Journal Orthopaedi and Traumatology Surabaya <p><strong>Journal Orthopaedi and Traumatology Surabaya (JOINTS)</strong> (<a href="">e-ISSN: 2460-8742</a> <a href="">p-ISSN: 2722-712X</a>) is an online peer-reviewed open-access journal published by the Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Hospital Surabaya. <strong>JOINTS</strong> is a biannual journal published twice a year in April and October, including all areas of basic and clinical research related to orthopedics and traumatology issues. The journal published a minimum of 5 articles on research, study literature, and case studies each period. The journal accepts manuscripts in English. Contributors to <strong>JOINTS</strong> included: orthopedic researchers, orthopedic practitioners, lecturers, and students from Indonesia and a broad range of other countries. JOINTS is an indispensable source for all orthopedists.</p><p> </p><p> <a href="/JOINTS/issue/view/1798"><img src="/public/site/images/joints/10._Coverl_JOINTS_Orthobaya_2021_website_4.jpg" alt="" /></a></p> en-US <div><p>The copyright of the article is thereby transferred to <strong>Journal Orthopaedi and Traumatology Surabaya (JOINTS)</strong> if and when the article is accepted for publication in the journal, by the acknowledgment of the author. The copyright of accepted articles includes the rights to publish articles in various forms (including reprints) shall be assigned to JOINTS as the publisher of the journal.</p><p>Authors are allowed to distribute the published article by sharing the link/DOI of the article at JOINTS. Any legal purposes deemed necessary by the authors are allowed to do without written permission form JOINTS.</p><p>The Copyright Transfer Agreement of JOINTS can be downloaded <a href="">here</a></p><p><span><a href="" target="_blank"><span>Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License</span></a></span></p><p><a href=""><img src="/public/site/images/joints/cc_by_nc_sa.png" alt="" /></a></p></div><p> </p> (Dr. Lukas Widhiyanto, M.D., Ph.D.) (Agisa Prawesti) Thu, 28 Apr 2022 07:54:53 +0000 OJS 60 VACUUM-ASSISTED CLOSURE AND MUSCLE FLAP AS AN ALTERNATIVE MODALITY FOR INFECTED WOUND AFTER ORIF OF TIBIAL FRACTURE: CASE REPORT <p class="BasicParagraph" style="text-align: justify;"><strong><span style="font-size: 10.0pt; line-height: 120%; font-family: 'Times New Roman',serif;">Background: </span></strong><span style="font-size: 10.0pt; line-height: 120%; font-family: 'Times New Roman',serif;">The blood supply of a bone can be decreased due to the use of an implant, leading to wound-bed bacterial colonization and the development of the SSI. The principle of vacuum-assisted closure (VAC) is to use a negative pressure environment in the wound to promote increased wound healing. The case shows that VAC application and muscle flap therapy provide the definitive healing of infected wounds after ORIF.</span></p> <p class="BasicParagraph" style="text-align: justify;"><strong><span style="font-size: 10.0pt; line-height: 120%; font-family: 'Times New Roman',serif;">Case Report: </span></strong><span style="font-size: 10.0pt; line-height: 120%; font-family: 'Times New Roman',serif;">A 45 years-old male presented with a close comminuted proximal third right tibia fracture and tense skin. The fracture was openly reduced and internally fixated with plate fixation and a skin flap on the fracture area. Still, the wound could not be closed due to difficulty covering the wound, so a counter incision was made. After four days, the patient developed necrosis in the post-operation wound and subsequently underwent debridement and muscle flap with VAC application.</span></p> <p class="BasicParagraph" style="text-align: justify;"><strong><span style="font-size: 10.0pt; line-height: 120%; font-family: 'Times New Roman',serif;">Discussion: </span></strong><span style="font-size: 10.0pt; line-height: 120%; font-family: 'Times New Roman',serif;">SSI can be treated by applicating of appropriate antibiotic and surgical procedures. In this case, the infection was treated using third-generation cephalosporin antibiotic, debridement, dissection, and re-elevation of gastrocnemius muscle flap covering the exposed plate area in inferior, split skin graft above the muscle flap and VAC above skin graft with 75 mmHg pressure.</span></p> <p class="BasicParagraph" style="text-align: justify;"><strong><span style="font-size: 10.0pt; line-height: 120%; font-family: 'Times New Roman',serif;">Conclusion: </span></strong><span style="font-size: 10.0pt; line-height: 120%; font-family: 'Times New Roman',serif;">Debridement with muscle flap and application of VAC in the deep infected wound of open reduction and internal fixation was found to be successful methods in minimizing complications and obtaining an optimal outcome. This finding was associated with accompanying morbidities or a good wound healing process.