3rd Phalanx Research Articles

“HOOF WOODPECKER” AT CORONARY BAND AND HOOF WALL LEVEL IN FORESTRY ENVIRONEMENT WORKING HORSES

"Hoof woodpeckers or penetrating foreign bodies in the hoof are frequently found in working horses. A special pathology is encountered in horses that work in forestry environment. Unlike the metalic foreing body (so called clou de rue) that just penetrate the sole, the wood goes in by hammering (by sudden pressure). Movement between the hoof and the 3rd phalanx causes the foreign body to advance in depth. The study was carried out on a number of 54 working horses in the forestry environment, males, aged between 4 and 14 years. The diagnosis was established on the basis of the clinical examination and the history, the radiological examination being inconclusive. As a particularity, the fragmentation of wooden foreign bodies does not occur at the time of extraction but at the time of hammering through the hard tissues due to the forces that determine the change of the penetration trajectory. Restraint was achieved by physical and chemical means (sedation and anesthesia). The wound was cleaned and then the hole in the hoof wall was widened with the help of the hoof knife. The foreign body was extracted using a thick forceps or a dental extraction forceps. The dressing was changed every 48h until healing. The wound had been washed with potassium permanganate solution (KMnO4) or betadine 10%."

Tuberculosis Mimicking-Musculoskeletal Tumor of The Hand: An Uncommon Case of Extrapulmonary Tuberculosis

Background: Musculoskeletal extrapulmonary tuberculosis is accounting for only 10-15% of all cases. Current attention has been focused on hand tuberculosis due to its increasing prevalence. This study describes an unusual case of extrapulmonary tuberculosis that manifested as a soft tissue tumor of the hand.Case Report: A 17-year-old male presented with a painful swollen part of the 3rd finger of the left hand. The mass was irregular and suppurative, with discoloration and foul smell. Laboratory results showed anemia and increased erythrocyte sedimentation rate. The computed tomography scan showed an isodense soft tissue (size 2.19 cm x 1.59 cm x 4.21cm) across the distal to the proximal part of 3rd phalanx bone to the metacarpal region with a decrease of phalanx bone density with no sign of bone destruction or any periosteal reaction. The histopathology study revealed a chronic granulomatous structure surrounded by epitheloid cells, datia Langhans cells, and caseating necrosis. The acid-fast staining confirmed the presence of bacilliform bacteria.Discussion: Extrapulmonary tuberculosis typically results from secondary hematogenous dissemination and reactivation of the main foci. There are no specific tests to diagnose musculoskeletal tuberculosis preoperatively, leading to delayed diagnosis. Histopathological examination and culture are needed to confirm the diagnosis.Conclusions: Slow progression and multiple differential diagnoses frequently result in a delayed diagnosis, which leads to complications. Initial radical excision and anti-tuberculosis multidrug therapy provide excellent functional outcomes and recurrence prevention.

Numeric and morphological studies of the African lion (Panthera leo leo) pectoral limb

BackgroundThe Importance of the appendicular skeleton in the conformation, shape and physiology of wild animals especially carnivores for adaptation and survival cannot be overemphasized, as limited and obsolete information on the bones of the forelimb necessitated this study. Matured adult African lions (Male and female) that weighed 173 kg and 112 kg were obtained at different times after post mortem examinations of their carcasses. Bone preparation was achieved via cold water maceration after proper skin and muscle removal to a barest minimum.ResultsThe acromion process of the scapula consisted of a ventral hamate and caudal suprahamate processes. The Clavicle was absent in this species. The musculospiral groove of the humerus was more or less absent while its supracondyloid foramen and crest were positioned above the medial condyle and lateral condyle respectively. The radio-ulna presented a twisted appearance with the radius slightly curved thereby creating an extensive interosseous space that spanned its entire length. The seven (7) carpal bones were uniquely arranged in two rows while the 5 metacarpals anchored 5 digits with 3 phalanges except the first with 2 phalanges each. Two sesamoid bones were located on the ventral surface of each Metacarpophalangeal joint. None was seen on its dorsal surface. The 3rd phalanx had a unique appearance with a crescent plate projecting from the ventral cavity. The average total number of bones constituting the pectoral limb was 80.ConclusionNumerical information and detailed anatomical features of the pectoral limb bones of the African lion (Panthera leo leo) have added some valuable literature to science. This further serves as a baseline data for future scientific exposition on this species.

