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ÇARġAMBA PERġEMBE CUMA 9.ġubat 10.ġubat 11.ġubat 7.30 Kayıt 8.00 AçılıĢ Töreni 8.30 9.00 Bilimsel Program Bilimsel Program 10.00 10.30 11.00 11.30 12.00 12.30 Kahve Molası Bilimsel Program Kahve Molası Bilimsel Program 13.00 Öğle Yemeği Öğle Yemeği 13.30 14.00 14.30 Bilimsel Program Bilimsel Program 15.00 Kayıt Kahve Molası ve Kahve Molası ve 15.30 Poster Sunumları Poster Sunumları 16.00 16.30 Serbest Bildiriler Serbest Bildiriler 17.00 17.30 KapanıĢ 18.00 18.30 19.00 HoĢ geldiniz Kokteyli 20.00 Gala Yemeği 2
Ġçindekiler/ Contens 1. Omuz ve Dirsek Cerrahisi Kongresi 9-11 Şubat 2000 Kongre ve Dernek BaĢkanlarının açılıģ konuģmaları / 4 Opening Speechs of the President of the Congress and Society Düzenleme Kurulu ve Bilimsel Kurul / 6 Organizing and Scientific Committee Bilimsel Program / Scientific Program 8 Konuk KonuĢmacılar / Invited Lectures 15 Serbest Bildiriler (Omuz) / Free papers (Shoulder) 27 Serbest Bildiriler (Dirsek) /Free papers (Elbow) 41 Posterler / Posters 51 Ġndeks / Index 100 3
Kıymetli MeslektaĢlarım, Omuz ve Dirsek Cerrahisi Derneği L.Kongresini, Yirmibirinci Yüzyılın Ģubat ayında Istanbul'da yapacağız. Kongremizin onursal baģkanı Dr. Charles Rockwood, Jr., son anda çıkan önemli bir mazereti nedeni ile aramızda olamayacaktır. Dr. Bernard Morrey, Dr. Andreas Imhoff, Dr. Kirk Jensen gibi omuz ve dirsek cerrahisinde deneyimli meslektaģlarımız, değerli bilimsel katkılarıyla kongremize onur vereceklerdir. Yeni bir yüzyılın ilk toplantısında, omuz ve dirsek cerrahisindeki geliģimleri ve tecrübeleri sizlerle birlikte paylaģmanın bizlere ayn bir mutluluk ve onur vereceğini bildirir, saygılarımı sunarım. Prof. Dr. Yılmaz AKALIN Kongre BaĢkanı Sayın MeslektaĢlarım, Omuz ve Dirsek Cerrahisi derneğimizin kurulmuģ olduğu 1993 yılından bu yana geçen 6 yıl içinde 5 adet bilimsel toplantı düzenlenmiģtir. Bunlardan dördü daha çok bu konuda deneyimli meslektaģların katılımıyla kurs tarzında düzenlenen sempozyumlar olmuģtur. 1996 yılmda ise, Istanbul' da Akif ġakir ġakar Günleri olarak düzenlenmiģtir. Bu toplantılara Dr.Charles Rockwood baģta olmak üzere önemli konuk meslektaģlanmız katılmıģtır. 2000 yılında ise gerekli omuz ve dirsek cerrahisi birikiminin olduğu inancı ile enternasyonel katılımlı ve tüm meslek-taģlarımızın bildirileri ile katılabileceği ilk kongremizi yapmayı planladık. Çok değerli yabancı konuklarımızın da katılacağı bu kongreye tüm meslektaģlarımızı bekliyoruz. Saygılarımla, Prof. Dr. Osman GÜVEN Omuz ve Dirsek Cerrahisi Dernek BaĢkanı 4
Dear Colleagues, I am proud and happy to inform you that the 1 st Congress of the Turkish shoulder and Elbow Society will be held in ıstanbul between February 9th - 11 th, 2000. Honotary President of our congres, Charles Rockwood, MD. is not able to join us, because of an immediate excuse. Our colleagues, experienced in shoulder and elbow surgery, like Bernard Morrey, MD., Andreas Imhoff, MD., Kirk Jensen, MD.; will honour out congress with their valuable scientific contributions. On the occasion of ourfirst Congress of the new millenniurn, it will be an honour and a privilege for all of us to share wit}ı you the recenı advances and experiences in shoulder and elbow surgery. Yours sincerely, Yılmaz AKALIN, M.D. Profesor of Orthopaedics and Traumatology, Congress President Dear Colleagues, Out Society for Surgery of Shoulder and Elbow has organised 5 scientific meetings since 1993 when it wasfounded. Four ofthese were course like symposia organised by our experienced colleagues, whereas in 1996 "Akif ġakir ġakar Days" was held in Istanbul. Dr. Charles Rockwood and other prominent guest colleagues from abroad were among the participants of these meetings Being encouragedjrom the level of our present knowledge and experiences in the field of shoulder and elbow suıgery, we have planned to organise ourfirst congress wiılı international participation in Istanbul in the year of 2000. We cordially invite all our colleagues from all over the world to take part in this congress with their valuable papeıs. Yours sincerely, Osman GÜVEN, M.D. Projesor of Otthopaedics and Traumatology, President of the Turkish Society for Surgery of Shouldet and Elbow 5
