5th Finger Research Articles

Two-Stage Flexor Tendon Reconstruction for Finger Contracture Secondary to Phlegmon: A Case Report

Flexor tendon reconstruction is a complex surgical procedure that requires great precision and specialized expertise. It remains a preferred treatment for patients with neglected lacerations of the digital flexor tendon and after the failure of flexor tendon repair. Improvements in tendon repair methods and follow-up techniques have enhanced outcomes after flexor tendon grafting. Case Presentation: A 14-year-old girl with a history of a phlegmon of the 4th finger of the right hand, treated with antibiotics and drainage. The evolution is marked after 2 years by the progressive development of a flexion contracture of the proximal interphalangeal (PIP) joint. On examination, there is a flexion attitude and an inability to extend the PIP joint without vascular or nervous disorders. A two-stage reconstruction was performed using the palmaris longus tendon as a graft. With a follow-up of 3 years, the girl has recovered complete flexion and has limited extension to 25° at the PIP joint. An arthrolysis was proposed, but the girl refused, and she is satisfied with the results.

Rare Case of Cutaneous Rosai Dorfman Disease Involving the Nail

Abstract Introduction/Objective Rosia-Dorfman Disease (RDD) is a rare benign non-Langerhans cell histiocytic disorder of unknown etiology with heterogeneous clinical features. RDD was first described by Destombes in 1965 under the term “adenitis with lipid excess.” However, it is named after Rosai and Dorfman, who characterized the further histopathological features of the disease in 1969. The characteristic presentation of RDD is lymphadenopathy, and extra nodal sites include bone, upper respiratory tract, central nervous system, retroperitoneum, and skin. The management of RDD depends on the site of involvement and the presence or absence of the symptoms. Multifocal and refractory diseases require systemic treatment. Surgical resection can be considered in symptomatic and resect- able diseases. Methods/Case Report A 16-year-old Asian female with no significant past medical history presented with a painful verrucous lesion on the left 5th finger for one year with bleeding and purulent discharge. Excision was performed, and histologically, there was extensive infiltration of large histocytes in the dermis with occasional lymphocytes and plasma cells. The histiocytes were engulfing the intact inflammatory cells, exhibiting the emperipolesis phenomenon. Immunohistochemically, S100 and CD68 were positive in the large histiocytes, and leukocyte common antigen (LCA) was positive in the background lymphocytes. Based on histology and immunohistochemistry, RDD diagnosis was rendered. Results (if a Case Study enter NA) N/A Conclusion RDD is a rare condition that poses challenges in diagnosis and management. The key diagnostic factors are histological features and immunohistochemistry to exclude other pathological disorders. Treatment should be tailored according to the needs of each patient and as required to optimize the outcome. We recommend an appropriate diagnosis of this entity in a timely manner to prevent any further long-term complications.

Study of Carpal Tunnel Syndrome Using Electroneurography and Ultrasound in a Spanish Cohort

Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Its diagnosis is clinically supported by the electroneurography (ENG). The use of ultrasound (US) has increased in recent years. Our objectives are: to describe the ENG and US findings in patients with suspected CTS, based on age, sex and anthropometric data; and to study the correlation of both tests based on the severity of CTS. Material and methods: prospective study of patients with suspected CTS who undergo ENG and US. ENG examination: antidromic sensory median at 3rd and 4th finger; distal motor of median. US: crosssectional area (CSA) prior to or within the tunnel (higher values). Inclusion criteria: patients aged 18 to 85 years. Exclusion criteria: previous trauma or previous surgery for CTS or forearm, carpus or hand. Statistical study with the SPSS 29.0 program. Results: 400 nerves from 266 patients (52.59 ± 12.09 years) were studied, 183 women and 83 men. According to the ENG, 129 did not have CTS, 61 were incipient, 113 mild, 19 moderate and 75 severe. The mean CSA was 8.37 ± 1.21 mm2 in non-CTS, 10.09 ± 1.45 mm2 in early, 11.33 ± 1.87 mm2 in mild, 14.63 ± 1.92 mm2 in moderate and 15.46 ± 3.33 mm2 in severe CTS, with a significance of p<0.01 (95% CI) in the ANOVA test. The highest and inverse correlation appears between the conduction velocities (CV) at the 4th finger with CSA (-0.816) and CV at the 3rd finger with CSA (-0.800), which coincides with the most sensitive ENG values for the diagnosis of CTS. Discussion: CSA is an appropriate test as a complement to ENG in the diagnosis of CTS. However, it has limitations when establishing the cut-off point between normality and neuropathy, as well as when classifying based on severity

