Finger Deformity Research Articles

Trends in Rheumatoid Hand Surgery: Indications, Techniques, and Outcomes.

Rheumatoid arthritis (RA) causes persistent synovitis and arthritis, resulting in joint deformity and destruction throughout the body. As RA medications have evolved over the past 30 years, the surgical indications and techniques for RA joint deformities have changed. The aim of this review article is to summarize the recent trend of surgery for rheumatoid hand/finger deformities in previous reports and to present our recent surgical methods and outcomes for these deformities. A typical hand and finger deformity caused by RA is ulnar deviation, which is mainly caused by joint laxity and dislocation of the metacarpophalangeal joints, in addition to extensor tendon dislocation and/or wrist joint deformity. Although the incidence of hand/finger deformity and ulnar deviation caused by RA is decreasing due to advances in RA medications, patients with long-term RA or those with difficult-to-treat RA may still develop hand/finger deformity and ulnar deviation. If the hand/finger deformity is mild, it can be reduced manually, and conservative treatment with orthoses or splints may be required. If joint pain is severe despite good medical control of RA, or if the patient hopes to improve the appearance of the hand or fingers, surgical intervention is required. If there is only subluxation of the joints, which preserves their structure, reconstruction with only soft tissue surgery may be required. For example, for swan-neck deformity and boutonniére deformity, two of the most typical finger deformities due to RA, when the joint structures are almost intact and can be corrected manually, we opt for a surgical procedure that involves only soft tissue manipulation without the use of prosthetic implants. For ulnar deviation without joint destruction, we usually use a soft tissue-only surgical procedure. Our results have shown that the soft tissue-only surgery for ulnar deviation is as effective as joint replacement with implants. If the destruction of the joint has occurred and its dislocation/subluxation cannot be reduced manually, implant arthroplasty becomes necessary. If the joint destruction is severe, only intra-articular arthrodesis is required. In the era when RA can be controlled by medication, the hand surgeon should not overlook the change in the stage of the rheumatoid hand and should perform surgical intervention via the appropriate surgical method.

Kirners deformity – a systematic review and surgery recommendations

BackgroundKirner deformity is a rare anomaly of the little finger in adolescents, characterized by a deformity of the distal phalanx and a radiologically L-shaped epiphysis, along with palmar and radial angulation of the distal phalanx. Due to the rarity of these pathological findings, there are no systematic literature reviews available. This work serves as an overview of the clinical presentation, frequency and age distributions, as well as possible conservative and surgical treatment options.MethodsWe present five cases of patients with Kirner’s deformity of the little finger who underwent surgical treatment. A partial tenotomy of the flexor digitorum profundus tendon from the metaphyseal/diaphyseal distal phalanx was performed. In one case, a dorsal epiphysiodesis was also carried out. Additionally, a systematic review of the literature on Kirner’s deformity was conducted, summarizing the prevalence, previously used surgical treatment options, and epidemiological data.ResultsIn the presented cases, the detachment of the FDP tendon and dorsal epiphysiodesis resulted in a good functional and aesthetic outcome. Regarding the epidemiological distribution of Kirner deformity, it is noted that significantly more females are affected than males (63% vs. 36%). The average age at presentation in the respective clinic was 9.36 years (± 2.5). In more than half of all reported cases, the deformity was bilateral. Surgical intervention was performed in only 7.4% of cases, which included FDP detachment or corrective osteotomies. More than 90% of patients were treated conservatively.ConclusionKirner’s deformity is a rare condition affecting adolescents. In cases where functional limitations or pain symptoms are present, we recommend surgical intervention via detachment of the FDP tendon. If the deformity is an incidental finding without functional or aesthetic limitations, conservative therapy with a corrective splint can be initiated. From our perspective, early surgical treatment before the age of 12 improves both the long-term functional and aesthetic outcomes.

