Mutlu ÇOBANOĞLU, Özgür ÖZBEY, Öner ŞAVK, Ferit ÖZGEZMEZ

What is the Effect of 90-Degree DoublePlate Fixation with Grafting on Healing of Humeral Shaft Non-unions

Amaç: Çalışmanın amacı, humerus cisim kırıkları sonrası gelişen kaynama yokluğunun (non-union), çift plak tespiti ve greftleme ile tedavisinden elde edilen radyolojik ve klinik sonuçları değerlendirmektir. Gereç ve Yöntemler: Humereus cisim non-union nedeniyle 2006 ve 2012 yılları arasında ameliyat edilen olgular retrospektif olarak değerlendirildi. Sadece çift plak tespiti uygulanan olgular çalışmaya dahil edildi. Eksternal fiksatör ile tespit, tek plak ile tespit, intramedüller tespit uygulanan olgular ile patolojik kırık nedeniyle ameliyat edilen olgular çalışmaya dahil edilmedi. Anterolateral veya posterior yaklaşımla uygulanan cerrahi teknik, radial sinir diseksiyonunu, dekortikasyonu, medüller kanalın yeniden oluşturulmasını, çift plak ile tespiti ve otojen veya allojen greft uygulamasını içermekteydi. Sonuçların değerlendirmesinde, non-union onarımının başarısı, tekrar cerrahi ve komplikasyon oranı, eklem hareket açıklığı, görsel ağrı ölçütü (GAS), fonksiyon ölçütleri (DASH) ve StewartHundley sınıflaması kullanıldı. Bulgular: Çalışmada çift plak tespiti uygulanan on olgu mevcuttu. Olgulardan altısı kadın, dördü erkekti. Kaynama tüm olgularda 4,5-8 ayda gerçekleşti. Ameliyat sonrası radial sinir felci veya enfeksiyon görülmedi. GAS ortalama 6,1'den 2'ye, DASH skoru 74,1'den 23,4'e geriledi. Dokuz olguda iyi ve mükemmel sonuç elde edildi. Sonuç: Çalışma, seviye 4 kanıt değerine sahip olup humerus cisim non-union olgularında çift plak tespit ve greftleme ile tedavinin, ciddi düzeyde komplikasyonu olmayan, yüksek kaynama oranına sahip, iyi ve mükemmel sonuçlar sağlayan bir yöntem olduğunu göstermektedir.

Doksan Derece Konumlandırılmış Çift Plak ile Tespit ve Greftlemenin Humerus Cisim Kaynama Yokluğunun İyileşmesi Üzerine Etkinliği Nedir?

Objective: Our aim was to investigate the clinical and radiological outcomes of double-plate fixation with grafting in the treatment of non-union of humeral shaft fractures. Materials and Methods: We performed a retrospective chart review of patients operated between 2006 and 2012 due to humeral shaft non-union. Patients undergoing surgery with double-plate fixation were included and those treated with external fixator, single plate, intramedullary nails and patients with pathological fractures and infected non-unions were excluded. Surgical intervention via anterolateral or posterior approach included radial nerve identification, decortication and reestablishment of medullary canal followed by compression plating with double-plate fixation and frequent application of autogenous grafts or allografts. Main outcome measures were success rate of non-union repair, rate of re-intervention and complications, range of motion, assessment of pain Visual analogue scale (VAS) and function Disabilities of the arm, shoulder and hand (DASH) and overall outcome Stewart-Hundley classification.Results: Ten patients were treated with double-plate fixation. The study group included six females and four males aged 36 to 70 years. Union was achieved within 4.5 and 8 months in all cases. The mean preoperative VAS score of 6.1 decreased to 2, postoperatively, with an associated decrease in the mean DASH score from 74.1 to 23.4. Excellent or good results were obtained in nine cases. There was no incidence of radial nerve palsy or infection. Conclusion: Our study provides level 4 evidence of the effectiveness of treating non-union fractures of the humeral shaft with double-plate fixation and grafting in providing good-to-excellent functional results and high union rate without any significant complication.

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