Evaluations of Repaired Artery Patency in Forearm Wounds Using the Allen Test, Handheld Doppler and Doppler Ultrasonography / Avaliações do lúmen da artéria reparada em lesões do antebraço usando o teste de Allen, Doppler portátil e ultrassonografia com Doppler

Abstract Objective The purpose of the present study was to evaluate the rate of patency in the postoperative period of arterial injuries of the forearm secondary to penetrating trauma. The injuries were subjected to primary repair and examined with the Allen test and a handheld Doppler device, and the results were later confirmed with Doppler ultrasonography. Methods Eighteen patients were included, with a total of 19 arterial lesions, 14 ulnar lesions, and 5 radial lesions; one patient had lesions on both forearms. All patients underwent surgery and three clinical evaluations: the Allen test and assessment of arterial blood flow by a handheld Doppler device at 4 and 16 weeks after surgery and Doppler ultrasonography performed at 12 weeks after surgery. Results At the first clinical evaluation, 77% of the patients had patency based on the Allen test, and 72% had a pulsatile sound identified by the handheld Doppler device. In the second evaluation, 61% of the patients had patency based on the Allen test, and the rate of pulsatile sound by the handheld Doppler device was 72%, similar to that observed 2 months earlier. Based on the Doppler ultrasonography evaluation (~12 weeks after surgery), the success rate for arteriorrhaphy was 88%. Regarding the final patency (Doppler ultrasonography evaluation) and trauma mechanism, all patients with penetrating trauma had patent arteries. Conclusion We cde that clinical evaluation using a handheld Doppler device and the Allen test is reliable when a patent artery can be palpated. However, if a patent artery cannot be located during a clinical examination, ultrasonography may be required.

Resumo Objetivo O objetivo deste estudo foi avaliar a taxa de perviedade pós-operatória de lesões arteriais do antebraço secundárias a traumatismo penetrante. As lesões foram submetidas a reparo primário e examinadas com o teste de Allen e um dispositivo Doppler portátil; posteriormente, os resultados foram confirmados à ultrassonografia com Doppler. Métodos Dezoito pacientes foram incluídos, com um total de 19 lesões arteriais, 14 lesões ulnares e 5 lesões radiais; um paciente tinha lesões em ambos os antebraços. Todos os pacientes foram submetidos à cirurgia e três avaliações clínicas: o teste de Allen e a avaliação do fluxo sanguíneo arterial com um dispositivo portátil de Doppler na 4ª e 16ª semanas após a cirurgia e ultrassonografia com Doppler 12 semanas após o procedimento. Resultados Na primeira avaliação clínica, 77% dos pacientes apresentavam perviedade segundo o teste de Allen e 72% apresentavam som pulsátil identificado pelo Doppler portátil. Na segunda avaliação, 61% dos pacientes apresentaram perviedade com base no teste de Allen e a taxa de som pulsátil ao Doppler portátil foi de 72%, semelhante à observada 2 meses antes. À ultrassonografia com Doppler (cerca de 12 semanas após a cirurgia), a taxa de sucesso da arteriorrafia foi de 88%. Em relação à perviedade final (avaliação por ultrassonografia com Doppler) e mecanismo de trauma, todos os pacientes com traumatismo penetrante apresentavam artérias pérvias. Conclusão Concluímos que a avaliação clínica com um dispositivo Doppler portátil e o teste de Allen é confiável caso a artéria pérvia possa ser palpada. No entanto, a ultrassonografia pode ser necessária em caso de impossibilidade de localização de uma artéria pérvia durante o exame clínico.

Yttrium-90 radiosynovectomy in knees and ankles (25 joints in 22 hemophilic patients). Short-term results

ABSTRACT Introduction: The radiosynovectomy (RS) is one treatment option for recurrent hemarthrosis in patients with hemophilia (PWH). A prospective cohort study was designed to evaluate the effects of the RS on the synovial membrane volume in the ankles and knees of PWH and patient characteristics related to the RS outcome. Methods: In a one-year follow-up, 25 joints of 22 PWH who presented 3 bleeds or more in the same joint over the last 6 months (target joints) were subjected to the RS. Two groups were compared: those who retained target joints following the RS and those who did not (less than 3 bleeds/6 months after the RS). The groups were analyzed according to age, hemophilia type/severity, joint, body mass index (BMI), inhibitor and Hemophilia Joint Health Score 2.1 (HJHS). The magnetic resonance images (MRI) of six ankles and six knees were acquired prior to, and 6 months after, the RS. The synovial membrane volume and arthropathy MRI scale were accessed and volumes were compared and correlated with the Yttrium-90 dose injected. Results: Patients with a mean age of 12 years and a mean HJHS of 6.7 (p < 0.05) retained target joints after the RS. The inhibitor, joint, type/severity of disease and BMI showed no significant differences between groups. The synovial membrane volume had a significant reduction after the RS (p = 0.03), but no correlation with the Yttrium-90 dose. In proportion to the synovial membrane volume, doses injected to the ankles were larger than those injected to the knees. Conclusion: The synovial membrane volume is reduced after the RS, regardless of the effective 90Y dose.

