Necmettin TURGUT, Ahmet İNCE, Meric UNAL

DİSTAL TİBİA KIRIKLARINDA FİBULAR FİKSASYON: KAYNAMA VE DİZİLİM AÇISINDAN GEREKLİ MİDİR?

Amaç Distal 1/3 tibia kırıklarının tedavi yönetimi tartışmalıdır. Bu çalışmanın amacı aynı zamanda yapılan fibular fiksasyonun kaynama oranlarını arttırıp arttırmadığını ve dizilim açısından gerekliliğini değerlendirmektir. Gereç ve Yöntem Bu çalışmaya distal 1/3 tibia kırığı nedeniyle tek bir merkezde Ocak 2016 ile Haziran 2020 arasında opere edilmiş 106 hasta alındı. Kırıklar plafond seviyesinden 3-12 cm arası mesafede lokalize olarak belirlendi. Hastalar fibulanın durumuna göre üç gruba ayrıldı: Grup 1 (bir fibula kırığı var ancak fibular fiksasyon yapılmamış, 47 vaka), Grup 2 (bir fibula kırığı var, eş zamanlı fibular fiksasyon yapılmış, 38 vaka) and Grup 3 (intakt fibula, 21 vaka). Tüm fibular fiksasyon cerrahileri kilitli kompresyon plakları ile, tibial fiksasyon ise kiltli kompresyon plakları veya intramedüller çivileme ile yapıldı. Primer sonuç ölçütleri kaynama ve dizilim olarak belirlendi. Yaş, cinsiyet, AO sınıflaması, fibula kırık seviyesi, açık kırık varlığı, implant tipi ve cerrahiye kadar geçen süre değerlendirildi. Bulgular Açık kırık varlığı haricindeki değişkenlerin hem kaynama oranlarını hem de dizilimi etkilemediği izlendi. Kaynama oranı eş zamanlı fibula fiksasyon grubunda açık kırık varlığında anlamlı oranda daha düşük saptandı (p<0.001). Kapalı kırıklar lojistik regresyon analizi yapıldığında daha iyi kaynama oranlarına sahipti (OR=5,00 (%95 CI 2,24-11,48). Sonuç Mevcut çalışma distal 1/3 tibia kırıklarında eş zamanlı bir fibular fiksasyon ameliyatının ne kaynama oranları ne de dizilim üzerine olumlu etkisi olmadığını gösterdi. Bundan dolayı, daha iyi sonuçlar almak için distal tibia kırıklarında bir fibular fiksasyon cerrahisi zorunluluk değildir ve açık kırık varlığında hem ek cerrahinin getirdiği yük hem de daha düşük kaynama oranı nedeni ile yapılmamasını önermekteyiz.

Anahtar Kelimeler:

distal tibia kırığı, fibula kırığı, kaynamama, Gustilo Anderson sınıflaması, intramedüller çivileme, eş zamanlı fibular fiksasyon

DISTAL THIRD TIBIAL FRACTURE SURGERY WITH FIBULAR FIXATION: IS IT NECESSARY FOR UNION AND ALIGNMENT?

Objective The management of distal third tibial fractures remain controversial. The aim of the present study was to evaluate whether concurrent fibular fixation changes union rates and aids in alignment in the case of distal third tibia fractures. Material and Method The study included 106 distal third tibia fracture operation cases in which the distance from the fracture to the plafond was between 3-12 cm at a single centre between January 2016 and June 2020. The patients were divided into three groups according to the status of the fibula: Group 1 (without fibular fixation with the presence of a fibula fracture, 47 cases), Group 2 (concurrent fibular fixation with the presence of a fibular fracture, 38 cases) and Group 3 (intact fibula, 21 cases). All fibular fixation surgeries were performed with locked plates (LCP) and tibial fixation with either LCP or intramedullary nailing (IMN). The primary outcome measures were union and alignment. Age, gender, AO classification, fibula fracture location, presence of an open fracture, implant type and time delay for surgery were also assessed. Results None of the variables except the presence of an open fracture was significant for the union rates or alignment. The union rate was significantly less if there was an open fracture in the concurrent fibular fixation group (p<0.001). Closed fractures were associated with better union rates according to the logistic regression analysis (OR=5,00 (%95 CI 2,24-11,48). Conclusion The present study suggests that a concurrent fibular fixation in the case of distal third tibia fractures improves neither the union rates nor the alignment. Therefore, we conclude that a fibular fixation is not a necessity in achieving better results and should not be performed in case of an open fracture considering the lesser union rate and the burden involved with an additional surgery.

Keywords:

distal tibia fracture, fibula fracture, nonunion, Gustilo Anderson classification, intramedullary nailing, concurrent fibular fixation,

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