SUPRAKONDİLLER HUMERUS KIRIKLARININ TEDAVİSİNDE MEDİAL VE LATERAL ÇAPRAZ PİNLEME VE SADECE LATERAL PİNLEME RETROSPEKTİF KARŞILAŞTIRMALI KLİNİK BİR ÇALIŞMA

Yıl 2021, Cilt: 22 Sayı: 3, 221 - 228, 17.05.2021

Mehmet Soylemez , Çağrı Özcan , Muhammed Enes Karataş

https://doi.org/10.18229/kocatepetip.723352

Öz

AMAÇ: Bu çalışmadaki amacımız suprakondiler humerus kırığı (SHK) sebebiyle opere edilen pediatrik hastalarda çapraz pinleme tekniği (ÇP) ile lateral pinleme tekniğinin (LP) klinik ve radyolojik sonuçlarını karşılaştırmaktır.
GEREÇ VE YÖNTEM: 2017 - 2019 yılları arasında hastanemizde ÇP yada LP ile SHK ameliyatı geçiren hastalar retrospektif olarak incelendi. Yaş, cinsiyet, redüksiyon şekli, Gartland sınıfı, ameliyat süresi, pin sayısı, postop nöro-vasküler durum, postop ilk Baumann açısı ve son takip Baumann açısı, lateral kapitello-humeral açı, pin çıkarma süresi, takip süresi, Flyinn kriterleri ve komplikasyonlar (fiksasyon yetmezliği, infeksiyon, sinir yaralanması, kaynamama, avasküler nekroz, revizyon cerrahisi) değerlendirildi.
BULGULAR: 77 hasta çalışmaya dahil edildi. 51 hastaya ÇP, 26 hastaya LP gerçekleştirildi. Çapraz pinlenen hastaların 24’üne medial açık redüksiyon uygulandı. Her iki grup arasında; kullanılan pin sayısı, postoperatif erken ve son kontrol baumann açısı, lateral capitello humeral açı, pin çıkarma süresi, takip süresi, Fly’in kriterleri ve komplikasyonlar açısından anlamlı bir fark görülmedi (p>0,005). Hiçbir hastada kaynamama, gecikmiş kaynama veya avasküler nekroz saptanmadı. Ameliyat süresi LP grubunda daha kısa idi (p = 0,038). ÇP grubunda 4 hastada iyatrojenikulnar sinir felci, LP grubunda 1 hastada fiksasyon hatası saptandı.
SONUÇ: Çalışmamız her iki grubun fonksiyonel sonuçlarının benzer olduğunu ortaya koymuştur. Bununla birlikte, ulnar sinir hasarı kapalı redüksiyon ve perkütançapraz-pinleme yapılan hastalarda daha yaygındı. İstatistiksel olarak komplikasyonlar açısından iki grup arasında anlamlı fark olmamakla birlikte, sınırlı medial açık prosedür ile çapraz pinleme veya sadece lateral pinleme suprakondiler humerus kırıklarının tedavisi için daha güvenli olabilir.

Anahtar Kelimeler

Pediatrik, humerus, suprakondiler kırık, , çapraz pinleme, lateral pinleme

MEDIAL AND LATERAL CROSSED-PINNING VERSUS ONLY LATERAL PINNING IN THE TREATMENT OF SUPRACONDYLAR FRACTURES OF HUMERUS A RETROSPECTIVE COMPARATIVE CLINICAL STUDY

Öz

OBJECTIVE: In this study, we aimed to compare the clinical and radiological results of cross-pinning technique (CP) and lateral pinning technique (LP) in pediatric patients operated for supracondylar humerus fracture (SHF).
MATERIAL AND METHODS: The medical records of patients undergoing operations for an SFH either with crossed-pinning technique or only lateral pining technique between the years 2017 and 2019 at the same institution were retrospectively reviewed. Age, gender, reduction type, Gartland class, duration of surgery, number of pins, postop neuro-vascular status, postoperative initial Baumann’s angle and Baumann’s angle at last follow-up visit, Lateral capitellohumeral angle, pin removal time, follow-up time, Flynn's criteria and complications (revision for fixation failure, infection, nerve palsy. nonunion, avascular necrosis ) were evaluated for all patients.
RESULTS: 77 patients were included in the study. Of these, crossed-pinning (CP) technique was performed on 51 patients while only lateral pinning technique (LP) was performed on 26 patients. Among the CP group, 24 of the cross-pinned patients had undergone a medial open reduction. There was no significant difference between the groups ; in terms of the number of pins used, postoperative initial Baumann’s angle and Baumann’s angle at last follow-up visit, Lateral capitellohumeral angle, pin removal time, follow-up time, Flynn's criteria and complications(p>0,005). Nonunion, delayed union or avascular necrosis was not detected in any of the patients. However, the duration of the surgery was shorter in the LP group (p= 0,038). Iatrogenic ulnar nerve palsy was detected in four patients in the CP group and 1 fixation failure was detected in the LP group.
CONCLUSIONS: Our study revealed that the results of both groups were comparable in terms of functional results. However, ulnar nerve injury was more common in patients undergoing closed reduction and percutaneous crossed-pinning. Although threre was no statistically difference in terms of complications among the groups, only lateral pinning or crossed-pinning with a limited medial open procedure may be safer for treatment of supracondylar humerus fractures.

Anahtar Kelimeler

Pediatric, humerus, supracondylar fracture, crossed-pinning, lateral pinning

Kaynakça

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