Diagnosis and Management of Congenital Hand Anomalies
Bill Cumming
" Many of the important congenital abnormalities are quite uncommon and in most
instances the more significant ones will require either to be accepted and left alone
or for the surgery to be performed by an experienced plastic/hand surgeon.
Nevertheless it is important for us to understand these anomalies and the
understanding must come from knowledge of the causative process.
The original classification by Alfred Swanson from Grand Rapids Michigan was
based on the appearance of the hand. It has been used for 40 years and is still used
by many surgeons.
However that classification is now, and must be superseded by a classification
based on the knowledge of formation of the limbs and the interplay between genetic
and peripheral influences on the active limb bud.. The limb bud forms very rapidly
and very early into the developed hand
There has been considerable new knowledge regarding this process which will be
presented because it is an essential in understanding the process and therefore the
management of the anatomical variations of the resultant anomaly.
The anomaly can be assisted surgically by a variety of principled activities and a
series of cases demonstrating these principles will be presented."
PediatricFemoralShaftFractureManagement
AnungBSatriadi
ProfDRRSoeharsoOrthopaedicHospital/FacultyofMedicineSebelasMaretUniversity
Surakarta
ABSTRACT
Pediatricfemoralshaftfractures,arethemostcommonmajorpediatricinjuriestreatedbythe
orthopedicsurgeon.Seventypercentoffemoralfracturesinvolvetheshaft.
Factorsthatmustbeconsiderintreatmentchoiceare:age,fracturecharacteristic,concomitant
injuryandotherfactorssuchasfamilyenvironment,theknowledgeandabilityofthesurgeon,
availabilityofimplant,potentialcomplicationsandfinancialconsiderations.
Theacceptedmethodsforyoungerthan2yearsoldareaPavlikharnessand/orsplintsforewborns
(<6monthofage)andanimmediateorearlyspicacastforolderinfants.
Thestandarttreatmentfor2-6yearsofageishipspicacasting(eitherimmediatelyorsubsequent
toinitialtraction).Forcomplexoropenfracturestheoptionsare:skeletaltractionfollowedbyhip
spicacasting,platefixation(eithersubmuscularoropen)orexternalfixation.
In6-14yearoldgroup,operativeinterventionisincreasinglyindicated.Flexibleintramedullarynails
istechniqueofchoiceforstabilizing.Inmorecomplexconditionoropenfracturestheoptionsare:
skeletaltractionfollowedbyhipspicacasting,platefixation(submuscularoropen)orexternal
fixation.Forolderthan14yearoldgroup,lockedintramedullarynailsisrecommendedtreatment
andInmorecomplexconditionoropenfracturestheoptionsare:skeletaltractionfollowedbyhip
spicacasting,platefixation(submuscularoropen)orexternalfixation.
Thesealgorithmissuitableforinstitutionswithaffordabletechnology.Butinsituationwhenthere
isafinanciallimitation,orinhospitalswithlimitedresources(technologyandhardware)orif
lengthyhospitalstays(intraction)aremoreaffordablethanthelatesttechnologywemust
considerednonsurgerymethodeasfirstlinetherapy.
Theabsoluteindicationforoperativetreatmentisopenfractureandfracturewithassociated
injuries(multiplefractures,headtrauma,orseveresofttissueorvascularinjuries).
Nonsurgerymethod(tractionandhipspicacasting)remainaneffectiveandreliablemethodfor
treatingfemoralshaftfracturesinchildrenespeciallyinyoungerthan14yearsold.
Tobesuccesspediatricfemoralshaftfracturestreatmentrequirejudiciouschoiceoftreatment
method,strictattentiontodetailandafrequent,meticulousfollow-up.
Keyword:Pediatricfemoralshaftfractures,nonsurgerytreatment,surgerytreatment
ReversePonsetiMethodfortreatmentCongenitalVerticalTalus
AnungBSatriadi
ProfDRRSoeharsoOrthopaedicHospital/FacultyofMedicineSebelasMaretUniversity
Surakarta
ABSTRACT
The incidence of Congenital Vertical Talus ( CVT ) was estimated 1: 10.000, and manifested as a
rigidrocker-bottomflatfoot.Thecalcaneusisinfixedequinus,andtheAchillestendonisverytight.
The hindfoot is in valgus, while the head of the talus is found medially in the sole, creating the
rocker-bottomappearance.Theforefootisabductedanddorsiflexed.Itscharacteristicradiographic
featureisadorsaldislocationofthenavicularonthetalus.Ifleftuntreated,CVTresultsinapainful
andrigidflatfootwithweakpush-offpower.
Treatment of CVT has traditionally consisted of extensive soft-tissue releases. This treatment is
oftenfollowedbyseverestiffnessofthefootandothercomplicationssuchaswoundnecrosis,talar
necrosis,undercorrectiondeformity,subtalarjointpseudarthrosis.
ThetrendtowardlesssurgeryforCVTcontinuedwithDobbsandcolleagues,whopublishedanew
methodconsistofcasting,pinningofthetalonavicularjointandpercutaneousheel-cordtenotomy.
The principles of manipulation and application of the plaster casts were similar to those used by
Ponsetitocorrectaclubfootdeformity,buttheforceswereappliedintheoppositedirection.Once
the talus and navicular were aligned, fixation of the talo-navicular joint with a Kirschner wire and
percutaneoustendoachillestenotomyunderanesthesiawereperformed,followedbyapplicationof
acastwiththefootinslightdorsiflexion.AsolidAFOwasfitted
This new method – sometimes called Reverse Ponseti Method – provides excellent results of in
terms of the clinical appearance of the foot, foot function, and deformity correction as measured
radiographicallyataminimumtwoyears,inpatientswithidiopathicCVT.
Key for success with this methode are: adhere to technique’s details, surgeon’s skill and good
behaviourandclosedinvolvementoftheparentsorcaregiver
Synonims: Congenital Vertical Talus, Congenital Convex Pes Valgus, Congenital Rocker-bottom Flatfoot, Congenital
FlatfootwithTalonavicularDislocation
Keyword:IdiophaticCongenitalVerticalTalus,ReversePonsetiMethod
'' DDH -­‐ How to Keep The Hip In?'' Dr. ASHOK N. JOHARI Redislocation of the hip following an open reduction is a devastating complication which happens between 0 to 8% cases. An orthopaedic surgeons needs to be aware of the causes and cure of this problem. The commonest cause of a redislocation is an incomplete reduction. When the femoral head is not deeply seated within the acetabulum there are chances that it will redislocate Getting a hip to be concentrically reduced implies the following: 1. All extraarticular obstacles to reduction are taken care of 2. All intraarticular obstacles to reduction are taken care of 3. The femur has a shape conducive to reduction 4. The acetabulum has a shape conducive to maintenance of reduction 5. The reduction is stable in the weight bearing position This lecture deals with the difficulties of obtaining a stable and concentric reduction and how to obtain it. It also deals with the management of redislocated hips. ''Beware of The Nightmare of Physeal Injuries'' Dr. ASHOK N. JOHARI Physeal injuries pose a problem in diagnosis and management. Even with the most judicious management, there are still possibilities of complications like growth arrest and shortening. It becomes important to recognise a physeal injury. Gentle handling and correct management is critical. Management may include closed or open reduction and fixation with minimal implants like K wires or screws to ensure accurate physeal and articular alignment. Inspite of excellent management, complications like growth arrest, deformity and shortening can take place. The family has to be counselled about these complications in advance and a long term follow up is demanded. The knee region is predisposed to physeal injuries and its complications. This lecture illustrates the problem of physeal injuries and the complications which can result esp. at the knee. Hence an outline would be given of physeal injuries in general, the late complications and their management. Sportinjuryinskeletallyimmatureadolescents
DrPThiagarajan
Immatureathletesareparticipatinginmoreandmoresportingactivitiesresultingin
injuries.Adolescentsareuniqueastheyhaveopenphysesandtraumaaffectsthejoints,
bonesandepiphyseswithpotentialforgrowthplatedamage.
Kneeisthemostcommonlyinjuredjointinthisagegroupresultinginmajorityof
injuries.Assessingimmaturepatientsonehastokeepalookoutforsubtleinjuries.Joint
laxityiscommoninthisagegroupandligamentinjuriesandtendonproblemsaremore
commonthanfractures.
ParticularlyACLinjuriesposeadilemmaforthesurgeonandparents.Immensepeer
pressureandathleticeventscompoundthemanagementoftheseinjuries.
Managementofligamentinjuriesrequirescarefulconsiderationoftheageofthepatient,
growthpotential,severityoftheinjury,alternativeavailabletreatmentandphysicaltherapy
andactivitymodification.
Itiswisetodefersurgerytillskeletalmaturityisreachedinligamentinjurieslike
ACL.Surgicaloptionsmustbediscussedwithparentswithrealisticexpectations.Nonphysealreconstructionoptionsneedtobecarefullyconsideredbeforeundertakingsurgery.
Modificationofactivityandrehabilitationmodalitiesshouldbethefirstpriorityintreating
adolescentsandwherepossiblesurgerydeferredtillphysealriskisminimized.
The Role of Orthopaedic Surgeons For The Care of Children With Osteogenesis Imperfecta Dr. ASHOK N. JOHARI Orthopaedic surgeons form a part of the team which manages OsteogenesisImperfecta. The disease demand a multidisciplinary management and the Orthopaedic Surgeon is involved with a paediatrician, geneticist and many other specialists on the team e.g. an auditory specialist, ophthalmologist etc. The orthopaedic surgeon may be called in for recurrent fractures occuring in childhood with trivial trauma. He may discover that there is a family history of osteogenesisimperfecta or this may be absent. He will need to investigate the patient and come to a diagnosis and counsel the family. The orthopaedic surgeon may be involved in the following roles: 1.To manage fractures -­‐ conservatively and operatively 2. To internally splint weak bones 3. To correct deformities 4. To correct shortening 5. Managing scoliosis Most situations may demand surgery and this lecture deals with the surgical modalities of management of OI. Complications of orthopedic lower extremity
surgery in cerebral palsy
Moon Seok Park, MDandGye Wang Lee, MD
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital,
Kyungki, Republic of Korea
Cerebral palsy (CP) is defined as a group of permanent disorders characterized by
impaired movement and posture caused by nonprogressive damage in the motor
control centers of the developing fetal or infant brain[1]. The general condition of
patients with CP is often poorer than that of patients without a chronic illness. CP
patients have a higher risk of postoperative complications from anesthesia and
orthopedic intervention[2].Complications of orthopedic lower extremity surgery in CP
can be divided into two categories according to the event time, and includeshortterm (perioperative)andlong-term complications. Perioperative complications include
intraoperative and immediate postoperative complications, such as hypotension,
bradycardia, pneumonia, upper respiratory infection, seizures, etc.First, we will
examine why CP patients have a higher risk of perioperative complications from
anesthesia or surgical procedures. Long-term complications include recurrence of
deformity and graft failure, failed internal fixation, fracture after osteotomy,
etc.Recurrence of deformity is a common long term complication and is clinically
important[3]. Therefore, our second focus will be on the common recurrence of
deformity.
1. Perioperative complications
Patients with CP havevarious chronic disorders that often require orthopedic surgery.
The prognosis of patients after surgery is greatly affected by their general condition,
nutritionalstatus, motor function, etc.[4]. Patients with CP have overall poorer health
than patients without a chronic illness,and often have comorbidities such as epilepsy,
gastrointestinal disorders, bladder control problems, ocular abnormalities, and pain[5].
The aerobic capacity of CP patients who are classified in the Gross Motor
Function Classification System (GMFCS) as level I or II isabout 85%of that of
normal, healthy children or adolescents[6]. According to our research, the incidence
of intraoperative hypothermia, absolute hypotension, and absolute bradycardia was
26.2%, 4.4%, and 20.0%, respectively. The incidence of intraoperative hypothermia,
absolute hypotension, and major postoperative complications was significantly higher
in patients at GMFCS levels IV and V, compared with patients at GMFCS levels I
to III (P < 0.001). A history of pneumonia was associated with intraoperative
absolute hypotension and major postoperative complications (P < 0.001). These
results revealed that GMFCS level, patient age, hip reconstructive surgery, and
history of pneumonia are associated with adverse effects on intraoperative body
temperature,
the
cardiovascular
system,
and
immediate
postoperative
complications(upper respiratory infection, pneumonia, ileus, urinary tract infection,
constipation, seizure, voiding difficulty,etc.)[7]. Because complications are more
common in patients with CP, surgeons and anesthesiologists must be aware of
perioperative morbidity and be prepared to recognize and treat perioperative
complications
2. Recurrence
The two major orthopedic procedures used for patients with CP are single event
multilevel surgery(SEMLS) for gait improvement, and hip reconstructive surgery for
pain reduction and facilitation of caregiving. SEMLS has become standard treatment
to improve gait in ambulatory patients who are at GMFCS level I to III[8][9].
SEMLS consists of the series of soft tissue and bony procedures, the recurrence
rates of which are different from each others.
Hip reconstructive surgery is usually performed for patients at GMFCS levels IV
and V who have hip instability[10]. SEMLS has become the standard treatment to
improve gait in ambulatory patients with spastic diplegicCP[11].Hip instability in
patients with CP is associated with a high risk of pain, severe contractures,
problems with walking, windswept deformity, decubitus ulceration, and a need for
perineal nursing care[12]. These problems result in impaired function, including
positioning, standing, walking, and sitting balance, as well as a reduction in quality
of life[13][14].The prevalence of spastic hip instability (subluxation or dislocation)
in patients with CP is related to the severity of involvement, and ranges from 1%
with spastic hemiplegia to 75% with spastic quadriplegia[15].We investigated the
recurrence ofhip instability after reconstructive surgery in patients withCP to
identify
the
factors
influencing
this
recurrence.The
head-shaft
angle
showed
asignificant change in those with GMFCS level IV (P = 0.008) but not in those
with level II, III (P = 0.201), or V (P = 0.591).The migration percentage did not
change significantly in patients with GMFCS level II or III (P = 0.742), but
increased significantly by 2.0% per year (P < 0.001) in patients with GMFCS level
IV, and by 3.5% per year (P = 0.003) in those with level V. This suggests that it
is important to consider the recurrence of hip instability after reconstructive surgery
in patients with CP who have a high GMFCS level, and to perform careful follow-
up monitoring in such cases.
Reference
1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B.
A report: the definition and classification of cerebral palsy April 2006. Dev Med Child
Neurol Suppl. 2007 Feb;109:8–14. PMID: 17370477
2. Wongprasartsuk P, Stevens J. Cerebral palsy and anaesthesia. Paediatr Anaesth. 2002
May;12(4):296–303. PMID: 11982834
3. Joo SY, Knowtharapu DN, Rogers KJ, Holmes L, Miller F. Recurrence after surgery for
equinus foot deformity in children with cerebral palsy: assessment of predisposing factors
for recurrence in a long-term follow-up study. J Child Orthop. 2011 Aug;5(4):289–296.
PMCID: PMC3234889
4. Master DL, Son-Hing JP, Poe-Kochert C, Armstrong DG, Thompson GH. Risk factors for
major complications after surgery for neuromuscular scoliosis. Spine. 2011 Apr
1;36(7):564–571. PMID: 20683386
5. Baxter P. Comorbidities of cerebral palsy need more emphasis--especially pain. Dev Med
Child Neurol. 2013 May;55(5):396. PMID: 23574476
6. Verschuren O, Takken T. Aerobic capacity in children and adolescents with cerebral palsy.
Res Dev Disabil. 2010 Dec;31(6):1352–1357. PMID: 20674266
7. Lee SY, Sohn H-M, Chung CY, Do S-H, Lee KM, Kwon S-S, Sung KH, Lee SH, Park MS.
Perioperative complications of orthopedic surgery for lower extremity in patients with
cerebral palsy. J Korean Med Sci. 2015 Apr;30(4):489–494. PMCID: PMC4366972
8. Ounpuu S, DeLuca P, Davis R, Romness M. Long-term effects of femoral derotation
osteotomies: an evaluation using three-dimensional gait analysis. J Pediatr Orthop. 2002
Apr;22(2):139–145. PMID: 11856918
9. Chang W-N, Tsirikos AI, Miller F, Lennon N, Schuyler J, Kerstetter L, Glutting J. Distal
hamstring lengthening in ambulatory children with cerebral palsy: primary versus revision
procedures. Gait Posture. 2004 Jun;19(3):298–304. PMID: 15125919
10. Park MS, Chung CY, Kwon DG, Sung KH, Choi IH, Lee KM. Prophylactic femoral varization
osteotomy for contralateral stable hips in non-ambulant individuals with cerebral palsy
undergoing hip surgery: decision analysis. Dev Med Child Neurol. 2012 Mar;54(3):231–239.
PMID: 22268527
11. Sung KH, Chung CY, Lee KM, Akhmedov B, Lee SY, Choi IH, Cho T-J, Yoo WJ, Park MS.
Long term outcome of single event multilevel surgery in spastic diplegia with flexed knee
gait. Gait Posture. 2013 Apr;37(4):536–541. PMID: 23041270
12. Bayusentono S, Choi Y, Chung CY, Kwon S-S, Lee KM, Park MS. Recurrence of hip
instability after reconstructive surgery in patients with cerebral palsy. J Bone Joint Surg
Am. 2014 Sep 17;96(18):1527–1534. PMID: 25232076
13. Hägglund G, Lauge-Pedersen H, Wagner P. Characteristics of children with hip
displacement in cerebral palsy. BMC Musculoskelet Disord. 2007;8:101. PMCID:
PMC2194677
14. Oh C-W, Presedo A, Dabney KW, Miller F. Factors affecting femoral varus osteotomy in
cerebral palsy: a long-term result over 10 years. J Pediatr Orthop Part B. 2007
Jan;16(1):23–30. PMID: 17159529
15. Scrutton D, Baird G, Smeeton N. Hip dysplasia in bilateral cerebral palsy: incidence and
natural history in children aged 18 months to 5 years. Dev Med Child Neurol. 2001
Sep;43(9):586–600. PMID: 11570627
Can musculoskeletal surgery increase the quality of
life in children with ambulatory cerebral palsy?
Moon Seok Park MD and Byung Chae Cho MD
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital,
Kyungki, Republic of Korea
Abstract
Cerebral palsy (CP) comprises a group of disorders of the development of
movement
and
posture
causing
activity
limitations
that
are
attributed
to
nonprogressive disturbances that occurred in the developing fetal or infant brain.
Children with ambulatory CP, hemiplegia, and diplegia comprise 48% to 79% of all
cases.1 Most ambulatory patients with CP experience limitations in their walking
skills and physical activity, such as decreased hip extension, decreased hip
abduction, increased knee flexion at initial and terminal swing phase, decreased
peak knee flexion, decreased dorsiflexion in stance, and abnormal foot progression
angle.2 Ambulatory patients with CP usually correspond to Gross Motor Function
Classification System (GMFCS) level I-III. Various musculoskeletal surgeries are
widely performed for ambulatory CP, and focus on improving gait function and
pattern. Single event multilevel surgery (SEMLS) has become the standard treatment
to improve gait in ambulatory patients with CP. Although less evidence is available
to show that surgery improves practical functioning or health-related quality of life
(HRQL), treating ambulatory children with CP has been highly effective in
correcting abnormal gait parameters.
Because of the nature of cerebral palsy, it is difficult to assess the functional status
of patients and to evaluate the overall outcome related to a certain treatment.
Therefore, more emphasis has been placed on quantifying overall patient function
using a functional scoring system such as the Pediatric Outcomes Data Collection
Instrument
Pediatric
(PODCI),
Evaluation
Gross
Motor
Disability
Function
Inventory,
Classification
Gillette
System
Functional
(GMFCS),
Assessment
Questionnaire (FAQ), Functional Mobility Scale, Activities Scale for Kids, or others.
Among these tools, the Pediatric Outcomes Data Collection Instrument (PODCI)
was developed to assess functional health outcomes in children and adolescents, and
focuses on musculoskeletal health. The items in PODCI consider function and
quality of life, and PODCI is frequently used to provide patients and parents with
evidence for likely clinical outcome. Several studies have reported improvements in
PODCI scores after surgery.2-4
We
conducted
a
study
by
using
several
questionnaires.
Demographic
data,
preoperative and postoperative PODCI, Functional Assessment Questionnaire (FAQ)
Walking Scale, and self-reported parental satisfaction with SEMLS were provided by
parents of 61 ambulatory patients with CP (40 male, 21 female; mean age 10 y 2
mo ± 3 y 8 mo; mean follow-up period 2 y 2 mo). The results were as follows:
FAQ, transfers/basic mobility, sports/physical activity, and global function subscales
of PODCI significantly improved after SEMLS. Age, GMFCS level, and the amount
of improvement in the sports/physical activity subscale were found to affect parental
satisfaction with SEMLS. Although changes in the sports/physical activity subscale
were relatively small, they significantly affected parental satisfaction. This suggests
that clinicians and researchers should consider sports and physical activities in
patients with CP.5
In a similar study on 279 ambulatory patients with CP (GMFCS levels I to III)
who had undergone soft tissue and bony procedures, the results were as follows:
the parents of patients classified as GMFCS level I CP were more satisfied than
parents of patients classified as GMFCS level II or III CP (P = 0.029). Surgical
satisfaction was higher for those who underwent unilateral procedures than for those
who had bilateral treatment (P < 0.001). Multiple regression analysis revealed
predictors of satisfaction to be preoperative GMFCS level, diagnosis, age at surgery,
and duration of follow-up.6
SEMLS is a generally accepted surgical principle when treating ambulatory children
with CP. We demonstrated that this surgery improves practical functioning and
HRQL. If ambulatory CP patients have appropriate indications, musculoskeletal
surgery is recommended.
Reference
1. Stanley, F.; Blair, E.; Alberman, E. How common are the cerebral palsies?. In:
Stanley, F.; Blair, E.; Alberman, E., editors. Cerebral Palsies: Epidemiology and
Causal Pathways. London, United Kingdom: MacKeith Press; 2000. p. 22-39.
2. Damiano DL, Gilgannon MD, Abel MF. Responsiveness and uniqueness of the
pediatric outcomes data collection instrument compared to the gross motor function
measure for measuring orthopaedic and neurosurgical outcomes in cerebral palsy. J
Pediatr Orthop. 2005;25:641–645.
3. Cuomo AV, Gamradt SC, Kim CO, et al. Health-related quality of life outcomes
improve after multilevel surgery in ambulatory children with cerebral palsy. J
Pediatr Orthop. 2007;27:653–657.
4. McMulkin ML, Baird GO, Gordon AB, et al. The pediatric outcomes data
collection instrument detects improvements for children with ambulatory cerebral
palsy after orthopaedic intervention. J Pediatr Orthop. 2007;27:1–6.
5. Lee KM, Chung CY, Park MS, Lee SH, Choi IH, Cho TJ, Yoo WJ.; Level of
improvement determined by PODCI is related to parental satisfaction after singleevent multilevel surgery in children with cerebral palsy.; J Pediatr Orthop. 2010
Jun;30(4):396-402
6. Lee SH, Chung CY, Park MS, Choi IH, Cho TJ, Yoo WJ, Lee KM: Parental
Satisfaction After Single-Event Multilevel Surgery in Ambulatory Children With
Cerebral Palsy, J Pediatr Orthop. 2009 Jun;29(4):398-401
GROWING PAIN PPS
PROF JOE GHABRIAL
Newcastle Bone and Joint Institute
Newcastle, Australia
Chronic musculo-skeletal pain in the back or limbs in children and adolescents are commonly
referred to as “growing pains” by senior members of the child’s family, usually the
Grandmother.
Persistent pain has a substantial impact on the emotional status of children and adolescents as
well as having a negative impact on family life.
It is critical to rule out potential serious or life threatening causes of pain as in, although rare,
soft tissue and bone sarcomas. It is essential to exclude common conditions in the growing
spine as well as lower limb.
A child or adolescent who complains of knee pain with normal x-rays can be diagnosed
wrongly as “growing pain”. Hip conditions and knee conditions can go unnoticed for some
time before a diagnosis is made. Ankle and feet conditions in children should be excluded.
A clinician should be aware of red flags related to psycho-social issues.
The success of management should be monitored by improvement of the function and not be
specific to immediate pain reduction.
ASPEK BIOMOLEKULER DASAR DAN ASPEK KLINIS POLI-TRAUMA
DAN FRAKTUR
Putu Astawa
abstrak:
Respon tubuh terhadap trauma dipengaruhi oleh faktor eksternal, yaitu mekanisme yang
menyebabkan perbedaan keparahan trauma jaringan , dan faktor internal, yaitu genetik
dan adanya penyakit komorbid pada pasien trauma. Respon terhadap trauma tersebut
dapat merupakan respon fisiologis atau respon patologis tergantung pada derajat
keparahan trauma tersebut.
Respon tubuh terhadap suatu trauma meliputi respon neuro-endokrin-imunmetabolik pada level selular yang bermanifestasi pada sistem organ yang bertujuan untuk
mempertahankan homeostasis tubuh sehingga dapat bertahan hidup dari trauma tersebut.
Respon tubuh tersebut berawal dari stimulus aferen yang berasal dari reseptor nyeri,
baroreceptor, chemoreceptor dan wound mediator, kemudian tubuh memberikan respon
eferen melalui autonomic nerve system dan respon hormonal. Respon-respon tersebut
merupakan mekanisme pertahanan tubuh terhadap terjadinya trauma.
Pada level selular, respon awal terhadap trauma bersifat nonspesifik yang
melibatkan sitokin, komplemen, faktor koagulasi, dan faktor neurohumoral. Sitokin
merupakan mediator inflamasi dan antiinflamasi, meliputi interleukin / IL, tumor necrosis
factor / TNF, dan platelet activating and inhibiting factor.Sitokin-sitokin ini kemudian
menginduksi pelepasan mediator-mediator selular lainnya, seperti nitric oxide, endothelin,
dan golongan eicosanoids, yang kemudian mediator-mediator tersebut mempengaruhi
permeabilitas jaringan dan vaskular yang bertujuan untuk meningkatkan aliran darah
regional untuk mengimbangi kondisi hipermetabolik yang terjadi pasca trauma. Aktivasi dari
kaskade komplemen merupakan dasar dari imunitas cell-mediated dan humoral. Selain hal
tersebut, beberapa komplemen, C3a dan C5a, juga berinteraksi dengan mediator endotel
untuk
mempengaruhi
permeabilitas
vaskular.
Faktor
koagulasi
berperan
dalam
menyeimbangkan proses koagulasi dan trombolisis yang bertujuan untuk mempertahankan
integritas vaskular dan stabilitas membran. Deplesi dari faktor koagulasi menyebabkan
terjadinya perdarahan yang kemudian dapat terjadi perburukan menjadi koagulopati dan
kerusakan endotel. Pasca trauma, juga terjadi respon neurohumoral yang didominasi oleh
sistem adrenergik yang kemudian pada level selular menyebabkan pelepasan calcium
intracellular dan peningkatan permeabilitas membran terhadap calcium. Selain sistem
adrenergik, terdapat juga respon melalui aksis renin-aldosterone-angiotensin yang
bertujuan untuk mempertahakan vasomotor tone. Respon-respon selular tersebut
kemudian bermanifestasi pada sistem-sistem organ vital yang meliputi sistem
kardiovaskular, sistem respirasi, sistem renal, otak, dan sistem endokrin yang pada fase awal
bertujuan untuk mengimbangi kondisi tubuh yang hipermetabolik.
Pada otak dapat terjadi cedera primer, akibat cedera yang didapat saat kejadian, dan
sekunder, akibat hipoksia dan hipotensi. Otak mempunyai mekanisme autoregulasi yang
lebih banyak dipengaruhi kondisi mikroenvironment, seperti kadar CO2, untuk
mempertahankan cerebral blood flow. Pasca trauma, sistem endokrin berintegrasi dengan
systemic autonomic response untuk mempertahankan homeostasis tubuh. Pada fase awal
trauma respon sistem endokrin menyebabkan terjadinya hiperglikemia yang awalnya
bertujuan untuk mengimbangi kondisi hipermetabolik kemudian selanjutnya dapat
menyebabkan gangguan fungsi sel darah putih, gangguan utilisasi protein, serta gangguan
fungsi neurologis.
Pada sistem kardiovaskular, respon simpatis yang terjadi bertujuan untuk
mempertahankan cardiac output dengan cara meningkatkan heart rate dan meningkatkan
stroke volume. Inervasi simpatis pada sistem vena menyebabkan terjadinya venoconstriction
sehingga menyebabkan terjadinya peningkatan venous return dan pre load. Adaptasi
keadaan hipermetabolik pada sistem respirasi bermanifestasi pada peningkatan ventilasi
untuk mengurangi level karbondioksida dan meningkatkan level oksigen. Respon inflamasi
yang masif pada paru menyebabkan terjadinya perubahan permeabilitas endotel alveolus
sehingga pada akhirnya dapat menyebakan terjadinya adult respiratory distress syndrome /
ARDS. Sistem renal, aksis neuroendokrin renin-angiotensin-aldosterone, merupakan sistem
untuk mepertahankan mean arterial pressure dan retensi air. Efek neuroendokrin tersebut
menyebabkan peningkatan tubular absorption sehingga pada fase awal trauma / ebb phase
(sampai dengan 48/72 jam) terjadi oligouria yang kemudian diikuti dengan flow phase dan
diakhiri dengan resolution phase yang ditandai dengan kembalinya diuresis yang normal.
Bila derajat trauma melampaui kemampuan tubuh untuk beradaptasi maka respon
inflamasi yang awalnya bersifat lokal menjadi sistemik yang kemudian disebut dengan
Systemic Inflammatory Response Syndrome atau SIRS. SIRS berhubungan dengan kebocoran
kapiler dan kebutuhan energi yang tinggi sehingga memerlukan keadaan hemodinamik yang
hiperdinamik dan meningkatkan kebutuhan akan oksigen. Keadaan hemodinamik yang
hiperdinamik akan menyebabkan peningkatan beban metabolik yang disertai dengan muscle
wasting, kehilangan nitrogen, dan pemecahan protein. Keadaan hipermetabolik ini akan
disertai dengan peningkatan suhu tubuh inti dan disregulasi suhu tubuh. Bila kondisi
tersebut tidak diikuti dengan resusitasi yang adekuat maka konsumsi energi yang tinggi akan
menyebabkan terjadinya burn out. SIRS kemudian akan menyebabkan gangguan terhadap
metabolisme sel dan microcirculatory perfusion.
Selain terjadi pelepasan mediator-mediator inflamasi, yaitu TNF-α, IL-1, IL-6, IFN,
TXA2, dan PAF, pada tubuh setelah terjadi trauma juga menghasilkan mediator-mediator
anti-inflamasi, yaitu IL-10, IL-4, TGF-β, IL-1ra, dan Lipoxin, yang mengakibatkan kondisi
hipoinflamasi yang kemudian menyebabkan terjadinya imunosupresi sehingga tubuh
menjadi rentan terhadap infeksi dan komplikasinya. Status imunologis tersebut disebut
dengan compensatory anti-inflammatory response syndrome / CARS. Tubuh kemudian
berusaha menyeimbangkan antara SIRS dan CARS, di satu sisi tubuh memerlukan inflamasi
untuk mekanisme reparasi dan membatasi masuknya mikroorganisme sedangkan di sisi lain
tubuh juga berusaha mencegah autoaggressive inflammation yang dapat meyebabkan
kerusakan jaringan dan kerentanan terhadap infeksi. Perpaduan antara dua mekanisme
tersebut dikenal dengan mixed antagonistic response syndrome / MARS.
Bila respon inflamasi yang terjadi cukup berat dan tidak terkontrol maka akan
menyebabkan perburukan klinis pada pasien dengan manifestasi berupa disfungsi beberapa
organ tubuh. Selain disfungsi beberapa organ tubuh, juga terjadi gangguan terhadap sistem
imunitas tubuh pasien berupa supresi imun. Sindrom tersebut dikenal dengan multiple
organ dysfunction syndrome (MODS). MODS kemudian akan menyebabkan terjadinya
multiple organ failure (MOF) yang kemudian berakhir dengan kematian.
Penanganan poli trauma adalah memberikan pertolongan sedini mungkin. ATLS telah
mengajarkan kepada kita untuk itu. Dimana penderita dapat digolongkan menjadi penderita
yang ada resnpon, borderline atau tidak ada respons dengan tindakan ATLS tersebut.
Internal fiksasi fraktur yang tidak sulit dapat dilakukan segera pada penderita yang
digolongkan responsible sedangkan pada penderita borderline dilakukan orthopaedic
damage control, untuk mencegah terjadinya SIRS/MOD/MOF yang berakhir dengan
kematian.
TKR:GapBalancingvsMeasuredResection:MyPreference
WendyHendrikaMD
Abstract
Tujuan dari Total Knee Arthroplasty adalah untuk memperoleh symmetric balancing saat fleksi
maupun ekstensi. Terdapat kontroversi mengenai teknik bedah terbaik untuk untuk mendapatkan
gap balance. Sebagian menganut penggunaan teknik measure resection di mana bony landmark
seperti transepicondylar axis, whiteshide line, atau posterior condyle axis digunakan untuk
menentukan rotasi femoral komponen yang tepat dan tidak tergantung pada reseksi tibia; bila
diperlukan akan dilanjutkan dengan soft tissue balancing. Sebagian lainnya mencoba untuk
menyeimbangkangapbalancingsebelumnya,dimanareseksikomponenfemoraldiposisikansejajar
dengan reseksi tibia proximal dengan masing-masing kolateral ligamen diregangkan untuk
mendapatkancelahfleksiyangrectangular.
