Ufuk NALBANTOĞLU, HÜSEYİN AREL GERELİ, BEKİR YAVUZ UÇAR, Barış KOCAOĞLU, Teoman DOĞAN

Metakarp kırıklarının açık redüksiyon ve düşük profilli plak vida sistemi ile tedavisi

Amaç: Açık redüksiyon ve düşük profilli mini plak vida ile tespit uygulanan düşük enerjili metakarp kırıklarında fonksiyonel sonuçlar ve yöntemin etkinliği değerlendirildi. Çalışma planı: Birinci metakarp dışındaki metakarplerdeki kırık nedeniyle açık redüksiyon ve mini plak vida ile tespit uygulanan 43 hastanın (37 erkek, 6 kadın; ort. yaş 31±9; dağılım 17-52) 50 metakarpı incelendi. Yirmi altı kırık oblik, 12 kırık transvers, 12 kırık parçalıydı. Üç olguda açık kırık vardı. Hastalarda objektif değerlendirme için toplam aktif eklem hareket aralığı (TAEHA) puanlaması kullanıldı ve kavrama gücü ölçüldü. Memnuniyet değerlendirmesi için Quick-DASH skorlamasının Türkçe uyarlaması kullanıldı. Radyografik değerlendirme ön-arka/yan ve oblik grafilerle yapıldı. Komplikasyonlar Page-Stern sistemine göre önemli ve hafif olarak sınıflandırıldı. Ortalama takip süresi 62.2±24.8 ay (dağılım 12-96 ay) idi. Sonuçlar: Son kontrolde ortalama TAEHA 220.5±43.9 derece (dağılım 30°-260°) bulundu. Sonuçlar 25 hastada mükemmel (%58.1), 12 hastada iyi (%27.9), beş hastada orta (%11.6), bir hastada kötü (%2.3) olarak değerlendirildi. Ortalama kavrama gücü kaybı %5.2±7.3 bulundu. Quick- DASH skoru ortalaması 2.0±2.8 (dağılım 0-11) idi. Tüm hastalarda kaynama sağlandı. On hastada (%23.2) önemli komplikasyon saptandı. Dört hastada (%9.3) plak çıkarılmasını gerektirecek ekstansör tenosinovit ve plak rahatsızlığı, altı hastada (%14) 180 dereceden az toplam aktif eklem hareket aralığı vardı. Çıkarımlar: Düşük enerjili metakarp kırıklarında açık redüksiyon ve mini plak vida uygulaması, erken ve güvenli fonksiyonel kullanıma izin veren başarılı bir tespit yöntemidir.

Anahtar Kelimeler:

Tedavi sonucu, Hareket açıklığı, eklem, Geriyedönük çalışma, Ameliyat sonrası komplikasyonlar, Metakarpus, El kuvveti, Kemik plakları, Kemik vidaları, İzleme çalışmaları, Kırık tespiti, internal, Yaralanma şiddeti skoru

Treatment of metacarpal fractures with open reduction and low-profile plate and screw fixation

Objectives: We evaluated functional results and effectiveness of open reduction and low-profile plate fixation for the treatment of low-severity metacarpal fractures. Methods: We retrospectively reviewed 50 metacarpal fractures of 43 patients (37 men, 6 women; mean age 31±9 years; range 17 to 52 years) who were treated with open reduction and low-profile plate fixation. Fractures of the first metacarpal were excluded. There were 26 oblique, 12 transverse, and 12 comminuted fractures. Three fractures were open. Objective assessment included total active motion (TARM) and grip strength. Subjective assessment was made using the Turkish version of the Quick-DASH scale. Radiographic evaluations were made on anteroposterior/ lateral and oblique roentgenograms. Complications were classified as major or minor according to the Page-Stern system. The mean follow-up was 62.2±24.8 months (range 12 to 96 months). Results: At final evaluations, the mean TARM was 220.5±43.9 degrees (range 30°-260°). The results were excellent in 25 patients (58.1%), good in 12 patients (27.9%), fair in five patients (11.6%), and poor in one patient (2.3%). The mean loss of grip strength was 5.2±7.3%. The mean Quick-DASH score was 2.0±2.8 (range 0-11). All fractures were united. Ten patients had major complications (23.2%), which included extensor tenosynovitis and plate-related discomfort requiring plate removal in four patients (9.3%), and less than 180 degrees of TARM in six patients (14%). Conclusion: Low-severity metacarpal fractures can be treated successfully with open reduction and low-profile plate fixation, allowing early and safe functional use.

Keywords:

Treatment Outcome, Range of Motion, Articular, Retrospective Studies, Postoperative Complications, Metacarpus, Hand Strength, Bone Plates, Bone Screws, Follow-Up Studies, Fracture Fixation, Internal, Injury Severity Score,

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