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Background: Low back pain and sciatic pain are some of the most common and infuriating pains. The prevalences are about 18-29%. The minimally invasive technique of spine decompression offers several advantages. One of the methods is percutaneous endoscopic lumbar discectomy (PELD) using the transforaminal approach. This study aimed to evaluate the needle angle and sleeve placement based on skin entry point using 3-dimensional (3D) computed tomography morphometric measurements. Methods: The data were collected using 3D computed tomography morphometric measurements on the 4th – 5th lumbar. The parameters comprised several aspects of the vertebral morphometry. The vertebral AP length, spinous to skin length, AP vertebral body length, 30% of vertebral body length, and angle of the needle insertion data were collected. All the data were then analyzed using SPSS. Results: There were 50 patients enrolled in this study. From vertebral morphometry, the average angle for the needle insertion for 4th lumbar spine in the coronal plane was 48.224 (± 4.138)°. The average distance of the needle insertion was 8.185 (±1.709) cm. The average twice the distance of the needle insertion was 16.370 (±3.417) cm and the average angle with the length doubled was 22.268 (±0.953)°. The average angle for 4th lumbar in the sagittal plane was 78.169 (±1.445)°. Conclusion: We found the angle in the coronal plane for PELD in the 4th vertebra lumbar was 48.224°. The angle of insertion was 22.268° when the distance was doubled. The angle in the sagittal plane for PELD in the 4th lumbar spine was 78.169°.

INTRODUCTION: Plasmacytoma is a solitary neoplastic lesion marked by a localized accumulation of monoclonal plasma cells without an evidence of a systemic proliferation. Plasmacytoma may arise in intramedullar (bone) or extramedullar (soft tissue). Extramedullary plasmacytoma is rare, with the most frequent locations in the nasal cavity and nasopharynx. Here, we describe a case of solitary extramedullary plasmacytoma of the shoulder region. CASE REPORT: A 49-year-old male patient presented with right shoulder mass that was solid, fixed, ulcerated, and poorly circumscribed, with size 20 × 15 × 10 cm. Shoulder X-ray and MRI results revealed a soft-tissue mass on the right shoulder with the destruction of lateral part of the right clavicle. Biopsy results suggested Non-Hodgkin Lymphoma; however, first panel of immunohistochemical (IHC) analysis showed negative staining of LCA, CK, CD20, and CD3, with high Ki67. Second panel of IHC revealed negative staining of ALK, TdT, and CD79a; meanwhile, CD138 was strongly expressed. Further hematological, biochemical, and radiological examinations that revealed no systemic involvement supported the diagnosis of solitary extramedullary plasmacytoma. Patient received radiotherapy treatment 60 Gy in 30 fractions and zometa within 4 weeks interval and showed remarkable response of the therapy. DISCUSSION: Solitary extramedullary (soft tissue) plasmacytomas (SEP) are less common than solitary bone plasmacytoma (SBP), yet it has a better prognosis since the majority can be cured by local radiotherapy. CONCLUSION: We report a case of SEP of the shoulder that showed remarkable response of therapy. In this case report, radiotherapy was shown to be a highly effective modality to treat a patient with solitary extramedullary plasmacytoma.

INTRODUCTIONThe trend of intertrochanter fractures has gradually increased leading to a high frequency of difficulties and damage as the result of the increased age and risk factors. Accordingly, the aim of stable fixation in these fractures is designed with appropriate surgical procedures and patient care. The contribution of a stable fixation is due to several considerations including fracture shape and assurance, bone quality, comminution pattern, implant choice, and surgical technique. This study aimed to assess the functional outcomes of the patients with an intertrochanteric fracture who underwent hemiarthroplasty with AO recon as buttressing.MATERIALS AND METHODSThis was a case series study conducted in Gadjah Mada University Academic Hospital in Yogyakarta from July 2017 to August 2018. Patients with Evans unstable intertrochanteric femoral fractures who underwent simultaneous bipolar hemiarthroplasty and fixation with AO reconstruction plate and SS wire as buttressing were evaluated. Pre and postoperative radiographs, postoperative Visual Analog Scale (VAS) score, walking ability using Harris Hip Score (HHS), and Lower Extremity Functional Score (LEFS) were the outcome parameters.RESULTSA total of 6 patients, 4 of whom were male with an average age of 81 years old were included in this study. All the mechanisms of injury were low-energy trauma. The mean VAS score was decreased, from 7 pre-operatively to 1.5 post-operatively at final follow-up (p-value 0.05). The patients had a mean HHS of 82.5 and a LEFS mean of 56.7.CONCLUSIONButtress plate fixation using an AO reconstruction plate for trochanteric fracture following bipolar hemiarthroplasty resulted in a good functional outcome.

