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The Treatment of Interlocking Intramedullary Nailing in Tibial Diaphyseal Fractures

Year 2009, Volume: 3 Issue: 1, 21 - 27, 19.03.2009

Tolga Tolunay

Abstract

We evaluated the results of interlocking intramedullary nailing in the treatment of tibial diaphyseal fractures. Reamed interlocking intramedullary nailing was performed with closed or mini-open reduction in 23 patients (15 males, 8 females; mean age 36.7 years; range 18 to 60 years). 17 fractures were closed, 6 fractures were open. Reamed and static interlocking intramedullary nailing was performed on all patients. The patient have delayed union patients were dynamisied. Partial weight-bearing was allowed in patients after the observation of callus formation. The evaluation in the study was performed according to Johner and Wrush criteria. The mean follow-up was 16.8 months (range 6 to 21 months). Union was achieved in all patients. Mean union period was 17,4 weeks (range 12 to 60 weeks). In four cases, a valgus angulation of 2-5 degrees was detected that whom had distal third tibial fractures. In one case, an external rotation more than 10° was detected and in another case, grave claudication was detected. In two cases, extremity shortning of 6-10 mm was detected. According to ankle and subtalar mobility; 17 (74%)of the patients had excellent, 5 (21.7%) good, 1 (4.3%) had moderate results. According to Johner and Wrush criteria; 52.5% of the patients had excellent, 34.8% good, 8.7% moderate and 4.3% had bad results. We suggested that reamed interlocking intramedullary nailing is an effective method in tibial diaphyseal fractures because of successful functional results, high union and low complication rates.

Keywords

Bone nails; tibial fractures/surgery; fracture fixation intramedullary/methods one nails

