Fingertip injuries: Does administration of antibiotics give benefits? A double-blind randomized controlled trial.

PURPOSE: Adequate debridement and defect closure is an important treatment in fingertip injuries in addition to administration of antibiotic. However, administration of anitibiotics remains controversial whether it necessary for fingertip injuries that have been treated with adequate debridement and defect closure. The goal of study is to assess the differences of infection rate between subgroups with administration of antibiotics and without antibiotic in FTI treated by debridement and simple defect closure. METHODS: The study design was a double-blind randomized clinical trial. Data collection was carried out at Cipto Mangunkusumo General Hospital, Jakarta and Tangerang Regency Hospital, Banten, in July 2022-February 2023. The target population of this study were adult patients with Fingertip injuries that treated by debridement and simple defect closures with antibiotics administration and without antibiotic. Infection was assessed at day-7, 14, and 21 follow-up. RESULTS: There were 31 FTI subjects with 41 fingers affected. The number of male subjects was 27 people and female subjects 4 people. The most affected finger was the little finger (12 fingers, 30.8%), with most type of Allen classification was type IV (18 fingers, 43.90%), most procedure performed was primary suture (24 fingers, 58.54%). 15 subjects randomized to antibiotic group and 16 subjects to no-antibiotic group. There was 1 subject of antibiotic group and 1 subject of no-antibiotic group has infection. There are no significant differences between two groups. CONCLUSION: There were no significant differences of infection rate between antibiotics administration and without antibiotic in FTI cases that treated by debridement and simple defect closures.

Glucomannan isolation from porang (Amorphophallus muelleri Blume) flour using natural deep eutectic solvents and ethanol: A comparative study.

Ethanol is a common solvent to isolate glucomannan from porang (Amorphophallus muelleri Blume) flour (NPF). This study investigated the use of natural deep eutectic solvents (NADESs) in glucomannan isolation from NPF. NADESs formed by the hydrogen bond acceptors (choline chloride and betaine) and the hydrogen bond donors (glycerol, 1,2-propanediol, formic acid, and acetic acid) in varying molar ratios of 1:2, 1:3, and 1:4 were characterized to optimize glucomannan isolation. The results showed that higher molar ratios of NADES tended to yield porang glucomannan flour (PGF) with higher glucomannan content and viscosity. The gel of PGF exhibited pseudoplastic behavior. The FTIR spectra indicated that betaine-based NADES removed the acetyl groups from glucomannan chains. The PGF obtained from NADESs with a molar ratio of 1:4 was comparable to those obtained from ethanol with a glucomannan content of 87.34 %-93.28 % and a weight-average molecular weight of 9.12 × 105-1.20 × 106 g/mol.

Prospect of Mesenchymal Stem Cells in Enhancing Nerve Regeneration in Brachial Plexus Injury in Animals: A Systematic Review.

Objectives: Brachial plexus injuries (BPI), although rare, often results in significant morbidity. Stem cell was thought to be one of BPI treatment modalities because of their nerve-forming regeneration potential. Although there is a possibility for the use of mesenchymal stem cells as one of BPI treatment, it is still limited on animal studies. Therefore, this systematic review aimed to analyze the role of mesenchymal stem cells in nerve regeneration in animal models of brachial plexus injury. Method: This study is a systematic review with PROSPERO registration number CRD4202128321. Literature searching was conducted using keywords experimental, animal, brachial plexus injury, mesenchymal stem cell implantation, clinical outcomes, electrophysiological outcomes, and histologic outcomes. Searches were performed in the PubMed, Scopus, and ScienceDirect databases. The risk of bias was assessed using SYRCLE's risk of bias tool for animal studies. The data obtained were described and in-depth analysis was performed. Result: Four studies were included in this study involving 183 animals from different species those are rats and rabbits. There was an increase in muscle weight and shortened initial onset time of muscle contraction in the group treated with stem cells. Electrophysiological results showed that mesenchymal stem cells exhibited higher (Compound muscle action potential) CMAP amplitude and shorter CMAP latency than control but not better than autograft. Histological outcomes showed an increase in axon density, axon number, and the formation of connections between nerve cells and target muscles. Conclusion: Mesenchymal stem cell implantation to animals with brachial plexus injury showed its ability to regenerate nerve cells as evidenced by clinical, electrophysiological, and histopathological results. However, this systematic study involved experimental animals from various species so that the results cannot be uniformed, and conclusion should be drawn cautiously.

