Digital Deformities Research Articles

Digital artery deformation on movement of the proximal interphalangeal joint.

This study aimed to characterize invivo human digital arteries in three-dimensions using photoacoustic tomography in order to understand the specific mechanism underlying arterial deformation associated with movement of the proximal interphalangeal joint. Three-dimensional morphological data were obtained on the radialis indicis artery (radial artery of the index finger) at different angles of the joint. The association between increased curvature of the deformation and the anatomical region was assessed. Characteristic morphological deformations in areas of major deformation were determined. The deformation of the artery was characterized by three consecutive curves in juxta-articular regions, which were particularly noticeable when the joint was flexed at an angle of ≥ 60°. The change in the curvature of the deformation during 30°-90° of flexion was lower in middle-aged individuals than in young individuals. Better understanding of the mechanism underlying deformation of the digital arteries may contribute to advancements in flap procedures and rehabilitation strategies after digital artery repair.

Distal Syme Hallux Amputation for Tip of Toe Wounds and Gangrene Complicated by Osteomyelitis of the Distal Phalanx: Surgical Technique and Outcome in Consecutive Cases

Distal hallux gangrene and neuropathic ulceration associated with digit deformity frequently result in osteomyelitis of the distal phalanx. Ideal treatment would involve limited resection to preserve function. We describe our surgical technique and retrospective results for distal Syme hallux amputation with plantar flap closure. An institutional review board-approved review was conducted on cases performed over 8 years. A total of 15 consecutive patients (16 digits) with hallux soft tissue loss who had undergone distal Syme hallux amputation were included. In each case, initial resection removed the distal hallux wound, nail bed, and distal phalanx. The proximal phalanx tip was remodeled, allowing margin biopsy and reduction of prominence. Of the 16 digits, 5 (31.3%) had hammertoe deformity and 1 (6.3%) was excessively long. Positive probe-to-bone status was identified in 8 of the 16 digits (50.0%). All 8 ulcers (100.0%) that probed to bone had histologic or culture results consistent with distal phalanx osteomyelitis. A proximal margin biopsy was taken in 12 of 16 digits (75.0%), and proximal phalanx osteomyelitis was observed in 4 of 12 proximal margin biopsies (33.3%). Two digits (12.5%) failed to heal. Three digits (18.8%) required a more proximal amputation, and the remaining 13 (81.3%) were found to be well-healed and functional at the final follow-up examination. The mean follow-up period was 27.6 (range 8 to 97) months. We have found distal Syme hallux amputation to be an effective treatment when used judiciously for distal hallux gangrene and osteomyelitis associated with neuropathic ulceration. This procedure permits bone biopsy for early diagnosis, confirmation of clean margins, removal of nonviable tissue and the abnormal toenail, and some deformity correction.

Surgical Management of Proximal Interphalangeal Joint Repetitive Stress Epiphyseal Fracture Nonunion in Elite Sport Climbers

Repetitive stress fracture of the middle phalanx epiphysis is an injury specific to elite adolescent sport climbers. As sport climbing becomes increasingly popular in younger age groups, an increased number of these injuries have been reported in recent years. To date, treatment of these fractures has been nonsurgical, with strict rest and physiotherapy prescribed until fracture union. However, when these patients present in a delayed fashion with an established nonunion, nonsurgical treatment may fail, leading to disabling chronic pain and/or digital deformity in some cases. In this article, we present 2 cases of surgical treatment for finger middle phalanx repetitive stress epiphyseal fracture nonunion, using a percutaneous spot drilling epiphysiodesis technique.

An improved SAR interferogram denoising method based on principal component analysis and the Goldstein filter

ABSTRACTInterferogram filtering is an important data processing step in Interferometric synthetic aperture radar (InSAR) applications, which has a direct impact on the accuracy of the phase unwrapping and digital elevation model (DEM) or deformation results retrieval. An improved synthetic aperture radar (SAR) interferogram denoising method based on principal component analysis and the Goldstein filter is proposed, which can improve the coherence of interferogram remarkably and get more coherent targets. First, homogeneous pixels are identified with stacks of SAR amplitude data, which can obtain the unbiased coherence estimation. Then, the noise phase of one resolution unit is suppressed based on the principal component analysis of multi-baseline InSAR coherence stacks by considering the relationship between pixel size and scattering mechanism. Finally, the remaining noise is smoothed with the iterative Goldstein filter over spatial domain. The proposed method is tested over one deformed and low-coherence region to verify the better performance in the terms of noise reduction and coherence increase.

