How Many Screws Are Needed for Reliable Stability of Extra-articular Nonosteoporotic Distal Radius Fractures Fixed with Volar Locking Plates?

BACKGROUND: We hypothesized that volar locking pate fixation using a minimum number of screws—four in the distal row and two in the shaft of the plate—will provide sufficient stability for unstable extra-articular fractures of the distal radius. We aimed to compare the biomechanical properties of different numbers and locations of screws in volar locking plate fixation and describe the clinical and radiological outcome of plate fixation using a minimum number of screws for distal radius fractures.METHODS: We divided 48 artificial radius fracture bones into four groups (group A–D) based on the number and location of screws used for fixation with volar locking plates. The artificial bone models were subjected to axial compression and volar bending load with a force of 250 N and 80 N, respectively, for 1,000 cycles at a frequency of 1 Hz. We also retrospectively reviewed 42 patients with unstable, extra-articular, distal radius fractures who were treated with volar locking plate fixation using a minimum number of screws.RESULTS: Group A (seven distal screws and three proximal screws) had the highest mean stiffness: 303.7 N/mm under axial compression and 61.1 N/mm under volar bending. Compared with group A, group D (four screws in the distal part and two screws in the shaft) showed significantly lower stiffness; therefore, group D was considered inferior in terms of stability. However, in the fatigue test, neither deformation of the metal plate nor detachment or breakage of the metal screws was observed in all groups. In the clinical study, all fractures united without displacement and satisfactory clinical outcome was obtained.CONCLUSIONS: In the dorsally comminuted, extra-articular, nonosteoporotic distal radius fractures, the minimum number of screws—four in the distal row and two in the shaft—in volar locking plate fixation can provide sufficient stability. Further biomechanical studies involving osteoporotic bone will be necessary to confirm the results because volar plate fixation is most commonly used in patients with osteoporosis.

Current status of ultrasonography of the finger

The recent development of advanced high-resolution transducers has enabled the fast, easy, and dynamic ultrasonographic evaluation of small, superficial structures such as the finger. In order to best exploit these advances, it is important to understand the normal anatomy and the basic pathologies of the finger, as exemplified by the following conditions involving the dorsal, volar, and lateral sections of the finger: sagittal band injuries, mallet finger, and Boutonnière deformity (dorsal aspect); flexor tendon tears, trigger finger, and volar plate injuries (volar aspect); gamekeeper's thumb (Stener lesions) and other collateral ligament tears (lateral aspect); and other lesions. This review provides a basis for understanding the ultrasonography of the finger and will therefore be useful for radiologists.

Osteosíntesis percutánea con placas volares bloqueadas en fracturas metafisarias distales de radio. Descripción de la técnica y resultados preliminares / Percutaneous volar locked plate fixation in metaphyseal fractures of distal radius. Technical description and preliminary results

Objetivo: Evaluar los resultados objetivos y subjetivos obtenidos luego de una osteosíntesis con placas en T bloqueadas volares, colocadas mediante una técnica mínimamente invasiva, en fracturas de radio distal con extensión metafisaria. Materiales y Métodos: Evaluación retrospectiva de seis pacientes adultos que presentaron fracturas inestables de radio distal, extrarticulares o articulares parciales, con extensión metafisaria, tratadas quirúrgicamente con placas en T largas de compresión bloqueadas volares, mediante una técnica mínimamente invasiva, entre 2007 y 2012. Edad promedio: 40.17 años. Fracturas de tipo 23A3 (n=6) de la Clasificación AO/OTA. Se realizó la reducción indirecta, bajo radioscopia y, a través de dos pequeñas incisiones, se deslizó, en forma percutánea, una placa bloqueada volar en T. Se analizaron los parámetros radiográficos, el rango de movimiento y la fuerza. Los resultados subjetivos fueron evaluados usando la escala DASH y la escala analógica visual. Resultados: Tiempo de consolidación promedio: 2.4 meses. Los resultados radiográficos no mostraron diferencias significativas entre el primero y el último control al año de seguimiento. Flexión y extensión promedio: 70° y 60°, pronación y supinación: 79° y 80°, respectivamente. Fuerza de prensión promedio: 78,4%. Puntaje DASH 19,82; escala analógica visual 1,5 puntos. Conclusiones: Las técnicas mínimamente invasivas reducen el daño quirúrgico y las complicaciones. Son una opción en pacientes con daño grave de partes blandas, conminución metafisaria y trauma de alta energía. La colocación de placas volares bloqueadas percutáneas es un procedimiento técnicamente demandante, permite obtener fijaciones estables y restaurar la anatomía radial en fracturas de radio distal con extensión metafisaria.

