Walter Yoshinori Fukushima

Randomized clinical trial between proximal row carpectomy and the four-corner fusion for patients with stage II SNAC.

Objective To compare the outcomes of patients with stage II SNAC submitted to surgical treatment by proximal row carpectomy (PRC) or four-corner fusion (FCF). Method Twenty-seven patients aged 18–59 years (mean 37.52 years) were included. Thirteen patients underwent PRC in Group A, and 14 underwent FCF of the wrist in Group B. Evaluations were made before and after surgery with follow-up between 45 and 73 months. Range of motion (ROM); pain assessment with a visual analog scale (VAS); grip strength; disability of the arm, shoulder, and hand (DASH); and return to work were evaluated. Results Group A patients had 68.5% and Group B patients, 58.01% of the ROM of the contralateral side. The VAS score was 2.3 in Group A and 2.9 in Group B. Grip strength was 78.67% and 65.42%, respectively, relative to the side not affected. The DASH score was 11 for PRC and 13 for FCF. In Group A, 9/13 (69.23%) and in Group B, 8/14 (57.14%) patients are currently working. Complications were symptomatic osteoarthritis in the mid-carpal joint in Group A and loosening of a screw in Group B. Conclusion The clinical and functional results do not present statistically significant differences for both analyzed methods.

BIOMECHANICS AND HISTOLOGICAL ANALYSIS IN RABBIT FLEXOR TENDONS REPAIRED USING THREE SUTURE TECHNIQUES (FOUR AND SIX STRANDS) WITH EARLY ACTIVE MOBILIZATION

Objective: Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. Methods: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). Results: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15th day and in 66.7% on the 30th day, making the biological tissue stronger and more resistant (p=0.095). Conclusion: This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques applied.

Complicações osteoarticulares da analgesia congênita

Os autores apresentam dois irmaos com diagnostico de analgesia congenita, com suas caracteristicas clinicas e evolucao. Essa doenca e rara, apresenta alta morbidade e gera complicacoes osteoarticulares de dificil solucao. O objetivo dos autores foi ressaltar a importância do diagnostico tanto para o tratamento de suas afeccoes secundarias, quanto para seu aspecto juridico.

Síndrome do túnel carpal: resultados do tratamento cirúrgico com a técnica de mini-incisão

Introducao: A sindrome do tunel carpal e constituida por um conjunto de sinais e sintomas caracteristicos como parestesia, formigamento, dor e perda da forca nas maos. Inicialmente os sintomas sao brandos, progredindo ao longo do tempo. Objetivo: Apresentar os resultados do tratamento cirurgico com mini-incisao, bem como discutir a relacao entre os resultados e a tecnica cirurgica utilizada. Metodo: Esta pesquisa foi realizada na Faculdade de Medicina do ABC, onde foram avaliados 79 punhos de 71 pacientes, todos submetidos ao tratamento cirurgico da sindrome do tunel carpal por “mini-incisao”, entre janeiro de 1996 e maio de 2007. A media de idade entre os pacientes foi de 52,4 anos, sendo a idade minima 27 e a maxima 80 anos. Sessenta e cinco pacientes eram do sexo feminino e seis do masculino. Quanto ao lado acometido, foram obtidos 36 punhos do lado direito e 27 do lado esquerdo, sendo 8 bilaterais. Resultados: Os resultados clinicos mostraram que 60 pacientes ficaram satisfeitos com os sintomas, com os resultados esteticos e funcionais e com a melhora da forca muscular para apreensao. Dois pacientes apresentaram complicacoes cutaneas com infeccao superficial e necessitaram de antibioticoterapia oral. Conclusoes: Concluimos que o tratamento cirurgico por “mini-incisao” e uma tecnica segura, com poucas complicacoes e resultados clinicos e esteticos satisfatorios para o tratamento da sindrome do tunel do carpo.