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Ele recebeu metilprednisolona oral &#40;0&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;dia&#41;&#44; com diminui&#231;&#227;o gradual da dose por mais de vinte dias&#46; Houve resolu&#231;&#227;o do edema ap&#243;s a terapia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>b&#41;&#44; mas ele apresentou onicomadese nesses dois dedos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>c&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso 2</span><p id="par0015" class="elsevierStylePara elsevierViewall">Adolescente de 15 anos que apresentou fratura do quarto e quinto ossos do metacarpo &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>a&#41;&#46; O antebra&#231;o&#44; o punho e a m&#227;o foram imobilizados com gesso na posi&#231;&#227;o intr&#237;nseco plus&#46; O gesso cobria do segundo ao quinto dedos e permaneceu no lugar por tr&#234;s semanas&#46; Duas semanas ap&#243;s a remo&#231;&#227;o do gesso&#44; o paciente apresentou edema periungueal do segundo ao quarto dedos&#44; que era mais leve em compara&#231;&#227;o ao primeiro paciente &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>b&#41;&#46; N&#227;o relatava dor nem sintomas neurol&#243;gicos no momento da apresenta&#231;&#227;o&#59; por&#233;m&#44; mencionou um leve formigamento e dor durante a imobiliza&#231;&#227;o&#44; algumas semanas antes&#46; Exame neurol&#243;gico&#44; EMG e exames de sangue n&#227;o revelaram nenhuma altera&#231;&#227;o&#46; Foram aplicados corticosteroides t&#243;picos e o edema foi resolvido em poucas semanas&#44; mas o paciente desenvolveu onicomadese nesses dois dedos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>c&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discuss&#227;o</span><p id="par0020" class="elsevierStylePara elsevierViewall">Um n&#250;mero limitado de pacientes foi relatado at&#233; o momento com altera&#231;&#245;es ungueais associadas &#224; imobiliza&#231;&#227;o gessada do antebra&#231;o e punho&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;9</span></a> A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> resume os casos publicados&#44; incluindo os dois casos descritos aqui&#44; e um total de 20 pacientes &#40;18 homens e duas mulheres&#59; faixa et&#225;ria&#44; 15 a 45 anos&#41; puderam ser recuperados&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;9</span></a> Como os sintomas iniciais &#40;principalmente edema das pregas ungueais&#41; apareceram um pouco depois da remo&#231;&#227;o do gesso &#40;varia&#231;&#227;o de alguns dias a seis semanas&#41;&#44; tanto o dermatologista quanto o ortopedista devem estar cientes dessa rara situa&#231;&#227;o para n&#227;o negligenciar o diagn&#243;stico&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Embora a dor e os sintomas neurol&#243;gicos estivessem ausentes em 14 dos pacientes relatados&#44; v&#225;rios sintomas se desenvolveram ap&#243;s a remo&#231;&#227;o do gesso nos outros seis&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;9</span></a> Esses sintomas foram&#58; dor em queima&#231;&#227;o&#44; parestesia&#44; disestesia&#44; hiperidrose&#44; sensa&#231;&#227;o de frio e formigamento&#46; Dez pacientes &#40;incluindo todos na s&#233;rie de Tosti et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> e o segundo paciente do presente relato de caso&#41; apresentaram queixa de parestesia moderada e dor durante a imobiliza&#231;&#227;o gessada&#46; Embora o exame neurol&#243;gico e os resultados da EMG tenham sido normais em todos os pacientes relatados cujos dados do exame neurol&#243;gico eram aplic&#225;veis &#40;n &#61; 18&#41;&#44; tr&#234;s pacientes foram diagnosticados com distrofia simp&#225;tica reflexa &#40;DSR&#41; sendo dois pacientes por exame de raios&#8208;X &#40;osteoporose irregular&#41; e um paciente por diagn&#243;stico cl&#237;nico&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7&#44;9</span></a> Foi relatado que a pele da m&#227;o afetada era fria&#44; lisa e brilhante em um paciente com DSR&#44; e brilhante&#44; edematosa e semelhante a esclerodermia&#44; com pelos ralos na outra&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;9</span></a> Os dados cl&#237;nicos n&#227;o foram aplic&#225;veis no terceiro paciente com DSR&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A DSR &#233; um transtorno de tr&#234;s etapas excessivamente complexo&#44; com achados cl&#237;nicos bem definidos em todas elas&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> O diagn&#243;stico de DSR geralmente depende do curso cl&#237;nico dos pacientes&#44; pois os resultados dos exames laboratoriais e da avalia&#231;&#227;o neurol&#243;gica s&#227;o normais na maioria dos casos&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;9</span></a> Tamb&#233;m foi relatado que as altera&#231;&#245;es ungueais durante a DSR t&#234;m diferentes causas&#44; al&#233;m da imobiliza&#231;&#227;o gessada&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Uma les&#227;o nervosa &#40;tempor&#225;ria e menos grave que DSR&#41; induzida por press&#227;o causada pela imobiliza&#231;&#227;o gessada tamb&#233;m foi considerada respons&#225;vel pela curta interrup&#231;&#227;o do crescimento da unha em pacientes sem achados t&#237;picos de DSR&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;5</span></a> Essa hip&#243;tese sugere que o crescimento recente da unha causa a inflama&#231;&#227;o