Journal of Southeast Asian Orthopaedics <p><strong>Editor-in-Chief </strong>▪️ Thanainit Chotanaphuti, MD. <br /><strong>Editorial Secretary </strong>▪️ Satit Thiengwittayaporn, MD.</p> <p><strong>ISSN: XXXX-XXXX (online)<br />ISSN: XXXX-XXXX (print)</strong></p> The Royal College Of Orthopaedic Surgeons Of Thailand en-US Journal of Southeast Asian Orthopaedics 0125-7552 Comparison between Video Podcasts and Traditional Learning in Osteoporosis for Orthopedic Resident Physicians During the COVID-19 Pandemic in Thailand <p><strong>Purpose: </strong>The coronavirus pandemic has posed challenges for medical education, including the loss of lecture hours. Resident physicians were offered video podcasts to compensate for the loss of lecture hours but without proven efficacy. This study aimed to investigate the effectiveness of video podcasts related to osteoporotic and metabolic bone diseases during residency training.</p> <p><strong>Methods: </strong>Orthopedic residents were voluntarily allocated to the video podcast or traditional group. Twenty-two video podcasts covering major topics in osteoporosis and metabolic bone diseases were developed by experts and offered to the podcast group. Each podcast was approximately 20-30 minutes long. Pre- and post-exposure examinations, comprising 60 multiple-choice questions, were conducted and compared. Confidence, perceived ability, and preferences were assessed using questionnaires.</p> <p><strong>Results: </strong>A total of 37 residents were recruited, 18 in the video group and 19 in the traditional group. With numerically lower pre-test scores (47.59%±9.77% in the video group, 53.95%±9.77% in the traditional group, p = 0.056), students in the video group significantly outperformed the traditional group in the post-test (89.81%±3.83% and 76.93%±10.92%, p &lt; 0.001). Junior residents watching videos scored higher than senior residents. Videos led to a greater gain in confidence and perceived ability. However, students still preferred live lectures to videos.</p> <p><strong>Conclusions: </strong>This study showed greater performance scores and confidence when using video podcasts, with junior residents improving more with podcasts. We suggest providing supplemental video podcasts in non-surgical-based subspecialties during the early training years as a supplement during the pandemic and a new normal residency training method.</p> Atiporn Therdyothin Tanawat Amphansap Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-08-01 2022-08-01 47 1 3 10 10.56929/jseaortho-022-0154 Appropriate FRAX® Intervention Threshold for Pharmacological Treatment of Osteoporosis in Thailand <p><strong>Purpose:</strong> The Fracture Risk Assessment Tool (FRAX<sup>®</sup>) has been recommended and incorporated into osteoporotic guidelines worldwide to assess fracture risk and promptly diagnose osteoporosis when bone mineral density is unavailable. However, a country-specific intervention threshold for Thai patients remains unknown. Therefore, we aimed to identify an appropriate cut-off point for the 10-year probability of hip fracture (HF), specifically in the Thai population.</p> <p><strong>Methods:</strong> This retrospective cohort study included members of the Thai population aged 50-90 years, enrolled from January 2018 to January 2020. Analysis of data collected from online FRAX<sup>®</sup> tool questionnaires was conducted and the receiver operating characteristic (ROC) curve was used to determine a new appropriate cut-off value as the intervention threshold.</p> <p><strong>Results:</strong> A total of 1,311 (HF: 422 [32.2%], non-HF: 889 [67.8%]) participants were included. The FRAX<sup>®</sup> 10-year probability of fracture in patients with HF was significantly higher than in non-HF (5.8% ± 4% vs. 4.7% ± 4.5%, respectively; P &lt; 0.01), whereas the probability of major osteoporotic fracture (MOF) was similar (11.0 ± 5.8% vs. 10.6 ± 6.2%, P = 0.27). The ROC curve revealed a new intervention threshold for the FRAX<sup>®</sup>-based 10-year risk for HF of 4.3% with a maximum area under the curve (AUC) (95% confidence interval: 0.632 (range: 0.602-0.663; P &lt; 0.001), with sensitivity and specificity of 62.9% and 60.7%, respectively.</p> <p><strong>Conclusions:</strong> The intervention threshold cut-off value for osteoporosis treatment among the Thai population was 4.3%, which is higher than the cut-off point recommended in the Thai national guidelines.</p> Tanawat Amphansap Chatdanai Phan-udom Pojchong Chotiyarnwong Nitirat Stitkitti Atiporn Therdyothin Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-10-08 2022-10-08 47 1 11 17 10.56929/jseaortho-022-0158 Delayed Admission Time and Its Reason in Patients with Geriatric Hip Fracture <p><strong>Purpose:</strong> Geriatric hip fractures are common. Surgical treatment is generally required to achieve a good quality of life. It was reported that a delayed time from injury to treatment leads to poor outcomes. We aimed to determine the time interval from injury to hospital admission in patients with geriatric hip fractures and explore the reasons for delay.</p> <p><strong>Methods:</strong> Information on geriatric hip fracture patients who received treatment at our hospital from November 2016 to October 2020 was extracted from medical records. The average delay time was analyzed and reported. The reasons for delay were collected from patients who were not referred from other hospitals and had a time interval from injury to admission of more than 24 h.