The use of bovine-derived hydroxyapatite xenograft for defect filling in opening-wedge high tibial osteotomy.

High tibial osteotomy is a reliable procedure for the correction of knee varus deformity. An opening-wedge high tibial osteotomy (OW-HTO) is the most popular technique. The results of the bone defect after opening the wedge needed special treatment to ensure bone healing. This study aims to evaluate the use of bovine-derived hydroxyapatite graft for defect filling after OW-HTO. Methods: A retrospective study was performed on all patients who received OW-HTO at Prof. Dr R. Soeharso Orthopaedic Hospital from November 2019 to December 2022. A total of 21 patients (24 knees) were included in this study. Clinical dan radiological evaluation was performed on all patients preoperative and postoperatively. The mean of the follow-up period was 12.6 months with a minimum of 4 months follow-up. Results: Primary medial uni-compartment knee osteoarthritis was the most common diagnosis, with 17 of 24 cases (70.8%). Mechanical axis deviation was changed from 31 mm medial deviation (range: 8-52 mm) to 0.45 mm medial deviation (range: 13 - (-8) mm). The anatomic tibiofemoral angle was corrected from a preoperative mean of 4.7° of varus to a mean of 5.8° of valgus postoperatively. Bone defect height was mean 15.9 mm with a range of 10-23 mm. Bone defect width was mean 46.7 mm (range: 34-60 mm). Hydroxyapatite graft integration with the host bone was found in all patients during the final follow-up period. Conclusions: Bovine-derived hydroxyapatite graft is a safe and effective material for bone defect filling in OW-HTO procedures with a high bone union rate.

Asymmetric bilateral traumatic hip dislocation: Report of two cases.

INTRODUCTION AND IMPORTANCE: Asymmetric bilateral hip dislocation is an extremely rare condition. The mechanism of injury and severity are variables. We reported two cases of asymmetric bilateral hip dislocation with different pattern of injury and different onset of injury. CASE PRESENTATION: The first case was a male 20 years old with 7 months neglected asymmetric bilateral hip dislocation. Total hip arthroplasty (THA) was performed on both hips, which resulted in good clinical outcomes. The second case was a male 32 years old with acute right open anterior dislocation (obturator type) and left posterior fracture-dislocation. Emergency debridement and open reduction were performed on the patients with reduction and fixation for the left hip. CLINICAL CASE DISCUSSION: To the best of our knowledge, this is the first reported case of open anterior hip dislocation with exposed femoral head on inguinal area in the setting of asymmetric bilateral hip dislocation. Furthermore, this article also presented another case with >6 months neglected time along with the surgical treatment. CONCLUSIONS: Asymmetric bilateral hip dislocation is a rare injury which usually associated with high-energy trauma. Open injury with the exposed femoral head is possible to occur in this kind of rare case. In the setting of long-term neglected cases, total hip arthroplasty could be recommended as the treatment choice.

Platelet-rich fibrin as a tissue engineering material in accelerate bone healing in rat bone defects: A systematic review and meta-analysis.

Introduction: Various techniques for tissue engineering have been introduced to help regenerate damaged or lost bone tissue. This study aimed to see the potential implication of platelet-rich fibrin (PRF) to accelerate the bone healing process in rat bone defects. Methods: A systematic literature search was conducted from several electronic databases on subjects looking at the use of PRF in rat bone defects and their results in bone regeneration. Specific results compared PRF vs. other methods, PRF vs. control, and PRV vs. combination PRF and other methods. Science Direct, PubMed, and Cochrane Library were the main information sources. The Cochrane Collaboration method is employed to assess the risk of bias. Results: A total of 483 rats were used in the twelve studies, and this meta-analysis showed that the PRF vs. other methods pooled odds ratio (OR) obtained was 0.92 (95% CI 0.42-2.04; p = 0.29; I2 = 18%), PRF versus control OR obtained 9.45 (95% CI 4.68-19.08; P = 0.01; I2 = 0%), the combination of PRF compared to PRF alone OR obtained 0.12 (95% CI 0.03-0.41; p = 0.01; I2 = 0%). Discussion: Platelet-rich fibrin accelerates the bone healing process in rat bone defects compared to physiologically. Platelet-rich fibrin combined with other methods can stimulate rat bone defects than utilization of platelet-rich fibrin only. The small number of articles assessed may cause limitations in sensitivity tests. This study was registered in the research registry (reviewregistry1341).

