Di Susun Oleh :
Pembimbing:
Puji syukur kami panjatkan kepada Allah Azza wa Jalla dengan karuniaNya semata
penulis dapat menyelesaikan tugas akhir yang berjudul :
Karya ilmiah ini tidak akan terselesaikan tanpa dukungan berbagai pihak, oleh karena
itu penulis mengucapkan terimakasih yang sebesar-besarnya kepada ;
5. Seluruh staf pengajar di FK UNS, RS Dr Moewardi dan RSO Prof. Dr. dr. Soeharso
7. Seluruh pihak yang tidak dapat saya sebutkan satu persatu yang telah membantu secara
langsung maupun tidak langsung
Semoga Allah SWT selalu melimpahkan rahmatNya dan semoga karya ini dapat
bermanfaat dikemudian hari. Terimakasih
Hormat kami,
Penulis
ii
LEMBAR PENGESAHAN
Telah disetujui dan disahkan oleh Pembimbing Tugas Akhir Program Pendidikan Dokter
Spesialis I Orthopaedi dan Traumatologi Fakultas Kedokteran Universitas Sebelas Maret /
RSUD Dr. Moewardi Surakarta / RSO Prof. Dr. dr. Soeharso hasil penelitian yang berjudul :
Sebagai salah satu persyaratan untuk menyelesaikan Program Pendidikan Dokter Spesialis I
Orthopaedi dan Traumatologi Fakultas Kedokteran Universitas Sebelas Maret / RSUD Dr.
Moewardi Surakarta / RSO Prof. Dr. dr. Soeharso
dr. Iwan Budiwan Anwar, Sp.OT (K) dr. Agus Priyono, Sp.OT (K)
NIP 196003041988011001
iii
Telah diuji dan diseminarkan pada hari November 2014
dr. Iwan Budiwan Anwar, Sp.OT (K) dr. Agus Priyono, Sp.OT (K)
NIP 196003041988011001
NIP 19570907198410100
NIP 196206291989031004
iv
DAFTAR ISI
HALAMAN JUDUL..................................................................................... i
KATA PENGANTAR................................................................................... ii
LEMBAR PENGESAHAN.......................................................................... iii
DAFTAR ISI................................................................................................. iv
DAFTAR GAMBAR..................................................................................... v
DAFTAR TABEL......................................................................................... vi
ABSTRAK..................................................................................................... vii
BAB I PENDAHULUAN.............................................................................. 1
1.1 Latar Belakang.......................................................................................... 1
1.2 Permasalahan............................................................................................ 3
1.3 Tujuan....................................................................................................... 3
1.4 Manfaat..................................................................................................... 4
BAB II TINJAUAN PUSTAKA.................................................................. 5
2.1 Osteoporosis.............................................................................................. 5
2.2 Pola Trabekula Femur Proksimal dan Singh Index.................................. 8
2.3 Beban pada Proksimal Femur Saat Jatuh.................................................. 16
2.4 Fraktur Panggul (Hip Fracture)................................................................ 19
2.5 Kerangka Konsep Teori............................................................................ 28
2.6 Hipotesis................................................................................................... 28
BAB III METODE PENELITIAN.............................................................. 29
3.1. Jenis Penelitian......................................................................................... 29
3.2. Lokasi Penelitian...................................................................................... 29
3.3. Obyek Penelitian...................................................................................... 29
3.4. Besar Sampel........................................................................................... 29
3.5. Pengambilan Sampel................................................................................ 30
3.6. Variabel Penelitian................................................................................... 31
3.7. Definisi Operasional Variabel Penelitian................................................. 31
3.8. Pengumpulan Data................................................................................... 32
3.9. Analisis data............................................................................................. 33
3.10. Kerangka Penelitian............................................................................... 33
BAB IV HASIL DAN PEMBAHASAN...................................................... 34
4.1 Distribusi umur......................................................................................... 34
4.2 Frekuensi modified Singh index pada populasi........................................ 36
4.3 Perbedaan umur pada kelompok fraktur femur proksimal....................... 41
4.4 Perbedaan modified Singh index pada fraktur femur proksimal ............. 41
4.5 Korelasi antara umur terhadap modified Singh index............................. 43
4.6 Korelasi umur terhadap pola fraktur femur proksimal.............................. 44
4.7 Korelasi bivariat modified Singh index terhadap pola fraktur femur
proksimal......................................................................................................... 45
BAB V KESIMPULAN DAN SARAN....................................................... 48
5.1 Kesimpulan............................................................................................... 48
5.2 Saran.......................................................................................................... 48
DAFTAR PUSTAKA.................................................................................... 49
LAMPIRAN................................................................................................... 50
v
DAFTAR GAMBAR
Gambar 2.1............................................................................................... 9
Gambar 2.2............................................................................................... 11
Gambar 2.3............................................................................................... 11
Gambar 2.4............................................................................................... 12
Gambar 2.5............................................................................................... 12
Gambar 2.6............................................................................................... 13
Gambar 2.7............................................................................................... 14
Gambar 2.8............................................................................................... 14
Gambar 2.9............................................................................................... 20
Gambar 2.10............................................................................................. 23
Gambar 2.11............................................................................................. 26
Gambar 2.12............................................................................................. 27
Gambar 2.13............................................................................................. 28
Gambar 3,1............................................................................................... 33
Gambar 4.1............................................................................................... 37
Gambar 4.2............................................................................................... 38
Gambar 4.3............................................................................................... 38
Gambar 4.4............................................................................................... 39
Gambar 4.5............................................................................................... 40
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DAFTAR TABEL
Tabel 2.1.................................................................................................. 6
Tabel 4.1.................................................................................................. 34
Tabel 4.2.................................................................................................. 35
Tabel 4.3.................................................................................................. 36
Tabel 4.4.................................................................................................. 41
Tabel 4.5.................................................................................................. 41
Tabel 4.6.................................................................................................. 42
Tabel 4.7.................................................................................................. 43
Tabel 4.8.................................................................................................. 44
Tabel 4.9.................................................................................................. 45
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STUDI KOMPARASI MODIFIED SINGH INDEX PADA KASUS FRAKTUR
COLLUM FEMUR DAN FRAKTUR INTERTROCHANTER FEMUR PADA PASIEN
WANITA GERIATRI
(Karya Akhir)
Abdul Basith Ash Shiddieqy
ABSTRAK
Latar Belakang: Osteoporosis sering disebut “silent epidemic” dengan biaya kesehatan
yang cukup signifikan dalam hubungannya dengan fraktur. Meskipun DEXA merupakan gold
standard untuk mengukur osteoporosis, banyak rumah sakit di Indonesia belum memiliki
fasilitas ini. Penelitian dengan menggunakan multi-detector computed tomography (MDCT)
mengungkapkan korelasi yang bermakna antara degenerasi trabekula dengan kejadian fraktur
collum atau intertrochanter femur. Pemeriksaan sederhana untuk osteoporosis yang dapat
dilakukan salah satunya yaitu dengan foto rontgen polos, dengan menilai pola trabekulasi
proximal femur dengan metode Singh (Singh Index). Tujuan dari penelitian ini adalah untuk
mengetahui perbedaan pola trabekulasi dengan metode Singh Index terhadap kejadian fraktur
collum femur atau fraktur intertrochanter.
