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"Pendahuluan: Fraktur adalah salah satu penyakit yang menjadi permasalahan yang cukup besar dalam bidang kesehatan di dunia, terutama di negara berkembang. Secara umum fraktur dapat sembuh dengan normal. Pada beberapa kondisi, penyembuhan fraktur mengalami komplikasi seperti delayed union atau non union. Penyembuhan fraktur yang sukses merupakan suatu interaksi yang kompleks antara proses angiogenesis dan osteogenesis. Stimulus fisika berupa pajanan PEMF (pulsed electromagnetic fields) menunjukkan pengaruh proses osteogenesis baik dalam tahap perkembangan penulangan embrio dan tahap penyembuhan fraktur.Tujuan: Penelitian ini bertujuan untuk mengetahui penyembuhan fraktur tulang delayed union pada hewan coba pada pemberian ELF-PEMF dengan melihat skor radiologi RUST dan Failure Load dari Pemberian Gaya Aksial.Metode: Dilakukan uji eksperimental pada 56 hewan coba di Laboratorium Hewan Departemen Gizi, Fakultas Kedokteran Universitas Indonesia, dengan membandingkan nilai RUST Score dan Load Score pada kedua kelompok hewan coba.Hasil: Penelitian dilakukan selama Agustus-September 2018. Tidak ada perbedaan karakteristik hewan coba pada penelitian. Didapati bahwa terdapat perbedaan bermakna Rust Score pada kelompok perlakuan dan kelompok kontrol pada setiap minggu pemeriksaan dan terdapat perbedaan bermakna Load Score pada minggu keempat dan kelima.Kesimpulan: Penelitian ini menyimpulkan terdapat perbaikan penyembuhan fraktur delayed union pasca pemberian ELF-PEMF dilihat dari perbedaan nilai Rust score dan load score.

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Background: Fracture is a major health problem in the world, especially in developing countries. Usually, fractures can heal normally. In some conditions, the healing process becomes delayed union or non union. Successful healing of fractures is a complex interaction between angiogenesis and osteogenesis. Physical stimuli such as exposure of PEMF (pulsed electromagnetic fields) influences the osteogenesis process both in the development stage of embryo reinforcement and the fracture healing stage.Objective: The aim is to determine the healing of delayed union fractures in experimental animals after exposure to ELF-PEMF.Methods: The experimental study was conducted at Department of Nutrition Animal Laboratory, Faculty of Medicine, Universitas Indonesia with 56 experimental rats. The study was conducted by comparing the RUST Score and Load Score values ​​in the two experimental animal groupsResult: The study was conducted during August-September 2018 There was no difference in animal characteristics in the study. There was significant difference in Rust Score in both groups in each examination week and there were significant differences in Load Score in the fourth and fifth weeks.Conclusion: There was improvement in delayed union fracture healing after the administration of ELF-PEMF as seen from the difference in Rust score and load score."

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Latar belakang : Fraktur tulang banyak terjadi pada kecelakaan lalu lintas, dan juga berasal dari osteoporosis. Penyembuhan fraktur tulang diperlukan untuk mengembalikan tulang secara normal. Prosesnya terdiri dari tiga tahap yaitu tahap inflamasi, perbaikan dan remodeling tulang. Keseimbangan remodeling tulang ini diatur oleh osteoblas dan osteoklas. Gen receptor activator of nuclear factor kappa-B (RANK) dengan receptor activator of nuclear factor kappa-B ligand (RANKL) adalah pengaktif osteoklas. receptor activator of nuclear factor kappa-B ligand RANKL dengan osteoprotegerin (OPG) adalah penghambat osteoklas. Pulsed electromagnetic field (PEMF) sebagai salah satu aplikasi alat medis dalam penyembuhan fraktur tulang.

Tujuan : Mengetahui efek pajanan PEMF pada ekspresi RANK, RANKL dan OPG dalam membantu proses penyembuhan fraktur tulang.

