Ismail Hadisoebroto Dilogo

Modified Masquelet technique using allogeneic umbilical cord-derived mesenchymal stem cells for infected non-union femoral shaft fracture with a 12 cm bone defect: A case report

Highlights • A case of infected non-union fracture with critical-sized bone defect.• Modified Masquelet technique was used to overcome the defect.• The addition of allogenic UC-MSCs, BMP-2 and hydroxyapatite encourages healing.• This technique may serve as an effective way to overcome large defects.

Autologous mesenchymal stem cell (MSCs) transplantation for critical-sized bone defect following a wide excision of osteofibrous dysplasia

Highlights • No recurrence of osteofibrous dysplasia at 84 week following a wide extraperiosteal excision.• The combination of autologous BM-MSCs, HA granules and BMP-2 successfully created new bone tissue.• The newly formed bone tissue filled in the gap of critical-sized bone defect and was able to improve the patient’s quality of life significantly.• No neoplastic, immunologic or other side-effects were noted at 84 weeks after autologous MSC transplantation.

Pelvic haemophilic pseudotumour: a case report.

We report on a 30-year-old haemophilic man with a pelvic pseudotumour compressing adjacent structures causing pain and swelling and destruction of surrounding soft tissues and bones. He underwent evacuation of the pseudotumour, acetabular reconstruction using the Harrington procedure, and total hip arthroplasty.

Internal fixation of S1-S3 iliosacral screws and pubic screw as the best configuration for unstable pelvic fracture with unilateral vertical sacral fracture (AO type C1.3): A biomechanical study

Background: Although internal fixation is the definitive treatment in unstable pelvic fractures with disruption of the anterior arch and a vertical fracture of the sacrum (AO type C1.3), there have been no agreement of the best technique of internal fixation yet. We aimed to derive comparable objective data on stiffness and load to failure in this type of fracture fixations. Methods: Synbone was modified into AO type C1.3 fracture model, while treatments were divided into six internal fixation treatment groups using tension band plate (TBP), symphysis pubis plate (SP) with iliosacral screw at S1 and S2 (IS S1-S2), pubic screw (PS) with iliosacral TBP, PS and IS S1-S2, SP and IS S1-S3, PS and S1-S3 and finally PS and IS S1-S3. Sensor was applied to detect the shifting and rotation of fracture fragments. Mechanical strength test conducted with the application of axial force on the sacrum vertebra (S1). Results: The highest translational stiffness was observed in the group IS S1-S3 + PS (830.36 N/mm, p = 0.031) and there was no difference on the rigidity of the rotation between the groups posterior fixation using IS S1-S2 and IS S1-S3 (p = 0.51). Meanwhile the highest load to failure was found in group IS S1-S3 + PS (1522.20 N). PS provided advantages compared to the use of plate. Conclusions: Group of PS and S1-S3 IS is the configuration of internal fixation with best translational and rotational stiffness and the largest load to failure compared to other techniques in AO type C1.3 fracture.

Evaluation of bone marrow-derived mesenchymal stem cell quality from patients with congenital pseudoarthrosis of the tibia

BackgroundThe treatment of congenital pseudoarthrosis of the tibia (CPT) remains challenging in pediatric orthopedics due to the difficulties in bone union, continuous angulation, joint stiffness, and severe limb length discrepancy. Mesenchymal stem cells (MSCs) therapy offers a complementary approach to improve the conventional surgical treatments. Although the autologous MSC treatment shows a promising strategy to promote bone healing in CPT patients, the quality of MSCs from CPT patients has not been well studied. The purpose of this study is to investigate the quality of MSCs isolated from patients with CPT.MethodsThe bone marrow-derived MSCs from the fracture site and iliac crest of six CPT patients were isolated and compared. The cumulative population doubling level (cPDL), phenotype characteristics, and trilineage differentiation potency were observed to assess the quality of both MSCs.ResultsThere were no significant differences of the MSCs derived from the fracture site and the MSCs from the iliac crest of the subjects, in terms of cPDL, phenotype characteristics, and trilineage differentiation potency (all p > 0.05). However, MSCs from the fracture site had a higher senescence tendency than those from the iliac crest.ConclusionMSC quality is not the main reason for delayed bone regeneration in those with CPT. Thus, autologous MSC is a promising source for treating CPT patients

Neglected acetabular fracture: Fix or replace?

