Comparison of Arthroplasty and Internal Fixation with Nail Method in the Treatment Of Trochanteric Proximal Femur Fractures

Yıl 2017, Cilt: 9 Sayı: 2, 69 - 83, 01.06.2017

Enes Eser Murat Aşçı Orhan Balta Bora Bostan Erkal Bilgiç Taner Güneş

Öz

Aim: The aim of the study is to compare independency level of
physical activities and daily life activities of patients who were applied
hemiarthroplasty and internal fixation with nail due to pertrochanteric femur
fractures.

Material and Method: Between
October 2007 and October 2013, 48 patients who were applied proximal femoral
nail and 38 patients who were done hemiarthroplasty in our clinic were
evaluated retrospectively. For functional evaluation and independency level, we
used Harris Hip Scoring System and Broos Independency Scale. Respectively the
patients were also analyzed according to their demographic features, fracture
parts, type of trauma and time between surgery and trauma, complications and
operation time.

Results: 49 (57%) of the patients were female and 37 (43%) of them
were male. The average age of our patients were 79.4(55-93) years. Mean
follow-up was 20.1 (12-72) months. 93% of the fractures resulted from simple
falls, 5% resulted from falls from height, and 2% resulted from traffic
accidents. No significant difference was observed between the groups regard to
the results of Harris Hip Scoring and Broos Independency level. 4 of the 48
patients (8,3%) who were applied proximal femoral nail, and 2 of 38 patients
(5,2%) who were operated with hemiarthroplasty had needed reoperation because
of mechanical complications.

Conclusions: Pertrochanteric femur fractures are serious trauma for
elderly patients and cause morbidity and mortality. Surgical treatment options
should be preferred in order to enable patients turn back to their movement and
functional levels before the injury early and quickly. In the treatment of
pertrochanteric fractures, proximal femoral nail is seen as a good option since
it can be applied with minimal invasive technique, it has short surgery time,
and it causes less hemorrhage. If internal fixation is not possible for old
active patients, hemiarthroplasty should be considered.

Anahtar Kelimeler

Pertrocanteric femur fractures, Proximal femur nail, Arthroplasty

Pertrokanterik Proksimal Femur Kırıkları Tedavisinde Artroplasti ve Çivi ile İnternal Fiksasyon Yönteminin Karşılaştırılması

Öz

Amaç:Pertrokanterik femur kırığı nedeniyle hemiartroplasti ve çiviile internal
fiksasyon yapılan hastaların fonksiyonel aktivitelerini, günlük yaşam
aktivitelerinde bağımsızlık derecelerini ve ölüm oranlarının
karşılaştırılmasıdır.

Hastalar  ve Yöntem: Kliniğimizde Ekim 2007-Ekim 2013 tarihleri arasında proksimal femur çivisi
yapılan 48 ve parsiyel protez yapılan 38 hasta retrospektif olarak
değerlendirildi. Fonksiyonel değerlendirmede Harris kalça skorlama
sistemi(HKS), bağımsızlık derecelerini belirlemede ise Broos bağımsızlık
cetveli(BBC) kullanıldı. Ayrıca, hastalar demografik özellikleri, kırık tarafı,
travma tipi, travmadan sonra ameliyata kadar geçen süre, ameliyat süresi,
komplikasyonlar açısından da değerlendirildi. Hastalarda radyolojik
değerlendirmeyle birlikte fonksiyonel durum değerlendirmesi yapıldı. HKS ve BBC
skorlarının cerrahi tedavi seçeneği ile ilişkisinin olup olmadığı istatistiksel
olarak değerlendirildi.

Bulgular: Hastaların yaş ortalaması 79,4(55-93)
yıl idi. Ortalama takip süresi 20,1(12-72) aydı. Değerlendirmeye alınan 86
hastanın 49’u(%57) kadın, 37’si(%43) erkekti. Kırıkların %93’ü basit ev içi
düşme kaynaklıydı. Hastaların travmadan sonra ameliyat oldukları ortalama gün
sayısı 3,4(1-13) gündü. Gruplar arasında HKS ve BBC sonuçları açısından
istatistiksel olarak anlamlı fark gözlenmedi.

Sonuç: Pertrokanterik femur kırıkları yaşlı
hastalar için mortal ve morbid sonuçları olan ciddi bir travmadır. Hastaları
erken ve hızlı bir şekilde yaralanma öncesi hareket ve fonksiyonel seviyesine
döndürmek için cerrahi tedavi tercih edilmelidir. Ameliyat için beklenilen süre
ve tedavi seçeneği mortalite ve fonksiyonel sonuçları değiştirmemektedir. Bu
nedenle ameliyat için mümkün olan en kısa sürede ve hastanın yaş/fonksiyonel
durumuna göre tedavi seçeneği belirlenip medikal hazırlıklar tamamlanmalıdır.

Anahtar Kelimeler

Pertrokanterik femur kırıkları, Proksimal femur çivisi, artroplasti

Kaynakça

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