Classificando fraturas do rádio com raio-X e tomografia

Filho, Paulo Roberto Miziara Yunes; Filho, Miguel Viana Pereira; Gomes, Fabiano Cortese Paula; Medeiros, Rodrigo Serikawa de; Paula, Emygdio José Leomil de; Júnior, Rames Mattar; Zumiotti, Arnaldo Valdir

doi:10.1590/s1413-78522009000200001

Cited by 4 publications

(2 citation statements)

References 20 publications

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“…The interobserver reliability of distal radius fracture classifications is questionable, but it is better when evaluated in conventional radiography than in the computed tomography alone. 25 The inclusion of the group and subgroup components of the AO/OTA classification reduces the interobserver and intraobserver reliability of the system. 26 Additionally, the use of the computed tomography does not increase the reliability of this classification.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography vs Standard Radiograph in Preoperative Planning of Distal Radius Fractures with Articular Involvement

Azi¹,

Teixeira²,

Carvalho³

et al. 2014

Strategies in Trauma and Limb Reconstruction

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Introduction: Distal radius fractures with articular involvement are more likely to require surgical management. Treatment decisions are based on parameters which are obtained from plain radiographs. This study aims to determine the differences between computed tomography and standard radiographs in the preoperative planning of distal radius fractures with articular involvement. This was performed by measuring the intraobserver and interobserver reliability between three systems used to interpret the main fracture characteristics and two treatment decisions. Materials and methods: Forty-three cases of distal radius fractures with articular involvement were included. Fracture displacement was measured using plain radiographic and computed tomography. Five orthopedic surgeons evaluate the images to determine the AO/OTA classification, the articular fragments, the biomechanical columns involved, and recommend a surgical approach and implant for fracture fixation. Results: An articular step-off was identified in 13 cases (30%) with the standard radiographs and in 22 (51%) cases with the computed tomography (p = 0.00). Interobserver variation for preoperative planning was slight when evaluated using the standard radiographs. Computed tomography improves reliability for AO/OTA classification and articular fragments but not for the biomechanical columns. Intraobserver variation for preoperative planning was slight to moderate for AO/OTA classification and slight to fair for identification of articular fragments and biomechanical columns. With regard to selection of the surgical approach, there was slight to moderate variation and, finally, for fracture fixation it was slight to fair. Conclusion: Information provided by conventional radiography and computed tomography are sufficiently different as to induce the surgeon to select different treatments for the same fracture.

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Section: Discussionmentioning

confidence: 99%

Computed Tomography vs Standard Radiograph in Preoperative Planning of Distal Radius Fractures with Articular Involvement

Azi¹,

Teixeira²,

Carvalho³

et al. 2014

Strategies in Trauma and Limb Reconstruction

View full text Add to dashboard Cite

show abstract

“…Segundo Rundgren et al 2 o mecanismo mais comum é a queda de própria altura (75%), enquanto trauma de altas energias, como queda de alturas e acidentes de trânsito apresentaram 8% e 5,9%, respectivamente. Além disso, 65% das FRD foram classificadas como extra articular, 12% como articular parcial e 23% foram classificadas com intra-articular total, sendo as fraturas intraarticulares mais comuns em homens e associadas a traumas de alta energia 1,2 [8][9][10][11][12][13][14] . Dessa forma, o uso da tomografia computadorizada (TC) pode ser útil na avaliação pré-operatória dos pacientes com fraturas com múltiplos fragmentos (cominuídas) para avaliação dos tamanhos dos fragmentos e planejamento cirúrgico 15 .…”

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Mapeamento Tomográfico de Pacientes com Fratura da Extremidade Distal do Rádio

Paladini-Filho,

Junqueira,

Tanaka

et al. 2024

Arch Health Invest

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Introdução. A fratura da extremidade distal do rádio é uma das fraturas mais comuns nos atendimentos hospitalares. Apresenta diferentes padrões de acordo com a faixa etária, sexo e energia do trauma, conferindo o aspecto bimodal epidemiológico. Fraturas da extremidade distal do rádio cominuídas apresentam maior complexidade, modificando o tipo de tratamento e prognóstico dos pacientes. O objetivo deste estudo é realizar o mapeamento tomográfico das fraturas articulares do rádio distal. Métodos. Estudo retrospectivo, baseado na revisão de prontuários e de exames de imagens disponíveis de pacientes submetidos a tratamento cirúrgico de fraturas da extremidade distal do rádio em um hospital terciário. As cominuições foram divididas em tipos de acordo a Classificação de Medoff. Resultados: A cominuição tipo 1 ocorreu em 45,8% dos casos, a tipo 2 em 79,2%, a tipo 3 em 16,7%, a tipo 4 em 31,3% e a cominuição tipo 5 em 93,8% das fraturas. Houve diferença estatística para sexo feminino e cominuição por impacção no fragmento central (p=0,009; teste do Qui-Quadrado). Conclusão: a compreensão biomecânica dos traços ou linhas articulares das fraturas do rádio distal e seus principais desvios apresentaram diferença estatística para cominuição no fragmento de impacção central em mulheres, contudo nosso estudo não foi capaz de explicar a relação entre cominuições na coluna radial e alterações na articulação radioulnar distal.

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Classification systems for distal radius fractures

et al. 2017

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Background and purpose — The reliability of conventional radiography when classifying distal radius fractures (DRF) is fair to moderate. We investigated whether reliability increases when additional computed tomography scans (CT) are used.Patients and methods — In this prospective study, we performed pre- and postreduction posterior–anterior and lateral radiographs of 51 patients presenting with a displaced DRF. The case was included when there was a (questionable) indication for surgical treatment and an additional CT was conducted within 5 days. 4 observers assessed the cases using the Frykman, Fernández, Universal, and AO classification systems. The first 2 assessments were performed using conventional radiography alone; the following 2 assessments were performed with an additional CT. We used the intraclass correlation coefficient (ICC) to evaluate reliability. The CT was used as a reference standard to determine the accuracy.Results — The intraobserver ICC for conventional radiography alone versus radiography and an additional CT was: Frykman 0.57 vs. 0.51; Fernández 0.53 vs. 0.66; Universal 0.57 vs. 0.64; AO 0.59 vs. 0.71. The interobserver ICC was: Frykman: 0.45 vs. 0.28; Fernández: 0.38 vs. 0.44; Universal: 0.32 vs. 0.43; AO: 0.46 vs. 0.40.Interpretation — The intraobserver reliability of the classification systems was fair but improved when an additional CT was used, except for the Frykman classification. The interobserver reliability ranged from poor to fair and did not improve when using an additional CT. Additional CT scanning has implications for the accuracy of scoring the fracture types, especially for simple fracture types.

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Classificando fraturas do rádio com raio-X e tomografia

Cited by 4 publications

References 20 publications

Computed Tomography vs Standard Radiograph in Preoperative Planning of Distal Radius Fractures with Articular Involvement

Computed Tomography vs Standard Radiograph in Preoperative Planning of Distal Radius Fractures with Articular Involvement

Mapeamento Tomográfico de Pacientes com Fratura da Extremidade Distal do Rádio

Classification systems for distal radius fractures

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