Flexor Digitorum Avulsion Secondary to Enchondroma of the Distal Phalanx / 대한정형외과학회잡지

This case report describes the unusual occurrence of a flexor digitorum profundus avulsion secondary to an enchondroma of the distal phalanx of the middle finger. The enchondroma was treated by simple curettage with an autogenous bone graft harvested from the olecranon. The avulsed bone fragment was reattached to the distal phalanx using the pull-out suture technique. Bony union and full function of the digit were achieved.

Relação espacial entre a falange distal e o estojo córneo em éguas Campolinas jovens com e sem sinais de obesidade / Spatial relationship between the distal phalanx and the hoof capsule in young Campolina mares with and without obesity

Estudos prévios têm demonstrado alterações radiográficas em cascos de equinos obesos. Os objetivos foram estudar, com avaliação radiográfica, a relação espacial entre estojo córneo e falange distal de éguas jovens da raça Campolina com e sem obesidade. Foram utilizadas 22 éguas entre três e cinco anos de idade, sendo analisadas varáveis de adiposidade e medidas radiográficas dos cascos dos membros torácicos de éguas com escore corporal de 5 a 7/9 (Grupo Controle) e de 8 a 9 (Grupo Obeso). Foram feitas comparações entre os grupos e correlacionaram-se as variáveis de adiposidade entre si, variáveis adiposidade com variáveis casco e variáveis de casco entre si. Utilizou-se o teste t de Student para variáveis paramétricas e o teste Mann-Whitney para as não-paramétricas, para as medidas de correlação, utilizou o teste de Pearson para duas amostras paramétricas e o teste de Spearman para comparações que envolvam pelo menos uma variável não paramétrica (P<0,05). Os resultados demonstraram que éguas Campolinas obesas, ainda jovens, já apresentam indícios de alteração na relação espacial entre estojo córneo e falange distal.(AU)

Previous studies have demonstrated radiographic changes in the hoof of obese horses. The objective was to study through radiographic evaluation the spatial relationship between the hoof capsule and the distal phalanx of Campolina mares with and without obesity. Twenty-two Campolina mares 3 to 5 years old were used. We analyzed adiposity variables and radiographic measurements of the hoof of both forelimbs of mares with body condition score from 5 to 7/9 (Control group) and from 8 to 9 (Obese group). Comparisons were made between groups using the Student t test for parametric variables and the Mann-Whitney test for the nonparametric ones. Pearson or Spearman tests were used to evaluate the correlation among parametric and nonparametric variables respectively (P<0.05). Evidences of changes in the spatial relationship between the hoof capsule and the distal phalanx were observed in obese Campolina young mares.(AU)

Intraosseous Epidermal Cyst of the Distal Phalanx: A Case Report / 대한골관절종양학회지

An intraosseous epidermal cyst is a rare benign cystic lesion. It is thought to result from congenital factors or trauma and can lead to bone destruction because the cyst develops at the soft tissue around the bone. Radiological findings of intraosseous epidermal cysts are a well-defined radiolucent lesion, with cortical expansion. It is important to differentiate an intraosseous epidermal cyst with other disease developed at distal phalanx because its clinical and radiological findings are similar. We report two rare cases of intraosseous epidermal cysts that developed at the distal phalanx.

Intermittent Bleeding Method after Replantation o the Distal Phalanx

PURPOSE: To evaluate the effect of intermittent bleeding method in the distal phalanx replantation. MATERIALS AND METHODS: From January 2007 through June 2009, authors have replanted 117 cases of distal phalangeal amputation in adults at Soo Hospital and Chonbuk National University Hospital. Cases of zone II were 60 cases and zone III 57 according to Allen classification. Male to female ratio was 8.7:1.3. The most common cause was machinery injury in the factory, 98 cases(83.8%), next one was belt injury of the machine, 11 cases(9.4%) and others, 8(6.8%). At least one digital artery and digital nerve were anastomosed under the operating microscope, but vein was impossible to anastomosis as unable to find out in the zone II and III. After anastomosis of one or more digital arteries and nerves, heparine(6,000-10,000 units) was kept to intravenous injection for 24 hours and at the same time fish mouth incision in 2-3 millimeter diameter was made in the distal radial and ulnar margin of the replanted distal phanlanx. From the first 30 minutes to an hour after replantation, incision site was swabbed with heparinized cotton ball for 5 minutes in every 30 to 40 minutes to make sure perfusion for 24 hours, every an hour at the second day, every two hours at the postoperative third to fifth day. RESULTS: 92 cases(78.6%) was completely survived at average postoperative third week follow-up and satisfied with preservation of the finger nail, digit length, good range of motion of the distal interphalangeal joint and acceptable sensibility at average 1.2 years follow-up. CONCLUSIONS: Intermittant bleeding method in replantation of crushed distal phalanx impossible to anastomosis of vein at zone II and III of Allen classification was regarded as one of the notable salvage procedure.

