Correlation between Degree of Gibbus Angulation, Neurological Deficits, and Pain in Spondylitis Tuberculosis Patients

Objective: To analyze the correlation between the degree of angulation and neurological deficits as well as pain in spondylitis tuberculosis (TB) patients.Methods: This observational-analytic study included bivariate analysis on data collected from the medical records of patients with presented with spondylitis TB to Dr. Hasan Sadikin General Hospital, Bandung outpatient clinic from January 2014 to December 2015. The variables were the degree of gibbus angulation, neurological deficits, and pain.Results: The study showed significant positive correlation between gibbus angulation and sensory neurological deficits (r=0.375; p=0.009) and there was significant positive correlation between gibbus angulation and pain (r=0.638, p=0.000). The study showed an insignificant correlation between gibbus angulation and motoric neurological deficits (r=0.125; p=0.525).Conclusions: There is a significant correlation between the degree of gibbus angulation and pain as well as sensory neurological deficits. Meanwhile, no significant correlation is found between the degree of gibbus angulation and motoric neurological deficits.Keywords: Gibbus angulation, neurological deficits, pain, spondylitis tuberculosis DOI: 10.15850/ijihs.v5n2.104

Teknik Rekonstruksi Turndown Flap Tendon Achilles dan Flap Fasiokutan Sural pada Ruptur Tendon Achilles yang Disertai Kerusakan Masif Jaringan Lunak: Laporan Kasus

Ruptur tendon achilles adalah cedera yang paling sering terjadi pada tendon ekstremitas bawah, meskipun merupakan tendon yang terbesar dan terkuat. Penelitian ini bertujuan menjelaskan teknik operasi dengan modifikasi augmentation pada penatalaksanaan ruptur tendon Achilles yang disertai kerusakan pada jaringan lunak yang luas. Kasus pada penelitian ini adalah seorang pasien (usia 30 tahun) dengan ruptur terbuka tendon Achilles akut dan terinfeksi, serta hilangnya tendon sampai dengan 5 cm, kecacatan tendon yang tidak menempel di bagian distal dan hilangnya sebagian tulang calcaneus. Kerusakan kulit diukur setelah dilakukan debridemen dengan rentan antara 8 cmx5 cm sampai dengan 15 cmx10 cm. Ruptur pada tendon dijahit dengan gastrosoleus turn down flap ke tulang calcaneus. Reverse sural artery digunakan untuk menutupi kulit. Flap yang dibuat berhasil hidup. Pasien dapat berjalan normal, dapat berdiri dengan ujung kaki, fleksi plantar yang aktif, dan dapat kembali beraktivitas dalam 2 bulan setelah operasi. Pasien memiliki rentang gerak penuh ke segala arah. Simpulan, debridemen, rekonstruksi tendon dalam satu tahap, dan reverse flow sural artery flap memberikan hasil yang memuaskan pada kasus robekan luas tendon Achilles dan kerusakan jaringan lunak yang luas. [MKB. 2016;48(1):58–62]Kata kunci: Gastrosoleus turn down flap, ruptur, sural artery flap, tendon Achilles Achilles Tendon Turndown Flap Reconstruction and Fasciocutanous Sural Flap in Severe Tendon Achilles Loss with Massive Tissue Defect: a Case ReportAbstractAchilles tendon rupture is the most common ruptur of tendon in the lower limb despite being one of the toughest tendons. This rupture presents a complex problem to the treating surgeon especially if it is associated with tendon and soft tissue loss. The case in this study is one patient (male, age 30-year old) with a spectrum of acute and infected open tendon-achilles rupture that includes loss of tendon of up to 5 cm, tendon defect with no distal attachment, and partial loss of the calcaneum. The skin defect measured after debridement ranged from 8 x 5 cm to 15 x 10 cm. The ruptured tendon was sutured using gastrocnemius-soleus turn down flap technic to calcaneus bone. A reverse sural artery was used to provide soft tissue cover. The flap survived. The patient had normal gait, were able to stand on tip toes, had active plantar flexion, and had returned to his original occupation 2 months after reconstruction. He had full range of movement at the ankle. Augmented repair of Achilles tendon rupture with large soft tissue defect using gastrocnemius- soleus turn down flap and sural artery flap are stable enough to allow early weight-bearing with favorable clinical result for this patient. Conclusions is single stage tendon reconstruction and reverse flow sural artery flap give good functional outcome in complex Achilles tendon rupture with tendon and soft tissue loss. [MKB. 2016;48(1):58–62] Key words: Achilles tendon, gastrocnemius-soleus turn down flap, rupture, sural artery fla

