Publications by authors named "Cláudio Henrique Barbieri"

35 Publications

Yttrium-90 radiosynovectomy in knees and ankles (25 joints in 22 hemophilic patients). Short-term results.

Hematol Transfus Cell Ther 2021 Jan-Mar;43(1):15-20. Epub 2020 Jan 30.

Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.

Introduction: The radiosynovectomy (RS) is one treatment option for recurrent hemarthrosis in patients with hemophilia (PWH). A prospective cohort study was designed to evaluate the effects of the RS on the synovial membrane volume in the ankles and knees of PWH and patient characteristics related to the RS outcome.

Methods: In a one-year follow-up, 25 joints of 22 PWH who presented 3 bleeds or more in the same joint over the last 6 months (target joints) were subjected to the RS. Two groups were compared: those who retained target joints following the RS and those who did not (less than 3 bleeds/6 months after the RS). The groups were analyzed according to age, hemophilia type/severity, joint, body mass index (BMI), inhibitor and Hemophilia Joint Health Score 2.1 (HJHS). The magnetic resonance images (MRI) of six ankles and six knees were acquired prior to, and 6 months after, the RS. The synovial membrane volume and arthropathy MRI scale were accessed and volumes were compared and correlated with the Yttrium-90 dose injected.

Results: Patients with a mean age of 12 years and a mean HJHS of 6.7 (p < 0.05) retained target joints after the RS. The inhibitor, joint, type/severity of disease and BMI showed no significant differences between groups. The synovial membrane volume had a significant reduction after the RS (p = 0.03), but no correlation with the Yttrium-90 dose. In proportion to the synovial membrane volume, doses injected to the ankles were larger than those injected to the knees.

Conclusion: The synovial membrane volume is reduced after the RS, regardless of the effective 90Y dose.
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http://dx.doi.org/10.1016/j.htct.2019.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910159PMC
January 2020

BIOMECHANICS OF BONE BLOCK GRAFT MODELS OF DIFFERENT GEOMETRY.

Acta Ortop Bras 2019 May-Jun;27(3):136-140

Hospital Universitário da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

Objective: To evaluate the mechanical behavior of different geometry bone block grafts in wooden models.

Methods: Constructs with rectangular (G1) and trapezoidal (G2) profile "grafts", fixed with 3.5 mm 8-hole dynamic compression plates were submitted to non-destructive bending, with the load applied alternately on the same surface as that of the plate fixation (upper) and on the opposite surface (lower), and torsion tests. A 50 N maximum load for bending and a 5° maximum deformation for torsion were considered. Rigidity (N/mm) was recorded for the former and torque (N.m) was recorded for the latter.

Results: Rigidity was consistently higher in G2 than in G1, but not significantly so for all comparisons. The exception was for the load applied on the same surface of plate fixation, significantly higher in G1 than in G2. Torque was higher in G1, but not significantly so.

Conclusion: The two different-profile "grafts" present a similar mechanical behavior and can be indistinctly used in clinical practice.
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http://dx.doi.org/10.1590/1413-785220192703188112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699400PMC
August 2019

SPRING PLATES IN DISTAL RADIO FRACTURES: MECHANICAL PROPERTIES.

Acta Ortop Bras 2018 ;26(6):423-427

Hand Surgery Program, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, SP, Brazil.

Background: Distal radius fractures are one of the most common orthopedic injuries and appear in various patterns. Volar plate fixation is not always considered the gold standard treatment.

Objective: To measure the resistance of a fragment-specific fixation assembly model obtained by plate fixation associated with different K-wire sizes.

Method: In this original experimental study, novel II, axial compression of bone materials was tested.

Results: In both groups, the maximum force supported by the fixation method in our study was ten times greater than the physiological load to which the wrist was subjected under physiological conditions.

Discussion: In this study, we obtained encouraging results when compared to results reported in the literature. Our study showed that our bone fixating system was mechanically adequate for articular fractures of the intermediate column of the radius (Melone classification). The results were similar or superior to the results of pressure resistance and stiffness when data from the literature was used as reference.

Conclusion: The proposed fixation method demonstrated adequate resistance for fixation of the intermediate column of the distal radius. Increasing K wire size caused augmented resistance of the fixation.
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http://dx.doi.org/10.1590/1413-785220182606190551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362686PMC
January 2018

Ultrasonographic characterization of the ulnar collateral ligament of normal thumbs in different age groups.

Clinics (Sao Paulo) 2018 10 29;73:e162. Epub 2018 Oct 29.

Departamento de Biomecanica, Medicina e Reabilitacao do Aparelho Locomotor, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR.

Objectives: The aim of this study was to perform ultrasonographic characterization of the normal ulnar collateral ligament in different age groups and compare it in men and women and in dominant and nondominant hands.

Methods: Forty right-handed volunteers in the age groups 20-30, 31-40, 41-50, and 51-60 years without a history of trauma or surgical procedure in the studied joint were evaluated. The studied parameters were ligament length, greatest ligament thickness, ligament longitudinal section area in the longitudinal plane, distance from the aponeurosis of the adductor muscle to the metacarpal head surface and joint opening at rest and under abduction stress.

Results: The results indicated that the mean values of all parameters had minor variations with age, hand dominance, and gender and were slightly higher in men than in women and in the dominant hand than the nondominant hand. However, a statistically significant difference was observed between the joint opening at rest and under stress. In terms of age, there was a small but nonsignificant decrease in the values, likely because of the natural aging process.