Surgical correction of posttraumatic triphalangeal joint flexion contractures of the fingers (systematic literature review)

Introduction Triphalangeal joint flexion contracture of the fingers is a common and challeging posttraumatic hand condition. The goal of surgical treatment is to correct finger deformity and increase interphalangeal range of motion.The objective was to systematize data on the causes of post-traumatic triphalangeal joint flexion contracture of the fingers and methods of surgical correction.Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru), the National Library of Medicine (www.pubmed.org), ScienceDirect, Google Scholar, Ovid databases according to PRISMA recommendations. Literature searches included both Russian and English studies, with one or more cases of post-traumatic triphalangeal joint flexion contracture of the fingers with the deformity surgically corrected. Cases of non-traumatic flexion contractures were excluded. Etiological factors of flexion contractures, heterogeneity of definitions and methods for recording the range of motion in the joint, anatomical features, surgical correction of flexion contractures and postoperative complications were reviewed.Results Common causes of flexion contractures included burns (32.3 %), dislocations and fracturedislocations of the finger joints (23.5 %). The median postoperative follow-up period was 13.5 months after surgical treatment. Surgical correction was produced with external fixation device (EFD) in 40 % of cases, open procedures performed in 50 % and a combined technique employed in one case (10 %). Based on calculations of the odds ratios of postoperative complications, a weak positive linear relationship was revealed between EFD and pain syndrome, and a weak negative linear relationship was observed between the open procedure and pain.Discussion There is heterogeneity of approaches regarding methods for correcting flexion contractures, surgical approaches, techniques for mobilizing joints and releasing the anatomical structures of the finger with open procedures, the distraction rate with EFD, methods for repair of soft tissue defects following the treatment of flexion contractures of interphalangeal joint of a finger.Conclusion Open procedures are commonly used for precise elimination of all components of flexion contracture of the joint and repair of soft tissue defects of the finger. A weak positive linear relationship was revealed between EF and pain syndrome. There was no significant correlation between open techniques and complications. There were no correlations between the treatment method and the contracture type; there are no treatment regimens for patients with this pathology.

Spontaneous Resolution of Congenital Insufficiency of the Extensor Tendon Central Slip.

The congenital insufficiency of the extensor tendon central slip of the fingers is a relatively rare condition, with only a few reported cases in pediatric patients, as described in 2 clinical series. In this study, we aimed to present the natural history of a significant number of untreated patients with this deformity. This study has received institutional review board approval, and parents provided informed consent following the Declaration of Helsinki guidelines for biomedical research involving humans. A retrospective analysis of children with this deformity, ranging from June 2008 to July 2021, was collected by 1 surgeon. The inclusion criteria included children with a supple PIP flexion deformity, characterized by MP hyperextension and PIP extension lag, which had been present since birth. Complete passive PIP extension and the absence of volar skin webbing differentiated this condition from camptodactyly. The mean age of 24 children with 57 involved digits at diagnosis was 7 months (range, 1 to 17) and the mean follow-up was 6 years to 9 months (2yr to 1mo to 13yr). Six patients had an incorrect previous diagnosis of camptodactyly.Active PIP extension recovered progressively. At the final follow-up, complete PIP extension occurred in all except 4 cases in which a residual 10° extension lag. The mean time for a complete active PIP extension was 2 years to 7 months (20mo to 3yr to 9mo). Nineteen cases (79%) showed a mild FDS contracture of the involved digits at the final follow-up.The deformity was bilateral in 15 children (62.5%) and involved only 1 finger (unilaterally or bilaterally) in 15 cases (62.5%), and 2 fingers in 6 (25%). Little and ring fingers were most commonly involved. In 7 cases, there was a family history of finger deformity. Congenital insufficiency of the extensor tendon central slip typically resolves spontaneously within the first 4 years of life. Literature suggests that splinting can expedite the correction of the deformity and thus, if possible, it can be used. In most cases, a residual, clinically insignificant FDS contracture may be present. This condition is often misdiagnosed as camptodactyly. IV.

Safety of TNF-α inhibitors: A real-world study based on the US FDA Adverse Event Reporting System Database.

