SUPRAKONDİLLER HUMERUS KIRIKLARINDA (GARTLAND TİP 2 VE TİP 3 KIR IKLAR) SINIR YARALANMALARI VE TEDAVİ YÖNETİMİ

Yıl 2018, Cilt: 11 Sayı: 2, 11 - 14, 15.12.2018

Sezai Özkan Cihan Adanaş

Öz

Suprakondiller humerus kırıkları çoçuklarda en sık görülen
kırıklardır. Suprakondiller humerus kırıkları sonrası sinir yara lan mala rı
%12-20 oranında görülür. Bu çalış mada tedavi edilen Gartland Tip 2 ve Tip 3
suprakondiller humerus kırıklarında sinir yaralanma insidansı ve tedavi
yönetimi ile ilgili deneyimlerin paylaşılması amaçlandı. Bu çalış mada
2015-2017 yılları arasında, suprakondiller humerus kırığ ı nedeniyle opere
edilen hastalar alındı. Suprakondiller humerus kırıkları Gart land sınıfla ma
sistemine göre sınıflandırıld ı. Kırığ ın tipi, hangi cerrahi tedavinin
uygulandığı, sinir yaralanması olup olmadığı ve bu sinir yara lan masının iy
ileş me süresi değerlendirildi. Suprakondiller humerus kırığı Gartland Tip 2 ve
Tip 3 olan toplam 40 hasta çalışmaya alındı. Çalış madaki hastaların 28’i erke
k, 12’si kız hasta idi. Gart land Tip 2 kırığı olan 12 hasta ve Gart land Tip 3
kırığı olan 28 hasta mevcuttu. Sinir yaralanması olan 8 hastadan 3
hastada travma sonrası, 5 hastada ise cerrahi müdahele sonrası sinir hasarı
tesbit edildi. Çalış madan elde edilen veriler doğrultusunda suprakondiller
humerus kırıklarında meydana gelen sinir yaralanmalarının çoğunun 4-6 ay
içerisinde kendiliğinden iyileştiği gözlendi

Anahtar Kelimeler

sinir yaralanması, Humerus, kırık

Nerve injuries and treatment management in supracondils humerus fractures (gartland type 2 and type 3 fractures)

Öz

Supracondylar humerus
fractures are the most common fractures in children. Nerve injuries after
supracondiller humerus fractures are around 12-20%. The aim of this study was
to share our experience with nerve injury incidence and treatment management in
Gartland Type 2 and Type 3 supracondylar humerus fractures. In this study,
patients who were operated for supracondylar humerus fracture between 2015 and
2017 were included. Supracondylar humerus fractures were classified according
to the Gartland classification system. Type of fracture, surgical treatment,
nerve in jury, and recovery time of this nerve injury were evaluated. A total
of 40 patients with Ga rtland Type 2 and Type 3 supracondylar humeral fractures
were included in the study. 28 of the patients were male and 12 were female.
There were 12 patients with Glandland Type 2 fracture and 28 patients with
Gartland Type 3 fractures. Nerve injury occurred in 8 patients. 3 of them had
nerve injury after fracture. 5 patients who had nerve injury occurred after
surgical intervention. According to the data obtained from the study, most of
the nerve injuries occurred in supracondylar humerus fractures spontaneously
recovered in 4-6 months.

