ERHAN YILMAZ, Lokman KARAKURT, Mehmet BULUT, OKTAY BELHAN, Erhan SERİN

Femur cisim kırıkları ve psödoartrozlarının kompresif, kilitli intramedüller çivileme ile tedavisi

Amaç: Bu çalışmada femur cisim kırıklarının kompresif, kilitli intramedüller çivilerle tedavisinden alman sonuçlar değerlendirildi. Çalışma planı: Otuz hastanın (23 erkek, 7 kadın; ort. yaş 36.9; dağılım 14-80) 33 femur kırığına kompresif, kilitli intramedüller çivilemeyle tespit yapıldı. Yirmi al¬tı kırık kapalı, yedi kırık (2 tip II, 5 tip IHA) ise açıktı. Üç olguda psödoartroz nedeniyle çivileme yapıldı. Win-quist sınıflamasına göre 13 tip I, sekiz tip II, sekiz tip III, dört tip IV kırık görüldü. Klinik, radyografik ve fonksiyonel sonuçlar Thoresen ölçütlerine göre değerlendirildi. Olguların ortalama izlem süresi 29 ay (dağılım 6-59 ay) idi. Sonuçlar: Ameliyat süresi ortalaması 105.7 dakika bulundu. Tüm olgularda ortalama 19.6 haftada kaynama sağlandı. Yeterli kallus görülmediği için altı olguda dinamizasyon uygulandı. Thoresen ölçütlerine göre 17 olguda (%56.7) mükemmel, sekiz olguda (%26.7) iyi, üç olguda (%10) orta, iki olguda (%6.7) kötü sonuç elde edildi. Üç olguda kısalık (2-4 cm), iki olguda varus (8 ve 11 derece), üç olguda dış rotasyon deformitesi, üç olguda diz ekleminde fleksiyon kısıtlılığı, sekiz olguda yüzeyel enfeksiyon, üç olguda trokanterik bursit, iki olguda distal vida iritasyonu görüldü. Çıkarımlar: Erişkin femur cisim kırıklarında kilitli intramedüller çivileme yüksek kaynama ve düşük komplikasyon oranlarına sahip olması nedeniyle ilk tercih edilmesi gereken güvenli bir tedavi yöntemidir. Tepe vidası ile ya¬pılan kompresyonun kırık hattında boşluk kalmasını önleyerek daha stabil bir tespit sağladığı sonucuna varıldı.

Anahtar Kelimeler:

Hareket açıklığı, eklem, Erişkin, Donanım tasarımı, Tedavi sonucu, Femur kırıkları, Kırık tespiti, intramedüller, Kemik çivileri, Kemik vidaları

Treatment of femoral shaft fractures and pseudoarthrosis with compressive and interlocking intramedullary nailing

Objectives: We evaluated the results of compressive and interlocking intramedullary nailing in femoral shaft fractures . Methods: Thirty-three femoral fractures of 30 patients (23 males, 7 females; mean age 36.9 years; range 14 to 80 years) were treated by compressive and interlocking intramedullary nailing. There were 26 closed and seven open (2 type II, 5 type mA) fractures. In three femurs, intramedullary nailing was performed due to pseudoarthrosis. According to the Winquist classification, there were 13,8,8, and 4 type I to IV fractures, respectively. Clinical, radiographic, and functional results were evaluated according to the Thoresen criteria. The mean follow-up was 29 months (range 6 to 29 months). Results: The mean operation time was 105.7 minutes. Union was obtained in all the patients within a mean duration of 19.6 weeks. In six cases, dynamization was performed due to insufficient callus formation. The results were excellent in 17 patients (56.7%), good in eight patients (26.7%), fair in three patients (10%), and poor in two patients (6.7%). Complications included shortening (n=3; 2 to 4 cm), varus deformity (n=2; 8 and 11 degrees), external rotation (n=3), restriction in knee flexion (n=3), superficial infection (n=8), trochanteric bursitis (n=3), and irritation of the skin by distal screws (n=2). Conclusion: High rates of union with low complication rates makes interlocking intramedullary nailing an appropriate method in the treatment of femoral shaft fractures in adults. Compression with top screws contributes to the stability of fixation by eliminating any looseness through the fracture line.

Keywords:

Range of Motion, Articular, Adult, Equipment Design, Treatment Outcome, Femoral Fractures, Fracture Fixation, Intramedullary, Bone Nails, Bone Screws,

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