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Librianto D, Saleh I, Utami WS, Librianto MY, Librianto KR, Hutami WD. Jefferson fracture as sport injury in weight-lifting athlete: A rare case report and literature review. Int J Surg Case Rep 2024; 117:109451. [PMID: 38452640 PMCID: PMC10937828 DOI: 10.1016/j.ijscr.2024.109451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Cervical spine fractures are rare in sports, but their potentially grave consequences mean that they must be given special attention. The aim of this study was to present the case of a recreational athlete with a fracture of C1 resulting from weightlifting. CASE PRESENTATION Young, recreational athlete came with severe neck pain right after weightlifting. There was no neurologic deficits occurred. X ray and CT scan examination showed complete fracture of the right posterior and anterior arch of C1 and disruptions of the right transverse foramen and ligament. MRI revealed no sign of impingement or compromised canal. Patient was then treated conservatively with sternal occipital mandibular immobilizer (SOMI) brace for 4 weeks. Thereafter, the neck pain resolved gradually. No neurologic deterioration occurred. At time of brace removal, patient was free of pain with normal motoric and sensory function. CLINICAL DISCUSSION Our case was the first report of a Jefferson fracture caused by a direct injury mechanism due to the weightlifting sport. The type III Jefferson fracture produced by this contrary injury mechanism showed that with adequate force, another spectrum of injury mechanisms may be created. CONCLUSION With adequate assessment and proper patient selection, Jefferson fracture can be treated effectively by SOMI brace with excellent functional outcomes.
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Affiliation(s)
- Didik Librianto
- Orthopaedic Spine Surgeon, Department of Orthopaedic & Traumatology, Fatmawati Hospital, Jalan Fatmawati Raya No. 4, Cilandak, Jakarta Selatan, Jakarta 12430, Indonesia
| | - Ifran Saleh
- Orthopaedic Spine Surgeon, Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta 10430, Indonesia
| | - Widyastuti Srie Utami
- Orthopaedic Spine Surgeon, Tarakan General Hospital, Jalan Kyai Caringin No. 7, Jakarta Pusat, Jakarta 10150, Indonesia
| | - Medisya Yasmine Librianto
- Faculty of Medicine, Universitas Indonesia, Jalan Salemba Raya No. 6, Jakarta Pusat, Jakarta 10430, Indonesia
| | - Kenandi Raihan Librianto
- Faculty of Medicine, Universitas Indonesia, Jalan Salemba Raya No. 6, Jakarta Pusat, Jakarta 10430, Indonesia
| | - Witantra Dhamar Hutami
- Department of Orthopaedic and Traumatology, Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta 10430, Indonesia.
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Kurniawan A, Ivansyah MD, Dilogo IH, Hutami WD. Umbilical cord mesenchymal stem cells combined with secretome for treating congenital pseudarthrosis of the Tibia: a case series. Eur J Orthop Surg Traumatol 2023; 33:2881-2888. [PMID: 36879164 DOI: 10.1007/s00590-023-03511-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Most patients with congenital pseudoarthrosis of tibia (CPT) do not have promising outcomes despite multiple attempts using conventional surgeries. The combination of umbilical cord-derived mesenchymal stem cells and conditioned medium (secretome) contains major components pivotal for the enhancement of fracture healing. The purpose of this study was to address fracture healing in CPT cases that were treated using the combined implantation of umbilical-cord mesenchymal stem cells (UC-MSCs) and secretome. MATERIALS AND METHODS From 2016 to 2017, six patients with CPT who were treated by one senior pediatric orthopedic consultant at a single center (3 girls and 3 boys; mean age of 5.8 years) were included in this case series. A combined procedure including resection of hamartomatous fibrotic tissue, implantation of MSCs and secretome, and fixation using a locking plate and screws was performed. Patients were followed up for a mean of 29 months. Leg-length discrepancy, refracture rate, functional outcome, and radiological outcomes were assessed preoperatively, immediately postoperatively and at the final follow-up. RESULT Five out of 6 (83%) of the patients experienced primary union. One patient experienced refracture; however, 8 months later, after another implantation and reconstruction were performed, union eventually occurred. Significant functional improvement was achieved after at least 1 year of follow-up. CONCLUSION This case series suggests that the combination of secretome and UC-MSCs is a potential treatment for CPT, it highlights the efficacy of the combined procedure in treating CPT and in achieving satisfying results. A larger number of subjects and longer follow-up are required for further study.
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Affiliation(s)
- Aryadi Kurniawan
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Muhammad Deryl Ivansyah
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Witantra Dhamar Hutami
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, 10430, Indonesia.
