HASAN BOMBACI, Tuncay CENTEL, Ata BABAY, İ. Metin TÜRKMEN

Femur boynu kırığı nedeniyle ilk 24 saatten sonra ameliyat edilen çocuklarda gelişen komplikasyonların değerlendirilmesi

Amaç: Femur boynu kırığı nedeniyle ilk 24 saatten sonra ameliyat edilen çocuklarda ortaya çıkan komplikasyonlar ve femur başı avasküler nekrozu (AVN) gelişmesine etki eden faktörler araştırıldı. Çalışma planı: Femur boynu kırığı nedeniyle ilk 24 saatten sonra ameliyat edilen 22 çocuğun (11 erkek, 11 kız; ort. yaş 10; dağılım 4-14) sonuçları geriye dönük olarak gözden geçirildi. Delbet sınıflamasına göre iki olguda tip I, 11 olguda tip II, dokuz olguda tip III kırık vardı. Yedi hastada ayrıca ek patoloji vardı. Yaralanma ile cerrahi tedavi arasında geçen süre ortalama yedi gün (dağılım 1-15 gün) idi. İki olgu dışında tüm hastalara kapalı redüksiyon yapıldı. Redüksiyondan sonra internal fiksasyon uygulandı. Sonuçlar Ratliff ölçütlerine göre değerlendirildi. Ortalama takip süresi 73 ay (dağılım 18-184 ay) idi. Olgular yaş, kırık tipi, kırık yer değiştirmesi, komplikasyonlar ve AVN açısından değerlendirildi. Sonuçlar: Ratliff ölçütlerine göre 12 hastada (%54.6) iyi, sekiz hastada (%36.4) orta, iki hastada (%9.1) kötü sonuç alındı. On yedi hastada (%77.3) komplikasyon görüldü; bunların 12’sinde birden fazla komplikasyon vardı. En sık komplikasyon erken fiz kapanması (14 hasta, %63.6) idi; bunu AVN (12 hasta, %54.6) izlemekteydi. Avasküler nekroz gelişen ve gelişmeyen hastalar arasında yaş, kırık tipi açısından; travmadan sonra ilk hafta ve ikinci hafta ameliyat edilen hastalar arasında AVN gelişmesi açısından anlamlı fark saptanmadı (p>0.05). Çıkarımlar: Çocuklardaki femur boynu kırıklarında ilk 24 saatten sonra yapılan ameliyat sonuçlarını esas olarak AVN gelişip gelişmemesi, ikincil olarak da kırık tipi etkilemektedir.

Anahtar Kelimeler:

Femur boynu kırıkları, Kırık tespiti, internal, Çocuk, Femur başı, Femur başı nekrozu, Ameliyat sonrası komplikasyonlar

Evaluation of complications of femoral neek fractures in children operated on at least 24 hours after initial trauma

Objectives: We evaluated complications and the factors affecting the development of avascular necrosis of the femoral head in children who underwent surgery for femoral neck fractures after at least a 24-hour delay. Methods: We reviewed the results of 22 children (11 boys, 11 girls; mean age 10 years; range 4 to 14 years) who were operated on after the first 24 hours for femoral neck fractures. According to the Delbet classification, two patients had type I, eleven patients had type II, and nine patients had type III fractures. Associated injuries were detected in seven patients. The mean duration from trauma to surgery was seven days (range 1 to 15 days). Internal fixation was performed following closed (n=20) or open (n=2) reduction. The results were assessed using the Ratliff criteria at the end of a mean follow-up of 73 months (range 18 to 184 months). The patients were evaluated with respect to age, type of fracture, displacement, complications, and avascular necrosis. Results: The results were good in 12 (54.6%), fair in eight (36.4%), and poor in two patients (9.1%). Complications developed in 17 patients (77.3%), 12 of whom had more than one. The most frequent complication was premature physeal closure (n=14; 63.6%) followed by avascular necrosis (n=12; 54.6%). No significant differences were found (i) with regard to age and the type of fracture between patients with and without avascular necrosis, and (ii) with regard to avascular necrosis between patients who were treated within the first and second week of trauma (p>0.05). Conclusion: The results of surgery performed after the first 24 hours are mainly influenced by the occurrence of avascular necrosis and, secondarily, by the type of fracture.

Keywords:

Femoral Neck Fractures, Fracture Fixation, Internal, Child, Femur Head, Femur Head Necrosis, Postoperative Complications,

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