,1752'8d®2
)UDWXUDOX[DomR GD DUWLFXODomR WDUVRPHWDWiUVLFD p UDUD WHQGR LQFLGrQFLDHPWRUQRGHSDUDSHVVRDVSRUDQRFRUUHVSRQ GHQGRDGHWRGDVDVIUDWXUDV5HFHEHDGHQRPLQDomRGH
/LVIUDQFHPKRPHQDJHPDRPpGLFRIUDQFrV-DFTXHV/LVIUDQFTXH GHVFUHYHXXPDDPSXWDomRGHVWDDUWLFXODomR
$OJXQVDXWRUHVFRQVLGHUDPDDXVrQFLDGHGLDJQyVWLFRSULQFLSDO PHQWHHPSROLWUDXPDWL]DGRVFRPRPRWLYRGDVXDEDL[DLQFLGrQFLD RTXHSRGHRFRUUHUHPWRUQRGHGRVFDVRV
eFRQVLGHUDGDFRPRXPDJUDYHOHVmRQRSpFRPSRWHQFLDOSDUD FRPSOLFDo}HVDJXGDVHFU{QLFDVFRPROHVmRYDVFXODUVtQGURPH FRPSDUWLPHQWDOOHVmRQHUYRVDQHFURVHGHSHOHJDQJUHQDDUWURVH SVHXGRDUWURVHH[RVWRVHVGRUFU{QLFDHQWUHRXWUDV
2 PHFDQLVPR GH WUDXPD GHVVDV OHV}HV QmR p EHP GHILQLGR H SRGHGHFRUUHUGHWUDXPDVGLUHWRVHLQGLUHWRV(VWXGRVLQYLWUR
DVVRFLDPWUDXPDHPIOH[mRSODQWDUGRVPHWDWDUVLDQRVFRPHVWUHVVH
WRUFLRQDO(VVDOHVmRUHVXOWDGHWUDXPDGHDOWDHQHUJLDVHQGRTXH
DVSULQFLSDLVFDXVDVVmRDFLGHQWHDXWRPRELOtVWLFRPRWRFLFOtVWLFR HRVLQGXVWULDLVTXHMXQWRVFRUUHVSRQGHPDPDLVGDPHWDGHGRV FDVRV/HV}HVGHEDL[DHQHUJLDWDPEpPSRGHPFDXVDUUXSWXUD
OLJDPHQWDUHVSHFLDOPHQWHHPDWOHWDVHSDFLHQWHVLGRVRV
5DGLRJUDILDV VLPSOHV HP DQWHURSRVWHULRU $3 SHUILO H REOtTXD VmR VXILFLHQWHV SDUD R GLDJQyVWLFR (P DOJXPDV VLWXDo}HV DV UDGLRJUDILDVFRQYHQFLRQDLVQmRVmRHVFODUHFHGRUDVSRGHQGRVHU QHFHVViULRXPWHVWHGHHVWUHVVHVREDQHVWHVLDGDDUWLFXODomRSDUD PRVWUDU D OHVmR9RXUL H $UR UHODWDUDP XPD VpULH RQGH HP
GRVFDVRVFDVRVRGLDJQyVWLFRUDGLRJUiILFRQmRIRLIHLWR LQLFLDOPHQWHFRQGX]LQGRDXPWUDWDPHQWRLQDGHTXDGR )UDWXUDGDEDVHGRPHWDWDUVRHDXPHQWRGRHVSDoRLQWHUPH
WDWiUVLFRVmRLQGLFDWLYRVGHOHVmRJUDYH
1RWUDWDPHQWRGDIUDWXUDOX[DomRGDDUWLFXODomRWDUVRPHWDWiUVLFDR GLDJQyVWLFRSUHFRFHDVVRFLDGRFRPXPDUiSLGDUHGXomRDQDW{PL FDHIL[DomRHVWiYHOSURSRUFLRQDPyWLPRVUHVXOWDGRV
$57,*225,*,1$/
&LWDomR3HUHLUD&-(VSLQRVD(*0LUDQGD,3HUHLUD0%&DQWR567$YDOLDomRGR WUDWDPHQWRFLU~UJLFRGDIUDWXUD/X[DomRGH/LVIUDQF$FWD2UWRS%UDV>SHULyGLFRQD ,QWHUQHW@'LVSRQtYHOHP85/KWWSZZZVFLHOREUDREDRE
&LWDWLRQ3HUHLUD&-(VSLQRVD(*0LUDQGD,3HUHLUD0%&DQWR567(YDOXDWLRQRI WKHVXUJLFDOWUHDWPHQWRIOLVIUDQFMRLQWIUDFWXUHGLVORFDWLRQ$FWD2UWRS%UDV>VHULDORQ WKH,QWHUQHW@$YDLODEOHIURP85/KWWSZZZVFLHOREUDRE
7UDEDOKRUHFHELGRHPDSURYDGRHP
$9$/,$d®2'275$7$0(172&,5Ô5*,&2'$)5$785$²
/8;$d®2'(/,6)5$1&
&
/%(5'(
-
(6863
(5(,5$(
'8$5'2*
20(6(
63,126$,
9$10
,5$1'$0
$5&(/2%
8(123
(5(,5$5
2%(5726
5*,2'(
7
$9$5(6&
$1727UDEDOKRUHDOL]DGRQR6HUYLoRGH2UWRSHGLDH7UDXPDWRORJLDGR+RVSLWDOGDV&OtQLFDVGD8QLYHUVLGDGH)HGHUDOGH8EHUOkQGLD
(QGHUHoRSDUDFRUUHVSRQGrQFLD0DUFHOR%XHQR3HUHLUD5XD$ODJRDVQ%DLUUR%UDVLO8EHUOkQGLD0*%UDVLO&(3(PDLOPDUFHOREXHQR#QHWVLWHFRPEU
0pGLFRDVVLVWHQWHGR*UXSRGH7RUQR]HORHSpGR6HUYLoRGH2UWRSHGLDH7UDXPDWRORJLDGR+RVSLWDOGDV&OtQLFDVGD8QLYHUVLGDGH)HGHUDOGH8EHUOkQGLD 0pGLFRDVVLVWHQWHGR*UXSRGH7RUQR]HORHSpGR6HUYLoRGH2UWRSHGLDH7UDXPDWRORJLDGR+RVSLWDOGDV&OtQLFDVGD8QLYHUVLGDGH)HGHUDOGH8EHUOkQGLD
