Stamatios PARASCHOU, Huseyin BEKIR, Helias ANASTASOPOULOS, Athanasios PAPAPANOS, John ALEXOPOULOS, Anestis KARANIKOLOS, Nick POUSSIS

Distal tibia kırıklarının ve kaynamamış kırıkların tedavisinde kilitli intramedüller çivilemenin değerlendirilmesi

Amaç: Eklemi etkilemeyen distal tibia kırıklarında ve kaynamamış kırıkların tedavisinde kilitli intramedüller çivilemenin sonuçları geriye dönük olarak değerlendirildi. Çalışma planı: Çalışmaya, distal tibia kırığı (n=35) veya kaynamamış kırık (n=10) nedeniyle kilitli intramedüller çivileme ile tedavi edilen 45 hasta (ort. yaş 42; dağılım 27-52) alındı. Kırıkların 31’i kapalı, dördü açık kırık idi. AO sınıflamasına göre, 27 kırık A1, altı kırık A2, iki kırık A3 idi. Ayrıca, iki hastada medial malleol, 14 hastada lateral malleol kırığı vardı. Tedavide 38 hastada Gross-Kempf (Howmedica) kilitli intramedüller çivisi, yedi hastada Expert (Synthes) çivisi kullanıldı. Yirmi iki hastada dinamik çivileme, 23 hastada statik çivileme yapıldı. Hiçbir hastada greft kullanılmadı. Hastalar ortalama 37 aylık (dağılım 24-60 ay) takip süresi içinde klinik ve radyografik olarak değerlendirildi. Sonuçlar: Tüm hastalarda ortalama 4.6 ay içinde (dağılım 3-7 ay) kaynama elde edildi. Üç hastada kaynama için dinamizasyona başvuruldu. Ortalama kaynama süresi dinamik çivileme uygulanan hastalarda 4.4 ay (dağılım 3-6 ay), statik çivileme uygulanan hastalarda 4.8 ay (dağılım 3-7 ay) bulundu. Hiçbir hastada ciddi komplikasyon görülmedi. Bir hastada (%2.2) geçici peroneal sinir felci gelişti. Dört hastada (%8.9) çivinin taşmasından dolayı ortaya çıkan diz ağrısı çivinin çıkarılmasından sonra kayboldu. Beş hastada (%11.1) ayak bileği hareketinde 5-10 derece arasında değişen azalma görüldü. Hiçbir hastada diz eklemi hareketlerinde sınırlılık gelişmedi. Çıkarımlar: Kilitli intramedüller çivileme, distal tibia kırıkları ve kaynamamış kırıklarda, kaynama oranı yüksek, komplikasyon oranı düşük güvenilir bir tedavi yöntemidir.

Anahtar Kelimeler:

Geriyedönük çalışma, Tibia kırıkları, Kırık tespiti, intramedüller, Ameliyat sonrası dönem, Kemik çivileri

Evaluation of interlocking intramedullary nailing in distal tibial fractures and nonunions

Objectives: The aim of this study was to evaluate the results of interlocking intramedullary nailing in the treatment of extra-articular distal tibial fractures and nonunions. Methods: The study included 45 patients (mean age 42 years; range 27 to 52 years) who were treated with interlocking intramedullary nailing for distal tibial fractures (n=35) and nonunions (n=10). Of 35 fractures, 31 were closed and four were open. The fractures were AO A1 (n=27), A2 (n=6), and A3 (n=2). In addition, two patients had medial, and 14 patients had lateral malleolus fractures. A Gross-Kempf (Howmedica) nail was used in 38 patients and an Expert nail (Synthes) was used in seven patients. Dynamic nailing was performed in 22 patients and static nailing was performed in 23 patients. No grafting was used. The patients were assessed clinically and radiographically within a mean follow-up period of 37 months (range 24 to 60 months). Results: Union was achieved in all the patients within a mean of 4.6 months (range 3 to 7 months). Dynamization was required in three patients. The mean time to union was 4.4 months (range 3 to 6 months) with dynamic nailing and 4.8 months (range 3 to 7 months) with static nailing. Complications were not serious. Transient peroneal nerve palsy developed in one patient (2.2%). Knee pain was seen in four patients (8.9%) due to the protrusion of the nail and it disappeared after removal of the nail. Five patients (11.1%) had limitation of ankle movements in a range of 5 to 10 degrees. None of the patients had restriction in knee motion. Conclusion: Intramedullary interlocking nailing is a reliable method of treatment for distal tibial fractures and nonunions, with a high rate of union and low complication rate.

Keywords:

Retrospective Studies, Tibial Fractures, Fracture Fixation, Intramedullary, Postoperative Period, Bone Nails,

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