bluuebunny/crossref_metadata_2025_split huggingface dataset:
SCREW FIXATION OF MEDIAL EPICONDYLE OF HUMERUS USING THE WIDE-AWAKE TECHNIQUE
Authors: Amiruddin AS , Ahmad AA , Ahmad AR 
Published: May 2020

Avulsion fracture of medial epicondyle fractures accounted for 30.77% of elbow fractures. Fixation is needed when the fragment displaced significantly. These cases were usually done under general anaesthesia / regional anaesthesia. We describe a novel technique of using WALANT to proceed with this surgery. Methods: A combination of lignocaine, 1:100000 epinephrine and 10:1 sodium bicarbonate with a safe limit of 7mg/kg for lignocaine and epinephrine is used. The operation was done with continuous visual analog score and vital signs monitoring until postoperatively. Range of motion and blood loss was monitored post fixation intraoperatively. In every patients who undergo an operation under WALANT technique, we will provide , IV Dynastat 40mg BD x 1/7, T Celebrex 200mg BD and T PCM 1g PRN x 1/52. Discussion: The limitation faced during the procedure is that, the local anaesthesia cannot reach the second cortex of the humerus. The problem arises when the drill bit touches the second cortex of the bone which will cause pain to the patient. To remedy this, we injected 5ml of the solution to the expected trajectory of the screw at the far cortex. However, the procedure does not need to go through second cortex of the bone, so this limitation is manageable. Results: Patient’s pain score remain 0-2 after administration of solution, throughout the surgery and postoperatively. Estimated blood loss was 80cc and range of motion was full post fixation intraoperatively. Conclusion: Screw fix medial epicondyle under WALANT is a good alternative for patients with multiple comorbids and high risk for surgery to be done under general anaesthesia. Patient remain comfortable throughout the procedure and post operatively. Range of motion can be assessed post fixation intaraoperatively thus allow light exercise post operatively which is good to prevent elbow stiffness. References: Ahmad AA., Yi LM., Ahmad AR Plating of Distal Radius Fracture Using the Wide-Awake Anesthesia Technique. Journal of Hand Surgery. (2018) 43 (11) , pp 1045. el- 1045.e5 -1045.e5
Epidemiology of Musculoskeletal Injuries at the Yongmoodo National Championship Kasad Cup at Kodam IX/Udayana Bali in 2018
Authors: Caitanya Ida Bagus Anom Krishna 
Published: May 2020

Background: Yongmoodo is one of a branch martial arts originating from South Korea by combining several types of martial arts. Technique in Yongmoodo are combination of punches, kicks and slamming. Yongmoodo has been applied in Indonesia since 2008. Yongmoodo was originally applied as a mandatory martial arts for the military. Objectives: To determine the epidemiology of musculoskeletal injury in Yongmoodo athletes in the Kasad Cup at Kodam IX/Udayana Bali in 2018. Methods: This research was a descriptive study with a cross sectional approach. Data collection was done by observation and medical record of inpatients in 2018. Sampling was done by incidental sampling. The inclusion criteria used were the Yongmoodo athlete who had a musculoskeletal injury and was hospitalized. This study measurement uses proportion. Results: From inpatient medical record and observations, there were 13 data records that fulfilled the inclusion criteria while the other 2 data were not included in the inclusion criteria because they did not had musculoskeletal injuries. Data are categorized by sex, military rank, type of injury, region and treatment. Based on gender, the proportion of men was 85.7%. Based on military rank, the proportion of each is 50% for enlisted and non-commissioned officers. Based on the type of injury, the proportion of athletes who have a fracture is 85.7%. Based on the region, the proportion of injuries to the upper limb is 71.4%. Based on the treatment, the proportion of treatment conservatively is 57.1% Discussion: Epidemiology of fractures in Yongmoodo were 2.3%. Karate 7%, Taekwondo 9.9% and Kung Fu 0.9%. The fracture rate on Yongmoodo is quite high and more common in the upper extremities. Yongmoodo is prone to fractures because the techniques used are punches, kicks, slamming. Future advice is to conduct research with an analytical method to find the cause of fracture susceptibility in Yongmoodo.
Open Reduction with Internal Fixation (ORIF) versus Hybrid Circular External Fixator (HCEF) as the Treatment of Choice for Bicondylar Tibial Plateau Fractures : A Systematic Review and Meta-Analysis
Authors: Susila I Made Arya , Savio Sherly Desnita , Dharmayuda Cokorda Gde Oka 
Published: May 2020

