients (11.1%) with two of them were due to infected implants. Other complications encountered included nonunion (2 patients, 4.4%), delayed union (1 patient, 2.2%),limb length discrepancy (1 patient, 2.2%), hematoma (1 patient, 2.2%) and leaking anastomosis in one patient (2.2%). Volkmann's ischemic contracture occurred in 3 (6.7%) patients. There was no complication noted in 8 (17.8%) patients Three patients (6.7%) died of whom two were not due to vascular causes. We conclude that early detection and revascularization of traumatic vascular injuries is important but delayed revascularization also produced acceptable results.
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http://dx.doi.org/10.5704/MOJ.1403.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093557PMC
March 2014

Outcome of surgical treatment of pelvic osteosarcoma: hospital universiti sains malaysia experience.

Malays Orthop J 2013 Mar;7(1):56-62

Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Kelantan.

Unlabelled: We reviewed the surgical treatment and outcomes of 13 patients with pelvic osteosarcoma treated in our centre in the past decade. The study sample included 9 males and 4 females with a mean age of 28.1 years. Four patients had ileal lesions, five had acetabulum lesions, one had a ischiopubis lesion, and three had involvement of the whole hemipelvis. Seven patients presented with distant metastases at diagnosis. Limb salvage was performed in 6 patients and amputation in 7. In 60% of cases in the limb salvage surgery group, we attempted wide resection with positive microscopic margin compared to only 16.7% in the amputation group. Local recurrence was higher in the limb salvage group. Overall survival was 18 months for mean follow up of 14.8 months. Median survival was 19 months in the limb salvage group compared to 9 months in amputation group. The outcome of surgical treatment of pelvic osteosarcoma remains poor despite advancements in musculoskeletal oncology treatment.

Key Words: Pelvic osteosarcoma, limb salvage surgery, hemipelvectomy, margins, oncologic outcomes.
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http://dx.doi.org/10.5704/MOJ.1303.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341051PMC
March 2013

Early Functional Outcome of Resection and Endoprosthesis Replacement for Primary Tumor around the Knee.

Malays Orthop J 2013 Mar;7(1):30-5

Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Unlabelled: We evaluated functional outcomes for patients who underwent surgery for resection and endoprosthesis replacement for primary tumours around the knee. We used the Musculoskeletal Tumour Society Scoring System (MSTS) for functional evaluations to compare differences between distal femur (DF) and proximal tibia (PT) placements. The study sample included 34 cases of distal femur and 20 cases of proximal tibia endoprosthesis replacement. Primary tumours were classified as follows: 33 osteosarcoma, 20 stage III giant cell tumour (GCT) and one case of mesenchymal chondrosarcoma. The mean MSTS score for both DF and PT endoprosthesis together was 21.13 (70.43%), and The MSTS scores for DF was 21.94 (73.13%) and PT was 19.75 (65.83%) Infection developed in 7 cases and 5 of which were PT endoprosthesis cases. Three deep infections required early, two-stage revision and resulted in poor MSTS scores. We conclude that endoprosthesis replacement for primary bone tumours had early good to excellent functional outcome. There were no differences in functional outcomes when comparing distal femur endoprostheses with proximal tibia endoprostheses.

Key Words: functional outcome, bone tumour, knee, and endoprosthesis.
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http://dx.doi.org/10.5704/MOJ.1303.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341046PMC
March 2013

Traumatic hemipelvectomy with free gluteus maximus fillet flap covers: a case report.

Malays Orthop J 2012 Nov;6(3):37-9

Department of Surgery, Universiti Sains Malaysia, Kota Bahru, Malaysia.

Abstract: Traumatic hemipelvectomy is an uncommon and life threatening injury. We report a case of a 16-year-old boy involved in a traffic accident who presented with an almost circumferential pelvic wound with wide diastasis of the right sacroiliac joint and symphysis pubis. The injury was associated with complete avulsion of external and internal iliac vessels as well as the femoral and sciatic nerves. He also had ipsilateral open comminuted fractures of the femur and tibia. Emergency debridement and completion of amputation with preservation of the posterior gluteal flap and primary anastomosis of the inferior gluteal vessels to the internal iliac artery stump were performed. A free fillet flap was used to close the massive exposed area.

Key Words: traumatic hemipelvectomy, amputation, and free gluteus maximus fillet flap.
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http://dx.doi.org/10.5704/MOJ.1207.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093599PMC
November 2012

Resection and reconstruction of malignant tumor involving sternum.

Med J Malaysia 2012 Apr;67(2):224-5

Orthopedic Department, School of Medical Sciences Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

We present a series of four cases of chest wall tumor, which underwent sternum resection. The methods of resection and reconstruction chest wall defect are discussed and the final outcome highlighted.
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April 2012

Soft tissue reconstruction following hemipelvectomy: eight-year experience and literature review.