Novel variants in the SOX11 gene: clinical description of seven new patients.

Pathogenic SOX11 variants have been associated with intellectual developmental disorder with microcephaly, and with or without ocular malformations or hypogonadotropic hypogonadism (HH) (IDDMOH, OMIM # 615866). In this article, we report seven new patients with de novo SOX11 variants. Five of the variants are missense, one nonsense, and one whole-gene deletion, most of them are novel variants. The main clinical features included neurodevelopmental delay (7/7) and intellectual disability (5/7), autism/attention deficit hyperactivity disorder (5/7), microcephaly (4/7), short stature (4/7), hypotonia (4/7), and clinodactyly of the 5th fingers (5/7). HH was confirmed in two female patients with primary amenorrhea, nonvisualized/prepubertal size of the uterus, and nonvisualized ovaries. Two of the male patients presented with micropenis, two had cryptorchidism, and one had decreased testicular size, which are suggestive findings of HH. This article contributes to the clinical characterization of patients with SOX11 variants and supports the role of this gene in HH.

DISTANT SOFT TISSUE FLAPS IN A DEGLOVING SKIN INJURY

Avulsion skin injuries of the glove removal type are one of the most challenging and difficult problems in reconstructive hand surgery. Immediate or early coverage of the hand is of utmost importance. Several options are proposed for early covering the preserved structures (tendons, bones and nerves) early, mainly skin grafting on the preserved viable structures. Case description: We present a case of a patient with 4th and 5th finger crushing and avulsion skin injury of thumb and index finger and lost distal phalanges. The 4th and 5th fingers had been amputated due to gangrene. Two anterior abdominal wall flaps were applied: a thoraco-umbilical flap and a horizontal Filatov stem" flap. On the 25th day, the flaps were separated from the fingers and following commissuroplasty 10 months later. Result: Fusion between the donor flap and the recipient structures was obtained without clinical evidence of infection, ulceration and flap necrosis. Conclusions: The usage of remote skin flaps is a safe and simple method to restore hand function when microsurgery cannot be applied.

Association of 2D:4D finger length ratio of People Working in different professions with personality traits

BackgroundThe ratio of the index finger (2nd finger) to the ring finger (4th finger) (2D:4D) can give information about harmony between personality and career of individuals. The developing technology makes it difficult to choose a profession. AimThis study aims to contribute to the career choice of individuals by analyzing the relationship between the 2D:4D finger digit ratio and personality traits of individuals working in different professions (Educator, Worker, Housewife, Civil servant, Healthcare professional/EWHCH). MethodThe participants were three hundred twenty-five individuals living in the province of Malatya. The SPSS 26.0 software was utilized in the data analysis. The p value of 0.05 was accepted as significance level in comparison tests. ResultsA statistically significant difference was determined between the participants, who had the 2D shorter than the 4D in right hand, in terms of professional groups (p < 0.05). In healthcare workers, a low level (r = 0.305) positive correlation was found between right hand 2D4D and both control (r = 0.264) and curiosity and left hand 2D:4D, and a low level (r = 0.255) negative correlation was found between Conscientiousness and right hand 2D:4D in housewives. There was a statistically significant difference between the groups (educator, worker, housewife, civil servant, healthcare professional) in terms of total score of the Five-Factor Personality Inventory (FFPI) and scores of extroversion, agreeableness, conscientiousness, neuroticism, and openness to experience subscales (p < 0.05). A weak positive statistically significant correlation was detected between the healthcare professionals’ score of Career Adapt-abilities Scale (CAAS) control subscale and the right-hand 2D:4D ratio. Conclusions: It is suggested to investigate the 2D:4D ratio over different professional groups. The present study is important since it gives information about personality and associates such information with the 2D:4D ratio.

