Distal tibia kırıklarında yeni dizayn edilmiş intramedüller çivi ve distal kilit sistemi ile tedavinin klinik ve radyolojik sonuçları

Abstract

Amaç : Bu çalışmanın amacı distal tibia kırıklarında yeni dizayn edilmiş intramedüller çivi ve distal kilit sistemi ile tedavinin klinik ve radyolojik sonuçlarını değerlendirmektir.

Materyal Metod: Nisan 2011 ile Haziran 2017 tarihleri arasında distal tibia  kırığı nedeniyle distal rijit kilitleme sistemli intramedüller çivi ile tedavi edilen 22 hasta retrospektif olarak değerlendirdi. Hastaların 17 (%77,2)’si erkek 5(%22.7)’ i kadındı. Kırıkların 16(%72.7)’sı açık 6 (%27.2)’sı kapalı kırıktı. Açık kırıklarda yaygın olarak kabul gören Gustillo-Anderson sınıflaması kullanıldı. 2 hasta Tip I, 12 hasta tip II, 2 hasta tip IIIA açık kırıktı. Kırık tiplerini belirlemek için OTA/AO  sınıflama sistemi kullanıldı. Hastaların fonksiyonel sonuçları AOFAS skorlama sistemi kullanılarak değerlendirildi.

Bulgular: Hastaların ortalama kaynama süresi 25.3 hafta (16-36 hafta)’idi. Ortalama tam yük verme süresi 9 hafta (6-16 hafta) idi. Tüm hastalarımızda tam kaynama elde edildi. Hastaların ortalama yaşı 32.5 (18-74)’idi. Hastaların 3 (%13.6)’ üne cilt problemleri nedeniyle ilk olarak eksternal fiksatör uygulandı. Tip II açık kırıklı bir (%5) hastamızda yüzeyel enfeksiyon gelişti.  3 (%15) hastamızda AP planda 5 dereceden fazla açılanma görüldü. Hastaların ortalama AOFAS skoru 92.25 (63-100) idi.

Sonuç: Distal tibia kırıklarında yeni dizayn edilmiş bu çivi ve kilitleme sistemi yüksek kaynama oranı, düşük floroskopi ihtiyacı gibi avantajları dolayısıyla güvenle uygulanabilir.

Keywords

• Distal,Tibia,İntramedüller,Kırık

References

1. 1. Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res. 1993 Jul; (292): 108-17
2. 2. Wyrsch B, McFerran MA, McAndrew M, Limbird TJ, Harper MC, Johnson KD, et al. Operative treatment of fractures of the tibial plafond. A randomized, prospective study. J Bone Joint Surg Am. 1996 Nov; 78(11):1646-57
3. 3. Whittle AP, Russell TA, Taylor JC, Lavelle DG. Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming. J Bone Joint Surg Am. 1992 Sep;74(8):1162-71
4. 4. Mc Cann PA, Jackson M, Mitchell ST, Atkins RM. Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia. Int Orthop. 2011 Mar; 35(3): 413-8
5. 5. Olerud S, Karlstrom G. Tibial fractures treated by AO compression osteosynthesis. Experiences from a five year material. Acta Orthop Scand Suppl. 1972; (140): 1–104.
6. 6. Blachut PA, O’Brien PJ, Meek RN, Broekhuyse HM. Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft. A prospective, randomized study. J Bone Joint Surg Am. 1997 May; 9(5): 640-6
7. 7. Bone LB, Kassman S, Stegemann P, France J. Prospective study of union rate of open tibial fractures treated with locked, unreamed intramedullary nails. J Orthop Trauma. 1994; 8(1): 45-9
8. 8. Bone LB, Johnson KD. Treatment of tibial fractures by reaming and intramedullary nailing. J Bone Joint Surg Am. 1986 Jul; 68(6): 877-87.