e&#47;ou onicomadese ao seu redor&#44; semelhante a um panar&#237;cio bacteriano&#46; O mecanismo de forma&#231;&#227;o dos granulomas piog&#234;nicos em alguns dos pacientes n&#227;o p&#244;de ser identificado&#59; entretanto&#44; a vasculariza&#231;&#227;o excessiva associada &#224; inflama&#231;&#227;o &#233; uma ideia conceb&#237;vel&#46; Como as altera&#231;&#245;es ungueais tamb&#233;m se desenvolveram nos dedos que n&#227;o foram afetados na les&#227;o prim&#225;ria&#44; &#233; mais prov&#225;vel que a imobiliza&#231;&#227;o gessada tenha sido respons&#225;vel pela interrup&#231;&#227;o do crescimento ungueal em vez da inj&#250;ria nervosa em si&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;4&#44;6&#44;8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; o mecanismo das altera&#231;&#245;es ungueais ap&#243;s a remo&#231;&#227;o do gesso do antebra&#231;o e do punho n&#227;o &#233; claramente identificado&#46; As altera&#231;&#245;es ungueais associadas &#224; imobiliza&#231;&#227;o gessada s&#227;o possivelmente muito mais comuns do que as relatadas&#44; por serem f&#225;ceis de passar despercebidas durante a pr&#225;tica di&#225;ria&#46; &#201; importante n&#227;o diagnosticar erroneamente o edema inicial como panar&#237;cio bacteriano para evitar o uso desnecess&#225;rio de antibi&#243;ticos&#46; Como os granulomas piog&#234;nicos apareceram ap&#243;s o edema periungueal e a onicomadese em alguns dos pacientes&#44; acreditamos que o uso precoce de corticosteroides sist&#234;micos pode tratar o edema e evitar os granulomas piog&#234;nicos associados nesses pacientes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Suporte financeiro</span><p id="par0040" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Contribui&#231;&#227;o dos autores</span><p id="par0045" class="elsevierStylePara elsevierViewall">S&#305;la K&#305;l&#305;&#231; Sayar&#58; Conceito&#44; igual&#59; curadoria de dados&#44; igual&#59; investiga&#231;&#227;o&#44; igual&#59; metodologia&#44; igual&#59; supervis&#227;o&#44; principal&#59; visualiza&#231;&#227;o&#44; igual&#59; escrita do projeto original&#44; principal&#59; escrita&#44; revis&#227;o e edi&#231;&#227;o&#44; igual&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Yasin Sayar&#58; Conceito&#44; igual&#59; curadoria de dados&#44; igual&#59; investiga&#231;&#227;o&#44; igual&#59; metodologia&#44; igual&#59; supervis&#227;o&#44; apoio&#59; visualiza&#231;&#227;o&#44; igual&#59; escrita do manuscrito original&#44; apoio&#59; escrita&#44; revis&#227;o e edi&#231;&#227;o&#44; igual&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflito de interesses</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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            1 => "Granuloma piog&#234;nico"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A imobiliza&#231;&#227;o gessada do antebra&#231;o e punho &#233; utilizada no manejo de v&#225;rias les&#245;es das articula&#231;&#245;es ou membros&#46; Altera&#231;&#245;es ungueais&#44; incluindo edema da prega ungueal&#44; onicomadese&#44; granuloma piog&#234;nico e traquion&#237;quia&#44; foram relatados ap&#243;s a remo&#231;&#227;o do gesso em vinte pacientes at&#233; o momento&#46; Embora a distrofia simp&#225;tica reflexa pare&#231;a ser o poss&#237;vel diagn&#243;stico em alguns desses casos&#44; isso n&#227;o &#233; t&#227;o claro quando os sinais neurol&#243;gicos associados est&#227;o ausentes&#46; O mecanismo n&#227;o &#233; claramente identificado em pacientes sem outros achados atribu&#237;dos &#224; distrofia simp&#225;tica reflexa&#44; e a nomenclatura dessa altera&#231;&#227;o at&#237;pica &#233; motivo de debate&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; K&#305;l&#305;&#231; Sayar S&#44; Sayar Y&#46; Nail disorders associated with cast immobilization of the forearm and wrist&#58; report of two cases and review of the literature&#46; An Bras Dermatol&#46; 2021&#59;96&#58;721&#8211;5&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado no Departamento de Dermatologia e Venereologia&#44; Bahe&#351;ehir University Faculty of Medicine&#44; Istanbul&#44; Turquia&#46;</p>"
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          "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Imagens cl&#237;nicas do caso 1&#46; &#40;A&#41;&#44; Edema acentuado das pregas ungueais do terceiro e quarto dedos&#46; &#40;B&#41;&#44; Regress&#227;o do edema&#46; &#40;C&#41;&#44; Onicomadese nos dois dedos&#46;</p>"
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          "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Imagens cl&#237;nicas e radiol&#243;gicas do caso 2&#46; &#40;A&#41;&#44; Fraturas do quarto e quinto ossos metacarpais &#40;imagem de raios&#8208;X&#41;&#59; &#40;B&#41;&#44; Edema da prega ungueal do terceiro e quarto dedos&#46; &#40;C&#41;&#44; Onicomadese nos dois dedos&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">EMG&#44; eletromiografia&#59; M&#44; sexo masculino&#59; F&#44; sexo feminino&#59; GP&#44; granuloma piog&#234;nico&#59; NA&#44; n&#227;o aplic&#225;vel&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> O tempo entre a remo&#231;&#227;o do gesso e o aparecimento dos achados das unhas&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">b</span> O tempo entre a les&#227;o e o aparecimento dos achados da unha&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Autores &#40;ano&#41;&#47; N&#250;mero