RETROGRAD İNTRAMEDÜLLER ÇİVİLEME İLE TEDAVİ EDİLEN FEMUR KIRIKLARININ ORTA-UZUN DÖNEM SONUÇLARININ DEĞERLENDİRİLMESİ

Year 2025, Volume: 26 Issue: 4, 371 - 376, 13.10.2025

Ebubekir Eravşar , İbrahim Özkan , Ali Güleç , Bahattin Kerem Aydın

https://doi.org/10.18229/kocatepetip.1597135

Abstract

AMAÇ: Femur kırıkları dikkatli tedavi edilmesi gereken yaralanmalardır. Bu kırıklarda retrograd intramedüller çivileme ile kırığın minimal invaziv bir şekilde tedavi edildiği ve periosteal kan akımının daha iyi korunduğu düşünülmektedir. Bu çalışmada, retrograd intramedüller çivileme ile tedavi edilen femur kırığı hastalarının orta ve uzun dönem sonuçlarının değerlendirilmesi amaçlanmıştır.
GEREÇ VE YÖNTEM: Bu retrospektif çalışmada femur kırığı nedeniyle retrograd çivileme yapılan ve minimum 2 yıllık takipleri olan 86 hasta incelendi. Hastaların demografik verileri, takip süreleri, kırıklarının karakteri, çekilen röntgenleri, kırık kaynama oranları ve komplikasyonlar incelendi. Hastaların son takiplerinde alınan karşı tarafa göre hareket açıklığı kayıpları ve son grafilerinde gözlenen koronal ve sagital açılanmaları ve bacak uzunluk farkları incelendi. Son kontrol muayenelerinde ağrı ve fonksiyonel değerlendirmeler adına visual analog scale (VAS), Lower Extremity Functional Scale (LEFS) ve Tegner Lysholm Knee Score (TLKS) skorlamaları uygulandı.
BULGULAR: Karşı tarafa göre diz ekleminde olan ortalama fleksiyon kaybı 7 ± 9 derece, ekstansiyon kaybı ise 3 ± 5 derece olarak bulundu. Bacak uzunluk farkı ortalama 0,8 ± 1.1 cm idi. Hastalarda ortalama 4 ± 4 derece koronal ve 4 ± 3 derece sagital deformiteler gözlendi. LEFS skoru 69 ± 10, TLKS skoru ise 82 ± 19 olarak bulundu. Hastaların preoperatif VAS skoru 9 iken postoperatif VAS skoru 2'ye geriledi (p<0,0005). Hastaların %92’sinde kaynama elde edildi. Çok parçalı kırıklarda kaynama süresi daha uzun bulundu (p=0,044). Açık ve kapalı kırıklar arasında ise kaynama süresi açısından fark gözlenmedi (p=0,86).
SONUÇ: Retrograd intramedüller çivileme ile femur kırıklarının tedavisinde fonksiyonel sonuçlar tatmin edicidir. Ancak çok parçalı kırıkların kaynama süresi uzamaktadır ayrıca deformiteler ve bacak uzunluk farkları ise fonksiyonel sonuçları olumsuz etkilemektedir. Geniş hasta gruplarıyla yapılacak ileri çalışmalar, retrograd çivilemenin uzun dönem sonuçlarını daha iyi anlamak için gereklidir.

Keywords

Çivi , Femur , İntamedüller , Retrograd

EVALUATION OF MID-LONG TERM RESULTS OF RETROGRADE INTRAMEDULLARY NAILING IN FEMORAL FRACTURES

Abstract

OBJECTIVE: Femoral fractures require careful treatment, with retrograde intramedullary nailing being a minimally invasive method that preserves periosteal blood flow. This study evaluates the mid-to-long term outcomes of femoral fracture patients treated with retrograde intramedullary nailing.
MATERIAL AND METHODS: In this retrospective study, 86 patients who underwent retrograde nailing for femoral fractures and had at least 2 years of follow-up were analyzed. Data on demographics, fracture characteristics, radiographs, union rates, and complications were examined. The range of motion (ROM) deficits in the contralateral limb, as well as coronal and sagittal malalignments and leg length discrepancies from final radiographs, were assessed. Pain and functional evaluations were done using the visual analog scale (VAS), Lower Extremity Functional Scale (LEFS), and Tegner Lysholm Knee Score (TLKS) during the final follow-up.
RESULTS: The average loss of flexion in the knee joint was 7 ± 9 degrees, and the loss of extension was 3 ± 5 degrees. The average leg length discrepancy was 0.8 ± 1.1 cm. Coronal deformity averaged 4 ± 4 degrees, and sagittal deformity averaged 4 ± 3 degrees. The LEFS score was 69 ± 10, and the TLKS score was 82 ± 19. The preoperative VAS score was 9, which decreased to 2 postoperatively (p<0.0005). Union occurred in 92% of patients. Healing time was longer in multi-part fractures (p=0.044), with no significant difference in healing time between open and closed fractures (p=0.86).
CONCLUSIONS: Retrograde intramedullary nailing provides satisfactory functional outcomes for femoral fractures. However, multi-part fractures result in prolonged healing times, and deformities and leg length discrepancies affect functional outcomes. Larger studies are needed to further assess the long-term results of retrograde nailing.ee replacement surgery performed under spinal anesthesia.

Keywords

Nail , Femur , Intramedullary , Retrograde

Ethical Statement

Ethical approval was obtained from the Selcuk University Local Ethics Committee. Date: 19.11.2024, Number: 2024/583. Informed consent is not applicable.

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