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Öz

Amaç: Bu çalışmada, distal humerus kaynamamalarının tedavisinde Coonrad-Morrey total dirsek protezinin orta dönem fonksiyonel ve radyolojik sonuçlarının değerlendirilmesi amaçlandı.Çalışma planı: Distal humerus kaynamama nedeniyle 7 hastaya Coonrad-Morrey total dirsek artroplastisi uygulanmıştır. Tamamı kadın olan n hastaların ortalama yaşı 65.6 idi. Ortalama takip süresi 73 ay iken minimum takip süresi 5 yıl olarak tespit edilmiştir. Ameliyat öncesi, hemen sonrası ve son kontrolde elde edilen dirsek anteriorposterior ve lateral grafileri ile radyolojik değişiklikler ve gevşeme değerlendirilirken, Mayo Elbow Performance Index (MEPI) ve Q-Dash skorları fonksiyonel değerlendirmede kullanılmıştır.Bulgular: Son kontrolde, 7 hastada da dirsek stabilitesinin sağlandığı görüldü. 6 hastanın(%87.5) ağrısı yoktu. Ameliyat öncesi 30° olan ortalama hareket açıklığının , son kontrolde ortalama 90.7° ye arttığı tespit edildi (p<0.05). MEPI (Mayo Elbow Performance Index) değerlendirmesinde 5 hastada (%71.4) mükemmel ve iyi sonuç elde edildği görüldü. Ortalama Q-Dash skoru 93.2 den 34.5 e gerilediği belirlendi (p<0.01). İki humeral komponent gevşemesi tespit edilirken biri revize edildi. Çıkarımlar: Distal humerus kaynamamalarında, semiconstrained (yarı kısıtlı) total dirsek artroplastisi internal fiksasyon teknikleri başarısız olduğunda güvenilir bir redavi yöntemi olabilir. Distal humerus kaynamama nedeniyle tedavi edilen hastalarda, semiconstrained (yarı kısıtlı) total dirsek artroplastisi ile stabil, ağrısız ve fonksiyonel bir dirsek elde edilebilmektedir

Anahtar Kelimeler

• Distal humerus kaynamama; toplam dirsek protezi

Is Coonrad-Morrey total elbow arthroplasty a viable option for treatment of distal humeral nonunions in the elderly?

Abstract

Objective: The purpose of this study was to evaluate the functional and radiological results of semiconstrained Coonrad-Morrey total elbow arthroplasty for distal humeral nonunions in the mid-term period.
Methods: Seven patients were treated with Coonrad-Morrey total elbow arthroplasty for distal humeral nonunion. All patients were female, and the mean age was 65.6 years (range: 64–68 years). Patients were followed for at least 5 years, and the mean follow-up time was 73 months (range: 63–84 months). Anteroposterior and lateral radiographs at preoperative and early postoperative period of the joint replacement and latest follow-up were used to detect postoperative radiological changes in terms of loosening. The Mayo Elbow Performance Index (MEPI) and Q-DASH Score were used for functional evaluation.
Results: At the latest follow-up, joint stability had been achieved in all 7 patients. Six patients (85.7%) were pain free. The mean range of motion was 30° (range: 0–60°) preoperatively, and this improved to 90.7° (range: 60–110°) at the latest follow-up (p<0.05). Five patients (71.4%) had excellent or good outcomes on the MEPI. The mean Q-DASH Score was improved from 93.2 to 34.5 (p<0.01). Two humeral components had aseptic loosening, and 1 of them was revised.
Conclusion: Semiconstrained total elbow arthroplasty can be a reliable choice of treatment if other internal fixation methods fail. Significant pain relief and improvements in elbow function and stability can be achieved with semiconstrained elbow arthroplasty in patients with distal humeral nonunion.

Keywords

• Distal humerus
• nonunion
• total elbow prosthesis

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