Öz
Aim The aim of this study is to report outcomes of 59 patients with intertrochanteric femoral fractures treated with a proximal femoral nail (Veronail).. Materials and Methods We have treated 59(28 female, 31 male) patients with intertrochanteric femoral fractures by using proximal femoral nail (veronail) between years 2011 and 2012. The mean age of patients was 69.1(±13.3). The fractures were classified according to AO system. The most common fracture type was A3(n=25), followed by A1 (n=20) and A2 (n=14). The early postoperative direct radiograms and the X-rays of third month were evaluated. Results In 52 of the 59 cases complete union of the fractures were achieved. One patient had a malunion that was treated with proximal femoral osteotomy. We notice in 6 of the cases proximal screw cutout on the follow up radiograms. The mean age of these patients were 77 (±7.4) years. There were two A1, two A2 and two A3 fractures according to AO system. All of these patients were revised with partial hip replacements. Conclusion In our series, of the 6 patients with cutouts 2 had type A1, 2 had type A2 and 2 had type A3 fractures. The type of the fracture had no significant effect on the cutout rates. The major factor effective on the development of cutout was the osteoporosis that increases with age of the patients. Proximal femoral nail (Veronail) is a suitable device that can be used in treatment of the intertrochanteric femoral fractures safely independent of the fracture type
Anahtar Kelimeler
intertrochanteric femoral fractures Veronail proximal femoral nail
Kaynakça
- Atay İM, Aslan A, Atay T ve ark. Genel ve spinal
- anestezi uygulanan yaşlı kalça kırığı olgularında deliryum yaygınlığı, risk faktörleri ve bilişsel fonksiyonlar. 2012;15(3):273-8. of Geriatrics
- Atay T, Yaman E, Baykal Y.B ve ark. Parsiyel Endoprotez Cerrahisi Uygulanan Yaşlı Hastalarda Postoperatif Klinik ve Radyolojik Uzunluk Farkları. Turkish Journal of Geriatrics 2010;13(4):238-43.
- Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AOASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;124:31-7.
- Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res. 1998;(348):87-94.
- Hornby R, Evans JG, Vardon V. Operative or conservative treatment for trochanteric fractures of the femur. A randomized epidemiological trial in elderly patients. J Bone Joint Surg Br. 1989;71:619- 23.
- Siegmeth AW, Gurusamy K, Parker MJ. Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br. 2005;87:1123-6.
- Baumgaertner MR, Curtin SL, Lindskog DM ve ark. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995;77:1058-64
- Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737-55.
- Madsen JE, Naess L, Aune AK ve ark. Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw. J Orthop Trauma. 1998;12:241-8.
- Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury. 1999; 30:327-32.
- Seral B, Garcia JM, Cegonino J ve ark. Finite element study of intramedullary osteosynthesis in the treatment of trochanteric fractures of the hip: Gamma and PFN. Injury. 2004; 35:130-5.
- Banan H, Al-Sabti A, Jimulia T, Hart AJ. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN)-our first 60 cases. Injury. 2002; 33:401-5.
- Boldin C, Seibert FJ, Fankhauser F ve ark. The proximal femoral nail (PFN)-a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a followup of 15 months. Acta Orthop Scand. 2003; 74:53-8.
- Takigami I, Matsumoto K, Ohara A ve ark.. Treatment of trochanteric fractures with the PFNA (proximal femoral nail antirotation) nail system - report of early results. Bull NYU Hosp Jt Dis. 2008; 66:276-9. 17. Schipper IB, Bresina S, Wahl D ve ark.
- Biomechanical evaluation of the proximal femoral nail.
- Clin Orthop Relat Res. 2002; (405):277-86.
- Boldin C, Seibert FJ, Fankhauser F ve ark. The proximal femoral nail (PFN)-a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a followup of 15 months. Acta Orthop Scand. 2003; 74:53-8.
İntertrokanterik Femur Kırıklarının Tedavisi İçin Proksimal Femur Çivisinin Kullanımı (Veronail İle Tedavi)
Öz
Amaç: Bu çalışmada, proksimal femurun intertrokanterik kırıkları için yeni bir intramedüller çivi olan Veronail Trokanterik Sistemini, kullanım kolaylığı, post-operatif sonuç ve komplikasyon oranları açısından araştırılmıştır.