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Kurniawan A, Wijaya T, Hutami WD. Spontaneous healing of a traumatic critical radius bone defect in adolescent: A rare case report. Int J Surg Case Rep 2021; 81:105806. [PMID: 33887843 PMCID: PMC8050725 DOI: 10.1016/j.ijscr.2021.105806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022] Open
Abstract
Osteogenesis in fracture requires osteogenic cells, osteoconductive components, and osteoconductive scaffold. Intact periosteum and sufficient soft tissue perfusion could be biologically required. Pediatric patient with significant bone defect is able to heal the defect speontaneously.
Introduction and importance Fracture with a critical bone loss is associated with a profound burden of disease impact. Although there are several options exist for its treatment, but still those reconstructive procedures are technically demanding, relatively expensive and sometimes the result is less than what was expected. The objective of this study is to report a rare case of spontaneous healing of a critical radial bone defect in an adolescent. Case presentation We reported a 15 year old boy with a segmental open fracture of left radius, open fracture of left distal shaft ulna and closed fracture of left intercondylar humerus. The middle fragment of a fractured radius was extruded out, pulled out and then thrown away by his parent. Debridement, open reduction, and internal fixation for ulna were performed as well as reposition and internal fixation for the intercondylar humerus fracture. The plan was to wait until the ulnar fracture and intercondylar fracture to heal without any sign of infection and proceed to overcome the radial critical bone defect. This case report had been reported in line with SCARE criteria. The patient showed up seven months later with solid union of the critical radius bone defect and fully functioning hand with only slight limitation in pronation. Clinical discussion Osteogenesis in fracture requires osteogenic cells, osteoinductive components, osteoconductive scaffold, and stability. Despite the fact that critical bone defect poses great challenge for its management, intact periosteum and sufficient soft tissue perfusion were able to provide those biologic requirements adequately for fracture healing and ensure spontaneous healing of a traumatic critical bone loss in adolescent without any reconstructive procedure. Conclusion Spontaneous healing in critical bone defect is possible, provided all the favorable factors present to support this phenomenon.
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Affiliation(s)
- Aryadi Kurniawan
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta 10430, Indonesia.
| | - Triadi Wijaya
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta 10430, Indonesia
| | - Witantra Dhamar Hutami
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta 10430, Indonesia
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Librianto D, Saleh I, Fachrisal, Utami WS, Hutami WD. Breach Rate Analysis of Pedicle Screw Instrumentation using Free-Hand Technique in the Surgical Correction of Adolescent Idiopathic Scoliosis. J Orthop Case Rep 2021; 11:38-44. [PMID: 34141640 PMCID: PMC8046465 DOI: 10.13107/jocr.2021.v11.i01.1956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Free-hand technique is one of the techniques used by spine surgeon during pedicle screw instrumentation of surgical correction of spinal deformities, including scoliosis. The previous studies showed that this technique is safe. However, some inherent factors may influence its outcomes, including screw breaching which is potentially violates spinal cord and other intimate structures. To confirm the safety and accuracy of this technique, additional study measuring the breach rate of pedicle screw placement in scoliosis is mandatory. Materials and Methods We performed a retrospective study of patients with adolescent idiopathic scoliosis (AIS) from Fatmawati General Hospital, Jakarta, treated for surgical correction during a period of 2017-2018 using free-hand technique for pedicle screw instrumentation. Post-operative computed tomography scan (CT scan) was analyzed to measure the medial and lateral breaches. P < 0.05 was deemed to be statistically significant. Results A total of 94 pedicle screws from six female patients with AIS were included in our study. Overall breach occurred in 33% instrumented screws, the majority of it was a low-grade breach. Of the breached screws, medial and lateral breach occurred in 20% and 12% of screws, respectively. There were no differences in the overall, medial, and lateral breaches between thoracic and lumbar vertebrae (P > 0.05). Medial breach was significantly higher in middle thoracic segment compared to other thoracic segments (P = 0.048). Risk of medial breach was 3 times higher in the convex side of deformity (P = 0.012), whereas risk of lateral breach was 4.6 times higher in the concave side of the deformity (P = 0.021). Conclusion The majority of breached screws were low-grade violation within the safe zone, with no neurological sequelae. Our study found that free-hand technique is safe and effective method of pedicle screw instrumentation for correction of AIS. Some inherent factors may influence the risk of pedicle screw breach.
