The Outcome of Orthopedics Treatment of Lombok Earthquake Victim 2018: A Cohort of One-Year Follow-Up Study-Lesson Learned After Lombok Earthquake.

Introduction: There was a magnitude 7 on the Richter scale earthquake on Lombok Island in 2018, causing more than 500 deaths. In the event of earthquakes, there is often an imbalance between overcrowding in hospitals and inadequate resources. The initial management of earthquake victims with musculoskeletal injuries is controversial, arguing over whether to utilize debridement, external or internal fixation, or conservative or operative treatment in an acute onset disaster situation. This study aims to determine the outcome of initial management after the 2018 Lombok earthquake, between immediate open-reduction and internal fixation (ORIF) and Non-ORIF procedures after one year follow-up. Methods: This is a cohort study to evaluate radiological and clinical outcomes one year after orthopedic treatment in the Lombok earthquake 2018. The subjects were recruited from eight public health center and one hospital in Lombok in September 2019. We evaluate radiological outcomes (non/malunion and union) and clinical outcomes (infection and SF-36 score). Results: Based on 73 subjects, the ORIF group has a higher union rate than the non-ORIF group (31.1% vs. 68.9%; p = 0.021). Incidence of infection only appeared in the ORIF group (23.5%). Clinical outcome as measured by SF36 showed the ORIF group had a lower mean of general health (p = 0.042) and health change (p = 0.039) clinical outcomes than the non-ORIF group. Discussion: The most affected public group is the productive age with significant impact on social-economy. ORIF procedure is a major risk factor of infection in initial treatment after earthquake. Therefore, definitive operation with internal fixation is not recommended in the initial phase of a disaster. Damage Control Orthopedic (DCO) surgery protocol is the treatment of choice in acute disaster setting. Conclusion: The ORIF group had better radiological outcomes than the non-ORIF group. However the ORIF group had higher cases of infection and lower SF-36 than the non-ORIF group. Definitive treatment in acute onset disaster setting should be prevented.

Osteofibrous dysplasia-like adamantinoma versus osteofibrous dysplasia in children: A case report of challenging diagnosis.

INTRODUCTION: Osteofibrous dysplasia (OFD) and Osteofibrous dysplasia-like Adamantinoma have a similar appearance both in clinical and radiography, but different in its histopathology. Despite this similarity, the treatment and prognosis are different, therefore the diagnosis should be established precisely. CASE ILLUSTRATION: A three-year-old boy was admitted to hospital after falling on his lower leg. A bead size lump appeared on his tibia with pain and swelling, which later became enlarged. Diagnosis of osteofibrous dysplasia and adamantinoma was considered. We performed limb-salvage procedure by curretage, bone grafting, and internal fixation application. The histology section showed woven bone rimmed by polygonal osteoblast cell with intervening fibrous stroma and small nests of tumour cells raised the possibility of epithelial differentiation. The positivity for cytokeratin immunostaining confirmed the diagnosis as osteofibrous dysplasia-like adamantinoma. In this case it is a very rare spectrum of malignancy in children. DISCUSSION: These two tumor entities have identical radiographic characteristics, histopathology features the distinction between classic adamantinoma and OFD-like adamantinoma based on the predominant epithelial component. The relationship of osteofibrous dysplasia with adamantinoma is unclear. Several authors considered possible calling relationship osteofibrous dysplasia as "juvenile adamantinoma". However, does not rule out the possible existence of de novo osteofibrous dysplasia not related to adamantinoma. CONCLUSIONS: OFD-like adamantinoma and Osteofibrous Dysplasia had similar histopathology pattern, a pathologist must be aware of this feature and perform immunohistochemical staining for keratin particularly when the histopathological feature of osteofibrous dysplasia showed small nests of tumor cells within the fibrous stroma. diagnostic challenging and require multidisciplinary approach.

Diffuse idiopathic skeletal hyperostosis (DISH) with ossification of the posterior longitudinal ligament (OPLL) in the cervical spine without neurological deficit - A Case report.

INTRODUCTION: Diffuse idiopathic skeletal hyperostosis (DISH), or Forestier disease, is a condition characterized by calcification and ossification of ligaments and enthuses (ligament and tendon insertion sites), which mainly affect the vertebral column. The clinical manifestation of DISH is variable. Some patients can be completely asymptomatic, whereas others can complain of painful stiffness, decreased range of movement, and myelopathy symptoms. OPLL usually produce myelopathy symptoms. Combined of OPLL and DISH are rare case. ILLUSTRATION: A 59 years old woman patient complained of neck and shoulder pain in the last 20 years ago, with decreased neck range of motion and dysphagia. There was no gross abnormality on patient's neck and back. Cervical x ray was showing a continuous ossification extending from the anterior surface of C2 to C7 in lateral radiograph. A similar ossification was also noticed on the posterior surface of the vertebral bodies from C2 to C6 abutting the spinal canal. DISCUSSION: Despite striking abnormal appearance of cervical DISH and OPLL seen on radiologic examinations, absence of myelopathy is an indication to non-operative treatment. Presence of dysphagia was not an indication of surgery in this patient, as dysphagia was not severe and myelopathy was absent. Patient was observed during her clinical course to document the progression of myelopathy. Prophylactic surgery was not indicated for this patient, and progression of myelopathy during observation is an indication for surgical intervention. CONCLUSION: Diffuse and large abnormalities in cervical area with normal neurological function is not indication for surgery. Selective treatment based on individual case.

Anterior debridement and fusion using expandable mesh cage only for the treatment of paraparese due to spondylitis tuberculosis: A case report.

INTRODUCTION: There is a controversy in the recent literature regarding the most appropriate approach to treat spondylitis tuberculosis, whether to choose anterior, posterior, and combined approach as well as one-stage versus two-stage approach. Mesh cage has potential advantages, including inhibition of infection by fusion and reconstruction technique combined with corpectomy. Anterior surgery has advantage as it allows direct access to the diseased vertebral bodies and intervertebral disc. CASE ILLUSTRATION: We present a case of spondylitis tuberculosis of lower lumbar vertebrae (L5) and L4-L5 intervertebral disc causing paraparese treated with anterior debridement and fusion with expendable mesh cage. Patient presented with weakness of lower limb and back pain, with history of anti-tuberculosis drugs. Patient was diagnosed with paraparesis due to spondylitis Tb of L4-S1 with paravertebral abscess at L4-S1 Frankle D. DISCUSSION: The patient was treated with anterior debridement and fusion using expendable mesh cage. Immediate postoperative radiograph showed restoration of vertebral height. This case showed that paraparesis can occur in lower lumbar vertebrae with distinct clinical appearance to that of lower thoracal or upper lumbar spondylitis tuberculosis, and that anterior approach for debridement and fusion using expendable mesh is a logical and direct means of addressing a tuberculous spine lesion, which predominantly affects anterior elements. CONCLUSION: The anterior approach has the advantage of leading the surgeon directly into the lesion and allowing a good visualization. Instrumentation after debridement and bone graft can provide instant stability for the spinal column, which can lead patients to resume activities.