1) The study examined the effect of tempeh extract in promoting callus growth in patients with femoral fractures over 16 days. 2) 28 subjects with femoral fractures were divided into two groups - 14 received 50ml tempeh extract daily and 14 did not receive the extract. 3) Analysis found the group receiving tempeh extract had higher rates of positive callus growth (39.3%) compared to the control group (14.3%), indicating tempeh extract significantly promotes fracture healing.

1. EFFECT OF TEMPE EXTRACT IN CALLUS GROWTH,
A RESEARCH IN FEMORAL FRACTURE PATIENTS
BANDA ACEH
By
Joko Siswanto
Joko Siswanto1, Safrizal Rahman2, Armia Indra Nur Alam2
1. Resident departement of surgery, faculty of medicine, university of syiahkuala, ZaenalAbidin General Hospital Of Banda Aceh
2. Orthopaedic surgeon , departement of surgery, faculty of medicine, university of syiahkuala, ZaenalAbidin General Hospital Of Banda Aceh

2. Background
WHO noted, in 2011-2012 there were 5.6 million people died and 1.3 million
people suffered fractures due to traffic accidents
According to Ministru of
Health RI 2011, cases of limb
fractures has the highest
prevalence
Fr. Femoral  19.629 cases
Fr. Cruris  14.027 cases
Fr. Tibia  3.775 cases
Fr. Fibula  336 cases
Fr. Small bone  970 cases
Fracture problems
• Lead long time Healing
• Decreased Productivity

3. Tempe is one of soy fermentation product group
of Leguminoceae
• Has Phytoestrogen isolate
• High enough Isoflavon compound
Isoflavones in tempe has derivate contain by
genistein, daidzein, formonentin and biochanin
that increase Bone Health
Preliminary Study in anymals
"Isoflavones derived from soy milk could increase the
osteoblasts in the first week and can accelerate callus
formation in male white rats with femoral fracture"

4. Bone Healing Process

5. Components of bone growth
Bone Matrix (98%),
consist with
• Collagen (95%)
• Non collagen (3%)
Bone cell (2%)
• Osteoblas
• Osteosit
• Osteoklas
water
Anorganic substantion
and mineral

6. ROLE TEMPE EXTRACT IN BONE FRACTURE HEALING

7. Research purposes
Membuktikan pemberian tempe dapat
mempercepat pertumbuhan kalus pada
pasien fraktur tulang tibia.
To find the effect of tempe extract that can increasing bone
callus growth in femoral bone fracture patient

8. Research methods
This research was conducted in orthopedic
polyclinic and emergency room General
Hospital dr. Zainoel Abidin (RSUDZA) and
Meuraxa Hospital Banda Aceh.
Penelitian ini merupakan penelitian uji
klinis (clinical trials) desain paralel dengan
matching.
A clinical trial research with parallel
matching design

9. • There’s 14 subject with intervention exctrac tempe and 14 as controls
• Patient aged 20 to 40 years, Male sex.
• Having normal Body Mass Index (BMI) (18.5 - 24.9)
• Closed and open grade I and II femoral fractur on the diaphisis of the femur, Fracture
less than 2 weeks, Has no previous fracture history
• We exclude subject with abnormalities of liver and kidney function, history with
diabetes, community fracture, open fracture grade III and patient that refused to be
subject of the study.
Sample subject

10. Research variable
• Independent Variables
Tempe extract given as much as 50 ml (containing 50 mg of
isoflavones) given once per day for 16 days
• Dependent variables
Callus formation in 16 days after intervention exam by radiology
rontgent x ray antero-posterior in fracture site

11. Extract Tempe
• The Qoir Tempe extract
contains 200 ml
containing 198 mg of
isoflavones
• Presentation: 50 ml of
tempe extract brewed in
250 ml of water

12. Data Analysis
• Non parametric study, with two unpaired groups using Mann Whitney Test
• Significant value was P≤0,05, that mean there’s the different of callus growth in subject with tempe
extract and control.

13. Research Ethical
• This research submitted to the Ethics Committee in Faculty of
Medicine, Syiah Kuala University
• Sampling is done without coercion.
• All the procedures explained to the research subject.
• Procedures will only be undertaken if the research subject has filled
out a statement of willingness or informed-consent.
• The obtained data will be kept confidential

14. Result
• The study was conducted in the period from April 1 to July 30, 2017
• There were 28 subjects of patients with femoral fractures
• 14 subjects with tempeh extract and 14 as the control group.
• All subjects underwent surgery ( open .
• Femur rontgent in day 1 post-operation taken as proof of homogeneity of the sample, then performed
post-operative xray on day 16.

