One-stage repair of full-thickness skin defect at dorsal skin of middle phalanx fingers using artificial dermis combing with digital artery perforator fascial flaps / 中国骨伤

OBJECTIVE@#To explore clinical effects of the stageⅠrepair of full-thickness skin defect at dorsal skin of middle phalanx fingers using artificial dermis combing with digital artery perforator fascial flaps.@*METHODS@#From January 2019 to May 2020, 21 patients(27 middle phalanx fingers)with full-thickness skin defect were repaired at stageⅠusing artificial dermis combing with digital artery perforator fascial flaps. All patients were emergency cases, and were accompanied by the exposure of bone tendon and the defects of periosteum and tendon membrane. Among patients, including 11 males and 10 females aged from 18 to 66 years old with an average age of (39.00±8.01) years old;9 index fingers, 10 middle fingers and 8 ring fingers;range of skin defect area ranged from (2.5 to 3.5) cm×(1.5 to 3.0) cm;range of exposed bone tendon area was (1.5 to 2.0) cm×(1.0 to 2.0) cm. The time from admission to hospital ranged from 1 to 6 h, operation time started from 3 to 8 h after injury.@*RESULTS@#All patients were followed up from 6 to12 months with an average of (9.66±1.05) months. The wounds in 26 cases were completely healed at 4 to 6 weeks after operation. One finger has changed into wound infection with incompletely epithelialized dermis, and achieved wound healing at 8 weeks after dressing change. All fingers were plump with less scars. The healed wound surface was similar to the color and texture of the surrounding skin. These fingers have excellent wearability and flexibility. According to the upper limb function trial evaluation standard of Hand Surgery Society of Chinese Medical Association, the total score ranged from 72 to 100. 26 fingers got excellent result and 1 good.@*CONCLUSION@#StageⅠrepair of full-thickness skin defect at dorsal skin of middle phalanx fingers using artificial dermis combing with digital artery perforator fascial flaps is easy to operate with less trauma. It has made satisfactory recovery of appearance and function of fingers. It could provide an effective surgical method for clinical treatment of full-thickness skin loss of fingers with tendon and bone exposure.

Middle phalanx epidermoid cyst, an unusual site: A case report

Background: Epidermoid cysts are cutaneous cysts frequently observed among farmers, factory workers, carpenters, and tailors due to their occupations’ predilection for repetitive minor hand trauma. Case Presentation: A 66-year-old male laborer presented to our hospital with a swelling on the palmar aspect of his right middle finger. The swelling was accompanied by pain and an inability to work over the previous four months. A 2.5 cm × 2.5 cm smooth, tender, immobile, non-compressible hard swelling was detected just above the middle phalanx during the clinical examination on the volar aspect of the right middle finger. The diagnosis was confirmed by histopathology after excision. The patient’s range of motion improved significantly following surgery, and his pain subsided. Conclusion: We present a novel location for an epidermal inclusion cyst and the importance of histopathologic evaluation in this case. Additionally, we emphasize the significance of extensively checking the cyst’s epithelium to guarantee complete capsule removal and rule out any additional pathology.

Encondroma protuberans de falange en paciente pediátrico / Enchondroma protruberans of phalanx in pediatric patient

El encondroma protuberans (EP) es una forma rara de encondroma que muestra un crecimiento exofítico, fuera de los márgenes del hueso cortical. Se presenta el caso de una paciente de 4 años previamente sana que asistió en el servicio de urgencia con un aumento de volumen no doloroso en meñique izquierdo. La radiografía mostró una lesión radiolúcida expansiva en la falange proximal. Se complementa estudio con tomografía computarizada y resonancia magnética descubriéndose una lesión que comprometía el canal medular, con extensión más allá de la cortical y un aumento de intensidad de señal en secuencia T2 sugestiva de matriz condroide. El paciente fue sometido a escisión quirúrgica, curetaje e injerto óseo. El estudio histopatológico postquirúrgico confirmó el diagnóstico de encondroma. En este estudio se describió un caso de EP que involucra una falange de la mano. El estudio imagenológico, en particular las imágenes por resonancia magnética juegan un papel clave para un diagnóstico preciso previo al procedimiento quirúrgico.

