Interobserver reliability on landmark-guided sacroiliac joint injection among 5th year residency in Orthopedic and Traumatology Department Faculty of Medicine Brawijaya University Malang, Indonesia

Background: The most common misdiagnosed low backpain is result from the sacroiliac joint. There are a lot of methods we can use to treat it such as steroid injection. This method can be done by using landmark-guided technique or image-guided. Unfortunately, not all hospital in this country has the same facility to do image-guided technique using fluoroscopy to do the injection. Therefore, landmark-guided technique still could be used for the treatment of choice.Methods: In this research, authors did injection on sacroiliac joint of 7 preserved cadavers, on both sacroiliac joint, injection were done by 2 operators, which both are 5th- year residents of Orthopedic and Traumatology Department using 2 coloring markers, therefore each of operator got 14 injection spots. Operator  1 uses methyl red, and operator 2 uses methylene blue. The success of the injection evaluated visually. If operator 1 achieved the injection, the sacroiliac joint would be bright red coloured. If operator 2 achieved the injection, the sacroiliac joint would be blue coloured. If both operator achieved the injection on the same joint, the mixture of both will be dark green coloured.Results: The result shown the success of both operator in doing injection for the sacroiliac joint is 9 joints (32.14%). There were 5  joints (17.86%) done by operator 1, and  4 joints (14.28%) done by operator 2. Operator 1 failed on 9 (32.14%) joints and operator 2 failed on 10 (35.72%) . The data was statistically analysed using Fisher Exact Test, result in p value 0.500 (p >0.05).Conclusions: In conclusion there is no significantly different the success of the injection between operator 1 and 2. The failure of the injection on sacroiliac joint could be affected by many factors such as injection technique, and anatomy variations of the sample.

Correction of kyphotic deformity due to neglected fracture dislocation thoracolumbar spine with posterior vertebral column resection

Kyphotic deformity is serious problem for sagittal spinal balance and resulting back pain, neurologic impairment, and also cosmetic problem. Post traumatic kyphotic deformity most common occur following unstable spine. A circumferential approach with anterior release via discectomies and corpectomies, followed by posterior instrumentation and fusion has been the standard of care. This is a case of progressive post traumatic kyphotic deformity due to fracture dislocation which was performed laminectomy without posterior instrumentation and succesfully corrected with single step posterior vertebral column resection.