Yusuf ÖZTÜRKMEN, Cemal DOĞRUL, Mehmet B. BALİOĞLU, Mahmut KARLI

Çocuk femur diafiz kırıklarının elastik Ender çivileriyle intramedüller stabilizasyonu

Amaç: Çocuk femur diafiz kırıklarının elastik Ender çivileriyle intramedüller cerrahi stabilizasyonunun sonuçları değerlendirildi. Çalışma planı: Yirmi altı çocuktaki (19 erkek, 7 kız; ort. yaş 8.9; dağılım 5.9–12.3) femur diafiz kırığına retrograt olarak fleksibl Ender çivileri ile osteosentez yapıldı. On dokuz olguda izole femur diafiz kırıkları bulunurken, diğer olgular politravmatize idi. Kırık femur, üç olguda 1/3 proksimalde, beş olguda 1/3 distalde, 18 olguda 1/3 ortada idi. Ortalama 22.3 ay (dağılım 8-47 ay) izlenen olguların radyolojik değerlendirmesi ön-arka ve yan grafilerle yapıldı. Takip süresi bir yılın üzerinde olan 25 olguda, ortoröntgenografi ile ektremite boyları ölçüldü. Klinik olarak kalça ve diz hareketleri, yürüme şekilleri değerlendirildi. Sonuçlar: Olguların hepsinde ortalama 6.6 haftada (dağılım 5-12 hafta) kaynama sağlandı. Yirmi dört olgu, radyolojik olarak ön-arka grafilere göre normal aksında iyileşirken, bir olgu 5° varus, bir olgu 7° valgusta iyileşti. Yan grafilere göre, bir olguda 7° öne, bir olguda 6° arkaya angulasyon vardı. On dokuz olguda (%76) femur, karşı taraf femuru ile eşit uzunlukta iken, dördünde (%16) ortalama 7 mm uzunluk, ikisinde (%8) ortalama 6 mm kısalık saptandı. Biri dışında bütün olgular simetrik adım atıyordu. Biri dışında hepsinde kalça ve diz hareket aralığı tam idi. Olguların hiçbirinde kaynama gecikmesi, enfeksiyon, kaynamama, çivi kırılması gözlenmedi. Hiçbir olguda büyüme potansiyelinin durması veya femur epifizlerinde hasar saptanmadı. Çivi çıkarılan olguların hiçbirinde kırık tekrarlamadı. Çıkarımlar: Elastik Ender çivileri ile intramedüller çivileme 6-12 yaş arası çocuklarda femur diafiz kırıklarının tedavisinde etkili bir fiksasyon yöntemidir.

Anahtar Kelimeler:

Kemik çivileri, Elastikiyet, Radyografi, Çocuk, Femur kırıkları, Kırık tespiti, intramedüller

Intramedullary stabilization of pediatric diaphyseal femur fractures with elastic Ender nails

We evaluated the results of intramedullary stabilization of pediatric diaphyseal femur fractures with elastic Ender nails. Methods: Twenty six children (19 boys, 7 girls, mean age 8.9 years, range 5.9 to 12.3 years) were stabilized with flexible intramedullary Ender nails placed by the retrograde technique. Nineteen were isolated femoral fractures. The fractures occurred in the middle third (n=18), distal third (n=5), and proximal third (n=3) of the femur. The mean follow-up was 22.3 months (range 8 to 47 months). Radiologically, anteroposterior and lateral radiographs were evaluated. To determine leg length discrepancy, 25 children had scanograms beyond 12 months. Clinically, the level of the hip and knee motion and walking patterns were evaluated. Results: Union was achieved in all patients within a mean of 6.6 weeks (range 5 to 12 weeks). Twenty four fractures healed with a normal anteroposterior alignment while two children had 5° varus and 7° valgus, respectively. Lateral radiographs showed an anterior a ngulation of 7° and a posterior angulation of 6° in two patients, respectively. The femur length remained equal to that of the contralateral side in 19 patients (76%), whereas it exceeded by a mean of 7 mm in four, and shortened by a mean of 6 mm in two children. All patients but one had a symmetric walking pattern. All children but one had a normal range of hip and knee motion. No instances were observed concerning delayed union, infection, nonunion, rod fractures, growth arrest, injury to the femoral epiphysis, or refractures after rod removal. Conclusion: Intramedullary nailing with the use of elastic Ender nails provided effective fixation in the treatment of femoral shaft fractures in children 6 to 12 years of age.

