Anatomia óssea e muscular do antebraço e mão de Chrysocyon brachyurus (Carnivora, Canidae) / Bone and muscular anatomy of the antibone and handof Chrysocyon brachyurus (Carnivora, Canidae)

O lobo-guará Chrysocyon brachyurus Illiger, 1815, é o maior canídeo da América do Sul, pesa cerca de 25 kg quando adulto e está ameaçado de extinção. Descrições anatômicas contribuem para a complementação das informações sobre espécies silvestres e para implicações conservacionistas, clínicas e cirúrgicas. Objetivou-se descrever os ossos e os músculos do antebraço e mão do lobo-guará. A preparação das peças foi feita a partir dos métodos usuais de dissecação, em animais preservados em solução de formol a 10%. Os espécimes pertencem ao acervo didático do Laboratório de Ensino e Pesquisa em Animais Silvestres da UFU e são provenientes de indivíduos atropelados. Os ossos descritos foram: rádio, ulna, ossos cárpico acessório, cárpico ulnar e cárpico intermédio; ossos cárpicos I, II, III e IV; ossos metacárpicos I, II, III, IV, V; falanges proximais, falanges médias e falanges distais do primeiro ao quinto dedo. Os músculos observados foram: extensor radial do carpo; pronador redondo; braquiorradial; extensor comum dos dedos; extensor ulnar do carpo; extensor lateral dos dedos; supinador; abdutor longo do dedo I; flexor radial do carpo; flexor profundo dos dedos; flexor superficial dos dedos; flexor ulnar do carpo; pronador quadrado; interflexor; lumbricais; abdutor curto dos dedos I e II e flexor curto do dedo I.

The maned wolf Chrysocyon brachyurus (Illiger, 1815) is the largest canid in South America, weighs about 25 kg as an adult and is threatened of extinction. Anatomical descriptions contribute to the complementation of information on wild species and for conservation, clinical and surgical implications. The purpose of this study was to describe the bones and muscles of the forearm and hand of the maned wolf. The methodology was through the usual dissecting methods in animals preserved in 10% formalin solution. The animals belong to the didactic collection of the Laboratory of Teaching and Research in Wild Animals of the UFU and come from run over. The bones evaluated were: radius, ulna, carpal accessory, carpi ulnar and carpi intermedium; carpal bones I, II, III and IV; metacarpal bones I, II, III, IV, V; proximal phalanges, middle phalanges and distal phalanges from first to fifth finger. The muscles observed were: radial extensor carpal; pronator round; brachioradial; common extensor of fingers; ulnar carpal extensor; lateral extensor of the fingers; supinator; abductor long finger I; flexor carpi radialis; flexor deep fingers; superficial flexor of the fingers; ulnar flexor of the carpus; square pronator; interflexor; lumbrils; short abductor of fingers I and II and short flexor of finger I.

Secuelas morfo-funcionales en mujeres operadas de cáncer de mama en las regiones de la Araucanía y del Bío-Bío, Chile / Morphofunctional consequences in women operated for breast cancer of the region of Araucanía and Bío-Bío, Chile

El tratamiento quirúrgico del cáncer de mama puede dejar secuelas tardías tales como escápula alada, pérdida de movilidad articular del hombro, sobrepeso, etc. Basado en lo anterior, el objetivo del presente estudio fue describir las secuelas morfofuncionales en mujeres operadas de cáncer de mama de las regiones de la Araucanía y del Bío-Bío, Chile, explorando también si el procedimiento quirúrgico conllevaría a la presencia de escápula alada. Para ello, se realizó un estudio cuantitativo, observacional y de corte transversal en treinta mujeres operadas de cáncer de mama, de edades comprendidas entre 28 y 76 años (55,67±11,60). Un profesional entrenado evaluó peso, estatura, índice de masa corporal (IMC), índice de cintura cadera (ICC), rangos articulares de hombro (ROM, Range of Movement) y fuerza prensil, aplicándose además la prueba de Hoppenfeld para identificar escápula alada. Los resultados mostraron diferencias significativas en el ROM a la abducción de hombro (p<0,05), correlación significativa positiva de leve (r=0,370) a moderada (r=0,514) entre el ROM del lado afectado tanto para la flexión como la abducción con la fuerza prensil. Destacan, un IMC de 28,91±5,31 kg/m2, un ICC de 0,86±0,06 cm y la presencia de escápula alada en el 36,7 % de las participantes. No se encontró asociación entre el abordaje quirúrgico y la presencia de escápula alada. Hubo secuelas morfo-funcionales en las mujeres en estudio, destacándose las alteraciones en el rango de movimiento del miembro superior, sobrepeso, riesgo cardiovascular y la presencia de escápula alada, sin asociarse al tipo de abordaje quirúrgico.

