Caracterización de las fracturas supracondíleas del húmero en niños que requirieron manejo quirúrgico en un hospital de Santander, Colombia / Characterization of Supracondylar Fractures of the Humerus in Children who Required Surgical Management at a Hospital in Santander, Colombia / Caracterização das fraturas supracondilianas do úmero em crianças que precisaram de tratamento cirúrgico em um hospital de Santander, Colômbia

Introducción. El objetivo del estudio fue describir las características sociodemográficas, tratamiento y complicaciones pre y posquirúrgicas de las fracturas supracondíleas del húmero distal en niños que requirieron manejo quirúrgico en un hospital de Santander, Colombia. Metodología. Se trata de un estudio observacional, descriptivo, de corte transversal con 58 pacientes que cumplieron los siguientes criterios de inclusión: edad entre 3 a 14 años, fracturas supracondíleas de manejo quirúrgico; como criterios de exclusión se tomó: antecedente de enfermedad ósea o neurológica previa y fracturas de más de 7 días de evolución. Para las variables continuas se usó medidas de tendencia central y dispersión, las categóricas en porcentajes y frecuencias absolutas. Resultados. La edad media de presentación fue de 6.2 años, el principal mecanismo de trauma fue caídas de altura con un 96.5%. El 65.5% provenía de zonas urbanas. El 13.8% se asoció con fracturas de antebrazo, y el 3.4% de epitróclea. La fijación se realizó en un 75% con técnica cruzada y un 17.2% se asoció con lesión iatrogénica del nervio ulnar. Discusión. En el estudio no se informaron lesiones vasculares; sin embargo, se documentó una alta prevalencia de lesión neurológica con la fijación medial, similar a lo descrito en la literatura (1.4%-17.7%); algunos autores describen técnicas que disminuyen estas lesiones hasta en un 0%. Conclusión. Las características sociodemográficas de nuestra población coinciden con la estadística publicada mundialmente; la principal complicación fue la lesión iatrogénica nervio ulnar, que se puede disminuir con un uso racional del pin medial y con el empleo de técnicas que busquen rechazar directamente el nervio. Palabras clave: Fracturas del Húmero; Fijación Interna de Fracturas; Clavos Ortopédicos; Codo; Niño; Nervio Cubital.

Introduction. The objective of this study was to describe sociodemographic characteristic, treatment, and pre- and post-surgical complications of supracondylar fractures of the distal humerus in children who required surgical management at a hospital in Santander, Colombia. Methodology. This was an observational, descriptive, and cross-sectional study involving 58 patients who met inclusion criteria: age between 3 and 14 years old, supracondylar fractures with surgical management; exclusion criteria include previous bone or neurological illness and fractures with more than 7 days of evolution. Central tendency and dispersion measures were used for continuous variables, and categorical variables in percentages and absolute frequencies. Results. The average age at presentation was 6.2 years old, the main mechanism of trauma was fall from height (96.5%). 65.5% came from urban zones. The 13.8% were associated with forearm fractures, and 3.4% with epitrochlear fractures. Pinning was performed at 75% with crossed technique and 17.2% were associated with iatrogenic ulnar nerve injury. Discussion. Study didn't inform vascular injuries. However, a high prevalence of neurological injury with medial pinning was documented, similar to that describe in the literature (1.4%-17.7%); some author described techniques that reduce these lesions by 0%. Conclusion. The sociodemographic characteristics of our population match with worldwide published statistics; the main complication was iatrogenic ulnar nerve injury, which can be reduced with the rational use of medial pin and with the application of techniques that seek to directly spare the nerve. Keywords: Humeral Fractures; Fracture Fixation, Internal; Bone Nails; Elbow; Child; Ulnar Nerve.

Introdução. O objetivo do estudo foi descrever as características sociodemográficas, o tratamento e as complicações pré e pós-cirúrgicas das fraturas supracondilianas do úmero distal em crianças que precisaram de tratamento cirúrgico em um hospital de Santander, Colômbia. Metodologia. Trata-se de um estudo observacional, descritivo e transversal com 58 pacientes que atenderam aos seguintes critérios de inclusão: idade entre 3 e 14 anos, fraturas supracondilianas tratadas cirurgicamente. Os critérios de exclusão foram: histórico de doença óssea ou neurológica prévia e fraturas com duração superior a 7 dias de evolução. Para variáveis contínuas foram utilizadas medidas de tendência central e dispersão, as categóricas em percentuais e frequências absolutas. Resultados. A média de idade de apresentação foi de 6.2 anos, o principal mecanismo de trauma foi a queda de altura com 96.5%. 65.5% vieram de áreas urbanas. 13.8% estavam associados a fraturas de antebraço e 3.4% a epitróclea. A fixação foi realizada em 75% com técnica cruzada e 17.2% esteve associada à lesão iatrogênica do nervo ulnar. Discussão. Nenhuma lesão vascular foi relatada no estudo. No entanto, foi documentada alta prevalência de lesão neurológica com fixação medial, semelhante à descrita na literatura (1.4%-17.7%). Alguns autores descrevem técnicas que reduzem essas lesões em até 0%. Conclusão. As características sociodemográficas da nossa população coincidem com as estatísticas publicadas mundialmente. A principal complicação foi a lesão iatrogênica do nervo ulnar, que pode ser reduzida com o uso racional do pino medial e com o uso de técnicas que buscam rejeitar diretamente o nervo. Palavras-chave: Fraturas do Úmero; Fixação Interna de Fraturas; Pinos Ortopédicos; Cotovelo; Criança; Nervo Ulnar

Endoscopic Release of the Ulnar Nerve at the Elbow: Technique Description and Case Series / Liberação endoscópica do nervo ulnar no cotovelo: Descrição da técnica e série de casos

Abstract Objective The endoscopic release of the ulnar nerve reproduces a simple (in situ) procedure with smaller incisions, less soft tissue damage, and higher preservation of nerve vascularization. Endoscopy allows the clear visualization of the entire path of the nerve and surrounding noble structures. Moreover, it reveals any signs of compression and allows a safe release of 10cm distally or proximally to the medial epicondyle. Methods A retrospective survey revealed that 15 subjects (1 with a bilateral injury) underwent an ulnar nerve compression release at the elbow using the endoscopic technique with Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA) equipment from January 2016 to January 2020. Results Symptoms of ulnar nerve compression improved in all patients; on average, they resumed their work activities in 26.5 days. There was no recurrence or need for another procedure. In addition, there were no severe procedure-related complications, such as infection and nerve or vascular injury. One patient had transient paresthesia of the sensory branches to the forearm, with complete functional recovery in 8 weeks. Conclusion Our study shows that the endoscopic release of the ulnar nerve at the elbow with the Agee equipment is a safe, reliable technique with good outcomes.

