ABDURRAHMAN ONUR KOCADAL, Murad PEPE, Hakan YOLAÇAN, Abdurrahman SAKAOĞULLARI, CEM NURİ AKTEKİN

Pediatrik Hastalarda Femur Boyun Kırıklarının Kanüle Vida ile Tespiti: Klinik ve Radyolojik Çalışma

Amaç: Femur boyun kırıkları, pediatrik hastalarda oldukça nadir görülür. Bu çalışmada, femur boyun kırığı nedeniyle cerrahi tedavi uygulanan pediatrik hastaların klinik ve radyolojik sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Ağustos 2013 ve Eylül 2016 tarihleri arasında femur boyun kırığı tanısı ile ameliyat edilmiş 16 yaşından küçük, 7 hasta (4 kız, 3 erkek) retrospektif olarak değerlendirildi. Olguların demografik verileri, travma mekanizması, eşlik eden yaralanmalar, takip süreleri ve hastalarda gelişen komplikasyonlar kaydedildi. Ratliff kriterleri kullanılarak fonksiyonel ve radyografik değerlendirme yapıldı. Bulgular: Olguların ortalama yaşı 10.74.1 yıl, ortalama takip süresi 15.112.9 ay idi. Dört olguda Delbet sınıflamasına göre tip 2, 3 olguda tip 3 kırık mevcuttu. Ratliff kriterlerine göre 5 olguda iyi, 1 olguda orta, 1 olguda kötü sonuç elde edildi. Birer olguda avasküler nekroz, koksa vara ve geniş skar dokusu olmak üzere toplam üç olguda komplikasyon görüldü. Sonuç: Pediatrik yaş gurubunda femur boyun kırıkları, tedavi prensipleri özellik arz eden, yüksek komplikasyon oranına sahip ciddi yaralanmalardır. Hastaların hızlı şekilde değerlendirilerek tedavi planlamasının yapılması, tedavi sonrası karşılaşılabilecek komplikasyonların ve bu komplikasyonların tedavisinin bilinmesi gerekmektedir.

Cannulated Screw Fixation for Femoral Neck Fractures in Pediatric Patients: A Clinical and Radiological Study

Objective: Femoral neck fractures are relatively uncommon in pediatric patients. In this study, we evaluated the clinical and radiological results of pediatric patients who underwent surgical treatment for femoral neck fractures. Material and Method: Seven patients (4 girls, 3 boys) who were operated between August 2013 and September 2016 due to femur neck fracture were evaluated retrospectively. The demographic data of the patients, the mechanism of injury, associated injuries, and complications in patients with follow-up periods were recorded. Functional and radiographic evaluations were performed using Ratliff criteria. Results: The mean age of the patients was 10.74.1 years and the mean follow-up time was 15.112.9 months. According to Delbet classification, type 2 fractures were present in 4 cases and type 3 fractures were present in 3 cases. According to the Ratliff criteria, good results were obtained in five cases, fair result in one case, and poor results in one case. Complications in a total of three cases, including avascular necrosis in one patient, coxa vara in one patient and wide scar tissue in another patient. Conclusion: Femur neck fractures in pediatric patients are serious injuries with high complication rates and specific treatment principles. It is neces-sary for patients to be assessed rapidly and planned for treatment, the complications that may be encountered after treatment, and the treatment of these cmplications.

