Çocuklarda eşzamanlı ipsilateral humerus ve önkol kırıkları

Amaç: Eşzamanlı ipsilateral humerus distal ve önkol çocuk kırıklarında erken redüksiyon ve internal tespitle tedavinin sonuçlarını incelemek. Çalışma planı: Kliniğimizde eşzamanlı ipsilateral humerus distal ve önkol kırığı nedeniyle tedavi gören altı hasta (1 kız, 5 erkek; ort. yaş 11.5; dağılım 9-13) değerlendirildi. Acil şartlarında tedaviye alınan olgulara redüksiyonu takiben perkutan ya da mini insizyonla K-telleri ile tespit uygulandı. İzlem sonunda olgular Flynn kriterlerine göre değerlendirildi. Dirsek ve önkolun radyolojik ve fonksiyonel değerleri sağlam tarafla karşılaştırıldı. Ortalama izlem süresi 35 ay (dağılım 24-52 ay) idi. Sonuçlar: Flynn kriterlerine göre, radyolojik olarak dört olguda çok iyi (%67), iki olguda iyi (%33), fonksiyonel olarak ise üç olguda çok iyi (%50), üç olguda iyi (%50) sonuç elde edildi. Dirsek ve önkol hareket açıklıkları ile dirsek radyolojik ölçümlerinde sağlam ve kırıklı ekstremiteler arasında anlamlı fark saptanmadı. Çıkarımlar: Eşzamanlı ipsilateral humerus distal ve ön-kol kırıklı olgularda yumuşak doku diziliminin sağlanması ve erken aktif rehabilitasyon tatminkar sonuçların alınabilmesi için önemli faktörlerdir. Bu tip kırıkların erken redüksiyon ve minimal yumuşak doku hasarı ile internal tespit yöntemleriyle tedavisini öneriyoruz.

Anahtar Kelimeler:

Atel, cerrahi, Kırık tespiti, internal, Huntington hastalığı, Radius kırıkları, Ulna kırıkları, Kemik telleri, Çocuk, Hareket açıklığı, eklem

Simultaneous ipsilateral humerus and forcarm fractures in children

Objectives: To evaluate the results of treatment with early reduction and internal fixation for simultaneous ipsilateral distal humeral and forearm fractures in children. Methods: The study included six patients (1 girl, 5 boys; mean age 11.5 years; range 9 to 13 years) who underwent treatment for ipsilateral humerus distal and forearm fractures. Reduction and fixation of fractures were performed percutaneously or by mini-open incisions. At the end of the follow-up period, patients were evaluated according to the Flynn's criteria. Radiologic and functional results on the involved side were compared with that of the normal. The mean follow-up period was 35 months (range 24 to 52 months). Results: According to the Flynn's criteria, radiologic outcome was perfect in four patients (%67), and good in two (%33); functional results were perfect in three (%50), and good in three patients (%50). There were no significant differences between the two extremities with respect to elbow and wrist range of motion and radiologic parameters of the elbows. Conclusion: Early anatomic realignment of soft tissues and early active rehabilitation in simultaneous ipsilateral fractures of the distal humerus and forearm are significant factors for a satisfactory outcome. Treatment with early reduction and internal fixation with minimal soft tissue damage seems to be the method of choice in these fractures.

Keywords:

Casts, Surgical, Fracture Fixation, Internal, Huntington Disease, Radius Fractures, Ulna Fractures, Bone Wires, Child, Range of Motion, Articular,

PDF

___

1.Alburger PD, Weidner PL, Betz RR. Supracondylar fractures of the humerus in children. J Pediatr Orthop 1992;12:16-9.
2. Wilkins KE. Supracondylar fractures with ipsilateral fractures. In: Rockwood CA, Wilkins KE, King RE, editors. Fractures in children. Vol. 3, 3rd ed. Philadelphia: Lippincott Co.; 1991. p. 607-10.
3. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up. J Bone Joint Surg [Am] 1974;56:263-72.
4. Ağuş H, Kalenderer Ö, Kayalı C. çocuk suprakondiler humerus kırıklarında kapalı redüksiyon ve perkütanöz çivileme sonuçlarımız. Acta Orthop Traumatol Turc 1999;33:18-22.
5. France J, Strong M. Deformity and function in supracondylar fractures of the humerus in children variously treated by closed reduction and splinting, traction, and percutaneous pinning. J Pediatr Orthop 1992;12:494-8.
6. Piggot J, Graham HK, McCoy GF. Supracondylar fractures of the humerus in children. Treatment by straight lateral traction. J Bone Joint Surg [Br] 1986;68:577-83.
7. Mehserle WL, Meehan PL. Treatment of the displaced supracondylar fracture of the humerus (type III) with closed reduction and percutaneous cross-pin fixation. J Pediatr Orthop 1991;11:705-11.
8. Shoemaker SD, Comstock CP, Mubarak SJ, Wenger DR, Chambers HG. Intramedullary Kirschner wire fixation of open or unstable forearm fractures in children. J Pediatr Orthop 1999;19:329-37.
9. Waseem M, Paton RW. Percutaneous intramedullary elastic wiring of displaced diaphyseal forearm fractures in children. A modified technique. Injury 1999;30:21-4.
10.Verstreken L, Delronge G, Lamoureux J. Shaft forearm fractures in children: intramedullary nailing with immediate motion: a preliminary report. J Pediatr Orthop 1988;8:450-3.
11. Amit Y, Salai M, Chechik A, Blankstein A, Horoszowski H. Closing intramedullary nailing for the treatment of diaphyseal forearm fractures in adolescence: a preliminary report. J Pediatr Orthop 1985;5:143-6.
12. Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop 1990;10:167-71.
13. Kay S, Smith C, Oppenheim WL. Both-bone midshaft forearm fractures in children. J Pediatr Orthop 1986;6:306-10.
14. Price CT, Scott DS, Kurzner ME, Flynn JC. Malunited forearm fractures in children. J Pediatr Orthop 1990;10:705-12.
15. Harrington P, Sharif I, Fogarty EE, Dowling FE, Moore DP. Management of the floating elbow injury in children. Simultaneous ipsilateral fractures of the elbow and forearm. Arch Orthop Trauma Surg 2000;120:205-8.
16. Blakemore LC, Cooperman DR, Thompson GH, Wathey C, Ballock RT. Compartment syndrome in ipsilateral humerus and forearm fractures in children. Clin Orthop 2000;(376):32-8.
17. Templeton PA, Graham HK. The 'floating elbow' in children. Simultaneous supracondylar fractures of the humerus and of the forearm in the same upper limb. J Bone Joint Surg [Br] 1995;77:791-6.
18. Papavasiliou V, Nenopoulos S. Ipsilateral injuries of the elbow and forearm in children. J Pediatr Orthop 1986;6:58-60.