Pediatric Wrist.

Pediatric wrist injuries pose unique diagnostic challenges due to distinct bone characteristics in children and their diverse injury patterns. The dynamic development of the wrist, marked by changes in bone age and emerging ossification centers, is crucial to evaluate growth and identify potential pathologies. The skeletal composition, rich in cartilage, renders bones relatively weaker yet more elastic, impacting their susceptibility to fracture. Forearm fractures display diverse patterns influenced by torsional forces. Scaphoid fractures, less common in children, differ from those in adults. Conditions like Madelung's deformity and ulnar variance are more common wrist disorders in the pediatric population. In addition, the scarcity and nonspecificity of symptoms in those with tendon injuries and triangular fibrocartilage complex lesions can be diagnostically challenging. This article reviews pediatric wrist injuries, emphasizing ossification patterns, common fracture types, and developmental variants. Grasping these complexities in pediatric wrist development and associated pathologies is essential for precise diagnosis and treatment.

[Trans-scapho-perilunar fracture-dislocation: a case report]. / Fractura-luxación transescafo-perilunar: reporte de un caso clínico.

Trans-scaphoid perilunate fractures-dislocations are rare injuries caused by high-energy trauma of the wrist. Diagnosis is based on medical history, physical examination, and tools such as radiographs, computed tomography scan, and magnetic resonance imaging. Early treatment consists of closed reduction and casting to stabilize the limb. Definitive treatment is surgical and includes bone and soft tissue repair. A case of trans-scaphoid perilunate fracture-dislocation is presented, along with diagnosis, management and outcome.

Las fracturas-luxaciones transescafo-perilunares son lesiones infrecuentes causadas por impactos de alta energía hacia la muñeca. El diagnóstico se basa en la historia clínica, exploración física y herramientas como la radiografía, la tomografía computarizada y la resonancia magnética. El manejo inmediato consiste en una reducción cerrada e inmovilización para estabilizar la extremidad. El tratamiento definitivo es de carácter quirúrgico e incluye la reparación ósea y de tejidos blandos. Se presenta un caso de fractura-luxación transescafo-perilunar, su diagnóstico, manejo y evolución.

Comparison of Sociodemographic and Radiographic Features in Distal Radio Fracture Treatment: Hand Surgeons versus Non-specialists / Comparação de características sociodemográficas e radiográficas no tratamento de fratura de rádio distal: Cirurgiões de mão versus não especialistas

Abstract Objective: This study evaluated sociodemographic and radiographic features of patients with distal radial fractures treated at a trauma hospital in southern Brazil, comparing those treated by hand surgery specialists (group 1) and non-specialists (group 2). Methods: This study consists of a retrospective cohort of 200 patients treated in 2020. After reviewing medical records and radiographs, the following parameters were analyzed: age, gender, trauma mechanism, laterality, associated comorbidities and fractures, fracture classification (AO), radial height, radial inclination, and volar inclination. Comparison of the two groups used the Student t-test, chi-square test, or Fisher exact test. Results: Most subjects were women (54%), sustained low-energy traumas (58%), and were left-handed (53%). Group 1 had a lower mean age (50.2 years); most of their subjects sustained high-energy trauma (54%) and had type C fractures (73%); type A fractures prevailed in group 2 (72%). Radiographs showed a significant difference regarding the mean radial inclination (21.5° in group 1 and 16.5° in group 2 [p < 0.001] in women, and 21.3° in group 1 and 17° in group 2 [p < 0.001] in men) and volar inclination (10.1° and 12.8° in groups 1 and 2, respectively [p < 0.001]). In addition, the absolute number of cases with reestablished anatomical parameters per the three evaluated variables was also significantly different; all parameters were better in group 1. Conclusion: Hand surgeons treated the most severe fractures and had the best radiographic outcomes.

