EMİN ÖZKUL, Mehmet GEM, CELİL ALEMDAR, Hüseyin ARSLAN, Ferit BOĞATEKİN, GÖKHAN MERİÇ

İleri evre Freiberg hastalığında cerrahi tedavi

Amaç: Freiberg hastalığı sıklıkla 2. ve 3. metatars başını tutan bir avasküler nekrozdur ve semptomatik olgularda cerrahi tedavi yöntemi tartışmalıdır. Bu çalışmada cerrahi yöntemle tedavi edilen ileri evre Freiberg hastalarının sonuçları değerlendirildi. Yöntemler: Nonoperatif yöntemle ağrıları giderilemeyen ve cerrahi uygulanan (6 debridman, 3 osteotomi, 3 metatars başı eksizyonu) 12 hasta (8 kadın, 4 erkek) çalışmaya dahil edildi. Hastaların ortalama yaşı 19,1 (en küçük 13, en büyük 31) ve ortalama takip süresi 30,8 ay (en az 25, en çok 94 ay) idi. Hastaların 9unda 2. metatarsta, 3ünde 3. metatarsta tutulum vardı. Smillie sınıflama sistemine göre 3 hastada tip 5, 8 hastada tip 4 ve 1 hastada tip 3 osteonekroz mevcuttu. Hastaların sonuçları Lesser Metatarsophalangeal-Interphalangeal Skalasına göre de- ğerlendirildi. Bulgular: Lesser Metatarsophalangeal-Interphalangeal skalasına göre 3 olguda mükemmel (%25), 6 olguda iyi (%50) ve 3 olguda (%25) kötü sonuç elde edildi. Kötü sonuç alınan hastaların 2si tip 5, 1i tip 4 idi ve her üç hastaya da eklem debridmanı uygulanmıştı. Sonuç: Freiberg hastalığının cerrahi tedavisinde seçilecek yöntem hastalığın evresine göre belirlenmelidir. Geç dönem hastaların tedavisinde debridman tek başına çoğu zaman yeterli olmadığı için diğer yöntemlerle kombine edilmelidir.

Surgical treatment of advanced stage Freiberg disease

Objective: Freiberg disesase is an avascular necrosis of the 2nd and 3rd metatarsal head and which kind of surgical option to be used is controversial in symptomatic patients. In this study the results of the advanced stage Freibergs disease patients, who were treated with surgery were evaluated. Methods: 12 patients (8 female, 4 male) whose pain could not be solved with conservative method and underwent surgery (6 debridement, 3 osteotomy, 3 excision of the metatarsal head) were included in this study. The mean age of the patients 19.1 (range 13- 31) and the mean follow-up 30.8(range 25-94) months. According to the Smillie classification 3 patients had type 5, 8 patients had type 4 and 1 patient had type 3 osteonecrosis. The results of the patients were evaluated according to Lesser Metatarsophalangeal-Interphalangeal Scale. Results: According to Lesser MetatarsophalangealInterphalangeal Scale 3 patients (%25) had excellent, 6 patients (%50) had good and 3 patients had poor results were obtained. 2 of 3 patients with poor results were type 5, and 1 patient was type 4 and all three patients underwent joint debridement. Conclusion: The method of surgical treatment of Freiberg disease determined according to the stage of the disease. Debridement alone in the treatment of patients with late stage is not enough, it should be combined with other methods.

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