References

  • 1. Kabak Ş, Ergün B, Duygulu F, Balkar B, Tun-cel M. Kapalı ve tip I açık tibia cisim kırıklarında oymalı intramedüller çivi uygulamaları. Açta Orthop Traumatol Turc 2001; 35:411-7.
  • 2. Whittle AP. Fractures of lower extremity. In: Canale ST, ed. Campbell's operative orthopaedics. Vol 3,9th ed. St.Louis: Mosby-Year Book Inc.,1998. p. 2042-179.
  • 3. Ege R. Travmatoloji; kırıklar, eklem ve diğer yaralanmalar. 2004;4:3923-4093.
  • 4. Schmidt AH, Finkemeier CG, Tornetta P. Tre- atment of closed tibial fractures. Ferlic DC. Instructional Course Lectures. Colorado; 2003. p.607-22.
  • 5. Russel TA,Taylor JC, Lavella DG. Fractures of the tibia and fibula.:Fractures,Rockwood, Jr.,Charles a.,Green .David P.ed. 4th ed. J.B Lipincott Co., Newyork; 1996. p.2127-201.
  • 6. Subaşı M, Kesmenli CC, Aslan H, Çakır Ö, Kapukaya A. Tibia kırıklarının intramedüler çivi ile tedavi sonuçları ve bir amputasyon olgusu. Artroplasti Artrosopik cerrahi. 2002 Vol. 13, No.4, (227/232).
  • 7. Reimer BL, Butterfield SL. Comparision of re amed and nonreamed solid core nailing of V bial diaphysis after external fixation. J Ortho) Trauma 1993;279-85.
  • 8. Johner R, Wruhs 0. Classification of tibial shat fractures and correlation with results after rigii internal fixation. Clin Orthop 1983; 178:7-25.
  • 9. Keating JF, Kuo RS, Court-Brown CM. Bifova fractures of the tibia and fibula. J Bone Joirt Surg 1994;76B:395-400.
  • 10. Kenwright J, Gardner T. Mechanical influences on tibial fracture healing. Clin Orthop 1998;358S:179-90.
  • 11. Richardson JB, Gardner TN, Hardy JRW, Evans M, Kuiper JH, Kenwright J. Dynamisa-tion of tibial fractures. J Bone Joint Surg 1995 77B: 412-6.
  • 12. Alho A, Ekeland A, Stromsoe K, Folleras G, Thoresen BO. Locked Intramedullary Nailing for Displaced Tibial Shaft Fractures. J Bone Joint Surg 1990;72B:805-9.
  • 13. Larsen LB, Madsen JE, Hoines PR, Ovre S. Should insertion of intramedullary nails for tibial fractures be with or without reaming? J Orthop Trauma March 2004; 18(3): 144-9.
  • 14. Bechtol JE, Kyle RF, Peren SM. Biomechanics of Intramedullary Nailing Browner BO. the Science and Practice of Intramedullary Nailing. 2nd ed. Williams and Wilkins 1996; 85-105.
  • 15. Chapman MW. The effect of reamed and nonreamed intramedullary nailing on fracture healing. Clin Orthop 1998;355S:230-8.
  • 16. Hutson JJ, Zych GA, Cole JD, Osterman P. Mechanical failures of intramedullar nails ap- plied without reaming.; Clin Orthop 1995;315: 9-137.
  • 17. Adrover AP, Garin MD, Alvarez MJ, Alonso PC. External Fixation and Secondary Intramedullary Nailing of Open Tibial Fractures. A Randomised Prospective Trial. From the Hospital de Sabadel, Barcelona, Spain. JBJS 1990;72(5):729-35.
  • 18. Esterhai JL. Adult Posttraumatic Osteomyelitis of the Tibia. Clinical Orthopaedics and Related Research 1999;1:14-21.
  • 19. Brown CMC, Will E, Christie J, McQueen MM. Reamed Or Unreamed Nailing for Closed Tibial Fractures. A Prospective Study in Tscherne C! Fractures. JBJS 1996;78(B): 580-3.
  • 20. Pape HC, Regal G, Dwenger A, et al: Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma. J Trauma 1993;35:709-16.
  • 21. Blachut PA, O'Brien PJ, Meek RN, Broekhuy-se HM. interlocking intramedullary nailing with and without reaming for the treatment of clo- sed fractures of the tibial shaft. A prospective, randomized study. J Bone Joint Surg Am 1997;79(3):640-6.
  • 22. Keating JF, O’Brien PJ, Blachaut PA, Meek RN . Locking intramedullarry nailing with and without reamimng for open fractures of the tibial shaft. J Bone Joint Surg [Am] 1997;79: 334-41.
  • 23. Cannada LK, Anglen JO, Archdeacon MT, Herscovici D Jr, Ostrum RF. Avoiding complications in the care of fractures of the tibia. J Bone Joint Surg [Am] 2008;90:1760-8.
  • 24. Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators, Bhandari M, Guyatt G, Tornetta P 3rd, Schemitsch EH, Swiontkows-ki M, Sanders D, et al. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg[Am] 2008;90:2567-78.
  • 25. Burç H, Dursun M, Orhun H, Gürkan V, Bayhan İ. Tibia diyafiz kırıklarının oymalı kilitli intramedullar çivi ile tedavisi. Acta Orthop Traumatol Turc 2009;43(1 ):7-13.

