Rockwood And Green 39;s Fractures In Adults Free Download

OBJECTIVE: To scientifically prove the high number of patients with fractures coming from the small towns of the State of Cear treated with surgery by the SUS (the Brazilian State healthcare system) in Fortaleza. METHODS: A transversal, prospective, descriptive study was carried out involving 1694 patients treated by the SUS in Fortaleza, from August 2006 to March 2007, in four public hospitals and three private hospitals. RESULTS: 38.78% of the patients came from small towns, and their ages ranged from 1 to 97 years old. The majority were single, male adults. The most common mechanism of injury was traffic accidents, accounting for 30.4% of all the cases. The forearm was the body segment most operated on, corresponding to 19%. CONCLUSIONS: These results suggest there is a need for preventive measures, such as public traffic safety awareness campaigns, in order to reduce accidents. We have also verified the importance of investments aimed at developing the Traumatology Emergency services in the small towns of Cear. Level of evidence II, Transversal, Prospective Study (lower quality prospective study).

OBJETIVO: Comprovar cientificamente o elevado nmero de pacientes com fraturas provenientes do interior do Cear tratados cirurgicamente pelo SUS em Fortaleza. MATERIAL E MTODO: Foi realizado um estudo transversal, prospectivo e descritivo com 1694 pacientes tratados pelo SUS em Fortaleza, de agosto de 2006 a maro de 2007, em sete hospitais, quatro pblicos e trs privados. RESULTADOS: Do total, 38,78% eram procedentes do interior, com a idade variando de 1 a 97 anos. A maioria era adulto, jovem, solteiro do sexo masculino. O mecanismo de trauma mais comum foi acidente de trnsito, envolvendo 30,4% dos pacientes. O antebrao foi a regio anatmica mais operada, correspondendo a 19%. CONCLUSO: Diante destes resultados, demonstramos a necessidade de incentivar medidas preventivas, como campanhas pblicas de conscientizao no trnsito, a fim de reduzir os acidentes. Verificamos tambm a importncia de realizar investimentos no sentido de aprimorar os servios de Emergncia Traumatolgica no interior do Cear. Nvel de evidncia II, Estudo Transversal e Prospectivo (Estudo prospectivo de menor qualidade).

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METHODS: A transversal, prospective, descriptive study was carried out involving 1694 patients treated by the SUS in Fortaleza, from August 2006 to March 2007, in four public hospitals and three private hospitals.

RESULTS: 38.78% of the patients came from small towns, and their ages ranged from 1 to 97 years old. The majority were single, male adults. The most common mechanism of injury was traffic accidents, accounting for 30.4% of all the cases. The forearm was the body segment most operated on, corresponding to 19%.

CONCLUSIONS: These results suggest there is a need for preventive measures, such as public traffic safety awareness campaigns, in order to reduce accidents. We have also verified the importance of investments aimed at developing the Traumatology Emergency services in the small towns of Cear. Level of evidence II, Transversal, Prospective Study (lower quality prospective study).

Trauma currently constitutes a serious public health issue, as it is responsible for a significant portion of the hospital care provided worldwide. Of the patients victims of closed trauma, 85% suffer injury to the musculoskeletal system,1 while the vast majority of these patients seek medical care in emergency clinics. In the age bracket from 0 to 39 years, for example, trauma ranked first as etiology of morbimortality.1 Braga Junior et al.1 Frame2 estimated that in terms of deaths among teenagers and children, respectively, 80% and 60% are secondary to traumatism. The annual costs for US society exceed 400 billion dollars, including hospitalization, insurance administration, labor costs and reduction of productivity.3

Several publications show that fractures occur frequently in traumatized patients. De Laet and Pols4 reported that, in elderly patients, osteoporosis and osteoporotic fractures are the main source both of morbidity and of cost, while the most common fractures are those of the hip, distal forearm and vertebrae. Rennie et al.5 reported in their study that 25% of children are injured every year, while 10-25% of these suffer fractures..

Although there are several studies in literature on the epidemiology of fractures in specific anatomical regions or age brackets, few studies address the epidemiological profile of fractures in general. Moreover, the results are controversial, with fracture incidence ranging from 9.0 to 22.8/1000/year,6 mainly affecting the age bracket of young adults.