</span></p> OK Ilham Abdullah Irsyam, Saraswati Hastika, Hendra Hendra, Andrew Budiartha Budisantoso, Tesar Akbar Nugraha Copyright (c) 2022 JOINTS (Journal Orthopaedi and Traumatology Surabaya) Thu, 28 Apr 2022 00:00:00 +0000 AGENESIS OF MEDIAL PATELLOFEMORAL LIGAMENT (MPFL) WITH HABITUAL PATELLAR DISLOCATION IN ADOLESCENT WOMAN WITH CEREBRAL PALSY – A CASE REPORT <p><strong>Background:</strong> The current treatment for habitual dislocation and nonoperative treatment failure is surgical therapy. Therefore, this study describes chronic patella dislocation's comprehensive evaluation and management in an adolescent woman with cerebral palsy (CP).<br /><strong>Case Report:</strong> A 15 years old female patient has suffered knee pain for almost three years. Furthermore, the physical examination revealed positive adam's forward bending test and left knee cap dislocation with positive patellar J-sign at 90°. Radiologic examination of the vertebrae and left knee shows scoliosis left thoracolumbar curved with 43 cobb angle and patellar shift. The patient was then diagnosed with habitual patellar dislocation, spastic diplegia type of CP, and neuromuscular scoliosis, consulted to the pediatric department, and then planned for medial patellofemoral ligament (MPFL) reconstruction. During the surgical examination, we discovered the MPFL Agenesis. Finally, lateral release and plication of the medial retinaculum were selected for surgery and planned to receive a Boston brace for scoliosis. After six weeks of follow up, the patient shows a reduction in pain.<br /><strong>Discussion:</strong> Lateral release and MPFL reconstruction for patellar stabilization generate better results. However, in this case, the absence of the medial patellar facet and the medial femoral condyle enhances Lateral release and plication of the medial retinaculum more preferable to fixate the left patella and improve functional limitation.<br /><strong>Conclusion:</strong> Comprehensive and immediate treatment for a patient with habitual patella dislocation and other predisposition diseases increases the chances of success.</p> Nurul Hidayah, Felix Giovanni Hartono, Bramta Putra Manyakori, Agus Sari Budaya Copyright (c) 2022 JOINTS (Journal Orthopaedi and Traumatology Surabaya) Thu, 28 Apr 2022 00:00:00 +0000 RE-FRACTURE AS IMPACT OF RIGID IMPLANT AND BONE OSTEOPOROSIS: A CASE REPORT <p><strong>Background:</strong> The increasing life expectancy of the world population associated with osteopenia and osteoporosis leads to low-energy fractures, especially in the lower limb. The overture of locking plates has widened the area of close fracture fixation, and it is essential to justify and optimize their usage. This study aims to report the potential postoperative re-fracture after implant removal and as a consequence of bone osteoporosis.<br /><strong>Case report:</strong> We present a re-fracture of proximal femur case in 60 years old female after a trivial fall into her right femur. This patient underwent a removal implant surgery a week before in the same spot where she fell. The open surgery was made with the same incision, and we do the Open Reduction Internal Fixation for her. <br /><strong>Discussion:</strong> The major design of the fixation tool is to secure the fracture with less effect on native axial load stress from the whole bone. Stress shielding caused due to firm bone-implant results in its resorption. The bone degradation underneath gives rise to the plate's collapse, resulting in repeated bone breakage. Early discharge, continued weight-bearing training for proximal femur fractures were associated with speedy improvement in daily activities. The photodynamic polymer liquid was the latest technology for bone stabilization.<br /><strong>Conclusion:</strong> Rigid bone plates can cause stress shielding, and when the implants are removed, re-fracture easily happens. Therefore, discharge of patients quickly for weight-bearing training in proximal femur fractures was encouraged to promote better healing.</p> Huda Fajar Arianto, Yunus Basrewan Copyright (c) 2022 JOINTS (Journal Orthopaedi and Traumatology Surabaya) Thu, 28 Apr 2022 00:00:00 +0000 IMPACT OF ONE YEAR COVID-19 ON HAND AND UPPER EXTREMITY INJURY: A CROSS-SECTIONAL STUDY <p><strong>Background:</strong> On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a worldwide pandemic. On March 31, 2020, Indonesia enacted a large-scale societal limitation. As a result, the number of patients seeking medical treatment for emergencies has decreased significantly. Home and fall accidents were the leading causes of a hand injuries, and this trend is anticipated to persist throughout the epidemic. Despite this, there is scarce information about the many forms and causes of hand and upper extremity injuries. This research aimed to see how COVID-19 affected hand and upper extremity injuries.