YAŞLI ERİŞKİNLERDE İNTRAMEDÜLLER KİLİTLİ ÇİVİLER KULLANILARAK FEMUR DİYAFİZ KIRIKLARININ TEDAVİSİ

Amaç: Bu çalışma, intramedüller kilitli çivi ile opere edilmiş 34 yaşlı hastada orta vadeli femural diafiz kırıklarının sonuçlarını bildirmek amacıyla yapılmıştır. Metod: Çalışmaya, evde düşme (n: 30), trafik kazası (n: 3) veya yüksek enerjili düşme (n : 1) nede- niyle femoral diyafiz kırığı şikayeti ile gelen ve yaş ortalaması 71,2 yıl olan, 19 kadın ile 15 erkek dahil edilmiştir. Kırıklar AO / OTA sınıflandırmasına göre derecelendirilmiştir. Hastaların 9’u A1, 12’si A2, 6’sı A 3, 4’ ü B1, 2’si B2 ve 1’i C2 olarak sınıflandırılmıştır. Osteopeniyi belirlemek için Singh indeksi kullanılmıştır. Ortalama takip 29,12 aydır (8-41 ay). Ameliyat için gecikme ortalama 1. 9 gündür. Bulgular: Üç olguda flebit mevcuttu ve 5 olguda ise yüzeysel deri enfeksiyonu gelişti. Bir olguda implant başarısızlığı görüldü. Kemik bütünlüğü 1,4-6,06 ayda sağlandı (ortalama 3 ay). 12. ayda 32 yaşayan hasta için klinik sonuçlar elde edildi. Beş hasta yardım almadan yürümeyi başardı, 17 hasta baston kullandı, 11 hasta koltuk değneğine gerek duydu ve 1 hasta ise yatağa bağımlı kaldı. Hastanede kalma süresi ortalama 5 gündü (3ila 8 gün arası). 34 hastadan 18’i preoperatif ambu- lasyon haline döndü. Sonuç: Kilitleme çivisi; küçülme, eşlik eden hastalıklar, düşük kemik kalitesi, osteoporoz ve özel- likle normal boyuta göre genişlemiş medulla gibi zorluklar olmasına rağmen yaşlı hastalarda femo- ral şaft kırıklarının yönetiminde etkili bir metod olarak gözükmektedir.

Treatment of Femur Diaphysis Fractures in Elderly Adults By Using Intramedullary Locked Nails

Aim: To report the outcome of midterm femoral diaphysis fractures operated with intramedularylocked nail in elderly 34 patients.Methods: This study included 19 women and 15 men, mean age 71,2 years, who suffered afracture of the femoral diaphysis due to a fall at home (n:30 ), a traffic accident (n:3) or a high-energy fall (n:1).The fractures were graded according to the AO/OTA classification. A 1 waspresent in 9, A 2 in 12, A 3 in 6, B 1 in 4, B2 in 2 and C2 in 1 patient. The Singh index was usedto determine the osteopenia. Mean follow up was 29,12 months (8-41 Month). Mean delay tosurgery was 1. 9 days (interval 1-5).Results: Three cases had phlebitis and superficial skin infection occurred in 5 cases. One implantfailure was seen. Bone union was achieved in 1,4-6,06 month (mean 3 month). Clinical outcomein 12th month was available for 32 living patients: Five were able to walk without assistance,17 used a cane, 11 required crutches and 1 was bedridden. Mean hospitilisation was 5 days(interval 3-8 day). Eighteen of the 34 patients returned to their preoperative level of ambulation.Conclusions: The locking nail appears to be a more effective method of managing femoral shaftfractures in the elderly patient despite the difficulty in reduction, comorbidity, poor bone quality,osteoporosis and especially enlarged medulla according to normal size.

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