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"Pendahuluan: Rekonstruksi ACL merupakan salah satu operasi orthopaedi yang paling sering dilakukan. Beratnya cedera, mahalnya harga implan dan teknik yang cukup sulit menimbulkan masalah sosial dan ekonomi yang cukup besar pada pasien dengan cedera ACL. Rekonstruksi ACL tanpa implan dengan teknik pressfit femoral dapat menjadi alternatif untuk pasien cedera ACL. Penelitian ini bertujuan untuk mengetahui apakah rekonstruksi ACL tanpa implan memberikan luaran fungsional objektif dan subjektif setara (non-inferior) dengan metode implan.Metode Penelitian: Duabelas pasien menjalani rekonstruksi ACL tanpa implan dengan teknik press-fit femoral dan 24 pasien menjalani rekonstruksi ACL dengan implan selama Maret 2013-Maret 2014 di RSPAD Gatot Subroto, Jakarta. Seluruh pasien diikuti mulai dari praoperasi dengan minimal follow-up 6 bulan paska operasi (cohort prospective). Luaran objektif berupa pengukuran rolimeter, serta luaran subjektif berupa skor IKDC, Tegner-Lysholm dan KOOS dinilai pada saat praoperasi, serta 1 bulan, 3 bulan dan 6 bulan pascaoperasi.Temuan Penelitian dan Diskusi: Tidak didapatkan perbedaan yang bermakna pada luaran fungsional objektif dan subjektif antara kelompok tanpa implan dan kelompok implan pada pengukuran praoperasi, serta 1 bulan, 3 bulan dan 6 bulan pascaoperasi. Didapatkan rerata hasil pengukuran rolimeter sebagai luaran fungsional objektif pada 6 bulan pascaoperasi dengan hasil lebih tinggi pada kelompok tanpa implan (95% IK) sebesar 0,82 (-0,09-1,73) milimeter (p=0,075). Nilai rolimeter 6 bulan pascaoperasi antara lutut yang cedera dan lutut yang sehat (side to side diference) menunjukkan median rentang antar kuartil (RAK) 1,00 (0,067-2,08) dan 1,34 (0,33-1,92) milimeter (p=0,779). Median (RAK) rolimeter praoperasi dan 6 bulan pascaoperasi (time to time diference) 5,17 (3,41-6,17) dan 5,00 (4,08-6,00) pada kelompok tanpa implan dan implan (p=0,882). Median (RAK) skor Tegner-Lysholm pada 6 bulan pascaoperasi untuk kelompok tanpa implan dan kelompok implan adalah 95.00 (87.00-100,00) dan 95,00 (90.00- 100,00) dengan p=0,989. Rerata (simpang baku) skor IKDC pada 6 bulan pascaoperasi untuk kelompok tanpa impan dan kelompok implan 73.47 (10.473) dan 69,65 (10.286) (p=0.303). Penilaian KOOS 6-bulan pascaoperasi pada kelompok tanpa implan dan kelompok implan memiliki median (RAK) 90,20 (81.13-90.95) dan 88,10 (84.65-93.35) dengan p=0,999. Non-inferioritas diperiksa secara parametrik dan batas non- inferioritas selisih rerata d=8 poin untuk skor IKDC dan d=10 poin untuk skor KOOS dan Tegner, tidak terlampaui.Simpulan: Luaran fungsional objektif dan subjektif pasien yang menjalani rekonstruksi ACL tanpa implan dengan teknik press-fit femoral menunjukkan hasil yang non-inferior dibandingkan dengan yang menggunakan implan dalam evaluasi yang dilakukan selama 6 bulan (short-term follow up).

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Introduction: ACL reconstruction is one of the most common procedures performed by many orthopedic surgeons. The severity of injury, cost of implants and high demanding technique operation leave enormous social and economic issues for the patient. Implantless ACL reconstruction with press-fit femoral fixation technique is one of the alternatives to solve the problems. The aim of this study was to find whether implantless ACL reconstruction gave comparable functional outcome (non-inferior) objectively and subjectively compared to the ACL reconstruction using implant technique.Methods: Twelve patients underwent implantless ACL reconstruction with pressfit femoral technique and 24 patients underwent ACL reconstruction with implant between March 2013 and March 2014 at Gatot Soebroto Army Hospital, Jakarta. All patients were followed from preoperative until minimum of 6 months follow up post operatively (cohort prospective). Objective functional outcome were measured using rolimeter, and subjective functional outcome were measured according to IKDC, Tegner-Lysholm and KOOS.Result and Discussion: There were no significant differences in objective and subjective functional outcome between implantless group compared to implant group at the preoperative measurement, as well as at 1 month, 3 months, and 6 months post operative. Mean rolimeter measurement result is obtained as objective functional outcome at 6 months post operative with higher result in implantless group (95%CI) of 0,82 (-0,09-1,73) millimeter (p=0,075). Rolimeter measurement in 6 months post operation between the injured knee and the healthy knee (side to side difference) showed a median inter-quartile range (IQR) 1,00 (0,067-2,08) and 1,34 (0,33-1,92) millimeter with p value 0,799. Median (IQR) for Tegner-Lysholm score at 6 months post operation for implantless group and implant group were 95.00 (87.00-100,00) and 95,00 (90.00-100,00) respectively with p value = 0,989. Mean (Standard Deviation) IKDC score at 6 months post operative in implantless group and implant group were 73.47 (10.473) and 69,65 (10.286) respectively with p value = 0.303. KOOS assessment at 6 month post operative in implant less group and implant group have median (IQR) 90,20 (81.13-90.95) and 88,10 (84.65-93.35) respectively, with p value = 0,999. Noninferiority was checked parametrically with non-inferiority border difference mean d = 8 points for IKDC score and d = 10 points for KOOS and Tegner score, were not concede.Conclusion: Objective and subjective functional outcome of patient who underwent implantless ACL reconstruction using press-fit femoral fixation showed a non-inferior result compared to patients who underwent ACL reconstruction using implant in 6 months of short term follow up."

