Free Osteoarticular Metatarsal Autograft in the Reconstruction of Giant Cell Tumor of Metacarpal: Report of Two Cases and Description of a Technique / Enxerto osteoarticular livre de metatarso em reconstrução de tumor de células gigantes de metacarpo: Relato de dois casos e descrição de técnica

Abstract Giant cell tumors are benign but locally aggressive bone neoplasms containing many multinucleated giant cells similar to osteoclasts. The author reports the case of two patients with giant cell tumor in the metacarpals, one of whom was multicentric. Giant cell tumor in the hand is a rare condition, and, at this location, it commonly presents at an advanced stage, with extensive bone destruction. Thus, its safe resection, associated with a large resulting bone failure, represents a great challenge to the orthopedist. The various treatment options described in the literature cause severe cosmetic and/or functional impairment to the hand. Thinking about it, the author describes the treatment technique through the transfer of metatarsus-free osteoarticular graft to the metacarpal with good functional and cosmetic results.

Resumo Os tumores de células gigantes são neoplasias ósseas benignas, mas localmente agressivas, que contêm muitas células gigantes multinucleadas semelhantes aos osteoclastos. O autor relata o caso de dois pacientes com tumor de células gigantes nos metacarpos, dos quais um era multicêntrico. O tumor de células gigantes na mão é uma condição rara e, nesta localização, comumente apresenta-se em um estágio avançado, com extensa destruição óssea. Dessa maneira, sua ressecção de forma segura, associada a uma grande falha óssea resultante, representa um grande desafio ao ortopedista. As várias opções de tratamento descritas na literatura ocasionam severa perda estética e/ou funcional da mão. Pensando nisso, o autor descreve a técnica de tratamento por meio da transferência de enxerto osteoarticular livre de metatarso para o metacarpo, com bons resultados funcionais e estéticos.

Metacarpal fractures treatment: comparasion between kirschner wire and intramedullary screw / Tratamento de fraturas metacarpais: comparação entre fios de kirschner e fixação intramedular

ABSTRACT Introduction: Metacarpal fractures are common and can be treated surgically using Kirschner wires (K-wires) or intramedullary fixation with compression screws (IMCS). Objectives: Analyze the postsurgical results from treating the metacarpal extra-articular fractures through the retrograde Kirschner wire technique, and compare it with the intramedullary compression screw fixation. Methods: Retrospective and quantitative studies were to analyze patients' medical records, and a postsurgical evaluation questionnaire was given to the patients, who were divided into K-wire and IMCS. Results: The period of immobilization with a splint took six weeks for the K-wire group and four weeks for the IMCS group. The average time for consolidation took, respectively, fifty-seven days and forty-seven days. The first group could restart their activities twenty-two days after the other, and the average force value of the treated hand, when compared with its contralateral, was 93.9% and 95.4%, respectively. Between the operated hand and its contralateral, there was a difference of 16° in the total measures of the metacarpophalangeal and interphalangeal joint's range of movement among the K-wire group and 5° among the IMCS group. Conclusion: The patients who participated in this study showed excellent results after surgery, and both treatments were proven to be safe and reliable. Evidence level III; Retrospective comparative study .

RESUMO Introdução: Fraturas dos metacarpos são frequentes e podem ser tratadas de forma cirúrgica com os fios de Kirschner (FK) e Fixação Intramedular com Parafuso de Compressão (FIPC). Objetivo: Analisar os resultados pós-operatórios do tratamento das fraturas extra-articulares dos metacarpos pela técnica retrógrada com fios de Kirschner e comparar com a fixação intramedular utilizando parafuso de compressão. Métodos: Estudo retrospectivo, quantitativo, com análise de prontuários, utilizando questionários de avaliação pós-operatória em dez pacientes divididos em dois grupos: FIPC e FK. Resultados: O período de imobilização com tala nos grupos FK e FIPC foram de seis e quatro semanas respectivamente, já o tempo médio para consolidação foi de 57 e 47 dias respectivamente. O grupo FK retornou as atividades laborais após os FIPC. O valor médio de força na mão acometida comparada a contralateral foi de 93,9% no grupo FK, e no FIPC de 95,4%. Medidas da soma de amplitude de movimento das articulações metacarpofalangeanas e interfalangeanas no grupo FK obtiveram diferença média entre as mãos operada e a contralateral de 16°, já na FIPC observou-se 5°. Conclusão: Os pacientes estudados apresentaram excelentes resultados pós-operatórios e ambos os tratamentos provam ser seguros e confiáveis. Nível de evidência III; Estudo retrospectivo comparativo .

