Amet Çağrı UYAR, Alauddin KOCHAİ, Mustafa UYSAL, Abdülhalim AKAR, Uğur ÖZDEMİR

Erişkin distal humerus kompleks kırıklarında ideal cerrahi tedavi seçeneği var mı?

Giriş: Çalışmanın amacı distal humerus kompleks kırklarında uygulanmış farklı cerrahi teknikler karşılaştırılarak ideal cerrahi tedavi seçeneğinin belirlenmesinde yol gösterici olmaktır. Gereç ve Yöntem: 2015-2020 yılları arasında distal humerus diafiz kırığı tanısı alarak cerrahi tedavi planlanan hastalardan posterior yaklaşım kullanılarak açık redüksiyon ile plak-vida osteosentezi(Grup A), minimal invaziv teknikle plaklama(Grup B), Lateral yaklaşım kullanılarak plak,vida osteosentezi(Grup C) ve eksternal fiksatör ile tespit(Grup D) yapılan 71 humerus kırığı çalışmaya dahil edildi. Hastalar yaş, cinsiyet, kırığın oluş mekanizması, kırığın şekli ve AO sınıfı, uygulanan cerrahi yöntem, ek yaralanmalar, ameliyat süresi, kanama miktarı, kullanılan floroskopi miktarı, hastanede kalış süreleri, radyolojik açısal değerler, kaynama zamanı, komplikasyonlar, muayene bulguları retrospektif olarak incelenerek belirtilen cerrahi yöntemler arası farklılıklar araştırıldı. Bulgular: Kan kaybı miktarı Grup B ve D' de istatistiksel olarak anlamlı derecede az bulundu (p<0.001). Floroskopi kullanımı; Grup A'da daha az bulundu. Hastanede kalış süresi Grup B'de Grup D'ye göre kısa bulundu (p<0.001). B ve D grubunda kaynama süresi A ve C grubuna göre anlamlı şekilde uzun bulundu (p<0.05). Omuz abdüksiyon kuvveti ölçümünde grup D' de grup A ve B'ye göre anlamlı kayıp vardı(p <0.001). Tartışma: Hibrid eksternal fiksatör ile tespit yönteminin plak yerleşimini zorlaştıracak kadar distal bölgede bulunan, yumuşak doku problemi olan, özellikle çok parçalı humerus diafiz kırıklarında kullanımı diğer yöntemlerle benzer şekilde iyi fonsiyonel sonuçlar vermesi açısından uygun bir cerrahi seçenektir.

Anahtar Kelimeler:

humerus kırığı, diyafiz, diaphysis

Is there an ideal surgical treatment option for adult distal humerus complex fractures?

Objective: The aim of this study is to define the ideal surgical treatment option for distal humerus fractures by comparing different surgical techniques. Material and methods: Seventy-one patients with distal humerus diaphysis fractures who were treated between 2015 and 2020 were retrospectively investigated,. The patients were operated on with the posterior approach of open reduction and plate-screw osteosynthesis (Group A), plated with the minimal invasive technique (Group B), operated on using the lateral approach (Group C) and treated with an external fixator (Group D). Age, gender, mechanism of fracture, fracture type and AO class, applied surgical method, additional injuries, duration of operation, amount of bleeding, amount of fluoroscopy used, length of hospital stay, radiological angular values, union time, complications, and clinical examination findings of the patients were examined retrospectively and the differences between the mentioned surgical methods were investigated. Results: Blood loss was significantly less in Groups C and D (p <0.001). The use of fluoroscopy was less in Group A. The length of stay in Group B was significantly shorter than for Group D (p <0.001). Union time was significantly longer for Groups B and D compared to Groups A and C (p <0.05). Shoulder abduction strength loss was higher in Group D (p <0.001). Conclusion: The fixation with the hybrid external fixator in cases in the distal area that makes plaque placement difficult and especially in multi-part humeral diaphysis fractures is a method that gives good functional results as well as other methods that can be used.

Keywords:

humerus fracture, diaphysis,

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1. Ward EF, Savoie FH, Hughes JL. Fractures of the diaphyseal humerus. Skeletal trauma: fractures, dislocation, ligamentous injuries. Vol.2.Saunders, Philadelphia,1998,p.1523-47.
2. Tytherleigh-Strong G, Walls N, McQueen MM. The epidemiology of humeral shaft fractures. J Bone Joint Surg [Br] 1998; 80: 249-53.
3. Robinson CM, Hill RMF, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 2003; 7 (1): 38-47.
4. Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA. Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am. 2000;82(4):478-486.
5. Fears RL, Gleis GE, Seligson D. Diagnosis and treatment of complications: fractures of the diaphyseal humerus. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal trauma: fractures, dislocations, ligamentous injuries. Toronto: WB Saunders; 1998. pp. 567–578.
6. Bisaccia M, Meccariello L, Rinonapoli G, et al. Comparison of Plate, Nail and External Fixation in the Management of Diaphyseal Fractures of the Humerus. Med Arch. 2017;71(2):97-102. doi:10.5455/medarh.2017.71.97-102
7. Scott CF Jr. Length of operation and morbidity: is there a relationships? Plast Reconstr Surg. 1982; 69 (6): 1017-21.
8. Wang DS. Re: How Slow is Too Slow? Correlation of operative time to complications: an analysis from the tennessee surgical quality collaborative. J Urol. 2016 ; 195 (5): 1510-1.
9. Esmailiejah AA; Abbasian MR; Safdari F; Ashoori K. Treatment of humeral shaft fractures: Minimally invasive plate osteosynthesis versus open reduction and internal fixation. Trauma Mon. 2015; 20 (3): e26271.
10. Catagni MA, Lovisetti L, Guerreschi F, Camagni M, Albisetti W, Compagnoni P, Combi A. The external fixation in the treatment of humeral diaphyseal fractures: Outcomes of 84 cases. Injury. 2010; 41 (11): 1107-11
11. J. Barker, S. Maguire, S. Mills et al. The Clinical Anaesthesia Viva Book.Cambridge University Press.Cambridge,2009.25: 417-421
12. Micic ID, Mitkovic MB, Mladenovic DS, Golubovic VZ, Jeon IH. Treatment of the humeral shaft aseptic nonunion using plate or unilateral external fixator. J Trauma. 2008; 64: 1290 - 1296
13. Wali MG, Baba AN, Latoo IA, Bhat NA, Baba OK, Sharma S. Internal fixation of shaft humerus fractures by dynamic compression plate or interlocking intramedullary nail: a prospective, randomised study. Strategies Trauma Limb Reconstr. 2014;9(3):133-140.
14. Salih S, Blakey C, Chan D, McGregor-Riley JC, Royston SL, Gowlett S, et al. The callus fracture sign: a radiological predictor of progression to hypertrophic non-union in diaphyseal tibial fractures. Strategies Trauma Limb Reconstr. 2015;10(3):149-153.
15. Bisaccia M, Meccariello L, Rinonapoli G, Rollo G, Pellegrino M, Schiavone A, et al. A. Comparison of Plate, Nail andExternal Fixation in the Management of Diaphyseal Fractures of the Humerus. MedArch. 2017; 71(2): 97-102.
16. Çeçen GS, Gülabi D, Pehlivanoğlu G, Bulut G, Bekler H, Asil K. Radiation in the orthopedic operating theatre. Acta Orthop Traumatol Turc. 2015;49(3):297-301.
17. Mariscalco MW, Yamashita T, Steinmetz MP, Krishnaney AA, Lieberman IH, Mroz TE. Radiation exposure to the surgeon during open lumbar microdiscectomy and minimally invasive microdiscectomy: a prospective, controlled trial. Spine (Phila Pa 1976). 2011;36(3):255-260.
18. An Z, Zeng B, He X, Chen Q, Hu S. Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique. Int Orthop. 2010;34(1):131-135.
19. Yin P, Zhang L, Mao Z, et al. Comparison of lateral and posterior surgical approach in management of extra-articular distal humeral shaft fractures. Injury. 2014;45(7):1121-1125.
20. Scaglione M, Fabbri L, Dell' Omo D, Goffi A, Guido G. The role of external fixation in the treatment of humeral shaft fractures: aretrospective case study review on 85 humeral fractures. Injury. 2015; 46 (2): 265-9.
21. Schoch BS. Padegimas EM. Maltenfort M. Krieg J. Namdari S. Humeral shaft fractures: national trends in management. J Orthop Traumatol (2017) 18: 259--263
22. Charles A, Rockwood Jr., David PG, Robert WB, James DH,: Rockwood and Green’s Fractures in adults Lippincott-Raven, 197-201, 1996
23. Broadbent MR, Will E, McQueen MM. Prediction of outcome after humeral diaphyseal fracture. Injury. 2010;41(6):572-7.
24. Gaullier O, Rebaï L, Dunaud JL, Moughabghab M, Benaissa S. Treatment of fresh humeral diaphysis fractures by Seidel intramedullary locked nailing. A study of 23 initial cases after 2.5 years with rotator cuff evaluation. Rev Chir Orthop Reparatrice Appar Mot. 1999; 85 (4): 349-61.
25. Hudak, P.L., P.C. Amadio, and C. Bombardier, Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med, 1996. 29(6): p. 602-8.
26. Öksüz, Ç., Düger, T, Yakut, E, Yörükan, S et al., The Turkish Version of The Disability Of The Arm, Shoulder And Hand (Dash) Questionnaire: Test-Retest Reliability and Validity. X. Hand and Upper Extremity Surgery Congress, verbal presentation. 2006: p. 25- 28.
27. Zhao G, Liu HN, Li N, He L, Wu XB. Comparison of mid-term surgical results between plate and intramedullary nail for humeral shaft fracture. Zhonghua Yi Xue Za Zhi. 2016; 96 (37): 2988-2992.
28. McCormack RG, Brien D, Buckley RE, McKee MD et al. Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail. J Bone Joint Surg Br. 2000;82-B:336-9.
29. Meekers FSL, Broos PLO. Operatıve treatment of humeral shaft fractures. Acta Orthop. Belg, 2002; 68 (5): 462-70
30. Aynacı O,Yıldız M, Aydın H, Kerimoğlu S. Humerus cisim kırıklarında eksternal fiksatör uygulamalarımız. Hacettepe Orthopedics Journal, 2000; 10 (4): p. 137-140