Introduction: Ligament injuries commonly occur in the knee region, and the anterior cruciate ligament (ACL) being the most usually injured. Currently, autograft or allograft is the most common material used for ACL reconstruction surgery. The result of the ACL reconstruction depends on the healing process of the graft or ligamentization between graft and bone tunnel. This study aims to evaluate the effect of Stromal Vascular Fraction (SVF) intratunnel injection to stimulates graft healing following ACL reconstruction surgery, as measured by histology examination. Method: This study was an experimental laboratory study with a post-test-only control group design using male Rattus novergicus. A random sampling procedure was used to choose the sample, which was then divided into two groups. The two groups consist of the control group that only had ACL reconstruction surgery and the treatment group that had reconstruction surgery with SVF administration. Result: This study used Advanced Ligament Maturity Index (LMI) score and showed a significant improvement of graft healing in the treatment group compared to the control group. The measurement is based on the cellular, collagen, and vascular aspect testing with P < 0,05 for each subscore. Conclusion: SVF intratunnel injection stimulates graft healing after ACL reconstruction surgery and causes a significant increase in cellular, collagen, and vascular aspects in the graft.

One of the main advance in orthopaedic surgery domain has a goal to investigates the safest and harmless method in surgical procedures. Less complications means a better outcome of surgery. One of the commonest risks at orthopaedic surgery is central and peripheral nerve injury. The modality of Intraoperative Neurophysiologic Monitoring (IONM) which act to limit the risk of nerve injury during operative procedure through the evaluation of nerve integrity and function enable the surgeon to decrease injury to the nerve associated with orthopaedic surgical procedure in the operating room. This article aims to explain and describe the latest modality of IONM, its basic concept and its function at surgery. The last part of the article discussed about orthopaedic surgical techniques which use IONM. The authors hope that this article will enhance the knowledge of all the readers about IONM. This article was written based on literature study searched at Google Scholar, Medline and PubMed. The references were taken from a relatively up to date study ranging from 2013-2018. The article was selected according to the authors inclusion criteria and six articles was chosen as the references for this review. As a conclusion, IONM has an important role to increase successful rate of surgery through minimizing nerve injury risk during surgical procedure.

Introduction: A Monteggia fracture was described initially as a fracture of the proximal third ulna and anterior dislocation of the proximal epiphysis radius. [ 1 ] In 1967, Bado discovered “true Monteggia lesions” and classified them into 4 groups. [ 2 ] He also used the term “equivalents” or “Monteggia-like-lesions” to describe specific injuries with similar radiographic patterns. [ 3 ] This type of fracture is rare and frequently associated with complications, poor functional results, and further operations. [ 4 ] Patient concerns: A 16-year-old girl was admitted to our emergency department after a single motorcycle accident. Her main complaint was the pain and swollen of her left elbow. She was reluctant to move her arm due to pain. Diagnosis: Radiograph examination showed a displaced fracture of the left proximal third ulna accompanied by displacement of the left proximal radius. This fracture was similar to the Monteggia type III fracture except for proximal radial disruption that occurred laterally through a Salter-Harris type II fracture. Interventions: The patient underwent surgical debridement, and the forearm was immobilized using a backslap in a supine position and elbow flexion 90 o . Open reduction and internal fixation were performed 5 days later. The ulna was reduced and stabilized first using a 3.5 mm one-third tubular plate (ORMED), and internal fixation of the radial epiphysis was done using a 1.6 mm miniplate (Prohealth). Outcomes: After 3 months, the patient showed improvement with the Mayo Elbow Performance Score (MEPS) of 85. She did not complain of any pain and decreased strength. The patient regained 0 to 125 o of elbow flexion and 0 to 165 o of supination and pronation. Conclusion: Monteggia-like-lesion has many variations in physical and radiograph appearance. Careful evaluation of fracture pattern, identification of injury mechanism, and appropriate treatment planning based on Monteggia fracture treatment principles are mandatory to achieve the patient's best outcome.

The hemiarthroplasty is most commonly used after a fracture or musculoskeletal tumor of the shoulder where the blood supply to the ball portion (the humeral head) of the humerus is damaged. Since then, hemiarthoplasty has been used in many shoulder diseases including osteoarthritis, avascular necrosis, rheumatoid arthritis, cuff-tear arthropathy, and fracture sequele. Methods are authors evaluated 2 patients who had shoulder hemiarthroplasty on October 2017. The first patient is 53-year-old male, surgery due to primary bone tumor right proximal humerus suspected chondrosarcoma and the second is 72-year-old female with closed fracture dislocation of left glenohumeral joint after traffic accident. The patients followed up until 2 years and get routine medical rehabilitation on outpatients’ workup. ROM of shoulder joints which had operated evaluated 2 years post-operative. Results are First patient, active ROM extension is 20o, flexion is 10o, abduction is 30o, adduction is 20o, external rotation is 10o, internal rotation is 40o, while passive ROM extension is 150o, flexion is 30o, abduction is 110o, adduction is 40o, external rotation is 30o while internal rotation is 50o. Second patient, active ROM extension is 60o, flexion is 20o, abduction is 40o, adduction is 40o, external rotation is 20o, internal rotation is 60o, while passive ROM extension is 10o, flexion is 45o, abduction is 160o, adduction is 45o, external rotation is 30o while internal rotation is 80o. Conclusions are Careful and long-term post-operative care including Rehabilitation plays an important role in functional outcomes after Shoulder hemiarthroplasty.