As a common treatment for rheumatoid arthritis (RA), the adverse reactions of TNF-α inhibitors (TNFis) in practical application have garnered attention. This study aims to investigate the adverse drug events (ADEs) associated with TNFi in RA patients as reported in the FDA Adverse Event Reporting System, to offer insights for clinical use. Cases related to RA and primarily involving TNFi were extracted from the FDA Adverse Event Reporting System database and compared by gender stratification. Screening was conducted based on reporting odds ratio and information component to identify positive ADEs for different TNFis and evaluate common and unique ADEs among various TNFis. There are 4 common ADEs among TNFis, including pulmonary tuberculosis, infection, hypersensitivity, and herpes zoster, as described in the package inserts. However, each TNFi has unique positive ADEs. Adalimumab has 63 unique positive ADEs, including lower respiratory tract inflammation, systemic lupus erythematosus rash, vascular dementia, ovarian neoplasm, adhesion, sarcoma, coccidioidomycosis, etc. Golimumab has 6 unique positive ADEs, including pneumonia cryptococcal, device deployment issue, pneumonia bacterial, polyneuropathy, device malfunction, device issue, etc; certolizumab has 24 unique positive ADEs, including maternal exposure before pregnancy, premature rupture of membranes, exposure via breast milk, staphylococcal sepsis, erysipelas, low birth weight baby, herpes virus infection, premature delivery, etc; etanercept has 180 unique positive ADEs, including joint destruction, chondrolysis, finger deformity, ankle deformity, joint warmth, etc; infliximab has 60 unique positive ADEs, including Hodgkin's disease, metastatic neoplasm, non-Hodgkin's Lymphoma, etc. Although the aforementioned 5 TNFis share common ADEs such as herpes zoster, clinicians must exercise caution when selecting specific medications, especially for RA patients concurrently suffering from malignancies. The analysis indicates that infliximab is associated with 60 unique positive ADEs, including Hodgkin's disease, metastatic neoplasm, and non-Hodgkin's lymphoma; therefore, these patients should use infliximab with greater caution. Similarly, certolizumab should be used with increased caution in pregnant and postpartum women.

An Investigation On The Effect Of Smartphone Use On Morphological And Radiological Changes Of The Fifth Finger

Background: The purpose of this study is to describe the macroscopic and radiological changes on the fifth finger related to mobile phone use and to evaluate the effect of size and weight of the device and the average time spent using the smartphone on these morphological alterations. Methods: One-hundred and one patient were included in the study. Age, weight, height, education, mobile phone data and digital photographs used in this cross-sectional study were obtained from interviews with the participants in an outpatient orthopedics clinic setting. Digital photographs of the dorsal aspects of both hands were taken with an iPhone X ® (dual 12-megapixel wide camera). The DIP joint angle of the fifth finger was measured on computer software (Image J® version 1.46, National Institute of Health, Bethesda, MD) separately for digital photographs and AP hand X-rays. Results: The proportion of smartphone usage time over 4 hours was significantly higher in patients with complaints than patients without complaints (p<0.05). The mean time of smartphone use over 4 hours was significantly higher in patients with shape discrepancy than in patients without shape discrepancy (p<0.05). Conclusion: Smartphone use of more than 4 hours per day, regardless of size and weight, can cause deformity of the fifth finger, which may disturb the patient even if it does not cause radiologically changes.

Joint-related manifestations of leprosy: A case report

Leprosy is a chronic granulomatous disease in which the musculoskeletal system has been described as the third most commonly affected system. Leprosy infections may manifest with various autoimmune phenomena reminiscent of classic autoimmune diseases. Among the leprosy factors affecting the prognosis of the disease, early diagnosis was reported to be the most effective. A 46-year-old married woman was referred to the hospital with initial articular symptoms. The patient also had deep folds, increased thickness of the skin in the forehead area, and dryness of the skin with a progressive course. The finger deformities and swelling are certainly misleading, but they may constitute an unsuspected inaugural form of leprosy, especially in its lepromatous form. The skin smear and biopsy confirmed leprosy, and treatment consisting of multi-drug therapy, as suggested by the WHO, was prescribed for the patient. According to these findings, it seems that one of the major symptoms of leprosy is musculoskeletal involvement and rheumatological manifestations, which may obscure and mislead diagnostic and treatment plans.

