Distal Tibia Eklemine Uzanan Tibia Diyafiz Kırıklarında Kapalı Perkütan Pinleme ve İntramedüller Çivileme ile Tatminkar Sonuçlar Elde Edilebilir

Year 2023, , 232 - 239, 30.06.2023

Batuhan Gencer , Özgür Doğan

https://doi.org/10.31832/smj.1204366

Abstract

Amaç: Amacımız, distal tibia eklem hattına uzanan tibia diyafiz kırıklarında intramedüller çivilemenin sonuçlarının araştırılması ve minimal invaziv plak osteosentez yöntemi ile karşılaştırılmasıdır.
Gereç ve Yöntem: Kliniğimizde tibia distal eklem hattına uzanan ancak eklemde impaksiyon izlenmeyen tibia diyafiz kırığı nedeni ile 2019 – 2021 yılları arasında tedavi ve takibi yapılan tüm hastalar retrospektif olarak araştırıldı. Tüm hastaların yaş, cinsiyet ve taraf gibi demografik verileri, yaralanma mekanizmaları, tibia diyafiz ve pilon kırık tipleri, klinik ağrı skorları, radyolojik kaynamaları ve komplikasyonları değerlendirildi.
Bulgular: Çalışmaya dahil edilen 27 hastadan 15 hasta (%55,56) intramedüller çivileme ile tedavi edilirken, 12 hastada (%44,44) minimal invaziv plak osteosentez kullanılmıştır. İMÇ uygulanan grubun ortanca yaşı 62 (Aralık: 34-67 yaş) iken, MİPO uygulanan grupta ortanca yaşı 51 (Aralık: 33-52) olduğu ve aralarında anlamlı fark olduğu görüldü (p=0,038). Yaralanma mekanizmaları açısından gruplar arasında anlamlı fark tespit edildi (p=0,023). Taraf, cinsiyet, kırık tipi ve ağrı skorları açısından iki grup arasında fark görülmedi (p>0,050). Hastaların tamamında radyolojik tam iyileşme elde edildi. Dört hastada (%14,81) yara yerinde yumuşak doku ilişkili komplikasyonlar tespit edildi. Komplikasyon gelişen hastaların tamamının MİPO grubunda olduğu görüldü ve gruplar arasında komplikasyon gelişimi açısından anlamlı fark tespit edildi (p=0,028).
Sonuç: Distal tibia eklem hattına uzanan tibia diyafiz kırıklarında, eklemde impaksiyon eşlik etmiyor ise, perkütan kanüllü vidalar ile eklemde mutlak stabilitenin elde edilmesini takiben uygulanan intramedüller çivileme ile tatminkar klinik ve radyolojik sonuçlar ve düşük komplikasyon oranları elde edilebilir.

Keywords

Tibia diyafiz kırığı, Ekleme uzanan diyafiz kırıkları, Perkütan pinleme, İntramedüller Çivileme, MİPO, Tibia diaphysis fracture, Joint-related diaphyseal fractures, Percutaneous pinning, Intramedullary Nailing, MIPO

Satisfactory Results Can Be Obtained by Closed Percutaneous Pinning and Intramedullary Nailing in Distal Tibial Joint-Related Tibia Diaphysis Fractures

Abstract

Objective: Our aim was to investigate the results of intramedullary nailing in tibial diaphyseal fractures extending to the distal tibial joint line and to compare them with the minimally invasive plate osteosynthesis method.
Materials and Methods: All patients who were treated and followed-up in our clinic between 2019 and 2021 for tibial diaphyseal fracture extending to the tibial distal joint line but without impact on the joint were retrospectively investigated. Demographic data such as age, gender and side, injury mechanisms, tibia diaphysis and pilon fracture types, clinical pain scores, radiological union rates and complications of all patients were evaluated.
Results: Of the 27 patients included in the study, 15 patients (55.56%) were treated with intramedullary nailing, while minimally invasive plate osteosynthesis was used in 12 patients (44.44%). While the median age of the IMN group was 62 years (Range: 34-67 years), the median age of the MIPO group was 51 years (Range: 33-52), and there was a significant difference between them (p=0.038). There was a significant difference between the groups in terms of injury mechanisms (p=0.023). There was no difference between the two groups in terms of side, gender, fracture type and pain scores (p>0.050). Radiological complete recovery was achieved in all patients. Soft tissue-related complications were detected at the wound site in four patients (14.81%). It was observed that all the patients who developed complications were in the MIPO group, and a significant difference was found between the groups in terms of complication rates (p=0.028).
Conclusion: In tibial diaphyseal fractures extending to the distal tibial joint line, if the joint is not accompanied by impaction, satisfactory clinical and radiological results and low complication rates can be obtained with intramedullary nailing, which is applied after obtaining absolute stability in the joint with percutaneous cannulated screws.