Keyword:TotalKneeArthroplasty,measureresection,gapbalancing
Sportinjuryinskeletallyimmatureadolescents
DrPThiagarajan
Immatureathletesareparticipatinginmoreandmoresportingactivitiesresultingin
injuries.Adolescentsareuniqueastheyhaveopenphysesandtraumaaffectsthejoints,
bonesandepiphyseswithpotentialforgrowthplatedamage.
Kneeisthemostcommonlyinjuredjointinthisagegroupresultinginmajorityof
injuries.Assessingimmaturepatientsonehastokeepalookoutforsubtleinjuries.Joint
laxityiscommoninthisagegroupandligamentinjuriesandtendonproblemsaremore
commonthanfractures.
ParticularlyACLinjuriesposeadilemmaforthesurgeonandparents.Immensepeer
pressureandathleticeventscompoundthemanagementoftheseinjuries.
Managementofligamentinjuriesrequirescarefulconsiderationoftheageofthepatient,
growthpotential,severityoftheinjury,alternativeavailabletreatmentandphysicaltherapy
andactivitymodification.
Itiswisetodefersurgerytillskeletalmaturityisreachedinligamentinjurieslike
ACL.Surgicaloptionsmustbediscussedwithparentswithrealisticexpectations.Nonphysealreconstructionoptionsneedtobecarefullyconsideredbeforeundertakingsurgery.
Modificationofactivityandrehabilitationmodalitiesshouldbethefirstpriorityintreating
adolescentsandwherepossiblesurgerydeferredtillphysealriskisminimized.
Fracture supracondyle of the humerus in children
I P. Sukarna
Fracture supracondyle of the humerus in children is the frequent fracture distal of humerus and
around the elbow and the second after fracture of the forearm.
The incidence increase by age, the peak is (5-8) year old and decrease after (8-15) year old.
There are 2 kinds of fracture: Extension type (98%), Flexion type (2%).
The extension type if devided into 3 types depend on severety of displacement: undisplaced,
displaced with contact the posterior cortex and displaced with no contact of the posterior cortex.
It is very important to recognize clinically the complication of vascular compromise, do not delay the
treatment to prevent Volkmann's ischemic contracture.
The treatment depend on the condition: close or open fracture, vascular condition, degree of
displacement (type of fracture).
The best result of the treatment is by close reduction. The best stabilisation is by lateral parallel
pinning.
Complication:
Early:
- Vascular compromise, neuropathy
Late:
- Malunion: deformity cubitus varus
- Limited range of motion
- Myositis ossificans
1. J Bone Joint Surg Am. 2004 Jan;86-A(1):22-7
Factors predictive of outcome after use of the Ponseti method
for the treatment of idiopathic clubfeet.
Dobbs Mb(1), Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA.
Author information:
(1)Washington Universtiy School of Medicine, St.Louis Children’s Hospital, St.Louis, MO
63110, USA. mattdobbs@earthlink.net.
BACKGROUND: The nonoperative technique for the treatment of idiopathic congenital
talipes equinovarus(clubfoot) described by Ponseti is a popular method, but it requires two
to four years of orthotic management. The purpose of this study was to examine the patient
characteristics and demographic factors related to the family that are predictive of recurrent
foot deformities in patients treated with this method.
METHODS: The cases of fifty-one consecutive infants with eighty-six idiopathic clubfeet
treated with use of the Ponseti method were examined retrospectively. The patient
characteristics at the time of presentation, such as the severity of the initial clubfoot
deformity, previous treatment, and the age at the initation of treatment, were examined
with use of univariate logistic regression analysis modeling recurrence. Demographic data on
the family, including annual income, highest level of education attained by the parents, and
martial status, as well as parental reports of compliance with the use of prescribed orthosis,
were studied in relation to the risk of recurrence.
RESULTS: The parents of twenty-one patients did not comply with the use of orthotics.
Noncompliance was the factor most related to the risk of recurrence, with an odds ratio of
183 (p<0.00001). Parental educational level (high-school education or less) also was a
significant risk factor for recurrence (odds ratio = 10.7, p < 0.03). With the numbers
available, no significant relationship was found between gender, race, parental marital
status, source of medical insurance, or parental income an the risk of recurrence of the
clubfoot deformity. In addition, the severity of the deformity, the age of the patient at the
initiation of treatment, and previous treatment were not found to have a significant effect
on the risk of recurrence.
CONCLUSION: Noncompliance and the educational level of the parents (high-school
education or less) are significant risk factors for the recurrence of clubfoot deformity after
correction with the Ponseti method. The identification of patients who are at risk for
recurrence may allow intervention to improve the compliance of the parents with regard to
the use of orthotics, and, as a result, improve outcome.
LEVEL OF EVIDENCE: Prognostic study, Level II-I (retrospective study). See Instructions to
Authors for a complete description of levels of evidence.
PMID : 14711941 [PubMed – indexed for MEDLINE]
1. J Bone Joint Surg Am. 2006 May;88(5);986-96.
Long-term follow-up of patients with clubfeet treated with
extensive soft-tissue release.
Dobss MB(1), Nunley R, Schoenecker PL.
Author information:
(1) Department of Orthopaedic Surgery, Washington University School of Medicine, One
Children’s Place, Suite 4S20, St.Louis, MO 63110, USA.
dobbsm@wudosis.wustl.edu
Comment in
J Bone Joint Surg Am.2006 Nov;88(11):2536;author reply 2537.
BACKGROUND: Although long-term follow-up studies have shown favorable results, in terms
of foot function, after treatment of idiopathic clubfoot with serial manipulations and casts,
we know of no long-term follow-up studies of patients in whom clubfoot was treated with
an extensive surgical soft-tissue release.
METHODS : Forty-five patients(seventy-three feet) in whom idiopathic clubfoot was treated
with either a posterior release and plantar fasciotomy (eight patients) or an extensive
combined posterior, medial and lateral release (thirty-seven patients) were followed for a
mean of thirty years. Patients were evaluated with detailed examination of the lower
extremities, a radiographic evaluation that included grading of osteoarthritis, and three
independent quality-of-life questionnaires, including the Short From-36 Medical Outcomes
Study.
RESULTS: At the time of follow-up, the majority of patients in both treatment groups had
significant limitation of foot function, which was consistent across the three independent
quality-of-life questionnaires. No significant difference between groups was noted with
regard to the results of the quality-of-life measures, the range of motion of the ankle or the
position of the heel, or the radiographic findings. Six patients who had been treated with
only one surgical procedure had better ranges of motion of the ankle and subtalar joints
(p<0.004) than those who had had multiple surgical producers.
CONCLUSIONS: Many patients with clubfoot treated with an extensive soft-tissue release
have poor long-term foot function. We found a correlation between the extent of the softtissue release and the degree of functional impairment. Repeated soft-tissue releases can
result in a stiff, painful, and arthritic foot and significantly impaired quality of life.
PMID: 16651573 [PubMed-indexed for MEDLINE]
1. Indian J Orthop.2008 Jan;42(1):68-72. doi : 10.4103/0019-5413.38584.
Use of the Ponseti method for recurrent clubfoot following
posteromedial release.
Garg S(1), Dobbs MB.
Author information:
(1)St.Louis Children’s Hospital, Shrines Hospital St.Louis, MO 63110, USA.
BACKGROUND: A child with recurrent of incompletely corrected clubfoot after previous
extensive soft-tissue release is treated frequently with revision surgery. This leads to further
scarring, pain and limitations in range of motion. We have utilized the Ponseti method of
manipulation and casting and when indicated, tibialis anterior tendon transfer, instead of
revision surgery for these cases.
MATERIALS AND METHODS: A retrospective review of all children treated since 2002 (n=11)
at our institution for recurrent or incompletely corrected clubfoot after previous extensive
soft tissue release was done. Clinical and operative records were reviewed to determine
procedure performed. Ponseti manipulation and casting were done until the clubfoot
deformity was passively corrected. Based on the residual equinus and dynamic deformity,
heel cord lengthening or tenotomy and tibialis anterior transfer were then done. Clinical
outcomes regarding pain, function and activity were reviewed.
RESULTS: Eleven children (17 feet) with ages ranging from 1.1 to 8.4 years were treated with
this protocol. All were correctable with the Ponseti method with one to eight casts. Casts
were applied until the only deformities remaining were either or both hindfoot equinus and
dynamic supination. Nine feet required a heel cord procedure for equinus and 15 required
tibialis anterior transfet for dynamic supination. Seven children have follow-up greater than
one year (average 27.1 months) and have bad execellent results. Two patients had
persistent hindfoot valgus which required hemiepiphyseodesis of the distal medial tibia.
CONCLUSION: The Ponseti method, followed by tibialis anterior transfer and/or heel cord
procedure when indicated, can be successfully used to correct recurrent clubfoot deformity
in children treated with previous extensive soft tissue release. Early follow-up has shown
correction without revision surgery. This treatment protocol prevents complications of
stiffness, pain and difficulty in ambulating associated with multiple soft tissue releases for
clubfeet.
PMCID : PMC2759586
PMID : 19823658 [PubMed]
1. J Bone Joint Surg Am. 2008 Jul;90(7):1501-7. doi : 10.2106/JBJS.G.00563.
Early results of the Ponseti method for the treatment of
clubfoot in distal arthrogryposis.
Boehm S(1), Limpaphayom N, Alaee F, Sinclair MF, Dobbs MB.
Author information:
(1)Department of Orthopaedic Surgery, Washington University School of Medicine, One
Children’s Place, Suite 4S20, St.Louis, MO 63110, USA.
BACKGROUND: Clubfoot occurs in approximately one in 100 libe births and is one of the
most common congenital birth defects. Although there have been several reports of
successful treatment of other forms of clubfoot has not been reported. The purpose of the
present study was to evaluate the early results of the Ponseti method when used for the
treatment of clubfoot associated with distal arthrogryposis.
METHODS: Twelve consecutive infants (twenty-four fett) with clubfoot deformity associated
with distal arthrogryposis were managed with the Ponseti method and were retrospectively
reviewed at a minimum of two years. The severity of the foot deformity was classified
according to the grading system of Dimeglio et al. The number of casts required to achieve
correction was compared with published data for the treatment of idiopathic clubfoot.
Recurrent clubfoot deformities or complications during treatment were recorded.
RESULTS: Twenty-one clubfeet in eleven patients were classified as Dimeglio grade IV, and
two clubfeet in one patient were classified as Dimeglio grade II. Initial correction was
achieved in all clubfeet with a mean of 6.9 +/- 2.1 casts (95% confidence interval, 5.6 to 8.3
casts), which was significantly greater than the mean of 4.5 +/- 1.2 casts (95% confidence
interval, 4.3 to 4.7 casts) needed in a cohort of 219 idiopathic clubfeet that were treated
during the same time period by the senior author with use of the Ponseti method (p=0.002).
Six feet in three patients had a relapse after initial successful treatment . All relapses were
related to noncompliance with prescribed brace wear. Four relapsed clubfeet in two
patients were successfully treated with repeat casting and/or tenotomy; the remaining two
relapsed clubfeet in one patient were treated with extensive soft tissue release operations.
CONCLUSIONS: Our early term results support the use of the Ponseti method for the initial
treatment of distal arthrogrypotic clubfoot deformity. Longer follow up will be necessary to
assess the risk of recurrence and the potential need for corrective clubfoot surgery in this
patient population, which historically has been difficult to treat nonoperatively.
PMID : 18594099 [PubMed-indexed for MEDLINE]
1. Iowa Orthop J.2008;28;22-6
Results of the Ponseti method in patients with clubfoot
associated with arthrogryposis.
Morcuende JA(1), Dobbs MB, Frick SL.
Author information:
(1)Department of Orthopaedic Surgery and Rehabilitation, University of Iowa, Iowa City,
Iowa 52242, USA. jose-morcuende@uiowa.edu
Clubfoot associated with arthrogryposis has been traditionally considered very resistant to
manipulation and casting, and therefore has requires surgical correction. The purpose of
this study was to evaluate the results of the Ponseti method of clubfoot casting in this
patient population. We reviewed the records of patients with clubfoot associated with
arthrogryposis consecutively treated at our respective institutions from January 1992 to
December 2004. All patients were treated by serial manipulations and casting following
the principles of the Ponseti method. Main outcome measures included initial correction of
the deformity, relapses and the need for surgical releases or any other surgeries. Average
age at last follow up was 4.6 years. There were 16 patients, all with bilateral deformities
(32 clubfeet). There were 11 males and 5 females. Nine patients had both upper and lower
extremity involvement. Seven patients had previous treatment elsewhere and one patient
had an Achilles tenotomy. Initial correction was obtained in all but 1 patient. Average
number of casts required for correction was 7 (range: 5 to 12). Average post tenotomy
dorsiflexion was 5 degrees. One patient required a posterior medial release (PMR) for
insufficient initial correction. Four cases required subsequent surgery for relapses (1
bilateral PMR with a repeat left PMR; 2 posterior releases (PR), 1 PR and anterior tibialis
transfer (ATT), and 1 ATT). No talectomies were required. This study demonstrates that the
Ponseti method is very effective for the correction of patients with clubfoot associated to
arthrogryposis. Although this deformity is more rigid than in idiopathic clubfoot, many
cases can be corrected when started in the first few weeks after birth.
PMCID : PMC2603345
PMID : 19223944 [PubMed-indexed for MEDLINE]
1. J Pediatr Orthop.2009 Oct-Nov;29(7):720-5. doi:
10.1097/BPO.0b013e3181b7694d.
A minimally invasive treatment protocol for the congenital
dislocation of the knee.
Shah NR(1), Limpaphayom N, Dobbs MB.
Author information:
(1)Department of Orthopaedic Surgery, Washington University School of Medicine, One
Children’s Place, and Saint Louis Shrines Hospital for Children, St.Louis, MO 63110, USA.
BACKGROUND: Congenital dislocation of the knee is a rare condition for which the
treatment is difficult and remains controversial. For severe cases associated with
neuromuscular disorders treatment has usually considered of extensive result of a new
method of treatment for this patient population that involves casting and less extensive
surgery.
METHODS: We retrospectively reviewed the cases of 8 consecutive patients, 4 girls and 4
boys, with 16 congenitally dislocated knees that had been diagnosed and treated by a single
surgeon with a new minimally invasive treatment protocol. Treatment consisted of serial
casting followed by a mini open quadriceps tenotomy. The mean age at presentation was
5.3 weeks (range, 1 to 13 wk). The mean follow up was 33 months (range, 12 to 72 mo). All
knees were graded in terms of function at final follow up.
RESULTS: Serial casting alone was effective in achieving correction in 3 knees. The remaining
13 knees had an average of 7 casts (range, 5 to 9 casts) before surgery. Ten knees were
treated with a mini open quadriceps tenotomy alone and 3 with an additional anterior
capsulotomy at the time of the initial surgery. Two knees developed recurrent deformities
and required additional surgery. Two knees sustained plastic deformation of the proximal
tibia during physical therapy that resolved with time. At final follow up, knee outcome was
execellent in 11 (69%) knees, good in 3 (19%), and fair in 2 (12%) knees.
CONCLUSIONS: The result of our study support the use of a less invasive approach for the
initial treatment of congenital dislocation of the knee in this patient population. This
approach avoids the complications of extensive scarring and stiffness that often accompany
the more invasive surgical treatments. Longer follow up, however, is necessary to see
whether reduction and knee range of motion are maintained.
LEVEL OF EVIDENCE: Level 4 case series
PMID : 20104152 [PubMed-indexed for MEDLINE]
1. Clin Orthop Relat Res. 2015 Sep 22. [Epub ahead of print]
Does Strict Adherence to the Ponseti Method Improve Isolated
Clubfoot Treatment Outcomes? A Two-institution Review.
Miller NH(1), Carry PM(2), Mark BJ(2), Engelman GH(2), Georgopoulos G(2), Graham S(2),
Dobbs MB(3).
Author information:
(1)Musculoskeletal Research Center, Department of Orthopaedic Surgery Children’s Hospital
Colorado, 13123 East 17th Avenue, B600, Aurora, CO, 80045, USA.
Nancy.Miller@ChildrensColorado.org. (2)Musculoskeletal Research Center, Department of
Orthopaedic Surgery, Children’s Hospital Coloradp, 13123 East 17th Avenue, B600, Aurora,
CO, 80045, USA. (3)Washington University School of Medicine, St.Louis, MO, USA.
BACKGROUND: Despite being recognized as the gold standard in isolated clubfoot
treatment, the Ponseti casting method has yielded variable results. Few studies have directly
compared common predictors of treatment failure between instructions with high versus
low failure rates.
QUESTIONS/PURPOSES: We asked : (1) is the provider’s rigid adherence to the Ponseti
method associated with a lower likelihood of unplanned clubfoot surgery, and (2) at the
institution that did not adhere rigidly to Ponseti’s principles, are any demographic or
treatment related factors associated with increased likelihood of unplanned clubfoot
surgery.
METHODS: After institutional review board approval, a consecutive series of patients with a
diagnosis of isolated clubfoot who underwent treatment between January 2003 and
December 2007 were identified. At Institution 1, 91 of 133 patients met the eligibility criteria
and were followed for a minimum of 2 years compared with 58 of 58 patients at Institution
2. At Institution 1, 16 providers manage care using a conservative casting approach based on
the Ponseti method. However, treatment was adapted by the provide(s). At Institution 2,
one orthopaedic surgeon managed care with strict adherence to the Ponseti method.
Surgical indications at both institutions included the presence of a persistent equinovarus
foot position while standing. A chart review was used to collect data related to proportion of
patients undergoing unplanned additional treatment for deformity recurrences after Ponseti
casting, demographics, and treatment patterns.
RESULT: The proportion of subjects who underwent unplanned major surgical intervention
was greater (odds ratio[OR], 51.1 ; 95% CI, 6.8-384.0; p < 0.001) at Institution 1 (60 0f 131,
47%) compared with Institution 2 (two of 91, 2%). Three was no difference (p=0.200) in the
proportion of patients who underwent additional casting, repeat tendo Achilles lengthening,
and/or anterior tibialis tendon transfer only (minor recurrence) at Institution 1 (nine of 131,
7%) compared with Institution 2 (11 of 91, 13%). At Institution 1, an increase in the number
of revision casts (multiple vs no casts, hazard ratio [HR] =3.9; 95% CI, 2.0-7.6; p < 0.001) and
an increase in the number of cast-related complications (multiple vs no complications,
HR=2.8; 95% CI, 1.2-6.7; p = 0.019) were associated with increased risk of major surgery in
the multivariate analysis.
CONCLUSIONS: Rigid commitment to the Ponseti method in the conservative treatment of
patients with isolated clubfoot was associated with a lower risk of subsequent unplanned
surgical intervention. In addition, clubfoot treatment programs that use a care model that
prioritizes continuity in care and dedication to the Ponseti method may decrease the
proportion of patients who undergo unplanned surgical intervention.
LEVEL OF EVIDENCE: Level III, therapeutic study.
PMID : 26394639 [PubMed-as supplied by publisher]
Presentasi podium: Descriptive and Outcome Study
Waktu
Judul Presentasi
08.00Distal
Femoral
GCT Treated
Withwide
Excision
08.10
&Megaprothesis Reconstruction At
Prof.
Dr.
R.
Soeharso
Orthopaedic
Hospitalsurakarta 2015 (Serialcase)
08.10Outcome Of Conservative Treatment In Clavicle
08.20
Fractures Patients January-July 2015 Dr. Soetomo
General Hospital Surabaya
08.20Operation Procedure For Spondylolisthesis Patient
08.30
08.30Ankle Arthrodesis With Cannulated Screw : A Case
08.40
Series
08.40Functional Outcome Of Intertrochanteric Fracture With
08.50
Dynamic Hip Screw In Elderly (January – Agustus
2015): A Case Series
08.50Lower Leg Deformity Correction Using Ilizarov System In
09.00
Dr Soetomo Hospital Surabaya
09.00Evaluation Of Scoliosis In Marfan Syndrome
09.10
09.10Neglected Tuberculosis Of The Wrist (Serial Case
09.20
Report)
09.20Clinical Outcome Of Comminuted Intraarticular Distal
09.30
Radius Fracture Treated With Closed Reduction And
Circular Cast(Retrospective Study At Moewardi Hospital
Surakarta July 2014 – June 2015)
09.30Orthopedic Complications Of Childhood Obesity
09.40
09.40Characteristics In Children With Supracondylar Humerus
09.50
Fracture At Hasan Sadikin Hospital From Januari 2009
– Januari 2014
09.50Functional Outcome Developmental Dysplasia Of The
10.00
Hip (Ddh) Patients After Operative Treatment At Walking
Age In Hasan Sadikin Hospital Bandung
10.00Characteristic Osteomyelitis Patients At Lower Extremity
10.10
In Hasan Sadikin General Hospital Periode January
2012—December 2014
10.10Treatment Of Single Segment Thoracic Spinal
10.20
Tuberculosis With Neurological Deficit In Adults. Case
Series
10.20Reverse Distal Femoral Locking Plate For Subtrochanter
10.30
Femur Fracture In Rscm. A Case Series
10.30Coffee Break
10.45
10.45Ponseti Method On Late Idiopathic Clubfoot
Kode
FP1.1
FP1.2
FP1.3
FP1.4
FP1.5
FP1.6
FP1.7
FP1.8
FP1.9
FP1.10
FP1.11
FP1.12
FP1.13
FP1.14
FP1.15
FP1.16
10.55
10.5511.05
11.0511.15
11.1511.25
11.2511.35
11.3511.45
11.4511.55
11.5512.05
12.0512.15
12.1512.25
12.2512.35
12.35selesai
Acute Correction In Patient With Severe Blount Disease
Using Proximal Tibia Osteotomy Followed By Internal
Fixation.
Outcome Of Unstable Intertrochanteric Fractures
Treated With PFNA-II In Elderly Patients
Acute Correction For Severe Blount’s Disease With
Ilizarov Method. A Case Series
Congenital Talipes Equinovarus Profile In Saiful Anwar
General Hospital : Three Years Follow Up 2013-2015
Distribution Profile Of Metastatic Bone Disease
In MoewardiHospital Surakarta July 2014 – June 2015
(Retrospective Study)
Profile Of Rhabdomyosarcoma In Children At Dharmais
Cancer Hospital 2005 – 2014
Evaluation Post Total Knee Arthroplasty Operationin
Prof. Dr. R. Soeharso Orthopaedic Hospital Surakarta
Januari 2014 – Juni 2015 (Retrospective Study)
Assessment Of Physical Fitness Status Of Orthopaedic
And Traumatology Resident At DR. Hasan Sadikin
Hospital
Tibial Length Measurement After Reduction By Bone
Setter In Lower Leg Fracture At Citapen, West Java
Fp1.26.
Mini-Open Technique For The Achilles
Tenotomy In Treatment Of Ctev To Reduce A Risk Of
Neurovascular Injury And Achieved Maximum Equinus
Correction
Makan siang
FP1.17
FP1.18
FP1.19
FP1.20
FP1.21
FP1.22
FP1.23
FP1.24
FP1.25
FP1.26
Presentasi podium: Basic and Clinical Correlation Study
Waktu Judul Presentasi
08.00- Comparative Functional Outcome Between Volar Plate And
08.10 Percutaneous Pinning In Treatment Of Fracture Of The
Distal Radius Extra Articular
08.10- Long Term Outcome Using Massive Allograft In The Bone
08.20 Tumor Reconstruction
08.20- Comparisson Functional Outcome Of The Knee Between
08.30 Semitendinosus
Graft
And
Combined
Graft
(Semitendinosus And Gracilis Graft) In Anterior Cruciate
Ligament Reconstruction By Using Koos And Tegner
Lysholm Knee Scoring Scale. A Serial Case
08.30- Screw Removal Effect Analysis On Delayed Union After
08.40 Interlocking Intramedullary Nailing In Tibial Diaphyseal
Fracture
08.40- Soft Tissue Release (Posteromedial Approach) And Tendon
08.50 Lengthening For Rigid Type Clubfoot
08.50- Outcome Of The Use Of Synthetic Bonegraft In Case Of
09.00 Fractures Inmoewardi Hospital Surakarta January 2013 –
May 2015 ( Retrospective Study)
09.00- Association Of Ponseti Serial Casting Outcome Between
09.10 Age, Classification, Type, And History Family Of Clubfoot
Patient In Hasan Sadikin Hospital
09.10- Correlation Between Sagittal Balance With Quality Of Life
09.20 On Patients After Posterior Interbody Fusion
09.20- Correlation Between Environmental Factors With Long Bon
09.30 eFracture In Children Treated
In Hasan
Sadikin
Hospital PeriodJanuary 2013 - December 2014
09.30- Outcome Hemiarthroplasty Bipolar Vs Total Hip
09.40 Arthroplasty For Displaced Femoral Neck Fracture In
Elderly
09.40- Studies On Gene Expressions At The Rna Level Associated
09.50 With Fibrosarcoma Cases In Jambi
09.50- Epidemiology Study Of Elbow Fractures In Children At
10.00 Saiful Anwar General Hospital Malang, June 2009 – June
2015
10.00- Epidemiology Of Physeal Plate Fracture At Sanglah
10.10 Hospital Emergency Unit In 2014
10.10- Survey Of Physeal Closure Age Of The Distal Radial Physis
10.20 On Adolescence Traffic Accidents Victims Admitted To
Emergency Department Dr. Hasan Sadikin General Hospital
From January 2012 To September 2015
10.20- Charateristic Patient With Osteosarcoma At Extremity In
10.30 Hasan Sadikin Hospital Bandung January 2014 –
December 2014
10.30- Coffee break
Kode
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10.45
10.45- Characteristic Of The Musculoskeletal Complain On The
10.55 Syndrome Lupus Erymathosus Patient In Dr. Hasan Sadikin
Hospital Bandung From January 2012 – December 2013
10.55- Musculoskeletal
Involvement
In
Thalassemia
And
11.05 Hemophilia Patient In Dr. Hasan Sadikin Hospital Bandung
From January 2012 – October 2014
11.05- Antibiotic Susceptibility And Bacterial Pattern In Patients
11.15 With Open Fracture Of Lower Extremity Gustillo-Anderson
Classification Grade Iii: A Retrospective Study
11.15- Neutrophil-Lymphocyte Ratio (Nlr) Is Associated With
11.25 Fracture Healing Process In Children
11.25- Responsiveness Of The Pirani Score In Neglected Clubfeet
11.35
11.35- Methylprednisolone Intralesional Injection For The
11.45 Treatment Of Aneurismal Bone Cyst In Children And
Adolescents: Serial Cases
11.45- Post Operative Shoulder Functional Comparation Between
11.55 Open
Acromioplasty
And
Arthroscopy
For
Shoulder Impingemen Syndrome Patients In Surabaya
11.55- Application Of Platelet Rich Fibrin As A Therapy For
12.05 Diabetic Foot Ulcer
12.05- Correlation Between Plain Radiograph Parameter And
12.15 Functional Outcome In Pediatric Supracondylar Humeral
Fracture
12.15- Correlation Between Plain Radiograph Parameter And
12.25 Functional Outcome In Pediatric Supracondylar Humeral
Fracture
12.25- Makan siang
selesai
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Presentasi Poster
Judul
1.
Ewing’s Sarcoma Of The Left Thigh And Lower Leg : A Case
Report
2.
Neglected Hangman’s Fracture In A 34-Year-Old Male
3.
Bilateral Traumatic Amputation Of The Wrist Treated By
Myoelectric Prosthesis (A Case Report)
4.
Comprehensive
Orthopaedic
Management
Of
Extracompartmental Giant Cell Tumor Of The Soft Tissue: A Very
Rare Case
5.
Mid-Term Outcome : Neurofibromatosis Scoliosis Treated
With Growing Rod
6.
Neglected Congenital Bilateral Trigger Thumb : A Case
Report
7.
Modification Yoshii Flap For Finger Tip Injury Of Thumb
8.
Macrosyndactyly Of The Toes
9.
Macrodactyly Of The Hand: A Case Report
10. Ilizarov Methode For Infected Bone Loss In Prof Dr R
Soeharso Orthopaedic Hospital Surakarta: A Case Report
11. Glomus Tumor Of The Fingertip: A Case Report
12. Finger Flexion Deformity And Carpal Tunnel Syndrome: A Rare
Case Of Tophus At Flexor Tendon
13. Constriction Band Syndrome: An Efficient One Stage Release
Combining Circumferential Excision And Z Plasty
14. Bilateral Congenital Amputation Of Lower Leg In A 2 Weeks
Old Baby
15. Avascular Necrosis : What Orthopedist Need, What
Radiologist Must Read.
16. Atypical Maisonneuve’s Fracture, A Case Report
17. Anterior Cruciate Ligament Rupture In Gouty Arthritis: A Case
Report
18. Anatomic Reconstruction Of The Distal Radio-Ulnar Ligament
And Osteotomy For Malunion Distal Radius And Ulna With Distal
Radio-Ulnar Joint Instability: A Case Report
19. An Uncommon Site Of A Common Tumour: Gct Of Vertebrae
20. The Bone Union In Patient With Non Nf-1 Congenital
Pseudoarthrosis Of Tibia With A History Of Malunion Fracture : A
Case Report
21. A Case Of Pulmonary Metastasis Of Recurrent Giant-Cell
Tumor Of Bone In Proximal Humerus
22. Non-Vascularized Head Fibular Graft In Ankle Reconstruction
For Recurrence Giant Cell Tumor On The Distal Fibula
23. Primitive Neuroectodermal Tumor At The Level Of Thoracic
Spine : A Case Report
24. Osteopetrosis : A Case Report
Kode
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P2
P3
P4
P5
P6
P7
P8
P9
P10
P11
P12
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P14
P15
P16
P17
P18
P19
P20
P21
P22
P23
P24
25. Clinical Outcome Of A Patient With Tetraplegic Spastic Type
Due To Cervical Tuberculousespondylitis With Abces Of C2 – C3 C4 And Subluxation Of Atlanto - Axial After Debridement,
Laminectomy Of C2 And Stabilization Of Occipito – C3 – C4in
Soeharso Orthopaedic Hospital Surakarta: A Case Report
26. Traumatic Shoulder Dislocation In A 4-Year-Old Child: A Case
Report
27. Spinal Epidural Abscess In Chronic Kidney Disease Patients
With Suspected Cystic Mass In The Thoracic Vertebra, A Case
Report
28. Osterior Tibial Plateu Fracture: A Dilemma Of The Approach. (
A Case Report)
29. Osteocutaneus Pedicle Fibular Graft Procedure For Limb
Salvage At Severe Injury Of Lower Extremity ( Case Report )
30. The Outcome Of Modified Kurokawa Laminoplasty For
Cervical Canal Stenosis: A Case Report
31. The Management Of Neglected Coxitis Tuberculosis In
Children : A Case Report
32. Sural Fasciocutaneous Flap For The Treatment Of Traumatic
Soft Tissue Defect At Dorsal Foot (Case Report)
33. Mid-Term Functional And Oncology Follow-Up Following
Buttockectomy Procedure Removing Major Hip Abductor Middle
Gluteal Muscle On A Fibrosarcoma Patient
34. Close Fracture Pelvic Young Burgess Lateral Compression
Type Ii Associated With Anterior Column Fracture Of Left
Acetabulum: Using Double Approach (A Case Report)
35. Joint Reconstruction Using Sternocleidomastoid Tendon
Autograft As Treatment For Traumatic Posterior Dislocation Of
Sternoclavicular Joint. A Case Report.
36. Distal Femoral Osteotomy As New Alternative For
Management Of Slipped Capital Femoral Epiphysis (Scfe) . A Case
Report
37. Management Of Bilateral Iliopsoas Muscle Hemophilic
Pseudotumor. A Case Report
38. Adjacent Segment Diseases Of L2 Post Decompression
(Laminectomy) And Posterior Stabilization Of L3-L5 Due To Lumbal
Canal Stenosis
39. Desmoplastic Fibroma Of Proximal Tibia Mimicking Malignant
Tumor
40. Limb Salvage Procedure As Operative Treatment For Giant
Cell Tumor Of Calcaneal Bone. A Case Report
41. Application Of Proximal Humerus Locking Plate As An
Alternative Fixed Angle Fixator On A Pediatric Femoral Neck
Fracture Delbet Iv. A Case Report
42. The Only Posterior Approach Of Correction Using Rod And
Screw Corrective Manipulation In Severe Adult Idiopathic
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P27
P28
P29
P30
P31
P32
P33
P34
P35
P36
P37
P38
P39
P40
P41
P42
Scoliosis. A Case Report
43. Chronic Inflammation Of Intra-Articular Plastic Foreign Body In
The Knee
44. Bony Reconstruction And Soft Tissue Procedure In
Osteoarthrits Of The Knee Due To Late Achondroplasia. Reverse
Pagoda Osteotomy And Lateral Collateral Ligament Fixation Using
Clancy Method
45. Bilateral Innominate Osteotomy Technique In Bladder
Exstrophy Repair. A Rare Case Report
46. Post Operative Evaluation For Treatment Of Volkmann
Ischemic Contracture With Free Function Muscle Transfer
P43
P44
P45
P46
F P1 .1 .