Surgical Management of Hollow Hoof Syndrome with Compression Shoeing in a Geriatric Mare

Hollow Hoof Syndrome (HHS) is a condition of equine foot that causes the hoof wall layers to separate. This separation starts at the solar surface of the foot and works its way dorsally (upward) toward the coronary band, though it can be managed with proper medical and surgical care. A mare was presented in Veterinary Clinical Complex, LUVAS, Hisar (India) with a history of lameness in right forelimb since last four months. Clinical examination revealed significant increase in the size of hoof accompanied with hard tissue swelling at fetlock joint and also nodding of head during landing of the affected hoof on the ground. Physical examination of hoof revealed that the epithelium of sole was eroded and 3rd phalanx was present just below the punctured keratinized epithelium at the solar surface of hoof. Radiographic examination revealed increased distance between the hoof wall and 3rd phalanx moving towards the apex of hoof confirming the rotation of pedal bone. Palmer digital nerve neurectomy was done to relieve the pain and use of compressive therapeutic shoe leads to uneventful recovery of animal.

Mac Gregor flap for injured ring finger in a child

We report the case of an 11-year-old female child who injured her ring finger (ring on the 4th finger hung on a nail fixed to the wall during a jump). Clinical examination showed 4th finger degloving injury with exposure of bone and tendon system and 3rd phalanx amputation (A). Following consultation with the family, the finger was preserved and McGregor inguinal flap was performed for aesthetic and functional outcome. Emergency surgery was performed under general anesthesia, with the patient in a supine position and preparation of the right upper limb and right flank. McGregor inguinal flap was performed after anatomical identification of the flap to place on the pathway of the superficial iliac artery (B). After dissecting the flap, it was tubularized on the finger to cover it (C). The postoperative course was uneventful and after three weeks the flap was weaned under general anesthesia (D); the result after one month was very satisfactory (E).

Correlations between weight-bearing 3D bone architecture and dynamic plantar pressure measurements in the diabetic foot

BackgroundMeasurements of plantar loading reveal foot-to-floor interaction during activity, but information on bone architecture cannot be derived. Recently, cone-beam computer tomography (CBCT) has given visual access to skeletal structures in weight-bearing. The combination of the two measures has the potential to improve clinical understanding and prevention of diabetic foot ulcers. This study explores the correlations between static 3D bone alignment and dynamic plantar loading.MethodsSixteen patients with diabetes were enrolled (group ALL): 15 type 1 with (N, 7) and without (D, 8) diabetic neuropathy, and 1 with latent autoimmune diabetes. CBCT foot scans were taken in single-leg upright posture. 3D bone models were obtained by image segmentation and aligned in a foot anatomical reference frame. Absolute inclination and relative orientation angles and heights of the bones were calculated. Pressure patterns were also acquired during barefoot level walking at self-selected speed, from which regional peak pressure and absolute and normalised pressure-time integral were worked out at hallux and at first, central and fifth metatarsals (LOAD variables) as averaged over five trials. Correlations with 3D alignments were searched also with arch index, contact time, age, BMI, years of disease and a neuropathy-related variable.ResultsLateral and 3D angles showed the highest percentage of significant (p < 0.05) correlations with LOAD. These were weak-to-moderate in the ALL group, moderate-to-strong in N and D. LOAD under the central metatarsals showed moderate-to-strong correlation with plantarflexion of the 2nd and 3rd phalanxes in ALL and N. LOAD at the hallux increased with plantarflexion at the 3rd phalanx in ALL, at 1st phalanx in N and at 5th phalanx in D. Arch index correlated with 1st phalanx plantarflexion in ALL and D; contact time showed strong correlation with 2nd and 3rd metatarsals and with 4th phalanx dorsiflexion in D.ConclusionThese preliminary original measures reveal that alteration of plantar dynamic loading patterns can be accounted for peculiar structural changes of foot bones. Load under the central metatarsal heads were correlated more with inclination of the corresponding phalanxes than metatarsals. Further analyses shall detect to which extent variables play a role in the many group-specific correlations.