Metode : Penelitian ini merupakan penelitian eksperimental in vivo menggunakan sampel dari kalus fraktur tulang femur yang tersimpan. Sampel diambil dari jaringan tulang tikus yang telah terfraktur dengan model delayed union dan dibagi menjadi dua kelompok (tanpa pemajanan dengan pemajanan PEMF). Metode menggunakan qPCR dan analisis data menggunakan two way ANOVA dan korelasi Pearson.

Hasil : Ekspresi RANK menunjukkan adanya perbedaan bermakna di hari ke 5,10,18 dan 28 pada kelompok tanpa pajanan PEMF sedangkan pada  kelompok  pajanan PEMF di hari ke 5,18 dan 28 (p<0,05). Perbedaan bermakna ekspresi RANKL di hari ke 5,10,18 dan 28 pada kelompok tanpa pajanan dengan pajanan PEMF di hari ke 18 dan 28 (p<0,05)  Perbedaan bermakna ekspresi OPG di hari ke 10 dan 28  pada tanpa pajanan dengan pada pajanan PEMF di hari ke 5,18 dan 28 (p<0,05). Hasil dari uji korelasi pearson tanpa pajanan memperlihatkan RANKL dengan OPG mempunyai korelasi positif yang bermakna dengan nilai r=0,60 , p=0,03 (p<0,05). Hasil uji korelasi pearson yang dipajan dengan PEMF menunjukkan korelasi positif yang bermakna pada RANK dengan OPG  dan mempunyai nilai r=0,73 , p=0,008 (p<0,05).

Kesimpulan : Ekspresi RANK, RANKL dan OPG yang tidak diberikan pajanan memperlihatkan proses delayed union. Pajanan PEMF mempengaruhi ekspresi RANK, RANKL dan OPG dengan memperlihatkan proses normal union. Korelasi RANKL dengan OPG terlihat pada kelompok tanpa pajanan. Korelasi RANK dengan OPG terlihat pada kelompok yang diberikan pajanan PEMF.

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Background : Many bone fractures occur in traffic accidents, and also come from osteoporosis. Healing of bone fractures is needed to restore bone normally. The process consists of three stages, namely the inflammatory, bone repair and remodeling. Bone remodeling balance is regulated by osteoblasts and osteoclasts. The receptor activator of nuclear factor kappa-B (RANK) gene with the receptor activator of nuclear factor kappa-B ligand (RANKL) is an osteoclast activator. The receptor activator of nuclear factor kappa-B ligand RANKL with osteoprotegerin (OPG) is an osteoclast inhibitor. Pulsed electromagnetic field (PEMF) as one of the applications of medical devices in healing bone fractures.

Purpose : To find out the effects of PEMF exposure on RANK, RANKL and OPG expression in helping the process of bone fracture healing.

Method : This research is an in vivo experimental study using samples from stored fracture of the femur bone callus. Samples were taken from bone tissue of rats that had been fractured with delayed union models and divided into two groups (without exposure and PEMF exposure). The method of using qPCR and data analysis using two way ANOVA and Pearson correlation.

Result : RANK expression showed a significant difference on days 5.10,18 and 28 in the group without exposure to PEMF while in the PEMF exposure group on days 5.18 and 28 (p <0.05). Significant differences in RANKL expression on days 5,10,18 and 28 in the group without exposure to PEMF exposure on days 18 and 28 (p <0,05) Significant differences in OPG expression on days 10 and 28 in non-exposure to exposure PEMF on days 5.18 and 28 (p <0.05). The results of the Pearson correlation test without exposure showed that RANKL with OPG had a significant positive correlation with a value of r = 0.60, p = 0.03 (p <0.05). Pearson correlation test results exposed with PEMF showed a significant positive correlation on RANK with OPG and had a value of r = 0.73, p = 0.008 (p <0.05).

Conclusion : RANK expression, RANKL and OPG that are not given exposure show delayed union processes. Exposure to PEMF affects the expression of RANK, RANKL and OPG by showing the normal union process. Correlation of RANKL with OPG was seen in groups without exposure. RANK correlation with OPG was seen in the group given PEMF exposure.