BACKGROUND: Bone metastasis is a complication that often occurs due to cancer in solid organs, and more often compared to primary bone tumors. Bone metastasis is associated with excessive osteolytic processes. AIM: This study was conducted to reveal the correlation between Receptor Activator of Nuclear factor kβ Ligand (RANKL) expression, lactate dehydrogenase (LDH), and neutrophil-lymphocyte ratio (NLR) level in patients with bone metastatic lesions. METHODS: This cross-sectional study was conducted in 15 subjects with bone metastatic lesions. The specimens were fresh bone tissues obtained by open biopsy. Expression of RANKL in mRNA level was detected quantitatively using reverse transcription-polymerase chain reaction. LDH and NLR were analyzed from the peripheral blood analysis. The correlation of RANKL expression with LDH and NLR was statistically analyzed. RESULTS: This study enrolled 15 subjects with bone metastasis disease based on the clinical, radiological, and histopathological results. The means of LDH, NLR, and RANKL expression were not significantly different. There was no significant association between the characteristics of metastatic lesion and RANKL expression. The correlation between LDH levels with RANKL expression was positive (p < 0.05), while the correlation between NLR and RANKL expression was negative (p < 0.05). CONCLUSION: RANKL expression was positively correlated with LDH and negatively correlated with the NLR. Both LDH and NLR can be used as predictive factors of RANKL expression in bone metastasis.

Background The objective of this study was to identify the predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus (HNP). Methods A prospective study was conducted between June 2010 and April 2012 in Banda Aceh, Indonesia. Clinical and baseline neurologic examinations such as passive straight leg raising test (SLRT), cross SLRT, and patellar and Achilles reflexes were assessed prior to the conservative management. The patients were evaluated at 2nd, 4th, 8th, 12th and 24th week following commencement of the conservative management. Results We recruited and followed 171 HNP patients of which 35.7% of them had good outcome. At univariate analysis, patients with more than 12 months duration of complaint, those with dominant radicular pain, severe pain intensity (visual analogue scale 7–10), positive SLRT, positive cross SLRT, and reduced motor power of knee extensors (muscle strength grade 1–4), were associated with poor outcome. Multivariate analysis suggested that patients with dominant radicular type of pain were likely to had poor outcome compared to those with dominant back pain (odd ratio (OR) 10.57 with 95% confidence interval (CI) 1.15–96.93). Patients with reduced motor power of knee extensors also had a higher chance to have poor outcome compared to those who were normal (OR: 10.57; 95% CI: 1.15–96.93). Conclusion Type of pain and the strength of lower extremities could be able to predict the failure of conservative management in patients with lumbar disc herniation. However, further studies with the bigger sample size are warrant to validate our results.

During a Physical Education (PE) class, students may encounter risks of injury. PE teachers, therefore, should possess competent knowledge and skill levels in sports injury prevention as well as good self-awareness of their abilities to manage any injury. This study aimed to evaluate the perceived knowledge, practices, and competence in the area of sports injury prevention, recognition, and management of PE teachers in Yogyakarta Special Province. The associations between PE teachers’ sociodemographic characteristics and their self-perceptions were also investigated. Subjects were Senior High School PE teachers who were willing to complete the questionnaire developed by the research team. 191 PE teachers voluntarily participated in the study. The results showed the lowest scores were found for: 1) the teachers’ practice in recording students’ medical history and assessing injury risk when starting a new academic year; 2) the teachers’ practice in evaluating the condition of first aid kits and Basic Life Support (BLS) devices; and 3) the teachers’ perceived competence in splinting. Only greater knowledge of the PRICE principle was associated with the teachers’ level of education and training experience and splinting competence with years of teaching. BLS training experience had the stronger association with perceptions of knowledge and skills in the recognition and treating of injuries.

Introduction: Pain in degenerative lumbar canal stenosis is caused by osteoarthritis of a facet joint and intervertebral disc degeneration. Some inflammatory mediators such as tumor necrosis factor (TNF)-α are present in degenerative lumbar canal stenosis. This study aimed to evaluate the correlation of pain and functional pre-operative scores with the expression of TNF-α in nucleus pulposus, annulus fibrosus, and facet joint. Methods: Patients diagnosed with degenerative lumbar canal stenosis and planned for surgical treatment were included in this study. Patients with history of fracture, neoplasm, and/or infection of the spine were excluded. Tissue samples were collected from the nucleus pulposus, annulus fibrosus, facet joint, flavum ligament and paraspinal muscles of the spine during the surgery. TNF-α expression was examined semi-quantitively and correlated with the axial and radicular pain that were measured using Visual Analog Score (VAS) score. The result was then statistically analyzed. Results: The expression of TNF-α in the paraspinal muscle (6.30±14.20) was significantly higher compared to other locations. TNF-α expression in the facet joint group was significantly correlated with the intensity of low back pain measured by VAS score (r=0.893, p < 0.001), and pre-operative functional outcome based on Oswestry Disability Index (ODI) (r=0.948, p < 0.001). Conclusion: TNF-α expression, especially in the facet joint, is significantly associated with the pain intensity and pre-operative ODI that allow pain reduction with less invasive treatment in lumbar canal stenosis patients.

