Association of adductor pollicis muscle thickness and anthropometric indicators in community older adults / Associação da espessura do músculo adutor do polegar e indicadores antropométricos em idosos da comunidade

INTRODUCTION: The measurement of the adductor pollicis muscle thickness (APMT) has been investigated as an index for muscle mass and undernutrition. OBJECTIVE: However, there are few studies related to community-living older adults. METHODS: Cross-sectional study carried out with community-dwelling older adults, of both sexes. The APMT, the body mass index (BMI), arm circumference (AC), arm muscle circumference (AMC), and calf circumference (CC) were evaluated. For APMT classification, the 25th percentile value (P25 ≤9 mm) of the sample was considered to identify muscle mass deficit. Chi-square test, Pearson's correlation, and Poisson regression were performed, with a significance level of p<0.05. RESULTS: Among men, APMT showed a correlation with AC (r=0.350; p<0.01), and among women it was with BMI (r=0.337; p=0.01). There was an association between the BMI classification and the APMT percentile (p=0.020). Older adults with BMI<23 kg/m² were 1.28 times more likely to have APMT≤P25 (p=0.007) and older adults with adequate BMI were 1.23 times more likely (p=0.023). Older adults with reduced CC have a 1.18 times more chance of presenting APMT≤P25 (p=0.064). CONCLUSION: APMT has been associated with BMI in older adults, proving to be a good parameter for the assessment of malnutrition.

INTRODUÇÃO: A espessura do músculo adutor do polegar (EMAP) tem sido sugerido como um índice de massa muscular e desnutrição. OBJETIVO: Verificar a associação da EMAP com indicadores antropométricos convencionais em idosos da comunidade. MÉTODOS: Estudo transversal realizado com 159 idosos da comunidade, de ambos os sexos, com média de idade de 70,9±29,4 anos. Foram avaliados a EMAP, o índice de massa corporal (IMC), as circunferências do braço (CB), muscular do braço (CMB) e da panturrilha (CP). Para classificação da EMAP se considerou o valor do percentil 25 (P25≤9 mm) da amostra para identificar déficit de massa muscular. Teste Qui-quadrado, Correlação de Pearson e Regressão de Poisson foram realizados, sendo adotado um nível de significância de p<0,05. RESULTADOS: Entre os homens, a EMAP apresentou correlação com a CB (r=0,350; p<0,01) e entre as mulheres foi com o IMC (r=0,337; p=0,01). Houve associação entre a classificação do IMC e o percentil da EMAP (p=0,020). Os idosos com IMC<23 kg/m² tinham 1,28 vezes mais chances de possuir EMAP≤P25 (p=0,007) e idosos com IMC adequado tinham 1,23 vezes mais chance (p=0,023). Idosos com CP reduzido apresentaram 1,18 vezes mais chance de apresentar EMAP≤P25 (p=0,064). Conclusão: A EMAP apresentou associação com o IMC em idosos, demostrando ser um bom parâmetro para a avaliação da desnutrição.

Ergonomics in digestive endoscopy: Prevalence, types of musculoskeletal disorders, and risk factors in endoscopists in Colombia / Ergonomía en endoscopia digestiva: prevalencia, tipos de trastornos musculoesqueléticos y factores de riesgo en endoscopistas de Colombia

Abstract Introduction: The practice of digestive endoscopy is a physically demanding activity, with musculoskeletal disorders present in 39 % to 89 % of endoscopists, associated with "excessive use" maneuvers. Due to a lack of knowledge of this problem in endoscopists in Colombia, the main objective is to determine the prevalence, types, and risk factors of musculoskeletal disorders in specialists and graduate students. The secondary objective is to identify the occupational impact, treatments used, and importance of prevention and education in ergonomics. Materials and methods: Analytical cross-sectional observational study. Electronic survey methodology, open from June 1 to 30, 2021. Purposive sampling of 450 endoscopists from four scientific associations and eleven graduate programs, including 50 questions in six groups according to the objectives. We validated 203 responses, with 131 confirmations of musculoskeletal disorders, the group on which the analysis was performed. Results: Global prevalence of musculoskeletal disorders of 64.5 % and prevalence in graduate students of 58.6 %. There was more significant involvement of the upper limbs (right shoulder, left thumb, right elbow), followed by lower back, neck, knees, and hips. Graduate students reported pain in the right hand/fingers (right thumb) and the lower back. There was no significant difference due to work factors, but there was a tendency for more reports when increasing the volume of procedures and years of professional practice. The labor impact showed 78 % absenteeism. The most used treatments were medication, physiotherapy, and rest; 93.8 % had not received ergonomic education. However, there is a positive perception (74.1 % to 90.9 %) of receiving formal training. Discussion: The prevalence reflected the health and safety problem for the endoscopist. Demographic risk factors plus those of the endoscopic practice give rise to an individualized risk framework that enables endoscopists to understand learning and training as a way to prevent musculoskeletal disorders in themselves and their work team.

Resumen Introducción: la práctica de la endoscopia digestiva es una actividad físicamente exigente, con trastornos musculoesqueléticos presentes en el 39 % a 89 %, asociados con maniobras de "uso excesivo". Debido al desconocimiento de este problema en endoscopistas de Colombia, el objetivo principal fue determinar la prevalencia, tipos y factores de riesgo del trastorno musculoesquelético en especialistas y estudiantes de posgrado. El objetivo secundario fue identificar el impacto laboral, los tratamientos utilizados y la importancia atribuida a la prevención y educación en ergonomía. Metodología: estudio observacional de corte transversal analítico. Metodología de encuesta electrónica, abierta del 1 al 30 de junio de 2021. Muestreo intencionado a 450 endoscopistas de 4 asociaciones científicas y 11 programas de posgrado, en el que se incluyeron 50 preguntas en 6 grupos según los objetivos. Se validaron 203 respuestas, con 131 confirmaciones de trastornos musculoesqueléticos, grupo al cual se le realizó el análisis. Resultados: prevalencia global de trastornos musculoesqueléticos de 64,5 % y prevalencia en estudiantes de posgrado de 58,6 %. Hubo mayor afectación de miembros superiores (hombro derecho, pulgar izquierdo, codo derecho); luego, en la espalda baja y cuello; y en las rodillas y caderas. En estudiantes de posgrado se registró dolor en la mano-dedos derechos (pulgar derecho) y en la espalda baja. No hubo diferencia significativa por aspectos laborales, pero hubo tendencia a un mayor reporte al aumentar el volumen de procedimientos y años de práctica profesional. El impacto laboral mostró 78 % de ausentismo laboral. Los tratamientos más empleados fueron medicamentos, fisioterapia y reposo. El 93,8 % no había recibido capacitación ergonómica y hay percepción positiva (74,1 % a 90,9 %) de recibir una didáctica formal. Discusión: la prevalencia evidenció el problema de salud y seguridad para el endoscopista. Los factores de riesgo demográficos más los propios de la práctica endoscópica generan un marco de riesgo individualizado que le permite al endoscopista entender el aprendizaje y la capacitación para prevenir trastornos musculoesqueléticos en sí mismo y su equipo de trabajo.

