Application of Locked İntramedullary Nails at Adult Tibia Diaphysis Fractures Surgical Treatment

Year 2018, Volume: 2 Issue: 1, 9 - 13, 12.03.2018

Uygar Daşar Tansel Mutlu Ahmet Ülker Ahmet Burak Satılmış Önder Ersan

https://doi.org/10.30565/medalanya.372916

Cited By: 1

Abstract

Aim: To evaluate the effect of the treatment of
locked intramedullary nails in adult patients with tibia diaphysis fractures.                                                                                     

Patients
and Methods:  Forty-eight adults that were
treated with reamed locked intramedullary nails for tibia shaft fractures were
evaluated. 27 of the patients were male (56,25%) and 21 were women
(43,75%).  Mean age was 42,6(18-59). 29
of the fracture were right leg and 19 were left. There wasn’t any patient that
had bilateral tibia shaft fracture. AO fracture classification system was used
and every patient except 2 had concurrent fibula fracture. Patients’ injury
mechanism, date of referral, date of operation, time of bne union (seeing 3
cortices bridging at X-ray), time to return to work, malalignment and joint
range of motion were evaluated.                                                                                                         

Results: We found that mean union time
was 14,2 weeks and mean time to return to work was 18,4 weeks. Out of 10 open
fracture patients; 1 had superficial infection, 2 had pseudarthrosis, 1 had
delayed union. Distal locking screw breaking occurred at 4 patients. Bone union
time was delayed for 22 months at patient that had superficial infection.
Patient was treated by providing dynamizition and giving antibiotics.                                 

Conclusions: We came to the conclusion
that reamed locked intramedullary nails have high success rates, low
complication rates, better functional results and provides rapid return to
work; therefore, being a suitable surgical method it is still accepted as gold
standard treatment.

Keywords

Tibia diaphysis fracture, İntramedullary nail, Closed Fracture

Erişkin Tibia Diafiz Kırıklarının Cerrahi Tedavisinde Kilitli İntramedüller Çivi Uygulaması

Abstract

Amaç: Erişkin tibia cisim kırıklarında uygulanan
oymalı kilitli intramedüller çivi kullanımının yerini ve etkisini değerlendirmek.       

Hastalar ve Yöntem:  Tibia diafiz kırığı nedeniyle
oymalı kilitli intramedüller çivi uygulaması yapılan toplam 48 erişkin hasta
çalışmaya dâhil edildi. Hastaların 27'si (%56,25) erkek, 21’i (%43,75) kadındı.
Hastalarımızın yaş ortalaması 42,6(18-59) olarak tespit edildi. 29 kırık vakası sağ bacakta iken
19’u sol bacakta idi. Kırık sınıflamasında AO sınıflaması kullanılmış olup iki
vaka dışında tüm vakalara fibula kırığı eşlik etmekteydi. Hastaların yaralanma
mekanizması, başvuru zamanı, ameliyat tarihi, kaynama zamanı olarak
röntgenogramda 3 kortekste köprüleşme görülmesi, işe geri dönüş zamanı, dizilim
bozukluğu ve eklem hareket açıklığına bakıldı.                                                                                                     

Bulgular:  Hastalarda ortalama kaynama zamanı 14,2±2,5
hafta, ortalama işe dönüş zamanı ise 18,4±3,6 hafta olarak bulundu. Açık kırık
olan 10 hastadan bir tanesinde yüzeyel enfeksiyon, iki tanesinde psödoartroz,
bir tanesinde ise kaynama gecikmesi olmuştur. Dört hastada ise distal kilitleme
vidasında kırılma meydana geldi. Yüzeyel enfeksiyon gelişen hastada kaynama 22
ay gecikme şeklinde oldu; dinamizasyon sağlanarak ve parenteral antibiyotik
tedavisi verilerek tedavi edildi.                                                                         

Sonuç:   Erişkin tibia cisim kırıklarında uygulanan
intramedüller çivileme tedavisinin yüksek başarı oranı ve komplikasyon oranının
düşüklüğü nedeniyle uygun bir cerrahi tedavi metodu olduğu ve halen altın
standart tedavi olarak kabul edilmesi sonucuna varılmıştır.

