Palavras-chave
Fractura de humero
codo
fractura-luxación
fracturas por avulsión
nervio cubital
niño
codo
fractura-luxación
fracturas por avulsión
nervio cubital
niño
Como Citar
Vergara Amador, E., & Castellar Torres, Y. (2019). Fracturas de epitróclea: serie de casos en un hospital pediátrico. Salud UIS, 51(4), 347–352. https://doi.org/10.18273/revsal.v51n4-2019008
Resumo
Las fracturas de la epitróclea representan el 11 al 20% de las lesiones en codo en población pediátrica y aproximadamente el 50% se asocia a luxación en el codo, siendo la incarceración menos frecuente. El objetivo del trabajo es describir los resultados funcionales de una serie de pacientes con fractura de epitróclea. Se realizó un estudio observacional descriptivo y retrospectivo de pacientes pediátricos con fracturas de epitróclea, atendidos en un hospital pediátrico. Se revisaron las historias clínicas y los datos fueron analizados en Excel. El estudio aprobado por el comité de ética del hospital. Se tomaron 42 casos de los cuales 39 cumplieron con los criterios de inclusión. La edad media fue 11.3 años (4-16 años). El 77% fueron operados y la fractura se asoció a luxación del codo en el 25.6%. El 7.6% de los casos tuvieron neuroapraxia de nervio cubital con recuperación espontáneamente. La fractura de la epitróclea se observa en población pediátrica involucrada en actividades de alto rendimiento. Puede ocurrir falla en diagnostico debido a la compleja osificación del codo y también a la superposición de imagen de la epitróclea con la tróclea humeral. Se asocia con luxación del codo entre un 25 a 50% de los casos. El tratamiento de esta fractura es ortopédico o quirúrgico. Las tasas de consolidación en ambos tratamientos son similares.
Referências
1. Lotz B, Akilapa O, Karthik K. Delayed reconstruction following incarceration of the medial epicondyle in the elbow joint. A case report and review of the literature. JBJS case connect. 2018; 8(3): e69. doi: 10.2106/JBJS.CC.17.00239.
2. Watson-Jones R. Fractures and joint injuries. Baltimore: Williams & Wilkins, 1946.
3. Beaty JH, Kasser JH. The elbow-physeal fractures, apophyseal injuries of the distal humerus, osteonecrosis of the trochlea, and T-condylar fractures. In: Beaty JH, Kasser JR, editors. Rockwood & Wilkins’ fractures in children. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. pp. 628-642.
4. Mehlman CT, Howard AW. Medial epicondyle fractures in children. Clinical decision making in the face of uncertainty. J Pediatr Orthop. 2012; 32(Suppl 2): S135-142. doi: 10.1097/ BPO.0b013e31824bdb78.
5. Blount WP. Injuries about the elbow: fractures of the medial epicondyle. Fractures in Children. 1st edition. Baltimore: Williams & Wilkins; 1955: 55-61.
6. Patel NM, Ganley TJ. Medial epicondyle fractures of the humerus: how to evaluate and when to operate. J Pediatr Orthop. 2012; 32(Suppl 1): S10-13. doi: 10.1097/BPO.0b013e31824b2530.
7. Haflah NH, Ibrahim S, Sapuan J, Abdullah S. An elbow dislocation in a child with missed medial epicondyle fracture and late ulnar nerve palsy. J Pediatr Orthop B. 2010; 19(5): 459-461. doi: 10.1097/BPB.0b013e32833b6032.
8. Nussberger G, Schädelin S, Mayr J, Studer D, Zimmermann P. Treatment strategy and long-term functional outcome of traumatic elbow dislocation in childhood: a single centre study. J Child Orthop. 2018; 12(2): 129-135. doi: 10.1302/1863- 2548.12.170167.
9. Beck JJ, Bowen RE, Silva M. What’s New in Pediatric Medial Epicondyle Fractures? J Pediatr Orthop. 2018; 38(4): e202-e206. doi: 10.1097/ BPO.0000000000000902.
10. Vergara-Amador E, Muñoz D, Vela Rodriguez F. Descripción anatómica del origen de los músculos flexores y pronadores en el epicóndilo medial del húmero. Rev Cubana Ortop Traumatol. 2013, 27(2): 199-208.
11. Cruz AI Jr, Steere JT, Lawrence JT. Medial Epicondyle Fractures in the Pediatric Overhead Athlete. J Pediatr Orthop. 2016; 36(Suppl 1): S56-62. doi: 10.1097/BPO.0000000000000759.
12. Karatas A, Apaydin N, Uz A, Tubbs SR, Loukas M, Gezen F. Regional anatomic structures of the elbow that may potentially compress the ulnar nerve. J Shoulder Elbow Surg. 2009; 18(4): 627-631. doi: 10.1016/j.jse.2009.03.004.
