Subtrokanterik femur kırıklarının intramedüller çivilemesinde redüksiyon yöntemlerinin karşılaştırılması

Amaç: Bu çalışmanın amacı subtrokanterik femur kırıklarının tedavisinde intramedüller çivi kullanılan üç redüksiyon tekniğinin sonuçlarını karşılaştırmak idi. Çalışma planı: İntramedüller çivi ile birlikte kemik klempi ile redüksiyon uygulanan 22, kablo serklaj uygulanan 11 ve bloklama vidası uygulanan 12 hasta olmak üzere toplam 45 subtrokanterik femur kırıklı hasta çalışmaya alındı. Redüksiyon teknikleri ameliyat sonrası erken dönem dizilim, ameliyat sonrası 1. yılda dizilim, tam yük verme süresi, kaynama süresi, 1. yıl sonu Harris kalça skoru, ameliyat süresi, skopi süresi, kan transfüzyonu miktarı, komplikasyon ve ilave girişim açısından istatistiksel olarak karşılaştırıldı. Bulgular: Kemik klempi grubunun tam yük verme süre ortalamaları istatistiksel olarak anlamlı derecede yüksek (p=0.038), 1. yılda Harris kalça skoru ortalamaları ise düşük bulundu (p=0.002). Bloklama vidası grubunda ameliyat ve skopi süreleri uzun idi. Kemik klempi ile kablo serklaj grupları arasında ameliyat süreleri ve skopi süreleri açısından anlamlı fark yokken, bloklama vidası grubu ile kemik klempi grubu arasında (sırasıyla p=0.0001, p=0.0001) ve bloklama vidası ile kablo serklaj arasında (sırasıyla p=0.037, p=0.0001) anlamlı fark vardı. Kemik klempi, kablo serklaj ve bloklama vidası grupları arasında, erken dönem dizilim, ameliyat sonrası 1. yılda dizilim, kaynama süresi, komplikasyon ve ilave girişim açısından istatistiksel olarak anlamlı farklılık gözlenmedi. Çıkarımlar: Kemik klempi ile redüksiyon yönteminde hasta ayağına daha geç yük vermekte ve 1. yıl sonundaki fonksiyonel durumu diğer gruplardan daha kötü olmaktadır. Bloklama vidası grubunda ameliyat ve skopi süreleri diğerlerinden daha uzundur.

Comparison of reduction methods in intramedullary nailing of subtrochanteric femoral fractures Mustafa Seyhan, Koray Unay, Nadir Sener

Objective: The aim of this study was to compare the outcomes of three reduction methods used during intramedullary nailing of the subtrochanteric femur fractures. Methods: This study included 45 patients with subtrochanteric femur fractures who were treated with intramedullary nailing. Twenty-two patients underwent clamp-assisted reduction, 11 reduction with cable cerclage, and 12 with blocking screws. Reduction techniques were compared with respect to the early postoperative alignment, one year postoperative alignment, time to full weight-bearing, time to union, Harris hip score at one year, operation and fluoroscopy times, blood transfusion amount, complications, and additional interventions. Results: The clamp-assisted reduction group had a statistically high mean time to full weight-bearing (p=0.038) and a low mean Harris hip score at one year (p=0.002). The blocking screw groups operation times and fluoroscopy times were statistically long. There was no statistically significant difference between the clamp-assisted reduction and cable cerclage groups in terms of operation times and fluoroscopy times. On the other hand, there were statistically significant differences between the clamp-assisted reduction and blocking screw groups (p=0.0001 and p=0.0001, respectively) and between the cable cerclage and blocking screw groups (p=0.037 p=0.0001, respectively) in terms of operation times and fluoroscopy times. There was no statistically significant difference between the clamp-assisted reduction, cable cerclage and the blocking screw groups in terms of early postoperative alignment, one year postoperative alignment, time to union, complications or additional interventions. Conclusion: Clamp-assisted reduction leads to a longer time to weight-bearing and a poorer functional status at one year. Operation time and fluoroscopy time were longest in the blocking screw group.

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