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"This book reviews the biomaterials (metallic, non-metallic and bone allografts) used for orthopaedic applications and explains both the engineering and clinical aspects of their use and performance within the human body."

"ABSTRAKPendahuluan: Pencarian implan berbahan biomaterial yang dapat diserap tubuh dengan baik terus berlanjut. Biomaterial untuk implan orthopaedi biodegradabel harus memenuhi kriteria tertentu, seperti waktu degradasi yang harus parallel dengan lini masa fisiologis penyembuhan tulang normal. Magnesium adalah mikronutrien tubuh alami sekaligus metal biodegradabel yang mempunyai sifat biomekanika menyerupai tulang. Akan tetapi, waktu degradasi metal ini sangatlah singkat dan menghasilkan produk korosi gas H2 serta sifat alkali. Karbonat apatit merupakan apatit biologis yang mempunyai osteokonduktivitas yang baik dan penyembuhan tulang tanpa jaringan fibrotik. Pencampuran magnesium dengan karbonat apatit diharapkan dapat menciptakan material biodegradabel yang dapat dipakai sebagai material dasar implant orthopaedi biodegradabel.Metode: Kami memfabrikasi specimen komposit magnesium dan karbonat apatit dengan kadar yang bervariasi menggunakan metode metalurgi bubuk, milling time bervariasi 3, 5 dan 7 jam pada 200 RPM, kompaksi pada suhu 300°C dan tekanan 265 MPa, sintering pada 550°C, waktu tahan 1 jam, laju panas 5°C/menit, atmosfir ruangan biasa untuk membuat spesimen uji berbentuk silinder dan miniplate. Spesimen tersebut kemudian dilakukan uji biomekanika, biotoksisitas MTT dan kontak langsung, serta korosi.Hasil: Kami dapat memfabrikasi komposit magnesium dan karbonat apatit dengan densitas yang sama dengan tulang manusia. Spesimen komposit magnesium dengan 10% karbonat apatit memiliki biokompatibilitas yang cukup baik. Walaupun, ketahanan tekanan, ketahanan regangan, modulus elastisitas fleksural dan ketahanan korosi spesimen tersebut masih rendah dibandingkan dengan tulang manusia. Paparan terhadap material komposit ini membuat lingkungan sekitar material menjadi bersifat alkali.Diskusi: Konsolidasi antar partikel dan ukuran partikel masih kurang baik karena terbentuknya pori mikrostruktural, yang kemungkinan disebabkan oleh lapisan Mg(OH)2 dan proses oksidasi saat sintering. Hal ini menyebabkan sifat biomekanik yang rendah dan laju korosi yang tinggi. Penggunaan uji berbasis reduksi tetrazolium dapat memberikan hasil false positive, disebabkan sifat produk korosi magnesium yang bersifat reduktan. Kondisi alkali yang disebabkan material ini dapat bermanfaat bagi penyembuhan tulang dan luka. Komposit logam magnesium dan biokeramik karbonat apatit mempunyai potensi yang besar untuk menjadi material dasar implan orthopaedi biodegradabel. Modifikasi teknik fabrikasi perlu dilakukan untuk bisa meningkatkan konsolidasi antar partikel, mengecilkan ukuran partikel, meningkatkan kekuatan biomekanika, mengurangi produk korosi, serta menurunkan laju degradasi.

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ABSTRACTIntroduction. The search for biodegradable orthopaedic implant is on the rally. Biomaterial for orthopaedic implant must fulfill some criteria, especially the degradation rate must be paralleled with normal bone healing timeline. Magnesium is a natural micronutrient as well as biodegradable metal with biomechanical characteristics close to that of bone. However, the degradation rate of this metal is very high and releasing H2 gas by-product as well as alkali environment. Carbonate apatite is a biological apatite which has good osteoconductivity and allow bone healing without fibrotic tissue. Fabrication of magnesium and carbonate apatite composite is expected able to produce a new biodegradable biomaterial that can be used as the base material of biodegradable orthopaedic implant.Methods. We fabricated magnesium composite specimens containing various content of carbonate apatite by powder metallurgy, various milling time (3, 5, 7 hours) at 200 RPM, warm compaction at 300°C and pressure of 265 MPa, sintering at 550°C, holding time of 1 hour, heating rate of 5°C/minutes and room atmosphere cooling. Biomechanical tests, biotoxicity tests (MTT assay and direct contact), and corrosion test were conducted.Results. We were able to fabricate magnesium-carbonate apatite composites with good density that is comparable with human bone. Magnesium composite with 10% content of carbonate apatite had good biocompatibility. Although, its flexural stress, flexural strain, flexural elasticity modulus and corrosion resistance were lower than human bone. Additionally, exposure to this material also turn the surrounding environment into alkali.Discussion: Interparticle consolidation and grain size were dissatisfactory due to microstructural pores that are possibly formed by Mg(OH)2 layer and oxidation process during sintering. These characteristics affect the low biomechanical properties and high corrosion rate. Additionally, the use of tetrazolium-based assay (MTT) may give a false positive result, as the magnesium corrosion products are reducing agent. Meanwhile, alkali condition caused by the material corrosion by-product might be beneficial for bone healing and wound healing process. Magnesium and carbonate apatite composite has enormous potential to be used as the orthopaedic biodegradable material. Modification on fabrication parameters need to be done in order to improve the interparticle consolidation, refining the grain size, improve biomechanical strength, reduce corrosion products, as well as improve the degradation rate."

