MUSTAFA ŞAHİN, Bülent A. TAŞBAŞ, Bülent DAĞLAR, Kenan BAYRAKCI, Mustafa S. SAVAŞ, Uğur GÜNEL

Colles kırıklarının konservatif tedavisinde kısa ve uzun kol alçılarının kemik mineral yoğunluğu ve redüksiyon üzerine etkisi

Amaç: Colles kırıklarının (CK) koriservatif tedavisinde uygulanan kısa veya uzun kol alçılamanın, önkol kenıik mineral yoğunluğu (KMY) ve redüksiyon kayıplarına olan etkisi araştırıldı. Çalışma planı: Tek taraflı izole CK saptanan 83 hasta (48 kadın, 35 erkek; ort. yaş 53; dağılım 30-76) kapalı redüksiyon ile tedavi edildikten sonra, 44'üne uzun kol, 39'una kısa kol alçılama yapıldı. Kırıklar Frykman sınıflamasına göre değerlendirildi. Redüksiyon sonrasında her iki el bilek grafîleri çekilerek radial yükseklik ve inklinasyon ve volar tilt ölçüldü. Radyografik değerlendirme Sarmiento ve ark. tarafından önerilen yöntemle yapıldı. Birinci haftada sağlam taraf referans olarak değerlendirilmek üzere, dört ayrı bölge (ultradistal, 1/3 proksimal, orta diyafiz ve tümü) esas alınarak önkol KMY Ölçümleri yapıldı. Alçılar ortalama 45.3 gün (dağılım 40-55 gün)sonra açıldı; KMY ölçümü ve radyografık incelemeler tekrarlandı. Sonuçlar Dünya Sağlık Örgütü'nün osteoporoz ölçütleri göz önüne alınarak değerlendirildi. Sonuçlar: Alçı grupları yaş, cinsiyet, Frykman sınıflaması, etkilenen ve dominant taraf açısından benzer bulundu. Kemik mineral yoğunluğu T skorlarına göre, olguların %20'sinde osteoporoz saptandı. Alçı uygulanan önkolun tamamında KMY'de azalma görüldü; ancak KMY farkı sadece orta diyafiz bölgesinde anlamlı idi (p0.05). Çıkarımlar: Colles kırıklarının tedavisinde uzun veya kısa kol alçılamanın önkol KMY ve redüksiyon kaybına etkisi olmadığı sonucuna varıldı

Anahtar Kelimeler:

Kemik yoğunluğu, Atel, cerrahi, Colles kırığı, Radius kırıkları, Ön kol yaralanmaları, Kırık tespiti

The effect of long- or short-arm casting on the stability of reduction and bone mineral density in conservative treatment of Colles' fractures

Objectives: We evaluated the effect of long- or short-arm casting on the stability of reduction and bone mineral densi¬ty (BMD) in the forearm in patients treated conservatively for Colles' fractures (CF):. Methods: Eighty-three patients (48 females, 35 males; mean age 53 years; range 30 to 76 years) with an isolated unilateral CF underwent closed reduction followed by a randomly assigned long-arm (n=44) or short-arm (n=39) casting. Fractures were classified according to the Frykman's system. After reduction, radiographs of both forearms were taken, on which radial height and inclination, and volar tilt were measured and assessed according to the criteria by Sarmiento et al. In the first week, BMD measurements were made on the unaffected side to obtain reference values from four sites of the forearm, namely ultradistal, 1/3 proximal, middle diaphysis, and total. Following removal of the casts (mean 45.3 days; range 40 to 55 days), radiographic and BMD assessments were repeated. Osteoporosis was defined according to the criteria of the World Health Organization. Results: The two casting groups were similar with respect to age, sex, Frykman's classification, involved side, and the dom¬inant extremity. Osteoporosis was detected in 20% according to the T scores. All the sites in the fractured forearm showed density losses, but the difference was significant only in the middle diaphysis (p<0.05). No significant relationship was found between BMD losses and the cast type. Angular measurements showed significant deterioration after union; however, none was found to be related to the cast type (p>0.05). Conclusion: Our results show that BMD losses and deterioration in reduction following treatment of CF occur irrespective of which type of casting is used.

Keywords:

Bone Density, Casts, Surgical, Colles' Fracture, Radius Fractures, Forearm Injuries, Fracture Fixation,

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