Biomechanics of bone block graft models of different geometry / Biomecânica de modelos de enxertos ósseos em bloco de geometrias diferentes

ABSTRACT Objective: To evaluate the mechanical behavior of different geometry bone block grafts in wooden models. Methods: Constructs with rectangular (G1) and trapezoidal (G2) profile "grafts", fixed with 3.5 mm 8-hole dynamic compression plates were submitted to non-destructive bending, with the load applied alternately on the same surface as that of the plate fixation (upper) and on the opposite surface (lower), and torsion tests. A 50 N maximum load for bending and a 5° maximum deformation for torsion were considered. Rigidity (N/mm) was recorded for the former and torque (N.m) was recorded for the latter. Results: Rigidity was consistently higher in G2 than in G1, but not significantly so for all comparisons. The exception was for the load applied on the same surface of plate fixation, significantly higher in G1 than in G2. Torque was higher in G1, but not significantly so. Conclusion: The two different-profile "grafts" present a similar mechanical behavior and can be indistinctly used in clinical practice. Level of evidence V, specialist's opinion based on basic studies.

RESUMO Objetivo: Avaliar o comportamento mecânico de enxertos ósseos em blocos com geometrias diferentes usando modelos de madeira. Métodos: Montagens com "enxertos" de perfil retangular (G1) e trapezoidal (G2), fixadas com placas de compressão dinâmica de 3,5 mm e oito orifícios, foram submetidas a ensaios não destrutivos de flexão, com a carga aplicada alternativamente na mesma superfície de fixação da placa (superior), na superfície oposta (inferior) e de torsão. Foram consideradas uma carga máxima de 50 N para a flexão e uma deformação máxima de 5° para a torsão. Foram registrados o desvio (mm) e a rigidez (N/mm) para o primeiro e o torque (N.m) para o segundo. Resultados: A rigidez foi consistentemente maior em G2 que em G1, mas não significantemente para todas as comparações. A exceção foi para a carga aplicada na mesma superfície da fixação com a placa, significantemente maior em G1 que em G2. O torque foi mais elevado em G1, mas não significantemente. Conclusão: Os dois "enxertos" de perfis diferentes apresentam comportamento mecânico semelhante, podendo ser utilizados indistintamente na prática clínica. Nível de evidência V; opinião de especialista baseada em matérias básicas.

Spring plates in distal radio fractures: "in vitro" mechanical properties / Placa mola nas fraturas distais do radio - propriedades mecânicas "in vitro"

ABSTRACT Background: Distal radius fractures are one of the most common orthopedic injuries and appear in various patterns. Volar plate fixation is not always considered the gold standard treatment. Objective: To measure the resistance of a fragment-specific fixation assembly model obtained by plate fixation associated with different K-wire sizes. Method: In this original experimental study, novel II, axial compression of bone materials was tested. Results: In both groups, the maximum force supported by the fixation method in our study was ten times greater than the physiological load to which the wrist was subjected under physiological conditions. Discussion: In this study, we obtained encouraging results when compared to results reported in the literature. Our study showed that our bone fixating system was mechanically adequate for articular fractures of the intermediate column of the radius (Melone classification). The results were similar or superior to the results of pressure resistance and stiffness when data from the literature was used as reference. Conclusion: The proposed fixation method demonstrated adequate resistance for fixation of the intermediate column of the distal radius. Increasing K wire size caused augmented resistance of the fixation. Level of Evidence II, Prospective comparative study.

RESUMO Introdução: A fratura da extremidade distal do rádio é uma afecção frequente, com variedade de apresentações e nem sempre são passíveis de fixação volar única. Objetivo: Quantificar a resistência obtida no modelo experimental de fixação do fragmento específico, utilizando fio de Kirschner pré moldado, associado a fixação proximal com placa e parafuso. Métodos: Estudo experimental original, nível II, no qual foram realizados ensaios mecânicos com objetivo de avaliar a resistência a compressão axial. Resultados: Os valores de força máxima suportada pelo método de fixação foram pelo menos 10x maiores do que a carga fisiológica a qual o punho é submetido. Discussão: A fixação do tipo fragmento específico vem se mostrando útil e segura, permitindo uma mobilidade precoce segura. Os resultados analisados demonstraram que a montagem proposta em nosso estudo foi mecanicamente adequada para a fixação das fraturas articulares da borda volar ulnar (classificação de Melone) do rádio, tendo resultados semelhantes ou superiores quando comparados a literatura, avaliando a rigidez e a pressão o qual o sistema foi submetido. Conclusão: O método de fixação proposto demonstrou resistência adequada para fixação das fraturas da coluna intermediária do rádio. O aumento da espessura do fio provocou um aumento da força resistida da montagem. Nível de Evidência II, Estudo prospectivo comparativo.

