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Highlights • Three case of radial head fracture treated with radial head arthroplasty. • Evaluation of the functional outcomes after operative treatment of radial head arthroplasty. • Functional outcomes assessment with active and passive range of motion. • Satisfying result on pain and a fair result on functional outcome on patient follow-up. • Good follow up is important to minimize the complications of radial head arthroplasty., Introduction Radial head arthroplasty (RHA) has become one of the mainstay surgical treatment for radial head fracture in certain conditions. Many previous studies compared the superiority of either open reduction and internal fixation (ORIF) and RHA with inconclusive result. Our case series aim to evaluate the functional outcome of the patients treated with RHA in our institution. Presentation of case We evaluated three patients who had RHA in 2018 and 2019. The function of flexion, extension, supination and pronation of the elbow was evaluated. The range of motion (ROM) was assessed in both active and passive way. Discussion An abundant of literatures stated that RHA result is superior than radial head resection and ORIF. Our case series present a satisfying result on pain and a fair result on functional outcome from the range of motion (ROM) evaluation on patient follow-up. Conclusion A good follow up for post-operative care plays an important role in management of RHA to minimize the rate of complications. In this case series, the functional outcomes after RHA is good, but a larger number of patient and longer follow up duration is needed for a better analysis.

Background Fracture is a discontinuity of bone tissue, growth plates and/or cartilage which generally caused by trauma. Fracture healing is influenced by many things, including patient condition, age, comorbidity, lifestyle, medication and management. The use of tourniquets in medical cases reached 20.000 cases per day around the world. In Norway between 2005 and 2006, the use of tourniquets on orthopedic surgery reached 63.484 cases. The goal of using a tourniquet is to obtain a blood-free operation field to achieve maximum operating results. However, deflation of tourniquets can lead to reperfusion mechanisms that cause injuries resulting from the production of Reactive Oxygen Species (ROS). This study aims to measure the level of malondialdehyde (MDA) and the osteoblast count after tourniquet application in murine mode. Methods Thirty-two male Wistar strain rats were divided into two groups and tibial fracture with consequence casting was performed. The rats were divided into two groups, one control group (n = 16) and one treatment group (n = 16). Both groups' rats’ right tibia was fractured and immobilized with a long-leg cast. The tourniquet (4.5 oz orthodontic rubber) was applied to the treatment group for two hours. The evaluation of the osteoblast count and the malondialdehyde (MDA) level was done on day 14. The quantitative osteoblast count was done under light microscopy within 10 high power fields in 4000x magnification. The MDA level was measured by using Thiobarbituric Acid Reactive Substances (TBARS) assay. Data analysis was done by using independent t-test. Results There was elevated MDA levels (0,126 in group 1 compared to 8763 in group 2) with p Conclusions The use of tourniquets can increase MDA levels due to oxidative stress arising from ischemic-reperfusion injury, as well as decreasing the number of osteoblasts.

Introduction: A Monteggia fracture was described initially as a fracture of the proximal third ulna and anterior dislocation of the proximal epiphysis radius.[1] In 1967, Bado discovered “true Monteggia lesions” and classified them into 4 groups.[2] He also used the term “equivalents” or “Monteggia-like-lesions” to describe specific injuries with similar radiographic patterns.[3] This type of fracture is rare and frequently associated with complications, poor functional results, and further operations.[4] Patient concerns: A 16-year-old girl was admitted to our emergency department after a single motorcycle accident. Her main complaint was the pain and swollen of her left elbow. She was reluctant to move her arm due to pain. Diagnosis: Radiograph examination showed a displaced fracture of the left proximal third ulna accompanied by displacement of the left proximal radius. This fracture was similar to the Monteggia type III fracture except for proximal radial disruption that occurred laterally through a Salter-Harris type II fracture. Interventions: The patient underwent surgical debridement, and the forearm was immobilized using a backslap in a supine position and elbow flexion 90o. Open reduction and internal fixation were performed 5 days later. The ulna was reduced and stabilized first using a 3.5 mm one-third tubular plate (ORMED), and internal fixation of the radial epiphysis was done using a 1.6 mm miniplate (Prohealth). Outcomes: After 3 months, the patient showed improvement with the Mayo Elbow Performance Score (MEPS) of 85. She did not complain of any pain and decreased strength. The patient regained 0 to 125o of elbow flexion and 0 to 165o of supination and pronation. Conclusion: Monteggia-like-lesion has many variations in physical and radiograph appearance. Careful evaluation of fracture pattern, identification of injury mechanism, and appropriate treatment planning based on Monteggia fracture treatment principles are mandatory to achieve the patient's best outcome.

