Sosyal dezavantaj, cerrahi tedavi edilen pediatrik suprakondiler humerus kırıklarında belirleyici bir faktör müdür?

Abstract

Amaç: Bu çalışmanın amacı, cerrahi olarak tedavi edilen pediatrik suprakondiler humerus kırığı hastalarında ailelerin sosyal dezavantaj düzeyi ile postoperatif sonuçlar arasındaki ilişkiyi değerlendirmektir. Yöntem: Bu retrospektif kohort çalışmasına, Şubat 2019 ile Nisan 2024 tarihleri arasında suprakondiler humerus kırığı nedeniyle cerrahi tespit uygulanan, yaşları 3–13 arasında değişen 153 çocuk dahil edilmiştir. Hastalar, Évaluation de la Précarité et des Inégalités de Santé pour les Centres d’Examens de Santé (EPICES) skoruna göre iki gruba ayrılmıştır: sosyal açıdan dezavantajlı (EPICES ≥30) ve dezavantajlı olmayan (EPICES <30). Dışlama kriterleri; açık kırık, 4 günden uzun cerrahi gecikme, yetersiz takip, nörovasküler eksplorasyon gereksinimi, daha önce aynı taraf dirsek kırığı öyküsü ve “floating elbow” yaralanması olarak belirlenmiştir. Tüm hastalar, iki lateral ve bir medial K teli kullanılarak kapalı veya açık redüksiyon ve perkütan pinleme yöntemiyle tedavi edilmiştir. Postoperatif sonuçlar Flynn kriterleri, Baumann açısı ve lateral humerokapitellar açı (LHCA) kullanılarak değerlendirilmiştir. Gruplar arasındaki karşılaştırmalarda ki-kare, bağımsız örneklem t-testi ve Mann–Whitney U testleri uygulanmış, anlamlılık düzeyi p<0.05 olarak kabul edilmiştir. Bulgular: Toplam 153 hastanın 71’i sosyal açıdan dezavantajlı olmayan, 82’si sosyal açıdan dezavantajlı gruptaydı. Demografik değişkenler (yaş, cinsiyet, kırık tipi, cerrahiye kadar geçen süre) açısından iki grup arasında anlamlı fark bulunmadı (p>0.05). Radyolojik parametreler —Baumann açısı (72.2°±8.3 ve 71.2°±8.8, p=0.512) ve LHCA (32.7°±9.7 ve 32.4°±8.9, p=0.927)— açısından da fark saptanmadı. Ancak, Flynn fonksiyonel faktör skorları sosyal dezavantajlı grupta daha yüksek (3.0±2.4 ve 2.3±2.0, p=0.096) ve kozmetik faktör skorları anlamlı derecede daha kötü bulundu (4.7±2.9 ve 3.5±2.7, p=0.009). Alt grup analizinde bu farkın özellikle kapalı redüksiyon ve internal fiksasyon uygulanan hastalarda daha belirgin olduğu görüldü (Flynn indeksi için p=0.024; fonksiyonel faktör için p=0.008). Yapılan post-hoc güç analizi çalışmanın yeterli istatistiksel güce sahip olduğunu gösterdi (0.83–0.94). Sonuç: Sosyal dezavantaj, cerrahi olarak tedavi edilen pediatrik suprakondiler humerus kırıklarında fonksiyonel iyileşmeyi olumsuz etkileyebilir. Radyolojik parametrelerde anlamlı fark saptanmamasına rağmen, sosyal açıdan dezavantajlı çocuklarda daha düşük Flynn fonksiyonel skorları, cerrahi başarının yalnızca teknik faktörlerle açıklanamayacağını göstermektedir. Bu nedenle, sosyal dezavantajlı hastalarda postoperatif dönemde rehabilitasyon uyumunu ve takip sürekliliğini artıracak destek mekanizmalarının oluşturulması, tedavi sonuçlarını iyileştirebilir.

Keywords

• suprakondiler humerus kırıkları
• sosyal yoksunluk
• EPICES skoru
• Pediatrik Ortopedi

Is social deprivation a determinant in surgically treated pediatric supracondylar humerus fractures?

Abstract

Aims: The aim of this study was to evaluate the relationship between familial social deprivation and postoperative outcomes in pediatric patients who underwent surgical treatment for supracondylar humerus fractures. Methods: This retrospective cohort study included 153 children (aged 3-13 years) who underwent operative fixation for supracondylar humerus fractures between February 2019 and April 2024. Patients were divided into two groups according to the Évaluation de la Précarité et des Inégalités de Santé pour les Centres d’Examens de Santé (EPICES) score: socially deprived (EPICES ≥30) and non-deprived (EPICES <30). Exclusion criteria included open fractures, delayed surgery (>4 days), inadequate follow-up, neurovascular exploration, previous ipsilateral elbow fracture, and floating elbow injury. All patients were treated by closed or open reduction and percutaneous pinning with two lateral and one medial K-wire. Postoperative outcomes were evaluated using Flynn’s criteria, Baumann angle, and lateral humerocapitellar angle (LHCA). Group comparisons were made using chi-square, independent t, and Mann–Whitney U tests, with a significance threshold of p<0.05. Results: Of the 153 patients, 71 were non-deprived and 82 were socially deprived. Demographic variables (age, sex, fracture type, and time to surgery) were comparable between groups (p>0.05). Radiological parameters, including Baumann angle (72.2°±8.3 vs. 71.2°±8.8, p=0.512) and LHCA (32.7°±9.7 vs. 32.4°±8.9, p=0.927), showed no significant differences. However, Flynn’s functional factor scores were poorer in the socially deprived group (3.0±2.4 vs. 2.3±2.0, p=0.096), and cosmetic factor scores were significantly worse (4.7±2.9 vs. 3.5±2.7, p=0.009). Subgroup analysis revealed that this difference was more pronounced in patients treated with closed reduction and internal fixation (p=0.024 for Flynn index; p=0.008 for functional factor). Post-hoc power analysis confirmed an adequate study power (0.83-0.94). Conclusion: Social deprivation was associated with poorer functional and cosmetic outcomes after surgical treatment of pediatric supracondylar humerus fractures, despite similar radiological results. These findings indicate that socioeconomic factors may influence recovery independent of surgical technique and underscore the importance of strengthened follow-up support for disadvantaged families.

Keywords

• Supracondylar humerus fracture
• social deprivation
• EPICES score
• pediatric orthopedics
• functional outcome

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