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Eklem dışı distal femur kırıklarının tedavisinde retrograd intramedüller çivileme

Year 2014, , 521 - 526, 12.11.2014
https://doi.org/10.3944/AOTT.2014.14.0004

Abstract

Amaç: Bu çalışmadaki amacımız, eklem dışı distal femur kırıklarının tedavisinde retrograd intramedüller çivileme (RİMÇ) ve köprü plaklama yöntemlerini karşılaştırmaktı.

Çalışma planı: 2007-2012 yılları arasında eklem dışı distal femur kırığına köprü plaklama uygulanan 15 hasta (13 erkek, 2 kadın; ortalama yaş: 36, dağılım: 17-55) ve RİMÇ uygulanan 13 hasta (11 erkek, 2 kadın; ortalama yaş: 31.1, dağılım: 17-49) geriye dönük olarak incelendi. Fonksiyonel sonuçlar Sanders kriterleri kullanılarak değerlendirildi. Ortalama takip süresi plak grubunda 31.3 dağılım: 20-46) ay, çivi grubunda 26.7 (dağılım: 18-62) ay idi.

Bulgular: Ortalama kaynama süresi plak grubunda 25.7 (dağılım: 12-72) hafta, çivi grubunda 22.3 (dağılım: 12-52) hafta idi. Kaynamama plak grubunda 2 hastada, çivi grubunda 1 hastada; kaynama gecikmesi plak grubunda 3 hastada, çivi grubunda 2 hastada; dizilim bozukluğu (>10°) plak grubunda 2 hastada, çivi grubunda 1 hastada; implant yetmezliği ise plak grubunda 1 hastada görüldü. Plak grubunda 12 hastada, çivi grubunda 10 hastada mükemmel/iyi fonksiyonel sonuç elde edildi. Gruplar arasında kaynama süresi, komplikasyonlar ve fonksiyonel sonuçlar açısından anlamlı bir fark saptanmadı (p>0.05).

Çıkarımlar: Eklem dışı distal femur kırıklarının tedavisinde köprü plaklama ve RİMÇ yöntemlerinin sonuçları benzerdir ve Gustilo-Anderson Tip 3B ve C açık kırıklar hariç tüm kırıklarda uygulanabilir.

References

  • Gurkan V, Orhun H, Doganay M, Salioğlu F, Ercan T, Dursun M, et al. Retrograde intramedullary interlocking nailing in fractures of the distal femur. Acta Orthop Traumatol Turc 2009;43:199-205.
  • Krettek C, Müller M, Miclau T. Evolution of minimally invasive plate osteosynthesis (MIPO) in the femur. Injury 2001;32 Suppl 3:SC14-23.
  • Doshi HK, Wenxian P, Burgula MV, Murphy DP. Clinical outcomes of distal femoral fractures in the geriatric population using locking plates with a minimally invasive approach. Geriatr Orthop Surg Rehabil 2013;4:16-20.
  • Kregor PJ, Stannard J, Zlowodzki M, Cole PA, Alonso J. Distal femoral fracture fixation utilizing the Less Invasive Stabilization System (L.I.S.S.): the technique and early results. Injury 2001;32 Suppl 3:SC32-47.
  • Hierholzer C, von Rüden C, Pötzel T, Woltmann A, Bühren V. Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: A retrospective analysis. Indian J Orthop 2011;45:243-50.
  • Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002;84:1093-110.
  • Handolin L, Pajarinen J, Lindahl J, Hirvensalo E. Retrograde intramedullary nailing in distal femoral fractures-results in a series of 46 consecutive operations. Injury 2004;35:517-22.
  • Markmiller M, Konrad G, Südkamp N. Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications? Clin Orthop Relat Res 2004;426:252-7.
  • Gao K, Gao W, Huang J, Li H, Li F, Tao J, et al. Retrograde nailing versus locked plating of extra-articular distal femoral fractures: comparison of 36 cases. Med Princ Pract 2013;22:161-6.
  • Pingsmann A, Lederer M, Wüllenweber C, Lichtinger TK. Early patellofemoral osteoarthritis caused by an osteochondral defect after retrograde solid nailing of the femur in sheep. J Trauma 2005;58:1024-8.
  • Wenda K, Runkel M. Systemic complications in intramedullary nailing. [Article in German] Orthopade 1996;25:292-9. [Abstract]
  • Leggon RE, Feldmann DD. Retrograde femoral nailing: a focus on the knee. Am J Knee Surg 2001;14:109-18.
  • Kubiak EN, Fulkerson E, Strauss E, Egol KA. The evolution of locked plates. J Bone Joint Surg Am 2006;88 Suppl 4:189-200.
  • Henderson CE, Lujan T, Bottlang M, Fitzpatrick DC, Madey SM, Marsh JL. Stabilization of distal femur fractures with intramedullary nails and locking plates: differences in callus formation. Iowa Orthop J 2010;30:61-8.
  • Apivatthakakul T, Chiewcharntanakit S. Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated. Int Orthop 2009;33:1119-26.
  • Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma 2004;18:488-93.
  • Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma 2014;28:83-9.
  • Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma 2011;25 Suppl 1:8-14.
  • Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma 1996;10 Suppl 1:v-ix, 1-154.
  • Sanders R, Swiontkowski M, Rosen H, Helfet D. Double-plating of comminuted, unstable fractures of the distal part of the femur. J Bone Joint Surg Am 1991;73:341-6.
  • Collinge CA, Wiss DA. Distal Femur Fractures. In: Bucholz RW, Court-Brown CM, Heckman JD, Tornetta III P, editors. Rockwood and Green’s Fractures in Adults. Vol. 2, 7th ed. Philadelphia: Lippincott-Williams & Wilkins; 20 p. 1719-51.
  • 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.

Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur

Year 2014, , 521 - 526, 12.11.2014
https://doi.org/10.3944/AOTT.2014.14.0004

Abstract

Objective: The aim of this study was to compare retrograde intramedullary nailing (RIMN) and bridge plating for the treatment of extra-articular distal femur fractures.

Methods: The study retrospectively examined 15 patients (13 males and 2 females; mean age: 36 years, range: 17 to 55 years) who underwent bridge plating and 13 patients (11 males and 2 females; mean age: 31.1 years, range: 17 to 49 years) who underwent RIMN for the treatment of extra-articular distal femur fractures between 2007 and 2012. Functional results were evaluated using the Sanders criteria. The mean follow-up time was 31.3 (range: 20 to 46) months and 26.7 (range: 18 to 62) months in the plate and the nail groups, respectively.

Results: Mean duration until union was 25.7 (range: 12 to 72) weeks in the plate group and 22.3 (range: 12 to 52) weeks in the nail group. Nonunion was observed in 2 patients in the plate group and in 1 in the nail group, delayed union in 3 patients in the plate and 2 in the nail groups, malalignment (>10°) in 2 patients in the plate group and 1 in the nail group and implant failure in 1 patient in the plate group. Excellent/good functional results were obtained in 12 and 10 patients in the plate and the nail groups, respectively. No significant difference was found between the groups in terms of duration of union, complications and functional results (p>0.05).

Conclusion: Bridge plating and RIMN have similar results in the treatment of extra-articular distal femur fractures. Both methods can be applied to all fractures, with the exception of Gustilo-Anderson Type 3B and C open fractures.

