Skafoid Kırıkları
Özet
Skafoid, üst ekstremitede en sık kırılan karpal kemik olup, genellikle el bileği dorsifleksiyondayken uzanmış el üzerine düşme sonucu yaralanır. Tanısında anatomik enfiye çukuru, skafoid tüberkül hassasiyeti ve başparmak aksiyel kompresyon testleri kullanılır. Kırıkların %70'i bel bölgesinde gerçekleşirken, Herbert ve Russe gibi sistemlerle stabilite ve yönelimlerine göre sınıflandırılırlar. Negatif direkt radyografi durumunda MRG tanısal altın standartken, deplasman miktarını belirlemede ve kaynama takibinde BT tercih edilir. Tedavi yaklaşımı kırığın yerine ve stabilitesine bağlıdır; distal kutup kırıkları iyi kanlandığı için 4-8 haftalık kısa kol alçı fiksasyonu ile sorunsuz iyileşirken, zayıf kan akımına sahip proksimal kutup kırıkları yüksek avasküler nekroz ve kaynamama riski taşıdığından genellikle dorsal cerrahi yaklaşım ve vida fiksasyonu gerektirir. Deplase olmamış bel kırıkları alçıyla %90 oranında 6 haftada kaynar, fakat instabil, parçalı veya 1 mm'den fazla deplase kırıklarda cerrahi stabilizasyon (volar ya da artroskopik yaklaşım) şarttır. 12 haftayı geçen kaynamama durumlarında fiksasyon stratejisi değiştirilmelidir. Ağır işe dönüş ise klinik muayene ve BT'de %50'den fazla trabeküler köprülenmenin tespitiyle mümkündür.
The scaphoid is the most frequently fractured carpal bone in the upper extremity, typically injured by falling on an outstretched hand while the wrist is dorsiflexed. For diagnosis, anatomical snuffbox tenderness, scaphoid tubercle tenderness, and axial compression tests of the thumb are utilized. While 70% of fractures occur in the waist region, they are classified based on their stability and orientation using systems like Herbert and Russe. In case of negative plain radiographs, MRI is the diagnostic gold standard, whereas CT is preferred for determining the degree of displacement and monitoring union. The treatment approach depends on fracture location and stability; distal pole fractures heal smoothly with short-arm cast immobilization for 4-8 weeks due to good vascularity, whereas proximal pole fractures, having poor blood supply, carry a high risk of avascular necrosis and nonunion, thus generally requiring a dorsal surgical approach and screw fixation. Nondisplaced waist fractures achieve a 90% union rate within 6 weeks using a cast, but surgical stabilization (volar or arthroscopic approach) is mandatory for unstable, comminuted, or displaced fractures greater than 1 mm. In cases of nonunion exceeding 12 weeks, the fixation strategy should be altered. Returning to heavy work is possible only after confirmation by clinical examination and a CT scan showing more than 50% trabecular bridging.
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