Memduh HEYBELİ, HASAN HİLMİ MURATLI, Levent ÇELEBİ, Serap GÜLÇEK, ALİ BİÇİMOĞLU

Çocuklardaki femur cisim kırıklarında titanyum elastik çivilerle intramedüller tespit sonuçları

Amaç: Çocukluk dönemindeki femur cisim kırıklarında titanyum elastik çivilerle (TEÇ) intramedüller tespitin kli-nik ve radyolojik sonuçları değerlendirildi. Çalışma planı: Retrograd yolla TEÇ ile intramedüller tespit uygulanan 35 femur kırığı (34 hasta; 20 erkek, 14 kız; ort. yaş 8.3; dağılım 5-14) çalışmaya alındı. Sonuçlar Flynn ve ark.mn TEÇ sonuç skorlamasına göre değerlendirildi. Kırık kaynama süreleri ile ön-arka ve yan planlarda açılanma miktarları radyografik olarak değerlendirildi. On dört hastada (14 kmk) bilgisayarlı tomografi (BT) ile femoral anteversiyon açıları (FAA) ve alt ekstremite uzunlukları ölçüldü ve sağlam taraf değerleri ile Wilcoxon testi kullanılarak karşılaştırıldı. Ortalama izlem süresi 28 ay (dağılım 4-48 ay) idi. Sonuçlar: Flynn ölçütlerine göre 25 kırıkta (%71.4) mükemmel, dokuz kırıkta (%25.7) başarılı, bir kırıkta (%2.9) kötü sonuç elde edildi. Radyografik kaynama süresi ortalama 7.4 hafta (dağılım 5-12 hafta) idi. Üç kırıkta 10 derece veya altında yan planda açılanma, birinde ön-arka planda sekiz derece açılanma saptandı. Yedi hastada (%20.6) bacak uzunluğunda 2 cm'den az eşitsizlik görüldü. Bilgisayarlı tomografi ile yapılan FAA ölçümlerinde kırık tarafın sağlam tarafa göre anlamlı derecede retroversiyonda olduğu saptandı (p

Anahtar Kelimeler:

Tomografi, x-ışınlı bilgisayarlı, Tedavi sonucu, Çocuk, Femur kırıkları, Titanyum, Kırık tespiti, internal, Kemik çivileri

The results of intramedullary fixation with titanium elastic nails in children with femoral fractures

Objectives: We evaluated clinical and radiologic results of intramedullary fixation with titanium elastic nails (TEN) in children with femoral fractures. Methods: The study included 35 femoral fractures of 34 patients (20 boys, 14 girls; mean age 8.3 years; range 5 to 14 years) who were treated by intramedullary fixation with TEN. The results were evaluated according to the scoring system proposed by Flynn et al. Time to union and residual angulations were assessed on anteroposterior and mediolateral radiographs. Femoral anteversion angles and limb lengths were measured in comparison with the normal side by computed tomography (CT) in 14 patients and the results were compared using the Wilcoxon test. The mean follow-up period was 28 months (range 4 to 48 months). Results: According to the criteria by Flynn et al., the results were excellent in 25 fractures (%71.4), successful in nine fractures (%25.7), and poor in one fracture (%2.9). The mean time to union was 7.4 weeks (range 5 to 12 weeks). Mediolateral and anteroposterior radiographs showed an angulation of 10 degrees or less in three fractures and of 8 degrees in one fracture, respectively. Limb length discrepancy of less than 2 cm was detected in seven patients (%20.6). Femoral anteversion angles measured by CT revealed significant retroversions on the fractured sides (p<0.01). Conclusion: Intramedullary fixation with TEN may be the preferred method for the treatment of femoral fractures in children aged 5 to 15 years. However, residual rotation detected by CT seems to be a technical challenge to be improved.

Keywords:

Tomography, X-Ray Computed, Treatment Outcome, Child, Femoral Fractures, Titanium, Fracture Fixation, Internal, Bone Nails,

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