Pediatrik Kırık ve Çıkıklar

Araç

güvenlik önlemlerinin artması, trafik kurallarının düzenlenmesi, sporda

koruyucu malzeme kullanımının yaygınlaştırılması ve sosyal güvenlik

politikalarının düzenlenmesine rağmen, travma çocuklarda mortalite ve

morbiditenin en önemli nedenlerindendir. Travma çocuk yaş grubunda sıklıkla

ekstremite kırıklarına sebep olur. İsveç kaynaklı 8000 den fazla çocuğun takip

edildiği bir çalışmada (0-16 yaş arası) en az bir kırık geçirenlerin insidansı

erkeklerde %42, kızlarda ise %27 olarak saptanmıştır.<!--[if supportFields]> ADDIN EN.CITE

<EndNote><Cite><Author>Landin</Author><Year>1983</Year><RecNum>1</RecNum><DisplayText>[1]</DisplayText><record><rec-number>1</rec-number><foreign-keys><key

app="EN" db-id="se2px2z562dtzieeve5xvvsxwtsew5xdwpfv"

timestamp="1431436491">1</key></foreign-keys><ref-type

name="Journal

Article">17</ref-type><contributors><authors><author>Landin,

Lennart

A</author></authors></contributors><titles><title>Fracture

Patterns in Children: Analysis of 8,682 Fractures with Special Reference to

Incidence, Etiology and Secular Changes in a Swedish Urban Population

1950-1979</title><secondary-title>Acta

Orthopaedica</secondary-title></titles><periodical><full-title>Acta

Orthopaedica</full-title></periodical><pages>3-109</pages><volume>54</volume><number>S202</number><dates><year>1983</year></dates><isbn>1745-3674</isbn><urls></urls></record></Cite></EndNote><![endif]-->[1]<!--[if supportFields]><![endif]--><o:p></o:p>

Çocuk

kemikleri biyomekanik, fizyolojik ve anatomik özellikleri nedeniyle

erişkinlerden bazı yönleriyle farklılıklar göstermektedir. Çocuk kemiklerinde

büyüme plakları (epifiz) ve büyüme merkezleri (apofiz) mevcuttur. Epifizler

kemiğe longitudinal büyüme sağlarken, apofizler bölgesel büyümeye neden olup

kas tendon gibi yapılara yapışma yüzeyi sağlarlar. Erişkinden farklı olarak

gelişmekte olan bu dokuların varlığı, kırık tedavisini olumlu veya olumsuz

yönleriyle etkiler. <o:p></o:p>

Çocuk

kemikleri erişkine nazaran daha az mineralize, damarsal yapıdan daha zengin, daha

esnek (elastik modulusu daha düşük), daha kalın periosta sahiptir.<!--[if supportFields]> ADDIN EN.CITE

<EndNote><Cite><Author>Currey</Author><Year>1975</Year><RecNum>7</RecNum><DisplayText>[2]</DisplayText><record><rec-number>7</rec-number><foreign-keys><key

app="EN" db-id="se2px2z562dtzieeve5xvvsxwtsew5xdwpfv"

timestamp="1431509737">7</key></foreign-keys><ref-type

name="Journal

Article">17</ref-type><contributors><authors><author>Currey,

JD</author><author>Butler,

G</author></authors></contributors><titles><title>The

mechanical properties of bone tissue in

children</title><secondary-title>The Journal of Bone &amp;

Joint Surgery</secondary-title></titles><periodical><full-title>The

Journal of Bone &amp; Joint

Surgery</full-title></periodical><pages>810-814</pages><volume>57</volume><number>6</number><dates><year>1975</year></dates><isbn>0021-9355</isbn><urls></urls></record></Cite></EndNote><![endif]-->[2]<!--[if supportFields]><![endif]--> Esneklik

kemikte plastik deformasyon denilen şekil bozukluklarına sebep olur. Plastik

deformasyon erişkinlerde de zaman bildirilmesine rağmen çocuklarda daha sıktır.<!--[if supportFields]> ADDIN EN.CITE

