Taner BEKMEZCİ, Emre BACA, Hakan KAYNAK, Rıfat KOCABAŞ, Murat TONBUL, Okan YALAMAN

Femur şaft kırıklarında genişleyebilir intramedüller çivilerde erken dönem tedavi sonuçları

Amaç: Femur şaft kırıklarında genişleyebilir intramedüller çivilerin klinik kullanımı, etkinliği ve kısa dönem sonuçları değerlendirildi. Çalışma planı: Femur şaft kırığı olan 20 hasta (10 kadın, 10 erkek; ort. yaş 31; dağılım 15-75) çalışmaya alındı. Tüm hastalarda AO sınıflamasına göre 32 A veya B tipinde kapalı kırık vardı. Tüm hastalarda genişleyebilir intamedüller çiviyle (Fixion expandable intramedullary nail) internal tespit uygulandı. Kırık oluşumundan ameliyata kadar geçen süre ortalama üç gün (dağılım 4 saat-8 gün) idi. Sonuçlar Thoresen ölçütlerine göre değerlendirildi. Hastalar ortalama 26 ay (dağılım 9-38 ay) izlendi. Sonuçlar: Tüm olgularda kaynama sağlandı. Ortalama ameliyat süresi 79 dakika (dağılım 45-120 dakika); kaynama süresi 12.8 hafta (dağılım 10-20 hafta) bulundu. Thoresen ölçütlerine göre 15 hastada mükemmel, bir hastada iyi, üç hastada orta, bir hastada kötü sonuç alındı. A tipi orta hat diyafizer kırıkların tamamında mükemmel sonuç alındı. Distal metadiyafizer yerleşimli A2-3 kırıklı dört hastanın birinde 5° valgus açılanmasıyla iyi sonuç alınırken, üç hastada 8-10° valgus açılanmasıyla (bir hastada 8 mm kısalık vardı) orta sonuç alındı. Kaynama gecikmesi, erken veya geç enfeksiyon, kompartman sendromu, kemik nekrozu gibi komplikasyonlar izlenmedi. İki yıllık takibini tamamlayan altı hastanın beşinde çiviler komplikasyonsuz çıkarıldı. Bir hastada ise kırılma yüzünden çivi çıkarılamadı. Çıkarımlar: Genişleyebilir intramedüller çiviler kolay uygulanabilen, statik çivilere ve oymalı uygulamalara oranla daha az invaziv implantlardır. Ancak, metadiyafizer bölgeler ve %50’den büyük fragmanlı kırıklarda yeterli stabilite sağlanamayabileceği göz önünde bulundurulmalıdır.

Anahtar Kelimeler:

Donanım tasarımı, Femur kırıkları, Kırık tespiti, intramedüller, Diyafiz, Kemik çivileri

Early results of treatment with expandable intramedullary nails in femur shaft fractures

Objectives: We evaluated the use of expandable intramedullary nails, their efficacy, and short-term results in the treatment of femur shaft fractures. Methods: The study included 20 patients (10 females, 10 males; mean age 31 years; range 15 to 75 years) who were treated with expandable intramedullary nails (Fixion intramedullary femur nail) for femur shaft fractures. All the fractures were closed and were rated as type 32 A or B according to the AO classification. The mean duration from injury to surgery was three days (range 4 hours to 8 days). The results were evaluated using the Thoresen criteria. The mean follow-up was 26 months (range 9 to 38 months). Results: The mean operation time was 79 minutes (range 45 to 120 min). Union was achieved in all the patients in a mean of 12.8 weeks (range 10 to 20 weeks). According to the Thoresen criteria, the results were excellent in 15 patients, good in one patient, fair in three patients, and poor in one patient. The results in all type A middle diaphyseal fractures were excellent. Of four patients with A2-3 distal metadiaphyseal fractures, one patient had a good result with a valgus of 5°, and three patients had a fair result with a valgus ranging from 8° to 10°, one of which also had 8-mm shortening. Delayed union, early or late infections, compartment syndrome, or bone necrosis were not seen. Of six patients who completed a follow-up of two years, the nails were removed in five patients, whereas removal was not possible in one patient due to a break in the upper part. Conclusion: Expandable intramedullary nails offer advantages in terms of ease of application and are less invasive than static nails and reamed applications. However, they may not provide adequate stability in metadiaphyseal regions and in fractures with fragments greater than 50%.

Keywords:

Equipment Design, Femoral Fractures, Fracture Fixation, Intramedullary, Diaphyses, Bone Nails,

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