Conclusion: The low variability in the evaluated parameters indicates that large differences between sides or genders are not to be expected. A greater change is likely to indicate a pathological situation.
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http://dx.doi.org/10.6061/clinics/2018/e162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6201147PMC
October 2018

LLLT actives MMP-2 and increases muscle mechanical resistance after nerve sciatic rat regeneration.

Lasers Med Sci 2017 May 6;32(4):771-778. Epub 2017 Mar 6.

Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.

The purpose of this study was to analyze the low-level laser therapy (LLLT) on metalloproteinase expression and the mechanical strength of skeletal muscle regeneration after peripheral nerve injury. Rats were subjected to crush injury of the right sciatic nerve, followed by LLLT (830 nm, 35, 70, 140, and 280 J/cm) for 21 consecutive days. Functional gait analysis was performed at weekly intervals and the animals were sacrificed after the last evaluation at day 21 for collection of the gastrocnemius muscles, which were submitted to analysis of resistance, and the tibialis anterior, for evaluation of metalloproteinase-2 (MMP-2). The results were statistically analyzed at a significance level of 5%. The irradiated groups showed a significant decrease in the sciatic functional index and a significant increase in the mechanical strength when compared to the injured group with no treatment (p < 0.05), with no significant difference among the energy densities used. While no difference among groups was observed for the activity of MMP-2 in pro-active band, at the intermediate band, the activity was significantly higher (p < 0.05) for the groups irradiated with 35, 70, and 140 J/cm, and at the active band, the activity was significantly more intense in the group irradiated with 280 J/cm. The present study demonstrated that injury of the sciatic nerve, with consequent muscle denervation, are benefited by the laser therapy, which restores neuromuscular function, active MMP-2 and increases the maximum breaking strength.
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http://dx.doi.org/10.1007/s10103-017-2169-yDOI Listing
May 2017

Correlation between ultrasound velocity and densitometry in fresh and demineralized cortical bone.

Clinics (Sao Paulo) 2016 Nov 1;71(11):657-663. Epub 2016 Nov 1.

Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto/SP, Brazil.

Objective:: To compare ultrasound propagation velocity with densitometry in the diaphyseal compact cortical bone of whole sheep metatarsals.

Methods:: The transverse ultrasound velocity and bone mineral density of 5-cm-long diaphyseal bone segments were first measured. The bone segments were then divided into four groups of 15 segments each and demineralized in an aqueous 0.5 N hydrochloric acid solution for 6, 12, 24 or 36 hours. All measurements were repeated after demineralization for each time duration and the values measured before and after demineralization were compared.

Results:: Ultrasound velocity and bone mineral density decreased with demineralization time, and most differences in the pre- and post-demineralization values within each group and between groups were significant: A moderate correlation coefficient (r=0.75956) together with a moderate agreement was determined between both post-demineralization parameters, detected by the Bland-Altman method.

Conclusion:: We conclude that both ultrasound velocity and bone mineral density decrease as a result of demineralization, thus indicating that bone mineral content is of great importance for maintaining the acoustic parameters of cortical bone, as observed for cancellous bone. Ultrasound velocity can be used to evaluate both compact cortical bone quality and bone mineral density.
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http://dx.doi.org/10.6061/clinics/2016(11)07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5108171PMC
November 2016

In vivo standardization of bone ultrasonometry of the clavicle.

Clinics (Sao Paulo) 2016 Mar;71(3):140-4

Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ortopedia, Ribeirão Preto/SP, Brazil.

Objective: The assessment of fracture union includes physical examination and radiographic imaging, which depend on the examiner's experience. The development of ancillary methods may avoid prolonged treatments and the improper removal of implants. Quantitative bone ultrasonometry has been studied for this purpose and will soon be included in clinical practice. The aims of the present study were to assess the feasibility of using this technique on the clavicle and to standardize its in vivo application.

Methods: Twenty adult volunteers, including 10 men and 10 women without medical conditions or a previous history of clavicle fracture, underwent axial quantitative ultrasonometric assessment using transducers in various positions (different distances between the transducers and different angulations relative to the clavicle).

Results: Similar values of wave propagation velocity were obtained in the different tested set-ups, which included distinct distances between the transducers and angular positions relative to the clavicle. There were significant differences only in the transducers positioned at 0° and at 5 or 7 cm apart.

Conclusions: The use of bone ultrasonometry on the clavicle is feasible and the standardization of the technique proposed in this study (transducers placed at 45° and at 7 cm apart) will allow its future application in clinical trials to evaluate the healing process of diaphyseal fractures of the clavicle.
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http://dx.doi.org/10.6061/clinics/2016(03)04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785852PMC
March 2016

Functional outcomes of proximal row carpectomy: 2-year follow-up.

Acta Ortop Bras 2015 Nov-Dec;23(6):311-4

Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Hand and Microsurgery Group, Ribeirão Preto, SP, Brasil. Work developed at Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Ribeirão Preto, SP, Brasil.

Objective: : To evaluate functional outcomes of patients submit-ted to proximal row carpectomy for the treatment of wrist arthri-tis.

Methods: : This is a retrospective study using wrist motion and grip strenght of patients diagnosed with Kienböck disease and scaphoid non-union surgically treated by this technique.