Keywords:

Bone Nails, Elasticity, Radiography, Child, Femoral Fractures, Fracture Fixation, Intramedullary,

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1.Heinrich SD, Drvaric DM, Darr K, MacEwen GD. The operative stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails: a prospective analysis. J Pediatr Orthop 1994;14:501-7.
2. Hansen ST. Internal fixation of children's fractures of the lower extremity. Orthop Clin North Am 1990;21:353-63.
3. Ogden JA. Skeletal injury in the child. 2nd ed. Philadelphia: W.B.Saunders; 1990.
4. Canale ST. Fractures and dislocations in children. In: Canale S T, editor. Campbell's operative orthopedics. 9th ed. St. Louis: Mosby; 1998. p. 2476-82.
5. Galpin RD, Willis RB, Sabano N. Intramedullary nailing of pediatric femoral fractures. J Pediatr Orthop 1994;14:184-9.
6. Carey TP, Galpin RD. Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop 1996;(332):110-8.
7. Canale ST, Tolo VT. Fractures of the femur in children. J Bone Joint Surg [Am] 1995;77:294-315.
8. Gray D. Femur fractures. In: Richards BS, editor. Orthopaedic knowledge update pediatrics. Illinois: American Academy of Orthopaedic Surgeons; 1996. p. 229-37.
9. Mann DC, Weddington J, Davenport K. Closed Ender nailing of femoral shaft fractures in adolescents. J Pediatr Orthop 1986;6:651-5.
10. Ligier JN, Metaizeau JP, Prevot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg [Br] 1988;70:74-7.
11.Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg [Am] 1984;66:529-39.
12. Buess E, Kaelin A. One hundred pediatric femoral fractures: epidemiology, treatment attitudes, and early complications. J Pediatr Orthop B 1998;7:186-92.
13. Reeves RB, Ballard RI, Hughes JL. Internal fixation versus traction and casting of adolescent femoral shaft fractures. J Pediatr Orthop 1990;10:592-5.
14. Newton PO, Mubarak SJ. Financial aspects of femoral shaft fracture treatment in children and adolescents. J Pediatr Orthop 1994;14:508-12.
15. Hughes BF, Sponseller PD, Thompson JD. Pediatric femur fractures: effects of spica cast treatment on family and community. J Pediatr Orthop 1995;15:457-60.
16.Ward WT, Levy J, Kaye A. Compression plating for child and adolescent femur fractures. J Pediatr Orthop 1992;12: 626-32.
17. Beaty JH, Austin SM, Warner WC, Canale ST, Nichols L. Interlocking intramedullary nailing of femoral-shaft fractures in adolescents: preliminary results and complications. J Pediatr Orthop 1994;14:178-83.
18. Lascombes P, Bodenreider O, Pr�vot J, Leneveu E. The use of flexible intramedullary pins in the treatment of fractures of the femur in children: 250 cases. J Bone Joint Surg [Br] 1993;(75 Suppl II):162.
19. MacEwen GD, Heinrich SD, Drvaric D, Dorr K. The North American experience of flexible intramedullary nails using the non C technique. J Bone Joint Surg [Br] 1993;(75 Suppl II):162.
20.Vrsansky P, Bourdelat D, Al Faour A. Flexible stable intramedullary pinning technique in the treatment of pediatric fractures. J Pediatr Orthop 2000;20:23-7.
21.Yağmurlu MF, Muratlı HH, Heybeli M, Biçimoğlu A. Kapalı intramedüller fleksibl titanyum çivileriyle izole pediatrik femoral şaft kırıklarının fiksasyonu. In:Alpaslan MM, editör. 17. Ulusal Ortopedi ve Travmatoloji Kongre Kitabı; 24-29 Ekim 2001; Antalya, Türkiye. İstanbul: Turgut; 2001. s. 319-21.
22. Clement DA, Colton CL. Overgrowth of the femur after fracture in childhood. An increased effect in boys. J Bone Joint Surg [Br] 1986;68:534-6.
23. Shapiro F. Fractures of the femoral shaft in children. The overgrowth phenomenon. Acta Orthop Scand 1981;52:649-55.
24. McCartney D, Hinton A, Heinrich SD. Operative stabilization of pediatric femur fractures. Orthop Clin North Am 1994;25:635-50.
25.Wallace ME, Hoffman EB. Remodelling of angular deformity after femoral shaft fractures in children. J Bone Joint Surg [Br] 1992;74:765-9.
26. Pankovich AM, Goldflies ML, Pearson RL. Closed Ender nailing of femoral-shaft fractures. J Bone Joint Surg [Am] 1979;61:222-32.