medigraphic.com
ISSN 2992-8036 (Digital)
ISSN 2306-4102 (Impreso)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2010, Número 4

<< Anterior Siguiente >>

Acta Ortop Mex 2010; 24 (4)


Resultado funcional en fracturas del radio distal. Comparación entre gravedad de la fractura, tratamiento de elección y parámetros radiológicos iniciales

Farías CE, Gil OF, Trueba DC, Jaspeado RR

Idioma: Español
Referencias bibliográficas: 45
Paginas: 220-229
Archivo PDF: 312.94 Kb.


RESUMEN

Antecedentes: La clasificación AO tiene valor pronóstico, ayudando a los médicos en planificar el manejo de fracturas. Los datos radiológicos y el cuestionario DASH se usan para evaluar el resultado de las fracturas radiales. En los últimos diez años se ha observado una tendencia hacia el tratamiento abierto, opuesto a los métodos de tratamiento cerrados o percutáneos. Métodos: Estudio descriptivo que evalúa el resultado funcional con seguimiento de 6 meses a 1 año con el cuestionario DASH, correlacionando los resultados con el tratamiento empleado, tipo de fractura, clasificaciones AO y Frykman y los parámetros radiológicos iniciales. Se registraron estabilidad de la fractura y tratamiento de elección. Los pacientes se agruparon de acuerdo al tratamiento empleado. Resultados: Se tomó un resultado DASH ≤ 20 como bueno, y › 20 como pobre. A los 6 a 12 meses de seguimiento se aplicaron los cuestionarios, el resultado promedio fue 14.46. No se encontró diferencia estadística entre un resultado bueno o malo de acuerdo al tipo de tratamiento. Se encontró correlación entre el tipo de fractura y los parámetros radiológicos con el resultado funcional. Conclusiones: Sin importar el tratamiento de elección para las fracturas del radio distal, el objetivo más importante es restaurar las mediciones radiológicas normales para mejorar el resultado funcional y reducir las complicaciones. No se encontró diferencia en el resultado funcional entre las opciones terapéuticas empleadas para las fracturas del radio distal. La clasificación AO es válida como indicador pronóstico y útil para tomar decisiones terapéuticas.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Colles A: Historical paper on the fracture of the carpal extremity of the radius [1814] Injury 1970; 2: 48-50.

  2. Putnam MD, Seitz WH: Fracturas distales del radio. Cap 20, en: Bucholz RW. Rokwodds & Green’s. Fracturas en el adulto. Tomo 2. Madrid, 2003.

  3. Anderson R, O’Neil G: Comminuted fractures of the distal end of the radius. Surg Gynecol Obstet 1944; 78: 434-40.

  4. Cole JM, Obletz BE: Comminuted fractures of the distal end of the radius treated by skeletal transfixion in plaster cast. An end-result study of thirty-three cases. J Bone Joint Surg 1966; 48A: 931-45.

  5. Ellis J: Smith’s and Barton’s fractures: a method of treatment. J Bone Joint Surg 1965; 47B: 724-7.

  6. Leung F, Tu Y, Chew WYC, Chow SP: Comparison of External and Percutaneous Pin Fixation with Plate Fixation for Intra-articular Distal Radial Fractures. A Randomized Study. J Bone Joint Surg Am 2008; 90: 16-22.

  7. Orbay JL, Fernandez DL: Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg [Am] 2002; 27: 205-15.

  8. Konrath GA, Bahler S: Open reduction and internal fixation of unstable distal radius fractures: results using the trimed fixation system. J Orthop Trauma 2002; 16: 578-85.

  9. Orbay JL, Fernandez DL: Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg [Am] 2004; 29: 96-102.

  10. Jupiter JB: Plate fixation of fractures of the distal aspect of the radius: relative indications. J Orthop Trauma 1999; 13: 559-69.

  11. Simic PM, Robison J, Gardner MJ, Gelberman RH, Weiland AJ, Boyer MI: Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment. J Hand Surg [Am] 2006; 31: 382-6.

  12. Jupiter JB, Ring D, Weitzel PP: Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years. J Hand Surg [Am] 2002; 27: 714-23.

  13. Wright TW, Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg [Am] 2005; 30: 289-99. Erratum in: J Hand Surg [Am] 2005; 30: 629.

  14. Rozental TD, Blazar PE: Functional outcome and complications after volar plating for dorsally displaced unstable fractures of the distal radius. J Hand Surg [Am] 2006; 31: 359-65.

  15. Kamath AF, Zurakowski D, Day CS: Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study. J Hand Surg [Am] 2006; 31: 1061-7.

  16. Ring D, Prommersberger K, Jupiter JB: Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J Bone Joint Surg Am 2004; 86: 1646-52.

  17. Rikli DA, Regazzoni P: Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br 1996; 78: 588-92.

  18. Drobetz H, Bryant AL, Pokorny T, Spitaler R, Leixnering M, Jupiter JB: Volar fixed-angle plating of distal radius extension fractures: influence of plate position on secondary loss of reduction-a biomechanic study in a cadaveric model. J Hand Surg [Am] 2006; 31: 615-22.

