Transferring Tendon..

Alhamdulillah...All praise to Allah.

It has been scheduled.InsyaAllah tomorrow morning I'll be joining my boss elective operation.Just finishing doing pre-op round today.One of the patient is a young lady with the congenital Erb's palsy.She is planned for right wrist tendon transfer KIV wrist fusion.


" who will join the OT tomorrow ? " Mr zairuddin, my ward specialist asked.

" Me, Mr zai.."

"..so you should have a look and read about tendon transfer " He encouraged while smiling.

Alhamdulillah...I just read about Principles of tendon transfer described by Roger Dee.Basically, there are 5 principles which have been outlined by Mayer, Steindler, Bunnell and Boyers.

Before that, what does it means by tendon transfer?

It is defined as " procedure in which the tendon of insertion or of origin of the functioning muscle is mobilized, detached, or divided, and reinserted into a bony part or into another tendon to supplement or substitute for the action of the recipient tendon "

Principles of Tendon Transfer

1. Correction of contractures

The joints must be freely movable, because a transferred tendon unit cannot overcome a fixed joint contracture.the skin and soft tissue must be supple and free of scarring.

2. Adequate power in the transfer

The muscle must be strong enough to perform the desired function.Thus, only muscles rated 4+, 5 or better should be considered acceptable donor.

3. Sufficient amplitude in the Transfer

The amplitude is a function of muscle sarcomere length.One should choose a donor with more than adequate amplitude for the desired function.The work capacity of a muscle is determined by the product of its power and amplitude.

4. Satisfactory Line of pull

The best course for a tendon transfer is a straigt line of pull througgh unscarred soft tissue.Each turn or bend in the transferred tendon can set up a point of friction, causing loss of effective power and amplitude.

5. Functional integrity

The transferred tendon cannot be expected to perform more than one function or to have separate amplitudes for different motions.The transferred muscle tendon unit must be expendable.For example, if both the FCR and FCU tendons are tranferred to the dorsum of the hand and wrist, active wrist flexion will be lost !


Hopefully we can learn something and may the operation tomorrow will be successful.May Allah bless.

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Breaking bad news

Alhamdulillah, yesterday we managed to handle 21 cases, 15 of them had been admitted.Sounds interesting, right ? :-)

Never regret for not having much time for sleep.In fact, we should be thankful, because not all people are given chance to 'open their eyes at 3 am !'Think the other way....

Last night we're doing call with Mr Aaron.Just after finishing round for new cases in ward, one of the staff nurse called up Mr Aaron,

" Mr Aaron,that son of patient bed 11 wants to know the progression of his father, could you tell him something..."

It was just 2 days I missed ward round, yet so much had been done.He came because of buttock pain and that caused him to mainly lie on bed, not much ambulating due to pain.At the same time, he got mass on his buttock.

Initial X-ray showed large lytic lesion over the pelvic bone as well as presence of mass at perihilar region of the lung.Suprisingly, he denied respiratory symptoms.Trucut biopsy of the mass had been performed, but the results not really conclusive..until then CT scan done and reported as possibility of lung cancer with metastasis to the liver and bone.

hem...I was quite surprised last night, because he was too healthy to have that cancer.But The Powerful Allah can do anything...

To break the bad news, was challenging.I do remember Mr Anwar says, be like a human, don't let yourself turn to be like a robot, doing works without sense of humanity.I realize it often, sometimes we just work and work, went out at 7am, came back at 6pm everyday the same.We sometimes forget that we have deep heart to express our sympathy, concerns and loves to other people surrounding.We are not robot, robot has got no HEART.We are human....

Mr Aaron had done it very well.He broke the news, like a human, in other words, he tried to put himself in other people situation.The son able to accept, even though I could see the tears.

We came from Allah, and to Him will we back.





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See you again, Penang

Alhamdulillah, at last....

Now i'm preparing myself for next CME ( continous medical education )for a topic on osteoporosis.Guess where am i now?

At last, I managed to complete my Orthopaedic Trauma Course 2011 in Penang.A 4-days course held at Hospital Pulau Pinang was really informative.Here we're dealing with cadavers, saw bones and 'new born' instruments to enhance our skills and knowledge in orthopaedic trauma surgery.To be honest, at first the programme quite tiring, but eventually I could get used to it.

Three of us, including Dr Anuar and Dr Arif stayed in Tune Hotels which was located just a few kms from the hospital.Alhamdulillah, facilities provided were almost complete.We did not need to be hurry most of the time since the traffic was not so busy in the morning.We could reach hospital roughly within only 10 minutes.

