Journal of The Department of Medical Services

Mycosis Fungoides with CD30 - positive Large Cell Transformation: Case Report

Areeya Srimuang — 2024-06-14

Mycosis fungoides is the most common type of cutaneous T - cell lymphoma, accounting for 50% of all primary cutaneous lymphomas. It typically affects older adults, with a mean age of 55 - 60 years, and is more common in males. Although the exact cause of mycosis fungoides is unknown, various factors such as genetics, environment, and the immune system have been considered as possible contributors. Large cell transformation is a rare occurrence and is associated with a poor prognosis. This case report presented the details of a 48 - year - old female patient who had multiple ulcerated tumors that emerged on scaly erythematous plaques on her neck, trunk, groin, and extremities for a duration of 4 months. Following the performance of biopsy with H&E stains and immunohistochemical studies, the patient was diagnosed with mycosis fungoides, specifically with CD30 - positive large cell transformation.

Enucleation with Root Resection of Large Periapical Cyst in Maxilla: A Case Report

Puttakrong Raksantikul — 2024-06-14

Periapical cyst, also known as radicular cyst is most common odontodgenic cyst in oral cavity. Periapical cyst frequency coexists with infected tooth and not more than 2 centimeters in size. However larger cyst can develop and may appeared to invade nearby structures. Report case female presented with swelling of upper lip and paranasal area. Cone-beam computed tomography (CBCT) showed radiolucency lesion that measured 2.81 centimeters in width. The nasal ﬂoor, hard palate and labial bone were all invaded by lesion. The right upper lateral tooth had undergone root canal treatment was in a good condition. Incisional biopsy revealed an inﬂammatory cyst on histopathology. Treatment was performed one-step by total enucleation with root resection of right upper lateral tooth under local anesthesia.9 months followed-up, CBCT revealed that the lesion’s size had much decreased. Bone regeneration was founded on the border of lesion. Total enucleation with root resection is still appropriate treatment for periapical cysts, including those greater than 2 centimeters. The procedure can be performed in a single appointment under local anesthesia. It is important to rule out other lesions with comparable clinical and radiographic features from the differential diagnosis. A large lesion extends to several teeth, a histopathologic study is essential. For precisely determining the size and boundary of a lesion, especially one that affects the maxilla, CBCT is a useful method. However, the cost and amenities may inﬂuence choice.

Hemisection of Primary Fused Tooth: A Case Report

Piyawan Tanglamai — 2024-06-14

Fused tooth is an anomaly characterized by a union between the dentine and/or enamel of 2 or more separate developing teeth. Fused tooth in the primary dentition is more frequently observed in the mandibular lateral incisor and canine. The most common complication of primary fused tooth is permanent tooth aplasia in that area. One of interesting managements of fused tooth is hemisection. This case report presented hemisection in primary fused tooth. The remainder of the tooth was still healthy and could keep space for permanent tooth after a follow up examination period of 24 months. Hemisection can be considered as an appropriate treatment alternative for primary fused tooth.

Outcome Following the Wide Excision Combined with Postoperative Brachytherapy and External Beam Radiation in Soft Tissue Sarcoma of Extremities: Case Series

Banjobe Ariyaboonsiri — 2024-06-14

To study “Outcome following the wide excision combined with postoperative brachytherapy and external beam radiation (EBRT) in soft tissue sarcoma of extremities”. This is a prospective case series study of seven patients with soft tissue sarcoma of the extremities treated at Rajavithi Hospital. All patients underwent surgical by single oncologic-orthopedic surgeon and treated with wide excision combined with brachytherapy and radiation. Then the patienes were evaluated acute wound complication by Khaled score in admission and at 3 months after surgery. Late complication was evaluated from extremity edema, subcutaneous fibrous and joint stiffness by Stern ‘s rating scale at 6 months, 1 year and 1.5 year after surgery. Evaluation of recurrent rate was done at 1.5 year after treatment. All of patients were classified in high grades soft tissue sarcoma of extremities. Acute complication was found 2 patients which were mild wound complication (seroma 5ml and wound separate 5 cm). Late complications at 6 months were found 3 patients (42.85%) all have extremity edema, at 1 year were found 3 patients (42.85%) have 1 (14.28%) extremity edema, 1 (14.28%) subcutaneous fibrosis and 1 (14.28%) joint stiffness. The complications at 1.5 year were found 2 patients (28.57%) have 1 (14.28%) subcutaneous fibrosis and 1 (14.28%) joint stiffness. In the 1.5 year follow up, all patients were not found recurrence. Inconclusion, outcome following treatment of the wide excision combined with postoperative brachytherapy and radiation in soft tissue sarcoma of extremities were found complication frequently. Acute complications were wound complication mostly. Chronic complications were extremity edema, subcutaneous fibrosis and joint stiffness. From this study, the patients who underwent wide excision combined with postoperative brachytherapy and external beam radiation (EBRT) should be carefully treated and observed for prevent the complication.