<br /><strong>Methods:</strong> The observational cross-sectional research was undertaken from March 2019 to February 2021. The Pre-COVID-19 phase was measured from March 2019 to February 2020, while the COVID-19 period was measured from March 2020 to February 2021. Patients who presented to Prof. Dr. R. Soeharso Orthopedic Hospital with hand and upper and lower extremity injury-related diagnoses from the emergency unit, outpatient, or inpatient were included in the study.<br /><strong>Results:</strong> The overall number of patients in this study was 2644, with a mean total number of patients of 141.83 (SD 43.21) in the pre-COVID-19 era and 78.5 (SD 32.55) in the COVID-19 era, a significant reduction (p 0.001).<br /><strong>Conclusion:</strong> There is a substantial drop in hand and upper extremity injury patients during the timespan of COVID-19 compared to the Pre-COVID-19. The findings might aid in the development of new ways for better understanding the service provisions needed in the case of injury during a pandemic.</p> Pamudji Utomo, Tito Sumarwoto, Naufal Aminur Rahman, Mochammadsyah Beizar Yudhistira Copyright (c) 2022 JOINTS (Journal Orthopaedi and Traumatology Surabaya) Thu, 28 Apr 2022 00:00:00 +0000 THE EFFECT OF CULTURE TECHNIQUES OF HYPOXIC STEM CELL SECRETOME ON THE NUMBER OF GROWTH FACTOR TGF-ß, BMP-2, VEGF <p><strong>Background:</strong> Mesenchymal stem / stromal cell therapy (MSCs) is now an effective therapeutic modality for treating various diseases. In its application, stem cells require signaling molecules which can be growth factors, cytokines, or chemokines. Signal molecules work orderly and are greatly influenced by the physiological environment. Stem cell culture techniques with hypoxic conditions can produce growth factors close to physiological conditions in fractures. This study aims to perceive the different expressions of some growth factors in cultured normoxic and hypoxic BMSC.<br /><strong>Methods:</strong> This study is an in vitro laboratory experimental study of normoxic Bone Marrow Stem Cells (BMSCs) and Hypoxic Bone Marrow Stem Cells (BMSCs) cultures. The BMSCs experimental unit was taken from rabbits and then propagated in vitro and cultured under two conditions, normoxia and hypoxia. Then the number of VEGF, TGF-β, BMP-2 growth fractures was observed using ELISA.<br /><strong>Results:</strong> VEGF, TGF-β, and BMP-2 expressions showed significant differences between the normoxia and hypoxia groups. VEGF, TGF-β, and BMP-2 expression were higher in the hypoxia group compared with the normoxia group (p &lt; 0.05).<br /><strong>Conclusion:</strong> The expression analysis of TGFβ-1, VEGF, and BMP-2 growth factors in cultured BMSC were statistically significant between normoxic and hypoxic conditions. TGFβ-1, VEGF, and BMP-2 expressions increase in hypoxic conditions.</p> Mouli Edward, Ferdiansyah Mahyudin, Dionysius Bramta Putra Manyakori Copyright (c) 2022 JOINTS (Journal Orthopaedi and Traumatology Surabaya) Thu, 28 Apr 2022 00:00:00 +0000 BETTER FUNCTIONAL OUTCOMES IN PLATE FIXATION OF MIDSHAFT CLAVICLE FRACTURE IN DR. SOETOMO GENERAL HOSPITAL <p><strong>Background:</strong> Clavicle fracture is one of the common fractures worldwide, which trends moved from conservative to operative treatment. This study evaluates functional outcomes between patients treated with plating and conservative in Dr. Soetomo, Hospital, Surabaya.<br /><strong>Methods:</strong> We found 531 cases with midshaft clavicle fracture that came to our ER from 1st January 2014 to 31st December 2018. Patients with a head injury, multiple traumas associated with neurovascular injury, history of re-fracture, malunion or nonunion, open fracture, and pathological fracture were excluded in this study. The final data was 161 patients to evaluate. A conservative group total of 84 patients was treated using an arm sling or figure of eight bandages, and an operative group of 77 patients performed ORIF with S-plate. Clinical and functional scores were evaluated retrospectively with a minimum of 6 months after treatment. Shoulder function evaluated using Shoulder Constant Score and Manual Muscle Test.<br /><strong>Results:</strong> We found that 117 (72.7%) patients were male with a mean age of 35.4 ± 12.33 years old. The right side was dominantly injured. The manual muscle test on the operative group was five, and the conservative group was four. The constant Shoulder group on the operative group was 93.38 ± 7.529, and the conservative group was 86.60 ± 7.560 (P&lt;0.001), and DASH score on the operative group was 10.05±6.98 and the conservative group 23.67±3.49 (P&lt;0.001).<br /><strong>Conclusion:</strong> In our study, surgery on clavicle midshaft fracture showed significant improvement and satisfaction in patients than conservative treatment. Patients gained better function in the outcome.</p> Mouli Edward, Steesy Benedicta, Teddy Heri Wardhana Copyright (c) 2022 JOINTS (Journal Orthopaedi and Traumatology Surabaya) Thu, 28 Apr 2022 00:00:00 +0000