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"ABSTRAKPendahuluan: Strategi koreksi akut pada penyakit Blount menyajikan metode yang lebih praktis dan singkat tanpa memberikan dampak psikososial dan resiko infeksi situs pin. Namun demikian, luaran anatomis pada berbagai derajat deformitas perlu dikaji kembali. Disamping itu, luaran fungsional juga merupakan aspek penting yang belum banyak dilaporkan. Metode: Sampel diambil tahun 2014-2017 dan dibagi menjadi kelompok deformitas ringan-sedang dan deformitas berat. Luaran anatomis dievaluasi berdasarkan Tibiofemoral Angle (TFA) dan Metaphyseal-Diaphyseal Angle (MDA). Rekurensi dinilai satu tahun pasca operasi. Luaran fungsional dievaluasi berdasarkan Lower Extremity Functional Scale (LEFS). Hasil: Terdapat 19 pasien dengan total 31 ekstremitas dan rerata usia operasi 8,19 (±3,10). Pada deformitas ringan-sedang, rerata pre operatif TFA adalah 32,90 (±4,38) dan MDA adalah 24,60 (±6,16). Pada deformitas berat, rerata pre operatif TFA adalah 57,57 (±11,88) dan MDA adalah 45,20 (±16,85). Berdasarkan analisa statistik, tidak didapatkan hubungan bermakna antara derajat deformitas pre operasi dengan luaran post operasi (TFA p=0,147; MDA p=0,327), satu tahun post operasi (TFA p=0,981; MDA p=0,265) dan angka rekurensi (TFA p=0,690; MDA p=0,445). Tidak didapatkan komplikasi neurovaskular maupun sindrom kompartemen post operasi. Rerata LEFS pre operasi adalah 67,00 (±7,95) pada deformitas ringan-sedangan dan 70,08 (±4,35) pada deformitas berat. Sedangkan post operasi adalah 73,85 (±2,73) pada deformitas ringan-sedang dan 75,33 (±2,46) pada deformitas berat. Pembahasan: Luaran anatomis koreksi akut pada deformitas ringan-sedang dan deformitas berat memberikan hasil yang sama baiknya. Angka rekurensi tidak dipengaruhi oleh besarnya deformitas pre operasi. Strategi ini aman diterapkan sepanjang tidak adanya komplikasi neurovaskular dan sindrom kompartemen yang didapatkan. Secara umum didapatkan peningkatan fungsional pada pre dan post operasi pada kedua kelompok.

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ABSTRACT

Introduction: Acute correction strategy in Blount disease provides more practical technique and shorter monitoring without psychosocial impact and pin site infections. However, the anatomical outcomes in various degree of deformity need more investigation. Moreover, functional outcomes are important aspect that had not widely reported. Method: Samples took in 2014-2017 and divided into mild-moderate deformity and severe deformity group. Anatomical outcomes evaluated from the tibiofemoral angle (TFA) and metaphyseal-diaphyseal angle (MDA). Recurrences were evaluated one year after operation. Functional outcome was evaluated with Lower Extremity Functional Scale. Result: There are 19 patients with total of 31extremity and operation age mean 8.19 (±3.10). In mild-moderate deformity group, the pre-operative TFA mean was 32.90 (±4.38) and MDA was 24.60 (±6.16). In severe deformity group, the pre-operative TFA mean was 57.57 (±11.88) and MDA was 45.20 (±16.85). By statistical analysis, we found no correlation between the pre-operative degree of deformity with outcomes in post-operative (TFA p=0.147; MDA p=0.327), one year after operation (TFA p=0.981; MDA p=0.265) and recurrence rate (TFA p=0,690; MDA p=0.445). There are no post-operative neurovascular and compartment syndrome complication. The pre-operative LEFS score mean was 67.00 (±7.95) in mild-moderate deformity group and 70.08 (±4.35) in severe deformity group. The post-operative mean was 73.85 (±2.73) in mild-moderate deformity group and 75.33 (±2.46) in severe deformity group. Discussion: Anatomical outcomes of acute correction strategy between mild-moderate deformity group and severe deformity group show equal good result. Recurrence rate were not related by pre-operative degree of deformity. The acute correction was a safe strategy since there were no neurovascular and compartment syndrome complication founded in this study. Generally, the functional state was increase from pre to post-operative in two groups."

