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Çocuklarda deplase suprakondiler humerus kırıklarında kapalı redüksiyon ve üç adet Kirschner teli ile perkütan çivileme

Year 2005, Volume: 39 Issue: 1, 23 - 29, 11.09.2006

Levent Karapinar Hasan Ozturk Taskin Altay Bayram Kose

Abstract

Amaç: Çocuklarda deplase suprakondiler humerus kırıklarının tedavisinde kapalı redüksiyon ve perkütan çivileme ile tedavi sonuçları değerlendirildi.
Çalışma planı: Altmış bir çocuk (41 erkek, 20 kız; ort. yaş 7.6; dağılım 2-13) deplase suprakondiler tip III humerus kırığı nedeniyle tedavi edildi. Tüm olgulara başvuru anından itibaren ilk altı saat içinde müdahale edildi. Hastaların nörolojik bakısında patoloji saptanmadı. Tüm olgularda kapalı redüksiyondan sonra, lateralden iki, medialden bir olmak üzere üç adet K-teliyle perkütan çivileme uygulandı. Medialdeki çivi dirsek fleksiyonu azaltılarak (80-90°) uygulandı. Ulnar sinir değerlendirmesi ameliyat sonrasında, taburcu olurken, ikinci haftanın sonunda, 3 ve 6. aylarda yapıldı. Son kontrolde her iki dirsekte hareket açıklığı ve taşıma açısı goniometreyle ölçüldü; etkilenen dirseğin ön-arka ve yan radyografileri incelendi. Sonuçlar, Flynn ve ark.nın klinik skorlama sistemine göre değerlendirildi. Hastanede kalma süresi ortalama 3.4 gün (dağılım 1-10) izlem süresi 28.9 ay (dağılım 17-53) idi.
Sonuçlar: Ameliyattan sonra iki olguda (%3.3) iyatrojenik ulnar sinir hasarı saptandı. Her iki olguda da üç ay içinde klinik olarak tam düzelme görüldü. Tüm kırıklar kaynadı. Dört olguda (%6.6) yüzeyel çivi yolu enfeksiyonu, bir olguda (%1.6) kubitus varus, bir olguda miyositis ossifikans görüldü. Derin enfeksiyon ve kompartman sendromu görülmedi. Tedavi sonuçları 49 hastada (%80.3) mükemmel, yedisinde (%11.5) iyi, ikisinde (%3.3) orta, üçünde (%5) kötü olarak değerlendirildi.
Çıkarımlar: Tip III deplase suprakondiler humerus kırıklarının tedavisinde üç adet K-teliyle uygulanan kapalı redüksiyon ve perkütan çivileme başarısı yüksek, komplikasyonları en az olan etkin ve güvenli bir yöntemdir.

Keywords

Bone wires;child;fracture fixation internal/methods;humeral fractures/therapy;humeral fractures/radiography;ulnar nerve/injuries

Closed reduction and percutaneous pinning with three Kirschner wires in children with type III displaced supracondylar fractures of the humerus

