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BackgroundTibiotalocalcaneal arthrodesis or hindfoot fusion is a salvage surgical option used to treat symptomatic or severe deformity as a result of Charcot’s arthropathy. It is an internal fixation that utilizes nails to stabilize the hindfoot after surgical correction of the deformity. This study intends to measure the change in functional outcomes of patients with Charcot's arthropathy using this technique and the time taken to achieve fusion.MethodThis study presents a series of 40 cases of Charcot's arthropathy where hindfoot fusion was done using a hindfoot arthrodesis nail. A retrospective analysis was done where these patients’ functional scores had been evaluated preoperatively and postoperatively (serially) with the Short-Form Health Survey 36 (SF-36), American Orthopedic Foot and Ankle Society (AOFAS), Foot and Ankle Outcome Score (FAOS), and Foot Function Index (FFI). Along with its complication, the length of time required for the fusion is also reported.ResultsThis study consists of 40 patients (13 men, 27 women; mean age 60.5 years; age range 52–68 years) with a mean follow-up of 64 months (range 24–108 months). The mean time taken for fusion was 5.1 months. All patients showed improvement in functional scoring (SF-36, AOFAS, FFI, and FAOS) postoperatively. We establish that the improvements were gradual over 2 years. Approximately 37.5% of patients had a minor complication and 2.5% had a major complication.ConclusionHindfoot fusion using a hindfoot arthrodesis nail results in improved functional outcome with an acceptable fusion time and acceptable complication rate.Level of evidenceLevel III.

Lower limb surgery is usually performed under general or regional anaesthesia in normal operating room setting. However, when the surgery need to be performed in situations where there are limited resources and equipment, especially during a pandemic outbreak, in battlefields or area of disaster occurrence, the wide-awake local anaesthesia no tourniquet (WALANT) surgery can be utilised. This study aims to assess the efficacy of performing lower limb surgery using WALANT technique. A randomised cross-sectional study was designed to assess the effectiveness of WALANT in lower limb surgery, particularly in terms of duration of anaesthesia, Hamilton Anxiety Rating Scale (HAM-A), pain visual analogue scale (VAS), duration of surgery, amount of estimated blood loss (EBL) and total length of stay (LOS). A total of 91 patients requiring lower limb surgery were recruited, with only 83 patients completed the VAS pain assessment for all time points of the study. Mean age of patients was 52.1 ± 14.9 years. Mean VAS score were 1.19 ± 1.53 and 1.46 ± 1.86, preoperatively and intraoperatively. Mean VAS score were 0.55 ± 1.52, 0.60 ± 1.41, and 1.06 ± 1.69 at 2, 4, and 6 h post-surgery, respectively. Majority (79; 86.8%) of patient has preoperative anxiety score that was

Diabetic foot requires careful attention and coordinated management by a dedicated team. Screening, prevention, adequate assessment, and appropriate referral are crucial to prevent complications. Multimodal treatment and rehabilitation are recommended to ensure a better quality of life and reduction of amputation rate in people with diabetic foot.

There is an increasing pressure to improve the cost-effectiveness of orthopaedic training, both temporally and financially. Accordingly, virtual reality (VR) has been incorporated into a number of surgical training programs, providing trainees a safe yet realistic environment to practice their craft before going into the operating room. Identification of critical success factors (CSFs) for VR integration in the orthopaedic training program, can be beneficial in guiding the focus of healthcare providers and VR designers during the VR platform development stage. The aim of this study is to identify VR-based training CSFs that encourage orthopaedic surgeons to use VR as a method for acquiring, maintaining, and improving skills. A total of 74 studies conducted between 2011 and 2021 were selected and examined. There were 73 CSFs listed as being essential for VR adoption in orthopaedic surgical training. The CSFs were divided into six general categories: HCI/VR Features, Learning Outcome, Usability, Control and Active Learning, Student and Limitation factors. Subsequently, recommendations were made to guide healthcare professionals, researchers, and designers for optimal adoption of VR in orthopaedic surgical training in the future.