Osteosynthesis of Fractures of the Metacarpal Neck with Self-Compressing Screw - Preliminary Analysis of 21 Cases / Osteossíntese de fraturas do colo do metacarpo com parafuso autocompressivo - Análise preliminar de 21 casos

Abstract Objective The present study aims to analyze the clinical results of the surgical treatment of metacarpal neck fractures with retrograde intramedullary fixation using cannulated headless screws (Herbert type). Methods Retrospective study of 21 closed fractures deviated from the metacarpal neck in 21 patients operated between April 2015 and November 2018. Results The sample included 19 men and 2 women. The mechanisms that caused the trauma were punching, falling to the ground and motor vehicle accident (n = 14, 5 and 2). The affected metacarpals were the 5th, 3rd, and 2nd (n = 19, 1 and 1). Surgical indications were neck-shaft diaphysis of the metacarpal > 30º for the 2nd and 3rd metacarpals and > 40º for the 5th metacarpal, shortening ≥ 5mm, rotational deviation, and the desire of the patient not to use plaster cast. In the immediate postoperative period, patients remained without immobilization and were instructed to mobilize their fingers according to tolerance. All patients had total active mobility > 240º and returned to their former occupations. All fractures consolidated and there were no reinterventions. Discussion The great advantages of the headless screw technique are its low morbidity, sufficient stability to avoid external immobilization, and reproducibility at low cost. Conclusion This is an easy, fast technique that has excellent results for the surgical treatment of displaced fractures of the neck of the metacarpals.

Resumo Objetivo O presente estudo visa analisar os resultados clínicos do tratamento cirúrgico das fraturas de colo do metacarpo com fixação intramedular retrógrada utilizando parafusos canulados sem cabeça (tipo Herbert). Métodos Estudo retrospectivo de 21 fraturas fechadas desviadas do colo do metacarpo em 21 pacientes operados entre abril de 2015 e novembro de 2018. Resultados A casuística incluiu 19 homens e 2 mulheres. Os mecanismos causadores do trauma foram soco, queda ao solo e acidente com veículo motorizado (n = 14, 5 e 2). Os metacarpos acometidos foram o V, III e II (n = 19, 1 e 1). As indicações cirúrgicas foram angulação colo-diáfise do metacarpo > 30º para os II e III metacarpos e > 40º para o V metacarpo, encurtamento ≥ 5mm, desvio rotacional e o desejo do paciente de não utilizar imobilização gessada. No pós-operatório imediato, os pacientes permaneceram sem imobilização e orientados a mobilizar os dedos conforme tolerância. Todos os pacientes ficaram com mobilidade ativa total > 240º e retornaram às suas antigas ocupações. Todas fraturas consolidaram e não houve reintervenções. Discussão As grandes vantagens da técnica com parafuso sem cabeça são sua baixa morbidade, estabilidade suficiente para não precisar de imobilização externa e reprodutibilidade com baixo custo. Conclusão Esta é uma técnica fácil, rápida, e que apresenta ótimos resultados para o tratamento cirúrgico das fraturas deslocadas do colo dos metacarpos.

Evaluación de medidas morfométricas de tendones y ligamentos metacarpales palmares por ultrasonografía en caballos criollos colombianos / Evaluation of morphometric measures of tendons and metacarpal ligaments by ultrasonography in Colombian creole horses

RESUMEN Objetivo. Determinar los parámetros morfométricos ultrasonográficos de los tendones y ligamentos metacarpales palmares de caballos criollos colombianos clínicamente sanos. Materiales y métodos. Treinta caballos criollos colombianos clínicamente sanos de 6.4 ± 2.5 años se evaluaron en diferentes zonas del departamento de Córdoba (Colombia). Se midieron las variables área transversal (cm2), ancho latero medial (ALM) (cm) y espesor dorso palmar (EDP) (cm) en las estructuras de la región metacarpiana en los dos miembros anteriores mediante ultrasonografía. Resultados. La ecografía reveló que el área transversal del ligamento suspensorio fue la estructura de mayor área en las regiones proximales (1A, 1B y 2A), tanto para la extremidad izquierda como para la derecha. Por otro lado, no hubo una diferencia significativa (p>0.05) entre la extremidad izquierda y derecha para las mediciones de las estructuras en cualquier zona, y no hubo una diferencia significativa entre los grupos de edades e índice de masa corporal (IMC) de los caballos. Conclusiones. Se obtuvieron valores de referencia para los tendones y ligamentos en la región metacarpiana palmar en equinos proporcionando una guía de referencia cuando se sospechan condiciones patológicas metacarpo en equinos.

