Úvod: Analýza príčin reoperácií po perkutánnej osteosyntéze suprakondylických zlomenín humeru (SFH) u detí. Materiál a metódy: Autori vyhodnotili komplikácie z osteosyntézy SFH u detí hospitalizovaných na Klinike detskej chirurgie (KDCH) DFNsP v Bratislave za 5ročné obdobie 2007–2011. Z 395 SFH bolo 372 riešených zatvorenou repozíciou a perkutánnou transfixáciou. Výsledky: U 32 (8,6 %) zo SFH riešených zatvorenou repozíciou a osteosyntézou (OS) boli indikované reoperácie: 8krát pre známky lézie n. ulnaris, 7krát pre migráciu Kirschnerových drôtov (KD), 17krát pre neanatomické postavenie alebo zlyhanie OS. Pri lézii n. ulnaris bol eliminovaný KD z ulnárnej strany a nahradený buď intramedulárne descendentne zavedeným KD na ulnárnu stranu kondylu alebo tromi divergentne zavedenými KD z radiálnej strany. Pri redislokácii pre zlyhanie OS bola štandardne prevádzaná reosteosyntéza (re-OS) tromi KD, dva paralelne alebo divergentne z radiálnej strany a jeden cez mediálny epikondyl. Záver: Počas tohto obdobia zavedením diferencovaného prístupu v liečbe SFH podľa typu zlomeniny a stupňa dislokácie sa výrazne znížil počet reoperácií. Tiež pri veľkom počte detských chirurgov, ktorí sa podieľajú na primárnom ošetrovaní SFH (spolu 18), k zníženiu viedla určite aj skutočnosť, že v UPS nemusia zlomeninu “za každú cenu” definitívne doriešiť.

Introduction: The authors carried out the analysis of the causes for re-operations after percutaneous osteosynthesis of supracondylar fractures of the humerus in children. Materials and methods: The authors evaluated the complications of osteosynthesis of supracondylar fractures in children hospitalized at the Clinic of Pediatric Surgery, University Hospital in Bratislava, for a 5-year period between 2007 and 2011. From the total number (395) of supracondylar fractures, 372 were treated as closed reduction and percutaneous transfixation. Results: 32 (8.6%) of supracondylar fractures that were treated as closed reduction and osteosynthesis were indicated for re-operation – 8 times for signs of lesion n. ulnaris, 7 times for migration of Kirschner wires, 17 times for non-anatomical status or osteosynthesis failure. In case of lesions of nervus ulnaris, Kirschner wires were eliminated from the ulnar side and replaced either with intramedullary descendently introduced Kirschner wire to the ulnar condyle (the first option) or with three divergent Kirschner wires from radial side (the second option). In case of failed osteosynthesis, reosteosynthesis was performed using three Kirschner wires (two parallel or divergent from the radial side and one through the medial epicondyle). Conclusion: During the period monitored, the introduction of a differentiated approach in the treatment of supracondylar fractures of the humerus in children according to the type of fracture and the degree of displacement has significantly reduced the number of reoperations. Subsequently, it is important to notice that the decreased number of reosteosynthesis can be also assigned to the fact that the initial operation is not necessarily carried out as an urgent one (e.g. by a surgical team on night duty), but can be postponed and performed by an experienced traumatological team next day. Keywords: supracondylar fracture of the humerus in children – complications – percutaneous fixation

Klinika detskej chirurgie LF UK a DFNsP Bratislava

Complications resulting from osteosynthesis in children after supracondylar fractures of the humerus