ERDİNÇ ESEN, Yunus DOĞRAMACI, SERAP GÜLTEKİN, Gökay GÖRMELİ, AHMET YILDIRIM, ULUNAY KANATLI, SELÇUK BÖLÜKBAŞI

Çocuklarda suprakondiler humerus kırıklarının açık-kapalı redüksiyon ve internal tespitle tedavisinde radyasyon sürelerinin karşılaştırılması

Amaç: Çocuklarda yer değiştirmiş suprakondiler humerus kırıklarında uyguladığımız K-teli ile yapılan iki tedavi yöntemi (Açık redüksiyon internal tespit-ARİF, Kapalı redüksiyon internal tespit, KRİF), ameliyat süresi ve radyasyona maruz kalma süresi açısından karşılaştırıldı. Çalışma planı: Yer değiştirmiş suprakondiler humerus kırığı (Gartland tip 3) tanısıyla cerrahi tedavi uygulanan 124 hasta (76 erkek, 48 kız) geriye dönük olarak incelendi. Elli iki hastaya (ort. yaş 7.5±2.8) ARİF, 72 hastaya (ort. yaş 6.1±2.5) KRİF uygulandı. İki gruptaki ameliyat süresi ve floroskopi uygulama süresi kaydedildi. Hastalar son takiplerde, eklem hareket açıklığı, varus-valgus açılanma derecesi, damar sinir muayenesi ve kozmetik görünüm açısından değerlendirildi. Fonksiyonel ve kozmetik sonuçların değerlendirilmesinde Flynn ve ark.nın ölçütleri kullanıldı. Ortalama takip süresi ARİF grubunda 49.3±18.6 ay, KRİF grubunda 50.4±17.9 ay idi. Sonuçlar: Tüm olgularda altıncı hafta sonunda radyografik kaynama görüldü. Kozmetik ve fonksiyonel açıdan iki grup arasında anlamlı fark saptanmadı (p>0.05). Mükemmel ve iyi sonuç oranı KRİF grubunda %90.3, ARİF grubunda %86.6 bulundu. Ortalama ameliyat süresi, KRİF grubunda 44.2±12.6 dk, ARİF grubunda 28.3±8.2 dk bulundu. Ortalama floroskopi uygulama süresi, KRİF grubunda 36.0±15.3 sn, ARİF grubunda 11.7±4.5 sn idi. Ameliyat süresi ve floroskopi süresinin KRİF grubunda anlamlı derecede uzun olduğu görüldü (p=0.000). Çıkarımlar: Uzamış skopi kullanımı radyasyona maruz kalmayı artırdığından, yer değiştirmiş suprakondiler humerus kırıklarında ARİF yönteminin tercih edilmesini öneriyoruz.

Anahtar Kelimeler:

İnternal fiksatörler, Geriyedönük çalışma, Kemik telleri, Çocuk, Floroskopi, Radyasyon dozu, Eksternal fiksatörler, Humerus kırıkları, Kırık tespiti, internal, Dirsek eklemi

Comparison of radiation exposure times in the treatment of pediatric supracondylar humeral fractures with open-closed reduction and internal fixation

Objectives: We compared open reduction-internal fixation (ORIF) and closed reduction-internal fixation (CRIF) with respect to operation and radiation exposure times in the treatment of displaced supracondylar humeral fractures in children. Methods: This retrospective study included 124 children (76 boys, 48 girls) who underwent surgical treatment for displaced supracondylar humeral fractures (Gartland type 3). Of these, 52 patients (mean age 7.5±2.8 years) underwent ORIF, and 72 patients (mean age 6.1±2.5 years) underwent CRIF. Operation and fluoroscopy times were recorded in both groups. Final assessments included range of motion, varus- valgus angulation, neurovascular findings, and cosmetic appearance. Functional and cosmetic results were assessed using the criteria of Flynn et al. after a mean follow-up period of 49.3±18.6 months and 50.4±17.9 months in the ORIF and CRIF groups, respectively. Results: Radiographical union was obtained in all the patients within six weeks postoperatively. The two groups did not differ with respect to functional and cosmetic results (p>0.05), with excellent-good results accounting for 90.3% in the CRIF group, and 86.6% in the ORIF group. The mean operation times were 44.2±12.6 and 28.3±8.2 minutes, and the mean fluoroscopy times were 36.0±15.3 and 11.7±4.5 seconds, in the CRIF and ORIF groups, respectively, both being significantly longer in the former (p=0.000). Conclusion: As extended fluoroscopy use increases radiation exposure, ORIF sems to be more convenient for the treatment of displaced supracondylar humeral fractures.

Keywords:

Internal Fixators, Retrospective Studies, Bone Wires, Child, Fluoroscopy, Radiation Dosage, External Fixators, Humeral Fractures, Fracture Fixation, Internal, Elbow Joint,

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