Clinical and Functional Outcomes of Ilizarov Bone Transport in Traumatic Tibial Bone Loss Mohd-Yusof N, Kow RY, Sulong AF, Nallayan RM, Zainal-Abidin MA Malaysian Orthopaedic Journal, 2025 Introduction: Bone loss is a serious complication following an open fracture or fracture-related infection in the tibia. Treatment with Ilizarov bone transport in this condition is preferred because it minimises additional soft tissue injury and is able to close the bone and soft tissue defects through distraction osteogenesis. The objective of this study is to evaluate the relationship between functional outcomes of patients with tibial bone loss treated with Ilizarov bone transport and return to work. Materials and methods: A cross-sectional study among 40 patients was carried out in 2 public hospitals. Patient records and radiographs were reviewed for information on the initial injuries, treatment, union of bone, and complications while on treatment. The clinical outcomes were evaluated with ASAMI Bone grading system while the functional outcome of the affected limb was assessed using Lower Extremity Score (LEFS) and ASAMI Functional grading system at least 10 months after the removal of the Ilizarov external fixator. Results: Thirty-eight (95%) achieved union. Thirty-six (90.0%) patients had excellent and good scores for clinical and functional results, respectively using the ASAMI grading system. The mean LEFS is 80.1% (range 58 to 91%). Thirty-three (82.5%) patients were able to return to work. The clinical outcome has a strong and positive correlation with functional outcome both on ASAMI functional score and LEFS (p<0.001). Patients with good and excellent ASAMI functional scores significantly correlate with higher odds to return to work (p<0.001). Return to work was also associated with a higher LEFS score (p=0.006). Conclusion: Most patients with tibial non-union treated with Ilizarov bone transport have good and excellent clinical and functional outcomes and are able to return to work. Return to work significantly correlates with good functional outcomes.
The Difference in Supine versus Standing Plain Radiograph of the Knee in Patients with Knee Osteoarthritis Musa AA, Shamsuddin-Perisamy R, Low CL, Zulkifly AH, Kow RY Malaysian Orthopaedic Journal, 2025 Introduction: Knee osteoarthritis is a degenerative joint disease attributed to failure in joint repair process. Key aspect of the diagnosis relies on thorough history, along with physical examination and radiology findings. The conventional weight-bearing plain radiograph remains the key modality to determine the severity of the condition and helps to plan the surgery. Nevertheless, not all patients can undergo weight-bearing plain radiographs, especially those who are wheelchair-bound or have severe deformities. The purpose of this study is to investigate whether a weight-bearing plain radiograph of the knee is essential in all patients with knee osteoarthritis. Materials and Methods: A prospective cohort study on patients with knee osteoarthritis receiving treatment in a single tertiary hospital was conducted. All patients consented to participate in this study. Patients were assessed functionally with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and radiologically with plain radiographs. Patients were subjected to undergo both supine and standing plain radiographs of the knee in the same setting for comparison purposes where measurement is done following patient functional outcome and radiological measurement for the patient. Results: Our study shows that reduction in joint space is more obvious in weight-bearing radiographs, however in severe or higher-grade osteoarthritis, a supine radiograph is adequate to diagnose knee osteoarthritis. Conclusion: Standing radiograph of the knee is preferred to a supine knee radiograph wherever possible due to the additional value it brings, however, in certain patient conditions, a supine radiograph is still acceptable.
Fibula Pro-tibia or Tibial Pro-fibula Dilemma: Order Defines Meaning Kow RY, Low CL, Mohd-Yusof N Malaysian Orthopaedic Journal, 2024 We read the excellent article by Jain et al with avid interest. The authors successfully managed complex distal tibia and fibula fractures with the rarely-used fibula pro-tibia fixation technique, achieving good or excellent outcomes in 29 out of 30 patients. In fact, this technique was first described by Campanacci and Zanoli in 1966 to treat non-union of the tibia by creating a fibular synostosis. Since then, a few authors have used the technique to treat ankle fractures in high-risk patients, such as those with osteoporotic bone or diabetes mellitus.
