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Pediatrik suprakondiler humerus kırıklarının cerrahi tedavisinde medial pin ile stabilite arzusu ulnar sinir iatrojenik yaralanmasını göze almaya değer mi?

Yıl 2018, Cilt: 51 Sayı: 2, 129 - 132, 29.08.2018

Öz

AMAÇ: Suprakondiler humerus kırıkları
pediatrik yaş grubu kırıklarının %10’u oluşturur. Cerrahi tedavisinde en seçkin
yöntem kapalı redüksiyon ve peruktan pinlemedir. Cerrahiye bağlı en önemli
komplikasyonlarından biri medialden yerleştirilen pin nedeniyle iyatrojenik
ulnar sinir yaralanmasıdır. Çalışmamızda, çocuk yaş Gartland tip 3
suprakondiler humerus kırıklarının tedavisinde, izole lateral pinlerle
fiksasyon ve bu osteosenteze ek stabilite sağlaması için yerleştirilen medial
pin konfigurasyonu karşılaştırılarak, takipteki korreksiyon kaybı ve kaynama
sonrası pin çıkarım süreleri açısından üstünlüklerinin değerlendirilmesi
amaçlanmıştır

GEREÇ VE YÖNTEM: 2014-2015 yıllarında Gartland tip 3
suprakondiler humerus kırığı nedeniyle çapraz pin (iki lateral bir medial)
uygulanan 30 hasta (22 erkek 8 kadın yaş
ortalaması
8,1 ± 2,6) ve lateral pin (iki lateral)
uygulanan 10 hasta (5 erkek 5 kadın ortalama yaş 7,1 ±
2,1) çalışmaya dahil edildi. Hastaların
ameliyat sonrası ilk radyografilerindeki ve pin çıkarımı
esnasında çekilen radyografilerinde Baumann açıları ölçüldü. Açılardaki
değişim, ilk kallus dokusunun görünür olma zamanı ve pin çıkarımına kadar geçen
süreler karşılaştırıldı.

BULGULAR: Cerrahi sonrası ilk dönemde ve tel
çıkartılması esnasındaki Baumann açılarında değişim sırasıyla; çapraz pin
grubunda 4,7
± 2,2 derece lateral pin grubunda 5,0 ± 2,3 derece idi ve gruplar arasında anlamlı bir
fark yoktu. Hastaların ilk kallus oluşum süreleri sırasıyla
19,7 ± 3,0 ve
20,0 ± 3,1 gün;
pin çıkartılma süreleri sırasıyla 35,3 ± 3,7 ve
35,9 ± 3,6 gün olarak ölçüldü ve gruplar
arasında
anlamlı bir
fark yoktu.







SONUÇ: Medialden pin yerleştirilmesi korreksiyonu korumak
için şart değildir, sadece lateral pinler ile uygulanan stablizasyon, yeterli
kırık kaynamasını sağlaması açısından güvenilir bir yöntemdir.