Ultrasonographic characterization of the ulnar collateral ligament of normal thumbs in different age groups

OBJECTIVES: The aim of this study was to perform ultrasonographic characterization of the normal ulnar collateral ligament in different age groups and compare it in men and women and in dominant and nondominant hands. METHODS: Forty right-handed volunteers in the age groups 20-30, 31-40, 41-50, and 51-60 years without a history of trauma or surgical procedure in the studied joint were evaluated. The studied parameters were ligament length, greatest ligament thickness, ligament longitudinal section area in the longitudinal plane, distance from the aponeurosis of the adductor muscle to the metacarpal head surface and joint opening at rest and under abduction stress. RESULTS: The results indicated that the mean values of all parameters had minor variations with age, hand dominance, and gender and were slightly higher in men than in women and in the dominant hand than the nondominant hand. However, a statistically significant difference was observed between the joint opening at rest and under stress. In terms of age, there was a small but nonsignificant decrease in the values, likely because of the natural aging process. CONCLUSION: The low variability in the evaluated parameters indicates that large differences between sides or genders are not to be expected. A greater change is likely to indicate a pathological situation.

Correlation between ultrasound velocity and densitometry in fresh and demineralized cortical bone

OBJECTIVE: To compare ultrasound propagation velocity with densitometry in the diaphyseal compact cortical bone of whole sheep metatarsals. METHODS: The transverse ultrasound velocity and bone mineral density of 5-cm-long diaphyseal bone segments were first measured. The bone segments were then divided into four groups of 15 segments each and demineralized in an aqueous 0.5 N hydrochloric acid solution for 6, 12, 24 or 36 hours. All measurements were repeated after demineralization for each time duration and the values measured before and after demineralization were compared. RESULTS: Ultrasound velocity and bone mineral density decreased with demineralization time, and most differences in the pre- and post-demineralization values within each group and between groups were significant: A moderate correlation coefficient (r=0.75956) together with a moderate agreement was determined between both post-demineralization parameters, detected by the Bland-Altman method. CONCLUSION: We conclude that both ultrasound velocity and bone mineral density decrease as a result of demineralization, thus indicating that bone mineral content is of great importance for maintaining the acoustic parameters of cortical bone, as observed for cancellous bone. Ultrasound velocity can be used to evaluate both compact cortical bone quality and bone mineral density.

In vivo standardization of bone ultrasonometry of the clavicle

OBJECTIVE: The assessment of fracture union includes physical examination and radiographic imaging, which depend on the examiner’s experience. The development of ancillary methods may avoid prolonged treatments and the improper removal of implants. Quantitative bone ultrasonometry has been studied for this purpose and will soon be included in clinical practice. The aims of the present study were to assess the feasibility of using this technique on the clavicle and to standardize its in vivo application. METHODS: Twenty adult volunteers, including 10 men and 10 women without medical conditions or a previous history of clavicle fracture, underwent axial quantitative ultrasonometric assessment using transducers in various positions (different distances between the transducers and different angulations relative to the clavicle). RESULTS: Similar values of wave propagation velocity were obtained in the different tested set-ups, which included distinct distances between the transducers and angular positions relative to the clavicle. There were significant differences only in the transducers positioned at 0° and at 5 or 7 cm apart. CONCLUSIONS: The use of bone ultrasonometry on the clavicle is feasible and the standardization of the technique proposed in this study (transducers placed at 45° and at 7 cm apart) will allow its future application in clinical trials to evaluate the healing process of diaphyseal fractures of the clavicle.

Functional outcomes of proximal row carpectomy: 2-year follow-up

ABSTRACTOBJECTIVE: To evaluate functional outcomes of patients submit-ted to proximal row carpectomy for the treatment of wrist arthri-tisMETHODS: This is a retrospective study using wrist motion and grip strenght of patients diagnosed with Kienböck disease and scaphoid non-union surgically treated by this techniqueRESULTS: Eleven patients with 2-year follow-up were evaluated. Wrist motion (flexion, extension and ulnar deviation) and grip strength were significantly better from preoperative values. Ho-wever, no difference in radial deviation was observed in these patientsCONCLUSION: Proximal row carpectomy provides an alternative option for treatment of wrist arthritis, resulting in better active range of motion and grip strength in the long run. Level of Evidence IV, Case Series.

Radial nerve injury associated with humeral shaft fracture: a retrospective study

Objective: To determine the profile of patients with humeral diaphyseal fractures in a tertiary hospital. Methods: We conducted a survey from January 2010 to July 2012, including data from patients classified under humeral diaphyseal fracture (S42.3) according to the International Classification of Diseases (ICD-10). The variables analyzed were: age, gender, presence of radial nerve injury, causal agent and the type of treatment carried out. Results: The main causes of trauma were car accidents. The radial nerve lesion was present in some cases and was caused by the same trauma that caused the fracture or iatrogenic injury. Most of these fractures occurred in the middle third of humeral diaphysis and was treated conservatively. Conclusion: The profile of patients with fracture of humeral shaft, in this specific sample, was composed mainly of adult men involved in traffic accidents; the associated radial nerve lesion was present in most of these fractures and its cause was strongly related to the trauma mechanism. Level of Evidence II, Retrospective Study.

