Kalça kırıklarının cerrahi tedavisinde kullanılan proksimal femoral çivilerinin distal kilitlenme tipinin radyolojik sonuçlarına etkisi
Öz
Amaç: Çalışmamızın amacı proksimal femoral çivilerin (PFN) distal kilitlenme tipinin kırık iyileşmesine etkisi, çivi distalinde olanlar başta olmak üzere genel komplikasyonların nedenleri ve olası komplikasyon oranlarının azaltılmasına ışık tutacak veriler elde etmektir.
Gereç ve Yöntem: 01.01.2015-01.01.2020 tarihleri arasında trokanterik kalça kırığı tanısı ile ameliyat edilen ve ikinci yıl takip süresini dolduran hastalar tıbbi kayıtlarından incelendi. Hastalar önce AO/OTA alt tiplerine göre (AO A1, A2 ve A3 olmak üzere üç grup) daha sonra distal kilitleme tipine göre gruplandırıldı (Grup 1: dinamik, grup 2: 2 vida ile statik distal kilitleme yapılan hastalar olarak iki grup). Kırık tipi, iyileşme durumu, kırık kaynama süresi, komplikasyon oranları ve komplikasyon gelişimi nedeniyle tekrar ameliyat verileri değerlendirildi.
Bulgular: 339 hasta çalışmaya dahil edildi [189 kadın, 150 erkek, ortalama yaş: 76.24 (60-102) yıl]. Genel komplikasyon oranı %15.6 idi. AO A3 tipi kırıkların her bir distal kilitleme grubunda diğer kırık alt tiplerine kıyasla daha uzun kırık kaynama süreleri vardı. AO A3 tipi kırıklar diğer tip gruplara göre daha sık komplikasyon oranlarına sahipti. Grup 2'deki AO A3 tip kırıkların genel komplikasyon oranları grup 1'e göre daha yüksekti. Grup 1 ile kadınlarda lag vidası sıyrılma komplikasyonu arasında ve grup 2 ile erkeklerde psödoartroz komplikasyonu gelişimi arasında anlamlı bir korelasyon vardı. Ayrıca, AO kırık alt tipi ile toplam komplikasyon görülme oranı, AO A2 kırık tipi ve lag vidası sıyrılması komplikasyonu gelişimi ve AO A3 kırık tipi ve psödoartroz komplikasyon oluşumu arasında istatistiksel olarak anlamlı bir ilişki vardı.
Sonuç: Statik distal kilitleme yapılmış AO/OTA 31 A3 tip kırıklı hastaların, dinamik kilitlemeye göre daha uzun kırık kaynama süresine ve daha yüksek komplikasyon oranına sahip olduğunu göstermektedir. Bununla birlikte, bulgularımız dinamik veya statik distal kilitlemenin özellikle PFN'lerin distalinde olanlar da dahil olmak üzere implant nedenli diğer komplikasyonlarla ilişkili olmadığını göstermektedir.
Anahtar Kelimeler
Kalça kırığı proksimal femur çivisi distal kilitleme komplikasyonlar
Teşekkür
Veri toplanması esnasında katkısından dolayı Harun Küçük'e ve verilerin analiz ve yorumlanması esnasında katkısından dolayı Cahit Özer'e teşekkür ederim.
Kaynakça
- 1. WHO. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Falls (who. int). April 27, 2021 Falls (who.int).
- 2. Matsuo M, Yamagami T, Higuchi A. Impact of age on postoperative complication rates among elderly patients with hip fracture: a retrospective matched study. J Anesth. 2018;3:452–6.
- 3. Niu E, Yang A, Harris AHS, Bishop J. Which fixation device is preferred for surgical treatment of intertrochanteric hip fractures in the United States? A survey of orthopaedic surgeons. Clin Orthop Relat Res 2015;11:3647–55
- 4. Nadeem A Lil, Vipul R Makwana, Tirth D Patel, Arjav R Patel. Comparative study of intertrochanteric fracture fixation using a proximal femoral nail with and without distal interlocking screws. World J Orthop 2022 March 18;3: 267-77.
- 5.Hapa O, Muratlı HH, Yüksel HY, Çelebi L, Doğruyol D, Biçimoğlu A. Single or double distal locking in intramedullary nailing of tibial shaft fractures: a prospective randomized study Ulus Travma Acil Cerrahi Derg 2010;1:33-7.
