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Introduction: Critical size defects (CSD) in the long bones of New Zealand White rabbits (Oryctolagus cuniculus) have been used for years as an experimental model for investigation of the effectiveness of a new bone substitute material. There are varieties of protocols available in the literature. This technical note attempts to present an alternative surgical technique of a CSD in the New Zealand white rabbit tibia. Methods: Thirty-nine New Zealand White rabbits were used in this study. A CSD of approximately 4.5 mm (width) X 9.0 mm (length) was surgically drilled at the proximal tibial metaphysis, approximately 1 cm from the knee joint. The surrounding of soft tissue was repositioned and sutured layer by layer with bioabsorbable surgical suture. Two x-rays of anteroposterior and lateral were taken before assessed under computed tomography scan at 6, 12 and 24 weeks. Results: This alternative method created CSD with less bleeding from the muscle observed. No mortality or other surgical complications observed within 6 weeks, 12 weeks and 24 weeks following surgery. Conclusion: A simple and safe method for performing CSD was demonstrated and recommended as an alternative approach for surgery on New Zealand White rabbits.

Spinal Schwannoma originates from the Schwann cells, hence it is called Schwannoma. The tumor localization is in various parts of the spinal cord, but prevails in cervical and thoracic. In the literature 70 to 80% of spinal schwannomas are reported to be intradural in location, and 15% with both intradural and extradural components. All 3 cases were female in their 4th-5th decade, presented with either low back pain, radiculopathy, weakness of both lower limbs associated with urinary incontinence. MRI revealed a well defined mass adjacent to conus medullary area located intradural, extramedullary. All three patients underwent microscopic assisted excision of the tumour. All patients had Good Early Outcome. Spinal schwannoma causing Conus Medullary Syndrome is rare. Back pain and radicular pain were most common early presenting symptoms while urinary symptoms occur later. Schwannomas typically arise from a single nerve root originating from the schwann cells. To obtain total resection, the affected nerve root is commonly sacrificed in order to prevent recurrence. Intradural Extramedullary Schwannoma, even presented at a later stage with significant neurological deficit, has a Good Outcome post operatively owing to its Benign nature, Extramedullary location, and a Meticulous Microscopic assisted Complete Surgical Excision.

Introduction: To evaluate the midterm functional outcomes of patients who had undergone total knee replacement (TKR) using posterior stabilized (PS) fixed bearing system from January 2005 until April 2006 for primary osteoarthritis of the knees. Methods: A retrospective study was done on forty-six patients, 87% female (n= 40) and 13% male (n=6), aged 54 to 81 years old (mean 69 ± 5.69) who had undergone primary TKR using the NexGen LPS-Flex Zimmer Warsaw. The patients were followed up for at least five years. A medial parapatellar approach and cemented posterior stabilized fixed bearing TKR system were used performed by one of two arthroplasty surgeons. All patients followed the same rehabilitation protocol post-operatively. Assessments were done using Oxford-12 knee scoring questionnaire to evaluate knee function and SF-36 to assess quality of life outcomes. Results: Oxford knee score revealed patients had lower (better) than average scores in terms of function (score 14.35 ± 4.21 out of 35) and pain (score 9.28 ± 3.01 out of 25). Analysis on the quality of life outcome score with SF-36 revealed a higher (better) score for mental component summary (MCS) relative to physical component summary (PCS). Patients had the highest score for role emotional (RE), followed by mental health (MH), and social functioning (SF). Conclusions: The NexGen LPS-Flex TKR produced a good functional outcome with minimal pain in the operated knee with better mental compared to physical health of patients in the midterm period post-total knee replacement.

Introduction: Infected non-union of proximal humerus after fixation is devastating consequence and remains challenging. Methods: The staged oncologic approach consists of wide resection and reconstruction ensures remissions of the infection. Results: We report a case of two-stage oncologic approach in a patient with infected non-union proximal humerus after fixation. In the first stage we have performed a wide resection and antibiotic cement spacer insertion. After complete eradication of infection, subsequent reconstruction of the shoulder using reverse shoulder replacement with modular humeral stem had been performed on purpose of restoring the acceptable joint functions. Conclusions: Reconstruction of the infected non-union of the proximal humerus is a challenging task, costly procedure that requires the use of the sophisticated limb reconstruction system. Staged approach incorporating the use oncologic wide resection to eradicate the infection with subsequent bony reconstruction ensure the optimum restoration of upper limb functions.

Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the value of TAD was evaluated to verify its usefulness. Methods: This is a retrospective study of 33 consecutive patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any fixation-related failure or complication. Results: Fifty two percent of patients did not achieved the recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration. Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of intertrochanteric fracture.

Renal arteriovenous malformation (AVM) is a rare congenital anomaly of the urinary system. We present a patient with bilateral renal AVMs who presented with back pain and microscopic hematuria. This case highlights the importance of careful diagnostic work-up in the evaluation of upper tract hematuria. KEY WORDS: Renal AVM, Transarterial Embolization, Hematuria.