bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of acute hematogenous infection after total knee arthroplasty with open arthrotomy debridement and polyethylene exchange combined with direct intra-articular antibiotic infusion: a midterm result with mean follow up of 75 months
Authors: Chaiyakit Pruk , Meknawin Surapoj , Hongkoo Nutthapong 
Published: May 2020

Background: Standard management of acute hematogenous infection after total knee arthroplasty consisted of open arthrotomy debridement and polyethylene exchange. However, the efficacy of this method was inconsistent with successful retention could be less than 50%. Direct intra-articular antibiotic infusion could be a potential adjuvant for this complicated problem. Objective: To report our results of open arthrotomy debridement and polyethylene exchange combined with direct intra-articular antibiotic for the treatment of acute hematogenous infection after TKA. Materials and Methods: We retrospectively review data from 16 knees (13 patients) with this type of infection and being treated by open arthrotomy debridement and polyethylene exchange combined with direct intra-articular antibiotic (IA-ATB) with our protocol since 2009. Results: all cases were diagnoses with acute hematogenous PJI and treated with semi-urgent basis and underwent open arthrotomy debridement and PE exchange combined with IA-ATB with our protocol were included in this study. 2 cases (2 knees) were loss to follow up after the infection were eradicated at 7 months and 48 months. 2 cases (3 knees) passed away with intact prosthesis at 6 years. 2 cases (2 knees) were reinfected with at 2 years and 5 years after operation and later need to do 2 stage revision. The longest follow up was 11 years with average follow up of 75 months. Therefore, 12 out of 14 infected knees were successful treated with this technique. Conclusions: Open arthrotomy debridement and polyethylene exchange combined with direct intra-articular antibiotic infusion is an effective method for the treatment of acute hematogenous infection after total knee arthroplasty.
Augmentation for Acetabular Deficiencies in Complex Total Hip Arthroplasty
Authors: Solayar Gandhi Nathan 
Published: May 2020

Introduction: Complex and revision Total Hip Arthroplasty (THA) is a challenging prospect in patients with acetabular bone deficiencies. Augmentation using allograft and trabecular metal (TM) are among some of the options in these situations. This study report the outcomes of 14 cases of complex and revision THA using acetabular augments performed in our institution between 2015 and 2018 Materials and Methods: In this retrospective study, data included demographic features, indication for THA, type of augments and clinical outcomes using the Harris hip score were collected for the to determine early results following THA. Results: The mean cohort age was 51.3 years. Gender distribution was equal with 7 male and female patients each. 7 THAs were augmented with allograft and 7 cases with TM augments. The average duration of follow-up was 16.9 months. Most patients (11 of 14) required complex primary THA following prior traumatic hip dislocations and its subsequent complications. The mean post-operative Harris hip score for functionality was 80.84 in our cohort at final follow-up (from an average of 33.8 pre-operatively). At present, there have been no reports of wound complications, infections or dislocations in this early cohort. Discussions: Complex/revision THA using allografts for acetabular augmentation have been used for decades with good and replicable results as shown in our series. TM is relatively new but current literatures show encouraging results. Both options have resulted in good outcomes in our cohort and further long term studies would be necessary before TM augments were to replace the need for allograft. Conclusions: Both allografts and TM acetabular augments showed good early results post-operatively in our cohort. With the improved flexibility of component selection and the lower risk of allograft infection, TM augments is currently our choice of acetabular augmentation and the early results are promising.
Gleno-humeral Joint Functional Outcome in Displaced Scapular Body Fracture Treated with Anatomical Scapula Plate: 2 case series
Authors: Afiq MA , Norhaslinda B , Rizal Z , Rauf A 
Published: May 2020