References

  • Gurkan V, Orhun H, Doganay M, Salioğlu F, Ercan T, Dursun M, et al. Retrograde intramedullary interlocking nailing in fractures of the distal femur. Acta Orthop Traumatol Turc 2009;43:199-205.
  • Krettek C, Müller M, Miclau T. Evolution of minimally invasive plate osteosynthesis (MIPO) in the femur. Injury 2001;32 Suppl 3:SC14-23.
  • Doshi HK, Wenxian P, Burgula MV, Murphy DP. Clinical outcomes of distal femoral fractures in the geriatric population using locking plates with a minimally invasive approach. Geriatr Orthop Surg Rehabil 2013;4:16-20.
  • Kregor PJ, Stannard J, Zlowodzki M, Cole PA, Alonso J. Distal femoral fracture fixation utilizing the Less Invasive Stabilization System (L.I.S.S.): the technique and early results. Injury 2001;32 Suppl 3:SC32-47.
  • Hierholzer C, von Rüden C, Pötzel T, Woltmann A, Bühren V. Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: A retrospective analysis. Indian J Orthop 2011;45:243-50.
  • Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002;84:1093-110.
  • Handolin L, Pajarinen J, Lindahl J, Hirvensalo E. Retrograde intramedullary nailing in distal femoral fractures-results in a series of 46 consecutive operations. Injury 2004;35:517-22.
  • Markmiller M, Konrad G, Südkamp N. Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications? Clin Orthop Relat Res 2004;426:252-7.
  • Gao K, Gao W, Huang J, Li H, Li F, Tao J, et al. Retrograde nailing versus locked plating of extra-articular distal femoral fractures: comparison of 36 cases. Med Princ Pract 2013;22:161-6.
  • Pingsmann A, Lederer M, Wüllenweber C, Lichtinger TK. Early patellofemoral osteoarthritis caused by an osteochondral defect after retrograde solid nailing of the femur in sheep. J Trauma 2005;58:1024-8.
  • Wenda K, Runkel M. Systemic complications in intramedullary nailing. [Article in German] Orthopade 1996;25:292-9. [Abstract]
  • Leggon RE, Feldmann DD. Retrograde femoral nailing: a focus on the knee. Am J Knee Surg 2001;14:109-18.
  • Kubiak EN, Fulkerson E, Strauss E, Egol KA. The evolution of locked plates. J Bone Joint Surg Am 2006;88 Suppl 4:189-200.
  • Henderson CE, Lujan T, Bottlang M, Fitzpatrick DC, Madey SM, Marsh JL. Stabilization of distal femur fractures with intramedullary nails and locking plates: differences in callus formation. Iowa Orthop J 2010;30:61-8.
  • Apivatthakakul T, Chiewcharntanakit S. Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated. Int Orthop 2009;33:1119-26.
  • Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma 2004;18:488-93.
  • Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma 2014;28:83-9.
  • Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma 2011;25 Suppl 1:8-14.
  • Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma 1996;10 Suppl 1:v-ix, 1-154.
  • Sanders R, Swiontkowski M, Rosen H, Helfet D. Double-plating of comminuted, unstable fractures of the distal part of the femur. J Bone Joint Surg Am 1991;73:341-6.
  • Collinge CA, Wiss DA. Distal Femur Fractures. In: Bucholz RW, Court-Brown CM, Heckman JD, Tornetta III P, editors. Rockwood and Green’s Fractures in Adults. Vol. 2, 7th ed. Philadelphia: Lippincott-Williams & Wilkins; 20 p. 1719-51.
  • 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.
There are 22 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Abdullah Demirtas This is me

İbrahim Azboy This is me

Emin Ozkul This is me

Mehmet Gem This is me

Celil Alemdar This is me

Publication Date November 12, 2014
Published in Issue Year 2014

Cite

APA Demirtas, A., Azboy, İ., Ozkul, E., Gem, M., et al. (2014). Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur. Acta Orthopaedica Et Traumatologica Turcica, 48(5), 521-526. https://doi.org/10.3944/AOTT.2014.14.0004
AMA Demirtas A, Azboy İ, Ozkul E, Gem M, Alemdar C. Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur. Acta Orthopaedica et Traumatologica Turcica. November 2014;48(5):521-526. doi:10.3944/AOTT.2014.14.0004
Chicago Demirtas, Abdullah, İbrahim Azboy, Emin Ozkul, Mehmet Gem, and Celil Alemdar. “Comparison of Retrograde Intramedullary Nailing and Bridge Plating in the Treatment of Extra-Articular Fractures of the Distal Femur”. Acta Orthopaedica Et Traumatologica Turcica 48, no. 5 (November 2014): 521-26. https://doi.org/10.3944/AOTT.2014.14.0004.
EndNote Demirtas A, Azboy İ, Ozkul E, Gem M, Alemdar C (November 1, 2014) Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur. Acta Orthopaedica et Traumatologica Turcica 48 5 521–526.
IEEE A. Demirtas, İ. Azboy, E. Ozkul, M. Gem, and C. Alemdar, “Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur”, Acta Orthopaedica et Traumatologica Turcica, vol. 48, no. 5, pp. 521–526, 2014, doi: 10.3944/AOTT.2014.14.0004.
ISNAD Demirtas, Abdullah et al. “Comparison of Retrograde Intramedullary Nailing and Bridge Plating in the Treatment of Extra-Articular Fractures of the Distal Femur”. Acta Orthopaedica et Traumatologica Turcica 48/5 (November 2014), 521-526. https://doi.org/10.3944/AOTT.2014.14.0004.
JAMA Demirtas A, Azboy İ, Ozkul E, Gem M, Alemdar C. Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur. Acta Orthopaedica et Traumatologica Turcica. 2014;48:521–526.
MLA Demirtas, Abdullah et al. “Comparison of Retrograde Intramedullary Nailing and Bridge Plating in the Treatment of Extra-Articular Fractures of the Distal Femur”. Acta Orthopaedica Et Traumatologica Turcica, vol. 48, no. 5, 2014, pp. 521-6, doi:10.3944/AOTT.2014.14.0004.
Vancouver Demirtas A, Azboy İ, Ozkul E, Gem M, Alemdar C. Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur. Acta Orthopaedica et Traumatologica Turcica. 2014;48(5):521-6.