Functional Outcomes of Neglected Elbow Dislocation Treated with Double Approach Surgery.

Background: Neglected elbow dislocation is common in developing countries. The chronic nature of the disease results in a level of complexity that makes treatments and outcomes contradictory. Several treatment methods have been described for neglected elbow dislocations. The goal of this study was to evaluate the results of neglected elbow dislocations treated using the double approach of reduction and K-wire fixation. Methods: This series included patients with neglected elbow dislocations who were treated with open reduction using double approaches (medial and lateral incisions) between November 2020 and March 2021. Patients were evaluated for a minimum of 6 months to ascertain functional recovery in accordance with the Mayo Elbow Performance Index (MEPI) and Disability of Arm, Shoulder, and Hand (DASH) score. Results: Nine patients with neglected elbow dislocations were included in the study, with an average delay of 3.44 months. Four patients had an excellent MEPI and five had a good score at the final follow-up, with a mean MEPI score of 86.67. The average DASH score was 36 (31-59). Five patients (55.56%) experienced no pain, but four patients (44.44%) had mild pain, with a range of pain points of 30-45. The motion arc improvement was 60°-100°, with a mean of 74.44°. Almost all of the patients (eight patients, 88.89%) had elbow stability, but one patient had ulnar nerve paresthesia postoperatively. Heterotopic ossificans was associated in 1 patient, and triceps lengthening was needed in 1 patient; both came 5 months later. Conclusion: Open reduction surgery with a double approach offers a good chance of a good result with few side effects and should be considered for all patients who have this condition.

The effect of preconditioning hypoxia in schwann-like-cells-derived adipose mesenchymal stem cells and rat sciatic nerve-derived stem cells: experimental research.

The preconditioning hypoxia for stem cells is a strategy to achieve effective conditions for cell therapy, indicate increased expression of regenerative genes in stem cell therapy, and enhance the secretion of bioactive factors and therapeutic potential of their cultured secretome. Objectives: This study aims to explore the response of Schwann-like cells derived from adipose-derived mesenchymal stem cells (SLCs) and Schwann cells rat sciatic nerve-derived stem cells (SCs) with their secretomes under normoxic and hypoxic conditions in vitro. Material and methods: SLCs and SCs were isolated from the adipose tissue and the sciatic nerve of the adult white male rat strain Wistar. Cells were incubated in 21% O2 (normoxic group) and 1%, 3%, and 5% O2 (hypoxic group) conditions. Concentration values of transforming growth factor-ß (TGF-ß), basic Fibroblast Growth factor (bFGF), brain-derived neurotrophic factor, glial-derived neurotrophic factor, vascular endothelial growth factor, and nerve growth factor were detected and calculated utilizing an enzyme-linked immunosorbent assay, and the growth curve was described. Results: SLCs and SCs indicated positive expression for mesenchymal markers and negative expression for hematopoietic markers. Normoxic conditions SLCs and SCs showed elongated and flattened morphology. Under hypoxic conditions, SLCs and SCs showed a classic fibroblast-like morphology. Hypoxia 1% gave the highest concentration in TGF-ß and bFGF from the SLCs group and TGF-ß, bFGF, brain-derived neurotrophic factor, and vascular endothelial growth factor from the SCs group. No significant differences in concentration of growth factors between the SLCs group compared to SCs group in all oxygen groups. Conclusions: Preconditioning hypoxia has an effect on the composing of SLCs, SCs, and their secretomes in vitro; no significant differences in concentration of growth factors between the SLCs group compared with the SCs group in all oxygen groups.

Asymmetric bilateral traumatic hip dislocation: Report of two cases.