Metode: Penelitian ini merupakan Penelitian Observational Analitic Cross Sectional. Objek
penelitian adalah foto rontgen pelvis AP dari pasien wanita geriatri (n: 64) yang mengalami
fraktur collum femur dan fraktur intertrochanter femur karena simple falls. Untuk mengurangi
bias, digunakan kriteria modified Singh index menurut Shankar, dengan penelaahan oleh
konsultan radiologi. Komparasi modified Singh index dilakukan antara kelompok fraktur
collum femur dan fraktur intertrochanter femur. Uji statistik dilakukan dengan t-test dan chi-
square.
Hasil penelitian: Pada kelompok umur antara fraktur collum femur dan fraktur
intertrochanter terdapat perbedaaan signifikan (p<0,05) dengan rata-rata usia fraktur collum
femur lebih tua (69.8470 vs 72.4030). Dengan uji chi-square, derajat modified Singh index
antara kelompok fraktur collum femur dan fraktur intertrochanter ditemukan perbedaan yang
signifikan (p: 0,008) dengan nilai t-test 1.2898 untuk kelompok fraktur intertrochanter dan
1.5539 untuk fraktur collum femur, dimana kelompok collum femur lebih baik. Tidak
ditemukan korelasi antara umur dengan pola modified Singh Index. Terdapat korelasi yang
bermakna antara modified Singh index dengan kejadian fraktur femur proksimal dengan
hubungan semakin jelek pola trabekula semakin memungkinkan terjadi fraktur
intertrochanter (p: 0,02).
Kesimpulan: Pada penelitian ini dapat ditarik kesimpulan bahwa terdapat korelasi yang
signifikan, pola degenerasi trabekula femur proksimal dengan metode modified Singh index,
terhadap kasus frakur collum femur dan frakur intertrochanter
Kata kunci: Modified Singh Index, Fraktur Proximal Femur, Wanita Geriatri
viii
COMPARATIVE STUDY OF MODIFIED SINGH INDEX ON FEMORAL NECK
FRACTURE AND INTERTROCHANTERIC FRACTURE IN GERIATRIC WOMAN
POPULATION
(Final Paper)
Abdul Basith Ash Shiddieqy
ABSTRACT
Background: Osteoporosis often called a silent epidemic with significant financial burden in
the relation of porosity fracture. Although DEXA was considered as a gold standard on
osteoporosis measurement, many hospital in Indonesia not have this facility yet. A study
using multi-detector computed tomography (MDCT) shows significant correlations betwen
trabecular degeneration with femoral neck fracture and intertrochanteric fracture. A simple
measurement for osteoporotic could be carried out using plain x-ray by evaluating the
proximal femur trabecular pattern using Singh index. The objective of this study was to
evaluate the difference of trabecular pattern of Singh index between femoral neck fracture
and intertrochanteric fracture
Method: The design of this study was observational analytic, cross sectional. The object of
the study was pelvic plain x-ray from geriatric woman patients (n:64) which sustaining
femoral neck fracture or intertrochanteric fracture due to simple falls. To reduce the bias, we
use modified Singh index by Shankar and the x-ray was interpreted by radiologic consultant.
A comparison of modified Singh index was carried out between femoral neck fracture and
intertrochanter fracture. The statistical analysis was using t-test and chi-square
Result: On the age group, there was a significant difference between femoral neck group and
intertrochanter group (p<0,05) with the mean age of femoral neck was older (69.8470 vs
72.4030). By chi-square analysis, the value of modified Singh index was different
significantly between group (p:0,008) with the mean value 1.5539 for femoral neck and
1.2898 for intertrochanter, the femoral neck was better. There was no correlation between age
and pattern of Singh index. There was significant correlation between modified Singh index
with occurence of proximal femur fracture, the poorer of trabecular pattern, the higher
possibility of intertrochanteric fracture (p:0,002)
Conclusion: In this study, there was a significant correlations of the proximal femur
trabecula degeneration pattern by modified Singh index method, in the case of femoral neck
and intertrochanteric fracture
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