bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors of blood transfusion in knee arthroplasty
Authors: Chaiyakit Pruk , Umpanpong Weeranate , Watcharotayangkoon Tawipat 
Published: May 2020

Objectives: The amount of blood transfusion after knee arthroplasty seem to vary in different reported study. We carried out a retrospective study to analysis pre-operative risk factors for blood transfusion in patient whom underwent knee arthroplasty in our institution. Methods: A retrospective study of 190 patients treated with 194 procedure (186 unilateral knee arthroplasty, 4 bilateral knee arthroplasty) from November 2014 to October 2015 was analyzed. A univariate analysis was performed to establish the relationship between all variables and the need for postoperative transfusion. Variables that were determined to have significant relationship were include in a multivariable analysis.. Results: The univariate analysis revealed a significant relationship between need for postoperative blood transfusion and preoperative hemoglobin levels, surgical technique, arthrotomy approach, DVT prophylaxis, operative blood loss, surgical technique and surgeon experience. The multivariate analysis identified a significant relationship between need for transfusion and preoperative hemoglobin level, surgical technique and operative blood loss. Patients with a preoperative hemoglobin less than 12 g/dL had a 5.1 times greater risk of having a transfusion than those with a hemoglobin level ≥ 12 g/dL. The surgical technique with computer assisted surgery had a 0.15 times lesser risk of having a transfusion than those with the conventional technique. Conclusion: The preoperative hemoglobin level < 12 g/dL was shown to increase risk of the need for blood transfusion after knee arthroplasty, while computer assist surgery total knee arthroplasty was shown to decrease risk of blood transfusion. We suggest that patients with preoperative hemoglobin < 12 g/dL need to be crossmatching PRC in pre-operative steps.
Functional Outcome & Revision Rate Of Pfna Vs Dhs For Osteoporotic Intertrochanteric Femur Fracture: A Meta Analysis
Authors: Savio Sherly Desnita , Susila I Made Arya , Dharmayuda Cokorda Gde Oka 
Published: May 2020

Objectives: Intertrochanteric femur fracture in elderly presents a challenge as the source of morbidity and mortality if not well-treated. This study investigates the functional outcome and revision rate of two of the most common treatments of choice for this condition, Proximal Femoral Nail Antirotation (PFNA) and Dynamic Hip Screw (DHS), while furthermore investigate the secondary functional outcome of the two procedures if proceeded to Conversion to Total Hip Arthroplasty (CTHA). Methods: A systematic search was conducted to identify relevant studies through PubMed, Google Scholar, and Cochrane database. A total of 9 studies (2.251 patients) were included, divided into 3 meta-analysis. Random effect model was used for continuous outcomes using Review Manager. Results: For primary Harris Hip Score (HHS), the mean HHS at 12-months follow-up for PFNA (n = 184) was 77.77, as for DHS (n = 187) was 78.33, indicating no significant difference (P = 0.73). The mean revision rates for PFNA (n=784) was 2.68%, as for DHS (n=766) was 2.48%, indicating no significant difference (P = 0.61). For secondary HHS after CTHA, the mean HHS 12-months postoperatively for PFNA (n =142) was 83.97, as for DHS (n = 190) was 83.65, indicating no significant difference (P = 0.59). Discussion: PFNA and DHS can both be considered in osteoporotic intertrochanter femur fracture, as the two procedures offer similar 1-year functional outcome and revision rate. However, PFNA may benefit with less blood loss and operation time. Some potential revision causes, such as peri-implant femoral fracture, infection, and implant failure should always be monitored perioperatively. Furthermore, when CTHA is indicated for revision, the two procedures offer comparable secondary functional outcome. Conclusion: Current meta-analysis suggests that PFNA and DHS both have comparable primary functional outcome, revision rate, and post-CTHA secondary functional outcome.
Functional Outcome of Traumatic Acetabulum Fractures : A 6 Months Comprehensive Follow Up Following Open Reduction Internal Fixation Surgery at Saiful Anwar General Hospital Malang
Authors: Putra DP , Pradana AS , Phatama KY , Mustamsir E , Hidayat M 
Published: May 2020

