Çocuklarda redükte edilemeyen metafizo-diyafiziel distal radius kırıklarında mini-açık teknikle yapılan pin tespiti sonuçları

Yıl 2024, Cilt: 29 Sayı: 1, 37 - 43, 27.01.2024

Levent Horoz , Mehmet Fevzi Çakmak

https://doi.org/10.21673/anadoluklin.1300210

Öz

Amaç: Pediatrik distal radius kırıklarının tedavisinde, konservatif tedavi genel tercih edilen tedavi olmasına karşın distal metafizodiafizier kırıklarda redüksiyon kayıpları ve redüksiyonun sağlanamaması başlıca sorun olarak karşımıza çıkmaktadır. Yer değiştirmiş metafizodiafizier distal radius kırıklarının cerrahi tedavisinde hangi tekniğin kullanılacağına dair fikir birliği bulunmamaktadır. Bu çalışmanın amacı; metafizodiafizier yerleşimli distal radius kırıklarında mini-açık teknik ile yapılan pin tespitinin sonuçlarını değerlendirmektir.

Yöntemler: 2018-2020 yılları arasında metafizodiafizier distal radius kırığı nedeni ile ameliyat edilen pediatrik vakalar geriye dönük incelenmiştir. Hastaların klinik takipleri ikinci, dördüncü, altıncı haftalarda ve üçüncü ayda yapıldı. Radyolojik iyileşme zamanı, takiplerde gelişen redüksiyon kayıpları, komplikasyonlar, el bileği ve önkol hareket açıklıkları değerlendirilmiştir.

Bulgular: Toplamda 19 hasta, 13’ü erkek ve 6’sı kız hasta olmak üzere incelemeye alınmıştır. Çalışmaya dahil edilen hastaların ortalama yaşı 10.1 (8-12 yıl) yıldır. Ameliyattan hemen sonra çekilen grafilerde koronal planda translasyon %5’in altında, sagittal planda ise %10’un altında bulunmuştur. Hastaların son takiplerindeki kırık iyileşmesine yönelik yapılan radyografik incelemelerde ön-arka grafilerde ortalama 3, yan grafilerde ise ortalama 4 derece açısal değişiklik tespit edilmiştir. Hastalarda herhangi bir hareket kısıtlılığı gözlemlenmemiştir.

Sonuç: Araştırmamız sonucunda; metafizodiafizier distal raidus kırıkların tedavisinde mini-açık teknik ile uygulanan pin tespiti yeterli stabilite ve dizilim elde edilmesi açısından uygun bir tekniktir.

Anahtar Kelimeler

Asgari invazif cerrahi, kırık tepiti, osteosentez, radius kırıkları

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

TÜm çalışma arkadaşlarıma teşekkür ederim.

Result of the pin fixation with mini-open technique for irreducible distal radius diaphyseal metaphyseal junction fractures in child

Öz

Aim: Although conservative treatment remains the preferred choice for distal radius fracture in children, reduction losses and failure to achieve reduction remain the main problems at diaphyseal metaphyseal junctional fractures. There is no consensus on the surgical treatment of displaced metaphyseal-diaphyseal distal radius fractures. This study aims to evaluate the result of the crossed pin fixation applied with the mini-open technique at pediatric metaphyseal-diaphyseal distal radius fractures.

Methods: The radiological and clinical outcomes of pediatric distal metaphyseal diaphyseal distal radius fractures operated between 2018 and 2020 were retrospectively investigated. The clinical follow-ups of the patients were performed in the second, fourth, sixth weeks and the third month. Radiological recovery time, reduction losses during follow-up, complications, and forearm and wrist range of motion were examined.

Result: There were 13 boys and 6 girls with an average age of 10.1 (8-12 years). Radiographs taken immediately after the operation showed less than 5% translation in the coronal plane and less than 10% translation in the sagittal plane. An average of 4 degrees of change was observed in the lateral radiographs, and an average of 3 changes was detected in the anterior to posterior (AP) radiographs at the last follow-up. No limitation in the range of motion was observed in the patients.

Conclusion: Our data showed that the pin fixation with the mini-open technique was a suitable method to treat metaphyseal-diaphyseal distal radius fractures with a satisfactory alignment and achieving stable fixation.

