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All Journal E-Jurnal Medika Udayana Indonesian Journal of Medicine Journal Orthopaedi and Traumatology Surabaya (JOINTS) Indonesian Journal of Global Health research Jurnal Penyakit Dalam Indonesia The Hip and Knee Journal
Aryana, I Gusti Ngurah Wien
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Konsep Diagnosis dan Penatalaksanaan Fraktur Osteoporosis Terkini Aryana, I Gusti Ngurah Wien; Febyan, Febyan
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
Publisher : UI Scholars Hub

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Abstract

Osteoporosis is a metabolic bone disease that is caused by a decreased amount of bone mass, and microarchitectural damage to bone tissue that affects the bone to break easily. Osteoporosis can be divided into primary and secondary etiologies. Vertebral, hip, distal radius, and proximal humerus are the most common predilection of fracture complication due to osteoporosis. The diagnosis of osteoporotic fractures is established based on the identification of risk factors, general clinical manifestations, specific manifestation from each fracture predilection, and advanced examinations, including radiology imaging and dual-energy x-ray absorptiometry. The purpose of osteoporotic fractures management in elderly is a stable fixation with early mobilization that will induce an optimal activation of osteoblast for new bone formation.
Hubungan Antara Waktu Tunggu Operasi pada Fraktur Collum Femur dengan Funsgional Outcome pada Pasien Berusia di atas 65 Tahun di RSUP Prof. Dr. I.G.N.G Ngoerah Denpasar pada Tahun 2021 Tandiono, Marco; Aryana, I Gusti Ngurah Wien; Meregawa, Putu Feryawan; Maharjana, Made Agus
E-Jurnal Medika Udayana Vol 13 No 4 (2024): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2024.V13.i04.P13

Abstract

Fractures are common occurrence, especially in the elderly. One type of fracture with the most cases is neck fracture of the femur. The presence of a fracture can sometimes interfere with the body's functional activities, both before and after surgery. Different treatment times will result in varying outcomes, as in mortality and postoperative body function. This study aims to determine the relationship between waiting time for collum femur fracture surgery with functional outcome in patients who aged over 65 years. This study was an observational study with a retrospective analytic cross-sectional approach. The sampling technique used is total sampling, which by taking all available samples. Members of the research sample will be interviewed about their body's functional abilities using the Modified Harris Hip Score scoring system. The obtained interview results will be calculated and categorized. Furthermore, the data will be tested by Chi-Square Test to determine its significance. Interviews were conducted on 19 willing families. A total of 12 people underwent surgery with waiting time 5 days post-trauma, and 7 people underwent surgery with waiting time >5 days post-trauma. The results of the interviews showed that as many as 7 people died after surgery after 1 year. Meanwhile, the scoring results show that the most functional outcomes are in the bad category. The results of the Chi-Square Test showed that there was no significant difference in waiting time for surgery on post surgery outcome (p<0.05). Waiting time for surgery on collum femur fractures shows no significance on functional outcome in patients over 65 years of age.
Karakteristik Fraktur Suprakondiler Humerus Pada Anak-Anak di RSUP Sanglah Denpasar Periode 2017-2020 Nanda, Km Junita Sari; Dewi, Kadek Ayu Candra; Meregawa, Putu Feryawan; Aryana, I Gusti Ngurah Wien
E-Jurnal Medika Udayana Vol 12 No 2 (2023): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2023.V12.i02.P07