INTRODUCTION AND IMPORTANCE: Asymmetric bilateral hip dislocation is an extremely rare condition. The mechanism of injury and severity are variables. We reported two cases of asymmetric bilateral hip dislocation with different pattern of injury and different onset of injury. CASE PRESENTATION: The first case was a male 20 years old with 7 months neglected asymmetric bilateral hip dislocation. Total hip arthroplasty (THA) was performed on both hips, which resulted in good clinical outcomes. The second case was a male 32 years old with acute right open anterior dislocation (obturator type) and left posterior fracture-dislocation. Emergency debridement and open reduction were performed on the patients with reduction and fixation for the left hip. CLINICAL CASE DISCUSSION: To the best of our knowledge, this is the first reported case of open anterior hip dislocation with exposed femoral head on inguinal area in the setting of asymmetric bilateral hip dislocation. Furthermore, this article also presented another case with >6 months neglected time along with the surgical treatment. CONCLUSIONS: Asymmetric bilateral hip dislocation is a rare injury which usually associated with high-energy trauma. Open injury with the exposed femoral head is possible to occur in this kind of rare case. In the setting of long-term neglected cases, total hip arthroplasty could be recommended as the treatment choice.

Dealing with soft tissue compromised in tibial plateau fractures by using a hybrid external fixation.

INTRODUCTION AND IMPORTANCE: Tibial plateau fractures are often accompanied by soft tissue compromise, especially in Schatzker 5 and 6, caused by high-energy trauma. In this situation, more careful consideration is needed. A rush decision will result in morbidity, bad postoperative wounds, and infections resulting in dehiscence. CASE PRESENTATION: We have three patients with the tibial plateau. In the first case, ORIF was still performed on the fracture with soft tissue compromised. The patient was found to have wound dehiscence resulting in an implant-exposed bone. In the subsequent two cases, Patients with tibial plateau Schatzker 6 fractures also showed blisters around their injured knees. We performed hybrid external fixation. Screwing fixation was performed to obtain compression. Kirschner wire 2.2 formed a raft configuration attached to the semicircular frame and uniplanar external fixation to support the tibial plateau. CLINICAL DISCUSSION: A hybrid external fixation is an excellent option for treating tibia plateau fractures with compromised soft tissue. It can achieve early fracture fixation while avoiding soft tissue problems; thus, the patients can start early rehabilitation. CONCLUSION: A hybrid external fixation can be applied to tibial plateau fractures with soft tissue compromised without waiting for subsiding and has satisfactory clinical and radiological outcomes. The author also explains this case report's hybrid external fixation technique.

Healthcare Failure Mode and Effect Analysis in Surgery Setting: A Bibliometrics Analysis and Literature Review.

Background: In the ever-evolving healthcare landscape, the imperative to ensure patient safety has driven the adoption of robust safety approaches. One of the most popular methods is Healthcare Failure Mode and Effect Analysis (HFMEA). Objective: This study aims to conduct a bibliometric analysis of HFMEA research in a surgery setting to identify relevant authors, topics, and journals, highlighting the scholarly collaboration trends in this area. This analysis can provide valuable insights into the current state of research, emerging trends, and future research directions. Methods: The data was acquired online from the PubMed database on December 16th, 2023. The downloaded data were analyzed using Google Sheets to predict trends. The publication output was then analyzed using VOSviewer. Subsequently, Biblioshiny was used to analyze the characteristics of the study, productive author, institution, and country; thematic map analysis; and topic timeline analysis. Results: This study analyzes 25 documents spanning 2005 to 2022, reflecting a collaborative effort involving 155 contributors. The upward trend in annual scientific publications, notably the surge from 2014 onwards and significant peaks in 2019 and 2022, underscores the growing recognition of HFMEA in enhancing patient safety within surgical environments. The prominent influence from prolific authors like Ahmed K, leading institutions such as King's College London, and the substantial contributions from Norway and the USA in shaping the HFMEA research landscape. Conclusion: This study contributes valuable insights that can shape the trajectory of HFMEA in the evolving landscape of surgical healthcare, ensuring enhanced patient safety and quality improvement.

The Characteristic of 374 Surgically Treated Traumatic Brachial Plexus Injury Patients at an Indonesian Orthopedic Referral Hospital: An Epidemiologic and Sociodemographic View.

