İntrameduller çivi uygulamasında erken yük vermenin kırık kaynamasına etkisi

Year 2019, Volume: 12 Issue: 1, 61 - 66, 18.01.2019

Nusret Ök , Bekir Alper Kılıç Fahir Demirkan , Çağdaş Yörükoğlu , Mehmet Yücens , Nadir Aydemir , Harun Reşit Güngör , Nihal Büker

https://doi.org/10.31362/patd.443164

Abstract

Giriş:
Tibia cisim kırıkları, ortopedi ve travmatoloji pratiğinde en sık görülen kırık
tiplerinden biridir. Bu çalışmada tibia cisim kırıkları tedavisinde kilitli
intramedüller çivi uygulanan hastaların klinik sonuçlarının ve fonksiyonel
durumlarının değerlendirilmesi ve yük verme ile kaynama zamanının
karşılaştırılması amaçlanmıştır.

Yöntem:
Çalışmaya 18-73 yaş arası, tibia cisim kırığı nedeni ile intramedüller
fiksasyon uygulanmış olan 44 hasta dahil edildi. Çalışmamızda sonuçlar, Johner
ve Wruhs Kriterlerine göre ve Karlstum-Olerud kriterlerine göre kaydedildi.
Radyolojik olarak iyileşme, radyografilerde hastanın desteksiz olarak yük
verebileceği düzeyde kallus formasyonu ve/veya kırık hattının kaybolması olarak
değerlendirildi. Klinik iyileşme ise hastanın ağrısız tam yük verebilmesi ve
günlük aktivitelerine dönebilmesi olarak değerlendirildi.

Bulgular:
Hastaların yaş ortalaması 38,7±14,9 (17-73) yıl idi. 44 hastadan Hastaların 16’
sında ( %36,4) tibia 1/3 orta cisim kırığı, 25’ inde (%56,8) tibia 1/3 distal
kırık, 3’ ünde ise ( %6,8) ise tibia 1/3 proksimal kırığı görüldü. Hastaların
ortalama kaynama süresi 11,36±3,8 (6-20) hafta olarak gözlendi.
Karlstrom-Olerud'un fiziksel fonksiyonel değerlendirme skalasına göre ; 21
hasta (%47,7)  mükemmel, 14 hasta (%31,8)
iyi,  1 hasta (%2,3) tatmin edici, 8
hasta ( %18,2 ) ise orta olarak kaydedildi ve hiç kötü sonuç yoktu. Johner-Wrush
kriterlerine göre 32 hastada (%72,7) 
mükemmel, 12 hastada ise %27,3 iyi olarak değerlendirildi. Takip
sürecinde bütün kırıkların kaynadığı gözlendi.

Sonuç:
Hastalar Johner-Wrush Kriterlerine göre mükemmel ve iyi skora sahiptiler.  Karlstrom-Olerud'un fiziksel fonksiyonel
değerlendirme skalasına göre ise hiçbir hasta kötü skora sahip değildi. Genç,
erken ağırlık aktaran ve çivi korteks mesafesi 2mm’den az olan hastalarda
kaynama süresi kısalmaktadır. 

Keywords

Tibia cisim kırıkları, Kilitli intramedüller çivileme, Yük verme

Impact of early loading on fracture healing with intramedullary nailing.

Abstract

Introduction: Tibial
diaphyseal fractures are one of the most common types of fractures in practise
of the orthopedics and traumatology. In this study, clinical results of the
patients with diaphyseal fractures of the tibia which have been treated with
locking intramedullary nailing tecnique and the weight bearing time and union
time   has been evaluated.

Method: Patients who applied
to our hospital with tibial diaphyseal fractures were evaluated
retrospectively. 43 patients  were
included in the study. Karlstrom-Olerud, Johner and Wruhs score were used to
evaluate clinical results. Radiologic improvement was assessed as loss of
callus formation and / or fracture line at the level that the patient could
load without support on radiographs. Clinical improvement was assessed as the
patient was able to give full pain relief and return to daily activities.

