IMPACT OF THE PROXIMAL FRACTURE STARTING ORIGIN ON THE REDUCTION QUALITY AND COMPLICATIONS IN AO/OTA 31-A2 INTERTROCHANTERIC FEMORAL FRACTURES TREATED WITH PROXIMAL FEMORAL NAIL ANTIROTATION

Öz

Objective: This study aimed to investigate the impact of the proximal fracture starting location relative to the tip of the greater trochanter on the reduction quality and complication rates in patients with AO/OTA 31-A2 intertrochanteric femoral fractures (IFFs) treated with Proximal Femoral Nail Antirotation (PFNA). Material and Methods: A retrospective analysis was conducted on 125 patients diagnosed with unstable AO/OTA 31-A2 IFFs treated by PFNA. The fractures were categorised into two subtypes based on the location of the proximal starting point of the fracture line rela tive to the tip of the greater trochanter: subtype 1 (medial or at the tip of the greater trochanter) or subtype 2 (lateral). The quality of reduction was assessed using the Baumgaertner reduction quality criteria, and complication rates, including lateral cortex fractures and blade cut-outs, were compared between the groups. Results: Patients whose fractures originated medially (subtype 1) demonstrated significantly better reduction quality (78% good re duction) compared with those with lateral starting points (subtype 2) (30% good reduction). Additionally, the lateral cortex fracture rate was significantly higher in subtype 2 (16%) than in subtype 1 (0%) (p<0.001). The blade cut-out rate was also higher in subtype 2 (11%) than in subtype 1 (2%) (p = 0.042)." Conclusion: For subtype 1 fractures, the classical trochanteric entry point for PFNA is effective, whereas a more medial entry point is recommended for subtype 2 fractures to prevent loss of reduction, reduce the risk of lateral cortical fractures, and decrease the likelihood of cut-out complications.

Anahtar Kelimeler

• Complication
• Fracture Starting Point
• Proximal Femoral Nail Antirotation (PFNA)
• Reduction Quality
• Unstable In tertrochanteric Femoral Fractures

PROKSİMAL FEMUR ÇİVİSİ ANTİROTASYON İLE TEDAVİ EDİLEN AO/OTA 31-A2 INTERTROKANTERİK FEMUR KIRIKLARINDA PROKSİMAL KIRIK BAŞLANGIÇ KONUMUNUN REDÜKSİYON KALİTESİ VE KOMPLİKASYONLARI ÜZERİNDEKİ ETKİSİ

Öz

Amaç: Bu çalışmanın amacı, Proksimal Femural Çivi Antirotasyon (PFNA) ile tedavi edilen AO/OTA 31-A2 intertrokanterik femur kırığı (IFF) olan hastalarda büyük trokanterin ucuna göre proksimal kırık başlangıç yerinin redüksiyon kalitesi ve komplikasyon oranları üzerindeki etkisini araştırmaktır. Gereç ve Yöntemler: PFNA ile tedavi edilen stabil olmayan AO/ OTA 31-A2 IFF tanılı 125 hasta üzerinde retrospektif bir analiz yapılmıştır. Kırıklar, kırık hattının proksimal başlangıç noktasının büyük trokanterin ucuna göre konumuna göre iki alt tipte kategorize edildi: alt tip 1 (medial veya büyük trokanterin ucunda) veya alt tip 2 (lateral). RedüksiyoKırıkları medialden başlayan hastaların (alt tip 1) redükn kalitesi Baumgaertner redüksiyon kalitesi kriterleri kullanılarak değerlendirildi ve lateral korteks kırıkları ve bıçak (blade) cut-out dahil olmak üzere komplikasyon oranları gruplar arasında karşılaştırıldı. Bulgular: Kırıkları medialden başlayan hastaların (alt tip 1) redüksiyon kalitesi (%78 iyi redüksiyon) lateralden başlayanlara (alt tip 2) kıyasla (%30 iyi redüksiyon) anlamlı derecede daha iyiydi. Ayrıca, lateral korteks kırığı oranı alt tip 2′de (%16) alt tip 1′e (%0) göre anlamlı derecede yüksekti (p<0,001). bıçak (blade) cut-out oranı da alt tip 2′de (%11) alt tip 1′e (%2) kıyasla daha yüksekti (p=0,042). Sonuç: Alt tip 1 kırıklarda, PFNA için klasik trokanterik giriş noktası etkili olurken, alt tip 2 kırıklarda redüksiyon kaybını önlemek, lateral kortikal kırık riskini azaltmak ve cut-out komplikasyonları olasılığını azaltmak için daha medial bir giriş noktası önerilir.

Anahtar Kelimeler

• Komplikasyon
• kırık başlangıç noktası
• proksimal femoral çivi antirotasyonu (PFNA)
• redüksiyon kalitesi
• stabil olmayan intertrokanterik femur kırıkları

Kaynakça

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