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

Yıl 2015, Cilt: 4 Sayı: 1, 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

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• Mann DC, Rajmaira S. Distribution of physeal and nonphyseal fractures in 2,650 long-bone fractures in children aged 0–16 years. J Pediatr Orthop 1990;10: 713–6.
• Creasman C, Zaleske DJ, Ehrlich MG. Analyzing forearm fractures in children. The more subtle signs of impending problems. Clin Orthop Relat Res 1984; 40–53.
• Vainionpaa S, Bostman O, Patiala H, Rokkanen P. Internal fixation of forearm fractures in children. Acta Orthop Scand 1987;58: 121–3.
• Ortega R, Loder RT, Louis DS. Open reduction and internal fixation of forearm fractures in children. J Pediatr Orthop 1996;16: 651–4.
• Voto SJ, Weiner DS, Leighley B. Use of pins and plaster in the treatment of unstable pediatric forearm fractures. J Pediatr Orthop 1990;10:85-9.
• Lee S, Nicol RO, Stott NS. Intramedullary fixation for pediatric unstable forarm fractures. Clin Orthop Relat Res 2002: 245-50.
• Nielsen AB, Simonsen O. Displaced forearm fractures in children treated with AO plates. Injury 1984;15: 393–6.
• Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop 1990;10: 167–71.
• Schranz PJ, Gultekin C, Colton CL. External fixation of fractures in children. Injury 1992;23: 80– 2.
• Daruwalla JS. A study of radioulnar movements following fractures of the forearm in children. Clin Orthop Relat Res 1979:114–20.
• Waseem M, Paton RW. Percutaneous intramedullary elastic wiring of displaced diaphyseal forearm fractures in children. A modified technique. Injury1999;30: 21–4.
• Luhmann SJ, Gordon JE, Schoenecker PL. Intramedullary fixation of unstable both-bone forearm fractures in children. J Pediatr Orthop 1998;18: 451–6.
• Shoemaker SD, Comstock CP, Mubarak SJ, Wenger DR, Chambers HG. Intramedullary Kirschner wire fixation of open or unstable forearm fractures in children. J Pediatr Orthop. 1999;19: 329 –37.
• Kucukkaya M, Kabukcuoglu Y, Tezer M, Eren T, Kuzgun U. The application of open intramedullary fixation in the treatment of pediatric radial and ulnar shaft fractures. J Orthop Trauma 2002;16: 340-4.
• Matthews LS, Kaufer H, Garver DF, Sonstegard DA. The effect on supination-pronation of angular malalignment of fractures of both bones of the forearm. J Bone Joint Surg 1982;64: 14–7.
• Tarr RR, Garfinkel AI, Sarmiento A. The effects of angular and rotational deformities of both bones of the forearm: An in vitro study. J Bone Joint Surg 1984;66: 65–70.
• Price CT, Scott DS, Kurzner ME, Flynn JC. Malunited forearm fractures in children. J Pediatr Orthop 1990;10: 705-12.
• Kay S, Smith C, Oppenheim WL. Both bone mid- shaft forearm fractures in children. J Pediatr Orthop 1986;6: 306-10.
• Verstreken L, Delronge G, Lamoureux J. Shaft forearm fractures inchildren: intramedullary nailing with immediate motion: a preliminary report. J Pediatr Orthop 1988;8: 450–3.
• Van der Reis WL, Otsuka NY, Moroz P, Mah J. Intramedullary nailing versus plate fixation for unstable forearm fractures in children. J Pediatr Orthop1998;18: 9–13.
• Yung SH, Lam CY, Choi KY, Ng KW, Maffulli N, Cheng JC. Percutaneous intramedullary Kirschner wiring for displaced diaphyseal forearm fractures in children. J Bone Joint Surg Br 1998; 80: 91–9.
• Richter D, Ostermann PA, Ekkernkamp A, Muhr G, Hahn MP. Elastic intramedullary nailing: a minimally invasive concept in the treatment of unstable forearm fractures in children. J Pediatr Orthop 1998;18: 457– 61.
• Ono M, Bechtold JE, Merkow RL, Sherman RE, Gustilo RB. Rotational stability of diaphyseal fractures of the radius and ulna fixed with Rush pins and/or fracture bracing. Clin Orthop Relat Res 1989:236–43.
• Yalcınkaya M, Dogan A, Ozkaya U, Sokucu S, Uzumcugil O, Kabukcuoglu M. Clinical results of intramedullary nailing following closed or mini open reduction in pediatric unstable diaphyseal forearm fractures. Acta Orthop Traumatol Turc 2010;44: 7- 13.