Resumo Objetivo: Avaliar as características sociodemográficas e radiográficas dos pacientes com fratura de rádio distal tratados em um hospital de trauma no sul do Brasil, comparando os casos tratados pelos especialistas em cirurgia da mão (grupo 1) com aqueles tratados por não especialistas (grupo 2). Métodos: Coorte retrospectiva realizada com 200 pacientes, no ano de 2020. Por meio da revisão de prontuários e radiografias, analisaram-se: idade, sexo, mecanismo de trauma, lateralidade, presença de comorbidades e fraturas associadas, classificação da fratura (AO), altura radial, inclinação radial e, inclinação volar. Comparou-se os dois grupos por meio do teste t de Student, qui-quadrado ou exato de Fisher. Resultados: A maioria era de pacientes do sexo feminino (54%), traumas de baixa energia (58%) e lateralidade esquerda (53%). O grupo 1 apresentou média de idade menor (50,2 anos), traumas de alta energia (54%), e fraturas tipo C (73%), enquanto no grupo 2 fraturas tipo A prevaleceram (72%). As radiografias apresentaram diferença significativa quanto à média de valores de inclinação radial (21,5° no grupo 1 e 16,5° no grupo 2 [p < 0,001] nas mulheres e, 21,3° no grupo 1 e 17° no grupo 2 [p < 0,001] nos homens) e inclinação volar (10,1° e 12,8° no grupo 1 e 2, respectivamente [p < 0,001]), bem como no número absoluto de casos que reestabeleceram os parâmetros anatômicos nas três variáveis avaliadas, sendo todos melhores no grupo 1. Conclusão: Os cirurgiões de mão trataram as fraturas mais graves e apresentaram os melhores resultados radiográficos.

Late consolidation of the scaphoid. Case report and literature review.

Scaphoid fractures are a common wrist injury accounting for 2-7% of all adult fractures. Nonunion is described in 5-12% of cases leading to osteoarthritis. Several classifications have been developed focused on this pathology and its complication. We present a case of a 28 years old male patient with a scaphoid fracture and nonunion who spontaneously consolidates without treatment. We performed a literature review to recognize this pathology, its common evolution and possible treatment options.

Las fracturas de escafoides son una lesión frecuente de la muñeca y representan de 2-7% de todas las fracturas en adultos. La no unión se describe en 5-12% de los casos y conduce a la osteoartritis. Se han desarrollado varias clasificaciones centradas en esta patología y su complicación. Presentamos el caso de un paciente varón de 28 años con fractura y no unión de escafoides que consolida espontáneamente sin tratamiento. Realizamos una revisión bibliográfica para reconocer esta patología, su evolución habitual y las posibles opciones de tratamiento.

Anterior dislocation of the lunate due to a high-energy trauma.

Semilunate and perilunate dislocation is an injury that mostly occurs when the subject is exposed to a high-energy trauma. Considered severe, it compromises the stability and function of the wrist. The case presented is that of a 50-year-old male patient who after having a motorcycle accident arrived at the ER with neurovascular affectation, swelling, deformity and a considerable decrease of the wrist joint movement. He was also referring severe pain. A Henry (Volar) intervention was done with the help of external fixation of the lunate, followed by K-wire fixation, once a prior closed reduction was unsuccessfully attempted. The scaphoid was connected to the semilunate, and then the latter with the capitate. Ligament reconstruction followed, and stability was clinically confirmed with an X-ray. Although improvement of symptomatology was observed during the follow-up analysis, motion of the wrist remained limited. Even with the best treatment, in terms of functionality, this type of injury presents a poor prognosis.

La luxación semilunar y perilunar es una lesión que se produce principalmente cuando el sujeto está expuesto a un traumatismo de alta energía. Considerada grave, compromete la estabilidad y la función de la muñeca. El caso presentado es el de un paciente varón de 50 años que tras sufrir un accidente de motocicleta llegó a urgencias con afectación neurovascular, tumefacción, deformidad y una considerable disminución del movimiento articular de la muñeca. También refería fuertes dolores. Se realizó una intervención de Henry (Volar) con la ayuda de fijación externa del lunar, seguida de fijación con agujas de Kirschner, una vez que se había intentado sin éxito una reducción cerrada previa. El escafoides se conectó con el semilunar y luego éste con el capitado. A continuación se reconstruyó el ligamento y se confirmó clínicamente la estabilidad con una radiografía. Aunque se observó una mejora de la sintomatología durante el análisis de seguimiento, el movimiento de la muñeca seguía siendo limitado. Incluso con el mejor tratamiento, en términos de funcionalidad, este tipo de lesión presenta un mal pronóstico.