Bone Material Properties of Human Phalanges Using Vickers Indentation.

ObjectiveTo investigate the microhardness distribution throughout the human hand phalanges using the Vickers method, which can be used to directly evaluate the bone mechanical properties at tissue level and provide an alternative means to investigate bone quality.MethodsThe phalanges bones involved in this study were collected from three healthy donors; fresh‐frozen right limbs were used. The phalanges bones were dissected and cut into 3‐mm thick slices perpendicular to the long axis in the phalanges base, the phalanges shaft, and the phalanges head with a low‐speed saw and then the slices were polished with sandpaper. A microindenter fitted with a Vickers indenter point was used to measure the Vickers hardness in the plantar, dorsal, medial, and lateral sites of cortical bone in metatarsal shaft and trabecular bone in the metatarsal base and head. The indentation load and dwell time was set to 50 g and 12 s for both the cortical and cancellous tissues in this study. For each site or region, five valid values were recorded and averaged as the Vickers hardness for the site or region.ResultsIn total, 96 bone slices were harvested from the base, shaft, and head of the 15 phalanges and 1920 indentations were performed. In general, the Vickers hardness in phalanges was 34.11 ± 7.95 HV. For the 5 phalanges, the 3rd phalanx showed the highest hardness (36.74 ± 7.10 HV), closely followed by the 1st (36.46 ± 5.96 HV) and 2nd (35.28 ± 6.52 HV) phalanx. The hardness in the 4th (31.90 ± 9.15 HV) and 5th (31.19 ± 8.22 HV) phalanx were significantly lower than in the other 3 phalanges. The hardness in the phalanx shaft (38.52 ± 6.67 HV) was significantly higher than that in both the base (30.73 ± 7.46 HV) and head (30.64 ± 6.81 HV) of the phalanx (F = 300.7, P = 0.000); no statistic difference existed between the base and head of the phalanx (P = 0.996). The Vickers hardness in the proximal, middle, and distal phalanx showed statistical difference in Vickers hardness (F = 19.278, P = 0.000). The proximal phalanx showed higher Vickers hardness than the middle phalanx in the 2nd to 5th phalanges (P = 0.002).ConclusionThis study reported on the Vickers hardness distribution of the human phalanges bone and provides the theoretical basis of differences in hardness, which will benefit the placement of plates and screws in orthopaedic surgery and contribute to the research on ideal artificial bones and 3D‐printed orthopaedic implants with inner gradient distribution of hardness.

9:12 AM Abstract No. 107 - Management of chest and shoulder arteriovenous malformations

To determine the efficacy of Endovascular Repair of Shoulder arteriovenous malformations (AVMs). Fifteen patients (10 females, 5 males) presented for repair of shoulder AVMs. Three patients had extension of AVM to the supraclavicular and axillary areas. Two patients had multiple AVMs. Eight patients had previous failed therapies (embo: PVA/coils/gelfoam; surgeries: excisions/bypass). All patients underwent ethanol endovascular AVM repair; seven patients had additional coil embolizations (110 treatments). Patient age range 18-76 years; mean age 47. Thirteen patients are cured at long-term follow-up (37 months mean follow-up). One patient with bilateral shoulder AVM and multiple other AVMs therapy is on-going. Another patient’s treatment is on-going. Complications include two patients with minor superficial blisters, one patient with transient radial nerve injury with complete recovery and one patient with clot embolus to hand, treated with urokinase w/distal 3rd phalanx removed. A recent report of shoulder AVM repair in JVIR documented failure of nBCA approach. These authors stated that shoulder AVMs were not possible to treat. This report documents cure of these difficult lesions is possible with ethanol endovascular and direct puncture approaches. Long-term cures are documented in this patient series despite previous publications stating treatments of these lesions are not possible. One patient with a massive left shoulder AVM demonstrates persistent cure at 16 year follow-up.