Pathomechanics of lumbrical and flexor digitorum profundus muscle tears in climbers: A cadaveric model

Lumbrical muscles originate on the flexor digitorum profundus (FDP) tendons and, during fist making, they move in the same direction when FDP muscle produces maximal proximal tendon gliding. Injuries of the bipennate lumbricals have been described when a shear force acts between the origins on adjacent tendons of the FDP, as they glide in opposite directions in asymmetric hand postures. Other structures of the deep flexors complex can be affected during this injury mechanism, due to the so-called quadriga effect, which can commonly occur during sport climbing practise. Biomechanical studies are needed to better understand the pathomechanism. A cadaveric study was designed to analyse the effects of load during the fourth lumbrical muscle injury mechanism. The amount of FDP tendon gliding and metacarpophalangeal (MCP) joint flexion of the 5th finger were calculated. Ten fresh-frozen cadaveric specimens (ten non-paired forearms and hands) were used. The specimens were placed on a custom-made loading apparatus. The FDP of the 5th finger was loaded, inducing isolated flexion of the 5th finger, until rupture. The rupture occurred in all specimens, under a load of 11 kg (SD 4.94), at 9.23 mm of proximal tendon gliding (SD 3.55) and at 21.4° (SD 28.91) of MCP joint flexion. Lumbrical muscle detachment from the 4th FDP was observed, from distal to proximal, and changes in FDP tendons at the distal forearm level too. The quadriga effect can lead to injury of the bipennate lumbrical muscles and the deep flexors complex in the hand and forearm.

Three in one - unusual palmaris longus muscle anatomical variation.

The palmaris longus muscle (PLM) is one of the most variable muscles in human body, pre-senting a wide range of morphological variants such as reversed course, biventer muscle, bi-furcated tendon or total agenesis. Their clinical impact is particularly important in diagnosis and treatment of carpal tunnel syndrome and reconstructive surgery. We present a case of PLM including a previously undescribed combination of variations. A routine dissection of male cadaver aged approximately 60 demonstrated a biventer muscle, with superior and inferior belly being interrupted by a long tendon. The inferior belly passed deep to the flexor retinaculum and its terminal tendon connected to flexor digitorum superfi-cialis tendon for 5th finger. The clinical importance of variations found have been described separately, including unsuita-bility of biventer muscles for tendon reconstruction and increased risk for developing carpal tunnel syndrome in patients with PLM tendon passing deep to the flexor retinaculum. In conclusion, as another variation of PLM is described, it is crucial to bear in mind the poten-tial morphological types of the muscle in diagnosis and treatment of patients, especially in surgery of the hand and forearm.

The Relationship of University Students' Internet Addiction Level Through Telephone Use and 2d:4d Ratio

Aim: To evaluate the relationship between the 2nd and 4th finger measurement ratio (2d:4d) ratio of university students' internet addiction level through phone use. Material and Method: 322 students were questioned about their demografic data, dominant extremity, and the device while using the internet. Hand width (HW), length (HL), grip strength (HGS), 2d:4d measurements were taken. Young Internet Addiction Scale (YIAS) was used for internet addiction, Smartphone Addiction Scale-Short Form (SAS) was used for smartphone addiction. Results: In men, it was determined that there was a statistically significant difference between the groups in terms of Right-Left HL, Left HGS, Right/4d, YIAS and SAS values. In addition, it was determined that the device preference, HL right, HL left, HGS left and Right/4d parameters originated from normal and dependent groups. It was determined that there was a statistically significant difference between the groups in women in terms of Left HL, Right/2d, Right/4d, Left/2d, Left/4d, Young and SAS values. It was determined that the device preference was due to individuals falling into the normal group of Left HL according to the YIAS, and the statistical difference of the Right/2d, Right/4d, Left/2d and Left/4d parameters. It was determined that there was a moderately strong negative correlation between SAS and Right/2d, Right/4d, Left/2d, Left/4d parameters in addicted men. Conclusion: The gender relations of the accepted scales regarding phone and internet addiction may be due to the length of the left hand and the movement function of the right 4d to provide control in phone use, rather than the 2d:4d finger ratios.