de pacientes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade &#40;a&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Causa da imobiliza&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tipo de imobiliza&#231;&#227;o gessada e detalhes da aplica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dura&#231;&#227;o<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Achados ungueais&#47; Dedos com unhas afetadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sinais e&#47;ou sintomas neurol&#243;gicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Exame neurol&#243;gico&#47; resultados da EMG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Curso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Presentes autores &#40;2021&#41;&#47;doispacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Lacera&#231;&#227;o do tend&#227;o flexor da zona II &#40;primeiro dedo da m&#227;o direita&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Imobiliza&#231;&#227;o gessada circunferencial &#40;estendendo&#8208;se do 2&#176; ao 5&#176; dedos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 semanas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edema de prega ungueal&#44; onicomadese&#47;3<span class="elsevierStyleSup">o</span>&#8211;4<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides sist&#234;micos&#44; emolientes t&#243;picos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura do 4&#176; e 5&#176; metacarpos &#40;m&#227;o direita&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada na posi&#231;&#227;o intr&#237;nseco plus &#40;estendendo&#8208;se ao 4&#176; ao 5&#176; dedos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edema de prega ungueal&#44; onicomadese&#47; 3&#176;&#8211;4&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor local &#40;durante a imobiliza&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides t&#243;picos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baykal<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> &#40;2018&#41;&#47;um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura da falange m&#233;dia do 3&#176; dedo esquerdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada circunferencial do antebra&#231;o &#43; punho &#40;estendendo&#8208;se at&#233; o 2&#176; ao 5&#176; dedos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GP&#44; edema de prega ungueal&#44; onicomadese&#47; 2&#176; a 4&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides e antibi&#243;ticos sist&#234;micos&#44; antibi&#243;ticos t&#243;picos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thakur<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> &#40;2016&#41;&#47; um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Luxa&#231;&#227;o da articula&#231;&#227;o radioulnar distal esquerda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada desde acima do cotovelo at&#233; os ossos metacarpais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GP&#44; onicomadese&#47; 1<span class="elsevierStyleSup">o</span>&#8211;2<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento da sudorese local&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Curetagem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Whitelaw<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> &#40;2014&#41;&#47; um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura da falange proximal do primeiro dedo esquerdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada estendendo&#8208;se at&#233; a m&#227;o e o pulso &#40;dedos m&#243;veis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edema ungueal e onicomadese&#47; 1&#176; &#8208; 3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pampin<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> &#40;2014&#41;&#47;um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ruptura distal do tend&#227;o do b&#237;ceps braquial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada da metade do bra&#231;o at&#233; a articula&#231;&#227;o metacarpal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GP e onicomadese&#47; 2&#176; &#8211; 4&#176; e 2&#176; &#8211; 5&#176;&#44; respectivamente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Piraccini<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> &#40;2010&#41;&#47; tr&#234;s pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#47;42&#47;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura de pulso ou outro osso do membro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada &#40;n&#227;o&#8208;detalhado&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 meses<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GP&#47; NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor intensa&#44; hiperidrose em um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Remo&#231;&#227;o cir&#250;rgica em 1&#44; tratamento com nitrato de prata em 2 pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa em dois pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pucevich<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> &#40;2008&#41;&#47;um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura no 3&#176; dedo a m&#227;o direita&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada no antebra&#231;o &#43; pulso &#40;n&#227;o detalhado&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Traquion&#237;quia&#47; Todos os dedos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor&#44; perda