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Surgical Treatment Results of Pediatric Femoral Fractures by Indirect Reduction and Locking plates

Yıl 2011, Cilt: 2 Sayı: 8, 1 - 11, 03.03.2015

Öz

Purpose: The aim of this study is evaluation of surgical treatment results by using locking
plates and indirect reduction in femoral fractures of childhood.
Materyal and Methods: This prospective study include 17( 7 females and 10 males) patients.
All patients had isolated femoral fractures. Type of femoral fractures in this study classified as
long spiral, oblique and shaft fractures of unstable in long axis. Mean age of patients in this
study was 6.2(range 5-12) years. All patients in this study treated by indirect reduction and
surgically minimal invasive approach with locking plates. Standard anterior-posterior and
lateral radiographs used for radiographic evaluation. Angulations more than 10 degrees in
radiographs accepted as deformity after fracture union.
Results: Mean follow-up time was 10(range3-17) months and mean hospital stay was
4.3(range 2-6) days. We used minimal contact titanium locking plates in all patients. The
avarage length of plates include 10 holes(range 8-12). The avarage of screws using with plates
was 6,7(6-9). Distribution of screws classified as distal and proksimal according to fracture
line. Mean number of proksimal screws were 3,2(3-4) and distal screws were 3,4(3-5). Mean
of fracture union time was 5,4(range 5-7) weeks. There are not any complication and all
fractures healed. İmplants removed in 4 patients.
Conclusion: Unstable long axis femoral fractures of childhood , from 5 years to skeletal
maturation, treated succesful by indirect reduction and locking plates in this study. This
surgical modality have a less complication and high fracture union rates and may alternatively
used instead of titanium elastic nail. Early mobilization and less hospitalization make
excellent family adaptation.

Kaynakça

  • Hinton RY, Lincoln A, Crockett MM, Sponseller P, Smith G: Fractures of the femoral shaft in children: Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg Am ; 81:500-509. Ferguson J, Nicol RO: Early spica treatment of pediatric femoral shaft fractures. J Pediatr Orthop 2000;20:189-19
  • Çelebi L, Biçimoğlu A. Çocuk femur cisim kırıkları Totbid dregisi 2006;5:34-43.
  • Flynn JM. Schwend MR Management of Pediatric Femoral Shaft Fractures J Am Acad Orthop Surg 2004;12:347-359
  • Fyodorov I, Sturm PF, Robertson WW Jr: Compression-plate fixation of femoral shaft fractures in children aged 8 to 12 years. J Pediatr Orthop 1999;19:578-581
  • Caird MS, Mueller Ka, Puryear A, et al. Copmression plating of pediatric femoral shaft fractures J Pediatr orthop2003;23:448-52.
  • Blasier RD, Aronson J, Tursky EA: External fixation of pediatric femur fractures J Pediatr Orthop 1997;17:342-6.
  • Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J: Titanium elastic nails for pediatric femur fractures: A multicenter study of early results with analysis of complications. J Pediatr Orthop 2001;21(1):4-8.
  • Flynn JM, Luedtke L, Ganley TJ, Pill SG: Titanium elastic nails for pediatric femur fractures: Lessons from the learning curve. Am J Orthop (Belle Mead NJ) 2002;31(2):71-74.
  • Agus H, Kalenderer O, Eryanılmaz G, Ömeroğlu H Biologic internal fixation of com- minuted femur shaft fracture by bridge plating in children J Pediatr Orthop 2003,23:184-9.
  • Thompson JD, Buehler KC, Sponseller PD, Gray DW, Black BE, Buckley SL, Griffin PP Shortening in femoral shaft fracture in children treated with spina cast Clin Orthop Relat Res ;338:74-8. Pollak AN, Cooperman DR, Thompson GH Spina cast treatment of femoral shaft fractures in children-the prognostic value of mechanism of injury J trauma 1994;37:223-229
  • Flynn JM, Luedtke LM, Ganley TJ, Dawson J, Davidson RS, Dormans JP, Ecker ML, Gregg JR, Horn BD, Drummond DS Comparison of titanium elastic nails with traction and a spca cast to treat femoral fractures in children J bone Joint Surgery Am 2004;86:770-77.
  • Saseendar S, Menon J, Patro K Treatment of femoral fractures in cildren :is titanium elastic nailing an improvement over hip spica casting? J Child Orthop 2010;4:245-251
  • Kelly Vander Have, MD, et al J Am Acad Orthop Surg 2008;16:436- 441
  • Narayanan UG, Hyman JE, Wainwright AM, Rang M, Alman BA: Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. J PediatrOrthop 2004;24(4):363-369.
  • Sink EL, Gralla J, Repine M: Complications of pediatric femur fractures treated with titanium elastic nails: A comparison of fracture types. J Pediatr Orthop 2005;25(5):577-580.
  • Sink EL, Faro F, Polousky J, Flynn K, Gralla J: Decreased complications of pediatric femur fractures with a change in management. J Pediatr Orthop 2010; 30(7):633-637.
  • Kanlic EM, Anglen JO, Smith DG, Morgan SJ, Pesántez RF: Advantages of submuscular bridge plating for complex pediatric femur fractures. Clin OrthopRelat Res 2004;(426):244
  • Sink EL, Hedequist D, Morgan SJ, Hresko T: Results and technique of unstable pediatric femoral fractures treated with submuscular bridge plating. J Pediatr Orthop 2006;26(2):177
  • Ying Li, Daniel J. Hedequist, J Am Acad Orthop Surg 2012;20: 596-603
  • Wallace ME, Hoffman EB: Remodelling of angular deformity after femoral shaft fractures in children. J Bone Joint Surg Br 1992;74:765-769.
  • Ellis HB, Ho CA, Podeszwa DA, Wilson PL: A comparison of locked versus nonlocked Enders rods for length unstable pediatric femoral shaft fractures. J Pediatr Orthop 2011;31(8): 833.

