Application of Locked İntramedullary Nails at Adult Tibia Diaphysis Fractures Surgical Treatment

Yıl 2018, Cilt: 2 Sayı: 1, 9 - 13, 12.03.2018

Uygar Daşar , Tansel Mutlu Ahmet Ülker , Ahmet Burak Satılmış Önder Ersan

https://doi.org/10.30565/medalanya.372916

Cited By: 1

Öz

Aim: To evaluate the effect of the treatment of
locked intramedullary nails in adult patients with tibia diaphysis fractures.                                                                                     

Patients
and Methods:  Forty-eight adults that were
treated with reamed locked intramedullary nails for tibia shaft fractures were
evaluated. 27 of the patients were male (56,25%) and 21 were women
(43,75%).  Mean age was 42,6(18-59). 29
of the fracture were right leg and 19 were left. There wasn’t any patient that
had bilateral tibia shaft fracture. AO fracture classification system was used
and every patient except 2 had concurrent fibula fracture. Patients’ injury
mechanism, date of referral, date of operation, time of bne union (seeing 3
cortices bridging at X-ray), time to return to work, malalignment and joint
range of motion were evaluated.                                                                                                         

Results: We found that mean union time
was 14,2 weeks and mean time to return to work was 18,4 weeks. Out of 10 open
fracture patients; 1 had superficial infection, 2 had pseudarthrosis, 1 had
delayed union. Distal locking screw breaking occurred at 4 patients. Bone union
time was delayed for 22 months at patient that had superficial infection.
Patient was treated by providing dynamizition and giving antibiotics.                                 

Conclusions: We came to the conclusion
that reamed locked intramedullary nails have high success rates, low
complication rates, better functional results and provides rapid return to
work; therefore, being a suitable surgical method it is still accepted as gold
standard treatment.

Anahtar Kelimeler

Tibia diaphysis fracture, İntramedullary nail, Closed Fracture

Erişkin Tibia Diafiz Kırıklarının Cerrahi Tedavisinde Kilitli İntramedüller Çivi Uygulaması

Öz

Amaç: Erişkin tibia cisim kırıklarında uygulanan
oymalı kilitli intramedüller çivi kullanımının yerini ve etkisini değerlendirmek.       

Hastalar ve Yöntem:  Tibia diafiz kırığı nedeniyle
oymalı kilitli intramedüller çivi uygulaması yapılan toplam 48 erişkin hasta
çalışmaya dâhil edildi. Hastaların 27'si (%56,25) erkek, 21’i (%43,75) kadındı.
Hastalarımızın yaş ortalaması 42,6(18-59) olarak tespit edildi. 29 kırık vakası sağ bacakta iken
19’u sol bacakta idi. Kırık sınıflamasında AO sınıflaması kullanılmış olup iki
vaka dışında tüm vakalara fibula kırığı eşlik etmekteydi. Hastaların yaralanma
mekanizması, başvuru zamanı, ameliyat tarihi, kaynama zamanı olarak
röntgenogramda 3 kortekste köprüleşme görülmesi, işe geri dönüş zamanı, dizilim
bozukluğu ve eklem hareket açıklığına bakıldı.                                                                                                     

Bulgular:  Hastalarda ortalama kaynama zamanı 14,2±2,5
hafta, ortalama işe dönüş zamanı ise 18,4±3,6 hafta olarak bulundu. Açık kırık
olan 10 hastadan bir tanesinde yüzeyel enfeksiyon, iki tanesinde psödoartroz,
bir tanesinde ise kaynama gecikmesi olmuştur. Dört hastada ise distal kilitleme
vidasında kırılma meydana geldi. Yüzeyel enfeksiyon gelişen hastada kaynama 22
ay gecikme şeklinde oldu; dinamizasyon sağlanarak ve parenteral antibiyotik
tedavisi verilerek tedavi edildi.                                                                         

Sonuç:   Erişkin tibia cisim kırıklarında uygulanan
intramedüller çivileme tedavisinin yüksek başarı oranı ve komplikasyon oranının
düşüklüğü nedeniyle uygun bir cerrahi tedavi metodu olduğu ve halen altın
standart tedavi olarak kabul edilmesi sonucuna varılmıştır.

Anahtar Kelimeler

Tibia cisim kırıkları, İntramedüller çivi, Kapalı kırık

Kaynakça

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