GARTLAND TİP 3 SUPRAKONDİLER HUMERUS KIRIKLARINDA CERRAHİ YÖNETİM STRATEJİLERİ

Öz

GİRİŞ

Çocuklarda humerus alt uç kırıkları ikinci en sık görülen kırıklardır. Gartland tip 3 kırıklarının tedavisinde tam bir fikir birliği yoktur. Bu çalışmanın amacı, suprakondiler humerus kırıklarında cerrahi yönetim stratejisi belirlemektir.

 

HASTALAR ve YÖNTEM:

Ocak 2015 - Aralık 2016 tarihleri arasında kliniğimizde opere edilen humerus suprakondiler Gartland tip III kırıklı 53 hasta çalışmaya dahil edildi. Çalışmada hastaların demografik verileri, kırığın oluş nedenleri, kırık tipleri, komplikasyonlar, radyolojik parametreler, kozmetik ve fonksiyonel sonuçlar değerlendirildi.

BULGULAR:                                                                                                           

Hastaların 30’ u erkek 23’si kadındı. Yaş ortalaması 6,5 olarak bulundu. Hastalar ortalama 4-24 ay takip edildi. Ortalama yatış süresi 3,15 gün olarak gözlendi. 3 hastada pseudovarus gözlendi. Flynn kriterlerine göre açık redüksiyon yapılmış hastalar ile kapalı redüksiyon yapılmış hastalar arasında fonksiyonel ve yatış süresi açısından anlamlı fark bulunamazken kozmetik olarak kapalı redüksiyon tedavisi açık redüksiyona göre daha başarılı olarak gözlendi. Çapraz K teli uygulanan hastalar ile izole lateral K teli uygulanan hastalar arasında da fonksiyonel ve yatış süresi açısından istatistiksel anlamlı fark bulunamadı. Açık veya kapalı redüksiyon K teli ile fiksasyon yapılmış hastalarda ilk 6 saatte opere edilenler ile 12.saatten sonra opere edilenler arasında yatış süreleri, flynn fonksiyonel sonuçları açısından anlamlı fark gözlenmedi.

SONUÇ

 

Kozmetik olarak daha avantajlı olması, komplikasyon oranlarının açık redüksiyona göre anlamlı olmaması nedeniyle kapalı redüksiyonun öncelikli tercih edilmesi kanaatindeyiz. K teli konfigürasyonları arasında fonksiyonel olarak fark olmaması nedeniyle 2 adet lateral K teli ile redüksiyonun kalitesinin ve fiksasyonun stabilitesinin yeterli olduğunu düşündüğümüz vakalarda medialden K teli uygulaması gerekli değildir. Cerrahi riski yüksek hastalar için en uygun cerrahi zaman beklenebilir.    

Anahtar Kelimeler

• Flynn kriterleri,suprakondiler kırıklar,açık redüksiyon,çocuklar,fiksasyon teknikleri

SURGICAL MANAGEMENT STRATEGIES IN GARTLAND TYPE 3 SUPRACONDYLAR HUMERAL FRACTURES

Öz

OBJECTIVE: Humeral lower extremity fractures are the second most common fractures in children. There is no consensus on the treatment of Gartland type 3 fractures. The purpose of this study is to determine the surgical management strategy for supracondylar humerus fractures.

 

MATERIAL AND METHODS: Between January 2015 and December 2016, 53 patients with humeral supracondylar Gartland type III fractures were included in our study. Demographic data, causes of fractures, fracture types, complications, radiological parameters, cosmetic and functional outcomes were evaluated in the study.

 

RESULTS: 30 of the patients were male and 23 were female. The mean age of patients were 6,5 years. The mean length of hospital stay was 3,15 days. The average follow up was 4-24 months. Pseudovarus were observed in 3 patients. Cosmetically closed reduction treatment was more successful than open reduction, although there was no significant difference in functional and length of stay between open reduction patients and closed reduction patients according to Flynn criteria. There was no statistically significant difference between patients who were treated with crossed K wire and those who were treated with isolated lateral K wire in terms of functional and length of stay. Patients who were K wire fixed with open or closed reduction did not differ significantly in terms of hospitalization time, flynn functional results in the first 6 hours and those who were oppressed after 12 hours.

 

CONCLUSION: We believe that closed reduction is the preferred choice because of the cosmetic advantage that complication rates are not significant compared to open reduction. Since there is no functional difference between the two configurations, medial K wires is not necessary when we think that the reduction quality and fixation stability with 2 lateral K wires are sufficient. For patients who are at high risk for surgery, optimal surgery time may be expected.

Anahtar Kelimeler

• Flynn criteria,supracondylar fractures,open reduction,children,fixation techniques

Kaynakça

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