Is there an association between the Hand Diagram and Electrodiagnostic Testing for Carpal Tunnel Syndrome?

Objective Verify if there is an association between the hand diagram of paresthesia (HDP) and the results of electroneuromyography (ENMG) in the diagnosis of carpal tunnel syndrome. Methods A total of 92 people filled in a schematic drawing of the hand with the exact location of the paresthesia (167 hands). The main author classified the diagrams according to the criteria of Katz et al. 5 The results of the HDP were crossed with the positive results of ENMG for the diagnosis of carpal tunnel syndrome. Results The possible pattern of the HDP was prevalent both in isolation and after crossing with the degrees of ENMG. Conclusion There was no association between the HDP and ENMG in the diagnosis of carpal tunnel syndrome.

Epidemiological and Clinical Aspects of Cleft Hand: Case Series From a Tertiary Public Hospital in São Paulo, Brazil.

Background: Cleft hand is a rare and congenital deformity that affects hands and feet and can be associated with other malformations. The objective was to evaluate the epidemiological and clinical aspects of cleft hand patient in a case series. Methods: Baseline characteristics associated with this deformity, such as sociodemographic characteristics, affected upper limb side, family history, clinical manifestations, and the degree of deficiency according to Barsky, Manske and Halikis, and Valenti classifications, were analyzed in 38 patients treated in the Department of Orthopedic Surgery of the Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil. Results: A predominance of typical hands as classified by Barsky, types II and IV by Manske and Halikis, and type IV by Valenti was found. A high frequency of typical cases (55.3%), as defined by Barsky, had a positive family history (P = .031) and were associated with other clinical manifestations (44.7%), when compared with atypical cleft hand patients (P < .001). Conclusion: In our study, there were more typical cleft hands than atypical, and they were more commonly associated with family history and other clinical manifestations.

ASSESSMENT OF THE RESULTS OF ACCESSORY TO SUPRASCAPULAR NERVE TRANSFER.

OBJECTIVE: Nerve transfers are an alternative in the reconstruction of traumatic brachial plexus injuries. In this study, we report the results of branchial plexus reconstruction using accessory to suprascapular nerve transfer. METHODS: Thirty-three patients with traumatic brachial plexus injuries underwent surgical reconstruction with accessory to suprascapular nerve transfers. The patients were divided into groups in which surgery was performed either within 6 months after the injury or more than 6 months after the injury. Results were assessed using the Constant score. RESULTS: There was no significant difference between the groups with respect to the Constant score. CONCLUSION: Accessory to suprascapular nerve transfer was not an efficient method for recovering active ROM or strength in the shoulder. However, it effectively improved pain control and shoulder stability. Level of evidence II, Retrospective Study.

OBJETIVO: A transferência de nervos é uma alternativa na reconstrução das lesões traumáticas do plexo braquial. Neste estudo, relatamos os resultados da reconstrução do plexo braquial com a transferência do nervo acessório para o nervo supraescapular. MÉTODOS: Trinta e três pacientes com lesões traumáticas do plexo braquial foram submetidos à reconstrução cirúrgica com transferência do nervo acessório para o nervo supraescapular. Os pacientes foram divididos em grupos em que a cirurgia foi realizada dentro de 6 meses a partir da lesão ou mais de 6 meses depois da lesão. Os resultados foram avaliados com o escore Constant. RESULTADOS: Não houve diferença significante entre os grupos com relação ao escore Constant. CONCLUSÃO: A transferência do nervo acessório para o nervo supraescapular não foi um método eficiente para recuperar a ADM ativa ou a força no ombro. No entanto, foi eficiente para melhorar o controle da dor e a estabilização do ombro. Nível de evidência II, Estudo Retrospectivo.

Assessment of the results of accessory to suprascapular nerve transfer / Avaliação dos resultados da transferência do nervo acessório para o supraescapular

ABSTRACT Objective: Nerve transfers are an alternative in the reconstruction of traumatic brachial plexus injuries. In this study, we report the results of branchial plexus reconstruction using accessory to suprascapular nerve transfer. Methods: Thirty-three patients with traumatic brachial plexus injuries underwent surgical reconstruction with accessory to suprascapular nerve transfers. The patients were divided into groups in which surgery was performed either within 6 months after the injury or more than 6 months after the injury. Results were assessed using the Constant score. Results: There was no significant difference between the groups with respect to the Constant score. Conclusion: Accessory to suprascapular nerve transfer was not an efficient method for recovering active ROM or strength in the shoulder. However, it effectively improved pain control and shoulder stability. Level of evidence II, Retrospective Study.

