Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 2;32(3):e278420.
doi: 10.1590/1413-785220243203e278420. eCollection 2024.

SUPRACONDYLAR FRACTURES IN CHILDREN: A SYSTEMATIC REVIEW OF TREATMENT OPTIONS

Douglas Hideo Higuchi  1 , Gabriel Alencar de Oliveira  1 , João Paulo Alves  1 , Lucas Lebedenco  1 , Eiffel Tsuyoshi Dobashi  1
Affiliations

SUPRACONDYLAR FRACTURES IN CHILDREN: A SYSTEMATIC REVIEW OF TREATMENT OPTIONS

Douglas Hideo Higuchi et al. Acta Ortop Bras. .

Abstract
in English, Portuguese

Objective: To compare the outcomes of surgical stabilization of pediatric supracondylar humeral fractures with the use of crossed Kirschner wires versus divergent lateral pinning wires.

Methods: This is a systematic review with meta-analysis carried out by searching the MEDLINE/PubMed, Science Direct and Scielo databases. In these, the search for journals was carried out between January and August 2023, where 695 studies were found. To assess the quality of the studies, the Jadad and the MINORS scales were used.. The selection and reading of relevant articles were carried out by the researchers and 11 studies met the selection criteria.

Results: From the 11 selected studies, 963 patients who met the criteria for the surgical treatment of these fractures were grouped. After the statistical analysis, we found that the ulnar nerve injury had a higher incidence when the crossed-K wire technique was used; and the lateral fixation is safer for the ulnar nerve.

Conclusion: Both fixation techniques determine good functional results. However, fixation with lateral Kirschner wires proves to be safer considering the risk of iatrogenic injury to the ulnar nerve. Crossed-K wire fixation is more effective in terms of stability and maintenance of fracture reduction. Level of Evidence II, Systematic Review of Level II or Level I Studies with discrepant results.

Objetivo: Comparar os desfechos da estabilização cirúrgica das fraturas supracondilianas do úmero pediátricas com o uso de fios de Kirschner cruzados versus fios laterais divergentes. Métodos: Trata-se de uma Revisão Sistemática com metanálise realizada pela pesquisa nas bases de dados MEDLINE/PubMed, Science Direct e Scielo. Nessas, a busca dos periódicos foi realizada entre janeiro e agosto de 2023, e foram encontrados 695 estudos. Para a avaliação da sua qualidade, foram utilizadas a escala de Jadad e a escala MINORS. A seleção e a leitura dos artigos pertinentes foram realizadas pelos pesquisadores e 11 estudos preencheram os critérios de escolha. Resultados: Dos estudos selecionados, agrupamos 963 pacientes que preenchiam os critérios para o tratamento cirúrgico das fraturas. Após a análise estatística, observamos que maior incidência de lesão do nervo ulnar quando foi utilizada a técnica de pinagem cruzada; e a fixação lateral demonstrou ser mais segura para tal. Conclusão: Ambas as técnicas de fixação determinam bons resultados funcionais. Entretanto, a fixação com fios de Kirschner laterais demonstra ser mais segura, considerando o risco de lesão iatrogênica do nervo ulnar. A fixação com fios cruzados é mais eficaz, levando em conta a estabilidade e a manutenção da redução das fraturas. Nível de evidência II, Revisão sistemática de Estudos de Nível II ou Nível I com resultados discrepantes.

Keywords: Child; Fracture Fixation; Humeral Fractures; Orthopaedic Fixation Devices; Postoperative Complications.

PubMed Disclaimer

Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

Figures

Figure 1.
Figure 1.. Diagrama de fluxo conforme recomendação PRISMA.
Figure 2.
Figure 2.. Forest plot showing the proportion of complications between cross and lateral fixation.
Figure 3.
Figure 3.. Forest plot showing the proportion of complications in the included studies.
See this image and copyright information in PMC

References

    1. Goodall R., Claireaux H., Hill J., Wilson E., Monsell F., Collaborative B., Tarassoli P. Comparison between a multicentre, collaborative, closed-loop audit assessing management of supracondylar fractures and the British Orthopaedic Association Standard for Trauma 11 (BOAST 11) guidelines. Bone Joint J. 2018;100-B(3):346–51. - PubMed
    1. Poggiali P., Nogueira F. C. S., Nogueira M. P. de M. Manejo da fratura supracondiliana do úmero na criança. Rev Bras Ortop. 2022;57(1):23–32. - PMC - PubMed
    1. Ho C. A., Podeszwa D. A., Riccio A. I., Wimberly R. L., Ramo B. A. soft tissue injury severity is associated with neurovascular injury in pediatric supracondylar humerus fractures. J Pediatr Orthop. 2018;38(9):443–9. - PubMed
    1. Carrazzone O. L., Mansur Mansur N. S. B., Matsunaga F. T., Matsumoto M. H., Faloppa F., Belloti J. C., et al. Crossed versus lateral K-wire fixation of supracondylar fractures of the humerus in children: a meta-analysis of randomized controlled trials. J Shoulder Elbow. 2021;30(2):439–48. - PubMed
    1. Kasirajan S., Govindasamy R., Sathish B. R. J., Meleppuram J. J. Trans-olecranon fossa four-cortex purchase lateral pinning in displaced supracondylar fracture of the humerus - a prospective analysis in 48 children. Rev Bras Ortop. 2018;53(3):342–9. - PMC - PubMed

LinkOut - more resources