Gartland Tip III Suprakondiler Humerus Kırıklarının Cerrahi Tedavisi Ne Zaman Yapılmalı?

Year 2018, Volume: 8 Issue: 4, 840 - 846, 30.12.2018

Alauddin Kochai Turgut Akgül Barış Gülenç Fevzi Birişik Gökhan Polat Önder Yazıcıoğlu

https://doi.org/10.31832/smj.475866

Abstract

 

        Amaç:Gartland tip III suprakondiler humerus kırıklarının tedavisinde cerrahi uygulama zamanının klinik ve radyolojik sonuçlar üzerine etkisinin retrospektif olarak değerlendirilmesi.

 

        Yöntem: Gartland tip III kırık nedeni ile opere edilen 72 hasta değerlendirildi. Açık kırık, damar yaralanması ve 14 aydan az takibi olanlar çalışma dışı bırakıldı. Hastalar cerrahi tedavinin zamanına göre 24 saatten öncesi ve sonrası, gece ve gündüz olarak gruplandırıldı. Skopi kontrolünde kapalı repozisyon ve perkütan pinleme yapıldı. Radyolojik sonuçlar Baumann ve Capitohumeral açısı, klinik sonuçlar dirsek taşıma açısı ölçülerek değerlendirildi. Gruplar arasındaki parametrik değerler student-t test ile nonparametrik değerler ise ki-kare testi ile değerlendirildi. 

      Bulgular:72 (40 erkek, 32 kız) (ilk 24 saat 40, >24 saat 32, 35 hasta gece ve 37 hasta  gündüz ameliyat edilmiş. Ortalama yaş 7,5/yıl ve ortalama takip süreleri 41/ay idi. Gece yapılan operasyon süresi ortalama 72 dakika iken gündüz ortalama 51 dakikaydı (P<0,05). İlk 24 saatte opere edilenlerde operasyon süresi 61.5±30 dakika, 24 saat sonra opere edilenlerde 63±15,5 dakika (p=0,63). Baumann açısı opere edilen tarafta 72±6,75 , edilmeyen tarafta 70±3,93 derece idi. İstatistiksel olarak anlamlı farklılık mevcuttu. Bu fark gece yapılanlardan kaynaklanmaktaydı (p=0,003, p=0,005). Opere edilen tarafta taşıma açısı 10,3±5,3 opere edilmeyen tarafta ortalama 12,02±3,6 derece idi, gruplar arasında istatistiksel farklılık yoktu (p>0,05). 24 saat öncesi ve sonrası yapılanlar arasında radyolojik ve klinik sonuçlar arasında istatistiksel anlamlı farklılık bulunmamakta. 3 malpozisyon, 2 sinir hasarı ilk 24 saatte gece yapılan olgularda görüldü.

     Sonuç: Suprakondiler humerus kırığının tedavisi geç ancak ideal şartlarda yapıldığında suboptimal şartlarında yapılmasına göre daha az komplikasyon ve daha iyi fonksiyonel sonuç vermektedir.

Keywords

Suprakondiler humerus kırığı; Kapalı repozisyon; Perkütan pinleme

When Should Surgical Treatment of Gartland Type III Supracondylar Humerus Fractures Take Place?

Abstract

Aim:We evaluated the effects of surgery time on clinical and radiological outcomes among Gartland type III Supracondylar humerus fractures (SFH). 

Method:We retrospectively examined 72 patients treated for Gartland type III SHF. Patient’s age, gender, surgery times, surgery durations, and complications were assessed. The radiological measurements of patients were assessed in comparison to the other elbow by using Baumann's and capitellohumeral angles

Results:72 patients (40 males, 32 females), mean age 7,5years and mean follow-up 41 months. 40 patients were operated on within the first 24 hours, 32 after 24 hours. Thirty-five were operated at night, 37 were on day. Mean surgery duration at night 72 minutes and at daytime 51 minutes. The difference was statistically significant (P<0,05). Mean surgery duration at first 24 hours was 61.5±30 minutes, while after 24 hours was 63±15,5 minutes (p=0,63), mean Baumann's angle was 72±6,75 degrees on the operated side, and 70±3,93 degrees on the other side. The difference was statistically significant (p=0,003). While a significant difference existed among the Bauman's angles of night time patients, no such difference was found among daytime patients. The mean carrying angle obtained was 10,3±5,3 degrees on the operated side, and 12,02±3,6 on the other side. The difference was not statistically significant. Similarly, no statistical difference was observed for capitellohumeral angles of patients operated on within and after the first 24 hours were compared to the non-operated side. 

