Çocuk radius boyun kırığının tedavisinde kapalı redüksiyon ve intramedüller çivileme: Olgu sunumu

On dört yaşında erkek çocuk, bisikletten düşerek sağ dirseğinden yaralanarak oldukça şiş ve ağrılı dirseği ile acil servise başvurdu. Olgunun radyolojik değerlendirmesinde, 90° açılanmalı radius boyun kırığı ile dirsek ekleminde instabilite saptandı. Genel anestezi altında, skopi kontrolünde manipülasyon ile denenen kapalı redüksiyon başarılı olamadı. İkinci aşamada yapılan perkütan çivileme ile redüksiyon girişimleri de başarısız oldu. Bunun üzerine önceden şekillendirilmiş bir K-teli ile skopi kontrolünde, distal radial stiloid lateralinden girilerek intramedüller çivileme ile kapalı redüksiyon ve tespit uygulandı. Dirsek eklemi üç hafta süreyle posterior alçı ateli ile korundu. Hasta daha sonra rehabilitasyon programına alındı. Tedavinin 16. ayında yapılan kontrolde, dirsek fleksiyonu 0-120°, ön kolda süpinasyon 60°, pronasyon 50° ölçüldü; kırık tamamen iyileşmişti. Elde edilen kemiksel iyileşmeye rağmen dirsek hareket genişliğindeki kısıtlılık nedeniyle klinik başarı düzeyi “iyi” olarak değerlendirildi.

Anahtar Kelimeler:

Radius kırıkları, Kırık tespiti, internal, Kıkırdak, eklem, Kemik çivileri, Dirsek eklemi, Kırık tespiti, intramedüller

Closed intramedullary pinning of a displaced radial neck fracture in a 14-year old child

A fourteen-year-old boy who had an elbow trauma due to a bicycle accident presented with complaints of swelling of the elbow joint and diffuse pain. His x-rays showed a radial neck fracture with a displacement of 90° and joint instability. Under general anesthesia, he underwent an unsuccessful closed reduction and manipulation under the guidance of an image intensifier. A second attempt of closed reduction with percutaneous pinning failed. Thus, closed reduction and intramedullary nailing was performed with the use of a pre-shaped Kirschner wire introduced through the lateral border of the radial styloid. The elbow joint was immobilized by a posterior elbow splint for three weeks, after which a rehabilitation program was instituted. In the 16th month, the extension and flexion of the elbow were 0° and 120°, and supination and pronation of the forearm were 50° and 60°, respectively. Complete healing of the fracture was observed. The clinical outcome was considered good because of the limited range of motion of the elbow joint.

Keywords:

Radius Fractures, Fracture Fixation, Internal, Cartilage, Articular, Bone Nails, Elbow Joint, Fracture Fixation, Intramedullary,

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