O objetivo deste estudo foi avaliar, por meio de uma análise histológica e histométrica, o processo de reparo ósseo em osteotomia mandibular e interface entre tecido ósseo e parafusos utilizando um sistema de fixação interna biodegradável de 2,0mm. Seis cães foram submetidos a uma osteotomia vertical unilateral realizada entre o 3º e o 4º pré-molares mandibulares (lado experimental), estabilizada com aplicação de duas placas de quatro furos e parafusos manufaturados com ácido poli-L-DL-lático (70:30). No lado mandibular contra-lateral (lado controle) foi realizada apenas uma demarcação óssea superficial na cortical vestibular e metade do sistema de FI (duas placas de dois furos) foi utilizado. Após 2 e 18 semanas os animais foram eutanasiados e as regiões de osteotomia e interface entre tecido ósseo e parafusos foram removidas para análise microscópica. Cada parafuso foi seccionado no seu longo eixo e a região de osteotomia foi dividida igualmente em três partes: a parte superior próxima ao processo alveolar foi denominada Terço de Tensão (TT), a parte inferior de Terço de Compressão (TC) e a parte entre TT e TC, Terço Intermediário (TI). A análise histológica mostrou no período de 2 semanas, áreas de contato ósseo direto entre a superfície do parafuso e o tecido ósseo lamelar original. No período de 18 semanas, um tecido conjuntivo não mineralizado composto por três camadas microscopicamente distintas foi observado na interface entre tecido ósseo e parafusos. Nesta área, não houve diferença estatisticamente significante no contato entre tecido ósseo e parafusos entre os lados controle e experimental em ambos os períodos analisados. Na área de osteotomia foi observada, em 18 semanas, união entre os fragmentos ósseos caracterizada por trabéculas ósseas interconectadas e alguns sistemas osteonais neofomados. Diferença estatisticamente significante de neoformação óssea foi verificada entre o TT, TI e TC (p=0,019). Em conclusão, o sistema biodegradável utilizado neste estudo permitiu a ocorrência do reparo ósseo na região de osteotomia devido ao ambiente biomecânico criado e as características teciduais adjacentes aos parafusos biodegradáveis foram altamente influenciadas pelas propriedades do ácido poli-L-DL-lático (70:30). / The aim of this study was to evaluate histologic and histometrically the bone repair in mandibular body osteotomy and bone-screw interface after using a biodegradable 2.0-mm internal fixation system. Six dogs were subjected to an unilateral osteotomy in mandibular body (experimental side), which was stabilized by applying two 4-hole plates manufactured with poly-L-DL-lactic acid (70:30). In the opposite side (control side), a superficial demarcation on the buccal cortical was performed and half of the IF system (two 2-hole plates) was applied. After 2 and 18 weeks, the dogs were euthanized and the osteotomy site and the bone-screw interface were removed for microscopic analysis. Each screw was sectioned along its long axis and the osteotomy sites were divided equally into three parts: the upper part was labelled the Tension Third (TT), the lower part Compression Third (CT), and the part between the TT and CT Intermediary Third (IT). Histologic analysis showed areas of direct contact between the screw surface and the parent lamellar bone at 2 weeks. At 18 weeks, three microscopically distinct layers at the bone-screw interface were noted. No statistically significant difference was observed in the bone-to-screw contact between the control and experimental sides for each time point. At the osteotomy sites, union between the bone fragments was observed at 18 weeks characterized by interconnected parallel-fibered bone trabeculae and some newly formed osteonal systems. Statistically significant difference of newly formed bone among TT, IT and CT (p=0.019) was observed. In conclusion, the biodegradable IF system used in this study was able to allow the bone repair at the osteotomy site due to the biomechanical environment created and the characteristics of the tissue adjacent to the biodegradable screws were highly influenced by the properties of the poly-LDL- lactic acid (70:30).

