Pediatrik Suprakondiler Humerus Kırıklarının Cerrahi Tedavisinde Cerrahi Yaklaşımın Tedavi Sonuçları ve Komplikasyonları Üzerine Etkisi Var mıdır?

Yıl 2021, , 661 - 668, 22.09.2021

Fevzi Sağlam , Halil Bekler

https://doi.org/10.31832/smj.885164

Öz

Amaç: Suprakondiler humerus kırıklarının (SKHK) cerrahi tedavisinde farklı tedavi yöntemleri ve cerrahi kesiler, distal parçanın yer değiştirme yönüne ve cerrahın deneyimine bağlıdır. Bu çalışmanın amacı, SKHK tedavi sonuçlarını ve komplikasyonları kapalı redüksiyon perkütan çivileme (KRPÇ) ile açık cerrahide cerrahi insizyon tipine göre karşılaştırmak ve bu sayede ideal yaklaşımı belirlemektir.
Gereç ve Yöntemler: 142 (% 63,4) erkek ve 82 (% 36,6) kadın, yaş ortalaması 5,95 ± 2,79 yıl (1-13 yaş) olan toplam 224 hasta retrospektif olarak incelendi. Gartland sınıflandırmasına göre 58'i (% 25,8) Tip 2, 166'sı (% 74,2) Tip 3 idi. Çalışmaya dahil edilen hastaları medial, lateral, posterior insizyon ve KRPÇ ile ameliyat edilenler olmak üzere dört gruba ayırdık.
Bulgular: En sık görülen komplikasyonlar: nörolojik defisit (n: 34,% 15.1), skarlaşma (n: 32,% 14.2), subkutan iğne migrasyonu (n: 24,% 10.2), cubitus varus (n: 20,% 8.9) ), çivi dibi enfeksiyonu (n: 15,% 6,6), fleksiyon kısıtlaması (n: 13,% 5,8), ekstansiyon kısıtlaması (n: 12,% 5,3), miyozit ossifikans (n: 12,% 5,3) ve kübitus valgus (n: 5,% 2,29). Açık redüksiyon internal fiksasyon uygulanan grup ile kapalı redüksiyon perkütan çivileme grubu arasında komplikasyonlar açısından farklılıklar olduğu belirlendi.
Sonuç: Kapalı redüksiyon perkütan çivileme ve açık cerrahi grupları arasında fonksiyonel sonuçlar arasında fark yoktur. Redüksiyon kapatılamayan hastalarda cerrahın tecrübesine ve tercihine bağlı olarak açık cerrahi kesiler tercih edilebilir.

Anahtar Kelimeler

Suprkondiler humerus kırıkları, komplikasyonlar, Nörolojik defisit, Flynn kriterleri

Does The Surgical Approach Have an Impact On Treatment Outcomes and Complications in The Surgical Treatment of Pediatric Supracondylar Humeral Fractures?

Öz

Objective: In the surgical treatment of supracondylar humerus fractures (SCHF), different treatment methods and surgical incisions are depending on the direction of displacement of the distal fragment and the surgeon’s experience. The aim of this study was to compare SCHF treatment results and complications according to closed reduction percutaneous pinning (CRPP) and the surgical incision type in open surgery and to determine the ideal approach thereby.
Material and Methods: A retrospective examination was made of a total of 224 patients for this study which was comprising 142 (63.4%) males and 82 (36.6%) females with a mean age of 5.95±2.79 years (range, 1-13 years). According to the Gartland classification, 58 (25.8%) were Type 2, 166 (74.2%) were Type 3. We divided the patients included in the study into four groups: medial, lateral, posterior incision and those who underwent surgery with CRRP.
Results: The most frequent complications observed were neurological deficit (n:34, 15.1%), scarring (n:32, 14.2%), subcutaneous pin migration (n:24, 10.2%), cubitus varus (n:20, 8.9%), pin tract infection (n:15, 6.6%), flexion restriction (n:13, 5.8%), extension restriction (n:12, 5.3%), myositis ossificans (n:12, 5.3%), and cubitus valgus (n:5, 2.29%). There were determined to be differences between the group applied with open reduction internal fixation and the closed reduction percutaneous pinning group in respect of complications.
Conclusion: There is no difference between functional results between closed reduction percutaneous pinning and open surgery groups. In patients who cannot be closed reduction, open surgical incisions may be preferred depending on the surgeon's experience and preference.

