Prevalence of Osteoporosis and Risk of Developing Fragility Fracture in Post-Menopausal Women

Introduction: Osteoporosis and fragility fracture pose major health concern and cause significant financial burdens in healthcare system. The objectives of this study were to determine the prevalence of osteoporosis among post-menopausal women and to predict the risk of having the major osteoporotic and hip fracture in 10 years using the WHO Fracture Risk Assessment Tool. Materials and Methods: This was a cross-sectional study spanning over a two-year period (from June 2015 to June 2017) investigating post-menopausal women who did their Bone Mass Density (BMD) test at Hospital Melaka. Collected BMD data and parameters were used for analysif of the prevalence of osteoporosis among the study population and FRAX calculation was used to predict the average risk of fragility fracture in 10 years. Statistical analysis was done using SPSS statistical package. Results: Prevalence of osteoporosis among 388 post-menopausal women age 45 to 90 years old was 29.9%. More than half of patients had osteoporosis were Chinese (51%) followed by Malay (43%), Indian (5%) and others (1%). The 10 years average percentage of developing major osteoporosis was 10.81 ± 9.55 %, while the average percentage of developing hip fracture was 4.20 ± 6.53. Conclusion: Prevalence of the post-menopausal women who were osteoporotic was about 30% which is comparable to other countries (Japan, Egypt, Australia, Mexico, Argentina and India). The 10 years average percentage of developing major osteoporosis and hip fracture in our study is quite high, approximately around 20% and 10%, respectively

Wrecked calcaneum: ORIF with primary subtalar fusion; a case report

INTRODUCTION: The calcaneum is the most frequently fractured tarsal bone and comprises 2% of all fractures. Approximately three quarters of these calcaneal fractures are intra-articular and treatment of these fractures is difficult. Treatment modalities range from conservative management to open reduction and internal fixation (ORIF) and subtalar fusion. ORIF of intra-articular calcaneal fractures leads to good and excellent results in 60-80% of the patients. But 2-17% of patients require secondary subtalar fusions because of the development of a painful subtalar arthritis. This has a direct correlation with the degree of subtalar comminution. CASE REPORT We are reporting a case of a 46-year-old man who was involved in an alleged motor vehicle accident. He sustained open comminuted fracture of right calcaneum with subtalar subluxation and underwent urgent wound debridement with cross ankle external fixation. Two weeks later, open reduction, internal fixation with calcaneal locking plate and primary subtalar fusion with cannulated screws were done. Patient was discharged home after an uncomplicated post operative stay in the ward of 5 days DISCUSSION: The treatment of comminuted intra-articular calcaneal fractures is still very much debated. Although several authors have reported good results in these fractures that were managed operatively, prognosis remain poor for some cases especially those with severe comminution. In his case series, Sanders reported secondary fusions in 7 of 30 (23%) Sanders Type III fractures and in 8 of 11 (73%) Type IV fractures. However, the results of secondary subtalar fusion after an intra- articular calcaneal fracture are not always satisfying. Themann et al. found only 10/17 (59%) good and excellent results using the AOFAS Score. The 7 patients (41%) with fair and poor results had an impaired ROM of the ankle joint with a secondary painful arthritis in the adjacent joints. Hence, a primary fusion after open reduction and internal fixation of the calcaneum at the same setting is recommended in selected cases. CONCLUSION: Primary subtalar fusion with ORIF of the calcaneum is certainly an option in treatment of severely comminuted intra-articular calcaneal fractures

Tibial pilon fracture in a skeletally immature patient: mini open with intrafocal pinning and reduction technique; a case report