A nonsense CC2D1A variant is associated with congenital anomalies, motor delay, hypotonia, and slight deformities

Autosomal recessive intellectual developmental disorder-3 is caused by homozygous or compound heterozygous mutations in the CC2D1A gene. The disorder is characterized by intellectual disability (ID) and autism spectrum disorder (ASD). To date, 39 patients from 17 families with CC2D1A -related disorders have been reported worldwide, in whom only six pathogenic or likely pathogenic loss-of-function variants and three variants of uncertain significance (VUS) in the CC2D1A gene have been identified in these patients. We described a patient with ID from a non-consanguineous Chinese family and whole-exome sequencing (WES) was used to identify the causative gene. The patient presented with severe ID and ASD, speech impairment, motor delay, hypotonia, slight facial anomalies, and finger deformities. Threatened abortion and abnormal fetal movements occurred during pregnancy with the proband but not his older healthy sister. WES analysis identified a homozygous nonsense variant, c.736C>T (p.Gln246Ter), in the CC2D1A gene. In addition, six novel likely pathogenic CC2D1A variants were identified by a retrospective review of the in-house database. This study expands the genetic and clinical spectra of CC2D1A-associated disorders, and may aid in increasing awareness of this rare condition. Our findings have provided new insights into the clinical heterogeneity of the disease and further phenotype-genotype correlation, which could help to offer scope for more accurate genetic testing and counseling to affected families.

Trigger Thumb, Trigger Finger and Clasped Thumb.

Finger deformities are a common reason for medical observation in children. Subtle clinical differences can have a significant impact on the diagnosis and treatment of these patients. Identification of the basic diagnostic and treatment principles of trigger thumb, trigger finger, and clasped thumb is of paramount importance to all general practitioners, pediatricians, and orthopedic surgeons who are involved in the care of children. The purpose of this article is to review the most important concepts regarding these important topics, focusing on etiology, epidemiology, clinical presentation, diagnosis, treatment and prognosis.

Modification of the Zancolli Lasso Procedure for Simultaneous Correction of Wartenberg's Sign.

Ulnar nerve injury initiates an imbalance between the intrinsic muscles and extrinsic extensors of the ring and small fingers, which leads to the characteristic hyperextension of the metacarpophalangeal (MP) joints and flexion of the proximal interphalangeal joints of these 2 digits-commonly referred to as the ulnar claw hand. In addition to these changes in the static posture of the hand, ulnar nerve palsy severely impairs grasp due to deficient active MP joint flexion. In most cases, motor balance can be restored by preventing MP joint hyperextension and augmenting MP joint flexion using the Zancolli lasso procedure (ZLP). Ulnar neuropathy can cause a second motor imbalance between the ulnar intrinsics and the extensor digit minimi leading to an abduction deformity of the small finger known as Wartenberg's sign. The inability to adduct the small finger can be a great source of frustration to patients. Using a cadaveric biomechanical model, we have developed a simple modification of the Zancolli lasso procedure that simultaneously corrects claw deformity and Wartenberg's sign and we report its efficacy in 2 clinical cases.

A Novel Prolene Suture Pull-out Technique Combined with Anchor Technique for the Treatment of Tendinous Mallet Finger.

Mallet finger deformity is a prevalent disability that causes discomfort and inconvenience to the patients. Despite the existence of various surgical approaches, surgical management remains a controversial subject. We retrospectively analyzed the clinical data of 26 patients with isolated tendinous mallet fingers who were admitted between January 2021 and June 2022. Among them, there were 18 men and eight women, aged between 20 and 56 years, with an average age of 38 years. The causes of injury were cutting injuries (15 cases), sports impact injuries (nine cases), and sprains (two cases). The time interval between injury and surgery ranged from 2 hours to 48 days, with an average of 12 days. During the surgical procedure, the distal interphalangeal joint was fixed in a mild dorsiflexion position using Kirschner wire. Absorbable anchors were used to assist in the reconstruction of the insertion point of the finger extensor tendon. Additionally, a 4-0 Prolene suture was used for reinforcement. All 26 patients were followed up for a period ranging from 6 to 24 months, with an average follow-up duration of 9 months. The function of distal interphalangeal joint was preserved. According to the Crawford functional evaluation criteria, the function of the affected fingers was excellent in 15 cases, good in eight cases, fair in three cases, and poor in no cases. A novel Prolene suture pull-out technique is an effective approach to repair tendon mallet finger and reconstruct the tendon-bone anatomical unit. This treatment option provides favorable outcomes, with high rates of excellent and good functional results.