'RXWRUHP2UWRSHGLDH7UDXPDWRORJLD&KHIHGR*UXSRGH7RUQR]HORHSpGR6HUYLoRGH2UWRSHGLDH7UDXPDWRORJLDGR+RVSLWDOGDV&OtQLFDVGD8QLYHUVLGDGH)HGHUDOGH8EHUOkQGLD 0pGLFRDVVLVWHQWHGR*UXSRGH7RUQR]HORHSpGR6HUYLoRGH2UWRSHGLDH7UDXPDWRORJLDGR+RVSLWDOGDV&OtQLFDVGD8QLYHUVLGDGH)HGHUDOGH8EHUOkQGLD
'RXWRUHP2UWRSHGLDH7UDXPDWRORJLDSUHFHSWRUGD5HVLGrQFLDPpGLFDGR+RVSLWDOGDV&OtQLFDVGD8QLYHUVLGDGH)HGHUDOGH8EHUOkQGLD 5(6802
(VWXGRUHWURVSHFWLYRGHFDVRVGHIUDWXUDOX[DomRGH/LVIUDQF WUDWDGRVFLUXUJLFDPHQWHQRSHUtRGRGHD2WHPSRGH DFRPSDQKDPHQWRIRLGHPHVHVYDULDQGRGHDPHVHV2 WUDWDPHQWRFLU~UJLFRIRLUHDOL]DGRQRGLDGRWUDXPDHPFDVRV FRPPpGLDGHGHPRUDGHKRUDV2FRUUHUDPOHV}HVH[SRV WDVHSDFLHQWHVIRUDPYtWLPDVGHSROLWUDXPDWLVPR2 PHFDQLVPRGHOHVmRPDLVIUHTHQWHIRLRDFLGHQWHPRWRFLFOtVWLFR VHJXLGRGDTXHGDGHDQLPDLVHGHDOWXUD8WLOL]RXVHDDYDOLDomR IXQFLRQDOSURSRVWDSHOD$2)$67KH$PHULFDQ2UWKRSDHGLF)RRW $QG$QNOH6RFLHW\TXHDSUHVHQWRXPpGLDGHYDULRXGH D+RXYHUHODomRHQWUHDTXDOLGDGHGDUHGXomRREWLGDHR UHVXOWDGRGRWUDWDPHQWRS HHQWUHRIDWRGRSDFLHQWHV VHUYtWLPDGHSROLWUDXPDWLVPRHXPUHVXOWDGRLQIHULRUGRHVFRUH $2)$6S
+RXYHFRPRFRPSOLFDomRDSUHVHQoDGH2VWHRDUWURVHHPFDVRV FRQILUPDQGRDFRPRDSULQFLSDOFRPSOLFDomRUDGLRJUi ILFDGHVWDVOHV}HV6XDRFRUUrQFLDIRLDQDOLVDGDFRPSDUDQGRVH FRPDTXDOLGDGHGDUHGXomRHFRPRVGLIHUHQWHVWLSRVGHOHVmR H[SRVWDOHVmROLJDPHQWDURXIUDWXUDVHOHVmRLVRODGDRXSROLWUDX PDWLVPRQmRHQFRQWUDQGRUHODomRFRPVLJQLILFkQFLDHVWDWtVWLFD S
'HVFULWRUHV)UDWXUDVyVVHDV/X[Do}HV2VVRVGRPHWDWDUVR $UWLFXODo}HVWDUVLDQDV
(9$/8$7,212)7+(685*,&$/75($70(172)/,6)5$1&-2,17)5$&785(',6/2&$7,21
6800$5<
7KLVZDVDUHWURVSHFWLYHVWXG\RIFDVHVRI/LVIUDQFIUDF
WXUHGLVORFDWLRQVXUJLFDOO\WUHDWHGGXULQJWKHSHULRGRI
7KHIROORZXSSHULRGZDVPRQWKVUDQJH
PRQWKV6XUJLFDOWUHDWPHQWZDVSURYLGHGRQWKHGD\RIWKH
LQMXU\LQFDVHVWDNLQJDQDYHUDJHRIKRXUV7KHUH
ZHUHRSHQLQMXULHVDQGSDWLHQWVH[SHULHQFHG
PXOWLSOH LQMXULHV 7KH PRVW IUHTXHQW PHFKDQLVPV RI LQMXU\
ZHUHPRWRUF\FOHDFFLGHQWVIROORZHGE\IDOOVIURPDQLPDOV
DQGKLJKIDOOV7KHIXQFWLRQDOHYDOXDWLRQSURSRVHGE\$2)$6
7KH $PHULFDQ 2UWKRSDHGLF )RRW DQG $QNOH 6RFLHW\ ZDV
HPSOR\HGZKLFKUHSRUWHGDQDYHUDJHRIUDQJLQJIURP
WR$FRUUHODWLRQZDVIRXQGEHWZHHQWKHTXDOLW\RI
WKHUHGXFWLRQDFKLHYHGDQGWUHDWPHQWRXWFRPHS
DQG EHWZHHQ PXOWLSOH WUDXPDV DQG SRRUHU $2)$6 VFRUH
UHVXOWVS &RPSOLFDWLRQVVXFKDVRVWHRDUWKULWLV
RFFXUUHGLQFDVHVFRQILUPLQJWKLVDVWKHPDLQ
UDGLRJUDSKLF FRPSOLFDWLRQ RI WKHVH LQMXULHV ,WV LQFLGHQFH
ZDVDQDO\]HGFRPSDULQJWKHTXDOLW\RIWKHUHGXFWLRQWRWKH
GLIIHUHQWW\SHVRILQMXU\RSHQRUFORVHGOLJDPHQWLQMXU\RU
IUDFWXUHLVRODWHGLQMXU\RUPXOWLSOHLQMXULHVQRWUHSRUWLQJDQ\
VWDWLVWLFDOO\VLJQLILFDQWFRUUHODWLRQS
IRUDPVXEPHWLGRVDWUDWDPHQWRFLU~UJLFRFRPPDLVGHKRUDVGH HYROXomRGHYLGRjGHPRUDGRGLDJQyVWLFRFDVRVHjVFRQGLo}HV FOtQLFDVQDFKHJDGDFDVRV
