Effect of Physical Therapy and Rehabilitation on Functional and Clinical Outcomes in Patients Operated on for Elbow Fracture Dislocation
Öz
Aim: In this study, the functional results of 28 patients with elbow fracture-dislocation in our clinic after open reduction and internal fixation between 2011 and 2017 were evaluated.
Material and Methods: Between December 2011 and March 2017, the elbows of 28 patients, who were diagnosed with adult elbow fracture-dislocation and underwent surgical treatment were included in the study. These patients, who were fixed with open reduction and internal fixation method, were evaluated in terms of functional and radiological results.
Results: The average age of the patients included in the study is 43.36±17.156. There were 8 women (28.6%) and 20 men (71.4%). Of the 8 female patients, 7 had radius upper end fractures, 2 had olecranon fractures, 2 had humeral lower end fractures, and 2 had coronoid process fractures. Of the 20 male patients, 12 had radius upper end fractures, 3 had olecranon fractures, 7 had humeral lower end fractures, and 4 had coronoid process fractures. There was no significant difference in functional results according to the types of fractures.
Conclusion: Surgical treatment is at the forefront in elbow fracture-dislocations, and the aim of surgical treatment is to obtain a stable joint and provide early joint range of motion. In surgical treatment, the bone structure must be fixed with absolute rigid fixation methods, and ligament repair must be performed in patients with ligament injury detected before and during surgery. After surgical treatment, movement should be started early and strenuous exercises should be avoided.
Anahtar Kelimeler
Kaynakça
- 1. Egol KA, Immerman I, Paksima N, Tejwani N, Koval KJ. Fracture-dislocation of the elbow functional outcome following treatment with a standardized protocol. Bull NYU Hosp Jt Dis. 2007;65:276-9.
- 2. Kälicke T, Muhr G, Frangen TM. Dislocation of the elbow with fractures of the coronoid process and radial head. Arch Orthop Trauma Surg. 2007;127:925-31.
- 3. Morrey BF, Ann KN. Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res. 1985;201:84-90
- 4. Bayrak A, Ozturk V, Koluman A, Ziroglu N, Duramaz A. Injury characteristics and management of orthopaedic trauma in refugee children. Int Orthop. 2021;45:649-56.
- 5. Basaran SH, Ercin E, Bayrak A, Cumen H, Bilgili MG, Inci E, et al. The measurement of tibial torsion by magnetic resonance imaging in children: the comparison of three different methods. Eur J Orthop Surg Traumatol. 2015;25:1327-32.
- 6. Schwab GH, Bennett JB, Woods GW, Tullos HS. Biomechanics of elbow instability: the role of the medial collateral ligament. Clin Orthop Relat Res. 1980;146:42-52
- 7. Virani S, Abdelghafour KM, Assiotis A, Yeoh C, Rumian A, Uppal H. Mid-term outcomes of elbow hemiarthroplasty using the triceps-on approach for comminuted distal humerus fractures. J Clin Orthop Trauma. 2024;61:102886.
- 8. Attenasio A, Doerr NA, Hong IS, Zapf CG, Jankowski JM, Liporace FA, et al. Treatment of extra-articular distal humerus fractures: current concepts and systematic review. Indian J Orthop. 2024;59:3-18.
- 9. Coonrad RW, Roush TF, Major NM, Basamania CJ. The drop sign, a radiographic warning sign of elbow instability. J Shoulder Elbow Surg. 2005;14:312–7.
- 10. Komijani M, Shamabadi A, Oryadi ZL, Nabian MH, Panjavi B, Shahriar KR. Outcomes of the pin and plate technique in complex fractures and nonunions of distal humerus. Arch Bone Jt Surg. 2023;11:503-9.
- 11. Lopiz Y, Garríguez-Pérez D, García-Fernández C, Del Baño L, Galán-Olleros M, Marco F. Complex fractures of the distal humerus in the elderly: primary total elbow arthroplasty or open reduction and internal fixation? Mid-term follow-up. Int Orthop. 2021;45:2103-10.
- 12. Ben Abdellah A, Ben Salah S, Darraz S, Tebbaa A, Jelti O, Mokhtari O, et al. Terrible triad injury of the elbow: a process-compliant surgical case series from Eastern Morocco. Ann Med Surg. 2022;78:103914.
- 13. O'Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 1991;73:440-6.
- 14. Linscheid RL, Wheeler DK. Elbow dislocations. JAMA. 1965;194:1171–6
- 15. Eygendaal D, Verdegaal SH, Obermann WR, Van Vugt AB, Pöll RG, Rozing PM. Posterolateral dislocation of the elbow joint. Relationship to medial instability. J Bone Joint Surg Am. 2000;82:555–60.
