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• Re: óÐÏÒ Ï ÄÏÐÕÓÔÉÍÙÈ ÓÍÅÝÅÎÉÑÈ ïÔÐÒÁ×ÉÔÅÌØ: Alexander Chelnokov 19 ñÎ×ÁÒØ 2012, 00:49

  äÏÐÕÓÔÉÍÙÅ ÓÍÅÝÅÎÉÑ ÐÏÓÌÅ ÉÎÔÒÁÍÅÄÕÌÌÑÒÎÏÇÏ ÏÓÔÅÏÓÉÎÔÅÚÁ ÎÉÞÅÍ ÎÅ ÏÔÌÉÞÁÀÔÓÑ ÏÔ ÔÁËÏ×ÙÈ, ËÁË ÅÓÌÉ ÂÙ ÐÅÒÅÌÏÍ ÇÏÌÅÎÉ ÌÅÞÉÓÑ ËÏÎÓÅÒ×ÁÔÉ×ÎÏ. ÷ÏÔ ÉÍÅÎÎÏ. éÔÏÇÏ×ÁÑ ÆÏÒÍÁ ËÏÎÅÞÎÏÓÔÉ ÂÕÄÅÔ ÐÒÉÅÍÌÅÍÁ, ÉÌÉ ÎÅÔ, ÂÅÚÏÔÎÏÓÉÔÅÌØÎÏ Ë ÔÏÍÕ, ËÁË É ÞÅÍ ÅÅ ÚÁÄÁÌÉ É ÕÄÅÒÖÉ×ÁÌÉ, ÐÏËÁ ÎÅ ÓÒÏÓÌÏÓØ. ëÒÉÔÅÒÉÉ «ÄÏÐÕÓÔÉÍÏÓÔÉ» ÄÏ×ÏÌØÎÏ ÕÓÌÏ×ÎÙÅ É «ÐÏÌÕÔÏÎÏ×ÙÅ», ÈÏÔÑ ËÏÅ-ÇÄÅ ÐÉÛÕÔ ËÁËÉÅ-ÔÏ ËÁË ÂÕÄÔÏ «ÔÏÞÎÙÅ» ÃÉÆÒÙ — 5 ÇÒÁÄÕÓÏ× ÔÏÇÏ ÉÌÉ 10 ÜÔÏÇÏ. îÁÓÞÅÔ Sarmiento — ÄÅÊÓÔ×ÉÔÅÌØÎÏ, ÏÎ ÕÂÅÄÉÔÅÌØÎÏ ÐÏËÁÚÁÌ, ÞÔÏ ÓÔÁÛÎÅÎØËÏ ×ÙÇÌÑÄÑÝÉÅ ÒÅÎÔÇÅÎÏÇÒÁÍÍÙ ÐÏÓÌÅ ÆÕÎËÃÉÏÎÁÌØÎÏÇÏ ÂÒÜÊÓÁ ÓÏ×ÅÒÛÅÎÎÏ ÎÅ ÏÂÑÚÁÔÅÌØÎÏ ÓÏÐÒÏ×ÏÖÄÁÀÔÓÑ ËÌÉÎÉÞÅÓËÉ ÎÅ ÔÏ ÞÔÏ ÚÎÁÞÉÍÏÊ, Á É ×ÉÄÉÍÏÊ ÄÅÆÏÒÍÁÃÉÅÊ. åÓÔØ ÐÕÂÌÉËÁÃÉÉ Merchant, Dietz (1989), Milner (2002), Ï ÔÏÍ, ÞÔÏ ÓÐÕÓÔÑ 30-40 ÌÅÔ ÐÏÓÌÉ ËÒÉ×Ï ÓÒÏÓÛÉÈÓÑ ÐÅÒÅÌÏÍÏ× ÎÅÔÕ ÎÅÇÁÔÉ×ÎÏÇÏ ×ÌÉÑÎÉÑ ÎÁ ÓÕÓÔÁ×Ù ÐÒÉ ÕÇÌÁÈ ÇÒÁÄÕÓÏ× ÞÕÔØ ÎÅ 20. ðÒÏ ÂÅÄÒÏ ×ÏÔ ÎÅÄÁ×ÎÑÑ ÐÕÂÌÉËÁÃÉÑ: Injury. 2011 Feb;42(2):156-61. Long-term follow-up of femoral shaft fracture: Relevance of malunion and malalignment for the development of knee arthritis. Phillips JR, Trezies AJ, Davis TR. Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK. jonphillips99@hotmail.com It has not yet been well established whether femoral shaft fracture malunion and malalignment lead to the development of knee osteoarthritis.This study has assessed a cohort of 62 patients after femoral shaft fracture at a median follow-up of 22 years (range 18–28). The mean age of the patients at time of follow-up was 42 years (33–80). Each patient was clinically examined for signs and symptoms of osteoarthritis, radiographs were taken to assess malalignment and radiographic osteoarthritic changes, and WOMAC and SF-36 (physical and mental) scores were measured.Radiographic changes consistent with osteoarthritis were present in only 5 (8%) ipsilateral and 3 (5%)contralateral knees. Clinical signs and symptoms of osteoarthritis were present in only two (3%)ipsilateral knees. However, 16 patients (26%) exhibited mild pain or stiffness in the ipsilateral knee,while only 4 patients (6%) had such findings in their ipsilateral knee (OR 4; p = 0.004).The median WOMAC score for knee pain was 3 (range 1–15; max 20), knee stiffness was 1 (0–8; max 8) and disability was 6 (0–55; max 68). The median SF-36 score for physical function was 85 (range 0–100; max 100).The mean coronal plane malunion was 58 (range 198 to 88). There was no significant association between any measures of malunion and the WOMAC scores, or the presence of either clinical or radiological osteoarthritis.It is concluded that femoral shaft malunion and malalignment does not cause an excess of knee arthritis at 22-year follow-up. However, a significant number of this cohort has developed mild symptoms of ipsilateral knee pain or stiffness at a median age of 42 years; the long-term significance of this is not known.

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÷ÏÔ ÎÅÓËÏÌØËÏ ÐÏÐÁ×ÛÉÈ ÐÏÄ ÒÕËÕ ÉÓÔÏÞÎÉËÏ×:

Kahn KM, Beals RK. Malrotation after locked intramedullary tibial nailing: three case reports and review of the literature. J Trauma. 2002 Sep;53(3):549-52. Review. PubMed PMID: 12352495.

Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland 97201, USA.

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