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EKLEM İÇİ DİSTAL HUMERUS KIRIKLARINDA OLEKRANON OSTEOTOMİSİ İLE TRİCEPS-REFLEKTİNG ANKONEUS PEDİKÜL YAKLAŞIMLARININ KARŞILAŞTIRILMASI

Yıl 2018, Cilt: 2 Sayı: 3, 170 - 177, 12.11.2018

Öz

Amaç:
İnterkondiler humerus kırıklarının cerrahi tedavisinde olekranon osteotomisi ve
triceps-reflecting anconeus pedikül (TRAP) yaklaşımını karşılaştırmak

Gereç ve Yöntem:
Kliniğimizde 2010 ve 2015 yılları arasında eklem içi distal humerus kırığı
nedeniyle ameliyat edilen 41 hasta geriye dönük değerlendirildi.  TRAP yaklaşımı 16 hastaya, olekranon
osteotomisi yaklaşımı 25 hastaya uygulandı. Kırıklar AO/OTA sınıflama sistemine
göre sınıflandırıldı. Hastalar Kol Omuz ve El Engellilik Skoru (DASH), Mayo
Dirsek Performans Skoru  (MEPS), dirsek
hareket açıklıkları, komplikasyon ve kaynama zamanı yönünden karşılaştırıldı.

Bulgular: İki
grup arasında kaynama zamanı açısından, DASH skorları ve MEPS skorları yönünden
istatistiksel anlamlı fark bulunamadı. Olekranon osteotomisi yapılan 5 hastada
TRAP yapılan 2 hastada komplikasyon gelişti.







Sonuç: Eklem
içi uzanımı olan distal humerus kırıklarında olekranon osteotomisi ve TRAP
yöntemleri arasında ameliyat sonrası fonksiyonel açıdan fark yoktur. TRAP
yöntemi komplikasyon oranının az olması ve tekrar ameliyat gereksiniminin
olmaması yönünden avantajlı görünmektedir.

Kaynakça

  • Anglen J. Distal humerus fractures. J Am Acad Orthop Surg 2005;13:291–7.
  • Eralp L, Kocaoglu M, Sar C, Atalar AC. Surgical treatment of distal intraarticular humeral fractures in adults. Int Orthop 2001;25:46–50.
  • Gupta R, Khanchandani P. Intercondylar fractures of the distal humerus in adults: a critical analysis of 55 cases. Injury 2002;33:511–5.
  • Pajarinen J, Björkenheim JM. Operative treatment of type C intercondylar fractures of the distal humerus: results after a mean follow-up of 2 years in a series of 18 patients. J Shoulder Elbow Surg 2002;11:48–52.
  • Bryan RS, Morrey BF. Extensive posterior exposure of the elbow. A triceps-sparing approach. Clin Orthop Relat Res 1982;166:188–92.
  • Campbell WC. Incision for exposure of elbow joint. Am J Surg 1932;15;65–7.
  • O’Driscoll SW. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. Orthop Clin North Am 2000;31:91–101
  • MacAusland WR (1915) Ankylosis of the elbow, with report offour cases treated by arthroplasty. JAMA 64:312–318
  • Wilkinson JM, Stanley D. Posterior surgical approaches to the elbow: a comparative anatomic study. J Shoulder Elbow Surg 2001;10:380–2.
  • Jupiter JB, Neff U, Holzach P, Allgöwer M. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg Am 1985;67:226– 39.
  • Chen G, Liao Q, Luo W, Li K, Zhao Y, Zhong D. Triceps-sparing versus olecranon osteotomy for ORIF: analysis of 67 cases of intercondylar fractures of the distal humerus. Injury 2011;42:366–70.
  • Li SH, Li ZH, Cai ZD, Zhu YC, Shi YZ, Liou J, et al. Bilateral plate fixation for type C distal humerus fractures: experience at a single institution. Int Orthop 2011;35:433–8.
  • Pankaj A, Mallinath G, Malhotra R, Bhan S. Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeus pedicle (TRAP) approach. Indian J Orthop 2007;41:219–23.
  • Ring D, Gulotta L, Chin K, Jupiter JB. Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus. J Orthop Trauma 2004;18:446–9.
  • Coles CP, Barei DP, Nork SE, Taitsman LA, Hanel DP, Bradford Henley M. The olecranon osteotomy: a six-year experience in the treatment of intraarticular fractures of the distal humerus. J Orthop Trauma 2006;20:164–71.
  • Gainor BJ, Moussa F, Schott T. Healing rate of transverse osteotomies of the olecranon used in reconstruction of distal humerus fractures. J South Orthop Assoc 1995;4:263–8.
  • McKee MD, Kim J, Kebaish K, Stephen DJ, Kreder HJ, Schemitsch EH. Functional outcome after open supracondylar fractures of the humerus. The effect of the surgical approach. J Bone Joint Surg Br 2000;82:646– 51.
  • Sanchez-Sotelo J, Torchia ME, O’Driscoll SW. Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique. Surgical technique. J Bone Joint Surg Am 2008 Mar;90 Suppl 2 Pt 1:31– 46.
  • Ozer H, Solak S, Turanli S, Baltaci G, Colakoğlu T, Bolukbasí S. Intercondylar fractures of the distal humerus treated with the triceps-reflecting anconeus pedicle approach. Arch Orthop Trauma Surg 2005;125:469– 74.
  • Tak SR, Dar GN, Halwai MA, Kangoo KA, Mir BA. Outcome of olecranon osteotomy in the trans-olecranon approach of intra-articular fractures of the distal humerus. Ulus Travma Acil Cerrahi Derg 2009;15:565–70.
  • Azboy İ, Bulut M, Ancar C, Demirtaş A, Özkul E, Gem M, Karadeniz H, Arslan H. The comparison of triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the treatment of intercondylar fractures of the humerus. Ulus Travma Acil Cerrahi Derg. 2016 Jan;22(1):58-65.
  • Athwal GS, Rispoli DM, Steinmann SP. The anconeus flap transolecranon approach to the distal humerus. J Orthop Trauma 2006;20:282–5.

