O objetivo neste estudo foi avaliar a possível relação entre os estágios de maturidade óssea avaliados em radiografias de mão e punho e das vértebras cervicais em telerradiografias em norma lateral, em indivíduos com idade média de 13 anos e 6 meses e desvio padrão de 2 anos e 3 meses (variando de 8 anos e 6 meses a 16 anos e 11 meses). A casuística foi composta por 209 conjuntos radiográficos (radiografias de mão e punho e telerradiografias em norma lateral) tomados na mesma data para cada indivíduo . Dois avaliadores, devidamente treinados e calibrados classificaram por estágios de maturidade óssea todas as radiografias, as de mão e punho segundo Helm et al, e a avaliação das vértebras cervicais nas telerradiografias em norma lateral, segundo O’Reilly e Yaniello (1988) e Baccetti, Franchi e McNamara (2002). Considerando a classificacão de Helm et al (1971) como padrão áureo, teste de correlação de Spearman foi aplicado para verificar relação com os dois métodos que avaliam as vértebras cervicais. Os resultados indicam que houve forte correlação entre os métodos de avaliação das vértebras cervicais e de mão e punho (Rs= 0,906 para O’Reilly e Yaniello(1988) e Helm et al. (1971) e Rs= 0,889 para Baccetti, Franchi e McNamara Jr (2002) e Helm et al. (1971), para todos p<0,001). A análise estatística descritiva indicou que houve maior número de ocorrências concordantes na identificação do início e do pico máximo do surto. Com base nesses resultados pode-se concluir que a avaliação da maturidade óssea pelas vértebras cervicais oferece confiabilidade para a identificação do início e pico do surto de crescimento puberal, mas não para a identificação dos estágios na fase descendente, portanto, continuar usando a radiografia de mão e punho ainda se faz imprescindível quando é necessária a identificação de algum potencial de crescimento restante . / The purpose of this study was to evaluate the possible relationship between the stages of skeletal maturation analyzed by means of hand-wrist radiography and cervical vertebrae in lateral cephalograms, from individuals with mean age of 13 years and 6 months, S.D. 2 years and 3 months (ranging from 8 years and 6 months to 16 years and 11 months). The sample was composed by 209 radiography sets (hand-wrist radiography and lateral cephalograms) taken in the same date for each individual. Two investigators, properly trained and calibrated, classified all the hand-wrist radiography relating them to the skeletal maturation according to Helm et al. The cervical vertebrae evaluation was performed in lateral cephalograms by means of the O'Reilly and Yaniello and Baccetti, Franchi and McNamara method. Considering the classification of Helm et al as “gold standard’, Spearman test correlation was applied to verify relationship with the two methods that evaluate the cervical vertebrae. The results indicated that there was strong correlation among the methods of evaluation of the cervical vertebrae and hand-wrist radiography (Rs =0,906 for O'Reilly and Yaniello and Helm et al and Rs = 0,889 for Baccetti et al and Helm et al, for all p <0,001). The descriptive statistical analysis indicated that there was larger number of concordant occurrences in the identification of the onset and maximum peak of the adolescent growth spurt. Based on these results, it can be concluded that the evaluation of the skeletal maturation by means of the cervical vertebrae method can offer reliability only for the identification of the onset and peak of adolescent growth spurt. Thus, is still indispensable to continue using the hand-wrist radiography when it is necessary the identification of some potential remaining growth.