ÇOCUKLUK ÇAĞI FEMUR KIRIKLARININ TEDAVİSİNDE DOLAYLI REDÜKSİYON VE KİLİTLİ PLAK UYGULAMA SONUÇLARIMIZ

Yıl 2011, Cilt: 2 Sayı: 8, 1 - 11, 03.03.2015

Öz

Amaç: Bu çalışmada çocukluk çağı femur kırıklarında dolaylı redüksiyon ve kilitli plak uygulamalarının sonuçlarını değerlendirmek.

Materyal ve Metod: Bu prospektif çalışmaya izole femur kırığı olan 17 (7 kız 10 erkek) hasta dahil edildi. Çalışmaya alınan femur kırıkları, uzun spiral, oblik ve uzunluk instabil olan femur diafiz kırıkları idi. Çalışmaya alınan hastaların yaş ortalaması 6,2 (5-12) yıl idi.

Hastaların hepsine dolaylı redüksiyon ve kilitli plak uygulandı. Hastaların radyolojik sonuçları standart olarak çekilen ön arka ve yan grafiler ile değerlendirildi. Hastalarda kaynama sonrası çekilen grafide 10 dereceden fazla olan angulasyonlar deformite olarak belirlendi.

Bulgular: Hastaların ortalama takip süreleri 10 (3-17) ay ve hastanede kalma süreleri ortalama 4,3 (2-6 ) gün idi. Hastaların tamamına az yüzey temaslı kilitli titanyum plaklar kullanıldı. Hastalara kullanılan ortalama plak uzunluğu 10 (8-12) delikli idi. Plak ile beraber ortalama kullanılan vida sayısı 6,7 (6-9) adet idi. Vidaların kırık hattının proksimal ve distal olarak dağılımları, proksimal ortalama 3,2 (3-4) ve distal ortalama 3,4 (3-5) adet olarak belirlendi. Hastaların kaynama zamanı ortalama 5,4 (4-7) hafta idi. Hastaların hepsinde tam kaynama gerçekleşti ve komplikasyon görülmedi. Hastaların dört tanesinden implant çıkarımı yapıldı.

Sonuç: Çalışmamızın sonucunda 5 yaş ile iskelet olgunlaşmasına kadarki süreçte oluşan uzunluk instabil femur kırıklarında dolaylı redüksiyon ile kilitli plak uygulaması ile başarılı sonuçlar elde edilmektedir. Düşük komplikasyon oranı ve yüksek kaynama başarısı ile titanyum elastik çivisi yerine kullanılabilecek alternatif bir yöntemdir. Erken mobilizasyon ve kısa süreli hastane yatışı ile yüksek oranda aile uyumu sağlanabilmektedir.

