Subtrokanterik Kırıklarda İntramedüller Çivileme

Tayfun Aman

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

Aman T. Subtrokanterik Kırıklarda İntramedüller Çivileme. Açan AE, Tokyay A, editör. Alt Ekstremitede İntramedüller Çivileme ve Komplikasyonları. 1. Baskı. Ankara: Türkiye Klinikleri; 2024.p.49-55.

ÖZET

Kalça kırıkları; 100.000 kişide yaklaşık 187,2 (2019) insidansa sahip olup dünya çapında önemli bir halk sağlığı sorunudur. Sakatlığa, yaşam kalitesinin düşmesine ve mortaliteye yol açarak önemli mor- bitide ve mortalite kaynağıdır. Subtrokanterik femur kırıkların tedavisinde çeşitli teknikler bildirilmiş olmasına rağmen erişkin travma grubunda tedavinin temelini intramedüller fiksasyon (imn) oluşturmaktadır. Diğer tekniklere göre intramedüller fiksasyonun belirgin mekanik avantajları bulunmaktadır. Subtrokanterik kırıklarda, proksimal parça gluteus medius ve minimus tarafından abdüksiyona alınır. İliopsoas da proksimal parçayı fleksiyona getirir ve dışarı doğru döndürür. Distal parça ise adduktor ve hamstringlerin kısalması sonucu varusa düşer. Bu üç kuvvet vektörü, kırığın uygun anatomik pozisyonda hizalanması ve nötralize edilmesi için zorlu bir durum yaratır. Tüm bu zorluklara nedeniyle subtrokanterik kırık cerrahisinde malpozisyonda kaynamaların engellenmesi için uygun redüksiyon ve stabil tespit büyük önem arz etmektedir. Travma yönetiminde ise özellikle yaşlı hasta popülasyonunun etkilendiği bu durumda inter disipliner yaklaşımlı geriatrik bakımın uygulanmasıyla, hastanede komplikasyon oranlarının azaldığı, hastanede kalış sürelerinin kısaldığı ve tekrar yatışların azaldığı gösterilmiştir.

Anahtar Kelimeler: Subtrokanterik femur kırıkları; İntramedüller çivileme; Geriatri

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