Distal Radius Eklem İçi Kırıklarının El Bilek Fiksatörü ile Tedavisinde Radio-Ulnar Açıdaki Değişikliklerin El Bilek Skorlamasına Etkisi

Abstract

Amaç: Bu çalışmada kapalı repozisyon ve penning tipi dinamik el bilek fiksatörü ile tedavi edilen radiusun distal intra-artiküler kırıkları (RDIK)’nda radyolojik ölçüm ile değerlendirilen radial inklinasyon (RI) açısının klinik sonuçlara olan etkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: 2012 ve 2020 yılları arasında RDIK nedeniyle kapalı redüksiyon ve dinamik el bilek fiksatörü uygulanan 120 hastanın dosyaları geriye dönük olarak incelendi. Hastaların post operatif 2., 6. ve 10. haftalarda radyolojik olarak el bileği ön/arka grafilerinden RI açıları ölçülerek, açısal değerlerdeki farklılıkların, Mayo el bilek skorlaması (MEBS) kriterlerine göre klinik sonuçlara olan etkisi araştırıldı. Bulgular: AO kırık sınıflamasına göre, 77 (%64,2) hastanın tip C1, 43 (%35,8) hastanın ise tip C2 kırığı vardı. Hastaların 69 (%57,7)’u kadın ve 51 (%42,3)’i erkek olup ortalama yaş 50,08±15,36 yıldı. Fiksatörler altıncı haftada çıkarıldı. Post op 10. haftada ölçülen RI açıları, 83 (%69,1) hastada 20°-30°, 32 (%26,6) hastada 10°-19° ve 5 (%4,3) hastada ise 0°-9° idi. MEBS’e göre, 39 (%32,5) hasta mükemmel, 76 (%63,3) hasta iyi ve 5 (%4,2) hasta ise orta olarak değerlendirildi. RI değerleri ile MEBS arasında pozitif yönde istatistiksel olarak anlamlı bir korelasyon gözlendi (r=0,369; p<0,001). Sonuç: Kapalı redüksiyon ile dinamik bilek fiksatör uygulaması basit ve minimal invaziv bir yöntemdir ve IFDR tedavisinde başarılı klinik ve fonksiyonel sonuçlar sağlar. Optimal RI açılarının klinik ve fonksiyonel sonuçlarda etkili olduğunu düşünüyoruz.

Keywords

• Radius
• eksternal fiksatör
• eklem içi kırıklar
• ortopedik cerrahi

The Effect of Changes in the Radio-Ulnar Angle on Wrist Scores on the Treatment of Intra-Articular Fractures of the Distal Radius with Wrist Fixator

Abstract

Aim: This study was aimed to evaluate the effect of radial inclination (RI) angle, assessed with radiological measurement, on the clinical outcomes of intra-articular fractures of the distal radius (IFDR) treated with closed reduction and penning type dynamic wrist fixator. Material and Methods: A total of 120 patients who underwent closed reduction and dynamic wrist fixation due to IFDR between 2012 and 2020 were retrospectively reviewed. The effects of the changes in RI on clinical outcomes according to Mayo wrist scoring (MWS) criteria were investigated by measuring the RI angles in anteroposterior wrist radiographs of the patients at postoperative 2nd, 6th, and 10th weeks. Results: According to the AO fracture classification, 77 (64.2%) of the patients had type C1 and 43 (35.8%) of the patients had type C2 fracture. The patients comprised 69 (57.7%) females and 51 (42.3%) males, and the mean age was 50.08±15.36 years. Fixators were removed at six weeks. RI angles measured at post-op week 10 were 20°-30° in 83 (69.1%) patients, 10°-19° in 32 (26.6%) patients, and 0°-9° in 5 (4.3%) patients. According to MWS, 39 (32.5%) patients were evaluated as excellent, 76 (63.3%) patients as good, and 5 (4.2%) patients as moderate. A statistically significant positive correlation was observed between RI values and MWS (r=0.369, p<0.001). Conclusion: Dynamic wrist fixation with closed reduction is a simple and minimally invasive method, and provides successful clinical and functional results in the treatment of IFDR. We consider that optimal RI angles are effective in clinical and functional outcomes.

Keywords

• Radius
• external fixation
• intra-articular fractures
• orthopedic surgery

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