Introduction: Scoliosis is a lateral spinal deformity of 10 degrees or more, resulting in a C-shaped or S-shaped curve of the spine. Information about adolescent idiopathic scoliosis (AIS) prevalence rate is important not only for paediatric health care planning strategy but also for parent's awareness. This study aims to find the suitable inclination cut-off angle and the prevalence rate of AIS in Surabaya, Indonesia. Materials and Methods: This is a descriptive crosssectional study conducted in 2010. We performed stratified random sampling of 784 Elementary and Junior High School students in Surabaya between 9-16 years of age. Scoliosis screening was performed by the Adam's forward bending test (FBT). The students with positive FBT were measured for the inclination angle with scoliometer, and then subjected to radiologic examination. Prevalence rate, gender ratio, and the cut-off point value of inclination angle were determined by a descriptive statistics analysis. Results: Adam's forward bending test was positive in 50 students (6,37%). Among them, 23 students (2,93%) four males and 19 females had Cobb angle of ≥10°. The 5° cutoff point value of inclination angle had a 95.6% sensitivity, an 18.5% specificity, a 50% positive predictive value (PPV), and a 83.33% negative predictive value (NPV); while the 7° cut-off point had a 78.26% sensitivity, a 88.88% specificity, a 85.7% PPV, and a 82.7% NPV. Conclusion: The prevalence rate of AIS in Surabaya is 2.93% and the 7° cut-off point of inclination angle is suitable for school-based screening.
Scoliosis ; Adolescent

Introduction: Osteosynthesis of the femur using an interlocking nail is the gold standard for treating diaphyseal fractures of the femur. There are two established entry points for the antegrade interlocking nails which is the piriformis fossa or the greater trochanter. It has been reported that varus malalignment was frequently seen in proximal femur fracture which were treated with interlocking nail utilizing the greater trochanter entry point. The study was done to find out if the problem was of significance. Materials and Methods: This was a retrospective study which included 179 patients with femur fractures which were treated from January 2013 till September 2015 in one Hospital. They were treated with interlocking nail either by utilizing the piriformis fossa (PF) or the greater trochanter (GT) entry points. Post-operative radiographs of the femur were used to measure the varus deformity. Results: Out of 179 patients, there were 5 patients who were reported to have unacceptable varus malalignment (2.79%). These 5 patients were out of the 88 (5.68%) patients utilizing the greater trochanter as the entry point. The same 5 patients were out 90 patients that were diagnosed with proximal femur shaft fractures (5.55%). Analysis with logistic regression was statistically not significant. Conclusion: There was higher rate of varus malalignment seen in proximal femur shaft fractures treated with interlocking nails utilizing the greater trochanter entry point. The incidence of varus malalignment was not significant statistically. Key Words: interlocking nail; greater trochanter entry point; varus deformity; femur shaft fracture

The authors describe a case of pneumocephalus following epidural anaesthesia for total knee arthroplasty. Multiple attempts in locating the epidural space for the anaesthesia and the use of loss of resistance to air (LORA) technique were identified as the source of air entry. Supportive management was given including high flow oxygenation therapy and spontaneous reabsorption of air was noted five days after surgery. The presence of pneumocephalus should be kept in mind if patient develops neurological complications postoperatively following epidural anaesthesia.
Pneumocephalus ; Anesthesia, Cardiac Procedures

Streptococcus constellatus is an extremely rare cause of pyogenic spondylodiscitis. Literature search yielded only one case report in an elderly 72 years old man with spontaneous T10-T11 S. constellatus spondylodiscitis. It is virtually unheard of in young teenage. We report the case of a 14 years old male teenager who presented with worsening low back pain for one year with no neurological deficit. Imaging studies were consistent with features of L4-L5 spondylodiscitis. CT guided biopsy grew a pure culture of streptococcus constellatus sensitive to penicillin and erythromycin. He showed full recovery with six weeks of intravenous antibiotics. Due to the insidious onset, this case highlight the importance of high clinical suspicion and early diagnosis, with image guided biopsy followed by treatment with appropriate intravenous antibiotics to enable full recovery without further neurological deterioration.

