Primary Hyperparathyroidism Caused by Single Parathyroid Adenoma

Primary hyperparathyroidism is rarely found in children under sixteen years old. We report the first case seen at the Department of Child Health, Medical School, University of Indonesia, Jakarta. This 15-year old girl was admitted to the Department, referred by an orthopedic surgeon because of pathologic fractures suspected to be caused by hyperparathyroidism. The physical examination was unremarkable, and the laboratory findings showed increased level of parathyroid hormone. Roentgenologic examination showed lytic skull lesions, loss of the lamina dura of the dentis, subperiosteal resorption of the symphysis and generalized osteoporosis with pathologic fractures. Color Doppler USG using a high resolution ultrasound examination was performed to find the etiology of primary hyperparathyroidism. The result revealed single parathyroid adenoma in the right superior region measuring 2.7 x 1.7 x 1 cm. The clinical manifestation and laboratory findings showed improvement following surgery.

Surgical Correction of the Sequelae of Obstetric Pubic Symphysis Ruptures

Twenty eight patients with old postpartum ruptures of pubic symphysis complicated by functional bladder disorders were operated on during the period from 2000 to 2013. Time interval between vaginal delivery and pelvic ring stabilization made up from 1 month to 8 years. Clinical and roentgenologic examination enabled to detect predisposing factors for neurogenic, i.e. hyperactive bladder development that were treated surgically. In all cases plate osteosynthesis for pubic symphysis and fixation of sacroiliac joint with cannulated screws was performed. Subjective improvement of patients’ condition as well as the results of uroflowmetry and complex urodynamic investigation enabled to conclude that orthopaedic reconstruction of pelvic ring in old obstetric ruptures of pubic symphysis was an effective and reliable technique for the treatment of bladder dysfunction.

Surgical Correction of the Sequelae of Obstetric Pubic Symphysis Ruptures

Twenty eight patients with old postpartum ruptures of pubic symphysis complicated by functional bladder disorders were operated on during the period from 2000 to 2013. Time interval between vaginal delivery and pelvic ring stabilization made up from 1 month to 8 years. Clinical and roentgenologic examination enabled to detect predisposing factors for neurogenic, i.e. hyperactive bladder development that were treated surgically. In all cases plate osteosynthesis for pubic symphysis and fixation of sacroiliac joint with cannulated screws was performed. Subjective improvement of patients’ condition as well as the results of uroflowmetry and complex urodynamic investigation enabled to conclude that orthopaedic reconstruction of pelvic ring in old obstetric ruptures of pubic symphysis was an effective and reliable technique for the treatment of bladder dysfunction.

Interdigital Hyperkeratosis of the Foot: Orthopaedic Approach to Surgical Treatment

Surgical treatment results for 27 patients with interdigital keratosis of the foot were analyzed. To determine the predisposing factors for keratosis development data of clinical and roentgenologic examination were used. In all cases transcutaneous technique that enabled to avoid surgical intervention directly on a pathologic focus was applied. Mean follow up period made up 6 months. It was shown that transcutaneous surgical intervention was an effective and reproducible method for interdigital keratosis treatment. That technique provided positive results with minimum risk of postoperative complications in the majority of cases and could be used at outpatient department.

Clinical, Roentgenologic and Pododynamography Results of Minimum Invasive Total Hip Arthroplasty

Clinical, roentgenologic and pododynamographic data were analyzed for 195 patients after 207 total hip arthroplasties performed via modified minimum invasive anteroexternal approach by Watson-Jones during the period from 2004 to 2006. Clinical results showed reduction of rehabilitation period and significant relief of postoperative pain syndrome. The rate of complications corresponded to that at conventional technique application. Despite slight varus position of the femoral component roentgenologic examination results were also comparable. Analysis of gait showed its considerable improvement and decrease in preoperative asymmetry between healthy and operated sides already in 4 months after operation. Residual differences were almost not observed in 6 months after intervention. Obtained clinical results confirmed the advantages of the applied technique.

