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GARTLAND TİP 3 SUPRAKONDİLER HUMERUS KIRIKLARINDA CERRAHİ YÖNETİM STRATEJİLERİ

Year 2017, Volume: 50 Issue: 2, 74 - 80, 01.12.2017

Abstract

GİRİŞ

Çocuklarda humerus alt
uç kırıkları ikinci en sık g
örülen kırıklardır.
Gartland tip 3 kırıklarının tedavisinde tam bir fikir birliği yoktur. Bu
çalışmanın
amacı
, suprakondiler humerus kırıklarında cerrahi yönetim
stratejisi belirlemektir.

 

HASTALAR ve YÖNTEM:

Ocak 2015 - Aralık 2016
tarihleri arasında kliniğimizde opere edilen humerus suprakondiler
Gartland tip III kırıklı
53 hasta çalışmaya dahil edildi. Çalışmada hastaların
demografik verileri, kırığın oluş nedenleri, kırık tipleri, komplikasyonlar,
radyolojik parametreler, kozmetik ve fonksiyonel sonu
çlar değerlendirildi.

BULGULAR:
                                                                                                          

Hastaların 30’ u erkek
23’si kadındı. Yaş ortalaması 6,5 olarak bulundu. Hastalar ortalama 4-24 ay
takip edildi. Ortalama yatış süresi 3,15 gün olarak g
özlendi. 3 hastada
pseudovarus g
özlendi.
Flynn kriterlerine g
öre açık redüksiyon yapılmış hastalar
ile kapalı redüksiyon yapılmış hastalar arasında fonksiyonel ve yatış süresi
açısından anlamlı fark bulunamazken kozmetik olarak kapalı redüksiyon tedavisi
açık redüksiyona g
öre daha başarılı olarak gözlendi. Çapraz K teli
uygulanan hastalar ile izole lateral K
teli uygulanan
hastalar arasında da fonksiyonel ve yatış süresi açısından istatistiksel
anlamlı fark bulunamadı. Açık veya kapalı redüksiyon K teli ile fiksasyon
yapılmış hastalarda ilk 6 saatte opere edilenler ile 12.saatten sonra opere edilenler
arasında yatış süreleri, flynn fonksiyonel sonu
çları açısından anlamlı fark
g
özlenmedi.

SONUÇ

 










Kozmetik olarak daha avantajlı olması,
komplikasyon oranlarının açık redüksiyona g
öre anlamlı olmaması nedeniyle kapalı
redüksiyonun
öncelikli
tercih edilmesi kanaatindeyiz. K teli konfigürasyonları arasında fonksiyonel
olarak fark olmaması nedeniyle 2 adet lateral K teli ile redüksiyonun
kalitesinin ve fiksasyonun stabilitesinin yeterli olduğunu düşündüğümüz
vakalarda medialden K teli uygulaması gerekli değildir. Cerrahi riski yüksek
hastalar i
çin
en uygun cerrahi zaman beklenebilir.
    

