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Ulna üst uç kırıklı çıkıkları

Year 2015, Volume: 49 Issue: 3, 233 - 240, 17.07.2015
https://doi.org/10.3944/AOTT.2015.14.0178

Abstract



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.

References

  • Doornberg J, Ring D, Jupiter JB. Effective treatment of fracture-dislocations of the olecranon requires a stable trochlear notch. Clin Orthop Relat Res 2004;429:292–
  • 2 Mortazavi SM, Asadollahi S, Tahririan MA. Functional outcome following treatment of transolecranon fracture- dislocation of the elbow. Injury 2006;37:284–8.
  • O’Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect 2003;52:113–34.
  • Ring D, Jupiter JB. Fracture-dislocation of the elbow. J Bone Joint Surg Am 1998;80:566–80.
  • Ring D, Jupiter JB, Sanders RW, Mast J, Simpson NS. Transolecranon fracture-dislocation of the elbow. J Or- thop Trauma 1997;11:545–50.
  • Sahajpal D, Wright TW. Proximal ulna fractures. J Hand Surg Am 2009;34:357–62.
  • Tashjian RZ, Katarincic JA. Complex elbow instability. J Am Acad Orthop Surg 2006;14:278–86.
  • Jupiter JB, Leibovic SJ, Ribbans W, Wilk RM. The poste- rior Monteggia lesion. J Orthop Trauma 1991;5:395–402.
  • Konrad GG, Kundel K, Kreuz PC, Oberst M, Sudkamp NP. Monteggia fractures in adults: long-term results and prognostic factors. J Bone Joint Surg Br 2007;89:354–60.
  • Manidakis N, Sperelakis I, Hackney R, Kontakis G. Frac- tures of the ulnar coronoid process. Injury 2012;43:989– 98.
  • Ring D, Jupiter JB, Simpson NS. Monteggia fractures in adults. J Bone Joint Surg Am 1998;80:1733–44.
  • Ring D, Jupiter JB. Reconstruction of posttraumatic elbow instability. Clin Orthop Relat Res 2000;370:44–56.
  • Strauss EJ, Tejwani NC, Preston CF, Egol KA. The poste- rior Monteggia lesion with associated ulnohumeral insta- bility. J Bone Joint Surg Br 2006;88:84–9.
  • Doornberg JN, Guitton TG, Ring D; Science of Variation Group. Diagnosis of elbow fracture patterns on radio- graphs: interobserver reliability and diagnostic accuracy. Clin Orthop Relat Res 2013;471:1373–8.
  • Giannicola G, Greco A, Sacchetti FM, Cinotti G, Nofro- ni I, Postacchini F. Complex fracture-dislocations of the proximal ulna and radius in adults: a comprehensive clas- sification. J Shoulder Elbow Surg 2011;20:1289–99.
  • Mellema JJ, Doornberg JN1, Dyer GS1, Ring D. Distribu- tion of coronoid fracture lines by specific patterns of trau- matic elbow instability. J Hand Surg Am 2014;39:2041–6.
  • McKee MD, Schemitsch EH, Sala MJ, O’driscoll SW. The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg 2003;12:391–6.
  • Buijze GA, Blankevoort L, Tuijthof GJ, Sierevelt IN, Kloen P. Biomechanical evaluation of fixation of com- minuted olecranon fractures: one-third tubular versus locking compression plating. Arch Orthop Trauma Surg 2010;130:459–64.
  • Edwards SG, Martin BD, Fu RH, Gill JM, Nezhad MK, Orr JA, et al. Quantifying and comparing torsional strains after olecranon plating. Injury 2012;43:712–7.
  • Ring D, Tavakolian J, Kloen P, Helfet D, Jupiter JB. Loss of alignment after surgical treatment of posterior Monteg- gia fractures: salvage with dorsal contoured plating. J Hand Surg Am 2004;29:694–702.
  • Siebenlist S, Torsiglieri T, Kraus T, Burghardt RD, Stöckle U, Lucke M. Comminuted fractures of the proximal ulna- Preliminary results with an anatomically preshaped locking compression plate (LCP) system. Injury 2010;41:1306–
  • Foruria AM, Augustin S, Morrey BF, Sánchez-Sotelo J. Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. J Bone Joint Surg Am 2013;95:66.

Fracture-dislocations of the proximal ulna

Year 2015, Volume: 49 Issue: 3, 233 - 240, 17.07.2015
https://doi.org/10.3944/AOTT.2015.14.0178

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.

