Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing

Yıl 2011, Cilt: 2 Sayı: 2, 168 - 174, 01.06.2011

Abdullah Demirtaş Mehmet Oğuz Durakbaşa İbrahim Azboy Atilla Polat Bekir Yavuz Uçar Yahya Coşar Gürkan Gümüşsuyu

https://doi.org/10.5799/ahinjs.01.2011.02.0233

Öz

Objectives: The aim of this study was to evaluate the results of reamed and locked intramedullary nailing for tibial di-aphysis fractures. Materials and methods: The study included 38 patients (26 males, 12 females) who were treated with reamed and locked intramedullary nailing for tibial diaphysis fractures. Fractures were classified according to Gustilo-Anderson classification and functional results were assessed using the Johner-Wrush criteria. Results: The mean age was 36 years (range 18-61). There were 21 AO/ASIF type A, 16 type B, and 1 type C fractures. Twenty-four fracture were closed (63.1%) and 14 (36.9%) were open fractures. According to the Gustilo-Anderson classification, 9 were grade I, 4 patients grade II, and one grade IIIA open fractures. Intramedullary nailing was per-formed following open reduction in 18 patients, and closed reduction in 20. The mean time to surgery was 9.4 days and the mean follow-up was 29 months. Union was achieved in all patients within a mean of 17.6 weeks. Anterior knee pain developed in 18 patients and infection developed in three patients. Angular deformity less than 10º was developed 12 patients (31.6%). There were screw breakacge and synostosis in four and two patients respectively. Ac-cording to the Johner-Wrush criteria, functional results were very good in 23 patients (60.5%), good in 12 patients (31.6%) and fair in 3 (7.9%) patients. Conclusion: Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing gives satisfactory results. It should be considered as first choice in the treatment of these fractures.

Anahtar Kelimeler

Tibia shaft fracture, closed-open surgery, intramedullary nail, reamed dynamisation, complication, locking screw.

Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing

Öz

Amaç: Bu çalışmanın amacı tibia cisim kırıklarının oymalı kilitli intramedüller çiviler ile tedavi sonuçlarını değerlendir-mektir. Gereç ve yöntem: Çalışmaya tibia cisim kırığı nedeniyle oymalı kilitli intramedüller çivi ile tedavi edilen 38 hasta (26 erkek, 12 kadın) alındı. Kırıklar Gustilo-Anderson sınıflamasına göre sınıflandırıldı, fonksiyonel sonuçlar Johner-Wrush değerlendirme kriterlerine göre değerlendirildi. Bulgular: Hastaların yaş ortalama yaşı 36 yıl (18-61 yıl) idi. AO/ASIF sınıflamasına göre kırıkların 21'i (%55.3) Tip A, 16'sı (%42.1) Tip B, 1'i (%2.6) Tip C kırık olarak değerlendirildi. Kırıkların 24'ü (%63.1) kapalı, 14'ü (%36.9) açık idi. Gustilo-Anderson sınıflamasına göre açık kırıkların 9'u (%23.6) Tip 1, dördü (%10.5) Tip 2 ve biri (%2.6) Tip 3A kırık idi. Kırıkların 20'sinde (%52.6) kapalı, 18'inde (%47.3) açık redüksiyon tekniği kullanılarak çivileme yapıldı. Kırık oluşumu ile ameliyat arasında geçen Tüm hastalarda kaynama sağlandı. Ortalama kaynama süresi 17.6 hafta idi. On sekiz has-tada (%47.3) diz önü ağrısı gelişti. Hastalarımızın 6'sında (%15.8) enfeksiyon gelişti. On iki hastada (%31.6) 10° ve altında açısal deformite saptandı. Dört hastada (%10.5) vida kırılması görüldü. Johner-Wrush kriterlerine göre 23 hastada (%60.5) mükemmel, 12 hastada (%31.6) iyi ve 3 hastada (%7.9) orta sonuç elde edildi. Sonuç: Tibia cisim kırıklarının tedavisinde oymalı kilitli intramedüller çivileme yönteminin çok iyi sonuçlar verdiği ve bu kırıkların tedavisinde öncelikli olarak düşünülmesi gerektiği sonucuna varıldı. kırıklarının oymalı kilitli intramedüller çi-viler ile tedavi sonuçlarını değerlendirmektir.

Anahtar Kelimeler

Tibia cisim kırığı, kapalı-açık cerrahi, intramedüller çivi, oymalı, dinamizasyon, komplikasyon, kilitleme vidası.

Kaynakça

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