Abstract

Fraktur suprakondiler humerus merupakan fraktur ekstermitas atas yang umum terjadi pada anak-anak di seluruh dunia. Kasus fraktur suprakondiler humerus di Indonesia terutama di Bali cukup sering ditemukan namun data penelitian mengenai karakteristik fraktur ini masih terbatas. Berdasarkan hal tersebut penelitian ini dilakukan dengan tujuan untuk mengetahui karakteristik fraktur suprakondiler humerus pada anak-anak di RSUP Sanglah Denpasar. Penelitian menggunakan metode deskriptif dengan rancangan cross sectional. Sampel diambil melalui data rekam medis pasien di RSUP Sanglah Denpasar dari Agustus 2017 - Desember 2020. Dilakukan analisis data menggunakan software SPSS versi 26 untuk mendapatkan karakteristik fraktur suprakondiler humerus berdasarkan usia, jenis kelamin, klasifikasi, tatalaksana, waktu penanganan dan komplikasi. Hasil penelitian menunjukan bahwa distribusi pasien yang sering datang yaitu pada kelompok anak-anak usia 5-9 tahun (56.9%) dengan berjenis kelamin laki-laki (73.8%). Klasifikasi yang banyak ditemukan pada penelitian ini yaitu fraktur Gartland tipe 3 (56.9%) dan diikuti oleh fraktur Gartland tipe 2 (29.2%). Sebagian besar pasien datang dan mendapatkan penanganan kurang dari 3 minggu setelah terjadinya fraktur (76.9%). Tatalaksana yang sering dilakukan yaitu secara operatif (90.8%). Terdapat beberapa komplikasi yang dapat terjadi seperti malunion (18.5%), sindrom kompartemen (1.5%) dan cedera saraf (1.5%). Fraktur Gartland tipe 3 sebagian besar terjadi pada anak dengan usia 5-9 tahun dikarenakan pada usia tersebut tulang anak masih dalam proses pematangan. Kebanyakan fraktur ini terjadi pada anak laki-laki dikarenakan aktivitas fisik yang lebih tinggi. Dengan dilakukan penalataksanaan yang baik maka dapat mengurangi risiko komplikasi.
HUBUNGAN USIA, JENIS KELAMIN, DAN PEKERJAAN TERHADAP DERAJAT KEPARAHAN PENDERITA OSTEOARTRITIS LUTUT BERDASARKAN KELLGREN-LAWRENCE DI RSUP SANGLAH DENPASAR Dhaifullah, M Rifqi; Meregawa, Putu Feryawan; Aryana, I Gusti Ngurah Wien; Subawa, I Wayan
E-Jurnal Medika Udayana Vol 12 No 1 (2023): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2023.V12.i01.P18

Abstract

Latar Belakang: Osteoartritis (OA) lutut merupakan penyakit pada sendi lutut yang paling umum terjadi. OA lutut umumnya terjadi pada lanjut usia, wanita, dan seseorang dengan pekerjaan berat yang derajat keparahannya dapat dinilai berdasarkan klasifikasi Kellgren-Lawrence. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara usia, jenis kelamin, dan pekerjaan terhadap derajat keparahan OA lutut berdasarkan kriteria Kellgren-Lawrence di Rumah Sakit Umum Pusat (RSUP) Sanglah Denpasar. Metode: Penelitian ini menggunakan metode potong-lintang analitik. Data penelitian merupakan data sekunder pasien OA lutut yang terdaftar dalam rekam medis RSUP Sanglah kota Denpasar periode Januari 2019 – Desember 2020 dan sudah menjalani pemeriksaan radiografi. Pengambilan data dilakukan dengan teknik consecutive sampling dan didapatkan 52 data yang memenuhi kriteria penelitian. Analisa data dilakukan dengan menggunakan SPSS versi 23. Hasil: Ditemukan hubungan positif yang cukup antara pekerjaan dengan derajat Kellgren-Lawrence (p = 0,001; r = 0,417). Ditemukan juga hubungan negatif yang lemah antara usia dengan derajat Kellgren-Lawrence (p = 0,040; r = -0,260). Namun, tidak ditemukan adanya hubungan antara jenis kelamin dengan derajat Kellgren-Lawrenece (p = 0,951). Simpulan: Pekerjaan memiliki hubungan yang lebih kuat terhadap derajat keparahan penderita OA lutut berdasarkan Kellgren-Lawrence di RSUP Sanglah Denpasar dibandingkan dengan usia dan jenis kelamin. Kata kunci : Jenis kelamin, Kellgren-Lawrence, osteoartritis lutut, pekerjaan, usia
Comparison of Mortality Rate Between Bipolar Hemiarthroplasty and Proximal Femoral Nail Anti-rotation for Intertrochanteric Fractures in Sanglah Hospital, Bali Dusak, I Wayan Suryanto; Aryana, I Gusti Ngurah Wien; Dharmayuda, Cokorda Gde Oka; Subawa, I Wayan; Nugraha, Hans Kristian; Susila, Made Arya; Mahadhana, Sri
The Hip and Knee Journal Vol 1, No 1 (2020): August
Publisher : Indonesian Hip and Knee Society (IHKS)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (844.577 KB) | DOI: 10.46355/hipknee.v1i1.25