References

  • 1. Battaglia, T.C., D.G. Armstrong, and R.M. Schwend, Factors affecting forearm compartment pressures in children with supracondylar fractures of the humerus. Journal of Pediatric Orthopaedics, 2002. 22(4): p. 431-439.
  • 2. McCarthy, S.M. and J.A. Ogden, Radiology of postnatal skeletal development. Skeletal radiology, 1982. 9(1): p. 17-26.
  • 3. DeLee, J., D. Green, and K. Wilkins, Fractures and dislocations of the elbow. Fractures in adults, 1984. 1: p. 559-652.
  • 4. Tachdjian, M.O., Pediatric orthopedics. Vol. 2. 1990: Saunders.
  • 5. Gartland, J.J., Management of supracondylar fractures of the humerus in children. Surgery, gynecology & obstetrics, 1959. 109(2): p. 145.
  • 6. Heal, J., et al., Reproducibility of the Gartland classification for supracondylar humeral fractures in children. Journal of Orthopaedic Surgery, 2007. 15(1): p. 12-14.
  • 7. France, J. and M. Strong, Deformity and function in supracondylar fractures of the humerus in children variously treated by closed reduction and splinting, traction, and percutaneous pinning. Journal of Pediatric Orthopaedics, 1992. 12(4): p. 494-498.
  • 8. Cheng, J.C., T. Lam, and W. Shen, Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children. Journal of orthopaedic trauma, 1995. 9(6): p. 511-515.
  • 9. Aktekin, C.N., et al., Open reduction via posterior triceps sparing approach in comparison with closed treatment of posteromedial displaced Gartland type III supracondylar humerus fractures. Journal of Pediatric Orthopaedics B, 2008. 17(4): p. 171-178.
  • 10. Wilkins, K. and J. Beaty, Fractures in children. Lippincott-Raven 4th Edition Tang CW, Kay RM, Skaggs DL (2002) Growth arrest of the distal radius following a metaphyseal fracture: case report and review of the literature. J Pediatr Orthop B, 1996. 11: p. 89-92.
  • 11. Shrader, M.W., Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthopedic Clinics of North America, 2008. 39(2): p. 163-171.
  • 12. Shim, J.S. and Y.S. Lee, Treatment of completely displaced supracondylar fracture of the humerus in children by cross-fixation with three Kirschner wires. Journal of Pediatric Orthopaedics, 2002. 22(1): p. 12-16.
  • 13. Kuoppala, E., et al., Low incidence of flexion-type supracondylar humerus fractures but high rate of complications: A population-based study during 2000–2009. Acta orthopaedica, 2016. 87(4): p. 406-411.
  • 14. Kumar, R., et al., Surgical management of the severely displaced supracondylar fracture of the humerus in children. Injury, 2002. 33(6): p. 517-522.
  • 15. Kazimoglu, C., et al., Operative management of type III extension supracondylar fractures in children. International orthopaedics, 2009. 33(4): p. 1089-1094.
  • 16. Reynolds, R.A. and H. Jackson, Concept of treatment in supracondylar humeral fractures. Injury, 2005. 36(1): p. S51-S56.
  • 17. Omid, R., P.D. Choi, and D.L. Skaggs, Supracondylar humeral fractures in children. J Bone Joint Surg Am, 2008. 90(5): p. 1121-1132.
  • 18. Wael, A., et al., Results of treatment of displaced supracondylar humeral fractures in children by percutaneous lateral cross-wiring technique. Strategies in Trauma and Limb Reconstruction, 2008. 3(1): p. 1-7.
  • 19. Li, J., et al., Surgical management of delayed irreducible Gartland III supracondylar fractures in children: open reduction and internal fixation versus external fixation. Journal of shoulder and elbow surgery, 2017. 26(2): p. 299-304.
  • 20. Roessingh, d.B. and Reinberg, Open or closed pinning for distal humerus fractures in children? Swiss surgery, 2003. 9(2): p. 76-81.
  • 21. FLYNN, J.C., J.G. MATTHEWS, and R.L. BENOIT, Blind pinning of displaced supracondylar fractures of the humerus in children. J Bone Joint Surg Am, 1974. 56(2): p. 263-272.
  • 22. Oh, C.-W., et al., Completely displaced supracondylar humerus fractures in children: results of open reduction versus closed reduction. Journal of orthopaedic science, 2003. 8(2): p. 137-141.
  • 23. Kocher, M.S., et al., Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. The Journal of Bone & Joint Surgery, 2007. 89(4): p. 706-712.
  • 24. Skaggs, D.L., et al., Operative treatment of supracondylar fractures of the humerus in children. J Bone Joint Surg Am, 2001. 83(5): p. 735-740. 25. Lee, S.S., et al., Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. Journal of Pediatric Orthopaedics, 2002. 22(4): p. 440-443.
  • 26. Woratanarat, P., et al., Meta-analysis of pinning in supracondylar fracture of the humerus in children. Journal of orthopaedic trauma, 2012. 26(1): p. 48-53.
  • 27. Larson, L., et al., Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures. Journal of Pediatric Orthopaedics, 2006. 26(5): p. 573-578.
  • 28. Silva, M., et al., Biomechanical testing of pin configurations in supracondylar humeral fractures: the effect of medial column comminution. Journal of orthopaedic trauma, 2013. 27(5): p. 275-280.
  • 29. Devnani, A., Late presentation of supracondylar fracture of the humerus in children. Clinical orthopaedics and related research, 2005. 431: p. 36-41.
  • 30. Lyons, J.P., E. Ashley, and M.M. Hoffer, Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children's elbows. Journal of Pediatric Orthopaedics, 1998. 18(1): p. 43-45.
  • 31. Özçelik, A., A. Tekcan, and H. Ömeroglu, Correlation between iatrogenic ulnar nerve injury and angular insertion of the medial pin in supracondylar humerus fractures. Journal of Pediatric Orthopaedics B, 2006. 15(1): p. 58-61.
  • 32. Royce, R.O., et al., Neurologic complications after K-wire fixation of supracondylar humerus fractures in children. Journal of Pediatric Orthopaedics, 1991. 11(2): p. 191-194.
  • 33. Ağuş, H., Ö. Kalenderer, and C. Kayalı, Çocuk suprakondiler humerus kırıklarında kapalı redüksiyon ve perkütanöz çivileme sonuçlarımız. Acta Orthop Traumatol Turc, 1999. 33: p. 18-22.
  • 34. Leet, A.I., J. Frisancho, and E. Ebramzadeh, Delayed treatment of type 3 supracondylar humerus fractures in children. Journal of Pediatric Orthopaedics, 2002. 22(2): p. 203-207.
  • 35. Iyengar, S.R., S.A. Hoffinger, and D.R. Townsend, Early versus delayed reduction and pinning of type III displaced supracondylar fractures of the humerus in children: a comparative study. Journal of orthopaedic trauma, 1999. 13(1): p. 51-55.
  • 36. Mulhall, K.J., et al., Displaced supracondylar fractures of the humerus in children. International orthopaedics, 2000. 24(4): p. 221-223.
  • 37. Mehserle, W.L. and P.L. Meehan, Treatment of the displaced supracondylar fracture of the humerus (type III) with closed reduction and percutaneous cross-pin fixation. Journal of Pediatric Orthopaedics, 1991. 11(6): p. 705-711.
  • 38. Aronson, D., E. Van Vollenhoven, and J. Meeuwis, K-wire fixation of supracondylar humeral fractures in children: results of open reduction via a ventral approach in comparison with closed treatment. Injury, 1993. 24(3): p. 179-181.

