Radius distal uç kýrýklarýnýn tedavisinde volar plak ve eksternal fiksatör tedavi sonuçlarýnýn karþýlaþtýrýlmasý: Ýzokinetik çalýþma

AMAÇ: Bu çalýþmada, eksternal fiksatör ve kilitli volar plak ile tedavi edilen distal radius kýrýklý hastalarda klinik ve izokinetik sonuçlarý karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: AO tip C1/C2/C3 olan 50 hasta çalýþmaya alýndý. Bunlardan 23 hastaya eksternal fiksatör, 27 hastaya volar kiliti plak uygula-masý yapýldý. Kýrýk tipleri AO sýnýflandýrma sistemine göre sýnýflandýrýldý, hastalar eksternal fiksatör ve volar kilitli plak uygulamasýna göre iki guruba ayrýldý. Tüm hastalar minimum 12 ay takip edildi ve ortalama takip süresi 13.5±1.02 (12–15) ay idi. Fonksiyonel sonuçlar eklem hareket açýklýðý (ROM) ve kavrama gücü ile ölçüldü. Radyografik parametreler (radial inklinasyon, radial yükseklik, radial tilt) ve izokinetik deðerlendirmeler ameliyattan altý ay ve bir yýl sonra ölçüldü. Elbilek skorlarý DASH puanlama sistemine göre yapýldý. Tüm verilerin analizi SPSS Windows 15.0 sistemi üzerinden yapýldý. Niteliksel verilerin analizi için ki-kare testi, eþleþtirilmiþ t-test kullanýldý ve anlamlýlýk p<0.05 düzeyinde deðerlendirildi.
BULGULAR: Her iki gurup arasýnda DASH Skoru, palmarfleksiyon ve kavrama gücü gibi fonksiyonel parametrelerde altýncý ayda anlamlý fark bulunurken (p<0.05), birinci yýl sonunda fark bulunamadý (p=0.79). Ýzokinetik deðerlendirmelerde volar plaklama yapýlan hastalarda eksternal fiksatör yapýlan hastalara göre altýncý ayda pik pronasyon tork ve total work daha iyiyken (p<0.05), birinci yýl sonunda fark bulunamadý (p=0.11). TARTIÞMA: Sonuç olarak, eksternal fiksatör ve volar plaklama uyguladýðýmýz bu ileriye yönelik çalýþmada, volar plaklama yapýlan hastalarda altýncý ayda eklem hareket açýklýðý ve izokinetik deðerlendirmeler daha iyi iken birinci yýl sonunda iki grup arasýnda anlamlý fark bulunamadý. Çalýþmamýzda birinci yýl sonunda bir gurubun diðerine üstünlüðü bulunamadý.

Volar-locking plate versus external fixator in the management of distal radius fractures: An isokinetic study

BACKGROUND: The aim of this study was to compare the clinical and isokinetic evaluation of distal radius fractures treated by volar locking plate (VLP) and external fixator.
METHODS: The study included fifty patients with distal radius fracture type C1/C2/C3. Twenty-seven patients (12 men, 15 women; mean age 49.5±4.42) underwent open reduction and VLP fixation, and 23 patients (10 men, 13 women; 52.1±4.6) underwent closed reduction and external fixation. The follow-up period was at least 12 months and the mean following time was 13.5±1.02 (12–15) months. The functional parameters measured were range of motion (ROM) and grip strength. Radiographic parameters (radial incli-nation, palmar tilt, and radial height) and isokinetic evaluation were measured at the 6 months and at the final follow-up after surgery. The isokinetic test was done at the speed of 60º/s. The non-fractured arm was tested first and all results were also expressed as a percentage of that on the normal side. Wrist scores according to the disability of the arm, shoulder, and hand (DASH) questionnaire were used.
RESULTS: The DASH scores, grip strength, and palmar flexion were better in VLP group at the 6 months (p<0.05). However, there were no differences between two groups at the one year (p=0.79). Isokinetic evaluation of the VLP showed that peak pronation torque and total pronation work were better than external fixation at the 6 month (p<0.05). At the final of follow-up was seen no significant differences between two groups (p=0.11).
CONCLUSION: We looked at external fixation and locked volar plates in a prospective study and we found an improved range of movement and isokinetic evaluation outcome at 6 months after locked plating, but there were no differences between two groups at the final of follow-up. Our study showed no evidence for the superiority of one treatment over the other at the final follow-up.