| dc.creator |
KOVALAK, Emrah; SÜLEYMAN DEMİREL ÜNİVERSİTESİ TIP FAKÜLTESİ |
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| dc.date |
2021-09-13T00:00:00Z |
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| dc.date.accessioned |
2021-12-03T11:46:53Z |
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| dc.date.available |
2021-12-03T11:46:53Z |
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| dc.identifier |
https://dergipark.org.tr/tr/pub/sdutfd/issue/64881/459407 |
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| dc.identifier |
10.17343/sdutfd.459407 |
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| dc.identifier.uri |
http://acikerisim.sdu.edu.tr/xmlui/handle/123456789/94109 |
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| dc.description |
ObjectivePertrochanteric fractures consist 50% of the hipfractures with a high rate of morbidity. The primary aimin treatment is anatomic reduction, preserving of thereduction with stable fixation and early mobilizationwith rehabilitation. Dynamic hip screws (DHS) areaccepted as the golden standard in treatment of thethese fractures. On the other hand, fixed angle plates,intramedullary nails and external fixators are also used.However, there is no consensus on the implant choicein the management of intertrochanteric fracturesparticularly for the unstable fractures. The aim of thepresent study is to discuss the functional results ofthe extramedullary stabilization of intertrochantericfractures in the light of the current literature.Materials and MethodsIn the present study, the patients over 18 years of agewho had Evans type 1 and type 2 intertrochantericfractures that were managed by open reduction andinternal fixation and, completed post-operative 1yearretrospectively evaluated. Varus, valgus angulationand loss of reduction evaluated in the anteriorposteriorradiographs. Harris Hip Score (HHS) andTraumatic Hip Scale (THS) were used to assessfunctional evaluation.ResultsEighteen patients were included in the study. Meanage of the patients was 52,5 years old, mean stay inthe hospital was 7 days and mean follow-up time was22 months. Cause of the admission to the hospitalwas traffic accident in 4 patients and was falling in14 patients. Seventeen of the fractures were type1 and one was type 2. Ten of the type 1 fractureswere stable and, 7 were unstable. DHS was usedin 13 of the patients and, DCS was used in 5 of thepatients. Functional results according to HHS; 14excellent, 3 good, 1 poor and according to THS; 9excellent, 7 good, 1 poor and 1unsuccessful.Varusangulation occurred in 12 patients with a mean angleof 8,25°and, valgus angulation occurred in 3 patientswith a mean angle of 4,6°. In 3 patients (Evans type1 unstable) no change occurred in neck-shaft angle.Mean sliding was 5,34 mm in unstable fractures and,was 1,76 mm in stable fractures.Non-union, cutoutand femoral shaft medialization, infection, deepvenous thrombosis, pulmoner emboli and myositisossificans was seen in none of the patients.ConclusionType of the fracture is one of the important factorsaffecting mortality. Mechanically stable reduction andpreserving of the reduction is the main effect thatprovides success. The increased revision incidencealso increases mortality. The present literature is faraway from describing the ideal implant. But, everyimplant has own advantages and disadvantages.Proximal femoral nails seem more advantageous thanDHS considering implant failure, bleeding amountand shorter hospitalization time. And also, proximalanatomic plates must be kept in mind for the certaintypes of the fractures. |
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| dc.description |
