NATIONAL ORTHOPAEDIC REGISTRY MALAYSIA … fileDr Nahulan A/L Theva Rajah Head of Department, ......

NATIONAL ORTHOPAEDIC REGISTRY MALAYSIA (NORM)

ANNUAL REPORT OF

NATIONAL ORTHOPAEDIC REGISTRY MALAYSIA (NORM) DIABETIC FOOT

2009

Editors:

Dr Mohammad Anwar Hau Abdullah Dr Ahmad Tajuddin Abdullah

Registry Committee

Dr Mohammad Anwar Hau Abdullah

Dr Ahmad Tajuddin Abdullah

Dr Zulkiflee Osman

Dr Saadon Ibrahim

Dr Mohamad Yazid Din

Dr Joehaimey Johari

Dr Se To Boon Chong

Dr Tan Boon Cheong

Dr Abdul Rauf Ahmad

Dr Mohd Zamzuri Mohd Zain

Dr Pan Chee Huan

A publication of the National Orthopaedic Registry of Malaysia (NORM) and the

Clinical Research Centre, Ministry of Health Malaysia

*********************************************************************

December 2010

© National Orthopaedic Registry of Malaysia (NORM)

Publisher:

Jointly published by the National Orthopedic Registry of Malaysia (NORM) and the

Clinical Research Centre (CRC), Ministry of Health Malaysia.

National Orthopaedic Registry of Malaysia

1st Floor MMA House,

124, Jalan Pahang,

53000 Kuala Lumpur,

Malaysia.

Tel : (603) 4044 3060 / (603) 4044 3070 Fax : (603) 4044 3080 Email : [email protected]

Website : http://www.acrm.org.my/norm

Suggested citation: Mohammad Anwar Hau Abdullah, Ahmad Tajuddin Abdullah (Eds). Annual Report of the NORM- Registry, 2009. Kuala Lumpur, Malaysia: National Orthopaedic Registry of Malaysia 2009.

Disclaimer:

Data reported in this report were collected for one year period (from January to

December 2009), this report is copyrighted. Reproduction and dissemination of this

report in part or in whole for research, educational or other non-commercial purposes

are authorized without any prior written permission from the copyright holders

provided the source is fully acknowledged.

Electronic version

The electronic version of this report may be downloaded at

http://www.acrm.org.my/norm or http://www.crc.gov.my/publication/report.

Funding

The National Orthopaedic Registry of Malaysia (NORM) – Diabetic Foot Registry is

funded with grants from the Ministry of Health Malaysia (MOH).

mailto:[email protected]

http://www.acrm.org.my/norm

http://www.crc.gov.my/publication/report

ACKNOWLEDGEMENTS

The National Orthopaedic Registry of Malaysia (NORM) would like to give its grateful

appreciation to everyone who has helped make this report possible.

We would especially like to thank the following:

Clinical Research Centre Dr Goh Pik Pin

Clinical Epidemiology Unit Dr Jamaiyah Haniff

Dr Dr Sharmini Selvarajah Dr Lim Chioa mei

Patient Registry Unit Dr Jaya Purany Stanley Ponniah Nurul Shuhada Binti Mohd Ali

Scottish Hip Fracture Registry

NORM Governance Board

Chairman Dato’ Dr Azmi Shafei

Director,

Division of Medical Development,

Ministry of Health Malaysia.

Members Dr Jamaiyah Haniff

Head Of Clinical Epidemiology Unit,

Clinical Research Center, Hospital Kuala Lumpur.

Dr Jaya Purany Stanley Ponniah

Head of Patient Registry Unit

Clinical Research Center, Hospital Kuala Lumpur.


Head of Department,

Department of Orthopaedic and Traumatology,

Hospital Raja Perempuan Zainab II, Kota Bharu.

Dr Ahmad Tajuddin Abdullah

Head of Department,


Hospital Sultanah Nur Zahirah, Kuala Terengganu.

Dr Saadon Ibrahim


Hospital Sultan Ismail, Johor Bharu.

Dr Se To Boon Chong


Hospital Pulau Pinang,Pulau Pinang.

Dato’ Dr Suresh Chopra,

Head of Department,


Hospital Sultanah Bahiyah, Alor Setar.

Dr Abdul Rauf Ahmad

Head of Department,


Hospital Tuanku Jaafar, Seremban.

Dato’ Dr Premchandran Menon

Head of Department,


Hospital Tengku Ampuan Afzan (HTAA), Kuantan.

Dr Pan Chee Huan

Head of Department,


Hospital Tuanku Fauziah, Kangar.

Dr Thirumal a/l Manickam

Head of Department,


Hospital Tengku Ampuan Rahimah, Klang.

Dr Nahulan A/L Theva Rajah

Head of Department,


Hospital Queen Elizabeth, Kota Kinabalu.

Dato’ Dr Ramanathan A/L Ramiah

Head of Department,


Hospital Raja Permaisuri Bainun, Ipoh.

Mr.Sivapathasundaram A/L Nadarajah

Head of Department,

Department of Orthopaedic and Traumatology

Hospital Melaka, Melaka.

Dr K. Thevarajan

Head of Department,


Hospital Sultanah Aminah, Johor Bharu.

