Bone banking and transplantation in developing countries.
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Bone Transplantation↗
Biomedical subjects
A Nather
Publications and source records attributed to A Nather.
Organisation, operational aspects and clinical experience of National University of Singapore Bone Bank.
The National University of Singapore (NUS) Bone Bank was started in October 1988 and is the first such bank in Singapore. Two Revco Freezers were installed to store bones at -80 degrees C. The NUS Bone Bank Protocol follows the multi-centre protocol in USA with Massachusetts General Hospital as the Central Registry. It strictly follows the guidelines for banking of musculo-skeletal tissues set up by the American Association of Tissue Banks. Strict donor selection is practised including screening for Aids, hepatitis, syphilis and infection. It does not provide for storage of articular cartilage. Currently, procurement is obtained from living donors. Mainly femoral heads have been obtained (63 donors to date). One whole tibia, one whole fibula, one lower end of femur have also been procured. Bone allograft transplantation has been safely performed in 14 recipients--mainly spinal fusions (seven cases), Sub-talar joint fusion in children (three cases) and packing Giant Cell tumors (two cases). Other cases include revision hip surgery (one case) and augmenting of hypoplastic mandible (one case). The biggest problem faced by the NUS Bone Bank is lack of donors. There is definitely a need for bone allografts in Singapore where such transplantation is legal. Presently, there is also a demand for whole bones to bridge large bone defects resulting from tumour resection and for reconstructing post-traumatic defects. This can only be met if we can procure more whole bones especially from cadaveric donors.
Bone Transplantation↗
Healing of non-vascularised diaphyseal bone transplants. An experimental study.
Four different experiments were performed to study the healing of a large, non-vascularised, diaphyseal, bone segment in adult cats. In the first experiment, a 4 cm segment of tibia with its periosteum was excised and replaced in its bed. The other experiments were similar, except that in the second, the periosteum of the segment was removed, in the third its medullary canal was blocked with a Silastic rod, and in the last group the segment was isolated from its muscle bed by a Silastic sheet. The reparative processes were quantified by estimating the resorption index, the cortical new bone formation index, the callus encasement index, and the osteocyte count. Bone resorption and apposition occurred in the segment even when the periosteum was absent or the medullary canal was blocked, with osseous union at both ends by eight to 12 weeks, provided the segment was not isolated from its muscle bed. Thus, the muscle bed played a significant role in these reparative processes.
Animals↗
Biomechanical strength of non-vascularised and vascularised diaphyseal bone transplants. An experimental study.
We studied the healing and torsional strength of non-vascularised (28) and vascularised (28) sections of tibial diaphyses in 56 cats. Both types of graft achieved fracture union in the same period of time, and at 12 and 16 weeks the non-vascularised grafts were as strong as the vascularised grafts.
Animals↗
Streptococcal necrotizing myositis: a rare entity. A report of two cases.
Deep muscle abscess or bacterial myositis is not an uncommon disease in the tropics. The commonest pathogen involved is Staphylococcus aureus. However, streptococcal myositis is rare. Only a few cases have been reported in literature. Furthermore, streptococcal myositis with extensive necrosis of muscles has not been reported. In two cases of streptococcal myositis with extensive muscle necrosis, both developed severe acute infection with septicaemia. Histologic observations revealed massive necrosis of muscle tissue with acute inflammatory infiltration. This condition, which we designate streptococcal necrotizing myositis should be treated as a separate disease entity. It requires not just incision and drainage, as in bacterial myositis, but radical excision of all the necrotic muscles in addition to appropriate antibiotics. Unless it is recognized, the treatment will be inadequate and un-necessarily prolonged. Intramuscular pressure may contribute to the pathogenesis of muscle necrosis and may stimulate compartmental syndrome.
Acute Disease↗
Malignant transformation of a benign cutaneous mixed tumour.
Whilst benign cutaneous mixed tumour is common, malignant cutaneous mixed tumour is rare. There are only eleven accepted cases of the malignant counterpart in the literature. In none was there residual benign tumour tissue present to suggest that they arose from malignant transformation of the benign tumour. We report a very rare case of a malignant transformation of a benign cutaneous mixed tumour in an eighty-four year old female. Other unusual features in this case included considerable involvement of bone in the primary lesion and the histological picture of extreme pleomorphism and active mitoses, not seen in other reported cases of the malignant tumour.