$UHGXomRIRLFRQVLGHUDGDLQVXILFLHQWHQDVUDGLRJUDILDVSyVRSH UDWyULDV HP FDVRV )RUDP GLDJQRVWLFDGDV OHV}HV OLJDPHQWDUHV SXUDV DWUDYpV GH DYDOLDomR FRP UDGLRJUDILDV RX IOXRURVFRSLDHPHVWUHVVHVREDQHVWHVLD
2PHFDQLVPRGHOHVmRPDLVIUHTHQWHIRLRWUDXPDGHDOWDHQHU JLDVHQGRRDFLGHQWHPRWRFLFOtVWLFRDSULQFLSDOFDXVD)LJXUD H FLQFR SDFLHQWHV GHUDP HQWUDGD QR SURQWRVRFRUUR YtWLPDV GH SROLWUDXPDWLVPR
)LJXUD²'LVWULEXLomRVHJXQGRDFDXVDGRDFLGHQWHGDOHVmRQRVFDVRV DYDOLDGRVH[SUHVVRVHPQ~PHURDEVROXWRHSRUFHQWDJHP
&RP UHGXomR DQDW{PLFD D GRV SDFLHQWHV DSUHVHQWDP UHVXOWDGRVVDWLVIDWyULRVHQTXDQWRTXHQRVSDFLHQWHVFRPUHGXomR QmRDQDW{PLFDRVUHVXOWDGRVVDWLVIDWyULRVVmRGDRUGHPGHD
2REMHWLYRGHVWHWUDEDOKRpDYDOLDURUHVXOWDGRGRWUDWDPHQWRFLU~UJL FRGDVOHV}HVGH/LVIUDQFVHJXQGRRFULWpULRGD$2)$6DYDOLDomR IXQFLRQDOSURSRVWDSHOD7KH$PHULFDQ2UWKRSDHGLF)RRW$QG$QNOH
6RFLHW\DWHQGLGDVQRQRVVRVHUYLoRQRSHUtRGRGHD
EHPFRPRDVXDHYROXomRHSRVVtYHLVFRPSOLFDo}HV
0$7(5,$,6(0e72'26
2SUHVHQWHHVWXGRpREVHUYDFLRQDOHUHWURVSHFWLYRGRVSDFLHQWHV FRPGLDJQyVWLFRGHIUDWXUDOX[DomRGH/LVIUDQFWUDWDGRVFLUXUJLFD PHQWHQRQRVVRVHUYLoRQRSHUtRGRGHD
2V&ULWpULRVGHLQFOXVmRIRUDPPDWXULGDGHHVTXHOpWLFDIUDWXUD OX[DomRRXOX[DomRGDDUWLFXODomRWDUVRPHWDWiUVLFDVHPOHV}HV SUpYLDVQRSpDFRPHWLGRHFRPLQGLFDomRGHWUDWDPHQWRFLU~UJLFR LQVWDELOLGDGHDUWLFXODUHGHVYLRV!PPGRVSDUkPHWURVUDGLRJUi ILFRVQRUPDLVGRSp
)RUDPOHYDQWDGRVMXQWRDRVHWRUGHDUTXLYRPpGLFRSDFLHQWHV TXHFXPSULUDPRVFULWpULRVGHLQFOXVmRRVTXDLVIRUDPFRQYLGDGRV SDUD SDUWLFLSDU GHVWH OHYDQWDPHQWR 'HVWHV FRPSDUHFHUDP HVSRQWDQHDPHQWH H IRUDP VXEPHWLGRV D XPD DYDOLDomR FOtQLFD H[DPH RUWRSpGLFR DWXDOL]DomR GH LQIRUPDo}HV SHUWLQHQWHV DR FDVRQRSURQWXiULRHWDEXODomRGRHVFRUH$2)$6HDXPHVWX GR UDGLRJUiILFR RQGH VH DYDOLRX D SUHVHQoD GH GHIRUPLGDGHV IDOrQFLDGRPDWHULDOGHVtQWHVHVLQDLVGHDUWURVHHRDOLQKDPHQWR yVVHRDWXDO
2 FRQKHFLPHQWR GDV UHODo}HV H GD DQDWRPLD UDGLROyJLFD GR Sp p LQGLVSHQViYHO SDUD R GLDJQyVWLFR H WUDWDPHQWR GHVVDV OH V}HV 2 FRPSOH[R GH /LVIUDQF p IRUPDGR SRU HVWUXWXUDV yVVHDVPHWDWDUVLDQRVFXQHLIRUPHVHFXEyLGHHOLJDPHQWDUHVOL JDPHQWRWUDQVYHUVRGRUVDOOLJDPHQWRWUDQVYHUVRSODQWDUOLJDPHQWR GH/LVIUDQFTXHGmRHVWUXWXUDHVXSRUWHDRDUFRSODQWDUVHQGRD EDVHGRPHWDWDUVLDQRRSRQWRFKDYHGDHVWDELOL]DomRGHVVD DUWLFXODomR$DUWLFXODomRGH/LVIUDQFWHPRIRU PDWRVHPHOKDQWHDXP´DUFRURPDQRµTXHFRQIHUHHVWDELOLGDGH MXQWDPHQWH FRP HVWUXWXUDV OLJDPHQWDUHV SULQFLSDOPHQWH R OLJD PHQWRGH/LVIUDQFTXHFRQHFWDRFXQHLIRUPHPHGLDOjEDVHGR PHWDWDUVLDQR2VSDUkPHWURVUDGLRJUiILFRVXVDGRV SDUDDYDOLDUDUHGXomRVmR
3DUDMXOJDUXPDUHGXomRDGHTXDGDIRUDPXWLOL]DGRVRVFULWpULRV SURSRVWRVSRU0\HUVRQTXHDYDOLDRHVSDoRHQWUHRHR PHWDWDUVLDQRVFRPRFXQHLIRUPHPHGLDOHLQWHUPpGLRGHYHVHU PPRkQJXORWDORPHWDWDUVLDQRQmRGHYHVHU!HGHVYLRV HQWUHRVPHWDWDUVLDQRVQRSODQRGRUVRSODQWDUQmRGHYHPH[LVWLU