2D/4D Finger Length Ratio in the Screening of Developmental Dysplasia of the Hip.

To investigate whether there is a relationship between the 2nd finger and 4th finger length measurement ratios and developmental dysplasia of the Hip (DDH). Cross-sectional observational study. Place and Duration of the Study:Department of Orthopaedics and Traumatology, Meram Faculty of Medicine Hospital, Konya, Turkiye, from January 2020 to May 2023. Infants were screened for DDH with Graff method for the ultrasounds of both hips. Lengths of the 2nd and 4th fingers of both hands were measured and recorded. Patients with additional risk factors for developmental dysplasia of the hip (breech birth, family history, oligohydramnios, swaddling) were excluded. Two hundred and fifty-six babies were screened including 55.1% (n = 141) girls and 44.9% (n = 115) boys. Their mean age was 2.51 ± 0.80 months. The average lengths were 31.73 ± 3.05 mm, for the left 2nd finger and 34.26 ± 3.48 mm for the left 4th finger. In the hip USG measurements, the mean alpha angles were 62.91 ± 3.12° for the right hip and, 63.20 ± 3.55° for the left hip. Eighteen (7%) of babies who underwent hip ultrasound (USG) had unilateral or bilateral DDH. Among these cases, 2.7% (n = 7) had right, 2.3% (n = 6) had left, and 2% (n = 5) had bilateral DDH. There was no statistically significant correlation between the ratios of right 2/4 finger lengths and the right alpha angle (rs = 0.051; p = 0.421). There was a statistically positive and statistically significant correlation between the ratios of left 2/4 finger lengths and the left alpha angle (rs = 0.154; p = 0.013). Only the left-hand finger ratio among the parameters in the model had a statistically significant effect on DDH. Therefore, the left hand 2D/4D finger length may be of value in screening for DDH. Developmental dysplasia of the hip, Second to fourth finger digit ratio, Ring finger, Digit ratios.

Long-term recurrence of Dupuytren’s disease treated with clostridium histolitycum collagenase. Surgical treatment and anatomopathological study

ObjectiveTo present the functional results obtained and the possible surgical difficulties after the surgical treatment of Dupuytren’s disease (DD) recurrence in patients previously treated with Clostridium histolyticum (CCH) collagenase.Materials and methodsIn this prospective study, 178 patients with DD were treated with CCH from 2011 to 2018; During long-term postoperative follow-up, 34 patients (19.1%) had recurrence of DD. In all patients injected in the IFP the disease recurred; In patients injected in the MCP, recurrence was highest in grade III and IV of the Tubiana classification, with involvement of the 5th finger and the two-finger Y-chord. Fourteen patients (7,8%) required surgery by partial selective fasciectomy due to recurrence of cord DD infiltration. The clinical and functional results of the patients, the difficulty of the surgical technique and the anatomopathological analysis of the infiltrated cords were evaluated in comparison with those of cords and patients who had had no previous CCH treatment.ResultsIn all patients, cord rupture was achieved after injection, reducing joint contracture. In 14 patients, we observed during the follow-up the existence of DD recurrence that required surgical treatment by selective partial fasciectomy. There were no major difficulties in surgery and good clinical and functional results at 6 months of follow-up. The anatomopathological study of the resected tissue did not present histological alterations with respect to the samples obtained from patients initially treated by selective partial fasciectomy.ConclusionsSelective fasciectomy after CCH injection does not lead to important operative difficulties, as long as the CCH injection is performed according to the recommendations. There were no histological changes in the tissue after CCH injection.Level of evidenceIII.

