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"Objective To compare the fixation stability between cloverleaf locking plate and Condylar Buttress Plate ill Supracondylar Femur Fracture Method These research is a biomechanical study, using femoral bovine bones as a specimen. There are two groups, first group using the cloverleaf locking plate and the second group using Condylar Buttress Plate. After instrumented with the implants, the bone were osteomised to make a gap 2,5 cm, then boths specimens are loaded with axial force with Shimadzu machine 0,05 mm per minute speed. The force that made the medial displacement of the bone 1,3,5, I 0 mm were recorded. Result: The axial loading that cause displacement 1,3 ,5, I 0 mm in cloverleaf locking plate are statically more significant with t-test independent significant p=O,OO «0,05).The load to failure in cloverleaf locking plate is at 3 mm displacement (3944N) and Condylar Buttress Plate is 3 mm (2810 N). Conclusion: The fixation of cloverleaf locking plate in axial forces is more stable than the Condylar Buttress Plate"

"Background data: The treatment of bicondylar tibia plateau fractures remains controversial. Lateral buttress plate and medial antiglide is favored by AOIASIF. Recently treatment of this fracture by less invasive stabilization system in the lateral side by using locked screw plate was gained acceptances by many surgeons. In Cipto Mangunkusumo Hospital local Iocked clover plate was designed, which is given better economics solutions. Objective: To compare the fixation stability between single lateral local locking plate and double plating system that using lateral buttress and medial antiglide in the treatment of bicondylar tibial plateau fracture. Design: One model (Synbone 1110, normal bone quality) tibia was used. Bicondylar tibia fracture model that design by Horwitz was used. Invite biomechanical axial loading, tested to the both group was tested. Intervention: Five pairs of fracture model was used. Stabilization using lateral buttresslmedial antiglide one third tubular in one group and unilateral local locking Clover plate (LCP) in other group. Five vertical loads levels were used (150 N, 300 N, 450 N, 600N and 750N). Irreversible (plastic) deformation was the main parameter of interest. Main out come measures: Irreversible (plastic) deformation was the main parameter of interest. Failure was defined as more than 5 mm displacement in the particular surface in medial condyle. Result: Vertical subsidence depended on the applied load but not on the method of fixation. The displacement of medial plateau was recorded. With confidence interval 95%, and P less than 0,05 was statistically significance. All the displacement was statistically no significantly difference P > 0,05 in five different level even the mean displacement was higher in the same loading in the local locked clover plate. Conclusion: Single lateral local locked clover plate could give good stability in the treatment of bicondylar tibial plateau fracture that statistically no difference to double plating which using lateral buttress and medial antiglide, even though still need further investigation."

"[ABSTRAKPada fraktur pelvis tidak stabil yang disertai dengan fraktur vertikal sakrum (AO Tipe C1.3) terdapat instabilitas terhadap gaya shearing aksial yang besar. Fiksasi pada fraktur tersebut harus memberikan kekuatan biomekanik yang baik dan minimal invasif. Penempatan sekrup iliosakral (SIS) di S1-S3 secara divergen dapat meningkatkan kekuatan biomekanik terutama kekakuan translasi. Tujuan penelitian ini adalah mengevaluasi kekuatan biomekanik SIS S1-S3 dan sekrup pubis (PS) dibandingkan konfigurasi fiksasi lain untuk memberikan solusi konfigurasi fiksasi baru pada fraktur pelvis AO Tipe C1.3.Simulasi fraktur pelvis dibuat dengan fraktur ramus pubis superior, inferior, dan fraktur vertikal sakrum ipsilateral (AO tipe C1.3) pada tulang sintetik Synbone®. Enam kombinasi fikasi yaitu Tension Band Plate (TBP)+PS, TBP+plat symphysis (SP), SIS S1-S2+PS, SIS S1-S2+SP, SIS S1-S3+PS, SIS S1-S3+SP diuji dengan diberikan beban aksial menggunakan mesin kompresi Tensilon® sampai titik kegagalan fiksasi sebesar ≥2 mm atau ≥20, kemudian dievaluasi kekakuan translasi, kekakuan rotasi, dan titik kegagalan fiksasi. Analisis statistik dilakukan dengan uji ANOVA dilanjutkan dengan uji post-hoc BonferroniDari hasil uji biomekanik didapatkan kelompok fiksasi SIS S1-S3+PS memiliki kekakuan translasi, kekakuan rotasi, dan titik kegagalan fiksasi tertinggi (830,36 N/mm, 599,68 N/°, dan 1522,20 N) terhadap beban aksial.Fiksasi SIS di S1-S3 dan sekrup pubis merupakan fiksasi terbaik untuk fraktur pelvis tidak stabil dengan fraktur vertikal sakrum karena mempunyai properti biomekanik yang baik dan secara klinis fiksasi ini memberikan keuntungan prosedur yang minimal invasif dan pasien dapat mobilisasi segera sehingga mengurangi komplikasi postoperatif.