Background : Reconstruction of the anterior cruciate ligament (ACL) is a commonly performed surgical procedure in recent years. Surgeons have to consider several factors including patient’s anthropometric variables to harvest the best graft. The hamstring tendon has its’ limitation, such as the tendon graft size deemed unfit especially for people of small statures. The peroneus longus tendon is a relatively new choice compared to hamstring. This study was conducted to know the correlation between anthropometric features with graft parameters or graft size in patients who underwent ACL reconstruction using peroneus longus and hamstring tendons. Materials and Methods : This cross-sectional study was performed in patients who underwent ACL reconstruction using peroneus longus or hamstring tendon autografts. We evaluated their anthropometric variables (age, gender, body mass index (BMI), height and weight) and correlated them with the graft diameter obtained during surgery. Post-operative results were assessed with Karlsson and Peterson Scoring System which represent the ankle function. Results : Twenty-three non-athletic patients underwent ACL reconstruction surgery. Patients with hamstring graft have the average height of 170 cm and 163.6 cm for the peroneal graft group. The average body weight of the hamstring graft group was 72.917 kg and the peroneal graft group was 68.82 kg. The measured BMI of the hamstring graft group was 25.2 kg/m2 and 7.833 mm of graft diameter in average, with 25.5 kg/m 2 and 7.636 mm respectively for the peroneus graft group. There were strong positive correlations between weight and BMI with hamstring tendon graft diameter, but negative weak correlations with peroneus tendon graft diameter. Conclusion : We found that body weight and BMI correlate with the diameter of both peroneus and hamstring tendon grafts. Both autografts showed equally good functional results.

Highlights • Complex injury and unique anatomic relationships at the sacropelvic region. • Use of modified approach to access the fracture site of the sacrum where dural tear is common. • No complications after surgery. • Alternative treatments for managing complex pelvic and sacral fractures Denis type 2., Introduction Posterior sacropelvic ring injury due to vertical shear type sacral fracture is the result of high-energy trauma. This fracture may be accompanied by neurological injury in 50% of cases. An understanding of sacral anatomy, its mechanisms of injury and types of sacral fracture, as well as treatment options may change the rational of the approach. The unique anatomic shape in the sacropelvic junction and the complex biomechanical forces can present challenges when attempting anterior and posterior pelvic reconstruction and instrumentation. Presentation of case In this case, we present a complex pelvic fracture and sacral fracture Denis type 2 managed with staged operations consisting of anterior reconstruction followed by posterior reconstruction using spanning unilateral fixation of 5th lumbar to 2th Sacral-Alar-Iliac with different incision technique from the normal conventional approach. Discussion The use of 2th sacral Alar iliac screws (S2AI screw) offered immediate stability and helped in fracture reduction while creating good biomechanical strength, there was no need for cross-connectors which minimized the prominence of the implant, and also decreased the risk of post-operative wound infection. Conclusion The new technique of spinopelvic fixation provides increased immediate postoperative stability. Success of this procedure can be achieved by performing the procedures systematically on appropriately selected patients.

Wear is a problem for metal on polymer (MOP) hip implants to perform lifetime endurance. Polymer excessive volumetric loss leads to implant failures. Attempts to solve this problem are usually initiated with tribological tests. The method is time-consuming because the sliding speed is low. There is a faster way to use a computational method to gather wear data. This research aims to investigate the numerical convergence of predicted wear volume with the finite element method (FEM). The model is a commercially pure titanium (cp Ti) and ultra-high molecular weight polyethylene (UHMWPE) MOP hip implant. A dynamic Paul physiological load was applied to the model. Volumetric loss of the polymer was calculated with a wear equation involved nonlinear contact load and contact area. The inputs of calculation are wear factor and the computational contact mechanic performed by FEM. The wear factor was obtained by performing biotribological experiments with a multidirectional pin on disc tribotest. Predicted wear volume was validated with hip simulator experimental data from the literature. Convergences were found at the mesh density of 1.38 elements/mm3. An acceptable numerical error was obtained in the model with 1 mm element size for femoral head and 0.3 mm for acetabular cup. This model was then used for the investigation of load increment effects. The result is that load increment variations do not affect wear volume and contact mechanic numerical outputs. The calculated stresses are below the UHMWPE yield stress limit. In this elastic region, the effects of strain rate caused by load increment are negligible.

Highlights • Various pathologies might occur at the adjacent segments after lumbar spinal fusion. • Some patients are afraid to undergo second or next open surgery and prefer minimally invasive surgery. • The procedure was successful with no complications. The radiculopathy decreased after the surgery., Introduction Spinal fusion is one of the most common procedure as the treatment of lumbar pathology, this procedure not only stops the progression of spinal pathology, but also immobilizes the painful motion segment. Furthermore, it also stabilizes the spine after neural decompression. However, the increase of mechanical stress and segmental motion at adjacent segments after spinal fusion has been reported regarding to this biomechanical alteration, various pathologies might occur at the adjacent segments, including acceleration of degenerative changes (Chul et al., 2015). Presentation of case Some patients are afraid to undergo second or next open surgery and prefer to choose other options such us minimally invasive surgery. Here we present management of distal adjacent segment disease using local anesthetic transforaminal foraminotomy and lumbar discectomy. We performed minimally invasive percutaneous endoscopic lumbar discectomy and foraminotomy in an awake and aware 55 years old man under local anesthesia. Conclusion The procedure was successful with no complications. There was improvement in VAS and ODI score as quantitative measurement for pain relieve and functional outcome respectively, and the radiologic follow up evaluation shows a stable segment.