Objective: To evaluate objective and subjective outcomes after closed reduction and minimally invasive volar locked T-plate osteosynthesis for distal radius fractures with metaphyseal involvement. Methods: We retrospectively evaluated six patients treated with minimally invasive volar locked T-plate osteosynthesis for unstable extra-articular or partial articular distal radius fractures with metaphyseal involvement, between 2007 and 2012. Average age: 40.17 years. According to the AO/OTA classification, all patients had 23A3 type fractures. Indirect reduction was performed. Two volar small incisions were made; a volar locked compression T-plate was introduced in the sub-muscular plane, under radioscopic guidance. Analysis included radiological parameters, range of motion and strength. Subjective results were assessed using DASH score and the Visual Analogue Scale. Results: All fractures healed within 2.4 months. Radiographic outcomes showed no differences between the first postoperative control and the last one at one-year follow-up. Average flexion and extension 70° and 60°, pronation and supination: 79° and 80°. Grip strength: 78.4%. DASH score 19.82 and visual analogue scale: 1.5 points. Conclusions: Minimally invasive technique decreases surgical injury and complications. It is an option in patients with metaphyseal comminution, severe soft tissue injuries and high energy trauma. Percutaneous volar locked compression plate allows to obtain a stable fixation and to restore distal radius anatomy in radius fractures with metaphyseal involvement.

Dorsal Approach for Distal Radius Fractures

Since the advent of volar locking plate, volar approach for internal fixation has become a major trend in the treatment for unstable distal radius fracture. However, dorsal approach is preferred for certain fracture pattern include AO type C3, dorsal Barton's fractures and concomitant intercarpal ligament injury, because it can afford excellent exposure of the articular surface. Although dorsal approach and plating technique has inherent disadvantages include extensor tendon irritation and rupture, improvements in implant design lead to decrease complication rate. Here, we provide overview of the pros and cons through historic perspective, indications, and surgical technique of the dorsal approach for the distal radius fracture.

Outcomes of Severe Comminuted Distal Radius Fractures with Pronator Preserving Approach

PURPOSE: We investigate the outcomes of treatment of patients with severe comminuted distal radius fractures with volar plate fixation using a pronator-preserving approach. MATERIALS AND METHODS: Fourteen patients with severe comminution of the distal radius fractures for whom anatomical reduction of the fractures was deemed difficult to achieve with traditional approaches were enrolled. The gender ratio was 8 males to 6 females, and the average age of the patients was 64.9 years. According to the AO/OTA classification of fractures, 2 patients had 23-A3 fractures, 7 patients had 23-C2, and 5 patients had 23-C3. Radial length, radial inclination, and volar tilt were measured for radiologic evaluation. Modified Mayo wrist score (MMWS) was used for clinical outcome. RESULTS: Bony union was achieved in all 14 patients without signs of complications. The average time-to-union was 4.3 months (3-6 months). The radiological findings at the final follow-up were as follows: the average radial inclination was 20.5degrees; the average volar tilt, 7.57degrees; and the average radial length, 11.8 mm. At the final follow-up, the results of the MMWS were 'Fair' in 1 patient, 'Good' in 4, and 'Excellent' in 9. CONCLUSION: We propose that a pronator-preserving approach is an effective treatment for severe comminuted distal radius fracture.

