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Rangga Rawung
Universitas Sam Ratulangi
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Nursing Public Health

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Bone Defect of the Tibia: A Case Report Andriessanto Lengkong; Djarot Noersasongko; Haryanto Sunaryo; Tommy Suharso; Rangga Rawung; Stefan Kambey; Nurmalasari Amira
Medical Scope Journal Vol. 5 No. 1 (2023): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v5i1.44238

Abstract

Abstract: Defects in long bones including tibia are still difficult problems in orthopaedic field for both the physician and the patient. We reported a case of a 56-year-old woman who came to the hospital with the chief complaint of being unable to walk since she was nine years old after getting a motorcycle accident. The patient complained that her leg did not grow since then. The patient was fully conscious and hemodynamically stable. Physical examination revealed that there was a deformity of the left lower leg with shortening of the lower leg and absence of the tibial bone. The patient was diagnosed with left tibia bone defect, therefore, above-the-knee amputation was performed. The amputation must be viewed as an opportunity to re-establish or enhance the patient’s functional level and facilitate a return to near normal locomotion using a prosthesis after amputation. Soft tissue and muscle quality, bone condition, neurovascular conditions and function of the limb can be considered in the selection of therapy in bone defect. The level of amputation can be determined by assessing the bone condition, neurovascular condition, and the ability of muscle and skin flaps to close the wound. In conclusion, amputation can be the treatment of choice for patient with bone defect. Improving lower limb function is proven to maximize the patient quality of life. Keywords: bone defect tibia; above-the-knee amputation; transfemoral amputation
Efektivitas Terapi Oksigen Hiperbarik pada Nyeri Kronik Osteoartritis Lutut Benny G. Siahaan; Rangga Rawung; Mendy Hatibie
Medical Scope Journal Vol. 5 No. 2 (2023): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v5i2.46565

Abstract

Abstract: Osteoarthritis (OA) is a degenerative joint disease characterized by progressive cartilage degeneration, subchondral bone changes, osteophyte formation, sinovitis or arthritis. The aim of osteoarthritis management is to reduce pain, increase joint function, and decrease disability. Hyperbaric oxygen therapy (HBOT) can inhibit astrocyte activation and inflammatory factor production, and maintain transmission and intergration of sensoric information through dorsal neurons, therefore, resulting in pain reduction. This study aimed to evaluate the effectiveness of HBOT in chronic pain of knee osteoarthritis. This was a parallel, two-arm, placebo-controlled, randomized clinical trial in adults with knee osteoarthritis at two hospitals in Manado, namely Badan Layanan Umum Rumah Sakit Umum Pusat Prof. Dr. R. D. Kandou and Rumah Sakit Siloam. The results obtained 44 patients suffered from knee osteoarthritis grade 1 dan 2 associated with chronic pain as subjects, divided into two groups namely intervention with HBOT and control groups. Determination of normality of numeric variables was performed with Shapiro-Wilk test. The statistic test confirmed that the distribution of VAS scores was relatively not different between before and after HBOT, and the control group (p=0.421 and p=0.634). In conclusion, hyperbaric oxygen therapy can be used to reduce chronic pain in knee osteoarthritis. Keywords: knee osteoarthritis; hyperbaric oxygen therapy; chronic pain   Abstrak: Osteoartritis (OA) merupakan suatu penyakit sendi degeneratif yang dikarakteristikkan dengan degenerasi kartilago progresif, perubahan tulang subkondral, pembentukan osteofit, dan sinovitis atau inflamasi sendi. Tujuan penatalaksanaan OA ialah untuk meredakan nyeri, meningkatkan fungsi, dan membatasi disabilitas Terapi oksigen hiperbarik (TOHB) dapat menginhibisi aktivasi astrosit dan produksi faktor inflamatorik serta mempertahankan transmisi dan integrasi informasi sensori melalui neuron dorsal sehingga nyeri menurun. Penelitian ini bertujuan untuk menilai efektifitas TOHB dalam penatalaksanaan nyeri kronik pada OA lutut. Penelitian ini didesain sebagai suatu parallel, two-arm, placebo-controlled, randomized clinical trial pada dewasa dengan OA lutut di dua rumah sakit di Manado, Badan Layanan Umum Rumah Sakit Umum Pusat Prof. Dr. R. D. Kandou dan Rumah Sakit Siloam. Sebanyak 44 pasien OA lutut grade 1 dan 2 dengan nyeri kronik menjadi subjek penelitian, yang dibagi secara acak atas dua kelompok: intervensi TOHB dan kontrol. Penentuan normalitas variabel numerik dilakukan menggunakan uji Shapiro-Wilk. Hasil statistik mengonfirmasi distribusi penurunan skor VAS relatif tidak berbeda bermakna sebelum dan setelah TOHB dan kelompok kontrol (p=0,421 dan p=0,634). Simpulan penelitian ini terapi oksigen hiperbarik kemungkinan dapat menurunkan nyeri kronik pada penderita osteoartristis lutut. Kata kunci: osteoartritis lutut; terapi oksigen hiperbarik; nyeri kronik
Non-Vascularized Fibular Bone Graft for Giant Cell Tumor of the Distal Ulna: A Case Report Albertus D. Noersasongko; Haryanto Sunaryo; Tommy Suharso; Andriessanto Lengkong; Rangga Rawung; Stefan Kambey; Patrick S. Arikalang
Medical Scope Journal Vol. 6 No. 1 (2024): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v6i1.51674