"With the time available to surgeons-in-training ever dwindling, there is great emphasis placed on practical learning tools. Mirroring his earlier book on practical procedures in trauma surgery, Prof Giannoudis has produced a reference in more elective techniques. In most medical schools, most emphasis is placed on orthopaedic trauma surgery, with elective techniques often delayed until much later in a surgeon?s training."

"This highly illustrated text book will be an essential guide for surgeons in training, providing step by step approaches to performing Joint Aspiration/Injection, Bone Graft Harvesting and Lower Limb Amputations. Practical guidance will be given on Indications- Preoperative assessment, positioning and preparing the patient, approach required, tips and tricks, closure, postoperative complications, protocol of mobilization and follow-up procedure. All the procedures performed will include numerous intraoperative photographs and illustrations."

"Tindakan operasi orthopaedi membutuhkan tarif yang tinggi karena dilakukandengan alat berteknologi tinggi, proses perawatan komplek dan seringkali menggunakanimplan berharga mahal. Terdapat variasi tarif rumah sakit pada operasi orthopaedi yangperlu diidentifikasi penyebabnya. Penelitian bertujuan mengetahui komponen tarif danmenganalisa faktor-faktor yang berhubungan dengan tarif operasi orthopaedi pasien JKNpada prosedur anggota tubuh atas, sendi tungkai bawah dan fusi tulang belakang padalengkungan tulang belakang di RSUP Fatmawati tahun 2017. Desain penelitian adalahcross sectional dengan pendekatan kuantitatif melalui menghitung tagihan danpendekatan kualitatif melalui wawancara mendalam.Hasil penelitian menunjukkangambaran rata-rata tarif prosedur anggota tubuh atas Rp22.264.612 terdiri atas komponenbahan alat 51, jasa rumah sakit 14 dan jasa pelayanan 35, gambaran rata-rata tarifprosedur sendi tungkai bawah Rp61.700.637 yaitu bahan alat 75, jasa rumah sakit 10 dan jasa pelayanan 15, dan gambaran rata-rata tarif prosedur fusi tulang belakangRp79.501.208 yaitu bahan alat 63, jasa rumah sakit 11 dan jasa pelayanan 26 .Faktor penggunaan dan harga implan, tingkat keparahan, lama hari rawat, danpenggunaan ICU mempengaruhi tarif pada tiga prosedur, sedangkan faktor metode costplus pricing dan kelas perawatan tidak mempengaruhi tarif pada tiga prosedur. RSUP Fatmawati telah melakukan upaya untuk mengatasi variasi tarif pada komponen bahanalat, jasa rumah sakit dan jasa pelayanan. Rumah Sakit perlu melakukan perhitungan unitcost berkala, pembuatan unit cost pada tagihan yang belum memiliki unit cost,pemenuhan dan kepatuhan Clinical Pathway dan Panduan Praktik Klinis untuk tindakanoperasi khususnya yang memiliki lama hari rawat dan jumlah terbanyakKata kunci: variasi tarif operasi orthopaedi, prosedur anggota tubuh atas, prosedur senditungkai bawah, prosedur fusi tulang belakang pada lengkungan tulang belakang, implan.

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Orthopedic surgery requires high rates because it is done with high tech tools,complex maintenance process and often use expensive implans. There are variations inhospital rates on orthopedic surgery that need to be identified. The objectives of the studywere to determine the tariff components and to analyze factors related to the operatingtariffs of JKN patients on upper limb procedures, lower limb joints and spinal fusion inthe spinal arch at Fatmawati Hospital 2017. This study is cross sectional study designwith quantitative approach through counting the bill and qualitative approaches throughin depth interviews.The results of this study showed that the average tariff procedure ofthe limbs of Rp22,264,612 consisted of 51 of appliance component, 14 hospitalsservice and 35 service, the average cost of lower limb joint procedure Rp61,700,637, ,hospital services 10 and service 15 , and average picture tariff of spinal fusionprocedure Rp79.501.208 yaitu appliance 63 , hospital services 11 and service 26 .Factors of use and implanation rates, severity, length of stay, and use of ICUs affect tariffson three procedures, while cost plus pricing and treatment class methods do not affecttariffs on three procedures. RSUP Fatmawati has made efforts to overcome the variationof tariff on components of equipment, hospital services and services. Hospital need to calculate unit cost periodically, unit cost creation on bills that do not have unit cost,compliance and compliance Clinical Pathway and Clinical Practice Guidelines forsurgery, especially those with long days of service and the highest numberKey words tariif variations of orthopeadi surgery, upper limb procedures, lower limbjoint procedures, spine fusion procedures in the spinal cord, implans."