Distal Femur Kırıkları için Retrograd Intramedüller Çivileme Sonuçlarının Değerlendirilmesi: 3. Basamak Travma Merkezi Retrospektif Çalışması

Yıl 2022, Cilt: 24 Sayı: 1, 44 - 48, 30.04.2022

Tuğrul Ergün Mehmet Kürşad Bayraktar Bulent Karslıoglu Ersin Taşatan Ali Çağrı Tekin Esra Akdas Tekin Hakan Gürbüz

https://doi.org/10.18678/dtfd.1038611

Cited By: 1

Öz

Amaç: Distal femur kırıkları modern anatomik plak ve çiviler ile tedavi edilebilmektedir. Bu çalışmanın amacı retrograd intramedüller çivi (RİÇ) ile tedavi edilen erişkin kişilerde deplase distal femur kırıklarının klinik ve radyolojik sonuçlarının incelenmesidir.
Gereç ve Yöntemler: Çalışmaya, Ocak 2013 ile Nisan 2018 arasında 3. seviye bir travma merkezinde distal femur kırığı nedeniyle RİÇ ameliyatı geçiren tüm hastalar dahil edildi. Hastalar kırık paternine göre açık kırık ve kapalı kırık olmak üzere iki gruba ayrıldı. Distal femur kırığı nedeniyle RİÇ tedavisi yapılan hastaların ameliyat süreci ve ameliyat sonrası dönemdeki klinik, radyolojik ve fonksiyonel özellikleri analiz edildi.
Bulgular: Çalışmaya 30 hasta dahil edildi. 21 (%70) hasta erkekti. Hastaların ortanca yaşı 39 (aralık, 18-58) yıl idi. Etkilenen femurların 17 (%56,7)'si sol taraflıydı. Kırık etiyolojisi 19 (%63,3) hastada trafik kazası ve düşme, 11 (%36,7) hastada ise ateşli silah yaralanmasıydı. Hastaların 17 (%56,7)'si kapalı kırık, 13 (%43,3)'ü açık kırıktı. İki grup arasında ameliyat süresi (p=0,086), floroskopi süresi (p=0,805), kan kaybı (p=0,967) açısından ve ameliyat sonrası dönemde hastanede yatış süresi (p=0,967), klinik ağrı ve fonksiyon skoru (p=0,341; p=0,902) ve kaynama zamanı (p=0,385) açısından istatistiksel olarak anlamlı fark bulunmadı.
Sonuç: RIN fazla kan kaybını engelleyen ve ameliyat süresini de kısaltabilen minimal invaziv bir cerrahi yöntemdir. Distal femur kırıklarının tedavisinde akla getirilmesi gereken etkili ve güvenilir bir cerrahi seçenektir.

Anahtar Kelimeler

Distal Femur Kırıkları, Travma, İntramedüller Çivi, Retrograd

Evaluating the Results of Retrograde Intramedullary Nailing for Distal Femur Fractures: A Level 3 Trauma Center Retrospective Study

Öz

Aim: Distal femur fractures can be treated with modern anatomic plates and nails. This study aimed to examine the clinical and radiological results of displaced distal femur fractures in adult people who had been treated with a retrograde intramedullary nail (RIN).
Material and Methods: The study included all patients who underwent RIN surgery for distal femur fracture between January 2013 and April 2018 in a level 3 trauma center. Patients were divided into two groups based on fracture pattern: open fracture and closed fracture. The preoperative and postoperative clinical, radiological and functional characteristics of patients who had RIN for a distal femur fracture were analyzed.
Results: Thirty patients were included in the study. 21 (70%) patients were male. The median age of the patients was 39 (range, 18-58) years. 17 (56.7%) of the affected femur were left-sided. The etiology of the fractures was traffic accident and fall in 19 (63.3%) patients and gunshot injury in 11 (36.7%) patients. Of the patients, 17 (56.7%) were closed fractures and 13 (43.3%) were open fractures. There were no significant differences between two groups related to the surgery time (p=0.086), fluoroscopy time (p=0.805), blood loss (p=0.967), and hospitalization time (p=0.967), clinical pain and function scores (p=0.341, p=0.902), and union time (p=0.385) at the postoperative period.
Conclusion: RIN is a minimally invasive method that may prevent excessive blood loss and decrease the duration of surgery time. It is an effective and reliable surgical intervention that should be considered for the treatment of distal femur fractures.