Conclusion:SHF treatment in ideal conditions results better functional outcomes and fewer complications than immediate surgery under suboptimal conditions.

Keywords

Supracondylar humerus fracture; Close reposition; Percutaneus pinning

References

• 1. Houshian S, Mehdi B, Larsen MS. The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci 2001;6(4):312–315
• 2. Cheng JC, Shen WY. Limb fracture pattern in different pediatric age groups: a study of 3,350 children. J Orthop Trauma 1993;7(1):15–22
• 3. Cheng JC, Ng BK, Ying SY, Lam PK. A 10-year study of the changes in the pattern and treatment of 6,493 fractures. J Pediatr Orthop. 1999 May-Jun; 19(3):344–350
• 4. Brown IC, Zinar DM. Traumatic and iatrogenic neurological complications after supracondylar humerus fractures in children. J Pediatr Orthop.1995 Jul-Aug;15(4):440–443.
• 5. Mehserle WL, Meehan PL. Treatment of the displaced supracondylar fracture of the humerus (type III) with closed reduction and percutaneous cross-pin fixation. J Pediatr Orthop. 1991 Nov-Dec;11(6):705–711.
• 6. Minkowitz B, Busch MT. Supracondylar humerus fractures. Current trends and controversies. Orthop Clin North Am. 1994 Oct;25(4):581–594.
• 7. Zaltz I, Waters PM, Kasser JR. Ulnar nerve instability in children. J Pediatr Orthop. 1996 Sep-Oct;16(5):567–569.
• 8. Paradis G, Lavallee P, Gagnon N, Lemire L. Supracondylar fractures of the humerus in children. Technique and results of crossed percutaneous Kwire fixation. Clin Orthop Relat Res. 1993 Dec;(297):231–237.
• 9. Mehlman CT, Strub WM, Roy DR, Wall EJ, Crawford AH. The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children. J Bone Joint Surg [Am]. 2001Mar;83-A(3):323-7
• 10. Iyengar SR, Hoffinger SA, Townsend DR. Early versus delayed reduction and pinning of type III displaced supracondylar fractures of the humerus in children: a comparative study. J Orthop Trauma. 1999 Jan;13(1):51–55.
• 11. Leet AL, Frisancho J, Ebramzadeh E. Delayed treatment of type 3 supracondylar humerus fractures in children. J Pediatr Orthop. 2002 Mar-Apr ;22(2):203–207.
• 12. Gupta N, Kay RM, Leitch K, Femino JD, Tolo VT, Skaggs DL. Effect of Surgical Delay on Perioperative Complications and Need for Open Reduction in Supracondylar Humerus Fractures in Children. J Pediatr Orthop. 2004 May-Jun;24(3):245-8
• 13. Mayne Al, Perry DC, Bruce CE. Delayed surgery in displaced paediatric supracondylar fractures:a safe approach? Results from a large UK tertiary paediatric trauma centre. Eur J Orthop Surg Traumatol. 2004 Oct;24(7):1107-10
• 14. Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959 Aug;109(2):145–154.
• 15. Danielsson L, Pettersson H. Open reduction and pin fixation of severely displaced supracondylar fractures of the humerus in children. Acta Orthop Scand. 1980 Apr;51(2):249-55.
• 16. Hart GM, Wilson DW, Arden GP.The operative management of the difficult supracondylar fracture of the humerus in the child. Injury.1977 Aug;9(1):30-4.
• 17. Walloe A, Egund N, Eikelund L. Supracondylar fracture of the humerus in children: review of closed and open reduction leading to a proposal for treatment.Injury. 1985 Mar;16(5):296-9.