THE COMPARISON OF TRICEPS-REFLECTING ANCONEUS PEDICLE AND OLECRANON OSTEOTOMY APPROACHES IN THE TREATMENT OF INTERCONDYLAR FRACTURES OF THE HUMERUS

Yıl 2018, Cilt: 2 Sayı: 3, 170 - 177, 12.11.2018

Öz

Objective: In this study we aim to evaluate
triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the
treatment of intercondylar fractures of the humerus

Material
and Methods: Forty one patients who were treated in our hospital between 2010-2015
years with intraarticular distal humerus fractures were retrospectively
analyzed. TRAP approach used in 16 patients(10 males, 6 females) and olecranon
osteotomy in 25 patients (15 males, 10 females). Fractures were classified in
the AO/OTA classification.Functional results were evaluated with the Mayo elbow
performance score (MEPS) and the Disabilities of Arm , Shoulder and Hand (DASH)
question naire score.

Results:
There were no significant differences noted between groups interms of clinical
fracture healing time, mean MEPS and DASH scores. Complication was noted on
five patients treated with olecranon osteotomy approach and two patients
treated with TRAP approach.







Conclusion:
There was no significant difference in terms of postoperative functional
outcomes between two methods but TRAP approach is superior to transolecranon
approach, reduces complications and reoperation rates.