"Pendahuluan: Ekstrofi buli merupakan suatu kelainan kongenital yang ditandai dengan tidak menutupnya dinding anterior dari rongga abdomen disertai kandung kemih yang membuka dengan manifestasi pada sistem traktus urinarius dan muskuloskeletal. Meskipun tatalaksana ekstrofi berkembang pesat, studi mengenai luaran klinis pasien ekstrofi buli masih jarang dilakukan. Di Indonesia, belum ada penelitian yang membahas mengenai luaran anatomis dan fungsional pasien ekstrofi buli pada tahun 2011-2017.Metode: Studi penelitian ini adalah studi kohor retrospektif melalui penulusuran data rekam medis dari tahun 2011 hingga 2017 dan dilakukan di bulan Januari 2017. Seluruh pasien diperiksa untuk luaran klinis di poliklinik orthopaedi. Luaran anatomis dinilai dengan mengukur presentasi aproksimasi pubis pada foto pelvis. Sementara itu, luaran fungsional dinilai dengan menggunakan kuesioner Pediatric Quality of Life Inventory (PedsQL 4.0).Hasil: 19 pasien ekstrofi buli dengan rerata usia 4,8±2,4 tahun kontrol rutin ke poli orthopaedi. Data yang dikumpulkan terdiri dari jenis kelamin laki-laki 11 (57,9%); perempuan 8 (42,1%), tipe ekstrofi buli (17 (89,5%); ekstrofi kloaka (2 (10,5%), anomali organ terkait yaitu epispadia 2 (10,5%); hipospadia 1 (5,3%); sisanya tidak kelainan tambahan 16 (84,2%), metode fiksasi gips 10 (52,6%); eksternal fiksasi 9 (47,4%), periode pasca operasi ≤36 bulan 10 (52,6%); >36 bulan 9 (47,4%), median usia operasi 6 bulan dengan kisaran 1-71 bulan, median nilai presentase aproksimasi 78,5% dengan kisaran 65-98,1%, rerata skor PedsQL setelah operasi 97,2±1,6. Terdapat hubungan bermakna antara usia operasi dan diastasis setelah operasi terhadap presentase aproksimasi dan skor PedsQL setelah operasi (p<0,05).Diskusi: Luaran anatomis dan fungsional pada pasien ekstrofi buli menunjukkan hasil yang baik. Faktor usia operasi dan diastasis setelah operasi mempengaruhi nilai presentase aproksimasi dan kualitas hidup pasien ekstrofi buli.

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Introduction: Bladder extrophy is an embryologic malformation that results in complex deficiency of the anterior midline, with urogenital and skeletal manifestations. Despite advances in management of bladder extrophy, the study of the patient outcome is rarely done. In Indonesia, there are no studies concerning about the anatomical and functional outcome of bladder extrophy patients in 2011-2017.Method: A cohort retrospective study of the hospital medical records from 2011 to 2017 was performed in January 2017. The patients were assesed for the clinical outcome in orthopaedic outpatient clinic. Data of patients with bladder exstrophy managed by anterior and posterior innominate osteotomy were analysed. The anatomical outcome was assessed by calculating the percentage pubic approximation and the functional outcome was assessed by using Pediatric Quality of Life Inventory (PedsQL 4.0) and compared with those of typical peers.Result: Nineteen children age 4,6±2,3 years presented to outpatient clinic for a routine control. Data was collected for gender man 11 (57,9%); woman 8 (42,1%), bladder extrophy 17 (89,5%); cloacal extrophy 2 (10,5%), epispadia 2 (10,5%); hipospadia 1 (5,3%); not having other congenital organ anomaly 16 (84,2%), fixation method slabs 10 (52,6%); external fixation 9 (47,4%), post operation period ≤36 months 10 (52,6%); >36 months9 (47,4%), the median of age at operation 6 months old with range from 1-71 m, the median of aproximation percentage 78,5% with range 65-98,1%, the mean of PedsQL score post operation 97,2±1,6. There was a significant correlation between age at operation and diastasis post operation to aproximation percentage and PedsQL score (p<0,05).Discussion: The clinical outcome of the bladder extrophy patients shows good result that's measured by percentage pubic approximation and PedsQL score. Age at operation and diastasis post operation affect aproximation percentage and quality of life of bladder extrophy patient."

