Our Surgical Treatment Results of Acetabuler Fractures
Abstract
Cerrahi olarak tedavi ettiğimiz asetabulum kırıklarının radyolojik ve klinik sonuçlarını değerlendirdik. Hastalar ve yöntem: Yüzüncü Yıl Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji kliniğimizde, ocak 2009 ile aralık 2013 tarihleri arasında en az 6 ay takibi olan, yeterli arşiv ve dosya bilgisine ulaşılan ve son kontrolleri yapılabilen 30 hasta değerlendirildi. Hastaların 25'i erkek (% 83.3), 5'i kadın (% 16.7) ve yaşları 18 ile 68 (ortalama 40) arasındaydı. Yirmi hastada (% 66.7) sağ kalçada, 10 hastada (% 33.7) sol kalçada asetabulum kırığı vardı. En sık travma nedeninin 13 hasta (% 43.3) ile yüksekten düşme olduğu görüldü. Letournel sınıflamasına göre 18 hasta (% 60) kompleks, 12 hasta (% 40) basit kırık sınıflaması içerisindeydi. Sekiz hastada posterior (% 26.5), 5 hastada (% 16.5) ise santral olmak üzere toplam 13 hastada (% 43.5) ilave olarak travmatik kalça çıkığı tespit edildi. Cerrahi tedavi endikasyonları, çekilen üç grafîden (ön-arka, obturator ve iliyak oblik ) herhangi birinde 3 mm'i geçen yer değiştirme, eklem içi kırık parçasının olması ve posterior instabilite olarak belirlendi. Kırık redüksiyonları değerlendirildiğinde, 13 hasta ( % 43.3 ) anatomik redüksiyon, 13 hasta (% 43.3) başarılı, 4 hasta da (%13.3) kötü redüksiyon olarak değerlendirildi. Redüksiyon kalitesinin klinik ve radyolojik sonuçlar üzerinde etkili olduğu ve kırığın basit ya da kompleks oluşuna göre de değişiklik gösterdiği görüldü. Ameliyat sonrası ortalama 28 ay takip edilen hastalar, Matta'nın radyolojik kriterlerine göre 13 hasta (% 43.3) mükemmel, 11 hasta (% 36.6) iyi, 4 hasta (% 13.3) orta, 2 hasta (% 6.6) kötü olarak sonuçlandı. Merle d'Aubigne ve Postel klinik iyileşme kriterlerine bakıldığında 7 hasta (% 23.3) çok iyi, 15 hasta (% 50) iyi, 4 hasta (% 13.3) orta ve 4 hasta (% 13.3) kötü olarak değerlendirildi. Sonuç: Hastaların kırıklarının çoğunun kompleks tip oluşu, hastalarla yeterli rehabilitasyon için uyum güçlüğü yaşanması, başlangıç deplasman miktarının fazla olması ameliyat sonuçlarımızı etkileyen nedenler arasındaydı. Kırık tipine göre uygun insizyon seçimi, biriken cerrahi tecrübe ve postoperatif dikkatli ve titiz hasta takipleri neticesinde başarılı ve tatminkar cerrahi sonuçlar elde edildiği inancındayız. Anahtar sözcükler: Asetabulum kırıkları, klinik ve radyolojik sonuç, letournel sınıflaması
To evaluate clinical and radiological results of the acetabular fractures that we have treated surgically. The Patients and Method: In our Orthopedics and Traumatology Clinic of Yüzüncü Yıl University Medical Faculty, 30 patients – who have been monitored at least 6 months between the date of January 2009 to December 2013, who have reachable adequate archive and file information and whose last controls have been completed – were been evaluated. 25 of patients were male (83.3 %), 5 of were female (16.7 %) and their ages were between 18 to 68 years (mean age: 40 years). There was acetabular fracture in the right hip of 20 patients (66.7 %) and in the left hip of 10 patients (33.7 %). The most common reason of trauma is falling down of hight was observed in 13 patients (%43.3). Eighteen patients (60 %) were within complex, 12 patients (40 %) were within simple fracture classification according to Letournel Classification. In addition, a total of 13 patients (43.5 %) with traumatic hip dislocation – posterior in 8 patients (26.5 %) and central in 5 patients (16.5 %) – were determined. Surgical therapeutic indications were established as displacement exceeding 3 mm, presence of intra-articular fracture and posterior instability in any of 3 radiographies (anterior-posterior, obturator and iliac oblique). When evaluating fracture reduction; 13 patients (43.3 %) were evaluated as anatomical reduction, 13 patients (43.3 %) were as successful reduction and 4 of them (13.3 %) were as bad reduction. It was seen that the quality of reduction is effective on clinical and radiological results and is variable according to simplicity or complexity of