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Factors Affecting Outcomes of Adult Forearm Fractures Treated by Locking Compression Plate

Yıl 2018, Sayı: 5, 464 - 478, 31.08.2018
https://doi.org/10.38079/igusabder.429347

Öz

Aim: Although internal fixation of forearm fractures by
dynamic compression plates had been studied extensively, the details of optimal
fixation by locking compression plates are not clearly defined. Besides the
factors affecting the functional outcome is still the subject of considerable
debate. The present study is designed to evaluate factors affecting the
outcomes of adult forearm fractures treated via locking compression plate.

Method: The patients with Gustillo Anderson type 3 open
fractures or the ones treated in intensive care unit were excluded and
thirty-six forearm fractures treated by locking compression plate were
prospectively followed.
Disability Arm Shoulder Hand (DASH) and Anderson criteria
scores for assessment of outcomes obtained at sixth month were evaluated.
The patients were followed up for 4 (3-6)
years on average.

Findings: In 18 (50%) patients, fractures were caused by simple
fall. The mean healing time of the fractures was 13.2 ± 2.1 weeks. Patients,
who smoked or had open fractures or complications, had longer healing time.
Mean DASH score was calculated as 13.9 ± 5.9. Upon presence of open fracture
or postoperative complication there was a significant deterioration in scores.
Although the cause of the injury had some effect on functional results the
mechanism (whether the injury was direct or indirect) made no difference.







Conclusion: Fracture type was the most
important factor affecting both healing time and outcome. Being an open
fracture or the presence of postoperative complication deteriorates the
outcome. The functional results were somewhat poorer in fractures caused by
simple fall.

Kaynakça

  • Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-697.
  • Kasten P, Krefft M, Hesselbach J, Weinberg AM. How does torsional deformity of the radial shaft influence the rotation of the forearm? A biomechanical study. J Orthop Trauma. 2003;17(1):57-60.
  • Tynan MC, Fornalski S, McMahon PJ, Utkan A, Green SA, Lee TQ. The effects of ulnar axial malalignment on supination and pronation. J Bone Joint Surg Am. 2000;82-A(12):1726-1731.
  • Gadegone W, Salphale YS, Lokhande V. Screw elastic intramedullary nail for the management of adult forearm fractures. Indian Journal of Orthopaedics. 2012;46(1):65-70.
  • Ruedi T, Buckley R, Moran C. AO Principles of Fracture Management. 2nd ed. Thieme Medical Publishers; 2007.
  • Saka G, Sağlam N, Kurtulmuş T, et al. New interlocking intramedullary radius and ulna nails for treating forearm diaphyseal fractures in adults: a retrospective study. Injury. 2014;45(Suppl 1):16-23.
  • Shah AS, Lesniak BP, Wolter TD, Caird MS, Farley FA, Vander HKL. Stabilization of adolescent both-bone forearm fractures: a comparison of intramedullary nailing versus open reduction and internal fixation. J Orthop Trauma. 2010;24(7):440-447. doi: 10.1097/BOT.0b013e3181ca343b.
  • Kim SB, Heo YM, Yi JW, Lee JB, Lim BG. Shaft fractures of both forearm bones: The outcomes of surgical treatment with plating only and combined plating and intramedullary nailing. Clinics in Orthopedic Surgery. 2015;7(3):282-290.
  • Yörükoğlu AÇ, Demirkan AF, Akman A, Kitiş A, Usta H. The effects of radial bowing and complications in intramedullary nail fixation of adult forearm fractures. Eklem Hastalık Cerrahisi. 2017;28(1):30-34. doi: 10.5606/ehc.2017.05.
  • Düger T, Yakut E, Öksüz Ç, et al. Kol, omuz ve el sorunları (Disabilities of the Arm, Shoulder and Hand - DASH) anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Fizyoterapi Rehabilitasyon. 2006;17(3):99-107.
  • Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602-608.
  • Anderson LD, Sisk D, Tooms RE, Park WI. Compression-plate fixation in acute diaphyseeal fractures of the radius and ulna. J Bone Joint Surg Am. 1975;57(3):287-297.
  • Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br. 2002;84(8):1093-1110.
  • Wagner M. General principles for the clinical use of the LCP. Injury. 2003;34(Suppl 2):31-42.
  • Matthews SJ, Nikolaou VS, Giannoudis PV. Innovations in osteosynthesis and fracture care. Injury. 2008;39(8):827-838. doi: 10.1016/j.injury.2008.06.016.
  • Azboy I, Demırtas A, Uçar BY, Bulut M, Alemdar C, Ozkul E. Effectiveness of locking versus dynamic compression plates for diaphyseal forearm fractures. Orthopedics. 2013;36(7):e917–922. doi: 10.3928/01477447-20130624-23.
  • Davis BJ, Roberts PJ, Moorcroft CI, Brown MF, Thomas PB, Wade RH. Reliability of radiographs in defining union of internally fixed fractures. Injury. 2004;35(6):557-561. doi: 10.1016/S0020-1383(03)00262-6.
  • Al-Hadithy N, Sewell MD, Bhavikatti M, Gikas PD. The effect of smoking on fracture healing and on various orthopaedic procedures. Acta Orthop Belg. 2012;78(3):285-290.
  • Scolaro JA, Schenker ML, Yannascoli S, Baldwin K, Mehta S, Ahn J. Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am. 2014;96(8):674-681.
  • Goldfarb CA, Ricci WM, Tull F, Ray D, Borrelli J. Functional outcome after fracture of both bones of the forearm. J Bone Joint Surg Br. 2005;87(3):374-379.

