AIM: The frequency, incidence, and types of fracture of the elbow are different between children and adult. The epidemiology of elbow fracture in children has been the subject of a limited number of studies. This study aims to observe the pattern of elbow fractures in children 18 years of age and younger, during a nine years period. METHODS: This is a retrospective study about elbow fracture cases in children 18 years old and younger treated in Saiful Anwar General Hospital Malang in the period of June 2009 until December 2018. The data obtained from the medical record include the age at the time of accidents, fracture site, type of lesion and ipsilateral injuries, time of accidents, and the mechanism of injury. RESULTS: There is a total of 99 elbow fracture, and there are 62 male (63%) and 37 female patients (37%). The mean age for the entire group is 7.3 years (8.1 years for male and 7.1 years for female). Most cases are supracondylar fracture (n=77, 78%). The supracondylar fracture is composed of 17 fracture classified to type II, and 60 fracture to type III as classified by Gartland. The most common etiology of fracture is associated with sports, recreational activities, and fall from height of less than two meters. Nerve injury involving the median, radial, and ulnar nerve is seen in eight patients with type III supracondylar fracture. Associated brachial artery injury is seen in four patients with type III supracondylar fractures. 78 patients (79%) were treated surgically and 21 patients (21%) were treated conservatively. CONCLUSION: The incidence of elbow fracture in children treated in Saiful Anwar General Hospital during a nine years period is 99 patients, with supracondylar fracture Gartland type III being the leading type of this group. Male patients are more common than female patients. Nerve injury was seen in 13.33% of cases and brachial artery injury was seen 6.67% with type III supracondylar fracture. Most of the elbow fracture in our institution were treated operatively.

Background: Achilles tendinopathy is common in diabetes mellitus and makes the tendon susceptible to rupture. Achilles tendon rupture healing is impaired in diabetics. Stromal vascular fraction can be an alternative treatment for Achilles tendon rupture in diabetic tendinopathy. Methods: Eighteen rats were used in this experimental study and divided into three groups: group 1, normoglycemia; group 2, diabetes mellitus; and group 3, diabetes mellitus injected with stromal vascular fraction. After 2 wk, we evaluated the fibroblasts, capillaries, and collagen. Results: The number of fibroblasts and capillaries and the amount of collagen were increased significantly in group 3 compared to group 1 and group 2 (P<0.05). Conclusions: Stromal vascular fraction increased the number of fibroblasts, angiogenesis, and the amount of collagen. Thus, stromal vascular fraction improved healing of Achilles tendon ruptures in rats with diabetic tendinopathy.

The syndesmosis is one of important stabilizer of the ankle joint and consists of a complex ligamentous structure: the anterior inferior tibiofibular ligament; the interosseous ligament; the posterior inferior tibiofibular and the transverse ligaments. The posterior syndesmosis plays the most important role providing 40–45% of the resistance to diastasis, while the AITFL provides around 35%. Major injuries of two of the syndesmosis components represent a loss of more than 50% of resistance to diastasis and may result in instability. Syndesmosis injury or a high ankle sprain, is a frequent athletic trauma accounting for 1% to 18% of all ankle sprains, 17 to 84% of all sport injuries, and 10% of all ankle fractures. Most of the mechanism injury is external rotation injury. A radiographic study suggested that about 20.3% of ankle sprains were combined with a syndesmosis injury. Without proper treatment, the chronic syndesmosis injury remains symptomatic for more than 6 months after the initial trauma, with persistent pain, functional disability, and early-stage ankle arthritis. Normally, syndesmosis widens 1 mm during normal gait. Widening of syndesmosis more than 1 mm can reduce tibiotalar contact surface about 42%. The degenerative changes can occur if the lateral talar shift more than 2 mm. Clinical tests for syndesmosis injuries are external rotation stress test, Cotton test, dorsiflexion-compression test, squeeze test, crossed-leg test, fibular translation and AITFL palpation. Standard radiographs are part of ankle trauma evaluation, especially for fracture exclusion, applying the Ottawa criteria. Computerized tomography (CT) scan is a useful tool to assess tibiofibular diastasis, fibular rotation and joint asymmetry, but shows low sensitivity. MRI is showing very high sensitivity and specificity in identification of syndesmotic injuries. For stable lesion can be treated with conservative means, including non weight bearing or protected weight bearing with a cast or walking boot and a rehabilitation protocol. An unstable lesion requires a surgical procedure to avoid long-term disability and chronic instability. Ankle arthroscopy remains essential for diagnosis and treatment. With accessory tools that measure the syndesmosis gap (e.g. 3.5 mm shaver canula or a metallic tools). Passage of a 3 mm spherical probe during external rotation indicates very high likelihood of rupture of both the AITFL and the IOL. Also, concomitant intra-articular pathologies (osteochondral lesions, other ligamentous rupture or loose bodies) can be presented, with 19% needs to be addressed, reinforcing the role of arthroscopy not only for diagnosis but also for treatment. It is also an excellent tool to evaluate anatomic reduction and residual diastasis.

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Background: Arthroscopic surgery has been one of the fastest-growing surgical treatments of choice in orthopedics in the last decade. Ankle arthroscopy is an established treatment of choice for most ankle pathologies. It has generally been performed with the use of anterior portals with the patient in the supine position. Only a few articles have been published on ankle arthroscopy performed using posterior portals, particularly with the patient in the prone position. Various arthroscopy techniques have been successfully applied to the treatment of various ankle pathologies, including equinus ankle contracture.Case presentation: A 34-year-old female patient presented with an equinus gait 2 years prior to the consultation. This occurred after open reduction with internal fixation (ORIF) of her left proximal tibia fracture. After the surgery, the patient had chronic osteomyelitis complications and deep peroneal palsy (drop foot). The patient had four previous surgeries of debridement of the tibia until the infection healed. As the deep peroneal palsy was left untreated, the patient developed an equinus ankle contracture. Achilles tendon lengthening with triple hemisection was planned with combined posterior and anterior ankle arthroscopic arthrodesis procedure. This included the release of the tibiotalar and subtalar capsule, along with arthrodesis of the ankle with 2 cannulated screws.Conclusion: Triple hemisection Achilles tendon lengthening with combined posterior and anterior ankle arthroscopy arthrodesis is an effective treatment modality in equinus ankle contracture cases. Arthroscopy is beneficial as it minimally invasive, with less surgical duration time and is associated with faster recovery and less postoperative infections.Â