- 6. Kneifel T, Buckley R. A comparison of one versus two distal locking screws in tibial fractures treated with unreamed tibial nails: a prospective randomized clinical trial. Injury 1996;27:271-3.
- 7. Mitchell PM, Collinge CA, Barcak E, Perez E, Triantafillou K. Proximity and risks of the anterior neurovascular and tendinous anatomy of the distal leg relative to anteriorly applied distal locking screws for tibia nailing: A plea for open insertion. J Orthop Trauma. 2017;31:375–9.
- 8. Ozkan K, Unay K, Demircay C, Cakir M, Eceviz E. Distal unlocked proximal femoral intramedullary nailing for intertrochanteric femur fractures. International Orthopaedics (SICOT) 2009 33:1397–1400.
- 9. Li X, Zhang L, Hou Z, Meng Z, Chen W, Wang P, Zhang Y. Distal locked and unlocked nailing for perthrochanteric fractures--a prospective comparative randomized study. Int Orthop 2015; 39: 1645-52.
- 10 Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones/AO classification of fractures. Springer-Verlag, Berlin, Heidelberg. 1990.
- 11. Ertürer RE, Sönmez MM, Sarı S, Seckin MF, Kara A, Öztürk İ. Yaşlı hastalarda intertrokanterik kalça k›r›klar›nda Profin® çivisi ile intramedüller osteosentez. Acta Orthop Traumatol Turc 2012;46(2):107-12.
- 12. Pascarella R, Fantasia R, Maresca A, Bettuzzi C, Amendola L, Violini S, et al. How evolution of the nailing system improves results and reduces orthopaedic complications: more than 2000 cases of trochanteric fractures treated with the Gamma Nail System. Musculoskelet Surg. 2016;1:1-8.
- 13. Suckel AA, Dietz K, Wuelker N, Helwig P. Evaluation of complications of three different types of proximal extra-articular femur fractures. Differences in complications, age, sex and surviving rates. International Orthopaedics (SICOT) 2007; 31:689–95.
- 14. Koyuncu Ş, Altay T, Kayalı C, Ozan F, Yamak K. Mechanical failures after fixation with proximal femoral nail and risk factors. Clinical Interventions in Aging 2015:10 1959–65.
- 15. Fogagnolo F, Kfuri Jr M, Paccola CAJ. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;1:31-7.
- 16. Bojan AJ,Beimel C, Speitling A, Taglang G, Ekholm C, Jönsson A. 3066 consecutive Gamma Nails. 12 years experience at a single centre. BMC Musculoskelet Disord. 2010; 11: 133.
- 17. Lang NW, Breuer R, Beiglboeck H, Munteanu A, Hajdu S, Windhager R, Widhalm HK. Migration of the Lag Screw after Intramedullary Treatment of AO/OTA 31.A2.1-3 Pertrochanteric Fractures Does Not Result in Higher Incidence of Cut-Outs, Regardless of Which Implant Was Used: A Comparison of Gamma Nail with and without U-Blade (RC) Lag Screw and Proximal Femur Nail Antirotation (PFNA)J Clin Med. 2019; 5: 615.
- 18. Laurence M, Freeman MA, Swanson SA. Engineering considerations in the internal fixation of fractures of the tibial shaft. Bone Joint Surg Br. 1969;51:754–68.
- 19. Kim K, Kim YH, Park WM, Rhyu KH. Stress concentration near pin holes associated with fracture risk after computer navigated total knee arthroplasty. Comput Aided Surg. 2010;15:98–103.
- 20. Ho KW, Gilbody J, Jameson T, Miles AW. The effect of 4 mm bicortical drill hole defect on bone strength in a pig femur model. Arch Orthop Trauma Surg. 2010;130:797–802.
- 21. Huang X, Yu B, Gu Y, Li Z. Biomechanical comparison of dynamic hip screw and gamma nail for the treatment of unstable trochanteric fractures: a finite element study. Int J Clin Exp Med. 2017;10:7867–74.
- 22. Norris R, Bhattacharjee D, Parker MJ. Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients. Injury. 2012;6:706-811.
