Treatment of pediatric displaced supracondylar humerus fractures by fixation with two cross K-wires following reduction achieved after cutting the triceps muscle in a reverse V-shape

Volkan Gurkan; Haldun Orhun; Ozan Akca; Tarcan Ercan; Sefa Ozel

Research Article

Çocuklardaki deplase suprakondiler humerus kırıklarının tedavisinde triseps kasının ters V şeklinde kesilmesiyle sağlanan redüksiyon ve iki adet çapraz K-teli ile tespit

Year 2008, Volume: 42 Issue: 3, 154 - 160, 12.08.2008

Volkan Gurkan Haldun Orhun Ozan Akca Tarcan Ercan Sefa Ozel

Abstract

Amaç: Çocuklarda deplase humerus suprakondiler kırıklarının cerrahi tedavi sonuçları değerlendirildi.
Çalışma planı: Çalışmaya 98 çocuk hasta (72 erkek, 26 kız; ort. yaş 7; dağılım 3 ay-14 yıl) alındı. Gartland sınıflamasına göre deplase suprakondiler humerus kırıklarının hepsi tip III kırıktı. On hastada (%10.2) fleksiyon tipi, 88 hastada (%89.8) ise ekstansiyon tipi yaralanma vardı. Beş hastada Gustilo-Anderson sınıflamasına göre tip 1 açık kırık vardı. Kırıkların hepsi posterior yaklaşımla tedavi edildi. Triseps kası ters V şeklinde kesilerek redüksiyon sağlandı ve epikondillerden çapraz gönderilen iki adet K-teli ile tespit yapıldı. Sonuçlar Flynn ve ark.nın ölçütlerine göre değerlendirildi. Son kontrolllerde, dirsek eklem hareket açıklıkları ve triseps kas kuvveti yanı sıra, çekilen grafilerde dirsek taşıma açısı, Baumann açısı, lateral humerokapitellar açı ölçüldü ve sağlam tarafla karşılaştırıldı. Ortalama takip süresi 42.6 ay (dağılım 7-80 ay) idi.
Sonuçlar: Flynn ve ark.nın ölçütlerine göre, 95 hastada (%96.9) kozmetik açıdan, 84 hastada (%85.7) ise fonksiyonel açıdan mükemmel ya da iyi sonuç elde edildi. Sağlam tarafla karşılaştırıldığında, ameliyat edilen tarafta ölçülen dirsek açıları, dirsek eklem hareket açıklığı ve triseps kas kuvveti anlamlı farklılık göstermedi (p>0.05). Ameliyata alınma süreleri kozmetik ve fonksiyonel sonuçlar açısından anlamlı farklılık yaratmadı (p>0.05). Hiçbir hastada işleme bağlı tel dibi enfeksiyonu, yetersiz kaynama görülmedi. Üç hastada (%3.1) kubitus varus deformitesi saptandı.
Çıkarımlar: Çocuklardaki deplase suprakondiler humerus kırıklarında, posterior girişim ile triseps kasının ters V şeklinde kesilmesiyle redüksiyon kolayca yapılabilmekte ve iki adet çapraz K-teli yeterli stabiliteyi sağlamaktadır. Tedavi sonucunda triseps kasında herhangi bir zayıflık meydana gelmemektedir.

Keywords

Bone wires; child; elbow joint/injuries/surgery; fracture fixation, internal/methods; humeral fractures/surgery.

Treatment of pediatric displaced supracondylar humerus fractures by fixation with two cross K-wires following reduction achieved after cutting the triceps muscle in a reverse V-shape