ABSTRACT Objective. To determine the ultrasonographic morphometric parameters of the palmar metacarpal tendons and ligaments of clinically healthy Colombian creole horses. Materials and methods. Thirty clinically healthy Colombian creole horses of 6.4 ± 2.5 years were evaluated in different areas of the department of Córdoba (Colombia). The variables cross-sectional area (cm2), medial lateral width (ALM) (cm) and dorsal palmar thickness (EDP) (cm) in the structures of the metacarpal region in the two anterior members were measured by means of ultrasound. Results. Ultrasonography revealed that the transverse area of the suspensory ligament was the structure with the largest area in the proximal regions (1A, 1B and 2A), for both the left and right limbs. On the other hand, there was no significant difference (P> 0.05) between left and right limb for measurements of structures in any area, and there was no significant difference between age groups and body mass index (BMI) of horses. Conclusions. Reference values for tendons and ligaments in the palmar metacarpal region were obtained in equines providing a reference guide when metacarpal pathological conditions in equines are suspected.

Use of a porous cellulose membrane (Membracel®) and moxibustion for severe excoriative injury in a chilean skua (Catharacta chilensis) / Utilização de membrana celular porosa (Membracel®) e moxabustão em lesão escoriativa severa em mandrião chileno(Catharacta chilensis)

The use of alternative therapeutic approaches in wild animals has gained notoriety due to its efficiency, low cost and reduced or nonexistent stressors. The present study evaluated the efficacy of treatment of a bilateral excoriative lesion in the region of the dorsal metacarpus in a Chilean skua (Catharacta chilensis) in a rehabilitation process with the use of a porous cell membrane, sold commercially, in concomitance with moxibustion sessions with herbs (Artemisia vulgaris). The healing time of 14 days was reduced when compared to traditional techniques and proved the viability and efficacy of the treatment.(AU)

O uso de abordagens terapêuticas alternativas em animais selvagens tem ganhado notoriedade em virtude de sua eficiência, baixo custo e estímulos estressores reduzidos ou inexistentes. Este estudo avaliou a eficácia do tratamento de uma lesão escoriativa bilateral em região do dorsal metacarpo em um mandrião chileno (Catharacta chilensis) em processo de reabilitação com o uso de uma membrana celular porosa vendida comercialmente, em concomitância com sessões de moxabustão com ervas (Artemisia vulgaris). O tempo de cicatrização de catorze dias mostrou-se reduzido quando comparado ao de outras técnicas tradicionais e provou a viabilidade e eficácia do tratamento.(AU)

Monostotic fibrous dysplasia of the metacarpal: a case report / Displasia fibrosa monostótica em metacarpo - Relato de caso

ABSTRACT Fibrous dysplasia is a bone disease characterized by abnormal differentiation of fibrous tissue in the bones; it is often asymptomatic. It may affect one bone (monostotic) or several bones (polyostotic). The monostotic form primarily affects the ribs, but hardly ever affects the hand. It is important to make the differential diagnosis with malignant bone tumors. This article describes the treatment and outcome of a rare case of a patient admitted with a history of tumor growth in the right hand, diagnosed as fibrous dysplasia of the right second metacarpal. Male patient, 14 years of age, admitted to the Sarah Hospital with lesion on the dorsum of the right hand without pain complaints, previous history of trauma, nor local signs of inflammation. Physical examination revealed swelling on the dorsum of the second metacarpal, painless, with unaltered mobility and sensitivity. Radiography, computed tomography, and magnetic resonance imaging indicated the involvement of the entire length of the second metacarpal: only the distal epiphysis was preserved, with areas of bone lysis. After biopsy confirmation, the patient underwent surgery, using a long cortical graft for reconstructing the metacarpal. During the follow-up period of five years there were no signs of recurrence, and proper digital growth and functionality of the operated hand were observed.