- 16. Ünlü MC, Güven MF, Aslan L, Aydıngöz Ö, Bilgili MG, Bayrak A, et al. Comparison of the functional results of radial head resection and prosthesis for irreparable mason type-III fracture. Ulus Travma Acil Cerrahi Derg. 2018;24:359-63.
- 17. Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. Comminuted fractures of the radial head: comparison of resection and internal fixation. Surgical technique. J Bone Joint Surg Am. 2006;88 Suppl 1 Pt 1:11-23.
- 18. Stevanovic M, Sharpe F, Itamura JM. Treatment of soft tissue problems about the elbow. Clin Orthop Relat Res. 2000;370:127–37.
- 19. Dürig M, Müller W, Rüedi TP, Gauer EF. The operative treatment of elbow dislocation in the adult. J Bone Joint Surg Am 1979;61:239–44.
- 20. McAuliffe JA, Wolfson AH. Early excision of heterotopic ossification about the elbow followed by radiation therapy. J Bone Joint Surg Am. 1997;79:749–55
- 21. Heijink A, Morrey BF, van Riet RP, O’Driscoll SW, Cooney WP. Delayed treatment of elbow pain and dysfunction following Essex-Lopresti injury with metallic radial head replacement: a case series. J Shoulder Elbow Surg. 2010;19:929–36.
- 22. Bayrak A, Duramaz A, Koluman A, Kural C, Ziroğlu N, Gözügül K, Peker G. Does plate-screw density affect the functional outcomes in the treatment of proximal humerus fractures? Ulus Travma Acil Cerrahi Derg. 2022;28:824-31.
- 23. Modi CS, Lawrence E, Lawrence T. Elbow instability. Orthop Trauma 2012;26:316–27.
Dirsek Kırıklı Çıkığı Nedeniyle Opere Edilen Hastalarda Fizik Tedavi ve Rehabiliatasyon Uygulamasının Fonksiyonel ve Klinik Sonuçlar Üzerine Etkisi
Öz
Amaç : Bu çalışmada kliniğimizde dirsek kırıklı çıkığı olan 28 hastanın, 2011-2017 yılları arasında açık redüksiyon ve internal fiksasyon sonrası fonksiyonel ve radyolojik sonuçları değerlendirildi.
Materyal ve Metod : Aralık 2011 –Mart 2017 tarihleri arasında erişkin dirsek kırıklı çıkık tanısıyla gelip cerrahi tedavi uygulanan 41 hastadan en az 6 ay kontrol ve takip yapılan 28 hastanın dirseği çalışmaya dahil edildi. Bu hastalar açık redüksiyon yöntemiyle k teli tespit, plak ve vida ile tespit edilen hastalar fonksiyonel ve radyaolojik sonuçlar açısından değerlendirildi.
Bulgular : Çalışmaya dahil edilen hastaların yaş ortalamaları 43,36±17,15’ dır. Kadınlar 8 kişi (%28,6) ve erkekler 20 kişi (%71,4) olarak bulunmaktaydı. 8 kadın hastanın 7’sinde radius üst uç kırığı, 2’sinde olekranon kırığı, 2’sinde humerus alt uç kırığı ve 2’sinde koronoid çıkıntı kırığı mevcuttu. 20 erkek hastanın 12’sinde radius üst uç kırığı, 3’ünde olekranon kırığı, 7’sinde humerus alt uç kırığı ve 4’ünde koronoid çıkıntı kırığı mevcuttu. Kırıkların tiplerine göre fonksiyonel ve radyolojik sonuçlar arasında anlamlı fark bulunmadı.
Sonuç : Dirsek kırıklı çıkıklarında cerrahi tedavi ön planda olup cerrahi tedavideki amaç stabil bir eklem elde ederek erken eklem hareket açıklığı sağlamaktır. Yapılan cerrahi tedavide kemik yapı mutlak rijit tespit yöntemleri ile fikse edilmeli, cerrahi öncesi ve cerrahi sırasında bağ yaralanması tespit edilen hastalarda bağ onarımı mutlaka yapılmalıdır. Cerrahi tedaviden sonra erken dönemde harekete başlanmalı, zorlayıcı egzersizlerden kaçınılmaldır.
Anahtar Kelimeler
Etik Beyan
Bakırköy Dr. Sadi Konuk EAH Yerel Etik Kurul (Etik kurul onay no: 2017/308), Çalışma tez çalışması olarak yapılmıştır. Tez danımanı Dr. Cemal Kural yazarlar arasındadır.
Kaynakça
- 1. Egol KA, Immerman I, Paksima N, Tejwani N, Koval KJ. Fracture-dislocation of the elbow functional outcome following treatment with a standardized protocol. Bull NYU Hosp Jt Dis. 2007;65:276-9.
- 2. Kälicke T, Muhr G, Frangen TM. Dislocation of the elbow with fractures of the coronoid process and radial head. Arch Orthop Trauma Surg. 2007;127:925-31.