the fracture. In postoperative patients that were monitored for an average of 28 months; 13 patients (43.3 %) were evaluated as perfect, 11 patients (36.6 %) were as good, 4 patients (13.3 %) were as moderate and 2 patients (6.6 %) were as bad according to radiological criteria of Matta. Considering the clinical improvement criteria of Merle d'Aubigne and Postel, 7 patients (23.3 %) were evaluated as very good, 15 patients (50 %) were as good, 4 patients (13.3 %) were as moderate and 4 patients (13.3 %) were as bad. VII Result: Most fractures in patients are complex type, adaptation difficulty with patients for the sufficient rehabilitation, much amount of initial displacement were the factors affecting our surgical results. We think that, we have successful and satisfactory results, as a result of suitable incision option per fracture type, cumulative surgical experience, attentive and meticulous follow-up of post - operative patients. Keywords: Acetabular fractures, clinicaland radiological result, letournel classification
To evaluate clinical and radiological results of the acetabular fractures that we have treated surgically. The Patients and Method: In our Orthopedics and Traumatology Clinic of Yüzüncü Yıl University Medical Faculty, 30 patients – who have been monitored at least 6 months between the date of January 2009 to December 2013, who have reachable adequate archive and file information and whose last controls have been completed – were been evaluated. 25 of patients were male (83.3 %), 5 of were female (16.7 %) and their ages were between 18 to 68 years (mean age: 40 years). There was acetabular fracture in the right hip of 20 patients (66.7 %) and in the left hip of 10 patients (33.7 %). The most common reason of trauma is falling down of hight was observed in 13 patients (%43.3). Eighteen patients (60 %) were within complex, 12 patients (40 %) were within simple fracture classification according to Letournel Classification. In addition, a total of 13 patients (43.5 %) with traumatic hip dislocation – posterior in 8 patients (26.5 %) and central in 5 patients (16.5 %) – were determined. Surgical therapeutic indications were established as displacement exceeding 3 mm, presence of intra-articular fracture and posterior instability in any of 3 radiographies (anterior-posterior, obturator and iliac oblique). When evaluating fracture reduction; 13 patients (43.3 %) were evaluated as anatomical reduction, 13 patients (43.3 %) were as successful reduction and 4 of them (13.3 %) were as bad reduction. It was seen that the quality of reduction is effective on clinical and radiological results and is variable according to simplicity or complexity of the fracture. In postoperative patients that were monitored for an average of 28 months; 13 patients (43.3 %) were evaluated as perfect, 11 patients (36.6 %) were as good, 4 patients (13.3 %) were as moderate and 2 patients (6.6 %) were as bad according to radiological criteria of Matta. Considering the clinical improvement criteria of Merle d'Aubigne and Postel, 7 patients (23.3 %) were evaluated as very good, 15 patients (50 %) were as good, 4 patients (13.3 %) were as moderate and 4 patients (13.3 %) were as bad. VII Result: Most fractures in patients are complex type, adaptation difficulty with patients for the sufficient rehabilitation, much amount of initial displacement were the factors affecting our surgical results. We think that, we have successful and satisfactory results, as a result of suitable incision option per fracture type, cumulative surgical experience, attentive and meticulous follow-up of post - operative patients. Keywords: Acetabular fractures, clinicaland radiological result, letournel classification
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Keywords
Ortopedi ve Travmatoloji, Asetabulum, Cerrahi Tedavi, Kırıklar-Kemik, Ortopedik Cerrahi, Radyografi, Orthopedics and Traumatology, Acetabulum, Surgical Treatment, Fractures-Bone, Orthopedic Surgery, Radiography
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105