The Effect on Clinical and Radiological Results of Open or Closed Reduction in Unstable, Paediatric Forearm Diaphyseal Fracture Surgery

Year 2015, , 38 - 43, 01.01.2015

Necdet Sağlam Tuhan Kurtulmuş Birkan Kibar Gürsel Saka Cem Coşkun Avcı Fuat Akpınar

https://doi.org/10.5505/abantmedj.2015.29484

Abstract

OBJECTIVE: Clinical and radiological results were evaluated of surgery to paediatric unstable forearm diaphyseal double-bone fractures, treated as both bones open, both bones closed and one open, one closed.METHODS: 63 children treated with intramedullar nailing for an unstable forearm mid 1/4 fracture were retrospectively evaluated. Group A comprised 3 females, 10 males mean age 10 years and underwent open reduction on both bones. Group B comprised 4 females, 23 males mean age 11 years and underwent closed reduction on both bones. Group C comprised 3 females, 20 male mean age 11 years, and underwent open reduction on one bone and closed reduction on the other. The Gustilo-Anderson classification showed 15 patients Type 1 and 2 patients Type 2 open fractures. Mean time to surgery was 4, 2, 2 days for Groups A,B, C. K-wires were used on all patients. Fixation was applied to both the radius and ulna. Mean follow-up periods were 38, 34, 39 months for Groups A, B, C. RESULTS: Union was achieved on mean Day 47, 45, 46 in Groups A,B, C. Nails were removed on mean Day 53, 82 and 67 respectively. No statistically significant difference was determined between the groups in terms of age, time to surgery, nail removal and follow-up period, gender, side, etiology or complications p>0.05 . No significant complications developed.CONCLUSION: In intramedullar fixation of paediatric unstable forearm diaphyseal fractures with K-wire, open or closed fracture reduction showed no statistical effect on the functional and radiological results.

Keywords

Child, forearm, fracture fixation, intramedullary, radius fractures/surgery, ulna fractures/surgery

İnstabil Çocuk Önkol Diyafiz Kırık Cerrahisinde Açık ya da Kapalı Redüksiyonun Klinik ve Radyolojik Sonuçlara Etkisi

Abstract

AMAÇ: Stabil olmayan çocuk önkol diyafiz çift kırıklarının cerrahisinde, kırık redüksiyonu her iki kemiği açık, her iki kemiği kapalı ve bir kemiği açık diğeri kapalı yapılan hastaların klinik ve radyolojik sonuçları değerlendirildi.YÖNTEMLER: İnstabil önkol 1/4 orta cisim kırığı nedeniyle intramedüller çivileme yöntemiyle tedavi edilen 63 çocuk geriye dönük değerlendirildi. Hastaların 13’üne Grup A; 3 kız, 10 erkek; ort. yaş 10; dağılım;5-15 her iki kemiğe açık yerleştirme; 27’sine Grup B; 4 kız, 23 erkek; ort. yaş 11; dağılım;5-16 her iki kemiğe kapalı yerleştirme; 23’üne Grup C; 3 kız, 20 erkek; ort. yaş 11; dağılım;7-14 bir kemiğe açık diğerine kapalı redüksiyon uygulandı. Gustilo-Anderson sınıflamasına göre 15 hastada tip1, iki hastada tip 2 açık kırık vardı. Yaralanmadan cerrahiye kadar geçen süre grup A’da 4, grup B’de 2, grup C’de 2 gündü. Hastalarda Kirschner teli kullanıldı. Hastaların hepsinde hem radius hem ulna tespit edildi. Ortalama takip süresi grup A’da 38, grup B’de 34, grup C’de 39 aydı.BULGULAR: Grup A’da ortalama 47, grup B’de 45, grup C’de 46 günde kaynama sağlandı. Çivilerin çıkarılma süreleri grup A’da ortalama 53, grup B’de 82, grup C’de 67 gündü. Gruplar arasında yaş, yaralanmadan cerrahiye kadar geçen süre, tel çıkarma ve takip süresi, cinsiyet, taraf, etiyoloji, komplikasyon dağılımlarında istatiksel anlamlı farklılık saptanmadı p>0.05 . Epifiz hasarı, redüksiyon kaybı, refraktür, derin enfeksiyon, kaynamama, nörovasküler yaralanma, Kirschner teli migrasyonu, sinostoz, angular ya da rotasyonel deformite ve anestezi komplikasyonu gelişmedi.SONUÇ: Çocuklarda instabil önkol diyafiz kırıklarının Kirschner teliyle intramedüller tespitinde açık veya kapalı kırık redüksiyonunun fonksiyonel ve radyolojik sonuçlar üzerine etkisi olmadığını istatistiksel olarak gösterildi.

Keywords

Çocuk, önkol, kırık tespiti, intramedüller, radius kırığı/cerrahi, ulna kırığı/cerrahi

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