Patofisiologi dan Tatalaksana Osteochondral Lesion of the Talus

Latar Belakang: Penyakit Osteochondral Lesion of the Talus (OLT) adalah kelainan pada tulang talus di lapisan subchondral yang berupa lesi osteochondral pada talar dome dengan konsekuensi abnormalitas pada tulang rawan sendi talar.  Review artikel bertujuan menjabarkan patofisiologi dan tatalaksana OLT.Metode: Review artikel menggunakan literatur terkini  yang relevan dengan topik OLT.Hasil: Pasien biasanya datang berobat ke tenaga kesehatan dengan keluhan yang tidak spesifik dan dengan gejala seperti nyeri pada pergelangan kaki, bengkak serta berkurangnya berkurangnya ruang gerak (range of movement). Penegakan diagnosis bisa dilakukan dengan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang sederhana seperti foto X-ray maupun pemeriksaan penunjang canggih seperti CT-Scan dan MRI. Tatalaksana pada OLT tergantung dari tahapan lesi, kronisitasnya, dan keluhan simtomatis yang menyertainya. Pasien dengan keluhan simtomatis yang akut dan non-displaced sering diberikan terapi konservatif dengan imobilisasi. Lesi yang tidak berhasil atau tidak menunjukkan perbaikan keluhan setelah 3 sampai 6 bulan, serta lesi dengan displacement dapat direncanakan untuk terapi operatif. Ada beberapa macam tehnik operatif yang dapat dilakukan untuk menyembuhkan OLT. Teknik operatif ini dapat dikategorikan menjadi cartilage repair, cartilage regeneration dan cartilage replacement techniques.Kesimpulan: OLT adalah lesiosteocondral pada talar dome yang dapat diterapi dengan terapi konservatif dan operatif  cartilage repair, cartilage regeneration dan cartilage replacement techniques.

Work Period as one of The Risk Factors of Suspected Carpal Tunnel Syndrome (CTS) among Worker in the “X” Furniture Manufacturing, Gresik-East Java 2018

Background: Carpal Tunnel Syndrome (CTS) is a nerve disorder where an entrapped median nerve in the carpal tunnel causes pain and numbness in the hand. Prolonged condition of CTS will decrease someone’s productivity in daily life that requires hand. Aim: This study aimed to analyze age, sex, and work period as the risk factors that can increase the incidence of suspected CTS in workers at the "X" Furniture Manufacturing, Gresik, East Java. Material and Methods: An analytic observational cross-sectional study, was conducted in August 2018. A number 47 worker of “X” furniture manufacturing in Gresik, East java, counted as samples obtained by consecutive sampling technique. The data were taken by questionnaires and checked by using the Phalen test. The correlation between the risk factors of age, sex, and work period with suspected Carpal Tunnel Syndrome (CTS) were analyzed using chi-square and Fisher exact test. Results: Based on the research, as many as 15 respondents had suspected CTS. Based on the chi-square test, the significance value between suspected CTS with the risk factor of age are p=0.659, sex are p=0.70, and Fisher exact test resulted in the significance value between suspected CTS with work period are p=0.020. Conclusion: There was a significant difference between suspected Carpal Tunnel Syndrome (CTS) with work period (p0.05)

Ankle Arthrodesis with Cannulated Screw: Case Series

ABSTRACT Ankle osteoarthritis patients are young and lack of available long last treatment. Ankle arthrodesis remains the gold standard and is the procedure of choice for younger patients who are heavy laborers. These case series evaluate and report five patients undergone ankle arthrodesis at RSUD Dr. Soetomo Surabaya on 2012-2016. The data were collected from patient files, radiographs, and a recent physical examination. The outcome has been assessed with SF-36 score and clinical scoring system Ankle-Hind foot American Foot and Ankle Society. Three male patients and two female patients underwent ankle arthrodesis with cannulated screw, caused by neglected severe ankle dislocation. One patient had open dislocation. Based on SF-36 scoring, the five patients had average score 76,7 with highest and lowest score were 95,9 and 56,7. Based on clinical score ankle-hind foot American Ankle and Foot Society, the average score was 68(51 – 88). The scoring result includes general health, physic, emotional, and social. And clinical scoring ankle-hind foot American Foot and Ankle Society evaluation includes pain, function, and alignment. It shows that there was patient that gains an almost perfect result. Patient with the lowest score also had knee osteoarthritis contralateral from the operated ankle. Early weight bearing on ankle arthrodesis with cannulated screw was the major factor caused unsatisfactory result of this patient. Ankle arthrodesis with cannulated screw has satisfactory result eventhough remain complain on one patient. Nevertheless, ankle arthrodesis with cannulated screw still has an important role in the treatment of choice on ankle reconstruction.Keywords                   : Ankle arthrodesis, cannulated screw, ankle joint fusion

Correlation Between Knee Osteoarthritis (Oa) Grade And Body Mass Index (Bmi) In Outpatients Of Orthopaedic And Traumatology Department Rsud Dr. Soetomo