Results: : Eleven patients with 2-year follow-up were evaluated. Wrist motion (flexion, extension and ulnar deviation) and grip strength were significantly better from preoperative values. Ho-wever, no difference in radial deviation was observed in these patients.

Conclusion: : Proximal row carpectomy provides an alternative option for treatment of wrist arthritis, resulting in better active range of motion and grip strength in the long run. Level of Evidence IV, Case Series.
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http://dx.doi.org/10.1590/1413-785220152306150054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775508PMC
April 2016

Radial nerve injury associated with humeral shaft fracture: a retrospective study.

Acta Ortop Bras 2015 Jan-Feb;23(1):19-21

Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil.

Objective: To determine the profile of patients with humeral diaphyseal fractures in a tertiary hospital.

Methods: We conducted a survey from January 2010 to July 2012, including data from patients classified under humeral diaphyseal fracture (S42.3) according to the International Classification of Diseases (ICD-10). The variables analyzed were: age, gender, presence of radial nerve injury, causal agent and the type of treatment carried out.

Results: The main causes of trauma were car accidents. The radial nerve lesion was present in some cases and was caused by the same trauma that caused the fracture or iatrogenic injury. Most of these fractures occurred in the middle third of humeral diaphysis and was treated conservatively.

Conclusion: The profile of patients with fracture of humeral shaft, in this specific sample, was composed mainly of adult men involved in traffic accidents; the associated radial nerve lesion was present in most of these fractures and its cause was strongly related to the trauma mechanism. Level of Evidence II, Retrospective Study.
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http://dx.doi.org/10.1590/1413-78522015230100823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544514PMC
September 2015

Influence of the osteosynthesis plate on ultrasound propagation in the bone.

Acta Ortop Bras 2014 ;22(5):269-74

Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

Objective: To analyze the influence of steel plates for osteosynthesis on the velocity of ultrasound propagation (VU) through the bone.

Methods: The transverse coronal and sagittal velocity of ultrasound propagation underwater were measured on the intact bone and then on assemblies of the same bone with two types of osteosynthesis plates (DCP and semi tubular), fixed onto the dorsal side of the bones. The first arriving signal (FAS) was the ultrasound parameter used, taking the coronal and sagittal diameters as the distances to calculate velocity. Intergroup statistical comparisons were made at significance level of 1% (p<0.01).

Results: Velocity was higher on the intact bones than on the bone-plate assemblies and higher for the semitubular than for the compression plates, although differences were not statistically significant for most comparisons (p=0.0132 to 0.9884), indicating that the steel plates do not interfere significantly with ultrasound wave propagation through the bone-plate assemblies.

Conclusion: The velocity reduction effect was attributed to the greater reflection coefficient of the steel as compared to that of bone and water. Ultrasonometry can, thus, be used in the evaluation of healing of fractures fixed with steel plates. Experimental Study.
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http://dx.doi.org/10.1590/1413-78522014220500733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199645PMC
October 2014

A comparative in vivo ultrasonometric evaluation of normal and delayed fracture healing in sheep tibiae.

Clinics (Sao Paulo) 2014 Sep;69(9):634-40

Medicine and Rehabilitation of the Locomotor Apparatus, Department of Biomechanics, Ribeirão Preto School of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

Objective: To compare normal and delayed bone healing by measuring ultrasound conduction velocity across the bone callus.

Methods: A model of transverse linear and 5 mm resection osteotomies of sheep tibiae was used. Fourteen sheep were operated on and were divided into two groups of seven according to osteotomy type. The procedure was performed on the right tibiae and the intact left tibiae were used as controls. The transverse and axial ultrasound velocities were measured at 30-day intervals for 90 days, after which the animals were killed and both the right and left tibiae were resected for in vitro biomechanical analysis.

Results: Both the transverse and axial ultrasound velocities progressively increased, but the increase was smaller for the delayed union that resulted from the resection osteotomy. The mechanical resistance was higher for the normally healed tibiae that resulted from a linear osteotomy; this result closely correlated with the ultrasound velocity results. Significant differences were found for the comparisons between the intact and operated tibiae in both groups and between the groups for both the transverse and axial ultrasound velocities, but the differences were greater for the latter.

Conclusion: We conclude that in vivo transverse and axial ultrasound velocities provide highly precise information about the healing state of both linear and resection diaphyseal osteotomies, but the axial ultrasound velocity most likely has greater discriminatory power. This method has the potential for clinical application in humans.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192429PMC
http://dx.doi.org/10.6061/clinics/2014(09)10DOI Listing
September 2014

Congenital syndactyly: case by case analysis of 47 patients.

Acta Ortop Bras 2013 ;21(6):333-5

Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil.

Objective: To assess and report clinical data from patients with syndactyly.

Methods: A retrospective review of 47 patients treated between April 2002 and April 2012.

Results: Among the 47 analyzed patients, 33 (70%) were male and 14 (30%) female. The total number of syndactylies was 116. The right hand was affected in 19 patients (40%), the left hand in 12 (24%) and 31 (36%) were bilaterally compromise. Sixteen patients (34%) also presented genetic syndromes. Among the 31 (66%) patients without syndromes, 12 (39%) had isolated syndactyly and 19 (61%) presented association with other hand anomalies. The third web space was affected 45 (39%) times; the fourth, 35 (30%) times; the second, 22 (19%) times and the first web space 14 (22%) times. Simple syndactyly was found 68 (59%) times, complete syndactyly in 44 (65%) and incomplete in 24 (55%). Complex syndactyly was found 48 (41%) times.

