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Abstract
Femorol neck fractures in children are uncommon injuries and often associated with excessive incidence of complications, such as avascular necrosis, malunion in coxa vara, nonunion and disturbance in growth. During last 12 years 37 cases with this injury are treated at Orthopedics and Traumatology Clinic of İstanbul Faculty of Medicine. Approximate ratio of adults to children with this iniury is thirty to one. Types of fractures, methods of treatment, results and com;plications of these 37 cases are studied. Immobilisation in a plaster spica was applied to eleven cases and result was five coxa vara and there avascular necrosis, immobilisation in a plaster spica after percutaneous insertion of Kirshner wires was employed in seven cases. This treatment prevented coxa vara deformity three of them had avascular necrosis. Internal fixation with Smith-Petersen nail was applied to three cases. This nail caused distraction of the fragments and should not be used in children. Internal fixation with Knowles pins was applied personaly to thirteen cases. Plaster cast immobilisation was not used in fresh fracture cases. Infection developed in two of these cases, one of them resulted in nonunion and avascular necrosis. Other two cases had late avascutar necrosis. In other cases fractures healed in three months and neither of them developped coxa vara nor disturbance of growth. Internal fixation and bone grafting after Mc Murray or Pauwels type osteotomy was applied to old ununited fractures of the older children. The neck and shaft angle was restored and union was achieved in all three cases. After reviewing the results of our cases and the previous reports in the literature, it is conciuded that= only undisplaced cemcothrocanteric and interthrocanteric fractures can be treated by immobilisation in the plaster cast. Displaced cervicothrocanteric fractures and transcervical fractures should be treated by internal fixation, Smith-Petersen nail should not be used in children. Internal fixation with Knowles pins should be the treatment of choice.
Özet
Çocuklarda femur boynu kırıkları, az görülmeleri, tedavilerinin zor ol;ması, femur başının avasküler nekrozunun daha sık görülmesi, koksa vara deformitesine, kaynama gecikmesi ve tarafta kısalık komplikasyonlarına neden olmaları bakımından yetişkinlerin kırıklarından farklıdırlar. Batı ülkelerinde ender görülen bu kırıklardan, İstanbul Tıp Fakültesi Ortopedi ve Travmatoloji Kliniğinde son 12 yılda 37 vaka, beş ayrı tedavi metodu uygulanarak tedavi edilmişlerdir. Bu çalışmada, alçı içinde tesbit, Kirschner telleri ile fiksasyondan sonra alçı ve Smith-Petersen çivisi ile çivileme metodlarının uygulanmış olduğu vakalar incelendikten sonra, 13 vaka üzerinde şahsen uyguladığım Knowles vidaları ile internal fiksasyon metodu üzerinde durulmuş, tekniği tanıtılmış, vakalar ayrı ayrı sunulmuştur. Alınan sonuçlar diğer metodların sonuçları ile karşılaştırılıp, konu ile ilgili literatür incelendikten sonra şu sonuça varılmıştır.