Background: Traumatic brachial plexus injury (TBPI) is a severe injury in the upper extremity which can affect the quality of life. The incidence of these injuries has been increasing in recent years. The purpose of this study was to describe the characteristic of TBPI patients treated by surgery at a tertiary Orthopedic hospital in Surakarta, Indonesia. Methods: This is a descriptive retrospective study of patients diagnosed with TBPI who underwent surgery between July 2013 and December 2021. Results: This study included 374 patients with male predominance (86.10%) and an average age of 30.61 years. The most common age group was 20-29 years (45.45% of all age groups). Traffic accidents were the most common cause of this injury (91.98%), especially motorcycle accidents (94.48% of traffic accidents). The most frequent type was complete preganglionic complete injury (48.93%). Most of the patients were the result of traction injury (96.26%). The right side (58.02%) was more common. One patient (0.27%) presented with bilateral lesions. As much as 52.67% of patients presented with concomitant injuries. Fractures were the most common concomitant injuries (90.73%). Humeral shaft fractures were the most common fractures (29.10%), followed by forearm and clavicle fractures (16.10% and 21.98% respectively). A total of 19.52% of patients underwent surgery between 3 and 6 months after trauma. Nerve procedures were performed in 57.38% of all surgical procedures and the rest were secondary procedures: Tendon transfers (36.92%), arthrodesis (2.53%), and Free Functional Muscle Transfer (FFMT) 2.74%. Conclusion: The young population, especially men, were commonly subjected to this injury with motorcycle accidents as the most common cause. Early recognition and optimum treatment must be done to improve functional outcomes. Improvement of road safety and spreading the health education of TBPI are recommended to reduce the incidence of injury and improve functional outcomes.

Prospect of Stem Cells as Promising Therapy for Brachial Plexus Injury: A Systematic Review.

Background: Brachial plexus injury is an advanced and devastating neurological injury, for which both nerve surgery and tendon transfers sometimes remain insufficient in restoring normal movement. Stem cell therapy may be applicable to rescue the injured motor neurons from degeneration which potentially improves muscle strength. Study Design: Systematic Review; Level of evidence V. Data Sources: A systematic literature search was conducted on PubMed (MEDLINE), EMBASE, the Cochrane Library, and Scopus using the terms ("stem cell") AND ("brachial plexus") as search keywords. Methods: The process of study selection was summarized by PRISMA flow diagram. The study included in vivo and in vitro studies with English language, humans or animals with some brachial plexus injuries, interventions, some applications of stem cells to the groups of study, with functional, biomechanical, or safety outcomes. Results: In total, there were 199 studies identified from the literature sources where 75 articles were qualified for forward evaluation following selecting the titles and abstracts. Ten studies were finally included in this systematic review after full-text assessment. Stem cells can produce neurotrophic factors in vitro and in vivo in rats, and their level was increased after injury. Electrophysiological measurement showed that the intervention group had distinctly higher CMAP amplitude and evidently shorter CMAP latency than the model group. Application of bone marrow stem cells (BMSCs) showed an elevation in the numbers of axons and density of myelinated fibers, the density of nerve fibers, the diameter of regenerating axons, and a decrease in axonal degeneration. A study in humans indicated an improvement of the movements in a patient with traumatic total BPI after injection of Ad-MSC. It is associated with increased muscle mass and sensory recovery and also suggested that mononuclear cell injection enhances muscle regeneration and reinnervation in the partly denervated muscle of brachial plexus injury. Various muscle groups had obtained strength together with restoration, the muscle strength attained after the previous transplantation were preserved. The results of this review support stem cell treatment in brachial plexus injury. Conclusion: This review provides evidence of the positive effects of stem cell treatment in brachial plexus injury.

Acute-shortening and re-lengthening (ASRL) procedure with monorail fixator to treat femur/tibia nonunion: A retrospective study.

BACKGROUND: The distraction osteogenesis procedure has a high potential to treat bone defect problems. The alternative technique to treat nonunion associated with a bone defect is the acute shortening and re-lengthening (ASRL) procedure. This study aimed to evaluate the outcome of ASRL procedure with a monorail fixator to treat femur/tibia nonunion associated with the bone defect. METHOD: Retrospective analysis was performed to patients who received ASRL procedure with monorail fixator for femur or tibia nonunion from October 2018 to October 2020 at Prof. Dr. R. Soeharso Orthopaedic hospital. One case was loss to follow-up and excluded from the study. The rest of 16 cases were included for further analysis. The evaluation was performed to the demographic, intraoperative procedure, problems/complications, additional procedure, and final outcome. RESULTS: There were 13 male and three female patients with age ranged from 16 to 64 years old. The follow-up period ranges 9-31 months. ASRL procedures performed to 6 femur and 10 tibias. The problems/complications: two cases with problems associated with callus formation, two cases of fracture at corticotomy site, one case of skin necrosis, one case of osteomyelitis, one case of malrotation. Additional surgical procedures were needed 5/16 (31.2%) cases. Evaluation at the final follow-up period showed 14/16 (87.5%) cases had a complete bone union. CONCLUSIONS: Acute shortening and re-lengthening (ASRL) could be reliable as a method of treatment for femur/tibia nonunion associated with the bone defect. Several possible complications need to be considered prior to perform this procedure.

