Elsayed Ibraheem Elsayed MASSOUD

Fixation of intracapsular femoral neck fractures: Effect of trans-osseous capsular decompression

Amaç: Kapsül içi femur boynu kırıkları hemartrozla birlikte bulunmuştur. Sağlam kapsüldeki sıvı kapsül içi basıncı femur başı kanlanmasını önleyecek seviyelere yükseltir. Femur başı dolaşımını korumak amacıyla kapsül dekompresyonu gerekli görülmektedir. Bu nedenle kemik içinden bir yol açarak hem kapsül içi basıncı azaltmak hem de kapsül ilişkili kan damarlarını zedelemeyecek bir yöntemi ileri sürüyoruz. Yöntemler: Bu sunulan çalışmada kapsül içi femur boynu kırığı olan ve kapalı redüksiyon ve internal sabitleme yapılan 27 hasta çalışmaya alındı. Kemik içinden bir yol oluşturup kapsül içi dekompresyon yapıldı. Hastalar ortalama 43.1 ay süreyle izlendi. Bulgular: Tüm kırıklar iyileşti. Ancak operasyon öncesi cilt traksiyonu uygulanan 17 yaşındaki hastada femur başı osteonekrozu gelişti. Sonuç: Sonuçlarımız kemik içinden kapsül dekompresyonu yapılmasının intrakapsüler hematomun boşalmasına yol açarak kapsül bütünlüğünü koruduğunu göstermektedir. Genç bir hastada operasyon öncesi kırık bulunan ekstermiteye traksiyon uygulanması femur başında osteonekroz gelişimine yol açmış oalbilir.

Femur boynu kırıklarının kapsül içi fksasyonu: Kemik içinden kapsül dekompresyonunun etkisi

Objectives: Intracapsular femoral neck fractures have been found as associated with hemarthrosis. The fuid in the intact capsule elevates the intracapsular pressure to a level could tamponades the vascular supply of the femoral head. Therefore, capsular decompression seems necessary to salvage the femoral head circulation. Negative impact of the capsular incision also has been reported Therefore, we hypothesize that creation of a trans-osseous portal can decompress the capsule as well as no threaten the capsular related blood vessels. Materials and methods: In present study, 27 patients with intracapsular femoral neck fractures were included Coinciding with closed reduction and internal fxation we made a trans-osseous portal for capsular decompression Patients were followed-up prospectively for a mean period of 43.1 months. Results: All fractures united. However, one patient 17 years-old who was nursed preoperatively in skin traction developed osteonecrosis of the femoral head. Conclusion: Our results supported that the trans-osseous capsular decompression has evacuated the intracapsular haematoma and has not threatened the capsular integrity Preoperative traction of the injured limb particularly in the young patient may play a role in development of osteonecrosis of the femoral head.

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