The effectiveness of intramedullary nailing on the fixation of tibia diaphyseal fractures: Biomechanical point of view

Yıl 2018, Cilt: 9 Sayı: 3, 221 - 226, 30.09.2018

Tolga Tolunay Mehmet Orçun Akkurt Ahmet Şükrü Solak

https://doi.org/10.18663/tjcl.439534

Öz

Aim: The aim of the study was to exhibit the success rate
of nailing on tibia shaft fractures. Biomechanical advantage of the nails was
also evaluated and discussed in this study.

Material
and Methods: Reamed and
static interlocking intramedullary nailing was performed with closed or
mini-open reduction in 35 patients (25 males, 10 females; mean age 37.14±13.13
years). 27 fractures were closed and 8 fractures were open
fractures. The evaluation in the study was performed according to Johner and
Wrush criteria.

Results:
The mean
follow-up period was 12.5
months (range 5 to 20 months).
Union occurred in all patients. Mean union period was 17.02±7.96
weeks. In four cases, a valgus angulation of 2-5 degrees
was detected that whom had distal third tibial fractures. In one case, an
external rotation more than 10⁰ was detected and in another case, grave
claudication was shown. In two cases, extremity shortening of 6-10 mm was seen.
According to ankle and subtalar mobility; 27 (77.1%) of the patients were
recorded as excellent, 7 (20%) good, 1 (2.9%) moderate results. According to
Johner and Wrush criteria; 54.3% of the patients were recorded as excellent,
34.3% good, 8.6% moderate and 2.8% bad results. 

Conclusion: This study suggests that reamed interlocking
intramedullary nailing is an effective method in tibia diaphyseal fractures
because of successful functional results, high union and low complication
rates. On the biomechanical side, anti-rotation of the fixation area and axial
load sharing capacity of nailing has critical demand on fracture healing.

Anahtar Kelimeler

Tibia diaphyseal fractures, biomechanics, intramedullary nailing, interlocking screws

Biyomekanik bakış açısıyla, intramedüller çivilemenin tibia diyafiz kırıklarının fiksasyonu üzerindeki etkinliğinin değerlendirilmesi

Öz

Amaç:
Çalışmanın amacı, tibia diyafiz kırıklarında intramedüller çivilemenin başarı
oranını değerlendirmektir. Bu çalışmada ayrıca çivilerin biyomekanik
avantajları da değerlendirildi ve tartışıldı.

Gereç ve Yöntemler:
Kilitli oymalı intramedüller çivileme, 35 hastada (25 erkek, 10 kadın; yaş
ortalaması 37,14 ± 13,13) kapalı veya mini açık redüksiyon ile yapıldı. Tibia
kırıklarının 27’si kapalı, 8’i açık kırıktı. Tüm hastalara oymalı ve statik
kilitlemeli intramedüller çivileme yapıldı. Çalışmada hastalar Johner ve Wrush
kriterlerine göre değerlendirildi.

Bulgular:
Ortalama takip süresi 12,5 ay (5-20 ay) idi. Hastaların hepsinde kaynama
gerçekleşti. Ortalama kaynama süresi 17,02 ± 7,96 hafta idi. Tibia 1/3 distal
kırığı olan dört olguda 2-5 derecelik valgus açılanması saptandı. Bir olguda,
dış rotasyon 10⁰'dan fazla tespit edildi ve başka bir olguda da yürümede
belirgin aksama tespit edildi. İki olguda, 6-10 mm'lik ekstremite kısalığı
tespit edildi. Ayak bileği ve subtalar eklem hareketlerine göre; hastaların
27'si (%77,1) mükemmel, 7'si (%20) iyi, 1'i (%2,9) orta dereceli olarak
değerlendirildi. Johner ve Wrush kriterlerine göre; hastaların %54,3'ü
mükemmel, %34,3'ü iyi, %8,6'sı orta ve %2,8'i kötü olarak saptandı.

Sonuçlar:
Kilitli oymalı intramedüller çivilemenin, tibia diyafiz kırıklarında başarılı
fonksiyonel sonuçları, yüksek kaynama oranları ve düşük komplikasyon oranları
nedeniyle etkin bir tedavi olduğunu düşünmekteyiz. Biyomekanik açıdan bakacak
olursak, fiksasyon alanının anti-rotasyonunun ve çivilemenin aksiyel yük
paylaşım kapasitesinin, kırık iyileşmesi üzerinde kritik bir öneme sahip olduğu
görülmektedir.

Anahtar Kelimeler

Tibia diyafiz kırıkları, biyomekanik, intramedüller çivileme, kilitleme vidaları

Kaynakça

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