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"Penyembuhan fraktur masih merupakan masalah besar. Banyak hal dilakukanuntuk mempercepat penyembuhan fraktur dan menghindari komplikasipenyembuhan fraktur. Pemberian vitamin C salah satunya. Penelitian ini bertujuanuntuk mengetahui peran vitamin C dalam mempercepat penyembuhan frakturpada fraktur dengan periosteal stripping di femur tikus putih Spague DawleyEvaluasi percepatan penyembuhan fraktur dilakukan secara radiologis denganskor RUST dan histologis dengan histomorphometri. Penelitian ini adalahpenelitian eksperimental. Penilaian dilakukan terhadap 32 ekor tikus dengandosis vitamin C yang berbeda-beda dan dievaluasi pada minggu ke 2 dan mingguke 4. Terdapat percepatan penyembuhan fraktur pada kelompok dengan dosisbesar pada skor RUST di minggu ke-4. Secara histologis pada histomorphometrididapatkan percepatan penyembuhan fraktur,tetapi secara statistik tidak bermakna.

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Fracture Healing still became a problem. There are many things to do to enhance

and avoid the complication of fracture healing. Vitamin C is one of the way to

enhance the fracture healing.. The purpose of this study is to know the role of

vitamin C in enhancement the fracture healing in fracture with periosteal stripping

at white rats femur. The evaluation of enhancement of fracture healing used

radiograpic with RUST score and histologic with histomorphometry. This is an

experimental study. The study used 32 rats which were given vitamin C in

different dosage and was evaluated at the 2nd and 4th week. There is

enhancement of fracture healing in all dosage, especially the large dosage of

vitamin C in RUST score evaluation in the 4th week. In histomorphometry

evaluation there were enhancement of fracture healing but statistically no

significant"

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Fraktur delayed union dan union sampai saat ini masih menjadi tantangan para dokter orthopaedi. Berbagai terapi menggunakan metode biologi dan biofisika digunakan untuk mendorong penyembuhan fraktur nonunion. Penelitian ini bertujuan untuk mengevaluasi penggunaan stimulasi PEMF (Pulsed Electromagnetic Fields) untuk mempercepat penyembuhan fraktur model delayed union dengan menggunakan hewan coba. Sebanyak dua puluh empat tikus Spraque Dawley dikelompokan menjadi dua yaitu kelompok Kontrol dan kelompok PEMF. Kelompok PEMF mendapatkan pajanan medan magnet dinamik dengan intensitas 1.6 mT, frequency 50 Hz dan lama pajanan 4 jam /hari selama 7 hari / minggu. Kemajuan penyembuhan fraktur dinilai secara histopatologi dengan metode histomorfometri dan secara biokimia pada hari ke 5, 10, 18 dan 28 paska fraktur. Parameter histomorfometri yang dievaluasi adalah persentase area fibrosa, tulang rawan dan tulang. Penanda biokimia penyembuhan fraktur yang dievaluasi adalah Alkaline Phosphatase pada serum darah yang diperiksa menggunakan metode Elisa. Hasil pemeriksaan histomorfometri menunjukkan pada kelompok PEMF, jaringan fibrosa menurun secara signifikan pada tahap awal penyembuhan fraktur. Aktivitas Alkaline Phosphatase meningkat signifikan menunjukkan kenaikan aktivitas osteoblas dalam membentuk matrik tulang. Berdasarkan analisis statistic menunjukkan adanya korelasi yang bermakna antara aktivitas Alkaline Phosphatase dengan presentasi jaringan tulang pada hari ke 10 paska fraktur, hal ini menunjukkan bahwa ALP dapat digunakan sebagai penanda awal proses penyembuhan fraktur.

 

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Delayed union and non-union fracture remain a major clinical challenge for the orthopedic surgeon. Many biophysical and biological modalities can be used to promote healing of non-union. The aim of this study was to evaluate the healing process of femoral delayed union fracture model after pulsed electromagnetic field (PEMF) stimulation. Twenty four rats were randomized into two groups; Control group and PEMF group, administration of PEMF stimulation (1.6 mT, frequency 50 Hz, 4 hours/day). The progression of healing was evaluated by histomorphometry and biochemical assessment at days 5, 10, 18 and 28 post fracture. The histomorphometry parameters were evaluated; percentages area of fibrous, cartilage and osseous tissue.  The serum biochemical marker of bone healing, Alkaline Phosphatase was determined using ELISA kit. Histomorphometry evaluation showed that in PEMF groups, fibrous tissue significantly decreased in the early phase of fracture healing. Alkaline phosphatase activity increased significantly in the PEMF group which indicated an increase in osteoblast activity in the bone matrices formation. The results of this study also showed a strong postitive correlation between ALP activity and bone formation on the 10th day after fracture, so that ALP can be used as a markers to assess fracture healing in the early stages.