Síndrome de Rubinstein ­ Taybi: características fenotípicas, reporte de caso / Rubinstein - Taybi syndrome: phenotypic characteristics, case report / Síndrome de Rubinstein - Taybi: características fenotípicas, relato de caso

Introducción: El síndrome de Rubinstein ­ Taybi es una patología de origen genético que afecta a 1 de cada 100.000 a 125.000 nacidos vivos, se caracteriza por presentar: retraso en el crecimiento, retraso en el desarrollo psicomotriz y anomalías morfológicas que incluyen: rasgos faciales peculiares (cejas arqueadas y gruesas, fisuras palpebrales inclinadas hacia abajo, puente nasal convexo con punta de la nariz por debajo de las alas), pulgares y hallux anchos. Su origen epigenético en el 60% de los casos se debe a una alteración en el gen CREBBP (codificador de la proteína CPB), en el 10% a un cambio en el gen EP300 (codificador de la proteína p300) y en el 30% no se han logrado identificar su causa. Caso clínico: Niño de 8 años de edad con retardo en el desarrollo psicomotriz, con dificultades para la adaptación escolar. Al examen físico con rasgos faciales: cejas superpobladas y arqueadas, hirsutismo en frente y región de labio superior, fisuras palpebrales inclinadas hacia abajo, hipertelorismo con estrabismo convergente, puente nasal ancho, nariz achatada, la punta se extiende levemente por debajo de las alas nasales. Con hirsutismo en región cervical e interescapular. En las manos se identifica dedos pulgares anchos, en el resto de dedos se evidencian falanges distales ensanchadas, de igual forma en la región de los pies se identifican hallux anchos y falanges distales ensanchadas. Evolución: El paciente sigue en observación por consulta externa, fue enviado a programas de terapia de lenguaje, lectura y psicomotriz. No ha desarrollado infecciones pulmonares hasta el cierre del seguimiento, 6 meses posteriores al diagnóstico. Conclusión: En presente caso reporta las alteraciones fenotípicas características faciales y de extremidades de un niño con síndrome de Rubinstein-Taybi, las cuales ayudaron al diagnóstico clínico.

Introduction: Rubinstein-Taybi syndrome is a pathology of genetic origin that affects 1 out of every 100,000 to 125,000 live births, it is characterized by: growth retardation, delay in psy-chomotor development and morphological abnormalities that include: peculiar facial features (thick arched eyebrows, downward sloping palpebral fissures, convex nasal bridge with tip of nose below wings), broad thumbs and hallux. Its epigenetic origin in 60% of cases is due to an alteration in the CREBBP gene (coding for CPB protein), in 10% to a change in the EP300 gene (coding for p300 protein) and in the 30% have not been able to identify its cause. Clinical case: 8-year-old boy with a delay in psychomotor development, with difficulties in adapting to school. On physical examination with facial features: overpopulated and arched eyebrows, hirsutism in the forehead and upper lip region, downward sloping palpebral fissures, hypertelorism with convergent strabismus, wide nasal bridge, flattened nose, the tip extends slightly below the nasal wings. With hirsutism in the cervical and interscapular region. In the hands, broad thumbs are identified, in the rest of the fingers there are widened distal phalanges, in the same way in the region of the feet, wide hallux and widened distal phalanges are identified. Evolution: The patient continues to be observed by outpatient consultation, he was sent to speech, reading and psychomotor therapy programs. He has not developed pulmonary infections until the close of follow-up, 6 months after diagnosis. Conclusion: In this case, it reports the phenotypic alterations of the facial and limb characteristics of a child with Rubinstein-Taybi syndrome, which helped the clinical diagnosis.

Introdução: A síndrome de Rubinstein-Taybi é uma patologia de origem genética que afeta 1 em cada 100.000 a 125.000 nascidos vivos, é caracterizada por: retardo de crescimento, atraso no desenvolvimento psicomotor e anormalidades morfológicas que incluem: características faciais peculiares (sobrancelhas arqueadas e grossas, descendente fissuras palpebrais, ponte nasal convexa com a ponta do nariz abaixo das asas), polegares largos e hálux. Sua origem epigenética em 60% dos casos deve-se a uma alteração no gene CREBBP (que codifica a proteína CPB), em 10% a uma alteração no gene EP300 (que codifica a proteína p300) e em 30% sua causa não foi identificada . Caso clínico: Menino de 8 anos com atraso no desenvolvimento psicomotor, com dificuldade de adaptação à escola. No exame físico com características faciais: sobrancelhas superpovoadas e arqueadas, hirsutismo na testa e região do lábio superior, fissuras palpebrais inclinadas para baixo, hipertelorismo com estrabismo convergente, ponte nasal larga, nariz achatado, a ponta se estende ligeiramente abaixo das asas nasais. Com hirsutismo na região cervical e interescapular. Nas mãos identificam-se os polegares largos, nos restantes dedos são identificadas falanges distais alargadas, da mesma forma que na região dos pés, hálux largo e falanges distais alargadas. Evolução: O paciente ainda está em acompanhamento ambulatorial, foi encaminhado para programas de fonoaudiologia. Ele não desenvolveu infecções pulmonares até o fechamento do acompanhamento, 6 meses após o diagnóstico. Conclusão: Nesse caso, relata as alterações fenotípicas das características faciais e de membros de uma criança com síndrome de Rubinstein-Taybi, o que auxiliou no diagnóstico clínico.

Traumatic Isolated Thumb Carpometacarpal Joint Dislocation - Report of Two Clinical Cases / Luxação traumática isolada da articulação trapéziometacárpica - Relato de dois casos clínicos

Abstract Isolated thumb carpometacarpal joint dislocation is a rare lesion that accounts for less than 1% of all hand lesions. The authors present two cases of traumatic isolated thumb carpometacarpal joint dislocation. One of them was treated with closed reduction and cast immobilization, and the other was treated with closed reduction, Kirschner-wires pinning, and cast immobilization. The first patient had a good functional outcome and showed no signs of thumb carpometacarpal instability. The patient treated with Kirschner wires presented signs of clinical instability and radiological subluxation. Isolated thumb carpometacarpal dislocation is a rare lesion that can cause joint instability, which interferes with the normal function of the hand and can lead to articular degenerative changes. The best management of this lesion is still controversial, since there is lack of evidence in the literature showing superiority of one treatment over the other.

Resumo A luxação traumática isolada da articulação trapézio-metacárpica é uma lesão rara que faz parte de menos de 1% de todas as lesões de mãos. Os autores apresentam dois casos de luxação traumática isolada da articulação trapézio-metacárpica. Um dos casos foi tratado com redução fechada e imobilização com gesso, e o outro foi tratado com redução fechada, fixação com fios Kirschner, e imobilização com gesso. O primeiro paciente teve um bom resultado funcional e não mostrou sinais de instabilidade trapeziometacarpal. O paciente tratado com fios Kirschner apresentou sinais de instabilidade clínica e subluxação radiológica. A luxação isolada da articulação trapeziometacarpal é uma lesão rara que pode causar instabilidade articular que interfere com a funcionalidade normal da mão e pode resultar em mudanças articulares degenerativas. O melhor manejo dessa lesão ainda é controverso, já que ainda faltam evidências na literatura que mostrem a superioridade de um tratamento em relação ao outro.

