RESUMO
Objetivo: Avaliar e comparar os resultados clínicos e radiológicos de pacientes com fratura de tíbia distal, sem acometimento articular, tratados com haste intramedular ou placa e parafusos. Métodos: Foram analisados 27 pacientes, sendo 15 tratados com placa e 12 com haste intramedular, após 6 meses completos de pós operatório. Foram aplicados os escores de EVA e de Olerud-Molander, além de análise radiográfica. A análise estatística foi realizada utilizando os testes de qui quadrado e o teste de Mann-Whitney. Resultados: A média de idade foi de 45 anos e o sexo masculino foi prevalente. Foi observada alta prevalência da fratura de fíbula associada (92,6%) sendo 25,9% fixadas. A media angular de desvio foi de 2,60o nos pacientes tratados com placa e 2,42o nos tratados com haste intramedular (p=0,829). A média do escore da EVA e Escore de Olerud-Molander não mostrou diferença estatisticamente significativa entre os dois grupos. Três pacientes apresentaram pseudoartrose, sendo dois deles tratados com haste. Conclusão: Não houve consenso da superioridade de um método em relação ao outro em nossa análise. A fixação da fibula pode ser um fator determinante no alinhamento das fraturas. Cada um dos métodos apresenta vantagens e desvantagens, porém ambos mostraram resultados bons e semelhantes. A escolha do tratamento deve ser atribuida ao perfil do trauma, a condições clinicas do paciente e a experiencia do profissional.
Objective: To evaluate and compare clinical and radiological outcomes of patients with distal tibial fractures, without joint involvement, treated with intramedularry nail or plate and screws. Methods: twenty seven patiens were analyzed, 15 treated with plates and 12 treated with intramedullary nail, after 6 complete months of postoperative period. The Olerud-Molander Ankle Score and the Visual Analogue Scale for Pain, as well as radiographic analysis. Statistical analysis was performed using the chi-squared and Mann-Whitney tests. Results: The mean age was 45 years and males were more prevalent. A high prevalence of associated fíbula fracture was observed (92,6%), with 25,9% being fixed. The mean angular deviation was 2,6 degreees in patients treated with plate and 2,42 degrees in those treated with nails. (p=0,829). The Olerud-Molander Ankle Scores and the EVA did not show statistically siginifcance difference between the two groups. Three patients evolved with nonunion, two of them being treated with intramedullary nail. Conclusions: There was no consensus of the superiority of one method over the other. Fíbula fixation can be a determining factor int the fracture alingnment. Both methods has advantages and disadvantages, but both shows good and similar results. Treatment's choice shoud be attributed to trauma profile, patient's clinical conditions and surgeon's experience.
RESUMO
Background: To reduce mortality of acute myocardial infarction, medical care must be provided within the first hours of the event. Objective: To identify the "front door" to medical care of acute coronary patients and the time elapsed between patients'admission and performance of myocardial reperfusion in the public health system of the city of Joinville, Brazil. Methods: The study was a retrospective analysis of the medical records of 112 consecutive patients diagnosed with acute myocardial infarction by coronary angiography. We identified the place of the first medical contact and calculated the time between admission to this place and admission to the referral hospital, as well as the time until coronary angiography, with or without percutaneous transluminal angioplasty. A descriptive analysis of data was made using mean and standard deviation, and a p < 0.05 was set as statistically significant. Results: Only 16 (14.3%) patients were admitted through the cardiology referral unit. Door-to-angiography time was shorter than 90 minutes in 50 (44.2%) patients and longer than 270 minutes in 39 (34.5%) patients. No statistically significant difference was observed in door-to-angiography time between patients transported directly to the referral hospital and those transferred from other health units (p < 0.240). Considering the time between pain onset and angiography, only 3 (2.9%) patients may have benefited from myocardial reperfusion performed within less than 240 minutes. Conclusion: Management of patients with acute myocardial infarction is not in conformity with current guidelines for the treatment of this condition. The structure of the healthcare system should be urgently modified so that users in need of emergency services receive adequate care in accordance with local conditions