Resumo Objetivo A liberação endoscópica do nervo ulnar permite reproduzir uma liberação simples (in situ), mas através de incisões menores e com menor lesão de partes moles e uma maior preservação da vascularização do nervo. A visualização clara através da endoscopia permite observar todo o trajeto do nervo e das estruturas nobres circundantes, mostrando os sinais de compressão, possibilitando realizar a liberação de forma segura em um trajeto de 10 cm nos sentidos distal e proximal ao epicôndilo medial. Método Foram encontrados, de forma retrospectiva, no período entre janeiro de 2016 e janeiro de 2020, 15 pacientes (sendo 1 com lesão bilateral) submetidos a liberação da compressão do nervo ulnar no cotovelo pela técnica endoscópica com equipamento de Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA). Resultados Todos os pacientes tiveram melhora dos sintomas de compressão do nervo ulnar e o período de retorno ao trabalho foi de em média 26,5 dias. Não houve recidivas e não houve a necessidade de outro procedimento. Também não houve complicações graves decorrentes do procedimento, como infecção, lesão nervosa ou vascular. Em um paciente, houve parestesia transitória dos ramos sensitivos para o antebraço, com retorno completo da função em 8 semanas. Conclusão Os resultados mostram que a liberação endoscópica do nervo ulnar no cotovelo comoequipamentodeAgeeéuma técnica segura, confiável e com bons resultados.

Cirugía de "Tommy John" en paciente adolescente lanzador de béisbol / Tommy John surgery in adolescent baseball pitcher

La lesión del ligamento colateral cubital (LCC) es una patología debilitante del codo, con alta prevalencia en deportistas. En este trabajo expondremos el caso de una reconstrucción del ligamento colateral cubital realizada en un beisbolista masculino de dieciséis años, mediante un abordaje con la técnica quirúrgica de docking.

Ulnar collateral ligament (UCL) injury is a debilitating pathology of the elbow, with high prevalence in athletes. We describe the case of a UCL reconstruction performed in a 16-year-old male baseball player, using the Docking surgical technique.

Síndromes compresivos del nervio mediano. Revisión y actualización de la bibliografía / Median nerve compression syndromes. Literature review and update

El nervio mediano desciende por el brazo y, en el codo, comienza a atravesar estructuras que pueden generar compresión, como el ligamento de Struthers, el lacertus fibrosus, el pronador redondo, el flexor superficial de los dedos. Finalmente, en la muñeca, se encuentra otro sitio de compresión producido por el ligamento transverso del carpo. Todas estas estructuras pueden provocar signos y síntomas de atrapamiento nervioso y favorecer el deterioro funcional del nervio. Nuestro objetivo es dar a conocer una actualización sobre estos sitios de atrapamiento del nervio mediano, y cómo realizar un diagnóstico preciso e indicar un trata-miento adecuado. Nivel de Evidencia: IV

The median nerve is a nervous structure that begins to cross structures at the level of the elbow that might cause compression. The Struthers ligament, lacertus fibrosus, pronator teres, and flexor digitorum superficialis are among them. Finally, the transverse carpal ligament creates another compression site in the wrist. All these structures can develop pathological signs and symptoms of nerve entrapment, which favors nerve functional degradation. Our objective is to provide an update on these median nerve entrap-ment sites, as well as information on how to establish an accurate diagnosis and provide adequate treatment. Level of Evidence: IV

Comparison of above elbow and below elbow immobilisation for conservative treatment of distal end radius fracture in adults: A systematic review and meta-analysis of randomized clinical trials / 中华创伤杂志(英文版)

PURPOSE@#The aim of this study was to analyze if any difference exists on the type of immobilisation (above elbow vs. below elbow) in the conservative treatment of distal end radius fractures in adults.@*METHODS@#The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses. An electronic literature search was performed up to 1st October 2021 in Medline, Embase, Ovid and Cochrane database using the search terms, "distal end radius fractures OR fracture of distal radius", "conservative treatment OR non-surgical treatment", "above elbow immobilisation" and "below elbow immobilisation". Randomized clinical trials written in English, describing outcome of distal end radius fractures in adults by conservative or non-surgical means using above elbow immobilisation or below elbow immobilisation were included and assessed according to the risk of bias assessment (RoB2) tool by Cochrane collaboration. Non-randomized clinical trials, observational studies, retrospective studies, review articles, commentaries, editorials, conference presentations, operative techniques and articles without availability of full text were excluded from this review. The meta-analysis was performed using Review Manager version 5.4.1 (The Cochrane Collaboration, Copenhagen, Denmark).@*RESULTS@#Six randomized clinical trials were included for quantitative review. High heterogeneity (I2 > 75%) was noted among all the studies. The standard mean difference (MD) between the disability of the arm, shoulder and hand scores in both the groups was 0.52 (95% CI: -0.28 to 1.32) which was statistically non-significant. There was no statistical difference in the radial height (MD = 0.10, 95% CI: -0.91 to 1.12), radial inclination (MD = 0.5, 95% CI: -1.88 to 2.87, palmar tilt (MD =1.06, 95% CI: -0.31 to 2.43) and ulnar variance (MD = 0.05, 95% CI: -0.74 to 0.64). It was observed that shoulder pain occurred more commonly as a complication in above elbow immobilisation and the values were statistically significant (above elbow: 38/92, 41.3%; below elbow: 19/94, 20.2%).@*CONCLUSION@#This two-armed systematic review on the above elbow or below elbow immobilisation to be used for conservative treatment of the distal end radius fracture in adults resulted in non-significant differences in terms of functional and radiological scores among the 2 groups but significant increase in the complication rates in the above elbow group.

