Distal Tibia Eklemine Uzanan Tibia Diyafiz Kırıklarında Kapalı Perkütan Pinleme ve İntramedüller Çivileme ile Tatminkar Sonuçlar Elde Edilebilir

Yıl 2023, , 232 - 239, 30.06.2023

Batuhan Gencer , Özgür Doğan

https://doi.org/10.31832/smj.1204366

Öz

Amaç: Amacımız, distal tibia eklem hattına uzanan tibia diyafiz kırıklarında intramedüller çivilemenin sonuçlarının araştırılması ve minimal invaziv plak osteosentez yöntemi ile karşılaştırılmasıdır.
Gereç ve Yöntem: Kliniğimizde tibia distal eklem hattına uzanan ancak eklemde impaksiyon izlenmeyen tibia diyafiz kırığı nedeni ile 2019 – 2021 yılları arasında tedavi ve takibi yapılan tüm hastalar retrospektif olarak araştırıldı. Tüm hastaların yaş, cinsiyet ve taraf gibi demografik verileri, yaralanma mekanizmaları, tibia diyafiz ve pilon kırık tipleri, klinik ağrı skorları, radyolojik kaynamaları ve komplikasyonları değerlendirildi.
Bulgular: Çalışmaya dahil edilen 27 hastadan 15 hasta (%55,56) intramedüller çivileme ile tedavi edilirken, 12 hastada (%44,44) minimal invaziv plak osteosentez kullanılmıştır. İMÇ uygulanan grubun ortanca yaşı 62 (Aralık: 34-67 yaş) iken, MİPO uygulanan grupta ortanca yaşı 51 (Aralık: 33-52) olduğu ve aralarında anlamlı fark olduğu görüldü (p=0,038). Yaralanma mekanizmaları açısından gruplar arasında anlamlı fark tespit edildi (p=0,023). Taraf, cinsiyet, kırık tipi ve ağrı skorları açısından iki grup arasında fark görülmedi (p>0,050). Hastaların tamamında radyolojik tam iyileşme elde edildi. Dört hastada (%14,81) yara yerinde yumuşak doku ilişkili komplikasyonlar tespit edildi. Komplikasyon gelişen hastaların tamamının MİPO grubunda olduğu görüldü ve gruplar arasında komplikasyon gelişimi açısından anlamlı fark tespit edildi (p=0,028).
Sonuç: Distal tibia eklem hattına uzanan tibia diyafiz kırıklarında, eklemde impaksiyon eşlik etmiyor ise, perkütan kanüllü vidalar ile eklemde mutlak stabilitenin elde edilmesini takiben uygulanan intramedüller çivileme ile tatminkar klinik ve radyolojik sonuçlar ve düşük komplikasyon oranları elde edilebilir.

Anahtar Kelimeler

Tibia diyafiz kırığı, Ekleme uzanan diyafiz kırıkları, Perkütan pinleme, İntramedüller Çivileme, MİPO, Tibia diaphysis fracture, Joint-related diaphyseal fractures, Percutaneous pinning, Intramedullary Nailing, MIPO

Satisfactory Results Can Be Obtained by Closed Percutaneous Pinning and Intramedullary Nailing in Distal Tibial Joint-Related Tibia Diaphysis Fractures

Öz

Objective: Our aim was to investigate the results of intramedullary nailing in tibial diaphyseal fractures extending to the distal tibial joint line and to compare them with the minimally invasive plate osteosynthesis method.
Materials and Methods: All patients who were treated and followed-up in our clinic between 2019 and 2021 for tibial diaphyseal fracture extending to the tibial distal joint line but without impact on the joint were retrospectively investigated. Demographic data such as age, gender and side, injury mechanisms, tibia diaphysis and pilon fracture types, clinical pain scores, radiological union rates and complications of all patients were evaluated.
Results: Of the 27 patients included in the study, 15 patients (55.56%) were treated with intramedullary nailing, while minimally invasive plate osteosynthesis was used in 12 patients (44.44%). While the median age of the IMN group was 62 years (Range: 34-67 years), the median age of the MIPO group was 51 years (Range: 33-52), and there was a significant difference between them (p=0.038). There was a significant difference between the groups in terms of injury mechanisms (p=0.023). There was no difference between the two groups in terms of side, gender, fracture type and pain scores (p>0.050). Radiological complete recovery was achieved in all patients. Soft tissue-related complications were detected at the wound site in four patients (14.81%). It was observed that all the patients who developed complications were in the MIPO group, and a significant difference was found between the groups in terms of complication rates (p=0.028).
Conclusion: In tibial diaphyseal fractures extending to the distal tibial joint line, if the joint is not accompanied by impaction, satisfactory clinical and radiological results and low complication rates can be obtained with intramedullary nailing, which is applied after obtaining absolute stability in the joint with percutaneous cannulated screws.

Anahtar Kelimeler

Tibia diaphysis fracture, Joint-related diaphyseal fractures, Percutaneous pinning, Intramedullary Nailing, MIPO

Kaynakça

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