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All Journal Sehat Rakyat: Jurnal Kesehatan Masyarakat Health & Medical Sciences
Rheza Fabianto Sebastian
QADR Hospital
Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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Autologous Bone Graft Versus Bone Morphogenetic Protein Augmentation for Comminuted Midshaft Femoral Fractures: A Systematic Review Andika Prasetyo Arifin; M Yogi Alamsyah; Arimurti Pratianto; Rheza Fabianto Sebastian
Health & Medical Sciences Vol. 3 No. 4 (2026): August
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/phms.v3i4.677

Abstract

Comminuted midshaft femoral fractures (AO/OTA 32-C2/C3) are complex injuries associated with extensive bone fragmentation, severe soft-tissue damage, and elevated risks of delayed union or nonunion. This systematic review, conducted in accordance with PRISMA guidelines, compared the efficacy and safety of autologous bone grafting (ABG) versus recombinant bone morphogenetic protein (BMP) augmentation as adjuncts to surgical fixation. Comprehensive searches of PubMed, Embase, and Cochrane databases identified twelve comparative studies involving patients treated with internal fixation plus biological enhancement. Primary outcomes included radiographic union rates, time to union, complications, functional recovery, and cost-effectiveness. Risk of bias was assessed using the ROBINS-I tool. Both ABG and BMP achieved high union rates (92% versus 90%), with BMP linked to an approximate two-week reduction in healing time. Substantial heterogeneity across studies, however, precluded definitive conclusions. ABG provided reliable results but was associated with donor-site morbidity in nearly one-fifth of patients. BMP avoided harvest-related complications yet increased risks of heterotopic ossification and soft-tissue edema while incurring significantly higher costs without proven superiority in preventing nonunion or reoperation. In conclusion, both ABG and BMP offer effective biological support for these fractures. Treatment selection should be individualized according to patient characteristics, fracture severity, complication profiles, and resource availability; routine BMP use is not currently justified.
Pure Decompression versus Decompression with Fusion in Degenerative Lumbar Spondylolisthesis: A Meta-Analysis of Long-Term Outcomes Andika Prasetyo Arifin; M. Yogi Alamsyah; Arimurti Pratianto; Rheza Fabianto Sebastian
Sehat Rakyat: Jurnal Kesehatan Masyarakat Vol. 5 No. 3 (2026): Agustus 2026
Publisher : Yayasan Pendidikan Penelitian Pengabdian Algero

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54259/sehatrakyat.v5i3.7406

Abstract

Degenerative lumbar spondylolisthesis is a common spinal problem seen in everyday practice, especially in older adults, and it often presents with ongoing low back pain, neurogenic claudication, and radicular symptoms. Although decompression surgery is generally considered effective for relieving neural compression, whether fusion should be added at the same time is still controversial, particularly when long-term results and resource use are taken into account. This meta-analysis followed PRISMA guidelines. We systematically searched PubMed, the Cochrane Library, and Google Scholar for randomized controlled trials involving adults with degenerative lumbar spondylolisthesis. The main outcomes were functional disability measured by the Oswestry Disability Index (ODI), along with separate assessments of low back pain and leg pain. Data were pooled in Review Manager 5.4 using fixed- or random-effects models as appropriate, and results were reported with 95% confidence intervals. Across the three included trials, the two surgical strategies performed similarly overall. There were no meaningful differences in ODI scores or in reported back and leg pain. Decompression alone was linked to a slightly higher reoperation rate, but the difference was not statistically significant. In contrast, adding fusion led to longer operative times and longer hospital stays, without providing a clear clinical benefit. Taken together, these findings suggest that decompression without fusion may be a simpler, more resource-efficient choice for carefully selected patients with degenerative lumbar spondylolisthesis who do not have instability or major deformity. That said, the evidence is still limited by the small number of trials and relatively short follow-up. Larger, well-designed studies with longer observation are needed to better determine how durable the outcomes are and what the true reoperation risk is.
Co-Authors Andika Prasetyo Arifin Arimurti Pratianto M Yogi Alamsyah M. Yogi Alamsyah