Cuboid fracture: Epidemiology and treatment algorithm on 28 patients

Distal hallux gangrene and neuropathic ulceration associated with digit deformity frequently result in osteomyelitis of the distal phalanx. Ideal treatment would involve limited resection to preserve function. We describe our surgical technique and retrospective results for distal Syme hallux amputation with plantar flap closure. An institutional review board-approved review was conducted on cases performed over 8 years. A total of 15 consecutive patients (16 digits) with hallux soft tissue loss who had undergone distal Syme hallux amputation were included. In each case, initial resection removed the distal hallux wound, nail bed, and distal phalanx. The proximal phalanx tip was remodeled, allowing margin biopsy and reduction of prominence. Of the 16 digits, 5 (31.3%) had hammertoe deformity and 1 (6.3%) was excessively long. Positive probe-to-bone status was identified in 8 of the 16 digits (50.0%). All 8 ulcers (100.0%) that probed to bone had histologic or culture results consistent with distal phalanx osteomyelitis. A proximal margin biopsy was taken in 12 of 16 digits (75.0%), and proximal phalanx osteomyelitis was observed in 4 of 12 proximal margin biopsies (33.3%). Two digits (12.5%) failed to heal. Three digits (18.8%) required a more proximal amputation, and the remaining 13 (81.3%) were found to be well-healed and functional at the final follow-up examination. The mean follow-up period was 27.6 (range 8 to 97) months. We have found distal Syme hallux amputation to be an effective treatment when used judiciously for distal hallux gangrene and osteomyelitis associated with neuropathic ulceration. This procedure permits bone biopsy for early diagnosis, confirmation of clean margins, removal of nonviable tissue and the abnormal toenail, and some deformity correction.

Mesoscale design of heterogeneous material systems in multi-material additive manufacturing

Mesoscale heterogeneous material systems are efficient and adaptive to real world environments, owing to the non-uniform stress fields that result from the convolution of component geometries, loading conditions, and environmental changes. With the advent of multi-material additive manufacturing, the production of heterogeneous material systems with a pre-defined mesoscale material distribution becomes feasible. This unlocks the design freedom at a characteristic length scale between the macroscale geometry and microstructures, but also calls for a new design framework to optimize the mesoscale material distribution in multi-material additive manufacturing. Here, we propose and demonstrate such a design framework by incorporating digital image correlation-based deformation mapping with 3D finite element modeling-based computational optimization. The constitutive behavior of each constituent material or their mixtures is calibrated by matching the local deformation data. The optimal mesoscale material distribution can then be determined using global optimization algorithms and validated experimentally.

Multiplanar Correction of the Lesser Digital Deviation and Indirect Plantar Plate Rupture Repair Using a Braided Polyethylene Nylon Suture: A Technique Guide.

Level V: Expert opinion.

An Adaptive Multilook Approach for Small Sets of Multitemporal SAR Data Based on Adaptive Joint Data Vector

The multitemporal interferometric synthetic aperture radar (InSAR) technique is a potential tool for measuring digital elevation models and surface deformation. It has the advantage of high precision, competitive spatial resolution, and wide coverage. To improve the accuracy of the final results, some adaptive multilook strategies have been proposed in which the identification of statistically homogeneous pixels (SHPs) is the key task. However, these methods are not always reliable in the case of small data sets. To improve this reliability, SHPs are identified based on the adaptive joint data vector comprising of temporal sample and spatial information in this letter. Additionally, the formulation of adaptive joint data vector is combined with local spatial features of SAR images. The presented adaptive multilook approach can be used in many interferometric applications, such as InSAR data filtering and coherence estimation. Experiments on six TerraSAR-X stripmap images of Tianjin in China validate the feasibility and effectiveness of the proposed approach.