RESUMO A displasia fibrosa é uma doença óssea que se caracteriza pela diferenciação anormal de tecido fibroso nos ossos e é muitas vezes assintomática. Pode acometer um osso (monostótica) ou vários ossos (poliostótica). A forma monostótica acomete principalmente as costelas, mas raramente acomete a mão. O diagnóstico diferencial com tumores ósseos malignos é importante. O artigo descreve o tratamento e evolução de um caso raro de paciente admitido com história de crescimento tumoral na mão direita, na qual foi diagnosticada displasia fibrosa do segundo metacarpo direito. Paciente do sexo masculino, 14 anos, admitido no Hospital Sarah com lesão no dorso da mão direita, sem queixa álgica, antecedente traumático ou alteração flogística local. No exame físico, apresentava aumento de volume no dorso do II metacarpo, indolor, mobilidade e sensibilidade inalteradas. Foram feitos exames de radiografia, tomografia e ressonância magnética, evidenciou-se o comprometimento de toda a extensão do segundo metacarpo; apenas a epífise distal estava preservada, com áreas de lise óssea. Fez-se tratamento cirúrgico após a biópsia de confirmação, com o uso de enxerto longo cortical para reconstrução do metacarpo. Durante o tempo de seguimento de cinco anos não foram verificados sinais de recidiva; adequado crescimento digital e funcionalidade da mão operada foram observados.

What is the real angle of deviation of metacarpal neck fractures on oblique views? a radiographic study / Qual é o ângulo real do desvio da fratura do colo do metacarpo nas incidências oblíquas? estudo radiográfico

OBJECTIVE: The aim of this study was to establish an indirect, easy-to-use, predictable and safe means of obtaining the true degree of displacement of fractures of the neck of the fifth metacarpal bone, through oblique radiographic views. METHODS: An anatomical specimen from the fifth human metacarpal was dissected and subjected to ostectomy in the neck region. A 1-mm Kirschner wire was fixed to the base of the fifth metacarpal bone, perpendicular to the longitudinal axis of the bone and parallel to the ground. Another six Kirschner wires of the same diameter were bent over and attached to the ostectomized bone to simulate fracture displacement. Axial rotation of the metacarpus was used to create oblique radiographic views. Radiographic images were generated with different angles and at several degrees of rotation of the bone. RESULTS: We deduced a mathematical formula that showed the true displacement of fractures of the neck of the fifth metacarpal bone by means of oblique radiographs. CONCLUSIONS: Oblique radiographs at 30° of supination provided the best view of the bone and least variation from the real value of the displacement of fractures of the fifth metacarpal bone. The mathematical formula deduced was concordant with the experimental model used.

OBJETIVO: Estabelecer uma forma indireta, fácil, previsível e segura na obtenção do valor real do desvio da fratura do colo do quinto metacarpo a partir de radiografias oblíquas. MÉTODOS: Uma peça anatômica de quinto metacarpo humano foi dissecada e submetida à ostectomia na região do colo. Um fio de Kirschner de 1 mm foi fixado perpendicular ao eixo longitudinal do osso e paralelo ao solo. Outros seis fios de Kirschner do mesmo diâmetro foram dobrados e presos ao osso ostectomizado para simular o desvio das fraturas. Rotação axial do metacarpo foi usada para criar as radiografias nas incidências oblíquas. Imagens radiográficas foram obtidas com diferentes ângulos e em vários graus de rotação do osso. RESULTADOS: Deduzimos uma equação matemática que demonstra o real desvio da fratura do colo do quinto metacarpo por meio de radiografias oblíquas. CONCLUSÕES: A radiografia oblíqua com 30° de supinação apresenta melhor visualização do osso e menor variação do valor real do desvio da fratura do colo do quinto metacarpo. A fórmula matemática deduzida foi concordante com o modelo experimental usado.