PDF

___

Bukva B, Abramovic D, Vrgoc G, et al. Femo-ral neck fractures in children and the role of early hip decompression in final outcome. Injury 2015; 46: 44-7.
Panigrahi R, Sahu B, Mahapatra AK, Palo N, Priyadarshi A, Biswal MR. Treatment analysis of paediatric femoral neck fractures: a prospec-tive multicenter theraupetic study in Indian sce-nario. Int Orthop 2015; 39: 1121-7.
Bimmel R, Bakker A, Bosma B, Michielsen J. Paediatric hip fractures: a systematic review of incidence, treatment options and complications. Acta Orthop Belg 2010; 76: 7-13.
Bekler H, Erdem H, Arslan H, Tokmak M. Çocukluk çağı femur boyun kırıkları ve komp-likasyonları. Acta Orthopaedica et Traumatolo-gica Turcica 1995; 29: 21-4.
Subaşı M, Kesemenli CC, Necmioğlu S, Kapu-kaya A, Tüzüner T, Kırkgöz T. Çocuk femur boyun kırıklarında erken dönemde yapılan açık redüksiyon sonuçları. Ulus Travma Acil Cerra-hi Derg 1998; 4: 197-201.
Yeranosian M, Horneff JG, Baldwin K, Hosal-kar HS. Factors affecting the outcome of fractu-res of the femoral neck in children and adoles-cents: a systematic review. Bone Joint J 2013; 95: 135-42.
Varshney MK, Kumar A, Khan SA, Rastogi S. Functional and radiological outcome after dela-yed fixation of femoral neck fractures in pediat-ric patients. J Orthop Traumatol 2009; 10: 211-6.
Bali K, Sudesh P, Patel S, Kumar V, Saini U, Dhillon MS. Pediatric femoral neck fractures: our 10 years of experience. Clin Orthop Surg 2011; 3: 302-8.
Dendane MA, Amrani A, El Alami ZF, El Medhi T, Gourinda H. Displaced femoral neck fractures in children: are complications predic-table? Orthop Traumatol Surg Res 2010; 96: 161-5.
Inan U, Kose N, Omeroglu H. Pediatric femur neck fractures: a retrospective analysis of 39 hips. J Child Orthop 2009; 3: 259-64.
Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Fractures of the femoral neck in children: long-term follow-up in 62 hip fractu-res. Injury 2005; 36: 123-30.
Moon ES, Mehlman CT. Risk factors for avas-cular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma 2006; 20: 323-9.
Colonna PC. Fracture of the neck of the femur in children. Am J Surg 1929; 6: 793-7.
Shrader MW, Jacofsky DJ, Stans AA, Shaugh-nessy WJ, Haidukewych GJ. Femoral neck fractures in pediatric patients: 30 years expe-rience at a level 1 trauma center. Clin Orthop Relat Res 2007; 454: 169-73.
Ratliff AH. Fractures of the neck of the femur in children. J Bone Joint Surg Br 1962; 44: 528-42.
Bagatur AE, Zorer G. Complications associated with surgically treated hip fractures in children. J Pediatr Orthop B 2002; 11: 219-28.
Beaty JH. Fractures of the hip in children. Ort-hop Clin North Am 2006; 37: 223-32.
Roposch A, Saraph V, Linhart WE. Treatment of femoral neck and trochanteric simple bone cysts. Arch Orthop Trauma Surg 2004; 124: 437-42.
Roman M, Recio R, Moreno JC, Fuentes S, Collantes F. Stress fracture of the femoral neck in a child. Case report and review of the litera-ture. Acta Orthop Belg 2001; 67: 286-9.
Holton C, Foster P, Templeton P. Fractures of the femoral neck in children. Current Orthopae-dics 2006; 20: 361-6.
Eren A, Abay B, Özbay H, Özcan K, Adanır O. Çocuk femur boyun kırıklarına yaklaşım. Tür-kiye Klinikleri Ortopedi Travmatoloji Dergisi (Özel Sayı) 2016; 9: 37-42.
Hosalkar HS, Varley ES, Glaser DA, Farnsworth CL, Wenger DR. Intracapsular hip pressures in a porcine model: does position and volume matter? J Pediatr Orthop B 2011; 20: 278-83.
Norouzi M, Naderi MN. Femoral neck fractures in children: A follow-up study of 19 cases. Eur J Trauma Emerg Surg 2009; 35: 124-6.
Morsy HA. Complications of fracture of the neck of the femur in children. A long-term fol-low-up study. Injury 2001; 32: 45-51.
Biçer ÖS, Toğrul E. Çocuk femur boyun kırık-ları. TOTBİD (Türk Ortopedi ve Travmatoloji Birliği Derneği) Dergisi 2008; 7: 127-32.