"[Pendahuluan: Congenital Talipes Equinovarus(CTEV) dan Developmental Dysplasia of the Hip (DDH) merupakan salah satu kelainan kongenital tersering dalam sistem muskuloskeletal. Pada patogenesis CTEV dan DDH, terdapat persamaan kemungkinan etiologi yaitu pada gaya mekanik intra-uterin panggul dan kaki yang menimbulkan gangguan perkembangan. Tujuan penelitian ini adalah untuk mengetahui prevalensi pasien CTEV yang menderita DDH, serta hubungan antara CTEV dengan timbulnya DDH.Metode Penelitian: Penelitian ini adalah penelitian deskriptif analitik dengan desain studi potong lintang. Dari data registrasi CTEV di Poliklinik Orthopaedi Rumah Sakit Cipto Mangunkusumo tahun 2011-2012 ditemukan 91 orang anak dengan CTEV primer. Dilakukan skrining dengan anamnesis dan pemeriksaan fisik untuk mengeksklusi pasien di luar rentang usia 6 bulan hingga 5 tahun, pasien dengan gangguan neuromuskular, dan kelainan kongenital. Terdapat 22 orang pasien yang memenuhi kriteria tersebut dan dilakukan pemeriksaan foto polos panggul untuk mengukur Indeks Acetabular (IA). IA<25° dinyatakan normal, 25-30° dinyatakan borderline DDH, dan >30° dinyatakan displasia berat.Temuan dan Diskusi Penelitian: Terdapat distribusi pasien yang homogen secara jenis kelamin (50% laki-laki, 50% perempuan), dan lokasi CTEV (50% bilateral, 50% unilateral). Didapatkan 19 subyek dengan IA di bawah 250 dan 1 subyek dengan IA antara 25-300. Didapatkan 2 subyek (9%) yang memiliki dysplastic hip dengan IA di atas nilai normal 300, kedua subyek tersebut memiliki bilateral CTEV dan menjalani serial casting ≥ 8 kali. Tidak terdapat hubungan yang bermakna secara statistik antara prevalensi DDH dengan rentang usia (p = 1), dengan jenis kelamin (p = 0.89), dengan lokasi CTEV (p = 0.89), dan dengan frekuensi casting (p = 0.05). Walaupun begitu, prevalensi hip dysplasia pada CTEV cenderung terjadi pada anak dengan CTEV bilateral dan menjalani serial casting ≥ 10 kali sehingga temuan ini dapat menjadi makna yang penting secara klinis.Simpulan: Prevalensi displasia panggul pada anak CTEV berusia 6 bulan hingga 5 tahun pada penelitian ini adalah 9% dan cenderung dialami oleh anak dengan CTEV bilateral dan menjalani serial casting 8 kali atau lebih., Introduction: Congenital Talipes Equinovarus (CTEV) and Developmental Dysplasia of the Hip (DDH) are one of the most common pediatric orthopaedic problems ini musculoskeletal system. There is similar pathogenesis between CTEV and DDH in mechanical force that causes developmental disorders. The goals of this research are to determine the prevalence of CTEV that will suffer DDH in later time, and the relationship between CTEV and DDH.Methods: This is a descriptive analytic study with cross sectional design. Ninety one patients with primary CTEV were registered in Orthopaedic Clinic at Cipto Mangunkusumo Hospital between 2011 and 2012. To exclude patients with neuromuscular disorders and congenital problems; screening is performed by conducting historical and physical examination. Patients between age 6 months and 5 years were included in this study. Twenty two patients met the criteria and pelvic x-ray was performed to measure the Acetabular Index (AI). AI<250 was considered normal; AI 25-300 was borderline DDH; and AI >300 was considered severe dysplasia.Result and Discussion: Patient distribution was homogenous in gender (50% are boys, 50% are girls), and the location of CTEV (50% bilateral and 50%). There were 19 subjects with AI lower than 250 and 1 subject with AI between 250-300. Both subjects underwent ≥ 8 times serial casting. There was no significant difference between DDH prevalence with age range (p = 1), with gender (p = 0.89), with CTEV location (p = 0.89), and with casting frequency (p = 0.05). However, dysplastic hip prevalence in CTEV tend to occur in bilateral CTEV with serial casting ≥ 10 times which could be important on clinical setting.Conclusion: Hip dysplasia prevalence on children with CTEV aged 6 months to 5 years was 9% and tend to occur in children with bilateral CTEV underwent ≥ 10 times serial casting.]"