Abstract Background Diabetic foot infection is a worldwide health problem is commonly encountered in daily practice. This study was conducted to identify the microbiological profile and antibiotic sensitivity patterns of causative agents identified from diabetic foot infections (DFIs). In addition, the assessment included probable risk factors contributing to infection of ulcers that harbour multidrug-resistant organisms (MDROs) and their outcomes. Methods We carried out a prospective analysis based on the DFI samples collected from 2016 till 2018. Specimens were cultured with optimal techniques in addition to antibiotic susceptibility based on recommendations from The Clinical and Laboratory Standards Institute (CLSI). A total of 1040 pathogens were isolated with an average of 1.9 pathogens per lesion in 550 patients who were identified with having DFIs during this interval. Results A higher percentage of Gram-negative pathogens (54%) were identified as compared with Gram-positive pathogens (33%) or anaerobes (12%). A total of 85% of the patients were found to have polymicrobial infections. Pseudomonas aeruginosa (19%), Staphylococcus aureus (11%) and Bacteroides species (8%) appeared to be the predominant organisms isolated. In the management of Gram-positive bacteria, the most efficacious treatment was seen with the use of Vancomycin, while Imipenem and Amikacin proved to be effective in the treatment of Gram-negative bacteria. Conclusion DFI’s are common among Malaysians with diabetes, with a majority of cases displaying polymicrobial aetiology with multi-drug resistant isolates. The data obtained from this study will be valuable in aiding future empirical treatment guidelines in the treatment of DFIs. This study investigated the microbiology of DFIs and their resistance to antibiotics in patients with DFIs that were managed at a Tertiary Care Centre in Malaysia.

BackgroundCharcot neuroarthropathy of the ankle and the hindfoot is a complex clinical entity with a high risk of amputation. Charcot neuroarthropathy limb reconstruction has been proposed as a limb-salvaging procedure. However, there was a lack of information on the various available reconstruction methods, including the outcomes and complications. The present study aimed to evaluate the current literature and update on the trends regarding the surgical management of Charcot neuroarthropathy of the ankle and the hindfoot.MethodsAll data published from January 2010 to January 2020 that investigated the methods of fixation and their respective outcomes for the surgical reconstruction in Charcot neuroarthropathy were analyzed. The union rate, amputation rates, and complications associated with these techniques were taken for statistical analysis.ResultsA total of 16 studies fit the inclusion criteria of this study, with four Level-III studies and 12 Level-IV studies were included. Ten studies utilized internal fixation only; five used a combination of internal fixation and circular external fixator, whereby there are three comparative studies between internal and external fixations, and two studies applied combined technique of internal and external fixations (hybrid fixation). One study describes the usage of circular external fixation only.ConclusionsThe use of retrograde intramedullary nail as a treatment of choice in the reconstruction of Charcot neuroarthropathy ankle is recommended before an ulcer occurrence. Hydroxyapatite (HA)- coated screws are recommended for the locking mechanism to prevent migration in Charcot neuroarthropathy due to poor bony quality. Hybrid fixation is recommended for reconstruction in a condition of ulceration and more complex deformity as it provides a higher rate of limb salvage with less soft tissue irritation.

Numerical modelling of real-world problems has a significant role in different disciplines like biology, physics, chemistry, economics, and many more. The numerical results are the authentication of the results of the dynamical analysis. We studied the heroin epidemic model's dynamics based on the law of mass action. The essential features of the model like positivity, boundedness, equilibria, and reproduction number are presented. Some standard and nonstandard computational methods like Euler, Runge-Kutta, and Nonstandard finite difference (NSFD) are given for the said model. The nonstandard finite difference method was developed to restore the fundamental properties of biological problems. Also, the proposed numerical model is consistent with the behaviour of the continuous model. To that end, simulations for the comparison of computational methods are presented.

