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BACKGROUND: Performing total hip arthroplasty (THA) or total hip replacement (THR) in hip ankylosis is not a simple procedure. CASE PRESENTATION: We presented a complicated case of a patient with flexion contracture and ankylosis of hip joint due to neglected avascular necrosis of femoral head treated with THR on one thigh, and periprosthetic fracture on the other which was also treated with THR later. One year after the surgery, the both hips function was improved and the patient was able to walk without assistive device. CONCLUSION: Total hip replacement is a modality that could be considered for the treatment of advanced AVNFH and ankylosis of hip joint, with femoral periprosthetic fracture as one of its potential complications. more...

Background: Cervical spondylotic myelopathy (CSM) is a clinical disease which characterized by degeneration of the intervertebral discs and nearby spinal structures. The goal of this study is to compare laminoplasty (LP) versus laminectomy and fusion (LF) for multilevel cervical spondylotic myelopathy (CSM) in terms of clinical safety and effectiveness. Methods: This study is a meta-analysis from randomized and non-randomized control study. The database being used were PubMed, Google Scholar, Cochrane Registry, and Embase. The authors extensively searched the relevant papers comparing the clinical efficacy and safety of LF and LP for the therapy of multilayer CSM. The outcome measures recorded were visual analog scale (VAS), cervical curvature index (CCI), The Japanese Orthopaedic Association (JOA) scores, Nurich grade, reoperation rate, complications, and rate of nerve palsies. The analysis were performed by using RevMan 5.3. Results: Our meta-analysis includes a total of 14 papers. The pooled mean difference between LF and LP was insignificant in terms of VAS of neck pain (p=0.54), post-operative CCI (p=0.24), JOA score (p=0.29), Nurich grade (p=0.16) and reoperation rate (p=0.21). The complication and nerve palsies rate was higher in LF group compared to LP group (OR 2.60, 95% CI 1.85, 3.64, I2=26%, P < .00001) and (OR 3.18, 95% CI 1.66, 6.11, I2=47%, P=.0005) respectively. Conclusion: Our meta-analysis demonstrates that the majority of clinical outcomes for surgical treatments of multilevel CSM utilizing LF and LP are comparable. However, it was discovered that LP was superior compared to LF in terms of nerve palsy rate. This needs additional validation and research in more extensive sample-size and randomized studies. more...

In developing countries, a large proportion of patients with scoliosis present late, especially the underprivilege, so the curves had become rigid and severe. There is still no consensus about the surgical management of the severe and rigid scoliosis and some literatures suggested that combined anterior and posterior or single-stage posterior-only instrumentation are generally required for the correction of these deformities. We presented three cases of severe rigid scoliosis treated surgically in our center with two staged operation (anterior surgery and posterior instrumentation). A retrospective review was undertaken of patients with severe scoliosis who had undergone two-staged operation in Orthopaedics and Traumatology Department of Prof Ngoerah General Hospital Bali during the period between January 2018 and February 2020. The data was obtained from the hospital’s medical records and archives in our department, included sex, age, the severity and reducibility of the Cobb angle, maturity rate, treatment, length of stay, complications found, and the Scoliosis Research Society: 30 Questionnaire (SRS-30) score before and three months after the surgery. During the period of between January 2018 and February 2020, there were three cases of severe rigid scoliosis who underwent two-staged operation. The two staged operation performed were anterior surgery (soft tissue release, corpectomy, and anterior fusion), and posterior instrumentation (facetetectomy, rotation, stabilization, and fusion). There were one case of intra-operative hypovolemic shock and anemia that could be corrected succesfully. All three patients showed no complaint and the clinical examination showed improvements of the deformity post operatively. There were also improvement of the total SRS-30 score of all three patients after the two staged procedures performed (mean = 4.4) compared to pre-operative score (mean = 3.4). The two-staged operation including anterior surgery and posterior instrumentation is still a safe and effective way in treatment of severe rigid scoliosis. more...

This meta-analysis aimed to compare the results of posterior stabilized and posterior cruciate-retaining prosthesis. To find randomized controlled studies comparing the clinical outcomes of cruciate-retaining and posterior-stabilized systems, a computerized literature search was performed. To find more pertinent studies, the table of contents of four significant orthopaedic journals and the references part of two arthroplasty text books were examined. Finally, 1114 individuals' knees totaling 1265 were compared. A statistical analysis showed that posterior-stabilized knees had significantly greater flexion and range of motion, but no change in complication rates. This's clinical significance is still unknown. The surgeon's preference and comfort level with a particular design should determine which design is used. more...