Reparación del músculo pronador cuadrado en fracturas de radio distal tratadas con fijación interna por abordaje palmar: una revisión sistemática y metaanálisis / Repair of the pronator quadratus muscle in distal radius fractures treated with internal fixation through a palmar approach: a systematic review and meta-analysis

Introducción: el músculo pronador cuadrado funciona como un estabilizador dinámico de la articulación radiocubital distal. Su reparación posterior a la fijación interna con placa de bloqueo volar en fracturas distales del radio es controvertida. Objetivo: determinar si la reparación del músculo pronador cuadrado influye en los resultados clínicos y funcionales de pacientes con fractura de radio distal que se sometieron a reducción abierta y fijación interna con placa de bloqueo volar. Materiales y métodos: se realizó una revisión sistemática y metanálisis. Las bases de datos analizadas fueron PubMed/Medline, Embase y Bireme/Lilacs (búsqueda realizada hasta el 20 de febrero del año 2023). Los términos de búsqueda fueron: distal radius fracture AND volar plate AND pronator quadratus. Se determinó la calidad metodológica según el manual de revisiones Cochrane. Resultados: en total se incluyeron 4 ensayos clínicos aleatorizados de adecuada calidad metodológica, lo cual corresponde al análisis de 213 participantes. Existen mejores resultados en la puntuación DASH a los 12 meses de seguimiento en el grupo de no reparación del músculo pronador cuadrado DM 2,8 [IC 95%: 0,51;5,10]. No hubo diferencias significativas al año de seguimiento en las puntuaciones de dolor, rangos de movilidad de la muñeca, fuerza de agarre e incidencia de complicaciones. Conclusión: no existe evidencia que sustente la reparación rutinaria del músculo pronador cuadrado posterior a la fijación interna con placa de bloqueo volar en las fracturas de radio distal. (AU)

Introduction: the pronator quadratus muscle functions as a dynamic stabilizer of the distal radioulnar joint, and its repair after internal fixation with volar locking plate in distal radius fractures is controversial. Objective: to determine whether the repair of the pronator quadratus muscle influences the clinical and functional outcomes of patients with distal radius fracture who underwent open reduction and internal fixation with volar locking plate. Materials and methods: a systematic review and meta-analysis were conducted. The analyzed databases were Pubmed/Medline, Embase, and Bireme/Lilacs (search performed until February 20th, 2023). The search terms were distal radius fracture AND volar plate AND pronator quadratus. Methodological quality was determined according to the Cochrane Reviewer's Handbook. Results: a total of 4 randomized clinical trials of adequate methodological quality, corresponding to the analysis of 213 participants, were included. Better DASH scores were observed at 12 months of follow-up in the non-repair group of the pronator quadratus muscle, with a mean difference of 2.8 [95% CI 0.51; 5.10]. There were no significant differences at one-year follow-up in pain scores, wrist mobility ranges, grip strength, and incidence of complications. Conclusion: there is no evidence to support routine repair of the pronator quadratus muscle after internal fixation with volar locking plate in distal radius fractures. (AU)

Total Wrist Arthrodesis: A Preoperative Test to Predict Functional Outcomes / Artrodese total do punho: Um teste pré-operatório para prever resultados funcionais

Abstract Objective The study aims to demonstrate an evaluation method to predict the functional success of total wrist arthrodesis (TWA) and assist its indication. Methods A prospective study including ten patients submitted to (TWA) posttraumatic arthritis. Exclusion criteria were patients who lost postoperative follow-up or incomplete information in the medical record. The objective functional assessment (handgrip strength, three-point pinch, lateral pinch and pulp-pulp pinch) and the subjective functional assessment (DASH, PRWE, EVA) were evaluated in 3 different periods: (1) Before surgery without articular anesthesia, (2) Before surgery under articular anesthesia and (3) 12 weeks after the surgical procedure. Results There was an increase in handgrip strength in all three pinches measurements after pain relief, both after joint anesthesia and after the consolidation of the arthrodesis (p < 0.05). In the comparisons between the subjective evaluations (DASH, PRWE and VAS), the patients had better scores in the postoperative evaluation after 12 weeks (p < 0.05). There was no statistical difference when comparing the mean strength values found after anesthesia and after 12 weeks of TWA. Conclusion the outcomes could propose an assessment protocol for patients with indication for TWA, in which patients with good response to intra-articular anesthetic infiltration would benefit from the effects of the surgical procedure.