Conclusion: The results in this study are similar to the literature. Epidemiological Study .
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http://dx.doi.org/10.1590/S1413-78522013000600007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874989PMC
January 2014

Effects of laser therapy in peripheral nerve regeneration.

Acta Ortop Bras 2013 ;21(5):266-70

Faculdade de Medicina de Ribeirão Preto-Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

Objective: The influence of dose of low power lasertherapy (AsGaAl, 830 nm) on the regeneration of the fibular nerve of rats after a crush injury was evaluated by means of the functional gait analysis and histomorphometric parameters.

Methods: Controlled crush injury of the right common fibular nerve, immediately followed by increasing doses (G1: no irradiation; G2: simulated; G3: 5 J/cm(2); G4: 10 J/cm(2); G5: 20 J/cm(2)) laser irradiation directly on the lesion site for 21 consecutive days. Functional gait analysis was carried out at weekly intervals by measuring the peroneal/fibular functional index (PFI). The animals were killed on the 21(st) postoperative day for removal of the fibular nerve, which was prepared for the histomorphometric analysis.

Results: The PFI progressively increased during the observation period in all groups, without significant differences between them (p>0.05). The transverse nerve area was significantly wider in group 2 than in groups 3 and 4, while fiber density was significantly greater in group 4 than in all remaining groups.

Conclusion: The low power AsGaAl laser irradiation did not accelerate nerve recovery with any of the doses used. Level of Evidence I, Therapeutic Studies Investigating the Results of Treatment.
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http://dx.doi.org/10.1590/S1413-78522013000500005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874995PMC
January 2014

Lack of effectiveness of laser therapy applied to the nerve course and the correspondent medullary roots.

Acta Ortop Bras 2013 Mar;21(2):92-7

Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - Ribeirão Preto, SP, Brazil.

Objective: To investigate the influence of low intensity laser irradiation on the regeneration of the fibular nerve of rats after crush injury.

Methods: Twenty-five rats were used, divided into three groups: 1) intact nerve, no treatment; 2) crushed nerve, no treatment; 3) crush injury, laser irradiation applied on the medullary region corresponding to the roots of the sciatic nerve and subsequently on the course of the damaged nerve. Laser irradiation was carried out for 14 consecutive days.

Results: Animals were evaluated by functional gait analysis with the peroneal functional index and by histomorphometric analysis using the total number of myelinated nerve fibers and their density, total number of Schwann cells, total number of blood vessels and the occupied area, minimum diameter of the fiber diameter and G-quotient.

Conclusion: According to the statistical analysis there was no significant difference among groups and the authors conclude that low intensity laser irradiation has little or no influence on nerve regeneration and functional recovery. Laboratory investigation .
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http://dx.doi.org/10.1590/S1413-78522013000200005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861963PMC
March 2013

Platelet-rich plasma gel promotes regeneration of articular cartilage in knees of sheeps.

Acta Ortop Bras 2013 Mar;21(2):80-6

Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - Ribeirão Preto, SP, Brazil.

Objective: To assess the regeneration of osteochondral defects in the joint cartilage of the knee induced by autologous platelet-rich plasma (PRP).

Methods: Osteochondral defects produced in the trochlear groove of both knees of ten sheep; defects of the right knees were filled with autologous PRP and the left knees were left unfilled. Macroscopic and microscopic evaluation was carried out 12 week later. The results were evaluated by the total score of both macroscopic and microscopic evaluations comparing the two sides through the Wilcoxon paired test.

Results: Macroscopic appearance was not uniform among animals, nor was it different between the right and left knees (p=0.3125), and in no case the regenerated tissue was equal to the normal surrounding cartilage. At histological examination, apparently normal cartilage was not detected in any knee, but a poorly differentiated cartilage was present in 7 right knees, compared to 3 left knees. Fibrocartilaginous tissue was present in most of the remaining knees, with a significant difference in the overall score between right and left knees (p=0.0313).

Conclusion: The PRP as used in this study has reparative properties of the joint cartilage of sheep knees, mostly by stimulating the formation of a fibrocartilaginous tissue. Laboratory investigation.
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http://dx.doi.org/10.1590/S1413-78522013000200003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861962PMC
March 2013

Ultrasonometry evaluation of axial compression osteosinthesis. An experimental study.

Acta Ortop Bras 2013 Jan;21(1):46-51

Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto, SP, Brazil.

Objective: To measure the ultrasound propagation velocity (UV) through a tibial transverse osteotomy in sheep, before and after the fixation with a DCP plate.

Material And Methods: Ten assemblies of a DCP plate with the diaphyseal segment of tibiae, in which a transverse osteotomy was made, were used. Both coronal and sagittal transverse and the axial UV were measured, first with the intact bone assembled with the plate and then with the uncompressed and compressed osteotomy; statistical comparisons were made at the 1% (p<0.01) level of significance.

Results: Compared with the intact bone assembly, axial UV significantly decreased with the addition of the osteotomy and significantly increased with compression, presenting the same behavior for the other modalities, although not significantly.