RESUMO Objetivo: A transferência de nervos é uma alternativa na reconstrução das lesões traumáticas do plexo braquial. Neste estudo, relatamos os resultados da reconstrução do plexo braquial com a transferência do nervo acessório para o nervo supraescapular. Métodos: Trinta e três pacientes com lesões traumáticas do plexo braquial foram submetidos à reconstrução cirúrgica com transferência do nervo acessório para o nervo supraescapular. Os pacientes foram divididos em grupos em que a cirurgia foi realizada dentro de 6 meses a partir da lesão ou mais de 6 meses depois da lesão. Os resultados foram avaliados com o escore Constant. Resultados: Não houve diferença significante entre os grupos com relação ao escore Constant. Conclusão: A transferência do nervo acessório para o nervo supraescapular não foi um método eficiente para recuperar a ADM ativa ou a força no ombro. No entanto, foi eficiente para melhorar o controle da dor e a estabilização do ombro. Nível de evidência II, Estudo Retrospectivo.

PROPOSAL TOMOGRAPHIC CLASSIFICATION FOR INTRA-ARTICULAR DISTAL RADIUS FRACTURES.

OBJECTIVE: The objective of this study was to present a proposal tomographic classification for intra-articular distal radius fractures. METHODS: This descriptive study was based on observing tomographic images from 74 patients with distal radius fractures. The cases were grouped by similarity according to the presence of several parameters which determine fracture complexity; the results of the descriptive analysis were transcribed as tomographic classification. RESULTS: The proposal tomographic classification for intra-articular distal radius fractures comprised three major groups and nine sub-groups, which are organized by increasing severity according to the presence of spacing between articular fragments, angulation, loss of radial height, cortical depression, and associated dislocation. CONCLUSION: This proposal tomographic classification for intra-articular distal radius fractures can help professionals indicate therapeutic options. Level of Evidence IV; Case series.

OBJETIVO: O objetivo deste estudo foi apresentar a proposta de uma classificação tomográfica das fraturas intra-articulares da extremidade distal do rádio. MÉTODOS: Este estudo descritivo baseou-se na observação de imagens tomográficas de 74 pacientes com fratura da extremidade distal do rádio. Os casos foram agrupados por semelhança de acordo com a presença de alguns parâmetros determinantes da complexidade da fratura. Os resultados da análise descritiva foram transcritos na forma de uma classificação tomográfica. RESULTADOS: A classificação tomográfica proposta para as fraturas intra-articulares da extremidade distal do rádio compreendeu três grupos maiores e nove subgrupos, organizados em ordem crescente de gravidade, de acordo com a presença de espaçamento entre os fragmentos articulares, desvio angular, perda da altura radial, afundamento cortical e luxação associada. CONCLUSÃO: Esta classificação tomográfica proposta para as fraturas intra-articulares da extremidade distal do rádio pode auxiliar os profissionais na indicação da conduta terapêutica. Nível de Evidência IV; Série de casos.

Proposal tomographic classification for intra-articular distal radius fractures / Proposta de classificação tomográfica para as fraturas intra-articulares da extremidade distal do rádio

ABSTRACT Objective: The objective of this study was to present a proposal tomographic classification for intra-articular distal radius fractures. Methods: This descriptive study was based on observing tomographic images from 74 patients with distal radius fractures. The cases were grouped by similarity according to the presence of several parameters which determine fracture complexity; the results of the descriptive analysis were transcribed as tomographic classification. Results: The proposal tomographic classification for intra-articular distal radius fractures comprised three major groups and nine sub-groups, which are organized by increasing severity according to the presence of spacing between articular fragments, angulation, loss of radial height, cortical depression, and associated dislocation. Conclusion: This proposal tomographic classification for intra-articular distal radius fractures can help professionals indicate therapeutic options. Level of Evidence IV; Case series.

