Recep DİNÇER, Hasan Basri PINAR, Tolga ATAY, Yakup Barbaros BAYKAL

YETİŞKİN DİSTAL HUMERUS EKLEM İÇİ KIRIKLARDA PARATRİSİPİTAL YAKLAŞIMLA ÇİFT PLAK UYGULANAN HASTALARIN KLİNİK SONUÇLARI

AmaçBu çalışmanın amacı distal humerus AO/OTA tip C1ve C2 kırıklarında triceps koruyucu paratrisipital yaklaşımla opere edilen hastaların orta dönem klinik, radyolojik ve fonksiyonel sonuçlarını değerlendirmektir.Gereç ve YöntemKliniğimizde 2013-2018 yılları arası AO/OTA tip C1 veC2 eklem içi distal humerus kırığı olup triceps koruyucu paratrisipital yaklaşım kullanılarak 2 faklı plandaçift plak uygulanarak ameliyat edilen ve takip süresien az 12 ay olan 21 hasta retrospektif olarak değerlendirildi. Olguların son kontrollerinde eklem hareketaralığı ölçümü (EHA) ve fonksiyonel değerlendirmeMayo Elbow Performance Score (MEPS) ile yapıldıve dirsek hareketleri kaydedildi.BulgularOlguların 13’ü (%61,9) erkek, 8’i (%38,1) kadın oluportalama yaş 43,2 yıl idi. 12 hastada 90° açılarla çiftplak uygulaması yapılırken, 9 hastada ise 180° açılarla çift plak kullanıldı. Tüm hastalar triceps koruyucuparatrisipital yaklaşımla opere edildi. Hastalar ortalama (12-23) 18 ay takip edildi. Ortalama kaynamasüresi 13(9-18 hafta) hafta olup tüm kırıklarda kaynama tespit edildi. Hastaların %81’inde hareket açıklığı,fonksiyonel hareket açıklığı olarak kabul edilen 30°-130° üzerindeydi. Ortalama MEPS skoru 86,9 puanolarak belirlendi, kategorik olarak; 10 hasta (%47,6)çok iyi, 7 hasta (%33,3) iyi, 4 olgu (%19,1) orta sonuçelde edildiği görüldü.SonuçEkstansör mekanizma koruyucu paratrisipital yaklaşım, AO/OTA tip C1 ve C2 eklem içi distal humeruskırıklarının fiksasyonunda eklem yüzü hakimiyeti kısıtlı olmakla birlikte yeterli ulaşım sağlar ve hasta içinfonksiyonel sonuçları memnun edicidir.

CLINICAL RESULTS OF PATIENTS WITH DUAL PLATE WHICH HAVE PARATRICIPITAL APPROACH IN ADULT HUMERUS DISTAL INTRA-ARTICULAR FRACTURES

Objective The aim of this study is to evaluate the clinical, radiological and functional results of patients operated with a paratricipital approach in AO/OTA Type C1 and C2 distal humerus fractures. Materials and Methods 21 patients with AO / OTA type C1 and C2 intraarticular distal humerus fracture in our clinic between 2013-2018 who were operated with dual plates in two different planes using a triceps protective paratricipital approach were evaluated retrospectively. Range of motion measurement (ROM) and functional evaluation were performed with Mayo Elbow Performance Score (MEPS) in the last controls of the patients and elbow movements were recorded. Results Thirteen (61.9%) of the patients were male and 8 (38.1%) were female, and the mean age was 43.2 years. In 12 patients, double plate was applied at 90° angles, and in 9 patients, dual plate was used at 180° angles. All patients were operated with a triceps protective paratricipital approach. The patients were followed for an average of 18 months (12-23). Mean union time 13 week (9-18 week) and all fractures were unioned. In 81% of patients, the range of motion was 30° -130°, which is considered the functional range of motion. The average MEPS score was determined as 86.9 points, categorically; It was observed that 10 patients (47.6%) were very good, 7 patients (33.3%) were good, and 4 patients (19.1%) had moderate results. Conclusion Paratricipital approach which extensor mechanism protective is limited for visualized in fixation of AO / OTA type C1 and C2 intraarticular distal humerus fractures, but it provides sufficient exposure and satisfies functional results for the patient.

PDF

___

1. Kozanek M, Bartonicek J, Chase SM, Jupiter JB. Treatment of distal humerus fractures in adults: a historical perspective. J Hand Surg Am. 2014;39(12):2481-5.
2. McKee MD, Jupiter JB. A contemporary approach to the management of complex fractures of the distal humerus and their sequelae. Hand Clin. 1994;10(3):479-94.
3. Riseborough EJ, Radin EL. Intercondylar T fractures of the humerus in the adult. A comparison of operative and non-operative treatment in twenty-nine cases. J Bone Joint Surg Am. 1969;51(1):130-41.
4. Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma. 2003;17(1):38-47.
5. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-7.
6. O'Driscoll SW. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. Orthop Clin North Am. 2000;31(1):91-101.
7. Bryan RS, Morrey BF. Extensive posterior exposure of the elbow. A triceps-sparing approach. Clin Orthop Relat Res. 1982(166):188-92.
8. Patterson SD, Bain GI, Mehta JA. Surgical approaches to the elbow. Clin Orthop Relat Res. 2000(370):19-33.
9. Ziran BH, Smith WR, Balk ML, Manning CM, Agudelo JF. A true triceps-splitting approach for treatment of distal humerus fractures: a preliminary report. J Trauma. 2005;58(1):70-5.
10. Morrey BF. Surgical treatment of extraarticular elbow contracture. Clin Orthop Relat Res. 2000(370):57-64.
11. Wilkinson JM, Stanley D. Posterior surgical approaches to the elbow: a comparative anatomic study. J Shoulder Elbow Surg. 2001;10(4):380-2.
12. Got C, Shuck J, Biercevicz A, Paller D, Mulcahey M, Zimmermann M, et al. Biomechanical comparison of parallel versus 90-90 plating of bicolumn distal humerus fractures with intra-articular comminution. J Hand Surg Am. 2012;37(12):2512-8.
13. Schwartz A, Oka R, Odell T, Mahar A. Biomechanical comparison of two different periarticular plating systems for stabilization of complex distal humerus fractures. Clin Biomech (Bristol, Avon). 2006;21(9):950-5.
14. Caravaggi P, Laratta JL, Yoon RS, De Biasio J, Ingargiola M, Frank MA, et al. Internal fixation of the distal humerus: a comprehensive biomechanical study evaluating current fixation techniques. J Orthop Trauma. 2014;28(4):222-6.