Correlation between Elbow Flexor Muscle Strength and Needle Electromyography Parameters after Musculocutaneous Nerve Injury / 法医学杂志

OBJECTIVES@#To explore the changes of elbow flexor muscle strength after musculocutaneous nerve injury and its correlation with needle electromyography (nEMG) parameters.@*METHODS@#Thirty cases of elbow flexor weakness caused by unilateral brachial plexus injury (involving musculocutaneous nerve) were collected. The elbow flexor muscle strength was evaluated by manual muscle test (MMT) based on Lovett Scale. All subjects were divided into Group A (grade 1 and grade 2, 16 cases) and Group B (grade 3 and grade 4, 14 cases) according to their elbow flexor muscle strength of injured side. The biceps brachii of the injured side and the healthy side were examined by nEMG. The latency and amplitude of the compound muscle action potential (CMAP) were recorded. The type of recruitment response, the mean number of turns and the mean amplitude of recruitment potential were recorded when the subjects performed maximal voluntary contraction. The quantitative elbow flexor muscle strength was measured by portable microFET 2 Manual Muscle Tester. The percentage of residual elbow flexor muscle strength (the ratio of quantitative muscle strength of the injured side to the healthy side) was calculated. The differences of nEMG parameters, quantitative muscle strength and residual elbow flexor muscle strength between the two groups and between the injured side and the healthy side were compared. The correlation between elbow flexor manual muscle strength classification, quantitative muscle strength and nEMG parameters was analyzed.@*RESULTS@#After musculocutaneous nerve injury, the percentage of residual elbow flexor muscle strength in Group B was 23.43% and that in Group A was 4.13%. Elbow flexor manual muscle strength classification was significantly correlated with the type of recruitment response, and the correlation coefficient was 0.886 (P<0.05). The quantitative elbow flexor muscle strength was correlated with the latency and amplitude of CMAP, the mean number of turns and the mean amplitude of recruitment potential, and the correlation coefficients were -0.528, 0.588, 0.465 and 0.426 (P<0.05), respectively.@*CONCLUSIONS@#The percentage of residual elbow flexor muscle strength can be used as the basis of muscle strength classification, and the comprehensive application of nEMG parameters can be used to infer quantitative elbow flexor muscle strength.

Limited internal fixation combined with a hinged external fixator in treatment of peri-elbow bone infection / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection.@*METHODS@#The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score.@*RESULTS@#All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up ( P<0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%.@*CONCLUSION@#Limited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.

Management of Supracondylar Humeral Fracture in Children / Manejo da fratura supracondiliana do úmero na criança

Abstract Supracondylar humeral fracture represents ~ 3 to 15% of all fractures in children. It is the fracture that most requires surgical treatment in the pediatric population. Advances in treatment and care have contributed to a reduction in the most dramatic complication: Volkmann ischemic contracture. Nevertheless, the risks inherent to the fracture remain. Absence of palpable pulse in type-III fractures is reported in up to 20% of the cases. Careful sensory, motor, and vascular evaluation of the affected limb is crucial in determining the urgency of treatment. Older children, male patients, floating elbow, and neurovascular injury are risk factors for compartment syndrome. Medial comminution can lead to varus malunion, even in apparently innocent cases. The recommended treatment of displaced fractures is closed reduction and percutaneous pinning. Technical errors in pin placement are the main cause of loss of reduction. There is enough evidence for the addition of a third lateral or medial Kirschner wire in unstable fractures (types III and IV). Medial comminution may lead to cubitus varus even in mild displaced fractures. Based on current concepts, a flowchart for the treatment of supracondylar humeral fracture in children is suggested by the authors.

Resumo A fratura supracondiliana do úmero representa cerca de 3 a 15% de todas as fraturas na criança, sendo a que mais requer tratamento cirúrgico na população pediátrica. Apesar de os avanços no tratamento e na assistência terem contribuído para uma redução drástica da complicação mais temida, a contratura isquêmica de Volkmann, os riscos inerentes à fratura permanecem. Ausência de pulso palpável em fraturas tipo III é reportada em até 20% dos casos. Uma cuidadosa avaliação sensitiva, motora e vascular do membro acometido é fundamental na determinação da urgência do tratamento. Crianças mais velhas, sexo masculino, cotovelo flutuante, e lesão neurovascular são fatores de risco para a síndrome de compartimento. A cominuição medial pode levar à consolidação em varo, mesmo nos casos aparentemente inocentes. O método de escolha para o tratamento da fratura desviada é a redução fechada e fixação percutânea. Os erros na fixação e posicionamento inadequado dos implantes são as principais causas de perda de redução. Já existem evidências suficientes para a utilização de um terceiro fio de Kirschner, lateral ou medial, nas fraturas instáveis (tipo III e IV). Baseado nos conceitos atuais, um fluxograma para o tratamento da fratura supracondiliana do úmero na criança é sugerido pelos autores.

Puntajes III / Scores III

El Comité Editorial quiere brindar a sus lectores una actualización de las escalas de uso corriente. El empleo de tablas y escalas es una práctica muy extendida en la Ortopedia y Traumatología. La medición y la cuantificación de los aspectos clínicos, funcionales y radiográficos se convirtieron en una herramienta imprescindible para la toma de decisiones en diferentes aspectos de la actividad asistencial. Llevamos a cabo una revisión de las escalas más utilizadas, definiendo su uso e incluyendo bibliografía original y actualizada. Nivel de Evidencia: V

The Editorial Committee wants to provide its readers with an update on the commonly used scales. The use of tables and scales is a widespread practice in Orthopedics and Traumatology. The measurement and quantification of clinical, functional, and radiographic aspects has become an essential tool for decision-making in different aspects of healthcare activity. We carry out a review of the most used scales, defining their use and including original and updated literature. Level of Evidence: V

