Suprakondiler humerus kırıklarının klinik sonuçları: Kapalı- açık redüksiyonun karşılaştırılması

Amaç: Suprakondiler humerus kırıkları çocuklarda en sık görülen yaralanmalar arasındadır. Gartland tip 2 ve 3 kırıkların tedavisinde kapalı veya açık redüksiyondan sonra perkutan pinleme uygulanır. Bu çalışmanın amacı Gartland tip 2 ve 3 suprakondiler humerus kırıklarında klinik sonuçları ve kapalı- açık redüksiyonun sonuçlara etkisini değerlendirmektir.Materyal ve metot: Çalışmamıza 2015-2018 yılları arasında suprakondiler humerus kırığı nedeniyle tedavi edilen, Gartland tip 2 ve 3 kırığı olan, 10 yaşın altında olan, en az 3 ay takibi olan 48 hasta dahil edildi. Hastaların medikal kayıtlarından ve radyografilerinden elde edilen veriler değerlendirildi. Hastaların demografik bilgileri, kırık geçirdiği taraf, kırık tipi, pin konfigürasyonu, cerrahi yapılana kadar geçen zaman, takip süresi kaydedildi. Radyografilerinde ölçülen Baumann açıları, son kontrolde değerlendirilen eklem hareket açıklıkları ve taşıma açıları değerlendirildi. Sonuçlar Flynn kriterleri kullanılarak değerlendirildi. Hastalar kapalı redüksiyon uygulananlar (Grup 1), açık redüksiyon uygulananlar (Grup 2) olmak üzere iki gruba ayrıldı ve sonuçlar karşılaştırıldı.Bulgular: Hastaların ortalama yaşı 5,94’dü(1-10yaş). 21 hastadan oluşan kapalı redüksiyon grubu (Grup 1) ve 27 hastadan oluşan açık redüksiyon grubu (Grup 2) arasında yaş, cinsiyet ve etkilenen taraf açısından fark yoktu. Hastalar ortalama 11,06 saat sonra (8-48 saat) ameliyata alındı ve ortalama 18,60 ay (3-44 ay) takip edildi. Gruplar arasında ameliyata alınma zamanı ve takip süresi açısından fark yoktu. Flynn kriterlerine göre 43 hastada (%89,5) mükemmel ve iyi sonuç elde edildi. Grup 1’deki hastaların Flynn kriterlerine göre 20’sinde (%95,2) mükemmel ve iyi sonuç elde edildi. Grup 2’deki hastaların Flynn kriterlerine göre 22’sinde (%81,5) mükemmel ve iyi sonuç elde edildi. 3 hastada orta sonuç (%11,1), 2 hastada (%7,4) kötü sonuç elde edildi. Gruplar karşılaştırıldığında kapalı redüksiyon grubunda mükemmel ve iyi sonucun daha fazla oranda olduğu görüldü, fakat istatistiksel olarak anlamlı fark yoktu. Sonuç: Suprakondiler humerus kırıklarının tedavisinde kapalı ve açık redüksiyon sonrasında pinlerle fiksasyon etkili ve güvenli bir tedavi yöntemidir. Öncelikle kapalı redüksiyon uygulanmalıdır, fakat kapalı redüksiyon sağlanamazsa açık redüksiyon da tatminkar sonuçlar sunar. Bu çalışmada kapalı- açık redüksiyonla tedavi edilen hastaların klinik sonuçları arasında anlamlı fark tespit edilmedi. Kapalı- açık redüksiyonun klinik sonuçlar üzerine etkisini daha iyi değerlendirebilmek için, daha fazla sayıda hasta içeren prospektif çalışmalar yapılabilir.

Anahtar Kelimeler:

Humerus kırıkları, Dirsek, Kapalı kırıklar

Clinical results of supracondylar humerus fractures: Comparison of closed- open reduction

Background: Humerus supracondylar fractures are among the most common injuries in children. Percutaneous pinning is applied after closed or open reduction for the treatment of Gartland type 2 and 3 fractures. The aim of this study is to evaluate the clinical results in Gartland type 2 and 3 humerus supracondylar fractures and the effect of closed- open reduction on results.Methods: Between 2015- 2018, 48 patients who were treated for Gartland type 2 and 3 humerus supracondylar fractures, below 10 years, minumum 3 months follow-up were included in our study. The data which were obtained from medical records and radiographs were evaluated. Demographic data, fracture side, fracture type, pin configuration, time to surgery, follow-up time were recorded. Measured Baumann angles on radiographs, range of motions and carrying angles on last follow-up were evaluated. Postoperative results were evaluated by using Flynn criteria. Patients were divided into two groups as patients were treated with closed reduction (Group 1), treated with open reduction (Group 2), and results were compared.Results: Mean patient age was 5,94 (1-10 years). Group 1 (21 patients) and Group 2 (27 patients) were not different according to patient age, sex and fracture side. Patients were operated after a mean of 11,06 hours (8- 48 hours), and the mean follow-up was 18,60 months (3- 44 months). The groups were not different according to time to operation and follow-up period. Excellent and good results were obtained in 43 patients (89,5 %) according to Flynn criterias. Excellent and good results were obtained in 20 patients (95,2 %) according to Flynn criterias in Group 1. Excellent and good results were obtained in 22 patients (81,5 %) according to Flynn criterias in Group 2. Fair results were obtained in 3 patients (11,1 %), poor results in 2 patients (7,4 %). In comparison, more excellent and good result rates were seen in closed reduction group, but there was no statistically significant difference. Conclusions: Percutaneus pinning after closed and open reduction is effective and safe in the treatment of humerus supracondylar fractures. First closed reduction must be performed, but if closed reduction could not obtained, open reduction serves satisfactory results. In this study, there was no significant difference between patients who were treated with closed or open reduction. For better evaluation of the effect of closed- open reduction on clinical results, prospective studies with more patients could be performed.

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