Discussion And Conclusion: In accordance with the literature data on the ultrasonometric evaluation of fracture healing, underwater UV measurement was able to demonstrate the efficiency of DCP plate fixation. The authors conclude that the method has a potential for clinical application in the postoperative follow-up of DCP plate osteosinthesis, with a capability to demonstrate when it becomes ineffective. Laboratory investigation.
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http://dx.doi.org/10.1590/S1413-78522013000100010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862021PMC
January 2013

Biomechanics of four techniques for fixation of the four-part humeral head fracture.

Acta Ortop Bras 2013 Jan;21(1):34-9

Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto, SP, Brazil.

Objective: To carry out a biomechanical study of four techniques for fixation of four-part humeral head fractures.

Methods: The fracture was reproduced in 40 plastic humeri, divided into groups of ten according to the fixation technique, each one employing different fixation resources, in different configurations. The humeral models were mounted on an aluminum scapula, with leather straps simulating the rotator cuff tendons, and submitted to bending and torsion tests in a universal testing machine, using relative stiffness as an evaluation parameter. Assemblies with intact humeri were analyzed for comparison.

Results: The biomechanical behavior of the fixation techniques varied within a wide range, where the assemblies including the DCP plate and the 4.5mm diameter screws were significantly more rigid than the assemblies with the Kirschner wires and the 3.5mm diameter screws.

Conclusion: The four fixation techniques were able to bear loads compatible with the physiological demand, but those with higher relative stiffness should be preferred for clinical application.

Laboratory Investigation: .
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http://dx.doi.org/10.1590/S1413-78522013000100007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862012PMC
January 2013

Auditory stimuli from a sensor glove model modulate cortical audiotactile integration.

Neurosci Lett 2013 Aug 28;548:33-7. Epub 2013 Apr 28.

Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil.

The purpose of this study was to shed light on cortical audiotactile integration and sensory substitution mechanisms, thought to serve as a basis for the use of a sensor glove in the preservation of the cortical map of the hand after peripheral nerve injuries. Fourteen subjects were selected and randomly assigned either to a training group, trained to replace touch for hearing with the use of a sensor glove, or to a control group, untrained. Training group volunteers had to identify textures just by the sound. In an fMRI experiment, all subjects received three types of stimuli: tactile only, combined audiotactile stimulation, and auditory only. Results indicate that, for trained subjects, a coupling between auditory and somatosensory cortical areas is established through associative areas. Differences in signal correlation between groups point to a pairing mechanism, which, at first, connects functionally the primary auditory and sensory areas (trained subjects). Later, this connection seems to be mediated by associative areas. The training with the sensor glove influences cortical audiotactile integration mechanisms, determining BOLD signal changes in the somatosensory area during auditory stimulation.
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http://dx.doi.org/10.1016/j.neulet.2013.04.019DOI Listing
August 2013

Influence of cortical bone thickness on the ultrasound velocity.

Acta Ortop Bras 2012 ;20(3):184-90

Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto - SP, Brazil.

Objective: An experimental in vitro study was carried out to evaluate the influence of cortical bone thickness on ultrasound propagation velocity.

Methods: Sixty bone plates were used, made from bovine femurs, with thickness ranging from 1 to 6 mm (10 of each). The ultrasound velocity measurements were performed using a device specially designed for this purpose, in an underwater acoustic tank and with direct contact using contact gel. The transducers were positioned in two ways: on opposite sides, with the bone between them, for the transverse measurement; and parallel to each other, on the same side of the bone plates, for the axial measurements.

Results: In the axial transmission mode, the ultrasound velocity speed increased with cortical bone thickness, regardless of the distance between the transducers, up to a thickness of 5 mm, then remained constant thereafter. There were no changes in velocity when the transverse measures were made.

Conclusion: Ultrasound velocity increased with cortical bone thickness in the axial transmission mode, until the thickness surpasses the wavelength, after which point it remained constant.

Level Of Evidence: Experimental Study.
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http://dx.doi.org/10.1590/S1413-78522012000300010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718431PMC
January 2014

Analysis of the reliability and reproducibility of goniometry compared to hand photogrammetry.

Acta Ortop Bras 2012 ;20(3):139-49

Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRPUSP) - Ribeirão Preto, SP, Brazil.

Objective: To evaluate the intra- and inter-examiner reliability and reproducibility of goniometry in relation to photogrammetry of hand, comparing the angles of thumb abduction, PIP joint flexion of the II finger and MCP joint flexion of the V finger.

Methods: The study included 30 volunteers, who were divided into three groups: one group of 10 physiotherapy students, one group of 10 physiotherapists, and a third group of 10 therapists of the hand. Each examiner performed the measurements on the same hand mold, using the goniometer followed by two photogrammetry software programs; CorelDraw(®) and ALCimagem(®).

Results: The results revealed that the groups and the methods proposed presented inter-examiner reliability, generally rated as excellent (ICC 0.998 I.C. 95% 0.995 - 0.999). In the intra-examiner evaluation, an excellent level of reliability was found between the three groups. In the comparison between groups for each angle and each method, no significant differences were found between the groups for most of the measurements.