Abstract

Abstract: Cases of bone giant cell tumors (GCT) are rarely found, generally benign and locally aggressive tumors. Surgical resection is the universal standard for treatment of bone GCT. Non vascularized fibular graft (NVFG) is useful in the reconstruction of skeletal defects, especially in cases of scarred and avascular recipient sites and patient with tumor surrounded by poor tissue condition. We report a 53-year-old woman, with a lump in her left hand for three years. X-ray examination revealed a mass with firm border and regular edge that reached the epiphysis expansively with thinning of the cortex in the distal region of the left ulna. Tumor excision was performed with open reduction internal fixation (ORIF) and fibular bone graft. To date, GCT is one of the most obscure and intensively examined bone tumors, and its histological images do not predict the clinical outcome. Moreover, many unanswered questions regard to the treatment and prognosis without any consensus regarding the ideal treatment selection. NVFG osteosynthesis shows encouraging results, and adequate therapy, wound care and patient compliance affect the patient’s outcome. In conclusion, NVFG and internal fixation are effective options for post tumor excision, and osteosynthesis has encouraging result. Keywords: non vascularized fibular graft (NVFG); giant cell tumor; bone graft; ulna
Treatment of Non-Union with Bone Loss in Femur Fracture Using Non-vascularized Fibular Graft: A Case Report Andriessanto Lengkong; Stefan Kambey; Rangga Rawung; Haryanto Sunarso; Albertus D. Noersasongko; Tommy Suharso; Ryan A. Senduk
e-CliniC Vol. 11 No. 3 (2023): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v11i3.44768

Abstract

Abstract: Fibula is a very versatile source of autogenous graft and has been used for decades in the field of limb reconstruction. Bony defects of the lower extremity are usually the result of high-energy trauma, tumor resection, or severe sepsis. Non-vascularized fibular graft (NVFG) is useful in the reconstruction of skeletal defects, especially in cases of scarred and avascular recipient sites, or in patients with combined bone and soft tissue defects. This study aimed to assess the effectiveness of NVFG in the management of non-union bone fracture. We reported a 16-years-old male with non-union femur fracture. Debridements were applied at the first time of admission to the hospital. Open reduction of fracture with internal femur fixation. Fibula bone was extracted as the donor of vascularized graft for the bone loss. After two years of follow-up, the patient acquired his motor functions back well, and was able to carry out daily activities as expected. In conclusion, taking together the repair and reconstruction of non-union bone in the lower extremity with NVFG and internal fixation is an effective and important option for treating non-union femoral fracture. NVFG osteosynthesis has encouraging results in such instances. It is technically less demanding, simple, and can be performed in almost all centers where image intensifier is available. Keywords: bone fracture; non-vascularized fibular graft; reconstructive microsurgery; femoral non-union
Giant Cell Tumor pada Ulna Distal: Laporan Kasus Djarot Noersasongko; Rangga Rawung; Andriessanto C. Lengkong; Haryanto Sunaryo; Maurits R. Saleh
e-CliniC Vol. 11 No. 3 (2023): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v11i3.46632

