Fixation of intracapsular femoral neck fractures: Effect of trans-osseous capsular decompression

Abstract

Objectives: Intracapsular femoral neck fractures have been found as associated with hemarthrosis. The fluid in the intact capsule elevates the intracapsular pressure to a level could tamponades the vascular supply of the femo­ral head. Therefore, capsular decompression seems nec­essary to salvage the femoral head circulation. Negative impact of the capsular incision also has been reported. Therefore, we hypothesize that creation of a trans-os­seous portal can decompress the capsule as well as not threaten the capsular related blood vessels. Materials and methods: In present study, 27 patients with intracapsular femoral neck fractures were included. Coinciding with closed reduction and internal fixation we made a trans-osseous portal for capsular decompression. Patients were followed-up prospectively for a mean pe­riod of 43.1 months. Results: All fractures united. However, one patient 17 years-old who was nursed preoperatively in skin traction developed osteonecrosis of the femoral head. Conclusion: Our results supported that the trans-osseous capsular decompression has evacuated the intracapsular haematoma and has not threatened the capsular integrity. Preoperative traction of the injured limb particularly in the young patient may play a role in development of osteone­crosis of the femoral head.

Keywords

• Femoral neck, intracapsular pressure, trans-osseous capsular decompression, traction, osteonecro­sis, avascular necrosis

Femur boynu kırıklarının kapsül içi fiksasyonu: Kemik içinden kapsül dekompresyonunun etkisi

Abstract

Amaç: Kapsül içi femur boynu kırıkları hemartrozla birlik­te bulunmuştur. Sağlam kapsüldeki sıvı kapsül içi basıncı femur başı kanlanmasını önleyecek seviyelere yükseltir. Femur başı dolaşımını korumak amacıyla kapsül dekom­presyonu gerekli görülmektedir. Bu nedenle kemik için­den bir yol açarak hem kapsül içi basıncı azaltmak hem de kapsül ilişkili kan damarlarını zedelemeyecek bir yön­temi ileri sürüyoruz. Yöntemler: Bu sunulan çalışmada kapsül içi femur boy­nu kırığı olan ve kapalı redüksiyon ve internal sabitleme yapılan 27 hasta çalışmaya alındı. Kemik içinden bir yol oluşturup kapsül içi dekompresyon yapıldı. Hastalar orta­lama 43.1 ay süreyle izlendi. Bulgular: Tüm kırıklar iyileşti. Ancak operasyon öncesi cilt traksiyonu uygulanan 17 yaşındaki hastada femur başı osteonekrozu gelişti. Sonuç: Sonuçlarımız kemik içinden kapsül dekompres­yonu yapılmasının intrakapsüler hematomun boşalma­sına yol açarak kapsül bütünlüğünü koruduğunu göster­mektedir. Genç bir hastada operasyon öncesi kırık bulu­nan ekstermiteye traksiyon uygulanması femur başında osteonekroz gelişimine yol açmış oalbilir.

Keywords

• Femur boynu, kasül içi basınç, ke­mik yoluyla kapsül dekompresyonu, çekme, osteonekroz, avasküler nekroz

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