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Biomedical subjects

Y P Low

Publications and source records attributed to Y P Low.

At least 19 recordsLinked to original sources
PubMed2001

Predictors of outcome of floating knee injuries in adults: 89 patients followed for 2-12 years.

Of the 98 floating knee injuries that were consecutively treated from 1987 to 1997, 89 patients were available for analysis. There were 80 males and 9 females, ranging from 15 to 70 years old. Average follow-up was 5 (2-12) years. Injury severity scores ranged from 18 to 45. 21 fractures were intra-articular. 55 fractures were open. Substantial comminuted and segmental fractures occurred in 57 cases and 35 cases, respectively. Multivariate analysis showed that increasing age was associated with delays in bony union and full weight bearing ability. An increase in the number of pack years smoked at the time of injury predicted the likelihood of knee stiffness, delays in bony union and full weight bearing ability. Higher injury severity scores were associated with delayed full weight bearing ability. The presence of open fractures predicted the likelihood of knee stiffness and delayed full weight bearing ability. Comminuted fractures were associated with malunion, and segmental fractures with delayed bony union. Using the outcome of floating knee injuries as fair or poor, according to Karlström and Olerud's criteria, we constructed a preoperative prognostic scoring scale which showed a sensitivity of 0.72 and a specificity of 0.90.

Activities of Daily Living↗
PubMed2000

Surgical results of intercondylar fractures of the adult femur.

INTRODUCTION: Although surgical treatment of intercondylar fractures of the adult femur gives satisfactory results in the majority of cases, there are complications reported with operative management. We aim to analyse the surgical results of these cases performed in our institution and compare them to other reported series. MATERIALS AND METHODS: A total of 16 patients with intercondylar fractures of the femur were operatively treated from 1989 to 1997. The ages of these patients ranged from 24 to 77 years, with a mean age of 42 years. Average length of follow-up was 28 months. The fractures were classified according to AO classification. Twenty-five per cent of the fractures were significantly comminuted. They were internally fixed with various implants such as cancellous screw fixation, dynamic condylar screw plate, condylar blade plate and condylar buttress plate. RESULTS: Average time to full weight bearing was 12 weeks. Results of treatment were assessed according to the criteria described by Shelbourne. Eighty-three per cent of minimally comminuted fractures had a good result, but only 50% of significantly comminuted fractures did well. CONCLUSIONS: We recommend the use of anterior midline approach and condylar buttress plate for very comminuted fractures. Infection, if detected early and treated aggressively could avoid a poor outcome. Elderly patients should benefit from internal fixation and earlier mobilisation.

Adult↗
PubMed1999

End-to-side anastomosis of transected nerves to prevent neuroma formation.

Neuroma can be painful and physically and psychologically disabling. Among the many methods of treatment available, one of the more successful is centrocentral nerve union with an autologous graft. However, it cannot be used in small nerves that lack two fascicles. This study evaluated neuroma prevention in an end-to-side anastomosis, a new technique applicable to all nerves. The lateral branch of the right sciatic nerve in 20 rats was transected at the midthigh level. The proximal segment was looped back to the main nerve and an end-to-side epineural anastomosis was performed. The lateral branch of the left sciatic nerve was transected to serve as a control, and the proximal nerve stump was closed by interrupted epineural sutures. The animals were sacrificed 12 weeks after the operation. Histologic analysis of specimens from the 12 controls showed neuroma formation. Specimens from 12 side-to-end anastomoses contained regenerated nerve tissues and formed smaller masses compared with that of the controls. The regenerated tissues at the anastomoses were orientated more orderly than were tissues from the controls in 75% of cases. The differences were statistically significant. Electron microscopic study on specimens from the remaining eight controls showed the presence of abundant large abnormal myelinated fibers (10-15 microns) with thick irregular myelin sheaths scattered among smaller myelinated fibers (2-10 microns) that had thin myelin sheaths. In the remaining eight end-to-side anastomoses, large abnormal myelinated fibers were absent. The myelinated fibers were 2 to 10 microns in diameters and had a normal appearance with thin myelin sheaths. End-to-side anastomosis formed a smaller mass of regenerated nerve tissues. Ultrastructurally they were formed better and orientated more orderly resembling normal nerve.

Anastomosis, Surgical↗
PubMed1999

Transscaphoid perilunate fracture/dislocations--results of surgical treatment.

Sixteen cases of dorsal transscaphoid perilunate fracture/dislocations in 15 patients were treated by open reduction and internal fixation of the scaphoid with a Herbert screw and/or Kirschner wires. All patients were male, with a mean age of 31 years. The average follow-up period was 3 years. These perilunate dislocations were transscaphoid in 13 cases, and transstyloid and transscaphoid in 3 cases. There was one case of median nerve deficit preoperatively. Open reduction was performed through a volar approach in all cases. Herbert screw fixation of the scaphoid was performed on 13 cases, of which supplemental Kirschner wires were used in 2 cases. Three cases had fixation with Kirschner wires only. There were 2 cases of non-union which required bone grafting on follow-up. A clinical evaluation scoring system assessing pain, occupational ability, range of motion and grip strength was used. Based on this, there were 10 excellent to good (62.5%) and 6 fair results. For the majority of our patients, surgical outcome is characterised by acceptable relief of pain, functional motion and grip strength.

