Venkat Ram Prasad VALLAMSHETLA, Murali Krishna SAYANA, Ravindranath VUTUKURU

Genç hastalarda kaynamamış intrakapsüler femur boynu kırıklarının kuadratus femoris kası saplı kemik grefti kullanılarak tedavisi

Amaç: Genç hastalarda geç dönemde saptanan intrakapsüler femur boynu k›r›klar› cerrahi aç›- dan sorun yaratabilir. Bu tür tablolar geliflmifl ülkelerde nadirdir, ancak geliflmekte olan ülkeler- de s›k görülebilir. Çal›flma plan›: Merkezimize geç dönemde baflvuran, kaynamam›fl intrakapsüler femur boynu k›- r›¤› bulunan 42 hastan›n (28 erkek ve 14 kad›n) kay›tlar› ve radyografileri geriye dönük olarak in- celenmifltir. Bu hastalar aç›k redüksiyon, arka iliyak ç›k›nt›dan al›nan kortiko-kanselöz kemik gref- ti ile desteklenen internal tespit ve kuadratus femoris kas› sapl› kemik grefti ile tedavi edilmifltir. Sonuçlar: Hastalar k›r›k olufltuktan ortalama 9 ay (da¤›l›m 3-18 ay) sonra baflvurmufltur. Hastala- r›n ifllem s›ras›ndaki ortalama yafl› 34 (da¤›l›m 24-51) olarak hesaplanm›flt›r. Radyolojik kaynama ortalama 6 ayda (da¤›l›m 3-13 ay) gerçekleflmifltir. Otuz alt› olguda (%86) kaynama gerçekleflmifl- tir. Alt› hastada (%14) kaynama gerçekleflmemifl ve revizyon ameliyat› gerekmifltir. Komplikasyon olarak dokuz hastada varus tipi kaynama, 10 hastada bacak boyunda ortalama 1.5 cm (da¤›l›m 1- 2.5 cm) k›salma gözlenmifltir. Ç›kar›mlar: Femur boynunun kaynamam›fl intrakapsüler k›r›klar›nda k›r›¤›n anatomik redüksi- yonu, femoral boynu tekrar oluflturmak için kortiko-kanselöz kemik greftleme, kanselöz vidalar- la internal tespit ve kuadratus femoris kas› sapl› kemik grefti ile makul sonuçlar elde edilebilir.

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1. Nagi ON, Dhillon MS, Gill SS. Fibular osteosynthesis for delayed type II and type III femoral neck fractures in chil- dren. J Orthop Trauma 1992;6:306-13.

2. Nagi ON, Gautam VK, Marya SK. Treatment of femoral neck fractures with a cancellous screw and fibular graft. J Bone Joint Surg Br 1986;68:387-91.

3. Marti RK, Schüller HM, Raaymakers EL. Intertrochanteric osteotomy for non-union of the femoral neck. J Bone Joint Surg Br 1989;71:782-7.

4. Judet R. Treatment of fractures of the femoral neck by pedicled graft. [Article in French] Acta Orthop Scand 1962;32:421-7.

5. Meyers MH, Harvey JP Jr, Moore TM. Treatment of dis- placed subcapital and transcervical fractures of the femoral neck by muscle-pedicle-bone graft and internal fixation. A preliminary report on one hundred and fifty cases. J Bone Joint Surg Am 1973;55:257-74.

6. Meyers MH, Moore TM, Harvey JP Jr. Displaced fracture of the femoral neck treated with a muscle-pedicle graft. With emphasis on the treatment of these fractures in young adults. J Bone Joint Surg Am 1975;57:718-20.

7. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 1985; 67:3-9.

8. Massie WK. Fractures of the hip. J Bone Joint Surg Am 1964;46:658-90.

9. Konishiike T, Makihata E, Tago H, Sato T, Inoue H. Acute fracture of the neck of the femur. An assessment of perfu- sion of the head by dynamic MRI. J Bone Joint Surg Br 1999;81:596-9.

10. Dickson JA. The unsolved fracture; a protest against defeatism. J Bone Joint Surg Am 1953;35-A:805-22.

11. Gallie WE, Lewis FI. Ununited fracture of the neck of the femur in the aged. J Bone Joint Surg 1940;22:76-80.

12. Baksi DP. Internal fixation of ununited femoral neck frac- tures combined with muscle-pedicle bone grafting. J Bone Joint Surg Br 1986;68:239-45.

13. Baksi DP. Treatment of osteonecrosis of the femoral head by drilling and muscle-pedicle bone grafting. J Bone Joint Surg Br 1991;73:241-5.

14. Gupta A. The management of ununited fractures of the femoral neck using internal fixation and muscle pedicle periosteal grafting. J Bone Joint Surg Br 2007;89:1482-7.

15. Meyers MH, Harvey JP Jr, Moore TM. Delayed treatment of subcapital and transcervical fractures of the neck of the femur with internal fixation and a muscle pedicle bone graft. Orthop Clin North Am 1974;5:743-56.

16. Meyers MH, Harvey JP Jr, Moore TM. The muscle pedi- cle bone graft in the treatment of displaced fractures of the femoral neck: indications, operative technique, and results. Orthop Clin North Am 1974;5:779-92.

17. Meyers MH. Osteonecrosis of the femoral head treated with the muscle pedicle graft. Orthop Clin North Am 1985;16:741-5.

18. Nagi ON, Dhillon MS, Goni VG. Open reduction, internal fixation and fibular autografting for neglected fracture of the femoral neck. J Bone Joint Surg Br 1998;80:798-804.

19. Hou SM, Hang YS, Liu TK. Ununited femoral neck frac- tures by open reduction and vascularized iliac bone graft. Clin Orthop Relat Res 1993;(294):176-80.