bluuebunny/crossref_metadata_2025_split huggingface dataset:
GUNSHOT INDUCED HUMERUS FRACTURE TREATED USING THE MASQUELET TECHNIQUE
Authors: Terence MD , Abdul Razak KA , Jagjoth S , Tan WL 
Published: May 2020

Humerus fractures secondary to gunshot injury are slow to unite and may require multiple surgeries to obtain union. 1We report a gunshot induced humerus fracture treated via the Masquelet technique. Report: A 27-year old gentleman had a shotgun injury to his left arm exposing the humerus bone. He underwent debridement and external fixator and a 4cm segmental bone loss was noted. The following debridement, a humeral nail and 3cm acute shortening was done, as well as the 1st stage Masquelet (Figure 1). After 6 weeks, the 2nd stage Masquelet was performed (Figure 2). At 1 year follow up, radiographical union was noted (Figure 3). [Figure: see text][Figure: see text][Figure: see text] Discussion: Masquelet technique consists of cement spacer insertion which is then exchanged with autologous cancellous bone graft packed into an induced membrane. 2To our knowledge, there have not been reported cases of Masquelet technique used to treat shotgun induced open humerus fractures. The use of an external fixator is proposed by many authors1. The key to success is a thorough debridement of the fracture3. Conclusion: The Masquelet technique is a reliable tool in the surgeon’s armamentarium in the management of humeral segmental bone defects2. Reference: Management of shotgun induced open fractures of the humerus with Ilizarov fixator;2015 The Masquelet Technique for Thumb Metacarpal Reconstruction Following Trauma ; JBJS; 2018 Muscle reconstruction in reconstructive surgery: soft tissue repair and long bone reconstruction; 2003
Therapeutic effect of Intra-articular normal saline and lidocaine injection after Arthrocentesis for Knee Hemarthrosis post traumatic injury in RS Muhammadiyah Palembang (RSMP): A Case Report
Authors: Afifurrahman MD 
Published: May 2020

Female 22 years old, come to RSMP with pain and swollen in the right knee after fall down from stairs 2 days ago. In Physical Examination found bruising around the knee with no sign of crepitation nor abnormality during ligament test. Patient than given initial treatment (analgesic and antifibrinolytic) for 1 week and X-ray examination of knee. One week later patient come with decreased but persisted pain and swollen knee. X-ray Examination suggests joint effusion. The Patient than admitted for arthrocentesis followed by Intra-articular normal saline and lidocaine injection. Bleeding into a joint is referred to as hemarthrosis and is an important cause of monoarticular joint pain and swelling. Its can be suspected based on patient history, physical exam, and multiple imaging modalities, however the best way to diagnose hemarthrosis is with arthrocentesis with synovial fluid analysis. Traumatic injury is the most common cause and the knee is a frequent site of hemarthrosis. Initial treatment of any acute hemarthrosis includes immobilization, ice, and compression. Analgesia for pain control may be required in the acute period. Arthrocentesis with aspiration from a joint can be both diagnostic and therapeutic by reducing pressure from the effusion. Intra-articular normal saline (IA-NS) injections have been utilized as a placebo in a number of researches pertaining to the management of joints problem such as knee osteoarthritis (OA). It is believed that these IA-NS injections may have a therapeutic effect that has not been quantified in the literature. Lidocaine have some mild anti-inflammatory effect during its relatively short halflife of 1.5 hours. The prompt effect of the local anesthetic providing temporary relief of symptoms can help confirm proper placement of the injection and support that the site injected was the source of the pain.
POSTERO-MEDIAL TIBIAL PLATEAU (MOORE’S TYPE) FRACTURE AND THE IMPORTANCE OF COMPUTER TOMOGRAPHY IN DIAGNOSIS: A CASE REPORT
Authors: Mohd Yunus R , Solayar G.N , Ahmad A. R 
Published: May 2020