Enchondroma protruberans (EP) is a rare form of enchondroma with exophytic growth outside the margins of cortical bone. We present the case of a previously healthy 4-year-old patient who attended the Emergency Department with painless enlargement of the left pinkie. The X-ray showed an expansive radiolucent lesion of the proximal phalanx. Further study with a computed tomography scan and magnetic resonance imaging revealed a lesion affecting the medullary cavity and extending beyond the cortical bone with an increase in signal strength in the T2 sequence suggestive of a chondroid matrix. The patient underwent surgical excision, curettage, and bone grafting. The post-surgical histopathological study confirmed the diagnosis of enchondroma. This study describes a case of EP involving a phalanx of the hand. The images, particularly those of the magnetic resonance imaging, played a key role in reaching an accurate diagnosis prior to surgery.

Classification and regression tree analysis for predicting morphological hand types based on radiography data / Análisis de árbol de clasificación y regresión para predecir tipos morfológicos de la mano basados en datos radiográficos

SUMMARY: Analysis and systematization of the longitudinal dimensions of the phalanges of the index and ring fingers for the classification of morphological types of the hand using classification and regression trees (CART). X-rays of the hands of 50 men and 50 women (mean age 47.16 (10.1) years, range 23-65 years) were studied. Each hand, depending on the ratio of the length of the index and ring fingers, was classified into three types: radial (R, 2d>4d), indefinite (N, 2d=4d), ulnar (U, 2d>4d). Morphometry of radiographs included measurements of the lengths of the proximal (PP), middle (MP), and distal (DP) phalanges. The sex differences of the analyzed indicators are statistically significant. There were no significant bilateral differences between the phalanges of the II and IV fingers in length, regardless of sex (p>0.05). A set of rules for classifying the morphological types of the hand depending on the lengths of the phalanges of the index and ring fingers was created by constructing a binary decision tree. The CART method demonstrates the usefulness of this statistical procedure for developing a scientifically based prediction of the morphological type of the hand. The results of this study can be the basis of an algorithm for determining the morphological type of the hand depending on the length of the phalanges of the fingers.

RESUMEN: En este estudio se realizó un análisis y sistematización de las dimensiones longitudinales de las falanges de los dedos índice y anular para la clasificación de tipos morfológicos de la mano, mediante árboles de clasificación y regresión (CART). Se estudiaron radiografías de las manos de 50 hombres y 50 mujeres (edad media 47,16 (10,1) años, rango 23-65 años). Cada mano, según la proporción de la longitud de los dedos índice y anular, se clasificó en tres tipos: radial (R, 2d> 4d), indefinida (N, 2d = 4d), ulnar (U, 2d> 4d). La morfometría de las radiografías incluyó mediciones de las longitudes de las falanges proximal (FP), media (FM) y distal (FD). Las diferencias de sexo de los indicadores analizados fueron estadísticamente significativas. No hubo diferencias bilaterales significativas entre las falanges de los dedos II y IV en longitud, independientemente del sexo (p> 0,05). Se creó un conjunto de reglas para clasificar los tipos morfológicos de la mano en función de las longitudes de las falanges de los dedos índice y anular mediante la construcción de un árbol de decisión binario. El método CART demuestra la utilidad de este procedimiento estadístico para desarrollar una predicción con base científica del tipo morfológico de la mano. Los resultados de este estudio pueden ser la base de un algoritmo para determinar el tipo morfológico de la mano en función de la longitud de las falanges de los dedos.

Proximal interphalangeal arthrodesis in seven horses: A retrospective study in Brazil (2011-2019) / Artrodese interfalangeana proximal em sete equinos: um estudo retrospectivo no Brasil (2011-2019)

ABSTRACT: This study discussed several cases of proximal interphalangeal arthrodesis in horses at a veterinary hospital in Brazil. The medical records of seven horses that underwent proximal interphalangeal arthrodesis between 2011 and 2019 were analyzed for indication, technique, and complications. Short- and long-term outcomes were obtained from both the medical records and telephone interviews with the owners. A dynamic compression plate (DCP) was used in one of the seven horses that underwent surgical arthrodesis, and locking compression plates (LCP) were used in the others. Hospital discharge was recorded in 71.4% (5/7) of the horses, with an average hospital stay of 79 ± 45 days. Casting was maintained for 59 ± 26 days. Contact with owners was possible in four cases, two of which regained their prior level of function. The proximal interphalangeal arthrodesis may improve a horse's well-being, especially when it is considered an early intervention, minimizing the chances of immediate postoperative complications. Additional cases of surgical arthrodesis should be evaluated in long term to better characterize the outcomes of this procedure in Brazil.