Results: Mean duration of
union was 11.36 ± 3.8 (6-20) weeks. According to Karlstrom-Olerud 21 patients
(47,7%) has received a full grade of 36, 14 patients (31,8%) have been
evaluated as good with a grade between 33 and 35, 1 patient (2,3%) was
satisfactory with a grade in the range 30-32 and 8 patients were in the range
27-29 and they are evaluated as fair. Non of the patients were evaluated as
poor.

Conclusion: Patients have an
excellent and good score according to the Johner-Wrush criteria. According to
Karlstrom-Olerud's physical functional assessment scale, no patient had a bad
scar. Younger, early-weight-bearing patients with a nail cortex distance of
less than 2mm, the duration of union is shortening. 

Keywords

Tibia fracture, Locked intramedullery nail, loading

References

• 1. Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury. 1998;29(7):529–534.
• 2. Larsen P, Elsoe R, Hansen SH, Graven-Nielsen T, Laessoe U, Rasmussen S. Incidence and epidemiology of tibial shaft fractures. Injury. 2015 Apr;46(4):746-750.
• 3. Courtney PM, Bernstein J, Ahn J. In brief: closed tibial shaft fractures. Clin Orthop Relat Res. 2011 Dec;469(12):3518-3521
• 4. Green SA, Moore TA, Spohn PJ. Nonunion of the tibial shaft. Orthopedics. 1988 Aug;11(8):1149-1157
• 5. Hooper GJ, Keddell RG, Penny ID. Conservative Management or Closed Nailing for Tibial Shaft Fractures. JBJS 1991; 73: 83-85.
• 6. Bhandari M, Guyatt G, Tornetta P, III, Schemitsch EH, Swiontkowski M, et al. Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2008;90:2567–2578.
• 7. Pobłocki K, Domaradzki M, Gawdzik J, Prochacki P, Rajewski R. [Complications after intramedullary nailing of the tibia]. Chir Narzadow Ruchu Ortop Pol. 2011 Sep-Oct;76(5):274-77
• 8. Vaughn J, Gotha H, Cohen E, Fantry AJ, Feller RJ, Van Meter J, Hayda R, Born CT. Nail Dynamization for Delayed Union and Nonunion in Femur and TibiaFractures. Orthopedics. 2016 Nov 1;39(6):e1117-e1123.
• 9. Walker RM, Zdero R, McKee MD, Waddell JP, Schemitsch EH. Ideal Tibial Intramedullary Nail Insertion Point Varies With Tibial Rotation. J Orthop Trauma. 2011;25(12):726-730. doi:10.1097/BOT.0b013e31821148c7.
• 10. Hernández-Vaquero D, Suárez-Vázquez A, Iglesias-Fernández S, García-García J, Cervero-Suárez J. Dynamisation and early weight-bearing in tibial reamed intramedullary nailing: Its safety and effect on fracture union. Injury. 2012;43:S63-S67. doi:10.1016/S0020-1383(13)70182-7.
• 11. Alho A, Ekeland A, Stromsoe K, Folleras G, Thoresen BO Locked intramedullary nailing for displaced tibial shaft fractures. J Bone Joint Surg 1990; 72: 805-9
• 12. Elniel AR, Giannoudis P V. Open fractures of the lower extremity. EFORT Open Rev. 2018;3(5):316-325. doi:10.1302/2058-5241.3.170072.
• 13. Whittle AP, Wester W, Russell TA. Fatigue failure in small diameter tibial nails. Clin Orthop Relat Res. 1995;315:119–128.
• 14. Karlström G, Olerud S. Fractures of the tibial shaft; a critical evaluation of treatment alternatives. Clin Orthop Relat Res 1974;105:82-115.
• 15. Busse JW, Morton E, Lacchetti C, Guyatt GH, Bhandari M. Current management of tibial shaft fractures. A survey of 450 Canadian orthopedic trauma surgeons. Acta Orthopaedica 2008;79:689–94
• 16. Kundu IK, Datta NK, Chowdhury AZ, Das KP, Tarik MM, Faisal MA. Close Intramedullary Interlocking Nailing Versus Locking Compression Plating In the Treatment of Closed Fracture Shaft of the Tibia. Mymensingh Med J. 2016 Jul;25(3):495-9