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Intraintrameduller çivi ile tedavi edilmiş distal tibia kırıklarının dizilim bozukluğu açısından incelenmesi. Evaluation of the distal tibial fractures treated with intramedullary nailing in terms of malalignment

Yıl 2018, Cilt: 4 Sayı: 2, 968 - 979, 15.08.2018
https://doi.org/10.30569/adiyamansaglik.449026

Öz

 



AMAÇ: Çalışmamızda
intramedüller çivileme ile tedavi edilmiş AO/OTA tip 43 A1, A2, A3 distal tibia
kırıklarının dizilim bozukluğu açısından sonuçlarını değerlendirmeyi
amaçladık. 
YÖNTEM : İntramedüller çivileme ile
tedavi edilmiş AO/OTA tip 43A1, A2, A3 distal tibia kırığı olan 55 hasta (38
erkek, 17 kadın, ortalama yaş 41.3±15.3, ortalama takip süresi 35.1±9 hafta);
retrospektif olarak değerlendirildi. Hastaların kırık kaynama durumu, kaynama
zamanı, komplikasyonlar ve kaynama durumları değerlendirildi. Klinik
değerlendirme için Olerud-Molander skoru kullanıldı. 
BULGULAR: Tüm hastalarda kaynama
sağlandı. Ortalama Olerud-Molander skoru 88.5 ± 8 idi. Ortalama varus
açılanması 0.6 ± 1.4°, ortalama valgus açılanması 2.1 ± 1.9°, ortalama
rekurvatum açılanması 0.7 ± 1.2°, ortalama prokurvatum açılanması 0.3 ± 0.7°,
ortalama rotasyon açısı ise 0.5 ± 1.4° olarak bulundu. İki hastada (%3.6)
varus, 6 hastada (%10.9) valgus, 1 hastada (%1.8) rekurvatum and 3 hastada
(%5.5) rotasyonda yanlış kaynama tespit edildi. 



 SONUÇ: İntramedüller çivileme ile
tedavi edilmiş distal tibia kırıklarında başarılı sonuçlar elde edilmiştir.
Bununla birlikte, dizilim problemleri, valgus dizilim bozukluğu nadir görülen
komplikasyonlar değildir(%10.9). Bu komplikasyonların engellenmesinde; cerrahi
tedavi esnasında dikkatli değerlendirme ve farklı teknikler
gerekebilmektedir. 

