The Incidence and Variation of Corona Mortis in Multiracial Asian: An Insight from 82 Cadavers.

Introduction: Corona Mortis (CMOR) is a term used to describe an anatomical vascular variant of retropubic anastomosis located posterior to superior pubic ramus. We aim to provide sufficient data on the incidence, morphology and mean location of 'crown of death' in Asian population. Other objectives include to assess the relationship between CMOR incidence with gender, race and age. Materials and methods: This is a cross-sectional cadaveric study involving 164 randomly selected fresh multiracial Asian hemipelves (82 cadavers). Hemipelves were dissected to expose and evaluate the vascular elements posterior to superior pubic rami. Data were analysed using Chi-Square, t-test and with the help of IBM SPSS Statistics v26 software. Results: CMOR was found in 117 hemipelves (71.3%). No new morphological subtype was found. The mean distance of CMOR to symphysis pubis was 54.72mm (SD 9.35). Based on the results, it is evident that precaution needed to be taken at least within 55mm from symphysis pubis during any surgical intervention. The lack of statistically significant correlation between CMOR occurrence and gender, race and age suggest that the incidence of CMOR could be sporadic in manner. Conclusion: We conclude that CMOR is not just aberrant vessel as the incidence is high and this finding is comparable to other studies. The mean location of CMOR obtained in this study will guide surgeons from various disciplines in Asia to manage traumatic vascular injury and to perform a safe surgical procedure involving the pelvis area.

An atypical sternoclavicular septic arthritis that was treated conservatively.

Sternoclavicular joint infection is rare. While it is usually treated surgically, we wish to report a case of non-operative treatment of such infection caused by an atypical organism. A 51-year-old woman, known case of diabetes mellitus, hypertension, dyslipidaemia and hyperthyroidism presented with pain over the left upper chest for two weeks associated with redness and fever for one week. The patient was diagnosed to have left sternoclavicular joint septic arthritis with medial end left clavicular osteomyelitis, left sternocleidomastoid, left anterior chest wall abscesses and left lower lobe posterior basal segment cavitating lung lesion with a single nodule in the lingular segment. The blood culture and sensitivity grew extended spectrum beta lactamase (ESBL) Klebsiella pneumonia and the patient was treated with two weeks of meropenem. Computed Tomography was then repeated 2 months later and features were suggestive resolving of left sternoclavicular joint septic arthritis with medial end left clavicular osteomyelitis. The patient is still under surveillance and is currently symptom free 1 year later. We present a case to our knowledge is the first case of rare gram negative rod organism, ESBL Klebsiella pneumoniae infection which caused the left sternoclavicular septic arthritis with medial end left clavicular osteomyelitis, left sternocleidomastoid and left anterior chest wall abscesses. The patient is most likely immunocompromised from being a diabetic with hyperthyroidism. First line treatment can be with antibiotics and when that fails, patient can be treated surgically. Two weeks of antibiotics therapy is possible in selected patients with monitoring of the infective markers.

Coracoid Process Morphology using 3D-CT Imaging in a Malaysian Population.

Introduction: The aims of this study are to define the coracoid process anatomy in a Malaysian population, carried out on patients in Hospital Serdang with specific emphasis on the dimension of the base of coracoid process which is important in coraco-acromial (CC) ligament reconstruction, to define the average amount of bone available for use in coracoid transfer, and to compare the size of coracoid process based on gender and race, and with findings in previous studies. Materials and Methods: Fifteen pairs of computed tomography (CT) based 3-dimensional models of shoulders of patients aged between 20 to 60 years old were examined. The mean dimensions of coracoid were measured and compared with regards to gender and race. The data were also compared to previously published studies. Results: The mean length of the coracoid process was 37.94 ± 4.30 mm. Male subjects were found to have larger-sized coracoids in all dimensions as compared to female subjects. The mean tip of coracoid dimension overall was 19.99 + 1.93mm length × 10.03 + 1.48mm height × 11.63 + 2.12mm width. The mean base of coracoid dimension was 18.96 + 3.71mm length × 13.84 + 1.76mm width. No significant differences were observed with regards to racial denomination. The overall coracoid size measurements were found to be smaller compared to previous studies done on the Western population. Conclusion: This study may suggest that Malaysians have smaller coracoid dimension compared to Caucasians. The findings further suggest that the incidence of coracoid fracture and implants pull out in Malaysian subjects may be higher.

The 'Chalky Culprit' of acute locked knee.

Acute locked knee is commonly caused by tears of the menisci in the knee, osteochondral injuries and also by the stump of a ruptured anterior cruciate ligament. We present two cases of acute locked knee atypically caused by gouty tophaceous lesions in the knee.

Short-term functional outcomes of a delayed single-stage reconstruction of chronic posterior cruciate ligament and posterolateral corner deficiency.

AIMS: To evaluate the functional outcomes of a delayed (>6 months post-injury) and combined reconstruction of grade III posterior cruciate ligament (PCL) and grade III posterolateral corner (PLC) deficiencies. PATIENTS AND METHODS: Between March 2006 and October 2009, a delayed surgery consisting of arthroscopically-assisted PCL reconstruction and open reconstruction of the PLC was performed on 19 men and 2 women (average age, 29 years). The mean time-to-surgery was 18 months (range, 7-51 months) and duration of follow-up was 22 months (range, 12-48 months). Postoperatively, patients were evaluated using Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) subjective and objective scores. RESULTS: At the final follow-up, majority of the knees (61.9%) achieved either normal or nearly normal rating objective IKDC score. The means of IKDC subjective score, Lysholm score and Tegner activity level were 62.09, 74.35 and 5.14 respectively. One patient was able to participate in competitive sport, 5 patients were able to be involved in recreational sports for at least 5 times per week, 10 patients were able to perform heavy labour and recreational sports for at least twice weekly, 4 patients were able to engage in moderately heavy labour work and one patient was only able to perform light labour work. There was no significant statistical association found between the time-to-surgery and the final patients' outcomes. CONCLUSIONS: A delayed simultaneous reconstruction of chronic grade III PCL and PLC deficiencies can restore sufficient function for standard daily and recreational sports activities to the patients.