Acta Ortopédica Brasileira (Apr 2013)
Exploração operatória e redução de sindesmose em lesão de tornozelo de Weber tipo C Operative exploration and reduction of syndesmosis in Weber type C ankle injury
Abstract
OBJETIVO: Investigar os métodos cirúrgicos no tratamento de fratura de tornozelo de Weber tipo C e estimar a necessidade de exploração cirúrgica da sindesmose. MÉTODOS: Quarenta e três pacientes que apresentavam fratura de tornozelo de Weber tipo C foram tratados com redução aberta e fixação interna de outubro de 2004 a dezembro de 2009. Vinte e nove pacientes foram tratados com o procedimento de rotina, que envolve redução aberta e fixação interna, exploração de sindesmose. Nos outros pacientes, foram realizados reparos adicionais. Trinta e quatro pacientes foram acompanhados durante um período médio de 31,2 meses (faixa, 18 a 50 meses), 22 pacientes desse total foram tratados com procedimentos de rotina e 12 foram tratados com exploração cirúrgica adicional da sindesmose. RESULTADOS: Todas as fraturas estavam unidas no período médio de 13,1 semanas (faixa, 10 a 18 semanas), tendo início o apoio de peso total. A escala média de tornozelo e retropé do escore da american orthopaedics foot and ankle society foi 79,86 (faixa, 65 a 98) no grupo procedimentos de rotina e 86,67 (faixa, 78 a 100) no grupo exploração da sindesmose. Os valores do escore de Olerud-Molander foram 77,27 (faixa, 55 a 100) e 86,67 (faixa, 75 a 100), respectivamente. Constatou-se diferença estatisticamente significante entre os dois grupos (P OBJECTIVE: to investigate the surgical methods in treating weber type C ankle injury and estimate the necessity of syndesmosis operative exploration. METHODS: forty three patients presenting weber type C ankle injury were treated with open reduction and internal fixation from october 2004 to december 2009. twenty nine patients were treated with routine procedure involving open reduction and internal fixation, syndesmosis exploration. additional repair was performed in the others. thirty four patients were followed during an average time of 31.2 months (range, 18 to 50 months), 22 patients of those were treated with routine procedures and 12 were treated with additional syndesmosis surgical exploration. RESULTS: all the fractures were united within the average time of 13.1 weeks (range, 10 to 18 weeks) and full weight bearing began. the mean ankle and hindfoot scale of the american orthopaedics foot and ankle society score was 79.86 (range, 65 to 98) in the routine procedures group and 86.67 (range, 78 to 100) in the syndesmosis exploration group. the values of olerud-molander score were 77.27 (range, 55 to 100) and 86.67 (range, 75 to 100), respectively. statistcally significant difference was found between the two groups (p<0.05). CONCLUSION: syndesmosis surgical exploration is essential in some weber type C ankle injuries, which make debridement and direct reduction of the syndesmosis possible, allowing higher stabilization of the ankle joint. Level of Evidence III, Retrospective Comparative Study.