Bibliometric Analysis of Malaysian Orthopaedic Journal using Scopus Database Kow RY, Low CL, Abbas AA, Zulkifly AH Malaysian Orthopaedic Journal, 2024 Introduction: The Malaysian Orthopaedic Journal (MOJ) (ISSN 1985-2533 / 2232-111X) is the official publication of the Malaysian Orthopaedic Association (MOA) and the ASEAN Orthopaedic Association (AOA). In May 2007, MOA published the first standalone issue of MOJ with the aim of disseminating new knowledge and providing updates in orthopaedics, trauma and musculoskeletal research. Since then, MOJ has grown significantly, achieving indexing in numerous databases and attaining a 2nd Quartile (Q2) rank in the Scopus database in 2022. This bibliometric analysis aims to explore the trends and distribution of articles published in MOJ. Materials and Methods: Bibliometric data for MOJ was extracted from the SCOPUS database, covering the years from its indexing to 2022. Information such as authors, country, document type, author’s keywords, citations, and other parameters were extracted using the bibliometrix package in the R Studio software. The data were then presented in tables and illustrative graphs using the same software. Results: A total of 305 articles were retrieved from the Scopus database during the study period. Two-thirds of the articles were original articles and review articles. The highest number of citations received by an article is 56, and top ten articles in MOJ were authored by researchers from seven different countries, highlighting the journal’s diversity. Despite receiving submissions from various countries, there is minimal collaboration between authors of different countries. Keywords such as “covid-19” and “pandemic” dominate the authors’ keyword section due to the once-in-a-life-time COVID-19 which during the study period, resulting in numerous publications related to this issue. Conclusion: This bibliometric analysis reviews all the articles indexed in the Scopus database and provides insight into the contributors’ information and the trends in orthopaedic research. By identifying the lack of collaboration between countries, it is hoped that this analysis can inspire more orthopaedic surgeons and researchers to collaborate and produce high-quality publications.
Comment to: The Incidence of Fracture-Related Infection in Open Tibia Fracture with Different Time Interval of Initial Debridement Esmat SM, Kow RY, Low CL Malaysian Orthopaedic Journal, 2024 We read with great interest the study by Hadizie et al in the February 2022 issue entitled “The Incidence of Fracture-Related Infection in Open Tibia Fracture with Different Time Interval of Initial Debridement”. In their paper, they presented the relationship between fracture-related infection in open fracture of the tibia with time intervals of initial debridement. With limited studies in Malaysia investigating the correlation between the timing of initial debridement and the incidence of infection in open fracture of tibia, this study potentially shed more light on the optimal timing of initial debridement.
Supracondylar Humerus Fractures in Infants and Toddlers: An Unexplored Area R. Y. Kow, C. L. Low, M. S. Awang Journal of Investigative Surgery, 2023 This write-up refers to the article ‘Supracondylar Humerus Fractures in Infants and Early Toddlers: Characteristics, Clinical and Radiological Outcomes Compared With Older Children’.
Staged Reconstruction for Humeral Osteomyelitis after Severe Crush Injury of the Shoulder: A Case Report Kow RY, Mohd-Yusof N, Abas MF, Low CL Malaysian Orthopaedic Journal, 2022 The incidence of humeral osteomyelitis is relatively rare as compared to incidence of lower limb osteomyelitis. Despite having no guideline in the management of humeral osteomyelitis, surgeons have utilised their experience in managing lower limb osteomyelitis to treat humeral osteomyelitis. By adhering to principles including thorough debridement of necrotic bone and soft tissue, staged bony and/or soft tissue reconstruction, and targeted antimicrobial therapy, a good outcome can be achieved in the management of humeral osteomyelitis. We report a case of Cierny-Mader type IV proximal humeral osteomyelitis after a severe crush injury of the left shoulder and its subsequent two-stage reconstruction using internal fixation and pedicled Latissimus dorsi musculocutaneous flap.
LETTER TO THE EDITOR Coronal Plane Screening of Lower Limb Deformity Kow RY, Low CL, Yusof MN Malaysian Orthopaedic Journal, 2022 Lower limb deformity is defined as deviation of the normal alignment or orientation of the affected limb1,2. Pre-operative planning for deformity correction involves identification of the cause of deformity, be it from the bone (femur or tibia), the joint (hip, knee or ankle) or both the bone and joint involvement. Nowadays, malalignment and malorientation test, described by Paley et al, is routinely being used in pre- operative planning to delineate and identify the pathological site1,2. Nevertheless, this technique is relatively difficult to comprehend especially by inexperienced personnel. This is due to multiple seemingly identical measurements such as lateral proximal femur angle (LPFA), mechanical lateral distal femur angle (mLDFA), anatomical lateral distal femur angle (aLDFA), medial proximal tibial ankle (MPTA), and lateral distal tibial ankle (LDTA), with all ranging from 81° to 90°. We propose an easier screening method to identify the site of deformity of the lower limb.