References

  • Doornberg J, Ring D, Jupiter JB. Effective treatment of fracture-dislocations of the olecranon requires a stable trochlear notch. Clin Orthop Relat Res 2004;429:292–
  • 2 Mortazavi SM, Asadollahi S, Tahririan MA. Functional outcome following treatment of transolecranon fracture- dislocation of the elbow. Injury 2006;37:284–8.
  • O’Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect 2003;52:113–34.
  • Ring D, Jupiter JB. Fracture-dislocation of the elbow. J Bone Joint Surg Am 1998;80:566–80.
  • Ring D, Jupiter JB, Sanders RW, Mast J, Simpson NS. Transolecranon fracture-dislocation of the elbow. J Or- thop Trauma 1997;11:545–50.
  • Sahajpal D, Wright TW. Proximal ulna fractures. J Hand Surg Am 2009;34:357–62.
  • Tashjian RZ, Katarincic JA. Complex elbow instability. J Am Acad Orthop Surg 2006;14:278–86.
  • Jupiter JB, Leibovic SJ, Ribbans W, Wilk RM. The poste- rior Monteggia lesion. J Orthop Trauma 1991;5:395–402.
  • Konrad GG, Kundel K, Kreuz PC, Oberst M, Sudkamp NP. Monteggia fractures in adults: long-term results and prognostic factors. J Bone Joint Surg Br 2007;89:354–60.
  • Manidakis N, Sperelakis I, Hackney R, Kontakis G. Frac- tures of the ulnar coronoid process. Injury 2012;43:989– 98.
  • Ring D, Jupiter JB, Simpson NS. Monteggia fractures in adults. J Bone Joint Surg Am 1998;80:1733–44.
  • Ring D, Jupiter JB. Reconstruction of posttraumatic elbow instability. Clin Orthop Relat Res 2000;370:44–56.
  • Strauss EJ, Tejwani NC, Preston CF, Egol KA. The poste- rior Monteggia lesion with associated ulnohumeral insta- bility. J Bone Joint Surg Br 2006;88:84–9.
  • Doornberg JN, Guitton TG, Ring D; Science of Variation Group. Diagnosis of elbow fracture patterns on radio- graphs: interobserver reliability and diagnostic accuracy. Clin Orthop Relat Res 2013;471:1373–8.
  • Giannicola G, Greco A, Sacchetti FM, Cinotti G, Nofro- ni I, Postacchini F. Complex fracture-dislocations of the proximal ulna and radius in adults: a comprehensive clas- sification. J Shoulder Elbow Surg 2011;20:1289–99.
  • Mellema JJ, Doornberg JN1, Dyer GS1, Ring D. Distribu- tion of coronoid fracture lines by specific patterns of trau- matic elbow instability. J Hand Surg Am 2014;39:2041–6.
  • McKee MD, Schemitsch EH, Sala MJ, O’driscoll SW. The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg 2003;12:391–6.
  • Buijze GA, Blankevoort L, Tuijthof GJ, Sierevelt IN, Kloen P. Biomechanical evaluation of fixation of com- minuted olecranon fractures: one-third tubular versus locking compression plating. Arch Orthop Trauma Surg 2010;130:459–64.
  • Edwards SG, Martin BD, Fu RH, Gill JM, Nezhad MK, Orr JA, et al. Quantifying and comparing torsional strains after olecranon plating. Injury 2012;43:712–7.
  • Ring D, Tavakolian J, Kloen P, Helfet D, Jupiter JB. Loss of alignment after surgical treatment of posterior Monteg- gia fractures: salvage with dorsal contoured plating. J Hand Surg Am 2004;29:694–702.
  • Siebenlist S, Torsiglieri T, Kraus T, Burghardt RD, Stöckle U, Lucke M. Comminuted fractures of the proximal ulna- Preliminary results with an anatomically preshaped locking compression plate (LCP) system. Injury 2010;41:1306–
  • Foruria AM, Augustin S, Morrey BF, Sánchez-Sotelo J. Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. J Bone Joint Surg Am 2013;95:66.
There are 22 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Arel Gereli This is me

Ufuk Nalbantoglu This is me

Goksel Dikmen

Mustafa Seyhan This is me

Metin Turkmen This is me

Publication Date July 17, 2015
Published in Issue Year 2015 Volume: 49 Issue: 3

Cite

APA Gereli, A., Nalbantoglu, U., Dikmen, G., Seyhan, M., et al. (2015). Fracture-dislocations of the proximal ulna. Acta Orthopaedica Et Traumatologica Turcica, 49(3), 233-240. https://doi.org/10.3944/AOTT.2015.14.0178
AMA Gereli A, Nalbantoglu U, Dikmen G, Seyhan M, Turkmen M. Fracture-dislocations of the proximal ulna. Acta Orthopaedica et Traumatologica Turcica. July 2015;49(3):233-240. doi:10.3944/AOTT.2015.14.0178
Chicago Gereli, Arel, Ufuk Nalbantoglu, Goksel Dikmen, Mustafa Seyhan, and Metin Turkmen. “Fracture-Dislocations of the Proximal Ulna”. Acta Orthopaedica Et Traumatologica Turcica 49, no. 3 (July 2015): 233-40. https://doi.org/10.3944/AOTT.2015.14.0178.
EndNote Gereli A, Nalbantoglu U, Dikmen G, Seyhan M, Turkmen M (July 1, 2015) Fracture-dislocations of the proximal ulna. Acta Orthopaedica et Traumatologica Turcica 49 3 233–240.
IEEE A. Gereli, U. Nalbantoglu, G. Dikmen, M. Seyhan, and M. Turkmen, “Fracture-dislocations of the proximal ulna”, Acta Orthopaedica et Traumatologica Turcica, vol. 49, no. 3, pp. 233–240, 2015, doi: 10.3944/AOTT.2015.14.0178.
ISNAD Gereli, Arel et al. “Fracture-Dislocations of the Proximal Ulna”. Acta Orthopaedica et Traumatologica Turcica 49/3 (July 2015), 233-240. https://doi.org/10.3944/AOTT.2015.14.0178.
JAMA Gereli A, Nalbantoglu U, Dikmen G, Seyhan M, Turkmen M. Fracture-dislocations of the proximal ulna. Acta Orthopaedica et Traumatologica Turcica. 2015;49:233–240.
MLA Gereli, Arel et al. “Fracture-Dislocations of the Proximal Ulna”. Acta Orthopaedica Et Traumatologica Turcica, vol. 49, no. 3, 2015, pp. 233-40, doi:10.3944/AOTT.2015.14.0178.
Vancouver Gereli A, Nalbantoglu U, Dikmen G, Seyhan M, Turkmen M. Fracture-dislocations of the proximal ulna. Acta Orthopaedica et Traumatologica Turcica. 2015;49(3):233-40.