Robotic - assisted stereoelectroencephalography (SEEG) placement surgery

ธีรเดช ศรีกิจวิไลกุล — 2024-06-14

การผ่าตัดโรคลมชักในประเทศไทยปัจจุบันเป็นที่ยอมรับว่าเป็นมาตรฐานในการรักษาโรคลมชักในผู้ป่วยที่ดื้อต่อยากันชัก การผ่าตัดโรคลมชักมีขั้นหลายขั้นตอนในการประเมินผู้ป่วยก่อนผ่าตัด เช่น การตรวจคลื่นไฟฟ้าสมอง 24 ชั่วโมง (24 - hour video - EEG), การตรวจภาพสมองด้วยคลื่นแม่เหล็กไฟฟ้า (magnetic resonance imaging หรือ MRI) การตรวจจิตวิทยาเมื่อได้ข้อมูลจากการตรวจประเมินเบื้องต้น ผู้ป่วยที่ข้อมูลจากการประเมินสอดคล้องกันก็จะสามารถผ่าตัดเพื่อรักษาโรคลมชักได้ แต่มีผู้ป่วยบางรายที่ข้อมูลในการประเมินเบื้องต้นไม่สามารถผ่าตัดได้ จำเป็นต้องผ่าตัดโดยการใส่ขั้วไฟฟ้าในกะโหลกศีรษะเพื่อหาจุดกำเนิดชัก และ/หรือเพื่อหาตำแหน่งของสมองที่มีหน้าที่สำคัญ (invasive EEG) การผ่าตัดโดยการใส่ขั้วไฟฟ้าในกะโหลกศีรษะในอดีต นิยมผ่าตัดโดยใส่ขั้วไฟฟ้าบนผิวสมอง (subdural electrodes) แต่จำเป็นต้องเปิดกะโหลกศีรษะขนาดใหญ่ มีภาวะแทรกซ้อน เช่น สมองบวม ติดเชื้อ ซึ่งจำเป็นต้องผ่าตัดเพื่อเอาขั้วไฟฟ้าออกและผ่าตัดจุดชักใน admission เดียวกัน นอกจากนี้คลื่นสมองที่ตรวจจับได้เฉพาะผิวสมอง ไม่สามารถตรวจจับคลื่นสมองจากส่วนลึกของสมองได้

The Comparison of Patient Clinical Outcomes between Antegrade and Retrograde Cannulation Methods Received Hemodialysis Machine Process at Arteriovenous Fistula

Nopparat Wimoolchart — 2024-06-14

Background: The arteriovenous fistula (AVF) is the most popular vascular access for hemodialysis (HD) procedures. Normally, it has two needle insertion methods at the arterial site, including the needle tip position has the parallel (antegrade) and the opposite (retrograde) directions to the arterial blood ﬂow. However, the clinical outcomes of the patients receiving HD with both antegrade and retrograde cannulations need to be investigated. Objective: To compare the clinical outcomes of HD patients receiving between antegrade and retrograde cannulation methods. Method: We conducted a randomized crossover trial in HD patients with AVF. All patients were randomly assigned to either the antegrade (study) or the retrograde (control) group and then switched to the other group in the following HD session. Baseline patient characteristics, HD characteristics, the patient clinical outcomes (e.g., dialysis adequacy, clotting duration after needle removal, access recirculation, and pain scores) and staff satisfaction were collected. All data were presented in terms of number with its percentage or mean±standard deviation. We employed multivariable multilevel Gaussian regression to adjust prognostic variables. Result: A total of 246 HD sessions were included. The results showed no significant difference in any clinical outcomes. However, HD nurses significantly prefer antegrade to retrograde cannulation. Conclusion: HD nurse can design the needle position with either antegrade or retrograde cannulations depending on the patient’s condition and the suitable HD procedure without significant difference in patient clinical outcomes.