Extension Type Locked Metacarpophalangeal Joint of the Little Finger due to Hyperextension Injury / 대한정형외과학회잡지

The extension type locked metacarpophalangeal joint of the little finger is an extremely rare condition characterized by loss of flexion with little or no loss of extension. The most common cause for locking is entrapment of a strap of the ruptured palmar plate. We treated a locked metacarpophalangeal joint of the little finger due to a hyperextension injury. The mechanism of locking was a torn part of the palmar ligament that forcefully rides across the prominence of the radial condyle of the metacarpal bone together with the accessory collateral ligament. These dislocated parts of the ligament formed a constricting bundle that prevented closed reduction. Locking was released successfully by an open reduction using the dorsal approach of the metacarpophalangeal joint without complication.

Effect of fixing distal radius fracture with volar locking palmar plates while preserving pronator quadratus / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>L-shaped incision of pronator quadratus (PQ) muscle along its radial and distal borders was always taken for distal radius fractures reduction and internal fixation. Repair of the PQ muscle was always recommended at the end of operation for some instructive reasons. But repair of PQ is not satisfied because of poor quality of muscle and fascial tissues which may cause pain or impede forearm pronation and supination for post-operative scarring around PQ. Inserting the locking palmar plate to pass under the pronator quadratus muscle and the locking screws are inserted through mini-incisions in pronator quadratus in some patients with distal radius fractures is a reasonable technique which can preserve the pronator quadratus. The purpose of this study was to evaluate and compare the clinical effects after volar plating of the distal radius fractures while preserving the pronator quadratus and pronator quadratus repair.</p><p><b>METHODS</b>Between September 2010 and April 2012, 65 patients (42 males and 23 females; aged 20-68 years and a mean age of 42.5 years) with distal radius fracture underwent open reduction and internal fixation using the volar locking palmar plates (Depuy or Smith companies). The patients were classified as 23A-2 through 23C-3 according to the Orthopaedic Trauma Association (OTA) classifications. All surgeries were completed by the same trained team. The volar locking palmar plates of distal radius performed with preserving pronator quadratus group involved 30 patients including 19 males and 11 females and performed with pronator quadratus repair group involved 35 patients including 23 males and 12 females. We compared the two groups for wrist pain, forearm range of motion, grip strength, perioperative complications and wrist functional recovery score.</p><p><b>RESULTS</b>The minimum follow-up for the whole cohort was one year. The differences between the two groups were significant with regard to wrist pain, forearm range of motion, grip strength and wrist function at 1, 2, and 6 weeks postoperatively, but insignificant at 6 and 12 months postoperatively. No significant differences were found in the perioperative complications and radiographs postoperatively.</p><p><b>CONCLUSIONS</b>Preservation of the pronator quadratus muscle is a satisfactory method for the treatment of majority of the fractures of the distal radius with volar locking palmar plates, as this technique can yield better early wrist function and shorten the rehabilitation.</p>

Treatment of Herbert B2-type scaphoid fracture with double screws prograde internal fixation through volar approach / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical and function efficacy of the treatment of Herbert B2-type scaphoid fracture through volar approach with double screws prograde internal fixation.</p><p><b>METHODS</b>From December 2005 to June 2010,18 patients with Herbert B2-type scaphoid fracture were treated with double screws prograde internal fixation through volar approach, including 14 males and 4 females with an average age of 33.11 years (ranged from 21 to 52 years). The fracture healing situation was evaluated by X-ray examination. Functional outcome was assessed by using Modified Mayo wrist score.</p><p><b>RESULTS</b>All patients were followed up with a mean time of (25.06 +/- 4.00) months. The bone healing time was (3.55 +/- 0.65) months. The pain,passive range of motion, grip of wrist were improved at 4 months after operation (P < 0.05). The Mayo wrist score were improved from preoperative 42.78 +/- 7.32 at 4 months after operation (93.89 +/- 5.83) (P < 0.05), the results were excellent in 9 cases and good in 9 cases.</p><p><b>CONCLUSION</b>Volar approach with double screws prograde internal fixation is an efficacy and safety surgical technique for Herbert B2-type scaphoid fracture.</p>

