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This paper presents an update on degenerative stenosis of the lumbar spine, which is a common pathological condition among patients over the age of 65 years. The anamnesis and physical examination need to be precise, since radiography often only provides indirect signs. Magnetic resonance imaging is necessary if the symptoms persist. The treatment for lumbar stenosis is a matter of controversy. However, there seems to be some benefit from surgical treatment rather than conservative treatment, such that surgery brings improvements in symptoms and functions for a period of up to two years.

To evaluate the results obtained from treatment of humeral shaft fractures and their complications using the Osteoline® uniplanar external fixator. Methods: The radiographic and functional results from 78 patients with humeral shaft fractures treated using the uniplanar external fixation technique were retrospectively assessed. The patients' ages ranged from 23 to 71 years, with a mean of 47 years. Male patients predominated (79%). Out of the 78 patients, 45 presented open fractures, 14 presented pseudarthrosis and six presented synthesis failure. There were no losses during the follow-up and all the patients were discharged after fracture consolidation and functional recovery. The results were evaluated based on the studies by Catagni, as good, fair or poor. Results: Fracture consolidation was observed in 98% of the cases treated with uniplanar external fixation. Only one pseudarthrosis case required conversion to rigid internal fixation and autologous bone grafting. At the end of the treatment, all the patients were discharged with consolidated fractures, without pain, and good limb function. Conclusion: The external fixation described in this paper was shown to be an efficient and safe method for treating humeral shaft fractures and their complications. It preserved the local biological status and enabled passive and active movement immediately after surgery.

Artigos que correlacionam achados clínicos e eletrofisiológicos da lesão do nervo ulnar no punho são incomuns na literatura, se comparados com lesões no cotovelo. Apresentamos o caso de um paciente com atrofia da musculatura intrínseca da mão, secundária à lesão exclusiva do ramo motor do nervo ulnar, localizada no canal de Guyon, próxima ao gancho do hamato. Revisamos aspectos anatômicos, clínicos, neurofisiológicos da lesão do nervo ulnar, de localização distal e enfatizamos a importância da abordagem multidisciplinar. Especificamente relacionado ao mecanismo de lesão do paciente (cabo de guerra), não encontramos casos semelhantes na literatura e alertamos quanto aos riscos durante o treinamento físico militar. _______________________________________________________________________________ ABSTRACT Papers correlating clinical and electrophysiological findings relating to ulnar nerve lesions in the wrist are uncommon in the literature, if compared with elbow injuries. We present the case of a patient with atrophy of the intrinsic musculature of the hand, secondary to injury only of the motor branch of the ulnar nerve, which is located in Guyon's canal close to the hamate hook. We review the anatomical, clinical and neurophysiological aspects of distal ulnar nerve injuries and we emphasize the importance of multidisciplinary approaches. Specifically in relation to the mechanism of injury of this patient (tug-of-war), we did not find any similar cases in the literature. We issue an alert regarding the risks during military physical training.

This case report presents a 15-year-old football player who was diagnosed with a pubis stress fracture and underwent conservative treatment with satisfactory results. After a review of the literature, the clinical picture, diagnosis and treatment are described. The importance of this paper comes from the rarity of finding reports about this kind of injury in the literature.

Hyaline cartilage covers joint surfaces and plays an important role in reducing friction and mechanical loading on synovial joints such as the knee. This tissue is not supplied with blood vessels, nerves or lymphatic circulation, which may be one of the reasons why joint cartilage has such poor capacity for healing. Chondral lesions that reach the subchondral bone (osteochondral lesions) do not heal and may progress to arthrosis with the passage of time. In young patients, treatment of chondral defects of the knee is still a challenge, especially in lesions larger than 4 cm. One option for treating these patients is autologous chondrocyte transplantation/implantation. Because this treatment does not violate the subchondral bone and repairs the defect with tissue similar to hyaline cartilage, it has the theoretical advantage of being more biological, and mechanically superior, compared with other techniques. In this paper, we describe our experience with autologous chondrocyte transplantation/implantation at the Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of Sâo Paulo, through a report on three cases.