Osteoarthritis (OA) is the number eight disease causes Years of Disability in developing countries. OA worsen life quality, from movement limitation until inability to perform normal daily routines. Obesity is one of the risk factor of OA. The doubles increasing trend of obesity from 1980, might possibly causes the escalation of OA case. However, there is still no study that explains the correlation between OA grade, especially knee OA, with Body Mass Index (BMI). The purpose of this study was to determine whether there is correlation between knee osteoarthritis (OA) grade with Body Mass Index (BMI) in outpatients of Orthopaedic and Traumatology department RSUD Dr. Soetomo. This study was cross-sectional study with analitical observational design and survey was the method to determine whether there is correlation between knee OA grade and BMI. Height and weight measurement and also knee x-ray reading were performed to determine the BMI and knee OA grade. The BMI categories that were used were based on standard from Health Department of Republic of Indonesia, while the grading system that were used were based on Kellgren-Lawrence’s grading system. Populations in this study were taken from the outpatients of Orthopaedic and Traumatology Department RSUD Dr. Soetomo during August until November 2015. After statistic test using Spearman correlation test was done, the result was p=0,822. It can be concluded that there was no significant correlation between knee OA grade and BMI. Furthermore, knee OA grade was not affected by BMI only, but also other risk factors as well

Low Tibial and Fibular Osteotomy for Treating Varus-Type Post-Traumatic Ankle Osteoarthritis: A Case Report

ABSTRACT In Indonesia, arthrodesis becomes a choice of treatment in the absence of ankle arthroplasty implants for young adults. Arthrodesis on ankle osteoarthritis (OA) often leads to functional impairment. Low tibiofibular osteotomy is an alternative and it has been known to be the preferable option for those in the productive-ages. A 22-year-old male with a previous history of a motorbike accident, operated eight years ago, came with persistent pain on the left ankle that has worsened over the years. Plain radiography with a tibialankle surface angle (TAS) of 74o (normally 88o -93o ) indicated varus deformity. Osteotomy was performed on distal tibia above the syndesmotic joint, as well as on the middle third of fibula. Open wedge osteotomy of the tibia was corrected until the normal TAS angle was reached by fluoroscopy. Cortical allograft was used to fill the osteotomy gap. Instrumentation was performed using a clover leaf® plate with 6 screws insertion for fixation stability. All results were satisfactory. Twelve weeks post-operatively, the patient was performing activities normally. Four-month post-operative radiological evaluation showed fusion of graft and the angle of TAS of 89°. Post-operative functional assessment using the American Academy of Orthopaedic Surgeon (AAOS) Foot and Ankle Measurement (FAM) questionnaires showed significant improvement (pre 89, post 38)

Anthropometric studies of distal femur and proximal tibia using magnetic resonance imaging methods in public hospitals

Background: The therapeutic choice for managing osteoarthritis is total knee arthroplasty (TKA). One of the important things in preparation for TKA operations is the determination of implant size. The TKA prosthesis used in Indonesia is based on European population measurements, whereas the size of Asians is smaller than the size of the Caucasian. Purpose: This study aims to determine the anthropometric size of the femur bone in the distal part and the tibia of the proximal part. Method: The subjects were 100 knee magnetic resonance imaging (MRI) patients who met the inclusion and exclusion criteria. In the data analysis, the Pearson correlation test was used to determine the relationship between all parameters. Result: In the measurement of distal femur parameters, a significant relationship was found between TEA (p = 0,000), AML (p = 0,000), PML (p = 0,000), and AP group (p = 0.003) with sex/gender and age. There is a relationship between the proximal tibia of width parameters ML (p = 0,000 and p = 0.002), and MPW (p = 0,000 and p = 0,000) with sex/gender and age. MPH by age with p-value = 0.001. LPW by gender (p = 0.001), while other parameters have no significant relationship. Conclusion: that the size of the distal femoral parameters and the proximal tibia were not affected by the patient’s ethnicity and BMI but were significantly affected by age and sex/gender

Antropometric study on the parameters of double-bundle anterior cruciate ligament reconstruction using magnetic resonance imaging

Abstract Background: The reconstruction techniques of double-bundle anterior cruciate ligament (ACL) can restore normal kinematics on the knees and its stability. Data regarding the reconstruction parameters of double-bundle ACL and ACL footprint’ size on femur and tibia have never existed in Indonesia. Purpose: This study aims to obtain the reconstruction parameters’ value of double-bundle ACL to determine the parameter value suitability with a minimum size, and the correlation of these parameters with age, sex, ethnicity, and body mass index (BMI). Methods: This study employed an analytic observational study with a cross-sectional design. In this study, eight parameters were measured, then analyzed based on age, gender, ethnicity, and BMI. The measurements were carried out using OsiriX program. Result: The average width of lateral condylar ridge amounted to 15.734 mm; the average diameter of ACL femoral footprint reached 15.85 mm; the average surface of ACL femoral footprint reached 72.72mm2 ; the average diameter of ACL tibial footprint 16.04 mm; the average surface of ACL tibial footprint amounted to 72.69mm2 , and the average width of intercondylar notch reached 21.29 mm. In addition, no significant correlation was identified between age, sex, ethnicity, and BMI to the double-bundle ACL reconstruction parameters. Conclusion: Double-bundle ACL reconstruction can be performed because the reconstruction parameters’ values have exceeded the minimum size. Subjects’ characteristics based on age, sex, ethnicity, and BMI do not affect these parameters’ values. The surface measurements of ACL femoral footprint and ACL tibial footprint significantly correlate with age