-

Abstract

Objective: We aimed to compare the results of surgeries for intracapsular femoral neck fractures with cannulated screws(CS) and dynamic hip screw(DHS), due to lack of evidence which implant for internal fixation of femoral neck fractures is better .Methods: In our clinic between September 2005 and November 2009, 38 patients were operated with intracapsular transcervical fracture of collum femoris between17 to 65 years of age. Eighteen were operated with DHS(47.4%) and 20 were operated with CS fixation(52.6%).Results: 16 patients (42.1%) were female and 22 (57.9%) were male and the mean age was 37.13 years. The mean duration of follow-up was 18.05 months. 26 patients were operated in 1st -3rd day (68.4%), 9 patients were operated in 4 to 7 day (23.7%), 3 patients were operated in after 7th day (7.9%). In the DHS group, 9 (50%) patients had avascular necrosis (AVN), 6 (33.3%) patients had implant failure, 3 (16.7%) patients had delayed union, 5 (27.8%) patients had nonunion, 1 (5.6%) patient had infection, and 1 (5.6%) patient had myositis ossificans. According to the criteria of Salvati Wilson hip joint assessment, in the DHS group 8 patients (44.4%) were very good, 5 patients (27.8%) were good, 5 patients (27.8%) were moderate. Salvati score was evaluated as average of 28 points . İn the CS group, 8 (40%) patients had AVN, 1 (5%) had delayed union, 3 (15%) of the cases had nonunion and 1 (5%) patients infection was detected. According to the criteria of the Salvati-Wilson, in the CS group13 (65%) of them are very good, 5 (25%) were good, 2 (10%) were assessed as moderate. Salvati score was evaluated as average of 33 points . In the CS group none of the patients had implant failure, in the DHS group 6 patients had implant failure (33.3%) (p<0,05).Conclusion: Except for the high rate of implant failure detection in the DHS group method, no significant difference between complications and functional results between two groups. J Clin Exp Invest 2015; 6 (3): 256-262

Keywords

• femoral neck fractures, dynamic hip screw, cannulated screw

Femur boyun kırıklarının tedavisinde kanüllü vida ile dinamik kalça vidasının karşılaştırılması

Öz

Amaç: Femur boyun kırıklarının internal fiksasyonu için hangi implantın üstün olduğunu gösteren belirgin kanıtların olmaması nedeniyle intrakapsuler femur boyun kırıklarında kanüllü vida (KV) ve dinamik kalça vidası (DKV) ile yapılan cerrahilerin sonuçlarını karşılaştırmayı amaçladık. Yöntemler: Kliniğimizde Eylül 2005 ile Kasım 2009 tarihleri arasında, 17 ila 65 yaş arası DKV ve KV ile cerrahi tedavi uygulanan intrakapsüler collum femoris kırıklı, düzenli kontrolleri olan hastalardan transservikal kırığı olan hastalar çalışmaya dahil edildi. Olgular 2 grupta incelendi. DKV uygulanan olgular 1. Grup, KV uygulanan olgular ise 2.grup olarak belirlendi. 38 hastanın 18’ine(%47,4) DKV, 20’sine(%52,6) KV ile osteosentez uygulandı. Bulgular: Hastaların 16’sı(%42,1) kadın, 22’si(%57,9) erkek idi ve ortalama yaşları 37,13(17-65) idi. Takip süresi ortalama 18,05(2-57) ay idi. Hastaların 26’sı(%68,4) 1-3. günde, 9’u(%23,7) 4-7.günde ve 3’ü(%7,9) 7.günden sonra operasyona alınmıştır. DKV grubunun 9(%50)’unda avasküler nekroz(AVN), 6(%33,3)’sında implant yetmezliği, 3(%16,7)’ünde geç kaynama, 5(%27,8)’inde kaynamama, 1(%5,6)’inde enfeksiyon ve 1(%5,6) hastada da miyozitis ossifikans saptandı. DKV grubunda Salvati-Wilson kalça eklemi değerlendirme kriterine göre hastalarımızın 8’i(%44,4) çok iyi, 5’i(%27,8) iyi, 5’i(%27,8) orta olarak değerlendirildi. Salvati puanı ortalama 28 puan olarak değerlendirildi(16-40). KV grubunun 8(%40)’inde AVN, 1 (%5)’inde geç kaynama, 3 (%15)’ünde kaynamama ve 1 (%5) hastada ise enfeksiyon tespit edildi. KV grubunun Salvati-Wilson kalça eklemi değerlendirme kriterine göre 13 (%65)’ü çok iyi, 5 (%25)’i iyi, 2 (%10)’si orta olarak değerlendirildi. Salvati puanı ortalama 33 puan olarak değerlendirildi (18-40). KV ile opere edilen hiçbir hastada implant yetmezliği gelişmezken DKV uygulanan grupta bu oran %33,3 idi (p < 0,05). Sonuç: Femur boyun kırıklarının internal fiksasyon ile tedavisinde DKV ile tespit yönteminde implant yetmezliği oranının yüksekliği dışında her iki tespit yönteminde komplikasyon ve fonksiyonel sonuçlar arasında anlamlı fark bulunamadı.