RESUMO Objetivo: O objetivo deste estudo foi apresentar a proposta de uma classificação tomográfica das fraturas intra-articulares da extremidade distal do rádio. Métodos: Este estudo descritivo baseou-se na observação de imagens tomográficas de 74 pacientes com fratura da extremidade distal do rádio. Os casos foram agrupados por semelhança de acordo com a presença de alguns parâmetros determinantes da complexidade da fratura. Os resultados da análise descritiva foram transcritos na forma de uma classificação tomográfica. Resultados: A classificação tomográfica proposta para as fraturas intra-articulares da extremidade distal do rádio compreendeu três grupos maiores e nove subgrupos, organizados em ordem crescente de gravidade, de acordo com a presença de espaçamento entre os fragmentos articulares, desvio angular, perda da altura radial, afundamento cortical e luxação associada. Conclusão: Esta classificação tomográfica proposta para as fraturas intra-articulares da extremidade distal do rádio pode auxiliar os profissionais na indicação da conduta terapêutica. Nível de Evidência IV; Série de casos.

Relationship of age and type of obstetric brachial plexus paralysis in forearm pronosupination.

OBJECTIVE: To evaluate the arc of forearm pronosupination of patients with sequelae of birth paralysis and correlate with these variables. METHODS: 32 children aged between 4 and 14 years with total or partial lesions of the brachial plexus were evaluated; measurements of pronation and supination, active and passive, were made, both on the injured side and the unaffected side. RESULTS: A statistically significant difference was observed between the injured side and the normal side, but there was no difference between the groups regarding age or type of injury. CONCLUSION: The age and type of injury did not impact on the limitation of the forearm pronosupination in children with sequelae of birth paralysis.

OBJETIVO: Avaliar o arco de pronossupinação do antebraço dos pacientes com sequela de paralisia obstétrica do plexo braquial e correlacionar com essas variáveis. MÉTODOS: Foram avaliadas 32 crianças entre 4 e 14 anos, com lesões totais ou parciais do plexo braquial, foram tiradas as medidas de pronação e supinação, ativa e passiva, tanto do lado lesionado quanto do lado não afetado. RESULTADOS: Observou-se diferença estatisticamente significativa entre o lado lesionado e o lado normal, porém não houve diferença entre os grupos por faixas etárias, nem quanto ao tipo de lesão. CONCLUSÃO: Os fatores idade e tipo de lesão não tiveram efeito sobre a pronossupinação nas crianças portadoras de sequela de paralisia obstétrica do plexo braquial.

Relationship of age and type of obstetric brachial plexus paralysis in forearm pronosupination / Relação entre a idade e o tipo de paralisia obstétrica do plexo braquial com o movimento de pronossupinação do antebraço

ABSTRACT Objective: To evaluate the arc of forearm pronosupination of patients with sequelae of birth paralysis and correlate with these variables. Methods: 32 children aged between 4 and 14 years with total or partial lesions of the , brachial plexus were evaluated; measurements of pronation and supination, active and passive, were made, both on the injured side and the unaffected side. Results: A statistically significant difference was observed between the injured side and the normal side, but there was no difference between the groups regarding age or type of injury. Conclusion: The age and type of injury did not impact on the limitation of the forearm pronosupination in children with sequelae of birth paralysis.

RESUMO Objetivo: Avaliar o arco de pronossupinação do antebraço dos pacientes com sequela de paralisia obstétrica do plexo braquial e correlacionar com essas variáveis. Métodos: Foram avaliadas 32 crianças entre 4 e 14 anos, com lesões totais ou parciais do plexo braquial, foram tiradas as medidas de pronação e supinação, ativa e passiva, tanto do lado lesionado quanto do lado não afetado. Resultados: Observou-se diferença estatisticamente significativa entre o lado lesionado e o lado normal, porém não houve diferença entre os grupos por faixas etárias, nem quanto ao tipo de lesão. Conclusão: Os fatores idade e tipo de lesão não tiveram efeito sobre a pronossupinação nas crianças portadoras de sequela de paralisia obstétrica do plexo braquial.

The Radial Artery's Sacrifice in the Chinese Flap Is Not Deleterious to Patients.

