Çocukluk Çağı Özel Kırıkları: Monteggia ve Galeazzi
Özet
Çocukluk çağı özel kırıklarından Monteggia ve Galeazzi kırıklı çıkıklarını ele alan bu metinde, her iki yaralanmanın tarihi, mekanizması, belirtileri, sınıflandırma yöntemleri, tedavi süreçleri ve olası komplikasyonları detaylandırılmaktadır. Monteggia lezyonu, nadir görülen ulnar diyafiz kırığı ile radius başı çıkığının birlikteliği olarak tanımlanmakta ve en yaygın Bado ile Letts sistemlerine göre sınıflandırılmaktadır; akut dönemde anatomik redüksiyon ve stabilizasyon kritik rol oynarken, kronik vakalarda proksimal ulna açık kama osteotomisi gibi cerrahi yöntemler tercih edilmektedir. Galeazzi lezyonu ise distal radius kırığı ile distal radioulnar eklem (DRUE) çıkığını veya fiziyel kırığı kapsamakta, çocuklarda supinasyon ve pronasyon kuvvetlerine bağlı olarak Walsh-Mclaren, Wilkins-O’Brien gibi sistemlerle gruplandırılmaktadır. Pediatrik hastalarda DRUE bağlarının yapısı sayesinde kapalı redüksiyon ve alçı uygulaması altın standart tedavi olarak kabul edilmekle birlikte, stabilite sağlanamayan veya redüksiyonun başarısız olduğu durumlarda cerrahi fiksasyon gerekmektedir; her iki kırık türünde de uygun tedavi edilmeyen vakalar hareket kısıtlılığı, sinir yaralanmaları ve DRUE instabilitesi gibi ciddi komplikasyonlara yol açabilmektedir.
This text, which addresses Monteggia and Galeazzi fracture-dislocations among special childhood fractures, details the history, mechanism, symptoms, classification methods, treatment processes, and potential complications of both injuries. The Monteggia lesion is defined as a complex injury involving a rare ulnar diaphysis fracture combined with a radial head dislocation, classified mostly by Bado and Letts systems; anatomical reduction and stabilization are critical in the acute period, whereas surgical methods like proximal ulna open wedge osteotomy are preferred in chronic cases. The Galeazzi lesion encompasses a distal radius fracture with distal radioulnar joint (DRUJ) dislocation or physeal fracture, grouped by systems like Walsh-Mclaren and Wilkins-O’Brien depending on supination and pronation forces in children. Although closed reduction and casting is the gold standard in pediatric patients due to intact DRUJ ligaments attached to the fractured fragment, surgical fixation is required when stability cannot be maintained or reduction fails; both fracture types can lead to serious complications such as motion restriction, nerve injuries, and DRUJ instability if left untreated.
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