INTRODUCTION: Pilon fractures are intra-articular fractures of the distal tibia associated with variable talar injury, articular disruption, and comminution. These fractures were first described by Destot in 1911 and have been reported to represent 7% of all tibial fractures and <1% of all lower extremity fractures in adults. Despite the low incidence of these fractures, the resulting morbidity is considerable. The vast majority of reported cases have involved adults, with sporadic inclusion of children. Pilon fractures are the result of complex forces with axial compression, forced dorsiflexion, often associated with violent rotation resulting in severe, comminuted fractures. Several classification systems have been described; however, the most widely used system in the literature is that proposed by Ruedi and Allgower. They classified pilon fractures into three categories, based on the extent of articular surface fracturing. Type I fractures were nondisplaced, type II fractures were displaced with minimal comminution, and type III injuries were markedly comminuted CASE REPORT We are reporting a case of a 13-year-old boy who fell from rooftop of 2 metres height and landed on his right ankle. Having sustained closed comminuted fracture of distal end right tibia and right lateral malleolus, he was duly planned for surgical intervention. We performed a mini open approach with intrafocal pinning, reduction and further stabilized by conventional plating. Patient was discharged home on day 3 post operation with no complications. DISCUSSION: Preservation of the soft tissue is of particular importance in the care of pilon fractures. Traditional open reduction internal fixation of pilon fractures allows for direct visualization of the fracture(s) but is often criticized for the large exposure and periosteal stripping. External fixation has also been used but has not demonstrated much advantage to internal fixation and requires significant postoperative care. As such, mini open or minimally invasive approach has gained popularity and fast becoming an option in management of pilon fractures. The reduction technique in mini open surgeries are always difficult. In this case, we used an intrafocal pinning and reduction method to reduce the articular fragment. Kapandji described the use of intrafocal K-wires to buttress the dorsal and radial fragments in extra-articular distal radius fractures. We applied the same principles, albeit in this case for the articular fragments of tibial plafond ▲ Pre-operative and intra-operative images CONCLUSION: Mini open approach supplemented with intrafocal pinning and reduction technique offers a reliable option in treatment of pilon fractures, especially in the skeletally immature group

Inventing and validation of questionnaires Muslim doctor questionnaire (MDQ) & Muslim medical student questionnaire (MMSQ)

Background:   International Islamic University Malaysia has pioneered the model of Islamic Input into Medical Program (IIMP). This is part of the main objective to enhance the affective domain in our curriculum. In order to evaluate the effectiveness of IIMP programme, it is important to an assessment tool. Once Kulliyyah is able to prove the effectiveness of IIMP, it is hope IIUM Kulliyyah of Medicine would be a role model in development of Islamic Medical Curriculum. At the moment there is not a single medical Islamic scale available. This we hope will be the pioneer of all.   Objectives:   To invent new questionnaires called MDQ & MMSQ that will be reliable and validated for the Muslim doctors and medical students respectively. To assess the good Muslim values in various academic years. To assess pre- and post- input of Islamic curriculum   Knowledge, Attitude, & Practice aspects on these domains;   Religiosity, Aqidah – (knowledge, practice) Knowledge of Relevant Medical Fiqh (knowledge), Ibadah (Rukhsah) Communication Skill – (attitude, practice) Behavior Professionalism Clinical Competence. Islamic Ethics, Islamic Medical Jurisprudence, Outward Manifestation Sincerity, Akhlak Morality, Confidentiality   Results; A total of 468 participants among students;. Reliability; Cronbach’s alpha of 0.91 and 8 domains were identified by using explanatory factor analysis with Varimax rotation. Validity; From items, 75% had good factor loading (>0.4). Therefore these 2 questionnaires are valid and reliable

The Quality of Life and Functional Outcome of Hindfoot Reconstructive Surgery in Charcot Foot

Introduction: Charcot foot problem is devastating and a difficult condition to treat. There are limited data and study regarding the quality of life and functional outcome of Charcot foot being treated surgically. This study evaluates the outcome of Charcot foot treated with reconstructive surgery. Materials and Methods: This is a cross-sectional study that compares the quality of life and functional outcome of patient with Charcot foot pre and post tibio-talar-calcaneal (TTC) arthrodesis surgery at Hospital Tengku Ampuan Afzan and International Islamic University Malaysia Medical Centre between 2016 and 2018. Patients were evaluate using SF-36 scores and AOFAS scores pre and post-operative at average of 6 months (range between 3 to 9 months). Results: Thirty patients had undergone reconstructive foot and ankle surgery using hindfoot arthrodesis nail (HAN) for TTC arthrodesis. The outcome was assessed using paired t-test comparing pre and postoperative for both SF-36 and AOFAS scores. The SF-36 components had significant improvement with a mean of 35 to 45.6 for physical component (PCS) and 46.6 to 52.5 for mental component (MCS) (p&lt;0.0001). The overall AOFAS score had significant improvement from average of 36 to 57.8 out of 100 (p&lt;0.0001). Pain component of AOFAS shows lower score of improvement. Two patients had suffered ulceration post operatively that requires multiple debridement and exostectomy with one patient requires removal of HAN eventually. Conclusions: Tibio-talo-calcaneal arthrodesis using HAN surgery improves the quality of life and functional outcome of Charcot foot

