Onur SÜER, Sertaç SARUHAN, Melikşah UZAKGİDER, Fener ÇELEBİ, Recep EYCEYURT, Cemil KAYALI

İNTRAMEDÜLLER ÇİVİ İLE TEDAVİ EDİLEN 65 YAŞ ÜSTÜ ATİPİK VE TİPİK FEMUR CİSİM KIRIKLI HASTALARIN KARŞILAŞTIRILMASI

Giriş: Bu yazının amacı intramedüller çiviler ile tedavi edilmiş 65 yaş üstü atipik ve tipik femur kırıklarının klinik ve radyolojik sonuçlarını karşılaştırmaktır. Gereç ve Yöntem: Toplam 36 hastanın 41 femurl cisim kırığı retrospektif olarak değerlendirildi. Kırıkların 29’u atipik, 12’si ise tipik idi. Bütün kırıklar kilitli intramedüller çivi ile tedavi edildi. Atipik grupta hastaların ortalama yaşı 83 ± 8,69,tipik grupta ise 82 ± 7,03 idi. Hastalar mortalite, kaynama, intraoperatif ve postoperatif komplikasyonlar açısından değerlendirildi. Sonuçlar istatistiksel olarak karşılaştırıldı. Bulgular: Atipik grupta ortalama takip 29,4 (1-96) ay ve tipik grupta ise 8,3 (1-24) aydı. İlk yılda ölüm oranımız atipik grupta %4,1 (1/24) ve tipik grupta ise %50 (6/12) idi, gruplar arasında istatistiksel fark vardı. Kaynama atipik grupta 19 hastadan (%65,5); tipik gruptan ise altı hastadan (%50) elde edildi; istatistiksel olarak anlamlı fark tespit edilmedi. Gruplar arasında hastane başvurusundan cerrahiye olan zaman ve taburculuk süresi açısından istatistiksel fark yoktu. Sonuç: Morbidite açısından intramedüller çivi ile tedavi edilen atipik ve tipik femur cisim kırıklı yaşlı hastalar arasında bir fark olmadığı sonucuna vardık, sefalomedüller kilitli çiviler hem atipik hem de tipik femur cisim kırıklarında ileride gelişebilecek çivi çevresi kırıkların önlenmesi açısından ilk seçenek olmalıdır.

COMPARISON OF PATIENTS OVER 65 YEARS WITH ATYPICAL AND TYPICAL FEMORAL SHAFT FRACTURES TREATED WITH INTRAMEDULLARY NAILING

Introduction: The aim of this study is to compare the clinical and radiological outcomes of atypical and typical femoral shaft fractures over 65 years of age treated with intramedullary nails. Material and Method: Total 36 patients with 41 femoral shaft fractures were retrospectively evaluated. 29 fracture were atypical and 12 typical. All fractures were treated with locked intramedullary nails. Mean age of patient’s was 83 ± 8,69 in atypical group and 82 ± 7,03 in typical group. Patients were evaluated in terms of mortality, union, intra and postoperative complications. Results were compared statistically. Results: Mean follow-up time 29,4 months (1-96) in atypical group and 8,3 (1-24) months in typical group. First year mortality rate was 4,1% (1/24) in atypical group and 50% (6/12) in typical group and there was statistically difference between the groups. Union was achieved from 19 (65,5%) femur in atypical group and six (50,0%) in typical group; no statistically difference was detected. There were no statistically difference between the groups in terms of mean time from hospital admission to surgery and discharge from hospital. Conclusion: We concluded that there was no difference between atypical and typical femur shaft fractures treated with intramedullary nailing in elderly patients with regard to morbidity, cephalomedullary locked intramedullary nails could be first choice for both atypical and typical femoral shaft fractures in terms of preventing future peri-nail fractures.

