İNTERTROKANTERİK FEMUR KIRIKLARININ TEDAVİSİNDE KULLANILAN İKİ FARKLI PROKSİMAL FEMUR ÇİVİSİNİN KLİNİK VE RADYOLOJİK SONUÇLARI

Öz

Amaç Bu çalışmanın amacı iki farklı tipte proksimal femur çivisi (PFÇ) kullanılarak internal fiksasyon uygulanan intertrokanterik femur kırığı (İTK) olgularında fonksiyonel ve radyolojik sonuçların karşılaştırılmasıdır. Gereç ve Yöntem Bu çalışmada 1 Ocak 2012 – 31 Aralık 2018 tarihleri arasında kliniğimizde İTK nedeniyle ameliyat edilen hastaların dosyaları retrospektif olarak incelendi. Olgular uygulanan PFÇ tipine göre Profin ve İnterTan olmak üzere iki gruba ayrıldı. Bulgular 78 olgunun 41’i Profin, 37’si İnterTAN grubundaydı. Olguların %47,4’ü erkek, yaş ortalaması 74,12 ± 8,91’di. İnterTan grubu ile karşılaştırıldığında, Profin grubunda skopi süresi ve mobilizasyona kadar geçen süre istatistiksel olarak anlamlı düzeyde daha fazlaydı (sırasıyla, p = 0,002, p = 0,037). Profin grubu ile karşılaştırıldığında, İnterTan grubunda hastanede yatış süresi istatistiksel olarak anlamlı düzeyde daha fazlaydı (p = 0,001). Operasyondan bir yıl sonra değerlendirilen femur boyun açısı İnterTan grubunda istatistiksel olarak anlamlı düzeyde daha fazlaydı (p <0.001). İnterTan grubu ile karşılaştırıldığında, Profin grubunda varus deformitesi sıklığı istatistiksel olarak anlamlı düzeyde daha fazlaydı (%8,11’e karşın %61,0, p <0.001). Gruplar arasında Harris kalça skoru bakımında istatistiksel olarak anlamlı bir fark yoktu (p = 0,630). Harris kalça skorunu etkileyen faktörleri belirlemek amacıyla yapılan çoklu doğrusal regresyon analizi sonucunda, komplikasyon gelişen (p<0,001) ve revizyon yapılan hastalarda (p<0,001) Harris kalça skorunun diğerlerine göre daha düşük olduğu saptandı. Sonuç Varus deformitesi Profin uygulanan olgularda daha fazla sıklıkta gelişmiş olsa da, gruplar arasında fonksiyonel sonuçlar, kırık kaynama süresi, komplikasyon ve revizyon sıklığı açısından anlamlı fark yoktu. İTK olgularında redüksiyon ve kırık tespiti iyi düzeyde yapılırsa, seçilen implant tipinin çok önemli olmadığı söylenebilir.

Anahtar Kelimeler

• İntertrokanterik femur kırığı
• proksimal femoral çivi
• Harris kalça skoru

CLINICAL AND RADIOLOGICAL RESULTS OF TWO DIFFERENT PROXIMAL FEMUR NAILS USED IN THE TREATMENT OF INTERTROCHANTERIC FEMUR FRACTURES

Öz

Objective The aim of this study was to compare the functional and radiological results of intertrochanteric femoral fractures (İTF) patients who underwent internal fixation using two different types of proximal femoral nails (PFN). Materials and Methods In this study, the files of patients who were operated for İTF in our clinic between January 1, 2012 and December 31, 2018 were retrospectively analyzed. The cases were divided into two groups as Profin and InterTan according to the type of PFN applied. Results 41 of 78 cases were in Profin group and 37 were in InterTAN group. 47.4% of the cases were male, the mean age was 74.12 ± 8.91. When compared to the InterTan group, the duration of fluoroscopy and time to mobilization were significantly higher in the Profin group (p = 0.002, p = 0.037, respectively). The duration of hospital stay was statistically significantly higher in the InterTan group compared to the Profin group (p = 0.001). The femoral neck angle evaluated one year after the operation was statistically significantly higher in the InterTan group (p <0.001). When compared with the InterTan group, varus deformity was statistically significantly more common in the Profin group (61.0% versus 8.11%, p <0.001). There was no statistically significant difference between the groups in terms of Harris Hip Score (HHS) (p = 0.630). As a result of multiple linear regression analysis performed to determine the factors affecting the HHS, it was found that the HHS was lower in patients with complications (p <0.001) and revision (p <0.001) compared to the others. Conclusion Although varus deformity was more frequent in patients who underwent Profin, there was no significant difference between the groups in terms of functional results, time to union, complications, and revision frequency. If reduction and fracture fixation is done well in ITF cases, it can be said that the type of implant chosen is not very important.

