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Dengesiz Distal Radius Kiriklarinin Volar Plaklama İle Tedavisi Sonrasinda Kötü Sonuçlarin Belirteçleri; Retrospektif Klinik Analiz

Yıl 2019, Cilt 3, Sayı 2, 168 - 172, 23.08.2019
https://doi.org/10.30565/medalanya.547982

Öz

Amaç: Bu çalışmada dengesiz radius distal uç kırıklarının volar kilitli plak ile tedavisi sonrası işlevsel ve radyolojik sonuçları, komplikasyonları değerlendirerek, kötü sonuçların belirteçlerini ortaya çıkarmayı amaçladık. 

Hastalar ve Yöntem: Mayıs 2006 ile Ağustos 2016 arasında distal radius kırığı nedeniyle volar kilitli plak uygulanmış 91 hasta (55 erkek / 36 kadın) geriye dönük çalışmamıza dâhil edildi. Tüm kırıklar AO sınıflama sistemiyle sınıflandırıldı. Mayo el bilek ve hızlı DASH-T skorları ile fonksiyonel sonuçlar, Steawart skorları ile de radyolojik sonuçlar değerlendirildi. Kötü radyolojik ve fonksiyonel sonuçların belirtecek çeşitli faktörler değerlendirildi. 

Sonuçlar: Hastaların yaş ortalaması 46,9 yıl (23-72 min-maks) ve ortalama takip süresi 29,6 ay (12-39 min-maks) idi. Ortalama kırık kaynama süresi 7,3 hafta (6-11 min-maks) idi. Hastaların son kontrollerinde ortalama hızlı DASH-T skoru 7.1 (0-65.9) ve Mayo el bilek skoru 85.8 (55-100) idi. 10 hastada takipte çeşitli komplikasyonlar görülmüştü; 8 hastada yara yeri enfeksiyonu, 2 hastada hipertrofik skar görüldü. Kötü sonuçların en güçlü belirteçlerinin kırığın tipi ve yara komplikasyonları olduğu tespit edildi. 

Sonuç: Volar kilitli plaklar dengesiz distal radius kırıklarının tedavisinde kabul edilebilir komplikasyon oranı ile tedavide tercih edilebilir. Yara yeri komplikasyonlarından kaçınmak için her türlü özen gösterilmelidir. 

Kaynakça

  • 1. Gartland JJ Jr, Werley CW. Evaluation of healed colles fractures. J Bone Joint Surg [Am] 1951;33-A:895-907. PMID: 14880544.
  • 2. Orbay JL,Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg 2002;27A:205-215. PMID: 11901379.
  • 3. Chiang PP, Roach S, Baratz ME. Failure of a retinacular flap to prevent dorsal wirst pai after titanium Pi plate fixation of distal radius fractures. J Hand Surg2002;27: 724-728. DOI: https://doi.org/10.1053/jhsu.2002.33703.
  • 4. Rozental TD,Beredijiklian PK,Bozentka DJ. Functional outcomes and complications following two types of dorsal plating for unstable fractures of the distal part of the radius. J Bone Joint Surg 2003;85:1956-1960. PMID: 14563804.
  • 5. Thelen S, Grassmann JP, Jungbluth P, Windolf J. Distal radius fractures: Current treatment concepts and controversies. Chirurg. 2018 Oct;89(10):798-812. DOI: 10.1007/s00104-018-0724-0.
  • 6. Lee SJ, Park JW, Kang BJ, Lee JI. Clinical and radiologic factors affecting functional outcomes after volar locking plate fixation of dorsal angulated distal radius fractures. J Orthop Sci. 2016 Sep; 21(5):619-24. DOI: 10.1016/j.jos.2016.05.007.
  • 7. Trumble TE,Schmitt SR,Vedder NB. Factors affecting functional outcomes of displaced intra-articular distal radius fractures. J Hand Surg 1994;19:325-340. DOI: 10.1016/0363-5023(94)90028-0.
  • 8. Kömürcü M, Kamaci L, Ozdemir MT, Ateşalp AS, Başbozkurt M. Treatment of AO type C2-C3 fractures of the distal end of the radius with external fixation. Acta Orthop Traumatol Turc. 2005;39(1):39-45. PMID: 15805753.
  • 9. Dicpinigaitis P,Wolinsky P,Hiebert R,Egol K,Koval K,Tejwani N. Can external fixation maintain reduction after distal radius fractures? J Trauma 2004;57:845-850. DOI: 10.1097/01.TA.0000106290.49252.20.
  • 10. Kambouroglou GK,Axelrod TS. Complications of the AO/ASIF titanium distal radius plate system (pi plate) in internal fixation of the distal radius: a brief report. J Hand Surg 1998;23:737-741. DOI: 10.1016/S0363-5023(98)80063-4.
  • 11. Ashall G. Flexor pollicis longus rupture after fracture of the distal radius. Injury 1991;22:153-155. PMID: 2037338.
  • 12. Drobetz H, Bryant AL,Pokomy T, et al. Volar fixed-angle plating of distal radius extension fractures: influence of plate position on secondary loss of reduction-a biomechanic study in a cadaveric model. J Hand Surg 2006;31A:615-622. DOI: 10.1016/j.jhsa.2006.01.011.
  • 13. Lee HC,Wong YS, Chan BK, Low CO. Fixation of distal radius fractures using AO titanium volar distal radius plate. Hand Surg. 2003;8:7-15. PMID: 12923928.
  • 14. Hove LM, Nilsen PT, Furnes O, Ouile HE, Solheim E, Mölsten AO. Open reduction and internal fixation of displaced intraarticuler fractures of the distal radius: 31 patients followed for 3-7 years. Acta Orthop Scand 1997;68:59-63. PMID: 9057570.
  • 15. Lisa M, Terry M. Complications of volar plate fixation for managing distal radius fractures. J Am Acad Orthop Surg 2009;17:369-377. DOI: 10.5435/00124635-200906000-00005.
  • 16. Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking plate. J Orthop Trauma 2007;21:316-322. DOI: 10.1097/BOT.0b013e318059b993.
  • 17. Drobetz H, Kutcha-Lissberg E. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop 2003;27:1-6. DOI: 10.1007/s00264-002-0393-x.
  • 18. Gutow A. Avoidance and treatment of complications of distal radius fractures. Hand Clin 2005;21:295-305. DOI: 10.1016/j.hcl.2005.04.004.
  • 19. Bienek T, Kusz D, Cielinski L: Peripheral nerve compression neuropathy after fractures of the distal radius. J Hand Surg [Br] 2006;31:256-260. DOI: 10.1016/j.jhsb.2005.09.021.
  • 20. Candan BB, Akalin Y, Cevik N, Ozturk A, Ozkan Y. Early and Mid-term efficacy of volar titanium locking plate applications in radial distal intraarticular fractures. Acta Med. Alanya 2019;3(1): 33-39. DOI:10.30565/medalanya.479342