SURGICAL MANAGEMENT STRATEGIES IN GARTLAND TYPE 3 SUPRACONDYLAR HUMERAL FRACTURES

Year 2017, Volume: 50 Issue: 2, 74 - 80, 01.12.2017

Abstract

OBJECTIVE: Humeral lower extremity fractures are
the second most common fractures in children.
There
is no consensus on the treatment of Gartland type 3 fractures.
The purpose of this study is to determine the
surgical management strategy for supracondylar humerus fractures.

 

MATERIAL AND METHODS: Between January 2015 and
December 2016, 53 patients with humeral supracondylar Gartland type III
fractures were included in our study.
Demographic
data, causes of fractures, fracture types, complications, radiological
parameters, cosmetic and functional outcomes were evaluated in the study.

 

RESULTS: 30 of the
patients were male and 23 were female. The mean age of patients were 6,5 years.
The mean
length of hospital stay was 3,15 days.
The average
follow up was 4-24 months.
Pseudovarus were observed in 3 patients. Cosmetically
closed reduction treatment was more successful than open reduction, although
there was no significant difference in functional and length of stay between
open reduction patients and closed reduction patients according to Flynn
criteria.
There was no statistically significant difference between patients who were
treated with crossed K wire and those who were treated with isolated lateral K
wire in terms of functional and length of stay.
Patients who were K wire fixed
with open or closed reduction did not differ significantly in terms of
hospitalization time, flynn functional results in the first 6 hours and those
who were oppressed after 12 hours.

 










CONCLUSION: We believe that closed reduction is the
preferred choice because of the cosmetic advantage that complication rates are
not significant compared to open reduction.
Since
there is no functional difference between the two configurations, medial K
wires is not necessary when we think that the reduction quality and fixation
stability with 2 lateral K wires are sufficient.
For
patients who are at high risk for surgery, optimal surgery time may be
expected.

