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Journal : e-CliniC

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