Ulus Travma Acil Cerrahi Derg. 2023; 29(7): 811-817 | DOI: 10.14744/tjtes.2023.43413

Pediatrik suprakondiler humerus kýrýklarýndan sonra rotasyonel deformite kötü sonuçlara neden olur mu?

Mete Gedikbaþ¹, Orhan Balta², Tahir Öztürk², Firat Erpala³, Mehmet Burtaç Eren², Eyup Cagatay Zengin^2
1Turhal Devlet Hastanesi Ortopedi ve Travmatoloji Kliniði, Tokat, Türkiye
²Gaziosmanpaþa Üniversitesi Týp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalý, Tokat, Türkiye
³Çesme Alper Cizgenakat Devlet Hastanesi Ortopedi ve Travmatoloji Kliniði, Ýzmir, Türkiye

AMAÇ: Bu çalýþmada, suprakondiler humerus kýrýðý (SKHK) cerrahisi sonrasý rotasyonel deformitenin kübitus varus deformitesi (KVD) komplikas-yonu geliþimine etkisini göstermeyi amaçladýk.
GEREÇ VE YÖNTEM: Distal humerus ossifikasyonu tamamlanmamýþ, Gartland Tip II ve daha ciddi kýrýðý olan ve kapalý redüksiyon perkütan pinleme (KRPP) ile tedavi edilen hastalar çalýþmaya dahil edildi. Hastalarýn deðerlendirilmesinde demografik veriler ve ameliyat sýrasýnda çekilen radyografiler tarandý. Rotasyonel deformite ölçümü, Henderson ve ark. tarafýndan tanýmlanan yönteme göre yapýldý. Rotasyonel deformitesi >10° olan hastalar grup 1’e, deformitesi <10° olan hastalar grup 2’ye alýndý. KVD geliþimi açýsýndan hastalar taþýma açýsýnda yapýlan Baumann açý ölçümleri ve son kont-rol grafileri ile deðerlendirildi. KVD geliþen hastalar iki gruba ayrýldý; Grup A, KVD geliþen hastalarý, grup B ise KVD geliþmeyen hastalarý içermektedir. Kozmetik ve fonksiyonel sonuçlar Flynn kriterleri kullanýlarak deðerlendirildi.
BULGULAR: Kabul edilme kriterlerini karþýlayan 88 hasta çalýþmaya alýndý, 32’si kadýn, 56’sý erkekti. Ameliyat anýndaki ortalama yaþ 6.0±2.8, ortala-ma takip süresi 5.1±2.5 yýldý. Ölçümlere göre grup 1’de 13 hasta, grup 2’de 75 hasta vardý. 88 kiþiden sadece dördünde KVD geliþmiþti. Bu hastalarýn üçünde ≥20° rotasyonel deformite vardý. Grup A’daki hastalarýn ortalama yaþý 2.1 ve ortalama taþýma açýsý 5.7°±1.5 varus idi (p<0,001). Flynn kozmetik kriterlerine göre, grup A ve grup 1 önemli ölçüde daha kötü sonuçlara sahipti (p<0.001).
TARTIÞMA: Sonuç olarak, distal fragmanýn rotasyonda sabitlenmesi KVD ile iliþkili olabilir, intraoperatif deðerlendirme, uzun süreli deformite ve kozmetik bozulmayý önlemek için büyük deðer taþýr.

Anahtar Kelimeler: Cubitus varus deformitesi, kapalý redüksiyon perkütan çivileme; pediatrik; rotasyonel deformite; suprakondiler humerus kýrýðý.

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Does rotational deformity cause poor outcomes after pediatric supracondylar humerus fractures?

Mete Gedikbaþ¹, Orhan Balta², Tahir Öztürk², Firat Erpala³, Mehmet Burtaç Eren², Eyup Cagatay Zengin^2
1Department of Orthopaedics and Traumatology, Turhal State Hospital, Tokat-Türkiye
²Department of Orthopaedics and Traumatology, Gaziosmanpasa University School of Medicine, Tokat-Türkiye
³Department of Orthopaedics and Traumatology, Cesme Alper Cizgenakat State Hospital, Ýzmir-Türkiye

BACKGROUND: We aimed to show the effect of rotational deformity on the development of cubitus varus deformity (CVD) com-plication after supracondylar humerus fracture surgery.
METHODS: Patients with Gartland type II, and more severe fractures treated with Closed reduction and percutaneous pinning alone were included in the study. Rotational deformity was assessed with the formula described by Henderson et al. Patients with rotational deformity >10° were included in Group 1, and patients with deformity <10° in Group 2. In terms of CVD development, patients were evaluated with the Baumann angle measurements made on the carrying angle and final follow-up radiographs. Patients who developed CVD were divided into two groups: Group A included patients who developed CVD and Group B included patients who did not develop CVD. The cosmetic and functional results were evaluated using Flynn criteria.
RESULTS: Eighty-eight patients who met the inclusion criteria were enrolled in the study, 32 were female and 56 were male. The mean age at the time of surgery was 6.0±2.8 years and the mean follow-up time was 5.1±2.5 years. Based on measurements, Group 1 had 13 patients and Group 2 had 75 patients. Only four of the 88 had developed CVD. Three of these patients had a rotational defor-mity of ≥20°. The mean age of patients in group A was 2.1 years and the mean carrying angle was 5.7°±1.5° varus (P<0.001). According to the Flynn cosmetic criteria, Group A and Group 1 had significantly worse outcomes (P<0.001).
CONCLUSION: In conclusion, fixation of the distal fragment in rotation may be associated with CVD and intraoperative assessment is of great value to avoid long-term deformity and cosmetic degradation.

Keywords: Closed reduction percutan pinning, cubitus varus deformity; pediatric; rotational deformity; supracondylar humerus fracture.

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