Aged↗
A rare case of carpal tunnel syndrome due to tenosynovial osteochondroma.
A rare case of carpal tunnel syndrome due to an extra-articular synovial osteochondroma arising from the synovial sheath of the flexor pollicis longus tendon, is described. This has not been described in the literature previously. The cyst with the contained osteochondroma was excised with good relief of symptoms. The histological examination of the osteochondroma revealed another interesting and unusual feature. We would like to document a case of tenosynovial chondrometaplasia of the synovial lining of a tendon sheath. Only a few such cases have been reported in the literature.
Carpal Tunnel Syndrome↗
Assessment of vascularity of head of femur by bone scan and histopathology.
A prospective study of 17 patients with fracture neck of femur was undertaken to study the vascularity of the femoral head by bone scan using Technetium-99m MDP, as well as to study the viability of the femoral head by histopathology, and therefore determine correlation, if any, between these two methods. Treatment was by primary endoprosthetic replacement (Moore's Arthroplasty). In 16 of the 17 patients the bone scan showed decreased vascularity of the head, but histopathological examination could not confirm non-viability of the head. It is likely that, since the majority of the patients were operated on within 4 days, there was insufficient time for histopathological evidence of ischemia to develop, prior to removal of the femoral heads.
Aged↗
Gait analysis in cerebral palsy.
Ambulation problems in cerebral palsy have been very difficult to analyse because it is the central control system rather than the motor system that is at fault. Until recently, decisions regarding surgical management has been made on clinical grounds, which by and large, have been subjective. Attempts to remedy this situation has resulted in the setting up of Gait Analysis Laboratories to provide a more objective method of evaluation of disorders of human motion. We have recently been using an opto-electronic computer-based gait analysis system to analyse normal as well as abnormal gait. Gait analysis can provide information regarding movements of both lower limbs in three planes, ground reaction forces, joint torque and dynamic electromyography. Children with various types of Cerebral Palsy have been assessed. The results of four clinical gait assessment cases are presented and discussed. Information provided by the Gait Analysis Laboratory has introduced more objectivity in pre-operative planning for these children.
Adolescent↗
Our experience with lumbar spinal stenosis in Singapore.
This is a study of 34 cases of lumbar spinal stenosis operated in the University Department of Orthopaedic Surgery from August 1973 to April 1980. Eleven cases were due to degenerative stenosis, 4 due to degenerative spondylolisthesis, 1 developmental, 3 post-fenestration/laminectomy, 1 post-fusion and 14 cases were due to combined aetiology. The average length of follow-up was 2.3 years. The clinical radiological and operative diagnostic features were analysed. Decompression alone was performed in 16 cases. Discectomy was also carried out in 16 cases and primary fusion in 3 cases. Good relief of backache, sciatica and neurogenic intermittent claudication was achieved in most cases. The majority were also able to return to their previous occupation, the average time taken being 4.9 months. 77% of cases gave either excellent or good results. The complications were spinal instability in 2 cases, impotence in 1 case, intra-operative nerve root damage in 2 cases and superficial wound infection in 1 case. Further surgery (lateral gutter fusion) was performed in only 1 case.
Adult↗
Secondaries to the spine with cord compression.
This is a study of 64 cases treated from January 1971 to February 1982. Although myelography was preferred, it was not essential except in three types of instances. Posterior decompression was performed in 60 cases and anterior decompression in 4 cases. About 70% died within 6 months after operation. Only 28% gave satisfactory results. A satisfactory result was seen mainly with nasopharyngeal carcinoma mild neurologic deficit, intact sphincter control, long duration of neurologic deficit, gradual onset of compression and lumbar level of involvement. In contrast, an unsatisfactory result occurred with lung, breast and liver cancers, severe neurologic deficit, loss of sphincter control, short duration of neurologic deficit, sudden onset of compression and thoracic level of involvement.