- 23. V. Ciaffaa, Vicentib G, Morib CM, Panellab A, Conservac V, Corinad G, etal. Unlocked versus dynamic and static distal locked femoral nails in stable and unstable intertrochanteric fractures. A prospective study. Injury, Int. J. Care Injured 2018: S19–S25
- 24. Zhong G, Teng L, Li H, Huang F, Xiang Z, Cen S. Surgical Treatment of Internal Fixation Failure of Femoral Peritrochanteric Fracture. Orthop Surg 2021;6:1739-47.
- 25. D'Arrigo C, Perugia D, Carcangiu A, Monaco E, Speranza A, Ferretti A. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthop. 2010;7:939-42.
Effect of distal locking type on radiological results of proximal femoral nails used in the surgical treatment of hip fractures
Öz
Purpose: The aim of our study is to obtain data that will shed light on the effect of the distal locking type of proximal femoral nails (PFN) on fracture healing, causes of general complications, especially those in the distal of the nails, and reduction of possible complication rates.
Materials and Methods: Patients who underwent surgery with the diagnosis of trochanteric hip fracture between 01.01.2015 and 01.01.2020 and completed the second year follow-up time were examined from the medical records. Patients were grouped first according to AO/OTA sub-types (Three groups as AO A1, A2 and A3), then grouped according to distal locking type (Two groups as group 1: dynamic, group 2: static distal locking with 2 screws). The fracture type, healing status, fracture healing time, complication rates and reoperation because of complication development data were evaluated.
Results: 339 patients enrolled in the study [189 women, 150 men, mean age: 76.24 (60-102) years]. The overall complication rate was 15.6%. AO A3 type fractures had long fracture healing times in each distal locking group compared to the other fracture sub-types. AO A3 type fractures had more frequent complication rates than the other subtype groups. AO A3 type fractures in group 2 had higher overall complication rates than in group 1. There was a significant correlation between group 1 and lag screw cut-out complication occurrence in females and between group 2 and pseudoarthrosis occurrence in males. In addition, there was a statistically significant relationship between the AO fracture sub-type and total rate of complication occurrence, AO A2 fracture type and lag screw cut-out complication occurrence and AO A3 fracture type and pseudoarthrosis complication occurrence.
Conclusion: Patients with AO/OTA 31 A3 type fractures with static distal locking have a longer fracture healing time and a higher complication rate compared to dynamic locking. However, dynamic or static distal locking is not associated with other implant-related complications, especially those in the distal to the tip of PFN’s.
Anahtar Kelimeler
Hip fracture proximal femoral nail distal locking complications
Kaynakça
- 1. WHO. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Falls (who. int). April 27, 2021 Falls (who.int).
- 2. Matsuo M, Yamagami T, Higuchi A. Impact of age on postoperative complication rates among elderly patients with hip fracture: a retrospective matched study. J Anesth. 2018;3:452–6.
- 3. Niu E, Yang A, Harris AHS, Bishop J. Which fixation device is preferred for surgical treatment of intertrochanteric hip fractures in the United States? A survey of orthopaedic surgeons. Clin Orthop Relat Res 2015;11:3647–55
- 4. Nadeem A Lil, Vipul R Makwana, Tirth D Patel, Arjav R Patel. Comparative study of intertrochanteric fracture fixation using a proximal femoral nail with and without distal interlocking screws. World J Orthop 2022 March 18;3: 267-77.
- 5.Hapa O, Muratlı HH, Yüksel HY, Çelebi L, Doğruyol D, Biçimoğlu A. Single or double distal locking in intramedullary nailing of tibial shaft fractures: a prospective randomized study Ulus Travma Acil Cerrahi Derg 2010;1:33-7.
- 6. Kneifel T, Buckley R. A comparison of one versus two distal locking screws in tibial fractures treated with unreamed tibial nails: a prospective randomized clinical trial. Injury 1996;27:271-3.
- 7. Mitchell PM, Collinge CA, Barcak E, Perez E, Triantafillou K. Proximity and risks of the anterior neurovascular and tendinous anatomy of the distal leg relative to anteriorly applied distal locking screws for tibia nailing: A plea for open insertion. J Orthop Trauma. 2017;31:375–9.
