Fios laterais comparados aos cruzados para o tratamento cirúrgico das fraturas supracondilianas do úmero em crianças. Revisão sistemática.

• Ano de defesa: 2019
• Autor(a) principal: Carrazzone, Oreste Lemos [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Humeral Fractures; Child; Surgical Treatment; Meta-Analysis; Fraturas Do Úmero; Criança; Tratamento Cirúrgico; Meta-Análise
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7669650; https://repositorio.unifesp.br/handle/11600/59710

Introduction: Closed reduction and percutaneous fixation with crossed or lateral wire configuration are the most acceptable treatment for displaced supracondylar humerus fractures in children. Nevertheless, there is still no consensus about the effectiveness of these treatment methods. Objective: The aim of this study was to assess the effectiveness of both wire configurations for the treatment of these fractures. Methods: A systematic review of randomized controlled trials or quasi-randomized controlled trials was performed in order to compare crossed to two lateral wires treatment techniques. The search was carried out using MEDLINE, LILACS, EMBASE, Cochrane Library and ongoing clinical trials database until February 2019. The main outcomes were function, measurement by Flynn criteria, complications (neurologic lesion, infection, loss of reduction, and residual deformity) and failure. Loss of movement and variation of Baumann’s angle and carrying angle were also assessed. Risk relative analysis was performed for dichotomous variable, difference of means for continuous, and confidence interval of 95% were stablished for all analysis. Results: Twelve randomized or quasi-randomized controlled trials with a total of 930 patients were included. Both groups presented satisfactory funcional results with no difference between them (RR=0.99; p=0.44). The lateral configuration group was superior, considering iatrogenic ulnar nerve lesion (p=0.03; RR 0.40). However, with regard to the loss of reduction, the crossed group was superior to lateral group (p=0.03; RR 1.39). Conclusion: There is evidence of very low quality that the fixation with lateral wires is safer when iatrogenic nerve lesion was considered, on the other hand, the crossed wires showed to be more effective to maintain the fracture reduction.