Korean Type Distal Radius Anatomical Volar Plate System: A Preliminary Report

BACKGROUND: Distal radius fracture is the most common fracture of the upper extremity, and approximately 60,000 distal radius fractures occur annually in Korea. Internal fixation with an anatomical volar locking plate is widely used in the treatment of unstable distal radius fractures. However, most of the currently used distal radius anatomical plate systems were designed based on the anatomical characteristics of Western populations. Recently, the Korean-type distal radius anatomical volar plate (K-DRAVP) system was designed and developed based on the anatomical characteristics of the distal radius of Koreans. The purpose of this study was to evaluate the preliminary results of the new K-DRAVP system, and to compare its radiologic and functional results with those of the other systems. METHODS: From March 2012 to October 2012, 46 patients with acute distal radius fractures who were treated with the K-DRAVP system at three hospitals were enrolled in this study. Standard posteroanterior and lateral radiographs were obtained to assess fracture healing, and three radiographic parameters (volar tilt, radial inclination, and radial length) were assessed to evaluate radiographic outcomes. The range of motion and grip strength, the Gartland and Werley scoring system, and the disabilities of the arm, shoulder and hand (DASH) questionnaire were used to assess clinical and functional outcomes. RESULTS: All radiologic parameters were restored to normal values, and maintained without any loosening or collapse until the time of final follow-up. Grip strength was restored to 84% of the value for the unaffected side. The mean range of motion of the wrist at final follow-up was restored to 77%-95% of the value for the unaffected side. According to the Gartland and Werley scoring system, there were 16 excellent, 26 good, and 4 fair results. The mean DASH score was 8.4 points. There were no complications after surgery. CONCLUSIONS: The newly developed K-DRAVP system could be used to restore and maintain good anatomical parameters, and provide good clinical outcomes with low complication rates. This system is a promising surgical option for the treatment of distal radius fractures in the Korean population.

Radiologic Results in Accordance with the Number of Distal Locking Screws in Volar Plate Fixation for Distal Radius Fractures

PURPOSE: The purpose of this study was to determine whether the number of distal locking screws affected the final radiologic results after volar plate fixation for distal radius fractures. METHODS: We retrospectively identified 176 patients (male, 36; female, 140; average, 60 years) who had distal radius fractures treated with open reduction and volar plate fixation between 2011 and 2012. The number of screws used for distal fixation was determined according to the surgeon's preference and the type of plate used. Radiologic parameters and their displacements were measured postoperatively and at final follow-up. The results of using 4 or 5 distal locking screws were compared with those of using more than 6 distal locking screws. RESULTS: There was no significant displacement in fracture fragment when using 4 or 5 distal locking screws compared with using more than 6 distal locking screws. Mean displacement in ulnar variance was 0.6 mm in group with less than 5 screws, and the displacement was 0.4 mm in group with more than 6 screws (p=0.772). Secondary displacement was not correlated with fracture type or the number of distal locking screws. There was no fixation failure during the study period. CONCLUSION: It seems that 4 or 5 distal locking screws are strong enough to prevent a significant loss of fracture reduction. Filling every distal screw hole is not recommended to limit cost and avoid extensor tendon complications.

