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

Yıl 2021, Cilt: 28 Sayı: 3, 441 - 447, 13.09.2021
https://doi.org/10.17343/sdutfd.856822

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.

Kaynakça

  • 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. Adeyemi A, Delhougne G. Incidence and economic burden of intertrochanteric fracture: a Medicare claims database analysis. JBJS Open Access 2019; 4(1).
  • 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. 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. 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. 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. 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. 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. 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. Mayhew D, Mendonca V, Murthy B. A review of ASA physical status–historical perspectives and modern developments. Anaesthesia 2019; 74(3): 373-9.
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.

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

Yıl 2021, Cilt: 28 Sayı: 3, 441 - 447, 13.09.2021
https://doi.org/10.17343/sdutfd.856822

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.

Kaynakça

  • 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. Adeyemi A, Delhougne G. Incidence and economic burden of intertrochanteric fracture: a Medicare claims database analysis. JBJS Open Access 2019; 4(1).
  • 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. 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. 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. 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. 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. 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. 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. Mayhew D, Mendonca V, Murthy B. A review of ASA physical status–historical perspectives and modern developments. Anaesthesia 2019; 74(3): 373-9.
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Cerrahi, Klinik Tıp Bilimleri
Bölüm Araştırma Makaleleri
Yazarlar

Mirza Zafer Dağtaş 0000-0001-6861-6555

Ömer Kays Unal 0000-0002-9445-1552

Yayımlanma Tarihi 13 Eylül 2021
Gönderilme Tarihi 9 Ocak 2021
Kabul Tarihi 6 Ağustos 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 28 Sayı: 3

Kaynak Göster

Vancouver Dağtaş MZ, Unal ÖK. İNTERTROKANTERİK FEMUR KIRIKLARININ TEDAVİSİNDE KULLANILAN İKİ FARKLI PROKSİMAL FEMUR ÇİVİSİNİN KLİNİK VE RADYOLOJİK SONUÇLARI. SDÜ Tıp Fak Derg. 2021;28(3):441-7.

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Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi/Medical Journal of Süleyman Demirel University is licensed under Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International.