Femur suprakondiler kırığının perkütan plak osteosentez ve retrograde intramedüler kilitli çivi ile tedavisinin karşılaştırması

Year 2022, , 152 - 160, 18.03.2022

Alper Kurtoğlu , Alauddin Kochai , Erhan Şükür , Erkan İnanmaz , Uğur Özdemir Yüksel Laçin Avan İhsan Öz , Zafer Şen , İsmail Daldal , Orhan Başoğlu , Amet Çağrı Uyar

https://doi.org/10.31832/smj.1039924

Abstract

Özet: Başlık: Femur suprakondiler kırığının perkütan plak osteosentez ve retrograde intramedüler kilitli çivi ile tedavisinin karşılaştırması.
Amaç : Femur suprakondiler kırıklarının uygun cerrahisi tedavisi net olarak aydınlatılmış değildir. Bu bölge kırıkları sonrası implant yetmezliği, kaynama gecikmesi, kaynamama ve diz eklem sertliği en sık görülen komplikasyonlardandır. Bu çalışmanın amacı suprakondiler femur kırıkları için en sık kullanılan iki cerrahi tekniğinin radiyolojik ve klinik sonuçlarını karşılaştırmasıdır.
Materyal Metod: Femur suprakondiler kırığı için kliniğimizde tedavi edilen 69 hasta çalışmaya alındı. Hastaların 45’i perkütan plak osteosentezi ( grup A) ile ve 24’ü retrograd intramedüler femur çivisiyle opera edilmiş. Hastalar ameliyat sonrası kaynama süresi, komplikasyon, eklem hareket açıklığı ve fonksiyonel sunuç açısından değerlendirildi. Hastaların fonksiyonel sonuçları diz eklem hareket açıklığı ve diz cemiyeti skoru ölçülerek değerlendirildi.
Bulgular: Her iki grubun demografik sonuçları birbirleriyle aynıydı. Kaynama süresi perkütan plak ile osteosentez yapılan hastalarda ortalama olarak 7.2±2.1 iken retrograd intramedüler çivi ile tedavi edilenler için bu süre 6.5±2 idi. Iki grup arasında istatiksel açısından farklılık saptanmadı (p=0.125). Aynı zamandan her iki grup arasında eklem hareket açıklığı (p=0.371) ve diz cemiyet skoru açısından (p=0.371) da istatistiksel açısından anlamlı farklılık bulunmadı. Hastanın son değerlendirmelerinde alt ekstremite dizilim anormallik açısından da istatistiksel açısından farklılık saptanmadı (p=0.791).
Çıkarım: Çalışmamızda hem perkütan plak fiksasyonu hem de retrograd inntramedüler çivi ile yapılan cerrahinin sonuçları birbirleri ile kaynama süresi, eklem hareket açıklığı ve diz cemiyeti skoru açısından aynıydı. Her iki cerrahi arasında komplikasyonlar bakımından da farklılık saptanmadı. Her iki cerrahi teknik femur suprakondiler kırıkları için güvenli bir şekilde uygulanabilir.

Keywords

Distal femur kırıkları, Perkütan plak osteosentez, İntramedüller çivi

Comparison of percutaneous plate osteosynthesis and retrograde interlocking femoral nail for femur supracondyler fractures

Abstract

Objectives: There is not optimal treatment option for distal femur. Implant failure, delayed union, nonunion and knee stiffness are the most common problem occur after distal femur fractures. The aim of this study is to compare clinical and radiological outcomes of the most used two techniques.
Materials and Methods: Sixty-nine patients with distal femur fractures were included in this study. 45 patients (group A) undergone locked-bridge plating and 24 patients (group B) undergone RIMN. Patients were evaluated in terms of duration of union, complications, range of motion and functional results. Functional results were evaluated according to the knee range of motion and Knee Society Score.
Results: There were no significant differences between the two groups in terms of demographic characteristics. While the mean union time was 7.2±2.1 months in the percutaneous plate group, it was 6.5±2 months in the RIMN group; however, there was no statistically significant difference between the study groups in terms of duration of bone healing (p=0.125). There was no statistically significant difference in the range of motion between the two groups at the last follow-up (p=0.371). There was no statistically significant difference in the Knee Society Scores between the two groups (p=0.353) too and also there was no statistically significant difference in the incidence of alignment disorders at the last follow-up between the two groups (p=0.791).
Conclusion: Both percutaneous plate osteosynthesis with RIMN to treat supracondylar-intercondylar femur fractures, both groups had similar results in terms of duration of union, range of motion, and Knee Society Scores. Furthermore, there were also similar complication rates in both groups. Both techniques can be used safely in the treatment of distal femoral fractures with satisfactory outcomes.
Keywords: Distal femur fractures, Percutaneous plate osteosynthesis, Intramedullary nail

