The purpose of this study was to evaluate the subjective and objective functional outcome after osteosynthesis of the forearm bone fractures with plates and screws (ORIF) or elastic nailing (CRIF).

We evaluated 55 patients (45 men and 10 women) who underwent internal fixation of both forearm bones with CRIF or ORIF, concerning the range of motion of the forearm, wrist and elbow (pronation, supination, flexion and extension), grip strength and a validated outcome measure (DASH score). The mean duration of follow-up was 3 years, and standardized radiographs of the forearm were evaluated. The mean age was 41.6.

We used the Student's t test to compare means and chi-square test to compare proportions.

The mean (confidence interval 95%) of the DASH scale was 29.6 (22.6 to 36.5), significantly higher (p<0.001) than the normative value in the U.S. (10.1). There was a statistically significant reduction of forearm supination (86.4 vs. 64.6, p<0.001) and grip strength (0.63 vs. 0.48, p<0.001) in relation to the opposite member; grip strength decrease correlated with worse subjective outcome (p<0.02). There were no significant differences between groups undergoing ORIF or CRIF. The risk of nonunion and reintervention was not different between groups (p=0214).

Forearm bones fractures are associated with high rates of consolidation and satisfactory mobility of the forearm since we obtain an anatomic reduction of the fracture, as is most easily achieved by plate fixation. However, elastic nailing is a less invasive technique that allows restoring function more quickly with less pain and no increased risk of complications. Given the scant scientific evidence currently available we will require a more comprehensive study to compare the anatomical and functional outcome after ORIF and CRIF.

The purpose of this study was to evaluate the results of subcutaneous ulnar nerve transposition in the treatment of Cubital Tunnel Syndrome (CTS) and the influence of prognostic factores such as preoperative McGowan stage, age and duration of symptoms.

36 patients (17 men and 19 women) with CTS who underwent subcutaneous ulnar nerve transposition between 2006 and 2009 were evaluated postoperatively, an average follow-up of 28 months. Sensory and motor recovery was evaluated clinically. The postoperative outcome was based on modified Bishop score, subjective assessment of function and on the degree of patient satisfaction. The dominant side was involved in 61% cases and the mean age was 51.2 years. There were 9 (25%) McGowan stage I, 18 (50%) stage II and 9 stage III patients.

We used the Mann-Whitney and Kruskal-Wallis test to compare continuous variables and chi-square and Fisher Exact Test for categorical variables.

There was a statistically significant improvement of sensory (p=0.02) and motor (p=0.02) deficits. We obtained 21 (58.3%) excellent results, seven (19.4%) fair, six (16.7%) satisfactory, and two bad ones (5.55%). There was a statistically significant improvement of function (p<0.001).

There is controversy in the literature regarding the best surgical treatment for CTS. The duration and severity of symptoms and advanced age, more than the surgical technique, seem to influence prognosis. With the technique used, the satisfaction rate was 86% and 72% recovered their daily activities without limitations. 78% of patients with severe neuropathy improved after surgery. The rates of postoperative complications were comparable with those of other studies. The severity of neuropathy and duration of symptoms (>12months) pre-operatively, but not age, had a negative influence on the outcome.

The results showed that the subcutaneous ulnar nerve transposition is safe and effective for postoperative clinical sensory and motor recovery for several degrees of severity in CTS. Given the major prognostic factors, surgical treatment should be advocated as soon as axonal loss has become clinically evident.

The Achilles tendon is formed by the fusion of gastrocnemius and soleus muscle, and is one of the strongest of the human body. Acute ruptures occur mostly in men between 30 and 50 years of age, with irregular sports activity. Rupture generally occurs in a low perfusion area, between 2 and 6 cm above the calcaneal tuberosity.

We reviewed and examined 45 patients with Achilles tendon rupture submitted to surgical correction, between January 2004 and December 2008 (5 years), in our Hospital.

For each patient was determined the injury type, time until diagnosis, time between diagnosis and surgery, surgical technique employed, immobilization period, rehabilitation program, occurrence of complications and rerupture, follow-up period and clinical outcome (AOFAS score).

The most frequent cause of rupture was professional activity (46%), followed by soccer practice (38%). The diagnosis was made in the first medical observation in 71% of patients. The mean surgical period until surgery was of 0.7 days, and the mean time of admission was of 3.56 days. The used surgical techniques were open surgery (25 cases), open surgery augmented with gastrocnemius fascia (5 cases), and percutaneous surgery with the Achillon system (15 cases).

The mean AOFAS score was of 92.42 (84–100), was of 100 in the Achillon group, 92 in the open surgery group and 91 in the augmented surgery group.

The complications all occurred in the open surgery group, with one infection, one surgical incision healing delay and one case of sural nerve injury.

The mean follow-up was of 4.4 months and the main complain was of local tenderness in the surgical wound, with all patients having returned to their normal level of activity.

This series complications rate is low, and the AOFAS score and satisfaction rate is higher in the percutaneous group, following the tendency expressed in the international literature. Reflecting the growing tendency for information in our patients, one important cause of dissatisfaction in the open surgery group is not to have had the opportunity of a percutaneous surgery.

The results of percutaneous surgery are excellent, with a lower rate of complications, less surgical wound complaints. The possibility raised by other studies of a higher rerupture rate in the percutaneous group was not confirmed in this group.

Currently all Achilles ruptures are treated percutaneously in our Hospital, if the rupture meets the indications criteria for this type of surgery.