13. Gottschalk HP, Eisner E, Hosalkar HS. Medial epicondyle fractures in the pediatric population. J Am Academ Orthop Surgery. 2012; 20: 223-232. doi: 10.5435/JAAOS-20-04-223.
14. Mehlman C, Howard A. Medial epicondyle fractures in children: clinical decision making in the face of uncertainty. J Pediatr Orthop. 2012; 32(Suppl 2): S135-142. doi: 10.1097/BPO.0b013e31824bdb78.
15. Pappas N, Lawrence JT, Donegan D, Ganley T, Flynn JM. Intraobserver and interobserver agreement in the measurement of displaced humeral medial epicondyle fractures in children. J Bone Joint Surg Am. 2010; 92(2): 322-327. doi: 10.2106/ JBJS.I.00493.
16. Souder CD, Farnsworth CL, McNeil NP, Bomar JD, Edmonds EW. The distal humerus axial view: assessment of displacement in medial epicondyle fractures. J Pediatr Orthop. 2015; 35(5): 449-454. doi: 10.1097/BPO.0000000000000306.
17. Farsetti P, Potenza V, Caterini R, Ippolito E. Long-term results of treatment of fractures of the medial humeral epicondyle in children. J Bone Joint Surg Am. 2001; 83(9): 1299-1305. doi: 10.2106/00004623-200109000-00001.
18. Stepanovich M, Bastrom TP, Munch J, Roocroft JH, Edmonds EW, Pennockc AT. Does operative fixation affect outcomes of displaced medial epicondyle fractures? J Child Orthop 2016; 10(5): 413-419. doi: 10.1007/s11832-016-0757-1.
19. Knapik DM, Fausett CL Gillmore A, Liu RW. Outcomes of nonoperative pediatric medial humeral epicondyle fractures with and without associated elbow dislocation. J Pediatr Orthop. 2017; 37(4): e224-e228) doi: 10.1097/BPO.0000000000000890.
20. Josefsson PO, Danielsson LG. Epicondylar elbow fracture in children: 35-year follow-up of 56 unreduced cases. Acta Orthop Scand. 1986; 57(4): 313-315. doi: 10.3109/17453678608994399.
21. Tarallo L, Mugnai R, Fiacchi F, Adani R, Zambianchi F, Catani F. Pediatric medial epicondyle fractures with intra-articular elbow incarceration. J Orthop Traumatol. 2015; 16(2): 117-123. doi: 10.1007/ s10195-014-0310-2.
22. Pace GI, Hennrikus WL. Fixation of displaced medial epicondyle fractures in adolescents. J Pediatr Orthop. 2017; 37(2): e80-e82. doi: 10.1097/ BPO.0000000000000743.
23. Louahem DM, Bourelle S, Buscayret F, Mazeau P, Kelly P, Dimeglio A, et al. Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Arch Orthop Trauma Surg. 2010; 130(5): 649-655. doi: 10.1007/s00402-009-1009-3.
24. Pathy R, Dodwell ER. Medial epicondyle fractures in children. Curr Opin Pediatr. 2015; 27(1): 58-66. doi: 10.1097/MOP.0000000000000181.
25. Fowles JV, Slimane N, Kassab MT. Elbow dislocation with avulsion of the medial humeral epicondyle. J Bone Joint Surg Br. 1990; 72(1): 102-104. doi: https://doi.org/10.1302/0301-620X.72B1.2298765.
2. Watson-Jones R. Fractures and joint injuries. Baltimore: Williams & Wilkins, 1946.
3. Beaty JH, Kasser JH. The elbow-physeal fractures, apophyseal injuries of the distal humerus, osteonecrosis of the trochlea, and T-condylar fractures. In: Beaty JH, Kasser JR, editors. Rockwood & Wilkins’ fractures in children. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. pp. 628-642.
4. Mehlman CT, Howard AW. Medial epicondyle fractures in children. Clinical decision making in the face of uncertainty. J Pediatr Orthop. 2012; 32(Suppl 2): S135-142. doi: 10.1097/ BPO.0b013e31824bdb78.
5. Blount WP. Injuries about the elbow: fractures of the medial epicondyle. Fractures in Children. 1st edition. Baltimore: Williams & Wilkins; 1955: 55-61.
6. Patel NM, Ganley TJ. Medial epicondyle fractures of the humerus: how to evaluate and when to operate. J Pediatr Orthop. 2012; 32(Suppl 1): S10-13. doi: 10.1097/BPO.0b013e31824b2530.
7. Haflah NH, Ibrahim S, Sapuan J, Abdullah S. An elbow dislocation in a child with missed medial epicondyle fracture and late ulnar nerve palsy. J Pediatr Orthop B. 2010; 19(5): 459-461. doi: 10.1097/BPB.0b013e32833b6032.
