Sefa KEY, Şükrü DEMİR, Murat GÜRGER, Erhan YILMAZ

Retrograd İntramedüller Çivileme ile Femur Distal Nonunion Tedavisinde Otogreft Gerekli mi?

Amaç: Distal femur kırıklarında günümüzde sık kullanılan kilitli plaklar sonrasında gelişen nonunion tedavisi için retrograde intramedüller çiviler ile tedavi edilen hastalarda otogreft kullanımının kaynama süresi ve diz fonksiyonları üzerine etkisini değerlendirmek. Gereç ve Yöntemler: Çalışmada reamerize intramedüller çivi ile tedavi edilmiş distal femur kaynaması olmayan 18 hastanın verileri retrospektif olarak incelendi. Çalışmaya femur 1/3 distalinde nonunion olan ve aktif enfeksiyon bulgusu olmayan tüm hastalar dahil edildi. Dokuz ay sonunda kaynama bulgusu olmayan ve implant yetmezliği görülen reamerize intramedüller çivi ile tedavi edilmiş hastalar incelendi. Kaynama değerlendirmesi ve diz fonksiyonları değerlendirildi. Sürekli değişkenler Student t testi kullanılarak karşılaştırıldı. P değeri <0.05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Hastaların ortalama takip süresi 24.7 (12-36) ay idi. Üç hastada varus deformitesi komplikasyon olarak izlendi. Hastaların Mize skoru esas alınarak 12’sinde iyi sonuç 3 hastada mükemmel, 3 hastada makul sonuç elde edildi. Ortalama kaynama sürelerine bakıldığında 5.2 (4-7) ay idi. Operasyon öncesi maksimum 91.7 (10-120) derece olan diz fleksiyonu, operasyon sonrası ortalama maksimum diz fleksiyonu 106 (70-120) derece bulundu. Otogreft kullanımında kaynama süresi bakımından anlamlı farklılık gözlenmedi. Sonuç: Distal femur nonunionlarda tedavi seçeneği olarak retrograde intramedüller çiviler ile başarılı sonuçlar alınabilir. Otogreft kullanımı kaynama süresi açısından sonucu etkilemese de bu konuda daha fazla çalışma yararlı olacaktır.

Anahtar Kelimeler:

Femur distal nonunion, Retrograde intramedüller çivi, fermur distal plak

Is Autograft Necessary in the Treatment of Femur Distal Nonunion with Retrograde Intramedullary Nailing?

Objective: To evaluate the effect of auto graft use on union time and knee functions in patients treated with retrograde intramedullary nails for the treatment of nonunion after locking plates, which are commonly used today in distal femur fractures. Materials and Methods: A retrospective study of 18 manufacturers with no intramedullary internal localization and no femoral union was studied. All people with nonunion in the 1/3 distal and without active signs are taken care of. At the end of 9 months, no sign of union and grown with intramedullary civilian after implant training were examined. Evaluation and value of union were evaluated. Continuous concordances Student’s t-test compared. P value <0.05 was considered significant. Results: The mean follow-up period of the patients was 24.7 (12-36) months. Varus deformity was observed as a complication in 3 patients. Based on the Mize score of the patients, good results were obtained in 12 patients, excellent results in 3 patients, and reasonable results in 3 patients. Considering the mean union times, it was 5.2 (4-7) months. The mean maximum knee flexion was 91.7 (10-120) degrees preoperatively and 106 (70-120 degrees) postoperatively. No significant difference was observed in terms of union time in auto graft use. Conclusions: Successful results can be obtained with retrograde intramedullary nails as a treatment option in distal femoral nonunions. Although the use of auto graft does not affect the result in terms of union time, more studies on this subject would be beneficial.

Keywords:

Femur distal nonunion, Retrograde intramedullary nail, Fermur distal plate,

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Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-697.
Jahangir AA, Cross WW, Schmidt AH. Current management of distal femoral fractures. Current Orthopaedic Practice. 2010;21(4):193–197.
Chan DB, Jeffcoat DM, Lorich DG, Helfet DL. Nonunions around the knee joint. Int Orthop. 2010;34(2):271-281.
Gwathmey FW Jr, Jones-Quaidoo SM, Kahler D, Hurwitz S, Cui Q. Distal femoral fractures: Current concepts. J Am Acad Orthop Surg. 2010;18(10):597-607.
Gautier E, Sommer C. Guidelines for the clinical application of the LCP. Injury. 2003;34Suppl 2:63-76.
Calori GM, Albisetti W, Agus A, Iori S, Tagliabue L. Risk factors contributing to fracture non-unions [published correction appears in Injury. 2007;38(10):1224.
Henderson CE, Lujan TJ, Kuhl LL, Bottlang M, Fitzpatrick DC, Marsh JL. 2010 mid-America Orthopaedic Association Physician in Training Award: Healing complications are common after locked plating for distal femur fractures. Clin Orthop Relat Res. 2011;469(6):1757-1765.
Hannouche D, Petite H, Sedel L. Current trends in the enhancement of fracture healing. J Bone Joint Surg Br. 2001;83(2):157-164.
Wu CC. Retrograde dynamic locked nailing for femoral supracondylar nonunions after plating. J Trauma. 2009;66(1):195-199.
Ebraheim NA, Martin A, Sochacki KR, Liu J. Nonunion of distal femoral fractures: A systematic review. Orthop Surg. 2013;5(1):46-50.
Wang JW, Weng LH. Treatment of distal femoral nonunion with internal fixation, cortical allograft struts, and autogenous bone-grafting. J Bone Joint Surg Am. 2003;85(3):436-440.
Oh JK, Bae JH, Oh CW, Biswal S, Hur CR. Treatment of femoral and tibial diaphyseal nonunions using reamed intramedullary nailing without bone graft. Injury. 2008;39(8):952-959.
Mize RD, Bucholz RW, Grogan DP. Surgical treatment of displaced, comminuted fractures of the distal end of the femur. J Bone Joint Surg Am. 1982;64(6):871-879.
Sabharwal S, Kumar A. Methods for assessing leg length discrepancy. Clin Orthop Relat Res. 2008;466(12):2910-2922.
Kempf I, Grosse A, Beck G. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J Bone Joint Surg Am. 1985;67(5):709-720.
Gardner MJ, Toro‐Arbelaez JB, Harrison M, Hierholzer C, Lorich DG, Helfet DL et al. Open reduction and internal fixation of distal femoral nonunions: Long‐term functional outcomes following a treatment protocol. J Trauma, 2008, 64:434–438.
Hierholzer C, Von Ruden C, Potzel T, Woltmann A, Bühren V. Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: A retrospective analysis. Indian J Orthop, 2011,45:243–250.
Scolaro J, Ahn J. Locked plating in practice: Indications and current concepts. Univ Pa Orthop J, 2011,21:18–22.
Zhang J, Yin W, Qiu Y, Shen Y, Cao S, Wang J. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018;32(1):36-39.
Meccariello L, Bisaccia M, Ronga M, et al. Locking retrograde nail, non-locking retrograde nail and plate fixation in the treatment of distal third femoral shaft fractures: radiographic, bone densitometry and clinical outcomes. J Orthop Traumatol. 2021;22(1):33.
Megas P. Classification of non‐union. Injury, 2005, 36 (Suppl 4):30–37.