Neglected traumatic dislocations of the hip is one of disabling condition in lower extremity which are seldom found in adults. However, in developing countries, neglected-unreduced traumatic dislocations are not uncommon. Total hip replacement (THR) still remains a recommendation for the treatment of neglected hip dislocation which occurs more than 3 months. A 45- years-old female came to the outpatient clinic complaining pain on her right hip with history of trauma 30 years before, but instead of seeking medical treatment, she went to bonesetter instead. On physical examination, there is 5 cm leg length discrepancy, and the patient walked with limping gait. Conventional x-ray confirmed persistent dislocation of the right hip. A soft tissue release procedure and femoral neck osteotomy with skeletal traction was done before, followed by delayed THR two months after. The patient’s functional status was improved, and the HHS score increased from 48 to 87. The patient had no pain or significant complaints, except for a finding of mild residual Trendelenburg gait.

The cervicothoracic junction (CTJ) is defined as the area extending from vertebral segment C7 to T2. Spinal metastases of CTJ are rare, range from 10% to less than 20%. A 47-year-old woman complained sensory and motor disturbance since 3 weeks prior to admission. History of lump on the left breast was confirmed. Neurological deficit was confirmed as ASIA C at the time of diagnosis. MRI finding suggest fracture of T1 vertebral body with kypothic angle 28° that causing anterior compression of spinal cord. The patient underwent decompression and posterior fusion from C4 to T4. A biopsy sample was also collected from the spine and left breast to confirm the diagnosis. Patient evaluation was done during discharge and at certain points of follow-up for improvement on its neurological, pain, and functional status. An MRI evaluation was performed to evaluate spinal stability and fusion. Significant improvements were observed in patient ambulatory and pain status. Cervicothoracic junction fusion procedure is a considerable choice for the management of pathological vertebral fractures with cervicothoracic junction involvement caused by spinal metastases of breast cancer.

Background: It is often difficult to distinguish between the clinical presentation of osteosarcoma and osteomyelitis in the early stages. Histopathological review, requiring planning, delaying early treatment, is the golden standard diagnosis for this disorder. This research aimed to find out if it is possible to use simple laboratory examinations to distinguish these diseases. Early treatment can also be carried out, which can lead to a stronger prognosis.Methods: A medical database of patients with reported osteosarcoma and osteomyelitis was used to collect data. Initial laboratory test results, including erythrocyte sedimentation rate, C-reactive protein, dehydrogenase lactate, alkaline phosphatase, and procalcitonin, were obtained. Statistical analysis was then conducted to determine the most useful laboratory parameter for distinguishing these two diseases. SPSS version 21 for Windows analyzed the results.Results: The results showed that there was a significant difference between osteosarcoma and osteomyelitis patients' age and body mass index (BMI) (p <0.05). Important variations between all test parameters were found, but the lactate dehydrogenase and procalcitonin parameters were considered to be the most sensitive and specific parameters for the distinction between the two diseases (p<0.05). A sensitivity level of 92.5 % and a specificity of 100% with an AUC value of 0.963 (P = 0.05) were shown to have cut points of 840 U/L for LDH and 0.465 ng/mL for PCT.Conclusion: Lactate dehydrogenase and procalcitonin have been shown to distinguish between early-stage osteomyelitis and osteosarcoma, making early treatment possible.  Latar Belakang: Gambaran klinis osteosarkoma dan osteomielitis seringkali sulit dibedakan pada fase-fase awal. Pemeriksaan gold standard untuk kedua penyakit ini adalah dengan pemeriksaan histopatologi, namun pemeriksaan ini memerlukan persiapan yang cukup lama, sedangkan tatalaksana kedua penyakit ini optimal bila dilakukan seawal mungkin. Penelitian ini bertujuan untuk melihat apakah pemeriksaan laboratorium sederhana dapat membedakan kedua penyakit ini, sehingga terapi dapat dilakukan sedini mungkin, dan menghasilkan prognosis sebaik mungkin.Metode: Dilakukan pengambilan data pasien sesuai desain cross sectional analytics, yaitu pasien yang telah terkonfirmasi osteosarkoma dan osteomielitis dari rekam medis. Kemudian dilakukan penelusuran data laboratorium saat awal pasien masuk, yaitu laju endap darah, C-reactive protein, lactate dehydrogenase, alkaline phosphatase, dan prokalsitonin. Kemudian dilakukan analisis statistik untuk menentukan parameter manakah yang paling berperan membedakan kedua penyakit ini. Data dianalisis dengan SPSS versi 21 untuk Windows.Hasil: Hasil penelitian menunjukkan terdapat perbedaan yang bermakna antara usia dan Indeks Masa Tubuh (IMT) pasien kelompok osteosarkoma dengan osteomielitis (p<0,05). Didapatkan perbedaan yang bermakna dari semua parameter yang diuji, namun parameter lactate dehydrogenase dan prokalsitonin dinilai yang paling sensitif dan spesifik dalam membedakan kedua penyakit tersebut (p<0,05). Titik potong 840 U/L untuk LDH dan 0.465 ng/mL untuk PCT terbukti memiliki tingkat sensitivitas sebesar 92.5% dan spesifisitas 100% dengan nilai AUC 0,963 (P=0,05).Kesimpulan: Pemeriksaan kadar lactate dehydrogenase dan prokalsitonin terbukti dapat membedakan osteomielitis dan osteosarkoma pada awal proses penyakitnya, sehingga terapi dapat dilakukan lebih dini.