O objetivo neste estudo foi avaliar a possível relação entre os estágios de maturidade óssea avaliados em radiografias de mão e punho e das vértebras cervicais em telerradiografias em norma lateral, em indivíduos com idade média de 13 anos e 6 meses e desvio padrão de 2 anos e 3 meses (variando de 8 anos e 6 meses a 16 anos e 11 meses). A casuística foi composta por 209 conjuntos radiográficos (radiografias de mão e punho e telerradiografias em norma lateral) tomados na mesma data para cada indivíduo . Dois avaliadores, devidamente treinados e calibrados classificaram por estágios de maturidade óssea todas as radiografias, as de mão e punho segundo Helm et al, e a avaliação das vértebras cervicais nas telerradiografias em norma lateral, segundo O’Reilly e Yaniello (1988) e Baccetti, Franchi e McNamara (2002). Considerando a classificacão de Helm et al (1971) como padrão áureo, teste de correlação de Spearman foi aplicado para verificar relação com os dois métodos que avaliam as vértebras cervicais. Os resultados indicam que houve forte correlação entre os métodos de avaliação das vértebras cervicais e de mão e punho (Rs= 0,906 para O’Reilly e Yaniello(1988) e Helm et al. (1971) e Rs= 0,889 para Baccetti, Franchi e McNamara Jr (2002) e Helm et al. (1971), para todos p<0,001). A análise estatística descritiva indicou que houve maior número de ocorrências concordantes na identificação do início e do pico máximo do surto. Com base nesses resultados pode-se concluir que a avaliação da maturidade óssea pelas vértebras cervicais oferece confiabilidade para a identificação do início e pico do surto de crescimento puberal, mas não para a identificação dos estágios na fase descendente, portanto, continuar usando a radiografia de mão e punho ainda se faz imprescindível quando é necessária a identificação de algum potencial de crescimento restante . / The purpose of this study was to evaluate the possible relationship between the stages of skeletal maturation analyzed by means of hand-wrist radiography and cervical vertebrae in lateral cephalograms, from individuals with mean age of 13 years and 6 months, S.D. 2 years and 3 months (ranging from 8 years and 6 months to 16 years and 11 months). The sample was composed by 209 radiography sets (hand-wrist radiography and lateral cephalograms) taken in the same date for each individual. Two investigators, properly trained and calibrated, classified all the hand-wrist radiography relating them to the skeletal maturation according to Helm et al. The cervical vertebrae evaluation was performed in lateral cephalograms by means of the O'Reilly and Yaniello and Baccetti, Franchi and McNamara method. Considering the classification of Helm et al as “gold standard’, Spearman test correlation was applied to verify relationship with the two methods that evaluate the cervical vertebrae. The results indicated that there was strong correlation among the methods of evaluation of the cervical vertebrae and hand-wrist radiography (Rs =0,906 for O'Reilly and Yaniello and Helm et al and Rs = 0,889 for Baccetti et al and Helm et al, for all p <0,001). The descriptive statistical analysis indicated that there was larger number of concordant occurrences in the identification of the onset and maximum peak of the adolescent growth spurt. Based on these results, it can be concluded that the evaluation of the skeletal maturation by means of the cervical vertebrae method can offer reliability only for the identification of the onset and peak of adolescent growth spurt. Thus, is still indispensable to continue using the hand-wrist radiography when it is necessary the identification of some potential remaining growth.

Objetivos: Avaliar a densidade radiográfica de três ossos do carpo - capitato, escafóide e hamato, em pacientes do sexo masculino e do sexo feminino, com idades entre 7 e 18 anos, por meio de um programa gerenciador de imagens - Adobe Photoshop - 6.0®. Métodos: Leituras das intensidades de cinza de cada imagem selecionada em cada osso e obtenção de um histograma referente aos valores de número de pixels da imagem analisada, valor médio dos tons de cinza, mediana e o desvio padrão da área selecionada na digitalização e tratamento estatístico destes dados. Resultados: As comparações entre médias de densidades dos ossos analisados para o sexo masculino, não apresentou médias estatisticamente diferentes somente para a comparação capitato x hamato, enquanto no sexo feminino as comparações entre ossos se mostraram estatisticamente desiguais; a comparação entre média de densidade de cada osso e idade cronológica apresentou dependência significativa somente para o osso hamato no sexo masculino; a comparação entre as médias de densidade dos ossos para os sexos masculino e feminino, mostrou não existir diferenças estatisticamente significativas entre ambos considerando-se os três ossos analisados. Conclusões: Para o sexo masculino na amostra analisada, houve dependência somente entre a média de densidade dos ossos capitato e hamato, enquanto para o sexo feminino não houve correlação de dependência entre os três ossos analisados; a comparação entre as densidades ósseas e a idade cronológica, indicou que somente o osso hamato apresenta grau de dependência significativo com a faixa etária no sexo masculino, enquanto no sexo feminino nenhum dos ossos apresentou grau de dependência significativo em relação à idade cronológica na amostra analisada; a densidade dos três ossos: hamato, capitato e escafóide, não apresentam diferenças significativas quando comparadas entre sexo masculino e feminino na mesma faixa etária. / Objectives: To evaluate the radiographic density of three carpal bones (hamate, capitate and scaphoid bones) in male and female patients aged 7 to 18 years by means of an image-editing software (Adobe Photoshop - 6.0®). Methods: Readings of gray intensities of each image selected in each bone and drawing of a histogram referring to the values of number of pixels of the analyzed image, mean value of the gray tons, median and standard deviation of the area demarcated in the digitized image and statistical analysis of data. Results: For the male patients, comparisons of the means of densities of the analyzed bones did not show statistically significant difference only for the hamate X capitate pair. For the female patients, comparisons among the bones appeared statistically different; comparison between the density means of each bone and the chronological age showed significant dependence only for the hamate bone in the male patients; comparison among the bone density means for the male and female patients showed no statistically significant difference between genders for the tree types of bone. Conclusions: In the evaluated population, for the male gender, there was dependence only between the density means of the capitate and hamate bones, while for the female gender there was no dependence correlation among the three bone types; comparison between the bone densities and the chronological age showed that only the hamate bone presented a significant degree of dependence with the age group in the male patients, while in the female patients none of the bone presented a significant degree of dependence in relation to the chronological age in the analyzed sample; the densities of the three bones (hamate, capitate and scaphoid bones) did no show statistically significant difference when compared between males and females belonging to the same age group.

