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Pediatrik Suprakondiler Humerus Kırıklarında Açık Redüksiyon ve Perkütan Pinleme İle Kapalı Redüksiyon ve Perkütan Pinleme Sonuçlarının Karşılaştırılması

Year 2021, Volume: 11 Issue: 2, 347 - 352, 29.06.2021
https://doi.org/10.31832/smj.911539

Abstract

Amaç: Çalışmamızın amacı kliniğimizde suprakondiler humerus kırığı tanısı alarak cerrahi olarak tedavi edilen ve cerrahi sonrası poliklinik takibi yapılan hastalardan açık ve kapalı redüksiyon uygulananların tedavi sonuçlarının retrospektif olarak değerlendirilmesi ve karşılaştırılmasıdır.
Gereç ve Yöntemler :2014 –2020 tarihleri arasında kliniğimizde suprakondiler humerus kırığı tanısı ile cerrahi tedavi uygulanmış 2-10 yaş arası çocuklar değerlendirmeye alındı. Kırık redüksiyonu kapalı uygulanan (Grup 1) ve açık uygulanan (Grup 2) olarak iki gruba ayrılan hastaların klinik ve radyolojik sonuçları retrospektif olarak değerlendirildi. Bu değerlendirme için Flynn kriterleri kullanıldı. Kırıkların sınıflandırılmasında Gartland sınıflandırması kullanıldı.
Bulgular : Hastaların 64 (%44,4)’ü kız, 80 (%55,6)’i erkek idi. Hastaların yaş ortalaması 5,39±2,22’dir. 108 (%75) hasta kapalı redüksiyon sonrası perkütan pinleme (Grup 1) ile, 36(%25) hasta açık redüksiyon ile perkütan pinleme (Grup 2) tekniği ile tedavi edildi. Yapılan istatistiksel değerlendirmede; gruplar arasında Flynn kriterleri-kozmetik faktörler yönünden anlamlı farklılık bulunmuştur(p=0,004). Grup 2’de kozmetik faktörün orta-kötü olma sıklığı %13,9 iken, Grup 1’de %0,9 dur. Gruplar arasında ‘’Flynn-Fonksiyonel faktör’’ yönünden incelendiğinde aralarında anlamlı fark bulunamamıştır (p=0,057).
Sonuç: Suprakondiler humerus kırıklarının tedavisinde amaç dirsek eklem hareket açıklığını tam olarak sağlamak, nörovasküler yaralanmaların önüne geçerek fonksiyonel ve kozmetik açıdan mükemmel sonuçlar elde etmektir. Açık redüksiyonun komplikasyonlarından kaçınmak bakımından ilk tercih kapalı redüksiyon ve perkütan fiksasyon olmasına karşın kapalı redüksiyon sağlanamayan kırıklarda açık redüksiyon uygulanabilir. Uygun kırık redüksiyonu sağlanarak stabil kırık tespiti yapıldığında her iki yaklaşımda da sonuçlar benzer ve tatminkardır.

