Journal Orthopaedi and Traumatology Surabaya

Front Matter

Front Matter — 2024-11-01

Front Matter

Suppurative Flexor Tenosynovitis: A Case Report

Pramono Ari Wibowo, M.D. — 2024-10-31

Background: Suppurative flexor tenosynovitis is an infection of the flexor tendon sheath. This case report presents the clinical course and management of a patient diagnosed with suppurative flexor tenosynovitis. The diagnosis is based on history taking, physical examination, and supporting examination findings.
Case Report: A 42-year-old man presented with chief complaints of pain, swelling, and immobility of the index finger of his right hand after being pierced by a fish spine 3 days prior. Physical examination revealed the second digit in a slightly flexed and swollen position, with pain elicited on palpation and passive extension, limiting the patient's range of motion. The patient was diagnosed with suppurative flexor tenosynovitis and treated with antibiotics, debridement, and drainage. Postoperative results were good, with no signs of complications such as spread of infection, tendon necrosis, osteomyelitis, or indications for amputation.
Discussion: The treatment for suppurative flexor tenosynovitis involves a combination of antibiotics and surgery. Surgical interventions typically include open drainage and debridement or closed catheter irrigation. Additionally, postoperative rehabilitation is a crucial aspect that requires careful consideration, as it has been shown to accelerate the healing process.
Conclusion: Suppurative flexor tenosynovitis is a rare but serious condition that demands early detection and a multidisciplinary approach. Timely surgical debridement and targeted antibiotics, guided by the identification of the causative organism, are essential for positive patient outcomes.

Hypergravity as a Possible Way of Bone Tissue Engineering in Osteoblastic Differentiation from Mesenchymal Stem Cells: A Systematic Review

Wisnu Sudrajad — 2024-10-31

Background: Tissue engineering development has become a highlight in recent decades. One of the key areas of focus is producing mature bone tissue to overcome orthopedic problems, such as bone defects. Various cultures have been implemented on stem cells; some induce osteoblastic differentiation markers, while others have the opposite effect. Microgravity has been proven in several studies to inhibit the expression of osteogenic differentiation markers. Conversely, hypergravity is expected to have the opposite impact, supporting stem cells in the osteogenesis pathway.

Methods: A literature search was conducted using online databases including Sciencedirect, PubMed, and Proquest, covering the period from 2008 to 2022. This search considered only experimental studies published in English. The keywords used in this research were "hypergravity" and "mesenchymal stem cell." All acquired data were processed and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (2020).

Results: Initially, 190 studies were collected from online databases based on relevant keywords. After screening, 5 studies were included in the final analysis, focusing on hypergravity treatment and its effects on mesenchymal stem cells (MSCs).

Conclusion: Hypergravity shows a significant and strong impact on osteoblastic differentiation. This study revealed that a gravity force of 30G and a culture duration of 7 to 14 days are the most optimal combination for inducing osteoblastic differentiation in MSCs.

The Potential Applications of Stem Cell Conditioned Medium Secretome in Knee Cartilage Regeneration: A Systematic Review

I Gusti Ngurah Wien Aryana — 2024-10-31

Background: Articular cartilage injuries often result from trauma, genetic predisposition, and degeneration. These injuries lack inherent regeneration mechanisms due to the absence of blood vessels and limited progenitor cell entry. Osteoarthritis is characterized by gradual cartilage deterioration. Mesenchymal stem cells (MSCs), particularly their secretome including exosomes, hold promise as a regenerative therapy. This review explores the application of MSCs and their secretome to address cartilage defects.
Methods: This review was conducted based on PRISMA guidelines. Animal model studies focusing on the use of stem cell secretomes for cartilage regeneration were explored. The search, encompassing PubMed, MEDLINE, the Cochrane Library, Scopus, Web of Science, and Science Direct from January 10, 2023, to July 27, 2023, was conducted utilizing Google Chrome as the search engine. Studies with outcomes based on OARSI or ICRS scores, as well as any additional outcomes related to MSC secretome utilization, cartilage regeneration, and proliferation, were included.
Results: Our systematic review identified six studies using MSCs in vivo and in vitro. Synovial membrane-derived MSCs significantly enhanced cartilage regeneration by elevating chondrogenic capabilities. Hydrogel-based systems techniques and 3D-printed scaffolds have emerged for innovative delivery. Specific microRNAs, such as miR-92a-3p, have been recognized for enhancing cartilage regeneration. Strategies for the effective targeting of MSC exosomes to the precise cartilage damage site have been explored.
Conclusions: The studies demonstrate the potential of MSC-derived secretomes and exosomes for knee cartilage regeneration in animal models. Further research and clinical trials are needed to refine these approaches for practical application.

Effects of Neoadjuvant Denosumab on Radiological and Histological Responses in Patients Undergoing En Bloc Resection for Giant Cell Tumor of Bone: A Systematic Review

Hendra Aditama — 2024-10-31

Background: Giant cell tumor of bone (GCTB) is a rare primary bone tumor. The standard treatment is en bloc resection, which can be challenging due to tumor size or location. Denosumab, a monoclonal antibody, has emerged as a promising neoadjuvant therapy for GCTB, potentially facilitating surgical resection. However, its optimal use remains unclear, with debate surrounding its impact on local recurrence. This systematic review aims to synthesize evidence on the histological and radiological changes induced by neoadjuvant denosumab and its impact on surgical outcomes.
Methods: This review followed PRISMA guidelines. The medical term "denosumab", "neoadjuvant", "GCTB", "radiological", and "histological" were used in PubMed (423 articles) and Google Scholar (18,100 articles), totaling 18,523 articles to discover studies of the effect of neoadjuvant denosumab on radiological and histological response up to July 2023. Six remaining studies were reviewed and screened for inclusion criteria based on their relevance to the study subject and clinical outcomes.
Results: Based on six studies in this review, five showed histological response by decreasing the multinucleated giant cells and osteoclasts after neoadjuvant DT. Six studies showed increased significant bone reconstitution as a radiological response in the GCTB locale, replaced the extending tumor into soft tissue by abundant bone production with peripheral shell, and increased ease of en bloc resection.
Conclusions: Neoadjuvant denosumab therapy shows promise in managing giant cell tumors of bone (GCTB) by reducing osteoclasts, shrinking tumor volume, and promoting cortical bone formation, thus facilitating en bloc resection. However, further research is needed to confirm these findings.