Orientador: Luis Augusto Passeri / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-07-31T15:14:06Z (GMT). No. of bitstreams: 1 Trivellato_AlexandreElias_D.pdf: 3724190 bytes, checksum: f29e801dbdb08b31267899c2943a54d9 (MD5) Previous issue date: 2001 / Resumo: O objetivo deste estudo foi avaliar a estabilidade da fixação promovida por placas e parafusos de titânio do sistema de 2,0 mm, realizada em osteotomia de costela bovina submetidas ao teste de resistência à flexão variando o número, a extensão e a localização das placas. Do teste de resistência à flexão, foram obtidos valores de carga aplicada e de deslocamento na área da osteotomia. Os valores foram avaliados por meio do teste de Tukey em nível de significância de 5%. Na carga aplicada foi observado melhor comportamento quando da utilização de duas placas de seis furos ou duas placas sendo uma de seis furos na base e de quatro furos na região superior. Em seguida, de duas placas de quatro furos e, em ordem decrescente, mas sem variação quanto ao tamanho das placas, por uma na porção superior e finalmente por uma na base. Quanto ao deslocamento, não houve variação pela extensão da placa, onde o menor valor foi observado para uma placa na posição superior e o pior com uma placa em borda inferior, não havendo diferença com duas placas relacionadas ao maior ou ao menor deslocamento / Abstract: The aim of this study was to evaluate the stability fixation promoted by titanium plates and screws of 2.0mm system. It was done in vitro by using 2.0mm system in osteotomies carried out in bovine ribs thereafter submitted to bending test changing the number, the extension, and the location of the plates. From bending tests were obtained the load applied and the gap between the superior cortices of bone in the osteotomy area. The values were compared through Tukey test with 5% of significance. Considering the applied load, the best results were seen when either two 6-hole plates or a combination of 6 hole and 4-hole were used, the former in the basis and the later superiorly. Those were followed by the results obtained with using two 4-hole plates. Lower applied loads were obtained, despite of the size, using only one plate superiorly and only one in the basis. Related to gap between the superior cortices of bone there was no influence of the plate extension, and the lower value was obtained with one plate superiorly and the higher was obtained with one plate in the basis / Doutorado / Cirurgia e Traumatologia Buco-Maxilo-Faciais / Doutor em Clínica Odontológica

The in vitro comparison of monotonic and cyclic mechanical properties of equine proximal interphalangeal joint arthrodeses stabilized using an open or closed technique and application of 2 abaxial transarticular lag screws combined with either an axial 4.5mm narrow 3-hole LC-DCP with 5.5mm cortical screws a 4.5mm narrow 3-hole LCP with 5.0mm locking screws. Limbs were tested for cyclic fatigue at 20,0000cycles and then in single-cycle to failure under 3-point, dorsopalmar bending. There were no significant differences in stiffness and single-cycle to failure values between the LCP and LC-DCP constructs, with or without PIPJ collateral ligament transaction. There was no interaction between the open and closed techniques, nor between plate types on force or stiffness at failure.

Thesis (M.S.)--Mississippi State University. Department of Clinical Sciences, College of Veterinary Medicine. / Title from title screen. Includes bibliographical references.

Made available in DSpace on 2014-12-17T15:43:48Z (GMT). No. of bitstreams: 1 KerlisonPO_DISSERT.pdf: 1641521 bytes, checksum: 5f1078757c465e02ee64ce8aff96f794 (MD5) Previous issue date: 2012-12-18 / The aim of this study was to comparatively evaluate the mechanical strength of squared and rectangular 2.0 mm system miniplates comparing them to the standard configuration with 2 straight miniplates in stabilizing fractures in the anterior mandible. Ninety synthetic polyurethane mandible replicas were used in mechanical test. The samples were divided into six groups of three different methods for fixation. Groups 1, 2 and 3 showed complete fractures in symphysis, characterized by a linear separation between the medial incisor, and groups 4, 5 and 6 showed complete fractures in parasymphysis with oblique design. Groups 1 and 4 were represented by the standard technique with two straight miniplates parallel to each other. Groups 2 and 5 were stabilized by squared miniplates and groups 3 and 6 were fixed by rectangular design. Each group was subjected to a mechanical test at a displacement speed of 10 mm/min on a universal testing machine, receiving linear vertical load on the region of the left first molar. The values of the maximum load and when displacements reached 5 mm were obtained and statistically analyzed by calculating the confidence