Mustafa ÜRGÜDEN, HAKAN ÖZDEMİR, A. Nedim YANAT, Erkan İNANMAZ, F. Feyyaz AKYILDIZ, Erdoğan ALTINEL

Femur kırıklarının kilitli intramedüller çivi ile tedavisinde karşılaşılan sorunlar

Amaç: Kilitli intramedüller çivileme ile tedavi edilen femur kırıklarında ameliyatta ve ameliyat sonrası oluşan sorunları değerlendirmek. Çalışma planı: İyileşmeye kadar takibi yapılabilen 92 olgunun 94 femuru çalışmaya dahil edildi. Hastalar (70 erkek, 22 kadın; ort. yaş 35.6; dağılım 17-73), beş farklı tip kilitli intramedüller çivi ile tedavi edildi. Ameliyat sırasında ve sonrasında kaydedilen sorunlar retrospektif olarak değerlendirildi. Sonuçlar: Ameliyat sırasında en sık sorun distal kilit vidalarının yerleştirilmesi sırasında yaşandı. Distal kılavuz sistemi ile kilitleme yapılmaya çalışılan 64 femurun 35’inde (%54.6), distal kilitlemenin beklenenden daha uzun sürdüğü ve problemli olduğu belirlendi. Ameliyat sırasındaki diğer sorunlar, kılavuz telin distale geçirilememesi, uygun çivi bulunamaması, delici kırılması, giriş yeri problemleri, çivi yarığına kemik fragman sıkışması, distal kilit bölgesinden suprakondiler kırık ve femur proksimalinde önden kapak şeklinde kırık olarak belirlendi. Takipte rastlanan en sık sorun 18 olguda (%19.1) görülen distal kilit vidasına bağlı irritasyon idi. Ayrıca, çivi proksimalinde bursit, malunion, distal kilit vidasının medial korteksten gevşemesi, varus deformitesi, enfeksiyon, kısalık, uyluk ağrısı ve çivi kırılması gibi sorunlarla karşılaşıldı. Çıkarımlar: İntramedüller kilitli çivileme sırasında ameliyatın en sorunlu kısmı distal kilitlenmedir. Cerrahi uygulamada ameliyat öncesi hazırlık, teknik ve ekipmanın önemi göz önüne alınarak uygulamalarda deneyim kazanılması ile sorunlar en aza indirilebilir.

Anahtar Kelimeler:

Kemik çivileri, Femur kırıkları, Femur, Kırık tespiti, intramedüller, Kırıklar, açık, Geriyedönük çalışma

The problems encountered in the treatment of femoral fractures with locked intramedullary nailing

Objectives: To evaluate the problems encountered intraoperatively and postoperatively during the treatment of femoral fractures with locked intramedullary nails. Methods: The study included 94 femurs of 92 patients whose follow up had been made until fracture healing. The patients (70 males, 22 females; mean age 35.6 years; range 17 to 73 years) were treated with the use of five different locked intramedullary nails. Problems encountered during surgery and throughout the follow-up period were evaluated. Results: Intraoperative problems were commonly related to the placement of distal interlocking screws. Of 64 femurs in which nails with distal guide systems were used, the procedure was prolonged and fraught with problems in 35 femurs (54.6%). Other problems were failure to forward the guide pin to the distal fragment, unavailability of nails with appropriate size, perforator break-down, inadequate entry portals, jamming of bony fragments into the nail hole, supracondylar fracture through the distal locking screw, and wedge-like fracture in the proximal-anterior part of the femur. The leading postoperative problem was irritation due to distal locking screws (18 patients, 19.1%). Others included bursitis in the proximal part of the nail, malunion, infection, varus deformity, shortening, thigh pain, breaking of the nail, and loosening of the distal locking screws from the medial cortex. Conclusion: The most complicated part of locked intramedullary nailing is the distal locking of the nail with the screw. The problems encountered can be minimized by appropriate preoperative preparation, technique, equipment, and enhanced experience.

Keywords:

Bone Nails, Femoral Fractures, Femur, Fracture Fixation, Intramedullary, Fractures, Open, Retrospective Studies,

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