Background: A widely discussed subject, albeit with few associated studies and publications, centers on whether sacrifice of the radial artery to perform the radial forearm flap (RFF) is deleterious to the patient. The objective of this study was to assess, by questionnaire, the complications reported at the donor site, particularly those related to sacrifice of the radial artery. Methods: During the 2014 Symposium of the Brazilian Society of Reconstructive Microsurgery, surgeons were asked to answer a questionnaire on RFF cases and complications. Results: Results were collected from hand and plastic surgeons. Regarding the opinion of respondents on the deleteriousness of sacrificing the radial artery, most answered negatively, that is, no deleterious effects reported. No statistically significant difference was found between the level of experience and opinion on whether sacrificing the radial artery was deleterious. Conclusions: Beyond performing some procedures and following evolution within a specific service, it was decided to broaden the range of opinions and enlarge the casuistic by assessing the opinions of many specialists from the fields of hand surgery and plastic surgery. Data collected using the questionnaire were compared to determine the sequelae at the donor site and particularly whether sacrifice of the radial artery in RFF was deleterious to the patient. Although complaints at the donor site were frequently cited, no objective reports on morbidity following the sacrifice of the radial artery in RFF were provided.

What is the real angle of deviation of metacarpal neck fractures on oblique views? A radiographic study.

OBJECTIVE: The aim of this study was to establish an indirect, easy-to-use, predictable and safe means of obtaining the true degree of displacement of fractures of the neck of the fifth metacarpal bone, through oblique radiographic views. METHODS: An anatomical specimen from the fifth human metacarpal was dissected and subjected to ostectomy in the neck region. A 1-mm Kirschner wire was fixed to the base of the fifth metacarpal bone, perpendicular to the longitudinal axis of the bone and parallel to the ground. Another six Kirschner wires of the same diameter were bent over and attached to the ostectomized bone to simulate fracture displacement. Axial rotation of the metacarpus was used to create oblique radiographic views. Radiographic images were generated with different angles and at several degrees of rotation of the bone. RESULTS: We deduced a mathematical formula that showed the true displacement of fractures of the neck of the fifth metacarpal bone by means of oblique radiographs. CONCLUSIONS: Oblique radiographs at 30̊ of supination provided the best view of the bone and least variation from the real value of the displacement of fractures of the fifth metacarpal bone. The mathematical formula deduced was concordant with the experimental model used.

OBJETIVO: Estabelecer uma forma indireta, fácil, previsível e segura na obtenção do valor real do desvio da fratura do colo do quinto metacarpo a partir de radiografias oblíquas. MÉTODOS: Uma peça anatômica de quinto metacarpo humano foi dissecada e submetida à ostectomia na região do colo. Um fio de Kirschner de 1 mm foi fixado perpendicular ao eixo longitudinal do osso e paralelo ao solo. Outros seis fios de Kirschner do mesmo diâmetro foram dobrados e presos ao osso ostectomizado para simular o desvio das fraturas. Rotação axial do metacarpo foi usada para criar as radiografias nas incidências oblíquas. Imagens radiográficas foram obtidas com diferentes ângulos e em vários graus de rotação do osso. RESULTADOS: Deduzimos uma equação matemática que demonstra o real desvio da fratura do colo do quinto metacarpo por meio de radiografias oblíquas. CONCLUSÕES: A radiografia oblíqua com 30̊ de supinação apresenta melhor visualização do osso e menor variação do valor real do desvio da fratura do colo do quinto metacarpo. A fórmula matemática deduzida foi concordante com o modelo experimental usado.

What is the real angle of deviation of metacarpal neck fractures on oblique views? a radiographic study / Qual é o ângulo real do desvio da fratura do colo do metacarpo nas incidências oblíquas? estudo radiográfico

OBJECTIVE: The aim of this study was to establish an indirect, easy-to-use, predictable and safe means of obtaining the true degree of displacement of fractures of the neck of the fifth metacarpal bone, through oblique radiographic views. METHODS: An anatomical specimen from the fifth human metacarpal was dissected and subjected to ostectomy in the neck region. A 1-mm Kirschner wire was fixed to the base of the fifth metacarpal bone, perpendicular to the longitudinal axis of the bone and parallel to the ground. Another six Kirschner wires of the same diameter were bent over and attached to the ostectomized bone to simulate fracture displacement. Axial rotation of the metacarpus was used to create oblique radiographic views. Radiographic images were generated with different angles and at several degrees of rotation of the bone. RESULTS: We deduced a mathematical formula that showed the true displacement of fractures of the neck of the fifth metacarpal bone by means of oblique radiographs. CONCLUSIONS: Oblique radiographs at 30° of supination provided the best view of the bone and least variation from the real value of the displacement of fractures of the fifth metacarpal bone. The mathematical formula deduced was concordant with the experimental model used.

