Role of Scaffold\u27s Biocompatibility in Influencing Comminuted Fracture Healing in Sprague-Dawley Rats

Introduction.The use of bone graft is still debatable for treating comminuted fracture. Autograft is the gold standardof bone graft. However, it has a limitation in supply. Therefore, the use of other source of graft (allograft, xenograft,or synthetic) is increasing. Graft must have good biocompatibility in order to enhance fracture healing.Materials and methods.Randomized post test only control group was conducted in 30 Sprague-Dawley rats inorder to evaluate biocompatibility of the scaffold. We used hidroxyapatite (HA)-Bongros®, nanocrystalline (HA)-CaSO4 (Perossal®), nanocrystalline HA (Ostim®), morselized bovine xenograft (BATAN), dan local HA from dr.Sutomo Hospital as the scaffold. Tissue reaction (foreign body giant cell (FBGC) and lymphocyte), radiological andhistological score was evaluated at 8th weeks.Results. The amount of FBGC and histological score showed significant difference (p=0,003 and p=0,013). LocalHA scaffold showed the most FBGC accumulation. There was no significant difference in the amount of lymphocyte(p=0,397) and radiological score (p=0,204 for antero-posterior projection and p=0,506 for medio-lateral projection).There was significant correlation between the amount of foreign body giant cell and histological score (p=0,034).Conclusions.Both physical and chemical factor influenced biocompatibility of scaffold. Scaffolds that have poresshowed better histological score compared to that has none. Chemical compound of the scaffold play important rolein tissue reaction. The amount of FBGC showed the cytotoxic level of the scaffold

Trauma and Injury Severity Score in Predicting Mortality of Polytrauma Patients

TRISS (Trauma and Injury Severity Score) is one of the most commonly used trauma score. Currently, there is no data about using TRISS in the care of polytrauma patients at emergency department of dr. Cipto Mangunkusumo Hospital (CMH). This research was intended to evaluate whether TRISS can predict the mortality of polytrauma patients at CMH. This was an analytic descriptive study with retrospective cohort design. Data was collected from medical records of polytrauma patients who were admitted to emergency department of CMH from 2011-201 4 then we analyzed the relationship between TRISS and patient\u27s prognosis. Furthermore, we conducted bivariate and multivariate analysis by SPSS 20 software. Seventy medical records were included in this study. The majority of patients were male (65%) in young age. There were 69 patients who experienced blunt trauma, with the majority (94.3%) were caused by motor vehicle accident. After receiving trauma care, there were 26 deaths, while other 44 patients survived. From bivariate and multivariate analysis, we found a significant difference between TRISS and patient\u27s prognosis. TRISS strongly predicts polytrauma patient\u27s mortality (AUC 0,899; IK95% 0,824-0,975). TRISS has 84,6% sensitivity and 81.8% specificity with optimal intersection point ≤ 90,5. TRISS is able to predict the mortality of polytrauma patients at CMH.&nbsp

Simple Bone Cyst Management: Percutaneous Steroid Injection Versus Curettage with Hydroxiapatite

The main goals of the therapy of simple bone cyst (SBC) are to get the bone healing, prevent pathological fractures, and management of pain symptom. There are various methods of the SBC treatments, however they still remain controversial because of their healing rate and invasiveness of surgery. A total of 10 SBC patients were divided into two groups namely curretage with hydroxyapatite (HA) and decompression and percutaneous steroid injection (PSI). PSI was performed three times at intervals of each month. The mean followup of 12-26 months. Evaluation of functional outcome by Musculoskeletal Tumour Society (MSTS) score and supported with radiologically based on Chang criteria. There were 5 patients (proximal femur 2; proximal humerus 2, radius 1) performed curretage with HA therapy. Remaining 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1) were performed PSI therapy. PSI group had better MSTS score, particulary at month 3 (55%) and month 6 (84%) than curettage with HA therapy (47% and 69.3%). Complete bone healing was found in both group at month 12 follow up, however solid union occurred faster in PSI group. PSI tends to have faster and better functional outcome than curettage and HA. Curettage with HA and PSI have similar complete bone healing at month 12 follow up

