Introduction: Bone Cement Implantation Syndrome (BCIS) is a lethal condition with complex physiological changes after the insertion of Methyl Methacrylate (MMA) cement during intraoperative arthroplasty. Despite the etiology and the pathophysiology of BCIS has not been fully understood, several mechanisms have been discovered. Some clinical manifestations of BCIS are hypotension, hypoxemia, a decrease of consciousness, arrhythmia, pulmonary hypertension, and cardiac arrest. Presentation of case: A 67 years old woman underwent cemented hemiarthroplasty operation due to intertrochanteric fracture in her right femur. The hemodynamic was stable before and during operation, but suddenly the patient went into cardiac arrest as the cement inserted. Immediate resuscitation was performed successfully and stable hemodynamic was achieved. Discussion: Several risk factors including underlying cardiovascular disease, advanced age, osteoporosis (enlarged porous cavities increase the risk of emboli generation), fracture type, metastatic bone disease, femoral canal diameter of more than 21 mm, previously non-instrumented femoral canal, and patent foramen ovale (paradoxical embolus). Some studies have shown usage of H1 and H2 antagonists, methylprednisolone, inotropes, vasopressor, and some alterations in surgical technique, can prevent the progression of the BCIS. Communication between the orthopaedic surgeon and anesthesiologist and high-quality cardiopulmonary resuscitation (CPR) will become a good basis in treating BCIS. Conclusion: Preoperative optimization by increasing oxygen inspiration concentration, usage of inotropes and vasopressor, and avoiding intravascular volume depletion during operation is essential in cemented arthroplasty procedure. Both orthopaedic surgeon and anesthesiologist should recognize the clinical presentation of BCIS and well-prepared for the management of BCIS including any supportive measures. Highlights:

Bone defect (3 mm in murine model) is a condition when the bone tissue cannot undergo a natural healing process caused by severe trauma, tumor, or irradiation. A bone defect is a challenge even for experienced Orthopaedic surgeons. Stromal vascular fraction (SVF) is a heterogeneous cell population derived from adipose tissue that results from minimal manipulation of the adipose tissue itself. Several studies have elucidated the effect of either SVF on bone defect healing. However, to the author's knowledge, there is no study evaluating the effect of SVF application on fracture healing, which was measured with osteocalcin biomarker. This study aims to evaluate the effect of SVF application on bone defect healing measured with osteocalcin as a biomarker of bone healing. This was an animal study involving twelve Wistar strain Rattus norvegivus. They were divided into three groups: negative group (normal rats), positive group (rats with bone defect and treated without SVF application), and SVF group (rats with bone defect and treated with SVF application). After 30 days, the rats were sacrificed, the osteocalcin biomarkers were evaluated. This biomarker was quantified using ELISA. Osteocalcin biomarker expressions were higher in the group treated with SVF application than those without using SVF. All comparisons of the SVF group and positive control group showed significant differences (p < 0.05). SVF application could aid the healing process in a murine model with bone defect, marked by increased osteocalcin levels.

Introduction: The use of K-wire (Kirschner wire) in acromioclavicular dislocation was the first trans-articular fixation technique to be described. Presentation of case: A 40-years-old man was presented to the emergency room (ER) with shortness of breath. He had a history of acromioclavicular dislocation two years ago, which had been treated using two K-wires and tension band wiring. The plain x-ray revealed left side pneumothorax with K-wire migrated into the left hemithorax. CT scan showed that K-wire migrated into the posterior cavum pleura. A chest tube was then inserted, and the removal of K-wire was performed using thoracoscopic assisted surgery followed by the removal of the remaining K-wire in the left shoulder. Three days post-surgery, the chest tube was removed, and the patient was discharged from the hospital. Discussion: This technique is easy and cheap, but it can cause lethal complications. K-wire can migrate into the area of vital organs, including the liver, heart, neck lung subclavian artery, and aorta. Conclusion: K-Wire should be used cautiously for treating upper extremity injury, especially acromioclavicular dislocation, due to its lethal complications. This method is outdated and should be restricted as much as possible. Highlights:

AIM: The aim of this study is to evaluate the in silico, biocompatibility, and attachment of mesenchymal stem cell (MSC) from stromal vascular fraction (SVF) combined with scaffolds. METHODS: This research is true experimental study. In silico study using HEX version 8.0. Attachment of MSC from SVF to scaffolds was evaluated using electron microscope and measured. Biocompatibility was evaluated using viability and apoptosis of MSC from SVF after combined with MSC with scaffold. RESULTS: From in silico study, the strongest bound to scaffold is between MSC from SVF to hydroxyapatite (HA) in both receptor which was integrin alpha V to HA which need a total energy of −89.24 (J/Mol) and integrin beta 2 to HA which need a total energy of −177.8 (J/Mol). MSC from SVF cells is capable to combine with three types of bone substitution material. At HA-calcium sulfate administration, SVF cells had apoptosis of 30.27%, and viable cells were 69.73%. At the administration of bovine bone cancellous, SVF cells had apoptosis of 22.20% and viable cells of 77.80%. From microscope electron study, the best result of attachment was obtained from MSC to HA-calcium phosphate with an average value of 12.66 cluster cells counting per 100 μm2 scaffold material. CONCLUSION: From in silico study showed that MSC from SVF could attach to scaffold with stronger binding between integrin alpha V and integrin beta 2 to HA scaffold. Bovine bone cancellous has the best biocompatibility and attachment among other scaffold with the highest viability and lowest cell apoptosis. From microscope electron study, we can prove that MSC can make a cluster cell in those scaffolds with HA-calcium sulfate having the biggest cluster cell counting.

BACKGROUND: Amputation is one of the most common surgical procedures in the world. One of the criteria for assessing amputation is the mangled extremity severity score (MESS). The MESS criterion has been used for many years, but the accuracy remains unknown. The aim of this study is to know the accuracy of MESS. METHOD: Keywords of “relevance,” “mangled extremity score,” and “amputation,” and its combination were entered into the PubMed database. Four evaluators reviewed articles from the past 5-year publication date with the English language to select relevant articles. RESULTS: The outcomes of this systematic review are the sensitivity and specificity of several scoring tools to predict amputation and recommendations for MESS use. The author identified 26 relevant articles with MESS to predict amputation, and most of them recommend using MESS. The sensitivity and specificity of MESS were variable from 63–73% to 70–76%. CONCLUSION: The MESS performs better in the amputation prediction of the lower extremity arterial injury. Other scoring recommendations are LogisticReg + Nearmiss, ISS, BN, and GHOIS.

Interprofessional collaboration plays a crucial role in the preparation for elective surgeries to enhance the quality, safety, and efficiency of patient care. However, its implementation continues to encounter substantial obstacles, which require the creation of a customized maturity model to effectively resolve these concerns. The aim of this study was to develop an interprofessional collaboration maturity model that is specifically designed for the context of elective surgery preparation. This qualitative study employed a case study approach, conducted in 2024. This maturity model was developed through four stages: (1) a literature study to identify key interprofessional collaboration indicators in surgery; (2) in-depth interviews with ten healthcare professionals at Universitas Muhammadiyah Malang Hospital, Malang, Indonesia; (3) adaptation of existing maturity models (Fleming, Hudson, collaboration maturity model, and quality management system) as a framework for synthesizing data from the findings of stage 2 (in-depth interviews); and (4) expert panel review to evaluate the maturity model. We successfully developed an interprofessional collaboration maturity model specifically applied to elective surgery preparation, Preoperative Interprofessional Collaboration Maturity Model (P-ICMM), consisting of five maturity levels: emerging, developing, coordinated, integrated, and optimized. Each level’s assessment criteria are based on indicators of interprofessional collaboration. This maturity model has been evaluated by the experts in elective surgery preparation to ensure its validity and applicability. This maturity model is expected to help hospitals identify the level of interprofessional collaboration, design strategies to enhance collaboration, and ultimately improve the quality of healthcare services and patient safety in the preparation for elective surgeries.