15. Basic Characteristics
Basic Characteristics Frequency (N) Percentage (%)
Usia
20-28 yo 19 67,9
29-40 yo 9 32,1
Location femoral fractur
Distal 2 7,1
Medial 21 75,0
Proximal 5 17,9
Site fracture
Dekstra 14 50,0
Sinistra 14 50,0
Bone trabecula in extract
subject
0/ no trabecula line 3 10,7
2 trabecula line 1 3,6
3 trabecula line 3 10,7
4 trabecula line 3 10,7
5 trabecula line 3 10,7
8 trabecula line 1 3,6
Bone trabecula in control
subjects
0/ no trabecula line 9 32,1
3 trabecula line 2 7,1
4 trabecula line 1 3,6
5 trabecula line 1 3,6
8 trabecula line 1 3,6
Total 30 100,0
• Mostly patients has medial femoral
fracture in 21 pastients (75%) with
equal number of right 50% and left
side 50% in extremity side
• The age characteristics subjects
were divided 20-28 years of 19
patients (67,9%) and 29-40 years
(32,1%).
• highest trabecular line seen in 4
subject (10,7%) with four lines,
three trabecular lines in 3 subjects
(10,7%) and 5 lines in 3 subjects
(10,7%).
• Against the control group without
provision of tempeh extract we
found the most subjects did not
show trabecular line 32,3%.

16. Discussion
• Subjects of femur fracture patients in this study were most aged 20-28 years 60% and 29-40
years 40%. Researchers have determined the age group of the subject is 20-40
• Variations in this age group were mostly young adults and were consistent with the mean in
epidemiological studies of femoral shaft fractures
• femoral fractures are often the result of high-energy trauma at a young age to adulthood,
high-energy trauma is associated with traffic accident incidents, falls and other violence
• femoral shaft fracture is the most common of limb fracture, it was number 2 of common
fratur 4.5% compared to the lower limb fracture in tibial 6.6% and 3.9% distal radius
Enninghorst N, McDougall D, Evans JA, Sisak K, Balogh ZJ. Population-based epidemiology
of femur shaft fractures. Journal of trauma and acute care surgery. 2013;74(6):1516-20.

17. Effect of giving tempe extract on growth callus fracture
Variable Result in day 16 P-value
Positif Negatif
Frequency
(n)
Percentage
(%)
Frequency
(n)
Percentage
(%)
With tempe
extract
11 39,3 3 10,0 0,024*
Control
without tempe
4 14,3 10 35,7
• The group with tempe extract has the highest amount in the positive results
with 12 subjects (39,3%)
• While the control group only had 4 subjects (14,3%).
• The negative result of absence of callus on day 16 was seen more in the
control group who did not receive tempe extract
• The effect of giving tempeh extract on callus growth was done by different
test which showed significant result (P = 0,024).

18. POD 1Preoperative POD 16
18

19. Prove of isoflavon promote bone healing
• In biomoleculer study genistein and daidzein (another isoflavone) has been show
inhibition effect for cytokine interleukin-6 (IL-6), interleukin-1β (IL-1β), nitric oxide
(NO) and prostaglandin E2 (PGE2).
• by isoflavone in soybeen there’s preasure of count cytokine proinflammation in 48 Hours
• The inhibiton of those cytokine could promote osteoblastic cell function and has role for
bone remodelling process
Sik Suh K, Koh G, Young Park C, Taek Woo J, Woon Kim S, Woo Kim J, et al. Soybean isoflavones
inhibit tumor necrosis factor-α-induced apoptosis and the production of interleukin-6 and prostaglandin E2
in osteoblastic cells. Phytochemistry. 2003;63(2):209-15.

20. Conclusion and suggestion
Conclusion
• Patients with femoral fracture who underwent surgery and receive tempeh extract had more
positif callus results (40%) than those who without the extract of tempe /control subject
(16,7%)
• The provision of tempe extract significantly influence (P = 0,028) on fracture callus growth
in post-operative bone fracture patients.
• Isoflavones has good benefit healing process of bone fracture.
Suggestion
• Required another study using more number of samples in bone fractures patients
• Needed more study in benefit of another antioxidan beside isoflavone in tempe extract

21. Documentation