Publications by authors named "Tet S Howe"

Background: Total elbow arthroplasty (TEA) is increasingly used for expanding indications but complications like aseptic loosening and periprosthetic fractures persist. Our objective is to examine the biomechanical behavior of the total elbow implant in response to varying implant lengths by investigating the stresses and the stress shielding effect in the bone-implant assembly using finite element (FE) modelling.

Methods: A fourth-generation synthetic humerus sawbone and its corresponding digital model were used in this study.

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Introduction: Though hip fractures are associated with significant mortality and morbidity, increasing life expectancy in developed countries necessitates an analysis of mortality trends and factors predicting long term survival. The aim of this study is to identify the predictors of 10-year mortality as well as assess the correlation of Age-adjusted Charlson comorbidity index (ACCI) with 10-year mortality in a surgically treated Asian geriatric hip fracture population.

Materials And Methods: From January 1, 2007 to December 31, 2009, 766 patients who underwent surgery for hip fracture with a minimum follow up of 10-years were recruited to the study (92% follow-up rate).

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Introduction: Due to an aging population, the rising prevalence and incidence of hip fractures and the associated health and economic burden present a challenge to healthcare systems worldwide. Studies have shown that a complex interplay of physiological, psychological, and social factors often affects the recovery trajectories of older adults with hip fractures, often complicating the recovery process.

Methods: This research aims to actively engage stakeholders (including doctors, physiotherapists, hip fracture patients, and caregivers) using the systems modeling methodology of Group Model Building (GMB) to elicit the factors that promote or inhibit hip fracture recovery, incorporating a feedback perspective to inform system-wide interventions.

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Introduction: Our aim was to analyse how the coronavirus disease 2019 (COVID-19) pandemic affects a hip fracture bundled care protocol. We hypothesised that key performance indicators, but not short-term outcomes, may be adversely affected.

Methods: Patients admitted under a hip fracture bundled care protocol were divided into two arms: 'COVID' group included patients admitted in 2020 during the COVID-19 pandemic and 'PRE-COVID' group included patients admitted in 2019.

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Case: We present a case of an incomplete periprosthetic femoral fracture at the mid-distal third of the femoral stem after 11 months of bisphosphonate use. It is 1 of 4 cases of mid-distal periprosthetic atypical femoral fractures (PAFFs) found in our literature review. She was treated with protected weight-bearing, cessation of bisphosphonates, and teriparatide.

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Introduction: The role of patient-reported outcomes in preoperative assessment is not well studied. There is recent interest in studying whether Patient-reported outcomes scores can be used either independently, or in conjunction with clinical findings, in the assessment of patients for surgery.

Aims: To investigate if improvement in clinically significant scores correlate with post-operative patient satisfaction in 1-2 level transforaminal lumbar interbody fusion (TLIF) surgery.

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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.

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Introduction: Incomplete atypical femoral fractures (iAFF) may occur with prolonged bisphosphonate usage. Factors influencing iAFF healing and progression are not well understood. This study of conservatively managed iAFF assessed factors influencing iAFF healing and progression including the effects of bisphosphonates and teriparatide use.

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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.

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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.

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Atypical femur fractures (AFFs) are rare complications of anti-resorptive therapy. Devastating to the affected individual, they pose a public health concern because of reduced uptake of an effective treatment for osteoporosis due to patient concern. The risk of AFF is increased sixfold to sevenfold in patients of Asian ethnicity compared with Europeans.

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Unlabelled: End stage renal disease (ESRD) is an independent risk factor for the development of hip fractures and is associated with a higher mortality and complication rates. As these patients significantly skew healthcare financing in a bundled care payment (BCP) program, a risk stratified approach to BCPs could be done to take into account the difference in resources required.

Introduction: End stage renal disease (ESRD) is an independent risk factor for the development of hip fractures and is associated with a higher mortality and complication rate.