Multiple Pinning in Base Fracture of Distal Phalanx

PURPOSE: The purpose of this study was to evaluate the use of multiple pinning in base fracture of distal phalanx. MATERIALS AND METHODS: We reviewed the results of 8 patients treated with a multiple pinning in fracture of distal phalanx base. There were 7 men and 1 woman, and the mean age was 52.6 years(45~66 years). The type of injury was a crushing injury in 6 patients and, in direct trauma in 2. The injured finger was thumb in 4 patients, index finger in 1, long finger in 1, and ring finger in 2. We used three K-wires for fixative devices in all fractured phalanx. The average removal period of K-wire was 6.5 weeks(5~8 weeks). RESULTS: Postoperatively, immobilization was applied for 6.5 weeks (5~8 weeks). The mean fragment size was 33.8%(10~50%) of long axis of distal phalanx. The range of motion was 1.3degrees (0~5degrees ) in extension lag and 88.1degrees (85~90degrees ) of flexion of the distal interphalangeal joint. CONCLUSION: The multiple pinning of base fracture of distal phalanx was one of the useful method to stabilizing of distal phalanx fracture.

Percutaneous Kirschner Wire Fixation of Acute Mallet Fractures Percutaneousely Reduced by Towel Clip

PURPOSE: To analyze the treatment of clinical results of the percutaneous Kirschner wire fixation of acute mallet fractures percutaneousely reduced by towel clip. MATERIALS AND METHODS: From August 2005 to April 2009, we evaluated nine fingers in eight patients, more than three months follow up. The type of injury was a axial loading in seven cases and direct blow in two. The average follow-up period was 10.1 months (range: 3~41 months). The indication of operative treatment was the presence of large bony fragment or the palmar subluxation of the distal phalnx. RESULTS: The range of motion was 3.7degrees (0~10degrees) in extension lag and 76.7degrees (60~90degrees) of flexion of the distal interphalangeal joint. CONCLUSION: The percutaneous Kirschner wire fixation of acute mallet fractures percutaneousely reduced by towel clip is one of the easy and simple method to stabilizing of bony mallet fracture.

Chondroblastoma in a Distal Phalanx of the Great Toe: A Case Report / 대한정형외과학회잡지

A chondroblastoma is a relatively rare benign bone tumor that is typically encountered in the epiphysis. The authors describe a case of a chondroblastoma arising in the great toe. An 82-year-old woman presented with pain over her left great toe with a 1 year duration. The radiographs showed an expansile osteolytic lesion with cortical thinning and coarse trabeculation that replaced the distal phalanx of the left great toe. An incisional biopsy and curettage were performed. Histologically, the tumor consisted of uniform, round to polygonal cells with clear to slightly eosinophilic cytoplasm and round to ovoid nuclei, mimicking chondroblasts, intermingled with osteoclast-like giant cells.

Seymour's Fracture of the Base of the Distal Phalanx in a Child

PURPOSE: Prior to closure of the epiphysis of the distal phalanx, fracture usually occurs through the growth plate, Salter-Harris type I or II, or through the juxtaepiphyseal region 1 to 2 mm distal to the growth plate. The terminal tendon of extensor inserts into the epiphysis only, while insertion site of the flexor digitorum profundus spans both the epiphysis and metaphysis. Because of the difference between these tendon insertions, this injury mimics a mallet deformity. But, this type of injury does not involve a tear or avulsion of the extensor, unlike mallet finger of adults. Seymour was the first to describe this type of injury in children and called after his name, Seymour's fracture. This fracture is prone to infection or remain the residual deformity unless adequate treatment. METHODS: We report a case of Seymour's fracture. A 9-year-old boy presented a laceration of the nail matrix, with the nail lies degloved from the nail fold on the right middle finger gotten from an impact against a door. An X-ray examination showed the fracture line lying 1 mm distal to the growth plate. The injury was treated with debridement and the fracture was reduced by applying hyperextension force. Under the C-arm, a single 0.7 mm K-wire was used to immobilize the distal interphalangeal joint. Intravenous antibiotics were applied for 5 days after surgery. RESULTS: The K-wire was removed in the 3rd week. No infection or significant deformity was found until follow-up of 12 months. CONCLUSION: Seymour's fracture may be at first classically mallet deformity by its appearance. But it is anatomically different and more problematic injury. If it isn't corrected at the time of injury, derangement of the extensor mechanism, and growth deformity of the distal phalanx may occur. The fracture site should be debrided, removed of any interposed soft tissue, and the patient should be given appropriate antibiotics. Reduction should be maintained by K-wire fixation. We experienced no infection or premature epiphyseal closure.

Chondromyxoid Fibroma Involving Distal Phalanx of the Big Toe Treated with Reconstructive Surgery: A Case Report / 대한정형외과학회잡지

Chondromyxoid fibroma is a rare benign cartilaginous tumor frequently involving the metaphysis of the long bones of the lower limbs of children and adolescents. We present a case of chondromyxoid fibroma involving the entire distal phalanx of a big toe causing macrodactyly, which was treated by excision and reconstruction using iliac bone graft instead of amputation. The patient was satisfied cosmetically and there was no evidence of recurrence four years after surgery.

Intraosseous Epidermoid Cyst of Distal Phalanx: A case report / 대한정형외과학회잡지

Epidermoid cyst is a common skin lesion. However, in areas where the skin is tightly adherent to the bone, a portion of the epidermis may be implanted into the bone traumatically or a subcutaneous epidermoid cyst may penetrate the bone cortex. Intraosseous epidermoid cyst is rare, and arises almost exclusively in the skull and phalanges of the hand. In the hands, terminal phalanx is involved in almost all cases. Differential diagnosis includes glomus tumor with bone erosion, enchondroma, osteomyelitis, aneurysmal bone cyst and metastatic tumors. We experienced a case of intraosseous epidermoid cyst in the distal phalanx of a 28-year-old woman, who had injured her finger about 20 years ago. We report the clinical, radiographic and pathological findings in detail.