Unicameral bone cyst (UBC) or simple bone cyst (SBC) is a benign cystic lesion commonly found in the humerus and femur that is mainly encountered during childhood. The currently available treatments for UBC of the hand commonly involve curettage, bone grafting, partial resection with or without grafting, multiple drilling, fracture immobilization and observation alone, and steroid injection. We herein report a case treated with total resection of the cyst and non-vascularized fibular graft in a 9-year-old right-handed female patient. The patient presented with a chief complaint of a large, fast growing lump over the first metacarpal of the left hand. Flexion of the first metacarpophalangeal joint was limited. After the diagnosis was established with plain radiographs followed by biopsy, the cyst was completely removed by resecting the shaft of the metacarpal bone with preservation of the epiphyseal plate. A bone graft was obtained from the fibula and inserted in the gap, distally attached to the epiphyseal plate of the metacarpal and fixed with a Kirshner wire proximally. Radiographs revealed solid union of the bone graft to the epiphyseal plate at the head after 7 weeks, with improving function of the thumb. SBC or UBC of the metacarpal bone is very rare. A more aggressive method, such as in the case presented herein, may be necessary to treat this condition.

BACKGROUND: Tourniquet use is prevalent in the orthopaedic field to achieve a bloodless operating field, but it poses risks of local and systemic complications, including lung injury. This study aims to examine the effect of tourniquet application on the hindlimb of a rat to its lung. MATERIALS AND METHODS: This is an experimental study with 48 male Wistar strain rats as samples. The rats were divided into group A (n = 24), killed directly after fracturization and tourniquet application, and group B (n = 24), killed 14 days post-procedure. Each group was divided into four: group A1/B1 (control group, three hours tourniquet application without reperfusion interval), A2/B2 (5-min reperfusion between 2-h and 1-h tourniquet application), A3/B3 (10-min reperfusion), and A4/B4 (15-min reperfusion). The lung tissue was examined histologically within ten high-power fields (400 × magnification). The severity of lung injury was measured using the Lung Injury Score (LIS). The oxidative damage was measured by determining the malondialdehyde (MDA) level, using the TBARS (thiobarbituric acid reactive substance assay) method. RESULTS: There was a dose-dependent decrease of LIS and MDA in groups A and B with increasing reperfusion interval. Fifteen-minute reperfusion interval caused a 54.55% and 45.33% LIS reduction in groups A and B, respectively. All pair-wise group comparisons (p

Rheumatoid arthritis (RA) is mainly treated with immunosuppressive drugs, which affects the immunological system. Therefore, the risk of tuberculosis was increased two to ten times in RA patients. Moreover, immunosuppressant is contraindicated in patients with tuberculosis arthritis. A 51-year-old male was presented with pain in his left elbow after he slipped on the floor. He was diagnosed with RA for 16 years and only took prednisone for six years. Six months before, he came to a rheumatologist and was given corticosteroid for six months for RA. The left elbow radiograph and joint aspiration revealed a tuberculosis infection. The patient treated with chloroquine and oral antituberculosis for one year and showed good clinical outcomes. Other diseases should be suspected in RA with uncommon symptoms. Chloroquine is the drug of choice in RA patients with tuberculosis who are contraindicated in immunosuppressant therapy because chloroquine has no immunosuppressant effect.

Background: Excessive oxidative stress on fracture case can inhibit fracture healing and decrease time of bone healing. Thymoquinone, an active substance of Nigella sativa, the so-called black cumin in common, is a potent antioxidant and have been studied as an antiosteoporotic agent. Thymoquinone is expected to be the adjuvant alternative that enhance the recovery process of fracture cases by reducing oxidative stress and promotes osteoblast proliferation on callus formation.Methods: Among 32 male mice Wistar Strain divided into 2 groups, conducted tibia fracture and casted. Group 1 was the control group without supplementation of Nigella sativa while black-cummin extract were given in group 2 orally at a dose of 800 mg/kg for 14 days. On the 14th day, group 1 and 2 were sacrificed, each bone tissue was taken to measure the levels of MDA by utilizing TBARS method and calculate the number of osteoblasts under the microscope. Data analysis were done using independent t-test.Results: There are both decreased MDA levels and increased number of osteoblasts that are histologically significant to the groups administered by Nigella sativa extract containing Thymoquinone compared to the control groups (p

