Ayhan KILIÇ, SAMİ SÖKÜCÜ, S. Atilla PARMAKSIZOĞLU, MURAT GÜL, S. Yavuz KABUKÇUOĞLU

Cerrahi olarak tedavi edilen kaynamamış skafoid kırıklarının radyolojik ve işlevsel sonuçları arasındaki ilişkinin değerlendirilmesi

Amaç: Çalışmamızda kaynamamış skafoid kırıklarının cerrahi tedavisi sonucunda sağlanan radyolojik iyileşme bulguları ve klinik sonuçlar arasındaki ilişkinin değerlendirilmesi amaçlandı. Çalışma planı: Kaynamayan skafoid kırıklarının neden olduğu yakınmalarla kliniğimize başvuran ve cerrahi olarak tedavi edilen 13 hasta geriye dönük olarak değerlendirildi. Kaynama bulguları göstermeyen kırıkların 9'u gövde, 4'ü proksimal kutup bölgesindeydi. Kırıkların Slade'in sınıflamasına göre 2'si 4. derece, 8'i 5. derece. 3'ü ise 6. derece idi. Tümü erkek olan hastaların yaş ortalaması 31 olup, travmadan sonra geçen süre ortalama 25 ay idi. Kırıkların tümü açık yerleştirme, otojen greftleme (4 olguda kaıısellöz, 9 olguda kortikokansellöz) ve kompresyon vidası tespiti ile tedavi edildi. Hastaların el bileği hareketleri ve kavrama kuvvetleri ölçüldü. Kemik morfolojisi, skafoid indeks ve karpal dizilim skafolunat açı ölçümlerine dayalı olarak radyolojik açıdan değerlendirildi. El bileğinin işlevselliğinin değerlendirilmesinde, hareket açıklığı ve kavrama kuvveti ölçümleri ile uyarlanmış Mayo el bileği değerlendirme ölçütleri kullanıldı. Bulgular: Hastaların ortalama gözlem süresi 16 ay idi. On hastada ortalama 12.4 hafta sonunda radyolojik kaynama sağlandı. Cerrahi sonrasında kavrama kuvvetleri ve hareket açıklığı değerlerinde belirgin gelişme görüldü. Uyarlanmış Mayo el bileği değerlendirme Ölçütlerine göre cerrahi öncesi dönemde ölçülen puan ortalama 41.5 iken, cerrahi sonrasında ortalama 79.2 puan oldu. Buna göre 4 hastada mükemmel, 2 hastada iyi, 5 hastada orta ve 2 hastada ise kötü sonuç alındı. Cerrahi öncesinde ortalama 45.8° olan skafolunat açı, cerrahi tedaviyle ortalama 32°'ye; ortalama 0.69 olan skafoid indeks, ortalama 0.6'ya geriledi. Tedavi öncesi 11 hastada görülen kamburlaşmanın, skafoid kemiğin uzunluğunun yeniden düzenlenmesiyle 10 hastada düzeldiği saptandı. Bu hastaların 4'ün-de bozuk olan karpal dizilim düzeltildi. Cerrahi olarak sağlanan yapısal düzeltmeler ve kaynama ile işlevsel sonuçlar arasında istatistiksel olarak anlamlı bir ilişki bulunamadı. Çıkarımlar: Kaynamayan skafoid kırıkların cerrahi tedavisi esnasında kemik morfolojisi ve dizilim sorunları düzeltilebilir. Ancak bu değerlerde sağlanan düzeltmeler ve kaynama, işlevsel sonuçların iyileştirilmesi için yeterli olmayabilir.

Comparative evaluation of radiographic and functional outcomes in the surgical treatment of scaphoid non-unions

Objective: The aim of our study was to evaluate the correlation between the radiological signs of union and functional outcomes in patients with surgically treated scaphoid non-unions. Methods: In our study, we evaluated 13 patients who underwent surgery at our clinic for complaints resulting from an unhealed scaphoid fracture. Of the scaphoid non-unions, 9 were on the scaphoid body and 4 were on the proximal pole. According to Slade’s classification system, there were two Grade 4, eight Grade 5, and three Grade 6 fractures. The patients were all male with a mean age of 31, with 25 months of mean time between the onset of trauma and surgery. All fractures were treated through open reduction with autogenous bone grafting (cancellous in 4 cases; corticocancellous in 9 cases) and fixation with compression screws. Bone morphology and carpal alignment were assessed through radiography, using the scaphoid index and scapholunate angle measurements, respectively. Range of motion and grip strength measurements together with the modified Mayo wrist scores were used in the assessment of wrist functionality. Results: Average duration of follow-up was 16 months. In 10 patients, radiological union was attained in a mean time of 12.4 weeks following the operation. There was a substantial improvement in grip strength and range of motion values after surgery. The preoperative mean modified Mayo wrist score of 41.5 improved to 79.2 postoperatively. Accordingly, 4 patients had perfect, 2 had good, 5 had fair and 2 had poor results. The surgical treatment allowed the preoperative mean scapholunate angle of 45.8° and the preoperative mean scaphoid index of 0.69 to be reduced to 32° and 0.6, respectively. The humpback deformity present in 11 patients before the surgery was restored in 10 patients by reconstruction of the scaphoid bone length. Abnormal carpal alignment was restored in 4 of these patients. No statistically significant correlation was found between the functional results and the surgically attained structural restorations and union process. Conclusion: The surgical treatment of scaphoid fracture non-unions can correct bone morphology and resolve alignment problems but might not be sufficient for the improvement of functional results.

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