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"This book reviews the biomaterials (metallic, non-metallic and bone allografts) used for orthopaedic applications and explains both the engineering and clinical aspects of their use and performance within the human body."

"ABSTRAKPendahuluan: Pencarian implan berbahan biomaterial yang dapat diserap tubuh dengan baik terus berlanjut. Biomaterial untuk implan orthopaedi biodegradabel harus memenuhi kriteria tertentu, seperti waktu degradasi yang harus parallel dengan lini masa fisiologis penyembuhan tulang normal. Magnesium adalah mikronutrien tubuh alami sekaligus metal biodegradabel yang mempunyai sifat biomekanika menyerupai tulang. Akan tetapi, waktu degradasi metal ini sangatlah singkat dan menghasilkan produk korosi gas H2 serta sifat alkali. Karbonat apatit merupakan apatit biologis yang mempunyai osteokonduktivitas yang baik dan penyembuhan tulang tanpa jaringan fibrotik. Pencampuran magnesium dengan karbonat apatit diharapkan dapat menciptakan material biodegradabel yang dapat dipakai sebagai material dasar implant orthopaedi biodegradabel.Metode: Kami memfabrikasi specimen komposit magnesium dan karbonat apatit dengan kadar yang bervariasi menggunakan metode metalurgi bubuk, milling time bervariasi 3, 5 dan 7 jam pada 200 RPM, kompaksi pada suhu 300°C dan tekanan 265 MPa, sintering pada 550°C, waktu tahan 1 jam, laju panas 5°C/menit, atmosfir ruangan biasa untuk membuat spesimen uji berbentuk silinder dan miniplate. Spesimen tersebut kemudian dilakukan uji biomekanika, biotoksisitas MTT dan kontak langsung, serta korosi.Hasil: Kami dapat memfabrikasi komposit magnesium dan karbonat apatit dengan densitas yang sama dengan tulang manusia. Spesimen komposit magnesium dengan 10% karbonat apatit memiliki biokompatibilitas yang cukup baik. Walaupun, ketahanan tekanan, ketahanan regangan, modulus elastisitas fleksural dan ketahanan korosi spesimen tersebut masih rendah dibandingkan dengan tulang manusia. Paparan terhadap material komposit ini membuat lingkungan sekitar material menjadi bersifat alkali.Diskusi: Konsolidasi antar partikel dan ukuran partikel masih kurang baik karena terbentuknya pori mikrostruktural, yang kemungkinan disebabkan oleh lapisan Mg(OH)2 dan proses oksidasi saat sintering. Hal ini menyebabkan sifat biomekanik yang rendah dan laju korosi yang tinggi. Penggunaan uji berbasis reduksi tetrazolium dapat memberikan hasil false positive, disebabkan sifat produk korosi magnesium yang bersifat reduktan. Kondisi alkali yang disebabkan material ini dapat bermanfaat bagi penyembuhan tulang dan luka. Komposit logam magnesium dan biokeramik karbonat apatit mempunyai potensi yang besar untuk menjadi material dasar implan orthopaedi biodegradabel. Modifikasi teknik fabrikasi perlu dilakukan untuk bisa meningkatkan konsolidasi antar partikel, mengecilkan ukuran partikel, meningkatkan kekuatan biomekanika, mengurangi produk korosi, serta menurunkan laju degradasi.

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ABSTRACTIntroduction. The search for biodegradable orthopaedic implant is on the rally. Biomaterial for orthopaedic implant must fulfill some criteria, especially the degradation rate must be paralleled with normal bone healing timeline. Magnesium is a natural micronutrient as well as biodegradable metal with biomechanical characteristics close to that of bone. However, the degradation rate of this metal is very high and releasing H2 gas by-product as well as alkali environment. Carbonate apatite is a biological apatite which has good osteoconductivity and allow bone healing without fibrotic tissue. Fabrication of magnesium and carbonate apatite composite is expected able to produce a new biodegradable biomaterial that can be used as the base material of biodegradable orthopaedic implant.Methods. We fabricated magnesium composite specimens containing various content of carbonate apatite by powder metallurgy, various milling time (3, 5, 7 hours) at 200 RPM, warm compaction at 300°C and pressure of 265 MPa, sintering at 550°C, holding time of 1 hour, heating rate of 5°C/minutes and room atmosphere cooling. Biomechanical tests, biotoxicity tests (MTT assay and direct contact), and corrosion test were conducted.Results. We were able to fabricate magnesium-carbonate apatite composites with good density that is comparable with human bone. Magnesium composite with 10% content of carbonate apatite had good biocompatibility. Although, its flexural stress, flexural strain, flexural elasticity modulus and corrosion resistance were lower than human bone. Additionally, exposure to this material also turn the surrounding environment into alkali.Discussion: Interparticle consolidation and grain size were dissatisfactory due to microstructural pores that are possibly formed by Mg(OH)2 layer and oxidation process during sintering. These characteristics affect the low biomechanical properties and high corrosion rate. Additionally, the use of tetrazolium-based assay (MTT) may give a false positive result, as the magnesium corrosion products are reducing agent. Meanwhile, alkali condition caused by the material corrosion by-product might be beneficial for bone healing and wound healing process. Magnesium and carbonate apatite composite has enormous potential to be used as the orthopaedic biodegradable material. Modification on fabrication parameters need to be done in order to improve the interparticle consolidation, refining the grain size, improve biomechanical strength, reduce corrosion products, as well as improve the degradation rate."

