Gökhan MERİÇ, Bülent KİŞİN, Mehmet GEM, İhsan ŞENTÜRK, Ali Engin UYSAL

ÇOCUK ÖNKOL KIRIKLARININ CERRAHİ TEDAVİSİNDE KANAL-İÇİ ELASTİK ÇİVİLEME; 23 HASTANIN GERİYE DÖNÜK ANALİZİ

AMAÇ: Önkol kırıklarının tedavisinde en seçkin yöntem kapalı redüksiyon ve alçı tespiti ile uygulanan konservatif tedavidir. Cerrahi gereken önkol çift kırığı tedavisinde kanal-içi titanyum elastik çivi(TEN) yöntemi sıklıkla kullanılmaktadır. Bizde önkol çift kırığı nedeniyle kanal-içi TEN yapılan hastalarımızın tedavi sonuçlarını değerlendirdik. YÖNTEMLER: Çalışmaya, önkol çift kırığı nedeniyle kanal-içi TEN yapılan ve en az 1 yıl süreyle izlenen 23 hasta (2 kız,19 erkek; ort. yaş 12,2;dağılım7–18 yaş) alındı. Hastaların fonksiyonel muayeneleri ve radyolojik takipleri yapıldı. Hastaların fonksiyonel değerlendirmesi Price kriterlerine göre yapıldı. Ortalama takip süresi 20,1(dağılım 12-48ay)aydır. BULGULAR: 23 hastanın 21’inde (%91,3) kaynama gözledik. Kaynamayan 2 hasta konservatif alçı tedavisiyle kaynama elde ettik. Kırıkların ortalama kaynama süresi 2,6 (dağılım 1,5-6 ay) aydır. Dört vakada pin dibi enfeksiyonu( % 17,4)gelişti bu hastalar antibiyoterapi ve debritman ile iyileşti. Üç vakada n.ulnaris duyu dalı felci (% 12,9) gelişti. Ekstensör policis longus (EPL) rüptürü gelişen 1 vakada (%4,3) ekstensör indicis propius tendon transferi ile başparmak ekstansiyonu sağladık. 1 vakada(%4,3) tel malpozisyonu gözlemledik. Fonksiyonel olarak %91,3 (21 vaka) mükemmel sonuç elde ettik. SONUÇ: Fonksiyonel sonuçlarının iyi olması, uygulama tekniğinin ve implant çıkartılmasının kolay olması, daha az yumuşak doku hasarına yol açması nedeniyle çocuk önkol çift kırıklarının cerrahi tedavisinde intramedüller TEN uygulamasının iyi bir seçenek olduğunu düşünüyoruz.

Anahtar Kelimeler:

çocuk önkol kırıkları, kanal-içi çivi

RESULTS OF TITANYUM ELASTIC INTRAMEDULLARY NAILING (TEN) IN FOREARM FRACTURES IN CHILDREN; A RETROSPECTIVE ANALYSIS OF 23 CASES

OBJECTIVE: The treatment of fractures of the forearm between the detection of the most exclusive method of conservative treatment with closed reduction and plaster. Surgical treatment of forearm fractures intramedullary TEN method to be used frequently. We evaluated the treatment results of forearm fractures in patients with intramedullary TEN. METHODS: The study of TEN and intramedullary bone forearm fractures in 23 patients followed for at least 1 year (2 female, 19 male, mean. Age 12.2; range 7-18 years) were included. Functional and radiological follow-up examinations were performed. Price criteria were used for the functional assessment of patients. Median follow-up 20.1 (range 12- 48months) months. RESULTS: .21 out of 23 patients (91.3%) observed union. We have two patients with nonunion achieved union with conservative treatment with plaster. Average time to union of fractures 2.6 (range 1.5-6 months) months. Pin-track infection in 4 cases (17.4%) of these patients improved with antibiotherapy and debridement, 3 cases (12.9%) were developed sensory branch of n. ulnaris palsy. 1 case (4.3%) extensor pollicis longus (EPL) rupture in with the thumb extensor indicis propius tendon transfer to provided extension. 1 case (4.3%) wire malposition observed. Functionally, 91.3% (21 cases) have achieved excellent results. CONCLUSION: We think that, good functional outcome, easy application technique, and less soft tissue injury when implant removal of forearm fractures in children due to lead practice in the surgical treatment of intramedullary TEN is a good option

Keywords:

pediatric forearm fractures, intramedullary nail,

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