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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(06): 899-910
DOI: 10.1055/s-0042-1754379
Revisão Sistemática e Metanálise
Mão

Resultados do manejo de fraturas do rádio distal nos últimos 5 anos: metanálise de ensaios clínicos controlados e randomizados[*]

Article in several languages: português | English
Anak Agung Gede Yuda Asmara
1   Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
,
Made Bramantya Karna
1   Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
,
Putu Feryawan Meregawa
1   Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
,
Maria Florencia Deslivia 
1   Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
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Resumo

Objetivo Nas últimas décadas, a placa volar bloqueada (PVB) tem sido o tratamento principal para fraturas do rádio distal (FRDs). Com o crescente conjunto de evidências, revisamos sistematicamente estudos sobre modificações recentes na PVB.

Métodos Uma pesquisa sistemática foi realizada utilizando o banco de dados PubMed/MEDLINE por estudos publicados em inglês nos últimos cinco anos. Os critérios de inclusão foram ensaios clínicos controlados e randomizados (ECCRs) sobre o tratamento cirúrgico de FRDs. Excluímos ensaios e estudos em andamento que não abordavam diretamente a FRD. Os desfechos primários avaliados foram desfechos clínicos subjetivos (como as pontuações no questionário de Deficiências do Braço, Ombro e Mão [Disabilities of the Arm, Shoulder and Hand, DASH, em inglês], na Avaliação do Punho Classificada pelo Paciente [Patient-rated Wrist Evaluation, PRWE, em inglês], no questionário Qualidade de Vida Europeia – 5 Dimensões [European Quality of Life–5 Dimensions, EQ-5D, em inglês], na Pesquisa de Saúde por Formulário Curto de 36 Itens [36-item Short Form Health Survey, SF-36, em inglês], e na Escala Visual Analógica [EVA]) e objetivos (taxa de complicações).

Resultados Identificamos 29 artigos publicados entre 2016 e 2020 com alta qualidade de evidência, exceto por um, de qualidade moderada. Ao todo, foram analisadas 3.079 FRDs neste estudo, Todos os estudos analisados, exceto por um, tinham maior proporção de participantes do gênero feminino, e somente em 1 estudo a idade média da amostra foi < 40 anos. Não houve diferença significativa entre a PVB e fixação externa (FE) em termos das pontuações no DASH (p = 0,18) e na PRWE (p = 0,77). Os resultados da PVB isolada, sem qualquer reparo do pronador quadrado (PQ), foram significativamente melhores.

Conclusão Em fraturas instáveis, a PVB e a FE produziram resultados comparáveis no longo prazo. Não há um benefício claro em se adicionar reparo do PQ à técnica cirúrgica atual da PVB.

Nível de Evidência Nível I

Palavras-chave

placas ósseas - fixadores externos - fraturas do rádio - traumatismos do punho

Contribuição dos Autores

Anak Agung Gede Yuda Asmara: concepção, metodologia, redação do rascunho original, supervisão; Made Bramantya Karna: concepção, metodologia, redação do rascunho original; Putu Feryawan Meregawa: curadoria de dados, investigação; Maria Florencia Deslivia: software, e redação, revisão e edição do artigo.


Suporte Financeiro

Os autores declaram que não receberam nenhum apoio financeiro para a pesquisa, autoria e/ou publicação deste artigo.


* Trabalho desenvolvido no Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia.




Publication History

Received: 17 July 2021

Accepted: 14 June 2022

Article published online:
16 December 2022

© 2022. 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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