"Fraktur pelvis kompleks merupakan fraktur yang tidak stabil pada lingkar pelvis yang disertai dengan cedera jaringan lunak sekitarnya dan dapat disertai dengan gangguan hemodinamik. Fraktur ini terdapat pada 10% fraktur pelvis. Tingkat mortalitas pada fraktur pelvis kompleks mencapai 33%. Menurut data di RSCM pada tahun 2011, insidensi terjadinya fraktur pelvis sebesar tiga persen. Manajemen utama pada pasien dengan fraktur pelvis kompleks ialah manajemen perdarahan, restorasi hemodinamik, diagnosis, stabilisasi lingkar pelvis, serta penanganan yang sesegera mungkin. Hasil terbaik dicapai dengan fiksasi interna sesegera mungkin pada segmen anterior dan posterior pelvis. Morbiditas yang ditemukan ialah nyeri kronis, disfungsi seksual, infeksi, dan nonunion fraktur. Penting sekali dilakukan penelitian mengenai luaran fraktur pelvis kompleks di RSCM untuk menilai keberhasilan terapi, sehingga dapat meyempurnakan tatalaksana fraktur pelvis dan mengurangi tingkat morbiditas dan mortalitas.Penelitian ini merupakan penelitian analitik dengan desain cross sectional. Sampel adalah semua pasien dengan fraktur pelvis kompleks yang sudah diterapi dengan ORIF pada tahun 2011-2014, kriteria inklusi penelitian ini ialah pasien dengan fraktur pelvis terbuka atau fraktur pelvis Tile tipe B atau C yang telah menjalani operasi ORIF dengan follow up lebih dari 6 bulan. Setelah itu dilakukan evaluasi morbiditas yang ditemui dan dinilai dengan skor Majeed dan Hannover. Untuk analisa univariat hubungan fraktur pelvis kompleks dengan morbidatas yang terjadi dan skor fungsionalnya dilakukan dengan menggunakan uji Fischer, sedangkan uji multivariate dengan menggunakan uji regresi logistik.Jumlah sampel pada penelitian ini sebanyak 26 pasien. Rerata umur pasien ialah 30,54 tahun, rerata Injury Severity Score (ISS) ialah 27,2, rerata lama follow up ialah 25 bulan. Sembilan pasien merupakan pasien politrauma. Fraktur pelvis terbuka ditemukan pada tujuh pasien, sedangkan 19 pasien merupakan fraktur pelvis tertutup. Fraktur pelvis Tile tipe B ditemukan pada 15 pasien dan dengan Tile tipe C sebanyak 11 pasien. Berdasarkan skor majeed pada Tile tipe B, skor excellent ditemukan pada 73,3% kasus, skor good ditemukan pada 20 % kasus, dan skor fair ditemukan pada 6,7% kasus. Pada Tile tipe C, skor excellent hanya sebanyak 45,5%, skor good ditemukan juga sebanyak 45,5 %, dan skor fair ditemukan sebanyak pada 9% kasus. Berdasarkan skor Hannover, pada Tile tipe B skor very good ditemukan sebanyak 33.3% kasus, skor good ditemukan pada 53,3% kasus dan skor fair ditemukan pada sebanyak 6,67% kasus. Pada Tile tipe C, skor very good ditemukan pada 18,2 % kasus, skor good ditemukan pada 72,7% kasus, dan skor fair ditemukan pada 9 % kasus. Infeksi lebih sering ditemukan pada fraktur pelvis terbuka (42,9%) dari kasus fraktur pelvis terbuka. Dengan uji regresi didapatkan bahwa tipe fraktur tidak berhubungan dengan disfungsi seksual yang timbul (p>0,05), tetapi ditemukan hubungan cedera urogenital pada fraktur pelvis kompleks dengan disfungsi seksual (p=0,005). Melalui studi ini juga ditemukan hubungan tipe fraktur pelvis Tile tipe B dan C dengan terjadinya nyeri kronis (p=0,017)Luaran fraktur pelvis kompleks di RSCM baik karena lebih dari 90% pasien memiliki skor fungsional excellent dan good (Majeed) dan skor very good dan good (Hannover). Rerata skor Majeed pada studi ini ialah 85.9. Infeksi lebih banyak ditemukan pada fraktur pelvis terbuka. Tipe fraktur tidak memiliki hubungan dengan terjadinya disfungsi seksual. Namun, tipe fraktur pelvis memiliki hubungan dengan timbulnya nyeri kronis.

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Complex pelvic fracture is unstable pelvic fracture associated with soft tissue injury in pelvic region and with haemodynamic instability. This fractures only represent 10% of pelvic fracture. In 2011, the incidence of pelvic fracture in Cipto Mangunkusumo hospital is 3 %. Main management of complex pelvic fracture is bleeding management, haemodynamic restoration, pelvic ring stabilization, and early treatment. Best outcome can be achieved by performing early internal fixation of anterior dan posterior part of the pelvis. It is very important to evaluate the outcome of this type of fracture to evaluate the effectiveness of the management and to reduce the mortality and morbidity rates.

This is an analitical study with cross sectional design. The inclusion criteria are patients with open pelvic fracture, unstable Tile type B or C pelvic fracture that had already undergone ORIF between 2011-2014 and had been followed for minimum 6 months. Then mobidities and functional score were evaluated. The functional score was evaluated using Majeed and Hannover pelvic score. This study was analyzed using Fischer test and logistic regression test.

There were 26 samples with mean age 30.54, mean ISS score was 27.2, mean follow up was 25 months. Nine patients were polytrauma patients. There were seven open pelvic fractures and 19 closed pelvic fractures. There were 15 Tile Type B and 11 Tile type C pelvic fractures. According to majeed pelvic score, In type B, there was 73.3% excellent score, 20% good score, and only 6.7% fair score. In type C, there were lower patients with excellent. There was 45,5% excellent score, 45.5% good score, and 9 % fair score. According to Hannover pelvic score, in type B there was 33.3 % very good score, 53.3% good score, and only 6.67% fair score. In Tile type C, there were 18.2 % very good score, 72.7% good score, and 9% fair score. Infection occur higher in open pelvic fracture (42.9%). There was association between chronic pain and fracture type (p=0.017). There was no association between fracture type and sexual dysfunction (p>0.05), but there was association between urogenital injury and sexual dysfunction (p<0.005).

The functional outcome of complex pelvic fracture after ORIF in Cipto Mangunkusumo hospital are satisfying. There were more than 90% patients that have excellent and good score (Majeed) and very good and good (Hannover). Mean majeed score was 85.9. Infection occurred higher in open pelvic fracture. There was no association between fracture type and sexual dysfunction, but there was association between fracture type and chronic pain."

"[Studi ini mengevaluasi pengaruh orientasi komponen (safe dan non-safe zone) THR, yang diwakilkan oleh sudut abduksi acetabulum, anteversi acetabulum, anteversi femur, ataupun kombinasinya terhadap luaran fungsional pasien. Penelitian analitik cross sectional ini melibatkan pasien dengan prosedur THR periode Januari 2008-Mei 2014. Tidak ditemukan hubungan bermakna antara sudut orientasi komponen prostesis THR dengan luaran fungsional HHS pasca-THR(<80 dan >80); sudut abduksi acetabulum, anteversi acetabulum, & sudut kombinasi anteversi(p>0,05). Aplikasi safe dan non-safe zone memberikan luaran fungsional yang sama. Posisi attahiyat dan squatting yang lebih tidak bisa dilakukan oleh kelompok safe zone sudut abduksi acetabulum bukan karena pengaruh sudut orientasi komponen THR. Skor HHS pasca-THR memiliki perbedaan bermakna: HHS pra-THR(p=0,001);This study evaluates whether total hip replacement (THR) prosthesis component orientation influence hip functional outcome. This is an analytical cross-sectional study involving post-THR patients in RSUPN Cipto Mangunkusumo in January 2008- May 2014. The component orientation angle (safe zone dan non-safe zone) are not related significantly with post-THR HHS (<80 dan >80); the acetabular abduction angle, the acetabular anteversion angle, the combined anteversion angle (p>0.05). There is no difference in outcome in both safe and non-safe zone groups. There is no influence of THR component orientation angle in patient’s ability to perform “attahiyat” and squatting position., This study evaluates whether total hip replacement (THR) prosthesis component orientation influence hip functional outcome. This is an analytical cross-sectional study involving post-THR patients in RSUPN Cipto Mangunkusumo in January 2008- May 2014. The component orientation angle (safe zone dan non-safe zone) are not related significantly with post-THR HHS (<80 dan >80); the acetabular abduction angle, the acetabular anteversion angle, the combined anteversion angle (p>0.05). There is no difference in outcome in both safe and non-safe zone groups. There is no influence of THR component orientation angle in patient’s ability to perform “attahiyat” and squatting position.]"