Tibialization of fibula in critical bone defect due to post traumatic osteomyelitis of the tibial shaft: A case report.

INTRODUCTION AND IMPORTANCE: Post-traumatic osteomyelitis in patients with an open fracture is one of the most common causes of a bone defect after an extensive debridement and one of the most challenging complications to treat. Removal of devitalized and infected tissue may result in a large defect that requires subsequent reconstruction. CASE PRESENTATION: Two patients that underwent tibialization were included in this study. The first patient is a 32-year-old male with an infected non-union of the left shaft tibia and the second patient is a 10-year-old boy with a gap non-union of the right shaft tibia due to open fracture with bone loss. Both patients resulted in proximal and distal bone union and full weight bearing on the affected leg without limitation and pain. Nine months Follow up for the first patient show the proximal and distal bone union and an addition to the width of the fibular graft in X-ray examination showing promising results. For the second patient, follow-up 12 months after surgery shows a complete union of the proximal and distal bone union. CLINICAL DISCUSSION: Debridement would lead to soft tissue loss, which usually results in large injury defects. Tibialization of the fibula, also known as fibula pro tibia grafting, is one of the known reconstruction methods in treating patients with segmental defects in the tibia. CONCLUSION: Critical bone defects remain one of the most challenging orthopaedic conditions to treat. Tibialization is an excellent option with an acceptable functional outcome to treat critical bone defects.

Do National Export Promotion Programs in Indonesia support export competitiveness?

This study examines the influence of export promotion programs (EPPs) in Indonesia on companies' resources, capabilities, strategies, and competitiveness, and whether such programs positively impact export performance and finances. Using data from 204 exporting companies in Indonesia and the structural equation model for analysis, this study finds that participation in EPPs reinforces the organizational resources and exporting capabilities needed for developing successful export strategies. This allows for the creation of competitive advantages in export costs, product superiority, and effective distribution, which in turn increases performance in terms of market share and finance. The results also indicate that the effect of EPPs is relatively more significant on small companies and those with more export experience. They confirm that EPPs have the most significant impact on firms' resources and capabilities, and that assistance programs that aim to improve organizational capabilities are needed to enhance marketing strategies. While innovative capabilities and business intelligence offer great potential to support export performance, EPP-type assistance programs have not been adequately developed in Indonesia.

Survey data on organizational resources and capabilities, export marketing strategy, export competitiveness, and firm performance in exporting firms in Indonesia.

This article presents a dataset of 204 exporting firms surveyed in Indonesia to assess the internationalization and participation of enterprises in government export promotion programs (EPP). Under a resource-based view (RBV) approach, the dataset includes four dimensions of government export assistance programs, three dimensions capturing organizational resources and organizational capabilities. In addition, the survey collects data on the firms' export marketing strategies, competitiveness, and market performance. Firm-level characteristics are identified to reveal the organizational characteristics, the companies' strategic features, and market orientation. The dataset also includes obstacles the companies face across dimensions and sub-components with critical attributes. In total, the dataset includes 19 constructs of questions with 180 variables. The dataset can be used to test the firms' competitive advantage in export markets, assess the role of government programs in the firms' export performance, examine export barriers as predictors, mediators, and moderators of export performance, etc. The dataset can be used under different theoretical approaches, i.e., RBV, internationalization process, or institutional theories.

Double-bundle ACL reconstruction versus anatomic single-bundle ACL reconstruction combined with anterolateral ligament reconstruction: a comparative study of clinical outcome.

