Modifiye Gartland Tip IV Suprakondiler Humerus Kırıkları, Tip III Kırıklardan Farklı Mıdır? Retrospektif Klinik Çalışma

Yıl 2020, Cilt: 4 Sayı: 2, 126 - 131, 12.07.2020

Duran Topak , İsmail Dere , Fatih Doğar , Burak Kuşçu , Ökkeş Bilal

https://doi.org/10.30565/medalanya.663618

Öz

Amaç: Bu çalışmada; modifiye Gartland tip IV suprakondiler humerus kırığı cerrahi tedavisinin klinik ve radyolojik olarak tip III kırıklardan farklı olup olmadığını araştırdık. 

Yöntemler: 2012-2015 yılları arasında kliniğimizde çocuk suprakondiler humerus kırığı tanısıyla cerrahi tedavi uygulanan 197 hastanın dosyaları retrospektif olarak incelenip, nörovasküler yaralanma olup olmadığı bakılmaksızın 76 hasta (49 erkek, 27 kadın) randomize olarak çalışmaya dahil edildi. Modifiye Gartland Tip III (n=36) ve tip IV (n=40) olarak iki gruba ayrıldı. Yaş ortalaması 5.88±3.29 (1-15) yıl olan hastalar, 19.80±4.83 (12-29) ay süreyle takip edildi. Hastaların tamamı ilk 24 saat içinde ameliyata alındı ve kapalı redüksiyon öncelikli olarak denendi. Kapalı redükte edilemeyen hastalara posteriordan açık redüksiyon uygulandı. Hastaların fonksiyonel ve kozmetik sonuçları Flynn kriterlerine göre değerlendirildi. Son kontrollerindeki röntgenlerinden Baumann açısı ölçüldü.

Bulgular: İki grubun fonksiyonel sonuçları karşılaştırıldığında, tip III grubunda %97.3, tip IV grubunda ise %87.5 tatminkar sonuç elde edildi, aradaki fark istatistiksel olarak anlamlı bulunmadı (p=0.509). Kozmetik sonuçlar karşılaştırıldığında sırasıyla %100 ve %97.5 tatminkar sonuç elde edildi, iki grup arasında anlamlı fark bulunamadı (p=0.495). İki grup arasındaki açık cerrahiye gereksinim, sinir lezyonu ve Baumann açıları arasında istatistiksel olarak anlamlı fark bulunamadı (p değerleri sırasıyla, p=0.776, p=0.108, p=0.069).

Sonuç: Modifiye Gartland tip IV pediatrik suprakondiler humerus kırıkları, tip III kırıklar gibi anatomik redüksiyon, stabil tespit ve erken eklem hareketlerine başlanarak başarılı bir şekilde tedavi edilebilir. 

Anahtar Kelimeler

humerus suprakondiler kırıkları, çocuk kırıkları

Are Modified Gartland Type IV Supracondylar Humerus Fractures Different From Type III Fractures? A Retrospective Clinical Study

Öz

Aim: The present study investigates whether surgical treatment of modified Gartland Type IV supracondylar humerus fracture is radiologically and clinically different from the treatment of Type III fractures. 

Methods: The medical charts of 197 patients who underwent surgical treatment for pediatric supracondylar humerus fracture in our clinic between 2012 and 2015 were retrospectively reviewed, and 76 patients humerus Gartland Type III and unstable Type IV fractures regardless of neurovascular injury (49 males, 27 females) were included in the study as randomize. The patients were divided into two groups as patients with modified Gartland Type III (n=36) and patients with Type IV fractures (n=40). The mean age of the patients was 5.88±3.29 (1-15) years, and the mean duration of follow-up was 19.80±4.83 (12-29) months. All patients underwent surgery within the first 24 hours and closed reduction was first attempted. Posterior open reduction was performed in patients with failed attempts of closed reduction. The functional and cosmetic outcomes of the patients were evaluated according to the Flynn criteria. The Baumann’s angle was measured on the X-rays obtained in the last control visit.

Results: The comparison of functional outcomes between the two groups revealed that satisfactory outcomes were obtained in 97.3% of patients in the Type III fracture group and 87.5% of patients in the Type IV fracture group; however, the difference was not statistically significant (p=0.509). The comparison of cosmetic outcomes showed that satisfactory outcomes have been obtained in 100% and 97.5% of the patients, and no significant difference was found between the two groups (p=0.495). There was no statistically significant difference between the two groups in terms of the need for open surgery, nerve injury, and Baumann’s angle (p=0.776, p=0.108, p=0.069, respectively).

Conclusion: Modified Gartland Type IV pediatric supracondylar humerus fractures can be treated successfully just like Type III fractures with anatomical reduction, stable fixation and early initiation of joint movements. 