Surgical treatment of breast cancer can leave late sequelae such as winged scapula, loss of joint mobility of the shoulder, overweight, etc. Based on the above, the objective of the present study was to describe the morpho-functional sequelae in women operated on for breast cancer from the regions of Araucanía and Del BíoBío, Chile, also exploring whether the surgical procedure would lead to the presence of scapula winged. For this, a quantitative, observational and cross-sectional study was conducted in thirty women operated on for breast cancer, aged between 28 and 76 years (55.67 ± 11.60). A trained professional evaluated weight, height, body mass index (BMI), hip waist index (ICC), shoulder joint ranges(ROM, Range of Movement) and prehensile strength, and applied the Hoppenfeld test to identify the winged scapula. The results showed significant differences in the ROM to shoulder abduction (p <0.05), positive significant correlation of mild (r = 0.370) to moderate (r = 0.514) between the ROM of the affected side for both flexion and abduction with prehensile force. Highlights, a BMI of 28.91 ± 5.31 kg / m2, an ICC of 0.86 ± 0.06 cm and the presence of winged scapula in 36.7 % of the participants. No association was found between the surgical approach and the presence of the winged scapula. There were morphofunctional sequelae in the women under study, highlighting the alterations in the range of movement of the upper limb, overweight, cardiovascular risk and the presence of the winged scapula, without being associated with the type of surgical approach.

Anátomo-radiografia dos ossos longos do membro torácico do Tamandua tetradactyla / Anatomo-radiography of long-bones in thoracic limb ofTamandua tetradactyla

Objetivou-se descrever os acidentes anatômicos dos ossos longos do membro torácico de Tamandua tetradactyla por meio de análises macroscópicas e radiográficas. Foram utilizados 34 espécimes, que foram a óbito por atropelamento. A avaliação do úmero demonstrou as mesmas estruturas presentes nos animais domésticos, além de outras sem prévia descrição. Já no antebraço, rádio e ulna se apresentaram completamente separados, e apesar de, como o úmero, serem identificados alguns dos mesmos acidentes anatômicos descritos em outras espécies, também notamos particularidades. Todas as estruturas descritas na análise macroscópica foram identificadas à radiografia, quando realizada em pelo menos duas projeções ortogonais. As estruturas anátomo-radiográficas dos ossos longos do T. tetradactyla demonstraram grande variação anatômica em comparação a outros mamíferos, o que torna a referida espécie muito singular. Assim o conhecimento de suas particularidades é fundamental para abordagens clínico-cirúrgicas mais seguras.

The objective was to describe the anatomical accidents of the long bones of the thoracic limb of Tamandua tetradactyla by means of macroscopic and radiographic analyzes. We used 34 specimens, which were deaths by running over. Evaluation of the humerus demonstrated the same structures present in domestic animals, besides others without previous description. In the forearm, radius and ulna were completely separated, and although, like the humerus, some of the same anatomical accidents described in other species were identified, we also noticed particularities. All the structures described in the macroscopic analysis were identified on radiography, when performed in at least two orthogonal projections. The anatomic-radiographic structures of the long bones of T. tetradactyla showed great anatomical variation compared to other mammals, which makes the species very unique. Thus knowledge of their particularities is fundamental for safer clinical-surgical approaches.