RESUMO: Este estudo teve como objetivo apresentar e discutir casos de artrodese interfalangeana proximal em equinos atendidos em um Hospital Veterinário no Brasil. Os prontuários de sete equinos submetidos à artrodese interfalangeana proximal foram analisados quanto à indicação, técnica e complicações, entre 2011 e 2019. As informações sobre os desfechos de curto e longo prazo foram obtidas pela avaliação dos prontuário e entrevista telefônica com os proprietários. Em um dos sete cavalos submetidos à artrodese cirúrgica foi utilizado implantes DCP, e nos demais, LCP. A alta hospitalar foi registrada em 71,4% (5/7), com média de permanência hospitalar de 79±45 dias. A imobilização externa durou 59±26 dias. O contato com os proprietários foi possível em quatro casos, dos quais, em dois, os animais voltaram às suas funções. A artrodese interfalangeana proximal pode melhorar a qualidade de vida dos equinos, principalmente quando se considera a intervenção precoce, minimizando as chances de complicações pós-operatórias imediatas. Casos adicionais devem ser avaliados ao longo prazo para melhor caracterizar os resultados desse procedimento no Brasil.

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.

Skeletal Age Assessment of SMI and MP3 Stages to Predict the Pubertal Growth Spurt / 대한소아치과학회지

This study aimed to assess the skeletal age of skeletal maturational indicator (SMI) and middle phalanx of the middle finger (MP3) stages and to predict the SMI and MP3 stages corresponding to pubertal growth spurt in boys and girls respectively.The skeletal age was assessed from hand-wrist radiographs of 363 children (182 boys, 181 girls) aged 7 to 16 years by radiologists using the Korean standard bone age chart. Also, SMI and MP3 stages were evaluated from the radiographs. From these records, the mean skeletal age of SMI and MP3 stages was calculated.The stages including pubertal growth spurt were SMI 4 – 5, MP3 FG – G stages in boys and SMI 3 – 4, MP3 F – FG stages in girls.

Measuring Agreement of Modified MP3 and CVMS according to BMI Percentile / 대한소아치과학회지

The objective of this study was to examine measuring agreement between middle phalanx of the third finger and cervical vertebrae analysis for assessing skeletal maturity according to body mass index percentile. A retrospective chart view was used to select patients with body mass index data, hand - wrist radiographs and lateral cephalograms of same day. The patients were divided into 4 groups by body mass index percentile. The hand - wrist radiographs were analyzed using modified middle phalanx of the third finger method and the lateral cephalograms were categorized according to cervical vertebral maturation stage. The degree of agreement between the 2 methods of analyzing skeletal maturation was measured by calculating weighted kappa statistic according to body mass index percentile group. There was a good agreement between the 2 methods in the entire body mass index percentile group. According to the body mass index percentile group, the agreement was found to be different, and the pattern was different between boys and girls. Pediatric dentist should consider sex and weight status when evaluating growing children and adolescents because it can affect the agreement of 2 method of analyzing skeletal maturation.

Surgical Fixation and Inter-phalangeal Arthrodesis of Symptomatic Non-union of Fracture of a Lesser Toe Distal Phalanx: A Case Report

@#Distal phalanx fractures of the toes are common injuries. The majority of them are treated conservatively with good outcome. We present the case of a painful non-union fracture of the distal phalanx of the 4th toe in a 60-year-old female patient with symphalangism of the 4th and 5th toes. She underwent surgical fixation of the fracture with concomitant inter-phalangeal joint (IPJ) arthrodesis for better stability. A transverse dorsal incision was made just distal to the IPJ to allow preparation of both the fracture site and IPJ. Fibrous tissue at the fracture non-union site was removed and the opposing surfaces drilled with a 0.88mm Kwire. Cartilaginous tissue at the IPJ was removed and similarly drilled with the 0.88mm K-wire. Stabilisation was achieved with a percutaneous headless compression screw. Radiographic union was achieved and the patient had resolution of symptoms 16 weeks after the surgery. The patient continued to be symptom-free at one year follow-up. This is the first case report of a surgically treated symptomatic non-union of distal phalanx fracture of a lesser toe in the literature.

