Dokuz yaştan daha küçük çocukların femur boyun kırıklarının tedavisinde Kirshner teli uygulaması

Smooth pinning in femoral neck fractures of children aged nine years old and younger

Özet

Amaç: Bu çalismada çocuk femur boyun kiriklarinda uyguladigimiz kapali redüksiyon, perkütan Kirshner teli ile tespit ve ameliyat sonrasi pelvipedal alçi sonuçlarimizi ve karsilastigimiz problemleri bildirdik. Gereç ve Yöntem: Femur boyun kirigi nedeniyle 1986-1998 yillari arasinda tedavi edilen 48 hastanin 49 kalçasi bu çalismaya dahil edildi. Hastalar ortalama 6.2 yasindaydi (2-9 yas arasi). Colonna siniflamasina göre dört kalça tip I, 27 kalça tip II, 16 kalça tip III, iki kalça tip IV olarak ayrildi. Tüm hastalara traksiyon masasinda C-kollu skopi cihazi ile kapali redüksiyon, perkütan yada açik ameliyat ile 2 veya 3 mm'lik Kirshner telleri ile tespit ve ameliyat sonrasi pelvipedal alçi uygulandi. Bulgular: Hastalar ortalama 43 ay (27-163 ay arasi) takip edilip, Ratliff degerlendirme kriterlerine göre degerlendirildiler. Buna göre 39 (%79.6) kalça iyi, 9 (%18.4) kalça orta, 1 (%2) kalça kötü olarak degerlendirildi. Komplikasyon olarak 10 (%20.4) kalçada avasküler nekroz, erken epifiz plagi kapanmasi 3(%6.1) kalçada, kaynamama 3(%6.1) kalçada, varus deformitesi 5(%10) kalçada, Kirshner teli gevsemesi ve geriye çikmasi 3(%6.1) kalçada tespit edildi. Sonuç: Çocuk femur boyun kiriklarinin cerrahi tedavisinde düz çivilerin uygulanmasi epifiz plagina daha az zarar verir, perkütan uygulama ile daha kisa süreli ameliyat yaninda çivilerin çikarilmasida kolaydir. Yetiskinlerden farkli olarak çocuklarda femur boyun kiriklarinda kompresyon yapan sistemlere ihtiyaç duyulmadan kirik kaynamasi elde edilebilmektedir. Düz çivilerin kullanildigi bu çalismada görülen komplikasyonlar çogunlukla yivli internal tespit araçlarinin kullanildigi diger çalismalarla karsilastirildiginda daha yüksek bulunmamistir.

Abstract

Introduction: In this study, we presented the results of smooth pinning which is a less aggressive surgical procedure with pelvipedal cast application in fractures of the neck of the femur in children. Materials and Methods: This study covers the results of surgically treated 48 hips of 49 children with fractured neck of femur who were admitted to our clinic between 1986-1998. The mean age was 6.2 years (range 2-9 years). According to Colonna classification, four hips were type I, 27 hips were type II, 16 hips were type III, and two hips were type IV. In all patients, closed reduction with three or four percutaneus or open surgical smooth pins of two or three millimeters in diameter was applied using image intensifier and traction table. Pelvipedal cast was applied postoperatively. Results: Patients were followed for 43 months (range 27-163 months) and the results were assessed using Ratliff's criteria. Thirty-nine (79.6%) hips had good, nine (18.4%) hips had fair, one (2%) hip had poor results. Complications included avascular necrosis in 10 hips, premature closure of the epiphyseal plate in 3 hips, non-union in 3 hips, varus deformity in five hips, pin loosening in three hips. Conclusion: We realized that smooth pins were advantageous as their damages on epiphyseal plate were less, their percutaneus applications were easier and removing them by minor surgical procedures was possible. Unlike in adults, the femoral fractures in children are healed easily without using compressive systems. In relation to this, we observed that smooth pins had no negative effects in fracture union. The complication rates in this study were not higher than other studies reported in the literature.

Anahtar kelimeler: Ortopedik fiksasyon araçları,Çocuk,Cerrahi işlemler, operatif,Femur boynu kırıkları,Kırık tespiti, internal