"Background data: The treatment of bicondylar tibia plateau fractures remains controversial. Lateral buttress plate and medial antiglide is favored by AOIASIF. Recently treatment of this fracture by less invasive stabilization system in the lateral side by using locked screw plate was gained acceptances by many surgeons. In Cipto Mangunkusumo Hospital local Iocked clover plate was designed, which is given better economics solutions. Objective: To compare the fixation stability between single lateral local locking plate and double plating system that using lateral buttress and medial antiglide in the treatment of bicondylar tibial plateau fracture. Design: One model (Synbone 1110, normal bone quality) tibia was used. Bicondylar tibia fracture model that design by Horwitz was used. Invite biomechanical axial loading, tested to the both group was tested. Intervention: Five pairs of fracture model was used. Stabilization using lateral buttresslmedial antiglide one third tubular in one group and unilateral local locking Clover plate (LCP) in other group. Five vertical loads levels were used (150 N, 300 N, 450 N, 600N and 750N). Irreversible (plastic) deformation was the main parameter of interest. Main out come measures: Irreversible (plastic) deformation was the main parameter of interest. Failure was defined as more than 5 mm displacement in the particular surface in medial condyle. Result: Vertical subsidence depended on the applied load but not on the method of fixation. The displacement of medial plateau was recorded. With confidence interval 95%, and P less than 0,05 was statistically significance. All the displacement was statistically no significantly difference P > 0,05 in five different level even the mean displacement was higher in the same loading in the local locked clover plate. Conclusion: Single lateral local locked clover plate could give good stability in the treatment of bicondylar tibial plateau fracture that statistically no difference to double plating which using lateral buttress and medial antiglide, even though still need further investigation."

"ABSTRAKPendahuluan: Kelengkungan sagital tulang belakang memiliki fungsi dalam menjaga distribusi beban aksial terutama pada saat berdiri. Parameter balans sagital mencakup pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), dan C7 plumb line distance (C7PL). Perubahan tersebut menyebabkan keluhan nyeri dan deformitas. Penelitian sebelumnya menyebutkan ketidakseimbangan sagital pasca fusi berhubungan dengan prognosis klinis yang buruk. Penelitian ini menggunakan skoring IDO untuk luaran klinis. Penelitian ini menilai hubungan parameter balans sagital dengan perbaikan klinis yang dibandingkan sebelum dan sesudah operasi, serta melihat koreksi dari parameter balans sagital sebelum dan sesudah operasi. Metode: Pengambilan data dilakukan di RSUPN dr. Cipto Mangunkusumo, Jakarta. Desain penelitian yang digunakan adalah analitik observasional dengan metode Cohort. Subjek adalah 31 orang, pria dan wanita dewasa yang dilakukan fusi lumbal pada Januari 2016 sampai Juli 2017. Pasien mengisi kuisioner IDO dan menjalani pemeriksaan xray whole spine sebelum dan setelah fusi lumbal. Peneliti melakukan analisis skor IDO dan parameter balans sagittal menggunakan program Surgimap. Hasil: Didapatkan hubungan yang tidak bermakna secara statistik antara PT, LL, C7PL. Sedangkan PI dan SS menunjukkan hubungan bermakna secara statistik. Koreksi parameter balans sagital setelah fusi lumbal tidak ditemukan hasil yang signifikan secara statistik. Pembahasan: Dari penelitian sebelumnya di Indonesia didapatkan PI dan C7PL yang berhubungan dengan luaran klinis. Namun pada penelitian ini didapatkan PI dan SS yang bermakna secara statistik terhadap perbaikan klinis. Tidak didapatkan hasil yang signifikan untuk koreksi parameter balans sagital pasca fusi lumbal. Hal ini dikarenakan karena sulitnya untuk mengevaluasi koreksi pada saat intraoperatif.

