Sinan ZEHİR, Ercan ŞAHİN, Serkan SİPAHİOĞLU

Yetişkin femur cisim kırıklarında genişleyebilir intramedüller çivi uygulamasının sonuçları

Amaç: Çalışmamızda AO-32A ve 32B yetişkin femur cisim kırıklarında genişleyebilir intramedüller çivilerin kullanımı ve sonuçlarını değerlendirdik.Hastalar ve metod: En az 1 yıllık takipleri olan, AO-32A ve 32B yetişkin femur cisim kırığı nedeniyle genişleyebilir intramedüller çivi tedavisi uygulanmış 71 hasta (25 kadın, 46 erkek; ortalama yaş 37,2 yıl; yaş aralığı, 17-83 yıl) retrospektif olarak çalışmaya alındı. Ameliyat süreleri ameliyat notlarından kayıt edildi. Hastalar son kontrollerinde klinik olarak Thoresen kriterlerine göre değerlendirildi ve alt ekstremite uzunluk farkları not edildi. Radyolojik olarak ise kırığın kaynamasına ve redüksiyonun devamlılığına bakıldı.Bulgular: 64 çivi açık cerrahi yaklaşımla, 7 çivi ise kapalı cerrahi yaklaşımla uygulandı ve ortalama ameliyat süresi 78 dakika (60-135 dakika) olarak bulundu. Olguların 63 (%88,7)’ünde kaynama gerçekleşti ve ortalama kaynama süresi 18 hafta (13-32 hafta) idi. Son kontrollerde yapılan muayenede Thoresen kriterlerine göre 51 (%71,8) çok iyi, 12 (%16,9) iyi, 6 (%8,4) orta ve 2(%2,8) olguda kötü sonuç alındı. 1 olguda 3 cm kısalık, 3 olguda 2 cm kısalık, bir olguda 1 cm kısalık ve 2 olguda ise <1 cm kısalık vardı. 7 olguda diz ön ağrısı gelişti. 3 (%4,2) olguda uygulanan çivi şişirilemedi. 15 (%21,1) olguda çivi uygulandıktan sonra şişirilmeyi takiben kırık hattı etrafında femur medullasının genişleme, bir olguda lateral sirkumfleks femoral arter yaralanması oluştu. Olguların 4 (%5,6)’ünde yüzeyel enfeksiyon görüldü ve antibiyotik tedavisi ile iyileşme sağlandı. Sonuç: Genişleyebilir intramedüller çiviler uygulama zorluğu ve sebep olabileceği komplikasyonlar nedeniyle sınırlı endikasyonlarla kullanılmalıdır.

Anahtar Kelimeler:

Femur kırıkları, intramedüller çivileme, genişleyebilen çivi

Results of expandable intramedullary nailing in femoral shaft fractures

Objective: To evaluate the use and results of expandable intramedullary nails applied to adult AO-32A and 32B femoral shaft fractures.Patients and methods: This retrospective study included 71 patients (25 females, 46 males; mean age 37.2 years, range 17-83 years) applied with expandable intramedullary nailing treatment for AO-32A and 32B femoral shaft fractures, with at least a 1-year follow-up period. Operating time was recorded from the operating notes. At the final follow-up examinations, patients were evaluated clinically according to the Thoresen criteria and lower limb length differences were recorded. Bone union and continuity of reduction were examined radiologically. Results: 64 nails were applied with an open surgical approach and 7 nails with a closed surgical approach. Operating time was mean 78 mins (range, 60-135 mins). In 63 (88.7%) cases, bone union was delayed and the mean time to union was 18 weeks (range, 13-32 weeks). According to the Thoresen criteria at the final follow-up examination, the results were very good in 51 (71.8%) cases, good in 12 (16.9%), fair in 6 (8.4%) and poor in 2 (2.8%). Shortness of 3cm was determined in 1 case, 2cm in 3 cases, 1cm in 1 case and <1cm in 2 cases. Anterior knee pain developed in 7 cases. The nail applied did not expand in 3 (4.2%) cases. In 15 (21.1%) cases, following inflation after application of the nail, expansion of the femur medulla developed around the fracture line and in 1 case this caused injury to the lateral circumflex femoral artery. Superficial infection was observed in 4 (5.6%) cases, which recovered with antibiotic treatment. Conclusion: As the application of expandable intramedullary nails is difficult and could cause complications, they should be used with limited indications.

Keywords:

Femur fractures, intramedullary nailing, expandable nail,

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