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All Journal E-Jurnal Medika Udayana Tadulako Law Review ISM (Intisari Sains Medis) : Jurnal Kedokteran Indonesian Journal of Global Health research The Hip and Knee Journal
I Wayan Subawa
Departemen Orthopaedi Dan Traumatologi, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Education Health Professions Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Public Health

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EVALUASI STATUS STRUKTURAL, STATUS FUNGSIONAL, DAN KOMPLIKASI PASCA INTERVENSI FRAKTUR ANKLE BIMALLEOLAR: A SYSTEMATIC REVIEW Indraswari, Made Ratna Savitri; Subawa, I Wayan; Wiguna, I Gusti Lanang Ngurah Agung Artha; Dusak, I Wayan Suryanto
E-Jurnal Medika Udayana Vol 11 No 4 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i04.P05

Abstract

Fraktur ankle bimalleolar merupakan jenis fraktur yang menyebabkan ketidakstabilan pada struktur anatomis sendi ankleatau sendi talokrural. Fraktur ini berpotensi menimbulkan gejala sisa pada pasien sehingga diperlukan manajemen intervensi adekuat untuk mengembalikan kondisi struktur maupun fungsi optimal. Systematic review ini bertujuan untuk mengetahui hasil evaluasi status struktural, status fungsional, dan komplikasi pasca intervensi fraktur ankle bimalleolar. Protokol PRISMA digunakan untuk menentukan langkah sistematis dan kriteria eligibility (kelayakan) sebagai pedoman menyeleksi artikelpenelitian. Rentangan tahun publikasi artikel penelitian adalah 2015-2020. Penilaian kualitas dan risiko bias dilakukan dengan kriteria OCEBM dan Cochrane. Sejumlah 7 artikel penelitian dari 249 artikel yang berpotensi diinklusi. Total subjek 496 (14-91 tahun) melaporkan hasil evaluasi intervensi operatif dan 1 studi melakukan perbandingan konservatif. Sebanyak 99,6% (n=494) subjek mencapai union, sedangkan non-union ditemukan pada 2 subjek dengan tindakan konservatif. Instabilitas struktural ditemukan pada 6 subjek dengan medial clear space > 4mm. Status fungsional dengan AOFAS, OMA, dan Biard and Jackson didapatkan 98,9% pada rentang sedang-baik, 5 subjek melaporkan skor buruk, dan tidak ada subjek melaporkan restriksi fungsional. Untuk komplikasi, kondisi yang ditemukan paling umum yaitu nyeri sedang 43,1%, osteoarhtitis ankle grade 1, serta infeksi superfisial dan dalam yang sembuh dengan intervensi antibiotik. Capaian status struktural union sangat tinggi (99,6%), namun 2 subjek mengalami non-union pada kelompok intervensi konservatif. Status fungsional pasien tercapai pada kategori sedang-sangat baik (98,9%) dan tanpa adanya restriksi fungsional meskipun terdapat 5 subjek dengan skor buruk. Komplikasi yang muncul pada pasien umumnya adalah nyeri sedang (43,1%), osteoarthritis ankle grade 1, serta infeksi superfisial dan dalam. Kata kunci : evaluasi pasca intervensi, fraktur ankle bimalleolar
PROFIL PENDERITA CHARCOT FOOT DENGAN DIABETES MELITUS DI POLI ORTHOPEDI RSUP PROF. DR. I.G.N.G NGOERAH TAHUN 2020-2021 Sitranata, Madeline Juliand; Subawa, I Wayan; Wiratnaya, Gede Eka; Suyasa, I Ketut
E-Jurnal Medika Udayana Vol 12 No 7 (2023): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2023.V12.i07.P18

