Araştırma Makalesi
BibTex RIS Kaynak Göster

Distal radius kırıklarda volar açılanmanın tam anatomik restorasyonu için yeni bir yöntem

Yıl 2015, , 115 - 119, 22.05.2015
https://doi.org/10.3944/AOTT.2015.14.0247

Öz

 Amaç: Bu çalışmanın amacı değişken-açılı volar kilitli plakla tespit edilen dorsale doğru deplase distal radius kırıklarında cerrahın volar açılanmayı kolayca ve güvenilir bir şekilde elde etmesini sağlayan bir tekniği sunmaktı. Bu çalışmada, redüksiyon aletleri olarak 2.4 mm’lik değişken-açılı kilitli vidaları kullanan bu teknik tanıtıldı ve bu tekniğin radyolojik sonuçları araştırıldı.

Çalışma planı: İnstabil distal radius kırıkları olan toplam 42 hasta (30 kadın ve 12 erkek; ort. yaş: 58, dağılım: 25–84) bu yöntem ile tespit edildi. Traksiyon, manipülasyon ve direkt parça manipülasyonu gibi klasik redüksiyon yöntemleri ile birincil kırık redüksiyonuna rağmen hastaların hepsinde yetersiz volar açılanma vardı. Ameliyat sonrası olarak, hastalara günde minimum 30 dakika evde uygulayacakları aktif ve pasif bilek hareketleri verildi ve atel çıktıktan sonra günlük aktivitelerini gerçekleştirme izni verildi. Hastalar, operasyon sonrası minimum 12 ay sonra radyografik olarak değerlendirildi.

Bulgular: Ortalama takip süresi 15.1 aydı (dağılım: 12–24 ay). Operasyon öncesi distal radiusun volar açılanması –11.9±10.4’tü (eksi değer dorsal angülasyon demek) ve vida kaldıraç sonrası 11.5±4.3°’tü (yaralanmamış taraf: 11.7±2.3°). Son takipteki ortalama radyolojik sonuçlar aşağıdaki gibiydi: volar açılanma: 10.8±4.5°, radial eğim: 24±3.2°, radial yükseklik: 12.2±1.7 mm ve ulnar varyans: 0.2±1.7 mm.

Çıkarımlar: Değişken-açılı volar kilitli plakla tespit edilen dorsale doğru deplase distal radius kırıklarında volar açılanmayı ince ayar düzeltmek için basit ve güvenilir bir tekniği açıkladık. Özellikle bu yöntem, klasik yöntemler ile birincil kırık redüksiyonuna rağmen volar açılanmanın yetersiz kaldığı durumlarda yararlıdır.

Kaynakça

  • Willis AA, Kutsumi K, Zobitz ME, Cooney WP 3rd. In- ternal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability. J Bone Joint Surg Am 2006;88:2411–7.
  • Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 2004;29:96–102.
  • Koval KJ, Harrast JJ, Anglen JO, Weinstein JN. Fractures of the distal part of the radius. The evolution of practice over time. Where’s the evidence? J Bone Joint Surg Am 2008;90:1855–61.
  • Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS. Functional outcomes for unstable distal radial frac- tures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am 2009;91:1837–46.
  • Park JH, Hagopian J, Ilyas AM. Variable-angle locking screw volar plating of distal radius fractures. Hand Clin 2010;26:373–80.
  • Ross M, Heiss-Dunlop W. Volar angle stable plating for distal radius fractures. In: Slutsky DJ, editor. Principle and practice of wrist surgery. Philadelphia: Saunders; 2010. p. 126–39.
  • Smith DW, Henry MH. Volar fixed-angle plating of the distal radius. J Am Acad Orthop Surg 2005;13:28–36.

A novel technique for full anatomic restoration of volar tilt in distal radius fracture

Yıl 2015, , 115 - 119, 22.05.2015
https://doi.org/10.3944/AOTT.2015.14.0247

Öz

Objective: The aim of this study was to present a technique that allows the surgeon to easily and reliably achieve volar tilt in dorsally displaced distal radius fractures treated with variable-angle volar locking plates. The study introduced this technique using 2.4 mm variable angle locking screws as reduction tools, and investigated the radiological outcomes of this technique.

Methods: A total of 42 patients (30 female and 12 male; mean age: 58 years, range, 25 to 84 years) with unstable distal radius fractures were treated with this technique. All were patients with insufficient volar tilt in spite of primary fracture reduction through classic reduction techniques such as traction, manipulation, and direct fragment manipulation. Postoperatively, the patients were instructed to perform wrist active and passive motion exercises at home for minimum 30 minutes a day, and were allowed to perform activities of daily living after removal of splint. The patients were evaluated radiographically at minimum twelve months after surgery.