Moore type I posteromedial split fracturedislocation of proximal tibia are relatively uncommon. It is a specific fracture pattern that is not well described by the AO (41B2.2/B3.2) or Schatzker (IV) classification system because these systems do not differentiate when the medial fragment is primarily posterior and associated with a dislocation as the Moore system does. 1The additional use of computed tomography scans in the assessment of tibial plateau fracture may improve surgeon’s agreement that lead to the final decision and optimization of treatment. 2Galla and Lobenhoffer described a direct posteromedial approach for managing Moore type I tibial plateau fracture1. Report: A 48 years old malay gentlemen was alleged motor-vehicle accident, sustained closed fracture tibial plateau of right knee. Initially patient was diagnosed with right tibial fracture schatzker IV based on right knee anterior-posterior and lateral view xray. But CT scan had done, show the proximal tibial fracture transversing medial aspect with coronal spliting. Patient was treated with posteromedial locking compression plate with Lobenhoffer approach. Intraoperatively, diagnosis was confirmed with Hohl & Moore classification type I, there is coronal split fracture extending to posteromedially. The importance of computerised tomography scans when dealing with intra-articular fracture of tibial plateau may improve regarding localisation of fracture lines, depression zone, comminution, and the surgical treatment plan. 2Alexander et al. reported after addition of computerised tomography scans significantly improved to “good” in all classification. The features of Moore’s type I fracture which is coronal split fracture dominantly posterior column, coronal view from CT scans is more useful compare than sagital view. Galla and Lobenhoffer have introduce a direct postero-medial approach that minimizes soft tissue injury while allowing excellent fracture visualization, reduction, and fixations. 1This technique protect the neurovascular bundle and requires only suboeriosteal elevation of the popliteus to obtain full exposure. Furthermore, because of the protecting posterior soft tissues, skin closure and wound healing are reliable. Conclusion: Moore’s type I fracture managed with postero-medial approach has better post operative outcome, improved reliability and shows good reproducibility when classified with computerised tomography scans. References: Johannes K.MF, et al,. Optimizing the Management of Moore Type I Postero-Medial Split Fracture Dislocations of the Tibial Head: Description of the Lobenhoffer Approach. J Orthop Trauma 2007;21:330-336 Alexander B, et al. Classification system for tibial plateau fractures: Does computed tomography scanning improve their reliability? Injury, Int. J. Care Injured 41 (2010) 173-178
Functional and Radiological Comparison of Umbilical Cord Mesenchymal Stem Cells, Somatotropin, and Hyaluronic Acid Injection for Cartilage Repair in Early Osteoarthritis of the Knee: A Randomized Controlled Trial
Authors: Fiolin J , Dilogo IH , Lubis AMT , Pawitan JA , Liem IK , Pandelaki J , Hanitya AL , Feby CA 
Published: May 2020

The umbilical cord-mesenchymal stem cells (UC-MSC) has been shown to improve the viability of degenerated chondrocytes in knee osteoarthritis (KOA) in cellular level. Additional somatotropin injection also shown clinical improvement in patients. The present trial is conducted to assess the efficacy of umbilical cord mesenchymal stem cells (UC-MSC) in comparison to somatotropin and hyaluronic acid (HA) injection to treat and slow the progression of knee osteoarthritis. Methods: This study was conducted from January 2016 to April 2018 in Cipto Mangunkusumo General Hospital. A total of 28 knees from 15 patients with early KOA Kellgren Lawrence I-II were randomized into three groups. Group A was treated with 1x106 units of intra-articular UC-MSCs + 2 ml HA followed with 2 consecutive weeks of HA injection; group B was treated with the same dose of HA with additional 8 IU of Somatotropin; group C was treated as control. The International Knee Documentation Committee (IKDC) score, The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue score (VAS), were assessed on the 1st and 3rd month, then every 3rd month until 12 months. Cartilage evaluation using MRI cartigram were performed at pre-implantation, and after the 6th and 12th month after implantation Results: General improvement were observed in all groups after 6 and 12 months. The IKDC score improved significantly among groups after 12 months (69.43 [48.3-89.66], 79.31 [51.72-90.08], and 75.9 [67.82-97.7] in group A, B, and C, respectively, p =0.005). We did not find a significant difference between groups in VAS and WOMAC results. However, we observed a medial T2 improvement in group A (39.55 [32.65-67.85] initially and 45.64 [38.12-70.65] 12 months after implantation). Conclusion: Injection of UC-MSC could improve knee function and cartilage profile in early KOA. However, further multicenter studies with larger samples are required to investigate the efficacy of such treatment for treating knee osteoarthritis.
Crab bite causing shewanella putrefaciens infection: Introduction to a possibly deadly and emerging threat
Authors: Razak Kamarul Arifin Abdul , Dass Terence Michal , Liang Tan Weng , Nadeson Yogeshwarran , Kaur Karenjit 
Published: May 2020