motora e disestesia do bra&#231;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidratante&#44; alfa&#8208;acetoxi&#225;cido&#44; biotina oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tosti<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> &#40;2001&#41;&#47; nove pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#8211;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura de uma falange em tr&#234;s&#44; um osso metacarpo em dois e do punho em quatro pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada no antebra&#231;o &#43; pulso &#40;n&#227;o detalhado&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#8211;30 dias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GP em todos&#44; onicomadese em tr&#234;s pacientes&#47; n&#227;o detalhado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parestesia e dor moderadas &#40;durante a imobiliza&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tosti<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> &#40;1993&#41;&#47;um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura da articula&#231;&#227;o ulnar&#8208;carpal e les&#227;o do ligamento colateral ulnar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada no antebra&#231;o &#43; pulso &#40;n&#227;o detalhado&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alguns dias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edema de prega ungueal&#47; 3&#176;&#8211; 4&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Formigamento&#44; dor em queima&#231;&#227;o&#44; hiperidrose e sensa&#231;&#227;o de frio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cremes antibi&#243;ticos e antiinflamat&#243;rios sist&#234;micos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2750895.png"
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de pacientes com relato de altera&#231;&#245;es ungueais associados &#224; imobiliza&#231;&#227;o gessada do antebra&#231;o e punho</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
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                            5 => "J&#46;C&#46; Belloti"
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                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:5 [
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            1 => array:3 [
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                            0 => "C&#46; Baykal"
                            1 => "S&#46; K&#305;l&#305;&#231;"
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            3 => array:3 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "A&#46; Pamp&#237;n"
                            1 => "H&#46; Sanz-Robles"
                            2 => "R&#46;A&#46; Feltes"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2013.07.004"
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            ]
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "S&#46;T&#46; Whitelaw"
                            1 => "G&#46; Bourke"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                  ]
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            5 => array:3 [
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                0 => array:2 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;M&#46; Piraccini"
                            1 => "S&#46; Bellavista"
                            2 => "C&#46; Misciali"
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                            5 => "B&#46; Richert"
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                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2010.09906.x"
                      "Revista" => array:6 [
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                          0 => array:2 [
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              ]
            ]
            6 => array:3 [
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              "etiqueta" => "7"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46; Pucevich"
                            1 => "L&#46; Spencer"
                            2 => "J&#46;C&#46; English"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2007.02.028"
                      "Revista" => array:6 [
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                        "fecha" => "2008"
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                        "paginaFinal" => "322"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18222330"
                            "web" => "Medline"
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            7 => array:3 [
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              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Onychomadesis and pyogenic granuloma following cast immobilization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "A&#46; Tosti"
                            1 => "B&#46;M&#46; Piraccini"
                            2 => "F&#46; Camacho-Martinez"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Dermato&#46;"
                        "fecha" => "2001"
                        "volumen" => "137"
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CASO CLÍNICO
Alterações ungueais associadas à imobilização gessada do antebraço e punho: relato de dois casos e revisão da literatura
Sıla Kılıç Sayara,
Autor para correspondência
s_kilic@windowslive.com

Autor para correspondência.
