Publications by authors named "Nilton Mazzer"

39 Publications

Devitalized Autograft Associated with the Vascularized Fibula Graft: Irradiation versus Freezing Methods.

J Reconstr Microsurg 2021 Feb 25. Epub 2021 Feb 25.

Orthopedic Oncologic Division of Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil.

Background:  Among the alternatives for the management of malignant bone tumors is the "devitalized autograft associated with vascularized fibula graft." The devitalization process is achieved by pasteurization, irradiation, or freezing. The combination of these grafts has been broadly researched for more than 25 years. However, there is no research currently published comparing the various methods or their respective outcomes.

Methods:  A retrospective study was compiled of 26 devitalized autografts associated with vascularized fibula performed to limb salvage of malignant bone tumors. They were divided into two groups according to the devitalization method: either freezing (12 procedures) or irradiation (14 procedures). Clinical, radiographic, and scintigraphic results were assessed at least 24 months after surgery.

Results:  The union rates reached 83.3% in the freezing group and 92.8% in the irradiated group but did not express different outcomes. Scintigraphic viability was observed in all the grafts that achieved radiographic union (Mann-Whitney -test:  = 0.005). Three patients had nonunion, with only one having no viability in the scintigraphy (Mann-Whitney -test:  = 0.001). There was no malignant recurrence in the autograft, only in surrounding soft tissues. Local recurrence was statistically higher in larger tumors (Mann-Whitney -test:  = 0.025).

Conclusion:  Both groups presented similar union rates and are considered safe to devitalize bone graft despite different outcomes observed. The survivor rates observed could be limited by the existence of the techniques.
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http://dx.doi.org/10.1055/s-0041-1724127DOI Listing
February 2021

Reliability, validity and responsiveness of Brazilian version of QuickDASH.

Musculoskelet Sci Pract 2020 08 5;48:102163. Epub 2020 Apr 5.

Department of Health Sciences - Post Graduation Program in Rehabilitation and Functional Performance, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil. Electronic address:

Objective: To analyse the construct validity, test-retest reliability and responsiveness of the Brazilian version of Quick-DASH (QD-Br) in patients with upper limb disorders.

Method: Participants completed the full Brazilian DASH, the QD-Br and the SF-12 Brazil questionnaires at the beginning of treatment, after 48-72h and the after 2-12 months. Construct validity was analysed by Pearson's correlation coefficient (r). To evaluate the test-retest reliability we used the Intraclass Correlation Coefficient (ICC) and the Cronbach's alpha coefficient to test the internal consistency. Responsiveness was analysed by Standardized Response Mean (SRM) and Effect Size (ES). The Minimal detectable change (MDC) score was based upon calculations of the standard error of measurement (SEM), confidence interval of 95%.

Results: The construct validity presented strong direct correlation with the total QD-Br score and the Brazilian DASH (r = 0.91), a moderate inverse correlation between the total QD-Br score and the physical component of the SF- 12 Brazil (r = -0.55) and weak inverse correlation between the QD-Br and the mental component of SF-12 Brazil (r = -0.49). The ICC test-retest showed good reliability of 0.81 (0.72-0.87). QD-BR presented high responsiveness, with ES of 1.06 and SRM of 0.94. The MDC was 17.27 points.

Conclusion: These results provide evidence that the QD-Br was a valid, reliable and responsive instrument when utilized in patients with upper limb traumatic and no-traumatic disorders in the Brazilian population.
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http://dx.doi.org/10.1016/j.msksp.2020.102163DOI Listing
August 2020

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

WRIST ARTHROSCOPY: BASIC TIPS FOR DRY ARTHROSCOPIC EXPLORATION.

Acta Ortop Bras 2017 Nov-Dec;25(6):291-294

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

Objective: This article provides details and tips on the dry arthroscopic technique, based on our experience and its clinical applications.

Method: The technique was applied to 65 patients (33 men and 32 women) aged between 20 and 62 years (average of 35.4 years) for treating: synovial cyst resection, scapholunate ligament injury repair, ulnocarpal impact correction, triangular fibrocartilage injury repair, and assisted reduction of distal radius fractures.

Results: A minimally invasive intra-articular evaluation has been observed as a benefit, with low infection rate, small scars, and high rates of early recovery, without affecting intra-articular fluid use, reducing the risk of compartment syndrome and infiltrated soft tissues, in the case of need for associated open surgery. As for the difficulties, we report the surgeon's view, which is commonly prevented by optical blurring or debris that hit the lens, and the need for radiofrequency care, since the heat generated is dissipated with greater difficulty than in the classical technique.