Reabilitação do polegar reimplantado: avaliação dos resultados funcionais em uma unidade de saúde no Rio de Janeiro / Rehabilitation of the replanted thumb: evaluation of functional results in a health unit in Rio de Janeiro

Introdução: O polegar é o dedo de maior importância funcional da mão, por isso a justificativa de reimplantação e reabilitação do mesmo. Objetivo: Realizar uma análise retrospectiva dos resultados, via revisão de prontuários de pacientes submetidos à reimplante de polegar, realizados pelo Serviço SOS-Reimplante do Hospital Estadual Adão Pereira Nunes. Metodologia: Trata-se de um estudo retrospectivo com amostra de conveniência, abrangendo o período entre janeiro de 2010 a dezembro de 2015, realizado através de prontuários de pacientes submetidos a processo de reimplante de polegar, atendidos no Serviço de Terapia Ocupacional/TO-Mão no Hospital estadual Adão Pereira Nunes, em Duque de Caxias, Rio de Janeiro. Foram coletadas informações sociodemográficas, além de força muscular, sensibilidade e tempo de reabilitação. Resultados: Foram revisados 63 prontuários de pacientes submetidos a procedimento de reimplante de polegar, na faixa etária de 18 a 65 anos. Quanto ao local do acidente, 76,1% dos casos foi decorrente de acidente de trabalho e 23,2% acidentes domésticos. Ao observamos à lateralidade da lesão, 92% dos pacientes eram destros, enquanto o polegar com maior número de lesões foi o esquerdo, com um total de 82,5% pacientes. Quanto ao nível da lesão, 25,3% pacientes sofreram lesão na falange proximal, 20,8% pacientes sofreram lesão na região da interfalangeana, e 53,9% dos pacientes apresentaram lesão na falange distal. Dentre os reencaminhados para nova avaliação, 28,5% pacientes, foram submetidos a outros procedimentos cirúrgicos. Houve ganho de força em global em 88,2% dos pacientes em de sensibilidade. Conclusão: A maioria dos pacientes que sofreram reimplante do polegar conseguiram obter ganho de força muscular e sensibilidade, conseguirem retornar as suas atividades laborais, com um tempo de reabilitação que variou de 4 a 14 meses. (AU)

Introduction: The thumb is the greatest functional finger of the hand, which is justifies its replantation and rehabilitation. Objective: To carry out a retrospective analysis of the medical records of patients undergoing thumb reimplantation, performed by the SOS-Reimplantation Service of the State Hospital Adão Pereira Nunes. Methodology: This is a retrospective study with a convenience sample, covering the period between January 2010 and December 2015, conducted thorough medical records of patients undergoing the process of thumb replantation, attended at the Occupational Therapy Service / TO - Hand at the Adão Pereira Nunes State Hospital, in Duque de Caxias, Rio de Janeiro. Sociodemographic information was collected, in addition to muscle strength, sensitivity, and rehabilitation time. Results: 63 medical records of patients who underwent thumb reimplantation procedure, aged 18 to 65 years, were reviewed. As for the accident site, 76.1% of the cases were due to occupational accidents and 23.2% to domestic accidents. When observing the laterality of the lesion, 92% of the patients were righthanded, while the thumb with the largest number of lesions was left, with a total of 82.5% patients. As for the level of the lesion, 25.3% of patients suffered an injury to the proximal phalanx, 20.8% of patients suffered an injury to the interphalangeal region, and 53.9% of the patients had lesions to the distal phalanx. Among those referred for further evaluation, 28.5% of patients underwent other surgical procedures. There was overall strength gain in 88.2% of patients in sensitivity. Conclusion: Most patients who underwent thumb reimplantation were able to obtain gains in muscle strength and sensitivity, being able to return to their work activities, with a rehabilitation time that varied from 4 to 14 months. (AU)

Cobertura de partes blandas del Pulgar. Guía en la toma de decisiones / Coverage of soft parts of the Thumb. Guide for decision making

Las lesiones digitales son extremadamente frecuentes y cuando estas involucran al pulgar pueden comprometer importantemente la función de la mano, tanto así que su amputación afecta hasta un 50% la función global de la mano y disminuye su fuerza hasta en un 20%. Para poder mantener el largo del pulgar en muchas ocasiones se requiere de cobertura mediante el uso de colgajos, los cuales no siempre son realizados por un cirujano de mano. La elección correcta del colgajo es esencial para evitar la restricción de movilidad y limitación funcional del dedo lesionado, existiendo múltiples alternativas descritas, que varían en su capacidad de cobertura y complejidad, haciendo difícil una adecuada elección. Nuestro objetivo es resumir y entregar una estrategia de análisis de lesiones del pulgar que permita comprender el tipo de lesión y objetivos del tratamiento quirúrgico, para así optimizar la cobertura según cada caso y los resultados a largo plazo.

Digital injuries are frequent in medical practice. When they involve the thumb, it is important to consider that an amputation affects up to 50% of the hands' function and decreases its strength by up to 20%. Management of thumb injuries often requires coverage with local flaps, which are not always performed by hand surgeons. Choosing the right flap is essential to avoid restrictions in mobility and functional limitations of the injured finger. Our objective is to summarize and provide a strategy for the analysis of thumb injuries that may help to understand the different types of lesions, and the surgical approaches recommend in order to optimize coverage and long term results.

Caracterización de la comunicación ulnar-mediano palmar profunda en una muestra con material cadavérico / Characterization of ulnar-median deep palmar communication in a sample with cadaveric material

RESUMEN: La comunicación Ulnar-Mediano Palmar Profunda (CUMPP) es la conexión entre la rama profunda del nervio ulnar (NU) y la rama del nervio mediano (NM) que inerva a los músculos tenares como la cabeza superficial del flexor corto del pulgar. Son escasos los trabajos que se ocupan de esta rama comunicante, y su prevalencia es reportada con una amplia variabilidad, en un rango del 16-77 %. Este estudio no probabilístico, descriptivo, transversal, evaluó la frecuencia y características morfológicas de la CUMPP en 106 manos de especímenes cadavéricos frescos no reclamados, a quienes se les practicó necropsia en el Instituto de Medicina Legal de Bucaramanga (Colombia). Se observó rama comunicante CUMPP en 39 especímenes (50,2 %), de los cuales 12 (44,5 %) fueron bilate- rales, 15 (55,6 %) unilaterales, con predominio unilateral derecho para 9 casos (60 %), sobre el izquierdo de tan solo 6 casos (40 %). No se evidenciaron diferencias estadísticamente significativas con relación al lado de presentación (P=0,223). En 21 especímenes (54 %) se observó el tipo IV; mientras que el tipo I fue encontrado en 4 casos (10 %). El promedio de la longitud de la rama comunicante fue de 24,67 DE 6,46 mm; mientras que la distancia del punto proximal de la CUMPP al surco distal del carpo fue de 41,4 DE 2,6 mm. Nuestros hallazgos no son concordantes con lo reportado en la mayoría de estudios previos. Diversos factores como el tamaño de las muestras, las diferentes metodologías de medición y las expresiones fenotípicas de cada grupo de población evaluado, pueden explicar la variabilidad de la CUMPP.