"[Pendahuluan. Congenital Talipes Equino Varus (CTEV, clubfoot) merupakan salah satu kelainan kaki bawaan yang paling sering ditemui di dunia. Jika tidak ditangani, clubfoot akan mempengaruhi kualitas hidup secara signifikan. Teknik Ponseti telah diterima secara universal sebagai metode terapi dengan hasil yang sangat memuaskan.Tujuan. Mengetahui korelasi antara parameter antropometri kaki dengan skor Dimeglio pasca Ponseti.Metode Penelitian. Penelitian analitik observasional dilakukan dengan desain cross sectional terhadap pasien clubfoot unilateral yang datang ke RSCM 2008-2013. Selain pencatatan data dasar dan jenis tatalaksana yang dilakukan, diukur juga panjang kaki, lebar kaki dan lingkar betis kedua kaki, serta penilaian skor Dimeglio. Uji t digunakan untuk menganalisis perbedaan rerata panjang kaki, lebar kaki dan lingkar betis kaki ctev dengan kaki normal. Sedangkan Uji korelasi Pearson digunakan untuk menganalisis korelasi antara selisih antropometri dengan Skor Dimeglio.Temuan dan Diskusi Penelitian. Rerata skor Dimeglio pasca terapi adalah 4,8. Uji t satu arah ditemukan panjang kaki, lebar kaki dan lingkar betis kaki CTEV lebih kecil signifikan dari kaki normal (t0>t, CI 95%). Korelasi selisih panjang kaki dengan Skor Dimeglio 0,694. Korelasi selisih lebar kaki dengan skor Dimeglio 0,367. Korelasi selisih lingkar betis dengan skor Dimeglio 0,305. Uji Korelasi Pearson ditemukan korelasi bermakna antara selisih panjang kaki dengan skor Dimeglio (P<0,01). Sedangkan tidak ditemukan korelasi antara lebar kaki dan lingkar betis dengan skor Dimeglio (P>0,01)Kesimpulan. Luaran metoda Ponseti dengan skor Dimeglio pada clubfoot unilateral adalah baik. Rerata panjang, lebar, dan lingkar betis kaki CTEV lebih rendah dari kaki normal. Terdapat korelasi antara selisih panjang kaki dengan skor Dimeglio pasca terapi.;Introduction. Clubfoot is one of the most common congenital foot deformity in the world which affect the quality of life. Ponseti technique has been universaly accepted as the method with a very satisfactory result. Objective. This study aims to find any correlation between Dimeglio score post Ponseti-treated clubfoot with anthropometric parameter of the foot. Method. This is an observational analytic study with cross sectional design. Unilateral clubfoot patients who came to Cipto Mangunkusumo Hospital from 2008 until 2013 were recruited. Measurement of foot length, foot width, and calf circumference of both feet and Dimeglio score assessment was done. T-test was used to analyze the differences of foot length, foot width, and calf circumference between both feet. Pearson correlation test was used to analyze the correlation between anthropometric differences and severity of clubfoot. Result and Discussion. The mean of post-treatment Dimeglio score was 4.8. One-way t-test found that the foot length, foot width and calf circumference of clubfeet were significantly smaller than the normal feet (t0>t, CI 95%). The correlation of difference in foot length, foot width, and calf circumference with Dimeglio score was 0.694, 0.367 and 0.305, respectively. Pearson correlation test found significant correlation between the difference in foot length and Dimeglio score (p<0.01).Conclusion. The outcome of Ponsetti technique for unilateral clubfoot using Dimeglio score is good. The means of foot length, foot width, and calf circumference for clubfoot were found to be less than normal foot. There were correlation between differences of foot length and post treatment Dimeglio score., Introduction. Clubfoot is one of the most common congenital foot deformity in the world which affect the quality of life. Ponseti technique has been universaly accepted as the method with a very satisfactory result. Objective. This study aims to find any correlation between Dimeglio score post Ponseti-treated clubfoot with anthropometric parameter of the foot. Method. This is an observational analytic study with cross sectional design. Unilateral clubfoot patients who came to Cipto Mangunkusumo Hospital from 2008 until 2013 were recruited. Measurement of foot length, foot width, and calf circumference of both feet and Dimeglio score assessment was done. T-test was used to analyze the differences of foot length, foot width, and calf circumference between both feet. Pearson correlation test was used to analyze the correlation between anthropometric differences and severity of clubfoot. Result and Discussion. The mean of post-treatment Dimeglio score was 4.8. One-way t-test found that the foot length, foot width and calf circumference of clubfeet were significantly smaller than the normal feet (t0>t, CI 95%). The correlation of difference in foot length, foot width, and calf circumference with Dimeglio score was 0.694, 0.367 and 0.305, respectively. Pearson correlation test found significant correlation between the difference in foot length and Dimeglio score (p<0.01).Conclusion. The outcome of Ponsetti technique for unilateral clubfoot using Dimeglio score is good. The means of foot length, foot width, and calf circumference for clubfoot were found to be less than normal foot. There were correlation between differences of foot length and post treatment Dimeglio score.]"

