Ufuk NALBANTOĞLU, HÜSEYİN AREL GERELİ, Barış KOCAOĞLU, UĞUR HAKLAR, Metin TÜRKMEN

Akut koronoid kırıklarının cerrahi tedavisi

Amaç: Erken dönemde cerrahi olarak tedavi edilen tip 2-3 koronoid kırıklarının sonuçları değerlendirildi ve sonucu etkileyen etmenler araştırıldı. Çalışma planı: Çalışmaya, deplase koronoid kırığı nedeniyle açık redüksiyon ve internal fiksasyon ile tedavi edilen 13 erkek hasta (ort. yaş 35; dağılım 17-53) alındı. Regan-Morrey sınıflamasına göre kırıklar dokuz hastada tip 2 (%69.2), dört hastada tip 3 (%30.8) idi. Dokuz hastada koronoid kırığına dirsek çıkığı, radius başı kırığı, olekranon kırığı veya bağ yaralanması eşlik etmekteydi. Hastalar yaralanmadan itibaren ortalama 2.3 gün (dağılım 1-7 gün) sonra ameliyat edildi. Fonksiyonel değerlendirmede Mayo dirsek performans skoru (MDPS) kullanıldı. Radyografik artroz bulguları Broberg-Morrey ölçütlerine göre değerlendirildi. Ortalama takip süresi 44.1 ay (dağılım 12-96 ay) idi. Sonuçlar: On hastada (%76.9) fonksiyonel dirsek eklem hareket aralığı (EHA) elde edildi. Son kontrolde ortalama dirsek EHA 110.7° (dağılım 85°-130°), önkol rotasyonları 134.2° (dağılım 120°-155°) bulundu. Parçalı koronoid kırığı veya eşlik eden dirsek yaralanmaları olan üç hastada EHA daha düşüktü. Hastaların hiçbirinde instabilite saptanmadı. Ortalama MDPS 86.5 (dağılım 75-100) idi; dört hastada (%30.8) mükemmel, dokuz hastada (%69.2) iyi sonuç elde edildi. İzole veya tek parça koronoid kırığı olan dört hastada mükemmel sonuç alınırken (MDPS 98.8), parçalı kırığı veya eşlik eden bağ ve kemik yaralanmaları olan hastalarda fonksiyonel skor daha düşük bulundu. Yedi hastada (%53.9) posttravmatik artrit bulguları saptandı; bu hastalarda MDPS ortalaması 81.4 idi. Fonksiyonel sonucu mükemmel olan hastalarda artrit bulgularına rastlanmadı. Tüm hastalar yaralanma öncesi aktivite düzeylerine dönebildi. Çıkarımlar: Koronoid kırıkları, çoklu dirsek yaralanmalarının en önemli kısmıdır. Kırığın parçalı olması, eşlik eden kemik veya bağ yaralanmaları ile posttravmatik artrit varlığı fonksiyonel sonucu olumsuz etkilemektedir.

Anahtar Kelimeler:

Tedavi sonucu, El bileği eklemi, Ulna kırıkları, Kırıklar, parçalı, Hareket açıklığı, eklem, Kırık tespiti, internal, Epifiz, Dirsek eklemi, Radius kırıkları, Çıkıklar

Surgical treatment of acute coronoid process fractures

Objectives: This study was designed to assess the results of surgical treatment for type 2-3 coronoid process fractures and to identify factors that might influence the outcome. Methods: Thirteen male patients (mean age 35 years; range 17 to 53 years) were treated with open reduction and internal fixation for displaced coronoid fractures. According to the Regan-Morrey classification, the fractures were type 2 in nine patients (69.2%), and type 3 in four patients (30.8%). Nine patients had associated injuries (elbow dislocation, radial head or olecranon fractures, and/or ligamentous injuries). The mean duration to treatment was 2.3 days (range 1 to 7 days). Functional results were assessed according to the Mayo elbow performance score (MEPS), and signs of arthritis were assessed according to the Broberg-Morrey criteria. The mean follow-up was 41.1 months (range 12 to 96 months). Results: A functional range of motion of the elbow joint was achieved in 10 patients (76.9%). The mean elbow range of motion was 110.7° (range 85° to 130°) and the mean forearm rotation was 134.2° (range 120° to 155°). Three patients who had comminuted fractures and associated elbow injuries had decreased range of motion. None of the patients exhibited signs of instability. The mean MEPS was 86.5 (range 75 to 100). The results were excellent in four patients (30.8%; the mean MEPS 98.8) having isolated or noncomminuted coronoid fractures, and good in nine patients (69.2%) with comminuted fractures and/ or associated bone or ligament injuries. Post-traumatic arthritis was detected in seven patients (53.9%) whose mean MEPS was 81.4. Patients with an excellent functional result did not develop arthritis. All the patients returned to preinjury activity levels. Conclusion: Coronoid fractures are the most important component of complex elbow injuries. The presence of comminuted fractures, associated bone and ligament injuries, and post-traumatic arthritis affect the outcome adversely.

Keywords:

Treatment Outcome, Wrist Joint, Ulna Fractures, Fractures, Comminuted, Range of Motion, Articular, Fracture Fixation, Internal, Epiphyses, Elbow Joint, Radius Fractures, Dislocations,

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