Karakteristik Implant Failure pada Pasien yang Menjalani Orif Plate and Screw pada Anggota Gerak Bawah di RSUP HAM Medan Tahun 2015-2019

Abstract

Objectives Orthopaedic implant is an artificial mechanical device which is installed on the musculoskeletal system in human and exposed with living cells, tissue, and biologic fluid so it can be a failure because of various factors. The purpose of this research to determine the charateristic of patient with implant failure who had ORIF with Plate and Screw in Haji Adam Malik General Hospital. Materials and Method The type of research conducted is a retrospective descriptive with cohort method. This study was conducted in Medan Haji Adam Malik General Hospital during the period of January 2015 – December 2019. The data used is secondary data taken from the records in the patient’s medical record. The collected medical and demographic data is tabulated and presented in the form of a frequency distribution diagram or table and analyzed descriptively using total sampling. Results During the period of research found from the medical record data of Medan Haji Adam Malik Hospital, there were 383 patients who had operation procedure and found 30 patient with implant failure (7,83%). The charateristic of patient’s gender is female as many as 9 patients (30%) and male as many as 21 patients (70%). The charateristics distribution range of age are11-20 years old as many as 6 patients (20%), 21-30 years old as many as 8 patients (26,7%), 31-40 years old as many as 4 patients (13,3%), 41-50 years old as many as 5 patients (16,7%), 51-60 years old as many as 6 patients (20%), and 61-70 patients as many as 1 patient (3,3%). The charateristics distribution of years of implant failure occurred on 2015 as many as 9 patients (30%), on 2016 as many as 7 patients (23,3%), on 2017 as many as 7 patients (23,3%), on 2018 as many as 4 patients (13,3%), and on 2019 as many as 3 patients (10%). The charateristics distribution location of implant failure are on proximal femur as many as 3 patients (10%), shaft femur as many as 19 patients (63,3%), distal femur as many as 3 patients (10%), shaft tibia as many as 3 patients (10%), distal tibia as many as 1 patient (3,3%), and distal fibula as many as 1 patient (3,3%). The charateristics distribution type of implant who had implant failure are locking plate as many as 2 patients (6,7%) and nonxiii locking plate as many as 28 patients (93,3%). The charateristic distribution of patient expriencing implant failure is minimum 1 month and maximum 10 months with average 3,5 months. The charateristics distribution cause of implant failure are early weight bearing as many as 18 patients (60%), fall slipped as many as 5 patients (16,7%), and infection as many as 7 patients (23,3%). The charateristics distribution type of fracture are open fractures 6 patients (20%) and closed fractures as many as 24 patients (80%). The charateristics distribution pattern of fractures are transverse as many as 1 patient (3,3%), oblique as many as 5 patients (16,7%), spiral as many as 6 patients (20%), comminutive as many as 17 patients (56,7%), and segmental as many as 1 patient (3,3%). The charateristics distribution of implant failure are plate as any as 16 patients (53,3%) and screw as many as 14 patients (46,7%). Conclusion Based on the study, it was found that the most patients who had implant failure is male in a range of 30 – 40 years old. The most common location of implant failure on lower extremity is shaft femur. The most common type of plate is non-locking plate. Range of time of implant failure is 3 – 4 months. The most common caused of implant failure is disobidient with doctor’s post operative instruction. Open fractures and infection are the higest risk factor which caused implant failure.