Aspiration and methylprednisolone injection to the cavity with IV cannula needle in the treatment of volar wrist ganglia: new technique

There are several types of treatment modalities for wrist ganglions. The aim of the study was to assess the effectiveness of cyst aspiration and methyl prednisolone acetate injection with double IV cannula rather than sharp pointed needle, as a new technique in the treatment of volar ganglia. The study involves total of 19 patients who received treatment by aspiration and methyl prednisolone injection into the cavity. Two IV cannulas are pricked to the cystic cavity. Cyst fluid is drained by the distally placed IV cannula meanwhile injecting methyl prednisolone by proximally placed IV cannula. The patient records and follow-up reports are retrospectively investigated. The patient age, sex, site of the cyst, the treatment that was applied, adjacency to the artery and the nerves and recurrence are recorded. Mean follow up time was 2.1 +/- 0.5 years. The study involved 19 patients that received aspiration treatment for volar ganglion cysts between January 2004 and December 2009. There were 12 [63.2%] female and 7 [36.8%] male subject with volar wrist ganglion cyst. The mean age of patients was 27.63 +/- 6.6 years. Fourteen [73.7%] patients of total had cysts close to the artery. We didn't observe any complication related to methyl prednisolone injection and arterial ischemia. Recurrence was observed in three [15.8%] patients. This method has lower recurrence rate than other aspiration therapy with sharp pointed needle. We prefer to use IV cannula needle for cyst aspiration and steroid injection in treatment of volar ganglia before any surgical intervention

Open Reduction of Proximal Interphalangeal Fracture-Dislocation through a Midlateral Incision Using Absorbable Suture Materials

BACKGROUND: Fracture-dislocation of the proximal interphalangeal (PIP) joint is a relatively common injury. Various treatments for fracture-dislocation of the PIP joint have been reported. In the present study, we performed open reduction through a midlateral incision using absorbable sutures to reduce the small bone fragments and performed volar plate repair. METHODS: We treated nine patients with fracture-dislocation of the PIP joint with small fractured bone fragments too small for pinning or screw fixation. Patients with volar plate injury were treated with open reduction and volar plate repair at the periosteum of the middle phalangeal bone base by the modified Kessler method using absorbable sutures. All patients were placed in a dorsal aluminum extension block splint, which maintained the PIP joint in approximately 30 degrees of flexion to avoid excessive tension on the sutured volar plate. RESULTS: At a mean final follow-up of postoperative 9 months, all patients were evaluated radiographically and had adequate alignment of the PIP joint and reduction of the displaced bone fragments. Range of motion was improved and there were no complications. CONCLUSIONS: This technique is an excellent alternative to the current method of treating patients with fracture-dislocations that include small fragments that are too small for pinning or screw fixation. It is a less invasive surgical method and enables stable reduction and early exercise without noticeable complications.

Posttraumatic Chronic Volar Instability of the Thumb Metacarpophalangeal Joint

Posttraumatic volar instability of the thumb metacarpophalangeal joint with hyperextensile laxity makes pain and weakness during pinch or grip exercise. Several surgical procedures have been described to eliminate thumb metacarpophalangeal joint hyperextension. We treated a patient who had suffered from volar instability with pain for 17 years using volar plate repair and capsulodesis with suture anchor. The result was successful with satisfactory recovery of the hand function.

Relationship between the Length of Distal Locking Screws and Diaphyseal Screws in Volar Plate Fixation of Distal Radius Fractures

PURPOSE: To determine the relationship between the length of distal locking screws and diaphyseal screws in volar plate fixation of distal radius fractures. METHODS: A retrospective review was performed of 169 patients who underwent volar locking plate fixation for treatment of distal radius fractures. All patients received 2.4 mm LCP volar extra-articular distal radius plate (DePuySynthes). The length of the diaphyseal screw which was placed in the elongated hole was correlated with the length of a distal locking screw from radial most (D1) to ulnar most (D4). We also evaluated distal screw penetration of the dorsal cortex and plate removal rate. RESULTS: The length of the diaphyseal screw which was placed in the elongated hole strongly correlated with the length of a distal locking screw. Average D1 screw length was 2 mm longer than the diaphyseal screw, and average D2 screw length was 4 mm longer than the diaphyseal screw. D3 and D4 screw were 6 mm longer than the diaphyseal screw. Plate removal was necessary in 13 patients (8%) due to screw irritation. These patients had significantly longer screws than average. Flexor or extensor tendon ruptures did not occur in this cohort. CONCLUSION: The length of the distal locking screws can be estimated with the length of the diaphyseal screw. This information may help surgeons to select the adequate length of distal locking screws during volar plating of distal radius fractures.

