Pediatrik Suprakondiler Humerus Kırıkları
Özet
Pediatrik suprakondiler humerus kırıkları, çocukluk çağı ortopedik acillerinde cerrahi açıdan büyük öneme sahip olup, dirsek travması nedeniyle hastaneye yatırılan çocukların yaklaşık üçte ikisini oluşturur. Genellikle açık el üzerine düşme sonucu dirseğin hiperekstansiyona zorlanmasıyla meydana gelen bu yaralanmaların %95-98'i ekstansiyon tipi kırıklardır. Tanı ve sınıflandırmada Gartland ve Modifiye Wilkins sistemleri kullanılırken; radyolojik değerlendirmede ön-arka ve lateral grafiler hayati rol oynar. Tedavi yaklaşımında Tip 1 ve stabil bazı Tip 2 kırıklar alçı ile takip edilebilirken; deplase, instabil veya rotasyonlu kırıklarda cerrahi müdahale gereklidir. Ameliyat zamanlaması literatürde tartışmalı bir konu olup, kapalı redüksiyon ve perkutan pinleme (özellikle diverjan veya çapraz pinleme teknikleri) tedavide altın standart olarak kabul edilmektedir. Cerrahi sonrasında kübitus varus, sinir hasarı ve eklem sertliği gibi komplikasyonlar gelişebileceğinden titiz bir planlama gereklidir.
Pediatric supracondylar humerus fractures are of great surgical importance in pediatric orthopedic emergencies, accounting for approximately two-thirds of children hospitalized due to elbow trauma. These injuries, usually caused by hyperextension of the elbow following a fall on an outstretched hand, consist of extension-type fractures in 95-98% of cases. Gartland and Modified Wilkins systems are utilized for diagnosis and classification, while anteroposterior and lateral radiographs play a vital role in radiological evaluation. In the treatment approach, Type 1 and certain stable Type 2 fractures can be managed with casting, whereas displaced, unstable, or rotated fractures require surgical intervention. Surgical timing remains a controversial topic in literature, and closed reduction with percutaneous pinning (especially divergent or cross-pinning techniques) is accepted as the gold standard in treatment. Meticulous planning is essential as complications such as cubitus varus, nerve injury, and joint stiffness may develop postoperatively.
Referanslar
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