Ulus Travma Acil Cerrahi Derg. 2011; 17(5): 407-412 | DOI: 10.5505/tjtes.2011.48716

Ýntertrokanterik kýrýklarda Ender çivilerinin eksternal fiksatörle desteklenmesi

Cemil Ertürk¹, Bilal Çaðman², Mehmet Akif Altay¹, Uður Erdem Iþýkan^1
1Harran Üniversitesi Týp Fakültesi, Ortopedi Ve Travmatoloji Anabilim Dalý, Yeniþehir, Þanlýurfa
²Av. Cengiz Gökçek Devlet Hastanesi, Ortopedi Kliniði, Þahinbey, Gaziantep

AMAÇ
Ýntertrokanterik kýrýklarda intramedüller Ender çivileme, geçmiþ yýllarda çok yaygýndý. Ancak bu yöntemin kullanýmý, komplikasyonlarýndan dolayý zaman içerisinde azaldý. Bu çalýþmanýn amacý, tek yanlý eksternal fiksatörle desteklenen Ender çivileme ile bu tür komplikasyonlarýn önlenmesi ile birlikte bu yöntemin sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM
Bu teknik 39 hastada kullanýldý (17 erkek, 22 kadýn; ortalama yaþ 71,4 yýl). Ameliyat öncesi tüm hastalarýn ortalama American Society of Anesthesiologists (ASA) skoru 1,84 (daðýlým, 1-4) idi. Kýrýklar AO/OTA sýnýflamasýna göre ayrýldý. Biz ameliyatýmýzda eksternal fiksatörü intramedüller çivilere destek amacýyla kullandýk. Son takipte, tüm hastalar Parker-Palmer mobility skoru ve Harris kalça skoru ile deðerlendirildi.
BULGULAR
Ortalama izlem süresi 29,2 ay (20-56) idi. Ýki hastada Ender çivilerinin dizden dýþarý çýkmasý, iki hastada 2 cm kýsalýkla birlikte varus deformitesi ve yedi hastada çivi dibi enfeksiyonu oluþtu. Yaþamýný sürdürebilen ve son takibi yapýlabilen 14 hastanýn ortalama Harris kalça skoru 64, Parker-Palmer skoru 6,8 idi.
SONUÇ
Bu yöntemin, herhangi bir ciddi sorun görülmeksizin, kýrýðýn kýsa sürede iyileþmesini saðlamasý ve ekstremitesine tam aðýrlýk vermesine uygun olmasý gibi üstünlükleri gösterilmiþtir.

Anahtar Kelimeler: Ender çivileri, eksternal fiksatörler; kýrýk tespiti; kalça kýrýklarý.

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The use of Ender nail in intertrochanteric fractures supported with external fixation

Cemil Ertürk¹, Bilal Çaðman², Mehmet Akif Altay¹, Uður Erdem Iþýkan^1
11 Harran University Faculty Of Medicine, Department Of Orthopaedic Surgery, Yenisehir, Sanliurfa, Turkey.
²Av. Cengiz Gökçek Statement Hospital, Department Of Orthopaedic Surgery, Sahinbey, Gaziantep, Turkey.

BACKGROUND
Intramedullary Ender nailing in intertrochanteric fractures was very popular in the past. However, this method has fallen in favor over time, due to complications. The purpose of this study was to evaluate results with this method and possible ways to prevent these complications, including the use of unilateral fixators to support the Ender nails.
METHODS
This technique (Ender nailing and external fixator) was used in 39 patients (17 M/22 F, mean age: 71.4 years). The preoperative mean American Society of Anesthesiologists (ASA) score was 1.84 (range: 1-4) for all the patients. AO/OTA classification of fractures was used. In our surgery, we used an external fixator to support the intramedullary nails. All patients were evaluated with Parker-Palmer mobility score and with the Harris hip score.
RESULTS
The follow-up period was 29.2 months (20-56). Two patients experienced nail migration in the knees, two patients had varus deformation with a reduction in length of 2 cm, and seven patients developed pin-track infection. The average Harris score and Parker-Palmer score of the 14 patients who presented for their last follow-up examination were 64 and 6.8, respectively.
CONCLUSION
This method demonstrated several advantages, in that it allows the patient to put weight on the extremity after a shorter period of time and enables the fracture to heal rapidly without any serious complications.

Keywords: Ender nails, external fixators; fracture fixation; hip fractures.

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ATIF KOPYALA