Pediatrik Suprakondiler Humerus Kırıklarının Cerrahi Tedavisinde Cerrahi Yaklaşımın Tedavi Sonuçları ve Komplikasyonları Üzerine Etkisi Var mıdır?

Year 2021, , 661 - 668, 22.09.2021

Fevzi Sağlam , Halil Bekler

https://doi.org/10.31832/smj.885164

Abstract

Amaç: Suprakondiler humerus kırıklarının (SKHK) cerrahi tedavisinde farklı tedavi yöntemleri ve cerrahi kesiler, distal parçanın yer değiştirme yönüne ve cerrahın deneyimine bağlıdır. Bu çalışmanın amacı, SKHK tedavi sonuçlarını ve komplikasyonları kapalı redüksiyon perkütan çivileme (KRPÇ) ile açık cerrahide cerrahi insizyon tipine göre karşılaştırmak ve bu sayede ideal yaklaşımı belirlemektir.
Gereç ve Yöntemler: 142 (% 63,4) erkek ve 82 (% 36,6) kadın, yaş ortalaması 5,95 ± 2,79 yıl (1-13 yaş) olan toplam 224 hasta retrospektif olarak incelendi. Gartland sınıflandırmasına göre 58'i (% 25,8) Tip 2, 166'sı (% 74,2) Tip 3 idi. Çalışmaya dahil edilen hastaları medial, lateral, posterior insizyon ve KRPÇ ile ameliyat edilenler olmak üzere dört gruba ayırdık.
Bulgular: En sık görülen komplikasyonlar: nörolojik defisit (n: 34,% 15.1), skarlaşma (n: 32,% 14.2), subkutan iğne migrasyonu (n: 24,% 10.2), cubitus varus (n: 20,% 8.9) ), çivi dibi enfeksiyonu (n: 15,% 6,6), fleksiyon kısıtlaması (n: 13,% 5,8), ekstansiyon kısıtlaması (n: 12,% 5,3), miyozit ossifikans (n: 12,% 5,3) ve kübitus valgus (n: 5,% 2,29). Açık redüksiyon internal fiksasyon uygulanan grup ile kapalı redüksiyon perkütan çivileme grubu arasında komplikasyonlar açısından farklılıklar olduğu belirlendi.
Sonuç: Kapalı redüksiyon perkütan çivileme ve açık cerrahi grupları arasında fonksiyonel sonuçlar arasında fark yoktur. Redüksiyon kapatılamayan hastalarda cerrahın tecrübesine ve tercihine bağlı olarak açık cerrahi kesiler tercih edilebilir.

Keywords

Suprkondiler humerus kırıkları, komplikasyonlar, Nörolojik defisit, Flynn kriterleri

Does The Surgical Approach Have an Impact On Treatment Outcomes and Complications in The Surgical Treatment of Pediatric Supracondylar Humeral Fractures?

Abstract

Objective: In the surgical treatment of supracondylar humerus fractures (SCHF), different treatment methods and surgical incisions are depending on the direction of displacement of the distal fragment and the surgeon’s experience. The aim of this study was to compare SCHF treatment results and complications according to closed reduction percutaneous pinning (CRPP) and the surgical incision type in open surgery and to determine the ideal approach thereby.
Material and Methods: A retrospective examination was made of a total of 224 patients for this study which was comprising 142 (63.4%) males and 82 (36.6%) females with a mean age of 5.95±2.79 years (range, 1-13 years). According to the Gartland classification, 58 (25.8%) were Type 2, 166 (74.2%) were Type 3. We divided the patients included in the study into four groups: medial, lateral, posterior incision and those who underwent surgery with CRRP.
Results: The most frequent complications observed were neurological deficit (n:34, 15.1%), scarring (n:32, 14.2%), subcutaneous pin migration (n:24, 10.2%), cubitus varus (n:20, 8.9%), pin tract infection (n:15, 6.6%), flexion restriction (n:13, 5.8%), extension restriction (n:12, 5.3%), myositis ossificans (n:12, 5.3%), and cubitus valgus (n:5, 2.29%). There were determined to be differences between the group applied with open reduction internal fixation and the closed reduction percutaneous pinning group in respect of complications.
Conclusion: There is no difference between functional results between closed reduction percutaneous pinning and open surgery groups. In patients who cannot be closed reduction, open surgical incisions may be preferred depending on the surgeon's experience and preference.

Keywords

Supracondylar humerus fracture, complications, neurological deficit, Flynn criteria

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