BACKGROUND: Neglected patellar tendon rupture is an extremely rare case among orthopedic injuries that severely compromises the function of the extensor mechanism of the knee. Therefore, a prompt and accurate diagnosis of a ruptured patellar tendon are a key to efficacious management, because a treatment delay is often associated with unsatisfactory functional outcomes. CASE PRESENTATION: We report the case of an adult male patient with traumatic patellar tendon rupture after 9 months of a motorcycle accident. The patient underwent reconstruction surgery using semitendinosus and gracilis tendon augmentation. This procedure restores the anatomical position of the patella and prevents extensor lag. At a 3-month follow-up, a full recovery of the structure and function of the extensor mechanism was perceived. The patient could return to normal daily activities following rehabilitation protocol. CONCLUSION: Semitendinosus and gracilis tendon autograft is the technique of choice to be applied in the surgical reconstruction of neglected patellar tendon rupture. more...

Hemorrhoidal disease is a pathological condition due to the abnormal engorgement of the arteriovenous plexus beneath the anal mucosa. Anatomically, it can be located under the skin on the outer part of the dentate line, known as external hemorrhoid; or inside the anus on the proximal part of the dentate line, called internal hemorrhoid. Internal hemorrhoid may further develop from a painless anal mass into protruded and painful mass throughout the anal canal, often accompanied by inflammation and more severe symptoms. Various management strategies need to be considered carefully to ensure the success of therapy and improve the quality of life of patients with internal hemorrhoids. Conservative management is the initial stage that can be performed, including the provision of high-fiber nutrition, education related to bathroom habits, and the use of flavonoid regimens. Surgical therapy can be divided into outpatient intervention and conventional surgeries. This review will encompass the comprehensive diagnostic approach and management of internal hemorrhoids to help clinicians understand the appropriate management and provide better clinical benefits for the patients. more...

The hepatorenal syndrome is one of various potential causes of acute kidney injury in patients with decompensated liver disease. Hepatorenal syndrome is diagnosed based on reducing kidney function without any evidence of intrinsic kidney disease, including proteinuria, hematuria, or abnormal kidney ultrasonography. Clinically, hepatorenal syndrome is divided into two types named type 1 and type 2. The most favorable therapy for HRS cases is liver transplantation; however, only a few undergo this procedure due to the high mortality. Other modalities for hepatorenal syndrome therapy are pharmacology and non-pharmacology approaches. The purpose of management HRS is to optimize and stabilize the patient until an organ transplant available. This review aims to discuss the underlying pathophysiology and demonstrate the diagnostic approach of hepatorenal syndrome to determine the most appropriate therapeutic measures in clinical practice. The clinicians must be aware of management principles of hepatorenal syndrome to improve the quality of care for patients and optimize the clinical conditions. more...

The continuing rise of obesity epidemic in the global population has been markedly associated with the escalating occurrence and severity of non-alcoholic fatty liver disease (NAFLD). This condition represents a complex metabolic imbalance, primarily characterized by excessive intrahepatic accumulation of triglycerides, known as hepatic steatosis. This pathophysiological process is initiated by the disproportionation between the uptake of dietary fatty acids in plasma, as well as the increase of de novo fatty acid synthesis, which is not equally accompanied by the exportation and oxidation of fatty acid in the form of triglycerides. As mentioned earlier, the underlying metabolic process becomes a significant risk factor for developing cardiometabolic complications, involving type 2 diabetes mellitus, insulin resistance, and dyslipidemia. This review presents a comprehensive understanding of the pathogenesis and pathophysiology of obesity and NAFLD to determine innovative management approaches for the prevention and treatment of the disease. more...

