Reduction of geometric misfit in straight antegrade humeral nailing by evaluating the effect of entry point angulation using a three-dimensional computational analysis.

Background: Straight antegrade intramedullary nails are generally inserted utilising the apex as the surgical entry point in accordance with the mechanical axis of the bone. Our objective is to optimise the bone-nail fit in intramedullary nailing by subjecting the surgical entry point to varying angulations in both the mediolateral and anterior-posterior directions via a quantitative fit assessment in each configuration to identify the optimal angulation, defined as the angulation with the lowest occurrence of thin-out to improve nail fitting within the humerus.

Methods: Computed tomography (CT) scans from 10 cadaveric humeri models were used to generate three-dimensional bone models.

Lower socioeconomic status is associated with increased co-morbidity burden and independently associated with time to surgery, length of hospitalisation, and readmission rates of hip fracture patients.

Unlabelled: This study examines the relationship between socioeconomic status, comorbidities, and clinical outcomes of hip fracture patients. Lower socioeconomic status is not only associated with poorer comorbidities but is also independently impacting surgical access and outcomes. This can be considered a "double setback" in the management of hip fractures.

Effect of implant length variations on stress shielding in proximal humeral replacement after tumor excision under torsion: Finite element study.

The proximal humerus is the most common site of occurrence of primary bone tumors in the upper limb. Endoprosthetic replacement is deemed as the preferred reconstructive option following primary resection of bone tumors. However, it has been also associated with complications such as stress shielding and aseptic loosening compromising prosthetic survival.

Higher Charlson Comorbidity Index Increases 90-Day Readmission Rate with Poorer Functional Outcomes in Surgically Treated Hip Fracture Patients.

Introduction: The associated mortality and morbidity in hip fracture patients pose a major healthcare burden for ageing populations worldwide. We aim to analyse how an individual's comorbidity profile based on age-adjusted Charlson Comorbidity Index (CCI) may impact on functional outcomes and 90-day readmission rates after hip fracture surgery.

Materials And Methods: Surgically treated hip fracture patients between 2013 and 2016 were followed up for 1-year and assessed using Parker Mobility Score (PMS), EuroQol-5D (EQ-5D) and Physical and Mental Component Scores (PCS and MCS, respectively) of Short Form-36 (SF-36).

Outcome satisfaction in long-term survivors of oncologic limb salvage procedures.

Objective: We present data from our recently completed study that suggests that joint salvage is the key parameter in keeping the limb salvage ethos relevant.

Methods: We reviewed all patients operated on nationally over 30 years (1978 to 2008). We identified 265 survivors of which 162 were available for evaluation at the time of survey.

Serum albumin level predicts survival after surgical treatment of metastatic femur fractures: a retrospective study.

Background: Surgical treatment for metastatic pathological femur fractures is associated with high mortality. Correct estimation of prognosis helps in determining the palliative value of surgical treatment and informs surgical decision. This study evaluates the risk factors for mortality in these patients who were surgically treated.

Clinical and radiographic outcomes of computer-navigated total knee arthroplasty are not adversely affected by body mass index.

Aim: To study the effect of obesity on clinical and radiographic outcomes of computer-navigated knee arthroplasty.

Materials And Methods: 117 patients underwent primary computer-navigated total knee arthroplasty. Eight were lost to follow-up and 8 had incomplete data.

Predicting individual knee range of motion, knee pain, and walking limitation outcomes following total knee arthroplasty.

Background and purpose - Up to 20% of patients are dissatisfied after total knee arthroplasty (TKA), mainly because of pain and restricted physical function. We developed a prediction model for 6-month knee range of motion, knee pain, and walking limitations in patients undergoing TKA surgery. Patients and methods - We performed a prospective cohort study of 4,026 patients who underwent elective, primary TKA between July 2013 and July 2017.

Association between preoperative anaemia and blood transfusion with long-term functional and quality of life outcomes amongst patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study.

Purpose: Preoperative anaemia affects up to one-third of patients undergoing total knee arthroplasty (TKA) and is associated with increased blood transfusion and prolonged hospitalisation. Prior studies have associated preoperative anaemia with poorer functional recovery after total hip arthroplasty. However, the association between preoperative anaemia and functional outcomes following TKA is unknown.

Biological significance and prognostic relevance of peripheral blood neutrophil-to-lymphocyte ratio in soft tissue sarcoma.

Peripheral blood indices of systemic inflammation such as the neutrophil-lymphocyte ratio (NLR) have been shown to be prognostic in various cancers. We aim to investigate the clinical significance of these indices in patients with soft tissue sarcoma (STS). Seven hundred and twelve patients with available blood counts at diagnosis and/or metastatic relapse were retrospectively examined.

Sacral chordoma: clinical experience of a series of 11 patients over 18 years.

Sacral chordoma are rare low-to-intermediate grade malignant tumours that occur most commonly within the sacrum. Sacrectomy with wide resection margins seems to offer the best long-term prognosis.  This study aims to review the management of sacral chordomas including the duration of symptoms, features, treatment, complications and local recurrence rate following surgery at a tertiary centre.

Gap difference in navigated TKA: a measure of the imbalanced flexion-extension gap.

Introduction: The success of Total Knee Arthroplasty (TKA) hinges on balanced flexion-extension gaps. This paper aims to evaluate the correlation between imbalanced gaps and clinical outcomes, and hence help quantify the imbalanced gap in navigation-assisted total knee arthroplasty.

