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Colles kırığı

Colles fracture

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez.

Özet

Colles kırığı, açık el üzerine düşmeyle sık ilişkilendirilen ve distal radius kırık parçasında dorsal açılanma ile yer değiştirme görülen bir kırık örüntüsüdür. Klasik tanım eklem dışıdır; BT, parçalanma, gizli eklem uzanımı ve distal radioulnar eklem ilişkisi grafilerle tam seçilemediğinde kırık anatomisini netleştirir. Dorsal tilt ile radius kısalmasının birlikte değerlendirilmesi karpal hizalanmayı anlamaya yardım eder. Eklem basamağı veya ulnar taraftaki eşlikçi yaralanma atlanırsa instabilite ve sonradan gelişebilecek eklem uyumsuzluğu yeterince tanımlanmayabilir.

Okuma sırası

  1. Distal radius metafizi. Distal radius şaftından eklem yüzüne inin; metafizer kırık seviyesini ve distal parçanın dorsal kortekse göre yönünü bulun.
  2. Distal radius sagittal profili. Sagittal kesitlerde eklem yüzünün volar eğiminin kaybolup kaybolmadığını, distal parçanın dorsale ötelenmesini ve radius kısalmasını izleyin.
  3. Dorsal metafiz. Dorsal metafizer bölgede kırık morfolojisini ve parçalanmayı ardışık kesitlerde değerlendirin.
  4. Radiokarpal yüz ve ulnar stiloid. Son olarak skafoid-lunat fossaları, sigmoid çentiği ve ulnar stiloidi tarayarak eklem uzanımı ile eşlikçi kırığı kayda geçirin.

Bu konu için açık lisanslı ve doğrulanmış bir olgu görüntüsü henüz bulunamadı.

Faz ve pencere

Kontrastsız tanısal
Kontrast gerekmez. BT, kırık morfolojisini, komünüt yapıyı ve kemik yer değiştirmesi ile hizalamayı detaylı olarak değerlendirir; ayrıca eklem yüzü çökmesi derecesi de ölçülebilir.
Kemik algoritması tanısal
Çok düzlemli BT rekonstrüksiyonlarında distal radius kırığının açılanma yönünü, kemik parçalarının yer değiştirme ve hizalanmasını, eklem yüzü çökmesini ve sigmoid çentik tutulumunu değerlendirin.

Önerilen pencereler: Kemik (G 1800 / M 400).

BT bulguları

  • Dorsal tilt — distal radius eklem yüzünün volar eğimi azalır veya dorsal yöne döner.
  • Dorsal translasyon — distal fragman dorsale yer değiştirir.
  • Metafizer impaksiyon — distal parça kısalır, trabeküler kemik yoğunlaşır ve radial yükseklik kaybı görülebilir.
  • Dorsal kortikal parçalanma — Colles kırığında dorsal parçalanma görülebilir; belirgin parçalanma instabil kırık örüntülerini tanımada kullanılan bulgulardandır.
  • Eklem içi uzanım — kırık hattı skafoid veya lunat fossaya ya da sigmoid çentiğe ulaşarak eklem yüzünü böler.
  • Ulnar stiloid kırığı — aynı travmada ulnar stiloid tabanında veya ucunda ek kortikal ayrışma bulunabilir.
  • Distal radioulnar eklem uyumsuzluğu — sigmoid çentik kenarında basamak veya ulnar başla eklem ilişkisinde bozulma izlenir.
  • Kırık raporunda ekstraartiküler ya da intraartiküler uzanımı, dorsal/volar açılanmayı, fragman yer değiştirmesini ve radial kısalmayı; eklem içi kırık varsa eklem basamağını ve sigmoid çentik tutulumunu belirtin.

Normalde

Distal radiusın eklem yüzünde skafoid fossası skafoidle, lunat fossası lunatla; sigmoid çentik ise distal ulnayla eklemleşir. Ölçümleri standart lateral ve PA bilek grafilerinde veya uygun düzlemdeki rekonstrüksiyonlarda değerlendirin. Bilek grafilerinde radial inklinasyon, radial yükseklik ve palmar tilt ölçülebilir.

Ayırıcı tanı

Eklem içi parçalı distal radius kırığı
dorsal tilt eşlik edebilir ancak eklem yüzü çoklu fragmanlarla bölünür; klasik eklem dışı Colles örüntüsü değildir.
Galeazzi kırıklı çıkığı
radius şaft kırığına distal radioulnar eklem çıkığı eşlik eder; temel lezyon metafizer Colles örüntüsü değildir.

Tuzaklar

  • Aksiyel BT'de eklem yüzü düzgün görünse bile sagittal görüntüde dorsal tilt ve şafttan distal parçaya geçişi izleyin; tek düzlem metafizer açılanmayı olduğundan az gösterebilir.
  • Colles terimi sıklıkla dorsal açılanmalı distal radius kırıkları için kullanılır; BT kırık morfolojisini ve kemik parçalarının yer değiştirme ile hizalanmasını ayrıntılı değerlendirmeye yardımcı olur.
  • Ulnar stiloid ucundaki küçük ossikülü değerlendirirken, eşlik eden ulnar stiloid kırığının direkt grafide zor seçilebileceğini ve distal radioulnar eklemin ayrıca dikkatle incelenmesi gerektiğini göz önünde bulundurun.

Kendini dene

  1. Colles kırığının en sık görülen travma mekanizması aşağıdakilerden hangisidir?

    Cevabı göster

    Uzanan el üzerine düşme (FOOSH). Sağlanan literatür, Colles kırığının tipik olarak uzanan el üzerine düşme (FOOSH) mekanizmasıyla oluştuğunu ve özellikle yaşlı popülasyonda osteoporozla ilişkili olduğunu belirtmektedir (S1, S20, S74).

  2. BT görüntüleme sırasında distal radius kırıklarında eklem içi uzanım açısından değerlendirilmesi gereken ve distal radioulnar eklem uyumsuzluğu ile ilişkili anatomik yapı hangisidir?

    Cevabı göster

    Sigmoid çentik. Sigmoid çentik distal radioulnar eklemin radius tarafındaki eklem yüzüdür. BT'de sigmoid çentik tutulumunu ve eklem basamağını değerlendirin.

İlgili konular

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 12 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.