Hari Jurdana

Long-term results of anterior cruciate ligament reconstruction: a comparison with non-operative treatment with a follow-up of 17–20 years

PurposeThe aim of our study was to review the clinical and radiological outcome of patients who had undergone anterior cruciate ligament (ACL) reconstruction in comparison to a group of non-operatively treated patients.MethodsIn a retrospective study we compared ACL reconstruction using a bone-patellar tendon-bone graft with a non-operatively treated group of patients 17–20 years later. Fifty-four patients that met the inclusion criteria, with arthroscopically proven ACL rupture, were treated between 1989 and 1991. Thirty-three patients underwent ACL reconstruction, forming group one. Eighteen non-reconstructed patients continued with rehabilitation and modification of activities (group two). The International Knee Documentation Committee (IKDC) subjective and objective evaluation forms and the Lysholm and Tegner scale were used to assess the knees at follow-up. Radiographic assessment was performed using the IKDC grading scale.ResultsFollow-up results showed that 83% of reconstructed patients had stable knees and normal or nearly normal IKDC grade. Patients in the non-reconstructed group had unstable knees with 84% having abnormal or severe laxity. The subjective IKDC score was significantly in favour of group one: 83.15 compared to 64.6 in group two. The Lysholm and Tegner score was also significantly better in group one. Conservatively treated patients all had unstable knees and worse scores. The rate of osteoarthritis showed more severe changes in non-reconstructed patients with additional meniscus injury.ConclusionsWe can conclude that 94% of patients who underwent ACL reconstruction had stable knees after 15–20 years and there was a significantly lower percentage of osteoarthritis in comparison to conservatively treated patients.

Salmonella typhimurium osteomyelitis of the femur in patient with Crohn's disease

ZusammenfassungOsteomyelitis ist eine durch infektiöse Organismen ausgelöste Entzündung des Knochens. Wir stellen in der folgenden Fallbeschreibung den ersten Fall einer Osteomyelitis des distalen Femurs vor, die durch Salmonella typhimurium bei einem Patienten mit Morbus Crohn ausgelöst wurde. Die Infektion wurde durch eine Kombination von antibiotischer und chirurgischer Therapie erfolgreich behandelt.SummaryOsteomyelitis is an inflammation of the bone caused by infecting organisms. We present here the first case of osteomyelitis of the distal femur caused by Salmonella typhimurium in a patient with Crohns disease. The infection was successfully treated with a combination of antibiotics and surgical treatment.

A prospective randomised non-blinded comparison of conventional and Dorgan's crossed pins for paediatric supracondylar humeral fractures.

BACKGROUND Closed reduction and percutaneous pinning are the preferred treatment of displaced supracondylar humeral fractures in children. The purpose of this study is to evaluate the non-standard Dorgans method and compare its results with those of the standard percutaneous cross pinning method in treatment of unstable or irreducible Gartland type II and III supracondylar humeral fractures in children. PATIENTS AND METHODS This was a prospective evaluation of 138 consecutive patients with Gartland type II or III extension supracondylar humeral fractures referred to University Childrens Hospital during a four-year period. The patients were randomized into two groups: the first group, comprised of 71 patients, was treated with standard pin configuration and the second group, comprised of 67 patients, underwent Dorgans method. The study included 88 boys and 50 girls aged 1.5-11.4 years (mean 6.5±2). At initial presentation 8.7% (n-12) fractures were classified as Gartland type IIa, 25.4% (n-35) as Gartland type IIb and 65.9% (n-91) as Gartland type III. RESULTS Flynns criteria were used to evaluate the results. An excellent clinical outcome was reported in about 90% of patients (n-90) treated with standard pin configuration and 89.5% (n-60) of patients treated with Dorgans method. There were no statistically significant differences in outcomes between the groups in terms of their gender, age, fracture types, function and cosmetics. Neurological lesions were observed in 9.9% of patients (n=7) who were treated using the standard configuration Kirschner pins, while in those treated by Dorgans method neurological complications were not observed. However, the procedure time was longer (mean 36.54±5.65min) and radiation exposure significantly higher (mean 10.19±2.70 exposures) in the group that was treated using Dorgans method, compared to the conventional method (mean 28.66±3.76min and 7.54±1.63 exposures). CONCLUSION Two laterally inserted crossed pins provide adequate stability with good functional and cosmetic outcome for most unstable paediatric supracondylar humeral fractures with no risk of iatrogenic ulnar nerve injury.

Correction of adult posttraumatic rigid severe pes equinovarus with tibiotalocalcaneal retrograde nailing

Introduction: Neglected pes equinovarus deformity at the adulthood is difficult to correct. It is usually a rigid deformity associated with arthritic changes of the hindfoot joint. Combined bone and soft tissue procedure is necessary to correct the deformity. Case report: We present a case of acquired severe rigid pes equinovarus in adulthood with varus ankle of 40o and equines deformity of 120o with concomitant degenerative osteoarthritic changes of the ankle joint. The deformity was successfully corrected with use of tiob-talo-calcaneal retrograde nail. Conclusion: The acquired severe complex and rigid deformity of the hind foot in adult could be successfully treated with use of retrograde tibio-talo-calcaneal nailing techniques. With this technique good bone remodeling can be achieved as well as reduction of the risk of complications.