Redução fechada e fixação percutânea versus redução aberta e fixação interna em fraturas pediátricas supracondilares do úmero: Uma revisão sistemática

Resumo

Objetivo Comparar as abordagens terapêuticas de redução fechada com fixação percutânea (closed reduction and percutaneous pinning, CRPP, em inglês) e redução aberta com fixação interna (open reduction and internal fixation, ORIF, em inglês) em fraturas supracondilares do úmero em pacientes pediátricos por meio de uma revisão sistemática de estudos de coorte e caso-controle.

Métodos As modalidades de tratamento CRPP e ORIF foram avaliadas usando os critérios funcionais de Flynn e o ângulo de Baumann como medidas de desfechos.

Resultados Os resultados deste estudo apoiam a equivalência clínica da CRPP e da ORIF em relação aos desfechos funcionais. Apesar do número limitado de estudos e do baixo nível de evidência dos artigos incluídos, este estudo não relatou diferenças significativas, o que condiz com os resultados gerais. Dados limitados sobre o ângulo de Baumann impediram comparações conclusivas a este respeito. Fatores como duração da internação hospitalar e resultados estéticos influenciaram as decisões de tratamento em fraturas supracondilares do úmero em pacientes pediátricos. Uma abordagem holística é essencial, considerando tanto a eficácia clínica quanto o conforto do paciente. Pesquisas futuras devem expandir a base de evidências e padronizar as avaliações de desfechos.

Conclusão A CRPP e a ORIF são tratamentos viáveis para fraturas supracondilares do úmero em pacientes pediátricos, particularmente as classificadas como tipo III de Gartland.

Palavras-chave

articulação do cotovelo - fios ortopédicos - fraturas distais do úmero - metanálise - pinos ortopédicos

Suporte Financeiro

Os autores declaram que não receberam suporte financeiro de agências dos setores público, privado ou sem fins lucrativos para a realização deste estudo.

Estudo realizado no Departamento de Ortopedia e Traumatologia, Prof. Ngoerah General Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali Surabaya, Indonésia.