Predictives of Poor Outcomes after Volar Plating an Unstable Distal Radius Fracture; A Retrospective Clinical Analysis

Yıl 2019, Cilt 3, Sayı 2, 168 - 172, 23.08.2019
https://doi.org/10.30565/medalanya.547982

Öz

Aim: We aimed to evaluate the functional and radiological outcomes and complications after an unstable distal radius fracture that was treated with a volar locked plate in adults and to find out the predictive factors of poor outcomes. 

Patients and Method: 91 patients (55 male / 36 female) that were operated for distal radius fractures with a volar locked plate between May 2006 and August 2016 were included in this retrospective study. All fractures were classified by AO classification system. Mayo Wrist score and Quick DASH-T measure were used to quantify the functional and Steawart scores for radiological outcomes. Varying factors were evaluated for predicting the poor radiological and functional outcomes. 

Results: Mean age of the patients was 46.9 years (23-72 min-max) and mean follow-up was 29.6 months (12-39 min-max) in this study. Mean union time was 7.3 weeks (6-11 min-max) for all patients. Mean Quick DASH-T score was 7.1 (0-65.9) and mean Mayo Wrist score was 85.8 (55-100) at the follow-up. There were 10 patients with various complications as; 8 patients had wound infections and 2 patients had hypertrophic scars. The strongest predictive factors of poor outcomes were the type of fracture and wound complications. 

Conclusion: Volar locked plates are useful for treatment of displaced unstable distal radius fractures with acceptable complication rate and any attempt should be considered to avoid wound complications. 

