Radius Distal End Fractures: A Prospective Randomized Comparison of Intrafocal (Kapandji) Pinning Versus External Fixaton

Yıl 2020, Cilt: 5 Sayı: 1, 106 - 116, 31.03.2020

Gökhan Ragıp Ulusoy Michel Vancabeke Philippe Boute Philippe Putz

https://doi.org/10.26453/otjhs.483551

Öz

Objective: The aim of this study was to compare intrafocal wire (Kapandji) and external fixation techniques, to evaluate the quality of the reduction, functional outcomes and the subjective opinions in dorsally displaced fractures of the distal radius.
Materials and Meyhods: Regardless of age, 101 closed dorsally displaced distal radius fractures, except those with multiple intraar-ticular fracture line, were included in this study. 46 of them were treated with Kapandji and 55 with external fixator.
Results: At post-op 3rd week, pain was more evident (p=0,049) in patients treated with Kapandji method. The range of motion, except for the patients with ulnar deviation, was better in patients treated with Kapandji at 6 weeks (flexion p<0,001, extension p<0,001). Regardless of surgical technique, intraarticular fractures do not affect functional progression (ROM, grip strength, daily activities). The results were similar at 6 months. The recovery of grip strength was better for intrafocal pinning at 6 weeks (p=0,000) and 3 months (p=0,011).
Conclusion: The results obtained with both techniques are similar. In our opinion, the consolidation period lasts longer than expected. It might be better to increase the immobilization time and delay the removal of the wires. In addition, bone grafting can be a solution to improve radiological outcomes for fractures with severe dorsal comminution.

Radius Distal Uç Kırıkları: Kapandji Yöntemiyle İntrafokal Telleme ve Eksternal Fiksatör Tekniklerinin Prospektif Randomize Bir Çalışma ile Karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı, radius distal uç kırıklarında, intrafo-kal telleme (Kapandji) ve eksternal fiksatör (EF) tekniklerini, karşı-laştırmak, radyolojik olarak redüksiyon’un kalitesi, fonksiyonel sonuçlar ve hastanın subjektif görüşlerini değerlendirmektir.
Materyal ve Metod: Yaş göz önüne alınmadan, birden fazla eklem içi kırık hattı olan çok parçalı kırıklar hariç, dorsale yer değiştirmiş radius distal uç kapalı kırığı ile başvuran 101 hasta değerlendirmeye alındı. 46 tanesi Kapandji, 55 tanesi EF ile tedavi edildiler.
Bulgular: Post-op 3. haftada, Kapandji yöntemiyle tedavi edilen hastalarda ağrı daha belirgindi (p=0,049). Hareket sınırları, ulnar deviasyon hariç, 6. haftada Kapandji yöntemiyle tedavi edilenlerde daha iyidi (fleksiyon için p<0,001, ekstansiyon için p<0,001). Eklem içi kırıkların, cerrahi teknik göz önüne alınmadan, fonksi-yonel ilerleme (Hareket açıklığı, el sıkma kuvveti, günlük aktivite) üzerine etki etmediği görüldü. Sonuçlar 6. ayda benzer bulundu. El sıkma kuvvetinin geri kazanılması intrafokal telleme için 6. hafta (p=0,000) ve 3. Ayda (p=0,011) daha iyiydi.
Sonuç: Her iki teknik ile elde edilen sonuçlar birbirine benzerdir. Bizce konsolidasyon süresi düşünülenden daha uzun sürmektedir. Acaba immobilizasyon süresinin biraz daha arttırılması veya telle-rin çıkarılmasının geciktirilmesi gerekmez mi? Ayrıca, kemik grefti, önemli dorsal çok parçalanma olan kırıklarda radyolojik sonuçları iyileştirecek bir çözüm olabilir.

Anahtar Kelimeler

Radius distal uç, eksternal fiksatör, Kapandji, kırık

Kaynakça

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