Adult↗
PubMed1998

The effect of the extent of A1 pulley release on the force required to flex the digits. A cadaver study on the thumb, middle and ring fingers.

The A1 pulley was released distally in consecutive stages by 25%, 50%, 75% and 100% of its length. The force required to fully flex the digit at each stage was recorded. The force decreased with more extensive A1 pulley release and this became significant when more than 50% of the pulley was released. These changes were probably due to loss of friction force rather than bowstringing of the tendon.

Biomechanical Phenomena↗
PubMed1998

Operative treatment of displaced talar neck fractures.

Twenty-two displaced talar neck fractures were treated by open reduction and internal fixation. Four open fractures were operated within 8 hours and 18 closed injuries were treated at an average interval of 13.8 hours after injury. Fractures were classified according to Hawkins' classification into 14 type II, 7 type III and 1 type IV. At an average follow up of 4.4 years, 18 cases obtained excellent or good results. Result was fair in 2 cases of delayed union and 1 case of avascular necrosis. Another case of avascular necrosis developed osteoarthritis of the ankle and had poor result. The overall incidence of avascular necrosis of the body of the talus was 9%.

Adult↗
PubMed1998

Delayed diagnosis of tuberculosis presenting as small joint arthritis--a case report.

Small joint arthritis is an uncommon manifestation of tuberculosis. We report a case of tuberculosis presenting as arthritis of the midtarsal joints with concomitant spinal involvement. This case illustrates the difficulties in diagnosing tuberculous arthritis as it has an insidious onset, paucity of constitutional symptoms, unremarkable early physical findings and frequent absence of associated pulmonary involvement. A high index of suspicion in high-risk individuals with chronic monoarthritis, is required to avoid delayed diagnosis.

Adult↗
PubMed1998

A case report of Atasoy antenna procedure.

A 25-year-old man presented with hook nail and painful atrophic pulp over the tip of the terminal phalanx of the right thumb 3 months following a crush injury. Lateral nail folds were poorly defined and the nail was curved. The patient was unable to pick up objects with a precision pinch. Reconstruction was performed with Atasoy antenna procedure. One year later, normal pulp contour of the injured thumb was restored and appearance of the nail was normal.

Adult↗
PubMed1997

Comparison between single injection transthecal and subcutaneous digital blocks.

A randomized double blinded study was performed on 142 patients to evaluate two different techniques of single injection digital anaesthesia. In group A, 86 digits in 71 patients were anaesthetized by a single injection transthecal technique using 3 cc of lignocaine and bupivacaine mixture. Anaesthesia of the whole digit was achieved in 83 (97%) digits. In group B, 80 digits in 71 patients were anaesthetized with a single injection subcutaneous technique using the same amount of anaesthetic mixture. Total anaesthesia of the digit was achieved in 75 (94%) digits. These two techniques were found to have no differences in effectiveness, distribution, onset and duration of anaesthesia.

Adult↗
PubMed1997

A retrospective study on elbow function after internal fixation of intercondylar fracture of adult humerus.

Between 1989 and 1993, 20 intercondylar fractures of the distal humerus were treated by open reduction, internal fixation and early postoperative mobilisation. One patient died on the third postoperative day as a result of multiple injuries, leaving 19 patients for evaluation. The mean follow-up period was 4.1 years (range 2.0 to 6.7 years). According to the Muller system, there were 7 type C1 and 12 type C2 fractures. Using the Jupiter criteria, 6 elbows were rated as excellent, 9 good and 4 fair. Complications included late ulnar neuritis in one patient and wound infection in another patient.

Adolescent↗
PubMed1997

A retrospective evaluation of operative treatment of ankle fractures.

Between 1990 and 1992, 89 patients with ankle fracture were treated by open reduction and internal fixation in accordance with the Arbeitsgemeinschaft für Osteosynthesefragen (AO) principles and were available for evaluation with a mean follow-up period of 3.6 years (range 3 to 5 years). According to the AO classification, there were 21 type A, 37 type B and 31 type C fractures. The results were rated by the Olerud and Molander score. Excellent or good results were seen in 20 type A, 35 type B and 25 type C fractures. Fair or poor results in 1 type A, 2 type B and 6 type C fractures. Complications included screws in the joint in 2 cases and infection in 3 cases.

Adolescent↗
PubMed1997

Necrotising fasciitis--an old enemy or a new foe.