Year 2005, Volume: 39 Issue: 1, 23 - 29, 11.09.2006

Levent Karapinar Hasan Ozturk Taskin Altay Bayram Kose

Abstract

Objectives: We evaluated the results of closed reduction and percutaneous pinning in the treatment of displaced supracondylar fractures of the humerus in children.
Methods: Sixty-one children (41 boys, 20 girls; mean age 7.6 years; range 2 to 13 years) were treated for type III displaced supracondylar fractures of the humerus within the first six hours after trauma. Initial neurologic examinations were normal. Treatment included closed reduction followed by percutaneous pinning with two lateral and one medial K-wires, the last being placed during decreased (80 to 90 degrees) elbow flexion. The ulnar nerve was examined intraoperatively, at the time of discharge, at the end of two weeks, and in the third and six months. On final examinations, the range of motion and carrying angles of both elbows were measured with a goniometer and anteroposterior and lateral radiograms of the affected elbows were examined. The results were evaluated using the clinical scoring system developed by Flynn et al. The mean hospital stay was 3.4 days (range 1 to 10 days) and the mean follow-up was 28.9 months (range 17 to 53 months).
Results: Iatrogenic ulnar nerve injury occurred in two patients (3.3%), which showed complete clinical improvement in three months. Union was achieved in all the patients. Superficial pin tract infections were seen in four patients (6.6%); and cubitus varus (1.6%) and myositis ossificans in two patients, respectively. Deep infection or compartment syndrome were not encountered. The results were excellent in 49 (80.3%), good in seven (11.5%), fair in two (3.3%), and poor in three patients (5%).
Conclusion: Closed reduction and percutaneous pinning with three K-wires is an efficacious and safe procedure with a low complication rate in the treatment of type III displaced supracondylar fractures of the humerus.

Keywords

Bone wires child fracture fixation internal/methods humeral fractures/therapy/radiography ulnar nerve/injuries

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Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Levent Karapinar This is me

Hasan Ozturk This is me

Taskin Altay This is me

Bayram Kose This is me

Publication Date September 11, 2006
Published in Issue Year 2005 Volume: 39 Issue: 1

Cite

APA Karapinar, L., Ozturk, H., Altay, T., Kose, B. (2006). Closed reduction and percutaneous pinning with three Kirschner wires in children with type III displaced supracondylar fractures of the humerus. Acta Orthopaedica Et Traumatologica Turcica, 39(1), 23-29.
AMA Karapinar L, Ozturk H, Altay T, Kose B. Closed reduction and percutaneous pinning with three Kirschner wires in children with type III displaced supracondylar fractures of the humerus. Acta Orthopaedica et Traumatologica Turcica. September 2006;39(1):23-29.
Chicago Karapinar, Levent, Hasan Ozturk, Taskin Altay, and Bayram Kose. “Closed Reduction and Percutaneous Pinning With Three Kirschner Wires in Children With Type III Displaced Supracondylar Fractures of the Humerus”. Acta Orthopaedica Et Traumatologica Turcica 39, no. 1 (September 2006): 23-29.
EndNote Karapinar L, Ozturk H, Altay T, Kose B (September 1, 2006) Closed reduction and percutaneous pinning with three Kirschner wires in children with type III displaced supracondylar fractures of the humerus. Acta Orthopaedica et Traumatologica Turcica 39 1 23–29.
IEEE L. Karapinar, H. Ozturk, T. Altay, and B. Kose, “Closed reduction and percutaneous pinning with three Kirschner wires in children with type III displaced supracondylar fractures of the humerus”, Acta Orthopaedica et Traumatologica Turcica, vol. 39, no. 1, pp. 23–29, 2006.
ISNAD Karapinar, Levent et al. “Closed Reduction and Percutaneous Pinning With Three Kirschner Wires in Children With Type III Displaced Supracondylar Fractures of the Humerus”. Acta Orthopaedica et Traumatologica Turcica 39/1 (September 2006), 23-29.
JAMA Karapinar L, Ozturk H, Altay T, Kose B. Closed reduction and percutaneous pinning with three Kirschner wires in children with type III displaced supracondylar fractures of the humerus. Acta Orthopaedica et Traumatologica Turcica. 2006;39:23–29.
MLA Karapinar, Levent et al. “Closed Reduction and Percutaneous Pinning With Three Kirschner Wires in Children With Type III Displaced Supracondylar Fractures of the Humerus”. Acta Orthopaedica Et Traumatologica Turcica, vol. 39, no. 1, 2006, pp. 23-29.
Vancouver Karapinar L, Ozturk H, Altay T, Kose B. Closed reduction and percutaneous pinning with three Kirschner wires in children with type III displaced supracondylar fractures of the humerus. Acta Orthopaedica et Traumatologica Turcica. 2006;39(1):23-9.