Slipped Capital Femoral Epiphysis (SCFE)

Slipped Capital Femoral Epiphysis (SCFE) adalah kelainan pada regio hip dimana didapatkan pergeseran dari epifisis kaput femoris mulai dari area metafisis hingga fisis. Prevalensi SCFE berbeda-beda mengikuti kelompok etnis tertentu, kondisi geografis, lokasi, dan perubahan musim. SCFE sering dijumpai pada anak-anak Hispanik dan Afrika dengan jumlah mencapai 3,94 hingga 2,53 kali dibandingkan anak-anak Kaukasia. Rasio antara anak laki-laki dibandingkan perempuan sebesar 1,6:1, dimana rasio ini mewakili usia puncak pertumbuhan mereka, yaitu usia 10 hingga 16 tahun, dengan usia rata-rata 12 tahun pada anak perempuan dan 13,5 tahun pada anak laki-laki. Pada pasien usia dewasa muda, SCFE dikaitkan dengan gangguan metabolisme endokrin. Faktor lain seperti genetika dapat berperan dalam SCFE dimana adanya riwayat di keluarga menyebabkan variabilitas yang lebih besar. Proses penentuan diagnosis yang tertunda dapat menyebabkan perburukan dari kondisi awal pasien, hingga terjadinya gejala proses degenerasi awal yang berujung arthritis sendi pinggul. Tidak jarang, diagnostik yang terlambat berujung pada kecacatan premanen. Dibutuhkan pemeriksaan awal (screening) berskala besar untuk SCFE yang belum pernah dilakukan hingga sekarang, agar proses penetuan diagnosis dapat dibuat lebih cepat

Surgical outcome of scoliosis in Marfan syndrome: a case series report

Scoliosis in marfan syndrome (MFS) manifests on 60% patients. Moreover, the scoliosis noticeable in earlier age is more progressive, refracted, and rigid compared to idiopathic adult scoliosis. The surgical correction provides notorious higher perioperative risk, whereas conservative treatment using brace is not effective to prevent progressivity of the scoliosis. In this a case report, we reported the surgical outcome of MFS scoliais patients with MFS who operated using posterior fusion instrumentation by mean of the quality of life SF-36 questioner. This was a retrospective case series involving five MFS scoliosis patients who underwent posterior fusion instrumentation with initial Cobb angle of 87.417.57o and initial kyphotic angle of 32.8 ± 14.52o. Clinical, radiological and quality of life of the patients based on SF-36 questionnaire were evaluated within 6-36 months follow up. Post-operative showed the Cobb angle become 46.2 ± 16.3o and the kyphotic angle become 21.6 ± 9.94o. No intraoperative or post-operative complications were observed. After 6-36 months follow up, the Cobb angle became 45.2 ± 17.48o and the kyphotic angle became 21.6 ± 9.94o. In addition, all patients had physical and mental health scored similar to 2 years post surgery scoliosis scoring according to SF-36 orthopedic scoring guidelines. I conclusion, the surgical outcome of posterior fusion instrumentation in MFS scoliosis showed good correction of Cobb angle and Kyphotic angle. The quality of life of the patients based on physical and mental health questionnaire is satisfactory

The rationale of surgical treatment in pediatric spine tuberculosis

Introduction: Extrapulmonary TB in pediatric patient affects the quality of life and must be considered seriously. Early surgical treatment is needed to eradicate infection, preserve the physis, and simultaneously correct the deformity. The aim of this study is to assess the efficacy of conservative treatment compared to early surgical treatment regarding neurological improvement, kyphotic correction, and pain relieve. Method: This is a retrospective case series. We reviewed 28 pediatric spine tuberculosis in Dr. Soetomo General Hospital Surabaya, Indonesia during year 2010-2012. All patients have received TB drugs and indicated for surgical treatment, yet the 15 patients did not provide parental consent. These were selected as non-surgical group. Thirteen patients obtained surgical treatment including bone graft, w/o instrumentation (surgical group). All clinical data were collected at the time of diagnosis and a year after treatment. The improvement of kyphotic (thoracic segments) was defined as narrowing of post-treatment Cobb’s angle. Conversely, lordotic improvement (cervical or lumbar segments) was defined as widening Cobb’s angle. Improvement of neurological status (Frankel classification) was analyzed using chi-square test. The deformity correction and pain relieved were analyzed using independent-samples t-test. All statistical analyses were conducted by SPSS-23. Result: VAS improvement was not significant. Frankle classification in the surgical group was significantly better. The kyphotic deformity correction was 0% (n=8) in the non-surgical group and, 57.1% (n=4) in the surgical group. There lordotic deformity correction was 74.1% (n=4) in non-surgical group and 83.3% (n=5) in surgical group. There is a significant difference of the kyphotic deformity correction between both groups. but no significant difference in lordotic correction. Conclusion: Surgical management showed better outcomes in the degree of correction (stopped and corrected the kyphosis progression), and also in the neurological improvement