2:42 PM Abstract No. 159 - Management of chest and shoulder arteriovenous malformations

Purpose PURPOSE: To determine the efficacy of Endovascular Repair of Shoulder arteriovenous malformations (AVMs). Materials and Methods Fifteen patients (10 females, 5 males) presented for repair of shoulder AVMs. Three patients had extension of AVM to the supraclavicular and axillary areas. Two patients had multiple AVMs. Eight patients had previous failed therapies (embo: PVA/coils/gelfoam; surgeries: excisions/bypass). All patients underwent ethanol endovascular AVM repair; seven patients had additional coil embolizations (110 treatments). Patient age range 18-76 years; mean age 47. Results Thirteen patients are cured at long-term follow-up (37 months mean follow-up). One patient with bilateral shoulder AVM and multiple other AVMs therapy is on-going. Another patient’s treatment is on-going. Complications in-clude two patients with minor superficial blisters, one patient with transient nerve injury with complete recovery and one patient with clot embolus to hand, Rx with urokinase w/distal 3rd phalanx removed. Conclusion A recent report of shoulder AVM repair in JVIR documented failure of nBCA approach. These authors stated that shoulder AVMs were not possible to treat. This report documents cure of these difficult lesions is possible with ethanol endovascular and direct puncture approaches. Long-term cures are documented in this patient series despite previous publications stating treatments of these lesions are not possible.

Bir Buzağıda Komplike Taban Ulkusu Olgusu ve Sağaltımı

In this report, a case of complicated sole ulcer and its treatment in male, aged of 1.5 months, Holstein calf has been subjected. According to radiologic and clinical findings, it was complicated with purulent arthritis in coffin joint, osteophyte formations 1st, 2nd, 3rd phalanx, and tendinitis of profound and superficial tendons. After two months from the beginning of the treatment, calf was able to walk without any lameness and there was no pain symptom on palpation. The aim of this case report was to contribute to the literature data for complicated sole ulcer that can be also seen in cows.

Exposure to Phenobarbital in a Foal after Nursing a Mare Treated with Phenobarbital

Exposure to Phenobarbital in a Foal after Nursing a Mare Treated with Phenobarbital

Review of Pododermatitis Circumscripta (Ulceration of the Sole) in Dairy Cows

Sole ulcers are among the most frequent causes of lameness in dairy cattle. They are found most commonly in the hind lateral claw, are frequently bilateral, and have a high rate of reoccurrence. The pathogenesis of sole ulceration is primarily based on mechanical injury by the 3rd phalanx to the corium, basement membrane, and basal layers of the sole epidermis as a result of failure of the suspensory apparatus in the claw. The main pathways in the failure of the suspensory system include inflammatory (dermal vascular changes followed by disruption of keratinocyte proliferation and differentiation caused by local and systemic mediators) and noninflammatory (hormonal and biochemical changes in the peripartum period resulting in alterations of connective tissue in the suspensory system) pathways. Sole ulcers tend to occur in specific locations; the most reported site is the junction of the axial heel and sole. Other locations include the apex of the toe and the heel. Varying degrees of lameness may result, and the most severe are seen with complicated cases in which ascending infection affects the deeper structures of the claw. Pathologic changes at the ulcer site include dyskeratosis and dilated horn tubules with microcracks. Vascular changes include dilatation and thrombosis of capillaries with “neocapillary formation.” Areas of dyskeratosis may remain for as long as 50 days at the ulcer site. Treatment includes corrective trimming and relief of weight bearing. Complicated cases may require surgical intervention.