Another fact to be considered is that patients with musculoskeletal trauma coming from small towns in the state of Cear currently represent a large portion of the hospital care recipients at the traumatology clinics of the capital.1 Braga Junior et al.1 2005 verified that of 500 patients treated in the traumatology emergency service of IJF, in Fortaleza, 24% came from small towns in Cear. This situation leads to the overcrowding of hospitals in the capital city, contributing to the quality impairment of the hospital service. Such a situation can be severely detrimental to the patient, as their prognosis is directly related to the quality of the medical care made available and to the speed at which such care is provided, besides the physician-patient relationship. These markers are also important in the medium and long-term follow-up of these patients.1

Given that the knowledge of fracture incidence is important not only for the therapeutic aspects, but also for preventive measures, and that the Northeast Region lacks studies conducted with patients from the small towns of states, the importance of this study, whose objective is to scientifically prove the high number of patients with fractures coming from small towns in the state of Cear treated surgically by SUS in Fortaleza, is noteworthy, drawing attention to the possibility of treatment of these patients in their place of origin, with the performance of public preventive policies.

It is a prospective transversal study, carried out at seven hospitals from the capital of Cear, Brazil affiliated to SUS, four of which are public, and three private, in the period from August 2006 to March 2007.

All the patients with fractures who were treated surgically by SUS at these hospitals in the abovementioned period were included in the study, totaling a sample of 1694 patients. These were interviewed through a questionnaire prepared according to the survey objectives, as well as an analysis of their medical records. Only patients who agreed to take part and signed the informed consent form after receiving an explanation about the study were included in the survey.

The following data were gathered: origin of the patients, sex, age, marital status and occupation; mechanism of injury, as well as the bone exposure of the fracture; the bone segment treated surgically.

Male patients predominated in the sample group originating from small towns of the state, with 65.4% of cases. The age ranged from 1 to 97 years, averaging 40.7 years. We verified that the average age was higher in the female sex, 50.9 years, and the age bracket with the highest incidence was that from 61 to 80 years. In the male sex, the average age was 35.2 years, mainly involving the age bracket from 21 to 40 years. (Figure 2)

According to the results presented, 38.78% of the patients included in the study came from small towns in Cear. This value is alarming, as it reflects the lack of support to accident victims in small towns, who are deprived of adequate and immediate care, and may have their prognosis compromised. Another factor to be considered is that the transportation of these patients to the capital is not always appropriate, causing discomfort and pain to the patient, particularly when we consider the time it takes for this individual to effectively receive medical care. Braga Junior et al.1 and Sobania et al.7 evidenced a reduction in the mortality of accident victims with adequate transportation. We also observed that of the patients coming from small towns, 66.21% suffered the accident in towns not belonging to the Metropolitan Region of Fortaleza, covering a longer distance to the capital. The high number of patients coming from small towns contributes considerably to the overcrowding of hospitals from the capital, consequently leading to the impairment of the quality of service offered to all the patients.

In our survey, the average age, of 40.7 years, was only slightly different from the average age of the study by Court-Brown et al, of 49.1 years. In relation to sex, we obtained concordance with the literature,1,6,8 with male patients predominating as 65.4% of the cases.

As we can see in the above results, the fracture epidemiology curve presented different behaviors between sexes, an observation already confirmed in other studies.6,8,9 In the men, the highest incidence of fractures occurred in the age bracket from 21 to 40 years (26.3%), formed especially by younger and potentially productive individuals,9 causing a strong economic impact. According to literature, the male curve is of the bimodal type,6,8 since there is a new peak in the elderly population. This situation has become increasingly obvious, since with the increase in life expectancy, the risks of osteoporotic fractures in men are higher.8 This curve, however, was not encountered in our study, possibly due to the high rates of mortality in the over-80s age bracket, still persistent in Brazil. Another hypothesis would be the inconsistencies in the methodology, since our study exclusively encompasses fractures treated with surgical procedures and patients from small towns, while the other trials encompass all fractures. 152ee80cbc

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