$&ODVVLILFDomRRULJLQDOSURSRVWDSRU4XHQHNXVVPRGLILFDGD SRU+DUGFDVWOHHPDLVUHFHQWHPHQWHSRU0\HUVRQHWDO pQRVGLDVDWXDLVDPDLVXWLOL]DGD)LJXUDHOHYDHPFRQVLGHUDomR DLPDJHPUDGLRJUiILFDHRVVLQDLVGHLQFRQJUXrQFLD 2VUHVXOWDGRVGDSUHVHQoDGHRVWHRDUWURVHHRUHVXOWDGRGRHVFRUH $2)$6IRUDPVXEPHWLGRVjDQiOLVHHVWDWtVWLFDSRUVXEJUXSRV XWLOL]DQGRSURJUDPD3URSKHFVRIWZDUHSDUD:LQGRZV%%1 6\VWHPVDQG7HFKQRORJLHV6DQ)UDQFLVFR&$TXHUHDOL]RXDQiOL VHVQmRSDUDPpWULFDVSDUDDYDOLDomRGRVGDGRVXWLOL]DQGRRVWHVWHV GH7SDUDGXDVDQiOLVHV7RWHVWHH[DWRGH)LVKHU)HRWHVWHGH 0DQQ:KLWQH\0:)RLFRQVLGHUDGRHVWDWLVWLFDPHQWHVLJQLILFDQWH SDUDDQiOLVHGRVUHVXOWDGRVXPS
5(68/7$'26
2WHPSRGHVHJXLPHQWRIRLHPPpGLDPHVHVYDULDQGRGHD PHVHV3DUWLFLSDUDPSDFLHQWHVVHQGRKRPHQV FRPPpGLDGHLGDGHGHDQRVYDULDQGRGHDDQRVFRP OHVmRSUHGRPLQDQGRGRODGR(VTXHUGRDSUHVHQWDQGR FDVRVFRPROHV}HVH[SRVWDV
2WUDWDPHQWRFLU~UJLFRIRLUHDOL]DGRQDPDLRULDGRVFDVRVFDVRV QRGLDGRWUDXPDFRPPpGLDGHGHPRUDGHKRUDVHFDVRV
2VFDVRVIRUDPGLVWULEXtGRVVHJXQGRDFODVVLILFDomRGH+DUGFDVWOH
PRGLILFDGDHRUHVXOWDGRIRLRVHJXLQWH7DEHOD
$ % &
$ODWHUDO $PHGLDO %PHGLDO %ODWHUDO &WRWDO &SDUFLDO
&DVRV 2 0 07 08 0 2
10,53 0 36,84 42,10 0 10,53
7DEHOD 'LVWULEXLomR GRV FDVRV DYDOLDGRV VHJXQGR D FODVVLILFDomR GH +DUGFDVWOHPRGLILFDGDHPQ~PHURGHFDVRVHSRUFHQWDJHP
$ FRQGXWD WHUDSrXWLFD UHDOL]DGD IRL HVTXHPDWL]DGD HP JUiILFR DQH[R)LJXUDVHQGRTXHRVFDVRVTXHVHDSUHVHQWDUDPFRPR OHV}HVH[SRVWDVFDVRV²IRUDPWUDWDGDVFRPFLUXUJLD DEHUWDFRPDPSORGHVEULGDPHQWRDQWHVGDIL[DomR
)LJXUD'LVWULEXLomRVHJXQGRRWUDWDPHQWRUHDOL]DGRGRVFDVRVDYDOLDGRV H[SUHVVRVHPQ~PHURDEVROXWRHSRUFHQWDJHP5HGXomRDEHUWDHIL[DomRFRP ILRGH.LUVFKQHU.5$)3UHGXomRLQFUXHQWDHIL[DomRSHUFXWkQHDFRPILRV GH.5,)3UHGXomRDEHUWDHIL[DomRFRPSDUDIXVRV5$),UHGXomRDEHUWD HIL[DomRFRPSDUDIXVRVHILRGH.5$),3UHGXomRDEHUWDHIL[DomRFRP SDUDIXVRVILRVGH.HIL[DGRUH[WHUQR5$),3)(
(PWUDEDOKRVUHFHQWHVRQGHVHDQDOLVRXRXVRGRHVFRUH$2)$6 FRPRSDUkPHWURGHDYDOLDomRGHUHVXOWDGRIRLREVHUYDGRTXHD UHGXomR DQDW{PLFD SURSRUFLRQD FRP VLJQLILFkQFLD HVWDWtVWLFD XP HVFRUH PHOKRU 2V SDFLHQWHV DSUHVHQWDUDP PpGLD GR
HVFRUH$2)$6GHYDULDQGRGHDGHVYLRSDGUmRGH 2UHIHULGRHVFRUHpEDVHDGRQXPDHVFDODTXHYDULDGHD SRQWRVOHYDQGRHPFRQVLGHUDomRDVSHFWRVFOtQLFRVHUDGLR JUiILFRV
7HPVHDGRWDGRSDUDDQiOLVHGHVHXVUHVXOWDGRVR VHJXLQWHHVFDORQDPHQWR7DEHODH
Excelente 90 a 100 Bom 80 a 90 Razoável 70 a 80
Ruim Menor que 70
7DEHOD$QiOLVHGHVHXVUHVXOWDGRVRVHJXLQWHHVFDORQDPHQWR (PQRVVDFDVXtVWLFDRVUHVXOWDGRVREWLGRVIRUDP
Excelente 3 casos Bom 6 casos Razoável 3 casos Ruim 7 casos 7DEHOD5HVXOWDGRVREWLGRV
1D DYDOLDomR FOtQLFRUDGLRJUiILFD IRUDP HYLGHQFLDGRV VLQDLV UD
6XEJUXSRV 3DFLHQWHVQ HVFRUH$2)$6
0ÑGLD'3 3 7HVWH
Lesão ligamentar pura 5 0.361 T
Lesão combinada ( ligamentar + óssea) 14 0.361 T
Lesão exposta 5 0.302 T
Lesão fechada 14 0.302 T
Redução anatômica 12 M.W.