Highlights • The diagnosis of epithelioid sarcoma based on only the clinical manifestation has proven to be difficult. • Thus, the histopathology examination followed by immunohistochemistry is considered as the main modality for the diagnosis. • Better understanding of clinical properties of epithelioid sarcoma will aid in deciding the best treatment for the patient., Introduction Epithelioid sarcoma (ES) is a rare mesenchymal tumor, accounting for less than 1% of all adult soft-tissue sarcomas. The diagnosis of such malignancy is challenging. We reported a 31-year-old male diagnosed with rhabdoid ES that histologically mimicked epithelioid rhabdomyosarcoma in a 31-year-old male. Case presentation A 39-year-old male presented with pain in the left thigh. He had planned for open reduction internal fixation due to left femur fracture. During the surgery, the surgeon found abnormal appearance of the bone and the surrounding tissue. The histopathology examination showed spindle-to-polygonal epithelioid cells arranged in nodular pattern with necrotic areas. Immunohistochemistry examination revealed vimentin and CK positive expression, while myogenin was negative. Further immunostaining using CD34 and HMB45 were also negative. Discussion The diagnosis of ES based on only the clinical manifestation has proven to be difficult. Thus, the histopathology examination followed by immunohistochemistry is considered as the main modality for the diagnosis. Better understanding of clinical properties of ES will aid in deciding the best treatment for the patient.

Purpose Interleukin-1 is the main proinflammatory cytokine in osteoarthritis (OA). Several single-nucleotide polymorphisms (SNPs) within the IL-1 gene cluster (IL-1β, IL-1R1, and IL-1RN) have been determined, but their associations with knee OA remain poorly understood. The present study aimed to identify the associations between IL-1 SNPs and knee osteoarthritis. Methods This meta-analysis and systematic review included all comparative studies published in the MEDLINE/PubMed, Embase, Google Scholar, and Cochrane Library databases. We performed a systematic search to identify relevant studies on the evaluation of the correlation between the IL-1 gene and knee OA published up to February 2020 that met the eligibility criteria. Nine studies on a total of 2256 knees with OA and 3527 healthy knees met the eligibility criteria. Results associated with IL-1A, IL-1B, IL-1R1, and IL-1RN SNPs were extracted and compared between knees with OA and healthy knees. Methodological quality was assessed using the Newcastle–Ottawa scale (NOS). All studies with fair or good quality were included. Results The meta-analysis showed that the risk of knee OA is decreased by the IL-1RN*1 and IL-1RN*1/*1 genotypes and increased by the IL-1RN*2 and I-L1RN*1/*2 genotypes. The systematic review revealed only two studies associating the IL-1RN allele, none associating the IL-1B polymorphism, and only one study associating IL-1A and IL-1R1 polymorphisms with knee OA. Conclusions Several IL-1RN alleles and genotypes play a role in knee OA but other genetic variations in the IL-1 region were still conflicting in its association with knee OA.

External fixators are the most common fixation method for fractures with substantial soft tissue compromise. Nonetheless, the frames used are bulky, uncomfortable, and cumbersome to patients. Using locking compression plate (LCP) as an external fixator (low profile external fixation/LPEF) owns the same properties as standard external fixators but may overcome disadvantages because of its low-profile frame. This case series aims to evaluate the results of LPEF for the management of tibia fracture with soft tissue compromise.We reviewed five patients at our centers who underwent surgery in 2020 with the application of LPEF. These patients had grade IIIA open tibia fracture with respective complications. The follow-up duration was 6 months post-operative in which we assessed Southampton Wound Assessment Scale (SWAS), laboratory infection markers, radiographic evaluation, and the Lower Extremity Functional Scale (LEFS). The results showed all wounds healed and cases with infection showed tendency of resolving, alongside varying degree of bone healing. The implant was well tolerated for patients and the functional outcome was overall good (mean LEFS: 71.26%).The LPEF is fortuitously lightweight and more convenient for patients to ambulate, thus the compliance of early functional exercise is more likely to happen.Application of LPEF can be considered as an option for treating soft tissue compromised tibia fracture. In our experience, it is low profile, more acceptable to the patients, and displayed favorable outcomes especially in terms of soft tissue or skin healing and infection resolution.

