İzole ulna cisim kırıklarında kilitli intramedüller ulna çivisi: Retrospektif bir çalışma

Year 2013, Volume: 47 Issue: 4, 236 - 243, 18.09.2013

Gursel Saka Necdet Saglam Tuhan Kurtulmus Coskun Ozer Meric Ugurlar Fuat Akpinar

Abstract

Amaç: Bu çalışmanın amacı ulna cisim kırıkları sonrası çok fonksiyonlu intramedüller (İM) ulna çivi uygulamasının sonuçlarını değerlendirmekti.
Çalışma planı: Mayıs 2008 - Ocak 2011 tarihleri arasında mini açık veya kapalı redüksiyon ile yeni IM ulna çivi uygulanan ve en az bir yıl takip edilen erişkin izole ulna cisim kırığı olan hastalar geriye dönük olarak değerlendirildi. Önceden geçirdikleri cerrahiler sonrası patolojik kırığı veya kaynamama bulgusu olan hastalar değerlendirmeye alınmadı. Fonksiyonel sonuçların değerlendirilmesinde Grace ve Eversmann derecelendirme sistemi ile Kol, Omuz ve El Sorunları (Disabilities of the Arm, Shoulder and Hand, DASH) anketi sonucu alınan hasta bildirimlerinden yararlanıldı. Bilek fleksiyonu ve ekstansiyonu bir gonyometre ile değerlendirildi.
Bulgular: İzole ulna cisim kırığı olan 18 hastanın (13 erkek, 5 kadın; ortalama yaş: 28, dağılım: 18-64) 20 ulna kırığı (2 olguda bilateral) geriye dönük olarak değerlendirildi. Ortalama kaynama süresi 13 (dağılım: 10-14) hafta olarak ölçüldü. Hiçbir hastada kaynamama, derin enfeksiyon ya da radioulnar sinostoz görülmedi. Takip süresi 12 ay ila 36 ay arasında değişmekteydi. Grace ve Eversmann skoru 15 hastada mükemel, 2 hastada iyi ve bir hastada ise kötü olarak değerlendirildi. Ortalama DASH skoru 8.08 (dağılım: 0-17.5) puandı.
Çıkarımlar: Yeni İM ulna çivileri erişkin ulna cisim kırıklarının cerrahi tedavisinde bir alternatif olarak düşünülebilir. Bu yöntemim üstünlüklerinden bazıları; operasyon süresinin kısalığı, çoğunlukla kapalı yöntemle ve minimal invaziv uygulanabilmesi ve yalnızca redüksiyon ve kilitlemenin kontrolü için skopi kullanılmasıdır. Estetik kusurun oldukça az olması, küçük ameliyat izi ve ameliyat sonrası ek tespite ihtiyaç duyulmaksızın erken harekete izin vermesi diğer avantajları arasında yer alır.

Keywords

İntramedüller çivi; redüksiyon; ulna cisim kırığı

Interlocking intramedullary ulna nails in isolated ulna diaphyseal fractures: a retrospective study

Abstract

Objective: The aim of this study was to evaluate the results of multifunctional intramedullary (IM) ulna nailing following diaphyseal fracture of the ulna.
Methods: Adult patients with isolated fractures of the ulna treated with closed or mini-open reduction using the new IM ulna nail between May 2008 and January 2011 and who were followed for a least one year were retrospectively reviewed. Patients with a pathological fracture or nonunion after previous surgeries were excluded. Functional outcome was assessed using the Grace and Eversmann rating system, patient-reported outcomes using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Wrist flexion and extension was evaluated using a goniometer.
Results: The 18 patients (13 male, 5 female; mean age: 28 years, range: 18 to 64 years) had a total of 20 isolated ulna fractures (two bilateral). Mean time to fracture union was 13 (range: 10 to 14) weeks. No patient had nonunion, deep infection or radioulnar synostosis. Follow-up time ranged from 12 to 36 months. Grace and Eversmann ratings were excellent in 15 patients, good in 2 and poor in one. Mean DASH score was 8.08 (range: 0 to 17.5) points.
Conclusion: The new IM ulna nails may be considered an alternative method for isolated diaphyseal fractures of the ulna. Advantages of this method include its short operative time, insertion by closed and minimal invasive techniques, use of scope only in reduction and locking control, as well as minimal cosmetic defect, small operative scar and early mobilization without additional fixation.

Keywords

Intramedullary nail, reduction, ulna diaphyseal fracture

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