Bicondylar Tibial Plateu Fractures (BTPF) present a challenge in management due to the involvement of articular surface, resulting in high complication rate. This study aims to compare two treatments, Open Reduction with Internal Fixation (ORIF) and Hybrid Circular External Fixation (HCEF) as the choice of surgical procedure for BTPF that still controversial until now. Discussion: BTPF is a complex and challenging injury associated with severe bone and soft tissue damage which may result in severe morbidity and chronic complications. The minimally invasive procedure offered by HCEF preserves soft tissue and offers lower rate of deep infection. Furthermore, HCEF should be more considered as the treatment of choice for BTPF due to its shorter hospital LoS which may minimalize nosocomial infection risks and costs. Materials and Methods: A systematic review using Cochrane Library, PubMed, and Google Scholar was conducted based on PRISMA guideline. Inclusion criteria were studies comparing HCEF and ORIF of BTPF. Studies of only one surgical technique modality, Schatzker types I-IV Tibial Plateu Fractures, and case reports were excluded, resulting in six included studies. For the meta-analysis of hospital length of stay (LoS), random effect model was used for continuous outcomes using Review Manager 5.3. Results: Most common complications are nerve injuries, infection, and non/delayed union. Blood loss was higher in ORIF group, while both procedures have similar operation time and functional outcome. The mean hospital LoS for ORIF (n = 60) was 18.45, as for HCEF (n =63) was 8.325. There was significant difference in terms of hospital LoS between ORIF and HCEF (P =0.003). Conclusion: ORIF and HCEF carry similar operation time, functional outcome, union rate, and complication, though HCEF is more beneficial in terms of blood loss and hospital LoS.
Plate on Plate Osteosynthesis : A Novel Method For Periplate Fracture Fixation
Authors: Singh Jagjoth , Razak Kamarul Arifin Abdul , Dass Terence Michal , Liang Tan Weng , Nadeson Yogeshwarran , Kaur Karenjit 
Published: May 2020

Periplate fractures may occur after plate fixation, especially in osteoporotic and non-united bones. We present a case of locking plate fixation over an existing plate for such fractures. Case Presentation: 58 years old man slipped and fell in sitting position 8 months post left distal femur LCP. He sustained pain and swelling of the left hip. The left thigh was externally rotated and shorter than the normal side. X-rays revealed a periplate fracture extending to the subtrochanteric region. A reverse right distal femur LCP was planned. A minimally invasive approach was used. Proximal screws were removed from the original plate and new screws were inserted through both plates which were of similar material, Titanium. Discussion: Elderly population makes a large subgroup of the cases due to osteoporosis and rigidity of the LCP construct2. This fixation provides a simple method to reduce surgical time, bleeding, and preserving more blood supply to enhance fracture healing, as opposed to using nails supplemented with cerclage/cable wires. Care should be taken to use the pre-existing screw holes in the overlapping segment of the two plates, as well as similar plate materials to avoid stress risers and reduce corrosion1. Conclusion: Plate on plate osteosynthesis is a novel method that may prove valuable due to the increasing population age and unique types of fractures. Further research is needed to determine any complications related to this type of fixation. References: Georgios Arealis et. al Plate On Plate Osteosynthesis For The Treatment Of Non Healed Periplate Fractures, Hindawi Publishing Corporation, Volume 2014, Article 367490 S. Ruchholtz, et al., “Less invasive polyaxial locking plate fixation in periprosthetic and peri-implant fractures of the femur—a prospective study of 41 patients,” Injury, vol. 44, no. 2, pp. 239–248, 2013
Primary Repair for Injury of Medial Collateral Ligament During Total Knee Arthroplasty
Authors: Jin Cheng , Zhao Jia-yi , Seon Jong-Keun , Santoso Asep 
Published: May 2020