INTRODUCTION: Recent studies showed increasing evidences of anterolateral ligament (ALL) reconstruction in conjunction with anterior cruciate ligament (ACL) reconstruction that proves to be more superior to the previous double-bundle (DB) ACLR technique especially in improving knee stability in biomechanic studies. However to date, there have been no studies evaluating the functional outcome of DB-ACLR vs single-bundle (SB) with ALL in ACLR. METHODS: A total of 138 patients with ACL deficient knee were enrolled to the study. Double-bundle ACL reconstruction (DB-ACLR) was performed in 75 patients and single-bundle ACL reconstruction with anterolateral ligament reconstruction (SB + ALL) ACLR was performed in 63 patients. Surgical outcomes were compared with The International Knee Documentation Committee Subjective Knee Form (IKDC) and the Kujala score at the 3rd, 6th and 9th month post-operative. RESULTS: The IKDC score in the 3rd and 6th month was superior in the SB + ALL group compared to the DB group. However, this difference was not statistically significant. In the meantime, there were no statistically significant difference between the Kujala Score at the 3rd, 6th, and 9th months consecutively. There were no statistically significant differences in the functional outcomes of DB-ACLR and SB + ALL groups at the 3rd, 6th, and 9th months post-operative period. CONCLUSION: The functional outcome comparison showed non-superiority of SB + ALL group compared to the DB-ACLR group. The patellar pain was less found in DB-ACLR group at 6- and 9-months post-operative period.

Structural Elucidation and Engineering of a Bacterial Carbohydrate Oxidase.

Flavin-dependent carbohydrate oxidases are valuable tools in biotechnological applications due to their high selectivity in the oxidation of carbohydrates. In this study, we report the biochemical and structural characterization of a recently discovered carbohydrate oxidase from the bacterium Ralstonia solanacearum, which is a member of the vanillyl alcohol oxidase flavoprotein family. Due to its exceptionally high activity toward N-acetyl-d-galactosamine and N-acetyl-d-glucosamine, the enzyme was named N-acetyl-glucosamine oxidase (NagOx). In contrast to most known (fungal) carbohydrate oxidases, NagOx could be overexpressed in a bacterial host, which facilitated detailed biochemical and enzyme engineering studies. Steady state kinetic analyses revealed that non-acetylated hexoses were also accepted as substrates albeit with lower efficiency. Upon determination of the crystal structure, structural insights into NagOx were obtained. A large cavity containing a bicovalently bound FAD, tethered via histidyl and cysteinyl linkages, was observed. Substrate docking highlighted how a single residue (Leu251) plays a key role in the accommodation of N-acetylated sugars in the active site. Upon replacement of Leu251 (L251R mutant), an enzyme variant was generated with a drastically modified substrate acceptance profile, tuned toward non-N-acetylated monosaccharides and disaccharides. Furthermore, the activity toward bulkier substrates such as the trisaccharide maltotriose was introduced by this mutation. Due to its advantage of being overexpressed in a bacterial host, NagOx can be considered a promising alternative engineerable biocatalyst for selective oxidation of monosaccharides and oligosaccharides.

Particular precautions and the role of intraoperative neuromonitoring in cervical cord injury in elder recreational cyclist: A case report.

INTRODUCTION AND IMPORTANCE: The trend in cycling nowadays affects all age groups. However, special precautions must be considered in the elderly group. Minor trauma to the cervical region can cause severe neurological deterioration, leading to fatality because of the pre-existing degenerative process. CASE PRESENTATION: We present a case of a 61-year-old male recreational cyclist with acute onset of tetraplegia following a minor fall. The radiological result revealed a long-standing degenerative process. Unfortunately, the patient deceased due to the sequelae of the paralysis and cardiac event despite our prompt surgical decompression and the improvement shown on intraoperative neuromonitoring. CLINICAL DISCUSSION: The degenerative process can aggravate cervical cord injury even in its mildest form of injury. In this study, immediate improvement was detected by the intraoperative neuromonitoring (IONM) - although the clinical improvement had not improved yet as the general condition is poor. CONCLUSION: The elder cycling population is increasing. Safety measures and injury avoidance are advisable along with expert consultation before the exercise. In a pre-existing degenerative condition of the cervical, a special precaution is also needed during the exercise. If the surgery has been indicated, the use of intraoperative neuromonitoring is found to be useful to guide the decompression and potentially beneficial as a predictive value for the clinal outcome.

A rare case of oxidized zirconium - All polyethylene tibia unicompartmental arthroplasty failure: A case report.