Effectiveness of Hyperthermia Combined with Radiation Therapy for Non-small Cell Lung Cancer: A Systematic Review

Arkorn Boonkerd — 2024-06-14

Background: Hyperthermia is a therapeutic technique that involves increasing the temperature of a tumor to help destroy and kill cancer cells without harming normal tissue. It is commonly used alongside other cancer treatments, such as radiotherapy or chemotherapy. However, its effectiveness depends on many factors, and the right method must be used to achieve efficiency. Objective: Our systematic review and meta-analysis aimed to compare the effectiveness of hyperthermia combined with radiation therapy versus radiation therapy alone in treating non-small cell lung cancer. Method: We used search methods to identify relevant studies in electronic databases, including the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE database via PubMed. Analyses were performed using the Reference Manager (RevMan). Result: Three studies with 155 patients were enrolled, including 72 patients in the hyperthermia combined with radiotherapy (RT+HT) group and 83 patients in the Radiation alone (RT) group. Treatment with hyperthermia combined with radiotherapy resulted in a large increase in 1 - year progression-free survival (1 - y PFS) compared to radiation alone hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.35, 0.81, p = .003). including increasing complete response (risk ratio (RR) 4.43, 95% CI 1.13, 16.74; p = .03). However, 1 - year overall survival between hyperthermia combined with radiotherapy and radiation alone groups showed little or no difference in risk of mortality and partial response (HR 0.71, 95% CI 0.44, 1.16, p = .18) and (RR 1.01, 95% CI 0.54, 1.35; p = .94). Conclusion: Due to the limited resources for analysis, our study suggests that hyperthermia combined with radiation therapy affects 1 - year progression - free survival and complete response in patients with advanced non-small cell lung cancer.

The Evaluation of Relationship between Speech and Velopharyngeal Anatomy in 6 to 12 Year - old Children with Operated Cleft Palate Patients

Thida Ratanawilaisak — 2024-06-14

Background: Velopharyngeal insufficiency is a cause of articulation disorders in patient with cleft palate. Objectives: (1) To study velopharyngeal anatomy (2) To evaluate the articulation in cleft palate compared to non - cleft palate patients (3) To study relationship between velopharyngeal anatomy and articulation. Method: The subjects were 23 cleft palate (mean age 8.93.5 years) and 52 non - cleft palate patients (mean age 9.30.7 years). Lateral cephalometric radiographs were traced for measured length of soft palate, velar thickness, DPS, depth of pharyngeal space and angle of soft palate. The passage “Ma Nee” was used for hyponasality test and the passage “Tuk Tuk” was used for hypernasality test. Result: The result showed significant difference between cleft and non - cleft palate patients in length of soft palate, depth of pharyngeal space, angle of soft palate, hypernasality and hyponasality (p < .05). A negative correlation between velopharyngeal anatomy (length of soft palate and angle of soft palate) and hypernasality was shown (p < .05). No correlation between velopharyngeal anatomy and hyponasality was found. Conclusion: (1) Lesser length of the soft palate, depth of pharyngeal space and angle of the palate were found in cleft compared to non - cleft patients. (2) A significant difference in hypernasality and hyponasality showed between two groups. (3) The length of the soft palate and angle of the palate negatively correlated with hypernasality.

Using of Platelet - rich Fibrin for the Treatment of Intrabony Defects: A Systematic Review and Meta – analysis

