Akut femur cisim kırıklarında traksiyon masası kullanmadan elle traksiyon yapılarak mini-açık intramedüller çivileme
Öz
Amaç: Femur cisim kırıkları en sık karşılaşılan kırıklardan biridir. Femur cisim kırıklarında oymalı teknikle
yapılan intramedüller (İM) çivileme klinik başarısı yüksek bir yöntemdir. Buna karşın bazı koşullarda, mini
açık redüksiyon yöntemi iyi bir seçenek olabilir. Bu çalışmanın amacı, femur cisim kırıklarında mini açık İM
çivileme yönteminin etkinliği, kolaylığı ve sonuçlarını değerlendirip; daha önceki yapılan çalışmalarla
karşılaştırmaktır.
Materyal ve metod: 18 olgunun (15 erkek, 3 kadın, ortalama yaşı 30.8±14.1 yıl), 18 femur cisim kırığına
mini-açık yöntemle İM çivileme yapıldı. 13 kırık sağ taraf, beş kırık ise sol taraftaydı. Kırıkların kaynama
zamanı, radyolojik ve işlevsel sonuçları Klemm Borrner ölçütlerine göre değerlendirildi.
Bulgular: Ortalama izlem süresi 33.6±12.9 aydı. Kırıklar ortalama 21.9±3.5 haftada kaynadı. Kaynama
gecikmesi iki (%11) olguda görüldü. Hiçbir olguda nörovasküler komplikasyon, infeksiyon, ve yanlış
kaynama saptanmadı. Fonksiyonel olarak 15 olguda (%83) çok iyi, 3 olguda (%17) iyi sonuç elde edildi.
Sonuç: Femur cisim kırıklarında, mini açık teknik ile İM çivileme uygulaması literatür eşliğinde kapalı
teknikle karşılaştırıldığında; kaynama zamanları arasında fark olmadığı, mini- açık redüksiyonun
komplikasyon oranı ve morbiditeyi artırmadığı saptandı. Bu nedenle, mini açık yöntemle kilitli İM çivileme
akut femur cisim kırıklarının cerrahi tedavisinde, kapalı redüksiyonla tedavinin uygun olmadığı koşullarda
bir seçenek olabilir.
Anahtar Kelimeler
Kaynakça
- 1) Whittle AP. Fractures of lower extremity. In: Canale ST, Beaty JH, editors. Campbell's operative orthopaedics, Vol. 3. Chapter:51. 11th ed. MosbyElsevier,Philadelphia;2008. P.3085-3236. 2) Duman E, Ateş y. Femur cisim kırıkları. TOTBİD Dergisi 2008;7(1):1-7. 3) Liao JC, Hsieh PH, Chuang TY, Su JY, Chen CH, Chen YJ. Mini-open intramedullary nailing of acute femoral shaft fracture: reduction through a small incision without a fracture table. Chang Gung Med J. 2003;26(9):660-8. 4) Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases.. J Bone Joint Surg Am. 1984 66(4):529-39. 5) Wolinsky PR, McCarty E, Shyr Y, Johnson K. Reamed intramedullary nailing of the femur: 551 cases. J Trauma. 1999;46(3):392-9. 6) Köseoğlu E, Durak K, Bilgen MS, Küçükalp A, Bayyurt S. Comparison of two biological internal fixation techniques in the treatment of adult femur shaft fractures (plate-screws and locked intramedullary nail). Ulus Travma Acil Cerrahi Derg. 2011;17(2):159-65. 7) Pape HC, Giannoudis P. The biological and physiological effects of intramedullary reaming. J Bone Joint Surg Br. 2007;89(11):1421-6. 8) Meldrum R, Lipscomb P. Compartment syndrome of the leg after less than 4 hours of elevation on a fracture table. South Med J. 2002;95(2):269-71. 9) Karadimas EJ, Papadimitriou G, Theodoratos G, Papanikolaou A, Maris J. The effectiveness of the antegrade reamed technique: the experience and complications from 415 traumatic femoral shaft fractures. Strategies Trauma Limb Reconstr. 2009;4(3):113-21. 10) Karpos PA, McFerran MA, Johnson KD. Intramedullary nailing of acute femoral shaft fractures using manual traction without a fracture table. J Orthop Trauma. 1995;9(1):57-62. 11) McFerran MA, Johnson KD. Intramedullary nailing of acute femoral shaft fractures without a fracture table: technique of using a femoral distractor. J Orthop Trauma. 1992;6(3):271-8. 12) Kimmatkar N, Hemnani JT, Hemnani TJ, Jain SK. Diaphyseal femoral intramedullary nailing: closing or open intervention? International Journal of scientific study. 2014; 15):15-18. http://www.ijsssn.com/uploads/2/0/1/5/20153321/ijss_feb-04.pdf 13) Russell TA, Mir HR, Stoneback J, Cohen J, Downs B. Avoidance of malreduction of proximal femoral shaft fractures with the use of a minimally invasive nail insertion technique (MINIT). J Orthop Trauma. 2008;22(6):391-8. 