Review of Pododermatitis Circumscripta (Ulceration of the Sole) in Dairy Cows

Sole ulcers are among the most frequent causes of lameness in dairy cattle. They are found most commonly in the hind lateral claw, are frequently bilateral, and have a high rate of reoccurrence. The pathogenesis of sole ulceration is primarily based on mechanical injury by the 3rd phalanx to the corium, basement membrane, and basal layers of the sole epidermis as a result of failure of the suspensory apparatus in the claw. The main pathways in the failure of the suspensory system include inflammatory (dermal vascular changes followed by disruption of keratinocyte proliferation and differentiation caused by local and systemic mediators) and noninflammatory (hormonal and biochemical changes in the peripartum period resulting in alterations of connective tissue in the suspensory system) pathways. Sole ulcers tend to occur in specific locations; the most reported site is the junction of the axial heel and sole. Other locations include the apex of the toe and the heel. Varying degrees of lameness may result, and the most severe are seen with complicated cases in which ascending infection affects the deeper structures of the claw. Pathologic changes at the ulcer site include dyskeratosis and dilated horn tubules with microcracks. Vascular changes include dilatation and thrombosis of capillaries with "neocapillary formation." Areas of dyskeratosis may remain for as long as 50 days at the ulcer site. Treatment includes corrective trimming and relief of weight bearing. Complicated cases may require surgical intervention.

Congelaciones de manos y pies en un montañero de elite: utilidad de la gammagrafía ósea para predecir el nivel de amputación

A 38 year old man was admitted to our hospital 10 days after suffering a frostbite injury in hands and feet while practicing mountain climbing, at 8,100 meters of altitude, while he was trying to reach the top of the K2 mountain. A 99mTc-MDP bone scan performed in aseptic conditions showed: in hands: absence of bone uptake in the 3rd phalanx and distal portion of 2nd phalanx of the 5th finger of the left hand, and multiple areas of increased uptake in the distal portion of both hands. In feet: uptake decreases in the 2nd phalanx of the first toe of the left foot, and absence of bone uptake in the 3rd phalanx of the 2nd toe of the left foot, and in 2nd phalanx of the 1st toe and 3rd phalanx of the 2nd, 3rd and 4th toes of the right foot. As in the hands, there were multiple areas of increased uptake in the distal portion of both feet. The phalanges with absence of bone uptake had to be amputated, while those that presented increased uptake recovered with conservative treatment. Bone scan is indicated in the evaluation of frostbite injuries and helps to establish the prognosis early.

The propagation of ps-laser-pulses through different bone structures

First results of angle and time resolved light scattering measurements performed on normal and osteoporotic human bone tissue are presented. The principle of measurement is based on time-correlated single photon counting (TCSPC) using a 10 ps laser diode (830 nm) and a micro channel plate- (MCP-) photomultiplier tube. In vitro results on human lumbar vertebrae (L1) obtained with this equipment show a correlation between the full width at half maximum (FWHM) of the scattered light pulses and the bone mineral densities (BMD) determined by Dual X-ray absorptiometry (DXA). The angle dependent scattering curves in vitro give distinct indications on the bone status in transmission mode. The in vivo measurements were taken of the 3rd phalanx of human probands, i. e. the 3rd bone of a person's middle finger, and the results are compared with those obtained by DXA (Lunar Expert) measurements. The FWHM-values of the transit time distributions of laser pulses scattered by the phalanx are linearly correlated with high significance (P< 0.0005) to the BMD values extracted from DXA measurements.

Radiographic evaluation of ossification of the collateral cartilages of the third phalanx in Finnhorses

Of 462 Finnhorses (age 1-20 years) evaluated and graded (scale 0-5) radiographically for ossification of the collateral cartilages of the 3rd phalanx of the front feet, 22.9% were totally free from sidebones (Grade 0), and 49.1% had minimal or mild ossification (Grade 1 or 2) at the base of 1 or more of the cartilages. Moderate ossification (Grade 3) was present in 10.2% of the horses, whereas ossification was advanced (Grade 4) or extensive (Grade 5) in 17.8%. In most horses > 1 cartilage was affected and 7.6% of the horses had separate centres of ossification in 1 or more of the cartilages. Large sidebones and separate centres of ossification were more common in females than in males (P < 0.001). The incidence of large sidebones was lower in young females (1-3 years) than in mares 4-6 years of age (P < 0.05), but did not increase significantly with age when young horses, 4-6 years of age, were compared with older ones. Grade 4 and 5 sidebones as well as separate centres of ossification were more common in the lateral than in the medial cartilage (P < 0.001), but no difference was observed in this respect between the front feet.