Thunwarut Ketsri — 2024-06-14

Background: Platelet rich fibrin (PRF), the second generation of platelet rich plasma (PRP) has been used for intrabony defect treatment. According to the fibrin matrix properties, PRF could release growth factor slowly and promote the healing of periodontal surgery both in soft and hard tissue. Moreover, it is useful for periodontal regeneration. Objective: To quantitatively find out how platelet rich fibrin could be used in the treatment of intrabony defects in combination with periodontal surgery, and platelet rich fbrin preparation affect the treatment of intrabony defects. Method: Systematically retrieved data from PubMed database and Google Scholar by selecting only English or Thai articles from 2010 to 2022. All 27 accepted articles were meta - analyzed by collecting the results of the clinical measurement which were the change of periodontal pocket depth and the clinical attachment level including the results of radiographic measurement. Results: The evidences suggested that the platelet rich fibrin with periodontal surgery group which was able to reduce periodontal pocket depth greater than in the control group (SMD = 1.793; 95% CI 1.347, 2.238, p < .001), and was increase the clinical attachment level greater than in the control group (SMD = 1.798; 95% CI 1.349, 2.248, p < .001). In addition, it was also able to increase the length of bone in the intrabony defects (SMD = 3.404; 95% CI 2.636, 4.171, p < .001), but disable to concluded because the data were heterogeneity (I² = 92.0%, I² = 92.3%, I² = 94.9%) which may not cause from only preparing PRF but also from other factors. Conclusion: Platelet - rich fibrin can be used with open ﬂap debridement as resulted in reduction of the periodontal pocket depth and increase the clinical attachment level and bone in the intrabony defects greater than the treatment with open ﬂap debridement alone but cannot conclude because of the heterogeneity of data.

The Study of Cognitive Function in Opioid Dependence Treated with Methadone Maintenance Treatment at Princess Mother National Institute on Drug Abuse Treatment

Sirincha Pitipanyakul — 2024-06-14

Background: Methadone maintenance treatment (MMT) is the most effective relapse prevention strategy, preventing relapse in opoid dependent patients. All types of drugs can cause brain damage and cognitive function, leading to cognitive impairment which affects treatment as well as quality of life. Objective: The study aimed to compare the cognitive function between opioid dependent patients with long-term methadone maintenance treatment then abstinent from opioid (MMTA) and still relapse patients (MMTR) at Harm Reduction Center of Princess Mother National Institute on Drug Abuse Treatment. Methods: This study was a cross-sectional analytic study that had been implemented from the sample group of 40 MMTA and 42 MMTR. The data had been collected from January to June 2023 by using questionnaire to measure demographic information, the Beck depression inventory (BDI) to measure depression severity, and the Montreal Cognitive Assessment (MoCA) to measure cognitive function. The Data were analyzed by computer programs and presented with descriptive statistics :- number, percentage, mean and standard deviation. The inferential analysis was done by using chi-square and Fisher’s exact test and independence t-test. The Mann-Whitney U test was employed for the data that were abnormally distributed at the statistical significance level of .05. Results: There were no statistically significant differences in the mean scores of the MoCA questionnaire between the two groups. Divided by age, MMTR between the ages of 20-29 years had lower mean MoCA scores than MMTA, and the age factor was shown to be significantly associated with cognitive impairment among MMTA at level .05. Conclusion: Our findings give a screening for cognitive dysfunction in opioid dependent patients receiving MMT is important especially in critical for MMTR patients under the age of 30, in order to develop the most effective treatment planning and favorable results.

INR Variability and Time in Therapeutic Range in Warfarin – Treated Patients with Chronic Kidney Disease: A Retrospective Cohort Study Using Electronic Database

Sasimaporn Yaengkratok — 2024-06-14

Background: Warfarin has been used for treatment and prevention of systemic thromboembolism in various indications. Several factors can affect to warfarin response, but the association between chronic kidney disease (CKD) and warfarin response has been limited. Objectives: To determine the relationship between INR variability and CKD and time in therapeutic range (TTR) and CKD. Methods: This was a retrospective cohort study at Rajavithi Hospital during January 2017 to June 2020. The inclusion criteria were 1) outpatients older than 18 years of age 2) taking warfarin for the first time at Rajavithi Hospital and 3) to follow up the treatment continuously in Rajavithi Hospital until the INR values were achieved the target range at least 2 consecutive times. The patients were divided by eGFR into 2 groups (group 1: eGFR ≥ 60 ml/min/1.73 m² and group 2: eGFR < 60 ml/min/1.73 m² without renal replacement therapy). The data were analyzed by using SPSS program version 22.0. Results: A total of 390 patients were identified. The mean age was 61.0017.39 years old and 55.64% were females. Each patient was classified by eGFR into 2 groups (group 1; n = 260 (66.67%) and group 2; n = 130 (33.33%), respectively). The median of INR variability was 0.15 with significant difference and the median of TTR was 60.22% with not significant difference between two groups. Conclusions: Our study showed that INR variability was significantly different in each group while TTR was not significantly different among studied groups. CKD patients had lower INR variability and TTR than the normal kidney function group.