Hem...knowledge need to be shared.I pray to Allah, may He gives me chances to convey all the messages here to other people.Hopefully, I could be a better junior orthopaedic surgeon, for a better service towards society.The most important, a better servant for Him.

See you again, Penang.

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Husband & Wife

I'm really touched....tears almost drop from my eyes.

She is a known case of cervical cancer stage III, and now it's already spread to her acetabulum.Because of massive disruption of hip joint, walking without pain is almost impossible.Yet, she seems to be strong enough.She even can give me smiles..and what really touched me is her husband always gives her full supports,motivations, helping her in ambulation.CINTA TANPA SYARAT.

Sadly, nothing much we can do for her.Main treatment now is palliative care, no more curative.The survival chance is poor.I pray to Allah, may He bless them two husband and wife, and unite them in paradise,insyaAllah.


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7th Asia Pasific Meeting

Praise to Allah.

A journey to Kuantan on last few days was really meaningful.Attending international course - 7th Asia Pasific on Diabetic Limb Problem Meeting at UIA auditorium has brought in confidence to myself.

Me, myself the only doctor accompanied by one sister and two nurses were the representatives of wound team of HRPZII.The last minute plan ended up with a journey by bus.Never mind..as long as we reached there safely,it was good .Being in the new place, was quite challenging.It was hard to find proper comfortable room to stay in.Most of the rooms were already booked..preserved.We didn't expect that actually.Alhamdulillah, at last we got one.Shahzan Inn.RM 140 per night worth it enough.

Many speakers were invited.All of them were really expert in dealing with diabetic foot.We have those from Hong Kong, Australia, India, Singapore and Indonesia professors delivering a very fantastic presentation.The utmost attractive part was the workshop where we could learn directly from real life and situation, how to handle each patient with problematic diabetic limb including assessment of wound and the best choice of dressing need to be offered.

And now HONEY is officially approved internationally as one of the best material that can be used to manage diabetic foot.What Allah says, definitely TRUE !

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Man or Woman

"Assalamu'alaikum Doctor, I'm Dr Redza, would like to refer to you one case of Brachial Plexus injury " She..actually he is........

" oh ya...sure.You may send him now."

That was the conversation between me and one of the medical officer in district hospital last week.When I heard the word 'brachial plexus injury' , I know already that I'll encounter an interesting and rare case for that day.Hmm...Alhamdulillah Allah wants to teach me something.

2 hours later, I got a call from A&E.

" Dr Hidayah, patient with brachial plexus injury already arrived here.Are you going to see him at casualty ? "

" yah...I'll go down now.Thank you."

At first glance, I thought the patient was a female, but suprisingly the name written in the card belonged to a male...ya it got bin, not binti.Huh..realy, it challenged me already.Now in my mind, suspicion came the first.

His neck was kept in left lateral position.He said he it was very painful to move his neck towards normal.He was unable to move his left upper limb and the sensation lost.Basically the neurology involved was from C5 to T1.

It sounds like he realy got some injury towards brachial plexus.Maybe the high velocity accident strecthed the nerve root which result with loss of motor and sensation around his unilateral upper limb.I need to consult bos now...

" Mr Aaron...Hidayah here,I need your opinion.Would like to show you a patient who suspected to have brachial plexus injury "

Mr Aaron is a very nice orthopaedic speacialist.He is generous and kind, always willing to help..and most of the time when we see him, he gives us smiles.

" well..Hidayah.I don't think he injured his brachial plexus.I think more of psychological.You see...when I passively flex his elbow, he actually can resist me.But never mind we'll see him again in 2 weeks time, see how he progress."

Hmm...my suspicion turned to be true anyway.Quite a number of patient have psycogenic component in their complaints.But as a doctor, we try not to put that as the first diagnosis.In this case, the apperance of a patient may give us a lot of clues,how a man could have lipstick on his lips, and he definitely was wearing a female cloth !

Subhanallah...




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Fasting month

Beutiful Ramadhan.

Are you still nil by mouth ? your operation need to be delayed,sorry for that.

"No, Doctor.I just finished my last slice of bread just now."

OH...I thought you're still fasting, ya...in this beutiful Ramadhan.

"Doc...I feel like very ill today.I can't."

Ic.....


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Have a barokah day, uncle !

" ya doc, thanks a lot.

Uncle still fasting,right ?

" for sure doc, we're in ramadhan month.Either i will be called up for operation or not I'll still keep fasting "

Alhamdulillah....very good, uncle.Keep it.

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Two different occasions with two different patients that I encountered.Taking things for granted, sometimes we don't realize.Ya Allah....please do bless us.