ScientificWorldJournal 2012 2;2012:702904. Epub 2012 May 2.

Reconstructive Sciences Department, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia.

Background And Objectives: Hemipelvectomy is a major surgical procedure that associates with significant morbidity, functional impairment, and psychological and body image problem. Reconstruction of the defect is a challenged since a large amount of composite tissues are needed. We would like to share our eight-year experience with massive pelvic resection and reconstruction.

Methods: A retrospective analysis of all cases of hemipelvectomy was conducted in our institution over eight-year period with particular attention given to the reconstruction choices and associated complications.

Results: Thirteen patients were included with median age of 39 years (range 13-78) of which all had advanced tumour with stage IIb (54%) and Stage III (46%). External hemipelvectomy was performed in all cases, and resultant defects were reconstructed with variety type of flaps. These include fillet thigh flaps, regional pedicle flaps of different designs, and free flap.

Conclusions: Massive pelvic tumour is rarely encountered in our population but can be seen across all age groups and usually due to late presentation. The defects should be reconstructed using local or regional flaps, incorporating the muscle component to enhance flap perfusion. The tissue should be harvested from the amputated limb, as it can limit the donor site morbidity.
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http://dx.doi.org/10.1100/2012/702904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353558PMC
October 2012

Clavicle fracture and subclavian vessels disruption with massive haemothorax mimic intrathoracic injury.

Malays J Med Sci 2011 Apr;18(2):74-7

Department of Orthopaedic, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.

We report a case of open fracture of the clavicle with subclavian artery and vein laceration and perforation of the parietal pleural below the first rib that caused massive haemothorax. Emergency thoracotomy and exploration followed by repair of both vessels were able to salvage the patient and the extremity.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216210PMC
April 2011

Early outcome of reamed interlocking nail for non-union of tibia.

Med J Malaysia 2006 Aug;61(3):339-42

Department of Orthopaedic, School of Medical Science, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan.

Aseptic non-union is a major problem following complicated fracture tibia, which carries significant morbidity and prolonged course of treatment. Plate fixation and autogenous bone grafting has been established as a method of treatment. However the risk of infection, implant failure and donor site morbidity are high. We reviewed twelve consecutive cases of established non-union tibia treated by closed reamed interlocking nail in our centre. All patients had clinical and radiological union at three months. Three patients were complicated with infection and one required removal of implant and re-reaming to eradicate infection. Reamed interlocking nailing is an alternative treatment for selected non-union of fracture tibia with promising results.
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August 2006

Forequarter amputation of the upper extremity for musculoskeletal tumors: posterior approach revisited.

Med J Malaysia 2006 Feb;61 Suppl A:57-61

Musculoskeletal Oncology Unit, School of Medical Science Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Forequarter amputation entails surgical removal of entire upper extremity, scapula and clavicle. Several techniques of forequarter amputation have been described. The anterior approach has been the preferred technique of exploration of axillary vessels and brachial plexus. The posterior approach has been condemned to be unreliable and dangerous for most large tumor of the scapula and suprascapular area. We describe a surgical technique using posterior approach of exploration of major vessels for forequarter amputation of upper extremity in eight patients who presented with humeral-scapular tumor. There were six patients with osteosarcoma: three with tumor recurrent and three chemotherapy recalcitrant tumors with vessels involvement. One patient had massive fungating squamous cell carcinoma and another had recurrent rhabdomyosarcoma. Four patients had fungating ulcer and six patients had multiple pulmonary metastases at the time of surgery. The mean estimated blood transfusion was 900 ml (range 0-1600 ml) and two patients did not require transfusion. The duration of surgery ranged 2.5-6.0 hours (mean 3.8 hours). Two patients with known pulmonary metastases required post-operative intensive care monitoring. The mean duration of survival was 5.8 months. The posterior approach of exploring major vessels for forequarter amputation of upper extremity with musculoskeletal tumor is safe and reliable.
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February 2006

Sliding compression screw fixation for delayed union/non-union of femoral neck fracture: is it a viable option.

Med J Malaysia 2006 Feb;61 Suppl A:36-9

Department of Orthopaedics, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Femoral neck fracture non-unions often present with significant difficult treatment decision as regards to surgical options and the risk of complication. We present three cases of femoral neck non-union treated with double screw stabilization technique using sliding compression hip screw and anti-rotational screw. The rationale for opting to these simple implants in our setting is discussed.
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February 2006

Femoral overgrowth following plate fixation of the fractured femur in children.

Singapore Med J 2006 Aug;47(8):684-7

Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.