- 8. Ozkan K, Unay K, Demircay C, Cakir M, Eceviz E. Distal unlocked proximal femoral intramedullary nailing for intertrochanteric femur fractures. International Orthopaedics (SICOT) 2009 33:1397–1400.
- 9. Li X, Zhang L, Hou Z, Meng Z, Chen W, Wang P, Zhang Y. Distal locked and unlocked nailing for perthrochanteric fractures--a prospective comparative randomized study. Int Orthop 2015; 39: 1645-52.
- 10 Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones/AO classification of fractures. Springer-Verlag, Berlin, Heidelberg. 1990.
- 11. Ertürer RE, Sönmez MM, Sarı S, Seckin MF, Kara A, Öztürk İ. Yaşlı hastalarda intertrokanterik kalça k›r›klar›nda Profin® çivisi ile intramedüller osteosentez. Acta Orthop Traumatol Turc 2012;46(2):107-12.
- 12. Pascarella R, Fantasia R, Maresca A, Bettuzzi C, Amendola L, Violini S, et al. How evolution of the nailing system improves results and reduces orthopaedic complications: more than 2000 cases of trochanteric fractures treated with the Gamma Nail System. Musculoskelet Surg. 2016;1:1-8.
- 13. Suckel AA, Dietz K, Wuelker N, Helwig P. Evaluation of complications of three different types of proximal extra-articular femur fractures. Differences in complications, age, sex and surviving rates. International Orthopaedics (SICOT) 2007; 31:689–95.
- 14. Koyuncu Ş, Altay T, Kayalı C, Ozan F, Yamak K. Mechanical failures after fixation with proximal femoral nail and risk factors. Clinical Interventions in Aging 2015:10 1959–65.
- 15. Fogagnolo F, Kfuri Jr M, Paccola CAJ. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;1:31-7.
- 16. Bojan AJ,Beimel C, Speitling A, Taglang G, Ekholm C, Jönsson A. 3066 consecutive Gamma Nails. 12 years experience at a single centre. BMC Musculoskelet Disord. 2010; 11: 133.
- 17. Lang NW, Breuer R, Beiglboeck H, Munteanu A, Hajdu S, Windhager R, Widhalm HK. Migration of the Lag Screw after Intramedullary Treatment of AO/OTA 31.A2.1-3 Pertrochanteric Fractures Does Not Result in Higher Incidence of Cut-Outs, Regardless of Which Implant Was Used: A Comparison of Gamma Nail with and without U-Blade (RC) Lag Screw and Proximal Femur Nail Antirotation (PFNA)J Clin Med. 2019; 5: 615.
- 18. Laurence M, Freeman MA, Swanson SA. Engineering considerations in the internal fixation of fractures of the tibial shaft. Bone Joint Surg Br. 1969;51:754–68.
- 19. Kim K, Kim YH, Park WM, Rhyu KH. Stress concentration near pin holes associated with fracture risk after computer navigated total knee arthroplasty. Comput Aided Surg. 2010;15:98–103.
- 20. Ho KW, Gilbody J, Jameson T, Miles AW. The effect of 4 mm bicortical drill hole defect on bone strength in a pig femur model. Arch Orthop Trauma Surg. 2010;130:797–802.
- 21. Huang X, Yu B, Gu Y, Li Z. Biomechanical comparison of dynamic hip screw and gamma nail for the treatment of unstable trochanteric fractures: a finite element study. Int J Clin Exp Med. 2017;10:7867–74.
- 22. Norris R, Bhattacharjee D, Parker MJ. Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients. Injury. 2012;6:706-811.
- 23. V. Ciaffaa, Vicentib G, Morib CM, Panellab A, Conservac V, Corinad G, etal. Unlocked versus dynamic and static distal locked femoral nails in stable and unstable intertrochanteric fractures. A prospective study. Injury, Int. J. Care Injured 2018: S19–S25
- 24. Zhong G, Teng L, Li H, Huang F, Xiang Z, Cen S. Surgical Treatment of Internal Fixation Failure of Femoral Peritrochanteric Fracture. Orthop Surg 2021;6:1739-47.
- 25. D'Arrigo C, Perugia D, Carcangiu A, Monaco E, Speranza A, Ferretti A. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthop. 2010;7:939-42.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2022 |
| Kabul Tarihi | 5 Eylül 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 47 Sayı: 3 |