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ABSTRACTIn unstable pelvic fracture with vertical sacral fracture (AO Type C1.3), there are tremendous instability towards axial shearing load. Ideally, the fixation should provide good biomechanical properties and minimal invasive. Divergent Iliosacral screw (ISS) placement on S1-S3 could enhance biomechanical strength. The purpose of this research was to evaluate the biomechanical properties of ISS S1-S3 and pubic screw (PS) compared to other configuration to provide solution for new configuration of fixation in AO Type C1.3 pelvic fracture.A simulation of pelvic fracture was created on superior and inferior pubic rami, and ipsilateral vertical sacral fracture (AO Type C1.3) on a synthetic bone (Synbone®). Six fixation combination including tension band plate (TBP)+PS, TBP+symphyseal plate (SP), ISS S1-S2+PS, ISS S1-S2+SP, ISS S1-S3+PS, ISS S1-S3+SP were tested using compression machine Tensilon® until failure point defined by ≥2 mm or ≥20 displacement was met. Translational stiffness, rotational stiffness and load to failure were evaluated. Statistical analysis was performed with ANOVA test followed by Bonferroni post hoc-test.From biomechanical test, fixation using ISS S1-S3+PS had the highest translational stiffness, rotational stiffness, and load to failure (830,36 N/mm, 599,68 N/°, and 1522,20 N respectively) toward axial load.Fixation by ISS S1-S3+PS was the best configuration in unstable pelvic fracture with vertical sacral fracture due to its good biomechanical strength, minimal invasiveness which renders early immobilization for patients hence decreasing postoperative complications., In unstable pelvic fracture with vertical sacral fracture (AO Type C1.3), there are tremendous instability towards axial shearing load. Ideally, the fixation should provide good biomechanical properties and minimal invasive. Divergent Iliosacral screw (ISS) placement on S1-S3 could enhance biomechanical strength. The purpose of this research was to evaluate the biomechanical properties of ISS S1-S3 and pubic screw (PS) compared to other configuration to provide solution for new configuration of fixation in AO Type C1.3 pelvic fracture.A simulation of pelvic fracture was created on superior and inferior pubic rami, and ipsilateral vertical sacral fracture (AO Type C1.3) on a synthetic bone (Synbone®). Six fixation combination including tension band plate (TBP)+PS, TBP+symphyseal plate (SP), ISS S1-S2+PS, ISS S1-S2+SP, ISS S1-S3+PS, ISS S1-S3+SP were tested using compression machine Tensilon® until failure point defined by ≥2 mm or ≥20 displacement was met. Translational stiffness, rotational stiffness and load to failure were evaluated. Statistical analysis was performed with ANOVA test followed by Bonferroni post hoc-test.From biomechanical test, fixation using ISS S1-S3+PS had the highest translational stiffness, rotational stiffness, and load to failure (830,36 N/mm, 599,68 N/°, and 1522,20 N respectively) toward axial load.Fixation by ISS S1-S3+PS was the best configuration in unstable pelvic fracture with vertical sacral fracture due to its good biomechanical strength, minimal invasiveness which renders early immobilization for patients hence decreasing postoperative complications.]"

