Fatih KÜÇÜKDURMAZ, Hasan Hüseyin CEYLAN, Ahmet Can ERDEM, Mahmut Nedim AYTEKİN

Erişkin önkol kırıklarının intramedüller çivi ile tedavisi

Amaç: Erişkin önkol diafiz kırıklarının tedavisinde en sık kullanılan cerrahi yöntem plak ile osteosentez tekniğidir. Bu çalışmada daha biyolojik bir tespit yaptığına inandığı- mız intramedüller çivi uygulaması ile kırık tespiti yapılan erişkin önkol kırıklı vakalarımızın erken dönem sonuçla- rını tartışmayı hedefledik. Materyal ve Metot: Önkol kırığı olan 14 hasta (10 Erkek/ 4 Bayan) çalışmamıza dahil edildi. Hastaların yaş ortalaması 29,4 (Aralık 15-51) idi. Tüm hastalarımızın önkol kırığı kapalı redüksiyon ve intramedüller çivi sistemi ile tedavi edildi. Bulgular: Ortalama takip süresi 10,9 ay (Aralık 6-21 ay) olarak belirlendi. Ortalama klinik iyileşme 20 gün, radyo- lojik iyileşme ise 40 gün olarak bulundu. Grade 2 açık kırık sonrası radiusa çivi ile osteosentez yapılan bir hastamızda oniki hafta sonra klinik ve radyolojik iyileşme saptanamadığından plak ile revizyon osteosentez yapıldı. Hastalardan iki tanesinde sağlam tarafa kıyasla minimal pronasyon defisiti izlendi. Hiçbir hastada yara yeri komplikasyonu izlenmedi. Sonuçlar: Önkol kırıklarının tedavisinde klasik plak yerine uygulanabilecek alternatif tedavi intramedüller çivi uygulamasıdır. Bu yöntemle hem plak uygulama- sında görülebilen komplikasyonlardan kaçınılmış, hem de kırık hematomu boşaltılmadan daha biyolojik bir tespit yapılmış olmaktadır.

(Treatment of forearm fractures in adults by intramedullary nail)

ABSTRACT Background: Plate osteosynthesis technique most commonly used surgical method in the treatment of diaphyseal forearm fractures in adults. In this study we aimed to discuss the the short-term results of intramedullary nailing practices of our clinic in the treatment of forearm fractures in adults, which is a more biological way of fixation. Material and Methods: Study included 14 patients (10 male/4 female) which had forearm fractures. The main age was 29.4 (Range 15-51). All of these patients treated by closed reduction and intramedullary nailing system. Results: Mean follow-up was 10.9 months (Range 6-21 month). Mean clinical healing was detected into 20 days and radiological healing occured into 40 days after surgery. In a case of grade 2 open fracture, the fracture didnt healed radiologically and clinically into 12 weeks. This case revised by plate osteosynthesis. Minimal pronation deficiency detected in two cases. No wound problems detected. Conclusions: The intramedullary nailing is an alternative way of plate osteosynthesis in cases of forearm fractures. By this way the fixation made by a more biological techniq which preserves the fracture haematoma.The complications related with plate osteosynthesis avoided.

PDF

___

1. Ring D, Jupiter JB, Sanders RA, Quintero J, Santoro VM, Ganz R, Marti RK. Complex nonunion of fractures of the femoral shaft treated by wave-plate osteosynthesis. J Bone Joint Surg Br 1997;79:289-94.
2. Lee YH, Lee SK, Chung MS, Baek GH, Gong HS, Kim KH. Interlocking contoured intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults. J Bone Joint Surg Am 2008;90:1891-8
3. Crenshaw AH, Zinar DM, Pickering RM. Intramedullary nailing of forearm fractures. Instr Course Lect 2002;51:279-89.
4. Rand JA, An KN, Chao EY, Kelly PJ. A comparison of the effect of open intramedullary nailing and compression-plate fixation on fracture-site blood flow and fracture union. J Bone Joint Surg Am 1981;63:427-42.
5. Weckbach A, Blattert TR, Weisser Ch. Interlocking nailing of forearm fractures. Arch Orthop Trauma Surg 2006;126:309-15.
6. Markolf KL, Lamey D, Yang S, Meals R, Hotchkiss R. Radioulnar load-sharing in the forearm. A study in cadavera. J Bone Joint Surg Am 1998;80:879-88.
7. Langkamer VG, Ackroyd CE. Internal fixation of forearm fractures in the 1980s: lessons to be learnt. Injury 1991;22:97-102.
8. Crenshaw AH Jr. Fractures of shoulder, arm and forearm.In: Canale ST, Daugherty K, Jones L, Azar FM, Beaty JH, Calandruccio JH, et al. editors. Campbells operative orthopaedics. 10th ed. St. Louis: Mosby; 2003. p. 2985-3069.
9. Matthews LS, Kaufer H, Garver DF, Sonstegard DA. The effect on supinationpronation of angular malalignment of fractures of both bones of the forearm. J Bone Joint Surg Am. 1982;64:14-7.
10. Grace TG, Eversmann WW Jr. Forearm fractures: treatment by rigid fixation with early motion. J Bone Joint Surg Am 1980;62:433-8.
11. Moerman J, Lenaert A, De Coninck D, Haeck L, Ve. Intramedullary fixation of forearm fractures in adults. Acta Orthop Belg 1996;62:34-40.
12. Rush LV, Rush HL. A technique for longitudinal pin fixation of certain fractures of the ulna and of the femur. J Bone Joint Surg Am 1939; 21:619-26.
13. Sage FP. Medullary fixation of fractures of the forearm: a study of the medullary canal of the radius and a report of fifty fractures of the radius treated with a prebent triangular nail. J Bone Joint Surg Am 1959;41:1489- 525.
14. Sage FP. Medullary fixation of fractures of the forearm. A study of the medullary canal of the radius and a report of fifty fractures of the radius treated with a prebent triangular nail. J Bone Joint Surg [Am] 1959;41: 1489-516.
15. McAuliffe JA. Forearm fixation. Hand Clin 1997;13:689-701.