INTRODUCTION Operative treatment of acute acetabular fractures has shown better results than the non-operative approach. There is, however, limited data regarding the operative treatment of neglected acetabular fracture. METHODS We present six subjects with neglected fracture of the acetabulum in Cipto Mangunkusumo National Hospital, Jakarta, Indonesia. One had only open reduction and internal fixation, three had open reduction and internal fixation first before we performed arthroplasty later, one had both open reduction and internal fixation with arthroplasty, and another had immediate arthroplasty. RESULTS Our subjects were 4 males and 2 females with the average age of 41.1 years and the average neglect period was 18 months. In four of our subjects, the fractures had posterior wall involvement, one had an anterior column-posterior hemitransverse fracture, and the last one had transverse fracture. All fractures were classified to either Elementary or Associated type according to the Letournel classification. We observed all subjects up to eighteen months post-operatively. One subject had poor outcome, four subjects had fair outcome, and one subject had excellent outcome according to the Harris Hip Score. CONCLUSION Even in neglected acetabular fracture, open reduction and internal fixation where possible should be attempted to restore the anatomical relationship to facilitate immediate or late total hip arthroplasty. Surgical treatment of such fractures should be based on individual case characteristics, which includes age, associated comorbidity, neglect period, as well as the type and union state of the fracture for a better outcome. Neglected Associated acetabular fracture types are more difficult to reduce and have poorer outcome compared to Elementary types. Likewise, malunited acetabular fractures are more difficult to operate on than non-united neglected acetabular fractures, where reduction is relatively easier.

Surgical technique of percutaneous iliosacral screw fixation in S3 level in unstable pelvic fracture with closed degloving injury and morrell lavallee lesion: Two case reports

Highlights This paper is very special because: • This is the first paper describing the technique of percutaneous Iliosacral screw insertion at the level of S3.• This is very severe and life threatening cases with with polytrauma who rarely survived in good outcome.• This technique of surgery provide good to excellent functional outcome for both patient.

Senescent Profile of Cryopreserved Adipose Mesenchymal Stem Cells After Multiple Passages

Starifulkani Arif , Ismail Hadisoebroto Dilogo , Jeanne Adiwinata Pawitan , Ria Anggraeni 2 1 Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia 2 Stem Cell Integrated Medical Technology Unit, Cipto Mangunkusumo Hospital, Jakarta, Indonesia 3 Department of Histology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

Osteogenic potency of human bone marrow mesenchymal stem cells from femoral atrophic non-union fracture site

Objective: Mesenchymal stem cells (MSCs) exist in the site of atrophic non-union fracture. The aim of this study was to evaluate the osteogenic potency of MSCs in order to have a better understanding of the unclear pathophysiology of atrophic non-union fracture Methods: This is an in vitro experimental study. Sample was obtained from the non-union site of a patient with a 6-years-history of atrophic non-union fracture of right femur. The MSCs was isolated from the fracture site and was cultured in the growth medium. Confirmation of the MSCs was performed and then osteogenic differentiation was performed in mono-layered MSC grown in both home-made and commercial osteogenic media. To evaluate the osteogenic differentiation, we performed Alizarin red staining and colorimetric assay for alkaline phosphatase (ALP). Results: From Alizarin red staining, most cells in the osteoblast medium were stained red by the staining. The result of colorimetric assessment of ALP shows that peak concentration was reached after 4 minutes in osteogenic group and control group. Conclusion: The presence of ALP activity and positive Alizarin red staining in our study showed that MSCs stem cells obtained from site of atrophic non-union is capable to be differentiated into osteogenic cells. J Clin Exp Invest 2014; 5 (2): 159-163