Conclusion: Dry arthroscopy emerges as an effective choice to treat wrist pathologies, however, deep knowledge and ease with the classical technique, as well as a learning curve, are key to obtain a good outcome.
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http://dx.doi.org/10.1590/1413-785220172506160670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782867PMC
January 2018

Leprosy with ulnar nerve abscess: ultrasound findings in a child.

Skeletal Radiol 2017 Jan 27;46(1):137-140. Epub 2016 Oct 27.

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

We report the ultrasound findings of a typical case of nerve abscess due to leprosy in an 11-year-old boy. The patient had previously undergone pediatric multibacillary leprosy multidrug therapy (MDT) in accordance with World Health Organization guidelines. He presented to our service with bilateral ulnar neuritis with no response to prednisone (1 mg/kg). Right ulnar nerve ultrasound revealed nerve hypoechogenicity, fascicular pattern disorganization, marked fusiform thickening, and a round anechoic area suggestive of intraneural abscess. Intense intraneural power Doppler signal was detected, indicating active neuritis. Intravenous methylprednisolone had a poor response and the patient was submitted to ulnar nerve decompression, which confirmed nerve abscess with purulent discharge during surgery. As the patient weighed more than 40 kg, treatment with a pediatric dose was considered insufficient and adult-dose MDT was prescribed, with improvement of nerve pain and function. Although leprosy is rare in developed countries, it still exists in the USA and it is endemic in many developing countries. Leprosy neuropathy is responsible for the most serious complications of the disease, which can lead to irreversible impairments and deformities. Nerve abscess is an uncommon complication of leprosy and ultrasound can efficiently demonstrate this condition, allowing for prompt treatment. There is scant literature about the imaging findings of nerve abscess in leprosy patients. Radiologists should suspect leprosy in patients with no other known causes of neuropathy when detecting asymmetric nerve enlargement and nerve abscess on ultrasound.
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http://dx.doi.org/10.1007/s00256-016-2517-1DOI Listing
January 2017

Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy.

Radiol Bras 2016 May-Jun;49(3):144-9

Associate Professor of Radiology, Division of Radiology, Internal Medicine Department, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.

Objective: To assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders.

Materials And Methods: We conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed.

Results: The mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6º, versus +1.6º for the normal, contralateral limbs.

Conclusion: The main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head.
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http://dx.doi.org/10.1590/0100-3984.2015.0039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938443PMC
July 2016

TREATMENT OF SCAPHOID NONUNION WITH OLECRANON BONE GRAFT AND COMPRESSION SCREW.

Acta Ortop Bras 2016 May-Jun;24(3):159-63

. Hospital Lifecenter, Belo Horizonte, MG, Brazil.

Objective: To evaluate the outcome of olecranon bone graft and compression screw for the treatment of nonunion of the Lichtman type I scaphoid.

Method: We evaluated 15 patients of 32 who underwent surgical treatment for nonunion of the Lichtman type I scaphoid with olecranon bone graft and screw compression.

Results: We obtained 100% consolidation in our sample. The mean flexion of the wrist on the affected side was 68° and 75° on the non-affected side. The average extension was 63° and 72°, respectively. The average grip strength was 35 kgf. This corresponds to 98% of the handgrip strength of the non-affected side, which was 37 kgf. The DASH score averaged 5 points.

Conclusion: We believe that the use of bone graft obtained from the olecranon and secured with cannulated screw is a resolute technique for cases of linear nonunion of the Lichtmann type I scaphoid. It has the advantages of a new anesthesia for removal of the graft and the access is easy, providing a good exposure for removal and good aesthetic results. Level of evidence IV. Case series.
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http://dx.doi.org/10.1590/1413-785220162403155935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863866PMC
July 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

Efficacy of low-level laser therapy associated to orthoses for patients with carpal tunnel syndrome: A randomized single-blinded controlled trial.

J Back Musculoskelet Rehabil 2016 Aug;29(3):459-66

School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.

Objective: Compare the efficacy of orthoses and patient education with and without the addition to Low-Level Laser Therapy (LLLT - 660 nm, 30 mW, a continuous regime and bean area of 0.06 cm2). The laser irradiation was delivered with the fluency of 10J/cm2 in patients with mild and moderate Carpal Tunnel Syndrome (CTS).

