Subtrokanterik kırıklarda proksimal femoral çivi tespiti

Abstract

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.

Keywords

• 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

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