"[Pendahuluan: Otot Palmaris Longus adalah salah satu otot pada grup fleksor lengan bawah manusia. Palmaris Longus ini sering digunakan dalam prosedur medis di berbagai bidang, khususnya di bidang Orthopaedi dalam prosedur tendon transfer dan rekonstruksi tendon. Absensi Palmaris Longus merupakan variasi normal pada tubuh manusia, absensi tersebut berbeda-beda pada berbagai populasi di seluruh dunia seperti pada populasi Serbia mempunyai angka absensi sebesar 42,4% sedangkan pada populasi Korea hanya sebesar 4,0%. Pengetahuan mengenai absensi Palmaris Longus pada populasi Indonesia penting untuk menghindari kesulitan dan kesalahan dalam operasi dan pengambilan graft Palmaris Longus. Absensi Palmaris Longus ini diduga berkaitan faktor genetik yang berkaitan erat dengan etnis dan jenis kelamin. Absensi Palmaris Longus pada satu sisi tangan saja diduga dapat mempengaruhi kekuatan tangan pada salah satu sisi. Penelitian absensi Palmaris Longus ini belum pernah dilakukan sebelumnya pada populasi Indonesia dengan etnis yang beranekaragam dan juga mengenai hubungannya dengan jenis kelamin dan sisi tangan dominan.Metode Penelitian: Penelitian ini adalah penelitian cross-sectional deskriptif analitik dengan melakukan pemeriksaan klinis Palmaris Longus dengan pemeriksaan standar yakni tes Schaeffer dan dikonfirmasi dengan pemeriksaan klinis lainnya. Pengambilan data dilakukan dengan pemeriksaan fisik langsung, dilengkapi dengan foto dan kuisioner oleh pemeriksa tunggal di berbagai kota di Indonesia yaitu Jakarta, Pemalang, Bandung, Bogor, Depok, Bukittinggi, Padang. Responden diambil dengan proportional consecutive sampling pada enam etnis terbesar di Indonesia dengan jumlah responden 1230 orang dengan 492 etnis Jawa, 246 etnis Sunda, 123 etnis Batak, 123 etnis Madura, 123 etnis Betawi dan 123 etnis Minang. Analisa statistik dilakukan untuk mengetahui hubungan absensi Palmaris Longus dengan etnis, jenis kelamin dan hubungan absensi unilateral dengan sisi tangan dominan. Analisa tersebut dilakukan dengan uji chi-square dengan signifikansi p<0,05.Temuan dan Diskusi Penelitian: Absensi Palmaris Longus pada keseluruhan responden populasi Indonesia baik bilateral dan unilateral adalah 128 dari 1230 orang responden (10,41%). Absensi Palmaris Longus tertinggi adalah pada etnis Batak dan Madura yaitu 15,45% diikuti oleh etnis Sunda yaitu 11,79%, etnis Jawa 9,96%, etnis Betawi 5,96% dan yang terendah adalah etnis Minang 4,07%. Perbedaan angka absensi Palmaris Longus di antara berbagai etnis ini bermakna secara statistik (p=0,008). Absensi Palmaris Longus pada jenis kelamin laki-laki dan perempuan tidak berbeda signifikan secara statistik (p=0,74) dimana absensi Palmaris Longus perempuan sedikit lebih banyak yakni 10,70% sedangkan laki-laki 10,20%. Di antara keseluruhan Absensi Palmaris Longus, absensi unilateral adalah sebanyak 62,5% dan bilateral 37,5% responden. Absensi Palmaris Longus unilateral tersebut tidak dapat dianalisis statistik dengan sisi tangan dominan karena sedikitnya jumlah responden dengan tangan dominan kiri yang mempunyai absensi Palmaris Longus unilateral yakni hanya 1 orang responden (1,25%).Simpulan: Absensi Palmaris Longus pada populasi Indonesia adalah 10,41%. Absensi tersebut berhubungan bermakna dengan etnis, namun tidak berhubungan bermakna dengan jenis kelamin. Absensi Palmaris Longus unilateral pada penelitian ini tidak dapat diuji secara statistik., Introduction: Palmaris Longus muscle is one of the muscle in human forearm flexor group. Palmaris Longus is often used in the medical procedure in various medical specialty, especially in orthopaedics which are used in the tendon transfer procedure and tendon reconstruction. Palmaris Longus absence is a normal variation on human body, the absence are different in the various pupulation over the world, like in the Serbian population have absence rate in 42,4% but in the Korean population only 4,0%. Knowledge about Palmaris Longus absence in Indonesian Population important to avoid difficulties and mistakes during operation or harvesting of Palmaris Longus graft. This absence of Palmaris Longus is likely related to genetic factor which are also related with ethnicity and sex. Unilateral absence of Palmaris Longus is suggested can affect hand power on the side of the absence. This study about this Palmaris Longus absence hasn’t been studied yet in the Indonesian population with its multiethnicity and also the relationship with sex and side of hand dominance.Methods: This research is a descriptive analytic cross-sectional study using Palmaris Longus clinical examination with standard examination Schaeffer test and confirmed with other clinical examinations. Data collections are performed with direct physical examination, photo and questionnare by a single examiner in various cities in Indonesia which are Jakarta, Pemalang, Bandung, Bogor, Depok, Bukittinggi and Padang. Respondent was taken with proportional consecutive sampling in the six largest ethnicities in Indonesia with total respondent 1230 people with 492 Java ethnicity, 246 Sunda ethnicity, 123 Batak ethnicity, 123 Madura ethnicity, 123 Betawi ethnicity and 123 Minang ethnicity. Statistical analysis used to find relationship of Palmaris Longus absence with ethnicity, sex and relationship of unilateral absence with hand side dominance. The analysis are performed with chi-square test with significance p<0,05. Result and Discussion: Palmaris Longus absence in overall Indonesian population respondent, bilateral and unilateral noted in 128 people from 1230 respondent (10,41%). Highest rate of Palmaris Longus absence is in the Batak and Madura ethnicities which are 15,45% followed by Sunda ethnicity 11,79%, Java ethnicity 9,96%, Betawi ethnicity 5,95% and the lowest is Minang ethnicity 4,07%. The difference rate between these ethnicities are statistically significant (p=0,008). Palmaris Longus absence between male and female sex is not different statistically (p=0,74) which are female sex slightly higher absence rate than male sex, 10,70 and 10,20 respectively. In overall absence of Palmaris Longus, unilateral absence is 62,5% and bilateral absence is 37,5%. This unilateral Palmaris Longus absence cannot be statistically analyzed with the hand dominance side because of the limitation number of the respondent with left hand dominance which have unilateral absence of Palmaris Longus, that only 1 respondent (1,25%). Conclusion: Palmaris Longus absence in Indonesian population is 10,41%. That absence is significantly related with ethnicity, but not significantly related with sex. Unilateral Palmaris Longus absence in this study cannot be analysed statistically.]"