Dr Faris Kamaruddin

Head of Department,


Hospital Umum Sarawak, Sarawak.

NORM Steering Committee members:

Chairman Dr Ahmad Tajuddin Abdullah

Head of Department,


Hospital Sultanah Nur Zahirah, Kuala Terengganu.

Co-Chairman Dr Zulkiflee Osman

Head of Department,


Hospital Kuala Lumpur.

Members Dr Mohammad Anwar Hau Abdullah

Head of Department,



Dr Saadon Ibrahim


Hospital Sultan Ismail, Johor Bharu.

Dr Se To Boon Chong


Hospital Pulau Pinang, Pulau Pinang.

Dr Tan Boon Cheong


Hospital Pulau Pinang, Pulau Pinang.

Dr Abdul Rauf Ahmad


Hospital Tuanku Jaafar, Seremban.

Dr Mohd Zamzuri Mohd Zain


Hospital Tengku Ampuan Afzan (HTAA), Kuantan.

Dr Pan Chee Huan


Hospital Tuanku Fauziah, Kangar.



Hospital Sultanah Bahiyah, Alor Setar.

Dr Joehaimey Johari



NORM SOURCE DATA PROVIDERS 2008/2009

The current source data providers for NORM are:

No. Hospital Site investigators Second person-in-charge

1 Hospital Kuala

Lumpur

Mr Zulkiflee Osman Dr Mahazura Hj Mat Lawi

Dr. Abdul Qahhar

2 Hospital Raja

Perempuan

Zainab II Kota

Bharu

Mr Mohammad Anwar Hau

Abdullah

Dr Joehaimey Johari

Sister Nik Noriah Nik Ibrahim

3 Hospital Sultanah

Nur Zahirah Kuala

Terengganu

Mr Ahmad Tajuddin Abdullah

Dr Mustaqim Afifi @ Apipi

Dr Hazulin Mohd Radzuan

Dr Muhammad Hilmi Nasir

Dr Mohd Ariff Razani Abd

Razak

4 Hospital Tengku

Ampuan Rahimah

Klang

Dr Gurjit Singh Dr M. Thirumal

5 Hospital Sultanah

Bahiyah Alor Setar


Dr Noor Mahazrinna

Hayadin

Dr Lim Chiao Yee

6 Hospital Sultanah

Aminah Johor

Bahru

Dr Yoga Raj A/L

Parameswaran

Dr Manamohan

Chandrarajan

Dr Mohd Adham Shah

Dr Teo Pock Chin

7 Hospital Melaka

Dr Rengsen Parthiban Dr Azhar Asari

Dr Mohd. Karim Md Isa

MA Mohd Fharid Johan

SN Marina Mohamed @

Osman

8 Hospital Sultan

Ismail Johor Bahru

Dr Saadon Ibrahim Dr Mursyida Md Nujid

Dr Jayamalar

Thurairajasingam

SN Rohayah Abdul Rahman

JM Yussilawani Mamat

9 Hospital Tuanku

Fauziah Kangar

Dr Pan Chee Huan

Mr Yeap Ewe Juan

Mr Zakaria Yusoff

Dr Badrul Hashim

Dr Zakaria Yusoff

MA Shahizam Shafiee

SN Norseha Baharom

10 Hospital Raja

Permaisuri Bainun

Ipoh

Dr Manoharan Dr Selvynlloyd

Dr Iyngkaran Arasalingam

11 Hospital Tengku

Ampuan Afzan

Kuantan

Dato' Dr N Premchandran

Dr. Mohd Zamzuri Mohd

Zain

Dr Alaudin Haris Osman

Dr Jeffrey Jaya Raj

Dr Ahmad Hafiz bin Zulkifly

12 Hospital Ampang Dr Ng Yue Oon Dr Lynn Azura Md Sham

Dr Samyu Ali

13 Hospital Tuanku

Ja’afar Seremban

Dr Abdul Rauf Ahmad Dr Ng Tiong Soon

Dr Johann Johari

Sr Khamisah A. Ghani

Sr Rohana Zakaria

14 Hospital Pulau

Pinang

Dr Se To Boon Chong Dr Tan Boon Cheong

Dr Ooi Chee Lean

Dr Chan Kok Yu

15 Hospital Serdang Dr Khoo Shaw Woei Dr Imma Isniza

Dr Harminder Singh

Randhawa

16 Hospital Selayang Dr Ng Swee Soon Dr Ritzwan Ismayatim

Dr Amir Fariz Zakaria

17 Hospital Queen

Elizabeth Kota

Kinabalu

Dr Nahulan A/L Theva Rajah Dr CS Kumar

18 Hospital Umum

Sarawak

Dr Faris Kamaruddin Dr Aaron Gerard Paul

MA Mikim A/K Radem

9

PREFACE

The National Orthopaedic Registry Malaysia has been collecting data since mid 2008

and it is with great pleasure and pride that we see this report materialised.

I would like to thank all those who have collected, verified and analysed the data.

The co-operation and energy demonstrated in units throughout the country indicates

the importance they place on improving patient management

The success of this report is due to continuous support and cooperation from various

people and agencies. The effort of the entire group must be congratulated and it has

been my sincere hope that this registry is able to sustain in coming years.