Rupture of the Extensor Pollicis Longus Tendon at the Proximal Screw of Volar Plate Fixation for Distal Radius Fracture: A Case Report

As volar plate fixation of distal radius fracture becomes more common, reports of ruptured extensor pollicis longus tendon by a protruding distal screw tip are also increasing steadily. Authors have experienced a rare case of ruptured extensor pollicis longus tendon at the prominent proximal screw of fixed volar plate for distal radius fracture, and we report it herein with a review of the literature.

Prevalence of agenesis of the palmaris longus muscle in Brazil and its clinics correlation

Introduction: The palmaris longus muscle it is considered one of the most variable muscles in the human body, and its agenesis is the most frequent anatomic variation. The aim of this study was to determine the prevalence of unilateral and bilateral agenesis of palmaris longus muscle for the subjects in the city of Jataí, Goiás. Material and methods: 740 subjects, 279 men and 461 women, in the age of 10-70 years old, were observed through clinical inspection in both forearms to absence of the tendon of palmaris. The data were described in percentage values and the absence of the muscle was analyzed statistically (Chi square test; P < 0.05). Results: The bilateral presence was identified in 73.5%, the absence on the left side in 7.8%, on the right in 6.5% and bilateral absence was observed in 12.2% of subjects. Among women and men the percentage values was 9.3%, 7.3%, 13.1% and 5.4%, 5%, 10.7%, respectively to agenesis in left side, in right side and bilateral agenesis. The unilateral/bilateral agenesis was more frequent in women (29.7%) than in men (21.1%; P < 0.05). Bilateral absence was 12.4% in right handed subjects and 9.1% in left handed subjects (P > 0.05). Left and right handed subjects showed absence of muscle similar in both forearms (P > 0.05). Conclusion: most subjects studied showed bilateral presence of palmaris longus muscle, the agenesis was significantly more common in women and with similar percentage in right and left handed subjects.

Multiple Flexor Tendon Injuries after Volar Plate Fixation for Distal Radius Fracture: Two Cases Report

As the, injury of flexor tendons has been rarely reported rarely after volar plate fixation in the distal radius fractures. Author experienced one case with delayed rupture of flexor pollicis longus and flexor digitorum profundus of index finger caused by anterior protrusion of volar plate. We also experienced another case with delayed rupture of flexor pollicis longus and wear on flexor digitorum profundus of index finger caused by volar plate placed distally to watershed line. Proper placement of volar plate and distal shape of the plate are important to prevent multiple tendon injury.

Transposición tendinosa con el palmar mayor para restablecer la extensión de los dedos en la parálisis del nervio radial / Tendinous transposition with palmaris major to restore the fingers extension in the radial nerve paralysis

INTRODUCCIÓN: Cuando se realizan transferencias tendinosas para restablecer la extensión de los dedos por parálisis del nervio radial ha sido motivo de controversia entre la decisión de que músculo a utilizar, el cubital anterior o palmar mayor. El objetivo de esta investigación es mostrar nuestra experiencia con el empleo del músculo palmar mayor. MÉTODOS: Se realizó un estudio longitudinal, en 39 pacientes con el diagnóstico de parálisis del nervio radial, donde se evaluó los resultados funcionales de las transposiciones tendinosas para restablecer la extensión de los dedos. El palmar mayor fue empleado en 27 pacientes, 15 por vía subcutánea y 12 a través de la membrana ánteríor ósea, y se utilizó cubital anterior en 12 pacientes como grupo control. RESULTADOS: La evaluación de la extensión de las articulaciones metacarpofalángicas de los dedos fue excelente y buena en 37 de los 39 pacientes sin que existiera asociación estadística en relación al músculo empleado. La fuerza muscular flexora de la muñeca después de la cirugía disminuyó a grado 3 en 11 de los 12 pacientes en que se utilizó el cubital anterior a diferencia de los que utilizaron el palmar mayor en los que la fuerza fue de grado 4 en 17 de los 27. La complicación más frecuente fue la desviación radial de la muñeca que se presentó en 4 pacientes, en todos se habÝa utilizado el cubital anterior. CONCLUSIONES: El músculo palmar mayor es la alternativa más recomendada para restablecer la extensión de los dedos en las parálisis del nervio radial

