65 Yaþ Üstü Ýntertrokanterik Femur Kýrýðý Hastalarýnda Kemik Morfolojisinin Kýrýk Tipine ve Tedavi Sonucuna Etkisi

AMAÇ: Ýntramedüller çivileme (IMÇ) ile tedavi edilen 65 yaþ üstü intertrokanterik kýrýklý hastada kemik morfolojisinin kýrýk tipine ve tedavi sonucuna etkisini araþtýrmayý amaçladýk. Çalýþmanýn birincil sonucu, kýrýk tipi (stabil veya stabil olmayan) ile kemik yoðunluðu arasýndaki iliþkiyi araþtýrmaktýr. GEREÇ VE YÖNTEM: Bu, tek travma merkezinde yürütülen, 2010–2021 yýllarý arasýnda hasta verilerinin deðerlendirildiði, ameliyat sonrasý en az üç aylýk kontrol, ameliyat sonrasý en az üç ay kontrolü olan hastalarý içeren, tek bir travma merkezinde yürütülen geriye dönük bir kohort çalýþmasýdýr. Tüm kýrýklar AO sýnýflandýrma sistemine göre sýnýflandýrýldý. Kliniðimizde 2010–2016 yýllarý arasýnda PFNA, 2016 yýlýndan sonra ise intertan kullanýlmýþtýr. Kemik morfolojisinin deðerlendirilmesi için hem kýrýk tarafýnýn hem de karþý tarafýn ön-arka kalça radyografisinde kanal-kalkar oranýný (KKO), kortikal kalýnlýk indeksi (KKÝ) ölçüldü ve Dorr morfolojisine göre sýnýflandýrýldý. Komplikasyonlar da radyolojik olarak deðerlendirildi. Baþarýsýzlýklar kaynamama veya fiksasyon yetersizliði olarak tanýmlandý. Üçüncü ay kontrol vizitinde kalça grafisi ile aþýrý kollaps ve vida belirginliði de deðerlendirildi. BULGULAR: Bu çalýþmaya 150 kadýn ve 59 erkek dahil edildi. Ortalama yaþ 81.6±8.8 yýldý. Yüz kýrk dört hasta Intertan ile ve 65 hasta býçak tipi IMÇ (PFNA) ile tedavi edildi. Stabil intertrokanterik (A1 tipi) kýrýðý olan 78 hasta, stabil olmayan olan 131 hasta (A2 tipi 109 hasta ve A3 AO tipi kýrýðý olan 22 hasta) vardý. Ortalama KKÝ kýrýk ve etkilenmemiþ femurlarda sýrasýyla 0.469±0.09 ve 0.510±0.09 (p<0.001), KKO kýrýk ve etkilenmemiþ femurlarda sýrasýyla 0.636±0.15 ve 0.568±12 idi (p<0.001) olarak saptandý. Kýrýk tarafýnda 36 hasta Dorr tip A, 115 hasta Dorr tip B ve 48 hasta Dorr tip C ve kýrýk olmayan tarafta is 65 hasta Dorr tip A, 123 hasta Dorr tip B ve 21 hasta Dorr tip C olarak saptandý (p<0.001). Vida (n=14) ve býçak (n=15) belirginliði olan 29 (%13.9) hasta vardý. Otuz hastada (%14.4) aþýrý kollaps görüldü ve 16 hastada (7.7) yetersizlik saptandý. TARTIÞMA: AO sýnýflamasýna göre stabil olmayan kýrýk grubunda stabil gruba göre istatistiksel olarak anlamlý olarak daha fazla yetersizlik saptadýk. Ortalama KTÝ, KKO ve Dorr indeksinin etkilenmeyen tarafa göre kýrýk tarafta anlamlý olarak düþük saptandý ki bu durum kýrýk tarafta daha düþük kemik kalitesi olduðunu gösterir.

The Effect of Bone Morphology on Fracture Type and Treatment Result in Patients with Intertrochanteric Femur Fracture Aged over 65 year

BACKGROUND: We aimed to investigate the effect of bone morphology on fracture type and treatment result in patient with inter-trochanteric fracture (IFF) treated with intramedullary nailing (IMN) aged over 65 years. Primary outcome of study was to investigate the relationship between fracture type (stable or unstable) and bone density.
METHODS: This was a retrospective cohort study conducted at single trauma center which included patients aged >65 years, minimum 3 months’ control postoperatively, patients with simple fall by evaluating the patient data from 2010 to 2021. All fractures were classified based on the AO classification system. Proximal femoral nail anti-rotation was used between 2010 and 2016, while InterTAN was used after 2016 in our clinic practice. For the evaluation of the bone morphology, we measured the canal-to-calcar ratio (CCR) and cortical thickness index (CTI) and classified with Dorr morphology on anteroposterior (AP) hip radiograph of both the fracture side and contralateral sides. Complications were also evaluated on radiological view. Failures were defined as non-union or failure of fixation. Excessive collapse and screw/blade prominence also evaluated by hip radiograph on the 3rd month control visit.
RESULTS: One hundred and fifty females and 59 males were included in this study. The average age was 81.6±8.8 years. One hundred and forty-four patients were treated with InterTAN and 65 patients with helical blade type IMN (PFN-A®). There were 78 patients with stable IFF type A1 fracture and 131 patients with unstable IFF (109 patients with A2 and 22 patients with A3 AO type fracture). The mean CTI was 0.469±0.09 and 0.510±0.09 in the fracture and unaffected side femurs, respectively (p<0.001), the CCR was 0.636±0.15 and 0.568±12 in the fracture and unaffected side femurs, respectively (p<0.001). There were 36 patients with Dorr type A, 115 patients with Dorr type B, and 48 patients with Dorr type C in fracture side and 65 patients with Dorr type A, 123 patients with Dorr type B, and 21 patients with Dorr type C in non-affected side (p<0.001). There were 29 (13.9%) patients with screw (n=14) and blade (n=15) prominence. Excessive collapse was seen 30 patients (14.4%) and 16 patients (7.7) evaluated as a failure.
CONCLUSION: We found a significant difference in the failure rate between unstable group than stable group which higher in unstable group according to the AO classification. In addition, the mean CTI, CCR, and Dorr index were significant difference in fractured side than unaffected side which indicated lower bone quality at fracture side.