Kilitli Kompresyon Plağı ile Tedavi Edilmiş Erişkin Önkol Kırıklarının Sonuçlarını Etkileyen Faktörler

Yıl 2018, Sayı: 5, 464 - 478, 31.08.2018
https://doi.org/10.38079/igusabder.429347

Öz

Amaç: Önkol kırıklarının dinamik
kompresyon plağı kullanılarak yapılan internal tespiti ile ilgili birçok
çalışma bulunmakla birlikte, kilitli kompresyon plakları ile yapılacak en uygun
fiksasyonun detayları henüz yeterince tanımlanmamıştır. Ayrıca fonksiyonel sonucu
etkileyen faktörler halen tartışma konusudur. Bu çalışmanın amacı, kilitli
kompresyon plağı kullanılarak tedavi edilen önkol kırıklarının klinik
sonuçlarına etkiyen faktörleri değerlendirmektir.



Yöntem:
Gustillo Anderson tip 3 açık kırığı olan veya yoğun bakımda yatan hastalar
hariç tutularak, kilitli kompresyon plağı ile tedavi edilen 36 önkol kırığı
hastası prospektif olarak değerlendirildi. Altıncı ayda Disability Arm Shoulder
Hand (DASH) skoru ve klinik sonuçların değerlendirilmesi için kullanılan
Anderson kriterleri skorları ile değerlendirildi. Hastalar ortalama 4 (3-6) yıl
takip edildi.



Bulgular: On
sekiz hastada (%50) kırık nedeni basit düşmeydi. Ortalama iyileşme süresi
13.2±2.1 hafta olarak bulundu. Sigara içen hastaların veya açık kırığı olanların
ya da ameliyat sonrası komplikasyon gelişen hastaların iyileşme süresi daha
uzundu. Ortalama DASH skoru 13.9±5.9 hesaplandı. Açık kırık veya komplikasyon
varlığının skorlar üzerinde anlamlı olumsuz etki yaptığı belirlendi. Yaralanma
nedeninin fonksiyonel sonuçlara az da olsa etkisi olmasına rağmen yaralanma
mekanizmasının  (direkt ya da dolaylı
olmasının) istatistiksel anlamlı bir etkisi saptanmadı.



Sonuç: Hem
iyileşme zamanı hem de klinik sonuçlara etki eden en önemli faktörün kırık tipi
olduğu tespit edildi. Açık kırık yada ameliyat sonrası komplikasyon varlığı
sonuçları kötü yönde etkilemektedir. Basit düşmeye bağlı gelişen kırıklarda
fonksiyonel sonuçlar biraz daha kötü olmaktadır.

