Non-operatif tedavi edilen Tip II suprakondiler humerus k�r�klar�nda redüksiyon kayb� ile ili�kili risk fakt�rleri

Y�ld�r�m, Timur; K�rk, Muhammed Bilal; Akp�nar, Evren; Sevencan, Ahmet

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Non-operatif tedavi edilen Tip II suprakondiler humerus k�r�klar�nda redüksiyon kayb� ile ili�kili risk fakt�rleri [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2022; 28(9): 1340-1346 | DOI: 10.14744/tjtes.2021.61350

Non-operatif tedavi edilen Tip II suprakondiler humerus k�r�klar�nda redüksiyon kayb� ile ili�kili risk fakt�rleri

Timur Y�ld�r�m¹, Muhammed Bilal K�rk², Evren Akp�nar³, Ahmet Sevencan³
¹Ni�anta�� niversitesi, Meslek Yüksekokulu, Ortopedi ve Travmatoloji B�lümü, �stanbul
²�stanbul Ba�ak�ehir �am ve Sakura �ehir Hastanesi, Ortopedi ve Travmatoloji Klini�i, �stanbul
³Metin Sabanc� Baltaliman� Kemik Hastal�klar� E�itim ve Ara�t�rma Hastanesi, Ortopedi ve Travmatoloji Klini�i, �stanbul

AMA�: Ekstansiyon Tip II suprakondiler humerus k�r�klar�n optimal tedavi y�ntemi se�imi �zerindeki tart��malar s�rmektedir. �o�u hasta kapal� red�ksiyon ve al��lama ile ba�ar�l� �ekilde tedavi edilse de bir grup hastan�n ba�lang��ta elde edilen red�ksiyonu al��da kald�� s�re boyunca kaybedilir. Bu �al��man�n amac� red�ksiyon kayb�na neden olan risk fakt�rlerinin tespitidir.
GERE� VE Y�NTEM: 2012�2018 y�llar� aras�nda kapal� red�ksiyon ve al�� tespiti ile tedavi etti�imiz 103 Tip II ekstansiyon suprakondiler humerus k�r�� hastas�n�n verilerini geriye d�n�k olarak inceledik. Red�ksiyon kayb�na neden olan hasta de�i�kenleri, k�r�k oblisitesi ve metafiz par�alanmas� gibi k�r�k karakter �zellikleri, tespit y�ntemi ve al��ya ait parametreleri de�erlendirdik.
BULGULAR: �ncelenen 103 hastan�n 62�si erkek, 41�i k�z ya� ortalamas� ise 5.4�2.5 (aral�k, 2�11.6) y�l idi. Seksen bir hasta (%79) kapal� red�ksiyon ve al�� tespiti ile ba�ar�l� �ekilde tedavi edilirken, 22 (%21) hastada red�ksiyon kayb� izlendi. Sagittal planda high oblique k�r�klar�n red�ksiyon kayb� oran� transvers olanlara g�re 3.17 kat y�ksekti (%95 CI: 0.99�10.03, p<0.05). Metafizer par�alanma olan k�r�klarda red�ksiyon kayb� riski 6.5 kat y�ksek bulundu (%95 CI: 1.6�26.5, p<0.01). Red�ksiyon kayb� ile Gartland subtipi, cinsiyet, ya�, ba�lang��taki rotasyon varl��, al�� a��s� ve yumu�ak doku/al�� i� �ap geni�li�i oranlar� aras�nda anlaml� ili�ki bulunmad�.
TARTI�MA: �al��ma grubumuzdan elde etti�imiz sonu�lara g�re ekstansiyon Tip II k�r�klar kapal� red�ksiyon ve al��lama ile %79 oran�nda ba�ar�l� �ekilde tedavi edilebilir. Sagittal plan oblisitesi ve metafiz par�alanmas� red�ksiyon kayb� i�in Gartland subtipinden ba��ms�z risk fakt�rleridir.

Anahtar Kelimeler: Al�� tedavisi, Gartland Tip II, humerus, oblik; red�ksiyon kayb�; suprakondiler.

Risk factors related reduction loss in nonoperatively treated Type II supracondylar humerus fractures

Timur Y�ld�r�m¹, Muhammed Bilal K�rk², Evren Akp�nar³, Ahmet Sevencan³
¹Department of Orthopaedics and Traumatology, Ni�anta�� University, Vocational School, �stanbul-Türkiye
²Department of Orthopaedics and Traumatology, �stanbul Ba�ak�ehir Pine and Sakura City Hospital, �stanbul-Türkiye
³Department of Orthopaedics and Traumatology, Metin Sabanc� Baltaliman� Bone Diseases Training and Research Hospital, �stanbul-Türkiye

BACKGROUND: Controversies continue about the optimal treatment method for extension Type II supracondylar humerus fractures (SCHFs). Although most patients are successfully treated with closed reduction and plaster casting, in some patients, the reduction initially obtained is lost during the time in the plaster cast. The aim of this study was to determine the risk factors causing reduction loss.
METHODS: A retrospective examination was made of the data of 103 patients with Type II extension SCHF treated with closed reduction and plaster cast fixation between 2012 and 2018. Reduction loss was evaluated in respect of patient variables, fracture char-acteristics as obliquity and metaphyseal fragmentation, fixation method, and plaster cast parameters.
RESULTS: The 103 patients evaluated comprised 62 males and 41 females with a mean age of 5.4�2.5 years (2�11.6 years). Successful treatment was achieved with closed reduction and plaster cast fixation in 81 (79%) patients and reduction loss was observed in 22 (21%) patients. The reduction loss of fractures showing high oblique in the sagittal plane was 3.17-fold higher than low sagittal oblique fractures (95% CI: 0.99�10.03, p<0.05). The risk of reduction loss in fractures with metaphyseal fragmentation was found to be 6.5-fold higher (95% CI: 1.6�26.5, p<0.01). No statistically significant relationship was determined between reduction loss and Gartland subtype, age, gender, the presence of rotation initially, plaster cast angle, and the soft-tissue/inner cast width ratio.
CONCLUSION: According to our study group, 79% of extension Type II fractures can be successfully treated with closed reduction and plaster casting. Sagittal plane obliquity and metaphyseal fragmentation are risk factors for reduction loss independent of Gartland subtype.

Keywords: Cast treatment, Gartland Type II, humerus, loss of reduction; obliquity; supracondylar.

Timur Y�ld�r�m, Muhammed Bilal K�rk, Evren Akp�nar, Ahmet Sevencan. Risk factors related reduction loss in nonoperatively treated Type II supracondylar humerus fractures. Ulus Travma Acil Cerrahi Derg. 2022; 28(9): 1340-1346

Sorumlu Yazar: Timur Y�ld�r�m, T�rkiye
Makale Dili: �ngilizce

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