Joel Xue Yi Lim’s research while affiliated with National University of Singapore and other places

Introduction: There is a paucity of published research on symptomatic venous thromboembolism (sVTE) after distal femur fractures (DFFs). This study aimed to explore the prevalence and risk factors of sVTE in DFFs. Methods: We identified a total of 131 patients who underwent DFF surgeries without routine pharmacological thromboprophylaxis between October 2007 and November 2016. Cases of sVTE included symptomatic pulmonary embolism (sPE) and symptomatic deep vein thrombosis (sDVT). Patients with sVTE were compared to those without, and differences in demographics and fracture-related characteristics were explored. Multivariate logistic regression was used to eliminate confounding factors. Results: Of the 131 patients, 20 (15.3%) had sVTE, of whom 16 (12.2%) had sDVT and six (4.6%) had sPE (two patients had both sPE and sDVT). Notably, 17 (85.0%) sVTE patients were aged ≥60 years, while only 62 (55.9%) non-sVTE patients were aged ≥60 years ( P = 0.014). Fourteen (82.4%) patients with sVTE had body mass index (BMI) ≥25 kg/m ² , while 49 (53.3%) patients without sVTE had BMI ≥25 kg/m ² ( P = 0.032). Multivariate logistic regression demonstrated that age ≥60 years (adjusted odds ratio [OR] 5.05; P = 0.040) and BMI ≥25 kg/m ² (adjusted OR 3.92; P = 0.045) were independently associated with a higher risk of sVTE after DFF. Conclusion: The prevalence of sVTE in DFFs is high at 15.3%. Advanced age (≥60 years) and being overweight (BMI ≥25 kg/m ² ) were two independent risk factors for sVTE in DFFs. The use of routine pharmacological thromboprophylaxis should be considered as a preventative measure.

Background: Calcaneal tuberosity avulsion fractures are uncommon but when present should be treated emergently due to the high risk of skin compromise. Multiple fixation techniques have been reported in the literature but there are little data regarding the ideal fixation construct and outcomes. We aimed to characterize the clinical presentation, focussing on soft tissue compromise and outcomes of operatively treated calcaneal tuberosity avulsion fractures with its associated complications. Methods: A retrospective review of all surgically treated calcaneus fracture in our institution from Jun 2008 to Jun 2017 was done. We reviewed patients’ demographics, types of avulsion fracture, presence of preoperative skin compromise, age of fracture, time to operation, types of fixation construct, postoperative weight bearing regime, union rates, complications and revision surgeries if present. Results: We found 9 patients from our database who met the inclusion criteria. They had an average age of 55.6 (range: 43 - 90) years with 5 (55.6%) of them aged 60 years and older. Seven (77.8%) patients were female. Four out of 9 patients (44.4%) presented with soft tissue compromise (3 cases of skin tenting and 1 case of blistering). None of them required soft tissue reconstructive surgery for skin defects postoperatively. However, 2 patients (22.2%) had wound complications after surgery requiring prolonged wound care for up to 4 months. There were 2 patients with fixation failure whereby both were allowed weight bearing prematurely. All of them were able to ambulate independently at their last review. Conclusion: Calcaneal tuberosity avulsion fractures have a high prevalence of soft tissue compromise and warrant early attention. This condition should be treated as both a bony and soft tissue injury rather than just a bony fracture alone. Management of this injury should take into account fracture reduction and stable fixation with neutralization of the Achilles tendon forces.

Study design: Retrospective cohort study on prospectively implemented EOS protocol. Objective: This study aims to audit and compare existing radiological definitions of gaze direction-chin brow vertical angle (CBVA), McGregor slope (McGS), slope of line of sight (SLS), orbital-internal occipital protuberance (OIOP) slope angle, and Tangent to the hard palate (THP) in a neutral, healthy, and asymptomatic cohort. Summary of background data: The ability to accurately define direction of gaze is the first step when striving for horizontal gaze restoration in any affected individual with rigid sagittal deformity. Yet, the radiological definition of gaze direction remains poorly standardized. Methods: Hundred healthy subjects who could achieve horizontal gaze underwent whole-body standing EOS radiographs taken under a strictly standardized protocol. Radiographic measurements of global spinal sagittal parameters and surrogate measures of horizontal gaze were analyzed and compared. Results: The mean age was 45 ± 15.9 years, with a balanced male-to-female-ratio. Their C7 SVA was -7.7 mm ± 24.8 mm, PI was 51.0o ± 11.4o, PI-LL was -0.9o ± 13.0o and T1-slope was 21.2o ± 9.2o. Measured horizontal gaze parameters were as follows: CBVA (1.07o ± 5.48o), McGS (-3.23o ± 5.63o), SLS (0.45o ± 5.34o), OIOP (5.03o ± 4.66o), THP (-0.17o ± 6.27o). CBVA correlated strongly with McGS (r = 0.679, P < 0.001), SLS (r = 0.592, P < 0.001), OIOP (r = 0.697, P < 0.001), and THP (r = -0.504, P < 0.001). OIOP had the lowest variance amongst all parameters and showed less variability compared to CBVA (SD 4.66 Var 21.69 vs. SD 5.48 Var 30.08, P = .012). Multivariate analysis showed that C2-7 angle was the only parameter found to be associated with OIOP values (P = 0.006). Conclusion: OIOP is the least variable, and most robust radiological method in determining gaze direction. It uses easily recognizable anatomical landmarks and an angular criterion, which makes it advantageous both with x-rays or slot scanners.Level of Evidence: 3.

Study design: Cross-sectional, epidemiological study. Objective: This study aims to describe the prevalence, risk factors, disability, and quality of life (QoL) burden of neck pain. Summary of background data: Neck pain is an increasingly common symptom that results in significant disability and loss of QoL to the individual, and imposes a considerable economic burden to developed countries. Methods: A cross-sectional, questionnaire-based study was conducted via multistage random sampling of public households in Singapore on individuals aged 21 and older. Questionnaires were administered face-to-face by trained interviewers. Data analyzed included the prevalence and characteristics of neck pain, its relationship with sociodemographic factors, and its association on QoL and disability via validated questionnaires: EQ5D questionnaire and Neck Disability Index (NDI), respectively. Results: A total of 626 individuals with a median age of 52.0 years (interquartile range 37.0-67.0), and even sex distribution of males (54.0%) and females (46.0%) were included in this study. A total of 144 individuals reported neck pain over the past 6 months, giving a 6-month period prevalence of 23.0%. Among them, nine (6.3%) had chronic, whereas 12 (8.3%) had severe neck pain. Female sex was the only significant risk factor for neck pain on multivariate analysis, with a risk ratio of 1.34 (95% confidence interval [CI] 1.00-1.80, P = 0.049). Individuals with neck pain had mean raw NDI scores of 4.91 ± 6.25, with higher disability seen with increasing pain duration and intensity (P < 0.001 and P = 0.002 respectively). Compared to individuals without neck pain, those with neck pain had poorer QoL with lower EQ5D-Index scores (0.84 ± 0.25 vs. 0.93 ± 0.15; 95% CI 0.046-0.132, P < 0.001) and EQ5D-VAS scores (68.76 ± 14.59 vs. 73.86 ± 13.64; 95% CI 2.510-7.697, P < 0.001). Conclusion: Our findings show that neck pain is a prevalent condition with chronicity and severity of symptoms associated with reduced QoL and increased disability. Population sample health scores can serve as potential reference targets in disease management and aid national health care policy-making.Level of Evidence: 3.