Next-generation Sequencing Findings and Clinical Correlations in Children with Unknown Causes of Epilepsy at a Tertiary Care Pediatric Hospital in Thailand

Sirorat Suwannachote — 2024-06-14

Background: Next-generation sequencing (NGS) has become an increasingly important technique for identifying the unknown causes of pediatric epilepsy. NGS increased the diagnostic yield by at least 30-40% in children with epilepsy, but these data in Thai children is still limited. This study aimed to determine the diagnostic yield and factors associated with the detection of disease-causing genes by NGS in children with unknown causes of epilepsy in Thailand. Methods: A single-center retrospective study of 42 children with unknown causes of epilepsy who had available NGS results for the diagnosis of genetic epilepsy from Jan 1^st, 2015 to June 30^th, 2021, was conducted at Queen Sirikit National Institute of Child Health, Thailand. Patients with identified causes of epilepsy were excluded. Gene variants were classified based on their pathogenicity, and related clinical factors were determined. Results: Of the 42 unexplained causes of epilepsy with available results from their NGS tests, 50% had a disease-causing gene detected and were identified as genetically causing epilepsy. Among these 21 patients with NGS-identified genetic epilepsy, 57.1% were female, 33.3% had a family history of epilepsy, 4.8% had a history of consanguinity, and all of them were developmentally delayed. The most common identified disease-causing gene was SCN1A (38.1%). The factor significantly associated with the detection of disease-causing genes was Dravet phenotype (p-value = .004), and other clinical parameters were not significant factors. Furthermore, the change in patient management after available NGS results was significantly greater in patients with NGS-identified genetic epilepsy than in those without NGS-identified genetic epilepsy (61.9% vs. 4.8%, p < .001). Conclusions: Genetic testing should be advised for finding disease-causing genes in children with undiscovered causes of epilepsy since genetic abnormalities were discovered by NGS in 50% of children with unknown causes of epilepsy, and the clinical care for these patients may change.

Nasal Obstruction Symptom Evaluation Questionnaire: Cross Cultural Adaptation, Validity and Reliability of the Thai Version

Siwaporn Suriyan — 2024-06-14

Background: Nasal obstruction is the most common rhinologic complaint that affects quality of life. There was no available fast and easy - to - use questionnaire related to nasal obstruction symptoms in Thai language. Objective: To translating and cross - culturally adapting the nasal obstruction symptom evaluation score into Thai (T - NOSE score) and to assess the validity, reliability of the translated version. Method: A cross - sectional study was conducted in adult patients with nasal obstruction in otolaryngology department at Rajavithi hospital from October 2020 - July 2021. The Beaton protocol for cross - cultural adaptation was used in the translation process. Five otorhinolaryngologists were asked to assess content validity while 30 participants were asked to fll in the questionnaire to assess Cronbach’s for internal consistency. Pearson correlation coefficient was used between T - NOSE score, visual analog score (VAS score) and peak nasal inspiratory (PNIF). Receiver operating characteristic (ROC) was applied to calculate area under the curve for cut point, sensitivity, and specificity for screening nasal obstruction. Result: The T - NOSE score had good content validity (IOC = 0.96). The Cronbach’s was 0.872 which is satisfactory indicating good internal consistency. 100 adult patients (41 males and 59 females) were recruited to assess correlation. Pearson correlation between T - NOSE score and VAS showed a strong correlation (r = 0.849). Simultaneously, T - NOSE score showed moderately reverse correlation with PNIF (r = –0.576) with statistically significant. The appreciate cut off point of T - NOSE score for screening was 32.5 with a sensitivity of 76.9 %, 64.6% specificity, 70.2% PPV and 72.1% NPV to predict nasal obstruction status. Conclusion: Thai NOSE score is a valid and reliable questionnaire which can be used for screening nasal obstruction symptom in adult Thai population.

