Treatment of diaphyseal forearm atrophic nonunions with intramedullary nails and modified Nicoll’s technique in adults

Yıl 2014, Cilt: 48 Sayı: 3, 262 - 270, 30.05.2014

Gursel Saka Necdet Saglam Tuhan Kurtulmus Cem Coskun Avci Fuat Akpinar

https://doi.org/10.3944/AOTT.2014.3259

Öz

Objective:The aim of this study was to evaluate the outcome of tricorticocancellous autologous bone grafting with intramedullary forearm nails in the treatment of radius or ulna aseptic nonunion.

Methods: The study included 8 patients (mean age: 39 years; range: 19 to 55 years) who underwent plate-screw osteosynthesis for the treatment of nonunion (6 ulna, 2 radius) following forearm fracture. In all cases, the length of the applied tricortical graft was below 3 cm. Patients were evaluated using the visual analog scale, Grace and Eversmann scale and DASH score. Wrist flexion and extension and postoperative hand and forearm grip strength were assessed.

Results: Graft incorporation and union was completed at a mean of 22 (range: 18 to 28) weeks. No patient had nonunion, deep infection or radioulnar synostosis. Follow-up ranged from 18 to 52 months. Radiographic union was achieved in all patients. Mean visual analog scale pain score was 1 (range: 0 to 3). Grace and Eversmann ratings were excellent in 5 and good in 3 patients. Mean DASH score was 10.7 (range: 1.7 to 21.7) points.

Conclusion: Intramedullary nailing and tricorticocancellous iliac bone block grafting appears to be a technically easy and reliable procedure that enables early postoperative rehabilitation in the treatment of nonunion of the forearm.

Anahtar Kelimeler

Forearm, intramedullary nail, nonunion, tricorticocancellous bone graft

Yetişkinlerde ön kol diyafizer atrofik kaynamamalarının intramedüller çivi ve modifiye Nicoll tekniği ile tedavisi

Öz

Amaç:Bu çalışmanın amacı radius veya ulnada aseptik kaynamama gelişen olguların intramedüller ön kol çivileri ve trikortikokansellöz otolog kemik grefti ile tedavisinin sonuçlarını değerlendirmekti.

Çalışma planı: Çalışmaya ön kol kırığı sonrası kaynamama (6 ulna, 2 radius) nedeniyle plak-vida ile osteosentez uygulanan 8 hasta (ortalama yaş: 39, dağılım: 19-55) alındı. Uygulanan trikortikal greftin uzunluğu tüm olgularda 3 cm’nin altında idi. Hastalar görsel analog skala, Grace ve Eversmann skalası ve DASH skoru ile değerlendirildiler. Bilek fleksiyon ve ekstansiyonu ile ameliyat sonrası el ve ön kol kavrama kuvvetleri incelendi.

Bulgular: Greft inkorporasyonu ve kaynamanın 22 (dağılım: 18-28) haftada tamamlandığı görüldü. Hastaların hiçbirinde kaynamama, derin enfeksiyon veya radyoulnar sinostoz bulgusu yoktu. Takip süresi 18 ile 52 ay arasındaydı. Kaynama tüm hastalarda radyografilerle doğrulandı. Ortalama görsel analog skala ağrı puanı 1 (dağılım: 0-3) olarak belirlendi. Grace ve Eversmann skorları 5 hastada mükemmel, 3 hastada iyi idi. Ortalama DASH skoru ise 10.7 (dağılım: 1.7-21.7) olarak kaydedildi.

Çıkarımlar: Ön kol kaynamamalarının intramedüller çivi ve trikortikokansellöz iliak kemik blok greftlemesi ile tedavisi teknik açıdan basit, ameliyat sonrası erken dönemde rehabilitasyona olanak sağlayan, güvenilir bir yöntemdir.

Anahtar Kelimeler

İntramedüller çivi; kaynamama; ön kol; trikortikokansellöz kemik grefti

Kaynakça

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