Systemic effects of experimental spinal cord injury on bone healing in rabbit

loss after spinal cord injury leads to increased fragility of bone and subsequent risk for low-trauma fractures in the sublesional parts of the body. Although in such injuries upper limbs are normally innervated, bone loss may occur in the upper extremities. The present study was designed to de-termine the systemic effects of spinal cord injury on the fracture healing of upper limbs in rabbits. Twenty nine skeletally mature New Zealand white rabbits received a transverse mid-humeral open osteotomy in the left upper limb with the use of a standardized technique and spinal cord injury was done using forceps model at T8 level. The animals were divided into three groups: experimental [laminectomy, spinal cord injury, and osteotomy], sham [laminectomy and osteotomy], and control [osteotomy alone]. The bone healing score was calculated using modified Sandhu system by two independent pathologists. The mean ['SD] of healing scores in experimental, control, and sham groups were 7.22 [ +/- 3.6], 8.6 [ +/- 3.3], and 8.5 [ +/- 4.3] respectively [P = 0.68]. The percentage of mesenchymal [20%] and cartilaginous tissue [35%] showed a slightly higher value in the experimental group compared with the sham group [15% and 20% respectively]. A reverse pattern was seen concerning the percentage of trabecular bone, though as a whole there was no significant difference regarding the percentage of selected components of bone healing between the three trial groups. Fracture healing in innervated upper limbs is not influenced by the systemic effects of spinal cord injury

Desenvolvimento e validacao de versao brasileira do questionario de avaliacao funcional dos membros superiores DASH - disabilities of the Arm, Shoulder and Hand / Development and validation of Brazilian version of the questionnaire for assessing performance of senior members DASH - disabilities of the arm, shoulder and hand

O questionario DASH e uma escala de avaliação funcional dos membros superiores, descrito na lingua inglesa em 1996. Tem hoje vinte e cinco versões ingluindo uma brasileira elaborada na Escola Paulista de Medicina (EPM). (AL)

[Disarticulation of the shoulder due to a high voltage electrical burn about 2 cases]

The high-voltage electrical bums cause an exceedingly high rate of morbidity resulting from the massive necrosis of deeper structures often necessitating major limb amputations. The authors report two rare cases of high-voltage electrical burns occurring accidentally, with a 49 and 19-year-old men, after an indirect contact with a high-voltage line. These high-voltage electrical burus caused massive necrosis and extended necrosis in the upper limb requiring the recourse to a disarticulation the shoulder. The indications and the operative techniques used are discussed

Sífilis congenita presentación de un caso clínico radiológico / Congenital syphilis radiological presentation of a clinical case

La sífilis congénita tiene origen en la infección materna y se debe a la transmisión que sufre el feto por vía transplacentaria durante el embarazo. En paises subdesarrollados se puede mencionar como factor de riesgo la ausencia de un diagnóstico precoz en los controles prenatales y la poca información sobre todo en las madres adolescentes hacia esta enfermedad, la misma que avanza hacia la muerte in útero del feto, o al nacimiento con múltiples alteraciones del recien nacido. Se presenta el caso de un neonato cuya madre infectada no recibio tratamiento y posterior al nacimiento el neonato presentó clínica significativa por lo que se le realizaron una serie de exámenes, dentro de los que destacan los radiológicos en huesos largos, donde se advierten alteraciones típicas de esta enfermedad.

Congenital syphilis originates by maternal infection and is due to the transplacental transmission which the fetus suffers during pregnancy. In underdeveloped countries, the absence of an early diagnostic test during prenatal care has to be mentioned as a risk factor as well as the poor information on this disease that exists among mothers, especially teenage mothers. Due to these facts the progression of the disease frequently leads to death in uterus of the fetus or to multiple birth defects when the baby is born.We present the case of a newborn baby whose infected mother was not treated, and who after birth presented important clinical signs due to which a series of tests were carried out among which the radiology of the long bones stands out where the typical alterations of the disease are seen.