Adhesions as an Uncommon Complication of K-Wiring in Paediatric Phalangeal Fractures

@#Paediatric hand fractures are common and prompt management is mandatory to achieve a good functional outcome. However many fail to realize that treating a fracture does not only involve bones but the soft tissues, as well. K-wiring itself can be difficult with multiple attempts inadvertently injuring the flexor or extensor tendons and resulting in adhesions. We highlight this possible complication of K-wiring which we believe is under reported due to the perception that K-wiring is a simple procedure. We present a case of a 9-year-old child, who sustained a closed displaced fracture of the base of the proximal phalanx (Salter Harris type 2) of the left index finger. He underwent percutaneous K-wiring but was complicated with severe adhesions of the flexor digitorum profundus (FDP) and flexor digitorum superficialis tendons (FDS). He was unable to flex the proximal and distal interphalangeal joints of the affected finger. We subsequently performed tendon adhesiolysis twice together with A2 pulley reconstruction, to restore movement of the finger. K-wiring of the fingers are not just simple bony procedures but also involve soft tissue components which can be prone to adhesions

Parosteal Lipoma Associated with Underlying Recurrent Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) of the Hand / 대한정형외과학회잡지

Parosteal lipoma is a benign tumor of the mature adipose tissue that contacts the periosteum of the underlying bone directly. The tumor commonly arises in the long bones, such as the femur, radius or tibia, and often exhibits underlying osseous changes, such as a cortical hyperostosis or erosion. Parosteal lipoma arising in a finger is rare. Furthermore, there are no reports of parosteal lipoma associated with underlying bizarre parosteal osteochondromatous proliferation. The authors present a rare case of parosteal lipoma of the proximal phalanx of the little finger accompanied by recurrent bizarre paroteal osteochondromatous proliferation in a 64-year-old male patient who had previously undergone an excisional biopsy at the same location 8 years earlier.

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)

A Case of Subungual Exostosis Located in the Left Fifth Toe / 대한피부과학회지

No abstract available.

A Case of Subungual Exostosis Located in the Left Fifth Toe / 대한피부과학회지

No abstract available.

Minimally invasive surgical treatment for unstable fractures of the proximal phalanx: intramedullary screw / Tratamento cirúrgico minimamente invasivo das fraturas instáveis da falange proximal: parafuso intramedular

To analyze the clinical-functional parameters and quality of life of patients undergoing minimally invasive surgical treatment for extra-articular fractures of the proximal phalanx, using an intramedullary screw (Acutrak(r)). METHODS: Between January 2011 and September 2014, a prospective study was conducted on 41 patients (48 fingers) with unstable extra-articular fractures of the proximal phalanx, who underwent minimally invasive surgical treatment using an intramedullary screw (Acutrak(r)). These patients were evaluated 12 months after the surgery by means of the DASH quality-of-life questionnaire, VAS pain scale, measurement of range of motion (ROM, in degrees) and radiographic assessment. RESULTS: All the patients achieved adequate reduction and consolidation of their fractures. There were statistically significant improvements in quality of life on the DASH scale, pain on the VAS scale and range of motion. CONCLUSION: The minimally invasive technique for treating unstable extra-articular fractures of the proximal phalanx using an intramedullary screw (Acutrak(r)) is effective and safe, and it presents satisfactory clinical-functional results.

Analisar os parâmetros clínico-funcionais e a qualidade de vida de pacientes submetidos ao tratamento cirúrgico minimamente invasivo das fraturas extra-articulares da falange proximal com uso do parafuso intramedular (Acutrak(r)). MÉTODOS: Um estudo prospectivo foi feito de janeiro de 2011 a setembro de 2014 e incluiu 41 pacientes e 48 dedos acometidos com fratura da falange proximal extra- articular e instável submetidos ao tratamento cirúrgico minimamente invasivo com parafuso intramedular (Acutrak(r)). Esses pacientes foram avaliados 12 meses após a cirurgia por meio do questionário DASH de qualidade de vida, escala de dor VAS, arco de movimento (adm em graus) e avaliação radiográfica. RESULTADOS: Todos os pacientes obtiveram redução adequada e consolidação das fraturas. Houve melhoria estatisticamente significativa da qualidade de vida (DASH), escala de dor (VAS) e arco de movimento. CONCLUSÃO: A técnica minimamente invasiva no tratamento das fraturas instáveis e extra-articulares da falange proximal com o parafuso intramedular Acutrak(r) é eficaz e segura e apresenta resultados clínico-funcionais satisfatórios.