I also take this opportunity to thank the Clinical Research Centre Ministry of Health

Malaysia, to have trust in us and to provide us with the funding for us embark in this

project. This annual report is a testament of all your combined effort.

Thank you,

Dr Ahmad Tajuddin bin Abdullah


Chairman National Orthopaedic Registry of Malaysia

Ministry of Health Malaysia

10

ABBREVIATIONS

ASA American Society of Anaesthesiologists

CRC Clinical Research Centre

CRF Case Report Form

csv Comma separated value

Dr Doctor

GA General Anaesthesia

HTAA Hospital Tengku Ampuan Afzan

ICT Information and Communication Technology

LMWH Low Molecular Weight Heparin

MJM Medical Journal of Malaysia

MOH Ministry of Health

NOHFR National Orthopaedic Hip Fracture Registry

NORM National Orthopaedic Registry of Malaysia

OT Operation Theater

PTH Parathyroid Hormone

RTA Road Traffic Accident

SDP Source Data Provider

SERMS Selective Estrogen Receptor Modulators

SMS Short Messaging System

txt Text-delimited format

xls Excel workbook

11

Table of Content

Table Page

SECTION 1: PATIENT DETAILS AND DEMOGRAPHIC ..................................................................... 13 Table 1.1: Profile demographic of respondents, Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009. (N=1254) ................................................................... 13 Table 1.2: Occupation of respondents, Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009. (N=1254) ...................................................................................... 14

SECTION 2: ADMISSION .............................................................................................................. 15 Table 2.1: Status of admision, Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009. .................................................................................................................... 15

SECTION 3: DIABETES HISTORY ................................................................................................... 16 Table 3.1: Status of diabetes mellitus, Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009. ...................................................................................................... 16

SECTION 4: TREATMENT OF DIABETES MELLITUS ......................................................................... 17 Table 4.1: Treatment of diabetes mellitus, Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009. ...................................................................................................... 17 Table 4.2: Status of compliance for treatment, Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009. ................................................................................... 18

SECTION 5: TREATMENT OF CURRENT DIABETES FOOT/ HANDS ULCER ........................................ 18 Table 5.1: Treatment of current diabetes foot/ hands ulcer, Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 ..................................................................... 18

SECTION 6: RISK FACTORS .......................................................................................................... 19 Table 6.1: Distribution of infection, Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 ....................................................................................................... 19 Table 6.2: Risk factors for upper limb (n = 60), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 .................................................................................... 19 Table 6.3: Risk factors of lower limb (n = 1198), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 .................................................................................... 20 Table 6.4: Risk factors (awareness), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 ....................................................................................................... 20 Table 6.5: Practice for past one year, Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 ....................................................................................................... 21 Table 6.6: Risk factors (co-morbidity, complications, family history), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 ......................................................... 22

SECTION 7: PREVIOUS HANDS/FOOT PROBLEMS (PAST ONE YEAR) .............................................. 23 Table 7.1: Previous hands/foot problems (past one year), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 ..................................................................... 23 Table 7.2: Highest level of amputation, previous hands/foot problems (past one year), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 ......................... 24

SECTION 8: CURRENT UPPER LIMBS INFECTIONS ......................................................................... 25 Table 8.1: Dominance of current upper limbs infections (n=60), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 ..................................................................... 25 Table 8.2: Infection and location of current upper limbs infections (n=60), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 .................................................. 25 Table 8.3: Diagnosis of current upper limbs infections (n=60), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 ..................................................................... 26 Table 8.4: Classification of current upper limbs infections (n=60), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 ......................................................... 26

12

Table 8.5: Associated complications of current upper limbs infections (n=60), Diabetes Foots and Hands, National Orthopaedic Registry Malaysia (NORM) 2009 ...................................... 27 Table 8.6: Precipitating factor of current upper limbs infections (n=60), Diabetes Foots and Hands, National Orthopaedic Registry Malaysia (NORM) 2009 ................................................ 27 Detail for precipitating factor in appendix 3 ..................................................................................... 27 Table 8.7: Physical findings of current upper limbs infections (n=60), Diabetes Foots and Hands, National Orthopaedic Registry Malaysia (NORM) 2009 ....................................................... 28 Table 8.8: Current upper limbs infections (culture), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 .................................................................................... 28 Table 8.9: Current upper limbs infections (operations during admision), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 .................................................. 29 Table 8.10: Current upper limbs infections (culture, operations during admission and clinical outcome), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 .................................................................................................................................... 30

SECTION 9: CURRENT LOWER LIMBS INFECTIONS ........................................................................ 30 Table 9.1: Current lower limbs infections (infections and location), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 ......................................................... 30 Table 9.2: Current lower limbs infections (diagnosis and classification), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 ......................................................... 31 Table 9.3: Current lower limbs infections (associated complications, precipitating factor and physical findings), Diabetes Foots and Hands, National Orthopaedic Registry Malaysia (NORM) 2009 .................................................................................................................................... 32 Table 9.4: Current lower limbs infections (culture), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 .................................................................................... 33 Table 9.5: Current lower limbs infections (operations during admision), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 .................................................. 34 Table 9.6: Current lower limbs infections (culture, operations during admission and clinical outcome), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 .................................................................................................................................... 35