Accuracy of Core Needle Biopsy for Musculoskeletal Lesion in Cipto Mangunkusumo Hospital Jakarta

Core needle biopsy (CNB) is considered to have similar results with open biopsy in accuracy and already becomes a routine procedure to establish the diagnosis of musculoskeletal lesion. However, the accuracy of CNB for muskuloskeletal lesion in Indonesia has not been reported. The aims of the study to know the accuracy of CNB for muskuloskeletal tumor diagnoses. From January 2011 to August 2015, all patients with musculoskeletal lesion in dr. Cipto Mangunkusumo Hospital underwent CNB and subsequently, tumour excision were indentified and enrolled. Diagnostic accuracy was evaluated for both histopathology and clinicopathological conference (CPC) conclusion. A total of 86 samples were enrolled in this study. The accuracy of CNB compared to post excision histopathology is 74.4%. With CPC conclusion, the accuracy is 83.7% with sensitivity 98%, specificity 59% (p<0.001). The accuracy of CNB after immunohistochemistry was increased from 74.4% to 84.9% with sensitivity 98%. The accuracy of CNB was 97.1% and 82.7% for benign lesion and Malignant lesion respectively (p<0.01). The accuracy of CNB to differ and to confirm diagnosis as primary or metastatic lesion was 97.2% and 85.7% respectively (p<0.001). Inconclusion, CNB is a reliable diagnostic method to establish musculoskeletal tumor diagnoses. CPC significantly provides better accuracy rate of CNB

The Effect of Bone Morphogenetic Protein-2 and Hydroxyapatite Granules on the Incorporation of Autoclaved Femoral Autografts in Sprague-Dawley Rats

Introduction.Numerous methods of limb salvage surgery have been utilized in musculoskeletal tumors, one of them being autoclaved autograft. Apart from killing tumor cells, autoclaving of autograft will also inevitably damage the inherent osteoblasts and bone morphogenetic proteins, thus impeding bone healing and graft incorporation. Bone Morphogenetic Protein-2 has been proven to accelerate fracture healing. Only few studies have investigated the effect of Bone Morphogenetic Protein-2 on the incorporation of autoclaved autografts. In this study we investigated the effect of Bone Morphogenetic Protein-2 on the incorporation of autoclaved autografts in Sprague-Dawley rats. The objective of the study is to evaluate the effect of Bone Morphogenetic Protein-2 with hydroxyapatite granules on healing or incorporation of autoclaved autografts. Materials and methods.Twenty Sprague-Dawley rats were randomized into three groups: control group, hydroxyapatite group, and Bone Morphogenetic Protein-2 group. All animals underwent osteotomy of the femoral shaft, and the resulting autograft fragments were autoclaved for 15 minutes under a temperature of 134o Celsius. Autoclaved autografts were then re-implanted and fixed with intramedullary Kirschner wires. hydroxyapatite granules were added into the fracture sites of animals belonging to hydroxyapatite group. In the Bone Morphogenetic Protein-2 group, hydroxyapatite granules that had been immersed in Bone Morphogenetic Protein-2 solution were added to the fracture sites. Meanwhile, rats from the control group received neither Bone Morphogenetic Protein-2 nor hydroxyapatite granules. Anteroposterior and lateral radiographs of the osteotomized femurs were taken eight weeks later, after which all animals underwent euthanasia. Osteotomized femurs were harvested and sent for histopathological examinations. Lane-Sandhu radiological score and Salkeld-Marino histological scores were calculated. Results.The median distal radiological scores in control, hydroxyapatite and Bone Morphogenetic Protein-2 groups were 0.5, 1 and 2, respectively (p=0.011). Proximal radiological scores did not differ between groups (p=0.160). The median proximal histological scores in control, hydroxyapatite and Bone Morphogenetic Protein-2 groups were 3, 4 and 13, respectively (p=0.004); and distal histological scores were 3, 1 and 13, respectively (p=0.001). Post-hoc analysis revealed that significant differences in histological scores and distal radiological score were found between control and Bone Morphogenetic Protein-2 groups, as well as between hydroxyapatite and Bone Morphogenetic Protein-2 groups. Scores did not differ between control and hydroxyapatite groups (p<0.05). Proximal radiological and proximal histological scores were not correlated (r = 0.267, p>0.05). Distal radiological and distal histological scores, however, were moderately correlated (r = 0.567, p<0.05). Conclusions. Bone Morphogenetic Protein-2 with hydroxyapatite granules accelerated the incorporation of autoclaved autograft in Sprague-Dawley rats, while hydroxyapatite granules alone did not