TRANSMETACARPAL REPLANTATION. ELEVEN YEARS LATER

A case in a series of nine transmetacarpal replantations was presented at the combined meeting of the 7th European congress on Prevention of Hand Traumas and the 7th congress of the Bulgarian Society for Surgery of the Hand, 19-21 October 2023, Plovdiv, Bulgaria.&#x0D; A male patient aged 42, a heavy truck driver, was an ideal candidate for replantation. In February 2012 he sustained transmetacarpal amputation by circular saw through the proximal third of the left hand, with local crush of the tissues. During replantation enormous tissue edema appeared, caused by long ischemia time with cryopreservation of the amputated part for three hours. Restoration of the common digital nerves was postponed and performed 4 months later (Millesi procedure).&#x0D; Eleven years later the following outcome is registered. TAM: 110 (good), ab-adduction of 2nd and 4th fingers is restored in limited range. The effect is attributed to reinnervation of some spared interosseous muscles by the motor branch of the ulnar nerve, restored during the autoplastic of the common digital nerves. The lateral pinch between the thumb and second finger is useful.&#x0D; The skin sensitivity is examined by Weber static two-point discrimination test (2pdt):12 mm for 2nd and 3rd fingers, 15 mm for the 4th finger and one point for the pulps of the 5th finger and the thumb; 2pdt, carried out on the palm, in the base of the fingers, is 10 mm.&#x0D; The gained useful function of the hand is 50%. Original working ability is restored, but it is forbidden for the patient to work as a professional driver. He can drive his own car.&#x0D; In transmetacarpal replantations with level through the proximal part of the palm some interosseous muscles are preserved, and repair of the motor branch of the ulnar nerve is with favorable prognosis regarding functional recovery.

Immediate effects of a novel hand rehabilitation board on fine motor skills in children with cerebral palsy: A pilot study.

In children with cerebral palsy (CP), fine motor skills limit forearm supination and active extension of the elbow, wrist, or fingers. Therapeutic interventions focusing on improving the ranges at these joints while facilitating active movements are the key to augmenting fine motor skills. This pilot study examines if children with CP (with UE involvement) exposed to the Novel Hand Rehabilitation (NHR) Board will demonstrate 1) changes in spasticity and passive ROM of forearm and wrist/finger muscles, and 2) improvement in fine motor abilities. The forearm and wrist/fingers of children with spastic CP (N = 15; M = 7, F = 8) aged 49-72 months (65.33±6.355 months) were positioned on the NHR board till their tolerance limit or a minimum duration of 30 minutes. The outcome measures, i.e., spasticity (Modified Ashworth Scale), passive range of motion (PROM) of wrist and fingers, and fine motor skills (PDMS-2 - Fine motor scale), were recorded. The spasticity of forearm pronators (0.001) and wrist flexors (0.008) reduced significantly, but not in wrist extensors. Post-intervention improvements in wrist extension (p = 0.005) and ulnar deviation ROM (p = 0.007) were significant. In thumb, changes were non-significant for the CMC flexion, but extension (0.003) and abduction (0.001) as well as MCP extension (0.004) were significant. The post-intervention MCP extension ROM for the 2nd (0.001), 3rd (0.007), and 4th fingers (0.014) were also substantial, but not for PIP and DIP joints. The post-intervention percentage change in the Grasping and Visual-motor integration subtests of PDMS-2 was 11.03% (p = 0.002) and 5.09% (p = 0.001) respectively. The immediate effects on fine motor skills in children with CP after the NHR board application were positive and encouraging. Hence, the NHR board can be recommended as an intervention to improve the fine motor abilities of children with CP.