Publication History

Received: 17 June 2024

Accepted: 06 November 2024

Article published online:
15 April 2025

• Referências

• 1 Zhu S, Zheng Y, Jiang Y, Yin H, Zhu D. Open versus closed reduction internal fixation for lateral condyle humeral fractures in children: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18 (01) 322
• 2 Santos IA, Cruz MAF, Souza RC, Barreto LVF, Monteiro AF. Rezende LGRA. Epidemiology of Supracondylar Fractures of the Humerus in Children. Arch Health Invest 2024; 13 (01) 18-23
• 3 Abzug JM, Dua K, Kozin SH, Herman MJ. Current Concepts in the Treatment of Lateral Condyle Fractures in Children. J Am Acad Orthop Surg 2020; 28 (01) e9-e19
• 4 Carrazzone OL, Barbachan Mansur NS, Matsunaga FT. et al. Crossed versus lateral K-wire fixation of supracondylar fractures of the humerus in children: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 2021; 30 (02) 439-448
• 5 Xie LW, Deng ZQ, Zhao RH. et al. Closed reduction and percutaneous pinning vs open reduction and internal fixation in pediatric lateral condylar humerus fractures displaced by > 4 mm: an observational cross-sectional study. BMC Musculoskelet Disord 2021; 22 (01) 985
• 6 Natalin HM, Silva JCSD, Volpon JB. Comparison of Two Methods of Fixation of Supracondylar Fractures of The Humerus In Children. Acta Ortop Bras 2021; 29 (05) 263-267
• 7 Bell P, Scannell BP, Loeffler BJ. et al. Adolescent Distal Humerus Fractures: ORIF Versus CRPP. J Pediatr Orthop 2017; 37 (08) 511-520
• 8 Ali S, Sarfraz AH, Nadeem RD, Sah RK, Nasir MB. Functional Outcome Following Closed Reduction and Percutaneous Pinning and Open Reduction and Pinning in Displaced Supracondylar Fractures of the Humerus in Children: A Single Center Study. Ann King Edward Med Univ Lahore Pakistan 2021; 27: 434-439
• 9 Kitta MI, Ismiarto YD, Saleh MR, Sakti M, Abidin MA, Putra LT. Analysis of radiological alignment and functional outcomes of pediatric patients after surgery with displaced supracondylar humerus fracture: A cross-sectional study. Int J Surg Open 2020; 24: 136-142
• 10 Poulios P, Serlis A, Durand-Hill M, Konstantopoulos G. Factors Influencing Functional Outcomes in Supracondylar Humerus Fractures: A Retrospective Study of Paediatric Patients in a Level One Trauma Centre. Cureus 2023; 15 (04) e37447
• 11 Shenoy PM, Islam A, Puri R. Current Management of Paediatric Supracondylar Fractures of the Humerus. Cureus 2020; 12 (05) e8137
• 12 Sterne JA, Hernán MA, Reeves BC. et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919
• 13 Higgins JP, Altman DG, Gøtzsche PC. et al; Cochrane Bias Methods Group, Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
• 14 Tomori Y, Nanno M, Takai S. Clinical results of closed versus mini-open reduction with percutaneous pinning for supracondylar fractures of the humerus in children: A retrospective case-control study. Medicine (Baltimore) 2018; 97 (45) e13162
• 15 Abousaleh MA, Zeidan AA, Mukhtar I. et al. Comparative Effectiveness of Closed Reduction With Percutaneous Pinning and Open Reduction With Internal Fixation in the Operative Management of Pediatric Type III Supracondylar Fractures. Cureus 2022; 14 (02) e22707
• 16 Ayub AK, Khan AR, Muhammad S. et al. Treatment of Paediatric Supracondylar Fractures of the Humerus: Closed or Open?. JPOA 2021; 33 (01) 17-20 . Accessed August 28, 2024 . https://jpoa.org.pk/index.php/upload/article/view/501
• 17 Ducić S, Bumbasirević M, Radlović V. et al. Displaced supracondylar humeral fractures in children: Comparison of three treatment approaches. Srp Arh Celok Lek 2016; 144 (1-2): 46-51
• 18 Hossain I, Alam I, Sagir MG, Rahman A, Hossain Y. Evaluation of Stiffness in Paediatric Closed Supracondylar Fracture Gartland Type III Treated Open Reduction and Internal Fixation by. Saudi J Med Pharm Sci 2023; 9 (04) 270-274
• 19 Keskin D, Sen H. The comparative evaluation of treatment outcomes in pediatric displaced supracondylar humerus fractures managed with either open or closed reduction and percutaneous pinning. Acta Chir Orthop Traumatol Cech 2014; 81 (06) 380-386
• 20 Lin-Guo X, Zhang XN, Yang JP. et al. A systematic review and meta-analysis of two different managements for supracondylar humeral fractures in children. J Orthop Surg Res 2018; 13 (01) 141
• 21 Barik S, Garg V, Sinha SK, Chaudhary S, Kandwal P, Singh V. A Meta-Analysis on Comparison of Open vs Closed Reduction of Gartland Type 3 Supracondylar Humerus Fractures in Children. Acta Chir Orthop Traumatol Cech 2023; 90 (03) 198-205
• 22 Ahmed M, Sahito B, Hamid R-N, Kumar M, Hussain G. Supracondylar fracture humerus (Gartland Type III) managed with closed reduction and percutaneous pinning (CRPP) in children. Prof Med J 2020; 27 (06) 1092-1096
• 23 Trung DT, Van NL, Huu VN. et al. Closed reduction and percutaneous pinning for supracondylar fractures of humerus in vietnamese children. Open Access Maced J Med Sci 2019; 7 (24) 4194-4198
• 24 Sinikumpu JJ, Victorzon S, Pokka T, Lindholm EL, Peljo T, Serlo W. The long-term outcome of childhood supracondylar humeral fractures: A population-based follow up study with a minimum follow up of ten years and normal matched comparisons. Bone Joint J 2016; 98-B (10) 1410-1417
• 25 Baidoo PK, Kumah-Ametepey R, Segbefia M, Buunaaim ADB. Treatment and outcomes of pediatric supracondylar humeral fractures in Korle Bu Teaching Hospital. OTA Int 2021; 4 (02) e124
• 26 Koşucu T, Şimşek EK, Haberal B, Dincer R, Kovalak E, Baykal YB. Does posterior approach always lead to poor functional and cosmetic outcomes in displaced pediatric supracondylar humeral fractures?. Ulus Travma Acil Cerrahi Derg 2023; 29 (04) 523-529
• 27 Shrestha A, Uprety S, Paudel S. Functional and radiological outcome after closed reduction and percutaneous pinning versus open reduction and children. JSSN 2016; 19 (02) 21-27