SECTION 10: ANTIBIOTICS ........................................................................................................... 36 Table 10.1: Antibiotics, Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009 .................................................................................................................................... 36

13

Section 1: Patient Details and Demographic

Table 1.1: Profile demographic of respondents, Diabetes Foots and Hands,

National Orthopadic Registry Malaysia (NORM) 2009. (N=1254)

Profile Statistics n %

Age

Mean (SD) 56.2 (11.6)

Median IQR (1stQ, 3rdQ)

Min, max 20, 94

Age group

18 – 29 21 1.7

30 – 39 60 4.8

40 - 49 255 20.3

50 - 59 438 34.9

≥ 60 480 38.3

Gender

Male 604 48.2

Female 650 51.8

Ethnicity (na=5)

Malay 935 74.6

Chinese 141 11.2

Indian 146 11.6

Others Malaysian 17 1.4

Non Malaysian 10 0.8

Residence (na=113)

Urban 610 53.5

Rural 351 46.5

Education level (na=467)

Primary 388 49.3

Secondary 355 45.1

Tertiary 44 5.6

14

Table 1.2: Occupation of respondents, Diabetes Foots and Hands, National

Orthopadic Registry Malaysia (NORM) 2009. (N=1254)

Profile n %

Occupation

Legislator senior 3 0.2

Technicians 3 0.2

Service 42 3.5

Related trade 4 0.3

Elementary occupation 7 0.6

Profesional 10 0.8

Clerical 17 1.4

Agricultural 21 1.7

Machine operator 20 1.7

Housewife 431 35.8

Unemployed 133 11.0

Retired 166 13.8

Unknown 185 15.4

Others 163 13.5

15

Section 2: Admission

Table 2.1: Status of admision, Diabetes Foots and Hands, National Orthopadic

Registry Malaysia (NORM) 2009.

Status of admision Statistics n %

Duration in days

Mean (SD) 13.7 (68.5)

Median IQR (1stQ, 3rdQ) 7.0 IQR (4.0, 14.0)

Min, max 0, 2228

Duration in days by age group Median IQR (1stQ, 3rdQ)

18 – 29 8.5 IQR (6.0, 17.5)

30 – 39 5.0 IQR (3.5, 10.5)

40 - 49 8.0 IQR (4.0, 15.0)

50 - 59 6.0 IQR (4.0, 12.0)

≥ 60 7.0 IQR (4.0, 14.5)

Previous admission (na=142)

Yes 425 38.2

No 687 61.8

Number of times (na=908)

1 time only 192 55.5

2 – 3 134 38.7

4 – 5 11 3.2

> 5 9 2.6

16

Section 3: Diabetes History

Table 3.1: Status of diabetes mellitus, Diabetes Foots and Hands, National

Orthopadic Registry Malaysia (NORM) 2009.

Status of diabetes Statistics n %

Type of diabetes

Type 1 197 16.2

By age group:

18 – 29 10 5.1

30 – 39 16 8.1

40 - 49 35 17.8

50 - 59 70 35.5

≥ 60 66 33.5

Type 2 1021 83.8

By age group:

18 – 29 9 0.9

30 – 39 43 4.2

40 - 49 211 20.7

50 - 59 356 35.0

≥ 60 398 39.1

Duration of diabetes in years:

Type 1

Mean (SD) 11.9 (7.7)


Min, max 1.0, 40.0

Type 2

Mean (SD) 10.4 (7.5)


Min, max 1.0, 40.0

17

Section 4: Treatment of Diabetes Mellitus

Table 4.1: Treatment of diabetes mellitus, Diabetes Foots and Hands, National


Treatment of Diabetes Mellitus Descriptive summary*

n %

Patient on treatment (na = 97 and missing = 2)

Yes 1071 92.7

No 84 7.27

Treatment for diet (na = 723 and missing = 176)

Yes 131 36.9

No 224 63.1

Duration for having diet treatment (days)* (n = 122)

Mean (SD) 75.9 (74.6)

Median IQR (1stQ, 3rdQ) 60 IQR (12, 120)

Min, max 1, 300

Other treatment (na = 111 and missing = 174)

Insulin 165 17.0

OHA 692 71.5

OHA and insulin 111 11.5

None of the above 1 -

Duration of having other treatment*

Insulin (n = 98)

Mean (SD) 45.5 (62.5)

Median (IQR) 20.5 IQR (7, 60)

Min, max 1, 360

OHA (n = 287)

Mean (SD) 75.1 (87.0)


Min, max 1, 480

OHA and insulin (n = 71)

Mean (SD) 75.8 (84.2)


Min, max 1, 362

18

Table 4.2: Status of compliance for treatment, Diabetes Foots and Hands, National


Treatment of Diabetes Mellitus

Status of compliance (na = 197 and missing = 181)

Yes n (%)

No n (%)

18 – 29 8 (61.5) 1.3 (38.5)

30 – 39 27 (64.3) 4.2 (35.7)

40 – 49 136 (74.7) 21.2 (25.3)

50 – 59 229 (75.3) 35.7 (24.7)

≥ 60 241 (72.4) 37.6 (27.6)