High-resolution peripheral quantitative computed tomography for the assessment of acro-osteolysis and calcinosis in patients with systemic sclerosis

ObjectiveTo assist the development of future treatments in systemic sclerosis (SSc), the development of reliable outcome measures is pivotal. We aimed to evaluate the use of high-resolution peripheral quantitative CT (HR-pQCT) for visualization and gradation of acro-osteolysis (AO) and calcinosis compared to conventional hand radiographs (CR) in patients with SSc. MethodsHR-pQCT scans of the 2nd to 4th fingers, CR, nail fold capillaroscopy, and a clinical examination were conducted. Images were reviewed for the presence and degree of AO and calcinosis according to semiquantitative grading scales. ResultsForty patients were included. Fourteen had AO according to CR, whereas HR-pQCT revealed AO in 18 patients. The sensitivity and specificity of classifying patients as having AO by HR-pQCT when CR was used as reference were 93% (95% CI: 66–99%) and 80% (95% CI: 59–93%), respectively. By CR and with HR-pQCT as reference, the sensitivity and specificity were 72% (95% CI: 47–90%) and 95% (95% CI: 76–99%). Patients with AO had more or larger calcifications than patients without AO according to the proposed HR-pQCT grading system, with a median grade of 2 (IQR: 1–3) versus 0 (IQR: 0–1) (P<0.01). Grade 3 changes were observed exclusively in patients with AO (n=6/14, 42.9%). Assessment of AO and calcinosis by HR-pQCT demonstrated moderate to excellent test-retest reliability. ConclusionHR-pQCT allowed precise and reliable classification and grading of acro-osteolysis and acral calcinosis. The modality could prove helpful for detecting and monitoring these lesions as well as facilitating early diagnosis and guide treatment of these patients.

A study on genotypes and phenotypes of short stature caused by epigenetic modification gene variants.

Mendelian disorders of the epigenetic machinery (MDEMs) are caused by genetic mutations, a considerable fraction of which are associated with epigenetic modification. These MDEMs exhibit phenotypic overlap broadly characterized by multiorgan abnormalities. The variant detected in genes associated with epigenetic modification can lead to short stature accompanied with multiple system abnormalities. This study is aimed at presenting and summarizing the diagnostic rate, clinical, and genetic profile of MDEMs-associated short stature. Two hundred and fourteen short-stature patients with multiorgan abnormalities were enrolled. Clinical information and whole exome sequence (WES) were analyzed for these patients. WES identified 33 pathogenic/likely pathogenic variants in 19 epigenetic modulation genes (KMT2A, KMT2D, KDM6A, SETD5, KDM5C, HUWE1, UBE2A, NIPBL, SMC1A, RAD21, CREBBP, CUL4B, BPTF, ANKRD11, CHD7, SRCAP, CTCF, MECP2, UBE3A) in 33 patients (15.4%). Of note, 19 variants had never been reported previously. Furthermore, these 33 variants were associated with 16 different disorders with overlapping clinical features characterized by development delay/intelligence disability (31/33; 93.9%), small hands (14/33; 42.4%), clinodactyly of the 5th finger (14/33; 42.4%), long eyelashes (13/33; 39.4%), and hearing impairment (9/33; 27.3%). Additionally, several associated phenotypes are reported for the first time: clubbing with KMT2A variant, webbed neck with SETD5 variant, retinal detachment with CREBBP variant, sparse lateral eyebrow with HUWE1 variant, and long palpebral fissure with eversion of the lateral third of the low eyelid with SRCAP variant.Conclusions: Our study provided a new conceptual framework for further understanding short stature. Specific clinical findings may indicate that a short-stature patient may have an epigenetic modified gene variant.

Alternative Surgical Treatment Method for 5th Metacarpal Neck Fractures: Comparison of Clinical Outcomes of Intramedullary and Transverse K-Wire Fixations with Additional Antirotational K-Wire.