interval of 95%. Fixation systems using squared (G2) and rectangular (G3) miniplates obtained similar results. No statistically significant differences with respect to the maximum load and the load at 5 mm displacement were found when compared to standard method in symphyseal fractures (G1). In parasymphysis the fixation method using squared miniplates (G5) obtained results without significant differences regarding the maximum load and the load at 5 mm when compared to the standard configuration (G4). The fixation method using rectangular miniplates (G6) showed inferior results which were statistically significant when compared to the standard configuration (G4) for parasymphysis fractures. The mechanical behavior of the fixation methods was similar, except when rectangular miniplates were used. The fixation methods showed better results with statistical significance in symphyseal fractures / O prop?sito deste estudo foi avaliar comparativamente a resist?ncia mec?nica de miniplacas quadradas e retangulares do sistema 2.0 mm, comparando-as ? configura??o padr?o, com 2 miniplacas retas, na estabiliza??o de fraturas na regi?o anterior de mand?bula. Noventa r?plicas de mand?bulas de poliuretano foram utilizadas no ensaio mec?nico. As amostras foram divididas em 6 grupos com 3 m?todos de fixa??o do sistema 2.0 mm. Os grupos 1, 2 e 3 apresentavam fraturas sinfis?rias completas, caracterizadas pela separa??o linear entre os incisivos mediais, e os grupos 4, 5 e 6 apresentavam fraturas parassinfis?rias completas com desenho obl?quo. Os grupos 1 e 4 foram representados pelo m?todo padr?o, com 2 miniplacas retas, dispostas paralelamente entre si. Os grupos 2 e 5 tiveram as mand?bulas estabilizadas por meio de miniplacas quadradas e os grupos 3 e 6, pelas retangulares. Cada grupo foi submetido a um teste mec?nico realizado por meio de uma m?quina de ensaio universal, na velocidade de 10mm/minuto, recebendo carga vertical linear na regi?o de primeiro molar esquerdo. Os valores da carga m?xima e da carga com deslocamento pr?-estabelecido em 5 mm foram obtidos e submetidos ? an?lise estat?stica a partir do c?lculo do intervalo de confian?a de 95%. Os sistemas de fixa??o utilizando miniplacas quadradas (G2) e retangulares (G3) obtiveram resultados similares, sem diferen?as estatisticamente significativas em rela??o ? carga m?xima e ? carga no deslocamento de 5 mm, quando comparada ? configura??o padr?o (G1), nas fraturas sinfis?rias da mand?bula. Nas fraturas parassinfis?rias, o m?todo de fixa??o utilizando miniplacas quadradas (G5) obteve resultados sem diferen?as estatisticamente significativas no que se refere ? carga m?xima e ? carga no deslocamento de 5 mm, quando comparadas ? configura??o padr?o (G4). O m?todo de fixa??o utilizando as miniplacas retangulares (G6) obteve resultados inferiores, estatisticamente significantes, quando comparado ? configura??o padr?o (G4) nas fraturas parassinfis?rias. O comportamento mec?nico dos m?todos de fixa??o estudados foi similar, exceto nas fraturas parassinfis?rias, quando se utilizaram as miniplacas com a configura??o retangular. Os m?todos de fixa??o utilizados apresentaram melhores resultados, com signific?ncia, nas fraturas sinfis?rias

Femoral neck fracture (FNF) is a great challenge for today´s health care and is associated with high mortality and morbidity in the elderly.  In the short term several studies in the literature have demonstrated improved hip function, quality of life and fewer re-operations in elderly patients treated with total hip arthroplasty (THA) instead of internal fixation (IF). There are few reports on the long-term outcome comparing IF and THA. The vast majority of orthopaedic departments in Sweden use the direct lateral (DL) or posteriolateral (PL) approaches for hip arthroplasty. The PL approach has been linked to an increased risk of dislocation of the prosthesis and a higher rate of revision surgery in comparison to the DL approach. There are few reports focusing on radiological risk factors for prosthetic dislocation and patient reported hip function comparing the two surgical approaches for hip arthroplasty in FNF. The randomized controlled trial (RCT) is the gold standard for evaluating medical or surgical interventions. An RCT of high quality has to be internally and externally valid. Internal validity refers to a correct study design to avoid bias skewing the results. External validity (EV) refers to whether the results will be clinically relevant to a definable group of patients and can be extrapolated to the general health care situation. There are only a few reports in the orthopaedic literature focusing on the EV of published studies and none in the field of hip fractures. Study I: This is a RCT of 100 patients with a displaced FNF comparing THA and IF. Follow-up evaluations were performed at three months and 1, 2, 