Muhammad Phetrus Johan

OBJECTIVE: To evaluate the safety and efficacy of BMP across different spinal procedures and anatomical sites to inform decision-making in spinal fusion. MATERIALS AND METHODS: A systematic search of PubMed and the Cochrane Central Register of Controlled Trials was performed, focusing on randomized controlled trials (RCTs) published between 2003 and 2023. The search utilized the Medical Subject Headings (MeSH) terms “bone morphogenetic protein,” “iliac crest bone graft,” and “spinal fusion.” RESULTS: Seventeen RCTs encompassing 1,788 patients compared BMP with ICBG in terms of efficacy, quality of life, morbidity, and safety outcomes. BMP consistently achieved higher spinal fusion success rates than ICBG, particularly at 6 and 24 months, and in lumbar procedures. BMP-2 outperformed ICBG, while OP-1 showed no significant benefit. BMP also reduced operative time and showed slightly better clinical outcomes in pain, disability, and return to work. Complication rates were 15% lower with BMP, notably fewer non-unions and revision surgeries with BMP-2. CONCLUSIONS: BMP, particularly BMP-2, demonstrates superior fusion success rates, improved clinical outcomes, and lower complication rates compared to ICBG, especially in lumbar spine procedures.

Limb salvage surgery has become the preferred treatment for primary malignant bone tumours, offering functional preservation without compromising oncologic outcomes. Biologic reconstruction using recycled bone allografts processed via deep freezing or liquid nitrogen is increasingly used, particularly in young patients. While both methods aim to maintain structural integrity and osteoconductivity, their effects on bone healing may differ. This study aims to compare the bone healing outcomes of liquid nitrogen-treated and deep-frozen allografts in the context of biologic limb reconstruction. This experimental study employed a post-test control group design involving 16 male New Zealand White rabbits. Animals underwent standardized radial bone defect surgery and were divided into two groups receiving either deep-frozen or liquid nitrogen-preserved bone allografts. Evaluations were conducted histologically, immunohistochemically (VEGF and TGF-β), and radiologically (modified Radiographic Union Scale for Tibial fractures, mRUST) at 4- and 8-weeks post-operation. Comparative analyses demonstrated no significant differences between the two preservation methods regarding osteoblast counts, micro vascularization, VEGF and TGF-β expressions, and mRUST radiological scores. Both methods exhibited similar progression in bone healing with p-values >0,05, respectively. The findings suggest that deep-freezing and liquid nitrogen preservation methods offer equivalent outcomes in supporting bone healing processes. Observed patterns align with known biological phases of bone regeneration, emphasizing comparable efficacy between both methods. Both deep-freezing and liquid nitrogen preservation methods are effective and comparable for bone allograft preservation. Further studies with longer observation periods, biomechanical evaluations, and clinical translational models are recommended to validate these findings

Background Patients with Metastatic Bone Disease (MBD) often present with complaints of pain and multiple osteolytic lesions findings. Remarkably, 30% of these cases exhibit an undetected primary lesion. Hence, categorizing them as MBD of unknown origin. The diagnostic processes of patients with MBD of unknown origin typically takes up to four months, rendering it as a catastrophic disease with the second-highest financial burden. Given its urgency, it is necessary to develop a evidence-based consensus for managing cases of MBD with an unknown origin. Purpose This study aimed to enhance the effectiveness and efficiency of treating patients with MBD of unknown origin through the application of the INA-MBD algorithm. Research method A quasi-experimental study with a pretest and post-test design was conducted with a total of 128 patients who met the inclusion and exclusion criteria. The patients were consecutively enrolled and categorized into two groups: the intervention group with the INA-MBD algorithm and the non-intervention group without the INA-MBD algorithm. The primary outcomes were the cost and time to diagnose MBD of unknown origin. The proposed measuring tool was the INA-MBD algorithm. Furthermore, for the cost-to-diagnosis variable, an extra measurement tool was used, which were summaries of the patient’s medical bill including hospital stays and medical procedures. The analysis of data related to the time-to-diagnosis variable was conducted using the Log Rank regression test, and cost-to-diagnosis variable was carried out using co-variance test.