8. Nussberger G, Schädelin S, Mayr J, Studer D, Zimmermann P. Treatment strategy and long-term functional outcome of traumatic elbow dislocation in childhood: a single centre study. J Child Orthop. 2018; 12(2): 129-135. doi: 10.1302/1863- 2548.12.170167.
9. Beck JJ, Bowen RE, Silva M. What’s New in Pediatric Medial Epicondyle Fractures? J Pediatr Orthop. 2018; 38(4): e202-e206. doi: 10.1097/ BPO.0000000000000902.
10. Vergara-Amador E, Muñoz D, Vela Rodriguez F. Descripción anatómica del origen de los músculos flexores y pronadores en el epicóndilo medial del húmero. Rev Cubana Ortop Traumatol. 2013, 27(2): 199-208.
11. Cruz AI Jr, Steere JT, Lawrence JT. Medial Epicondyle Fractures in the Pediatric Overhead Athlete. J Pediatr Orthop. 2016; 36(Suppl 1): S56-62. doi: 10.1097/BPO.0000000000000759.
12. Karatas A, Apaydin N, Uz A, Tubbs SR, Loukas M, Gezen F. Regional anatomic structures of the elbow that may potentially compress the ulnar nerve. J Shoulder Elbow Surg. 2009; 18(4): 627-631. doi: 10.1016/j.jse.2009.03.004.
13. Gottschalk HP, Eisner E, Hosalkar HS. Medial epicondyle fractures in the pediatric population. J Am Academ Orthop Surgery. 2012; 20: 223-232. doi: 10.5435/JAAOS-20-04-223.
14. Mehlman C, Howard A. Medial epicondyle fractures in children: clinical decision making in the face of uncertainty. J Pediatr Orthop. 2012; 32(Suppl 2): S135-142. doi: 10.1097/BPO.0b013e31824bdb78.
15. Pappas N, Lawrence JT, Donegan D, Ganley T, Flynn JM. Intraobserver and interobserver agreement in the measurement of displaced humeral medial epicondyle fractures in children. J Bone Joint Surg Am. 2010; 92(2): 322-327. doi: 10.2106/ JBJS.I.00493.
16. Souder CD, Farnsworth CL, McNeil NP, Bomar JD, Edmonds EW. The distal humerus axial view: assessment of displacement in medial epicondyle fractures. J Pediatr Orthop. 2015; 35(5): 449-454. doi: 10.1097/BPO.0000000000000306.
17. Farsetti P, Potenza V, Caterini R, Ippolito E. Long-term results of treatment of fractures of the medial humeral epicondyle in children. J Bone Joint Surg Am. 2001; 83(9): 1299-1305. doi: 10.2106/00004623-200109000-00001.
18. Stepanovich M, Bastrom TP, Munch J, Roocroft JH, Edmonds EW, Pennockc AT. Does operative fixation affect outcomes of displaced medial epicondyle fractures? J Child Orthop 2016; 10(5): 413-419. doi: 10.1007/s11832-016-0757-1.
19. Knapik DM, Fausett CL Gillmore A, Liu RW. Outcomes of nonoperative pediatric medial humeral epicondyle fractures with and without associated elbow dislocation. J Pediatr Orthop. 2017; 37(4): e224-e228) doi: 10.1097/BPO.0000000000000890.
20. Josefsson PO, Danielsson LG. Epicondylar elbow fracture in children: 35-year follow-up of 56 unreduced cases. Acta Orthop Scand. 1986; 57(4): 313-315. doi: 10.3109/17453678608994399.
21. Tarallo L, Mugnai R, Fiacchi F, Adani R, Zambianchi F, Catani F. Pediatric medial epicondyle fractures with intra-articular elbow incarceration. J Orthop Traumatol. 2015; 16(2): 117-123. doi: 10.1007/ s10195-014-0310-2.
22. Pace GI, Hennrikus WL. Fixation of displaced medial epicondyle fractures in adolescents. J Pediatr Orthop. 2017; 37(2): e80-e82. doi: 10.1097/ BPO.0000000000000743.
23. Louahem DM, Bourelle S, Buscayret F, Mazeau P, Kelly P, Dimeglio A, et al. Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Arch Orthop Trauma Surg. 2010; 130(5): 649-655. doi: 10.1007/s00402-009-1009-3.
24. Pathy R, Dodwell ER. Medial epicondyle fractures in children. Curr Opin Pediatr. 2015; 27(1): 58-66. doi: 10.1097/MOP.0000000000000181.
25. Fowles JV, Slimane N, Kassab MT. Elbow dislocation with avulsion of the medial humeral epicondyle. J Bone Joint Surg Br. 1990; 72(1): 102-104. doi: https://doi.org/10.1302/0301-620X.72B1.2298765.
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