Methods: 48 patients were randomized and 30 finished the protocol (a sample loss of 37.5%), 90% female and 10% males. Randomization was applied to allocate the patients in each one of the groups, with association or not to LLLT (group orthoses or LLLT and orthoses). All of them were submitted to ergonomic home orientations. The short-term symptoms and function outcome were assessed through: Boston Carpal Tunnel Questionnaire (BCTQ) - Severity of Symptoms (SS) Functional Score (FS). Pain (VAS), Semmes-Weinstein monofilaments, 2PD and pinch strength was used for characterization of the sample. Most of the participants were women, over 4th decade enrolled on heavy hand duties occupations, right-handed, 66.7% affected on dominant hand, without alterations in sensory median nerve thresholds or pinch strength.

Results: Both groups showed a reduction of total BCTQ score and its subdomains after six weeks, with significant difference (p< 0.05), comparing to baseline. No significant difference was found between groups. A Minimal clinical change was observed after the intervention in 92.3% of participants for BCTQ subdomain severity of symptoms at individual comparison for LLLT and orthoses group and 76.5% for the orthoses group, demonstrating clinical relevance. Effect size Cohen's index was moderate for the severity of symptoms.

Conclusion: LLLT in association to orthoses and ergonomic orientation seems to be effective in short-term symptoms relieve for patients with mild and moderate CTS.
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http://dx.doi.org/10.3233/BMR-150640DOI Listing
August 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

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

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

Assessment of functional recovery of sciatic nerve in rats submitted to low-level laser therapy with different fluences. An experimental study: laser in functional recovery in rats.

J Hand Microsurg 2013 Dec 25;5(2):49-53. Epub 2013 Apr 25.

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

Peripheral nerve lesions caused sensory and motor deficits along the distribution of the injured nerve. Numerous researches have been carried out to enhance and/or accelerate the recovery of such lesions. The objective of this study was to assess the functional recovery of sciatic nerve in rats subjected to different fluences of low-level laser therapy (LLLT). Thirty-six animals were randomly divided into four groups: one consisting of sham rats and three others irradiated with progressive fluencies of 10 J/cm(2), 40 J/cm(2) and 80 J/cm(2) of laser AsGaAl (830 nm) for 21 consecutive days. They were evaluated by the Sciatic Functional Index (SFI) method. The crush injury was performed by using a portable device with dead weight of 5,000 g whose load was applied for 10 min. A digital camera was used to record the footprints left on the acrylic track, before surgery and after, on the 7th, 14th, and 21st days. The results also showed that on the 7th day, there was a difference between the groups irradiated with 40 J/cm(2), when compared with the sham group (p < 0.05). On the 14th day the groups irradiated with 40 J/cm(2) and 80 J/cm(2) also presented better results when compared with sham, however, on the 21st day, no inter-group difference was found (p > 0.05). It was possible to observe that the LLLT at fluency of 40 J/cm(2) and 80 J/cm(2) had a positive influence on the acceleration of the functional nerve recovery.
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http://dx.doi.org/10.1007/s12593-013-0096-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827659PMC
December 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

Should we think about wrist extensor after flexor tendon repair?

SAGE Open Med 2013 24;1:2050312113494974. Epub 2013 Jul 24.

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

Objective: To evaluate the activity of wrist extensor muscle, correlating with wrist motion during gripping after flexor tendon repair.

Design: Cross-sectional clinical measurement study.

Setting: Laboratory for biomechanics and rehabilitation.

Subjects: A total of 11 patients submitted to rehabilitation by early passive motion of the fingers with wrist flexion position were evaluated after 8 weeks of fingers flexor tendon repair and 11 healthy volunteers, all ranging from 20 to 37 years of age.

Intervention: Volunteers performed an isometric standardized gripping task.

Main Measures: We used electrogoniometry to analyze wrist range of motion and surface electromyography, considering 100% maximum voluntary contraction to represent the amplitude of electromyographic activity of the extensor carpi radialis and flexor digitorum superficialis.

Results: Patients with flexor tendon repair showed co-activation deficit between wrist extensor (extensor carpi radialis) and flexor finger muscles (flexor digitorum superficialis) during gripping in the intermediate phase of rehabilitation, despite some recovering mobility for wrist extension (p ≤ 0.05). A moderate correlation between range of motion and extensor carpi radialis was present only for injured group (r = 0.32). Total active motion score, which represents finger active excursion, was regular or poor in 65% of cases, all with nerve repair associated.

