Highlights The first case report of a 27 years follow up congenital insensitivity of pain in Indonesia. Unrecognizing of the clinical pictures in the past, misleads to a late diagnosis and management. Both patients suffered from debilitating consequence of amputation and death of the male patient. Open reduction and internal fixations of metaphyseal fractures may eventually lead to non-union. Diaphyseal fractures more likely result in bony unions with casting immobilization.

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Introduction Spontaneous quadriceps tendon rupture (SQTR) is a rare injury to the knee extensor mechanism that is usually associated with systemic diseases such as end stage renal diseases (ESRD) and it is more prevalent in the elderly. Due to the underlying pathology, quadriceps tendon rupture warrants special considerations and management in its repair. Case report We present two cases of quadriceps tendon rupture in end-stage renal disease (ESRD) patients. The first case; a 57 years old female who had bilateral SQTR and is undergoing hemodialysis. The second patient, a 26 years old male had unilateral quadriceps tendon rupture caused by minimal trauma. The first patient had a trans-osseous repair by direct suturing the quadriceps tendon stump to the proximal pole patella. The second patient was repaired with a modified Bunnel suture and anchor placement on the proximal pole patella. The first case had a re-rupture of the right quadriceps tendon and the second case has recovered with improved outcomes. Discussion Spontaneous quadriceps tendon rupture is usually underlined by degenerative changes of the tendons. Special care is needed to address the pathologic tendon underlying SQTR. The current surgical literature still lacks the statistical data that shows which surgical approach is most optimal for SQTR in ESRD patients. Conclusion SQTR rupture is generally an injury of brittle tendons caused by underlying diseases. A multidisciplinary and comprehensive approach including a proper surgical approach and postoperative managements are crucial for good functional outcomes of the extensor mechanism.

Highlights Medial Uni-compartmental Knee Arthroplasty (MUKA) is a newer minimally invasive procedure that gained recent spotlight. Cheaper, less blood loss, faster hospitalization and less pain and makes it more favorable compared to the conventional TKA (Total Knee Arthroplasty). Fewer studies compared to TKA have been reporting its complication. Meniscal bearing dislocation is one of the most common complication in UKA. We reported simple open reduction technique which is lest costly, effective with satisfying result.

Abstrak Latar belakang: Penelitian ini bertujuan untuk menunjukkan perbedaan rerata nilai rasio Kolagen I (Kol I)/NitricOxide(NO), Kolagen IV (Kol IV)/NO, Tissue Factor (TF)/NO, P-selectin (P-sel) (p = 0,007; p = 0,028; p = 0,049) Hasil: Kejadian TVD positif didapatkan pada 18 pasien (26,1%). Perbedaan rerata kadar antara TVD positif dan TVD negatif ditemukan pada Kol IV sebelum operasi (p = 0,022) dan pada NO 72 jam sesudah operasi (p = 0,014). Perbedaan rerata nilai rasio protrombogenik/ antitrombogenik antara TVD positif dan TVD negatif ditemukan pada rasio Kol IV/NO, TF/NO, dan P-sel/NO pada 72 jam sesudah operasi AbstractBackground: This study was aimed to show differences in the mean values of Collagen I (Col I)/Nitric Oxide (NO), Collagen IV (Col IV)/NO, Tissue Factor (TF)/NO, and P-selectin (P-sel)/NO ratios between patients with DVT and those without DVT, following hip and knee meta-epiphyseal cancellous bone traumatization in major orthopedic surgeries.