Yusuf ÖZTÜRKMEN, Mahmut KARAMEHMETOĞLU, İbrahim AZBOY

Çocuklarda ayrılmış suprakondiler humerus kırıklarının tedavisinde kapalı redüksiyon ve lateralden perkütan çivileme

Amaç: Çocuklarda ayrılmış suprakondiler humerus kırıklarının tedavisinde kapalı redüksiyon ve lateralden perkütan çivileme ile tedavi sonuçları değerlendirildi. Çalışma planı: Otuz dört çocuk (25 erkek, 9 kız; ort. yaş 7.2; dağılım 3-13) ayrılmış suprakondiler humerus kırığı nedeniyle tedavi edildi. Beş hastada Gartland tip 2, 29 hastada tip 3 kırık vardı. Tüm olgularda kapalı redüksiyondan sonra, lateralden iki K-teli 11 olguda paralel, 23 olguda çapraz olarak gönderildi. Beş olguda üç adet K-teli kullanıldı. Tespit süresi ortalama 3.8 hafta (dağılım 3-6 hafta) idi. Son kontrollerde dirsek ön-arka grafilerinde Baumann ve taşıma açıları; yan grafilerde humerokapitellar açı ölçüldü ve sağlam taraf ile karşılaştırıldı. Klinik olarak fleksiyon-ekstansiyon aralığı muayene edildi. Sonuçlar Flynn ve ark.nın ölçütlerine göre değerlendirildi. Ortalama izlem süresi 22.6 ay (dağılım 10-48 ay) idi. Sonuçlar: Tüm kırıklar kaynadı. Olguların hiçbirinde çivi yolu enfeksiyonu, miyozitis ossifikans, kompartman sendromu ve iyatrojenik sinir yaralanması oluşmadı. Flynn ve ark.nın ölçütlerine göre, fonksiyonel olarak tüm olgularda (%100), radyografik olarak 33 olguda (%97.1) tatminkar sonuç elde edildi. Bir olguda 14 derece kubitus varus saptandı. Son kontrollerde ortalama Baumann açısı, humerokapitellar açı ve taşıma açısı sağlam taraf ile anlamlı farklılık göstermedi (p>0.05). Çıkarımlar: Çocuklarda ayrılmış suprakondiler humerus kırıklarının tedavisinde kapalı redüksiyon ve lateralden perkütan çivileme etkili, güvenilir ve sağlam bir yöntemdir.

Anahtar Kelimeler:

Humerus kırıkları, Dirsek eklemi, Kırık tespiti, internal, Çocuk, Kemik telleri

Closed reduction and percutaneous lateral pin fixation in the treatment of displaced supracondylar fractures of the humerus in children

Objectives: We evaluated the results of closed reduction and percutaneous lateral-pin fixation in the treatment of displaced supracondylar fractures of the humerus in children. Methods: Thirty-four children (25 boys, 9 girls; mean age 7.2 years; range 3 to 13 years) were treated for displaced supracondylar fractures of the humerus. Five patients had Gartland type 2, and 29 patients had type 3 fractures. After closed reduction, lateral-pin fixation was performed with two parallel (n=11) or crossed (n=23) K-wires. Three K-wires were used in five patients. The mean duration of fixation was 3.8 weeks (range 3 to 6 weeks). For comparison with the normal side, the Baumann and carrying angles were measured on anteroposterior, and the humerocapitellar angle on lateral radiographs. The range of motion of the elbow was assessed clinically. The results were evaluated according to the criteria of Flynn et al. after a mean follow-up of 22.6 months (range 10 to 48 months). Results: Union was achieved in all the patients. Complications such as pin-tract infections, myositis ossificans, compartment syndrome, or nerve injuries did not occur. According to the criteria of Flynn et al., functional and radiographic results were satisfactory in all the patients (%100) and in 33 patients (%97.1), respectively. One patient developed cubitus varus of 14 degrees. No significant differences were found between the mean Baumann, humerocapitellar, and carrying angles of the normal and affected sides (p>0.05). Conclusion: Closed reduction and percutaneous lateral pinning proved an efficient, reliable, and safe method in the treatment of displaced supracondylar fractures of the humerus in children.

Keywords:

Humeral Fractures, Elbow Joint, Fracture Fixation, Internal, Child, Bone Wires,

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