Ascorbic acid (vitamin C) is an essential micronutrient that the human's body cannot synthesize endogenously. Scurvy, a disease of ascorbic acid deficiency, can manifest in a myriad of presentations. Due to its rarity in the modern world, scurvy is considered as a disease of the past. We present a paediatric case of scurvy with musculoskeletal manifestations as a result of picky eating behavior.We report a previously healthy nine-year-old boy who presented with unexplained progressive bilateral lower limb generalized weakness and pain for two months. All initial biochemical and radiological investigations were unremarkable. Upon further history taking, he had severe picky eating behavior which raised the suspicion of scurvy. The diagnosis was confirmed with a serum ascorbic acid test. After ascorbic acid supplementation, his symptoms resolved immediately. Further food behavioral modification counselling to his family members helped to change his diet in a lasting way. As a result, he had no recurrence of symptoms. This case highlights the importance of having a high index of suspicion for an uncommon disease and emphasizes the need for a detailed dietary history upon patient's presentation.

Introduction: Anterior cruciate ligament (ACL) reconstruction has evolved during past decade. All inside technique is introduced aiming for less invasive procedure, bone stock preservation, preservation of tendon at its donor site, better graft positioning and fixation technique. This study is conducted to compare the outcomes of this new technique to the previous biotransfix screw. Materials and method: A cross sectional study was conducted in patients with ACL injury treated with ACL reconstruction surgery in Hospital Sultanah Nur Zahirah, Kuala Terengganu and Hospital Kemaman, Terengganu. Functional outcome with International Knee Documentation Committee (IKDC) score, SF-36 quality of life score and time taken to return to normal activities were evaluated at 18 to 24 months post-operative. Results: Forty patient were recruited, 20 in each group. Of this, 37 were male with age of 25±6.48 years old. 25 were office worker and the rest were field worker. 37.5% were smoker. Patients in biotransfix screw technique operated at 21.3±12.6 months after the injury while those in all inside technique at 17.7±11.9 months(p-value 0.35). BMI was 24.58±4.59. The SF-36 score were similar in both groups with p-value 0.59. Both groups have same IKDC score of 82.99±12.55. Time taken to return to normal activity level was 46.3±19.7 weeks which was similar in both groups(p-value 0.943). Re rupture rate were 10% in biotransfix screw technique and 5% in all inside technique. None of them has any form of infection. There were no correlation between quality of life SF-36 score with age, tobacco use, BMI, duration of injury until operation and occupation of the patient in both techniques. Conclusion: The functional outcome, quality of life and time return to normal activity were similar between patients who had biotransfix screw and all inside technique. There were also no correlations between factors studied with quality of life in both groups.

Osteosarcoma is a common primary malignancy of the bone. Osteosarcoma prognosis improves tremendously when chemotherapy is given in adjunct to surgical intervention. Limb reconstruction with sterilized autologous bone graft stabilized by orthopaedics implants has become a choice of treatment, but the biomechanical property of the bone treated with such sterilization method is a point of concern as a graft with inferior biomechanical property might lead to graft failure. This study compares the biomechanical properties of the bones treated with cryotherapy using liquid nitrogen and pasteurization in the form of four-point bending compression tests. Six sheep tibia bones were used for each group of treatment with one control group where no treatment was given. In the four-point bending test, osteotomy was performed at the tibia; the proximal tibia was treated with liquid nitrogen and pasteurization respectively. The treated bone is then reconstructed with the corresponding distal bone with locking plate and screws (Jiangsu Trauhiu Medical Instrument Co. Ltd., Changzhou, China). The four-point bending test was performed with an Electropulse® E3000 universal testing machine (Instron®, High Wycombe, United Kingdom) and results in the form of maximum compressive load, stress, and strain were collected. Photographic analysis of the fracture location and pattern were documented and analysed. We found that both methods of sterilization did not alter the biomechanical properties of the treated bone to the extent of statistical significance in comparison with the control group. However, other factors such as histological changes post treatment, equipment availability, and long-term outcome must be considered.

Introduction: Shoulder impingement syndrome is a common diagnosis leading to shoulder disabilities. Subacromial decompression surgery either arthroscopic or mini open is indicated in patients who failed conservative therapy. Arthroscopic surgery is introduced to reduce soft tissue dissection hence less soft tissue damage and fasten rehabilitation. This study is conducted to compare the outcome of mini open and arthroscopic surgery. Materials and Methods: A cross sectional study was conducted in patients who were diagnosed with shoulder impingement syndrome with or without rotator cuff tear who underwent subacromial decompression surgery, with mini open or arthroscopic surgery at Hospital Tengku Ampuan Afzan, Kuantan. Functional outcome was assessed using American Shoulder and Elbow Surgeon (ASES) score and Constant score. Results: Six patients were recruited in the mini open group while 11 in the arthroscopic group. Of these, all were female in mini open group, aged 56.7 ± 7.9 while seven female and four male in the arthroscopic group aged 55.1 ± 9.4 (p-value 0.733). They were evaluated at 3 to 5 years after surgery in the mini open, and at six months in the arthroscopic group. There was no significant different in the ASES score in the mini open group (89.8 ± 11.7) and arthroscopic group (89.8 ±17.9), with p-value of 0.998. Constant score in the mini open was 18.67 ± 7.61, while in the arthroscopic was 16.18 ± 15.03; and there was no significant difference in this two groups (p-value 0.712). Three patients each has good and fair outcome in the mini open surgery, while six patients has excellent, two each has good and fair; and one has poor outcome in the arthroscopic surgery. Conclusion: There were no significant differences in the functional outcomes between mini open and arthroscopic subacromial decompression surgery.

Introduction This appears to be the first biomechanical study that compares the stability of various locations of the crossing points in crossed pinning Kirschner wiring (K-wire) construct in treating pediatric supracondylar humerus fracture (SCHF). Additionally, this study compared the biomechanical stability between crossed pinning K-wire construct and the three-lateral divergent K-wire construct. Methods For the study purpose, 30 synthetic humerus bones were osteotomised at mid-olecranon fossa, anatomically reduced, and pinned using two 1.6-millimeter K-wires in five different constructs. A total of six samples were prepared for each construct and tested for extension, flexion, valgus, varus, internal rotation, and external rotation forces. Results As for crossed pinning K-wire construct, the center crossing point emerged as the stiffest construct in both linear and rotational forces, in comparison to the lateral crossing point, superior crossing, and medial crossing point Conclusion Based on this analysis, it is highly recommended that, if the crossed pinning construct is selected to treat supracondylar humerus fracture, the surgeon should aim for center crossing point as it is the most stable construct. Nevertheless, if lateral and superior crossing points are obtained during the initial attempt of fixation, the fixation may be accepted without revising the K-wire as the stability of these two constructs are comparable and portrayed no significant difference when compared to that of the center crossing point. Additionally, it is essential to avoid the medial crossing point as it is significantly less stable in terms of rotational force when compared to the center crossing point.