Study epidemiology of risk fracture in osteoporosis based on frax score, and osta score, with risk of fall using Ontario score in elderly Indonesia.

Background: Osteoporosis is characterized by a low bone mass of bone tissue. If osteoporosis is not treated properly, it will increase the high risk of fracture. The common causes of fracture on osteoporosis condition due to falls. This study aims to find the correlation between the risk of osteoporosis with fall risk (ONTARIO) based on osteoporosis fracture risk (FRAX). Methods: This study is an analytic study with a cross-sectional method. We collected the sample using random cluster sampling in the six primary health care in Malang on different times service since August-September 2021. Total patient 139, however only 132 patients were included in this study. After collecting data is complete, we analyze using Chi-square tests. Results: The mean age of participants was 63.9 ± 7.14. with the age group was dominated by the range of 60-64. It was found that the result of the FRAX SCORE had a low-risk category for major fracture osteoporosis and risk hip fracture. In contrast, from the OSTA score in this study, more than 68 participants (50.8%) were found medium and high-risk scores. Then, in ONTARIO score of the risk fall assessment, and high score in 57 participants (43.2%). If compared between OSTA and ONTARIO, there was a significant relationship between OSTA score and ONTARIO score (p < 0.000) with high-risk OSTA have a significant relationship with a high risk of falling and vice versa. Conclusion: In this study, there was a relationship between the risk of high osteoporosis and the risk of falling.

The Management Growth Plate Injury in Animal Studies with Stem Cells Technique: Systematic Review.

Background: Injury of growth plate may lead to serious complications such as bone bridge formation, deformity, growth disturbance, and limb length discrepancy. Stem cell therapy is one of the fields studied to mitigate this problem. There are various types and techniques which can be implemented. Objective: This systematic review aims to review the most common techniques used in the experimental animal study about the application of stem cells to treat growth plate injury. Methods: This study was conducted according to PRISMA guidelines. The following strategy was used. The terms used on the search engine were "stem cell growth plate injury" in PubMed database. A bibliometric evaluation was done on all the search results. Results: The initial PubMed search yielded 74 results, but 5 articles were eliminated because they could not be accessed. From the remaining 69 articles, 50 were excluded after abstract and full-text review. Further, 7 articles were eliminated because they did not meet the inclusion criteria. Most studies are experimental animal studies, and there is no human trial regarding this matter. Conclusion: There are still a few studies evaluating the application of stem cell in treating growth plate injuries, but the present results are generally satisfactory. Hopefully, clinical trials could be conducted in the near future.

The Management Growth Plate Injury in Animal Studies with Stem Cells Technique: Systematic Review.

Background: Injury of growth plate may lead to serious complications such as bone bridge formation, deformity, growth disturbance, and limb length discrepancy. Stem cell therapy is one of the fields studied to mitigate this problem. There are various types and techniques which can be implemented. Objective: This systematic review aims to review the most common techniques used in the experimental animal study about the application of stem cells to treat growth plate injury. Methods: This study was conducted according to PRISMA guidelines. The following strategy was used. The terms used on the search engine were "stem cell growth plate injury" in PubMed database. A bibliometric evaluation was done on all the search results. Results: The initial PubMed search yielded 74 results, but 5 articles were eliminated because they could not be accessed. From the remaining 69 articles, 50 were excluded after abstract and full-text review. Further, 7 articles were eliminated because they did not meet the inclusion criteria. Most studies are experimental animal studies, and there is no human trial regarding this matter. Conclusion: There are still a few studies evaluating the application of stem cell in treating growth plate injuries, but the present results are generally satisfactory. Hopefully, clinical trials could be conducted in the near future.

Surgical Site Infection Management following Spinal Instrumentation Surgery: Implant Removal vs. Implant Retention: an Updated Systematical Review.

Background: The number of lumbar spine surgery increased in recent years. Spinal instrumentation surgery was an integral component in the treatment of spinal pathologies, which can cause surgical site infection (SSI). Surgical site infections (SSIs) are the leading cause of mortality and morbidity after spinal instrumentation surgery. The management of SSI was implant retention and removal is still unclear. Objective: The objective of this literature is to systematically review the implant removal and retention method for SSI management after spinal instrumentation surgery. Methods: We searched in PubMed and ScienceDirect for cohort and randomized control trial studies in English, published between 2002 and 2022, which had data on patients with spinal instrumentation surgery. The underlying disease, comorbidities, common bacteria, type of infection, the onset of infection, implant removal, and retention percentage and recommendation were analyzed. Bias analysis using Newcastle-Ottawa Quality Assessment. Results: We included 15 studies with a total sample were 2.584 with an average of age 15 to 66 years old. The most common organism detected were S. Aureus, MRSA, and S. Epidermis. The most common surgical procedure indications were degenerative followed by scoliosis. Implant removal and retention rate were 0-100% and 0-90,32% respectively. Implant removal is more frequently used in patients after spinal instrumentation surgery than the implant retention method. Conclusion: Implant retention can be performed in case of SSI is < 3 months after surgery. Implant removal is recommended if the incidence of SSI is > 3 months. Empirical antibiotics therapy is necessary to reduce the possibility of implant removal after debridement. Further studies on the effect of implant removal and retention in patients on infection recurrence, pain, and quality of life of patients are needed.

Osteotomy treatments and post-operative fixations for Blount disease: A systematic review.

