Importancia da realiza？？o de radiografias em posi？？o ortostática na avalia？？o inicial de pacientes com fraturas toracolombares

objective: the management of stable thoracolumbar fractures is controversial, especially in patients without functional deficits. this study questions the reason of doing images study only in supine position since, paradoxically, nonoperative treatment includes early orthostatism. the purpose of this study is to determine the influence of weight-bearing radiographs on defining the treatment of patients with thoracolumbar fractures classified as type "a" of ao-asif. methods: from january 2007 to november 2008, patients with thoracolumbar fractures were evaluated by radiographs in supine position and computed tomography to identify signs of instability. fractures classified radiographically as type "a" of ao-asif, initially treated with nonoperative care, were submitted to weight-bearing radiographs without bracing in acute phase and their radiographic parameters were re-evaluated. results: 59 patients with stable thoracolumbar fractures (t11 to l4) were included in this study,and all of them tolerated the weight-bearing radiographs. the vertebral kyphosis increased 46.8%. the anterior collapse increased 15.52%. three of these patients (5.1%) were submitted to surgical treatment after weight-bearing radiographs due to instability criteria. conclusions: weight-bearing radiographs were efficient in identifying patients with instability not established yet. this exam is able to predict the satisfactory evolution during the nonoperative treatment and it is a safe and low cost diagnostic examination with easy applicability. in this study, a total of 5.1% of the patients had their treatment changed from conservative to surgical.