Treatment of fractures of long bones with flixible intramedullary nailing [minimal invasive technique]

Intramedullary nailing to fix femoral shaft fractures have been described by Rush [Rush, 1968], who used the rods he designed. The technique was made popular by Ender and Simon-Weidner [Ender et al. 1970] in Europe and by Pankovitch [Pankovitch, 1987] in the United States. The principle of osteosynthesis with intramedullary fixation is a biomechanic idea that aims at developing the bridging of external callus; traction forces are transformed to compression forces on the fracture by two bent pins that cross each other and touch the bone at three points. The flexibility of the pins allows microscopic oscillating movements, putting changing compression on the different parts of the fracture line. Under radiographic control, fractures of the femur, tibia and humerus were stabilized with multiple pins according to the diameter of the medulla of the shaft. Forearm fractures were splinted with a single pin each in radius and ulna. The method is safe in elective trauma surgery and will especially be useful in poly traumatized patients with minimal x-ray exposure in a short time. During a 2-year period [2002-2003], 58 patients were treated with intramedullary stabilization with Ender nails. Thirty patients with trochanteric fractures had a median age of 65 years and fourteen patients with tibial fractures had a median age of 30 years. Four patients with humeral shaft fractures had a median age of 45 years and ten patients with fractures of the forearm had a median age of 20 years. In our results, trochanteric fractures united in 26 cases [86.6% excellent results] and penetration of the pins and varus deformity in 4 cases [13.4%]. Tibial fractures united in 12 cases [85.6% excellent results] and varus deformity less than 30 degrees in one case [7.2%] and posterior angulation in one case [7.2%]. Forearm fractures united in 8 cases [80% excellent results] and delayed union in 2 cases [20%]. Humeral shaft fractures united in 3 cases [75% excellent results] and delayed union in 1 case [25%].In conclusion, nailing with flexible prebent Ender nails reduces the operating period, x-ray exposure, and allow minimal surgical wound especially in trochanteric fractures. The use of this technique is not ideal in unstable fractures because the nails fail to control external rotation and shortening

Upper Limb lengthening in children and adolescents using monoiaterai fixators

Upper limb lengthening is indicated in large length discrepancies, severe angular deformities due to exostosis, trauma to the epiphyseal plate or congenital deficiency, which may result in functional and cosmetic problems. In our work, 8 upper limb segments in 8 patients were lengthened, which included 6 ulnae, 1 radius and 1 humerus. The cases included 3 patients with multiple hereditary osteochondromatosis, 2 patients with congenital short ulna and dislocated head radius and 2 post-traumatic patients with [pbyseal injuries and old fractures] and one patient with Ollier's disease. The average age at the time of surgery was 11.5 years [range 5-19]. In all cases the Orthofix Limb reconstruction system LRS [pediatric size] was used. Callotasis method was applied. The average follow up period was 19.5 months [range 6- 44]. The average lengthening achieved was 3 cm [range 2.3-5]. The percentage increase over initial length averaged 20% [range 15-31%]. The healing index [HI] averaged 45.7 days/cm. In one case callus deformity occurred and temporary decrease of the radio-carpal joint mobility occurred in another case. In conclusion, the results of our work on upper limb lengthening as regards the functional and aesthetic out come, the complication rate and the healing [HI] index were satisfactory

Método strain index: aplicado para evaluar trabajos con riesgo de desarrollar trastornos dolorosos de extremidad superior distal / Strain index: applied to risk of upper limb muscle skeletal disorders evaluation

