Bones Of Hand Research Articles

Research on the Intelligent Assessment Algorithm of Bone Age Based on Attention Mechanism

Bone age is a reliable index to reflect the maturity of physical development, which is of great significance to evaluate the growth and development of children and adolescents, diagnosis and treatment of diseases. Traditional bone age assessment based on artificial has many problems, such as its time-consuming and subjective result, which may lead to great fluctuation of assessment results. Based on the X-ray image of the hand bones, this study proposes an intelligent prediction model of bone age in Deep Learning based on attention mechanism, combined with the traditional methods of bone age interpretation in Deep Learning. In the pre-processing stage, U-Net is used to remove the background of X-ray image of hand bones, and the dense connection network of attention mechanism is used to extract image features, and the mean absolute error function is introduced to improve the accuracy of this model. In the data set of RSNA competition, the mean absolute error of the method proposed in this study is 0.38 ± 0.10 years old, and obtained the best results reported at present.

Assessment of longitudinal bone growth in osteogenesis imperfecta using metacarpophalangeal pattern profiles.

Osteogenesis imperfecta (OI) is commonly associated with short stature, but it is unclear whether this is exclusively secondary to fractures and bone deformities or whether there is a primary defect in longitudinal bone growth. As metacarpal and phalangeal bones are rarely affected by fractures and deformities, any length deficits in these bones should reflect a direct disease effect on longitudinal growth. This study therefore assessed the relationship of hand bone length with clinical OI type and genotype. Prospective study. The length of all 19 tubular hand bones were measured in 144 individuals (age 6 to 57years; 68 female) who had OI caused by COL1A1 or COL1A2 variants. Measurements of bone length were converted to z-scores using published reference data. Bone length was mostly normal in OI type I but was significantly decreased in OI types III and IV. Mean hand bone length z-score (i.e., the average length z-score of all 19 bones of a hand) was -0.2 for OI type I, -2.9 for OI type III and -1.2 for OI type IV. Mean hand bone length z-score was positively associated with height z-score (r2=0.65, P<0.001). Regarding genotype-phenotype correlations, mean hand bone length z-score was close to 0 in individuals with COL1A1 mutations leading to haploinsufficiency but were significantly lower in the presence of mutations leading to triple-helical glycine substitutions in either the alpha 1 or alpha 2 chain of collagen type I. COL1A1 and COL1A2 mutations affect bone growth not only by inducing fractures and bone deformities, but also through longitudinal growth deficits in bones that do not fracture or deform.

Examining the Short-, Medium-, and Long-Term Success of an Embodied Learning Activity in the Study of Hand Anatomy for Clinical Application.

A student's own body provides an often disregarded site of knowledge production and corporeal wisdom. Learning via cognitive processes anchored in physical movement and body awareness, known as embodied learning, may aid students to visualize structures and understand their functions and clinical relevance. Working from an embodied learning perspective, the current article evaluates the use of an offline physical learning tool (Anatomical Glove Learning System; AGLS) for teaching hand anatomy for clinical application in medical students. Two student samples (N1 =105; N2 =94) used the AGLS in two different ways. In the first sample, the AGLS was compared to a traditional approach using hand bones, models and prosected specimens. Secondly, the AGLS and traditional approach were combined. The evaluation consisted of three outcomes: short-term learning (post-test), medium-term applications (mock-objective structured clinical examination, MOSCE), and longer-term assessment (objective structured clinical examination, OSCE). Findings from the first sample indicated no significant differences between the AGLS and traditional laboratory groups on short- (F(1,78) = 0.036, P=0.849), medium- (F(1,50) = 0.743, P=0.393), or longer-term (F(1,82) = 0.997, P=0.321) outcomes. In the second sample using the AGLS in combination with a traditional approach was associated with significantly better short-term post-test scores (F(2,174) = 5.98, P=0.003) than using the AGLS alone, but demonstrated no effect for long-term OSCE scores. These results suggest an embodied learning experience alone does not appear to be advantageous to student learning, but when combined with other methods for studying anatomy there are learning gains.