Efecto de la práctica mental kinestésica en la fuerza y actividad mioeléctrica del bíceps braquial, luego de un periodo de inmovilización de codo en adultos-jóvenes sanos / Effects of kinesthetic mental practice in strength and myoelectric activity of the brachialis biceps due to an elbow immobilization period in healthy young adults

RESUMEN: El objetivo de este estudio fue determinar el efecto de la práctica mental kinestésica (PMK) en la fuerza y actividad eléctrica muscular (AEM) del bíceps braquial, luego de un periodo de inmovilización del codo en un grupo de personas adultos jóvenes sanos. Un total de 14 personas (18,64 ± 0,92 años de edad) participaron voluntariamente del estudio, a las cuales se les evaluó la fuerza muscular de prensión y la AEM del bíceps braquial utilizando un dinamómetro de mano y un equipo de electromiografía, respectivamente, antes y después de un periodo de inmovilización del brazo no dominante, y se asignaron aleatoriamente a uno de dos grupos: grupo control (GC) o experimental (GE). El GE realizó PMK: tres series de 15 repeticiones con un minuto de descanso entre series, tres veces al día durante los seis días de inmovilización, mientras que el GC no realizó PKM durante su inmovilización. Al aplicar una prueba de ANOVA de dos vías, no se encontraron diferencias significativas en la fuerza ni en la AEM. Sin embargo, la fuerza del GC disminuyó en 23,75%, mientras que la del GE aumentó en 33,19%. Los resultados sugieren que un periodo de inmovilización del codo de seis días no fue suficiente para que la fuerza ni la AEM disminuyan significativamente, lo que supone que la PMK realizada no es necesaria en periodos menores a seis días.

ABSTRACT: The aim of this study was to determine the effect of kinesthetic mental practice (KMP) on the strength and muscular electrical activity (MEA) of the brachial biceps, after a period of immobilization of the elbow in a group of healthy young adults. A total of 14 volunteer participants (18.64 ± 0.92 years of age) were part in the study. The muscle strength and the AEM of the brachial biceps were assessed using a hand dynamometer and an electromyography equipment, respectively, before and after a period of immobilization of the non-dominant arm. After the pretest, they were randomly assigned to one of two groups: control group (GC) or experimental group (GE). The GE performed 3 sets of 15 repetitions with one-minute rest between sets, three times a day of PMK during the 6 days of immobilization, while the GC did not perform PKM during its immobilization. A 2-way ANOVA test (group x measurement) indicated non-significant differences in strength or AEM. However, the strength of the GC decreased by 23.75%, while increased by 33.19% in the GE. The results suggest that a period of immobilization of the elbow of 6 days was not enough for the strength or the AEM to decrease significantly, which means that the PMK is not necessary in periods of immobilization of less than 6 days.

The improvement of pca algorithm and its application in the prediction of elbow knee joint injury / O aprimoramento do algoritmo pca e sua aplicação na predição de lesão da articulação do cotovelo e do joelho / La mejora del algoritmo pca y su aplicación en la predicción de la lesión de la articulación del codo y la rodilla

ABSTRACT Objective: There were many constraints produced by training time and joint injury to analyze the influence of the training intensity on the elbow and knee joints of athletes during the training process. Methods: An improved algorithm-based master component analysis (PCA) modeling method is proposed .1 4 4 athletes were selected in xxx and compared in three groups. Results: The improved PCA models for injury prediction were applied to athletes from group A, the traditional injury models for prediction were adopted for athletes from group B, and athletes from group C received the hospital physical examinations. The results showed that the accuracy of elbow injury in group A due to excessive exercise was 66.86%, the accuracy of hospital physical examination in group C was 67%, and the accuracy of the traditional algorithm in group B was 50%, finding that the accuracy of group A was obviously different from group B (P < 0.05). Compared with other injuries caused by excessive friction, the detection accuracy of knee injuries caused by excessive friction in group A was 62%, that in group B was 44%, and that in group C was 63%. There was a statistically marked difference between groups A and B (P < 0.05). Conclusions: A PCA - based model of athletes' overtraining injury has high accuracy and adaptability, predicting elbow injury. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Objetivo: Houve uma grande quantidade de restrições produzidas pelo tempo de treinamento e lesão articular a fim de analisar a influência da intensidade do treinamento nas articulações do cotovelo e joelho dos atletas durante o processo de treinamento. Métodos: É proposto um método de modelagem aprimorado de análise de componentes mestre (PCA) baseado em algoritmo .1 4 4 atletas foram selecionados em xxx e comparados em três grupos. Resultados: Os modelos aprimorados de PCA para previsão de lesões foram aplicados a atletas do grupo A, os modelos tradicionais de lesões para previsão foram adotados para atletas do grupo B e os atletas do grupo C receberam os exames físicos hospitalares. Os resultados mostraram que a acurácia da lesão de cotovelo no grupo A devido ao exercício excessivo foi de 66,86%, a acurácia do exame físico hospitalar no grupo C foi de 67% e a acurácia do algoritmo tradicional no grupo B foi de 50%, achando que a acurácia do grupo A era obviamente diferente do grupo B (P <0,05). Em comparação com outras lesões causadas por atrito excessivo, a precisão de detecção de lesões no joelho causadas por atrito excessivo no grupo A foi de 62%, no grupo B foi de 44% e no grupo C foi de 63%. Houve uma diferença estatisticamente marcada entre os grupos A e B (P <0,05). Conclusões: Um modelo baseado na PCA de lesão por overtraining em atletas tem alta precisão e adaptabilidade, o que pode prever lesões de cotovelo. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento.

