Navegando por Palavras-chave "Radius fractures"
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- ItemAcesso aberto (Open Access)Are distal radius fracture classifications reproducible? Intra and interobserver agreement(Associação Paulista de Medicina - APM, 2008-05-01) Belloti, Joao Carlos [UNIFESP]; Tamaoki, Marcel Jun Sugawara [UNIFESP]; Franciozi, Carlos Eduardo da Silveira [UNIFESP]; Santos, João Baptista Gomes dos [UNIFESP]; Balbachevsky, Daniel [UNIFESP]; Chap, Eduardo Chap [UNIFESP]; Albertoni, Walter Manna [UNIFESP]; Faloppa, Flávio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Various classification systems have been proposed for fractures of the distal radius, but the reliability of these classifications is seldom addressed. For a fracture classification to be useful, it must provide prognostic significance, interobserver reliability and intraobserver reproducibility. The aim here was to evaluate the intraobserver and interobserver agreement of distal radius fracture classifications. DESIGN AND SETTING: This was a validation study on interobserver and intraobserver reliability. It was developed in the Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina. METHOD: X-rays from 98 cases of displaced distal radius fracture were evaluated by five observers: one third-year orthopedic resident (R3), one sixth-year undergraduate medical student (UG6), one radiologist physician (XRP), one orthopedic trauma specialist (OT) and one orthopedic hand surgery specialist (OHS). The radiographs were classified on three different occasions (times T1, T2 and T3) using the Universal (Cooney), Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF), Frykman and Fernández classifications. The kappa coefficient (κ) was applied to assess the degree of agreement. RESULTS: Among the three occasions, the highest mean intraobserver k was observed in the Universal classification (0.61), followed by Fernández (0.59), Frykman (0.55) and AO/ASIF (0.49). The interobserver agreement was unsatisfactory in all classifications. The Fernández classification showed the best agreement (0.44) and the worst was the Frykman classification (0.26). CONCLUSION: The low agreement levels observed in this study suggest that there is still no classification method with high reproducibility.
- ItemAcesso aberto (Open Access)Estudo da relação anatômica do nervo sensitivo radial após fixação percutânea com fios de Kirschner(Sociedade Brasileira de Ortopedia e Traumatologia, 2008-03-01) Labronici, Pedro José; Franco, José Sergio; Hoffmann, Rolix; Silva, Anselmo Fernandes Da; Passos, Marco Aurélio Rodrigues Da Fonseca; Lourenço, Paulo Roberto Barbosa De Toledo; Fernandes, Hélio Jorge Alvachian [UNIFESP]; Reis, Fernando Baldy dos [UNIFESP]; Hospital Santa Teresa Clínica do Serviço de Ortopedia e Traumatologia Prof. Dr. Donato D'Ângelo; Universidade Federal do Rio de Janeiro Faculdade de Medicina Departamento de Ortopedia e Traumatologia; Faculdade de Medicina de Petrópolis; Universidade do Estado do Rio de Janeiro; Hospital de Ipanema Grupo de Trauma; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To establish the risk of lesion to the radial sensory nerve after percutaneous fixation in the distal radius region of cadavers. METHODS: The authors used 24 upper limbs of 12 skeletally mature cadavers, 10 male, and 2 female, mean age estimated as 50 years. A Kirschner wire was introduced in the styloid process of the radius to make the following determinations: distance between the wire and the radial sensory nerve, between the wire and the closest dorsal nerve branch, between the wire and the tendons of the first osteofibrous tunnel, and, finally, the number of branches of the radial sensory nerve. RESULTS: The site were the nerve appeared, between the two tendons and the Kirschner wire in the radial styloid process was a mean 5.09 cm, with a standard deviation of 0.75 cm. The distance between the Kirschner wire and the first dorsal branch was a mean 4.33 cm, ranging from zero to 10 cm. The number of nervous branches was a mean of four, ranging from two to eight branches. CONCLUSION: Results of this experimental study showed that when the wire is introduced in the styloid process of the radius, the risk of lesioning the radial sensory nerve is not a big risk. This risk is directly related to the number of nervous branches and to the angles of the wires while they are being introduced in the distal end of the radius.
- ItemAcesso aberto (Open Access)Fractures of the distal radius (Colles' fracture)(Associação Paulista de Medicina - APM, 2007-05-01) Belloti, Joao Carlos [UNIFESP]; Santos, João Baptista Gomes dos [UNIFESP]; Atallah, Álvaro Nagib [UNIFESP]; Albertoni, Walter Manna [UNIFESP]; Faloppa, Flávio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Although Colles' fracture is a common clinical situation for the orthopedist, we did not find any information in the literature that would allow safe decision-making on the best treatment for each fracture type. The aim of the present study was to investigate Brazilian orthopedists' opinions regarding the main aspects of treatments for Colles' fracture. DESIGN AND SETTING: Cross-sectional study conducted during the 34th Brazilian Congress of Orthopedics and Traumatology. METHODS: Five hundred questionnaires containing 12 items were randomly distributed to orthopedists who were attending the congress; 439 were filled out correctly and were considered in this study. RESULTS: The main factors in making decisions on interventions in fracture cases were whether the fracture was intra-articular, the existence of shortening of the distal radius and the patient's age. The classification method most used was Frykmann. The closed reduction method most used was manual reduction. The principal surgical interventions were percutaneous pinning (39%), external fixation (27%) and volar plate (19%). Most of the interviewees only used bone grafts for osseous gaps in special cases. The most frequent complications were impairment of joint mobility and residual pain. CONCLUSIONS: Brazilian orthopedists have concordant opinions regarding conservative treatment methods and the use of bone grafts. There were conflicting opinions regarding surgical treatment methods, classification types and complications.
- ItemAcesso aberto (Open Access)The IDEAL classification system: a new method for classifying fractures of the distal extremity of the radiudescription and reproducibility(Associação Paulista de Medicina - APM, 2013-01-01) Belloti, Joao Carlos [UNIFESP]; Santos, João Baptista Gomes dos [UNIFESP]; Moraes, Vinícius Ynoe de [UNIFESP]; Wink, Felipe Vitiello; Tamaoki, Marcel Jun Sugawara [UNIFESP]; Faloppa, Flávio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE There is no consensus concerning which classification for distal radius fractures is best and the existing methods present poor reproducibility. This study aimed to describe and assess the reproducibility of the new IDEAL classification, and to compare it with widely used systems. DESIGN AND SETTING Reproducibility study, Hand Surgery Section, Universidade Federal de São Paulo. METHODS The IDEAL classification and its evidence-based rationale are presented. Sixty radiographs (posteroanterior and lateral) from patients with distal radius fractures were classified by six examiners: a hand surgery specialist, a hand surgery resident, an orthopedic generalist, an orthopedic resident and two medical students. Each of them independently assessed the radiographs at three different times. We compared the intra and interobserver concordance of the IDEAL, AO, Frykman and Fernandez classifications using Cohen's kappa (κ) (for two observers) and Fleiss's κ (for more than two observers). RESULTS The concordance was high for the IDEAL classification (κ = 0.771) and moderate for Frykman (κ = 0.556), Fernandez (κ = 0.671) and AO (κ = 0.650). The interobserver agreement was moderate for the IDEAL classification (κ = 0.595), but unsatisfactory for Frykman (κ = 0.344), Fernandez (κ = 0.496) and AO (κ = 0.343). CONCLUSION The reproducibility of the IDEAL classification was better than that of the other systems analyzed, thus making the IDEAL system suitable for application. Complementary studies will confirm whether this classification system makes adequate predictions for therapy and prognosis.