 

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"Pendahuluan: Penanganan nonunion dan delayed union bukanlah penanganan yang murah dan mudah. Berbagai metode telah dilakukan untuk mengatasi masalah tersebut. Beras angkak terbukti memiliki peranan dalam penyembuhan fraktur. Beras angkak, mengandung monakolin, suatu senyawa dengan aktivitas sebanding lovastatin. Pemberian statin secara lokal dan oral terbukti meningkatkan penyembuhan tulang dengan menginduksi diferensiasi osteoblas melalui peningkatan ekspresi BMP-2. Penelitian ini dilakukan untuk membuktikan efektivitas monakolin pada beras angkak dalam meningkatkan ekspresi BMP-2 dan penyembuhan fraktur pada model delayed union tikus sprague- dawley. Material dan Metode: Studi eksperimental pada 24 hewan coba tikus putih Sprague-Dawley (SD) yang telah mengalami patah tulang femur disertasi dengan gangguan vaskularisasi (model delayed-union). Hewan coba dibagi menjadi empat kelompok (n=6) terdiri dari; kelompok pemberian ekstrak monakolin selama empat minggu (PM4), kelompok pemberian ekstrak monakolin selama dua minggu (PM2), kelompok kontrol empat minggu (KM4) dan kelompok kontrol dua minggu (KM2). Setelah dilakukan sacrifice pada minggu kedua dan keempat, dilakukan penilaian ekspresi BMP-2 secara semikuantitatif dengan pewarnaan imunohistokimia melalui skor imunoreaktif (IRS). Analisis histomorfometri untuk menilai penyembuhan fraktur dengan mengukur persentase area fibrosa, tulang rawan dan tulang imatur. Hasil: Pada evaluasi parameter IRS dan histomorfometri didapatkan ekspresi BMP-2 lebih tinggi (p=0.03), persentase area fibrosa lebih sedikit (p=0.005) dan area tulang rawan lebih besar (p=0.04) pada kelompok PM2 dibandingkan dengan kelompok KM2. Selain itu didapatkan pula secara ekspresi BMP-2 lebih tinggi (p=0.011), presentase area tulang imatur lebih besar (p=0.01), dan presentase area fibrosa lebih kecil (p=0.03) pada kelompok PM4 dibandingkan dengan kelompok KM4. Di sisi lain, didapatkan presentase area fibrosa lebih kecil (p=0.02), area tulang rawan lebih sedikit (p=0.05), dan peningkatan area tulang imatur lebih besar (p=0.04) pada kelompok PM4 dibandingkan dengan kelompok PM2. Ekspresi BMP-2 sama-sama meningkat pada kelompok PM2 dan PM4. Kesimpulan: Pemberian monakolin pada beras angkak pada model delayed-union tikus Sprague Dawley terbukti meningkatkan ekspresi BMP-2 dan meningkatkan penyembuhan fraktur.

