Tratamiento conservador versus tratamiento quirúrgico de fracturas de estiloides cubital en el contexto de fracturas de radio distal. [Conservative vs. surgical management of ulnar styloid fractures associated with distal radius fractures]

Contenido principal del artículo

Cristian Robles
Santiago Iglesias
Christian Allende Nores
Pablo Rotella
Martín Caloia
Miguel Capomassi

Resumen

Objetivo: Determinar si los resultados clínicos y radiográficos difieren después del tratamiento conservador y el tratamiento quirúrgico para las fracturas de la estiloides cubital asociadas a fracturas inestables del radio distal tratadas mediante placa volarbloqueada.Materiales y Métodos: Estudio multicéntrico, retrospectivo y descriptivo que incluye pacientes operados en cuatro instituciones, entre 2009 y 2012. Todos tenían fracturas de la estiloides cubital en el contexto de una fractura del radio distal. Las fracturas de la estiloides cubital fueron tratadas de forma conservadora (grupo I) o con cirugía (grupo II).Resultados: El seguimiento promedio fue de 56 meses. Se evaluó a 57 pacientes; grupo I (29 casos) y grupo II (28 casos). Los pacientes del grupo II tuvieron 2,76 veces (IC95% 1,086; 8,80) más posibilidades de lograr una consolidación que aquellos del grupo I. El puntaje DASH  el dolor, tanto en reposo como en actividad, no presentaron diferencias significativas (p = 0,276 y p = 0,877). La desviación cubital y la fuerza obtuvieron mejores resultados en el grupo I (p = 0,0194 y p = 0,024).Conclusiones: Aunque los pacientes con estabilización quirúrgica de la estiloides cubital tuvieron 2,76 más posibilidades de lograr la consolidación que aquellos del grupo I, no hubo diferencias significativas en la evaluación subjetiva (DASH y dolor) entre ambos grupos. Tampoco hubo diferencias significativas cuando se consideró el grado de compromiso de la estiloides cubital, pero la fuerza y la desviación cubital presentaron mejores resultados en el grupo sin fijación de la estiloides cubital. AbstractObjectives: To evaluate potential differences in clinical and radiological outcomes after surgical versus conservative management of ulnar styloid fractures associated with unstable distal radius fractures treated by locked volar plating. Materials and Methods: This was a multicenter, retrospective and descriptive study including surgical patients treated at four different institutions between 2009 and 2012 for ulnar styloid fractures associated with unstable distal radius fractures. Ulnar styloid fractures were treated conservatively in group I and surgically in group II. Results: The average follow-up was 56 months. The study included 57 patients divided into two groups (group I [29 cases] and group II [28 cases]). Patients in group II had 2.76 times (95% CI: 1.086; 8.80) more chances of achieving bone union than those in group I. DASH and pain scores, both at rest and during activity, did not show significant differences between the two groups (p = 0.276 and p = 0.877). Group I presented milder ulnar deviation and better strength (p = 0.0194 and p = 0.024). Conclusions: Although patients who underwent surgery for ulnar styloid fractures had 2.76 more chances of achieving bone union than those who received conservative management, there were no significant differences between both groups in subjective evaluations (DASH and pain scores) or when considering the degree of ulnar styloid involvement. However, the parameters of strength and ulnar deviation were better in the conservative management group. 

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Robles, C., Iglesias, S., Allende Nores, C., Rotella, P., Caloia, M., & Capomassi, M. (2019). Tratamiento conservador versus tratamiento quirúrgico de fracturas de estiloides cubital en el contexto de fracturas de radio distal. [Conservative vs. surgical management of ulnar styloid fractures associated with distal radius fractures]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(4), 353-360. https://doi.org/10.15417/issn.1852-7434.2019.84.4.879
Sección
Investigación Clínica
Biografía del autor/a

Cristian Robles, Sanatorio Allende, Córdoba, Argentina

Médico del Servicio de Ortopedia y Traumatología, Sanatorio Allende, Córdoba, Argentina

Santiago Iglesias, Sanatorio Allende, Córdoba, Argentina

Servicio de Ortopedia y Traumatología, Sanatorio Allende, Córdoba, Argentina

Christian Allende Nores, Sanatorio Allende, Córdoba, Argentina

Servicio de Ortopedia y Traumatología, Sanatorio Allende, Córdoba, Argentina

Pablo Rotella, Traumatología y Ortopedia del Norte, San Miguel de Tucumán, Tucumán, Argentina

Médico en Traumatología y Ortopedia del Norte, San Miguel de Tucumán, Tucumán, Argentina

Martín Caloia, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina

Médico en el Hospital Universitario Austral, Pilar, Buenos Aires, Argentina

Miguel Capomassi, Sanatorio de la mujer, Rosario, Santa Fé, Argentina

Médico traumatólogo del Sanatorio de la mujer, Rosario, Santa Fé, Argentina

Citas

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