The Treatment of Interlocking Intramedullary Nailing in Tibial Diaphyseal Fractures

Yıl 2009, Cilt: 3 Sayı: 1, 21 - 27, 19.03.2009

Tolga Tolunay

Öz

We evaluated the results of interlocking intramedullary nailing in the treatment of tibial diaphyseal fractures. Reamed interlocking intramedullary nailing was performed with closed or mini-open reduction in 23 patients (15 males, 8 females; mean age 36.7 years; range 18 to 60 years). 17 fractures were closed, 6 fractures were open. Reamed and static interlocking intramedullary nailing was performed on all patients. The patient have delayed union patients were dynamisied. Partial weight-bearing was allowed in patients after the observation of callus formation. The evaluation in the study was performed according to Johner and Wrush criteria. The mean follow-up was 16.8 months (range 6 to 21 months). Union was achieved in all patients. Mean union period was 17,4 weeks (range 12 to 60 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 10° was detected and in another case, grave claudication was detected. In two cases, extremity shortning of 6-10 mm was detected. According to ankle and subtalar mobility; 17 (74%)of the patients had excellent, 5 (21.7%) good, 1 (4.3%) had moderate results. According to Johner and Wrush criteria; 52.5% of the patients had excellent, 34.8% good, 8.7% moderate and 4.3% had bad results. We suggested that reamed interlocking intramedullary nailing is an effective method in tibial diaphyseal fractures because of successful functional results, high union and low complication rates.

Anahtar Kelimeler

Bone nails; tibial fractures/surgery; fracture fixation, intramedullary/methods, one nails

Tibia Şaft Kırıklarının Kilitli intramedüller Çivi ile Tedavisi

Öz

Tibia şaft kırıklarında kilitli intramedüller çivi uyguladığımız hastalarımızın sonuçları değerlendirildi. 23 hastaya (15 erkek, 8 kadın; yaş ortalaması 36.7; dağdım 18-60) kapalı redüksiyon veya mini açık redüksiyon sonrası oymalı ve de kilitli intramedüller çivi de tedavi uygulandı. Tibia kırıklarının 17’si kapalı, 6’sı açık kırık idi. Tüm kırıklara oyma işlemi ve de statik kilitleme uygulandı. Takiplerde kaynamanın geciktiği düşünülen hastalara dinamizasyon uygulandı. Radyografilerde kallus dokusu görüldükten sonra kısmi yüklenmeye izin verildi. Çalışmamızda hastalar, fonksiyonel ve radyolojik olarak Johner ve Wruhs Kriterleri ne göre değerlendirildi. Ortalama takip süresi 16.8 ay (12-21 ay) idi. Hastaların hepsinde kaynama elde edildi. Hastalarımızın ortalama kaynama süresi 17.4 hafta (12-60 hafta) idi. Tibia 1/3 distal kırığı olan 4 hastamızda 2-5 derecelik valgus açılanması saptandı. Hastalarımızdan birinde 10 derecenin üzerinde rotasyon mevcuttu ve bir hastamızda da yürümede belirgin aksama vardı. 2 hastamızda 6-10 mm kısalık mevcut idi. Ayak bileği ve subtalar eklem hareketleri 17 hastada (%74) çok iyi, 5 hastada (%21.7) iyi, 1 (%4.3) hastada orta olarak değerlendirildi. Johner ve Wruhs Kriterlerine göre; %52.5 çok iyi, %34.8 iyi, %8.7 orta, %4.3 kötü sonuç elde edildi. Tibia şaft kırıklarında oymalı ve de kilitli intramedüller çivilemenin, başarılı fonksiyonel sonuçlan, yüksek kaynama ve düşük komplikasyon oranlan nedeniyle etkin bir tedavi yöntemi olduğunu düşünüyoruz.

Dr. Tolga TOLUNAY,
Dr. D. Ali ÖÇGÜDER,
Dr. Bulent BEKTAŞER ,
Dr. Ferhat GÜLER,
Dr. Murat DEMİRDÖĞEN,
Dr. Şükrü SOLAK

Anahtar Kelimeler

Kemik çivileri; tibial kırıklar/cerrahi; kınk fıksasyonu, intramedüller/yöntem, Kemik çivileri

Kaynakça

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