Rheumatological complaints in H syndrome: from inflammatory profiling to target treatment in a case study

BackgroundH Syndrome is a rare genetic condition caused by biallelic pathogenic variants in the SLC29A3 gene. It is characterized by a wide range of clinical manifestations, many of which are related to the immune-rheumatological field. These include scleroderma-like skin changes, deforming arthritis, and enlarged lymph nodes. The condition also features cardiac and endocrine defects, as well as hearing loss, for which the immune pathogenesis appears less clear. Immunomodulatory medications have been shown to improve many symptoms in recent experiences.Case presentationA 21-year-old girl was referred to our institute after being diagnosed with H syndrome. Her medical history was characterized by the development of finger and toe deformities, which developed since the first years of life and progressively worsened with clinodactyly. At 6 years of age, she was diagnosed with diabetes mellitus without typical autoantibodies and with bilateral sensorineural hearing loss. She also complained of frequent episodes of lymphadenopathy, sometimes with colliquation and growth retardation due to pancreatic insufficiency. It wasn’t until the genetic diagnosis of H syndrome that the continual increase in acute phase reactants was noticed, suggesting that an immunological pathogenesis may be the source of her problems. During her visit to our institute, she reported serious pain in both feet and hands and difficulty walking due to knee arthritis and muscle contractures. Conventional therapy with steroid injection in affected joints and methotrexate only led to partial improvement. After a thorough assessment of her inflammatory profile showing a high interferon score, the girl received treatment with baricitinib. Furthermore, based on recent data showing that SLC29A3 deficiency results in interferon production because of Toll-like Receptor 7 activation in lysosomes, hydroxychloroquine was also added. The combination of the two drugs resulted for the first time in a rapid and persistent normalization of inflammatory markers, paralleled by a dramatic improvement in symptoms.ConclusionsWe describe the results of inhibiting IFN inflammation in H syndrome and discuss how JAK inhibitors and antimalarials might represent a mechanistically based treatment for this orphan drug disorder.

Surgical Treatment of the Bony Mallet Injuries with Augmented Extension Block Technique: Clinical Outcomes of a New Modification

Surgical Treatment of The Bony Mallet Deformity with Augmented Extension Block Technique: Clinical Outcomes of a New Modification Introduction: Mallet finger deformity is a common pathology and the ‘Extension Block Technique’, is one of the most popular surgical techniques for the treatment of this condition. However, several complications may occur with this method such as fixation failure, compression failure of the dorsal part and loss of reduction. In the current study, it is aimed to report the result of our modification which is augmented extension block technique. Materials & Method: The medical records of patients, who were operated with the diagnosis of bony mallet finger between 2015 and 2021, were evaluated retrospectively. Demographic data, mechanism of trauma, duration of operation, time from injury to surgery, follow-up period, implant removal time, and postoperative complications were collected from hospital records. Patients aged between 18 - 65 years who had been operated with augmented extension block technique with a minimum follow-up period of 6 months were included in the study. A total of 10 patients who met these criteria constituted the study group. Radiological evaluation of the cases was performed with anteroposterior and lateral radiographs. Range of motion and presence of pain were questioned and these data were evaluated according to Crawford criteria. Results: The mean age of the all patients was 40.2 ± 10.9 (range, 24-56) years. The mean follow-up period was 39.6 ± 26.7 (range, 13-76) months. Complete union was achieved in all patients on the final follow-up radiographs. According to Crawford evaluation criteria, the results were ‘excellent’ in six of the patients and ‘good’ in four of them. There were no patients with loss of flexion however, 5° extension loss was observed in four of the subjects. Discussion: This study demonstrates that the augmented extension block technique is a suitable option for the surgical treatment of bony mallet cases with lower complication rate and successful functional results. This modification can be considered as an alternative option for traditional extension block technique which avoids some related complications as postoperative reduction loss, rotational instability and extension loss. Keywords: Mallet finger, Bony mallet, Extension Block

Evaluation of Outcome Measures of Zone V Flexor Tendon Injury: A Systematic Review.

