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.

Introduction: Intramedullary nailing of the humerus for the treatment of diaphyseal fractures can be done through both extremities of the bone. The aim of the authors is to evaluate the positive and negative aspects of both techniques, evaluating postoperative shoulder and elbow function, union rates and complications.

Material and methods: Retrospective analysis with a maximal regression of 58 months, of patients submitted to surgical management of diaphyseal humeral fractures with intramedullary nailing (locked nails). Two different approaches were applied – antegrade and retrograde. The AO classification was utilized. Clinical evaluation of the shoulders was done using the Constant score and VAS. The elbows were evaluated using the Mayo Elbow Performance Score (MEPS) and VAS. The shoulder, humerus and elbow were radiologically evaluated. Patient satisfaction and re-intervention rates were also evaluated.

Results: 27 patients were surgically treated (21 males and 6 females). Age varied from 16 to 77y (average 48y). AO type 12.B2 fractures were more common. Motor vehicle accidents were the most common mechanism of injury. Two patients presented with radial nerve injury, one being iatrogenic (during placing of the distal screw in antegrade intramedullary nailing). Union rate was near 90%. In the medium term there were no significant differences between the MEPS and Constant score of the operated and non-operated upper limbs. Patient satisfaction was high in both types of approaches, There were no vascular lesions or infections.

Discussion and Conclusion: Retrospective analysis, with an acceptable sample and follow up period. Both surgical techniques are effective in the treatment of humeral diaphyseal fractures and have a low complication rate. In this study there were no significant differences in function between the operated and non-operated limbs