Knee Bone Age using MRI: Validation of a Novel Method to Reduce Hand Bone Age Radiographs

Objectives:Determining bone age in skeletally immature patients is critical for proper management and surgical planning. Pennock et al. recently created and validated a bone age atlas using the ossification pattern of the knee on MRI in pediatric patients, obfuscating the need for a hand radiograph and its associated cost, radiation exposure, and clinical inefficiency. This aim of this study was to create and validate a shorthand method of bone age determination using knee MRI.Methods:We identified patients who underwent both knee MRI and hand bone age radiograph within a ninety-day period. From the findings of Pennock et al., a stepwise algorithm for predicting bone age on knee MRI was developed for males and females separately, in collaboration with a pediatric musculoskeletal radiologist. Six raters at varying levels of training used the algorithm to assign a bone age to each knee MRI. Intraclass correlation coefficient (ICC) was used to compare each rater’s predicted knee bone age to the Greulich and Pyle (G&P) hand bone age and validate the shorthand algorithm. Inter- (two-way random, absolute agreement) and intra-rater (two-way mixed, absolute agreement ) reliability were also calculated using ICC.Results:Thirty-eight patients (44.7% females) underwent a knee MRI at a mean age of 12.8 years (range 9.3-15.7). The mean time between hand bone age x-ray and knee MRI was 20.2 days (range 0-88). The inter-rater reliability for the application of our shorthand algorithm was 0.81 (95% CI: 0.72 – 0.88), indicating good inter-observer agreement. The shorthand algorithm was also shown to be a reliable predictor of hand bone age across level of training, as medical students (ICC 0.77, 95% CI 0.60-0.88), residents (ICC 0.80, 95% CI 0.65-0.89), and attending physicians (ICC 0.80, 95% CI 0.63-0.89) all achieved strong correlation between predicted knee bone age and G&P hand bone age. All respondents also demonstrated consistency, with intra-rater ICCs between 0.85-0.93.Conclusion:This shorthand algorithm is a consistent, reliable and valid way to determine skeletal maturity using knee MRI in patients aged 10 to 15 and can be utilized across different levels of orthopaedic and radiographic expertise. We believe this method is readily applicable in a clinical setting and may reduce the need for routine hand bone age radiographs.Figure 1.Table 1.Correlation between knee MRI bone age and hand radiograph bone age (G&P) for each rater, as determined using intraclass correlation coefficients (ICC). Note: Intra-rater reliability has not been competed for “Resident 2” at this time. Validity of MRI Knee Bone Age and Hand Bone Age Intra-Rater Reliability Rater ICC 95% CI ICC 95% CI Student 10.750.57-0.860.930.79-0.97Student 20.730.53-0.860.930.87-0.97Resident 10.730.54-0.850.850.73-0.92Resident 20.780.60-0.88--Attending 10.740.54-0.850.860.70-0.93Attending 20.800.63-0.890.860.72-0.93

Stature estimation of the Malaysian population based on sacrum CT scans

BackgroundThe evolution of virtual technology in estimating stature through multi-slice computed tomography scanning can be essential for mass disasters and forensic cases. Regression formulae were generated directly from other skeleton parts such as cranium, sternum, vertebrae, clavicle, scapula, sacrum, pelvis, hand and foot bones to estimate stature. Previous studies have shown that pelvic shape score is significantly associated and correlated with stature for both sexes. The sacrum as part of the pelvis is located between the two os coxae via a sacroiliac joint. As such, this study aims to correlate the morphological measurement of sacrum with stature based on sex and ancestry among the Malaysian population from a total of 373 sacral computed tomography (CT) images collected at the Kuala Lumpur Hospital. The three-dimensional sacrum bones were segmented from CT images using the Mimics Research 17.0 software. Inter-landmark distances were measured using Microsoft 3D Builder, and their respective indices were computed.ResultsThe auricular lengths are the most comparatively useful stature estimator at R > 0.5 among all the sacral morphometrics that were investigated on in this study. Results from this study should only be applied within the Malaysian population (Malay, Chinese and Indian).ConclusionThe results could enhance the existing database of stature estimation, especially when dealing with skeletal material from Malaysia and when long bones are unavailable for the identification of incomplete unknown human remains.

