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      Desvios rotacionais na fratura supracondiliana do úmero em crianças: novo método de avaliação Translated title: Rotational deviations in supracondylar humerus fractures in children: a new method of evaluation

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          Abstract

          Objetivo: Descrever um novo método para identificar e quantificar os desvios rotacionais da fratura supracondiliana do úmero. Métodos: O estudo foi realizado usando modelos sintéticos de úmero, serrando-o perpendicular ao seu longo eixo, na região da fossa olecraniana, fixando-o com diferentes desvios rotacionais, e então uma radiografia das peças foi obtida. Foi realizada uma análise descritiva da sensibilidade e especificidade do método de visualização do "esporão metafisário" com o teste não paramétrico de Kruskal-Wallis. A análise de regressão linear foi utilizada para identificar uma relação entre tamanho do esporão e o grau de desvio rotacional da fratura. Resultados: A sensibilidade e a especificidade do método foram de 100% a partir de 15 graus de desvio rotacional e houve uma relação estatisticamente significante entre o tamanho do esporão e o grau do desvio rotacional. Conclusão: O método demonstrou ser de fácil aplicação, confiável e reprodutível neste trabalho.

          Translated abstract

          Objective: To describe a new method to identify and quantify the rotational displacement on a supracondylar fracture of humerus. Methods: The study was conducted using synthetic models of the humerus, sawing it perpendicular to its long axis, in the olecranon fossa level, fixing with different rotational deviations,and then a radiograph of the construct was obtained. We performed a descriptive analysis of the sensitivity and specificity of the method of viewing the “metaphyseal spurs” with the nonparametric Kruskal- Wallis test. The linear regression analysis was used to identify a relationship between size of the spur and the degree of rotation deviation of the fracture. Results: The sensitivity and specificity was 100% from the 15 degrees of rotational deviation and there was a statistically relationship between the size of the spur and the degree of rotational deviation. Conclusion: The method proved to be easy to use, reliable and reproducible in this work.

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          Most cited references25

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          Supracondylar humeral fractures in children.

          Operative fixation is indicated for most type-II and III supracondylar humeral fractures in order to prevent malunion. Medial comminution is a subtle finding that, if treated nonoperatively, is likely to lead to unacceptable varus malunion. Angiography is not indicated for a pulseless limb, as it delays fracture reduction, which usually corrects the vascular problem. A high index of suspicion is necessary to avoid missing an impending compartment syndrome, especially when there is a concomitant forearm fracture or when there is a median nerve injury, which may mask symptoms of compartment syndrome. Lateral entry pins have been shown, in biomechanical and clinical studies, to be as stable as cross pinning if they are well spaced at the fracture line, and they are not associated with the risk of iatrogenic ulnar nerve injury.
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            Operative management of displaced flexion supracondylar humerus fractures in children.

            Flexion-type supracondylar humerus fractures remain an uncommon variant of the common extension-type injury. They are often thought to be more difficult injuries, more probable to require open reduction, and have neurovascular complications. We reviewed the 10-year history of flexion-type supracondylar elbow fractures treated at 1 institution and compared these cases with those of an extension-type cohort collected during a similar period. The patients in the flexion-type group (mean age, 7.5 years) were significantly older than those in the extension-type group (mean age, 5.8 years). The fractures in flexion-type group were also more probable to require open reduction (31%) than those in the extension-type group (10%). There was no difference in the incidence of preoperative nerve symptoms; however, the flexion-type group had a significantly increased incidence rate of ulnar nerve symptoms (19% vs 3% in the extension-type group) and need for ulnar nerve decompression. The flexion-type variant should be recognized preoperatively, and the potential pitfalls involved with the treatment of these injuries appreciated.
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              Intraoperative control of axes, rotation and length in femoral and tibial fractures technical note

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                Author and article information

                Journal
                rbort
                Revista Brasileira de Ortopedia
                Rev. bras. ortop.
                Sociedade Brasileira de Ortopedia e Traumatologia (São Paulo, SP, Brazil )
                0102-3616
                1982-4378
                2011
                : 46
                : suppl 4
                : 45-50
                Affiliations
                [01] São Paulo SP orgnameSanta Casa de São Paulo orgdiv1Departamento de Ortopedia e Traumatologia Brasil
                [02] São Paulo SP orgnameSanta Casa de São Paulo orgdiv1Faculdade de Ciências Médicas Brasil
                [03] Salvador BA orgnameHospital Espanhol orgdiv1Departamento de Ortopedia e Traumatologia Brasil
                Article
                S0102-36162011001000009 S0102-3616(11)04600009
                a21964c4-e9b4-4e60-b023-75a4f2e3575d

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 31 August 2011
                : 24 August 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 6
                Product

                SciELO Brazil

                Categories
                Artigos Originais

                Elbow,Humeral Fractures,Criança,Cotovelo,Fraturas do Úmero,Child

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