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ABSTRACT<>br>Introduction: Normal anatomy of the spine curvature has a function to distribute axial loading. Sagittal balance parameters consist of pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL) and C7 plumb line distance (C7PL). Changes on these parameters may cause pain and other disabilities. The author used ODI score to measure clinical outcome. The goal of this research is to show the correlation between the parameter of sagittal balance with clinical outcome that is measured using ODI score taken before and after surgery and to show whether the sagittal balance parameters are corrected post operatively. Methods: Data collection was taken in dr. Cipto Mangunkusumo Hospital, Jakarta. The study design is analytic observational with cohort. The subjects were 31, consist of male and female adult that undergo lumbar fusion during January 2016 until July 2017. All patients got whole spine xray and fill the ODI score questionnaire before and after the surgery. The sagittal balance parameters was measured using Surgimap software.Results The results showed that there was no significant relationship between PT, LL, C7PL with improvement of the patients statistically. There was a significant relationship between PI and SS with improvement of the patients statistically. There was no statistically significant correction of the sagittal balance parameters post operatively. Discussion: Previous study in Indonesia showed PI and C7PL were significant clinically. But this study concluded PI and SI that influence the clinical outcome. We found that the current surgical technique did not correct the sagittal balance parameters. This may be caused by the difficulty to monitor the correction intraoperatively. "

"Dari hasil pemeriksaan histology, radiolagy, biomekanik dan biokimia pada penelitian ini dapat ditarik kesimpulan bahwa proses penyembuhan patah tulang pada tibia kanan adalah lebih cepat di banding tibia kiri atau proses penyembuhan patah tulang dengan pencucian larutan NaCl lebih cepat dari pada pencucian dengan larutan povidone iodine encer. Ini menunjukkan kemungkinan adanya pengaruh larutan povidone iodine pada proses penyembuhan patah tulang"

"[Rumah Sakit Umum Pusat Fatmawati merupakan rumah sakit rujukan nasional tipe A yang melayani salah satunya pelayanan bedah orthopedi. Pelayanan bedah orthopedi merupakan pelayanan terbanyak yang dilakukan di IBS, dan memiliki demand yang sangat tinggi. Demand yang tinggi menyebabkan lamanya waktu tunggu. Apalagi ditambah dengan tingginya kejadian penundaan operasi, terutama penundaan operasi orthopedi. Skripsi ini menganalisis standar waktuoperasi yang ada apakah sesuai dengan kejadian real di lapangan atau tidak dan meilai efektivitas pelayanan bedah orthopedi khusunya ORIF (Open Reduction Internal Fixation) dengan metode Lean Hospital. Didapatkan hasil bahwa standar operasi yang ada sesuai dengan lapangan bahkan kurang dari waktu standar yang ditentukan, akan tetapi banyak terdapat waste pada setiap aktivitas pelayananyang menghambat operasi. Waste di ruangan serah terima (36,4%). Non value added pada waktu aktivitas di ruangan ini sebanyak 1870 ?s atau 81,7%. Waste di ruangan persiapan (42,9%). Non value added pada waktu aktivitas di ruangan ini sebanyak 2460 ?s atau 89,1%. Waste pada saat persiapan operasi (21%). Non value added pada waktu aktivitas di ruangan ini sebanyak 1490 ?s atau 48,2%.Waste di pada saat operasi (29,4%). Non value added pada waktu aktivitas di ruangan ini sebanyak 900 ?s atau 12,4%. Waste di ruangan pemulihan atau recovery (12,5%). Non value added pada waktu aktivitas di ruangan ini sebanyak2390 ?s atau 47,8%. Berdasarkan hasil analisis ditemukan penyebab waste yang terjadi, dan dibutuhkan perbaikan segera untuk melancarkan jalannya pelayanan bedah serta penambahan value added pada pelayanan.

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Rumah Sakit Umum Pusat Fatmawati is the national referral hospital type A which serves one orthopedic surgical services. Orthopedic surgical care is a service of the highest in Central Surgery Installation, and has a very high demand. High demand led to long waiting times. Coupled with the high incidence of surgery delay, especially orthopedic surgery delay. This thesis analyzes the surgery standard is in accordance with real events or not, and assess the effectiveness of orthopedic surgical services especially ORIF (Open Reduction Internal Fixation) by the method of Lean Hospital. Showed that

surgical standards that are applicable to the field even less than the time specified standards, but there is a lot of waste in any activity that inhibits surgery services.