Tubercular dactylitis with deformity ipsilateral involvement of hand and foot in an adult: a case report

&lt;p&gt;Tubercular dactylitis is a rare entity and usually involves bones of hands and feet, involvement of feet is less common. Here we report case of 18 years old female with neglected tubercular involvement of her left thumb and left great toe of foot with hallux varus deformity. Her diagnosis was delayed as she did not seek any healthcare advice for a long time and also lack of suspicion of entity. This entity which should be kept in mind when making differential diagnosis that can be treated conservatively when diagnosed early.&lt;/p&gt;

Retrospective study to find the prevalence of neoplasia in swellings of hand and foot bones

Lesions occurring in them are infrequently reported. In this retrospective study, we analyze all types of lesions affecting bones of the hands or feet, including infections and inflammatory conditions, benign and malignant tumors, and tumor like lesions, correlating clinical, pathologic and biopsy findings. Out of 50 lesions included in the study, infections/ inflammatory lesions constituted 46.0%, benign tumors 32.0%, malignant tumors 12.0%, and tumor like lesions 10.0%. Osteomyelitis was the most common lesion in this series, accounting for 44% of the cases. In other study also it is the commonest lesion. Walking barefoot and Diabetes mellitus constitutes a significant predisposing risk factor for osteomyelitis of the foot. Tuberculosis constitutes the major cause of osteomyelitis in India hence higher incidence of tuberculous osteomyelitis in the small bones of the hands or feet as compared to that in the West. Benign tumors were more common than malignant tumors in our series, GCT constituting 43.8% of benign tumors. Chondrosarcoma was the most common malignant tumor. Metastatic bone lesions and hematologic neoplasms were not seen in our study. Bones of the hands and feet are the most common extragnathic sites for GCR. Three such cases with typical histologic features were diagnosed in bones of the hand. It was difficult to differentiate them clinically and radiologically from GCT. This is important in view of the lower recurrence rate in the former compared to the latter. The only other 3 cases of GCR reported during the study period were located in the mandible. In view of overlapping ultrastructural and light microscopic features, as well as similar biologic behavior, aneurysmal bone cyst and giant-cell reparative lesions are thought to represent related responses to intraosseous hemorrhage. Florid reactive periostitis is a reactive process that predominantly involves the bones of the hands or feet, mostly in young women, and a history of minor trauma is seen in less than half of the cases. Similar clinical findings were noted in our patient as well. The importance of this entity lies in the possibility of it being misdiagnosed as a malignant lesion, especially osteosarcoma. Such a lesion was not seen in any other bone in our institution during the study period. Conclusion: Lesions of the bones of the hands or feet are uncommon. Infections/inflammatory lesions are more common in India. Benign tumors were more common than malignant tumors in our series. Giant cell tumor is the commonest neoplastic lesion. . Awareness and correlation of clinical, radiologic, and pathologic features help in making correct diagnoses Keywords: Hand Swelling, Foot swelling, Neoplasia in Hand, Neoplasia in foot

A 3-Dimensional-Printed Hand Model for Home-Based Acquisition of Fracture Fixation Skills Without Fluoroscopy

ObjectiveTo design a low cost ($40), realistic and fluoroscopy-free percutaneous Kirschner wire hand fracture fixation training instrument kit for home-based skill acquisition during the COVID-19 pandemic.DesignA 3D-printed hand was designed from a computed tomography scan of a healthy hand. These data were used to create replaceable hand and wrist bones and reusable silicone molds for a replica of the soft tissue envelope. The model is currently being integrated into the simulation curriculum at 2 integrated plastic surgery residency programs for training in percutaneous wire fixation of hand fractures.SettingBrown University, Warren Alpert Medical School of Brown University. Department of Surgery, Division of Plastic and Reconstructive Surgery. Large academic quaternary referral institution. Yale University, Yale School of Medicine. Department of Surgery, Division of Plastic and Reconstructive Surgery. Large academic quaternary referral institution.ParticipantsPGY 1-4 plastic surgery residents preparing to meet ACGME Accreditation for Graduate Medical Education hand surgery specific milestones.ResultsA realistic and durable 3D model with interchangeable bones allows trainees to practice the key motor skills necessary for successful fixation of hand and wrist fractures with K-wires in a home-based setting.ConclusionsA low cost, realistic and durable 3D hand model with interchangeable bones allows easy integration into any home-based hand surgery curriculum. With 3D printers and programming becoming more prevalent and affordable, such models offer a means of low-cost and safe instruction of residents in fracture fixation with no harm to patients.

