Ýnstabil intertrokanterik kýrýklarda iki farklý proksimal femoral çivinin radyolojik parametreler açýsýndan karþýlaþtýrýlmasý

AMAÇ: Bu çalýþmanýn amacý instabil intertrokanterik kýrýðý olan 65 yaþ üzeri mobil hastalarda kapalý redüksiyon ve proksimal femoral çivileme tedavisinde kullanýlan iki farklý çiviyi radyolojik parametreler açýsýndan karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Haziran 2013 ve Aðustos 2018 tarihleri arasýnda tek merkezde intertrokanterik kýrýk tanýsý ile kapalý redüksiyon ve internal fiksasyon uygulanan ameliyat öncesi mobil olan 65 yaþý üzerinde 108 olgu çalýþmaya dahil edildi. Olgular kullanýlan proksimal femoral çiviye göre 2 gruba ayrýldý (Intertan (IT) ve Talon Distal Fix Nail/Lag Screw (TDFN)). Gruplar yaþ, cinsiyet, komplikasyon oranlarý ve radyolojik parametrelerine (redüksiyon kalitesi, tip apex distance (TAD), Parker indeksi, kaynama zamaný, cut out oraný, varus kollapsý) göre karþýlaþtýrýldý.
BULGULAR: Gruplar arasýnda yaþ, cinsiyet, kaynama zamaný ve postoperatif ilk grafide ölçülen redüksiyon kalitesi, Parker indeksi, kollodiafizyal açý açýsýndan fark yoktu. Postoperatif ilk grafide IT grubunda 12, TDFN grubunda 5 olguda TAD ölçümü 25 mm üzerindeydi. TAD ölçümünün yüksek olduðu hasta sayýsýnýn istatistiksel olarak IT grubunda fazla olmasýna raðmen varus kollapsý ve cut out komplikasyonlarýnýn TDFN çivisinde istatistiksel olarak fazla görüldüðü gözlendi. IT kullanýlan grupta 4 olguda çivi baðýmlý komplikasyona rastlandý. (3 olguda trokanter majör kýrýðý, 1 olguda distal vida yerinden femur kýrýðý) TDFN grubunda çivi dizaynýna baðlý komplikasyona rastlanmadý.
TARTIÞMA: Varus kollapsý ve cut out komplikasyonlarýný önlemekte ve radyolojik parametrelerin kýrýk kaynamasýna kadar devamlýlýðýný saðlamakta intertan çivisinin odi çivisine göre daha üstün olduðu saptandý. Bunun yanýnda intertan çivisi kullanýlan hastalarda komplikasyon oranýnýn daha yüksek olmasý bu çivinin handikapý olarak görüldü.

Comparison of two different proximal femoral nails in instabil intertrochanteric fractures concerning radiological parameters

BACKGROUND: The aim of this study was to compare two different nail types (i.e., Intertan (IT) and Talon Distal Fix Nail / Lag Screw (TDFN)) used in the treatment of unstable intertrochanteric fractures in mobile patients over 65 years of age in terms of radiological parameters.
METHODS: Between June 2013 and August 2018, 106 patients over 65 years old who were operated with closed reduction and internal fixation for intertrochanteric fractures were included in this single-center study. Patients were divided into two groups based on the proximal femoral nail used: IT group and TDFN group. These two groups were compared in terms of age, sex, complication rates and radiological parameters (i.e., reduction quality, tip apex distance (TAD), Parker index, union time, cut-out rate, and varus collapse).
RESULTS: There were no differences between the groups in terms of age, sex, fracture union time as well as reduction quality measured on the first postoperative radiograph, Parker index, and collodiaphysial angle. In the first postoperative radiographs, TAD was higher than 25 mm in 12 patients in the IT group and in 5 patients in the TDFN group. Although the number of patients with high TAD was more than that of the IT group, varus collapse and the cut-out complications were higher in TDFN nail. In the IT group, nail-dependent complications emerged in 4 patients (trochanter major fracture in 3 cases, femoral fracture in distal screw in 1 case) while there was no complication in the TDFN group.
CONCLUSION: Intertan nail is superior to TDFN in preventing varus collapse and the cut-out complications as well as in maintaining of radiological parameters until fracture union. On the other hand, the higher complication rate is a disadvantage of this nail.