"Pendahuluan. Glukosamin, Kondroitin sulfat dan Methylsufonylmethane (MSM) merupakan suplemen yang sering diberikan pada pasien osteoarhritis (OA) derajat I dan II. Organisasi kedokteran seperti AAOS, OARSI, EULAR memberikan rekomendasi yang berbeda tentang penggunaannya. Studi ini bertujuan untuk menilai efektivitas Glukosamin-Kondroitin sulfat (GK) dan GKM terhadap perbaikan klinis pasien OA sendi lutut.Bahan dan Cara Kerja. Studi ini merupakan uji klinis acak tersamar ganda pada 147 pasien dengan OA lutut derajat Kellgren-Lawrence I atau II. Subjek dipilih dengan metode randomisasi dengan blok permutasi ke tiga kelompok yaitu GK (n=49), GKM (n=50) dan plasebo (n=48). Obat-obatan ini diberikan sekali sehari selama 3 bulan berturut-turut. Skor VAS dan WOMAC dinilai sebelum pemberian suplemen, kemudian minggu ke 4, 8, dan 12.Hasil. Rata-rata usia pasien adalah 61 tahun, dimana 67,3% pasien adalah perempuan. Bila dibandingkan terhadap Skor WOMAC pada kelompok Plasebo, kelompok GKM menurunkan skor WOMAC secara signifikan (perbedaan rerata 7.15, IK 12.06-2.23, p=0.005). Kelompok GK menurunkan Skor WOMAC secara signifikan (perbedaan rerata 8.17, IK 13.49-2.84, p=0.003). Sementara itu pada penilaian Skor VAS, kelompok GKM menurunkan skor secara signifikan terhadap dua kelompok lain, yaitu terhadap kelompok GK secara signifikan (perbedaan rerata 0.68, IK 1.18-0.19, p=0.007), dan Plasebo (perbedaan rerata 0.86, IK 1.37-0.35, p=0.001).Simpulan. Kombinasi suplemen GKM lebih efektif dalam menurunkan nyeri dan meningkatkan fungsi pada pasien OA sendi lutut derajat I dan II dibandingkan dengan GK dan plasebo. Sedangkan suplemen GK secara keseluruhan tidak lebih baik dibandingkan dengan plasebo dalam memberikan perbaikan klinis pada pasien OA sendi lutut derajat Kellgren Lawrence I-II.

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Introduction. Glucosamine-Chondroitin sulfate-Methylsufonylmethane (MSM) as combination are the most popular supplements for patients with knee osteoarthritis (OA). There are emerging controversies and also different recomendation from many medical associations such as AAOS, OARSI, and EULAR regarding the effectiveness of these supplements. This current study evaluated the efficacy of Glucosamine-Chondroitin sulfate (GC), Glucosamine-Chondroitin-MSM (GCM), and placebo on clinical improvement of patients with knee OA Kellgren Lawrence gr I-II.

Material and Methods. This study was a double blind, randomized controlled clinical trial on 147 patients with knee OA Kellgren-Lawrence grade I-II. Subjects were allocated by permuted block randomization to three groups, either GC (n=49), or GCM (n=50), or placebo (n=48). VAS and WOMAC score were measured before treatment, then at 4 th, 8 th and 12th week after treatment.

Result. Mean age of patients was 61 years, and 67,3% were woman. As compared with Placebo group, WOMAC score in GCM group was significantly lower (MD 7.15, CI 12.06-2.23, p=0.005), and in GC group WOMAC Score was also lower (mean difference 8.17, CI 13.49-2.84, p=0.003). Whereas VAS score in GCM group was significantly lower compared to that in GC group (MD 0.18, CI 1.18-0.19, p=0.007) and also compared with Placebo group (MD 0.86, CI 1.37-0.35, p=0.001).

Conclusions. Combinations of GCM made a clinical improvement in patients with knee OA Kellgren Lawrence gr I-II compared with GC and Placebo. GC did not make clinical improvement in overall groups of patients with knee OA Kellgren Lawrence gr I-II."

