Functional outcomes evaluation after radial head arthoplasty in DR. Syaiful Anwar General Hospital: Case series.

INTRODUCTION: Radial head arthroplasty (RHA) has become one of the mainstay surgical treatment for radial head fracture in certain conditions. Many previous studies compared the superiority of either open reduction and internal fixation (ORIF) and RHA with inconclusive result. Our case series aim to evaluate the functional outcome of the patients treated with RHA in our institution. PRESENTATION OF CASE: We evaluated three patients who had RHA in 2018 and 2019. The function of flexion, extension, supination and pronation of the elbow was evaluated. The range of motion (ROM) was assessed in both active and passive way. DISCUSSION: An abundant of literatures stated that RHA result is superior than radial head resection and ORIF. Our case series present a satisfying result on pain and a fair result on functional outcome from the range of motion (ROM) evaluation on patient follow-up. CONCLUSION: A good follow up for post-operative care plays an important role in management of RHA to minimize the rate of complications. In this case series, the functional outcomes after RHA is good, but a larger number of patient and longer follow up duration is needed for a better analysis.

Emergency Surgery in High Volume Osteosarcoma of Left Proximal Humerus Due to Vascular Compromise: A Case Report.

BACKGROUND Osteosarcoma is the most common type of malignant bone tumor arising from mesenchymal stem cell. When occurring on the proximal humerus, it is associated with poor outcomes; there are numerous neurovascular structures around proximal humerus. Unfortunately, the degree of vascular involvement in osteosarcoma is rarely evaluated and reported. Thus, we would like to highlight our case. CASE REPORT We reported a case of left proximal humerus osteosarcoma causing dead limb in a 14-year-old boy. The dead limb progressed in the span of 3 weeks. An emergency forequarter amputation (FQA) was conducted to prevent further complications such as septicemia and mortality. Two months after the surgery, the patient had improved quality of life. One year after, the patient had no local recurrence. However, there was a lung metastasis detected 9 months after the surgery. The patient died 13 months after the surgery. CONCLUSIONS Osteosarcoma of the proximal humerus can potentially compromise vascular structures. Early diagnosis and treatment are mandatory to prevent such complications.

Union of Brodsky type 1/Eichenholtz stage III Charcot neuroarthropathy after forefoot arthrodesis.

INTRODUCTION: One of the surgical intervention options for Charcot neuroarthropathy (CN) is arthrodesis. The arthrodesis procedure for the foot and ankle joint have been widely used in previous studies. This study aimed to evaluate the functional and radiological outcomes after arthrodesis procedure for the CN patient with Brodsky type 1/Eichenholtz stage III. PRESENTATION OF CASE: A 49-years-old diabetic woman presented with alteration of her right foot's shape and a cracking sensation while walking in the last six months. Rocker-bottom deformity and a decreased sensation on the right foot were found, and the initial American Orthopaedic Foot & Ankle Society (AOFAS) score was 45. Subsequently, forefoot arthrodesis of the right foot was performed. DISCUSSION: Several studies state that arthrodesis procedure is often used for CN management in order to achieve a plantigrade and stable foot. This study presents an improvement of the foot arch, AOFAS score, and union of the talus six months after surgery. CONCLUSION: The arthrodesis procedure by using screws and Kirschner wire (K-wire) fixation is an effective method in CN management if the patient is compliant. This study showed a good result, anatomically restored the foot arch, and excellent radiological union, but different tools to analyze foot functional status and longer follow up period are needed for a better analysis.

Primary single stage Total Hip Arthroplasty in a patient 40 years post traumatic Hip dysplasia, a case report.

INTRODUCTION: Hip dysplasia refers to an abnormal development of size, shape, or organization of the femoral head, acetabulum, or both. Managing acetabular dysplasia is very challenging in arthroplasty especially in traumatic hip dysplasia case. Mostly, hip dysplasia cases need a special implant, procedure and techniques. CASE PRESENTATION: We performed primary Total Hip Arthroplasty (THA) + partial tenotomy of hamstring, iliotibial band, hip abductor in a 73 year old male. His main complaint was that he was unable to sit due to an increasingly intense pain since 3 months ago and he has been unable to walk properly since 40 years ago when he had a major traffic accident and received inadequate treatment. The procedure had been successfully done using a well press-fit cementless acetabular cup and a cementless narrow stem application 1 cm on leg length discrepancy (LLD). CONCLUSION: Preoperative planning, surgical techniques and a post-surgery rehabilitation are the key to a successful management in this case.

ß-Glucan of Candida albicans Cell Wall Extract Inhibits Salmonella Typhimurium Colonization by Potentiating Cellular Immunity (CD8 + and CD4 + T Cells).