This study, we aim to determine whether intraoperative over-release of MCL that is treated with primary repair can achieve satisfactory clinical results when compared to those who did not have over-release of MCL. At the same time, we seek to look into the difference between two methods of primary repair (anchor suture and staple) in terms of clinical outcomes. Purposes: We determined whether, after TKA, patients with CIA versus patients with CACB demonstrated (1) decreased pain scores (2) greater ambulatory ability postoperatively (3) decreased daily opioid consumption and hospital length of stay Methods: 3897 TKAs were performed from year 2003-2014. Sixty-five patients with MCL injury due to over-release during TKA who were repaired with suture anchor or staple (suture anchor: 36 vs. staple: 29) were studied whereas matched group of 65 patients without MCL injury were selected and served as the control group. Subjective feeling of instability and functional score were assessed using Knee Society Score (KSS) and Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Objective stability was evaluated through measurement of opening angles in extension and 30° of knee flexion on valgus stress radiographs. The clinical and stability results of repair between the suture anchor and staple were compared. Results: The KSS and WOMAC scores in patients with primary repair of MCL during TKA from 50.6±14.8 to 87.3±8.3 and 65.9±16.3 to 17.7±8.3, respectively. However, there were neither statistical nor clinical significant difference when comparing between the group with primary repair and the control group. Radiographic stability also showed no differences between repair and control groups in extension and 30° of flexion (p= .63 and p= .37). Regarding the subgroups, There were no significant differences between the suture anchor and staple in terms of the stability and clinical outcomes Conclusion: Primary repair either with suture anchor or with staple for injury of the MCL in varus gonarthrosis during TKA provides a good stability and clinical outcomes as those of result with no MCL injury.
PRIMARY TOTAL KNEE ARTHROPLASTY FOR SEVERE VALGUS DEFORMITY: A 2YEAR FOLLOW-UP STUDY AT HASAN SADIKIN HOSPITAL
Authors: Luthfi K. A. M. , Mulyadi D. , Tanjung F.A. 
Published: May 2020

Valgus deformity (VD) accounts for only 10% of total knee arthroplasties (TKAs), but is frequently considered the most challenging to manage. The aim of this study was to review outcome of primary total knee arthroplasty for severe valgus deformity at Hasan Sadikin Hospital, Bandung. Methods: From January 2015 and December 2017 consecutive patients undergoing unconstrained primary total knee arthroplasty with severe VD, grade II and III were enrolled in a prospective observational cohort study. Preoperatively, at 6 weeks, and 2 years after surgery, patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), and the Knee Society Score (KSS, 2011, modified version). Femorotibial angle were measured on the frontal standing X-rays. Results and Discussions: There were twenty-four patients (18 women, 6 men) with mean age of 66 years (55 - 80). The knee range of motion improved from a mean of 71 degrees preoperatively to a mean of 95 degrees. KOOS Quality of life had increased significantly 6 weeks – 2 years after surgery. KOOS pain mean score was 40.3 points before surgery and increased significantly to 86.6 at two year follow up. OKS mean score increased from 22.1 to 41.8 two years after surgery. KSS 2011 mean objective score increased from 22 to 96 and mean function score increased from 32 to 81 two years after surgery. The mean femorotibial angle were improved from valgus 32.72º±9.68º pre-operation to 4.89º±0.90º post-operation (P <0.001). Conclusion: Primary total knee arthroplasty can be effective and safe for severe valgus deformity and the clinical results up to two years after surgery are promising. As our results show, if proper ligament balancing techniques are used and proper ligament balance is attained, the knee may not require the use of a more constrained components.
Continuous Intra-articular Analgesic Injection Versus Continuous Adductor Canal Block in Postoperative Total Knee Arthroplasty
Authors: Limtharapond Kadchan , Leelasestaporn AVM Chumroonkiat 
Published: May 2020

Continuous adductor canal block (CACB) provides effective analgesia after TKA but this technique requires skill of anesthesiologists and equipment such as ultrasonography. A new technique, continuous intra-articular analgesia injection (CIA) is developed recently and found good results. However, effectiveness of these two techniques after TKA is not established. Purposes: We determined whether, after TKA, patients with CIA versus patients with CACB demonstrated (1) decreased pain scores (2) greater ambulatory ability postoperatively (3) decreased daily opioid consumption and hospital length of stay Methods: Between October 2016 and October 2018, 50 patients underwent unilateral TKA at our practice site, whom 50% (n = 25) had CACBs and the others had CIAs. The results were collected in postoperative day (POD) 1,2 and 3. Results: The results were analyzed by SPSS V18 and used student T-test for measurement of mean visual analog pain scale, time up-and-go test, 6-minute walk test and daily total opioid consumption and knee society score. All results show no statistical significant difference between two groups. Conclusion: This study shows continuous intra-articular injection in postoperative TKA is as effective as continuous adductor canal block. It can be used as alternative in postoperative TKA.
TENSION BAND WIRING (TBW) OF DISTAL END CLAVICLE : A FORGOTTEN TECHNIQUE : SIMPLER, CHEAPER AND BETTER
Authors: Zufahrizzat S , Nadzim AS , Saifudin O , Abdul Rauf A 
Published: May 2020