Keywords

Tibia diaphysis fracture, Joint-related diaphyseal fractures, Percutaneous pinning, Intramedullary Nailing, MIPO

References

• Referans1. Inci F, Yildirim AO, Ciliz DS, Kocak C, Ceyhan E, Öken ÖF. Intraoperative rotation control in closed intramedullary nailing in tibia diaphyseal fractures: a prospective, randomised study. Acta Orthop Belg 2018;84(4):461-8.
• Referans2. Gencer B, Doğan Ö. Consequences of the COVID-19 pandemic on fracture distribution: Epidemiological data from a tertiary trauma center in Turkey. J Exp Clin Med 2022;39(1):128-33.
• Referans3. Beytemür O, Barış A, Albay C, Yüksel S, Çağlar S, Alagöz E. Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2). Acta Orthop Traumatol Turc 2017;51(1):12-6.
• Referans4. Başer MY, Arslan A, Utkan A, Özkurt B. Factors affecting the results of tibial pilon fractures treated with open reduction internal fixation. Med Science 2018;7(1):58-61.
• Referans5. Gencer B, Doğan Ö, İğdir V, Çulcu A, Çalışkan E, Biçimoğlu A. Searching for a New Parameter in the Healing of Tibia Pilon Fractures: Fracture Area Measurement. J Am Podiatr Med Assoc. 2022;112(4):20-137.
• Referans6. Mauffrey C, Vasario G, Battiston B, Lewis C, Beazley J, Seligson D. Tibial pilon fractures: a review of incidence, diagnosis, treatment, and complications. Acta Orthop Belg 2011;77(4):432-40.
• Referans7. Kovalak E. İntertrokanterik Femur Kırıklarında Ekstramedüller Tespit, Fonksiyonel Sonuçlar ve Güncel Literatür. SDÜ Tıp Fakültesi Dergisi 2021;28(3): 371-8.
• Referans8. Dinçer R, Pınar H, Atay T, Baykal Y. Yetişkin Distal Humerus Eklem İçi Uzanımlı Kırıklarda Paratrisipital Yaklaşımla Çift Plak Uygulanan Hastaların Klinik Sonuçları. SDÜ Tıp Fakültesi Dergisi 2021;28(1):67-72.
• Referans9. Barcak E, Collinge CA. Metaphyseal Distal Tibia Fractures: A Cohort, Single-Surgeon Study Comparing Outcomes of Patients Treated With Minimally Invasive Plating Versus Intramedullary Nailing. J Orthop Trauma 2016;30(5):e169-74.
• Referans10. Fakıoğlu RC, Gencer B, Utkan A. Cerrahi olarak tedavi edilen yetişkin ayak bileği kırıklarında üç farklı hasta bazlı değerlendirme ölçek sonuçlarının karşılaştırılması. Çukurova Medical Journal 2022;47(2):638-51.
• Referans11. Bakhsh WR, Cherney SM, McAndrew CM, Ricci WM, Gardner MJ. Surgical approaches to intramedullary nailing of the tibia: Comparative analysis of knee pain and functional outcomes. Injury 2016;47(4):958-61.
• Referans12. Mioc ML, Prejbeanu R, Deleanu B, Anglitoiu B, Haragus H, Niculescu M. Extra-articular distal tibia fractures-controversies regarding treatment options. A single-centre prospective comparative study. Int Orthop 2018;42(4):915-9.
• Referans13. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma 2018;32 Suppl 1:S1-S170.
• Referans14. Lisitano L, Mayr E, Rau K, Wiedl A, Reuter J, Foerch S. Accompanying injuries in tibial shaft fractures: how often is there an additional violation of the posterior malleolus and which factors are predictive? A retrospective cohort study. Eur J Trauma Emerg Surg 2022;48(4):3171-6.
• Referans15. Huang Z, Liu Y, Xie W, Li X, Qin X, Hu J. Pre-operative radiographic findings predicting concomitant posterior malleolar fractures in tibial shaft fractures: a comparative retrospective study. BMC Musculoskelet Disord 2018;19(1):86.
• Referans16. Sobol GL, Shaath MK, Reilly MC, Adams MR, Sirkin MS. The Incidence of Posterior Malleolar Involvement in Distal Spiral Tibia Fractures: Is it Higher than We Think? J Orthop Trauma 2018;32(11):543-7.
• Referans17. Jung KJ, Chung CY, Park MS, Chung MK, Lee DY, Koo S, et al. Concomitant Ankle Injuries Associated With Tibial Shaft Fractures. Foot Ankle Int 2015;36(10):1209-14.
• Referans18. Warner SJ, Schottel PC, Garner MR, Helfet DL, Lorich DG. Ankle injuries in distal tibial spiral shaft fractures: results from an institutional change in imaging protocol. Arch Orthop Trauma Surg 2014;134(12):1661-6.
• Referans19. Wenger R, Oehme F, Winkler J, Perren SM, Babst R, Beeres FJP. Absolute or relative stability in minimal invasive plate osteosynthesis of simple distal meta or diaphyseal tibia fractures? Injury 2017;48(6):1217-23.
• Referans20. Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma 2011;25(12):736-41.
• Referans21. Lai TC, Fleming JJ. Minimally Invasive Plate Osteosynthesis for Distal Tibia Fractures. Clin Podiatr Med Surg 2018;35(2):223-32.
• Referans22. Hendrickx LAM, Virgin J, van den Bekerom MPJ, Doornberg JN, Kerkhoffs GMMJ, Jaarsma RL. Complications and subsequent surgery after intra-medullary nailing for tibial shaft fractures: Review of 8110 patients. Injury 2020;51(7):1647-54.