A management strategy for giant cell tumor of the metacarpal: A single-center series of 11 cases

BackgroundPrimary giant cell tumor (GCT) arising from bones of hand are rare to occur. Metacarpals are often the most common site of involvement among hand bones. There are no uniform guidelines for treatment of GCT involving metacarpals due to lack of relevant literature. ObjectiveTo suggest a management strategy for GCT involving metacarpals. MethodsRetrospective review of cases of GCT involving metacarpals over a period of 15 years from 2005 to 2019 managed at department of Orthopaedics, All India Institute of Medical Sciences, New Delhi. ResultsA total of 12 cases of GCT involving metacarpal were included, out of which one was lost to follow-up. Four cases were recurrent, and seven were primary at the time of surgery. All the patients were operated with wide excision of the tumor. In seven patients reconstruction of the metacarpal and MCPJ was done using fibular strut graft and silastic artificial joint, while in two patients, MCPJ arthrodesis was performed using fibula and/or iliac crest bone graft. In another two patients, the MCPJ was reconstructed using reversed vascularised toe transfer. Mean follow up of the patients was 3.22 ± 2.07 years. Mean Quick DASH score at latest follow-up of patients operated with silastic joint reconstruction, reversed vascularised toe transfer and arthrodesis of MCP joints were 30.5 ± 9.5, 25 ± 2.3 and 39.8 ± 3.4 respectively. Local recurrence occurred only in one patient at one year after surgery. All the patients were pain free at latest follow-up with quite functional and cosmetically acceptable hand. ConclusionReversed vascularised metatarsal transfer has obtained better functional results compared to reconstruction with fibular grafting and silicone joint replacement but due to technical difficulties, vascularised joint transfer may not be performed in every setting and there is risk of donor site morbidities with this technique. Our strategy for the treatment of GCT involving metacarpal was to do vascularised joint transfer or arthrodesis for border digits and reconstruction with silicone joint for central digits.

Clinicopathologic Analysis of Chondroblastoma in Adults: A Single-Institution Case Series.

Chondroblastoma is a rare benign tumor of immature cartilage cells that generally occurs in an epiphyseal location of skeletally immature individuals. However, a few studies have reported cases in older patients. The purpose of this study was to evaluate the clinical, radiographic, and pathologic features of chondroblastoma in an adult population. The pathology archives of our institution were searched for cases of chondroblastoma diagnosed in patients ≥25 years of age. Of 14 patients identified, 8 were male and 6 were female with a median age of 34 years (range = 29-54 years). Most lesions occurred in short bones of hands and feet (N = 7, 50%), followed by the long tubular bones (N = 4, 28%). All demonstrated typical histologic features of chondroblastoma, but more extensive calcification, necrosis, and degenerative changes were also seen. At follow-up (median = 73.5 months), 2 patients (17%) had local recurrence. None had metastasis. In summary, chondroblastoma in adults tends to involve the short bones of the hands and feet and demonstrate histologic changes associated with long-standing growth of a benign tumor.

Mimicking the radiologists' workflow: Estimating pediatric hand bone age with stacked deep neural networks.

Pediatric endocrinologists regularly order radiographs of the left hand to estimate the degree of bone maturation in order to assess their patients for advanced or delayed growth, physical development, and to monitor consecutive therapeutic measures. The reading of such images is a labor-intensive task that requires a lot of experience and is normally performed by highly trained experts like pediatric radiologists. In this paper we build an automated system for pediatric bone age estimation that mimics and accelerates the workflow of the radiologist without breaking it. The complete system is based on two neural network based models: on the one hand a detector network, which identifies the ossification areas, on the other hand gender and region specific regression networks, which estimate the bone age from the detected areas. With a small annotated dataset an ossification area detection network can be trained, which is stable enough to work as part of a multi-stage approach. Furthermore, our system achieves competitive results on the RSNA Pediatric Bone Age Challenge test set with an average error of 4.56 months. In contrast to other approaches, especially purely encoder-based architectures, our two-stage approach provides self-explanatory results. By detecting and evaluating the individual ossification areas, thus simulating the workflow of the Tanner-Whitehouse procedure, the results are interpretable for a radiologist.