INTRODUCTION: When tendinous transfers are carried out to restore the finger extension due to radial nerve paralysis, there are controversies in the decision of which muscle be used, the anterior cubital one or the palmaris major. The objective of present research is to show our experience with the use of the palmaris major muscle. METHODS: A longitudinal study was conducted in 39 patients diagnosed with radial nerve paralysis, where we assessed the functional results of tendinous transpositions to restore the finger extension. The palmaris major was used in 27 patients, 15 by subcutaneous route and 12 through the interosseous membrane and the anterior cubital one was used in 12 patients as control group. RESULTS: The assessment of the extension of fingers metacarpophalangeal joints was excellent and good in 37 of the 39 patients without statistic association in relation to the muscle used. The flexor muscular strength of wrist after surgery decreased at grade 3 in 11 of the 12 patients in which we used the anterior cubital one unlike those used the palmaris major where the strength was of grade 4 in 17 of the 27 patients. The more frequent complication was the wrist radial deviation present in 4 patients in which we used the anterior cubital one. CONCLUSIONS: The palmaris major muscle is the more recommended alternative to restore the fingers extension in radial nerve paralyses

Placa hiperpigmentada en la palma de mano de un anciano / Hyperpygmented patch in a old man´s palm

Se presenta el caso de un paciente anciano que acude por una placa marrón en la palma de una mano asintomática. Se comprometen posteriormente la otra palma y las plantas de ambos pies. Presenta serología treponémica positiva, dermatitis en banda con infiltrado inflamatoria a predominio de células plasmáticas, tinción argéntica sugerente y respuesta terapéutica por lo que se concluye que se trataba de un cuadro de sífilis secundaria simulando una tina negra.

We present the case of an old man who seeks medical care because a brown patch in a hand palm without symptoms. A couple of weeks after that both soles and the other hand has been compromised too. We get a positive luetic serology, band dermatitis with great amount of plasma cells, suggestive silver dye, and therapeutic response. We conclude that the case was a luetic secondarily mimic black tinea.

Description of some dermatoscopic features of acral pigmented lesions in Iranian patients: a preliminary study

Proper differentiation between acral malignant melanoma and benign pigmented lesions like melanocytic nevi is of great value. To avoid unnecessary biopsies, dermatoscopy has been introduced as a non-invasive modality and has improved the clinical diagnostic accuracy in recent decades. We aimed to describe dermoscopic patterns of acral pigmented lesions of patients in the clinic of dermatology in Razi Hospital, Tehran, Iran. This study was conducted as a descriptional study among a total of 62 pigmented lesions located on volar skin of palms and soles. After initial clinical evaluation, lesions were examined entirely by dermoscopy. All the patterns within a lesion were described, and lesions suspicious of malignancy [clinically or dermatoscopically] were selected for histopathological evaluation. Of our 62 lesions, three lesions were not melanocytic. According to our final clinicopathological diagnosis, 47 lesions were benign melanocytic nevi and 12 lesions were malignant melanoma. Parallel furrow pattern was the most frequent among our benign lesions [51.1%] followed by lattice-like pattern [23.4%] and acral reticular pattern [21.3%]. Diffuse multi-component pattern, parallel ridge pattern and abrupt edge were respectively most common patterns among malignant melanomas. Acral benign melanocytic nevi and malignant melanomas respectively have well distinctive characteristics in dermatoscopy among our patients