Background Flexor tendon injury zone V is a multicomponent soft tissue injury involving tendons, nerves, and vessels. Outcome assessment of repair thus requires evaluation of the hand as a whole rather than solely evaluating tendon function. The purpose of this Preferred Reporting Items for Systematic Reviews and Meta-Analyses -compliant systematic review was to identify and assess the components of outcome measures used in flexor zone V. Methods A total of 3,761 studies were retrieved from four databases (PubMed, ProQuest, Cochrane Central, and Google Scholar). These studies were then screened for inclusion using a validated screening form. Fifteen articles fulfilling the eligibility criteria were included in the review. Subsequently, the included studies were assessed for methodological quality using the Joanna Brigg Institute tool. Results Out of the 15 studies, 11 were case series, 3 were cross-sectional studies, and 1 was a randomized controlled trial. Out of 15 included studies, 13 were of low risk, whereas 2 studies suggested moderate risk when assessed for methodological quality using the Joanna Brigg Institute tool. Eight outcome measures were identified, out of which the most frequently used were Total Active Motion by the American Society for Surgery of Hand (TAM-ASSH) and Noaman's criteria. Our study found that Noaman's criteria assessed sensory-motor function and finger deformity in addition to the range of motion (ROM), which was found to be assessed by all the other outcome measures. Conclusion We concluded that although Buck-Gramcko criteria is well suited for the ROM evaluation, Noaman's criteria, a recently developed outcome measure used exclusively for combined injuries in zone V, took into consideration the implications of nerve injury along with tendon function. Although being specifically designed for combined injuries of tendons, nerves, and vessels in zone V, there is a lack of usage of Noaman's in the literature. There still exists a lack of a consistent and appropriate choice of outcome measure.

Polymelia of the upper limb

BACKGROUND: The most rare and extremely rare malformation of the upper limb is polymelia, i.e., doubling (triple) limb. In the literature, no more than 20 cases of an increase in the number of lower limbs and only three cases of doubling (triple) of the upper limb (in humans) have been described.
 CLINICAL CASE: A 2-year-old child diagnosed with polymelia of the right upper limb was examined and treated at our clinic. Clinical examination revealed two shoulder blades and one clavicle, with a normal anatomical location and development. Behind, an upper limb ended with the stump of the forearm, represented by an underdeveloped ulna. Moreover, the elbow joint was in a state of flexion contracture at an angle of 170, and the ulna was turned posteriorly and 1520 medially. The anterior humerus in the proximal section was underdeveloped, and in the distal section, it articulated in a normally formed elbow joint with the radius and ulna. The hand had five fingers with moderate underdevelopment and deformity of the 5th finger. After examining the bone, muscle, and vascular anatomy of the doubled limb, surgery was performed; as a result, a nearly complete anatomical and functional limb was reconstructed from the two segments of one upper limb.
 DISCUSSION: Polymelia is an extremely rare variant of a congenital anomaly of the limbs; thus, only a few cases are reported in the literature, which differs significantly from each other in clinical manifestations. Many questions related to the etiology and pathogenesis of these malformations are unexplored. The doubling of the limbs in animals is caused by both teratogenic environmental factors and genetic mutations. In any case, reconstructive surgery makes it possible to effectively treat children with such anomalies in the development of the limbs and obtain good results.
 CONCLUSIONS: The restoration of the upper limb of children with polymelia is quite difficult, but doable. Adequate analysis of all examination data and rational planning of surgical intervention in such cases creates conditions that enable achieving the maximum anatomical and functional results of upper limb reconstruction in children with this developmental anomaly.

