The treatment of tibia diaphyseal fractures with locked intramedullary nailing; midterm results

Objectives: The evaluation of the clinical and radiological midterm results of the patients with tibia diaphysis fractures treated by locked intramedullary nails.
Methods: 67 patients with tibia diaphysis fracture who were treated with locked intramedullary nail (45 male, 22 female; mean age 36,9; range 16 to 69) were included in the study. The fractures were on the right side in 42 patients and on the left side in 25 patients. The mean period between the operation and the onset of the fracture was 12 days (range 1-35 days) and the mean follow-up period was 46,5 months (range 6 to 123 months). The results were evaluated according to Johner-Wruhs criteria.
Results: In our study group, the average time to union was 21,1 weeks (median 18 weeks, range 6 to 36 weeks). According to the Johner-Wruhs criteria; of 67 patients, the results were excellent in 36 patients (53,7%), good in 17 patients (25,3%), fair in 7 patients (%10,5) and poor in 7 patients (10,5%). 14 patients (20,9%) with malalignment and 12 patients (17,9%) with restriction of adjacent joint motion were also reported.
Conclusion: Malalignment and the restriction of adjacent joint motion were found to be the two important factors responsible of the decrease in the clinical satisfaction rates. We believe that in order to fix those two factors; proper reduction of the fracture during the primery surgery, welldetermination of the cases necessiating statical locking, much care taken about dinamisation and weight bearing times and an appropriate rehabilitation program are mandatory.

Tibia diyafiz kýrýklarýnýn kilitli intramedüller çivileme ile tedavisinde orta dönem sonuçlarýmýz

Amaç: Tibia diafiz kýrýðý nedeniyle kilitli intramedüller çivi uygulanan hastalarýn klinik ve radyografik orta dönem sonuçlarýnýn deðerlendirilmesi.
Çalýþma planý: Tibia diafiz kýrýðý nedeniyle kilitli intramedüller çivi ile internal tespit uygulanan 67 hasta (45 erkek, 22 kadýn; ort. yaþ 36,9; daðýlým 16-69) çalýþmaya dahil edildi. Kýrýklar 42 hastada sað, 25 hastada ise sol tarafta idi. Hasta grubumuzda, kýrýðýn oluþ anýndan ameliyata kadar geçen süre ortalama 12 gün (daðýlým 1–35 gün), ortalama takip süresi ise 46,5 ay (daðýlým 6–123 ay) idi. Takip sonuçlarý Johner ve Wruhs kriterlerine göre deðerlendirildi.
Sonuçlar: Çalýþma grubumuzda ortalama kaynama süresi 21,1 hafta olarak bulundu (medyan 18 hafta, daðýlým 6–36 hafta). Johner ve Wruhs kriterlerine göre 67 olgunun 36’sýnda (%53,7) mükemmel, 17’sinde (%25,3) iyi, 7’sinde (%10,5) orta ve 7’sinde (%10,5) kötü sonuç elde edildi. 67 olgunun 14’ünde (%20,9) açýsal dizilim kusuru, 12’sinde (%17,9) komþu eklem hareket kýsýtlýlýðý görüldü.
Çýkarýmlar: Bu çalýþma grubunda klinik baþarý oranýný düþüren en önemli iki faktörün açýlý kaynama ve komþu eklem hareket kýsýtlýlýðý olduðu görüldü. Bu iki problemin de, primer cerrahi esnasýnda kýrýk redüksiyonuna dikkat edilmesi, sistemin statik kilitlenmesini gerektiren olgularýn iyi belirlenmesi, dinamizasyon ve yük verme zamanýna daha dikkatli karar verilmesi, ayný zamanda bu hastalarýn düzgün bir rehabilitasyon programýna alýnmasý gerekliliði ortaya çýkmýþtýr.