Rehabilitation plays a major role to maximize outcome and prevent complications following musculoskeletal trauma and its interventions. It is reported in several studies that mortality risk in patients not receiving rehabilitation was higher compared with patients who received one. The key principles include adequate pain management, anti-infection measures, early ambulation and physical therapy, establishing proper milestones and goals, well-communicated multi-disciplinary approach, and the establishment of standardized and personalized treatment protocol. Early mobilization is supported, as long as wound healing has been taken into consideration. Holistic approach to ensure both physical and psychosocial well-being is recommended, along with special care for geriatric and paediatric populations. Furthermore, alternative medicines such as acupuncture and meditation are currently gaining popularity and subsequently advocated as adjunct therapies.
Supracondylar humeral fractures are the most common paediatric elbow fractures. However, open supracondylar humeral fractures are rarely found in children. In developing countries, delayed treatment is common, and patient can present to hospital as neglected case. The aim of this article is to report immediate surgical treatment in neglected case of open supracondylar humeral fracture. A case of 16-year-old boy who suffered from neglected open left supracondylar humeral fracture was reported. He had history of traffic accident 10 days before admission, and was treated by traditional bone setter. He has already undergone surgery by debridement and followed by an open reduction with cross K-wire internal fixation, and external support post operatively. The fracture has already reduced and fixated well postoperatively. Immediate surgical treatment of neglected open supracondylar humeral fractures is recommended to achieve the best reduction of the fractures and prevent the infection.Key words: Surgical Treatment; Neglected Case, Open Fracture, Supracondylar Humeral ABSTRAK Fraktur humerus suprakondiler merupakan fraktur yang paling sering pada siku anak-anak. Namun, fraktur terbuka humerus suprakondiler jarang ditemukan pada anak-anak. Di negara berkembang, sering dijumpai penanganan yang tertunda, dan pasien bisa datang ke rumah sakit dalam keadaan sebagai kasus yang terabaikan. Tujuan dari artikel ini adalah untuk melaporkan penanganan pembedahan segera pada kasus fraktur terbuka humerus suprakondiler yang terabaikan.Dilaporkan seorang anak laki-laki berusia 16 tahun yang menderita fraktur humerus suprakondiler kiri yang terabaikan. Dia memiliki riwayat kecelakaan lalu lintas 10 hari sebelum datang ke rumah sakit, dan awalnya ditangani oleh dukun sangkal putung tradisional. Dia telah menjalani operasi dengan debridemen dan diikuti oleh reduksi terbuka dan pemasangan fiksasi internal menggunakan k-wire silang, dan pemasangan slab gips eksternal pasca operasi. Hasil pasca operasi menunjukkan bahwa fraktur tereduksi dan terfiksasi dengan baik. Penanganan pembedahan segera untuk fraktur terbuka humerus suprakondiler yang terabaikan direkomendasikan untuk mendapatkan reduksi terbaik dari fraktur dan mencegah infeksi.Kata kunci: Penanganan Pembedahan; Kasus Terabaikan, Fraktur Terbuka, Humerus Suprakondiler
Background:Knee osteoarthritis (OA), known as degenerative joint disease, is typically the result of wear and tear and progressive loss of articular cartilage, most common in elderly women and men. Knee OA is a leading cause of disability and increase with an aging and overweight population. Total Knee Arthroplasty (TKA) is a common surgical treatment of OA knee that highly cost-effective procedure. Stable placement of components is difficult and thus it presents technical challenges for the surgeon but various options are available for managing these defects. Case Report: A 58 years-old housewife came to our clinic due to chronic left knee pain with associated instability since two years ago and getting worse in last three months. She already had knee joint supplementation injections and physical therapy but no improvements. Based on our clinical and radiological findings, our assessment was secondary left knee osteoarthritis with medial instability and tibial defect due to chronic abscess. Patient underwent TKA to correct this condition. A revised implant was used to close the defect in the medial part of the tibia and soft tissue reconstruction procedure was used to correct the instability.Result: On the first postoperative month, the patient underwent rehabilitation and physical therapy to strengthen her lower limb muscles. On the second month, she started to walk using walking assisted device. On the ninth months follow-up, the patient was able to walk normally without assisted device, the pain disappeared and the symptoms of knee instability were reduced. Conclusion:Bone defects are commonly encountered during TKA, which still has no standard treatment to cure. In this case, the use of metal augmentation with revision implant give satisfactory results with good clinical outcome.
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