Influence of the osteosynthesis plate on ultrasound propagation in the bone

Analisar a influência das placas de aço de osteossíntesesobre a velocidade de propagação de ultrassom (VU) através doosso. Métodos: Foram medidas as VUs subaquáticas transversalcoronal e sagital no osso intacto e a seguir nas montagens domesmo osso com dois tipos de placas de osteossíntese (DCP esemitubular), fixadas na face dorsal do osso. O primeiro sinal achegar (first arriving signal, FAS) foi o parâmetro ultrassônico utilizadopara as medidas, tomando os diâmetros coronal e sagitalcomo distância percorrida para o cálculo da VU. Comparaçõesestatísticas intergrupos foram feitas ao nível de significância de1% (p<0,01). Resultados: A VU foi maior em ossos intactos doque nas montagens osso-placa, mas as diferenças entre os gruposnão foram significativas para a maioria das comparações(p=0,0132 a 0,9884), indicando que as placas de aço não interferemsignificantemente com a VU através das montagens osso--placa. Conclusão: O efeito de redução da VU nas montagensfoi atribuído ao maior coeficiente de reflexão do aço comparadoao osso e à água. Do ponto de vista prático, a ultrassonometriapode ser empregada para a avaliação da consolidação de fraturasfixadas com placas de aço. Estudo experimental...

To analyze the influence of steel plates for osteosynthesison the velocity of ultrasound propagation (VU) through the bone.Methods: The transverse coronal and sagittal velocity of ultrasoundpropagation underwater were measured on the intact bone and thenon assemblies of the same bone with two types of osteosynthesisplates (DCP and semi tubular), fixed onto the dorsal side of thebones. The first arriving signal (FAS) was the ultrasound parameterused, taking the coronal and sagittal diameters as the distancesto calculate velocity. Intergroup statistical comparisons were madeat significance level of 1% (p<0.01). Results: Velocity was higheron the intact bones than on the bone-plate assemblies and higherfor the semitubular than for the compression plates, althoughdifferences were not statistically significant for most comparisons(p=0.0132 to 0.9884), indicating that the steel plates do not interferesignificantly with ultrasound wave propagation through thebone-plate assemblies. Conclusion: The velocity reduction effectwas attributed to the greater reflection coefficient of the steel ascompared to that of bone and water. Ultrasonometry can, thus, beused in the evaluation of healing of fractures fixed with steel plates.Experimental study...

A comparative in vivo ultrasonometric evaluation of normal and delayed fracture healing in sheep tibiae

OBJECTIVE: To compare normal and delayed bone healing by measuring ultrasound conduction velocity across the bone callus. METHODS: A model of transverse linear and 5 mm resection osteotomies of sheep tibiae was used. Fourteen sheep were operated on and were divided into two groups of seven according to osteotomy type. The procedure was performed on the right tibiae and the intact left tibiae were used as controls. The transverse and axial ultrasound velocities were measured at 30-day intervals for 90 days, after which the animals were killed and both the right and left tibiae were resected for in vitro biomechanical analysis. RESULTS: Both the transverse and axial ultrasound velocities progressively increased, but the increase was smaller for the delayed union that resulted from the resection osteotomy. The mechanical resistance was higher for the normally healed tibiae that resulted from a linear osteotomy; this result closely correlated with the ultrasound velocity results. Significant differences were found for the comparisons between the intact and operated tibiae in both groups and between the groups for both the transverse and axial ultrasound velocities, but the differences were greater for the latter. CONCLUSION: We conclude that in vivo transverse and axial ultrasound velocities provide highly precise information about the healing state of both linear and resection diaphyseal osteotomies, but the axial ultrasound velocity most likely has greater discriminatory power. This method has the potential for clinical application in humans. .

O gel de plasma rico em plaquetas propicia a regeneração da cartilagem articular do joelho de ovelhas / Platelet-rich plasma gel promotes regeneration of articular cartilage in knees of sheeps

Objetivo: Avaliar a regeneração da cartilagem articular em defeitos osteocondrais do joelho induzidos pelo plasma rico em plaquetas (PRP) autógeno. Métodos: Defeitos osteocondrais produzidos no sulco troclear de ambos os joelhos de dez ovelhas foram preenchidos com PRP autógeno à direita e deixados vazios à esquerda. Avaliação macroscópica e histológica foram efetuadas 12 semanas mais tarde. Os resultados foram avaliados por um escore geral de ambas as avaliações macroscópica e histológica comparativamente entre os lados por meio do teste pareado de Wilcoxon. Resultados: o aspecto macroscópico não foi uniforme entre os animais, nem diferiu entre os joelhos direitos e esquerdos (p=0,03125); em nenhum caso o tecido regenerado se nivelou com a cartilagem normal circundante. Ao exame histológico, cartilagem aparentemente normal não foi detectada em nenhum joelho, mas uma cartilagem pouco diferenciada estava presente em sete joelhos direitos e em três joelhos esquerdos. Tecido fibrocartilaginoso estava presente nos joelhos restantes, com diferença significante no escore geral entre os joelhos direitos e esquerdos (p=0,0313). Conclusão: o PRP como usado neste estudo tem propriedades reparativas da cartilagem articular no joelho de ovelhas, principalmente por estimular a formação de tecido fibrocartilaginoso. Trabalho Experimental.