DÜZENLEME KURULU / ORGANIZING COMMITTEE Onursal BaĢkan / Honorary President: Kongre BaĢkanı / Congress President: Kongre Sekreterleri / Congress Secretaries: Charles Rockwood Yılmaz Akalın IĢık Akgün Mehmet Demirhan Dernek BaĢkanı / President of TSSSE: Üyeler / Members: Osman Güven ġenol Akman Ata Can Atalar Muharrem Babacan Murat Bezer Ahmet Ekin Mustafa Karahan OMUZ ve DĠRSEK CERRAHĠSĠ DERNEĞĠ YÖNETĠM KURULU / TURKİSH SOCİETY FOR SURGERY OF SHOULDER AND ELBOW EXECUTİVE COMMITTEE Osman Güven (BaĢkan / President) Ahmet Ekin (1. BaĢkan Yardımcısı / Ist Vice President) Selçuk BölükbaĢı (2.BaĢkan Yardımcısı / 2nd Vice President) Mehmet Demirhan (Genel Sekreter / Secretary General) Yılmaz Akalın (Üye / Member) IĢık Akgün (Üye / Member) Muharrem Babacan (Üye / Member) 6
BĠLĠMSEL KURUL / SCIENTIFIC COMMITTEE Sinan Adıyaman Ġsmail Çallı Nail Kır Yılmaz Akalın Mehmet Demirhan Levent Köstem IĢık Akgün Mehmet DemirtaĢ Ünal Kuzgun Sercan Akpınar Mahmut Nedim Doral Veli Lök Erdoğan Altınel Ahmet Ekin Mustafa Özkan Faik AltıntaĢ Rıfat Erginer Halit Pınar Aziz Alturfan Öner Gedikoğlu Sinan Seber Bülent Alpaslan Akif Güleç Ġsmet Tan ġahap Atik Ġzge Günal Reha Tandoğan A. Turan Aydın Birol Gürman Ömer TaĢer Nevres Aydoğan Ethem Gür Metin Türkmen Muharrem Babacan Semih Gür Okan Yalaman Ömer Lütfü Baydar Hakan Gürbüz Aydın Yücetürk Mehmet Binnet Osman Güven Selçuk BölükbaĢı Ayhan Nedim Kara Mustafa Caniklioğlu Mustafa Karahan Konuk KonuĢmacılar / Guest Speakers Kirk JENSE,M.D. Bemard MORREY, M.D. Andreas IMHOFF, M.D. PROFESSIONAL CONGRESS ORGANIZER (PCO) & OFFIClALTRAVELAGENCY / PROFESYONEL KONGRE ORGANĠZATÖRÜ (PCO) ve SEYAHAT ACENTASI Magister Tours / Magister Turizm Halaskargazi Cad. GüneĢ Apt. 321 /1 ġiģli, 80260 Istanbul Turkiye Phone / Telefon : 90 0212 230 00 00-230 90 06 Fax / Faks : 90 0212 248 40 30-233 15 52 E-mail : congress@magister.com.tr Website : www.magister.com.tr 7
BĠLĠMSEL PROGRAM / SCIENTIFIC PROGRAM 9 ġubat / FEBRUARY 2000 12:00-19:00 Kayıt / Registration 19:00 HoĢgeldin Kokteyli / Welcome Cocktail 10 ġubat / FEBRUARY 2000 08:00-08:15 AçılıĢ / Opening Ceremony 08:15-08:35 2000'li Yıllarda Omuz artroplatisi/ Shoulder Aıthroplasty in 2000 Dr. Ch. Rockwood, Jr. 08:35-09:35 Humerus Üst Uç Kırıkları / Fractures of the Proximal Humerus Oturum BaĢkanı / Moderator : Dr.Yılmaz Akalın Dr. K. Jensen Dr. Y. Akalın Dr. A. Ekin 09:35-10:00 TartıĢma / Discussion 10:00-10:20 Kahve Molası / Coffee Break 10:20-10:40 Glenohumeral Artroz ve Omuz Artroplastisi / Glenohumeral Osteoarthritis and Shoulder Aıthroplasty Dr. K. Jensen 10:40-11:00 TartıĢma & Video Gösterisi / Discussion & Video Presentation 11:00-12:20 Rotator ManĢet Yırtıkları: Tamir ve Debridman / Rotator CuffTears: Repair and Debridernent Oturum BaĢkanı / Moderator : Dr. Selçuk BölükbaĢı Dr. K. Jensen Dr. A. Imhoff Dr. S. BölükbaĢı Dr. O. Güven Dr. M. Demirhan 12:20-12:30 TartıĢma / Discussion 12:30-14:00 Öğle Yemeği / Lunch 14:00-14:40 Omuz Instabiliteleri / Shoulder lnstabilities Dr. A. Imhoff 14:40-15:00 TartıĢma / Discussion 15:00-15:30 Poster Sunuları & Kahve Molası / Poster Discussion & Coffee Break 8
