Pediatrik Hastalarda Femur Diafiz Kırıklarının Elastik Titanyum Çiviler ile Tedavisi

Year 2016, Volume: 43 Issue: 2, 224 - 228, 01.06.2016

Yunus Güzel Kenan Güvenç Onur Bilge Serdar Toker Mustafa Yel

Abstract

Amaç: Araştırmanın amacı elastik titanyum çivi ile intramedüller
tespit uygulanan stabil olmayan femur kırıklarının
fonksiyonel ve radyolojik sonuçlarını değerlendirmek
ve sonuçlara etki eden faktörleri belirlemektir.
Yöntemler: 2001 ile 2014 yılları arasında, 4-17 yaş arası
femur diafiz kırığı nedeniyle intramedüller elastik çivi ile
tedavi edilen 32 hasta incelendi. On iki hastada sol femur
diafiz kırığı, 18 hastada sağ ve 2 hastada bilateral femur
diafiz kırığı mevcuttu. On bir hastada parçalı, 11 hastada
kısa oblik, 8 hastada transvers ve 4 hastada spiral kırık
paterni tespit edildi. Tüm hastalarda aynı cerrahi teknik
ve ameliyat sonrası bakım uygulandı. Cerrahi sonrasında
ve kontrollerde ön-arka ve yan direk grafiler ile sagital ve
koronal açı ölçümleri yapıldı. Hastalar ortalama 54 (aralık,
12-156 ay) ay takip edildi. Ağrısız tam yük verme ve direk
grafilerde en az üç kortekste kallus köprü olumu kaynama
kriterleri olarak kabul edildi.
Bulgular: Takiplerde bir hasta hariç tüm hastalarda kaynama
elde edildi. Hastalar eski aktivitelerine geri döndü.
Diz ve kalça eklem hareket açıklıkları geri kazanıldı. Ortalama
kaynama süresi radyolojik olarak 9 (aralık, 6-16
hafta) hafta tespit edildi. Beş (14%) hastada kısalık tespit
edildi. Kırık paterni ile kısalık arasında istatistiksel anlamlı
ilişki saptanmadı. On dereceden fazla varus ya da valgus
açılanması görülmedi.
Sonuç: Elastik titanyum çivi uygulaması hastanın erken
yük vermesine izin veren konforlu, ekonomik ve güvenli
bir yöntemdir.

Keywords

Pediatrik, femur, kırık, titanyum elastik çiviler

Management of Femoral Shaft Fractures with Elastic Titanium Nails in Pediatric Patients

Abstract

Objective: The aim of this study was to evaluate the func­tional and radiological results of the application of intra­medullary fixation with elastic titanium nails in unstable femoral fractures and to determine the factors affecting these results. Methods: A total of 32 patients aged 4-17 years treated with intramedullary elastic nails for a femoral diaphysis fracture between 2001 and 2014 were included. The frac­ture was left side in 12 cases, right side in 18 and bilateral in 2. The fracture pattern was determined as fragmented in 11 cases, short oblique in 11, transverse in 8 and spi­ral in 4. The same surgical technique and postoperative care was applied to all the patients. Sagittal and coronal angle measurements were made from postoperative and follow-up anterior-posterior and lateral radiographs. The mean follow-up period was 54 months (12-156 months). Positive union criteria were accepted as pain-free weight-bearing and callus bridging in at least 3 cortices seen on direct radiographs. Results: Union was achieved in all except one patient. They were able to return to previous activities with full knee and hip joint range of movement. Radiologically, the mean time to union was determined as 9 weeks (range, 6-16 weeks). Limb shortness was determined in 5 (14%) patients. No significant association was detected be­tween shortness and fracture pattern. No varus or valgus angulation of >10˚ was determined in any patient. Conclusion: Application of titanium elastic nails in pe­diatric femoral diaphysis fractures is a comfortable, eco­nomic, and reliable method which is allows early weight-bearing.