Tibia Şaft Kırıklarının Kilitli intramedüller Çivi ile Tedavisi

Year 2009, Volume: 3 Issue: 1, 21 - 27, 19.03.2009

Tolga Tolunay

Abstract

Tibia şaft kırıklarında kilitli intramedüller çivi uyguladığımız hastalarımızın sonuçları değerlendirildi. 23 hastaya (15 erkek, 8 kadın; yaş ortalaması 36.7; dağdım 18-60) kapalı redüksiyon veya mini açık redüksiyon sonrası oymalı ve de kilitli intramedüller çivi de tedavi uygulandı. Tibia kırıklarının 17’si kapalı, 6’sı açık kırık idi. Tüm kırıklara oyma işlemi ve de statik kilitleme uygulandı. Takiplerde kaynamanın geciktiği düşünülen hastalara dinamizasyon uygulandı. Radyografilerde kallus dokusu görüldükten sonra kısmi yüklenmeye izin verildi. Çalışmamızda hastalar, fonksiyonel ve radyolojik olarak Johner ve Wruhs Kriterleri ne göre değerlendirildi. Ortalama takip süresi 16.8 ay (12-21 ay) idi. Hastaların hepsinde kaynama elde edildi. Hastalarımızın ortalama kaynama süresi 17.4 hafta (12-60 hafta) idi. Tibia 1/3 distal kırığı olan 4 hastamızda 2-5 derecelik valgus açılanması saptandı. Hastalarımızdan birinde 10 derecenin üzerinde rotasyon mevcuttu ve bir hastamızda da yürümede belirgin aksama vardı. 2 hastamızda 6-10 mm kısalık mevcut idi. Ayak bileği ve subtalar eklem hareketleri 17 hastada (%74) çok iyi, 5 hastada (%21.7) iyi, 1 (%4.3) hastada orta olarak değerlendirildi. Johner ve Wruhs Kriterlerine göre; %52.5 çok iyi, %34.8 iyi, %8.7 orta, %4.3 kötü sonuç elde edildi. Tibia şaft kırıklarında oymalı ve de kilitli intramedüller çivilemenin, başarılı fonksiyonel sonuçlan, yüksek kaynama ve düşük komplikasyon oranlan nedeniyle etkin bir tedavi yöntemi olduğunu düşünüyoruz.

Dr. Tolga TOLUNAY,
Dr. D. Ali ÖÇGÜDER,
Dr. Bulent BEKTAŞER ,
Dr. Ferhat GÜLER,
Dr. Murat DEMİRDÖĞEN,
Dr. Şükrü SOLAK

Keywords

Kemik çivileri; tibial kırıklar/cerrahi; kınk fıksasyonu intramedüller/yöntem Kemik çivileri

