Nusret ÖK, Bekir Alper KILIÇ, Fahir DEMİRKAN, Çağdaş YÖRÜKOĞLU, Mehmet YÜCENS, Nadir AYDEMİR, Harun Reşit GÜNGÖR, Nihal BÜKER

İntrameduller çivi uygulamasında erken yük vermenin kırık kaynamasına etkisi

Giriş: Tibia cisim kırıkları, ortopedi ve travmatoloji pratiğinde en sık görülen kırık tiplerinden biridir. Bu çalışmada tibia cisim kırıkları tedavisinde kilitli intramedüller çivi uygulanan hastaların klinik sonuçlarının ve fonksiyonel durumlarının değerlendirilmesi ve yük verme ile kaynama zamanının karşılaştırılması amaçlanmıştır.Yöntem: Çalışmaya 18-73 yaş arası, tibia cisim kırığı nedeni ile intramedüller fiksasyon uygulanmış olan 44 hasta dahil edildi. Çalışmamızda sonuçlar, Johner ve Wruhs Kriterlerine göre ve Karlstum-Olerud kriterlerine göre kaydedildi. Radyolojik olarak iyileşme, radyografilerde hastanın desteksiz olarak yük verebileceği düzeyde kallus formasyonu ve/veya kırık hattının kaybolması olarak değerlendirildi. Klinik iyileşme ise hastanın ağrısız tam yük verebilmesi ve günlük aktivitelerine dönebilmesi olarak değerlendirildi.Bulgular: Hastaların yaş ortalaması 38,7±14,9 (17-73) yıl idi. 44 hastadan Hastaların 16’ sında ( %36,4) tibia 1/3 orta cisim kırığı, 25’ inde (%56,8) tibia 1/3 distal kırık, 3’ ünde ise ( %6,8) ise tibia 1/3 proksimal kırığı görüldü. Hastaların ortalama kaynama süresi 11,36±3,8 (6-20) hafta olarak gözlendi. Karlstrom-Olerud'un fiziksel fonksiyonel değerlendirme skalasına göre ; 21 hasta (%47,7) mükemmel, 14 hasta (%31,8) iyi, 1 hasta (%2,3) tatmin edici, 8 hasta ( %18,2 ) ise orta olarak kaydedildi ve hiç kötü sonuç yoktu. Johner-Wrush kriterlerine göre 32 hastada (%72,7) mükemmel, 12 hastada ise %27,3 iyi olarak değerlendirildi. Takip sürecinde bütün kırıkların kaynadığı gözlendi. Sonuç: Hastalar Johner-Wrush Kriterlerine göre mükemmel ve iyi skora sahiptiler. Karlstrom-Olerud'un fiziksel fonksiyonel değerlendirme skalasına göre ise hiçbir hasta kötü skora sahip değildi. Genç, erken ağırlık aktaran ve çivi korteks mesafesi 2mm’den az olan hastalarda kaynama süresi kısalmaktadır.

Anahtar Kelimeler:

Tibia cisim kırıkları, Kilitli intramedüller çivileme, Yük verme

Impact of early loading on fracture healing with intramedullary nailing.

Introduction: Tibial diaphyseal fractures are one of the most common types of fractures in practise of the orthopedics and traumatology. In this study, clinical results of the patients with diaphyseal fractures of the tibia which have been treated with locking intramedullary nailing tecnique and the weight bearing time and union time has been evaluated. Method: Patients who applied to our hospital with tibial diaphyseal fractures were evaluated retrospectively. 43 patients were included in the study. Karlstrom-Olerud, Johner and Wruhs score were used to evaluate clinical results. Radiologic improvement was assessed as loss of callus formation and / or fracture line at the level that the patient could load without support on radiographs. Clinical improvement was assessed as the patient was able to give full pain relief and return to daily activities.Results: Mean duration of union was 11.36 ± 3.8 (6-20) weeks. According to Karlstrom-Olerud 21 patients (47,7%) has received a full grade of 36, 14 patients (31,8%) have been evaluated as good with a grade between 33 and 35, 1 patient (2,3%) was satisfactory with a grade in the range 30-32 and 8 patients were in the range 27-29 and they are evaluated as fair. Non of the patients were evaluated as poor. Conclusion: Patients have an excellent and good score according to the Johner-Wrush criteria. According to Karlstrom-Olerud's physical functional assessment scale, no patient had a bad scar. Younger, early-weight-bearing patients with a nail cortex distance of less than 2mm, the duration of union is shortening.

Keywords:

Tibia fracture, Locked intramedullery nail, loading,

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