Marcelo Rosa de Resende

Treatment of scaphoid nonunion with vascularised and nonvascularised dorsal bone grafting from the distal radius

We conducted a prospective randomised study comparing the clinical, functional and radiographic results of 46 patients treated for scaphoid nonunion using a vascularised bone graft from the dorsal and distal aspect of the radius (group I), relative to 40 patients treated by means of a conventional non-vascularised bone graft from the distal radius (group II). Surgical findings included 30 sclerotic, poorly-vascularised scaphoids in group I versus 20 in group II. Bone fusion was achieved in 89.1% of group I and 72.5% of group II patients (p = 0.024). Functional results were good to excellent in 72.0% of the patients in group I and 57.5% in group II. Considering only patients with sclerotic, poorly-vascularised scaphoids, the mean final outcome scores obtained were 7.5 and 6.0 for groups I and group II, respectively. We conclude that vascularised bone grafting yields superior results and is more efficient when there is a sclerotic, poorly-vascularised proximal pole in patients in scaphoid nonunion.

Median nerve fascicle transfer versus ULNAR nerve fascicle transfer to the biceps motor branch in C5-C6 and C5-C7 brachial plexus injuries: Nonrandomized prospective study of 23 consecutive patients

The purpose of this study was to observe whether the results of the median nerve fascicle transfer to the biceps are equivalent to the classical ulnar nerve fascicle transfer, in terms of elbow flexion strength and donor nerve morbidity. Twenty‐five consecutive patients were operated between March 2007 and July 2013. The patients were divided into two groups. In Group 1 (n = 8), the patients received an ulnar nerve fascicle transfer to the biceps motor branch. In Group 2 (n = 15), the patients received a median nerve fascicle transfer to the biceps motor branch. Two patients with follow‐up less than six months were excluded. Both groups were similar regarding age (P = 0.070), interval of injury (P = 0.185), and follow‐up period (P = 0.477). Elbow flexion against gravity was achieved in 7 of 8 (87.5%) patients in Group 1, versus 14 of 15 (93.3%) patients in Group 2 (P = 1.000). The level of injury (C5‐C6 or C5‐C7) did not affect anti‐gravity elbow flexion recovery in both the groups (P = 1.000). It was concluded that the median nerve fascicle transfer to the biceps is as good as the ulnar nerve fascicle transfer, even in C5‐C7 injuries.

Emprego do músculo gastrocnêmio no tratamento das lesões infectadas do joelho

OBJECTIVE: to prospectively evaluate the use of gastrocnemius muscle flap in the treatment of knee infected injuries. METHODS: twelve patients were operated on: eleven males with ages ranging from 19 to 78 years, mean: 55 years. Coverage of injuries with medial gastrocnemius muscle was accomplished in 11 patients and a lateral in 1. The mean number of preoperative surgical debridement procedures was 3.2, ranging from 1 to 9. RESULTS: all flaps survived. The most common etiological agent was S. aureus, in 54.5%. After a mean follow-up of 20.08 months (13 to 31), all patients show stable coverage without recurrence of infection signs or symptoms. CONCLUSION: gastrocnemius muscle use in knee infected injuries treatment presented good results and low morbity rates.

Avaliação artroscópica e macroscópica do complexo da fibrocartilagem triangular do punho. Estudo em cadáveres

O complexo da fibrocartilagem triangular tem importante papel na biomecânica do punho. O diagnostico preciso das lesoes e fundamental para se obter sucesso no tratamento. Ha controversias acerca da especificidade e sensibilidade dos metodos de imagem empregados atualmente. A artroscopia de punho e um metodo pouco empregado para o diagnostico das lesoes do CFCT em nosso meio, embora apresente grandes vantagens, como possibilidade de visao direta das lesoes e tratamento no mesmo tempo cirurgico. O objetivo deste estudo foi o de avaliar o papel da artroscopia de punho na inspecao do CFCT, bem como na deteccao de possiveis lesoes, comparando os dados com a disseccao macroscopica. Foram avaliados 15 punhos de cadaveres sexo masculino, media de idade de 56,1 anos. A artroscopia demonstrou presenca de lesoes em 33,3% dos punhos avaliados. Estes achados foram coincidentes apos estudo anatomico com ampla disseccao. Concluimos que houve absoluta correlacao entre o exame artroscopico e a disseccao macroscopica na deteccao de lesoes do CFCT.

A reinforcement of the sutured microvascular anastomosis with fibrin glue application: A retrospective comparative study with the standard conventional technique

Although a reasonable number of studies report satisfactory results with fibrin glue application in microvascular anastomosis since 1977, its utilization in the clinical setting has being scant in the literature. The aim of this study was to report the cumulated experience with the fibrin glue in free flaps over a period of 10 years, comparing the survival rate with the standard sutured anastomosis.

Fratura distal do rádio em pacientes com mais de 60 anos: placas ortogonais versus placa volar

OBJECTIVE: To compare the results from surgical treatment between volar plates with angular stability and orthogonal plates of unstable distal radius fractures in patients aged over 60 years. METHODS: Selected patients were randomized in two groups treated with volar plates or orthogonal plates. Clinic al and radiographic results were analyzed prospectively. RESULTS: The study groups presented similar clinical and radiographic results six months after the operation. However three months after surgery the volar plate group obtained superior results considering most of the parameters studied. CONCLUSION: Both the volar plates and the orthogonal plates presented good functional results. Surgical treatment enabled early rehabilitation for these patients. Orthogonal plate technique required a longer learning curve, presented more complications and worst early results.

Distal radial fractures in patients over 60 years old: orthogonal plates versus volar plate

Objective: To compare the results from surgical treatment between volar plates with angular stability and orthogonal plates in unstable distal radius fractures, in patients aged over 60 years. Methods: The patients were divided into two groups that were treated with volar plates or orthogonal plates. Clinical and radiographic results were analyzed prospectively. Results: The study groups presented similar clinical and radiographic results six months after the operation. However, three months after the surgery, the volar plate group had superior results. Conclusion: Both group presented good functional results. Surgical treatment enabled early rehabilitation. The orthogonal plate technique required a longer learning curve, presented more complications and worse initial results.

Lesões crônicas de tendões flexores na mão: reconstrução em dois estágios

The authors present the results of a two-stage treatment of chronic flexor tendon injuries of the hand. In the first stage a silicone prosthesis is implanted and in the second stage a tendon graft. Details of the technique and results of the analysis are presented and compared with the scientific literature. The authors concluded that satisfactory results were achieved in most of the cases.