LUARAN FUNGSIONAL DARI PEMBEDAHAN RUPTUR LIGAMEN MEDIAL PATELLOFEMORAL DI RUMAH SAKIT HASAN SADIKIN BANDUNG

Pendahuluan: Dislokasi patella dan cedera yang berhubungan dengan medial patellofemoral ligament (MPFL) merupakan cedera lutut yang paling umum pada masa remaja yang  memberikan kontribusi 53 hingga 60% dari gaya tarik medial terhadap pergeseran ke arah lateral. Tujuan dari penelitian ini adalah untuk menggambarkan luaran setelah operasi dilaksanakan pada center kami. 1 Metodologi: Penelitian analitik observasional pada ‘pasien cedera MPFL antara Januari 2015 dan Juli 2019 dengan jumlah 31 pasien. Pencarian database indeks medis/bedah di Rumah Sakit Hasan Sadikin Bandung dilakukan dengan menggunakan kata kunci Cedera Ligamentum Patellofemoral Medial dan ruptur Ligamentum Patellofemoral Medial dengan hasil data berupa catatan klinis dan operatif, serta studi pencitraan. Hasil klinis dievaluasi menggunakan Skor Kujala untuk menilai rasa sakit, kualitas hidup, dan kekambuhan.Hasil: 31 pasien memenuhi kriteria inklusi dan menjalani operasi selama 2 tahun. Menurut jenis kelamin terdapat 11 pasien pria (35,48%) dan 20 wanita pasien (64,52%). Usia rata-rata adalah 26,87 tahun (kisaran 15-42 tahun). Mekanisme cedera pada 23 pasien adalah cedera olahraga (74,2%) dan 8 pasien cedera non-olahraga. Terdapat 25 pasien (80,64%) yang menjalani operasi MPFL dengan retinacular lateral release, dan 6 pasien (19,36%) menjalani operasi MPFL tanpa lateral retinacular release. 22 pasien (70,96%) menjalani rekonstruksi MPLF dengan endo-button dan graft, dan 9 pasien (29,04%) menjalani perbaikan MPFL dengan jahitan primer. Terdapat peningkatan median skor Kujala sebelum dan setelah operasi (setelah 1 tahun), dari 63,90 (kisaran 45-75) menjadi 88,19 (kisaran 80-100) dan dianalisis dengan pair t-test dengan hasil signifikan secara statistik (p <0,05).Kesimpulan: Tatalaksana dislokasi patella menggunakan rekonstruksi MPFL menunjukkan luaran klinis yang lebih baik yaitu sangat mengurangi rasa sakit, tingkat kekambuhan, dan membantu meningkatkan kualitas hidup

Both Posterior Root Lateral-Medial Meniscus Tears With Anterior Cruciate Ligament Rupture: The Step-by-Step Systematic Arthroscopic Repair Technique

The occurrence of posterior root tear of both the lateral and medial menisci, combined with anterior cruciate ligament rupture, is rare. Problems may be encountered such as the difficulty to access the medial meniscal root tear, the confusing circumstances about which structure to repair first, and the possibility of the tunnel for each repair to become taut inside the tibial bone. We present the arthroscopy technique step by step to overcome the difficulties in an efficient and time-preserving manner

Correlation between Degree of Gibbus Angulation, Neurological Deficits, and Pain in Spondylitis Tuberculosis Patients

Objective: To analyze the correlation between the degree of angulation and neurological deficits as well as pain in spondylitis tuberculosis (TB) patients. Methods: This observational-analytic study included bivariate analysis on data collected from the medical records of patients with presented with spondylitis TB to Dr. Hasan Sadikin General Hospital, Bandung outpatient clinic from January 2014 to December 2015. The variables were the degree of gibbus angulation, neurological deficits, and pain. Results: The study showed significant positive correlation between gibbus angulation and sensory neurological deficits (r=0.375; p=0.009) and there was significant positive correlation between gibbus angulation and pain (r=0.638, p=0.000). The study showed an insignificant correlation between gibbus angulation and motoric neurological deficits (r=0.125; p=0.525). Conclusions: There is a significant correlation between the degree of gibbus angulation and pain as well as sensory neurological deficits. Meanwhile, no significant correlation is found between the degree of gibbus angulation and motoric neurological deficits

<p>Penatalaksanaan kegawatdaruratan evakuasi benda asing pada regio oral maksilofasial</p><p>Emergency management of corpus alienum evacuation in the oral maxillofacial region</p>