Model of A Critical Size Defect in the New Zealand White Rabbit’s Tibia

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

Numerical modelling of multiple tuned mass damper equipped with magneto rheological damper for attenuation of building seismic responses

TMD is basically designed to be tuned to the dominant frequency of a structure which the excitation frequency will resonate the structural motion out of phase to reduce unwanted vibration. However, a single unit TMD is only capable of suppressing the fundamental structural mode and for multimode control, more than one TMD is needed. In this study, a 3-storey benchmark reinforced structural building subjected to El Centro seismic ground motion is modelled as uncontrolled Primary Structure (PS) by including properties such as stiffness and damping. For the case of controlled PS which the passive mechanism is included to the system, optimum parameters of both TMD and Multiple TMD (MTMD) are designed to be tuned to the dedicated structural modes where the performance is dependent on parameters such as mass ratio, optimum damping ratio, and optimum frequency ratio. The input and output components of structural system arrangements are then characterized in the transfer function manner and then converted into state space function. For enhancement of the passive system, Magneto-Rheological (MR) damper is added to both single TMD and MTMD passive system. The response analysis is executed using both time history and frequency response analysis. From the analysis, semi-active case is the most effective mechanism with 99% displacement reduction for the third and second floors, and 98% for the first floor, compared to the uncontrolled case. It is concluded that the MR damper significantly contributed to the enhancement of the passive system to mitigate structural seismic vibration

Biomechanical analysis of different K-wire configurations for percutaneous fixation of two-part proximal humerus fractures

The increasing prevalence of proximal humerus fractures in the elderly population, particularly osteoporotic fractures, necessitates a biomechanical evaluation of Kirschner wire (K-wire) configurations used in percutaneous fixation. This study investigates the stability of different K-wire configurations and examines the effect of wire size and type (smooth vs. threaded). Using 27 synthetic humeri models, we compare three configurations as follows: four parallel ascending K-wires (box-type), two ascending and two descending Kwires, and a combination of both. Results show that adding descending K-wires significantly enhances stability, particularly against torsional forces. This study highlights the importance of wire type and configuration in stabilizing proximal humerus fractures. Multiplanar constructs with descending K-wires, especially threaded ones, offer better stability. These insights help improve surgical techniques for elderly and osteoporotic patients, but further research using cadaver models is needed for clinical validation

Knowledge, Attitude and Practicality of Solat Among the Hospitalised Patients

Introduction: A Muslim is obliged to perform solat five times every day at dedicated times. This must be performed regardless of the situation, either in ease or difficulty. The aims of this study were to investigate the awareness, knowledge and practicality of solat for sick Muslim patients when they hospitalised. Methods: A cross sectional study involving 160 patients was conducted between 18th July 2013 and 28th August 2016. A valid, self-administered questionnaire was given to all Muslim patients to assess the awareness, knowledge, and practicality of solat during illness. The questionnaires were distributed to hospitalised Muslim patients from six selected hospitals in Malaysia. Results: All 160 respondents are Muslim and know that solat is obligatory to be perform (100%). The majority of them 129 (80.6%) practice solat five times daily, while 26 (16%) practice it sometimes and five (3.1%) of them never perform it. However, only 103 (64.4%) were still practising solat when they were hospitalised, while 57 (35.6%) did not. More than half (56.9%) said that the pain and illness had limited their daily ritual practice. Overall, 113 (70.6%) of the respondents felt guilty when they unintentionally did not perform solat. Seventy (43.8%) patients said that the facilities in the hospital did not meet their expectations in terms of helping them to perform solat. Conclusion: This study implies that there is a need for measures and interventions to help Muslim people perform solat while hospitalised. We hope that by conducting proper training and upgrading the facilities, the level of awareness and practice can be improved