Tratamento das fraturas da diáfise do úmero: osteossíntese com placa em ponte versus tratamento não cirúrgico com órtese funcional. Ensaio clínico randomizado
Data
2015
Autores
Matsunaga, Fabio Teruo 
Orientadores
Belloti, João Carlos
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O tratamento não cirúrgico é, atualmente, considerado o
método de escolha para a maioria das fraturas da diáfise do úmero, apesar
de pacientes tratados com órtese funcional poderem apresentar resultados
insatisfatórios. A osteossíntese com placa em ponte tem se mostrado uma
técnica segura, com bons resultados. Objetivo: Avaliar a efetividade do
tratamento das fraturas da diáfise do úmero, com placa em ponte (PP), em
comparação com a órtese funcional (OR), considerando-se a função do
membro superior. Métodos: Pacientes com fraturas da diáfise do úmero
foram aleatoriamente alocados em um dos dois grupos. Os alocados no
grupo PP foram encaminhados para o tratamento cirúrgico, com técnica
conforme descrita por LIVANI, BELANGERO (2004). Os pacientes
alocados no grupo OR foram tratados com órtese funcional, após 14 dias de
uso de tala gessada. Todos os pacientes foram submetidos ao mesmo
programa de reabilitação e acompanhados por até um ano. O desfecho
primário foi a função do membro superior avaliada pelo questionário The
Disabilities of the Arm, Shoulder and Hand (DASH). Como desfechos
secundários, avaliamos a qualidade de vida, pelo questionário SF-36,
complicações, dor, avaliada pela escala visual analógica, função do ombro,
medido pelo escore Constant e radiografias. Resultados: Cento e dez
pacientes foram incluídos no estudo. Houve diferença estatística favorável
ao grupo PP, no DASH, após seis meses. No entanto, essa diferença não foi
clinicamente significante. Não foi possível detectar diferença entre os
grupos no questionário SF-36, dor, Constant e deformidade residual nas
radiografias, incidência em perfil. Quanto à ocorrência de pseudartrose,
tempo de consolidação e deformidade radiográfica residual no plano
coronal, houve uma superioridade do grupo PP. Conclusão: Não houve
diferença clínica entre o tratamento com PP com OR, quanto à função do
membro superior, com um ano após intervenção.
Background: Conservative treatment is still considered the standard treatment of the majority of humeral shaft fractures. However, patients treated with this method can present unsatisfactory results. Minimally invasive bridge plate osteosynthesis have been showing a safe technique with good results. Objective: To investigate the effectiveness of surgical treatment of humeral shaft fractures with bridge plating in comparison to conservative treatment with functional brace, considering upper limb function. Method: Patients with humeral shaft fractures were allocated, after randomization, to one of the two groups. The ones allocated in bridge plate group were sent to surgical treatment, according to technique described by LIVANI and BELANGERO (2004). Patients allocated in nonoperative treatment were treated with functional brace after 14 days of initial cast immobilisation. All patients were included in the same rehabilitation program and were followed up for 1 year after intervention. Primary outcome was the DASH score. As secondary outcomes, we assessed , SF-36 questionnaire, treatment complications, Constant score, pain and radiographs. Results: one hundred and ten patients were included. Statistical difference was found in DASH scores favourable to bridge plate group 6 months after treatment. This difference was not clinically relevant. We could not detect difference between both groups in SF-36 questionnaire, pain, Constant score and radiographic deformity in lateral view. Nonunion rates, time of fracture healing and residual deformity in coronal plane were favourable to bridge plate group. Conclusion: Surgical treatment with bridge plating showed similar results compared to functional brace, considering upper limb function, one year after intervention.
Background: Conservative treatment is still considered the standard treatment of the majority of humeral shaft fractures. However, patients treated with this method can present unsatisfactory results. Minimally invasive bridge plate osteosynthesis have been showing a safe technique with good results. Objective: To investigate the effectiveness of surgical treatment of humeral shaft fractures with bridge plating in comparison to conservative treatment with functional brace, considering upper limb function. Method: Patients with humeral shaft fractures were allocated, after randomization, to one of the two groups. The ones allocated in bridge plate group were sent to surgical treatment, according to technique described by LIVANI and BELANGERO (2004). Patients allocated in nonoperative treatment were treated with functional brace after 14 days of initial cast immobilisation. All patients were included in the same rehabilitation program and were followed up for 1 year after intervention. Primary outcome was the DASH score. As secondary outcomes, we assessed , SF-36 questionnaire, treatment complications, Constant score, pain and radiographs. Results: one hundred and ten patients were included. Statistical difference was found in DASH scores favourable to bridge plate group 6 months after treatment. This difference was not clinically relevant. We could not detect difference between both groups in SF-36 questionnaire, pain, Constant score and radiographic deformity in lateral view. Nonunion rates, time of fracture healing and residual deformity in coronal plane were favourable to bridge plate group. Conclusion: Surgical treatment with bridge plating showed similar results compared to functional brace, considering upper limb function, one year after intervention.
Descrição
Citação
MATSUNAGA, Fabio Teruo. Tratamento das fraturas da diáfise do úmero: osteossíntese com placa em ponte versus tratamento não cirúrgico com órtese funcional. Ensaio clínico randomizado. 2015. 103 f. Tese (Doutorado em Ciências em Cirurgia translacional) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2015.