Oxidized zirconium (Oxinium) implants has been claimed as the best material in terms of wear reduction. However, longevity of an all polyethylene uni knee arthroplasty (UKA) has been a long debate. We reported a rare case of 74 year old female who was performed all polyethylene UKA 6 years prior and fell 3 months prior. After the incident, patient was wheel-chair ridden afterwards. There was no evidence of fracture upon conventional radiography examination. Conversion of UKA to total knee replacement (TKA) was performed and patient was able to walk with aid after the surgery. The failed Oxinium all polyethylene UKA failure in this case is suspected due osteoarthritis progression.

Evaluation of patellar dimension and Bristol Index in Asian population: An MRI study.

BACKGROUND: Restoration of patellar thickness is pivotal during a total knee arthroplasty (TKA). Several studies showed there are differences in the knee measurements between Asian and Western population. PURPOSE: This study aims to evaluate the patellar dimension and Bristol Index of patellar width to thickness (BIPWiT) using magnetic resonance imaging (MRI) in Asian population. STUDY DESIGN: This is a descriptive epidemiology study. METHODS: 101 MRI scans of young adult patients with normal patellofemoral joint (PFJ) age 17-40 were evaluated from January 2019 to December 2020. Exclusion criteria included patella-femoral pathology and degenerative joint disease. Data of gender, body height and weight were obtained from physical examination, while patella height, width and thickness were obtained using MRI measurement. Descriptive analysis was used to get the mean and standard deviation of patella dimension, whereas correlation between patella thickness with patella width and length were analyzed using Pearson correlation and BIPWiT ratio was obtained by dividing the patellar width and patellar thickness. RESULTS: Mean patellar length was 30.06 ± 2.94 (29.48-30.64); patellar width was 44.13 ± 4.44 (43.26-45.01); and patellar thickness was 23.89 ± 2.33 (23.43-24.35). Patellar dimension in male were significantly larger compared to female (P < 0.001). However, there was no difference in cartilage thickness between male and female (P = 0.305). There was strong correlation between patellar width and patellar thickness (r = 0.66; P < 0.001) with BIPWiT ratio of 1.85 ± 0.15. CONCLUSION: BIPWiT of 1.8:1 between patellar width and patellar thickness was recommended as a guide for patellar thickness restoration during TKA. There is no difference of patellar dimension between Asian and Western population in a healthy knee. CLINICAL RELEVANCE: The result of BIPWiT ratio found in this study may aid upon pre-operative planning prior TKA for surgeons in order to achieve optimal patellar thickness and avoid patellofemoral problem. WHAT IS KNOWN ABOUT THE SUBJECT: Currently there are raising concerns about the different sizes of knee measurements between Asian and Western population which will affect techniques during TKA to achieve optimum result. WHAT THIS STUDY ADDS TO THE EXISTING KNOWLEDGE: This study not only prove that there is no difference between patellar dimension of Asian and Caucasian but also found a similar BIPWiT ratio for patellar resection during TKA with previous literature. LEVEL OF EVIDENCE: Level III.

Anthropometric study as a predictor of anterior cruciate ligament sizes in Asian Indonesian population.

OBJECTIVES: To evaluate whether anthropometric data can predict anterior cruciate ligament (ACL) sizes on magneti resonance imaging (MRI) in Asian population. BACKGROUND: Reconstruction of ACL has been performed over a decade ago. Recently, more individualized ACL reconstruction is performed taking account of each patient's ACL characteristics. However, there has been limited study regarding ACL sizes in Asian Indonesian population. This study aimed to evaluate the role of anthropometric data in ACL sizes using MRI in Asian Indonesian population. STUDY DESIGN: Retrospective Study. METHOD: A series of 531 knees from 420 patients with knee pain and intact ACL confirmed by MRI study. Length, width and inclination angle of ACL were measured using a T2-weighted sagittal MRI 3.0 Tesla Magnetom Skyra. Height, weight, body mass index (BMI) and age were recorded. Multiple regression analysis was used to determine relationship between the anthropometric data and size of ACL measurements. RESULT: ACL length and width were significantly different between male and female, consecutively. Mean ACL length was 35.36 ± 3.63 mm, male was significantly longer (36.59 ± 3.24 mm) compared to female (32.77 ± 2.99 mm), p < 0.0001. Mean ACL width was 10.23 ± 1.84 mm, male was significantly wider (10.85 ± 1.59 mm) compared to female (8.93 ± 1.64 mm), p < 0.0001. The mean ACL inclination angle was 47.75° ± 3.07° (range 40.17°-57.12°). The strongest correlation for ACL length was height and weight (r = 0.437; r = 0.341 consecutively, p < 0.0001). Females had stronger correlation compared to males for ACL length (R2 = 0.489 vs R2 = 0.418). ACL width showed weak correlation with anthropometric data. The following regression analysis equation was obtained for ACL length: ACL length = 60.697 - 0.11*age + 0.461*weight (kg) - 16.522*height (meter) - 1.093*BMI (R2 = 0.539; p < 0.0001). CONCLUSION: Anthropometric data can be utilized as a predictor of ACL length in Asian Indonesian population. The ACL length in Asian Indonesian population is shorter than that in Western population study.

