Mahmut KÖMÜRCÜ, Levent KAMACI, M. Taner ÖZDEMİR, A. Sabri ATEŞALP, Mustafa BAŞBOZKURT

Radius distal uç kırıklarının (AO tip C2-C3) ekstrenal fiksatörle tedavisi

Amaç: Radius distal uç kırığı nedeniyle kapalı redüksiyon, greftleme, K-teli ve eksternal fiksasyon, uygulanan hastalar tedavi sonuçları açısından değerlendirildi. Çalışma planı: Çalışmaya 24 hasta (15 erkek, 9 kadın; ortv yaş 34; dağılım 21-73) alındı. Kırıklar, AO sınıflamasına göre 16 hastada C2, sekiz hastada C3 tipte idi. Üç hastada açık kırık, dört hastada median sinir basısı bulguları vardı. Tedavi olarak, redüksiyon ve otolog greftlemeden (16 olgu) son¬ra K-teli (2-5 adet) ile fiksasyon ve eksternal fiksatör uygulandı. Sonuçlar, klinik olarak Gartland-Werley, radyografik olarak Stewart ölçütleri ile değerlendirildi. Dejeneratif değişiklikler Knirk-Jupiter skalasına göre sınıflandırıldı. Ortalama izlem süresi 35 ay (dağılım 25-52 ay) idi. Sonuçlar: Çalışan 19 hastanın hepsi, ortalama 3.5 ayda yaralanma öncesi aktivitelerine döndü. Radyografilerde, radial uzunluğun büyük oranda korunduğu saptandı. Eklem yüzeyinde ortalama 1.4 mm çökme gözlendi. Radial inklinasyon-da ortalama %6.7, volar tiltte %17.6 kayıp vardı. Stewart ölçütlerine göre, 12 olguda iyi, dokuz olguda orta, üç olguda kötü sonuç alındı. Eklem hareket genişliklerinde fleksiyon-ekstansiyonun %75, supinasyon-pronasyonun %70, radial-ulnar deviyasyonun %75 korunduğu görüldü. Yakalama gücünde, karşı tarafa göre %70'lik bir değere ulaşıldı. Gart¬land-Werley ölçütlerine göre, sonuçlar üç olguda mükem¬mel, sekiz olguda iyi, 10 olguda orta, üç olguda kötü bulun¬du. Knirk-Jupiter sınıflamasına göre, altı olguda dejenerasyon hiç yoktu; 11 olguda hafif, altı olguda orta, bir olguda ileri derecede dejeneratif değişiklik saptandı. Dört hastada K-teli yoluyla ilgili sorun; iki hastada erken dönemde geçici refleks sempatik distrofi; iki hastada radial sinir yüzeyel da¬lının geçtiği bölgede hipoestezi görüldü. Çıkarımlar: Radius distal uç kırıklarında (AO tip C2-Ç3) eksternal fiksasyon, otogreft ve perkütan K-teli kombinasyonu ile tedavi normale yakın radyografik ve klinik sonuçlar sağlamaktadır.

Anahtar Kelimeler:

Colles kırığı, Eksternal fiksatörler, Kırık tespiti, internal, Radius kırıkları, El bileği yaralanmaları, Kırıklar, parçalı, Hareket açıklığı, eklem

Treatment of AO type fractures of the distal end of the radius with external fixation

Objectives: We evaluated the results of combined treatment with closed reduction, grafting, K-wires, and external fixation in patients with fractures of the distal end of the radius. Methods: Of 24 patients (15 males, 9 females; mean age 34 years; range 21-73), 16 patients had C2, eight patients had C3 fracturejjs according to the AO classification. Three patients had open fractures, and four patients had signs of median nerve compression. Treatment included closed reduction, autologous grafting (16 cases) followed by fixation with 2 to 5 K-wires, and an external fixator. Clinical and radiographic results were assessed , according to the Gartland-Werley's and Stewart's criteria, respectively, and degenerative changes to the Knirk-Jupiter's criteria. The mean follow-up was 35 months (range 25 to 52 months). Results: All of the 19 patients who were employed returned to preinjury working conditions in a mean of 3.5 months. Radial length was preserved to a great extent. The mean amount of collapse of the joint surface was 1.4 mm. The mean loss was 6.7% in radial inclination, and 17.6% in the volar tilt. According to the Stewart's criteria, the results were good, moderate, and poor in 12, mine, and three patients, respectively. Flexion-extension (75%), supination-pronation (70%), and radial-ulnar deviation (75%) were preserved to a great extent. Grip force amounted to 70% of the healthy side. According to the Gartland-Werley criteria, three patients had excellent, eight patients had good, 10 patients had moderate, and three patients had poor results. According to the Knirk-Jupiter's criteria, degenerative changes were slight in 11 patients, moderate in six patients, and severe in one patient. Six patients had no signs of degeneration. Complications included pin track infections (n=4), early transient reflex sympathetic dystrophy (n=2), and hypoesthesia along the superficial branch of the radial nerve (n=2). Conclusion: Treatment of the distal end fractures of the radius (AO type C2-C3) with a combination of external fixation, grafting, and percutaneous K-wires provides almost normal radiologic and clinical parameters.

Keywords:

Colles' Fracture, External Fixators, Fracture Fixation, Internal, Radius Fractures, Wrist Injuries, Fractures, Comminuted, Range of Motion, Articular,

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