Section 5: Treatment of Current Diabetes Foot/ Hands Ulcer

Table 5.1: Treatment of current diabetes foot/ hands ulcer, Diabetes Foots and

Hands, National Orthopadic Registry Malaysia (NORM) 2009

Treatment of current DFH Descriptive summary*

n %

Management of the ulcer prior to hospitalization

Nil 312 -

Self treatment 78 7.7

General practitioner 114 11.3

Private hospital 36 3.6

Traditional 34 3.4

Government hospital 510 50.6

Government clinic 233 23.1

Alternative treatment 3 0.3

Duration of treatment (days) (n = 327)

Mean (SD) 568.2 (1615.0)


Min, max 1, 10950 *10950 is similar to 30.4 years

19

Section 6: Risk Factors

Table 6.1: Distribution of infection, Diabetes Foots and Hands, National Orthopadic

Registry Malaysia (NORM) 2009

Infection Single Both Total

n row% n row% n col%

Upper limb infection (na = 86 and no = 1108))

60 100.0 0 0.0 60 100.0

By age group

18 – 29 4 100.0 0 0.0 4 6.8

30 – 39 9 100.0 0 0.0 9 15.3

40 - 49 17 100.0 0 0.0 17 28.8

50 – 59 12 100.0 0 0.0 12 20.3

≥ 60 17 100.0 0 0.0 17 28.8

Lower limb infection (na= 5 and no = 51)

1151 96.1 47 3.9 1198 100.0

By age group

18 – 29 17 100.0 0 0.0 17 1.4

30 – 39 50 98.0 1 2.0 51 4.3

40 - 49 230 96.2 9 3.8 239 20.0

50 – 59 414 96.7 14 3.3 428 35.8

≥ 60 439 95.0 23 5.0 462 38.6

Table 6.2: Risk factors for upper limb (n = 60), Diabetes Foots and Hands, National

Orthopadic Registry Malaysia (NORM) 2009

Risk factors n %

Activities at work:

Use hand predominantly 46 76.7

Hand wet at work 22 36.7

20

Table 6.3: Risk factors of lower limb (n = 1198), Diabetes Foots and Hands, National


Risk factors n %

Activities at work:

Involve lots of walking/standing

568 47.4

Feet wet at work 228 19.0

Footware at work: (na = 221 and missing = 10)

Barefoot 99 10.2

Slippers 457 47.3

Shoes 408 42.2

Socks only 3 0.3

Footware at home: (na = 126 and missing = 10)

Barefoot 526 49.5

Slippers 487 45.9

Shoes 36 3.4

Socks only 13 1.2

Table 6.4: Risk factors (awareness), Diabetes Foots and Hands, National


Risk factors n %

Foot/hands problem (N = 1254)

Aware of increased foot/hand problem 779 62.1

Aware: Inspect feet/hand 627 50.0

Foot problem (n = 1198)

Aware:Wash feet 830 69.3

Aware: Apply emollients 278 23.2

Aware: Use appropriate shoes 318 26.5

Aware: Attend diabetes foot clinic 211 17.6

Aware: Education on diabetes footcare (formal) 327 27.3

Aware: Education on diabetes footcare (informal) 595 49.7

Aware: Keeping on diabetes care booklet 273 22.8

21

Table 6.5: Practice for past one year, Diabetes Foots and Hands, National


Practice for past one year: n %

Inspect feet/hand (N = 1254) 563 44.9

Frequent Inspect feet/hand

Daily 206 37.3

Weekly 63 11.4

Occationally 284 51.4

Total 553

Wash feet (n = 1198) 733 64.5

Frequent wash feet

Daily 501 69.8

Weekly 36 5.0


Total 718

Apply emollients (n = 1198) 299 19.1

Frequent apply emollients

Daily 132 45.4

Weekly 20 6.9


Total 291

Use appropriate shoes (n = 1198) 286 23.9

Frequent use appropriate shoes

Daily 134 48.9

Weekly 17 6.2


Total 274

Attend diabetes foot clinic (n = 1198) 190 15.9

Frequent attend diabetes foot clinic

Daily 58 28.3

Weekly 122 59.5

Occationally 0 0.0

Total 180

22

Table 6.6: Risk factors (co-morbidity, complications, family history), Diabetes Foots

and Hands, National Orthopadic Registry Malaysia (NORM) 2009

Risk factors n %

Co-morbidity:

Unknown 468

Hypertension 685 61.2

Hypercholesterolemia 133 11.9

IHD 102 9.1

TIA 1 0.1

CVA 39 3.5

Renal disease 51 4.6

Retinopathy 54 4.8

Others 55 4.9

Complications:

Nil 216

Unknown 253

Retinopathy 205 17.2

Vascular 194 16.3

Neuropathy 420 35.2

Skin 261 21.9

Nephropathy 101 8.5

Others 12 1.0

Family history:

Unknown 636

Hypertension 291 29.9

DM 538 55.3

Hypercholesterolemia 38 3.9

IHD 65 6.7

TIA 1 0.1

CVA 18 1.8

Renal disease 3 0.3

Retinopathy 7 0.7

Others 12 1.2 Co-morbidity details refer to appendix 1 Complications details refer to appendix 2 Family history details refer to appendix 2

23

Section 7: Previous Hands/foot problems (past one year)

Table 7.1: Previous hands/foot problems (past one year), Diabetes Foots and


Previous problems n %

Previous operations performed (N = 1254)