Kaynakça

  • 1. Gartland JJ Jr, Werley CW. Evaluation of healed colles fractures. J Bone Joint Surg [Am] 1951;33-A:895-907. PMID: 14880544.
  • 2. Orbay JL,Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg 2002;27A:205-215. PMID: 11901379.
  • 3. Chiang PP, Roach S, Baratz ME. Failure of a retinacular flap to prevent dorsal wirst pai after titanium Pi plate fixation of distal radius fractures. J Hand Surg2002;27: 724-728. DOI: https://doi.org/10.1053/jhsu.2002.33703.
  • 4. Rozental TD,Beredijiklian PK,Bozentka DJ. Functional outcomes and complications following two types of dorsal plating for unstable fractures of the distal part of the radius. J Bone Joint Surg 2003;85:1956-1960. PMID: 14563804.
  • 5. Thelen S, Grassmann JP, Jungbluth P, Windolf J. Distal radius fractures: Current treatment concepts and controversies. Chirurg. 2018 Oct;89(10):798-812. DOI: 10.1007/s00104-018-0724-0.
  • 6. Lee SJ, Park JW, Kang BJ, Lee JI. Clinical and radiologic factors affecting functional outcomes after volar locking plate fixation of dorsal angulated distal radius fractures. J Orthop Sci. 2016 Sep; 21(5):619-24. DOI: 10.1016/j.jos.2016.05.007.
  • 7. Trumble TE,Schmitt SR,Vedder NB. Factors affecting functional outcomes of displaced intra-articular distal radius fractures. J Hand Surg 1994;19:325-340. DOI: 10.1016/0363-5023(94)90028-0.
  • 8. Kömürcü M, Kamaci L, Ozdemir MT, Ateşalp AS, Başbozkurt M. Treatment of AO type C2-C3 fractures of the distal end of the radius with external fixation. Acta Orthop Traumatol Turc. 2005;39(1):39-45. PMID: 15805753.
  • 9. Dicpinigaitis P,Wolinsky P,Hiebert R,Egol K,Koval K,Tejwani N. Can external fixation maintain reduction after distal radius fractures? J Trauma 2004;57:845-850. DOI: 10.1097/01.TA.0000106290.49252.20.
  • 10. Kambouroglou GK,Axelrod TS. Complications of the AO/ASIF titanium distal radius plate system (pi plate) in internal fixation of the distal radius: a brief report. J Hand Surg 1998;23:737-741. DOI: 10.1016/S0363-5023(98)80063-4.
  • 11. Ashall G. Flexor pollicis longus rupture after fracture of the distal radius. Injury 1991;22:153-155. PMID: 2037338.
  • 12. Drobetz H, Bryant AL,Pokomy T, et al. Volar fixed-angle plating of distal radius extension fractures: influence of plate position on secondary loss of reduction-a biomechanic study in a cadaveric model. J Hand Surg 2006;31A:615-622. DOI: 10.1016/j.jhsa.2006.01.011.
  • 13. Lee HC,Wong YS, Chan BK, Low CO. Fixation of distal radius fractures using AO titanium volar distal radius plate. Hand Surg. 2003;8:7-15. PMID: 12923928.
  • 14. Hove LM, Nilsen PT, Furnes O, Ouile HE, Solheim E, Mölsten AO. Open reduction and internal fixation of displaced intraarticuler fractures of the distal radius: 31 patients followed for 3-7 years. Acta Orthop Scand 1997;68:59-63. PMID: 9057570.
  • 15. Lisa M, Terry M. Complications of volar plate fixation for managing distal radius fractures. J Am Acad Orthop Surg 2009;17:369-377. DOI: 10.5435/00124635-200906000-00005.
  • 16. Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking plate. J Orthop Trauma 2007;21:316-322. DOI: 10.1097/BOT.0b013e318059b993.
  • 17. Drobetz H, Kutcha-Lissberg E. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop 2003;27:1-6. DOI: 10.1007/s00264-002-0393-x.
  • 18. Gutow A. Avoidance and treatment of complications of distal radius fractures. Hand Clin 2005;21:295-305. DOI: 10.1016/j.hcl.2005.04.004.
  • 19. Bienek T, Kusz D, Cielinski L: Peripheral nerve compression neuropathy after fractures of the distal radius. J Hand Surg [Br] 2006;31:256-260. DOI: 10.1016/j.jhsb.2005.09.021.
  • 20. Candan BB, Akalin Y, Cevik N, Ozturk A, Ozkan Y. Early and Mid-term efficacy of volar titanium locking plate applications in radial distal intraarticular fractures. Acta Med. Alanya 2019;3(1): 33-39. DOI:10.30565/medalanya.479342

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Yayınlanma Tarihi 2019-2
Bölüm Araştırma Makalesi
Yazarlar

Alper Öztürk (Sorumlu Yazar)
ANKARA DIŞKAPI YILDIRIM BEYAZIT EĞİTİM VE ARAŞTIRMA HASTANESİ
0000-0003-2986-4083
Türkiye


Yenel Gürkan Bilgetekin
ANKARA DIŞKAPI YILDIRIM BEYAZIT EĞİTİM VE ARAŞTIRMA HASTANESİ
0000-0002-9677-3088


Mehmet Faruk ÇATMA
ANKARA DIŞKAPI YILDIRIM BEYAZIT EĞİTİM VE ARAŞTIRMA HASTANESİ
0000-0002-0305-2039


Mutlu AKDOĞAN
ANKARA DIŞKAPI YILDIRIM BEYAZIT EĞİTİM VE ARAŞTIRMA HASTANESİ
0000-0003-0704-8704


Halis Atıl ATİLLA
ANKARA DIŞKAPI YILDIRIM BEYAZIT EĞİTİM VE ARAŞTIRMA HASTANESİ
0000-0002-5670-1469


Önder ERSAN
ANKARA DIŞKAPI YILDIRIM BEYAZIT EĞİTİM VE ARAŞTIRMA HASTANESİ
0000-0002-9068-7963

Yayımlanma Tarihi 23 Ağustos 2019
Başvuru Tarihi 2 Nisan 2019
Kabul Tarihi 20 Mayıs 2019
Yayınlandığı Sayı Yıl 2019, Cilt 3, Sayı 2

Kaynak Göster

Vancouver Öztürk A. , Bilgetekin Y. G. , Çatma M. F. , Akdoğan M. , Atilla H. A. , Ersan Ö. Predictives of Poor Outcomes after Volar Plating an Unstable Distal Radius Fracture; A Retrospective Clinical Analysis. Acta Medica Alanya. 2019; 3(2): 168-172.

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