Hasan MAY, Melih ÜNAL, Ömer Faruk KILIÇASLAN

Pediatrik Femur Kırıklarında İnkorpore Pelvipedal Alçılama Sonrası Rezidüel Deformite Sonuçları

Amaç: Çocuk femur kırıklarının tedavisinde amaç, en az invaziv müdahale ile yeterli ve kabul edilebilir bir dizilim elde ederek kaynamanın sağlanmasıdır.Özellikle 2-6 yaş aralığında tedavi tartışmalı olmasına rağmen pelvipedal alçılama bu yaş grubunda en yaygın kullanılan tedavi yöntemidir. Güvenli ve daha az invaziv olmasına rağmen iyileşme sonrası rezidüel deformite görülebilmektedir. Bu çalışmanın amacı erken inkorpore pelvipedal alçılama ile tedavi edilen 7 yaş altı pediatrik hastaların rezidüel deformite açısından radyolojik sonuçlarını sunmaktır. Gereç ve Yöntemler: Bu çalışmada pediatrik femur cisim kırığı sebebiyle opere edilmiş 10’u erkek, 6’sı kız toplam 16 hasta değerlendirildi ve hastaların iyileşme sonrası takiplerindeki deformiteler ölçüldü. Hastaların ön-arka ve yan plan açılanması ile ekstremite eşitsizlikleri radyografi yardımıyla; rotasyon deformiteleri ise prone pozisyonunda fizik muayene ile değerlendirildi. Bulgular: Ortalama takip süresi 50,8±16,9 ay (24-78) olan 16 hastanın yaş ortalaması 33±21,1 ay(6- 84) idi. Hastaların iyileşme sonrası ortalama ön-arka plan açılanması 5,2 ± 6,7 derece ve yan plan açılanması 12,3± 7,5 dereceydi. 6 hastada 3,3±2,7 mm kısalık saptanırken 5 hastada ise 8,8±3,9 mm uzama tespit edildi. Sonuç: Sonuç olarak erken inkorperepelvipedal alçılama yatış süresi ve maliyet açısından avantajlı bir tedavi olmasının yanı sıra deformite açısından da güvenlidir.

Residual Deformity Results After Incorporated Spica Casting in Pediatric Femur Fractures

Aim: The aim of the treatment of pediatric femoral fractures is to provide union by obtaining an adequate and acceptable alignment with the least invasive intervention. Although the treatment is controversial, especially in the age range of 2-6, pelvipedal casting is the most widely used treatment method in this age group. Although it is safe and less invasive, residual deformity can be seen after healing. The aim of this study is to present the radiological results in terms of residual deformity in pediatric patients under 7 years of age who were treated with early in corperated pelvipedal casting. Material and Methods: In this study, a total of 16 patients (10 males and 6 females) whowere operated for pediatric femoral shaft fractures, were evaluated and the deformities in the post-recovery follow-up of the patients were measured. Angulation and limblenght discrepancy were evaluated on radiography and rotational deformities were measured by physical examination in the prone position. Results: The mean age of 16 patients was 50,8 ± 16,9 months (24-78) and mean follow-up period of was 33 ± 21,1 months. After recovery, mean coronal plan angulation was 5,2 ± 6,7 degrees and sagittalplan angulation was 12,3 ± 7,5 degrees. While 3,3 ± 2,7 mm shortening was detected in 6 patients, and 8,8 ± 3,9 mm elongation was detected in 5 patients. Conclusion: Early in corporated spica casting is an advantageous treatment in terms of hospital stay and cost, besides it also safe in terms of deformity.