Outcomes of the Development for Children with Hearing Impairment Post cochlear Implantation, Rajavithi Hospital

Supranee Boonmee — 2024-06-14

Background: Children born with severe hearing loss are deaf in both ears, which affects speech and language development. Cochlear implant helps with hearing rehabilitation. Due to the situation of COVID - 19 affecting the world, commuting to the hospital could lead to a risk of infection. As a result, children with cochlear implants need rehabilitation to hear continuously. Objective: To study the hearing ability of children with hearing impairment, post - cochlear implants, and to compare the development of listening ability in children with hearing impairment post - cochlear implants who received an auditory - verbal training (AVT) at a hospital, as well as AVT combined with onsite and online training. Methods: A retro - prospective descriptive study on 51 children under five, with post - cochlear implants was conducted from January 2005 to August 2021, using the patients’ medical records. Tools used to collect data records were The Categories of Auditory Performance - II, developed by Gilmore L. Scoring according to CAP - II has 10 levels, i.e., 0 - 9. Data were analyzed using descriptive statistics to examine the frequency, mean, as well as standard deviation. The statistics used for comparison were repeated measures ANOVA, paired - samples t - test, and hypothesis testing. The result showed a statistical significance of p < .05. Results: It was found that there was an increase in hearing ability of the research subjects with post - cochlear implantation. AVT combined with onsite and online training improved listening ability better than on - site - only AVT. Conclusion: There are many factors that impact the hearing ability of deaf children after cochlear implantation. It depends on the duration of the cochlear implant. ;the longer you wear it, the more exposure to language input, the better your listening experience will become. A good cooperation in auditory - verbal practice training combined with onsite & online improved their listening ability more than those who received auditory - verbal training (AVT) in a hospital onsite only. It also helps children post - cochlear implants have good language development.

Precision Assessment of the Radiological Technologists for the Measurement of Bone Mineral Density in Adults with Densitometer at Rajavithi Hospital

Orathai Singusaha — 2024-06-14

Background: Precision is integral to the monitoring of bone mineral density (BMD) change using dual energy X - ray absorptiometry (DXA). The International Society for Clinical Densitometry (ISCD) stated that in addition to evaluate the accuracy of a DXA, the radiological technologist’s precision assessment of BMD measurement is also required. Objective: To assess the radiological technologists’s precision of the BMD measurement for lumbar spine, femoral neck, total hip and forearm in adults at Rajavithi Hospital. Method: This study examined BMD measurement of 240 participants with a mean age 62.76 yr (SD = 8.85; range 45 - 90 yrs) for lumbar spine, femoral neck, total hip, and forearm by 8 technologists. Each technologist measured 30 participants twice by reposition, then the precision error (percent coefficient of variation; %CV) and 95% the least significant change (LSC) were calculated and analyzed statistically. Result: There were statistically significant correlation in all sites (0.994-0.998, p value < .05) for two BMD measurements. The precision error of BMD measurement by 8 technologists gave high precision in total hip, lumbar spine and femoral neck (%CV: 0.76%, 0.85%, and 1.10% respectively) and within the ISCD criteria. The region with the highest error was the forearm (%CV:1.46%) but still represented good reproducibility. When the participants were grouped by body mass index (BMI), lumbar spine and femoral neck were found to be the highest error in the BMI > 25.0 kg/m2 (%CV: 0.90% and 1.22%, respectively), but total hip and forearm regions were found to be the highest error in the BMI < 18.5 kg/m2 (%CV: 1.08% and 2.41%, respectively). There were statistically significant differences of precision error between technologists in all sites, but between different BMI groups, there were no statistically significant differences in all sites. Conclusion: The precision assessment of BMD measurement by all technologists had high precision and were within the ISCD criteria.

Prevalence of Sacral Dysmorphia of Patients in Rajavithi Hospital, A Retrospective Study

