Total elbow arthroplasty surgery in neglected elbow stiffness post open reduction and internal fixation with plate and screw: a case report

Post-traumatic and post-operative stiffness of the elbow joint constitutes a significant problem since the elbow is prone to develop soft-tissue contractures and heterotopic bone formation especially if happened in dominant arm. Total elbow replacement is considered as an ultimate treatment in salvaging a stiff elbow which has failed conservative and operative therapeutic procedures to overcome the stiffness and return the elbow to an effective functional arc. A 35-year-old female came to orthopaedic outpatient clinic in Sanglah Hospital, complaining on stiffness in her right elbow since one year prior to admission. This complain was felt after she underwent internal fixation on July 19th 2016, for closed fracture right monteggia bado type-3 post internal fixation. After the surgery, she couldn’t move her elbow because of inappropriate physiotheraphy. Neglected elbow stiffness in this patient was treated surgically with total elbow arthroplasty after physiotherapy has failed to improve her range of motion over 1-year period postoperatively. This decision stated when nonsurgical treatment fails, the patient who has realistic expectations of eventual outcome and who can comply with the arduous postoperative rehabilitation program may be a surgical candidate. Total elbow arthroplasty conducted for these patients resulted in satisfying functional outcome with using quick disabilities of the arm, shoulder and hand (DASH) score improved from 81.8 to 43.2 postoperatively and no complication was reported

Stable ankle after modified brostrom technique using one anchor with double suture at Sanglah Hospital: a case report

Ankle sprains are commonly seen injuries among athletic and young population, and it is necessary to stabilize the patient ankle as soon as possible. Authors report the cost-effective option of using a modified Brostrom technique with one suture anchor in a limited resource setting. Case a 24- year-old male came to the orthopaedic clinic with chief complaint of left ankle pain for the past 2 weeks after jumping and landing in a twisted position. Patient also complained of unstable ankle after the fall. On physical examination, the ankle showed tenderness and instability when anterior drawer test was performed. The patient was diagnosed with lateral ankle instability. This case report describes a modification to the original Brostrom procedure using one suture anchor to anatomically reconstruct the lateral ankle ligaments in treating high demand patient who have lateral ankle instability. After six months follow up, the patient has shown significant improvement on his left ankle. Despite of all the modifications of Brostrom procedure, the use of more suture anchors or sophisticated technique such as arthroscopy might result in increasing cost. Reasonably good outcome can still be achieved with modified Brostrom procedure that utilizes minimal incision, simple steps, and single suture anchor. Due to its cost-effectiveness, authors believe that modified Brostrom technique with one suture anchor is an effective and practical treatment option for lateral ankle instability. Brostrom technique using suture anchors as shown here can provide similarly good outcomes compared with other more complex techniques

Comparison between the results of bipolar hemiarthroplasty with lateral approach and posterior approach in Sanglah General Hospital in 2018: a case series

The purpose of this study was to compare the preoperative, intraoperative and postoperative parameters of Bipolar Hemiarthroplasty procedure using lateral approach and posterior approach in Sanglah General Hospital in 2018. Thirty-five patients diagnosed with femoral neck fracture or intertrochanter fracture underwent Bipolar Hemiarthroplasty using either lateral approach or posterior approach at our institution between January 2018 and December 2018. The primary outcome measures were postoperative complication and hip function. The secondary outcome measures were surgical time, transfusion rate, length of hospital stay, intraoperative blood loss and postoperative haemoglobin. There were 14 patients in Lateral Approach group and 21 patients Posterior Approach group included for analysis. There were no significant differences between the two groups regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between Bipolar Hemiarthroplasty with Lateral Approach and Bipolar Hemiarthroplasty with Posterior Approach group in comparison of intraoperative blood loss (p<0.05) and length of stay (p<0.05). The present study concluded that both lateral and posterior approaches are comparable in terms of functional outcomes and complications. However, there is a tendency of longer hospital of length of stay and more of intraoperative blood loss using posterior approach which should be kept in mind when orthopaedic surgeon is performing a bipolar hemiarthroplasty

Functional outcome in patient with giant cell tumour distal radius after reconstruction by en-bloc resection and non-vascularized fibular bone graft: a case report

Giant cell tumor (GCT) is a relatively common benign primary bone tumor, commonly seen in end of long bones. Treatment goals for GCT of the distal radius are complete excision of the tumor and preservation of wrist function. Usually it can be treated by en-bloc resection and reconstruction using autogenous non vascularized ipsilateral proximal fibular graft. Authors present a case of twenty two years old female complaining of pain and lump in left wrist since two years ago. The pain worsened since 1 month before consultation, but did not radiate elsewhere. Pain was aggravated by movement and decreased with rest. Physical examination revealed a 3 cm mass with tenderness over left wrist. With clinical suspicion of benign bone tumor on left wrist, further evaluation was needed. Plain radiograph revealed an expansile, lytic lesion and soap bubble appearance on her left distal radius like a GCT. Open biopsy result revealed similar morphology with GCT. Reconstruction by en-bloc surgical excision, followed with non-vascularized fibular bone graft fixed with dynamic compression plate (DCP) and wrist ligament reconstruction and fixation of the head of the fibula with carpal bones and distal end of the ulna using K-wires along with palmaris longus tendon were performed. En-bloc resection of giant cell tumors of the lower end radius is a widely accepted method. Reconstruction with non-vascularized fibular graft, internal fixation with DCP with trans fixation of the fibular head and wrist ligament reconstruction minimizes the problem and gives satisfactory functional results