Objective: To assess the regeneration of osteochondral defects in the joint cartilage of the knee induced by autologous platelet-rich plasma (PRP). methods: osteochondral defects produced in the trochlear groove of both knees of ten sheep; defects of the right knees were filled with autologous PRP and the left knees were left unfilled. macroscopic and microscopic evaluation was carried out 12 week later. the results were evaluated by the total score of both macroscopic and microscopic evaluations comparing the two sides through the wilcoxon paired test. Results: macroscopic appearance was not uniform among animals, nor was it different between the right and left knees (p=0.3125), and in no case the regenerated tissue was equal to the normal surrounding cartilage. At histological examination, apparently normal cartilage was not detected in any knee, but a poorly differentiated cartilage was present in 7 right knees, compared to 3 left knees. Fibrocartilaginous tissue was present in most of the remaining knees, with a significant difference in the overall score between right and left knees (p=0.0313). conclusion: the pRp as used in this study has reparative properties of the joint cartilage of sheep knees, mostly by stimulating the formation of a fibrocartilaginous tissue. Laboratory Investigation.

Ineficácia da laserterapia aplicada no trajeto do nervo e nas raízes medulares correspondentes / Lack of effectiveness of laser therapy applied to the nerve course and the correspondent medullary roots

Objetivo: Verificar a influência da irradiação do laser de baixa intensidade na regeneração do nervo fibular comum de ratos após lesão por esmagamento. Métodos: Foram utilizados 25 ratos, divididos em três grupos: 1) nervo intacto, e não tratados; 2) nervo lesado, e não tratado; 3) nervo lesado, e laser irradiado sobre a região medular correspondente às raízes do nervo ciático e subsequentemente no trajeto do nervo lesado. A irradiação foi realizada por 14 dias consecutivos. Resultados: Foram avaliados por meio da análise funcional da marcha, através do índice funcional do peroneiro, e por análise morfométrica através do número total de fibras nervosas mielinizadas e sua densidade, número total de células de Schwann, número total de vasos sanguíneos e sua área, diâmetro mínimo da fibra e razão-G. Conclusão: De acordo com a análise estatística, não houve diferença significativa entre os grupos, e os autores concluem que a irradiação do laser de baixa intensidade possui pouca ou nenhuma influência na regeneração nervosa e recuperação funcional. Trabalho experimental.

Objective: To investigate the influence of low intensity laser irradiation on the regeneration of the fibular nerve of rats after crush injury. Methods: twenty-five rats were used, divided into three groups: 1) intact nerve, no treatment; 2) crushed nerve, no treatment; 3) crush injury, laser irradiation applied on the medullary region corresponding to the roots of the sciatic nerve and subsequently on the course of the damaged nerve. Laser irradiation was carried out for 14 consecutive days. Results: animals were evaluated by functional gait analysis with the peroneal functional index and by histomorphometric analysis using the total number of myelinated nerve fibers and their density, total number of schwann cells, total number of blood vessels and the occupied area, minimum diameter of the fiber diameter and G-quotient. Conclusion: according to the statistical analysis there was no significant difference among groups and the authors conclude that low intensity laser irradiation has little or no influence on nerve regeneration and functional recovery. Laboratory investigation.

Perfil dos pacientes com lesões traumáticas do membro superior atendidos pela fisioterapia em hospital do nível terciário / Profile of patients with traumatic injuries of the upper limb treated in a tertiary hospital

A incidência de lesões traumáticas dos membros superiores em um hospital terciário além de ser elevada, possui uma grande variedade. Neste sentido torna-se importante a criação de um banco de dados único, para conhecer o perfil dos pacientes atendidos. Objetivo: traçar o perfil dos pacientes com lesões traumáticas dos membros superiores, atendidos pela Fisioterapia no Centro de Reabilitação do Hospital das Clínicas de Ribeirão. Método: foram avaliadas 223 fichas de pacientes (58 mulheres e 116 homens), com idade média de 34,54 (± 19,05) anos, encaminhados pelo ambulatório de ortopedia do referido hospital. Resultados: do total de casos analisados, as lesões de punho e mão obtiveram maior incidência (60,99%), seguidos por lesões de ombro (20,63%), cotovelo (12,55%), braço (3,59%) e antebraço (2,24%). Nas lesões de punho e mão o mecanismo de trauma com maior porcentagem foi o acidente de moto, relacionado com as fraturas múltiplas de ossos da mão. Queda da própria altura, acidente motociclístico e queda de escada foram os mecanismos de trauma, correlacionando com as fraturas de úmero proximal, luxação de ombro e fraturas de escápula respectivamente. Conclusão: Foi verificada a incidência de lesão, mecanismo de trauma e as características da população para futuramente aprimorar os protocolos específicos para as disfunções e investir em campanhas de prevenção.

