D. Ali ÖÇGÜDER, Hamza ÖZER, Şükrü SOLAK, R. Yavuz ÖNEM, Savaş AĞAOĞLU

Tibia açık kırıklarının Ilizarov sirküler eksternal fiksatörüyle tedavisinin fonksiyonel sonuçları

Amaç: Ilizarov sirküler eksternal fiksatörü ile tedavi edilen tibia açık kırıklarında fonksiyonel sonuçlar değerlendirildi. Çalışma planı: Çalışmaya tibia açık kırıklı 33 hasta (26 erkek, 7 kadın; ort. yaş 38; dağılım 16-69) alındı. AO/OTA sınıflamasına göre yedi kırık tip A, 16 kırık tip B, 10 kırık tip C; Gustilo-Anderson sınıflandırmasına göre sekiz kırık grade I, 12 kırık grade II, 13 kırık grade III idi. Hastalar ortalama 5.7 gün (dağılım 3-12 gün) içinde ameliyat edildi. Beş hastada kompresyon-distraksiyon uygulanarak kemik kaynamasına yardımcı olundu. Fonksiyonel sonuçlar Karlstrom-Olerud ölçütlerine göre değerlendirildi. Ortalama izlem süresi 28 ay (dağılım 19-34 ay) idi. Sonuçlar: Grade I ve grade II açık kırıklar arasında iyileşme süresi açısından anlamlı fark yoktu (p>0.05). Grade I ve grade III, grade II ve grade III arasında kaynama süresi açısından anlamlı farklılık bulundu (sırasıyla p=0.0001, p=0.001). Karlstrom-Olerud ölçütlerine göre, fonksiyonel sonuçlar 14 hastada (%42.4) iyi, 11'inde (%33.3) tatmin edici, sekizinde (%24.2) orta idi. Tel dibi enfeksiyonu en sık görülen (%28.4) komplikasyondu. Yedi adet K-teli değiştirildi. Osteomiyelit gelişen iki hastada (%6.1) iki K-teli çıkarılarak sekestrektomi uygulandı. İki hastada K-teli uygulamasına bağlı peroneal sinir hasan görüldü. Fiksatör uygulamasına bağlı olarak yedi hastada ayak bileği, dört hastada diz hareketleri olumsuz etkilendi. Çıkarımlar: Tibia açık kırıklarının sirküler eksternal fiksatör ile tedavisinde tel dibi enfeksiyon riski yüksek olsa da, erken mobilizasyon ve eklem hareketlerine izin vermesi nedeniyle fonksiyonel sonuçlar kabul edilebilir düzeydedir.

Anahtar Kelimeler:

Cerrahi yara enfeksiyonu, Eksternal fiksatörler, Kırıklar, açık, Tibia kırıkları, Hareket açıklığı, eklem, Ilizarov tekniği

Functional results of the Ilizarov circular ezternal fixator in the treatment of open tibial fractures

Objectives: We evaluated functional results with the Iliza circular external fixator in the treatment of open tibial ft tures. Methods: Thirty-three patients (26 males, 7 females; mean 38 years; range 16 to 69 years) with open tibial fractures w included. According to the AO/OTA classification, there w seven type A, 16 type B, 10 type C fractures; according to Gustilo-Anderson classification, eight, 12, and 13 fractures w grade I, n, and İÜ, respectively. The mean time to surgery was days (range 3 to 12 days). Compression-distraction was app] in five patients to speed up union. Functional outcomes w assessed according to the Karlstrom-Olerud scoring system.'. mean follow-up was 28 months (range 19 to 34 months). Results: Time to union did not differ significantly betw grade I and II fractures (p>0.05). However, there were sign cant differences between grade I and III (p=0.0001) and gr n and III (p=0.001) fractures with respect to union tin According to the Karlstrom-Olerud scores, functional outcc was good in 14 (42.4%), satisfactory in 11 (33.3%), and fai eight (24.2) patients. The most common complication was tract infections (28.4%). Seven K-wires were replaced. 1 patients (6.1%) who developed osteomyelitis underw sequestrectomy following removal of two K-wires. Peror nerve injury occurred in two patients associated with K-wi Ankle and knee movements were adversely affected due to external fixator in seven and four patients, respectively. Conclusion: Although the use of the circular external fixate associated with a relatively high risk of pin tract infectk functional results may justify its use in the treatment of 0] tibial fractures, with an added advantage of early mobilizati

Keywords:

Surgical Wound Infection, External Fixators, Fractures, Open, Tibial Fractures, Range of Motion, Articular, Ilizarov Technique,

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