Eklem dışı distal tibia kırıklarının (AO-43A) tedavisinde intramedüller çivi ve minimal invaziv perkütan plak osteosentez uygulamalarının karşılaştırılması

Yıl 2019, Cilt: 44 Sayı: 2, 464 - 470, 30.06.2019

Mustafa Özer , Kayhan Kesik Veysel Başbuğ Faik Türkmen Burkay Kutluhan Kaçıra İsmail Hakkı Korucu Tahsin Sami Çolak Recep Memik

https://doi.org/10.17826/cumj.461674

Öz

Amaç: Bu çalışmanın amacı eklem uzanımı olmayan distal tibia kırıklarının tedavisinde intramedüller çivi (İMÇ) ve minimal invaziv perkütan plak osteosentez (MİPPO) uygulamaları sonuçlarının karşılaştırılmasıdır.

Gereç ve Yöntem: Ocak 2016 ve Nisan 2017 tarihleri arasında eklem uzanımı olmayan distal tibia kırığı nedeniyle İMÇ uygulanan 38 hasta ve MİPPO uygulanan 31 hasta çalışmaya dahil edildi. Ortalama takip süresi 20,12±3,93 aydı. Hastalarda; yaş, cinsiyet, taraf, yaralanma mekanizması, açık kırık varlığı, fibula kırığı varlığı, kaynama oranları, enfeksiyon oranları, Olerud-Molander ayak bileği skoru (OMAS) ve dizilim bozuklukları değerlendirilerek gruplar arasında karşılaştırma yapıldı.  

Bulgular:  İMÇ uygulanan grupta; eşlik eden fibula kırığı oranı %18.4 bulunurken, %7.9 fibula kırığına yönelik plak uygulanmıştı. MİPPO uygulanan grupta ise eşlik eden fibula kırığı oranı %58 hastada bulunurken, %54.8 fibula kırığına yönelik plak uygulanmıştı. Cerrahi sonrası 6. ayda kaynama oranı İMÇ uygulanan grupta % 92,1 olarak bulunurken, MİPPO uygulanan grupta % 90,3 olarak bulundu. Takip OMAS skoru İMÇ uygulanan grupta 85±16.56 olarak bulunurken, MİPPO uygulanan grupta 84.19±17.08 olarak bulundu.

Sonuç: Çalışmamız; eklem uzanımı olmayan distal tibia kırıklarında, İMÇ ve MİPPO uygulamalarının birbirine belirgin bir üstünlüğünün olmadığını, her iki tekniğin düşük komplikasyon, yüksek kaynama oranları ve iyi fonksiyonel sonuçlar ile başarılı bir şekilde uygulanabileceğini desteklemektedir.

Anahtar Kelimeler

Distal tibia kırığı, intramedüller çivi, minimal invaziv perkütan plak osteosentez, kaynama, malunion

Comparison of Intramedullary nailing and minimally invasive percutaneous plate osteosynthesis in the treatment of extra-articular distal tibia fractures (AO-43A)

Öz

Purpose: The aim of this study was to compare the results of intramedullary nail (IMN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) applications in the treatment of extra-articular distal tibia fractures.

Materials and Methods: Thirty eight patients who underwent IMN and 31 patients who underwent MIPPO for extra-articular distal tibia fracture between January 2016 and April 2017 were included in the study. The mean follow-up period was 20.12 ± 3.93 months. In patients, a comparison was made between groups by evaluating age, sex, side of injury, injury mechanism, presence of open fracture, presence of fibular fracture, union rates, infection rates, Olerud-Molander ankle score (OMAS) and malunion.  

Results: In the IMN group; the rate of concomitant fibula fracture was 18.4% and a plate was applied to 7.9% of all group. In the MIPPO group, the rate of concomitant fibula fracture was found in 58% of the patients, and a plate application was performed for 54.8% of all group. At the 6th month after surgery, the rate of union was found to be 92.1% in the IMN group, while it was 90.3% in the MIPPO group. The follow-up OMAS score was 85±16.56 in the IMN group and 84.19±17.08 in the MIPPO group.

Conclusion: Our study showed that IMN and MIPPO applications do not have a significant superiority to each other in the treatment of extra-articular distal tibia fractures, and both techniques can be successfully applied with low complications, high union rates and good functional results.

