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Distal falanks kırığı olan erişkin hastalarda kapalı redüksiyon ve perkutan Kirschner teli uygulaması ile açık redüksiyon internal fiksasyon uygulaması sonuçları karşılaştırılması

Yıl 2021, , 765 - 771, 27.12.2021
https://doi.org/10.31832/smj.949226

Öz

Amaç: Çalışmada; kapalı redüksiyon ve perkutan Kirschner teli (K teli) ile açık redüksiyon internal fiksasyon uyguladığımız distal falanks kırığı olan erişkin hastaların fonksiyonel ve radyolojik sonuçlarının değerlendirilmesi amaçlandı.
Gereç ve Yöntemler: Şubat 2019 ile Aralık 2020 tarihleri arasında 13 hasta (8 erkek, 5 bayan), iki ayrı gruba ayrılarak retrospektif olarak değerlendirildi. 1. gruba kapalı redüksiyon ve perkutan K teli ( 6 hasta) ve 2. gruba açık redüksiyon internal fiksasyon (7 hasta) uygulandı. Fonksiyonel sonuçlar total aktif eklem hareket açıklığı (TAEHA) skalasına göre değerlendirildi. Analiz Statistical Package for the Social Sciences (SPSS) ve Friedman’s p korelasyon testine göre yapıldı. p<0.05 olması anlamlı kabul edildi. Gruplarda işe dönüş zamanı karşılaştırıldı.
Bulgular: Hastaların ortalama yaşı 37 (24-51) ve ortalama takip süresi 13 (10-18) aydı. TAEHA skalasına göre 11 hasta mükemmel ve 2 hastada iyi sonuç elde edildi. Ortalama 4 (3-6) hafta içinde tüm hastalarda tam kaynama görüldü. Radyolojik ve fonksiyonel açıdan anlamlı fark saptanmadı. İşe dönüş zamanı açısından 2. grup anlamlı bulundu (p=0.03). Enfeksiyon, redüksiyon kaybı, kaynamama ve kompleks bölgesel ağrı sendromu gibi komplikasyonlar görülmedi.
Sonuç: Distal falanks kırığı olan erişkin hastalarda uygulanan 2 ayrı tedavi yöntemi ile tatmin edici fonksiyonel ve radyolojik sonuçlar elde edilmesine rağmen, açık redüksiyon internal fiksasyon uygulanan hastalarda işe dönüş açısından daha anlamlı olduğu görülmektedir.