Sampai saat ini masih ada kesalahan pemahaman terhadap penggunaan antibiotik. Banyak antibiotik digunakan pada infeksi selain bakteri. Penggunaan antibiotik yang tidak tepat dapat menyebabkan resistensi antibiotik. Berdasarkan Kementerian Kesehatan RI angka kematian akibat resistensi antimikroba sampai pada tahun 2014 sebesar 700.000 per tahun. Resistensi dapat menyebabkan infeksi lebih sulit diobati, oleh karena itu penggunaan antibiotik harus mengikuti strategi peresepan antibiotik. Penelitian ini bertujuan untuk mengetahui gambaran tentang penggunaan antibiotik tanpa resep dokter di kalangan guru Kecamatan Labakkang, Kabupaten Pangkajene dan Kepulauan. Penelitian ini menggunakan studi cross-sectional dengan menggunakan data primer (kuesioner). Terdapat 236 sampel guru yang memenuhi kriteria inklusi dan ekslusi. 185 orang (78,4%) pernah menggunakan antibiotik tanpa resep dokter. Pengguna antibiotik tanpa resep dokter paling banyak dengan keluhan utama demam 47 orang (25,4%), jenis antibiotik adalah golongan penisilin 113 orang (61,1%), lama pemakaian < 3 hari 132 orang (71,4%), mendapatkan informasi dari keluarga 71 orang (38,4%), tempat membeli di apotik 146 orang (78,9%), dan 161 orang (87%) menjawab bukan masalah ekonomi, alasan menggunakan antibiotik tanpa resep sebanyak 137 orang (74,1%) menjawab pengobatan terdahulu memberi hasil yang baik dan 125 orang (67,6%) menjawab tidak meminum antibiotik sampai habis, yang memiliki persediaan antibiotik sewaktu-waktu 98 orang (53%). Tingkat penggunaan antibiotik tanpa resep dokter responden cukuptinggi. Masih banyak responden yang belum memahami dengan baik kegunaan/ indikasi antibiotik yang mereka gunakan. more...

Sepsis berat didefinisikan sebagai sepsis dengan disfungsi satu atau lebih organ. Salah satu penyebab sepsis di Intensive Care Unit (ICU) adalah Hospital-Acquired Pneumonia (HAP). HAP terjadi 5-10 kasus per 1000 pasien yang memakai alat bantu napas mekanis. Ventilator Associated Pneumonia (VAP) merupakan bagian dari hospital-acquired pneumonia (HAP), terutama disebabkan oleh Pseudomonas aeruginosa. Beberapa faktor penting pada patogenesis VAP, antara lain sistem barier Na+-K+-Cl– transporter-1 (NKCC1), ETT tanpa antibiofilm. Upaya pencegahan VAP berupa oral higiene, alat ETT berbahan antibiofilm, elevasi kepala 30 derajat, evaluasi kemampuan batuk, dan fungsi menelan. more...

Ewing’s sarcoma is a highly malignant small round cell tumor from bone or soft tissue. The clinical manifestation is non-specific, with local pain being the most common symptom by far. It affects prevalently among children younger than ten years. The chromosomal translocation t(11;22)(q24:q12) is one of the causes of Ewing’s sarcoma. The gold standard diagnostic is incisional biopsy, additionally with cytogenic immunohistochemical. The current standard treatment for resectable Ewing’s sarcoma begins with neoadjuvant chemotherapy, followed by limb salvage procedure and postoperative adjuvant chemotherapy. After resection of Ewing’s sarcoma, the large bone defects should be reconstructed to restore the function of the affected limbs. The main options for reconstruction include autogenous bone grafts and endoprosthesis. Prognosis of Ewing’s sarcoma is highly dependent on clinically evident metastatic disease, which may be preventable with early detection and treatment with aggressive local disease control and systemic multidrug chemotherapy. This article presents a rare case of an 8-year-old elementary schoolboy, diagnosed with Ewing’s sarcoma of the proximal left humerus that was confirmed by plain radiograph and immunohistochemical biopsy. Patient’s family discontinued the chemotherapy schedule and ignored the surgical reconstruction procedure. more...

Posterior shoulder dislocation is a unique finding in the orthopedics field. Although it is rarely found, this condition is one that must be considered in the presence of acute shoulder pain. Most clinicians often miss this diagnosis on initial examination; therefore, imaging radiographs are often needed to confirm the diagnosis. Unfortunately, insufficient radiographic assessment can be the greatest pitfall in establishing an accurate diagnosis. Multiple radiographic projections, including anteroposterior view, scapular Y view, and the axillary view, are important to achieve an accurate diagnosis. In this study, we present a middle-aged patient with a pain and trauma history on the shoulder. Anteroposterior radiographic examination revealed an atypical finding. Fortunately, additional radiographic projections were successful in establishing the proper diagnosis of posterior shoulder dislocation. This study also presents a comprehensive review of the keys in the recognition and treatment of the injury. more...

