Oğuz DURAKBAŞA, UĞUR HAKLAR, Hakan TUYGUN, Metin TÜRKMEN

Erişkin femur cisim kırıklarının intramedüller çivilerle tedavisi

Amaç: Erişkin femur cisim kırıklarının intramedüller çivilerle tedavi sonuçları değerlendirildi. Çalışma planı: Kilitli intramedüller çivi ile osteosentez uygulanan 64 femur cisim kırığı (63 hasta; 15 kadın, 48 erkek; ort. yaş 29; dağılım 16-62) çalışmaya alındı. Kırıkların %83'ü kapalı, %17'si açık kırık idi. Winquist sınıflandırmasına göre, 16 olguda (%25) W0, 22 olguda (%34) W1, dokuz olguda (%14) W2, dokuz olguda (%14) W3, sekiz olguda (%13) W4 kırık vardı. Travma ile ameliyat arasında geçen süre ortalama 18 gün (dağılım 4-130 gün); hastanede kalış süresi ortalama 25 gün (dağılım 11-142 gün) idi. İntramedüller çivilerin ikisi kapalı (%3), 62'si açık (%97) yöntemle uygulandı; çivilemelerin dokuzu kilitsiz, 39'u dinamik, 16'sı statik idi. Açık teknikle ameliyat edilen hastaların 14'üne intramedüller çivileme sonrası grefonaj, sekizine serklaj, 10'una grefonaj ve serklaj, birine grefonaj ve vida ile tespit uygulandı. Sonuçlar Thoresen ve ark.nın ölçütlerine göre değerlendirildi. Hastalar ortalama 28 ay (dağılım 7-62 ay) süreyle izlendi. Sonuçlar: Hastaların %80'inde iyi, %20'sinde kötü sonuç alındı, Gönderilen 20 proksimal kilitleme vidasının tamamı çivi deliklerinden geçerken, distale gönderilen 95 vidanın 23'ü (%24) delikleri tutmadı. Komplikasyonların dağılımı yüzeysel enfeksiyon (3 hasta), osteomiyelit (4 hasta), trokanterik bursit (1 hasta), distal vida irritasyonu (4 hasta), heterotopik ossifikasyon (6 hasta), 1 cm'den fazla kısalık (8 hasta), 10 dereceden fazla rotasyon kusuru (2 hasta), çivi distalinin diz eklemine girmesi (2 hasta), distal vida deliklerinin açılması sırasında dril kırılması (2 hasta), diz hareket açıklığının 100 derecenin altında olması (6 hasta), kaynama gecikmesi (2 hasta) şeklindeydi. Çıkarımlar: İntramedüller çivileme stabil ve instabil bütün femur cisim kırıklarında öncelikle tercih edilmelidir.

Anahtar Kelimeler:

Kemik çivileri, Erişkin, Femur kırıkları, Kırık tespiti, intramedüller, Kırıklar, kapalı, Kırıklar, açık

Intramedullary nailing of adult femoral fractures

Objectives: We evaluated the results of treatment of adult femoral fractures treated by intramedullary nails. Methods: Sixty-two patients (15 females, 48 males; mean age 29 years; range 16 to 62 years) with 64 femoral fractures were treated by intramedullary nailing. Eighty-three percent of the fractures was closed and 17% was open. According to the Winquist (W) classification, there were 16 (25%) W0, 22 (34%) W1, nine (14%) W2, nine (14%) W3, and eight (13%) W4 fractures. The mean duration between trauma and surgery was 18 days (range 4 to 130 days), and the mean hospital stay was 25 days (range 11 to 142 days). Open and closed techniques were employed in 62 (97%) and two (3%) fractures, respectively. Nine fractures were unlocked; dynamic and static locking were performed in 39 and 16 fractures, respectively. In the open technique, secondary procedures involved grafting in 14 cases, cerclage in eight cases, grafting and cerclage in 10 cases, and grafting and screw fixation in one case. The results were assessed according to the criteria by Thoresen et al. The mean follow-up was 28 months (range 7 to 62 months). Results: Fifty-one patients (80%) had satisfactory, 13 patients (20%) had poor outcome. All proximal locking screws (n=20) were successfully inserted, whereas 23 (24%) of 95 distal screws missed the nail holes. Complications included superficial infection (n=3), osteomyelitis (n=4), trochanteric bursitis (n=1), irritation of the skin by the distal screws (n=4), heterotopic ossification (n=6), shortening more than 1 cm (n=8), rotational malalignment greater than 10$\circ$ (n=2), migration of the nail through the knee joint (n=2), drill breakage while preparing the distal holes (n=2), knee range of motion below 100$\circ$ (n=6), and delayed union (n=2). Conclusion: Intramedullary nailing should be the primary indication for stable and unstable femoral fractures.

Keywords:

Bone Nails, Adult, Femoral Fractures, Fracture Fixation, Intramedullary, Fractures, Closed, Fractures, Open,

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