Triple Curve Scoliosis Presented with Developmental Dysplasia of the Left Hip in Marfan Syndrome

Introduction: Marfan syndrome is an autosomal dominant disorder of connective tissue, and skeletal system involvements are the cardinal features.  Triple rigid large major curve in conjunction with developmental dysplasia of the hip in Marfan syndrome is rare then sagittal and coronal imbalance correction on this case is challengingCase Presentation: We reported a case of 12 years old female with Marfan syndrome presented triple rigid large Major curve scoliosis on left cervico-thoracal, right main  thoracal and left thorakolumbal, also developmental dysplasia of the left hip has been done correction surgery consist of open reduction following cast immobilization of the left hip, multiple ponte osteotomy and asymetrical pedicle substraction osteotomy to correct sagittal and coronal imbalance.Discussion: the treatment of scoliosis in patients with Marfan syndrome parallels that in patients with idiopathic scoliosis and spinal fusion and instrumentation should be considered for curves greater than 45 to 50 degrees. Posterior technique, Ponte osteotomy correct 10 to 20 degrees and pedicle substraction osteotomy correct 30 to 40 degrees at each segment are effective for managing sagittal and coronal imbalance in scoliosis. Open reduction developmental dysplasia of the hip to overcome complicated coronal balance correction.Conclusion : Detailed planning scoliosis surgery is needed to correct a rare the sagittal and coronal imbalance due to scoliosis complicated with developmental dysplasia of the hip in Marfan syndrome

Biomaterials in Orthopaedics

In general knowledge, orthopaedic surgery treats the disease and injuries of musculoskeletal system including bone fractures, anomalies, degenerative disease, tumor, and infection. Significant difference in orthopaedic cases occurs between developed and developing countries. In the latter, the majority of cases are caused by injury and infection. Most surgical treatment needs the use of implants can be selected from metals, polymers and ceramics oe their combination. In Indonesia, certain type of orthopaedic implants have been produced locally but still cannot fullfill the high demand. The current technology used by local manufacturers has some limitations in production capacity and product variety mainly for complex implants like arthroplasty. Collaboration in R&D activities on orthopaedic implants is on-going between local manufacturers with universities and goverment institutions under the assistance of orthopaedic surgeons. This collaboration receives a full support from the Indonesian Goverment as it aligns with the national programme on supporting local products and the new general health insurance programme which covers every citizen of Indonesia

Studi Epidemiologi Fraktur Vertebra di RSUD Dr.Soetomo Surabaya Pada Tahun 2013-2017