AmaçPertrokanterik kırıklar kalça kırıklarının yaklaşık %50’sini oluşturan, yüksek oranlarda mortaliteye sahip kırıklardır.Tedavideki temel amaç anatomik redüksiyon,redüksiyonun stabil bir tespit ile korunması ve erkenmobilizasyon ile rehabilitasyondur. Dinamik kalça vidaları(DHS) intertrokanterik kırıkların tedavisinde altınstandart olarak kabul edilmekle beraber, sabit açılıplaklar, intramedüller çiviler ve eksternal fiksatörlerde kullanılmaktadır. Ancak, özellikle instabil kırıklarolmak üzere kesin kabul görmüş bir tespit materyaliyoktur. Bu çalışma ile intertrokanterik kırıkların ekstramedüllertespitinin fonksiyonel sonuçlarının güncelliteratürün ışığında tartışılması amaçlandı.Gereç ve YöntemEvans tip 1 ve tip 2 intertrokanterik femur kırığı tanısıile açık redüksiyon ve internal tespit yapılan, ameliyatsonrası 1 yılı tamamlamış 18 yaş üstü hastalar retrospektifolarak değerlendirildi. Anteroposterior ve lateralradyografilerde, varus – valgus açılanması ve redüksiyonkaybına bakıldı. Fonksiyonel skorlama amacı ileHarris Kalça Skoru (HHS) ve Travmatik Kalça Skalası(TKS) kullanıldı.BulgularÇalışmaya 18 hasta alındı. Yaş ortalaması 52,5 yıl,hastanede kalış süresi ortalama 7 gün ve takip süresi22 ay idi. Hastaların 4’ü trafik kazası, 14’ü düşmenedeni ile başvurmuş idi. Kırıkların 17’si tip 1, biritip 2 idi. Tip 1 kırıkların 10’u stabil, 7’si instabil idi. 13hastada dinamik kalça vidası (DHS), 5 hastada dinamikkondiler vida (DCS) kullanılmış idi. Fonksiyonelsonuçlar HHS göre 14 hastada mükemmel, 3 hastadaiyi, 1 hastada kötü sonuç. TKS göre 9 hasta mükemmel,7 hasta iyi,1 hasta kötü, 1 hasta başarısız olarakdeğerlendirildi. 12 hastada varus açılanması (ortalama8,25°), 3 hastada valgus açılanması (ortalama4,6°) saptandı. 3 hastada (Evans tip 1 instabil) boyuncisimaçısında değişim saptanmadı. Kayma miktarıinstabil kırıklarda ortalama 5,34 mm. ve stabil kırıklarda1,76 mm. idi. Hiçbir hastada non-union, cut-outve femur cisim medializasyonu, enfeksiyon, derin ventrombozu, pulmoner emboli ve myositis ossifikans görülmedi.Bir hastada mal-union gelişti ancak revizyonyapılmadı.SonuçKırık tipi ameliyat sonrası dönemde mortaliteyi etkileyenönemli faktörlerden olup mekanik olarak stabil redüksiyonve bunun korunması başarıyı sağlayan anaetkendir. Artan revizyon insidansı mortaliteyi de arttırmaktadır.Mevcut literatür ideal implantı tarif etmektenuzak olmakla beraber her bir implantın kendine özgüavantaj ve dezavantajları vardır. Proksimal femoral çiviler,implant yetmezliği, kanama miktarı, kısa hastanedekalış süresi ile DHS’ye göre daha avantajlı gözükmektedir.Proksimal femoral anatomik plaklar da kırık tipine göre alternatif olarak akılda bulundurulmalıdır. |
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| dc.format |
application/pdf |
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| dc.language |
tr |
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| dc.publisher |
Süleyman Demirel Üniversitesi |
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| dc.publisher |
Süleyman Demirel University |
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| dc.relation |
https://dergipark.org.tr/tr/download/article-file/610983 |
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| dc.source |
Volume: 28, Issue: 3
371-378 |
en-US |
| dc.source |
1300-7416 |
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| dc.source |
2602-2109 |
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| dc.source |
SDÜ Tıp Fakültesi Dergisi |
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| dc.subject |
intertrochanteric fracture,dynamic hip screw,hip fracture |
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| dc.subject |
intertrokanterik kırık,dinamik kalça çivisi,kalça kırıkları |
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| dc.title |
EXTRAMEDULLARY FIXATION, FUNCTIONAL RESULTS AND THE CURRENT LITERATURE IN INTERTROCHANTERIC FRACTURES OF FEMUR |
en-US |
| dc.title |
İNTERTROKANTERİK FEMUR KIRIKLARINDA EKSTRAMEDÜLLER TESPİT, FONKSİYONEL SONUÇLAR VE GÜNCEL LİTERATÜR |
tr-TR |
| dc.type |
info:eu-repo/semantics/article |
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