, Yasin Sayarb
a Departamento de Dermatologia e Venereologia, Baheşehir University Faculty of Medicine, Istanbul, Turquia
b Departamento de Ortopedia e Traumatologia, Health Sciences University, Sultan II Abdülhamid Han Training and Research Hospital, Istanbul, Turquia
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foram relatados ap&#243;s a remo&#231;&#227;o do gesso do antebra&#231;o e do punho&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;9</span></a> Embora a distrofia simp&#225;tica reflexa &#40;DSR&#41; pare&#231;a ser o diagn&#243;stico poss&#237;vel na maioria dos casos&#44; isso n&#227;o &#233; muito claro quando os sintomas neurol&#243;gicos associados est&#227;o ausentes&#46; O objetivo aqui &#233; relatar dois pacientes e descrever as caracter&#237;sticas de diversas altera&#231;&#245;es ungueais nesses pacientes ap&#243;s a remo&#231;&#227;o da imobiliza&#231;&#227;o gessada do antebra&#231;o e punho&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Caso 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">Homem de 28 anos de idade&#44; que apresentou lacera&#231;&#227;o do tend&#227;o flexor da zona II do polegar direito em decorr&#234;ncia de um traumatismo perfurante&#46; O tend&#227;o foi cirurgicamente reparado&#44; e a m&#227;o foi imobilizada com gesso que se estendia do meio do antebra&#231;o na parte superior at&#233; as pregas ungueais proximais do segundo ao quinto dedos na parte inferior&#44; por tr&#234;s semanas&#46; Duas semanas ap&#243;s a remo&#231;&#227;o do gesso&#44; ocorreu edema periungueal no terceiro e no quarto dedos da mesma m&#227;o&#44; lembrando panar&#237;cio bacteriano &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>a&#41;&#46; O paciente n&#227;o tinha queixas de dor nem quaisquer sintomas neurol&#243;gicos&#46; O exame neurol&#243;gico e os resultados da eletromiografia &#40;EMG&#41; foram normais&#46; Os n&#237;veis dos reagentes de fase aguda nos exames de sangue e outros exames laboratoriais b&#225;sicos estavam dentro dos limites normais&#46; As imagens de resson&#226;ncia magn&#233;tica mostraram edema ao redor das unhas afetadas&#46; Antibi&#243;ticos t&#243;picos e sist&#234;micos n&#227;o foram eficazes no tratamento do paciente&#46; Ele recebeu metilprednisolona oral &#40;0&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;dia&#41;&#44; com diminui&#231;&#227;o gradual da dose por mais de vinte dias&#46; Houve resolu&#231;&#227;o do edema ap&#243;s a terapia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>b&#41;&#44; mas ele apresentou onicomadese nesses dois dedos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>c&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso 2</span><p id="par0015" class="elsevierStylePara elsevierViewall">Adolescente de 15 anos que apresentou fratura do quarto e quinto ossos do metacarpo &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>a&#41;&#46; O antebra&#231;o&#44; o punho e a m&#227;o foram imobilizados com gesso na posi&#231;&#227;o intr&#237;nseco plus&#46; O gesso cobria do segundo ao quinto dedos e permaneceu no lugar por tr&#234;s semanas&#46; Duas semanas ap&#243;s a remo&#231;&#227;o do gesso&#44; o paciente apresentou edema periungueal do segundo ao quarto dedos&#44; que era mais leve em compara&#231;&#227;o ao primeiro paciente &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>b&#41;&#46; N&#227;o relatava dor nem sintomas neurol&#243;gicos no momento da apresenta&#231;&#227;o&#59; por&#233;m&#44; mencionou um leve formigamento e dor durante a imobiliza&#231;&#227;o&#44; algumas semanas antes&#46; Exame neurol&#243;gico&#44; EMG e exames de sangue n&#227;o revelaram nenhuma altera&#231;&#227;o&#46; Foram aplicados corticosteroides t&#243;picos e o edema foi resolvido em poucas semanas&#44; mas o paciente desenvolveu onicomadese nesses dois dedos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>c&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discuss&#227;o</span><p id="par0020" class="elsevierStylePara elsevierViewall">Um n&#250;mero limitado de pacientes foi relatado at&#233; o momento com altera&#231;&#245;es ungueais associadas &#224; imobiliza&#231;&#227;o gessada do antebra&#231;o e punho&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;9</span></a> A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> resume os casos publicados&#44; incluindo os dois casos descritos aqui&#44; e um total de 20 pacientes &#40;18 homens e duas mulheres&#59; faixa et&#225;ria&#44; 15 a 45 anos&#41; puderam ser recuperados&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;9</span></a> Como os sintomas iniciais &#40;principalmente edema das pregas ungueais&#41; apareceram um pouco depois da remo&#231;&#227;o do gesso &#40;varia&#231;&#227;o de alguns dias a seis semanas&#41;&#44; tanto o dermatologista quanto o ortopedista devem estar cientes dessa rara situa&#231;&#227;o para n&#227;o negligenciar o diagn&#243;stico&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Embora a dor e os sintomas neurol&#243;gicos estivessem ausentes em 14 dos