14) Özcan H, Tomak Y, Karaismailoğlu TN, Dabak N, Pişkin A. Erişkin femur cisim kırıkları ve psödoartrozlarının kilitli intramedüller çivileme ile tedavisi. Artroplasti Artroskopik Cerrahi. 2003;14(2):81- 88. 15) Sever GB, Karaca SG, Dursun M, Gürkan V, Karaca S. Erişkin femur cisim kırıklarında sınırlı açık redüksiyon ile antegrad kilitli intramedüller çivileme uygulamasının sonuçları. Kartal Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2006;18(2):77-81. 16) Shetty S, Bangera VV, Bhandary B,Mangalore K. Mini-open intramedull interlocking nailing of fracture femur in a tertiary care center; our experience. RRJMHS. 2 0 1 3 ; 2 ( 3 ): 5 4 h t t p : / / w w w.rr o i j . c om/ jmh s/ index.php/jmhs/article/viewFile/RRJMHS39/pdf 17) Altay MA, Erturk C, Cece H, Isikan UE. Mini-open versus closed reduction in titanium elastic nailing of paediatric femoral shaft fractures: a comparative study. Acta Orthop Belg. 2011;77(2):211-7. 18) Klemm KW, Börner M. Interlocking nailing of complex fractures of the femur and tibia. Clin Orthop Relat Res. 1986;(212):89-100. 19) Altay MA, Ertürk C, Altay N, Oztürk IA, Baykara I, Sert C, Isikan UE. Comparison of intracompartmental pressures in a rabbit model of open and closed tibial fractures: an experimental study. Bone Joint J. 2013;95-B(1):111-4. 20) Stephen DJ, Kreder HJ, Schemitsch EH, Conlan LB, Wild L, McKee MD. Femoral intramedullary nailing: comparison of fracture-table and manual traction. a prospective, randomized study. J Bone Joint Surg Am. 2002;84-A(9):1514. 21) Wolinsky PR, McCarty EC, Shyr Y, Johnson KD. Length of operative procedures: reamed femoral intramedullary nailing performed with and without a fracture table. J Orthop Trauma. 1998;12(7):485-95. 22) O'Toole RV, O'Brien M, Scalea TM, Habashi N, Pollak AN, Turen CH. Resuscitation before stabilization of femoral fractures limits acute respiratory distress syndrome in patients with multiple traumatic injuries despite low use of damage control orthopedics. J Trauma. 2009;67(5):1013- 21. 23) Ertürer E, Öztürk İ, Dirik Y, Uzun M, Aksoy B. Erişkinlerdeki cisim kırıklarında kilitli oymasız intramedüller çivi osteosentezinin radyografik ve fonksiyonel sonuçları Acta Orthop traumatol Turc 2005;39:381-6.
Mini-open intramedullar nailing of acute femoral shaft fractures using manual traction without a fracture table
Öz
Background: Fractures of the femoral shaft are one of the most common fractures. Reamed intramedullary
(IM) nailing is a successful technique in the treatment of femoral shaft fractures. However, in certain
situations, a mini-open reduction technique may be alternative and advantageous. The aim of the study is to
evaluate the efficacy, convenience and outcomes of mini-open IM nailing for femur shaft fracture and to
compare with the previously published reports.
Material and methods: We have treated 18 patients (15 males, 3 females; mean age 30.8±14.1 years) who
had 18 femur shaft fractures by using mini-open IM nailing. Thirteen fractures were right leg and five were
left leg. We followed up the patients for mean 33.6±12.9 months. We evaluated the union time of fractures, radiological and functional results according to Klemm Borrner criteria.
Results: Mean follow-up periods of 33.6±12.9 months. The fractures healed in mean 21.9±3.5 weeks.
Delayed union was seen in two (11%) patients. None of the patients had any complication like neurovascular
damage, infection and malunion. Functionally, 15 patients (83%) have excellent and three patients (17%)
have good results.
Conclusions: We noticed that there is no discrimination for union time in femur fractures which treated by
intramedullary nailing with mini open or closed technique. The mini open technique was not increase
complication rate and morbidity. Therefore, in cases where closed reduction is not possible mini open locked
intramedullary nailing could be preferred in treatment of femur shaft fractures as an alternative of closed
technique.