15:30-17:20 Serbest Bildiriler / Free Papers Oturum BaĢkanları / Moderators : Dr. ġahap Atik, Dr. Semih Gür 15:30-15:36 Özkan M, Bacakoğlu A.K, Ekin A, Özcan C. Travmatik Omuz Ġnstabilitesinde Kapsüler Plikasyonun Yeri 15:36-15:42 Duygulu F, KaraoğluS, Baktır A, KarakaĢ E, Balkar F Rekürren Anterior Omuz Ġnstabilitesinde Bankart Operasyonu Sonuçlarımız 15:42-15:48 Güven O, Karahan M, Bezer M,GökkuĢ K, Saygı B,Güven Z, Kara H Anterior Omuz Ġnstabilitesi Bulunan Otuz Vakanın Bankart Ameliyatı ile Tedavisinin Geç Takip Sonuçları 15:48-16:02 Bayram H, Herdem M, Tan Ġ, Demirdelen A Glenoid Ön Kenar Defekti Olan Travmatik Öne Omuz Ġnstabilitesinde Uyguladığımız Tedavi ve Sonuçlarımız 16:02-16:08 Demirhan M, Atalar A.C, Sıvacıoğlu S, Akalın Y Superior Labrum Anterior-Posterior (SLAP) Lezyonunun Artroskopik Tedavisi 16:08-16:14 Aydoğan N.H, Baydar M.L, ġehirliroğlu A,Tünay S, YanmıĢ Ġ Travmatik Öne Glenohurneral Ġnstabilitede Eklem içi DeğiĢikliklerin Değerlendirilmesi 16:14-16:29 TartıĢma / Discussion 16:29-16: 35 Boldin CH, Schippinger G, Fankhauser F Is There a Correlation Between Suture Material and Septic or Aseptic Complications After Rotator Cuff Surgery? 16:35-16:41 Binnet M, Bilgin S.S, Gürkan Ġ, Altay M, Adıyaman S Rotator Kaf Yırtıklarında Cerrahi Tedavi Deneyimimiz 16:41-16:47 Sarısaltık H, ÇalıĢır A, Akıncı O Evre III Subakromıal Impigement Sendromunda Cuff Tamiri, Akromioplasti, Distal Klavikula Rezeksiyonu Sonuçları 16:47-16:53 Güven Z, Kaptan A, Güven O, Özaras N, Kayhan Ö Anterior Akromiyoplasti Operasyonu Sonrası Kısa ve Uzun Dönem Rehabilitasyon Sonuçlarımız 16:53-17:03 TartıĢma / Discussion 17:03-17:09 Demirhan M, Altınel L, Atalar A.C, Akalın Y Proksimal Humerus Kırıklarında Herniartroplasti Ne Kadar BaĢarılı Bir Yöntemdir? 9
17:09-17:15 Esenyel C. Z, YeĢiltepe R, Bülbül M, Kara A.N Humerus Proksimal Bölge Kırıklarında Cerrahi Tedavi Sonuçlarımız 17:15-17:20 TartıĢma / Discussion 20:00-23:00 Gala Yemeği / Gala Dinner (Conrad Oteli, Balo Salonu / Conrad Hotel, Ball Room) 11 ġubat / FEBRUARY 2000 08:00-08:20 Dirsek Eklemi Sertliği / Stiff elbow Dr. B. Morrey 08:20-09:30 Dirsek Kırıkları / Elbow Fractures Oturum BaĢkanı / Moderator : Dr. IĢık Akgün Dr. B. Morrey Dr. K. Jensen Dr. I. Akgün Dr. M. DemirtaĢ Dr. V. Kırdemir 09:00-10:00 TartıĢma / Discussion 10:00-10:20 Kahve Molası / Coffee Break 10:20-10:40 Dirsek Artroplastileri / Elbow Arthroplasties Dr. B. Morrey 10:40-11:00 TartıĢma & Video Gösterisi / Discussion & Video Presentaıion 11:00-12:00 Dirsek instabiliteleri / Elbow Instabilities Oturum BaĢkanı / Moderator: Dr. Ahmet Ekin Dr. B. Morrey Dr. M. Demirhan Dr.A. Ekin Dr. M. Babacan 12:00-12:30 TartıĢma / Discussion 12:30-14:00 Öğle Yemeği / Lunch 14:00-15:00 Sporcularda Omuz ve Dirsek Yaralanmaları / Shoulder and Elbow Injuries ofatlıletes Oturum BaĢkanı / Moderator: Dr. Osman Güven Dr. A. Imhoff Dr. M. Karahan Dr. O. Güven Dr. M.N. Doral 10
15:00-15:15 En iyi Posterler Ödül Töreni / Best Posters Awards Ceremony 15:15-15:30 Kahve Molası / Coffee Break 15:30-16:40 Serbest Bildiriler / Free Papers Oturum BaĢkanları / Moderators: Dr. Ġsmail Çallı Dr. Sinan Adıyaman 15:30-15:36 Özerdemoğlu R.A, Yorgancıgil H, Mumcu E.F Çocuklarda Dirsek TaĢıma Açısı ve Hareket GeniĢliği 15:36-15:42 Sağlam N, Talu U, Bilen E, Tözün Ġ.R Total Dirsek Protezi 15:42-15:48 Aynacı O, ġener M, PiĢkin A, Kerimoğlu S Olekranon Kırıklarında Cerrahi Tedavi Sonuçlarımız 15:48-15:53 TartıĢma / Discussion 15:53-15:59 Küçükkaya M, Tezer M, Uyar S, Öztürk Ġ Çocuk Lateral Kondil Kırıklarının Cerrahi Tedavisi: Ortalama 8 Yıllık Sonuçlar 15:59-16:05 Özkaleli E, Can F, Atik ġ Dirsek Eklemini ilgilendiren Kırıkların Postoperatif Rehabilitasyonunda CPM' in Yeri 16:05-16:11 Altay T, Günal Ġ, Öztürk H, Us M.R, Kaya A Lateral Epikondilit Tedavisinde Lokal Anestezik ile Kortizon Tedavisi (Prospektif Randomize Çift Kör Kontrollü ÇalıĢma) 16:11-16:16 TartıĢma / Discussion 16:16-16:22 Bacakoğlu A.K, Özcan C, Özkan M, Aliekberov C, Ekin A Humerus Diafiz Pseudo-Artrozlarının Sirküler Eksternal Fiksatör Yöntemi ile Tedavisi 16:22-16:28 Tezer M, Küçükkaya M, Uyar Z, Kuzgun Ü Tip 3 Akromiyoklaviküler Çıkıklarda Modifiye Gergi Bandı Yöntemiyle Cerrahi Tedavinin Yeri ve Orta Dönem Takip Sonuçları 16:28-16:34 Vedzizhev G.M, Vedzizhev B.G Operative Treatment of Shoulder Tumors with Arthroplasty 16:34-16:40 TartıĢma / Discussion 16:40 KapanıĢ / Congress Closing 11
