Fractures of the distal radius in children: A retrospective evaluation

Yıl 2012, Cilt: 39 Sayı: 2, 179 - 183, 01.06.2012

Cengiz Işık Hüsamettin Çakıcı Kamil Çağrı Köse Mustafa Özşahin Selma Yazıcı

https://doi.org/10.5798/diclemedj.0921.2012.02.0123

Öz

Objectives: This study designed to evaluate the results of treatment, closed reduction and percutaneous wires, of the distal radius fractures in children. Materials and methods: A retrospective analysis was carried out in children aged between 5-15 years who presented with a displaced fracture of the distal radius to our hospital. They were initially treated with closed reduction and cast immobilization. If the fractures redisplaced treated by percutaneous Kirschner (K-) wire with scope under a general anaesthesia. Results: Totally 104 patients, who have distal radius fractures were treated by closed reduction and immobilization in a plaster cast. 13 patient who have distal radius fractures were treated by closed reduction under general anaesthesia and fixed by percutaneous Kirschner (K-) wire. Patients with impaired the alignment of the fracture in late period were usually completely displaced fractures. (n=5, 4,3%), in early period, completely displaced fractures (n=5, 4,3%) are superior to partial displaced fractures (n=2, 1,7%). Conclusion: In our study, when children with distal radius fracture first come, they were treated by closed reduction and immobilization in a plaster cast. We thought that in redisplaced fractures patients were suitable for the closed reduction with percutaneous wire treatment.

Anahtar Kelimeler

Fracture, radius, treatment, child

Çocuklarda radius alt uç kırığı sonuçlarının retrospektif değerlendirilmesi

Öz

Amaç: Çalışmamızın amacı radius alt uç kırığı ile gelen, konservatif ve perkütan pinlemeyle tedavi edilen çocuk hastaların retrospektif değerlendirilmesiydi. Gereç ve yöntem: Radius alt uç kırığı tedavisi uygulanan 5-15 yaş arası 117 hasta değerlendirilmeye alındı. Tüm hastalara ilk olarak kapalı redüksiyon ve alçılama uygulandı. Redüksiyonun sağlanamadığı veya kontrollerde redüksiyonu bozulduğu görülen hastalara anestezi altında skopi kontrollü kapalı redüksiyon perkütan Kirschner(K) teli ile fiksasyon yapıldı. Bulgular: Toplam 117 hastanın 104 tanesi kapalı redüksiyon ve alçılama ile tedavi edildi. 13(6 geç-7 erken) hastaya redüksiyonun yetersiz olması veya korunamaması nedeni ile anestezi altında skopi kontrollü kapalı redüksiyon ve K-teli ile fiksasyon yapıldı. Geç dönemde redüksiyonu bozulan hastaların büyük oranda tam yer değiştirmiş kırıklar olduğu gözlendi. Erken dönemde de tam yer değiştirmiş kırıklar (5 hasta) kısmi yer değiştirmiş kırıklardan (2 hasta) fazlaydı. Sonuç: Çalışmamızda distal radius kırıklı çocuk ilk geldiği zaman kapalı redüksiyon ve alçıyla immobilizasyon yapıldı. Sonuç olarak iyileşme ve remodelizasyonun yüksek olduğu çocuk radius alt uç kırıklarında deplasman miktarına bakılmaksızın kapalı redüksiyon denenmesi yeterli redüksiyon sağlanamadığı veya kontrollerde redüksiyon bozulduğu durumlarda cerrahi yapılması uygun olacaktır.

Anahtar Kelimeler

Kırık, radius, tedavi, çocuk

Kaynakça

• Jones IE, Cannan R, Goulding A. Distal forearm fractures in New Zealand children: annual rates in a geographically defined area. N Z Med J 2000;113(3):443-5
• Luscombe KL, Chaudhry S, Dwyer JS, Shanmugam C, Maf- fulli N. Selective Kirschner wiring for displaced distal radial fractures in children. Acta Orthop Traumatol Turc 2010;44(1):117-23.
• Boutis K, Willan A, Babyn P, Goeree R, Howard A. Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial. CMAJ 2010;182(14):1507-12.
• Khosla S, Melton LJ, Dekutoski MB, et al. Incidence of childhood distal forearm fractures over 30 years: a popula- tion-based study. JAMA 2003;290(10):1479-85
• Do TT, Strub WM, Foad SL, Mehlman CT, Crawford AH. Reduction versus remodeling in pediatric distal forearm fractures: a preliminary cost analysis. J Pediatr Orthop B 2003;12(1):109-15.
• Canale S.T. Fractures and dislocations in childeren, Canale ST, Beaty J.H.(eds), Campbell’s operative orthopaedics, 11th ed. Vol II, p1545-56, Mosby, 2008.
• Bae DS. Pediatric distal radius and forearm fractures. J Hand Surg 2008;33A:1911-23
• Alemdaroğlu KB, İltar S, Çimen O, Uysal M, Alagöz E, Atlıhan D. Risk factors in redisplacement of distal radial fractures in children. J Bone Joint Surg Am 2008;90:1224- 30
• Bohm ER, Bubbar V, Yong Hing KY, Dzus A. Above and below-the-elbow plaster casts for distal forearm fractures in children. J Bone Joint Surg Am 2006;88(1):1-8.
• Webb GR, Galpin RD, Armstrong DG. Comparison of short and long arm plaster casts for displaced fractures in the dis- tal third of the forearm in children. J Bone Joint Surg Am 2006;88(1):9-17.
• Alemdaroğlu KB, Iltar S, Aydoğan NH, et al. Three-point index in predicting redisplacement of extra-articular distal radial fractures in adults. Injury 2010;41(2):197-203.
• Choi KY, Chan WS, Lam TP, Cheng JC. Percutaneous Kirschner-wire pinning for severely displaced distal radial fractures in children. A report of 157 cases. J Bone Joint Surg [Br] 1995;77(6):797-801.
• McLauchlan GJ, Cowan B, Annan IH, Robb JE. Manage- ment of completely displaced metaphyseal fractures of the distal radius in children. A prospective, randomised con- trolled trial. J Bone Joint Surg [Br] 2002;84(3):413-7.
• Muratlı HH, Yağmurlu MF, Yüksel HY, Aktekin CN, Biçimoğlu A, Tabak AY. Treatment of childhood unstable radius distal methaphysis fractures with closed reduction and percutaneous Kirschner wires.[Article in Turkish] Acta Orthop Traumatol Turc 2002;36(1):52-7.
• Yung PS, Lam CY, Ng BK, Lam TP, Cheng JC. Percuta- neous transphyseal intramedullary Kirschner wire pinning: a safe and effective procedure for treatment of displaced diaphyseal forearm fracture in children. J Pediatr Orthop 2004;24(1):7-12.
• Zamzam MM, Khoshhal KI. Displaced fracture of the distal radius in children: factors responsible for redis- placement after closed reduction. J Bone Joint Surg [Br] 2005;87(7):841-3.
• Miller BS, Taylor B, Widmann RF, Bae DS, Snyder BD, Waters PM. Cast immobilization versus percutaneous pin fixation of displaced distal radius fractures in chil- dren: a prospective, randomized study. J Pediatr Orthop 2005;25(3):490-4.