Abstract

Abstract: Giant cell tumor (GCT) in the distal end of ulna is extremely uncommon. We report a woman aged 53 tahun with a lump in the left wrist for three years that grew gradually and slowly. Physical examination of the left forearm revealed a tumor sized 8x9x10 cm, distinct border, hard in palpable without pain. X-ray of the left forearm showed a mass with distinct margin, regular edge, expansively invaded the epiphysis associated with thinning of cortex of distal ulna indicating a GCT in distal ulna. The aim of treatment in this case was to prevent recurrency and to keep the function of left forearm and hand. Patient was treated with tumor excision and fibular bone graft. Excision was performed after ulnar osteotomy until its clear margin. Fibular osteotomy 10 cm length was carried out followed by fibular bone graft to replace the excised ulna. Histopathological examination confirmed the diagnosis of a GCT. Patient was admitted for five days. Follow up after three months did not show any recurrency. Range of motion was within normal limit, and patient could do her daily activities. In conclusion, CGT in distal ulna treated with tumor excision until its clear margin followed by fibular bone graft showed satisfying result. Kata kunci: giant cell tumor; fibular bone graft; tumor excision; primary bone tumor   Abstrak: Giant cell tumor (GCT) pada bagian distal ulna merupakan kasus langka. Kami melaporkan seorang perempuan berusia 53 tahun dengan benjolan di tangan kiri sejak tiga tahun yang membesar perlahan. Pada pemeriksaan fisik regio antebraki sinistra, didapatkan benjolan ukuran 8x9x10 cm, berbatas tegas, konsistensi keras, terfiksasi, tanpa disertai nyeri tekan. Rontgen manus sinistra memperlihatkan massa berbatas tegas, tepi reguler, mengenai epifisis ekspansif dengan penipisan korteks distal os ulna sinistra, kesan GCT distal os ulna sinistra. Tujuan terapi pada GCT untuk mencegah kekambuhan lokal dan menjaga fungsi anggota tubuh. Pasien diterapi dengan eksisi tumor dan fibular bone graft. Eksisi tumor dilakukan setelah osteotomi ulna hingga batas tulang yang sehat selanjutnya dilakukan osteotomi fibula sepanjang 10 cm dan dilakukan fibular bone graft menggantikan bagian ulna yang diangkat. Konfirmasi histopatologik sampel tumor menunjukkan interpretasi kesan giant cell tumor grade III.  Pasien dirawat selama lima hari. Hasil follow-up selama tiga bulan tidak menunjukan tanda-tanda rekurensi. Range of motion pasien saat kontrol dalam batas normal, dan pasien dapat mengerjakan aktivitas sehari-hari. Simpulan kasus ini ialah GCT pada tulang ulna dengan pilihan terapi eksisi tumor hingga batas tulang yang sehat, dilanjutkan dengan fibular bone graft berhasil memuaskan. Kata kunci: giant cell tumor; fibular bone graft; eksisi tumor; tumor primer tulang
Co-Authors Albertus D. Noersasongko Andriessanto C. Lengkong Andriessanto Lengkong Benny G. Siahaan Djarot Noersasongko Haryanto Sunarso Haryanto Sunaryo Maurits R. Saleh Mendy Hatibie Nurmalasari Amira Patrick S. Arikalang Ryan A. Senduk Stefan Kambey Tommy Suharso