Posterler / Posters 1. Omuz ve Dirsek Cerrahisi Kongresi 9-11 Şubat 2000 P01 P02 P03 P04 P05 P06 P07 P08 P09 P10 P11 P12 P13 Yel M, Mutlu M, Ertürk E, Kutlu A Öne Omuz lnstabilitelerinde Modifiye Bristow Ameliyatı Sonuçları Can F, Dolunay E, Yücetürk A, Tandoğan R Bankart Ameliyatı Sonrası Omuz Rehabilitasyonu Sonuçlarımız Tuncay Ġ, Tosun N, Akpınar F Anterior Omuz Ġnstabilitelerinin Sütür Ankorlar ile Tedavisinin Erken Sonuçları DemirtaĢ M, Altay M, Adıyaman S, Yılmaz C, Binnet M Glenohumeral Instabilıtelerın Cerrahı Tedavisinde Kısa ve Orta Dönem Bankart Uygulama Sonuçlarımız Yel M, Memik R Arazi M, ġarlak A Rotator ManĢet Yırtıklarında Artroskopi, Açık Subakromial Dekompresyon ve ManĢet Tamiri Uygulamalarımız Ünver B, BaĢkurt F, Göcen Z, Yurtseven E, Özkan M Nonopere Rotator Cuff Patolojılerinde Rehabilitasyon Akpınar S, Demirhan M, Hersekli M.A, Atalar A.C, Tandoğan R.N Tamir Eddemeyen Rotator ManĢet Yırtıklarında Latissimus DorsiTransferi Güven O, Karahan M, Ünsal M, Bezer M, Saygı B, GökkuĢ K Önemli Bır Rotator Kılıf Yırtığı Nedeni: Os Akromiale! Atalar A.C, Demirhan M Akalın Y, Sıvacıoğlu S Artroskopik Subakromial Dekompresyon ve Mini - Açık Rotator ManĢet Tamiri Can F,.Dolunay E, CoĢkun G, Tandoğan R, Atilla B Omuz Impingement Sendromunun Reliabilitasyonunda Manuel Tedavinin Etkisi Baltacı G, Binnet M.S, Ergun,Yılmaz C Artroskopjk Subakromial Dekompresyon YaĢam Kalitesini Hangi Düzeyde DeğiĢtiriyor? Baltacı G, Kantar Ö, Özlü H, Ergun N Artroskopik Subakromial Dekompresyon: CYBEX 6000 Kullanılarak Omuz Rotator ve Abduktor - Adduktorlerin Konsentrik Peak Torque Değerleri BeĢler A, Baltacı G, Bayrakcı V, Ergun N Omuzun SıkıĢma Sendromunda ki Tedavi YaklaĢımı: Klasik Fizyoterapiye KarĢı Manual Terapi 12
P14 P15 P16 P17 P18 P19 P20 P21 P22 P23 P24 P25 P26 Sert Ö.A, Öğün T.C, Arazi M, ġariak A Omuz "ımpingement" Sendromunda Konservatif Tedavi Sonuçlarımız Demirhan M, Atalar A.C, Akalın Y Omuz Ġnstabilitelerinde Artroskopik Kapsüler BüzüĢtürme (Shrinkage) Akpınar S, Hersekli M.A, Demirörs R.N, Tandoğan R.N Artroskopik Subakromiyal Dekompresyon ve Mini-Açık Rotator ManĢet Tamiri Baltacı G, BeĢler A, Bayrakçı V, Ergun N, Binnet M Artroskopik Subakromial Dekorupresyon ile Tedavi EdilmiĢ Hastalarda Omuz Rehabilitasyonu Özcan A, Özdemir N, Türeyen C, Ekin A Omuz Hemiartroplastilerinde Postoperatif Fizyoterapi ve Rehabilitasyon Uygulamaları Siakir O, Ergun N, Baltacı G, Bayrakçı V, BeĢler A, Aksu S Profesyonel Voleybolcularda Omuz Ekleminin Fonksiyonel Testlerle Değerlendiri lmesi Bağrıaçık A, Parmaksızoğlu A, Esenyel C 174 GüreĢ Milli Takım Sporcusunda Görülen 227 Omuz Sakatlığı Güven O, Karahan M, Bezer M, Erol B, Saygı B, GökkuĢ K, Güven Z, Yıldırım Y Akromioklaviküler Eklem Dislokasyonlarının Modifiye Weaver- Dunn Cerrahi Tekniğiyle Tedavisinin Geç Sonuçları Yel M, Arazi M, Kapıcıoğlu M.Ġ.S Ihmal EdilmiĢ Travmatik Posterior Stemoklavikular Çıkık ve Korakoid Impingement Sendromu (Olgu Sunumu) Öztürk i, Kabukçuoğlu Y, TekkeĢin M, Aksoy B Protez Uygulamalarımız Kabukçuoğlu Y.S., Tezer M, Armağan R, Kuzgun Ġ Proksimal Humerus Malign Tümörlerinde Cerrahi Tedavi ġener M, Aydın H, Aynacı O, Altay M.A Os Acromiale Parmaksizoğlu F, Teksöz A EriĢkinlerde Distal Humerus Eklem Içi Parçalı Kırıkların Çok Sayıda Kirschner Teli ile Tespiti 13
P27 P28 P29 P30 P31 P32 P33 P34 P35 P36 P37 P38 P39 P40 P41 Bağrıaçık A, Esenyel C, Demirkaya M Humerus Distal Uç Kırıklarında, Açık Redüksiyon ve Minimal Osteosentez OIcay E, Yıldırım Ö.S,Bülbül M Bikondiler Intraartiküler Distal Humerus Kırıklarının Tedavisinde Transolekranon YaklaĢımla Olekranonun Modifiye Osteosentezi Akpınar O, Çetinus E, Cever Ġ Suprakondiler Humerus Kırıklarının Tedavisi ġener M, Aydın H, Aynacı O, Altay M.A, Önder Ç Çocuk Suprakondiler Humerus Kırıklarının Traksiyonla Tedavisi ġener M, Aynacı O, Aydın H, Kerimoğlu S Humerus Cisim Kırıklarında Ekstemal Fiksatör Uygulamalarımız Aynacı O, ġener M, Aydın H, Kerimoğlu S Humerus Cisim Kırıklarının U - Ateli ile Konservatif Tedavisi Fankhauser F, Schippinger G, Boldin C