Children's Digital Research Articles

Transmission Electron Microscopic Pathoanatomy of Congenital Trigger Thumb

Previous studies of trigger digits in children have been limited to gross morphology and light-microscopic histology. Nine children with 11 trigger thumbs formed a preliminary study group for electron-microscopic evaluation of tendon nodules and A-1 pulleys. This pathoanatomic investigation was not previously reported. Comparison was made with light-microscopic sections. Large amounts of mature collagen was observed. Fibroblasts with prominent rough endoplasmic reticulum were present. No degenerative or inflammatory changes were noted in either tendon or sheath. We believe that although the etiology of trigger digits is still uncertain, an infectious, inflammatory, or degenerative process is unlikely.

Bone lengthening for treatment of aquired shortening of the digits in children

Bone lengthening for treatment of aquired shortening of the digits in children

Surgical treatment of carpal tunnel syndrome and trigger digits in children with mucopolysaccharide storage disorders

The role of surgical intervention for carpal tunnel syndrome (CTS) and trigger digits in children with mucopolysaccharide storage disorders (MPSDs) has not been clearly defined, particularly as the treatment of the underlying disease has advanced to include bone marrow transplantation. This study reviews our experience in the treatment of CTS and trigger digits in 22 children with MPSDs who were evaluated for CTS by electromyographic (EMG)/nerve conduction velocity (NCV) testing. Seventeen children were diagnosed with CTS by EMG/NCV testing and were treated with bilateral open surgical release with or without flexor tenosynovectomy. The EMG/NCV testing revealed normal results in 5 patients who are subsequently being monitored. Forty-five digits in 8 children were diagnosed clinically with trigger digits. Nineteen digits were treated by annular pulley release alone. Twenty-six digits were treated by annular pulley release with partial flexor digitorum superficialis tendon resection. The average age at the time of hand surgery was 6.3 years, and at the time of follow-up, 9.6 years. Postoperative EMG/NCV testing in 7 children showed 1 with improvement and 6 with normalization. None of the patients undergoing carpal tunnel release went on to develop thenar atrophy or absent sensibility, as has been reported in untreated cases. Patients were evaluated for triggering digits both by preoperative tendon palpation and by intraoperative flexor tendon excursion at the time of open carpal tunnel release. All patients undergoing trigger release had improved active digital flexion seen at the final follow-up visit. Because of the very high incidence of CTS and trigger digits in this population, the authors currently recommend routine screening of EMG/NCV for all children with MPSDs. Early surgical intervention for nerve compression and stenosing flexor tenosynovitis can maximize hand function in these children.

The assessment of phonological memory skills in preschool children

Findings from a longitudinal study designed to investigate phonological working memory skills in preschool children are reported. Two phonological memory tests, digit span and nonword repetition, were given to a large cohort of children at 3,4 and 5 years of age. The majority of children at all ages cooperated on both tests even at 3 years of age, indicating that the tasks are in principle suitable for use with young children. Individual differences in nonword repetition scores at 3 years were highly stable across the following two‐year period; there was, however, less stability in differences in the children's digit span scores across the same period. It is concluded that phonological memory skills can be reliably assessed in children as young as 3 years, and that the nonword repetition paradigm is highly suitable for this purpose.

Micro-anastomosis of 0.3-0.4 mm vessels after cold ischemia using a rat model of toe-to-thumb transplantation.

Anastomoses of vessels of less than 0.5 mm in diameter remain a challenge from the technical aspect. Clinically such anastomoses are necessary for replantation of the distal digit in adults and whole digits in children. Survival data for replantation of these parts after prolonged ischemia have not yet been reported. Since a rat foot has an anatomic structure similar to the human hand, we used 40 rats as models of toe-to-thumb transplantation to study the survival rates of transplanted toes after various periods of cold ischemia (4 degrees C) of the amputated part. While a 100% success rate was achieved following immediate transplantation of the amputated digits (control group), the survival rates were 87.5, 75, 75, and 62.5% after transplantation of digits cooled for 24, 48, 72, and 96 hours, respectively (groups 2-5). No exact ischemic time limit was demonstrated. The results suggest that, in this model, optimal digital replantation results are achievable even after a 24 hour period of cooling preservation.

Congenital Trigger Digit

Release of the sheath of the flexor tendon is the accepted solution for the problem of congenital trigger digits in children. A series of 27 patients with 37 trigger digits were observed over a period of 18 years: the average follow-up on these patients was 46.9 months. Thirty-two thumbs, three long fingers, and two ring fingers showed locking and a degree of triggering. Thirty-three digits required surgery. The surgical treatment is simple and effective. The outcome in most cases shows that this is a conservative approach.

Phlegmon de la gaine des fléchisseurs après décollement épiphysaire ouvert. A propos d'un cas

Injuries of the distal phalanx of the digits in children may lead to various lesions. The association of avulsion of the nail with an epiphyseal separation is not uncommon. This is in fact an open fracture, with the risk of infection of the flexor digitorum tendon sheath. The authors report such an observation and discuss the mechanism and treatment.

Current Procedures in China on Replantation of Severed Limbs and Digits

Since the first successful replantation of a severed right hand was reported in 1963, surgeons in China have performed more than 3735 replantations of limbs and digits with increasing improvement in the survival rate. Of special interest is that local hospitals have reported numerous successful cases revealing a popularization of this kind of operation in China. The replantation survival rate is related to the type of injury and duration of anoxia. The types of injury include avulsion or crush amputation, severed distal segments of fingers, immersion conditions, amputated limbs or digits in children, and segmental resection of diseased tissues. The results are analyzed by a special system of functional evaluation.