Conclusion: Goniometry and photogrammetry are reliable and reproducible methods for evaluating measurements of the hand. However, due to the lack of similar references, detailed studies are needed to define the normal parameters between the methods in the joints of the hand. Level of Evidence II, Diagnostic Study.
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http://dx.doi.org/10.1590/S1413-78522012000300003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718433PMC
January 2014

A comparative analysis between ultrasonometry and computer-aided tomography to evaluate bone healing.

J Orthop Res 2012 Jul 8;30(7):1076-82. Epub 2011 Dec 8.

Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto School of Medicine, São Paulo University. Campus Universitário, 14049-900 Ribeirão Preto, SP, Brazil.

An ultrasonometric and computed-tomographic study of bone healing was undertaken using a model of a transverse mid-shaft osteotomy of sheep tibiae fixed with a semi-flexible external fixator. Fourteen sheep were operated and divided into two groups of seven according to osteotomy type, either regular or by segmental resection. The animals were killed on the 90th postoperative day and the tibiae resected for the in vitro direct contact transverse and axial measurement of ultrasound propagation velocity (UV) followed by quantitative computer-aided tomography (callus density and volume) through the osteotomy site. The intact left tibiae were used for control, being examined in a symmetrical diaphyseal segment. Regular osteotomies healed with a smaller and more mature callus than resection osteotomies. Axial UV was consistently and significantly higher (p ≤ 0.01) than transverse UV and both transverse and axial UV were significantly higher for the regular than for the segmental resection osteotomy. Transverse UV did not differ significantly between the intact and operated tibiae (p=0.20 for regular osteotomy; p=0.02 for resection osteotomy), but axial UV was significantly higher for the intact tibiae. Tomographic callus density was significantly higher for the regular than for the resection osteotomy and higher than both for the intact tibiae, presenting a strong positive correlation with UV. Callus volume presented an opposite behavior, with a negative correlation with UV. We conclude that UV is at least as precise as quantitative tomography for providing information about the healing state of both regular and resection osteotomy.
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http://dx.doi.org/10.1002/jor.22039DOI Listing
July 2012

Intraobserver and interobserver reliability of radial torsion angle measurements by a new and alternative method with computed tomography.

Clinics (Sao Paulo) 2010 ;65(11):1093-7

Department of Biomechanics, Medicine and Rehabilitation, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, São Paulo, Brazil.

Objective: To evaluate the intraobserver and interobserver reliability of radial torsion angle measurement using computed tomography.

Methods: Twelve pairs of cadaver radii and 116 forearms from 58 healthy volunteers were evaluated using axial computed tomography sections measured at the level of the bicipital tuberosity and the subchondral region of the radius. During digital imaging, the angle was formed by two lines, one diametrically perpendicular to the radial tubercle and the other tangential to the volar rim of the distal joint surface. Measurements were performed twice each by three observers.

Results: In cadaveric bones, the mean radial torsion angle was 1.48º (-6º - 9º) on the right and 1.62º (-6 º - 8º) on the left, with a mean difference between the right and left sides of 1.61º (0º - 8º). In volunteers, the mean radial torsion angle was 3.00° (-17° - 17°) on the right and 2.91° (-16°- 15°) on the left, with a mean difference between the sides of 1.58º (0º - 7º). There was no significant difference between each side. The interobserver correlation coefficient for the cadaver radii measurements was 0.88 (0.72 - 0.96) and 0.81 (0.58 - 0.93) for the right and left radius, respectively, while for the volunteers, the difference was 0.84 (0.77 - 0.90) and 0.83 (0.75 - 0.89), respectively. Intraobserver reliability was high.

Conclusion: The described method is reproducible and applicable even when the radial tubercle has a rounded contour.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999701PMC
http://dx.doi.org/10.1590/s1807-59322010001100006DOI Listing
October 2011

Ultrasound propagation velocity and broadband attenuation can help evaluate the healing process of an experimental fracture.

J Orthop Res 2011 Mar 29;29(3):444-51. Epub 2010 Sep 29.

Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto School of Medicine, São Paulo University, São Paulo, Brazil.

Ultrasonometry seems to have a future for the evaluation of fracture healing. Ultrasound propagation velocity (USPV) significantly decreases at the same time that bone diameter decreases as healing takes place, thus approaching normal values. In this investigation, both USPV and broadband ultrasound attenuation (BUA) were measured using a model of a transverse mid-diaphyseal osteotomy of sheep tibiae. Twenty-one sheep were operated and divided into three groups of seven, according to the follow-up period of 30, 60, and 90 days, respectively. The progress of healing of the osteotomy was checked with monthly conventional radiographs. The animals were killed at the end of the period of observation of each group, both operated-upon and intact tibiae being resected and submitted to the measurement of underwater transverse and direct contact transverse and longitudinal USPV and BUA at the osteotomy site. The intact left tibia of the 21 animals was used for control, being examined on a symmetrical diaphyseal segment. USPV increased while BUA decreased with the progression of healing, with significant differences between the operated and untouched tibiae and between the periods of observation, for most of the comparisons. There was a strong negative correlation between USPV and BUA. Both USPV and BUA directly reflect and can help predict the healing of fractures, but USPV alone can be used as a fundamental parameter. Ultrasonometry may be of use in clinical application to humans provided adequate adaptations can be developed.
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http://dx.doi.org/10.1002/jor.21258DOI Listing
March 2011

A new treadmill-type motorized walking belt machine for video recording of the rat's gait and sciatic functional index measurement. A comparative study with other methods.