Increased tumor marker ca-125 in multiple myeloma: a case report

Multiple myeloma (MM) is a malignant B-cell lymphoproliferative disorder of the marrow, with plasma cells predominating. It is unlikely to encounter rising level of any tumor marker in MM patient. We present a case of 46-year-old female came to the orthopaedic clinic with chief complains of pain on her right arm, left shoulder and right hip after 5 months. The results of the bone survey of these patients showed multiple lytic lesions with a punched-out appearance in calvaria. The expansive lytic mass was seen with cortical destruction in one third proximal metaphysis to diaphysis of humerus with periosteal reaction and surrounding soft tissue mass. The basic metabolic panel (BMP) result of these patient is hipocellular with decrease of erythroid, myeloid, and megakaryocytes activity and there are 30% plasma cells with positive myeloma cells. Therefore, the patient was diagnosed with MM. The laboratory result of these patient also showed elevation of carbohydrate antigen 125 (CA-125) marker to 56 and 92 (normal range is <35). The patient reported herein showed clear signs and symptoms of MM accompanied by elevated level of CA-125 and CA-15.3 tumor markers. Elevated CA-125 values most often are associated with epithelial ovarian cancer, although levels also can be increased in other malignancies such as endometrial, fallopian tube, breast, lung, esophageal, gastric, hepatic, and pancreatic. However, there were no clear mechanism of how a malignant B-cell lymphoproliferative disorder of the marrow stimulates the production of tumor marker such as CA-125

Management of trimalleolar fracture in Sanglah hospital: a case series

Trimalleolar fractures are one of the most complex fracture around ankle. This study aims to assess the functional outcome and result of the surgical treatment for trimalleolar fracture. Case 1: A 49-years-old male experience closed fracture left ankle Lauge-Hansen PER type IV caused by traffic accident. Patient present with swollen and painful around ankle with an inability to bear weight on the affected extremity. Case 2: A 36-years-old female sustained closed fracture at right trimalleolar ankle, closed fracture at right talus nondisplace Hawkins I, and closed fracture at second, third, and fourth metatarsal. Case 3: A 57-years-old female came with history the left ankle twisted after got slipped and fell down at the yard. Patient was diagnosed by closed fracture left ankle Lauge Hansen SER type IV. Ankle fracture mostly happen in young men and older women during sporting activities or even bicycle or car accidents. The Lauge-Hansen system classify the fracture based on the postion and the direction of the ankle when trauma happen. The AOFAS was use for evaluation patient-relevant outcomes in patients operated on with anatomical ankle injury. In or present study of 3 patients with ankle fractures that were unstable, displaced or both treated surgically by open reduction with internal fixation in accordance with Lauge-Hansen classification. The result in our series confirm that all of 3 patients have a good result based on AOFAS scoring for evaluation the treatment and it means the management approve the good functional outcomes for the patients with ankle fractures

Penentuan Dosis Efektif Pada Abdo Pelvis dan Organ Kritis dari Hasil Penyinaran Computed Tomography Scanner (CT Scan)

Determination of the effective dose on the abdo pelvis and organs at risk has been carried out from the results of the CT Scan irradiation at Sanglah General Hospital.The study began by collecting secondary data from the results of an abdominal CT scan, namely the CTDIvol and DLP values. Then the data was grouped based on gender of 40 patients with an age range of 20-70 years. The value of the effective dose in the abdo pelvis is obtained by multiplying the DLP value and the conversion coefficient k. While the effective dose to organs at risk is obtained from the product of the CTDIvol and wt. The results of the effective dose in the abdo pelvis were obtained in the range of 4.596-6.738 mSv for male patients while for female patients it was 4.209-5.232 mSv. The results of the effective dose in the abdo pelvis are still at the threshold set by BAPETEN, which is 13.275 mSv, so the CT scan is still suitable for use. Average effective dose values for critical organs were 0.2882 mSv for the liver, 0.8646 mSv for the kidney, and 0.5764 mSv for the gonad. The highest dose was received by the gonads. This shows that the gonads are the organs that have the highest sensitivity in receiving radiation doses in the abdo pelvi

Outcome following cervicothoracic junction fusion in T1 pathological fracture of breast cancer spinal metastases: a case report