Introduction The thoracolumbal region is often a difficult area to reconstruct for orthopaedic surgeons. Reconstruction of this area with a standard free tissue transfer is not always possible, and locoregional flaps are often failed due to poor quality outcome and mobilization difficulty. Case report A case was presented with unilateral distally based latissimus dorsi flaps reconstruction in patient with midline thoracal soft tissue defect underwent kyphosis deformity correction surgery. This study reported a patient, male, 33 years old who was diagnosed with ankylosing spondylitis and kyphosis deformity. The patient underwent surgical correction of the kyphosis deformity. After 1 month, the patient complained about his open surgical wounds. Clinical discussion In our institution, this patient underwent second debridement surgery and unilateral reverse latissimus dorsi flap for thoracal soft tissue defect coverage to obtain well-vascularised tissue, with good resistance to bacterial contamination and easy to shape into such defect. After follow-up for 6 months, the patient shows good outcome and postoperative wound healing was favorable. Conclusion We believe that the “reverse” latissimus dorsi flap is a good option to cover this particular region. It is simple, safe, and reliable. It also provides a backup plan for the microsurgery in this region., Highlights • Challenges in reconstruction of soft tissue defect at thoracolumbal region • Experience of reverse latisimmus dorsi flap at thoracolumbar region • Outcome of reverse latisimmus dorsi flap at thoracolumbar region

BACKGROUND: At present, few reports are comparing these 2 major cervical posterior laminoplasty methods with Open-door and French-door Laminoplasty in terms of neurological recovery, cervical alignment, and surgical complications. Moreover, most of the research has not been well designed. AIM: This study aims to determine comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy. METHODS: The Meta-analysis is used in this study. The study sample is a published research articles on comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy on the internet through databases on PubMed and ProQuest and published between 1997 until December 2018. Weighted mean difference and pooled weighted mean difference are calculated by using the fixed-effect model or random-effect model. Data is processed by using Review Manager 5.3 (RevMan 5.3). RESULTS: This study reviews 58 articles. There are 6 studies conducted a systematic review and continued with Meta-analysis of relevant data. The results showed significant higher postoperative Japanese Orthopaedic Association (JOA) score in open-door laminoplasty (ODL) than French-door laminoplasty (FDL) (weighted mean difference [WMD] = 0.71; 95% confidence interval [CI]: 0.35 to 1.07; p < 0.05). The outcome of procedures treatment of multilevel cervical myelopathy revealed the operative time, cervical range of motion, axial canal diameter postoperative, axial pain reduction and complications events in ODL and FDL there was no significant difference. But for a cervical lordotic angle in ODL and FDL, there was a significant difference; the ODL group were significantly lesser than the FDL group. The recovery rate in ODL and FDL, there was a significant difference; the ODL was shown to be significantly higher than FDL (p < 0.05). CONCLUSION: This analysis suggests that neither cervical laminoplasty approach is superior, based on the postoperative radiological data and complication rate. But the open-door laminoplasty resulted in a higher functional outcome and recovery rate as compared to the French-door laminoplasty.

Background: Understanding the biomechanical structure of the body is important to preventing and treating the musculoskeletal system problems. The increase in body mass index contributes to the elevated peak plantar pressure and decreased longitudinal arch of the foot. This condition, consequently, may cause mal-alignment of the lower extremity, leading to promote cartilage breakdown, osteophyte formation, subchondral bone hypertrophy, lead to progression of knee joint destruction and functional deficits. Objective: The aim of the study was to examine the correlation between body weight, plantar pressures, ankle and knee angle measurement parameters. Methods: The research study sample included 30 female who met inclusion and exclusion criteria. In order to evaluate the structural characteristic of plantar foot, we used the blueprint method on bare-foot and also when carrying 15 and 25 kilogram of load. Furthermore, to measure knee-angle parameters, we also performed a bilateral standing radiograph approach of lower extremity. Results: This study showed a significant correlation between BMI/Body mass index and HW/heel width (p = 0,00) with low positive correlation for both sides. Furthermore, BMI and PAW/plantar arch width (p = 0,00) showed a moderate positive correlation for both sides. In contrast to that, BMI and MFA/mid-foot area (p = 0,00) showed a moderate positive correlation for the right side but low positive correlation for the left side. Another measurement such as BMI and AI/arch index (p = 0,00) had a strong positive correlation on the right side and moderate positive correlation on the left side. Moreover, BMI and AAL/Ankle angle alignment (p = 0,00) revealed a strong positive correlation for both sides, BMI and XCTP/trans-condylar tibial plateau angle (p < 0,05) had a low positive correlation for both sides, meanwhile BMI and AA/ankle angle (p = 0,00) showed a low positive correlation for both sides. Conclusion: Increasing axial load was statistically significant correlated with increasing plantar pressure and ankle-knee radiographic angle parameter. The results also revealed that increasing axial load was found to have strong correlation to the arch index (AI) and ankle angle alignment (AAL). It was a compensatory phenomenon, which can cause structural disturbances and function of the lower limb.

Objective: This research aimed to developing customized pedicle screw based on Indonesian vertebral anatomy and compare the insertion time, pull-out strength, and screw-media interface area of different screw design. We have developed 3 different types of pedicle screws (v-thread cylinder-core, square-thread cylinder-core and square-thread conical-core). The thread diameter was calculated from pedicle width of Indonesian population (6 mm). We used commercially available pedicle screw as control group (6.2 mm). Result: The insertion time were significantly difference between v-thread cylinder-core pedicle screw (22,94 s) with commercially available pedicle screw (15.86 s) (p2). The data comparison showed that the square-thread conical-core customized pedicle screw group has comparable insertion time and has better pull-out strength than commercially available pedicle screw.