Resumo Objetivo O estudo tem como objetivo demonstrar um método de avaliação para predizer o sucesso funcional da artrodese total do punho (ATP) e auxiliar na sua indicação. Métodos Um estudo prospectivo incluindo dez pacientes submetidos a ATP por artrite pós-traumática. Os critérios de exclusão foram pacientes que perderam o acompanhamento pós-operatório ou informações incompletas no prontuário. A avaliação funcional objetiva (força de preensão manual, pinça de três pontos, pinça lateral e pinça polpa-a-polpa) e a avaliação funcional subjetiva (DASH, PRWE, EVA) foram avaliadas em 3 momentos diferentes: (1) Antes da cirurgia sem anestesia articular, (2) Antes da cirurgia sob anestesia articular e (3) 12 semanas após o procedimento cirúrgico. Resultados Houve aumento da força de preensão palmar nas três medidas de pinça após o alívio da dor, tanto após a anestesia articular quanto após a consolidação da artrodese (p < 0,05). Nas comparações entre as avaliações subjetivas (DASH, PRWE e VAS), os pacientes tiveram melhores escores na avaliação pós-operatória após 12 semanas (p < 0,05). Não houve diferença estatística ao comparar os valores médios de força encontrados após a anestesia e após 12 semanas de ATP.

Use of Smartphones as a Risk Factor for the Development of Morbidities in the Wrist and Fingers / Uso de smartphones como fator de risco para o desenvolvimento de morbidades no punho e nos dedos*

Abstract Objective To investigate the long-term use of smartphones as a risk factor for the development of morbidities in the wrist and fingers. Methods The present is a descriptive, exploratory study with a quantitative approach based on injury prevalence among one hundred smartphone users of a private university in the state of Pernambuco, Northeastern Brazil. We applied a semi-structured questionnaire and the Boston Carpal Tunnel Questionnaire (BCTQ), as well as the Visual Analog Scale (VAS) and the Finkelstein, Phalen, reverse Phalen, and Tinel signal tests on the wrist. Results The average of the sample was of 22.73 years, with a prevalence of single, right-handed female participants. Most of them had been using smartphones for 5 to 10 years, and 85% reported discomfort in the wrist and fingers while using the device, with numbness as the most prevalent symptom. Most clinical tests were negative, and the Finklestein test showed greater positivity. The BCTQ is composed of a symptom severity scale (S scale) and a functional status scale (F scale): the overall score on the S scale was of 1.61, indicating mild to moderate symptoms, and the F scale revealed that the symptoms did not affect functionality. Conclusion There was a significant correlation between the length of use of smartphones and discomfort in the wrist and fingers; as such, smartphones are a risk factor for the development of morbidities.

Resumo Objetivo Investigar o uso de smartphones em longo prazo como fator de risco para o desenvolvimento de morbidades no nível do punho e dos dedos. Métodos Realizou-se um estudo descritivo, exploratório, de abordagem quantitativa, para a obtenção de medidas de prevalência com cem acadêmicos usuários de smartphones de uma faculdade privada localizada no sertão de Pernambuco. Foram aplicados um questionário semiestruturado e o Questionário de Síndrome doTúnel do Carpo de Boston (Boston Carpal Tunnel Questionnaire, BCTQ, na sigla em inglês), além da Escala Visual Analógica (EVA) e dos testes de Finkesltein, Phalen, Phalen reverso, e sinal de Tinel no punho. Resultados A idade média da amostra foi de 22,73 anos, com prevalência de solteiros, de destros, e do sexo feminino. O tempo de uso do smartphone indicado pela maioria dos participantes era entre 5 e 10 anos, e 85% da amostra relatou já ter sentido desconforto no punho e nos dedos durante o uso do aparelho, sendo a dormência o sintoma mais prevalente. Com relação aos testes clínicos, houve prevalência de resultados negativos, e o de Finklestein apresentou maior positividade. Quanto ao BCTQ, dividido em duas escalas, uma de gravidade dos sintomas (escala G) e uma de estado funcional (escala F), a média geral das pontuações foi de 1,61 na escala G, o que indica sintomas de leve a moderados, já a escala F revelou que os sintomas não afetavam a funcionalidade. Conclusão Foi possível observar uma correlação significativa entre o tempo de uso dos smartphones e a presença de desconforto no punho e nos dedos, o que indica que se trata de um fator de risco para o desenvolvimento de morbidades.

Percutaneous Suspensory Stabilization of Chronic Distal Radioulnar Joint (DRUJ) Dislocation Using an Adjustable Loop Endobutton Construct: Case Report / Fixação suspensiva percutânea de luxação crônica da articulação radioulnar distal (ARUD) usando um dispositivo de endobutton de laço ajustável: Relato de caso

Abstract Chronic distal radioulnar joint (DRUJ) dislocation has been treated historically with complex osteotomies and reconstructive procedures, often resulting in intractable stiffness and loss of function. It is desirable to use a technique of fixation that will not only restore the wrist biomechanics but also be cosmetically appealing to the individual. We present a novel technique of reduction and fixation of a chronically dislocated DRUJ in a 26-year-old male using a minimally invasive approach, with successful restoration of DRUJ function and no postoperative complications.