Cervical Fracture During COVID-19 Pandemic Era: A Case Series.

BACKGROUND: Cervical fractures are potentially serious and can have fatal consequences if not treated properly. Correct diagnosis and classification of injury is the first step in determining the most appropriate treatment. Cervical fractures will have an impact on the patient's work, and COVID-19 is a challenge in the hospital to treat a cervical fracture. This study aims to discuss the case of patients with cervical fractures that have undergone surgical treatment in the COVID-19 pandemic. CASE PRESENTATION: Two cases of emergency patients with cervical injury treated at the hospital in the acute setting of the COVID-19 pandemic. All these patients experienced delayed timing to arrive in the emergency department of Prof. Dr. R. Soeharso Orthopedic Hospital. Neurological outcome was assessed before being discharged after surgery and a 3-month follow-up post-surgery. RESULTS: Laminectomy and posterior stabilization and fusion (PSF) were performed immediately after diagnosis was established in both patients. Physical rehabilitation was performed. In a 3-month follow-up, both patients' neurological functions improved. CONCLUSION: Clinical outcomes of cervical injury patients can be affected by some factors, for example, timing to diagnosis, timing to traction application, timing to surgery, and timing to rehabilitation. Depending on the institution, weekend days can also affect the delay of the COVID-19 PCR swab. MRI schedule and patient optimal condition can also affect the timing to surgery. The immediate diagnosis and prompt treatment are needed to make a better outcome, especially better neurological status.

Kyphotic angle correction and neurological status evaluation after operation in spinal tuberculosis patients: Single center retrospective study.

BACKGROUND: Previous studies have indicated that correction of an established kyphosis in spine tuberculosis is both difficult and hazardous. There has not been any publication about evaluation of surgical correction of spine tuberculosis in Indonesia, despite of high incidence of spine tuberculosis cases. Therefore, we evaluated the outcome of kyphotic angle correction and neurological status after surgery of spinal tuberculosis patients for better understanding. METHODS: Retrospectively, 96 patients with spinal tuberculosis that underwent operation in Soeharso Orthopedic Hospital from June 2016 to July 2019 were selected. Operation procedure includes laminectomy, debridement and posterior stabilization. We obtained plain x-ray of spine to evaluate the kyphotic deformity before and after surgery. We also examined neurological status of the patient before and after surgery. RESULTS: The average pretreatment kyphotic angle in thoracic tuberculosis was 33.69° (range 8°-86°), which improved into a significant change to 13.27° (range 0°-56°). Correction angle was <25° in 34 people, 25°-50° in 17 people, and >50° in 4 people. While in the lumbar tuberculosis, it was 25.52° (range 6°-80°), and improved into 11.51° (range 2°-48°). Correction angle was <25° in 35 people, 25°-50° in 4 people, and >50° in 2 people. Improved neurological deficit was shown in 12% of patient with lumbar tuberculosis, and the rest had constant neurological deficit. While in thoracic tuberculosis found that 7% have improved neurological deficit and the rest is constant. None of them have worsen neurological status after the surgery. CONCLUSIONS: Surgical treatment for kyphotic deformity in patient with thoracolumbar tuberculosis are effective and safe, even in high corrective angle (>50°).

In Vitro Degradation and Cytotoxicity of Eggshell-Based Hydroxyapatite: A Systematic Review and Meta-Analysis.

