BÜLENT ÖZKURT, Murat Altay, Cem Nuri AKTEKİN, Ali TOPRAK, Yalçın TABAK

Humerus cisim kırıklarında fonksiyonel breys tedavisinin yeri

Amaç: Bu çalışmada humerus cisim kırığı nedeniyle fonksiyonel breys uygulanan hastaların klinik, radyografik ve fonksiyonel sonuçları değerlendirildi. Çalışma planı: Humerus cisim kırıklı 30 hasta (19 erkek, 11 kadın; ort. yaş 34; dağılım 18-64) uzun kol alçı atel ve sonrasında fonksiyonel breys ile tedavi edildi. Kırıkların 18’i sağ, 12’si sol taraftaydı. Tümü kapalı kırık idi. Kırıkların 10’u spiral, dokuzu parçalı, altısı transvers, beşi oblik olarak değerlendirildi; 16’sı humerus 1/3 orta, sekizi 1/3 üst, altısı 1/3 alt kesimde idi. Fonksiyonel breys uygulamasına ortalama altıncı günde (dağılım 0-16 gün) başlandı. Breys tedavi süresince günde 24 saat kullanıldı ve radyografik olarak yeterli kaynama dokusu oluşumu, kırık hattında belirgin iyileşme olması ile sonlandırıldı. Fonksiyonel değerlendirme Hunter ölçütlerine göre yapıldı. Hastalar ortalama 20 ay (dağılım 10-58 ay) takip edildi. Sonuçlar: Yirmi dört hastada (%80) ortalama 14 haftada (dağılım 11-21 haftada) tam kaynama elde edilirken, altı hastada (%20) kaynama görülmemesi üzerine cerrahi tedaviye başvuruldu. Hunter ölçütlerine göre, 24 hastada (%80) iyi (G3-4), altı hastada (%20) mükemmel (G5) sonuç alındı. Fonksiyonel breys ile kaynama elde edilen hastalarda ortalama 6 derece varus-valgus açılanması, ortalama 8 derece ön-arka açılanma gelişti. Dört hastada breys nedeniyle ciltte maserasyon görüldü. Kaynama elde edilen bir hastada (%3.3) 1.7 cm’lik kısalık gelişti. Çıkarımlar: Klinik ve radyografik sonuçlarımız, endikasyonun uygun konması durumunda, ödemin gerilemesi sonrası uygulanan fonksiyonel breys tedavisinin humerus cisim kırıklarında ilk tedavi seçeneği olabileceğini göstermektedir.

Anahtar Kelimeler:

Tedavi sonucu, Kırık iyileşmesi, Korseler, Kırık tespiti, Hareket açıklığı, eklem, Humerus kırıkları

The role of functional bracing in the treatment of humeral shaft fractures

Objectives: We evaluated clinical, radiographic, and functional results of patients treated with functional bracing for humeral shaft fractures. Methods: Humeral shaft fractures of 30 patients (19 males, 11 females; mean age 34 years; range 18 to 64 years) were treated with functional bracing. Fractures were on the right in 18 patients, on the left in 12 patients. All were closed fractures, being spiral in 10, comminuted in nine, transverse in six, and oblique in five patients. Humeral fractures were in the upper third, middle third, and distal third in 16, 8, and 6 patients, respectively. Functional brace was applied after a mean of six days (range (0 to 16 days) and was worn throughout day and night until radiographic signs of sufficient union and healing was observed. Functional assessment was made according to the Hunter criteria. The mean follow-up was 20 months (range 10 to 58 months). Results: Union was achieved in 24 patients (80%) after a mean of 14 weeks (range 11 to 21 weeks). Six fractures (20%) failed to unite and were subsequently treated with surgery. According to the Hunter criteria, 24 patients (80%) were evaluated as good (G3-4), and six patients (20%) as excellent (G5). The mean varus-valgus rotation was 6°, the mean anterior-posterior translation was 8° in patients who had union with functional bracing. Four patients developed skin macerations secondary to brace use. Limb shortening of 1.7 cm occurred in one patient whose fracture was united with bracing. Conclusion: Our clinical and radiographic results suggest that, based on proper indications, functional bracing applied after regression of edema may be the treatment of choice in humeral shaft fractures.

Keywords:

Treatment Outcome, Fracture Healing, Braces, Fracture Fixation, Range of Motion, Articular, Humeral Fractures,

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