Author/Editor		Andoljšek, Matej
Title		Ponovne operacije po zlomu stegneničnega vratu?
Translated title		Reoperations after fracture of the femoral neck?
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 66, št. Suppl 1
Publication year		1997
Volume		str. I-17-20
Language		slo
Abstract		Background. A failure of the osteosynthesis in a fracture of the femoral neck is common. The question was whether the reoperation rate could be decreased after liberal use of primary prosthetic replacement. Methods and results. 282 fracture of the femoral neck (249 medial, 33 lateral) were operated and 21 fractures (20 medial, 1 lateral) were reoperated from January, 1989 to February, 1995. In 108 fractures an osteosynthesis (OS) and in 174 fractures prosthesis (in 162 partial prosthesis = PEP, of these 20 biarticular; in 12 total prosthesis = TEP) were done. 19 hips after OS (two primarly operated elsewhere) and two hips treated with PEP were reoperated. In 19 failed OS two reosteosynthesis, one valgisation osteotomy and 16 prosthesis (5x PEP, 11x TEP) were done. Secondary displacement and/or non-union of the fractures (16x) were the most commom couse of the reoperation; aseptic necrosis with segmental collaps were rare (3x). One PEP was extracted due to infection, in another PEP loosed stem was replaced with bigger one. Conclusions. (UN)understanding of the rehabilitation demainds and/or (un)ability of weight-bearing control of the operated leg limit the rate of success in OS of the femoral neck fractures. Age and patient's activity as well as type of the fracture according to Garden are still leading guidelines in therapy, but each patient should be judged individually. The exact place of primary prosthetics in the treatment of the femoral neck fractures is not defined yet.
Summary		Izhodišča. Osteosinteze zlomov stegneničnega vratu so pogosto neuspešne. Zanimalo nas je, ali lahko s pogostejšo uporabo protez v primarni oskrbi teh zlomov zmanjšamo število ponovnih operacij? Metode in rezultati. Od leta 1989 do februarja 1995 smo prvič operirali 282 (249 medialnih, 33 lateralnih) in ponovno operirali 21 (20 medialnih, 1 lateralni) zlomov stegneničnega vratu. 108 zlomov smo oskrbeli z osteosintezo (OS), 174 zlomov s protezo (162 z delno = PEP, od tega 20 z biartikularno; 12 s popolno - TEP). Ponovno smo operirali 19 kolkov po OS (2 sta bila prvič operirana drugje) in 2 kolka po vstavitvi PEP. Neuspelo primarno OS smo dvakrat reševali s ponovno osteosintezo, enkrat z valgizacijsko osteotomijo in pri ostalih 16 poškodovancih s protezo (5-krat PEP, 11-krat TEP). Najpogostejša razloga za ponovno operacijo po OS sta bila sekundarna dislokacija in/ali nezaraščanja zloma (16-krat), redkeje aseptična nekroza s segmentim kolapsom (3-krat). Eno protezo smo odstranili zaradi globoke okužbe, pri drugi protezi pa smo premajhno steblo zamenjali z večjim. Zaključki. Uspešnost OS po zlomu stegneničnega vratu omejuje (ne)razumevanje zahtev rehabilitacije in/ali (ne)zmožnost razbremenjevanja operirane okončine. Osnovne smernice pri izbiri vrste operativnega zdravljenja so starost in aktivnost poškodovanca ter tip zloma po Gardnu, vendar moramo vsak primer presoditi individualno. Pogostejša uporaba protez v primarni oskrbi zlomov stegneničnega vratu zmanjšuje število zgodnjih ponovnih operacij. Uporaba protez pri primarni oskrbi teh zlomov pa še ni dokončno določena.
Descriptors		FEMORAL NECK FRACTURES REOPERATION AGE FACTORS SEX FACTORS HIP PROSTHESIS