Osteoradionecrosis, a rare complication of radiation therapy, is a slow progression disease which affects the surrounding structures of spinal components. It essentially weakens the soft tissue and bony configuration and can cause nerve impingement or cord compression. We describe a patient who underwent radiotherapy for thyroid cancer and presented with cervical kyphosis with anterolisthesis of C3/C4 and C4/C5 some 32 years later. We explore the role of anterior and posterior fusion, as well as hyperbaric oxygen therapy in promoting healing.
Osteoradionecrosis

Surgical management of scoliosis in Neurofibromatosis type I may be challenging at times especially when dealing with dystrophic curves. We highlight the importance of meticulous study of the radiological imaging and careful pre-operative planning in a patient with dystrophic scoliosis. Key Words: neurofibromatosis scoliosis; dystrophic curve; rib-head excision

The brachial artery is rarely injured in closed posterior dislocation of the elbow, unlike the high rate of vascular injury seen after dislocation of the knee. Despite the anatomical proximity of the brachial artery to the elbow joint, most cases of brachial artery injury after dislocation of the elbow are related to an associated fracture, an open injury or high-energy trauma. A high index of suspicion should be maintained as well as a thorough neurovascular examination with regards this potentially disastrous complication. We describe an unusual case of complete thrombosis of the brachial artery presenting with a posterior elbow dislocation following a fall (low energy trauma) that was treated nonoperatively. At three months follow-up, patient had good circulation over the affected limb, no complaints of ischemic pain or cold intolerance, no signs of Volkmann's ischemic contracture, and a range of motion that was comparable to the contralateral limb.

The PROSTALAC (PROSThesis Antibiotic Loaded Acrylic Cement) functional spacer is made with antibiotic-loaded acrylic cement. We use it as an interim spacer in two-stage exchange arthroplasty in cases of infected total knee or total hip replacement. PROSTALAC allows continuous rehabilitation between stages as it maintains good alignment and stability of the joint with a reasonable range of movement. It also helps to maintain the soft-tissue planes, thereby facilitating the second-stage procedure. We report here early outcomes of the use of PROSTALAC in 5 patients - 3 in total knee replacements, 1 in a total hip replacement and 1 in a bipolar hemiarthroplasty.

This study was undertaken to investigate the outcome of traumatic intracapsular neck of femur fractures treated with total hip arthroplasty (THA). Patients aged ? 60 years who underwent THA for traumatic intracapsular neck of femur fractures from January 2005 to March 2009 were included in the study. Telephone or personal interviews were conducted. There were 49 patients identified within the study period. The mean age was 74.12 years. Most patients were females (81.6%), with a male: female ratio of 1: 4.4. In total, 29 patients were available for outcome scoring. The one-month mortality rate was 4.1%, and the one-year mortality rate was 20.5%. Of the 29 patients 82.8% obtained a Zukerman Functional Outcome Score of good (80 ?100) and 13.8% obtained a score of fair (60 ?80). THA for the treatment of traumatic neck of femur fractures in elderly is a good option with 96.6% of patients obtaining a satisfactory functional outcome, with acceptable morbidity and mortality statistics.

Phantom limb pain may reduce ambulation and mobility in amputees, resulting in diminished quality of life. We conducted a prospective study to compare the perioperative analgesic use of intravenous morphine infusion in 27 patients (Group A) and intramuscular diclofenac sodium in 28 patients (Group B) in patients undergoing lower limb amputation. All patients underwent amputation under spinal anaesthesia and reported a Modified Verbal Numerical Pain Score of less than two prior to the procedure. Presence of phantom pain was assessed on the first, second, third and seventh day as well as at the third month and sixth month post-operatively. Twelve (44 %) patients from group A and 21 patients (75 %) from group B developed phantom limb pain following amputation, a statistically significant difference between groups (p<0.05). We conclude that intravenous morphine infusion is more effective than intramuscular diclofenac sodium in preventing the occurrence of phantom limb pain following amputation.