Redução não anatômica (insufi ciente) 7 M.W.
Lesão isolada 14 M.W.
Politraumatizado 5 M.W.
Osteoartrose presente 8 0.152 M.W.
Osteoartrose ausente 11 0.152 M.W.
7DEHOD$QiOLVHFRPSDUDWLYDGRVUHVXOWDGRVGRHVFRUH$2)$6GRVFDVRVDYDOLDGRVQRVGLIHUHQWHVVXEJUXSRV$QiOLVHVQmRSDUDPpWULFDVSDUDDYDOLDomRGRV GDGRVXWLOL]DQGRRVWHVWHVGH7SDUDGXDVDQiOLVHV7RWHVWHH[DWRGH)LVKHU)HRWHVWHGH0DQQ:KLWQH\0:GHVYLRSDGUmR'3WHVWHGHVLJQLILFkQFLD FRQVLGHUDGRVLJQLILFDQWHTXDQGR3
GLRJUiILFRVGHDUWURVHGDDUWLFXODomRGH/LVIUDQFHPSDFLHQWHV HGHIRUPLGDGHYLVtYHOHPFDVRV
)RUDPREVHUYDGDVFRPRFRPSOLFDo}HVGDIDVHDJXGD
• FDVRGHPiFREHUWXUDFXWkQHDGHFRUUHQWHGHH[SORVmRGRSp • FDVRFRPVtQWHVHLQDGHTXDGDVHQGRVXEPHWLGRDQRYDLQWHU
YHQomRDLQGDQDLQWHUQDomR
• 1mRIRLGLDJQRVWLFDGDVtQGURPHFRPSDUWLPHQWDOLQIHFomRRXVROWXUD
GRPDWHULDOGHVtQWHVH
',6&866®2
&RPRGHVFULWRQDOLWHUDWXUDDVOHV}HVGH/LVIUDQFVmRGHFRUUHQWHV GHWUDXPDVGHDOWDHQHUJLD(PQRVVROHYDQWDPHQWRRDFL
GHQWHPRWRFLFOtVWLFRDSDUHFHXFRPRDSULQFLSDOFDXVD)LJXUD FRQFRUGDQGRFRPDOLWHUDWXUD
+iTXHPGHIHQGDDLQWHUYHQomRPDLVSUHFRFHSRVVtYHOSDUDGUH QDJHPGRKHPDWRPDHHYLWDUVtQGURPHFRPSDUWLPHQWDORXWURV DGYRJDPXPDLQWHUYHQomRDSyVDOJXQVGLDVSDUDGLPLQXLURHGHPD HYLWDQGRGHLVFrQFLDVHQHFURVHGDSHOH([LVWHPERQVUHVXOWD
GRVGHVFULWRVFRPUHGXomRDEHUWDDWpVHPDQDVDSyVDOHVmR
(PQRVVDVpULHRDWUDVRQRWUDWDPHQWRLQLFLDOFDVRVTXHQmRIRUDP VXEPHWLGRVDWUDWDPHQWRFLU~UJLFRQDFKHJDGDSURSRUFLRQRXXPD PpGLDGHGLDVDWpDFLUXUJLDHHVWHVSDFLHQWHVDSUHVHQWDUDP PpGLDGHQRHVFRUH$2)$6UHSUHVHQWDQGRXPERPUHVXOWD GRFRPSDUDGRjPpGLDREWLGDQDDPRVWUD7DEHOD1mR SDUHFHKDYHUFRUUHODomRHQWUHRDWUDVRGRSURFHGLPHQWRFLU~UJLFR HDSUHVHQoDGH2VWHRDUWURVH
&DVRV 0ÑGLDHVFRUH
$2)$6 RVWHRDUWURVH3UHVHQÐD
KRUDV 14 73,92 6
!KRUDV 5 87,6 2
7RWDO 19 77,53 8
7DEHOD$YDOLDomRFRPSDUDWLYDGRVFDVRVWUDWDGRVQDFKHJDGDKRUDV HRVWUDWDGRVFRPPDLVGHKRUDVGHHYROXomRDYDOLDQGRVHRHVFRUH$2)$6 HDSUHVHQoDGH2VWHRDUWURVH
(PWUDEDOKRVUHFHQWHVRQGHVHDQDOLVRXRXVRGRHVFRUH$2)$6 FRPRSDUkPHWURGHDYDOLDomRGHUHVXOWDGRSyVRSHUDWyULRIRLRE VHUYDGRTXHDUHGXomRDQDW{PLFDSURSRUFLRQDFRPVLJQLILFkQFLD HVWDWtVWLFDXPHVFRUHPDLRU$DQiOLVHGRVGDGRVREWLGRV
GHPRQVWUDTXHH[LVWHUHODomRHQWUHDTXDOLGDGHGDUHGXomRRE WLGDHRUHVXOWDGRGRWUDWDPHQWR7DEHODUHIOHWLGRQRHVFRUH $2)$6S FRQFRUGDQGRRSURSRVWRQDOLWHUDWXUDRQGH DUHGXomRDQDW{PLFDpIDWRUHVVHQFLDOGHERPUHVXOWDGRWHUDSrX
6XEJUXSRV 3DFLHQWHVQ 3UHVHQÐDGHDUWURVHSÚVWUDXPDQ 1£ 3 WHVWH
Lesão ligamentar pura 5 2 40,00 1 Fisher
