İntertrokanterik kırık

Özet

İntertrokanterik kırık, femur boynu ile şaft arasındaki trokanterik bölgede, çoğunlukla düşme sonrası gelişen ekstrakapsüler bir kırık örüntüsüdür. Kontrastsız BT ve üç boyutlu rekonstrüksiyon, kırık çizgilerinin seyrini ve trokanterik bölgedeki kırık morfolojisini değerlendirmeye yardımcı olur. Büyük veya küçük trokanter fragmanlarının ayrışması ve ters oblik uzanım instabil örüntüyü düşündürür. Grafiye dayalı sınıflama kırığın karmaşıklığını olduğundan az gösterebilir; üç boyutlu kontrastsız BT kırık morfolojisinin daha ayrıntılı değerlendirilmesini sağlar.

Faz ve pencere

Kontrastsız tanısal

İntertrokanterik kırık değerlendirmesinde görüntüleme alanı femur başını, boynu, her iki trokanteri ve proksimal şaftı kapsamalıdır. İntravenöz kontrast gerekmez.

Kemik algoritması tanısal

3B BT, küçük trokanter fragmanın boyutu ve uzantısı, posterokoronal parçanın ön genişlemesi, lateral duvar ve ön korteks kırıkları ile anteromedial inferior köşe komminüsyonu gibi kırık özelliklerini değerlendirir.

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

BT bulguları

• İntertrokanterik ana hat — büyük trokanterden küçük trokantere veya trokanterler arasındaki kortekse uzanan oblik kırık.
• Posteromedial parçalanma — küçük trokanter ve komşu calcar korteksinin ayrı fragman olarak ayrılması destek kaybını gösterir.
• Lateral duvar kesintisi — kırık hattı büyük trokanterin lateral korteksine ulaşır ve parçayı şafttan ayırır.
• Ters oblik örüntü — AO/OTA 31-A3 kırıkları ters oblik veya transvers kırıklar olarak sınıflandırılır.
• Transtrokanterik/transvers uzanım — yataya yakın hat lateral korteksten çıkarak trokanterik parçayı ayırabilir.
• İntertrokanterik kırıklar eşlik eden femur boyun, asetabulum veya diğer kemik yaralanmaları ile birlikte görülebilir.
• Parçalı eklem dışı uzanım — ana hattın femur boynuna, subtrokanterik şaft bölümüne veya eklem içine devamı aranır.

Ölçütler ve sınıflamalar

AO/OTA 31-A (2018)

AO/OTA 2018 trokanterik kırık sınıflamasında lateral duvar bütünlüğü dikkate alınır; lateral duvar kalınlığı ölçümü tekrarlanabilir bulunmuştur. Lateral duvar kalınlığı ölçümü, lateral duvar yetersizliğini değerlendirmede tekrarlanabilir bulunmuştur; lateral duvar yetersizliği kırık instabilitesiyle ilişkilidir.

Evans

Evans, intertrokanterik femur kırıklarını sınıflandırmak için kullanılan sistemlerden biridir.

Normalde

İntertrokanterik kırıkta lateral duvar, posteromedial korteks ve küçük trokanter fragmanının morfolojisi değerlendirilir; ön-arka görüntüde pozitif veya nötral kortikal destek, daha iyi sekonder stabiliteyle ilişkilidir.

Ayırıcı tanı

Femur boyun kırığı

femur boynu kırıkları, intertrokanterik ve subtrokanterik kırıklardan ayrı bir proksimal femur kırık kategorisidir.

Subtrokanterik kırık

bu kırık grubunun görüntülemede morfolojisi ve parçalanma derecesi değerlendirilir.

Büyük trokanter avulsiyonu

izole fragman büyük trokanterde sınırlıdır; küçük trokanter ve calcar sağlam kalabilir.

Patolojik kırık

kırık çevresinde litik, sklerotik veya kemik korteksini genişleten lezyon görülür.

Tuzaklar

• Lateral duvar bütünlüğü trokanterik kırık sınıflamasında dikkate alınır; lateral duvar kalınlığı ölçümü ön-arka grafilerde değerlendirilmiş ve tekrarlanabilir bulunmuştur.
• Küçük trokanter fragmanının distal uzanımı ve posterior koronal fragmanın anterior genişliği, kırık sınıflamasında dikkate alınan morfolojik özelliklerdir.
• AO/OTA 31-A3 alt tipleri basit oblik, basit transvers ve kama ya da çok parçalı kırık örüntülerini içerir.
• Düşük BT HU değerleri daha kötü kemik kalitesiyle ilişkilidir ve instabil intertrokanterik kırık örüntüleriyle bağlantı göstermiştir.

Kendini dene

1. İntertrokanterik kırıkta ön-arka görüntüde pozitif veya nötral kortikal destek neyle ilişkilidir?

   • Daha iyi sekonder stabiliteyle
   • Femur başı osteonekrozu gelişmesiyle
   • Asetabulum kırığının bulunmasıyla
   • Kırığın eklem içine uzanmasıyla
   Cevabı göster

   Daha iyi sekonder stabiliteyle. Ön-arka görüntüde pozitif veya nötral kortikal destek, lateral görüntüde redükte ya da öne yer değiştirmiş fragmanla birlikte olduğunda daha iyi sekonder stabiliteyle ilişkilidir.

2. AO/OTA 31-A3 kırıklarının alt tipleri hangi örüntüleri içerir?

   • Basit oblik, basit transvers ve kama/çok parçalı örüntüler
   • Subkapital, baziservikal ve deplase femur boynu kırıkları
   • Tek parçalı, segmental ve parçalı femur şaftı kırıkları
   • Ön duvar, arka duvar ve kolon asetabulum kırıkları
   Cevabı göster

   Basit oblik, basit transvers ve kama/çok parçalı örüntüler. AO/OTA 31-A3 alt tipleri basit oblik, basit transvers ve kama ya da çok parçalı kırık örüntülerini içerir.

İlgili konular

• Femur boyun kırığı
• Subtrokanterik femur kırığı

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 11 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.