Kaynakça

  • Farnsworth, C.L., P.D. Silva, and S.J. Mubarak, Etiology of supracondylar humerus fractures. J Pediatr Orthop, 1998. 18(1): p. 38-42.
  • Mulpuri, K. and K. Wilkins, The treatment of displaced supracondylar humerus fractures: evidence-based guideline. J Pediatr Orthop, 2012. 32 Suppl 2: p. S143-52.
  • Baratz, M., C. Micucci, and M. Sangimino, Pediatric supracondylar humerus fractures. Hand Clin, 2006. 22(1): p. 69-75.
  • Omid, R., P.D. Choi, and D.L. Skaggs, Supracondylar humeral fractures in children. J Bone Joint Surg Am, 2008. 90(5): p. 1121-32.
  • Lee, K.M., et al., Medial and lateral crossed pinning versus lateral pinning for supracondylar fractures of the humerus in children: decision analysis. J Pediatr Orthop, 2012. 32(2): p. 131-8.
  • Marsland, D. and S.M. Belkoff, Biomechanical analysis of posterior intrafocal pin fixation for the pediatric supracondylar humeral fracture. J Pediatr Orthop, 2014. 34(1): p. 40-4.
  • Wang, X., et al., Biomechanical analysis of pinning configurations for a supracondylar humerus fracture with coronal medial obliquity. J Pediatr Orthop B, 2012. 21(6): p. 495-8.
  • Silva, M., et al., Biomechanical testing of pin configurations in supracondylar humeral fractures: the effect of medial column comminution. J Orthop Trauma, 2013. 27(5): p. 275-80.
  • Chen, T.L., et al., Stiffness of various pin configurations for pediatric supracondylar humeral fracture: a systematic review on biomechanical studies. J Pediatr Orthop B, 2015. 24(5): p. 389-99.
  • France, J. and M. Strong, Deformity and function in supracondylar fractures of the humerus in children variously treated by closed reduction and splinting, traction, and percutaneous pinning. J Pediatr Orthop, 1992. 12(4): p. 494-8.
  • Edmonds, E.W., J.H. Roocroft, and S.J. Mubarak, Treatment of displaced pediatric supracondylar humerus fracture patterns requiring medial fixation: a reliable and safer cross-pinning technique. J Pediatr Orthop, 2012. 32(4): p. 346-51.
  • Brauer, C.A., et al., A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatr Orthop, 2007. 27(2): p. 181-6.
  • Eberl, R., et al., Iatrogenic ulnar nerve injury after pin fixation and after antegrade nailing of supracondylar humeral fractures in children. Acta Orthop, 2011. 82(5): p. 606-9.
  • Rose, R.E. and W. Phillips, Iatrogenic ulnar neuropathies post-pinning of displaced supracondylar humerus fractures in children. West Indian Med J, 2002. 51(1): p. 17-20.
  • Ozcelik, A., A. Tekcan, and H. Omeroglu, Correlation between iatrogenic ulnar nerve injury and angular insertion of the medial pin in supracondylar humerus fractures. J Pediatr Orthop B, 2006. 15(1): p. 58-61.
  • Garg, S., et al., Clinical characteristics of severe supracondylar humerus fractures in children. J Pediatr Orthop, 2014. 34(1): p. 34-9.
  • Mehserle, W.L. and P.L. Meehan, Treatment of the displaced supracondylar fracture of the humerus (type III) with closed reduction and percutaneous cross-pin fixation. J Pediatr Orthop, 1991. 11(6): p. 705-11.
  • Topping, R.E., J.S. Blanco, and T.J. Davis, Clinical evaluation of crossed-pin versus lateral-pin fixation in displaced supracondylar humerus fractures. J Pediatr Orthop, 1995. 15(4): p. 435-9.
  • Lee, S.S., et al., Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop, 2002. 22(4): p. 440-3.
  • Zionts, L.E., H.A. McKellop, and R. Hathaway, Torsional strength of pin configurations used to fix supracondylar fractures of the humerus in children. J Bone Joint Surg Am, 1994. 76(2): p. 253-6.
  • Gottschalk, H.P., et al., Biomechanical analysis of pin placement for pediatric supracondylar humerus fractures: does starting point, pin size, and number matter? J Pediatr Orthop, 2012. 32(5): p. 445-51.
  • Aarons, C.E., et al., Repair of supracondylar humerus fractures in children: does pin spread matter? J Pediatr Orthop B, 2012. 21(6): p. 499-504.
  • Skaggs, D.L., et al., Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am, 2004. 86-a(4): p. 702-7.

Is demand of stability with medial pin worth the iatrogenic injury of the ulnar nerve in surgical treatment of pediatric supracondylar humerus fractures?

Yıl 2018, Cilt: 51 Sayı: 2, 129 - 132, 29.08.2018

Öz

INTRODUCTION: Supracondylar humerus fractures are
10% of the fractures in children.
The preferred treatment of displaced supracondylar
humerus fractures in hildren is immediate closed reduction and percutaneous
fixation with pins. One of the most important complications of the surgery is
the iatrogenic ulnar nerve injury due to the pin placed medially. In our study,
we aimed to evaluate Gartland type 3 supracondylar humerus fractures were
treated with isolated lateral pinning and medial pin placed configuration for
additional stability in the osteosynthesis and superiority of configurations
about correction loss and time to pin removal.

MATERİAL AND METHODS: 30 patients (22 males, 8 females, mean age
8,1 ± 2,6) who applied cross pin ( two lateral one medial) and 10 patients (5
males, 5 females, mean age 7,1 ± 2,1) who applied lateral pin (two lateral) in
pediatric supracondylar humeral fractures between 2014-2015 were included in
the study. Baumann’s angle was measured on first radiographs after surgery and the
radiographs after pin removal. The differences in the angles, the time of
appearance of the first callus tissue and the time to pin removal were
compared.

RESULTS: The differences in the Baumann’s angles in the
cross pin group was 5.0 ± 2.3 degrees and in the lateral pin group of 4.7 ± 2.2
degrees and there was no significant difference between the groups. In terms of
initial callus formation and times to pin removal there was no significant
difference between the groups.







CONCLUSİON: Medial pin placement is not
necessary to preserve the correction, stabilization applied with only lateral
pins is a reliable method for adequate fracture healing.