Lesão combinada (ligamentar + óssea) 14 6 42,85 1 Fisher
Lesão exposta 5 2 40,00 1 Fisher
Lesão fechada 14 6 42,85 1 Fisher
Redução anatômica 12 3 25,00 0.0739 Fisher
Redução não anatômica (insufi ciente) 7 5 71,42 0.0739 Fisher
Lesão isolada 14 5 35,71 0,6027 Fisher
Politraumatismo 5 3 60,00 0,6027 Fisher
7DEHOD$QiOLVHFRPSDUDWLYDGRVFDVRVDYDOLDGRVRQGHRFRUUHUDP2VWHRDUWURVHQRVGLIHUHQWHVVXEJUXSRVDQiOLVHVQmRSDUDPpWULFDVSDUDDYDOLDomR GRVGDGRVXWLOL]DQGRRVWHVWHVGH7SDUDGXDVDQiOLVHV7RWHVWHH[DWRGH)LVKHU)HRWHVWHGH0DQQ:KLWQH\0:WHVWHGHVLJQLILFkQFLDFRQVLGHUDGR VLJQLILFDQWHTXDQGR3
)LJXUDDQRVPDVFXOLQRYLWLPDGHTXHGDGHDOWXUDOHVmRWLSR&SDUFLDO HIHFKDGDVXEPHWLGRDWUDWDPHQWRFLU~UJLFRDSyVGLDVGDOHVmRVHQGRTXHD UHGXomRIRLFRQVLGHUDGDDGHTXDGD$YDOLDGRDSyVDQRVHPHVHVFRPERD DYDOLDomRFOLQLFRUDGLRJUiILFDVFRUH$2)$6 $UDGLRJUDILDSUpRSHUDWyULD %UDGLRJUDILDSyVRSHUDWyULDLPHGLDWD&UDGLRJUDILDTXDQGRGDHQWUHYLVWD
(QFRQWURXVHUHODomRVLJQLILFDQWHHQWUHRHVFRUH$2)$6HRIDWR GRSDFLHQWHVHUSROLWUDXPDWL]DGRDSUHVHQWDQGRXPHVFRUH$2)$6 PHQRU S IDWR QmR REVHUYDGR QRV WUDEDOKRV DQDOLVD GRV7DEHOD,VWRWDOYH]VHH[SOLTXHSHORIDWRGHVWHHVFRUH
OHYDUHPFRQVLGHUDomRIDWRUHVVXEMHWLYRVHTXHRSDFLHQWHFRP P~OWLSODV OHV}HV DSUHVHQWH VHTHODV GH RXWURV WUDXPDV R TXH WRUQDGLItFLODGLVVRFLDomRGHXPWRGRSDUDDQDOLVDUDFRQWULEXLomR GHXPDOHVmRHVSHFtILFD
+RXYHFRPRFRPSOLFDomRDSUHVHQoDGH2VWHRDUWURVHHPFDVRV FRQILUPDQGRDFRPRDSULQFLSDOFRPSOLFDomRUDGLRJUiILFD DGYLQGD GHVWDV OHV}HV1mR KRXYH UHODomR FRP VLJQLILFkQFLD
HVWDWtVWLFDSHQWUHDSUHVHQoDGHRVWHRDUWURVHHRVVXE JUXSRVFRQIRUPHGHVFULWRDEDL[R7DEHOD
)LJXUDDQRVPDVFXOLQRDFLGHQWHDXWRPRELOtVWLFROHVmRWLSR%ODWHUDO VXEPHWLGR D WUDWDPHQWR FLU~UJLFR FRP KRUDV GH HYROXomR HYROXLX FRP DUWURVHSyVWUDXPiWLFDHGHIRUPLGDGHGDFROXQDPHGLDO$SUHVHQWRXVFRUH $2)$6 UDGLRJUDILDSUpRSHUDWyULDUDGLRJUDILDSyVRSHUDWyULD UDGLRJUDILDTXDQGRGDHQWUHYLVWD
(VWHUHVXOWDGRQmRFRQGL]FRPWUDEDOKRVUHFHQWHVVREUHRDVVXQWR TXHFRUUHODFLRQDDRFRUUrQFLDGHDUWURVHGDDUWLFXODomRGH/LVIUDQF FRPDTXDOLGDGHGDUHGXomRREWLGDQDFLUXUJLD7DOYH]HVVD
GLIHUHQoDHVWDWtVWLFDVHGHYDDRWDPDQKRGHQRVVDDPRVWUDTXHIRL PHQRUGRTXHXPGRVUHIHULGRVWUDEDOKRVHDSUHVHQWRXGLIHUHQoD LPSRUWDQWHGHUHODomRDRQ~PHURGHFDVRVGHRVWHRDUWURVHHP SDFLHQWHVFRPUHGXomRQmRDQDW{PLFDRWUDEDOKRFLWDGRPRVWURX TXHWRGRVRVFDVRVHPTXHDUHGXomRIRLFRQVLGHUDGDLQDGHTXDGD KRXYHRVWHRDUWURVH
&21&/86®2