PDF

___

1. Bahuaud C, Beneteau M, Dorr MF. Treatment of fractures of the femoral diaphysis in children. Soins Chir 1993;(150-151):36- 42.
2. Carey TP, Galpin RD. Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop Relat Res 1996;(332):110-118.
3. Rewers A, Hedegaard H, Lezotte D, Meng K, Battan FK, Emery K, Hamman RF. Childhood femur fractures, associated injuries, and sociodemographic risk factors: A population-based study. Pediatrics 2005;115(5):e543-e52.
4. Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg 2004;12(5):347-359.
5. Sanders JO, Browne RH, Mooney JF, Raney EM, Horn BD, Anderson DJ, Hennrikus WL, Robertson WW. Treatment of femoral fractures in children by pediatric orthopedists: Results of a 1998 survey. J Pediatr Orthop 2001;21(4):436-441.
6. Aslani H, Tabrizi A, Sadighi A, Mirbolook AR. Treatment of pediatric open femoral fractures with external fixator versus flexible intramedullary nails. Arch Bone Jt Surg 2013;1(2):64- 67.
7. Cassinelli EH, Young B, Vogt M, Pierce MC, Deeney VF. Spica cast application in the emergency room for select pediatric femur fractures. J Orthop Trauma 2005;19(10):709-716.
8. Hughes BF, Sponseller PD, Thompson JD. Pediatric femur fractures: Effects of spica cast treatment on family and community. J Pediatr Orthop 1995;15:457-460.
9. Frech-Dörfler M, Hasler CC, Häcker FM. Immediate hip spica for unstable femoral shaft fractures in preschool children: Still an efficient and effective option. Eur J Pediatr Surg 2010;20(1):18- 23.
10. Thompson JD, Buehler KC, Sponseller PD, Gray DW, Black BE, Buckley SL, Griffin PP. Shortening in femoral shaft fractures in children treated with spica cast. Clin Orthop Relat Res 1997;(338):74-78.
11. Flynn JM, Garner MR, Jones KJ, D’Italia J, Davidson RS, Ganley TJ, Horn BD, Spiegel D, Wells L. The treatment of low- energy femoral shaft fractures: A prospective study comparing the “walking spica” with the traditional spica cast. J Bone Joint Surg Am 2011;93(23):2196-2202.
12. Kasser JR, Beaty JH. Femoral shaft fractures. In: Rockwood, Wilkins, Beaty, eds. Fractures in Children, Vol. III. 5th ed. Philadelphia, PA.: Lippincott Williams & Wilkins; 2001: 941-80.
13. Ramo BA, Martus JE, Tareen N, Hooe BS, Snoddy MC, Jo CH. Intramedullary nailing compared with spica casts for isolated femoral fractures in four and five-year-old children. J Bone Joint Surg Am 2016;98(4):267-275.
14. Sagan ML, Datta JC, Olney BW, Lansford TJ, McIff TE. Residual deformity after treatment of pediatric femur fractures with flexible titanium nails. J Pediatr Orthop 2010;30(7):638- 643.
15. Akşahin E, Celebi L, Yüksel HY, Hapa O, Muratli HH, Aktekin CN, Biçimoğlu A. Immediate incorporated hip spica casting in pediatric femoral fractures: Comparison of efficacy between normal and high-risk groups. J Pediatr Orthop 2009;29(1):39- 43.
16. Martinez AG, Carroll NC, Sarwark JF, Dias LS, Kelikian AS, Sisson GA Jr. Femoral shaft fractures in children treated with early spica cast. J Pediatr Orthop 1991;11(6):712-716.
17. AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). J Orthop Trauma 2018;32 Suppl 1:S117-S140.
18. Tisherman RT, Hoellwarth JS, Mendelson SA. Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures. J Child Orthop 2018;12(2):136-144.
19. Illgen R 2nd, Rodgers WB, Hresko MT, Waters PM, Zurakowski D, Kasser JR. Femur fractures in children: Treatment with early sitting spica casting. J Pediatr Orthop 1998;18(4):481-487.
20. Sahin V, Baktir A, Türk CY, Karakaş ES, Aktaş S. Femoral shaft fractures in children treated by closed reduction and early spica cast with incorporated supracondylar Kirschner wires: A long- term follow-up results. Injury 1999;30(2):121-128.
21. Shapiro F. Fractures of the femoral shaft in children. The overgrowth phenomenon. Acta Orthop Scand 1981;52(6):649- 655.
22. Epps HR, Molenaar E, O’connor DP. Immediate single-leg spica cast for pediatric femoral diaphysis fractures. J Pediatr Orthop 2006;26(4):491-496.
23. Jaafar S, Sobh A, Legakis JE, Thomas R, Buhler K, Jones ET. Four weeks in a single-leg weight-bearing hip spica cast is sufficient treatment for ısolated femoral shaft fractures in children aged 1 to 3 years. J Pediatr Orthop 2016;36(7):680- 684.
24. Nork SE, Bellig GJ, Woll JP, Hoffinger SA. Overgrowth and outcome after femoral shaft fracture in children younger than 2 years. Clin Orthop Relat Res 1998;357:186-191.
25. Nordin S, Ros MD, Faisham WI. Clinical measurement of longitudinal femoral overgrowth following fracture in children. Singapore Med J 2001;42(12):563-565.
26. Buehler KC, Thompson JD, Sponseller PD, Black BE, Buckley SL, Griffin PP. A prospective study of early spica casting outcomes in the treatment of femoral shaft fractures in children. J Pediatr Orthop 1995;15(1):30-35.