İntramedüller Çivileme Komplikasyonları – 1: Alingment, Rotasyon, Uzamış Floroskopi Süresi

Tolga Sezer

Sancaktepe Şehit Prof. Dr. İlhan Varank EAH, Ortopedi ve Travmatoloji, İstanbul, Türkiye

Sezer T. İntramedüller Çivileme Komplikasyonları – 1: Alingment, Rotasyon, Uzamış Floroskopi Süresi. Açan AE, Tokyay A, editör. Alt Ekstremitede İntramedüller Çivileme ve Komplikasyonları. 1. Baskı. Ankara: Türkiye Klinikleri; 2024.p.151-159.

ÖZET

İntramedüller çivi kullanımı sık uygulanan bir tedavi yöntemidir, ancak malaligment ve malrotasyon gibi komplikasyonlara neden olabilir. Ameliyat sonrası torsiyonel deformiteler yeterince telafi edil- diğinde, malrotasyon asemptomatik kalabilir ve uzun vadeli fonksiyonel sonuçlarda farklılık olma- yabilir. Ancak, femur ve tibia malrotasyonu yanlış hizalanmalara ve osteoartrit riskine yol açabilir. Çoğu zaman, bu durum ilk ameliyat sırasında titiz preoperatif planlama ve intraoperatif floroskopinin dikkatli kullanımı ile önlenebilir. İntramedüller çivi uygulanan femur ve tibia kırıklarında, ameliyat esnasında rotasyonun değerlendirilmesi için pek çok yöntem vardır. Her bir teknik, yaralanmamış eks- tremitenin floroskopik görüntülerini, yaralı ekstremiteye anatomi kazandırmak için bir şablon olarak kullanır. Rotasyonel deformiteyi en aza indirmek için daha objektif intraoperatif yöntemler bulmaya yönelik yapılan çalışmalar sınırlıdır. Daha fazla araştırma yapılması ve farklı anatomik varyasyonlar göz önünde bulundurulması gerekmektedir. Ayrıca farklı bireylerde anatomik varyasyonlar göz önünde alınarak büyük rotasyonel hataların önlenmesi için ek kontroller yapılmalıdır. Ancak, rotasyonel hiza- lanmayı klinik muayene ile değerlendirmek hala zordur.

Anahtar Kelimeler: Kemik çivileri; İntramedüller kırık sabitlenmesi; Kemik dizilim bozukluğu