COVID-19 Pandemic: Two-year Experience and Response of a Teaching Hospital in Malaysia and the Effect on Postgraduate Orthopaedic Training Kow RY, Khalid KA, Zakaria Z, Awang MS Malaysian Orthopaedic Journal, 2022 As the number of COVID-19-related infections and deaths increased exponentially in the during 2020, few countries were equipped to manage and curb this novel coronavirus. Initially there was no proven cure or vaccine to this novel virus (SARS-Cov-2), leaving the authorities with no choice but to impose quarantines at the short-term expense of their economies. As we gain more knowledge on this novel virus, the tried-and-tested method of selective testing of the symptomatic patients, used successfully in almost all infectious respiratory diseases, has been replaced with trace-and-test method, as most of the infected patients remained asymptomatic. In early 2021, the availability of vaccines provided a shed of light out from this pandemic. Nevertheless, we faced an enormous task in juggling between vaccination of the population, managing patients with COVID-19 infection as well as non-COVID-19 patients. Here, we share our experience and response in managing this healthcare crisis across a two-year period during the pandemic and we hope other centres can learn from what we went through and help them derive a protocol to navigate through a future pandemic.
Microbiology of diabetic foot infections in three district hospital in malaysia and comparison with south east asian countries Medical Journal of Malaysia, 2019
Imageless Kinematic Versus CT-Based Functional Alignment in Robotic-Assisted Total Knee Arthroplasty: A Propensity Score–Matched Comparative Study Y Ng, JTE Lim, RY Kow, HN Pang, DKJ Tay, SJ Yeo, MHL Liow Journal of Orthopaedics , 2026 2026
Preheating 2-Octyl Cyanoacrylate Reduces Curing Time in Robotic Total Knee Arthroplasty: A Pilot Randomized Study RY Kow, WT Lo, Y Ng, JTE Lim, CL Tan, MHJ Cheng, MHL Liow, ... Cureus 17 (7) , 2025 2025
Clinical and Functional Outcomes of Ilizarov Bone Transport in Traumatic Tibial Bone Loss N Mohd-Yusof, RY Kow, AF Sulong, RM Nallayan, MA Zainal-Abidin Malaysian Orthopaedic Journal 19 (2), 91 , 2025 2025 Citations: 4
The Difference in Supine versus Standing Plain Radiograph of the Knee in Patients with Knee Osteoarthritis AA Musa, R Shamsuddin-Perisamy, CL Low, AH Zulkifly, RY Kow Malaysian Orthopaedic Journal 19 (2), 50 , 2025 2025 Citations: 1
Comparison of Thermal Imaging and Magnetic Resonance Imaging in Evaluating the Extension of Diabetic Foot Infections: A Report of Two Cases ARM Sirajudeen, CL Low, MR Abidin, MW Ahmad, AS Sulaiman, ... Cureus 17 (4) , 2025 2025
Surgical Consideration in Total Knee Arthroplasty for a Patient With Incidental Femoral Intramedullary Fibrous Dysplasia KR Yi, ZA Suraya, WT Lo, XF Chen, LMH Lincoln Cureus 17 (2) , 2025 2025
Fibula Pro-tibia or Tibial Pro-fibula Dilemma: Order Defines Meaning RY Kow, CL Low, N Mohd-Yusof Malaysian Orthopaedic Journal 18 (3), 88 , 2024 2024
Mapping the research landscape of intra-articular knee injections: a bibliometric analysis using the scopus database AA Musa, CL Low, KN Siron, MHM Nazarallah, RY Kow, IBA Bakar, ... Cureus 16 (7), e65647 , 2024 2024 Citations: 3
Bibliometric analysis of Malaysian orthopaedic journal using Scopus database RY Kow, CL Low, AA Abbas, AH Zulkifly Malaysian Orthopaedic Journal 18 (2), 1 , 2024 2024 Citations: 2