"Pendahuluan: Infeksi luka operasi superfisial merupakan komplikasi yang sering muncul pada tatalaksana operatif fraktur tulang panjang. Untuk mencegah terjadinya infeksi tersebut, diberikan antibiotik profilaksis sebelum operasi, yang kemudian dilanjutkan dengan antibiotik terapeutik. Penelitian ini bertujuan untuk membandingkan angka kejadian infeksi luka operasi superfisial antara pemberian antibiotik profilaksis intravena saja dan yang diteruskan dengan pemberian antibiotik oral selama 7 hari pasca operasi.Metode: Penelitian ini menggunakan desain studi klinis non-inferioritas terkontrol tersamar ganda. Sampel penelitian adalah pasien dewasa yang menjalani operasi elektif reposisi terbuka fiksasi interna untuk kasus fraktur tertutup tulang panjang di RSUPN Dr. Cipto Mangunkusumo Jakarta dan RSU Siaga Medika Banyumas pada bulan Juli 2022 hingga Maret 2023. Subjek penelitian dibagi secara acak menjadi dua kelompok, yakni kelompok tanpa pemberian antibiotik oral selama 7 hari pasca operasi (perlakuan) dan kelompok dengan pemberian antibiotik oral selama 7 hari pasca operasi (kontrol). Hasil: Penelitian ini melibatkan 80 subjek yang memenuhi kriteria inklusi dan eksklusi, yang terdiri dari 47 (58,75%) subjek laki-laki dan 33 (41,25%) subjek perempuan. Angka kejadian infeksi luka operasi superfisial baik pada kelompok perlakuan dan kontrol adalah 2,5%. Pada hari ke-30 pasca operasi, terdapat 1 (2,5%) kejadian infeksi baik di kelompok perlakuan maupun kontrol. Hasil tersebut secara statistik tidak berbeda bermakna (p = 1.000).Kesimpulan: Tidak terdapat perbedaan yang bermakna dalam kejadian infeksi luka operasi superfisial antara kelompok dengan maupun tanpa pemberian antibiotik oral selama 7 hari pasca operasi.

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Introduction: Superficial surgical site infection is a common complication in the operative management of long bone fractures. To prevent the infection, prophylactic antibiotics are given prior to surgery, followed by therapeutic antibiotics. This study aimed to compare the superficial surgical site infection rate between subjects who was given intravenous prophylactic antibiotic only and those with continued oral antibiotic for 7 days postoperatively.

Method: This study was a double-blind, controlled, non-inferiority clinical study. The sample was adult patients who underwent open reduction internal fixation surgery for closed long bone fractures at Dr Cipto Mangunkusumo Central Hospital Jakarta and Siaga Medika Hospital Banyumas from July 2022 to March 2023. The subjects of the study were randomized into two groups, namely the group without oral antibiotics for 7 days postoperatively (treatment) and the group with oral antibiotics for 7 days postoperatively (control).

Result: This study involved 80 subjects who met the inclusion and exclusion criteria, consisting of 47 (58.75%) male and 33 (41.25%) female subjects. The superficial surgical site infection rate in both treatment and control groups were 2,5%. At day 30 post- operation, there was one case of infection both on the treatment and control groups. The results showed no statistically significant difference (p = 1.000).

Conclusion: There was no significant difference in the superficial surgical site infection rate between the groups with and without oral antibiotics for 7 days postoperatively."

