Neslihan AKSU, MEHMET FATİH KORKMAZ, Abdullah GÖĞÜŞ, AYHAN NEDİM KARA, Zekeriya Uğur IŞIKLAR

Koronoid kırıklarının eşlik ettiği dirsek çıkıklarında cerrahi yaklaşım

Amaç: Regan-Morrey tip 2-3 koronoid kırıklarının eşlik ettiği dirsek çıkıklarının cerrahi tedavi sonuçları değerlendirildi. Çalışma planı: Çalışmaya, koronoid kırığının eşlik ettiği dirsek çıkığı nedeniyle cerrahi tedavi uygulanan sekiz hasta (6 erkek, 2 kadın; ort. yaş 44; dağılım 23-76) alındı. Koronoid kırıkları, Regan-Morrey sınıflamasına göre, üç hastada tip 2, beş hastada tip 3 idi. Eşlik eden diğer yaralanmalar, Mason-Johnston tip 4 radius başı kırığı (n=6), olekranon kırığı (n=4), humerus lateral kondil kırığı (n=1), lateral (n=5) ve medial (n=2) kollateral bağ yırtığı idi. Koronoid kırıklarından birine eksizyon uygulanırken, diğerlerine serklaj, vida veya koronoid plağı ile tespit uygulandı. Radius başı kırıklarının ikisi plak veya vida ve K-teli ile tespit edilirken, dördüne radius başı protezi ile rekonstrüksiyon uygulandı. Olekranon kırıkları ise plak veya AO tension band yöntemiyle tedavi edildi. Fonksiyonel sonuçlar Mayo dirsek performans skoru ile değerlendirildi. Ortalama takip süresi 22.6 ay (dağılım 1-65.5 ay) idi. Sonuçlar: Tüm olgularda kaynama sağlandı. Son kontrollerde Mayo dirsek performans skoru ortalama 84.3 (dağılım 50-100) bulundu. Koronoid kırığı için eksizyon uygulanan hasta hariç, tüm hastalar sonuçtan memnundu. Olekranon kırıklı hastalarda, kaynama sonrasında implanta bağlı ağrı nedeniyle olekranondaki tespit materyalleri çıkarıldı. Koronoid anteromedial faset kırıklı iki hastada ulnar sinir transpozisyonu yapıldı. İki hastada dirsek hareket açıklığını etkilemeyen heterotopik ossifikasyon saptandı. Çıkarımlar: Regan-Morrey tip 2-3 koronoid kırıklarının eşlik ettiği dirsek çıkıklarında cerrahi tedavi dirseğin konsantrik redüksiyonu ve stabilitesini sağlamakta, erken hareketi mümkün kılmaktadır.

Anahtar Kelimeler:

Ulna kırıkları, Tedavi sonucu, Hasta memnuniyeti, Hareket açıklığı, eklem, Radius kırıkları, Çıkıklar, Dirsek eklemi, Kırık tespiti, internal

Surgical treatment of elbow dislocations accompanied by coronoid fractures

Objectives: We evaluated the results of surgical treatment for elbow dislocations accompanied by Regan-Morrey type 2-3 coronoid fractures. Methods: Eight patients (6 males, 2 females; mean age 44 years; range 23 to 76 years) underwent surgical treatment for elbow dislocations accompanied by a coronoid fracture. Three patients had Regan-Morrey type 2, five patients had type 3 coronoid fractures. Accompanying injuries were Mason- Johnston type 4 radial head fractures (n=6), olecranon fractures (n=4), lateral humeral condyle fracture (n=1), and lateral (n=5) or medial (n=2) collateral ligament ruptures. Coronoid fractures were fixed with a plate, screw, or a cerclage wire in all the patients except for one patient who underwent coronoid excision. For radial head fractures, plate or screw and Kwire fixation was performed in two patients and radial head prosthesis was used in four patients. Olecranon fractures were fixed with a plate or AO tension band. Functional results were assessed using the Mayo elbow performance score. The mean follow-up period was 22.6 months (range 1 to 65.5 months). Results: Union was achieved in all the patients. At the latest assessments, the mean Mayo elbow performance score was 84.3 (range 50 to 100). All the patients expressed satisfaction with surgical treatment except for one patient who underwent coronoid excision. All the fixation materials used for olecranon fractures were removed after union due to implant-associated pain. Ulnar nerve transposition was required in two patients with fractures involving the anteromedial facet of the coronoid process. Two patients developed heterotopic ossification that did not affect the range of motion of the elbow. Conclusion: Surgical treatment of elbow dislocations associated with Regan-Morrey type 2-3 coronoid fractures enables a concentric reduction of the elbow, stability, and early motion.

Keywords:

Ulna Fractures, Treatment Outcome, Patient Satisfaction, Range of Motion, Articular, Radius Fractures, Dislocations, Elbow Joint, Fracture Fixation, Internal,

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