Kaynakça

  • REFERENCES:1. Casstevens C, Le T, Archdeacon MT, Wyrick JD. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation. J Am Acad Orthop Surg. 2012;20(11):675-83.
  • 2. Aksekili MA, Celik I, Arslan AK, Kalkan T, Ugurlu M. The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures. Acta Orthop Traumatol Turc. 2012;46:161-7.
  • 3. Katsenis DL, Begkas D, Spiliopoulos G, Stamoulis D, Pogiatzis K. The results of closed intramedullary nailing for intra-articular distal tibial fractures. J Orthop Trauma. 2014;28:108-13.
  • 4. Marcus MS, Yoon RS, Langford J, Kubiak EN, Morris AJ, Koval KJ, et al. Is there a role for intramedullary nails in the treatment of simple pilon fractures? Rationale and preliminary results. Injury. 2013;44:1107-11.
  • 5. Li Y, Jiang X, Guo Q, Zhu L, Ye T, Chen A. Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. Int Orthop. 2014;38:1261-7.
  • 6. Janssen KW, Biert J, van Kampen A. Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients. Int Orthop. 2007;31:709-14.
  • 7. Egol KA, Weisz R, Hiebert R, Tejwani NC, Koval KJ, Sanders RW. Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures? J Orthop Trauma. 2006;20:94-103.
  • 8. Koval KJ, Clapper MF, Brumback RJ, Ellison PS, Jr., Poka A, Bathon GH, et al. Complications of reamed intramedullary nailing of the tibia. J Orthop Trauma. 1991;5:184-89
  • 9. Mosheiff R, Safran O, Segal D, Liebergall M. The unreamed tibial nail in the treatment of distal metaphyseal fractures. Injury. 1999;30:83-90.
  • 10. Moongilpatti Sengodan M, Vaidyanathan S, Karunanandaganapathy S, Subbiah Subramanian S, Rajamani SG. Distal tibial metaphyseal fractures: does blocking screw extend the indication of intramedullary nailing? ISRN Orthop. 2014;2014:542623.
  • 11. Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA. Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am. 2005;87:1213-21.
  • 12. Polat A, Kose O, Canbora K, Yanik S, Guler F. Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial. J Orthop Sci. 2015;20:695-701.
  • 13. McArthur JR, Makrides P, Wainwright D. Resemblance of valgus malalignment of the distal tibia in 15-degree craniocaudal radiographs. J Orthop Surg (Hong Kong). 2013;21:337-9.
  • 14. Brink O. Suprapatellar nailing of tibial fractures: surgical hints. Curr Orthop Pract. 2016;27:107-12.
  • 15. Avilucea FR, Triantafillou K, Whiting PS, Perez EA, Mir HR. Suprapatellar Intramedullary Nail Technique Lowers Rate of Malalignment of Distal Tibia Fractures. J Orthop Trauma. 2016;30:557-60.
  • 16. Beytemur O, Albay C, Adanir O, Yuksel S, Gulec MA. Is intramedullary nailing applicable for distal tibial fractures with ankle joint extension? Eklem Hastalik Cerrahisi. 2016;27:125-31.
  • 17. Ristiniemi J, Luukinen P, Ohtonen P. Surgical treatment of extra-articular or simple intra-articular distal tibial fractures: external fixation versus intramedullary nailing. J Orthop Trauma. 2011;25:101-5.
  • 18. Kumar A, Charlebois SJ, Cain EL, Smith RA, Daniels AU, Crates JM. Effect of fibular plate fixation on rotational stability of simulated distal tibial fractures treated with intramedullary nailing. J Bone Joint Surg Am. 2003;85:604-8.
  • 19. Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma. 2008;22:307-11.
  • 20. Varsalona R, Liu G. Distal tibial metaphyseal fractures: the role of fibular fixation. Strategies in trauma and limb reconstruction. 2006;1:42-50.

Evaluation of the distal tibial fractures treated with intramedullary nailing in terms of malalignment

Yıl 2018, Cilt: 4 Sayı: 2, 968 - 979, 15.08.2018
https://doi.org/10.30569/adiyamansaglik.449026

Öz

Background:
The
aim of the present study was to evaluate outcomes of distal tibia fractures
AO/OTA 43 A1, A2, A3 whom we have treated through intramedullary nailing
especially for alignment disorders.

Materials
and Methods:
Fifty-five
patients with distal tibia fractures AO/OTA type 43A1, A2, A3 (38 males, 17
females, mean age 41.3
±15.3
years, mean follow-up period 35.1
±9
weeks) who were treated through intramedullary nailing were evaluated
retrospectively.  Fracture union status,
union time, complications and alignment disorders of the patients were
evaluated. Olerud-Molander score was used for clinical evaluation.

Results:
Union
was achieved in all patients. Mean Olerud-Molander score was 88.5
± 8. Mean varus angle
was 0.6
±
1.4°, mean valgus angle was 2.1
±
1.9°, mean recurvatum angle was 0.7
±
1.2°, mean procurvatum angle was 0.3
±
0.7°, mean rotation angle was 0.5
±
1.4°.
Two patients (3.6%) had varus malunion; 6 patients (10.9%) had valgus
malunion, 1 patient (1.8%) had recurvatum malunion and 3 patients (5.5%) had
rotation malunion.







Conclusion:
Successful
results are obtained by intramedullary nailing treatment of distal tibia
fractures. However, alignment problems, valgus alignment disorder in particular
are not a rare complication (10.9%).  A
careful evaluation during surgical treatment and different techniques may help
to prevent this complication. 