Kaynakça

  • 1. Day C, Stern P. Fractures of the metacarpals and phalanges. In: Wolfe S, editor. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2011.
  • 2. Van Oosterom FJ, Brete GJ, Ozdemir C, Hovius SE. Treatment of phalangeal fractures in severely injured hands. J Hand Surg Br 2001;26:108-11.
  • 3. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am 2001;26:908-15.
  • 4. Oetgen ME, Dodds SD. Non-operative treatment of common finger injuries. Curr Rev Musculoskelet Med 2008;1:97-102.
  • 5. van Onselen EB, Karim RB,, Hage JJ, Ritt MJ. Prevalence and distribution of hand fractures. J Hand Surg Br 2003;28:491-5.
  • 6. Cotterell IH, Richard MJ. Metacarpal and phalangeal fractures in athletes. Clin Sports Med 2015;34:69-98.
  • 7. Karl JW, Olson PR, Rosenwasser MP. The epidemiology of upper extremity fractures in the United States, 2009. J Orthop Trauma 2015;29:e242-4.
  • 8. Taghinia AH, Talbot SG. Phalangeal and metacarpal fractures. Clin Plast Surg 2019;46:415-23.
  • 9. Schneider LH. Fractures of the distal phlanx. Hand Clin 1988;4:537-47.
  • 10. Gaston RG, Chadderdon C. Phalangeal fractures: displaced/nondisplaced. Hand Clin 2012;28:395-401.
  • 11. Hay RA, Tay SC. A comparison of K-wire versus screw fixationon the outcomes of distal phalanx fractures. J Hand Surg Am 2015;40:2160-7.
  • 12. Bhatt RA, Schmidt S, Stang F. Methods and pitfalls in treatment of fractures in the digits. Clin Plast Surg 2014;41:429-50.
  • 13. Ahmed Z, Haider MI, Buzdar MI, Bakht Chugtai B, Rashid M, Hussain N et al. Comparison of miniplate and K-wire in the treatment of metacarpal and phalangeal fractures. Cureus 2020;12:e7039. doi: 10.7759/cureus.7039.
  • 14. Shim WC, Yang JW, Roh SY, Lee DC, Kim JS. Percutaneous cerclage wiring technique for phalangeal fractures. Tech Hand Up Extrem Surg 2014;18:36-40.
  • 15. Cheah AE, Yao J. Hand fractures: Indications, the Tried and True and New ınnovations. J Hand Surg Am 2016;41:712-22.
  • 16. Apic G, Mentzel M, Röhm A, Schöll H, Gülke J. Distal phalangeal fractures of the finger. Results of conservative and surgical treatment. Unfallchirurg 2014;117:533-8.
  • 17. Kremer L, Frank J, Lustenberger T, Marzi I, Saner AL. Epidemiology and treatment of phalangeal fractures: conservative treatment is the predominant therapeutic concept. Eur J Trauma Emerg Surg 2020; doi: 10.1007/s00068-020-01397-y.
  • 18. Prunieres G, Gouzou S, Facca S, Matheron AS, Maire N, Hidalgo Diaz JJ et al. Treatment of unstable distal phalanx fractures by extra-articular DIP pinning: A series of 12 cases. Hand Surg Rehabil 2016;35:330-4.
  • 19. Senesi L, Marchesini A, Pangrazi PP, de Francesco M, Gigante A, Riccio M et al. K-wire fixation vs 23-gauge percutaneous hand- crossed hypodermic needle fo the treatment of distal phalangeal fractures. BMC Musculoskelet Disord 2020;21:590. doi: 10.1186/s12891-020-03606-6.
  • 20. Liao JCY, Das De S. Management of tendon and bony injuries of the distal phalanx. Hand Clin 2021;37:27-42.
  • 21. Auchincloss JM. Mallet-finger injuries: a prospective, controlled trial of internal and external splintage. Hand 1982;14:168-73.
  • 22. Hofmeister EP, Mazurek MT, Shin AY, Bishop AT. Extension block pinning for large mallet fractures. J Hand Surg Am 2003;28:453-9.
  • 23. Metcalfe D, Aquilina AL, Hedley HM. Prophylactic antibiotics in open distal phalanx fractures: systematic review and meta-analysis. J Hand Surg Eur 2016;41:423-30.
  • 24. Abboudi J, Kirkpatrick WH, Schroeder J. Low-intensity pulsed ultrasound bone stimulator treatment for symptomatic distal phalangeal shaft fracture nonunion. JBJS Case Connect 2015;5:e78.
  • 25. Boyacı A, Tutoğlu A, Boyacı FN, Yalçın Ş. Complex regional pain syndrome type 1 after fracture of distal phalanx: case report. Agri 2014;26:187-90.

Comparison of closed reduction with percutaneous Kirschner wire fixation versus open reduction with internal fixation in adult patients with distal phalangeal fractures

Yıl 2021, , 765 - 771, 27.12.2021
https://doi.org/10.31832/smj.949226

Öz

Objectives: We aimed to compare functional and radiological results of closed reduction with percutaneous Kirschner wire (K-wire) fixation versus open reduction with internal fixation in adult patients with distal phalangeal fractures.
Patients and Methods: A total of 13 patients (8 males, 5 females) who were operated for distal phalangeal fractures in our center between February 2019 and December 2020 were retrospectively reviewed. The patients were divided into two groups according to the type of surgery: Group 1 (n=6) undergoing closed reduction with percutaneous K-wire fixation and Group 2 (n=7) undergoing open reduction with internal fixation. Functional results were evaluated using the total active range of motion (TAROM) scale. Demographic and clinical characteristics and operative data were recorded. The time to return to work was assessed between the groups.
Results: The median age was 37 (range, 24 to 51) years and the median follow-up was 13 (range, 10 to 18) months. According to the TAROM scale, excellent and good results were achieved in 11 and two patients, respectively. The median time to complete union was 4 (range, 3 to 6) weeks. There was no significant difference in the functional and radiological results between the groups. However, the median time to return to work was significantly shorter in Group 2 (p=0.03). None of the patients had postoperative complications such as infection, reduction loss, nonunion or complex regional pain syndrome.
Conclusion: Although both treatment methods yield satisfactory and comparable functional and radiological results in patients with distal phalangeal fractures, open reduction with internal fixation is significantly associated with a shorter time to return to work.