Year 2008, Volume: 42 Issue: 3, 154 - 160, 12.08.2008

Volkan Gurkan Haldun Orhun Ozan Akca Tarcan Ercan Sefa Ozel

Abstract

Objectives: We evaluated the results of surgical treatment for pediatric displaced supracondylar humerus fractures.
Methods: The study included 98 pediatric patients (72 boys, 26 girls; mean age 7 years; range 3 months to 14 years). According to the Gartland classification, all the displaced supracondylar humerus fractures were type III, being of flexion type in 10 patients (10.2%), and extension type in 88 patients (89.8%). Five were Gustilo-Anderson type 1 open fractures. All fractures were approached posteriorly. Reduction was achieved by cutting the triceps muscle in a reverse V-shape, followed by fixation using two cross K-wires from the epicondyles. The results were assessed according to the criteria of Flynn et al. At final followups, elbow range of motion, the strength of the triceps muscle and, on radiographs, the carrying angle of the elbow, Baumann angle, and lateral humerocapitellar angle were measured. The mean follow-up was 42.6 months (range 7 to 80 months).
Results: According to the criteria of Flynn et al., 95 patients (96.9%) had perfect or good cosmetic results, 84 patients (85.7%) had perfect or good functional results. Elbow angles, elbow range of motion, and the strength of the triceps muscle were similar to those measured on the normal side (p>0.05). Time from injury to surgery did not have a significant influence on cosmetic and functional results (p>0.05). None of the patients exhibited procedure-related pin tract infection or insufficient bone union. Three patients (3.1%) developed cubitus varus deformity.
Conclusion: Reduction of pediatric displaced supracondylar humerus fractures may be achieved easily by the posterior approach, after cutting the triceps muscle in a reverse Vshape, and fixation with two cross-pinned K-wires provides adequate stability. This procedure does not result in weakness of the triceps muscle.

Keywords

Bone wires, child, elbow joint/injuries/surgery, fracture fixation, internal/methods, humeral fractures/surgery

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Details

Primary Language	English
Subjects	Health Care Administration
Journal Section	Original Article
Authors	Volkan Gurkan This is me Haldun Orhun This is me Ozan Akca This is me Tarcan Ercan This is me Sefa Ozel This is me
Publication Date	August 12, 2008
Published in Issue	Year 2008 Volume: 42 Issue: 3

Cite

APA	Gurkan, V., Orhun, H., Akca, O., Ercan, T., et al. (2008). Treatment of pediatric displaced supracondylar humerus fractures by fixation with two cross K-wires following reduction achieved after cutting the triceps muscle in a reverse V-shape. Acta Orthopaedica Et Traumatologica Turcica, 42(3), 154-160.
AMA	Gurkan V, Orhun H, Akca O, Ercan T, Ozel S. Treatment of pediatric displaced supracondylar humerus fractures by fixation with two cross K-wires following reduction achieved after cutting the triceps muscle in a reverse V-shape. Acta Orthopaedica et Traumatologica Turcica. August 2008;42(3):154-160.
Chicago	Gurkan, Volkan, Haldun Orhun, Ozan Akca, Tarcan Ercan, and Sefa Ozel. “Treatment of Pediatric Displaced Supracondylar Humerus Fractures by Fixation With Two Cross K-Wires Following Reduction Achieved After Cutting the Triceps Muscle in a Reverse V-Shape”. Acta Orthopaedica Et Traumatologica Turcica 42, no. 3 (August 2008): 154-60.
EndNote	Gurkan V, Orhun H, Akca O, Ercan T, Ozel S (August 1, 2008) Treatment of pediatric displaced supracondylar humerus fractures by fixation with two cross K-wires following reduction achieved after cutting the triceps muscle in a reverse V-shape. Acta Orthopaedica et Traumatologica Turcica 42 3 154–160.
IEEE	V. Gurkan, H. Orhun, O. Akca, T. Ercan, and S. Ozel, “Treatment of pediatric displaced supracondylar humerus fractures by fixation with two cross K-wires following reduction achieved after cutting the triceps muscle in a reverse V-shape”, Acta Orthopaedica et Traumatologica Turcica, vol. 42, no. 3, pp. 154–160, 2008.
ISNAD	Gurkan, Volkan et al. “Treatment of Pediatric Displaced Supracondylar Humerus Fractures by Fixation With Two Cross K-Wires Following Reduction Achieved After Cutting the Triceps Muscle in a Reverse V-Shape”. Acta Orthopaedica et Traumatologica Turcica 42/3 (August 2008), 154-160.
JAMA	Gurkan V, Orhun H, Akca O, Ercan T, Ozel S. Treatment of pediatric displaced supracondylar humerus fractures by fixation with two cross K-wires following reduction achieved after cutting the triceps muscle in a reverse V-shape. Acta Orthopaedica et Traumatologica Turcica. 2008;42:154–160.
MLA	Gurkan, Volkan et al. “Treatment of Pediatric Displaced Supracondylar Humerus Fractures by Fixation With Two Cross K-Wires Following Reduction Achieved After Cutting the Triceps Muscle in a Reverse V-Shape”. Acta Orthopaedica Et Traumatologica Turcica, vol. 42, no. 3, 2008, pp. 154-60.
Vancouver	Gurkan V, Orhun H, Akca O, Ercan T, Ozel S. Treatment of pediatric displaced supracondylar humerus fractures by fixation with two cross K-wires following reduction achieved after cutting the triceps muscle in a reverse V-shape. Acta Orthopaedica et Traumatologica Turcica. 2008;42(3):154-60.