"ABSTRAK Pendahuluan Penggunaan megaprostesis sebagai pilihan dalam manajemen LSSmemberikan harapan baru bagi pasien tumor tulang di Indonesia. Namun, sampaisaat ini belum ada data hasil luaran dari tata laksana ini.Metode Penelitian ini merupakan prospektif observational pada 34 pasien tumortulang di RS Cipto Mangunkusumo pada tahun 2011-2015. Diagnosis ditegakkanmelalui Clinical Pathological Conference. Evaluasi pascaoperasi dilakukan padabulan ke-3, 6, 9, 12, 24, 36, dan 48 dengan menggunakan skoring dari MSTS.Luaran onkologi dievaluasi dengan adanya rekurensi dan metastasis jauh.Komplikasi berupa infeksi, dislokasi, cedera saraf dan pembuluh darah, sertagangguan mekanisme ekstensor juga dievaluasi. Hasil Dua orang ahli bedah muskuloskeletal onkologi melakukan operasi LSS danrekonstruksi dengan megaprostesis. Dua pasien dieksklusi karena keputusanintraoperatif untuk memakai non modular endoprostesis. Kehilangan darahintraoperatif memiliki median (RAK) 890,0 (700,0?1200,0) ml. Skor MSTSsebagian besar pasien menunjukkan kategori baik dan sangat baik, yaitu 67.9%baik pada MSTS 6 bulan, 79,2% baik pada MSTS 9 bulan, 63.4% sangat baikpada 12 bulan, 90% sangat baik pada 24 bulan dan 100% sangat baik pada MSTS36 bulan. Terdapat hubungan bermakna antara karakteristik pasien yaitu jenistumor (p=0,001), usia (p=0,039), jenis kelamin (p=0,049), dan hasil laboratoriumALP (p=0,031) dengan luaran fungsional MSTS 3 bulan. Terdapat hubunganbermakna antara karakteristik pasien yaitu perdarahan intraoperatif (p=0,013) danALP (p=0,009) dengan mortalitas; dan juga antara tumor tulang yang menjalanirekonstruksi jaringan lunak ekstensif dengan komplikasi (p=0,019) namun antaralokasi tumor dan komplikasi tidak terdapat hubungan bermakna. Kesimpulan Luaran fungsional pada pasien yang dilakukan rekonstruksimegaprostesis adalah baik dan sangat baik sehingga dapat menjadi tatalaksanapilihan bagi pasien tumor tulang yang akan menjalani LSS. Luaran onkologi padapasien yang dilakukan prosedur LSS baik dengan rendahnya rekurensi lokal, metastasi, dan komplikasi. ABSTRACT Introduction Advancement in bone tumor management has elaborated surgeon?schoice of treatment not merely sentenced the patients into a limb ablation.Likewise, patients with bone tumors, regardless its malignant nature and limitedsurvival time, had an equal privileges to opt for LSS to experience a better qualityof life. In this study, we manage to evaluate the functional and oncologic outcomeof lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors wereprospectively reviewed between 2011 and 2015 in a tertiary referral generalhospital. All patients were managed through a Clinical Pathology Conference.Functional outcome was evaluated using MSTS score and follow up was recordedat 3, 6, 12 months; and 2, 3, 4 years.Results Two orthopedic musculoskeletal oncologic surgeons were performing thesurgeries. Two patients were excluded because the final instruments used werenot a modular type. The final result of functional score was good to excellent with67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,90% excellent at 24 months and 100% excellent at 36 months. Complicationsoccurred and varied. A statistical significant result was found between age(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 monthsfunctional outcome; between intraoperative blood loss (p=0,013) and mortality,as well as SAP with mortality (p=0,009); between tumor that underwent extensivesoft tissue reconstruction procedure and complication (p=0,019).Conclusion Megaprosthesis reconstruction in bone tumors gives a good andexcellent result, which provides orthopaedic oncologic surgeons a rationalizationto make a selective decision-making in tumor cases regardless its survival andtumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?schoice of treatment not merely sentenced the patients into a limb ablation.Likewise, patients with bone tumors, regardless its malignant nature and limitedsurvival time, had an equal privileges to opt for LSS to experience a better qualityof life. In this study, we manage to evaluate the functional and oncologic outcomeof lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors wereprospectively reviewed between 2011 and 2015 in a tertiary referral generalhospital. All patients were managed through a Clinical Pathology Conference.Functional outcome was evaluated using MSTS score and follow up was recordedat 3, 6, 12 months; and 2, 3, 4 years.Results Two orthopedic musculoskeletal oncologic surgeons were performing thesurgeries. Two patients were excluded because the final instruments used werenot a modular type. The final result of functional score was good to excellent with67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,90% excellent at 24 months and 100% excellent at 36 months. Complicationsoccurred and varied. A statistical significant result was found between age(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 monthsfunctional outcome; between intraoperative blood loss (p=0,013) and mortality,as well as SAP with mortality (p=0,009); between tumor that underwent extensivesoft tissue reconstruction procedure and complication (p=0,019).Conclusion Megaprosthesis reconstruction in bone tumors gives a good andexcellent result, which provides orthopaedic oncologic surgeons a rationalizationto make a selective decision-making in tumor cases regardless its survival andtumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?schoice of treatment not merely sentenced the patients into a limb ablation.Likewise, patients with bone tumors, regardless its malignant nature and limitedsurvival time, had an equal privileges to opt for LSS to experience a better qualityof life. In this study, we manage to evaluate the functional and oncologic outcomeof lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors wereprospectively reviewed between 2011 and 2015 in a tertiary referral generalhospital. All patients were managed through a Clinical Pathology Conference.Functional outcome was evaluated using MSTS score and follow up was recordedat 3, 6, 12 months; and 2, 3, 4 years.Results Two orthopedic musculoskeletal oncologic surgeons were performing thesurgeries. Two patients were excluded because the final instruments used werenot a modular type. The final result of functional score was good to excellent with67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,90% excellent at 24 months and 100% excellent at 36 months. Complicationsoccurred and varied. A statistical significant result was found between age(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 monthsfunctional outcome; between intraoperative blood loss (p=0,013) and mortality,as well as SAP with mortality (p=0,009); between tumor that underwent extensivesoft tissue reconstruction procedure and complication (p=0,019).Conclusion Megaprosthesis reconstruction in bone tumors gives a good andexcellent result, which provides orthopaedic oncologic surgeons a rationalizationto make a selective decision-making in tumor cases regardless its survival andtumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?schoice of treatment not merely sentenced the patients into a limb ablation.Likewise, patients with bone tumors, regardless its malignant nature and limitedsurvival time, had an equal privileges to opt for LSS to experience a better qualityof life. In this study, we manage to evaluate the functional and oncologic outcomeof lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors wereprospectively reviewed between 2011 and 2015 in a tertiary referral generalhospital. All patients were managed through a Clinical Pathology Conference.Functional outcome was evaluated using MSTS score and follow up was recordedat 3, 6, 12 months; and 2, 3, 4 years.Results Two orthopedic musculoskeletal oncologic surgeons were performing thesurgeries. Two patients were excluded because the final instruments used werenot a modular type. The final result of functional score was good to excellent with67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,90% excellent at 24 months and 100% excellent at 36 months. Complicationsoccurred and varied. A statistical significant result was found between age(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 monthsfunctional outcome; between intraoperative blood loss (p=0,013) and mortality,as well as SAP with mortality (p=0,009); between tumor that underwent extensivesoft tissue reconstruction procedure and complication (p=0,019).Conclusion Megaprosthesis reconstruction in bone tumors gives a good andexcellent result, which provides orthopaedic oncologic surgeons a rationalizationto make a selective decision-making in tumor cases regardless its survival andtumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?schoice of treatment not merely sentenced the patients into a limb ablation.Likewise, patients with bone tumors, regardless its malignant nature and limitedsurvival time, had an equal privileges to opt for LSS to experience a better qualityof life. In this study, we manage to evaluate the functional and oncologic outcomeof lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors wereprospectively reviewed between 2011 and 2015 in a tertiary referral generalhospital. All patients were managed through a Clinical Pathology Conference.Functional outcome was evaluated using MSTS score and follow up was recordedat 3, 6, 12 months; and 2, 3, 4 years.Results Two orthopedic musculoskeletal oncologic surgeons were performing thesurgeries. Two patients were excluded because the final instruments used werenot a modular type. The final result of functional score was good to excellent with67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months,90% excellent at 24 months and 100% excellent at 36 months. Complicationsoccurred and varied. A statistical significant result was found between age(p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 monthsfunctional outcome; between intraoperative blood loss (p=0,013) and mortality,as well as SAP with mortality (p=0,009); between tumor that underwent extensivesoft tissue reconstruction procedure and complication (p=0,019).Conclusion Megaprosthesis reconstruction in bone tumors gives a good andexcellent result, which provides orthopaedic oncologic surgeons a rationalizationto make a selective decision-making in tumor cases regardless its survival andtumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence."