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Introduction: Management of nonunion and delayed union could be difficult and expensive. Various methods have been studied to overcome this problem. Red-yeast-rice has a role in fracture healing. Red-yeast-rice contains monacolin, which has similar activity to lovastatin. Local application and oral administration of statins have been shown to improve bone healing by inducing osteoblast differentiation and matrix production via increasing BMP-2 expression. This study was conducted to prove the effectiveness of monacolins inside red-yeast-rice in increasing the expression of BMP-2 and fracture healing. Methods: This experimental animal study was conducted using 24 delayed union models Sprague-Dawley (SD) Rats. There were 4 groups (n=6), consist of; 4-weeks-given-monacolin group (PM4), 2-weeks-given-monacolin group (PM2), 4-weeks-control group (PM2) and 2-weeks control group (KM2). After they were sacrificed in the second and fourth weeks, immunohistochemical staining was conducted to evaluate BMP-2 expression by Immunoreactive Score (IRS). The histomorphometric evaluation was also conducted to evaluate fracture healing by measuring fibrous area, cartilage area, and woven bone area percentage. Results: There was significantly higher BMP-2 expression (p=0.03), less fibrous area (p=0.05), and larger cartilage area (p= 0.04) in the PM2 group compared to the KM2 group. There was significantly higher expression of BMP-2 (p=0.011), larger woven bone area (p=0.01), and less fibrous area (p = 0.03) in the PM4 group compared to the KM4 group. It was also presented, there was a significantly less fibrous area (p=0,02), larger cartilage area (p=0.05), and larger woven bone area (p=0.04) in the PM4 group compared to the PM2 group. The expression of BMP-2 in the PM2 group was as high as the PM4 group. Conclusion: Monacolin in red-yeast-rice effectively increased BMP-2 expression and fracture healing in the delayed union model of SD rats."

