Konservatif Tedavi ile Pediatrik Radius Distal Uç Kırıklarında Düşük Redüksiyon Kaybı

Yıl 2020, Cilt: 22 Sayı: 2, 263 - 270, 31.08.2020

İbrahim Deniz Canbeyli , Caner Baysan , Ozan Pehlivan

Öz

Amaç: Pediatrik distal radius kırıklarında konservatif tedavinin (kapalı redüksiyon ve alçı immobilizasyonu) sonuçlarını değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Bu retrospektif çalışmaya distal radius kırığı olan ve acil servis şartlarında kapalı redüksiyon ve alçı immobilizasyonu uygulanan, yaşları 3 ila 16 arasında olan toplam 138 pediatrik hasta dahil edildi. Kapalı redüksiyon sırasında hastaların ortalama yaşı 11.47 ± 3.60 (aralık: 3-16) yıl idi. Hastaların yaş, cinsiyet, kırık sınıflandırması, taraf ve yaralanma mekanizmaları tarandı. Ayrıca, radius distal uç kırığı olan pediatrik hastaların 1., 2., 4. ve 6. hafta takiplerindeki deplasman ve açılanma verileri PACS entegre hastane bilgi yönetim sisteminden kaydedildi. Hastaların demografik özellikleri ve radyografik redüksiyon kaybı değerlendirildi.

Bulgular: Elli hasta kadın, seksen sekiz hasta erkekti. Otuz bir hastada (%22.5) redüksiyon kaybı vardı. 1., 2., 4. ve 6. hafta takip görüntülemelerinde Colles kırıklarının; SH Tip-2 ve Torus/Buckle kırıklarına göre AP (Sırasıyla p<0.001; <0.001; <0.001 ve <0.001) ve lateral plandaki (Sırasıyla p=0.013; <0.001; <0.001 ve <0.001) açılanmaları anlamlı olarak daha yüksekti. Tüm takip döneminde kadın ve erkek hastalar arasındaki varus-valgus deformitesi (Sırasıyla p=0.160; 0.283; 0.263 ve 0.744) ve AP angulasyonu (Sırasıyla p=0.996; 0.943; 0.816 ve 0.237) açısından anlamlı bir fark yoktu. Takip görüntülemelerinde yaş ile varus-valgus ve AP angulasyonu arasında bir korelasyon yoktu.

Sonuç: Kapalı redüksiyon ve alçı immobilizasyonunun, Colles, SH Tip II ve Torus/Buckle distal radius kırıkları için etkili bir tedavi yöntemi olduğunu gösterdik.

Anahtar Kelimeler

Pediatrik radius distal uç kırıkları, colles kırıkları, torus/buckle kırıkları, SH tip II kırıklar

LOW LOSS OF REDUCTION RATES IN PEDIATRIC DISTAL RADIUS FRACTURES WITH CONSERVATIVE TREATMENT

Öz

Objective: We aimed to assess the outcomes of conservative treatment (closed reduction and cast immobilization) in the management of pediatric distal radius fractures.

Material and Methods: A total of 138 pediatric patients aged 3 to 16 years who sustained a distal radius fracture and underwent closed reduction and cast immobilization in emergency department were included in this retrospective study. The mean age of patients at the time of close reduction was 11.47 ± 3.60 (range, 3-16) years. Age, gender, classification of fracture, side, and mechanism of injury were documented. In addition, displacement and angulation data were recorded from PACS integrated hospital information management system. We evaluated demographic characteristics of patients and radiographic loss of reduction.

Results: A total of 50 patients were female, whereas 88 patients were male. Thirty-one patients (22.5%) had loss of reduction. Colles fractures had significantly higher varus-valgus deformity (p<0.001; <0.001; <0.001 and <0.001, respectively) and AP angulation (p=0.013; <0.001; <0.001 and <0.001, respectively) than SH type-2 and Torus/Buckle fractures at the first, second, 4th, and 6th weeks follow-up views. There is no significant difference in terms of varus-valgus deformity (p=0.160; 0.283; 0.263 and 0.744, respectively) and AP angulation (p=0.996, 0.943, 0.816 and 0.237, respectively) at each follow-up period between female and male patients. We did not find any correlation between age and varus-valgus and AP angulation at the follow-up views.

Conclusion: We demonstrated that closed reduction and cast immobilization is an effective treatment method for colles, SH type II, and Torus/Buckle distal radius fractures.