OBJETIVO: Estabelecer uma forma indireta, fácil, previsível e segura na obtenção do valor real do desvio da fratura do colo do quinto metacarpo a partir de radiografias oblíquas. MÉTODOS: Uma peça anatômica de quinto metacarpo humano foi dissecada e submetida à ostectomia na região do colo. Um fio de Kirschner de 1 mm foi fixado perpendicular ao eixo longitudinal do osso e paralelo ao solo. Outros seis fios de Kirschner do mesmo diâmetro foram dobrados e presos ao osso ostectomizado para simular o desvio das fraturas. Rotação axial do metacarpo foi usada para criar as radiografias nas incidências oblíquas. Imagens radiográficas foram obtidas com diferentes ângulos e em vários graus de rotação do osso. RESULTADOS: Deduzimos uma equação matemática que demonstra o real desvio da fratura do colo do quinto metacarpo por meio de radiografias oblíquas. CONCLUSÕES: A radiografia oblíqua com 30° de supinação apresenta melhor visualização do osso e menor variação do valor real do desvio da fratura do colo do quinto metacarpo. A fórmula matemática deduzida foi concordante com o modelo experimental usado.

Computed tomography's influence on the classifications and treatment of the distal radius fractures.

INTRODUCTION: Distal radius fractures are common in emergency centers. The radiographic routine includes at least two radiographic projections used for diagnosing most of these fractures. Computed tomography (CT) is indicated for evaluating complex fractures that affect the articular surface, as well as the fragments' size and position. There are not enough comparative studies on choosing classification and treatment by means of the four radiographic projections and computed tomography (CT) and the association of these with the levels of expertise. METHODS: We conducted a randomized cross-sectional study by observing images from 61 patients with distal radius fractures organized in two phases: the first phase comprising radiographic images alone and the second one with those same images associated with tomograms. Seventeen evaluators with different levels of training and expertise classified the fractures according to the AO and Universal classification systems and proposed treatment guidelines. RESULTS: The agreement between the AO and Universal classification ratings was poor (worse for the former), with smaller Fleiss' kappa resulting from data obtained by orthopedics residents and non-specialist orthopedists. CT influenced the classification choice, with a higher change frequency for more complex patterns in the AO classification system and intra-articular and irreducible fractures in the Universal classification system, especially in the group comprised of orthopedic residents and orthopedic physicians. CT did not influence the treatment choice made by the group comprised of hand surgery residents and hand surgeons. CONCLUSION: The less experienced in hand surgery the observer was, the more important computed tomography was for determining the fracture pattern.

Anatomical study of sensory anastomoses in the hand.

OBJECTIVE: The aim of this study is to evaluate the prevalence, topography and morphometry of sensitive nervous anastomoses in the hand. METHODS: Thirty anatomic parts irrespective of race, gender and age have been dissected. Measurements of anastomoses' length, origin and terminus regarding the transverse carpal ligament were noted. The anastomoses were classified according to the scheme proposed by Meals & Shaner and modified by Bas & Kleinert. RESULTS: Type 1 anastomosis was the most prevalent. The distance between the origin of the anastomosis to the distal limit of the transverse carpal ligament was 0.7 cm in average. CONCLUSION: This study showed that Berretini anastomosis is high prevalent, usually beginning in the ulnar and distal nerve until the transverse carpal ligament. Level of Evidence IV, Case Series.

Anatomical study of sensory anastomoses in the hand

Objective: The aim of this study is to evaluate the prevalence, topography and morphometry of sensitive nervous anastomoses in the hand. Methods: Thirty anatomic parts irrespective of race, gender and age have been dissected. Measurements of anastomoses' length, origin and terminus regarding the transverse carpal ligament were noted. The anastomoses were classified according to the scheme proposed by Meals & Shaner and modified by Bas & Kleinert. Results: Type 1 anastomosis was the most prevalent. The distance between the origin of the anastomosis to the distal limit of the transverse carpal ligament was 0.7 cm in average. Conclusion: This study showed that Berretini anastomosis is high prevalent, usually beginning in the ulnar and distal nerve until the transverse carpal ligament. Level of Evidence IV, Case Series. .