Introduction: The gleno-humeral (GH) or shoulder joint complexity of its biomechanics had been subjected for a number of study for many years. The ability of the shoulder joint to have multiple degrees of motion is contributed by the interaction between the structures surrounding the joint which maintain its stability. Methods: We report 2 cases of displaced scapular body fracture in our trauma centre fixed using anatomical scapular plate. Both underwent surgery within 3 weeks after their accident, using modified Judet approach and used implant from the same provider. All patients were followed up at 6, 12 , 18 and 72 weeks. At 6 months post operation the motion of the gleno-humeral joint were assessed. The functional status and pain score were joint also assessed using QuickDASH score and Visual Analogue Scale respectively. Results: Active shoulder range of motion, QuickDASH and VAS score are shown in Table 1. Lower QuickDASH score have better functional outcome while lower VAS score indicate lesser pain experience. [Table: see text] Discussions: Scapulo-thoracic joint also important in gleno-humeral joint motion. Scapulothoracic motion allows shoulder movement beyond initial 120o provided by the glenohumeral joint1. This coordinated movement between the scapula-thoracic and glenohumeral joint is termed as scapula-thoracic rhythm2. Displaced scapula fracture will affect the function of the scapula-thoracic rhtym. Scapula bone has uneven bony mass distribution. Anatomical scapular plate is a pre-contoured implant which is specially designed to meet the morphology of the scapula bone. Restoration of the anatomy of the scapula is very important since it will restore the scapula-thoracic rhythm and thus gleno-humeral joint function. Conclusion: In our short follow up, displaced scapular body fracture shows good gleno-humeral joint functional outcome when treated with anatomical scapula plate. Scapula bone plays important role in maintaining the biomechanics of gleno-humeral joint. References: 1. Terry GC, Chopp TM. Functional anatomy of the shoulder. J Athlet Train 2000;35(3):248–55. 2.Halder AM, Itoi E, An K. Anatomy and biomechanics of the shoulder. Orthop Clin NA 2000;31(2).
Acute Traumatic Posterior Shoulder Dislocation With Greater Tuberosity Fracture
Authors: Zufahrizzat S , Nuruddin MY , Saifudin O , Rauf A 
Published: May 2020

INTRODUCTION: Posterior shoulder dislocation is a rare injury and represents 2-5% of all shoulder dislocation cases. Even less frequent , posterior fracture-dislocation represents 0.9 % of shoulder fracture dislocation. Mechanism of injury include a traumatic event with axial loading of the adducted , internally rotated arm or more commonly from violent muscle contraction following a seizure or electrocution injury. Delays in diagnosis it are common, estimating 50 % are missed and it can lead to chronic pain, stiffness and long-term functional disability. METHOD: A 44 years old male was brought to our emergency department following road traffic accident. He was riding a motorcycle when he was hit by car from the left side. He complained of severe pain and functional disability of his left shoulder. Radiographs revealed posterior shoulder dislocation (light bulb sign) with quiry greater tuberosity (GT) fracture. CT scan was performed to assess fracture displacement. U slab was then applied, and the patient was taken to operation theatre after a routine blood investigations. RESULT: The patient was placed in semi beach position under general anesthesia. Incision was made via transdeltoid approach. Intraoperatively, posterior dislocation of the humeral head was confirmed. GT fragment size 2.7 cm x 1.6 cmwas indentified and reduced with temporary Kirschner-wires. The reduction was confirmed under image guidance and final fixation achieved with two partially threaded 4.0 mm cannulated screws. The shoulder was then immobilized with a sling 2 weeks subsequently pendulum exercise and progressive range of motion exercise was started. DISCUSSION: Inadequate radiograph including axillary view and poor physical examination are the main factors of misdiagnosis.The physicalfindings that may present are shoulder locked in an internally rotated posititon with limited external rotation , prominent posterior shoulder and coracoid . Radiograph will showing positive rim sign , absence of the half-moon overlap , light-bulb sign, and the trough line. A delay in diagnosis and treatment of posterior shoulder dislocation or fracture-dislocation has increased risks of nonunion, subsequent humeral head collapse, avascular necrosis and post-traumatic arthritis. CONCLUSION: Posterior dislocation of shoulder associated with greater tuberosity fracture is a rare and frequently missed injury. A thorough clinical and radiographic evaluation should avoid the missed diagnosis. REFERENCES: Figueiredo A et al Posterior fracturedislocation of the shoulder: An often unrecognized traumatic injury Orthopedics, Traumatology and Sports Med Int Journal (2018) 1 :8-11
Anterior Cruciatel Ligament Reconstruction with Peroneus Longus Tendon Autograft: Functional Outcome and Donor Site Morbidity
Authors: Kusumastutia Auliana Hayu , Rukmoyo Tedjo , Rhatomy Sholahuddin , Sakti Yudha Mathan 
Published: May 2020