Acetabular fractures commonly occurred in young adult patient who suffered from high impact trauma which often associated with life threatening injuries. Displaced acetabular fractures lead to abnormal distribution on joint cartilage pressures. It produces early cartilage disruption and development of premature osteoarthritis at the hip. Anatomical reduction and fixation operation in acetabulum fractures still a major challenges due to its complications such as poor functional outcome after surgery. Despite its difficulty to predict the outcomes of acetabular fractures surgeries, functional outcomes scoring such as Oxford Hip Score (OHS) and Harris score may help surgeon to measure long term outcome following acetabular fractures. A total of 13 patients were treated over period of January 2018 until March 2019 in Saiful Anwar General Hospital Malang. The mean age of patients in this serial case is 37 years old and were operated within 2 weeks of injury. All the patients undergone an ORIF (Open Reduction Internal Fixation) operation and observed for the OHS and also Harris score 6 months following surgeries to measure functional outcome of the patients. The mean score of OHS in this serial case is 41 (satisfactory joint function) and the mean score of harris hip score is 91 (excellent). Some patients experience pain during activities, tingling sensation after standing in some periods of time, and heaviness when taking stairs 6 months after operation. This results conclude that the preoperative, operative and post operative management of patient with acetabular fracture in Saiful Anwar Hospital has satisfactory results.
ASYMMETRICAL DISLOCATION OF BILATERAL HIP IN AN ADOLESCENT
Authors: Terence  , Tan TS , Jagjoth S , Yogeshwaran N. 
Published: May 2020

Hip joint being an inherently stable joint requires a significant amount of force to dislocate. Different mechanism of injury causing different pattern of dislocation. We presented a rare injury of simultaneous asymmetrical dislocation of bilateral hip in an adolescent patient following motor vehicle injury. Presentation: 15 years old girl, pillion rider sustained a motor vehicle accident whereby she was thrown forward with her right hip adducted and flexed, the knee hit on the motorcycle bumper and her left hip in abduction and knee in flexion hit on the road divider. On admission her left lower limb was flexed, abducted, and externally rotated; in contrast, the right lower limb was flexed, adducted, and internally rotated. A pelvic radiograph (figure1) revealed bilateral hip dislocation with the femoral head displaced antero-inferiorly on the left side and posteriorly on the right side. Closed reduction of the joints was done under sedation and subsequently put on traction. Repeated radiograph showed both hip joints well reduced (Figure 2), skin traction was applied for 5 days and subsequently she was allowed for wheelchair ambulation. [Figure: see text][Figure: see text] Discussion: Bilateral simultaneous hip dislocations are an extremely rare injury (1.25%)1, however bilateral asymmetric dislocations of hip are even rarer. Based on described mechanisms, they ranged from pedestrian being hit by a car to head on collision of vehicles and motorcycle crash. The single common mechanism involved in most of these cases was a sudden deceleration injury which occurred in motor vehicle accidents. Treatment for asymmetrical dislocations are still similar, with concentric reduction still the main goal either closed or open reduction. Conclusion: Asymmetric bilateral hip dislocation is a rare entity especially in adolescents and requires high velocity collision with sudden deceleration injury. 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
UNUSUAL TALUS FRACTURE IN CHILDREN
Authors: Zulfahrizzat S , Nadzim AS , Norshaidi S , Abdul Rauf A 
Published: May 2020

