Abdullah EREN, Afşar T. ÖZKUT, Faik ALTINTAŞ, Melih GÜVEN

Çocuklarda suprakondiler humerus tip III kırıkların tedavisinde lateral ve medial girişimler ile cerrahi tedavi sonuçlarının fonksiyonel ve kozmetik açıdan karşılaştırılması

Amaç: Çocuklarda suprakondiler humerus tip III kırıklarda lateral ve medial girişim ile cerrahi tedavi sonuçları fonksiyonel ve kozmetik açıdan karşılaştırıldı. Çalışma planı: Çalışmaya, suprakondiler humerus tip III kırığı nedeniyle lateral (12 erkek, 8 kız; ort. yaş 7.2; dağı- lım 4-12) ve medial (16 erkek, 4 kız; ort. yaş 7.4; dağılım 3-11) girişim ve iki adet çapraz Kirschner teli ile tespit uygulanan iki hasta grubu alındı. Fonksiyonel ve kozmetik sonuçlar Şynn ve ark.nın ölçütlerine göre değerlendirildi. Ortalama izlem süresi lateral girişim grubunda 19.8 ay (dağı- lım 8-30 ay), medial girişim grubunda 19.5 ay (dağılım 12- 27 ay) idi. Ayrıca, hastaların kesi yeri ile ilgili memnuniyetleri araştırıldı. Sonuçlar: Lateral girişim grubunda, fonksiyonel sonuçlar 18 olguda (%90) mükemmel, bir olguda (%5) iyi, bir olguda orta; kozmetik sonuçlar ise 19 olguda (%95) mükemmel, bir olguda (%5) orta olarak değerlendirildi. Medial girişim grubundaki sonuçlar, fonksiyonel açıdan 19 olguda (%95) mükemmel, bir olguda (%5) iyi; kozmetik açıdan ise tüm olgularda mükemmel olarak değerlendirildi (p>0.05). Lateral girişim grubunda bir olguda ameliyat sonrasında geçici ulnar sinir paralizisi, bir başka olguda hareket kısıtlılığı ile birlikte kübitus varus deformitesi gelişti. Lateral grupta olguları n %25’i, medial grupta ise %70’i kesi yerinden memnun kaldığını belirtti. Çıkarımlar: Çocuk suprakondiler humerus kırıklarının cerrahi tedavisinde lateral ve medial girişimler arasında fonksiyonel ve kozmetik sonuçlar açısından anlamlı fark olmamasına karşın, ulnar sinir yaralanması olasılığının daha düşük olması ve medial kesi skarının estetik açıdan daha kabul edilebilir olması nedeniyle medial girişim tercih edilebilir.

Anahtar Kelimeler:

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

Comparison between the lateral and medial approaches in terms of functional and cosmetic results in the surgical treatment of type III supracondylar humeral fractures in children

Objectives: We compared the functional and cosmetic results of lateral and medial approaches in the surgical treatment of type III supracondylar humeral fractures in children. Methods: The study included two groups in which type III supracondylar humeral fractures were treated using either lateral (12 boys, 8 girls; mean age 7.2 years; range 4 to 12 years) or medial (16 boys, 4 girls; mean age 7.4 years; range 3 to 11 years) approaches and internal fixation. Functional and cosmetic results were assessed according to the criteria proposed by Flynn et al. The mean follow-up periods were 19.8 months (range 8 to 30 months) and 19.5 months (range 12 to 27 months) in the lateral and medial approach groups, respectively. Patient satisfaction was also inquired regarding the site of the incision scar. Results: In the lateral approach group, functional results were excellent in 18 patients (90%), good in one patient (5%), and fair in one patient, while cosmetic results were excellent in 19 patients (95%) and good in one patient. In the medial approach group, 19 patients (95%) had excellent and one patient (5%) had good functional results, while all the patients had an excellent cosmetic result (p>0.05). Complications were seen only in the lateral approach group, including transient ulnar nerve palsy in one patient, and cubitus varus deformity due to limited range of motion in another. The satisfaction rates concerning the site of the incision scar were 25% and 70% in the lateral and medial approach groups, respectively. Conclusion: Although no significant differences were found between the lateral and medial approaches in terms of functional and cosmetic results, the medial approach may be more convenient due to a lower risk for ulnar nerve injury and to a greater acceptability of the medial incision scar on the part of the patients.

Keywords:

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

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