pacientes relatados&#44; v&#225;rios sintomas se desenvolveram ap&#243;s a remo&#231;&#227;o do gesso nos outros seis&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;9</span></a> Esses sintomas foram&#58; dor em queima&#231;&#227;o&#44; parestesia&#44; disestesia&#44; hiperidrose&#44; sensa&#231;&#227;o de frio e formigamento&#46; Dez pacientes &#40;incluindo todos na s&#233;rie de Tosti et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> e o segundo paciente do presente relato de caso&#41; apresentaram queixa de parestesia moderada e dor durante a imobiliza&#231;&#227;o gessada&#46; Embora o exame neurol&#243;gico e os resultados da EMG tenham sido normais em todos os pacientes relatados cujos dados do exame neurol&#243;gico eram aplic&#225;veis &#40;n &#61; 18&#41;&#44; tr&#234;s pacientes foram diagnosticados com distrofia simp&#225;tica reflexa &#40;DSR&#41; sendo dois pacientes por exame de raios&#8208;X &#40;osteoporose irregular&#41; e um paciente por diagn&#243;stico cl&#237;nico&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7&#44;9</span></a> Foi relatado que a pele da m&#227;o afetada era fria&#44; lisa e brilhante em um paciente com DSR&#44; e brilhante&#44; edematosa e semelhante a esclerodermia&#44; com pelos ralos na outra&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;9</span></a> Os dados cl&#237;nicos n&#227;o foram aplic&#225;veis no terceiro paciente com DSR&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A DSR &#233; um transtorno de tr&#234;s etapas excessivamente complexo&#44; com achados cl&#237;nicos bem definidos em todas elas&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> O diagn&#243;stico de DSR geralmente depende do curso cl&#237;nico dos pacientes&#44; pois os resultados dos exames laboratoriais e da avalia&#231;&#227;o neurol&#243;gica s&#227;o normais na maioria dos casos&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;9</span></a> Tamb&#233;m foi relatado que as altera&#231;&#245;es ungueais durante a DSR t&#234;m diferentes causas&#44; al&#233;m da imobiliza&#231;&#227;o gessada&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Uma les&#227;o nervosa &#40;tempor&#225;ria e menos grave que DSR&#41; induzida por press&#227;o causada pela imobiliza&#231;&#227;o gessada tamb&#233;m foi considerada respons&#225;vel pela curta interrup&#231;&#227;o do crescimento da unha em pacientes sem achados t&#237;picos de DSR&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;5</span></a> Essa hip&#243;tese sugere que o crescimento recente da unha causa a inflama&#231;&#227;o e&#47;ou onicomadese ao seu redor&#44; semelhante a um panar&#237;cio bacteriano&#46; O mecanismo de forma&#231;&#227;o dos granulomas piog&#234;nicos em alguns dos pacientes n&#227;o p&#244;de ser identificado&#59; entretanto&#44; a vasculariza&#231;&#227;o excessiva associada &#224; inflama&#231;&#227;o &#233; uma ideia conceb&#237;vel&#46; Como as altera&#231;&#245;es ungueais tamb&#233;m se desenvolveram nos dedos que n&#227;o foram afetados na les&#227;o prim&#225;ria&#44; &#233; mais prov&#225;vel que a imobiliza&#231;&#227;o gessada tenha sido respons&#225;vel pela interrup&#231;&#227;o do crescimento ungueal em vez da inj&#250;ria nervosa em si&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;4&#44;6&#44;8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; o mecanismo das altera&#231;&#245;es ungueais ap&#243;s a remo&#231;&#227;o do gesso do antebra&#231;o e do punho n&#227;o &#233; claramente identificado&#46; As altera&#231;&#245;es ungueais associadas &#224; imobiliza&#231;&#227;o gessada s&#227;o possivelmente muito mais comuns do que as relatadas&#44; por serem f&#225;ceis de passar despercebidas durante a pr&#225;tica di&#225;ria&#46; &#201; importante n&#227;o diagnosticar erroneamente o edema inicial como panar&#237;cio bacteriano para evitar o uso desnecess&#225;rio de antibi&#243;ticos&#46; Como os granulomas piog&#234;nicos apareceram ap&#243;s o edema periungueal e a onicomadese em alguns dos pacientes&#44; acreditamos que o uso precoce de corticosteroides sist&#234;micos pode tratar o edema e evitar os granulomas piog&#234;nicos associados nesses pacientes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Suporte financeiro</span><p id="par0040" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Contribui&#231;&#227;o dos autores</span><p id="par0045" class="elsevierStylePara elsevierViewall">S&#305;la K&#305;l&#305;&#231; Sayar&#58; Conceito&#44; igual&#59; curadoria de dados&#44; igual&#59; investiga&#231;&#227;o&#44; igual&#59; metodologia&#44; igual&#59; supervis&#227;o&#44; principal&#59; visualiza&#231;&#227;o&#44; igual&#59; escrita do projeto original&#44; principal&#59; escrita&#44; revis&#227;o e edi&#231;&#227;o&#44; igual&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Yasin Sayar&#58; Conceito&#44; igual&#59; curadoria de dados&#44; igual&#59; investiga&#231;&#227;o&#44; igual&#59; metodologia&#44; igual&#59; supervis&#227;o&#44; apoio&#59; visualiza&#231;&#227;o&#44; igual&#59; escrita do manuscrito