Anstabil tibial kýrýklarýn intramedüller çivileme ile tedavisinde yeni redüksiyona yardýmcý destek çerçevesi: Ýlk sonuçlar

AMAÇ: Anstabil tibial kýrýklarýn yönetimi, proksimal ve distal metafizer bölgenin geniþ olmasý, yumuþak doku problemleri ve zayýf damarlanma nedeniyle zor olabilir. Kullanýlmýþ tübüler eksternal fiksatör sistemleri ile oluþturulan yeni tibial ortopedik redüksiyon desteði (TORS) çerçevesinin redüksiyon ve kýrýk iyileþmesinin kalitesi açýsýndan etkisini manuel traksiyon tekniði ile karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Anstabil tibial kýrýk ile baþvuran ve intramedüller çivileme yapýlan toplam 65 hasta deðerlendirildi; 43 hastaya manuel traksiyon tekniði, 22 hastaya TORS tekniði uygulandý. Ýlk ameliyat sonrasý radyografilerde sagital ve koronal düzlem açýlanmalarý deðerlendirildi ve takip röntgenlerinde tibia kýrýklarý için radyolojik kaynama skorlarý (RUST) karþýlaþtýrýldý.
BULGULAR: Hastalarýn ortalama yaþý manuel traksiyon grubunda 43.49±19.09, TORS grubunda 43.41±16.8 yýl idi. Manuel traksiyon grubunda ortalama koronal düzlem açýlanmasý 1.84±3.16, TORS grubunda ise 1.86±4.21 idi. Manuel traksiyon grubunda ortalama sagital düzlem açýlanmasý 1.19±1.93 ve TORS grubunda 0.32±0.65 idi. Manuel traksiyon grubunda koronal ve sagital düzlem açýlanmasý >5° olanlarýn sayýsý TORS grubuna göre daha yüksekti. 6., 9. ve 12. ay kontrollerindeki ortalama RUST skorlarý TORS grubunda manuel traksiyon grubuna göre anlamlý olarak daha yüksekti. 9. ve 12. ay kontrollerinde TORS grubunda kaynama oranlarý daha yüksekti.
TARTIÞMA: TORS çerçevesi basit ve ucuz bir tekniktir ve stabil olmayan tibial kýrýklarýn intramedüller çivileme ile tedavisinde redüksiyon desteði olarak düþünülmelidir.

A novel reduction support frame for management of unstable tibial fractures with intramedullary nail: Preliminary report

BACKGROUND: Management of unstable tibial fractures (UTF) can be challenging due to widening of the proximal and distal metaphyseal zone, soft tissue problems, and poor vascularity. We aimed to compare the effect of novel tibial orthopedic reduction support (TORS) frame constructed by re-used tubular external fixator systems and manual traction with regard to the quality of re-duction, and fracture healing.
METHODS: A total of 65 patients who were admitted with UTF and underwent intramedullary nailing were assessed; 43 patients un-derwent manual traction technique, and 22 patients underwent TORS technique. The sagittal and coronal plane angulations were eval-uated in initial postoperative radiographs, and radiologic union scores for tibial fractures (RUST) were compared at follow-up X-rays.
RESULTS: The mean age of patients was 43.49±19.09 years in the manual-traction group and 43.41±16.8 years in the TORS group. The mean coronal plane angulation was 1.84±3.16 in the manual traction group and 1.86±4.21 in the TORS group. The mean sagittal plane angulation was 1.19±1.93 in manual traction group and 0.32±0.65 in the TORS group. The number of coronal and sagittal plane angulations >5° was higher in manual traction group than TORS group. The mean RUST was significantly higher in the TORS group than in the manual traction group at 6th, 9th, and 12th-month controls. The union rates were also higher in the TORS group at 9th and 12th-month controls.
CONCLUSION: TORS frame is a simple and cheap technique and should be considered as reduction support in the management of UTF by intramedullary nailing.