DISTAL FEMORAL GCT TREATED WITHWIDE EXCISION &MEGAPROTHESIS
RECONSTRUCTION AT PROF. DR. R. SOEHARSO ORTHOPAEDIC
HOSPITALSURAKARTA2015 (SERIALCASE)
Bagus Nur Graha Wahyu Aji*, Mujaddid Idulhaq**
* :Resident of Orthopaedi& Traumatology, School of Medicine, SebelasMaret University- Prof.Dr.R.Soeharso
Orthopaedic Hospital, Surakarta.
**: Orthopaedic and traumatology Surgeon, Musculoskeletal Tumor Consultant,Secretary of Orhtopaedic
Program Medical Faculty of SebelasMaret University- Prof Dr R Soeharso Orthopaedic Hospital, Surakarta
.
ABSTRACT
Introduction. Giant Cell Tumor (GCT) known asoesteoclastomais a tumor characterized by multinuclear giant
cell. At Prof. Dr. R. Soeharso Orthopaedic Hospital Surakarta in 2014-2015 there was 27 GCT patients, 18 of
them were diagnosed asdistal femoral GCT.Wide excision and megaprothesis reconstruction were
management of complex GCT in which has reccurent or destructive
Objective. To evaluateoutcomeof GCT patient treated with wide excision and megaprothesis reconstruction
Methods. Reporting3 patients32, 37 and 43 years old malediagnosed withdistal femoral GCT stage II. Patient
complaining lump over knee region accompanied by progresive pain.Wide Excision and megaprothesis
reconstruction had been done to treat that patients. Clnical and radiological evaluation had done before and
after surgery. Clincal parameter using MSTS score.
Result. Four weeks post operative all patients can flex 90o of the knee, partial weight bearing using double
crutch, pain has subside, can doing assistive home activity, good wound healing and no sign of infection over
the wound. Based on MSTS score, first patient has 31 points, second patient has 29 points, and 27 points for
third patient. And avarage percentage about 82,7% for all patients. This result can be define as good result.
Conclusion. Wide excision and megaprothesis reconstruction offer good result in treating patient with distal
femoral GCT, and can be the treatment of choice for this case.
Keywords: GCT, wide excision, megaprothesis
1
F P1 .2 .
OUTCOME OF CONSERVATIVE TREATMENT IN CLAVICLE FRACTURES
PATIENTS JANUARY-JULY 2015 DR. SOETOMO GENERAL HOSPITAL
SURABAYA
Brilliant Citra Wirashada * , Teddy Heri Wardhana * *
∗Resident Of Orthopaedic & Traumatology Faculty Medicine Of Airlangga University / Dr. Soetomo General
Hospital Surabaya
∗∗Senior Staff Of Orthopaedic & Traumatology Faculty Medicine Of Airlangga University / Dr. Soetomo
General Hospital Surabaya
ABSTRACT
Introduction. Shoulder pain is a complaint that is quite often found in daily practice. Shoulder pain was
recorded at 16 percent of all musculoskeletal disorders (Urwin et al, 1998). Shoulder pain was first reported
by Duplay in 1872 in France, that the stiffness and shoulder pain is a symptom periartritis humeroskapularis.
Two symptoms of shoulder pain are abundant in society, affects approximately 15 to 30 percent of the adult
population. Causes of shoulder pain vary, for example, a degenerative disease of the gleno humeral joint, and
network akromio kalvikular backers and inflammatory diseases such as rheumatoid arthritis, as well as injury
or fracture of the collarbone (clavicle) (Richard etal, 2004). Multi factorial etiology of shoulder pain caused
management becomes difficult and often unsatisfactory (Jackson etal, 2002). Pain and loss of function is
what makes a high degree of disability in the community, especially at the age of 40years and older (Richard
etal, 2004). Some literature mentions clavicle fracture is one of the causes of the onset of pain and disability
in the shoulder. The purpose of drafting a paper presenting this case is to show the presence or absence of
shoulder pain and disability in patients who had been recovered from a broken clavicle.
Method. Case report series of 15 patients in Dr. Soetomo General Hospital who ever diagnosed a clavicle
fracture during January – July 2015. The data taken from medical record, patients’ clinical notes, home visit,
and physical examination, also sampling the SPADI and Quick DASH questioner then measure the value.
Result. In the patient case reports have been conducted conservative treatment and data collection as well
as the provision of questioner SPADI and Quick DASH . From the calculation results obtained questioner
SPADI varied results , from 15 patients there were 8 patients ( 53 % ) with the result of 0 % , 1 patient (7 %)
with a score of 0.63% , 1 patient ( 7 % ) with a score of 1.25 % , 1 patient ( 7 % ) with a score of 5.90%, 1
patient ( 7 % ) with a score of 7.13% , 1 patient ( 7 % ) with a score of 8.50 % , 1 patient ( 7 % ) with a score of
9 , 90 % , and 1 patient ( 7 % ) with a score of 10.50 % . Results scoring questioner Quick DASH score also had
varied results . There were 10 patients ( 67 % ) with a score of 0 , 3 patients ( 20 % ) with a score of 2.27 , 1
patient ( 7 % ) with a score of 13.6 , and 1 patient ( 6 % ) with a score of 6.81
Conclusion.Pain in the shoulder can result from acute events clavicle fracture , and some may arise due to
imperfect healing as malunion and non - union , handled well after conservative or operative . ( 1 ) The
results of the clinical evaluation and a physical examination of 15 patients , was not obtained complaints of
pain and disability in the shoulder joint after fracture of the clavicle ( 2 ) From the evaluation results of the
calculation of the value questioner SPADI and Quick DASH not found complaints of pain and disability
shoulder joint , which means , ( 3 ) Treatment of clavicle fractures conservatively covered on either granting
or backpack armsling velban can still be used as the main option . ( 4 ) in the middle third clavicle fractures
has the largest distribution.
Keywords : fracture clavicle, shoulder pain
2
F P1 .3 .
OPERATION PROCEDURE FOR SPONDYLOLISTHESIS PATIENT
Januar Ari Subiantoro, dr*, Primadenny A. Airlangga, dr., MSi., Sp.OT(K)**
ABSTRACT
Introduction.
Low back pain often experienced by all people with the same ratio between men and
women with onset between the ages of 30-50 years. Many factors that can cause Low back pain such as
frequent heavy lifting, obesity, age, trauma, and one of them is the shift of the vertebrae called
Spondylolisthesis. Spondylolisthesis is about 5-6% of the population of men, and 2-3% of women.
Method.In this case, the authors describe two patients with Male aged 42 years and Female aged 43 years
with Spondylolisthesis Lumbal Vertebra 4-5 with complaints of pain in the lower spine radiating to both legs.
In both patients had surgery Decompression + TLIF + PSR.
Result. Evaluation after Operation Procedure, there is a satisfactory outcome to the complaint of patients is
greatly reduced by the difference of the Visual Analogue Scale very meaningful.
Discussion.Spondylolisthesis could perform with varies symptoms, the disorder is often characterized by pain
in the back, pain in the thighs and legs. Many cases can be treated conservatively. However, in individuals
with radiculopathy, neurogenic claudication, postural abnormalities and gait, which did not work with nonoperative treatment like in this patients, the Surgery is preferred.
Conclusion.Operation Procedure with Decompression + TLIF + PSR for the Spondylolisthesis patients has a
success in the return of the physical and social activity of the patient so that the quality of life of the patient
can be increased.
Keywords:Low Back Pain, Spondylolisthesis, TLIF, VAS
3
F P1 .4 .
ANKLE ARTHRODESIS WITH CANNULATED SCREW : A CASE SERIES
H. Yazid, AT Desnantyo
Orthopaedic and Traumatology Department Airlangga University - Dr. Soetomo General Hospital
Surabaya, INDONESIA
Introduction. Osteoarthritis of the ankle is unique compared to the other major lower extremity arthritidies.
Relatively the patients are young and lack of available long lasting treatment. On the end stage, ankle
arthritis can causes joint deformity, disability, and decreasing income that can affect the quality of life. Ankle
arthrodesis remains the gold standard and is the procedure of choice for younger patients who are heavy
laborers.
Methods. Evaluate and report 5 patients undergone ankle arthrodesis at RSUD Dr. Soetomo Surabaya on
2011-2015. The data were collected form patient files, clinical notes, radiographs, and a recent physical
examination. The outcome has been assed with SF-36 score and clinical scoring system Ankle-Hind foot
American Foot and Ankle Society.
Result. This study includes 3 male patients and 2 female patients undergone ankle arthrodesis with
cannulated screw, caused by neglected severe ankle dislocation. One patient had open dislocation. Based on
SF-36 scoring, the five patient had average score 76,7 with highest and lowest score were 95,9 and 56,7.
Based on clinical score ankle-hind foot American Ankle and Foot Society, the average score was 68(51 – 88).
SF-36 scoring result includes general health, physic, emotional, and social. And clinical scoring ankle-hind foot
American Foot and Ankle Society evaluation includes pain, function, and alignment. It shows that there were
patient that gain an almost perfect result. But still there is patient had remain complain after this procedure.
Patient with the lowest score also had knee osteoarthritis contra lateral from the operated ankle. Early
weight bearing on ankle arthrodesis with cannulated screw was the major factor caused unsatisfactory result
of this patient.
Conclusion.Ankle arthrodesis with cannulated screw has satisfactory result even remain complain on one
patient. The failure was result from in obedient of early weight bearing. Nevertheless, ankle arthrodesis with
cannulated screw still has the important role on the treatment of choice on ankle reconstruction.
Keywords : Ankle arthrodesis with cannulated screw, ankle fusion
4
F P1 .5 .
FUNCTIONAL OUTCOME OF INTERTROCHANTERIC FRACTURE WITH
DYNAMIC HIP SCREW IN ELDERLY (JANUARY – AGUSTUS 2015): A CASE
SERIES
Agus Eka Wiradiputra* Cok Gede Darmayuda**
*Resident of Orthopedic and Trauma, Faculty of Medicine Udayana University, Sanglah
Hospital
**Orthopaedic and Traumatology Senior, Udayana University, Sanglah General Hospital
Denpasar
Introduction. The incidence of Intertrochanteric femoral fractures has increased significantly in recent years
and is expected to continue to rise with increasing life expectancy of elderly patients. Medical comorbidities
and ambulatory status play a significant role in surgical treatment options and patient outcomes. The general
goal of surgical management is to restore functional anatomy in a way that will allow for early mobilization
and rehabilitation while promoting fracture healing. Surgical treatment of the various types of hip fractures
differs significantly. Dynamic Hip Screw (DHS) is one of treatment choice for intertrochanteric femoral
fracture.
Methods. Seven case of intertrochantertic fracture was treated by DHS in Sanglah General Hospital from
January until August 2015. Patient was followed up for functional outcome after surgery using Harris Hip
Score.
Result. Harris Hip Score for all elderly patient that underwent ORIF DHS following Intertrochanteric Femoral
fracture was good (total range of point 70-79). In terms of functional outcomes, same study found that 70%
of patients treated with a compression hip screw required ambulatory aid 6 months after surgery, compared
to only 38% pre-injury. Similarly, Medoff and Maes found only 50% of patients to be walking independently
at the time of hospital discharge following compression hip screw treatment.
Conclusion. Surgical fixation of an intertrochanteric fracture is not different from any other geriatric hip
fracture – the surgeon must consider not only fracture pattern but also the patient’s age, medical condition,
and pre-injury functional status. Dynamic Hip Screw is one choice of surgical treatment of intertrochanter
femoral neck in elderly that give good result of functional outcome after surgery.
Keywords: Intertrhocanter Femoral Fracture, Elderly, Funtional Outcome
5
F P1 .6 .
LOWER LEG DEFORMITY CORRECTION USING ILIZAROV SYSTEM IN DR
SOETOMO HOSPITAL SURABAYA
Citra Ahdi Prasetya*. Jeffry Andrianus Muslim**, Dwikora N. Utomo **
Introduction. Limb deformity, especially lower leg deformity is a common case in orthopaedic practice. Limb
deformity can be classified according to cause (Congenital, developmental, post trauma), geometry
(angulation, rotation, shortening), severity and progression. In severe and complex deformity, the treatment
choice is gradual correction using Ilizarov system. Benefit of the gradual correction using Ilizarov system are:
(1) reduce the risk of neurovascular injury, (2) minimal soft tissue disturbance, (3) multiplanar correction.Dr
Soetomo Hospital already done correction using Ilizarov System for correction of lower leg deformity.
Method. We studied retrospectively all patient with lower leg deformity managed with Ilizarov system during
January 2013 – September 2015 in Dr Soetomo Hospital Surabaya.
Result. Elevent patient was managed by Ilizarov system for gradual deformity correction. four patients
already finished the treatment and the frame was removed. Two patients was changed with other fixation
because implant failure during correction phase. Five patients still in correction phase (bone lengthening,
bone transport and deformity correction). In 4 patients who already finished the correction phase, we can
correct the deformity until less than 1 cm leg length discrepancy.
Conclusion. Ilizarov system has a good result to correct lower limb deformity patients in Dr Soetomo General
Hospital.
Keywords: Lower leg deformity, Ilizarov, limb lengthening
6
F P1 .7 .
EVALUATION OF SCOLIOSIS IN MARFAN SYNDROME
Gestana R. Wardana *, Komang Agung Irianto S **
* Resident of Orthopaedic & Traumatology Department, Airlangga University / Dr. Soetomo General Hospital,
Surabaya
** Staff of Paediatric Division Orthopaedic & Traumatology Department, Airlangga University / Dr. Soetomo
General Hospital, Surabaya
ABSTRACT
Introduction.Scoliosis is the most common symptom that’s complained by the patient with Marfan
syndrome. The purpose of this study is to evaluate clinical, radiological, and quality of life of the patient
Marfan syndrome with scoliosis that have been treated using conservative or operative treatment, and
untreted patient
Method.In a retrospective case series in Dr.Soetomo Hospital, 8 patients Marfan syndome with scoliosis with
mean cobb angle 66°. 4 patients have been treated, 1 patient treated conservatively using brace, 3 patients
treated operatively; and 4 patients untreated yet. Evaluate clinically, radiologically, and quality of life using
SF-36 questionaire. Mean follow up of 1,72 years (1 year and 9 months) after being diagnosed.
Result.Good progression of cobb angle 5° on patient that have been treated conservatively, and mean cobb
angle 40° on patients that have been treated operatively, while untreted patients have worse progression of
cobb angle by mean 9,25°. Results of SF-36 questionaire, on treated patients shows good physical health (n =
4), good mental health (n = 3), poor mental health (n = 1). On untreated patients shows good physical and
mental health (n = 1), and poor physical and mental health (n = 3).
Conclusion. Scoliosis treatment using conservatively or operatively offers good progression of cobb angle and
good quality of life, based on physical and mental health
Keywords: scoliosis, Marfan syndrome, cobb angle, questionaire SF-36, physical health, mental health
7
F P1 .8 .
NEGLECTED TUBERCULOSIS OF THE WRIST (SERIAL CASE REPORT)
Kristianto, Yanuar *, Huwae, Thomas Erwin C.J. **
*Resident of Orthopaedic & Traumatology, Faculty of Medicine Brawijaya University, Saiful Anwar General
Hospital Malang
** Staff of Orthopaedic & Traumatology, Faculty of Medicine Brawijaya University, Saiful Anwar General
Hospital Malang
Introduction. Tuberculosis of the wrist is one manifestation of Mycobacterium Tuberculosis and the
prevalence is 1-5% of all cases. These disease have varied clinical presentation and often underdiagnosed
because its clinical features is not spesific in the early stage, thus influence the choice of treatment and
outcome.
Methods.This is a serial case study of 3 patients who presented tuberculosis of the wrist. Two patient male,
and one female. All of the patients were diagnosed as rheumatoid arthritis. We established the diagnosis as
Tuberculosis of the wrist by clinical features, X-Ray and Biopsy in some cases.
Result.Tuberculous infection of the musculoskeletal system is rare even in areas of high TB prevalence. The
early symptoms initially are non-specific. Sclerosis and osteolytic lesions, the main radiographic features of
bony tuberculosis, are non-specific and are present in other conditions such as inflammatory arthritis,
pyogenic osteomyelitis, and some malignancies . Other radiographic features include osteopenia, soft-tissue
swellings, periosteal reaction, narrowing of the joint space and bone cysts. The diagnosis of TB may be
confirmed on the recognition of Mycobacterium tuberculosis on culture from bone tissue.
Systemic disease, diabetes mellitus, and local factors such as trauma or intra-articular steroids may
predispose to activation of a distant focus. Gold standard diagnosis is established by open biopsy and tissue
culture. Surgery is an adjunct to the antituberculosis medications as surgical procedures may be necessary to
control the disease or to improve the function.
Conclusion. In summary, persistent swelling of bones or joints of the wrist could be a presenting sign of
tuberculosis. The diagnosis are easily missed and underdiagnosed because of the non-specific clinical signs
resulting in progression of disease and more advanced disability also complicated treatment. We should have
high index of suspicion when dealing with long standing inflammatory of the joints that not responding to
conservative measures. Also when confronted with unusual inflammatory findings, always send tissue for
examination pathology anatomy for the golden diagnosis & bacterial culture or PCR. MRI is optional for wrist
tuberculosis.
Keywords: Neglected Tuberculosis of the wrist, Rheumatoid Arthritis, Biopsy as Golden standard diagnosis.
8
F P1 .9 .
CLINICAL OUTCOME OF COMMINUTED INTRAARTICULAR DISTAL RADIUS
FRACTURE TREATED WITH CLOSED REDUCTION AND CIRCULAR CAST
(RETROSPECTIVE STUDY AT MOEWARDI HOSPITAL SURAKARTA JULY
2014 – JUNE 2015)
Arief Indra Perdana Prasetya*, Tito Soemarwoto**
*Resident of Orthopaedic & Traumatology Faculty of Medicine Sebelas Maret University/Dr. Moewardi
General Hospital/Orthopaedic Hospital Prof.Dr.R.Soeharso
**Staff Orthopaedic & Traumatology Faculty of Medicine Sebelas Maret University/Dr. Moewardi General
Hospital/Orthopaedic Hospital Prof.Dr.R.Soeharso
ABSTRACT
Introduction. Comminuted intraarticular distal radius fracture was rarely treated conservatively. We
observed the outcome of comminuted intraarticular distal radius fracture was treated with closed reduction
and circular cast at Moewardi Hospital Surakarta.
Objective. To observe the clinical outcome of patient with comminuted intraarticular distal radius fracture
that was treated with closed reduction and circular cast at Moewardi Hospital Surakarta.
Method. This study had been done retrospectively from patient comminuted intraarticular distal radius
fracture that was treated with closed reduction and circular cast at Moewardi Hospital Surakarta since July
2014 – June 2015. The information about patient collected from medical record including age, sex, site of
injured distal radius (dominant/or non dominant hand), and type of intraarticular comminuted fracture. The
data about function after treatment we collected by visiting patient at home or when patients controlled to
hospital using DASH score and range of motion of wrist joint.
Result. Eleven patients comminuted intraarticular distal radius fracture was threated with concervative
treatment. Consist of 7 male and 4 female had been evaluation. 10 patient have a good condition DASH
Score and 1 patient have average DASH Score. All patients have normal Range of Motion of wrist joint .
Conclusion. Patients with comminuted intraarticular distal radius fracture that was treated with closed
reduction and circular cast at Moewardi Hospital Surakarta at July 2014 - June 2015 have nomal wrist ROM
100% (11 patients), Good DASH SCORE 90.90% (10 patients), Average DASH SCORE 9.99% (1 patient). Further
investigation with more patients and analysis is needed to get better conclusion.
Keywords :Distal radius fracture, intraarticular, comminuted, closed reduction and circular cast
9
F P1 .10 .
ORTHOPEDIC COMPLICATIONS OF CHILDHOOD OBESITY
Ricky Wibowo * , Hermawan Nagar Rasyid * * , Yoyos Dias Ismiarto * * , Gibran Tristan * *
* Resident of Orthopaedic and Traumatology Department, Hasan Sadikin General Hospital, Faculty of
Medicine Universitas Padjadjaran, Bandung
** Teaching staff of Orthopaedic and Traumatology Department, Hasan Sadikin General Hospital, Faculty of
Medicine Universitas Padjadjaran, Bandung
ABSTRACT
Introduction.The number of people classified as overweight or obese continues to rise throughout the world.
These problems include spinal complications, slipped capital femoral epiphysis and Blount disease, The
mechanism of the relationship of obesity and SCFE is not defined simply by the increased force on the
femoral head secondary to the increased load from an increased body mass. Hip abduction increases in those
who are obese; hence, the shear component applied to the capital femoral growth plate is also increased,
resulting in a higher risk of SCFE. Increased body mass exerted on the epiphysis increases both compressive
and shear forces. The compressive forces generated at the medial compartment of the knee were considered
of sufficient magnitude to alter physeal growth.
Objective. The purpose of this article is to describe the orthopedic problems known to be associated with
being overweight or obese during childhood to assist the clinician in the evaluation and management of
these patients.
Methods.All data collected from Outpatience Departement medical record from January 2013 – December
2014 from Age <18 years old, with BMI > 25
Results. All patients with overweight has symptom about 27%, obesity 50%. Patients with overweight has
SCFE 33%, and obesity has SCFE 66%. Patients with overweight has BD 40%, and obesity has 60%.
Conclusion. Overweight and obesity increased incidence of SCFE and BD
Keyword: overweight, obesity, slipped capital femoral epiphysis (SCFE), Blount Disease (BD)
10
CHARACTERISTICS IN CHILDREN WITH SUPRACONDYLAR HUMERUS
FRACTURE AT HASAN SADIKIN HOSPITAL FROM JANUARI 2009 – JANUARI
2014
F P1 .11 .
Sulaeman, A., Ismiarto Y.D.
Department of Orthopaedic and Traumatology, Faculty of Medicine Padjadjaran University / DR. Hasan
Sadikin Hospital, Bandung
ABSTRACT
Introduction. Supracondylar humerus fracture fractures are common childhood injuries, accounting for
about 10% of all childhood fractures. In many cases, a simple fracture will heal well with conservative cast
treatment. Some types of elbow fractures, however, including those in which the pieces of bone are
significantly out of place, may require surgery. Other structures in the elbow such as nerves, blood vessels,
and ligaments may also be injured when a fracture occurs and require treatment, as well.
Method. This study is a retrospective and it processed in descriptive analyticat the period Januari 2009 Januari 2014, There were 15 pediatric patients who were admitted in Dr. Hasan Sadikin Hospital
Bandung.Amounts of supracondylar humerus fractures in children patients that comes to Dr. Hasan Sadikin
Hospital with characteristicsincludegender,age of the patient, location of the fracture, management, type of
trauma, wherethe incidenceandcomplicationsin patientswho receivedsurgery.
Result.There was showed thatsupracondylar humerus fractures in children dominant in male (73.3%), Mostof
the sceneat home (66.7%) andnotfoundcomplications insupracondylarfracturesof the humerusinHasan
Sadikin Hospitalperformedsurgery.
Conclusion. There is colleration betweensuprakondilarhumerusfracturesin children, especially boys, and
where it happenedmostat homemeans thatthe need forparental supervisionof childrenfurther.
Keywords: Supracondylar humerus, fracture characteristics
11
F P1 .12 .
FUNCTIONAL OUTCOME DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)
PATIENTS AFTER OPERATIVE TREATMENT AT WALKING AGE IN HASAN
SADIKIN HOSPITAL BANDUNG
Achmad I.H., Ismiarto Y.D.
Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Padjadjaran/ Hasan Sadikin
General Hospital, Bandung
ABSTRACT
Introduction. Cases of developmental dislocation of the hip (DDH) still occur after walking age because of
late or missed diagnosis and failed conservative treatment. The choice of treatment for DDH after walking
age is surgical procedure has been a challenge to the orthopaedic fields. The aim of this study was to assess
the clinical and radiographic results of surgical treatment of DDH after the walking age.
Methods. The study included 13 patients (15 hips) in Hasan Sadikin Hospital Bandung from 2012 – 2015 ,
they had been treated by different combinations of open reduction, femoral and pelvic osteotomy. The age
at the time of the operation ranged from 1 to 7 years old.
Result. The final clinical results at the end of follow up (a mean of 22 months) was excellent in 5 (33.3%)
patients, good in 7 (46.7%) patients, fair in 2 (13.3%) patients and poor in 1 (6.7%) patients. The radiological
end result was Class I (excellent) in 8 (53.3%) patients, Class II (good) in 5 (33.3%) patients, Class III (fair) in 1
(6.7%) patients and Class IV (poor) in 1 (6.7%) patients. The satisfactory patient was 10 (80%) patients
clinically and 11 (86.6%) patients radiologically.
Conclusion. We concluded that functional outcome DDH patients after operative treatment in the walking
age mostly have a good results.
Keywords : developmental displasia of the hip, DDH
12
F P1 .13 .
CHARACTERISTIC OSTEOMYELITIS PATIENTS AT LOWER EXTREMITY IN
HASAN SADIKIN GENERAL HOSPITALPERIODE JANUARY 2012—
DECEMBER 2014
Dewangga TH, Ismiarto Y D
Orthopaedi and Traumatologi Department Faculty of Medicine Padjadjaran University/ Dr. Hasan Sadikin
Hospital Bandung West Java Indonesia
ABSTRACT
Introduction. Micro-organisms may reach the musculoskeletal tissues by a direct introduction through the
skin (a pinprick,an injection, a stab wound, a laceration, anopen fracture or an operation), direct spread
froma contiguous focus of infection, or indirect spreadvia the blood stream from a distant site such as the
noseor mouth, the respiratory tract, the bowel or the genitourinarytract.1 Infection of the bone is different
than that of the soft tissue, in which the bone has compact compartments hence more prone of blood
vessels injury and cellular death.2Osteomyelitis is a common orthopaedic infection and a major medical
problem in developing countries. Time is a critical factor in the evolution of the chronic disease as most of
our cases are progression from acute haematogenous osteomyelitis. Understanding the disease is crucial to
achieve a rapid and accurate diagnosis and provide potentially limb-sparing interventions.3
Objective. To describe the demographic andclinical data of patients with osteomyelitis of the lower limbs in
Hasan Sadikin Hospital within period of Januari 2012 – Desember 2014
Methods. Retrospective case analysis of 43 patients with osteomyelitis of the lower limbs that came to
Hasan Sadikin Hospitalbetween Januari 2012 – Desember 2014. Age, sex, chronicity, region affected,
systemic risk factors, etiology, and management were recorded
Results. There were 43 samples, with male predominance (55.81%) and average age was 32.5 within range of
2 – 77 years old. Majority of the case was chronic in respect of duration (97.68%). Femur was the most
affected region of lower extremity (46.51%), followed by cruris (32.55%). Several patients had systemic risk
factor such as DM in 7 patients (16.28%) and malnutrition in 5 patients (11,26%). The cause of osteomyelitis
mostly is from open wound 22 patients (51.17%) another cause is haematogenous 2 patients (4,65).
Definitive management of the patients consisted of several surgical intervention, such as debridement in 1
patient (2.32%), debridement with addition of antibiotic beads (13.95%), combination of debridement,
sequestectomy, and antibiotic beads in 25 patients (58.13%), combination of debridement and amputation in
2 patients (4.67%), and only amputation in 5 patients (11.63%).
Conclusion. Osteomyelitis patients of lower extremity in Hasan Sadikin Hospital were mostly male and
chronic in duration. Many of them occurred in femur and cruris region. Systemic risk factors such as DM and
malnutrition that play important role in the pathogenesis of the disease were also found in several patients
of this study. The most common surgical intervention was the combination ofdebridement, sequestectomy,
and antibiotic beads.
Keywords: osteomyelitis, infection, femur, cruris, lower extremity, debridement
13
F P1 .14 .
TREATMENT OF SINGLE SEGMENT THORACIC SPINAL TUBERCULOSIS
WITH NEUROLOGICAL DEFICIT IN ADULTS. CASE SERIES
Yudistira Prama Tirta*; Ifran Saleh**
*Orthopaedic resident in University of Indonesia, Cipto Mangunkusumo Hospital
** Consultan of Orthopaedic Spine, Dpet. of Orthopaedic and Traumatology, University of Indonesia, Dr. Cipto
Mangunkusumo Hospital
ABSTRACT
Introduction. Neurological deficits is one of the complication of Spinal tuberculosis. The single segment
thoracic spinal tuberculosis with neurological deficits (STSTND) is rarely been reported in literature. STSTND
is characterized by kyphosis deformity, abscess formation, and spinal cord compression. Posterior
instrumentation and fusion, anterior debridement and fusion, and anterior and posterior fusion have been
described as effective operative treatment for spinal tuberculosis. But there is lack of concensus of the most
effective operative treatment in management of STSTND.
Method. We reported 5 cases of Adult patients with STSTND in Ciptomangunkusomo Hospital in 2014. The
neurological state was evaluated pre-operatively with Frankel classification and short form-36 (SF-36) health
survey. Before surgery, the patients had already consumed anti TB chemoteraphy according to WHO
recommendation. The patient was treated with debridement, surgical decompression, stabilization and
fusion of the pathological area. Then we re-evaluate the clinical and neurological outcome of the patients
after 1 year.
Result. One year after the surgical treatment combinded with anti-TB chemotheraphy, all 5 patients with
STSTND had improvement of neurological classification based on Frankel and improved SF-36 scores.
Conclusion. Surgical management combined with anti-TB chemotherapy STSND in adults patients gives good
clinical and neurological outcomes.
Keywords: Treatment, Spinal Tuberculosis, Neurological Deficit.
14
F P1 .15 .
REVERSE DISTAL FEMORAL LOCKING PLATE FOR SUBTROCHANTER
FEMUR FRACTURE IN RSCM. A CASE SERIES
Peter Giarso*; Ismail Hadisoebroto Dilogo **
*Orthopaedic and Traumatology Resident,Universitas Indonesia, RSCM
** Consultan of Orthopaedic and Traumatology, Dept. of Orthopaedic & Traumatology, Universitas Indonesia,
RSCM
ABSTRACT
Introduction. Various implants and methods have been proposed. in the treatment of subtrochanteric
femoral fracture, each with its specific advantages without any one single superior choice. The use of
reversed distal femoral locking plate has been one of the promising alternatives. Reports on radiological and
functional outcome of this plate are necessary to evaluate whether this plate is comparable with the others
in the treatment of proximal femur.
Methods. We reported serial cases of femoral subtrochanteric fracture in RSCM in 2014 and 2015. In this
serial cases we used titanium LCP-DF plate (Synthes)9-11 hole using LISS or open reduction technique. We
further evaluate functional and radiological outcomes in 6 months.
Results. There were four cases of subtrochanteric femoral fractures treated in our hospital during 2014-2015.
Three of four patients are male suffering from motor vehicle accident and one female was due to accident in
the bathroom. First patient is male 34 years old with closed fracture of right subtrochanter femur
Seinsheimer 2B with Harris Hip Score (HHS) consecutively in 0, 6th and 12th months of (17, 96 and 97). While
second patient, male 24 years old with closed comminutive fracture of right subtrochanter femur
Seinsheimer V with HHS of 0, 6th, and 12th month of (13, 93 and 97). Third patientis a male, 39 years old with
non union of left subtrochanteric femur fracture Seinsheimer 2C with HHS 0, 6th, and 12th month of (38, 73,
and 77). The last patient is a female, 3 years old with closed fracture of subtrochanteric right femur
Seinsheimer IIB with HHS of 0 and 6th month of 23 and 40.
Technically, a reversed LCP-DF (Locking Compression Plate-Distal Femur) does not differ significantly
compared to other conventional techniques. However, fewer plate holes will increase the availability of
alternatives for operator to insert the screw. Radiologicallythe us of LCP-DF could satisfy the alignment and
angulation in sagittal and coronal. Six months until twelve months follow up of these patients showed fair to
excellent results.
Conclusion. Reversed LCP-DF application for proximal femur fracture is a promising alternative just like any
other implants. However, further researches are needed to compare the outcome of reversed LCP-DF plate
with other implants in the terms of surgical procedure, radiological outcomes and clinical especially long
term follow up.
Keywords: subtrochanter fracture, reverse distal femoral locking plate
15
F P1 .16 .
PONSETI METHOD ON LATE IDIOPATHIC CLUBFOOT
Faisal Mi’raj * , Rangga Ardianto Prasetyo * *
* Pediatric Consultant, Orthopaedic and Traumatology Department, Fatmawati Hospital
** Orthopaedic resident in University of Indonesia, Fatmawati Hospital
Introduction. The Ponseti method is reportedly effective for treating idiopathic clubfoot in children.
However, whether age at the beginning of treatment influences the rate of successful correction and the rate
of relapse is unknown. The Ponseti method has found most use in developing countries where late
presentation of clubfoot is also fairly common. The goal of treatment is to achieve a functional, pain-free,
plantigrade foot with good mobility and able to fit into regular shoes.