"Penelitian ini bertujuan untuk mengetahui formasi fiksasi interna yang terbaik dan perbedaan stabilitas pelvis dengan penambahan fiksasi posterior rongga pelvis pada model fraktur pelvis cedera open book dan disrupsi sendi sakroiliaka anterior (klasifikasi OTA/AO B1.1). Studi yang ada menunjukkan belum terdapatnya data mengenai kekuatan mekanik tipe-tipe fiksasi tersebut di atas.Desain penelitian adalah studi eksperimental dengan 25 model tulang pelvis buatan (Synbone®) dengan perlakuan cedera open book dan disrupsi sendi sakroiliaka anterior (klasifikasi OTA/AO B1.1). Variabel bebas dalam studi ini adalah lima tipe fiksasi interna terhadap fraktur pelvis. Masing-masing kelompok diberikan gaya aksial dan anteroposterior sampai terjadi pergeseran ≥ 2 mm pada sendi sakroiliaka (load to failure).Hasil uji biomekanik terhadap setiap kelompok fiksasi menunjukkan nilai rerata load to failure terkecil sampai dengan yang terbesar pada pemberian gaya aksial diperoleh pada kelompok dengan urutan fiksasi: dua plat simfisis (730,03 N), satu plat simfisis pubis dan satu screw iliosakral (posterior) (1224,18 N), dua plat simfisis pubis dan dua plat anterior sendi iliosakral (1405,06 N), satu plat simfisis dan dua screw iliosakral S1 (1444,64 N), satu plat simfisis dan dua screw masingmasing satu di S1 dan S2 (1490,36 N). Analisis perbandingan rerata load to failure (menggunakan uji one-way ANOVA post hoc Bonferroni) antar kelompok menunjukkan bahwa terdapat perbedaan yang bermakna secara statistik (p< 0,05) pada rerata load to failure kelompok fiksasi dua plat simfisis (anterior) dengan empat kelompok lainnya (anterior dan posterior). Selain itu terdapat pula perbedaan yang bermakna (p< 0,05) antara kelompok fiksasi satu plat simfisis pubis dan satu screw iliosakral (posterior) dengan kelompok fiksasi satu plat simfisis pubis dan dua screw masing-masing satu di S1 dan S2.Penambahan fiksasi sendi sakroiliaka (posterior) dengan screw iliosakral di S1 dan S2 merupakan formasi fiksasi interna terbaik dilihat dari kekuatan mekanik. Fiksasi sendi simfisis pubis (anterior) saja mempunyai kekuatan mekanik paling rendah dibandingkan fiksasi sendi simfisis pubis (anterior) dan sendi sakroiliaka (posterior). Fiksasi dua screw sakroiliaka di S1 dan S2 meningkatkan stabilitas pelvis dibandingkan fiksasi satu screw sakroiliaka di S1.

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This study is aimed to identify the best internal fixation formation and the differences in pelvic stability with the addition of posterior fixation at the pelvic cavity in pelvic fracture model with open-book injury and anterior sacroiliac joint disruption (OTA/AO B1.1 classification). Literature review revealed no data about the mechanical strength of the above fixation types.

This was an experimental study with 25 artificial pelvic bones (Synbone®) of which their pubic symphisis and anterior sacroiliac joint were disrupted. The independent variable was five types of internal fixation of the OTA/AO B1.1 classification pelvic fracture. Each group was given axial and anteroposterior load until a displacement of ≥ 2 mm occurred at the sacroiliac joint (load to failure).

Biomechanical test results of each type of fixation demonstrated that the lowest to highest load to failure mean scores against axial load were obtained by fixation groups with the order of: two symphisis plates (730,03 N), one pubic symphisis plate and one iliosacral screw (posterior) (1224,18 N), two pubic symphisis plates and two anterior iliosacral joint plates (1405,06 N), one symphisis plate dan and two S1 iliosacral screws (1444,64 N), one symphisis plate and two screws each on S1 dan S2 (1490,36 N). Load to failure mean score comparison analysis (using one-way ANOVA, post hoc Bonferroni test) revealed a statistically significant difference (p< .05) between the load to failure of two symphisis plates fixation group with those of the other four groups. There is also a significant difference (p< .05) between the load to failure of one pubic symphisis plate and one iliosacral screw (posterior) fixation group with that of the one pubic symphisis plate and two screws each on S1 and S2.