373 29.7

1 time 235 65.1

2 – 4 times 116 32.1

5 – 7 times 8 2.2

8 – 10 times 2 0.6

Total 361

24

Table 7.2: Highest level of amputation, previous hands/foot problems (past one

year), Diabetes Foots and Hands, National Orthopadic Registry Malaysia (NORM)

2009

Highest level of amputation n

None 289

Upper limbs (single) 2

Finger’s 0

Ray 2

Below wrist 0

Below elbow 0

Above elbow 0

Forequarter 0

Upper limbs (both) 0

Finger’s 0

Ray 0

Below wrist 0

Below elbow 0

Above elbow 0

Forequarter 0

Lower limbs (single) 44

Disarticulation 9

Ray 24

Transmetatarsal 0

Syme’s 0

Below knee 6

Through knee 0

Above knee 5

Hip disarticulation 0

Left lower limbs (both) 3

Disarticulation 0

Ray 2

Transmetatarsal 0

Syme’s 0

Below knee 1

Through knee 0

Above knee 0

Hip disarticulation 0

25

Section 8: Current Upper Limbs Infections

Table 8.1: Dominance of current upper limbs infections (n=60), Diabetes Foots and


Right Left Total

n % n % n %

Dominance (na=3) 50 87.7 7 12.3 57 100.0

Table 8.2: Infection and location of current upper limbs infections (n=60), Diabetes

Foots and Hands, National Orthopadic Registry Malaysia (NORM) 2009

Total

n %*

Infections 60 100.0

Digit

1 7 11.7

2 7 11.7

3 11 18.3

4 3 5.0

5 3 5.0

0.0

Arm 4 6.7

Forearm 5 8.3

Hand: Pulmer surface 17 28.3

Hand: Dorsum 11 18.3

Web space 0.0

1st 1 1.7

2nd 4 6.7

3rd 4 6.7

4th 4 6.7

Amputation stump 0.0

Below wrist 1 1.7

Below elbow 3 5.0

Above elbow 0 0.0 % derived using denominator 60 (number of upper limb infection)

26

Table 8.3: Diagnosis of current upper limbs infections (n=60), Diabetes Foots and


Total

n %*

Diagnosis

Cellulitis 16 26.7

Felon 2 3.3

Thenar abscess 5 8.3

Mid palmar abscess 4 6.7

Hypothenar 2 3.3

Collar button abscess 1 1.7

Flexor tenosynovitis 5 8.3

Radial bursae/thumb 3 5.0

Paronychia 2 3.3

Septic arthritis 1 1.7

Dry gangrene 4 6.7

Wet gangrene 4 6.7

Necrotising fascilitis 1 1.7

Ulcer 2 3.3

Osteomyelitis 0 0.0

Others 13 21.7

Total 65 Diagnosis details refer to appendix 2 % derived using denominator 60 (number of upper limb infection)

Table 8.4: Classification of current upper limbs infections (n=60), Diabetes Foots


Total

n %*

Stage

A 7 11.7

B 9 15.0

C 1 1.7

D 2 3.3

Grade 0.0

0 4 6.7

1 9 15.0

2 4 6.7

3 2 3.3 % derived using denominator 60 (number of upper limb infection)

27

Table 8.5: Associated complications of current upper limbs infections (n=60),

Diabetes Foots and Hands, National Orthopaedic Registry Malaysia (NORM) 2009

Total

n %*

Nil 56 93.3*

Associated complications

Septicaemia 3 5.0

Pneumonia 0 0.0

Stroke 0 0.0

UGIB 0 0.0

Renal failure 0 0.0

CCF 1 1.7

Pressure sores 0 0.0 % derived using denominator 60 (number of upper limb infection)

Table 8.6: Precipitating factor of current upper limbs infections (n=60), Diabetes

Foots and Hands, National Orthopaedic Registry Malaysia (NORM) 2009

Total

n %*

Precipitating factor

Spontaneous 25 41.7

Minor trauma 22 36.7

Major trauma 1 1.7

Insect bite 0 0.0

Animal bite 3 5.0

Work related 0 0.0

Recreational related 0 0.0

Latrogenic 1 1.7

Others 3 5.0

Unknown 5 8.3 Detail for precipitating factor in appendix 3 % derived using denominator 60 (number of upper limb infection)

28

Table 8.7: Physical findings of current upper limbs infections (n=60), Diabetes

Foots and Hands, National Orthopaedic Registry Malaysia (NORM) 2009

Physical findings Total

n %*

Palpable brach. artery 47 78.3

Palpable radial artery 47 78.3

Peripheral neuropathy 16 26.7 % derived using denominator 60 (number of upper limb infection)

Table 8.8: Current upper limbs infections (culture), Diabetes Foots and Hands,

National Orthopadic Registry Malaysia (NORM) 2009

Infections Total

n %*

Culture:

1st culture

No growth 18 30.0

Mixed growth 7 11.7

Single growth 23 38.3

Mixed growth

Acinetobacter 1 1.7

Anaerobic 0 0.0

Bacteroides 0 0.0

Coagulase 1 1.7

Enterococcus 0 0.0

Enterobacter 3 5.0

Escherichia 0 0.0

Klebsiella 7 11.7

Proteus 0 0.0

Serratia 0 0.0

Pseud. aeruginosa 1 1.7

Pseud. spp 0 0.0

Staphylococcus 15 25.0

B-hemolytic strep. 3 5.0

Viridans strep. 0 0.0

Others 3 5.0 Mixed growth details refer to appendix 3 % derived using denominator 60 (number of upper limb infection)

29

Table 8.9: Current upper limbs infections (operations during admision), Diabetes


Infections Total

n %*

Operation during admission

Nil 11 18.3

Amputation 19 31.7

Wound debridement 40 66.7

Amputation 0.0

Fingers 14 23.3

Ray 3 5.0

Below wrist 0 0.0

Below elbow 1 1.7

Above elbow 1 1.7

Forequarter 0 0.0

Finger’s 0.0

1 2 3.3

2 1 1.7

3 7 11.7

4 1 1.7

5 3 5.0

Ray (missing = 1)

0.0

1 1 1.7

2 0 0.0

3 0 0.0

4 0 0.0

5 1 1.7 % derived using denominator 60 (number of upper limb infection)

30

Table 8.10: Current upper limbs infections (culture, operations during admission

and clinical outcome), Diabetes Foots and Hands, National Orthopadic Registry

Malaysia (NORM) 2009

Infections Total

n %*

Clinical outcome

Wound healed by itself

0 0.0

Split skin grafting 37 61.7

Wound clean, granulate

2 3.3

Wound covered 0 0.0

Amputation, healed 0 0.0

Amputation, infected 0 0.0

Death, due to septic 1 1.7

Death, due to medical 1 1.7

Discharged at own risk

0 0.0

% derived using denominator 60 (number of upper limb infection)

Section 9: Current Lower Limbs Infections

Table 9.1: Current lower limbs infections (infections and location), Diabetes Foots


Infections Total

n %*

Infections (no = 51, na = 5)

1198 100.0

Digit

1 274 22.9

2 176 14.7

3 152 12.7

4 139 11.6

5 128 10.7

Plantar, metatarsal 342 28.5

Dorsum 338 28.2

Plantar, heel area 180 15.0

Ankle: medial 66 5.5

Ankle: Lateral 70 5.8

Thigh 27 2.3

Leg 104 8.7

31

Web space

1st 95 7.9

2nd 80 6.7

3rd 63 5.3

4th 76 6.3

Amputation stump

Below knee 86 7.2

Above knee 16 1.3

Syme’s 1 0.1

Transmetatarsal 29 2.4

Hip 0 0.0 % derived using denominator 1198 (number of lower limb infection)

Table 9.2: Current lower limbs infections (diagnosis and classification), Diabetes


Infections Total

n %*

Diagnosis

Cellulitis 150 12.5

Paronychia 5 0.4

Abscess 293 24.5

Ulcer 522 43.6

Gas gangrene 21 1.8

Dry gangrene 117 9.8

Wet gangrene 160 13.4

Necrotising fasciitis 76 6.3

Osteomyelitis 283 23.6

Others 18 1.5

Stage

A 75 6.3

B 218 18.2

C 65 5.4

D 63 5.3

Grade

0 31 2.6

1 207 17.3

2 124 10.4

3 65 5.4 % derived using denominator 1198 (number of lower limb infection) See appendix 4 for details of others diagnosis

32

Table 9.3: Current lower limbs infections (associated complications, precipitating

factor and physical findings), Diabetes Foots and Hands, National Orthopaedic

Registry Malaysia (NORM) 2009

Infections Total

n %*

Associated complications

Nil 1033 86.2

Septicaemia 75 6.3

Pneumonia 9 0.8

Stroke 13 1.1

UGIB 2 0.2

Renal failure 75 6.3

CCF 3 0.3

Pressure sores 6 0.5

Precipitating factor 0.0

Spontaneous 433 36.1

Minor trauma 407 34.0

Major trauma 10 0.8

Insect bite 10 0.8

Animal bite 10 0.8

Work related 20 1.7

Recreational related 7 0.6

Latrogenic 12 1.0

Others 40 3.3

Unknown 266 22.2

Physical findings 0.0

Palpable dorsalis 890 74.3

Palpable posterior 888 74.1

Periph. neuropathy 363 30.3 % derived using denominator 1198 (number of lower limb infection) See appendix 5 for details of others diagnosis

33

Table 9.4: Current lower limbs infections (culture), Diabetes Foots and Hands,

National Orthopadic Registry Malaysia (NORM) 2009

Infections Total

n %*

Culture:

1st culture

No growth 332 27.7

Mixed growth 162 13.5

Single growth 375 31.3

Mixed growth

Acinetobacter 32 2.7

Anaerobic 3 0.3

Bacteroides 2 0.2

Coagulase 5 0.4

Enterococcus 14 1.2

Enterobacter 34 2.8

Escherichia 51 4.3

Klebsiella 75 6.3

Proteus 90 7.5

Serratia 2 0.2

Pseud. aeruginosa 99 8.3

Pseud. spp 12 1.0

Staphylococcus 67 5.6

B-hemolytic strep. 22 1.8

Viridans strep. 4 0.3

Others 129 10.8 % derived using denominator 1198 (number of lower limb infection) See appendix 6 and 7 for details of mixed growth