Considerando el aumento en la sintomatología musculo-esquelética de las extremidades superiores de trabajadores, donde se requieren posturas sostenidas, trabajo con esfuerzo y movimientos repetidos, fue establecido un programa para la detección y prevención de lesiones de extremidades superiores en una industria textil de Santiago, Chile. Se estudiaron clínicamente 256 trabajadores y mediante un método semicuantitativo (Strain index), fue evaluado el riesgo de sufrir lesiones músculo-esqueléticas en los puestos de trabajo. Se determinó que el 47 por ciento de los trabajadores estaba potencialmente en riesgo de desarrollar alguna lesión músculo-esquelética de la mano y muñeca. Los puestos de trabajo más inadecuados (Strain index > a 10 puntos) coincidieron con los trabajadores con el grado más alto de dolor durante la prueba. El 33 por ciento del grupo estudiado reveló tener una patología de mano y muñeca. Un 20 por ciento del grupo era sano, con la puntuación de Strain index < a 7 puntos, en sus respectivos puestos de trabajo. Además, se realizaron intervenciones de ergonomía en los puestos de trabajo; capacitación sobre autocuidado, detección temprana de síntomas, rotación de puestos de trabajo e implementación de una pausa activa, con lo cual finalmente hubo una significativa disminución de las lesiones de extremidad superior

Anatomia humana aplicada: mienbros / Anatomia Humana aplicada / Applied human anatomy: mienbros

Contiene: Osteologia; huesos del miembro superior; huesos del miembro inferior, artrologia; miologia; vasos y nervios; arterias; venas; linfaticos; nervios; caracteristicas clinicas; figuras y esquemas

Equipamento de apoio para membros superiores: uma nova proposta ergonômica / Arm support equipment: a new ergonomic proposal

O presente artigo relata o caso clínico de uma cirurgiä-dentista que desenvolveu lesäo típica de DORT (Doença Osteomuscular Relacionada ao Trabalho) e, para que seus movimentos näo ficassem limitados, inventou um equipamento acessório adaptável a qualquer cadeira odontológica. O objetivo deste equipamento é proporcionar um apoio funcional e ergonômico para toda a musculatura da cintura escapular, coluna cervical e articulaçäo dos membros superiores. Também constatou que o seu uso precoce e adequado reduz a fadiga muscular e tendinosa e contribui para a prevençäo da DORT

Estimulacao eletrica neuromuscular e exercicios com movimentos na diagonal para ganho de forca em biceps e triceps braquial / Neuromuscular electrical stimulation and diagonal exercises to incremental of strength in biceps and triceps braquial

O proposito deste estudo foi avaliar os efeitos do exercicio contra-resistido em diagonal com halter e da estimulacao eletrica neuromuscular(EENM) combinada com exercicio isometrico ou combinada com exercicio contra-resistido em diagonal com halter no inremento de forca e no aumento de massa nos musculos biceps e triceps braquial. Para isso, 28 individuos de ambos os sexos foram divididos em quatro grupos (n=7 cada): grupo I - exercicios contra-resistidos em diagonal com halter; grupo II - EENM associado a isomtria; grupo III - exercicio contra-resistido em diagonal com halter associado a EENM; e o grupo IV - controle. Todos os voluntarios foram submetidos a um teste incremental de membros superiores (TIMS) com movimentos em diagonal, seguindo os principios do metodo de facilitacao neuromuscular proprioceptiva(FNP). Foram controladas, nesse teste, as seguintes variaveis: esforco de membros superiores(Escala de Borg), pressao arterial (PA), frequencia cardiaca (FC), perimetria e tempo em que o voluntario realizou o teste e a carga em que terminou. Apos 24 sessoes de treinamento, realizadas tres vezes por semana com a carga fixa de 50 por cento da carga maxima obtida no TMS, foi repetida a avaliacao. Diferencas significativas (p<0,05) foram encontradas na carga e no tempo pos-treinamento no grupo III e no aumento da perimetria no membro superior esquerdo do grupo I. Nao houve diferenca significativa para Escala de Borg entre os grupos, sugerindo a necessidade de mais pesuisas na area

