Results of expandable intramedullary nailing in femoral shaft fractures

Yıl 2017, , 66 - 72, 01.06.2017

Sinan Zehir , Ercan Şahin , Serkan Sipahioğlu

https://doi.org/10.21601/ortadogutipdergisi.263896

Öz

Objective: To evaluate the use
and results of expandable intramedullary nails applied to adult AO-32A and 32B
femoral shaft fractures.

Patients
and methods: This retrospective
study included 71 patients (25 females, 46 males; mean age 37.2 years, range
17-83 years) applied with expandable intramedullary nailing treatment for AO-32A
and 32B femoral shaft fractures, with at least a 1-year follow-up period.
Operating time was recorded from the operating notes. At the final follow-up
examinations, patients were evaluated clinically according to the Thoresen
criteria and lower limb length differences were recorded. Bone union and
continuity of reduction were examined radiologically.

Results: 64 nails were applied
with an open surgical approach and 7 nails with a closed surgical approach.
Operating time was mean 78 mins (range, 60-135 mins). In 63 (88.7%) cases, bone
union was delayed and the mean time to union was 18 weeks (range, 13-32 weeks).
According to the Thoresen criteria at the final follow-up examination, the
results were very good in 51 (71.8%) cases, good in 12 (16.9%), fair in 6
(8.4%) and poor in 2 (2.8%). Shortness of 3cm was determined in 1 case, 2cm in
3 cases, 1cm in 1 case and <1cm in 2 cases. Anterior knee pain developed in
7 cases. The nail applied did not expand in 3 (4.2%) cases. In 15 (21.1%)
cases, following inflation after application of the nail, expansion of the
femur medulla developed around the fracture line and in 1 case this caused
injury to the lateral circumflex femoral artery. Superficial infection was
observed in 4 (5.6%) cases, which recovered with antibiotic treatment.  

Conclusion: As the application of
expandable intramedullary nails is difficult and could cause complications,
they should be used with limited indications. 

Anahtar Kelimeler

Femur fractures, intramedullary nailing, expandable nail

Yetişkin femur cisim kırıklarında genişleyebilir intramedüller çivi uygulamasının sonuçları

Öz

Amaç:
Çalışmamızda AO-32A ve 32B yetişkin femur
cisim kırıklarında genişleyebilir intramedüller çivilerin kullanımı ve
sonuçlarını değerlendirdik.

Hastalar
ve metod: En az 1 yıllık
takipleri olan,  AO-32A ve 32B yetişkin
femur cisim kırığı nedeniyle genişleyebilir intramedüller çivi tedavisi
uygulanmış 71 hasta (25 kadın, 46
erkek; ortalama yaş 37,2 yıl; yaş aralığı, 17-83 yıl)  retrospektif olarak çalışmaya alındı. Ameliyat
süreleri ameliyat notlarından kayıt edildi. Hastalar son kontrollerinde klinik
olarak Thoresen kriterlerine göre değerlendirildi ve alt ekstremite uzunluk
farkları not edildi. Radyolojik olarak ise kırığın kaynamasına ve redüksiyonun
devamlılığına bakıldı.

Bulgular: 64 çivi açık cerrahi yaklaşımla, 7 çivi ise kapalı
cerrahi yaklaşımla uygulandı ve ortalama ameliyat süresi 78 dakika (60-135
dakika) olarak bulundu. Olguların 63 (%88,7)’ünde kaynama gerçekleşti ve
ortalama kaynama süresi 18 hafta (13-32 hafta) idi. Son kontrollerde yapılan
muayenede Thoresen kriterlerine göre 51 (%71,8) çok iyi,  12 (%16,9) 
iyi,  6 (%8,4) orta ve 2(%2,8)
olguda kötü sonuç alındı. 1 olguda 3 cm kısalık, 3 olguda 2 cm kısalık, bir
olguda 1 cm kısalık ve 2 olguda ise <1 cm kısalık vardı. 7 olguda diz ön ağrısı gelişti. 
3 (%4,2) olguda uygulanan çivi şişirilemedi. 15 (%21,1)  olguda çivi uygulandıktan sonra şişirilmeyi
takiben kırık hattı etrafında femur medullasının genişleme, bir olguda lateral
sirkumfleks femoral arter yaralanması oluştu. Olguların 4 (%5,6)’ünde yüzeyel
enfeksiyon görüldü ve antibiyotik tedavisi ile iyileşme sağlandı.

Sonuç: Genişleyebilir intramedüller çiviler uygulama
zorluğu ve sebep olabileceği komplikasyonlar nedeniyle sınırlı endikasyonlarla
kullanılmalıdır.

Anahtar Kelimeler

Femur kırıkları, intramedüller çivileme, genişleyebilen çivi

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