SUMMARY: Deep Palmar Ulnar-Medium Communication (DPUMC) is the connection between the deep branch of the ulnar nerve (UN) and the median nerve (MN) branch, that innervates the thenar muscles as the superficial head of the short flexor of the thumb. Few studies dealing with this communicating branch, and its prevalence is reported with a wide variability in the range of 16-77 %. This non-probabilistic, descriptive, cross-sectional study; evaluated the frequency and morphological characteristics of DPUMC in 106 hands of fresh unclaimed cadaveric specimens, that underwent necropsy at the Institute of Legal Medicine of Bucaramanga (Colombia). DPUMC communicating branch was observed in 39 specimens (50.2 %), of which 12 (44.5 %) were bilateral, 15 (55.6 %) unilateral, with right unilateral predominance for 9 cases (60 %), on the left of only 6 cases (40 %). There were no statistically significant differences in relation to the presentation side (P = 0.223). In 21 specimens (54%), type IV was observed; while type I was found in 4 cases (10%). The average length of the communicating branch was 24.67 SD 6.46 mm; while the distance from the proximal point of the DPUMC to the distal carpal groove was 41.4 SD 2.6 mm. Our findings are not consistent with those reported in most previous studies. Various factors such as sample size, different measurement methodologies and phenotypic expressions of each population group evaluated can explain the variability of the DPUMC.

Colgajo en cometa como tratamiento de secuelas de quemadura en pulgar / Kite flap for correction of thumb deformities after burn

Introducción. Múltiples técnicas han sido descriptas para la reconstitutición de la función del pulgar quemado, aunque sin relación costo-beneficio. El colgajo en cometa, descripto por Foucher en 1979, aporta cobertura cutánea, sensibilidad y permite mejoría funcional. El objetivo de este trabajo es presentar nuestra experiencia y resultados utilizando el kite flap. Materiales y métodos. Se realiza un estudio restrospectivo, descriptivo, de 4 casos de secuelas de quemaduras en pulgar de la mano atendidas en el Servicio de Cirugía Plástica y Reparadora del Hospital de Quemados de la Ciudad de Buenos Aires en un periodo comprendido desde el año 2016 al 2019. Se realizan colgajos en cometa en isla o tunelizados y posterior rehabilitación kinésica. El seguimiento mínimo de la serie es de 3 meses y se toman registros fotográficos pre-, intra- y posoperatorios. Las variables analizadas incluyen: sufrimiento de colgajos, dehiscencia, congestión venosa, prendimiento de injertos en zona dadora, reintervenciones y mejoría en la función de abducción del pulgar y pinza de la mano. Resultados. Se realizaron 3 colgajos en cometa tunelizados y 1 en isla. La totalidad se presentaron vitales aunque con congestión venosa en las primeras 72 hs. No se registraron complicaciones y no fueron necesarias reintervenciones. La mejoría en la función de pinza y de abducción del pulgar fue objetivable mediante la observación y referida por los pacientes y/o familiares según correspondiera. Conclusiones. Creemos que el colgajo en cometa es la mejor opción de tratamiento para las secuelas de quemadura en pulgar por aportar adecuada cobertura cutánea, ser técnicamente sencillo y poder hallar el pedículo en el 100% de la población. La congestión venosa es la regla, aunque también la supervivencia, siendo la morbilidad de la zona dadora mínima y la mejoría en la función de pinza y abducción del pulgar francamente objetivable.

Introduction. Multiple techniques have been described for repair the burned thumb function, although without cost-benefit ratio. The kite flap described by Foucher in 1979, provides skin coverage, sensitivity and allows functional improvement. The goal of this study it to present our experience and results obtained using the kite flap Materials and methods. A retrospective, descriptive study of 4 cases of burned hand's thumb treated in the Plastic Surgery Unit of the Hospital de Quemados on Buenos Aires in a three year's period from 2016 to 2019. Island or tunneled's kite flaps and subsequent kinesic rehabilitation are performed. The minimum follow-up of the series is 3 months and fotographic records pre, intra and postoperative are taken. The variables analyzed include: suffering from flaps, dehiscence, venous congestion, grafting losts on the donor zone, reinterventions and improvement in the function of thumb abduction and hand clamp . Results. 3 tunelled kite flaps and 1 on island were made. All of them were vital, although with venous congestion in the first 72 hours. No complications were recorded and no reinterventions were necessary. The improvement in hand clamp function and thumb abduction was marked through observation and when it posible, referred by patients. Conclusions. We believe that kite flap is the best option of treatment for sequelae of burns affecting hand's thumb for providing adequate skin coverage, being technically simple and being able to find the pedicle at 100% of the population. Venous congestion is the rule, although survival is also. Donor zone´s morbidity is minimal and the improvement in thumb function is clear

Colgajo dorsolateral versus colgajo en isla mediopalmar radial para el tratamiento de lesiones traumáticas distales del pulgar. Evaluación clínica / Dorsolateral flap vs. radial midpalmar island flap in the treatment of traumatic distal thumb injuries. Clinical evaluation

Objetivo: Evaluar clínicamente a pacientes con lesiones distales combinadas del pulgar tratados mediante colgajo dorsolateral o colgajo en isla mediopalmar radial. Materiales y Métodos: Se comparó retrospectivamente a 20 pacientes (14 hombres y 6 mujeres; promedio de edad 35 años) con lesiones traumáticas combinadas distales del pulgar, operados por dos cirujanos, con técnicas diferentes. Los pacientes no tenían antecedentes quirúrgicos y el seguimiento mínimo fue de 24 meses. Se evaluaron el resultado subjetivo usando el índice de satisfacción, la escala analógica visual para dolor y el puntaje QuickDASH, y el resultado objetivo mediante el test de discriminación de 2 puntos, el tiempo quirúrgico promedio y la necesidad de reeducación espacial digital. Resultados: La media desde el ingreso hasta el alta laboral fue de 7 semanas (rango 6-8). Resultados promedio posoperatorios: escala analógica visual 01/10, ambos grupos. Grupo con colgajo dorsolateral: índice de satisfacción 97%, test de discriminación de 2 puntos 4 mm, puntaje QuickDASH 2,5; tiempo quirúrgico 45 min, sin necesidad de reeducación espacial digital. Grupo con colgajo en isla mediopalmar radial: índice de satisfacción 92%, test de discriminación de 2 puntos 6 mm, puntaje QuickDASH 8, tiempo quirúrgico 60 min; 4 pacientes requirieron reeducación espacial digital. Conclusión: Los colgajos dorsolateral y en isla mediopalmar radial resultaron eficaces en el tratamiento de lesiones traumáticas distales del pulgar, aunque el colgajo dorsolateral tuvo mejores puntajes de evaluación objetiva y requirió menos tiempo quirúrgico. Nivel de Evidencia: III

