ABSTRACT
Abstract Objective To compare the clinical results between conservative (CS) and surgical treatment (CXS) of A3 and A4 fractures without neurological deficit. Methods Prospective observational study of patients with thoracolumbar fractures type A3 and A4. These patients were separated between the surgical and conservative groups, and evaluated sequentially through the numeric rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5D (EQ-5D) quality of life questionnaire, and Denis work scale (DWS) up to 2.5 years of follow-up. Results Both groups showed significant improvement, with no statistical difference in pain questionnaires (NRS: CXS 2.4 ± 2.6; CS 3.5 ± 2.6; p> 0.05), functionality (RMDQ: CS 7 ± 6.4; CXS 5.5 ± 5.2; p> 0.05), quality of life (EQ-5D), and return to work (DWS). Conclusion Both treatments are viable options with equivalent clinical results. There is a tendency toward better results in the surgical treatment of A4 fractures.
Resumo Objetivo Comparar os resultados clínicos entre os tratamentos conservador (CS) e cirúrgico (CXS) das fraturas A3 e A4 sem déficit neurológico. Métodos Estudo prospectivo observacional de paciente com fraturas toracolombares tipo A3 e A4. Esses pacientes foram separados entre os grupos cirúrgico e conservador e avaliados sequencialmente através da escala numérica de dor (NRS), do questionário de incapacidade de Roland-Morris (RMDQ), do EuroQol-5D (EQ-5D) e da escala de trabalho de Denis (DWS) até 2,5 anos de acompanhamento. Resultados Ambos os grupos apresentaram melhora significante, sem diferença estatística nos questionários de dor (NRS: CXS 2,4 ± 2,6; CS 3,5 ± 2,6; p> 0,05), funcionalidade (RMDQ: CS 7 ± 6,4; CXS 5,5 ± 5,2; p> 0,05), qualidade de vida (EQ-5D) e retorno ao trabalho (DWS). Conclusão Ambos os tratamentos são opções viáveis e com resultados clínicos equivalentes. Há uma tendência a melhores resultados no tratamento cirúrgico das fraturas A4.
Subject(s)
Humans , Spinal Fractures/surgery , Treatment Outcome , Conservative Treatment , Fracture Fixation, InternalABSTRACT
Las fracturas del calcáneo representan aproximadamente 2% de todas las fracturas del cuerpo humano y 60% de las fracturas del tarso. Menos del 7% son bilaterales. Las fracturas intra-articulares desplazadas (Sanders Tipo IV) son el resultado de traumatismos de alta energía, usualmente debido a precipitaciones o accidentes automovilísticos. Es una lesión compleja que se asocia con elevados índices de incapacidad cuando no es tratada de forma correcta y oportuna. Se trata de paciente masculino, de 38 años de edad, quien presenta una fractura bilateral de calcáneo Sanders tipo IV, manejada quirúrgicamente, mediante reducción directa, reconstrucción anatómica del calcáneo, osteosíntesis con placa anatómica y artrodesis subtalar. Las fracturas del calcáneo siguen siendo un gran reto para el cirujano ortopedista y traumatólogo debido a la controversia en cuanto a su manejo. El diagnóstico preciso y precoz, basado en estudios imagenológicos, es necesario para una adecuada caracterización de la fractura, planificación preoperatoria y resolución quirúrgica(AU)
Calcaneal fractures represent approximately 2% of all fractures of the body and 60% of fractures of the tarsus. Less than 7% are bilateral. The displaced intra-articular fractures (Sanders type IV) are the result of high energy trauma, usually because of rainfall or auto accidents. It is a complex injury that is associated with high rates of disability when not treated properly and timely. The case of male 38-year-old man presented with bilateral calcaneal fractures Sanders type IV, which were managed surgically by direct reduction of the calcaneus and anatomical reconstruction píate fixation and anatomic subtalar arthrodesis. Calcaneal fractures remain a major challenge for orthopedic surgeons and trauma due to controversy regarding their management. The early and accurate diagnosis based on imaging studies, it is necessary for proper characterization of the fracture, preoperative planning and surgical resolution(AU)