Kaynakça

  • Farnsworth, C.L., P.D. Silva, and S.J. Mubarak, Etiology of supracondylar humerus fractures. J Pediatr Orthop, 1998. 18(1): p. 38-42.
  • Mulpuri, K. and K. Wilkins, The treatment of displaced supracondylar humerus fractures: evidence-based guideline. J Pediatr Orthop, 2012. 32 Suppl 2: p. S143-52.
  • Baratz, M., C. Micucci, and M. Sangimino, Pediatric supracondylar humerus fractures. Hand Clin, 2006. 22(1): p. 69-75.
  • Omid, R., P.D. Choi, and D.L. Skaggs, Supracondylar humeral fractures in children. J Bone Joint Surg Am, 2008. 90(5): p. 1121-32.
  • Lee, K.M., et al., Medial and lateral crossed pinning versus lateral pinning for supracondylar fractures of the humerus in children: decision analysis. J Pediatr Orthop, 2012. 32(2): p. 131-8.
  • Marsland, D. and S.M. Belkoff, Biomechanical analysis of posterior intrafocal pin fixation for the pediatric supracondylar humeral fracture. J Pediatr Orthop, 2014. 34(1): p. 40-4.
  • Wang, X., et al., Biomechanical analysis of pinning configurations for a supracondylar humerus fracture with coronal medial obliquity. J Pediatr Orthop B, 2012. 21(6): p. 495-8.
  • Silva, M., et al., Biomechanical testing of pin configurations in supracondylar humeral fractures: the effect of medial column comminution. J Orthop Trauma, 2013. 27(5): p. 275-80.
  • Chen, T.L., et al., Stiffness of various pin configurations for pediatric supracondylar humeral fracture: a systematic review on biomechanical studies. J Pediatr Orthop B, 2015. 24(5): p. 389-99.
  • France, J. and M. Strong, Deformity and function in supracondylar fractures of the humerus in children variously treated by closed reduction and splinting, traction, and percutaneous pinning. J Pediatr Orthop, 1992. 12(4): p. 494-8.
  • Edmonds, E.W., J.H. Roocroft, and S.J. Mubarak, Treatment of displaced pediatric supracondylar humerus fracture patterns requiring medial fixation: a reliable and safer cross-pinning technique. J Pediatr Orthop, 2012. 32(4): p. 346-51.
  • Brauer, C.A., et al., A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatr Orthop, 2007. 27(2): p. 181-6.
  • Eberl, R., et al., Iatrogenic ulnar nerve injury after pin fixation and after antegrade nailing of supracondylar humeral fractures in children. Acta Orthop, 2011. 82(5): p. 606-9.
  • Rose, R.E. and W. Phillips, Iatrogenic ulnar neuropathies post-pinning of displaced supracondylar humerus fractures in children. West Indian Med J, 2002. 51(1): p. 17-20.
  • Ozcelik, A., A. Tekcan, and H. Omeroglu, Correlation between iatrogenic ulnar nerve injury and angular insertion of the medial pin in supracondylar humerus fractures. J Pediatr Orthop B, 2006. 15(1): p. 58-61.
  • Garg, S., et al., Clinical characteristics of severe supracondylar humerus fractures in children. J Pediatr Orthop, 2014. 34(1): p. 34-9.
  • Mehserle, W.L. and P.L. Meehan, Treatment of the displaced supracondylar fracture of the humerus (type III) with closed reduction and percutaneous cross-pin fixation. J Pediatr Orthop, 1991. 11(6): p. 705-11.
  • Topping, R.E., J.S. Blanco, and T.J. Davis, Clinical evaluation of crossed-pin versus lateral-pin fixation in displaced supracondylar humerus fractures. J Pediatr Orthop, 1995. 15(4): p. 435-9.
  • Lee, S.S., et al., Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop, 2002. 22(4): p. 440-3.
  • Zionts, L.E., H.A. McKellop, and R. Hathaway, Torsional strength of pin configurations used to fix supracondylar fractures of the humerus in children. J Bone Joint Surg Am, 1994. 76(2): p. 253-6.
  • Gottschalk, H.P., et al., Biomechanical analysis of pin placement for pediatric supracondylar humerus fractures: does starting point, pin size, and number matter? J Pediatr Orthop, 2012. 32(5): p. 445-51.
  • Aarons, C.E., et al., Repair of supracondylar humerus fractures in children: does pin spread matter? J Pediatr Orthop B, 2012. 21(6): p. 499-504.
  • Skaggs, D.L., et al., Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am, 2004. 86-a(4): p. 702-7.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Araştırma Makalesi
Yazarlar

Abdullah İyigün

Eren İmamoğlu Bu kişi benim

Yayımlanma Tarihi 29 Ağustos 2018
Gönderilme Tarihi 24 Temmuz 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 51 Sayı: 2

Kaynak Göster

AMA İyigün A, İmamoğlu E. Pediatrik suprakondiler humerus kırıklarının cerrahi tedavisinde medial pin ile stabilite arzusu ulnar sinir iatrojenik yaralanmasını göze almaya değer mi?. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. Ağustos 2018;51(2):129-132.