"ABSTRAK Pendahuluan. Kesulitan dalam tatalaksana defek tulang yang luas merupakan salah satu tantangan dewasa ini. Selain tatalaksananya yang kompleks juga dapat memberikan dampak jangka panjang negatif yang berat. Penggunaan BMP-2 dalam tatalaksana fraktur dengan defek tulang yang luas memegang peranan penting. BMP-2 berperan pada proses osteogenesis dan chondrogenesis dan menghambat osteoclastogenesis melalui RANKL signaling. Penelitian ini bertujuan untuk mengetahui efek dari perbedaan dosis BMP-2 terhadap penyembuhan fraktur dengan defek tulang yang luas. Metode. Penelitian dilakukan di Laboratorium Animal Gizi di FKUI dan Laboratorium Patologi Anatomi FKUI-RSCM, pada bulan Juli hingga September 2015. Desain penelitian adalah randomized post test control group. Sejumlah 25 ekor tikus putih Sprague Dawley dengan usia 3-4 bulan dan berat badan antara 250 ? 350 gram, dibagi secara acak menjadi kelompok kontrol hidroksiapatit (HA) saja dan kelompok kombinasi HA + BMP-2 1 μg/ml, HA + BMP-2 5 μg/ml, HA + BMP-2 10 μg/ml, HA + BMP-2 20 µg/ml. Tiap kelompok dilakukan tindakan berupa frakturisasi dengan defek tulang 10mm pada femur kanan dan dilakukan fiksasi interna dengan menggunakan intramedullary k-wire ukuran 1,4 mm secara retrograd. Setelah 6 minggu dilakukan penilaian secara histomorfometri, radiologis dan Scanning Electron Microscope (SEM). Hasil. Berdasarkan hasil penelitian secara histomorfometri ditemukan terdapat perbedaan rerata total area kalus yang bermakna diantara kelompok penelitian (p<0,001),terdapat perbedaan bermakna rerata area penulangan antara kelompok kontrol dengan kelompok 1 μg/ml, 5 μg/ml, 10 μg/ml, 20 μg/ml (masing-masing p=0,009, p=0,016, p=0,009 dan p=0,016), terdapat perbedaan bermakna rerata area kartilago antara kelompok kontrol dengan kelompok 1 μg/ml, 5 μg/ml, 10 μg/ml, 20 μg/ml (masing-masing p=0,009, p=0,009, p=0,009 dan p=0,028), terdapat perbedaan bermakna rerata area fibrosis antara kelompok kontrol dengan kelompok 1 μg/ml dengan kelompok kontrol dan 10 μg/ml(masing-masing p=0,047 dan p=0,009).Secara radiologis dengan RUST score didapatkan perbedaan bermakna antara kelompok kontrol dengan kelompok 1 μg/ml, 5 μg/ml, 10 μg/ml, 20 μg/ml (masing-masing p=0,005, p=0,006, p=0,005 dan p=0,006). Dengan SEM didapatkan gambaran kalus yang lebih homogen dan padat pada kelompok 10μg/ml dibandingkan dengan 5 μg/ml dan 20 μg/ml. Kesimpulan: Pemberian BMP-2 dapat menstimulasi proses penyembuhan fraktur pada defek tulang luas (critical bone defect) yang bermakna secara statistik, histomorfometri, radiologis maupun secara kualitatif dengan SEM. Terdapat dosis optimal dalam pemberian BMP-2.ABSTRACT Introduction: Difficulties in the management of extensive bone defects is one of today's challenges. It is not only complex treatment but also can provide long-term negative severe effects. The use of BMP-2 in the treatment of fractures with extensive bone defect plays an important role. BMP-2 plays a role in the process of osteogenesis and chondrogenesis and inhibits osteoclastogenesis via the RANKL signaling. This study aims to determine the effect of differences in doses of BMP-2 on the healing of the fracture with extensive bone defects. Methods: The study was conducted at the Laboratory of Animal Nutrition at the Faculty of Medicine University of Indonesia (FMUI) in July until September 2015. The study design was randomized posttest control group. A number of 25 Sprague Dawley rats aged 3-4 months and bodyweight between 250-350 grams, were randomly divided into a control group of hydroxyapatite (HA) alone and HA+BMP-2 1 µg / ml, HA+BMP -2 5 ug / ml, HA + BMP-2 10 µg / ml, HA + BMP-2 20 ug / ml. Each group carried out fracturization with 10mm bone defect in right femur and internal fixation by using intramedullary K-wire size of 1.4 mm retrograde. After 6 weeks we did histomorfometri assessment, radiological and Scanning Electron Microscope (SEM). Results: Based on the research results histomorfometrcally found there are differences in the mean total area of ​​callus significantly between the study group (p <0.001), there were significant differences in the mean area of ​​woven bone between the control group with group 1 ug / ml, 5 µg / ml, 10 µg / ml, 20 ug / ml (respectively p = 0.009, p = 0.016, p = 0.009 and p = 0.016), there were significant differences in the average area of ​​the cartilage between the control group with group 1 ug / ml, 5 µg / ml, 10 µg / ml, 20 ug / ml (respectively p = 0.009, p = 0.009, p = 0.009 and p = 0.028), there were significant differences in the average area of ​​fibrosis between the control group with group 1 ug / ml in the control group and 10 mg / ml (respectively -masing p = 0.047 and p = 0.009) .In radiologist assessment with RUST scores obtained significant differences between the control group and group 1 ug / ml, 5 µg / ml, 10 µg / ml, 20 µg / ml (respectively p = 0.005 , p = 0.006, p = 0.005 and p = 0.006). SEM features with callus more homogeneous and dense in the group of 10μg / mL compared with 5 ug / ml and 20 µg / ml. Conclusion: Administration of BMP-2 could stimulate the process of fracture healing in large bone defects (critical bone defect) which was statistically significant with histomorfometri assestment, radiological and qualitatively with the SEM. There is an optimal dose in the administration of BMP-2.;Introduction: Difficulties in the management of extensive bone defects is one of today's challenges. It is not only complex treatment but also can provide long-term negative severe effects. The use of BMP-2 in the treatment of fractures with extensive bone defect plays an important role. BMP-2 plays a role in the process of osteogenesis and chondrogenesis and inhibits osteoclastogenesis via the RANKL signaling. This study aims to determine the effect of differences in doses of BMP-2 on the healing of the fracture with extensive bone defects. Methods: The study was conducted at the Laboratory of Animal Nutrition at the Faculty of Medicine University of Indonesia (FMUI) in July until September 2015. The study design was randomized posttest control group. A number of 25 Sprague Dawley rats aged 3-4 months and bodyweight between 250-350 grams, were randomly divided into a control group of hydroxyapatite (HA) alone and HA+BMP-2 1 µg / ml, HA+BMP -2 5 ug / ml, HA + BMP-2 10 µg / ml, HA + BMP-2 20 ug / ml. Each group carried out fracturization with 10mm bone defect in right femur and internal fixation by using intramedullary K-wire size of 1.4 mm retrograde. After 6 weeks we did histomorfometri assessment, radiological and Scanning Electron Microscope (SEM). Results: Based on the research results histomorfometrcally found there are differences in the mean total area of ​​callus significantly between the study group (p <0.001), there were significant differences in the mean area of ​​woven bone between the control group with group 1 ug / ml, 5 µg / ml, 10 µg / ml, 20 ug / ml (respectively p = 0.009, p = 0.016, p = 0.009 and p = 0.016), there were significant differences in the average area of ​​the cartilage between the control group with group 1 ug / ml, 5 µg / ml, 10 µg / ml, 20 ug / ml (respectively p = 0.009, p = 0.009, p = 0.009 and p = 0.028), there were significant differences in the average area of ​​fibrosis between the control group with group 1 ug / ml in the control group and 10 mg / ml (respectively -masing p = 0.047 and p = 0.009) .In radiologist assessment with RUST scores obtained significant differences between the control group and group 1 ug / ml, 5 µg / ml, 10 µg / ml, 20 µg / ml (respectively p = 0.005 , p = 0.006, p = 0.005 and p = 0.006). SEM features with callus more homogeneous and dense in the group of 10μg / mL compared with 5 ug / ml and 20 µg / ml. Conclusion: Administration of BMP-2 could stimulate the process of fracture healing in large bone defects (critical bone defect) which was statistically significant with histomorfometri assestment, radiological and qualitatively with the SEM. There is an optimal dose in the administration of BMP-2."