- 3. Morrey BF, Ann KN. Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res. 1985;201:84-90
- 4. Bayrak A, Ozturk V, Koluman A, Ziroglu N, Duramaz A. Injury characteristics and management of orthopaedic trauma in refugee children. Int Orthop. 2021;45:649-56.
- 5. Basaran SH, Ercin E, Bayrak A, Cumen H, Bilgili MG, Inci E, et al. The measurement of tibial torsion by magnetic resonance imaging in children: the comparison of three different methods. Eur J Orthop Surg Traumatol. 2015;25:1327-32.
- 6. Schwab GH, Bennett JB, Woods GW, Tullos HS. Biomechanics of elbow instability: the role of the medial collateral ligament. Clin Orthop Relat Res. 1980;146:42-52
- 7. Virani S, Abdelghafour KM, Assiotis A, Yeoh C, Rumian A, Uppal H. Mid-term outcomes of elbow hemiarthroplasty using the triceps-on approach for comminuted distal humerus fractures. J Clin Orthop Trauma. 2024;61:102886.
- 8. Attenasio A, Doerr NA, Hong IS, Zapf CG, Jankowski JM, Liporace FA, et al. Treatment of extra-articular distal humerus fractures: current concepts and systematic review. Indian J Orthop. 2024;59:3-18.
- 9. Coonrad RW, Roush TF, Major NM, Basamania CJ. The drop sign, a radiographic warning sign of elbow instability. J Shoulder Elbow Surg. 2005;14:312–7.
- 10. Komijani M, Shamabadi A, Oryadi ZL, Nabian MH, Panjavi B, Shahriar KR. Outcomes of the pin and plate technique in complex fractures and nonunions of distal humerus. Arch Bone Jt Surg. 2023;11:503-9.
- 11. Lopiz Y, Garríguez-Pérez D, García-Fernández C, Del Baño L, Galán-Olleros M, Marco F. Complex fractures of the distal humerus in the elderly: primary total elbow arthroplasty or open reduction and internal fixation? Mid-term follow-up. Int Orthop. 2021;45:2103-10.
- 12. Ben Abdellah A, Ben Salah S, Darraz S, Tebbaa A, Jelti O, Mokhtari O, et al. Terrible triad injury of the elbow: a process-compliant surgical case series from Eastern Morocco. Ann Med Surg. 2022;78:103914.
- 13. O'Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 1991;73:440-6.
- 14. Linscheid RL, Wheeler DK. Elbow dislocations. JAMA. 1965;194:1171–6
- 15. Eygendaal D, Verdegaal SH, Obermann WR, Van Vugt AB, Pöll RG, Rozing PM. Posterolateral dislocation of the elbow joint. Relationship to medial instability. J Bone Joint Surg Am. 2000;82:555–60.
- 16. Ünlü MC, Güven MF, Aslan L, Aydıngöz Ö, Bilgili MG, Bayrak A, et al. Comparison of the functional results of radial head resection and prosthesis for irreparable mason type-III fracture. Ulus Travma Acil Cerrahi Derg. 2018;24:359-63.
- 17. Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. Comminuted fractures of the radial head: comparison of resection and internal fixation. Surgical technique. J Bone Joint Surg Am. 2006;88 Suppl 1 Pt 1:11-23.
- 18. Stevanovic M, Sharpe F, Itamura JM. Treatment of soft tissue problems about the elbow. Clin Orthop Relat Res. 2000;370:127–37.
- 19. Dürig M, Müller W, Rüedi TP, Gauer EF. The operative treatment of elbow dislocation in the adult. J Bone Joint Surg Am 1979;61:239–44.
- 20. McAuliffe JA, Wolfson AH. Early excision of heterotopic ossification about the elbow followed by radiation therapy. J Bone Joint Surg Am. 1997;79:749–55
- 21. Heijink A, Morrey BF, van Riet RP, O’Driscoll SW, Cooney WP. Delayed treatment of elbow pain and dysfunction following Essex-Lopresti injury with metallic radial head replacement: a case series. J Shoulder Elbow Surg. 2010;19:929–36.
- 22. Bayrak A, Duramaz A, Koluman A, Kural C, Ziroğlu N, Gözügül K, Peker G. Does plate-screw density affect the functional outcomes in the treatment of proximal humerus fractures? Ulus Travma Acil Cerrahi Derg. 2022;28:824-31.
- 23. Modi CS, Lawrence E, Lawrence T. Elbow instability. Orthop Trauma 2012;26:316–27.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Cerrahi (Diğer) |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Haziran 2025 |
| Gönderilme Tarihi | 5 Mart 2025 |
| Kabul Tarihi | 13 Mayıs 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 4 Sayı: 2 |
Kaynak Göster
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