Ulus Travma Acil Cerrahi Derg. 2007; 13(2): 115-121

Çocuk femur cisim kýrýklarýnda esneyebilen intramedüller çivi uygulamasý

Cem Nuri Aktekin, Akif Muhtar Öztürk, Murat Altay, Ali Toprak, Bülent Özkurt, Abdullah Yalçýn Tabak
Ankara Numune Eðitim Ve Araþtýrma Hastanesi Ortopedi Ve Travmatoloji Kliniði, Ankara, Türkiye

AMAÇ: 6-12 yaþ arasý çocuklarda femur cisim kýrýklarýnýn tedavisinde farklý tedavi yöntemleri uygulanmaktadýr. Titanyum elastik çivi de bunlardan biridir ve çalýþmamýzda kliniðimizin bu uygulamayla ilgili sonuçlarý araþtýrýldý.
GEREÇ-YÖNTEM: Kliniðimizde retrograd titanyum elastik çiviyle tespit uygulanan femur cisim kýrýklý 21 hasta incelendi. BULGULAR: Hastalar 5,1-14,7 yaþlarýnda ortalama 9,6±2,4 yaþta ve bütün kýrýklar femur diyafizinde idi. Kýrýklarýn dokuzu (%42,9) transvers, yedisi (%33,3) oblik, beþi de (%23,8) spiraldi. Kýrýk redüksiyonu 9 hastada (%42,9) kapalý, 12 hastada (%57,1) lateralden mini insizyonla açýk olarak yapýldý. Çivilerin biri medial diðeri ise lateralden olmak üzere iki adet ve retrograd yöntemle gönderildi. Ameliyat sonrasý dönemde 8 hastaya (%38) alçý atel uygulandý. Hastalarýn ortalama takip süresi 29±11,6 ay (9-48) olarak gerçekleþti. Ortalama 13±11,9 haftada (4-52) tam kaynama saptandý. Ortalama 7±2,2 ayda (6-16) implantlar çýkarýldý. Ameliyat sonrasý birinci yýlda tüm hastalarýn kalça ve diz hareket geniþlikleri tamdý ve klinik olarak rotasyonel veya açýsal deformite saptanmadý. Radyolojik olarak 8 hastada ortalama 11±1,7 (10-15) derecelik varus-valgus deformitesi görülmesine raðmen iki yýllýk takip sonucunda bu açý ortalama 5±1,9 (3-9) dereceye düþtü. SONUÇ: 6-12 yaþ arasý çocuklardaki femur cisim kýrýklarýnýn tedavisinde titanyum elastik çiviyle tespitin sonuçlarý, bu grup hastalarýn tedavisinde ilgili yöntemin ilk tercih olabileceðini düþündürmektedir.

Anahtar Kelimeler: Biyomekanik, kemik çivileri; çocuk; elastik çivileme; pediatrik femur diyafiz kýrýklarý.

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Flexible intramedullary nailing of the children

Cem Nuri Aktekin, Akif Muhtar Öztürk, Murat Altay, Ali Toprak, Bülent Özkurt, Abdullah Yalçýn Tabak
Ankara Numune Research And Training Hospital Orthopaedy And Taumatoulogy Clinic, Ankara, Turkey

BACKGROUND: Various methods are being used in the treatment of femur diaphysial fractures in children aged between 6 to 12 years. Titanium elastic nailing is one of the alternatives. We evaluated our experience in flexible intramedullary nailing.
METHODS: We investigated 21 patients with femur diaphysial fractures who were with titanium elastic nailing. RESULTS: The mean age of the patients was 9.6±2.4 (range between 5.1-14.7 years) and all the fractures were at the diaphyisis. The fracture pattern was as following: 9 (42.9%) transverse, 7 (33.3%) oblique, 5 (23.8%) spiral. Fixations were performed with two nails which were implanted in retrograde manner. The average time of follow-up was 29±11.6 months (range; 9-48 month). The mean time to fracture union was 13±11.9 weeks (4-52). Implant removal was performed after a mean time of 7±2.2 months (range; 6-16 month). Patients’s hip and knee range of motions were complete and clinically there were no angular or rotational deformity at postoperative one year. There were radiologically 11±1.7 (range; 10-15) degrees of varus valgus malalignment in 8 patients; these angles were reduced to 5±1.9 (range; 3-9) degrees at the follow of two years. CONCLUSION: The results of the flexible titanium nailing in femur diaphysial fractures of the children, aged between 6 to 12 years, suggest that this method may be a first choice therapy in this particular group of patients.

Keywords: Biomechanics, bone nails; child; flexible nailing; fediatric femur diaphyseal fractures.

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