Objetivos: Avaliar a densidade radiográfica de três ossos do carpo - capitato, escafóide e hamato, em pacientes do sexo masculino e do sexo feminino, com idades entre 7 e 18 anos, por meio de um programa gerenciador de imagens - Adobe Photoshop - 6.0®. Métodos: Leituras das intensidades de cinza de cada imagem selecionada em cada osso e obtenção de um histograma referente aos valores de número de pixels da imagem analisada, valor médio dos tons de cinza, mediana e o desvio padrão da área selecionada na digitalização e tratamento estatístico destes dados. Resultados: As comparações entre médias de densidades dos ossos analisados para o sexo masculino, não apresentou médias estatisticamente diferentes somente para a comparação capitato x hamato, enquanto no sexo feminino as comparações entre ossos se mostraram estatisticamente desiguais; a comparação entre média de densidade de cada osso e idade cronológica apresentou dependência significativa somente para o osso hamato no sexo masculino; a comparação entre as médias de densidade dos ossos para os sexos masculino e feminino, mostrou não existir diferenças estatisticamente significativas entre ambos considerando-se os três ossos analisados. Conclusões: Para o sexo masculino na amostra analisada, houve dependência somente entre a média de densidade dos ossos capitato e hamato, enquanto para o sexo feminino não houve correlação de dependência entre os três ossos analisados; a comparação entre as densidades ósseas e a idade cronológica, indicou que somente o osso hamato apresenta grau de dependência significativo com a faixa etária no sexo masculino, enquanto no sexo feminino nenhum dos ossos apresentou grau de dependência significativo em relação à idade cronológica na amostra analisada; a densidade dos três ossos: hamato, capitato e escafóide, não apresentam diferenças significativas quando comparadas entre sexo masculino e feminino na mesma faixa etária. / Objectives: To evaluate the radiographic density of three carpal bones (hamate, capitate and scaphoid bones) in male and female patients aged 7 to 18 years by means of an image-editing software (Adobe Photoshop - 6.0®). Methods: Readings of gray intensities of each image selected in each bone and drawing of a histogram referring to the values of number of pixels of the analyzed image, mean value of the gray tons, median and standard deviation of the area demarcated in the digitized image and statistical analysis of data. Results: For the male patients, comparisons of the means of densities of the analyzed bones did not show statistically significant difference only for the hamate X capitate pair. For the female patients, comparisons among the bones appeared statistically different; comparison between the density means of each bone and the chronological age showed significant dependence only for the hamate bone in the male patients; comparison among the bone density means for the male and female patients showed no statistically significant difference between genders for the tree types of bone. Conclusions: In the evaluated population, for the male gender, there was dependence only between the density means of the capitate and hamate bones, while for the female gender there was no dependence correlation among the three bone types; comparison between the bone densities and the chronological age showed that only the hamate bone presented a significant degree of dependence with the age group in the male patients, while in the female patients none of the bone presented a significant degree of dependence in relation to the chronological age in the analyzed sample; the densities of the three bones (hamate, capitate and scaphoid bones) did no show statistically significant difference when compared between males and females belonging to the same age group.