4, 11 and 17 years. It was found that the Harris hip score (HHS) was higher and the rate of reoperations lower for patients treated with THA. Study II: This is a prospective cohort study of 185 hips, comparing the DL and the PL approaches in patients treated with a hemiarthroplasty (HA) for a displaced FNF. Follow-up was after 1 year. There was no difference in patient reported outcome between the groups measured with the HHS and WOMAC index. The PL approach resulted in a higher re-operation rate while the DL approach in a higher incidence of limping. Study III: This is a retrospective cohort study of 373 patients with a cemented bipolar HA using a PL approach for a FNF with a follow-up ranging from 6 months to 7 years. Radiographs and all surgical records were reviewed regarding femoral offset (FO), leg length discrepancy (LLD) and Wiberg angle. Patients with recurrent dislocations had a decreased postoperative FO, LLD and shallower acetabulum on the operated side compared with their controls. Study IV: This is a prospective cohort study of 840 hips comparing patients included in a RCT with those that did not give their informed consent (NC) or did not fulfill the criteria for participating in the trial (MS). Patients in the NC and MS groups had an increased mortality rate in comparison to those included in the study. We did not find any differences in hip function between these groups. The main conclusions of this thesis are: Healthy and lucid elderly patients with good hip function preoperatively, should be treated with THA for a displaced FNF. The DL approach is favourable in treating displaced FNF with HA due to its decreased risk of reoperation but with an identical hip function outcome as the PL approach. Care should be taken to restore the LLD and FO otherwise this may increase the risk of recurrent dislocation of a HA. Our findings suggest that trial participants had a lower mortality rate than non-participants but the functional outcome of non-participants appeared to be satisfactory. This is important to take into consideration when extrapolating study results to a health care system. / Lårbenshalsfrakturer (FNF) är en utmaning för dagens sjukvård och förknippad med hög mortalitet i den äldre befolkningen. FNF orsakas främst av lågenergitrauma efter fall i samma plan hos patienter med benskörhet. Total höftledsprotes (THA) har visat sig ge en bättre höftfunktion, livskvalitet med färre omoperationer hos äldre patienter än sluten reposition samt fixering med skruvar (IF) under de första två-fyra åren efter operation. Få studier har publicerats med långtidsuppföljning av THA jämfört med IF. Vid behandling av felställd FNF med halv höftledsplastik (HA) eller THA finns olika kirurgiska metoder (snittföring) för implantation av protesen. Majoriteten av ortopedkliniker i Sverige använder direkt lateral (DL) eller posteriolateral (PL) snittföring. PL har kopplats till en ökad risk för luxation av protesen (urledsvridning), vilket i sin tur genererat en högre risk för omoperation jämfört med DL. Få studier har utvärderat höftfunktion med avseende på snittföring. Detsamma gäller vilka radiologiska faktorer som påverkar risken förprotesluxation. Det finns olika typer av studiedesigner för utvärdering av medicinska och kirurgiska behandlingsmetoder. Studiedesignen med högst bevisvärde anses vara den randomiserade kontrollerade studien (RCT). För att en RCT skall hålla hög kvalitet krävs intern och extern validitet. Intern validitet syftar på ett korrekt studieupplägg som mäter det som avses och undviker påverkan av icke önskvärda faktorer. Extern validitet (EV) innebär att erhållna resultat från studien är generaliserbara och kan extrapoleras till andra grupper än den studerade. Det inga rapporter i ortopediska litteraturen med fokus på EV med patienter som drabbats av FNF. Studie I: Prospektiv randomiserad studie av 100 patienter med en felställd FNF jämförs THA med IF med avseende på höftfunktion och reoperationer. Uppföljning gjordes efter tre månader samt 1, 2, 4, 11 och 17 år. HHS som mått på höftfunktion var högre och andelen reoperationer lägre för patienter som behandlades med THA. Studie II: Prospektiv kohortstudie med 183 patienter med felställd FNF behandlade med HA och antingen DL eller PL. Vi fann ingen skillnad i patientrapporterad höftfunktion utvärderat med HHS och WOMAC efter 1 år men en ökad förekomst av hälta vid DL. Studie III: Retrospektiv kohortstudie av 373 patienter opererade med en cementerad bipolär HA och PL. Postoperativa röntgenbilder granskades avseende femoral offset (FO), postoperativ benlägdsskillnad (LLD) samt acetabulär Wibergvinkel och relaterades till återkommande protesluxationer. Detta relaterades till återkommande luxationer. Uppföljningstiden varierade mellan 6 månader och 7 år. Patienter med återkommande luxationer hade en minskad postoperativ global