Erden ERTÜRER, İrfan ÖZTÜRK, Yalın DİRİK, METİN UZUN, Bülent AKSOY

Erişkinlerdeki femur cisim kırıklarında kilitli oymasız intramedüller çivi osteosentezinin radyografik ve fonksiyonel sonuçları

Amaç: Femur cisim kırığı nedeniyle kilitli intramedüller (‹M) çivi osteosentezi uygulanan erişkin hastalarda radyografik ve fonksiyonel sonuçlar değerlendirildi. Çalışma planı: Yetmiş üç hastanın (57 erkek, 16 kadın; ort. yaş 36; dağılım 18-77) 78 femur cisim kırığı kilitli İM çivi osteosentezi ile tedavi edildi. Kırıklar 39 hastada sol, 29 hastada sağ taraftaydı; beş hastada iki taraflı femur diafiz kırığı vardı. On sekiz hastada (%24.7) açık kırık, 28 hastada travmaya bağlı başka patolojiler vardı. Travma ile ameliyat arasında geçen süre ortalama 10.7 gün (dağılım 3-15 gün) idi. Kırık tipi Winquist- Hansen sınıflaması, fonksiyonel sonuçlar Thoresen sistemine göre değerlendirildi. Hastalar ortalama 25 ay (dağılım 12- 54 ay) izlendi. Sonuçlar: Altmış dokuz hastanın 73 kemiğinde (%93.6) tam kaynama elde edildi. Radyografik kaynama süresi ortalama 14 hafta (dağılım 10-28 hafta) idi. Dört kırıkta (%5.2) kaynama dinamizasyon sonrasında elde edildi. Dinamizasyona rağmen kaynama elde edilemeyen bir hastada (%1.2) sirküler eksternal fiksatör ile revizyon uygulandı. Hastanede yatış süresi ortalama 19.8 gün (dağılım 8-26 gün) idi. Thoresen ölçütlerine göre 64 hastada (%87.7) çok iyi veya iyi, dokuz hastada (%12.3) orta veya kötü sonuç alındı. Elli altı hasta (%76.7) kısıtlamasız, 13 hasta (%17.8) hafif kısıtlamalarla ortalama 12 haftada eski iş ve aktivitelerine döndü. Ameliyat sırasında dokuz hastada distal kısımda kelebek parçası oluştu, iki hastada distal kilitleme vidalarının uygunsuz yerleştirildiği görüldü. Ameliyat sonrası dönemde dört hastada kaynama gecikmesi, bir hastada kaynamama, iki hastada distal kilitleme vida yerinde yüzeyel enfeksiyon görüldü. Çıkarımlar: Erişkinlerde femur cisim kırıklarının tedavisinde İM kilitli çivi uygulaması, yüksek kaynama ve düşük komplikasyon oranları, yaşam aktivitelerine kısa sürede dönüş ve tatminkar fonksiyonel sonuçlar elde edilmesi nedeniyle iyi bir seçenektir.

Anahtar Kelimeler:

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

Radiographic and functional results of osteosynthesis with locked unreamed intramedullary nailing of femoral shaft fractures in adults

Objectives: We evaluated the radiographic and functional results of treatment with locked unreamed intramedullary nailing of femoral shaft fractures in adults. Methods: Seventy-eight femoral shaft fractures of 70 adult patients (57 men, 16 women; mean age 36 years; range 18 to 77 years) were treated with locked unreamed intramedullary nailing. The fractures were on the right in 39, on the left in 29, and bilateral in five patients. Eighteen patients (24.7%) had open fractures and 28 patients had associated pathologies. The mean time from injury to surgery was 10.7 days (range 3 to 15 days). The fractures were classified according to the Winquist-Hansen system and functional results were evaluated according to the Thoresen criteria. The mean follow-up was 25 months (range 12 to 54 months). Results: Union was achieved in 73 fractures (93.6%) of 69 patients within a mean duration of 14 weeks (range 10 to 28 weeks). Four fractures (5.2%) united after dynamization and one patient (1.2%) required revision with a circular external fixator following dynamization. The mean duration of hospitalization was 19.8 days (range 8 to 26 days). According to the Thoresen criteria, the results were excellent or good in 64 patients (87.7%), and moderate or poor in nine patients (12.3%). Fifty-six (76.7%) and 13 (17.8%) patients returned to previous work and daily activities with no or minor limitations in a mean of 12 weeks, respectively. Perioperatively, a distal fissure occurred in nine patients, and distal locked screws were improperly placed in two patients. Postoperative complications included delayed union in four patients, nonunion in one patient, and superficial infection at the site of distal screws in two patients. Conclusion: Intramedullary locked nailing may be the preferred method in the treatment of femoral shaft fractures in adults due to high union but low complication rates, early mobilization of the patient, and satisfactory functional results.

Keywords:

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

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