Radius distal uç fizis yaralanması sonrası oluşan deformitenin ilizarov distraksiyon osteogenezi ile düzeltimi
Amaç: Çalışmamızın amacı, travma sonrası ihmal edilmiş radius distal uç fizis yaralanmasına bağlı radius kısalığının neden olduğu ileri el bilek eklemi şekil bozukluklarının tedavisinde oste-otomi ve İlizarov eksternal fiksatör ile germe osteogenezi tedavisinin sonuçlarının incelenmesi idi. Çalışma planı: Çalışmada hastalar geriye dönük olarak incelendi. Cerrahi uygulama esnasında ortalama yaşı 16 (dağılım: 14-19) olan 4 hasta çalışmaya alındı. Fizis yaralanmasına neden olan travma ile cerrahi arasındaki süre ortalama 8 (dağılım: 4-12) yıl idi. Ortalama takip süresi 83 (dağılım: 40-126) aydı. Hastalar radyolojik ölçümler (kısalık oranı, uzatma oranı, radyoulnar eklem seviyesi eşitlenmesi ve distal radyoulnar ekletn uyumu), objektif fonksiyonel ölçümler (kavrama kuvveti, çimdik kuvveti ve eklem hareket açıklığı (range of motion [ROMj ölçümleri) ve sübjektif fonksiyonel ölçümler (Mayo el bileği derecelendirmesi ve Disabilities of the Arm. Shoulder and Hand [DASHJ anketi) ile değerlendirildiler. Araştırmamızda parametrik test varsayımları yerine getirilmediğinden dolayı non-parametrik test olan Mann-Whitney U testi uygulandı. Bulgular: Radyolojik ölçüm değerleri cerrahi öncesi ve cerrahi sonrası son kontrolde elde edildi. Radiusun cerrahi öncesi ortalama kısalık oranı %14.6 (dağılım: %9.3-%l8.7), ortalama uzatma oranı % 15.9 (dağılım: % 13.2-% 18.3) idi. Bir hastada distal radyoulnar eklem uyumu sağlansa da seviye eşitlenmesi tam olarak sağlanamadı (4 mm ulna pozitif varyans). Objektif fonksiyonel ölçümlerde kavrama kuvveti, çimdik kuvveti, radyal ve ulnar deviyasyonda el bilek ROM'unda cerrahi uygulanmayan taraf ile anlamlı bir fark saptanmadı. Supinasyon ve pronas-yon hareket açıklığının ise cerrahi uygulanmayan tarafa göre anlamlı ölçüde etkilendiği gözlendi (p
Deformity correction by Ilizarov distraction osteogenesis after distal radius physeal arrest
Objective: The aim of this study was to evaluate the results of osteotomy and distraction osteogenesis using Ilizarov circular external fixator to treat radial shortening and severe wrist deformity due to neglected post-traumatic distal radius physeal arrest. Methods: The study retrospectively reviewed 4 patients (4 males; average age: 16 years; range: 14 to 19 years) who underwent osteotomy and distraction osteogenesis to treat radial shortening and severe wrist deformity due to neglected distal radius physeal arrest. Mean interval between trauma and surgical intervention was 8 (range: 4 to 12) years and mean follow-up time was 83 (range: 40 to 126) months. Patients were evaluated with radiographic measurements (shortening and lengthening ratio, radioulnar joint leveling, distal radioulnar joint congruency), objective functional measurements (grip and pinch strength, range of motion measurements [ROM]) and subjective functional measurements (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire and Mayo wrist score). Statistical analysis was made using the Mann-Whitney U non-parametric test. Results: Radiographic measurements were obtained preoperatively and at the final follow-up. The mean shortening ratio of the radius was 14.6% (range: 9.3% to 18.7%) and mean lengthening ratio was 15.9% (range: 13.2% to 18.3%). Normal distal radioulnar joint leveling and distal radioulnar congruency resembling a joint was established in all but one patient with four millimeters of ulna plus deformity. According to the Mann-Whitney U non-parametric test, there was no statistical difference in grip and pinch power, ROM on flexion/extension, and ulnar/radial deviation axis between the operated and non-operated sides. There was statistically significant pronation/supination restriction between the operated and non-operated sides (p<0.04). Mean DASH score was 2.07 (range: 0.0 to 8.3) and the mean Mayo wrist score was 89 (range: 75 to 100) points. According to the Mayo wrist score, results were excellent in one patient, good in two patients, and satisfactory in one patient. Conclusion: The use of distal metaphyseal osteotomy and Ilizarov distraction osteogenesis is a viable treatment method for neglected physeal fractures of the distal radius as it establishes acceptable deformity correction and a functional wrist joint.
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