Abstract

Latar belakang: Charcot foot merupakan proses inflamasi yang mengenai bagian sendi, tulang, dan jaringan lunak lainnya dan termasuk salah satu komplikasi dari diabetes melitus. Data profil penderita charcot foot dengan diabetes melitus masih belum ada hingga saat ini di Bali, termasuk di poli orthopedi RSUP Prof. Dr. I.G.N.G Ngoerah. Tujuan: Mengetahui distribusi profil penderita charcot foot dengan diabetes melitus di poli orthopedi RSUP Prof. Dr. I.G.N.G Ngoerah selama periode 2020-2021. Metode: Penelitian ini menggunakan metode deskriptif potong lintang dengan memakai data rekam medis penderita charcot foot dengan diabetes melitus di poli orthopedi RSUP Prof. Dr. I.G.N.G Ngoerah tahun 2020-2021 dengan sampel sebanyak 14 orang. Hasil penelitian: Didapatkan bahwa penderita charcot foot dengan diabetes melitus didominasi pada kelompok usia 40-44 tahun 28,6% dan berjenis kelamin perempuan 64,3% dengan status nutrisi obesitas 57,1%. Seluruh kasus menderita diabetes melitus tipe 2 dan kadar HbA1c ?6,5% sebanyak 78,6%. Kesimpulan: Profil penderita charcot foot dengan diabetes melitus di poli orthopedi RSUP Prof. Dr. I.G.N.G Ngoerah didominasi dari kelompok usia 40-44 tahun dan berjenis kelamin perempuan yang dimana seluruh kasus menderita diabetes melitus tipe 2 dengan status nutrisi obesitas dan kategori kadar HbA1c nya ?6,5%. Kata kunci : Profil, Charcot Foot, Diabetes Melitus
HUBUNGAN USIA, JENIS KELAMIN, DAN PEKERJAAN TERHADAP DERAJAT KEPARAHAN PENDERITA OSTEOARTRITIS LUTUT BERDASARKAN KELLGREN-LAWRENCE DI RSUP SANGLAH DENPASAR Dhaifullah, M Rifqi; Meregawa, Putu Feryawan; Aryana, I Gusti Ngurah Wien; Subawa, I Wayan
E-Jurnal Medika Udayana Vol 12 No 1 (2023): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2023.V12.i01.P18

Abstract

Latar Belakang: Osteoartritis (OA) lutut merupakan penyakit pada sendi lutut yang paling umum terjadi. OA lutut umumnya terjadi pada lanjut usia, wanita, dan seseorang dengan pekerjaan berat yang derajat keparahannya dapat dinilai berdasarkan klasifikasi Kellgren-Lawrence. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara usia, jenis kelamin, dan pekerjaan terhadap derajat keparahan OA lutut berdasarkan kriteria Kellgren-Lawrence di Rumah Sakit Umum Pusat (RSUP) Sanglah Denpasar. Metode: Penelitian ini menggunakan metode potong-lintang analitik. Data penelitian merupakan data sekunder pasien OA lutut yang terdaftar dalam rekam medis RSUP Sanglah kota Denpasar periode Januari 2019 – Desember 2020 dan sudah menjalani pemeriksaan radiografi. Pengambilan data dilakukan dengan teknik consecutive sampling dan didapatkan 52 data yang memenuhi kriteria penelitian. Analisa data dilakukan dengan menggunakan SPSS versi 23. Hasil: Ditemukan hubungan positif yang cukup antara pekerjaan dengan derajat Kellgren-Lawrence (p = 0,001; r = 0,417). Ditemukan juga hubungan negatif yang lemah antara usia dengan derajat Kellgren-Lawrence (p = 0,040; r = -0,260). Namun, tidak ditemukan adanya hubungan antara jenis kelamin dengan derajat Kellgren-Lawrenece (p = 0,951). Simpulan: Pekerjaan memiliki hubungan yang lebih kuat terhadap derajat keparahan penderita OA lutut berdasarkan Kellgren-Lawrence di RSUP Sanglah Denpasar dibandingkan dengan usia dan jenis kelamin. Kata kunci : Jenis kelamin, Kellgren-Lawrence, osteoartritis lutut, pekerjaan, usia
Hubungan Usia, Jenis Operasi, dan Waktu Operasi dengan Outcome Pasca Operasi Fraktur Tibia Terbuka Derajat III di RSUP Sanglah Denpasar pada Tahun 2018-2020 Kesumaputri, Komang Diah Kurnia; Subawa, I Wayan; Dewi, Kadek Ayu Candra; Meregawa, Putu Feryawan
E-Jurnal Medika Udayana Vol 12 No 10 (2023): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2023.V12.i10.P16

