DIP Joint Research Articles

The Membrane-Like Structure From Extensor Tendon to the Nail in the Distal End of Digits: An Anatomical Study of Structure, Function, and Utility.

The nail structures of 6 cadavers were investigated in each of the 10 digits of the hand. In the histological study, the thickness, length, and location of the SEP were measured in each digit of 3 cadavers. In the other 3 cadavers, the moving distance of the SEP was measured macroscopically with the distal interphalangeal joint in flexion at 0 to 60 degrees for confirmation of the function. This moving distance could be considered as an indicator of the SEP straining the surrounding (retaining) structure and improving the stability of the nail in pinches. The SEP was recognized in all the digits. The average length of the SEPs was 2.38 ± 0.11 mm (mean ± SE). The average thickness of the SEPs was 0.35 ± 0.02 mm. The nail matrix and its feeding artery were found beneath the SEP in all digits. The average moving distance of the SEP was 1.38 ± 0.06 mm. This moving distance could be considered sufficiently large to support the role of SEP in the pinches compared with the excursion of the extensor tendon at the DIP joint in a previous report. The SEP has been shown to play an essential role in fingertip stabilization in pinches. It can serve as an anatomical marker to avoid iatrogenic damage to the nail matrix in surgical approaches.

Failure in rock with intersecting rough joints under uniaxial compression

Uniaxial compressive tests were performed on Y-jointed granite specimens to explore how intersecting rough joints affect the strength, failure mode, and precursory damage characteristics of the jointed rock mass. The mechanical properties, joint dip angles, and joint roughness of the specimens were measured prior to the tests, then the loading stress, surface displacement fields, acoustic emission (AE) signals, and failure modes were recorded during the loading process. As the uniaxial compressive strength (σc) of the specimens increased, three different failure modes appeared: shear failure along the persistent joint with rock wedge falling, compressive failure with rock wedge ejection, and overall crushing accompanied with rock fragment splashing, the σc thresholds of the three failure modes are about 50 MPa and 90 MPa, respectively. The deformability of the specimens weakened gradually as σc increased. AE events spread from the joint surface to the interior of the rock block until final failure. For specimens that failed in shear mode, multiple sudden stress drops along with sharp displacement increases occurred during the tests but no entire failure occurred. Other specimens tended to present one eventual unstable failure. When the peak shear strength of the non-persistent joint was higher than or near to that of the persistent joint, the σc of a given Y-jointed specimen was mainly determined by the persistent joint. Otherwise, it was simultaneously controlled by the two joints. Both the joint dip angle and joint roughness were found to significantly influence the σc of the specimens. Each stress drop was accompanied by significant AE signal variations, though the AE indicators are difficult to effectively utilize for early warning of specimen failure.

Development of a revolute-type kinematic model for human upper limb using a matrix approach

AbstractA mathematical model is proposed for a revolute joint mechanism with an n-degree of freedom (DOF). The matrix approach is used for finding the relation between two consecutive links to determine desired link parameters such as position, velocity and acceleration using the forward kinematic approach. The matrix approach was confirmed for a proposed 10 DOF revolute type (R-type) human upper limb model with servo motors at each joint. Two DOFs are considered each at shoulder, elbow and wrist joint, followed by four DOF for the fingers. Two DOFs were considered for metacarpophalangeal (mcp) and one DOF each for proximal interphalangeal (pip) and distal interphalangeal (dip) joints. MATLAB script function was used to evaluate the mathematical model for determining kinematic parameters for all the proposed human upper limb model joints. The simplified method for kinematic analysis proposed in this paper will further simplify the dynamic modeling of any mechanism for determining joint torques and hence, easy to design control system for joint movements.

Novel application of optical coherence tomography and capillaroscopy in psoriatic arthritis in relationship to psoriasis and hand osteoarthritis.