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1. Desai PA. Atypical femoral fractures: a review of the literature. Curr Osteoporos Rep 2013; 11(3): 179-87.
2. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 2005; 90(3): 1294–301.
3. Yoon RS, Hwang JS, Beebe KS. Long-term bisphosphonate usage and subtrochanteric insufficiency fractures: a cause for concern. J Bone Joint Surg Br 2011; 93(10): 1289–95.
4. Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the american society for bone and mineral research. J Bone Miner Res 2014; 29(1): 1–23.
5. Kayali C, Altay T, Ozan F, Sozkesen S, Yamak K . Femoral shaft fractures secondary to long-term bisphosphonate therapy J Orthop 2017; 14(2): 226–30.
6. Elbarbary AN, Hassen S, Badr IT. Outcome of intramedullary nail for fixation of osteoporotic femoral shaft fractures in the elderly above 60. Injury 2021; 52(3): 602-5.
7. Koh A, Guerado E, Giannoudis PV. Atypical femoral fracturesrelated to bisphosphonate treatment: issues and controversiesrelated to their surgical management. Bone Joint J 2017; 99-B(3): 295-302.
8. Shkolnikova J, Flynn J, Choong P. Burden of bisphosphonate-associated femoral fractures. ANZ J Surg 2013; 83(3): 175– 81.
9. Teo BJ, Koh JS, Goh SK, Png MA, Chua DT, Howe TS. Post-operative outcomes of atypical femoral subtrochanteric fracture in patients on bisphosphonate therapy. Bone Joint J 2014; 96-B(5): 658–64.
10. Schilcher J, Koeppen V, Aspenberg P, Michaelsson K. Risk of atypical femoral fracture during and after bisphosphonate use. Acta Orthop 2015; 86(1): 100–7.
11. Khow KS, Paterson F, Shibu P, Yu SC, Chehade MJ, Visvanathan R. Outcomes between older adults with atypical and typical femoral fractures are comparable. Injury 2017; 48(2): 394-8.
12. Davenport D, Duncan J, Duncan R, Dick A, Bansal M, Edwards MR. outcomes for elderly patients with atypical femoral fractures compared to typical femoral fractures for length of stay, discharge destination, and 30-day mortality rate. Geriatr Orthop Surg Rehabil. 2018; 9: 2151459318820222.
13. Thompson RN, Phillips JR, McCauley SH, Elliott JR, Moran CG.Atypical femoral fractures and bisphosphonate treatment: experiencein two large United Kingdom teaching hospitals. J Bone Joint Surg Br 2012; 94(3): 385-90.
14. Egol KA, Park JH, Rosenberg ZS, Peck V, Tejwani NC. Healing delayed but generally reliable after bisphosphonateassociated complete femur fractures treated with IM nails. Clin Orthop Relat Res 2014; 472(9): 2728–34.
15. Schilcher J, Koeppen V, Aspenberg P, Michaë lsson K. Risk ofatypical femoral fracture during and after bisphosphonate use. Acta Orthop 2015; 86(1): 100-7.
16. Shkolnikova J, Flynn J, Choong P. Burden of bisphosphonate-associated femoral fractures. ANZ J Surg 2013; 83(3): 175– 81.
17. Teo BJ, Koh JS, Goh SK, Png MA, Chua DT, Howe TS. Post-operative outcomes of atypical femoral subtrochanteric fracture in patients on bisphosphonate therapy. Bone Joint J 2014; 96-B(5): 658–64.
18. Bronson WH, Kaye ID, Egol KA. Atypical femur fractures: a review. Curr Osteoporos Rep 2014; 12(4): 446–53.
19. Spinelli MS, Marini E, Daolio PA, Piccioli A. Atypical diaphyseal femoral fractures: Considerations on surgical technique. Injury 2019; 50 (2ek 2): 65-9.
20. Park JH, Lee Y, Shon OJ, Shon HC, Kim JW. Surgical tips of intramedullary nailing in severely bowed femurs in atypical femur fractures: simulation with 3D printed model. Injury 2016; 47(6): 1318-24.
21. Özsoy MH, Aksekili MA, Kızılay O, Dinçel VE, Aydoğan NH, Ozsoy A. Femoral insufficiency fractures in the elderly - excessive medial femoral bowing complicates intramedullary nailing. Acta Orthop Traumatol Turc 2014; 48(5): 507-12.