TENDON TRANSFERS FOR RADIAL NERVE PALSY

Background: High radial nerve palsy mostly caused by injury of nerve branching from proximal to the elbow resulting in function loss of wrist, finger and thumb extension, as well as thumb abduction. Tendon transfers are the most common technique for motor reconstruction indicated in high radial nerve palsy if the patients fail to achieve nerve regeneration and recovery. This procedure will restore finger, thumb, and wrist function, without foisting other motoric deficits on the hand, with satisfying results. Case: 19 years old male was referred to RSUP dr. Mohammad Hoesin Palembang with right wrist joint instability and limited range of motion (ROM). Past history of fracture at the middle third of the right humerus 6 months ago. Physical examination showed total loss of active wrist extension, thumb extension and abduction, and finger extension at metacarpophalangeal (MCP) joints. The patient is diagnosed as a high lesion of radial nerve palsy. Tendon transfers procedure were prepared to restore better wrist function and ROM. Tendon transfers performed with Riordan method, using pronator teres as extensor carpi radialis brevis for wrist extension, flexor carpi ulnaris to extensor digitorum communis for finger extension, palmaris longus to extensor pollicis longus for thumb extension. Conclusion: Tendon transfers for high radial nerve palsy is an effective technique to restore the function of wrist extension, finger extension, and power of handgrip

Evaluation of CTEV Management in Children's Walking Ability Assessed by "BANGLA" Club Foot Tool Score System

Abstract Congenital talipes equinovarus (CTEV) or clubfoot is a congenital deformity that involves an abnormal position of the calcaneonaviculare complex. "Bangla clubfoot tool score system" is an assessment that indicates the effectiveness of CTEV management. The purpose of this study was to evaluate the management of CTEV on children's ability to walk as assessed by the Bangla clubfoot tool score system. A cross sectional study was conducted at the Hospital Dr. Mohammad Hoesin Palembang. There were 24 CTEV patients who received CTEV management before the age of 3 years and were not associated with a neurological disorder. A comparison of the average total Bangla clubfoot score tool system was analyzed by assessing parental satisfaction, walking ability and clinical examination. The majority of CTEV patients were women (58.3%) with and mostly being treated before 1 year old (79.2%). The most types of CTEV were bilateral (70.8%), and most of them performed surgery (66.7%). Assessment with the Bangla clubfoot tool system shows that the level of parental satisfaction is sufficient, gait is good, but physical foot examination is poor (20%). The score is influenced by age at first therapy and compliance using the brace. Parents must continue to support their children to undergo integrated management after therapy to maintain their walking ability

Pirani Score Difference in CTEV Patients Treated with Ponseti’s Serial Cast in RSUP dr. Mohammad Hoesin Palembang

Congenital talipes equinovarus (CTEV) is a congenital deformity involving calcaneo-navicular complex. It is best understood with mnemonic CAVE which includes cavus, adduction, varus, and equinus of the foot. Ponseti’s method, the gold standard of treating CTEV, includes strapping and tapping technique, manipulation, serial casting, and functional therapy. The purpose of this study is proving that there is a significant Pirani score difference in CTEV patients treated with Ponseti’s serial casts. It is an observational study with time series design. Observation and evaluation to the CTEV patients were conducted during the period of August-December 2017 at The Orthopedics Clinic in RSUP dr. Mohammad Hoesin Palembang. All the data were analyzed with Wilcoxon test using IBM SPSS version 24. Total 14 CTEV feet were treated with Ponseti method. From all of the 7 patients, four were females (57.1%) and three were males (42.9%). Every patient had bilateral deformity and less than a year in age. Mean Pirani score of the study group after the second plaster cast were 3.78 ± 2.05 for the left feet and 4.07 ± 1.66 for the right feet. Mean post-treatment Pirani score of the study group, respectively left and right feet, were 0.57 ± 0.60 and 0.28 ± 0.39. Total 92% of the feet were treated successfully by Ponseti’s serial casts. There is a significant difference in Pirani score before and after the treatment of CTEV using Ponseti’s serial casts (p < 0.05)

CLINICAL OUTCOME OF STEINDLER FLEXORPLASTY AND SAHA PROCEDURE IN TREATING SUPERIOR TRUNK BRACHIAL PLEXUS INJURY

Abduction is the most important functional movement of the glenohumeral joint, and at the same time one of the most complex movements of the entire body. Brachial plexus injury can make shoulder fail to abduction. Saha’s procedure (trapezius transfer) one procedure that safe and significantly improve the shoulder movement especially abduction. We report a teenager male presented with inability to move his right shoulder and elbow after a motor vehicle accident 5 weeks before. He was unable to move the elbow and shoulder, but the hand and wrist still had a good function. From the right shoulder X-Ray there is proximal humerus fracture. Steindler flexorplasty was performed after 3 months strengthening program. 6 months after Steindler flexorplasty, Saha’s procedure was performed to improve the shoulder movement. The shoulder can abduction 200-550 and the elbow can flex 200-800 after the surgery. In this case, the superior trunk of the brachial plexus was injured due to the shoulder and the neck forcibly widens after direct shoulder trauma. Saha’s procedure after Steindler flexorplasty is best for superior trunk brachial plexus injury, a simple procedure with minimal blood loss, which provided functional improvement. Steindler flexorplasty and Saha’s Procedure are two procedures very beneficial to the patients who experienced superior trunk brachial plexus injury

Sub-surface configuration in the northern part of Lembang groundwater basin recharge area

Abstract Lembang groundwater basin has an area of 209 km2. Increased tourism activities in the Lembang Groundwater Basin require sufficient groundwater resources to support the sustainability of these tourism activities. The purpose of this study was to analyze the hydrostratigraphy of the groundwater recharge zone of the Lembang groundwater basin in the Cikole-Lembang. Electrical Resistivity Tomography (ERT) with dipole–dipole electrode array and seismic refraction was used to analyze the hydrostratigraphy. The results of ERT and seismic refraction inversion show that Tangkubanparahu Pyroclastic Fall 2 can be characterized as aquifers. This layer consists of low (123–292  $$\Omega$$ Ω m) and intermediate (293–700  $$\Omega$$ Ω  m) resistivity value and also has low (300–1350 m/s) to medium (2700–1350 m/s) velocity. Tangkubanparahu lava (Tl) layer has a high resistivity value (701–3875  $$\Omega$$ Ω  m) and high (1350–2999 m/s) velocity. The Tangkubanparahu Pyroclastic Fall 1 has a resistivity of 300–700 ohms. Tangkubanparahu (Tl) lava deposits can be characterized as fracture aquifer and impermeable layers in the Tangkubanparahu volcanic hydrogeological system depend on the historical structural geology event