Anahtar Kelimeler

• Femur boyun kırıkları, dinamik kalça vidası, kanüllü vida

Kaynakça

1. Stevens JA, Olson S. Reducing falls and resulting hip fractures among older women. MMWR Recomm Rep 2000;49:3-12.
2. Caviglia HA, Osorio PQ, Comando D. Classification and diagnosis of intracapsular fractures of the proximal femur. Clin Orthop 2002;399:17-27.
3. Miyamoto RG, Kaplan KM, Levine BR, et al. Surgical management of hip fractures: An Evidence-based review of the literature I: Femoral neck fractures. J Am Acad Orthop Surg 2008;16:596-607.
4. Davidovitch RI, Jordan CJ, Egol KA, Vrahas MS. Challenges in the treatment of femoral neck fractures in the non elderly adult. J Trauma 2010;68:236-242.
5. Bray TJ. Femoral neck fracture fixation, Clinical decision making. Clin Orthop Relat Res 1997;339:20-31.
6. Keklikçi K, Çilli F, Pehlivan Ö, Kuşkucu M. Femur boyun kırıkları .TOTBİD dergisi 2009;8:1-6.
7. Bhandari M, Tornetta P, Hanson B, Swiontkowski MF. Optimal internal fixation for femoral neck fractures: multiple screws or sliding hip screws?. J Orthop Trauma 2009; 23:403-407.
8. Lee KBL, Howe TS, Chang HC. Cancellous screw fixation for femoral neck fractures: one hundred and sixteen patients. Ann Acad Med Singapore 2004;33:248-251.