Chromosome 12q13.13q13.13 microduplication and microdeletion: a case report and literature review

BackgroundDuplications or deletions in the 12q13.13 region are rare. Only scattered cases with duplications and/or deletions in this region have been reported in the literature or in online databases. Owing to the limited number of patients with genomic alteration within this region and lack of systematic analysis of these patients, the common clinical manifestation of these patients has remained elusive.Case presentationHere we report an 802 kb duplication in the 12q13.13q13.13 region in a 14 year-old male who presented with dysmorphic features, developmental delay (DD), mild intellectual disability (ID) and mild deformity of digits. Comparing the phenotype of our patient with those of reported patients, we find that patients with the 12q13.13 duplication or the deletion share similar phenotypes, including dysmorphic facies, abnormal nails, intellectual disability, and deformity of digits or limbs. However, patients with the deletion appear to have more severe deformity of digits or limbs.ConclusionsDeletion and duplication of the 12q13.13 region may represent novel contiguous gene alteration syndromes. All seven reported 12q13.13 deletions and three of four duplications are de novo and vary in size. Therefore, these genomic alterations are not due to non-allelic homologous recombination.

A Midterm Review of Lesser Toe Arthrodesis With an Intramedullary Implant

Therapeutic, Level IV: Case series.

Olmsted Syndrome: a case report

Olmsted syndrome is a rare keratinisation disorder characterised by mutilating palmoplantar keratoderma with peri-orificial hyperkeratosis. Till now around 73 cases have been reported. We are reporting a case of 3 year old female child with keratoderma of palms and soles since birth along with peri-orificial hyperkeratosis flexion deformity of digits of palms hypotrichosis and onychodystrophy. There was no history of hyperhidrosis no dental abnormalities and no sensorineural hearing loss. Hence the diagnosis of Olmsted syndrome was made.

Le complicanze della chirurgia mini-invasiva dell’avampiede

There is increasing interest in and use of minimally invasive foot surgery (MIFS), as it involves short operating time, quicker recovery, reduced hospital stays, better cosmetic results and fewer complications compared to open surgery. However, limited evidence is available in relation to complications associated with MIS for forefoot deformity correction. Available publications lack of homogeneity in terms of case series, patient selection and clinical indicators, mostly being retrospective observational studies with insufficient randomised control trials. The aim of this study was to report the complications following MIFS. In this evaluation, as the Author conceived it as a feasible tool of current clinical practice, complications can be broadly divided into three categories: (1) those related to the learning curve; (2) typical postoperative clinical conditions, such as oedema and haematoma; and (3) true complications. MIFS procedures are safely performed in a range of clinical settings, on varying degrees of digital deformity, resulting in an overall low complication rate compared to conventional open surgery. Long-term safety and efficacy of these techniques need further scientific validations as well as future treatment algorithms to guide clinical decision making.

Presiones plantares de las patologías más frecuentes en el pie

Objetivos: Conocer la evidencia científica de los valores de presión plantar establecidos como “normales”, así como la modificación de éstas en las patologías más frecuentes del pie. El estudio de las presiones plantares se realizará complementario a la exploración, y servirá de ayuda para el diagnóstico de diversas patologías.Material y Métodos: Revisión narrativa realizada a través de 76 referencias (8 libros, 55 artículos científicos, 1 tesis doctoral y 3 páginas de internet.). Usando palabras clave como pressure plantar, cavus foot, flatfoot, claw toe… etc, en distintas bases de datos, siendo PubMed la más usada.Resultados: Los datos de presiones plantares reflejan la arquitectura del pie, por lo que, por regla general, el pie cavo posee mayores presiones en antepié por la verticalización de los metatarsianos, mientras que el pie plano tiene mayores picos de presión en mediopié por el aplanamiento del arco. Las afecciones del metatarso y las deformidades digitales reflejan mayor presión en la zona metatarsal por la sobrecarga a la que los metatarsianos se encuentran sometidos. Las presiones en las disimetrías reflejan variaciones según la pierna larga y la pierna corta, obteniendo mayores presiones plantares la pierna larga en el antepié.Conclusiones: Los resultados obtenidos confirman que al realizar el estudio de presiones plantares nos servirá de ayuda para realizar un diagnóstico y tratamiento eficaz, ya que cada patología muestra diferencias significativas respecto a la presión plantar del pie normal.