ObjectivesNailfold video capillaroscopy (NVC) and angiographic optical coherence tomography (OCTA) have potential in diagnosing PsA and differentiating it from psoriasis vulgaris (PsO) and hand OA. We aimed to assess the diagnostic properties of NVC and OCTA in patients with PsA compared with patients with PsO and hand OA based on nailfold capillary patterns.MethodsPatients with DIP joint PsA and nail involvement (n = 50), PsO with nail involvement (n = 12) and OA (n = 13) were included in this cross-sectional study. Capillaries were evaluated semi-quantitatively and qualitatively. Differences in capillary findings between groups were assessed using mixed linear models. Binary logistic regression analyses were performed to determine the probability for PsA diagnosis based on capillaroscopy findings.ResultsBelow mean capillary density and reduced nailfold blood flow in OCTA images distinguished PsA from both PsO (P = 0.004 and P = 0.052, respectively) and OA (P = 0.024 and P < 0.001, respectively). Qualitative analysis revealed that glomerular capillaries were found in only 3% of PsA patients but in 13% of PsO patients (P = 0.003). Furthermore, crossed vessels were seen in only 55% of PsA patients and 71% of PsO patients (P = 0.043). NVC microhaemorrhage was dominant in PsA patients (13%) and significantly different from OA patients (P <0.05). No capillary pattern was associated with an increased probability of the PsA diagnosis.ConclusionA pathognomonic pattern for PsA diagnosis was not identified; however, we demonstrated some characteristic capillaroscopy findings for PsA, such as decreased capillary density, reduced blood flow and fewer crossed vessels in OCTA and presence of NVC microhaemorrhages.

The relationship between the nail and systemic enthesitis in psoriatic arthritis.

ObjectivePsoriatic nail disease is more common in PsA than in isolated skin psoriasis (PsO). The nail is closely integrated to the DIP joint entheses. US data have shown that those patients with nail disease in PsO are more likely to have systemic enthesitis. We examined whether there was a relationship between nail disease, DIP enthesitis and systemic enthesitis in established PsA.MethodsForty-six PsA participants with nail disease underwent US scanning of the nail unit and the DIP entheses along with peripheral entheseal sites according to the Madrid sonographic enthesitis index (MASEI).ResultsAt the finger level, there was a mild to moderate correlation between nail US changes and both clinical nail disease and DIP enthesis changes (DIP US) [Spearman correlation (rS) = 0.30, P < 0.001 and rS = 0.16, P < 0.001, respectively]. At the patient level, there was a moderate correlation between the nail US score and nail psoriasis severity index score and DIP US (rS = 0.33, P = 0.024 and rS = 0.43, P = 0.003, respectively). At the patient level, there was also a positive correlation between a higher nail US score and the active peripheral enthesitis score (MASEI-active) (rS = 0.35, P = 0.018). When power Doppler was part of nail US score, similar results were demonstrated at both the finger and patient levels.ConclusionThis study has demonstrated the utility of nail US imaging and the close relationship, on scanning, between the DIP entheses and the nail unit. In PsA, we have seen a correlation between active US changes at the nail and peripheral enthesitis, which requires further analysis.Trial registrationClinicalTrials.gov, https://clinicaltrials.gov, NCT03955861.

Technical challenges in chronic zone 2 flexor tendon reconstruction and analysis of function in toddler: A rare case Report

Introduction: Flexor tendon injury in zone 2 is challenging to treat, when child was presented late. As flexor tendon are smaller in size, the repair or reconstruction technique along with rehabilitation becomes very challenging. We report a technical challenge in chronic zone 2 flexor tendon reconstruction in toddler presented two month post accidental glass cut injury. Case presentation: An 18-month-old male toddler presented with inability to flex left little finger after twomonths post accidental glass cut injury proximal to proximal interphalangeal (PIP) joint in zone two of left index finger. The passive range of motion (RoM) of DIP was zero degree to 60 degrees and PIP joint RoM was zero to 95 degrees. Child was unable to do active flexion of PIP and DIP joint movement. The parents of child were counselled for exploration and staged reconstruction of flexor digitorum profundus (FDP) tendon using either flexor superficialis (FDS) slip or palmaris longus. One slip of FDS graft was harvested and utilised to reconstruct FDP. At two years follow up, the injured index finger was normal in cosmesis and function. The active DIP joint movement was 50 degrees with complete healing of surgical site. Conclusion: Zone two flexor tendon injury in toddlers needs thorough clinical judgement and assessment by ultrasonography to locate the cut ends of tendons. Reconstruction of pulley, FDP reconstruction using FDS slip and supervised rehabilitation is recommended surgical option to achieve excellent function.

