Mustafa ÖZKAN, Kadir YALDIZ, A. Kadir BACAKOĞLU, Ahmet EKİN, Cem ÖZCAN

Radius distal uç eklem içi kırıklarında yumuşak doku yaralanmaları ve bunların el bileği fonksiyonlarına etkileri

Amaç: Bu çalışmada radius distal uç eklem içi kırıkları ile birlikte görülen yumuşak doku yaralanmalarının sıklığı ve bu yaralanmaların fonksiyonel sonuca etkileri incelendi. Hastalar ve yöntem: Radius alt uç eklem içi kırığı nedeniyle tedavi edilen 34 hastanın 34 el bileği çalışmaya alındı. Hastaların 12’si kadın, 22’si erkek; yaş ortalaması 47.1 (dağılım 17-72) idi. Interossöz ligaman ve triangüler fibrokartilaj kompleks (TFCC) yaralanmaları Geissler ve Palmer sınıflandırmalarına göre değerlendirildi. Ortalama izlem süresi 26.9 ay (dağılım 24-32 ay) idi. Sonuçlar: Altı el bileğinde (%17.6) eklem içi yumuşak doku lezyonu bulunmadı; beş el bileğinde (%14.7) bir, 23 el bileğinde ise (%67.7) iki veya daha fazla eklem içi yumuşak doku lezyonu saptandı. Skafolunat ligaman (SL) (n=17) ve TFCC’nin (n=17) en çok yaralanan eklem içi yapılar oldu- ğu görüldü. Kırık tipi ile yumuşak doku yaralanmalarının sayısı ve tipi arasında istatistiksel ilişki saptanmadı. (p>0.05). Bununla birlikte, yumuşak doku lezyonları instabiliteye yol açtıklarında klinik sonuçları kötü yönde etkiledi ği gözlendi. Skafolunat ligamanın, radioskafokapitat bağ ile birlikte yaralandığı olgularda SL instabilitesi saptandı. Çıkarmlar: Distal radius kırıklarında anatomik redüksiyon sağlansa bile, yumuşak doku yaralanmalarının yarattı ğı instabilite nedeniyle fonksiyonel sonuçlar kötü olabilir. Bu yüzden, kırığın anatomik redüksiyonu yanında yumuşak doku yaralanmalarının saptanması ve tedavisi de önemlidir.

Anahtar Kelimeler:

Colles kırığı, Eklem instabilitesi, El bileği yaralanmaları, Yumuşak doku yaralanmaları, Artroskopi, Atel, cerrahi, Kıkırdak, eklem, Kırık tespiti, internal

Soft tissue injuries in intra-articular fractures of the distal end of the radius and their effects on wrist function

Objectives: This study was designed to evaluate the frequency of soft tissue lesions in intra-articular fractures of the distal end of the radius and their effects on functional outcome. Methods: Thirty-four patients (12 females, 22 males) who underwent treatment for intra-articular fractures of the distal end of the radius were evaluated. The mean age was 47.1 years (range 17 to 72 years). Injuries to the interosseous ligaments and triangular fibrocartilage complex (TFCC) were classified according to the Geissler and Palmer systems. The mean follow-up was 26.9 months (range 24 to 32 months). Results: Six patients (17.6%) exhibited no soft tissue lesions. Five patients (14.7%) had single, 23 patients (67.7%) had two or more ligament lesions. The scapholunate (SL) ligament (n=17) and TFCC (n=17) were the most frequently injured structures. No significant correlation was found between the type of fracture and type and severity of soft tissue lesions (p>0.05). However, soft tissue lesions seemed to exert a worsening effect on functional outcome when they were associated with instability. Instability of SL was marked when injury to the SL ligament was accompanied by that to the RSC ligament. Conclusion: Even if anatomic reduction is achieved, functional results may be undesirable because of instability caused by ligamentous injuries. Attention should be focused not only on achieving an anatomic reduction, but also on the detection and treatment of associated ligament injuries.

Keywords:

Colles Fracture, Joint Instability, Wrist Injuries, Soft Tissue Injuries, Arthroscopy, Casts, Surgical, Cartilage, Articular, Fracture Fixation, Internal,

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