Introduction. Inferior shoulder dislocation is considered a rare event. Although there is a seemingly low chance of occurrence, this condition should not be prematurely ruled out in the presence of acute shoulder pain. Case. A 45 years old woman complained of pain in her left shoulder and was unable to bring her arm lower than 90° after a car accident. The patient unintentionally put her left arm outstretched above her head to avoid head impact during the crash, causing hyperabduction of the shoulder. She experienced pain, numbness and could not move the ipsilateral hand. Her left arm was locked in hyperabduction (100°), and her elbow was extended. Close inspection showed a  loss of left shoulder contour. On palpation, the humeral head was palpable in the axilla. Anteroposterior X-ray view confirmed inferior dislocation of the left shoulder with associated greater tuberosity fracture. A closed reduction under general anesthesia with the traction-counter traction technique was conducted as commonly used in rural settings. After perfect anatomical reduction was obtained and confirmed with X-ray, the patient was immobilized using an arm sling. The shoulder was immobilized for three weeks in adducted position to support soft tissue healing. Physiotherapy was started after three weeks. Conclusion. Inferior shoulder dislocation is a rare orthopedic pathology that should not be easily dismissed in post-traumatic shoulder pain. The mechanism of injury is characterized by downward force or lever mechanism on the hyperabducted arm. Orthopedic surgeons in rural areas could utilize the Traction-countertraction method.

Introduction: The rising prevalence of obesity forces the orthopedist to consider it in fracture risk assessment. Multiple studies have consistently demonstrated that people with obesity have increased bone mineral density (BMD). Although it appears other factors in bone strength may influence the fracture risk, including bone microarchitecture, which recently can be measured by trabecular bone score (TBS). The complex associations between TBS and BMI remain unclear, and some studies show inconsistent findings. This systematic review and meta-analysis aimed to understand whether increased BMI is associated with lower TBS by indirectly pooling all the available evidence from the published literature. Methods: A literature search was carried out using PubMed, Cochrane Library, Google Scholar and other popular journal databases using the terms "trabecular bone score", "body mass index" and the possible synonyms. We extracted the total sample, mean and standard deviation of TBS for patients within each BMI category from the selected literature. A meta-analysis was conducted using a random-effects model and inverse variant methods to synthesize the pooled effect size (mean difference) for each gender subgroup. Results: After an initial search and screening of 2399 studies, seven reports published between 2016-2019 were included (five cross-sectional, one cohort, and one randomized clinical trial). These include 2872 samples which were mostly women (2286). One thousand thirty-one samples were with normal BMI, 1124 samples were with overweight BMI, and 717 samples were with obesity. The included studies varied by age group and gender. The between-study heterogeneity with I2 index ranging 0%-76% studies in man showed higher heterogeneity. Compared with normal individuals, those with overweight and obesity had lower TBS with a mean difference of -0.02 (95% CI -0.03 to -0.01) and -0.07 (95% CI, -0.09 to -0.05), respectively. The differences were consistent across gender, although larger differences were found in men. Conclusion: Individuals with higher BMI have a lower TBS than individuals with normal BMI in a stepwise manner. It suggests that the inclusion of TBS can improve the assessment of fracture risk in obese individuals.

Background: Medical students, as academic people, in the course of his lectures can not be separated from various stresses. Causes of stress can be sourced from academic life, such as demands from lectures, examinations held every two weeks, and OSCE examination at the end of each semester. These demands also include changes in competence and the increasing complexity of lecture materials that increasingly difficult.Aim: This study aims to know the level of the wellness of medical students, so that if there is a lack of dimension, the results can be used as self – reflection to be a better person.Methods: A descriptive observational study with cross-sectional study design was conducted in January 2018. Wellness was measured through seven dimensions, namely emotional, enviromental, intellectual, occupational, physical, social, and spiritual. Respondents in this study were active students as many as 143 students from the number of affordable population of 740 students using stratified random sampling.Results: From 143 study samples, 43 people were male (30.1%) and 100 people were female (69.9%). 141 people had good environmental and social wellness. Meanwhile, 35 people had low physical wellness.Conclusion: The results showed that the wellness dimension of the highest number of categories was enviromental and social wellness (98.6%), then intellectual wellness (96.5%), spiritual wellness (95.1%), occupational wellness (86.7%), emotional wellness (76.9%), and the lowest is physical wellness (75.5%). Latar belakang: Seorang mahasiswa kedokteran dalam proses perkuliahannya tidak terlepas dari berbagai stres. Penyebab stres dapat bersumber dari kehidupan akademiknya, seperti  tuntutan dari tugas kuliah, ujian yang dilaksanakan setiap dua minggu sekali, dan ujian OSCE di setiap akhir semester. Tuntutan ini juga termasuk perubahan kompetensi dan meningkatnya kompleksitas materi perkuliahan yang semakin lama semakin sulit. Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui gambaran tingkat wellness mahasiswa kedokteran, sehingga jika nantinya terdapat dimensi yang kurang, hasil tersebut dapat digunakan sebagai refleksi diri untuk menjadi yang lebih baik.Metode: Penelitian ini menggunakan rancangan penelitian deskriptif potong lintang dan dilakukan pada bulan Januari 2018. Wellness diukur melalui tujuh dimensi, yaitu emotional, enviromental, intellectual, occupational, physical, social, dan spiritual. Responden dalam penelitian ini adalah mahasiswa aktif sebanyak 143 mahasiswa dari jumlah populasi terjangkau 740 mahasiswa dengan menggunakan stratified random sampling. Hasil: Dari 143 sampel penelitian yang termasuk dalam jenis kelamin laki laki sebanyak 43 orang (30,1%) sedangkan untuk jenis kelamin perempuan sebanyak 100 orang (69,9%). 141 orang memiliki environmental dan social wellness baik Sementara 35 orang memiliki physical wellness yang kurang.Kesimpulan: Dari penelitian ini bisa disimpulkan bahwa dimensi wellness dari jumlah kategori baik yang tertinggi adalah enviromental dan social wellness (98,6%), selanjutnya intellectual wellness (96,5%), spiritual wellness (95,1%), occupational wellness (86,7%), emotional wellness (76,9%), dan yang terendah yaitu physical wellness (75,5%).