The purpose of this study was to assess the clinical outcomes and complications associated with intramedullary and transverse K-wire fixations of 5th metacarpal neck fractures. Patients who were operated for 5th metacarpal neck fractures between 2019 and 2022 were evaluated retrospectively. Regarding the surgical treatment methods, patients were assessed by dividing them into two groups. The first group comprised patients who underwent treatment with an intramedullary K-wire. The second group comprises patients who underwent transverse K-wire fixation. The average quick DASH score of all patients was 5.6±4.7 in the intramedullary K-wire fixation group and 5.9±5.1 in the transverse K-wire fixation group. An average 5th finger metacarpophalangeal joint extension limitation was 6.2±5.7° in the intramedullary fixation group and 6.1±5.8° in the transverse K-wire group. The mean radiological union time was 4.9±0.7 weeks in the intramedullary fixation group and 5.1±0.7 weeks in the transverse K-wire group. No statistically significant difference was found between the quick DASH scores and degrees of the MCP joint extension limitation ( p=0.785). Intramedullary fixation and transverse K-wire fixations are effective surgical treatment methods for metacarpal neck fractures. It has been reported that the intramedullary fixation method in metacarpal bone fractures is more effective than the fixation methods with cross and transverse K-wire. But our results revealed no difference in clinical outcomes between the two surgical fixation methods. We observed no statistically significant difference between the two fixation techniques with regard to union, clinical outcomes, or complications. intramedullary fixation; metacarpal neck fracture; transverse K-wire fixation.

THE PATTERN OF SILVER-RUSSELL SYNDROME: OWN OBSERVATION

Silver-Russell syndrome (SRS) –is an orphan disease characterized by intrauterine and postnatal growth retardation. Children have special phenotypes, difficulties in feeding, the threat of insulin resistance, hypoglycemia, and accelerated sexual development. Aim: Increasing the effectiveness of SRS diagnosis based on the study of the features of the clinical and genetic course. Material and Methods: Clinical examination, blood tests, biochemistry, genetic tests, polymer chain reactions, and ultrasound examination have been carried out. Results: The child, 5 years old, was born from 2nd full-term pregnancy at 37 weeks, 2nd cesarean delivery with a body weight of 1900 g, height of 46 cm, head circumference of 30 cm, and chest circumference of 27 cm. Apgar scored 6/7 points. Neonatal adaptation disorders, intrauterine development, symmetrical shape, risk of hemolytic disease of the newborn according to the Rhesus factor (total bilirubin 190.0 μmol/l). The child had a special phenotype: asymmetry of the body with a relative increase in head circumference, a small triangular face with a protruding forehead, a narrow chin, a small jaw, and curvature of the 5th finger. From birth, insufficient body weight gain was observed (60 g per week, 400 g from birth in 6 weeks), which was explained by physiological vomiting and lactase deficiency (homozygous carrier of genotype C/C during PCR analysis). Body weight at the age of 1 year 5.200 g, height 63 cm, at the age of 5 years body weight 10.2 kg, height 91 cm. The child had heightened intellectual and psychological development. For the sake of differential diagnosis, a study was conducted for the presence of Gaucher’s disease (the result was negative). The results of immunologic tests: IgA 0.77 g/l, tTgIgA&lt; 2.0 units/ml, and tTgIgG 0.05 denied the presence of celiac disease. Clinical diagnosis was established according to the Netchine-Harbison scoring system (NH-CSS), which consists of 6 clinical criteria of NH-CSS. Gene sequencing revealed changes in the variant of uncertain significance SLK25A15, the genetic significance of which is unknown, which did not allow to confirm the diagnosis. Invitae Chromoso-mal Microarray Analysis of genome research on microdeletions (duplications) revealed, with a normal female genomic profile, uniparental dysfunction with two areas of homozygosity ROH&gt;5Mb (GRCh370) in chromosome 20: 20q13-p12.3(1-6690101; 6.69Mb and 20q13.32- q13.33(57394420- 63025520); 5.63 Mb. This change is characterized as a SRS variant, which created the basis for the diagnosis. Therefore, the child has a genetically confirmed diagnosis of SRS and congenital lactose intolerance. Somatotropic hormone (Omnitrop) was prescribed at a dose of 0.6 mg/day continuously. Conclusions: 1. The child’s SRS diagnosis was established on the basis of phenotype data, slow weight gain and growth, genetic research data, and the exclusion of the possibility of other conditions with the impaired physical development of the child. 2. The child needs a multidisciplinary approach to observation and treatment by a pediatrician or family doctor, endocrinologist, geneticist, nutritionist, surgeon, and gynecologist.