Παρά τον μεγάλο όγκο της βιβλιογραφίας σχετικά με τα αποτελέσματα της αντιμετώπισης των ασταθών καταγμάτων του περιφερικού άκρου της κερκίδας με κλειστή ανάταξη και ελάχιστα επεμβατική οστεοσύνθεση υπάρχουν ακόμα σημαντικά αναπάντητα ερωτήματα. Πιό συγκεκριμένα, δεν υπάρχουν επαρκή στοιχεία γιά τον ρυθμό αποκατάστασης των κλινικών παραμέτρων κατά τη διάρκεια της μετατραυματικής περιόδου, γιά το τελικό αποτέλεσμα όπως εκφράζεται από τους ασθενείς με τη χρήση κλιμάκων αυτο-αξιολόγησης, καθώς και γιά τον βαθμό επίδρασης συγκεκριμένων ακτινολογικών παραμέτρων στο τελικό λειτουργικό αποτέλεσμα. Επίσης, δεν έχει διερευνηθεί ο συσχετισμός μεταξύ της ακτινολογικής παραμέτρου της παλαμιαίας γωνίας του περιφερικού άκρου της κερκίδας και των φορτίων που αναπτύσσονται στην φυσιολογική κερκιδοκαρπική άρθρωση. Η εργασία αυτή αποτελεί μία προοπτική μελέτη ασταθών καταγμάτων του περιφερικού άκρου της κερκίδας που αντιμετωπίστηκαν με κλειστή ανάταξη και ελάχιστα επεμβατική (διαδερμική) οστεοσύνθεση. Έγινε ανάλυση ακτινολογικών και κλινικών παραμέτρων καθώς και χρησιμοποίηση κλίμακας αυτο-αξιολόγησης της δυσλειτουργίας της πηχεοκαρπικής άρθρωσης γιά συνολικό διάστημα ενός έτους μετά τον τραυματισμό. Τα αποτελέσματα έδειξαν ότι ο ‘τυπικός’ ρυθμός μετατραυματικής αποκατάστασης αντιστοιχεί σε ταχεία κλινική βελτίωση κατά τη διάρκεια των τριών πρώτων μηνών ακολουθούμενη από ήπιου βαθμού δυσλειτουργία. Ωστόσο σημαντική δυσλειτουργία παραμένει σε 10% των ασθενών ένα έτος μετά τον τραυματισμό. Επίσης, τα αποτελέσματα δείχνουν σημαντικές διαφορές στο βαθμό κατά τον οποίο ο περιορισμός συγκεκριμένων αντικειμενικών κλινικών παραμέτρων αντανακλά το επίπεδο δυσλειτουργίας της πηχεοκαρπικής άρθρωσης. Ακτινολογικά, η μόνιμη απώλεια της παλαμιαίας γωνίας, η κερκιδική βράχυνση και η παρουσία ανωμαλίας της αρθρικής επιφάνειας της πηχεοκαρπικής με αρθρικό ‘βήμα’ τουλάχιστον ενός χιλιοστού σχετίζονται με επιμένοντα συμπτώματα πόνου και δυσλειτουργίας, ενώ δεν υπάρχει εμφανής συσχέτιση μεταξύ του τύπου του κατάγματος και του τελικού λειτουργικού αποτελέσματος. Επιπλέον, ανάλυση δυνάμεων της φυσιολογικής πηχεοκαρπικής άρθρωσης έδειξε φορτίσεις που μπορεί να φθάνουν έως 4,2 φορές το ανυψούμενο βάρος, αντίστροφο συσχετισμό μεταξύ της παλαμιαίας γωνίας του περιφερικού άκρου της κερκίδας και του μέγιστου φορτίου στην κερκιδοκαρπική άρθρωση καθώς και μη σημαντική διαφορά μεταξύ της γωνίας διεύθυνσης του μέγιστου φορτίου της κερκιδοκαρπικής και της παλαμιαίας γωνίας του περιφερικού άκρου της κερκίδας. / Despite the large volume of published literature on the results of management of unstable fractures of the distal radius using closed reduction and minimally invasive fixation there are still significant unanswered questions. More specifically, there is no sufficient evidence about the rate of recovery of the clinical parameters over the post-traumatic period, the final outcome as expressed by the patients using self-assessment scores and the degree that specific radiographic parameters influence the final functional outcome. Furthermore, the correlation between the radiographic parameter of volar tilt of the distal radius and the normal loads in the radiocarpal joint has not been investigated. The present thesis is a prospective study of unstable fractures of the distal radius managed with closed reduction and minimally invasive (percutaneous) fixation. Analysis of radiographic and clinical parameters as well as of patient-rated wrist dysfunction score for one year following injury was carried out. The results showed that a ‘typical’ rate of post-traumatic recovery corresponds to an initial rapid clinical improvement for the first three months followed by mild wrist dysfunction. However, significant dysfunction persists in 10% of patients one year following injury. Furthermore, the results showed significant differences in the degree to which the restriction of specific objective clinical parameters reflected the level of wrist dysfunction. Regarding the radiographic parameters, permanent loss of palmar tilt of the distal radius, radial shortening and the presence of articular incongruency with an articular ‘step off’ of at least 1 mm correlate with persisting pain and dysfunction while there is no obvious correlation between the fracture type and the final functional outcome. Moreover, force analysis in the normal wrist showed loads as high as 4.2 times the lifted weight, a reverse relationship between the angle of palmar tilt of the distal radius and the maximum radiocarpal load as well as a nonsignificant difference between the angle of the maximum radiocarpal force and the angle of palmar tilt of the distal radius.