Resumo Luxação crônica da articulação radioulnar distal (ARUD) foi tratada historicamente com osteotomias complexas e procedimentos reconstrutivos, geralmente resultando em rigidez intratável e perda de função. É desejável usar uma técnica de fixação que não apenas restaure a biomecânica do punho, mas também seja esteticamente atraente para o indivíduo. Apresentamos uma nova técnica de redução e fixação de uma ARUD deslocada cronicamente em um homem de 26 anos, usando uma abordagem minimamente invasiva, com restauração bem-sucedida da função da ARUD e sem complicações pós-operatórias.

Arthroscopic Assisted Treatment of Combined Trapezium and Bennett Fracture-Dislocation.

Trapezium fractures are unusual; however, they represent the third most frequent fracture of the carpal bones. As they usually follow a high-energy trauma, they are associated with distal radius, Bennett, or Rolando fractures in 80% of cases. Traditional treatment options include, closed reduction and percutaneous pinning, or open reduction and internal fixation. To minimize the additional surgical trauma, an arthroscopic technique has been developed for safe, minimally invasive management of complex injuries of the first carpo-metacarpal joint. Intra-articular dislocated fracture fragments are reduced under direct visualization and fixed through small incisions. Limiting additional surgical damage on the carpo-metacarpal joint ligaments, capsule, and other soft tissues around the fracture preserves the blood supply to fracture fragments and also the proprioceptive system, which is key for the dynamic stability of such a hypermobile joint. This report confirms that the procedure is feasible, and a complete functional recovery can be expected with reduced postoperative rehabilitation.

Proprioceptive rehabilitation strategies in posttraumatic wrist injuries. Scoping review.

Background: The proprioceptive approach can effectively improve strength, mobility, edema reduction, and pain reduction, which in turn has a positive impact on functionality. Objective: To identify proprioceptive rehabilitation strategies reported in the literature in adults with traumatic wrist injuries. Methods: A scoping review was performed following the parameters of the Prisma ScR strategy. We included research with adult patients diagnosed with posttraumatic wrist injuries who used proprioceptive rehabilitation. Pain, functionality, strength, joint mobility ranges, and edema were evaluated. Results: After removing duplicates and applying the exclusion criteria, a total of 123 articles were found, which left six articles, including 125 patients. Rehabilitation protocols based on proprioceptive neuromuscular facilitation and using sensorimotor tools that promote wrist recovery have been generated. In addition, other approaches have been established, such as motor imagery, which generates a work of identification and organization of movement, improving pain and manual function. However, longer follow-ups, standardization of the instruments used during proprioceptive intervention, and increasing the observed population are needed to generate a recommendation for early intervention and cost-benefit estimates. Conclusion: Proprioceptive rehabilitation has demonstrated benefits in the recovery of the lower limb and hip or back. However, for the rehabilitation of traumatic wrist injuries, it is research pending. Well-described data and good quality designs are needed to routinely propose this strategy in the clinic.

Antecedentes: El enfoque propioceptivo puede mejorar de manera efectiva la fuerza, la movilidad, la reducción del edema y la disminución del dolor; lo que a su vez tiene un impacto positivo en la funcionalidad. Objetivo: Identificar las estrategias de rehabilitación propioceptiva reportadas en la literatura, en adultos con lesiones traumáticas de muñeca. Metódos: Se efectuó una revisión de alcance siguiendo los parámetros de la estrategia Prisma ScR. Se incluyeron investigaciones con pacientes adultos, diagnóstico de lesión postraumática de muñeca, que utilizaron rehabilitación propioceptiva. Se evaluó el dolor, la funcionalidad, la fuerza, los rangos de movilidad articular y el edema. Resultados: Se incluyeron seis artículos, que involucraron 125 pacientes al aplicar los criterios de exclusión. Se han generado protocolos de rehabilitación basados en facilitación neuromuscular propioceptiva y el uso de herramientas sensoriomotoras que promueven la recuperación de la muñeca. Además, se han establecido otros abordajes como la imaginería motora, que genera un trabajo de identificación y organización del movimiento, mejorando el dolor y la función manual. Faltan seguimientos de mayor tiempo, estandarización de los instrumentos utilizados durante la intervención propioceptiva y aumentar la población observada para generar una recomendación de intervención temprana y estimaciones entre el costo y el beneficio. Conclusión: La rehabilitación propioceptiva ha demostrado beneficios en la recuperación del miembro inferior y la cadera o espalda. Para la rehabilitación de las lesiones traumáticas de muñeca, es un pendiente de la investigación. La información bien descrita y los diseños de buena calidad son necesarios para proponer rutinariamente esta estrategia en la clínica.

