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

Tibia şaft kırıklarında genişleyebilir intramedüller çivilerle erken dönem tedavi sonuçları

Amaç: Tibia şaft kırıklarında genişleyebilir intramedüller çivilerin klinik kullanımı, etkinliği ve kısa dönem sonuçları değerlendirildi. Çalışma planı: Tibia şaft kırığı nedeniyle genişleyebilir intramedüller çiviyle (Fixion®) internal tespit uygulanan 19 hasta (8 kadın, 11 erkek; ort. yaş 38; dağılım 17-65) çalışmaya alındı. Tüm hastalarda kapalı kırık vardı. Dört hastada kırıklara başka yaralanmalar eşlik etmekteydi. AO sınıflandırmasına göre tüm kırıklar 42-A, B, C tipi kırıklardan oluşuyordu. Kırık oluşumundan ameliyata kadar geçen süre ortalama 2.8 gündü (dağılım 6 saat-14 gün). Sonuçlar Johner-Wruhs ölçütlerine göre değerlendirildi. Hastalar ortalama 23 ay (dağılım 9-39 ay) izlendi. Sonuçlar: Ortalama ameliyat süresi 47 dakika (dağılım 25-53 dakika) idi. Tüm olgularda ortalama 11.5 haftada (dağılım 8-18 hafta) kaynama sağlandı. Johner-Wruhs ölçütlerine göre, sonuçlar 17 hastada (%89.5) mükemmel, iki hastada (%10.5) iyi bulundu. Distal metadiyafizer yerleşimli parçalı-oblik (42-B2) kırığı olan iki hastada 5° valgus açılanması, birinde 5 mm kısalık gelişti. Bu iki olguda sonuç iyi bulundu. Kaynama gecikmesi, erken veya geç enfeksiyon, kompartman sendromu, kemik nekrozu gibi komplikasyonlar görülmedi. Tüm hastaların diz ve ayak bileği hareket açıklıkları karşı tarafla aynı düzeye ulaştı. Çıkarımlar: Genişleyebilir intramedüller çiviler, kolay uygulanabilen, statik çivilere ve oymalı uygulamalara oranla daha az invaziv implantlardır. Ancak, %50’den büyük parçalı kırıklarda yeterli stabilite sa¤lanamayabileceği göz önünde bulundurulmalıdır.

Anahtar Kelimeler:

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

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

Objectives: We evaluated the use of expandable intramedullary nails, their efficacy, and short-term results in the treatment of tibia shaft fractures. Methods: The study included 19 patients (8 females, 11 males; mean age 38 years; range 17 to 65 years) who were treated with expandable intramedullary nails (Fixion®) for tibia shaft fractures. All the fractures were closed. Four patients had associated injuries. According to the AO classification, the fractures were type 42-A, B, or C. The mean duration from injury to surgery was 2.8 days (range 6 hours to 14 days). The results were evaluated using the Johner-Wruhs criteria. The mean follow-up was 23 months (range 9 to 39 months). Results: The mean operation time was 47 minutes (range 25 to 53 min). Union was achieved in all the patients in a mean of 11.5 weeks (range 8 to 18 weeks). According to the Johner-Wruhs criteria, the results were excellent in 17 patients (89.5%) and good in two patients (10.5%). Treatment of fragmented-oblique fractures of the distal metadiaphysis (42-B2) resulted in a valgus angulation of 5 degrees in two patients, and extremity shortening of 5 mm in one patient, both of whom had good results. Complications such as delayed union, early or late infections, or bone necrosis did not occur. The range of motion of the knee and ankle reached that of the contralateral side in all the patients. 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 fractures with fragments greater than 50%.

Keywords:

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

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