Anterior Cruciate Ligament (ACL) is a knee ligament that is very important in maintaining the stability of the knee joint. The incidence of isolated ACL tears remain a common orthopaedic injury with significant increase in the rate of ACL reconstruction over time. Several types of autografts used for ACL reconstruction have some potential occurrence of donor site morbidity, including Bone-Patellar Tendon-Bone (BPTB), hamstring tendon, and quadriceps tendon. Peroneus longus tendon can be an option as a graft donor because it has biomechanical characteristics that are not significantly different from the hamstring tendon. Purpose: The aim of the study was to evaluate the functional outcome and donor site morbidity of anterior cruciate ligament (ACL) reconstruction using peroneus longus tendon autograft. Methods: This study was an observational analytical with retrospective cohort design using medical record. The functional outcomes were assessed with IKDC, Modified Cincinnati, Tegner-Lysholm, and KSS scoring system 12 months after surgery. Donor site morbidity was assessed with AOFAS and FADI scoring system, eversion strength, and plantarflexion strength. Results: Seventy five patients fulfilled the inclusion criteria (59 males and 16 females). Mean of peroneus longus tendon graft diameters were 8.39 ± 0.69 mm (range 6.5-10 mm). Significant increase of functional score (p<0.05) were found 12 months after surgery. Mean score of IKDC was 55.26 ± 12.76 preoperative; 96.69 ± 3.36 postoperative, Modified Cincinnati was 65.45 ± 16.25 preoperative; 93.29 ± 7.04 postoperative, Tegner-Lysholm was 67.80 ± 15.29 preoperative; 89.71 ± 8.35 postoperative, KSS (Knee) was 65.33 ± 19.46 preoperative; 95.17 ± 5.94 postoperative, and KSS (Function) was 76.52 ± 20.25 preoperative; 93.20 ± 10.29 postoperative. Mean score of AOFAS was 98.93 ± 3.11 and FADI was 99.80 ± 0.59 at six months after surgery. The eversion and plantarflexion strength were not significantly different (p>0.05) between donor and contralateral side ankle. There was neurapraxia in 3 (4%) patients at six months postoperative. Conclusion: The peroneus longus tendon can be an ideal source of graft for ACL reconstruction because it has good functional outcome and minimal donor site morbidity.
Patella Fracture Fixation Via Wide Awake Local Anesthesia No Tourniquet (Walant) Technique
Authors: Safie Shaqirin , Adham Amir , Ahmad  , Ahmad Abdul Rauf 
Published: May 2020

Introduction: Fracture of the tibia are the most common long bone fracture, with an incidence greater than 75,000 per year in the US1. With the recent breakthrough of operation under WALANT (Wide Awake Local Anaesthesia No Tourniquet) technique. We reported a patient with midshaft tibia fracture who underwent plating under the WALANT technique Methodology: 18 yearold gentleman sustained a closed fracture of his left tibia after his motorbike skidded. He wascounselled for the surgery to be done under the wide-awake technique as we have limited operating theatre time for the case to be done under general/regional anaesthesia. Preoperatively, the WALANT solution is prepared using 50 cc lidocaine 2%, 1cc of epinephrine, 10cc of sodium bicarbonate 8.4% then dilute into 50 cc normal saline. Total of 50 cc WALANT solution was injected along the planned skin incision and at subperiosteum 30 minutes before operation started. Result: Pain score patient remain 0-3/10 during and after removal of backslab, throughout the surgery and postoperatively. The use of epinephrine for hemostasis provide good surgical field view since there is minimal bleeding. Postoperatively the anaesthesia effect lasted for 6 hour and was patient able to move the leg straight away without have to keep lying in bed for 6 hours after spinal or drowsiness from sedation. Conclusion: Plating of tibia under WALANT is a good alternative for patient who have financial difficulty, high risk operation under general anaesthesia, hospital which have limited slot for operation under general anaesthesia and etc. Additionally, the strength and stability of the plate can be assessed intraoperatively by asking the patient to actively move his limb. Reference: Praemer A, Furner S, Rice DP. Musculoskeletal Conditions in the United States. Park Ridge, IL: American Academy of Orthopaedic Surgeons; 1992.
Comparative Biomechanical Study Between Minimally Invasive Popliteus and LCL Reconstruction Versus LaPrade Technique
Authors: Chernchujit Bancha , Artha Arrisna , Anilabol Panin 
Published: May 2020