Kaynakça

  • REFERENCES:1. Casstevens C, Le T, Archdeacon MT, Wyrick JD. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation. J Am Acad Orthop Surg. 2012;20(11):675-83.
  • 2. Aksekili MA, Celik I, Arslan AK, Kalkan T, Ugurlu M. The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures. Acta Orthop Traumatol Turc. 2012;46:161-7.
  • 3. Katsenis DL, Begkas D, Spiliopoulos G, Stamoulis D, Pogiatzis K. The results of closed intramedullary nailing for intra-articular distal tibial fractures. J Orthop Trauma. 2014;28:108-13.
  • 4. Marcus MS, Yoon RS, Langford J, Kubiak EN, Morris AJ, Koval KJ, et al. Is there a role for intramedullary nails in the treatment of simple pilon fractures? Rationale and preliminary results. Injury. 2013;44:1107-11.
  • 5. Li Y, Jiang X, Guo Q, Zhu L, Ye T, Chen A. Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. Int Orthop. 2014;38:1261-7.
  • 6. Janssen KW, Biert J, van Kampen A. Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients. Int Orthop. 2007;31:709-14.
  • 7. Egol KA, Weisz R, Hiebert R, Tejwani NC, Koval KJ, Sanders RW. Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures? J Orthop Trauma. 2006;20:94-103.
  • 8. Koval KJ, Clapper MF, Brumback RJ, Ellison PS, Jr., Poka A, Bathon GH, et al. Complications of reamed intramedullary nailing of the tibia. J Orthop Trauma. 1991;5:184-89
  • 9. Mosheiff R, Safran O, Segal D, Liebergall M. The unreamed tibial nail in the treatment of distal metaphyseal fractures. Injury. 1999;30:83-90.
  • 10. Moongilpatti Sengodan M, Vaidyanathan S, Karunanandaganapathy S, Subbiah Subramanian S, Rajamani SG. Distal tibial metaphyseal fractures: does blocking screw extend the indication of intramedullary nailing? ISRN Orthop. 2014;2014:542623.
  • 11. Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA. Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am. 2005;87:1213-21.
  • 12. Polat A, Kose O, Canbora K, Yanik S, Guler F. Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial. J Orthop Sci. 2015;20:695-701.
  • 13. McArthur JR, Makrides P, Wainwright D. Resemblance of valgus malalignment of the distal tibia in 15-degree craniocaudal radiographs. J Orthop Surg (Hong Kong). 2013;21:337-9.
  • 14. Brink O. Suprapatellar nailing of tibial fractures: surgical hints. Curr Orthop Pract. 2016;27:107-12.
  • 15. Avilucea FR, Triantafillou K, Whiting PS, Perez EA, Mir HR. Suprapatellar Intramedullary Nail Technique Lowers Rate of Malalignment of Distal Tibia Fractures. J Orthop Trauma. 2016;30:557-60.
  • 16. Beytemur O, Albay C, Adanir O, Yuksel S, Gulec MA. Is intramedullary nailing applicable for distal tibial fractures with ankle joint extension? Eklem Hastalik Cerrahisi. 2016;27:125-31.
  • 17. Ristiniemi J, Luukinen P, Ohtonen P. Surgical treatment of extra-articular or simple intra-articular distal tibial fractures: external fixation versus intramedullary nailing. J Orthop Trauma. 2011;25:101-5.
  • 18. Kumar A, Charlebois SJ, Cain EL, Smith RA, Daniels AU, Crates JM. Effect of fibular plate fixation on rotational stability of simulated distal tibial fractures treated with intramedullary nailing. J Bone Joint Surg Am. 2003;85:604-8.
  • 19. Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma. 2008;22:307-11.
  • 20. Varsalona R, Liu G. Distal tibial metaphyseal fractures: the role of fibular fixation. Strategies in trauma and limb reconstruction. 2006;1:42-50.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makalesi
Yazarlar

Serdar Yüksel

Yayımlanma Tarihi 15 Ağustos 2018
Gönderilme Tarihi 30 Temmuz 2018
Kabul Tarihi 8 Ağustos 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 4 Sayı: 2

Kaynak Göster

AMA Yüksel S. Evaluation of the distal tibial fractures treated with intramedullary nailing in terms of malalignment. ADYÜ Sağlık Bilimleri Derg. Ağustos 2018;4(2):968-979. doi:10.30569/adiyamansaglik.449026