Kapal› ve tip I aç›k tibia cisim k›r›klar›nda oymal› intramedüller çivi uygulamalar› The results of reamed intramedullary nailing in patients with closed and type I open tibial shaft fractures

Son y›llarda gelifltirilen internal ve eksternal fik- sasyon ayg›tlar›na ramen, tibia cisim k›r›klar›n›n tedavisinde en iyi tedavi yonteminin hangisi olduu konusunda hala tart›flmalar vard›r. (1-3) Kapal› tibia ci- sim k›r›klar›n›n tedavisinde, kapal› reduksiyon-alc› uygulamas› veya erken yuk vermeye olanak tan›yan fonksiyonel breys kullan›m›n›n ilk tercih olmas› ge- rektii konusunda bircok cal›flmada gorufl birlii ol- Amac: Kapal› ve tip I ac›k tibia cisim k›r›klar›nda intra- meduller tibial civi ile tedavi sonuclar›n› inceledik. Cal›flma plan›: K›rk hastan›n (32 erkek, 8 kad›n; ort. yafl 38.2; da¤›l›m 20-83) kapal› ve tip I ac›k tibia cisim k›r›¤› kapal› teknikle, oymal› tibial intrameduller civileme ile tedavi edildi. ‹ntrameduller civileme endikasyonlar› 17 olguda alc› uygulamas› sonras›nda k›r›¤›n yanl›fl pozis- yonda olmas›, 15 olguda instabil tibia k›r›¤›, sekiz olguda coklu k›r›k olmas› idi. Ortalama izleme suresi 58 ay (da- ¤›l›m 44-72 ay) idi. Sonuclar Folleras ve ark.n›n kriterle- rine gore deerlendirildi. Sonuclar: Ortalama kaynama suresi 13.7 hafta (da¤›l›m 8-29 hafta) idi. Kaynama gecikmesi geliflen bir olguda otojen kemik grefti uyguland›. Bir olguda distal kilitleme vidas› k›r›ld›. ‹ki olguda 5i d›fl rotasyon deformitesi sap- tand›. Ortalama diz fleksiyonu 120i idi. Ameliyat sonras› hicbir olguda kompartman sendromu geliflmedi. Folleras ve ark.n›n kriterlerine gore 36 olguda cok iyi, iki olguda iyi, bir olguda orta, bir olguda kotu sonuc al›nd›.

[1]  R. Gustilo,et al.  JSBS classics. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. Retrospective and prospective analyses. , 1976, The Journal of bone and joint surgery. American volume.

[2]  A. Schmidt,et al.  A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft. , 2000, Journal of orthopaedic trauma.

[3]  E. Schemitsch,et al.  Muscle perfusion after intramedullary nailing of the canine tibia. , 1998, The Journal of trauma.

[4]  J. Keating,et al.  Reamed interlocking intramedullary nailing of open fractures of the tibia. , 1997, Clinical orthopaedics and related research.

[5]  P. Blachut,et al.  Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft. A prospective, randomized study. , 1997, The Journal of bone and joint surgery. American volume.

[6]  I. Mccarthy,et al.  The acute vascular response to intramedullary reaming. Microsphere estimation of blood flow in the intact ovine tibia. , 1995, The Journal of bone and joint surgery. British volume.

[7]  C. Court-Brown,et al.  The epidemiology of tibial fractures. , 1995, The Journal of bone and joint surgery. British volume.

[8]  J. Watson.  Treatment of unstable fractures of the shaft of the tibia. , 1994, The Journal of bone and joint surgery. American volume.

[9]  A. Alho,et al.  Comparison of functional bracing and locked intramedullary nailing in the treatment of displaced tibial shaft fractures. , 1992, Clinical orthopaedics and related research.

[10]  G J Hooper,et al.  Conservative management or closed nailing for tibial shaft fractures. A randomised prospective trial. , 1991, The Journal of bone and joint surgery. British volume.

[11]  K. Strømsøe,et al.  Locked intramedullary nailing of fractures of femur and tibia. , 1990, Injury.

[12]  C. Court-Brown,et al.  Closed intramedullary tibial nailing. Its use in closed and type I open fractures. , 1990, The Journal of bone and joint surgery. British volume.

[13]  C. Court-Brown,et al.  Compartment pressures after intramedullary nailing of the tibia. , 1990, The Journal of bone and joint surgery. British volume.

[14]  Henley Mb,et al.  Intramedullary devices for tibial fracture stabilization. , 1989 .

[15]  A. Alho,et al.  Interlocking intramedullary nailing in the treatment of tibial fractures. A report of 45 cases. , 1988, Clinical orthopaedics and related research.

[16]  A. Sarmiento,et al.  Prefabricated functional braces for the treatment of fractures of the tibial diaphysis. , 1984, The Journal of bone and joint surgery. American volume.

[17]  E. J. Hargadon,et al.  Is conservative treatment of displaced tibial shaft fractures justified? , 1984, The Journal of bone and joint surgery. British volume.

[18]  J. Greiff,et al.  Fractures of the shaft of the tibia treated with AO-compression osteosynthesis. , 1982, Injury.