Methods: We studied 195 knees with an average follow-up of two years.

Accelerometer-Based and Computer-Assisted Navigation in Total Knee Arthroplasty: A Reduction in Mechanical Axis Outliers Does Not Lead to Improvement in Functional Outcomes or Quality of Life When Compared to Conventional Total Knee Arthroplasty.

Background: Accelerometer-based navigation (ABN) is a novel navigation system that attempts to combine the accuracy of computer-assisted surgery (CAS) with the familiarity of conventional instrumentation (CON). No studies have compared the clinical outcomes of this new technology with existing techniques to date.

Methods: From July 2013 to April 2014, 152 consecutive patients (152 knees) underwent total knee arthroplasty using ABN (n = 38), CAS (n = 38), or CON (n = 76).

Treatment and outcomes of melanoma in Asia: Results from the National Cancer Centre Singapore.

Background: Acral melanoma (AM) and mucosal melanoma (MM) make up more than half of melanomas in Asia but comprise only 5% of cases in Caucasians, where cutaneous melanoma (CM) predominates. AM and MM are thought to be genetically and biologically distinct from CM. We report the characteristics and outcomes of melanoma patients from the National Cancer Centre Singapore.

Germline Mutations in Cancer Predisposition Genes are Frequent in Sporadic Sarcomas.

Associations of sarcoma with inherited cancer syndromes implicate genetic predisposition in sarcoma development. However, due to the apparently sporadic nature of sarcomas, little attention has been paid to the role genetic susceptibility in sporadic sarcoma. To address this, we performed targeted-genomic sequencing to investigate the prevalence of germline mutations in known cancer-associated genes within an Asian cohort of sporadic sarcoma patients younger than 50 years old.

Association between preoperative anaemia with length of hospital stay among patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study.

Objectives: Studies in western healthcare settings suggest that preoperative anaemia is associated with poor outcomes after elective orthopaedic surgery. We investigated the prevalence of preoperative anaemia among patients with primary unilateral total knee arthroplasty (TKA) in Singapore and its association with length of hospital stay (LOS), perioperative blood transfusion and hospital readmission rates.

Methods: Retrospective cohort study performed in a tertiary academic medical centre in Singapore, involving patients who underwent primary unilateral TKA between January 2013 and June 2014.

Critical evaluation of contemporary management in a new Pelvic Exenteration Unit: The first 25 consecutive cases.

Aim: To critically appraise short-term outcomes in patients treated in a new Pelvic Exenteration (PE) Unit.

Methods: This retrospective observational study was conducted by analysing prospectively collected data for the first 25 patients (16 males, 9 females) who underwent PE for advanced pelvic tumours in our PE Unit between January 2012 and October 2016. Data evaluated included age, co-morbidities, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) status, preoperative adjuvant treatment, intra-operative blood loss, procedural duration, perioperative adverse event, lengths of intensive care unit (ICU) stay and hospital stay, and oncological outcome.

Accelerometer-Based Navigation Is as Accurate as Optical Computer Navigation in Restoring the Joint Line and Mechanical Axis After Total Knee Arthroplasty: A Prospective Matched Study.

The Zimmer iASSIST system is a novel accelerometer-based navigation system for TKA. 76 patients (76 knees) were prospectively matched for age, BMI, gender, diagnosis, and pre-operative scores, and underwent TKA using the iASSIST (n=38) or optical CAS (n=38). There were no significant differences in clinical outcomes or satisfaction rates at six months post-operatively (P>0.

Colchicine effectiveness in symptom and inflammation modification in knee osteoarthritis (COLKOA): study protocol for a randomized controlled trial.

Background: Despite the high prevalence and global impact of knee osteoarthritis (KOA), current treatments are palliative. No disease modifying anti-osteoarthritic drug (DMOAD) has been approved. We recently demonstrated significant involvement of uric acid and activation of the innate immune response in osteoarthritis (OA) pathology and progression, suggesting that traditional gout therapy may be beneficial for OA.

Risk factors for recurrence of giant cell tumours of bone.

Purpose: To determine the risk factors for recurrence of giant cell tumours (GCTs) of bone.

Methods: Medical records of 29 men and 29 women (mean age, 34 years) treated for primary (n=53) or recurrent (n=5) GCTs of bone and followed up for a mean of 40.2 months were reviewed.

Accuracy of core needle biopsy for musculoskeletal tumours.

Purpose: To evaluate the sensitivity and specificity of core needle biopsy in determining musculoskeletal tumours in our hospital.

Methods: Records of 134 patients who underwent core needle biopsy followed by definitive surgery were retrospectively reviewed. Results of the core needle biopsy were compared with those of the final histology.

Joint line changes in cruciate-retaining versus posterior-stabilized computer-navigated total knee arthroplasty.

Introduction: This study compared joint line changes and functional outcomes between cruciate-retaining (CR) and posterior-stabilized (PS) computer-navigated total knee arthroplasties (TKAs). With the increased precision offered by computer navigation, we hypothesized that there should be minimal differences in the joint line changes between the groups and thus no significant differences in the clinical outcomes.

Materials And Methods: A retrospective study of 195 patients with a minimum of 2-year follow-up following primary surgery was conducted.