BACKGROUND: Post-operative non-articular tibia fracture several problems that can occur include; pain, muscles atrophy, muscles weakness, joint stiffness, delayed union, and non-union that makes patients limited in their daily activities. Several factors that play a role in the process of fracture healing include osteoblast activity and exercise. Isometric exercises plantar flexor might effectively prevent the problem. Markers of osteoblast activity are bone-specific alkaline phosphatase (BSAP) levels and Hummer scale callus formation. Not yet known the effect isometric exercise of plantar flexor on osteoblast activity in the post open reduction internal fixation of non-articular tibia fractures, due to the lack of studies in this field. AIM: This research was conducted to investigate the effect of isometric plantar flexor on osteoblast activity and callus formation in patients post open reduction internal fixation nonarticular tibial fractures. HYPOTHESIS: There are differences in osteoblast activity and callus formation between groups that do isometric exercises of plantar flexor muscles with those that without isometric exercises plantar flexor. ANALYSIS: Hypothesis test used a paired t-test with a value of α 0.05 and a confidence level of 95%. METHODS: This clinical trial was true experimental with pre-post test control group design divided into two groups, group I obtained treatment of isometric exercises of the plantar flexor muscle, range of motion knee joint, and ankle while group II obtained the range of motion knee joints and ankle. Osteoblast activity measured with bone-specific alkaline phosphatase level and callus formation. RESULTS: The result of the study found to increase mean bone-specific alkaline phosphatase group I; 15.6 and group II; 5.2. A paired t-test of independent samples with α of 0.05 and confidence interval 95% was obtained p-value = 0.000, there is a significant difference in increased levels of bone-specific alkaline phosphatase group I obtained isometric exercises plantar flexor with group II without isometric exercises plantar flexor in patients post open reduction internal fixation of a non-articular tibia fracture. Radiographic examination of Hummer scale callus in group I who carried out isometric exercises plantar flexor had an average value of 2.63, whereas group II without isometric exercises plantar flexor average of 3.06. Wilcoxon test with a 0.05 and 95% confidence interval obtained p-value = 0.000, there is a significant difference in callus image in both groups of patients post open reduction internal fixation non-articular tibia fracture. The linear regression calculated of callus assessment with bone-specific alkaline phosphatase obtained the value of R quadrat = 0.793, which showed that the formation of callus Hummer classification could predict the change in bone-specific alkaline phosphatase value by 79%. CONCLUSION: The research found isometric exercise plantar flexor in patients post open reduction internal fixation non-articular tibia fracture enhances osteoblast activity and callus formation that will likely short the healing process time and prevent delayed union or non-union.
Osteoporosis in children is rare and usually secondary to an underlying disease process. Most of the reported bone fracture incidences associated with acute lymphoblastic leukemia occur during the course of the chemotherapy, not at the point of the first symptoms of leukemic disease, as happened with the case presented here.
Objective-Giant Cell Tumors (GCT) in bone is a rare musculoskeletal tumor. The purpose of this study was to study the characteristics of patients with Giant Cell Tumors in RSUP. Haji Adam Malik for 2013- 2018. Materials and Methods-The type of research conducted is a retrospective descriptive research method. This research was conducted in RSUP. Adam Malik Haji Medan based on medical records of patients with Giant Cell Tumors during the period of January 2013 - December 2018. The collected medical and demographic data is tabulated and presented in the form of a frequency distribution chart or table and analyzed in full. Data analysis used in this study uses total sampling which is presented in the form of tables or diagrams.Results-During the period of the study taken from the medical record data of Medan Haji Adam Malik Hospital, 37 patients with Giant Cell Tumors were treated. Distribution of the number of sample subjects with diagnoses of giant cell tumors of male sex as many as 19 patients (51.3%) while female sex numbered 18 patients (48.6%). Based on the location of giant cell tumors obtained by distal radius of 3 patients (8.1%), femur as many as 9 patients (24.3%), fibula as many as 2 patients (5.4%), proximal tibia as many as 14 patients (37 , 9)%), then in categories other than long bones (digiti) as many as 5 patients (13.5%), patella as many as 2 patients (5.4%), and pedis as many as 2 patients (5.4%). Based on the actions taken, as many as 21 people (56.7%) carried out extensive excision, curettage + bone cement as many as 11 people (29.7%), amputation in 3 patients (8.1%), ORIF + bone grafts by 2 people (5.5%). In this study, of 37 patients with giant cell tumors with stage 1 no patients, stage 2 as many as 12 people (32.4%), stage 3 as many as 25 people (67.5%).Conclusion- Patients with tumor giant cells were found at productive age, there was not much difference in sex, the most campanacci stage was in stage 3, the most common sites were proximal to the tibia, the most extensive measures were also available, and metastases were not available to other organs.
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