Extension block pinning for mallet finger-A case series of 15 cases

Introduction: A mallet fracture is a bony mallet finger which happens due to avulsion fracture of dorsal base of distal phalynx. While multiple options like microscrew fixation, pullout sutures, tension band wiring are available for treatment of a mallet fracture, Ishiguro introduced the extension block pinning method which is very simple, easy to perform and gives good clinical outcome. Materials and Methods: 15 patients from year 2018 to 2020 with mallet fracture were operated using Extension block pinning. All the patients were followed up for a minimum of 4 months and results were evaluated using Crawford criteria. Results: Results were calculated at the end of 4 months. Ten patients had excellent results, 5 patients had good results. Conclusion: Extension block pinning is a easy to perform, effective option for acute mallet fracture and in our series we were able to achieve excellent results. Keywords : Mallet finger, Extension block pinning, Dorsal DIP joint crease.

Ultrasound in osteoarthritis of the hand: a comparison to computed tomography and histology.

To compare structural findings between US, micro-CT (µCT) and histology in people with OA of the hands. We analysed DIP and PIP joints of 31 fingers from 15 dissecting-room cadavers with OA of the hands. The occurrence of bone erosions and osteophytes were recorded by US, µCT and histology at 16 regions for each joint and compared for each method. In total, US (n = 558, 56.2% of 992 examined regions) and µCT (n = 493, 49.7%) detected a higher frequency of osteophytes at PIP and DIP joints than histology (n = 161, 23.4% of 689 histological examined regions; P = 0.01). We found a comparable number of erosions with each method [US, n = 52 (5.2%); µCT, n = 43 (4.3%); histology, n = 35 (5.2%)]. Both imaging techniques correlated moderately with each other regarding the detection of osteophytes (r = 0.54, P = 0.002) and erosions (r = 0.43, P = 0.017). Neither US nor µCT correlated with histology regarding erosions or osteophytes. With histology as the reference, US had a sensitivity of 80% and a specificity of 32% to detect osteophytes, whereas µCT had a sensitivity of 73% and a specificity of 27%. For erosions, sensitivities (US 10% and µCT 6%, respectively) were much lower. Microscopically, erosions contained fibrous myxoid tissue extending from subcortical cavities through the breach of cortical bone. The ability of US to identify osteophytes was comparable to that of µCT, yielding a good sensitivity when histology was used as the gold standard. The sensitivity of US and µCT to detecting erosions was low compared with histology.

Luxation ouverte de l’articulation inter-phalangienne distale : analyse de 20 cas

IntroductionSeveral isolated closed dislocations of the dorsal interphalangeal joint are reported, and sometimes they may be associated with other fractures/dislocations. Less is known about the open dorsal dislocation of the distal interphalangeal joint. HypothesisOpen dorsal dislocations are stable after reduction and prone to develop dorsal interphalangeal joint stiffness. MethodsTwenty patients with open dorsal dislocation were treated by open reduction and volar plate repair. The diagnosis was made, and the displacement was noted. Associated injuries, fractures, and dislocations were also reported. Postoperative x-rays, range of movements, visual analog score, return to work, and functional outcomes were analyzed. ResultsThe average follow-up was 23 months (range, 19–27 months). There were dorso-radial (n=13), dorsal (n=5) and dorso-ulnar (n=2) dislocations. Follow up with radiographs showed good reduction and congruent distal interphalangeal joint. The mean range of DIP joint movement was 53% (range, 40–65%) and grip strength 70% (range, 50–76%) of the opposite side. THE Median VAS score was 0.6 (range, 0–2). 17/20 patients who were operated on <8hours of injury had a significant impact on the functional outcome (p<0.05). Three patients who had treatment delay>8hours of injury developed significant postoperative joint stiffness. DiscussionAdequate debridement and an early open reduction of the dorsal interphalangeal joint dislocation produces stable and congruent joint with good functional outcome and early return to normal activities. Open dislocations do not behave like closed dislocations, and joint stiffness is more common and inevitable. Level of evidenceIV; retrospective case study.

