Geriatrik Hastalarda Distal Tibia Kırıklarının Cerrahi Tedavisinde İntramedüller Çivi ve Minimal İnvaziv Plak ile Osteosentezin Karşılaştırılması

Abstract

Amaç: Tibia kırıklarının tedavisinde minimal invaziv plak ile osteosentez ve intramedüller çivi kabul edilmiş ve etkili tedavi yöntemidir. Bu çalışmada geriatrik grupta ayakbileği eklemine uzanmayan distal tibia kırıklarının intramedüller çivi ve MIPO tedavi sonuçlarının ve komplikasyonlarının retrospektif olarak değerlendirilmesi amaçlanmıştır. Gereç ve yöntemler: Geriatrik grupta ayak bileği eklemine uzanmayan distal tibia kırığı olan cerrahi tedavi yapılan hastalar retrospektif olarak değerlendirilmiştir. Çalışmaya dahil olma kriterleri geriatrik yaş grubunda olan ayak bileği eklemine uzanmayan distal tibia kırığı olan hastalar ve takip dosyalarında Johner Wrush kriterleri olan hastalar olarak belirlenmiştir. Bulgular: Çalışmaya 42 hasta dahil edildi. Hastaların ortalama yaşı 70 ± 3.4 yıl olarak belirlendi. 22 hastaya intramedüller çivi ile tespit yapıldı. 20 hastanın tedavisinde MIPO yapıldı. İntramedüller çivi yapılan grupta Johner Wrush kriterlerine göre 16 hasta çok iyi, 5 hasta iyi ve 1 hasta kötü olarak değerlendirildi. MIPO yapılan grupta 15 hasta çok iyi, 3 hasta iyi, 1 hasta orta ve 1 hasta kötü olarak değerlendirildi. Sonuç: Geriatrik yaş grubunda ayak bileği eklemine uzanmayan distal tibia kırıklarının klinik sonuçları ve komplikasyonları açısından her iki tedavi grubunda anlamlı bir fark tespit edilmedi ve her iki cerrahi tedavi metodu geriatrik hastalarda etkili bir şekilde uygulanabilir.

Keywords

• Geriatri
• Kırık
• Tibia kırıkları

Comparison of Intramedullary Nail Fixation and Minimally Invasive Plate Osteosynthesis in Distal Tibial Fractures in Geriatric Patients

Abstract

Introduction: Minimally invasive plate osteosynthesis (MIPO) and intramedullary nails are two accepted and effective methods in the treatment of tibial fractures. This study was aimed to evaluate the surgical treatment and complications of distal tibial fractures not related to the ankle joint with MIPO and intramedullary nails in the geriatric group retrospectively. Materials and Methods: Between 2019 and 2020, 42 patients in the geriatric group with distal tibia fractures that did not extend to the ankle joint and who underwent surgical treatment were evaluated retrospectively. The patients were divided into two groups: those who underwent MIPO and those who underwent osteosynthesis with an intramedullary nail. Patients were evaluated according to Johner Wrush criteria. Results: This study enrolled 42 patients. The mean age of the patients was 70±3.4 years. 22 of these patients underwent osteosynthesis with intramedullary nailing. MIPO was performed in the treatment of 20 patients. Based on the Johner Wrush criteria, the intramedullary nail group evaluated 16 patients as very good, 5 as good, and 1 as bad. The MIPO group evaluated 15 patients as excellent, 3 as good, 1 as moderate, and 1 as poor. Conclusion: In geriatric age groups, there was no significant difference in clinical outcomes or complications from surgical treatment of closed tibial distal fractures that do not extend to the ankle joint. Both surgical treatment methods can be applied effectively to geriatric patients.

