Femur Þaft Kýrýklarýnýn Ýntramedüller Çivilenmesinde, Talon Fiksasyonu Zahmetli Distal Kilitlemeyle Baþa Çýkmada Yararlýdýr, Ancak Vidalarla Konvansiyonel Distal Kilitleme Daha Stabil Bir Yapý Sunar. Talon Femoral Çiviye Karþý Konvansiyonel Femoral Çivi

AMAÇ: Distal kilitlemenin zorluðuyla baþa çýkmak için distal talon açýlýmýna sahip yeni tasarýmlý bir femoral çivi (Talon-FÇ) piyasaya çýkmýþtýr. Bu çalýþmada, femoral þaft kýrýklarýnýn (FÞK) tedavisinde Talon-FÇ’nin radyolojik ve fonksiyonel sonuçlarýnýn konvansiyonel bir femoral çivi (Kon-FÇ) ile karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmaya, Ekim 2014–2018 arasý, FÞK (AO tip 32-A ve B) nedeniyle ameliyat edilen 85 hasta (57 erkek, 28 kadýn; ortalama yaþ: 46.8±23.9 yýl, Talon-FÇ: 41 hasta, Kon-FÇ: 44 hasta) alýndý. Fonksiyonel deðerlendirme için, Diz Yaralanmasý ve Osteoartrit Sonuç Skoru Fiziksel Fonksiyon Kýsa Formu, Kalça Yaralanmasý ve Osteoartrit Sonuç Skoru Fiziksel Fonksiyon Kýsa Formu, Kýsa Kas-Ýskelet Fonksiyon Deðerlendirmesi Rahatsýzlýk ve Disfonksiyon Ýndeksleri kullanýldý.
BULGULAR: Ortalama takip süresi 25.8±6.7 aydý. Talon-FÇ ve Kon-FÇ için komplikasyon oranlarý sýrasýyla %19.6 ve %20.5 idi (p=0.92). Malunion, iki çivi tipi için de en yaygýn komplikasyondu (Talon-FÇ: %9.8, Kon-FÇ: %9.1). Talon-FÇ grubunun tüm malunionlarý aksiyeldi (kýsalýk ve malrotasyon) ve zaman içinde kademeli olarak gerçekleþti. Buna karþýlýk, Kon-FÇ grubunun tüm malunionlarý angülerdi (varus ve valgus) ve malredüksiyon kaynaklý idi. Talon-FÇ grubunun kýsalýðý olan iki hastasýnda (%4.9) AO 32-B tipi kýrýk, malrotasyonu olan diðer ikisinde (%4.9) AO 32-A3 tipi kýrýk vardý ve bu dört kýrýðýn tamamý da femoral istmusun distalinde lokalize idi. Ameliyat sonrasý fonksiyonel sonuçlar gruplar arasýnda benzerdi (tümü p>0.05). Ortalama operasyon/floroskopi süresi ve ortalama kan kaybý Talon-FÇ grubunda daha düþükken, ortalama kaynama süresi Con-FN grubunda daha kýsaydý (tümü p<0.01). Her iki grupta da nonunion görülmedi. Reoperasyon oranlarý iki grupta da yaklaþýk %5 olmak üzere benzerdi (p=0.95). TARTIÞMA: Çalýþma sonuçlarýmýz, Kon-FÇ ile benzer fonksiyonel sonuçlara sahip olan Talon-FÇ’nin ameliyat/floroskopi süresini kýsalttýðýný ve intra-operatif kan kaybýný azalttýðýný ortaya koymuþtur. Bununla birlikte, Kon-FÇ, daha kýsa bir kemik kaynama süresi ile aksiyel maluniona karþý daha stabil bir yapý sunmaktadýr. Talon-FÇ, femoral istmusun distalindeki kýsalýk ve malrotasyona açýk bazý FÞK tiplerinde kullanýlmamalýdýr.

For Intramedullary Nailing of Femoral Shaft Fractures, Talon Fixation is Helpful to Cope With the Troublesome Distal Locking, But Conventional Distal Locking With Screws Offers a More Stable Construct. Talon Femoral Nail Versus Conventional Femoral Nail

BACKGROUND: A novel-design femoral nail (FN) with distal talon deployment (Talon-FN) has emerged in the market to cope with problematic distal locking. We aimed to compare the radiological and functional outcomes of the Talon-FN with a conventional FN (Con-FN) for the treatment of femoral shaft fracture (FSFs).
METHODS: This retrospective study included 85 patients (57 men, 28 women; mean age: 46.8±23.9 years) with FSFs (AO types 32-A and B) who were treated with FNs (Talon-FN: 41, Con-FN: 44) during October 2014–2018. Knee injury and Osteoarthritis Outcome Score Physical Function Shortform, Hip injury and Osteoarthritis Outcome Score Physical Function Shortform, Short musculoskeletal function assessment bother and dysfunction indexes were used for functional assessment.
RESULTS: The mean follow-up time was 25.8±6.7 months. The complication rates were 19.6% and 20.5% for Talon-FN and Con-FN, respectively (p=0.92). Malunion was the most common complication for each FN type (Talon-FN: 9.8%, Con-FN: 9.1%). All of the Talon-FN group’s malunions were axial (shortening and malrotation) and happened gradually. In contrast, the Con-FN group’s malu-nions were angular (varus and valgus) and caused by initial malreduction. The Talon-FN group’s two patients with shortening (4.9%) had AO 32-B type fractures, and the other two with malrotation (4.9%) had AO 32-A3 type fractures, all of four fractures were localized distal to the femoral isthmus. The post-operative functional outcomes were similar between the groups (all p>0.05). The mean op-eration/fluoroscopy time and the mean blood loss were lower in the Talon-FN group, while the mean union time was shorter in the Con-FN group (all p<0.01). No nonunion was noted in either group. The reoperation rates were similar at approximately 5% (p=0.95).
CONCLUSION: Our study results revealed that the Talon-FN shortens the operation/fluoroscopy time and decreases the intra-operative blood loss with similar functional outcomes. However, the Con-FN seems to offer a more stable construct against axial malunion with a shorter bone union time. The Talon-FN should not be used in FSFs distal to the femoral isthmus with certain types of fractures prone to shortening and malrotation.