Methods. We therefore reviewed 4 consecutive children with idiopathic clubfoot treated by the Ponseti
technique in Fatmawati hospitals. We included patients who presented with untreated clubfoot. We
excluded from this study all children with clubfoot secondary to any other cause and all children with
previous posteromedial or posterior release. The duration for the correction was 8 to 15 weeks since January
to december 2015. Treatment by this technique was recommended to every patient (age range, 6 to
13 years). The protocol followed was the same in the hospital. The orthopaedic surgeon performed the
manipulation and casting according to the Ponseti method then Achilles tendon lengthening, and bracing.
Results. Correction was achieved in every child by means of the Ponseti method. Although all the children
were older than 4 years of age at followup, all of the children were still using their FAO at night. The average
number of casts necessary to achieve correction was 7 (range, 6 to 10 casts). Percutaneous Achilles
Lengthening was needed in all of the cases. At a mean followup of 6 months, there were no relapse in all
cases. There were no major complications with the technique, namely any bleeding problems associated with
the tendon lengthening, but there were some minor complications.
Conclusion. All patients older than 6 years were respond well to the Ponseti method. Number of casts
needed to achieve initial correction, rate of relapses, need for ATL, and the need for FAO at the time of
followup for this study were the same. Age at the beginning of treatment did not seem to influence the final
outcome. We believe the maximum cut-off age for successful Ponseti treatment has yet to be defined and
late-presenting cases should be given a trial for Ponseti treatment, because this does not preclude any
subsequent options and has a high probability of success.
Keywords: late clubfoot, Ponseti methods
16
F P1 .17 .
ACUTE CORRECTION IN PATIENT WITH SEVERE BLOUNT DISEASE USING
PROXIMAL TIBIA OSTEOTOMY FOLLOWED BY INTERNAL FIXATION
Aryadi Kurniawan * , Omar Luthfi * *
* Consultan of Pediatric Orthopaecic, Department of Orthopaedic and Traumatology, Faculty of Medicine
Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
** Resident of Department of Orthopaedic and Traumatology Faculty of Medicine Universitas Indonesia, Cipto
Mangunkusumo Hospital, Jakarta, Indonesia
Introduction. Blount disease is a common childhood condition that requires surgical correction. The choice of
management, either with acute or gradual correction is still a debate since each of it has advantages and
disadvantages. The complications of acute correction which consist of neurovascular injury, compartment
syndrome, and loss of correction are the main cautions. Despite of the reported prevalence of complications
following gradual correction is lower than the acute correction, other comparative study shows no
neurovascular complication among the two groups. In addition, the gradual correction strategy requires high
degree of compliance and the using of external fixation gives psychosocial impact for the patients. Hence, the
outcomes and complications following acute correction technique need more investigation weather it is still
applicable or not.
Method. We reported a serial case of 6 patients with bilateral and unilateral Blount disease who underwent
acute correction using proximal tibia osteotomy followed by internal fixation. We used clinical examination
to measure the neurovascular complication and serial X ray examination to measure any loss of correction
until the patient achieve full weight bearing.
Result. Among the subject, there were no neurovascular complication following the surgery. By measuring
tibiofemoral and metaphyseal-diaphyseal angle in serial X ray, we found no loss of reduction until the patient
achieve full weight bearing.
Conclusion. Either acute or gradual correction following proximal tibial osteotomy are both a wellestablished treatment strategy. According to this case series result, the acute correction is an acceptable
choice of treatment dealing with severe Blount disease, since we found no neurovascular complication and
any loss of reduction.
Keywords: severe Blount disease, acute correction, proximal tibia osteotomy, internal fixation
17
F P1 .18 .
OUTCOME OF UNSTABLE INTERTROCHANTERIC FRACTURES
TREATED WITH PFNA-II IN ELDERLY PATIENTS
Silalahi Thurman H*, S. jamot**, Nugroho Bambang**
*Fellowship training of Indonesia Hip and Knee Society,
**Department of Orthopaedic Surgery, University of Indonesia-Fatmawati Hospital, Jakarta
ABSTRACT
Introduction. The preferred treatment of intertrochanteric fractures in aged patients is
controversial. The purpose ofthe present study was to evaluate the outcomes of the PFNA-II for
stabilization of such fractures.
Methods. The PFNA-II was used to treat intertrochanteric fractures in 10 elderly patients from
january 2014 to March 2015. The patients comprised 3 men and 7 women with age more than
75 year. All fractures were classifiedby the Orthopaedic Trauma Association classification
system. We statistically evaluated the operation time, incision length and postoperative
outcomes. Patients were followed up for 3 and 6 month. Functional outcomes were assessed
according to the Harris hip scoring system..
Results. Statistical analysis revealed an average operation time of 48,9 minutes, average
andtotal incision length of 7,23 cm, fracture healing time was 17 weeks. The Harris hip score was
88,2 points. There were no varus hip deformities, implant failure, or femoral shaft fractures and
leg length discrepancy less than 1 cm.
Conclusion. PFNA-II has the advantages of a simple operation, few complications, and clinical
efficacy for thetreatment of intertrochanteric fractures. However, evaluation of its long-term
efficacy and risk of other complicationsrequires a large-sample, multicenter observational study.
Keywords : UnstableIntertrochanteric fractures, PFNA-II, outcome.
18
F P1 .19 .
ACUTE CORRECTION FOR SEVERE BLOUNT’S DISEASE WITH
ILIZAROV METHOD. A CASE SERIES
Nicko Perdana Hardiansyah*, Faisal Miraj**
*Resident of Orthopaedic and Traumatology Department Fatmawati Hospital
*Pediatric Consultant, Orthopaedic and Traumatology Department Fatmawati Hospital
Introduction. Severe Blount’s disease results in progressive multiplanar deformity of lower limb.
There were varus and rotational deformity with shortening of the limb. The mechanical axis fell
medially away from the knee joint center. Treatment is vary for each patient, depends on age,
magnitude of deformity, discrepancy, psychosocial factor, and surgeon experience. The aim of
treatment is to correct deformity and realign mechanical axis. Ilizarov method could achieve the
aim of treatment safe and effectively.
Method. Twenty legs from 14 patients (6 female and 8 male) were undergone minimal invasive
correction using Ilizarov methods in Fatmawati Hospital from January 2014 to November 2015.
Six patients had bilateral deformities, and 8 patients had unilateral deformity. All have MAD
(mechanical axis deviation away medial to the center of the knee. MPTA (Medial proximal tibia
angle) were 40-65 which in normaly 85-90. All parameters were recorded postoperativly such as
infection, compartment syndrom, nerve palsy, weight bearing and range of motion, duration of
ilizarov application, and union time.
Result. MPTA and MAD were improved, no complication of compartment syndrome and nerve
palsy were found. Patient could perform early weight bearing on first month after surgery. No
significant postoperative infection occurred. Ilizarov were applied for 1,5 to 2 months and union
time achieved in 3 months.
Conclusion. Acute correction of severe Blount’s disease with Ilizarov technique is safe and
effective. This technique allows early mobilization and weight bearing and with minimal soft
tissue damage during operation, higher union rate would be achieved.
Keywords: severe Blount’s disease, ilizarov method, complications , early weight bearing, union
rate
19
F P1 .20 .
CONGENITAL TALIPES EQUINOVARUS PROFILE IN SAIFUL ANWAR
GENERAL HOSPITAL : THREE YEARS FOLLOW UP 2013-2015
Shirley Novianty S.W. *, Panji Sananta ***
*Resident of Orthopaedic & Traumatology, Faculty of Medicine Brawijaya University, Saiful
Anwar General Hospital Malang
** Staff of Orthopaedic& Traumatology, Faculty of Medicine Brawijaya University, Saiful Anwar
General Hospital Malang
Introduction. The casualty rates of club foot have been high in several areas in Indonesia. One of
the most impacted area is around Malang regency and its outskirt areas. There are several
methods to treat this case; the simplest one will be serial ponseti cast, and the more advanced
one like Achilles tenotomy, Achilles tendon lengthening, as well as posterior-medial release. The
success rate of these treatments are determined by several factors, such as the first time the
patient being treated, the parent’s obedience to control their child to the doctor, and the
operative procedure that has been done. This research has been undertaken towards club foot
patients who seek medical attention in Saiful Anwar General Hospital Malang, and receive
further medical treatment from 2013 until September 2015
Method. Case series study of 3 years evaluation. We take several parameters including sex,
unilateral and bilateral, age distribution for the first time control to the hospital, and non
operative or operative treatment.
Result. For three years evaluation, we collected 39 cases. (37,037 %) cases were female, and
(62,96% ) cases were male. (44,4%) cases were bilateral, and (55,6%) cases were unilateral. With
age distribution for the first time control to the hospital, (66,6%) cases control before first
month, (22,2%) cases between 1 month until 1 year old, and 6 cases (11,1%) come to hospital
after 1 year old, while the most neglected case is 7 years old. As for the success rate,only 20%
cases succeeded with non operative treatment, while the rest need tenotomy or posterior
medial release. Six patients was observed until they reached 2 years old, where they were able
to walk. Two patients received non operative treatment, and four patients received operative
treatment (Achilles tenotomy). However, all 6 patients who received operative and non
operative treatments had the same positive outcome, and they had no difficulties in walking
normally.
Conclusion. Three years follow up of CTEV profile in Saiful Anwar General Hospital Malang has
provide wide perspective about distribution pattern, proportion, and even a benchmark to
determine the success of CTEV management. It is not depends only the doctor skill, but also
parent concern about the whole treatment. However, there are children with club foot that
cannot be fully treated with Ponseti method. This can be due to underlying conditions which
make treatment more challenging It is a hope that we can manage CTEV cases in Saiful Anwar
General Hospital better in the future.
Keywords: CTEV, Club foot, Profile, Saiful Anwar General Hospital
20
DISTRIBUTION PROFILE OF METASTATIC BONE DISEASE
INMOEWARDI HOSPITAL SURAKARTA JULY 2014 – JUNE 2015
(RETROSPECTIVE STUDY)
F P1 .21 .
R. Bagas Widhiarso*, Rhyan Darma Saputra**, Mujaddid Idulhaq***
*Resident of Orthopaedic& Traumatology, Faculty of Medicine SebelasMaret University
**Orthopaedic & Traumatology Subdivision of Surgery Department Dr.Moewardi Hospital
Surakarta
***Department ofOrthopaedic& Traumatology, Faculty of MedicineSebelasMaret University –
Prof Dr R.Soeharso Orthopaedic Hospital Surakarta
ABSTRACT
Introduction. Bone is one of the most common sites for metastatic with over 400,000 individuals
affected in the United States annually. Patients over 50 years bone metastasesare seen more
frequently than all primary malignantbone tumours.The patient is usually aged 50–70 years;
with any destructive bone lesion in this age group, the differential diagnosis must include
metastasis. The commonest sites for bone metastases are the vertebrae, pelvis, the proximal
femur and the humerus. The commonest source is carcinoma of the breast; next in frequency
are carcinomas of the prostate, kidney, lung, thyroid, bladder and gastrointestinal tract. In about
10 per cent of cases no primary tumour is found..
Methods. A retrospective study of Metastatic Bone Disease patients who received inhospital
treatment in dr. Moewardi Hospital on July 2014 – June 2015. Patients were evaluated for their
age, sex, regions involved, primary tumour, and treatment.
Result. In dr. Moewardi Hospital, on July 2014 – June 2015, there were 40 patients of metastatic
bone disease, with 17 (42,5 %) male patients and 23 (57,5 %) female patients. Mean age are
50,86 years old (range: 29 – 80 years old). Spine is the most frequenty involved region (37,5%),
Followed with lower extremity (35 %), and upper extremity (27,5 %). Carcinomaof the breast is
the most frequently has metastatic to the bone (37,5 %), followed with carcinoma of the lung,
prostate, bladder, undifferentiated carcinoma,colorectal,thyroid,nasopharynx, and uterus. Nonoperativetreatment is the most common (58,33 %).
Conclusion. Spine is the most frequently involved region (37,5%) of metastatic bone disease.
Carcinoma of the breast is the commonest source of metastatic bone disease (37,5 %).
Keywords: Metastatic bone disease, dr.Moewardi Hospital Surakarta
21
F P1 .22 .
PROFILE OF RHABDOMYOSARCOMA IN CHILDREN AT DHARMAIS
CANCER HOSPITAL 2005 - 2014
Devi LK, Mahdi HIS, Tehuteru ES
Introduction. Rhabdomyosarcoma is is a cancer that occurs in muscle cells and tends to occur in
children 1-5 years old. Rhabdomiosarcoma is a type of malignant tumor and it can be found
attached to muscle tissues of the body. The disease commonly occured in younger children and
accounts up to 8% of the total malignancies in children. Survival rate of this disease is as low as
70%, but because this rate is based on the population as a whole, an individual prognosis may be
different depending on the condition of the children.
Methods. The aims of this study is to investigate the characteristics of children with
rhabdomyosarcoma in “Dharmais” Cancer Hospital. Retrospective descriptive study was
conducted data was gathered from medical records. There are of 42 children from January 2005
to December 2014.
Result. There were a total 42 cases of rhabdomyosarcoma treated in “Dharmais” cancer Hospital
during this period of time. Among the 42 children are male (57,1%) and the age between 3
months up to 5 years old (52,4%). Histopathological review found that the disease is mostly
diagnosed at embryonal stages (81%), while the majority of primary are found in the extremity
(35.7%). Many of children were found at stage IV (52.4%) and using high risk chemotherapy
approach (54.8%). Most of the metastases found in lymph nodes (35.7%), and death due to the
disease (42.9%).
Conclusion.it is most commonly in children less than 5 years old. The embryonal histological
subtype was the most frequent and most occur in skeletal muscle, such as the Extremity. Many
of children were found at stage IV, often with a poor condition. The refferal system has been
suggested to reform, therefore preclinical treatment can be administered at the early stages.
Keywords : Childhood, rhabdomyosarcoma, profile
22
F P1 .23 .
EVALUATION POST TOTAL KNEE ARTHROPLASTY OPERATIONIN
PROF. DR. R. SOEHARSO ORTHOPAEDIC HOSPITAL SURAKARTA
JANUARI 2014 – JUNI 2015 (RETROSPECTIVE STUDY)
Alifia Rifki Rimanda*, Ismail Mariyanto**
* Resident of Orthopaedic & Traumatology Faculty of Medicine Sebelas Maret University
Surakarta
** Consultant of Adults Reconstructionof Orthopaedic & Traumatology Surgeon Sebelas Maret
University – Prof DR dr Soeharso Orthopaedic Hospital Surakarta
ABSTRACT
Introduction. Total knee replacement (TKR) is the mainstay of treatment for people with endstage osteoarthriris of knee. As a high cost, high volume procedure with a worldwide demand
that continues to grow it has become increasingly popular tomeasure response to surgery.While
the majority who undergo TKR report improvements in pain and function following surgery.
Accurate and meaningful capture and interpretationof outcome data are imperative for
appropriate patient selection, informing those at risk, and for developing strategies to
mitigatethe risk of poor results and dissatisfaction.
Objective. The purpose of this study was to determine the outcome of total knee replacement
operation in Orthopaedic Hospital of Prof. RS Dr. R. Soeharso (RSO) Surakarta from January
2014–June 2015.
Method. The research sample using total sampling method in which as many as 82 patients
were included in the study.
Result. From 82 patient there were 20 male (24,39%) and 62 female (75,61%).Average age that
had TKR is 61years old and knee that had operation 51 patient (62,19%) in left site and 31 pasien
(37,8%) in right site.Patient that hadTKR operation with bone graft 18 patient (21,95%) andnone
of TKR revision in this study period. From Knee Society Score (KKS)2011 result 4 patient were
excellent (4,87%), 34 patient were good score (41,46 %), 23 were fair (28,04%), and 11 patient in
poor (13,41%).
Conclusion. In this study, we found that patients that had Total Knee Replacemet in RSO
Surakarta has mostly good result referred to Knee Society Score 2011 New.
Keyword: knee, KSS, osteoarthritis, RSO, score, TKA, TKR.
23
F P1 .24 .
ASSESSMENT OF PHYSICAL FITNESS STATUS OF ORTHOPAEDIC
AND TRAUMATOLOGY RESIDENT AT DR. HASAN SADIKIN
HOSPITAL
Farid F., Ismiarto Y.D.
Department of Orthopaedic and Traumatology, Faculty of Medicine, Padjadjaran University / Dr
Hasan Sadikin Hospital, Bandung
ABSTRACT
Introduction. The demand for physical fitness of every person is different. This is usually
influenced by the type of work of each person. Army required to have a higher physical fitness
than employees or students, because the army forces have to work harder and longer while on
duty, for example, to fight or to guard, while the resident is used the physical fitness to study,
and activities that support the college lectures . Therefore should every resident should have a
good physical fitness in order to support, facilitate, and expedite activities.
Objective. This study aimed to assess the level of physical fitness the Orthopaedic &
Traumatology Resident at Hasan Sadikin Hospital, Bandung
Method. The design used in this study is a survey research, with the technique is the test, with a
sample of 55 residents. To determine the physical fitness test instruments used to run laps for
12 minutes of the Cooper test.
Results. The level of physical fitness of Orthopaedic & Traumatology residents are as follows: (1)
Two (3.63%) residents are included in the category of Very Poor (VP)., (2) Ten (18:18%) residents
are included in the category of Poor (P), (3) Fifteen (27.27%) residents are included in the
category of Medium (M), (4) twenty (36.36%) residents are included in the category of Good (G).
, (5) eight (14:54%) residents are included in the category of Very Good (VG), (6) Zero (0.00%)
residents are included in the category of Outstanding (O).
Conlusion. Most of residents have medium to good physical fitness.
Keywords: Physical Fitness, Status Fitness, Cooper Test
24
F P1 .25 .
TIBIAL LENGTH MEASUREMENT AFTER REDUCTION BY BONE
SETTER IN LOWER LEG FRACTURE AT CITAPEN, WEST JAVA
Yulianto, F, Ismiarto YD
Department of Orthopaedic and Traumatology, Hasan Sadikin Hospital, Faculty of Medicine
Universitas Padjadjaran
ABSTRACT
Introduction. Fracture management by the bone setter still the most popular treatment when
they had an injury after traffic accident, especially in West Java. They detect a fracture pattern
by their supranatural ability, then they performed reposition and immobilization by wood splint.
Methods. The descriptive study had been conducted to 68 persons between July 2014 until July
2015 whosecomplain pain and deformity in the lower leg suspected closed fracture in lower leg
by traffic accident. The tibial component measured by the distance from knee joint line to lateral
maleolus after reduction.
Result. Result of this research showed 28 persons (41,2%) suffered discrepancy more than 2 cm
and 14 person (20,5%) suffered discrepancy 2 cm compared with unaffected side.Seven persons
have similar length compared with unaffected side before treatment, after the treatment five
persons had shorter size.
Conlcusion. The conclusion of this research were the reposition performed by bone setter is
inadequate. It will emerge a back pain, gait disturbance, and osteoarthritis in the future.
Keywords: Bone setter, Tibial component
25
FP2.1.
COMPARATIVE FUNCTIONAL OUTCOME BETWEEN
VOLAR PLATE AND PERCUTANEOUS PINNING IN TREATMENT OF
FRACTURE OF THE DISTAL RADIUS EXTRA ARTICULAR
Salman Al Wahaby
ABSTRACT
Introduction. Distal radius fracture is one of the most frequent injury of upper extremity fracture in
orthopedic department. Even distal radius fracture happens frequently, the best method for
treatment is still a debate. There are many choice of technique to treat this fracture including
percutaneous pinning and open reduction internal fixation using volar plate. This study aimed to
evaluate and to compare the functional outcome of these two techniques in treating distal radius
fracture.
Method. This is a retrospective longitudinal study presenting 21 patient who underwent the
application of volar plate and 15 patients with percutaneous pinning during September 2012 September 2014. Data is then processed using Mann-Whitney test.
Results. The mean of QuickDASH score of patients treated with application of volar plate is 7.9 with
standard deviation 3.638, and mean of Quick DASH score of patients treated with percutaneous
pinning is 9.8 with standard deviation 2.806. The result of non-parametric statistic test using MannWhitney is p = 0.135. Functional outcome of patients treated in using volar plate has slightly
higher score compared to percutaneous pinning, which could happen because volar plates give a
more rigid fixation to the fracture segment.
Conclusion. The statistic analysis shows no significant difference between the functional outcome of
patients treated using volar plate or percutaneous pinning.
Keywords:distal radius fracture, volar plate, percutaneous pinning, quickDASH score.
FP2.2.
LONG TERM OUTCOME USING MASSIVE ALLOGRAFT IN
THE BONE TUMOR RECONSTRUCTION
Aries Rakhmat Hidayat *, Mouly Edward **, Ferdiansyah ***
*Resident of Orthopaedic & Traumatology Department, Airlangga University / Dr. Soetomo General
Hospital, Surabaya
** Staff of Musculoskeletal Tumor Division, Orthopaedic & Traumatology Department, Airlangga
University / Dr. Soetomo General Hospital, Surabaya
*** Head of Musculoskeletal Tumor Division, Orthopaedic & Traumatology Department, Airlangga
University / Dr. Soetomo General Hospital, Surabaya
ABSTRACT
Introduction.As the development ofmedical science,modalitiesforreconstruction ofbone defects in
musculoskeletal
tumor
are
alsoavailableso
that
morelimbscan
be
salvaged.
Eachmodalityreconstructionhasits
own
problemsanddifferentclinicaloutcomes.
Massiveboneallograftshave long been usedas natural resources forbone defect reconstruction. This
study
wasto
determine
outcome
ofsurgeryin
patientswhoreceivedmassiveallograftsurgeryinSurabaya.
Method.This retrospective study was performed on patients with benign aggressive and malignant
bone tumors underwent limb reconstruction with massive allograft between 2000 and 2013 in
Surabaya, Indonesia. The data was collected from patient files, clinical notes, radiographs and recent
physical examinations, objectively evaluated by MSTS-ISOLS score. Fracture of allograft, nonunion,
infection, resorption, infection, osteoarthritis, and tumor recurrent were recorded as complications.
Result.Total case are 62 patients, but only 40 patients can be evaluated, consist of 17 males and 23
females. The mean age of patients is 22 years. There were 7 (18%) patients with complications
recorded; those were allograft fracture (28,5%), and also nonunion, infection, resorption, infection,
osteoarthritis, and tumor recurrent (14,3% for each). Most complications are allograft fractures and
mostly occurred in lower extremity reconstruction cases.
Conclusion.Massive allograft replacement for bone defect caused by bone tumors remains as an
option with good results and some following complications recorded. To avoid complications better
fixation is recommended. An optimum sterility and graft processing procedure is mandatory.
Keywords: Bone tumors, massive allograft, limb reconstruction
FP2.3.
COMPARISSON FUNCTIONAL OUTCOME OF THE KNEE
BETWEEN SEMITENDINOSUS GRAFT AND COMBINED GRAFT
(SEMITENDINOSUS AND GRACILIS GRAFT) IN ANTERIOR
CRUCIATE LIGAMENT RECONSTRUCTION BY USING KOOS AND
TEGNER LYSHOLM KNEE SCORING SCALE. A SERIAL CASE
Putu Feryawan Meregawa *, IGN Wien Aryana **
*Orthopaedic and Traumatology Resident, Udayana University, Sanglah General Hospital, Denpasar
**Orthopaedic and Traumatology Staff, Udayana University, Sanglah General Hospital, Denpasar
ABSTRACT
Introduction. Nowadays, reconstruction in Anterior Cruciate ligament injury became change very
faster. It is caused by many research has found a new things for the best treatment and the
technology has grew up unpredictable. As we know, the most common graft is used for the
reconstruction of Anterior Cruciate ligament injury are semitendinosus graft and combined graft
(semitendinosus with gracilis graft). So we need to know, how are the functional outcome of the
knee after had the reconstruction with both of the grafts.
Methods. We reported six patients. Three patients, cases diagnosed with rupture Anterior Cruciate
ligament. Those patients are treated by Arthroscopy (reconstruction with combined of
semitendinosus - gracilis grafts) on January 2015. And the other of three patients, cases diagnosed
with rupture of Anterior Cruciate ligament. Then patients are treated by Arthroscopy (reconstruction
with semitendinosus graft) on January 2015. Those six patients had treated by Arthroscopy
reconstruction. And we had evaluated functional outcome of the knee of those six patients with
Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner Lysholm Knee Scoring Scale.
Result. We had the result that the KOOS and Tegner Lysholm Knee Scoring Scale of the three
patients who had used Semitendinosus graft is more than 90% (excellent) and for the other three
patients who used combined graft (Semitendinosus and Gracilis graft) is more than 90% (excellent).
Those patients can did daily activities very greatfully including did some exercise, such us walking,
running, squatting, jumping, twisting, cycling, and kneeling.
Conclusion. There is no different result of functional outcome of the knee between Anterior Cruciate
ligament reconstruction which used the semitendinosus graft with combined semitendinosus and
gracilis graft in Anterior Cruciate ligament injury.
Keywords: Anterior Cruciate Ligament Injury, Semitendinosus Graft, Semitendinosus and Gracilis
Graft, Functional Outcome of The Knee, KOOS and Tegner Lysholm Knee Scoring Scale
FP2.4.
SCREW REMOVAL EFFECT ANALYSIS ON DELAYED UNION
AFTER INTERLOCKING INTRAMEDULLARY NAILING IN TIBIAL
DIAPHYSEAL FRACTURE
RisqiTazlianshahTuahuns
ABSTRACT
Introduction. Delayed union of tibial diaphyseal fracture after interlocking intramedullary nailing is a
common problem. There are many methods of delayed tibial diaphyseal fracture management, one
of them is removal of screw or dynamization. The purpose of this study is to know the effect of
screw removal after interlocking intramedullary nail on delayed union tibial diaphyseal fracture.
Methods. This retrospective cross sectional study is underwent with 24 samples of patients who had
previously been treated with interlocking intramedullary nail and is now treated with screw removal
or dynamization with or without iliac bone graft. Bone healing is then evaluated using the Callus
index assessed through serial plain radiographs each 6 weeks.
Result. Radiological evaluation shown screw removal on interlocking intramedullary solid nail cases
results in an union rate of 95.8%. Among 24 patients, only one patient had nonunion. There is
significant time lapse difference on bone healing of patients with additional bone graft. Fracture
location did not affect the duration of bone healing. There is no significant complication.Screw
removal of interlocking intramedullary nail on delayed union of tibial diaphyseal fracture going to
induce solid union. Bone graft increased the bone healing process.
Conclusion. Screw removal procedure of interlocking intramedullary nail is a procedure of choice
that results in satisfactory union rate.
Keywords:Delayed union, tibial diaphyseal fracture, Interlocking Intramedullary Nail, Bone Graft
FP2.5.
SOFT TISSUE RELEASE (POSTEROMEDIAL APPROACH)
AND TENDON LENGTHENING FOR RIGID TYPE CLUBFOOT
Ichsan Fahmi*, Hafas Hanafiah**, Iman Dwi winanto**
*Resident of Orthopaedic & Traumatology Department of Medical Faculty of University North of
Sumatera
**Staf of Orthopaedic & Traumatology Departement of Medical Faculty of University North of
Sumatera
ABSTRACT
Introduction. The clubfoot also called congenital talipes equinovarus (CTEV), is a congenital
deformity involving one foot or both that unclear etiology. Most of the cases present in neglected
status or did not get adequate treatment especially in conservative treatment in early months of
birth (stretching, casting and bracing are not enough to correct a child's clubfoot). Surgery may be
needed to adjust the tendons, ligaments and joints in the foot/ankle and usually corrects all clubfoot
deformities at the same time.
Methods. There are three patients with rigid type clubfoot was underwent softtissue release for
correction the deformity. The first female 1 year old with unilateral clubfoot and the other patient
male 2 years old with bilateral clubfoot. All of them was performed soft tissue release and casting
for 6 weeks after operative treatment and then use ponseti brace 23 hours a day for 3 months, and
ponsetti brace at night for 1 years. The soft tissue release (posteromedial) is operative treatment by
capsulectomy joint of talotibia, subtalar joint and talonavicular joint, lengthening achilles tendon,
posterior tibialis tendon, Flexor digitorum longus tendon and flexor hallucis longus tendon.
Result.All of patients had good correction the deformity and can walk after 3 month, no recurrence
was found. The child have more better foot than before. He or she can run and play without pain
and wear normal shoes.
Conclusion.Soft tissue release (Posteromedial) is one of the treatment of choice for the rigid type of
clubfoot and have good result. The child have more better foot than before. The corrected clubfoot
will still not be perfect, however; a clubfoot usually stays 1 to 1½ sizes smaller and somewhat less
mobile than a normal foot. The calf muscles in a leg with a clubfoot will also stay smaller.
Keywords:Rigid type Clubfoot, Soft tissue release
FP2.6.
OUTCOME OF THE USE OF SYNTHETIC BONEGRAFT IN
CASE OF FRACTURES INMOEWARDI HOSPITAL SURAKARTA
JANUARY 2013 – MAY 2015 ( RETROSPECTIVE STUDY)
Anggita T. Yurisworo*, Bintang Soetjahjo**
*Resident of Orthopaedic & Traumatology, Faculty of Medicine Sebelas Maret University
**Department of Orthopaedic & Traumatology, Faculty of Medicine Sebelas Maret University – Dr.
Moewardi General Hospital / Prof Dr R. Soeharso Orthopaedic Hospital Surakarta
ABSTRACT
Introduction.Nowadays, musculoskeletal diseases, fractures are a common problem in health care
centers. Direct and high energy trauma or other bone pathology processes can result in fracture.
Bonegraft that use synthetic biomaterials/bonegraft substitute (calcium sulfate and synthetic
hydroxyapatite) currently used by orthopedic surgeons. The good bonegraft can stimulate bone
growth as well as have the nature of osteoconductive, osteoinductive, and osteogenic. The aim of
this study is to evaluate the results of the use of synthetic bonegraft (calcium sulfate and synthetic
hydroxyapatite) in case of fractures in Dr. Moewardi General Hospital.
Methods.A retrospective study of patients whom admitted to Dr. Moewardi Hospital with both open
and close fractures that were treated operatively with synthetic bonegraft (calcium sulfate and
synthetic hydroxyapatite) between January 2013 until May 2015. The study was made by taking the
patient's data and evaluated based on gender, age, the type of fracture, the region of fracture and
the radiological outcome were assessed within a period of at least 3 months after the surgery, and
no later than 8 months after surgery.
Results.A total of 22 patients have been analyzed and studied, there were 10 females (45%) and 12
males (55%). Most cases found in the age group of 40-60 years, which is 10 patients (45%). The
region that affected the most were lower extremities with 19 patients (86%) while in upper
extremity fractures are 3 patients(14%). The most of case are closed fracture, as many as 15 patients
(68%),with radiological results showed nonunion in 1 patient (7%) and 14 patients (83%) had union
outcome. While in open fractures are 7 patients (32%), obtained 2 patients (29%) suffered nonunion and 5 patients (71%) had union outcome. The non union on 3 patients are complication due to
osteomyelitis.
Conclusions.In this study, we conclude that the operative treatment using synthetic bonegraft as an
osteoconductive (calcium sulfate and synthetic hydroxyapatite) for the treatment of fractures in Dr.
Moewardi General Hospital, has a quite satisfactory results with total union rates is 86% (19
patients) and the nonunion rates is 14% (3 patients). The use of synthetic bonegraft is a good choice
therapy in the case of both open and close fractures.
Keywords:Fracture, Synthetic Bone Graft, Moewardi Hospital
FP2.7.
ASSOCIATION OF PONSETI SERIAL CASTING OUTCOME
BETWEEN AGE, CLASSIFICATION, TYPE, AND HISTORY FAMILY OF
CLUBFOOT PATIENT IN HASAN SADIKIN HOSPITAL
Rachman Y F, Ismiarto Y D, Rasyid H N, Alfarian G T
Bagian / SMF Orthopaedi FK UNPAD / RS Hasan SadikinBandung
ABSTRACT
Introduction. Congenital Talipes Equinovarus (CTEV) or clubfoot is a congenital disease that
commonly found in orthopaedic practice. This disorder are easy to diagnosed but has difficulty on
therapy adequately by an expert. It comprises of foot adduction and supination of forefoot, heel
varus on subtalar joint, equinus on ankle joint. Clubfoot are commonly found on Hasan Sadikin
hospital, managed and corrected by ponseti serial casting. There are many factor that influenced the
outcome of therapy that consist of age, classification, clubfoot type and genetic.
Objective. The purpose of this research is to know the association of outcome ponseti serial casting
between the factors that influence of clubfoot patient on Hasan Sadikin hospital.
Methods. This retrospective stude are done on January 2010 between January 2015. The total
patients are 110 from outpatient and inpatient ward.
Results. Patients amount are 110 that consist of 174 foot. boys 58 and girls 52. The youngest age
was 2 days and the oldest is 12 years old. Corrrection of deformity was success with Ponseti
methode in 88 patients (80%), and 22 patients (20%) other have to performed Postero Medial
Released operation for correct the deformity. Based on age, best result came from patient 0-6
month old group at the first time get treatment.(98,5%). Based on classification, 92 patients
idiophatic type (92,4%) can be corrected. Based on Clubfoot type, 87 patients with flexible type
(92,6%) can be corrected. And based on genetic factors, 71 patients (81,6%) without family history of
clubfoot can be corrected.
Conclusion. Conservative therapy with Ponseti casting showed good result on most patient. Fair
results were found due to late therapy. Syndromic and rigid clubfoot are type that commonly found
with failure of therapy. But genetic factor are less contribute to outcome.