The Ineidence of Ganglion Cysts Around The Shoulder: Diagnosis and Treatment Option Özerdemoğlu R.A, Heybeli N, Mumcu E.F Travmanın Dirsek TaĢıma Açısı ve Hareket GeniĢliği Üzerindeki Etkisi Özerdemoğlu R.A, Heybeli N, Mumcu E.F Dirsek Hiperekstansiyonu Gerçekten Bir Fleksibilite Kriteri midir? Akın E, Ekin A, Türeyen Z.C, Özkan M Kronik Lateral Epikondilitin Tedavisinde Magnetoterapinin Etkisi Baltacı G, Ergun N, Bayrakçı V Lateral Epikondilitin Tedavisinde Cyriax'a Göre Mobilizasyon ve Dirsek Bandının Etkisi Gelecek N, Kaçak G, Bacakoğlu K Dirsek ve Onkol Kırıklarında Rehabilitasyon Durmaz H, Demirhan M, Atalar A.C, Akalın Y Capitellumun Osteokondritis Dissekansı (Panner Hastalığı?) Kabak ġ, Ekinci N, Karaoğlu S, Halıcı M Median Sinirin OluĢum Varyasyonları (Kadavra ÇalıĢması) Kılıçoğlu Ö, Demirhan M, Akman Ģ, Yavuzer Y, Alturfan A Tanısı BilateralOmuz Posterior Fraktür - Dislokasyonu ile Koyulan Beyin Tümörü Olgusu ve EĢzamanlı Ġki Taraflı Hemiartroplasti ile Tedavisi 14
P42 P43 P44 P45 Akman ġ, Enson C, Kılıçoğlu Ö, Berkman M, Ege Y, Yeğinsu O Klavikula Osteomyeliti (Klavikula Medial Uçta Osteornyelit olgusu ve Tedavisi) Güven Z, A. Kaptan, O Güven, Özaras N, Bezer M, Kayhan Ö Modifiye Bankart Ameliyatı Sonrası Rehabilitasyon Sonuçlarımız Güven O, Karahan M, Bezer M, Saygı B, GökkuĢ K, Yıldırım Y, Güven Z Rotatar Kılıf Yırtığı Tamirlerin Uzun Dönem Fonksiyonel Sonuçları Herdem M, Bayram H, Özbarlas S, Özkan C Distal Humerus Kırıklarında Olecranon Osteotomisi ile Yapılan Cerrahi Tedavi Sonuçları P46 Adıyaman S, Bilgin S.S, Yılmaz C, KarakaĢ A, DemirtaĢ M Omuzda SıkıĢma Sendromunun Cerrahi Tedavisi P47 DemirtaĢ M, Adıyaman S, Bilgin S, Uçar H, Yılmaz C, Post Travmatik Dirsek Hareket Kısıtlılığında Tedavi Tecrübemiz 15
KONUK KONUġMACILAR lnvited LECTURES 16
11 ġubat 2000 Saat 08.00-08.20 1. Omuz ve Dirsek Cerrahisi Kongresi 9-11 Şubat 2000 Surgery in 2000: New Solutions for an Old Problem B.F. Morrey, M.D. THE OLD PROBLEM: THE STIFF ELBOW Presentation It is very important to define the pathology responsible for the stiff elbow and we classify this into two major types: intrinsic and extrinsic. INTRINSIC PATHOLOGY Caused by in intra-articular pathology EXTRINSIC PATHOLOGY Periarticular pathology: capsule, ectopic bone MIXED In reality most will present with elements of both: example, degenerative arthritis PHYSICAL EXAMINATlON Pain absent in traumatic arthritis Impingement pain present in degenerative arthritis P/S usually normal STUDIES Lateral tomogram is the helpful single tool for all intrinsic pathology Examination under anesthesia without obvious etiology or radiographic pathology especially af ter he ad injury SPECIALS STUDIES MRI of O value, arthrogram of NO value CT-OK for ectopic bone Patient Seetion POST- TRAUMATlC Rarely offer release done if contracture is less than 40 degres OSTOARHRITlS Capsular release done in conjunction with removal of osteophytes if contracture is a significant problem THE NEW SOLUTlONS (TECHNIQUES): THE COLUMN PROCEDURE, ARTHROSCOPIC INTERVENTION, INTERPOSITlO ARTHROPLASTY "COLUMN PROCEDURE" Indications Marked limitation of flexion and/or extension: osteoarthrilis Extrinsic pathology: Traurnatic arthritis Anterior contracture and/or post contracıure 17
TECHNIQUE Extensive - Kocher Identify - ECRL, common extensor tendon -ECROL/distal brachioradialis (4 cm) -Brachialis freed from capsule Excise - anterior capsule -Rernove osteophyte if present ASSESS If full extension, full ROM - stop If lacks flexi on or full extension CONTINUE Elevate triceps from posterior lateral colomn Exeise posterior capsule Exeise tip olecranon if prorninent Limited produres, isolated removal of impingernent of little value ARTHROSCOPIC RELEASE Arthroscopic release of value if technically cornpetent and limited extrinsic (capsular) pahology Ernerging as a viable option in those with technical cornpetency Anterior and posterior osteophytes can be released Anterior