İntertrokanterik femur kırıklarının proksimal femoral çivi antirotasyon (PFNA) ile lateral dekübit pozisyonda tespiti

Year 2014, , 513 - 520, 12.11.2014

Ali Turgut Onder Kalenderer Burak Gunaydin Burak Onvural Levent Karapinar Haluk Agus

https://doi.org/10.3944/AOTT.2014.14.0098

Abstract

Amaç: Bu çalışmanın amacı, intertrokanterik femur kırıklarının Proksimal Femoral Çivi Antirotasyon (PFNA) kullanılarak, traksiyon masasız, lateral dekübit pozisyonda uygun bir şekilde redükte edilip tespit edilip edilemediğinin değerlendirilmesi idi.

Çalışma planı: Çalışmaya 81’i erkek, 126’sı kadın olmak üzere 207 hasta (ortalama yaş: 75, dağılım: 22-95) dahil edildi. Evans sınıflamasına göre; 7 Tip 1, 40 Tip 2, 33 Tip 3, 38 Tip 4, 61 Tip 5 ve 28 ters oblik kırık mevcuttu. Ameliyat sonrası röntgenlerde; implant ucu-apeks mesafesi, helikal bıçağın Cleveland ve Bosworth kadranı, Ikuta redüksiyon alt grubu, kollodiyafizer açı ve redüksiyon aralıkları ölçüldü.

Bulgular: Ortalama takip süresi 20.4 (dağılım: 6-38) ay olan hastalarda Ikuta sınıflamasına göre 176 kırık (%85) normal alt tip, 15 kırık (%7.2) posterior alt tip ve 16 kırık (%7.7) anterior alt tip olarak redükte edilmişti. Herman kriterlerine göre hastaların %99’unda iyi veya kabul edilebilir redüksiyon sağlandığı görüldü. Ortalama implant ucu-apeks mesafesi 29.2 mm, ortalama ameliyat süresi 57.2 dakika olarak ölçüldü. Uygun kadran (merkez-merkez, alt-merkez) yerleşimi hastaların %53.5’inde sağlanmışken, üst-arka kadran yerleşimi hastaların sadece %2.4’ünde görüldü. Dokuz hastada (%4.3) sıyrılma komplikasyonu gerçekleşti.

Çıkarımlar: İntertrokanterik kırıkların lateral dekübit pozisyonda çivilenmesi uygun kadran yerleşiminin sağlanması ve implant ucu-apeks mesafesinde ideal değerlerin elde edilmesinde başarılı olmasa da, muhtemelen PFNA tarafından sağlanan mükemmel stabilite sayesinde sonuçlar cesaret vericidir.

Keywords

İntertrokanterik kırıklar; lateral dekübit pozisyon; ; Proksimal Femoral Çivi Antirotasyon; traksiyon masası.

Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table

Abstract

Objective: The aim of this study was to evaluate whether intertrochanteric femur fractures can be reduced and nailed properly in the lateral decubitus position using Proximal Femoral Nail Antirotation (PFNA) as a fixation device without the use of a traction table.

Methods: The study included 207 patients (81 male and 126 female; mean age: 75 years, range: 22 to 95 years). According to the Evans classification, there were 7 Type 1, 40 Type 2, 33 Type 3, 38 Type 4, 61 Type 5 and 28 reverse oblique fractures. Radiographs were used to measure the  tip-apex distance (TAD), the quadrant of the helical blade according to Cleveland and Bosworth, Ikuta’s reduction subgroup, collodiaphyseal angle and reduction gaps postoperatively.

Results: Mean follow-up time was 20.4 (range: 6 to 38) months. According to Ikuta’s classification, 176 (85%) reduced fractures were of subtype N, 15 (7.2%) subtype P and 16 (7.7%) subtype A. Good or acceptable reduction according to the Herman criteria was obtained in 99% of fractures. Mean TAD was 29.2 millimeters. Mean operation time was 57.2 minutes. Optimal blade position (center-center or inferior-center) was achieved in 53.5% of patients and was in the superior-posterior quadrants in only 2.4% of patients. Cut-out complication occurred in 9 patients (4.3%).

Conclusion: While the nailing of intertrochanteric fractures in a lateral decubitus position does not provide ideal quadrant placement and TAD, results are encouraging probably due to the excellent stability that is provided by PFNA.

Keywords

Intertrochanteric fractures, lateral decubitis position, Proximal Femoral Nail Antirotation, traction table

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