Keywords: club foot, seral casting, Postero-medial release.
FP2.8.
CORRELATION BETWEEN SAGITTAL BALANCE WITH
QUALITY OF LIFE ON PATIENTS AFTER POSTERIOR INTERBODY
FUSION
Hantonius, Ramdan A. , Tiksnadi B.
Department of Orthopaedic and Traumatology, Universitas Padjajaran/ Dr. Hasan Sadikin Hospital,
Bandung
ABSTRACT
Introduction. The sagittal balance analysis has gain importance in surgery of the spine. With the
increasing used of vertebral fusion, these effects on sagittal balance are related to the locked
position of the fused vertebrae. Clinical evidence has indicated that if fusion surgery is undertaken,
improved outcome can be achieved by correcting any sagittal deformity present. Some studies has
show the correlation of spinopelvic paramaters with health related quality of life and pain measures.
Methods. This study was done retrospectively. The data was taken from medical record within range
of time from July 2013 – July 2015. There were44 eligible patients with post posterior interbody
fusión of vertebrae in Dr Hasan Sadikin Hospital Bandung. The main outcome is the measure of
radiographic pelvic and spinal parameters for sagittal balance analysis and the healthed related
quality of life measured by Oswerty Disability Index (ODI) and Visual Analoque Pain Scores (VAS).
Results. Patients with improvement of sagittal spinopelvic parameters after fusion are 35 people
(79,5%) have average ODI 50.85 and average VAS 5.25 preoperatively, and these improved to
average ODI 25.54 and average VAS 2.34 post operatively. Patients without improvement of sagittal
spinopelvic parameters after fusion are 9 people (20,5%) have average ODI 52.22 and average VAS
5.66 preoperatively, and these improved to average ODI 31.55 and average VAS 3.33 post
operatively.
Conclusion. It may be concluded that patients with improvement of sagittal spinopelvic parameters
after fusion were found to have a better heath related quality of life. It is important to quantify
sagittal spinopelvic parameters and promote sagittal balance when performing vertebral fusion.
Keywords:Sagittal balance, Vertebral fusion, Health related quality of life
FP2.9.
CORRELATION BETWEEN ENVIRONMENTALFACTORS
WITH LONGBONEFRACTUREINCHILDRENTREATED INHASAN
SADIKIN HOSPITALPERIODJANUARY2013-DECEMBER2014
Arif Y P , Ismiarto Y D
Department of Orthopaedic and Traumatology, Medical Faculty Padjadjaran University/ DR Hasan
Sadikin Hospital, Bandung
ABSTRACT
Introduction. Fractures can occur at any age, including children. An increase in the incidence of
fractures in children with increasing mobility in highways, sports activities, recreation and home
environments. Long bone fractures are of particular concern because of the presence of the growth
plate that contributed to the growth of children. This study aims to determine the relationship
between environmental factors with long bone fractures in children treated in Dr Hasan Sadikin.
Methods. The study was conducted retrospectively in the period January 1, 2013 until December 31,
2014. Data derived primarily from the Medical Records department of Dr. Hasan Sadikin the number
of children treated patients as much as 156 people. Data processed descriptively that include
gender, age group, long bone fracture, and the environment in which the injury occurred.
Results. During the study period found patients with the highest gender is male with a number of 57
persons (58.8%), the age group 11-15 years are the age group with the highest number of 55
(59.7%), long bones most fractured femur was 47 cases (48.4%). The house is the most risky
environment for the occurrence of fractures in infants under 2 years of age. Children above 11 years
of age at risk of fracture in sports facilities and highways.
Conclusion. There is a significant correlation between environmental factors with age children who
suffered fractures.
Keywords: long bone fracture, paediatric, environtment factors
FP2.10. OUTCOME HEMIARTHROPLASTY BIPOLAR VS TOTAL HIP
ARTHROPLASTY FOR DISPLACED FEMORAL NECK FRACTURE IN
ELDERLY
Othdeh Samuel Halomoan Siahaan*; Bambang N**;Jamot S**
*Orthopaedic resident in University of Indonesia, Cipto Mangunkusumo Hospital
**Orthopaedic consultant in Orthopaedic Department, Fatmawati Hospital
Introduction. Displaced fracture of the femoral neck has been a common clinical problem, especially
in aged patients. Orthopaedic surgeons vary in their management of displaced intracapsular
fractures of the hip in healthy older patients. Therefore the optimal treatment choice remains
controversial. The purpose of this study is to compare the functional outcome between
Hemiarthroplasty bipolar with Total Hip replacement using Harris Hip score
Methods. five patient from 67 to 80 years old patient had an Total Hip Replacement (THR) and five
patient from 67 to 72 years old patient had Hemiarthroplasty bipolar ( HA) performed by senior
surgeon. ten patient were available for follow-up (average, 12 months) and patient were evaluated
using the Haris Hip Score (0-100 points).Displaced femoral neck fracture were defined as type III and
IV according to Garden Classification.
Result. The mean score for pain in THR group is 38.8 and 32 in HA group. The mean functional
outcomes 36.8 in THR group and 35.2 in HA group. The mean absence of deformity 5.6 in THR group
and 4 in HA group. The mean range of motion ( ROM ) 5.6 in THR group and 4.8 in HA group. The
mean total haris hip score is 86.8 in THR group compare 76 in HA group. The comparison of pain
score between THR and HA group are not significant ( with p = 0.058) 95% CI (-0.285 to 13.885 ). The
comparison of function score between THR and HA group are not significant ( with p = 0.490) 95% CI
(-3.494 to 6.694). The comparison of absence deformity score between THR and HA group are not
significant ( with p = 0.141) 95% CI (-0.659 to 3.859 ). The comparison of ROM score between THR
and HA group are not significant ( with p = 0.545) 95% CI (-2.117 to 3.717) . The comparison of total
harris hip score between THR and HA group are significant ( with p = 0.005) 95% CI (-6.779 to 14.821
).
Conclusion. Functional outcome using Harris Hip Score were better in the THR patient group
compare to Bipolar Hemiarthroplasty group, for displaced femoral neck fracture in elderly. Even
though there is a higher rate of dislocation THR, this disadvantage could be accounted for, on the
basis of a better functional score and the lower revision rate
Keywords: displaced femoral
Hemiarthroplasty,Harris Hip Score
neck
fracture
elderly,Total
Hip
Replacement,
Bipolar
FP2.11. STUDIES ON GENE EXPRESSIONS AT THE RNA LEVEL
ASSOCIATED WITH FIBROSARCOMA CASES IN JAMBI
Humaryanto*, M. Nurhalim Shahib**
*Faculty of Medicine & Health Study, Jambi University, Indonesia
**Department of Biochemistry and Molecular Biology, Faculty of Medicine, Padjadjaran University,
Bandung, Indonesia.
ABSTRACT
Introduction. Fibrosarcoma, is a rare soft tissue sarcoma, reported only 1-3% of all soft tissue
sarcomas. It is like other soft-tissue sarcomas, has no definite cause. Recognized causes include
exposure Ionizing radiation, various physical and chemical factors, infection with Human Herpes
Virus (HHV8) and Epstein–Barr virus (EBV). Current research indicates that many sarcomas are
associated with genetic mutations.
Methods. In this study, we investigated relationship of regulation of gene expression KLF4, MDM2
and C-Myc at level of RNA in fibrosarcoma cases. The genes expression was examined using
quantitative Real Time PCR (qRT-PCR) and we analyzed the relative gene expression using the 2-ΔΔCt
method). Ten samples of fibrosarcoma cases in Jambi city, from 2011 till 2015. The order of three
targeting genes was placed ini the order from lowest to highest base on their Ct values compared to
internal control genes using GAPDH genes.
Result. There are, respectively, MDM2 1.85 ± 2.14, KLF-4 2.06 ± 3.86, dan C-Myc 2.9 ± 2.66. A
relative quantification by normalized target gene relative to GAPDH, describes the changes in
expression of three genes, the status of MDM2 and KLF-4 were relatively decreased expression by 2
fold, and the states of C-Myc were relatively decreased by more than 3 fold.
Conclusion. This suggest that the C-Myc gene were suppressed stonger than those MDM2 and KLF-4
gene in fibrosarcoma.
Keywords: fibrosarcoma – relative gene expression – MDM2 – KLF-4 – C-Myc
FP2.12. EPIDEMIOLOGY STUDY OF ELBOW FRACTURES IN
CHILDREN AT SAIFUL ANWAR GENERAL HOSPITAL MALANG,
JUNE 2009 – JUNE 2015
Hamka Aditya Erlangga**, Panji Sananta*
*Department of Paediatric Orthopaedics & Traumatology Brawijaya University
**Resident of Orthopaedics & Traumatology Brawijaya University
ABSTRACT
Introduction. The frequency, incidence, and type of fracture of the elbow differ between children
and adult. The epidemiology of elbow fractures in children has to our knowledge been the subject
only a limited number of studies. This is a study of the pattern of elbow fractures in children under
14 years of age, during a 6-year period.
Methods. All elbow fractures in children aged under 14 years treated in Saiful Anwar General
Hospital Malang, in the period of June 2009 to June 2015, were included. Personal data, age at the
time of accident, fracture site, type of lesion and ipsilateral injuries, time of accident and the
mechanism of injury were collected and analyzed from medical records.
Results. There were 124 elbow fractures, and there were 84 boys (67,7%) and 40 girls (32,3%). The
mean age for the entire group was 7.3 years (for boys, 8,1 years; for girls, 7,1 years). Most cases is
supracondylar fracture (79%). From 74 supracondylar fractures (including 7 combination fractures), 7
were type I, 17 were type II, and 50 were type III (as classified by Gartland). The most common
causes of fracture were related to sports and leisure activities, or a fall from the same level, or a fall
from a height less than 2m. Nerve injuries involving the median, radial, and ulnar nerves were seen
in 7 patients with type III supracondylar fractures. Associated brachial artery injuries were seen in 4
patients, with type III supracondylar fractures. Ninety seven fractures (78,2%) were treated
operatively, 18 fractures (14,5%) nonoperatively and 9 fractures (7,2%) were refused to be treated.
Conclusion. The incidence of elbow fracture in children treated in Saiful Anwar General Hospital
during 6-year period is 124 patients, with the most common type is supracondyler fracture, Gartland
III extension type. Among distribution, boys more common than girls. Nerve injury were seen 5,6%
and brachial artery injury were seen 3,2% with type III supracondyler fracture. Most of elbow
fracture were treated operatively.
Keywords Children · Elbow fracture pattern
FP2.13.
EPIDEMIOLOGY OF PHYSEAL PLATE FRACTURE AT
SANGLAH HOSPITAL EMERGENCY UNIT IN 2014
Permana, Endi*; Kawiyana, Siki I Ketut**.
* Orthopaedic and Traumatology Resident of Udayana University, Sanglah Hospital Denpasar
**Teaching Staff of Orthopaedic and Traumatology of Udayana University, Sanglah Hospital
Denpasar
ABSTRACT
Introduction. The key difference between the child's bone and that of an adult is the presence of a
physis. Physeal injuries are very common in children, making up 15-30% of all bony injuries. One
consequence of trauma was fracture. Fracture type was influenced by age and mechanism of injury.
There were several fracture type that more common on particular age group and several fracture
type that more often caused by particular mechanism of injury.
Objective. This study purpose to know epidemiology of Physeal Plate fracture at Sanglah Hospital
Emergency Unit in 2014.
Methods. This study was descriptive retrospective and held in Sanglah Hospital. Data was achieved
from patient’s data that had treatment at Sanglah Hospital Emergency Unit in 2014.
Results. In 2014, there were total 995 Trauma case at Sanglah Hospital Emergency Unit, and 60 of
them are Physeal plate fracture. Most of patient age was 12 years old, occured at age of 1-18 years
old. With most affected region is distal radius, most of them is boys 76.7%, 90% cases are closed
fracture. And the majority of physieal fracture type is Salter Harris type II 80%.
Conclusion. There were several fracture type that more common at particular age group. That was
caused by difference on mechanism of injury and difference on bone’s strength between age group.
Keywords: Epidemiology, fracture, Sanglah, epyphysis
FP2.14. SURVEY OF PHYSEAL CLOSURE AGE OF THE DISTAL
RADIAL PHYSIS ON ADOLESCENCE TRAFFIC ACCIDENTS VICTIMS
ADMITTED TO EMERGENCY DEPARTMENT DR. HASAN SADIKIN
GENERAL HOSPITAL FROM JANUARY 2012 TO SEPTEMBER 2015
Suprapto D, Herman H, YD Ismiarto, Rasyid HN
Orthopaedi and Traumatologi Department Faculty of Medicine Padjadjaran University/ Dr. Hasan
Sadikin Hospital Bandung West Java Indonesia
ABSTRACT
Introduction. Age estimation is an important task and valuable tool to assist in many civil and
criminal procedures such in establishing liability in accidents. 17 is the age where adolescent is liable
for wrongdoing. This is especially crucial in the developing countries such as Indonesia where some
population are not aware of the importance of registration of births or the record of registration
may not be properly maintained. Physical methods for age estimation are not accurate and eruption
of the teeth (except third molar) is already completed by the age of 16 years. Alternative method to
validate and approximate age is hence needed. The purpose of the study is to survey the physeal
closure stage of adolescent accidents victims and relate them to their chronological age.We aimed at
identifying age range of each stage, specifically identifying the stage that correlate with legal age of
17 or older, hence liable as adult.
Methods. Epiphyseal fusion of long bones is relatively constant in timings and important for age
estimation in such cases up to the age of 22 years. This present retrospective study with an attempt
to study physeal closure age of the distal radial physis on adolescenceby using anteroposterior wrist
joint x-ray in the age-group of 13-22 years among traffic accidents victimsduring January 2012 September 2015 at Emergency Department of Orthopaedic and Traumatology Department Dr.
Hasan Sadikin General Hospital Bandung. Physeal closure stage is according to Radiographic Atlas of
Skeletal Development of the Hand and Wrist. We grouped stage I and II as open physis, and stage III
and IV as closed physis. Distribution of physeal closure stage, open and closed physis is presented as
Histogram.
Result. Female gender is severely under represented in our survey (40,81%), this represents the low
incidents of female involvement in traffic accidents. Main age of victims are 18. We found that stage
+++ correlate with age 18 or older.Stage ++ correlate with age 17-19.Stage + correlate with age 1316.
Conclusion. The distal radial physis closure processes and progresses, begins at the age of 13-14
years and completes by the end of 20 years and female show closure in advance of male subjects.
We assume someone as adult if their physeal stage is +++ or at least ++, any victims with stage + are
still under 17.
Keywords : physeal closure, distal radial physis, legal age determination
FP2.15. CHARATERISTIC PATIENT WITH OSTEOSARCOMA AT
EXTREMITY IN HASAN SADIKIN HOSPITAL BANDUNG JANUARY
2014 – DECEMBER 2014
Sitanggang G L, Ismiarto Y. D.
Department Of Orthopaedi and Traumatologi, Medical Faculty Of Padjadjaran University / Hasan
Sadikin Hospital, Bandung
ABSTRACT
Introduction. Osteosarcoma is a primary malignant bone tumor during childhood and adolescence,
common at 10th – 20th decade of age. Direct spreading arises through periosteoum and surrounding
tissues. The tumor is mostly found at the metaphysis of the long bone. Medical treatment of
Osteosarcoma had a lot of advancement, including radiotheraphy, cemotheraphy, surgery and
combined therapy. The purpose of this study is to report patients with osteosarcoma who have been
treated with limb salvage procedure in Hasan Sadikin Hospital in 2014.
Method. This is a retrospective study. Documents were taken from hospital’s medical record starting
from January 2014 to December 2014, where 121 patients with Osteosarcoma of extremity treated
in Hasan Sadikin Hospital were taken for sample.
Result. Patients with Osteosarcoma at extremity in Hasan Sadikin Hospital documented according
the location of tumor are as mentioned : Femur (30,5%), tibia &fibula (25,6%), humerus (9,9%),
radius & ulna (11%), others (24,8%). Based on Enneking classificationare as mentioned : Stage 1A
(19%), 1B (11,5%0, 2A (9,1%), 2B (14,2%), 3A (18%) and 3B (18,2%). The patients were treated by
limb salvage procedure (69,4%) and amputation (30,6%)
Conclusion. The numbers of patients with Osteosarcoma at extremity in Hasan Sadikin Hospital
treated by limb salvage are more than the patients treated with amputation. Long time follow up is
needed to diagnosed recurrency or any spreading to other organs.
Keywords: Osteosarcoma, Limb Salvage
FP2.16. CHARACTERISTIC OF THE MUSCULOSKELETAL COMPLAIN
ON THE SYNDROME LUPUS ERYMATHOSUS PATIENT IN DR.
HASAN SADIKIN HOSPITAL BANDUNG FROM JANUARY 2012 –
DECEMBER 2013
Priono B.H., Ismiarto Y.D.
Department of Orthopaedic and Traumatology, Medical FacultyPadjadjaranUniversity / DR. Hasan
Sadikin Hospital, Bandung
ABSTRACT
Introduction. Systemic Lupus Erymatosus is prtotype of multisystem autoimune disease with wide
symptom, that affected almost all tissue, including musculosceletal system. The symptom of lupus
usually complain for more than six weeks until few years. This disorder causes inflamation, pain and
impact the body.
Methods. This study was done retrospectively, with in range of time from January 2012 – December
2013, with used samples were 206 eligible patients with syndrome lupus erymathosus admitted to
Dr Hasan Sadikin Hospital Bandung. Amounts of patient with systemic lupus erymathosus that
comes to DR. HasanSadikin Hospital with musculoskeletal complain is so various in numbers and
kinds, these paper will describe the characteristic.
Results. From the result we get females (186) as the highest incident in Syndrome Lupus
Erymathosus, compare with males (20). Amount of patient with Syndrome Lupus Erymathosus are
same likely in all age. Mayority of the patient is complain about arthritis (164).
Conclusion. Female has the highest incident of Syndrome Lupus Erythemathosus.
Keywords : Musculosceletal, Syndrome Lupus Erymathosus
FP2.17. MUSCULOSKELETAL INVOLVEMENT IN THALASSEMIA
AND HEMOPHILIA PATIENT IN DR. HASAN SADIKIN HOSPITAL
BANDUNG FROM JANUARY 2012 – OCTOBER 2014
Fajar Adam, Ismiarto Y.D.
Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Padjajaran/ Dr.
Hasan Sadikin Hospital, Bandung
ABSTRACT
Introduction. There are 2 types of congenital blood disorder that often cause problems in
musculoskeletal system. Many thalassemia’s suffer from longstanding bone disease, reduced or low
bone mass, pathological fractures and bone pain. Patients with severe haemophilia are at risk of
musculoskeletal problems, that consist of haemarthrosis, recurrent bleeding dan synovitis,
pseudotumor, and hemophilic arthropathy.
Objective. To describe the patient characteristics and distributions according to sex, age, types of
thalassemia and hemophilia, and musculoskeletal involvement that appears in thalassemia and
hemophilia patients.
Method. This studywas done retrospectively. The data taken from medical recordwithinrange of
time fromJanuary 2012 – October 2014, with used samples were 270medical record with
thalassemia and 229 medical record with hemophilia admitted to Dr Hasan Sadikin Hospital
Bandung
Result. From the result we get thatmost of the thalassemia patient admitted in Dr. HasanSadikin
Hospital are male (50,74%). The age between 0-9 years old is the most frequent group of
thalassemia patient (55.95%). Beta-thalassemia is the highest incidence (81.11%), with bone pain is
the main problem involved in musculoskeletal system (33.70%).Most of hemophilia patient are male
(74.24%). The age between 0-9 years old is the most frequent group of hemophilia patient (55.11%).
Hemophilia A is the highest incidence (45.42%), with hemarthrosis is the most musculoskeletal
involvement in hemophilia patient (26.64%).
Conclusion. The main musculoskeletal involvement in thalassemia patients is bone pain. The most
musculoskeletal involvement in hemophilia patient ishemarthrosis.
Keywords: Thalassemia, Hemophilia, Musculoskeletal
FP2.18. ANTIBIOTIC SUSCEPTIBILITY AND BACTERIAL PATTERNIN
PATIENTS WITH OPEN FRACTURE OF LOWER EXTREMITY
GUSTILLO-ANDERSON CLASSIFICATION GRADE III: A
RETROSPECTIVE STUDY
Kurniawati A, Ismiarto YD
ABSTRACT
Introduction. Sixty percent of open fracture wounds are contaminated at the time of injuries. They
require immediate debridement and administration of initial antibiotic to prevent infection.
Antibiotic should be administered properly depend on the bacterial pattern and then adjusted based
on culture result. Cephazolin is the most frequently prescribed antibiotic in open fracture cases at
Dr. Hasan Sadikin Hospital, Bandung based on the bacterial pattern in the hospital. The aim of this
study is to analyze if Cefazoline effective as a prophylactic antibiotic for patients with open fracture
of lower extremity Gustillo-Anderson Classification grade IIIat Dr. Hasan Sadikin Hospital, Bandung.
Methods. Medical records from Dr. Hasan Sadikin Hospital, Bandung were used to identify all
patients diagnosed with with open fracture of lower extremity Gustillo-Anderson Classification grade
III during the period November 2013 to October 2014. We reviews the bacterial profile of the
infected wound and antibiotic resistance pattern of specimens.
Result. From 32 patients (aged 13-67 years), all samples showed bacterial growth. Eleven different
species of bacteria were isolated. Gram negative bacilli were more prevalent (65.1%) than gram
positive cocci (34.9%). Pseudomonas aeruginosa (42.9%) and Klebsiella pneumonia (24.3%) were the
most common organisms. All of the bacterial isolates were sensitive to Amikacin and Meropenem,
but resistant to Cephazolin.
Conclusion.Pseudomonas aeruginosa and Klebsiella pneumonia were the most common causes of
wound infections in patients with open fractures. All of the bacterial isolates were resistant to
cephazolin. It is should be considered whether we should change Cephazoline to Amikacin or
Meropenem as an antibiotic prophylactic.
Keywords: open fracture, infection, antibiotic prophylactic, bacterial pattern
FP2.19.
NEUTROPHIL-LYMPHOCYTE RATIO (NLR) IS ASSOCIATED
WITH FRACTURE HEALING PROCESS IN CHILDREN
Irasiqin Wibawanto S * , Ardhanis Ramadhanti * , M. Nadlir Fakhry * *
* Internship Doctor, RSUD Dr. H. Slamet Martodirdjo, Pamekasan, East Java, Indonesia
** Orthopaedic Dept, RSUD Dr. H. Slamet Martodirdjo, Pamekasan, East Java, Indonesia
ABSTRACT
Introduction. Neutrophil-lymphocyte ratio (NLR) has been studied extensively, it well known that
NLR has been suggested to be associated with systemic inflammation in cardiovascular disorder,
malignancies, hepatic cirrhosis and osteoporosis. However, the relation between NLR and fracture
inflammation remain unclear. Neutrophil has a dual role that is stimulate the inflammatory response
to induce healing process, but increased or prolonged inflammation impairs fracture healing
especially fractures that are accompanied by severe injury. In this study we determine the relation
between NLR with fracture type pre and post treatment.
Methods. A total 49 patients fracture in children, 28 patients with closed fracture and 21 patients
with open fracture were used. NLR was measured using laboratory result during pre-admission
followed by after operative procedure.
Results.Leukocyte and neutrophil was significantly increase in open fracture compare with closed
fracture, and it was reduced after operative procedure, while no significance change between closed
fracture pre-post operative procedure. Interestingly, there was no change on lymphocyte. New
injury severity score (NISS), injury severity score (ISS) and revised trauma score (RTS) were
significantly higher in open fracture compare with closed fracture. Our data suggested that NLR can
be used as an indicator for reducing inflammation and healing process. The higher level of NLR due
to increasing of neutrophil may associated with long period of bone healing process and worsening
of fracture.
Conclusions. This result gives preliminary information about the importance of fracture
management in children using NLR indicator. Taken together, it suggested that NLR may associated
with fracture healing process.
Keywords: Neutrophil-lymphocyte ratio (NLR), fracture, inflammation, healing process
FP2.20.
RESPONSIVENESS OF THE PIRANI SCORE IN NEGLECTED
CLUBFEET
Permana Yudhadibrata* Hafas Hanafiah** Iman Dwi Winanto**
*Resident of Orthopaedic & Traumatology Department Universitas Sumatera Utara
**Staff of Orthopaedic & Traumatology Department Universitas Sumatera Utara
ABSTRACT
Introduction. ANeglected clubfoot is a clubfoot that didn’t get early treatment at all or inadequate
early treatment and is a major problem in low and middle income countries. About 80% of children
with clubfeet are born in these countries and most of the children don’t have access to good health
care. The Pirani score reflects the severity of clubfeet but little is known about the responsiveness of
this scoring system in neglected cases.
Methods. Twenty five patients with neglected clubfeet were assessed before and after treatment.
Pre-and postoperative scores were analyzed with correlation coefficients and linear regression.
Results. The mean age at presentation was 66,1 month (6–192). The mean Total Pirani score before
operation was 4,66±1,13 (2-6). After the operation it was 1.88±0.88 (0-4) and the mean difference
between pre and postop was 2.78±0.63 (4 to 2) p <0.001.
As expected the Pirani score is higher in older children both before (r=0.67) and after treatment
(r=0.85). The change in score is not related to age but only to the preoperative Pirani score using
both uni- and multivariate linear regression.
Conclusion. The Pirani score decreased after treatment of neglected clubfeet in all cases between 2
and 4 points (mean 2.78 points) and seems to be also valuable in neglected clubfeet.
Keywords: Neglected clubfoot, Pirani Score, Operative Treatment
FP2.21. METHYLPREDNISOLONE INTRALESIONAL INJECTION FOR
THE TREATMENT OF ANEURISMAL BONE CYST IN CHILDREN AND
ADOLESCENTS: SERIAL CASES
Achmad Ali Sidiq*, Istan Irmansyah Irsan**, Satria Pandu Persada Isma**
* Orthopedic & Traumatology Resident of Brawijaya University, Saiful Anwar General Hospital
Malang
** Oncology Orthopedic Consultant, Orthopedic & Traumatology Surgeon of Brawijaya University,
Saiful Anwar General Hospital Malang
ABSTRACT
Introduction. An aneurismal bone cyst (ABC) is a benign, locally proliferative vascular disorder of
non-neoplastic oseous lesions in children and young adults. Seventy-five percent of ABCs occur
before the age of 20 years. They comprise 1.4% of all primary bone tumors, and commonly occur in
the long bones. We report 3 such patients who presented with limping gait and pain in their lower
extremities. They underwent 3 times intralesional injection of steroid (methylprednisolone).
Objective. To assess the benefits of intralesion steroid injection for the treatment of aneurismal
bone cyst.
Methods. Three patients with ABC of long bones, two located in the proximal femur and one in
proximal tibia, were treated percutaneously with intralesional injection of methylprednisolone. All
patients were adolescents with ages varying from 10 to 20 years. All of them presented with pain
and mass in lower extremities.
Results. Clinical follow up with pain and gait evaluation showed an improvement of the gait and
reduction of the pain with VAS method. Imaging follow up with plain films showed volume reduction
of all lesions.
Conclusion. Intralesional injection of methylprednisolone is a safe treatment option for ABC. The CT
scan is especially valuable as a good tool for the follow-up of ossification of the treated ABCs. The
other alternative is clinical outcome and plain films.
Keywords: Aneurismal Bone Cyst (ABC), primary bone tumor, intralesional injection,
methylprednisolone.
FP2.22. POST OPERATIVE SHOULDER FUNCTIONAL
COMPARATION BETWEEN OPEN ACROMIOPLASTY AND
ARTHROSCOPY FOR SHOULDER IMPINGEMEN SYNDROME
PATIENTS IN SURABAYA
Moch Fathoni Arief R*, Erwin Ramawan**
*Resident of Orthopaedic & Traumatology Department, Airlangga University / Dr. Soetomo General
Hospital, Surabaya
**Staff of Upper Extremity Division, Orthopaedic & Traumatology Department, Airlangga University /
Dr. Soetomo General Hospital, Surabaya
ABSTRACT
Introduction. Shoulder pain is a common disease that complained by most of people, with the result
of shoulder disfunction that happen permanently or reccurent with 54% happen reccurently every 3
years. Impingement syndrome is one of the cause of shoulder pain and one of the reason people
seek for treatment. Yet the treatment for shoulder impingement is still controversial. The two
surgery method of treatment that often used is by open acromioplasty and arthroscopy. The
objective of this study is to compare which method is better by assessing the shoulder function post
operatively between acromyoplasty and arthroscopy for shoulder impingement,
Methods. This retrospective study was performed on patients with shoulder impingement syndrome
that already done the operation in Siloam Hospital Surabaya, Indonesia between Januari 2014 until
December 2014. There were two method of surgery used, and the patients divided into two groups
according to the method of surgery performed. The first group was already performed open
acromyoplasty and the second was arthroscopy of shoulder. Retrospectivelly, follow up was
performed six months until one year after they underwent the operation. The shoulder function was
examined using DASH (Dissabilities of the Arm, Shoulder and Hand) score.
Results. Total patients are 30 patients that subjected in this study, consist of 19 females and 11
males. There were 16 patients (53,33%) underwent open acromyoplasty and 14 patients (46,66%)
underwent arthroscopy. Aside differences in technique and length of operations, which result less
scar in arthroscopy because of minimal incision but more time in operation because of preparation
using special arthroscopic tools, follow up after six months until one year post operative using DASH
score revealed good result for both of them and there was no significant differences in term of
shoulder function.
Conclusion.The result of this study revealed no significant differences in post operative function at
six months to one year follow up between open acromyoplasty and arthroscopy.
Keywords: Impingement syndrome; shoulder; open acromyoplasty; arthroscopy
FP2.23.
APPLICATION OF PLATELET RICH FIBRIN AS A THERAPY
FOR DIABETIC FOOT ULCER
Putramega D*, Dewo P **
*Resident of Department of Orthopaedics and Traumatology, Sardjito General Hospital
**Staff of Department of Orthopaedics and Traumatology, Sardjito General Hospital, Faculty of
Medicine, University of Gadjah Mada, Yogyakarta
Introduction. Diabetic foot ulcers are chronic wounds arise from the neuropathy and vasculopathy
complications of diabetes mellitus. In diabetic foot ulcers, the decreased healing potential makes it
complex and hard to heal. The primary goal for diabetic foot ulcer is to obtain wound closure.
Platelets are considered to play an important role in the healing process of bones and wounds, as
they release growth factors.
Objective.This study will elaborate application of platelet rich fibrin for therapy of diabetic foot ulcer
in RSUP Dr. Sardjito Yogyakarta from October 2015 – October 2016.
Methods. This is an experimental study. The subjects are diabetic foot ulcer patients in Sardjito
General Hospital who agree to be treated with platelet rich fibrin. Subjects will undergo serial
application of Platelet Rich Fibrin which taken from their own blood sample. Evaluation of healing
progress of the ulcer will be documented on each application of PRF. The parameters to be
evaluated is the dimension of the ulcer , before and after application of platelet rich fibrin.
Results. This is an ongoing research with the purpose to determine the effect of PRF in the
treatment of diabetic foot ulcer.
Conclusion. This is an ongoing research with the purpose to determine the effect of PRF in the
treatment of diabetic foot ulcer.
Keywords: Diabetic Foot Ulcer, Platelet Rich Fibrin, Ulcer Healing, Chronic ulcer
FP2.24. CORRELATION BETWEEN PLAIN RADIOGRAPH
PARAMETER AND FUNCTIONAL OUTCOME IN PEDIATRIC
SUPRACONDYLAR HUMERAL FRACTURE
Bayu Wicaksono M*, Dewo P **
* Resident of Department of Orthopaedics and Traumatology, Sardjito General Hospital
**Staff of Department of Orthopaedics and Traumatology, Sardjito General Hospital, Faculty of
Medicine, University of Gadjah Mada, Yogyakarta
Introduction. Supracondylar humerus fractures are the second common type of pediatric fractures.
Supracondylar fracture ± 60% of all pediatric elbow fractures. Generally, conservative treatment
options are preferred in pediatric fractures and surgical procedures are the treatment of choice in
displaced supracondylar humerus fractures. Humerus fractures are a significant part of pediatric
fractures due to high incidence, high morbidity and serious complications.
Objective : Measure the functional outcome of Supracondylar humeral fracture in children treated
with operative or conservative. The functional outcome was also correlated with Baumann angle and
Carrying angle after the treatment.
Methods. This is a descriptive study with retrospective data in Sardjito hospital. The data were 104
patients with SCHF, there is 78 Patients SCHF reachable and 26 patients unreachable, during January
2014 – July 2015. Data were collected from patient medical record and the Baumann Angle (Pre and
Post treatment) and Carrying Angle ( Pre and Post treatment) was determined to measure the
radiological profile in this patient. The functional outcome of the patient was assessed with DASH
Score. The radiological profile then compared with the DASH score to determine the relationship
between them and then assessed statistically with SPSS v.23 to measure the significance between
them.