Anahtar Kelimeler

Fracture fixation, minimally invasive, osteosynthesis, radius fractures

Proje Numarası

Yok

Kaynakça

• Colaris JW, Allema JH, Biter LU, et al. Re-displacement of stable distal both-bone forearm fractures in children: a randomised controlled multicentre trial. Injury. 2013;44(4):498-503.
• Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM. Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in children: a prospective, randomized study. J Pediatr Orthop. 2005;25(4):490-4.
• Zamzam MM, Khoshhal KI. Displaced fracture of the distal radius in children: factors responsible for redisplacement after closed reduction. J Bone Joint Surg Br. 2005;87(6):841-3.
• Marcheix PS, Peyrou P, Longis B, Moulies D, Fourcade L. Dorsal distal radius fractures in children: role of plaster in redisplacement of these fractures. J Pediatr Orthop B. 2011;20(6):372-5.
• Sato K, Mimata Y, Takahashi G, Murakami K, Numata N, Doita M. Fractures of the proximal segments of the pediatric distal radial metaphysis exhibit less angular stability than fractures of the distal segments. J Pediatr Orthop B. 2022;31(5):471-8.
• Flynn JM, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop. 2010;30(4):313-9.
• Slongo TF. The choice of treatment according to the type and location of the fracture and the age of the child. Injury. 2005;36 Suppl 1:A12-9.
• Joulié S, Laville JM, Salmeron F. Posteromedial elastic stable intra-medullary nailing (ESIN) in volarly displaced metaphyso-diaphyseal distal radius fractures in child. Orthop Traumatol Surg Res. 2011;97(3):330-4.
• van Egmond JC, Selles CA, Cleffken BI, Roukema GR, van der Vlies KH, Schep NWL. Plate Fixation for Unstable Displaced Distal Radius Fractures in Children. J Wrist Surg. 2019;8(5):384-7.
• Lieber J, Schmid E, Schmittenbecher PP. Unstable diametaphyseal forearm fractures: transepiphyseal intramedullary Kirschner-wire fixation as a treatment option in children. Eur J Pediatr Surg. 2010;20(6):395-8.
• Du M, Han J. Antegrade elastic stable intramedullary nail fixation for paediatric distal radius diaphyseal metaphyseal junction fractures: A new operative approach. Injury. 2019;50(2):598-601.
• Cai H, Wang Z, Cai H. Fixation of distal radial epiphyseal fracture: Comparison of K-wire and prebent intramedullary nail. J Int Med Res. 2016;44(1):122-30.
• Pan Pannu GS, Herman M. Distal radius-ulna fractures in children. Orthop Clin North Am. 2015;46(2):235-48.
• Bohm ER, Bubbar V, Yong Hing K, Dzus A. Above and below-the-elbow plaster casts for distal forearm fractures in children. A randomized controlled trial. J Bone Joint Surg Am. 2006;88(1):1-8.
• Zimmermann R, Gschwentner M, Pechlaner S, Gabl M. Remodeling capacity and functional outcome of palmarly versus dorsally displaced pediatric radius fractures in the distal one-third. Arch Orthop Trauma Surg. 2004;124(1):42-8.
• Li CT, Hung GK, Fong KN, Gonzalez PC, Wah SH, Tsang HW. Effects of home-based occupational therapy telerehabilitation via smartphone for outpatients after hip fracture surgery: A feasibility randomised controlled study. J Telemed Telecare. 2022;28(4):239-47.
• Li J, Rai S, Tang X, Ze R, Liu R, Hong P. Fixation of delayed distal radial fracture involving metaphyseal diaphyseal junction in adolescents: a comparative study of crossed Kirschner-wiring and non-bridging external fixator. BMC Musculoskelet Disord. 2020;21(1):365.
• Lieber J, Sommerfeldt DW. Die diametaphysäre Unterarmfraktur im Kindesalter. Pitfalls und Empfehlungen in der Behandlung. Unfallchirurg. 2011;114(4):292-9.
• Parikh SN, Jain VV, Youngquist J. Intrafocal pinning for distal radius metaphyseal fractures in children. Orthopedics. 2013;36(6):783-8.
• Colaris J, Reijman M, Allema JH, et al. Angular malalignment as cause of limitation of forearm rotation: an analysis of prospectively collected data of both-bone forearm fractures in children. Injury. 2014;45(6):955-9.
• Cai H, Wang Z, Cai H. Prebending of a titanium elastic intramedullary nail in the treatment of distal radius fractures in children. Int Surg. 2014;99(3):269-75.
• Varga M, Józsa G, Fadgyas B, Kassai T, Renner A. Short, double elastic nailing of severely displaced distal pediatric radial fractures: A new method for stable fixation. Medicine (Baltimore). 2017;96(14):e6532.
• Nisar A, Bhosale A, Madan SS, Flowers MJ, Fernandes JA, Jones S. Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures. J Orthop. 2013;10(1):17-24.
• Poutoglidou F, Metaxiotis D, Kazas C, Alvanos D, Mpeletsiotis A. Flexible intramedullary nailing in the treatment of forearm fractures in children and adolescents, a systematic review. J Orthop. 2020;20:125-30.
• Jubel A, Andermahr J, Isenberg J, Issavand A, Prokop A, Rehm KE. Outcomes and complications of elastic stable intramedullary nailing for forearm fractures in children. J Pediatr Orthop B. 2005;14(5):375-80.
• Wang R, Wu L, Wang Y, et al. Limited Open Reduction and Transepiphyseal Intramedullary Kirschner Wire Fixation for Treatment of Irreducible Distal Radius Diaphyseal Metaphyseal Junction Fracture in Older Children. Front Pediatr. 2022;10:871044.
• Van der Reis WL, Otsuka NY, Moroz P, Mah J. Intramedullary nailing versus plate fixation for unstable forearm fractures in children. J Pediatr Orthop. 1998;18(1):9-13.
• Vopat ML, Kane PM, Christino MA, et al. Treatment of diaphyseal forearm fractures in children. Orthop Rev (Pavia). 2014;6(2):5325.
• Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg. 1998;6(3):146-56.
• Bronstein AJ, Trumble TE, Tencer AF. The effects of distal radius fracture malalignment on forearm rotation: a cadaveric study. J Hand Surg Am. 1997;22(2):258-62.