Conclusion: Wrist extensors have an important synergist role at handgrip, although some imbalance can be present after flexor tendon repair. These preliminary findings suggest that emphasis could be directed to add synergistic wrist motion in rehabilitation protocols after flexor tendon repair. Future studies with early active rehabilitation are necessary.
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http://dx.doi.org/10.1177/2050312113494974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4687777PMC
January 2016

Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial.

BMC Musculoskelet Disord 2012 Dec 13;13:248. Epub 2012 Dec 13.

Rehabilitation and Functional Performance Program, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900 Ribeirão Preto, SP CEP 14049-900, Brasil.

Background: Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome.

Methods/design: Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test.

Discussion: This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome.

Trial Registration: Brazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184.
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http://dx.doi.org/10.1186/1471-2474-13-248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3552983PMC
December 2012

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

High voltage pulsed current stimulation of the sciatic nerve in rats: analysis by the SFI.

Acta Ortop Bras 2012 ;20(2):93-7

Postdoctoral Course of the School of Medicine of Ribeirão Preto of Universidade de São Paulo - São Paulo, Brazil.

Objective: To analyze the efficiency of high voltage pulsed current (HVPC) with early application in three different sites, in the regeneration of the sciatic nerve in rats submitted to crush injury, the sciatic functional index (SFI) was used to assess the functional recovery.

Methods: After crushing of the nerve, 57 animals were submitted to cathodal HVPC at frequency of 50Hz and voltage of 100V, 20 minutes per day, 5 days per week. The rats were divided into five groups: control group; ganglion group; ganglion + muscle group; muscle group; and sham group. The SFI was determined weekly for seven weeks, from the preoperative period to the 6(th) postoperative week.

Results: Compared with the control group, the results showed a significantly better performance of group 2 for the first 3 weeks; group 3 showed significantly better performance in the third week; and group 4 showed a significantly negative performance during the 4(th) and 6(th) weeks.

Conclusion: Early application of HVPC had a positive effect in the treatment of the spinal cord region and the sciatic nerve root ganglion with a dispersive electrode on the contralateral lumbar region or on the gastrocnemius. However, HVPC had a negative effect in the treatment with an active electrode on the gastrocnemius and a dispersive electrode on the contralateral thigh. Level of evidence II, Prospective comparative study.
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http://dx.doi.org/10.1590/S1413-78522012000200007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718424PMC
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

Microscopic evidences that bone marrow mononuclear cell treatment improves sciatic nerve regeneration after neurorrhaphy.

Microsc Res Tech 2011 Apr 23;74(4):355-63. Epub 2010 Aug 23.

Department of Orthopaedics and Traumatology, Famerp/Funfarme, São José Rio Preto, SP, Brazil.

Cell therapy constitutes a possibility for improving nerve regeneration, increasing the success of nerve repair. We evaluate the use of mononuclear cells in the regeneration of the sciatic nerve after axotomy followed by end-to-end neurorrhaphy. Forty adult male Wistar rats (250-300 g) were divided into four groups: (1) sham, (2) neurorrhaphy: the sciatic nerve was sectioned and repaired using epineural sutures, (3) culture medium: after the suture, received an injection of 10 μL of culture medium into the nerve, and (4) mononuclear cell: after the suture, a concentration of 3 × 10(6) of mononuclear cell was injected in epineurium region. Mononuclear cells were obtained from the bone marrow aspirates and separated by Ficoll-Hypaque method. The histological analyses were performed at the 4th postoperative day. The sciatic functional index, histological, and morphometric analyzes were used to evaluate nerve regeneration at the 6th postoperative week. Six rats were used for immunohistochemical analysis on the 4th postoperative day. In the group 4, on the fourth day, the histological analysis demonstrated a more accelerated degenerative process and an increase of the neurotrophic factors was observed. In the 6th week, all the morphometric results of the group 4 were statistically better compared with groups 2 and 3. There was a statistically significant improvement in the sciatic functional index for group 4 compared with groups 2 and 3. Mononuclear cells stimulated nerve regeneration, most probably by speeding up the Wallerian degeneration process as well as stimulating the synthesis of neurotrophic factors.
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http://dx.doi.org/10.1002/jemt.20916DOI Listing
April 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