Referanslar

  1. Ritchie, R.O. 2010. How does human bone resist fracture? Ann. N.Y. Acad. Sci. 1192: 72-80. [Crossref]  [PubMed]
  2. Betts, D.C. & R. Muller. 2014. Mechanical regulation of bone regeneration: theories, models, and experiments. Front. Endocrinol. 5: 1-14. [Crossref]  [PubMed]  [PMC]
  3. Lindsey JD, Krieg JC. Femoral malrotation following intramedullary nail fixation. J Am Acad Orthop Surg 2011;19(1):17-26. [Crossref]  [PubMed]
  4. Kim TY, Lee YB, Chang JD, et al. Torsional malalignment, how much significant in the trochanteric fractures? Injury 2015;46(11):2196-200. [Crossref]  [PubMed]
  5. Mavrogenis AF, Panagopoulos GN, Megaloikonomos PD, et al. Complications after hip nailing for fractures. Orthopedics 2016;39(1):e108-16. [Crossref]
  6. Yang KH, Han DY, Jahng JS, et al. Prevention of malrotation deformity in femoral shaft fracture. J Orthop Trauma 1998;12(8):558-62. [Crossref]  [PubMed]
  7. Ramanoudjame M, Guillon P, Dauzac C, et al. CT evaluation of torsional malalignment after intertrochanteric fracture fixation. Orthop Traumatol Surg Res 2010;96(8):844-8. [Crossref]  [PubMed]
  8. Karaman O, Ayhan E, Kesmezacar H, et al. Rotational malalignment after closed intramedullary nailing of femoral shaft fractures and its influence on daily life. Eur J Orth Surg Traumatol 2014; 24(7):1243-7. [Crossref]  [PubMed]
  9. Braten M, Terjesen T, Rossvoll I. Torsional deformity after intramedullary nailing of femoral shaft fractures. Measurement of anteversion angles in 110 patients. J Bone Joint Surg Br 1993;75(5): 799-803. [Crossref]  [PubMed]
  10. Jaarsma RL, Pakvis DF, Verdonschot N, et al. Rotational malalignment after intramedullary nailing of femoral fractures. J OrthopTrauma2004;18(7):403-9. [Crossref]  [PubMed]
  11. Krettek C, Miclau T, Grun O, et al. Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury 1998; 29(Suppl 3):C29-39. [Crossref]  [PubMed]
  12. Puloski S, Romano C, Buckley R, et al. Rotational malalignment of the tibia following reamed intramedullary nail fixation. J Orthop Trauma 2004; 18(7):397-402. [Crossref]  [PubMed]
  13. Theriault B, Turgeon AF, Pelet S. Functional impact of tibial malrotation following intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am 2012;94(22):2033-9. [Crossref]  [PubMed]
  14. Jafarinejad AE, Bakhshi H, Haghnegahdar M, et al. Malrotation following reamed intramedullary nailing of closed tibial fractures. Indian J Orthop 2012;46(3):312-6. [Crossref]  [PubMed]  [PMC]
  15. Gugala Z, Qaisi YT, Hipp JA, et al. Long-term functional implications of the iatrogenic rotational malalignment of healed diaphyseal femur fractures following intramedullary nailing. Clin Biomech (Bristol, Avon) 2011;26(3):274-7. [Crossref]  [PubMed]
  16. van der Schoot DK, Den Outer AJ, Bode PJ, et al. Degenerative changes at the knee and ankle related to malunion of tibial fractures. 15-year follow-up of 88 patients. J Bone Joint Surg Br 1996;78(5):722-5. [Crossref]  [PubMed]
  17. Jaarsma RL, Ongkiehong BF, Gruneberg C, et al. Compensation for rotational malalignment after intramedullary nailing for femoral shaft fractures. An analysis by plantar pressure measurements during gait. Injury 2004;35(12):1270-8. [Crossref]  [PubMed]
  18. Tornetta P, Ritz G, Kantor A. Femoral torsion after interlocked nailing of unstable femoral fractures. J Trauma 1995;38(2):213-9. [Crossref]  [PubMed]
  19. Gugenheim JJ, Probe RA, Brinker MR. The effects of femoral shaft malrotation on lower extremity anatomy. J Orthop Trauma. 2004; 18:658-664. [Crossref]  [PubMed]
  20. Lee TQ, Anzel SH, Bennett KA, Pang D, Kim WC. The influence of fixed rotational deformities of the femur on the patellofemoral contact pressures in human cadaver knees. Clin Orthop Relat Res. 1994:69-74. [Crossref]
  21. Eckhoff DG, Kramer RC, Alongi CA, et al. Femoral anteversion and arthritis of the knee. J Pediatr Orthop. 1994; 14:608-610. [Crossref]  [PubMed]
  22. Tetsworth K, Paley D. Malalignment and degenerative arthropathy. Orthop Clin North Am. 1994; 25:367-377. [Crossref]  [PubMed]
  23. Sharma L, Song J, Felson DT, et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 2001; 286:188-195. [Crossref]  [PubMed]
  24. Kettelkamp DB, Hillberry BM, Murrish DE et al. Degenerative arthritis of the knee secondary to fracture malunion. Clin Orthop Relat Res. 1988; 234:159-169. [Crossref]