Anterior cruciate ligament (ACL) injury is the most common knee ligament injured. Anterior drawer and Lachman tests are the most common physical examinations for helping diagnose ACL injuries, while magnetic resonance imaging (MRI) is the first choice of supporting examination for evaluating any internal abnormality of the knee. However, studies concerning the accuracy of those examinations in the Indonesian population are limited. This study aimed to compare the accuracy between the anterior drawer test, Lachman test, and MRI in diagnosing ACL injury in Javanese patients. This retrospective study used medical records data of patients who underwent knee arthroscopy in the Department of Orthopaedics and Traumatology, Dr. Sardjito General Hospital, Yogyakarta in 2018. The MRI and the clinical examination results were compared to the arthroscopy results as the gold standard. The study showed the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for the anterior drawer test were 86.67% (95%CI: 69.28-96.24%), 80% (CI: 44.39-97.48%), 92.86% (CI: 78.88-97.84), 66.67% (CI: 43.28-83.98%), and 85% (CI: 70.16-94.29%), respectively. Lachman test had 96.67% (CI: 82.78-99.92%) sensitivity, 90% (CI: 55.50-99.75%) specificity, 96.67% (CI: 81.86-99.47%) PPV, 90% (CI: 56.44-98.43%) NPV, and 95% (CI: 83.08-99.39%) accuracy. The diagnostic parameters of MRI were 83.33% (CI: 65.28-94.36%) for sensitivity, 60% (CI: 26.24-87.84%) for specificity, 86.21% (CI: 74.21-93.14%) for PPV, 54.55% (CI: 31.77-75.57%) for NPV, and 77.50% (CI: 61.55-89.16%) for accuracy. In conclusion, the Lachman test has better accuracy than the anterior drawer test. Both the anterior drawer and Lachman tests had higher accuracy compared to the MRI.

Vascular endothelial growth factor (VEGF) expression is associated with malignancy progression, metastasis, and poor prognosis in many malignancies, including osteosarcoma. However, studies concerning correlations between VEGF expression and histopathological prognostic factors ofosteosarcoma are limited. This study aimed to evaluate the correlations between VEGF expression and histopathological findings in osteosarcoma’spatients.This was a cross-sectional study using formalin-fixed paraffin embedded (FFPE) samples of 32 osteosarcoma’s patients from Dr. Sardjito General Hospital, Yogyakarta. Histopathological findings of specimens were re-evaluated by two independent observers, recorded for the subtypes, invasiveness, grading, mitotic counts, and tumor infiltrating lymphocytes (TIL). Expression of VEGF was determined based on immunostaining and evaluated using immunoreactivity score (IRS).Chi-square and Spearman correlation test were used to analyze the association between variables. Range of VEGF expression score was 0 to 11, with mean 5.09. Significant negative correlation between the VEGF expression and TIL was observed (p=0.046). However, there was no significant correlations between the VEGF expression and osteosarcomas subtypes, invasion, grading or mitotic counts (p> 0.05). In conclusion, the VEGF expression is associated with TIL. Further study is needed to evaluate the roles of VEGF and lymphocytes in osteosarcoma development dan progression in order to better understand of the role of VEGF in immunotherapy of osteosarcoma.

Hip fractures often occur in elderly people and are a major global health challenge causing many consequences, both in health and socioeconomic costs. This review aimed to identify complications that occur in patients with postoperative hip fracture between 30 days and 60 months after discharge. This review was conducted on articles published from 2005 to 2017 obtained from the EBSCO, PubMed, ProQuest and Google Scholar databases. The literature search followed PRISMA Guidelines. Key search words included the terms: hip fracture, complication, postoperative, community, and nursing. Articles were considered eligible if discussed the complications of hip fracture with surgical treatment, occurring post hospital discharge and the patient was in the community. In this review, 23 articles were included that met the inclusion criteria. There were 16 articles that cohort studies, 3 were retrospective studies, 3 were randomized control trials and 1 article was an observational study. The time of observation varied from 30 days to the longest of 5 years. Quality assessment of the levels of evidence used the Oxford CEBM recommendations. The review results found that postoperative hip fracture patients after discharge still experienced various complications after 30 days and up to 1-3 years post-operation.