Aneurysmal fibrous histiocytoma is rare clinicopathological variant of Cutaneous Fibrous Histiocytoma. The clinical manifestation of Aneurysmal Fibrous Histiocytoma is often confusing to distinguish from other skin lesions. Most of the cases showed rapid increase in size or a history of recurrence, however histologically all are almost similar. Rarity of aneurysmal fibrous histiocytoma and high numbers of recurrence rate poses a big diagnostic challenge. Late treatment will result in a decrease until loss of function of the affected region. In this article, author reported the case of aneurysmal fibrous histiocytoma of the hand in 7 years old girl with restricted at 2nd-3rd metacarpophalangeal joints. The patient had undergone a series of investigations until finally a wide excision was carried out. Excision tissue was performed CD 68 and CD 34 immunocytochemical smear to establish the diagnosis. It was not simple to make diagnosis aneurysmal fibrous histiocytoma. While it is benign, the lesion can appear malignant, and one should consider an excisional biopsy to rule out malignant conditions. The diagnosis had to be confirmed by histopathological and performed immunocytochemical smear. It was often necessary to take aggressive actions with wide excision and reconstruction.

The free vascularized fibular graft has been successfully applied as a reconstruction option in patient with large secondary skeletal defects result from excision of pathologic tissue after neurofibroma surgical excision. It provides a strong cortical strut for reconstruction of defects, so that the free vascularized fibular graft is ideal for ulna reconstruction. A 22-year-old male with lump in his right forearm for 3 months previously which become bigger and more painful. There was also sings of ulnar nerve disfunction. From the CPC result, we diagnosed forearm neurofibroma. We performed wide excision and reconstruction using free vascularized fibular graft. On the last follow up, the active and passive ranges of motion (ROM) of 4th and 5th metacarpal was measured with the help of a goniometer. The ulnar neurological state was tested by manual testing and graded on the Medical research council (MRC) scale. Four weeks after surgery, the operation wound at the right forearm and right lower leg was good and no infection signs. The graft viability was good with compromised vascularity. The post-operative passive and active ROM of the 4th and 5th metacarpal able did full extend. The post-operative sensoris level of the ulnar area improved from pre-operative sensoris level.Post-operative follow-up, in the early period (up to 6 weeks) we monitor the graft viability. Our case reported good result in the operation wound, the graft viability, the passive and active ROM of the 4th and 5th metacarpal and the sensoris level of the ulnar area.

Objective: This study evaluated the validity of prescriber, patient, and research assistant ratings of adherence to prescribed oral antipsychotic medication among outpatients with schizophrenia or schizoaffective disorder in comparison with electronic monitoring. Methods: Adult outpatients with schizophrenia (N=35) or schizoaffective disorder (N=26) received adherence assessments via electronically monitored medication vial caps as well as by monthly prescriber, patient, and research assistant report for up to six months. Results: Electronic monitoring detected greater nonadherence rates (57%) than either prescribers (7%) or patients (5%), though the research assistant ratings were 54%. No directional bias was found between electronic monitoring and assignment of adherence by research assistants, although disagreement occurred in 36% of cases. Conclusions: Both patients and prescribers grossly overestimated medication adherence, which may interfere with or reduce the effectiveness of diligent medication management. (Psychiatric Services 58:844–847, 2007)

Building and analyzing models of business processes has gained increased importance for any activity that requires a close examination of the business processes involved, e.g., Business Process Reengineering efforts. In this chapter we introduce a Petri net based approach to support such activities. Business processes are modeled using standard place/transition nets enhanced with some notions needed to integrate all aspects of business processes that are relevant with respect to analysis purposes, e.g., the notion of time and costs. The Petri net models of business processes are simulated by generating partially ordered runs. We will show how these runs can then be used for performance analysis of important key indicators such as throughput time. All introduced concepts are summarized in a 3-step approach that supports users to base their decision between possible alternatives for the design of a business process on facts.