Objective: To clinically evaluate patients with combined distal thumb lesions treated by a dorsolateral flap or radial midpalmar island flap. Materials and Methods: We retrospectively compared 20 patients (14 males and 6 females, averaging 35 years) with combined distal thumb traumatic lesions, who were operated on by two surgeons using different techniques. Patients had no previous surgical history and a minimum follow-up period of 24 months. Subjective outcome was evaluated by satisfaction index (SI), visual analogue scale (VAS), and QuickDASH score. Objective outcome was evaluated by two-point discrimination test (TPDT), average surgical time (ST), and need for digital spatial reeducation (DSR). Results: Time from admission to medical discharge averaged 7 weeks (range, 6-8). Average postoperative results: VAS for pain, 01/10 (both groups); IS, 97% vs. 92% (dorsolateral flap group vs. radial midpalmar island flap); TPDT, 4 mm vs. 6 mm; QuickDASH, 2.5 vs. 8; ST, 45 minutes vs. 60 minutes; need for DSR, 0 vs. 4 cases. Conclusion: Both the dorsolateral flap and the radial midpalmar island flap techniques were effective in the treatment of distal thumb traumatic lesions, although the dorsolateral flap achieved better objective evaluation scores and required less ST. Level of Evidence: III

Colocación de un tornillo transfisario medial en la cadera espástica de niños con parálisis cerebral. Eficacia y seguridad / Medial transphyseal screw placement for spastic hip treatment in children with cerebral palsy. Effectiveness and safety

Introducción: En estudios experimentales y clínicos, los resultados con el tornillo excéntrico transfisario medial para producir varo fueron alentadores. El propósito de este estudio fue determinar si colocar un tornillo en el fémur proximal es un gesto eficaz y seguro en caderas espásticas de niños con parálisis cerebral. Materiales y Métodos: Se incluyó a pacientes con parálisis cerebral infantil y caderas en riesgo. Se compararon la serie A: pacientes con liberación de partes blandas más colocación de un tornillo excéntrico transfisario medial en el fémur proximal y la serie B: pacientes solo con liberación de partes blandas. Se determinaron el test de Rang, el índice de migración de Reimer, el ángulo cervicodiafisario y las complicaciones, antes de la cirugía y después. Resultados: Se operó a 18 pacientes (36 caderas): 10 de la serie A y 8 de la serie B, con una mediana de edad de 51 meses y una mediana de seguimiento, de 3 años. Al comparar por delta de medianas todas las variables preoperatorias y posoperatorias, hubo una diferencia estadísticamente significativa solo en el delta de mediana del ángulo cervicodiafisario de las caderas izquierdas (-5 vs. 0, p 0,02). Conclusiones: La liberación de partes blandas es eficaz para prevenir la luxación de la cadera espástica. La colocación de un tornillo transfisario excéntrico en la cadera espástica no produjo cambios y no fue inocua. La hemifisiodesis medial de la cadera es una atractiva solución teórica para tratar los problemas ocasionados por el valgo excesivo, pero se requieren más estudios. Nivel de Evidencia: III

Introduction: Animal and clinical studies have shown promising results for the varus-producing placement of a medial eccentric transphyseal screw. The purpose of this study was to establish if the placement of a screw in the proximal femur is an effective and safe approach for spastic hips in children with cerebral palsy (CP). Materials and Methods: We compared two series of pediatric CP patients (Gross Motor Function Classification System [GMFCS] III, IV and V) with "hips at risk." Series A patients were treated with soft-tissue release plus a medial eccentric transphyseal screw in the proximal femur. Series B patients were only treated with soft-tissue release. Patients were evaluated pre and postoperatively to determine their Rang test score, Reimer's migration index (MI), diaphyseal cervical angle, and complications. Results: From a total of 18 patients operated, 36 hips, 55% (10) belonged to the A Series and 45% (8) to the B Series. The median age was 51 months (IQR, 41-108). The median follow-up was 3 years (IQR, 2.4-5.8). The comparative analysis of all preoperative and postoperative variables yield only one statistically significant difference: the median left hip diaphyseal cervical angle (-5 vs. 0, P 0.02). Conclusions: The release of soft tissues was effective to prevent the spastic hip dislocation. The placement of medial eccentric transphyseal screw in spastic hips produced some complications and no beneficial changes. Medial hemiphysiodesis of the hip remains nothing but an attractive theoretical solution for the treatment of problems caused by excessive valgus. However, further studies are warranted. Level of Evidence: III

Correlação entre a Espessura do Músculo Adutor do Polegar e o Estado Nutricional / Correlation Between the Adductor Pollicis Muscle Thickness and the Nutritional Status / Correlación entre el Espesor del Músculo Adductor Pollicis y el Estado Nutricional

Introdução: A desnutrição é altamente prevalente na população oncológica e aumenta a morbidade e mortalidade nos estágios avançados da doença. A espessura do músculo adutor do polegar (EMAP) parece ser uma variável importante para avaliar o compartimento muscular. Objetivo: Estabelecer um ponto de corte da EMAP para desnutrição entre pacientes oncológicos hospitalizados. Método: Estudo transversal, entre 100 pacientes oncológicos internados em um hospital geral de Porto Alegre ­ RS, com idade ≥20 anos, admitidos nas enfermarias e avaliados nas primeiras 72 horas de admissão hospitalar. Foi realizada a avaliação subjetiva global (ASG), mensurados peso, altura, circunferência de braço (CB), prega cutânea triciptal (PCT), circunferência da panturrilha (CP) e a EMAP da mão dominante (EMAPD) e não dominante (EMAPND); calculada a circunferência muscular do braço (CMB) e o índice de massa corporal (IMC). Resultados: Conforme a ASG, 31% e 33% eram, respectivamente, moderadamente e gravemente desnutridos. Pacientes desnutridos apresentaram significativamente menores valores de IMC, CB, PCT, CMB, CP, EMAPD e EMAPND, bem como maior tempo de internação e óbito. O melhor ponto de corte da EMAPD para o desfecho desnutrição foi 13,2 mm (sensibilidade 65% e especificidade 75%) e, para EMAPND, foi 13,3 mm (sensibilidade de 65% e especificidade 77%). Conclusão: O melhor ponto de corte da EMAPD para o desfecho desnutrição, proposto neste estudo, foi 13,2 mm e, para EMAPND, foi 13,3 mm. No entanto, mais estudos são necessários para confirmar estes achados.

Introduction: Malnutrition is highly prevalent in the oncologic population and is the major cause of morbidity and mortality in the advanced stages of the disease. The adductor pollicis muscle thickness (APMT) seems to be an important variable to assess muscle compartment. Objective: To establish cutoff point for malnutrition from APMT among hospitalized oncologic patients. Method: Cross-sectional study with 100 oncologic patients hospitalized in a general hospital in Porto Alegre ­ RS, aged ≥20 years, admitted at the outpatient and evaluated within the first 72 hours of hospital admission. Subjective Global Assessment (SGA) was performed; weight, height, arm circumference (AC), tricipital skinfold (TSF), calf circumference (CC), APMT of the dominant (APMTDH) and non-dominant hand (APMTNDH) were measured; arm muscle circumference (AMC) and body mass index (BMI) were calculated. Results: According to the SGA, 31% of the sample was moderately malnourished and 33%, severely malnourished. Malnourished patients had significantly lower values of BMI, AC, TSF, CC, APMTDH and APMTNDH, as well as, longer hospital stay and death. The best cutoff point for APMTDH for the malnutrition outcome was 13.2 mm, (sensitivity of 65% and specificity of 75%) and for APMTNDH, 13.3 mm, with a sensitivity of 65% and specificity of 77%. Conclusion: The best cutoff point proposed in this study for APMTDH for the outcome malnutrition was 13.2 mm and 13.3 mm for APMTNDH. However, further studies are needed to confirm our findings.