The incidence of traumatic injuries of the upper limbs in a tertiary hospital has a wide variety. This is why the creation of a unified database becomes important-to know the patients’ profile. Objective: this study sought to determine the profile of patients with traumatic injuries of the upper limbs, treated by Physical Therapy in Rehabilitation Center of the Clinics Hospital of Ribeirão Preto. Method: Two hundred and twenty-three patient records were evaluated (58 women and 116 men). They had an average age of 34.54 (± 19.05) years and were referred by the orthopedic clinic of this hospital. Results: of the cases studied, wrist and hand injuries had the highest incidence (60.99%), followed by injuries of the shoulder (20.63%), elbow (12.55%), arm (3.59%) and forearm (2.24%). In injuries of wrist and hand, the trauma mechanism with the highest percentage was the motorcycle accident, associated with multiple handbone fractures. Falling down, motorcycle accidents, and falling off a ladder were the mechanisms of injury correlated with proximal humerus fractures, shoulder dislocations, and broken scapulas, respectively. Conclusion: the incidence of injury, trauma mechanism, and characteristics of the population was verified and further improvements in protocols for specific disorders and prevention can be made.

Biomecânica de quatro técnicas de fixação da fratura em quatro partes da cabeça umeral / Biomechanics of four techniques for fixation of the four-part humeral head fracture

Objetivo: Realizar um estudo biomecânico de quatro técnicas de fixação das fraturas em quatro partes da cabeça umeral. Métodos: A fratura foi reproduzida em 40 úmeros plásticos, divididos em grupos de dez conforme a técnica de fixação, cada uma delas empregando diferentes recursos de fixação, em configurações distintas. Os modelos umerais foram montados em uma escápula de alumínio, com tiras de couro mimetizando os tendões do capuz rotador, e submetidos a ensaios de encurvamento e de torção em uma máquina universal de ensaios, usando a rigidez relativa como parâmetro de avaliação. Montagens com o úmero intacto foram analisadas para comparação. Resultados: O comportamento biomecânico das técnicas de fixação variou dentro de uma ampla faixa, as montagens incluindo a placa DCP e os parafusos de 4,5mm de diâmetro sendo significantemente mais rígidos do que as montagens com os fios de Kirschner e os parafusos 3,5 mm de diâmetro. Conclusão: As quatro técnicas foram capazes de suportar cargas compatíveis com a demanda fisiológica, mas aquelas com a maior rigidez relativa devem ser as preferidas para finalidades clínicas. Trabalho experimental.

Objective: To carry out a biomechanical study of four techniques for fixation of four-part humeral head fractures. Methods: The fracture was reproduced in 40 plastic humeri, divided into groups of ten according to the fixation technique, each one employing different fixation resources, in different configurations. The humeral models were mounted on an aluminum scapula, with leather straps simulating the rotator cuff tendons, and submitted to bending and torsion tests in a universal testing machine, using relative stiffness as an evaluation parameter. Assemblies with intact humeri were analyzed for comparison. Results: The biomechanical behavior of the fixation techniques varied within a wide range, where the assemblies including the DCP plate and the 4.5mm diameter screws were significantly more rigid than the assemblies with the Kirschner wires and the 3.5mm diameter screws. Conclusion: The four fixation techniques were able to bear loads compatible with the physiological demand, but those with higher relative stiffness should be preferred for clinical application. Laboratory investigation.

Avaliação ultrassonométrica da osteossíntese de compressão axial: estudo experimental / Ultrasonometric evaluation of axial compression osteosinthesis: experimental study

Objetivo: Medir a velocidade de propagação do ultrassom (VU) através de uma osteotomia transversal em tíbias de ovelha, antes e após a fixação com uma placa DCP. Métodos: Foram utilizadas dez montagens de uma placa DCP com o segmento diafisário das tíbias, no qual era feita uma osteotomia transversal. Foi realizada a medida subaquática transversal, nos planos coronal e sagital, e axial da VU, no osso íntegro, nas montagens sem osteotomia e, depois, com osteotomia sem e com a compressão axial pela placa DCP; comparações estatísticas foram feitas ao nível de significância de 1% (p<0,01). Resultados: Em comparação com a montagem com o osso intacto, a VU diminuiu com a adição da osteotomia e aumentou com a compressão axial, com significância somente para a modalidade axial de medida da VU. Conclusão: Concluiu-se que esse dado pode ser aplicável ao acompanhamento pós-operatório das osteossíntese com placa DCP, com a capacidade de demonstrar quando esta se torna ineficiente. Trabalho experimental.

Objective: To measure the ultrasound propagation velocity (UV) through a tibial transverse osteotomy in sheep, before and after the fixation with a DCP plate. Material and methods: Ten assemblies of a DCP plate with the diaphyseal segment of tibiae, in which a transverse osteotomy was made, were used. Both coronal and sagittal transverse and the axial UV were measured, first with the intact bone assembled with the plate and then with the uncompressed and compressed osteotomy; statistical comparisons were made at the 1% (p<0.01) level of significance. Results: Compared with the intact bone assembly, axial UV significantly decreased with the addition of the osteotomy and significantly increased with compression, presenting the same behavior for the other modalities, although not significantly. Discussion and conclusion: In accordance with the literature data on the ultrasonometric evaluation of fracture healing, underwater UV measurement was able to demonstrate the efficiency of DCP plate fixation. The authors conclude that the method has a potential for clinical application in the postoperative follow-up of DCP plate osteosinthesis, with a capability to demonstrate when it becomes ineffective. Laboratory investigation.