Introduction: The purpose of this study is to determine the overgrowth phenomenon of the affected femur following plate fixation of femoral fractures in children.

Methods: 15 patients (aged between eight and 14 years old), who underwent open reduction and plate fixation for fractures of the femur, were assessed at two years postoperation for limb length discrepancy. Measurements were made using a computed tomography (CT) scanogram. Its association with age, limb dominancy and site of fracture were analysed.

Results: There were 12 boys and three girls. All children had femoral overgrowth of the injured femur, ranging from 0.1 cm to 2.0 cm with a mean of 1.15 cm. There was a significant correlation between age and bone overgrowth. Limb dominancy and site of fracture had no significant influence on femoral overgrowth.

Conclusion: The amount of femoral overgrowth following fracture stabilisation with plate in children was minimal. It could still occur even without fracture overlapping during the healing process. The overgrowth was less in older subjects.
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August 2006

Aggressive giant cell tumour of bone.

Singapore Med J 2006 Aug;47(8):679-83

Department of Orthopaedics, Musculoskeletal Oncology Unit, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.

Introduction: The surgical treatment of Stage III or aggressive giant cell tumour of the bone, whether to perform intralesional or en-bloc resection, remains controversial. The aim of this study is to identify the effectiveness of en-bloc resection for local control and final oncological outcome of the disease.

Methods: The data of 20 consecutive patients with Stage III giant cell tumour were retrospectively reviewed to determine the local control and oncological outcome after treatment with wide resection.

Results: The majority of the patients presented late with mean duration of symptoms of 24 months, and four patients presented with recurrences. All patients were treated with wide resection except for two patients who underwent ablative surgery due to major neurovascular involvement. Ten patients required free vascularised tissue transfer to cover massive soft tissue defect. Local recurrence occurred in one patient who was again treated with wide resection and vascularised flap. Six patients had pulmonary metastases. Two patients with resectable disease were treated with thoracoscopic surgery and they remained disease-free 36 months after surgery. Two patients with multiple lung metastases were treated with chemotherapy and the disease remained non-progressive. The remaining two patients who refused chemotherapy showed radiological progression, and one succumbed to the disease with massive haemoptysis.

Conclusion: Aggressive giant cell tumour of bone should be treated with wide resection for better local control, and treatment of pulmonary metastases is mandatory for overall prognosis.
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August 2006

Residual nonunion following vascularised fibular graft treatment for congenital pseudarthrosis of the tibia: a report of two cases.

J Orthop Surg (Hong Kong) 2006 Apr;14(1):64-6

Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Resection and reconstruction using a vascularised fibular graft is a viable alternative treatment for congenital pseudarthrosis of the tibia, although distal junctional nonunion and residual deformity are known complications that are difficult to treat. We illustrate 2 cases in which bony union was achieved following a technique using fibular grafting and intramedullary nailing, without additional bone grafting. This technique was feasible because of hypertrophy of the fibular graft.
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http://dx.doi.org/10.1177/230949900601400114DOI Listing
April 2006

Abdominal aorta and inferior vena cava thromboses in advanced stage of malignant fibrous histiocytoma.

Med J Malaysia 2005 Oct;60(4):495-7

Department of Orthopaedic, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan.

Asymptomatic simultaneous thrombosis of abdominal aorta and inferior vena cava is a rare complication in advanced malignancy. We described an incidental finding of this clinical entity in our patient who presented with advance stage of malignant fibrous hystiocytoma of soft tissue and pathological fracture. The radiological evaluation with spiral computed tomography scan of abdominal aorta and inferior vena cava are presented and the subsequent management highlighted.
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October 2005

Modular endoprosthetic replacement after total femur resection for malignant bone tumor.

Med J Malaysia 2005 Jul;60 Suppl C:45-8

Musculoskeletal Oncology Unit, Department of Orthpaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia.

Total femur endoprothesis is an alternative replacement for massive malignant bone tumor with intramedullary extension or skip lesion. Four patients underwent total femoral resection and replacement with megaprosthesis: three had primary malignant bone tumor and one had salvage procedure for aseptic loosening of the distal femoral replacement. Tumor-free margins were achieved in all patients with two patients required vascularized latissimus dorsi free flap cover for reconstruction of soft tissue defects. The average follow-up was 24 months (range 16 - 60 months). All four patients were still alive with three of them being disease-free and one survived even with the presence of lung metastasis. The functional results obtained were either excellent or good in all patients in accordance to the Musculoskeletal Tumors Society grading system.
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July 2005

Pulmonary metastases of giant cell tumour of the bone.

