ALTMIŞ YAŞ VE ÜZERİ HASTALARDA RADİUS ALT UÇ KIRIKLARININ KONSERVATİF TEDAVİSİNİN KLİNİK VE RADYOLOJİK OLARAK SONUÇLARI

Yıl 2014, Cilt: 3 Sayı: 1, 27 - 33, 30.04.2014

Ali Turgut Cemil Kayalı Burak Günaydın Seydi Ahmet Eren Levent Sürer Önder Kalenderer

Öz

AMAÇ: Bu makalenin amacı 60 yaş ve üzerindeki radius alt uç kırıklı hastalarda konservatif tedavinin özellikle instabil kırığa sahip olan gruptaki klinik ve radyolojik sonuçlarını retrospektif olarak irdelenmesini içermektedir.

YÖNTEMLER: Bu çalışmaya acil servisimize 2005 ve 2011 yıllarında radius alt uç kırığı nedeni ile başvuran 60 yaş ve üzerindeki 65 hasta dahil edildi. Dahil edilme kriterleri; kemik dansitometre ölçümü olması, 60 yaş üzerinde olma, kapalı redüksiyon ve kısa kol alçı uygulanmış olma idi. Bütün hastaların medikal kayıtları incelenerek hasta özellikleri bulundu. Hastalar poliklinik kontrolüne çağırıldı. Hastalara her iki elbileği kıyaslamalı röntgenleri çekildi, el dinamometresi ile her iki elin kavrama güçleri ölçüldü. Klinik sonuçlar Modifiye Gartland ve Werley Puanlama Sistemi’ne (MGWPS), radyolojik sonuçlar Scheck Kriterleri’ne (SK) göre değerlendirildi.

BULGULAR: Bu çalışmaya dahil edilen 65 hastanın 40’ı kadın, 25’i erkek olup kırık anındaki yaşları ortalama 68.1 yıl (60-82)idi. Bu hastaların ortalama takip süreleri 25.5 ay (10-45)idi. Hastaların ortalama T skoru değeri – 2.47 (– 1.2; – 4.9)idi. MGWPS sonuçları ortalama 7.5 (0-22)idi.5 mm’nin üzeri radial yükseklik kaybı olmayan ve 10°‘nin üzerinde volar eğim açısı kaybı olmayan 26 hastanın ortalama yumruk yapma güçleri sağlam taraf ile karşılaştırıldığında ortalama %76.5 ( %37-100) iken bu oran; radial yükseklik kaybı 5mm.‘nin üzerinde olan 24 hastada ortalama %62.3 (%33-89), 10°‘den fazla volar eğim açısı değişikliği olan 26 hastada ortalama %71.2 (%37-100), her iki durumun bulunduğu 11 hastada ise ortalama %60.1 (%33-89) idi.

SONUÇ: Yaşlı hastaların distal radius kırıkları düşük aktivite beklentisi nedeni ile genellikle konservatif olarak tedavi edilmektedirler. Ancak implant teknolojisinin gelişmesi ile birlikte özellikle radial kısalık ve volar tilt kaybı bulunan hastalarda cerrahi tedavi ile iyi sonuçlar alınabilir.

Anahtar Kelimeler

Radius alt uç kırığı, Konservatif tedavi, Kemik yoğunluğu, El bileği, Yaşlı hasta

CLINICAL AND RADIOLOGICAL RESULTS OF CONSERVATIVE TREATMENT IN FRACTURES OF DISTAL RADIUS IN THE PATIENTS 60 OR MORE YEARS OLD

Öz

OBJECTIVE: The aim of this study is to evaluate retrospectively clinical and radiological results of the conservatively treated distal radius fractures of 60 years or older patients.

METHODS: 65 patients (40 male,25 female) with radius distal fracture that had occurred between 2005-2011 were included in the study. Inclusion criteria was; patients who had closed reduction and short arm cast, patients who had bone mineral density evaluation, patients who was older than 60 years old. All included patients were called to come examination. When the patients come to examination; comparative direct radiograms of both wrists of the patients were taken. The grip strength of both hands was measured. Clinical results were evaluated based on the Modified Gartland and Werley Scoring System (MGWSS) and the radiological results were evaluated based on Scheck’s Criteria (SC).