Abstract

Introduction: Intertrochanteric fractures occur in about 50% of all hip fracture events, with a mortality rate within 1 year after fracture reaching 15 to 20%. The most common treatment nowadays is either the bipolar hemiarthroplasty procedure or proximal femoral nail anti-rotation (PFNA), although there is still no consensus regarding which is better from the two, especially on patient mortality.Method: This study was an observational study using a retrospective cohort design. A total of 102 study subjects who met the inclusion requirements were grouped into 2 groups, one with bipolar hemiarthroplasty fixation treatment and another with PFNA fixation treatment. Mortality rate was recorded by survey 2 years after surgery.Results: Chi-square test showed that 2-year mortality rate after intertrochanteric fracture treated with bipolar hemiarthroplasty (21.4%) was significantly higher than the PFNA group (10.3%) (p = 0.028). Bipolar hemiarthroplasty group also had longer length of stay (50%) than the PFNA group (32.4%), albeit statistically insignificant (p = 0.13). There was no significant difference between the 2-year mortality rate and length of stay (p = 0.976).Conclusion: Patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty have significantly higher 2- year mortality rate than similar patients underwent fixation with PFNA, while they did not experience higher length of stay than the PFNA group. Future prospective, multi center study with larger sample size will be likely to validate similar fixation choice needed to decrease the mortality rate in intertrochanteric fractures.
Clinical Outcomes Comparison in Administration of Secretome vs Hyaluronic Acid in Patients with Knee Osteoarthritis Kellgren-Lawrence Grade I-III Aryana, I Gusti Ngurah Wien; Suyasa, I Ketut; Dharmayuda, Cokorda Gde Oka; Febyan; Gunawan, Dary
Indonesian Journal of Medicine Vol. 9 No. 4 (2024)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2024.9.4.798

Abstract

Background: The prevalence of OA in Indonesia is predicted to reach more than 20% of the population aged over 60 years in 2050, with a high risk of disability. So far, early treatment of osteoarthritis in the form of administering hyaluronic acid has not been completely satisfactory and tends to be progressive until ending in more invasive operative therapy. This study aimed to compare the clinical outcomes between secretome injection and hyaluronic acid in patients with Kellgren-Lawrence grade I-III knee osteoarthritis. Subjects and Method: This was a single-blind experimental study. This study was conducted in the orthopedic polyclinic at General Hospital Prof. Dr. I.G.N.G. Ngoerah Bali. A total sample of 36 knee osteoarthritis patients was selected using permuted block sampling with randomization. The sample was divided into two groups, (1) secretome (intervention group) and (2) hyaluronic acid (control group). The independent variables were secretome injection and hyaluronic acid injection. The dependent variable was pain. Pain was measured using Western Ontario and McMaster University (WOMAC), Knee Osteoarthritis Outcome Score (KOOS), Visual Analog Score (VAS), and Patient-Reported Outcome Measure (PROM). Results: Based on gender, there are more women than men and the right foot is more affected at 58.3%. Functional score parameters in each secretome and hyluronic acid group were compared between the 3rd and 6th months of follow-up. Pain in the hyaluronic acid group was lower than in the secretome group. Conclusion: Hyaluronic acid has better effect in pain reduction than secretome. Further studies could explore the underlying mechanisms and potential long-term effects to better understand these differences in pain outcomes.
The Potential Applications of Stem Cell Conditioned Medium Secretome in Knee Cartilage Regeneration: A Systematic Review Aryana, I Gusti Ngurah Wien; Febyan, Febyan; Ustriyana, Nyoman Gede Grenata Nanda
(JOINTS) Journal Orthopaedi and Traumatology Surabaya Vol. 13 No. 2 (2024): October 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/joints.v13i2.2024.84-99

Abstract

Background: Articular cartilage injuries often result from trauma, genetic predisposition, and degeneration. These injuries lack inherent regeneration mechanisms due to the absence of blood vessels and limited progenitor cell entry. Osteoarthritis is characterized by gradual cartilage deterioration. Mesenchymal stem cells (MSCs), particularly their secretome including exosomes, hold promise as a regenerative therapy. This review explores the application of MSCs and their secretome to address cartilage defects.Methods: This review was conducted based on PRISMA guidelines. Animal model studies focusing on the use of stem cell secretomes for cartilage regeneration were explored. The search, encompassing PubMed, MEDLINE, the Cochrane Library, Scopus, Web of Science, and Science Direct from January 10, 2023, to July 27, 2023, was conducted utilizing Google Chrome as the search engine. Studies with outcomes based on OARSI or ICRS scores, as well as any additional outcomes related to MSC secretome utilization, cartilage regeneration, and proliferation, were included.Results: Our systematic review identified six studies using MSCs in vivo and in vitro. Synovial membrane-derived MSCs significantly enhanced cartilage regeneration by elevating chondrogenic capabilities. Hydrogel-based systems techniques and 3D-printed scaffolds have emerged for innovative delivery. Specific microRNAs, such as miR-92a-3p, have been recognized for enhancing cartilage regeneration. Strategies for the effective targeting of MSC exosomes to the precise cartilage damage site have been explored.Conclusions: The studies demonstrate the potential of MSC-derived secretomes and exosomes for knee cartilage regeneration in animal models. Further research and clinical trials are needed to refine these approaches for practical application.
Intrafracture Recombinant Platelet-Derived Growth Factor Improves Fracture Healing Process on Wistar Rat Aryana, I Gusti Ngurah Wien; Giri, Kadek Gede Bakta; Suyasa, I Ketut; Lestari, Anak Agung Wiradewi
Indonesian Journal of Medicine Vol. 8 No. 2 (2023)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2023.8.2.615