Isolated osteoblastoma of the cuboid bone: A case report and review of the literature

Osteoblastoma is a relatively rare, benign, bone-forming tumor, commonly observed in the second and third decades of life. Spine and the long tubular bones are the most common sites of involvement. Osteoblastoma is infrequently seen in other sites, including the bones of hand and foot. A rare case of a 35-year-old man that presented an osteoblastoma of the cuboid bone is reported. The patient was treated with surgical resection and grafting. After the intervention, the patient recovered with no clinical and radiological evidence of recurrence after one year of follow-up.Several cases of osteoblastoma-like variant of osteosarcoma of the cuboid have been previously reported, but, to our knowledge, this is the first case of conventional and isolated osteoblastoma involving the cuboid bone reported in the literature.

Relation between muscle architecture and first metacarpal morphology, and its implications for human hand evolution.

Previous studies have proposed that our ability to produce and use stone tools was the primary selective pressure explaining the evolution of the human hand. Derived traits in humans include a robust first metacarpal and longer thumbs relative to the other fingers. Along with other anatomical peculiarities, humans can exert forceful precision and have powerful grips, and can resist loads during tool production and use. Despite this biomechanical explanation for the morphology of the human hand, limited work has been done on the soft tissue and, therefore, the relationship between the hand bones and the muscles most heavily relied upon during tool-related behaviours still requires thorough investigation. For this purpose, we have dissected 23 forearms and hands of fresh human cadavers of known sex and age at death, and dissected all the muscles attached at the first metacarpal (the first dorsal interosseous, opponens pollicis, and abductor pollicis longus muscles). Variations in physiological cross-sectional area, muscle mass, and fibre length were compared with metacarpal anatomy. In no case bone traits were a significant predictor of muscle features. In contrast, sex and age predicted muscle architecture in several cases, thus substantially affecting the functional analysis based on linear measurements of this bone. The data, therefore, failed to provide a deductive framework for predicting muscle recruitment based on measurements of bone from the fossil record.

Design and Development of Prosthetic Hand Controlled by Wireless Gestures for Differently Able People

This paper focuses on the design and development of Prosthetic hand to help differently-able people who lost their hands due to accidents and diseases. Our research purpose is to develop a master and slave robotic system that will be a substitute for the lost hand to do the day-to-day activities of a person. The person has to wear smart gloves in the hand to do gesture action. The gloves will able to transfer the hand gestures of differently-able people to react suitably and move the hand gripper (which contains spring coils similar to bones in human hand) based on the data from smart gloves. The methodology behind this research is that the analog signals produced in the flex sensor due to the gesture action are transferred to the servo motors to do a similar action in the 3D printed prosthetic hand through the Wi-Fi module. This research project involves two Arduino microcontrollers for communicating and controlling applications in both master and slave sections. A number of flex sensors are placed in the glove to get readings of the motion of human fingers and it is transmitted through the Wi-Fi module by using the Arduino microcontroller. The transmitted signals are received by the Wi-Fi module in the slave section through the Arduino microcontroller and further uses this signal to control various servo motors and it controls the slave robotic hand by using the ropes attached between the servo motor and 3D printed parts. Not only for differently-able people, but the enlarged model of this project can also be used in industries to handle hazardous, harmful, high temperatures and harmful things.

Benign bone tumors of hand and wrist: evaluation of diagnosis and treatment

Objectives This study aims to investigate the choice of graft or cement, the relationship between the graft types and union rates, functional results, and complications in hand and wrist benign bone lesions while also evaluating the diagnosis and treatment modalities of lesions with high recurrence potential like giant cell- containing lesions.Patients and methods Between September 2005 and May 2016, 48 benign osseous hand and wrist tumors of 48 patients (22 males, 26 females; mean age 33±13.1 years; range, 11 to 70 years) were reviewed retrospectively. Patients were evaluated according to demographic data, complaints at admission, radiological findings, surgical methods, graft type, pathological diagnosis, and complications.Results Although not statistically significant, there were differences between cement, allograft, and autograft according to union time and loss of range of motion. There was no statistical difference between cement, allograft, and autograft according to complications.ConclusionAutograft obtained percutaneously with a trephine needle may provide earlier union with minimal donor site morbidity. Wide resection and reconstruction options should be kept in mind in giant cell-containing tumors. Further investigations are needed about the relationship between soft tissue edema in magnetic resonance imaging and the recurrence risk in hand and wrist benign bone tumors.