The addition of sacroiliac joint (posterior) fixation, either with plate or screw, will inrease the mechanical strength when axial load is applied. The mechanical strength may increase up until two times compared to that of the pubic symphisis (anterior) joint fixation only. The fixation of two sacroiliac screws at S1 and S2 increases the pelvic stability compared to that of one sacroiliac screw fixation at S1."

"Masih terdapat kontroversi dalam penanganan burst fracture pada tulang belakang bagian thoracolumbar. Tujuan utama dari penanganan pasien dengan burst fracture adalah reduction, stabilization dan fusion. Pada pasien dengan defisit neurologis akibat burst fracture, dekompresi dari canal spinalis rnerupakan tujuan utama dari pembedahan. Dekompresi anterior, strut graft dan instrumentasi anterior diindikasikan untuk penatalaksanaan unstable burst fracture. Sebaliknya instrumentasi posterior sering digunakan untuk penanganan burst fracture pada thoracolumbar spine. Penggunaan instrumentasi transpedicular semakin popular saat ini karena dapat menghasilkan fiksasi yang rigid yang menggunakan implant lebih pendek dengan segmental fixation dan fusi.PSSW (Pedicle Screw Sublaminary Wiring) sistem instrumentasi posterior untuk tulang belakang yang dikembangkan di RSCM-FKUI. Instrumentasi ini menggunakan sekrup cortical 4,5 mm untuk pedicle screw dan soft wire 1,2 mm untuk sublaminary wiring.Oleh karena itu kami melakukan penelitian yang membandingkan stabilitas antara instrumentasi anterior dan instrumentasi posterior berupa PSSW untuk membuktikan hypothesis bahwa fiksasi burst fracture dengan menggunakan PSSW akan memberikan fiksasi yang minimal setara dengan instrumentasi anterior terhadap gaya axial."

"Dengan menggunakan tes pembebanan secara kontinu dan penilaian secara histologis, teknik jahitan running locking memiliki kelebihan dibanding Kessler modifikasi. Dalam hal kekuatan hasil jahitan, mencegah terjadinya celah sambungan tendon, proses penyembuhan tendon itu sendiri. Teknik jahitan running locking, adhesi terhadap jaringan sekitarnyahanya sedikit. Jadi teknik ini dapat digunakan untuk menyambung tendon fleksor yang cedera.

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By using continuous loading tests and histological assessments, the running locking stitch technique has advantages over modified Kessler. In terms of the strength of the sutures, preventing the occurrence of tendon joints, the tendon healing process itself. Running locking stitch technique, adhesion to the surrounding network

just a little. So this technique can be used to connect injured flexor tendons."