"Fraktur mandibula merupakan fraktur kraniomaksilofasial yang paling umum dan seringkali menyebabkan gangguan mengunyah. Tata laksana definitif fraktur mandibula adalah reduksi terbuka dan fiksasi interna menggunakan plat dan sekrup sistem 2.0, seperti plat tiga dimensi (3D). Namun, desain plat 3D konvensional memiliki keterbatasan karena bentuknya yang tidak dapat diubah, sehingga sulit menghindari garis fraktur atau struktur anatomi penting seperti akar gigi dan saraf saat melakukan pemasangan sekrup. Untuk mengatasi masalah ini, diperlukan desain plat 3D yang dapat diubah konfigurasinya. Oleh karena itu, dikembangkanlah desain plat 3D interlocking. Berbeda dengan plat 3D yang sudah ada selama ini, plat 3D interlocking memiliki kebaruan yaitu plat ini dapat dirangkai dari beberapa jenis plat dengan menumpuk 2 buah plat menjadi 1 kesatuan plat. Sambungan kedua buah plat ini tidak menambah ketebalan plat dan dapat diubah konfigurasinya dengan menyesuaikan sudut antara plat horizontal dan plat vertikal. Finite Element Analysis (FEA) dilakukan untuk menentukan kelayakan desain plat 3D interlocking. Setelah FEA memastikan kelayakan desain, purwarupa yang diproduksi dilakukan pengujian biomekanik menggunakan sepuluh mandibula kambing untuk menilai kekuatan mekanik dan stabilitas plat 3D interlocking. Biokompatibilitas dan penyembuhan tulang dievaluasi dalam uji hewan coba yang melibatkan 28 kambing. Biokompatibilitas dinilai dengan mengevaluasi respons inflamasi dari uji radiologik dan histopatologik (pewarnaan Hematoxylin-Eosin). Penyembuhan tulang dinilai melalui berbagai metode, termasuk uji radiologik yang mengukur kepadatan tulang, uji histopatologik menggunakan pewarnaan Mason Trichome, dan analisis penanda tulang melalui imunohistokimia dan ELISA. Selain itu, uji kemudahan penggunaan dilakukan dengan sembilan Spesialis Bedah Plastik Rekonstruksi dan Estetik untuk menilai tingkat kenyamanan dan durasi yang diperlukan untuk mengaplikasikan plat pada model mandibula sintetik. Uji biomekanik juga dilakukan pada uji kemudahan penggunaan sebagai komponen evaluasi objektif. Dalam uji biomekanik, plat 3D interlocking menunjukkan kemampuan yang lebih baik dalam mempertahankan stabilitas fraktur yang memungkinkan gerakan mikro yang terkendali. Selanjutnya, uji biokompatibilitas menunjukkan bahwa kelompok plat 3D interlocking menghasilkan reaksi jaringan dan respons inflamasi yang lebih rendah dibandingkan plat tolok ukur pada uji hewan coba. Selain itu, plat 3D interlocking juga mempercepat proses penyembuhan tulang, terbukti dari peningkatan bermakna dalam pembentukan dan kepadatan tulang pada uji hewan coba. Hasil uji kemudahan penggunaan menunjukkan bahwa plat 3D interlocking dapat digunakan dengan mudah seperti halnya plat tolok ukur. Secara keseluruhan, plat 3D interlocking menunjukkan potensi sebagai alternatif yang layak untuk tata laksana fraktur mandibula.