MRI KNEE BONE AGE: A NOVEL SHORTHAND APPROACH TO REDUCE BONE AGE RADIOGRAPHS IN CHILDREN

Background:Determining bone age in skeletally immature patients is critical for proper management and surgical planning. Pennock et al. recently created and validated a bone age atlas using the ossification pattern of the knee on MRI in pediatric patients, obfuscating the need for a hand radiograph and its associated cost, radiation exposure, and clinical inefficiency.Hypothesis/Purpose:We sought to validate and demonstrate reliability of a novel shorthand method of bone age determination using knee MRI across multiple levels of medical training.Methods:We identified patients who underwent knee MRI and hand bone age radiograph within a ninety-day period. In collaboration with a pediatric musculoskeletal radiologist, stepwise algorithms for predicting bone age on knee MRI were developed- one for males and one for females. Six raters at varying levels of training used the algorithm to assign a bone age for each patient. Intraclass correlation coefficient (ICC) was used to compare each rater’s predicted knee bone age to the Greulich and Pyle (G&P) hand bone age and validate the shorthand algorithm. Inter-rater reliability was also calculated using ICC.Results:Thirty-eight patients (44.7% female) underwent a knee MRI at a mean age of 12.8 years (range 9.3-15.7). The mean time between hand bone age x-ray and knee MRI was 20.2 days (range 0-88). The inter-rater reliability for the application of our shorthand algorithm was 0.81 (95% CI: 0.72 – 0.88), indicating good inter-observer agreement. The shorthand methos was shown to be a good predictor of G&P hand bone age, both for each individual rater (ICC range: 0.73 – 0.80) and the mean knee MRI bone age across all raters (ICC 0.81; 95% CI 0.65 – 0.90). It was also shown to be a consistent predictor of hand bone age across level of training, as medical students (ICC 0.77, 95% CI 0.60-0.88), residents (ICC 0.80, 95% CI 0.65-0.89), and attending physicians (ICC 0.80, 95% CI 0.63-0.89) all achieved strong correlation between predicted knee MRI bone age and G&P hand bone age.Conclusions:This novel shorthand algorithm is a reliable and valid way to determine skeletal maturity using knee MRI. It can be utilized clinically across different levels of radiographic and orthopaedic expertise and reduces the need for hand bone age radiographs and consequential radiation exposure in children.Figure 1.Shorthand Algorithm for Knee Bone Age Using MRI for MalesFigure 2.Shorthand Algorithm for Knee Bone Age Using MRI for FemalesTable 1.Correlation between knee MRI bone age and hand radiograph bone age (G&P) for each rater, as determined using intraclass correlation coefficients (ICC). Rater ICC 95% CI Student 10.750.57 – 0.86Student 20.730.53 – 0.86Resident 10.730.54 – 0.85Resident 20.780.60 – 0.88Attending 10.740.54 – 0.85Attending 20.800.63 – 0.89Mean0.830.68 – 0.91

CT Image Measurement and Analysis of the Influence of Different Motion Modes on the Geometrical Morphology of Carpal Bone

The purpose of this study is to explore the influence of different movement modes on the geometrical morphology of carpal bones. In this study, Computed Tomography (CT) imaging is used for measurement and analysis. The results show that the changes of wrist bone volume of athletes are not significant compared with that of non-athletes, and the changes of bone density of the wrist bone are more obvious under the motion stress stimulation. According to results of CT imaging measurement and calculation, the average CT values of triangular bone, trapezoid bone, capitate bone and pisiform bone in the left hand and hamate bone in the right hand of the athlete are greater than that of the non-athlete, and the difference is statistically significant. Therefore, CT imaging technology can help to reconstruct the three-dimensional image of the carpal bone and deeply understand the geometric shape of the carpal bone of athletes.