Keywords

Pediatric, femur, fracture, titanium elastic nails

References

• 1. Hedström EM, Svensson O, Bergström U, Michno P. Epidemiology of fractures in children and adolescents. Acta Orthop 2010;81:148-153.
• 2. Heideken J, Svensson T, Blomqvist P, et al. Incidence and trends in femur shaft fractures in Swedish children between 1987 and 2005. J Pediatr Orthop 2011;31:512-519.
• 3. Schalamon J, Dampf S, Singer G, et al. Evaluation of fractures in children and adolescents in a level I trauma center in Austria. J Trauma 2011;71:E19-25.
• 4. Reynolds RA, Legakis JE, Thomas R, et al. Intramedullary nails for pediatric diaphyseal femur fractures in older, heavier children: early results. Child Orthop 2012;6:181- 188.
• 5. Carey TP, Galpin RD. Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop Relat Res 1996;332:110-118.
• 6. Kuremsky MA, Frick SL. Advances in the surgical management of pediatric femoral shaft fractures. Curr Opin Pediatr 2007;19:51-57.
• 7. Uçar BY, Gem M, Bulut M, et al. Titanium elastic intramedullary nailing: closed or mini-open reduction? Acta Orthop Belg 2013;79:406-410.
• 8. Flinck M, von Heideken J, Janarv PM, et al. Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model. J Child Orthop 2015;9:77-84.
• 9. Narayanan UG, Hyman JE, Wainwright AM, et al. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. J Pediatr Orthop 2004;24:363-369.
• 10. Winquist RA, Hansen ST Jr. Comminuted fractures of the femoral shaft treated by intramedullary nailing. Orthop Clin North Am 1980;11:633-648.
• 11. Martinez AG, Carroll NC, Sarwark JF, et al. Femoral shaft fractures in children treated with early spica cast. J Pediatr Orthop 1991;11:712-771.
• 12. Pollak AN, Cooperman DR, Thompson GH. Spica cast treatment of femoral shaft fractures in children—the prognostic value of the mechanism of injury. J Trauma 1994;37:223-229.
• 13. Saseendar S, Menon J, Patro DK. Treatment of femoral fractures in children: is titanium elastic nailing an improvement over hip spica casting? J Child Orthop 2010;4:245-251.
• 14. Ligier JN, Metaizeau JP, Prévot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg Br 1988;70:74-77.
• 15. Flynn JM, Hresko T, Reynolds RA, Blasier RD, et al. Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop 2001;21:4-8.
• 16. Vrsansky P, Bourdelat D, Al Faour A. Flexible stable intramedullary pinning technique in the treatment of pediatric fractures. J Pediatr Orthop 2000;20:23-27.
• 17. Ho CA, Skaggs DL, Tang CW, Kay RM. Use of flexible intramedullary nails in pediatric femur fractures. J Pediatr Orthop 2006;26:497-504.
• 18. Khazzam M, Tassone C, Liu XC, et al. Use of flexible intramedullary nail fixation in treating femur fractures in children. Am J Orthop (Belle Mead NJ) 2009; 38:E49-55.
• 19. Kuremsky MA, Frick SL. Advances in the surgical management of pediatric femoral shaft fractures. Curr Opin Pediatr 2007;19:51-57
• 20. Li Y, Stabile KJ, Shilt JS. Biomechanical analysis of titanium elastic nail fixation in a pediatric femur fracture model. J Pediatr Orthop 2008;28:874-878
• 21. Sagan M, Datta J, Olney B, et al. Residual deformity after treatment of pediatric femur fractures with flexible titanium nails. J Pediatr Orthop 2010;30:638-643.
• 22. Parikh SN, Nathan ST, Priola MJ, Eismann EA. Elastic nailing for pediatric subtrochanteric and supracondylar femur fractures. Clin Orthop Relat Res 2014;472:2735-2744.
• 23. Anglen JO, Choi L. Treatment options in pediatric femoral shaft fractures. J Orthop Trauma 2005;19:724-733.
• 24. Park KC, Oh CW, Byun YS, et al. Intramedullary nailing versus submuscular plating in adolescent femoral fracture. Injury 2012;43:870-875.
• 25. Caglar O, Aksoy MC, Yazici M, Surat A. Comparison of compression plate and flexible intramedullary nail fixation in pediatric femoral shaft fractures. J Pediatr Orthop B 2006;15:210-214.
• 26. Li Y, Hedequist DJ. Submuscular plating of pediatric femur fracture. J Am Acad Orthop Surg 2012;20:596-603.
• 27. Samora WP, Guerriero M, Willis L, Klingele KE. Submuscular Bridge Plating for Length-Unstable, Pediatric Femur Fractures. J Pediatr Orthop 2013;33:797-802.