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Mandibular fractures are the most common craniomaxillofacial fractures, often resulting in mastication disturbances. Mandibular fracture management typically involves the use of 2.0 system plates and screws, such as three-dimensional (3D) plates. However, the conventional 3D plate designs for mandibular fracture management have limitations. Their fixed shape makes it challenging to avoid fracture lines or vital anatomical structures, such as dental roots and nerves when placing screws. A 3D plate design that allows for configuration changes is needed to address this issue. Therefore the interlocking 3D plate was developed. This novel design features components that can be adjusted to avoid critical anatomical structures and fracture lines while still offering the stability of a 3D plate, enhancing its utility in mandibular fracture management. Finite element analysis was performed to establish the feasibility of the interlocking 3D plate design. Once that was established, biomechanical evaluation was conducted using ten goat mandibles to assess the mechanical strength and stability of the interlocking 3D plate. Biocompatibility and bone healing properties were evaluated in an animal study involving 28 goats. Biocompatibility was assessed by evaluating inflammatory responses from radiological and histopathological (Hematoxylin-Eosin staining) study. Bone healing properties were assessed through various methods, including radiological study measuring bone density, histopathological study using Mason Trichome staining, and analyzing bone markers through immunohistochemistry and ELISA. Additionally, usability study were conducted with nine plastic surgeons to assess the level of comfort and the duration required to apply the plate on a synthetic mandibular model. These findings were correlated with biomechanical test results. The biomechanical evaluation revealed that the interlocking 3D plate design better-maintained fracture stability while allowing controlled micro-movement. Regarding biocompatibility, the interlocking 3D plate exhibited better results than the standard plate, as indicated by lower tissue reaction and inflammatory response in animal study. The interlocking 3D plate also facilitated faster bone healing, with significant bone formation and bone density improvements in animal study. Usability study demonstrated that the interlocking 3D plate was as easy to use as the standard plate, with no significant differences in application time. Overall, the interlocking 3D plate demonstrates significant potential as a viable alternative for managing mandibular fractures."

"ABSTRAKFractures of the neck of condyle usually are the result of a blow to the mandible. A lateral blow to the body of the mandible commonly cause a contralateral condylar fracture. There are many signs and symptoms of a condylar fracture, for example crepitation, deviation of the mandible to the side of injury, and spasm of the associate group of muscles. These will result in a functional disability, which is usually seen as a limited mandibular movement. This paper reported a patient with a fracture of the right condylar neck. Patient had been treated with closed reduction and immobilization for 2 months. After that, she felt that her bite was charged, she could not occlude her teeth well, and she had clicking sound in the right joint when she opened her mouth. Besides that, patient had difficulties to move the mandible to the left side, and she could not open her mouth widely. The patient was treated with a repositioning splint and she had to do some jaw exercises.The purposes were to regain the position of condyle, to reduce the muscle spasm and finally got the normal jaw movement."

"Summary: Apley and Solomon's Concise System of Orthopaedics and Trauma is firmly established as the leading introductory textbook of orthopaedic practice and the principles of fracture management. Praised in previous editions for its systematic approach, balanced content and easy-to-read style, the fourth edition has been brought fully up to date with more than 800 illustrations, many new to this edition, providing an invaluable pictorial account of this highly visual subject. Key features of the Fourth Edition: Reflects the changing pattern of musculoskeletal disease around the world Focuses on actua"