Shewanella species are gram-negative bacteria found in warm, temperate regions and are normal microflora of the marine environment1. Human infections are unusual and have a restricted geographic distribution. Presentation: A 45 years old lady was bitten by a crab while preparing to cook it. She developed fever and swelling of the right thumb with hemoserous discharge and blackish discolouration.Upon examination, the thumb was erythematous and swollen with a hematoma filled blister formation over the dorsal aspect. Deblistering was done and fluid samples were sent for culture and sensitivity which later returned as Shewanella Putrefaciens. Empirically she was started on IV Augmentin. Discussion: Most common clinical manifestation associated with Shewanella spp are superficial soft tissue infection1. Other reported clinical features are primary and secondary bacteremia, hepatobiliary, bone, joint and CNS infection, endocarditis, eye, ear and respiratory infection2. Antibiotics susceptibility includes aminoglycosides, 3rd and 4th generation cephalosporins, carbapenems and fluoroquinolones1. About 79% of patients have underlying conditions such as diabetes mellitus, venous congestion and heart failure; they are immunocompromised, as is our patient3. Conclusion: Proper handling of seafood during preparation should be encouraged as a simple bite may turn deadly. Initiation of antibiotics according to suspected organisms should be performed to prevent worsening of soft tissue infections. References: Diaz, J.H, Lopez, F.A Skin, Soft Tissue and Systemic Bacterial Infections Following Aquatic Injuries and Exposures. The American Journal of the Medical Sciences, 349(3), 269275 Finkelstein,R, Oren,I. Soft Tissue Infections Caused by Marine Bacterial Pathogens: Epidemiology, Diagnosis, and Management. Current Infectious Disease Report (2011)13(5):470–477 N. Vignier et al; Human Infection with Shewanella putrefaciens and S. algae: Report of 16 Cases in Martinique and Review of the Literature; Am. J. Trop. Med. Hyg., 89(1), 2013, pp. 151–156
Femoral Shaft Bowing Angle in The Coronal Plane Affects Distal Femoral Valgus Cutting Angle: A Radiographic Study
Authors: Suvarly Prettysia , Sindunata Nyoman Aditya , Aditya Rio , Muljadi Rusli , Butarbutar John 
Published: May 2020

Postoperative limb alignment is important for successful total knee arthroplasty (TKA). Femoral shaft bowing angle (FBA) in coronal plane may influence distal femoral valgus cutting angle (DFVCA) and 5±2º may not perpendicular to mechanical axis. Methods: Sixty-six lower extremity long film x-ray of osteoarthritic knees were collected and analyzed with IntstaRISPACS (digital radiography software). The correlation and linear regression between FBA and DFVCAwere measured using SPSS 24. Results: Our study shows a strong correlation between FBA and DFVCA. Lateral FBA tends to present with DFVCA outside 7º as shown in linear regression test, vice versa. Conclusion: Since DFVCA is influenced by FBA, we recommend preoperative femoral x-ray in all knee replacement candidates. References: Rezende FC, Carneiro M. Is it safe the empirical distal femoral resection angle of 5° to 6°of valgus in the Brazilian geriatric population? Rev Bras Orthop. 2013; 48(5): 421-6. Kim CW, Lee CR. Effects of femoral lateral bowing on coronal alignment and component position after total knee arthroplasty: a comparison of conventional and navigation-assisted surgery. Knee Surg Relat Res. 2018 Mar; 30(1): 64–73. Kim JM, Hong SH, Kim JM, Lee BS, Kim DE, Kim KA, Bin et al. Femoral shaft bowing in the carinal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):1936-42
NECROTISING FASCIITIS : PREVELANCE AND DISTRIBUTION OF CAUSATIVE MICROORGANISM IN A MALAYSIA TERTIARY HOSPITAL - A 2 YEAR STUDY
Authors: M.Asyraf A.H , Ashraf- Fareeq S , Zulfahrizzat S , Arvinder-Singh HS , Neela Vasantha Kumari , Abdul-Rauf A , Sanjiv-Rampal  
Published: May 2020

