Higher rank ligand/osteoprotegerin ratio results in lower callus diameter and osteocalcin expression on the healing of femur fracture between diabetic and nondiabetic rats using intramedullary wire

Background: Diabetes with uncontrolled glucose level offer a significant risk of acute or chronic complications. One of the chronic complications is a decrease in bone mineral density which is regulated by RANKL and OPG balance. Diabetes is estimated to slow the healing process of fracture. Both are related to fracture risk and fracture healing process. Fracture healing is characterized by measurement of callus diameter and osteocalcin expression. Aim: This research aimed to find out the difference in RANKL/OPG ratio, callus diameter and osteocalcin expression on the fracture healing in diabetic and nondiabetic rats. Methods: This is an experimental randomized post-test only with 32 Wistar rats. The population was divided into two groups, the control group did not get treatment and the second group was the diabetes modeling. On the 7th day, both groups were examined for their ratio of RANKL/OPG using ELISA and fracture was performed. On the 28th day, the rats were sacrificed, and the effects were assessed using histopathology examination of callus diameter and immunohistochemistry examination of osteocalcin expression at the fracture area. Result: Higher median ratio of RANKL/OPG in diabetic than nondiabetic rats with p = 0,000 (p <0,05). The diameter of callus on the healing of femur fracture in the nondiabetic group was higher than the diabetic group with p = 0,000 (p <0.005). Osteocalcin levels in nondiabetic group were higher than diabetic group with p = 0,000 (p <0.005). There was a negative correlation between RANKL/OPG ratio with callus diameter and osteocalcin level with a correlation coefficient of -0.701 and -0.652 respectively with p = 0,000 (p <0,05). Conclusions: Level of RANKL/OPG ratio has a negative correlation with callus size and osteocalcin expression on healed femur fractures in diabetic rats model.

Intramedullary epinephrine and surgical hole on femoral cortex before intramedullary K-wire and bone cement insertion resulting in lower amount of PMMA (polymethyl methacrylate) particles on rabbit’s myocardium

Background: Cemented hip arthroplasty can result in devastating complication such as Bone Cement Implantation Syndrome (BCIS). BCIS consists of decreased blood pressure, decreased heart rate, a decrease of consciousness, and sudden death. This devastating condition caused by systemic circulation of polymethyl methacrylate (PMMA). Decrease heart rate caused by  PMMA reaction with the heart muscle. PMMA reach heart muscle due to the increased intramedullary pressure and the opening of the intramedullary blood vessel during cementation. Aim: The purpose of this study is to prove that intramedullary epinephrine and femoral hole before the insertion of bone cement and K-wire result in the lower amount of PMMA in rabbit’s myocardium. Methods This research is conducted as experimental research with post-test only control group design with the subject rabbits. A total of 28 research subjects who met the inclusion criteria of the study were randomly divided into treatment and control groups. The control group did not receive epinephrine and femoral hole treatment. Treatment group 1 received epinephrine intramedullary only, treatment group 2 received femoral hole only, and treatment group 3 received intramedullary epinephrine and femoral hole. Results: Statistical analysis using parametric tests one-way ANOVA found a significant difference between treatment and control groups on the amount of rabbit’s heart muscle. The amount of PMMA particle in all treatment groups are lower than the control group with a p-value of 0.000 (p<0.05). The amount of PMMA particle in treatment group 3 (received epinephrine and femoral hole) is lower than the control group with a p-value of 0.000 (p<0.05). Conclusion: The conclusion of this research is intramedullary epinephrine and femoral hole making before the insertion of bone cement and K-wire result in the lower amount of PMMA particle in rabbit’s myocardium

GREEN TEA EXTRACT RESULTED IN A LOWER VALUE OF IL-6 AND TNF- EXPRESSIONS ON RABBIT MODEL OF ANTERIOR CRUCIATE LIGAMENT (ACL) RUPTURE

Background : Anterior Cruciate Ligament (ACL) rupture often occur at young age. There is still debate about timing of the surgical interventions. Many studies recommended that ACL reconstruction should be done after the third week of injury. Provision of green tea extract on ACL rupture is expected to more rapidly reduce the inflammatory reaction, which is characterized by a lower IL-6 levels and a lower TNF-α expression at the first, second and third week as compared with no administration of green tea extract, so that surgical intervention can be done earlier.

Methods: This research is an experimental randomized post-test only group design with 24 ACL-transected rabbit samples and divided into 6 groups. 3 treatment groups and 3 control groups were further divided into first, second, and third week groups. The treatment group was administered with 300mg/kgBW green tea extract and control group was not administered. IL-6 and TNF-α were examined in each treatment and control group during the first, second and third weeks.

Results: Oneway-ANOVA study showed that serum IL-6 in treatment group was lower as compared to control group at first, second, and third week with p = 0.000 (p <0.05). Kruskal-Wallis study for TNF-α expression in the treatment group was lower than control group at first, second, and third week with p = 0.000 (p <0.05).

Conclussion: Green tea extract resulted in lower IL-6 expression and lower TNF-α level than with those not administered green tea extract.

Keywords: ACL rupture, inflammation, green tea extract, IL-6, TNF- α

Management of traumatic intrusion of permanent teeth with immediate surgical repositioning: A case report from Hasan Sadikin Hospital, Bandung-Indonesia

Introduction: Traumatic dental injuries (TDI) of permanent teeth frequently occur in children and young adults. Intrusive luxation is one of the most severe forms of traumatic injuries in which the affected tooth is forced to displace deeper into the alveolus. As a consequence of this type of injury, maximum damage occurs to the pulp and all the supporting structures. The aim of this study is for proper diagnosis, treatment planning and follow up for improving a favorable outcome.

Case: A 14 years old male patient came to the emergency department of Hospital Dr. Hasan Sadikin with bleeding from mouth due to an accident. Through clinical and radiographic examination discovered there was an intrusion of teeth 11,21. The intruded teeth were immediately repositioned and splinted within hours following injury with Arch Bar. Antibiotic therapy was initiated at the time of repositioning and maintained for five days. The splint was removed one month later. Clinical and radiographic examination one month after the surgical extrusion revealed satisfactory progressive apical and periodontal healing. Intrusion injuries have the poorest prognosis and complex treatment among all tooth injuries. No consensus has been reached on the optimal treatment of this type of injuries. The recommended treatment options for intruded teeth include the following such as allowing spontaneous re-eruption of the teeth, immediate surgical repositioning, and fixation and orthodontic repositioning. The treatment has to be adaptable according to complications.

Conclusion: Further surgical repositioning in the presented case with one month follow up proved to be a viable treatment method for intruded teeth without any additional risk of resorption.