Background: Many aspects of the posterolateral corner (PLC) of the knee have been extensively studied within the past 20 years. Quantitative anatomic and biomechanical studies have demonstrated the importance of the 3 static stabilizers of the lateral side of the knee: the fibular collateral ligament, the popliteus tendon, and the popliteofibular ligament. There are various methods of reconstruction. However, currently, there is no consensus on the preferred reconstruction technique for treating patients with chronic PLC injuries. We have developed a new reconstructive technique for PLC based on tibiofibular-based technique, similar to LaPrade, and this technique is less invasive than the previous techniques. Hypothesis: There is no difference between minimally invasive popliteus and LCL reconstruction and LaPrade’s method in restoring the posterolateral stability of knees Methods: Six paired fresh-frozen cadaveric knees were assessed in the intact state and then dissected to simulate a grade III posterolateral knee injury. By using a “Blocked randomization”, each paired knee was randomized into 2 groups (1) reconstruction via LaPrade’s method, (2) minimally invasive popliteus and LCL reconstruction. Biomechanical testing using varus stress radiographs was performed to compare knee stability between 2 groups. Results: This study included six paired knees, three males and three females. The mean age of the cadaver was 70.8 years (range 57-85 years). No difference was found in the demographic data (sex distribution, lateral opening gap of intact knee and side-to-side difference of lateral opening gap of sectioned knee) between the 2 groups. The side-to-side difference in lateral joint opening on the varus stress radiographs significantly improved after PLC reconstruction in both groups (p <0.001, p <0.001), However, there were no differences between the 2 groups in side-to-side difference of lateral opening gap after reconstruction (Mean difference=-0.05 (95%CI, -0.46 to 0.36); p- value=0.039). Conclusion: Biomechanically, minimally invasive popliteus and LCL reconstruction is equivalent to LaPrade’s technique in restoring the stability of knees in case of grade III PLC injury. Additionally, this technique is less invasive than all traditional open technique of PLC reconstruction. The minimally invasive popliteus and LCL reconstruction technique may be a treatment option for grade III PLC injury. Keywords: posterolateral corner; ligament reconstruction; popliteus tendon; lateral collateral ligament; popliteofibular ligament; knee biomechanics; minimally invasive surgery
Comparison of Bone Marrow Aspirate Concentrate and Allogeneic Human Umbilical Cord Blood-derived Mesenchymal Stem Cells in Patients with Kissing Lesion on Initial Arthrocopy After High Tibial Osteotomy in Medial Unicompartmental Osteoarthritis of Knee
Authors: Na Seung-Min , Choi Ik-sun , Seon Jong-Keun , Song Eun-Kyoo 
Published: May 2020

Purpose: The purpose of this study was to compare the outcome of cartilage regeneration between bone marrow aspirate concentrate (BMAC) augmentation and the stem cell-based medicinal product (a composite of culture-expanded allogeneic hUCB-MSCs and hyaluronic acid hydrogel [Cartistem]) in medial unicompartmental osteoarthritis of knee Methods: Out of 81 cases underwent for second look arthroscopy who treated for medial unicompartmental osteoarthritis between 2016 and 2019, 31 cases were kissing lesion which was shown full thickness cartilage defect(over ICRS grade 3B) in medial femoral cartilage and medial tibial cartilage at initial surgery. We retrospectively compared clinical outcomes, including International Knee Documentation Committee (IKDC) subjective score, Knee Society Score (KSS) pain and function, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between BMAC group comprising of 25 cases and Cartistem group comprising of 14 cases at minimum of 1 year follow up. Also, cartilage regeneration was graded by International Cartilage Repair Society Cartilage Repair Assessment (ICRS CRA) grading system at secondary arthroscopy. Radiologic measurement including Hip-Knee-Ankle (HKA) angle, posterior tibial slope angle, and correction angle were assessed. Results: At the final follow-up, clinical outcomes were improved. However, there were no statistical significances between two groups in clinical outcome and radiologic outcome(p>0.05). Regarding the findings of second-look arthroscopy, Cartistem group was significantly better than BMAC group in medial femoral cartilage and medial tibial cartilage(p=0.002, 0.000). About medial femoral cartilage, grade I cartilage regeneration was found in 0 case, grade II in 10 cases (40%), grade III in 6 cases (16%), grade IV in 9 cases (36%) in BMAC group and grade I cartilage regeneration was found in 1 case (7.1%), grade II in 11 cases (85.7%), and grade III in 1 case (7.1%) in Cartistem group. About medial tibial cartilage, grade I cartilage regeneration was found in 0 case , grade II in 8 cases (32%), grade III in 4 cases (16%), grade IV in 13 cases (52%) in BMAC group and grade I cartilage regeneration was found in 0 case, grade II in 12 cases (85.7%), and grade III in 1 case(7.1%), grade IV in 1 case (7.1%) in cartistem group. Conclusion: Clinical outcomes were improved regardless of which augmentation was administered. However, microfracture with Cartistem is more effective for cartilage regeneration than microfracture with BMAC in medial unicompartmental OA. Keywords : High tibial osteotomy, Unicompartmental osteoarthritis, Microfracture, Cartilage regeneration, Bone marrow aspirate concentrate, Cartistem.
A Prospective Cohort Study of Outcome In Total Knee Arthroplasty With Or Without Drainage At Dr. Hasan Sadikin General Hospital From January 2017 To January 2018
Authors: Magetsari R.M.S.N , Mulyadi D , Tandjung F.A 
Published: May 2020

