Tratamento das fraturas redutíveis e instáveis da extremidade distal do rádio - ensaio clínico randomizado comparativo dos métodos de fixação com placa volar bloqueada e com fixador externo
Arquivos
Data
2015
Autores
Raduan Neto, Jorge 
Orientadores
Belloti, Joao Carlos
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: No tratamento das fraturas instáveis da extremidade distal do rádio não
há evidência conclusiva quanto à maior efetividade de um dos métodos de redução e
fixação: incruenta com fixador externo (FE) ou aberta com placa volar bloqueada
(PVB). Objetivo: O objetivo é determinar qual dos dois métodos é mais efetivo.
Métodos: Oitenta pacientes foram incluídos neste ensaio clínico randomizado. O
desfecho primário foi o questionário Disabilities of the Arm, Shoulder and Hand
(DASH) e a mensuração da dor (EVA). A avaliação final deu-se com 12 meses de
pós-operatório. Resultados: Na avaliação final não houve diferença entre os grupos
nas avaliações do questionário DASH (3,71 para o grupo PVB e 2,72 para o grupo
FE, p=0,58), e da dor pela EVA (0,84 para o grupo PVB e 0,53 para o grupo FE,
p=0,39). O tratamento com PVB foi mais efetivo que aquele com FE na avaliação
precoce com oito semanas para questionário DASH (21,82 para o grupo PVB e 39,88
para o grupo FE, p=0,0012). No grupo tratado com PVB, houve 11,7% de
complicações e, no grupo tratado com fixador externo, 26,3%. Houve três falhas de
tratamento no grupo tratado com PVB e nenhuma no outro grupo. Conclusão: Não se
aferiram diferenças entre os grupos nas avaliações finais do questionário DASH e da
dor pela EVA. Na avalição precoce com oito semanas, houve diferença favorável ao
método de PVB.
Introduction: In the treatment of unstable fractures of the distal radius there is no conclusive evidence about the greater effectiveness of the reduction and fixation methods: bloodless external fixation (BEF) or open locked volar plate (LVP). The goal is to determine which of the two methods is most effective. Methods: Eighty patients were enrolled in this randomized clinical trial. The primary endpoint was the DASH questionnaire and measurement of pain (VAS). The final assessment was given at 12 months postoperatively. Results: In the final evaluation there was no difference between groups in assessments of the DASH questionnaire (3.71 for the LVP group and 2.72 for the BEF group, p = 0.58), and pain by VAS (0,84 to LVP group and 0.53 for the BEF group, p = 0.39). Treatment with LVP was more effective than one with BEF in early evaluation with eight weeks to DASH questionnaire (21.82 for the LVP group and 39.88 for the BEF group, p = 0.0012). In the group treated with LVP, there were 11.7% of complications and, in the group treated with external fixator, 26.3%. There were three treatment failures in the group treated with LVP and none in the other group. Conclusions: There were not assessed differences between groups in the final evaluations of the DASH questionnaire and the pain by VAS. In the early eight week assessment, there was positive difference to the LVP method.
Introduction: In the treatment of unstable fractures of the distal radius there is no conclusive evidence about the greater effectiveness of the reduction and fixation methods: bloodless external fixation (BEF) or open locked volar plate (LVP). The goal is to determine which of the two methods is most effective. Methods: Eighty patients were enrolled in this randomized clinical trial. The primary endpoint was the DASH questionnaire and measurement of pain (VAS). The final assessment was given at 12 months postoperatively. Results: In the final evaluation there was no difference between groups in assessments of the DASH questionnaire (3.71 for the LVP group and 2.72 for the BEF group, p = 0.58), and pain by VAS (0,84 to LVP group and 0.53 for the BEF group, p = 0.39). Treatment with LVP was more effective than one with BEF in early evaluation with eight weeks to DASH questionnaire (21.82 for the LVP group and 39.88 for the BEF group, p = 0.0012). In the group treated with LVP, there were 11.7% of complications and, in the group treated with external fixator, 26.3%. There were three treatment failures in the group treated with LVP and none in the other group. Conclusions: There were not assessed differences between groups in the final evaluations of the DASH questionnaire and the pain by VAS. In the early eight week assessment, there was positive difference to the LVP method.
Descrição
Citação
RADUAN NETO, Jorge. Tratamento das fraturas redutíveis e instáveis da extremidade distal do rádio - ensaio clínico randomizado comparativo dos métodos de fixação com placa volar bloqueada e com fixador externo. 2015. 207 f. Tese (Doutorado em Ciências) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2015.