Yetiþkin izole radius kýrýklarýnda intramedüller çivi tedavisi

AMAÇ: Bu çalýþmada izole radius diafiz kýrýðý nedeniyle yeni dizayn intramedüller radius çivi tedavisi uyguladýðýmýz eriþkin hastalarda intramedüller çivi tedavisinin etkinliðini, fonksiyonel ve kozmetik sonuçlarýný deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Ýzole deplase radius diafiz kýrýðý nedeniyle intramedüller çivi tedavisi uygulanan17 hasta geriye dönük olarak deðerlendirildi. Çalýþmaya kapalý izole radius diafiz kýrýðý olan hastalar dahil edildi. Tüm hastalara kapalý yöntemle tespit uygulandý. Hastalarýn son kontrollerinde gonyometre ile önkol ve dirsek hareket açýlarý ölçüldü. Hidrolik el dinamometresi ile saðlam ve tedavi edilen önkollar için kavrama gücü ölçüldü. Önkol direkt grafide maksimum radial eðim ve lokalizasyonlarý saðlam ve tedavi edilen ekstremiteler için ayrý ayrý ölçüldü. Kaynama ve fonksiyonel sonuçlarýn deðerlendirilmesi Grace-Eversman kriterleri ve Disabilities of the Arm, Shoulder and Hand (DASH) scoreanketine göre yapýldý.
BULGULAR: Ýzole radius diafiz kýrýðý olan 17 eriþkin hasta deðerlendirmeye alýndý. Hastalarýn 11’i (%64.7) erkek, altýsý (%35.3) kadýndý. Yaþ ortalamasý 35.76 (23–61) idi. On bir (%64.7) hastada sað, altý (%35.3) hastada sol tarafta kýrýk vardý. Ortalama kaynama süresi 10.2 (8–20) hafta olarak deðerlendirildi. Ortalama supinasyon 75.35 (67–80) derece, pronasyon 85.18 (74–90) derece idi. Grace-Eversman deðerlendirme kriterlerine göre 16 (%94) olguda mükemmel bir (%6) olguda iyi sonuç elde edildi. Hastalarýn DASH ortalamasý 12.58 (3.3–32.5) olarak deðerlendirildi.
TARTIÞMA: Eriþkin deplase radius diafiz kýrýklarýnýn cerrahi tedavisinde altýn standart tedavi yöntemi plak vida osteosentezidir. Ancak fonksiyonel sonuçlarýnýn çok iyi olmasý ve plak vida osteosentezine benzer kaynama oranlarý nedeniyle intramedüller çivi tedavisinin izole radius diafiz kýrýklarýnda alternatif bir tedavi yöntemi olarak kullanýlabileceðini düþünüyoruz.

Intramedullary nailing of adult isolated diaphyseal radius fractures

BACKGROUND: The aim of the present study was to evaluate functional and cosmetic outcomes of adult patients who underwent intramedullary nailing with newly designed intramedullary radius nails for isolated radius diaphyseal fractures.
METHODS: Seventeen adult patients who had undergone intramedullary nailing for radius diaphyseal fractures were retrospectively evaluated. Patients with isolated radius diaphyseal closed fractures were included. Closed reduction was achieved in all patients. Wrist and elbow ranges of movement were calculated at final follow-up. Grip strength was calculated using a hydraulic hand dynamometer. Maximum radial bowing (MRB) and maximum radial bowing localization (MRBL) were calculated for treated and uninjured arms. Functional evaluation was performed using Grace-Eversman evaluation criteria and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score.
RESULTS: Of the 17 patients with isolated radius diaphyseal fractures evaluated, 11 (64.7%) were male and 6 (35.3%) were female, with a mean age of 35.76 years (range: 23–61 years). Fractures were right-sided in 11 (64.7%) and left-sided in 6 (35.3%) patients. Mean time to bone union was 10.2 weeks (range: 8–20 weeks). Mean supination was 75.35º (range: 67º–80º), pronation was 85.18º (range: 74º–90º). According to Grace-Eversman evaluation criteria, results were excellent in 16 (94%) and good in 1 (6%) patient. Mean DASH score was 12.58 (3.3–32.5).
CONCLUSION: The gold-standard treatment of adult isolated radius diaphyseal fractures is plate and screw osteosynthesis. However, intramedullary nailing of isolated radius fractures is a good alternative treatment method, with excellent functional results and union rates similar to those of plate and screw osteosynthesis.