Mehmet Ümit ÇETİN, Abdulkadir POLAT, Fırat FİDAN

Orta kolonu ilgilendiren distal radius kırıklarında artroskopik destekli fragman spesifik fiksasyon standart volar plak ile fiksasyona göre üstün müdür?

Amaç: Bu çalışmada, medial kolonun etkilendiği AO Tip B-C distal radius kırığı nedeniyle ameliyat edilen hastalarda kullanılan volar plaklama ve artroskopik müdahale destekli fragmana özgü tespit tekniklerinin klinik ve radyolojik sonuçlarını karşılaştırıldı. Gereç ve Yöntem: Nisan 2011 ile Ocak 2017 arasında radius distal uç (DER) kırığı nedeniyle cerrahi tedavi uygulanan 98 hastanın röntgen ve klinik kayıtları geriye dönük analiz edildi. Artroskopi destekli fragmana yönelik tespit ile tedavi edilen(Grup A), artroskopik müdahale olmaksızın volar yaklaşımla plak vida fiksasyonu uygulanan (Grup B) hasta grupları eklem hareket açıklıkları, kavrama güçleri klinik skorlar açısından karşılaştırıldı. Eklem hareket açıklığı ölçümünde standart gonyometre ile ölçülen fleksiyon ve ekstansiyon, ulnar deviasyon, radyal deviasyon, pronasyon, supinasyon açıları kaydedildi. Güç ölçümü için Jamar dinamometre ile kavrama kuvveti ölçüldü. Klinik değerlendirmede DASH skoru kullanıldı. Bulgular: Her iki hasta grubunun ameliyatlı bilekleri karşılaştırıldığında DASH skoru, kavrama kuvvetleri, palmar fleksiyon ve pronasyon hareket açıları ortalamaları arasında anlamlı fark görülmedi. Sırasıyla A grubunda ortalama 55 derece ve B grubunda ortalama 44 derece ölçülen dorsifleksiyon açıları, 25 ve 19 derece ölçülen ortalama radial deviasyon açıları, 87 ve 80 derece ölçülen ortalama supinasyon açıları arasında istatistiksel olarak anlamlı farklılık gözlendi. Sonuç: Eklem içi distal radius kırıklı hastalarda, artroskopik yardımlı fragman spesifik fiksasyon teknik olarak, öğrenme eğrisi gerektiren zahmetli bir işlem olmasına rağmen, özellikle genç ve yüksek eklem hareket açıklığı beklentisi olan hastalarda daha iyi postoperatif sonuçlar sağlamak adına faydalı olabilir.

Is arthroscopic intervention-assisted fragment-specific fixation technique superior to volar plating in distal radius fractures involving the middle column?

Purpose: In this study, the clinical and radiological results of volar plating and arthroscopic intervention-assisted fragment-specific fixation techniques used in patients operated for AO Type B-C distal radius fracture in which the medial colon is affected were compared. Materials and Methods: X-ray and clinical records of 98 patients who underwent surgical treatment for radius distal end (DER) fracture between April 2011 and January 2017. The patient groups treated with arthroscopy-assisted fragment-oriented fixation (Group A) and plate screw fixation with a volar approach without arthroscopic intervention (Group B) were compared in terms of joint range of motion, grip strength, and clinical scores. Flexion and extension, ulnar deviation, radial deviation, pronation, and supination angles measured with a standard goniometer were recorded in the joint range of motion measurement. Grip strength was measured with a Jamar dynamometer for power measurement. DASH score was used in clinical evaluation. Results: When the operated wrists of both patient groups were compared, there was no significant difference between the DASH score, grip strength, palmar flexion, and pronation angles of motion. A statistically significant difference was observed between the mean dorsiflexion angles of 55 degrees in group A and 44 degrees in group B, mean radial deviation angles of 25 and 19 degrees, and the mean supination angles of 87 and 80 degrees, respectively. Conclusion: Although arthroscopic-assisted fragment-specific fixation is technically a laborious procedure that requires a learning curve in patients with intra-articular distal radius fractures, it may be beneficial to provide better postoperative results, especially in young patients with high range of motion expectations.

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