Determining the Optimal Level of Proximal Locking Screw Insertion in Femoral Nailing

Yıl 2017, Cilt: 8 Sayı: 3, 12 - 16, 20.12.2017

Ahmet A. Karaarslan Nihat Acar A. Meric Unal

https://doi.org/10.22312/sdusbed.318582

Öz

Objectives: The aim is to investigate the
optimum level of insertion for proximal locking screw in the proximal femurs.

Methods: The distance between the
trochanteric fossa and lesser trochanter and the medial- lateral femur canal
diameters 20 mm proximal and 20 mm distal to the lesser trochanter within an intervals
of 10 millimeters on AP radiograms of 208 patients in both genders and
different age groups were measured.

Results: The average distances between the
trochanteric fossa and lesser trochanter level were 60.8 mm in male and 52.2 mm
in female populations (p=0.000). The average femoral canal diameter
at the level of the lesser trochanter was 29.2 ± 4.3 mm, whereas 10 mm proximal
to the lesser trochanter  it was 39 ± 4.6
mm, the difference was statistically significant with  p=0.000.  

Conclusions: Lesser trochanter level is the
optimal level for transverse proximal locking screw insertion since it contains
the relatively narrowest canal in the proximal femur. Orthopedic surgeons
should be aware of choosing the femoral nails with a proximal tip to proximal
screw hole distance of a 61 mm in male and a 52 mm in female populations to increase
three point bending resistance of proximal locking screw and to prevent early
implant failure. 

Anahtar Kelimeler

Femur fracture; Intramedullary nailing; Proximal locking screw; Three point bending

Femur İntramedüller Çivilemede Proksimal Kilitleme Vidası Uygulaması Optimal Seviyesinin Saptanması

Öz

Amaç; Çalışmanın
amacı femur intramedüller çivilemede proksimal kilitleme vidası uygulamasının
optimal yerleşim seviyesini saptamaktır.

Hastalar ve Metod:
Her iki cinsiyetten ve farklı yaş gruplarından 208 hastanın kalça
anteroposterior grafileri değerlendirilmiştir. Trokanter minor seviyesinin 20
mm distal ve 20 mm proksimal aralığı 10 mm lik aralıklara bölündü. Trokanterik
fossa ile trokanter minor arası mesafe ve yukarıda belirlenen seviyeler
arasında mediolateral femoral kanal çapları ölçüldü.

Sonuçlar: Trokanterik
fossa ve trokanter minor arası ortalama mesafe erkeklerde 60,8 mm kadınlarda
ise 52,2 mm olarak saptandı(p=0,000). Trokanter minor seviyesindeki ortalama
femoral kanal çapı 29,2 ± 4,3 mm ve trokanter minörün 10 mm
proksimalinde ise 39 ± 4,6 mm olarak ölçüldü. Fark istatistiksel olarak anlamlı
bulundu(p=0,000).

Çıkarımlar: Trokanter
minor seviyesi, rölatif olarak proksimal femurun en dar yeri olması nedeni ile
transvers proksimal kilitleme vidası için optimal seviye olarak saptandı.
Ortopedik cerrahların femoral çivi seçerken çivinin tepesi ile proksimal
kilitleme vidası arası mesafenin –üç nokta bükülme direncinin yüksek olması ve
erken implant yetmezliği riskini azaltması nedeni ile- erkeklerde 61 mm ve
kadınlarda 52 mm olmasına dikkat etmesinde fayda vardır.

Anahtar Kelimeler

Femur kırığı; İntramedüller çivileme; Proksimal kilitleme vidası; Üç nokta bükülme testi

Kaynakça

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