Ahmet Adnan KARAASLAN, Nihat ACAR, A. Meriç ÜNAL

Femur İntramedüller Çivilemede Proksimal Kilitleme Vidası Uygulaması Optimal Seviyesinin Saptanması

Amaç; Çalışmanın amacı femur intramedüller çivilemede proksimal kilitleme vidası uygulamasının optimal yerleşim seviyesini saptamaktır.Hastalar ve Metod: Her iki cinsiyetten ve farklı yaş gruplarından 208 hastanın kalça anteroposterior grafileri değerlendirilmiştir. Trokanter minor seviyesinin 20 mm distal ve 20 mm proksimal aralığı 10 mm lik aralıklara bölündü. Trokanterik fossa ile trokanter minor arası mesafe ve yukarıda belirlenen seviyeler arasında mediolateral femoral kanal çapları ölçüldü. Sonuçlar: Trokanterik fossa ve trokanter minor arası ortalama mesafe erkeklerde 60,8 mm kadınlarda ise 52,2 mm olarak saptandı(p=0,000). Trokanter minor seviyesindeki ortalama femoral kanal çapı 29,2 ± 4,3 mm ve trokanter minörün 10 mm proksimalinde ise 39 ± 4,6 mm olarak ölçüldü. Fark istatistiksel olarak anlamlı bulundu(p=0,000). Çıkarımlar: Trokanter minor seviyesi, rölatif olarak proksimal femurun en dar yeri olması nedeni ile transvers proksimal kilitleme vidası için optimal seviye olarak saptandı. Ortopedik cerrahların femoral çivi seçerken çivinin tepesi ile proksimal kilitleme vidası arası mesafenin –üç nokta bükülme direncinin yüksek olması ve erken implant yetmezliği riskini azaltması nedeni ile- erkeklerde 61 mm ve kadınlarda 52 mm olmasına dikkat etmesinde fayda vardır.

Anahtar Kelimeler:

Femur kırığı; İntramedüller çivileme; Proksimal kilitleme vidası; Üç nokta bükülme testi

Determining the Optimal Level of Proximal Locking Screw Insertion in Femoral Nailing

Objectives: The aim is to investigate the optimum level of insertion for proximal locking screw in the proximal femurs.Methods: The distance between the trochanteric fossa and lesser trochanter and the medial- lateral femur canal diameters 20 mm proximal and 20 mm distal to the lesser trochanter within an intervals of 10 millimeters on AP radiograms of 208 patients in both genders and different age groups were measured. Results: The average distances between the trochanteric fossa and lesser trochanter level were 60.8 mm in male and 52.2 mm in female populations (p=0.000). The average femoral canal diameter at the level of the lesser trochanter was 29.2 ± 4.3 mm, whereas 10 mm proximal to the lesser trochanter it was 39 ± 4.6 mm, the difference was statistically significant with p=0.000. Conclusions: Lesser trochanter level is the optimal level for transverse proximal locking screw insertion since it contains the relatively narrowest canal in the proximal femur. Orthopedic surgeons should be aware of choosing the femoral nails with a proximal tip to proximal screw hole distance of a 61 mm in male and a 52 mm in female populations to increase three point bending resistance of proximal locking screw and to prevent early implant failure.

Keywords:

Femur fracture; Intramedullary nailing; Proximal locking screw; Three point bending,

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1. Yilmaz E, Karakurt L, Bulut M, Belhan O, Serin E. [Treatment of femoral shaft fractures and pseudoarthrosis with compressive and interlocking intramedullary nailing]. Acta Orthop Traumatol Turc. 2005;39(1):7-15.
2. Whittle AP, Wester W, Russell TA. Fatigue failure in small diameter tibial nails. Clin Orthop Relat Res. 1995(315):119-28.
3. Boenisch UW, de Boer PG, Journeaux SF. Unreamed intramedullary tibial nailing--fatigue of locking bolts. Injury. 1996;27(4):265-70.
4. Hapa O, Muratli HH, Yuksel HY, Celebi L, Dogruyol D, Bicimoglu A. Single or double distal locking in intramedullary nailing of tibial shaft fractures: a prospective randomized study. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES. 2010;16(1):33-7.
5. Kinast C, Frigg R, Perren SM. Biomechanics of the interlocking nail. A study of the proximal interlock. Archives of orthopaedic and trauma surgery. 1990;109(4):197-204.
6. Aper RL, Litsky AS, Roe SC, Johnson KA. Effect of bone diameter and eccentric loading on fatigue life of cortical screws used with interlocking nails. American journal of veterinary research. 2003;64(5):569-73.
7. Rubin PJ, Leyvraz PF, Aubaniac JM, Argenson JN, Esteve P, de Roguin B. The morphology of the proximal femur. A three-dimensional radiographic analysis. The Journal of bone and joint surgery British volume. 1992;74(1):28-32.
8. Siwach RCDS. Anthropometric study of proximal femur geometry and its clinical application. Indian J Orthop. 2003;37(4):247-51.
9. Atilla B, Oznur A, Caglar O, Tokgozoglu M, Alpaslan M. [Osteometry of the femora in Turkish individuals: a morphometric study in 114 cadaveric femora as an anatomic basis of femoral component design]. Acta Orthop Traumatol Turc. 2007;41(1):64-8.
10. Sen RK, Tripathy SK, Kumar R, Kumar A, Dhatt S, Dhillon MS, et al. Proximal femoral medullary canal diameters in Indians: correlation between anatomic, radiographic, and computed tomographic measurements. Journal of orthopaedic surgery. 2010;18(2):189-94.
11. Umer M, Sepah YJ, Khan A, Wazir A, Ahmed M, Jawad MU. Morphology of the proximal femur in a Pakistani population. Journal of orthopaedic surgery. 2010;18(3):279-81.
12. Rawal B, Ribeiro R, Malhotra R, Bhatnagar N. Anthropometric measurements to design best-fit femoral stem for the Indian population. Indian J Orthop. 2012;46(1):46-53.
13. Ericksen MF. Aging changes in thickness of the proximal femoral cortex. American journal of physical anthropology. 1982;59(2):121-30.
14. Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS. The anatomic basis of femoral component design. Clin Orthop Relat Res. 1988(235):148-65.
15. Karaarslan AA, Karakaşlı A, Aycan H, Çeçen B, Yıldız DV, Sesli E. The best location for proximal locking screw on femur. Indian Journal of Orthopaedics. 2016; 50: 94-98
16. Smith HW, De Smet AA, Levine E. Measurement of cortical thickness in a human cadaver femur. Conventional roentgenography versus computed tomography. Clin Orthop Relat Res. 1982(169):269-74.