Buku ini disusun sesuai dengan Standar Kompetensi Dokter Indonesia Edisi Tahun 2012 yang dikeluarkan oleh KKI. Materi dari buku ini merupakan terjemahan dari buku standar/dasar Apley & Solomon’s System of Orthopaedics and Trauma dan buku penunjang lain yang dipergunakan didalam pendidikan sistem muskuloskeletal. Buku ini diterjemahkan karena ujian UKMPPD dilaksanakan dalam bahasa Indonesia baik untuk mahasiswa dari Indonesia maupun dari luar negeri karena mereka harus mengikuti ujian UKMPPD sebagai tanda telah menyelesaikan pendidikan dokter di Fakultas.

Background: Extra pulmonary tuberculosis (TB) accounts for 10% of all TB patients. Involvement of the musculoskeletal system accounts for only 3%, with ankle TB less than 1% of all musculoskeletal TB. In Indonesia the prevalence of TB is 660 within 100,000 persons, and data for extrapulmonary TB and musculoskeletal TB are unknown. Diagnosis of TB infection in a joint is difficult. Untreated ankle TB and diagnostic delay may result in local cartilage destruction, functional disability, and poorer prognosis. Methods: EBSCO, Proquest, Pubmed, ScienceDirect, and Google Scholar were searched using the terms “ankle”, “tuberculosis”, “arthroscopic*”, “debridement” and “open.” English language studies with surgical management of ankle TB by arthroscopy or open debridement that were published between 2004 and 2019 were included. Studies of arthrodesis and multi-drug resistant TB were excluded. Results: After an initial search of 60 studies, 28 were excluded, and 20 were duplicates. Twelve studies (six case-control studies, four case series, and two cohort) were included. In total, 103 patients with a mean age of 43.8 (7 to 90) years were treated for ankle TB with arthroscopy debridement, open debridement, and synovectomy. The mean time to surgery was 10.9 (1 to 80) months, and a mean postoperative treatment of 35.5 (1.5 to 260) months. All patients had a mean treatment time of 10 (4 to 21) months with rifampicin, isoniazid, pyrazinamide, and ethambutol. No patients were lost to follow-up. Conclusions: Early debridement is recommended to improve outcome in managing ankle TB. This review is limited by the lack of high evidence level studies from high-quality randomized controlled trials, lack of control groups, heterogenous outcomes reporting, small sample sizes, and no objective scoring were used to report the outcomes. However, larger sample sizes with long-term follow-up data were not found. Level of Evidence: Level IV.

Introduction and importance Charcot neuroarthropathy (CN) is a degenerative, progressive disease affecting the ankle and foot and it is usually a disabling factor in diabetic patients. Surgical management of CN aims to obtain a painless stable plantigrade foot which can be achieved through fusion. Achieving joint arthrodesis in CN usually carries a high failure rate. Cases presentation We presented two patients with late-stage CN foot deformity. The first case is a 52-year-old female with CN on her left ankle and presented without any infection or prior correction. The second case reported a 47-year-old man with complaints of deformity on his right ankle, he had undergone surgical treatment with an external fixator before, and now presented with infection in the surgical site. Clinical discussion Ankle arthrodesis has been considered by many as the treatment of choice for severe and late-stage CN foot. This treatment aims to give a rigid enough fixation which will maintain the stability of the ankle joint and prevents further destruction of surrounding tissue. Multiple modalities of treatment are available and must be chosen accordingly to each clinical case. Minimal implants and the use of multiple bone grafts could be considered as a plan of treatment. Both patients have promising and positive results from the two procedures. Conclusion Treatment of CN Foot with internal plate fixation combined with fibular strut graft seemed to give promising results, both radiographically and functionally. Furthermore, a slight modification of treatment with a minimal implant or iliac graft may be considered.