Ultrasound findings of finger, wrist and knee joints in Mucopolysaccharidosis Type I

IntroductionMusculoskeletal findings in MPS can progress after enzyme replacement. Our aim was to examine synovial recesses, tendons, retinacula and pulleys using ultrasonography for structural and inflammatory changes. Material and methodsThe wrist, metacarpophalangeal (MCP), proximal and distal interphalangeal (PIP and DIP) joints, the finger flexor tendons and the knee including entheses of quadriceps and patella tendons were assessed clinically.Ultrasonography of the various synovial recesses of the wrist as well as the extensor retinaculum, carpal tunnel, MCP, PIP and DIP joints of the second finger, extensor and flexor tendons, A1-5 pulleys and the knee joint including relevant entheses followed. Significance of differences between patient values and available normative data were assessed using t-tests. ResultsUltrasonography showed significant abnormal intraarticular material in the wrist without a clear distribution to synovial recesses and without effusions. Doppler signals were found in a perisynovial distribution and not intrasynovial as expected in in inflammatory arthritis. Findings were similar in the knee but not the fingers. Flexor and extensor tendons were also mostly normal in their structure but significant thickening of retinaculae and the flexor tendon pulleys was seen (p<0.0001 compared to normal). ConclusionMPS I patients showed intraarticular deposition of abnormal material in the wrist and knee but not in the finger joints where significant thickening of retinaculae/pulleys controlling tendon position was dominant. No ultrasound findings of inflammatory pathology were demonstrated but rather a secondary reaction to abnormal deposition and direct damage of GAG.

Spiral Oblique Retinacular Ligament Procedure Using Flexor Digitorum Profundus Hemi-Tendon Transfer: Anatomical Basis and Clinical Application

The spiral oblique retinacular ligament (SORL) procedure acts as a dynamic tenodesis to restore distal interphalangeal joint (DIP) extension and restrain proximal interphalangeal hyperextension. Despite the ingenious technique based on the oblique retinacular ligament anatomy, obtaining strong internal fixation remains an issue during the SORL procedure. We present a modified technique using the flexor digitorum profundus (FDP) hemi-tendon transfer. We dissected 5 fresh cadaveric specimens to evaluate morphometric parameters of the SORL procedure using the hemi-FDP. The volar groove of the FDP tendon was identified in zone I of the flexor sheath and the tendon was divided into radial and ulnar bundles. The selected hemi-tendon was divided at the proximal edge of the A1 pulley and a SORL procedure was performed through a transosseous tunnel in the distal phalanx. This technique was used in 3 patients with swan neck deformity. The optimal distance between the DIP joint and the anterior drill hole of the transosseous tunnel was 7.6 mm (range, 6.8-8.5 mm). The relative loss of length of the tendon owing to the SORL path was 25.8 mm (range, 19.6-29.9 mm). In the clinical cases, the procedure improved DIP joint extension lag and prevented proximal interphalangeal joint hyperextension. Preserving one-half of the FDP allowed complete flexion of the DIP joint. The procedure is technically feasible. Its main advantages are that a distal suture is not required and that the substantial length of the tendon allows sturdy proximal internal fixation. Therapeutic V.

Ultrasound, magnetic resonance imaging and radiography of the finger joints in psoriatic arthritis patients.

To report the discrepancies and agreements between US, MRI and radiography of the hand in PsA, and to compare the sensitivity and specificity of US and radiography to MRI as the gold standard imaging study in PsA. All of the 100 prospectively recruited consecutive PsA patients underwent clinical assessment and concomitant radiographic, US and MRI studies of the MCP, PIP and DIP joints of one hand. Synovitis, flexor tenosynovitis, extensor paratenonitis, erosions and bone proliferations were identified and scored. All readers were blinded to clinical data, and agreement was calculated based on prevalence-adjusted bias-adjusted kappa (PABAK). The prevalence of synovitis, flexor tenosynovitis, extensor paratenonitis and erosions was similar for US and MRI, while that of bone proliferation was significantly increased in US and radiography compared with MRI (P < 0.001). The absolute agreement between US and MRI was good-to-very good for synovitis (85-96%, PABAK = 0.70-0.92), flexor tenosynovitis (93-98%, PABAK = 0.87-0.96) and extensor paratenonitis (95-98%, PABAK = 0.90-0.97). Agreement between US, MRI and radiography was 96-98% (PABAK = 0.92-0.97) for erosions and 71-93% (PABAK = 0.47-0.87) for bone proliferations. Sensitivity of US with MRI as gold standard was higher for synovitis (0.5-0.86) and extensor paratenonitis (0.63-0.85) than for flexor tenosynovitis (0.1-0.75), while the specificity was high for each pathology (0.89-0.98). There is very good agreement between US and MRI for the detection of inflammatory changes in finger joints in PsA. US, radiography and MRI have a good-to-very good agreement for destructive changes.