Abstract

Open tibial fracture is one of the most common lower extremity fractures in the world, especially in Denpasar City. Clinically, open tibial fracture grade III has higher risk of worse outcome, such as infection and bone healing complication than grades I and II, thus it should be evaluated further regarding risk factors affecting that occurrence. This research aims to know the relationship between several risk factors, those are age, surgery type, and time to surgery with postoperative outcomes in open tibial fractures grade III in terms of clinical, radiological, and functional based on Johner-Wruhs criteria. This research used cross-sectional method and used patients with open tibial fracture grade III who underwent surgery at RSUP Sanglah Denpasar in 2018-2020. Based on the data collection, there were 31 patients fulfilled the inclusion and exclusion criteria. The data collected were characteristics and postoperative outcome assessed using Johner-Wruhs criteria which consisted of 4 categories. From Kendall Tau correlation test, there was no significant relationship between age and outcome (p=0,215) and a significant relationship between time to surgery and outcome (p=0,021). Moreover, the results of Fisher’s Exact Test did not find significant relationship between surgery type and outcome (p=0,720). Based on the results, it can be concluded that time to surgery (debridement) has significant effect on postoperative outcome compared to age and surgery type. Time to debridement also has unidirectional relationship with outcome, which means the longer time to debridement, the worse outcome experienced by the patient. Keywords : open tibial fracture, surgery type, outcome, age, time to surgery
Hubungan Usia, Jenis Operasi, dan Waktu Operasi dengan Outcome Pasca Operasi Fraktur Tibia Terbuka Derajat III di RSUP Sanglah Denpasar pada Tahun 2018-2020 Kesumaputri, Komang Diah Kurnia; Subawa, I Wayan; Dewi, Kadek Ayu Candra; Meregawa, Putu Feryawan
E-Jurnal Medika Udayana Vol 11 No 10 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i10.P17

Abstract

Open tibial fracture is one of the most common lower extremity fractures in the world, especially in Denpasar City. Clinically, grade III open tibial fracture has higher risk of worse outcome, such as infection and bone healing complication than grade I and II, thus it should be evaluated further regarding risk factors affecting that occurrence. This research aims to know the relationship between several risk factors, those are age, surgery type, and time to surgery with postoperative outcomes in grade III open tibial fractures in terms of clinical, radiological, and functional based on Johner-Wruhs criteria. This research used cross-sectional method and used patients with grade III open tibial fracture who underwent surgery at Sanglah Denpasar General Hospital in 2018-2020. Based on the data collection, there were 31 patients fulfilled the inclusion and exclusion criteria. The data collected were characteristics and postoperative outcome assessed using Johner-Wruhs criteria which consisted of 4 categories. From Kendall Tau correlation test, there was no significant relationship between age and outcome (p=0,215) and a significant relationship between time to surgery and outcome (p=0,021). Moreover, the results of Fisher’s Exact Test did not find significant relationship between surgery type and outcome (p=0,720). Based on the results, it can be concluded that time to surgery (debridement) has significant effect on postoperative outcome compared to age and surgery type. Time to debridement also has unidirectional relationship with outcome, which means the longer time to debridement, the worse outcome experienced by the patient. Keywords: open tibial fracture, surgery type, outcome, age, time to surgery
Comparison of Mortality Rate Between Bipolar Hemiarthroplasty and Proximal Femoral Nail Anti-rotation for Intertrochanteric Fractures in Sanglah Hospital, Bali Dusak, I Wayan Suryanto; Aryana, I Gusti Ngurah Wien; Dharmayuda, Cokorda Gde Oka; Subawa, I Wayan; Nugraha, Hans Kristian; Susila, Made Arya; Mahadhana, Sri
The Hip and Knee Journal Vol 1, No 1 (2020): August
Publisher : Indonesian Hip and Knee Society (IHKS)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (844.577 KB) | DOI: 10.46355/hipknee.v1i1.25