Kaynakça

  • Anglen J. Distal humerus fractures. J Am Acad Orthop Surg 2005;13:291–7.
  • Eralp L, Kocaoglu M, Sar C, Atalar AC. Surgical treatment of distal intraarticular humeral fractures in adults. Int Orthop 2001;25:46–50.
  • Gupta R, Khanchandani P. Intercondylar fractures of the distal humerus in adults: a critical analysis of 55 cases. Injury 2002;33:511–5.
  • Pajarinen J, Björkenheim JM. Operative treatment of type C intercondylar fractures of the distal humerus: results after a mean follow-up of 2 years in a series of 18 patients. J Shoulder Elbow Surg 2002;11:48–52.
  • Bryan RS, Morrey BF. Extensive posterior exposure of the elbow. A triceps-sparing approach. Clin Orthop Relat Res 1982;166:188–92.
  • Campbell WC. Incision for exposure of elbow joint. Am J Surg 1932;15;65–7.
  • O’Driscoll SW. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. Orthop Clin North Am 2000;31:91–101
  • MacAusland WR (1915) Ankylosis of the elbow, with report offour cases treated by arthroplasty. JAMA 64:312–318
  • Wilkinson JM, Stanley D. Posterior surgical approaches to the elbow: a comparative anatomic study. J Shoulder Elbow Surg 2001;10:380–2.
  • Jupiter JB, Neff U, Holzach P, Allgöwer M. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg Am 1985;67:226– 39.
  • Chen G, Liao Q, Luo W, Li K, Zhao Y, Zhong D. Triceps-sparing versus olecranon osteotomy for ORIF: analysis of 67 cases of intercondylar fractures of the distal humerus. Injury 2011;42:366–70.
  • Li SH, Li ZH, Cai ZD, Zhu YC, Shi YZ, Liou J, et al. Bilateral plate fixation for type C distal humerus fractures: experience at a single institution. Int Orthop 2011;35:433–8.
  • Pankaj A, Mallinath G, Malhotra R, Bhan S. Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeus pedicle (TRAP) approach. Indian J Orthop 2007;41:219–23.
  • Ring D, Gulotta L, Chin K, Jupiter JB. Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus. J Orthop Trauma 2004;18:446–9.
  • Coles CP, Barei DP, Nork SE, Taitsman LA, Hanel DP, Bradford Henley M. The olecranon osteotomy: a six-year experience in the treatment of intraarticular fractures of the distal humerus. J Orthop Trauma 2006;20:164–71.
  • Gainor BJ, Moussa F, Schott T. Healing rate of transverse osteotomies of the olecranon used in reconstruction of distal humerus fractures. J South Orthop Assoc 1995;4:263–8.
  • McKee MD, Kim J, Kebaish K, Stephen DJ, Kreder HJ, Schemitsch EH. Functional outcome after open supracondylar fractures of the humerus. The effect of the surgical approach. J Bone Joint Surg Br 2000;82:646– 51.
  • Sanchez-Sotelo J, Torchia ME, O’Driscoll SW. Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique. Surgical technique. J Bone Joint Surg Am 2008 Mar;90 Suppl 2 Pt 1:31– 46.
  • Ozer H, Solak S, Turanli S, Baltaci G, Colakoğlu T, Bolukbasí S. Intercondylar fractures of the distal humerus treated with the triceps-reflecting anconeus pedicle approach. Arch Orthop Trauma Surg 2005;125:469– 74.
  • Tak SR, Dar GN, Halwai MA, Kangoo KA, Mir BA. Outcome of olecranon osteotomy in the trans-olecranon approach of intra-articular fractures of the distal humerus. Ulus Travma Acil Cerrahi Derg 2009;15:565–70.
  • Azboy İ, Bulut M, Ancar C, Demirtaş A, Özkul E, Gem M, Karadeniz H, Arslan H. The comparison of triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the treatment of intercondylar fractures of the humerus. Ulus Travma Acil Cerrahi Derg. 2016 Jan;22(1):58-65.
  • Athwal GS, Rispoli DM, Steinmann SP. The anconeus flap transolecranon approach to the distal humerus. J Orthop Trauma 2006;20:282–5.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm ARAŞTIRMA MAKALESİ
Yazarlar

Ahmet Safa Tarğal Bu kişi benim

Mustafa Caner Okkaoğlu Bu kişi benim

Yüksel Uğur Yaradılmış

Ahmet Ateş Bu kişi benim

İsmail Demirkale

Murat Altay Bu kişi benim

Yayımlanma Tarihi 12 Kasım 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 2 Sayı: 3

Kaynak Göster

APA Tarğal, A. S., Okkaoğlu, M. C., Yaradılmış, Y. U., Ateş, A., vd. (2018). EKLEM İÇİ DİSTAL HUMERUS KIRIKLARINDA OLEKRANON OSTEOTOMİSİ İLE TRİCEPS-REFLEKTİNG ANKONEUS PEDİKÜL YAKLAŞIMLARININ KARŞILAŞTIRILMASI. Balıkesir Medical Journal, 2(3), 170-177.