Results. The results showed that there is a relationship between Baumann angel (p:0,034) and
caryying angel (p:0,039) with DASH score Operative patients. There is a relationship between
Baumann angel (p:0,004) and caryying angel (p:0.005)with DASH score non operative. This is
indicated by the significance of the correlation value is smaller than 0,05.(p<0,05)
Conclusion. There is good functional outcomes can be expected with pediatric SCHF based on
Baumann-Caryying Angle treatment post operrative, Baumann-Caryying angle post treatment non
opretive ,the DASH questionnaire, regardless of Sex, Gartland clasification, fracture type, mechanism
of injury, most common injury provided satisfactory reduction is achieved and maintained
Keywords: Gartland supracondylar fracture and DASH Score
P1.
EWING’S SARCOMA OF THE LEFT THIGH AND LOWER LEG : A
CASE REPORT
Kesuma I, Mathan Sakti Y
Department of Orthopedic and Traumatology Faculty of Medicine Universitas Gadjah Mada/
Sardjito General Hospital
ABSTRACT
Background. Ewing’s sarcoma is a highly malignant tumour of bone and soft tissue in children
and adolescent. It can affect all bones, but is slightly more common in tubular bones. It is the
second most common primary malignant tumor of bone in children with characteristic
predilection for an age group between 10-20 years. In this study we present a case of 13 years
old boy with Ewing’s sarcoma of the left femur and fibula, with history of reccurence after initial
management of series of chemotherapy.
Case presentation. A 13 years old boy presented with pain and swelling in left thigh. MRI and
FNAB showed characteristic of Lymphoblastic Lymphoma and the patient was treated with serial
chemotherapy (cyclophosphamide, metothrexate) and radiotherapy. After lymphoma
chemotherapy protocol was done, the patient was told that the tumor was already gone, based
on clinical appearance and MRI. 4 years later, the patient complained about pain in hist left leg
with restricted range of motion, leucocytosis, and radiograph of the ankle joint showed portion
of bone destruction. MRI of the left ankle showed mass and bone destruction in the distal part
of fibula. From histopathology examination taken from open biopsy, there was a homogeneous
population of malignant small round cells.A Clinico-Pathological Conference then arranged with
the result of Ewing’s sarcoma, and planned for limb ablation with hip disarticulation because the
criteria of limb salvage was not achieved.
Discussion. Ewing’s sarcoma is a malignant tumor of the bone which consist of small round
tumour and is considered rare. In this case, the accuracy of history, physical examination, plain
radiograph, MRI, and histopathologic examination played an important role to diagnose this
tumor. In this patient, the initial treatment regiment was given without appropriate Clinicopathological conference, which eventually lead to innaccurate diagnosis and treatment, and
even false statement which said that the tumor was already completely resolved, which then
lead to reccurence of the tumor which eventually lead to the need of limb ablation. The classical
clinical and radiological presentation of Ewing’s sarcoma may not be the rule; one should be
highly suspicious of the disease even if there is no direct pointer to the disease as was
encountered in this case. Orthopaedic surgeon should be alert to this rare atypical occurrence
because early diagnose of this tumor very important to maintain good prognosis.
Keywords: Ewing’s sarcoma, Malignancy, chemotherapy
P2.
NEGLECTED HANGMAN’S FRACTURE IN A 34-YEAR-OLD
MALE
Adipranoto G, Drajat R.S
Department of Orthopedic & Traumatology Department, Medical Faculty, Brawijaya University
ABSTRACT
Background. Traumatic fractures of the posterior elements of the axis may occur after
hyperextension injuries as seen in motor vehicle accidents, diving, and falls or judicial hangings.
Therefore, the term “hangman’s fracture” was coined by Schneider in 1965. Garber described
eight patients with “pedicular” fractures of the axis after motor vehicle accidents and used the
term “traumaticspondylolisthesis” of the axis. Hangman’s fracture classified by Effendi earlier
and modified by Levine & Edwards, type I which is isolated hairline fracture, type II displacement
of the anterior fragment & disruption of the disc below the axis, type II-A displacement of the
anterior fragment with the body of the axis in the flexed position without C2-C3 facet
dislocation, type III displacement of the anterior fragment with the body of the axis in the flexed
position in conjunction with C2-C3 facet dislocation.Type I fracture usually treated nonoperatively, type II, II-A and III usually need operative treatment.
Case presentation.A 34-year-old male, trauma patient, came to emergency room suffered from
neck pain and stiffness after tumbling car accident 20 days before admission. In physical
examination there was no neurological deficit found. In the cervical spine x-ray a fracture line in
the C2 was presented, with angulation and displacement of the anterior fragmentin flexed
position which result in instability. This patient had been diagnosed traumatic spondylolisthesis
of C2 (Hangman’s fracture) type IIA. We put hard collar brace to this patient, and put Gardner
Well Tong. Ten days after admission we had chosen open reduction procedure, used the
posterior approach instead of anterior one, and fixed the fracture using transpedicular screw
insertion.
Discussion. In this case which is classified into neglected type II-A hangman’s fracture, which is
hard to reduce using traction, then an operative treatment had become the treatment of choice
to stabilize the fracture using posterior approach and fixed by transpedicular screw insertion.
The result was satisfying, without any neurological complications.Neglected case commonly
present in upper cervical injury. Such in this case we found 20-days neglected traumatic
spondylolisthesis of the C2, classified into type II-A hangman’s fracture which is unstable and
need surgical treatment, and the result was satisfying.
Keywords:Hangman fracture, neglected fracture, cervical fracture
P3.
BILATERAL TRAUMATIC AMPUTATION OF THE WRIST
TREATED BY MYOELECTRIC PROSTHESIS (A CASE REPORT)
Steesy Benedicta*, Adi Suriyanto**, Heri Suroto ***
*Resident of Orthopaedic and Traumatology, Faculty of Medicine, Airlangga University, Surabaya
**Orthopaedic Surgeon, Dr. Ramelan Marine Public Hospital, Surabaya
*** Teaching Staff of Department Orthopaedic and Traumatology, Faculty of Medicine,
Airlangga University/Dr. Soetomo General Hospital, Surabaya
Background. Upper extremity amputee reported 34% of all 1.6 millions American citizen in 2005.
Most cases are found in war battle injury. Reporting a case of 44 years old male with grenade
blast injury. He underwent debridement and bilateral traumatic wrist disarticulation surgery.
After the wound healed, he got applied myoelectric hand prosthesis on his right hand, while left
hand using body powered prosthesis. As the first person using myoelectric hand in Indonesia, we
reported this case as a new era of prosthetics in Indonesia.
Case presentation. Data gathered from the patient from the last examination of the patient
after using the myoelectric hand. Both of his hands got blast injured by grenade explotion while
preceding marine training on September 23rd 2014 in South Malang. He then transferred into Dr.
Ramelan Marine Public Hospital, Surabaya and underwent on bilateral traumatic wrist
disarticulation surgery. After the wound healed, he was going in rehabilitation therapy and being
prepared for using a myoelectric hand prosthesis. At March 3rd 2015, the myoelectric hand
applied on his amputee and synchronized with electrode and keep trained by that. At March 9th
2015, the myoelectric hand presented in public. We examine the functional using DASH score
and also satisfaction by using prosthetic hand.
Discussion. The patient admitted to the hospital due to blast injury on both of his hand. By
physical examination and radiologic findings, he was decided to underwent a bilateral traumatic
wrist disarticulation surgery and stump was prepared for using myoelectric hand prosthetic. This
type of myoelectric prosthesis has tripod, power, pinch, key, finger point, active index, precision,
hook, finger adduction, open palm, relaxed hand, column and mousse function with two thumb
position: opposed and non-opposed. Hand had complex function that it has to be replaced as
normal as possible. When amputate a patient, design of stump must be considered. This case is
a marine grenade instructor amputee and expected to be back to his career in marine.
Myoelectric hand is the newest prosthetic system that work by myoelectric and quite worked
like normal hand.
Keywords: Myoelectric Hand, Bilateral Traumatic Wrist Disarticulation, Grenade Blast Injury,
Marine, Surabaya
P4.
COMPREHENSIVE ORTHOPAEDIC MANAGEMENT OF
EXTRACOMPARTMENTAL GIANT CELL TUMOR OF THE SOFT
TISSUE: A VERY RARE CASE
Demy Faheem Dasril*, Achmad Fauzi Kamal**
*) Orthopaedic and Traumatology Resident of Faculty of Medicine Universitas Indonesia
**) Oncology senior consultant of Orthopaedic and Traumatology Department of Cipto
Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia
ABSTRACT
Background. Giant cell tumor (GCT) of soft tissue is a very rare neoplasm and are mainly seen in
adults and in the elderly population, usually in the extremities. The diagnosis can be made
accordingly when evaluated along with clinical, radiological, and histopathological features.
Eventhough the histopathological morphology is the same as GCT of the bone, the management
of this entity slightly differs compared to other variant of GCT. We employ comprehensive
orthopaedic treatment. Prior to surgery, we perform the clinico-pathological conference (CPC) to
establish diagnosis and the most sufficient treatment for this rare case. Comprehensive
management includes operative and postoperative care for this patient.
Case presentation. In this paper, we report a case, 34 years old female, with
extracompartmental GCT of soft tissue in the right brachii region. Patient was presented to our
center regarding a slow growing, painless mass on her anterior part of the brachii. Besides from
the mass, there are no abnormalities found in this patient. We performed wide excision and
bony reconstruction with ORIF plate and screw of the right humerus. After the procedure, we
evaluate the patient for postoperative care. Patient was closely followed-up in the outpatient
clinic.We evaluate the patient’s functional outcome with DASH score. The postoperative DASH
score was not significantly different compared to preoperative. Patient was able to perform daily
activities without any handicap.
Discussion.Thegoal of treatment was to maintain adequate function after the operative
management. In cases of extracompartmental GCT, it is mandatory to obtain satisfactory
surgical margin (free from tumor cells). Hence, we perform wide excision of the tumor mass. In
this case, the tumor has already infiltrated some of the humeral cortex (bevel-in lesion). We did
an en-bloc resection along with the invaded humeral shaft cortex. The defect after the resection
is filled with bone graft (strut graft) and augmented with plate & screw. In addition, we also add
bone substitute to enhance construct of the bone. This lesion is classified as potentially low
grade malignant tumor. And in the spite of the nature of the tumor, it is very likely to instill local
recurrence even after a wide excision. We also apply chemical agents (ethanol 96%, peroxide) to
decrease local recurrence up until 17%.GCT of the soft tissue is a very rare case, especially in the
global population. The orthopaedic management consists of preoperative assessment (CPC),
operative treatment, and postoperative care. It is essential to do serial evaluation of the patient
after the operation to ensure no local recurrence nor other complications following the
operation.
Keywords: GCT of the soft tissue, wide excision, chemical agents, augmentation fixation, DASH
score
P5.
MID-TERM OUTCOME : NEUROFIBROMATOSIS SCOLIOSIS
TREATED WITH GROWING ROD
Fajar Baskoro Gardjito* R Andhi Pridjosedjati * *
*PPDS Orthopedi & Traumatologi Fakultas Kedokteran Universitas Sebelas Maret
**Bagian Orthopedi & Traumatologi Fakultas Kedokteran Universitas Sebelas Maret
Sub Bagian Spine, RS. Orthopedi Prof. Dr. dr. R. Soeharso,Surakarta
ABSTRACT
Background.Scoliosis defined as apparent lateral (sideways) curvature if the spine. That lateral
curvature associated with rotation of vertebrae, in which produces a three-dimensional
deformity of the spine that occurs in sagittal, frontal and coronal planes. Neurofibromatosis is an
autosomal dominant disorder, with the scoliosis is the most common osseus defect associated
with neurofibromatosis, with incidence around 10%-60%, with still exact cause still unknown.
Basic form of neurofibromatosis are nondystrophic and dystrophic. In nondystrophic
neurofibromatosis scoliosis, it mimic with idiopathic scoliosis, and it can be treated as idiopathic
scoliosis. The growing rod construct used has advantages to provide temporary internal bracing
of rapidly progressive curves. Principally, it limits curve progression without arresting axial spine
growth.
Case presentation. A female, 14 years old, at first admission, present to our spine department
with chief complaint spinal deformity. On physical examination shoulder imbalance, different
body arm distance, and Adam forward test were all positive. There is no neurologic deficit. The
patient had a cafe au lait spot and premenarchal. From the scoliosis series x ray, the apex
vertebra was thoracal XII(end vertabra thoracal X – lumbal III) with cobb angle 580 and 60 of
thoracic kyphosis. The risser index was 0. On bending x ray the cobb angle became 80 which
indicating a flexible curve. We performed singlegrowing rod construct with 38° cobb angle
postoperatively. At follow-up, 6 months later we performed lengthening rod.
Discussion. Post operatively cobb angle was 80. Follow-up 6 months later,the patient didn’t
develop anysign of infection and no neurologic deficit.The treatment of scoliosis in dystrophic
neurofibromatosis scoliosis can be treated as idiopathic scoliosis.By using growing rod construct,
it provide advantages in maintaining spinal growth, limit curve progression without arresting
axial spine growth and continue to be treatment options in scoliosis surgery.
Keywords: scoliosis, neurofibromatosis, dystrophic,growing rod construct, lengthening rod
P6.
NEGLECTED CONGENITAL BILATERAL TRIGGER THUMB : A
CASE REPORT
Rudy 1 , Huwae, TECJ 2 , Bastian, J. 3
1 Resident of Orthopaedic and Traumatology, Faculty Of Medicine, University of Brawijaya, Saiful
Anwar General Hospital Malang
2 Hand Consultant of Orthopaedic and Traumatology Dept, Faculty of Medicine, University of
Brawijaya, Saiful Anwar General Hospital Malang
3 Consultant of Orthopaedic and Traumatology Dept, Kanjuruhan General Hospital Kepanjen
ABSTRACT
Background. Neglected congenital bilateral trigger thumb is an uncommon anomaly in children.
Its management is controversial, ranging from observation to extensive surgical release. We
report a case presentation of bilateral trigger thumb with a brief review of Literature
Case presentation. A 3 years old girl presented with fixed flexion deformityof interphalangeal
joints of both thumb. It is diagnosed as trigger thumb and release of bilateral A1 pulleys is
done.The operation was performed under general anaesthesia. A transverse incision was made
over the nodule in the tendon of flexor pollicis longus. The A 1 pulley was divided longitudinally.
The tendon of flexor pollicis longus was then delivered into the wound to break down any
adhesions. The thumb was assessed for full extension at the interphalangeal joint.All thumb MP
(metacarpophalangeal) joints were stable with less than 200 of passive hyperextension.The
range of motion of MP and IP was symmetric for both thumb.The children were allowed to
mobilise the thumb freely within the dressings.
Discussion. Trigger thumb in children is relatively uncommon and the aetiology remains unclear.
Some believe the condition to be congenital while others consider it to be acquired. Our patient
undergo operation for her bilateral trigger thumb. The result that both of her thumb were able
to have complete active extension of IP joint post operatively.
Keywords:Congenital trigger thumb, bilateral trigger thumb, A1 pulley
P7.
MODIFICATION YOSHII FLAP FOR FINGER TIP INJURY OF
THUMB
Sebastian Mihardja*, Henry Yurianto**, M. Ruksal Saleh**
*Resident of Orthopaedic and Traumatology Department, Hasanuddin University, Makassar
**Staff of Orthopaedic and Traumatology Department, Hasanuddin University, Makassar
ABSTRACT
Background. The objective in management of soft tissue injuries of the hand is to achieve
primary wound healing. Primary wound healing minimizes the inflammatory reaction, scar
formation, and joint stiffening. Surgical approach include primary closure, skin grafts, flaps, and
free tissue transfers. The choice of treatment is based on mechanism of injury, the size of the
defect, location and status of the wound, the patient’s age, sex, general health, and occupation.
Casepresentation.In February 2015, 14-year-old Male complained of amputated at left thumb.
When he was washing his motorcycle, then pinched his finger in the motor chain strap. He was a
student and left hand dominan. Physical examination and x-ray radiography at left hand region
we diagnosed as a finger tip injury of left thumb allen type IV. The Yoshii flap used ulnar side of
the forth finger. The release of the pedicle is done by a volar zig-zag incision. The pedicle is
released as far as possible in the palm until superfisial palmar arch. Mobilization of the flap on its
neurovascular pedicle and transfer to the recipient area. The donor area closed by skin graft
from the wrist.
Discussion. Three months after operation. The skin of the thumb is closed well, fingernails
started to grow. The patient could fell something with his thumb, and could actively work with
his finger. The aim of this procedur is to raise a sensitive and vascularized hemipulp to restore
the sensibility of the thumb
Keywords: Yoshii flap, Finger tip injury, Thumb, Sensibility,
P8.
MACROSYNDACTYLY OF THE TOES
M. Arief Faisal*, M. Ruksal Saleh**, Henry Yurianto**
*Resident of Orthopaedic & Traumatology Department, Hasanuddin University, Makassar
**Staff of Orthopaedic & Traumatology Department, Hasanuddin University, Makassar
ABSTRACT
Background. Macrosyndactyly is webbing of two neighboring oversized digits, usually second
and third toe or middle and ring fingers. Macrodactyly is a rare nonhereditary congenital
enlargenment, which ninety percent of cases are unilateral and 70% of cases involve multiple
digit, except metacarpal and metatarsal. The macrosyndactyly usually appears with involvement
of the other anatomical structure.
Case presentation. In this case report we presented a boy, 4 years old with Macro-syndactily
2nd and 3rd toe. Physical examination revealed complete syndactyly and macrodactyly of the
2nd and 3rd toe of the right foot. The soft tissue between the toes already fusion untill the tip of
the toe and become enlarged too if compared with the other toes and the nail also become
hypoplasia. The challange of this case is the foot become metatarsus adductus and make the
patient cannot wear shoes in the affected site. The Patient subsequently underwent surgical
correction with special technique because there’s no surgical technique in literature that explain
for patient have macro-syndactyly. We performed surgical Z-plasty, debulking for the fat in the
plantar region, and Ray amputation for the 2nd toe untill the base of 2nd metatarsal and
Resectionof the head metatarsal and base proximal phalanx. Three weeks after the operation
the patient can walk normally and the shoes has fit allready for his right foot.
Discussion. The macrosyndactyly is a rare case that usually appear on separated case,
macrodactyly or syndactyly it self. For this macrosyndactyly case we performed some
modification technique.
Keywords: Macrosyndactyly, Ray amputation, Debulking, Arthrodesis.
P9.
MACRODACTYLY OF THE HAND: A CASE REPORT
Ira Juliet Anestessia*, Nino Nasution**, Aga SP Ketaren**
*Resident of Orthopaedic and Traumatology Faculty Medicine University of Sumatera
Utara/ Haji Adam Malik Hospital-Medan
**Consultant of Orthopaedic and Traumatology Faculty Medicine University of
Sumatera Utara/ Haji Adam Malik Hospital-Medan
ABSTRACT
Background.Macrodactyly is enlargement of the digits involving bone. It is a rare case. In the
approximately 190 years that have been followed only 300 cases of macrodactyly of the hand
and 60 cases of the macrodactyly of the toes have been reported. The etiology is remain
unknown. Clinically macrodactyly was classified into four type according to Upton with their own
characteristic histologic appearance which determine the treatment.
Case presentation. Patient is six year old boy came with chief complaint enlargement of the
index finger, middle finger and part of the thumb of the dominant hand. The patient was
diagnosed as macrodactyly type I by clinic appearance, plain x-ray, MRI and EMG. The treatment
are disarticulation of the MTPJ and epiphysiodesis of the index and middle finger. Patient and
his parent feel satisfied with the result. Suitable to the patient’s complaint, he was embarrassed
and psychologically uncomfortable with his hand. He also feels limited by the shape and weight
of his hand.
Discussion. Macrodactyly is rare case. We still need many data to help determine the pathology,
pathophysiology and therapy which suitable.
Keywords: macrodactyly, amputation, epiphysiodesis.
P10.
ILIZAROV METHODE FOR INFECTED BONE LOSS IN PROF DR
R SOEHARSO ORTHOPAEDIC HOSPITAL SURAKARTA: A CASE
REPORT
Dhina Hafiz Sa’ban*, Ismail Maryanto**
* : Resident of Orthopaedic & Traumatology, Sebelas Maret University- Prof. Dr. R. Soeharso
Orthopaedic Hospital Surakarta.
**: Departement of Orthopaedic & Traumatology Faculty of Medicine Sebelas Maret
UniversitySoeharso Orthopaedic Hospital, Surakarta
ABSTRACT
Background. Although well known as a method for limb lengthening and deformity correction
Ilizarov methode is effective treatment for nonunions and bone infections . Defects regardless
their extent can be reconstructed from the remaining healthy bone without the need for
grafting. The surgeon can perform extensive debridements according to oncologic principles and
this makes the eradication of the infection possible. By using the transport technique the bone
defect can be filled and concomitant length discrepancy, axial or rotational deformities can be
adjusted.
Case presentation. A case of 28 years old male pateient suffered infected non union and
bone loss of the right femur. 8 years ago patient have open fracture of the right femur
due to motor vehicle accident and was performed emergency debridement and open
reduction and internal fixation. But in progress patient have infected non union with
bone defect approximately 8 cm ( showed by ray). After was performed several
operation procedure but fail, pasien came to RS Orthopedic Prof Soeharso and was
treated by Ilizarov methode.
Discussion. Six month after performed Ilizarov methode , infection can be eradicated and bone
defect was filled by new bone formation ( showed by x –ray).Ilizarov methode is effective
methode for treat infected bone loss . Because we can eradicate the infection effectively and
filled the bone defect by bone transpot technique.
Key words: Infected bone loss, Ilizarov, Bone Transport.
P11.
GLOMUS TUMOR OF THE FINGERTIP: A CASE REPORT
Herbert Yurianto*, Henry Yurianto**, M. Ruksal Saleh **
*Resident of Orthopaedic and Traumatology Department, Hasanuddin University, Makassar
**Staff of Orthopaedic and Traumatology Department, Hasanuddin University, Makassar
ABSTRACT
Background. The glomus tumors are rare, benign neoplasm that is raised from neuromyoarterial
glomus, which is an arteriovenous anastomosis functioning without an intermediary capillary
bed.They account for 1-5% of all soft tissue tumors of the upper extremity, occuring in the hand
in 75% and in the nail bed in 50-90% of cases.
Case presentation. A 34-year-old housewife has complained of pain at right ring finger and
exacerbated by touching things with it since 2014. Occasionally, the pain is worsen either in cold
weather or holding cold things.Progressive and disturbing pain caused her to seek medical
attention. Previous treatment were by neurologist and given local injection and by general
surgeon and performed nail extraction. Treatment relieved temporary symptoms but never
resolve.Due to debilitating pain, the patient consulted to Orthopaedic surgeon in the early 2015
for amputation and later was diagnosed with Glomus Tumor.
Discussion. Marginal excision of the tumor was performed and the the biopsy sample was sent
for pathology examination. One month after operation, the patient was relieved of pain and
could actively work with his finger.The Glomus tumor can be misdiagnosed or difficult to be
diagnosed. Most of these tumors arise in subcutanous or subungual tissue of the phalanges of
hands.
Keywords: Glomus Tumor, Subungual
P12.
FINGER FLEXION DEFORMITY AND CARPAL TUNNEL
SYNDROME:A RARE CASE OF TOPHUS AT FLEXOR TENDON
F C Winata*, K T Biakto**
*Resident of Orthopedic and Traumatology Department, Hasanuddin University, Makassar
**Staff of Orthopedic and Traumatology Department, Hasanuddin University, Makassar
ABSTRACT
Background. Gouty tophus is a common presentation that can appear at multiple various site.
But gout presenting tophus at flexor tendon that make finger flexion deformity and compress
median nerve at carpal tunnel is a rare case, had been reported only on 5 international journal.
Case presentation. We report a 48 years old right handed male as a village officer. He suffered
gouty arthritis and presenting tophi since 10 years before, 1 year lately he notice a mass at his
right wrist and gradually fell numbness at his tip of thumb, index and long fingers, lately his long
finger is fixed in flexion position and atrophy of his thenar muscle. Whenever he tries to extend
his long finger the numbness increased and pain arise but the numbness decreased by adding
flexion of long finger. He cannot use his right hand normally and disturb his daily job. We
performed longitudinal incision of transverse carpal ligament and debulking of tophus at digital
superficial flexor tendon
Discussion. Day after surgery, he feel improvement from numbness and can actively flex and
extend his long finger, after 1 month he can go back to work normally. Gout presenting tophus
at digital flexor tendon can impinge median nerve at carpal tunnel. By releasing transverse
carpal ligament and debulking of tophus can give satisfying result
Keywords: Carpal tunnel syndrome, tophus, digital flexor tendon, finger flexion deformity
P13.
CONSTRICTION BAND SYNDROME:
AN EFFICIENT ONE STAGE RELEASE COMBINING CIRCUMFERENTIAL
EXCISION AND Z PLASTY
dr.Firmansyah Muhammad, dr. Yvonne Sarah, SpOT (K), dr. Juniarita Eva Santy, SpOT
ABSTRACT
Background.Constriction band syndrome is the most common cause of congenital malformation
of a limb. Management of constriction band syndrome is focused on optimizing function,
facilitatiing growth and development, and improving esthetical appearance. Superficial bands do
not need any treatment, but deeper bands are managed with excision and Z plasty. The
circumferential bands are usually released in two or three stages to prevent vascular
compromise. The purpose of our study was to present the outcome of one stage release.
Case presentation. The patient having constriction band in both lower limbs and seen at the
junction of distal third. Our case provide the combination of circumferential release and Z plasty
in single stage treatment of constriction band syndrome.
Discussion. A one stage release of circumferential constriction band was performed in two
extremities. No vascular compromise was noted during or after the procedure, no wound
problem occured even when there had been marked swelling of the extremity distal to the band.
On follow up, distal swelling reduced.Congenital contriction band can be effectively release with
combination circumferential excision and Z plasty.This one stage is an efficient technique and
safer to minimize the surgical trauma in children.
Keyword: Constriction Band Syndrome, Z Plasty
P14.
BILATERAL CONGENITAL AMPUTATION OF LOWER LEG IN A 2
WEEKS OLD BABY
Basunanda, T.A*, Dradjat, R.S **
*Resident of Orthopaedic & Traumatology Faculty of Medicine, Brawijaya University, Malang
**Pediatric Division Orthopaedic & Traumatology Departement Faculty of Medicine, Brawijaya
University, Malang
ABSTRACT
Background. Congenital amputation is birth without a limb or limbs, or without a part of a limb
or limbs. The overall rate of congenital amputation is 0.3 to 1 per 1,000 live birth in United
States. Dillingham et.al note 58 percent of all congenital amputation in new borns involve the
upper limb. Less than half involve the lower limb.
Case presentation. We report a 2 weeks old baby boy presented to us with chief complaint both
of lower leg was amputated since birth. On physical examination there were incomplete
amputation both of lower leg with the border like constriction in middle third of right and left
femur with distal part necrotic and dysplasia of the femoral bone.The baby boy was first son,
premature (BW 1240 gram), age gestation 30-32 weeks,apgar score 6-8, with sectio caesaria
delivery for indication oligohidramnion and gemelli (the twins was baby boy, premature (1100
gram),anemia (Hb 4 mg/dl),without congenital anomaly,was died 3 day after delivery because
respiratory distress). The mother was 40 year old, history of hipertension before and during
precnancy, 4 times abortion before, had an medication for toxoplasma and rubella 3 years ago.
Surgery was planned to necrotomy and repair stump at the level proximal shaft of the right and
left femur with septic condition for this baby. The operation done in 15 minutes, with minimal
blood loss, 10cc.Post operation the patient send to NICU, on follow up for 3 days the condition
decreased, with septic condition, and on 4 days post operation the patient was died with septic
condition and intracranial bleeding.
Discussion. The exact cause of congenital amputation is unknown and can result from a number
of causes. However, most cases show that the first three months in a pregnancy are when most
birth defects occur because that is when the organs of the fetus are beginning to form. One
common cause is amniotic band syndrome (ABS), which occurs when the inner fetal membrane
(amnion) ruptures without injury to the outer membrane (chorion). Fibrous bands from the
ruptured amnion float in the amniotic fluid and can get entangled with the fetus, thus reducing
blood supply to the developing limbs to such an extent that the limbs can become strangulated;
the tissues die and are absorbed into the amniotic fluid. A baby with congenital amputation can
be missing a portion of a limb or the entire limb. Amnion ruptures can be caused by : teratogenic
drugs, environmental chemicals, ionizing radiation, infections, metabolic imbalance, trauma.
Ultrasonographic analysis allows for the detection of ABS prenatally by visualization of amniotic
sheets or band attached to the fetus. In the first trimester, it is extremely difficult to detect ABS,
especially if the bands are limited to the extremities. However, in the second and third trimester
of pregnancy, it is relatively easy to detect the major anomalies of ABS by its characteristic
features and restrictions of motion. Additionally, elevated maternal serum alpha-fetoprotein
(MASFP) has been associated with ABS. However, elevated MASFP is not diagnostic for ABS,
since it is also elevated in neural tube defects, placental chorioangioma and congenital
nephrosis. MASAFP is now a standard screening test recommended for all pregnancies, through
rarely elevated. The recent study for extremity amniotic band with risk of amputation is
fetoscopic release with the advent of less-invasive fetal surgery techniques by YAG laser, to
prevent necrotic of the distal part of the limb.Congenital amputation of the limbs is devastating,
but recenly with the early detection and intervention with fetoscopic release for amniotic band
and collaboration multidiscipline, Paediatric Orthopaedic Surgery, Pediatric Surgery, Obstetric,
and Paediatric Radiology,to save the limb congenital amputation should be prevented, by early
detection of constriction band.
Keywords : Congenital amputation,constriction band
P15.
AVASCULAR NECROSIS :
WHAT ORTHOPEDIST NEED, WHAT RADIOLOGIST MUST READ.
Dadang Rona Sasetyo, Anggun Esti Wardani
Background. Femoral neck fracture in adolescent regarded as the most difficult to treat, epithet
as the “unsolved fracture”. Since the femoral neck fractures is intracapsular, intrasynovial
angiogenesis inhibiting factor interfering the healing process and ceased the repair with no
periosteal layer caused a merely subsequent endosteal healing. Susceptible arterial ring on
femoral neck surface to compromization of blood supply result from surge of intracapsularintraosseus pressures exceeding diastolic pressure following injury.
Case presentation. A 18 y.o male referred to Orthopaedic department with 4-month neglected
femoral neck fracture causing 4 cm right lower limb shortening. X Ray shown non union fracture
with tapering of femoral column and end bone resorbtion. Orthopaedist sent the patient to MR
section . There were no significant difference between X Ray and MR report. The possibility of
avascular necrosis of femoral head were overlooked.
Discussion. Neglected fracture is a delay to seek for medical help over 30 days or more. The
delay in developing country caused by poverty, ignorance, lack of facilities or faith in traditional
bone setter. In our case, the delayed caused by the first third.The role of Radiologist help the
pre-operative planning. Fracture position, deformity, remaining fracture fragment, the gap
between fragments, and sign of avascular necrosis as the important point to decide whether
joint sacrifice needed or joint salvage procedure in the absence of femoral head necrosis.
Keywords: Adolescent, neglected fracture, Femoral neck, Avascular necrosis, Radiologist,
Orthopaedist.
P16.
ATYPICAL MAISONNEUVE’S FRACTURE, A CASE REPORT
Rachman, A *, Dradjat, R.S. **
* : Orthopedic & Traumatology resident of Brawijaya University, Saiful Anwar General Hospital
Malang
** : Consultant of Orthopedic & Traumatology Dept of Brawijaya University, Saiful Anwar
General Hospital Malang
ABSTRACT
Background.A Maisonneuve’s Fracture is a fracture of proximal third fibula associated with a
disruption of the distal tibiofibular syndesmosis, the interosseous membrane and associated
injuries (eg, fracture of the medial malleolus, fracture of the posterior malleolus, and rupture of
the deltoid ligament). The mechanism for the fracture is an external rotation force to the ankle
with transmission of the force through the interosseous membrane which causes a proximal
fibular fracture. In a very rare form, we can found an unusual pattern of the level of the involved
fibula, such as middle third of fibula.
Case presentation.A 19 year old male came to ER with a painfull, twisted and swelling of his left
ankle after fell while playing futsal. He was unable to weightbear. From physical examination we
found deformity, swelling and tenderness on his left ankle. Range of motion was decreased. On
initial plain x ray we found dislocation of ankle joint, with disruption of syndesmotic and fracture
comminutive middle third of fibula. We performed operation wich are consists of three
procedures, closed reduction of the dislocation, percutaneous fixation of syndesmotic by using a
single transfixing screw, and plate and screw of the fibula fracture. Patient mobility return
normally after 8 weeks, with out pain on full weightbearing.
Discussion.The pattern of the fracture-dislocation of the ankle discussed is very rare. The
mechanism of the injury is a twisting motion of the upperbody inward, while the foot is planted,
resulting a more higher energy impacted to the ankle and fibula. We performed closed reduction
easily by reverse the mechanism of injury.
Keywords: Maisonneuve’s Fracture, distal tibiofibular syndesmosis, interosseous membrane,
rupture of the deltoid ligament
P17.
