İntertrokanterik Kalça Kırıklarında Güncel Cerrahi Tedavi Yöntemleri
Özet
Femur intertrokanterik kırıkları, özellikle yaşlı ve osteoporotik bireylerde basit düşme gibi düşük enerjili travmalar sonucu meydana gelen, yüksek morbidite ve mortalite oranlarına sahip önemli bir halk sağlığı sorunudur. Yaşam süresinin uzamasıyla görülme sıklığı artan bu kırıkların cerrahi tedavisindeki temel amaç, hastaları en kısa sürede mobilize ederek yatak istirahatine bağlı gelişebilecek enfeksiyon ve bası yarası gibi sistemik komplikasyonları en aza indirmek ve fonksiyonel seviyeyi geri kazandırmaktır. Kalça anatomisinin, kalkar femorale bütünlüğünün ve trabeküler kemik yapısının Singh indeksi ile doğru değerlendirilmesi cerrahi başarıyı doğrudan etkilemektedir. Kırıklar klinik pratikte çoğunlukla AO-OTA ve Evans-Jensen sistemlerine göre sınıflandırılmaktadır. Cerrahi başarısı kemik kalitesi, kırık tipi, redüksiyon kalitesi, implant seçimi ve pozisyonu gibi değişkenlere bağlıdır. Güncel tedavi protokollerinde, stabil kırıkların tedavisinde kayan kalça vidası (DHS) gibi aygıtlar tercih edilirken; anstabil kırıklarda biyomekanik olarak daha güçlü olan proksimal femur çivisi (PFN) gibi intramedüller implantlar veya ileri yaşta yüksek riskli hastalarda primer artroplasti uygulamaları ön plana çıkmaktadır. Sonuç olarak güncel yaklaşım, uygun redüksiyon ve rijit tespiti sağlayarak erken dönemde güvenli yük vermeyi mümkün kılmaktır.
Femoral intertrochanteric fractures are a significant public health problem with high morbidity and mortality rates, occurring as a result of low-energy traumas such as simple falls, especially in elderly and osteoporotic individuals. The main objective in the surgical treatment of these fractures, whose incidence increases with prolonged lifespans, is to mobilize patients as early as possible to minimize systemic complications such as infections and pressure sores due to bed rest, and to restore their pre-fracture functional levels. Correct evaluation of hip anatomy, the integrity of the calcar femorale, and the trabecular bone structure via the Singh index directly affects surgical success. Fractures are mostly classified according to the AO-OTA and Evans-Jensen systems in clinical practice. Surgical success depends on variables such as bone quality, fracture type, reduction quality, implant selection, and its positioning. In current treatment protocols, fixators such as the dynamic hip screw (DHS) are preferred for the treatment of stable fractures, whereas biomechanically stronger intramedullary implants like the proximal femoral nail (PFN) or primary arthroplasty applications in elderly high-risk patients come to the fore for unstable fractures. Consequently, the contemporary approach is to enable safe early weight-bearing by achieving proper reduction and rigid fixation.
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