"With the time available to surgeons-in-training ever dwindling, there is great emphasis placed on practical learning tools. Mirroring his earlier book on practical procedures in trauma surgery, Prof Giannoudis has produced a reference in more elective techniques. In most medical schools, most emphasis is placed on orthopaedic trauma surgery, with elective techniques often delayed until much later in a surgeon?s training."

"This highly illustrated text book will be an essential guide for surgeons in training, providing step by step approaches to performing Joint Aspiration/Injection, Bone Graft Harvesting and Lower Limb Amputations. Practical guidance will be given on Indications- Preoperative assessment, positioning and preparing the patient, approach required, tips and tricks, closure, postoperative complications, protocol of mobilization and follow-up procedure. All the procedures performed will include numerous intraoperative photographs and illustrations."

"Identifikasi mengenai pemilihan Cefazolin sebagai antibiotik profilaksis pasien bedah ortopedi yang diterapkan di RSUD Tarakan Jakarta penting dilakukan untuk mengetahui pemberian antibiotik profilaksis yang telah diterapkan merupakan pilihan yang tepat atau terdapat alternatif antibiotik lain yang lebih baik dibandingkan Cefazolin jika dilihat dari tatalaksana umum yang berlaku. Perbandingan antara penerapan yang telah dilakukan RSUD Tarakan Jakarta dengan tatalaksana yang berlaku dilakukan agar apoteker dapat memahami alur pemberian antibiotik profilaksis yang tepat pada pasien bedah ortopedi. Pengamatan dilakukan secara retrospektif pada salah satu pasien di Gedung A lantai 4 unit OK Sentral lalu dilanjutkan saat pasien telah pindah kembali ke ruang rawat inap di Gedung A lantai 1 unit IGD RSUD Tarakan Jakarta. Kajian ini menggunakan data sekunder berupa daftar pemakaian obat pasien. Hasil pengamatan yang diperoleh diketahui bahwa penggunaan antibiotik profilaksis Cefazolin dari hasil observasi tanggal 22 Juni 2022 di unit OK Sentral RSUD Tarakan Jakarta pada pasien Ny. Y dengan diagnosis fraktur femur merupakan pilihan yang tepat. Hal ini dilihat dari perbandingannya dengan tatalaksana yang tercantum dalam ASHP. Selanjutnya, waktu pemberian antibiotik profilaksis Cefazolin 30-60 menit sebelum operasi dan dosis pemberian antibiotik profilaksis Cefazolin sebesar 2 gram pada pasien bedah ortopedi Ny. Y yaitu di RSUD Tarakan Jakarta telah sesuai dan tidak bertentangan dengan tatalaksana ASHP dimana untuk operasi bedah ortopedi diberikan Cefazolin dosis 2-3 gram untuk pasien dewasa dan waktu pemberian <60 menit sebelum operasi.

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Identification regarding the choice of Cefazolin as a prophylactic antibiotic for orthopedic surgery patients applied at the Tarakan Hospital Jakarta, is important to determine whether the prophylactic antibiotic that has been applied is the right choice or there are other antibiotic alternatives that are better than Cefazolin if seen from the general guideline that applied. A comparison between the implementation carried out by the Tarakan District Hospital in Jakarta and the existing guideline was carried out so that apothecary could understand the appropriate way of administering prophylactic antibiotics to orthopedic surgery patients. Observations were carried out retrospectively on one of the patients in Building A, 4th floor, OK Sentral unit, then continued when the patient had moved back to the inpatient room in Building A, 1st floor, ER unit, Tarakan Hospital Jakarta. This study uses secondary data in the form of a list of patient medication use. The results of the observations obtained revealed that the use of the prophylactic antibiotic Cefazolin from the results of observations on June 22 2022 in the Central OK unit of the Tarakan Regional Hospital, Jakarta in the patient Mrs. Y with a diagnosis of femur fracture is the right choice. This can be seen from the comparison with the management listed in ASHP. Furthermore, the time for giving Cefazolin prophylactic antibiotics is 30-60 minutes before surgery and the dose of Cefazolin prophylactic antibiotics is 2 grams for orthopedic surgery patients, Mrs. Y at Tarakan Regional Hospital Jakarta is appropriate and does not conflict with ASHP guidelines where for orthopedic surgery, a dose of 2-3 grams of Cefazolin is given for adult patients and the administration time is <60 minutes before surgery"