Hastalar ve Yöntem:İntertrokanterik kırık tanısı ile 2011-2012 yılları arasında Proksimal Femur çivisi (veronail) ile osteosentez uygulanan 59 (28 bayan, 31 erkek) hasta değerlendirilmeye alındı. Hastaların yaş ortalaması 69,1 ( ±13,3 ) olarak tesbit edildi. Ameliyat öncesi kırıklar AO sınıflamasına göre 25 kırık (%42,3) tip A3, 20 kırık (%33,8) tip A1 ve 14 kırık (%23,7) tip A2 olarak değerlendirildi. Hastalar erken post-operatif dönemde ve 3. Ayda direk grafi çekilerek değerlendirildi.
Sonuç:3 ay sonunda, 52 hastada tam kaynama görüldü. 1 hastada malunion gelişti ve proksimal femoral osteotomi yapılarak tedavi edildi . 6 hastada radyografik olarak çivinin baştan sıyrılması tesbit edildi. Sıyrılma olan hastaların yaş ortalaması 77 ( ±7.4 ) yıldı. Hastaların AO sınıflamasına göre ikisi A1, ikisi A2 ve kalan ikisi A3 olarak gruplandırıldı. Sıyrılma gelişen ve kaynama sağlanamayan altı olguda kalkar destekli kısmi kalça protezi ile revizyon ameliyatı uygulandı.
Tartişma:Çalışmamızda gözlenen komplikasyonların çoğu hastaların yaşı ve kemik kalitesinden kaynaklanmaktadır. Bu komplikasyonlar arasından sadece sıyrılma gözlenen olgularda kısmi protez ile revizyon gerekmiştir. İntertrokanterik kalça kırığında dengeli bir osteosentez elde etmek için, kullanılan çivinin tekniğine uygun şekilde yerleştirilmesi, kuvvetli boyun tespiti sağlayan implantların kullanılması, hastaların kemik kalitesini ve yaşını dikkate almak uygun olacaktır
Kaynakça
- Atay İM, Aslan A, Atay T ve ark. Genel ve spinal
- anestezi uygulanan yaşlı kalça kırığı olgularında deliryum yaygınlığı, risk faktörleri ve bilişsel fonksiyonlar. 2012;15(3):273-8. of Geriatrics
- Atay T, Yaman E, Baykal Y.B ve ark. Parsiyel Endoprotez Cerrahisi Uygulanan Yaşlı Hastalarda Postoperatif Klinik ve Radyolojik Uzunluk Farkları. Turkish Journal of Geriatrics 2010;13(4):238-43.
- Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AOASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;124:31-7.
- Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res. 1998;(348):87-94.
- Hornby R, Evans JG, Vardon V. Operative or conservative treatment for trochanteric fractures of the femur. A randomized epidemiological trial in elderly patients. J Bone Joint Surg Br. 1989;71:619- 23.
- Siegmeth AW, Gurusamy K, Parker MJ. Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br. 2005;87:1123-6.
- Baumgaertner MR, Curtin SL, Lindskog DM ve ark. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995;77:1058-64
- Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737-55.
- Madsen JE, Naess L, Aune AK ve ark. Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw. J Orthop Trauma. 1998;12:241-8.
- Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury. 1999; 30:327-32.
- Seral B, Garcia JM, Cegonino J ve ark. Finite element study of intramedullary osteosynthesis in the treatment of trochanteric fractures of the hip: Gamma and PFN. Injury. 2004; 35:130-5.
- Banan H, Al-Sabti A, Jimulia T, Hart AJ. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN)-our first 60 cases. Injury. 2002; 33:401-5.
- Boldin C, Seibert FJ, Fankhauser F ve ark. The proximal femoral nail (PFN)-a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a followup of 15 months. Acta Orthop Scand. 2003; 74:53-8.
- Takigami I, Matsumoto K, Ohara A ve ark.. Treatment of trochanteric fractures with the PFNA (proximal femoral nail antirotation) nail system - report of early results. Bull NYU Hosp Jt Dis. 2008; 66:276-9. 17. Schipper IB, Bresina S, Wahl D ve ark.
- Biomechanical evaluation of the proximal femoral nail.
- Clin Orthop Relat Res. 2002; (405):277-86.
- Boldin C, Seibert FJ, Fankhauser F ve ark. The proximal femoral nail (PFN)-a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a followup of 15 months. Acta Orthop Scand. 2003; 74:53-8.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Ekim 2015 |
| Yayımlandığı Sayı | Yıl 2013 Cilt: 1 Sayı: 3 |