Bone banks are necessary for providing biological material for a series of orthopedic procedures. The growing need for musculoskeletal tissues for transplantation has been due to the development of new surgical techniques, and this has led to a situation in which a variety of hospital services have been willing to have their own source of tissue for transplantation. To increase the safety of transplanted tissues, standards for bone bank operation have been imposed by the government, which has limited the number of authorized institutions. The good performance in a bone bank depends on strict control over all stages, including: formation of well-trained harvesting teams; donor selection; conducting various tests on the tissues obtained; and strict control over the processing techniques used. Combination of these factors enables greater scope of use and numbers of recipient patients, while the incidence of tissue contamination becomes statistically insignificant, and there is traceability between donors and recipients. This paper describes technical considerations relating to how a bone bank functions, the use of grafts and orthopedic applications, the ethical issues and the main obstacles encountered.

The Louisville VCA (Vascularized Composite Allograft) Program is one of the largest hand transplant programs in the world. During my hand surgery fellowship at the Christine M. Kleinert Institute, the team performed the eighth hand transplant on the seventh recipient in Louisville. The Louisville VCA Program has done 9 hand transplants in 8 recipients with one bilateral case. Among these are the first 5 hand transplant cases in the United States. The first case was done in 1999 and has the World's longest follow-up. The seventh case was performed in a 36-year-old male on July 10, 2011. The result achieved so far can be considered excellent with a very good patient satisfaction. There is a large multidisciplinary team involved in such procedures with all members playing a crucial role for the achievement of the best result possible. The present paper focuses on the surgical procedure for the seventh recipient, which was unique due to the level of amputation of the recipient's hand, with preservation of nerve to the thumb.

