[The effect of surgical exposure on the clinic outcomes of supracondylar humerus fractures in children]. / Cocuk suprakondiler humerus kiriklarinda cerrahi yaklasimin sonuca etkisi.

BACKGROUND: The clinic outcomes of supracondylar humerus fractures in children treated with open reduction and internal fixation by using two different surgical exposures were studied. METHODS: The clinic outcomes of seventeen and ten patients to whom lateral (LA) and posterior (PA) approaches were used respectively, were evaluated according to the Flynn's criteria. All fractures were extension type and classified as type II and III according to Gartland's classification. Left arm was broken in nineteen children and right arm in eight. The mean age was 8.5 years (range 3-13 years) and mean follow up was 19.4 months (range 8-50). RESULTS: Four (23.52%) of the seventeen patients with LA and two (20%) of the ten patients with PA suffered from a loss in the range of motion (ROM) of the elbow more than 10 degrees (p>0.05). Mean operation time was 53.14+/-18.11 minutes in the patients used LA and 68.54+/-17.67 minutes in the patients with PA. Satisfactory results were obtained in thirteen of the seventeen patients (76.47%) in the group with LA and in eight of the ten patients (80%) in the group with PA. CONCLUSION: It is concluded that in the open reduction of childhood supracondylar fractures of the humerus, LA and PA approaches without dividing triceps muscle do equally affect the ROM of the elbow. Although PA decreases the risk of ulnar nerve injury with Kirschner wire, it prolongs the operation time.

[Surgical treatment of elbow fracture-dislocations seen in children and adolescents]. / Cocukluk ve adölesan dönemlerinde görülen dirsek kirikli çikiklarinin cerrahi tedavisi.

OBJECTIVES: We evaluated surgical indications and radiologic features of elbow fracture-dislocations in children and adolescents. METHODS: Thirteen patients (12 boys, 1 girl; mean age 13 years; range 6 to 17 years) with elbow fracture-dislocations were treated surgically. Coexisting fractures included medial epicondyle fractures (n=5), medial and lateral epicondyle fractures (n=3), radial head and olecranon fractures (n=2), radial head and medial epicondyle fractures (n=1), lateral condyle fracture (n=1), and fracture of the coronoid process (n=1). Eleven dislocations were closed, two were open. Open reduction and Kirschner wire fixation were performed in all the patients. Posterior (n=6), medial (n=5), anteromedial, and lateral incisions were used. Active range of motion exercises were initiated following the removal of sutures. Above-elbow cast was applied for three weeks. The mean follow-up period was 38 months (range 7 to 58 months). The results were evaluated with the use of the Mayo elbow performance score. RESULTS: Ten patients had satisfactory (very good or good) results, while two patients with open dislocations and ipsilateral major injuries, and one patient who developed myositis ossificans postoperatively had unsatisfactory (moderate or bad) results. No postoperative nerve injuries were detected. CONCLUSION: The surgical indications for fracture-dislocations of the elbow in children and adolescents are the presence of intraarticular loose bodies or instability after reduction. The presence of open dislocation or ipsilateral major injuries are associated with unsatisfactory results.