Relación entre la fórmula digital y las deformidades del antepié en una población joven

Introducción: Una observación minuciosa del antepié, permite realizar una clasificación del mismo según la longitud de los dedos, que dará origen a las llamadas fórmulas digitales (pie egipcio, pie cuadrado y pie griego).Objetivo: El objetivo de este estudio es analizar los tipos de pie en una población juvenil y su posible relación con diferentes patologías del antepié y otros factores como la edad y el sexo.Materal y métodos: Se realizó un estudio observacional descriptivo a 103 participantes y se determinó el tipo de pie y la presencia de deformidades digitales.Resultados y conclusiones: Podemos afirmar para nuestra población, que el tipo de pie más habitual es el egipcio y el menos frecuente el griego. Las patologías digitales tienen una incidencia del 46,15%. Quintus varus es la alteración digital más frecuente y se relaciona con el pie cuadrado, y por otro lado el Juanete de sastre, parece ser significativamente más incidente en el pie griego a pesar de estar también presente en el pie cuadrado. Destaca que las mujeres son las más afectadas por estas patologías.Estos datos sirven para que el podólogo los tenga en cuenta en la realización de tratamientos específicos que favorezcan la salud y el bienestar del pie.

Exome Sequencing of a Pedigree Reveals S339L Mutation in the TLN2 Gene as a Cause of Fifth Finger Camptodactyly.

Camptodactyly is a digit deformity characterized by permanent flexion contracture of one or both fifth fingers at the proximal interphalangeal joints. Though over 60 distinct types of syndromic camptodactyly have been described, only one disease locus (3q11.2-q13.12) for nonsyndromic camptodactyly has been identified. To identify the genetic defect for camptodactyly in a four-generation Chinese Han family, exome and Sanger sequencings were conducted and a missense variant, c.1016C>T (p.S339L), in the talin 2 gene (TLN2) was identified. The variant co-segregated with disease in the family and was not observed in 12 unaffected family members or 1,000 normal controls, suggesting that p.S339L is a pathogenic mutation. Two asymptomatic carriers in the family indicated incomplete penetrance or more complicated compensated mechanism. Most of p.S339L carriers also have relatively benign cardiac phenotypes. Expression of wild and mutant TLN2 in HEK293 cells suggested the predominant localization in cytoplasm. Our data suggest a potential molecular link between TLN2 and camptodactyly pathogenesis.

Sustainability of Forefoot Reconstruction for the Rheumatoid Foot

Ninety percent of patients with rheumatoid arthritis will display foot and ankle pathologic features, including hallux valgus, lesser metatarsophalangeal (MTP) joint subluxation/dislocation, and hammertoe deformity. Recently, a trend has ensued toward joint preservation with distal metatarsal osteotomies and various bunion corrective procedures. However, the reference standard remains first MTP joint fusion, lesser metatarsal head resection, and lesser proximal interphalangeal joint fusion. The present retrospective study followed the results of 4 different surgeons who had performed the reference standard rheumatoid forefoot reconstruction from August 2008 to August 2012 on patients with rheumatoid arthritis. Radiographic and statistical analysis of the data from 20 patients determined an overall first MTP joint fusion rate of 90%, often occurring by 108 (range 64 to 202) days postoperatively. Radiographic nonunion occurred in 2 of the 20 patients (10%), although both were asymptomatic, with no revision necessary. Lesser digit deformity revision occurred in 1 patient (5%), and mild to moderate infection developed in 4 patients (20%). The radiographic and clinical follow-up period was 12 months. Our study found that this technique provides exceptional radiographic improvement, an acceptable time to fusion, a low reoperation rate, and minimal complications. In addition, correction of the deformity was maintained at 1 year postoperatively. In conclusion, first MTP joint fusion with lesser metatarsal head resection should remain the reference standard for surgical intervention of the rheumatoid foot.