Adipose tissue is an abundant source of extracellular substances that support the tissue repair process. This pilot study was carried out to determine the efficacy of 3D-bioprinted autologous adipose tissue grafts on diabetic foot ulcers (DFUs), with fibrin gel used to stabilise the graft. This was a single-arm pilot study in a tertiary hospital that provides diabetic wound care services. A total of 10 patients with a DFU were enrolled, and the primary endpoint was complete healing within 12 weeks. The secondary endpoints were wound size reduction, time to healing, and adverse events. Seven out of ten patients showed complete healing of their DFU within 12 weeks (at 2, 4, 5, 10, and 12 weeks, respectively). The wound size reduction rate was significantly and progressively reduced over time. According to our data, autologous adipose tissue grafting using a 3D bioprinter, with the addition of fibrin gel that acts as a scaffold, promotes wound healing with high-quality skin reconstruction. Throughout this study period, no adverse events were observed.

Background: Avascular necrosis (AVN) of the talus is a challenging condition that is caused primarily by trauma. The severity of the talus fracture determines the risk of AVN. Severe osteonecrosis with the loss of talar integrity can be treated with arthrodesis and structural bone graft.Method: This study shows the experience of pantalar arthrodesis using hindfoot arthrodesis nail, screw fixation, and femoral head allograft in four patients.Result: All patients were satisfied in terms of pain and function after an average of 4 months postsurgery. Limb length discrepancy was

Glomus tumour is a rare small benign lesion which is typically located at fingertip. Most patients with glomus tumour have delayed diagnosis. Recognition of the classical triad of glomus tumour which include paroxysmal pain, exquisite tenderness to touch and cold intolerance; and advanced imaging like MRI and biopsy would help in making the diagnosis. Here, a case of an elderly patient is reported with painful right forearm swelling for three years which progressively increased in size. The size of the swelling was unusually large for glomus tumour. Unfortunately, during the same time period he suffered from acute coronary event. MRI revealed subcutaneously located lobulated soft tissue mass. Surgical biopsy with marginal excision was done. Histopathological examination revealed small uniform rounded cells surrounding capillary vessels, consistent with the diagnosis of glomus tumour. There was no recurrence up to 2 year of follow-up and his cardiac symptoms also stabilised.

Virtual reality (VR) is one of the state-of-the-art technological applications in the healthcare domain. One major aspect of VR applications in this domain includes virtual reality-based training (VRT), which simplifies the complicated visualization process of diagnosis, treatment, disease analysis, and prevention. However, not much is known on how well the domain knowledge is shared and considered in the development of VRT applications. A pertinent mechanism, known as ontology, has acted as an enabler toward making the domain knowledge more explicit. Hence, this paper presents an overview to reveal the basic concepts and explores the extent to which ontologies are used in VRT development for medical education and training in the healthcare domain. From this overview, a base of knowledge for VRT development is proposed to initiate a comprehensive strategy in creating an effective ontology design for VRT applications in the healthcare domain.

In this mathematical study, the effect of buoyancy parameters along with radiation on magneto-hydrodynamic (MHD) micro-polar nano-fluid flow over a stretching/shrinking sheet is taken into consideration. Suitable similarity variables are used to convert the governing non-linear partial differential equations into a system of coupled non-linear ordinary differential equations which are then numerically solved by R.K method with shooting scheme. The influence of pertinent parameters on the velocity profile, temperature profile, micro-rotation profile, and concentration profile is investigated. It is founded that the velocity profile is decreased with the increment in the values of M and the opposite behavior is noticed for micro-rotation, thermal, and concentration profiles. It is also founded that an increase in the values of buoyancy parameters causes an increase in velocity profile while micro-rotation, thermal, and concentration profiles are decreased. The results are exposed and discussed through tables and graphs.