Anahtar Kelimeler

Pediatric distal radius fractures, colles fractures, SH tip II kırıkları, Torus/Buckle fractures

Kaynakça

• 1. Alemdaroglu KB, Iltar S, Cimen O, Uysal M, Alagoz E, Atlihan D. Risk factors in redisplacement of distal radial fractures in children. J Bone Joint Surg Am. 2008;90(6):1224-30.
• 2. Kropman RH, Bemelman M, Segers MJ, Hammacher ER. Treatment of impacted greenstick forearm fractures in children using bandage or cast therapy: a prospective randomized trial. J Trauma. 2010;68(2):425-8.
• 3. Shah AS, Lesniak BP, Wolter TD, Caird MS, Farley FA, Vander Have KL. Stabilization of adolescent both-bone forearm fractures: a comparison of intramedullary nailing versus open reduction and internal fixation. J Orthop Trauma. 2010;24(7):440-7.
• 4. Smith VA, Goodman HJ, Strongwater A, Smith B. Treatment of pediatric both-bone forearm fractures: a comparison of operative techniques. J Pediatr Orthop. 2005;25(3):309-13.
• 5. 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.
• 6. Ravier D, Morelli I, Buscarino V, Mattiuz C, Sconfienza LM, Spreafico AA et al. Plaster cast treatment for distal forearm fractures in children: which index best predicts the loss of reduction? J Pediatr Orthop B. 2020;29(2):179-86.
• 7. Vopat ML, Kane PM, Christino MA, Truntzer J, McClure P, Katarincic J et al. Treatment of diaphyseal forearm fractures in children. Orthop Rev (Pavia). 2014;6(2):5325.
• 8. Franklin CC, Robinson J, Noonan K, Flynn JM. Evidence-based medicine: management of pediatric forearm fractures. J Pediatr Orthop. 2012;32 Suppl 2:131-4.
• 9. Dittmer AJ, Molina Dt, Jacobs CA, Walker J, Muchow RD. Pediatric Forearm Fractures Are Effectively Immobilized With a Sugar-Tong Splint Following Closed Reduction. J Pediatr Orthop. 2019;39(4):245-7.
• 10. Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg. 1998;6(3):146-56.
• 11. Rockwood CA BJ, Kasser JR. Rockwood and Wilkins’ Fractures in Children. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2010: xiii, 1076.; 2010.
• 12. Goldstein RY, Otsuka NY, Egol KA. Re-displacement of extraphyseal distal radius fractures following initial reduction in skeletally immature patients--can it be prevented? Bull Hosp Jt Dis. 2013;71(2):132-7.
• 13. Edmonds EW, Capelo RM, Stearns P, Bastrom TP, Wallace CD, Newton PO. Predicting initial treatment failure of fiberglass casts in pediatric distal radius fractures: utility of the second metacarpal-radius angle. J Child Orthop. 2009;3(5):375-81.
• 14. Levy J, Ernat J, Song D, Cook JB, Judd D, Shaha S. Outcomes of long-arm casting versus double-sugar-tong splinting of acute pediatric distal forearm fractures. J Pediatr Orthop. 2015;35(1):11-7.
• 15. Crawford SN, Lee LS, Izuka BH. Closed treatment of overriding distal radial fractures without reduction in children. J Bone Joint Surg Am. 2012;94(3):246-52.
• 16. Friberg KS. Remodelling after distal forearm fractures in children. II. The final orientation of the distal and proximal epiphyseal plates of the radius. Acta Orthop Scand. 1979;50(6 Pt 2):731-9.
• 17. Friberg KS. Remodelling after distal forearm fractures in children. III. Correction of residual angulation in fractures of the radius. Acta Orthop Scand. 1979;50(6 Pt 2):741-9.
• 18. Nietosvaara Y, Hasler C, Helenius I, Cundy P. Marked initial displacement predicts complications in physeal fractures of the distal radius: an analysis of fracture characteristics, primary treatment and complications in 109 patients. Acta Orthop. 2005;76(6):873-7.
• 19. Houshian S, Holst AK, Larsen MS, Torfing T. Remodeling of Salter-Harris type II epiphyseal plate injury of the distal radius. J Pediatr Orthop. 2004;24(5):472-6.
• 20. Luscombe KL, Chaudhry S, Dwyer JS, Shanmugam C, Maffulli N. Selective Kirschner wiring for displaced distal radial fractures in children. Acta Orthop Traumatol Turc. 2010;44(2):117-23.