Gartland Tip III Suprakondiler Humerus Kırıklarının Cerrahi Tedavisi Ne Zaman Yapılmalı?

Abstract

 

        Amaç:Gartland tip III suprakondiler humerus kırıklarının tedavisinde cerrahi uygulama zamanının klinik ve radyolojik sonuçlar üzerine etkisinin retrospektif olarak değerlendirilmesi.

 

        Yöntem: Gartland tip III kırık nedeni ile opere edilen 72 hasta değerlendirildi. Açık kırık, damar yaralanması ve 14 aydan az takibi olanlar çalışma dışı bırakıldı. Hastalar cerrahi tedavinin zamanına göre 24 saatten öncesi ve sonrası, gece ve gündüz olarak gruplandırıldı. Skopi kontrolünde kapalı repozisyon ve perkütan pinleme yapıldı. Radyolojik sonuçlar Baumann ve Capitohumeral açısı, klinik sonuçlar dirsek taşıma açısı ölçülerek değerlendirildi. Gruplar arasındaki parametrik değerler student-t test ile nonparametrik değerler ise ki-kare testi ile değerlendirildi. 

      Bulgular:72 (40 erkek, 32 kız) (ilk 24 saat 40, >24 saat 32, 35 hasta gece ve 37 hasta  gündüz ameliyat edilmiş. Ortalama yaş 7,5/yıl ve ortalama takip süreleri 41/ay idi. Gece yapılan operasyon süresi ortalama 72 dakika iken gündüz ortalama 51 dakikaydı (P<0,05). İlk 24 saatte opere edilenlerde operasyon süresi 61.5±30 dakika, 24 saat sonra opere edilenlerde 63±15,5 dakika (p=0,63). Baumann açısı opere edilen tarafta 72±6,75 , edilmeyen tarafta 70±3,93 derece idi. İstatistiksel olarak anlamlı farklılık mevcuttu. Bu fark gece yapılanlardan kaynaklanmaktaydı (p=0,003, p=0,005). Opere edilen tarafta taşıma açısı 10,3±5,3 opere edilmeyen tarafta ortalama 12,02±3,6 derece idi, gruplar arasında istatistiksel farklılık yoktu (p>0,05). 24 saat öncesi ve sonrası yapılanlar arasında radyolojik ve klinik sonuçlar arasında istatistiksel anlamlı farklılık bulunmamakta. 3 malpozisyon, 2 sinir hasarı ilk 24 saatte gece yapılan olgularda görüldü.

     Sonuç: Suprakondiler humerus kırığının tedavisi geç ancak ideal şartlarda yapıldığında suboptimal şartlarında yapılmasına göre daha az komplikasyon ve daha iyi fonksiyonel sonuç vermektedir.

Keywords

• Suprakondiler humerus kırığı; Kapalı repozisyon; Perkütan pinleme

When Should Surgical Treatment of Gartland Type III Supracondylar Humerus Fractures Take Place?

Abstract

Aim:We evaluated the effects of surgery time on clinical and radiological outcomes among Gartland type III Supracondylar humerus fractures (SFH). 

Method:We retrospectively examined 72 patients treated for Gartland type III SHF. Patient’s age, gender, surgery times, surgery durations, and complications were assessed. The radiological measurements of patients were assessed in comparison to the other elbow by using Baumann's and capitellohumeral angles

Results:72 patients (40 males, 32 females), mean age 7,5years and mean follow-up 41 months. 40 patients were operated on within the first 24 hours, 32 after 24 hours. Thirty-five were operated at night, 37 were on day. Mean surgery duration at night 72 minutes and at daytime 51 minutes. The difference was statistically significant (P<0,05). Mean surgery duration at first 24 hours was 61.5±30 minutes, while after 24 hours was 63±15,5 minutes (p=0,63), mean Baumann's angle was 72±6,75 degrees on the operated side, and 70±3,93 degrees on the other side. The difference was statistically significant (p=0,003). While a significant difference existed among the Bauman's angles of night time patients, no such difference was found among daytime patients. The mean carrying angle obtained was 10,3±5,3 degrees on the operated side, and 12,02±3,6 on the other side. The difference was not statistically significant. Similarly, no statistical difference was observed for capitellohumeral angles of patients operated on within and after the first 24 hours were compared to the non-operated side. 

Conclusion:SHF treatment in ideal conditions results better functional outcomes and fewer complications than immediate surgery under suboptimal conditions.

Keywords

• Supracondylar humerus fracture; Close reposition; Percutaneus pinning

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