Antegrade Locked Nailing Of Adult Femoral Shaft Fractures And Non-Unions: A Retrospective Review Of 48 Cases Erişkin Femur Şaft Kırıklarının Ve Non-Unionlarının Antegrad Kilitli Çivileme Yöntemi İle T

Year 2007, Volume: 60 Issue: 3, 123 - 129, 01.03.2007

Hakan Selek , Hakan Atalar Hakan Kınık Osman Yüksel Yavuz Ertan Mergen

Abstract

Keywords

-

Erişkin Femur Şaft Kırıklarının Ve Non-Unionlarının Antegrad Kilitli Çivileme Yöntemi İle Tedavisi: 48 Olgunun Retrospektif Değerlendirilmesi

Abstract

Amaç: Bu makalede, akut femur cisim kırığı veya non-unionu nedeni ile antegrade kilitli intramedüller
kilitli çivileme yapılan 48 olgunun fonksiyonel sonuçları retrospektif olarak değerlendirildi.
Gereç ve Yöntem: Bu çalışmaya dahil edilen 48 hastaya toplam 52 antegrad kilitli intramedüller
çivileme uygulandı. Akut femur cisim kırıklarının 27’sinde oymasız antegrad kilitli intramedüller çivileme
uygulandı. Akut femur kırığı olan 4 ve non-union olan 21 hastada ise fiksasyon oymalı kilitli
çivileme ile sağlandı. Olguların yaş ortalaması 40.2 (17-80) idi. Serimizdeki hastaların 16’sı bayan
(%33.3) ve 32 ’si erkekti (%66.7).
Bulgular: Hastaların takipleri ile elde edilen veriler, Thoresen kriterlerine göre; femoral aks deformitesi,
femoral kısalık, diz eklemi hareket açıklığı ve ağrı veya ödem varlığı incelenerek değerlendirildi.
Hastalar ortalama 21 ay (10-46 ay) takip edildi. Bir tanesi haricinde tüm olgularda kaynama görüldü
(%98.07). Yüzeyel enfeksiyon üç hastada izlendi ve bunlardan bir olgunun takiplerinde derin enfeksiyon
gelişti. Akut kırık grubundan gastrointestinal kanama öyküsü olan Winquist tip IV kırıklı bir
hastaya, antikoagülan tedavi verilemediğinden, derin venöz trombüs izlendi. Non-union grubundan
bir hastada ise, ameliyattan sonraki dördüncü günde pulmoner emboli gelişti.
Sonuç: İntramedüller çivileme yöntemleri akut femur cisim kırıkları ve non-unionlarında etkili bir
tedavi metodudur. Oymalı çivileme metodu, oymasız çivileme metodu ile karşılaştırıldığında daha
az başarısızlık izlenirken, yöntem sağlam stabilizasyon sağlar.