Anahtar Kelimeler

Supracondylar humerus fracture, complications, neurological deficit, Flynn criteria

Kaynakça

• Referans 1. Holt JB, Glass NA, Shah AS. Understanding the Epidemiology of Pediatric Supracondylar Humeral Fractures in the United States: Identifying Opportunities for Intervention. J Pediatr Orthop. Published online 2018. doi:10.1097/BPO.0000000000001154
• Referans 2. Hanlon CR, Estes WL. Fractures in childhood-A statistical analysis. Am J Surg. Published online 1954. doi:10.1016/S0002-9610(54)90128-2
• Referans 3. Cramer KE, Green NE, Devito DP. Incidence of anterior interosseous nerve palsy in supracondylar humerus fractures in children. J Pediatr Orthop. Published online 1993. doi:10.1097/01241398-199307000-00015
• Referans 4. Spinner M, Schreiber SN. Anterior interosseous-nerve paralysis as a complication of supracondylar fractures of the humerus in children. J Bone Joint Surg Am. Published online 1969. doi:10.2106/00004623-196951080-000085. Referans 5. Wendling-Keim DS, Binder M, Dietz HG, Lehner M. Prognostic Factors for the Outcome of Supracondylar Humeral Fractures in Children. Orthop Surg. Published online 2019. doi:10.1111/os.12504
• Referans 6. Choi PD, Melikian R, Skaggs DL. Risk factors for vascular repair and compartment syndrome in the pulseless supracondylar humerus fracture in children. J Pediatr Orthop. Published online 2010. doi:10.1097/BPO.0b013e3181c6b3a8
• Referans 7. Minkowitz B, Busch MT. Supracondylar humerus fractures: Current trends and controversies. Orthop Clin North Am. Published online 1994.
• Referans 8. Kwok, I. H. Y., et al. "Nerve injuries associated with supracondylar fractures of the humerus in children: our experience in a specialist peripheral nerve injury unit." The Bone & Joint Journal 98.6 (2016): 851-856.
• Referans 9. Takahara M, Sasaki I, Kimura T, Kato H, Minami A, Ogino T. Second fracture of the distal humerus after varus malunion of a supracondylar fracture in children. J Bone Jt Surg - Ser B. Published online 1998. doi:10.1302/0301-620X.80B5.8831
• Referans 10. Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Jt Surg - Ser A. Published online 2008. doi:10.2106/JBJS.G.01354
• Referans 11. Hyatt BT, Schmitz MR, Rush JK. Complications of Pediatric Elbow Fractures. Orthop Clin North Am. Published online 2016. doi:10.1016/j.ocl.2015.09.011
• Referans 12. Defrancesco CJ, Shah AS, Brusalis CM, Flynn K, Leddy K, Flynn JM. Rate of Open Reduction for Supracondylar Humerus Fractures Varies Across Pediatric Orthopaedic Surgeons: A Single-Institution Analysis. In: Journal of Orthopaedic Trauma. ; 2018. doi:10.1097/BOT.0000000000001262
• Referans 13. Koudstaal MJ, De Ridder VA, De Lange S, Ulrich C. Pediatric supracondylar humerus fractures: The anterior approach. J Orthop Trauma. Published online 2002. doi:10.1097/00005131-200207000-00007
• Referans 14. Baydar ML, Aydoğan N, Kırdemir V, Solakoğlu C, Gür E. Çocuk Humerus Suprakondiler Kırıklarında Tedavi Prensipleri ve Sonuçları. Hacettepe J Ortop Surg 1993;3:124-9.
• Referans 15. Kumar R, Malhotra R. Medial approach for operative treatment of the widely displaced supracondylar fractures of the humerus in children. J Orthop Surg. 2000;8(2):13-18. doi:10.1177/230949900000800204
• Referans 16. Lyons ST, Quinn M, Stanitski CL. Neurovascular injuries in Type III humeral supracondylar fractures in children. In: Clinical Orthopaedics and Related Research. ; 2000. doi:10.1097/00003086-200007000-00010
• Referans 17. 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 Jt Surg - Ser A. Published online 1974. doi:10.2106/00004623-197456020-00004
• Referans 18. Cheng JCY, Lam TP, Shen WY. Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children. J Orthop Trauma. Published online 1995. doi:10.1097/00005131-199509060-00009
• Referans 19. Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. Lateral-Entry Pin Fixation in the Management of Supracondylar Fractures in Children. J Bone Jt Surg - Ser A. Published online 2004. doi:10.2106/00004623-200404000-00006
• Referans 20. Boyd DW, Aronson DD. Supracondylar fractures of the humerus: A prospective study of percutaneous pinning. J Pediatr Orthop. Published online 1992. doi:10.1097/01241398-199211000-00017
• Referans 21. Mehlman CT, Strub WM, Roy DR, Wall EJ, Crawford AH. The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children. J Bone Jt Surg - Ser A. Published online 2001. doi:10.2106/00004623-200103000-00002
• Referans 22. Kropelnicki A, Ali AM, Popat R, Sarraf KM. Paediatric supracondylar humerus fractures. In: British Journal of Hospital Medicine. ; 2019. doi:10.12968/hmed.2019.80.6.312