Subtrokanterik kırıklarda proksimal femoral çivi tespiti

Öz

Amaç: Bu çalışmada akut subtrokanterik kırıklarda proksimal femoral çivi tespiti yönteminin sonuçlarının değerlendirilmesi amaçlandı. Çalışma planı: Akut subtrokanterik kırık tanısıyla Mart 2006 ile Şubat 2011 tarihleri arasında kurumumuzda intramedüller çivi ve spiral bıçak proksimal femoral çivileme uygulanan 33 hastanın (17 erkek ve 16 kadın) kayıtları geriye dönük olarak incelendi. En sık (%67) ve ağırlıklı olarak yaşlılarda görülen yaralanma mekanizması yere basar durumdayken düşme idi. Sonuçlar kaynama süresi, implant yetmezliği, enfeksiyon oranı ve fonksiyonel sonuçlar açısından değerlendirildi. Bulgular: Ortalama cerrahi süresi 2.4 saat olarak kaydedilirken, hastanede ortalama yatış süresinin 7 gün olduğu görüldü. Ortalama radyolojik iyileşme ise 16 haftada gerçekleşti. Hastaların 31’inde (%94) cerrahiden sonra 6 ay içinde tam iyileşme gözlendi. İyileşmelerin 28’inde (%85) komplikasyona rastlanmaz iken, 3 (%9) hastada gecikmiş iyileşme kaydedildi. Bu hastalardan ikisinde dinamizasyon, birinde kemik grefti uygulamasına gerek duyuldu. Cerrahiden sonraki 2 ay içinde 2 (%6) hastada implant yetmezliği saptandı ve tekrar cerrahi gerekti. Bir (%3) hastada varusta kötü kaynama vardı. Çıkarımlar: Akut subtrokanterik kırıkların tedavisinde intramedüller çivi ve spiral bıçakla tedavi umut verici sonuçlarıyla iyi bir seçenektir. Subtrokanterik kırıkların tespitinde geleneksel yöntemlerle kıyaslayacak olursak bu yöntemin daha üstün olduğunu düşünüyoruz.

Anahtar Kelimeler

• Femoral çivi; spiral bıçak; subtrokanterik kırık

Use of femoral nail with spiral blade in subtrochanteric fractures

Abstract

Objective: The aim of this study was to evaluate the outcome of acute subtrochanteric fractures managed with intramedullary nail and spiral blade fixation of the proximal fragment.
Methods: Charts of 33 patients (17 males and 16 females) with acute subtrochanteric fractures operated with intramedullary nail and spiral blade at our institution between March 2006 and February 2011 were retrospectively reviewed. The most common (67%) mechanism of injury was ground-level fall, predominantly involving elderly patients. Results were evaluated in terms of union time, implant failure rate, infection rate and functional outcome.
Results: Mean duration of surgery was 2.4 hours and average length of hospital stay was 7 days. Mean radiological healing time was 16 weeks. Good healing occurred in 31 (94%) patients within 6 months of surgery. Uneventful healing occurred in 28 (85%) patients and 3 (9%) had delayed healing requiring dynamization in two patients and bone grafting in one. Implant failure occurred in 2 (6%) patients within 2 months of index surgery requiring repeat surgery. One (3%) patient had varus malunion.
Conclusion: Intramedullary nailing with spiral blade is a good option for acute subtrochanteric fractures with promising results. We think that this is a superior device compared to conventional methods of fixation for subtrochanteric fractures.

Keywords

• Femoral nail
• spiral blade
• subtrochanteric fracture

References

1. Lavelle DG. Campbell’s operative orthopaedics. 10th ed. St. Louis: Mosby; 2003. p. 2897.
2. Wheeler DL, Croy TJ, Woll TS, Scott MD, Senft DC, Duwelius PJ. Comparison of reconstruction nails for high subtrochanteric femur fracture fixation. Clin Orthop Relat Res 1997;338:231-9.
3. Sims SH. Subtrochanteric femur fractures. Orthop Clin North Am 2002;33:113-26
4. Craig NJ, Maffulli N. Subtrochanteric fractures: current management options. Disabil Rehabil 2005;27:1181-90.
5. Halwai MA, Dhar SA, Wani MI, Butt MF, Mir BA, Ali MF, et al. The dynamic condylar screw in the management of subtrochanteric fractures: does judicious use of biological fixation enhance overall results? Strategies Trauma Limb Reconstr 2007;2:77-81.
6. Miclau T, Martin RE. The evolution of modern plate osteosynthesis. Injury 1997;28 Suppl 1:A3-6.
7. Bedi A, Toan Le T. Subtrochanteric femur fractures. Orthop Clin North Am 2004;35:473-83.
8. DeLee JC, Clanton TO, Rockwood CA Jr. Closed treatment of subtrochanteric fractures of the femur in a modified cast-brace. J Bone Joint Surg Am 1981;63:773-9.

9. Tencer AF, Johnson KD, Johnston DW, Gill K. A biomechanical comparison of various methods of stabilization of subtrochanteric fractures of the femur. J Orthop Res 1984;2:297-305.
10. Jiang LS, Shen L, Dai LY. Intramedullary fixation of subtrochanteric fractures with long proximal femoral nail or long gamma nail: technical notes and preliminary results. Ann Acad Med Singapore 2007;36:821-6.
11. Vaidya SV, Dholakia DB, Chatterjee A. The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Injury 2003;34:123-8. Siebenrock KA, Müller U, Ganz R. Indirect reduction with a condylar blade plate for osteosynthesis of subtrochanteric femoral fractures. Injury 1998;29 Suppl 3:C7
12. Hoffmann R, Südkamp NP, Müller CA, Schütz M, Haas NP. Osteosynthesis of proximal femoral fractures with the modular interlocking system of unreamed AO femoral intramedullary nail. Initial clinical results. [Article in German] Unfallchirurg 1994;97:568-74. [Abstract]
13. Broos PL, Reynders P. The use of the unreamed AO femoral intramedullary nail with spiral blade in nonpathologic fractures of the femur: experiences with eighty consecutive cases. J Orthop Trauma 2002;16:150-4.
14. Vanderschot P, Vanderspeeten K, Verheyen L, Broos P. A review on 161 subtrochanteric fractures--risk factors influencing outcome: age, fracture pattern and fracture level. Unfallchirurg 1995;98:265-71.
15. Warwick DJ, Crichlow TP, Langkamer VG, Jackson M. The dynamic condylar screw in the management of subtrochanteric fractures of the femur. Injury 1995;26:241-4. Saarenpää I, Heikkinen T, Jalovaara P. Treatment of subtrochanteric fractures. A comparison of the Gamma nail and the dynamic hip screw: short-term outcome in 58 patients. Int Orthop 2007;31:65-70.
16. Datir SP, Bedi GS, Curwen CH. Unreamed femoral nail with spiral blade in subtrochanteric fractures: experience of 55 cases. Injury 2004;35:191-5.
17. Brumback RJ, Uwagie-Ero S, Lakatos RP, Poka A, Bathon GH, Burgess AR. Intramedullary nailing of femoral shaft fractures. Part II: Fracture-healing with static interlocking fixation. J Bone Joint Surg Am 1988;70:1453-62.
18. Stockenhuber N, Schweighofer F, Bratschitsch G, Szyszkowitz R. UFN system. A method of minimal invasive surgical management of femoral shaft fractures. Langenbecks Arch Chir 1996;381:267-74.
19. Stover MD, Lin I, Bosse MJ. Removal of a broken Synthes proximal spiral blade. J Orthop Trauma 1998;12:190-1.