Background: Anterior cruciate ligament (ACL) injury is one of the most prevalent factors contributing to knee instability worldwide. This study aimed to evaluate modified metal fixation techniques for ACL reconstruction compared to factory-made implants, such as polyether ether ketone (PEEK) screws, bioabsorbable screws, and modified metal implants. Methods: A retrospective cohort analysis was conducted to assess the functional outcomes of ACL using various fixation methods. Patients who underwent arthroscopic ACL reconstruction at several healthcare facilities were included in the study. The functional outcomes were evaluated using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score questionnaire at 6- and 12 months post-surgery. Statistical analyses, including the Shapiro–Wilk test and analysis of variance, were performed to compare outcomes among the fixation groups. Results: Thirty-three patients who underwent ACL reconstruction surgery with varying distributions across the three fixation groups (modified metal implants, PEEK screws, and bioabsorbable screws) were included in the study. As measured by the Lysholm and IKDC scores at 6- and 12 months post-surgery, the PEEK group demonstrated the highest average scores. Nevertheless, these functional outcomes were not significantly different between the groups (p = 0.140, 0.770, 0.150, and 0.200). These findings align with those of meta-analyses comparing different fixation methods for ACL reconstruction. Conclusions: While acknowledging the small sample size as a limitation, this study suggests that modified metal implants represent viable options for ACL reconstruction. The selection of fixation methods should consider patient characteristics and preferences, emphasizing biomechanical stability and long-term outcomes. Further research is needed to validate these findings and explore their biomechanical properties and cost-effectiveness.

Background Patients with Metastatic Bone Disease (MBD) often presenting with complaints of pain and multiple osteolytic lesions findings. Remarkably, 30% of these cases exhibit an undetected primary lesion. Hence, categorizing them as MBD of unknown origin. The diagnostic processes of patients with MBD of unknown origin typically takes up to four months, rendering it as a catastrophic disease with the second-highest financial burden. Given its urgency, it is necessary to develop a systematic and evidence-based consensus for managing cases of MBD with an unknown origin. Purpose This study aimed to enhance the effectiveness and efficiency of treating patients with MBD of unknown origin through the application of the INA-MBD algorithm. Research method A quasi-experimental study with a pretest and post-test design was conducted with a total of 128 patients who met the inclusion and exclusion criteria. The patients were consecutively enrolled and categorized into two groups: the intervention group with the INA-MBD algorithm and the non-intervention group without the INA-MBD algorithm. The primary outcomes were the cost and time to diagnose MBD of unknown origin. The proposed measuring tool was the INA-MBD algorithm. Furthermore, for the cost-to-diagnosis variable, an extra measurement tool was used, which were summaries of the patient’s medical bill including hospital stays and medical procedures. The analysis of data related to the time-to-diagnosis variable was conducted using the Log Rank regression test, and cost-to-diagnosis variable was carried out using co-variance test.

Introduction: Open fractures of the tibia are challenging injuries to treat. The neutrophil-lymphocyte ratio (NLR) has been used to predict poor prognosis in various orthopedic conditions. This study aims to analyze the role of NLR in the wound healing of patients with open fractures. Methods: This is a retrospective study with data taken from all patients with grade IIIA open tibial fractures admitted to the hospital for treatment between January 2018 and June 2023. The initial NLR value and wound healing state were recapped after 6 weeks of follow-up. A statistical analysis between NLR values and wound healing state was done to measure the significance between variables. Results: There were 49 participants included in this study. Our current study found a significant difference between the mean NLR value of the healed and nonhealed wound (12.59±11.2 vs 10.46±7.9, P =0.015). The mean NLR in the healed group was significantly higher than in the nonhealed group. Calculating NLR involves dividing the absolute count of neutrophils by the total count of lymphocytes, which can be obtained through a complete blood count test. This ratio offers valuable insights into the balance between inflammatory and anti-inflammatory responses in the body. Conclusion: The NLR was significantly higher in the healed group than in the nonhealed group. Further research with higher-quality studies might be needed to prove its prognostic factor.

