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Background: Neglected elbow dislocation is common in developing countries. The chronic nature of the disease results in a level of complexity that makes treatments and outcomes contradictory. Several treatment methods have been described for neglected elbow dislocations. The goal of this study was to evaluate the results of neglected elbow dislocations treated using the double approach of reduction and K-wire fixation. Methods: This series included patients with neglected elbow dislocations who were treated with open reduction using double approaches (medial and lateral incisions) between November 2020 and March 2021. Patients were evaluated for a minimum of 6 months to ascertain functional recovery in accordance with the Mayo Elbow Performance Index (MEPI) and Disability of Arm, Shoulder, and Hand (DASH) score. Results: Nine patients with neglected elbow dislocations were included in the study, with an average delay of 3.44 months. Four patients had an excellent MEPI and five had a good score at the final follow-up, with a mean MEPI score of 86.67. The average DASH score was 36 (31-59). Five patients (55.56%) experienced no pain, but four patients (44.44%) had mild pain, with a range of pain points of 30-45. The motion arc improvement was 60°-100°, with a mean of 74.44°. Almost all of the patients (eight patients, 88.89%) had elbow stability, but one patient had ulnar nerve paresthesia postoperatively. Heterotopic ossificans was associated in 1 patient, and triceps lengthening was needed in 1 patient; both came 5 months later. Conclusion: Open reduction surgery with a double approach offers a good chance of a good result with few side effects and should be considered for all patients who have this condition.
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INTRODUCTION AND IMPORTANCE: Tibial plateau fractures are often accompanied by soft tissue compromise, especially in Schatzker 5 and 6, caused by high-energy trauma. In this situation, more careful consideration is needed. A rush decision will result in morbidity, bad postoperative wounds, and infections resulting in dehiscence. CASE PRESENTATION: We have three patients with the tibial plateau. In the first case, ORIF was still performed on the fracture with soft tissue compromised. The patient was found to have wound dehiscence resulting in an implant-exposed bone. In the subsequent two cases, Patients with tibial plateau Schatzker 6 fractures also showed blisters around their injured knees. We performed hybrid external fixation. Screwing fixation was performed to obtain compression. Kirschner wire 2.2 formed a raft configuration attached to the semicircular frame and uniplanar external fixation to support the tibial plateau. CLINICAL DISCUSSION: A hybrid external fixation is an excellent option for treating tibia plateau fractures with compromised soft tissue. It can achieve early fracture fixation while avoiding soft tissue problems; thus, the patients can start early rehabilitation. CONCLUSION: A hybrid external fixation can be applied to tibial plateau fractures with soft tissue compromised without waiting for subsiding and has satisfactory clinical and radiological outcomes. The author also explains this case report's hybrid external fixation technique.
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Since the 1990s, new insights in wrist arthroscopy have led to the introduction of numerous treatment methods. Consequently, therapeutic procedures are no longer limited to resection as more specialized repair and functional reconstruction methods, involving tissue replacement and essential structural augmentation, have been shown to be beneficial. This article discusses the most prevalent reasons and uses for wrist arthroscopy, with an emphasis on Indonesia's most recent and major advances in reconstructive arthroscopic surgery. Joint debridement, synovectomy, ganglionectomy, capsular release, and osteotomies are frequent resection operations. Ligament repair and arthroscopy-aided reduction and fixation for fractures and nonunion are all examples of reconstructive surgery.