X-ray characteristics of metacarpus and phalange in adult patients with Kaschin-Beck disease in Qinghai Province / 中华地方病学杂志

Objective To analyze the radiographic characteristics of right hand X-ray film of adult patients with Kaschin-Beck disease (KBD) in Qinghai Province, to understand the most affected locations in adult KBD. Methods According to the criteria of KBD diagnose (WS/T 207-2010), 111 cases of patients were taken X-ray films of right hands. Joint space narrow, joint deformity, subchondral sclerosis, osteophyte, coarse and irregularity of joint, marginal retraction sign and capsule changes were chosen as the descriptive indexes, and these indexes were analyzed with SPSS 17.0. Results A total of 111 cases adult patients with KBD were examined right hand by X-ray, abnormality on X-ray film were 103 cases, the abnormal rate was 92.79%. The most affected fingers were Ⅱ- Ⅳphalanx bones, Ⅱphalanx bones accounted for about 92.23% (95/103), Ⅲ phalanx bones accounted for about 99.03% (102/103), and Ⅳ phalanx bones accounted for about 99.03% (102/103). There was significant difference of the abnormality between th e proximal phalanx and the middle phalanx among the Ⅱ - Ⅳ phalanx bones(χ2=79.33, P<0.05). Abnormal numbers of joint deformity, marginal retraction sign, coarse and irregularity of joint, osteophyte, capsule changes and joint space narrow in the proximal phalanx were 212, 7, 134, 47, 15 and 115 in Ⅱ - Ⅳ proximal phalanx, respectively; while the abnormal numbers of joint deformity, marginal retraction sign, coarse and irregularity of joint, osteophyte, capsule changes and joint space narrow in the middle phalanx were 77, 37, 137, 26, 19 and 126 in Ⅱ - Ⅳmiddle phalanx, respectively. Conclusion The Ⅱ - Ⅳ phalanx bones of right hand are the most affected locations in adult KBD.

Computed tomography and cross sectional anatomy of the metacarpus and digits of the one-humped camel and egyptian water buffalo / Anatomía por tomografía computarizada y sección transversal del metacarpo y dígitos del camello de una joroba y el búfalo de agua egipcio

The use of advanced imaging in diagnostic patient evaluations is increasing as well as the availability of machines for veterinary practices. The purpose of this study was to provide an atlas of synchronized normal computed tomography and cross sectional anatomy of the metacarpus and digits in the one-humped camel and Egyptian water buffalo to provide a basis for diagnosis of their diseases by the aid of CT. One cm contiguous transverse CT images and cross sectional anatomy were obtained and photographed. Clinically applicable anatomic structures were identified and labeled at each level. In both animals, the medullary cavity of the fused third and fourth metacarpal bones was divided internally by a vertical bony septum which was a complete septum in the camel, complete at the proximal and distal extremities in the buffalo and small and incomplete in main part of fused shaft of metacarpal bones in buffalo. The CT of the present study in both camel and buffalo showed the adjacent extensor tendons as transverse narrow strap with undifferentiated outlines on the dorsal aspect of fused metacarpal bones, proximal phalanges and middle phalanges and the adjacent flexor tendons as roughly rounded mass with undifferentiated outlines on the palmar aspect of fused metacarpal bones, proximal phalanges and middle phalanges. The undifferentiated outlines of the adjacent extensor or flexor tendons in CT images is equivalent to cross sectional anatomy without dissection of the intervening fascia, where the outlines didn't appear in the latter also. Therefore, the cross sectional anatomy is superior to CT only when the intervening fascia is dissected. CT images of the current study have the potential to become part of our standard diagnostic investigation for anatomic regions previously difficult to be evaluated in the camel and buffalo.

El uso de imágenes avanzadas en las evaluaciones diagnósticas del paciente es cada vez mayor, así como la disponibilidad de máquinas para la práctica veterinaria. El propósito de este estudio fue proporcionar un atlas de anatomía por tomografía computarizada sincronizada normal y sección transveral del metacarpo y los dedos en el camello de una joroba y búfalos de agua Egipcios para proporcionar una base para el diagnóstico de sus enfermedades con la ayuda de TC. Fueron obtenidas y fotografiadas imágenes anatómicas de TC transversales de 1 cm contiguas y de sección transversal. Las estructuras anatómicas de aplicación clínica fueron identificadas y etiquetadas en cada nivel. En ambos animales, la cavidad medular de los huesos metacarpianos tercero y cuarto fusionados se dividió internamente por un septo vertical de hueso, el cual era un septo completo en el camello y completo en los extremos proximal y distal en los búfalos, y pequeños e incompletos en la parte principal de eje de fusión de los huesos metacarpianos en los búfalos. La TC mostró tanto en camellos como en búfalos a los tendones extensores adyacentes como una correa transversal estrecha con los contornos indiferenciados en la cara dorsal de los metacarpianos fusionados, falanges proximales y falanges media y, los tendones flexores adyacentes como una masa más o menos redondeada con contornos no diferenciados en la cara palmar de la fusión de los huesos metacarpianos, falanges proximales y falanges medias. Las líneas diferenciadas de los tendones extensores o flexores adyacentes en las imágenes de TC fue equivalente a la anatomía de sección transversal sin disección de la fascia de intervención, donde las líneas no aparece en el último. Por lo tanto, la anatomía de sección transversal es superior a la TC sólo cuando la intervención diseca la fascia. Las imágenes de TC del presente estudio tienen el potencial para convertirse en parte de nuestra investigación de diagnóstico estándar para...