Thermography research in diabetic foot: insights from a Scopus-based bibliometric study SA Zakaria, CL Low, RY Kow, ZZ Mohamad, MR Abidin, AC Ahmad, ... Cureus 16 (6) , 2024 2024 Citations: 10
Shoulder arthroplasty: a bibliometric analysis using the Scopus database KN Siron, RY Kow, NANM Amin, CL Low, AN Wahid, F Jasni, MR Abidin, ... Cureus 16 (6) , 2024 2024 Citations: 6
Robotic-assisted hip and knee arthroplasty: a bibliometric analysis using the scopus database RY Kow, RA Rani, MHM Nazarallah, JF Leong, MF Hayyun, CL Low, ... Cureus 16 (3) , 2024 2024 Citations: 26
Comment to: The Incidence of Fracture-Related Infection in Open Tibia Fracture with Different Time Interval of Initial Debridement SM Esmat, RY Kow, CL Low Malaysian Orthopaedic Journal 18 (1), 153 , 2024 2024 Citations: 1
Supracondylar Humerus Fractures in Infants and Toddlers: An Unexplored Area RY Kow, CL Low, MS Awang Journal of InvestIgatIve surgery 36 (1), 2136803 , 2023 2023 Citations: 1
Evaluation of feasibility of medial plantar artery flap with computed tomography angiography in diabetic patients: a pilot radioanatomic study AAA Alwi, CL Low, RY Kow, FA Tajudin, BC Lim, AAH Lim, ... Cureus 15 (10) , 2023 2023 Citations: 3
Bibliometric analysis of diagnostic yield of CT pulmonary angiogram (CTPA) in the diagnosis of pulmonary embolism (PE) RY Kow, K Razali, CL Low, KN Siron, ZZ Mohamad, MM Yusof, ... Cureus 15 (7) , 2023 2023 Citations: 13
The role of medial plantar artery flap in heel pad reconstruction: a report of two cases ZS Oon, RY Kow, AAA Alwi, MAS Ayeop, CL Low, AC Ahmad, AAA ALWI Cureus 15 (7) , 2023 2023 Citations: 9
Diagnostic yield of CT pulmonary angiogram in the diagnosis of pulmonary embolism and its predictive factors CL Low, RY Kow, A Abd Aziz, MM Yusof, BC Lim, NA Kamarudin, ... Cureus 15 (6) , 2023 2023 Citations: 22
Outcomes of geriatric hip fractures in a tertiary referral center in Malaysia during the COVID-19 pandemic MHA Khan, RY Kow, S Ramalingam, A Sofian, JPY Ho, KSJ Singh, JJ Raj, ... Cureus 15 (6) , 2023 2023 Citations: 8
Telescoping allograft prosthetic composite (APC) reconstruction of the femur following revision arthroplasty for neglected developmental dysplasia of the hip (DDH) JC Yuen, HN Pang, RY Kow Cureus 15 (6) , 2023 2023 Citations: 4
MOST CITED SCHOLAR PUBLICATIONS
Predictive factors of major lower extremity amputations in diabetic foot infections: a cross-sectional study at district hospital in Malaysia RY Kow, CL Low, JK Ruben, MZ Zaharul-Azri, BC Lim Malaysian Orthopaedic Journal 13 (3), 45 , 2019 2019 Citations: 30
Microbiology of diabetic foot infections in three district hospital in Malaysia and comparison with South East Asian Countries. RY Kow, CL Low, JK Ruben, WMZ Zaharul Azri, ESK Mor Japar Khan The Medical Journal of Malaysia 74 (5), 394-399 , 2019 2019 Citations: 27
Robotic-assisted hip and knee arthroplasty: a bibliometric analysis using the scopus database RY Kow, RA Rani, MHM Nazarallah, JF Leong, MF Hayyun, CL Low, ... Cureus 16 (3) , 2024 2024 Citations: 26
Diagnostic yield of CT pulmonary angiogram in the diagnosis of pulmonary embolism and its predictive factors CL Low, RY Kow, A Abd Aziz, MM Yusof, BC Lim, NA Kamarudin, ... Cureus 15 (6) , 2023 2023 Citations: 22