original&#44; apoio&#59; escrita&#44; revis&#227;o e edi&#231;&#227;o&#44; igual&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflito de interesses</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A imobiliza&#231;&#227;o gessada do antebra&#231;o e punho &#233; utilizada no manejo de v&#225;rias les&#245;es das articula&#231;&#245;es ou membros&#46; Altera&#231;&#245;es ungueais&#44; incluindo edema da prega ungueal&#44; onicomadese&#44; granuloma piog&#234;nico e traquion&#237;quia&#44; foram relatados ap&#243;s a remo&#231;&#227;o do gesso em vinte pacientes at&#233; o momento&#46; Embora a distrofia simp&#225;tica reflexa pare&#231;a ser o poss&#237;vel diagn&#243;stico em alguns desses casos&#44; isso n&#227;o &#233; t&#227;o claro quando os sinais neurol&#243;gicos associados est&#227;o ausentes&#46; O mecanismo n&#227;o &#233; claramente identificado em pacientes sem outros achados atribu&#237;dos &#224; distrofia simp&#225;tica reflexa&#44; e a nomenclatura dessa altera&#231;&#227;o at&#237;pica &#233; motivo de debate&#46;</p></span>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">EMG&#44; eletromiografia&#59; M&#44; sexo masculino&#59; F&#44; sexo feminino&#59; GP&#44; granuloma piog&#234;nico&#59; NA&#44; n&#227;o aplic&#225;vel&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> O tempo entre a remo&#231;&#227;o do gesso e o aparecimento dos achados das unhas&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">b</span> O tempo entre a les&#227;o e o aparecimento dos achados da unha&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Autores &#40;ano&#41;&#47; N&#250;mero de pacientes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dura&#231;&#227;o<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Exame neurol&#243;gico&#47; resultados da EMG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Curso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presentes autores &#40;2021&#41;&#47;doispacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lacera&#231;&#227;o do tend&#227;o flexor da zona II &#40;primeiro dedo da m&#227;o direita&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada circunferencial &#40;estendendo&#8208;se do 2&#176; ao 5&#176; dedos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edema de prega ungueal&#44; onicomadese&#47;3<span class="elsevierStyleSup">o</span>&#8211;4<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides sist&#234;micos&#44; emolientes t&#243;picos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura do 4&#176; e 5&#176; metacarpos &#40;m&#227;o direita&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada na posi&#231;&#227;o intr&#237;nseco plus &#40;estendendo&#8208;se ao 4&#176; ao 5&#176; dedos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edema de prega ungueal&#44; onicomadese&#47; 3&#176;&#8211;4&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor local &#40;durante a imobiliza&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides t&#243;picos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baykal<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> &#40;2018&#41;&#47;um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura da falange m&#233;dia do 3&#176; dedo esquerdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada circunferencial do antebra&#231;o &#43; punho &#40;estendendo&#8208;se at&#233; o 2&#176; ao 5&#176; dedos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GP&#44; edema de prega ungueal&#44; onicomadese&#47; 2&#176; a 4&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides e antibi&#243;ticos sist&#234;micos&#44; antibi&#243;ticos t&#243;picos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thakur<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> &#40;2016&#41;&#47; um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Luxa&#231;&#227;o da articula&#231;&#227;o radioulnar distal esquerda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada desde acima do cotovelo at&#233; os ossos metacarpais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GP&#44; onicomadese&#47; 1<span class="elsevierStyleSup">o</span>&#8211;2<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento da sudorese local&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Curetagem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Whitelaw<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> &#40;2014&#41;&#47; um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura da falange proximal do primeiro dedo esquerdo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada estendendo&#8208;se at&#233; a m&#227;o e o pulso &#40;dedos m&#243;veis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edema ungueal e onicomadese&#47; 1&#176; &#8208; 3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pampin<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> &#40;2014&#41;&#47;um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ruptura distal do tend&#227;o do b&#237;ceps braquial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada da metade do