Mehmet Akdemir, Çağdaş Biçen, Ahmet Cemil Turan, Mehmet Aykut Türken, Alper Arıkan, Ahmet Ekin

İzole ulna şaft kırıklarının kısa kol sirküler alçı ile tedavisi

Amaç: İzole ulna krıkları nadir görülen kırıklardır ve kaynama gecikmesi nadir görülen bir durum değildir. Uzun kol alçı ile plaklı tespitte kaynama gecikmesi ve yetersiz kaynama sorunları ile karşılaşılabilmektedir. Biz bu çalışmamızda izole ulna kırığı olan ve kısa kol alçı ile tedavi ettiğimiz hastalarımızın klinik ve radyolojik sonuçlarını tartıştık.Yöntem: kliniğimizde ulna diyafiz kırığı nedeniyle konservatif tedavi ettiğimiz 13 hasta çalışmaya dahil edildi. Hastaların yaş ortalaması 44'tü; 6 hasta erkek, 7 hasta kadındı. Hastalardan tümü kısa kol sirküler alçı ile takip edildiler. Kırıkların 2'si proksimal 1/3, 7’si orta, 4’ü distal yerleşimli izole ulna şaft kırığıydı. 5 hastada direkt darbe, 5 hastada düşme, 3 hastada ise araç içi trafik kazası sonucu kırık oluşmuştu. Hastaların radyolojik değerlendirilmesinde ap grafide ulna şaftının eğilme açıları, el bileği seviyesinde ulnar varyans ve kaynama durumuna bakıldı. Hastaların klinik değerlendirilmesinde vizüel ağrı skalası, Q-DASH skorlamasına bakıldı. Bulgular: Hastaların ortalama takip süresi 26.5 aydı. Tüm hastalarda kaynama elde edildi. Ortalama kaynama süresi 6.15 haftaydı. Ortalama Q-DASH skoru 2.97 idi. Hastaların ap grafide ortalama ulna şaft açıları kırık anında ortalama 1.8 derece, kaynama sonunda 3.48 dereceydi. Tedavi sonunda el bilek ulnar varyans ortalama değeri 1 hastada nötral, 2 hastada pozitif, 10 hastada negatifti. 4 hastada radyolojik malunion saptanmıştı. Sonuç: izole ulna şaft kırıkları kısa kol alçı ile tedavisi sonuçları iyidir. Belirli düzeyde malunion görülse de klinik üzerine etkisi yoktur. İzole ulna şaft kırıklarında uzun kol atel-alçı tespiti geçici kullanılmalı, tedavinin tamamında kullanılmamalıdır.

Anahtar Kelimeler:

Ulna, izole şaft kırığı, kısa kol alçı, konservatif tedavi

Treatment of isolated ulnar shaft fractures with short arm cast

Objectives: isolated ulnar shaft fractures are rare injuries but union problems are common. Treatment with long arm cast and plate osteosynthesis has a potential risk of nonunion and delayed union. In this study we aimed to discuss the radiological and clinical results of isolated ulnar shaft fractures, treated with short arm cast.Methods: 13 patients treated with short arm cast in our clinic, were included to the study. Mean age of patients was 44. The etiologies of fracture were direct blow for five, fall for five and traffic accident for three patients. The radiographic evaluation was made according to ulnar shaft anatomic angle, ulnar variance at the wrist joint and presence of union. Clinical evaluation was made by Quick DASH (Disabilities of Arm Shoulder and Hand) and Visual Analog Scale.Results: MEan follow-up duration was 26.5 months. Among all patients union was achieved. Mean union duration was6.15 weeks. Mean Q-DASH score was 2.97. mean ulnar shaft anatomic angle was 1.8 degrees for at the time of fracture and 3.48 at the end of the union. At the end of the treatment, one patient had neutral ulnar variance , two positive and ten negative. Four patients had radiologic malunion.Conclusion:the treatment results of short arm cast treatment of isolated ulnar shaft fractures are good. Patients had some sort of malunion but it had little effect on clinical results. Long arm cast should be used temporarily fort the treatment of isolated ulnar shaft fractures, not till the end of the treatment.

Keywords:

Ulna, isolated shaft fracture, short arm cast, conservative treatment,

PDF

___

1. Handoll HH, Pearce P. Interventions for treating isolated diaphyseal fractures of the ulna in adults. Cochrane Database Syst Rev. 2012 Jun 13;6:CD000523. doi: 10.1002/14651858.CD000523.pub4. Review.
2.Grace TG, Eversmann WW Jr. The management of segmental bone loss associated with forearm fractures. J Bone Joint Surg Am. 1980 Oct;62(7):1150-5.
3.Pollock FH, Pankovich AM, Prieto JJ, Lorenz M.The isolated fracture of the ulnar shaft. Treatment without immobilization. J Bone Joint Surg Am. 1983 Mar;65(3):339-42.
4.Mackay D, Wood L, Rangan A. The treatment of isolated ulnar fractures in adults: a systematic review. Injury 2000; 31(8): 565–70.
5.Atkin DM, Bohay DR, Slabaugh P, Smith BW. Treatment of ulnar shaft fractures: A prospective, randomised study. Orthopedics 1995;18(6):543–7.
6.Yao CK, Lin KC, Tarng YW, Chang WN, Renn JH. Removal of forearm plate leads to a high risk of refracture: decision regarding implant removalafter fixation of the forearm and analysis of risk factors of refracture. Arch Orthop Trauma Surg. 2014 Dec;134(12):1691-7. doi: 10.1007/s00402-014-2079-4. Epub 2014 Aug 29.
7.Sarmiento A, Latta LL, Zych G, McKeever P, Zagorski JP. Isolated ulnar shaft fractures treated with functional braces. J Orthop Trauma. 1998 Aug;12(6):420-3; discussion 423-4.
8.Coulibaly MO, Jones CB, Sietsema DL, Schildhauer TA. Results of 70 consecutive ulnar nightstick fractures. Injury. 2015 Jul;46(7):1359-66. doi: 10.1016/j.injury.2015.02.012. Epub 2015 Feb 23.
9.Chapman MW, Gordon JE, Zissimos AG. Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am. 1989 Feb;71(2):159-69.
10.Leung F, Chow SP. A prospective, randomized trial comparing the limited contact dynamic compression plate with the point contactfixator for forearm fractures. J Bone Joint Surg Am. 2003 Dec;85-A(12):2343-8.
11.Freeland AE, Kregor PJ. Treatment of isolated fractures of the ulnar shaft. Orthopedics. 1997 Nov;20(11):1081-2. Review.
12.Gebuhr P, Hölmich P, Orsnes T, Soelberg M, Krasheninnikoff M, Kjersgaard AG. Isolated ulnar shaft fractures. Comparison of treatment by a functional brace and long-arm cast. J Bone Joint Surg Br. 1992 Sep;74(5):757-9.
13.Zych GA, Latta LL, Zagorski JB. Treatment of isolated ulnar shaft fractures with prefabricated functional fracture braces. Clin Orthop Relat Res. 1987 Jun;(219):194-200.
14.Brakenbury PH, Corea JR, Blakemore ME. Non-union of the isolated fracture of the ulnar shaft in adults. Injury. 1981 Mar;12(5):371-5.
15.Charles M Court-Brown principles of nonoperative treatment, Robert V. Bucholz et al, Rockwood and Green, Fractures in Adults, 7th edition, Wolters Kluver- Lippincott Williams & Wilkins Philadelphia, USA, 2010 p; 124-61