�leri ya�l� (≥65 ya�) y�ksek riskli olgularda geli�en intertrokanterik femur k�r�klar�n�n eksternal fiksat�rle tedavisi

At�c�, Teoman; �ahin, Nam�k; �zt�rk, Alpaslan; Yaray, Osman

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�leri ya�l� (≥65 ya�) y�ksek riskli olgularda geli�en intertrokanterik femur k�r�klar�n�n eksternal fiksat�rle tedavisi [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2010; 16(5): 413-420

�leri ya�l� (≥65 ya�) y�ksek riskli olgularda geli�en intertrokanterik femur k�r�klar�n�n eksternal fiksat�rle tedavisi

Teoman At�c�¹, Nam�k �ahin², Alpaslan �zt�rk³, Osman Yaray¹
¹Uluda� �niversitesi T�p Fak�ltesi, Ortopedi Ve Travmatoloji Anabilim Dal�, Bursa
²Ali Osman S�nmez Onkoloji Hastanesi Ortopedi Ve Travmatoloji Klini�i, Bursa
³Y�ksek �htisas E�itim Ve Ara�t�rma Hastanesi Ortopedi Ve Travmatoloji Klini�i, Bursa

AMA�
�al��mam�zda, y�ksek riskli olgulardaki intertrokanterik k�r�klar�n tedavisinde, minimal invaziv ve biyolojik osteosentez y�ntemi olan kapal� red�ksiyon ve eksternal fiksat�r uygulamas�n�n sonu�lar� de�erlendirildi.
GERE� VE Y�NTEM
�ntertrokanterik k�r�� olan y�ksek riskli (ASA 3-4) 23 olguya (14 kad�n, 9 erkek ortalama ya�: 74; da��l�m: 65-88 ya�) k�sa s�reli anestezi alt�nda kapal� red�ksiyon ve unilateral eksternal fiksat�r uyguland�. K�r�klar�n 14�� stabil (%60,8), 9�u (%39,2) stabil de�ildi. �zlem s�resi ortalama 23,8 ay (da��l�m, 4-58 ay) olan olgularda; ameliyat ve hastanede yat�� s�releri, k�r�k kaynama zaman�, mobilizasyon kapasiteleri, komplikasyonlar ve mortalite oranlar� de�erlendirildi.
BULGULAR
Ameliyat s�resi ortalama 25 dk (da��l�m, 15-40 dk), hastanede kal�� s�resi ortalama 4 g�n (da��l�m, 2-9 g�n) olup kaynama s�resi ortalama 13 hafta (da��l�m, 11-16 hafta) idi. Ameliyat sonras� ilk alt� ayda 5 olgu (%21,7) ek sa�l�k sorunlar� nedeniyle �ld�. Olgular�n 11�inde (%47,8) y�zeyel �ivi dibi enfeksiyonu geli�ti. Materyel yetersizli�i hi�bir olguda geli�medi. Son izlemde stabil k�r�klarda ortalama 5� varus (da��l�m, 0-8�), 1 cm k�sal�k (da��l�m, 0-3 cm), stabil olmayan k�r�klarda ise ortalama 15� varus (da��l�m, 8�-20�) ve 3 cm k�sal�k (da��l�m, 2-5 cm) tespit edildi.
SONU�
�ntertrokanterik k�r�klar�n tedavisinde �evre dokuya olduk�a az hasar vererek k�r�k kaynamas�n� temin eden, uygulamas� kolay, etkili ve g�venli biyolojik tespit y�ntemi olan kapal� red�ksiyon ve eksternal fiksat�r uygulamas�, �zellikle y�ksek riskli olgularda tercih edilebilir.

Anahtar Kelimeler: Biyolojik osteosentez, eksternal fiksat�r; intertrokanterik femur k�r��; minimal invaziv.

Treatment of intertrochanteric femur fractures in high-risk geriatric patients (≥65 years) with external fixation

Teoman At�c�¹, Nam�k �ahin², Alpaslan �zt�rk³, Osman Yaray¹
¹Medical Faculty Of Uludag University, Department Of Orthopaedics And Traumatology, Bursa
²Ali Osman S�nmez Oncology Hospital, Clinics Of Orthopedics And Traumatology, Bursa
³Y�ksek �htisas Research Hospital, Clinics Of Orthopedics And Traumatology, Bursa

BACKGROUND
We evaluated the results of intertrochanteric hip fractures treated with closed reduction and external fixation (minimally invasive and biological osteosynthesis) in patients with high surgical risk.
METHODS
Twenty-three patients (14 females, 9 males; mean age 74 [65-88]) with intertrochanteric hip fracture classified as group III and IV according to American Society of Anesthesiologists (ASA) criteria were treated with closed reduction and unilateral external fixation under short-term anesthesia. Fourteen fractures were stable (60.8%) and nine were unstable (39.2%). The mean follow-up was 23.8 months (4-58). We evaluated the operation time, hospitalization time, union time, mobilization capacity, complications, and mortality rates.
RESULTS
The mean duration of operation was 25 minutes (15-40), mean duration of hospital stay 4 days (2-9) and average union time 13 weeks. Five patients (21.7%) died due to additional health problems in the first six months after surgery. Superficial pin tract infection occurred in 11 cases (47.8%). There was no implant failure. In the last follow up, an average 5� varus (range: 0-8�) and 1 cm shortening (range: 0-3) in stable fractures and an average 15� varus (range: 8-20�) and 3 cm shortening (range: 2-5) in unstable fractures were determined.
CONCLUSION
The treatment of intertrochanteric hip fractures with closed reduction and external fixation is an easy, effective and safe biological fixation method with minimal damage to surrounding tissues, especially in patients with high surgical risk.

Keywords: Biological osteosynthesis, external fixator; intertrochanteric femur fractures; minimally invasive.

Teoman At�c�, Nam�k �ahin, Alpaslan �zt�rk, Osman Yaray. Treatment of intertrochanteric femur fractures in high-risk geriatric patients (≥65 years) with external fixation. Ulus Travma Acil Cerrahi Derg. 2010; 16(5): 413-420

Sorumlu Yazar: Teoman At�c�, T�rkiye
Makale Dili: T�rk�e

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