9. 9. Bonnevialle P, Savorit L, Combes JM, Rongières M, Bellumore Y, Mansat M. Value of intramedullary locked nailing in distal fractures of the tibia [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1996; 82(5): 428-36.
10. 10. Konrath G, Moed BR, Watson JT, Kaneshiro S, Karges DE, Cramer KE. Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. J Orthop Trauma. 1997 Apr; 11(3): 200-5.
11. 11. Watson JT. Treatment of unstable fractures of the shaft of the tibia. J Bone Joint Surg Am. 1994 Oct; 76(10): 1575-84.
12. 12. 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 Jun; 87(6): 1213-21.
13. 13. Küçükdurmaz F, Akpınar F, Saka G, Sağlam N, Acı C. A newly designed intramedullary nail with distal interlocking system for tibia fractures in adults - the clinical results. Ulus Travma Acil Cerrahi Derg. 2012 May; 18(3): 243-9.
14. 14. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun; 58(4): 453-8.
15. 15. Association OT. Committee for Coding and Classification Fracture and dislocation compendium. J orthop trauma. 1996; 10 Suppl 1:v-ix, 1-154.
16. 16. Fan CY, Chiang CC, Chuang TY. Interlocking nails for displaced metaphyseal fractures of the distal tibia. Injury. 2005 May; 36(5): 669-74.
17. 17. Robinson CM, McLauchlan GJ, McLean IP, Court-Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing. J Bone Joint Surg Br. 1995 Sep; 77(5): 781-7.
18. 18. Krishan A, Peshin C, Singh D. Intramedullary nailing and plate osteosynthesis for fractures of the distal metaphyseal tibia and fibula. J Orthop Surg (Hong Kong). 2009 Dec; 17(3): 317-20.
19. 19. Li Y, Liu L, Tang X, Pei F, Wang G, Fang Y, et al. Comparison of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures. Int Orthop. 2012 Jul; 36(7): 1457-62
20. 20. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010 Jul; 92(7): 984-8.
21. 21. Penzkofer R, Maier M, Nolte A, von Oldenburg G, Püschel K, Bühren V, et al. Influence of intramedullary nail diameter and locking mode on the stability of tibial shaft fracture fixation. Arch Orthop Trauma Surg 2009 Apr; 129(4): 525-31.
22. 22. Bhandari M, Tornetta P, Sprague S, Najibi S, Petrisor B, Griffith L. Predictors of reoperation following operative management of fractures of the tibial shaft. J Orthop Trauma 2003 May; 17(5): 353-61.
23. 23. Hou T, Li Q, Luo F, Xu J, Xie Z, Wu X, et al. Controlled dynamization to enhance reconstruction capacity of tissue engineered bone in healing critically sized bone defects: an in vivo study in goats. Tissue Eng Part A 2010 Jan; 16(1): 201-12
24. 24. Forster MC, Bruce AS, Aster AS. Should the tibia be reamed when nailing? Injury 2005 Mar; 36(3): 439-44.
25. 25. Wehner T, Penzkofer R, Augat P, Claes L, Simon U. Improvement of the shear fixation stability of intramedullary nailing. Clin Biomech (Bristol, Avon) 2011 Feb; 26(2): 147-51
26. 26. Gueorguiev B, Wähnert D, Albrecht D, Ockert B, Windolf M, Schwieger K. Effect on dynamic mechanical stability and interfragmentary movement of angle-stable locking of intramedullary nails in unstable distal tibia fractures: a biomechanical study. J Trauma 2011 Feb; 70(2): 358-65.
27. 27. Schüller M, Weninger P, Tschegg E, Jamek M, Redl H, Stanzl-Tschegg S. Micromotion at the fracture site after tibial nailing with four unreamed small-diameter nails--a biomechanical study using a distal tibia fracture model. J Trauma 2009 May; 66(5): 1391-7.
28. 28. Kaspar K, Schell H, Seebeck P, Thompson MS, Schütz M, Haas NP,et al. Angle stable locking reduces interfragmentary movements and promotes healing after unreamed nailing. Study of a displaced osteotomy model in sheep tibiae. J Bone Joint Surg Am 2005 Sep; 87(9): 2028-37.
29. 29. Hupel TM, Weinberg JA, Aksenov SA, Schemitsch EH. Effect of unreamed, limited reamed, and standard reamed intramedullary nailing on cortical bone porosity and new bone formation. J Orthop Trauma 2001 Jan; 15(1): 18-27
30. 30. Shepherd LE, Shean CJ, Gelalis ID, Lee J, Carter VS. Prospective randomized study of reamed versus unreamed femoral intramedullary nailing: an assessment of procedures. J Orthop Trauma 2001 Jan; 15(1): 28-32
31. 31. Saldua NS, Kuhn KM, Mazurek MT. Thermal necrosis complicating reamed intramedullary nailing of a closed tibial diaphysis fracture: a case report. J Orthop Trauma 2008 Nov-Dec; 22(10): 737-41
32. 32. Leunig M, Hertel R. Thermal necrosis after tibial reaming for intramedullary nail fixation. A report of three cases. J Bone Joint Surg Br 1996 Jul; 78(4): 584-7.
33. 33. Larsen LB, Madsen JE, Høiness PR, Øvre S. Should insertion of intramedullary nails for tibial fractures be with or without reaming? A prospective, randomized study with 3.8 years’ follow-up. J Orthop Trauma 2004 Mar; 18(3): 144-9.
34. 34. Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma 2011 Dec; 25(12): 736-41
35. 35. Whatling GM, Nokes LD. Literature review of current techniques for the insertion of distal screws into intramedullary locking nails. Injury 2006 Feb; 37(2): 109-19
36. 36. Barry TP. Radiation exposure to an orthopedic surgeon. Clin Orthop Relat Res 1984 Jan-Feb; (182): 160-4.
37. 37. Babis GC, Benetos IS, Zoubos AB, Soucacos PN. The effectiveness of the external distal aiming device in intramedullary fixation of tibial shaft fractures. Arch Orthop Trauma Surg 2007 Dec; 127(10): 905-8
38. 38. Suhm N, Jacob AL, Nolte LP, et al. Surgical navigation based on fluoroscopy--clinical application for computer-assisted distal locking of intramedullary implants. Comput Aided Surg 2000; 5(6): 391-400.
39. 39. Suhm N, Messmer P, Zuna I, Jacob LA, Regazzoni P. Fluoroscopic guidance versus surgical navigation for distal locking of intramedullary implants. A prospective, controlled clinical study. Injury 2004 Jun; 35(6): 567-74.