RESUMEN Objetivo: Hubo una gran cantidad de restricciones producidas por el tiempo de entrenamiento y la lesión articular para analizar la influencia de la intensidad del entrenamiento en las articulaciones del codo y la rodilla de los atletas durante el proceso de entrenamiento. Métodos: Se propone un método mejorado de modelado de análisis de componentes maestros (PCA) basado en algoritmos .1 4 Se seleccionaron 4 atletas en xxx y se compararon en tres grupos. Resultados: Los modelos mejorados de PCA para la predicción de lesiones se aplicaron a los atletas del grupo A, los modelos tradicionales de predicción de lesiones se adoptaron para los atletas del grupo B y los atletas del grupo C recibieron los exámenes físicos hospitalarios. Los resultados mostraron que la precisión de la lesión del codo en el grupo A por ejercicio excesivo fue del 66,86%, la precisión del examen físico hospitalario en el grupo C fue del 67% y la precisión del algoritmo tradicional en el grupo B fue del 50%, encontrando que la precisión del grupo A fue obviamente diferente del grupo B (P <0.05). En comparación con otras lesiones causadas por fricción excesiva, la precisión de detección de las lesiones de rodilla causadas por fricción excesiva en el grupo A fue del 62%, en el grupo B del 44% y en el grupo C del 63%. Hubo una diferencia estadísticamente marcada entre el grupo A y B (P <0.05). Conclusiones: Un modelo basado en PCA de la lesión por sobreentrenamiento de los atletas tiene una alta precisión y adaptabilidad, lo que puede predecir la lesión del codo. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.

Retalho de padrão axial da artéria torácica lateral para reconstrução de lesão cutânea em região de cotovelo de cão: Relato de caso / Use of lateral thoracic axial pattern flap to repair cutaneous defect in a dog elbow: Case report

Os retalhos cutâneos são técnicas de escolha para reconstrução de grandes defeitos. Objetivou-se relatar o emprego do retalho de padrão axial da artéria torácica lateral em paciente com ferida cirúrgica ocasionada imediatamente após exérese de neoformação na região da articulação do cotovelo. Foi atendido paciente canino macho, 10 anos, pesando 12 kg, apresentando neoformação em tecidos moles, de grande volume, localizada na região medial do cotovelo. Como tratamento definitivo, implementou-se a exérese marginal da neoplasma seguida de reconstrução com a técnica de retalho de padrão axial da artéria torácica lateral. A técnica possibilitou completa síntese e oclusão do defeito, obtendo-se ótima recuperação pós operatória, não sendo observada deiscência de sutura ou necrose do retalho. Conclui-se que a implementação do retalho da artéria torácica lateral foi uma técnica viável na reconstrução em cotovelo após a exérese do neoplasma no paciente relatado, observando resultados satisfatórios quanto aos aspectos funcionais e cosméticos, após o período cicatricial.

Skin flaps are suitable methods of wound closure in large cutaneous defects. I The present study aims to report the use of lateral thoracic axial pattern flap to repair an elbow wound secondary to a neoplasm resection. A 10-year-old male dog weighing 12 kg was presented with a large soft tissue neoplasm in the medial aspect of the elbow. The patient underwent surgical resection of the neoplasm using the lateral thoracic cutaneous flap to achieve a complete defect closure, resulting in an excellent postoperative wound healing without suture failure or skin flap necrosis. It is concluded that the implementation of the lateral thoracic artery flap was a viable technique in elbow reconstruction after neoplasm excision in the reported patient, with satisfactory results regarding functional and cosmetic aspects after the healing period.

Angioedema hereditário inaugural na idade pediátrica / Hereditary angioedema in a child with no family history of disease

O angioedema hereditário por défice de C1-inibidor é uma doença rara autossômica dominante com uma prevalência estimada em 1:50.000. Habitualmente a história familiar aponta para este diagnóstico. No entanto, a apresentação atípica com história familiar negativa pode atrasar o diagnóstico de meses a anos. Os autores apresentam o caso de uma criança de 6 anos sem antecedentes pessoais ou familiares relevantes que recorreu ao Serviço de Urgência pediátrico por edema, calor e rubor do cotovelo, joelho e maléolos direitos com 12h de evolução, sem fatores associados. Ao exame objetivo: edema do cotovelo, joelho e maléolos direitos, exantema não pruriginoso maleolar homolateral com discreto desconforto à palpação. Sem elevação dos parâmetros infeciosos ou inflamatórios. Foi iniciada corticoterapia sistêmica, com melhoria lenta do quadro. Teve alta, referenciada à consulta de Imunoalergologia. Na anamnese foram apurados quatro episódios de edema periarticular nos doze meses prévios. A avaliação analítica da criança revelou C1 inibidor 62 mg/dL, C1 inibidor funcional 29%, confirmada em duas determinações, e a dos pais e dos dois irmãos foi normal. No estudo genético não foram identificadas mutações nos genes SERPING. O angioedema hereditário por défice de função do C1-inibidor - tipo II - representa 15 a 20% dos casos. Embora a história familiar seja o maior sinal de alerta para o diagnóstico desta patologia, em 20-25% dos casos ocorre mutação espontânea. Nestes casos um elevado grau de suspeição é necessário e um atraso no diagnóstico pode levar a consequências graves. As opções terapêuticas em crianças menores de 12 anos são ainda limitadas.

Hereditary angioedema with C1-inhibitor deficiency is a rare autosomal dominant disease with an estimated prevalence of 1:50 000. Usually, family history points to this diagnosis. However, atypical presentation with negative family history may delay diagnosis in months to years. The authors describe the case of a 6-year-old girl with apparently no significant family or past medical history, presenting to the emergency department for edema, warmth, and redness of the right elbow, knee, and ankle, which started 12 hours earlier, without associated factors. On physical examination, edema of the right elbow, knee, and ankle, and nonpruritic rash on the right ankle with a slight discomfort on palpation were found. Laboratory infection or inflammation markers were not elevated. Systemic corticosteroids were started, with slow improvement. She was discharged and referred to an immunoallergology outpatient clinic. On medical history taking, four episodes of periarticular edema in the past 12 months were identified. Laboratory evaluation revealed C1-inhibitor at 62 mg/dL and functional C1-inhibitor at 29%, confirmed in two samples; the parents and two siblings were normal. On genetic testing, there were no mutations on the SERPING genes. Hereditary angioedema with C1-inhibitor deficiency ­ ie, type II ­ accounts for 15 to 20% of cases. Even though family history is the major indicator for diagnosis of this condition, a de novo mutation occurs in 20 to 25% of cases. In these cases, a high suspicion is necessary, and a delayed diagnosis could have severe implications. Therapeutic options in children under the age of 12 are limited.