Anahtar Kelimeler
Kaynakça
- 1) Whittle AP. Fractures of lower extremity. In: Canale ST, Beaty JH, editors. Campbell's operative orthopaedics, Vol. 3. Chapter:51. 11th ed. MosbyElsevier,Philadelphia;2008. P.3085-3236. 2) Duman E, Ateş y. Femur cisim kırıkları. TOTBİD Dergisi 2008;7(1):1-7. 3) Liao JC, Hsieh PH, Chuang TY, Su JY, Chen CH, Chen YJ. Mini-open intramedullary nailing of acute femoral shaft fracture: reduction through a small incision without a fracture table. Chang Gung Med J. 2003;26(9):660-8. 4) Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases.. J Bone Joint Surg Am. 1984 66(4):529-39. 5) Wolinsky PR, McCarty E, Shyr Y, Johnson K. Reamed intramedullary nailing of the femur: 551 cases. J Trauma. 1999;46(3):392-9. 6) Köseoğlu E, Durak K, Bilgen MS, Küçükalp A, Bayyurt S. Comparison of two biological internal fixation techniques in the treatment of adult femur shaft fractures (plate-screws and locked intramedullary nail). Ulus Travma Acil Cerrahi Derg. 2011;17(2):159-65. 7) Pape HC, Giannoudis P. The biological and physiological effects of intramedullary reaming. J Bone Joint Surg Br. 2007;89(11):1421-6. 8) Meldrum R, Lipscomb P. Compartment syndrome of the leg after less than 4 hours of elevation on a fracture table. South Med J. 2002;95(2):269-71. 9) Karadimas EJ, Papadimitriou G, Theodoratos G, Papanikolaou A, Maris J. The effectiveness of the antegrade reamed technique: the experience and complications from 415 traumatic femoral shaft fractures. Strategies Trauma Limb Reconstr. 2009;4(3):113-21. 10) Karpos PA, McFerran MA, Johnson KD. Intramedullary nailing of acute femoral shaft fractures using manual traction without a fracture table. J Orthop Trauma. 1995;9(1):57-62. 11) McFerran MA, Johnson KD. Intramedullary nailing of acute femoral shaft fractures without a fracture table: technique of using a femoral distractor. J Orthop Trauma. 1992;6(3):271-8. 12) Kimmatkar N, Hemnani JT, Hemnani TJ, Jain SK. Diaphyseal femoral intramedullary nailing: closing or open intervention? International Journal of scientific study. 2014; 15):15-18. http://www.ijsssn.com/uploads/2/0/1/5/20153321/ijss_feb-04.pdf 13) Russell TA, Mir HR, Stoneback J, Cohen J, Downs B. Avoidance of malreduction of proximal femoral shaft fractures with the use of a minimally invasive nail insertion technique (MINIT). J Orthop Trauma. 2008;22(6):391-8. 14) Özcan H, Tomak Y, Karaismailoğlu TN, Dabak N, Pişkin A. Erişkin femur cisim kırıkları ve psödoartrozlarının kilitli intramedüller çivileme ile tedavisi. Artroplasti Artroskopik Cerrahi. 2003;14(2):81- 88. 15) Sever GB, Karaca SG, Dursun M, Gürkan V, Karaca S. Erişkin femur cisim kırıklarında sınırlı açık redüksiyon ile antegrad kilitli intramedüller çivileme uygulamasının sonuçları. Kartal Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2006;18(2):77-81. 16) Shetty S, Bangera VV, Bhandary B,Mangalore K. Mini-open intramedull interlocking nailing of fracture femur in a tertiary care center; our experience. RRJMHS. 2 0 1 3 ; 2 ( 3 ): 5 4 h t t p : / / w w w.rr o i j . c om/ jmh s/ index.php/jmhs/article/viewFile/RRJMHS39/pdf 17) Altay MA, Erturk C, Cece H, Isikan UE. Mini-open versus closed reduction in titanium elastic nailing of paediatric femoral shaft fractures: a comparative study. Acta Orthop Belg. 2011;77(2):211-7. 18) Klemm KW, Börner M. Interlocking nailing of complex fractures of the femur and tibia. Clin Orthop Relat Res. 1986;(212):89-100. 19) Altay MA, Ertürk C, Altay N, Oztürk IA, Baykara I, Sert C, Isikan UE. Comparison of intracompartmental pressures in a rabbit model of open and closed tibial fractures: an experimental study. Bone Joint J. 2013;95-B(1):111-4. 20) Stephen DJ, Kreder HJ, Schemitsch EH, Conlan LB, Wild L, McKee MD. Femoral intramedullary nailing: comparison of fracture-table and manual traction. a prospective, randomized study. J Bone Joint Surg Am. 2002;84-A(9):1514. 21) Wolinsky PR, McCarty EC, Shyr Y, Johnson KD. Length of operative procedures: reamed femoral intramedullary nailing performed with and without a fracture table. J Orthop Trauma. 1998;12(7):485-95. 22) O'Toole RV, O'Brien M, Scalea TM, Habashi N, Pollak AN, Turen CH. Resuscitation before stabilization of femoral fractures limits acute respiratory distress syndrome in patients with multiple traumatic injuries despite low use of damage control orthopedics. J Trauma. 2009;67(5):1013- 21. 23) Ertürer E, Öztürk İ, Dirik Y, Uzun M, Aksoy B. Erişkinlerdeki cisim kırıklarında kilitli oymasız intramedüller çivi osteosentezinin radyografik ve fonksiyonel sonuçları Acta Orthop traumatol Turc 2005;39:381-6.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Nisan 2015 |
| Gönderilme Tarihi | 8 Aralık 2014 |
| Kabul Tarihi | 12 Aralık 2014 |
| Yayımlandığı Sayı | Yıl 2015 Cilt: 12 Sayı: 1 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty