Objective:To evaluate the epidemiology of traumatic injuries of the upper limbs treated at a university hospital and identify the causes, types of injuries, and risk factors.Methods:A prospective study was performed with accidents resulting in trauma categorized into three groups: domestic, occupational, or transportation-related. A questionnaire containing information about the patient and the accident was administered. Lesion characteristics were evaluated according to the injured area, the type of injury, and the management strategy adopted for each case.Results:A total of 613 patients were evaluated. The most frequent accidents were domestic (66.6%), predominantly involving men (67.9%) with a mean age of 31 years. Wrist lesions prevailed in transportation-related (31.1%) and domestic (29.6%) accidents, and in accidents involving fingers at work (54.2%). Closed fractures were more frequent and conservative treatment was indicated most often. Serious injuries were associated with finger accidents (39.4%). There was a correlation between the level of education and the type of accident.Conclusion:Traumatic injuries of the upper limbs were more frequent in domestic accidents and in male patients. Closed fractures were the most common type of fracture and were usually treated conservatively. Serious injuries were more often related to finger trauma. Education level influenced domestic, transportation-related, and occupational accidents. Level of Evidence IV, Case Series.

Background Knowledge on the anatomical and morphological characteristics of the superficial peroneal nerve is amenable to further refinement. This cadaveric study aimed to further evaluate anatomical and morphological characteristics of the superficial peroneal nerve. Methods In this study, 10 lower limbs from five fresh cadavers were dissected. The anatomical characteristics of the superficial peroneal nerve were identified. Nerve segments were submitted for histological and morphometric analyses, and nerve thicknesses and number of fascicles were assessed. Results Regarding the superficial peroneal nerve's bifurcation, 80% of the terminal branches were distal to the point of emergence from the fascia. In 90% limbs, two sensory branches were observed immediately after the distal bifurcation of the superficial peroneal nerve. The mean distance from the fibular head to the superficial peroneal nerve's emergence from the fascia was 24.6 cm and mean nerve thickness at this point was 0.3 cm. The mean distance between the lateral malleolus and the main nerve trunk at the ankle was 4.68 cm. The mean distance from the motor branch of the peroneus brevis to the lateral malleolus was 29.3 cm. Morphometric analyses revealed an average five nerve bundles at the broadest nerve diameter (2.6 mm). Conclusion The anatomical and morphometrical characteristics of the superficial peroneal nerve indicate that it may be a safe and useful donor for autologous graft treatment of peripheral nerve injuries. Our morphological study shows a median of five fascicles, and that the thickest diameter of the nerve was 2.6 mm at the emergence from the deep to the superficial compartment.

ObjectiveTo evaluate the clinical results from treating chronic peripheral nerve injuries using the superficial peroneal nerve as a graft donor source.MethodsThis was a study on eleven patients with peripheral nerve injuries in the upper limbs that were treated with grafts from the sensitive branch of the superficial peroneal nerve. The mean time interval between the dates of the injury and surgery was 93 days. The ulnar nerve was injured in eight cases and the median nerve in six. There were three cases of injury to both nerves. In the surgery, a longitudinal incision was made on the anterolateral face of the ankle, thus viewing the superficial peroneal nerve, which was located anteriorly to the extensor digitorum longus muscle. Proximally, the deep fascia between the extensor digitorum longus and the peroneal longus muscles was dissected. Next, the motor branch of the short peroneal muscle (one of the branches of the superficial peroneal nerve) was identified. The proximal limit of the sensitive branch was found at this point.ResultsThe average space between the nerve stumps was 3.8 cm. The average length of the grafts was 16.44 cm. The number of segments used was two to four cables. In evaluating the recovery of sensitivity, 27.2% evolved to S2+, 54.5% to S3 and 18.1% to S3+. Regarding motor recovery, 72.7% presented grade 4 and 27.2% grade 3. There was no motor deficit in the donor area. A sensitive deficit in the lateral dorsal region of the ankle and the dorsal region of the foot was observed. None of the patients presented complaints in relation to walking.ConclusionsUse of the superficial peroneal nerve as a graft source for treating peripheral nerve injuries is safe and provides good clinical results similar to those from other nerve graft sources.

Objective: To evaluate diagnostic tests described for rhizarthrosis, to determine its sensitivity, specificity and accuracy, and to try to establish correlations between clinical and radiological conditions.Method: This is a prospective study carried out at a university hospital, in the city of Campinas, Brazil. Patients were divided into 2 groups, Group A was evaluated according to the following data: age, sex, laterality of the pathology, dominant hand, length of symptoms, diagnostic tests (Grind Test, Digit-Pressure Test, Shear Test, 1st Metacarpal Flexion test, and 1st Metacarpal Extension Test), pain, radiological evaluation, and upper extremity functional index through the Quick DASH method. Group B (control group -with the same number of patients) was evaluated using the same methodology as Group A according to age, sex, diagnostic tests, and radiological evaluation.Results: Group A-34 patients were evaluated, 30 of whom were female (88.2%), with a mean age of 60.6 years. Regarding the radiological classification, 3% were Eaton type 1, 38% type 2, 56% type 3, and 3%, type 4. The mildest group (Eaton type 1 and 2) represented 41.2% of the patients, and the more severe group (type 3 or 4) represented 58.8%.There was statistical significance for the diagnosis of rhizarthrosis with the Digit-Pressure test (p<0.001), Digit-Pressure test/Shear test (p<0.001), Metacarpal Extension test (p<0.001), Digit-Pressure/Metacarpal Extension tests (p<0.001), Grind Test/Digit-Pressure test (p<0.001), and Shear Test (p=0.001). The Shear test/Metacarpal Extension test had the highest specificity, with 85.7%. The Grind Test/Digit-pressure test had the highest accuracy, with 70.6% and the Digit-pressure test had the highest sensitivity, with 100%. When all the tests were analyzed, individually and in pairs, there was greater specificity in digit-pressure test (85.1%); sensitivity in digit-pressure test (95.2%) and greater accuracy in digit-pressure test (88.2%). There was statistical significance of the radiological classification with the Digit-Pressure test (p=0.030), and the Grind test/Digit-Pressure test combination (p=0.026) with Eaton and Littler stages 3 and 4.

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HAND 11(1S) 36.9 months (range, 25-49 months postinjury). The range of active motion of joints, grip and pinch strength, cutaneous sensibility, upper-extremity functioning, and subjective satisfaction using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ), and psychological sequelae including depression, anxiety, and postraumatic stress disorder (PTSD) were assessed. A correlation analysis among variables was also performed. Results: According to the Strickland criteria, the active motion of digits was excellent in 4 (15%), good in 6 (5%), fair in 9 (35%), and poor in 9 (45%) digits. The mean value of the total grip, pinch strength, and the Semmes-Weinstein monofilament testing exceeded 80% of value of the healthy hand. However, the average value of static two point discrimination (s2PD) was less than half value of the healthy hand. The mean score for the DASH and MHQ was 6.9 and 58.9, respectively. The incidence of cold intolerance was 60%. Only 1 patient has showed the symptoms of depression and PTSD after 49 months postinjury as yet. Almost all patients returned to work and half of them did not change their former type of occupations. Conclusions: We concluded that the objective functional results of replanted digits did not affect the daily life and satisfaction of patients.