Qual a melhor incidência radiográfica para avaliar o desvio das fraturas tipo die-punch? Estudo em cadáver / What is the best radiographic view for "die punch" distal radius fractures? A cadaver model study

OBJETIVO: Avaliar qual a melhor incidência radiográfica para diagnosticar os desvios da fratura tipo die-punch da extremidade distal do rádio. MÉTODOS: Utilizou-se um rádio do Banco de Tecidos Salvador Arena. Após limpeza e retirada de partes moles, realizou-se osteotomia da região dorsoulnar da superfície articular com microsserra, osteótomo e martelo. Fixou-se o fragmento distal com fita adesiva, nos degraus articulares de 1, 2, 3 e 5mm. A peça foi submetida a radiografias nas incidências frente, perfil, oblíqua semipronada, oblíqua semissupinada e tangencial (75º com o plano da mesa). Em uma segunda etapa, avaliou-se o desvio da fratura em cada radiografia, com auxílio do software AutoCAD 2010®. RESULTADOS: A incidência tangencial foi a melhor para identificar os desvios de 1 e 3mm e a segunda melhor nos desvios de 2 e 5mm. No desvio de 2mm a melhor incidência foi a oblíqua semipronada e no de 5mm a oblíqua semissupinada, sendo que não se consegue identificar os desvios de 1 e 2mm na oblíqua semissupinada. CONCLUSÃO: A incidência tangencial foi superior na avaliação do degrau articular de 1mm e 3mm e a segunda melhor quando houve degrau de 2mm e 5mm.

OBJECTIVE: the aim of this study is try to show the best view for distal radius fractures so called die-punch fractures. METHODS: There has been used a human cadaver radius bone from the Salvador Arena Tissue Bank. This bone was cleaned up after removing the soft tissues and osteotomies created displaced lunate fossa fractures of 0, 1, 2, 3 and 5 mm. We have fixed this fragment with adhesive tape. Then the joint deviation were significantly increased with step-offs of 1 mm. Radiographs were then taken into 5 different positions: postero-anterior view, lateral view, oblique views and tangencial view for each of the deviations. The resulting lunate fossa depression in each X-ray film was analyzed by the AutoCAD 2010® software. RESULTS: The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees. The pronated oblique view was the best to see the 2mm degrees and the oblique supinated view wasn't able to see the degrees between 1 and 2mm. CONCLUSION: The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees.

Effect of Ginkgo biloba extract (GbE-761) on the survival of fasciocutaneous flaps in rats.

Cutaneous and fasciocutaneous flaps are used widely in the surgical reconstruction of various body segments, especially to cover exposed vital tissues. Partial or total necrosis of these flaps, secondary to insufficient tissue irrigation, is one possible complication. Therefore, investigations into antiplatelet aggregation, vasodilation and antioxidant properties are highly significant. The aim of the present study was to analyse the effect of GbE 761 on the survival of fasciocutaneous flaps in rats. For that purpose, GbE 761 was administered to 30 rats after the creation of 10 × 3 cm dorsal flaps on each animal. The rats were divided into three equal groups. GbE 761 was administered to Group A, starting immediately after surgery; Group B received it 24 h after the flap was cut; and Group C (controls) received 0.9% NaCl solution. The average area of necrosis was 29.53% in Group A, 26.25% in Group B and 46.12% in Group C. The difference between Groups B and C was statistically significant (p = 0.026). These initial findings suggest that GbE 761 administered on day 1 after surgery reduces the percentage of necrosis in fasciocutaneous flaps, relative to not giving GbE at all.

WHAT IS THE BEST RADIOGRAPHIC VIEW FOR "DIE PUNCH" DISTAL RADIUS FRACTURES? A CADAVER MODEL STUDY.

