Kondiler destek plağı uygulaması sonrası femoral suprakondiler varus yanlış kaynamalarının retrograd kilitli intramedüller çivi ile tedavisi

Year 2014, , 388 - 395, 03.09.2014

Chi-chuan Wu

https://doi.org/10.3944/AOTT.2014.3264

Abstract

Amaç: Bu çalışmanın amacı, kondiler destek plağı (KDP) uygulaması sonrası femoral suprakondiler kırıklarda meydana gelen varus yanlış kaynamalarının tedavisinde retrograd kilitli intramedüller çivi kullanımını değerlendirmek idi.

Çalışma planı: Çalışmaya KDP uygulaması sonrası femoral suprakondiler kırıklarında görülen varus yanlış kaynamaları retrograd kilitli çivi ile tedavi edilen 32 ardışık erişkin hasta katıldı. Sonuçlar iyileşme süresi, alt ekstremite dizilimi ve diz fonksiyonlarına göre değerlendirildi.

Bulgular: Otuz iki hastadan takipleri tamamlanan 27’sinin ortalama takip süresi 2.8 (dağılım: 1.1-5.6) yıl idi. Osteotomi yapılan bölgelerin ortalama 4.0 (dağılım: 3.5-5.0) ayda iyileştiği görüldü. Cerrahi sonrası ortalama varus diz deformitesi 19.6° (dağılım: 14°-26°) olarak ölçüldü. Cerrahiden hemen sonraki ortalama varus diz deformitesi 0.4° (dağılım: 2° valgus-3° varus) idi (p<0.001). Son takipte, ortalama varus diz deformitesi 1.5° (dağılım: 1° valgus-3° varus) olarak kaydedildi (p<0.001). Hastaların tatmin edici derecedeki diz fonksiyonları %0’dan %93’e gelişim gösterdi. Hiçbir hastada ciddi bir komplikasyona rastlanmadı.

Çıkarımlar: Femoral suprakondiler kırıklarda KDP tedavisi sonrası gelişen varus yanlış kaynamalarının retrograd kilitli çivi yöntemi ile tedavisinin mükemmel bir alternatif olduğu görülmektedir. Basit olmasının yanı sıra, bu teknikle yüksek derecede tatmin edici sonuçlar alınmaktadır.

Keywords

Femoral suprakondiler; kondiler destek plağı; retrograd kilitli çivi; varus yanlış kaynaması.

Correction of femoral supracondylar varus malunions after condylar buttress plating by using retrograde locked intramedullary nailing

Abstract

Objective: The aim of this study was to evaluate the use of retrograde locked intramedullary nailing for the treatment of varus malunion occurring following condylar buttress plating (CBP) for femoral supracondylar fractures.

Methods: The study included 32 consecutive adult patients treated with retrograde locked nailing for varus malunion of femoral supracondylar fractures following CBP. Patient results were evaluated based on healing time, lower extremity alignment and knee functions.

Results: Average follow-up was 2.8 (range: 1.1 to 5.6) years for the 27 of the 32 patients who completed follow-up. All osteotomy sites healed at an average of 4.0 (range: 3.5 to 5.0) months. Average preoperative varus knee deformity was 19.6° (range: 14° to 26°). Immediate postoperative varus knee deformity was an average of 0.4° (range: valgus 2° to varus 3°) (p<0.001). At the final follow-up, the varus knee deformity was an average of 1.5° (range: valgus 1° to varus 3°) (p<0.001). Satisfactory knee function in patients improved from 0% to 93% (p<0.001). There were no serious complications.

Conclusion: Retrograde locked nailing appears to be an excellent alternative for the treatment of varus malunion of femoral supracondylar fractures after CBP treatment. It is a simple technique with high satisfaction rates.

Keywords

Condylar buttress plate, femoral supracondylar, retrograde locked nail, varus malunion

