Ulna üst uç kırıklı çıkıkları

Öz

Amaç: Ulna üst uç kırıklı çıkıklarındaki yaralanma tipleri ile olası komplikasyonlar ve fonksiyonel sonuçlar arasındaki ilişkiyi incelemek.Çalışma planı: Çalışma grubundaki 15 hasta (10 erkek, 5 kadın, ortalama yaş 49.1; ortalama takip 49 ay) geriye dönük incelendi. Ulna üst uç kırıklı çıkığı altı hastada anterior, dokuz hastada posterior yöndeydi. Kırıklar 13 hastada plak ve vidalar ile iki hastada ise gergi bandı yöntemi ile tespit edilmişti. Son kontrolde dirsek eklem hareket açıklığı (EHA) ve Mayo dirsek performans skoru (MDPS) ölçülerek kaydedildi. Eklemdeki artrozu evrelemek için Broberg Morrey sistemi kullanıldı.Bulgular: Eşlik eden radius başı kırığı posterior çıkık grubunda tüm hastalarda görüldü. Bu grupta dört hastada bağ yaralanması da vardı. Anterior çıkık grubunda radius başı kırığı ve bağ yaralanması görülmedi. Bu grupta tüm hastalarda troklear çentik kırılmıştı. Tüm hastaların ortalama dirsek fleksiyonu 130.6° (100–140°), ekstensiyon kaybı 12.6° (0–30°) ve ortalama MDPS 92.3 (70–100) bulundu. Posterior kırıklı çıkık hastalarında ortalama EHA ve MDPS’u anterior kırıklı çıkık hastalarına göre daha düşüktü. Bu grupta daha fazla dirsek artrozu gözlendi. Gergi bandı yöntemi ile tedavi edilen iki hastada tekrar çıkık gözlendi.Çıkarımlar: Ulna üst uç kırıklı çıkıklarında radius başı kırığı ve bağ yaralanması posterior kırıklı çıkığa özgü bileşenlerdir. Anterior kırıklı çıkıklarda yaralanma büyük oranda troklear çentiğe sınırlı kalmaktadır. Posterior kırıklı çıkıklarda fonksiyonel sonuç daha kötü olmaktadır. Ulna üst uç kırığı basit iki parçalı bile olsa mutlaka plak vida tespiti gibi güçlü sistemlerle onarılmalıdır.

 

 

DOI: 10.3944/AOTT.2015.14.0178

Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.

Anahtar Kelimeler

• Dirsek çıkığı; kırıklı-çıkık; proksimal ulna.

Fracture-dislocations of the proximal ulna

Abstract

Objective: To investigate the relationship between injury patterns, complications, and the functional outcomes of patients with proximal-ulna fracture-dislocations.
Methods: Retrospective analysis of 15 patients (10 men, 5 women; mean age, 49.1 years; mean follow-up 49 months) with 6 anterior and 9 posterior fracture-dislocations of the proximal ulna. The proximal ulna was reconstructed with plates and screws in 13 patients and tension-band wiring in 2 patients. At the final follow-up, elbow range of motion (ROM) was measured and Mayo elbow scores (MEPS) were recorded. Broberg-Morrey criteria were used for osteoarthritis staging.
Results: Concomitant radial-head fracture was seen in all posterior fracture-dislocations. Four ligamentous injuries occurred in this group. All anterior dislocations had trochlear-notch fractures without associated injuries. Mean flexion ROM was 130.6° (100°–140°) and mean loss of extension ROM was 12.6° (0°–30°) in the study group. The mean MEPS score was 92.3 (70–100). Patients with posterior fracture-dislocations showed lower ROM and MEPS and higher level of osteoarthritis than patients with anterior fracture-dislocations. Recurrent dislocations occurred in 2 patients who had ulna fractures fixed with tension-band wiring.
Conclusion: Radial-head fracture and ligamentous injury are specific components of posterior fracture-dislocations. The injury is limited to the trochlear notch in anterior fracture-dislocations. Posterior fracture-dislocations have lower functional outcomes. Proximal-ulna fractures should be fixed with rigid internal fixation (plate and screw) even if the fracture is a simple 2-part fracture.

Keywords

• Proximal ulna
• elbow dislocation
• fracture-dislocation

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