<EndNote><Cite><Author>Simonian</Author><Year>1996</Year><RecNum>4</RecNum><DisplayText>[3]</DisplayText><record><rec-number>4</rec-number><foreign-keys><key

app="EN" db-id="se2px2z562dtzieeve5xvvsxwtsew5xdwpfv"

timestamp="1431440780">4</key></foreign-keys><ref-type

name="Journal

Article">17</ref-type><contributors><authors><author>Simonian,

Peter T</author><author>Hanel, Douglas

P</author></authors></contributors><titles><title>Case

Report: Traumatic Plastic Deformity of an Adult Forearm: Case Report and

Literature Review</title><secondary-title>Journal of orthopaedic

trauma</secondary-title></titles><periodical><full-title>Journal

of orthopaedic trauma</full-title></periodical><pages>213-215</pages><volume>10</volume><number>3</number><dates><year>1996</year></dates><isbn>0890-5339</isbn><urls></urls></record></Cite></EndNote><![endif]-->[3]<!--[if supportFields]><![endif]--> Teorik olarak bütün

uzun kemiklerde gelişebilmesine rağmen klinik pratikte en sık ön kol

kırıklarında karşılaşılmaktadır. Küçük çocuklarda (<5 yaş) plastik deformasyon,

yeniden şekillenmeyle düzelse de 20 derece üzeri açılanmalar redükte

edilmelidir. <o:p></o:p>

Kalın

periost, plastik deformasyon gibi unsurlar; torus fraktürü, yeşil ağaç fraktürü

gibi çocukluk çağına özgü kırık şekillerinin görülmesine sebep olur. Torus

fraktürleri sıklıkla diafiz–metafiz geçişlerinde görülen bükülme tarzı

kırıklardır. Yeşil ağaç kırıklarında ise bir korteks sıkıştırıcı güçlere maruz

kalarak plastik deformasyona uğrarken karşı korteks gerdirici güçlere maruz

kalarak tamamen kırılır. Literatürde yeşil ağaç kırıklarında görülen bu tek

korteks kırılmalarında, karşı korteksinde kırılmasını savunan yayınlar olduğu

gibi kısmi kırığın tam kırığa çevrilmesinin gerekmediğini bildiren yayınlar da

mevcuttur.<!--[if supportFields]> ADDIN EN.CITE

<EndNote><Cite><Author>Evans</Author><Year>1951</Year><RecNum>5</RecNum><DisplayText>[4,

5]</DisplayText><record><rec-number>5</rec-number><foreign-keys><key

app="EN" db-id="se2px2z562dtzieeve5xvvsxwtsew5xdwpfv"

timestamp="1431440927">5</key></foreign-keys><ref-type

name="Journal Article">17</ref-type><contributors><authors><author>Evans,

E

Mervyn</author></authors></contributors><titles><title>Fractures

of the radius and ulna</title><secondary-title>Journal of Bone &amp;

Joint Surgery, British

Volume</secondary-title></titles><periodical><full-title>Journal

of Bone &amp; Joint Surgery, British

Volume</full-title></periodical><pages>548-561</pages><volume>33</volume><number>4</number><dates><year>1951</year></dates><isbn>2049-4394</isbn><urls></urls></record></Cite><Cite><Author>Herring</Author><Year>2013</Year><RecNum>170</RecNum><record><rec-number>170</rec-number><foreign-keys><key

app="EN" db-id="se2px2z562dtzieeve5xvvsxwtsew5xdwpfv"

timestamp="1432640073">170</key></foreign-keys><ref-type

name="Book">6</ref-type><contributors><authors><author>Herring,

John

A</author></authors></contributors><titles><title>Tachdjian&apos;s

pediatric orthopaedics: from the Texas Scottish Rite Hospital for

children</title><secondary-title>general principles of managing

orthopaedic injuries</secondary-title></titles><dates><year>2013</year></dates><publisher>Elsevier

Health

Sciences</publisher><isbn>1455737402</isbn><urls></urls></record></Cite></EndNote><![endif]-->[4, 5]<!--[if supportFields]><![endif]--><o:p></o:p>

Çocuk

kırıklarında görülen yapısal farklılıklar, kırık sonrası iyileşme dönemini de

etkileyerek; genel olarak erişkinlerden daha yüz güldürücü sonuçlar elde

edilmesini sağlar. Çocuk kırıkları daha hızlı kaynar ve yeniden şekillenme

kapasitesine sahiptir. Yeniden şekillenme (remodelizasyon) kapasitesi; çocuğun

kalan büyüme miktarı (kemik yaşı), fize yakınlığı, fizin büyüme kapasitesi gibi

etkenlere bağlıdır.<!--[if supportFields]> ADDIN EN.CITE ADDIN EN.CITE.DATA <![if gte mso 9]><xml>

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</xml><![endif]--><!--[if supportFields]><![endif]--> Büyüme

kapasitesi ne kadar fazla ise yeniden şekillenme potansiyeli o kadar fazladır. <o:p></o:p>