Functional evaluation of various surgical modalities in treatment of hand fractures

Background: “Hand fractures can be complicated by deformity from no treatment, stiffness from over treatment, both deformity and stiffness from poor treatment.” - Swanson. Fracture of metacarpal bone of the hand constituting between 14-28% of all visit to hospital following trauma by various means like assault, road traffic accidents, industrial accidents, agriculture accidents etc. Fracture of the bones of hand are among the commonest fracture in humans, but their management varies widely in the different regions of world. This variability is due to many reasons, including availability of resources, social factors, geographic constraints, surgeon preference and experience, and local practice patterns. Among the spectrum of hand and wrist injuries, fractures of the wrist rank first in terms of frequency and morbidity, with an estimated incidence of 400 fractures per 100,000 inhabitants per year3. 3 Fracture healing in the hand is not an isolated goal; rather the functional result is of paramount importance. Recent studies have shown good functional results with surgical treatment of metacarpal fractures using K-wires, bicondylar plates and screws as compared to conservative treatment. Material and Method: The sample size of the study was 28 patient in 12 patient in k-wire group, 8 patient in jess group and 8 in plate group. The functional outcome was assessed by calculating Total active range of motion (TAM) as suggested by the American Society of Surgery of Hand. At every follow up TAM (total active range of motion) will be calculate as follows TAM= (Active flexion at MCP+PIP+DIP)-Extension deficit at MCP, PIP, DIP. Recovery was calculated as percent regained in motion compared to normal range of digital motion (260 degree). Result: Fracture healing in the hand is not an isolated goal; rather the functional result is paramount importance. JESS, Plating and K-wire comprised of 8, 8 and 12 subjects respectively. Mean age (in years) of the subjects in JESS group was 41.75±21.93 while the mean age of the subjects in plating and K-wire group was 39.12±20.18 and 43.83±21.84 respectively. 14.35, 21.4% and 17.9% of the subjects in JESS, Plating and K-wire group respectively were injured due to fall from height. Road traffic as mode of injury was reported in 14.3%, 7.1% and 25% of the subjects in JESS, Plating and K-wire group respectively. Conclusion: Plate and screw fixation is a good option for treating closed unstable metacarpal fractures, where other modalities of fixation are less effective, the rigid stable fixation provided by plating which withstands load without failure allowed early mobilization and achieved good functional results.

Abstract 46: 4-year Follow-up Of The World’S First Pediatric Bilateral Hand-forearm Transplants: The Growth And Progress Continues

Introduction: In 2015, the first bilateral pediatric hand-forearm transplant was performed in an 8-year old boy. The long-term functional outcomes and growth of transplanted upper extremities was unknown. Methods: Forearm and bone age radiographs were obtained annually. Radius and ulna measurements were performed and mathematically normalized by a pediatric musculoskeletal radiologist (JCN) alongside coauthors (SCA, NM, RK). Greulich & Pyle Atlas was used to estimate hand bone age. Functional testing and patient reported outcomes are reviewed. Results: From July 2015 to July 2019, bone length increased 33 mm and 37 mm for right ulna and radius, 38 mm and 37 mm for left ulna and radius, respectively. Distal physes of the donor limbs increasingly contributed to overall bone length relative to proximal physes, which grew slowly. Normalized growth between the two limbs was statistically similar (p>0.05). At each annual follow-up, the bone age increased by 1-year. Bone healing resulted in normal structure in the transplanted and recipient bone. Motor, sensory and functional independence measures are encouraging. No pain was noted (0) during exercises (0-10 scale). Conclusions: Successful pediatric hand-forearm transplantation offers the advantage of growth similar to non-transplanted pediatric patients. The transplanted distal physes contributes more to the overall growth, paralleling normal pediatric growth patterns. The patient continues to make gains in all domains, functional activities of daily living and grasping.

Recommendations for Improving Photo Quality in Close Range Photogrammetry, Exemplified in Hand Bones of Chimpanzees and Gorillas

Recommendations for Improving Photo Quality in Close Range Photogrammetry, Exemplified in Hand Bones of Chimpanzees and Gorillas