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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(04): 619-628
DOI: 10.1055/s-0041-1726062
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Determinação dos parâmetros anatômicos limítrofes para melhor desfecho funcional da fratura de Colles: Um estudo prospectivo[*]

Article in several languages: português | English
Tapasa Kumar Panigrahi 
1   Departamento de Ortopedia, S. C. B. Medical College and Hospital, Cutack, Odisha, Índia
,
Satyajeet Ray 
1   Departamento de Ortopedia, S. C. B. Medical College and Hospital, Cutack, Odisha, Índia
,
Manoranjan Mallik 
1   Departamento de Ortopedia, S. C. B. Medical College and Hospital, Cutack, Odisha, Índia
,
Ramesh Chandra Maharaj 
1   Departamento de Ortopedia, S. C. B. Medical College and Hospital, Cutack, Odisha, Índia
,
Jugaratna Khatua 
1   Departamento de Ortopedia, S. C. B. Medical College and Hospital, Cutack, Odisha, Índia
,
Debi Prasad Nanda 
1   Departamento de Ortopedia, S. C. B. Medical College and Hospital, Cutack, Odisha, Índia
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Resumo

Objetivo O tratamento da fratura de Colles pode deformar o pulso. Alguns estudos afirmam que essa deformidade raramente dificulta as atividades diárias, enquanto outros relatam o contrário; assim, a redução anatômica é desejável. Nosso objetivo foi analisar os resultados anatômicos e funcionais da fratura de Colles para descobrir os valores de parâmetros individuais correspondentes ao melhor desfecho funcional.

Métodos Este estudo prospectivo incluiu 70 pacientes idosos com fratura de Colles. Todos os pacientes foram tratados de forma conservativa. Os parâmetros anatômicos foram a angulação dorsal, a inclinação radial e a altura radial, avaliados de acordo com Stewart et al. O resultado funcional foi avaliado segundo a tabela de pontuação de pulso Mayo. Os resultados foram analisados por meio do teste de associação do qui-quadrado, considerando o valor de p < 0,001 estatisticamente significativo. A força das associações foi analisada por razões de possibilidades com intervalos de confiança de 95%.

Resultados Excelentes e bons resultados anatômicos e funcionais foram obtidos em 68,5% e 78,5% dos casos, respectivamente, com diferença estatística significativa (p = 0,0009). Dos três parâmetros anatômicos, a angulação dorsal inferior a 10° e a perda da inclinação radial inferior a 9° apresentaram associação estatisticamente significativa com os resultados funcionais (p = 0,0006), mas não a perda de altura radial inferior a 6 mm (p = 0,0568); no entanto, a perda da altura radial inferior a 4 mm foi associada de forma significativa aos desfechos funcionais (p = 0,00062).

Conclusão As fraturas com redução anatômica apresentam melhores desfechos funcionais. Os parâmetros anatômicos limítrofes aceitáveis para a obtenção de resultados funcionais excelentes ou bons são angulação dorsal inferior a 10°, perda da inclinação radial inferior a 9° e perda da altura radial inferior a 4 mm.

Palavras-chave

fratura de Colles - tratamento conservador/métodos - idoso

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* Trabalho desenvolvido no Departamento de Ortopedia, S.C.B. Medical College and Hospital, Cutack, Odisha, Índia.




