IntroductionFractures of the neck femur that occur in the elderly are caused by minor trauma with most common age more than 50 years old. While in young adult patients, fractures of the neck femur are caused by severe trauma such as a fall from a height or a traffic accident. Hemiarthroplasty cemented or uncemented are the most common methods of treatment neck femur fracture in elderly patients. Modified Harris Hip Score (MHHS) is a tool to measure the functional capacity and pain to assess the conditions of the patients before and after surgical procedures Methodology This is an observational analytic research study with a case control design at Adam Malik Hospital Medan and several network hospitals in Medan. Total of 32 patients with age more than 50 years old were diagnosed with femoral neck fracture with 16 patients underwent cemented bipolar hemiarthroplasty and 16 patients underwent uncemented bipolar hemiarthroplasty surgery during the period September 2021 until August 2022 assessed clinical functional outcome with MHHS scores and the proportion of dislocation 1 month postoperative. ResultMean MHHS value for cemented bipolar hemiarthroplasty was 79.00±5.40 and uncemented bipolar hemiarthroplasty 78.81±7.43 and there were no dislocations 1 month post operation. Discussion Statistical analytic using independent T-Test showing there was no significant different between MHHS scores in cemented bipolar arthroplasty and uncemented bipolar hemiarthroplasty 1 months post operative with P Value 0.935 (>0.05) without any dislocations was found.
Introduction :Several systemic markers are used to predict the prognosis of several malignant tumours, but no study has been done to observe the correlation between inflammatory markers and 2-year survival rate of osteosarcoma patients. The purpose of this study is to identify the correlation between NLR and PLR with osteosarcoma prognosis and the patient's 2-year survival rate. Methodology: This is a retrospective study with a diagnostic research design. Data of patients who were diagnosed with osteosarcoma from January 2013 -December 2018 in Haji Adam Malik Hospital is collected from their medical record or through by-phone interview to assess the patient's management history and progression post-treatment. Result: A total of 40 samples were included in this study. Using the Kaplan-Meier graph, 2-year survival rate was analysed according to age, gender, tumour location, metastatic status, previous treatment, NLR, and PLR value. Only 1 subject has a survival rate of more than 2 years. In relation to NLR and PLR, it is shown that subjects with lower values have higher survival rate as compared to subjects with higher values. Discussion: ROC analysis was performed to see the incidence of osteosarcoma by observing AUC determine its significance. The AUC NLR value for osteosarcoma (0.972, p-value 0.002, 95% CI, 0.919-1000) was obtained, and the NLR cut-off value was 1.41 (sensitivity 75%; specificity 97%). The AUC PLR value for osteosarcoma (0.944, p-value 0.004, 95% CI 0.871 -1,000) and cutoff value of 97.477 (sensitivity 75%, specificity 89%) were obtained. The 2-year survival rate of osteosarcoma patients was higher, namely 29 months in subjects with low NLR values, 13 months in subjects with high NLR, 17 months in subjects with low PLR values , and 14 months in subjects with high PLR values.
Introduction Lumbar spinal stenosis is often the result of advanced degeneration of motion segments of the lumbar spine. The incidence of this case is 3.57% (3570 per 100,000) population in Southeast Asia. The main symptoms are low back pain, numbness, and weakness in the lower extremity that occur and intensify on walking caused by the load of the body weight on the spine. Loss of disc height, facet displacement and hypertrophy, spondylosis, and spondylolisthesis , all contribute to impact the spinal canal and intervertebral foramen in lumbar stenosis . There is a subgroup of patients with spinal stenosis in whom the spine is unstable preoperatively or become destabilized following decompression who would benefit from fusion procedure. Objective Surgical treatment of lumbar spinal stenosis by posterior lumbar interbody fusion is indicated for patients with symptoms of low back pain and lower limb radicular pain, that are unsuccessful treated with medicines and /or patients with persisting or worsening neurological deficit.However, this procedure may lead to possible complications. This case report study was conducted to show how our hospital handling spinal stenosis case. Case A 67-year-old woman presented with low back pain that has occured for two years, and had been worsening for the past 3 months. She described the pain as an intermitten ache down on her leg, the pain was severe and worsened when the patient is standing, sitting, or walking for a long time , The pain severity was measured by visual analog score (vas), graded between 7/10 to 9/10. She also complained numbness from the bilateral gluteal region to the lateral side of lower extremities, when she feel too tired. On the physical examination, She was found to have limited range of motion for flexion and extension, on the lumbar spine, due to pain. The motoric strength of both lower limbs were decreased, so did the sensory function. The Radiological examination showed a severe stenosis at lumbar spinal bone region on L4-L5 area. After the examination, the patient agreed to undergo the suggested operative procedure and gare the consent at the hospital.
ObjectivePercutaneous Endoscopic Lumbar Discectomy (PELD) is a modern minimally invasive surgical technique used mainly to remove lumbar disc and has several advantages over open discectomy or microdiscectomy techniques. The purpose of this research is to identifythe characterictics of Herniated Nucleus Pulposus (HNP) patients treated with PELD. Material dan MethodsThis is a retrospective descriptive research with a cross sectional design held in Medan, Indonesia from June 2019 up until December 2020. Sample was obtained using total sampling method from the medical records of patients diagnosed with HNP undergoing PELD surgery. The information obtained would include the patient's demographic information, length of stay, intraoperative bleeding, duration of operation, HNP type, and HNP location. The data obtained would then be analized and presented through a table and description. ResultA total of 7 patients was obtained, 1 male (14.3%) and 6 female (85.7%) The sample's mean age is 47.86 17.325 years old with a range between 20 and 68 years old, the median age is 55 years old. The sample's mean body weight is 61.43 3.952 kg, mean operation duration is 2.29 1.254 hours, length of stay is 3.00 0.816 days, dan intraoperative bleeding is 328.57 111.270 ml. The type of HNP observed is buldging (72%), extruded (14%), and prolapsed (14%). Most HNP occurs at L5-S1 (50%), while at L4-L5 and L3-4 occurrence is 33% and 17% respectively. ConclusionThrough the data obtained, it can be concluded that PELD is a minimally invasive surgery, efective for patients of all ages which causes minimal intraoperative bleeding and has shorter operation and post-operative hospital length of stay compared to other surgical methods. PELD can and should be acknowledged to be a good surgical intervention for HNP patients.
Patient presented with paraparesis of the arm after sustaining a motorvehicle accident. X-Ray Cervical showed type II odontoid fracture. Tetraparesis has been reported to be associated with fracture of axis and/ or atlas and acute CCS has rarely been associated with the fractures. However, this case illustrated patient with central cord syndrome asscociated with odontoid fracture. MRI of the cervical spine has revealed lesion consistent with the acute central cord syndrome at C2-C3 level. Treatment with gallie method has shown lower fusion rate than screw rod construct. Patient underwent posterior atlantoaxial fusion with screw rod construct and was discharged with a good neurological improvement.
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