Introduction: Fracture femur distal third is a common orthopedic problem in patients of all ages. Malunion is common due to neglected conditions; an osteotomy plus ORIF PS procedure is required in the management. Surgery is currently the treatment of choice for distal femoral malunion fractures. Malunion requires deep fixation of compression using lag screws, cortical screws or cancellous screws depending on the type of fracture. Patients with distal femoral malunion are also treated with grafting using bone graft, allograft, autograft, synthetic graft and blade plate with screws in combination with a safe quadriceps approach. Case description: A 16-year-old female patient complained of unbalanced walking and cramps in the right leg for the last 3 months. The patient had a history of traffic accidents and then suffered femur fracture 9 months ago, debridement and a plaster cast. The physical examination found that the right leg was shorter than the left, and the AVN and active ROM distal right leg were still good. Then X-Ray examination obtained the results of his Malunion fracture of the middle 1/3 right femur and then decided to do an osteotomy + ORIF PS. The patient returned home in good condition and then controlled through the outpatient polyclinic. Conclusion: In most malunion patients, osteotomy and PS ORIF are surgical methods. Corrective osteotomy with ORIF PS should be regarded as a salvage procedure for treating distal third malunion.
The use of PRP (platelet-rich plasma) is beneficial and even more important in the future. The most common indications were tendon damage (77%), osteoarthritis (68%), muscle damage (57%) and cartilage damage (51%). It is a purified autologous blood product with a higher platelet concentration than whole blood. It is rich in various cytokines and growth factors and has been shown to initiate and enhance healing by stimulating cell migration, cell proliferation, angiogenesis, and matrix synthesis. In rotator cuff injury, PRP injection led to significant long-term pain relief but not in functional improvements. In Osteoarthritis, PRP injection is associated with long-term pain relief and function improvements. PRP injection has a better outcome in VAS (visual analog scale) and DASH (The Disabilities of the Arm, Shoulder and Hand) scores in elbow ulnar collateral ligament pathologies, including lateral elbow epicondylitis. In medial epicondylitis, a paucity of studies causing therapeutic modality for PRP has not yet been established. In acute muscle injury, PRP used has no differences in imaging, pain, ROM (range of motion), muscle strength, and muscle function. In Achilles Tendinopathy, PRP injection has been associated with improvement in VAS, but no difference in VISA-A (The Victorian Institute of Sports Assesment – Achilles Questionnaire) score. However, the majority of published literature is secondary and tertiary evidence. Future studies could provide important information about the optimal concentrations of growth factors, platelets and leukocytes required for the desired effect in many specific tissues, as well as the appropriate method of administration and timing of drug application.
Chronic osteomyelitis is an inflammatory process in the bone followed by bone destruction caused by microorganism infection. The annual incidence of osteomyelitis is approximately 21.8 cases per 100,000 person-years in the general population. Implanting antibiotic-loaded carriers directly at the site of infection becomes a promising treatment approach. PerOssal® is an osteoconductive synthetic bone substitute for restoring and filling bone defects. PerOssal® pellets contain 51.1% nanocrystalline hydroxyapatite and 48.5% calcium sulfate. It has a role as bone material to fill bone defects caused by dead bone in chronic osteomyelitis. The porosity of PerOssal® allows a high initial antibiotic release, then decreases to ensure a local concentration of the antibiotic. PerOssal® did not show any in vitro cytotoxicity and fatal adverse event as bone material. PerOssal® is a promising antibiotic-loaded carrier for the management of chronic osteomyelitis. It demonstrates good biocompatibility with initial high antibiotic release without in vitro cytotoxicity and fatal adverse event.