Gyroscope Sensor Based In Vivo Finger Axes of Rotation Identification Using Screw Displacement.

This paper presents a low-cost, efficient, and portable in vivo method for identifying axes of rotation of the proximal interphalangeal and distal interphalangeal joints in an index finger. The approach is associated with the screw displacement representation of rigid body motion. Using the matrix exponential method, a detailed derivation of general spatial displacement of a rigid body in the form of screw displacement including the Rodrigues' formulae for rotation is presented. Then, based on a gyroscope sensor, a test framework for determining axes of rotation of finger joints is established, and experiments on finding the directions of joint axes of the PIP and DIP joints are conducted. The results obtained highly agree with those presented in literature through traditional but complex methods.

Open dorsal distal interphalangeal joint dislocations: A report of 20 cases

IntroductionSeveral isolated closed dislocations of the dorsal interphalangeal joint are reported, and sometimes they may be associated with other fractures/dislocations. Less is known about the open dorsal dislocation of the distal interphalangeal joint. HypothesisOpen dorsal dislocations are stable after reduction and prone to develop dorsal interphalangeal joint stiffness. MethodsTwenty patients with open dorsal dislocation were treated by open reduction and volar plate repair. The diagnosis was made, and the displacement was noted. Associated injuries, fractures, and dislocations were also reported. Postoperative x-rays, range of movements, visual analog score, return to work, and functional outcomes were analyzed. ResultsThe average follow-up was 23months (range: 19–27months). There were dorso-radial (n=13), dorsal (n=5) and dorso-ulnar (n=2) dislocations. Follow-up with radiographs showed good reduction and congruent distal interphalangeal joint. The mean range of DIP joint movement was 53% (range: 40–65%) and grip strength 70% (range: 50–76%) of the opposite side. The Median VAS score was 0.6 (range: 0–2). Seventeen out of 20 patients who were operated on<8hours of injury had a significant impact on the functional outcome (p<0.05). Three patients who had treatment delay>8hours of injury developed significant postoperative joint stiffness. DiscussionAdequate debridement and an early open reduction of the dorsal interphalangeal joint dislocation produces stable and congruent joint with good functional outcome and early return to normal activities. Open dislocations do not behave like closed dislocations, and joint stiffness is more common and inevitable. Level of evidenceIV; retrospective case study.

Suzuki Frame Results in the Treatment of Comminuted Phalanx Fractures

Background: Comminuted fracture of the PIP joint is one of the most challenging fractures to be treated in hand surgery practice. The pins and rubber traction frame is an easy method to perform for these fractures. This study aimed to present the treatment stages of patients who had PIP joint fractures-dislocations with the pins and rubber traction frame and the functional results of patients.Methods: The results of eight patients with fracture-dislocations of the PIP joint between 2016 and 2019 were retrospectively analyzed. Age and gender of patients, time between trauma and surgery, postoperative follow-up periods, affected area on the joint surface, postoperative complications, range of motion of PIP and DIP joints, affected finger, and the causes of the trauma were recorded.Results: Five (62.5%) patients were male, and three (37.5%) patients were female in this study. The mean age of the patients was 28.50 ± 3.42 years. The mean range of motion of the PIP joint examined in the postoperative 12th month was 4.88° to 86.25°. In the same period, the mean range of motion of the DIP joint of the patients was 4.38° to 86.25°. We obtained union in all patients. Malunion or nonunion and osteomyelitis were not seen in any patients.Conclusions: The pins and rubber traction frame is a method that can be used safely and effectively in fractures of the phalanx joints that are difficult, comminuted, and involving the joint.

Clinical Test of a Wearable, High DOF, Spring Powered Hand Exoskeleton (HandSOME II).