The outburst of the pandemic Coronavirus disease since December 2019, has severely impacted the health and economy worldwide. The epidemic is spreading fast through various means, as the virus is very infectious. Medical science is exploring a vaccine, only symptomatic treatment is possible at the moment. To contain the virus, it is required to categorize the risk factors and rank those in terms of contagion. This study aims to evaluate risk factors involved in the spread of COVID-19 and to rank them. In this work, we applied the methodology namely, Fuzzy Analytic Hierarchy Process (FAHP) to find out the weights and finally Hesitant Fuzzy Sets (HFS) with Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) is applied to identify the major risk factor. The results showed that “long duration of contact with the infected person” the most significant risk factor, followed by “spread through hospitals and clinic” and “verbal spread”. We showed the appliance of the Multi Criteria Decision Making (MCDM) tools in evaluation of the most significant risk factor. Moreover, we conducted sensitivity analysis.

This article focus the elimination and control of the infection caused by COVID-19. Mathematical model of the disease is formulated. With help of sensitivity analysis of the reproduction number the most sensitive parameters regarding transmission of infection are found. Consequently strategies for the control of infection are proposed. Threshold condition for global stability of the disease free state is investigated. Finally, using Matlab numerical simulations are produced for validation of theocratical results.

Triggering of the big toe is an uncommon presentation. Here we present a case of a ballet dancer complaint of pain along the posteromedial aspect of the left ankle, associated with triggering of her big toe. To our knowledge, there have not been any reports on the above condition in our region. With changing of lifestyle and demand of the population, clinicians should be aware of this, therefore appropriate management and treatment can be given.

Background: The study aims to evaluate the short-term functional outcome of open reduction and internal fixation of extraarticular scapular neck and body fractures treated at our center over a period of 2-year duration at a tertiary referral center.Patients and Methods: Between October 2015 and October 2017, we operated on 20 extraarticular scapular neck and body fracture. Ten were available for a one-off assessment. The mean time to surgery was 10 days (range, 3–19 days) and one-off assessment was done within 6–24 months (mean, 13 months). Indications includes (1) medial/lateral displacement (M/L) ≥ 20 mm, (2) M/L ≥ 15 mm if angular deformity ≥ 30°, (3) Angular deformity ≥ 45°, (4) Double lesion of superior shoulder suspensory complex (SSSC), with displacement ≥10 mm in both lesion, (5) Glenopolar angle (GPA) ≤ 22°, and (6) open scapular fracture. The functional outcome was measured using range motion and strength. Patient-reported outcome was assessed using Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Short-Form-36 (SF-36) version 1.Results: All patients achieved radiological union at time of assessment. None of the patients had post-operative complications. The mean DASH score was 19.3 (range, 1.7–39.3). All subcategories of SF-36 questionnaire scores between 70 and 89.6, with exception to REE (role limitations due to emotional problems) and REP (role limitations due to physical health). The average range of motion for the injured shoulders; forward flexion 157°, abduction 114°, and external rotation 42°. The strength of operated and non-operated shoulders, respectively, 6.5 and 8.1 kgF of forward flexion, 5.5 and 7.2 kgF of abduction, and 4.1 and 6.3 kgF of external rotation.Conclusion: Open reduction and internal fixation of surgically indicated scapular neck and body fracture is feasible with predictably good functional outcome. The reduced external rotation ROM and strength may be due to the use of Classic Judet approach, however we do not enough data to support this.