Background: The lateral humeral condylus fracture in a child can be difficult to diagnose because the bones of a child not ossification yet. This resulted the fracture is difficult to see or even pass in viewing. In management, the lateral humeral condylus fracture in children has controversy, between non-operative and operative (especially in fracture with minimal displace). This case report discusses the case of the humeral lateral condyle fracture in a two-year-old child and discusses its treatment.Case: A two-years-old boy was delivered by his parents to the Emergency Room (ER) in the Wangaya Regional General Hospital Denpasar with complaints of pain in the left elbow since a day ago. Complaints appear after the patient falls on the floor in his home while playing with his brother. On physical examination of the upper extremity, the left elbow is swollen at the elbow with minimal deformity without an open wound. In manage it, open reduction surgery is performed by apply Kirschner-wire and then backslab is placed on the left arm with supination and 30o flexion positions.Conclusions: Difficulties in diagnosing humeral lateral condylus fractures in children are due to the fact that there are still many condyle plates that have not ossification yet, so that it is difficult for radiological examination to see the fracture line. The operative actions that can be taken are open reduction with the installation of Kirschner-wire. Latar Belakang: Fraktur kondilus lateral humerus pada anak dapat sulit terdiagnosis akibat tulang anak yang belum terosifikasi. Hal ini mengakibatkan gambaran fraktur sulit terlihat atau bahkan terlewati. Dalam penatalaksanaanya, fraktur kondilus lateral humerus pada anak memiliki kontroversi, antara non-operatif dan operatif (terutama pada fraktur dengan pergeseran minimal). Laporan kasus ini bertujuan untuk membahas kasus fraktur kondilus lateral humerus pada anak umur dua tahun dan membahas tatalaksananya.Kasus: Seorang anak laki-laki berumur dua tahun diantar oleh orangtuanya ke Unit Gawat Darurat (UGD) Rumah Sakit Umum Daerah Wangaya Denpasar dengan keluhan nyeri pada siku kiri sejak satu hari yang lalu. Keluhan muncul setelah pasien terjatuh di lantai rumah saat sedang bermain dengan saudaranya. Pada pemeriksaan fisik ekstremitas atas, pada siku kiri didapatkan bengkak pada siku dengan deformitas minimal tanpa disertai luka terbuka. Dalam penanganannya, dilakukan tindakan operasi reduksi terbuka dengan pemasangan Kirschner-wire kemudian dipasang backslab pada lengan kiri dengan posisi supinasi dan fleksi 30o.Simpulan: Dalam mendiagnosis fraktur kondilus lateral humerus pada anak diakibatkan masih banyak lempeng kondilus yang masih belum terosifikasi, sehingga pada pemeriksaan radiologis sulit melihat garis frakturnya. Tindakan operatif yang dapat dilakukan berupa reduksi terbuka dengan pemasangan Kirschner-wire.
Fat embolism (FE) is defined as fat embolism circulating in the bloodstream, with or without symptoms. Fat embolism syndrome (FES) is a circulatory fat embolism which is a secondary complication and causes specific clinical manifestations in the lungs, brain, skin. This incident is often found in orthopedic trauma, especially in long bone trauma, pelvis, and multiple trauma. In non-traumatic cases, such as hip or knee arthroplasty, FES may also be present. Gurd and Wilson's current criteria can help guide the diagnosis, but at this time there are no standardized diagnostic tests. There is no definitive therapy for FES and only supportive therapy.  Emboli lemak (FE) didefinisikan sebagai emboli lemak yang beredar di aliran darah, dengan atau tanpa gejala. Fat Embolism Syndrome (FES) adalah emboli lemak peredaran darah yang merupakan komplikasi sekunder dan menyebabkan manifestasi klinis spesifik di paru-paru, otak, kulit. Kejadian ini sering ditemukan pada trauma ortopedi, terutama pada trauma tulang panjang, trauma panggul, dan trauma multipel. Dalam kasus non-traumatis, seperti artroplasti pinggul atau lutut, FES juga mungkin dapat ditemukan. Kriteria Gurd dan Wilson saat ini dapat membantu memandu diagnosis, tetapi saat ini belum ada tes diagnostik standar. Tidak ada terapi definitif untuk FES dan hanya terapi suportif.
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