The cervicothoracic junction (CTJ) is defined as the area extending from vertebral segment C7 to T2. Spinal metastases of CTJ are rare, range from 10% to less than 20%. A 47-year-old woman complained sensory and motor disturbance since 3 weeks prior to admission. History of lump on the left breast was confirmed. Neurological deficit was confirmed as ASIA C at the time of diagnosis. MRI finding suggest fracture of T1 vertebral body with kypothic angle 28° that causing anterior compression of spinal cord. The patient underwent decompression and posterior fusion from C4 to T4. A biopsy sample was also collected from the spine and left breast to confirm the diagnosis. Patient evaluation was done during discharge and at certain points of follow-up for improvement on its neurological, pain, and functional status. An MRI evaluation was performed to evaluate spinal stability and fusion. Significant improvements were observed in patient ambulatory and pain status. Cervicothoracic junction fusion procedure is a considerable choice for the management of pathological vertebral fractures with cervicothoracic junction involvement caused by spinal metastases of breast cancer

Medial swivel type dislocation of the talonavicular joint with associated cuboid fracture: a case report

Medial Swivel-type dislocation are dislocation of talonavicular joint (TNJ) medially and the calcaneus swivels under the talus, with the calcaneocuboid joint intact. This is a rare injury due to the strong network of ligament and tendinous structures. An 11-year-old girl presented after 1 week of injury to the left foot. She had pain, swelling on the mid-foot and inability to weight bearing. X-ray and computerized tomography (CT) scan showed medial dislocation of TNJ, with fracture of cuboid body. A closed reduction was attempted but it failed. Patient then underwent open reduction with K-wire fixation and immobilization by below knee cast for 3 weeks. After K-wire removal, the foot was stable with near normal ankle and sub-talar joint range of motion and patient started to partial weight bearing Midtarsal dislocations of the foot are rare injuries. In this case dislocation is resulted from high-energy medial forces to the forefoot. The associated cuboid fracture possibly as a result of tensile forces through the lateral structure of midfoot with adduction. ‘Swivel dislocation’ in which the TNJ dislocates, usually medially, and the calcaneus swivels under the talus, with the calcaneocuboid joint intact. A careful assessment of initial radiograph and CT scan should be done to determine type of dislocation and associated fracture. An open reduction K-wire fixation bring a stable reduction. Talonavicular dislocations are rare injuries, occur as a result of high-energy trauma. A stable reduction and good outcome are anticipated

Pemberian Ransum Berenergi Tinggi Memperbaiki Performans Induk dan Menambah Bobot Lahir Pedet Sapi Bali (PROVISION HIGHER LEVEL OF ENERGY RATION IMPROVE CATTLE PERFORMANCE AND CALVES BIRTH WEIGHT)

This study aimed to determine the effect of energy levels in bali cattle rations of seven months pregnant on birth weight calves. The study was conducted in Farm Sobangan Badung Regency on 12 pregnant breeding phase of pre-calving (two months before the birth) with the parent body weight at average 300 kg/head. The treatments were four types of rations which was iso protein 10% with the energy level were 2000, 2100, 2200, and 2300 kcal ME/kg respectively. Variables measured were: weight gain, consumption of dry matter (DM), organic matter (OM), consumption energy, crude protein (CP) and crude fiber (CF), and birth weight calves. The design used was a randomized block design. Results showed DM intake varied from 5175.80 to 5366.80 g/d. Consumption of OM ranging from 4438.54 to 4610.44 g/d. Calf birth weight was also highest in the parent with treatment D is 18 kg. All these differences were not statistically significant (P>0.05). Energy consumption significantly highest (P <0.05) at the treatment D i.e. 19320.65 kcal GE/d. The conclusion of this study is energizing ration of 2000–2300 kcal ME/kg increase energy consumption however, improve performance seven months pregnant bali cattle and calf birth weight to add into 18 kg. ABSTRAK Penelitian ini bertujuan untuk mengetahui pengaruh level energi ransum pada sapi bali bunting tujuh bulan terhadap bobot lahir pedet. Penelitian dilakukan di Stasiun Penelitian Sobangan, Mengwi, Badung, Bali pada 12 ekor induk bunting fase pre-calving (dua bulan menjelang kelahiran) dengan bobot badan induk sekitar 300 kg/ekor. Perlakuan yang diberikan adalah empat jenis ransum iso protein 10% dengan level energi berbeda (2000, 2100, 2200, dan 2300 kkal ME/kg) sebagai perlakuan A, B, C, dan D. Peubah yang diamati: pertambahan bobot badan, konsumsi bahan kering (BK), bahan organik (BO), konsumsi energi, protein kasar (PK), serat kasar (SK), dan bobot lahir pedet. Rancangan yang digunakan adalah Rancangan Acak Kelompok. Hasil penelitian menunjukkan konsumsi BK bervariasi dari 5175,80–5366,80 g/h. Konsumsi BO mulai dari 4438,54–4610,44 g/e/h. Bobot lahir pedet juga tertinggi pada induk dengan perlakuan D yaitu 18 kg/e. Semua perbedaan ini secara statistika tidak nyata (P>0,05). Konsumsi energi nyata (P<0,05) tertinggi pada perlakuan D yaitu 19,320,65 kkal GE/h. Simpulan dari hasil penelitian ini adalah pemberian energi ransum dari 2000–2300 kkal ME/kg meningkatkan konsumsi energi, memperbaiki performans sapi bali bunting tujuh bulan, dan menambah bobott lahir pedet sehingga menjadi 18 kg