Introduction Occipitocervical fixation (OCF) can provide good fusion rate to treat various craniovertebral junction (CVJ) pathologies. Biomechanically it gives rigid fixation, good fusion rate, and allows for effective decompression. However, rigid fixation on the mobile occipitocervical junction has shortcomings that affect the post-operative clinical functional outcomes and range of motion. This study aimed to evaluate and elaborate the functional outcomes, range of motions, and radiographic findings in our patients underwent OCF. Case report We presented a report of 3 patients underwent posterior decompression procedure followed by occipitocervical fixation. All three patients' clinical outcome was assessed clinically by, Japanese Orthopaedic Association (JOA) score and grading, Karnofsky, range of motion and radiographic cervical alignment evaluation parameters. Result All patients have seen improvement (minimal 1 grade in JOA and >30 points of Karnofsky score) in 3 months after the procedure, had a tolerable range of motion limitation, normal range of cervical lordotic and cervical brow vertebral angle (CBVA). Unfortunately, one patient with loss of cranial fixation may be related to history of infection and lack of post-operative wound care. Conclussion Our cases conclude that Occipitocervical fixation is a safe technique that provides excellent fusion rate with good functional outcome and tolerable range of motion limitation. Due to its unique anatomy and technically demanding, serial post-operative monitoring evaluation of this procedure is paramount., Highlights • Occipitocervical fixation (OCF) provide good fusion rate to treat various craniovertebral junction (CVJ) pathologies • Rigid fixation on the mobile occipitocervical junction has shortcomings that affect the post-operative clinical functional outcomes and range of motion. • A report of 3 patients underwent posterior decompression procedure followed by occipitocervical fixation.

Background: The pathogenesis of herniated nucleus pulposus (HNP) is complex and may involve the wide variety of gene polymorphism. However, the reports from the existing studies are inconclusive. The objective of this study was to determine the role of single nucleotide polymorphisms (SNPs) in interleukin 1 alpha (IL-1A), tumor necrosis factor-alpha (TNF-A), and vitamin D receptor (VDR) genes on the susceptibility to herniated nucleus pulposus (HNP). Methods: Four databases (PubMed, Embase, Cochrane, and Web of Science) were searched as of April 1 st, 2021. Authors, publication year, targeted genes, genotype and allele frequency in each case and control groups were collected. Newcastle-Ottawa scale was used to evaluate the publication quality. The pooled estimates of association of IL-1A -889C>T (rs1800587), TNF-A -238G>A (rs361525), and VDR TaqI (rs731236) and susceptibility to HNP were assessed using Z test. Results: We screened 3,067 unique studies for eligibility and three, two and nine case-control studies on IL-1A -889C>T, TNF-A -238G>A, and VDR TaqI were included, respectively, in our meta-analysis. The studies consisting 369 HNP cases and 433 controls for IL-1A -889C>T, 252 cases and 259 controls for TNF-A -238G>A and 1130 cases and 2096 controls for VDR TaqI. Our pooled estimates indicated that there was no significant association of those SNPs with the susceptibility to HNP in any genotype, dominant model, recessive model, or allele comparations. Conclusion: Although individual studies suggested the important role of gene expression dysregulation associated with SNPs in IL-1A, TNF-A, and VDR, our data indicated that IL-1A -889C>T, TNF-A -238G>A, and VDR TaqI had weak association with HNP susceptibility in both genotypes and allele distributions. However, since heterogeneity was identified among studies included in this meta-analysis, further meta-analysis with a larger population and subgroup analysis on specific population are warranted to support this finding.

AISI 316L has been used to produce implant plates such as dynamic copmresion plates (DCP). The implant plates might experienced failure due to either suffer higher stresses exceeding the allowable maximum strenght or presents small crack growing through fatigue mechanism. Most of DCP fractures occured at the gliding holes region. This study conducted improving strength of DCP locally on the gliding holes. Strengthening on the gliding holes of DCP was performed by cold working method involving plastically deformation using an expanded hole technique. This study was conducted by both experimental and numerical simulation. Increasing strength locally on the gliding hole region was evaluated by measuring some parameters incorporated with strain hardening mechanism such as hardness and residual stresses. Increasing yields strength locally on the hole region was estimated by Takakuwa’s formulas. By this method, yields strength of the gliding hole of DCP made of AISI 316L increased from 325 MPa to be 600−1050 MPa.

Introduction: Combination between SCIWORA and Brown-Sequard syndrome in a patient is a rare condition. In SCIWORA, there is usually a delay in neurologic deficits which can potentially lead to misdiagnosis. Therefore, the clinician should have a good understanding of the course of the disease to make a good diagnosis and treatment. Case report: Reporting a case of female 20 years old with chief complaint of severe neck pain and delayed limbs weakness. The mechanism of injury was fall with the head hit the ground in left lateral flexion position. The physical examination showed zero motor power of the right limbs and contralateral pain and temperature deficit 1 h after the injury. We diagnosed the patient with incomplete spinal cord injury at C4 level with associated Brown-Sequard syndrome. We gave soft collar neck for immobilization, medication with NSAID for analgetic and Methylprednisolon. We found dramatic improvement in 10 h after the injury with motor improvement from 0 to 5 and normal sensory function. The patient then was discharged with good functional outcome and with no sequelae. Conclusion: Incomplete cervical spinal cord injury without radiological abnormality that manifested as Brown-Sequard syndrome is a rare case and potentially confusing condition. Better understanding of the course of the disease may help the clinician to make a right diagnosis and plan for management. Keywords: SCIWORA, Brown-Sequard syndrome, Spinal cord injury

