Ufuk NALBANTOĞLU, HÜSEYİN AREL GERELİ, BEKİR YAVUZ UÇAR, Metin TÜRKMEN

Deplase ve instabil radius distal uç kırıklarında dorsal T plak ile kilitli palmar plak yöntemlerinin karşılaştırılması

Amaç: Deplase ve instabil radius distal uç kırıklarında dorsal T plak ve kilitli palmar plak yöntemleriyle tespit sonuçları karşılaştırıldı. Çalışma planı: Radius distal uç kırığı nedeniyle dorsal T plak (n=41) veya kilitli palmar plak (n=23) ile tespit uygulanan 63 hasta (64 radius) çalışmaya alındı. Dorsal plak grubunda ortalama yaş 46±14 (dağılım 21-82), palmar kilitli plak grubunda 47±14 (dağılım 18-69) idi. Kırıklar AO/ASIF sistemine göre sınıflandırıldı. Objektif değerlendirme Gartland-Werley ölçeği, subjektif değerlendirme Quick-DASH ölçeği ile yapıldı. Ortalama takip süresi dorsal plak grubunda 78±19 ay (dağılım 12-101 ay), palmar kilitli plak grubunda 18±5 ay (dağılım 12-28 ay) idi. Sonuçlar: Dorsal plak uygulanan grupta ortalama Gartland- Werley puanı 2.3±2.1 (dağılım 0-9), Quick-DASH puanı 2.0±2.2 (dağılım 0-9) bulundu. Bu değerler palmar kilitli plak grubunda sırasıyla 2.0±2.1 (dağılım 0-6) ve 1.9±2.7 (dağılım 0-9) idi. İki değerlendirme açısından gruplar arasında anlamlı fark yoktu (p>0.05). İşe veya gündelik yaşama dönüş süreleri de iki grupta benzerdi (1.9±0.3 ay ve 1.8±0.4 ay). Ancak, ameliyat sonrası erken ve geç dönem grafilerinden ölçülen palmar açılanma kaybı (p=0.001), radial uzunluk kaybı (p=0.001), radial eğim kaybı (p=0.049) ve ulnar varyansta değişim (p=0.049) dorsal plak grubunda anlamlı derecede fazlaydı. Dorsal plak grubunda sekiz olguda (%19.5) komplikasyon görülürken, palmar kilitli plak grubunda komplikasyonla karşılaşılmadı (p=0.024). Çıkarımlar: İki yöntem arasında fonksiyonel sonuçlar açısından fark bulunmasa da, palmar kilitli plak uygulaması radius kırıklarında, düşük komplikasyon oranıyla birlikte radyografik çökmeye karşı daha dirençli tespit sağlamaktadır.

Anahtar Kelimeler:

Radius kırıkları, Kemik plakları, Kırık tespiti, internal, Fonksiyon iyileşmesi, Hareket açıklığı, eklem, Karşılaştırmalı çalışma, Donanım tasarımı, Tedavi sonucu

Comparison between fixation with dorsal T plate and palmar locking plate in the treatment of unstable displaced distal radius fractures

Objectives: We compared the results of fixation with dorsal T plate and palmar locking plate in the treatment of unstable displaced distal radius fractures. Methods: Sixty-three patients (64 radii) with distal radius fractures were treated with dorsal T plate (n=41) or palmar locking plate (n=23). The mean age was 46±14 years (range 21 to 82 years) in the dorsal and 47±14 years (range 18 to 69 years) in the palmar plate groups. The fractures were classified according to the AO/ASIF system. Objective and subjective functional assessments were made using the Gartland- Werley and Quick-DASH scales, respectively. The mean follow-up was 78±19 months (range 12 to 101 months) and 18±5 months (range 12 to 28 months) with dorsal and palmar plating, respectively. Results: The mean Gartland-Werley and Quick-DASH scores were 2.3±2.1 (range 0 to 9) and 2.0±2.2 (range 0 to 9) with dorsal plating, and 2.0±2.1 (range 0 to 6) and 1.9±2.7 (range 0 to 9) with palmar plating, respectively. The two groups did not differ with respect to Gartland-Werley and Quick-DASH scores (p>0.05). Time to return work or daily activities was also similar (1.9±0.3 months vs 1.8±0.4 months). However, patients treated with dorsal plating exhibited significantly greater values in the following parameters measured on early and late postoperative radiograms: loss of palmar tilt (p=0.001), radial height (p=0.001), radial inclination (p=0.049), and change in ulnar variance (p=0.049). Moreover, complications were seen in eight patients (19.5%) with dorsal plating, whereas no complications occurred with palmar locking plate (p=0.024). Conclusion: Although the two fixation methods do not differ with respect to functional results, palmar locking plating seems to provide a more rigid fixation resulting in significantly reduced collapse and a very low complication rate.

Keywords:

Radius Fractures, Bone Plates, Fracture Fixation, Internal, Recovery of Function, Range of Motion, Articular, Comparative Study, Equipment Design, Treatment Outcome,

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