References

  • 1. Battaglia, T.C., D.G. Armstrong, and R.M. Schwend, Factors affecting forearm compartment pressures in children with supracondylar fractures of the humerus. Journal of Pediatric Orthopaedics, 2002. 22(4): p. 431-439.
  • 2. McCarthy, S.M. and J.A. Ogden, Radiology of postnatal skeletal development. Skeletal radiology, 1982. 9(1): p. 17-26.
  • 3. DeLee, J., D. Green, and K. Wilkins, Fractures and dislocations of the elbow. Fractures in adults, 1984. 1: p. 559-652.
  • 4. Tachdjian, M.O., Pediatric orthopedics. Vol. 2. 1990: Saunders.
  • 5. Gartland, J.J., Management of supracondylar fractures of the humerus in children. Surgery, gynecology & obstetrics, 1959. 109(2): p. 145.
  • 6. Heal, J., et al., Reproducibility of the Gartland classification for supracondylar humeral fractures in children. Journal of Orthopaedic Surgery, 2007. 15(1): p. 12-14.
  • 7. France, J. and M. Strong, Deformity and function in supracondylar fractures of the humerus in children variously treated by closed reduction and splinting, traction, and percutaneous pinning. Journal of Pediatric Orthopaedics, 1992. 12(4): p. 494-498.
  • 8. Cheng, J.C., T. Lam, and W. Shen, Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children. Journal of orthopaedic trauma, 1995. 9(6): p. 511-515.
  • 9. Aktekin, C.N., et al., Open reduction via posterior triceps sparing approach in comparison with closed treatment of posteromedial displaced Gartland type III supracondylar humerus fractures. Journal of Pediatric Orthopaedics B, 2008. 17(4): p. 171-178.
  • 10. Wilkins, K. and J. Beaty, Fractures in children. Lippincott-Raven 4th Edition Tang CW, Kay RM, Skaggs DL (2002) Growth arrest of the distal radius following a metaphyseal fracture: case report and review of the literature. J Pediatr Orthop B, 1996. 11: p. 89-92.
  • 11. Shrader, M.W., Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthopedic Clinics of North America, 2008. 39(2): p. 163-171.
  • 12. Shim, J.S. and Y.S. Lee, Treatment of completely displaced supracondylar fracture of the humerus in children by cross-fixation with three Kirschner wires. Journal of Pediatric Orthopaedics, 2002. 22(1): p. 12-16.
  • 13. Kuoppala, E., et al., Low incidence of flexion-type supracondylar humerus fractures but high rate of complications: A population-based study during 2000–2009. Acta orthopaedica, 2016. 87(4): p. 406-411.
  • 14. Kumar, R., et al., Surgical management of the severely displaced supracondylar fracture of the humerus in children. Injury, 2002. 33(6): p. 517-522.
  • 15. Kazimoglu, C., et al., Operative management of type III extension supracondylar fractures in children. International orthopaedics, 2009. 33(4): p. 1089-1094.
  • 16. Reynolds, R.A. and H. Jackson, Concept of treatment in supracondylar humeral fractures. Injury, 2005. 36(1): p. S51-S56.
  • 17. Omid, R., P.D. Choi, and D.L. Skaggs, Supracondylar humeral fractures in children. J Bone Joint Surg Am, 2008. 90(5): p. 1121-1132.
  • 18. Wael, A., et al., Results of treatment of displaced supracondylar humeral fractures in children by percutaneous lateral cross-wiring technique. Strategies in Trauma and Limb Reconstruction, 2008. 3(1): p. 1-7.
  • 19. Li, J., et al., Surgical management of delayed irreducible Gartland III supracondylar fractures in children: open reduction and internal fixation versus external fixation. Journal of shoulder and elbow surgery, 2017. 26(2): p. 299-304.
  • 20. Roessingh, d.B. and Reinberg, Open or closed pinning for distal humerus fractures in children? Swiss surgery, 2003. 9(2): p. 76-81.
  • 21. FLYNN, J.C., J.G. MATTHEWS, and R.L. BENOIT, Blind pinning of displaced supracondylar fractures of the humerus in children. J Bone Joint Surg Am, 1974. 56(2): p. 263-272.
