Comparison of Supine Position and Traction Table in the Surgical Treatment of Unstable Intertrochanteric Fractures with PFNA

Yıl 2023, Cilt: 13 Sayı: 3, 561 - 565, 31.05.2023

Özgür Avci Ömer Polat

https://doi.org/10.16899/jcm.1290485

Öz

Aim: Intertrochanteric femur fractures (IFF) are a major cause of morbidity and mortality in the elderly population. Proximal femoral nail-anti-rotation (PFNA) is one of the most preferred surgical treatment methods. This study aimed to compare the clinical and radiologic results of two different patient positions used during PFNA and to reveal the intraoperative advantages and disadvantages.
Material and Method: Cases operated due to IFF between January 2020 and December 2022 were retrospectively analyzed. The study was conducted with 123 patients meeting the inclusion criteria. The minimum follow-up period was determined as one year. Two groups were formed: those operated on the traction table (opereted-TT) and those operated in supine lithotomy without traction table (operated-SP). The groups were compared regarding operative time, reduction quality, type-apex distance (calTAD), and radiologic and clinical results.
Results: There were 76 patients in the operated-TT group and 47 in the operated-SP group. The mean age of the operated-TT group was 81.00±8.52 years, and the mean age of the operated-SP group was 79.30±8.12 years. (p=0.213) Gender, follow-up time, time from trauma to surgery, and fracture classification were similar for the groups. The mean operative time was 95.18±8.54 minutes in the operated-TT group and 88.23±7.12 minutes in the operated-SP group, and the operation was completed in a shorter time in the operated-SP group. (p=0.001) There were no differences between the groups in terms of reduction quality, calTAD, Harris Hip Score, VAS score, infection rates, and cut-out rates.
Conclusion: Based on this study, the radiologic and clinical results of the cases operated with manual traction in the supine position and those operated using a traction table in treating IFF with PFNA are similar. In addition, it was concluded that shorter operation time was an advantage of the operated-SP group.

Anahtar Kelimeler

Intertrochanteric fracture, proximal femoral nail anti-rotation, position

İnstabil İntertrokanterik Kırıkların PFNA ile Cerrahi Tedavisinde Supin Pozisyon ile Traksiyon Masasının Karşılaştırılması

Öz

Amaç: İntertrokanterik femur kırıkları (IFF) yaşlı popülasyonda önemli morbidite ve mortalite sebebidir. Cerrahi tedavisinde proksimal femoral nail-antirotation (PFNA) en sık tercih edilen yöntemlerden biridir. Çalışmanın amacı; PFNA uygulanırken kullanılan iki farklı hasta pozisyonunun klinik ve radyolojik sonuçlarını karşılaştırmak, intraoperatif avantaj ve dezavantajlarını ortaya çıkarmaktır.
Gereç ve Yöntem: Ocak 2020 ile Aralık 2022 yılları arasında IFF nedeni ile opere edilen olgular retrospektif olarak incelendi. Dahil edilme kriterlerine uyan 123 olgu ile çalışma yürütüldü. Minimum takip süresi bir yıl olarak belirlendi. Traksiyon masasında opere edilenler (opereted-TT) ile traksiyon masasız supin litotomi pozisyonda opere edilenler (opereted-SP) olarak iki grup oluşturuldu. Gruplar ameliyat süresi, redüksiyon kalitesi, type-apex distance (calTAD), radyolojik ve klinik sonuçlar açısından karşılaştırıldı.
Bulgular: Opereted-TT grubunda 76, opereted-SP grubunda 47 hasta yer aldı. Opereted-TT grubunun yaşı ortalama 81.00±8.52 yıl, opereted-SP grubunun yaşı ortalama 79.30±8.12 yıl idi. (p=0.213) Cinsiyet, takip süresi, travmadan ameliyata kadar geçen süre ve kırık sınıflaması gruplar için benzerdi. Ameliyat süresi opereted-TT grubunda ortalama 95.18±8.54 dakika, opereted-SP grubunda ortalama 88.23±7.12 dakika olarak tespit edildi ve opereted-SP grubunda ameliyatın daha kısa sürede tamamlandığı görüldü. (p=0.001) Reduction quality, calTAD, Harris Hip Score, VAS skoru, enfeksiyon oranları, cut-out oranları açısından gruplar arasında fark tespit edilmedi.
Sonuçlar: Bu çalışmaya göre; IFF’nin PFNA ile tedavisinde supin pozisyonda manuel traksiyon ile opere edilen olgular ile traksiyon masası kullanarak opere edilen olguların radyolojik ve klinik sonuçları benzerdir. Bunun yanında ameliyat süresinin daha kısa olmasının opereted-SP grubunun avantajı olduğu sonucuna ulaşılmıştır.

Anahtar Kelimeler

İntertrokanterik kırık, proksimal femoral çivi anti-rotasyon, pozisyon

Kaynakça

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