Anahtar Kelimeler

• Intertrochanteric femur fracture
• proximal femoral nail
• Harris hip score

Kaynakça

1. 1. Peizhen H, Xinmin C, Liqin Z, Ziling L, Hang D, Qunbin C, et al. Osteoporosis effects on the treatment of intertrochanteric fracture of femur with proximal femoral anti-rotation intramedullary nail: a finite element simulation. Chinese J Tissue Eng Res 2020; 24(24): 3808.
2. 2. Adeyemi A, Delhougne G. Incidence and economic burden of intertrochanteric fracture: a Medicare claims database analysis. JBJS Open Access 2019; 4(1).
3. 3. Min B-W, Lee K-J, Oh J-K, Cho C-H, Cho J-W, Kim B-S. The treatment strategies for failed fixation of intertrochanteric fractures. Injury 2019; 50(7): 1339-46.
4. 4. Xue D, Yu J, Zheng Q, Feng G, Li W, Pan Z, et al. The treatment strategies of intertrochanteric fractures nonunion: An experience of 23 nonunion patients. Injury 2017; 48(3): 708-14.
5. 5. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane database of systematic reviews 2010; (9).
6. 6. Myderrizi N. Proximal femoral nailing is better choice in treatment of intertrochanteric fracture in elderly people. Int J Surg 2016; 3(2): 781-5.
7. 7. Xu Z, Zhang M, Yin J, Ren L, Zeng Y. Redisplacement after reduction with intramedullary nails in surgery of intertrochanteric fracture: cause analysis and preventive measures. Arch Orthop Trauma Surg 2015; 135(6): 751-8.
8. 8. Uzer G, Elmadağ NM, Yıldız F, Bilsel K, Erden T, Toprak H. Comparison of two types of proximal femoral hails in the treatment of intertrochanteric femur fractures. TJTES 2015; 21(5): 385-91.

9. 9. Duramaz A, İlter MH. The impact of proximal femoral nail type on clinical and radiological outcomes in the treatment of intertrochanteric femur fractures: a comparative study. Eur J Orthop Surg Traumatol 2019; 29(7): 1441-9.
10. 10. Mayhew D, Mendonca V, Murthy B. A review of ASA physical status–historical perspectives and modern developments. Anaesthesia 2019; 74(3): 373-9.
11. 11. Papasimos S, Koutsojannis C, Panagopoulos A, Megas P, Lambiris E. A randomised comparison of AMBI, TGN and PFN for treatment of unstable trochanteric fractures. Arch Orthop Trauma Surg 2005; 125(7): 462-8.
12. 12. Werner-Tutschku W, Lajtai G, Schmiedhuber G, Lang T, Pirkl C, Orthner E. Intra-and perioperative complications in the stabilization of per-and subtrochanteric femoral fractures by means of PFN. Der Unfallchirurg 2002; 105(10): 881.
13. 13. Strauss EJ, Kummer FJ, Koval KJ, Egol KA. The “Z‐effect” phenomenon defined: A laboratory study. J Orthop Res 2007; 25(12): 1568-73.
14. 14. Kouvidis G, Sakellariou V, Mavrogenis A, Stavrakakis J, Kampas D, Galanakis J, et al. Dual lag screw cephalomedullary nail versus the classic sliding hip screw for the stabilization of intertrochanteric fractures. A prospective randomized study. Strategies Trauma Limb Reconstr 2012; 7(3): 155-62.
15. 15. Kouvidis GK, Sommers MB, Giannoudis PV, Katonis PG, Bottlang M. Comparison of migration behavior between single and dual lag screw implants for intertrochanteric fracture fixation. J Orthop Surg Res 2009; 4(1): 1-9.
16. 16. Kubiak EN, Bong M, Park SS, Kummer F, Egol K, Koval KJ. Intramedullary fixation of unstable intertrochanteric hip fractures: one or two lag screws. J Orthop Trauma 2004; 18(1): 12-7.
17. 17. Lin J. Encouraging results of treating femoral trochanteric fractures with specially designed double-screw nails. J Trauma Acute Care Surg 2007; 63(4): 866-74.
18. 18. Ponce S, Laird M, Waddell J. Intramedullary nailing in pertrochanteric fractures of the proximal femur. Eur J Trauma Emerg Surg 2014; 40(3): 241-7.
19. 19. Mavrogenis AF, Panagopoulos GN, Megaloikonomos PD, Igoumenou VG, Galanopoulos I, Vottis CT, et al. Complications after hip nailing for fractures. Orthopedics 2016; 39(1): e108-e16.
20. 20. Henschel J, Eberle S, Augat P. Load distribution between cephalic screws in a dual lag screw trochanteric nail. J Orthop Surg Res 2016; 11(1): 41.
21. 21. Ozkan K, Eceviz E, Unay K, Tasyikan L, Akman B, Eren A. Treatment of reverse oblique trochanteric femoral fractures with proximal femoral nail. Int Orthop 2011; 35(4): 595-8.
22. 22. Ertürer RE, Sönmez MM, Sari S, Seckin MF, Kara A, Öztürk I. Intramedullary osteosynthesis of instable intertrochanteric femur fractures with Profin® nail in elderly patients. Acta Orthop Traumatol Turc 2012; 46(2): 107-12.
23. 23. Koyuncu Ş, Altay T, Kayalı C, Ozan F, Yamak K. Mechanical failures after fixation with proximal femoral nail and risk factors. Clin Interv Aging 2015; 10: 1959.