References

  • 1.Shrader MW. Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthop Clin North Am 2008 Apr;39(2):163-71, v. doi: 10.1016/j.ocl.2007.12.005. PMID: 18374807.
  • 2.Erdil M,Ceylan H H,Demir N,Elmadağ N M,Bilsel K,Polat G. Pediatrik Gartland Tip 3 Suprakondiler Humerus Kırıkları Cerrahi Tedavisinde Erken Dönem Sonuçlarımız. Jinekoloji Obstetrik Pediatri ve Pediatrik Cerrahi Dergisi 2013; 5(1): 27 - 31.
  • 3.Acar E, Memik R Surgical Treatment Results in Pediatric Supracondylar Humerus Fractures. Eurasian J Emerg Med 2020;19(1): 25-9. DOI: 10.4274/eajem.galenos.2017.74046
  • 4.Ladenhauf HN, Schaffert M, Bauer J. The displaced supracondylar humerus fracture: indications for surgery and surgical options: a 2014 update. Curr Opin Pediatr. 2014 Feb;26(1):64-9. doi: 10.1097/MOP.0000000000000044. PMID: 24378825
  • 5. Heal J, Bould M, Livingstone J, Blewitt N, Blom AW.Reproducibility of the Gartland classification for supracondylar humeral fractures in children. J of Orthop Surg 2007;15:12-4.
  • 6. Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am 2008;90(5):1121-32. http://dx.doi.org/10.2106/JBJS.G.01354 PMid:18451407
  • 7. İnan M, Yücel B. Çocuklarda humerus suprakondiler bölge kırıkları. Totbid Der 2008;(7)3:104-11.
  • 8. Eren A, Özkut AT, Altıntaş F, Güven M. Çocuklarda suprakondiler humerus tip III kırıkların tedavisinde lateral ve medial girişimler ile cerrahi tedavi sonuçlarının fonksiyonel ve kozmetik açıdan karşılaştırılması. Acta Orthop Traumatol Turc 2005;39(3):199-204. PMid:16141725
  • 9. Karapınar L, Sürenkök F, Öztürk H, Us MR. Immediate Closed Reduction and Percutaneous Pinning in Children with Displaced Type 3 Supracondylar Fractures of the Humerus: Investigation of 258 Cases. Joint Dis Rel Surg 2003;14(3):164-75.
  • 10. Pirone AM, Graham HK, Krajbich JL. Management of displaced extension- type supracondylar fractures of the humerus in children. J Bone Joint Surg Am 1988;70(A):641-50. 6. Gosens T, Bongers KJ. Neurovascular complic
  • 11. Joshi T, Koder A, Herman MJ. Staying Out of Trouble: Complications of Supracondylar Humerus Fractures. Instr Course Lect. 2019;68:357-366. PMID: 32032077.
  • 12. Abraham E, Powers T, Witt P, Ray RD. Experimental hyperextension supracondylar fractures in monkeys. Clin Orthop Relat Res 1982;(171):309-18.
  • 13. Hussein al-Algawy, A.A., Aliakbar, A.H. & Witwit, I.H.N. Open versus closed reduction and K-wire fixation for displaced supracondylar fracture of the humerus in children. Eur J Orthop Surg Traumatol 29, 397–403 (2019). https://doi.org/10.1007/s00590-018-2305-9
  • 14. Slobogean BL, Jackman H, Tennant S, Slobogean GP, Mulpuri K. Iatrogenic ulnar nerve injury after the surgical treatment of displaced supracondylar fractures of the humerus: number needed to harm, a systematic review. J Pediatr Orthop 2010 Jul-Aug;30(5):430-6. doi: 10.1097/BPO.0b013e3181e00c0d. PMID: 20574258.
  • 15. Reynolds RA, Mirzayan R. A technique to determine proper pin placement of crossed pins in supracondylar fractures of the elbow.Journal of Pediatric Orthopaedics 2000; 20:4 485-489.
  • 16. Eralp L, Demirhan M, Dikici F, Önen M. Deplase humerus suprakondiler kırıklarının tedavisinde çapraz Kirschner teli ve üç tel konfigürasyonlarının radyolojik olarak karşılaştırılması. Acta Orthop Traumatol Turc 2000;34:278-83
  • 17. Afaque SF, Singh A, Maharjan R, Ranjan R, Panda AK, Mishra A. Comparison of clinic-radiological outcome of cross pinning versus lateral pinning for displaced supracondylar fracture of humerus in children: A randomized controlled trial. J Clin Orthop Trauma 2020 Mar-Apr;11(2):259-263. doi: 10.1016/j.jcot.2019.01.013. Epub 2019 Jan 15. PMID: 32099290; PMCID: PMC7026539.
  • 18. Dekker AE, Krijnen P, Schipper IB. Results of crossed versus lateral entry K-wire fixation of displaced pediatric supracondylar humeral fractures: A systematic review and meta-analysis. Injury 2016 Nov;47(11):2391-2398. doi: 10.1016/j.injury.2016.08.022. Epub 2016 Aug 29. PMID: 27596688.
  • 19. Eguia F, Gottlich C, Lobaton G, Vora M, Sponseller PD, Lee RJ. Mid-term Patient-reported Outcomes After Lateral Versus Crossed Pinning of Pediatric Supracondylar Humerus Fractures. J Pediatr Orthop 2020 Aug;40(7):323-328. doi: 10.1097/BPO.0000000000001558. PMID: 32271317.
  • 20. Vashisht S, Banerjee S. Cubitus Varus 2020 Aug 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 32809529
  • 21. Canales-Zamora OA, Mora-Ríos FG, Mejía-Rohenes LC, Anaya-Morales A, González-Gijón OR, López-Hernández JR. Complicaciones de fracturas supracondíleas humerales en niños [Complications of supracondylar humeral fractures in children]. Acta Ortop Mex 2020 Mar-Apr;34(2):91-95. Spanish. PMID: 33244908.
Year 2021, Volume: 11 Issue: 2, 347 - 352, 29.06.2021
https://doi.org/10.31832/smj.911539