bra&#231;o at&#233; a articula&#231;&#227;o metacarpal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GP e onicomadese&#47; 2&#176; &#8211; 4&#176; e 2&#176; &#8211; 5&#176;&#44; respectivamente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Piraccini<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> &#40;2010&#41;&#47; tr&#234;s pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#47;42&#47;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura de pulso ou outro osso do membro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada &#40;n&#227;o&#8208;detalhado&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 meses<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GP&#47; NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor intensa&#44; hiperidrose em um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Remo&#231;&#227;o cir&#250;rgica em 1&#44; tratamento com nitrato de prata em 2 pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa em dois pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pucevich<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> &#40;2008&#41;&#47;um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura no 3&#176; dedo a m&#227;o direita&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada no antebra&#231;o &#43; pulso &#40;n&#227;o detalhado&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Traquion&#237;quia&#47; Todos os dedos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor&#44; perda motora e disestesia do bra&#231;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidratante&#44; alfa&#8208;acetoxi&#225;cido&#44; biotina oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tosti<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> &#40;2001&#41;&#47; nove pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#8211;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura de uma falange em tr&#234;s&#44; um osso metacarpo em dois e do punho em quatro pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada no antebra&#231;o &#43; pulso &#40;n&#227;o detalhado&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#8211;30 dias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GP em todos&#44; onicomadese em tr&#234;s pacientes&#47; n&#227;o detalhado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parestesia e dor moderadas &#40;durante a imobiliza&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cicatriza&#231;&#227;o completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tosti<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> &#40;1993&#41;&#47;um paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fratura da articula&#231;&#227;o ulnar&#8208;carpal e les&#227;o do ligamento colateral ulnar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imobiliza&#231;&#227;o gessada no antebra&#231;o &#43; pulso &#40;n&#227;o detalhado&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alguns dias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edema de prega ungueal&#47; 3&#176;&#8211; 4&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Formigamento&#44; dor em queima&#231;&#227;o&#44; hiperidrose e sensa&#231;&#227;o de frio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&#47; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cremes antibi&#243;ticos e antiinflamat&#243;rios sist&#234;micos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2750895.png"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de pacientes com relato de altera&#231;&#245;es ungueais associados &#224; imobiliza&#231;&#227;o gessada do antebra&#231;o e punho</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
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        0 => array:2 [
          "identificador" => "bibs0015"
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            3 => array:3 [
              "identificador" => "bib0070"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "A&#46; Pamp&#237;n"
                            1 => "H&#46; Sanz-Robles"
                            2 => "R&#46;A&#46; Feltes"
                            3 => "J&#46;L&#46; L&#243;pez-Estebaranz"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2013.07.004"
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                        "paginaFinal" => "529"
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            ]
            4 => array:3 [
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                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => false
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                            1 => "G&#46; Bourke"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2014"
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                  ]
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              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
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                0 => array:2 [
                  "contribucion" => array:1 [
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