INTRODUCTION: Antimicrobial resistance has been reported in the drugs used for the treatment of typhoid fever. The immunomodulatory substance ß-glucan can be used as an alternative therapy as it potentiates host immunity. The aims of this study are to observe the effect of Candida albicans cell wall (CCW) extract towards host immunity (TCD8+ and TCD4+ cells in spleen, intestinal sIgA) and its capacity to kill Salmonella in the intestine and liver of typhoid fever mice models. METHODS: Typhoid fever mice models were created by infecting mice with S. Typhimurium orally. Mice were divided into four groups: the Non-Infected, Infected, CCW (infected mice treated with 300 µg CCW extract/mouse once a day), and Ciprofloxacin groups (infected mice treated with 15 mg/kg BW ciprofloxacin twice a day). RESULTS: Secretory IgA (sIgA) concentrations of mice in the CCW group remained unchanged. However, their TCD4+ and TCD8+ cells increased substantially compared to those in the Non-Infected group. In the Ciprofloxacin group, sIgA concentrations increased markedly compared to those in the Non-Infected and CCW groups; TCD4+ and TCD8+ cells also increased significantly compared to those in the Infected Group, but not significant compared to those in the CCW group. Colonization of S. Typhimurium in the intestine and liver decreased significantly in the CCW and Ciprofloxacin groups compared to that in the Infected group, with the lowest reduction being found in the Ciprofloxacin group. CONCLUSIONS: The inhibition of S. Typhimurium colonization by CCW is associated with the increase in TCD4+ and TCD8+ cells.

Elbow Fracture in Children at Saiful Anwar General Hospital, Nine Years Experiences.

AIM: The frequency, incidence, and types of fracture of the elbow are different between children and adult. The epidemiology of elbow fracture in children has been the subject of a limited number of studies. This study aims to observe the pattern of elbow fractures in children 18 years of age and younger, during a nine years period. METHODS: This is a retrospective study about elbow fracture cases in children 18 years old and younger treated in Saiful Anwar General Hospital Malang in the period of June 2009 until December 2018. The data obtained from the medical record include the age at the time of accidents, fracture site, type of lesion and ipsilateral injuries, time of accidents, and the mechanism of injury. RESULTS: There is a total of 99 elbow fracture, and there are 62 male (63%) and 37 female patients (37%). The mean age for the entire group is 7.3 years (8.1 years for male and 7.1 years for female). Most cases are supracondylar fracture (n = 77, 78%). The supracondylar fracture is composed of 17 fracture classified to type II, and 60 fracture to type III as classified by Gartland. The most common etiology of fracture is associated with sports, recreational activities, and fall from height of less than two meters. Nerve injury involving the median, radial, and ulnar nerve is seen in eight patients with type III supracondylar fracture. Associated brachial artery injury is seen in four patients with type III supracondylar fractures. A group of 78 patients (79%) were treated surgically and 21 patients (21%) were treated conservatively. CONCLUSION: The incidence of elbow fracture in children treated in Saiful Anwar General Hospital during a nine years period is 99 patients, with supracondylar fracture Gartland type III being the leading type of this group. Male patients are more common than female patients. Nerve injury was seen in 13.33% of cases and brachial artery injury was seen 6.67% with type III supracondylar fracture. Most of the elbow fracture in our institution were treated operatively.

Β-Glucan of candida albicans cell wall extract inhibits salmonella typhimurium colonization by potentiating cellular immunity (cd8 + and cd4 + t cells)

Abstract INTRODUCTION: Antimicrobial resistance has been reported in the drugs used for the treatment of typhoid fever. The immunomodulatory substance β-glucan can be used as an alternative therapy as it potentiates host immunity. The aims of this study are to observe the effect of Candida albicans cell wall (CCW) extract towards host immunity (TCD8+ and TCD4+ cells in spleen, intestinal sIgA) and its capacity to kill Salmonella in the intestine and liver of typhoid fever mice models. METHODS: Typhoid fever mice models were created by infecting mice with S. Typhimurium orally. Mice were divided into four groups: the Non-Infected, Infected, CCW (infected mice treated with 300 µg CCW extract/mouse once a day), and Ciprofloxacin groups (infected mice treated with 15 mg/kg BW ciprofloxacin twice a day). RESULTS: Secretory IgA (sIgA) concentrations of mice in the CCW group remained unchanged. However, their TCD4+ and TCD8+ cells increased substantially compared to those in the Non-Infected group. In the Ciprofloxacin group, sIgA concentrations increased markedly compared to those in the Non-Infected and CCW groups; TCD4+ and TCD8+ cells also increased significantly compared to those in the Infected Group, but not significant compared to those in the CCW group. Colonization of S. Typhimurium in the intestine and liver decreased significantly in the CCW and Ciprofloxacin groups compared to that in the Infected group, with the lowest reduction being found in the Ciprofloxacin group. CONCLUSIONS The inhibition of S. Typhimurium colonization by CCW is associated with the increase in TCD4+ and TCD8+ cells.