Clavicle fracture is a common injury, and can be classified into middle third, medial third, and distal third fractures. Only 10-15% of clavicle fracture occur in the distal third segment. Neer classified the distal clavicle fracture into five types ; type II and V are unstable and requiring fixation . Various common methods of stabilizations are introduced such as K-wiring , tension band fixation , plate fixation, osteosynthesis with hook plate and coracoclavicular screw however all those operative methods have their own advantages and disadvantages. Materials and Methods: We presented a case of 21 years old male with left shoulder pain after motor vehicle accident. Examination revealed tenderness on his left shoulder, and radiograph showed fracture of distal end left clavicle Neer type II, requiring fixation. He was counselled for lateral extension clavicle locking plate but unable to pay due to financial constraint. Results: The patient underwent open reduction and internal fixation using Kirschner wire with tension band fixation . The fracture site was visualized and the hematoma was curetted and washed. The fracture was reduced and fixed with two 1.4 mm trans-acromial Krischner wires and the reduction was checked with an image intensifier. Then the TBW is applied using stainless steel wire size 1.0 . The K-wires are bent beneath the skin. Sling immobilization is used for 2 weeks after the operation. Unrestricted tolerable shoulder motion is permitted. Stretched and exertional exercise is allowed after radiography shows osseous union and the implants are removed. Discussions: TBW is widely employed to treat limb fractures, such as patella and olecranon fracture but seldom used for distal clavicle nowadays. The advantages of TBW are higher antirotation and antibending force compared with that in K-wire fixation and lower profile compared with the bone plate, which reduces tendon irritation and prominent implant. The use of K-wires and TBW also required only the exposure of the fracture site. The soft tissue around the clavicle incurred little damage, leading to a lower infection rate. In addition, the use of K-wires and TBWs can provide a more rigid fixation than K-wires only. Rigid fixation with little complication contributes to good results . Conclusion: Surgical management is recommended for unstable distal clavicle fracture. TBW can be preferred because of the simplicity of the procedure, low cost, simple hardware, high union rate and easy availability of the implant.
Hip Transposition as a Limb Salvage Procedure Following Resection of Extensive Ewing Sarcoma of The Pelvis and Proximal Femur
Authors: Budi MNS , Rubiansyah P 
Published: May 2020

Pelvic resection in limb salvage surgery always pose a major challenge for orthopedic surgeon, especially in large tumor extension that requires combination of pelvic and femoral resection with sacrificing the hip joint. Complex anatomy and preservation major structure (arteries, veins, nerves, muscle and visceral organs) is a major consideration. Methods: We evaluated the oncologic, functional outcome and complications of a patient 27 years old with Ewing sarcoma involving the left pelvis (ilium, ischium and pubic) and femoral proximal until middle third, who underwent pelvic resection type II, III involving hip joint with femoral resection. The reconstruction that has been done were: hip transposition using cemented scaffold and modified Harrington as framework, proximal femoral megaprosthesis, capsuloplasty using polypropylene mesh and reattachment of muscles around the hip. Results: Follow-up at 3 months showed a good oncological and tolerable function outcome; by means of no local recurrence or distant metastatic with painless partial weight bearing. Active motion of the hip is preserved with muscle power of 4/5 and LLD of 3 cm. The patient were able to ambulate by himself, sitting in normal position with no pain. There were no major complications were found in this patient such as infection, dislocation, loosening implant or visceral complications. Conclusion: The choice of limb salvage in pelvic tumor followed with complex reconstruction of the hip still amenable in patient with malignant tumor of pelvic and femur, regarding the oncological, functional outcome and complication.
THUMB TUBERCULOSIS: A CASE REPORT
Authors: Mohd Yunus R. , Ahmad A.A. , Ahmad A.R. 
Published: May 2020

