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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(01): 023-032
DOI: 10.1055/s-0040-1709734
DOI: 10.1055/s-0040-1709734
Artigo de Atualização
Ortopedia Pediátrica
Manejo da fratura supracondiliana do úmero na criança
Article in several languages: português | English
Resumo
A fratura supracondiliana do úmero representa cerca de 3 a 15% de todas as fraturas na criança, sendo a que mais requer tratamento cirúrgico na população pediátrica. Apesar de os avanços no tratamento e na assistência terem contribuído para uma redução drástica da complicação mais temida, a contratura isquêmica de Volkmann, os riscos inerentes à fratura permanecem. Ausência de pulso palpável em fraturas tipo III é reportada em até 20% dos casos. Uma cuidadosa avaliação sensitiva, motora e vascular do membro acometido é fundamental na determinação da urgência do tratamento. Crianças mais velhas, sexo masculino, cotovelo flutuante, e lesão neurovascular são fatores de risco para a síndrome de compartimento. A cominuição medial pode levar à consolidação em varo, mesmo nos casos aparentemente inocentes. O método de escolha para o tratamento da fratura desviada é a redução fechada e fixação percutânea. Os erros na fixação e posicionamento inadequado dos implantes são as principais causas de perda de redução. Já existem evidências suficientes para a utilização de um terceiro fio de Kirschner, lateral ou medial, nas fraturas instáveis (tipo III e IV). Baseado nos conceitos atuais, um fluxograma para o tratamento da fratura supracondiliana do úmero na criança é sugerido pelos autores.
Publication History
Received: 17 August 2019
Accepted: 27 January 2020
Article published online:
23 July 2020
© 2020. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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Referências
- 1 Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am 2008; 90 (05) 1121-1132
- 2 Robertson AK, Snow E, Browne TS, Brownell S, Inneh I, Hill JF. Who Gets Compartment Syndrome?: A Retrospective Analysis of the National and Local Incidence of Compartment Syndrome in Patients With Supracondylar Humerus Fractures. J Pediatr Orthop 2018; 38 (05) e252-e256
- 3 Alton TB, Werner SE, Gee AO. Classifications in brief: the Gartland classification of supracondylar humerus fractures. Clin Orthop Relat Res 2015; 473 (02) 738-741
- 4 Skaggs DL, Flynn JM. Supracondylar Fractures of the Distal Humerus. In: Waters PM, Skaggs DL, Flynn JM, Court-Brown CM. editors. Rockwood & Wilkins' fractures in children. Philadelphia: Wolters Kluwer; 2010: 754-844
- 5 Holt JB, Glass NA, Shah AS. Understanding the Epidemiology of Pediatric Supracondylar Humeral Fractures in the United States: Identifying Opportunities for Intervention. J Pediatr Orthop 2018; 38 (05) e245-e251
- 6 Sankar WN, Hebela NM, Skaggs DL, Flynn JM. Loss of pin fixation in displaced supracondylar humeral fractures in children: causes and prevention. J Bone Joint Surg Am 2007; 89 (04) 713-717
- 7 Abzug JM, Herman MJ. Management of supracondylar humerus fractures in children: current concepts. J Am Acad Orthop Surg 2012; 20 (02) 69-77
- 8 Badkoobehi H, Choi PD, Bae DS, Skaggs DL. Management of the pulseless pediatric supracondylar humeral fracture. J Bone Joint Surg Am 2015; 97 (11) 937-943
- 9 American Academy of Orthopaedic Surgeons. The Treatment of Pediatric Supracondylar Humerus Fractures. Rosemont, IL: AAOS; 2011
- 10 American Academy of Orthopaedic Surgeons. Appropriate Use Criteria for the Management of Pediatric Supracondylar Humerus Fractures. Rosemont, IL: AAOS; 2014
- 11 Ho CA, Podeszwa DA, Riccio AI, Wimberly RL, Ramo BA. Soft Tissue Injury Severity is Associated With Neurovascular Injury in Pediatric Supracondylar Humerus Fractures. J Pediatr Orthop 2018; 38 (09) 443-449
- 12 Flynn K, Shah AS, Brusalis CM, Leddy K, Flynn JM. Flexion-Type Supracondylar Humeral Fractures: Ulnar Nerve Injury Increases Risk of Open Reduction. J Bone Joint Surg Am 2017; 99 (17) 1485-1487
- 13 Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 1959; 109 (02) 145-154
- 14 Wilkins KE. Supracondylar fractures: what's new?. J Pediatr Orthop B 1997; 6 (02) 110-116
- 15 Spencer HT, Dorey FJ, Zionts LE. et al. Type II supracondylar humerus fractures: can some be treated nonoperatively?. J Pediatr Orthop 2012; 32 (07) 675-681