Keywords

• Fracture
• Geriatric
• Tibia

References

1. Newman SD, Mauffrey CP, Krikler S. Distal metadiaphyseal tibialfractures. Injury 2011;42 :975-84.
2. Wang B, Zhao Y, Wang Q, Hu B, Sun L, Ren C, et al. Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: A systematic review and meta-analysis. J Orthop Surg Res 2019;14:456.
3. Cebesoy O. Distal tibial fractures and minimal invasive techniques.Injury, 2007;38:255.
4. Duda GN, Mandruzzato F, Heller M, Goldhahn J, Moser R, Hehli M, et al. Mechanical boundary conditions of fracture healing: Borderline indications in the treatment of unreamed tibial nailing. J Biomech. 2001;34:639-50.
5. Borrelli J, Jr, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and the effects of different plating techniques: A human cadaveric study. J Orthop Trauma. 2002;16:691-5.
6. Trafton PG. Tibial shaft fractures. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal trauma: fractures, dislocations, ligamentous injuries. 2nd ed. Philadelphia: W. B. Saunders; 1998. p. 2187-294.
7. Mioc ML, Prejbeanu R, Deleanu B, Anglitoiu B, Haragus H, Niculescu M. Extra-articular distal tibia fractures-controversies regarding treatment options. A single-centre prospective comparative study. Int Orthop. 2018;42:915-9.
8. Daolagupu AK, Mudgal A, Agarwala V, Dutta KK. A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extra articular distal tibial fractures. Indian J Orthop. 2017;51:292-8.

9. Bilgili F, Kılıç A, Sökücü S, Parmaksızoğlu AS, Çepni KS, Kabukçuoğlu YS. Retrospective analysis of AO 42A-B type tibia fractures treated with percutaneus locked plating and intramedullary nailing. Ulus Travma Acil Cerrahi Derg. 2016;22:90-6.
10. Ekman E, Lehtimäki K, Syvänen J, Saltychev M. Comparison Between Nailing and Plating in the Treatment of Distal Tibial Fractures: A Meta-Analysis. Scand J Surg. 2021;110:115-22.
11. Vidović D, Matejčić A, Ivica M, Jurišić D, Elabjer E, Bakota B. Minimally-invasive plate osteosynthesis in distal tibial fractures: Results and complications. Injury. 2015;46 Suppl 6:S96-99.
12. Beebe MJ, Morwood M, Serrano R, Quade JH, Auston DA, Watson DT, et al. Extreme Nailing: Is it Safe to Allow Immediate Weightbearing After Intramedullary Nail Fixation of Extra-articular Distal Tibial Fractures (OTA/AO 43-A)? J Orthop Trauma. 2019;33:392-6.
13. Fanter NJ, Inouye SE, Beiser CW. The risk of iatrogenic injury to anterior tibial artery variations during tibial nail distal interlocking. J Orthop Surg (Hong Kong). 2017;25:2309499016684471.
14. Yaligod V, Rudrappa GH, Nagendra S, Shivanna UM. Minimizing the complications of intramedullary nailing for distal third tibial shaft and metaphyseal fractures. J Orthop. 2013;11:10-8
15. Liu XK, Xu WN, Xue QY, Liang QW. Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta-Analysis. Orthop Surg. 2019;11:954-65.
16. Çepni S, Yaman F, Veizi E, Fırat A, Çay N, Tecimel O. Does malrotation following MIPO treatment of distal tibia metaphyseal fractures effect the functional results of the ankle and knee joints? J Orthop Trauma. 2021;35:492-8
17. Song X, Huang X, Yakufu M, Yan B, Feng C. Minimally invasive plate osteosynthesis or conventional intramedullary nailing for distal tibial fractures: A cohort study protocol. Medicine (Baltimore). 2020;99:e21779.
18. Jain D, Selhi HS, Yamin M, Mahindra P. Soft tissue complications in distal tibial fractures managed with medial locking plates: A myth or reality? J Clin Orthop Trauma. 2017;8 Suppl 2: S90-S95.
19. Lau TW, Leung F, Chan CF, Chow SP. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop. 2008;32:697-703.
20. Galal S. Minimally invasive plate osteosynthesis has equal safety to reamed intramedullary nails in treating Gustilo-Anderson type I, II and III-A open tibial shaft fractures. Injury. 2018;49:866-70.
21. Labronici PJ, Lyra FS, Moreira IL, Hoffmann R, Franco JS, de Toledo Lourenço PR,et al. Fractures of the distal extremity of the tibia treated with intramedullary nail or bridge plate: Comparison of radiation exposure duration between the two methods. Rev Bras Ortop. 2015;45:132-5.