Comparison of lateral versus triceps-splitting posterior approach in the surgical treatment of pediatric supracondylar humerus fractures
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Dosyalar
Tarih
2016
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Cilt Başlığı
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Suprakondiler humerus kırıkları çocukluk döneminin en sık dirsek kırığıdır. Kapalı redüksiyon ve perkütan çivileme altın standart tedavi ola-rak kabul edilir. Bununla beraber bazen açık redüksiyon gerekebilir. Bu geriye dönük çalışmamızın amacı suprakondiler humerus kırıklarında triseps kasını kesen posterior ve lateral yaklaşımların klinik ve fonksiyonel sonuçlarını karşılaştırmaktır.GEREÇ VE YÖNTEM: Toplam 38 hasta posterior veya lateral insizyonla ameliyat edildi. Grup 1'de posterior insizyonlu 30 hasta, Grup 2'de lateral insizyonlu sekiz hasta mevcuttu. Kozmetik ve klinik sonuçları karşılaştırmak için Flynn kriterleri kullanıldı. Kırık kaynaması AP ve lateral grafilerle değerlendirildi. Hastalar ve ebeveynlerine dirseğini tam aktif olarak ne kadar sürede hareket ettirebildiği ve tedavi sürecinden tatmin durumları sorularak kayıt tutuldu.BULGULAR: Ortalama kaynama süresi Grup 1 ve Grup 2 için sırasıyla 44.1 gün ve 46.3 gün, tam veya tama yakın dirsek hareketlerine kavuşma süresi Grup 1 ve Grup 2 için sırasıyla atel çıkarımı sonrası 57.5 ve 55.7 gün olarak bulundu. Grup 1'deki 30 hastanın ve ebeveynin 21'i, Grup 2'deki sekiz hastanın ve ebeveynin altısı sonuçtan tam olarak tatmin olduklarını ifade ettiler. Grup 1'deki 30 hastanın 21'i, Grup 2'deki sekiz hastanın ve altısı her iki Flynn kriterlerine göre (kozmetik ve fonksiyonel) çok iyi grupta yer aldı.TARTIŞMA: Pediatrik suprakondiler humerus kırıklarının tedavisinde kapalı redüksiyon ve perkütan çivilemenin altın standart tedavi olduğuna ina-nıyoruz. Bu metodun uygulanamadığı olgularda trisepsi kesen posterior yaklaşımın daha kolay kırık redüksiyonu ve muhtemelen daha kısa ameliyat süresi gibi avantajlarından dolayı güvenli ve lateral yaklaşımla karşılaştırılabilir olduğunu düşünüyoruz.
BACKGROUND: Supracondylar humerus fracture is the most common fracture of the elbow in children. Closed reduction and percutaneous pinning is considered to be the optimal treatment strategy; however, in some instances, open reduction may be necessary. The aim of this retrospective study was to compare clinical and functional results of triceps-splitting posterior versus lateral approach in pediatric supracondylar humerus fracture surgery.METHODS: A total of 38 patients underwent surgery; Group 1 consisted of 30 patients on whom posterior approach was used, while lateral approach was used on the 8 patients in Group 2. Flynn criteria were used to evaluate cosmetic and clinical results. Fracture healing was assessed with anteroposterior and lateral x-rays. Patients and parents were asked to describe time needed for complete return of full elbow range of motion (ROM) and overall satisfaction.RESULTS: Mean fracture union time was 44.1 days and 46.3 days, and time required to regain complete or near complete elbow ROM was 57.5 days and 55.7 days after splint removal for Group 1 and Group 2, respectively. Twenty-one of 30 patients (and parents) in Group 1, and 6 of 8 patients (and parents) in Group 2 were totally satisfied with the results. Twenty-one of 30 patients in Group 1, and 6 of 8 patients in Group 2 had excellent cosmetic and functional results according to Flynn outcome criteria.CONCLUSION: In cases of pediatric supracondylar humerus fracture, early closed reduction and percutaneous pinning is preferred; however, when this method is not applicable, triceps-splitting posterior approach is a safe and comparable method to lateral approach with advantages of easier fracture reduction and shorter operating time.
BACKGROUND: Supracondylar humerus fracture is the most common fracture of the elbow in children. Closed reduction and percutaneous pinning is considered to be the optimal treatment strategy; however, in some instances, open reduction may be necessary. The aim of this retrospective study was to compare clinical and functional results of triceps-splitting posterior versus lateral approach in pediatric supracondylar humerus fracture surgery.METHODS: A total of 38 patients underwent surgery; Group 1 consisted of 30 patients on whom posterior approach was used, while lateral approach was used on the 8 patients in Group 2. Flynn criteria were used to evaluate cosmetic and clinical results. Fracture healing was assessed with anteroposterior and lateral x-rays. Patients and parents were asked to describe time needed for complete return of full elbow range of motion (ROM) and overall satisfaction.RESULTS: Mean fracture union time was 44.1 days and 46.3 days, and time required to regain complete or near complete elbow ROM was 57.5 days and 55.7 days after splint removal for Group 1 and Group 2, respectively. Twenty-one of 30 patients (and parents) in Group 1, and 6 of 8 patients (and parents) in Group 2 were totally satisfied with the results. Twenty-one of 30 patients in Group 1, and 6 of 8 patients in Group 2 had excellent cosmetic and functional results according to Flynn outcome criteria.CONCLUSION: In cases of pediatric supracondylar humerus fracture, early closed reduction and percutaneous pinning is preferred; however, when this method is not applicable, triceps-splitting posterior approach is a safe and comparable method to lateral approach with advantages of easier fracture reduction and shorter operating time.
Açıklama
WOS:000386543000013
PubMed ID:27849326
PubMed ID:27849326
Anahtar Kelimeler
Posterior approach, Supracondylar humerus fracture, Triceps, Posterior yaklaşım, Suprakondiler humerus kırığı, Triseps
Kaynak
Ulusal Travma ve Acil Cerrahi Dergisi
WoS Q Değeri
Q4
Scopus Q Değeri
Q2
Cilt
22
Sayı
5
Künye
Türkmen, F., Toker, S., Kesik, K., Korucu, İ. H., Acar, M. A. (2016). Comparison of lateral versus triceps-splitting posterior approach in the surgical treatment of pediatric supracondylar humerus fractures. Ulusal Travma Ve Acil Cerrahi Dergisi, 22, 5, 483-488.