Waste in the handover room (36.4%). Non value added at the activity in this room as much as 1870 's or 81.7%. Waste in the preparation room (42.9%). Non value added at the activity in this room as much as 2460's or 89.1%. Waste at the time of preparation of the surgery (21%). Non value added at the activity in this room as much as 1490's or 48.2%. Waste at surgery process (29,4%). Non value

added at the activity in this room as much as 900's or 12,4%. Waste in the recovery room or recovery (12.5%). Non value added at the activity in this room as much as 2390's or 47.8%. Based on the analysis found the cause of waste that occurs, and needed urgent repairs to expedite the course of the surgical services and the addition of value in services., Rumah Sakit Umum Pusat Fatmawati is the national referral hospital type A

which serves one orthopedic surgical services. Orthopedic surgical care is a

service of the highest in Central Surgery Installation, and has a very high

demand. High demand led to long waiting times. Coupled with the high

incidence of surgery delay, especially orthopedic surgery delay. This thesis

analyzes the surgery standard is in accordance with real events or not, and assess

the effectiveness of orthopedic surgical services especially ORIF (Open

Reduction Internal Fixation) by the method of Lean Hospital. Showed that

surgical standards that are applicable to the field even less than the time specified

standards, but there is a lot of waste in any activity that inhibits surgery services.

Waste in the handover room (36.4%). Non value added at the activity in this

room as much as 1870 's or 81.7%. Waste in the preparation room (42.9%). Non

value added at the activity in this room as much as 2460 's or 89.1%. Waste at the

time of preparation of the surgery (21%). Non value added at the activity in this

room as much as 1490 's or 48.2%. Waste at surgery process (29,4%). Non value

added at the activity in this room as much as 900 ‘s or 12,4%. Waste in the

recovery room or recovery (12.5%). Non value added at the activity in this room

as much as 2390 's or 47.8%. Based on the analysis found the cause of waste that

occurs, and needed urgent repairs to expedite the course of the surgical services

and the addition of value in services.]"

"Buku ini membahas cara memeriksa secara sistematik seluruh tubuh bayi baru lahir. Dimulai dari kelainan yang dapat segera dilihat, dan dilanjutkan dengan pemeriksaan yang lebih terarah."

"Implan biomaterial telah menjadi solusi yang menjanjikan untuk pengobatan ortopedi, dengan tujuan menggantikan atau memperbaiki fungsi jaringan tulang yang rusak. Dalam penelitian ini, kami menginvestigasi efek penambahan kalsium (Ca) pada paduan Zn-Zr sebagai biomaterial implan untuk aplikasi ortopedi. Tujuan penelitian ini adalah untuk meningkatkan kekuatan mekanik, biokompatibilitas, dan kemampuan osteogenesis paduan Zn-Zr melalui penambahan kalsium. Metode penelitian melibatkan persiapan paduan Zn-Zr dengan komposisi yang berbeda, termasuk variasi kandungan kalsium. Sifat-sifat fisik dan mekanik dari paduan tersebut dianalisis menggunakan teknik karakterisasi seperti mikroskopi optik (OM), uji kekerasan, dan pengamatan XRD. Selain itu, evaluasi biokompatibilitas dan kemampuan osteogenesis paduan Zn-Zr dengan penambahan kalsium juga dilakukan melalui uji polarisasi. Hasil penelitian menunjukkan bahwa penambahan kalsium pada paduan Zn-Zr signifikan meningkatkan kekuatan mekanik paduan tersebut, dengan kekerasan dan kekuatan tarik yang lebih tinggi dibandingkan dengan paduan tanpa penambahan kalsium. Selain itu, paduan dengan penambahan kalsium menunjukkan biokompatibilitas yang lebih baik dan mendorong pertumbuhan sel tulang yang lebih baik, menunjukkan potensi sebagai biomaterial implan untuk pengobatan ortopedi.

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Biomaterial implants have emerged as a promising solution for orthopedic treatment, aiming to replace or repair damaged bone tissue. In this study, we investigate the effect of calcium (Ca) addition to the Zn-Zr alloy as a biomaterial implant for orthopedic applications. The objective of this research is to enhance the mechanical strength, biocompatibility, and osteogenic ability of the Zn-Zr alloy through calcium addition. The research method involves the preparation of Zn-Zr alloys with different compositions, including variations in calcium content. The physical and mechanical properties of the alloys are analyzed using characterization techniques such as optical microscopy (OM), hardness testing, and XRD analysis. Furthermore, the biocompatibility evaluation and osteogenic capability of the Zn-Zr alloy with calcium addition are also conducted through polarization testing. The research findings show that calcium addition to the Zn-Zr alloy significantly improves its mechanical strength, with higher hardness and tensile strength compared to the alloy without calcium addition. Moreover, the alloy with calcium addition exhibits better biocompatibility and promotes better bone cell growth, demonstrating its potential as a biomaterial implant for orthopedic treatment."