and posterior capsule can be released TECHNIQUE Portal 1- Anterior medial then 2- Anterior lateral Release - humeral attachmerıt use shaver, scisbors, or basket forceps do not use suction Complications: radial nerve BEWARE INTRINSIC PATHOLOGY This is the most commorı presentation in post-traumatic arthritis and certainly is the most difficult. We proceed in a stepwise fashion as follows: DISTRACTION ARTHROPLASTY - EXTERNAL FIXATION Indications: capsular contracture requiring extensive dissection Reease of the collateralligament rendering the joint unstable and/or interposition arthplasty TECHNIQUE 1. Extensive Kocher or posterior appoach 2. Identify and protect or free ulnar nerve if needed 3. Release triceps off of the tip of the olecranon by reflecting Sharpey's fibers 4. The entire extensor mechanism is reflected to fully expose the posterior joint 5. The scar tissue of tissue of the posterior capsule is excised 18
6. The elbow is f1exed to see if the flexion contracture is due to the posterior tether 7. The tip of the olecranon is then removed. If the patient has normal motion after this procedure, then one would stop here. This is rarely the case and anterior exposure is usually indicated. 8. The common extensor muscles and ECRL are elevated exposing the anterior capsule. The anterior capsule is then excised fram lateral to madial and the elbow is extended. 9. A lateral collateralligament is either preserved or, if contracted, it is released. 10. In most instances, an are of approximately 10 to 130-140' is obtainable. If there is anterior osteophyte block from the coronoid, this is removed. 11. If the joint surface is badly involved, interposition with dermis or Achilles tendon allograft is performed. EXTERNAL FIXATOR Technique Use of half pins Remove the axis pin Leave on approximentely 3 weeks Indications: If collateral Iigament repair or reconstruction is tenuous If interposition tissue was used. BIBLIOGRAPHY 1. Breen TF, Gelberınan RH, Ackerman GN: Elbow flexion contractures: Treatment By anterior release and continuous passiye motion J Hand Surg 13B:286, 1988 2. Green DP, McCoy H: Tumbuckle orthotic correction of elbow-f1exion contractures af ter acute injuries. J.Bone Joint Surg 61AXlO92, 1979 3. Husband JB, Hastings H: The lateral approach for operative release of posttraatic contracture of the elbow. J Bone Joint Surg na: 1353,1990 4. Morrey Bf: Treatment of the contracted elbow: Distraction arthroplast. J Bone Joint Surg na(4):601-618, 1990 5. Morrey BF: The Elbow and Its Disorders. The StiffElbow. Raven Press, Y, 1994. 6. Urbaniak JR et al: Correction of posttraumatıc f1exion contracture of the elbow by anterior capsulotomy. J Bone Joint Surg 67A:1l60-1164, 1985. 7. Weizenbult M, Eichenblat M, Lipskeir E, Kessler I: Arthrolysis of the elbow: 3 cases of posttraumatic stiffness. Acta Orthop Scand 60:642, 1989 19
11 ġubat 2000 Saat 08:20-09:30, Dirsek Kırıkları Panali Fracture Dislocation of the Elbew B.F. MOITey, M.D. I. DEFINITION - Complex Instability Articular fracture + ligamentous disruption - hence: " Fracture / Dislocation of the Elbow "(6) II. CONTRIBUTION TO STABILITY (3,4) A. Articular 1. Ulna a. olecranon - contribution is proportional to percent of the structure present (1) b. coronoid (trochlea)- posterior displacement is resisted if at least 50% is present (8) 2. Radial head contribution a. valgus stress: intact MCL 0% contribution of radial head torn MCL, 75% stability from radial from head b. axial displacement (Essex Lopresti) (6) iftorn: intraosseous membrane, DRUJ: 100% stability from radial head 3. Contribution of co ro no id AND radial head a. Elbow unstable if 75 to 100% coronoid absent (Type III) even in flexion past 90' b. IF radial head absent elbow unstable in extension unless greater then 50% coronoid present Summary: For stability need: a. 50% (Type II) coronoid b. 50% olecranon c. radial head IF MCL tom d. radial head absent, need at least 50% coronoid III. CLASSIFICATION BY PATHOANATOMY AND PRESENTATION A. Dislocation of Elbow 1. Pathology Tom MCL in all Torn LCL in most B. Fracture dislocation / subluxation Fracture: 1. Radial head 2. Coronoid 3. Olecranon 4. Radial head with coronoid and/or olecranon C. Angular injury 1. Fractured radial head 2. Tom medial collateralligament 20