$OHVmRGH/LVIUDQFpXPDOHVmRJUDYHDSUHVHQWDFRPSOLFDo}HVLQ FDSDFLWDQWHVVHQGRDPDLVLPSRUWDQWHDRVWHRDUWURVHSyVWUDXPi WLFDTXHSRGHHYROXLUFRPGRUHOLPLWDomRIXQFLRQDOVLJQLILFDWLYD 1mRKRXYHGLIHUHQoDGRVUHVXOWDGRVWUDWDGRVWDUGLDPHQWHFRPSD UDGRVDRVTXHIRUDPVXEPHWLGRVDRWUDWDPHQWRQDFKHJDGDUHIRU oDQGRDLGpLDGHTXHRPDLVLPSRUWDQWHpDTXDOLGDGHGDUHGXomR HQmRDSUHFRFLGDGHGRWUDWDPHQWR1RHQWDQWRFRQVLGHUDPRV PXLWR LPSRUWDQWH R WUDWDPHQWR FLU~UJLFR SUHFRFH SDUD SUHYHQLU (QFRQWUDPRVDGHIRUPLGDGHSyVWUDXPiWLFDFDVRVHDDUWURVH GDDUWLFXODomRGH/LVIUDQFFDVRVFRPRDVFRPSOLFDo}HVWDU GLDVPDLVFRPXQVHPFRQVRQkQFLDFRPDOLWHUDWXUDDWXDO
(VVDVFRPSOLFDo}HVWrPFRPRLQGLFDomRWHUDSrXWLFDDDUWURGHVH GDDUWLFXODomRSURFXUDQGRFRUULJLUHYHQWXDLVGHIRUPLGDGHV
)LJXUD'HYHVHDWHQWDUSDUDRIDWRGHTXHQHPVHPSUHVLQDO UDGLRJUiILFRGHRVWHRDUWURVHFRUUHODFLRQDFRPSLRUHVUHVXOWD GRV FOtQLFRV$OJXQV SDFLHQWHV GH QRVVD DPRVWUD FRP
5()(5È1&,$6
HRXWUDWDUDVtQGURPHFRPSDUWLPHQWDOGRSpTXHpDFRPSOLFDomR DJXGDPDLVIUHTHQWHHWHPtYHO
3DUHFHKDYHUXPDUHODomRHQWUHRIDWRGRSDFLHQWHVHUYtWLPDGHSROL WUDXPDWLVPRFRPSLRUHVUHVXOWDGRVUHIOHWLGRVQRHVFRUH$2)$6
2 HVFRUH $2)$6 SDUHFH VHU XP ERP SDUkPHWUR GH DQiOLVH GR WUDWDPHQWRGDIUDWXUDOX[DomRGH/LVIUDQFQHFHVVLWDQGRGHXPD DQiOLVH SURVSHFWLYD HRX FRP XPD FDVXtVWLFD PDLRU SDUD XPD DYDOLDomRPDLVVLJQLILFDWLYDGDHILFiFLDGRVHXXVR
$UQW]&9HLJWK5+DQVHP6)UDFWXUHVDQGIUDFWXUHGLVORFDWLRQVRIWKHWDUVR PHWDWDUVDOMRLQW-%RQH-RLQW6XUJ$P
0DF\1'H%RHU30LGWDUVDOGLVORFDWLRQRIWKHILUVW5D\$FDVHUHSRUW-%RQH -RLQW6XUJ$P
$LWNHP$33RXOVRQ''LVORFDWLRQRIWKHWDUVRPHWDWDUVDOMRLQW-%RQH-RLQW6XUJ $P
+DUGFDVWOH3+5HVFKDXHU5.XWVFKD/LVVEHUJ(6FKRIIPDQQ:,QMXULHVWR WKHPHWDWDUVDOMRLQW,QFLGHQFHFODVVLILFDWLRQDQGWUHDWPHQW-%RQH-RLQW6XUJ %U
%X]]DUG%0%ULJJV3-6XUJLFDOPDQDJHPHQWRIDFXWHWDUVRPHWDWDUVDOIUDFWXUH GLVORFDWLRQLQWKHDGXOW&OLQ2UWKRS5HODW5HV
3HUXJLD ' %DVLOH $ %DWWDJKOLD $ 6WRSSRQL 0 'H 6LPHRQLEXV $8 )UDFWXUH GLVORFDWLRQVRI/LVIUDQF VMRLQWWUHDWHGZLWKFORVHGUHGXFWLRQDQGSHUFXWDQHRXV IL[DWLRQ,QW2UWKRS
5LFKWHU0:LSSHUPDQQ%.UHWWHN&6FKUDWW+(+XIQHU77KHUPDQ+)UDF WXUHGLVORFDWLRQVRIWKHPLGIRRWRFRUUHQFHFDXVHVDQGORQJWHUPUHVXOWV)RRW $QNOH,QW
3HUURQ$'%UDG\:-.HWV7(2UWKRSHGLU3LWIDOOVLQWKH('OLVIUDQFIUDFWXUH GLVORFDWLRQ$P-(PHUJ0HG
'XGNR6.XV]'3LHU]FKDD$/LVIUDQFLQMXU\oIL[DWLRQZLWK.LUVFKQHUZLUHV )RRW$QNOH6XUJ
9XRUL-$UR+/LVIUDQFMRLQWLQMXULHVWUDXPDPHFKDQLVPVDQGDVVRFLDWHGLQMX ULHV-7UDXPD
%UXQHW-:LOH\-7KHODWHUHVXOWVRIWDUVRPHWDWDUVDOMRLQWLQMXULHV-%RQH-RLQW 6XUJ%U
)DFLV]HZVNL7%XUNV50DQDVWHU%6XEWOHLQMXULHVRIWKHOLVIUDQFMRLQW-%RQH -RLQW6XUJ$P