Keywords

Tibia cisim kırıkları, İntramedüller çivi, Kapalı kırık

References

• 1. Inan M, Tuncel M, Karaoglu S, Halici M. Treatment of type II and III open tibial fractures with Ilizarov external fixation. Acta Orthop Traumatol Turc 2002;36:390-6.
• 2. Papakostidis C, Kanakaris NK, Pretel J, Faour O, Morell DJ, Giannoudis PV. Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo–Anderson classification. Injury 2011;42:1408–15.
• 3. Metsemakers WJ., et al. Individual risk factors for deep infection and compromised fracture healing after intramedullary nailing of tibial shaft fractures: a single centre experience of 480 patients. Injury, 2015, 46.4: 740-745.
• 4. Aksekili MA, Celik I, Arslan AK, Kalkan T, Uğurlu M. The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures. Acta Orthop Traumatol Turc 2012;46(3):161-7.
• 5. Russell TA. Fractures of theTibia and Fibula: Rockwood and Green’s fractures in adults. 3rd.ed. 1991; 1925-1982.
• 6. Toivanen JA, Honkonen SE, Koivisto AM, et al. Treatment of the low energy tibial shaft fractures. Plaster cast compared with intramedullary nailing. Int Orthop 2001;25(1):110-13.
• 7. Subaşı M, Kesmenli CC, Aslan H, Çakır Ö, Kapukaya A. Tibia kırıklarının intramedüler çivi ile tedavi sonuçları ve bir amputasyon olgusu. Eklem Hastalık Cerrahisi 2002; 227-232.
• 8. Konya MN, Kaya ÖA. [Can radiation exposure be reduced in the treatment of femur fractures with the Intrameduller nail?] Turkish. Acta Med. Alanya 2017;1(1):20-23.
• 9. Orhun, Haldun; Bayhan, Ilhan Avni. Treatment of adult tibial diaphysis fractures with reamed and locked intramedullary nailing. Acta Orthop Traumatol Turc, 2009, 43.1: 7a13.
• 10. C.M. Court-Brown, B. Caesar Epidemiology of adult fractures: a review Injury, 2006;37: 691-697.
• 11. Zalavras CG, Marcus RE, Levin LS, Patzakis MJ. Management of open fractures and subsequent complications. Instr Course lect 2007;57:51–63.
• 12. KO, Sebastian J., et al. Trajectory of Short-and Long-Term Recovery of Tibial Shaft Fractures After Intramedullary Nail Fixation. Journal of Orthopaedic trauma, 2017;31(10): 559-563.
• 13. Sahibzada AS, Khan MA, Khan MS. Management of tibial bone defect due to high energy trauma using the locally manufactured external fixator by segmental bone transport. J Ayub Med Coll Abbottabad 2005;17:68–72.
• 14. Sürel YB, Zorer G, Karlı M, Çelikyurt R. Eriskin tibia kırıklarının tedavisinde intramedüller ender çivileri. Acta Orthop. Traumotol. Turc. 1994;28,1:236-239.
• 15. Grutter R, Cordey J, Wahl D, Koller B, Regazzoni P. A biomechanical enigma: why are tibial fractures not more frequent in the elderly? Injury 2000; 31:72-77.
• 16. Türktaş U, Yalçın MN. Erişkin Tibia Cisim Kırıklarında Kilitli İntrameduller Çivi Uygulamaları. Van Tıp Dergisi 2011; 18 (1):20-26.
• 17. Ellis H. The Speed of Healing After Fracture of the tibial Shaft. J. Bone Joint Surg.1958; 40B:42-46.
• 18. Saruhan CS, Algün R, Barış B, Budak K. [Unlocked using of interlocked intramedullary nails in tibial shaft fractures]. Eklem Hastalik Cerrahisi. 2013;24(1):23-9. [Turkish]
• 19. Hooper GJ, Keddell RG, Penny ID. Conservative management or closed nailing for tibial shaft fractures. A randomised prospective trial. J Bone Joint Surg Br 1991; 73:83-85.
• 20. R.J. Weiss, S.M. Montgomery, A. Ehlin, Z. Al Dabbagh, A. Stark, K.A. Jansson Decreasing incidence of tibial shaft fractures between 1998 and 2004: information based on 10,627 Swedish inpatients Acta Orthop 2008;79:526-533.
• 21. Whittle AP. Fractures of lower extremity. In Canale ST (Ed.). Campbell’s Operative Orthopedics. Vol 3, 9 th ed. St.Louis: Mosby Year Book Inc 1998; 2067-2094.
• 22. Aslan A, Uysal E, Ozmeriç A. A staged surgical treatment outcome of type 3 open tibial fractures. ISRN Orthop. 2014 Apr 15;2014:721041.
• 23. Chapman, M.V.: Fractures of the tibial and fibular shafts. In Evarts CM (Ed). Surgery of the musculoskletal system.2 nd edition. New York: Churchill Livingstone Inc;1990 Vol 4 pp 3741-3799.
• 24. Ekeland, A.., Stromsoe, K.., Folleras, G.., and Thoresen, B.O.: Locked Intramedullary Nailing for Displaced Tibial Shaft Fractures. J.Bone Joint. Surg. 1990; 72B:805-809.
• 25. Court-Brown CM, Christie J and McQueen MM. Closed Intramedullary Tibial Nailing: Its Use in Closed and Type I Open Fractures. J.Bone Joint Surg 1990; 72B:605-611.
• 26. Alho A, Ekeland A, Stromsoe K.,Folleras, G and Thoresen BO. Locked Intramedullary Nailing for Displaced Tibial Shaft Fractures. J.Bone Joint. Surg 1990;72B:805-809.
• 27. Demirtaş A, Durakbaşa MO, Azboy İ et al. Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing. J Clin Exp Invest. 2011; 2 (2):168-174.[Turkish]
• 28. Bhandari M, Adili A, Leone J, Lachowski RJ,Kwok DC. Early versus delayed operative management of closed tibial fractures. Clin Orthop Relat Res 1999;368:230-239.