Erden ERTÜRER, Mustafa TEKKEŞİN, Yalın DİRİK, Bülent AKSOY, İrfan ÖZTÜRK

Subtrokanterik femur kırıklarında kilitli intramedüller çivileme ile osteosentezin radyografik ve fonksiyonel sonuçları

Amaç: Kilitli intramedüller çivi uyguladığımız subtrokanterik femur kırıklı olgularda radyografik ve fonksiyonel sonuçlar değerlendirildi. Çalışma planı: Subtrokanterik femur kırığı nedeniyle 19 hasta (14 erkek, 5 kadın; ort. yaş 51.8; dağılım 20-87) kilitli intramedüller çivi ile tedavi edildi. Kırıklar dokuz hastada sağ, 10 hastada sol tarafta idi. Kırık nedeni 12 hastada basit düşme, dördünde trafik kazası, ikisinde yüksekten düşme, birinde ateşli silah yaralanması idi. Altı hastada travmaya bağlı ek kırıklar; dokuz hastada travma öncesinde dahili sorunlar vardı. Kırıklar Russel-Taylor sistemine göre sınıflandırıldı. Sonuçlar Harris skorlama sistemine göre değerlendirildi. Hastalar ortalama 25 ay (dağılım 12-58 ay) süreyle izlendi. Sonuçlar: Ameliyat süresi ortalama 40 dakika, kanama miktarı ortalama 150 mi bulundu. Tüm hastalarda tam kay¬nama sağlandı. Dört olguda kaynama dinamizasyon sonrasında elde edildi. Harris skorlamasına göre 10 olguda (%52.6) mükemmel, altı olguda (%31.6) iyi, iki olguda (%10.5) orta, bir olguda (%5.3) kötü sonuç alındı. Tedavi sonucunun başka kemik kırıkları ve dahili sorunlardan etkilendiği görüldü. Hastaların tümü ortalama 12 haftada eski aktivitelerine dönebildi. İki hastada ameliyat sırasında distal kısımda fissür oluştu; üç hastada ise ameliyat sonrasında distal vida yerinde yüzeysel enfeksiyon gelişti. Çıkarımlar: Subtrokanterik femur kırıklarının cerrahi tedavisinde intramedüller çivileme, yüksek kaynama oranı, erken dönemde mobilizasyona izin vermesi, ameliyat süresinin kısa ve kanama miktarının düşük olması nedeniyle tercih edilebilir bir yöntemdir.

Anahtar Kelimeler:

Kırık tespiti, intramedüller, Femur kırıkları, Kırık tespiti, internal, Kalça kırıkları, Kemik çivileri

Radiographic and functional results of osteosynthesis with locked intramedulary nailing of subtrochanteric fractures of the femur

Objectives: We evaluated the radiographic and functional results of locked intramedullary nailing in the treatment of subtrochanteric fractures of the femur. Methods: Nineteen patients (14 men, 5 women; mean age 51.8 years; range 20 to 87 years) underwent locked intramedullary nailing for subtrochanteric fractures of the femur. The fractures were on the right in nine patients and on the left in 10 patients. The injuries were caused by a simple fall (n=12), motor vehicle accident (n=4), falling from a height (n=2), and gun shot (n=1). Six patients had associated fractures and nine patients had preexisting medical problems. The fractures were classified according to the Russel-Taylor system. The results were evaluated according to the Harris scoring system. The mean follow-up was 25 months (range 12 to 58 months). Results: The mean operation time was 40 minutes and the mean amount of bleeding was 150 ml. Union was obtained in all the patients, occurring after dynamization in four. According to the Harris system, the results were excellent in 10 patients (52.6%), good in six patients (31.6%), moderate in two patients (10.5%), and poor in one patient (5.3%). Outcomes were adversely affected by associated fractures and preexisting medical problems. All the patients returned to daily activities in a mean of 12 weeks. At surgery, a distal fissure occurred in two patients and, postoperatively, three patients developed superficial infections at the site of distal screws. Conclusion: Intramedullary nailing may be the preferred method in the treatment of subtrochanteric fractures of the femur due to high rates of union, early mobilization of the patient, short operation time, and less perioperative bleeding.

Keywords:

Fracture Fixation, Intramedullary, Femoral Fractures, Fracture Fixation, Internal, Hip Fractures, Bone Nails,

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