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Affiliation(s)
- Didik Librianto
- Department of Orthopaedic and Traumatology, Fatmawati Hospital Jl. RS. Fatmawati Raya No.4, Cilandak, Kota Jakarta Selatan, Jakarta, Indonesia
| | - Ifran Saleh
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No. 71, Senen, Kota Jakarta Pusat, Jakarta, Indonesia
| | - Fachrisal
- Department of Orthopaedic and Traumatology, Fatmawati Hospital Jl. RS. Fatmawati Raya No.4, Cilandak, Kota Jakarta Selatan, Jakarta, Indonesia
| | - Widyastuti Srie Utami
- Department of Orthopaedic and Traumatology, Tarakan Hospital, Jl. Kyai Caringin No. 7, Cideng, Kota Jakarta Pusat, Jakarta, Indonesia
| | - Witantra Dhamar Hutami
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No. 71, Senen, Kota Jakarta Pusat, Jakarta, Indonesia
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Kurniawan A, Sitorus IP, Loho T, Hutami WD. A rare case of septic arthritis of the knee caused by Salmonella typhi with preexisting typhoid fever in a healthy, immunocompetent child - A case report. Int J Surg Case Rep 2020; 78:76-80. [PMID: 33316609 PMCID: PMC7744635 DOI: 10.1016/j.ijscr.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Septic arthritis is a rapid and progressive infection caused by invasion of bacteria into the synovial joint. Disease of the joint causedby Salmonella spp in healthy children is an unusual event, with an estimated incidence of 0.1 to 0.2% of septic arthritis cases among children. The incidence of knee septic arthritis caused by Salmonella typhi with preexisting typhoid fever is very rare. Method We reported a case of 2-years old boy with a history of saddle-type fever 2 weeks prior to right knee pain. Typhoid fever was confirmed by immunoassay test. Knee septic arthritis was established from clinical findings, increased CRP level, ultrasonography, and joint aspiration. Culture of the aspirate subsequently grew Salmonella typhi. This case report had been reported in line with SCARE criteria. Result Arthrotomy and debridement were immediately performed.Intravenous piperacillin tazobactam was given for 6 days and replaced by amoxicillin clavulanic acid after the culture and sensitivity test was available. Patient recovered completely 5 months post surgery and showed excellence result with normal range of knee joint motion. Conclusion This case report suggests that any episode of joint swelling following preexisting typhoid fever should arise the physician’s awareness toward the possibility of septic arthritis and warrant immediate as well as proper management.
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Affiliation(s)
- Aryadi Kurniawan
- Pediatric Orthopaedic Surgeon, Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta 10430, Indonesia.
| | - Immanuel Panca Sitorus
- Department of Orthopaedic and Traumatology, Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta 10430, Indonesia
| | - Tonny Loho
- Department of Clinical Pathology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta 10430, Indonesia
| | - Witantra Dhamar Hutami
- Department of Orthopaedic and Traumatology, Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta 10430, Indonesia
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Oesman I, Dhamar Hutami W. Gamma-treated placental amniotic membrane allograft as the adjuvant treatment of unresponsive diabetic ulcer of the foot. Int J Surg Case Rep 2019; 66:313-318. [PMID: 31901740 PMCID: PMC6948253 DOI: 10.1016/j.ijscr.2019.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 11/25/2022] Open
Abstract
Unresponsive diabetic ulcer is ulcer that does not reduce in size within a month. It is caused by senescent cells, absence of growth factors, and other cellular abnormalities. To maximize wound healing, skin substitute can be used to prevent infection and dessication. Amniotic membrane favoured healing of unresponsive and non-healing ulcers.
Introduction Diabetic ulcer of the foot is a major cause of morbidity and is a leading cause of hospitalization in patients with diabetes, and causes productivity and financial losses that lower the quality of life of the patient. The wound is categorized as responsive and unresponsive wound, which occurs in debilitated patients as seen in diabetes mellitus. The delay in wound repair can be caused by senescent cells, absence of growth factors, and other cellular abnormalities. Method This is a retrospective, single-centre case series with non-consecutive cases. Patients with diabetic ulcer of the foot managed using gamma-treated placental amniotic membrane, with the minimum follow up of 1 month in academic practice setting were recruited. Result Three patients with 4 weeks period of oozing ulcers and signs of inflammation were included in this case series. Two layers of amniotic membrane dressing was applied weekly after cleaning and debridement for 3 weeks. Wound size and secretion were documented by taking photographs every week. At the end of the third week, the wound healed. Discussion Placental amniotic membranes are composed of cells, extra-cellular matrix (ECM), and a complex of regulatory cytokines which promote cell proliferation, cell modulation, and cytokine secretion by variety of cell types involved in wound healing. Our study showed that the treatment of diabetic ulcer wound using amniotic membrane was successful in achieving wound healing in unresponsive, chronic wound of diabetic ulcer of the foot. Conclusion Our results clearly indicated the usefulness of the application of amniotic membranes in treatment of diabetic ulcer of the foot. Amniotic membrane favoured healing of unresponsive and non-healing ulcers.
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Affiliation(s)
- Ihsan Oesman
- Orthopaedic Surgeon, Consultant of Foot and Ankle, Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine of Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta 10430, Indonesia
| | - Witantra Dhamar Hutami
- Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine of Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta 10430, Indonesia.
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