Surgical Management of Macrodystrophia Lipomatosa, a rare case report of the left hand middle finger macrodactyly.

INTRODUCTION: Macrodystrophia Lipomatosa is a rare congenital non-hereditary disorder, characterized by the presence of gigantism of a small part of the limb or the whole limb due to an overgrowth and disproportionate growth of fibroadipose tissue, causing macrodactyly. CASE PRESENTATION: One case of the 14-year-old girl presented with an enlarged middle finger of her left hand since birth, discomfort during the last 6 months, and resistance to flex, was underwent surgery by performing debulking procedure and a yellow cord-like mass was obtained from the digital nerve covered and enlarged by fibrofatty tissue to the palm area, could be cut off completely. Imaging and histopathological examination revealed to macrodystrophia lipomatosa. We follow up the patient for the finger's range of motion, the neurological disturbance and re-enlargement of the tumor. DISCUSSION: Since there were compression of the nerves, functional impairment due to enlarge fingers and cosmesis problems, the surgery was indicated. Types of surgery may include debulking of soft tissue, especially adipose tissue. The mass size was decrease, motor function and movement of the middle finger were normal post operatively, but sensory deficits persisted according to the distribution of the digital nerves. Three months and six years after surgery, no enlargement of the middle finger, normal motor function, normal finger movements but sensory deficit still persisted according to the distribution of the digital nerves. CONCLUSION: Surgical management in macrodactyly due to macrodystrophia lipomatosa of the finger give the satisfactory result.

Role of adipose mesenchymal stem cells and secretome in peripheral nerve regeneration.

The use of stem cells is a breakthrough in medical biotechnology which brings regenerative therapy into a new era. Over the past several decades, stem cells had been widely used as regenerative therapy and Mesenchymal Stem Cells (MSCs) had emerged as a promising therapeutic option. Currently stem cells are effective therapeutic agents againts several diseases due to their tissue protective and repair mechanisms. This therapeutic effect is largely due to the biomolecular properties including secretomes. Injury to peripheral nerves has significant health and economic consequences, and no surgical procedure can completely restore sensory and motor function. Stem cell therapy in peripheral nerve injury is an important future intervention to achieve the best clinical outcome improvement. Adipose mesenchymal stem cells (AdMSCs) are multipotent mesenchymal stem cells which are similar to bone marrow-derived mesenchymal stem cells (BM-MSCs). The following review aims to provide an overview of the use of AdMSCs and their secretomes in regenerating peripheral nerves.

Prospect of stem cells conditioned medium (secretome) in ligament and tendon healing: A systematic review.

BACKGROUND: Tendon or ligament tears can decrease patients' quality of life. Many therapeutic interventions are available to treat such injuries. Mesenchymal stem cells (MSCs) have been shown to be effective in treating tendon or ligament tears; however, the use of stem cell-conditioned medium (CM) requires further investigation. This review focused on the use of stem cell CM as treatment for tendon or ligament tears. METHODS: A systematic literature search was performed on PubMed (MEDLINE), OVID, EMBASE, the Cochrane Library, Scopus, Web of Science, and Science Direct with the terms conditioned media or conditioned medium or secretome or microvesicle or extracellular vesicle or exosome, and tendon or ligament as the search keywords. A total of 852 articles were reviewed. Five articles were identified as relevant for this systematic review. RESULTS: Meta-analysis could not be performed because of the high heterogeneity of the reviewed studies; however, the results of this study support a positive effect of conditioned media in tendon and ligament treatment. CONCLUSION: This review provides evidence of improvement in the tendon and ligament healing process with stem cell CM therapy in preclinical studies.