ANTERIOR CRUCIATE LIGAMENT RUPTURE IN GOUTY
ARTHRITIS: A CASE REPORT
I G.N. Yudhi Setiawan* I G.N. Wien Aryana **
*Resident of Orthopedic and Traumatology Department, Sanglah General Hospital,
Udayana University, Bali
** Staff of Orthopedic and Traumatology Department, Sanglah General Hospital,
Udayana University Bali
Background. Gout is a disorder of purine metabolism characterized by hypreuricaemia,
deposition of monosodium urate monohydrate crystals in joints and peri-articular tissues and
recurrent attacks of acute synovitis. Gout is the most common inflammatory arthropathy
reported to vary from 1 to over 10 per 1000. Chronic tophaceous gout can develop after years
of acute intermittent gout. In 10 per cent of patients with gout, tophi form, these may destroy
skin, tendons, ligaments, and the skeletal structures. Although tophaceous gout without arthritis
might be more common than previously recognized and intra-articular gouty deposits in the
knee are common, tophaceous gout infiltration of the anterior cruciate ligament (ACL) is
extremely rare.
Case presentation. A 39-years-old male presented with intermittent pain of the right knee since
8 years ago. The symptom then accompanied with instability that gradually affected his daily
living especially when walking or doing sports. These complaints initially triggered by neglected
sport injury. From the clinical exam revealed no sign of effusion, no acute inflammation signs
e.g. redness, swelling, deformity, localized joint tenderness around knee and the range of
motion slightly limited with the extension of -5 to flexion of 110. Special test with Lachmann test
showed a grade 2 positive and grade 2 positive pivot shift maneuver with no concurrent
meniscal problem. From the laboratory examination revealed a high level of uric acid (8.5
mg/dL). A radiograph of knee showed no abnormalities but a non contrast MRI scans showed
bursitis of the supra and retropatellar bursa, partial thickness tear of anterior cornu of the right
lateral meniscus, and total tear of the anterior cruciate ligament. An arthroscopy was performed
and revealed calcific material scattered in almost all compartments of knee join. The ACL was
covered with that material and torn at the femoral attachment site, the other ligament was
intact but also covered by these material. A synovectomy and transtibial ACL reconstruction was
then performed using Hamstrings graft with semitendinosus three-bundle technique,
endobutton and fixation with pioscrew. Specimen that are taken were done for analysis. The
results revealed an identically histology of tophaceus gouty arthritis.
Discussion. We encountered a rare case of ACL rupture accompanied by intra-ligament
tophaceous gout infiltration. Treatment for this condition involved an extensive synovectomy for
debridement of intra-articular tophi and an ACL reconstruction using autohamstring tendons. If
hyperuricemia persists for a long time, tophaceous deposits may be found in the subcutaneous
tissues and the various joints, particularly the first metatarsophalangeal joint, the hand, wrist, or
elbow, finger pads, sacroiliac joint, carpal tunnel, ankle, shoulder, dorsum of the feet, knee,
acromioclavicular joint and axial skeleton. Chronic tophaceous gout classically occurs after 10
years or more of recurrent polyarticular gout. Although intra-articular gouty deposits in the knee
are common, our patient did not have a history of acute gouty arthritis tophi elsewhere and in
this case tophaceous gout infiltration of the anterior cruciate ligament(ACL) is extremely rare.
Keywords: Anterior Cruciate Ligament Rupture, Tophaceous Gout Arthritis.
P18.
ANATOMIC RECONSTRUCTION OF THE DISTAL RADIO-ULNAR
LIGAMENT AND OSTEOTOMY FOR MALUNION DISTAL RADIUS AND
ULNA WITH DISTAL RADIO-ULNAR JOINT INSTABILITY: A CASE
REPORT
Putu Mega Wiyastha*, A.A. Gde Yuda Asmara**,
* Orthopaedic and Traumatology Resident of Udayana University, Sanglah Hospital Denpasar
**Teaching Staff of Orthopaedic and Traumatology of Udayana University, Sanglah Hospital
Denpasar
Background. Stability of the distal radioulnar joint (DRUJ) is provided by bony architecture and
by soft tissues such as the triangular fibrocartilage complex (TFCC), the joint capsule, and
surrounding muscles. Anatomic reconstruction of the major structures responsible for joint
stability is the most important principle for the treatment of instability of an injured joint with an
intact articular surface by using a palmaris longus tendon graft.
Case presentation. Male, 19 year old with DRUJ instability associated with distal radial and ulna
malunion. Patient had history of trauma two years ago. On examination there is restricted of the
Range Of Motion (ROM) wrist flexion-extension and forearm supination. The management with
corrective osteotomy of the distal radius and ulna with the radioulnar ligament reconstruction.
Discussion. Restoration of stability and a full painless arc of pronation–supination are the goals
of treatment for the posttraumatic unstable DRUJ. The reconstruction procedures suggested by
some authors using the palmaris longus tendon has been shown to be the most reliable and
anatomically acceptable surgical technique. We performed distal radioulnar ligament
reconstruction after osteotomy distal radius and ulna then fixation using plate and screw.
Keywords: Distal radioulnar joint, malunion, ligament reconstruction
P19.
AN UNCOMMON SITE OF A COMMON TUMOUR:GCT OF
VERTEBRAE
Satria Prawira*, KaryaTriko Biakto**
*Resident of Orthopedic and Traumatology Department Hasanuddin University, Makassar
**Staff of Orthopedic and Traumatology Department Hasanuddin University, Makassar
Background.Giant cell tumour is a benign, locally aggressive neoplasm which is composed of
sheets of neoplastic ovoid mononuclear cells interspersed withuniformly distributed large,
osteoclast like giant cells.Giant cell tumour represents around 4-5% of all primary bone tumours,
and approximately 20% of benign primary bone tumours. The peak incidence is between the
ages of 20 and 45. Giant cell tumours typically affect the ends of long bones, especially the distal
femur, proximal tibia, distal radius and proximal humerus. Around 5% affect flat bones,
especially those of the pelvis. The sacrum is the commonest site in the axial skeleton, while
other vertebral bodies are less often involved.
Case presentation. A 30 years old female with weakness both of lower limb that noticed since
two mounth.initially she felt pain at lower back pain,after that weakness both of lower limb until
now.she cannot walking again.No,fever,weight loss associated.plain radiograph and CT-Scan of
the vertebrae shows primary bone tumour of the 3rd lumbar.Exicisional biopsy to identify the
tumour after that,curettage and fusion vertebrae with implantation proceed to radiotherapy.
Conclusion of histopatologic evaluation is Giant cell tumour.
Discussion. Giant cell Tumour ( GCT ) of bone is generally a benign tumour composed of
mononuclear stromal cell and characteristic multinucleated giant cell that exhibit osteoclastic
activity.it usually develops in long bones but can occur in unusual location.GCT of vertebrae is a
rare cases and diagnosis might be missed both clinically and radiologically. A rare case of Giant
cell Tumour.
Key words:Giant Cell Tumour vertebra,benign tumour
P20.
THE BONE UNION IN PATIENT WITH NON NF-1 CONGENITAL
PSEUDOARTHROSIS OF TIBIA WITH A HISTORY OF MALUNION
FRACTURE : A CASE REPORT
Zainarda* K.A. Candra Dewi **
*Resident of Orthopedic and Traumatology Department, Sanglah General Hospital, Udayana
University, Bali
** Staff of Orthopedic and Traumatology Department, Sanglah General Hospital, Udayana
University, Bali
ABSTRACT
Background. Congenital Pseudoarthrosis of the Tibia (CPT), is usually associated with
neurofibromatosis type 1 (NF1), a common autosomal dominant genetic disorder. The reported
incidence of Congenital pseudarthrosis of the tibia (CPT) varies between 1:140,000 and 1:250,000.1
The tibia shows area of segmental dysplasia resulting in anterolateral bowing of the bone. This
osseous dysplasia leads to a tibial nonunion and, because of tibial bowing and reduced growth in the
distal tibial epiphysis, shortening of the limb usually occurs.2Osteosclerotic bowed bone with a small
number of osteoclasts in CPT was suggested as a bone healing problem by dysfunction of bone
remodeling. The natural history of the disease is extremely unfavorable and, once a fracture occurs,
there is a little or no tendency for the lesion to heal spontaneouslyand leads to failure in union.3
Case presentation. In this report, we describe a 14-year old male with Non NF-1 Congenital
Psuedoarthrosis of Tibia (CPT) with a hstory of malunion fracture of left tibia. Patient was an
orphanage boys with history of normal delivery. He felt bowing on his left tibia since 5 years old and
getting worse each day. Patient had a history of traffic accident at 12 years old on his left bowing
tibia and never got a medical treatment at all. The patient has undergone an osteotomy surgery
procedure with plate screw and bone graft. We here describe time of healing based on clinical and
physical imaging for 6 months-follow up results.
Discussion. After 6-months follow up patient demonstrated completed delayed union with 10 mm
residual Leg Length Discrepancy (LLD), and no evidence of recurrence were seen during the follow
up. The longer period of partial weight bearing was done and the bone healing takes 6-month to
complete union.
Keywords: Congenital pseudoarthrosis tibia, neurofibromatosis type 1, osteotomy open reduction
internal fixation. Leg Length Discrepancy, Range Of Motion
P21.
A CASE OF PULMONARY METASTASIS OF RECURRENT GIANTCELL TUMOR OF BONE IN PROXIMAL HUMERUS
Aris Kurniawan*, Mujaddid Idulhaq**
*Resident of Orthopaedic & Traumatology Faculty of Medicine Sebelas Maret University – dr.
Moewardi General Hospital – Prof. DR. R. Soeharso Orthopaedic Hospital, Solo
** Staff of Orthopaedic & Traumatology Faculty of Medicine Sebelas Maret University – dr.
Moewardi General – Prof. DR. R. Soeharso Orthopaedic Hospital, Solo
ABSTRACT
Background. Giant cell tumor (GCT) of bone is a locally destructive tumor that occurs
predominantly in long bones of post-pubertal adolescents and young adults, where it occurs in
the epiphysis. The majority are treated by aggressive curettage or resection. Vascular invasion
outside the boundary of the tumor can be seen. Metastasis, with identical morphology to the
primary tumor, occurs in a few percent of cases, usually to the lung. Giant-cell tumor (GCT)
represents 5% of bone neoplasm and typically occurs in 20-40 year-old patients.Although these
tumors are usually benign and locally destructive metastases have been reported in some
patients.Recurrence is most common in the lung, but there have been case reports of
metastases at other sites, such as the lymph nodes, bone, skin, and breast.Some patients with
pulmonary metastases have spontaneous regression or remain asymptomatic for many years.
Others have rapidly progressive courses, even though they exhibit histologically benign features.
The overall mortality rate in patients with pulmonary metastases is approximately 15%.
Case presentation. A 40 year-old male was diagnosed with a giant cell tumor of the left proximal
humerus in April 2014. He underwent intralesional curettage, on basis of outpatient there was
no evidence of recurrence. Eight months later, in December 2014, the patient had a local
recurrence of the tumor and was treated by wide excision. The patient presented in April 2015
with a dyspneu and recurrence in the same place. He was taken to surgery, and a disarticulation
of GlenoHumeral Joint was performed. On Chest x-ray, we revealed a nodul within both lung,
and suspected with a metastasis of the tumor to the lung.
Discussion. GCT usually occurs in young adults and presents as an epiphyseal osteolytic bone
lesion. Although this type of lesion was originally classified as a benign tumor, its potential for
metastasis has been reported variously in 1-9% of patients. The lung was the most common site
of metastasis and extrapulmonary metastasis was rare. Patients’ age and sex are not risk factors
for metastatic disease and there is no predilection for the right or left side. The reported interval
between diagnosis of the primary tumor and detection of metastasis ranges from 0 to 10 years
(average, 3.5 years). Although lung metastasis may spontaneously evolve into necrosis or
ossification, the treatment of lung metastases is usually surgical resection.If removal of the
lesion is unfeasible, chemotherapy including adriamycin, dacarbazine, vincristine, cytoxan,
actinomycin, or bleomycin can control evolution of the disease.Radiotherapy is contraindicated
because of the risk of induced malignancy. The mortality of pulmonary metastatic GCT is variable
and uncertain, depending on the length of the follow-up and the prognosis of a GCT with
pulmonary metastasis is quite favorable.
Keywords: Recurrent giant cell tumor, pulmonary metastasis
P22.
NON-VASCULARIZED HEAD FIBULAR GRAFT IN ANKLE
RECONSTRUCTION FOR RECURRENCE GIANT CELL TUMOR ON THE
DISTAL FIBULA
Muhammad Rangga Akbari Siregar*, Nazar Moesbar**
*Resident of Orthopaedic and Traumatology, Faculty of Medicine, University of North Sumatera
**Consultant, Dept. Of Orthopaedic & Traumatology, Faculty of Medicine, University of Sumatera Utara
Haji Adam Malik General Hospital, Medan, Indonesia
ABSTRACT
Background. The fibula may be used as graft material in the cervical spine, clavicle, humerus, radius,
ulna, lumbar spine, femur, tibia and ankle. Candidates for fibula graft are patients in whom
conventional bone grafting has failed, or those who have large defects > 6 cm in length or who have
soft tissue bed that is characteristically notorius for poor healing, such as patients who have undergone
radiation or those with severe peripheral vascular disease.
Case presentation. Patient with recurrence giant cell tumor in distal fibula with bone defect more than
9 cm, we treated the patient with non vascularized fibula graft, multiple screws and K-wire without
addition of cancellous bone graft. Patient previously has been treated with bone cement but the
patient complaint pain and lump on the distal part of the cruris.
Discussion. Numerous treatments of bone defect that treated with free vascularized or vascularized
fibula graft have been reported with variable success rates. Non vascularized fibula graft is more
simple, less expensive and shorter procedure than the use of vascularized graft and allows remodelling
of the fibula at the donor site, it is a biological reconstruction with good long – term result, and
relatively low donor site complication.The outcome of the treatment was assessed by bone healing
(union on radiology, no infection, good range of motion) of forearm. Non vascularized fibula graft
method for fibula bone defect > 9 cm following recurrence tumor case show satisfactory result.
Keywords: Reconstruction, GCT, Bone Tumor, Non-vascularized fibula graft
P23.
PRIMITIVE NEUROECTODERMAL TUMOR AT THE LEVEL OF
THORACIC SPINE : A CASE REPORT
Akbar A*, Magetsari R / Mathan Sakti Y **
*Resident of Department of Orthopaedics and Traumatology, Sardjito General Hospital
**Staff of Department of Orthopaedics and Traumatology, Sardjito General Hospital
Faculty of Medicine, University of Gadjah Mada, Yogyakarta
ABSTRACT
Background. Primitive neuroectodermal tumors (PNET) are malignant tumors thought to arise from
the neural ectoderm and comprise of undifferentiated small round cells that affect soft tissue and
bone. An estimated 6.5% of primary lesions arise in the chest wall . These tumors occur primarily in
children and adolescents (thirteen to sixteen years old), with a tendency to recur and metastasize
especially to lungs, bone marrow, brain and lymph nodes. PNET are uncommon malignancies that
are increasingly reported in the literature and located in the spine are extremely rare. In this study
we present a case of 14 years old girl with PNET of the thoracic spine which reccur after initial
resection.
Case presentation. A 14 years old girl presented with low back pain and progressive weakness of
both of lower limbs of three months duration. On physical examination, motor and sensory function
was lost, motoric strenght in the lower limbs was grade 1/5 with hypoesthesia below L1 level.
Magnetic Resonance Imaging (MRI) of the spine showed burst pathologic fracture of the 12th
thoracic spine with suspicious malignant lesion in the 12th thoracic spine. Initially the condition was
treated with laminectomy, decompression, stabilization and open biopsy. Histopathology and
immunohistochemistry of the lesion revealed the diagnosis of PNET. During the early postoperative
course, she had instance neurological recovery and was able to walk unassisted. But, 2 months later
the neurologic deficit reccured and she was treated with extended laminectomy with tumor
debulking. Then the patient received chemotherapy and planned for radiotherapy.
Discussion. Primitive neuroectodermal tumors (PNET) are devastating malignancies that appear to
be more common than has previously been reported. The clinician should give consideration to the
possibility of this diagnosis, especially in the setting of a young adult or child with an intraspinal
mass. While there are no widely accepted standards for the management of spinal PNET, it is
advocated that complete resection is performed when possible with the goals of neurological
stabilization and obtaining sufficient tissue for accurate diagnosis. This should then be followed by
an individualized combination of chemotherapy and/or radiation. Primitive neuroectodermal tumors
(PNET) are extremely rare and are aggressive with poor outcomes. Diagnosis requires
histopathological examination and immunohistochemistry.
Keywords: Primitive neuroectodermal tumor (PNET), Malignant Tumor, Rare Tumor, Spinal Tumor
P24.
OSTEOPETROSIS : A CASE REPORT
Hutahaean, D. Y. P. *,.Mathan Sakti Y**, Magetsari R**
* Resident of Orthopedic and Traumatology Gadjah Mada University Yogyakarta
**Staff of Department of Orthopedic and Traumatology Gadjah Mada University/
Sardjito General Hospital, Yogyakarta
ABSTRACT
Background. Osteopetrosis (OP) is a rare heterogeneous group of inherited skeletal dysplasias
characterised by osteoclast dysfunction, impaired bone resorption and poor bone remodeling with
incidence rate of 1/200 000 births. Three groups can be categorised on the basis of clinical findings
and by genetic investigations including autosomal recessive malignant, intermediate, and autosomal
dominant. The increase of bone mass in osteopetrosis lead to the condition where the bone more
likely to be fractured. The diagnosis of the disease is made from clinical history, detailed family
history, physical examination, radiodiagnostic and bone marrow examination.
We present a case of 21 years old girl with OP diagnosed since 7 years ago and suffered repeated
fracture in extremities.
Case presentation. A 21 years old girl presented with recurrent fractures on her upper and lower
limbs since she was 6 years old (right and left humerus, right clavicle, and the right 3rd toe) . All the
mechanism of trauma was trivial injury (low energy trauma). She was born without prenatal or
antenatal problem. There was no history of genetic disorder in the family. She was also diagnosed
with anemia due to congenital diserythropoietic, ventricular septal defect and failure to thrive. The
X-ray examination shows Cortex thickening with minimal or no medullary bone. The patient
presented with history of fracture in her extremity which treated with conservative treatment using
cast or splint with good clinical and functional outcome.
Discussion. Osteopetrosis is a rare bone condition which predisposed the patient to repeated
fractures in extremity which needed attention from the physician especially orthopaedic surgeon.
The examination has to be done thoroughly from radiodiagnostic, bone marrow examination, and if
possible genotype examination. Education to avoid injury was also an important aspect of
management of patient with osteopetrosis. about the condition of the the disease must be informed
to the patient and family to prevent future repeated fracture. Management of other complication
including anemia caused by dysfunction of erythropoietic process/
Conclusion. Osteopetrosis is a rare case with incidence rate of 1/200 000 births, diagnosis is made by
clinical history, detailed family history, physical examination, and laboratory (radiodiagnostic and
bone marrow examination). The important aspect of osteopetrosis management is treatment of the
current fracture and prevention of repeated fracture including genetic investigation.
Keywords: Osteopetrosis, recurrent fracture
P25.
CLINICAL OUTCOME OF A PATIENT WITH TETRAPLEGIC
SPASTIC TYPE DUE TO CERVICAL TUBERCULOUSESPONDYLITIS
WITH ABCES OF C2 – C3 - C4 AND SUBLUXATION OF ATLANTO AXIAL AFTER DEBRIDEMENT, LAMINECTOMY OF C2 AND
STABILIZATION OF OCCIPITO – C3 – C4IN SOEHARSO ORTHOPAEDIC
HOSPITAL SURAKARTA: A CASE REPORT
KhrisnantoNugroho*, Andhi Prijosedjati**
* Resident of Orthopaedic& Traumatology Faculty of Medicine SebelasMaret University
** Consultant of Spine of Orthopaedic& Traumatology Surgeon SebelasMaret University –
Orthopaedic Hospital Prof dr.Soeharso Surakarta
Background. Cervical tuberculousespondylitis is a rare disease with a high complication rate.
Tuberculouse of the cervical spine is reported in about 6-9% of all cases of spinal tuberculouse. Early
diagnosis and treatment of spinal tuberculouse is essential in order to prevent neurological deficit.
Management strategies for spinal tuberculouse range from ambulatory chemotherapy to radical
surgical debridement with fusionspondylitis.
Case presentation. A 27-year-old woman was admitted to our hospital with a chief
complainweaknessof all extremities since 10 days prior to admission. At first, patient often
complained of neck pain, after that the patient seeking for alternative treatment to the bone setter
and underwent traditional massage around her neck. The day after,the patient complained that all
of her extremitiescan not be moved. Past Illness, the patient often complain of pain around her neck
since the last 3 months. Losing weight the past few months (+), a long history of cough (+), sweating
at night, recurrence fever (+).
Discussion. Several examination was performed to constitute the diagnose, from neurological
examination showed weakness of all extremities. Laboratory results found increased of erythrocyte
sedimentation rate (ESR). Cervical X-Rayshowed the destruction process of the odontoid with craniocervical subluxation. CervicalMRI showed compression fracture at corpus of VC 2 with destruction
odontoidprocessusresulting subluxation ofcranio-cervical junction with prominent abscess as high as
VC 2- VC 4. Suggestive of acervical tuberculous spondylitis process. The patient following surgery
such as debridement, laminec- tomy of C2 and Stabilization ofOccipito- C3 - C4and tuberculouse
drugs. The patient has experienced a significant improvement of neurological status after 3 months
of follow-up.
Keywords:Cervical Tuberculouse Spondylitis, Occipito-Cervical Stabilization
P26.
TRAUMATIC SHOULDER DISLOCATION IN A 4-YEAR-OLD
CHILD: A CASE REPORT
Juliando, Rasyid .H N,Prasetia .R
Departement of Orthopaedic& Traumatology, Faculty of Medicine University Padjadjaran, Dr.
HasanSadikin General Hospital,
Bandung, Indonesia
ABSTRACT
Background. Shoulder dislocations are rare in children. In contrast to adults, traumatic glenohumeral
dislocation is a rarely observed condition among children. In some cases, success in durable
reduction with conservative methods, and achieving lasting treatment, may not be possible. The aim
of this study, is to report a rare case of young boy with traumatic glenohumeral dislocation of the
proximal humerus.
Case presentation. A 4-year-old boy with a history of a fall from a height does playing a wood swing.
The mechanism of trauma is his hand hold the body (out stretch). After that, he complaints of left
shoulder pain and being unable to move his shoulder especially on abduction position. A physical
examination identified tenderness on his left shoulder, a slight swelling and limitation of movement.
The patient underwent closed reduction under sedation with C-Arm. The patient was
postoperatively followed-up 2 weeks in Velpeau bandage.
Discussion. After an exercise program of 2 weeks, the range of motion of the patient’s joint was
almost fully restored, no pain. The range of motion of his shoulder joint was at the same level as his
healthy side.Glenohumeral dislocation is very rare case in children. On physical examination
sometimes can be missed diagnose, rather difficult to assess for dislocation. The parents came to the
Orthopaedi clinic only for complaint about limitation of the motion.
Keywords: Glenohumeral, dislocation, shoulder, closed reduction
P27.
SPINAL EPIDURAL ABSCESS IN CHRONIC KIDNEY DISEASE
PATIENTS WITH SUSPECTED CYSTIC MASS IN THE THORACIC
VERTEBRA, A CASE REPORT
Warih A. M *, Syaifullah A.**
* Orthopedic & Traumatology resident of Brawijaya University, Saiful Anwar General Hospital
Malang
** Spine consultant, Orthopedic & Traumatology surgeon of Brawijaya University, Saiful Anwar
General Hospital Malang
ABSTRACT
Background.Spinal epidural abscesses in patients with chronic kidney disease are rare, they can
cause severe neurological complications that can be fatal because only nonspecific symptoms
appear in the early stages of the infection. The increased number of cases is related to the use of
dialysis catheters in hemodialysis patients. The signs and symptoms of epidural abscess are
nonspecific and can range from low back pain to sepsis. Early diagnosis and proper treatment are
important to prevent neurological complications. Achieving correct diagnosis in cases of Spinal
Epidural Abscess may be challenging, 50% of this cases are initially misdiagnosed. The treatment of
choice in most patients is surgical decompression followed by four to six weeks of antibiotic therapy
Case presentation. A 71-year-old male with chronic kidney disease and routine hemodialysis since 2
months previously. Patient has complaining fever in one month and suddenly acute paralysis in both
lower leg in two weeks after hospitalized. From physical examination, sensorik and motorik was
decreased with normal bladder and bowel function. Leukositosis has found in the first laboratory
test while patient hospitalized and on microbiology test there found Staphylococcus aureus caused
the infection. In the x rays did not reveal any significant findings but on MRI found cyst mass
pressing the spinal cord at level thoracic vertebrae I – IV. Patient underwent surgical decompression
with posterior stabilization and then followed by two weeks of antibiotic therapy. After operation,
The fever decreased and leukosit level is back to normal. In two weeks the patient did not have
symptoms of fever and backache but paralysis still exist. The patient still cannot move on both lower
leg and the sensorik level still numbness. Patients were treated with antibiotic in 2 weeks and then
discharged with improvement general condition
Discussion. In this case, the patient has risk factors for spinal epidural abscess occurs that is chronic
kidney disease and a history of the use of catheters dyalisis. The patient has fever in one month and
not decreased with antipyretic agent. The early diagnosed from Intermal Medicine of this patient
was acute fever infection due to infection from double lumen catheter. When acute paralysis occurs,
MRI of the spine suggested a cyst mass pressing the spinal cord at level thoracic vertebrae cause the
paralysis and then consult to our departement. From history and clinical appearance, we suggest the
acute paralysis not caused by cyst mass but from infection. We diagnosed with Spinal Epidural
Abscess and need surgical decompression urgently. In two weeks after acute paralysis occur, surgical
decompression performed. We performed hemilaminectomy at level thoracic vertebrae IV-V and
found abscess in epidural, and then performed evacuation, drainage of the abscess and posterior
stabilization. From culture of the abscess we found Staphylococcus aureus caused infection in spinal
epidural.Spinal epidural abscesses can cause severe neurological complications. Although rare,
infection in hemodialysis patients occurs in the central venous catheters used for dialysis, spreading
to become epidural inflammation. The 3 typical signs of spinal epidural abscess are low back pain,
pyrexia, and progressive neural symptoms. This condition can be diagnosed early with an MRI. T2weighted MRI without contrast has diagnostic efficasy in Spinal epidural abscess, but also a high rate
of false negative. Surgical methods are preferred over conservative antibiotic therapy alone, but the
latter can be attempted if progress is carefully monitored in the early stages without neurological
damage. The morbidity and mortality rates of epidural abscesses are extremely high. Early diagnosis,
identification of specific strains, and early treatment can improve the prognosis
Keywords : Spinal epidural abscesses, chronic kidney disease
P28.
POSTERIOR TIBIAL PLATEU FRACTURE:A DILEMMA OF THE
APPROACH.( A CASE REPORT)
Arafah, M. * , Martiana, I. K.
**
* Resident of the Department of Orthopaedics and Traumatology, University of Airlangga/ Dr.
Soetomo hospital, Surabaya.
** Staff Division of Spine Orthopaedics, Department of Orthopaedics and Traumatology, University of
Airlangga / Dr. Soetomo hospital, Surabaya
Background. Pure posterior tibial plateau fracture including rare cases . Latest classification system
based on CT mapping that uses computed tomography ( CT ) imaging , the system is able to identify
the type of fracture that is not included in the classification Schatzker and AO / Orthopaedic Trauma
Association. Better in identifying pieces of axial tibial plateau and divide into three parts ; lateral ,
medial and bicondylar fracture maps. This classification system enables orthopedic surgeons to
reconstruct and plan a better approach before surgery
Case presentation. This is a case report of woman, 41 years old, with a closed fracture of the right
posterior tibial plateau in dr. Soetomo in May 2015, data extracted from medical records and
through history, physical examination, radiological and laboratory examinations.A 41-year-old
woman was diagnosed with closed fracture of the right posterior tibial plateau. mode of injury fell
off the motorcycle with flexion of the knee with varus and internal rotation of the femoral medial
kondile. There are two pure posterior fracture fragment that is the posteromedial and posterolateal
thus providing a challenge in determining the approach to its operations. Finally the chosen method
of operation using a posterior approach with L-Incision continued with the installation of small
locking T-third tubular plate and roofing along with K-wire of 1.4 mm. Postoperative clinical results
obtained twelfth week the patient is able to mobilize well.
Discussion. Closed fracture of the posterior tibial plateau fracture is a rare case. Methods posterior
approach operation on posterior tibial plateau is quite difficult to orthopedic surgeons more than
anteroposterior or posteromedial approach. But posterior approach allows an operator to identify
the site of fracture clearly.
Keywords: tibial plateau fracture, posterior approach, three column concept.
P29.
RARE CASE OF THE DEEP BENIGN FIBROUS HISTIOCYTOMA
(ABDOMINAL INTRAPERITONEAL): CASE REPORT
Nurjalaluddin Djawie*, Henry Yurianto**, M. Ruksal Saleh** Karya Triko Biakto**
*Resident at Department of Orthopaedic& Traumatology,Faculty of Medicine,Hasanuddin University,
Makassar
**Teaching Staff at Department of Orthopaedic & Traumatology, Faculty of Medicine,Hasanuddin
University, Makassar
ABSTRACT
Background. Benign fibrous histiocytoma is a rare tumor of mesenchymal origin, well known tumor
of the somatic soft tissue or of bone. In soft tissue it can be either superficial or deep. They may
develop at any age, but most affect adults over 25 years old, with a predominance in males.Few case
of this tumor in bone (1 % ) compared with those in soft tissue, 1/3 arise around the knee (distal
femur and proximal tibia), 1/3 from the wing of the ilium, the rest arise from the ribs, fibula, skull,
etc. Deeply located fibrous histiocytomas are rare. Based on the only published series, they
represent less than 1% of fibrohistiocytic tumours. Deep benign fibrous histiocytoma located in
subcutaneous tissue (91 %) or deep visceral soft tissue ( 9 %), can grow anywhere from 0,5 cm to 25
cm in size. Usually extremities, head and neck, trunk. Rarely in deep soft tissue of retroperitoneum,
mediastinum or pelvis.
Case presentation. A 49 years old man, had tumor at his abdomen, he felt the abdomen enlarged
since 4 years ago, but he did not realize it. Until then he began to feel uncomfortable. He checked at
Awal Bros Hospital and found tumor and underwent operation for tumor removal.From MSCT
abdomen : Seen large intraperitoneal mass ( ± 19,06 x 18,25 x 24,60 cm ), adhere to the lumbosacral
vertebra, mixed density with component : solid, cistyc and calcificate, press both ureters, iliopsoas
muscles expecially at right side.
Discussion. For this case, the patient was treated by orthopaedic surgeon, accompanied with
digestive and urologic surgeon. The patient underwent tumor excision, with laparatomi exploration,
used anterior abdominal approach. Histopatologhy revealedstoriform pattern cell,non atypical,
mature spindle cell, giant cell datia. Deep benign fibrous histiocytoma at intraabdominal is a rare
case.
Keywords: Deep benign fibrous histiocytoma, intraabdominal mass
P30.
THE OUTCOME OF MODIFIED KUROKAWA LAMINOPLASTY
FOR CERVICAL CANAL STENOSIS: A CASE REPORT
Dr. Tjok Agung Y. Vidyaputra*, Dr. I G. Lanang. N. A. Artha Wiguna SpOT (K)**
*Resident of Orthopaedic and Traumatology Department, Sanglah General Hospital, Udayana
University, Bali
**Staff of Orthopaedic and Traumatology Department, Sanglah General Hospital, Udayana
University, Bali
Background. We report on outcome of patient with Cervical Canal Stenosis who had Posterior
Stabilization and Laminoplasty with Modified Kurokawa Technique at Sanglah General Hospital
Denpasar Bali.
Case presentation. Patient is female 64 years old with neck pain that progressively increasing in 6
months and with sign of cervical myelopathy. Imaging result is herniated disc at level C4 until C7 and
OPLL.
Discussion. Treatment of cervical canal stenosis with herniated disc can be challenging. Operative
treatment have indicated that surgery leads to superior results, especially in short-term pain relief.
Many technique has been described, in this case we use Posterior Stabilization with Modified
Kurokawa Laminoplasty.This study has shown that Posterior Stabilization with Modified Kurokawa
Laminoplasty has good outcome to relieve patient complain. There is a high incidence of good
results. Surgery enables these patients to have a better quality of life, better social life function, and
better walking ability.We have evaluated the results for about 18 months. The patients were
interviewed and asked to comment on their neck pain and quality of life pre-operatively and
postoperative period, and The JOA Cervical Myelopathy Evaluation Questionnaire were used. In this
study, the improvement of neck pain and neurologic symptoms was satisfactory.
Keywords: neck pain, cervical canal stenosis, laminoplasty
P31.
THE MANAGEMENT OF NEGLECTED COXITIS TUBERCULOSIS
IN CHILDREN : A CASE REPORT
Dominica Henry * , Sentono Sulis Bayu * *
* Intern at Orthopaedic & Traumatology Departement, Airlangga University / Dr. Soetomo General
Hospital, Surabaya
** Staff in Pediatri Orthopaedic Division, Orthopaedic & Traumatology Departement, Airlangga
University / Dr. Soetomo General Hospital, Surabaya
ABSTRACT
Background. Tuberculosis is one of serious health problems throughout the world, including in
Indonesia. The incidence of tuberculosis continue to increase annually, especially the case of bone
tuberculosis which is part of extra pulmonary tuberculosis as much as 10-20%.