Efeitos da laserterapia na regeneração nervosa periférica / Effects of laser therapy in peripheral nerve regeneration

OBJETIVO: Analisar o efeito do laser nas doses de 5, 10 e 20J/cm2 na reparação do nervo fibular de ratos após esmagamento. Os resultados foram avaliados por meio da análise funcional da marcha e de parâmetros morfométricos.MÉTODOS: Lesão por esmagamento controlado do nervo fibular comum direito e submetidos a intensidades crescentes (G1: sem irradiação; G2: sham; G3: 5J/cm2; G4: 10J/cm2; G5: 20J/cm2) de irradiação do laser diretamente sobre o local da lesão por 21 dias consecutivos. A análise funcional da marcha foi realizada a intervalos semanais, tendo sido medido o índice funcional do fibular (IFF). Os animais foram sacrificados nos 21º dia pós-operatório para remoção do nervo fibular, que foi preparado para a análise morfométrica.RESULTADOS: Não houve diferença significativa (p>0,05) dos valores da análise de marcha (IFF) entre os grupos em qualquer momento de avaliação para o parâmetro. A área total da secção transversal do nervo foi significantemente maior no grupo 2 do que nos grupos 3 e 4, enquanto a densidade de fibras foi significantemente maior no grupo 4 do que no demais grupos.CONCLUSÃO: A irradiação com o laser AsGaAl de baixa potência não acelerou a regeneração do nervo fibular com nenhuma das doses utilizadas. Nível de Evidência I, Estudos terapêuticos - Investigação dos Resultados do Tratamento.

OBJECTIVE: The influence of dose of low power lasertherapy (AsGaAl, 830 nm) on the regeneration of the fibular nerve of rats after a crush injury was evaluated by means of the functional gait analysis and histomorphometric parameters.METHODS: Controlled crush injury of the right common fibular nerve, immediately followed by increasing doses (G1: no irradiation; G2: simulated; G3: 5 J/cm2; G4: 10 J/cm2; G5: 20 J/cm2) laser irradiation directly on the lesion site for 21 consecutive days. Functional gait analysis was carried out at weekly intervals by measuring the peroneal/fibular functional index (PFI). The animals were killed on the 21st postoperative day for removal of the fibular nerve, which was prepared for the histomorphometric analysis.RESULTS: The PFI progressively increased during the observation period in all groups, without significant differences between them (p>0.05). The transverse nerve area was significantly wider in group 2 than in groups 3 and 4, while fiber density was significantly greater in group 4 than in all remaining groups.CONCLUSION: The low power AsGaAl laser irradiation did not accelerate nerve recovery with any of the doses used. Level of Evidence I, Therapeutic Studies Investigating the Results of Treatment.

Análise casuística da sindactilia congênita: experiência com 47 pacientes / Congenital syndactyly: case by case analysis of 47 patients

OBJETIVO: Analisar e comparar as características dos pacientes com sindactilia congênita com os dados da literatura.MÉTODOS: Estudo retrospectivo baseado na análise do prontuário médico de 47 pacientes tratados em um período de 10 anos.RESULTADOS: Dos pacientes, 33 (70%) eram do sexo masculino e 14 (30%) do feminino. O número total de sindactilias foi de 116. A mão direita foi acometida em 19 casos (40%), a mão esquerda em 12 (24%) e em 17 (36%) o acometimento foi bilateral. Dezesseis (34%) pacientes possuíam síndromes genéticas. Entre os 31 (66%) não-sindrômicos, 12 (39%) apresentavam sindactilias isoladas e 19 (61%) associação com outras malformações da mão. O terceiro espaço foi acometido 45 (39%) vezes, seguido do quarto espaço com 35 (30%), do segundo com 22 (19%) e do primeiro com 14 (12%). As sindactilias simples foram encontradas 68 (59%) vezes, sendo completas em 44 (65%) situações e parciais em 24 (55%). As complexas foram identificadas 48 (41%) vezes.CONCLUSÃO: Os resultados obtidos na presente série são muito semelhantes aos dados encontrados na literatura. Estudo Epidemiológico.

OBJECTIVE: To assess and report clinical data from patients with syndactyly.METHODS: A retrospective review of 47 patients treated between April 2002 and April 2012.RESULTS: Among the 47 analyzed patients, 33 (70%) were male and 14 (30%) female. The total number of syndactylies was 116. The right hand was affected in 19 patients (40%), the left hand in 12 (24%) and 31 (36%) were bilaterally compromise. Sixteen patients (34%) also presented genetic syndromes. Among the 31 (66%) patients without syndromes, 12 (39%) had isolated syndactyly and 19 (61%) presented association with other hand anomalies. The third web space was affected 45 (39%) times; the fourth, 35 (30%) times; the second, 22 (19%) times and the first web space 14 (22%) times. Simple syndactyly was found 68 (59%) times, complete syndactyly in 44 (65%) and incomplete in 24 (55%). Complex syndactyly was found 48 (41%) times.CONCLUSION: The results in this study are similar to the literature. Epidemiological Study.

