N. Serdar NECMİOĞLU, Mehmet SUBAŞI, Cuma KAYIKÇI

Ateşli silah yaralanması sonucu oluşan femur kırıklarının minimal invaziv plaklama tekniği ile tedavisi

Amaç: Bu çalışmada, ateşli silahla yaralanma sonucu oluşan açık parçalı femur kırıklarının indirekt redüksiyonla tedavisi değerlendirildi. Çalışma planı: Ateşli silahla yaralanma sonucu oluşan açık parçalı femur kırığı nedeniyle tedavi edilen 17 hasta (15 erkek, 2 kadın; ort. yaş 34; dağılım 15-67) geriye dönük olarak incelendi. Kırıklar AO sistemine göre sınıflandırıldı. Minimal invaziv perkütan plaklama yönteminin erken veya geç dönemde uygulanmasına karar verilirken Gustilo-Anderson açık kırık sınıflaması temel alındı. Kırıkların yedisi subtrokanterik, yedisi suprakondiler, üçü diyafiz bölgesindeydi. Vasküler patolojisi olan iki hastaya eksplorasyon ile birlikte damar tamiri uygulandı. Nörolojik yaralanması olan iki hastada sinir eksplore edilmedi. Yedi hasta erken dönemde ortalama 1.3 günde (dağılım 1-2 gün), 10 hasta geç dönemde ortalama 11.1. günde (dağılım 7-15 gün) ameliyat edildi. Ortalama izlem süresi 25 ay (dağılım 14-42 ay) idi. Sonuçlar: On altı hastada ortalama 4.4 ayda (dağılım 2.5-7 ay) kaynama elde edildi. Dört hastada kavitasyon ve defekt görülmesi üzerine geç dönemde primer, bir hastada dördüncü ayda kaynama gecikmesi üzerine sekonder otojen kemik grefti uygulandı. Ameliyat sonrası dönemde komplikasyon olarak bir olguda (%5.9) yüzeyel enfeksiyon, bir olguda derin enfeksiyon, sekiz olguda (%47.1) 0.5-2 cm arasında ekstremite eşitsizliği ve ortalama 5° (3-8°) varus-valgus açılanması gözlendi. İzlem süresince tekrarlayan kırık görülmedi. Çıkarımlar: Ateşli silah yaralanması ile oluşan tip IHA ve tip IIIB açık femur kırıklarında minimal invaziv perkütan plakla tespit yönteminin uygun bir tedavi seçeneği olduğunu düşünüyoruz.

Anahtar Kelimeler:

Kırık tespiti, internal, Cerrahi işlemler, minimal invaziv, Kemik plakları, Yaralar, ateşli silah, Femur kırıkları

Minimally invasive plate osteosynthesis in the treatment of femur fractures due to gunshot injuries

Objectives: The results of treatment with minimally i plate osteosynthesis were evaluated in open comi femur fractures due to high-velocity gunshot injuries. Methods: Seventeen patients (15 males, 2 females; mea years; range 15 to 67 years) with open comminuted fen tures due to high-velocity gunshot injuries were includ fractures were classified according to the AO system. Ti minimally invasive percutaneous plate fixation was det according to the classification of open fractures in the Anderson system. There were seven subtrochanteric supracondylar, and three diaphyseal fractures. During exploration, two patients underwent vascular repair pathologies. No exploration was performed in two cas neurological damage. Seven patients were operated oi early period (mean 1.3 days; range 1 to 2 days) and 10 pa the late period (mean 11.1 days; range 7 to 15 days). Th follow-up was 25 months (range 14 to 42 months). Results: Union was obtained in a mean of 4.4 months 2.5 to 7 months) in 16 patients. Autogenous grafting w formed in four patients who presented with a cavitati defect in the late period and in one patient due to c union in the postoperative fourth month. Compli included superficial infection in one patient (5.9%i infection in one patient, and length discrepancy ( to 2 cm) with a varus-valgus angulation (mean 5°, ran 8°) in eight patients (47.1%). No refractures occurred the follow-up period. Conclusion: Minimally invasive percutaneous plat tion can be considered an alternative technique in tyj and IIIB open fractures resulting from high-velocit shot injuries.

Keywords:

Fracture Fixation, Internal, Surgical Procedures, Minimally Invasive, Bone Plates, Wounds, Gunshot, Femoral Fractures,

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