Luxaciones puras de codo en pacientes pediátricos: tratamiento conservador y complicaciones asociadas a una patología poco prevalente. Serie de 4 casos / Isolated elbow dislocation in pediatric patients: non-operative treatment and complications associated with an infrequent pathology. Series of 4 cases

Si bien el codo es la articulación más frecuentemente luxada en niños, representa el 3-6 % de las lesiones en ese sitio. Las luxaciones sin fracturas asociadas son muy raras y son producto de una caída con el codo en extensión. El paciente consulta por dolor, impotencia funcional y deformidad evidente. La finalidad del tratamiento es restaurar la congruencia articular, lograr estabilidad y minimizar los riesgos de posibles lesiones neurovasculares.Se presentan 4 pacientes tratados con manejo conservador con excelentes resultados funcionales, incluso aquel que presentó una neuropraxia del mediano con restitución ad integrum.Según nuestra experiencia, suelen ser lesiones con buena evolución. Se destaca la importancia de un rápido y preciso examen neurovascular, optando, de ser posible, por una conducta expectante ante las lesiones nerviosas. Se resalta la indicación de una inmovilización acotada con movilización temprana que evite rigidez del codo.

Even though the elbow is the most often dislocated joint in children, this injury accounts for 3-6 % of elbow pathology. Dislocations without associated fractures are extremely rare. They result from a fall onto an outstretched hand. The patient is always referred with a painful joint, movement impairment and even clinical deformity. Acute treatment aims to achieve quick reduction and adequate joint stability, avoiding neurovascular injuries.We sought to analyze the functional outcomes and the complications after non-operative treatment. Our 4 patien had excellent functional results at the latest follow-up, and one of them suffered from a median nerve palsy without further consequences.In our experience, these injuries presented excellent outcomes and we would like to highlight the importance of a quick and precise neurovascular examination with the possibility of non-surgical management of nerve injuries. A short period of immobilization with early rehabilitation should be indicated to avoid joint stiffness

Estudio morfométrico del radio proximal en una población chilena / Morphometric study of the proximal radius in a Chilean population

RESUMEN: El objetivo de esta investigación fue determinar la morfometría del extremo proximal del radio, mediante mediciones efectuadas en la cabeza, cuello y tuberosidad del radio, en una población chilena y compararlas según sexo. Se efectuó un estudio transversal analizando exámenes de Tomografía Computarizada (TC) de codo, realizados entre enero de 2014 y diciembre de 2018. Se incluyó 32 TC, correspondientes a 16 hombres y 16 mujeres. Se transfirió las imágenes formateadas al software RadiAnt, para efectuar las mediciones en el radio proximal. El análisis estadístico de los resultados se realizó mediante el software SPSS 22. El diámetro de la cabeza del radio en hombres osciló entre 22,8±1,3 y 25,0±1,7 mm; en mujeres osciló entre 19,4±1,4 y 20,7±1,4 mm. El diámetro del cuello del radio proximal en hombres osciló entre 14,0±0,8 y 15,6±0,7 mm; en mujeres osciló entre 11,7±0,8 y 13,3±1,3 mm. El diámetro del cuello del radio distal en hombres osciló entre 14,4±1,0 y 16,0±1,2 mm; en mujeres osciló entre 12,5±1,0 y 13,8±1,5 mm. El diámetro de la tuberosidad radial en hombres osciló entre 15,1±1,5 y 17,7±1,8 mm; en mujeres osciló entre 13,2±1,1 y 15,5±1,8 mm. El promedio de altura de la cabeza del radio fue de 11,2±1,2 mm en hombres y de 9,5+0,8 mm en mujeres. El análisis comparativo entre sexos mostró diferencias estadísticamente significativas en todas las mediciones precedentes. El promedio de altura del cuello del radio fue de 11,2±1,2 mm en hombres y 10,1±1,6 mm en mujeres, sin diferencia significativa (p= 0,15). Los valores promedios de la morfometría del radio proximal de la población chilena difieren de los descritos para la población europea y presentan algunas similitudes con la población china. Nuestros resultados pueden ser de utilidad para el diseño de implantes y prótesis para el extremo proximal del radio y para una correcta planificación quirúrgica en ortopedia y traumatología.

SUMMARY: The aim of this research was to determine the morphometry of the proximal radius in a Chilean population, by means of measurements made in head of radius, neck of radius and radial tuberosity, and to compare them according to sex. A cross-sectional study was conducted analyzing Computed Tomography scans (CT) of elbows, performed between January 2014 and December 2018. Thirty-two CT corresponding to 16 men and 16 women were included. The formatted images were transferred to the RadiAnt software in order to perform measurements in the proximal radius. The statistical analysis of the results was performed using the SPSS 22 software. The diameter of the head of radius in men ranged between 22.8±1.3 and 25.0±1.7 mm; in women it ranged between 19.4±1.4 and 20.7±1.4 mm. The diameter of the proximal neck of radius in men ranged between 14.0±0.8 and 15.6±0.7 mm; in women, it ranged between 11.7±0.8 and 13.3±1.3 mm. The diameter of the distal neck of radius in men ranged between 14.4±1.0 and 16.0±1.2 mm; in women, it ranged between 12.5±1.0 and 13.8±1.5 mm. The diameter of radial tuberosty in men ranged between 15.1±1.5 and 17.7±1.8 mm; in women, it ranged between 13.2±1.1 and 15.5±1.8 mm. The mean height of the head of radius was 11.2±1.2 mm in men and 9.5±0.8 mm in women. Statistically significant sex differences were revealed in all the preceding measurements. The mean height of the neck of radius was 11.2±1.2 mm in men and 10.1±1.6 mm in women, with no significant difference (p= 0.15). The average values of morphometry of the proximal radius of the Chilean population differ from those describing the European population, and show some similarities with the Chinese population. Our results may be useful to design of implants and prostheses for the proximal radius, and to correct surgical planning in orthopedics and traumatology.