  25. Jaarsma RL, van Kampen A. Rotational malalignment after fractures of the femur. J Bone Joint Surg Br. 2004; 8:1100- 1104. [Crossref]  [PubMed]
  26. Svoboda SJ, McHale K, Belkoff SM, et al. The effects of tibial malrotation on the biomechanics of the tibiotalar joint. Foot Ankle Int 2002;23(2):102-6. [Crossref]  [PubMed]
  27. Patel NM, Yoon RS, Cantlon MB, et al. Intramedullary nailing of diaphyseal femur fractures secondary to gunshot wounds: predictors of postoperative malrotation. J Orthop Trauma 2014;28(12):711-4. [Crossref]  [PubMed]
  28. Stephen DJ, Kreder HJ, Schemitsch EH, et al. Femoral intramedullary nailing: comparison of fracture-table and manual traction. A prospective, randomized study. J Bone Joint Surg Am 2002; 84(9):1514-21. [Crossref]  [PubMed]
  29. Dugdale TW, Degnan GG, Turen CH. The use of computed tomographic scan to assess femoral malrotation after in- tramedullary nailing. A case report. Clin Orthop Relat Res 1992;(279):258-63. [Crossref]
  30. Liodakis E, Doxastaki I, Chu K, et al. Reliability of the assessment of lower limb torsion using computed tomography: analysis of five different techniques. Skeletal Radiol 2012;41(3):305-11. [Crossref]  [PubMed]
  31. Krettek, C., Blauth, M., Miclau, T., Rudolf, J., Könemann, B., & Schandelmaier, P. (1996). Accuracy of intramedullary templates in femoral and tibial radiographs. The Journal of Bone & Joint Surgery British Volume, 78-B (6), 963-964. [Crossref]
  32. Deshmukh RG, Lou KK, Neo CB, Yew KS, Rozman I, George J. A technique to obtain correct rotational alignment during closed locked intramedullary nailing of the femur. Injury. 1998;29: 207-210. [Crossref]  [PubMed]
  33. Jaarsma RL, Verdonschot N, van der Venne R, van Kampen A. Avoiding rotational malalignment after fractures of the femur by using the profile of the lesser trochanter: an in vitro study. Arch Orthop Trauma Surg. 2005; 125:184-187 [Crossref]  [PubMed]
  34. Marchand, Lucas S et al. "Is the Lesser Trochanter Profile a Reliable Means of Restoring Anatomic Rotation After Femur Fracture Fixation." Clinical orthopaedics and related research vol. 476,6 (2018): 1253-1261. [Crossref]  [PubMed]  [PMC]
  35. Braten M, Tveit K, Junk S, et al. The role of fluoroscopy in avoiding rotational deformity of treated femoral shaft fractures: an anatomical and clinical study. Injury 2000;31(5):311-5. [Crossref]  [PubMed]
  36. Ruedi TP, Murphy WM. AO Principles of Fracture Management. New York: Thieme; 2000:210-214.
  37. Bell AL, Brand RA. Roentgenographic changes in proximal femoral dimensions due to hip rotation. Clin Orthop Relat Res. 1989;240: 194-199. [Crossref]
  38. Eckrich SG, Noble PC, Tullos HS. Effect of rotation on the radiographic appearance of the femoral canal. J Arthroplasty. 1994; 9:419-426. [Crossref]  [PubMed]
  39. Feik SA, Thomas CD, Bruns R, et al. Regional variations in cortical modeling in the femoral mid-shaft: sex and age differences. Am J Phys Anthropol. 2000; 112:191-205. [Crossref]
  40. Langer, Jakub S et al. "The cortical step sign as a tool for assessing and correcting rotational deformity in femoral shaft fractures." Journal of orthopaedic trauma vol. 24,2 (2010): 82-8. [Crossref]  [PubMed]
  41. Reikeras O, Høiseth A, Reigstad A, et al. Femoral neck angles: a specimen study with special regard to bilateral differences. Acta Orthop Scand 1982; 53(5):775-9. [Crossref]  [PubMed]
  42. Clementz BG. Assessment of tibial torsion and rotational deformity with a new fluoroscopic technique. Clin Orthop Relat Res 1989;(245):199-209. [Crossref]
  43. Bleeker, Nils Jan et al. "Intraoperative fluoroscopic protocol to avoid rotational malalignment after nailing of tibia shaft fractures: introduction of the 'C-Arm Rotational View (CARV)'." European journal of trauma and emergency surgery : official publication of the European Trauma Society vol. 49,6 (2023): 2329-2336. [Crossref]  [PubMed]  [PMC]
  44. Cain ME, Hendrickx LAM, Bleeker NJ, Lambers KTA, Doorn berg JN, Jaarsma RL. Prevalence of rotational malalignment after intramedullary nailing of Tibial shaft fractures: can we reliably use the contralateral uninjured side as the reference standard? J Bone Joint Surg Am. 2020;102(7):582-91. [Crossref]  [PubMed]
  45. Clementz BG, Magnusson A. Assessment of tibial torsion employing fluoroscopy, computed tomography and the cryosectioning technique. Acta Radiol 1989;30(1):75-80. [Crossref]