Talus fracture are extremely rare in children. The talus is predominantly made up of cartilage with higher elastic resistance than adult bone thus the pediatric talus bone can sustain higher forces before fractures. The prevalence for paediatric trauma in talus fracture is estimated to be five times rarer than for adult trauma . The most common mechanism of injury in talus fractures is axial loading of the talus against the anterior tibia with the foot in dorsiflexion. The talar neck is the most common fracture site, followed by the talar body. Report: A 9-year-old boy was brought to emergency department following a fall from bicycle after his right foot caught in back wheel. He was unable to weightbear on his right foot and his anterior ankle region was swollen, with no open wounds or abrasions. Radiographs of right ankle revealed a fracture at neck of right talus (Hawkins type II ) then proceed with CT scan to characterize the fracture pattern and extent of injury. His fracture was fixed with two headless cannulated screws size 4.0 under I/I guidance. The patient was advised non-weight bearing with below knee cast for 6 weeks. After 2 months the patient was pain free and had resumed all his activities. X-ray after 1 year showed a consolidation of the fracture without evidence of avascular necrosis. The Hawkins classification can be used to describe the different types of fractures of the talar neck and to predict the risk of avascular necrosis. These injuries can be difficult to diagnose with plain radiograph, and further assessment with CT scan or MRI may be necessary. Undisplaced fracture can be managed non-operatively with cast immobilization and displaced fracture can be treated with either closed or open reduction. Complications are still likely to be encountered in the course of talus fractures treatment considering the precarious blood supply to the bone as well as complex ankle and subtalar articulations. According to Smith et al study with 29 subjects , displaced pediatric talus fractures and those associated with high-energy trauma resulted in more complications ; avascular necrosis (7%), arthrosis (17%),delayed union (3%),neuropraxia (7%) and the need for further surgery (10%). [Figure: see text][Figure: see text] Conclusion: Talar fractures in the pediatric age group are very rare. A minimal or undisplaced fracture of talus is less likely to undergo avascular necrosis than a displaced fracture but even with optimal treatment, avascular necrosis may still occur. It is of prime significance that these fractures should be diagnosed well in time to avert complications. Therefore an appropriate length of follow-up is required. References: Vivek D , Jairam DJ , Paediatric Talus Fracture :Volume 5 Issue 8, International Journal of Science and Research August 2016 PG 1040-1041
Management of Recurrent Posterior Hip Dislocation in a Down Syndrome Patient with Dysplastic Hip Using Ganz Periacetabular Osteotomy: Follow Up After 4 Years
Authors: Dilogo Ismail H. , Fiolin Jessica 
Published: May 2020

Recurrent hip dislocation in a Down Syndrome patient with dysplastic hip is a very challenging case to treat even for an expert orthopaedic hip surgeon. Least compliant patient and family, lowly educated with low socioeconomic status and the dysplastic hip forces limited option as a treatment. This is the first case world wide reporting 4 year follow up of dysplastic hip with Down Syndrome treated successfully with PAO technique. Methods: An eighteen years old female with history of Down Syndrome had multiple posterior hip dislocation episodes since 3 years prior. Several attempts of close reduction and hip spica applications were performed upon dislocation despite no successful retaining of reduction. Acetabular index of right hip were 550 and epiphyseal plate hasclosed. PatientwasperformedopenreductionusingSouthern-Mooreposteriorapproachand osteotomy of ischium, continued with capsulorrhaphy followed with Smith-Peterson anterior approach and osteotomy of superior ramus pubis and iliac bone. Then, derotation maneuver was performed under image intensifier to obtain adequate coveragefollowedwithbonegraftandfixationusing2cannulatedscrewandhipspica castapplication. Results: Within four years after surgery, the hip has never been dislocated again, patient could sit without pain and walk with full weight bearing although Harris Hip Score could not be performed due to Down Syndrome. Leg length discrepancy was negligible,fracture has fully united and acetabularin dex was300. Conclusions: Ganz periacetabular osteotomy, although a technically demanding surgery, is a preferable treatment in recurrent hip dislocation for Down Syndrome patient with good to excellent clinical and radiological ou tcome
TRAUMATIC DORSAL DISLOCATION OF INTERMEDIATE CUNEIFORM : A RARE MIDFOOT INJURY
Authors: Shamsudin Z , Abdull Sitar MN , Alias A , Ahmad AR 
Published: May 2020