FO, förkortad LLD och grundare acetabulum på den opererade sidan jämfört med kontroller. Studie IV: Prospektiv kohortstudie av 840 patienter med felställd FNF där patienter som ingick i en RCT jämförs med de som inte gav sitt samtycke för deltagande eller ej inkluderats i screeningprocessen. De patienterna som inte gav sitt samtycke hade ökad dödlighet, men ingen skillnad i höftfunktion jämfört med deltagare. Slutsatser • Friska och kognitivt vitala äldre patienter med god höftfunktion innan en felställd lårbenshalsfraktur bör behandlas med total höftledsprotes. • DLsnittföring ger ett lika bra patientrapporterad höftfunktion men en ökad förekomst av hälta jämfört med PL snitt vid behandling med halvprotes på grund av en felställd lårbenshalsfraktur. • Ansträngning bör göras för att återställa benlängdsskillnad samtfemoral offset och därigenom minska risken för återkommande luxation. • Våra resultat tyder på att patienter som deltar i en randomiserad studie har lägre dödlighet än patienter som avböjt att delta samt de som missats i screeningprocessen. Det är viktigt att ta hänsyn till när extrapolerar studieresultat till ett hälso-och sjukvårdssystem. Detta bör vägas in i värderingen av studieresultatens externa validitet.

Hip fracture is a global and a growing public health problem. More women than men sustain hip fractures, the incidence increases exponentially with age and mean age is above 80. About one third of hip-fracture patients suffer from dementia and are prone to develop acute confusional state (delirium). Delirium is one of the most common complications after hip-fracture surgery, and seriously impacts on morbidity and mortality. Malnutrition is also common in hip-fracture patients and is associated with postoperative complications, such as delayed healing of the wound, infections and decubitus ulcers. Arthroplasty is usually preferred procedure in displaced femoral neck fractures but is, however, controversial in patients with dementia due to the fear of dislocation of the prosthesis. The aims of this thesis are to identify risk factors for delirium and the impact of delirium on rehabilitation outcome, to evaluate whether a postoperative multi-factorial intervention program could reduce delirium, to investigate the effect of a nutritional intervention and to evaluate complications, functional outcome and mortality regarding two surgical methods, hemiarthroplasty (HAP) and internal fixation (IF), in old patients with femoral neck fracture. Thirty-eight out of 61 consecutive patients (62%) were delirious on admission to hospital or developed postoperative delirium. An increased risk of postoperative delirium was found among hip-fracture patients with dementia and/or depression. Delirious patients were hospitalized longer, were more dependent in their activities of daily living, had poorer psychological well-being and suffered more complications than non-delirious patients. A postoperative multi-factorial and multidisciplinary intervention program reduced the incidence, at 55% vs 75% (p=0.003), and number of days with delirium, 5 vs 10 days (p=0.009). Postoperative complications were also reduced; decubitus ulcers 9% vs 22% (p= 0.010), urinary tract infections 31% vs 51% (p=0.005), falls 12% vs 27% (p=0.007), and the mean hospitalization period was 10 days shorter in the intervention group (p=0.030). Malnutrition was common among all these patients (53 %) and associated with postoperative complications such as decubitus ulcers and delirium. However, the nutritional intervention had no effect on nutritional parameters at four months, nevertheless men had better nutritional outcomes than women. A higher proportion of patients with dementia operated on using HAP had regained their pre-fracture ability to walk independently at the one-year follow up compared with those operated on using IF. Six of 83 patients dislocated their HAP during hospitalization and during an episode of delirium, none had dementia. No difference in mortality between the surgical methods was seen. Dementia per se should not be a reason to disqualify patients from being treated with the most appropriate surgical method. It is clinically important to discriminate between dementia and delirium, since delirium can be prevented and treated even in patients with dementia. Old patients undergoing surgery have special needs that are not always catered for in ordinary orthopaedic or surgical wards. The special care for these patients should include: a combined nursing and medical care based on comprehensive geriatric assessments, systematic prevention, detection and treatment of postoperative complications such as delirium, hypoxemia, urinary tract infections, pain, malnutrition and an active rehabilitation. It is obvious that improved quality of care reduces patient suffering and seemingly the costs for society.

