Suprakondiler humerus kırıklarının klinik sonuçları: Kapalı- açık redüksiyonun karşılaştırılması

Yıl 2019, , 305 - 309, 29.08.2019

Atilla Çıtlak

https://doi.org/10.35440/hutfd.541519

Öz

Amaç: Suprakondiler humerus kırıkları
çocuklarda en sık görülen yaralanmalar arasındadır. Gartland tip 2 ve 3
kırıkların tedavisinde kapalı veya açık redüksiyondan sonra perkutan pinleme
uygulanır. Bu çalışmanın amacı Gartland tip 2 ve 3 suprakondiler humerus
kırıklarında klinik sonuçları ve kapalı- açık redüksiyonun sonuçlara etkisini
değerlendirmektir.

Materyal
ve metot:
Çalışmamıza 2015-2018 yılları arasında suprakondiler humerus kırığı nedeniyle
tedavi edilen, Gartland tip 2 ve 3 kırığı olan, 10 yaşın altında olan, en az 3
ay takibi olan 48 hasta dahil edildi. Hastaların medikal kayıtlarından ve
radyografilerinden elde edilen veriler değerlendirildi. Hastaların demografik
bilgileri, kırık geçirdiği taraf, kırık tipi, pin konfigürasyonu, cerrahi
yapılana kadar geçen zaman, takip süresi kaydedildi. Radyografilerinde ölçülen
Baumann açıları, son kontrolde değerlendirilen eklem hareket açıklıkları ve
taşıma açıları değerlendirildi. Sonuçlar Flynn kriterleri kullanılarak
değerlendirildi. Hastalar kapalı redüksiyon uygulananlar (Grup 1), açık
redüksiyon uygulananlar (Grup 2) olmak üzere iki gruba ayrıldı ve sonuçlar
karşılaştırıldı.

Bulgular: Hastaların ortalama yaşı
5,94’dü(1-10yaş). 21 hastadan oluşan kapalı redüksiyon grubu (Grup 1) ve 27
hastadan oluşan açık redüksiyon grubu (Grup 2) arasında yaş, cinsiyet ve
etkilenen taraf açısından fark yoktu. Hastalar ortalama 11,06 saat sonra (8-48 saat)
ameliyata alındı ve ortalama 18,60 ay (3-44 ay) takip edildi. Gruplar arasında
ameliyata alınma zamanı ve takip süresi açısından fark yoktu. Flynn
kriterlerine göre 43 hastada (%89,5) mükemmel ve iyi sonuç elde edildi. Grup
1’deki hastaların Flynn kriterlerine göre 20’sinde (%95,2) mükemmel ve iyi
sonuç elde edildi. Grup 2’deki hastaların Flynn kriterlerine göre 22’sinde
(%81,5) mükemmel ve iyi sonuç elde edildi. 3 hastada orta sonuç (%11,1), 2
hastada (%7,4) kötü sonuç elde edildi. Gruplar karşılaştırıldığında kapalı
redüksiyon grubunda mükemmel ve iyi sonucun daha fazla oranda olduğu görüldü,
fakat istatistiksel olarak anlamlı fark yoktu.

Sonuç: Suprakondiler humerus kırıklarının
tedavisinde kapalı ve açık redüksiyon sonrasında pinlerle fiksasyon etkili ve
güvenli bir tedavi yöntemidir. Öncelikle kapalı redüksiyon uygulanmalıdır,
fakat kapalı redüksiyon sağlanamazsa açık redüksiyon da tatminkar sonuçlar
sunar. Bu çalışmada kapalı- açık redüksiyonla tedavi edilen hastaların klinik
sonuçları arasında anlamlı fark tespit edilmedi. Kapalı- açık redüksiyonun
klinik sonuçlar üzerine etkisini daha iyi değerlendirebilmek için, daha fazla
sayıda hasta içeren prospektif çalışmalar yapılabilir.

Anahtar Kelimeler

Humerus kırıkları, Dirsek, Kapalı kırıklar

Clinical results of supracondylar humerus fractures: Comparison of closed- open reduction

Öz

 

Background: Humerus supracondylar fractures are among the
most common injuries in children. Percutaneous pinning  is applied after closed or open reduction for
the treatment of Gartland type 2 and 3 fractures. The aim of this study is to
evaluate the clinical results in Gartland type 2 and 3 humerus supracondylar
fractures and the effect of closed- open reduction on results.

Methods: Between 2015- 2018, 48 patients who were
treated for Gartland type 2 and 3 humerus supracondylar fractures, below 10
years, minumum 3 months follow-up were included in our study. The data which
were obtained from medical records and radiographs were evaluated. Demographic
data, fracture side, fracture type, pin configuration, time to surgery, follow-up
time were recorded. Measured Baumann angles on radiographs, range of motions
and carrying angles on last follow-up were evaluated. Postoperative results
were evaluated by using Flynn criteria. Patients were divided into two groups
as patients were treated with closed reduction (Group 1), treated with open
reduction (Group 2), and results were compared.

Results: Mean patient age was 5,94 (1-10 years). Group
1 (21 patients) and Group 2 (27 patients) were not different according to
patient age, sex and fracture side. Patients were operated after a mean of
11,06 hours (8- 48 hours), and the mean follow-up was 18,60 months (3- 44
months). The groups were not different according to time to operation and
follow-up period. Excellent and good results were obtained in 43 patients (89,5
%) according to Flynn criterias. Excellent and good results were obtained in 20
patients (95,2 %) according to Flynn criterias in Group 1. Excellent and good
results were obtained in 22 patients (81,5 %) according to Flynn criterias in
Group 2. Fair results were obtained in 3 patients (11,1 %), poor results in 2
patients (7,4 %). In comparison, more excellent and good result rates were seen
in closed reduction group, but there was no statistically significant
difference.

Conclusions: Percutaneus pinning after closed and open
reduction is effective and safe in the treatment of humerus supracondylar
fractures. First closed reduction must be performed, but if closed reduction
could not obtained, open reduction serves satisfactory results. In this study,
there was no significant difference between patients who were treated with
closed or open reduction. For better evaluation of the effect of closed- open
reduction on clinical results, prospective studies with more patients could be
performed. 

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