ABSTRAK Pendahuluan: Benda asing yang menusuk pada daerah oral maksilofasial dapat disebabkan oleh trauma ataupun faktor iatrogenik. Kecelakaan olahraga merupakan salah satu etiologi terjadinya luka penetrasi. Setiap benda asing yang berpenetrasi pada jaringan lunak di daerah oral maksilofasial harus segera dilakukan evakuasi untuk mencegah terjadinya infeksi. Tujuan laporan kasus ini menyampaikan penatalaksanaan kegawatdaruratan evakuasi benda asing pada regio oral maksilofasial. Laporan kasus: Kasus ini terjadi pada seorang atlet anggar laki-laki dengan usia 16 tahun dibawa ke instalasi gawat darurat Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung dengan kondisi pedang anggar tertancap di dalam mulutnya. Kecelakaan terjadi 2 jam sebelum masuk rumah sakit ketika latihan bersama dengan lawan tanding di daerah Antapani tanpa menggunakan pelindung wajah. Pedang lawan tanding menusuk dan menancap pada mulut pasien. Pemeriksaan klinis dan penunjang berupa foto rontgen dilakukan sebelum tindakan evakuasi pada pasien. Pedang kemudian di evakuasi secara anestesi lokal dan dilakukan penutupan luka. Kontrol dilakukan pada hari ke-7 pasca tindakan. Simpulan: Penatalaksanaan kegawatdaruratan evakuasi benda asing pada regio oral maksilofasial yang cepat dan tepat dibutuhkan untuk keberhasilan penyembuhan pasien seperti tampak pada saat kontrol hari ketujuh yang menunjukkan perbaikan tanpa komplikasi. Kata kunci: Evakuasi, gawat darurat, benda asing, oral maksilofasial.     ABSTRACT Introduction: Corpus alienum (foreign object) which stabbing the oral maxillofacial area can be caused by the trauma or iatrogenic factors. Sports accidents are one of the aetiologies of the penetration wound. Any foreign objects that penetrate the soft tissue in the oral maxillofacial area should be evacuated immediately to prevent infection. This case report was aimed to address the emergency management of corpus alienum evacuation in the oral maxillofacial region. Case report: This case occurred when a male fencing athlete aged 16-years-old was taken to the emergency department of Dr Hasan Sadikin Hospital Bandung, with a fencing sword stuck in his mouth. The accident occurred 2 hours before being admitted to the hospital while training together with opponents in the Antapani area without wearing face shields. The opponent's sword stabbed and penetrated the patient's mouth. Clinical and supporting examinations in the form of X-rays were performed prior to the patients’ evacuation. The sword was then evacuated under local anaesthesia, and the wound closure was performed. Control was carried out on the 7th-day post-treatment. Conclusion: Fast and precise emergency management of corpus alienum evacuation in the oral maxillofacial region is needed for the successful healing of the patient as seen on the seventh day of control which showed improvement without complications. Keywords: Evacuation, emergency department, corpus alienum, oral maxillofacial

The pathology of oxidative stress-induced autophagy in a chronic rotator cuff enthesis tear

Partial-thickness rotator cuff tears (PTRCTs) are often found in daily orthopedic practice, with most of the tears occurring in middle-aged patients. An anaerobic process and imbalanced oxygenation have been observed in PTRCTs, resulting in oxidative stress. Studies have shown the roles of oxidative stress in autophagy and the potential of unregulated mechanisms causing disturbance in soft tissue healing. This article aims to review literature works and summarize the potential pathology of oxidative stress and unregulated autophagy in the rotator cuff enthesis correlated with chronicity. We collected and reviewed the literature using appropriate keywords, in addition to the manually retrieved literature. Autophagy is a normal mechanism of tissue repair or conversion to energy needed for the repair of rotator cuff tears. However, excessive mechanisms will degenerate the tendon, resulting in an abnormal state. Chronic overloading of the enthesis in PTRCTs and the hypovascular nature of the proximal tendon insertion will lead to hypoxia. The hypoxia state results in oxidative stress. An autophagy mechanism is induced in hypoxia via hypoxia-inducible factors (HIFs) 1/Bcl-2 adenovirus E1B 19-kDa interacting protein (BNIP) 3, releasing beclin-1, which results in autophagy induction. Reactive oxygen species (ROS) accumulation would induce autophagy as the regulator of cell oxidation. Oxidative stress will also remove the mammalian target of rapamycin (mTOR) from the induction complex, causing phosphorylation and initiating autophagy. Hypoxia and endoplasmic reticulum (ER) stress would initiate unfolded protein response (UPR) through protein kinase RNA-like ER kinase (PERK) and activate transcription factor 4, which induces autophagy. Oxidative stress occurring in the hypovascularized chronic rotator cuff tear due to hypoxia and ROS accumulation would result in unregulated autophagy directly or autophagy mediated by HIF-1, mTOR, and UPR. These mechanisms would disrupt enthesis healing

The role of suprascapular nerve block in hydrodilatation for frozen shoulder

Introduction: Frozen shoulder is a debilitating problem that requires comprehensive diagnosis and management. Patients usually recover, but the possibility of not reobtaining a full range of motion exists. Thus, early shoulder exercises are necessary to achieve their full range of motion. This study aims to understand the effects of suprascapular nerve block (SSNB) augmentation at the spinoglenoid notch in hydrodilatation to treat frozen shoulder to facilitate early shoulder exercises. Methods: The current study retrospectively observed 31 patients, including 40–60-year-old patients diagnosed and treated with primary frozen shoulder. The participants were divided into groups A (hydrodilatation) and B (hydrodilatation and the augmentation of an SSNB). Shoulder function and pain scores were assessed before, during, and after the intervention (at months 1 and 6). Results: The result of this study shows that suprascapular nerve block plays a role in decreasing pain in intraintervention (0.69 vs. 5.73; p  0.05). Better delta functional scores were noted in the therapy group during month 1 of the follow-up (delta American shoulder and elbow surgeons [ASES]: 19.29 vs. 34.40, p  0.05; delta DASH: 36.63 vs. 38.92, p > 0.05). Discussion: One rationale for using an SSNB augmentation at spinoglenoid notch in hydrodilatation for treating frozen shoulder was to obtain pain relief immediately to facilitate early manual exercise. SSNB has positive effects on short-term evaluation of shoulder pain and function after glenohumeral hydrodilatation, but not in the long term