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O objetivo deste estudo é o de comparar os resultados clínicos e radiográficos do tratamento cirúrgico das fraturas da diáfise do úmero com haste intramedular bloqueada ou placa em ponte. Quarenta fraturas da diáfise do úmero, em 39 pacientes, dos tipos A, B ou C da classificação do grupo A.O., foram tratadas no período compreendido entre junho de 2003 e dezembro de 2007. Destas, após seleção por sorteio, 21 fraturas foram submetidas à osteossíntese com placas em ponte de 4,5 mm e parafusos (grupo PP) e 19 com hastes intramedulares bloqueadas não fresadas (grupo HIB). Duas eram fraturas expostas, uma do tipo II e outra do tipo III-a de Gustilo. Vinte e cinco pacientes eram do sexo masculino (64%) e a idade variou de 19 a 75 anos (idade média de 41 anos e 10 meses). O lado direito foi acometido em 22 pacientes (55%) e a queda, o mecanismo de trauma mais freqüente (46%). O tempo mínimo de seguimento foi de seis meses e o máximo de 60 meses para o grupo PP (M=34,5 meses) e de oito e 58 meses (M=27meses) para o grupo HIB. Em apenas um caso, operado com haste intramedular bloqueada, não houve a consolidação. Houve um caso de infecção profunda no grupo PP e um de infecção superficial no grupo HIB. Dois casos do grupo PP evoluíram com capsulite adesiva e, em apenas um dos casos do grupo HIB, o parafuso distal ficou saliente. Ocorreu neuropraxia do nervo cutâneo lateral do antebraço em um dos casos do grupo HIB que regrediu em três dias. Não houve diferença entre os grupos com relação ao tempo total da cirurgia. O tempo de utilização da radioscopia no ato operatório foi maior no grupo HIB. Houve semelhança entre os dois métodos de fixação nos resultados referentes à dor, à função, à flexão ativa e à força de flexão na articulação do ombro e também com relação à dor, mobilidade, força muscular e estabilidade na articulação do cotovelo. Segundo os critérios da UCLA para o ombro, obtivemos resultados excelentes e bons em 85,7% no grupo operado com placa em ponte e 79% no grupo com haste intramedular bloqueada e de acordo com os critérios de Broberg e Morrey para o cotovelo, obtivemos resultados excelentes e bons em 85,7% no grupo operado com placa em ponte e 90,5% no grupo com haste intramedular bloqueada. Na avaliação subjetiva, duas pacientes, uma do grupo HIB e outra do PP, não ficaram satisfeitas. Conclusão: Não houve diferença no resultado clínico e radiográfico entre os dois métodos / The purpose of the study is to compare clinical and radiographic outcomes between nonreamed locked intramedullary nail and bridging plate for the treatment of humeral shaft fracture. Forty humeral shaft fractures in 39 patients, A, B or C AO types were treated between June 2003 and December 2007. The cases were randomly assigned into two groups being 21 fractures fixed by a 4.5 mm bridging plate, and 19 by nonreamed intramedullary locking nail. Two cases had open fractures, one Gustilo type II, the other type IIIa. Twenty five patients were male (64%), ages ranging from 19 to 75 years old (mean age 41 years and 10 months). The right side was treated in 22 patients (55%) and fall was the most frequent cause of fracture (46%). The minimal period of follow-up was six months and the maximum was 60 months for the bridging plate group (mean=34.5 months) and ranged from eight to 58 months (mean=27months) for the nail group. Only one case from the nail group presented a nonunion. One case, in the plate group, developed a deep infection, and another one, in the nail group, had a superficial infection. Two cases of the bridging plate group had adhesive capsulites and in one case of the nail group the distal screw became prominent. A transient neuropraxis of the antebrachial lateral cutaneous nerve was found in one case of the nail group, but it recovered in three days. There were no differences between the groups concerning pain, function, active flexion and strength of flexion of the shoulder, as well as pain, range of motion, muscle strength, and stability of the elbow. According to the UCLA score, we had 85.7% excellent and good results in the plate group and 79% in the nail group. According to Broberg and Morrey score for the elbow, we had 85.7% excellent and good results in the plate group and 90.5% in the nail group. Just one patient, from the nail group, was not satisfied with the final result, according to subjective criteria. In conclusion, there were no differences in the final clinical and radiographic results between the two methods of fixation

