O<'l> çocuklarda k>r>klar>n tedavisi önemli bir problem-
dir (fiekil 198.15). Oluflan kallus, iskeletin kalan> ile ayn>,
plastik yap>dad>r ve mekanik kuvvetlerle kolayl>kla defor-
me olabilir. Genellikle kapal> tedavi yöntemleri uygulan>r.
E¤er kapal> yöntemler yetersiz kal>rsa, intramedüller çivi-
lerle internal fiksasyon düflünülmelidir. Intramedüller çivi-
ler (yükü-paylaflan implantlar), zay>flam>fl kemikten s>yr>l-
ma ihtimali yüksek olan plak ve vida kombinasyonlar>na
tercih edilmelidir (18).
Uzun kemiklerde meydana gelmifl fliddetli diafizyel de-
formiteler ve belli bir bölgedeki tekrarlayan k>r>klar, cerra-
hi tedavi gerektirebilir. Genellikle femurun anterolateral
ve tibian>n da anterior e¤ilmesi ayakta durmay> ve ambu-
lasyonu güçlefltirir. Bu durumlarda multipl osteotomiler
ile kemi¤in normal diziliminin sa¤lanmas> ve ekspansil
(uzayabilen) çivilerle intramedüller fiksasyon uygulanmas>
gerekir. Psödoartroz hastalar>n %20'sinde görülür. O<'l>
hastalarda tedavisi güç di¤er bir problem ise skolyozdur.
Bu çocuklardaki omurga e¤rilikleri ilerleme e¤ilimindedir
ve korseleme genellikle bu ilerlemeyi durduramaz. Kemik
kalitesinin kötü olmas> nedeni ile segmental enstrümentas-
yon uygulan>r (9).
K
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KISIM 10
n
Ortopedik Sorunlar ve Yaklafl>mlar
3232
fiekil 198.15
Osteojenezis imperfektan>n k>s>r döngüsü.