Kaynakça

  • 1. Day C, Stern P. Fractures of the metacarpals and phalanges. In: Wolfe S, editor. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2011.
  • 2. Van Oosterom FJ, Brete GJ, Ozdemir C, Hovius SE. Treatment of phalangeal fractures in severely injured hands. J Hand Surg Br 2001;26:108-11.
  • 3. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am 2001;26:908-15.
  • 4. Oetgen ME, Dodds SD. Non-operative treatment of common finger injuries. Curr Rev Musculoskelet Med 2008;1:97-102.
  • 5. van Onselen EB, Karim RB,, Hage JJ, Ritt MJ. Prevalence and distribution of hand fractures. J Hand Surg Br 2003;28:491-5.
  • 6. Cotterell IH, Richard MJ. Metacarpal and phalangeal fractures in athletes. Clin Sports Med 2015;34:69-98.
  • 7. Karl JW, Olson PR, Rosenwasser MP. The epidemiology of upper extremity fractures in the United States, 2009. J Orthop Trauma 2015;29:e242-4.
  • 8. Taghinia AH, Talbot SG. Phalangeal and metacarpal fractures. Clin Plast Surg 2019;46:415-23.
  • 9. Schneider LH. Fractures of the distal phlanx. Hand Clin 1988;4:537-47.
  • 10. Gaston RG, Chadderdon C. Phalangeal fractures: displaced/nondisplaced. Hand Clin 2012;28:395-401.
  • 11. Hay RA, Tay SC. A comparison of K-wire versus screw fixationon the outcomes of distal phalanx fractures. J Hand Surg Am 2015;40:2160-7.
  • 12. Bhatt RA, Schmidt S, Stang F. Methods and pitfalls in treatment of fractures in the digits. Clin Plast Surg 2014;41:429-50.
  • 13. Ahmed Z, Haider MI, Buzdar MI, Bakht Chugtai B, Rashid M, Hussain N et al. Comparison of miniplate and K-wire in the treatment of metacarpal and phalangeal fractures. Cureus 2020;12:e7039. doi: 10.7759/cureus.7039.
  • 14. Shim WC, Yang JW, Roh SY, Lee DC, Kim JS. Percutaneous cerclage wiring technique for phalangeal fractures. Tech Hand Up Extrem Surg 2014;18:36-40.
  • 15. Cheah AE, Yao J. Hand fractures: Indications, the Tried and True and New ınnovations. J Hand Surg Am 2016;41:712-22.
  • 16. Apic G, Mentzel M, Röhm A, Schöll H, Gülke J. Distal phalangeal fractures of the finger. Results of conservative and surgical treatment. Unfallchirurg 2014;117:533-8.
  • 17. Kremer L, Frank J, Lustenberger T, Marzi I, Saner AL. Epidemiology and treatment of phalangeal fractures: conservative treatment is the predominant therapeutic concept. Eur J Trauma Emerg Surg 2020; doi: 10.1007/s00068-020-01397-y.
  • 18. Prunieres G, Gouzou S, Facca S, Matheron AS, Maire N, Hidalgo Diaz JJ et al. Treatment of unstable distal phalanx fractures by extra-articular DIP pinning: A series of 12 cases. Hand Surg Rehabil 2016;35:330-4.
  • 19. Senesi L, Marchesini A, Pangrazi PP, de Francesco M, Gigante A, Riccio M et al. K-wire fixation vs 23-gauge percutaneous hand- crossed hypodermic needle fo the treatment of distal phalangeal fractures. BMC Musculoskelet Disord 2020;21:590. doi: 10.1186/s12891-020-03606-6.
  • 20. Liao JCY, Das De S. Management of tendon and bony injuries of the distal phalanx. Hand Clin 2021;37:27-42.
  • 21. Auchincloss JM. Mallet-finger injuries: a prospective, controlled trial of internal and external splintage. Hand 1982;14:168-73.
  • 22. Hofmeister EP, Mazurek MT, Shin AY, Bishop AT. Extension block pinning for large mallet fractures. J Hand Surg Am 2003;28:453-9.
  • 23. Metcalfe D, Aquilina AL, Hedley HM. Prophylactic antibiotics in open distal phalanx fractures: systematic review and meta-analysis. J Hand Surg Eur 2016;41:423-30.
  • 24. Abboudi J, Kirkpatrick WH, Schroeder J. Low-intensity pulsed ultrasound bone stimulator treatment for symptomatic distal phalangeal shaft fracture nonunion. JBJS Case Connect 2015;5:e78.
  • 25. Boyacı A, Tutoğlu A, Boyacı FN, Yalçın Ş. Complex regional pain syndrome type 1 after fracture of distal phalanx: case report. Agri 2014;26:187-90.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Erdinç Acar 0000-0002-2154-0108

Uğur Bezirgan 0000-0001-9053-8637

Mehmet Armangil 0000-0003-0433-0253

Yayımlanma Tarihi 27 Aralık 2021
Gönderilme Tarihi 7 Haziran 2021
Yayımlandığı Sayı Yıl 2021

Kaynak Göster

AMA Acar E, Bezirgan U, Armangil M. Distal falanks kırığı olan erişkin hastalarda kapalı redüksiyon ve perkutan Kirschner teli uygulaması ile açık redüksiyon internal fiksasyon uygulaması sonuçları karşılaştırılması. Sakarya Tıp Dergisi. Aralık 2021;11(4):765-771. doi:10.31832/smj.949226

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