Valoración de la rigidez articular y complicaciones anatómofuncionales de fracturas supracondíleas pediátricas tratadas con reducción cerrada o abierta
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2022
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Las fracturas supracondíleas de húmero pediátricas son lesiones comunes y significativas que pueden causar complicaciones anatomo-funcionales. No existe evidencia clara sobre la mayor predisposición de rigidez articular del codo ya sea con reducción cerrada o abierta. Objetivo: Valorar la rigidez articular y complicaciones anatomofuncionales de fracturas supracondíleas pediátricas tratadas con reducción cerrada o abierta. Analizando las características clínicas, establecer los resultados anatomofuncionales pro tipo de intervención, e identificar los factores predictores de rigidez articular. Metodología: Estudio de tipo observacional, analítico, prospectivo, de corte longitudinal y de diseño no experimental, que se llevó a cabo en el Hospital Francisco de Icaza Bustamante desde el 1 de enero hasta 31 de diciembre del 2018. Resultados: Se analizaron 114 pacientes, 81 de sexo masculino y 43 de sexo femenino. El promedio de edad fue de 4,4 años (DE ± 3,891). Se encontraron fracturas Gartland tipo II (63%) y III (37%), 96 pacientes (84%) la resolución realizada fue reducción cerrada y 18 (16%) fue reducción abierta. La reducción cerrada proporciona resultados estéticos-funcionales en mayor proporción que la reducción abierta (76% vs 31%), mientras que la reducción abierta aumenta la proporción de resultados funcionales malos (17% vs 3%) respecto a la reducción cerrada. Se obtuvo un P-valor de 0,0001 cuando se relacionó la variable resultado satisfactorio con la variable reducción cerrada. Se obtuvo un P-valor de 0,0001 al relacionar la variable resultado insatisfactorio con la variable reducción abierta. Los factores de riesgo fueron la rotación del fragmento distal (88%), desplazamiento posterolateral (75%) y fractura Gartland tipo III (88%). Conclusiones: La reducción cerrada se asocia significativamente con resultados funcionales satisfactorios, mientras que la reducción abierta eleva 5 veces el riesgo de rigidez del codo en comparación a la reducción cerrada. El desplazamiento de la fractura posteromedial, rotacional y las fracturas Gartland tipo III son predictores significativos de rigidez articular del codo postoperatoria
Pediatric humeral supracondylar fractures are common and significant lesions. There is no clear international evidence on the greater predisposition of joint stiffness of the elbow with either closed or open reduction. Objective: To analyze joint stiffness and its predictors in pediatric supracondylar fractures treated with closed or open reduction and their anatomofunctional results, in addition, to determine the clinical characteristics of patients with this pathology. Methodology: An observational, analytical, prospective, longitudinal and non-experimental design study, which was carried out at the Francisco de Icaza Bustamante Hospital. Results: 114 patients, 81 male and 43 females, were analyzed. The average age was 4.4 years (SD ± 3,891). The Gartland fractures type II (63%) and III (37%) were found, 96 patients (84%) required closed reduction and 18 (16%) open reduction. Closed reduction provides aesthetic-functional results in greater proportion than open reduction (76% vs. 31%), while open reduction increases the proportion of regular and poor functional outcomes (34% vs. 4% of regular results and 17% vs. 3% of bad results) regarding the closed reduction. A p-value of 0.0001 was obtained when the satisfactory result variable was related to the closed reduction variable. A p-value of 0.0001 was obtained by relating the unsatisfactory outcome variable with the open reduction variable. The risk factors were rotation of the distal fragment (88%), posterolateral displacement (75%) and Gartland fracture type III (88%). Conclusions: Closed reduction is significantly associated with satisfactory functional results, while open reduction raises 5 times the risk of elbow stiffness compared to the closed reduction. The displacement of the posteromedial, rotational fracture and Gartland fractures type III are significant predictors of joint stiffness of the postoperative elbow
Pediatric humeral supracondylar fractures are common and significant lesions. There is no clear international evidence on the greater predisposition of joint stiffness of the elbow with either closed or open reduction. Objective: To analyze joint stiffness and its predictors in pediatric supracondylar fractures treated with closed or open reduction and their anatomofunctional results, in addition, to determine the clinical characteristics of patients with this pathology. Methodology: An observational, analytical, prospective, longitudinal and non-experimental design study, which was carried out at the Francisco de Icaza Bustamante Hospital. Results: 114 patients, 81 male and 43 females, were analyzed. The average age was 4.4 years (SD ± 3,891). The Gartland fractures type II (63%) and III (37%) were found, 96 patients (84%) required closed reduction and 18 (16%) open reduction. Closed reduction provides aesthetic-functional results in greater proportion than open reduction (76% vs. 31%), while open reduction increases the proportion of regular and poor functional outcomes (34% vs. 4% of regular results and 17% vs. 3% of bad results) regarding the closed reduction. A p-value of 0.0001 was obtained when the satisfactory result variable was related to the closed reduction variable. A p-value of 0.0001 was obtained by relating the unsatisfactory outcome variable with the open reduction variable. The risk factors were rotation of the distal fragment (88%), posterolateral displacement (75%) and Gartland fracture type III (88%). Conclusions: Closed reduction is significantly associated with satisfactory functional results, while open reduction raises 5 times the risk of elbow stiffness compared to the closed reduction. The displacement of the posteromedial, rotational fracture and Gartland fractures type III are significant predictors of joint stiffness of the postoperative elbow
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Articulaciones, Fracturas Cerradas , Factores de riesgo, Hospital del Niño Francisco Icaza Bustamante, Cantón Guayaquil, Ecuador