Abstract

Percutaneous Pinning Results in Pediatric Supracondylar Humerus Fractures
Objective: The aim of our study is to retrospectively evaluate and compare the treatment results of patients who underwent open and closed reduction among the patients who were diagnosed with supracondylar humerus fractures and treated surgically and were followed up in the outpatient clinic after surgery.
Material And Methods: Children, aged 2-10 years, who underwent surgery with the diagnosis of supracondylar humerus fracture between 2014 and 2020 were evaluated. The clinical and radiological results of the patients who were divided into two groups as closed fracture reduction (Group 1) and open (Group 2) were retrospectively evaluated. Flynn criteria were used for this evaluation. Gartland classification was used for the classification of the fractures.
Results: 64 (44.4%) of the patients were female and 80 (55.6%) were male. The average age of the patients was 5.39 + -2.22. 108 (75%) patients were treated with percutaneous pinning (Group 1) after closed reduction, 36 (25%) patients were treated with open reduction and percutaneous pinning (Group 2) technique. A statistically significant difference was found between the groups in terms of Flynn criteria-cosmetic factors (p = 0.004). The frequency of having moderate-severe cosmetic factor in Group 2 was 13.9%, while it was 0.9% in Group 1. When the groups were examined in terms of "Flynn-Functional factor", no significant difference was found between them (p = 0.057).
Conclusion : The aim of the treatment of supracondylar humerus fractures is to provide full range of motion of the elbow joint and to achieve excellent functional and cosmetic results by preventing neurovascular injuries. Although the first choice in treatment is closed reduction and percutaneous fixation, open reduction can be applied in fractures where closed reduction cannot be achieved. When stable fracture fixation is made with appropriate fracture reduction, the results are similar and satisfactory in both approaches.