Abstract

Background: Femoral fracture is associated with high morbidity and mortality, especially in young adults with high-energy injuries. Abnormal fracture healing presents as a significant matter in management of femoral fracture. Platelet Derived Growth Factor (PDGFBB) is proposed as potential agent in fracture healing. Up to this point, PDGF has been scientifically studied improve wound healing by enhancing fibroblast proliferation, extracellular matrix synthesis, and revascularization. This study aims to evaluate role of PDGF on fractured bone healing.Subjects and Method: This was a randomized controlled trial conducted at Animal and Biomedical Laboratory of Udayana University, from March to September 2022. 36 male and healthy Wistar Rats at 34 months old and weighs 140160 grams were selected for this study. The dependent variables were Allen score, type I and type III collagen levels. The independent variable was administration of 10 mcg PDGFBB following femoral osteotomy and intramedullary wire fixation. Type I and III collagen levels are assessed using ELISA methods. Statistical analysis is performed using independent T-test in SPSS ver 25.0 software.Results: Allen score in the PDGFBB group (Mean= 3.89; SD= 1.40) was higher than control group (Mean= 2.28; SD= 1.48), with p=0.002. Type I collagen in the PDGFBB group (Mean= 4.97; SD= 0.54) was higher than control group (Mean= 4.41; SD= 0.74), with p=0.014. Type III collagen in the PDGFBB group (Mean= 12.1; SD= 2.49) was higher than control group (Mean= 10.01; SD= 1.61), with p=0.005.Conclusion: In comparison to the nonPDGFBB group, Wistar rats that had their femurs osteotomized and joined with intramedullary wire in the PDGFBB group has higher mean of Allen score, type I and type III collagen levels.Keywords: femoral fracture, allen score, type I collagen, type III collagen, PDGFBBCorrespondence: IGN Wien Aryana, Consultant of Sports Medicine, Dept. Orthopaedic and Traumatology, Prof IGNG Ngoerah General Hospital, Faculty of Medicine, Udayana University. Jl. Diponegoro, Dauh Puri Klod. Denpasar City, Bali 80113. Email: wienaryanaortho@gmail.com. Mobile: +62811385263.Indonesian Journal of Medicine (2023), 08(02): 136141https://doi.org/10.26911/theijmed.2023.08.02.02
Clinical Demographics Characteristic of Total Knee Arthroplasty at Prof IGNG Ngoerah General Hospital, Bali, Indonesia Aryana, I Gusti Ngurah Wien; Dharmayuda, Cokorda Gde Oka; Febyan, Febyan; Dimitri, Dominicus; Limena, Shianita; Kuswara, Leonardus William
Indonesian Journal of Medicine Vol. 8 No. 2 (2023)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2023.8.2.616