Anahtar Kelimeler

Humerus, fracture, nerve injury

Kaynakça

• Houshian S, Mehdi B, Larsen MS. The epidemiology of elbow fractur e in children: analysis of 355 fr actures, with special reference to supr acondy lar humerus fractur es. J Orthop Sci 2001; 6:312–5.
• Rasool MN. Ulnar nerv e injury after K-wire fixation of supraco ndylar humerus fractur es in children. J Pediatr Orthop 1998; 18:686–90.
• Cramer KE, Green NE, Devito DP. Incidence of anterior inteross eous nerve palsy in supr acondylar humerus fractur es in childr en. J Pediatr Orthop 1993; 13:502–5.
• Dormans JP, Squillante R, Sharf H. Acute neurovascular complications with supr acondylar humerus fractur es in childr en. J Hand Surg [Am] 1995; 20: 1–4.
• Skaggs DL, Hale JM, Bassett J. Oper ative tr eatment of supracondylar fractures of the humerus in children. J Bone Joint Surg Am 2001; 83-A: 735–40.
• Ristic S, Strauch RJ, Rosenwasser MP. The assessment and treatment of nerv e dysfunction after trauma around the elbow. Clin Orthop 2000; 370:138–53.
• Birch R, Achan P. Peripher al nerve r epairs and their results in childr en. H and Clin 2000; 16: 579–95 Lyons JP, Ashley E, Hoffer MM. Ulnar nerve palsies after percutaneous cross pinning of supr acondylar fractur es in childr en’s elbows. J Pediatr Orthop 1998; 18:43–5.
• Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 1959; 109:145– 54.
• Gustilo RB, Anderson JJ. Pr evention of infection in the treatment of one thousand and tw enty fiv e open fractures of long bones. Retrospective and prospective analysis. J Bone Joint Surg Am 1976; 58A: 435–8.
• Waters PM, Bae DS. Distal humerus fr actures. In: Waters PM, Bae DS, eds. Pediatric Hand and Upper Limb Surgery: A Practic al Guide Philadelphia, PA: Lippincott Williams & Wilkins; 2012:287–315.
• Karapınar L, Sürenkok F, Ozturk H, Us MR. Çocuk humerus deplas e tip 3 supr akondil er kır ıkl arında erken k apalı redüksiyon +perkütan çivil eme: 258 olgunun değerl endiril mes i. Clin Res 2003;14:164-75.
• Gosens T, Bongers J. Neurovascular complications and functional outcome in displaced supracondylar fractures of the humerus in child ren. Injury2003;34:267-73.
• Jobst CA, Spurdle C, King WF, Lopez M. Percutaneous pinning of pediatric supracondylar humerus fractures with the semisteril e technique, the Miami experience. J Pediatr Orthop 2007; 27:17–22.
• Flynn JC, Mattews JG, Benoit RL. Blind pinning of displaced supracondylar fractur s of the humerus in children: sixteen years ’ experience with long-term follow-up. J Bone Joint Sur g Am 1974; 56:263– 72.
• Zaltz I , Waters PM, Kasser JR. Ulnar nerve instability in children. J Pediatr Orthop 1996; 16:567–9. Davis T, Gorczyca T, Kevin. Supr acondylar humer us fractures in children Comparison of oper ativ e treatment methods. Clin Orthop Relat Res 2000;376:49-55. Mostafavi R, Spero C. Crossed pin fixation of displaced supracondylar humerus fractures in children. Clin Orthop Relat Res 2000;376: 56-61.
• Dodge H.S. Displaced supr acondylar fr actures of the humerus in childr en treatment by dunlop's tr action. J Bone Joint Surg 1972;54A:1408-1418.
• McGraw J.J. Akbarnia B.A., Hanel D.P., Keppler L., Burdge RE. Neurological complications resulting from supracondylar fractur es of the humerus in children. J Pediatr Orthop 1986; 6:647-650.
• Xipscomb P.R. Vascular and neural comlicatıons in supracondylar fractures of the humerus in children. J Bone Joint Surg 1955;37A: 487- 492.
• Otsuka N.Y., Kasser J.R . Supracondylar fr actur es of humerus in childr en. J Am Acad Orthop Sur g 1997;5: 19-26.
• Royce R.O., Dutkowsky J.P., Kasser J.R. Rand F.R . Neurolojic complications after K-wire fixatio n of supracondylar humer us fractur es in children. J Pediatr Orthop 1991; 11: 191-194.
• Kurer M.H.J., Regan M.W. Completely displaced supr acondylar fractur e of the humerus in children. Clin Orthop 1990; 256:205-214.
• Campbell CC, Wat ers PM, Emans JB , et al. Neurovascular injury and displac ement in type III supracondylar humer us fract ures . J Pediatr Orthop 1995