- 16 Ariyawatkul T, Eamsobhana P, Kaewpornsawan K. The necessity of fixation in Gartland type 2 supracondylar fracture of the distal humerus in children (modified Gartland type 2A and 2B). J Pediatr Orthop B 2016; 25 (02) 159-164
- 17 Silva M, Delfosse EM, Park H, Panchal H, Ebramzadeh E. Is the “Appropriate Use Criteria” for Type II Supracondylar Humerus Fractures Really Appropriate?. J Pediatr Orthop 2019; 39 (01) 1-7
- 18 Leitch KK, Kay RM, Femino JD, Tolo VT, Storer SK, Skaggs DL. Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified Gartland type-IV fracture. J Bone Joint Surg Am 2006; 88 (05) 980-985
- 19 Novais EN, Andrade MAP, Gomes DC. The use of a joystick technique facilitates closed reduction and percutaneous fixation of multidirectionally unstable supracondylar humeral fractures in children. J Pediatr Orthop 2013; 33 (01) 14-19
- 20 Mulpuri K, Wilkins K. The treatment of displaced supracondylar humerus fractures: evidence-based guideline. J Pediatr Orthop 2012; 32 (02, Suppl 2): S143-S152
- 21 Garg S, Weller A, Larson AN. et al. Clinical characteristics of severe supracondylar humerus fractures in children. J Pediatr Orthop 2014; 34 (01) 34-39
- 22 Choi PD, Melikian R, Skaggs DL. Risk factors for vascular repair and compartment syndrome in the pulseless supracondylar humerus fracture in children. J Pediatr Orthop 2010; 30 (01) 50-56
- 23 Mehlman CT, Strub WM, Roy DR, Wall EJ, Crawford AH. The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children. J Bone Joint Surg Am 2001; 83 (03) 323-327
- 24 Gupta N, Kay RM, Leitch K, Femino JD, Tolo VT, Skaggs DL. Effect of surgical delay on perioperative complications and need for open reduction in supracondylar humerus fractures in children. J Pediatr Orthop 2004; 24 (03) 245-248
- 25 Abbott MD, Buchler L, Loder RT, Caltoum CB. Gartland type III supracondylar humerus fractures: outcome and complications as related to operative timing and pin configuration. J Child Orthop 2014; 8 (06) 473-477
- 26 Bales JG, Spencer HT, Wong MA, Fong YJ, Zionts LE, Silva M. The effects of surgical delay on the outcome of pediatric supracondylar humeral fractures. J Pediatr Orthop 2010; 30 (08) 785-791
- 27 Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am 2004; 86 (04) 702-707
- 28 Pennock AT, Charles M, Moor M, Bastrom TP, Newton PO. Potential causes of loss of reduction in supracondylar humerus fractures. J Pediatr Orthop 2014; 34 (07) 691-697
- 29 Bloom T, Robertson C, Mahar AT, Newton P. Biomechanical analysis of supracondylar humerus fracture pinning for slightly malreduced fractures. J Pediatr Orthop 2008; 28 (07) 766-772
- 30 Wallace M, Johnson Jr DB, Pierce W, Iobst C, Riccio A, Wimberly RL. Biomechanical Assessment of Torsional Stiffness in a Supracondylar Humerus Fracture Model. J Pediatr Orthop 2019; 39 (03) e210-e215
- 31 Bauer JM, Stutz CM, Schoenecker JG, Lovejoy SA, Mencio GA, Martus JE. Internal Rotation Stress Testing Improves Radiographic Outcomes of Type 3 Supracondylar Humerus Fractures. J Pediatr Orthop 2019; 39 (01) 8-13
- 32 Zenios M, Ramachandran M, Milne B, Little D, Smith N. Intraoperative stability testing of lateral-entry pin fixation of pediatric supracondylar humeral fractures. J Pediatr Orthop 2007; 27 (06) 695-702
- 33 Gottschalk HP, Sagoo D, Glaser D, Doan J, Edmonds EW, Schlechter J. Biomechanical analysis of pin placement for pediatric supracondylar humerus fractures: does starting point, pin size, and number matter?. J Pediatr Orthop 2012; 32 (05) 445-451
- 34 Kocher MS, Kasser JR, Waters PM. et al. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. A randomized clinical trial. J Bone Joint Surg Am 2007; 89 (04) 706-712
- 35 Lee KM, Chung CY, Gwon DK. et al. Medial and lateral crossed pinning versus lateral pinning for supracondylar fractures of the humerus in children: decision analysis. J Pediatr Orthop 2012; 32 (02) 131-138
- 36 Gaston RG, Cates TB, Devito D. et al. Medial and lateral pin versus lateral-entry pin fixation for Type 3 supracondylar fractures in children: a prospective, surgeon-randomized study. J Pediatr Orthop 2010; 30 (08) 799-806
- 37 Lee YH, Lee SK, Kim BS. et al. Three lateral divergent or parallel pin fixations for the treatment of displaced supracondylar humerus fractures in children. J Pediatr Orthop 2008; 28 (04) 417-422
