Arslan Hüseyin, Kapukaya Ahmet, Kesemenli Cumhur Cevdet, Necmioğlu Serdar, Subaşi Mehmet, Coban Vafi
Dicle Universitesi Tip Fakültesi Ortopedi ve Travmatoloji Anabilim Dali.
Acta Orthop Traumatol Turc. 2003;37(2):107-12.
We evaluated the presenting features of ipsilateral femoral and tibial fractures in adults, and the effects of both fracture type and severity of skeletal injury on the results.
The study included 24 patients (22 men, 2 women; mean age 38 years; range 17 to 75 years). According to the classification by Letts et al., the types of the fractures were as follows: type A (7), type B (2), type C (5), type D (7), and type E (3). Femur fractures were treated by locked intramedullary nails, AO plates, plate-screws, unilateral external fixator, or dynamic condylar screws, and tibia fractures by external fixator, plate-screws, locked intramedullary nailing, or with conservative methods. Amputation at the fracture level was required in a patient with type 3C open tibia fracture. The mean follow-up was 3.2 years (range 1.3 to 7 years).
According to the criteria by Kalström and Olerud, the results were excellent in three patients, good in nine patients, fair in five patients, and poor in six patients. The mean skeletal injury scores were 4.4 and 3 in patients having fair and poor results and in those with good and excellent results, respectively. Fair and poor results corresponded to type A (1 patient), type C, type D, or type E fractures. Five patients with type 3 open fractures had fair or poor results. Thirteen patients (54%) had at least one complication.
Patients with type C, D, or E fractures and those with greater skeletal injury scores are more likely to have fair or poor results due to the open nature of the fracture and to increased involvement of the knee joint. Although there is not an ideal method, rigid internal fixation seems to be more appropriate in fractures other than type 3 open tibia fractures.
我们评估了成人同侧股骨和胫骨骨折的呈现特征，以及骨折类型和骨骼损伤严重程度对结果的影响。
该研究纳入了24例患者（22例男性，2例女性；平均年龄38岁；范围17至75岁）。根据Letts等人的分类，骨折类型如下：A型（7例）、B型（2例）、C型（5例）、D型（7例）和E型（3例）。股骨骨折采用锁定髓内钉、AO钢板、钢板螺钉、单侧外固定架或动力髁螺钉治疗，胫骨骨折采用外固定架、钢板螺钉、锁定髓内钉或保守方法治疗。1例3C型开放性胫骨骨折患者需要在骨折水平进行截肢。平均随访时间为3.2年（范围1.3至7年）。
根据Kalström和Olerud的标准，3例患者结果为优，9例为良，5例为中，6例为差。结果为中、差的患者与结果为良、优的患者的平均骨骼损伤评分分别为4.4和3。结果为中、差的情况对应于A型（1例患者）、C型、D型或E型骨折。5例3型开放性骨折患者结果为中或差。13例患者（54%）至少有1种并发症。
C型、D型或E型骨折患者以及骨骼损伤评分较高的患者，由于骨折的开放性和膝关节受累增加，更有可能获得中或差的结果。虽然没有理想的方法，但对于3型开放性胫骨骨折以外的骨折，坚强内固定似乎更合适。
