Gürsel SAKA, Fatih KÜÇÜKDURMAZ, Necdet SAĞLAM, Fuat AKPINAR

Tuber iskium avülsiyon kırığının modifiye subgluteal yaklaşımla cerrahi tedavisi: Olgu sunumu

Bu olgu sunumunda, bir futbol maç› s›ras›nda yaralanan ve deplase tuber iskium avülsiyon k›r›¤› sap- tanan 16 yafl›ndaki bir erkek futbolcu bildiriyoruz. Cerrahi tedavi planlanan hastaya subgluteal yaklafl›m ve longitüdinal insizyonla aç›k redüksiyon ve internal tespit uyguland›. Hasta ameliyattan 6 ay sonra sportif aktivitelere geri döndü ve ameliyat sonras› 16. ay takibinde ameliyat öncesi sportif per- formans›na ulaflt›. Bu tip k›r›klarda, özellikle siyatik sinire ba¤l› komplikasyonlar ve ekspojür zorlu¤u nedeniyle, s›kl›kla cerrahi tedaviden kaç›n›lmaktad›r. Ancak biz, bu insizyonun, nörovasküler yap›lara zarar vermeden yeterli ekspojür sa¤lamas›ndan dolay› mevcut yöntemlere güvenli bir alternatif oldu¤una inan›yoruz. Bu çal›flmada, tuber iskium avülsiyon k›r›klar›n›n cerrahi tedavisinde uygulanan bu alternatif insizyonu de¤erlendirmeyi amaçlad›k.

___

1. Gidwani S, Jagiello J, Bircher M. Avulsion fracture of the ischial tuberosity in adolescents — an easily missed diagnosis. BMJ 2004;329:99-100.

2. Gidwani S, Bircher MD. Avulsion injuries of the hamstring origin – a series of 12 patients and management algorithm. Ann R Coll Surg Engl 2007;89:394-9.

3. Bolgla LA, Jones DL, Keskula DR, Duncan JB. Hip pain in a high school football player: a case report. J Athl Train 2001; 36:81-4.

4. Servant CT, Jones CB. Displaced avulsion of the ischial apoph- ysis: a hamstring injury requiring internal fixation. Br J Sports Med 1998;32:255-7.

5. Akova B, Okay E. Avulsion of the ischial tuberosity in a young soccer player: six years follow-up. J Sports Sci Med 2002;1:27- 30.

6. Wootton JR, Cross MJ, Holt KW. Avulsion of the ischial apophysis. The case for open reduction and internal fixation. J Bone Joint Surg Br 1990;72:625-7.

7. Abbate CC. Avulsion fracture of the ischial tuberosity: a case report. J Bone Joint Surg Am 1945;27:716-7.

8. Kaneyama S, Yoshida K, Matsushima S, Wakami T, Tsunoda M, Doita M. A surgical approach for an avulsion fracture of the ischial tuberosity: a case report. J Orthop Trauma 2006; 20:363-5.

9. Miller SL, Gill J, Webb GR. The proximal origin of the ham- strings and surrounding anatomy encountered during repair. A cadaveric study. J Bone Joint Surg Am 2007;89:44-8.

10. Wood DG, Packham I, Trikha SP, Linklater J. Avulsion of the proximal hamstring origin. J Bone Joint Surg Am 2008;90: 2365-74.

11. Muscato M, Lim-Dunham J, Demos TC, Lomasney LM. Avulsion fracture of the apophysis of the ischial tuberosity. Orthopedics 2001;24:1127,1198-200.

12. Miller A, Stedman GH, Beisaw NE, Gross PT. Sciatica caused by an avulsion fracture of the ischial tuberosity. A case report. J Bone Joint Surg Am 1987;69:143-5.

13. Salvi AE, Metelli GP, Corona M, Donini MT. Spontaneous healing of an avulsed ischial tuberosity in a young football player. A case report. Acta Orthop Belg 2006;72:223-5.

14. Schlonsky J, Olix ML. Functional disability following avulsion fracture of the ischial epiphysis. Report of two cases. J Bone Joint Surg Am 1972;54:641-4.

15. Miller SL, Webb GR. The proximal origin of the hamstrings and surrounding anatomy encountered during repair. Surgical technique. J Bone Joint Surg Am 2008;90:108-16.

16. Metzmaker JN, Pappas AM. Avulsion fractures of the pelvis. Am J Sport Med 1985;13:349-58.