Functional evaluation of lumbar spinal stenosis treated with conservative treatment retrospective study

Background: Approximately 75% men have low-back pain, and most of them come to get treated for acute low-back pain and cure without operation. Conservative treatment procedures, including surgery, have never been evaluated carefully. Objectives: To assess the efficacy of conservative treatment in Lumbar Spinal Stenosis (LSS) and how to choose the patient for conservative treatment. Material and Methods: As many as 30 patients (9 men and 21 women) who were undergoing treatment between January and December 2014 in Orthopaedic and Traumatology Department, Faculty of Medicine, Airlangga Unversity-dr. Soetomo General Hospital, Orthopaedic and Traumatology Hospital (RSOT) Surabaya were recruited for the study. The mean of age of the participants was 51.9 years LSS (diagnostic with plain radiography and MRI) without indicated operation and they were treated conservatively with TENS, WSD, and ultrasonography and NSAIDs for 6–12 weeks. We evaluate VAS and ODI and assigned scores to predict the efficacy of conservative treatment. Results: VAS decreased significantly in patients with mild and moderate VAS prior to conservative treatment 68.1% (p &lt; 0.001). ODI improved significantly in a patient with a mild and moderate disability prior to conservative treatment 87.5% (p &lt; 0,000). On the basis of scores assigned to predict the efficacy of conservative treatment, we fixed sensitivity and specificity at cut point £ 3.50. Conclusions: Conservative treatment can be effective in some LSS patients if the indications are correctly presented.</p

Surgical outcome of scoliosis in Marfan syndrome: a case series report

Scoliosis in marfan syndrome (MFS) manifests on 60% patients. Moreover, the scoliosis noticeable in earlier age is more progressive, refracted, and rigid compared to idiopathic adult scoliosis. The surgical correction provides notorious higher perioperative risk, whereas conservative treatment using brace is not effective to prevent progressivity of the scoliosis. In this a case report, we reported the surgical outcome of MFS scoliais patients with MFS who operated using posterior fusion instrumentation by mean of the quality of life SF-36 questioner. This was a retrospective case series involving five MFS scoliosis patients who underwent posterior fusion instrumentation with initial Cobb angle of 87.417.57o and initial kyphotic angle of 32.8 ± 14.52o. Clinical, radiological and quality of life of the patients based on SF-36 questionnaire were evaluated within 6-36 months follow up. Post-operative showed the Cobb angle become 46.2 ± 16.3o and the kyphotic angle become 21.6 ± 9.94o. No intraoperative or post-operative complications were observed. After 6-36 months follow up, the Cobb angle became 45.2 ± 17.48o and the kyphotic angle became 21.6 ± 9.94o. In addition, all patients had physical and mental health scored similar to 2 years post-surgery scoliosis scoring according to SF- 36 orthopedic scoring guidelines. I conclusion, the surgical outcome of posterior fusion instrumentation in MFS scoliosis showed good correction of Cobb angle and Kyphotic angle. The quality of life of the patients based on physical and mental health questionnaire is satisfactory

Intermediate Screw pada Unstable Thoracolumbar Fracture: Case Series dan Review Article

Area thorakolumbar merupakan hampir 90% dari semua spinal injuries dan 10% dari cedera tersebut merupakan burst fracture yang membutuhkan intervensi operatif. Terapi burst fracture thorakolumbar meliputi restorasi dari alignment, stabilisasi spinal, koreksi kifotik, dan dekompresi spinal kanal. Pertimbangan penggunaan intermediate screw masih menjadi topik perdebatan. Penambahan intermediate pedicle screw dipercaya dapat menambah stabilitas dan membantu koreksi kifosis pada long segment, short segment fixation. Penelitian ini merupakan systematic literature review. Pencarian literatur menggunakan mesin pencari elektronik PubMed, MEDLINE, PMC, Cochrane Library, Nature, Taylor and Francis Online dan Springerlink, dari tanggal 28 Desember 2017 sampai 20 Februari 2018. Kriteria inklusi: burst fracture dari mekanisme traumatik, fraktur tulang belakang bagian thorax atau lumbal, intermediate pedicle screw dan penelitian dari tahun 2010 sampai 2017. Ditemukan 10 artikel (15,15%) artikel yang masuk kedalam kriteria inklusi. Terdapat tiga penelitian level 1, satu penelitian level 2, empat penelitian level 3 yang mendukung teknik SSPF+IS dengan hasil reduksi fraktur dan evaluasi radiologis yang baik, correction loss dan implant failure yang lebih rendah, mengurangi nyeri pascaoperasi. Teknik SSPF+IS merupakan teknik yang aman dan efektif memberikan hasil fiksasi yang stabil, hasil evaluasi akhir radiologis serta hasil evaluasi akhir klinis yang baik