Emergency orthopaedic surgery in the pandemic era: A case series at Cipto Mangunkusumo national tertiary hospital in Jakarta, Indonesia.

INTRODUCTION: Every emergency surgery performed is aimed at saving lives; however, during COVID-19 pandemic, surgeries are often postponed. Many existing recommendations take into account postponing surgery during a pandemic. How these surgeries can lead to increasing infection rates has not been widely published. This study aims to investigate the relationship of emergency orthopaedic surgery and the incidence rate of COVID-19. PRESENTATION OF CASE: This was a case series of 14 patients. The study was performed at the emergency department unit at a national tertiary hospital in Jakarta, Indonesia. A total of 14 patients underwent orthopaedic surgery in the emergency room of our institution. The mean age of the subjects was 40.07 ± 20.5 years. Twelve (85.7%) were male patients and 2 (14.3%) were female patients. The average duration of surgery was 125 minutes. The most used type of anaesthesia was general anaesthesia for 6 operations (50%). Patients were hospitalized for an average length of 4 days. Three patients had infiltrates found on plain x-ray examination, which required further examination to determine whether the cause was COVID-19 infection or not. There was no ground glass appearance (GGO) in the three patients in further follow-up examination. CONCLUSIONS: We found that emergency orthopaedic surgery was not associated with increasing number of COVID-19 cases. Factors including duration of surgery, length of stay, types of anaesthesia and comorbidities were also not associated with COVID-19 cases in this study.

Well-differentiated liposarcoma disguised as a recurrent lipoma of the forearm flexor compartment: A case report.

INTRODUCTION: Lipomas are common benign mesenchymal tumor that arise from the adipose tissue. Differential diagnosis between the benign and malignant form (liposarcoma) must be made to prevent complication and recurrence. PRESENTATION OF CASE: We reported a 63-year-old man who presented with recurrent large-sized mass on the right forearm with the first presentation approximately 28 years before being treated in our center. Main complaints were discomfort, social embracement, and difficulty in dressing. There were no compression symptoms observed. We performed marginal excision and sent the sample for histopathological examination. The work has been reported in line with the Surgical Case Report (SCARE) criteria. DISCUSSION: During one year of post-operative period, no recurrence was detected and a complete relief of symptoms was as expected. CONCLUSION: Diagnostic challenge in such a large-sized (giant) lipoma is in differentiating it with the malignant form. Surgical excision is the choice of treatment. However, long-term follow up is needed due to the risk of recurrence.

Functional elbow range of motion 6 months after contracture release and ORIF K-wire in elbow stiffness with malunion capitellum and neglected radial head and ulnar dislocation: a case report.

INTRODUCTION: Elbow stiffness is the most common complication following trauma of the elbow. This is because the elbow joint is susceptible to effusion, hemarthrosis, scarring, and capsule thickening due to its small intracapsular volume. Surgical treatment is therefore necessary to release soft tissue contracture. CASE: A male teenager was unable to flex his elbow since 1 year prior to admission after falling down during football practice. He didn't seek any medical treatment and had his elbow massaged since 5 months ago. On physical examination, his right elbow was extended, with flexion-extension range of motion (ROM) of 300 - 00. On the radiograph, there was malunion fracture of left capitellum and neglected posterosuperior dislocation of radial head and ulna. Surgery was performed to release contracture and correct the malunion. Normal activity with functional elbow flexion-extension ROM of 1100 - 300 was achieved in 6 months after operation. DISCUSSION: Elbow stiffness is a challenging case for surgeon, especially in regards of developing good perioperative plan. The aim of treatment for elbow stiffness is to achieve a pain-free and functional elbow ROM. CONCLUSION: To achieve functional elbow ROM, surgical treatment was necessary to release the contracture. In addition, the etiology of trauma must be thoroughly investigated and a good rehabilitation program must be integrative to the treatment.