Introduction: Acromioclavicular joint dislocations represent a frequent condition, affecting a very specific and generally active population and accounting for around 9% of all shoulder injuries. Case Presentation: We present a series of patients who underwent AC Joint reconstruction using Semitendinosus graft with internal bracing. The beach chair position is used for acromioclavicular reconstruction surgery. In this technique, we restore the anatomy, reconstruct the coracoclavicular ligament, and reinforced the acromioclavicular ligament. And it is reliable for chronic acromioclavicular joint injury. At final follow up we found excellent results with average pain score of 1.6, and average ROM of 160° of forward flexion and abduction, 70° of external rotation, and internal rotation level at T11. Postoperative function also showed great improvements with average ASES of 85 points, an average Constant Score of 89 points. This technique also achieved acceptable radiographic results, with an average coracoclavicular distance increase of 1.4 mm Discussion & Conclusion: The loss of AC joint congruence with the Weaver Dunn procedure suggested that possibly the problem wasn’t only biological. This technique seems to be especially advantageous as it allows for an anatomic, biological, and minimally invasive procedure while avoiding some of the inconveniences described in other reports. Although demanding, it can be reproducibly performed arthroscopically, and good clinical outcomes should be expected. more...

An isolated sustentaculum tali fracture is a rare manifestation of orthopedic injury involving the supporting bone of the middle calcaneal facet. Globally, the incidence is estimated to be less than 1% of all calcaneus fractures. We reported a 42-year-old man with persistent ankle pain and instability on the right foot following a week after a motorcycle accident. The Computed tomography evaluation showed an avulsion of the medial sustentaculum tali on the right calcaneus bone. An open reduction and internal fixation procedure was performed using two cannulated cancellous screws applied across the lateral wall through the sustentaculum bone medially. The subjective postoperative evaluation showed that the patient responded well and gradually returned to daily routine activities without pain and instability. Informed Patient Consent: The patient has already been assigned for informed consent and agreed to the publication of the case and clinical images for medical education purposes. Funding: None Conflict of Interests: None more...

Gastric cancer remains the second most common GI cancer in the world, and is usually found in men, especially those over 50 years of age. Gastric cancer is a multifactorial disease resulting from the interactionbetween genetic and environmental factors at the stomach mucosa level. The diagnosis is made by endoscopic biopsy. The high frequency of late diagnosis or advanced stages accounts for the overall poor prognosis for this tumor. Surgery is the most frequently employed modality for both cure and palliation. However, most patients present with advanced disease that is incurable. We reported a rare case of young male patient aged 24 years old with advanced gastric adenocarcinoma. The main clinical features were epigastric pain, vomiting, melena and weight loss. An abdominal mass was palpable on physical examination. Endoscopy showed a giant tumor mass causing gastric outlet obstruction, that appear edematous, there were hemorrhagic lesions. The histopathologic examination revealed poorly differentiated adenocarcinoma. Palliative resection could not be performed because the tumor tightly adhered to adjacent structures. Jejunostomy or nasojejunostomy tube were performed to allow enteral nutrition. Best supportive care is very important to improve the quality of life. more...

Introduction An isolated sustentaculum tali fracture is a rare manifestation of orthopaedic injury involving the supporting bone of the middle calcaneal facet. Globally, the incidence is estimated to be less than 1% of all calcaneus fractures. Presentation of case We reported a 42-year-old man with persistent ankle pain and instability on the right foot following a week after a motorcycle accident. The Computed tomography evaluation showed an avulsion of the medial sustentaculum tali on the right calcaneus bone. An open reduction and internal fixation procedure was performed using two cannulated cancellous screws applied across the lateral wall through the sustentaculum bone medially. The subjective postoperative evaluation showed that the patient responded well and gradually returned to daily routine activities without pain and instability. Discussion and conclusion Surgical approach using the cannulated cancellous screw to establish a firm fixation of sustentaculum tali fracture fragment into calcaneus bone and to prevent pathological movement., Highlights • Sustentaculum tali fracture is an extremely rare in orthopaedics cases. • Middle age adult with persistent pain and instability on the foot could sometimes highly benefit from CT scan imaging modality. • Surgical treatment must be always following with rehabilitation protocol to restore the normal function. more...