METİN UZUN, Erden ERTÜRER, İRFAN ÖZTÜRK, Şenol AKMAN, Faik SEÇKİN, İSMAİL BÜLENT ÖZÇELİK

Dengesiz intertrokanterik femur kırıklarının proksimal femoral çivi ile tedavisi sonrasında geç dönem radyograﬁk komplikasyonlar ve bunların fonksiyonel sonuçlara etkileri

Amaç: Dengesiz (instabil) intertrokanterik kalça kırıklarının Proksimal Femoral Çivi (PFN) ile tedavisi sonrasında gelişen radyografik komplikasyonlar ve bu komplikasyonların fonksiyonel sonuçlara etkileri değerlendirildi. Çalışma planı: Dengesiz intertrokanterik kırık nedeniyle 35 hasta (23 kadın, 12 erkek; ort. yaş 71; dağılım 62-111) PFN ile tedavi edildi. AO sınıflamasına göre 12 kırık tip AII-1, 12 kırık AII-2, 3 kırık AII-3, 3 kırık AIII-1, 5 kırık AIII-3 idi. Hastalar travma tarihinden sonra ortalama 13. günde (dağılım 5-32 gün) ameliyat edildi. Otuz bir hastada kapalı redüksiyon uygulandı. Olgular ortalama 32.4 ay (dağılım 26-52 ay) takip sonunda klinik (Harris kalça skoru) ve radyografik olarak incelendi ve oluşan komplikasyonlar belirlendi. Sonuçlar: Tüm olgularda iyi ya da kabul edilebilir redüksiyonun sağlandığı görüldü. İmplant ucu-apeks mesafesi ortalama 24.2 mm (dağılım 16-40 mm) ölçüldü. İkisi hariç tüm olgularda tam kaynama elde edildi. Olguların Harris kalça skoru ortalaması 82.1 bulundu. On bir hastada (%31.4) çok iyi, 15 hastada (%42.9) iyi, yedi hastada (%20) orta, iki hastada (%5.7) kötü sonuç alındı. Radyografik komplikasyon olarak, dokuz olguda (%25.7) ikincil varus gelişimi, iki olguda (%5.7) trokanter majör ucunda kalsifikasyon oluşumu görüldü. İkincil varusun proksimal vida sıyrılması (n=2), kırık hattında çökmeye bağlı vidaların geri gelmesi (n=2) ve ters Z etkisine (n=5) bağlı meydana geldiği görüldü. Trokanter majörde kalsifikasyon görülen iki olguda klinik sonuçlar iyi bulundu. İkincil varusu olan dokuz olgunun altısında Harris kalça skoru çok iyi veya iyi, iki olguda orta, bir olguda ise kötü idi. Beş olguda (%14.3) ikinci ameliyat uygulandı. Çıkarımlar: Osteosentez materyalinin doğru pozisyonda yerleştirilmesi ve proksimal parçanın daha kuvvetli tespitini sağlayan intramedüller çivi kullanımı dengesiz intertrokanterik kalça kırıklarının tedavisinde mekanik komplikasyonları azaltacaktır.

Anahtar Kelimeler:

Reoperasyon, Kırık tespiti, intramedüller, Ameliyat sonrası komplikasyonlar, Ameliyat sonrası dönem, Femur kırıkları, Kemik çivileri, Kalça kırıkları

Long-term radiographic complications following treatment of unstable intertrochanteric femoral fractures with the proximal femoral nail and effects on functional results

Objectives: We aimed to evaluate radiographic complications occurring after treatment of unstable intertrochanteric hip fractures with the Proximal Femoral Nail (PFN) and their effect on functional results. Methods: The study included 35 patients (23 women, 12 men; mean age 71 years; range 62 to 111 years) who were treated with the PFN for unstable intertrochanteric hip fractures. According to the AO classification, there were 12 type AII-1, 12 AII-2, 3 AII-3, 3 AIII-1, 5 AIII-3 fractures. The mean time to surgery was 13 days (range 5 to 32 days). Closed reduction was achieved in 31 patients. The patients were evaluated clinically (Harris hip score) and radiographically after a mean follow-up of 32.4 months (range 26 to 52 months) and complications were recorded. Results: Reduction was assessed as good or acceptable in all the patients. The mean tip-apex distance was measured as 24.2 mm (range 16 to 40 mm). Complete union was achieved in all but two patients. The mean Harris hip score was 82.1. The results were excellent in 11 patients (31.4%), good in 15 patients (42.9%), fair in seven patients (20%), and poor in two patients (5.7%). Radiographic complications mainly included secondary varus displacement in nine patients (25.7%), and calcification at the tip of the greater trochanter in two patients (5.7%). Secondary varus displacement was due to cut-out of the proximal screws (n=2), screw loosening due to collapse of the fracture site (n=2), and reverse Z-effect (n=5). Clinical results were good in two patients with calcification at the tip of the greater trochanter. Of nine patients with secondary varus displacement, the results were excellent or good in six patients, fair in two patients, and poor in one patient. Five patients (14.3%) required a subsequent operation. Conclusion: The correct position of the osteosynthesis material and use of an intramedullary nail providing a stronger fixation of the proximal part may reduce mechanical complications following the treatment of unstable intertrochanteric hip fractures.

Keywords:

Reoperation, Fracture Fixation, Intramedullary, Postoperative Complications, Postoperative Period, Femoral Fractures, Bone Nails, Hip Fractures,

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