Dislocation of the intermediate cuneiform is a rare injury, and only a few cases have been reported .Cuneiforms dislocations have been treated in a variety of methods, ranging from open or closed reduction, without or with fixation such as Krischner wires or screws. Methods: A 24 years old female presented with right foot pain following fall from motorbike after got hit by a car from back. She related a history that her right foot was forced into torsion and plantarflexion at impact . On examination there was a bony protuberance on the dorsal surface, at cuneiform area . Radiograph showed dorsal dislocation of intermediate cuneiform. CT scan was performed and supported the radiographical findings. Manipulation under sedation was attempted, but was unsuccessful. Results: Patient was placed supine under spinal anesthesia . A dorsal incision was made centering over the protuberance proceeded distally up to the base of the second-metatarsal. The dislocated middle cuneiform was identified. There was proximal soft tissue attachment to the middle cuneiform which was carefully preserved. It temporarily reduced with Krishner wires and a 2.7 mm variable angle locking plate was fixed dorsally to butress the bone dislocation . The foot was immobilized with a boot slab for 6 weeks and subsequently physiotherapy was instituted and gradual weight-bearing started. Postoperative follow-up was uneventful. Discussion: Intermediate cuneiform is a part of the transverse and medial longitudinal arches of the foot and the stability is achieved by the deep transverse, dorsal, and plantar ligaments. It’s shaped like a wedge, the thin end pointing downwards, situated between medial and lateral cuneiforms, and articulates with the navicular posteriorly, the second metatarsal anteriorly and with the other cuneiforms on either side. Because it is wedge shaped and positioned dorsally, it has a tendency to dislocate dorsally, particularly when a plantar flexion force is applied to the midfoot. Immediate reduction and maintaining in reduced position is needed for good ligamentous healing. Conclusion: Intermediate cuneiform dislocation is a rare injury to encounter due to stable articulation of joints and ligament. Significant trauma is required for these injuries to take place. Open reduction is the gold standard treatment for these injuries. References: Kumaravel S et al An isolated middle cuneiform dislocation with a rare violence Journal of clinical orthopaedic and trauma 5 (2014) 161-171 Name
Knee Arthroplasty in Severe Varus Advanced Knee Osteoarthritis with Proximal Tibia Malunion: a case report
Authors: Sindunata Nyoman Aditya , Suvarly Prettysia , Aditya Rio , Butarbutar John 
Published: May 2020

Alignment is crucial for successful knee arthroplasty.1 Tibia malunion will make arthroplasty more challenging. In this case, we present advanced knee osteoarthritis with tibia vara due to malunion that needs corrective osteotomy during knee arthroplasty. Case Presentation: A 70 years old female presented to our office complaining pain in both knees markedly on the left, profoundly felt during walking. She has a history of being hit by motorcycle 15 months ago and left knee was more bent since then. Physical examination of the left knee showed severe varus, mild effusion, tenderness on medial tibial condyle, otherwise normal. Plain radiographs showed advanced bilateral knee osteoarthritis with left proximal tibia malunion. Patient underwent left knee arthroplasty with corrective tibia and fibula osteotomy. Solutions and Outcome: Patient underwent closed wedge tibial osteotomy together with fibula osteotomy followed by knee arthroplasty with posterior-stabilized implant and tibial stem extension in a single surgery. Tibial osteotomy was reinforced using plate and screws. Partial weight bearing was achieved in second postoperative day and discharged on the third day. Patient able to walk with painless left knee after 1 month. Discussion: Severe deformity that causes huge malalignment makes knee arthroplasty difficult. Some methods are available to correct malalignment.1 In this case, the surgeon chose to do closed wedge tibial osteotomy reinforced with plate and screws to correct the proximal tibia malunion. Arthroplasty was done using posterior-stabilized implant and tibial stem extension. Patient shows good result in alignment and function. Conclusion: Correcting the associated deformity is crucial in achieving good alignment in knee arthroplasty. Even in our case of severe genu varus due to proximal tibia malunion, correcting proximal tibia varus deformity prior to knee arthroplasty shows good alignment and function. References: Mullaji AB, Padmanabhan V, Jindal G. Total Knee Arthroplasty for Profound Varus Deformity. 2005;20(5):550–61.
Cemented Hip Arthroplasty: Dealing with Bone Cement Implantation Syndrome
Authors: Ifran S , Ramzi D , Handi SE , Melyana S 
Published: May 2020