Anahtar Kelimeler

Distal tibia fractures, intramedullary nail, minimally invasive percutaneous plate osteosynthesis, union, malunion

Kaynakça

• 1. Newman SD, Mauffrey CP, Krikler S. Distal metadiaphyseal tibial fractures. Injury. 2011;42:975-84.
• 2. Achten J, Parsons NR, McGuinness KR, Petrou S, Lamb SE, Costa ML. UK Fixation of Distal Tibia Fractures (UK FixDT): protocol for a randomised controlled trial of ‘locking' plate fixation versus intramedullary nail fixation in the treatment of adult patients with a displaced fracture of the distal tibia. BMJ Open. 2015;5(9):e009162.
• 3. Ma H, Zhao J, Yu B, Ye B. A gross anatomic study of distal tibia and fibula for single-incision approach. J Orthop Surg Res. 2014;9:28.
• 4. Wani IH, Gani N, Yaseen M, Bashir A, Bhat MS, Farooq M. Operative management of distal tibial extra-articular fractures - ıntramedullary nail versus minimally ınvasive percutaneous plate osteosynthesis. Ortopedia Traumatologia Rehabilitacja. 2017;19(6):537-41.
• 5. Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury. 1998;29(7):529-34.
• 6. Bong MR, Kummer FJ, Koval KJ, Egol KA. Intramedullary nailing of lower extremity: biomechanics and biology. J Am Acad Orthop Surg. 2007;15(2): 97-106.
• 7. Mauffrey C, McGuinness K, Parsons N, Achten J, Costa ML. A randomised pilot trial of locking plate fixation versus intramedullary nailing for extra-articular fractures of the distal tibia. J Bone Joint Surg Br. 2012;94(5):704-8.
• 8. Iqbal HJ, Pidikiti P. Treatment of distal tibia metaphyseal fractures; plating versus intramedullary nailing: A systematic review of recent evidence. Foot and Ankle Surgery. 2013;19:143-7.
• 9. Mao Z, Wang G, Zhang L, Zhang L, Chen S, Du H, Zhao Y, Tang P. Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis. Journal of Orthopaedic Surgery and Research 2015;10:95.
• 10. 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;92(7):984-8.
• 11. 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(6):1261-7.
• 12. Castevens C, Le T, Archdeacon MT, Wyrick JD. Management of extra articular fractures of the tibia: intramedullary nailing versus plate fixation. J Am Acad Orthop Surg. 2012;20(11):675-83.
• 13. Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibial shaft fractures. J Orthop Trauma 2011;25(12):736-41.
• 14. Joveniaux P, Ohl X, Harisboure A, Berrichi A, Labatut L, Simon P, Mainard D, Vix D, Dehoux E. Distal tibia fractures: management and complications of 101 cases. Int Orthop 2010;34(4):583-8.
• 15. Zou J, Zhang W, Zhang CQ. Comparison of minimally invasive percutaneous plate osteosynthesis with open reduction and internal fixation for treatment of extra-articular distal tibia fractures. Injury. 2013;44(8):1102-6.
• 16. Shen J, Xu J, Tang M, Luo C, Zhang C. Extra-articular distal tibia facture (AO-43A): A retrospective study comparing modified MIPPO with IMN. Injury. 2016;47:2352-9.
• 17. Richard RD, Kubiak E, Horwitz DS. Techniques for the surgical treatment of distal tibia fractures. Orthop Clin North Am. 2014;45:295-312.
• 18. 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. International Orthopaedics. 2018;42:915-9.
• 19. Lau TW, Leung F, Chan CF, Chow SP. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop. 2008;32(5):697-703.
• 20. Kwok CS, Crossman PT, Loizou CL. Plate versus nail for distal tibial fractures: a systematic review and meta-analysis. J Orthop Trauma. 2014;28(9):542-8.
• 21. Çillioğlu O, Seyfettinoğlu F, Çiçek H, Yılmaz A, Görgülü FF, Tuhanioğlu Ü, Oğur HV. Distal tibia kırıklarında minimal invaziv plak osteosentez sonuçları. Cukurova Medical Journal. 2017;42(3):518-25.
• 22. Çolak TS, Kesik K, Özer M, Türkmen F, Kaçıra BK, Korucu İH. Femur distal diyafiz kırıklarının intramedüller çivi ile tedavisinde dizilimin değerlendirilmesi. Selcuk Med J. 2018;34(1):23-7.
• 23. Vidovic D, Matejcic A, Ivica M, Jurišic D, Elabjer E, Bakota B. Minimally-invasive plate osteosynthesis in distal tibial fractures: results and complications. Injury. 2015;46(Suppl (6)):S96-9.
• 24. Attal ELR, Hansen M, Rosenberger R, Smekal V, Rommens PM, Blauth M. Intramedullary nailing of the distal tibia illustrated with the expert (TM) tibia nail. Oper Orthop Traumatol. 2011:23(5):397-410.
• 25. Im GI, Tae SK. Distal metaphyseal fractures of the tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. J Trauma. 2005;59:1219-23.
• 26. Janssen KW, Biert J, vanKampen A. Treatment of distal tibial fractures: plate versus nail. A retrospective outcome analysis of matched pairs of patients. Int Orthop. 2007;31:709-11.
• 27. Yang SW, Tzeng HM, Chou YJ, Teng HP, Liu HH, Wong CY. Treatment of distal tibial metaphyseal fractures: plating versus shortened intramedullary nailing. Injury. 2006;37:531-5.