Huge Turret Exostosis of Metacarpus: A Case Report / 대한골관절종양학회지

A turret exostosis was known a smooth, dome-shaped extracortical collection of subperiosteal bone beneath the extensor apparatus. In most cases, turret exostosis involve middle and distal phalanges compared with involving metacarpal cases have been rarely reported in the literature.

Design and application of the reversed dorsal metacarpal island flap pedicled on the digital proper artery / 中华创伤骨科杂志

objective To explore a new method of repairing skin defects complicated with fracture and tendon rupture at the middle and distal sections of the second to fifth fingers. Methods The reversed dorsal metacarpal island flap was designed to be pedicled on the digital proper artery-common digital artery-fingerweb artery-dorsal metacarpal artery-cutaneous branch of dorsal metacarpal artery.In repairing digital palmar skin defects,after the flap was dissected,the proximal incision was extended along the direction of dorsal metacarpal nerve to harvest an enough length of the nerve so that the dorsal metacrppal nerve can be anastomosed with the digital proper nerve to restore the sensation of finger pulp.From the June 2003 to March 2009,the flap was used to repair 26 fingers in 24 patients with middle and distal digital skin defects complicated with fracture and tendon rupture.They were 17 men and 7 women,aged from 16 to 63 years (average,37 years).There were 15 cases of palmar skin defect and 9 cases of dorsal skin defect.In the 2 cases of combined tendon defects,a section of the extensor tendon of index(or little) finger was dissected together with the flap to repair the tendon rupture. Results The areas of the flap ranged from 3.1 cm ×1.6 cm to 6.0 cm × 4.0 cm.The flaps survived in all 24 cases without any vascular crisis.Twenty-two patients obtained an average follow-up of 14 months (from 4 to 32 months) but 2 were lost to the follow-up.The flaps were fine in texture,colour and appearance.The finger pulps appeared full and recovered sensations of pain and temperature.The average two-point discrimination was 7.5 mm (from 5 to 9 mm).Sensory function evaluation revealed an outcome of S3 + ～ S4.Tendon adhesion occurred in 4 cases which recovered digital function following secondary lysis 3 to 6 months postoperation. Conclusion Application of the reversed dorsal metacarpal island flap pedicled on the digital proper artery is a good way to repair skin defects complicated with fracture and tendon rupture at the middle and distal sections of the second to fifth fingers.

Avaliação da composição macroelementar do osso terceiro metacarpiano de equinos / Evaluation of the macro elemental composition of the equine third metacarpal bone

O terceiro osso metacarpiano equino é uma região de particular interesse devido ao grande número de lesões a que está sujeito. Assim, justifica-se o estudo detalhado da sua estrutura anatômica, dimensões e composição elementar para o aprimoramento de técnicas de diagnóstico, tratamento e prevenção de lesões. Neste trabalho,foi estudada a composição macroelementar óssea de 30 pares de osso terceiro metacarpiano equino e sua relação com a idade, sexo, peso, raça, alimentação e atividade dos animais. As concentrações médias de cálcio e fósforo das amostras foram 205 ± 62 mg/g e 97 ± 32 mg/g, respectivamente. A relação [Ca]/[P] encontrada foi de 2,12 ± 0,13, indicando que a proporção entre o cálcio e fósforo no tecido ósseo é constante e aproximadamente igual à razão 2:1. A análise estatística dos dados mostrou normalidade para todo o conjunto de medidas. A avaliação entre os animais com atividade física intensa e os animais com atividade física leve, em que a quantidade de material mineralizado para o primeiro e segundo conjuntos são, respectivamente, [Ca] = 222 ± 57 mg/g e [Ca] = 179 ± 47 mg/g, evidenciou a existência de correlação estatística entre o depósito de material mineral e a função exercida pelos animais. Para as demais características, não foram verificadas evidências estatísticas de inter-relações. Tais achados serão subsídios para estudos posteriores acerca de possíveis correlações com enfermidades de origem fisiológica ou nutricional frente à casuística de fraturas e outras afecções comuns ao aparelho locomotor equino.