Profile of Lumbar Spinal Stenosis Patients at Dr. M. Djamil Central Public Hospital from 2018-2022

Inasa Faiza Akbar — 2024-10-31

Background: Lumbar Spinal Stenosis (LSS) is a pathological condition characterized by narrowing of the spinal canal in the lower back. In Indonesia, comprehensive data on LSS is currently unavailable. This study aimed to determine the profile of LSS patients at Dr. M. Djamil Central Public Hospital.

Methods: This descriptive cross-sectional study utilized medical record data from 122 LSS patients at Dr. M. Djamil Central Public Hospital between 2018 and 2022, selected via consecutive sampling. Inclusion criteria included age over 18 years and a confirmed LSS diagnosis. Exclusion criteria included incomplete medical records, lack of MRI results, and follow-up visits without treatment. Univariate analysis was performed using SPSS 25.0 to describe patient characteristics, causative factors, symptoms, location of stenosis, and management type.

Results: In this study, 122 samples met the inclusion and exclusion criteria. LSS was mainly found in patients aged 60-69 years (33.6%) and in women (59%). Most LSS patients had obesity (BMI category I, 32%). Many LSS patients were housewives (42.62%) and reported light work activity (63.1%). The most common cause of LSS was degenerative factors (59%). The main symptom experienced by LSS patients was lower back pain (94.3%), frequently accompanied by radicular pain (79.5%). The most common location of stenosis was L4-L5 (43.4%). Most LSS patients in this study were managed both conservatively and operatively (70.5%).

Conclusion: These findings contribute to a better understanding of LSS prevalence and distribution among patients. Further multicenter studies are needed to establish a comprehensive national LSS profile.

Characteristics and Management of Neck and Trochanteric Femur Fractures at a Tertiary Hospital in Indonesia: A Retrospective, Single-Center Study

Ndilalah Pulungan — 2024-10-31

Background: Although hip fractures are common among the elderly population, there are still limited studies on neck-trochanteric fractures, one of the less common types of hip fractures. This study aims to describe the characteristics of patients and their management in patients with neck trochanteric fractures.

Methods: This retrospective cross-sectional study analyzed medical records of patients aged >18 years with trochanteric fractures from a tertiary hospital in Central Java, Indonesia, between January and December 2021. Fracture types were identified and classified using the Garden, Pauwels, and AO/OTA classifications. Demographic data, risk factors, fracture locations, and treatment types were also collected. Statistical analysis was performed using SPSS 21.0 to describe patient characteristics.

Results: The total sample was 77 patients, most were female (n = 55 (71.4%)) and aged > 60 years. More than a third of diagnosed fractures were neck of the femur fractures in 33 patients (42.9%). Among the most common classification types of fractures were Garden Type 3, Pauwels Type 3, and AO/OTA type A1.1. A total of 33 patients (42.9%) underwent open reduction of the fracture with internal fixation.

Conclusions: Our findings show that the prevalence of neck-trochanteric fractures mostly occurs in patients > 60 years of age and in females. Although open reduction with internal fixation is generally performed, there are several cases of fractures that are not classifiable due to limited imaging examinations. Further research on a wider population is needed to confirm the findings of this study.

Correlation Between Shoulder Pain Severity, Acromion Morphology, and Acromiohumeral Distance Using MRI: A Study at Haji Adam Malik Hospital Medan in 2022

Husnul Fuad Albar — 2024-10-31

Background: Studies have shown that rotator cuff tears (RCTs) are the most common cause of shoulder pain and restricted movement. The acromion is a posterior shoulder landmark. Specific acromion morphologies may predispose individuals to rotator cuff tears. Furthermore, studies have found a correlation between supraspinatus tendon tears and acromiohumeral distance. This study examines how shoulder pain assessed with American Shoulder and Elbow Surgeons (ASES) score relates to acromion morphology and acromiohumeral distance on MRI at Haji Adam Malik Hospital in 2022.
Methods: This descriptive analytical study employed a cross-sectional approach. A total of 38 patients with a confirmed diagnosis of shoulder pain underwent shoulder MRI examinations and were assessed using the ASES score. Statistical analysis included assessing data normality and performing Spearman correlation analysis. Data were processed and analyzed using SPSS version 25.0.
Results: In this study of 38 patients, most participants were women with an average age of 54.66 years. The most common acromion type was type 1 (flat), and the most frequent acromiohumeral distance category was normal. There was no correlation between acromion type and ASES scores, but a moderate correlation was found between the scores and acromiohumeral distance (p=0.016). A positive correlation was observed between type III acromion and ASES score.
Conclusion: Shoulder pain based on ASES score has a moderate correlation with acromiohumeral distance and acromion type III variation has a positive correlation although there is no significant correlation was found between shoulder pain and acromion type.