Abstract The incidence of spinal trauma in the world is 0.019-0.088% per year. However, the epidemiological data from each country varies according to the specificities of each country. Until now, there have been no reports of epidemiological research for vertebral trauma in Indonesia. This research is a descriptive analytic study. The sample of this study were all patients with vertebral fractures who entered the Dr. Soetomo Hospital in 2013-2017. The data were obtained through medical records and electronic data in hospital databases. The data are displayed in tables and graphs and comparative analysis of variables is carried out. Based on data from 2014-2017, there were a total of 442 patients with vertebral fractures, with male and female ratio of 3.3: 1. The mean age of patients was 43.6 year. The causes of vertebral fractures are due to fall from altitude (38%), traffic accidents (34%), and direct impact / hit burden (10%). Based on fracture level, most fractures were at the lumbar level (153 patients, 34,6%). At the lumbar level, the most fracture subtypes were type A with a percentage of 91.5% and the most mechanism of injury was due to falling from a height. Based on the fracture subtype, type A (compression or burst) fracture is the most common type of fracture. Lumbar vertebral fracture is the most fractured in vertebral fractures. The most common cause of fracture in the vertebrae is trauma with great energy due to falling from a height. Keywords: Epidemiology, vertebral fractures, spinal trauma Correspondence to : [email protected]   Abstrak  Insiden trauma spinal di dunia tercatat sebesar 0,019% hingga 0,088% per tahun, namun data epidemiologi dari masing-masing negara adalah berbeda-beda, sesuai dengan kekhususan dari masing-masing negara. Hingga saat ini, belum terdapat laporan penelitian epidemiologi untuk trauma vertebra di Indonesia. Penelitian ini merupakan penelitian deskriptif analitik. Sampel penelitian ini adalah seluruh pasien dengan fraktur vertebra yang masuk di RS Dr. Soetomo Surabaya pada tahun 2013-2017. Data penelitian ini didapatkan melalui data berkas rekam medis dan database elektronik rumah sakit. Data ditampilkan dalam bentuk tabel dan grafik serta dilakukan analisa komparasi dari variabel. Berdasarkan data tahun 2014-2017 didapatkan total 442 pasien dengan fraktur vertebra, dengan perbandingan laki-laki dan perempuan sebesar 3,3:1.  Rerata usia pasien adalah 43,6 tahun. Penyebab fraktur vertebra adalah akibat jatuh dari ketinggian (38%), kecelakaan lalu lintas (34%), dan benturan langsung/ tertimpa beban (10%). Berdasarkan level fraktur, fraktur terbanyak sejumlah 153 pasien (34,6%) pada level lumbal. Pada level lumbal didapatkan subtIpe fraktur terbanyak adalah tipe A dengan persentase 91,5% dan mechanism of injury terbanyak adalah akibat jatuh dari ketinggian. Berdasarkan subtipe frakturnya, fraktur tipe A (kompresi atau burst) merupakan jenis fraktur yang paling banyak terjadi. Fraktur vertebra lumbal adalah fraktur terbanyak pada kasus fraktur pada vertebra. Penyebab terbanyak fraktur pada vertebra adalah trauma dengan energi besar akibat jatuh dari ketinggian. Laki-laki 3 kali lebih banyak mengalami fraktur vertebra dibanding perempuan. Kata kunci: Epidemiologi, fraktur vertebra, trauma spinal Korespondensi  : [email protected]

Combination of bone marrow aspirate, cancellous bone allograft, and platelet-rich plasma as an alternative solution to critical-sized diaphyseal bone defect: A case series

Introduction: Nonunion due to a critical-sized bone defect is a complicated problem. The healing process must fulfill three mandatory elements of osteogenesis, osteoinduction, and osteoconduction. One ideal source to provide an abundant number of osteogenic cells is from the process of the culture of bone marrow stem cells which demands the availability of processing facility. Unfortunately, this sophisticated option is not always feasible in every hospital in low-income to middle-income countries. We tried to fulfill the requirement of osteogenic cells by using simple and cost-effective bone marrow aspirate. We presented two cases of critical-sized diaphyseal bone defect treated with the combination of bone marrow aspirate, cancellous bone allograft, and platelet-rich plasma (PRP). Presentation of cases: The defect sizes were five and six centimeters in humerus and tibia respectively. We applied a combination of bone marrow aspirate, cancellous bone allograft, and PRP to promote bone healing in the defect sites. Both patients have achieved the good clinical and radiological outcome. Discussion: Critical-sized bone defects require the application of tissue engineering. Aspirated bone marrow can be used as a more affordable option to provide the element of osteogenic cells in bone healing. Combined with cancellous bone allograft and PRP, they fulfill the required ingredients to promote bone regeneration. Conclusion: Bone defects remain one of the most challenging conditions to treat in orthopedic. There are many options to treat the defect but the fundamental prerequisites of cells, scaffolds and growth factors for healing have developed into the concept of tissue engineering: osteogenesis, osteoinduction, and osteoconduction