Outcomes of femoral neck fractures in young patients and the factors associated with complications: a multicenter study from Malaysia JJ Raj, RY Kow, K Ganthel, DE Kunasingh, GK Panicker, BC Lim, CL Low, ... Cureus 13 (9) , 2021 2021 Citations: 21
COVID-19 infodemiology: association between Google search and vaccination in Malaysian population RY Kow, NM Rafiai, AAA Alwi, CL Low, MW Ahmad, Z Zakaria, AH Zulkifly, ... Cureus 14 (9) , 2022 2022 Citations: 19
COVID-19 collateral damage: management of periprosthetic joint infection in Malaysia MHA Khan, RY Kow, S Ramalingam, JPY Ho, JJ Raj, K Ganthel, CL Low, ... Cureus 13 (10) , 2021 2021 Citations: 16
Humeral supracondylar fractures in children: a novel technique of lateral external fixation and Kirschner wiring RY Kow, AR Zamri, JK Ruben, S Jamaluddin, MT Mohd-Nazir Malaysian orthopaedic journal 10 (2), 41 , 2016 2016 Citations: 15
Characteristics and microbiological profile of patients with diabetic foot infections in Kuantan, Pahang RY Kow, CL Low, MAS Ayeop, A Che-Ahmad, MS Awang Malaysian Orthopaedic Journal 16 (1), 11 , 2022 2022 Citations: 14
Bibliometric analysis of diagnostic yield of CT pulmonary angiogram (CTPA) in the diagnosis of pulmonary embolism (PE) RY Kow, K Razali, CL Low, KN Siron, ZZ Mohamad, MM Yusof, ... Cureus 15 (7) , 2023 2023 Citations: 13
Surgical reconstruction of an open medial malleolus fracture using a novel technique: a case report RY Kow, JC Yuen, AAA Alwi, MF Abas, CL Low JBJS Case Connector 9 (2), e0163 , 2019 2019 Citations: 11
Thermography research in diabetic foot: insights from a Scopus-based bibliometric study SA Zakaria, CL Low, RY Kow, ZZ Mohamad, MR Abidin, AC Ahmad, ... Cureus 16 (6) , 2024 2024 Citations: 10
The Malay version of the Michigan hand outcomes questionnaire: cross-cultural adaptation, validation and reliability testing JX Lye, RY Kow, R Ismail, KA Khalid The Journal of Hand Surgery (Asian-Pacific Volume) 26 (02), 166-179 , 2021 2021 Citations: 10
Life-threatening chlorhexidine anaphylaxis: a case report RY Kow, CL Low, JK Ruben, MZ Zaharul-Azri, MS Ng Malaysian Orthopaedic Journal 11 (2), 72 , 2017 2017 Citations: 10
The role of medial plantar artery flap in heel pad reconstruction: a report of two cases ZS Oon, RY Kow, AAA Alwi, MAS Ayeop, CL Low, AC Ahmad, AAA ALWI Cureus 15 (7) , 2023 2023 Citations: 9
Malaysian public interest in common medical problems: a 10-year Google Trends analysis RY Kow, NM Rafiai, AAA Alwi, CL Low, NR Rozi, KN Siron, AH Zulkifly, ... Cureus 14 (1) , 2022 2022 Citations: 9
Scurvy: a neglected cause of muscle pain and weakness in a child with picky eating behavior RY Kow, NANA Adel, AHA Razak, CL Low, MS Awang Cureus 13 (7), e16289 , 2021 2021 Citations: 9
Outcomes of geriatric hip fractures in a tertiary referral center in Malaysia during the COVID-19 pandemic MHA Khan, RY Kow, S Ramalingam, A Sofian, JPY Ho, KSJ Singh, JJ Raj, ... Cureus 15 (6) , 2023 2023 Citations: 8
The creation of articulating cement spacer using custom-fabricated silicone mold for the treatment of periprosthetic joint infection: two case reports JC Yuen, RY Kow, JJ Raj, CL Low, J Raj Cureus 14 (12) , 2022 2022 Citations: 8
COVID-19 pandemic: two-year experience and response of a teaching hospital in Malaysia and the effect on postgraduate orthopaedic training RY Kow, KA Khalid, Z Zakaria, MS Awang Malaysian Orthopaedic Journal 16 (2), 1 , 2022 2022 Citations: 8
