ALİ ENGİN ULUSAL, Ünal BOZ, Zeki SERTÖZ, R. Gür USTAOĞLU

Erişkinlerde humerus alt uç kırıklarında tedavi yaklaşımları ve sonuçların karşılaştırılması

Amaç: Bu çalışmada humerus alt uç kırıklarının tedavisinde uygulanan cerrahi tekniklerin sonuçları karşılaştırıldı. Çalışma planı: Çalışmaya humerus alt uç kırığı tanısıyla tedavi edilen 22 hasta (15 erkek, 7 kadın; ort. yaş 52; dağılım 21-80) alındı. Tüm kırıklar kapalı tipteydi. Kırıklarının sınıflandırmasında Müller sınıflaması ve Mehne-Matta eklem içi kırık sınıflaması kullanıldı. Kırıkların 18'i tip 3, dördü tip 4 idi. Yedi hastaya (%32) açık redüksiyon, çift zincir plakla rijit internal fiksasyon; sekizine (%36) açık redüksiyon, K-telleriyle minimal internal fiksasyon; yedisine (%32) açık redüksiyon, vidayla internal fiksasyon uygulandı. Ortalama takip süresi 42 ay (dağılım 24-72 ay) idi. Sonuçlar Mayo Dirsek Performans Skorlama sistemi kullanılarak değerlendirildi. Sonuçlar: Beş olguda (%22.7) çok iyi, sekiz olguda (%36.4) iyi, beş olguda orta, dört olguda (%18.2) kötü sonuç alındı. Altı hastada (%27.3) valgus, üç hastada (%13.6) varus deformitesi; 12 hastada (%54.6) kuvvet kaybı görüldü. K-teli uygulanan iki hastada (%9.1) kaynama yetersizliği nedeniyle instabilite gelişti. Beş hastada (%22.7) heterotopik ossifikasyon gelişti. On bir olguda (%50) ara sıra, hafif şiddette, dokuz olguda (%40.9) aktiviteyle ortaya çıkan orta şiddette ağrı vardı. Sürekli veya şiddetli ağrısı olan olgu yoktu. İki hastada (%9.1) hiç ağrı şikayeti olmadı. Mayo Dirsek Performans ortalama skoru çift zincir plakla rijit fiksasyon uygulanan grupta 88, vida uygulanan grupta 72, K-teli uygulanan grupta 55 bulundu. Çıkarımlar: Humerus alt uç kırıklarının tedavisinde açık redüksiyon ve çift zincir plakla rijit internal fiksasyonun diğer tedavi seçeneklerinden üstün olduğu sonucuna varıldı.

Anahtar Kelimeler:

Kemik çivileri, Kemik plakları, Kemik vidaları, Kırık tespiti, internal, Humerus kırıkları

Approaches to distal humeral fractures in adults and comparison of treatment results

Objectives: We compared the results of surgical techniques used in the treatment of distal humeral fractures. Methods: The study included 22 patients (15 men, 7 women; mean age 52 years; range 21 to 80 years) who were treated for closed distal humeral fractures. The fractures were classified according to the Müller’s classification (18 type 3, 4 type 4) and Mehne-Matta’s classification of intraarticular fractures. Following open reduction, internal fixation was performed with the use of double reconstructive plates in seven patients (32%), multiple K-wires in eight patients (36%), and multiple screws in seven patients (32%). The mean follow-up period was 42 months (range 24 to 72 months). The results were assessed using the Mayo Elbow Performance Scoring system. Results: The results were very good in five patients (22.7%), good in eight patients (36.4%), fair in five patients, and poor in four patients (18.2%). Valgus and varus deformities were found in six (27.3%) and three (13.6%) patients respectively, and 12 patients (54.6%) had decreased muscle strength. Two patients (9.1%) in the K-wire group developed instability due to insufficient union. Heterotopic ossification was detected in five patients (22.7). None of the patients had persistent or severe pain. Two patients (9.1%) were free of pain, while 11 patients (50%) had occasional and mild pain, and nine patients (40.9%) had moderate pain on activity. The mean Mayo Elbow Performance scores were 88, 72, and 55 with plate, screw, and K-wire applications, respectively. Conclusion: It was concluded that open reduction followed by internal fixation with double reconstructive plates was superior to K-wire and screw fixations in the treatment of distal humeral fractures.

Keywords:

Bone Nails, Bone Plates, Bone Screws, Fracture Fixation, Internal, Humeral Fractures,

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