Case presentation. A case report of 2 years old girl, with a neglected posterior hip dextra et causa
coxitis tuberculosa dextra in Soetomo General Hospital, in period October 2013 until September
2015. Data were taken from the retrospective medical record through the anamnesis, physical
findings, radiological, and laboratory examinations. Shewas diagnosed as Neglected Posterior Hip
dextra et causa Coxitis TB dextra, carried out of open biopsy, debridement, and open repositioning
through the anterior approach Smith Peterson. Do installation of K-Wires and external fixation with
hemispica. Given anti-tuberculosis drug for 12 months. In the monitoring for 2 years postoperatively, the patient reported an improvement.
Discussion. Coxitis tuberculosis have a variety of mànifestasi similar to other diseases. Biopsy of the
bone tissue lesions is a gold standard diagnosis coxitis TB. However interpretation of the early
picture of pelvic radiology can be a predictor outcome in the case of coxitis TB.
Keywords: tuberculosis pelvis, tissue biopsy, anterior approach smith peterson.
P32.
SURAL FASCIOCUTANEOUS FLAP FOR THE TREATMENT OF
TRAUMATIC SOFT TISSUE DEFECT AT DORSAL FOOT(CASE REPORT)
Wira Sundoko*, Henry Yurianto**, M.Ruksal Saleh**
*Resident at Department of Orthopaedic and Traumatology, Faculty of Medicine, Hasanuddin
University, Makassar
**Teaching Staff at Department of Orthopaedic and Traumatology, Faculty of Medicine, Hasanuddin
University, Makassar
ABSTRACT
Background. The sural fasciocutaneous flap is a skin flap that can be used for coverage of soft tissue
defects in lower leg, ankle, and hindfoot. It is a reliable flap, easy and applicable. The main
advantage of this flap, its constant and reliable blood supply without the sacrifice of any major
artery.
Case presentation.A 7 years old girl, had traumatic soft tissue and bone defect at dorsal aspect of
the right foot, treated at Wahidin Sudirohusodo Hospital of Makassar. Initially treated with
emergency debridement with open wound care, and after there was no sign of infection, the second
operation for wound closure was performed.
Discussion.The flap from posterior aspect of the calf 1/3 upper and 1/3 middle. This flap depends on
a peroneal perforator 5 cm proximal to the lateral malleolus and also includes the lesser saphenous
vein. Use of the flap sacrifices the sural nerve, leaving the lateral foot insensate. Skin incision was
started along the line in which the fascial pedicle would be taken. The subdermal layer was dissected
to expose the sural nerve, accompanying superficial sural vessels and short saphenous vein. At the
proximal margin of the flap, the nerve and the vessels were severed and ligated. The skin island was
elevated with the deep fascia.The flap showed slight venous congestion which cleared within a few
days. After several times of follow up, the superficial skin shown necrotic, but with good wound
cares, it was healed without any additional operation. After 3 months of follow up the patient now
can walk.
The sural fasciocutaneous flap not only used for coverage of soft tissue defects in lower leg, ankle,
and hindfoot but also for coverage defects in midfoot at dorsal aspect.
Keywords : Suralfasciocutaneous flap, soft tissue defect, dorsal foot.
P33.
MID-TERM FUNCTIONAL AND ONCOLOGY FOLLOW-UP
FOLLOWING BUTTOCKECTOMY PROCEDURE REMOVING MAJOR
HIP ABDUCTOR MIDDLE GLUTEAL MUSCLE ON A FIBROSARCOMA
PATIENT
Adisuhanto M., Herman H., Budi M.N.S., Ismono D.
Department of Orthopaedics and Traumatology
Faculty of Medicine Universitas Padjadjaran/ Dr. Hasan Sadikin Hospital, Bandung
ABSTRACT
Background. Buttock is a common site for high- and low-grade soft tissue sarcoma. Traditionally,
high- and low-grade soft tissue sarcomas of the buttock were treated with a posterior cutaneous flap
hemepelvectomy. Today, most sarcomas of the buttock can be resected with safe margins.We have
performed a complete resection of a fibrosarcoma of gluteus medius, a main abductor mucle,
including its origin and insertion in accordance with oncology principle. Mid-term follow-up, showed
no recurrence and none to minimal functional deficit following surgery.
Case presentation.An unusual case of a malignant soft tissue tumor at left gluteus due to high grade
fibrosarcoma in a young female is presented. The patient was managed with wide local excision of
the tumor followed by coverage with gluteus maximus flap. Intraoperatively, tumor was found to
reside completely within the gluteus medius muscle, well encapsulated and had not infiltrate other
muscle.
The patient, a 33-year-old female, came with chief complain of a lump at her left buttock since 1
year ago. She first noted the lump was the size of a ping pong ball. Physical examination found a
lump at left buttock with size 20x15x8 cm without peau d’orange, redness or ulcer. There was no
tenderness neither neurological deficit. Intial biopsy, with FNAB revealed a low grade fibrosarcoma.
Preoperative MRI was prescribed as surgical planning tool and for later post operative evaluation.We
performed resection of gluteus medius muscle utilizing classic Henry approach for buttockectomy.
Post operative Histopathology examination revealed a high grade sarcoma instead, with clean
margin. Accordingly, we prescribed adjuvant chemotherapy once wound had healed.Mid-term
follow up 6 months following surgery, showed that she has no recurrence of the tumor and that she
has returned to functional daily living. We evaluated her Quality of life, utilizaing RAND 36-Item
Short Form Health Survey (SF-36) 1.0 Questionnaire.
Discussion. Buttock sarcomas presents a special surgical difficulties due to the proximity of the
sciatic nerve and tumors propensity to extend into the pelvis and perineum. Sequalae post operative
procedure largely depended on the function of the resected muscle. In our case, complete removal
of gluteus medius resulted in none to minimal functional deficit during mid-term follow-up. a longer
follow-up shall offer a better picture of oncologic and funcional outcomes.
Keywords: Sarcoma of Gluteal Muscle, buttockectomy, Oncologic Follow Up, Functional Follow Up,
SF36 questionairre
P34.
CLOSE FRACTURE PELVIC YOUNG BURGESS LATERAL
COMPRESSION TYPE II ASSOCIATED WITH ANTERIOR COLUMN
FRACTURE OF LEFT ACETABULUM: USING DOUBLE APPROACH (A
CASE REPORT)
B. Jati Nugroho* Ismail Maryanto**
*Resident of Orthopaedic & Traumatology Faculty of Medicine, Sebelas Maret University, Solo
** Orthopaedic Surgeon of Soeharso’s Orthopaedic Hospital, Solo
ABSTRACT
Background. Close Fracture Pelvic Young Burgess Lateral Compression Type II that associated with
Anterior Column Fracture of left Acetabulum is a difficult clinical problem.
Case presentation. Male 59 y.o came to our emergency department with a Close Fracture Pelvic
Young Burgess Lateral Compression Type II associated with Anterior Column Fracture of left
Acetabulum. Posterior approach was done to reduce the left Sacroiliac joint disruption by ORIF with
two partial treaded Cancelous screw. Anterior approach was done later to ORIF anterior column of
left acetabulum and reduce the sympisiolysis using reconstruction plate.
Discussion. This patient return to previous activities in 3 months after injury, with a perfect function
of their hip joints and no pain.Double approach is a good surgical approach that combining easy and
good reduction so it can decreased long term complications. Urgent reduction of femoral head in the
acetabulum & anatomical reduction of acetabular fracture <1 mm gap is needed for long term good
results in case of anterior column fracture of acetabulum.
Keywords:Close Fracture Pelvic Young Burgess Lateral Compression Type II, Anterior Column
Fracture of left Acetabulum, Double Approach
P35.
JOINT RECONSTRUCTION USING STERNOCLEIDOMASTOID
TENDON AUTOGRAFT AS TREATMENT FOR TRAUMATIC
POSTERIOR DISLOCATION OF STERNOCLAVICULAR JOINT. A CASE
REPORT.
Muh Trinugroho Fahrudhin * , Wahyu Widodo * *
* Resident of Orthopaedic Surgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo
Hospital, Jakarta, Indonesia
** Consultant of Orthopaedic Hand, Dept. of Orthopaedi & Traumagology, Faculty of Medicine
Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Background. Sternoclavicular joint dislocation is an uncommon injury with potentially lifethreatening consequences. Sternoclavicular joint stability relies on the presence and function of
intact capsular and costoclavicular ligaments. Numerous methods of surgery are available to
stabilize the SC joint in patients with sternoclavicular dislocation. In the present report, we
presented a seventeen-year-old male patient who was admitted to our center with pain on the left
chest wall after motor vehicle collision. He was diagnosed as posterior dislocation of sternoclavicular
joint, and was undergone joint reconstruction with sternocleidomastoid tendon autograft.
Case presentation. We presented a case of a seventeen-year-old male patient who was diagnosed
with traumatic posterior dislocation. He underwent joint reconstruction using sternocleidomastoid
tendon autograft, and the operation went well. At four-week and fourteen-week follow-up, the pain
subsided and the shoulder function improved significantly. These findings provide evidence that the
method of joint reconstruction and augmentation may produce good outcome for posterior
dislocation of sternoclavicular joint.
Discussion. Posterior dislocations of the sternoclavicular joint are rare, but important to recognize.
The potential severity of the injury is due to the proximity of the great vessels, brachial plexus,
trachea, esophagus, lungs, and recurrent laryngeal nerve to the sternum. Posterior displacement of
the medial end of the patient’s left clavicle was readily suspected with a loss of clavicular notch and
limitation of shoulder movement. This case represented a clear indication of surgical reconstruction
of the joint. We treated the patient with joint reconstruction and augmentation with
sternocleidomastoid tendon autograft. In this report, the patient had an improved shoulder
movement at 4 weeks post-operatively, and finally gained full range of movement at 14-week
follow-up.This reconstruction method is a safe and effective surgical technique that offers reliable
pain relief and functional improvement for patients with posterior dislocation of sternoclavicular
joint.
Keywords: Traumatic dislocation, sternoclavicular joint, joint reconstruction, sternocleidomastoid
tendon autograft.
P36.
DISTAL FEMORAL OSTEOTOMY AS NEW ALTERNATIVE FOR
MANAGEMENT OF SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE) . A
CASE REPORT
Bagus Pramantha Putra Wijaya*, Paruhum Ulitua Siregar**
* Resident of Orthopaedic and Traumatology Department, Universitas Indonesia/Cipto
Mangunkusumo Hospital, Jakarta, Indonesia.
* Consultant of Pediatric Orthopaedic, Dept. Orthopaedic and Traumatology, Universitas
Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Background. Osteotomies for patients with SCFE are recommended most commonly as secondary
procedures after clinically significant residual deformity develops. They are aimed at altering the arc
of motion and at attempting to retard the onset of osteoarthrosis.
Case presentation. This is a single case report of a 17-year-old adolescent male patient with an 8
months history of hip pain and abnormality in physical examination (abnormal gait, decreased hip
motion, externally rotated foot progression angle, and thigh atrophy). Radiography showed Klein’s
line positive, and steel sign. We diagnosed the patient with SCFE stable type grade 2 on both sides.
We have fixed the slip with bilateral 6.5mm cannulated screw for 15 months. Hence we performed
osteotomy at the distal shaft of femur in turn bilaterally.
Discussion. This technique is expected to provide similar or even better correction than proximal
osteotomy in terms of flexion, valgus and derotation. The approach taken is to perform an
osteotomy at the distal shaft of the femur. Patient has already return to daily activity, with better
functional result than pre operative, objectively measured using Lower Extremity Functional Score
(LEFS). However we still closely observe of hip pain as sign of Femoroacetabular Impingement (FAI),
which we plan to do debridement per arthroscopy if it presents.To the best of our knowledge, this is
the first literature to report the osteotomy on distal from the epiphyses. The main reason is the
difficulty to find the suitable osteotome for subtrochanter femur, and along with the preferable
angle blade plate. This technique could become an alternative approach to the treatment of SCFE
With this approach is also expected that the post-operative complications such as osteonecrosis may
be minimal. However it is necessary to conduct further research in order to obtain definitive
conclusions.
Keywords: Slipped capital femoral epiphysis, SCFE, hip, adolescent, distal femoral osteotomy,
osteonecrosis
P37.
MANAGEMENT OF BILATERAL ILIOPSOAS MUSCLE
HEMOPHILIC PSEUDOTUMOR. A CASE REPORT
Ananto Satya Pradana*, Achmad Fauzi Kamal**
* Resident of Department of Orthopaedic and Traumatology Faculty of Medicine Universitas
Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
** Consultant of Oncology Orthopaedic, Department of Orthopaedic and Traumatology Faculty of
Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
ABSTRACT
Background. Haemophilic soft tissue pseudotumour is one of the rarest complications of
haemophilia. Haemophilic soft tissue pseudotumour was caused by repetitive bleeding that result in
encapsulated mass of clotted blood and necrotic tissue.
Case presentation. We presented a case of a haemophilic soft tissue pseudotumour of bilateral
iliopsoas muscle in a 22 year old haemophiliac man. He was diagnosed with severe haemophilia at 3
months of age with coagulation factor 0.85%. He had neurologic deficit and flexion contracture of
the hip. Excision of the pseudotumour was done under coagulation factor replacement therapy. At
three months after surgery there was no recurrence and significant complication. There was
improvement in muscle power of his lower limb from score 2/5 to 4/5, he was able to stand up
assisted for about 10-20 seconds.
Discussion.Intramuscular bleeding are generally related with direct trauma or may also rise de novo.
Recurrent and nonresolving soft-tissue bleeding will be organized and cause joint contractures and
soft tissue pseudotumours. Soft tissue pseudotumour in this case was not only cause flexion
contracture but also chronic pain and femoral nerve compression that cause severe disability.
Surgical excision is the treatment of choice in this case of haemophilic soft tissue pseudotumour.
This procedure should only be performed in major haemophilic center by an integrated
multidisciplinary surgical team.
Keywords: haemophilic pseudotumour, iliopsoas, haemophilia
P38.
ADJACENT SEGMENT DISEASES OF L2 POST DECOMPRESSION
(LAMINECTOMY) AND POSTERIOR STABILIZATION OF L3-L5 DUE TO
LUMBAL CANAL STENOSIS
Muhammad Anggawiyatna*, S. Dohar A. L. Tobing**
* Resident of Department of Orthopaedic and Traumatology Faculty of Medicine Universitas
Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
** Consultan of Spine Orthopaedic, Department of Orthopaedic and Traumatology Faculty of
Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
ABSTRACT
Background. For about 50 years spinal decompression and fusion has been effective treatment for
myelopathy or radiculopathy attributable to a degenerated, herniated, or unstable intervertebral
disc. Radiographic and clinical studies have shown that in time the disc adjacent to the fused spinal
segment occasionally degenerates or becomes unstable.
Case presentation. We reported a case of a 61 years old patient with adjacent segment diseases of
L2 post decompression (laminectomy) and posterior stabilization of L3-L5 due to lumbal canal
stenosis who previously had a decompression and posterior stabilization and posterolateral fusion
about five years ago. For this patient we performed implant removal, decompression (laminectomy
in level L2-L3), posterior stabilization (pedicle screw and rod in level L2-L3), and posterolateral
fusion.
Discussion. Previouslythe patient was felt back pain and radicular pain on his left thigh. After surgery
there was no neurovascular problem found on the patient. The symptomps also has been relieved
and the patient is able to walk normally.It is believed that the disease is related to increased
biomechanical stress on the motion segment adjacent to the fused area.There is no gold standard
treatment for ASD, but there are methods to treat its symptoms. Several studies have shown that
treatment with decompression of neural elements with possible extension of fusion may relieve
symptoms. Although there seems to be some pain relief with extension of fusion, these studies
indicated that extension of fusion may result in higher rates of ASD in the newly created adjacent
segments.
Keywords: spinal decompression and fusion, adjacent segment disease, posterior stabilization,
lumbal canal stenosis,
P39.
DESMOPLASTIC FIBROMA OF PROXIMAL TIBIA MIMICKING
MALIGNANT TUMOR
Mochammad Ridho Nur Hidayah* Yogi Prabowo**
* Orthopaedic and Traumatologic Resident of Faculty of Medicine Universitas Indonesia
** Oncology consultant of Orthopaedic and Traumatologic Department of CIpto Mangunkusumo
General Hospital, Faculty of Medicine Universitas Indonesia
ABSTRACT
Background. Desmoplastic fibroma is one of the most uncommon bone tumours, approximately
0.1% of all primary bone tumours and 0.3% of benign bone tumours.It is benign bone tumour
composed of spindle cells with minimal cytological atypia and abundant collagen production but
locally aggressive. It occur most often in the first three decades of life and in long tubular bones,
mandible, and pelvis. Surgical resection with a wide margin has been advocated for the treatment.
Case presentation. We present a rare case of desmoplastic fibroma in a 18 year old female with a
progressive mass on his right popliteal since 1 year prior. The large and hard consistency of the mass
and the increased lactate dehydrogenase (LDH) serum level along with the infiltration to the soft
tissue characteristic shown in the magnetic resonance imaging (MRI) increased the suspicion of a
malignant bone tumor. Fine Needle Aspiration Biopsy (FNAB) results were inconclusive, so we
performed the histopathology examination with core biopsy. All the data were discussed at the
Clinico-pathological-conference, and the conclusion was chondromyxoid fibroma. So we plan to do
marginal excision, followed by curettage to preserve proximal tibia bone and inserting bone graft
completed by internal fixation with plate and screw.
Discussion. Intraoperative, we found lobulated solid mass extended distally to posterior
compartment of cruris. Then we resected the tumor completely and do the curettage of
intramedullary mass. We sent the tumor mass to the Pathology Anatomy to confirm the diagnosis.
After the next clinico-pathological-conference, it is concluded that the diagnosis is a desmoplastic
fibroma of proximal tibia.In this patient, we had the first pathological result from core biopsy was a
chondromyxoid fibroma, but at the second pathological result from biopsy intraoperative was a
desmoplastic fibroma. Surgical treatment is the most effective method for Desmoplastic Fibroma.
Curettage has been associated with a local recurrence rate varies between 37% and 72%.One study
reported, marginal resection may result in a recurrence compare to wide excision and
reconstruction, it had no recurrence after 1-year follow-up.Diagnostic of Desmoplastic fibroma is not
easy, because it is mimicking malignant bone tumor and should be established in CPC (ClinicPathologic Conference). Good surgical planning is very important to minimize complication and rates
of recurrence.
Keywords: Desmoplastic Fibroma, mimicking malignant tumour, proximal tibia bone tumor
P40.
LIMB SALVAGE PROCEDURE AS OPERATIVE TREATMENT FOR
GIANT CELL TUMOR OF CALCANEAL BONE. A CASE REPORT
Agus Waryudi*, Achmad Fauzi Kamal**
* Resident of Orthopaedic Surgery, Faculty of Medicine Indonesia University, Cipto Mangunkusumo
Hospital, Jakarta, Indonesia
** Consultant of Orthopaedi Oncology, Dept. of Orthopaedic & Traumatology, Faculty of Medicine
Indonesia University, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Background. Giant Cell Tumor (GCT) of bone is a benign neoplasm consisted of mononuclear stromal
cells and characterized by multinucleated giant cells that exhibit osteoclastic activity. The tumor is
typically appeared as an eccentric lytic lesion with a well-defined but non sclerotic margin which can
extend near the articular surface. However, GCT may have aggressive features, including cortical
expansion or destruction with a soft-tissue component. Fluid-fluid levels, consistent with secondary
formation of Aneurysmal BoneCcysts, are seen in 14% of cases. GCT can mimic or be mimicked by
other benign or malignant lesions at both radiologic evaluation and histologic analysis. Rarely, GCT is
associated with histologically benign lung metastases or undergoes malignant degeneration.1,2
Case presentation. Patient, 46-year-old male who was admitted to our center with a lump at the
right heel since 8 months ago. He was diagnosed with Giant Cell Tumor of the right calcaneus,
Campanacci 3 with secondary aneurysmal bone cyst and was treated wide excision with bony
reconstruction using femoral head allograft was performed. Intraoperatively we found the lesion
was soft, reddish, and well-defined. Femoral head allograft was inserted at the calcaneal bone
defect. Afterwards,achillestenodesis and tendon lengthening were performed and the wound was
closed by using Sural Flap technique
Discussion. Afterwards, post-operative radiograph was taken, and demonstrated that the graft was
implanted very well. Five months after the surgery, patient still had little difficulties in using his foot
for walking because of pain, but the appearance of clinical and radiological are very good. In
conclusion, we presented a case of forty-six-year-old male patient with Giant Cell Tumor of the Right
Calcaneus Campanacci 3. We performed wide excision and bony reconstruction using femoral head
allograft, and we closed the wound using sural flap. It produced excellent outcome, both functionally
and esthetically. Also from this case report, we suggested superficial sural island flap as a good
treatment option for an exposed Achilles tendon.
Keywords: Giant cell tumor, calcaneal tumor
P41.
APPLICATION OF PROXIMAL HUMERUS LOCKING PLATE AS
AN ALTERNATIVE FIXED ANGLE FIXATOR ON A PEDIATRIC FEMORAL
NECK FRACTURE DELBET IV. A CASE REPORT
Doli Mauliate Sitompul *, Aryadi Kurniawan**
* Resident of Orthopaedic Surgery, Faculty of Medicine Indonesia University, Cipto Mangunkusumo
Hospital, Jakarta, Indonesia
** Consultant of Orthopaedi Pediatri, Faculty of Medicine Indonesia University, Cipto
Mangunkusumo Hospital, Jakarta, Indonesia
Background. Pediatric femoral neck fracture is rare,only about 1% among all type of pediatric
fracture and since this type of fracture mostly result in unsatisfying outcome, it is quiet chalenging to
treat. The main problem of this type of fracture is the complexity of mechanical structures of the
femoral neck, as well as the strength of the surrounding muscle and pattern of the vascularity, which
need suitable device to deliver stable fixation. The availibility of fixation device suitable for this type
of fracture in Indonesia is also limited. The objective of this study is to report the outcome of a
pediatric femoral neck fracture Delbet type 4 which was fixed using proximal humerus locking plate
and hip spica from clinical and radiological perspective.
Case presentation. The patient is a 10 years old boy refered from Ambon, with multiple fracture due
to motorvehicle accident, one of which was got right femoral neck fracture. We performed open
reduction internal fixation using the proximal humeral locking plate supplemented with hip spica.
Two holes on the first row were filled with cancelous screws poimting to femoral neck,
acommpanied with 3 locking screws and one cancelous screw as lag screw on the second and third
row. Assessment of the final outcome was made at the last follow-up visit using clinical and
radiological parameters pre operatively, post operatively and at 1 month follow up.
Discussion. Preoperative clinical evaluation there were no leg length discrepancy and external
rotation, while radiologic evaluation show bone gap with anterosuperior displacement of the femur,
disrupted shenton line and lose of neck-shaft angle. Postoperative, the leg length was the same and
the external rotation were corrected. Radiologic evaluation also show that the fracture gap has
reduced, shenton line without disruption and the neck-shaft angle approximatelly similar to
contralateral femur (48o to 49 o). Follow up 1 month after operation show the same clinical result,
and the the callus grow normally along the fracture site, Evaluation also performed after the the hip
spica removal, the result remain as post operative result.Internal fixation on femoral neck fracture
has been accepted worlwide as the best treatment for this type of fracture, but there is still no
publication about the application of proximal humerus locking plate for ORIF of femoral neck
fracture. Compare to other study worldwide, compare the application of pediatric hip screw, the
result was similar Although there is no comparative data about the outcome, consideration about
the post operative complication still need to be followed. The outcome of this report are promising
but there are advantages and disadvantages of the treatment. The advantage such as the availability
and sustainable material of implant, while there are also disadvantageous such as the high price of
implant and the need of image intensifier during operation. Further study about the outcome and
complication post operative also need tobe examined.
Keywords: Pediatric femoral fracture, internal fixation, proximal humeral locking plate.
P42.
THE ONLY POSTERIOR APPROACH OF CORRECTION USING
ROD AND SCREW CORRECTIVE MANIPULATION IN SEVERE ADULT
IDIOPATHIC SCOLIOSIS. A CASE REPORT
Dyah Purnaning*, Rahyussalim**, Ifran Saleh**
* Resident of Orthopaedic Surgery, Faculty of Medicine Indonesia University, Cipto Mangunkusumo
Hospital, Jakarta, Indonesia
** Consultant of Orthopaedi Spine, Faculty of Medicine Indonesia University, Cipto Mangunkusumo
Hospital, Jakarta, Indonesia
Background. Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a
Cobb angle of more than 10o in the coronal plain. In the past, the treatment of severe idiopathic
scoliosis with the main curve more than 80o Cobb was performed by an anterior release with an
open thoracotomy. Posterior-only approach arthrodesis with all-pedicle screw instrumentation has
correction rate similar to that was obtained by traditional combined anterior-posterior approach as
well as avoids the complications related to the thoracic approach.
Case presentation. We reported a case of 25 years old male Adult Idiopathic Scoliosis with double
curve Cobb angle in main Thoracic 1500 and Lumbal 890. The patient underwent single step surgery
(posterior approach surgery).
Discussion. The study concluded that the patients treated with pedicle screw-only instrumentation
presented similar results to those who underwent combined treatment, and avoided the negative
effects on pulmonary function which the anterior release causes. The posterior only approach avoids
complications associated with thoracic approach, and reduces the surgery time of the combined
procedure as well as morbility and patient hospital recovery. After surgery the Cobb angle become
830 in main thoracic and 400in lumbal. The complaint after surgery was minimal, the patient already
back to normal activity with good functional activity. There is no complaint at two months after
surgery; he has already back to normal activity with good functional activity.
Keywords: Adult idiopathic scoliosis, rod and screw corrective manipulation
P43.
CHRONIC INFLAMMATION OF INTRA-ARTICULAR PLASTIC
FOREIGN BODY IN THE KNEE
Andri M.T. Lubis * , Ivan Mac Theda * *
* Consultant of Knee and Shoulder Division, Department of Orthopedics and Traumatology, Cipto
Mangunkusumo National Central Hospital – Faculty of Medicine, Universitas Indonesia
** Resident of Department of Orthopedics and Traumatology, Cipto Mangunkusumo National
Central Hospital – Faculty of Medicine, Universitas Indonesia
ABSTRACT
Background. Injury into or near the joint is quite common these days. The knee joint is the most
common lower-extremity joint injured. Chronic inflammation of the knee joint due to existence of
intra-articular foreign bodies is rare. Several cases of foreign bodies in the knee joint have been
reported. Many ways have been stated regarding the Background of these foreign bodies into the
joints. Nevertheless, most commonly it is caused by trauma.
Case presentation. We reported a case of 33-year old man who had a foreign body in his knee for 13
years. The patient only started to complain pain the last 2 months. We performed arthroscopic
removal of the foreign body.
Discussion. During the radiological examination, we suspected that the foreign body changed
position and it caused the patient to experienced pain, swelling on the knee and “click” sensation,
causing difficulty to walk. We performed arthroscopic removal of the foreign body.The foreign body
extracted from the patient is found to be plastic. According to previous studies, plastic is an inert
material that may not cause any sign of inflammation reactions. The patient started to had
symptoms because of the positional changes of the foreign body.
Keywords: foreign body, knee, plastic, arthroscopic removal
P44.
BONY RECONSTRUCTION AND SOFT TISSUE PROCEDURE IN
OSTEOARTHRITS OF THE KNEE DUE TO LATE ACHONDROPLASIA.
REVERSE PAGODA OSTEOTOMY AND LATERAL COLLATERAL
LIGAMENT FIXATION USING CLANCY METHOD
Melitta Setyarani* Ismail Hadisoebroto Dilogo**
* Resident of Department of Orthopaedic and Traumatology Faculty of Medicine Universitas
Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
** Consultant of Trauma and Reconstruction, Department of Orthopaedic and Traumatology Faculty
of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background. Varus knee is the most common deformity in achondroplasia. Deficient endochondral
ossification, irregular development of the growth-plate cartilage, laxity of the lateral collateral
ligament and a differential growth rate between the tibia and fibula render varum deformity of the
tibia. Advanced medial wear in varus knees may produce a sagittal pagoda-shaped deformity, with
the medial femoral condyle embedded in the worn medial tibial plateau. There are still debates in
the correction procedure for varus deformity on osteoarthritis knee due to late achondroplasia. We
would like to report a case of varus deformity in achondroplasia patient treated with reverse pagoda
osteotomy and lateral collateral ligament fixation using Clancy method.
Case presentation. We reported a female, 50 years old with osteoarthritis of the left knee KL IV and
achondroplasia. The tibia is deformed in the reverse pagoda shape there was also laxity of the lateral
collateral ligament found. We decided to perform reverse pagoda osteotomy and biceps muscle
augmentation using Clancy method. Post operatively we observed the neurovascular complication,
union rate, visual analogue scale (VAS), oxford knee score, lower extremity functional scale (LEFS)
and the patient full bearing time.There was no neurovascular complication following the surgery.
Mean VAS score was improved from 4 to 2. Oxford knee and LEFS score were also improved
consecutively from 34 to 26 (23%) and 19 to 46 (33%). By measuring tibiofemoral and metaphysealdiaphyseal angle in serial X-ray, we found no loss of reduction until the patient achieved full weight
bearing.
Discussion. Although the short-term satisfactory results and long-term outcomes of osteotomy are
still debated, from our observations, high tibial osteotomy is a promising alternative surgical
procedure for a varus knee in achondroplasia. Beside its advantage as a less complicated procedure,
osteotomy with internal fixation could maintain a good angular correction and improvement of
clinical outcome. Thus, close-wedged high tibial osteotomy and Clancy method is a recommended
bony and soft tissue procedure in achondroplasia patients with varus knee as it is cheap, relatively
easy to perform, and can maintain a good anatomical correction and clinical outcome.
Keywords: reverse pagoda tibia, wedge osteotomy, achondroplasia, lateral collateral ligament,
Clancy method
P45.
BILATERAL INNOMINATE OSTEOTOMY TECHNIQUE IN
BLADDER EXSTROPHY REPAIR. A RARE CASE REPORT
Harry Jonathan*, Aryadi Kurniawan**
*) Resident of Department of Orthopaedic and Traumatology Faculty of Medicine Universitas
Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
**) Consultan of Pediatric Orthopaecic, Department of Orthopaedic and Traumatology, Faculty of
Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Background. Classic bladder exstrophy is a developmental defect presenting at birth with a wide
pubic separation and an exposed bladder. Several reconstruction procedures have been performed
with various outcomes.
Case presentation. We reported a rare case of 5.5 year old girl with classic neglected bladder
exstrophy underwent a one-staged bladder repair, bilateral innominate osteotomy, symphysioplasty
reconstruction and immobilization of the pelvic ring with external fixation. Bladder closure,
continence, normal gait, and pelvic radiographs were observed preoperatively, postoperatively, and
one month after surgery.
Discussion. Post external fixation removal, complete healing of the osteotomy sites and reduction of
the symphyseal diastasis were observed. Bladder closure was still maintained, continence was
achieved and normal gait was obtained. Patient was able to walk, run, squat and jump. Bilateral
innominate osteotomy is a promising technique and effective step of bladder exstrophy repair in
older child, which primary goals are to reduce the tension in the closed bladder and promote
continence by restoring the sling of pelvic floor muscles and improve abnormal gait.
Keywords: bladder exstrophy, bilateral innominate osteotomy, symphysioplasty, external fixation
P46.
POST OPERATIVE EVALUATION FOR TREATMENT OF
VOLKMANN ISCHEMIC CONTRACTURE WITH FREE FUNCTION
MUSCLE TRANSFER
Donny Permana*, Heri Suroto**
* Resident of Orthopaedic and Traumatology Department, Airlangga University, dr.Soetomo General
Hospital, Surabaya
**Teaching staff of Orthopaedic and Traumatology Department, Airlangga University, dr.Soetomo
General Hospital, Surabaya
Background. The acute compartment syndrome of the forearm is rare and may therefore be easily
missed. Although many clinicians will not see such a patient during their entire career, profound
knowledge of the symptoms is required to recognize the syndrome in time. Besides immediate
identification of the compartment syndrome early surgical treatment is mandatory to avoid its
devastating consequences. Then the functional results can be good, but if the correct diagnosis is
missed a Volkmann’s ischemic contracture will invariably develop. This paper aims to attend the
reader to this diagnostic pitfall. A patients with a compartment syndrome of the forearm which have
underwent Free Functional Muscle Transfer 12 months ago are described to illustrate both ends of
this diagnostic challenge. Pathophysiological, anatomical and clinical aspects, classification and
therapeutic modalities are reviewed.
Case presentation. Report the patient with volkmann ischemic contracture which have underwent
Free Function Muscle Transfer procedure 12 months ago.
Discussion. Patient has increased his range of movement.The Free function muscle transfer
procedure can rise the percentage of using the patient's forearm functionally.
Keywords: Volkmann Ischemic contracture, Free Function Muscle Transfer