The equine third metacarpal bone has been seen as a region of particular interest due to the large number of injuries to which it is subject. Thus, the detailed study of its anatomical structure, size and elemental composition is justified for the improvement of diagnostic techniques, treatment and prevention of injuries. In this work it has been studied the macro elemental composition of 30 pairs of equine third metacarpal bone and its relation with age, sex, weight, breed, nutrition and activity of animals. The average concentrations of calcium and phosphorus of the samples were 205 ± 62 mg/g and 97 ± 32 mg/g, respectively. The ratio [Ca] / [P] was found to be 2.12 ± 0.13, indicating that the ratio of calcium and phosphorus in bone tissue is constant and approximately equal to the ratio 2:1. The statistical analysis showed normal values for the entire set of measurements. In the evaluation of the animals with intense physical activity, and animals with light physical activity, it was found that the amount of mineralized material for the first and second sets respectively ([Ca] = 222 ± 57 mg/g [Ca] = 179 ± 47 mg/g), showing the existence of statistical correlation between the deposit of mineral material and the function performed by the animals. For the other characteristics were not found statistical evidence of correlations. These findings will be input for further studies of possible correlations with diseases of nutritional origin or physiological outside the series of fractures and other disease common to the equine locomotor system.

Ultra-sonografia da face palmar da região metacarpal em eqüinos / Ultrasonography of equine palmar metacarpus region

Introdução - Na literatura verificou-se o número reduzido de informações sobre as dimensões e a técnica de escolha para estudo ultra-sonográfico das estruturas da face palmar metacarpal de eqüinos. Material e Métodos - Foram realizados em 16 membros de animais da espécie eqüina, sem raça definida, machos castrados e de idade variando de 6 a 20 anos, sonogramas da face palmar em região metacárpica. Utilizou-se um transdutor setorial, com freqüência de 7,5 MHz, acoplado a um stand off de silicone. Resultados - A técnica de ultra-sonografia tendínea foi avaliada e comparada aos dados da literatura. O tendão dos músculos flexor digital superficial e do flexor digital profundo, o ligamento acessório do tendão do músculo flexor digital profundo e o músculo interósseo foram mensurados, em secção dorso palmar e os resultados comparados aos existentes em literatura. Conclusões - Foi possível observar que a técnica empregada é satisfatória para avaliar os tendões, ligamentos e músculos da região metacarpal. Notou-se, ainda, que não há consenso entre os autores sobre a técnica a ser empregada, nem tão pouco quanto às dimensões normais das estruturas avaliadas.

Introduction - There is lack of information in the literature regarding the extension of equine palmar metacarpus region and the best ultrasonography technique to access these structures. Material and Methods - Sonograms of palmar metacarpus region have been accomplished in 16 animals of the equine specie, ages between 6 and 20 years old, non defined breed and geldings.The setorial probe, with the frequency of 7,5 MHz, has been used, plugged to a stand off of silicone. Results - The tendon of superficial digital flexor muscle, the deep digital flexor muscle's tendon, the accessory ligament of the deep digital flexor tendon and the interosseus muscle have been measured on transverse view. The results were compared to the literature ones. Conclusions - It was possible to observe that the technique was enough to evaluate the tendon's bonds and muscle of the metacarpus. We also notice that there is no consensus among the authors about this technique and either about the standards dimension of the evaluated structures.

Treatment of metacatpal and phalangeal fractare with AO mini-plate / 中国基层医药

Objective To investigate the freatment outcome of internal fixation of the metacarpal and phalanx fracture using the pure fitanium mini plate.Methods 42 cases(78 lesions) of metacarpal and phalanx fracture were involved.Internal fixation with custom made pur titanium mini plate was done.Results Postoperative follow up rauged from 3 to 14 months and the fracture was healed in 42 cases.The bone union of roantgenographic eridence was 6 to 12 weeks.According to the functional evaluation of TAM ascles the excellent and good rate was 85.7%.Conclusion The AO mini-plate in treatment of the metacarpal and phalax fracture has a firm fixation.It is an optimal strategy for metarcarpal and phalanx fracture.