Tuberculosis is caused by Mycobacterium tuberculosis, occurs in about 2 billion people. Approximately 8 million people/year develop the active form.1,2 Tuberculosis in the hand is manifested as osteomyelitis in carpals, metacarpals and phalanges.1 Musculoskeletal tuberculosis occurs, in most cases, through haematogenous dissemination from the primary focus. In immunosuppression circumstances, it is reactivated. Methods: 47 years old lady, who had underlying pulmonary tuberculosis on anti-TB medications since June 2018, presented to us for swelling over right thumb. Associated with tender, erythematous skin and limited range of motion of right thumb. Results: Plain radiograph demonstrated soft tissue swelling, joint space narrowing, mottled lucency of the proximal phalanx and cystic degenerative changes. MRI shows osteomylities proximal phalanx of right thumb. Patient underwent wound debridement of right thumb, culture and sensitivity shows Mycobacterium tuberculosis infections. Post debridement, range of motion of MCP joint of right thumb was improved and anti-TB medications to restart. Discussions: Tuberculosis involvement of the metacarpals and phalanges is a rare presentation of extrapulmonary TB. The radiographic features of osseous tuberculosis are present in conditions such as inflammatory arthritis, pyogenic osteomyelitis, osteopenia, softtissue swelling with minimal periosteal reaction, narrowing of the joint space, cysts in bone adjacent to joints, and subchondral erosions. The gold standard to diagnose is culture of Mycobacterium tuberculosis from bone tissue. Current treatment is a 2 month initial phase of isoniazid, rifampin, pyrazinamide, and ethambutol followed by a 6 to 12 month regimen of isoniazid and rifampin. Conclusion: Finger swelling is a rare presenting sign of disseminated tuberculosis. Early biopsy and appropriate microbiologic testing can avoid diagnostic delay. References: Malaviya AN, et al. Best Pract Res Clin Rheumatol. 2003;17:319–43. Fortún J, et al. Mycobacterium tuberculosis infection? Medicine. 2010;10:3808–19. DOI: 10.1016/S0304-5412(10)70119-0.
Outcomes of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis at Hasan Sadikin General Hospital Bandung
Authors: Pardamean A , Mulyadi D , Tandjung F.A 
Published: May 2020

Peripheral joints involvement in Ankylosing spondylitis (AS) has been reported in 73% of these cases, with the hip being the most commonly affected diarthrodial joint. The reported prevalence of hip involvement in AS varies from 19 to 36%. Total Hip Arthroplasty (THA) is often required to manage pain and restore function and mobility. The aim of this study was to retrospectively analyze outcomes related to performing THA on patients with AS. Methods: We evaluated the oncologic, functional outcome and complications of a patient 27 years old with Ewing sarcoma Data of 19 AS patients who underwent 29 THAs between 2014 and 2018 were retrospectively analyzed. Clinical and imaging data were collected preoperatively, postoperatively, and during the follow-up period for surgical outcomes. Results: There were 14 males and 5 females with 29 affected hips (53% bilateral, 47% unilateral). The average patient at surgery was 31.7 years old (range, 17-47 years). After surgeries, overall inclinations and anteversions of acetabular cups were 44.9°±0.3° (range, 30°–50°) and 18.42°±0.30° (range, 0°–25°) respectively. Mean Visual Analogue Scale (VAS) score decreased from 7.4±0.14 (range, 4–10) preoperatively to 3.21±0.09 (range, 0–4) at final follow-up. Mean Harris Hip Score (HHS) improved from 24.36±2.6 (range, 15–45) to 92±1.66 (range, 80–95) at final follow-up. Postoperative Range of Motion (ROM) was improved from 10.26°±2.61° (range, 0°–50°) preoperatively to 84.26°±0.76° (range, 70°–100°) at final follow-up. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, which shows the activity of disease, was 7.6±0.17, and it decreased to 3.5±0.15 at last follow-up. There were post-operative complications in 8 hips (27.6%). Superficial wound infection was documented in 3 hips (10.3%), sciatic nerve injury in 1 hip (3.4%), implant loosening in 2 hip (6.9%), and heterotopic ossification was documented in 2 hips (6.9%) at final follow-up. Conclusion: Surgical outcomes of THA for AS patients with hip involvement are satisfactory.