Introducción: La desnutrición es altamente prevalente en la población con cáncer y aumenta la morbilidad y la mortalidad en las etapas avanzadas de la enfermedad. El espesor del músculo adductor pollicis (EMAP) parece ser una variable importante para evaluar el compartimento muscular. Objetivo:Establecer un punto de corte EMAP para la desnutrición en pacientes con cáncer hospitalizados. Método: Estudio transversal entre 100 pacientes con cáncer ingresados en un hospital general en Porto Alegre ­ RS, edad ≥20 años y evaluados dentro de las primeras 72 horas de ingreso hospitalario. Se realizó una evaluación global subjetiva (EGS), se midió el peso, la altura, la circunferencia del brazo (CB), el pliegue cutáneo tricipital (PCT), la circunferencia de la pantorrilla (CP) y la EMAP de las manos dominantes (EMAPD) y no dominantes (EMAPND). Se calcularon la circunferencia muscular del brazo (CMB) y el índice de masa corporal (IMC). Resultados: Según la EGS, el 31% y el 33% estaban desnutridos moderada y severamente, respectivamente. Los pacientes desnutridos tuvieron valores significativamente más bajos de IMC, CB, PCT, CMB, CP, EMAPD y EMAPND, así como una mayor estadía hospitalaria y muerte. El mejor punto de corte para EMAPD para el resultado de desnutrición fue 13.2 mm (sensibilidad 65% y especificidad 75%), y para EMAPND fue 13.3 mm (sensibilidad 65% y especificidad 77%). Conclusión: El mejor punto de corte para EMAPD para el resultado de desnutrición fue de 13.2 mm y para EMAPND fue de 13.3 mm. Sin embargo, se necesitan más estudios para confirmar nuestros hallazgos.

Descripción de la prueba semiológica de Compresión y flexión del pulgar, para el diagnóstico de Rizartrosis. Estudio de Cohorte Transversal / Description of thumb compression and flexion test for the diagnosis of rhizarthrosis. Cross sectional Cohort Study

Introducción El dolor del pulgar secundario a la artrosis de la articulación trapecio-metacarpiana es una condición común, especialmente en mujeres llegando a causar niveles altos de incapacidad en algunos pacientes. El diagnóstico de rizartrosis se basa en el dolor localizado, la inflamación e inestabilidad en la exploración física además de la valoración radiológica. Existen en la actualidad varias pruebas semiológicas que podemos utilizar en el diagnóstico de la rizartrosis sintomática, una de ellas es la prueba de Grind o molienda, que es considerada el patrón de oro. El presente estudio tiene como objetivo describir y evaluar la prueba de Compresión y flexión del pulgar ideada para el diagnóstico de rizartrosis. Materiales y Métodos Se realizó un estudio de corte transversal en el periodo de enero del 2007 a mayo del 2013, Se evaluaron 230 pacientes que acudieron a consulta con síntomas sugestivos de rizartrosis a quienes se les practico simultáneamente la prueba de Grind y la prueba de compresión y flexión para la confirmación del diagnóstico. Resultados De los 230 pacientes que acudieron a consulta, el 87.8% (202) eran mujeres con una edad promedio de 60 años (32 a 86 años). El 14.8% de los pacientes presentaron una afectación bilateral. El 47.8% tenían comorbilidades presentes entre las que se encuentran síndrome de túnel carpiano en el 67.3%, dedo en gatillo 11.8%, entre otras. El índice de concordancia PABAK entre los dos signos semiológicos fue de 0.948, indicando un nivel de acuerdo excelente entre ambos. El 100% de los pacientes fueron diagnosticados por la prueba de flexión y compresión. Discusión producto de obtener una prueba positiva en la totalidad de los pacientes evaluados con la prueba de compresión y flexión, consideramos puede ser una opción que complemente la pesquisa clínica en el paciente con rizartrosis, es necesario entonces estudios posteriores para validar dicha prueba y poder obtener su sensibilidad y especificidad.

Background Thumb pain secondary to osteoarthritis of the trapezium-metacarpal joint is a common condition, especially in women, and causing high levels of disability in some patients. The diagnosis of rhizarthrosis is based on localised pain, inflammation, and instability on physical examination, in addition to radiographic evaluation. There are currently several semiological tests that can be used in the diagnosis of symptomatic rhizarthrosis, one of which is the Grind or grinding test, which is considered the gold standard. The present study aims to describe and evaluate the thumb compression and flexion test designed for the diagnosis of rhizarthrosis. Methods A cross-sectional study was carried out during the period from January 2007 to May 2013. The study included a total of 230 patients that came to the clinic with symptoms suggestive of rhizarthrosis, and on whom the Grind test, the compression test, and flexion were simultaneously performed to confirm the diagnosis. Results Of the 230 patients who attended the clinic, 87.8% (202) were women with a mean age of 60 years (32 to 86 years). A bilateral involvement was observed in 14.8% of the patients. Just under half (47.8%) currently had co-morbidities that included, among others, carpal tunnel syndrome (67.3%) and trigger finger (11.8%). The prevalence-adjusted and bias-adjusted kappa (PABAK) concordance index between the two semiological signs was 0.948, indicating an excellent level of agreement between both. All (100%) of the patients were diagnosed by the flexion and compression test. Discussion Due to obtaining a positive test in all the patients evaluated with the compression and flexion test, it should be considered as a complementary test in the clinical evaluation of patients with rhizarthrosis. Further studies are necessary to validate this test in order to establish its sensitivity and specificity.

Dermatoglyphic traits of brazilian golfers / Traços dermatoglíficos dos golfistas brasileiros

ABSTRACT Played all over the world, golf has gained popularity, for it is a sport that depends on individual abilities. For this reason the search for tools that aim to seek and guide its respective talented players has become very important. Therefore, this study had the objective of comparing the distribution of the dermatoglyphic indicators of high performance golfers and of a group control of non-athletes. The sample was composed of 46 individuals with paired age and gender, divided into two groups: the Group Golf (GG), composed of 23 golfers, and the Group Control (GC), composed of 23 individuals control randomly selected. The golfers, part of the Project Golf Brazil of the Brazilian Golf Confederation, were between 11 and 21 years old. The results demonstrated that the number of lines in the pattern was of six possible variables of fingerprint (MESQL1, MESQL2, MESQL4, MESQL5, SQTLE, SQTL) is significantly higher in the golfers (GG) when compared to the group control (GC). When observed the qualitative variables, i. e., the pattern type, significant diferences where observed between the groups, since the golfers (GG) presented more Radial Loops (RL) in MDT5 when compared to the group control (GC). The results found in this study demonstrated that the dermatoglyphic profile of high performance golfers differ from the non-athlete population.

