Yaşlılarda görülen femur yetmezlik kırıkları - Aşırı medial femoral eğrilik intramedüller çivilemeyi güçleştirir

Abstract

Amaç: Bu çalışmada yaşlılarda görülen düşük enerjili femur yetmezlik kırıklarının özelliklerinin incelenmesi amaçlanmıştır.

Çalışma planı: 2009-2011 yılları arasında, düşük enerjili femur diyafiz ve subtrokanterik kırığı ile kliniğimize başvuran 4 hastanın klinik seyri geriye dönük olarak değerlendirildi. Hastaların üçünde uzun dönem alendronat tedavisi, birinde ise glukokortikoid tedavisi öyküsü mevcuttu.

Bulgular: Çalışmaya dahil edilen 4 hastada 5 femur diyafiz kırığı, 2 tamamlanmamış femur diyafiz kırığı, 2 subtrokanterik ve 1 intertrokanterik femur kırığı mevcuttu. Tüm femur diyafiz kırıklarında, karakteristik görünüm olan proksimal fragmanın lateral korteksinde kalınlaşma izlendi. Altı femurda kanal içi çivilemeyi zorlaştıran aşırı medial femoral eğrilik izlendi. Daha önceki kırıkları kısa implantlarla tedavi edilen bir hastanın her iki femurunda yeni kırıklar meydana geldi. Femurların birinde iki odaklı kırık izlendi. Tüm hastalarda kaynama elde edildi. Hastalardan ikisi yardımsız, biri tek baston ile diğeri ise çift koltuk değneği ile yürüyebilmekteydi.

Çıkarımlar: Bu çalışmayla birlikte yaşlılarda görülen düşük enerjili femur diyafiz kırıkları için ‘aşırı medial femoral eğrilik’ şeklinde farklı bir radyolojik patern öneriyoruz. Femurdaki bu eğrilik, intramedüller çivi uygulamasını zorlaştırmaktadır. Buna ek olarak, yetmezlik kırıkları uzun sefalomedüller çiviler ile tespit edilmelidir.

Keywords

• Düşük enerjili kırık; femur diyafiz; femur medial femoral eğrilik; intramedüller çivi; yaşlı.

Femoral insufficiency fractures in the elderly – Excessive medial femoral bowing complicates intramedullary nailing

Abstract

Objective: The aim of this study was to evaluate the characteristics of low-energy femoral insufficiency fractures in elderly patients.

Methods: The study retrospectively evaluated the clinical course of 4 patients with low-energy femoral shaft and subtrochanteric fractures admitted to our department between 2009 and 2011. Three patients had prior long-term alendronate therapy and one had prior glucocorticoid therapy.

Results: There were 5 femoral shaft fractures, 2 incomplete shaft fractures, 2 subtrochanteric and 1 intertrochanteric fractures. All femoral shaft fractures had characteristic fracture patterns with thickened lateral cortices at the proximal fragment. Six femurs had excessive medial femoral bowing, which complicated intramedullary nailing. Additional fractures were seen on both femurs of one patient who had been primarily treated with short implants. A bifocal femoral fracture was seen in one femur. Union was achieved in all patients. Two patients were able to walk independently, one with a cane and one with double crutches.

Conclusion: We suggest the addition of another radiographic pattern of ‘excessive medial femoral bowing’ in low-energy femoral shaft fractures in elderly patients. This bowing complicates intramedullary nailing. Moreover, these insufficiency fractures should be fixed with long cephalomedullary nails.

Keywords

• Elderly
• femoral shaft
• intramedullary nail
• low-energy fracture
• medial femoral bowing

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