BACKGROUND: In the global pandemic of the 2019 coronavirus disease (COVID-19), many countries have reported a decrease in visits to hospitals, and health-care systems around the world are reshaping health protocols. Health service and education in orthopedics are also affected although not at the frontline in dealing COVID-19. METHODS: The data from this study collected from several official databases, including the Indonesian Ministry of Health, Central Java provincial government, general hospital, and orthopedic surgery cases. RESULTS: Pandemic COVID-19 started in March 2020 in Indonesia. Surakarta has become one of the epicenters. Health services in the orthopedic department also experienced a decrease cases on all divisions (outpatient clinics, emergency rooms, and inpatients). Mann–Whitney non-parametric comparative test showed significance result in p value operation of orthopedic cases and inpatients (p = 0.016 and p = 0.016; p < 0.05), meanwhile, outpatient visits did not show significance result with p = 0.0509 (p > 0.05). The decrease in the number of cases being treated in the orthopedic service also has an impact on education and training programs. The digital era is one of the choices in the field of education. However, digital resources cannot substitute for direct patient exposure. CONCLUSION: The average number of orthopedic patients during the pandemic period from January to December 2020 decreased compared to visits in the same period in 2019 so that orthopedic services at tertiary and academic referral hospitals experienced a significant decrease in cases. The education and services department must adapt to the policy on educational activities for residents and medical students. The education department and hospital institutions restructured and reorganized resident doctors to continue providing services. The digital era is an option that supports the education process during a pandemic.

Introduction: Osteoarthritis is a chronic degenerative disease characterized by pain and joint cartilage damage. Osteoarthritis is a disease that disrupts the homeostasis of cartilage metabolism so that it damages the proteoglycan structure in cartilage caused by age, excessive joint wear, anatomic defects, mechanical or chemical stress, obesity, genetics and humoral. Osteoarthritis generally occurs in the knees, feet, shoulders, hands, spine, and hips. Certain work conditions that require more strenuous physical movements such as lifting heavy weights and going up and down stairs are a risk factor for osteoarthritis. The purpose of this study was to determine the relationship between work history and the degree of osteoarthritis in women aged over 65 years. Methods: This is an analytical observational research with cross sectional study design. The Subject in this research is medical record patient RSUD DR MOEWARDI SURAKARTA Hospital who have met the criteria. Sampling was done using simple random sampling technique. Data was collected and then analyzed using Spearman correlation test. Results: The analysis result from 46 samples using Spearman correlation test obtained a p value of less than 0.05 indicating that there is a significant relationship between work history and the degree of osteoarthritis in women aged over 65 years. Conclusion: There is a significant relationship between work history and the degree of osteoarthritis in women aged over 65 years. Keywords: Osteoarthritis; Occupational History; Degree of OA

Aneurysma bone cyst (ABC) is a rare case, rapidly growing, and destructive benign bone tumor that rarely involves the bones of the hand. Pathogenesis of these tumors remains controversial and may be vascular, traumatic, or genetic disorders.  This study aimed to evaluate patient’s out come after steroid injection. A male child presented with a history of pain and local swelling over his fifth metacarpal right hand of two months duration with hemofilia condition. Physical and radiographic examination of the hand was consistent with aneurysmal bone cyst. The patient the VIII factor 2 hours before doing steroid injection on his lump over fifth metacarpal right hand. A month evaluation after injection for this patient, we had a good result clinically and radiologically. Radiological evaluation obtained appearance of cortex thickening on the bone affected. We concluded that steroid injection should be considered as one of ABC’s treatment with hemophilia, but the outcome still needed more evaluation.  Keywords: Aneurysmal Bone Cyst, Hemophilia, Steroid Injection ABSTRAK Kista tulang aneurisma adalah kasus yang jarang terjadi, tumbuh dengan cepat, dan tumor tulang jinak destruktif yang jarang melibatkan tulang-tulang tangan. Patogenesis tumor ini masih kontroversial dan mungkin bersifat kelainan vaskular, traumatis, atau genetik. Penelitian ini bertujuan untuk mengevaluasi pasien setelah injeksi steroid. Seorang anak laki-laki dengan riwayat nyeri dan pembengkakan lokal pada metacarpal kelima tangan kanannya selama dua bulan dengan kondisi hemofilia. Pemeriksaan fisik dan radiografi tangan menegakkan adanya kista tulang aneurisma. Pasien diberi faktor VIII 2 jam sebelum injeksi steroid pada benjolan di atas metacarpal kelima tangan kanannya. Evaluasi sebulan setelah injeksi untuk pasien ini, kami memiliki hasil yang baik secara klinis dan radiologis. Evaluasi radiologis diperoleh penampilan penebalan korteks pada tulang yang terkena. Kami menyimpulkan bahwa injeksi steroid harus dipertimbangkan sebagai salah satu pengobatan kista tulang aneurisma dengan hemofilia, namun hasilnya masih perlu evaluasi lebih lanjut.Kata kunci: Kista Tulang Aneurisma, Hemofilia, Injeksi steroid

Introduction: An aneurysmal bone cyst (ABC) is benign but has a progressive nature that can cause severe problems if it occurs close to joints such as the knee. The ultimate goal of treatment is to remove the tumor, maintain limb function, and prevent a recurrence. Local therapy is still better than tumor resection. This study aims to describe a rare case about distal femur ABC treated with two stages of surgery in the pandemic COVID-19 by excision-skeletal traction and endoprosthesis replacement. Case description: A 31-year-old woman presented with a lump on the right knee. The patient has complained of limping. Open biopsy was performed, and the patient was confirmed to have ABC on the distal of her right femur. The patient had a leg length discrepancy of 8 cm. We decided to do skeletal traction first. One week after the skeletal traction, the patient undergoes endoprosthesis replacement. Conclusion: The management of wide excision of the tumor requires special postoperative attention. This is because aggressive measures can reduce the recurrence rate of tumors, but large reconstructions are also needed to maintain joint function.

Background:Knee osteoarthritis (OA), known as degenerative joint disease, is typically the result of wear and tear and progressive loss of articular cartilage, most common in elderly women and men. Knee OA is a leading cause of disability and increase with an aging and overweight population. Total Knee Arthroplasty (TKA) is a common surgical treatment of OA knee that highly cost-effective procedure. Stable placement of components is difficult and thus it presents technical challenges for the surgeon but various options are available for managing these defects. Case Report: A 58 years-old housewife came to our clinic due to chronic left knee pain with associated instability since two years ago and getting worse in last three months. She already had knee joint supplementation injections and physical therapy but no improvements. Based on our clinical and radiological findings, our assessment was secondary left knee osteoarthritis with medial instability and tibial defect due to chronic abscess. Patient underwent TKA to correct this condition. A revised implant was used to close the defect in the medial part of the tibia and soft tissue reconstruction procedure was used to correct the instability.Result: On the first postoperative month, the patient underwent rehabilitation and physical therapy to strengthen her lower limb muscles. On the second month, she started to walk using walking assisted device. On the ninth months follow-up, the patient was able to walk normally without assisted device, the pain disappeared and the symptoms of knee instability were reduced. Conclusion:Bone defects are commonly encountered during TKA, which still has no standard treatment to cure. In this case, the use of metal augmentation with revision implant give satisfactory results with good clinical outcome.