The objective of this study was to evaluate the prevalence of microorganism isolates types, antibiotic usage preference, the prevalence of diabetic amputations in necrotizing fasciitis (NF) and predicitive factors of amputation. Methodology: This study was a cross-sectional study conducted by looking at medical records ttraced from Hospital Seremban identifying all necrotizing fasciits admissions in the year of 2017/2018. The researchers first traced all medical records via electronic medical records. All case records were reviewed and identifiers were removed. Patients with missing notes/medico-legal cases were excluded from this study. Results: A total of 159 records were traced of which none met the exclusion criteria. The mean age of patients were 56.09 (SD:12.20), mean days stayed at hospital 25.09 (17.70) and the mean number of days patients were on at least one antibiotic was 18.87 (41.78). From the total, 145 (91.2%) were suffered at the lower limbs, 68 (42.8%) suffered an amputation [of which 31 were above-knee-amputations], 97 (61.0%) suffered from sepsis and 19 (11.9%) suffered mortality. 139 (87.4%) of the patients were diabetics, 105 (66.0%) were hypertensives and 87 (54.7%) were immunocompramised. The majority were caused by unknown aetiology [103 (64.8%)], 131 (82.4%) presented with erythema/cellulitis and 116 (73.0%) had good prognosis. The commonest type of NF was type 2 [103 (64.8%)]. The top 3 commonest isolates were Pseudomonas aeruginosa (15.7%), Klebsiella pneumoniae (12.6%) and β haemolytic Group B Streptococcus (10.7%). The 3 commonest antibiotics started were ampicillin/sulbactam combination (69.8%), ceftazidime (9.4%) and amoxycillin/clavulanate (4.4%). The mean LRINEC score was 7.72 (SD:2.31). Among the 139 diabetics, 68 (48.9%) ended up with an amputation. Among the 102 patients having both diabetes and hypertension (n=102), 50% suffered an amputation. A cross tabulation done showed that Klebsiella pneumoniae (17.2%), β haemolytic Group B Streptococcus (15.5%) and Proteus mirabillis (13.8%) were the common causative organisms in an amputation. A regression analysis done to identify predictive variables for an amputation showed no statistical significant variables. Conclusion: Proper handling of seafood during preparation should be encouraged as a simple bite may turn deadly. Initiation of antibiotics according to suspected organisms should be performed to prevent worsening of soft tissue infections. Conclusion: From this study, we concluded that the commonest type of isolates at our centre was Pseudomonas aeruginosa and the commonest antibiotic choice was the ampicillin/sulbactam combination and nearly half of diabetics with NF ended up with an amputation. There were no predictive factors for an amputation among the collected variables
The Results of Two-stage Revision for Methicillin-resistant Periprosthetic Joint Infection (PJI) of the Hip
Authors: Santoso Asep , Anwar Iwan Budiwan , Sibarani Tangkas SMHS , Soetjahjo Bintang , Yoon Taek-Rim , Park Kyung Soon 
Published: May 2020

Patellar tendon rupture after total knee arthroplasty is a rare, but often catastrophic complication. In addition, infection is also a dreaded complication after total knee arthroplasty. We report an 84-year-old female that has late infected total knee arthroplasty with patellar tendon rupture treated with resection arthroplasty and then subsequent arthrodesis with retrograde intramedullary nail. Objective: Periprosthetic joint infection (PJI) of the hip due to methicillin-resistant bacteria is difficult to treat and remain a challenge for arthroplasty surgeon. Methods: Retrospective review was done to the patients who received two-stage revisions with antibiotic loaded cement-spacer for PJI of the hip between January 2010 to June 2015. We found 65 patients (65 hips) with positive culture findings. Eight patients were lost to followup and excluded from the study. Among the rest of the 57 patients, methicillin-resistant infection (MR Group) was found in 28 cases. For comparison, we also evaluated the 29 other cases that caused by other pathogen (Non-Methicillin resistant group/Non-MR group). We compared all of the relevant medical records and the treatment outcomes between the two groups. Results: The mean of follow-up period was 33.7 months in the methicillin-resistant group and 28.4 months in the nonmethicillin-resistant group (p = 0.27). The causal pathogens in the methicillin-resistant group were: Methicillin-resistant Staphylococcus aureus (MRSA) in 10 cases, Methicillin-resistant Staphylococcus epidermidis (MRSE) in 16 cases and Methicillin-resistant coagulase-negative Staphylococcus (MRCNS) in 2 cases. The reimplantation rate was 92.8% and 89.6% in the methicillin-resistant and nonmethicillinresistant groups, respectively (p= 0.66). The rates of recurrent infection after reimplantation were 23.1% (6/26) in the methicillin-resistant group and 7.6% (2/26) in the nonmethicillinresistant group (p= 0.12). The overall infection control rate was 71.4% (20/28) and 89.6% (26/29) in the methicillin-resistant and nonmethicillin-resistant groups, respectively (p = 0.08). Both group showed comparable baseline data on mean age, BMI, gender distribution, preoperative ESR/CRP/WBC and comorbidities. Conclusion: Two-stage revision still resulted a higher recurrency rate and lower infection control rate for the treatment of periprosthetic joint infection (PJI) of the hip due to methicillin-resistant infection compared to nonmethicillin-resistant infection.
Hyaluronic Acid in Improving Clinical Outcome of Knee Joint after Anterior Cruciate Ligament Reconstruction: A Systemic Review
Authors: Putra Fajar Defian 
Published: May 2020

