Ekstraartiküler Proksimal Falanks Kırıklarında Kapalı Redüksiyon ve Kirschner Teli Tespitin Klinik ve Radyolojik Sonuçları

Yıl 2019, Cilt: 10 Sayı: 37, 30 - 35, 06.10.2019

Ahmet Köse , Muhammed Çağatay Engin Murat Topal , Mehmet Köse , Ayşe Şencan

https://doi.org/10.17944/mkutfd.468120

Öz

Amaç: Bu çalışmada ekleme uzanım göstermeyen proksimal falanks kırıklarında uyguladığımız Kirschner teli fiksasyonun radyolojik ve klinik sonuçlarını sunmayı amaçladık.

Gereç ve Yöntem: Kapalı, unstabil, ekstrartiküler proksimal falanks kırığı nedeniyle kapalı redüksiyon ve Kirschner teli ile fiksasyon uyguladığımız 16 hastanın klinik ve radyolojik verileri retrospektif olarak incelendi. Tüm hastalarda ameliyat sonrası 6.ay değerlendirme parametreleri esas alınarak değerlendirme ve istatiksel analiz yapıldı. Aktif ve pasif metakarpofalangial eklem ve interfalangial eklem hareket açıklıkları, Total eklem hareket açıklığı, kırık ve sağlam eller için kavrama gücü ölçümü, subjektif ağrı değerlendirmesi için görsel analog skor değerlendirmesi, fonksiyonel değerlendirme için Disabilities of the arm, shoulder and hand skoru, opere edilen parmakta pulpa ve palmar curve arası mesafe ölçümü, Belsky skoru, reoperasyon ve komplikasyonlar değerlendirildi.

Bulgular: Ortalama 4.8 (4-8) haftada radyolojik kaynama elde edildi. Hastaların fonksiyonel sonuçları değerlendirildiğinde; aktif metakarpofalangial eklem fleksiyonu ortalama 87.8 (60-90) derece, proksimal interfalangeal eklem fleksiyonu ortalama 77.5 (55-100) derece, distal interfalangial eklem fleksiyonu ortalama 73.4 (60-90) derece, ortalama total eklem hareket açıklığı 230 (170-270) derece olarak değerlendirildi. Kırığın olduğu elde kavrama gücü 36 (23-50) kgw, sağlam elde yapılan karşılaştırmada 39.5 (30-50) kgw olarak ölçüldü. İstatiksel açıdan kavrama gücü açısından anlamlı fark saptanmadı (p<0.05). Görsel analog skor ortalaması 1.25 (0-5), Disabilities of the arm, shoulder and hand skoru ortalaması 10.5 (2-34), parmak pulpası ve parmak curve arası mesafe ortalama 6.25 (0-23) mm olarak değerlendirildi.

 

Sonuçlar: Proksimal falanks; kapalı, ekstraartiküler, unstabil kırıklarında kapalı redüksiyon ve Kirschner teli ile fiksasyon uygulaması kabul edilen ve ucuz bir tedavi metodudur. Uygun endikasyonda seçilen hastalarda özellikle komünike, transvers ve kısa oblik kırıklarda başarılı radyolojik ve fonksiyonel sağlayan bir yöntemdir.

Anahtar Kelimeler

Falanks, kırık, K teli

Clinical And Radiological Outcomes Of Closed Reduction And Kirschner Wire Fixation In Treatment Of Extra-Articular Fractures Of The Proximal Phalanx

Öz

Aim: In this study, we aim to discuss the radiological and clinical results of closed reduction and Kirschner wire fixation we performed on 16 cases with extra-articular unstable proximal phalangeal fractures

Materials and Methods: Clinical and radiological data of 16 patients with closed, unstable (transverse or short oblique), extra-articular proximal phalangeal fractures to whom we performed closed reduction and fixation with Kirschner wire in Erzurum Regional Training and Research Hospital Orthopedics and Traumatology Clinic and Hand Surgery Clinic between 2014-2017 were retrospectively reviewed

Results: Functional results of the patients are evaluated; mean active MP joint flexion was 78.75 (60-90) degrees, proximal IP joint flexion was 77.5 (65-100) degrees, distal IP joint flexion was 73.4 (60-80) degrees and mean TAM was 230 (170-270) degrees. Mean passive MP joint flexion was evaluated as 81.25 (60-90) degrees, mean proximal IP joint flexion as 83 (60-100) degrees and mean distal IP joint flexion as 74 (65-90) degrees. The grip strength was measured as 36 (23-50) kgW in the fractured hand and the healthy hand comparison was 40 (30-50) kgW. Statistically, there was no significant difference between the two groups in terms of grip strength (p<0.05). VAS mean was 1.25 (0-5), DASH mean was 10.5 (2-34), the mean distance between finger pulp and finger curve was 6.25 (0-23) mm. Belsky score was excellent in 4 patients, good in 9 patients and poor in 3 patients (Table 2). Two patients underwent tenolysis due to PIP joint contracture. Sudeck atrophy was observed in 1 patient for an average of 8 weeks. We achieved improvement with physical therapy, contrast bathing and medical treatment. There were no complications such as non-union, late union, superficial and deep infection, tenosynovitis. Our patients did not develop material extraction due to soft tissue and skin irritation. Radiologic evaluation of the follow up direct X-ray graphies revealed no displacement, angulation, and rotational deformities.

