Fırat SEYFETTİNOĞLU, Ümit TUHANİOĞLU, Burç ÖZCANYÜZ, Hakan USLU, Osman ÇİLOĞLU, Hasan Ulaş OĞUR

YAŞLI HASTALARDA FEMUR İNTRAMEDÜLLER ÇİVİ UYGULAMALARINDA TUZAKLAR

Amaç Yaşlı osteoporotik hastalarda kalça bölgesi kırıkları kadar sık görülmesede femur cisim kırıklarıyla da karşılaşılmakta ve tedavi konusunda sorunlar yaşanabilmektedir. Çalışmanın amacı yaşlılarda düşük enerjili travma ile meydana gelen femur cisim kırıklarında kaynama problemlerini incelemek fiksasyon yönteminin yetersizliklerini değerlendirmektir. Gereç ve Yöntem 2012- 2016 yılları arası femur cisim kırığı nedeniyle opere edilen 65 yaş üstü osteopenik ve osteoporotik (BMD≤-2) 34 hasta çalışmaya dahil edildi. 26 hastaya kapalı yöntemle kilitli intramedüller çivi(İMN), 8 hastaya açık cerrahi yöntemle kilitli İMN uygulandı, bunlardan 2’si plak yetmezliği sonrası sekonder çivi uygulaması yapılan hastalar idi. 28 kadın 6 erkek çalışmaya dahil edildi. Kırık sınıflamasında AO/OTA sınıflaması kullanıldı. 6 hasta 1/3 proksimal-orta birleşim, 20 hasta orta bölge, 8 hasta 1/3 distal-orta birleşim kesimde idi. Klinik, fonksiyonel skorlar, kaynama zamanı, desteksiz mobilizasyon süreleri ve komplikasyonlar değerlendirildi. Bulgular Çalışmaya katılan 34 hastanın yaş ortalaması 73.8, ortalama takip süresi 26 ay(12-36) idi. Erken dönem klinik sonuçlar,kan kaybı(187+/- 35 ml) ve kırık bölgesinde kallus görülmesi açısından kapalı uygulanan intramedüller çivilerle daha iyi sonuçlar elde edildi(p

PITFALL IN FEMORAL INTRAMEDULLAR NAIL APPLICATIONS IN ELDERLY PATIENTS

ObjectiveFemoral shaft fractures are not seen in older patientswith osteoporosis as often as fractures in the hip region, and problems may be experienced in treatment.The aim of this study was to examine union problemsin femoral shaft fractures which occurred with low-energy trauma in the elderly and to evaluate deficienciesin the fixation method.Material and MethodsThe study included 34 patients with osteopenia andosteoporosis (bone mineral density ≤ -2), aged >65years who underwent surgery for a femoral shaftfracture between 2012 and 2016. Locking intramedullary nailing (IMN) was applied to 26 patients with theclosed method and to 8 patients with open surgery,and secondary nailing was applied in 2 of these patients, after plate failure. The patients comprised 28females and 6 males. The fractures were classifiedaccording to the AO/OTA classification. In 6 patients,the fracture was in the proximal third -mid region, in20 patients in the mid region, and in 8 patients in thedistal third-mid region. The clinical and functionalscores, time to union, time to unassisted mobilization,and complications were evaluated.ResultsThe mean age of the 34 patients was 73.8 years, andthe mean follow-up time was 26 months (range, 12-36) months. Better results were obtained from the patients who underwent closed IMN in respect of earlystage clinical results, blood loss (187±35 ml) and visualization of callus in the fracture site (p

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