free paper hastomo juara 1
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Lipofbromatous Hamartoma with
Macrodactyly o Third Digit Let Handin Soeharso Orthopaedic HospitalSurakarta
A Case Report
Hastomo Agung Tito Sumarwoto
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CASE
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!ase
• Female (student) 14 y.o with macrodactyly of
the third digit left hand since born
• Complained of clumsiness, tingling and her
third digit gradually increased in last 6 months• No history of trauma, no family history
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Local Status "#
rd
digit$! ocali"ed gigantism
#eddish colour at distal partF! $oft mass, mobile,
%enderness (&)
'ipoesthesia () at distal part! #* still normal
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Assesmentacrodactyly of third digit left hand,
suspect associated with +ascular malformation
%lan
lain -&rayC%&$can with contrast
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Assesment &&acrodactyly of third digit left hand, suspect
associated with macrodystrophia lipomatous
%lan
$urgery
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ig&"ag incision, we found yellow and cordli/e mass(16 cm in length, 0 mm in diameter) that
surrounded and enlarged by fibrofatty tissue
2e do the debul/ing procedure
&ntra'Operati(e
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icrophotograph shows fibroadipose tissue around the lession(hematoxylin-eosin,original magnification 100x & 50x)
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%ost'operati(e !are
• 3nalgetic antibiotic intra+enous treatment
(1st day post&op)
• #outine medication e+ery 45 hours, and
remo+ing suture after 14 days post&op
• 3cti+e #* e-ercise after second day post&op
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# Months %ost'op)esults*
– decrease of the mass si"e
– motoric function and range of motion of the thirdfingger was normal
– returned to normal acti+ity 0 wee/s after surgery
–sensoric deficit of third fingger
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DISCUSSION
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Macrodatyly
Green's Operative Han !"rgery, #th e
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Lipofbromatous Hamartoma
• 3 rare, fibrofatty benign tumor comprised of
proliferation of mature adipoctyes, mostly within
peripheral ner+es forming a palpable mass• 170 of cases associated with macrodactyly
• 8!1 female to male ratio, within first three decade
• %hought to be congenital or de+elopmental in origin
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Lipofbromatous Hamartoma
• %he mass is usually slow&growing and may cause
ner+e compression sensory change, pain and
loss of motor function
• 9ifferential diagnosis! +ascular malformations,traumatic neuroma, ganglion cysts and lipomas
• Only rarely is the correct
diagnosis made preoperatively
$merican %o"rnal of Orthopaeics 00
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Histologic +indings:iopsy has been needed as the standard approach
to establish the diagnosis
icrophotograph of the e"l*e lipofiromato"s hamartoma,
sho+s firoaipose tiss"e et+een nerve fascicles
Green's Operative Han !"rgery, #th e
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Treatment
• )elated to macrodactyly debulking(s no treatment "contro(ersial$
• Mostly consider waiting tumorbecome symptomatic or cosmeticproblem
•Debulking
can impro(e unctionaloutcome but sensibility defcit ",$
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!onclussion
• A rare case and preoperati(e diagnosis isdi-cult
• Our treatment is to do debulking
procedurewith consideration* symptomatic masswith cosmetic problem
• )esults* decrease the mass si.e normalmotoric unction and )OM ne(erthelesssensoric defcit according ner(edistribution
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