Determining the utility of minimum F-wave latency alterations in the electrodiagnosis of ulnar neuropathy at the elbow / Determinação da utilidade das alterações mínimas da latência da onda F no eletrodiagnóstico da neuropatia ulnar do cotovelo

ABSTRACT Background: Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. There is little information about the application of F-wave studies for evaluation of UNE. Objective: The aim of this study was to evaluate the diagnostic value of minimum F-wave (F-min) latency alterations by comparing this with nerve conduction analyses in UNE-suspected patients. Methods: Ninety-four UNE-suspected patients were admitted to this study. Sensory and motor nerve conduction and F-wave analyses on the median and ulnar nerves were performed on both upper extremities. Results: A total of 188 upper extremities of 94 patients were examined. Their mean age was 41.4±12.9 years, and 69 patients were female (73.4%). The mean ulnar-nerve across-elbow motor conduction velocity (MCV) in the affected arms was significantly slower than the velocity in healthy arms. The mean ulnar-nerve F-min latencies were significantly longer in the affected arms. Fifty-one patients were electrophysiologically diagnosed as presenting UNE (54.2%). Significantly slower mean ulnar-nerve across-elbow MCV, longer mean ulnar-nerve F-min latency and longer distal onset latency were detected in UNE-positive arms. Lastly, patients who were symptomatic but had normal nerve conduction were evaluated separately. Only the mean ulnar F-min latency was significantly longer in this group, compared with the healthy arms. Conclusion: Our study confirmed the utility of F-min latency measurements in the electrodiagnosis of UNE. F-wave latency differences can help in making an early diagnosis to provide better treatment options.

RESUMO Introdução: A neuropatia ulnar do cotovelo (NUC) é a segunda neuropatia por encarceramento mais comum. Existem poucas informações sobre a aplicação dos estudos da onda F para avaliação da NUC. Objetivo: O objetivo deste estudo foi avaliar o valor diagnóstico das alterações mínimas de latência da onda F (F-min), comparando-as com análises de condução nervosa em pacientes com suspeita de NUC. Métodos: Noventa e quatro pacientes com suspeita de NUC foram admitidos neste estudo. A condução nervosa sensitiva e motora e as análises da onda F nos nervos mediano e ulnar foram realizadas em ambas as extremidades superiores. Resultados: Um total de 188 membros superiores de 94 pacientes foi examinado. A média de idade foi 41,4±12,9 anos e 69 pacientes eram do sexo feminino (73,4%). A velocidade de condução motora média do nervo ulnar através do cotovelo (VCM) nos braços afetados foi significativamente mais lenta do que a velocidade em braços saudáveis. As latências médias F-min do nervo ulnar foram significativamente mais longas nos braços afetados. Cinquenta e um pacientes foram diagnosticados eletrofisiologicamente como apresentando NUC (54,2%). Pacientes com presença de NUC tiveram, de forma significativa, detecção de VCM mais lenta no nervo ulnar ao nível do cotovelo, presença de latência mais longa da onda F-mínima no nervo ulnar, bem como latência de início distal mais longa. Por fim, os pacientes sintomáticos, e com condução nervosa normal, foram avaliados separadamente. Apenas a latência da onda F mínima média do nervo ulnar foi significativamente maior neste grupo, em comparação com os braços saudáveis. Conclusão: Nosso estudo confirmou a utilidade das medidas de latência da onda F-mínima no eletrodiagnóstico da NUC. As diferenças de latência da onda F podem ajudar a fazer um diagnóstico precoce para fornecer melhores opções de tratamento.

Congenital elbow luxation grade I treated by radial head ostectomy in an English Bulldog / Luxação congênita de cotovelo grau I tratada por ostectomia da cabeça do rádio em um Bulldog Inglês

The aim of this study is to report a long term follow up of a congenital luxation of the radial head (CLRH) case of a young Bulldog treated by radio head ostectomy (RHO). CLRH is an uncommon condition in dogs, but it is the most commom form of elbow dislocation (grade I). An English Bulldog, male, 6 months, 14 kilograms, was suspected of elbow dislocation. Physical examination revealed a lateral proeminence on the lateral surface of the right elbow, as well as grade I lameness and mild pain. Range of motion was normal. Previous radiographs and tomography confirmed CLHR. RHO was chosen instead of corrective techniques, due to the age of the animal at the time of the procedure and the difficulty in repositioning the radial head in the joint. Three and a half years after surgery, new clinical and radiographic examaminations were performed. The patient had no pain, good limb support and good range of motion, allowing good elbow movement. There was a partial regrowth of the proximal segment of the radial head causing better readjustment of it in the joint. Mild signs of joint degeneration were present. RHO proved to be effective in this case, proving to be a good technique to be used in cases of CLRH when conservative treatment or reduction techniques can no longer be used.

O objetivo deste relato foi o de apresentar o acompanhamento tardio de um caso de luxação congênita de cabeça de rádio (LCCR) em um Buldog Inglês jovem, tratada por ostectomia da cabeça radial (OCR). A LCCR é uma condição incomum nos cães, mas é a forma mais comum de luxação de cotovelo nos mesmos (grau I). Um Bulldog Inglês, macho, 6 meses, 14 quilos, foi atendido com suspeita de luxação do cotovelo. Exame físico revelou uma proeminência na superfície lateral do cotovelo direito, além de claudicação grau I e dor leve. Amplitude de movimento apresentava-se normal. Radiografias e tomografia prévias confirmaram LCCR. Optou-se pela OCR ao invés de técnicas corretivas, devido à idade do animal à época do procedimento e à dificuldade no reposicionamento do rádio na articulação. Após 3 anos e meio de pós-operatório, foram realizados novos exames clínicos e radiográficos. O paciente não apresentava dor, apresentava bom apoio do membro e boa amplitude de movimento, permitindo bom movimento do cotovelo. Houve um novo crescimento parcial do segmento proximal da cabeça do rádio ocasionando melhor readequamento do mesmo na articulação. Sinais leves de degeneração articular estavam presentes. A OCR se mostrou efetiva neste caso, provando ser uma boa técnica a ser utilizada nos casos de LCCR quando tratamento conservativo ou técnicas de redução já não podem ser mais utilizados.