Outcomes of the Management of Distal Radius Fractures in the Last 5 Years: A Meta-analysis of Randomized Controlled Trials / Resultados do manejo de fraturas do rádio distal nos últimos 5 anos: metanálise de ensaios clínicos controlados e randomizados

Abstract Objective Over the last decades, volar locking plates (VLPs) have been the mainstay treatment for distal radius fractures (DRFs). With the growing body of evidence, we systematically reviewed studies on recent VLP modifications. Methods A systematic search was performed in the PubMed/MEDLINE database for studies published in English in the past five years. The inclusion criteria were randomized controlled trials (RCTs) on the operative treatment of DRFs. We excluded ongoing trials and studies not directly addressing DRF. The primary outcomes assessed were subjective (such as the scores on the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire, the Patient-rated Wrist Evaluation [PRWE], the European Quality of Life-5 Dimensions [EQ-5D], the 36-item Short Form Health Survey [SF-36], and the Visual Analog Scale [VAS]) and objective clinical outcomes (the complication rate). Results We identified 29 articles published from 2016 to 2020 with high quality of evidence, except for one, which had evidence of moderate quality. In total, 3,079 DRFs were analyzed in the present study. All studies except one had a greater proportion of female participants, and only in 1 study the mean age of the sample was < 40 years old. There were no significant differences between the VLP and external fixation (EF) in terms of the scores on the DASH (p= 0.18) and PRWE (p= 0.77). The VLP alone without pronator quadratus (PQ) repair yielded significantly better outcomes. Conclusion In unstable fractures, the VLP and EF yielded comparable long-term results. There is no clear benefit of adding PQ repair to current the VLP surgical technique. Level of EvidenceLevel I

Resumo Objetivo Nas últimas décadas, a placa volar bloqueada (PVB) tem sido o tratamento principal para fraturas do rádio distal (FRDs). Com o crescente conjunto de evidências, revisamos sistematicamente estudos sobre modificações recentes na PVB. Métodos Uma pesquisa sistemática foi realizada utilizando o banco de dados PubMed/MEDLINE por estudos publicados em inglês nos últimos cinco anos. Os critérios de inclusão foram ensaios clínicos controlados e randomizados (ECCRs) sobre o tratamento cirúrgico de FRDs. Excluímos ensaios e estudos em andamento que não abordavam diretamente a FRD. Os desfechos primários avaliados foram desfechos clínicos subjetivos (como as pontuações no questionário de Deficiências do Braço, Ombro e Mão [Disabilities of the Arm, Shoulder and Hand, DASH, em inglês], na Avaliação do Punho Classificada pelo Paciente [Patient-rated Wrist Evaluation, PRWE, em inglês], no questionário Qualidade de Vida Europeia - 5 Dimensões [European Quality of Life-5 Dimensions, EQ-5D, em inglês], na Pesquisa de Saúde por Formulário Curto de 36 Itens [36-item Short Form Health Survey, SF-36, em inglês], e na Escala Visual Analógica [EVA]) e objetivos (taxa de complicações). Resultados Identificamos 29 artigos publicados entre 2016 e 2020 com alta qualidade de evidência, exceto por um, de qualidade moderada. Ao todo, foram analisadas 3.079 FRDs neste estudo, Todos os estudos analisados, exceto por um, tinham maior proporção de participantes do gênero feminino, e somente em 1 estudo a idade média da amostra foi < 40 anos. Não houve diferença significativa entre a PVB e fixação externa (FE) em termos das pontuações no DASH (p= 0,18) e na PRWE (p= 0,77). Os resultados da PVB isolada, sem qualquer reparo do pronador quadrado (PQ), foram significativamente melhores. Conclusão Em fraturas instáveis, a PVB e a FE produziram resultados comparáveis no longo prazo. Não há um benefício claro em se adicionar reparo do PQ à técnica cirúrgica atual da PVB. Nível de EvidênciaNível I