Surgical management of infected bone cavities

Thirty patients with chronic bone infection and infected bone cavities in different skeletal sites were treated surgically by radical debridement and obliteration of the dead space either by cancellous bone grafting or by local muscle transposition, together with specific antibiotic therapy after proper identification of the infecting bacteria. These cases were done in the period from 1994 to 1997. Half of the cases [group I] [fifteen cases] were treated surgically by radical debridement and obliteration of the dead space by cancellous bone grafting. The other fifteen cases [group II] were treated by radical debridement and obliteration of the dead space by local muscle transposition. Results were evaluated both clinically and statistically. Clinically local muscle transposition for obliteration of bone cavities gave better results [93% eradication of infection] than cancellous bone grafting [80% eradication of infection]. Statistically there are no significant differences between both methods of treatment

Síndrome de Freeman-Sheldon. Revisión bibliográfica / Freeman-Sheldon syndrome. A bibliographic review

Se realiza una revisión bibliográfica actualizada sobre las peculiaridades clínicas de la displasia craneocarpotarsal o síndrome de Freeman-Sheldon. Los hallazgos característicos de este síndrome se presentan en el nacimiento, con predominio de anomalías musculoesqueléticas, cuyos signos relevantes fueron la microstomía, la hipoplasia del tercio medio de la cara y el surco en forma de H en el mentón, signo patognómico. El diagnóstico de esta afección se efectúa por los hallazgos faciales y de los miembros; de mucha utilidad resultaron los estudios radiográficos de cráneo, la biopsia del músculo buccinador y los estudios electromiográficos. El tratamiento quirúrgico se indica para mejorar la apariencia facial y la función de las manos y de los pies. Se profundiza en los aspectos clínicos, diagnóstico y terapéuticos de esta enfermedad

Injerto vascularizado de Peroné y minifijador externo en defectos óseos del miembro superior / Vascularized fibular graft and external minifixator in bone defects of the upper extremity

Se realiza un estudio retrospectivo descriptivo donde se muestran los resultados de 10 pacientes tratados con injerto vascularizado de peroné y minifijador externo modelo del Profesor Dr. Sc. Rodrígo Álvarez Cambras, tratados en el período comprendido de enero de 1996 a febrero del 2001, debido a defectos óseos > 6 cm con el objetivo de evaluar la efectividad de esta técnica quirúrgica. De estos pacientes, el 50 (por ciento) pertenece al sexo masculino y femenino respectivamente, con rango de edad entre 12 y 48 años, (el 20 por ciento húmero, 50 por ciento cúbito y 30 por ciento radio). El tiempo promedio de consolidación fue de 29 semanas. De las complicaciones 2 requirieron tratamiento quirúrgico (20 por ciento). Un foco seudoartrósico y una fractura por fatiga que se solucionaron con tratamiento quirúrgico. La evaluación de la técnica fue de 8 (80 por ciento) bueno y 2 (20 por ciento) regular, por lo que podemos concluir que la técnica efectiva para los defectos óseos > 6 cm en el miembro superior

Utilizaçäo dos monofilamentos de Semmes-Weinstein na avaliaçäo de sensibilidade dos membros superiores de pacientes hansenianos atendidos no Distrito Federal / Use of Semmes-Weisntein monofilaments to evaluate sensitivity of upper limbs of Hansen's disease patients attended in the Federal District

O presente trabalho teve como objetivo identificar a prevalência das alteraçöes de sensibilidade nos membros superiores dos pacientes hansenianos inscritos no Programa de Controle de Hanseníase do Distrito Federal. Trata-se de um estudo descritivo de delineamento transversal cuja amostra constou 80 pacientes e o instrumento utilizado na coleta de dados foram os monofilamentos de Semmes-Weinstein, também conhecidos como estesiômetro (modelo de bolso-"Sensikit"). O estesiômetro consite em um instrumento de grande importância na prática clínica. As informaçöes evidenciaram que a grande maioria acima de 50(por cento) dos pacientes em todas as formas clínicas responderam ao estímulo do monofilamento verde, indicando com isso que a sensibilidade na mäo encontrava-se normal. O trabalho conclui, e concorda com a literatura, que a perda da sensibilidade consiste no principal fator fisiopatogênico das deficiencias fisícas nos membros supeiores dos pacientes hansenianos