Erişkin Tip C Distal Humerus Kırıklarına Olekranon Osteotomisi ve Paralel Plak Uygulamasının Orta Dönem Sonuçları

Yıl 2018, Cilt: 2 Sayı: 2, 75 - 80, 02.07.2018

İsmet Bilgi Ferdi Sarı Halil Büyükdoğan Cihan Sevim Cemil Ertürk

https://doi.org/10.30565/medalanya.384408

Öz

Amaç: Bu çalışmanın amacı AO tip C distal humerus kırığı tanısıyla cerrahi tedavi uygulanan erişkin hastanın orta dönem sonuçlarını değerlendirmektir. 

Hastalar ve Yöntem: Geriye dönük çalışmamızda, AO tip C distal humerus kırığı tanılı 20 hastaya (12 kadın, 8 erkek, ortalama yaş 44.3) posterior yaklaşım ile olekranon chevron tipi osteotomi ve Paralel Plak Vidayla tespit uygulandı. Olguların ortalama izlem süresi 74 aydı (56-94 ay). Olguların son kontrollerinde hareket aralığı ölçümü, Mayo Elbow Performance Score (MEPS) ve the Disabilities of the Arm Shoulder and Hand (DASH) score ile fonksiyonel değerlendirme yapıldı. 

Bulgular: MEPS ile değerlendirmede kategorik olarak; 6 olgu çok iyi, 10 olgu iyi, 2 olgu orta, 2 olgu kötü sonuç olarak belirlendi. Hastaların hareket aralığına bakıldığında ortalama fleksiyon 125.3°, ortalama ekstansiyon kaybı ise 13.8° idi. Hastaların %75’inde hareket açıklığı, fonksiyonel hareket açıklığı olarak kabul edilen 30°-130° veya üzerindeydi. DASH anketine göre ortalama skor 7.2 olarak belirlendi. Radyolojik olarak orta dönemde hiçbir hastada dirsekte artroz bulgusu ve implant gevşemesi tespit edilmedi. 

Sonuç: AO tip C distal humerus kırıklarında olekranon osteotomisi ve paralel plak vida ile tespitin kabul edilebilir bir cerrahi teknik olduğu söylenebilir. 

Anahtar Kelimeler

distal humerus kırıkları, cerrahi, MEPS

Mid-term results of olecranon osteotomy and parallel plate screw surgical treatment of type C distal humeral fractures in adults.

Öz

Aim: The aim of this study was to evaluate the mid-term results of surgical treatment of AO type C distal humeral fractures in adults. 

Patients and Method: In our retrospective study, 20 adult patients (12 females, 8 males, mean age 44,3 years) with AO type C distal humeral fracture were treated with olecranon Chevron type osteotomy and parallel plate screw splinting with posterior approach. The average follow-up period of cases was 74 months (56-94 months). At the last follow-up of cases, the functional measurement of range of motion (ROM) was evaluated using the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm Shoulder and Hand (DASH) scoring systems. 

Results: According to the evaluation with MEPS; categorically, 6 cases were very good, 10 cases were good, 2 cases were moderate and 2 cases were poor results. When ROM of patients were examined, the mean elbow flexion was 125,30 and the mean extension loss was 13,80. In 75% of patients’ ROM were 30-1300 or above which is considered to be the range of functional motion. According to the DASH survey, the average score was determined as 7,2. Radiologically, no arthrosis and implant loosening evidence were observed in the mid-term patients. 

Conclusion: It can be accepted that olecranon osteotomy and parallel plate screw splinting technique may be the appropriate surgical treatment method in the AO type C distal humerus fractures. 