References

  • 1.Shrader MW. Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthop Clin North Am 2008 Apr;39(2):163-71, v. doi: 10.1016/j.ocl.2007.12.005. PMID: 18374807.
  • 2.Erdil M,Ceylan H H,Demir N,Elmadağ N M,Bilsel K,Polat G. Pediatrik Gartland Tip 3 Suprakondiler Humerus Kırıkları Cerrahi Tedavisinde Erken Dönem Sonuçlarımız. Jinekoloji Obstetrik Pediatri ve Pediatrik Cerrahi Dergisi 2013; 5(1): 27 - 31.
  • 3.Acar E, Memik R Surgical Treatment Results in Pediatric Supracondylar Humerus Fractures. Eurasian J Emerg Med 2020;19(1): 25-9. DOI: 10.4274/eajem.galenos.2017.74046
  • 4.Ladenhauf HN, Schaffert M, Bauer J. The displaced supracondylar humerus fracture: indications for surgery and surgical options: a 2014 update. Curr Opin Pediatr. 2014 Feb;26(1):64-9. doi: 10.1097/MOP.0000000000000044. PMID: 24378825
  • 5. Heal J, Bould M, Livingstone J, Blewitt N, Blom AW.Reproducibility of the Gartland classification for supracondylar humeral fractures in children. J of Orthop Surg 2007;15:12-4.
  • 6. Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am 2008;90(5):1121-32. http://dx.doi.org/10.2106/JBJS.G.01354 PMid:18451407
  • 7. İnan M, Yücel B. Çocuklarda humerus suprakondiler bölge kırıkları. Totbid Der 2008;(7)3:104-11.
  • 8. Eren A, Özkut AT, Altıntaş F, Güven M. Çocuklarda suprakondiler humerus tip III kırıkların tedavisinde lateral ve medial girişimler ile cerrahi tedavi sonuçlarının fonksiyonel ve kozmetik açıdan karşılaştırılması. Acta Orthop Traumatol Turc 2005;39(3):199-204. PMid:16141725
  • 9. Karapınar L, Sürenkök F, Öztürk H, Us MR. Immediate Closed Reduction and Percutaneous Pinning in Children with Displaced Type 3 Supracondylar Fractures of the Humerus: Investigation of 258 Cases. Joint Dis Rel Surg 2003;14(3):164-75.
  • 10. Pirone AM, Graham HK, Krajbich JL. Management of displaced extension- type supracondylar fractures of the humerus in children. J Bone Joint Surg Am 1988;70(A):641-50. 6. Gosens T, Bongers KJ. Neurovascular complic
  • 11. Joshi T, Koder A, Herman MJ. Staying Out of Trouble: Complications of Supracondylar Humerus Fractures. Instr Course Lect. 2019;68:357-366. PMID: 32032077.
  • 12. Abraham E, Powers T, Witt P, Ray RD. Experimental hyperextension supracondylar fractures in monkeys. Clin Orthop Relat Res 1982;(171):309-18.
  • 13. Hussein al-Algawy, A.A., Aliakbar, A.H. & Witwit, I.H.N. Open versus closed reduction and K-wire fixation for displaced supracondylar fracture of the humerus in children. Eur J Orthop Surg Traumatol 29, 397–403 (2019). https://doi.org/10.1007/s00590-018-2305-9
  • 14. Slobogean BL, Jackman H, Tennant S, Slobogean GP, Mulpuri K. Iatrogenic ulnar nerve injury after the surgical treatment of displaced supracondylar fractures of the humerus: number needed to harm, a systematic review. J Pediatr Orthop 2010 Jul-Aug;30(5):430-6. doi: 10.1097/BPO.0b013e3181e00c0d. PMID: 20574258.
  • 15. Reynolds RA, Mirzayan R. A technique to determine proper pin placement of crossed pins in supracondylar fractures of the elbow.Journal of Pediatric Orthopaedics 2000; 20:4 485-489.
  • 16. Eralp L, Demirhan M, Dikici F, Önen M. Deplase humerus suprakondiler kırıklarının tedavisinde çapraz Kirschner teli ve üç tel konfigürasyonlarının radyolojik olarak karşılaştırılması. Acta Orthop Traumatol Turc 2000;34:278-83
  • 17. Afaque SF, Singh A, Maharjan R, Ranjan R, Panda AK, Mishra A. Comparison of clinic-radiological outcome of cross pinning versus lateral pinning for displaced supracondylar fracture of humerus in children: A randomized controlled trial. J Clin Orthop Trauma 2020 Mar-Apr;11(2):259-263. doi: 10.1016/j.jcot.2019.01.013. Epub 2019 Jan 15. PMID: 32099290; PMCID: PMC7026539.
  • 18. Dekker AE, Krijnen P, Schipper IB. Results of crossed versus lateral entry K-wire fixation of displaced pediatric supracondylar humeral fractures: A systematic review and meta-analysis. Injury 2016 Nov;47(11):2391-2398. doi: 10.1016/j.injury.2016.08.022. Epub 2016 Aug 29. PMID: 27596688.
  • 19. Eguia F, Gottlich C, Lobaton G, Vora M, Sponseller PD, Lee RJ. Mid-term Patient-reported Outcomes After Lateral Versus Crossed Pinning of Pediatric Supracondylar Humerus Fractures. J Pediatr Orthop 2020 Aug;40(7):323-328. doi: 10.1097/BPO.0000000000001558. PMID: 32271317.
  • 20. Vashisht S, Banerjee S. Cubitus Varus 2020 Aug 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 32809529
  • 21. Canales-Zamora OA, Mora-Ríos FG, Mejía-Rohenes LC, Anaya-Morales A, González-Gijón OR, López-Hernández JR. Complicaciones de fracturas supracondíleas humerales en niños [Complications of supracondylar humeral fractures in children]. Acta Ortop Mex 2020 Mar-Apr;34(2):91-95. Spanish. PMID: 33244908.
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Mümin Karahan 0000-0002-2137-2634

Ahmet Çağrı Uyar This is me 0000-0002-8905-6320

Ahmet Taha Bitlis This is me 0000-0002-0459-8367

Publication Date June 29, 2021
Submission Date April 8, 2021
Published in Issue Year 2021 Volume: 11 Issue: 2

Cite

AMA Karahan M, Uyar AÇ, Bitlis AT. Pediatrik Suprakondiler Humerus Kırıklarında Açık Redüksiyon ve Perkütan Pinleme İle Kapalı Redüksiyon ve Perkütan Pinleme Sonuçlarının Karşılaştırılması. Sakarya Tıp Dergisi. June 2021;11(2):347-352. doi:10.31832/smj.911539

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