Necrotising fasciitis when described by Meleney was caused predominantly by Streptococcus pyogenes. Since then, there were several reports which confirmed streptococcus as the main organism identified in this disease entity. However, recently there were reports of necrotising fasciitis caused by organisms other than Streptococcus. We analysed 19 cases of necrotising fasciitis seen in the Department of Orthopaedic Surgery over a period of 24 months to see if this disease entity has changed significantly. The patients in our series were between the ages of 19 to 85 years with an average age of 57.2 years. Males were more often affected (16 out of 19). The majority of the patients have some form of underlying disease (16 out of 19 cases). There was a trend towards polymicrobial infection and many were resistant to standard antimicrobial therapy. The mortality rate was 21.1%. Our results are comparable to many earlier series.

Adult↗
PubMed1997

Spine surgery in geriatric patients.

AIM: Many elderly patients are crippled by degenerative spine conditions. Operative treatment is often not offered due to fear of complications and consideration of life span. The objective of this study was to look at the diagnosis, surgical results and post-operative complications of elderly patients who underwent spinal surgery. METHODS: A cohort of 44 patients, 65 years and older, who had surgery in Tan Tock Seng Hospital from January 1990-August 1995 were reviewed. Twenty-five of them had spinal stenosis, II had tumour and 9 had traumatic fracture/dislocation/subluxation. There were 3 patients each with disc herniation, infection and spondylolisthesis. Nine patients had more than one diagnosis. All patients were investigated post-operatively. The data was entered into a computer-coded protocol. The diagnosis was determined intraoperatively. Type of surgery, co-morbid conditions and results were looked into. Patient's opinion on relief symptoms was graded on a 5-point scale. Functional improvement was tabulated as the patient's ambulatory status. RESULTS: The analysis of results was divided into two groups, patients with tumour and those without tumour. Twenty-seven of the 33 patients without tumour were alive at follow-up. Twenty-six of these patients had improvement of symptoms and 18 of 27 had improved functional status post-operatively. In the group with tumours, 2 had worsening symptoms and 3 had decreased function. CONCLUSION: Surgical intervention should be a treatment option in elderly patients with spinal disease.

Aged↗
PubMed1996

Complications following metal removal: a follow-up of surgically treated forearm fractures.

We undertook a retrospective study of 82 patients with 128 diaphyseal fractures of the forearm who had been operated at our institution for their initial injury and subsequently had implant removal when the fractures had healed. The majority of the patients (97.5%) had no major complications after the removal of implants but 2 patients sustained a re-fracture of the same bone within 6 months after plate removal. Both patients had suffered from open fracture at the initial injury and sustained re-fracture in the original fracture site after implant removal. These fractures were both treated conservatively in a cast and united without further problems. Another 20 patients (24.4%) had minor complications ranging from mild superficial wound infection to nerve injury.

Adolescent↗
PubMed1995

A cadaver study of the effects of dorsal angulation and shortening of the metacarpal shaft on the extension and flexion force ratios of the index and little fingers.

Two experiments were performed on the second and fifth metacarpals of five normal cadaver hands. The forces obtained on full extension and flexion of the digits were measured. An oblique osteotomy was performed on the shaft of the metacarpal and fixed with dorsal angulation. The forces obtained on extension and flexion of the digits were measured. The relationships between the changes in force and the angle were analyzed. Flexion force decreased and extension force increased as the dorsal angulation increased, and these were significant beyond 30 degrees of dorsal angulation. The differences between index and little fingers were not significant. In the second experiment, the metacarpal bone was shortened at the osteotomy site, and the same measurements made. Flexion and extension forces both decreased, and were significant beyond 3 mm of shortening. The differences between index and little fingers were not significant.

Analysis of Variance↗
PubMed1995

Delayed abscess formation in the wrist due to an unusual retained foreign body--a case report.

It is well documented that retained foreign bodies can be associated with delayed abscess formation in the body. We report an unusual case of a large bomb shrapnel in the wrist of a 64-year-old Chinese woman which was retained for 52 years, causing gross wrist destruction and delayed abscess formation. An open drainage of the wrist abscess was done and the shrapnel was removed. A secondary closure was subsequently done but the patient refused another procedure for a formal wrist arthrodesis.

Abscess↗
PubMed1995

Primary hyperparathyroidism: a case with severe skeletal manifestations.

Over the years, patients with primary hyperparathyroidism are often asymptomatic and diagnosis is suspected on the incidental finding of hypercalcaemia. We report a patient, a middle-aged man from northern Sumatra, with a florid but uncommon presentation of severe bone pains and bilateral femoral neck fractures. He was found to have a solitary parathyroid adenoma which was successfully removed surgically. Postoperatively, the patient had severe symptomatic hypocalcaemia that required aggressive replacement therapy with calcium, magnesium and active vitamin D. He was well clinically and had significant improvement of biochemical indices on follow-up at 3 months. This report is followed by a review on the management of this condition.

Adenoma↗