Unreamed intramedullary nailing in tibial shaft fractures

Abstract

63 patients who were diagnosed as tibial shaft fractures have been treated by intramedullary nailing in the years between March 1993 and May 1997 at our clinic. The mean follow-up period for these patients was 16, 7 months. The mean age of the patients was 33, 9 years. The aetiologic factor was motor vehicle accidents in 55 cases (87, 30%). The others were industrial accidents in 6 cases (9,5%), falling in 2 cases (3,1%), and stroke injuries in 1 case (1, 5%). 32 (50,79 %) of them were closed fractures and 31 (49,21 %) were open. According to Gustilo Anderson classification systems the distributions of open fractures were as follows : Type 1: 11, Type 2: 13, Type 3: 7. Closed nailing was applied to 52 patients (82,53 %), while open nailing was applied to 11 patients (17,47%) for various reasons. Conventional nails were applied to 53 cases while interlocking nails were used in 10 cases (4 of them were static and 6 of them were dynamic). Clinical recovery occurred in 14, 0 weeks, on the otherhand radiological recovery in 17,0 weeks. Only in 2 patients there was shortening over 10 mm. In 2 cases angulation at mediolateral plane was over 5 mm, whereas in 1 patient angulation at anteroposterior plane was over 5mm. In 2 cases delayed union was seen. Rotational deformity , neurologic or vascular complication , nonunion and osteomyelitis have not been observed in any of the cases. According to Johner and Wruhs Evaluation Criteria, We realised that we obtained excellent results in 38 cases (60,31%), good in 18 (28,57%), fair in 7 (11,11%) . We have not observed any poor result. While we obtained 25 excellent (78,13%), 5 good (15,62%), and 2 fair (6, 25%) results in closed fractures, we obtained 15 excellent (48,38 %), 11 good (35,48 %) and 5 fair (16,12 %) results in open fractures.

Keywords

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Tibia cisim kırıklarında medüller kanal oyulmadan intramedüller çivi uygulaması

Öz

Kliniğimizde Mart 1993-Mayıs 1997 tarihleri arasında tibia kırığı tanısı konan 63 hastaya modüller ka-nal oyulmadan intramedüller çivi uygulandı. Bu hastalar için ortalama takip süremiz 16,7 aydı. Hastaların ortalama yaşı 33,9 olarak bulundu. % 87,30 olguda neden trafik kazasıydı. Bu kırıkların 32'si kapalı 31'i açık kırıktı (11 olgu Gustilo Anderson Tip l, 13 olgu Tip 2 ve 7 olgu Tip 3). 52 hastaya (% 82,53) kapalı, 11 hastaya (% 77, 47) ise değişik nedenlere bağlı olarak açık çivileme uygulandı. 53 başlaya konvansiyonel çi-vi, 6 olguya dinamik, 4 olguya da statik kilitli intramedüller çivi uygulandı. Klinik iyileşme ortalama 14 haftada, radyolojik iyileşme ise 17 haftada gerçekleşti. Sadece 2 hastada 1 cm üzerinde kısalık oluştu. 2 ol-guda mediolateral plandaki angulasyon, 1 olguda da anteroposterior plandaki angulasyon 50'nin üzerindeydi. 2 olguda kaynama gecikmesi saptandı. Hiçbir olguda rotasyonel deformite, nörovasküler bozukluk, kaynama yokluğu ve osteomyelit gözlenmedi. Johner ve Wruhs değerlendirme kriterlerine göre 38 olguda (% 60, 31) mükemmel, 18 olguda (% 28, 57) iyi, 7 olguda da (% 11,11) orta sonuç almış oldugumuzu ve hiç kötü sonuç alınmadığını tespit ettik. Kapalı kırıklarda, 32 hastada 25 mükemmel (% 78, 13), 5 iyi (% 15, 62), 2 orta (% 6, 25) sonuç ve açık kırıklarda 31 hastada 15 mükemmel (%48, 38), 11 iyi (%35, 48), 5 orta (% 16, 12) sonuç elde edilmiştir.

Anahtar Kelimeler

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