Ulus Travma Acil Cerrahi Derg. 2007; 13(1): 49-54

Çocuk suprakondiler humerus kýrýklarýnda cerrahi yaklaþýmýn sonuca etkisi

Hasan Bombacý¹, Arel Gereli¹, Önder Küçükyazýcý², Mücahit Görgeç¹, Gökmen Deniz^1
1Haydarpaþa Numune Eðitim Ve Araþtýrma Hastanesi, 1. Ortopedi Ve Travmatoloji Kliniði, Ýstanbul
²Tokat Devlet Hastanesi, Ortopedi Ve Travmatoloji Kliniði, Tokat

AMAÇ
Ýki farklý cerrahi yaklaþým kullanýlarak, açýk redüksiyon ve internal fiksasyonla tedavi edilen çocukluk çaðý suprakondiler humerus kýrýklarýnýn sonuçlarý araþtýrýldý.
GEREÇ VE YÖNTEM
Lateral yaklaþým uygulanan 17 çocuðun sonuçlarý ve triseps adelesi kesilmeden yapýlan posterior yaklaþým uygulanan 10 çocuðun sonuçlarý Flynn’ýn kriterlerine göre deðerlendirildi. Bütün kýrýklar Gartland’a göre tip II-III ve ekstansiyon tipi kýrýk idi. Hastalarýn on dokuzunun sol kolu, sekizinin sað kolu kýrýk idi. Hastalarýn ortalama yaþý 8,5 (3-13 yaþ), ortalama takip süresi 19,4 ay (8-50 ay) idi.
BULGULAR
Lateral yaklaþým uygulanan on yedi hastanýn dördünün (%23,52), posterior yaklaþým uygulanan on hastanýn ikisinin (%20) dirsek hareket açýklýðýnda on dereceden fazla kayýp meydana geldi. Ortalama ameliyat süresi lateral yaklaþým uygulanan olgularda 53,14±18,11 dk, posterior yaklaþým kullanýlan olgularda 68,54±17,67 dk idi. Flynn kriterlerine göre, lateral yaklaþým kullanýlan gruptaki on yedi hastanýn on üçünde (%76,47), posterior yaklaþým kullanýlan gruptaki on hastanýn sekizinde (%80) tatminkâr sonuç elde edildi.
SONUÇ
Çocuk suprakondiler humerus kýrýklarýnda, lateral yaklaþým ile triseps adelesini kesmeden yapýlan posterior yaklaþýmýn dirsek hareket açýklýðýný eþit oranda etkilediði kanaatine varýldý. Posterior yaklaþým ulnar sinirin Kirschner teliyle doðrudan yaralanma ihtimalini azaltmakta ancak ameliyat süresini uzatmaktadýr.

Anahtar Kelimeler: Çocuk humerus suprakondiler kýrýk, lateral/posterior yaklaþým.

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The effect of surgical exposure on the clinic outcomes of supracondylar humerus fractures in children

Hasan Bombacý¹, Arel Gereli¹, Önder Küçükyazýcý², Mücahit Görgeç¹, Gökmen Deniz^1
11st Department Of Orthopedics, Haydarpaþa Training And Research Hospital, Istanbul
²Department Of Orthopedics, Tokat State Hospital, Tokat, Turkey

BACKGROUND
The clinic outcomes of supracondylar humerus fractures in children treated with open reduction and internal fixation by using two different surgical exposures were studied.
METHODS
The clinic outcomes of seventeen and ten patients to whom lateral (LA) and posterior (PA) approaches were used respectively, were evaluated according to the Flynn’s criteria. All fractures were extension type and classified as type II and III according to Gartland’s classification. Left arm was broken in nineteen children and right arm in eight. The mean age was 8.5 years (range 3-13 years) and mean follow up was 19.4 months (range 8-50).
RESULTS
Four (23.52%) of the seventeen patients with LA and two (20%) of the ten patients with PA suffered from a loss in the range of motion (ROM) of the elbow more than 10° (p>0.05). Mean operation time was 53.14±18.11 minutes in the patients used LA and 68.54±17.67 minutes in the patients with PA. Satisfactory results were obtained in thirteen of the seventeen patients (76.47%) in the group with LA and in eight of the ten patients (80%) in the group with PA.
CONCLUSION
It is concluded that in the open reduction of childhood supracondylar fractures of the humerus, LA and PA approaches without dividing triceps muscle do equally affect the ROM of the elbow. Although PA decreases the risk of ulnar nerve injury with Kirschner wire, it prolongs the operation time.

Keywords: Paediatric supracondylar humerus fractures, lateral/posterior approach.

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ATIF KOPYALA