References

  • 1. Kabak Ş, Ergün B, Duygulu F, Balkar B, Tun-cel M. Kapalı ve tip I açık tibia cisim kırıklarında oymalı intramedüller çivi uygulamaları. Açta Orthop Traumatol Turc 2001; 35:411-7.
  • 2. Whittle AP. Fractures of lower extremity. In: Canale ST, ed. Campbell's operative orthopaedics. Vol 3,9th ed. St.Louis: Mosby-Year Book Inc.,1998. p. 2042-179.
  • 3. Ege R. Travmatoloji; kırıklar, eklem ve diğer yaralanmalar. 2004;4:3923-4093.
  • 4. Schmidt AH, Finkemeier CG, Tornetta P. Tre- atment of closed tibial fractures. Ferlic DC. Instructional Course Lectures. Colorado; 2003. p.607-22.
  • 5. Russel TA,Taylor JC, Lavella DG. Fractures of the tibia and fibula.:Fractures,Rockwood, Jr.,Charles a.,Green .David P.ed. 4th ed. J.B Lipincott Co., Newyork; 1996. p.2127-201.
  • 6. Subaşı M, Kesmenli CC, Aslan H, Çakır Ö, Kapukaya A. Tibia kırıklarının intramedüler çivi ile tedavi sonuçları ve bir amputasyon olgusu. Artroplasti Artrosopik cerrahi. 2002 Vol. 13, No.4, (227/232).
  • 7. Reimer BL, Butterfield SL. Comparision of re amed and nonreamed solid core nailing of V bial diaphysis after external fixation. J Ortho) Trauma 1993;279-85.
  • 8. Johner R, Wruhs 0. Classification of tibial shat fractures and correlation with results after rigii internal fixation. Clin Orthop 1983; 178:7-25.
  • 9. Keating JF, Kuo RS, Court-Brown CM. Bifova fractures of the tibia and fibula. J Bone Joirt Surg 1994;76B:395-400.
  • 10. Kenwright J, Gardner T. Mechanical influences on tibial fracture healing. Clin Orthop 1998;358S:179-90.
  • 11. Richardson JB, Gardner TN, Hardy JRW, Evans M, Kuiper JH, Kenwright J. Dynamisa-tion of tibial fractures. J Bone Joint Surg 1995 77B: 412-6.
  • 12. Alho A, Ekeland A, Stromsoe K, Folleras G, Thoresen BO. Locked Intramedullary Nailing for Displaced Tibial Shaft Fractures. J Bone Joint Surg 1990;72B:805-9.
  • 13. Larsen LB, Madsen JE, Hoines PR, Ovre S. Should insertion of intramedullary nails for tibial fractures be with or without reaming? J Orthop Trauma March 2004; 18(3): 144-9.
  • 14. Bechtol JE, Kyle RF, Peren SM. Biomechanics of Intramedullary Nailing Browner BO. the Science and Practice of Intramedullary Nailing. 2nd ed. Williams and Wilkins 1996; 85-105.
  • 15. Chapman MW. The effect of reamed and nonreamed intramedullary nailing on fracture healing. Clin Orthop 1998;355S:230-8.
  • 16. Hutson JJ, Zych GA, Cole JD, Osterman P. Mechanical failures of intramedullar nails ap- plied without reaming.; Clin Orthop 1995;315: 9-137.
  • 17. Adrover AP, Garin MD, Alvarez MJ, Alonso PC. External Fixation and Secondary Intramedullary Nailing of Open Tibial Fractures. A Randomised Prospective Trial. From the Hospital de Sabadel, Barcelona, Spain. JBJS 1990;72(5):729-35.
  • 18. Esterhai JL. Adult Posttraumatic Osteomyelitis of the Tibia. Clinical Orthopaedics and Related Research 1999;1:14-21.
  • 19. Brown CMC, Will E, Christie J, McQueen MM. Reamed Or Unreamed Nailing for Closed Tibial Fractures. A Prospective Study in Tscherne C! Fractures. JBJS 1996;78(B): 580-3.
  • 20. Pape HC, Regal G, Dwenger A, et al: Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma. J Trauma 1993;35:709-16.
  • 21. Blachut PA, O'Brien PJ, Meek RN, Broekhuy-se HM. interlocking intramedullary nailing with and without reaming for the treatment of clo- sed fractures of the tibial shaft. A prospective, randomized study. J Bone Joint Surg Am 1997;79(3):640-6.
  • 22. Keating JF, O’Brien PJ, Blachaut PA, Meek RN . Locking intramedullarry nailing with and without reamimng for open fractures of the tibial shaft. J Bone Joint Surg [Am] 1997;79: 334-41.
  • 23. Cannada LK, Anglen JO, Archdeacon MT, Herscovici D Jr, Ostrum RF. Avoiding complications in the care of fractures of the tibia. J Bone Joint Surg [Am] 2008;90:1760-8.
  • 24. Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators, Bhandari M, Guyatt G, Tornetta P 3rd, Schemitsch EH, Swiontkows-ki M, Sanders D, et al. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg[Am] 2008;90:2567-78.
  • 25. Burç H, Dursun M, Orhun H, Gürkan V, Bayhan İ. Tibia diyafiz kırıklarının oymalı kilitli intramedullar çivi ile tedavisi. Acta Orthop Traumatol Turc 2009;43(1 ):7-13.
There are 25 citations in total.

Details

Primary Language Turkish
Subjects Orthopaedics
Journal Section Research Article
Authors

Tolga Tolunay

Publication Date March 19, 2009
Published in Issue Year 2009 Volume: 3 Issue: 1

Cite

APA Tolunay, T. (2009). Tibia Şaft Kırıklarının Kilitli intramedüller Çivi ile Tedavisi. Türk Tıp Dergisi, 3(1), 21-27.
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