Conclusion: The proximal phalanx is 'small in size' for the body and 'functioning big' for the upper limb. Fractures of the proximal phalanges can be fixed with Kirshner wires after failed stabilization with closed reduction and brace fixation. It is a practical method which has satisfactory outcomes and has a relatively low cost.

Anahtar Kelimeler

proximal phalanx, fracture, K wire

Kaynakça

• Drenth DJ, Klasen HJ. External fixation for phalangeal and metacarpal fractures. J Bone Joint Surg Br. 1998;80(2):227-30.
• Le Nen D. Extra-articular fractures of the digital metacarpals and phalanges of the long fingers. Chir Main. 2014;33(1):1-12.
• Kurzen P, Fusetti C, Bonaccio M, Nagy L. Complications after plate fixation of phalangeal fractures. J Trauma. 2006;60(4):841-3.
• Lins RE, Myers BS, Spinner RJ, Levin LS. A comparative mechanical analysis of plate fixation in a proximal phalangeal fracture model. J Hand Surg Am. 1996;21(6):1059-64.
• Robinson LP, Gaspar MP, Strohl AB, Teplitsky SL, Gandhi SD, Kane PM, et al. Dorsal versus lateral plate fixation of finger proximal phalangeal fractures: a retrospective study. Arch Orthop Trauma Surg. 2017;137(4):567-72.
• Kamath JB, Harshvardhan, Naik DM, Bansal A. Current concepts in managing fractures of metacarpal and phalangess. Indian J Plast Surg. 2011;44(2):203-11.
• Kozin SH, Thoder JJ, Lieberman G. Operative treatment of metacarpal and phalangeal shaft fractures. J Am Acad Orthop Surg. 2000;8(2):111-21.
• Franz T, von Wartburg U, Schibli-Beer S, Jung FJ, Jandali AR, Calcagni M, et al. Extra-articular fractures of the proximal phalanges of the fingers: a comparison of 2 methods of functional, conservative treatment. J Hand Surg Am. 2012;37(5):889-98.
• Faruqui S, Stern PJ, Kiefhaber TR. Percutaneous pinning of fractures in the proximal third of the proximal phalanx: complications and outcomes. J Hand Surg Am. 2012;37(7):1342-8.
• Gaston RG, Chadderdon C. Phalangeal fractures: displaced/nondisplaced. Hand Clin. 2012;28(3):395-401, x.
• Desaldeleer-Le Sant AS, Le Sant A, Beauthier-Landauer V, Kerfant N, Le Nen D. Surgical management of closed, isolated proximal phalanx fractures in the long fingers: Functional outcomes and complications of 87 fractures. Hand Surg Rehabil. 2017;36(2):127-35.
• Lee SG, Jupiter JB. Phalangeal and metacarpal fractures of the hand. Hand Clin. 2000;16(3):323-32, vii.
• Ebinger T, Erhard N, Kinzl L, Mentzel M. Dynamic treatment of displaced proximal phalangeal fractures. J Hand Surg Am. 1999;24(6):1254-62.
• Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) (corrected). The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602-8.
• Belsky MR, Eaton RG, Lane LB. Closed reduction and internal fixation of proximal phalangeal fractures. J Hand Surg Am. 1984;9(5):725-9.
• Logters TT, Lee HH, Gehrmann S, Windolf J, Kaufmann RA. Proximal Phalanx Fracture Management. Hand (N Y). 2017:1558944717735947.
• Rajesh G, Ip WY, Chow SP, Fung BK. Dynamic treatment for proximal phalangeal fracture of the hand. J Orthop Surg (Hong Kong). 2007;15(2):211-5.
• Held M, Jordaan P, Laubscher M, Singer M, Solomons M. Conservative treatment of fractures of the proximal phalanx: an option even for unstable fracture patterns. Hand Surg. 2013;18(2):229-34.
• Henry MH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg. 2008;16(10):586-95.
• Meals C, Meals R. Hand fractures: a review of current treatment strategies. J Hand Surg Am. 2013;38(5):1021-31; quiz 31.
• Li G, Liu S, Chen G, Li Z, Liu Y, Sun G, et al. Comparison of Clinical Outcomes of Phalangeal Fracture Treated with Dorsolateral Approach or Post-middle Approach Using AO Mini Titanium Plate. Indian J Surg. 2015;77(Suppl 2):657-61.
• Page SM, Stern PJ. Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg Am. 1998;23(5):827-32.
• Onishi T, Omokawa S, Shimizu T, Fujitani R, Shigematsu K, Tanaka Y. Predictors of Postoperative Finger Stiffness in Unstable Proximal Phalangeal Fractures. Plast Reconstr Surg Glob Open. 2015;3(6):e431.
• Basar H, Basar B, Basci O, Topkar OM, Erol B, Tetik C. Comparison of treatment of oblique and spiral metacarpal and phalangeal fractures with mini plate plus screw or screw only. Arch Orthop Trauma Surg. 2015;135(4):499-504.
• Horton TC, Hatton M, Davis TR. A prospective randomized controlled study of fixation of long oblique and spiral shaft fractures of the proximal phalanx: closed reduction and percutaneous Kirschner wiring versus open reduction and lag screw fixation. J Hand Surg Br. 2003;28(1):5-9.