{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:52:51Z","timestamp":1765846371240,"version":"3.48.0"},"reference-count":4,"publisher":"Georg Thieme Verlag KG","issue":"05","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":75,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev Bras Ortop (Sao Paulo)"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Resumo<\/jats:title>\n                  <jats:p>As fraturas extra-oitavas da quinta falange proximal s\u00e3o les\u00f5es fis\u00e1rias do tipo II de Salter-Harris e provocam desvio ulnar e angula\u00e7\u00e3o dorsal. A redu\u00e7\u00e3o inadequada dessas fraturas pode causar deformidade est\u00e9tica, perda de alinhamento e comprometimento funcional. M\u00e9todos tradicionais de redu\u00e7\u00e3o, como a manobra de Jahss, podem ser tecnicamente complexas, agressiva e frequentemente exigem seda\u00e7\u00e3o ou cirurgia, o que limita seu uso em crian\u00e7as pequenas e ambientes com recursos limitados.<\/jats:p>\n                  <jats:p>Relatamos nossa experi\u00eancia com a \u201ct\u00e9cnica do l\u00e1pis\u201d assistida por fulcro para redu\u00e7\u00e3o fechada em quatro crian\u00e7as, com idades entre 4 e 11 anos, sob bloqueio nervoso digital sem seda\u00e7\u00e3o ou tra\u00e7\u00e3o. O m\u00e9todo emprega um l\u00e1pis simples, que atua como fulcro, posicionado na base do quarto espa\u00e7o interdigital pr\u00f3ximo \u00e0 articula\u00e7\u00e3o metacarpofalangiana. Uma leve press\u00e3o de adu\u00e7\u00e3o e flex\u00e3o \u00e9 aplicada \u00e0 falange proximal, o que corrige o desvio ulnar e a angula\u00e7\u00e3o dorsal por alavancagem biomec\u00e2nica. A redu\u00e7\u00e3o foi confirmada cl\u00ednica e radiograficamente, realizando-se imobiliza\u00e7\u00e3o solid\u00e1ria com a t\u00e9cnica de \u201cbuddy strapping\u201d ou tala de estanho, mantida por 3 semanas.<\/jats:p>\n                  <jats:p>Na consulta de acompanhamento, realizada 6 a 12 semanas ap\u00f3s o procedimento, todos os pacientes apresentaram redu\u00e7\u00e3o est\u00e1vel, cicatriza\u00e7\u00e3o sem intercorr\u00eancias, amplitude de movimento completa e indolor, e retorno \u00e0s atividades b\u00e1sicas. Os resultados funcionais avaliados pelo escore Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) foram excelentes: dois pacientes com pontua\u00e7\u00e3o 0, um com 2,27 e o \u00faltimo com 4,55. N\u00e3o foram observadas complica\u00e7\u00f5es ou novas luxa\u00e7\u00f5es.<\/jats:p>\n                  <jats:p>A t\u00e9cnica do fulcro com l\u00e1pis \u00e9 simples, segura, reprodut\u00edvel e econ\u00f4mica. Representa uma valiosa adi\u00e7\u00e3o ao arsenal de m\u00e9dicos para tratamento de fraturas extra-oitavas pedi\u00e1tricas, particularmente em ambulat\u00f3rios, emerg\u00eancias e institui\u00e7\u00f5es com poucos recursos.<\/jats:p>","DOI":"10.1055\/s-0045-1813232","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:50:16Z","timestamp":1765846216000},"page":"001-005","source":"Crossref","is-referenced-by-count":0,"title":["T\u00e9cnica do fulcro com l\u00e1pis: Um m\u00e9todo simples para redu\u00e7\u00e3o fechada de fraturas da falange proximal por mecanismo de hiperabdu\u00e7\u00e3o, o \u201cmecanismo do pianista\u201d, em crian\u00e7as"],"prefix":"10.1055","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6474-4285","authenticated-orcid":false,"given":"Vivek M.","family":"Sodhai","sequence":"additional","affiliation":[{"name":"Departamento de Ortopedia Pedi\u00e1trica, Sancheti Institute for Orthopaedics & Rehabilitation, Pune, \u00cdndia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1203-2569","authenticated-orcid":false,"given":"Darshan","family":"Munot","sequence":"additional","affiliation":[{"name":"Departamento de Ortopedia Pedi\u00e1trica, Sancheti Institute for Orthopaedics & Rehabilitation, Pune, \u00cdndia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3908-2034","authenticated-orcid":false,"given":"Rahul","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"Departamento de Ortopedia Pedi\u00e1trica, Sancheti Institute for Orthopaedics & Rehabilitation, Pune, \u00cdndia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8821-9730","authenticated-orcid":false,"given":"Sandeep","family":"Patwardhan","sequence":"additional","affiliation":[{"name":"Departamento de Ortopedia Pedi\u00e1trica, Sancheti Institute for Orthopaedics & Rehabilitation, Pune, \u00cdndia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"publisher","first-page":"270","DOI":"10.5811\/cpcem.2021.3.51806","article-title":"\u201cOne Note Higher\u201d: A Unique Pediatric Hand Fracture","volume":"5","author":"S Szymanski","year":"2021","journal-title":"Clin Pract Cases Emerg Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.jpeds.2017.03.018","article-title":"Extra-Octave Fracture in a 14-Year-Old Basketball Player","volume":"186","author":"L Mims","year":"2017","journal-title":"J Pediatr"},{"issue":"01","key":"ref3","first-page":"178","article-title":"Fractures of the metacarpals: a new method of reduction and immobilization","volume":"20","author":"S A Jahss","year":"1938","journal-title":"J Bone Joint Surg Am"},{"issue":"04","key":"ref4","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/S0749-0712(21)01068-4","article-title":"Wrist and hand skeletal injuries in children","volume":"6","author":"E Beatty","year":"1990","journal-title":"Hand Clin"}],"container-title":["Revista Brasileira de Ortopedia"],"original-title":[],"language":"pt","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0045-1813232.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:50:19Z","timestamp":1765846219000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0045-1813232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":4,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2025,11,4]]},"published-print":{"date-parts":[[2025,10]]}},"alternative-id":["s00451813232"],"URL":"https:\/\/doi.org\/10.1055\/s-0045-1813232","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0102-3616","1982-4378"],"issn-type":[{"value":"0102-3616","type":"print"},{"value":"1982-4378","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]}}}