Efficacy of trifocal versus bifocal bone transport on large tibial bone defect: a systematic review and meta-analysis

One of the most common long-term complication of chronic osteomyelitis of tibia is segmental bone loss. One of the methods to manage the segmental bone loss in osteomyelitis is bone transport technique, which is able to reconstruct a defect of more than 6 cm. This paper aims to systematically review and analyze the outcome of bifocal and trifocal bone distraction technique on the tibial bony defect. A comprehensive literature search was performed using PubMed, Google Scholar, and Cochrane library. The inclusion criteria were any studies about comparison between bifocal bone transports with trifocal bone transport in management of large tibial bone defect. The outcomes assessed includes external fixation index, duration of regenerate consolidation, lengthening speed, bone transport distance, and operating time. Two studies reported shorter external fixation index in total of 57 fractures in the trifocal group and 61 fractures in the bifocal group. The meta-analysis showed significant difference in external fixation index between the two groups (Figure 1; RR=-44.37; 95% CI 73.73-15.01; p<0.0001) with significant heterogeneity (Chi square=11.38, p=0.0007); I2: 91%. Although only two studies were compared, both studies had almost similar subjects, and shown that trifocal bone transport technique had faster external fixator index compared to the bifocal bone transport group in the setting of severe bone loss in tibial fracture

THE TRANSFORMATION OF PRIVATE VEHICLE USERS TO PUBLIC TRANSPORT USERS (CASE STUDY: BALI, INDONESIA)

One of the roots traffic congestion is high number of private vehicle which triggered by an increase in the number of population. Switching users of private vehicle to public transport regarding to the affecting factor supposed to be examining first to solve traffic congestion. Based on factor analysis, there are two major factor on transport mode choice; quality (time, comfort, cleanness, safety, security, accessibility, and reliability ) and cost. Therefore, the government should be taking into considerations priority, which offer high contribution on solution made as priority. In order to achieving goal; the quality criteria reached contribution value that of 68% and 32% for cost criteria. Quality criteria compiled by time which has 61.8% of contribution value, safety (15.2%), accessibility (9.1%), security (8.8%), reliability (2.4%), comfort (1.7%), and cleanness as the priority within quality criteria has 1% of contribution. On the other dimension, cost criteria contain of fuel subsidy reached 95.664% of contribution, parking rate (3.947%), progressive tax (0.366%), and LCGC issue (0.023%)

THE SHIFTING OF PRIVATE VEHICLE USERS TO PUBLIC TRANSPORT USERS (CASE STUDY : BALI, INDONESIA)

Bali has quite similar problems on traffic disorder compare to other city in Indonesia. One of the roots traffic congestion is high number of private vehicle which triggered by an increase in the number of population. Furthermore, the increasing of private vehicle tends to stimulate additional problems such as pollution, noise, and energy consumption. These circumstances cannot be neglected since it leads to the decreasing quality of life and threaten sustainability development. Numerous efforts have been conducted in order to solve those problems. Yet, the government remains focuses on build new infrastructure or based on conventional approaches. On the contrary, constructing the new infrastructure might even increase the demand of transport. Hence, in order to overcome traffic congestion through switching users of private vehicle to public transport, the affecting factor supposed to be examining first. Based on factor analysis, there are two major factor on transport mode choice in Bal