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.
Background: Chronic osteomyelitis is still an important problem in the orthopedic field, especially in developing countries. Cat's claws contain many harmful microorganisms and can cause significant morbidity ranging from infection of skin tissue, muscle, and even deeper to bone tissue (osteomyelitis). The aim of this study was to report that injuries caused by cat-scratches and not receiving proper treatment can develop into chronic osteomyelitis. Case presentation: A 14-year-old boy came to the orthopedic polyclinic of Wangaya General Hospital with complaints of a left leg wound that had not healed since 2 years ago after got cat-scratches. The wound was oozing pus, tenderness, and the ankle area was found to be difficult to move because the patient's leg felt stiff. On physical, laboratory, and radiographic examination were found to be suggestive of chronic osteomyelitis. Conclusion: In general, cat scratch injuries are simple and harmless wounds, but if left untreated can lead to infection and morbidity in the future. Persistent symptoms and unrelieved wound conditions should be important indications for patients and practitioners of the possibility of infection that extends to soft tissue or bone tissue. A good understanding of acute wound management is very important in preventing serious infections. Latar belakang: Osteomielitis kronik masih merupakan masalah penting di bidang ortopedi terutama di negara berkembang. Pada cakaran kuku kucing mengandung banyak mikroorganisme berbahaya dan dapat menyebabkan morbiditas yang signifikan mulai dari infeksi jaringan kulit, otot, bahkan lebih dalam sampai mengenai jaringan tulang (osteomielitis). Tujuan dari penelitian ini adalah untuk melaporkan cidera yang disebabkan oleh cakaran kucing dan tidak mendapatkan pengobatan dengan baik dapat berkembang menjadi osteomielitis kronis. Laporan kasus: Seorang anak laki-laki berusia 14 tahun datang ke poliklinik ortopedi RSUD Wangaya dengan keluhan luka kaki kiri yang tidak kunjung sembuh sejak 2 tahun yang lalu, luka mengeluarkan nanah, nyeri tekan, serta pada daerah ankle ditemukan sulit untuk digerakkan yang dikarenakan kaki pasien terasa kaku. Pada pemeriksaan fisik dan laboratorium ditemukan mengarah pada osteomielitis kronis. Simpulan: Pada umumnya cidera cakaran kucing hanya luka sederhana dan tidak berbahaya, tetapi jika diabaikan dapat menyebabkan infeksi dan morbiditas dikemudian hari. Gejala yang menetap dan kondisi luka yang tidak membaik harus menjadi indikasi penting bagi penderita dan praktisi terhadap kemungkinan infeksi yang meluas ke jaringan lunak ataupun jaringan tulang. Pemahaman yang baik tentang penanganan luka akut menjadi sangat penting dalam mencegah terjadinya infeksi yang serius.
Clavicle fracture is one of common injuries in young adult and fracture in the middle third is the most common injury cases in clavicle fractures. Although clavicle fractures are often seen, in some circumstances bilateral clavicle fractures can occur due to high-energy impact injury, but this is an extremely rare and seldom reported on. Clavicle fracture is not commonly mentioned as an indication for operative intervention, but in cases of bilateral clavicle fracture surgical intervention managed to limit the duration of functional disability and allowing for an earlier functional recovery.
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.
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.
Background: Osteomyelitis has its challenges in its management. Not only because it requires time and cost in treatment, but also a collaboration between doctors, the patient and the environment of family and significant person to the patient himself to achieve optimal management. Case Description: This report was conducted to find the therapy results in a patient with a diagnosis of chronic osteomyelitis, which has suffered the patient for 15 years. This study used a case reports study. Therapy given to the 29 years old male patient with a diagnosis of chronic osteomyelitis of the right femur Cierny Mader IVA was debridement and incision, as well as giving empirical antibiotics according to culture results. The result of the treatment was satisfactory. Conclusion: The patient’s condition improved, and no complaints were reported. The patient can do activities with an assistive device. Latar Belakang: Osteomielitis memiliki tantangan tersendiri dalam penatalaksanaanya, selain karena membutuhkan waktu dan biaya dalam pengobatan, dibutuhkan kerjasama antara dokter, pasien dan lingkungan baik itu keluarga ataupun orang terdekat pasien itu sendiri agar dapat mencapai penatalaksanaan yang optimal. Deskripsi Kasus: Laporan ini bertujuan untuk mengetahui hasil pemberian terapi pada pasien dengan diagnosa osteomielitis kronis yang sudah diderita oleh pasien sejak 15 tahun yang lalu. Penelitian ini menggunakan metode laporan kasus. Terapi yang diberikan kepada pasien laki-laki 29 tahun dengan diagnosa osteomielitis kronis femur kanan cierny mader IVA berupa debridemen dan insisi, disertai pemberian antibiotik empirik sesuai hasil kultur. Hasil dari pemberian terapi tersebut cukup memuaskan. Kesimpulan: Pasien mengalami perbaikan kondisi dan tidak didapatkan keluhan serta pasien dapat beraktifitas dengan alat bantu
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