EKLEM DIŞI TIBIA KIRIKLARI TEDAVISINDE MINIMAL İNVAZIV PLAK OSTEOSENTEZ UYGULAMA SONUÇLARINI ETKILEYEN FAKTÖRLER

AMAÇ: Bu çalışmada eklem dışı tibia kırıkları minimal invazivplak osteosentezi (MİPO) ile tedavi edilen hastalar değerlendirerekhasta ve tedavi yöntemine ait çeşitli faktörlerin; fonksiyonel, klinikve radyografik sonuçlara olan etkisinin araştırılması amaçlanmıştır.GEREÇ VE YÖNTEMLER: Ekim 2010 – Nisan 2014 tarihleriarasında eklem dışı tibia kırıkları MİPO tekniği ile tedavi edilen 33hasta değerlendirildi. Ameliyat öncesi hasta faktörleri, fonksiyonelskor ve ameliyat esnasındaki cerrahi teknikle ilgili faktörler ilefonksiyonel skor, klinik ve radyolojik sonuçlar ile kıyaslandı.BULGULAR: Ortalama yaş 46,1 (20-70) idi. Kırıkların %12,1’iproksimalde, %33,3’ü diafizde, 18 (%54,5)’i distalde oluşmuştu.Kırıkların 4 (%12,1)’i tip 1 açık, 4 (%12,1)’i tip 2 açık, diğer 25(%75,8) kırık ise kapalı kırıktı. Tüm hastaların kırıkları ortalama21,2 haftada kaynadı. Direkt travma sonucu daha sık görülenparçalı kırıkların daha geç kaynadığı tespit edildi. Komplikasyongelişen altı hastanın kırığı daha geç kaynadı. Dizilim bozukluğu 5dereceden fazla olan hasta sayısı ameliyat sonrası 3 (%9,1) iken, 12.ayda 4 (%12,1) olarak tespit edildi. Fonksiyonel durumları LEFSskoru ile değerlendirilen hastaların LEFS skorundaki ortalama 4,72puanlık düşüşü klinik olarak anlamlı değildi. Plak kırık uzunlukoranının; kaynama süresi, dizilim ve LEFS skorundaki değişimleilişkisi olmadığı görüldü.SONUÇ: MİPO yöntemi özellikle parçalı kırıklarda ve metafizerbölge kırıklarında göreceli stabilite ve biyolojik kaynamanınavantajları ile hızlı kaynama sağlayarak fonksiyonel iyileşmeyisağlamaktadır. Diafizer bölgenin basit kırıklarında açısal vetorsiyonel stabil fiksasyon sağlaması sebebi ile MİPO alternatif birtedavi yöntemidir.

FACTORS EFFECTING RESULTS OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS FOR EXTRA-ARTICULAR TIBIA FRACTURES

INTRODUCTION: In this study we aimed to analyze the relationships between patient and treatment related factors and healing time, alignment, LEFS score by evaluating the results of patients whom were treated with MIPO for extra-articular tibial fractures. MATERIAL AND METHOD: Thirty-three patients with extraarticular tibial fractures that were treated with MIPO between October 2010- April 2014 in our clinic were included in the study. Patient related factors and surgical technique details were compared with functional, clinical and radiological results. RESULTS: Mean age of 33 patients was 46.1 (20-70). 12.1% of fractures was proximal, 33.3% was diaphyseal, 54.5% was distal; 4 (12.1%) of them were type 1 open, 4 (12.1%) were type 2 open, remaining 25 (75.8%) were closed fractures. All fractures were healed an average of 21.2 weeks. Comminuted fractures which are result of direct trauma frequently healed later. Also fractures of six patients with complications healed within longer union times. There were 3 (9.1%) patients with more than 5 degrees malalignment at the beginning and 4 (12.1%) at 12th month. Patients’ functional status which were evaluated with LEFS score showed 4.72 decrease at an average but this much is clinically not significant. Plate span ratio was not correlated with union time, malalignment and change in LEFS score. CONCLUSION: MIPO method allows rapid functional healing especially in comminuted fractures and metaphyseal region fractures with relative stability and advantages of biologically healing. With torsional and angular stability MIPO is a good treatment option in simple fractures of diaphyseal region.

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