TUS SINAVINA HAZIRLANAN BİR MESLEKTAŞIMIZDA UYARICI İLAÇLARLA İNDÜKLENEN EPİLEPSİ NÖBETİ SONRASI KİLİTLİ POSTERIOR OMUZ KIRIKLI ÇIKIĞI

Aydıner Kalacı, Yunus Doğramacı, Raif Özden, Ahmet Nedim Yanat
1.221 566

Öz


Posterior omuz çıkığı nadir bir durumdur ve humerus başında ters Hill-Sachs lezyonuna yol açabilir. Humeral baştaki defekt eklem yüzünün %20’sinden fazlasını oluşturuyorsa omuz iç rotasyonunda instabiliteye yol açar. Bu durumda kapalı redüksiyon sağlansa da stabilizasyon için cerrahi gerekir. Biz burada uyanıklık sağlayan ve etki mekanizması tam bilinmeyen bir ajan olan modafilin kullanan Tıpta Uzmanlık Sınavına (TUS) hazırlanan bir meslektaşımızda görülen, ilacın indüklendiğini düşündüğümüz epilepsi nöbeti sonrası kilitli posterior omuz kırıklı çıkığında uyguladığımız otolog kemik greftlemeyle başarılı tedavi ettiğimiz olgumuzu sunduk. Diğer tekniklerden farklı olarak anatomik restorasyonu sağlayan bu tekniğin özellikle genç aktif hastalarda akut dönemde uygulanması gerektiğini düşünüyoruz. Biz greftleme dışındaki seçeneklerin normal fizyolojiye uygun olmayan girişimler olduğundan, greftleme gibi daha basit ve fizyolojik bir yöntemde başarı sağlanamıyan hastalar olursa bunların geç dönem rekonstrüksiyonlarda kurtarıcı ameliyat olarak saklanması gerektiği fikrine sahibiz. Otogreft kullanımında döner saha sorunu dezavantaj oluşturuyorsa da tarif ettiğimiz greft alma yöntemiyle bunun en aza indirileceğini düşünüyoruz.

Anahtar Kelimeler: Kemik grefti; kilitli posterior omuz çıkığı; modafilin; nöbet; Ters Hill-Sachs lezyon.

SUMMARY

Posterior dislocation of the shoulder joint is a rare condition which may cause a reverse Heel- Sachs lesion. If the defect in the humeral head is more than 20%, it will result in instability during the internal rotation; in that case even if the joint closely reduced the surgical stabilization will be necessary. In this case we report a case of locked posterior, fracture- dislocation of the shoulder joint in a medical doctor secondary to a seizure (epileptic) attack induced by an alerting agent, with unknown mechanism of action, called Modafilin, which he used during the preparation for the TUS exam. The case was managed surgically using autologus bone graft and internal fixation. The current technique, unlike previous procedures, provides anatomic restoration and we think that it should be applied in young and active patients. We think that, choices other than grafting are non-physiological and should be used as a salvage method for late cases following graft failure. Although graft harvesting is a disadvantage, the method of graft harvesting which we used will minimize the disadvantages.

Keywords: Bone grafting; locked posterior shoulder dislocation, modafilin, seizure, reverse Hill-Sachs lesion.


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