"Fraktur mandibula merupakan fraktur kraniomaksilofasial yang paling umum dan seringkali menyebabkan gangguan mengunyah. Tata laksana definitif fraktur mandibula adalah reduksi terbuka dan fiksasi interna menggunakan plat dan sekrup sistem 2.0, seperti plat tiga dimensi (3D). Namun, desain plat 3D konvensional memiliki keterbatasan karena bentuknya yang tidak dapat diubah, sehingga sulit menghindari garis fraktur atau struktur anatomi penting seperti akar gigi dan saraf saat melakukan pemasangan sekrup. Untuk mengatasi masalah ini, diperlukan desain plat 3D yang dapat diubah konfigurasinya. Oleh karena itu, dikembangkanlah desain plat 3D interlocking. Berbeda dengan plat 3D yang sudah ada selama ini, plat 3D interlocking memiliki kebaruan yaitu plat ini dapat dirangkai dari beberapa jenis plat dengan menumpuk 2 buah plat menjadi 1 kesatuan plat. Sambungan kedua buah plat ini tidak menambah ketebalan plat dan dapat diubah konfigurasinya dengan menyesuaikan sudut antara plat horizontal dan plat vertikal. Finite Element Analysis (FEA) dilakukan untuk menentukan kelayakan desain plat 3D interlocking. Setelah FEA memastikan kelayakan desain, purwarupa yang diproduksi dilakukan pengujian biomekanik menggunakan sepuluh mandibula kambing untuk menilai kekuatan mekanik dan stabilitas plat 3D interlocking. Biokompatibilitas dan penyembuhan tulang dievaluasi dalam uji hewan coba yang melibatkan 28 kambing. Biokompatibilitas dinilai dengan mengevaluasi respons inflamasi dari uji radiologik dan histopatologik (pewarnaan Hematoxylin-Eosin). Penyembuhan tulang dinilai melalui berbagai metode, termasuk uji radiologik yang mengukur kepadatan tulang, uji histopatologik menggunakan pewarnaan Mason Trichome, dan analisis penanda tulang melalui imunohistokimia dan ELISA. Selain itu, uji kemudahan penggunaan dilakukan dengan sembilan Spesialis Bedah Plastik Rekonstruksi dan Estetik untuk menilai tingkat kenyamanan dan durasi yang diperlukan untuk mengaplikasikan plat pada model mandibula sintetik. Uji biomekanik juga dilakukan pada uji kemudahan penggunaan sebagai komponen evaluasi objektif. Dalam uji biomekanik, plat 3D interlocking menunjukkan kemampuan yang lebih baik dalam mempertahankan stabilitas fraktur yang memungkinkan gerakan mikro yang terkendali. Selanjutnya, uji biokompatibilitas menunjukkan bahwa kelompok plat 3D interlocking menghasilkan reaksi jaringan dan respons inflamasi yang lebih rendah dibandingkan plat tolok ukur pada uji hewan coba. Selain itu, plat 3D interlocking juga mempercepat proses penyembuhan tulang, terbukti dari peningkatan bermakna dalam pembentukan dan kepadatan tulang pada uji hewan coba. Hasil uji kemudahan penggunaan menunjukkan bahwa plat 3D interlocking dapat digunakan dengan mudah seperti halnya plat tolok ukur. Secara keseluruhan, plat 3D interlocking menunjukkan potensi sebagai alternatif yang layak untuk tata laksana fraktur mandibula.

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Mandibular fractures are the most common craniomaxillofacial fractures, often resulting in mastication disturbances. Mandibular fracture management typically involves the use of 2.0 system plates and screws, such as three-dimensional (3D) plates. However, the conventional 3D plate designs for mandibular fracture management have limitations. Their fixed shape makes it challenging to avoid fracture lines or vital anatomical structures, such as dental roots and nerves when placing screws. A 3D plate design that allows for configuration changes is needed to address this issue. Therefore the interlocking 3D plate was developed. This novel design features components that can be adjusted to avoid critical anatomical structures and fracture lines while still offering the stability of a 3D plate, enhancing its utility in mandibular fracture management. Finite element analysis was performed to establish the feasibility of the interlocking 3D plate design. Once that was established, biomechanical evaluation was conducted using ten goat mandibles to assess the mechanical strength and stability of the interlocking 3D plate. Biocompatibility and bone healing properties were evaluated in an animal study involving 28 goats. Biocompatibility was assessed by evaluating inflammatory responses from radiological and histopathological (Hematoxylin-Eosin staining) study. Bone healing properties were assessed through various methods, including radiological study measuring bone density, histopathological study using Mason Trichome staining, and analyzing bone markers through immunohistochemistry and ELISA. Additionally, usability study were conducted with nine plastic surgeons to assess the level of comfort and the duration required to apply the plate on a synthetic mandibular model. These findings were correlated with biomechanical test results. The biomechanical evaluation revealed that the interlocking 3D plate design better-maintained fracture stability while allowing controlled micro-movement. Regarding biocompatibility, the interlocking 3D plate exhibited better results than the standard plate, as indicated by lower tissue reaction and inflammatory response in animal study. The interlocking 3D plate also facilitated faster bone healing, with significant bone formation and bone density improvements in animal study. Usability study demonstrated that the interlocking 3D plate was as easy to use as the standard plate, with no significant differences in application time. Overall, the interlocking 3D plate demonstrates significant potential as a viable alternative for managing mandibular fractures."