Glomus tumor-induced lower extremity pain: A case report

tINTRODUCTION: Glomus tumor located in the lower limb could be easily mistaken as lower extremitypain whether it is radiating, sciatic, or just a localized one. This could lead to misdiagnosis and impropermanagement.PRESENTATION OF CASE: This case reported a 56-year-old man complaining of pain in his left thigh. Thepain was characterized as sharp and sometimes radiated to the skin of the calf muscles region. There wasno history of trauma. Physical examination of the left thigh region revealed a small and barely palpabledeep subcutaneous mass. Ultrasound examination showed a 6 × 5.3 mm partly cystic subcutaneous massin the posteromedial region of the left distal femur. Doppler USG showed that the blood flow in the cysticlesion originated from the medial genicular artery. Surgical tumor excision through the medial femoralapproach exposed a 15 × 10 × 5 mm yellowish-white thin encapsulated subdermal tumor attached tothe vascular wall. Histopathology examination resulted in a Glomus Tumor.DISCUSSION: Glomus tumor usually occurs in areas that are rich in glomus bodies. Thigh is not a specificlocation for glomus bodies. It presented as bluish small nodule that are sensitive to touch and temperaturechanges. Glomus tumors in the thigh region rarely recurs since they are solitary and encapsulated, makingthem easily recognizable from the surrounding tissue during the operation.CONCLUSION: Meticulous history taking, physical examination, and imaging modalities are necessary todifferentiate between tumor and non-tumor lesions in less common areas

Proximal fibula osteotomy as an alternative to TKA and HTO in late-stage varus type of knee osteoarthritis

Background Knee osteoarthritis has a high prevalence in Indonesia. Aim of this research is knowing the outcome of knee osteoarthritis patient after PFO procedure. Methods Data collected and analyzed in hospitals in Surabaya from July to December 2017. This study compares preoperative and postoperative outcome on radiological evaluation, patient satisfaction, and clinical function. Results The study includes 15 patients. Radiological evaluation on Tibiofemoral Angle and Joint Space Ratio increases significantly. Patient satisfaction evaluation using SF12 significantly improve. Evaluation using KOOS and Oxford Knee Score also increase significantly. Conclusion PFO could become an alternative treatment for last stage knee osteoarthritis

Correction of severe valgus deformity of knee osteoarthritis with non-constrained total knee arthroplasty implant: A case report

Introduction Knee osteoarthritis with valgus deformity presents a surgical challenge that must be solved during total knee arthroplasty (TKA). In some case whereby ligament imbalance is found, constrained implant should be used. Unfortunately, the implant is not always readily accessible in some developing countries. The objective of this paper is to provide alternative solution to such case. Presentation of case We reported a 71-year-old female patient with a painful and fixed valgus deformity of her right knee. Preoperatively, the patient’s right knee range of motion (ROM) was 10–145° of flexion with a 32° fixed valgus deformity. A constrained implant was not accessible. To balance the ligament, Medial Collateral Ligament (MCL) origin was shifted to superior and anterior. A non-constrained implant was used. The valgus deformity was corrected intraoperatively and ROM achieved 0–140° of flexion. Discussion It is crucial that attention is given not only to the restoration of proper bony alignment but even more importantly to soft tissue balancing. By using the non-constrained implant, the cost can also be reduced and suitable for developing countries with limited coverage of state insurance. Conclusion Three months after the surgery, the patient achieved stable and painless knee with 10–90° of flexion and complete correction of her valgus deformity

Effect of Platelet-Rich Plasma and Amniotic Membrane in Patients with Rotator Cuff Repair

Rotator cuff disorders are the most common source of shoulder problems, ranging from mild strain to massive tears. Platelet-rich plasma (PRP), an autologous blood with platelets concentration above baseline values represents a source of multiple growth factors that promotes tissue repair. This review examines the potential of using PRP to augment rotator cuff repair. Reporting 4 patients with impingement syndrome and supraspinatus tear who underwent decompression acromioplasty and supraspinatus repair augmented with platelet-rich plasma and amniotic membrane. An evaluation was made 3-24 months postoperative using Shoulder Pain and Disability Index (SPADI). Average preoperative pain score is 64%, disability score 54.58%, and total score 58.19%. Average postoperative pain score is 0%, disability score 0.42%, and total score 0.26% (Minimum Detectable Change at 90% confidence for pain score is 18%, disability score 13%, and total score 11%). This result is consequent with research by Luoay Fallouh, stating that improvement is caused by growth factor effects in platelet-rich plasma which promotes soft tissue healing. It can be concluded that platelet-rich plasma and amniotic membrane have promising effects to enhance soft tissue healing in patients with rotator cuff syndrome. Shoulder function is restored with no limitation on daily activity and pain is no longer present