</p> <p><strong>Results:</strong> The median time interval was 0.38 days, and 127 (32%) visited the hospital more than 24 h later. In patients not referred from other hospitals, the most common cause of delay was that patients overlooked the possibility of bone fractures (58%). Other reasons included unavailable transportation (20%), missed diagnosis from other hospitals (11%), inability to afford the transportation cost (7%), and inability to talk and/or caregivers did not notice the injury (4%).</p> <p><strong>Conclusions:</strong> Almost one-third of geriatric hip fracture patients had a time from injury to admission of more than 24 h. Knowing the reason for delay and determining a solution to minimize this time interval may improve treatment quality. This information demonstrates that public and healthcare providers should pay attention to elderly patients with a history of fall injury.</p> Pongsakorn Rungchamrussopa Piyabuth Kittithamvongs Puthi Tantikosol Chavanont Sumanasrethakul Kitjaput Tiracharnvut Science Metadilogkul Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-09-25 2022-09-25 47 1 18 22 10.56929/jseaortho-022-0163 Comparison of the Short-Term Outcomes of Cementless Bipolar Hemiarthroplasty and Cementless Total Hip Arthroplasty for Displaced Femoral Neck Fractures in the Elderly <p><strong>Purpose:</strong> Displaced femoral neck fracture (DFNF) in elderly patients are frequently managed by hip replacement. However there is no consensus on bipolar hemiarthroplasty (BHA), which has a lower dislocation rate, less blood loss and shorter operative time, while total hip arthroplasty (THA) provides better functional and long term outcomes. This study aimed to evaluate patient function and complications following both BHA and THA in an elderly population who presented with DFNF.</p> <p><strong>Methods:</strong> A prospective, randomized controlled trial comparing BHA and THA for DFNF treatment was performed. Patients over 60 years of age with DFNF (Garden’s classification types 3 and 4) participated in this study, while patients with preexisting hip conditions and impaired cognitive function were excluded from the study. All operations were performed by a single surgeon using the same techniques the posterior approach. Demographic data, intraoperative blood loss, operative time, and morbidity and mortality statistics were collected. Patients were followed up at 1, 3, 6 and 12 months and their functional scores were calculated according to the Harris hip score. Statistical analyses were performed to the intention-to-treat principle.</p> <p><strong>Results:</strong> The cohort comprised 75 patients, with 38 patients in the BHA group (mean age 76.7 years) and 37 patients in the THA group (mean age75.7 years). The mean operative times for the BHA and THA groups were 40.76 and 51.08 minutes respectively. The average intraoperative blood loss was 200 cc and 279.7 cc, respectively. The mean hospital stay was 5.07 days for the BHA group and 4.92 days for the THA group. The mean Harris hip scores at 1, 3, 6 and 12 months in the BHA group were 71.5, 78, 85 and 86, respectively, while in those in the THA group were 71, 79, 85.5 and 88 respectively. Statistically, there were no significant difference between the two groups. Morbidities including fractures and dislocations, and mortality rates, also showed no statistically significant difference.</p> <p><strong>Conclusions:</strong> Harris hip score, dislocation, length of hospital stay and mortality rate at one year is not statistically different between group. Blood loss and operative time were significantly lower in the BHA group than in the THA group.</p> Wiboon Wanitcharoenporn Nattapong Sasipotiwan Witoon Thremthakanpol Burin Sutthapakti Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-09-30 2022-09-30 47 1 23 29 10.56929/jseaortho-022-0166 Does the Entry Point of Proximal Femoral Nail Antirotation Affect the Malalignment of Intertrochanteric Fracture? A Cadaveric Study <p><strong>Purpose:</strong> Proximal femoral nailing (PFN) is a reliable and common procedure for treating intertrochanteric fractures. The optimal entry point is considered a critical step in avoiding malreduction. This study investigated the effects of various entry points on fracture displacement and force reduction.</p> <p><strong>Methods:</strong> Twenty-four cadaveric femurs were randomly categorized into three groups: the greater trochanter (GT) tip, medial to the GT tip, and lateral to the GT tip. Each intact femur was provisionally stabilized using a ring external fixator. The entry point was identified and reamed to accommodate the nail insertion. After osteotomy was performed to simulate an A1-type fracture, the PFN was inserted. Digital calipers were used to measure horizontal fracture displacements. The force required to reduce displaced fractures to the anatomical position was measured using a digital force gauge. Fluoroscopic images were recorded to assess changes in the neck-shaft angle.</p> <p><strong>Results:</strong> The lateral entry group showed significantly displaced fractures in the coronal plane, whereas the medial and tip entry groups were insignificant. Displacement in the sagittal plane was not significantly different between the groups. The lateral entry group showed significantly irreducible displaced fractures compared with the other groups. After nail insertion, the changes in the neck-shaft angle were 0.77° varus, 3.66° valgus, and 3.16° varus in the tip, medial, and lateral entry groups, respectively. The degree of neck-shaft angle change demonstrated significant differences between the groups.