"ABSTRAK Latar Belakang: Simple bone cyst (SBC) adalah tumor tulang jinak, berisi cairan.Tujuan utama terapi SBC adalah mendapatkan penyembuhan tulang, mencegahfraktur patologis, dan manajemen gejala khususnya nyeri. Terdapat berbagaimetode pengobatan SBC, namun saat ini masih kontroversial karena angkakesembuhan dan tingkat invasi operasi. Terapi injeksi perkutaneus steroidmerupakan metode operasi dengan tingkat invasi rendah sehingga penyembuhantulang dan luaran fungsional lebih baik. Metode: Total terdapat 10 pasien (6 laki-laki, 4 perempuan, rerata usia13 tahun)SBC yang terbagi dalam dua kelompok. 5 pasien (proksimal femur 3; proksimalhumerus 1; calcaneus 1) dilakukan terapi injeksi perkutaneus steroid dan 5 pasien(proksimal femur 2; proksimal humerus 2, radius 1) terapi kurease denganhidroksiapatit. Injeksi perkutaneus steroid dilakukan sebanyak tiga kali denganinterval waktu tiap satu bulan. Rerata follow up adalah 12-26 bulan. Evaluasipenyembuhan tulang dinilai secara radiologi dengan kriteria Chang dkk. Luaranfungsional dinilai berdasarkan skor MSTS.Hasil: Penyembuhan tulang komplit didapatkan pada kedua kelompok, namunsolid union lebih cepat terjadi pada kelompok terapi injeksi perkutaneus steroid. Luaran fungsional didapatkan nilai yang lebih baik pada kelompok injeksiperkutaneus steroid terutama pada bulan ke-3 (55%) dan ke-6 (84%) pasca operasiberdasarkan skor MSTS dibandingkan terapi kuretase dengan hidroksiapatit(bulan ke-3 47% dan ke-6 69,3%). Simpulan: Terapi injeksi perkutaneus steroid masih tetap menjadi pilihan utamametode terapi SBC dengan solid union lebih cepat, tingkat prosedur operasi invasi rendah, lebih mudah, efektif, dan aman.ABSTRACT Background: Simple bone cysts (SBC) are a benign bone tumor, fluid-filled. The maingoals of the therapy are to get the bone healing, prevent pathological fractures, andmanagement of pain symptom. There are various methods of the SBC treatment, howeverstill remains controversial because of their healing rate and invasiveness of surgery.Steroid injection therapy is a surgical procedure with a low level of invasiveness so thatbetter bone healing and functional outcomes.Methods: A total of 10 patients (6 males, 4 females, mean age 13 year) SBC were dividedinto two groups. 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1)performed percutaneous steroid injection therapy and 5 patients (proximal femur 2; 2proximal humerus, radius 1) performed curretage with hydroxyapatite therapy.Percutaneous steroid injection was performed three times at intervals of each month. Themean follow-up of 12-26 months. Evaluation of bone healing radiological asseesed byChang criteria and the functional outcome by MSTS score.Results: Complete bone healing was found in both group, but solid union occurred fasterin steroid injection theraphy group. The functional outcomes found better value in thesteroid injection theraphy group, particulary at 3 months (55%) and 6 months (84%) thancurettage with hydroxyapatite therapy(3 months 47% and 6 months 69,3%) postoperation based on MSTS score.Conclusions: Percutaneus steroid injection therapy is still the main choice of SBCtreatment with faster solid union, a lower level operating procedures invasion, easy, effective, and safe.;Background: Simple bone cysts (SBC) are a benign bone tumor, fluid-filled. The maingoals of the therapy are to get the bone healing, prevent pathological fractures, andmanagement of pain symptom. There are various methods of the SBC treatment, howeverstill remains controversial because of their healing rate and invasiveness of surgery.Steroid injection therapy is a surgical procedure with a low level of invasiveness so thatbetter bone healing and functional outcomes.Methods: A total of 10 patients (6 males, 4 females, mean age 13 year) SBC were dividedinto two groups. 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1)performed percutaneous steroid injection therapy and 5 patients (proximal femur 2; 2proximal humerus, radius 1) performed curretage with hydroxyapatite therapy.Percutaneous steroid injection was performed three times at intervals of each month. Themean follow-up of 12-26 months. Evaluation of bone healing radiological asseesed byChang criteria and the functional outcome by MSTS score.Results: Complete bone healing was found in both group, but solid union occurred fasterin steroid injection theraphy group. The functional outcomes found better value in thesteroid injection theraphy group, particulary at 3 months (55%) and 6 months (84%) thancurettage with hydroxyapatite therapy(3 months 47% and 6 months 69,3%) postoperation based on MSTS score.Conclusions: Percutaneus steroid injection therapy is still the main choice of SBCtreatment with faster solid union, a lower level operating procedures invasion, easy, effective, and safe.;Background: Simple bone cysts (SBC) are a benign bone tumor, fluid-filled. The maingoals of the therapy are to get the bone healing, prevent pathological fractures, andmanagement of pain symptom. There are various methods of the SBC treatment, howeverstill remains controversial because of their healing rate and invasiveness of surgery.Steroid injection therapy is a surgical procedure with a low level of invasiveness so thatbetter bone healing and functional outcomes.Methods: A total of 10 patients (6 males, 4 females, mean age 13 year) SBC were dividedinto two groups. 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1)performed percutaneous steroid injection therapy and 5 patients (proximal femur 2; 2proximal humerus, radius 1) performed curretage with hydroxyapatite therapy.Percutaneous steroid injection was performed three times at intervals of each month. Themean follow-up of 12-26 months. Evaluation of bone healing radiological asseesed byChang criteria and the functional outcome by MSTS score.Results: Complete bone healing was found in both group, but solid union occurred fasterin steroid injection theraphy group. The functional outcomes found better value in thesteroid injection theraphy group, particulary at 3 months (55%) and 6 months (84%) thancurettage with hydroxyapatite therapy(3 months 47% and 6 months 69,3%) postoperation based on MSTS score.Conclusions: Percutaneus steroid injection therapy is still the main choice of SBCtreatment with faster solid union, a lower level operating procedures invasion, easy, effective, and safe."

"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."