J Neurosci Methods 2010 May 15;189(1):23-9. Epub 2010 Mar 15.

Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Av. dos Bandeirantes s/n, Faculdade de Medicina de Ribeirão Preto - USP, Campus Universitário Bairro Monte Alegre 14049-900, Ribeirão Preto, SP, Brazil.

The sciatic functional index (SFI) is a remarkable tool to assess dysfunction and functional recovery of the sciatic nerve of rats. Usually measured on hind foot imprints on paper, a new method is now being proposed, by direct analysis of video recorded foot sole images obtained with a treadmill-type walking belt machine functioning with gait speed control (G1). Results were compared with the SFI measured on imprints on paper (G2) and on video recorded foot sole images obtained with a static see-through runway (G3). The right sciatic nerve of 19 adult female Wistar rats was crushed by the application of a controlled load. Impressions/images obtained both preoperatively and at weekly intervals for eight consecutive postoperative weeks were digitized, stored and analyzed in a computer loaded with specific software, the SFI being automatically calculated after measuring the appropriate parameters. SFI differed significantly between G1 and G2 and G1 and G3 (p<0.05), but not between G2 and G3 (p>0.05) during the first and second postoperative weeks, nonsignificant differences (p>0.05) being observed for any comparison between groups during the third through eighth postoperative weeks. We conclude that the three methods yielded equivalent results from the third week onward, but both video recording methods (G2 and G3) permitted a more adequate early evaluation (first and second weeks), since the SFI parameters were more easily identifiable. Images obtained with the walking belt machine are more uniform and sharper, thus contributing to reduce the influence of biases observed with imprints on paper.
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http://dx.doi.org/10.1016/j.jneumeth.2010.03.005DOI Listing
May 2010

Comparative effects of wavelengths of low-power laser in regeneration of sciatic nerve in rats following crushing lesion.

Lasers Med Sci 2010 May 6;25(3):423-30. Epub 2010 Feb 6.

Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto 14049-900, SP, Brazil.

Peripheral nerves are structures that, when damaged, can result in significant motor and sensory disabilities. Several studies have used therapeutic resources with the aim of promoting early nerve regeneration, such as the use of low-power laser. However, this laser therapy does not represent a consensus regarding the methodology, thus yielding controversial conclusions. The objective of our study was to investigate, by functional evaluation, the comparative effects of low-power laser (660 nm and 830 nm) on sciatic nerve regeneration following crushing injuries. Twenty-seven Wistar rats subjected to sciatic nerve injury were divided into three groups: group sham, consisting of rats undergoing simulated irradiation; a group consisting of rats subjected to gallium-aluminum-arsenide (GaAlAs) laser at 660 nm (10 J/cm(2), 30 mW and 0.06 cm(2) beam), and another one consisting of rats subjected to GaAlAs laser at 830 nm (10 J/cm(2), 30 mW and 0.116 cm(2)). Laser was applied to the lesion for 21 days. A sciatic functional index (SFI) was used for functional evaluation prior to surgery and on days 7, 14, and 21 after surgery. Differences in SFI were found between group 660 nm and the other ones at the 14th day. One can observe that laser application at 660 nm with the parameters and methods utilised was effective in promoting early functional recovery, as indicated by the SFI, over the period evaluated.
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http://dx.doi.org/10.1007/s10103-009-0750-8DOI Listing
May 2010

Morphologic and morphometric evaluation of experimental acute crush injuries of the sciatic nerve of rats.

J Neurosci Methods 2008 Aug 1;173(2):249-58. Epub 2008 Jul 1.

The Laboratory of Microsurgery, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto School of Medicine, São Paulo University, 14049-900 Ribeirão Preto (SP), Brazil.

In order to qualify and quantify nerve fiber lesion following an acute crush injury, a morphologic and morphometric study was carried out in 25 Wistar rats divided into five groups of five animals each according to the crushing load applied, i.e., 500, 1,000, 5,000, 10,000, and 15,000 g. The injury was produced under general anesthesia on a 5mm-long intermediate segment of the right sciatic nerve for 10 min using a dead-weight machine. The animals were killed with an excessive dose of anesthetics 72 h later and submitted to perfusion with a fixing solution through the abdominal aorta immediately after death. Both the right and left sciatic nerves were removed and prepared for histologic and morphometric examinations; 5 microm-thick sections stained with 1% Toluidine blue were examined under a light microscope equipped with a video camera linked to a computer loaded with a graphic program (KS 400). The morphometric studies included measuring total number of fibers, fiber density, fiber diameter, myelin fiber area, axon diameter, axon area and G ratio. The results showed that damage to the nerve fibers began to appear as early as with the 500 g load and was similar in all groups despite the load applied, increasing with the 10,000 and 15,000 g loads, although the external supporting tissues and small diameter fibers were preserved. The predominant type of lesion produced was axonotmesis.
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http://dx.doi.org/10.1016/j.jneumeth.2008.06.019DOI Listing
August 2008

Mechanical resistance of peripheral nerve repair with biological glue and with conventional suture at different postoperative times.

J Reconstr Microsurg 2008 Jul 2;24(5):327-32. Epub 2008 Jul 2.

Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor Apparatus (Laboratory of Bioengineering), Faculty of Medicine of Ribeirão Preto, USP, Ribeirão Preto, SP, Brazil.

