Çocukta diz çevresi fizis kırığı

Özet

Diz çevresi fizis kırıkları çocuk ve ergenlerde distal femur ya da proksimal tibia büyüme plağını etkiler; yüksek enerjili travma veya spor yaralanması sonrası oluşabilir. Kontrastsız BT, özellikle eklem yüzüne uzanan epifiz kırıklarında kemik parçalarının yerini ve eklem basamağını gösterir; kıkırdak fizis ve kemik iliği hasarı grafide/BT'de belirsiz kalırsa MRG tamamlayıcıdır. Bu bölgedeki fizis hasarı büyüme duraklaması, ekstremite uzunluk farkı veya açısal deformiteyle sonuçlanabilir. Kırık hattının fizis-metafiz-epifiz ilişkisini atlamak, büyüme plağı riskinin ve eklem içi uzanımın eksik tanımlanmasına yol açar.

Faz ve pencere

Kontrastsız tanısal

Fizis boyunca genişleme veya basamak, metafizer ya da epifiz uzanımlı kırık çizgisi, kortikal kesinti ve eklem yüzü uyumsuzluğu değerlendirilir; kontrast gerekmez.

Kemik algoritması tanısal

Koronal ve sagittal ince kesitler kırık hattının fizisten metafize/epifize geçişini, deplasmanı ve eklem basamağını gösterir; karşı taraf fizisi yaşa uygun kontur ve kapanma görünümü için kıyaslanır.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

• Distal femur veya proksimal tibia fizisinde fokal genişleme, düzensizlik ya da kortikal devamlılık kaybı.
• Kırık hattının epifize ve eklem yüzüne geçmesi; eklem basamağı veya kondiler yüz uyumsuzluğu.
• Epifiz-metafiz parçalarının fizis boyunca ayrılması ve deplasman yönü.
• Fizis yaralanması sonrası kemik köprüsü (fizis barı) ve buna bağlı uzuv uzunluğu farkı ya da açısal deformite zamanla gelişebildiğinden uzun dönem takip ve büyüme öngörüsü gerekir.
• Efüzyon ve komşu yumuşak doku şişliği akut diz travmasına eşlik edebilir.
• Açık, kapanmakta olan veya kapanmış fizis görünümü hastanın gelişim evresi ve karşı tarafla birlikte değerlendirilir; normal fizis dar ve düzgün olabilir.

Ölçütler ve sınıflamalar

Salter–Harris sınıflaması

Tip I: kırık fizis boyunca; Tip II: fizis ve metafiz; Tip III: fizis ve epifiz/eklem yüzü; Tip IV: metafiz, fizis ve epifiz boyunca; Tip V: fizisin kompresyon ezilmesi. BT özellikle eklem içi Tip III-IV uzanımı ve kemik deplasmanını göstermede yararlıdır.

Normalde

Normal açık fizis, distal femur veya proksimal tibia metafiziyle epifiz arasında düzgün, kesintisiz bir radyolüsent çizgi olarak izlenir; yaş ilerledikçe fizis incelir ve fizyolojik kapanma odakları oluşabilir. Karşı tarafta aynı kemiğin fizis genişliğini ve kapanma şeklini, ayrıca metafizer korteks ile eklem yüzünün kesintisizliğini kıyaslayın.

Ayırıcı tanı

Fizyolojik fizis kapanması

yaşa uygun, düzgün ve çoğu kez simetrik kemikleşme köprüleri gösterir; komşu akut kortikal kırık hattı yoktur.

Metafizer kırık, fizis dışı

kortikal veya trabeküler çizgi metafizde kalır ve fizis/epifiz boyunca uzanmaz.

Tibial eminens avulsiyonu

interkondiler eminens merkezinde kemik fragmanı vardır; proksimal tibia fizisi boyunca ayrışma değildir.

Distal femur kondil osteokondral yaralanması

eklem yüzü altı fragman ve kıkırdak hasarı ön plandadır; fizis çizgisini takip eden ayrışma görülmez.

Eski fizis yaralanmasına bağlı bar

sınırlı kemik köprü ve asimetrik büyüme görünümü kronikliği destekler; akut travmaya ait yeni kırık kenarı olmayabilir.

Tuzaklar

• Kapanmakta olan fizisi kırık hattı sanma; karşı tarafla aynı düzeydeki fizis kalınlığı ve kemikleşme düzenini kıyasla.
• Salter–Harris I yaralanmasında BT'nin normal olmasını fizis yaralanmasını dışlayan kanıt sayma; kıkırdak ve kemik iliği ödemi için MRG daha duyarlıdır.
• Epifiz uzanımını yalnız aksiyel kesitte arama; eklem yüzü basamağı ve kırık hattının fizisle ilişkisi koronal-sagittal rekonstrüksiyonlarda daha iyi haritalanır.
• Fizis barı ve büyüme duraklaması travmayı izleyen aylar ya da yıllar içinde gelişebildiğinden akut BT'de kesinleştirilemez; uzun dönem takip ve büyüme öngörüsü gerekir.

Kendini dene

1. Epifiz, fizis ve metafizi birlikte tutan Salter-Harris kırık tipi hangisidir?

   • Tip IV
   • Tip I
   • Tip II
   • Tip V
   Cevabı göster

   Tip IV. Salter-Harris tip IV kırık; epifiz, fizis ve metafiz bölümlerini birlikte içeren bir büyüme plağı kırığıdır. Tip III ise epifize ve eklem içine uzanır.

2. Fizis ve epifiz boyunca ilerleyip eklem yüzünde basamak oluşturan kırık için en uygun sınıf hangisidir?

   • Salter–Harris Tip III
   • Salter–Harris Tip I
   • Salter–Harris Tip II
   • Salter–Harris Tip V
   Cevabı göster

   Salter–Harris Tip III. Tip III kırık fizis ile epifizi geçerek eklem yüzüne ulaşır. Tip IV ise epifiz, fizis ve metafizi birlikte içeren bir fizis kırığıdır.

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.