Luxations traumatiques du coude de l'enfant: aspects épidémiologiques, thérapeutiques et évolutifs / Traumatic dislocations of the elbow in children: epidemiological, therapeutic and progressive aspects

Contexte. Les luxations traumatiques du coude de l'enfant sont des lésions peu fréquentes. Elles nécessitent une prise en charge en urgence afi n d'éviter les complications fonctionnelles. Le but de cette étude était de décrire les aspectsépidémiologiques, thérapeutiques et évolutifs. Méthodes. Il s'agissait d'une étude rétrospective descriptive et analytique des luxations récentes traumatiques du coude. Elle a concerné les patients de moins de 15 ans. Elle a été réalisée du 1er janvier 2016 au 31 décembre 2019 aux urgences de chirurgie. Les données étudiées étaient : les aspects épidémiologiques, thérapeutiques et évolutifs. Un test exact de Fisher a été réalisé pour rechercher les facteurs pouvant infl uencer le résultat fonctionnel. Résultats. Dix-huit luxations traumatiques du coude ont été colligéesdans le service des urgences chirurgicales. Elles représentaient 0,08 % des traumatismes du coude. L'âge moyen était de 10±3,1ans (7-12 ans).Les accidents de jeu étaient l'étiologie la plus fréquente (n=15). La forme convergente postéro-latérale était observée dans tous les cas. La fracture de l'épicondyle médiale (n=3) et la parésie du nerf ulnaire (n=1) étaient associées. Le délai moyen du traitement était de 150±6,8 minutes (60- 360min).Le traitement a été orthopédique. La durée moyennecontention plâtrée était de 25±4,6 jours (21-45 jours).Les résultats fonctionnels globaux selon les critères de Robert étaient excellents dans 14 cas au recul moyen de 06 ±4,7 mois (3-13 mois).Il n'existait aucun lien entre le résultat fonctionnel, le délai de réduction et la présence ou non de lésions associées. Conclusion. Les luxations traumatiques du coude étaient peu fréquentes. La réduction en urgence a donné un bon pronostic fonctionnel.

Study on the biomechanical analysis and influencing factors study for the treatment of humeral epicondylitis by Bachuorounian manipulation / 中国骨伤

OBJECTIVE@#To quantitatively study the biomechanical parameters of Bachuorounian manipulation in the treatment of humeral epicondylitis, and discuss the effects of individual characteristics on the biomechanical parameters were discussed.@*METHODS@#From July 2019 to February 2020, 40 patients with external humeral epicondylitis were selected, including 18 males and 22 females, ranging in age from 20 to 50 years old, with an average of (34.37±8.41) years old;and the course of disease ranged from 1 to 11 months, with a mean of (6.05±2.71) months. The biomechanical parameters of the elbow joint of the affected side were measured by using the biomechanical sensor. At thesame time, the individual characteristic parameters of patients were collected to analyze the influence of different individual characteristics of patients on biomechanical parameters.@*RESULTS@#The results of mechanical analysis in each stage of the bachuorounian manipulation were as follows:the rolling back rotation force was (31.17±2.99) N;the buckling bending drawing force was (44.99±2.38) N;the rolling pre rotation force was (31.03±2.75) N;and stretching drawing force was (48.75±2.09) N. The correlation analysis between the parameters showed that there was a significant positive correlation between the buckling bending drawing force and the stretching drawing force parameters, and a significant positive correlation between the rolling force back-rotation force and the rolling pre-rotation force parameters. The multivariate linear regression analysis on the parameters of influencing factors and manipulative biomechanics showed that there was a significant correlation between body weight and rolling back-rotation force, significant correlation between elbow tenderness and the buckling bending drawing force, and significant correlation between disease duration and the stretching drawing force.@*CONCLUSION@#The bachuorounian manipulation of humeral epicondylitis has a certain range of operating force. Manipulation of each stage has a correlation and systematic. The patient's weight, elbow tenderness and disease course are important factors affecting the bachuorounian manipulation.

Restoration of Elbow Flexion for Upper Trunk Brachial Plexus Injuries: Evaluation of Nerve Transfers and Modified Steindler Flexorplasty

@#INTRODUCTION: In patients with delayed presentation between 6 to 12 months, surgical treatment guidelines are not well defined in brachial plexus injury. Still, several authors have agreed that functional outcomes in patients treated within six months from the date of injury have the best results. Nerve transfers are still considered one of the treatment options in the said subset of patients even after six months. In contrast, a primary Steindler flexorplasty, or proximal advancement of the flexor-pronator group, is an ideal technique for elbow flexion with an elapsed time from injury >6 to 9 months. OBJECTIVE: The purpose of this investigation was to compare the clinical outcome s of nerve transfers versus modified Steindler flexorplasty for the restoration of elbow flexion in upper type brachial plexus injuries (BPI). METHODS: A retrospective review of 28 patients who underwent nerve transfers (NT) and 12 patients who underwent modified Steindler flexorplasty (MSF) was done to determine the outcome of treatments. The manual muscle testing using the Medical Research Council scaling system, Visual Analog Scale for pain, active range of motion, and Disabilities of the Arm, Shoulder and Hand form scores were taken as dependent variables. RESULTS: The NT group had a median age of 27.5 years, with 26 men, a median surgical delay of 5.6 months, and a median follow-up of 33 months. Twenty out of 28 patients (71%) had ≥M3 with a median range of 117.6° elbow flexion motion. Median postoperative DASH (n=16) and VAS scores were 29.2 and 3, respectively. For the MSF patients, the median age was 27 years, including ten men, the median surgical delay was 12 months, and the median follow-up was 18.4 months. All the 12 patients had ≥M3, with a median range of motion of 106°. The median postoperative DASH score (n=5) and VAS score were 28.3 and 0, respectively. In the NT group, 73.3% (11/15) achieved ≥M3 elbow flexion if the operation was done in <6 months. CONCLUSION: Nerve transfers and the modified Steindler procedure are still excellent options for successful elbow flexion reanimation in patients with brachial plexus injuries. Our results also showed that those with surgical delays of less than six months had the highest rate of achieving ≥M3 elbow flexion strength in the nerve transfer group.