Öz
Amaç: Çalışmamızda elde 4. ve 5. karpometakarpal (KMK) kırıklı çıkık tanısı konularak cerrahi tedavi uygulanan olguların orta dönem sonuçlarını değerlendirmeyi amaçladık.
Çalışma planı: Çalışmaya 2008 ile 2012 yılları arasında KMK çıkık tanısı ile açık redüksiyon ve internal tespit uygulanan 9 olgu alındı. Ortalama yaşı 31.2 (dağılım: 20-40) olan olguların tümü erkek idi. Ortalama 19.4 ay izlenen olgularımızda travma ile ameliyat arasındaki sürenin ortalama 10.7 (dağılım: 3-35) gün olduğu saptandı. Hastaların son kontrollerinde radyolojik değerlendirmeleri yapıldı. El kavrama gücü el dinamometresi ile ölçülerek, kırık ve sağlam taraflar karşılaştırıldı.
Bulgular: El dinamometresi ölçümlerinin kırık bulunan tarafla kıyaslandığında anlamlı derecede farklı olduğu görüldü (p<0.05). Üç olgunun ağır işler sırasında ağrısı olduğu, bu olguların da ikisinin tanısında gecikme olan olgular, diğer olgunun ise parçalı KMK çıkık olgusu olduğu ve eski işine dönemediği saptandı. Hastalarımızın hiçbirinde nüks çıkığı görülmedi ve revizyon cerrahisi gerektirecek komplikasyon oluşmadı.
Çıkarımlar: Dördüncü ve 5. KMK çıkıklarda erken tanı ve tedavi ile anatomik ve fonksiyonel açıdan başarılı sonuçlar alınmaktadır. Bu bölgedeki gecikmeli veya yanlış tanılar ciddi radyolojik ve fonksiyonel problemlere neden olmaktadır. Detaylı fizik ve radyolojik muayene ile KMK çıkıklarının gözden kaçırılmasının önüne geçilebilir.
Anahtar Kelimeler
Kaynakça
- Mito K, Nakamura T, Sato K, Toyama Y, Ikegami H. Dorsal dislocations of the second to fifth carpometacarpal joints: a case report. Hand Surg 2008;13:129-32. CrossRef
- Hartwig RH, Louis DS. Multiple carpometacarpal dis- locations. A review of four cases. J Bone Joint Surg Am 1979;61:906-8.
- Güler F, Çicek Eİ, Fırat A, Öçgüder A, Akkurt OM. Car- pometacarpal dislocation on the ulnar side of the hand. [Article in Turkish] Dirim Tıp Gazetesi 2008;83;152-4.
- Gaheer RS, Ferdinand RD. Fracture dislocation of carpometacarpal joints: a missed injury. Orthopedics 2011;34:399.
- Siddiqui YS, Zahid M, Sabir AB, Kumar GM. Multiple carpometacarpal fracture dislocation of the hand – an uncommon pattern of injury which is often missed: a case report with review of literature. J Clin Diagn Res 2011;5:618-20.
- Bora FW Jr, Didizian NH. The treatment of injuries to the carpometacarpal joint of the little finger. J Bone Joint Surg Am 1974;56:1459-63.
- de Beer JD, Maloon S, Anderson P, Jones G, Singer M. Multiple carpo-metacarpal dislocations. J Hand Surg Br 1989;14:105-8. CrossRef
- Cain JE Jr, Shepler TR, Wilson MR. Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg Am 1987;12:762-7. CrossRef
- Henderson JJ, Arafa MA. Carpometacarpal disloca- tion. An easily missed diagnosis. J Bone Joint Surg Br 1987;69:212-4.
- Pullen C, Richardson M, McCullough K, Jarvis R. Injuries to the ulnar carpometacarpal region: are they being under- diagnosed? Aust N Z J Surg 1995;65:257-61. CrossRef
- Lawlis JF 3rd, Gunther SF. Carpometacarpal dislocations. Long-term follow-up. J Bone Joint Surg Am 1991;73:52- 9.
Öz
Objective: The aim of this study was to evaluate the mid-term results of patients with surgically treated 4th and 5th carpometacarpal (CMC) fracture dislocation.
Methods: The study included 9 CMC dislocation patients (9 males; mean age: 31.2 years, range: 20 to 40 years) treated with open reduction and internal fixation between 2008 and 2012. Mean follow-up period was 19.4 months. Mean interval between trauma and operation was 10.7 (range: 3 to 35) days. Radiological evaluation was performed at the final follow-up. Hand grip power was measured using a hand dynamometer and the injured and uninjured sides were compared.
Methods: There was a statistically significant difference compared to the injured side in hand dynamometer measurements (p<0.05). Three patients experienced pain during heavy labor. Among these cases, 2 had delayed diagnosis and 1 a comminuted CMC dislocation and was unable to return to his previous job. There were no recurrent dislocations or revision surgery due to complications.
Conclusion: Early diagnosis and treatment of 4th and 5th CMC dislocation results in good anatomical and functional results. Delayed or incorrect diagnosis of this region causes severe radiological and functional problems. Detailed physical and radiological examination can prevent CMC dislocation from being overlooked.
Anahtar Kelimeler
Carpometacarpal joint dislocation fracture surgical treatment
Kaynakça
- Mito K, Nakamura T, Sato K, Toyama Y, Ikegami H. Dorsal dislocations of the second to fifth carpometacarpal joints: a case report. Hand Surg 2008;13:129-32. CrossRef
- Hartwig RH, Louis DS. Multiple carpometacarpal dis- locations. A review of four cases. J Bone Joint Surg Am 1979;61:906-8.
- Güler F, Çicek Eİ, Fırat A, Öçgüder A, Akkurt OM. Car- pometacarpal dislocation on the ulnar side of the hand. [Article in Turkish] Dirim Tıp Gazetesi 2008;83;152-4.
- Gaheer RS, Ferdinand RD. Fracture dislocation of carpometacarpal joints: a missed injury. Orthopedics 2011;34:399.
- Siddiqui YS, Zahid M, Sabir AB, Kumar GM. Multiple carpometacarpal fracture dislocation of the hand – an uncommon pattern of injury which is often missed: a case report with review of literature. J Clin Diagn Res 2011;5:618-20.
- Bora FW Jr, Didizian NH. The treatment of injuries to the carpometacarpal joint of the little finger. J Bone Joint Surg Am 1974;56:1459-63.
- de Beer JD, Maloon S, Anderson P, Jones G, Singer M. Multiple carpo-metacarpal dislocations. J Hand Surg Br 1989;14:105-8. CrossRef
- Cain JE Jr, Shepler TR, Wilson MR. Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg Am 1987;12:762-7. CrossRef
- Henderson JJ, Arafa MA. Carpometacarpal disloca- tion. An easily missed diagnosis. J Bone Joint Surg Br 1987;69:212-4.
- Pullen C, Richardson M, McCullough K, Jarvis R. Injuries to the ulnar carpometacarpal region: are they being under- diagnosed? Aust N Z J Surg 1995;65:257-61. CrossRef
- Lawlis JF 3rd, Gunther SF. Carpometacarpal dislocations. Long-term follow-up. J Bone Joint Surg Am 1991;73:52- 9.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orijinal Makale |
| Yazarlar | |
| Yayımlanma Tarihi | 16 Ocak 2015 |
| Yayımlandığı Sayı | Yıl 2014 Cilt: 48 Sayı: 6 |