Legg-Calve-Perthes disease (LCPD) started to be studied 100 years ago (1910), thanks to the advent of the possibility of conducting clinical studies by means of radiographic images (1895). However, many questions remain open, both in relation to the etiology of this orthopedic condition and in relation to which therapeutic measures are valid. Thus, great controversy has been generated. In 1910, three studies were published, respectively by A. Legg, J. Calve and G. Perthes. These studies described a new condition affecting children's hips that differed from joint tuberculosis, which was the commonest disease found at that time. Calve (1875-1954) worked at the “Berck Sur Mer” hospital, which was the biggest specialized tuberculosis service in France. In 1898, he acquired an X-ray machine and, using this, he identified 10 patients with the new disease, which he named pseudo-coxalgia. In turn, working in Leipzig, Germany, Perthes (1869-1927) was one of the first surgeons to use radiographs in his country, and he defined six clinical cases of a condition that he named “juvenile deforming arthritis”, which differed from tuberculosis of the hip. In the same year, in Boston, United States, the Harvard graduate Legg (1874-1939) described a new condition in a study on “an obscure hip condition”. Since then, over all the intervening years, around 2000 studies on this topic have been published. Some techniques and concepts have been described both for conservative treatment and for surgical treatment. The incidence of LCPD is around 15 cases per 100,000 individuals, and it is more common in boys than in girls, with a ratio of 5:1. The disease is very rare among Afrodescendent and Chinese individuals. It is interesting to note that its incidence is greater among individuals of poorer social class: 26 per 100,000 in class 5 versus 4 per 100,000 in class 1. What is known in relation to its etiology? The etiology continues to be obscure, with occurrences of disorders of the arterial circulation or the venous drainage of the growing femoral head, or both of these. Trueta (1949) attributed the cause of the necrosis to closure of the epiphyseal vessels located in the posterosuperior region of the hip, thus demonstrating that in children aged four to seven years, the only source of blood supply to the proximal femoral epiphysis is the lateral epiphyseal vessels. Trauma or inflammatory processes affecting these vessels, with consequent obstruction, may lead to LCPD. Camargo et al (1984) and Godoy Jr. (1988) demonstrated through selective angiographic studies on deep arteries that patients with LCPD present partial or total occlusion of the medial circumflex artery of the affected hips, which may make the proximal femoral epiphysis susceptible to ischemia within the age group from four to eight years. Dr. Robert Salter made an especially large contribution towards the anatomopathology of this condition through an experimental model in pigs. However, there is no reason to question the hypothesis that LCPD is caused by ischemia of the epiphysis. A deficit in the venous drainage of the hip may also occur. Hence, the etiopathology of this disease may be explained thus: 1) at birth, the child carries vascular abnormalities that are probably of genetic origin; 2) with the passage of time, the child develops abnormalities of skeletal growth and bone maturation; and 3) within the age group from four to eight years, when the epiphysis is most susceptible to ischemia, because of the vascular pattern in this age group, the process could be triggered by a factor capable of breaking down the precarious circulatory equilibrium that had been maintained until that time. This triggering factor could be: trauma to the joint, thereby causing arterial and/or venous obstruction; an episode of traumatic or inflammatory synovitis (due to a distant infectious focus), thus producing arterial and/or venous plugging and obstruction; or fractures due to stress or pathological conditions in the epiphysis, thereby interrupting the blood irrigation to a greater or lesser degree. The vascular abnormalities seen in LCPD consist of diminished vascularization on the affected side or absence of the medial circumflex artery, or alternatively, presence of an atrophied medial circumflex artery or one with obstructions in its distal branches. Dimeglio (1995) advocated these ideas in relation to delayed development of the hip joint, occurrences of local microtrauma and vascular abnormalities. Research and papers on this topic in Brazil go back more than 50 years. In 1957, Prof. Flavio Pires de Camargo published the results from an original study on so-called “bone grafting through inversion” which produced satisfactory surgical treatment for LCPD. His study showed the possibility for “biological” treatment, in which vascularization of the proximal femoral epiphysis would be stimulated based on theories put forward by Trueta, who had studied and investigated bone tissue circulation. Thus, Camargo proposed that revascularization of the femoral neck could be achieved using an inverted bone graft and through stimulating the formation of collateral vessels that would undergo anastomosis with the epiphyseal vessels. What is known about the treatment? The aim in treating LCPD is always to improve hip mobility and the anatomical relationship between the femoral head and the acetabulum, in an attempt to diminish the deleterious effect of the disease on the joint. Precise indication of the best type of treatment is sometimes difficult. The treatment ranges from clinical and radiographic follow-up of the child, to conservative treatment consisting of the use of traction, orthopedic braces or plaster casts for hip abduction; and to operative treatment when the criteria that have been defined allow such indications. Operative treatment is indicated primarily in the initial phases of LCPD and is based on two distinct recommended approaches: proximal femoral osteotomy for varization and derotation; or osteotomy on the iliac bone, in the innominate region of the bone. Both of these osteotomy procedures have the aim of improving the cover of the compromised femoral head. Several studies have compared the femoral and iliac osteotomy techniques, and it has been demonstrated that the results regarding the shape and containment of the femoral head are similar, thereby increasing the polemic about this issue. Cordeiro (1972, 1980) analyzed the role of intertrochanteric femoral osteotomy as a “mechanical and biological” operative treatment method for LCPD and showed that around 60% of the results were satisfactory. Guarniero et al (1995, 1997) published new analyses on the results from femoral osteotomy procedures and showed that 65% of the results were satisfactory. Rossi (1995) suggested an easier technique for performing the osteotomy. Teloken (1992) followed up 31 patients who had been treated by means of Salter acetabular osteotomy and concluded that the normal duration of the fragmentation phase of the disease became shortened, which could be explained by the increased blood flow to the femoral head that the surgery promoted, through an increase in the collateral vascular network going to the epiphysis. In a study conducted in 1993, Kuwajima found that the time taken for evolution from the necrosis stage to fragmentation decreased when Salter osteotomy was performed, with an increase in the vascularization of the epiphysis. What would the role of arthrodiastasis using an external fixator consist of in cases of LCPD? According to the studies and investigations conducted in our orthopedics service since 1991, we can affirm that arthrodiastasis using a monolateral external fixator applied to the hip, with or without articulation, promotes acceleration of the reossification of the femoral head and induces improvement of the degree of joint mobility. This procedure is indicated in the necrosis and fragmentation phases of LCPD. The prognostic factors involved in this disease include: the patient's age at the time of disease onset; the extent to which the femoral epiphysis is compromised; presence of two or more so-called “radiographic signs of a head at risk” (as described by Catterall); the height of the lateral pillar (Herring classification); and premature closure of the epiphyseal growth plate. It can be concluded from reviewing the recently published studies that the treatment used for LCPD is based much more on the orthopedist's personal experience than on truly scientific foundations. Additional prospective studies are needed in order to deepen our knowledge about different results from orthopedic treatment. There is also a need for guidelines and protocols, in order to ensure uniformity between the different types of therapeutic possibility.