Comparative Study of Cross and Lateral Fixations on Supracondylar Humerus Fracture among Children

Background: Management of Gartland type III supracondylar humerus fractures is conduc­ted by open and closed repositioning. An ade­quate re­p­o­sition and a stable and accurate fixation are des­perately needed to prevent fixation failure, defor­mi­ty, and complication. The study aims to com­pa­re the clinical and radiological results bet­ween crossed and lateral fixation techniques.Subjects and Method: The study was a retro­s­pective study toward Gartland type III SCHF children in Dr. Soetomo Hospital, Surabaya, Indonesia from 2013–2016. The dependent vari­able is Supracondylar hu­me­rus fracture. Independent variables were the type of fixation option, clini­cal functional test, degrees of satisfactory, and radiology evalua­tion. The radiology para­me­ter used was Skaggs criteria. An observation was conducted for the occurrence of complications in the form of infection and peripheral nerve injury. All data were analyzed using Kolmogorov Smirnov and Fischer exact test.Results: The study discovered 28 patients consisted of 20 males and 8 females with an age range from 3 – 13 years old with an average age in crossed fixation group was 7.6 years and in lateral fi­x­ation was 4.7 years. The injury sides were 46.4% right elbow and 53.5 % left elbow. Among the cros­sed fixation group, there were 54.5 % left elbow and 45.5 % right elbow. Among lateral fix­a­tion group, there were 50% left side and 50% right side. There was no significant difference in cli­nical fun­ctions, radiology as well as com­pli­ca­tion in the form of infection and peripheral ner­ves injury.Conclusion: There is no difference of functional clinical, radiology result as well as post-surgery com­plication in the form of infection and peri­phe­ral nerves injury between crossed fixation tech­nique and lateral fixation technique.Correspondence: Komang Agung Irianto. Department of Ortho­pe­dics and Traumatology, Faculty of Medicine, Universitas Airlangga/ Dr. Soetomo Hospital, Sura­ba­ya. Email: [email protected]. Mo­bile­: +6281133608­0.Indonesian Journal of Medicine (2020), 05(01): 31-37https://doi.org/10.26911/theijmed.2020.05.01.0

K-wire migration to unexpected site

Kirschner wire migration is a notorious incident in orthopedic surgery. Efforts to avoid it was carried out by several standard procedures, including bending the wire and reporting the cases all around the world in many journals. Nevertheless, the incident still happens, and some include symptoms that amazed doctors as to how the wire travelled. We reported a migration of forgotten wire to contra lateral region presented as corpus alienum of the lung in a 34-year-old woman after distal clavicular fracture surgery three years previously. We also reported a migrating wire fragment after a fall accident in sport activity of a 28-year-old male; which travelled from clavicular region to cervical 6–7 region in 4 days. Both cases were successfully managed without extravagant surgery or serious damage, helped by meticulous history taking, physical examination, precise imaging, and prompt management. These cases render lessons and discussion for further understanding of the wire migration and the exact protocol in handling K-wire patient

Release of retromalleolar flexor retinaculum and combined flexor digitorum longus and flexor hallucis longus Z-plasty in checkrein deformity: a case report

Background Checkrein deformity is a rare abnormality comprising flexor hallucis longus (FHL) tendon entrapment in the posterior foot due to post-traumatic or ischemic retraction of the FHLtendon following soft tissue trauma. The diagnosis is essentially clinical, but complemented by imaging to rule out unrecognized causes and evaluate the fracture healing process. This case report is the first Indonesian study to describe release of the flexor retinaculum and Z-plasty (lengthening) of flexor digitorum longus (FDL) and FHL tendons through a medial retromalleolar approach to repair the deformity. Case Description We present the case of a 51-year-old male who complained of clawing of his right first and second toes. The interest of this study lies in the fact that this patient had never experienced ankle or distal tibial fractures, only a trivial injury two years back when the patient kicked a stone at work and had a bruise on his right second toe with no fracture. Exploration of FHL tendons was performed at the level of the midfoot. The patient was planned for surgery with a medial retromalleolar ankle approach, which facilitates the release of the flexor retinaculum, in conjunction with a Z-tenotomy on the FHL and FDL tendons. Conclusion A correction was achieved, and two months post-surgery there were no recurrences of the deformity. However, this surgical procedure requires more cases to support an evaluation of its effectiveness. We suggest that exploration at the ankle and midfoot should be the primary surgical intervention in similar cases of checkrein deformity