- 38 Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am 2001; 83 (05) 735-740
- 39 Silva M, Knutsen AR, Kalma JJ. et al. Biomechanical testing of pin configurations in supracondylar humeral fractures: the effect of medial column comminution. J Orthop Trauma 2013; 27 (05) 275-280
- 40 Woratanarat P, Angsanuntsukh C, Rattanasiri S, Attia J, Woratanarat T, Thakkinstian A. Meta-analysis of pinning in supracondylar fracture of the humerus in children. J Orthop Trauma 2012; 26 (01) 48-53
- 41 Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop 2010; 30 (03) 253-263
- 42 Slobogean BL, Jackman H, Tennant S, Slobogean GP, Mulpuri K. Iatrogenic ulnar nerve injury after the surgical treatment of displaced supracondylar fractures of the humerus: number needed to harm, a systematic review. J Pediatr Orthop 2010; 30 (05) 430-436
- 43 Silva M, Cooper SD, Cha A. The Outcome of Surgical Treatment of Multidirectionally Unstable (Type IV) Pediatric Supracondylar Humerus Fractures. J Pediatr Orthop 2015; 35 (06) 600-605
- 44 Kwak-Lee J, Kim R, Ebramzadeh E, Silva M. Is medial pin use safe for treating pediatric supracondylar humerus fractures?. J Orthop Trauma 2014; 28 (04) 216-221
- 45 Ay S, Akinci M, Kamiloglu S, Ercetin O. Open reduction of displaced pediatric supracondylar humeral fractures through the anterior cubital approach. J Pediatr Orthop 2005; 25 (02) 149-153
- 46 Mahan ST, May CD, Kocher MS. Operative management of displaced flexion supracondylar humerus fractures in children. J Pediatr Orthop 2007; 27 (05) 551-556
- 47 Novais EN, Carry PM, Mark BJ, De S, Miller NH. Posterolaterally displaced and flexion-type supracondylar fractures are associated with a higher risk of open reduction. J Pediatr Orthop B 2016; 25 (05) 406-411
- 48 Karalius VP, Stanfield J, Ashley P. et al. The Utility of Routine Postoperative Radiographs After Pinning of Pediatric Supracondylar Humerus Fractures. J Pediatr Orthop 2017; 37 (05) e309-e312
- 49 Shore BJ, Gillespie BT, Miller PE, Bae DS, Waters PM. Recovery of Motor Nerve Injuries Associated With Displaced, Extension-type Pediatric Supracondylar Humerus Fractures. J Pediatr Orthop 2019; 39 (09) e652-e656
- 50 Harris LR, Arkader A, Broom A. et al. Pulseless Supracondylar Humerus Fracture With Anterior Interosseous Nerve or Median Nerve Injury-An Absolute Indication for Open Reduction?. J Pediatr Orthop 2019; 39 (01) e1-e7
- 51 Valencia M, Moraleda L, Díez-Sebastián J. Long-term Functional Results of Neurological Complications of Pediatric Humeral Supracondylar Fractures. J Pediatr Orthop 2015; 35 (06) 606-610
- 52 Patriota GS, Assunção Filho CA, Assunção CA. Qual a Melhor Técnica para Fixação no Tratamento de Fratura Supracondilar do Úmero em Crianças?. Rev Bras Ortop 2017; 52 (04) 428-434
- 53 Schmale GA, Mazor S, Mercer LD, Bompadre V. Lack of Benefit of Physical Therapy on Function Following Supracondylar Humeral Fracture: A Randomized Controlled Trial. J Bone Joint Surg Am 2014; 96 (11) 944-950
- 54 Spencer HT, Wong M, Fong YJ, Penman A, Silva M. Prospective longitudinal evaluation of elbow motion following pediatric supracondylar humeral fractures. J Bone Joint Surg Am 2010; 92 (04) 904-910
- 55 Fletcher ND, Schiller JR, Garg S. et al. Increased severity of type III supracondylar humerus fractures in the preteen population. J Pediatr Orthop 2012; 32 (06) 567-572
- 56 Moraleda L, Valencia M, Barco R, González-Moran G. Natural history of unreduced Gartland type-II supracondylar fractures of the humerus in children: a two to thirteen-year follow-up study. J Bone Joint Surg Am 2013; 95 (01) 28-34
- 57 Worlock P. Supracondylar fractures of the humerus. Assessment of cubitus varus by the Baumann angle. J Bone Joint Surg Br 1986; 68 (05) 755-757
- 58 Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up. J Bone Joint Surg Am 1974; 56 (02) 263-272
- 59 O'Driscoll SW, Spinner RJ, McKee MD. et al. Tardy posterolateral rotatory instability of the elbow due to cubitus varus. J Bone Joint Surg Am 2001; 83 (09) 1358-1369
- 60 Spinner RJ, O'Driscoll SW, Davids JR, Goldner RD. Cubitus varus associated with dislocation of both the medial portion of the triceps and the ulnar nerve. J Hand Surg Am 1999; 24 (04) 718-726