Hakan SELEK, Hakan KINIK, Ertan MERGEN, Hakan ATALAR, Osman Yüksel YAVUZ

Antegrade locked nailing of adult femoral shaft fractures and non-unions: a retrospective review of 48 cases

Amaç: Bu makalede, akut femur cisim kırığı veya non-unionu nedeni ile antegrade kilitli intramedüller kilitli çivileme yapılan 48 olgunun fonksiyonel sonuçları retrospektif olarak değerlendirildi. Gereç ve Yöntem: Bu çalışmaya dahil edilen 48 hastaya toplam 52 antegrad kilitli intramedüller çivileme uygulandı. Akut femur cisim kırıklarının 27’sinde oymasız antegrad kilitli intramedüller çivileme uygulandı. Akut femur kırığı olan 4 ve non-union olan 21 hastada ise fi ksasyon oymalı kilitli çivileme ile sağlandı. Olguların yaş ortalaması 40.2 (17-80) idi. Serimizdeki hastaların 16 ’sı bayan (%33.3) ve 32 ’si erkekti (%66.7). Bulgular: Hastaların takipleri ile elde edilen veriler, Thoresen kriterlerine göre; femoral aks deformitesi, femoral kısalık, diz eklemi hareket açıklığı ve ağrı veya ödem varlığı incelenerek değerlendirildi. Hastalar ortalama 21 ay (10-46 ay) takip edildi. Bir tanesi haricinde tüm olgularda kaynama görüldü (%98.07). Yüzeyel enfeksiyon üç hastada izlendi ve bunlardan bir olgunun takiplerinde derin enfeksiyon gelişti. Akut kırık grubundan gastrointestinal kanama öyküsü olan Winquist tip IV kırıklı bir hastaya, antikoagülan tedavi verilemediğinden, derin venöz trombüs izlendi. Non-union grubundan bir hastada ise, ameliyattan sonraki dördüncü günde pulmoner emboli gelişti. Sonuç: İntramedüller çivileme yöntemleri akut femur cisim kırıkları ve non-unionlarında etkili bir tedavi metodudur. Oymalı çivileme metodu, oymasız çivileme metodu ile karşılaştırıldığında daha az başarısızlık izlenirken, yöntem sağlam stabilizasyon sağlar.

Erişkin femur şaft kırıklarının ve non-unionlarının antegrad kilitli çivileme yöntemi ile tedavisi: 48 olgunun retrospektif değerlendirilmesi

Background: Here we present a retrospective evaluation of the functional outcomes of 48 patients who underwent antegrade locked intramedullary nailing for acute femoral shaft fracture or nonunion. Methods: A total of 52 antegrade locked intramedullary nailings were performed in the 48 patients included in the study. In 27 of the acute femoral shaft fractures, fi xation was provided via unreamed antegrade locked intramedullary nailing. In 4 acute femoral fractures and in all 21 cases of nonunion, fi xation was provided via reamed antegrade locked intramedullary nailing. Average age was 40.2 years (range 17-80 years). Of these patients, 16 were female (33.3%) and 32 were male (66.7%). Results: Patient data obtained during follow up were evaluated according to the Thoresen criteria, in which lower extremity function is graded in terms of femoral axis deformity, femoral shortening, knee range of motion and pain or oedema. Patients were followed up for an average of 21 months (range 10-46 months). Union was found in all patients except one (98.07%). Superfi cial infection occurred in three patients, and in one of these a deep infection developed. In the acute fracture group, one patient with a Winquist type IV fracture had a history of gastrointestinal bleeding and could not be given anticoagulants, and developed a deep venous thrombosis. In the nonunion group, one patient developed pulmonary emboli on the 4th postoperative day. Conclusion: Intramedullary nailing is an eff ective treatment method for both acute femoral shaft fracture and nonunion. It provides rigid stabilization, and the reamed method is associated with less frequent failures compared to the unreamed method.

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