Abstract

Introduction: Intertrochanteric fractures occur in about 50% of all hip fracture events, with a mortality rate within 1 year after fracture reaching 15 to 20%. The most common treatment nowadays is either the bipolar hemiarthroplasty procedure or proximal femoral nail anti-rotation (PFNA), although there is still no consensus regarding which is better from the two, especially on patient mortality.Method: This study was an observational study using a retrospective cohort design. A total of 102 study subjects who met the inclusion requirements were grouped into 2 groups, one with bipolar hemiarthroplasty fixation treatment and another with PFNA fixation treatment. Mortality rate was recorded by survey 2 years after surgery.Results: Chi-square test showed that 2-year mortality rate after intertrochanteric fracture treated with bipolar hemiarthroplasty (21.4%) was significantly higher than the PFNA group (10.3%) (p = 0.028). Bipolar hemiarthroplasty group also had longer length of stay (50%) than the PFNA group (32.4%), albeit statistically insignificant (p = 0.13). There was no significant difference between the 2-year mortality rate and length of stay (p = 0.976).Conclusion: Patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty have significantly higher 2- year mortality rate than similar patients underwent fixation with PFNA, while they did not experience higher length of stay than the PFNA group. Future prospective, multi center study with larger sample size will be likely to validate similar fixation choice needed to decrease the mortality rate in intertrochanteric fractures.
Combination of Zadek Osteotomy and Achilles Tendon Re-Attachment in Severe Haglund Deformity: A Case Report Kusuman, Kevin; Subawa, I Wayan; Ismail, Mohamad Dimas
Indonesian Journal of Global Health Research Vol 7 No 2 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i2.5679

Abstract

Haglund deformity refers to a bony exostosis on the posterosuperior aspect of the calcaneus, often causing retrocalcaneal bursitis and Achilles tendinopathy. Conservative treatments, including physiotherapy and medication, may not relieve symptoms in severe cases. Surgical intervention is indicated when non-operative treatments fail. This report highlights a case of severe Haglund deformity managed with Zadek osteotomy and Achilles tendon re-attachment.Case Presentation: A 45-year-old female presented with 2 months of severe right heel pain and a 2-year history of a prominent bump. Physical therapy yielded no improvement. Clinical and radiographic evaluation confirmed Haglund deformity with insertional Achilles tendinopathy. Surgical treatment involved Zadek osteotomy, fixation with screws, and Achilles tendon re-attachment using a suture anchor. The combined approach addressed both the bony deformity and tendon degeneration. Post-operative outcomes showed significant improvement. At the 3-month follow-up, the patients Visual Analog Scale (VAS) pain score decreased from 7/10 to 1/10, and the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score improved from 55 to 90. The range of motion was near normal, and functional recovery was excellent. This case demonstrates the effectiveness of combining Zadek osteotomy and Achilles tendon re-attachment for treating severe Haglund deformity. This approach provided significant pain relief and functional recovery, making it a viable option for patients with similar conditions refractory to conservative management.
Comparison of Plating Versus Intramedullary Nailing in Metaphyseal Fractures: A Systematic Review and Meta-Analysis Anak Agung Ngurah Bagus Surya Darma; I Wayan Subawa
Indonesian Journal of Global Health Research Vol 7 No 2 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i2.5117