Current concepts in traumatic mallet finger management

Mallet finger deformities can be divided into tendinous deformities caused by tendon rupture and bony deformities caused by fracture. In many cases, conservative treatment is possible. The goal of treating traumatic mallet finger deformities is to accurately restore the ruptured tendon or fractured bone to its proper position, correct extension lag or flexion contracture, prevent joint arthritis, and restore the full range of motion through appropriate range of motion exercises at the right time. In cases of tendinous mallet finger, immobilization with a splint or cast for at least 6 weeks in the extended position is required. During this period, flexion at the distal interphalangeal joint should be strictly limited, while movement at the proximal interphalangeal joint is allowed. Patient compliance with the protocol is essential for achieving good treatment outcomes. If conservative treatment fails or if the deformity recurs after initial surgery, satisfactory results can be achieved through tenodermodesis surgery. If the bony mallet finger involves a bone fragment of 3 mm or more or subluxation of the distal phalanx, surgical treatment is recommended. The primary surgical treatment involves closed reduction and percutaneous pinning with the extension block technique.

Additive Manufacturing and Upper-Limb Orthoses: A Scoping Review

ABSTRACT Introduction Additive manufacturing has the potential to revolutionize the orthotic fabrication process for health professionals. Although there is evidence to suggest the benefits of additive manufacturing in rehabilitation-related fields, there is still fairly limited evidence supporting the use of 3D-printed orthoses as an effective and feasible alternative to manually fabricated devices used for the upper limb (UL). The purpose of this scoping review was to examine how 3D printers are currently being used in UL orthotic fabrication within the scope of rehabilitation professionals. Methods A literature search was conducted using five databases from 2011 to 2021. Two independent researchers reviewed the abstracts and full text of the articles. The PRISMA process was used to report findings, and data extraction and charting were completed according to the JBI-suggested scoping review protocol. Results Thirty-three studies were reviewed as determined by inclusion criteria from various disciplines and countries. Eight diagnostic categories identifying indications for use were derived from the studies including arthritic conditions, burns/contractures and wound care, finger deformities, neurological and neuromuscular disorders, and traumatic, strain, and nerve injuries. Both benefits and challenges are identified with the use of 3D-printed orthoses. Conclusions The scope of the 3D-printed orthoses produced in this review is broad and internationally widespread. More evidence is needed to determine the effectiveness of 3D-printed orthoses for each of the identified conditions, but the benefits outside of healing are obvious. The current state of the evidence suggests that this technology remains exploratory in respect to UL orthoses and is therefore not yet ready to be implemented in clinics. With appropriate supports and more evidence, 3D printing still has the potential to revolutionize the UL orthotic fabrication process. Clinical Relevance It may be unrealistic for rehabilitation professionals to design and fabricate 3D-printed orthoses without the proper education or time, but it is important for health care professionals to have an emphasized presence in this conversation, as it is their responsibility to treat the patients. This suggests that co-design, combining professionals' expertise, might be the best approach to fabricating these devices for patients.

0476 Peripheral Arterial Tonometry-Based Home Sleep Apnea Test vs. Polysomnography in Detection of Central Disordered Breathing Events

Abstract Introduction In-laboratory polysomnography (PSG) is the gold standard diagnostic test for sleep-disordered breathing (SDB). WatchPAT® is a type of home sleep apnea testing (HSAT) that utilizes peripheral arterial tone (PAT) signals and other sensors to evaluate for SDB. There is an abundance of data to support the use of a PAT-based HSAT for obstructive sleep apnea (OSA), though data to support its use in central sleep apnea (CSA) in the general population undergoing PSG is lacking. We therefore aimed to compare the agreement of a PAT-based HSAT and PSG in detecting central disordered breathing events in the general population undergoing PSG. Methods A prospective cross-sectional study was conducted in eligible adult participants with suspected sleep apnea who were scheduled to undergo diagnostic or split-night PSG at the Center for Sleep Medicine at Mayo Clinic in Rochester, MN, between May 2021 and October 2022. The PAT-based HSAT was applied during the night of PSG to obtain simultaneous recording. Subjects were excluded if they had chronic atrial fibrillation, permanent pacemaker, or finger deformity precluding finger probe use or if they were on alpha- antagonists or short-acting nitrates. The PAT-based HSAT data were automatically scored with the use of proprietary software, and the PSG data were manually scored by registered polysomnography technologists. All studies were reviewed by board-certified sleep medicine providers. Results A total of 147 subjects (53% female) were included in the final analysis after excluding 18 subjects due to malfunction of the PAT-based HSAT. The subjects had a mean age of 58±15 yrs and BMI of 34±9 kg/m². 95 (65%) subjects underwent split-night studies. OSA was diagnosed in 81% with a mean PSG AHI of 28±27 events per hour. CSA was diagnosed in 3% of subjects with a mean PSG AHI of 33±27 events per hour. Of the total 2120 central disordered breathing events reported by the PAT-based HSAT (mean pAHIc 3±5 events per hour), 365 (17%) correlated with central apneas and 78 (3.7%) correlated with central hypopneas found on PSG. Conclusion In our prospective study, the PAT-based HSAT demonstrated low positive predictive value in detecting central disordered breathing events when compared to PSG. Support (if any)