Treatment of Posttraumatic Lower Limbs Length Discrepancy without Breach of Bone Integrity in combination with Deformity in Children and Adolescents

During the period from 1994 to 2009 two hundred nine children (aged 2 - 18 years) with posttraumatic lower limbs length discrepancy without breach of bone integrity in combination with deformity were treated on. Corrective osteotomy or the combination with elongating osteotomy by monolocal methods were the main treatment techniques. Bi- and polylocal techniques were mainly applied when deformity was localized in an unfavorable for elongation zone and in significant shortening. A risk group for delayed regenerate ossification was identified. In that group treatment was supplemented with preventive bone plasty using either auto- or allografts in the zone of osteotomy. For objective complex evaluation of distraction regenerate condition in dynamics roentgenologic examination and ultra-sound investigation as well as elaborated method for determination of relative bone regenerate mineral density were used. The latter method enabled to study the regenerate density using digital image of standard roentgenogram and graphic computer program. Differentiated approach to the treatment and monitoring of distraction regenerate condition enabled to achieve excellent and good results in 84% of cases.

Treatment Results after ACL Plasty with M. Semitendenous and M. Gracilis Tendons, and Patellar Ligament

Treatment results for 60 patients with anterior cruciate ligament injuries (ACL) are presented. As a graft either tendons of m. semitendenous and m. gracilis (group 1, 30 patients) or patellar ligament (group 2, 30 patients) were used. Clinical instrumental and roentgenologic examination was performed at least 8 months after surgical intervention. Good and excellent results (85-100 by Lysholm scale) were achieved in 29 (96.7%) patients from the first group and in 27 (92.0%) patients from the second group. However examination on arthrometer KT-1000 showed that in 4 (13.3%) out of 30 patients from the second group anterior shift of the shin exceeded 5 mm. X-ray examination showed early signs of deforming arthrosis in 7 (27.7%) patients from the first and 15 (50%) patients from the second group.

Age-Related Dynamics of Roentgenologic Characteristics of Pelvis and Spine Osseous Growth Activity in Patients with Idiopathic Scoliosis

Roentgenologic examination of pelvis and spine osseous growth activity was performed with the purpose to determine the peculiarities of its age-related dynamics in patients with idiopathic scoliosis. Total number of 2006 patients (1770 females and 236 males) was examined. Age if patients ranged from 4 to 20 years. Severity of spine deformity corresponded to I-IV stages. Activity of pelvis growth was assessed by Risser test (R), of spine growth - by Sadof'eva test (S).Results of those tests were divided into three groups of osseous growth activity state: group of active growth included indices R-0 - R-III and S-0 - S III, group of stabilized growth - R-IV and S-IV, group of completed growth - R-V and S-V. It was stated that in idiopathic scoliosis pelvis and spine came into periods of apophyseal ossification, synostosis and osseous growth completion at later age terms than at norm - the lag made up from 1 to 4 years. It was also detected that in given pathology the spine itself started and completed its physiologic growth with 1-3 years delay as compared with pelvic bones. The obtained results indicated that in idiopathic scoliosis Risser test results should be considered as an objective but indirect information on spine growth activity. Direct objective precise information on the spine growth activity could be obtained by Sadof'eva test that reflected directly the stage of leading affected organ development in that pathology.

Experimental Evaluation of Osteoinduction of Recombinant Bone Morphogenic Protein (rhBMP-2) of Native Production Fixative on Biocomposite or Bone Matrix

Data on experimental evaluation of osteoinduction of recombinant bone morphogenic protein of native production fixative on xenogenic demineralizated bone matrix or collagen-calcium-phosphate biocomposite material. Evaluation was performed using experimental model of end-to-end osteosynthesis of diaphyseal femur fragments by external fixative device in Wistar rats. Roentgenologic examination, study of autopsy material and evaluation of bone consolidation strength using biomechanical twisting test showed high osteoinduction of rhBMP-2 containing biocomposites.