Tulgar TOROS, Kemal ÖZAKSAR, Tahir Sadık SÜGÜN, Fuat ÖZERKAN

Reconstruction of humeral diaphyseal non-unions with vascularized fibular graft

Amaç: Bu çalışmanın amacı humerus cisim kaynamaması tanılı 5 olgunun damarlı fibula grefti ile onarım sonuçlarını değerlendirmekti. Çalışma planı: 2002-2007 yılları arasında humerus cisim kırığı kaynamaması tanısı ile başvuran ortalamayaşları 47 (dağılım: 21-57) olan 6 hastaya (3 erkek, 3 bayan), damarlı fibula grefti ile onarım uygulandı. Kaynamama süresi ortalama 59 (dağılım: 12-156) ay idi. Kemik tespiti 3 hastada kanal içi çivi ile, 3 hastada plak ile sağlandı. Bir hasta ameliyatın 3. ayında klinik takipten çıktı. Kalan beş hasta ortalama 37 (dağılım: 12-53) ay izlendi. Bulgular: Beş hastanın dördünde tek operasyon ile ortalama 4.4 ayda kaynama sağlandı. Bir hastada greftin proksimal ucundaki kaynama gecikmesi greftlenerek kaynama elde edildi. Sağlam taraf ile ameliyatlı taraf arasındaki radyolojik uzunluk farkı ortalama 3.6 (dağılım: 1-7) cm bulundu. Ortalama dirsek hareket genişliği 130 (dağılım: 100-145), omuz fleksiyonu 167.5 (dağılım: 165-170), omuz abdüksiyonu 172.5 (dağılım: 170-180), omuz iç rotasyonu 75 (dağılım: 70-80), ve omuz dış rotasyonu 92.5 (dağılım: 80-100) derece olarak ölçüldü. DASH skor ortalaması 10 (dağılım: 5-19) olarak hesaplandı. Tang sınıflamasına göre 3 hastada mükemmel, 2 hastada iyi klinik sonuç elde edildi. Radyolojik değerlendirmede ise 4 hastada mükemmel, 1 hastada orta sonuç elde edildi. Donör saha morbiditesine rastlanmadı. Çıkarımlar: Damarlı kemik grefti humerus cisim kaynamamalarının onarımında etkili bir tedavi yöntemi olarak karşımıza çıkmaktadır.

Humerus cisim kaynamamasının damarlı fibula grefti ile rekonstrüksiyonu

Objective: The aim of this study was to review the results of 5 diaphyseal non-unions reconstructed using vascularized fibular grafts. Methods: This study included six non-unions (3 males and 3 females; average age: 47 years; range: 21 to 57 years) reconstructed using vascularized fibular grafts between 2002 and 2007. Average duration of non-union was 59 (range: 12 to 156) months. Fixation was achieved with intramedullary nailing in 3 patients and plates in 3. One case was lost to follow-up at the third postoperative month. The remaining five patients were followed up for an average of 37 (range: 12 to 53) months. Results: In four cases, union was achieved with a single operation at an average of 4.4 months. A secondary intervention for grafting was required for one patient for inadequate consolidation of the proximal bone-graft interface. Mean radiographic humeral length difference was 3.6 (range: 1 to 7) cm. Average elbow range of motion was 130 (range: 100 to 145), shoulder flexion 167.5 (range: 165 to 170), shoulder abduction 172.5 (range: 170 to 180), internal rotation 75 (range: 70 to 80), and external rotation 92.5 (range: 80 to 100) degrees. Mean DASH score was 10 (range: 5 to 19). According to the Tang system, 3 patients had excellent and 2 good clinical evaluations. Radiologic evaluation revealed four excellent and one fair result. No donor site morbidity was detected. Conclusion: Our results suggest that vascularized fibular grafting is an effective treatment option for the reconstruction of humeral diaphyseal non-unions

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