RESULTS: Mean age was 68.1 years (60 – 82). Average follow-up duration was 25.5 months (10–45). Average T score was –2.47 (–1.2; – 4.9). Average of the MGWSS results was 7.5 (0 – 22). Average strength of fist squeezing in 26 patients without loss of radial height more than 5mm or volar inclination more than 10 degrees was 76.5% (37 – 100) compared to the uninvolved side whereas it was 62.3% (33 – 89%) in 24 patients with loss of radial height more than 5mm, 71.2% (37 – 100%) in 26 patients with volar inclination more than 10 degrees, and 60.1% (range: 33 – 89%) in 11 patients who has both radial shortening and volar tilt loss.

CONCLUSION: Elderly patient’s distal radius fractures are commonly being treated conservatively because of patients’ low physilogic demand. Because of development in implant techniology, surgery can give good results in cases with both radial shortening and volar tilt loss.

Anahtar Kelimeler

Radius distal fracture, conservative treatment, bone mineral density, elderly patient

Kaynakça

• 1. Crilly RG, Delaquerriere RL, Roth JH, et al. Postural stability and Colles’ fracture. Age Ageing. 1987;16:133–8.
• 2. Lafontaine M, Delince P, Hardy D, et al. Instability of fractures of the lower end of the radius: apropos of a series of 167 cases. Acta Orthop Belg. 1989;55:203–16.
• 3. Bucholz RW, Heckman JD, Court B, Charles M; Fractures of the distal radius and ulna. Rockwood and Green's Fractures in Adults, 6. Edition 2006 Lippincott Williams and Wilkins.
• 4. Diego L. Fernandez. Closed manipulation and casting of distal radius fractures. Hand Clin 21 (2005) 307-16.
• 5. McQueen M, Caspers J. Colles' fracture: does the anatomical result affect the final function? J Bone Joint Surg 1988;70(4):649-51.
• 6. Jenkins NH, Mintowt-Czyz WJ. Mal-union and dysfunction in Colles' fracture. J Hand Surg Br 1988;13:291-3.
• 7. Beumer A, McQueen MM. Fractures of the distal radius in low-demand elderly patients: closed reduction of no value in 53 of 60 wrists. Acta Orthop Scand. 2003;74:98–100.
• 8. Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60years. J Hand Surg [Am]. 2000;25:19–28.
• 9. Karnezis IA, Panagiotopoulos E, Tyllianakis M, et al. Correlation between radiological parameters and patient-rated wrist dysfunction following fractures of the distal radius. Injury. 2005;36:1435–9.
• 10. Rohit Arora, Markus Gabl, Martin Gschwentner, Christian Deml, et al. AComparative Study of Clinical and Radiologic Outcomes of Unstable Colles Type Distal Radius Fractures in Patients Older Than 70 Years: Nonoperative Treatment Versus Volar Locking Plating: J. Orthop Trauma 2009;23:237-42.
• 11. Barton T, Chambers C, Bannister G. A comparison between subjective outcome score and moderate radial shortening following a fractured distal radius in patients of mean age 69 years. J Hand Surg [Br]. 2007;32:165–9.
• 12. Altissimi M, Antenucci R, Fiacca C, et al. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop RelatRes. 1986;206:202–10.
• 13. Anzarut A, Johnson JA, Rowe BH, et al. Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg [Am]. 2004;29:1121–7.
• 14. Jorge L. Orbay, Diego L. Fernandez. Volar Fixed-Angle Plate Fixation for Unstable Distal Radius Fractures in the Elderly Patient. J Hand Surg 2004;29A/1:96-102.
• 15. Gessensway D, Putnam MP, Mente PL, Lewis JL. Design and biomechanics of a plate for the distal radius. J Hand Surg 1995;20A:1021–7.
• 16. Jupiter JB, Morent Huben M. Operative management of distal radial fractures with 2.4 milimeter locking plates. A multicenter prospective case series. J. Bone Joint Surg. Am. 2009 Jan;91(1):55-65.
• 17. Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg 2002;27A:205–215.
• 18. Kambouroglou GK, Axelrod TS. Complications of the AO/ASIF titanium distal radius plate system in internalfixation of the distal radius: a brief report. J Hand Surg 1998;23A:737–41.
• 19. Jupiter JB, Ring D, Weitzel PP. Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years. J Hand Surg 2002;27A:714–23.
• 20. Mudgal CS, Jupiter JB. Plate fixation of osteoporotic fractures of the distal radius. J. Orthop. Trauma 2008 Sep;22/8 (Suppl):s106-15.