Kaynakça

  • Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-697.
  • Kasten P, Krefft M, Hesselbach J, Weinberg AM. How does torsional deformity of the radial shaft influence the rotation of the forearm? A biomechanical study. J Orthop Trauma. 2003;17(1):57-60.
  • Tynan MC, Fornalski S, McMahon PJ, Utkan A, Green SA, Lee TQ. The effects of ulnar axial malalignment on supination and pronation. J Bone Joint Surg Am. 2000;82-A(12):1726-1731.
  • Gadegone W, Salphale YS, Lokhande V. Screw elastic intramedullary nail for the management of adult forearm fractures. Indian Journal of Orthopaedics. 2012;46(1):65-70.
  • Ruedi T, Buckley R, Moran C. AO Principles of Fracture Management. 2nd ed. Thieme Medical Publishers; 2007.
  • Saka G, Sağlam N, Kurtulmuş T, et al. New interlocking intramedullary radius and ulna nails for treating forearm diaphyseal fractures in adults: a retrospective study. Injury. 2014;45(Suppl 1):16-23.
  • Shah AS, Lesniak BP, Wolter TD, Caird MS, Farley FA, Vander HKL. Stabilization of adolescent both-bone forearm fractures: a comparison of intramedullary nailing versus open reduction and internal fixation. J Orthop Trauma. 2010;24(7):440-447. doi: 10.1097/BOT.0b013e3181ca343b.
  • Kim SB, Heo YM, Yi JW, Lee JB, Lim BG. Shaft fractures of both forearm bones: The outcomes of surgical treatment with plating only and combined plating and intramedullary nailing. Clinics in Orthopedic Surgery. 2015;7(3):282-290.
  • Yörükoğlu AÇ, Demirkan AF, Akman A, Kitiş A, Usta H. The effects of radial bowing and complications in intramedullary nail fixation of adult forearm fractures. Eklem Hastalık Cerrahisi. 2017;28(1):30-34. doi: 10.5606/ehc.2017.05.
  • Düger T, Yakut E, Öksüz Ç, et al. Kol, omuz ve el sorunları (Disabilities of the Arm, Shoulder and Hand - DASH) anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Fizyoterapi Rehabilitasyon. 2006;17(3):99-107.
  • Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602-608.
  • Anderson LD, Sisk D, Tooms RE, Park WI. Compression-plate fixation in acute diaphyseeal fractures of the radius and ulna. J Bone Joint Surg Am. 1975;57(3):287-297.
  • Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br. 2002;84(8):1093-1110.
  • Wagner M. General principles for the clinical use of the LCP. Injury. 2003;34(Suppl 2):31-42.
  • Matthews SJ, Nikolaou VS, Giannoudis PV. Innovations in osteosynthesis and fracture care. Injury. 2008;39(8):827-838. doi: 10.1016/j.injury.2008.06.016.
  • Azboy I, Demırtas A, Uçar BY, Bulut M, Alemdar C, Ozkul E. Effectiveness of locking versus dynamic compression plates for diaphyseal forearm fractures. Orthopedics. 2013;36(7):e917–922. doi: 10.3928/01477447-20130624-23.
  • Davis BJ, Roberts PJ, Moorcroft CI, Brown MF, Thomas PB, Wade RH. Reliability of radiographs in defining union of internally fixed fractures. Injury. 2004;35(6):557-561. doi: 10.1016/S0020-1383(03)00262-6.
  • Al-Hadithy N, Sewell MD, Bhavikatti M, Gikas PD. The effect of smoking on fracture healing and on various orthopaedic procedures. Acta Orthop Belg. 2012;78(3):285-290.
  • Scolaro JA, Schenker ML, Yannascoli S, Baldwin K, Mehta S, Ahn J. Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am. 2014;96(8):674-681.
  • Goldfarb CA, Ricci WM, Tull F, Ray D, Borrelli J. Functional outcome after fracture of both bones of the forearm. J Bone Joint Surg Br. 2005;87(3):374-379.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Makaleler
Yazarlar

Ali Utkan 0000-0002-3653-3998

Burak Koçak Bu kişi benim 0000-0003-4327-3431

Kubilay Uğurcan Ceritoğlu 0000-0002-7111-6831

Aydın Arslan 0000-0001-5036-517X

Bülent Özkurt 0000-0002-6135-1870

Yayımlanma Tarihi 31 Ağustos 2018
Kabul Tarihi 21 Haziran 2018
Yayımlandığı Sayı Yıl 2018 Sayı: 5

Kaynak Göster

JAMA Utkan A, Koçak B, Ceritoğlu KU, Arslan A, Özkurt B. Factors Affecting Outcomes of Adult Forearm Fractures Treated by Locking Compression Plate. IGUSABDER. 2018;:464–478.

 Alıntı-Gayriticari-Türetilemez 4.0 Uluslararası (CC BY-NC-ND 4.0)