OBJECTIVE: This review focuses on the in vitro degradation of eggshell-based hydroxyapatite for analyzing the weight loss of hydroxyapatite when applied in the human body. Cytotoxicity tests were used to observe cell growth and morphological effects. A systematic review and meta-analysis were conducted to observe the weight loss and viable cells of hydroxyapatite when used for implants. METHOD: Based on the Population, Intervention, Comparison, and Outcome (PICO) strategy, the articles used for literature review were published in English on SCOPUS, PubMed, and Google Scholar from 1 January 2012 to 22 May 2021. Data regarding existing experiments in the literature articles the in vitro degradation and cytotoxicity testing of eggshell-based hydroxyapatite determined the biocompatibility of the materials. A meta-analysis was conducted to calculate the mean difference between the solutions and soaking times used for degradation and the stem cells used for cytotoxicity. RESULTS: From 231 relevant studies, 71 were chosen for full-text analysis, out of which 33 articles met the inclusion criteria for degradation and cytotoxicity analysis. A manual search of the field of study resulted in three additional articles. Thus, 36 articles were included in this systematic review. SIGNIFICANCE: The aim of this study was to highlight the importance of the biocompatibility of eggshell-based hydroxyapatite. The weight loss and viability cells of eggshell-based hydroxyapatite showed optimum results for viable cells requirements above 70%, and there is a weight loss of eggshell-based hydroxyapatite for a material implant. The meta-analysis indicated significant differences in the weight loss of eggshell-based hydroxyapatite materials with different soaking times and solutions used. The various kinds of stem cells for incubation of cultured cells in contact with a device, either directly or through diffusions with various kinds of stem cells from animals and humans, yielded viability cells above 70%.

Distraction osteogenesis at the site of previously cystic bone lesion of femur: A case report.

INTRODUCTION AND IMPORTANCE: Limb length discrepancy can be occurred as residual problems after bone cyst treatment. Distraction osteogenesis is one of surgical option to treat this problem. CASE PRESENTATION: A male 27 years old came with 3 cm residual lower limb discrepancy after treatment of femoral aneurismal bone cyst (ABC). Distraction osteogenesis has been successfully performed to treat this case at the site of previously cystic bone lesion. CONCLUSION: Good quality of callus could be expected at the site of distraction osteogenesis that previously a cystic bone lesion.

An Unusual Case of Anteriorly Displaced Posterior Cruciate Ligament Tibial Attachment Avulsion Injury.

BACKGROUND: Avulsion injury to the tibial attachment of posterior cruciate ligament (PCL) is frequently occur. The purpose of this report is to highlight an unusual variation of PCL avulsion injury. CASE PRESENTATION: A 24-year-old female was suffered a motorcycle accident 1 day before admission. The patient complained of severe right knee pain. Plain radiograph and CT-scan revealed an anteriorly displaced tibial attachment PCL avulsion fracture. Open surgical fixation was done to the patient. A satisfactory outcome was observed until the final 1-year follow-up. CONCLUSIONS: The bony fragment of the tibial attachment of posterior cruciate ligament avulsion injury can be displaced to the anterior compartment of the knee. Concomitant injury to other knee structures should be suspected when finding this case. Special consideration is also needed during the management of this unusual case.

Bilateral Congenital Absence of Femur: A Rare Case Report.

INTRODUCTION: Bilateral congenital absence of femur is a rare congenital anomaly. CASE REPORT: We report a 2-year-old Indonesian female child, the third of the birth of diabetic mother. There is no congenital abnormality among her siblings. She has a normal mentality and normal upper limbs. She was brought to us with a complaint of the short lower limb. Examination revealed short lower limb with an absence of thigh, a full range of motion of the hip and ankle and left club foot. A detailed history was obtained and she was radiologically examined. The X-ray of the pelvis and lower limb shows shallow of the acetabulum, absence of bilateral femur, and uncommon form of tibia fibula. She was diagnosed with bilateral congenital absence of femur. CONCLUSION: We report this case because it does not meet the existing classification criteria for congenital femur deficiency. Proper evaluation and management of this case can help the patient and the parents to accept her condition and be able to live a good social and economically productive life.