KİLİTLİ İNTRAMEDÜLLER ÇİVİ İLE TEDAVİ EDİLEN 75 YAŞ ÜSTÜ FEMUR CİSİM KIRIKLI HASTALARIN KLİNİK SONUÇLARI

Giriş: İntramedüller çivileme yetişkin femur cisim kırıklarında kabul edilmiş bir tedavi yöntemidir. İleri yaştaki hastalarda kemik, eklem yapısındaki değişiklikler ve ek komorbid hastalıklar nedeniyle intramedüller çivileme yetişkin hastalara göre özellik arzetmektedir. İleri yaş femur cisim kırıklarında intramedüller çivileme ile ilgili çalışma sayısı azdır.Bu çalışmada femur cisim kırığı olan yaşlı hastalarda intramedüller çivilemenin klinik ve radyolojik sonuçları değerlendirilmiştir. Gereç ve Yöntem: 2012-2019 yılları arasıda 20 hastanın 20 femuru retrospektif olarak incelendi. Ölüm, kaynama, komorbid hastalıklar, intraoperative ve postoperatif komplikasyonlar değerlendirildi. Onüç hastaya açık, yedisine kapalı redüksiyon uygulandı. Yedi hastada lateral girişli ve sefalomedüller kilitlemeli, 13 olguda priform girişli statik transvers kilitlemeli çivi uygulandı. Bulgular: Hastaların ortalama yaşı 84,2 (75-97) olup ortalama 15,4 ay (1-54) takip edildiler. Altı vaka (%30) ilk bir yıl içinde öldü, iki vaka yatalak kaldı. Kaynama oranımız %85,4’tü. Preoperatif 18 hastada bir veya daha çok komorbid hastalık vardı. Operasyon sırasında bir olguda femur cisminde parçalanma, postoperative iki vakada femur boyun kırığı ve bir vakada diz eklemine çivi migrasyonu izlendi. Sonuç: Kilitli intramedüller çivileme yaşlı osteoporotik femur cisim kırıklarında güçlü bir stabilite sağlamalarından dolayı güvenli ve etkili bir tedavi yöntemidir. Gelişebilecek femur boyun kırıklarından kaçınmak için lateral girişli sefalomedüller kilitlemeli çiviler öncelikle tercih edilmelidir.

THE CLINICAL OUTCOMES OF PATIENTS ABOVE 75 YEARS WITH FEMORAL SHAFT FRACTURES TREATED WITH LOCKED INTRAMEDULLARY NAILS

Introduction: Intramedullary nailing is an accepted treatment method in adult femoral shaft fractures. In this group of patients, intramedullary nailing is challenging than in adult patients due to changes in bone and joint structure and additional comorbid diseases. There are few studies on intramedullary nailing in elderly femoral shaft fractures. In this study, clinical and radiological results of intramedullary nailing in elderly patients with femoral shaft fractures were evaluated.. Material and Method: Between 2012 and 2019, 20 femurs of 20 patients were analyzed retrospectively. Death, union, comorbid diseases, intraoperative and postoperative complications were evaluated. Open reduction was performed in 13 patients and closed reduction was performed in seven patients. Lateral access and cephalomedullary locking nails were performed in 7 patients; a static transverse locking nail with priform entry was used in 13 patients. Results:The mean age of the patients was 84.2 (75-97) and they were followed up for 15.4 months (1-54). Six cases (30%) died within the first year, two cases were bedridden. Our rate of union was 85.4%. Preoperative 18 patients had one or more comorbid diseases. During the operation, femoral refracture in one case, femoral neck fracture was developed in two cases postoperatively, and nail migration to the knee joint in one case were observed. Conclusion: Locked intramedullary nails are a safe and effective treatment modality in elderly osteoporotic femoral shaft fractures as they provide strong stability. In order to avoid possible femoral neck fractures, lateral entry cephalomedullary locking nails should be preferred first.

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