Spiral oblique retinacular ligament reconstruction using lateral band technique to treat swan neck deformity due to chronic mallet finger: A case report

INTRODUCTION

Swan neck deformity (SND) is characterized by hyperextension of proximal interphalangeal (PIP) joint and extension lag of distal interphalangeal (DIP) joint with functional loss of finger and impairs of tight grip of the finger. SND often results from chronic mallet injury and requires surgical treatment. One of the procedure is spiral oblique retinaculum ligament (SORL) reconstruction. We reported good outcome of swan neck deformity due to chronic mallet finger cases treated with SORL reconstruction using lateral band technique.

CASE PRESENTATION

We presented 2 case of swan neck deformity due to chronic mallet finger. A 21-year-old male with deformity of the left index finger for 2 years with with extension lag 50° and -20° PIP joint hyperextension and A 18-year-female with deformity of right ring finger for 4 years with extension lag 40° and -20° PIP joint hyperextension. We performed SORL reconstruction using lateral band technique. Ten weeks after surgery, patient achieved good range of motion and stability of PIP and DIP joint was obtained.

DISCUSSION

SORL reconstruction in a finger with a chronic mallet deformity coordinates extension of PIP and DIP joints by a dynamic tenodesis effect. This concept improves stability of both DIP and PIP joints by linking the volar flexor sheath to the lateral aspect of the terminal tendon using lateral band, thereby providing a mechanism of for automatic DIP joint extension upon active PIP extension.

CONCLUSION

SORL reconstruction using lateral band technique may be a good choice for treating swan neck deformity.

Emergency orthopaedic surgery in the pandemic era: A case series at Cipto Mangunkusumo national tertiary hospital in Jakarta, Indonesia

INTRODUCTION

Every emergency surgery performed is aimed at saving lives; however, during COVID-19 pandemic, surgeries are often postponed. Many existing recommendations take into account postponing surgery during a pandemic. How these surgeries can lead to increasing infection rates has not been widely published. This study aims to investigate the relationship of emergency orthopaedic surgery and the incidence rate of COVID-19.

PRESENTATION OF CASE

This was a case series of 14 patients. The study was performed at the emergency department unit at a national tertiary hospital in Jakarta, Indonesia. A total of 14 patients underwent orthopaedic surgery in the emergency room of our institution. The mean age of the subjects was 40.07 ± 20.5 years. Twelve (85.7%) were male patients and 2 (14.3%) were female patients. The average duration of surgery was 125 minutes. The most used type of anaesthesia was general anaesthesia for 6 operations (50%). Patients were hospitalized for an average length of 4 days. Three patients had infiltrates found on plain x-ray examination, which required further examination to determine whether the cause was COVID-19 infection or not. There was no ground glass appearance (GGO) in the three patients in further follow-up examination.

CONCLUSIONS

We found that emergency orthopaedic surgery was not associated with increasing number of COVID-19 cases. Factors including duration of surgery, length of stay, types of anaesthesia and comorbidities were also not associated with COVID-19 cases in this study.

Does elective orthopaedic surgery in pandemic era increase risk of developing COVID-19? A combined analysis of retrospective and prospective study at Cipto Mangunkusumo Hospital, Jakarta, Indonesia

BACKGROUND

To date, no recommendations have been published on when and how to start again carrying out elective, non-urgent surgery on COVID-19-negative patients after the epidemic peak has been reached in a given country or region and the pressure on healthcare facilities, healthcare workers and resources has been released by so far that elective surgery procedures can be safely and ethically programmed again. This study aims to investigate whether elective orthopaedic surgery will increase the risk of developing COVID-19.

MATERIALS AND METHODS

This was a combined retrospective and prospective studies performed at a national tertiary hospital in Jakarta, Indonesia. Subjects were patients who underwent elective orthopaedic surgeries at our institution from April to May 2020. Those who were previously infected with COVID-19 from polymerase chain reaction (PCR) reverse transcriptase (RT) examination obtained via nasopharynx and oropharynx swab, as well as those who were reluctant to participate were excluded from the study.

RESULTS

A total of 35 subjects (mean age 32.89 ± 17.42) were recruited. Fifteen (42.9%) subjects were male, and 20 subjects (57.1%) were female. Mean duration of surgery was 240 min with the longest and shortest duration of 690 and 40 min, respectively. General anaesthesia was performed in the majority of cases in 18 surgeries (51.4%) with local anaesthesia as the least in 2 surgeries (5.7%). Length of stay of our study was 6 days of average. None of the patients developed symptoms suggestive of COVID-19 infection.

CONCLUSION

We found that elective orthopaedic surgery may not be associated with increased cases of COVID-19 cases. However, our study was limited by short duration of follow-up. Further studies are required in order to investigate the affect of undergoing elective surgery and the number of COVID-19 cases.

Well-differentiated liposarcoma disguised as a recurrent lipoma of the forearm flexor compartment: A case report

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The giant size and other unusual characteristics raised the awareness of malignant lipomatous mass.

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Differential diagnosis between giant lipoma and liposarcoma is of great importance.

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Post-operative histopathological diagnosis was well-differentiated liposarcoma lipoma-like.

Introduction

Lipomas are common benign mesenchymal tumor that arise from the adipose tissue. Differential diagnosis between the benign and malignant form (liposarcoma) must be made to prevent complication and recurrence.

Presentation of case

We reported a 63-year-old man who presented with recurrent large-sized mass on the right forearm with the first presentation approximately 28 years before being treated in our center. Main complaints were discomfort, social embracement, and difficulty in dressing. There were no compression symptoms observed. We performed marginal excision and sent the sample for histopathological examination. The work has been reported in line with the Surgical Case Report (SCARE) criteria.

Discussion

During one year of post-operative period, no recurrence was detected and a complete relief of symptoms was as expected.

Conclusion

Diagnostic challenge in such a large-sized (giant) lipoma is in differentiating it with the malignant form. Surgical excision is the choice of treatment. However, long-term follow up is needed due to the risk of recurrence.

Tuberculosis of the wrist mimicking rheumatoid arthritis - A rare case

INTRODUCTION

Mycobacterium tuberculosis causes infection in approximately one-third of the world's population. Arthritis due to Mycobacteriurn tuberculosis usually presents as a chronic, slowly progressive, monoarticular infection that predominantly involves the weight-bearing joints and the spine. The hand and wrist are rare sites for tuberculosis (TB) and comprises of < 1% of all skeletal TB. Even though it is rare, TB of the wrist is a cause of great morbidity. We presented a case of wrist TB treated with debridement and synovectomy.

PRESENTATION OF CASE

A 35 years old woman came with the chief complaint of pain and swelling on the right wrist since 1 year ago and was diagnosed with rheumatoid arthritis of the wrist. Patient then was given methylprednisolone 4 mg twice a day and methotrexate 175 mg once a week. However, the pain and swelling of her right wrist became worse. Subsequently patient was admitted to hospital and laboratory findings suggested a tuberculous arthritis of the wrist. Debridement, synovectomy, and biopsy, in addition to antituberculosis therapy, were then performed.

DISCUSSION

Tuberculous arthritis is generally a monoarticular disease that typically involves the spine or large and medium-sized joints. Rheumatoid arthritis (RA) and tuberculous arthritis may have similar clinical characteristics, which consists of a chronic course with periarticular soft-tissue swelling.

CONCLUSION

Tuberculous arthritis and RA can have similar characteristic but laboratory examination can help in establishing diagnosis.