Bülent DAĞLAR, Önder Murat DELİALİOĞLU, Bülent Adil TAŞBAŞ, Kenan BAYRAKCI, Mustafa AĞAR, Uğur GÜNEL

Akut humerus cisim kırıklarının cerrahi tedavisinde plak vida ile şişebilen intramedüller çivi yöntemlerinin karşılaştırılması

Amaç: Bikondiler tibia plato kırıklarının, artroskopi eşliğinde sirküler eksternal fiksatör ile tedavi sonuçları değerlendirildi. Çalışma planı: Bikondiler tibia plato kırığı olan 13 hasta (12 erkek, 1 kadın; ort. yaş 27; dağılım 18-37) artroskopi kontrolünde sirküler eksternal fiksatör ile tedavi edildi. Kırık nedenleri dokuz olguda trafik kazası, iki olguda spor yaralanması, iki olguda yüksekten düşme idi. Sekiz olguda açık kırık vardı. Olgular travma sonrası ortalama iki gün içerisinde kliniğimize getirildi. Yumuşak doku lezyonlarına (menisküslerde yırtık ve eklem içinde zedelenmiş kıkırdak bölgeleri) traşlama ve eksizyon uygulandı. Kırıklar Schatzker sınıflamasına göre sınıflandırıldı; fonksiyonel değerlendirmede Lysholm ve Gillquist diz skorlaması kullanıldı. Ortalama takip süresi 35 ay (dağılım 16-38 ay) idi. Sonuçlar: Hiçbir olguda ameliyat öncesi ve sonrasında nörovasküler patolojiye rastlanmadı. Lysholm ve Gillquist diz skorlamasına göre iki olguda çok iyi, altı olguda iyi, dört olguda orta, bir olguda kötü sonuç elde edildi. Takip sonundaki ortalama diz skoru 82.46 bulundu. Kötü sonuç alınan hastada diz ekstansiyon ve fleksiyonunda önemli kısıtlılık gelişti. Ameliyat sonrasında iki hastada yüzeyel yumuşak doku enfeksiyonu, altı hastada çivi dibi enfeksiyonu görüldü. Çıkarımlar: Bikondiler tibia plato kırıklarında artroskopi desteği ile uygulanan sirküler eksternal fiksasyonun iyi sonuç için yeterli olduğu görüldü.

Anahtar Kelimeler:

Humerus kırıkları, Kemik çivileri, Kemik plakları, Kırık tespiti, internal, Diyafiz, Anketler, Hareket açıklığı, eklem, Tedavi sonucu, Ameliyat sonrası komplikasyonlar

Comparison of plate-screw fixation and intramedullary fixation with inflatable nails in the treatment of acute humeral shaft fractures

Objectives: We compared the results of plate-screw fixation and intramedullary fixation with inflatable nails for the treatment of acute humeral diaphyseal fractures. Methods: The study included 34 patients (20 females, 14 males; mean age 36.4 years; range 18 to 62 years) who were selected from patients treated with plate-screw fixation or inflatable intramedullary nails. The groups were matched for age, sex, severity of fracture, and the type of humeral fracture. Eighteen fractures were treated in each group. Classification of humeral fractures and open fractures were made according to the AO and Gustilo-Anderson systems, respectively. Functional evaluations were made at postoperative six and 12 months using Constant shoulder and Mayo elbow performance scores. All the patients were administered the Short-Form 36 (SF-36) questionnaire at 12 months. The two groups were compared with respect to operation time, perioperative need for blood transfusion, time to union, complications, and shoulder and elbow functions. Results: The mean operation time was significantly shorter (25.3 min vs 66.1 min; p<0.001) and the need for blood transfusion was significantly less (p=0.001) with inflatable intramedullary nails. Constant shoulder and Mayo elbow scores did not differ significantly between the two groups. Implant failure was only encountered with plate-screw fixation in three patients. Union problems were observed in five patients (3 plate-screw, 2 intramedullary nail). Following plate-screw fixation, two patients developed superficial infection, two patients developed transient radial paralysis. Conclusions: Inflatable intramedullary nails can be used safely in the treatment of acute humeral diaphyseal fractures without increasing union problems and complications.

Keywords:

Humeral Fractures, Bone Nails, Bone Plates, Fracture Fixation, Internal, Diaphyses, Questionnaires, Range of Motion, Articular, Treatment Outcome, Postoperative Complications,

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