BACKGROUND: At present, few reports are comparing these 2 major cervical posterior laminoplasty methods with Open-door and French-door Laminoplasty in terms of neurological recovery, cervical alignment, and surgical complications. Moreover, most of the research has not been well designed. AIM: This study aims to determine comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy. METHODS: The Meta-analysis is used in this study. The study sample is a published research articles on comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy on the internet through databases on PubMed and ProQuest and published between 1997 until December 2018. Weighted mean difference and pooled weighted mean difference are calculated by using the fixed-effect model or random-effect model. Data is processed by using Review Manager 5.3 (RevMan 5.3). RESULTS: This study reviews 58 articles. There are 6 studies conducted a systematic review and continued with Meta-analysis of relevant data. The results showed significant higher postoperative Japanese Orthopaedic Association (JOA) score in open-door laminoplasty (ODL) than French-door laminoplasty (FDL) (weighted mean difference [WMD] = 0.71; 95% confidence interval [CI]: 0.35 to 1.07; p < 0.05). The outcome of procedures treatment of multilevel cervical myelopathy revealed the operative time, cervical range of motion, axial canal diameter postoperative, axial pain reduction and complications events in ODL and FDL there was no significant difference. But for a cervical lordotic angle in ODL and FDL, there was a significant difference; the ODL group were significantly lesser than the FDL group. The recovery rate in ODL and FDL, there was a significant difference; the ODL was shown to be significantly higher than FDL (p < 0.05). CONCLUSION: This analysis suggests that neither cervical laminoplasty approach is superior, based on the postoperative radiological data and complication rate. But the open-door laminoplasty resulted in a higher functional outcome and recovery rate as compared to the French-door laminoplasty.

Tribological assessment of orthopedic biomaterials requires a lot of testing time. Researchers must test the biomaterials in millions of cycles at low frequency (1 Hz) to mimic the in vivo conditions. It is a problem because product designs and developments could not wait longer for wear data to predict the lifetime of their products. The problem can be solved with the use of computation techniques to model the wear phenomena and provide predicted data. The aim of this research is to predict the wear volume of the commonly used ultra high molecular weight polyethylene (UHMWPE) sliding against commercially pure titanium (cp Ti) in the unidirectional pin on flat tests. The 9 mm diameter UHMWPE pin and cp Ti plate contact mechanics were modeled using Abaqus. Contact pressure was set at 3 MPa. Outputs of the computations (contact pressure and contact area) were used to calculate the wear volume with Archard law. A custom Python script was made to automate the process. The results were then compared with experimental data for validations. The predicted data were in a good trend with numerical errors from 0.3% up to 26%.

The aim of this work is to investigate the effect of sandblasting and electropolishing on roughness and corrosion rate of AISI 316L stainless steel. The equipment used was sandblasting machine with a working pressure of 5-7 kg/cm2 with a duration of 10 minutes. The silica sand was used with size of 500-800 μm. The equipment used in the electropolishing process is the DC power supply with a maximum output of 2x100A. Anode and cathode material were AISI 316L stainless steel. Electrolyte solution consisted of 96% mass fraction of sulfuric acid and 85% mass fraction of phosphoric acid with a ratio of 1. The parameters used in the electropolish process were voltage, electrodes distance and electropolishing duration process. The combination of sandblasting and electropolishing cause the decrease in surface roughness by more than 28 times, from 3.17 to 0.11 μm. The decrease in the rate of corrosion on specimens that have been treated sandblasting and electropolishing by 37%. The optimum parameters for testing surface roughness and corrosion rate contained in the sandblasting process electropolishing for 10 minutes with a distance of 1 cm, duration 20 minutes and voltage 8V.

Hip implants are prostheses designed for severe hip arthritis patients. One of its components, acetabular cup is mostly made from ultra-high molecular weight polyethylene (UHMWPE). This polymer has a wear problem. Its debris would cause osteolysis followed by implant failures. Numerical studies of this problem were commonly used a linear contact pressure wear equation. Recently it was found not suitable to model the polymer wear in hip implants. This study used a nonlinear equation to predict the UHMWPE volumetric wear. It states a nonlinear relation between wear, load and contact area. The computation model was a biaxial rocking motion hip simulator assembly with UHMWPE acetabular cup sliding on commercially pure titanium femoral head. Multidirectional pin on disc experiments conducted to obtain wear factor and coefficient of friction data for the computations. Commercial finite element software calculated the other parameters. Predicted volumetric wear has a good agreement with the experimental data. Lowest numerical error was found 0.53 %.

Numerical investigation is a method capable to study the expensive and long-time duration wear problems in biotribology. The technique has been used to predict the wear of hip implants specially those made from metal on polymer biomaterials. This research studied the effect of commercially pure titanium (CP-Ti) femoral head diameter on the wear volume of ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. Diameter variations are 22 mm, 28 mm and 32 mm. Hip implant models were created and the numerical approximations conducted with the finite element method. Wear calculations used a nonlinear load and contact area mathematical model. A Python script was developed to proceed the calculations. Accurate wear predictions can be obtained with the use of fine elements those maximum contact loads are closer to the physiological load. Verification with experimental data on the 32 mm femoral head model shows a good agreement with error rates below 1%.