</p> <p><strong>Conclusions:</strong> The lateral entry point of PFNA tends to displace reduced fractures, resulting in malalignment and irreducibility. Lateral entry points should be avoided to prevent surgery-related complications.</p> Chittawee Jiamton Nonpawit Nimmankiatkul Pongsakorn Rungchamrassopa Wichan Kanchanatawan Pariyut Chiarapatanakom Wirat Kongcharoensombat Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-10-06 2022-10-06 47 1 30 37 10.56929/jseaortho-022-0165 Application of Topical Tranexamic Acid Reduces Postoperative Blood Loss after Posterior Spinal Fusion with Instrumentation in Patients with Adolescent Idiopathic Scoliosis <p><strong>Purpose:</strong> There is limited literature regarding the topical use of tranexamic acid (TXA) to control postoperative bleeding during spinal deformity correction and fusion procedures, which often require blood transfusions. This study aimed to evaluate the effect of topical TXA on postoperative blood loss in patients undergoing deformity correction and posterior spinal fusion (PSF) surgeries.</p> <p><strong>Methods:</strong> A retrospective study was conducted between January 2011 and April 2017 in 51 patients with adolescent idiopathic scoliosis who underwent long-segment PSF with hybrid thoracic-hook pedicle screw instrumentation or pedicle-screw-alone constructs. Twenty-five patients were assigned to receive topical TXA (1 g/20 mL), and the drain was clamped for 2 h. Twenty-six patients in the control group were treated with antifibrinolytic agents.</p> <p><strong>Results:</strong> Median drainage blood loss, median day of drain removal, and median postoperative hospitalization were significantly lower in the topical TXA group (all <em>p </em>&lt;0.05). The postoperative packed red cell transfusion rate was significantly lower in the topical TXA group than that in the control group (15 of 25, 60% vs. 23 of 26, 88.5%; <em>p</em>=0.02; risk ratio, 0.68; 95% confidence interval, 0.48–0.96).</p> <p><strong>Conclusions:</strong> The use of topically administered 1 g TXA in AIS patients undergoing instrumented PSF effectively reduced postoperative transfusion requirements, decreased the total amount of drainage blood loss, reduced the time till drain removal, and shortened the length of postoperative hospitalization.</p> Sarut Jongkittanakul Terdpong Tanaviriyachai Kongtush Choovongkomol Urawit Piyapromdee Weera Sudprasert Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-10-15 2022-10-15 47 1 38 45 10.56929/jseaortho-022-0164 “Through and Through” Fluoroscopically Guided Catheter Drainage of Extensive Spinal Epidural Abscess: A Case Report <p><strong>Purpose:</strong> We aimed to present a case of spondylodiscitis with extensive spinal epidural abscess (SEA) that was successfully treated using a minimally invasive technique supplemented with fluoroscopically guided catheter drainage and systemic antibiotic therapy.</p> <p><strong>Methods:</strong> A 58-year-old man presented with severe back pain and high-grade fever. He had progressive radiating pain in the lower extremities, followed by sensory deficits in both the lower limbs. Laboratory investigations revealed leukocytosis and high C-reactive protein levels. Magnetic resonance imaging of the thoracic and lumbar regions revealed an extremely large posterior SEA that extends from T6 to S1. As the patient did not respond to intravenous antibiotics alone, he underwent skipped laminectomies with fluoroscopically guided catheter drainage and irrigation.</p> <p><strong>Results:</strong> <em>Escherichia coli</em> were detected in purulent material from the abscess. His clinical symptoms were dramatically and immediately relieved after the procedure. The patient achieved complete neurological recovery after six weeks of antibiotic therapy.</p> <p><strong>Conclusions:</strong> We suggest a limited approach to the spine with the use of small radio-opaque catheters, representing an interesting option to effectively drain extensive SEAs with less morbidity than the conventional open extensive surgical drainage.</p> Terdpong Tanaviriyachai Patchara Pornsopanakorn Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-08-01 2022-08-01 47 1 46 50 10.56929/jseaortho-022-0155 Serratia marcescens Septic Arthritis and Osteomyelitis after COVID-19: A Case Report and Literature Review <p><strong>Purpose:</strong> Septic arthritis and osteomyelitis due to <em>Serratia marcescens </em>are very rare, with only a few cases reported in the literature. This report presents a case of septic arthritis and osteomyelitis of the hip joint caused by <em>Serratia marcescens </em>after COVID-19.</p> <p><strong>Methods:</strong> A case report of a patient who had septic arthritis of <em>Serratia marcescens</em> was reported. A review of literature of the bone and joint infection caused by <em>Serratia marcescens</em> was also done. </p> <p><strong>Results:</strong> The patient was successfully treated with an open arthrotomy, debridement, and intravenous antibiotics. After 9 months, the patient showed good functional outcomes, with no signs of recurrent infection.</p> <p><strong>Conclusions:</strong> Septic arthritis caused by <em>Serratia marcescens</em> is a rare condition. Early diagnosis and urgent surgical debridement are key factors for success.</p> Puthi Tantikosol Chavanont Sumanasrethakul Charoenchai Pakpianpairoj Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-11-02 2022-11-02 47 1 51 55 10.56929/jseaortho-022-0169