Joint reconstruction using sternocleidomastoid tendon autograft as a treatment for traumatic posterior dislocation of sternoclavicular joint: A case report.

INTRODUCTION: Posterior sternoclavicular joint dislocations are extremely rare and emergent injuries. PRESENTATION OF CASE: We presented a case of a seventeen-year-old male patient who was diagnosed with traumatic posterior dislocation. He underwent joint reconstruction using sternocleidomastoid tendon autograft, and the operation went well. DISCUSSION: At four-week and fourteen-week follow-up post-operatively revealed a surgical wound that healed well, regained stable sternoclavicular joint that was marked by a normal left sternoclavicular notch, full range of movement of the left shoulder and the pain subsided. CONCLUSION: These findings provide evidence that the method of joint reconstruction and augmentation may produce good outcome for posterior dislocation of the sternoclavicular joint.

Zancolli procedure and nerve repair with sural graft as a treatment for patient with claw hand due to complete rupture of ulnar and median nerve: A case report.

INTRODUCTION: Combined injuries of peripheral nerve of upper extremity are usually the result of severe trauma to the extremity, and are often associated with substantial soft tissue, vascular, and bony injuries. The most common form of such combined injury is a low median-ulnar palsy, usually due to laceration of the volar wrist. It is a devastating injury, and with delayed presentation the injury is going to be more difficult to reconstruct. PRESENTATION OF CASE: Ten-year-old girl was admitted to hospital with numbness of her left palm and fingers, 5 months before admission. She was hit by a car while riding a bicycle from opposite direction from she was heading and cut her left forearm by licensed plate. Initially treated at nearby clinic but later couldn't extend her fingers after the pain subsided and left untreated for 5 months. DISCUSSION: Traditionally, number of static procedures have been described to correct the claw hand deformity by preventing MCP joint hyperextension. Nevertheless, these procedures are reserved for those having ability to extend IP joints while MCP joint hyperextension were prevented. Conversely, static procedure like Zancolli capsulodesis is simple and do not sacrifice any motors in an already compromised extremity. Combined with sural graft, the outcome for the patient is hopefully better than Zancolli procedure alone. CONCLUSION: Zancolli procedure along with nerve repair with sural graft as a treatment of claw hand due to complete rupture of ulnar and median nerve is one of feasible treatment options to correct claw hand deformity with such combined palsy.

Vascularized fibular graft as a surgical option for osteosarcoma of distal humerus: A case report.

INTRODUCTION: Distal humerus is a very rare predilection site of osteosarcoma. Limb salvage surgery has widely replaced amputation for surgical treatment of most types of malignant bone sarcomas. PRESENTATION OF CASE: We presented a 42 years old male with rapidly growing osteosarcoma on his right distal humerus. After induction chemotherapy, wide excision and reconstruction using free vascularized fibular graft followed with interpositional elbow arthroplasty technique was done. DISCUSSION: One of the option for surgical treatment for distal humerus osteosarcoma is limb salvage sugery with free vascularized fibular graft technique. Good functional outcome and no signs of local recurrence were found during 2,5 years follow up. CONCLUSION: Free vascularized fibular graft with interpositional elbow arthroplasty is a good option for management of bone sarcoma of distal humerus.

Lipoblastoma and lipoblastomatosis of the lower leg.

Lipoblastoma is a benign lesion of immature fat cells that is found almost exclusively in pediatric population. This tumor is a rare tumor that occurs in infancy and early childhood, accounting for less than 1% of all childhood neoplasm. It is more common in male than in female and often presents as an asymptomatic, rapidly enlarging, soft lobular mass on the extremity. Although benign, it gives great difficulty in its management, due to its extensions into different facial planes, especially in lipoblastomatosis. Thus, complete surgical excision is the treatment of choice.