IV. TREATMENT Goal - Restore all constrainnts but basic principal is: *MUST RESTORE ULNO-HUMERAL JOINT A. Radial head fracture: 1. With MCL tear a. Fix radial head/replace radial he ad (numerous implast being developed) b. Stabilize MCL if stiıı unstable OR c. apply distractor (ex fix) (2,5) Author Preference: Restore or reconstruct radial head, apply external fixator, leave MCL to heal. 2. With radial head fracture and elbow dislocation Mason Fracture Type Type I - Reduce. Test for stability. Spiint in stable arc. Surgery not necessary Type II - ORIF - Test for stability. If stil unstable: a) Splint in stab1e are b) Fix LCL c) Distractor (ex fix) Type III - Resect. Test for stability. Splint in stable arc. If unstable: a) Try implant (but avoid) silastic) b) Fix MCL/LCL c) distractor (ex fix) if necessary (2,S) B. Ulna Fracture 1. Olecranon (6) Mayo Type III (fracture dislocation) a) ORIF olecranon if not comminuted b) OR IF plus distractor if comminuted 2. Coronoid (8) Type II - Test for stability - ORIF if unstable Type III - ORIF as able - distraction device in all BĠBLOGRAPHY 1. An KN, Morrey BF, Chao EYS: The effect of parti al removal of proximal on elbow constraint. Clin Orthop 209-279, 1986. 2. Co bb TK, Morrey BF: Use of distraction arthroplast in unstable fracture dislocation. of the elbow. Submitted to Clin Orthop. 3. Morrey BF, An KN: Articular Iigamentous contributions to the stability of the elbow joint Amer.1. Sports Med. 11:0S:31S-319, 1983 4. Morrey BF, An KN, Tanaka S: Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop 26S:1878-189S, 1991. 5. Morrey BF: Distraction arthroplasty: Clinical application. Clin Orthop 293:4S-S4, Aug.1993 6. Morrey BF: Complex instability of the elbow. J Bone Joint Surg 79A:460-469 1997. 7. O'Driscoll SW, Morrey BF, Korinek S, An KN: Elbow subluxation and dislocation: A spectrum of istability. Clin Orthop 280: 17-28, 1992 8. Regan W, Morrey BF: Fractures of the coronoid process of the ulna. J Bone Joint Surg 7lA:9:1348-13S4, Oct., 1989. 21
11 ġubat 2000, Saat 10:20-10:40 Total Elbow Arthroplasty (TEA) : An Update B.E Morrey. M.D. Treatment at Mayo is predicated on radiographic classfication: Class I: normal x-ray, synovitis present; Class II: joint norrawing, architecture of the joint preserved, synovitis; Class III: architectural changes with continued synovitis, this is subdivided into relatively mild (A) versus more severe, (B) architectural changes; Clas IV: gross destruction of the joint. Synovectomy. Today synovectomy is performed arıhroscopically. Indications include: 1) Type I or II involement; 2) young patients, <50;3) high functional expectation. When possible the radial head is debrided, but not removed. Results are less gratifying long-term when arthroscally performed. Since the 95% satisfactory at 6 months decreases to 67% at 3 years, the arthroscopic technique is now more aggressively being carried out (3). TOTAL ELBOW - Indications. The indications for total elbow arthroplasty in rheumatoid arthritis is relentless pain, failure of medical management for over six rnonths, Mayo classification of radiographic involvement of grade lia or worse. There is no particuler age indication for total elbow arthroplast since there is no good treatment option even for the young patients. Thus, juvenile rheurnatoids rnay be considered candidates for this procedure DESIGN TYPES - Resurfacing Designs. There are two basic philosophies of joint replacernent at the elbow. One is a resurfacing implant and the other a serni-corıstrained device. Resurfacing irnplast have had