Radius alt uç kırıklarında eksternal fiksatör ve konservatif tedavi sonuçlarının değerlendirilmesi
Loading...
Files
Date
2009
Authors
Kara, Hasan
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Radius alt uç kırıkları çocuklarda ve yetişkinlerde çok sık görülen kırıklardır. Her kırıkta olduğu gibi, bu kırıklarda da özellikle eklem etkilenmişse, mümkün olan en iyi redüksiyon yapılmalıdır. Konservatif tedavi bugün yerini kırık patolojisinin ve tiplerinin daha iyi ortaya konulmasıyla birlikte teknolojik gelişmelerin de ışığında yerini cerrahi tedavi yöntemlerine bırakmıştır.Bu çalışmamıza Ocak 2005 ve Aralık 2008 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesine başvuran 46 hastanın konservatif veya eksternal fiksatör tedavi yönteminin uygulandığı 48 radius alt uç kırığı dahil edildi.Anatomik sonuçlar Steward ve ark. geliştirdiği radyolojik skorlama kriterlerine göre değerlendirildi. Cerrahi grupta hastaların 5'i (%18,5) mükemmel, 21'i (%77,8) iyi, 1'i (%3,7) orta, konservatif grupta hastaların 3'ü (%14,3) mükemmel, 18'i (%85,7) iyi sonuç olarak hesaplandı Fonksiyonel sonuçlar ise Sarmiento tarafından modifiye edilen Gartland Werley'in skorlama sistemi, omuz, kol ve el yetersizlik anketi (Quick DASH), ve kavrama gücü ile değerlendirildi. Cerrahi gruptaki hastaların 3'ü (%11,1) mükemmel, 8'i (%29,6) iyi, 12'si (%44,4) orta, 4'ü (%14,8) kötü, konservatif grupta ise 1'i (%4,8) mükemmel, 13'ü (%61,9) iyi, 7'si (%33,3) orta sonuç olarak bulundu. Kavrama gücü sağlam taraf ile karşılaştırıldığında cerrahi grupta %69,01 konservatif grupta %76,05 oranında geri dönülebilir olarak hesaplandı.Sonuç olarak konservatif yöntem doğru hastaya endikasyonu olduğu sürece ucuz ve kolay bir tedavidir. İnstabil ve eklem içi kırıkların onarımında ise son yıllarda yerini açık cerrahi ve internal fiksatör cerrahisine bırakan minimal invaziv bir yöntem olan eksternal fiksatör kullanılabilir.İyi bir anatomik restorasyon iyi bir fonksiyonel sonuç için her zaman yeterli olmayabilir. Başarılı sonuçlar için kırığın iyi değerlendirilmesi ve eklem bütünlüğünün tam onarımını en iyi sağlayacak yöntemin uygulanması gerekir.
The fractures of distal radius are one of most seen fractures in children and adult. The best reduction must be applied especially if the joint is involved in these fractures as the all other fractures. Recently surgical treatment has taken the place of conservative management in these fractures with the understanding of the pathology and type of fractures as well as improvement in the technology.In this study, conservative or external fixator treatment were applied to 48 fractures of distal radius of 46 patients in who registered to Medical School of Uludag University between January 2005 and December 2008 were included.Anatomical results were assessed according to radiological scoring system defined by Steward et al. 5 (18,5%) patients were excellent, 21 (77,8%) were good, one (3,7%) was fair in surgical group and 3 (14,3%) were excellent,18 (85,7%) were good in conservative group. Functional results were assessed with Gartland Werley scoring system modified by Sarmiento and disability of shoulder, arm and hand questionnaire (Quick DASH) and grip strength. excellent results were seen in 3 (11,1%) patients, good in 8 (29,6%) fair in 12 (44,4%) and poor in 4 (14,8%) in surgical group and in conservative group one patient (4,8%) was found excellent result, 13 (61,9%) were good and 7 (33,3%) were fair. Reversibility of 69,01% in surgical group and 76,05% in conservative group were found when the grip strength is compared with the healthy side.In conclusion, conservative method is more economic and simple if performed with correct indication to suitable patient. External fixator which is a minimal invasive method can be used in the management of instable and intraarticular fractures. Good anatomical restoration always can not be sufficient for the functional results. The best treatment modality which provides the maintenance of joint integrity and clear assessment of fracture are needed to obtain successful results.
The fractures of distal radius are one of most seen fractures in children and adult. The best reduction must be applied especially if the joint is involved in these fractures as the all other fractures. Recently surgical treatment has taken the place of conservative management in these fractures with the understanding of the pathology and type of fractures as well as improvement in the technology.In this study, conservative or external fixator treatment were applied to 48 fractures of distal radius of 46 patients in who registered to Medical School of Uludag University between January 2005 and December 2008 were included.Anatomical results were assessed according to radiological scoring system defined by Steward et al. 5 (18,5%) patients were excellent, 21 (77,8%) were good, one (3,7%) was fair in surgical group and 3 (14,3%) were excellent,18 (85,7%) were good in conservative group. Functional results were assessed with Gartland Werley scoring system modified by Sarmiento and disability of shoulder, arm and hand questionnaire (Quick DASH) and grip strength. excellent results were seen in 3 (11,1%) patients, good in 8 (29,6%) fair in 12 (44,4%) and poor in 4 (14,8%) in surgical group and in conservative group one patient (4,8%) was found excellent result, 13 (61,9%) were good and 7 (33,3%) were fair. Reversibility of 69,01% in surgical group and 76,05% in conservative group were found when the grip strength is compared with the healthy side.In conclusion, conservative method is more economic and simple if performed with correct indication to suitable patient. External fixator which is a minimal invasive method can be used in the management of instable and intraarticular fractures. Good anatomical restoration always can not be sufficient for the functional results. The best treatment modality which provides the maintenance of joint integrity and clear assessment of fracture are needed to obtain successful results.
Description
Keywords
Radius alt uç kırığı, Konservatif, Eksternal fiksatör, Fractures of distal radius, Conservative, External fixator
Citation
Kara, H. (2009). Radius alt uç kırıklarında eksternal fiksatör ve konservatif tedavi sonuçlarının değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.