OBJECTIVE: the aim of this study is try to show the best view for distal radius fractures so called die-punch fractures. METHODS: There has been used a human cadaver radius bone from the Salvador Arena Tissue Bank. This bone was cleaned up after removing the soft tissues and osteotomies created displaced lunate fossa fractures of 0, 1, 2, 3 and 5 mm. We have fixed this fragment with adhesive tape. Then the joint deviation were significantly increased with step-offs of 1 mm. Radiographs were then taken into 5 different positions: postero-anterior view, lateral view, oblique views and tangencial view for each of the deviations. The resulting lunate fossa depression in each X-ray film was analyzed by the AutoCAD 2010® software. RESULTS: The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees. The pronated oblique view was the best to see the 2mm degrees and the oblique supinated view wasn't able to see the degrees between 1 and 2mm. CONCLUSION: The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees.

EVALUATION OF UPPER-LIMB FUNCTION IN PATIENTS WITH OBSTETRIC PALSY AFTER MODIFIED SEVER-L'EPISCOPO PROCEDURE.

OBJECTIVE: To evaluate upper-limb function by means of the Mallet score, in patients with medial rotation contracture of the shoulder who underwent the modified Sever-L'Episcopo procedure, and to correlate evolution with age and length of postoperative follow-up. METHODS: Sixteen patients were assessed by comparing the pre and postoperative Mallet scores and correlating the differences between these scores with age at the time of surgery and length of follow-up. RESULTS: A statistically significant improvement in the postoperative Mallet score was observed. The correlations of the differences in scores with age and length of follow-up were not statistically significant. CONCLUSION: The modified Sever-L'Episcopo procedure led to improved upper-limb function according to the Mallet score. Limb function did not present correlations with age or length of follow-up.

Avaliação da função do membro superior nos pacientes com paralisia obstétrica após cirurgia de Sever-L'Episcopo modificada / Evaluation of upper-limb function in patients with obstetric palsy after modified Sever-L'Episcopo procedure

OBJETIVO: Avaliar a função do membro superior acometido, por meio do escore de Mallet, nos pacientes com contratura em rotação medial do ombro submetidos à cirurgia de Sever-L'Episcopo modificada, e correlacionar a evolução com a idade e com o tempo de seguimento pós-operatório. MÉTODOS: Dezesseis pacientes foram avaliados, sendo comparadas as medidas pré e pós-operatórias do escore de Mallet, e correlacionada a diferença entre esses valores com a idade no momento da cirurgia e tempo de seguimento. RESULTADO: Observou-se melhora do escore de Mallet pós-operatório estatisticamente significante, enquanto a correlação da diferença dos valores do escore com a idade e o tempo de seguimento não foram estatisticamente significantes. CONCLUSÃO: A cirurgia de Sever-L'Episcopo modificada proporcionou melhora da função do membro superior, de acordo com o escore de Mallet. Não houve relação entre a idade e o tempo de seguimento com a função do membro.

OBJECTIVE: To evaluate upper-limb function by means of the Mallet score, in patients with medial rotation contracture of the shoulder who underwent the modified Sever-L'Episcopo procedure, and to correlate evolution with age and length of postoperative follow-up. METHODS: Sixteen patients were assessed by comparing the pre and postoperative Mallet scores and correlating the differences between these scores with age at the time of surgery and length of follow-up. RESULTS: A statistically significant improvement in the postoperative Mallet score was observed. The correlations of the differences in scores with age and length of follow-up were not statistically significant. CONCLUSION: The modified Sever-L'Episcopo procedure led to improved upper-limb function according to the Mallet score. Limb function did not present correlations with age or length of follow-up.

Congenital pseudoarthrosis of the tibia ­ results of treatment by free fibular transfer and associated procedures ­ preliminary study.

We evaluated 16 children with congenital pseudoarthrosis of the tibia treated with contralateral fibular graft, with the aim to report the difficulties and clinical results in the affected limb after consolidation. Sixty-three percent of the children had characteristics of neurofibromatosis. Consolidation was achieved after the main surgery in 37%of patients, and the remainder, after multiple procedures. Consolidation time was longer for male patients. Refracture was observed in six patients and recurrence of the anterior bowing in six; four of these patients were submitted to correction. Four patients presented femur overgrowth. The average shortening of the affected leg was 3.6 cm. The proposed procedure leads to a long treatment course with many reoperations for correction of possible complications.