Results: Mean follow-up period was 15.1 months (range: 12 to 24 months). Volar tilt of the distal radius before surgery was –11.9±10.4 (minus value means dorsal angulation), and after screw leverage was 11.5±4.3° (uninjured side: 11.7±2.3°). Mean radiological outcomes at final visit were as follows: volar tilt; 10.8±4.5°, radial inclination; 24±3.2°, radial height; 12.2±1.7 mm, and ulnar variance;0.2±1.7 mm.

Conclusion: We describe a simple, reliable technique to fine-tune volar tilt in dorsally displaced distal radius fractures fixed with variable-angle volar locking plates. This technique is especially useful when volar tilt remains insufficient in spite of primary fracture reduction through classic techniques.

Kaynakça

  • Willis AA, Kutsumi K, Zobitz ME, Cooney WP 3rd. In- ternal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability. J Bone Joint Surg Am 2006;88:2411–7.
  • Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 2004;29:96–102.
  • Koval KJ, Harrast JJ, Anglen JO, Weinstein JN. Fractures of the distal part of the radius. The evolution of practice over time. Where’s the evidence? J Bone Joint Surg Am 2008;90:1855–61.
  • Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS. Functional outcomes for unstable distal radial frac- tures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am 2009;91:1837–46.
  • Park JH, Hagopian J, Ilyas AM. Variable-angle locking screw volar plating of distal radius fractures. Hand Clin 2010;26:373–80.
  • Ross M, Heiss-Dunlop W. Volar angle stable plating for distal radius fractures. In: Slutsky DJ, editor. Principle and practice of wrist surgery. Philadelphia: Saunders; 2010. p. 126–39.
  • Smith DW, Henry MH. Volar fixed-angle plating of the distal radius. J Am Acad Orthop Surg 2005;13:28–36.
Toplam 7 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orijinal Makale
Yazarlar

Jong Woong Park Bu kişi benim

Young Hwan Kim Bu kişi benim

Ki Chul Park Bu kişi benim

Jung İl Lee Bu kişi benim

Yayımlanma Tarihi 22 Mayıs 2015
Yayımlandığı Sayı Yıl 2015

Kaynak Göster

APA Park, J. W., Kim, Y. H., Park, K. C., Lee, J. İ. (2015). A novel technique for full anatomic restoration of volar tilt in distal radius fracture. Acta Orthopaedica Et Traumatologica Turcica, 49(2), 115-119. https://doi.org/10.3944/AOTT.2015.14.0247
AMA Park JW, Kim YH, Park KC, Lee Jİ. A novel technique for full anatomic restoration of volar tilt in distal radius fracture. Acta Orthopaedica et Traumatologica Turcica. Mayıs 2015;49(2):115-119. doi:10.3944/AOTT.2015.14.0247
Chicago Park, Jong Woong, Young Hwan Kim, Ki Chul Park, ve Jung İl Lee. “A Novel Technique for Full Anatomic Restoration of Volar Tilt in Distal Radius Fracture”. Acta Orthopaedica Et Traumatologica Turcica 49, sy. 2 (Mayıs 2015): 115-19. https://doi.org/10.3944/AOTT.2015.14.0247.
EndNote Park JW, Kim YH, Park KC, Lee Jİ (01 Mayıs 2015) A novel technique for full anatomic restoration of volar tilt in distal radius fracture. Acta Orthopaedica et Traumatologica Turcica 49 2 115–119.
IEEE J. W. Park, Y. H. Kim, K. C. Park, ve J. İ. Lee, “A novel technique for full anatomic restoration of volar tilt in distal radius fracture”, Acta Orthopaedica et Traumatologica Turcica, c. 49, sy. 2, ss. 115–119, 2015, doi: 10.3944/AOTT.2015.14.0247.
ISNAD Park, Jong Woong vd. “A Novel Technique for Full Anatomic Restoration of Volar Tilt in Distal Radius Fracture”. Acta Orthopaedica et Traumatologica Turcica 49/2 (Mayıs 2015), 115-119. https://doi.org/10.3944/AOTT.2015.14.0247.
JAMA Park JW, Kim YH, Park KC, Lee Jİ. A novel technique for full anatomic restoration of volar tilt in distal radius fracture. Acta Orthopaedica et Traumatologica Turcica. 2015;49:115–119.
MLA Park, Jong Woong vd. “A Novel Technique for Full Anatomic Restoration of Volar Tilt in Distal Radius Fracture”. Acta Orthopaedica Et Traumatologica Turcica, c. 49, sy. 2, 2015, ss. 115-9, doi:10.3944/AOTT.2015.14.0247.
Vancouver Park JW, Kim YH, Park KC, Lee Jİ. A novel technique for full anatomic restoration of volar tilt in distal radius fracture. Acta Orthopaedica et Traumatologica Turcica. 2015;49(2):115-9.