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Article Synopsis
  • * Initially asymptomatic on one side, she experienced right hip pain but was conservatively managed with protected weight bearing, leading to symptom resolution within three months.
  • * The report highlights that AFFs can occur in patients receiving denosumab, even without prior bisphosphonate use, emphasizing the need for patient counseling and monitoring for these complications.
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The use of risk stratification tools in identifying high-risk hip fracture patients plays an important role during treatment. The aim of this study was to compare our locally derived Combined Assessment of Risk Encountered in Surgery (CARES) score with the the American Society of Anesthesiologists physical status (ASA-PS) score and the Deyo-Charlson Comorbidity Index (D-CCI) in predicting 2-year mortality after hip fracture surgery. A retrospective study was conducted on surgically treated hip fracture patients in a large tertiary hospital from Jan 2013 through Dec 2015.

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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).

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 An important surgical landmark in the distal radius is the watershed line. The watershed line is a landmark for the positioning of volar locking plates (VLP) in the distal radius. Inconsistencies remain in the literature as to the presence and dimensions of landmarks in this compact area.

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Background: In a study from our institution, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon for recalcitrant lateral elbow tendinopathy showed excellent safety profiles, high tolerability, efficiency, sustained pain relief, functional improvement, and sonographic evidence of tissue healing in 20 patients at 3 years' follow-up.

Purpose: To explore the long-term clinical and sonographic results of ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon.

Study Design: Case series; Level of evidence, 4.

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Background: There are few studies investigating the effects of acute postoperative pain on functional outcomes after total knee arthroplasty (TKA). The aims of this study are to identify perioperative factors associated with increased early postoperative pain and investigate the effects of acute postoperative day 1 and 2 pain on outcomes at 6 months and 2 years post-TKA.

Methods: 1041 unilateral TKA patients were included in this retrospective cohort study.

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Identifying appropriate attachment sites is important in the planning of medial patellofemoral ligament (MPFL) reconstruction. Two criteria are advanced to describe normal MPFL function, namely isometric criterion and desired pattern criterion. Subsequently, computational methods have applied these criteria to determine optimal attachment sites.

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On February 8, 2020, Singapore raised its Disease Outbreak Response System Condition (DORSCON) level to Orange, indicating that coronavirus 2019 (COVID-19) was a severe disease with high human transmissibility. Using lessons learned from the severe acute respiratory syndrome (SARS) outbreak in 2003, the orthopaedic surgery department at Singapore General Hospital, a tertiary-level referral center, was prepared to handle this pandemic through business-continuity planning. The business that we are referring to is the "business" of orthopaedic surgery, encompassing clinical care, education, research, and administration.

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The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges to healthcare systems worldwide. Orthopaedic departments have adopted business continuity models and guidelines for essential and non-essential surgeries to preserve hospital resources as well as protect patients and staff. These guidelines broadly encompass reduction of ambulatory care with a move towards telemedicine, redeployment of orthopaedic surgeons/residents to the frontline battle against COVID-19, continuation of education and research through web-based means, and cancellation of non-essential elective procedures.

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Introduction: A complete suprapatellar plica of the knee is a rare condition that separates the suprapatellar pouch from the rest of the knee cavity. Synovial osteochondromatosis is a rare benign monoarticular arthropathy affecting synovial joints that are clinically manifested as intra-articular multiple loose bodies. Isolated synovial osteochondromatosis within a concealed suprapatellar pouch caused by complete suprapatellar plica is an exceptionally rare occurrence.

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Background: From 1980s to the new millennium, the number of patients surviving with end stage renal disease (ESRD) has increased by 3 fold. This is driven by early detection of primordial and primary risk factors, state of the art renal replacement therapy and ease of public access to healthcare. Renal osteodystrophy (RO) is a metabolic bone disease causing significant morbidity in patients with ESRD, in particular fragility fractures.

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Background: World Health Organization declared coronavirus disease-19 (COVID-19) a global pandemic on 11 March 2020, after the coronavirus claimed 4628 lives worldwide. Mental health challenges such as making impossible decisions and working under extreme pressures are expected to be faced by frontline healthcare workers who are directly involved in the care of COVID-19 patients. However, we question if significant stress levels might also be observed in a subspecialty musculoskeletal outpatient department, where staff are not first-line care providers of COVID-19 patients.

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