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2023, vol. 18, iss. 2, pp. 105-112
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Retrograde Talon intramedullary nails versus distal locking plates in the management of extra-articular distal femoral shaft fractures
Retrogradni intramedularni klinovi naspram distalnih ploča za zaključavanje u lečenju ekstraartikularnih preloma distalne femoralne osovine
aHitit University Erol Olçok Training and Research Hospital, Department of Orthopedics and Traumatology, Çorum, Turkey bVan Yüzüncü Yıl University, Department of Orthopedics' and Traumatology, Van, Turkey
email: dundarabd@hotmail.com
Keywords: Talon Distal Fix; locking plate; distal third femur; union; distal locking
Ključne reči: distalni fiksator; distalna zaključavajuća ploča; distalni trećina femura; spajanje; distalno zaključavanje
Abstract
Introduction: Distal femoral shaft fractures are characterized by their increasing incidence and complexity, presenting a significant challenge in management. The objective of this retrospective study was to compare the clinical and radiological results of patients with extra-articular distal third femoral shaft fractures treated using either retrograde Talon Distal Fix nail or a distal femur locking plate. Material and Method: The study comprised 40 patients aged > 18 years who presented at our hospital with a distal third femoral shaft fracture between January 2017 and January 2023. The patients were divided into two groups: Group TDN, treated with retrograde Talon Distal Fix nailing (n = 18), and Group DLP, treated with a distal locking plate (n = 22). Demographic data, follow-up period, operating time, time to union, range of motion (ROM), mechanism of injury (traffic accident, fall from height, workplace accident, gunshot injury), fracture type, complications, and surgical method were retrospectively recorded. Clinical evaluation included deformity, knee ROM, pain, and the knee total score (KSS) for walking and knee stability. Results: The mean age of the patients was 48.03 ± 12.31 (min-max: 23-69) years, and the mean follow up time for all patients was 15.88 ± 2.32 (12-21) months. The mean time to union was 25.55 ± 1.86 (22-30) weeks. Delayed union and non-union rates were similar between the research groups (P = 1.000, P = 0.673, respectively). Union time (weeks) and mean ROM were not significantly different between the groups (P = 0.881, P = 0.892, respectively). The mean operation time of the TDF group (48.78 ± 3.94 minutes) was significantly lower than that of the DLP group (62.45 ± 3.33 minutes) (P < 0.001). The mean blood loss values of the TDF group (267.5 ± 32.4) were significantly lower than those of the DLP group (324.1 ± 20.2) (P < 0.001). Conclusion: This study demonstrated that both retrograde talon nails and locking plates provided satisfactory clinical and radiological results in the management of distal third femoral shaft fractures. Moreover, the retrograde talon nail offered the advantages of a shorter operating time and less intraoperative blood loss.
Sažetak
Uvod: Prelomi distalnog dela butne kosti karakte-rišu se povećanom učestalošću i složenošću i predsta-vljaju značajan izazov u lečenju. Cilj ove retrospektiv-ne studije bio je uporediti kliničke i radiološke rezulta-te lečenja pacijenata sa ekstraartikularnim prelomima distalnog dela butne kosti, lečenih retrogradnim intramedularnim klinom ili distalnom zaključavajućom pločom butne kosti. Materijali i Metode: Studija je obuhvatila 40 pacijenata starijih od 18 godina koji su se javili u našu bolnicu sa prelomom distalnog trećeg dela butne kosti u periodu od januara 2017. do januara 2023. godine. Pacijenti su podeljeni u dve grupe: Grupa TDN, koja je lečena retrogradnim intramedularnim klinom (n = 18), i Grupa DLP, koja je lečena distalnom zaključava-jućom pločom butne kosti (n = 22). Demografski po-daci, period praćenja, vreme operacije, vreme spajanja preloma, opseg pokreta (ROM), mehanizam povrede (saobraćajna nesreća, pad sa visine, radna povreda, prostrelna rana), tip preloma, komplikacije i hirurška metoda su retrospektivno zabeleženi. Klinička procena uključila je deformitet, opseg pokreta u kolenu, bol i ukupni bodovi za koleno (KSS) za hodanje i stabil-nost kolena. Rezultati: Prosečna starost pacijenata bila je 48,03 ± 12,31 (min-max: 23-69) godina, a prosečno vreme praćenja svih pacijenata bilo je 15,88 ± 2,32 (12-21) meseci. Prosečno vreme spajanja preloma iznosilo je 25,55 ± 1,86 (22-30) nedelja. Stope kasnog spajanja i neujedinjenja bile su slične između istraživačkih grupa (P = 1.000, P = 0.673, redom). Vreme spajanja (u nede-ljama) i prosečni opseg pokreta (ROM) nisu značajno različiti između grupa (P = 0.881, P = 0.892, redom). Prosečno vreme operacije u grupi sa retrogradnim in-tramedularnim klinom (48,78 ± 3,94 minuta) bilo je značajno kraće od prosečnog vremena operacije u gru-pi sa distalnom zaključavajućom pločom (62,45 ± 3,33 minuta) (P < 0,001). Prosečne vrednosti gubitka krvi u grupi sa retrogradnim intramedularnim klinom (267,5 ± 32,4) bile su značajno manje od prosečnih vredno-sti gubitka krvi u grupi sa distalnom zaključavajućom pločom (324,1 ± 20,2) (P <0,001). Zaključak: Ova studija je pokazala da su kako retrogradni intramedularni klinovi tako i distalne za-ključavajuće ploče pružili zadovoljavajuće kliničke i radiološke rezultate u lečenju preloma distalnog trećeg dela femura. Osim toga, retrogradni intramedularni klin je pružio prednosti kraćeg vremena operacije i manjeg gubitka krvi tokom operacije.
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