TİBİA DİYAFİZER KIRIKLARININ İNTRAMEDÜLLER ÇİVİ İLE TEDAVİSİNDE SAĞLAM FİBULANIN KAYNAMAYA VE FONKSİYONEL SONUÇLARA ETKİSİ: RADYOGRAFİK KAYNAMA SKORLAMA SİSTEMİ İLE DEĞERLENDİRME

Öz

Amaç: İntramedüller çivi ile tedavi edilen izole tibia ve krus çift kırıklarının radyografik kaynama skorlama sistemi (RUST) skorları, kaynama durumu ve fonksiyonel sonuçlarının karşılaştırılması. Gereç ve Yöntem: Ocak 2015 ile Aralık 2020 tarihleri arasında tibia diyafiz kırığı tanısı alan ve intramedüller çivileme ile tedavi edilen 205 hastanın kayıtları incelendi ve 74 hasta çalışmaya dahil edildi. İzole tibia kırığı (Grup 1) ve krus çift kırık (Grup 2) olmak üzere hastalar 2 gruba ayrıldı. Sigara içme durumu ve açık kırık olup olmadığı bilgileri not edildi. RUST 3., 6., 9. ve 12. aylardaki grafilerle retrospektif olarak değerlendirildi. Son kontrollerinde SF-36 fiziksel fonksiyon skoru ve VAS değerlendirildi. Bulgular: Hastaların ortalama yaşı 41,9 (18-77) idi. Yirmi beş hastada (evre 1′de 12, evre 2′de 8 ve evre 3′de 5) açık kırık mevcuttu. RUST puanları değerlendirildiğinde Grup 2’de Grup 1'e göre 3., 6., 9. ve 12. aylarda istatistik olarak daha yüksek oranda kaynama görüldü. Kaynama Grup 2’de ortalama 6. ay grafilerinde görülürken Grup 1'de 12. ayda görülmüştür. Sigara içmek ve açık kırık olması 6. ay RUST skorlarını anlamlı olarak düşürmüştür. Ancak 12. ay RUST skorlarında fark izlenmemiştir. Ayrıca son kontrollerinde her iki grup arasında SF-36 fiziksel fonksiyon skoru ve VAS arasında anlamlı fark belirlenmemiştir. Sonuç: İzole tibia kırıklarında krus çift kırıklarına göre radyolojik olarak kaynama daha yavaş olmakla birlikte 12. ayda her iki grupta da kaynama sağlanabilmektedir. Sigara kullananlarda ve açık kırıklarda da benzer bir durum gözlenmektedir. Özellikle izole tibia kırıklarında, sigara içen hastalarda ve açık kırıklarda ek işlem için bu süreyi beklemek faydalı olacaktır.

Anahtar Kelimeler

• Hem tibia hem de fibula kırığı
• intramedullar çivileme
• kaynama
• kaynamama
• Tibia kırıklarında radyografik kaynama skorlama sistemi
• izole tibia kırığı

THE EFFECT OF INTACT FIBULA ON UNION AND FUNCTIONAL OUTCOMES FOR TREATING TIBIAL DIAPHYSEAL FRACTURES WITH INTRAMEDULLARY NAILING: EVALUATION WITH RADIOGRAPHIC UNION SCORE IN TIBIAL FRACTURES

Öz

Objective: To compare radiographic union score for tibial (RUST) fractures scores, union status, and functional outcomes of isolated tibial and both tibia and fibula fracture treated with intramedullary nailing. Materials and Methods: The records of 205 patients diagnosed with tibial diaphyseal fractures and treated with intramedullary nailing between January 2015 and December 2020 were reviewed, and 74 patients were included in the study. Patients were divided into two groups: isolated tibial fracture (Group 1) and both tibia and fibula fracture (Group 2). The smoking status and presence of open fractures were noted. The RUST was retrospectively evaluated using radiographs at 3rd, 6th, 9th, and 12th months. The SF-36 physical function score and VAS were evaluated at the last follow-up visit. Results: The mean age of the patients was 41.9 years (18-77). Twenty five patients (stage 1 in 12, stage 2 in 8 and stage 3 in 5) had open fractures. When the RUST scores were evaluated, a statistically higher rate of union was observed in Group 2 than in Group 1 at the 3rd, 6th, 9th and 12th months. While union was seen in the 6th month radiographs in Group 2, it was seen in the 12th month in Group 1. Smoking and open fractures significantly decreased RUST scores at 6th month. However, there was no difference in RUST scores at the 12th month. In addition, there was no significant difference in the SF-36 physical function score or VAS between the two groups at the last follow-up. Conclusion: Although radiological union is slower in isolated tibial fractures than in both tibia and fibula fractures, union can be achieved in both groups at the 12th month. A similar phenomenon was observed in smokers and open fractures. Especially in isolated tibial fractures, smokers and patients with open fractures; it is advisable to wait for this period before performing additional procedures.

Anahtar Kelimeler

• Both tibia and fibula fracture
• intramedullary nailing
• union
• nonunion
• radiographic union score in tibial fractures
• isolated tibia fracture

Kaynakça

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