9. Kınık H, Polat O, Mergen E. Kanüle vidalar ile tedavi edilen femur boyun kırıkları. Acta Orthop Traumatol Turc 1999;33:13-17.
10. Lee YS, Chen SH, Tsuang YH, et al. Internal fixation of undisplaced femoral neck fractures in the elderly: a retrospective comparison of fixation methods. J Trauma 2008; 64:155-162.
11. Majernicek M, Dungl P, Kolman J, et al. Osteosynthesis of intracapsular femoral neck fractures by dynamic hip screw (DHS) fixation. Acta Chir Orthop Traumatol Cech 2009;76:319-325.
12. Seçinti C, Bayram H, Baytok G. Erişkinlerin femur boyun kırıklarında internal tesbit ve sonuçları. Acta Orthop Traumatol Turc 1987;21:140-145.
13. Madsen F, Linde F, Andersen E, et al. Fixation of displaced femoral neck fractures : a comparison between sliding screw plate and four cancellous bone screws. Acta Orthop Scand 1987;58:212-216.
14. Kuokkanen H, Korkala O, Antti-Poika I, et al. Three cancellous bone screws versus a screw-angle plate in the treatment of Garden I and II fractures of the femoral neck. Acta Orthop Belg1991;57:53-57.
15. Levi N. Dynamic hip screw versus 3 parallel screws in the treatment of garden 1 + 2 and garden 3 + 4 cervical
16. hip fractures. Panminerva Med.1999;41:233-237.
17. Parker MJ, Blundell C. Choice of implant for internal fixation of femoral neck fractures: Meta-analysis of 25 randomised trials including 4925 patients. Acta Orthop Scand 1998;69:138-143.
18. Asnis SE, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck. Results of cannulated screw fixation. J Bone Joint Surg Am 1994;76:1793-1803.
19. Dai Z, Li Y, Jiang D. Meta-Analysis comparing arthroplasty with internal fixation for displaced femoral neck fracture in the elderly. J Surg Res 2011;165:68-74.
20. Kayali C, Ağuş H, Arslantaş M, Turgut A. Complications of nternally fixed femoral neck fractures. Ulus Travma Acil Cerrahi Derg 2008;14:226-230
21. Protzman RR, Burkhalter WE. Femoral-neck fractures in young adults. J Bone Joint Surg Am 1976;58:689–695.
22. Swiontkowski MF, Winquist RA, Hansen ST. Fractures of the femoral neck in patients between the ages of twelve and forty-nine years. J Bone Joint Surg Am 1984;66:837-846.
23. Gautam VK, Anand S, Dhaon BK. Management of displaced femoral neck fractures in young adults (a group at risk). Injury 1998;29:215–218.
24. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am 1994;76:15-25.
25. Canale S.T. Campbells operative orthopaedics, 10.baskının Türkçesi, Cilt3, Hayat tıp kitapçılık. 2007 s: 3147-3151
26. Parker MJ, Raghavan R, Gurusamy K. İncidence of fracture healing complications after femoral neck fracture. Clin Orthop Relat Res 2007;458:175-179.
27. Christie J, Howıe CR, Armour PC. Fixation of displaced subcapital femoral fractures compression screw fixation versus double divergent pins. J Bone Joint Surg Br1988;70:199-201.
28. Alho A, Benterud JG, Solovieva S. Internally fixed femoral neck fractures. Early prediction of failure in 203 elderly patients with displaced fractures. Acta Orthop Scand 1999;70:141-144.
29. Ly TV, Swiontkowski MF. Management of femoral neck fractures in young adults. Indian J Orthop 2008;42:3-12.
30. Brown TI, Court-Brown C. Faılure of sliding nail-plate fixation in subcapital fractures of the femoral neck. J Bone Joint Surg Br 1979;61:342-346.
31. Palm H, Gosvig K, Krasheninnikoff M, et al. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year. Acta Orthop 2009;80:303–307 .
32. Parker MJ, Pyror GA. İnternal fixation or arthroplasty for displaced cervical hip fractures in the elderly. A randomized controlled trial of 208 patients. Acta Orthop Scand 2000;71:440-446.
33. Keating JF, Grant A, Masson M, et al. Randomized comparison of reduction and fixation bipolar hemiarthroplasty and total hip rthroplasty. Treatment of displaced intracapsuler hip fractures in ealthy older patients. J Bone Joint Surg Am 2006;88:249-260.
34. Swiontkowski MF. İntracapsuler hip fractures. J Bone Joint Surg Am 1994;76:129-138.
35. Jain R, Koo M, Kreder HJ, et al. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg Am 2002;84:1605–1612.
36. Haidukewych GJ, Rothwell WS, Jacofsky DJ, et al. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am 2004;86:1711–1716.
37. Upadhyay A, Jain P, Mishra P, et al. Delayed internal fixation of fractures of the neck of the femur in young adults. A prospective randomised study comparing closed and open reduction. J Bone Joint Surg Br 2004;86:1035–1040