Treatment the fractures of the base of the first metacarpal with mini external fixator / 中华骨科杂志

Objective To introduced the clinical application and indication of treatment the fractures of the base of the first metacarpal with mini external fixator. Methods From October 2002 to December 2004, 37 cases of different typical fractures of the base of the first metacarpal were treated with mini external fixator and followed up, which included type Ⅰ (Bennett fracture) 19 cases, type Ⅱ (Rolando fracture) 10 cases, type Ⅲ 8 cases. Defferent operations were applicated accroding to the fresh degree and classification of fractures. In type Ⅰ and fresh type Ⅱ fractures, closed reduction and fixation with mini external fixator were applicated at first. If the reduction was insatisfied, open reduction and fixation with Kirschner wire and external fixator were necessary. In old type Ⅱ fractures, open reduction associating internal and external fixation was applicated. In fresh type Ⅲ fractures, close and external fixation were applicated. In old type Ⅲ fractures, open reduction and external fixation were done. Results All the cases were followed up average 15 monthes and all the fractures were union successfully. The average union time were 5.5 weeks and 7.5 weeks in the fresh and old fractures. Function evaluation was made according to pain degree, thumb joint activity and proportion of traumatic arthritis. The overall good-excellent rate was 94.6%, the clinical results were satisfactory. Conclusion Treatment of fractures of the base of the first metacarpal with mini external fixator is better than conventional methods. This method is simple and reliable, and may shorten heal time, decrerase joint pain, limitation of joint movement and proportion of traumatic arthritis. It is an effective method in treatment of fractures of the base of the first metacarpal.

Classification and treatment in the injury of hamatometacarpal joint / 中华骨科杂志

Objective To study the classification, management and outcome of the injury of hamatometacarpal joint. Methods Retrospective analysis was carried out in 17 patients with injury of hamatometacarpal joint. There were 16 males and 1 female aged 19-51 years old. 3 in left hand and 14 in right hand were injuried. The dominant hands of all were right hand. The injury of hamatometacarpal joint might be classified into 4 major groups based on the condition of the hamate, and subdivided into 2 subtypes based on the isolated dislocation(subluxation) or fracture-dislocation of metacarpal base. Carpometacarpal joint ligment injury without fracture of hamatum and the fourth or fifth metacarpal base dislocation without fracture was defined as typeⅠa. When there was a fracture of the fourth or fifth metacarpal base following typeⅠa was defined as typeⅠb. Avulsion fracture of the back of hamatum and the fourth and/or the fifth metacarpal base dislocation without fracture was defined as type Ⅱa. With the fracture of the fourth or fifth metacarpal base following the typeⅡa was defined as type Ⅱb. Splintered fracture of the back of hamatum with the fourth and/or fifth metacarpal base dislocation without fracture was defined as typeⅢa. With the fracture of metacarpal base following typeⅢa was defined as typeⅢb. The split fracture of coronal side of hamatum with the fourth and/or fifth metacarpal base dislocation and without fracture was defined as type Ⅳa. With fracture of the fourth and/or fifth metacarpal base following type Ⅳa was defined as type Ⅳb. There were 7 typeⅠb, 2 typeⅡa, 1 typeⅡb, 2 typeⅢb, 1 typeⅣa, 4 type Ⅳb in our group. We chose conservative or operative treatment according to the type of injury. Results The follow-up was 4-96 months. The patients had fracture union rate of 100%, and no traumatic osteoarthritis was occurred. There was a statistical significance when the motion of two-side joints was compared post surgery. There was no significant difference between bilateral hand in grip strength. Subjective evaluations of the patients were good or excellent. No complications was occurred. There is no case involved in any complications such as traumatic arthrositis, inflammation, neural injuries and adhesion of tendon. Conclusion The stable injury of hamatometacarpal joint should be ideally treated by closed reduction and immobilization in a well-moulded cast or splint. Satisfactory outcome can be got if keeping under strict surveillance. The unstable or intra-articular fracture should be treated by surgery. The outcome is also satisfactory and the rate of the complication of traumatic arthritis is low in short period follow-up. The outcome of fresh injury is much better than old one.