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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
Artigo de Atualização
Ortopedia Pediátrica

Manejo da fratura supracondiliana do úmero na criança

Artikel in mehreren Sprachen: português | English
Pedro Poggiali 
1   Pediatric Orthopedic Surgery, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brazil
,
Francisco Carlos Salles Nogueira 
1   Pediatric Orthopedic Surgery, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brazil
,
Maria Paula de Mello Nogueira 
1   Pediatric Orthopedic Surgery, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brazil
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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.

Palavras-chave

fraturas do úmero - cotovelo - criança - fixação de fratura


Publikationsverlauf

Eingereicht: 17. August 2019

Angenommen: 27. Januar 2020

Artikel online veröffentlicht:
23. Juli 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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