The use of postoperative drainage after total knee arthroplasty (TKA) in osteoarthritis patients was believed effective in decreasing hematoma, swelling, infection, and postoperative pain. However, the drainage can also cause infection due to retrograde migration of bacteria and impair early postoperative rehabilitation. The aim of the study was to compare pain intensity (VAS), hemoglobin level (Hb), range of motion (ROM), clinical results (KSS and WOMAC) in TKA patients with and without postoperative drainage. This study was a prospective cohort study with samples of 98 patients at Dr. Hasan Sadikin Hospital from January 2017-January 2018. Simple random sampling with closed envelopes was used to determine TKA patients who undergone postoperative drainage and without drainage. The drainage group (K1) was 46 knees, the without drainage group (K2) was 52 knees. Both groups were compared based on VAS, Hb, ROM, KSS and WOMAC score on preoperative, 1st, 3rd, 5th day, 1st, 6th month, and 1 year postoperative. VAS score on K1 group showed better results (3rd day VAS K2 1.77; K1 1.32; p-value 0.070; 5th day K2 1.46; K1 1.22; p-value 0.090; p-value < 0.1). Based on postoperative Hb, K2 group was better (K2: 11.74;K1: 10.835; p-value 0.06). ROM on K2 is better than K1 (1st day ROM K2 52.50; K1 42.85; p-value 0.64;3rd day K2 53.70; K1 47.24; p-value 0.832; 5th day K2 54, 60; K1 45.85; p-value 0.73). Based on the KSS and WOMAC score there were no significant differences between K2 and K1. Our study concluded that there are several advantages for not using drainage after TKA in terms Hb, ROM on 1st, 3rd, and 5th day postoperative and early mobilization with weight bearing using walker at 3rd day postoperative. There is no rationale for the use of drain after primary TKA.
Role of Mesenchymal Stem Cell-Conditioned Medium (MSC-CM) in ligament or tendon healing: A Systematic Review from 1998-2018
Authors: Rhatomy Sholahuddin , Sumarwoto Tito , Prijosedjati Andhi , Romaniyanto  , Prasetyo Thomas Edison 
Published: May 2020

Background: The therapeutic value of mesenchymal stem cells (MSCs) in tissue engineering and regenerative medicine is attributable in part to paracrine pathways triggered by several secreted factors secreted into culture media. The secreted factor here is known as the conditioned medium (CM) or secretome. Objectives: This review is aimed to investigate and summarise the in-vitro, pre-clinical in-vivo studies regarding the role of CM-MSC in ligament or tendon healing from 1998 until 2018. Data Sources: A systematic literature search on PubMed, MEDLINE, OVID, Scopus, Google scholar, and Cochrane library was carried out by using search terms: Secretome, conditioned medium, mesenchymal stem cell, ligament, tendon and healing. Methods: A total of 904 articles were reviewed. Five articles were identified as relevant for this systematic literature review. Results: One tables of studies were constructed for in vitro studies and in-vivo studies. Conclusion: All of the included in-vitro studies and in-vivo studies have shown a promoting effect of ligament or tendon healing at various stages in vitro or in vivo. Although there are no clinical studies regarding the use of CM- MSC in the human ligament or tendon healing that have been conducted, transplantation of secretome has shown a promising result in the acceleration of ligament or tendon healing process.