Bone Cement Implantation Syndrome (BCIS) is a rare but potentially fatal complication of cemented orthopedic surgery, 0.5 – 1.7% resulting in cardiovascular collapse. BCIS characterized by hypoxia and/or hypotension, pulmonary hypertension, arrhythmias, loss of consciousness, and the worst is cardiac arrest. We experienced two cases with fatal outcomes. Methods: Two case report were reviewed from medical record and meeting discussion between orthopedic and anesthesiologist department. Case Presentation: Hip hemiarthroplasty was performed in two patients on February and March 2019. A 90-years-old man had history of cemented hemiarthroplasty on his left hip two years ago, low back pain, and osteoporosis, and a 77-years-old woman had no history of cemented hemiarthroplasty, controllable diabetic, corrected hypo-albumin. Both of them have same BCIS high risk comorbidity as right intertrochanter fracture, geriatric, and ASA III. Five minutes after cementation, the patients suffered a cardiac arrest and anesthesiology’s team start CPR with advanced cardiac life support protocols, surgeon finished the surgery immediately, and patients transferred to Intensive care, but the patient didn’t survive. Discussion: These cases urge us to pay more attention to BCIS and some recommendation must be made to improve better management and increasing the survival chances. With agreement of final theory of BCIS etiology is multimodal model, the understanding of cement behavior and cementing techniques are the keys of orthopedic role. Preparation, closely observation at peri-cementing to 24 hours post-surgery, and appropriate management are the keys of anesthesiologist role. As a concrete recommendation that our discussed, BCIS risk assessment tools made by Cheryl and Angela at AORN journal are believed to be able to increase alertness and preparation to manage severe BCIS. Conclusion: Propose a pre-operative BCIS risk assessment tool based on Cheryl and Angela’s tool to minimalized fatality of BCIS incidence is being our concern. Alongside that, communication and suggestion protocol between surgeon and anesthesiologist, knowing the BCIS clinical features, timing of BCIS incident, and informed concern are important to BCIS management.
Neuropathic Pain Component Insights in Patients with Knee Osteoarthritis: An Observational Study
Authors: Prapto Devindra , Tertia Clarissa , Purvance Ivander 
Published: May 2020

Osteoarthritis (OA) is one of the most leading cause of chronic disability in musculoskeletal area with pain as the main manifestation. Chronic pain often leads to an abnormal excitability in pain pathway, resulting a central sensitization which corresponding to neuropathic pain (NP). To date, the existence of neuropathic component in osteoarthritis of the knee remains controversial. Methods: The cross-sectional study involved 74 patients of knee osteoarthritis who were diagnosed by using ACR classification criteria for osteoarthritis of the knee. The presence of NP component was assessed by DN4 and painDETECT questionnaire. All participant also completed the WOMAC score to evaluate their status of knee OA, and was divided into two groups, which were mild and severe OA. The prevalence of NP component within knee OA patients was evaluated and then compared between the mild and severe groups. Results: 45,9% of the participants examined with DN4 score were likely to have the NP component, while the others were doubtful. On the other hand, painDETECT score revealed that 36,5% of the patients were likely to have NP component, 21,6% unclear, and 41,9% unlikely. Comparison between WOMAC score and DN4 showed that 67,6% of the severe population had NP component, significantly higher than the mild population, 24,3% (p<0,05). Alternatively, painDETECT score showed 13,5% likely to have NP component, 24,3% unclear, 62,2% doubtful in the mild population, while in the severe group 59,5% likely, 18,9% unclear, 21,6% unlikely (p<0,05). Conclusion: Knee osteoarthritis has a significantly high prevalence of neuropathic pain component. NP component prevalence appears higher in the severe OA population, whether it assessed by DN4 or painDETECT scoring.