Olmsted Syndrome: Rare Occurrence in Four Siblings.

Olmsted syndrome is a very rare and severe cicatrizing keratoderma associated with periorificial lesion. Most cases are sporadic but familial occurrence has been also seen. Till now around 73 cases have been reported and none of the reported cases have 4 siblings affected from this disease. We are reporting cases of 4 siblings of age 30 year female, 26 year female, 20 year male and 10 year male who were born to a third degree consangueinous marriage and presented with palmoplantar keratoderma, periorificial hyperkeratosis, flexion deformity, pseudoainhum and contracture of digits. There was no cardiac involvement. Hence, the diagnosis of Olmsted syndrome was made and all four patients were non responsive to treatment which included topical corticosteroid, topical salicylic acid, systemic isotretinoin, systemic acitretin and oral zinc in child.

Optical Digital Imitation Painting Design Based on Self-Adaptive Image Feature

Based on the study of existing digital imitation camouflage technology, we propose a kind of optical digital imitation camouflage design algorithm which is based on the characteristic of self-adaptive image. Picking main color feature of the background by using K-means clustering algorithm, counting the shape characteristics of each main color spots by separating layers, we generated digital camouflage pattern automatically by segmenting the background region characteristics and fill the background color image according to the statistics expected value. The simulation results show that, the digital camouflage generated automatically is blend well with the background .It keeps the background color and shape features, so has good camouflage effect. This algorithm can also provide the basic algorithm foundation for digital deformation camouflage.

Extensor Digitorum Brevis Transfer Technique to Correct Multiplanar Deformity of the Lesser Digits.

Lesser digital deformities may present a surgical challenge to even the most skilled foot and ankle surgeon. Multiplanar toe deformities, including the crossover toe, are especially difficult to correct with reproducible results. Undercorrection, pain, stiffness, and recurrent deformity are well reported throughout foot and ankle literature. The goal of this article is to describe a method of correcting digital deformity utilizing the extensor digitorum brevis tendon transfer and a biotenodesis screw. The controlled tension established with the extensor tendon provides the necessary stability for multiplanar correction of multiplanar digital deformities. This technical tip article should serve as pilot study for future evaluation of this method of correction. Level IV: Case series.

Proximal row carpectomy in total arthrodesis of the rheumatoid wrist

BackgroundAdvanced proximal carpal row damage is common in rheumatoid arthritis (RA). Proximal row carpectomy (PRC) simplifies total wrist arthrodesis, obviating the need for an iliac bone graft. In theory, PRC also improves the chances of healing, as fusion of a single joint space is needed for the procedure to be successful. Potential effects of the loss of carpal height related to PRC are unknown. HypothesisWe hypothesised that PRC performed concomitantly with total wrist arthrodesis in patients with RA produces good clinical and radiological outcomes, without inducing loss of strength or digital deformities. Material and methodsIn 38 total arthrodeses of rheumatoid wrists, a clinical evaluation was performed, including a visual analogue scale (VAS) pain score, the Patient-Rated Wrist Evaluation (PRWE), grip strength, digital deformities, and patient satisfaction. A standard radiographic workup was obtained to assess healing and carpal height indices. ResultsAfter a mean follow-up of 50 months, the mean VAS pain score was 0.4 (range: 0–7), the mean PRWE score was 21 (range: 0–80.5), and grip strength as a percentage of the contralateral limb was 76%. The healing rate was 92% (35/38 wrists), and 34 (90%) patients reported being satisfied or very satisfied. No effects of carpal height loss on clinical or radiographic parameters was detected. DiscussionTotal wrist arthrodesis combined with PRC provides reliable and reproducible benefits. This study found no evidence of adverse effects related to the loss of carpal height. Level of evidenceIV, retrospective study.