Ekstraartiküler Proksimal Falanks Kırıklarında Kapalı Redüksiyon ve Kirschner Teli Tespitin Klinik ve Radyolojik Sonuçları

Öz

Amaç: Bu çalışmada ekleme uzanım göstermeyen proksimal falanks kırıklarında uyguladığımız Kirschner teli fiksasyonun radyolojik ve klinik sonuçlarını sunmayı amaçladık.

Gereç ve Yöntem: Kapalı, unstabil, ekstrartiküler proksimal falanks kırığı nedeniyle kapalı redüksiyon ve Kirschner teli ile fiksasyon uyguladığımız 16 hastanın klinik ve radyolojik verileri retrospektif olarak incelendi. Tüm hastalarda ameliyat sonrası 6.ay değerlendirme parametreleri esas alınarak değerlendirme ve istatiksel analiz yapıldı. Aktif ve pasif metakarpofalangial eklem ve interfalangial eklem hareket açıklıkları, Total eklem hareket açıklığı, kırık ve sağlam eller için kavrama gücü ölçümü, subjektif ağrı değerlendirmesi için görsel analog skor değerlendirmesi, fonksiyonel değerlendirme için Disabilities of the arm, shoulder and hand skoru, opere edilen parmakta pulpa ve palmar curve arası mesafe ölçümü, Belsky skoru, reoperasyon ve komplikasyonlar değerlendirildi.

Bulgular: Ortalama 4.8 (4-8) haftada radyolojik kaynama elde edildi. Hastaların fonksiyonel sonuçları değerlendirildiğinde; aktif metakarpofalangial eklem fleksiyonu ortalama 87.8 (60-90) derece, proksimal interfalangeal eklem fleksiyonu ortalama 77.5 (55-100) derece, distal interfalangial eklem fleksiyonu ortalama 73.4 (60-90) derece, ortalama total eklem hareket açıklığı 230 (170-270) derece olarak değerlendirildi. Kırığın olduğu elde kavrama gücü 36 (23-50) kgw, sağlam elde yapılan karşılaştırmada 39.5 (30-50) kgw olarak ölçüldü. İstatiksel açıdan kavrama gücü açısından anlamlı fark saptanmadı (p<0.05). Görsel analog skor ortalaması 1.25 (0-5), Disabilities of the arm, shoulder and hand skoru ortalaması 10.5 (2-34), parmak pulpası ve parmak curve arası mesafe ortalama 6.25 (0-23) mm olarak değerlendirildi.

 

Sonuçlar: Proksimal falanks; kapalı, ekstraartiküler, unstabil kırıklarında kapalı redüksiyon ve Kirschner teli ile fiksasyon uygulaması kabul edilen ve ucuz bir tedavi metodudur. Uygun endikasyonda seçilen hastalarda özellikle komünike, transvers ve kısa oblik kırıklarda başarılı radyolojik ve fonksiyonel sağlayan bir yöntemdir.

Anahtar Kelimeler

• Falanks,kırık,K teli

Clinical And Radiological Outcomes Of Closed Reduction And Kirschner Wire Fixation In Treatment Of Extra-Articular Fractures Of The Proximal Phalanx

Öz

Aim: In this study, we aim to discuss the radiological and clinical results of closed reduction and Kirschner wire fixation we performed on 16 cases with extra-articular unstable proximal phalangeal fractures

Materials and Methods: Clinical and radiological data of 16 patients with closed, unstable (transverse or short oblique), extra-articular proximal phalangeal fractures to whom we performed closed reduction and fixation with Kirschner wire in Erzurum Regional Training and Research Hospital Orthopedics and Traumatology Clinic and Hand Surgery Clinic between 2014-2017 were retrospectively reviewed

Results: Functional results of the patients are evaluated; mean active MP joint flexion was 78.75 (60-90) degrees, proximal IP joint flexion was 77.5 (65-100) degrees, distal IP joint flexion was 73.4 (60-80) degrees and mean TAM was 230 (170-270) degrees. Mean passive MP joint flexion was evaluated as 81.25 (60-90) degrees, mean proximal IP joint flexion as 83 (60-100) degrees and mean distal IP joint flexion as 74 (65-90) degrees. The grip strength was measured as 36 (23-50) kgW in the fractured hand and the healthy hand comparison was 40 (30-50) kgW. Statistically, there was no significant difference between the two groups in terms of grip strength (p<0.05). VAS mean was 1.25 (0-5), DASH mean was 10.5 (2-34), the mean distance between finger pulp and finger curve was 6.25 (0-23) mm. Belsky score was excellent in 4 patients, good in 9 patients and poor in 3 patients (Table 2). Two patients underwent tenolysis due to PIP joint contracture. Sudeck atrophy was observed in 1 patient for an average of 8 weeks. We achieved improvement with physical therapy, contrast bathing and medical treatment. There were no complications such as non-union, late union, superficial and deep infection, tenosynovitis. Our patients did not develop material extraction due to soft tissue and skin irritation. Radiologic evaluation of the follow up direct X-ray graphies revealed no displacement, angulation, and rotational deformities.

Conclusion: The proximal phalanx is 'small in size' for the body and 'functioning big' for the upper limb. Fractures of the proximal phalanges can be fixed with Kirshner wires after failed stabilization with closed reduction and brace fixation. It is a practical method which has satisfactory outcomes and has a relatively low cost.

Anahtar Kelimeler

• proximal phalanx,fracture,K wire

Kaynakça

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