Embryonal Rhabdomyosarcoma of the Forearm: a Diagnostic Dilemma and Surgical Management

Establishing the diagnosis of primary soft-tissue sarcoma is a difficult task even for an experienced clinician. There is a plethora of clinical manifestation yet its radiological appearancecan be very deceiving in every way.  We report a case of embryonal rhabdomyosarcoma in an adultfemale with lump in her left distal forearm, with clinical manifestation and radiological appearance thatimmitate bone sarcoma. The diagnosis was not established until the biopsy result came up whichalso confirmed by immunohistochemistry stain. The treatment is a novelty limb salvage surgery withmodified forearm segmental amputation and shortening procedure. Six months after the surgery thepatient had good functional outcome without local recurrence and distant metastasis

Sacral Tumor: Experience in a Single Institution

Introduction. Sacral tumors are rare, and experience of these tumors is usually limited to a small number of patients. Inthis study, we evaluated profile, survival rates, and functional outcome in a series of sacral tumor treated in our institution.Method. We retrospectively reviewed the records of 22 sacral tumor patients from January 1995 to February 2014 inCipto Mangunkusumo National Central Hospital, Jakarta, Indonesia. Kaplan-Meier method was used to describedsurvival and functional outcome. Their correlation with clinical profile, histological type, level of sacral involvement,treatment, and complication were analyzed by Log rank test.Results. From 22 patients, 5 of them were excluded from this study. Thus, there were 17 cases of sacral tumor, 16 ofthem were Malignant and one case was benign. In Kaplan-Meier Analysis, there were no significant difference insurvival found between sex, age group, biopsy type, level of sacral involvement, treatment, and complication. There wassignificant difference in survival found between histopathology result (p=0.012), and giant cell tumor GCT showed thehighest survival, followed by chordoma, metastatic lession, and Ewing Sarcoma. Sacral tumor at the level of S2 andbelow had better functional outcome compared to the one above S2 (p=0.001). There were no difference in functionaloutcome found between histopathology type and treatment (p=0.137 and p=0.210).Conclusion. The majority of primary tumors of sacrum are chordoma which present with nonspecific early signs andsymptoms. Survival rate and functional outcome of the sacral tumor patients were determined by histopathology resultand level of sacral involvement. Lower level of sacral involvement lead to better survival and functional outcome

Schwannoma Nervus Ulnaris

Ulnar nerve schwannoma is a rare peripheral nerve tumor. Accurate preoperative diagnosis is very important to evaluate the involvement of certain peripheral nerve and surgical planning. MRI is very important investigation for diagnosis before surgery. Surgical management principle in this case is to remove the tumor mass and preserve main ulnar nerve.Schwannoma nervus ulnaris merupakan tumor saraf tepi yang jarang ditemukan. Diagnosis yang akurat sebelum pembedahan sangat penting untuk menilai keterlibatan saraf tepi tertentu dan merencanakan tindakan pembedahan. MRI merupakan pemeriksaan penunjang yang sangat bermanfaat untuk menegakkan diagnosis sebelum pembedahan. Prinsip penatalaksanaan bedah pada kasus ini adalah mengangkat massa tumor dan mempertahankan serabut utama nervus ulnaris