Keywords

femur, kırık tespiti, kırık iyileşmesi, intramedüller çivileme

References

• Canadian Orthopaedic Trauma Society. Nonunion following intramedullary nail- ing of the femur with and without ream- ing. Results of multicenter randomized clinical trial. J Bone Joint Surg Am 2003; 85: 2093-6.
• Bekmezci T, Baca E, Kaynak H,et al results of treatment with expandable intramed- ullary nails in femur shaft fractures. Acta Orthop Traumatol Turc. 2006;40:1-5.
• Daglar B, Bayrakci K, Tasbas BA, et al. A comparison of different fixation com- binations for the treatment of ipsilateral hip and femoral diaphyseal fractures Ulus Travma Derg. 2004;10:123-7.
• Webb LX, Winquist RA, Hansen ST. In- tramedullary nailing and reaming for de- layed union or nonunion of the femoral shaft. A report of 105 consecutive cases. Clin Orthop 1986; 212: 133-41.
• Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 1984; 66: 529-39.
• Wolinsky PR, McCarty E, Shyr Y, et al. Reamed intramedullary nailing of the fe- mur: 551 cases. J Trauma 1999; 46: 392- 9.
• Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thou- sand and twenty-five open fractures of long bones. J Bone Joint Surg Am 1976 ;58: 453-8.
• Gustilo RB, Mendoza RM, Williams DM. Problems in the management of type III (severe) open fracture: A new classifica- tion of type III open fractures. J Trauma 1984; 24: 742-6.
• Galois L, Mainard D, Delagoutte JP. Beta- tricalcium phosphate ceramic as a bone substitute in orthopaedic surgery. Int Or- thop. 2002;26:109-15.
• McAndrew MP, Gorman PW, Lange TA. Tricalcium phosphate as a bone graft sub- stitute in trauma: preliminary report. J Orthop Trauma. 1988;2:333-9.
• Ebraheim NA, Mekhail AO, Darwich M. Open reduction and internal fixation with bone grafting of clavicular nonun- ion. J Trauma. 1997 Apr;42:701-4.
• Thoresen BO, Alho A, Ekeland A, et al. Interlocking intramedullary nailing in femoral shaft fractures. A report of forty- eight cases. J Bone Joint Surg Am 1985; 67: 1313–20.
• Alonso J, Geissler W, Hughes JL. External fixation of femoral fractures: Indications and Limitations. Clin Orthop 1989; 241: 83-8.
• Dabezies EJ, D’Ambrosia R, Shoji H, et al. Fractures of the femoral shaft treated by external fixation with the Wagner device. J Bone Joint Surg Am 1984; 66: 360–4.
• Murphy CP, D’Ambrosia RD, Dabezies EJ, et al. Complex femur fractures: treatment with the Wagner external fixation device or the Grosse-Kempf interlocking nail. J Trauma 1988; 28: 1553-61.
• O’Beirne J, O’Connell RJ, White JM, et al. Fractures of the femur treated by femoral plating using the anterolateral approach. Injury 1986; 17: 387-90.
• Thompson F, O’Beirne J, Gallagher J, et al. Fractures of the femoral shaft treated by plating. Injury 1985; 16: 535-8.
• Bach AW, Hansen ST Jr. Plates versus ex- ternal fixation in severe open tibial shaft fractures. Clin Orthop 1989; 241: 89-94.
• Magerl F, Wyss A, Brunner C, et al. Plate Osteosynthesis of femoral shaft fractures in adults. A follow-up study. Clin Orthop 1979; 138: 62-73.
• Rothwell AG. Closed Küntscher Nailing for Comminuted Femoral Shaft Fractures. J Bone Joint Surg Br 1982; 64: 12-6.
• Riemer B, Butterfield SL, Burke CJ 3rd, et al. Immediate plate fixation of highly comminuted femoral diaphyseal fractures in blunt polytrauma patients. Orthoped- ics 1992; 15: 907-16
• Okcu G, Aktuglu K. Antegrade nailing of femoral shaft fractures combined with neck or distal femur fractures. A retro- spective review of 25 cases, with follow- up of 36-150 months. Arch Orthop Trau- ma Surg 2003; 123: 544-50.
• Tornetta P 3 rd, Tiburzi D. The treatment of femoral shaft fractures using intramed- ullary interlocked nails with and without intramedullary reaming: a preliminary re- port. J Orthop Trauma 1997; 11: 89-92.
• Weninger P,Figl M, Spitaler R, et al. Early unreamed intramedullary nailing of femo- ral fractures is safe in patients with severe thoracic trauma. J Trauma.2007;62:692- 6.
• Starr AJ, Hunt JL, Chason DP, et al. Treat- ment of femur fracture with associated head injury. J Orthop Trauma 1998; 12: 38-45.
• Brundage SI, McGhan R, Jurkovich GJ, et al. Timing of femur fracture fixation: ef- fect on outcome in patients with thoracic and head injuries. J Trauma 2002; 52: 299-307.
• Meek RN, Vivoda EE, Pirani S. Compari- son of mortality of patients with multi- ple injuries according to type of fracture treatment—a retrospective age- and in- jury-matched series. Injury 1986; 17: 2-4.
• Canadian Orthopaedic Trauma Society. Reamed versus unreamed intramedullary nailing of the femur: comparison of the rate of ARDS in multiple injured patients. J Orthop Trauma. 2006 ;20:384-7.
• Neudeck F, Wozasek GE, Obertacke U, et al. Nailing versus plating in thoracic trauma: an experimental study in sheep. J Trauma 1996; 40: 980-4.
• Grosse A, Christie J, Taglang G, et al. Open adult femoral shaft fracture treated by early intramedullary nailing. J Bone Joint Surg Br 1993 ; 75: 562–5.
• Soto-Hall R, McCloy NP. Cause and treat- ment of angulation of femoral intramed- ullary nails—experimental evidence on the preferred position of the clover-leaf nail. Clin Orthop 1953; 2: 66-74.