OUR EXPERIENCE WITH LEINBACH PROSTHESIS IN INTERTROCHANTERIC FEMORAL FRACTURES

We employed Leinbach prosthesis in 19 patients with intertrochanteric hip fractures between September 1995 and November 1997. Of these, two patients (10.5%) were men and 17 (89.5%) were women (age range 70-95 years, mean age 81.8years). In calcar femoris fractures were detected in 14 patients (73,6 %) All operations were performed under spinal anesthesia. The patients achieved sitting position in bed on the postoperative first day; full weight-bearing position with an aid of walkers was obtained after the removal of the drainage. Mean hospital stay was 22 days with a mean follow-up of 19 months. According to the account given by patients' relatives, two patients died from cardiac causes and another two from debilitating conditions developed after fractures. Two patients, although they were alive, were not available for follow-up because of hemiplegic conditions caused by postoperative neurologic problems. Merle d' Aubigne functional hip scores were used for evaluation of the patients. 1 patient (5.2%) was classified excellent, 7 patients (36.8%) were good, 5 patients (26.3%) were fair and 6 patients (31.5%) were poor. Thirteen patients (68.4%) achieved walking and implementation of daily activities. Radiologic examinations did not show loosening of the stem, dislocation, and acetabular protrusion. The object of treatment in elderly and osteoporotic patients with intertrochanteric hip fractures is to achieve early mobilization and rapid restoration of daily activities. Leinbach prosthesis appears to be appropriate for intertrochanteric hip fractures.

ÝNTERTROKANTERÝK FEMUR KIRIKLARINDA LEINBACH PROTEZÝ UYGULAMALARIMIZ

Kliniðimizde Eylül 1995 ve Kasým 1997 yýllarý arasýnda 19 femur intertrokanterik kýrýklý hastaya Leinbach hemiprotez uygulandý. Hastalardan ikisi erkek (%10.5), 17"si kadýndýr (%89.5). Ortalama yaþ 81.8'dir (yaþ daðýlýmý 70-95). On dokuz hastanýn 14'ünde (%73.6) kalkarda kýrýk saptandý. Tüm ameliyatlar spinal anestezi yardýmý ile yapýldý. Ameliyat sonrasý birinci günde hastalarýn hepsi yataklarýnda oturtuldu; dren alýnmasýndan sonra yürüteç yardýmý ile tam yük vererek yürütüldü. Hastanede kalýþ süresi ortalama 22 gün, takip süresi ortalama 19 aydýr. Ýki hastanýn kardiak nedenlerle, iki hastanýn da kýrýk sonrasý geliþen düþkünlük dolayýsýyla ex olduðu hasta yakýnlarýndan öðrenildi. Ýki hasta, halen hayatta olmalarýna raðmen ameliyat sonrasý geçirmiþ olduklarý nörolojik problemler nedeniyle hemiplejik olduklarýndan son kontrole gelemediler. Hastalarýn fonksiyonel deðerlendirilmesi Merle d'Aubigne kriterlerine göre yapýldý. Bu kriterlere göre 1 hastada çok iyi (%5.2), 7 hastada iyi (%36.8), 5 hastada orta (%26.3), 6 hastada kötü (%3 1.5) sonuç elde edildi. On üç hastanýn (%68.4) yürüyebildikleri ve günlük iþlerini yapabildikleri saptandý. Takip süresi içinde radyolojik olarak deðerlendirilen 13 hastanýn hiçbirinde stemde gevþeme, dislokasyon ve asetabuluma protrüzyon saptanmadý. Ýleri derecede yaþlý ve osteoporotik hastalarýn intertrokanterik femur kýrýklarýnda tedavide amaç, hastanýn erken mobilizasyon ve günlük hayatýna en kýsa sürede dönebilmesidir. Bu amaca yönelik tedavide Leinbach tip hemiprotezlerin uygulanabileceði görülmüþtür.