References

• Wu CC, Shih CH. Distal femoral nonunion treated with interlocking nailing. J Trauma 1991;31:1659-62.
• Merchan EC, Maestu PR, Blanco RP. Blade-plating of closed displaced supracondylar fractures of the distal femur with the AO system. J Trauma 1992;32:174-8.
• Wähnert D, Hoffmeier K, Fröber R, Hofmann GO, Mückley T. Distal femur fractures of the elderly-different treatment options in a biomechanical comparison. Injury 2011;42:655-9.
• Wu CC, Shih CH. Treatment of femoral supracondylar unstable comminuted fractures. Comparisons between plating and Grosse-Kempf interlocking nailing techniques. Arch Orthop Trauma Surg 1992;111:232-6.
• Collinge CA, Gardner MJ, Crist BD. Pitfalls in the application of distal femur plates for fractures. J Orthop Trauma 2011;25:695-706.
• Kolb K, Grützner P, Koller H, Windisch C, Marx F, Kolb W. The condylar plate for treatment of distal femoral fractures: a long-term follow-up study. Injury 2009;40:440-8.
• Davison BL. Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate. Am J Orthop (Belle Mead NJ) 2003;32:27-30.
• Petsatodis G, Chatzisymeon A, Antonarakos P, Givissis P, Papadopoulos P, Christodoulou A. Condylar buttress plate versus fixed angle condylar blade plate versus dynamic condylar screw for supracondylar intra-articular distal femoral fractures. J Orthop Surg (Hong Kong) 2010;18:35-8.
• Tanaka S, Hamanishi C, Kikuchi H, Fukuda K. Factors related to degradation of articular cartilage in osteoarthritis: a review. Semin Arthritis Rheum 1998;27:392-9.
• Huang TL, Tseng KF, Chen WM, Lin RM, Wu JJ, Chen TH. Preoperative tibiofemoral angle predicts survival of proximal tibia osteotomy. Clin Orthop Relat Res 2005;432:188-95.
• Murphy SB. Tibial osteotomy for genu varum. Indications, preoperative planning, and technique. Orthop Clin North Am 1994;25:477-82.
• Phillips MJ, Krackow KA. High tibial osteotomy and distal femoral osteotomy for valgus or varus deformity around the knee. Instr Course Lect 1998;47:429-36.
• Wu CC. Retrograde dynamic locked nailing for femoral supracondylar nonunions after plating. J Trauma 2009;66:195-9.
• Poyanli O, Unay K, Akan K, Guven M, Ozkan K. No evidence of infection after retrograde nailing of supracondylar femur fracture in gunshot wounds. J Trauma 2010;68:970-4.
• Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976;58:453-8.
• Wu CC. Femoral supracondylar malunions with varus medial condyle and shortening. Clin Orthop Relat Res 2007;456:226-32.
• Paley D, Maar DC, Herzenberg JE. New concepts in high tibial osteotomy for medial compartment osteoarthritis. Orthop Clin North Am 1994;25:483-98.
• Carmack DB, Moed BR, Kingston C, Zmurko M, Watson JT, Richardson M. Identification of the optimal intercondylar starting point for retrograde femoral nailing: an anatomic study. J Trauma 2003;55:692-5.
• Whittle AP. Fractures of the lower extremity. In: Canale ST, Beaty JH, editors. Campbell’s operative orthopedics. 11th ed. Philadelphia, PA: Mosby; 2008. p. 3085-236.
• Pihlajamäki HK, Salminen ST, Böstman OM. The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma 2002;16:39440
• Mize RD, Bucholz RW, Grogan DP. Surgical treatment of displaced, comminuted fractures of the distal end of the femur. J Bone Joint Surg Am 1982;64:871-9.
• Karlström G, Olerud S. Fractures of the tibial shaft; a critical evaluation of treatment alternatives. Clin Orthop Relat Res 1974;105:82-115.
• Tew M, Waugh W. Tibiofemoral alignment and the results of knee replacement. J Bone Joint Surg Br 1985;67:551-6.
• Coventry MB. Proximal tibial osteotomy. Orthop Rev 1988;17:456-8.
• Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial alignment of the lower extremity and loadbearing distribution at the knee. Clin Orthop Relat Res 1990;255:215-27.
• Dingwall I. Biomechanics of the knee. In: Barrett D, editor. Essential basic sciences for orthopedics. Oxford, UK: Butterworth-Heinemann; 1994. p. 94-108.
• Wu CC. Retrograde dynamic locked nailing for aseptic nonunion of femoral supracondyle after antegrade locked nailing. Arch Orthop Trauma Surg 2011;131:513-7.
• Wu CC. Modified retrograde-locked nailing for aseptic femoral supracondylar nonunion with severe osteoporosis in elderly patients. J Trauma 2011;71:E26-30.
• Johnson F, Leitl S, Waugh W. The distribution of load across the knee. A comparison of static and dynamic measurements. J Bone Joint Surg Br 1980;62:346-9.
• Chao EY, Neluheni EV, Hsu RW, Paley D. Biomechanics of malalignment. Orthop Clin North Am 1994;25:379
• Rand JA, An KN, Chao EY, Kelly PJ. A comparison of the effect of open intramedullary nailing and compression-plate fixation on fracture-site blood flow and fracture union. J Bone Joint Surg Am 1981;63:427-42.
• Kessler SB, Hallfeldt KK, Perren SM, Schweiberer L. The effects of reaming and intramedullary nailing on fracture healing. Clin Orthop Relat Res 1986;212:18-25.
• Koval KJ, Kummer FJ, Bharam S, Chen D, Halder S. Distal femoral fixation: a laboratory comparison of the 95 degrees plate, antegrade and retrograde inserted reamed intramedullary nails. J Orthop Trauma 1996;10:378-82.
• Zlowodzki M, Williamson S, Cole PA, Zardiackas LD, Kregor PJ. Biomechanical evaluation of the less invasive stabilization system, angled blade plate, and retrograde intramedullary nail for the internal fixation of distal femur fractures. J Orthop Trauma 2004;18:494-502.
• Ito K, Grass R, Zwipp H. Internal fixation of supracondylar femoral fractures: comparative biomechanical performance of the 95-degree blade plate and two retrograde nails. J Orthop Trauma 1998;12:259-66.
• Wu CC. Retrograde dynamic locked nailing for valgus knee correction: a revised technique. Int Orthop 2012;36:1191-7.
• Henry SL, Trager S, Green S, Seligson D. Management of supracondylar fractures of the femur with the GSH intramedullary nail: preliminary report. Contemp Orthop 1991;22:631-40.
• Ricci WM. Femur: trauma. In: Vaccaro AR, editor. Orthopedic knowledge update: 8. Rosemont, IL: American Academy of Orthopedic Surgeons; 2005. p. 425-31.
• Heiney JP, Barnett MD, Vrabec GA, Schoenfeld AJ, Baji A, Njus GO. Distal femoral fixation: a biomechanical comparison of trigen retrograde intramedullary (i.m.) nail, dynamic condylar screw (DCS), and locking compression plate (LCP) condylar plate. J Trauma 2009;66:443-9.