GARTLAND TİP 3 SUPRAKONDİLER HUMERUS KIRIKLARINDA CERRAHİ YÖNETİM STRATEJİLERİ

Yıl 2017, Cilt: 50 Sayı: 2, 74 - 80, 01.12.2017

Gökhun Arıcan Özay Subaşı Ahmet Özmeriç Özgür Şahin Kadir Bahadır Alemdaroğlu Serkan İltar

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

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