  19. Grindel SI, Wang M, Gerlach M, McGrady LM, Brown S: Biomechanical comparison of fixed-angle volar plate versus fixed-angle volar plate plus fragment specific fixation in a cadaveric distal radius fracture model. J Hand Surg [Am] 2007; 32: 194-9.

  20. Taylor KF, Parks BG, Segalman KA: Biomechanical stability of a fixed-angle volar plate versus fragment-specific fixation system: cyclic testing in a C2-type distal radius cadaver fracture model. J Hand Surg [Am] 2006; 31: 373-81.

  21. Osada D, Viegas SF, Shah MA, Morris RP, Patterson RM: Comparison of different distal radius dorsal and volar fracture fixation plates: a biomechanical study. J Hand Surg [Am] 2003; 28: 94-104.

  22. Grewal R, Perey B, Wilmink M, Stothers K: A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation, and external fixation. J Hand Surg [Am] 2005; 30: 764-72.

  23. Kreder HJ, Hanel DP, Agel J, McKee M, Schemitsch EH, Trumble TE, Stephen D: Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius: a randomized, controlled trial. J Bone Joint Surg Br 2005; 87: 829-36.

  24. Margaliot Z, Haase SC, Kotsis SV, Kim HM, Chung KC: A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures. J Hand Surg [Am] 2005; 30: 1185-99.

  25. Handoll HHG, Madhok R: Closed reduction methods for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003: 1: CD003763.

  26. Handoll HHG, Madhok R: Conservative interventions for treating distal radial fractures in adults. Cochrane Database of Syst Rev. 2003: 2: CD000314.

  27. Handoll HHG, Madhok R: Surgical interventions for treating distal radial fractures in adults. Cochrane Database of Syst Rev. 2003: 3: CD003209.

  28. Hudak P, Amadio PC, Bombardier C: and the Upper Extremity Collaborative Group. Development of an Upper Extremity Outcome Measure: The DASH (Disabilities of the Arm, Shoulder, and Hand). Am J Ind Med 1996; 29: 602-8.

  29. Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowsi MF: Consistency of AO fracture classification for the distal radius. J Bone Joint Surg Br 1996; 78: 726-31.

  30. Gausepohl T, Worner S, Pennig D, Koebke J. Extraarticular external fixation in distal radius fractures pin placement in osteoporotic bone. Injury 2001; 32(suppl 4): SD79-85.

  31. Steinberg BD, Plancher KD: Clinical Anatomy of the Wrist and Elbow in The Athletic Elbow and Wrist: Diagnosis and Conservative Treatment. Clin Sports Med 1995; 14: 299-313.

  32. Fernandez DL: “Distal Radius and Wrist”, AO principles of fracture management, ed. T. P. Ruedi, W. M. Murphy, New York, Thieme, 2000.

  33. Nesbitt KS, Failla JM, Les C: Assessment of instability factors in adult distal radius fractures. J Hand Surg 2004; 29A: 1128-38.

  34. Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI: Wrist fractures: What the Clinician Wants to Know. Radiology 2001; 219: 11-28.

  35. Altissimi M, Mancini GB, Azzara A, at al: Early and late displacement of fractures of the distal radius, the prediction of instability. Int Orthop 1994; 18(2): 61-5.

  36. Fernandez DL, Jupiter JB: Fractures of the Distal Radius. Berlin Heidelberg New York: Springer-Verlag. 1995.

  37. Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski MF: X-ray film measurements for healed distal radius fractures. J Hand Surg 1996; 21A: 31-39. Erratum in: J Hand Surg [Am] 1996; 21: 532.

  38. Beaton DE, Davis AM, Hudak P, McConnell S: The DASH (Disabilities of the arm, shoulder, and hand) outcome measure: What do we know about it now? J Hand Ther Br 2001; 6(4): 109-18.

  39. Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC, Kim HM: Treatment of unstable distal radial fractures with volar locking plating system. J Bone Joint Surg Am 2006; 88: 2687-94.

  40. Westphal T, Piatek S, Schubert S, Winckler S: Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF. Arch Orthop Trauma Surg 2005; 125: 507-14.

  41. Arora J, Malik AC: External fixation in comminuted, displaced intra-articular fractures of the distal radius: is it sufficient? Arch Orthop Trauma Surg 2005; 125: 536-40.

  42. Kreder HJ, Hanel DP, Agel J, et al: Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius: a randomized, controlled trial. J Bone Joint Surg 2005; 87B: 829-36.

  43. Grewal R, Perey B, Wilmink M, Stothers K: A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation and external fixation. J Hand Surg 2005; 30A: 764-72.

  44. Jupiter JB, Marent-Huber M and the LCP Study Group. Operative Management of Distal Radial Fractures with 2.4-Millimeter Locking Plates. A Multicenter Prospective Case Series. Bone Joint Surg Am 2009; 91: 55-65.

  45. Friedman SL. Complicaciones en ortopedia. Fracturas del radio distal. Jeffrey O. Anglen, AAOS. Barcelona, Ars Médica, 2008.




2020     |     www.medigraphic.com