6FKHQFN5+HFNPDQ-)UDFWXUHVDQGGLVORFDWLRQVRIWKHIRUHIRRWRSHUDWLYH DQGQRQRSHUDWLYHWUHDWPHQW-$P$FDG2UWKRS6XUJ
7UHYLQR6.RGURV6&RQWURYHUVLHVLQWDUVRPHWDWDUVDOLQMXULHV2UWKRS&OLQ1RUWK $P
*RVVHQV 0 'H 6WRRS 1 /LVIUDQF )UDFWXUH 'LVORFDWLRQV HWLRORJ\ UDGLRORJ\ DQGUHVXOWVRIWUHDWPHQW$UHYLHZRIFDVHV&OLQ2UWKRS5HODW5HV
+HFNPDQ-')UDFWXUHVDQGGLVORFDWLRQRIWKHIRRW,QMXULHVRIWKHWDUVRPHWD WDUVDO/LVIUDQF VMRLQWV,Q5RFNZRRG&$-U*UHHQ'3HGLWRUV)UDFWXUHVLQ DGXOWVWK3KLODGHOSKLD/LSSLQFRWW
0\HUVRQ0)LVKHU5%XUJHVV$.HQ]RUD-()UDFWXUHGLVORFDWLRQVRIWKHWDU VRPDWDWDUVDOMRLQWV(QGUHVXOWVFRUUHODWHGZLWKSDWKRORJ\DQGWUHDWPHQW)RRW $QNOH
0\HUVRQ067KHGLDJQRVLVDQGWUHDWPHQWRILQMXU\WRWKHWDUVRPHWDWDUVDOMRLQW FRPSOH[-%RQH-RLQW6XUJ%U
.RUUHV'63VLFKDULV,3*DQGDLILV13DSDGRSXORV(&=RXERV$%1LNRORSRX ORV.2XWFRPHDIWHUDQDWRPLFUHGXFWLRQDQGWUDQVIL[DWLRQZLWK.LUVFKQHUZLUHV RI/LVIUDQFMRLQWLQMXULHV(XU-2UWKRS6XUJ7UDXPDWRO :LOH\--7KHPHFKDQLVPRIWDUVRPHWDWDUVDOMRLQWLQMXULHV-%RQH-RLQW6XUJ%U
3DOPD/6DQWXFFL$6DEHWWD635DSDOL6$QDWRP\RIWKH/LVIUDQFMRLQWFRP SOH[)RRW$QNOH
$UQW]&79HLK5*+DQVHQ67)UDFWXUHVDQGIUDFWXUHGLVORFDWLRQVRIWKHWDUVR PHWDWDUVDOMRLQW-%RQH-RLQW$P
&XUWLV0-0\HUVRQ066]XUD%7DUVRPHWDWDUVDOMRLQWLQMXULHVLQWKHDWKOHWH$P -6SRUW0HG
.XR567HMZDQL1&'L*LRYDQQL&:+ROW6.%HQLUVFKNH6.+DQVHQ67HW DO2XWFRPHDIWHURSHQUHGXFWLRQDQGLQWHUQDOIL[DWLRQRI/LVIUDQFMRLQWLQMXULHV-%RQH-RLQW6XUJ$P
5RVHQEHUJ*$3DWWHUVRQ%07DUVRPHWDWDUVDO/LVIUDQF VIUDFWXUHGLVORFD WLRQV$P-2UWKRS6XSSO
/DUD /&5 $OYHV *9 &DUYDOKR 5&0 )UDQFR )LOKR 1 7UDWDPHQWR GD IUDWXUD OX[D°¬RGH/LVIUDQF5HY%UDV2UWRS
6DQWLQ5$/)HUUHLUD5&0HUFDGDQWH07/HV½HVGDDUWLFXOD°¬RGH/LVIUDQF 5HY%UDV2UWRS
6DORP¬R2$UUR\R/6)UDWXUDOX[D°¬RGH/LVIUDQFWUDWDPHQWR5HY%UDV2U WRS
3HLFKD*/DERYLW]-6WHLEHUW)-*UHFKHQLJ::HLJOHLQ$3UHLGOHU.:HWDO 7KHDQDWRP\RIWKHMRLQWDVDULVNIDFWRUIRU/LVIUDQFGLVORFDWLRQDQGIUDFWXUH GLVORFDWLRQ-%RQH-RLQW6XUJ%U
%HUJ-+6LOYHUL&3+DUULV09DULDQWRIWKH/LVIUDQFIUDFWXUHGLVORFDWLRQ$FDVH UHSRUWDQGUHYLHZRIWKHOLWHUDWXUH-2UWKRS7UDXPD
7RUUHV-00LUDQGD507RUUHV&0//DUD9$3LPHQWD3737UDWDPHQWRFLUÂU JLFRGDIUDWXUDOX[D°¬RGH/LVIUDQF5HY%UDV2UWRS
<DPDVKLWD)6DNDNLGD.+DUD.6HQSR.'LDVWDVLVEHWZHHQWKHPHGLDODQG WKHLQWHUPHGLDWHFXQHLIRUPV-%RQH-RLQW6XUJ%U
0\HUVRQ07KHGLDJQRVLVDQGWUHDWPHQWRILQMXU\WRWKHWDUVRPHWDWDUVDOMRLQW FRPSOH[2UWKRS&OLQ1RUWK$P
.LWDRND +% $OH[DQGHU ,- $GHHODU 56 1XQOH\ -$ 0\HUVRQ 06 6DQGHUV 0 &OLQLFDOUDWLQJV\VWHPVIRUWKHDQNOHKLQGIRRWPLGIRRWKDOOX[DQGOHVVHUWRHV )RRW$QNOH,QW