Volar radial Carpometacarpal dislocation of the fourth and fifth fingers

Carpometacarpal ligaments converge at the base of the metacarpal. Only very violent trauma can cause carpometacarpal dislocation. We report the case of a 23-year-old patient admitted for volar dislocation of the 4th and 5th finger with radial displacement. We did proceed to a closed reduction maintained by a splint the evolution was satisfactory with the recuperation of grip force. The mechanism of the injury can be direct or indirect. The displacement can suggest is there or not a complete rupture of the carpometacarpal ligaments. After closed reduction, the treatment can be surgical (which is preferred) with k-wire fixation or nonsurgical with splint immobilization with a close follow-up to avoid the loss of the reduction.

The ratio of second and fourth finger lengths (2D:4D) can determine handedness

Objective: The human body exhibits both structural and functional asymmetry. One measure of this asymmetry is the ratio of 2D:4D, which is the proportion of measurements of the 2nd (2D) and 4th finger (4D). In this research, our objective is to investigate the potential association between the ratio of 2D:4D and handedness with voluntary individuals.&#x0D; Methods: A total of 312 individuals volunteered to take part in the research, where their left and right hand's 4th and 2nd finger lengths were measured using a precise digital caliper. The "Edinburgh Handedness Inventory" was used to determine hand lateralization. To determine the significance between the two independent groups, the Mann Whitney U Test was used. On the other hand, to determine the significance between the two dependent groups, the Wilcoxon Signed Rank Test was utilized.&#x0D; Results: Of the participants, 154 were male and 158 were female (age range 18-55, mean age=28.34). According to the Edinburgh Handedness Inventory, 275 individuals were right handed, 18 were left handed, and 19 were bimanual. The Mann Whitney U Test showed a significant result in the ratio of right hand 2D:4D between male and female participants who were right handed (z =-1.979, p = 0.048). Additionally, the Wilcoxon Signed Ranks Test demonstrated a difference between the right and the left hand ratio of 2D:4D for all participants which was significant (z = -2.822, p = 0.005), as well as for participants who were right handed (z = -2.850, p = 0.004).&#x0D; Conclusion: The ratio of 2D:4D finger lengths could be a significant indicator of hand preference in both male and female healthy individuals. The ratio of 2D:4D holds potential as an indicator and research tool in understanding human emotions, thoughts, and behaviors.

Dental Treatment Approach in an Adolescent Patient With Coffin-Siris Syndrome

Coffin-Siris Syndrome (CSS) is a rare genetic disease with delayed growth, congenital anomalies, abnormal facial features, and mental retardation. Hypoplasia of the 5th fingers or nail agenesis, hirsutism, coarse facial appearance, thick eyebrows, wide lips and nose, dentofacial anomalies, and delayed eruption of teeth are clinically distinctive features. Specific findings and multidisciplinary approac-hes are important for dental treatments. This case report includes the clinical, oral findings, and dental treatments of the patient with CSS. A 15.5-year-old female patient consulted our clinic with the complaint of tooth sensitivity and missing teeth. The patient's family was informed that the patient has CSS. In clinical examination, coarse face, mental retardation, hypoplastic 5th fingers, wide mouth, and lips, sparse hair, and hirsutism, in the oral examination, poor oral hygiene, dental caries, delayed dentition, lack of upper perma-nent first incisor, gingival hyperplasia, gingivitis, and hypoplasia were seen. Panoramic radiography and tomography revealed that the upper permanent incisor and supernumerary canine teeth were impacted. Under general anesthesia, dental scaling, fillings were made, impacted permanent incisors, canine, and lower left third molars were extracted. After general anesthesia, fluoride application and a fiber-supported Maryland bridge designed from the patient's teeth were applied to the anterior region. Regular controls of the patient continue. After the growth and development, the oral surgery department will be consulted for implant application. In den-tistry, preventive applications, oral hygiene motivation, pharmacological and non-pharmacological treatments are important for CSS patients. After consultation with relevant departments, multidisciplinary approaches and appropriate treatments increase the quality of life.