"Pendahuluan: Fraktur intertrochanter dapat dilakukan tata laksana dengan beberapa metode, di antaranya dengan proximal femoral nail antirotation (PFNA). PFNA merupakan tindakan yang minimal invasif dan dapat mempercepat proses penyembuhan ekstremitas. Namun, pada beberapa kasus dapat terjadi kegagalan yang dipicu oleh berbagai faktor, di antaranya pemasangan yang kurang tepat dan kualitas densitas tulang yang buruk. Oleh karena itu, penelitian ini bertujuan untuk mengetahui faktor-faktor yang berkontribusi terhadap terjadinya kegagalan implan pada pasien fraktur intertrochanter pasca PFNA.Metode: Sebuah penelitian kohort retrospektif dilakukan melibatkan pasien dengan intertrochanter yang dilakukan fiksasi menggunakan PFNA di RSCM, RSUP Fatmawati, dan RSUP Persahabatan pada Januari 2019 – Desember 2023. Penelitian ini menilai hubungan posisi blade screw, panjang nail, tip-apex distance (TAD), calcar-referenced tip-to-apex distance (CalTAD), tipe fraktur intertrochanter, neck shaft angle (NSA), densitas tulang, dan kualitas reduksi terhadap kejadian kegagalan implan pasca PFNA dan luaran fungsional menggunakan harris hip score.Hasil dan Diskusi: Sebanyak 48 sampel dengan fraktur intertrochanter yang menjalani operasi PFNA dengan 4 (8,33%) kasus kegagalan implan. Terdapat hubungan signifikan antara kualitas reduksi dengan kejadian kegagalan implan (p = 0,015) dan harris hip score (p < 0,001). Tidak terdapat hubungan signifikan antara posisi blade screw berdasarkan indeks parker anteroposterior dan lateral, TAD, CalTAD, panjang nail, tipe fraktur intertrochanter, NSA, dan densitas tulang dengan kejadian kegagalan implant PFNA (p > 0,05).Kesimpulan: Kualitas reduksi merupakan faktor risiko utama terjadinya kegagalan implan fraktur intertrochanter dengan PFNA.

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Introduction: Management of intertrochanteric fractures can be conducted through various methods, among which is the Proximal Femoral Nail Antirotation (PFNA). PFNA offers a minimally invasive approach and can facilitate early healing of the extremity. However, in some cases, failure may occur due to various factors, including blade screw position and poor bone density quality. Therefore, this study aims to identify factors contributing to implant failure in patients with intertrochanteric fractures after PFNA.

Methods: A retrospective cohort study was conducted involving patients with intertrochanteric fractures treated with PFNA fixation at Cipto Mangunkusumo Hospital, Fatmawati Hospital, and Persahabatan Hospital from January 2019 to December 2023. This research examines the relationship of blade screw position, nail length, tip-apex distance (TAD), calcar-referenced tip-to-apex distance (CalTAD), intertrochanteric fracture type, neck shaft angle (NSA), bone density, and reduction quality with PFNA implant failure and functional outcomes using Harris Hip Score.

Results and Discussion: A total of 48 samples with intertrochanteric fractures undergoing PFNA surgery were analyzed, with 4 (8.33%) cases of implant failure. There was a significant relationship between the reduction quality and the occurrence of implant failure (p = 0.015) and Harris Hip Score (p < 0.001). There were no significant relationships between the position of the blade screw based on the parker index anteroposterior and lateral, TAD, CalTAD, nail length, type of intertrochanteric fracture, NSA, and bone density with PFNA implant failure.

Conclusion: Reduction quality is a primary risk factor for the occurrence of implant failure in intertrochanteric fractures treated with PFNA."