Kaynakça

  • Hinton RY, Lincoln A, Crockett MM, Sponseller P, Smith G: Fractures of the femoral shaft in children: Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg Am ; 81:500-509. Ferguson J, Nicol RO: Early spica treatment of pediatric femoral shaft fractures. J Pediatr Orthop 2000;20:189-19
  • Çelebi L, Biçimoğlu A. Çocuk femur cisim kırıkları Totbid dregisi 2006;5:34-43.
  • Flynn JM. Schwend MR Management of Pediatric Femoral Shaft Fractures J Am Acad Orthop Surg 2004;12:347-359
  • Fyodorov I, Sturm PF, Robertson WW Jr: Compression-plate fixation of femoral shaft fractures in children aged 8 to 12 years. J Pediatr Orthop 1999;19:578-581
  • Caird MS, Mueller Ka, Puryear A, et al. Copmression plating of pediatric femoral shaft fractures J Pediatr orthop2003;23:448-52.
  • Blasier RD, Aronson J, Tursky EA: External fixation of pediatric femur fractures J Pediatr Orthop 1997;17:342-6.
  • Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J: Titanium elastic nails for pediatric femur fractures: A multicenter study of early results with analysis of complications. J Pediatr Orthop 2001;21(1):4-8.
  • Flynn JM, Luedtke L, Ganley TJ, Pill SG: Titanium elastic nails for pediatric femur fractures: Lessons from the learning curve. Am J Orthop (Belle Mead NJ) 2002;31(2):71-74.
  • Agus H, Kalenderer O, Eryanılmaz G, Ömeroğlu H Biologic internal fixation of com- minuted femur shaft fracture by bridge plating in children J Pediatr Orthop 2003,23:184-9.
  • Thompson JD, Buehler KC, Sponseller PD, Gray DW, Black BE, Buckley SL, Griffin PP Shortening in femoral shaft fracture in children treated with spina cast Clin Orthop Relat Res ;338:74-8. Pollak AN, Cooperman DR, Thompson GH Spina cast treatment of femoral shaft fractures in children-the prognostic value of mechanism of injury J trauma 1994;37:223-229
  • Flynn JM, Luedtke LM, Ganley TJ, Dawson J, Davidson RS, Dormans JP, Ecker ML, Gregg JR, Horn BD, Drummond DS Comparison of titanium elastic nails with traction and a spca cast to treat femoral fractures in children J bone Joint Surgery Am 2004;86:770-77.
  • Saseendar S, Menon J, Patro K Treatment of femoral fractures in cildren :is titanium elastic nailing an improvement over hip spica casting? J Child Orthop 2010;4:245-251
  • Kelly Vander Have, MD, et al J Am Acad Orthop Surg 2008;16:436- 441
  • Narayanan UG, Hyman JE, Wainwright AM, Rang M, Alman BA: Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. J PediatrOrthop 2004;24(4):363-369.
  • Sink EL, Gralla J, Repine M: Complications of pediatric femur fractures treated with titanium elastic nails: A comparison of fracture types. J Pediatr Orthop 2005;25(5):577-580.
  • Sink EL, Faro F, Polousky J, Flynn K, Gralla J: Decreased complications of pediatric femur fractures with a change in management. J Pediatr Orthop 2010; 30(7):633-637.
  • Kanlic EM, Anglen JO, Smith DG, Morgan SJ, Pesántez RF: Advantages of submuscular bridge plating for complex pediatric femur fractures. Clin OrthopRelat Res 2004;(426):244
  • Sink EL, Hedequist D, Morgan SJ, Hresko T: Results and technique of unstable pediatric femoral fractures treated with submuscular bridge plating. J Pediatr Orthop 2006;26(2):177
  • Ying Li, Daniel J. Hedequist, J Am Acad Orthop Surg 2012;20: 596-603
  • Wallace ME, Hoffman EB: Remodelling of angular deformity after femoral shaft fractures in children. J Bone Joint Surg Br 1992;74:765-769.
  • Ellis HB, Ho CA, Podeszwa DA, Wilson PL: A comparison of locked versus nonlocked Enders rods for length unstable pediatric femoral shaft fractures. J Pediatr Orthop 2011;31(8): 833.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Original Articles
Yazarlar

Turgut Akgül Bu kişi benim

İzet Korkmaz Bu kişi benim

Güzelali Özdemir Bu kişi benim

Ferit Yücel Bu kişi benim

Özgür Çiöekli Bu kişi benim

Yayımlanma Tarihi 3 Mart 2015
Gönderilme Tarihi 28 Şubat 2015
Yayımlandığı Sayı Yıl 2011 Cilt: 2 Sayı: 8

Kaynak Göster

Vancouver Akgül T, Korkmaz İ, Özdemir G, Yücel F, Çiöekli Ö. ÇOCUKLUK ÇAĞI FEMUR KIRIKLARININ TEDAVİSİNDE DOLAYLI REDÜKSİYON VE KİLİTLİ PLAK UYGULAMA SONUÇLARIMIZ. mkutfd. 2015;2(8):1-11.