Anahtar Kelimeler

Supracondylar fractures of the humerus, , pediatric fractures

Kaynakça

• 1. Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959;109:145–54. PMID: 13675986
• 2. Shrader MW. Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthop Clin North Am. 2008;39(2):163-71. DOI: 10.1016/j.ocl.2007.12.005
• 3. Yaokreh JB, Gicquel P, Schneider L, Stanchina C, Karger C, Saliba E, Ossenou O, Clavert JM. Compared outcomes after percutaneous pinning versus open reduction in paediatric supracondylar elbow fractures. Orthop Traumatol Surg Res. 2012;98(6):645-51. DOI: 10.1016/j.otsr.2012.03.021
• 4. Fayssoux RS, Stankovits L, Domzalski ME, Guille JT. Fractures of the distal humeral metaphyseal-diaphyseal junction in children. J Pediatr Orthop. 2008;28(2):142-6. DOI: 10.1097/BPO.0b013e3181653af3
• 5. Leitch KK, Kay RM, Femino JD, Tolo VT, Storer SK, Skaggs DL. Treatment of multidirectionally unstable supracondylar humeral fractures in children: a modified Gartland Type-IV fracture. J Bone Joint Surg Am. 2006;88:980–5. DOI: 10.2106/JBJS.D.02956
• 6. Skaggs DL, Flynn JM, Supracondylar Fractures of the Distal Humerus. In: Beaty JH Kasser, eds. Rockwood and Wilkins’ Fractures in Children. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:487–582.
• 7. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up. J Bone Joint Surg Am. 1974;56(2):263-72. PMID: 4375679
• 8. Ladenhauf HN, Schaffert M, Bauer J. The displaced supracondylar humerus fracture: Indications for surgery and surgical options: a 2014 update. Curr Opin Pediatr. 2014;26(1):64-9 DOI:10.1097/MOP.0000000000000044
• 9. Mitchell SL, Sullivan BT, Ho CA, Abzug JM, Raad M, Sponseller PD. Pediatric Gartland Type-IV Supracondylar Humeral Fractures Have Substantial Overlap with Flexion-Type Fractures. The Journal of Bone and Joint Surgery 2019;101(15):1351–1356. DOI: 10.2106/JBJS.18.01178
• 10. Aparicio Martínez JL, Pino Almero L, Cibrian Ortiz de Anda RM, Guillén Botaya E, García Montolio M, Mínguez Rey MF. Epidemiological study on supracondylar fractures of distal humerus in pediatric patients. Rev Esp Cir Ortop Traumatol. 2019;63(6):394-9. DOI: 10.1016/j.recot.2019.07.001
• 11. Campbell CC, Waters PM, Emans JB, Kasser JR, Millis MB. Neurovascular injury and displacement in Type III supracondylar humerus fractures. J Pediatr Orthop. 1995;15:47-52. DOI: 10.1097/01241398-199501000-00011
• 12. Muchow RD, Riccio AI, Garg S, Ho CA, Wimberly RL. Neurological and vascular injury associated with supracondylar humerus fractures and ipsilateral forearm fractures in children. J Pediatr Orthop. 2015;35:121-5. DOI: 10.1097/BPO.0000000000000230
• 13. Erçin E, Bilgili MG, Baca E, Başaran SH, Bayrak A, Kural C, Avkan MC. Medial mini-open versus percutaneous pin fixation for Type III supracondylar fractures in children. Ulus Travma Acil Cerrahi Derg. 2016;22(4):350-4. DOI: 10.5505/tjtes.2015.20268
• 14. Aslan A, Konya MN, Ozdemir A, Yorgancigil H, Maralcan G, Uysal E. Open reduction and pinning for the treatment of Gartland extension Type III supracondylar humeral fractures in children. Strategies Trauma Limb Reconstr.2014 Aug;9(2):79-88. DOI: 10.1007/s11751-014-0198-7.
• 15. Gopinathan NR, Sajid M, Sudesh P, Behera P. Outcome Analysis of Lateral Pinning for Displaced Supracondylar Fractures in Children Using Three Kirschner Wires in Parallel and Divergent Configuration. Indian J Orthop. 2018;52(5):554-60. DOI: 10.4103/ortho.IJOrtho_462_17
• 16. Nayak AR, Natesh K, Bami M, Vinayak S. Is closed manipulative reduction and percutaneous Kirschner wiring of supracondylar humeral fracture in children as day care surgery a safe procedure? Malays Orthop J. 2013;7(2):1-5. DOI: 10.5704/MOJ.1307.006
• 17. Li M, Xu J, Hu T, Zhang M, Li F. Surgical management of Gartland Type III supracondylar humerus fractures in older children: a retrospective study. J Pediatr Orthop B. 2019;28(6):530-5. DOI: 10.1097/BPB.0000000000000582
• 18. Su Y, Nan G. Evaluation of a better approach for open reduction of severe Gartland Type III supracondylar humeral fracture. J Invest Surg. 2019;12:1-7. DOI: 10.1080/08941939.2019.1649766
• 19. Sahin E, Zehir S, Sipahioglu S. Comparison of medial and posterior surgical approaches in pediatric supracondylar humerus fractures. Niger J Clin Pract. 2017;20(9):1106-11. DOI: 10.4103/njcp.njcp_104_16
• 20. Pei X, Mo Y, Huang P. Leverage application on Gartland Type IV supracondylar humeral fracture in children. Int Orthop. 2016;40(11):2417-22. DOI: 10.1007/s00264-016-3206-3