Anahtar Kelimeler

Distal Femur Fractures, Trauma, İntramedullary Nail, Retrograde

Kaynakça

• Mair O, Biberthaler P, Hanschen M. [Distal femoral fractures]. Unfallchirurg. 2020;123(7):547-59. German.
• von Keudell A, Shoji K, Nasr M, Lucas R, Dolan R, Weaver MJ. Treatment Options for Distal Femur Fractures. J Orthop Trauma. 2016;30(Suppl 2):S25-7.
• Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol Surg Res. 2013;99(3):353-60.
• Canavese F, Alberghina F, Dimeglio A, Pavone V, Andreacchio A. Displaced distal femur metaphyseal fractures: clinical and radiographic outcome in children aged 6-16 years treated by elastic stable intramedullary nailing. J Pediatr Orthop B. 2021;30(5):415-22.
• Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma. 2011;25(Suppl 1):S8-14.
• Tüzüner T, Subaşi M, Kapukaya A, Necmi̇oğlu NS. [Treatment of femoral shaft fractures with interlocking intramedullary nailing]. Acta Orthop Traumatol Turc. 2002;36(3):211-9. Turkish.
• Beltran MJ, Gary JL, Collinge CA. Management of distal femur fractures with modern plates and nails: state of the art. J Orthop Trauma. 2015;29(4):165-72.
• Griffin XL, Costa ML, Phelps E, Parsons N, Dritsaki M, Achten J, et al. Intramedullary nails versus distal locking plates for fracture of the distal femur: results from the Trial of Acute Femoral Fracture Fixation (TrAFFix) randomised feasibility study and process evaluation. BMJ Open. 2019;9(5):e026810.
• Eri̇nç S, Özdemi̇r MH. Evaluation of the risk factors for mechanical failure of intertrochanteric femoral fracture treated with intramedullary nailing. Duzce Med J. 2021;23(3):282-8.
• Piétu G, Ehlinger M. Minimally invasive internal fixation of distal femur fractures. Orthop Traumatol Surg Res. 2017;103(1S):S161-9.
• 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;58(4):453-8.
• Martinet O, Cordey J, Harder Y, Maier A, Bühler M, Barraud GE. The epidemiology of fractures of the distal femur. Injury. 2000;31(Suppl 3):C62-3.
• Elsoe R, Ceccotti AA, Larsen P. Population-based epidemiology and incidence of distal femur fractures. Int Orthop. 2018;42(1):191-6.
• Anandasivam NS, Russo GS, Fischer JM, Samuel AM, Ondeck NT, Swallow MS, et al. Analysis of bony and internal organ injuries associated with 26,357 adult femoral shaft fractures and their impact on mortality. Orthopedics. 20171;40(3):e506-12.
• Wertheimer A, Olaussen A, Perera S, Liew S, Mitra B. Fractures of the femur and blood transfusions. Injury. 2018;49(4):846-51.
• Norris GR, Checketts JX, Scott JT, Vassar M, Norris BL, Giannoudis PV. Prevalence of deep surgical site infection after repair of periarticular knee fractures: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(8):e199951.
• O'Toole RV, Riche K, Cannada LK, Hennessy M, Sciadini MF, Shi LL, et al. Analysis of postoperative knee sepsis after retrograde nail insertion of open femoral shaft fractures. J Orthop Trauma, 2010;24(11):677-82.
• Rashid MS, Aziz S, Haydar S, Fleming SS, Datta A. Intra-operative fluoroscopic radiation exposure in orthopaedic trauma theatre. Eur J Orthop Surg Traumatol. 2018;28(1):9-14.
• Raffetto ML, Blum LE, Abbenhaus EJ, Hautala GS, Lemieux B, Pease T, et al. Radiation exposure among orthopaedic trauma surgeons: deconstructing commonly held myths and misperceptions. J Orthop Trauma. 2022;[Epub ahead of print]. doi: 10.1097/BOT.0000000000002340
• Grimwood D, Harvey-Lloyd J. Reducing intraoperative duration and ionising radiation exposure during the insertion of distal locking screws of intramedullary nails: a small-scale study comparing the current fluoroscopic method against radiation-free, electromagnetic navigation. Eur J Orthop Surg Traumatol. 2016;26(8):867-76.
• Riina J, Tornetta P 3rd, Ritter C, Geller J. Neurologic and vascular structures at risk during anterior-posterior locking of retrograde femoral nails. J Orthop Trauma. 1998;12(6):379-81.
• Dehghan N, Schemitsch EH. Extended applications of the reamer-irrigator-aspirator (RIA) system. Injury. 2017;48(Suppl 1):S47-51.
• Cox G, Jones E, McGonagle D, Giannoudis PV. Reamer-irrigator-aspirator indications and clinical results: a systematic review. Int Orthop. 2011;35(7):951-6.
• Çolak TS. [Evaluation of femoral alignment in femur distal diaphyseal fractures which treated with intramedullary nailling]. Selçuk Med J. 2018;34(1):23-7. Turkish.