Background: Blount disease is a developmental abnormality characterized by abnormal ossification of proximal tibia, resulting in lower limb deformities with tibia vara. The condition worsens into knee deformity, gait abnormalities, and premature medial compartment osteoarthritis if left untreated. Managements of those deformities have also advanced in line with the understanding of the deformities. Without proper care management, they could lead into residual and translational deformities, increase of recurrence, and complicate the revision surgery. Methods: This study aims to enrich our understanding about the recent advances of treatments for Blount disease by reviewing 15 articles published with osteotomy surgeries and fixation methods. We also highlight many aspects of pre-operative assessment and planning, post-operative complications and recurrence, patients' follow-up, and overall satisfaction from patients' self-assessment. Results: The scope of this review is considered small but still covers various efforts to manage Blount diseases, including single-stage double osteotomy, grafting fibular fragments into tibia, two comparison studies, two unique case study, and experimental techniques to manage special cases requiring novel procedures. Conclusion: Careful surgical planning, acute or gradual correction options, and the use of fixator should be tailored to individual cases.

Functional outcome and fusion rates of translaminar screw fixation of the lumbar and lumbosacral spine: A case series.

INTRODUCTION: Pedicle screw fixation has been the gold standard because this technique allows solid arthrodesis and provides a degree of stiffness that immediately diminishes mechanical back pain. Although the translaminar screw technique is considered inferior to the pedicle screw technique due to the thought that it is minimally invasive, studies proved that both fixation systems had significantly greater stiffness and reduced range of motion compared with the normal vertebrae. The purpose of this study is to determine the fusion rate, the clinical outcome of translaminar screw fixation of the lumbar and lumbosacral for the long term. CASE PRESENTATION: We evaluate six patients with a degenerative lumbar disorder and performed posterior lumbar fixation and fusion with the translaminar screw. The translaminar screw was performed monosegmentally (3 patients), across two segments (1 patient), and across three segments (2 patients). We then evaluate Oswestry Disability Index (ODI) score one week, three months, and one year postoperatively. DISCUSSION: When lumbosacral spine fusion procedures are performed without supplemental internal fixation, a 10% pseudoarthrosis rate can be expected for single-level fusions, and the percentage can reach 30% if more than two levels are fused. Compared to the pedicle screw technique, the translaminar technique provides a limited profile and less bony invasion that will minimize the risk of failure. CONCLUSION: Translaminar screw offers immediate postoperative stability, seen in postoperatively, patients experienced better quality of life than preoperatively. It also represents a useful and inexpensive technique for short segment fusion of the non-traumatic lumbar and lumbosacral spine.

Tibial reference point in total knee arthroplasty in patient with proximal tibia vara: A case report.

INTRODUCTION: Center of the intercondylar eminence at the proximal tibia had been widely used as a reference point for tibial bone cut in the Total Knee Arthroplasty (TKA) procedure. However, in the presence of preexisting tibia vara, the center of intercondylar eminence as tibial bone cut reference point often leads to varus malalignment after TKA procedure. CASE REPORT: 75 years old male patient complained of worsening pain on the left knee. The patient has had a history of knee osteoarthritis for the past seven years. The radiograph on the right knee revealed osteoarthritis grade 3 and left knee osteoarthritis grade 4, both with tibia vara. We planned to perform total knee arthroplasty surgery on his left knee with a preoperative planning tibial reference point of 10 mm lateral to the center. Six months after the knee replacement, there was minimal pain on activity, and full ROM was achieved on his left knee. On the radiographic X-ray evaluation, the alignment between the tibial implant surface and mechanical axis is 0.43 degrees valgus. CLINICAL DISCUSSION: In a varus knee malignment, the mechanical axis passes through one-third of the medial side of the knee, which makes the medial side of the implant wear off faster, resulting in the collapse of the medial tibia, thus decreasing implant survival and increasing the need for revision for TKA. CONCLUSION: In patients with preexisting tibia vara, tibial bone cut reference point planning before TKA procedure is important to provide longevity of implant survival and better quality of life.

Superconstructs in reconstruction surgery of Charcot foot Brodsky 1: A case report.

INTRODUCTION: Charcot neuropathic osteoarthropathy (CN) is a chronic, progressive condition of joints, soft tissues, and bones. CN causes considerable high mortality and morbidity. A common issue is early diagnosis and appropriate treatment. Thus, the operative treatment is indicated when patients have progressive deformities, infection and ulceration. The superconstructs method for Charcot foot (CF) is considered giving better clinical outcome than other methods. PRESENTATION OF CASE: A 61-year-old male admitted to an outpatient clinic with chief complaint of swelling and pain on a left foot with history of diabetes mellitus type 2. From the physical examination, left foot revealed a swelling with rocker bottom deformity and limited range of motion. The radiological examination showed sclerotic appearance of bone deformity metatarsal joint of midfoot of toe. The patients were diagnosed with left Charcot foot Brodsky Type 1, Eichenholtz grade III with diabetes mellitus type 2. DISCUSSION: We made superconstructs rather than standard fixation which is frequently inadequate due to changes accompanying the Charcot process. Thus, we performed an adequate reduction of deformity, reduce soft tissue tension, fixation extension beyond a zone of injury, then use of strongest fixation devices that are applied to maximize mechanical function. CONCLUSION: This study showed that superconstructs provide satisfactory clinical and outcomes. This method is useful for achieving construct and stable fixation especially for Charcot foot.