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Background: Traumatic brachial plexus injury (TBPI) is a severe injury in the upper extremity which can affect the quality of life. The incidence of these injuries has been increasing in recent years. The purpose of this study was to describe the characteristic of TBPI patients treated by surgery at a tertiary Orthopedic hospital in Surakarta, Indonesia. Methods: This is a descriptive retrospective study of patients diagnosed with TBPI who underwent surgery between July 2013 and December 2021. Results: This study included 374 patients with male predominance (86.10%) and an average age of 30.61 years. The most common age group was 20-29 years (45.45% of all age groups). Traffic accidents were the most common cause of this injury (91.98%), especially motorcycle accidents (94.48% of traffic accidents). The most frequent type was complete preganglionic complete injury (48.93%). Most of the patients were the result of traction injury (96.26%). The right side (58.02%) was more common. One patient (0.27%) presented with bilateral lesions. As much as 52.67% of patients presented with concomitant injuries. Fractures were the most common concomitant injuries (90.73%). Humeral shaft fractures were the most common fractures (29.10%), followed by forearm and clavicle fractures (16.10% and 21.98% respectively). A total of 19.52% of patients underwent surgery between 3 and 6 months after trauma. Nerve procedures were performed in 57.38% of all surgical procedures and the rest were secondary procedures: Tendon transfers (36.92%), arthrodesis (2.53%), and Free Functional Muscle Transfer (FFMT) 2.74%. Conclusion: The young population, especially men, were commonly subjected to this injury with motorcycle accidents as the most common cause. Early recognition and optimum treatment must be done to improve functional outcomes. Improvement of road safety and spreading the health education of TBPI are recommended to reduce the incidence of injury and improve functional outcomes.
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BACKGROUND: The distraction osteogenesis procedure has a high potential to treat bone defect problems. The alternative technique to treat nonunion associated with a bone defect is the acute shortening and re-lengthening (ASRL) procedure. This study aimed to evaluate the outcome of ASRL procedure with a monorail fixator to treat femur/tibia nonunion associated with the bone defect. METHOD: Retrospective analysis was performed to patients who received ASRL procedure with monorail fixator for femur or tibia nonunion from October 2018 to October 2020 at Prof. Dr. R. Soeharso Orthopaedic hospital. One case was loss to follow-up and excluded from the study. The rest of 16 cases were included for further analysis. The evaluation was performed to the demographic, intraoperative procedure, problems/complications, additional procedure, and final outcome. RESULTS: There were 13 male and three female patients with age ranged from 16 to 64 years old. The follow-up period ranges 9-31 months. ASRL procedures performed to 6 femur and 10 tibias. The problems/complications: two cases with problems associated with callus formation, two cases of fracture at corticotomy site, one case of skin necrosis, one case of osteomyelitis, one case of malrotation. Additional surgical procedures were needed 5/16 (31.2%) cases. Evaluation at the final follow-up period showed 14/16 (87.5%) cases had a complete bone union. CONCLUSIONS: Acute shortening and re-lengthening (ASRL) could be reliable as a method of treatment for femur/tibia nonunion associated with the bone defect. Several possible complications need to be considered prior to perform this procedure.
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INTRODUCTION: Macrodystrophia Lipomatosa is a rare congenital non-hereditary disorder, characterized by the presence of gigantism of a small part of the limb or the whole limb due to an overgrowth and disproportionate growth of fibroadipose tissue, causing macrodactyly. CASE PRESENTATION: One case of the 14-year-old girl presented with an enlarged middle finger of her left hand since birth, discomfort during the last 6 months, and resistance to flex, was underwent surgery by performing debulking procedure and a yellow cord-like mass was obtained from the digital nerve covered and enlarged by fibrofatty tissue to the palm area, could be cut off completely. Imaging and histopathological examination revealed to macrodystrophia lipomatosa. We follow up the patient for the finger's range of motion, the neurological disturbance and re-enlargement of the tumor. DISCUSSION: Since there were compression of the nerves, functional impairment due to enlarge fingers and cosmesis problems, the surgery was indicated. Types of surgery may include debulking of soft tissue, especially adipose tissue. The mass size was decrease, motor function and movement of the middle finger were normal post operatively, but sensory deficits persisted according to the distribution of the digital nerves. Three months and six years after surgery, no enlargement of the middle finger, normal motor function, normal finger movements but sensory deficit still persisted according to the distribution of the digital nerves. CONCLUSION: Surgical management in macrodactyly due to macrodystrophia lipomatosa of the finger give the satisfactory result.