The results of the treatment of the lateral condyle fractures of the humerus in children

Year 2013, , 191 - 193, 01.09.2013

Cengiz Işık Hüsamettin Çakıcı Fuat Akpınar Abdullah Alper Şahin Yasin Durukan

https://doi.org/10.5505/abantmedj.2013.44127

Abstract

OBJECTIVE: In children humerus lateral condyle fractures are second most common fractures after supracondyler humerus fractures and it is the most commen type inside distal humeral epiphyseal fractures. Because of the important complications such as non – union, mal – union, open reduction and internally fixation is favorable, especially in displaced fractures. In our study, we aimed to compare the results of surgery or conservative treatments of children with humerus lateral condyle fractures.METHODS: For our study, we chose 36 patients with humerus lateral condyle fracture that we treated between July 2009 – September 2012. 6 of them was type I 4 mm fracture. 2 of them were treated with close reduction and percutaneous pinning and 7 of them were treated with open reduction and pinning because of the insufficient reduction with close reduction method. We operated 2 of these 7 patients again and put graft to the fracture site because of non – union. We removed casts at the end of fourth week and started motion and exercise to the elbow joint of patients that we followed up conservatively. We used cast or braces during postoperative period in the patients we treated by surgery. At the end of fourth week we removed casts or braces and started motion and exercise to the elbow joint after surgery. After radiologic signs of union we removed pins. For 6 months from the beginning of treatment, we followed up the patients about range of motion, spur formation, union of fracture event or varus – valgus deformity. RESULTS: 25 patients 69.4 % were male, 11 30.6 % patients were female. Their average age was 5.7 3.4 – 8.1 . Patients were followed up for an average of 25 6 – 24 months. None of them had function loss. But in 14 patients spur formation was seen on lateral humerus. Spur formation was seen in all patients who were treated by open surgery. Spur formation was seen in 5 patients with type II fractures that treated by close surgery. There was more spur formation in patients with type III fractures that treated by open surgery than patients with type III fractures that treated by close surgery. We didn’t re-operate any patient for spur excision. There was a superficial pin – tract infection in 1 patient 2.7 % . Deep pin – tract infection wasn’t seen in any patient. No patient had any varus – valgus deformity or supination – pronation loss when compared with contralateral elbow joint. CONCLUSION: In children humerus lateral condyle fractures that has displacement 2mm or more, needs surgery. In our cases we find similar results about spur formation compared with literature, it was related with the displacement at the beginning as literature says. Similar with literature spur formation didn’t cause any limitation on range of motion.

Keywords

pediatric, humerus distal lateral condyle fracture, lateral spur

Çocuklarda humerus lateral kondil kırığı tedavi sonuçları

Abstract

Amaç: Lateral kondil kırıkları çocuklarda humerus suprakondil kırıklarından sonra 2. sırada, humerus distal epifiz kırıkları içerisinde ise en sık görülen kırıklardır. Yanlış kaynama ve kaynamama gibi önemli komplikasyonları olması nedeniyle özellikle ayrışması fazla olan kırıklarda açık cerrahi ve redüksiyon sonrası fiksasyon ile tedavi edilmesi bu kırıklarda ön plandadır. Çalışmamızda lateral kondil kırığı ile gelen çocuklarda uyguladığımız cerrahi ve konservatif tedavi sonuçlarımızı sunmayı amaçladık. Yöntem: : 2009 Temmuz-2012 Eylül döneminde lateral kondil kırığı tanısı ile tedavi edilen 36 hasta çalışmaya alındı. Bulgular: Hastaların 25’i %69.4 erkek, 11’i %30.6 kız çocuğu olup, yaş ortalamaları 5.7 3,4-8,1 yıl idi. Hastalar ortalama 25 6-24ay ay izlendi. Hiçbir hastada fonksiyon kaybı olmadı. Fakat 14 hastada lateralde spur oluştu. Açık cerrahi yapılanların tümünde spur mevcuttu. Kapalı yapılanlardan tip II kırıklardan 5’sinde görüldü. Tip III kırık olup kapalı yapılanlarda Tip III kırık olup açık cerrahi yapılanlara göre daha küçük boyutta spur saptandı. Tip I kırıklarda spur yoktu. Hiçbir hastaya lateralde oluşan spur nedeni ile cerrahi eksizyon uygulanmadı. Cerrahi uygulanan hastalardan 1'inde %2.7 yüzeyel pin dibi enfeksiyonu görüldü. Sonuç: Çocuk humerus lateral kondil kırıklarında 2mm’nin altındaki kırıklar hariç cerrahi tespit gerekmektedir. Çalışmaya dahil ettiğimiz olgularda lateral spurun görülmesi literatürle benzerlik göstererek başlangıç deplasmanı ile ilişkili olduğu gösterilmiştir. Yine literatürle benzer olarak şupurun oluşması eklem hareketlerinde kısıtlılığa neden olmamıştır.

Keywords

çocuk, humerus distal lateral kondil kırığı, lateral spur

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