Pediatrik Hastalarda Femur Diafiz Kırıklarının Elastik Titanyum Çiviler ile Tedavisi

Amaç: Araştırmanın amacı elastik titanyum çivi ile intramedüller tespit uygulanan stabil olmayan femur kırıklarının fonksiyonel ve radyolojik sonuçlarını değerlendirmek ve sonuçlara etki eden faktörleri belirlemektir. Yöntemler: 2001 ile 2014 yılları arasında, 4-17 yaş arası femur diafiz kırığı nedeniyle intramedüller elastik çivi ile tedavi edilen 32 hasta incelendi. On iki hastada sol femur diafiz kırığı, 18 hastada sağ ve 2 hastada bilateral femur diafiz kırığı mevcuttu. On bir hastada parçalı, 11 hastada kısa oblik, 8 hastada transvers ve 4 hastada spiral kırık paterni tespit edildi. Tüm hastalarda aynı cerrahi teknik ve ameliyat sonrası bakım uygulandı. Cerrahi sonrasında ve kontrollerde ön-arka ve yan direk grafiler ile sagital ve koronal açı ölçümleri yapıldı. Hastalar ortalama 54 (aralık, 12-156 ay) ay takip edildi. Ağrısız tam yük verme ve direk grafilerde en az üç kortekste kallus köprü olumu kaynama kriterleri olarak kabul edildi. Bulgular: Takiplerde bir hasta hariç tüm hastalarda kaynama elde edildi. Hastalar eski aktivitelerine geri döndü. Diz ve kalça eklem hareket açıklıkları geri kazanıldı. Ortalama kaynama süresi radyolojik olarak 9 (aralık, 6-16 hafta) hafta tespit edildi. Beş (14%) hastada kısalık tespit edildi. Kırık paterni ile kısalık arasında istatistiksel anlamlı ilişki saptanmadı. On dereceden fazla varus ya da valgus açılanması görülmedi. Sonuç: Elastik titanyum çivi uygulaması hastanın erken yük vermesine izin veren konforlu, ekonomik ve güvenli bir yöntemdir.

Anahtar Kelimeler:

Pediatrik, femur, kırık, titanyum elastik çiviler

Management of Femoral Shaft Fractures with Elastic Titanium Nails in Pediatric Patients

Objective: The aim of this study was to evaluate the functional and radiological results of the application of intramedullary fixation with elastic titanium nails in unstable femoral fractures and to determine the factors affecting these results. Methods: A total of 32 patients aged 4-17 years treated with intramedullary elastic nails for a femoral diaphysis fracture between 2001 and 2014 were included. The fracture was left side in 12 cases, right side in 18 and bilateral in 2. The fracture pattern was determined as fragmented in 11 cases, short oblique in 11, transverse in 8 and spiral in 4. The same surgical technique and postoperative care was applied to all the patients. Sagittal and coronal angle measurements were made from postoperative and follow-up anterior-posterior and lateral radiographs. The mean follow-up period was 54 months (12-156 months). Positive union criteria were accepted as pain-free weight-bearing and callus bridging in at least 3 cortices seen on direct radiographs. Results: Union was achieved in all except one patient. They were able to return to previous activities with full knee and hip joint range of movement. Radiologically, the mean time to union was determined as 9 weeks (range, 6-16 weeks). Limb shortness was determined in 5 (14%) patients. No significant association was detected between shortness and fracture pattern. No varus or valgus angulation of >10˚ was determined in any patient. Conclusion: Application of titanium elastic nails in pediatric femoral diaphysis fractures is a comfortable, economic, and reliable method which is allows early weight-bearing.

Keywords:

Pediatric, femur, fracture, titanium elastic nails,

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