Abstract

Metaphyseal fractures are common orthopedic injuries that often require surgical intervention for optimal management. The choice between plating and intramedullary nailing as fixation methods remains a subject of debate among orthopedic surgeons, with considerations including fracture type, patient characteristics, and surgical outcomes. This study aim to compare the efficacy, safety, and outcomes of plating versus intramedullary nailing in the treatment of metaphyseal fractures.Methods: A comprehensive search was conducted across major electronic databases for relevant studies published up to 2023. Studies comparing plating and nailing techniques in metaphyseal fracture fixation were included. Data regarding study characteristics, patient demographics, surgical techniques, outcomes, and follow-up durations were extracted and analyzed using appropriate statistical methods. Our primary outcomes were union rate and time, functional outcome using patient reported outcome measure, and complications. Results: The initial search yielded a total of 687 studies, of which 7 studies met the inclusion criteria, consisting of a total of 758 skeletally-mature patients with metaphyseal fractures treated with either intramedullary nailing or plate fixations. The meta-analysis revealed that there is no evidence to draw definitive conclusions on which indicates the best method in treating metaphyseal fractures. Subgroup analyses were performed based on fracture type, patient age, and other relevant factors to further elucidate the comparative effectiveness of plating versus screwing.Conclusion: The meta-analysis findings indicated that using intramedullary nailing led to shorter surgical and complications when compared to plate fixation. Additionally, both treatments frequently resulted in similar union times and union-related issues. However, further randomized controlled trials (RCTs) are necessary to bolster the existing evidence base.
Comparison of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing for Tibial Shaft Fracture: A Systematic Review and Meta-Analysis I Wayan Subawa; Anak Agung Ngurah Bagus Surya Darma
Indonesian Journal of Global Health Research Vol 7 No 2 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i2.5130

Abstract

Tibia shaft fractures are thought to affect 4% of the elderly population. Both low energy and high energy mechanisms have the potential to damage the tibia. Two frequently utilized surgical procedures that are superior to other available choices (external fixation and conventional plate fixation) for the treatment of tibia shaft fractures are intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO). We compare minimally invasive plate osteosynthesis versus intramedullary nailing for tibial shaft fracture in terms of return to work, hospital stay, and complications over the duration of 1-2 years of follow-up.Methods: A PRISMA guided systematic review was done. A comprehensive literature search was performed to find study in English comparing between MIPO and IMN for tibial shaft fracture from January 2017 until August 2022. PubMed, Google Scholar, and Cochrane Library. The focus in this systematic review and meta-analysis is to compare outcome between MIPO and IMN for tibial shaft fracture. ((“Minimally Invasive Plate Osteosynthesis”, “Intramedullary Nailing”), AND (“Tibial Shaft Fracture”), AND (“Outcome Measure”)) were utilized in the search.Results: This meta-analysis included a total number of 214 patients with 91 patients undergoing MIPO and 123 patients undergoing IMN. The follow-up period was 1-2 years after the treatment. There were found no significant differences statistically in terms of hostpital stay, return to work, infection, malunion, and non union. Conclusion: Our investigations show that both IMN and MIPO are safe and effective methods in treating tibial shaft fractures, and our results show that both methods provide similar outcomes in length of stay, return to work, infection, malunion, and non-union aspects.
Co-Authors Agung Artha Wiguna Anak Agung Ngurah Bagus Surya Darma Aryana, I Gusti Ngurah Wien Dewi, Kadek Ayu Candra Dhaifullah, M Rifqi Dharmayuda, Cokorda Gde Oka Dusak, I Wayan Suryanto Eka Wiratnaya Gabriel Audrey Wijaya Hans Kristian Nugraha, Hans Kristian Herryanto Agustriadi Simanjuntak I G A A Diah Pradnya Paramita I Gusti Lanang Ngurah Agung Artha Wiguna I Gusti Ngurah Wien Aryana I Ketut Suyasa I Made Suka Adnyana I Made Suwitra, I Made I Wayan Arthana I Wayan Jorden Junior I Wayan Suryanto Dusak Indraswari, Made Ratna Savitri Ismail, Mohamad Dimas Kardi Rahayu Kesumaputri, Komang Diah Kurnia Ketut Gede Mulyadi Ridia Ketut Siki Kawiyana Ketut Trisna Parama Kartika Kusuman, Kevin Made Suka Adnyana Meregawa, Putu Feryawan Ni Putu Ayu Pande Arista Dewi Ni Putu Sawitri Nandari Putu Astawa Putu Prabhawati DwiKrisna Putu Sinta Ratna Sari Dewi Sitranata, Madeline Juliand Sri Mahadhana, Sri Susila, Made Arya Vivi Paula Putri Wiguna, I Gusti Lanang Ngurah Agung Artha Wiratnaya, Gede Eka