  • 22. Oh, C.-W., et al., Completely displaced supracondylar humerus fractures in children: results of open reduction versus closed reduction. Journal of orthopaedic science, 2003. 8(2): p. 137-141.
  • 23. Kocher, M.S., et al., Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. The Journal of Bone & Joint Surgery, 2007. 89(4): p. 706-712.
  • 24. Skaggs, D.L., et al., Operative treatment of supracondylar fractures of the humerus in children. J Bone Joint Surg Am, 2001. 83(5): p. 735-740. 25. Lee, S.S., et al., Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. Journal of Pediatric Orthopaedics, 2002. 22(4): p. 440-443.
  • 26. Woratanarat, P., et al., Meta-analysis of pinning in supracondylar fracture of the humerus in children. Journal of orthopaedic trauma, 2012. 26(1): p. 48-53.
  • 27. Larson, L., et al., Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures. Journal of Pediatric Orthopaedics, 2006. 26(5): p. 573-578.
  • 28. Silva, M., et al., Biomechanical testing of pin configurations in supracondylar humeral fractures: the effect of medial column comminution. Journal of orthopaedic trauma, 2013. 27(5): p. 275-280.
  • 29. Devnani, A., Late presentation of supracondylar fracture of the humerus in children. Clinical orthopaedics and related research, 2005. 431: p. 36-41.
  • 30. Lyons, J.P., E. Ashley, and M.M. Hoffer, Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children's elbows. Journal of Pediatric Orthopaedics, 1998. 18(1): p. 43-45.
  • 31. Özçelik, A., A. Tekcan, and H. Ömeroglu, Correlation between iatrogenic ulnar nerve injury and angular insertion of the medial pin in supracondylar humerus fractures. Journal of Pediatric Orthopaedics B, 2006. 15(1): p. 58-61.
  • 32. Royce, R.O., et al., Neurologic complications after K-wire fixation of supracondylar humerus fractures in children. Journal of Pediatric Orthopaedics, 1991. 11(2): p. 191-194.
  • 33. Ağuş, H., Ö. Kalenderer, and C. Kayalı, Çocuk suprakondiler humerus kırıklarında kapalı redüksiyon ve perkütanöz çivileme sonuçlarımız. Acta Orthop Traumatol Turc, 1999. 33: p. 18-22.
  • 34. Leet, A.I., J. Frisancho, and E. Ebramzadeh, Delayed treatment of type 3 supracondylar humerus fractures in children. Journal of Pediatric Orthopaedics, 2002. 22(2): p. 203-207.
  • 35. Iyengar, S.R., S.A. Hoffinger, and D.R. Townsend, Early versus delayed reduction and pinning of type III displaced supracondylar fractures of the humerus in children: a comparative study. Journal of orthopaedic trauma, 1999. 13(1): p. 51-55.
  • 36. Mulhall, K.J., et al., Displaced supracondylar fractures of the humerus in children. International orthopaedics, 2000. 24(4): p. 221-223.
  • 37. Mehserle, W.L. and P.L. Meehan, Treatment of the displaced supracondylar fracture of the humerus (type III) with closed reduction and percutaneous cross-pin fixation. Journal of Pediatric Orthopaedics, 1991. 11(6): p. 705-711.
  • 38. Aronson, D., E. Van Vollenhoven, and J. Meeuwis, K-wire fixation of supracondylar humeral fractures in children: results of open reduction via a ventral approach in comparison with closed treatment. Injury, 1993. 24(3): p. 179-181.
There are 37 citations in total.

Details

Journal Section Original research article
Authors

Gökhun Arıcan

Özay Subaşı This is me

Ahmet Özmeriç

Özgür Şahin This is me

Kadir Bahadır Alemdaroğlu

Serkan İltar

Publication Date December 1, 2017
Submission Date June 20, 2017
Published in Issue Year 2017 Volume: 50 Issue: 2

Cite

AMA Arıcan G, Subaşı Ö, Özmeriç A, Şahin Ö, Alemdaroğlu KB, İltar S. GARTLAND TİP 3 SUPRAKONDİLER HUMERUS KIRIKLARINDA CERRAHİ YÖNETİM STRATEJİLERİ. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. December 2017;50(2):74-80.