Anahtar Kelimeler

Distal humeral fractures, surgery, MEPS

Kaynakça

• Referans 1. Nauth A, McKee MD, Ristevski B, Hall J, Schemitsch EH. Distal humeral fractures in adults. J Bone Joint Surg Am. 2011;93(7):686-700.
• Referans 2. Pollock JW, Faber KJ, Athwal GS. Distal humerus fractures. Orthop Clin North Am. 2008;39(2):187-200.
• Referans 3. Bégué T. Articular fractures of the distal humerus. Orthop Traumatol Surg Res. 2014 ;100(1 Suppl):S55-63. doi: 10.1016/j.otsr.2013.11.002.
• Referans 4. Tian D, Jing J, Qian J, Li J. Comparison of two different double-plate fixation methods with olecranon osteotomy for intercondylar fractures of the distal humeri of young adults. Exp Ther Med. 2013 ;6(1):147-151.
• Referans 5. Lan X, Zhang LH, Tao S, Zhang Q, Liang XD, Yuan BT, Xu WP, Yin P, Tang PF. Comparative study of perpendicular versus parallel double plating methods for type C distal humeral fractures. Chin Med J (Engl). 2013 ;126(12):2337-42.
• Referans 6. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 ;58(4):453-8.
• Referans 7. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996 ;29(6):602-8.
• Referans 8. Turchin DC, Beaton DE, Richards RR. Validity of observer-based aggregate scoring systems as descriptors of elbow pain, function, and disability. J Bone Joint Surg Am. 1998 ;80(2):154-62.
• Referans 9. DeSimone LJ, Sanchez-Sotelo J. Total elbow arthroplasty for distal humerus fractures. Orthop Clin North Am. 2013 ;44(3):381-7, ix-x.
• Referans 10. Frankle MA, Herscovici D Jr, DiPasquale TG, Vasey MB, Sanders RW. A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma. 2003 ;17(7):473-80.
• Referans 11. Gupta R, Khanchandani P. Intercondylar fractures of the distal humerus in adults: a critical analysis of 55 cases. Injury. 2002 ;33(6):511-5.
• Referans 12. John H, Rosso R, Neff U, Bodoky A, Regazzoni P, Harder F. Operative treatment of distal humeral fractures in the elderly. J Bone Joint Surg Br. 1994 ;76(5):793-6.
• Referans 13. Korner J, Lill H, Müller LP, Rommens PM, Schneider E, Linke B. The LCP-concept in the operative treatment of distal humerus fractures--biological, biomechanical and surgical aspects. Injury. 2003 ;34 Suppl 2:B20-30.
• Referans 14. 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(3):164-71.
• Referans 15. 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(1):48-52.
• Referans 16. Schmidt-Horlohé KH1, Bonk A, Wilde P, Becker L, Hoffmann R. Promising results after the treatment of simple and complex distal humerus type C fractures by angular-stable double-plate osteosynthesis. Orthop Traumatol Surg Res. 2013 ;99(5):531-41.
• Referans 17. Korner J, Diederichs G, Arzdorf M, Lill H, Josten C, Schneider E, Linke B. A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates. J Orthop Trauma. 2004 ;18(5):286-93.
• Referans 18. O'Driscoll SW. Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg. 2005 ;14(1 Suppl S):186S-194S.
• Referans 19. Ring D, Jupiter JB. Complex fractures of the distal humerus and their complications. J Shoulder Elbow Surg. 1999 ;8(1):85-97.
• Referans 20. Min W, Ding BC, Tejwani NC. Comparative functional outcome of AO/OTA type C distal humerus fractures: open injuries do worse than closed fractures. J Trauma Acute Care Surg. 2012 ;72(2):E27-32.
• Referans 21. Russell GV Jr, Jarrett CA, Jones CB, Cole PA, Gates J. Management of distal humerus fractures with minifragment fixation. J Orthop Trauma. 2005 ;19(7):474-9.
• Referans 22. Ruan HJ, Liu JJ, Fan CY, Jiang J, Zeng BF. Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus. J Trauma. 2009 ;67(6):1397-401.
• Referans 23. Wang KC, Shih HN, Hsu KY, Shih CH. Intercondylar fractures of the distal humerus: routine anterior subcutaneous transposition of the ulnar nerve in a posterior operative approach. J Trauma. 1994 ;36(6):770-3.
• Referans 24. Mardanpour K, Rahbar M. Open reduction and internal fixation of intraarticular fractures of the humerus: evaluation of 33 cases. Trauma Mon. 2013 Winter;17(4):396-400.
• Referans 25. Helfet DL, Schmeling GJ. Bicondylar intraarticular fractures of the distal humerus in adults. Clin Orthop Relat Res. 1993 Jul;(292):26-36.
• Referans 26. Sanchez-Sotelo J, Torchia ME, O'Driscoll SW. Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique. J Bone Joint Surg Am. 2007 ;89(5):961-9.
• Referans 27. Claessen FM, Braun Y, Peters RM, Kolovich GP, Ring D. Plate and Screw Fixation of Bicolumnar Distal Humerus Fractures: Factors Associated With Loosening or Breakage of Implants or Nonunion. J Hand Surg Am. 2015 ;40(10):2045-2051.e2.
• Referans 28. Saragaglia D, Rouchy RC, Mercier N. Fractures of the distal humerus operated on using the Lambda® plate: report of 75 cases at 9.5 years follow-up. Orthop Traumatol Surg Res. 2013 ;99(6):707-12.
• Referans 29. Doornberg JN, van Duijn PJ, Linzel D, Ring DC, Zurakowski D, Marti RK, Kloen P. Surgical treatment of intra-articular fractures of the distal part of the humerus. Functional outcome after twelve to thirty years. J Bone Joint Surg Am. 2007 ;89(7):1524-32.