Influência da tomografia computadorizada no planejamento cirúrgico das fraturas do maléolo posterior

Resumo

Objetivo

Este estudo teve como objetivo avaliar a influência da tomografia computadorizada (TC) no planejamento pré-operatório das fraturas do maléolo posterior (MP) do tornozelo, comparando suas informações com as de radiografias convencionais (RX) e o seu impacto no tratamento cirúrgico.

Métodos

A pesquisa incluiu 81 pacientes com fraturas do MP, cujas imagens de RX e TC foram analisadas por 33 cirurgiões ortopédicos especializados. O estudo foi dividido em duas etapas, com avaliação de RX na primeira e de RX e TC na segunda. Em ambas as etapas, perguntou-se o tamanho do MP, a estabilidade da fratura, a conduta pré-operatória e as possíveis modificações após avaliar a TC.

Resultados

Os resultados mostraram que, ao considerar apenas o RX, 83,5% dos avaliadores decidiram pela fixação do MP. No entanto, ao adicionar a TC, essa decisão foi modificada em 49,1% dos casos, influenciando a via de acesso cirúrgico e o tipo de osteossíntese. Em 34,7% dos casos, a TC revelou um fragmento maior do MP em comparação ao RX, demonstrando sua superioridade na avaliação do tamanho e morfologia da fratura.

Conclusão

A TC deve ser incluída de forma rotineira no planejamento cirúrgico das fraturas do tornozelo com comprometimento do maléolo posterior, pois permite uma avaliação mais precisa do traço de fratura e pode mudar a decisão terapêutica baseada somente na RX.

Abstract

Objective

The present study aimed to evaluate the influence of computed tomography (CT) on the preoperative planning of posterior malleolus (PM) fractures of the ankle, comparing its information with that of conventional radiographs and assessing its impact on surgical treatment.

Methods

The study included 81 patients with PM fractures, whose radiological and CT images were analyzed by 33 specialized orthopedic surgeons. The study had two stages, with a radiological assessment on the first, and the second having radiological and CT evaluation. In both stages, we asked surgeons about the PM size, fracture stability, preoperative management, and potential modifications after CT analysis.

Results

Considering only radiographs, 83.5% of the evaluators selected PM fixation. However, CT addition modified this choice in 49.1% of the cases, influencing the surgical access route and the type of osteosynthesis. In 34.7% of cases, CT revealed a larger PM fragment than radiographs, demonstrating that it is superior in evaluating fracture size and morphology.

Conclusion

The surgical planning of ankle fractures with PM involvement should routinely include CT scans for a more precise fracture line assessment and a potential change in the therapeutic decision based on simple radiography alone.

Palavras-chave

cirurgiões - fraturas do tornozelo - radiografia - tomografia computadorizada por raios x

Keywords

ankle fractures - radiography - surgeons - tomography, x-ray computed

Contribuições dos Autores

Cada autor contribuiu individual e significativamente para o desenvolvimento deste artigo: NDMN: conceptualização, validação, coleta e análise formal de dados, metodologia, e rascunho e escrita do artigo. PFTN: validação, coleta e análise formal de dados, metodologia, rascunho e escrita do artigo, e edição e formatação de tabelas e figuras. JMPB: escrita, revisão da escrita e edição e formatação de tabelas e figuras. MTC: revisão da escrita e edição. RWC: conceptualização, metodologia, e revisão final. NRS: conceptualização, metodologia, e revisão final.

Trabalho desenvolvido no Departamento de Ortopedia e Traumatologia da Santa Casa de São Paulo – Pavilhão “Fernandinho Simonsen,” Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil.

Publikationsverlauf

Eingereicht: 13. November 2024

Angenommen: 26. Mai 2025

Artikel online veröffentlicht:
08. September 2025

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