Perilunat Çıkıklar
Özet
Perilunat çıkıklar, el bileğindeki bağ yaralanması veya kırıklar sonucu gelişen, nadir fakat eklem yüzeyini hasarlandırıp kronik instabiliteye yol açabilen yüksek enerjili yaralanmalardır. Zorlu hiperekstansiyon ve ulnar deviasyon gibi mekanizmalarla oluşan bu travmalar, Mayfield progresyonuna göre dört evrede incelenir ve en sık skafoid kırığı eşlik eder. Klinik değerlendirmede ağrı, şişlik ve deformitenin yanı sıra akut karpal tünel sendromu gibi nörolojik komplikasyonlar görülebilir; tanı posteroanterior ve lateral grafiler ile bilgisayarlı tomografi kullanılarak Gilula çizgilerindeki bozulmalar ve özel radyolojik işaretler üzerinden konur. Tedavide ilk müdahale kapalı redüksiyon ve atelleme olsa da konservatif yaklaşım kötü fonksiyonel sonuçlar doğurduğundan, anatomik restorasyonu sağlamak adına ilk 8 hafta içinde volar, dorsal ya da kombine cerrahi yaklaşımlarla açık redüksiyon ve internal fiksasyon tercih edilir. Perilunat çıkıklar, hastaların çoğunda posttravmatik artrit ve osteonekroz gibi ciddi komplikasyon riskleri barındıran ağır yaralanmalardır.
Perilunate dislocations are rare, high-energy injuries resulting from ligament damage or fractures around the lunate that cause chronic instability and joint surface damage. Occurring through forced hyperextension and ulnar deviation, these traumas progress in four stages according to the Mayfield classification and are most frequently accompanied by scaphoid fractures. Clinical evaluation reveals pain, swelling, and deformity, alongside neurological complications like acute carpal tunnel syndrome; diagnosis is established through posteroanterior and lateral radiographs and CT scans by detecting disruptions in Gilula lines and specific radiological signs. Although initial management involves closed reduction and splinting, conservative treatment yields poor functional outcomes, making open reduction and internal fixation via volar, dorsal, or combined surgical approaches the preferred treatment within the first 8 weeks to restore anatomy. Perilunate dislocations are severe injuries carrying high risks of long-term complications, such as posttraumatic arthritis and osteonecrosis in most patients.
Referanslar
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