Hyaluronic acid (HA) is a viscosupplementation which is currently used as treatment option for non-operative management of knee osteoarthritis (OA). HA could be a pain medication and joint regulator, which might play a beneficial role in restoring overall joint homeostasis and reduce pro-inflammatory stimuli after knee surgery, e.g. anterior cruciate ligament (ACL) reconstruction thus reducing pain and accelerating range of motion (ROM). Therefore, there is possibility of administering intraarticular HA to reduce post-operative inflammation, which can reduce pain and hasten recovery Objectives: To identify the clinical outcome of the knee joint after HA administration in post ACL reconstruction. Methods: We conducted a literature search through medical databases to identify randomized controlled trials (RCTs) that focused on clinical outcome of knee joint after HA administration in post ACL reconstruction patients. Included articles were assessed. The key findings and conclusions from each article were obtained and analyzed. Results: We found four included studies from 64 relevant citations. It contained three articles of level of evidence 1 and one article of level of evidence 2. The administration methods are intraarticular in three articles and per oral in one article. We obtained some parameters used to assess the improvement of clinical outcome of knee joint after HA administration. Some parameters, such as VAS, IKDC, SF-36 Health Survey PF and Tegner score showed no significant improvement after HA administration, yet KOOS and LKSS score showed improvement. In three articles, the effect of HA showed improvement in active ROM. Analgesic consumption also showed lower use in patients who was administered HA in two articles. Conclusion: The current study suggested that there was limited evidence of HA administration after ACL reconstruction in improving clinical outcome of the knee joint. Future high-quality studies are highly needed to confirm these findings.
Single Stage Hemiarthroplasty Bipolar Surgical Procedure in 1 year Neglected Femoral Neck Fracture with 4cm Limb Shortening: A Case Report
Authors: Dusak I Wayan Suryanto , Prasada I Dewa Gede Bracika Damma 
Published: May 2020

The neglected femoral neck fractures in young adults have always presented a difficult problem with high rates of non-union and avascular necrosis. In developing countries many of these fractures present late, often as a result of delayed referral or because of initial management by traditional bone-setters. Case Presentation: A 25- year-old female came to the outpatient clinic with chief complain pain on her right groin after a motorcycle accident 1 year ago. On physical examination a 4 cm leg length discrepancy was measured, and the patient walked with limping gait. Conventional x-ray confirmed displaced fracture of neck femur. Patient is treated with hemiarthroplasty bipolar without soft tissue release. Discussion: Neglected femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Fracture displacement disrupts the terminal branches to the femoral head and leads to development of osteonecrosis. The goal of treatment in neglected femoral neck fracture is to achieve a painless, mobile and stable hip. In neglected femoral neck fracture more than 6 months, hence prosthetic replacement (hemi or total) is generally preferred. Hemiarthroplasty can be performed when the acetabulum is normal. Conclusion: Hemiarthroplasty bipolar give satisfactory outcome for neglected femoral neck fracture and provides a predictable, reproducible functional recovery although long-term results are yet to be seen