Çocuk femur cisim kırıklarında titanyum elastik çivileme cerrahisinin uzun dönemde femur gelişimine etkisi

Year 2020, Volume: 45 Issue: 2, 656 - 661, 30.06.2020

Gökhan Bülent Sever

https://doi.org/10.17826/cumj.673504

Abstract

Amaç: Bu çalışmanın amacı çocuk femur cisim kırıklarında titanyum elastik çivileme ile tespit cerrahisinin uzun dönemde femur gelişimine etkisinin araştırılmasıdır.
Gereç ve Yöntem: Kliniğimizde tek taraflı femur cisim kırığı tanısı ile titanyum elastik çivileme cerrahisi uygulanmış cerrahi esnasında ortalama yaşları 62,1 (15-160) ay olan 35 hasta çalışmaya dahil edildi. Son kontrolde hastalar fizik muayene ve karşılaştırmalı femur ön arka ve lateral grafisi ile değerlendirildiler. Alt ekstremite uzunluk farkı, frontal ve sagital planda deformiteler, femur cisim boyun açısı, mekanik distal femoral lateral açılar hesaplandı ve sağlam femur uzunluğu ve açıları ile karşılaştırıldı.
Bulgular: Hastalar ortalama 69,8 (36-120) ay takip edildiler. Kırıkların ortalama kaynama süresi 11,2 (8-13) haftaydı. Ortalama implant çıkarma süresi 5,1 (2-12) aydı. Son kontrolde sağlam femurla karşılaştırıldığında 1(%2,8) hastanın femurunda klinik bulgu vermeyen 5 mm kısalık , 3(%8,5) hastada da ortalama 6±4 mm uzunluk saptandı. 8 (%22,8) hastada kırık hattında ortalama 4,7°±2,1 derece klinik bulgu vermeyen varus angulasyonu saptandı.
Sonuç: Femur cisim kırıklarının titanyum elastik çivileme cerrahisi ile tedavisinin uzun dönemde femur gelişimine etkisi sınırlıdır. Çocuk femur kırıklarının titanyum elastik çivileme” cerrahisi ile cerrahi tedavisi kolay uygulanabilen, uzun dönemde komplikasyonları az ve güvenle uygulanabilecek bir tedavi şeklidir. 

Keywords

Çocuk femur cisim kırığı, titanyum elastik çivileme, femur gelişimi

Effect of titanium elastic nailing surgery on the femoral development in pediatric femoral fractures

Abstract

Purpose: The aim of this current study was to investigate the effect of titanium elastic nailing surgery following the pediatric femoral shaft fractures on the long-term pediatric femoral development.
Materials and Methods: Thirty-five patients with a mean age of 62.1 months(15-160) who underwent surgery with titanium elastic nailing following unilateral femoral shaft fracture in our clinic were included in this study..At the last postoperative visit, patients were further evaluated through the physical examination and comparative femoral anterior posterior and lateral radiographs.The difference in length of the lower extremities and deformities in the frontal and sagittal plane, collodiaphyseal angle, mechanical distal femoral lateral angles were all calculated and compared with the intact femoral length and angles.
Results: The mean follow-up period in our study was 69.8 months (36-120).The mean fracture union time period was 11.2 weeks(8-13).The mean implant removal time was 5.1months(2-12).At the last follow-up, 1 patient(2.8%) had 5mm shortening in the femur lenght while 3 patients’ femurs(8.5%) got longer with the average of 6 ± 4mm compared to that of the intact femur. In 8 patients (22.8%), varus angulation was measured as 4.7°± 2.1 at the fracture line.
Conclusion: The treatment of femoral shaft fractures with titanium elastic nailing surgery has a limited effect on pediatric femur development in the long term. Surgical treatment of pediatric femoral fractures with titanium elastic nailing is a simple and safe method of treatment with low long-term complications.

Keywords

Pediatric femoral shaft fracture, titanium elastic nailing, femoral development

References

• 1- Fabrizio Donati, Giuseppe Mazzitelli, Marco Lillo, Amerigo Menghi, Carla Conti, Antonio Valassina, Emanuele Marzetti, et al. Titanium elastic nailing in diaphyseal femoral fractures of children below six years of age. World Journal of Orthopaedics. 2017 February 18;8(2):156-162. 2- Beyaz S. Early period hospital mortality after orthopedic surgery and affecting factors. Cukurova Medical Journal. 2019;44(3):977-983 3- S. Terry Canale, James H. Beaty. Fractures and Dislocations in Children. In Campbells Operative OrthopaedicsTwelfth Edition (Ed: S. Terry Canale and James H. Beaty); Volume 2:1363-1522, Philadelphia, Mosby Elsevier, 2013. 4- Saikia K, Bhuyan S, Bhattacharya T, Saikia S. Titanium elastic nailing in femoral diaphyseal fractures of children in 6-16 years of age. Indian J Orthop. 2007;41:381–385. 5- Flynn JM, Skaggs DL, Sponseller PD, Ganley TJ, Kay RM, Leitch KK. The surgical management of pediatric fractures of the lower extremity. Instr Course Lecture 2003;52:647-659. 6- Thompson JD, Buehler KC, Sponseller PD, Gray DW, Black BE, Buckley SL et al. Shortening in femoral shaft fractures in children treated with spica cast. Clin Orthop Relat Res. 1997;338:74-8. 7- Greisberg J, Bliss MJ, Eberson CP, Solga P, d’Amato C. Social and economic benefits of fleksible intramedullary nails in treatment of pediatric femoral shaft fractures. Orthopaedics. 2002;25(10):1067-70. 8- Kawalkar A, Badole C.M. Percutaneous titanium elastic nail for femoral shaft fracture in patient between 5 and 15 years. Journal of Orthopaedics 2018;15:695-700. 9- Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J. Titanium elastic nails for paediatric femur fractures: a multi-center study of early results with analysis of complications. J Pediatr Orthop. 2001;21:4-8. 10- Buechsenschuetz KE, Mehlman CT, Shaw KJ, Crawford AH, Immerman EB. Femoral shaft fractures in children: traction and casting versus elastic stable intramedullary nailing. J Trauma. 2002;53(5):914-921. 11- Kayaokay K, Aktuğlu K. Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age group of 6-15 years mid-term and long-term outcomes. Pak J Med Sci. 2018;34(6):1529-1533. 12- Buehler KC, Thompson JD, Sponseller PD, Black BE, Buckley SL, Griffin PP. A prospective study of early spica casting outcomes in the treatment of emoral shaft ractures in children. J Pediatr Orthop. 1995;15(1):30-35. 13- Truesdell ED. Inequality of the lower extremities following fracture of the shaft of the femur in children Ann Surg. 1921;74(4):498-500.