Med J Malaysia 2004 Dec;59 Suppl F:78-81

Musculoskeletal Oncology Unit, School of Medical Science, University Sains Malaysia, Kubang Kerian, Kelantan.

The clinical presentation and behaviour of giant cell tumour of bone vary. The progression of the disease and metastasis are unpredictable, but the overall prognosis is good. Six patients with pulmonary metastases of giant cell tumour have been treated at our institution since 1998. This represents 15% of all patients treated for giant cell tumour of the bone. Early detection and treatment of this tumour is important as complete resection of this tumour have favourable prognosis. Multiple lung nodules which preclude resection may remain dormant and asymptomatic with systemic chemotherapy.
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December 2004

Resection and reconstruction of retroperitoneal sarcoma of spinal roots.

Med J Malaysia 2004 Dec;59 Suppl F:75-7

Spine Unit, Department of Orthopaedics, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kelantan.

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December 2004

Osteosarcoma: the outcome of limb salvage surgery.

Med J Malaysia 2004 Dec;59 Suppl F:24-34

Musculoskeletal Oncology Unit, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kelantan.

We reviewed the surgical and oncological management 23 consecutive patients with osteosarcoma of the long bones to determine the outcome of limb salvage technique performed in our centre. All patients received neoadjuvant chemotherapy. There were 15 males and 8 females with a mean age at diagnosis of 19 years (9 to 36). The median follow-up was 30 months (10 to 60). Fifteen had lesion around the knee joint followed by three in the proximal humerus, two in distal humerus, two in the pelvis, and one in the distal tibia. Six patients presented with lung metastases at diagnosis. We performed limb salvage surgery to control local disease in 16 patients and amputation in 7. The resection margins of the primary lesion were adequate and free of tumour cells in all patients. Local recurrence developed in 1 patient of limb salvage group. The overall median survival was 22 months and actuarial survival was 52% at 3 years. Eleven patients died of pulmonary metastases within 2 years of follow-up. Median survival of the limb salvage surgery group was 30 months compared to 6 months in the amputation group. As per our experience, limb salvage technique is a feasible option in extremity osteosarcoma without compromising survival.
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December 2004

Natural history of giant cell tumour of the bone.

Singapore Med J 2003 Jul;44(7):362-5

Department of Orthopaedics, School of Medical Science, University Science of Malaysia, 16150 Kubang, Kerian, Kelantan, Malaysia.

The clinical presentation and behaviour of giant cell tumours of bone vary. The progression of the disease and metastases are unpredictable, but the overall prognosis is good. We describe the natural history and different clinical presentations of two cases of giant cell tumour of bone where the patients had refused the initial treatment and presented several years later with the disease.
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July 2003

Mechanical failure of Dynamic Hip Screw (DHS) fixation in intertrochanteric fracture of the femur.

Med J Malaysia 2001 Dec;56 Suppl D:12-7

Department of Orthopaedics, School of Medical Science, Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan.

We studied 60 intertrochanteric fractures of the femur fixed with Dynamic Hip Screw (DHS). There were 10 cases (16.7%) with cutting-out of device through femoral head and neck. Stable fracture pattern, postero-inferior and central position of screw in the femoral neck and head produced high percentage of good result, whereas anterior or superior position of screw produced higher incidence of cut-out. We found osteoporosis and distance of screw tip to subchondral bone to have no influence on the final outcome.
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December 2001

Metastatic disease of the proximal femur.

Med J Malaysia 2003 Mar;58(1):120-4

Department of Orthopaedic, School of Medical Science, Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan.

Since January 1999, ten patients had undergone surgical treatment for metastatic bony lesions of proximal femur at this centre. Seven of these patients were treated for complete pathological fractures, one for impending fracture and one for revision of internal fixation and loosening of hemiarthroplasty. Primary malignancies were located in breast in four cases, prostate in three and one in lung, thyroid and neurofibrosarcoma. Two patients had died within six months after surgery, four after 1 year while the remaining four were still alive. The mean duration of survival was eleven months. Nine patients had been ambulating pain free and there were no failure of reconstruction.
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March 2003

Clinical measurement of longitudinal femoral overgrowth following fracture in children.

Singapore Med J 2001 Dec;42(12):563-5

Department of Orthopaedic, School of Medical Science, HUSM, Kelantan, Malaysia.

We have studied residual limb length inequality following femoral shaft fractures in 62 children. From 61.2% of the children who had shortening of more than 1 cm at union, 34.21% still maintained the shortening at the completion of study. The longitudinal femoral overgrowth occurred significantly during the first 18 months of the fracture in 77.4% of the children, with an average of 1.17 cm. Children with proximal-third fractures and those who sustained the fractures before eight years of age have higher capability to correct the limb length disparity.
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December 2001
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