Evaluatýon Of The Causes Of Faýlure In Elderly Patýents After Dýfferent Fýxatýon Methods In Pertrochanterýc Femur Fractures

INTRODUCTION: To investigate the efficiency and failure of different fixation methods in trochanteric region fractures owing to different biomechanics of older bone. The causes of failure in different fracture types were evaluated in accordance with their priority.
METHODS: The study included 186 elderly patients aged ≥65 years, who underwent surgery and were followed up between April 2011 and October 2016. The mean follow-up period was 16 months. Fractures were classified in accordance with AO-Müller/Orthopaedic Trauma Association (AO/OTA) classification. Proximal Femoral Nail (PFN) was applied to 98 patients, Proximal Femur Locking Compression Plate (PF-LCP) to 14 patients, and Dynamic Hip Screw (DHS) to 74 patients. The causes of failure after fixation were evaluated. The clinical results were evaluated in accordance with the Salvati and Wilson hip score, and Baumgaertner’s reduction standards were used in the evaluation of radiological results.
RESULTS: Nine failures were detected in PFN, 5 in DHS, and 2 were detected in PF-LCP. Twelve patients were regarded to have unstable fractures in accordance with the AO classification (31A2.2-3 and 31A3). Four were stable fractures(31A2.1) of which; 2 had DHS, and 2 had PFN.
DISCUSSION AND CONCLUSION: Fracture classification defines the fracture as stable or unstable, which is very important for the selection of the appropriate implant. It is thought that some 31 A2.1 type fractures and osteoporotic fractures with a thin lateral cortex which are accepted as stable should be approached with suspicion and could be evaluated as unstable. Provision of medial calcar and posteromedial cortex continuity is one of the most important criteria for the prevention of failure. Computerized tomography can be used to detect posteromedial continuity.

Geriatrik Pertrokanterik Femur Kýrýklarýnda Farklý Fiksasyon Metodlarý Sonrasý Geliþen Yetmezlik Nedenlerinin Deðerlendirilmesi

GÝRÝÞ ve AMAÇ: Yaþlý kemiðin farklý biyomekaniði dolayýsýyla trokanterik bölge kýrýklarýnda farklý fiksasyon yöntemlerinin etkinliði ve yetersizliklerini ortaya koymak amaçlanmýþtýr. Farklý kýrýk tiplerinde yetmezlik sebepleri öncelik sýrasýna göre deðerlendirilmiþtir
YÖNTEM ve GEREÇLER: Bu çalýþmaya Nisan 2011- Ekim 2016 yýllarý arasýnda ameliyat edilen ve takibi saðlanabilen 65 yaþ ve üstü 186 geriatrik hasta (115 kadýn,71erkek) dahil edildi. Hastalarýn ortalama takip süresi 16 ay idi. Kýrýklar AO/OTA sýnýflamasýna göre sýnýflandýrýldý. 98 hastaya PFN, 14 hastaya proksimal kilitli femur plaðý(PF-LCP),74 hastaya DHS uygulandý. Fiksasyon sonrasý yetmezlik nedenleri deðerlendirildi. Klinik sonuçlar Salvati ve Wilson’s kalça skoruna göre, radyolojik sonuçlar Baumgaertner redüksiyon ölçütlerine göre deðerlendirildi.
BULGULAR: Yetmezlik görülen 16 hastanýn 9’ u Proksimal femur çivisi (PFN) 5’i DHS, 2’si proksimal femur plaðý yapýlan hasta idi. 12 hasta AO sýnýflamasýna göre instabil kabul edilen kýrýklardý.4’ü stabil olup 2’si DHS yapýlan 2’si PFN yapýlan hastalar idi.
TARTIÞMA ve SONUÇ: Kýrýk sýnýflamasý kýrýðý stabil veya instabil olarak tanýmlar; bu uygun implant seçimi için çok önemlidir. Stabil kabul edilen ince lateral korteksi olan 31 A2.1 tipi kýrýklar ve osteoporotik kýrýklara þüphe ile yaklaþýlmasý ve instabil olarak deðerlendirilebileceði düþünülmektedir.Medial kalkar ve posteromedial korteks devamlýlýðýnýn saðlanmasý, baþarýsýzlýðýn önlenmesinde en önemli kriterlerden biridir. Postoromedial devamlýlýðý tespit etmek için bilgisayarlý tomografi kullanýlabilir.