Çocuklardaki Monteggia eşdeğer lezyonlarında tedavi sonuçları
Küçük Resim Yok
Tarih
2008
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Monteggia eşdeğer lezyonlu çocuklarda konservatif ve cerrahi tedavi sonuçları değerlendirildi. Çalışma planı: Çalışmaya, Monteggia eşdeğer kırıklıçıkığı nedeniyle tedavi edilen 13 çocuk hasta (3 kız, 10 erkek; ort. yaş 8; dağılım 4-13) alındı. Yedi hastada (%53.9) Bado tip 1, altı hastada (%46.2) ise tip 3 eşdeğer lezyon vardı. Tip 3 eşdeğer lezyonlu hastaların ikisinde aynı zamanda humerus lateral kondil kırığı saptandı. Bir hastada (%7.7) radial sinir felci vardı. Açık kırıklı-çıkık nedeniyle acil debridman ve irigasyon uygulanan bir hasta dışında, tüm hastalarda öncelikle kapalı redüksiyon denendi. Sekiz hastada (%61.5) konservatif tedaviyle yeterli redüksiyon sağlandı. Dört hastada (%30.8) redüksiyon sağlanamaması nedeniyle, yaralanmadan sonra ilk 24 saat içinde cerrahi girişim uygulandı. Fonksiyonel değerlendirme Reckling evrelemesine göre yapıldı. Ortalama takip süresi 4.1 yıl (dağılım 2-7 yıl) idi. Sonuçlar: Hiçbir olguda kaynamama gözlenmedi. Konservatif tedavi gören hastaların hiçbirinde radius başında redüksiyon kaybıyla karşılaşılmadı ve dirsek hareketlerinde kısıtlılık gözlenmedi. Bir hastada (%7.7) dirsekte 5° kubitus varus deformitesi, radyografik olarak ise ulnada kırık hattında 20° posteriora açılanma saptandı. Konservatif tedavi gören hastaların hepsinde fonksiyonel sonuçlar iyi idi. Cerrahi tedavi uygulanan dört hastada fonksiyonel sonuçlar iyi iken, açık kırıklı-çıkığı olan olguda kötü sonuç alındı. Bir hastada 10° supinasyon kısıtlılığı vardı. Dirsek eklemi hareket genişliğinde fleksiyon ve ekstansiyon kısıtlılığı yoktu. Başvuru anında radial sinir felci olan bu hastada sinir lezyonu ameliyat sonrası üçüncü ayda düzeldi. Çıkarımlar: Çocuklardaki Monteggia eşdeğer lezyonlarda öncelikli tedavi kapalı redüksiyondur. Redüksiyon sağlanamaması durumunda cerrahi tedavi gündeme gelir.
Objectives: We evaluated the results of conservative and surgical treatment of pediatric Monteggia equivalent lesions. Methods: The study included 13 children (3 females, 10 males; mean age 8 years; range 4 to 13 years) who underwent treatment for Monteggia equivalent lesions. Seven patients (53.9%) had Bado type 1 and six patients (46.2%) had type 3 equivalent lesions. Two patients with type 3 equivalent lesions also had a lateral humeral condyle fracture. On presentation, one patient (7.7%) had radial nerve palsy. Primarily, closed reduction was attempted in all the patients except for one patient who underwent urgent debridement and irrigation for an open fracture-dislocation. Reduction was successful in eight patients (61.5%). Upon failure of closed reduction, four patients (30.8%) underwent surgery within the first 24 hours of injury. Functional assessment was made according to the Reckling’s criteria. The mean follow-up period was 4.1 years (range 2 to 7 years). Results: None of the patients had nonunion. Conservative treatment did not result in loss of reduction of the radius head or limitation in the range of motion of the elbow joint. Except for the patient with an open fracture-dislocation leading to a poor functional result, the results were good in all the patients receiving conservative or surgical treatment. One patient (7.7%) treated conservatively developed cubitus varus (5°) and posterior angulation (20°) of the ulnar fracture line. One patient treated surgically had limitation of supination (10°) without limitation of flexion or extension of the elbow joint. Accompanying radial nerve palsy in this patient disappeared in the postoperative third month. Conclusion: Closed reduction is the first choice of treatment in pediatric Monteggia equivalent lesions. Surgical treatment becomes necessary if closed reduction fails.
Objectives: We evaluated the results of conservative and surgical treatment of pediatric Monteggia equivalent lesions. Methods: The study included 13 children (3 females, 10 males; mean age 8 years; range 4 to 13 years) who underwent treatment for Monteggia equivalent lesions. Seven patients (53.9%) had Bado type 1 and six patients (46.2%) had type 3 equivalent lesions. Two patients with type 3 equivalent lesions also had a lateral humeral condyle fracture. On presentation, one patient (7.7%) had radial nerve palsy. Primarily, closed reduction was attempted in all the patients except for one patient who underwent urgent debridement and irrigation for an open fracture-dislocation. Reduction was successful in eight patients (61.5%). Upon failure of closed reduction, four patients (30.8%) underwent surgery within the first 24 hours of injury. Functional assessment was made according to the Reckling’s criteria. The mean follow-up period was 4.1 years (range 2 to 7 years). Results: None of the patients had nonunion. Conservative treatment did not result in loss of reduction of the radius head or limitation in the range of motion of the elbow joint. Except for the patient with an open fracture-dislocation leading to a poor functional result, the results were good in all the patients receiving conservative or surgical treatment. One patient (7.7%) treated conservatively developed cubitus varus (5°) and posterior angulation (20°) of the ulnar fracture line. One patient treated surgically had limitation of supination (10°) without limitation of flexion or extension of the elbow joint. Accompanying radial nerve palsy in this patient disappeared in the postoperative third month. Conclusion: Closed reduction is the first choice of treatment in pediatric Monteggia equivalent lesions. Surgical treatment becomes necessary if closed reduction fails.
Açıklama
Anahtar Kelimeler
Ortopedi, Pediatri
Kaynak
Acta Orthopaedica et Traumatologica Turcica
WoS Q Değeri
Scopus Q Değeri
Q2
Cilt
42
Sayı
2