Ayhan KILIÇ, Yavuz KABUKÇUOĞLU, Ufuk ÖZKAYA, MURAT GÜL, Sinem SÖKÜCÜ, Ümit ÖZDOĞAN

Radius alt uç instabil kırıklarının volar yerleşimli kilitli plakla tespiti

Amaç: Volar yerleşimli kilitli plak vida tespitleri ile tedavi edilen instabil radius alt uç kırıklarının radyograﬁk ve işlevsel sonuçları değerlendirildi. Çalışma planı: Radius alt uç instabil kırığı nedeniyle volar yerleşimli kilitli plak tespiti uygulanan 27 hasta (15 erkek, 12 kadın, ort. yaş 45; dağılım 18-77) incelendi. AO sınıﬂamasına göre kırıkların 22’si (%81.5) tip C, beşi (%18.5) tip B idi. İki hastada (%7.4) tip I açık kırık vardı. Kırıkların 21’inde (%77.8) dorsal, altısında (%22.2) volar açılanma vardı. Dört hastada (%14.8) kırığa dirsek çıkığı ve/veya kırık eşlik etmekteydi. Dokuz hastada (%33.3) distal radioulnar eklem sorunları vardı. On hastada (%37) kırık tespitine ek olarak otolog krista iliyka grefti kullanıldı. Hastaların hareket açıklıkları, kavrama kuvvetleri ölçüldü, Stewart ölçütlerine göre radyograﬁk değerlendirmeleri yapıldı. Fonksiyonel değerlendirmede Quick-DASH-T (Disabilities of the Arm, Shoulder and Hand-Türkçe) sorgulaması ve Gartland-Werley değerlendirme formu kullanıldı. Ortalama takip süresi 18 ay (dağılım 12-34 ay) idi. Sonuçlar: Kırıkların tümü ortalama 6.5 haftada (dağılım 6-8 hafta) sorunsuz kaynadı. Yirmi bir hastada (%77.8) ulnar varyans, 13 hastada (%48.2) radial inklinasyon açısı, sekiz hastada (%29.6) radial tilt açısı, 11 hastada (%40.7) radial yükseklik sağlam taraﬂa eşitlendi. Stewart ölçütlerine göre ortalama radyograﬁ puanı 0.5 (dağılım 0-3) bulundu. Tedavi edilen tarafta kavrama gücü, sağlam tarafın ortalama %72.4’ü (18 kg) idi. Quick-DASH-T skoru ortalaması 8.3 (dağılım 0-70.5), Gartland-Werley puanı ortalaması 4.7 (dağılım 0-16) bulundu. Gartland-Werley değerlendirmesine göre, 12 hastada (%44.4) mükemmel, 12 hastada iyi, üç hastada (%11.1) ise orta sonuç alındı. İki hastada dizilim kaybı ve bir hastada çevre dokularda uyumsuzluk olmak üzere üç (%11.1) hastada komplikasyon görüldü. Çıkarımlar: Volar yerleşimli kilitli plak uygulamaları radius alt uç anatomisinin düzeltilmesinde ve korunmasında etkilidir.

Anahtar Kelimeler:

Donanım tasarımı, Kırıklar, açık, Ortopedik fiksasyon araçları, El bileği eklemi, Hareket açıklığı, eklem, Radius kırıkları, Nakil, otolog

Volar locking plate ﬁxation of unstable distal radius fractures

Objectives: We evaluated radiographic and functional results of volar locking plate ﬁxation of unstable distal radius fractures. Methods: The study included 27 patients (15 males, 12 females; mean age 45 years; range 18 to 77 years) who were treated with volar locking plate ﬁxation for unstable distal radius fractures. Twenty-two patients (81.5%) had AO type C and ﬁve (18.5%) had type B fractures. Two patients (7.4%) had type I open fractures. Dorsal and volar angulation were present in 21 (77.8%) and six (22.2%) fractures, respectively. Four patients (14.8%) also had elbow dislocation and/or fracture and nine patients (33.3%) had disruption of the distal radioulnar joint. Autologous iliac crest graft was used in 10 patients (37%). Postoperative assessments included range of movement and grip strength measurements, and radiographic parameters using the Stewart criteria. Functional results were assessed using the Q-DASH (Quick-Disabilities of the Arm, Shoulder and Hand) questionnaire and the Gartland-Werley scale. The mean follow-up was 18 months (range 12 to 34 months). Results: All fractures united without a problem within a mean of 6.5 weeks (range 6 to 8 weeks). The following parameters became equal to the unaffected side: ulnar variance (n=21, 77.8%), radial inclination angle (n=13, 48.2%), radial tilt angle (n=8, 29.6%), and radial height (n=11, 40.7%). The mean radiographic Stewart score was 0.5 (range 0 to 3). The mean grip strength of the operated side was 72.4% (18 kg) of the normal side. The mean Q-DASH and Gartland-Werley scores were 8.3 (range 0 to 70.5) and 4.7 (range 0 to 16), respectively. According to the Gartland-Werley scale, the results were excellent in 12 patients (44.4%), good in 12 patients, and moderate in three patients (11.1%). Three complications (11.1%) occurred, including loss of alignment in two patients, and screw-related discomfort in one patient. Conclusion: Volar locking plate ﬁxation is an effective treatment in the anatomical and functional restoration of unstable distal radius fractures.

Keywords:

Equipment Design, Fractures, Open, Orthopedic Fixation Devices, Wrist Joint, Range of Motion, Articular, Radius Fractures, Transplantation, Autologous,

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