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Proksimal Tibia Medial Aç ık Kama Osteotomisinde Lateral Plato Kırığı Oluşumunu Önlemek için Alternatif Uygulama: Dana Tibialarında Deneysel Çalışma

An Alternative Technique for Prevention of Lateral Tibial Plateau Fractures During The Proximal Tibial Medial Opening Wedge Osteotomy: An Experimental Study At Calf Tibiae

Journal Name:

  • İnönü Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2005

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Aim: Aim of this study is to define a simple method for preventing lateral tibial plateau fractures performing proximal tibia medial opening wedge osteotomy. Materials ve Methods: 30 calf tibiae in the same age and weight group were used for the experiments. They were assigned randomly into two groups. Of the 30 specimens, 15 were selected randomly as Group A. Five of them were divided in two equal parts on frontal plane with a large saw in order to observe the efficiancy of the procedures. Others were undivided. In this group, one or two provisional Kirschner wires or Schanz screws were applied 1.5-2 cm below and paralel to the articular surface. Later, oblique or nearly oblique osteotomies were performed medio-laterally 2 cm medial to the lateral cortex and 1.5 cm and 3 cm below the lateral tibial plateau. Following osteotomy, distractionwas made with angle-scale distractor. Of the 30 specimens, 15 were selected randomly as Group B. Five o f t h em were divided in t w o equal parts o n the frontal plane w i t h a large saw. Others were again undivided. Oblique or nearly oblique osteotomies were performed medio-laterally 2 c m medial to the lateral cortex and 1,5 cm and 3 c m b e l ow the lateral tibial plateau. F o l l o w i ng osteotomy, distraction was made with angle-scale distractor. Results: I n Group A where the osteotomies were more distant f r om the articular surface and lateral cortex, no p r o b l em was seen d u r i n g the first stage where the angle o f distraction was mean 9.0°. A p p l i c a t i o n above the mean angle o f 9.0° o f distraction created fracture line proximally but these lines could not pass the level o f provisional Kirschner wires or Schanz screws. The fracture lines extended to the lateral cortex under the Kirshner wires or Schanz screws. Tibial plateau fracture was not observed. However i n G r o u p B osteotomy was made 3 cm distally f r om the articular surface and 2 cm medially f r om the lateral cortex, no p r o b l em was seen d u r i n g the first stage where the mean angle of distraction was 9.1°. I n these specimens fractures reached tibial plateau or lateral cortex above the mean o f 9.1° o f distraction manoeuvres. Conclusion: K-wires o r Schanz screws applied paralel to the articular surface o f tibial plateau guide the fracture line the lateral cortex and prevent intraarticular fracture formation on the plateau.
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Abstract (Original Language): 
Amaç: Proksimal tibia medial açık kama osteotomi uygulamalarında lateral plato kırığı oluşumunu önlemek için alternatif bir yöntem tanımlamak. Gereç ve Yöntem: Bu çalışma için yaklaşık aynı yaş grubunda ve ağırlığındaki danalara ait 30 tibia kullanıldı. Rastgele iki gruba ayrıldılar; 30 tibianın 15 tanesi rastgele seçilerek Grup A'yı oluşturdular. Bunlardan 5 tanesi, yöntemin etkinliğini ve sonuçlarını göstermek için hizar ile frontal planda iki eşit parçaya ayrıldı. Kalan 10 tibia bölünmeden kullanıldı. Bu grupta, eklem yüzeyine paralel ve 1.5-2 cm distalinden bir veya iki adet Kirshner teli veya Schanz çivisi uygulandı. Sonra, lateral korteksin 2 cm mediali ile lateral tibia platosu eklem yüzeyinin 1.5 ile 3 cm distaline olmak üzere medio-lateral doğrultuda oblik veya hafif oblik osteotomiler yapıldı. Osteotomi sonrası açı skalalı distraktör ile distraksiyon uygulandı. Kalan 15 tibia Grup B'yi oluşturdu. Bunlarda 5 tanesi yöntemin etkinliğini ve sonuçlarını göstermek için hizar ile frontal planda iki eşit parçaya ayrıldı. Kalan 10 tibia bölünmeden kullanıldı. Sonra, lateral korteksin 2 cm mediali ile lateral tibia platosu eklem yüzeyinin 1.5 ile 3 cm distalinden olmak üzere medio-lateral doğrultuda oblik veya hafif oblik osteotomiler yapıldı. Osteotomi sonrası açı skalalı distraktör ile distraksiyon uygulandı. Bulgular: Grup A'da eklem yüzeyinden ve lateral korteksten daha uzak olan osteotomilerde distraksiyonun ortalama ilk 9 derecesini uygularken problem oluşmadı. Ortalama 9 derecenin üzerinde distraksiyon uygularken proksimale doğru uzanan kırık hattı oluştu. Kırık hatları Kirshner telleri veya Shanz çivileri seviyesini daha proksimale doğru aşamadılar, tel ve çivilerin altından lateral kortekse doğru yönlendiler. Tibial plato kırığı gözlenmedi. Buna karşılık Grup B'yi oluşturan osteotomilerden eklem yüzeyinin 3 cm distalinden ve lateral korteksin 2 cm medialinden yapılan osteotomilerde ortalama ilk 9.1 derece distraksiyona kadar problem oluşmadı. Bu değerlerin üzerinde ise lateral tibial plato veya lateral kortekse uzanan kırıklar saptandı. Sonuçlar: Eklem yüzeyine paralel olarak uygulanan Kirshner telleri veya Schanz çivileri oluşan kırık hattının lateral kortekse yönlenmesini sağlayarak platoda eklem içi kırık oluşumunu önlemektedir
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