Femur cisim kırığı

Özet

Femur cisim kırığı, diyafizin yüksek enerjili travmada parçalı ya da basit kırılmasını; kemik zayıflığında ise patolojik kırığı kapsar. Kontrastsız BT travma taraması sırasında kırık hattının yönünü, kortikal parçalanmayı, deplasmanı ve proksimal/distal uzanımı gösterebilir. Tüm femurun görüntülenmesi aynı kemikte ikinci bir kırık odağını, kemik lezyonunu veya mevcut implant ilişkisini yakalamaya yardımcı olur. Yalnız tek kırık seviyesini raporlamak eşlik eden ek yaralanma veya belirgin kısalık/rotasyonun gözden kaçmasına neden olabilir.

Faz ve pencere

Kontrastsız tanısal

Aksiyel ince kesit BT’nin kemik algoritmalı koronal ve sagittal rekonstrüksiyonlarında kortikal kesinti, kırık hattının yönü ve uzunluğu, serbest fragmanlar, şaft translasyonu/kısalması, angulasyon ve proksimal ya da distal ek kırık seviyeleri değerlendirilir. Kırık morfolojisi için intravenöz kontrast gerekmez; femur boyunca eşlik eden kemik lezyonu ve implant ilişkisi de taranır.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

• Transvers, oblik veya spiral hat — çizginin şaft uzun eksenine göre yönünü ve kortekslerden hangi sırayla çıktığını belirtin.
• Segmental örüntü — aynı diyafizde iki ayrı tam kırık seviyesi arasında serbest kemik segmenti bulunur.
• Parçalanma — kelebek fragman, çoklu kortikal kırıntı veya çevresel kemik kaybı kemik penceresinde görünür.
• Translasyon ve örtüşme — distal veya proksimal ana fragmanın yer değişikliği ve şaft kısalması tanımlanır.
• Açılanma ve rotasyon — koronal/sagittal düzlemde eksen sapması; aksiyel düzlemde kortikal kontur ve küçük trokanter yönü yardımcı olabilir.
• Tüm femurda ek odak — proksimal boyun/trokanter ve distal suprakondiler bölge dahil görüntülenen kemiğin geri kalanı taranır.
• Patolojik veya implant ilişkili kırık — kırık odağındaki litik/sklerotik değişiklik, protez sapı ya da tespit materyaliyle ilişki gösterilir.

Ölçütler ve sınıflamalar

AO femur diyafizi sınıflaması (32)

Normalde

Normal femur diyafizinde korteks proksimalden distale kesintisiz ilerler ve medüller kanal düzenli kalibrededir; şaftın fizyolojik eğriliği iki düzlemde izlenir. Karşı femuru ve aynı femurun kırık dışındaki seviyelerini kıyaslayarak normal kontur, kemik yoğunluğu, kanal çapı ve varsa eski implant pozisyonunu ayırt edin.

Ayırıcı tanı

Subtrokanterik kırık, femurun subtrokanterik bölgesinde yer alır ve şaft kırığından anatomik konumuyla ayrılır.

Distal femur kırığı

kırık suprakondiler/metafizer bölgede veya eklem yüzüne uzanır, diyafiz merkezli değildir.

Stres veya yetersizlik kırığı

kortikal kalınlaşma ve sınırlı periosteal reaksiyonla birlikte ince çizgi olabilir; çoğu kez belirgin akut deplasman yoktur.

Kemik tümörü zemininde patolojik kırık

fokal medüller lezyon kortikal yıkım veya genişlemeyle kırık hattına eşlik eder.

Eski iyileşmiş kırık

kallus ve kortikal yeniden şekillenme vardır; kırık uçlarında akut keskin ayrışma beklenmez.

Tuzaklar

• Kalça veya diz odaklı kısmi tarama femur şaftındaki ayrı bir kırığı dışlamaz; inceleme hacmi boyunca tüm femuru gözden geçirin.
• Tek aksiyel kesitte görülen çizgi damar oluğu veya besleyici kanal olabilir; kortikal sonlanmayı ardışık kesit ve ortogonal düzlemde doğrulayın.
• Yumuşak doku hematomu kırığın yerini destekler ancak kortikal kenarları örtebilir; kemik algoritmasıyla yeniden kurun.
• Rotasyon açısı tek bir aksiyel kesitten güvenilir belirlenmez; raporda doğrudan ölçülmüş gibi sayı vermek yerine belirgin yön değişikliğini anatomik olarak tarif edin.

Kendini dene

1. Diyafizde iki tam kırık hattı arasında serbest bir kemik segmenti ve belirgin parçalanma var. Bu örüntü nasıl adlandırılır?

   • Segmental femur cisim kırığı
   • İzole trokanter avulsiyonu
   • Femur başı kırığı
   • Subkapital boyun kırığı
   Cevabı göster

   Segmental femur cisim kırığı. İki ayrı kırık seviyesi arasında kalan serbest diyafiz segmenti segmental cisim kırığını tanımlar. Diğer seçenekler proksimal femur çıkıntısı, baş veya boyun bölgesindedir.

2. Şaft kırığı BT'sinde ek raporlama için en kritik tarama hangisidir?

   • Femurun tamamında ikinci odak
   • Yalnız kalça eklem aralığı
   • Karşı diz menisküsü
   • Sakroiliak eklem gazı
   Cevabı göster

   Femurun tamamında ikinci odak. Femurun tüm uzunluğu boyunca ikinci kırık, lezyon veya implant ilişkisi aranmalıdır. Diğer yapılar tek başına aynı kemikteki ek odağı dışlamaz.

İlgili konular

• Subtrokanterik femur kırığı

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 2 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.