MODIFIED INTRAMEDULLARY FIXATION WITH TWO Kirschner WIRES FOR EXTRA-ARTICULAR FRACTURE OF PROXIMAL PHALANGEAL BASE / 中国修复重建外科杂志

METHODS: Between June 2012 and November 2015, 18 cases (18 fingers) of fresh extra-articular fracture of the proximal phalangeal base were treated, including 16 males and 2 females with an average age of 31 years (range, 21-57 years). The causes included strike injury in 10 cases, fall injury in 4 cases, mechanical injury in 1 case, twist injury in 1 case, crush injury in 1 case, and cutting injury in 1 case. The injured fingers were little finger in 16 cases, ring finger in 1 case, and index finger in 1 case. Of the 18 cases, 17 had closed fractures and 1 had open fracture. X-ray film showed transverse fracture in 14 cases and transverse-oblique fracture in 4 cases. The time between injury and operation was 3 hours to 4 days (mean, 2 days). After anatomical reduction, two Kirschner wires were used for intramedullary fixation. Functional exercises were done at 2 days after operation. The Kirschner wires were removed at 4 weeks after operation.

Bilateral proximal delta phalanges of hand: a rare case report with review of literature.

Delta phalanx or longitudinal bracketed epiphysis is a rare congenital anomaly that affects phalanges in the hand more commonly than toes. It results from a defective secondary ossification that extends longitudinally along the diaphysis and brackets the diaphysis and metaphysis, causing restricted longitudinal growth and resultant angular deformities. Although rare, longitudinal epiphyseal bracket most commonly manifests in the hands as clinodactyly and in the feet as hallux varus. We report a case of 18 year old male patient with isolated bilateral multiple proximal delta phalanges of hand. Keywords:

Sarcoma de Ewing de la falange proximal del meñique. Reporte de caso / Ewing sarcoma of the proximal phalanx of the little finger: Case report

El sarcoma de Ewing se presenta en la segunda década de la vida y tiene predilección por las diáfisis de los huesos largos y en la pelvis. Pueden existir localizaciones raras como en los metacarpianos. Reportamos un caso de sarcoma de Ewing localizado en la falange proximal proximal del 5to dedo de la mano izquierda en un paciente masculino de 44 años de edad. Ante la poca frecuencia de presentación, resulta importante considerar los diagnósticos diferenciales de otras patologías neoplásicas de la mano, como el osteosarcoma de células pequeñas. Ésta es una rara pero agresiva forma de osteosarcoma cuyo diagnóstico es difícil de realizar y fue nuestra primera sospecha diagnóstica por valoración radiológica. Sin embargo, se caracterizó al sarcoma de Ewing con la ayuda de la biopsia y la histopatología. El control local de la enfermedad se logró mediante la excéresis del tumor con márgenes amplios.

Ewing's sarcoma occurs in the second decade of life and has a predilection for the diaphysis of long bones and pelvis. There may be rare locations, such as in the metacarpals. A case is reported of Ewing's sarcoma located in the proximal phalanx of the 5th finger of the left hand in a male patient aged 44. Given the infrequency of presentation, it is important to consider the differential diagnosis of other neoplastic diseases of the hand and small cell osteosarcoma. The latter is a rare but aggressive form of osteosarcoma, which is difficult to diagnose and was our first suspicion diagnosed by radiological assessment. However Ewing's sarcoma was characterized with the help of the biopsy and histopathology. Local disease control was achieved by tumoral exeresis with wide margins.

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.

Reliability of the frontal sinus index as a maturity indicator.

Aim: The aim of this study was to compare the reliability of frontal sinus as a skeletal maturity indicator in males and females. Setting and Sample Population: Lateral cephalograms of 75 males and 75 females, both in preand post-pubertal stages of development as determined by Middle phalanx of the third finger (MP3) radiographs. Materials and Methods: Lateral cephalograms were analyzed for frontal sinus maturity. Maximum height, maximum width and height to width ratio of the sinus were calculated. The mean height to width ratio of the sinus at respective MP3 stages were tabulated and subjected to statistical analysis to determine the correlation. Correlation at different MP3 stages between males and females was also determined. Results: Statistically significant differences were observed between the mean values of F and FG along with F and I stage in males, significant difference between the values of FG stage among males and females were also observed. Conclusion: Based on statistical and direct comparison of raw data, study concludes that frontal sinus is not reliable as a sole criterion for prediction of skeletal maturity.