Güray ALTUN, Tuhan KURTULMUŞ, Birkan KİBAR, Çağrı ÖZCAN

Çocuk tibia diafiz kırılarının tedavisinde titanyum elastik çivi ve Kirschner telinin klinik ve radyolojik sonuçlarının karşılaştırılması

Amaç: Bu çalışmada, Kirschner Teli (K-teli) ve Titanyum Esnek Çivi (TEÇ) ile intramedüller tespit uygulanan çocuk tibia kırıklarının klinik ve radyolojik sonuçlarının karşılaştırmasını yapmayı amaçladık. Gereç ve Yöntem: Otuzdokuz hasta retrospektif olarak değerlendirildi ve tüm hastalar TEÇ uygulanan 20 hasta grup 1 ve K-teli uygulanan 19 hasta grup 2 olarak iki gruba ayrıldı. En az bir yıllık takip sonrası hastalar radyolojik ölçümleri ve Flynn Ten skorlamasına göre karşılaştırıldı. Bulgular: Flynn skorlamasına göre, grup 1’de % 75 mükemmel ve % 25 iyi sonuç, grup 2’de % 70 mükemmel ve % 30 iyi sonuç tespit edildi. Hiçbir vakada erken fiz kapanması, tekrar kırık, tekrar cerrahi girişim veya tespit materyali yetmezliği saptanmadı. Dizilim bozukluğu grup 1’de dört hastada ve grup 2’de iki hastada 10 derecenin üzerinde olmamak suretiyle tespit edildi. Sonuç: Her iki grubun klinik ve radyolojik sonuçları benzerlik göstermiş olsa da, pediatrik tibia şaft kırıklarında K-teli ile fiksasyonun daha düşük bütçeli ve elde edilebilirliğinin daha kolay olması sebebiyle TEÇ’ye göre avantajlı olabilir.

Comparison of clinical and radiological outcomes of titanium elastic nail and Kirschner wire in the treatment of pediatric tibia diaphyseal fractures

Purpose: The aim of this study was to compare the clinical and radiological results of paediatric tibia shaft fractures treated by intramedullary fixation with Kirschner (K) wire and titanium elastic nail (TEN). Materials and Methods: Thirtynine patients were evaluated retrospectively. Included 20 patients treated with TEN (group 1) and 19 patients treated with K-wire (group 2). At the end of the 1-year follow-up, radiological measurements for malalignment and the Flynn TEN outcome scoring system were used to compare the clinical results. Results: According to the Flynn classification, in group 1, results were excellent in 75% and good in 25%, and in group 2, excellent in 70% and good in 30%. In any cases has not been experienced physeal early closure or refracture, nor did they need re-manipulation or re-operation, and no implant insufficiency was detected. Malalignment was found in four patients in group 1, and in two patients in group 2 of lesser than 10 degrees. Conclusions: Even though two methods showed similar clinical and radiological results, fixation paediatric tibial fractures with K-wire may have some advantages as lower-cost and easy accessibility according to TEN.

Keywords:

pediatric tibia fracture, titanium elastic nail, kirschner wire,

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1. Lieber J, Schmittenbecher P. Developments in the treatment of pediatric long bone shaft fractures. Eur J Pediatr Surg. 2013;23: 427–33.
2. Mashru RP, Herman MJ, Pizzutillo PD.Tibial shaft fractures in children and adolescents. J Am Acad Orthop Surg. 2005;13:345-52.
3. Shannak AO.Tibial fractures in children: follow-up study. J Pediatr Orthop. 1988;8 :306-310.
4. Qidwai SA.Intramedullary Kirschner wiring for tibia fractures in children. J Pediatr Orthop. 2001;21:294-7.
5. Pandya NK. Flexible intramedullary nailing of unstable and/or open tibia shaft fractures in the pediatric population. J Pediatr Orthop. 2016;36:19-23.
6. Blasier RD, Barnes CS. Age as a prognostic factor in open tibial fractures in children. Clin Orthop Relat Res. 1996;331:261-4.
7. Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J. Titanium elastic nails of paediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop. 2001;21:4-8.
8. Carey TP, Galpin RD. Flexible intramedullary nail fixation of paediatric femoral fractures. Clin Orthop Relat Res. 1996;332:110-8.
9. Metaizeau JP.Stable elastic intramedullary nailing for fractures of the femur in children. J Bone Joint Surg Br. 2004;86:954-7.
10. Linhart WE, Roposch A. Elastic stable intramedullary nailing for unstable femoral 24-fractures in children: preliminary results of a new method. J Trauma. 1999;47:372-8.
11. Stenroos A, Jalkanen J, Sinikumpu JJ, Palmu S, Koskimies-Virta E, Laaksonen T et al. Treatment of unstable pediatric tibia shaft fractures in Finland. Eur J Pediatr Surg. 2019;29:247-52.
12. Gordon JE, O'Donnell JC. Tibia fractures: what should be fixed? J Pediatr Orthop. 2012;32:52-61.
13. Chitgopkar SD. Flexible nailing of fractures in children using stainless steel Kirschner wires. J Pediatr Orthop. 2005;17:251-5.
14. Kubiak EN, Egol KA, Scher D, Wasserman B, Feldman D, Koval KJ.Operative treatment of tibial fractures in children: are elastic stable intramedullary nails an improvement over external fixation? J Bone Joint Surg Am. 2005;87:1761-8.
15. O'Brien T, Weisman DS, Ronchetti P, Piller CP, Maloney M. Flexible titanium nailing for the treatment of unstable paediatric tibial fracture. J Pediatr Orthop. 2004;24:601-9.
16. Coury JG, Lum ZC, O'Neill NP, Gerardi JA. Single incision pediatric flexible intramedullary tibial nailing. J Orthop. 2017;14:394-7.
17. Wall EJ, Jain V, Vora V, Mehlman CT, Crawford AH. Complications of titanium and stainless steel elastic nail fixation of paediatric femoral fractures. J Bone Joint Surg Am. 2008;90:1305-13.
18. Lascombes P. Flexible Intramedullary Nailing in Children: the Nancy University Manual. Heidelberg: Springer. 2009.
19. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453-8.
20. Gordon JE, Gregush RV, Schoenecker PL, Dobbs MB, Luhmann SJ. Complications after titanium elastic nailing of paediatric tibial fractures. J Pediatr Orthop. 2007;27:442-6.
21. Slongo TF. Complications and failures of the ESIN technique. Injury. 2005;36:78-85.