Is there an ideal surgical treatment option for adult distal humerus complex fractures?

Yıl 2023, Cilt: 13 Sayı: 2, 305 - 313, 30.06.2023

Amet Çağrı Uyar , Alauddin Kochai , Mustafa Uysal , Abdülhalim Akar , Uğur Özdemir

https://doi.org/10.31832/smj.1190747

Öz

Objective: The aim of this study is to define the ideal surgical treatment option for distal humerus fractures by comparing different surgical techniques.

Material and methods: Seventy-one patients with distal humerus diaphysis fractures who were treated between 2015 and 2020 were retrospectively investigated,. The patients were operated on with the posterior approach of open reduction and plate-screw osteosynthesis (Group A), plated with the minimal invasive technique (Group B), operated on using the lateral approach (Group C) and treated with an external fixator (Group D). Age, gender, mechanism of fracture, fracture type and AO class, applied surgical method, additional injuries, duration of operation, amount of bleeding, amount of fluoroscopy used, length of hospital stay, radiological angular values, union time, complications, and clinical examination findings of the patients were examined retrospectively and the differences between the mentioned surgical methods were investigated.

Results: Blood loss was significantly less in Groups C and D (p <0.001). The use of fluoroscopy was less in Group A. The length of stay in Group B was significantly shorter than for Group D (p <0.001). Union time was significantly longer for Groups B and D compared to Groups A and C (p <0.05). Shoulder abduction strength loss was higher in Group D (p <0.001).

Conclusion: The fixation with the hybrid external fixator in cases in the distal area that makes plaque placement difficult and especially in multi-part humeral diaphysis fractures is a method that gives good functional results as well as other methods that can be used.

Anahtar Kelimeler

humerus fracture, diaphysis

Erişkin distal humerus kompleks kırıklarında ideal cerrahi tedavi seçeneği var mı?

Öz

Giriş: Çalışmanın amacı distal humerus kompleks kırklarında uygulanmış farklı cerrahi teknikler karşılaştırılarak ideal cerrahi tedavi seçeneğinin belirlenmesinde yol gösterici olmaktır.
Gereç ve Yöntem: 2015-2020 yılları arasında distal humerus diafiz kırığı tanısı alarak cerrahi tedavi planlanan hastalardan posterior yaklaşım kullanılarak açık redüksiyon ile plak-vida osteosentezi(Grup A), minimal invaziv teknikle plaklama(Grup B), Lateral yaklaşım kullanılarak plak,vida osteosentezi(Grup C) ve eksternal fiksatör ile tespit(Grup D) yapılan 71 humerus kırığı çalışmaya dahil edildi. Hastalar yaş, cinsiyet, kırığın oluş mekanizması, kırığın şekli ve AO sınıfı, uygulanan cerrahi yöntem, ek yaralanmalar, ameliyat süresi, kanama miktarı, kullanılan floroskopi miktarı, hastanede kalış süreleri, radyolojik açısal değerler, kaynama zamanı, komplikasyonlar, muayene bulguları retrospektif olarak incelenerek belirtilen cerrahi yöntemler arası farklılıklar araştırıldı.
Bulgular: Kan kaybı miktarı Grup B ve D' de istatistiksel olarak anlamlı derecede az bulundu (p<0.001). Floroskopi kullanımı; Grup A'da daha az bulundu. Hastanede kalış süresi Grup B'de Grup D'ye göre kısa bulundu (p<0.001). B ve D grubunda kaynama süresi A ve C grubuna göre anlamlı şekilde uzun bulundu (p<0.05). Omuz abdüksiyon kuvveti ölçümünde grup D' de grup A ve B'ye göre anlamlı kayıp vardı(p <0.001).
Tartışma: Hibrid eksternal fiksatör ile tespit yönteminin plak yerleşimini zorlaştıracak kadar distal bölgede bulunan, yumuşak doku problemi olan, özellikle çok parçalı humerus diafiz kırıklarında kullanımı diğer yöntemlerle benzer şekilde iyi fonsiyonel sonuçlar vermesi açısından uygun bir cerrahi seçenektir.

Anahtar Kelimeler

humerus kırığı, diyafiz, diaphysis

Kaynakça

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