Peerasun Keeratitechakorn — 2024-06-14

Background: Sacral dysmorphia entails abnormal anatomy of the upper sacrum. Dysmorphic sacra have narrow and angled upper osseous corridors, increasing the risk of cortical perforation during iliosacral screw and transacral screw insertion. To date, no statistical data regarding this condition exist in Thailand. We aimed to collect statistical data for this patient group in Thailand. Objective: To determine the prevalence of sacral dysmorphia among patients at Rajavithi Hospital. Methods: Data were collected from Rajavithi Hospital’s database for the past 5 years, from January 1, 2016, to December 31, 2020, and analyzed to determine the prevalence of sacral dysmorphia and safe corridors for percutaneous screw fixation at the sacrum. Results: A total of 594 patient records were collected. Sacral dysmorphia was found in 136 cases, accounting for 23%. Gender was found to have no effect on disease prevalence but did affect sacral size, with males being significantly larger. The sacral dysmorphia group had 94.1% unable to insert a transacral screw at position S1, with an average width and height of 15.46 and 17.00 mm, respectively. At position S2, both iliosacral and transacral screws of all sizes (6.5, 7.0, and 7.3 mm) could be inserted, with average width and height of 13.98 and 17.84 mm, respectively. Conclusion: We recommend using the S2 position instead of the S1 position for percutaneous screw fixation in individuals with sacral dysmorphia due to advantages including safety, low complication rates, ease of surgery, and strength.

Effect of Gap Size on Ulnar Variance Changes in Malunited Distal Radius after Open Wedge Osteotomy with Volar Locking Plate without Bone Graft in Malunited Distal Radius

Kittiwan Supichyangur — 2024-06-14

Background: Distal radius malunion may result in wrist pain, decreased range of motion, midcarpal instability, and affect the quality of life of the patients. There are many osteotomy techniques to correct malunion of the distal radius. The usage of a volar locking plate can also avoid extensor tendon irritation problems. To date, no previous study has mentioned about relation of gap size and radiographic parameter after corrective osteotomy, leading to the question of this study. Objective: to determine whether the time to union and the post-operative radiographic parameter changes were affected by gap size in malunited distal radius patients who underwent opening wedge osteotomy with volar locking plate without bone graft. Method: Retrospectively and prospectively analyzed data from 24 patients, including gap size, union time, and three radiographic parameters (ulnar variance, radial inclination, and volar tilt). The three radiographic parameters were collected at preoperative, immediate postoperative, and at the union time. The average follow-up time was 6 months. Result: The average gap size was 4.7 mm. The average union time was 11.2 weeks. No significant loss of reduction was found regarding the three radiographic parameters. All radiographic parameters were improved. No correlations between gap size and union time, as well as the three radiographic parameters, were found. Preoperative volar tilt had a moderate negative correlation and time from injury had a positive moderate correlation with the union time. Conclusion: When performing corrective osteotomies of malunited distal end radius without bone graft, increasing gap size was not correlated with delay union time nor radiographic reduction loss. Decreasing preoperative volar tilt and delayed operation may negatively affect union time.

Comparison of Outcome in Surgical Treatment of Patients with Metastatic Impending and Pathological Fractures of Proximal Femur: Intramedullary vs. Extra Medullary Fixation

Banjobe Ariyaboonsiri — 2024-06-14

Background: Metastatic bone tumors often result in debilitating fractures of the proximal femur, necessitating surgical intervention to alleviate pain and restore function. While intramedullary and extramedullary fixation techniques are commonly employed, their comparative effectiveness in achieving treatment goals remains uncertain. Objective: The purpose of this study was to compare treatment outcomes of metastatic bone tumor of proximal femur with fracture surgically treated at Rajavithi Hospital, by focusing on patients treated with intramedullary fixation and extramedullary fixation. The Musculoskeletal Tumor Society (MSTS) functional outcome score and post-operative complications between two groups were compared. Methods: Data record of patients with pathological fracture or impending fracture underwent surgery in Rajavithi Hospital. Collected data included baseline and post-operative data. Results: Forty cases of pathological proximal femur fracture or impending fracture were reviewed (18 males and 22 females), patients were categorized into intramedullary fixation (20 cases) and Extramedullary fixation (20 cases). Most recorded type of primary tumor was Breast cancer with a total number of 16 cases. Pathological fracture or impending fractures included 33 cases of intertrochanteric region, 4 cases of sub trochanteric region and 3 cases of proximal femoral shaft region. Mean MSTS score was 23.901.07 in intra- medullary fixation group and 19.701.13 in extramedullary fixation group. One case of post-operative wound infection was found in extramedullary fixation group. Conclusion: MSTS functional score was higher and intra-operative blood loss was significantly lesser in Intramedullary fixation group. No significant difference in postoperative complication was found. However, to be able to study more about outcomes, and other complications such as Implant survival and failure rates, higher number of patients and longer follow up period are required.