Análise da confiabilidade e reprodutibilidade da goniometria em relação à fotogrametria na mão / Analysis of the reliability and reproducibility goniometry photogrammetry regarding the hand

OBJETIVO: Avaliar a confiabilidade intra e interexaminadores e a reprodutibilidade da goniometria em relação à fotogrametria na mão, comparando os ângulos da abdução de polegar, flexão da AIFP do II dedo e flexão da AMCF do V dedo. MÉTODOS: PARTIciparam deste estudo 30voluntários foram divididos em 3 grupos, um grupo de 10 estudantes de Fisioterapia, outro por 10 fisioterapeutas e o terceiro com 10 terapeutas da mão. Cada avaliador realizou as medidas no mesmo molde de mão, utilizando o goniômetro e em seguidadois softwares de fotogrametria, o CorelDraw® e o ALCimagem®. RESULTADOS: Os resultados revelaram que os grupos e os métodos propostos apresentam confiabilidade interexaminadores no geral classificada como excelente (ICC 0,998 I.C. 95% 0,995 - 0,999). Na avaliação intraexaminadores, foi encontrado excelente nível de confiabilidade entre os três grupos. Na comparação entre os grupos para cada ângulo e cada método, observou-se que não houve diferença significativa entre os grupos para a maioria das medidas. CONCLUSÃO: A goniometria e a fotogrametria são métodos confiáveis e reprodutíveis para avaliação de medidas na mão. Porém, pela escassez de referências semelhantes, necessita-se de estudos aprofundados para definição de parâmetros de normalidade entre os métodos nas articulações da mão. Nível de Evidência II, Estudo Diagnóstico.

OBJECTIVE: To evaluate the intra and inter and reproducibility of goniometry compared to photogrammetryin hand, comparing the angles of abduction of thumb flexion, flexion of proximal interphalangeal joint of the index finger and flexion of the metacarpophalangeal joint of the fifth finger. METHODS: The study included 30 volunteers were divided in to three groups, one group of 10 students of physiotherapy for 10 physiotherapist sand other third with 10 therapist shand. Each examiner performed the measure mentsin the same mold by hand, using the goniometer and then two photogrammetry software, Corel Draw® and ALCimagem®. RESULTS: The results revealed that the groups and the methods proposed inter examiner reliability have generally rated as excellent (ICC 0.99895% CI0.995 to 0.999) In assessing rater was found excellent level of reliability among the three groups. Incomparison between groups for each angle and each method, we found that there was no significant difference between groups for most measures. CONCLUSION: Goniometry and photogramme tryare reliable and reproducible methods to evaluate measures in hand. However, the scarcity of similar references, it requires detailed studies to define normal parameters of the methods in the joints of the hand. Level of Evidence II, Diagnostic Study.

Influência da espessura do osso cortical sobre a velocidade de propagação do ultrassom / Influence of cortical bone thickness on the ultrasound velocity

OBJETIVO: Avaliar a influência da espessura do osso cortical sobre a velocidade de propagação do ultrassom (in vitro). MÉTODO: Foram utilizadas 60 lâminas ósseas confeccionadas a partir do fêmur de bovinos, com diferentes espessuras, variando de 1 a 6mm (10 de cada). As medidas da velocidade do ultrassom foram realizadas por aparelho projetado para este fim, utilizando técnica subaquática e por contato direto com auxílio de gel de acoplamento. Os transdutores foram posicionados de duas maneiras diferentes; opostos entre si, com o osso entre eles, sendo a medida chamada de transversal; e, paralelos na mesma superfície cortical, sendo a medida chamada de axial. RESULTADOS: Com o modo de transmissão axial, a velocidade de propagação do ultrassom aumenta conforme a espessura do osso cortical aumenta, independente da distância entre os transdutores, até a espessura de 5mm, mantendo-se constante após. Não houve alteração da velocidade quando o modo de transmissão foi transversal. CONCLUSÃO: A velocidade de propagação do ultrassom aumenta com o aumento da espessura da cortical óssea, no modo de transmissão axial, até o momento em que a espessura supera o comprimento da onda, mantendo a velocidade constante a partir de então. Nível de Evidência: Estudo Experimental.

OBJECTIVE: An experimental in vitro study was carried out to evaluate the influence of cortical bone thickness on ultrasound propagation velocity. METHODS: Sixty bone plates were used, made from bovine femurs, with thickness ranging from 1 to 6 mm (10 of each). The ultrasound velocity measurements were performed using a device specially designed for this purpose, in an underwater acoustic tank and with direct contact using contact gel. The transducers were positioned in two ways: on opposite sides, with the bone between them, for the transverse measurement; and parallel to each other, on the same side of the bone plates, for the axial measurements. RESULTS: In the axial transmission mode, the ultrasound velocity speed increased with cortical bone thickness, regardless of the distance between the transducers, up to a thickness of 5 mm, then remained constant thereafter. There were no changes in velocity when the transverse measures were made. CONCLUSION: Ultrasound velocity increased with cortical bone thickness in the axial transmission mode, until the thickness surpasses the wavelength, after which point it remained constant. Level of Evidence: Experimental Study.