Publication History

Received: 29 July 2020

Accepted: 28 October 2020

Article published online:
05 May 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury 2006; 37 (08) 691-697
    CrossrefPubMedGoogle Scholar
  • 2 Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord 2007; 8: 48
    CrossrefPubMedGoogle Scholar
  • 3 Hesp R, Klenerman L, Page L. Decreased radial bone mass in Colles' fracture. Acta Orthop Scand 1984; 55 (05) 573-575
    CrossrefPubMedGoogle Scholar
  • 4 Summers K, Fowles SM. Colles' Fracture. [Updated 2020 Jan 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553071/
    Google Scholar
  • 5 Edward A. Perez. Perez. Fractures of the shoulder, arm and forearm. In: Frederick M, Azar MD. editors. Campbell's operative orthopaedics. 13th ed.. Philadelphia: Elsevier; 2017: 2994
    Google Scholar
  • 6 Gartland Jr JJ, Werley CW. Evaluation of healed Colles' fractures. J Bone Joint Surg Am 1951; 33-A (04) 895-907
    CrossrefPubMedGoogle Scholar
  • 7 Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg Am 2006; 88 (09) 1944-1951
    Google Scholar
  • 8 Cassebaum WH. Colles' fracture; a study of end results. J Am Med Assoc 1950; 143 (11) 963-965
    CrossrefPubMedGoogle Scholar
  • 9 Golden GN. Treatment and prognosis of Colles' fracture. Lancet 1963; 1 (7280): 511-515
    CrossrefPubMedGoogle Scholar
  • 10 Finsen V, Rod O, Rød K, Rajabi B, Alm-Paulsen PS, Russwurm H. The relationship between displacement and clinical outcome after distal radius (Colles') fracture. J Hand Surg Eur Vol 2013; 38 (02) 116-126
    Google Scholar
  • 11 Wolfe SW. Distal Radius Fractures. In: Wolfe SW, Pederson WC, Cohen Mark S. editors. Green's Operative Hand Surgery. 7th ed.. Philadelphia: Elsevier; 2017: 530
    Google Scholar
  • 12 Bilić R, Ruzić L, Zdravković V, Boljević Z, Kovjanić J. Reliability of different methods of determination of radial shortening. Influence of ulnar and palmar tilt. J Hand Surg [Br] 1995; 20 (01) 97-101
    CrossrefPubMedGoogle Scholar
  • 13 Stewart HD, Innes AR, Burke FD. Functional cast-bracing for Colles' fractures. A comparison between cast-bracing and conventional plaster casts. J Bone Joint Surg Br 1984; 66 (05) 749-753
    CrossrefPubMedGoogle Scholar
  • 14 Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 1987; (214) 136-147
    PubMedGoogle Scholar
  • 15 Chung KC, Cho HE, Kim Y, Kim HM, Shauver MJ. WRIST Group. Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2020; 3 (01) e1919433
    CrossrefPubMedGoogle Scholar
  • 16 Perez EA. Fractures of the shoulder, arm and forearm. In: Azar FM, Canale ST, Beaty JH. editors. Campbell's operative orthopaedics. 13th ed.. Philadelphia: Elsevier; 2017: 2993
    Google Scholar
  • 17 Mishra PK, Nagar M, Gaur SC, Gupta A. Morphometry of distal end radius in the Indian population: A radiological study. Indian J Orthop 2016; 50 (06) 610-615
    CrossrefPubMedGoogle Scholar
  • 18 Dario P, Matteo G, Carolina C. et al. Is it really necessary to restore radial anatomic parameters after distal radius fractures?. Injury 2014; 45 (Suppl. 06) S21-S26
    PubMedGoogle Scholar
  • 19 Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 2011; 93 (23) 2146-2153
    CrossrefPubMedGoogle Scholar
  • 20 Anzarut A, Johnson JA, Rowe BH, Lambert RG, Blitz S, Majumdar SR. Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg Am 2004; 29 (06) 1121-1127
    CrossrefPubMedGoogle Scholar
  • 21 Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am 2000; 25 (01) 19-28
    CrossrefPubMedGoogle Scholar
  • 22 Kong L, Kou N, Wang Y, Lu J, Tian D, Zhang B. The Necessity of Restoration of Radiologic Parameters by Closed Reduction in Elderly Patients with Distal Radius Fractures. Med Sci Monit 2019; 25: 6598-6604
    CrossrefPubMedGoogle Scholar
  • 23 Solgaard S. Function after distal radius fracture. Acta Orthop Scand 1988; 59 (01) 39-42
    CrossrefPubMedGoogle Scholar
  • 24 Jenkins NH, Mintowt-Czyz WJ. Mal-union and dysfunction in Colles' fracture. J Hand Surg Br 1988; 13 (03) 291-293
    PubMedGoogle Scholar
  • 25 Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res 1986; (206) 202-210
    PubMedGoogle Scholar
  • 26 Salmon JM, Pattern S. Prevention of malunion of distal radius fracture. J Bone Joint Surg Br 1999; 81 (01) 5
    Google Scholar
  • 27 Fujii K, Henmi T, Kanematsu Y, Mishiro T, Sakai T, Terai T. Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results. J Orthop Surg (Hong Kong) 2002; 10 (01) 9-15
    CrossrefPubMedGoogle Scholar
  • 28 Smilovic J, Bilic R. Conservative treatment of extra-articular Colles' type fractures of the distal radius: prospective study. Croat Med J 2003; 44 (06) 740-745
    PubMedGoogle Scholar
  • 29 Cooney III WP, Dobyns JH, Linscheid RL. Complications of Colles' fractures. J Bone Joint Surg Am 1980; 62 (04) 613-619
    CrossrefPubMedGoogle Scholar