Objektif Implan orthopaedi merupakan alat mekanis buatan yang dipasang pada sistem muskuloskeletal manusia yang terkespos dengan sel yang hidup, jaringan, dan cairan biologis sehingga dapat mengalami suatu kegagalan akibat berbagai macam faktor. Penelitian ini bertujuan untuk mengetahui karateristik implant failure pada pasien yang menjalani ORIF Plate and Screw di RSUP Haji Adam Malik Medan. Material dan Metode Jenis penelitian yang dilakukan adalah metode penelitian retrospektif dengan pendekatan kohort. Penelitian ini dilakukan di RSUP Haji Adam Malik Medan berdasarkan rekam medis penderita implant failure selama rentang waktu Januari 2015 – Desember 2019. Data yang digunakan adalah data sekunder yang diambil dari pencatatan pada rekam medik pasien. Data medis dan demografi yang terhimpun ditabulasi dan disajikan dalam bentuk diagram atau tabel distribusi frekuensi serta dianalisa secara deskriptif atau tabel distribusi frekuensi serta dianalisa secara deskriptif menggunakan total sampling. Hasil Selama kurun waktu penelitian dijumpai dari data rekam medis RSUP Haji Adam Malik Medan dijumpai seluruh operasi anggota gerak bawah dari tahun 2015 – 2019 diapatkan sebanyak 383 operasi dimana terdapat 30 pasien yang mengalami implant failure (7,83%). Karateriksik jenis kelamin subjek yang mengalami kejadian implant failure sebanyak perempuan 9 orang (30%) dan laki-laki 21 orang (70%). Karateriksik rentang usia subjek yang mengalami kejadian implant failure yaitu 11-20 tahun sebanyak 6 orang (20%), 21-30 tahun sebanyak 8 orang (26,7%), 31-40 tahun sebanyak 4 orang (13,3%), 41-50 tahun sebanyak 5 orang (16,7%), 51-60 tahun sebanyak 6 orang (20%), 61-70 tahun sebanyak 1 orang (3,3%). Karateriksik tahun terjadinya implant failure adalah tahun 2015 sebanyak 9 orang (30%), tahun 2016 sebanyak 7 orang (23,3%), tahun 2017 sebanyak 7 orang (23,3%), tahun 2018 sebanyak 4 orang (13,3%), dan tahun 2019 sebanyak 3 orang (10%). Distribusi karateristik lokasi yang mengalami implant failure adalah proximal femur sebanyak 3 pasien (10%), shaft femur 19 pasien (63,3%), distal femur sebanyak 3 pasien (10%), shaft tibia sebanyak 3 pasien (10%), distal tibia sebanyak 1 pasien (3,3%), dan distal fibula sebanyak 1 xi pasien (3,3%). Distribusi karateristik jenis implant yang mengalami implant failure adalah locking plate sebanyak 2 pasien (6,7%) dan non-locking plate sebanyak 28 pasien (93,3%). Distribusi karateristik waktu pasien yang mengalami implant failure adalah minimum 1 bulan dan maximum 10 bulan dengan rata-rata 3,5 bulan. Distribusi pennyebab terjadinya implant failure adalah early weight bearing sebanyak 18 orang (60%), fall slipped 5 orang (16,7%), dan infeksi sebanyak 7 orang (23,3%). Distribusi karateristik jenis patahan pasien adalah patah terbuka sebanyak 6 orang (20%) dan patah tertutup sebanyak 24 orang (80%). Distribusi karateristik pola patahan adalah transverse sebanyak 1 orang (3,3%), oblique sebanyak 5 orang (16,7%), spiral sebanyak 6 orang (20%), kominutif sebanyak 17 orang (56,7%), dan segmental sebanyak 1 orang (3,3%). Distribusi karateristik impaln yang menglami kegagalan adalah plate sebanyak 16 orang (53,3%), dan screw sebanyak 14 orang (46,7%). Kesimpulan Dari hasil studi yang dilakukan, didapati bahwa pasien yang paling banyak terjadi implant failure berjenis kelamin laki-laki dengan rentang usia 30-40tahun. Lokasi pada ekstremitas bawah yang lebih sering adalah pada shaft femur. Plat yang lebih banyak mengalami kasus implant failure adalah plat non-locking. Jangka waktu failure dari awal pemasangan dan juga terjadi failure adalah 3-4 bulan. Penyebab yang sering menyebabkan adalah ketidakpatuhan pasien dengan instruksi dokter paska operasi. Patah tulang terbuka dan infeksi merupakan faktor resiko tinggi dapat menyebabkan implant failure.