Hasan KATIÖZ, Hasan BOMBACI, Mücahit GÖRGEÇ

Trimalleolar kırıkların tedavisi. Eklem yüzeyinin %25'inden az ölçülen posterior malleol kırıklarında osteosentez gerekli mi?

Amaç: Ayak bileği kırıklarında, eklem yüzünün %25'inden azını kapsayan posterior malleol kırıklarının sonuç üzerindeki etkisi araştırıldı. Çalışma planı: Ayak bileği kırığı nedeniyle cerrahi tedavi uygulanan 44 hasta (21 kadın, 23 erkek; ort. yaş 44; dağılım 17-76) değerlendirildi. Weber B veya C tipi olan kırıklarda fibula kırığının yanında, 12 olguda deltoid bağ yırtığı, 32 olguda medial malleol kırığı vardı. Posterior malleol kırığı olan (n=16) ve olmayan (n=28) hastalar Phillips'in ölçütlerine göre ayrı ayrı değerlendirildi. Grupların ortalama klinik, anatomik ve artritik skorları belirlendi ve iki grup istatistiksel olarak karşılaştırıldı. Ortalama izlem süresi 29.5 ay (dağılım18-64 ay) idi.Sonuçlar: iki grup arasında klinik ve anatomik skorlar açısından anlamlı farklılık bulunmadı. Posterior malleol kırığı olan hastalarda artritik skor diğer gruba göre yüksek olmasına rağmen, bunun anlamlı bir farklılık oluşturmadığı görüldü (p>0.05). Çıkarımlar: Posterior malleol kırıklarının eklem yüzünün %25'inden azını kapsadığı durumlarda kabul edilebilir sınırlarda redüksiyon elde edilebilirse, posterior fragmana osteosentez yapılmasa da tatminkar sonuç elde edilebilmektedir.

Anahtar Kelimeler:

Kırık tespiti, internal, Eklem instabilitesi, Biyomekanik, Ayak bileği yaralanmaları

Treament of trimalleolar fractures. Is osteosynthesis needed in posterior malleolar fractures measuring less than 25% of the joint surface?

Objectives: We evaluated the effect of posterior malleolar fractures, which measured less than 25% of the joint surface, on the results of ankle fractures. Methods: The study included 44 patients (21 females, 23 males; mean age 44 years; range 17 to 76 years) who underwent surgical treatment for Weber types B or C ankle fractures. Fibula fractures were associated with deltoid ligament ruptures in 12 patients, and with medial malleolar fractures in 32 patients. Sixteen patients and 28 patients with and without posterior malleolar fractures, respectively, were evaluated as separate groups according to the Phillips' criteria for comparison of clinical, anatomical, and arthritic scores. The mean follow-up was 29.5 months (range 18 to 64 months). Results: There were no significant differences between the two groups with regard to clinical and anatomical scores. Although the mean arthritic score was higher in patients with a posterior malleolar fracture, it did not reach significance (p>0.05). Conclusion: Our data show that satisfactory results can be achieved in posterior malleolar fractures measuring less than 25% of the joint surface when an acceptable reduction is performed even without osteosynthesis.

Keywords:

Fracture Fixation, Internal, Joint Instability, Biomechanics, Ankle Injuries,

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