O objetivo deste estudo é o de comparar os resultados clínicos e radiográficos do tratamento cirúrgico das fraturas da diáfise do úmero com haste intramedular bloqueada ou placa em ponte. Quarenta fraturas da diáfise do úmero, em 39 pacientes, dos tipos A, B ou C da classificação do grupo A.O., foram tratadas no período compreendido entre junho de 2003 e dezembro de 2007. Destas, após seleção por sorteio, 21 fraturas foram submetidas à osteossíntese com placas em ponte de 4,5 mm e parafusos (grupo PP) e 19 com hastes intramedulares bloqueadas não fresadas (grupo HIB). Duas eram fraturas expostas, uma do tipo II e outra do tipo III-a de Gustilo. Vinte e cinco pacientes eram do sexo masculino (64%) e a idade variou de 19 a 75 anos (idade média de 41 anos e 10 meses). O lado direito foi acometido em 22 pacientes (55%) e a queda, o mecanismo de trauma mais freqüente (46%). O tempo mínimo de seguimento foi de seis meses e o máximo de 60 meses para o grupo PP (M=34,5 meses) e de oito e 58 meses (M=27meses) para o grupo HIB. Em apenas um caso, operado com haste intramedular bloqueada, não houve a consolidação. Houve um caso de infecção profunda no grupo PP e um de infecção superficial no grupo HIB. Dois casos do grupo PP evoluíram com capsulite adesiva e, em apenas um dos casos do grupo HIB, o parafuso distal ficou saliente. Ocorreu neuropraxia do nervo cutâneo lateral do antebraço em um dos casos do grupo HIB que regrediu em três dias. Não houve diferença entre os grupos com relação ao tempo total da cirurgia. O tempo de utilização da radioscopia no ato operatório foi maior no grupo HIB. Houve semelhança entre os dois métodos de fixação nos resultados referentes à dor, à função, à flexão ativa e à força de flexão na articulação do ombro e também com relação à dor, mobilidade, força muscular e estabilidade na articulação do cotovelo. Segundo os critérios da UCLA para o ombro, obtivemos resultados excelentes e bons em 85,7% no grupo operado com placa em ponte e 79% no grupo com haste intramedular bloqueada e de acordo com os critérios de Broberg e Morrey para o cotovelo, obtivemos resultados excelentes e bons em 85,7% no grupo operado com placa em ponte e 90,5% no grupo com haste intramedular bloqueada. Na avaliação subjetiva, duas pacientes, uma do grupo HIB e outra do PP, não ficaram satisfeitas. Conclusão: Não houve diferença no resultado clínico e radiográfico entre os dois métodos / The purpose of the study is to compare clinical and radiographic outcomes between nonreamed locked intramedullary nail and bridging plate for the treatment of humeral shaft fracture. Forty humeral shaft fractures in 39 patients, A, B or C AO types were treated between June 2003 and December 2007. The cases were randomly assigned into two groups being 21 fractures fixed by a 4.5 mm bridging plate, and 19 by nonreamed intramedullary locking nail. Two cases had open fractures, one Gustilo type II, the other type IIIa. Twenty five patients were male (64%), ages ranging from 19 to 75 years old (mean age 41 years and 10 months). The right side was treated in 22 patients (55%) and fall was the most frequent cause of fracture (46%). The minimal period of follow-up was six months and the maximum was 60 months for the bridging plate group (mean=34.5 months) and ranged from eight to 58 months (mean=27months) for the nail group. Only one case from the nail group presented a nonunion. One case, in the plate group, developed a deep infection, and another one, in the nail group, had a superficial infection. Two cases of the bridging plate group had adhesive capsulites and in one case of the nail group the distal screw became prominent. A transient neuropraxis of the antebrachial lateral cutaneous nerve was found in one case of the nail group, but it recovered in three days. There were no differences between the groups concerning pain, function, active flexion and strength of flexion of the shoulder, as well as pain, range of motion, muscle strength, and stability of the elbow. According to the UCLA score, we had 85.7% excellent and good results in the plate group and 79% in the nail group. According to Broberg and Morrey score for the elbow, we had 85.7% excellent and good results in the plate group and 90.5% in the nail group. Just one patient, from the nail group, was not satisfied with the final result, according to subjective criteria. In conclusion, there were no differences in the final clinical and radiographic results between the two methods of fixation