RESUMO Jogado em todo o mundo, o golfe está ganhando popularidade, sendo um esporte que depende das habilidades individuais, tornando-se importante a busca por ferramentas que visem buscar e orientar seus respectivos talentos. O presente estudo teve por objetivo comparar a distribuição dos indicadores dermatoglíficos de golfistas de alto rendimento e de um grupo controle de não atletas. A amostra foi composta por 46 indivíduos com idade e sexo pareados, divididos em dois grupos: o Grupo Golf (GG), composto por 23 golfistas e o Grupo Controle (GC), composto por 23 indivíduos controle aleatoriamente selecionados. Os golfistas, parte do Projeto Golf Brasil da Confederação Brasileira de Golfe, tinham idade entre 11 e 21 anos. Os resultados demonstram que o número de linhas no padrão de seis possíveis variáveis de impressão digital (MESQL1, MESQL2, MESQL4, MESQL5, SQTLE, SQTL) é maior nos golfistas (GG) quando comparado ao grupo controle (GC). Quando observadas as variáveis qualitativas, ou seja, o tipo de figura, observaram-se diferenças significativas entre os grupos, visto que os Golfistas (GG) apresentaram maior quantidade de Presilha Radial (LR) no MDT5 quando comparados ao grupo controle (GC). Os resultados encontrados neste estudo demonstraram que o perfil dermatoglífico de golfistas de alto rendimento difere da população não atleta.

Adductor Pollicis Muscle Thickness as a Marker of Nutritional Status in Heart Failure

Malnutrition is associated with morbidity and mortality in patients with heart failure (HF). Thus, it is essential to apply reliable indicators to assess the nutritional status of these individuals. Objective: To evaluate the thickness of the adductor pollicis muscle (APM) in patients with HF as an indicator of somatic protein status and correlate the obtained values with conventionally used parameters and electrical bioimpedance (EBI) markers. Methods: Cross-sectional study with patients with HF undergoing regular outpatient treatment. APM thickness was measured in the dominant arm, and the values obtained were classified according to gender and age. The anthropometric parameters assessed included the body mass index (BMI) and specific parameters to assess the muscle (arm muscle circumference [AMC] and arm muscle area [AMA]). Values of phase angle (PA), standard PA (SPA), and lean mass were obtained by EBI. Statistical analyses were performed with the software Statistical Package for the Social Sciences, version 19, using unpaired Student's t, Mann-Whitney, or one-way analysis of variance (ANOVA) tests for comparisons between groups, as appropriate. The correlation between variables of interest was performed using Pearson's or Spearman's correlation coefficient, as adequate. The level of significance was set at 5%. Results: About 70% of the 74 patients evaluated were classified as malnourished according to the APM thickness. Values of AMC, AMA, and lean mass correlated positively with APM thickness (p < 0.005). The APM thickness also correlated positively with PA and SPA (r = 0.49, p < 0.001 and r = 0.31, p = 0.008, respectively). Conclusion: Patients with HF presented a high frequency of protein malnutrition when APM thickness was used as an indicator of nutritional status. APM thickness values correlated with conventional measures of somatic protein evaluation and may be related to the prognosis of these patients, since they correlated positively with PA and SPA

Onychocytic matricoma

Abstract Onychocytic matricoma is a newly described tumor of the nail matrix. Clinically, it presents with localized thickening of the nail plate and melanonychia. Histologically, it represents a benign acanthoma of onychocytes. There are 8 cases reported in the literature. A 12-year-old girl presented with localized melanonychia and concurrent thickening of the nail plate restricted to the area of pigmentation affecting the right thumb, with no history of trauma or pain. We report a case of this rare tumor occurring in late childhood and provide a comprehensive review of its clinical presentation and differential diagnosis. Both clinicians and dermatopathologists should be aware of the presentation of onychocytic matricoma and include it in their scope of diagnosis of longitudinal nail bands.

Thumb adductor muscle thickness used in the nutritional assessment of chronic kidney disease patients under conservative treatment / Espessura do músculo adutor do polegar para avaliação nutricional de portadores de doença renal crônica em tratamento conservador

Abstract Introduction: Evaluate the association between the thumb adductor muscle thickness and the patient's nutritional status, and propose cutoff points for muscle mass depletion in elderly patients with chronic kidney disease (CKD) under conservative treatment. Epidemiological and cross-sectional study, including patients with CKD stages 3 to 5, older than 60 years. Socioeconomic, clinical, physical activity and anthropometric data was obtained. TAMT was described and compared according to CKD stage, socioeconomic data, physical activity, nutritional status and correlated with age, glomerular filtration rate and anthropometric variables. Receiver Operating Characteristic (ROC) curves were produced, considering the lean tissue index classification as reference. The cut-off point was defined by the Youden index. Results: We evaluated 137 individuals. The TAMT was lower in malnourished and/or depleted muscle mass individuals; among males it was higher among those who practiced physical activities (p <0.05). This measure was moderately correlated with BMI, calf and brachial circumferences, lean body tissue, lean tissue index and body cell mass (r <0.7); negatively with age (r = -0.34). The ROC curve analysis determined cut points of 15.33 mm for females and 20.33 mm for males, with 72.22% and 62.50% accuracy, respectively. Conclusion: TAMT is used to estimate muscle mass and we suggest the cutoff point is useful to rule out the likelihood of muscle mass depletion. It is recommended that it be used in a complementary way in nutritional assessment.

Resumo Introdução: Avaliar a associação da espessura do músculo adutor do polegar (EMAP) com o estado nutricional e propor pontos de corte para depleção de massa muscular em idosos portadores da doença renal crônica (DRC) em tratamento conservador. Metodologia: Estudo epidemiológico, delineamento transversal, incluindo portadores de DRC estágios 3 a 5, acima de 60 anos. Obteve-se dados socioeconômicos, clínicos, prática de atividade física e antropométricos. A EMAP foi descrita e comparada de acordo com o estágio da DRC, dados socioeconômicos, atividade física e estado nutricional e correlacionada com idade, taxa de filtração glomerular e variáveis antropométricas. Foram produzidas curvas Receiver Operating Characteristic (ROC), considerando como padrão de referência a classificação do índice de tecido magro. O ponto de corte foi definido pelo índice Youden. Resultados: Avaliou-se 137 indivíduos. A EMAP foi inferior nos desnutridos e/ou com depleção de massa muscular; no sexo masculino foi superior nos praticantes de atividade física (p<0,05). A medida se correlacionou moderadamente com IMC, circunferência da panturrilha e braquial, tecido de massa magra, índice de tecido magro e massa celular corporal (r<0,7), e negativamente com a idade (r=-0,34). A análise da curva ROC determinou pontos de corte de 15,33 mm para o sexo feminino e 20,33 mm para o masculino, com acurácia de 72,22% e 62,50%, respectivamente. Conclusão: A EMAP serve para estimar a massa muscular, e o ponto de corte sugerido é útil para afastar a probabilidade de depleção de massa muscular. Recomenda-se que seja utilizada de forma complementar na avaliação nutricional.

