Yörükoğlu Ali Çağdaş, Demirkan Ahmet Fahir, Akman Alp, Kitiş Ali, Usta Hande
Department of Orthopedics and Traumatology, Medical Faculty of Pamukkale University, 20160 Kınıklı, Denizli, Turkey.
Eklem Hastalik Cerrahisi. 2017 Apr;28(1):30-4. doi: 10.5606/ehc.2017.05.
This study aims to evaluate the effects of radial bowing changes on fracture healing and functional results in adult forearm intramedullary nail applications and complications of forearm nails that have been discussed rarely in the literature.
Twenty-three patients -11 with isolated radius and 12 with both radius and ulna fractures- (17 males, 6 females; mean age 38.6 years; range 18 to 69 years) who were operated between September 2009 and August 2014 were included in the study. The effects of radial bowing changes on bone healing rates, time to union, and functional levels of the forearm as well as complications of forearm nails were evaluated.
We observed fracture healing without any complication in 20 patients (86.9%) and nonunion in three patients (13.1%) although six months had passed after the operation. Statistically significant difference was detected between radial bowing change and nonunion (p=0.01). Two patients (8.6%) with AO/OTA Classification (The Arbeitsgemeinschaft für Osteosynthesefragen [AO]/Orthopaedic Trauma Association [OTA] Classification), type B3 forearm double fractures had synostosis. Extensor pollicis longus tendon rupture or impingement was detected in six patients (26.8%) for which nails were applied on radius fracture.
Intramedullary nail application may be an appropriate treatment alternative in forearm fractures with their high healing rates; however, synostosis may arise with its use in wedge fractures (AO/OTA type B3) at the same level. Although radial bowing changes do not have a significant effect on ranges of motion of the forearm, it should be kept in mind that fracture healing may be affected adversely in patients with radial bowing changes of high rates. Complications regarding extensor pollicis longus tendon may develop during intra- or postoperative periods in patients for which a radius nail has been applied.
本研究旨在评估桡骨弓形变化对成人前臂髓内钉固定时骨折愈合及功能结果的影响，以及前臂髓内钉的并发症，这些并发症在文献中鲜有讨论。
纳入2009年9月至2014年8月间接受手术的23例患者（17例男性，6例女性；平均年龄38.6岁；年龄范围18至69岁），其中11例为单纯桡骨骨折，12例为桡骨和尺骨双骨折。评估桡骨弓形变化对骨愈合率、愈合时间、前臂功能水平的影响以及前臂髓内钉的并发症。
术后6个月，20例患者（86.9%）骨折愈合且无任何并发症，3例患者（13.1%）骨折不愈合。桡骨弓形变化与骨折不愈合之间存在统计学显著差异（p = 0.01）。2例（8.6%）AO/OTA分类（ Arbeitsgemeinschaft für Osteosynthesefragen [AO]/Orthopaedic Trauma Association [OTA]分类）为B3型的前臂双骨折患者出现了骨桥形成。在18例桡骨骨折行髓内钉固定的患者中，6例（26.8%）检测到拇长伸肌腱断裂或嵌顿。
髓内钉固定因其高愈合率可能是前臂骨折的一种合适治疗选择；然而，在同一水平的楔形骨折（AO/OTA B3型）中使用可能会出现骨桥形成。尽管桡骨弓形变化对前臂活动范围没有显著影响，但应牢记，高比率桡骨弓形变化的患者骨折愈合可能会受到不利影响。对于行桡骨髓内钉固定的患者，术中或术后可能会出现拇长伸肌腱相关并发症。