Abstract

Background:  Total knee arthroplasty (TKA) is a widespread surgical procedure for severe arthritis. By 2030, primary TKA would reach over 1.2 million procedures annually in the United States. In Indonesia, the prevalence of joint disease is about 19.5 million cases. This study aims to evaluate the clinical demographics characteristics of TKA in Prof. Ngoerah General Hospital, Bali, Indonesia.Subjects and Method:  This is a descriptive study using a Cross-Sectional method with a total 57 adult patients undergoing TKA caused by Osteoarthritis grade III/IV in Prof IGNG Ngoerah Hospital from June 2020-June 2022. The dependent variable is the TKA procedure. Independent Variable is Age, gender, grade of knee osteoarthritis, comorbidities, and complications Data from the medical record was collected and stored in a Microsoft Office Excel 365 spreadsheet, the distributive table was analyzed and collected by using SPSS.Results:  Patient characteristic is dominated by an elderly female (84.2%), with age group 61-70 (38.6%). Comorbidities in this study include hypertension (28.1%), type II diabetes (10.5%), and rheumatoid disease (1.8%). The main complication recorded in this study includes joint stiffness (3.5%), and persistent pain (5.3%).Conclusion:  After Total Knee Arthroplasty was performed on 57 patients with a wide range of comorbidities, only a small number of complications occurred. This study implied that TKA could be performed even if the patient had some comorbidities as long as the patient pursued a complete pre and post-operative evaluation algorithm of the procedure.Keywords:  knee arthroplasty, osteoarthritis, human and medicine, rehabilitationCorrespondence:  IGN Wien Aryana, Consultant of Sports Medicine, Dept. Orthopaedic and Traumatology, Prof IGNG Ngoerah General Hospital, Faculty of Medicine, Udayana University. Jl. Diponegoro, Dauh Puri Klod. Denpasar City, Bali 80113 Email: wienaryanaortho@gmail.com. Mobile: +62811385263.Indonesian Journal of Medicine (2023), 08(02): 128-135https://doi.org/10.26911/theijmed.2023.08.02.01 
Anterior Cruciate Ligament Ruptured Concomitant Meniscus Discoid in Young Patient: A Rare Case Report Aryana, I Gusti Ngurah Wien; Trisaputra, I Ketut Wahyu; Febyan, Febyan
Indonesian Journal of Medicine Vol. 8 No. 3 (2023)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2023.8.3.654

Abstract

Background:  Abnormalities of the human meniscus, including discoid meniscus, double-layered meniscus, and ring-shaped meniscus, have been reported. The prevalence of discoid meniscus is extremely rare, with an incidence of 0.9%－2.4% in the Asian population. Traditionally, discoid meniscus concomitant anterior cruciate ligament (ACL) ruptures are extremely rare cases. The aim of this study is to discuss a rare case to provide diagnosis and management properly by using arthroscopy.Case Presentation:  A 21-year-old male Balinese, complained of pain in his right knee after fast walking for two months and an unstable knee in the past 1 year ago. On physical examination, the range of motion was limited due to the pain for flexion of more than 90°. Special tests such as Lachman test positive, and Anterior drawer test positive. The patient had medial joint line tenderness, and a McMurray test elicited pain on the medial joint line. Meanwhile, an MRI examination of the right knee showed a discoid medial meniscus with a horizontal cleavage tear and a discoid lateral meniscus with an incomplete tear. We performed a partial meniscectomy of the incomplete discoid medial meniscus and resection of the pathologic medial patellar plica. We performed surgical reconstruction of the ACL ruptured after the meniscus was repaired.Results:  We presented a 21-year-old male with discoid meniscus concomitant ACL rupture to his right knee. After the patient was performed with partial meniscectomy of the incomplete discoid medial meniscus and resection of pathologic medial patellar plica following surgical reconstruction of the ACL ruptured. The patient had no limitation of motion or pain 1 year after the operation and he had no complaints and was satisfied with the result by radiograph.Conclusion:  We concluded that This rare case of medial discoid meniscus concomitant with the ACL rupture must be reconstructed. The treatment of discoid meniscus should consider its tear pattern and whether it is symptomatic. With the development of arthroscopic techniques, the treatment of discoid meniscus has gradually changed from total meniscectomy or partial meniscectomy.Keywords:  anterior cruciate ligament, meniscus, discoid, knee, arthroscopy.Correspondence:  I Gusti Ngurah Wien Aryana. Department of Orthopaedic & Traumatology, General Central Hospital of I.G.N.G Ngoerah Central Hospital/ Faculty of Medicine, Udayana University, Bali, Indonesia. Email: wienaryanaortho@gmail.com. Mobile: +62811-385-263.Indonesian Journal of Medicine (2023), 08(03): 317-324https://doi.org/10.26911/theijmed.2023.08.03.09
Co-Authors Anak Agung Wiradewi Lestari Darma, Anak Agung Ngurah Bagus Surya Dewi, Kadek Ayu Candra Dhaifullah, M Rifqi Dharmayuda, Cokorda Gde Oka Dimitri, Dominicus Dusak, I Wayan Suryanto Febyan Febyan, Febyan Febyan, Febyan Giri, Kadek Gede Bakta Gunawan, Dary Hans Kristian Nugraha, Hans Kristian I Ketut Suyasa I Wayan Subawa Kuswara, Leonardus William Limena, Shianita Maharjana, Made Agus Meregawa, Putu Feryawan Nanda, Km Junita Sari Putu Astawa Sri Mahadhana, Sri Susila, Made Arya Tandiono, Marco Trisaputra, I Ketut Wahyu Ustriyana, Nyoman Gede Grenata Nanda