Erdinç ACAR, Uğur BEZİRGAN, Mehmet ARMANGİL

Distal falanks kırığı olan erişkin hastalarda kapalı redüksiyon ve perkutan Kirschner teli uygulaması ile açık redüksiyon internal fiksasyon uygulaması sonuçları karşılaştırılması

Amaç: Çalışmada; kapalı redüksiyon ve perkutan Kirschner teli (K teli) ile açık redüksiyon internal fiksasyon uyguladığımız distal falanks kırığı olan erişkin hastaların fonksiyonel ve radyolojik sonuçlarının değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Şubat 2019 ile Aralık 2020 tarihleri arasında 13 hasta (8 erkek, 5 bayan), iki ayrı gruba ayrılarak retrospektif olarak değerlendirildi. 1. gruba kapalı redüksiyon ve perkutan K teli ( 6 hasta) ve 2. gruba açık redüksiyon internal fiksasyon (7 hasta) uygulandı. Fonksiyonel sonuçlar total aktif eklem hareket açıklığı (TAEHA) skalasına göre değerlendirildi. Analiz Statistical Package for the Social Sciences (SPSS) ve Friedman’s p korelasyon testine göre yapıldı. p<0.05 olması anlamlı kabul edildi. Gruplarda işe dönüş zamanı karşılaştırıldı. Bulgular: Hastaların ortalama yaşı 37 (24-51) ve ortalama takip süresi 13 (10-18) aydı. TAEHA skalasına göre 11 hasta mükemmel ve 2 hastada iyi sonuç elde edildi. Ortalama 4 (3-6) hafta içinde tüm hastalarda tam kaynama görüldü. Radyolojik ve fonksiyonel açıdan anlamlı fark saptanmadı. İşe dönüş zamanı açısından 2. grup anlamlı bulundu (p=0.03). Enfeksiyon, redüksiyon kaybı, kaynamama ve kompleks bölgesel ağrı sendromu gibi komplikasyonlar görülmedi. Sonuç: Distal falanks kırığı olan erişkin hastalarda uygulanan 2 ayrı tedavi yöntemi ile tatmin edici fonksiyonel ve radyolojik sonuçlar elde edilmesine rağmen, açık redüksiyon internal fiksasyon uygulanan hastalarda işe dönüş açısından daha anlamlı olduğu görülmektedir.

Anahtar Kelimeler:

distal falanks kırığı, erişkin hasta, Kirschner teli, açık redüksiyon, internal fiksasyon

Comparison of closed reduction with percutaneous Kirschner wire fixation versus open reduction with internal fixation in adult patients with distal phalangeal fractures

Objectives: We aimed to compare functional and radiological results of closed reduction with percutaneous Kirschner wire (K-wire) fixation versus open reduction with internal fixation in adult patients with distal phalangeal fractures. Patients and Methods: A total of 13 patients (8 males, 5 females) who were operated for distal phalangeal fractures in our center between February 2019 and December 2020 were retrospectively reviewed. The patients were divided into two groups according to the type of surgery: Group 1 (n=6) undergoing closed reduction with percutaneous K-wire fixation and Group 2 (n=7) undergoing open reduction with internal fixation. Functional results were evaluated using the total active range of motion (TAROM) scale. Demographic and clinical characteristics and operative data were recorded. The time to return to work was assessed between the groups. Results: The median age was 37 (range, 24 to 51) years and the median follow-up was 13 (range, 10 to 18) months. According to the TAROM scale, excellent and good results were achieved in 11 and two patients, respectively. The median time to complete union was 4 (range, 3 to 6) weeks. There was no significant difference in the functional and radiological results between the groups. However, the median time to return to work was significantly shorter in Group 2 (p=0.03). None of the patients had postoperative complications such as infection, reduction loss, nonunion or complex regional pain syndrome. Conclusion: Although both treatment methods yield satisfactory and comparable functional and radiological results in patients with distal phalangeal fractures, open reduction with internal fixation is significantly associated with a shorter time to return to work.

Keywords:

Distal phalangeal fracture, adult, Kirschner wire, open reduction, internal fixation,

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