Adult↗
Malignant fibrous histiocytoma at site of metal implant.
The occurrence of malignant tumors at the site of metal implants is rare. The significance of this association is not settled. Its implications, however, are serious. A malignant fibrous histiocytoma arising at the site of an implant done 14 years ago for traumatic fracture of the femur in a 44-year-old man is reported. Previous reports are briefly summarized.
Amputation, Surgical↗
Treatment of valgus hindfoot in cerebral palsy by peroneus brevis lengthening.
Twenty cerebral-palsied patients (30 feet) with hindfoot valgus due to muscle imbalance were reviewed and it was shown that the deformity can be reduced by peroneus brevis lengthening. The method of choice is intramuscular lengthening, which reduces the power of peroneus brevis by one point on the MRC grading and corrects the hindfoot valgus by one grade of severity. For full correction by tendon lengthening, the deformity must be treated while it is still mild. Repeat lengthening may be necessary if there is a severe muscle imbalance.
Adolescent↗
The results of decompression of cord or cauda equina compression from metastatic extradural tumors.
The role of decompression in spinal metastases with neurologic deficit is controversial. This series demonstrates that the benefit from decompression depends on the nature of the tumor and the neurologic status of the patient. Prognosis is good for patients with incomplete paraplegia, intact sphincter control, a long duration of neurologic deficit and pain, and a gradual onset of compression. The prognosis is poor in cases with complete paraplegia, loss of sphincter control, a short duration of neurologic deficit and pain, and a sudden onset of compression. Surgery is not advocated for all cases, because many patients are already very ill. Surgery is recommended only for selective cases in which the prognosis is good. However, decompression is only palliative. Posterior decompression is preferred, inasmuch as the surgery is less extensive compared to anterior decompression and fusion.
Adult↗
Application of Kuntscher Y nailing for fractures involving upper end of femur.
Kuntscher Y nail is biomechanically a stable assembly and is useful in the management of unstable intertrochanteric, subtrochanteric and pathological fractures involving the upper end of the femur. In addition, it was ideal in special situations with fracture of the upper end of the femur; in a mentally ill patient with an unstable trochanteric fracture, for non-union of a trochanteric fracture and for a fracture of the upper end of the femur associated with a fracture further distally of the femoral shaft. Although it proved to be a very stable fixation, the control of external rotation of the distal femoral shaft was a significant problem in two cases. In all six cases stable fixation was achieved which progressed to sound union, including the case with ununited fracture. No technical difficulty was encountered at the time of operation although this could pose a significant problem. The main danger is the splintering of the lateral subtrochanteric femoral cortex during insertion of the neck piece and inability to negotiate the Kuntscher nail through the fenestration in the neck piece.
Adult↗
Carpal tunnel syndrome produced by an organising haematoma within the anomalous second lumbrical muscle.
A rare case of carpal tunnel syndrome due to an anomalous second lumbrical muscle passing through the carpal tunnel is described. Its presentation as an organising haematoma in the anomalous muscle due to trauma precipitating the syndrome has not been reported in the literature previously. The anomalous muscle with its contained haematoma was excised with complete relief of symptom.
Adult↗
Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient.
This paper reports a prospective study of eight cases of unstable, comminuted intertrochanteric fractures in elderly patients with associated osteoporosis, operated on between June 1978 and May 1979 using a short-stem Thompson's prosthesis with cement. The posterior approach is employed. The operative technique is described in detail. The amount of blood loss encountered with this technique is not more than that with nail reduction methods. The results have been encouraging in enabling the patients to walk.
Aged↗
Acute carpal tunnel syndrome secondary to thrombosis of a persistent median artery (with high division of the median nerve). A case report.
An unusual case of median nerve compression due to thrombosis of a persistent median artery with a high division of the median nerve is described. The most probable case of the thrombosis is probably the repeated stretch and vibration that is associated with the use of a stiff clutch in a new motor cycle. This report serves to emphasise the need for early diagnosis and in immediate decompression in such cases. The use of an adequate incision for good exposure of the carpal tunnel and all its contents is recommended.
Adult↗