Análise da capacidade funcional e qualidade de vida em indivíduos após fraturas de tornozelo
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2019-10-11
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The unstable ankle fractures (AFs) can affect the quality of life (QOL) of the young and elderly population in different forms. Among youth, there are more AFs in men than women, but after 50 years of age, the rate per gender reverses. The consequences of these injuries do not only include pain and disability but can also result in long-term physical, psychological, and social impacts. Recently there was an increase in the incidence of AFs reported in the last studies, with a peak of incidence among young men estimated at 157.1/100,000/year. Of these, approximately 53% are unstable fractures requiring surgical treatment. The general objective of this thesis was to evaluate and compare the functionality, pain and QOL of active and inactive adult individuals whose AF was surgically treated; and the specific objectives were: i) To conduct a systematic review evaluating functional outcomes and the QOL of patients with surgically treated AF compared with the nonfractured population; ii) To compare adult men and women residing in Brazil’s interior who were treated with open reduction and internal fixation (ORIF) following AF; and iii) To describe and prospectively analyze unstable AF, surgically treated through ORIF, in adults in the Jequitinhonha Valley region of Brazil. From July 2015 to November 2016, 86 patients (n=57, men; n=29, women) with unstable AF treated surgically with ORIF were analyzed and included in the overall sample. Of these, ten men patients were lost in the follow-up and excluded. The remaining patients (n=76) were split into two groups [(active, n=58 X inactive, n=18)], of the man [(active, n=38; inactive, n=9)] and woman [(active, n=20; inactive, n=9)]. The International Physical Activity Questionnaire (IPAQ), Mini Mental State Examination (MMSE), the 36-item Short-Form Health Survey (SF-36), Visual Analogic Scale (VAS), sociodemographic and clinical questionnaires were applied in person at hospital admission or at most in up to two weeks after surgery. The SF-36 and VAS questionnaires were reapplied in an average period of 3 months after the surgery in the return of the patient for possible medical discharge. The morphology of AFs was analyzed according to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification system. Out of 86 patients, young men predominated in all variables researched. The commonest injury cause seen was motorcycle crash followed by soccer accidents (p≤0.001) caused by high-energy trauma (p≤0.05). Other factors that can be mentioned are related to the predominant fractures on the right side (p≤0.05), and more fractures AO/OTA 44 type B2 e C1 (p≤0.05), malleolus lateral and bimalleolar fractures (p≤0.01). Regarding the sociodemographic variables we verified significant differences in the variables smoking (p≤0.05), racial composition (p≤0.001), work category (p≤0.01) and educational level (p≤0.05) of the patients. Active and inactive patients of both genders show significant differences (p≤0.05) in the functional capacity and physical aspect domains; and the bodily pain domain revealed significant difference in active and inactive men (p≤0.05) between the periods post-surgical and 3 months after surgery (on average). Moderate and significant correlations were found (p≤0.05) between functional capacity, physical aspect and bodily pain domains of the SF-36 and the VAS pain scores for active and inactive patients of both genders in the final follow-up period. Other significant correlations (p≤0.05) for inactive men (physical aspect and bodily pain) and inactive women (functional capacity and bodily pain) are observed (after 3 months of surgery). The study of our systematic review concluded that less functionality and lower physical capacity represent the major limitations in patients with surgically treated AF, compared with the nonfractured population. These limitations may prevail for long periods and may become the main threat to the QOL of these patients. In relation to the field research, based on our results, we conclude that adult men of the region of Jequitinhonha Valley in Brazil are more likely to suffer AFs that require surgical treatment than adult women. Unstable AF treated with ORIF in adult wage earners can cause physical disability that keeps them away from physical activity and work for a significant period of time, affecting them financially. Three months after surgery (on average), active and inactive men had functional limitations and pain symptoms. These factors seem to have negatively influenced the patient's social involvement, worsening their QOL. Most active and inactive patients had a positive self-perception of their general health status, emotional aspects and mental health domains. Regarding active women, we observed lower energy and vitality after the same postoperative period.
Descrição
Tese acadêmica apresentada com o objetivo de obter o grau de doutoramento em Ciências do Desporto
Palavras-chave
Fratura de tornozelo , tratamento cirúrgico