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

Falanks kırıklarında açık düzeltme ve mini plak ve/veya vida ile tespit yönteminin yeri

Amaç: Açık düzeltme ve mini plak ve/veya vida ile tespit uygulanan falanks kırıklarının fonksiyonel sonuçları ve yöntemin etkinliği değerlendirildi. Çalışma planı: Çalışmaya, eklemi ilgilendirmeyen falanks kırığı olan 17 hasta (5 kadın, 12 erkek; ort. yaş 33±10; dağılım 17-48) alındı. Bir hastada iki parmakta kırık vardı. Kırıkların 14’ü proksimal, dördü orta falankstaydı. Kırıkların yedisi oblik, dördü spiral, biri transvers, altısı parçalı kırık idi. Kırıkların hepsi kapalıydı. Hastalar kırık oluştuktan ortalama 2.6±2.9 gün (dağılım 0-11 gün) sonra ameliyat edildi. Açık redüksiyondan sonra, yedi kırıkta mini plak ve vidalar, 11 kırıkta sadece mini vidalar ile tespit sağlandı. Fonksiyonel sonuçlar için parmaktaki toplam aktif eklem hareket açıklığı (TAEHA) ve kavrama gücü ölçüldü ve Q-DASH (Quick-Disabilities of the Arm, Shoulder and Hand) sorgulaması uygulandı. Hastalar ortalama 35±20 ay (dağılım 12-75 ay) takip edildi. Sonuçlar: Tüm hastalarda ortalama 4.5 ayda kaynama elde edildi. Son kontrollerde ortalama TAEHA değeri 200±39.5° (dağılım 160°-260°) hesaplandı. Bu açıdan, altı parmakta (%33.3) mükemmel, beş parmakta (%27.8) iyi, yedi parmakta (%38.9) orta sonuç alındı. Mini vidalar ile tespit sağlanan 11 kırığın sekizinde (%72.7), mini plak ve vidalar ile tespit sağlanan yedi kırığın üçünde (%42.9) mükemmel veya iyi TAEHA elde edildi. Ameliyat edilen elde kavrama gücünde sağlam tarafa göre ortalama %7.5 (dağılım %0-%20) azalma görüldü. Q-DASH skoru ortalama 3.4±4.4 bulundu. Page ve Stern sınıﬂamasına göre, yedi önemli (%38.9), altı haﬁf (%33.3) komplikasyon görüldü. İki parmakta (%11.1) kaynama gecikmesi gözlendi. Çıkarımlar: Cerrahi müdahale gerektiren falanks kırıklarında açık redüksiyon ve plak ya da vida tespiti ilk seçenek değildir. Eğer açık düzeltme ve internal tespit yapılması gerekliyse, mümkün olan en minimal invaziv yöntem (vida tespiti gibi) kullanılmalıdır.

Anahtar Kelimeler:

Parmak falanksları, El kuvveti, Kırık tespiti, internal, El parmağı yaralanmaları, Kemik vidaları, Kemik plakları

Open reduction and low-proﬁle plate and/or screw ﬁxation in the treatment of phalangeal fractures

Objectives: We evaluated the functional results and the effectiveness of open reduction and low-proﬁle plate and/or screw ﬁxation in the treatment of phalangeal fractures. Methods: The study included 17 patients (5 women, 12 men; mean age 33±10 years; range 17 to 48 years) with closed, nonarticular phalangeal fractures. One patient had two phalangeal fractures. There were 14 proximal and four mid phalangeal fractures, including seven oblique, four spiral, one transverse, and six comminuted fractures. The mean duration from injury to surgery was 2.6±2.9 days (range 0 to 11 days). Following open reduction, seven fractures were treated with a mini plate and screws, and 11 fractures with mini screws. For functional evaluations, total active motion (TARM) and grip strength were measured and the Q-DASH (Quick-Disabilities of the Arm, Shoulder and Hand) questionnaire was administered. The mean follow-up was 35±20 months (range 12 to 75 months). Results: Union was obtained in all the patients in a mean of 4.5 months. At ﬁnal assessments, TARM ranged from 160° to 260° (mean 200±39.5°), showing excellent, good, and moderate results in six ﬁngers (33.3%), ﬁve ﬁngers (27.8%), and seven ﬁngers (38.9%), respectively. An excellent or good TARM was obtained in eight ﬁngers (72.2%) treated with mini screws, and in three ﬁngers (42.9%) treated with plate-screw ﬁxation. The mean grip strength decreased by 7.5% (range 0 to 20%) on the affected side. The mean Q-DASH score was 3.4±4.4. According to the classiﬁcation of complications proposed by Page and Stern, seven major (38.9%) and six minor (33.3%) complications were seen. Two patients (11.1%) had delayed union. Conclusion: Our ﬁndings do not justify open reduction and low-proﬁle plate and/or screw ﬁxation as the ﬁrst choice in the treatment of phalangeal fractures. If plate and screw ﬁxation is necessary, the most minimally invasive method such as screw ﬁxation should be preferred.

Keywords:

Finger Phalanges, Hand Strength, Fracture Fixation, Internal, Finger Injuries, Bone Screws, Bone Plates,

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