Association between air pollutants and birth defects in Xiamen, China.

To explore the relationship between common air pollution and common birth defects, and to provide reference for the prevention of birth defects. We conducted a case-control study in Xiamen, a city in southeastern China from 2019 to 2020. Logistics regression was used to analyze the relationship between sulfur dioxide(SO2), fine particulate matter 2.5(PM2.5), nitrogen dioxide(NO2), ozone(O3), carbon monoxide(CO) and the occurrence of common birth defects such as congenital heart disease, facial cleft, and finger deformity. SO2 significantly increased the risk of birth defects such as congenital heart disease, cleft lip and/or cleft palate, and ear deformity in the first and second months of pregnancy. Exposure to common air pollutants increases the risk of birth defects, and SO2 significantly affects the occurrence of birth defects in the first two months of pregnancy.

Relation of Primary Fingerprint Patterns With Gender and Blood Group: A Dermatoglyphic Study From a Tertiary Care Institute in Eastern India.

Background Identification of an individual plays a vital part in any medicolegalinvestigation. The fingerprint is one of the oldestand most reliable biometric methods and is taken as legitimate proof of identification of an individual. Positive relationships between the fingerprint pattern and blood group and the fingerprint pattern and gender were demonstrated in some of the previous studies but weren't consistent across them. Objectives (a) To studythe distribution of fingerprint patterns among the study participants by gender and ABO and Rh blood groups and (b) to find an association between the fingerprint pattern andgender and blood group. Methods A cross-sectional observational study was carried out in the year 2021 on 800 healthcare students and workers of All India Institute of Medical Sciences, Patna, Bihar, Eastern Indiahaving different ABO and Rh blood groups. Healthy individuals i.e., those who were not suffering from any illness which can affect the fingerprints, aged 18 years or above were included and individuals having hand or finger deformities or missing fingers, having an allergy to the ink pad, and having blood group diseases were excluded. Rolled imprints of all the 10 digits of the participants were taken on a white A4 size Performa and were classified into loops, whorl, arches, and composite. The distribution of the fingerprint patterns was then compared by gender, ABO and Rh blood group. Chi-square/Fischer exact tests were applied to comparetwo groups andfind the association. P-value<0.05 was taken as statistically significant. Results The majority (66.0%) of the participants in the study were males with a male: female ratio of 1.9:1. Most common blood group was blood group B (37.7%) followed byO (29.8%), A (23.0%), and AB (9.5%). Rh-positive cases constituted around 96% of all the studied cases with the rest being Rh-ve. The general distribution of the fingerprint pattern showed a high frequency of loops registering 55.9%; followed by whorls (34.9%), arches (6.0%), and composite (3.1%). The distribution of fingerprint patterns among the male and femalegender was found to be similar with no significant difference (p=0.11). However, the distribution of the finger patterns across the ABO blood groups showed a statistically significant difference (p=0.0003) whereas it was non-significant across the Rh blood groups (p=0.08). Conclusion This study concludes that the distribution of the primary fingerprint patterns relates to the "ABO" blood group but not to gender and Rh blood group. An individual's fingerprints may be used to predict his/her blood group and vice versa.