34

Table 9.5: Current lower limbs infections (operations during admision), Diabetes


Infections Total

n %*

Operation during admission

Nil 198 16.5

Amputation 405 33.8

Wound debridement 712 59.4

Bypass surgery 0 0.0

Amputation

Disarticulation 81 6.8

Ray 242 20.2

Transmetatarsal 8 0.7

Syme’s 2 0.2

Below knee 105 8.8

Through knee 1 0.1

Above knee 21 1.8

Hip disarticulation 2 0.2

Not available 0 0.0

Disarticulation

1 33 2.8

2 27 2.3

3 21 1.8

4 20 1.7

5 11 0.9

Ray 0 0.0

1 82 6.8

2 72 6.0

3 62 5.2

4 51 4.3

5 60 5.0 % derived using denominator 1198 (number of lower limb infection)

35

Table 9.6: Current lower limbs infections (culture, operations during admission and

clinical outcome), Diabetes Foots and Hands, National Orthopadic Registry


Infections Total

n %*

Clinical outcome

Wound healed by itself

126 10.5

Split skin grafting 17 1.4

Wound clean, granulate

740 61.8

Wound covered 20 1.7

Amputation, healed 106 8.8

Amputation, infected 13 1.1

Death, due to septic 12 1.0

Death, due to medical 2 0.2

Discharged at own risk

55 4.6

% derived using denominator 1198 (number of lower limb infection)

36

Section 10: Antibiotics

Table 10.1: Antibiotics, Diabetes Foots and Hands, National Orthopadic Registry


Antibiotics Duration

0 n (%)

1 – 6 n (%)

7 – 13 n (%)

≥ 14 n (%)

All N (%)*

1. Amikacin 0 (0.0) 1 (33.3) 1 (33.3) 1 (33.3) 3 (0.2)

2. Ampicillin 0 (0.0) 8 (44.4) 8 (44.4) 2 (11.1) 18 (1.2)

3. Ampicillin/Sulbactam 1 (0.1) 256 (36.2) 301 (42.6) 149 (21.1) 707 (46.3)

4. Amoxicillin/Clavulanate 1 (5.0) 13 (65.0) 3 (15.0) 3 (15.0) 20 (1.3)

5.Aztreonam 0 (0.0) 0 (0.0) 1 (100.0) 0 (0.0) 1 (0.1)

6. Cloxacillin 3 (2.7) 52 (46.0) 29 (25.7) 29 (25.7) 113 (7.4)

7. Cephalexin 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) 1 (0.1)

8. Cefuroxime 2 (1.0) 74 (35.6) 78 (37.5) 54 (26.0) 208 (13.6)

9. Cefoperazone 0 (0.0) 16 (40.0) 18 (45.0) 6 (15.0) 40 (2.6)

10. Ceftriaxone 0 (0.0) 5 (27.8) 12 (66.7) 1 (5.6) 18 (1.2)

11. Ceftazidime 0 (0.0) 18 (39.1) 17 (37.0) 11 (23.9) 46 (3.0)

12. Ciprofloxacin 0 (0.0) 14 (38.9) 14 (38.9) 8 (22.2) 36 (2.4)

13.Clindamycin 0 (0.0) 2 (33.3) 2 (33.3) 2 (33.3) 6 (0.4)

14. Cotrimoxazole 0 (0.0) 1 (50.0) 0 (0.0) 1 (50.0) 2 (0.1)

15. Fucidic Acid 0 (0.0) 6 (37.5) 2 (12.5) 8 (50.0) 16 (1.1)

16. Gentamicin 0 (0.0) 10 (58.8) 5 (29.4) 2 (11.80 17 (1.1)

17. Imipenem/Cilastatin 0 (0.0) 0 (0.0) 4 (80.0) 1 (20.0) 5 (0.3)

18. Meropenem 0 (0.0) 3 (30.0) 6 (60.0) 1 (10.0) 10 (0.7)

19. Metronidazole 1 (0.6) 74 (43.8) 71 (42.0) 23 (13.6) 169 (11.1)

20. Piperacillin/tazobactam 0 (0.0) 0 (0.0) 4 (57.1) 3 (42.9) 7 (0.5)

21. Rifampicin 0 (0.0) 1 (20.0) 2 (40.0) 2 (40.0) 5 (0.3)

22. Trimethoprim/Sulfamethoxazol 0 (0.0) 0 (0.0) 3 (60.0) 2 (40.0) 5 (0.3)

23. Vancomycin 0 (0.0) 1 (50.0) 1 (50.0) 0 (0.0) 2 (0.1)

24. Sulbactam/Cefoperazone 0 (0.0) 2 (50.0) 2 (50.0) 0 (0.0) 4 (0.3)

Others 0 (0.0) 29 (43.3) 26 (38.8) 12 (17.9) 67 (4.4)

Not Available 0 (0.0) 0 (0.0) 2 (100.0) 0 (0.0) 2 (0.1)

Total 8 (0.5) 587 (38.4) 612 (40.1) 321 (21.0) 1528 *Column percent

NATIONAL ORTHOPAEDIC REGISTRY MALAYSIA … fileDr Nahulan A/L Theva Rajah Head of Department, ......

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