Regardless of its type, the repair of a peripheral nerve must ideally permit early motion of the affected limb and resist disruption by the tensile forces generated throughout the healing process and regeneration. A comparative study of the mechanical resistance of the repair of the sciatic nerve with biological glue and conventional microsurgical suture over time was undertaken in 48 rats. Both right and left sciatic nerves were exposed simultaneously and repaired at random with the glue on one side and conventional suture on the opposite side. Mechanical resistance of the repair was evaluated in situ with a universal testing machine using a hooklike accessory applied proximally to the repair site, immediately and at 7, 14, and 28 days postoperatively. A load was applied at the rate of 2 mm/min till rupture. The resistance of both types of repair significantly increased up to day 14 ( P < 0.001), and the repair with the glue was significantly less resistant than repair with conventional suture immediately postoperatively ( P < 0.001) and on day 7 ( P = 0.03). Resistance became equivalent for the two types of repair on days 14 ( P = 0.67) and 28 ( P = 0.34). The change in resistance of both types of repair with time was in accordance with the power function numeric formula.
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http://dx.doi.org/10.1055/s-2008-1080535DOI Listing
July 2008

Is the Sciatic Functional Index always reliable and reproducible?

J Neurosci Methods 2008 May 2;170(2):255-61. Epub 2008 Feb 2.

Orthopedic and Rehabilitation Postgraduation Program, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto School of Medicine, São Paulo University, Brazil.

The Sciatic Functional Index (SFI) is a quite useful tool for the evaluation of functional recovery of the sciatic nerve of rats in a number of experimental injuries and treatments. Although it is an objective method, it depends on the examiner's ability to adequately recognize and mark the previously established footprint key points, which is an entirely subjective step, thus potentially interfering with the calculations according to the mathematical formulae proposed by different authors. Thus, an interpersonal evaluation of the reproducibility of an SFI computer-aided method was carried out here to study data variability. A severe crush injury was produced on a 5 mm-long segment of the right sciatic nerve of 20 Wistar rats (a 5000 g load directly applied for 10 min) and the SFI was measured by four different examiners (an experienced one and three newcomers) preoperatively and at weekly intervals from the 1st to the 8th postoperative week. Three measurements were made for each print and the average was calculated and used for statistical analysis. The results showed that interpersonal correlation was high (0.82) in the 3rd, 4th, 5th, 7th and 8th weeks, with an unexpected but significant (p<0.01) drop in the 6th week. There was virtually no interpersonal correlation (correlation index close to 0) on the 1st and 2nd weeks, a period during which the variability between animals and examiners (p=0.24 and 0.32, respectively) was similar, certainly due to a poor definition of the footprints. The authors conclude that the SFI method studied here is only reliable from the 3rd week on after a severe lesion of the sciatic nerve of rats.
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http://dx.doi.org/10.1016/j.jneumeth.2008.01.022DOI Listing
May 2008

IFSSH Flexor Tendon Committee Report 2007.

J Hand Surg Eur Vol 2007 Jun;32(3):346-56

Hand Surgery Department, St. Andrew's Centre for Plastis Surgery, Broomfield Hospital, Chelmsford, Essex, UK.

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http://dx.doi.org/10.1016/J.JHSE.2007.03.005DOI Listing
June 2007

Can therapeutic ultrasound influence the integration of skin grafts?

Ultrasound Med Biol 2007 Sep 4;33(9):1406-12. Epub 2007 Jun 4.

Orthopedic and Rehabilitation Post-graduation Program, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto School of Medicine, São Paulo University, São Paulo, Brazil.

Therapeutic ultrasound (TUS) is a widely used coadjuvant physical means to promote biological tissue repair. In the present investigation, the influence of TUS on the integration of full-thickness skin graft was studied in rabbits. Twenty female adult rabbits were used and two 2x2-cm square full-thickness skin grafts were obtained from both scapular regions and swapped, the one cut out on the right being placed on the left and vice versa. The graft on the right was irradiated with TUS (3 MHz, 0.5 W/cm2, 5-min duration) once a day for seven consecutive days, beginning on the third postoperative day; the graft on the left was submitted to simulated irradiation. The animals were killed on the 11th day and the grafted areas were resected (graft+safety margin) for histological examination. Five-mum-thick sections were alternatively stained with Gomori's trichrome, proliferating cell nuclear antigen (PCNA) and picrosirius red and examined under the light microscope, and the epidermal and dermal areas were measured and proliferating cells and new blood vessels counted. The results showed a significant increase (p=0.007) in the number of proliferating epidermal cells (12.18% and 7.34% of the total number of cells in the irradiated and control grafts, respectively) and new blood vessels per field (p=0.0001) in the irradiated grafts (6.27 compared with 3.07). Despite the increased number of proliferating cells and blood vessels, there was no significant difference between the epidermis (246,392 microm2 and 200,626 microm2 in groups 1 and 2, respectively; p=0.07) and dermis (2,157,730 microm2 and 2,109,150 microm2 in groups 1 and 2, respectively; p=0.21) areas as a function of thickness for both groups. We conclude that TUS induces morphological alterations in biological processes, such as epidermic germinative layer cell proliferation and neoangiogenesis, which are involved in the integration of full-thickness skin grafts. This has a potential for clinical use in humans.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2007.04.002DOI Listing
September 2007