Introduction: MyAnkleTM software is semi-automated digital templating software for total ankle replacement surgery. This software enables a surgeon to review multiple sizes of implant over the radiograph for implant size determination. It has autoscaling properties which matches the magnification of the radiograph and template. This software is evaluated by testing the accuracy and inter-observer reliability of pre-operative digital templating for total ankle replacement. Aim: To evaluate the accuracy and inter-observer reliability of pre-operative digital templating of tibia and talar component size for total ankle replacement using MyAnkleTM digital templating software. Materials and Methods: This was retrospective study in which digital radiographs of patients who had undergone primary total ankle arthroplasty were evaluated. The operations were done in between year 2014 until 2017 in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). All cases were using nonconstrained anatomic shaped 3-component system prosthesis (Hintegra). The digital templating software (MyAnkleTM) was used for templating, by two foot and ankle surgeons from different centres. The predicted implant size was compared with the actual components selected at the time of surgery and its accuracy was measured. The inter-observer reliability was analysed using the linear weighted kappa (κ) analysis. Results: The size of tibial and talar component was accurate in 83.3% and 91.7% respectively. The accuracy of correct predicted size for second surgeon was 66.7% for talar component size and 58.3% for tibia component size. The inter-observer reliability for tibial and talar component size was substantial, weighted kappa (κ)=0.802 (95% CI, 0.623 to 0.982), p

We describe a series of three patients who sustained multiplanar sacral fracture with spinopelvic dissociation treated with bilateral triangle osteosynthesis supplemented with a gullwing plate. Multiplanar sacral fracture causes the sacrum to divide into two parts which in severe cases, fracture displacement results in neurological injury. Spinopelvic fixation supplemented with a gullwing plate surgical treatment is still a viable option with an acceptable outcome. The average waiting time prior to surgery is 3 weeks.

Diabetic Foot Osteomyelitis (DFO) has been described as one of the factor that can interrupt the healing process of a Diabetic Foot Ulcer (DFU). It shows that it has a significant correlation with lower limb amputation. One of the methods to treat this condition is by virtual amputation in which the infected bone is debrided with the ulcer site and the wound has a better chance to heal faster. This also shortens the duration of antibiotic course. We present a case series consisting of six patients that have been treated with virtual amputation from June 2017 till August 2017. These patients were treated by removing part of the osteomyelitic bone and dead tissues. Although there is no bone to support but the surrounding soft tissue coverage helps to maintain the configuration of the affected part in which it retained good appearance, cosmetically.

Congenital pseudarthrosis of tibia is a rare condition and it is highly associated with neurofibromatosis. The goals of surgery are to restore the tibial alignment, achieve bone union and re-establish the length of the tibia. The treatment includes resection of the pseudarthrosis followed by fixation with external fixation devices to perform callus distraction, intramedullary nail or open reduction and plate fixation in combination with bone graft. We present a case of a 16-year-old male with underlying neurofibromatosis and congenital pseudarthrosis of right distal third of tibia. Patient was treated with excision of the pseudarthrosis followed by reduction and fixation using locking compression plate and bone graft. Radiograph showed union of the tibia at eight months postoperation. Patient had limb length discrepancy of 10 cm and was ambulating with a shoe raised. At two years follow-up, there was no refracture of the tibia. The patient was satisfied with his current functional status and had adapted well. Due to his good functional outcome, he declined to undergo limb lengthening surgery. We thereby concluded that locking compression plate may be considered as a suitable option for the treatment of congenital pseudarthrosis of tibia.

OBJECTIVE: The main aim of the study was to analyze the outcomes of clavicle fractures in adults treated non-surgically and to evaluate the clinical effects of displacement, fracture patterns, fracture location, fracture comminution, shortening and fracture union on shoulder function. METHODS: Seventy clavicle fractures were non-surgically treated in the Orthopedics Department at the Tuanku Ja'afar General Hospital, a tertiary care hospital in Seremban, Malaysia, an average of six months after injury. The clavicle fractures were treated conservatively with an arm sling and a figure-eight splint for three weeks. No attempt was made to reduce displaced fractures, and the patients were allowed immediate free-shoulder mobilization, as tolerated. They were prospectively evaluated clinically and radiographically. Shoulder function was evaluated using the Constant scoring technique. RESULTS: There were statistically significant functional outcome impairments in non-surgically treated clavicle fractures that correlated with the fracture type (comminution), the fracture displacement (21 mm or more), shortening (15 mm or more) and the fracture union (malunion). CONCLUSION: This article reveals the need for surgical intervention to treat clavicle fractures and improve shoulder functional outcomes.