Pulgarización del índice en amputación traumática de pulgar mediante técnica de Buck-Gramcko modificada. Reporte de caso / Index finger pollicisation for traumatic amputation of the thumb using modified Buck-Gramcko technique. Case report

Introducción Las amputaciones traumáticas del pulgar representan un pequeño pero devastador porcentaje de consulta de urgencias. Se presenta aquí la experiencia de un caso de pulgarización de índice como manejo reconstructivo en una amputación compleja de pulgar de la mano dominante en un niño de 10 años. El objetivo es reportar el proceso quirúrgico de pulgarización del índice como alternativa reconstructiva en la amputación traumática de pulgar y analizar los resultados obtenidos. Materiales y métodos Reporte de un caso de amputación traumática de pulgar el cual se reconstruyó tomando como base la técnica de pulgarización descrita por Buck-Gramko, modificada por el equipo quirúrgico para obtener los resultados requeridos en anatomía, funcionalidad y estética. Paciente evaluado a los 6 meses postquirúrgicos con excelentes resultados medidos a través de la escala Percival Hand Score para funcionalidad del pulgar obteniendo el puntaje máximo de calidad superior a 20 puntos. Se recuperaron las funciones de pinza fina y prensión cilíndrica de la mano con independencia para movilidad de flexo-extensión, aducción y oposición del pulgar en más del 90% de su capacidad. Discusión La pulgarización del índice es una alternativa quirúrgica importante para el manejo de las amputaciones traumáticas de pulgar, por los excelentes resultados que se obtienen en cuanto a funcionalidad, anatomía y estética.

Background Traumatic amputation of the thumb is an uncommon injury but nevertheless a devastating one, and represents a small percentage of emergency visits. The aim of this study is to present the experience of index finger pollicisation as a complex reconstructive management for a thumb amputation of the dominant hand in a 10-year-old patient, as well performing an analysis of the functional results. Case Report A 10-year-old patient with traumatic amputation of thumb had a surgical reconstruction of the injury by using an index finger pollicisation technique as described by Buck-Gramcko and modified by the senior author in order to achieve the results required in anatomy, functionality, and aesthetics. Excellent results, measured by Percival Hand functionality thumb Score, were obtained 6 months after the surgery, with a maximum score of 20 points (higher quality). Pincer grip and cylindrical hand grip skills were recovered as well as flexion, extension, adduction, and opposition of the thumb for an overall rate 90% when compared with an uninjured thumb. Discussion Index finger pollicisation is important for the management of traumatic thumb amputation due to the excellent results obtained in terms of functionality, aesthetics, and anatomy, and should always be considered as a surgical alternative.

Adductor Pollicis Muscle Thickness for nutritional assessment: a systematic review / Espesura del Músculo Aductor del Pulgar para evaluación nutricional: una revisión sistemática / Espessura do Músculo Adutor do Polegar para avaliação nutricional: uma revisão sistemática

ABSTRACT Objective: The aim of this study is to systematically review the scientific findings about the efficacy of the measure of the Adductor Pollicis Muscle Thickness for nutritional assessment of individuals in various clinical conditions. Method: Systematic review study performed according to the methodology Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: 13 original articles published between 2004 and 2016 were included. The measure was associated/correlated to parameters of nutritional status (such as weight, body mass index and Global Subjective Assessment) and muscle mass markers (such as circumference brachial muscle circumference, brachial muscle area, calf circumference, and muscle mass). All these correlations were weak or moderate. Conclusion: The measurement can be used in different populations, being able to estimate nutritional status and muscle mass. However, it is suggested that it be used in a complementary way to the nutritional evaluation, not constituting a single diagnostic/monitoring parameter.

RESUMEN Objetivo: Revisar de forma sistemática las constataciones científicas acerca de la eficacia de la medida de la Espesura del Músculo Aductor del Pulgar para evaluación nutricional de los individuos bajo diversas condiciones clínicas. Método: Estudio de revisión sistemática, realizado conforme la metodología Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados: Se incluyeron 13 artículos originales publicados entre 2004 y 2016. La medida se presentó asociada/correlacionada a los parámetros de evaluación del estado nutricional (peso, índice de masa corporal y Evaluación Subjetiva Global) y a los marcadores de masa muscular (como circunferencia braquial, circunferencia muscular braquial, área muscular braquial, circunferencia de la pantorrilla y masa muscular). Todas estas correlaciones fueron débiles o moderadas. Conclusión: La medida puede ser utilizada en diferentes poblaciones, siendo capaz de estimar el estado nutricional y la masa muscular. Sin embargo, se sugiere que se emplee de forma complementaria la evaluación nutricional, no constituyendo un parámetro único de diagnóstico/monitoreo.

RESUMO Objetivo: Revisar de forma sistemática as constatações científicas acerca da eficácia da medida da Espessura do Músculo Adutor do Polegar para avaliação nutricional de indivíduos em diversas condições clínicas. Método: Estudo de revisão sistemática, realizado conforme a metodologia PreferredReportingItems for SystematicReviewsand Meta-Analyses (PRISMA). Resultados: Foram incluídos 13 artigos originais publicados entre 2004 e 2016. A medida apresentou-se associada/correlacionada aos parâmetros de avaliação do estado nutricional (como peso, índice de massa corporal e Avaliação Subjetiva Global) e aos marcadores da massa muscular (como circunferência braquial, circunferência muscular braquial, área muscular braquial, circunferência da panturrilha e massa muscular). Todas essas correlações foram fracas ou moderadas. Conclusão: A medida pode ser utilizada em diferentes populações, sendo capaz de estimar o estado nutricional e a massa muscular. No entanto, sugere-se que seja empregada de modo complementar à avaliação nutricional, não constituindo um parâmetro único de diagnóstico/monitoramento.

Adductor pollicis muscle thickness and prediction of postoperative mortality in patients with stomach cancer / Espessura do músculo adutor do polegar e predição de mortalidade pós-operatória em pacientes com câncer gástrico

ABSTRACT Background: Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. Adductor pollicis muscle thickness (APMT) appears as an important objective, quick, inexpensive and noninvasive measure to assess the muscle compartment Aim: To compare APMT and other nutritional assessment methods and to correlate these methods with postoperative mortality Methods: Forty-four patients, 29 men and 15 women, mean age of 63±10.2 and ranging from 34-83 years, who underwent nine (20.5%) partial and 34 (77.3%) total gastrectomies due to stomach cancer (stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and laboratorial profile Results: APMT better predicted death (p<0.001) on both, dominant and non-dominant hand, and well correlated with albumin (p=0.039) and PG-SGA (p=0.007) Conclusion: APMT clearly allowed to determine malnutrition and to predict risk of death in patients with gastric cancer.

RESUMO Racional: A desnutrição é muito prevalente em pacientes com câncer gástrico e aumenta o risco de morbidade e mortalidade. A espessura do músculo adutor do polegar (APMT) aparece como uma importante medida objetiva, rápida, barata e não invasiva para avaliar o compartimento muscular. Objetivo: O objetivo deste estudo foi comparar a APMT e outros métodos de avaliação nutricional e correlacionar esses métodos com a mortalidade pós-operatória. Métodos: Quarenta e quatro pacientes, 29 homens e 15 mulheres; média (SD) de 63 anos (10,2) e variando de 34 a 83 anos, que foram submetidos a 9 (20,5%) gastrectomias parciais e 34 (77,3%) totais por câncer de estômago (Estágio II a IIIa) e avaliados no pré operatório por Avaliação Subjetiva Global Produzida Pelo Paciente (PG-SGA), antropometria e perfil laboratorial. Resultados: APMT melhor predisse morte (p<0,001) em ambas mãos, dominante e não-dominante, e se correlacionou bem com albumina (p=0,039) e PG-SGA (p=0,007). Conclusão: APMT permitiu claramente determinar a desnutrição e prever o risco de morte em pacientes com câncer gástrico.