References

• 1. Ng AC, Drake MT, Clarke BL, et al. Trends in subtrochanteric, diaphyseal,and distal femur fractures, 1984-2007. Osteoporos Int, 2012, 23:1721–1726.
• 2. Wahnert D, Hoffmeier K, Frober R, Hofmann GO, Muckley T. Distal femur fractures of the elderly different treatment options in a biomechanical comparison. Injury. 2011;42:655–59
• 3. Demirtaş A, Azboy I, Özkul E, Gem M, Alemdar C. Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur. Acta Orthop Traumatol Turc. 2014;48:521-26.
• 4. Griffin XL, Parsons N, Zbaeda MM, et al. Interventions for treating fractures of the distal femur in adults. Cochrane Database Syst Rev 2015;8:CD010606
• 5. Gao K, Gao W, Huang J, Li H, Li F, Tao J, et al. Retrograde nailing versus locked plating of extra-articular distal femoral fractures: comparison of 36 cases. Med Princ Pract 2013;22:161-6.
• 6. Krettek C, Müller M, Miclau T. Evolution of minimally invasive plate osteosynthesis (MIPO) in the femur. Injury 2001;32 Suppl 3:SC14-23.
• 7. Kregor PJ, Stannard J, Zlowodzki M, Cole PA, Alonso J. Distal femoral fracture fixation utilizing the Less Invasive Stabilization System (L.I.S.S.): the technique and early results. Injury 2001;32 Suppl 3:SC32-47.
• 8. Hierholzer C, von Rüden C, Pötzel T, Woltmann A, Bühren V. Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: A retrospective analysis. Indian J Orthop 2011;45:243-50.
• 9. Handolin L, Pajarinen J, Lindahl J, Hirvensalo E. Retrograde intramedullary nailing in distal femoral fractures results in a series of 46 consecutive operations. Injury 2004;35:517-22.
• 10. Markmiller M, Konrad G, Südkamp N. Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications? Clin Orthop Relat Res 2004;426:252-7.
• 11. Gurkan V, Orhun H, Doganay M, Salioğlu F, Ercan T, Dursun M, et al. Retrograde intramedullary interlocking nailing in fractures of the distal femur. Acta Orthop Trau- matol Turc 2009;43:199-205.
• 12. Kubiak EN, Fulkerson E, Strauss E, Egol KA. evoluation of locked plates. J Bone Joint Surg Am 2006;88 Suppl 4:189-200.
• 13. Henderson CE, Lujan T, Bottlang M, Fitzpatrick DC, Madey SM, Marsh JL. Stabilization of distal femur fractures with intramedullary nails and locking plates: differences in callus formation. Iowa Orthop J 2010;30:61-8.
• 14. Apivatthakakul T, Chiewcharntanakit S. Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated. Int Orthop 2009;33:1119-26.
• 15. Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma 2014;28:83-9.
• 16. Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma 2011;25 Suppl 1:8-14.
• 17. Smith JRA, Morrison R, Yip G, et al. Distal femoral fractures: the size of the problem in the UK. Orthopaedic Trauma Society 2013.
• 18. Pingsmann A, Lederer M, Wüllenweber C, Lichtinger TK. Early patellofemoral osteoarthritis caused by an osteochondral defect after retrograde solid nailing of the femur in sheep. J Trauma 2005;58:1024-8.
• 19. Wenda K, Runkel M. Systemic complications in intramedullary nailing. [Article in German] Orthopade 1996;25:292-9.
• 20. Leggon RE, Feldmann DD. Retrograde femoral nailing: a focus on the knee. Am J Knee Surg 2001;14:109-18.
• 21. Gao K, Gao W, Huang J, Li H, Li F, Tao J et al. Retrograde nailing versus locked plating of extra-articular distal femoral fractures: comparison of 36 cases. Med Princ Pract. 2012;22:161-6.
• 22. Kellam JF, Meinberg EG, Agel J, Karam MD, Roberts CS. Introduction: fracture and dislocation classification compendium-2018: International Comprehensive Classification of Fractures and Dislocations Committee. J Orthop Trauma. 2018 Jan;32(Suppl 1):S1–10.
• 23. Frank O, Sutter PM, Regazzoni P. First experiences with Less Invasive Stabilisation System (L.I.S.S.) in distal femoral fractures. Swiss Surg. 2000;6:28.
• 24. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–4.
• 25. Hoffmann MF, Jones CB, Sietsema DL, Tornetta III P, Koenig SJ. Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort. Journal of Orthopaedic Surgery and Research. 2013;8:43.
• 26. Smith WR, Ziran BH, Anglen JO, Stahel PF. Locking plates: tips and tricks. J Bone Joint Surg Am. 2007;89:2298–307.
• 27. Papadokostakis G, Papakostidis C, Dimitriou R, Giannoudis PV. The role and efficacy of retrograting nailing for the treatment of diaphyseal and distal femoral fractures:a systematic review of the literature. Injury. 2005;36:813-22 .
• 28. Becher S, Ziran B (2012) Retrograde intramedullary nailing of open femoral shaft fractures: a retrospective case series. J Trauma Acute Care Surg 72:696–698
• 29. Marks DS, Isbister ES, Porter KM. Zickel supracondylar nailing for supracondylar femoral fractures in elderly or infirm patients. J Bone Joint Surg. 1994;76:596-601.
• 30. Zlowodzki M, Bhandari M, Marek DJ, Cole PA, Kregor PJ. Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989 to 2005). J Orthop Trauma. 2006;20:366–71. 31. Zlowodzki M, Williamson S, Cole PA, Zardiackas LD, Kregor PJ. Biomechanical evaluation of the less invasive stabilization system, angled blade plate, and retrograde intramedullary nail for the internal fixation of distal femur fractures. J Orthop Trauma. 2004;18:494–502.