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Tratamento cirúrgico das fraturas do epicôndilo medial em idade pediátrica
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Introdução: As fraturas do epicôndilo medial representam 20% das fraturas do cotovelo em idade pediátrica. A sua incidência tem vindo a aumentar devido à maior participação e intensidade na atividade desportiva. O tratamento destas fraturas permanece controverso na ausência de indicações absolutas para cirurgia. Objetivos: Rever os resultados funcionais e a incidência de complicações do tratamento cirúrgico das fraturas do epicôndilo medial em idade pediátrica e comparar os resultados obtidos com a literatura. Metodologia: Estudo retrospetivo tipo “case series”, realizado através da análise de processos clínicos eletrónicos e radiográficos dos doentes em idade pediátrica, operados a fratura do epicôndilo medial, no período compreendido entre janeiro de 2012 e dezembro de 2020 no Hospital Beatriz Ângelo. Identificamos uma série de 17 doentes tratados cirurgicamente a fraturas do epicôndilo medial em idade pediátrica. 10 doentes foram incluídos no nosso estudo com uma média de 11,11 (8,51 – 15,39) anos à data da fratura, com uma descoaptação média de 9 ± 4,24 mm. Resultados: Não se verificaram alterações na amplitude de movimento, instabilidade residual ou lesões neurológicas iatrogénicas. Os resultados funcionais e presença de dor foram excelentes, com uma média de pontuação na Mayo Elbow Score de 99,5 ± 1,5, na escala DASH de 4,48 ± 4,87 e no módulo de desporto da mesma escala 14,38 ± 23,05, tendo 2 doentes pontuado acima de 20. Na VAS, a pontuação média foi de 0,6 ± 0,9. Foi identificado 1 caso (10%) de cubitus valgus. Foi necessária EMOS em 6 doentes (60%). Conclusões: As pontuações ótimas nas escalas de resultados funcionais, a baixa prevalência de dor e a baixa incidência de complicações, demonstram que a abordagem cirúrgica é segura, traz benefícios à população pediátrica e prima pela estabilidade articular. Não obstante, as elevadas taxas de EMOS devem ser consideradas.
Introduction: Fractures of the medial epicondyle represent 20% of elbow fractures in children. Their incidence has been increasing due to greater participation and intensity in sports. The treatment of these fractures remains controversial in the absence of absolute indications for surgery. Objectives: To review the functional outcomes and the incidence of complications of surgical treatment of medial epicondyle fractures in pediatrics and to compare our results with the literature. Methodology: This study is a retrospective "case series" study, conducted through analysis of electronic clinical and radiographic records of paediatric patients who underwent surgery for medial epicondyle fractures between January 2012 and December 2020 at Hospital Beatriz Ângelo. We identified a cohort of 17 patients surgically treated for medial epicondyle fractures in pediatric age. 10 patients were included in our study with a mean age of 11.11 (8.51 - 15.39) years at the date of fracture, with a mean displacement of 9 ± 4.24 mm. Results: There were no changes in range of motion, residual instability or iatrogenic neurological injuries. Functional results and presence of pain were excellent, with a mean Mayo Elbow Score of 99.5 ± 1.5, DASH score of 4.48 ± 4.87 and in the sports module 14.38 ± 23.05, with 2 patients scoring above 20. In VAS, the mean score was 0.6 ± 0.9. 1 case (10%) of cubitus valgus was identified. EMOS was required in 6 patients (60%). Conclusions: The optimal scores on the functional outcome scales, the minimal prevalence of pain and the low incidence of complications demonstrate that the surgical approach is safe, brings benefits to the pediatric population and excels in joint stability. Nevertheless, the high rates of EMOS should be considered.
Introduction: Fractures of the medial epicondyle represent 20% of elbow fractures in children. Their incidence has been increasing due to greater participation and intensity in sports. The treatment of these fractures remains controversial in the absence of absolute indications for surgery. Objectives: To review the functional outcomes and the incidence of complications of surgical treatment of medial epicondyle fractures in pediatrics and to compare our results with the literature. Methodology: This study is a retrospective "case series" study, conducted through analysis of electronic clinical and radiographic records of paediatric patients who underwent surgery for medial epicondyle fractures between January 2012 and December 2020 at Hospital Beatriz Ângelo. We identified a cohort of 17 patients surgically treated for medial epicondyle fractures in pediatric age. 10 patients were included in our study with a mean age of 11.11 (8.51 - 15.39) years at the date of fracture, with a mean displacement of 9 ± 4.24 mm. Results: There were no changes in range of motion, residual instability or iatrogenic neurological injuries. Functional results and presence of pain were excellent, with a mean Mayo Elbow Score of 99.5 ± 1.5, DASH score of 4.48 ± 4.87 and in the sports module 14.38 ± 23.05, with 2 patients scoring above 20. In VAS, the mean score was 0.6 ± 0.9. 1 case (10%) of cubitus valgus was identified. EMOS was required in 6 patients (60%). Conclusions: The optimal scores on the functional outcome scales, the minimal prevalence of pain and the low incidence of complications demonstrate that the surgical approach is safe, brings benefits to the pediatric population and excels in joint stability. Nevertheless, the high rates of EMOS should be considered.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Fratura Epicôndilo medial Tratamento Pediatria Ortopedia