Falanks cisim ve eklem içi kırıkları

Özet

Falanks kırıkları çocuklarda sık görülen üst ekstremite kırıkları arasındadır. Parmak grafileri ilk değerlendirmede kullanılır; parmak kırıklarının değerlendirilmesinde klinik fonksiyon muayenesi de gereklidir. Rotasyon deformitesi klinik muayeneyle değerlendirilir; tendon ve bağ değerlendirmesinde MR kullanılabilir.

Faz ve pencere

Kontrastsız tanısal

Parmak travmalarında destekleyici görüntüleme olarak bilgisayarlı tomografi kullanılır ve kemik yaralanmaların ayırt edilmesinde etkili olabilir [S9, S76]. Bilgisayarlı tomografi, ön operatif planlama için oldukça yararlı olan çok boyutlu ve üç boyutlu yeniden yapılandırmalar sağlar [S2].

BT bulguları

• Proksimal falanks kırıklarında transvers veya kısa oblik patern görülebilir. Kırık özellikleri ve el işlevi, tedavi planında dikkate alınmalıdır.
• Proksimal falanks kırıklarında anatomik azaltım, özellikle intramedüller vida sabitlemesinde, postoperatif fonksiyonu önemli ölçüde tahmin eder [S19].
• PIP eklem kırıklı çıkıkları dorsal, volar veya pilon paterni olarak tanımlanabilir.
• PIP eklem içi kırıklarında orta falanksın volar tabanında eklem uyumunu ve stabilitesini bozabilen bir avulsiyon fragmanı bulunabilir.
• DIP eklem içi kırıkları distal falanks tabanında, orta falanks kondilinde veya her iki bölgede görülebilir.
• Kondil kırıkları falanks kondilini tutabilir; DIP eklem içi kırıklarında orta falanks kondili tutulabilir.
• Eklem basamağı ve impaksiyon — subkondral yüz eş düzlemde devam etmez veya eklem tabanı çökmüştür.
• İki haftadan fazla süren ihmal edilmiş volar PIP eklem kırık-çıkıklarında yumuşak doku fibrozisi ve kapsül kontraktürü ilerlemiş olabilir [S60].
• PIP kırıklı çıkığında redüksiyon sonrası eklemin iyi hizalanıp korunması olumlu sonuç için önemlidir. PIP kırıklı çıkığında stabilite ve uygun tedavi değerlendirmesi klinik fonksiyon muayenesiyle birlikte yapılmalıdır.
• Eklem içi falanks kırıklarında BT, kemik yapıyı ve kırık morfolojisini ayrıntılı değerlendirmeye yardımcı olabilir.

Ölçütler ve sınıflamalar

Morfolojik kırık paterni

Proksimal falanks gövde kırıkları transvers veya kısa oblik; PIP eklem kırıklı çıkıkları ise dorsal, volar ya da pilon paterni olarak tanımlanabilir. Bu betimleme, kırığın anatomik bölümünü ve stabiliteyi etkileyebilecek eklem geometrisini belirtir.

Normalde

Falanks deformitesi değerlendirilirken etkilenmemiş karşı tarafın görüntüsü karşılaştırma için kullanılabilir.

Ayırıcı tanı

Normal varyant veya eski travmatik değişiklik olasılığında, karşılaştırmalı radyografiler görüntü bulgularının değerlendirilmesine yardımcı olabilir.

Hiperekstansiyon sonrası kilitlenmiş MP eklemi değerlendirmede röntgenlerin incelenmesi ve ileri görüntüleme düşünülmesi şarttır [S64].

Tuzaklar

• Röntgenlere kıyasla bilgisayarlı tomografi, projeksiyon veya yapışan yapılarla sınırlı olmayan üç boyutlu değerlendirmenin sağladığı hassas kemik detayını sunar [S2].
• PIP eklem tabanı impaksiyonu yalnız kırık çizgisi şeklinde görünmeyebilir; karşı eklem konturuna göre subkondral çökme ve basamak arayın.
• Kemik BT'si kemik yapıların değerlendirilmesini sağlar; el ve el bileğindeki tendon ve bağ yaralanmalarını değerlendirmede MRI kullanılabilir.
• Rotasyon deformitesini değerlendirmek için görüntülemeye ek olarak ilgili parmağın fleksiyonda olduğu klinik fonksiyonel muayene gerekir.

Kendini dene

1. Orta falanksın volar tabanındaki fragman PIP eklem uyumunu ve stabilitesini bozuyorsa hangi yaralanma düşünülmelidir?

   • PIP eklem kırıklı çıkığı
   • Mallet kırığı
   • Falanks cisim kırığı
   • Besleyici kanal
   Cevabı göster

   PIP eklem kırıklı çıkığı. Orta falanksın volar tabanındaki fragman ve eklem uyumunun bozulması PIP eklem kırıklı çıkığını düşündürür.

2. PIP eklem kırıklı çıkıklarında tanımlanan üç patern hangileridir?

   • Dorsal, volar ve pilon
   • Transvers, oblik ve spiral
   • Avulsiyon, stres ve patolojik
   • Proksimal, orta ve distal
   Cevabı göster

   Dorsal, volar ve pilon. PIP eklem kırıklı çıkıklarında dorsal, volar ve pilon paternleri tanımlanır.

İlgili konular

• Diğer metakarp cisim, baş ve taban kırıkları

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 27 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.