a satisfactory experience for the treatment of inflammatory arthritis at the elbow with approximately 90% being functional at five years. However, a dislocation rate of 14% after 30 procedures lirnits our erıthusiasm. Thus resurfacing implast are not used at Mayo at this time. Semiconstrained Device. Definition: Coupled components with 7 - LO degress "laxity" ın varus/valgus, internal, external rotation (1) Current design: Coonrad- Morrey used at Mayo since 1981 (S). Semiconstrained Replacement. Indication: Over the last IS years the use of semiconstrained coupled implant has also proven to be effective in treatment of patients wıth rheumatoid arthritis, as well as for ıraumatic conditions. Anattractive feature of this design option is that the patient with more severe involvemerıt are adequatly treated which is not the case for cornprornise. RHEUMATOID ARTHRITIS - Results and Complication. Recent designs of both resurfacing and semiconstrained implası have proven to be extermely successful for ınflammatory arthritis. The Mayo Clinic 10-15 year experience in over 80 patients with the semi-constrained device have dernostraıed a 90% satisfactory rate at 12 years. Motion averages 25-130 degress. The loosening rate is less than 1 %. The infection rate is 2%. Permanent ulnar nerve symptoms occur in 1% and dislocatin is not seen. The 10-15 year survinal rate by Kaplan- 22
Meier analysis is 93 percent (2). Resurfacing designs nowall have sterns. For rheumatoid arthritis their effectiveness is about 90% at five years A functional are of motion averaging 30-130 degress is to be expected ( ). Complieations: Percent Instability (resurfacing only) 5-7% UInar nerve 2-5 Loosening 2-10 - 10 years Wear 5-7 - 10 years ConcIusion. Rheumatoid involvement in the elbow is successfully treated with synovectomy and especially with elbow joint replacement. While both design concepts are effective, the full spectrum of pathology is most effectively addressed with a semiconstrained implant. In these circumstances, patients may be offered a high likelihood of functional motion with limited pain and a long-term survival of the implant. TRAUMATlC ARTHRITlS This series of problems are best treated with the semi-constrained device. Mayo expeıience with three traumatic conditions amenable to prosthetic elbow replacement include: 1) traumatic arthritis; 2_ distal humeral nonunion; 3) selected acute fractures. Traumatic arthritis. Experince with 41 patients followed for over five years reveals a mechanical loosening in patients treated with the Mayo modified Coonrad implant (6). Distal humeral nonunion. This group of patients is extremely diffucult to manage due to the pre-existing procedures and complications. In 39 consecutive procedures average age at the time of surgery is 68 years with follow-up over 4 years. The overally satisfactory rate is 91 percent and motion is from 16 to 127 degrees (4). Acute fraeture: Of 21 consecutive elderly patients with severe comminuted elbow fractures treated by joint replacement all are free of pain and have functioning implast. No patient has been revised for loosening. Complications include one transient ulnar neuropraxia in thee cases, reflex dystrophy in one and a fractured ulnar component in one. Technique. if the distal humerus is an acute fracture or for treating nonuniorı, treceps is left attached to ulna. This tecnique allows immediate motion with low morbidity. This exposure was used for the latter two categories and appears to hasten functional recovery (1). Summary Results Overally, 101 patients with traumatic conditions in these theree categories revealy a greater than 90% succerss rate at five years. It is concluded that elbow arthroplasty is not only a viable option but is even the treatment of choice in selected patient with residual for posttraumatic arthritis for distal humeral nununion and for the carefully selected patient with acute fracture. 23