Background: Reconstruction after en-bloc resection can be challenging in cases of Campanacci grade 3 giant cell tumour of the bone (GCTB) of the distal radius. Here, the authors examined the outcomes of patients with Campanacci grade 3 GCTBs of the distal radius who underwent wrist arthrodesis and reconstruction with ulnar translocation. Material and methods: This case series was a retrospective single-centre study. Clinical assessments regarding the functional status and complications were follow-up. The functional results were evaluated using the Musculoskeletal Tumor Society (MSTS) and Disability of Arm, Shoulder, and Hand (DASH) Score. Paired t-tests were used to compare the MSTS and DASH scores separately before and after the operation. Statistical differences were considered significant at P less than 0.05. Results: Seven patients were included in this study. The mean follow-up period was 14.43±8.08 months. The average length of tumour resection was 9.78±2.88 cm. The average range of motion of the involved forearm was 82.66° of supination and 81.54° of pronation. The average MSTS score was 11.71±2.21 before and 25.14±2.41 after the operation (PP<0.05). Of the seven cases, one case had a recurrence, and one patient had radioulnar synostosis. Conclusion: Wrist arthrodesis combined with ulnar translocation can be considered a simple and effective reconstruction method with preservation of function after en-bloc resection of Campanacci grade 3 GCTB of the distal radius. It provides good functional outcomes with low complication rates.

Unknown etiology Frozen shoulder (FS) is a common conditions that causes significant morbidity. It is characterized by restriction of both active and passive shoulder motion (ROM) of the glenohumeral joint. The etiology, pathology, and most efficacious treatments are unclear. The purpose of FS treatment is complete elimination of pain and recovery of shoulder joint function. Prolotherapy injects certain compounds into articular spaces, ligaments, and/or ten-dons to relieve pain and disability around joint spaces and to stimulate a proliferation cascade to enhance tissue repair and strength. This case report aims to describe functional outcome changes in 2 patients with FS, comparing prolotherapy combined with physical therapy vs physical therapy only. We report the cases of 2 patients with confirmed FS. Patient A was 66-year-old man with chief concern of right shoulder pain and limited ROM in the past 3 months, which disrupted daily life, with a visual analog scale (VAS) of 6 out of 10. Patient B was 65-year-old man with chief concern of right shoulder pain and limited ROM in the past 2 months. The symptoms affected his general quality of life, with a VAS of 5 out of 10. Patient A underwent prolotherapy combined with physical therapy and had significantly improved ROM after 2 weeks, with relieved pain and improved shoulder function. Patient B underwent physical therapy only and showed similar ROM and no significant pain improvement. Initial treatment with prolotherapy combined with physical therapy for patients with frozen shoulder achieved fast improvement of active and passive ROM, significantly decreased pain, and improved quality of life compared to physical therapy intervention only.

OBJECTIVE: Inflammation has a vital role in tumor development and metastasis. Changes in blood count parameters have been associated with tumor prognosis. We aimed to evaluate the prognostic significance of neu-trophil to lymphocyte ratio (NLR) in predicting lung metastasis of giant cell tumors of the bone (GCTB) of the extremities. PATIENTS AND METHODS: 34 GCTB pa-tients (22 males and 12 females) were includ-ed in the study. Patients were divided into two groups. The metastasis group (n = 7) included GCTB patients with lung metastasis, while the non-metastasis group (n = 27) included those without lung metastasis. Descriptive statistics and frequency distribution were calculated [age, white blood cell (WBC), neutrophil, lymphocyte, platelets, neutrophil to lymphocyte ratio (NLR), and platelets to lymphocytes ratio (PLR)]. Con-tinuous normal variables were expressed as mean +/- standard deviation and compared using Student's t-tests. The receiver operating charac-teristic (ROC) curve analysis was used to eval-uate the ability of NLR and PLR to predict lung metastasis. The factors were considered to be statistically significant at p < 0.05. RESULTS: There were no significant differ-ences between the lymphocyte count (1.81 vs. 2.23 10(3)/mm(3)), platelet count (436 vs. 364 10(3)/ mm(3)), and PLR values (247 vs. 190) of the two groups (p > 0.05). The WBC count (11.8 vs. 8.95 10(3)/mm(3)), neutrophil count (8.78 vs. 5.69 10(3)/mm(3)), and NLR levels (5.45 vs. 2.81) (p < 0.05) were significantly higher in the metasta-sis group. The presence of an NLR cut-off val-ue of 3.7 significantly predicted the existence of lung metastasis (AUC = 0.857 [95%CI = 0.714-1], p = 0.004) with a sensitivity of 85% and specific-ity of 82%. CONCLUSIONS: NLR may serve as a prom-ising prognostic marker for predicting lung me-tastasis in GCTB patients.