İntramedüller Çivileme ile Tedavi Edilen İntertrokanterik Femur Kırıklarında Mekanik Yetmezliğe Etki Eden Risk Faktörlerinin Değerlendirilmesi

Amaç: Bu çalışmanın amacı intramedüller çivileme ile tedavi edilen pertrokanterik femur kırıklı hastalarda proksimal çektirme vidasının mekanik yetmezliğine sebep olabilecek radyolojik ve klinik risk faktörlerini değerlendirmektir. Gereç ve Yöntemler: Tüm intertrokanterik kırık vakaları retrospektif olarak değerlendirildi ve 24’ünde mekanik yetmezliği olan 298 hasta bu çalışmaya dahil edildi. Hastalar, demografik veriler, Singh indeksi, Baumgartner skalasına göre redüksiyon kalitesi, Cleveland-Bosworth kadranlarına ve Parker oranı göre proksimal çektirme vida pozisyonu, femoral kalkarın restorasyonu ve tip-apeks mesafesi açısından karşılaştırıldı. Bulgular: İki grup arasında cinsiyet (p=0.745), yaş (p=0.848), Amerikan Anesteziyoloji Derneği (American Society of Anesthesiology) skorları (p=0.725), vücut kitle indeksi (p=0.648) ve Singh indeksi (p=0.119) açısından istatistiksel olarak anlamlı bir farklılık yoktu. Aşağıdaki değişkenler açısından iki grup arasında istatistiksel olarak anlamlı farklılıklar vardı; stabil olmayan kırığı olan hasta sayısı (p<0,001), kötü redüksiyon kalitesi (p<0,001), femoral kalkar restorasyonu (p<0,001), merkez-merkez/merkez-alt çektirme vidası pozisyonu (p<0,001) ve lateral görünümde Parker oranı (p=0,002). Lojistik regresyon analizine göre merkez-merkez/merkez-alt çektirme vidası pozisyonu, iyi redüksiyon kalitesi ve femoral kalkar restorasyonunun üstün sonuçları öngören parametreler olduğu saptandı. Sonuç: Bu çalışmanın sonuçlarından; proksimal çektirme vidasının mekanik yetmezliğinin önlenebilmesi için kırığın redüksiyon kalitesine ve uç-apeks mesafesine dikkat edilmesinin zorunlu olması ile birlikte, intramedüller çivileme ile sabitlenen interochanterik femur kırığı tedavisinde posteromedial kalkar restorasyonunun ve çektirme vidasının femur başı içindeki konumunun ciddi bir role sahip olduğu sonucuna varıldı.

Anahtar Kelimeler:

: intertrokanterik femoral kırık, intrameduller çivileme, proksimal femoral çivileme

Evaluation of the Risk Factors for Mechanical Failure of Intertrochanteric Femoral Fracture Treated with Intramedullary Nailing

Aim: The aim of this study was to evaluate the radiological and clinical risk factors predisposing the proximal lag screw to mechanical failure in patients with pertrochanteric femur fractures treated with intramedullary nailing. Material and Methods: All intertrochanteric fracture cases were evaluated retrospectively and 298 patients (24 had mechanical failure) were included in this study. The patients were compared in terms of demographic data, Singh index, reduction quality according to the Baumgaertner scale, proximal lag screw position according to Cleveland-Bosworth quadrants and the Parker ratio, and the calcar femorale restoration and tip-apex distance. Results: There was no statistically significant difference in terms of gender (p=0.745), age (p=0.848), American Society of Anesthesiology scores (p=0.725), body mass index (p=0.648) and Singh index (p=0.119) between the two groups. There were statistically significant differences between the two groups in terms of the following variables; number of patients with unstable fracture (p<0.001), poor reduction quality (p<0.001), calcar femorale discontinuity (p<0.001), center-center/center-inferior lag screw position (p<0.001), and Parker ratio on the lateral view (p=0.002). The center-center/center-inferior lag screw position, good reduction quality and calcar femorale restoration were found to be parameters predicting superior outcomes according to logistic regression analyses. Conclusion: From the results of this study, it was concluded that although the preoperative reduction of the fracture and tip-apex distance are mandatory to prevent failure of the proximal lag screw, posteromedial discontinuity and lag screw position have a vital role in the treatment of interochanteric femur fracture fixed with intramedullary nailing.

Keywords:

Intertrochanteric fracture, intramedullary nailing, proximal femoral nailing,

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