In previous work, we developed an exoskeleton, Hand Spring Operated Movement Enhancer (HandSOME II), that allows movement at 15 hand degrees of freedom (DOF). Eleven separate elastic elements can be added to customize the extension assistance for individuals with impaired hand function. In this pilot study of twelve individuals with stroke, we measured the immediate improvements in range of motion (ROM) and upper extremity function when wearing the device. Index finger ROM was significantly improved at the PIP (p=.01) and DIP joints (p=.026), and the max extension was significantly increased at the MCP (p<.001), PIP (p=.013) and DIP joints (p=.016). The thumb CMC abduction max (p=.017) and CMC flexion/extension ROM also increased (p=.04). In a grip and release task involving various objects, six subjects were unable to complete the tasks without assistance. Across these 6 subjects, 13 of 42 tasks were completed without assistance, while 36 of 42 tasks were completed when wearing HandSOME II. Despite the extension assistance provided by the device, flexion grip force was not statistically decreased. HandSOME II can potentially increase the effectiveness of repetitive task practice in patients with moderate-severe hand impairment by allowing completion of grasp and release tasks that are impossible to complete unassisted.

Anatomical analysis of inflammation in hand psoriatic arthritis by Dual-Energy CT Iodine Map

ObjectiveThis study aimed to identify the detailed location of inflammatory lesions and its frequency of hand PsA on DECT Iodine Map with referring the cadaveric specimen. Materials and methodsThirty-eight anatomical landmarks were selected as a potential inflammatory sites in the thumb and middle finger. We included 22 symptomatic PsA patients who underwent contrast enhanced DECT of the hand. MR images and macroscopic specimens of thumb and middle finger were prepared from a cadaver. Two musculoskeletal radiologists evaluated DECT with referring the cadaveric images to determine the precise location of inflammatory sites and its frequency. ResultsThe frequently observed inflammation sites of active PsA patients were either classical or functional entheses, and coincide with the well-known hypothesis that primary inflammatory sites of PsA are enthesis. We have noticed that there was remarkable enhancement around DIP joints (13.6 %–45.5 %). ConclusionDECT could assess the detailed anatomical sites of the inflammatory lesion in hand psoriatic arthritis, which coincided with enthesis.

The "Horse Saddle" Sign: A New Ultrasound Sign for Osteoarthritis

Objective: To assess the sensitivity and specificity of the “horse saddle” sign in the diagnosis of osteoarthritis Methods: An exploratory clinical comparative cross-sectional study where an ultrasound of the hands and comparative radiographs in PA view were performed on patients with osteoarthritis, inflammatory arthritis and healthy patients seen in the Rheumatology clinic of the Vall de Hebron Hospital. Age, sex and time of evolution of the disease were collected as clinical variables. The MCP, PIP and DIP joints from the second to the fifth finger of both hands were viewed with grayscale in longitudinal and transverse plane of both the dorsal and palmar face, assessing for osteophytes, synovitis and the horse saddle sign. Results: A total of 38 patients with osteoarthritis, 20 patients with inflammatory arthritis (8 psoriatic, 9 RA, 1 LES, 1 PMR and 1 Sjogren) and 2 healthy patients were assessed. It was found that the horse saddle sign had a sensitivity of 66.7% and specificity of 86.4% in osteoarthritis showing a p-value of 0.052 by means of the chi-square test. 87% of patients with the horse saddle sign had osteoarthritis and only in 2 patients with RA and in the patient with LES. Conclusion: The horse saddle sign is an ultrasound sign with good sensitivity and specificity for the diagnosis of hand osteoarthritis comparable to other classic ultrasound signs such as osteophytes and synovitis.

Digit Necrosis After Hand Surgery in Pregnancy: A Case Report

Digital blocks are routinely used for excision of lesions. We describe a unique presentation of digit necrosis after excisional biopsy with digital block and finger tourniquet in a pregnant patient with a history of ulcerative colitis. The patient had a history of a long-standing painful dorsal PIP joint mass and was scheduled for excision under local anaesthetic. On the day of the procedure, she disclosed that she was pregnant in the second trimester. After extensive discussion of risks and benefits between the patient and the surgeon, the decision was made to proceed with an excisional biopsy of the lesion because of its impact on her quality of life. Twelve hours after the procedure, she presented to the emergency department with blistering and severe pain to the digit. Doppler ultrasound showed flow through both digital arteries and the digit appeared viable. Over the coming days her pain continued to worsen and on post-operative day 3, she was admitted to hospital for attempted salvage of the digit using conservative methods. Her digit went on to demarcate at the level of the middle phalanx. Five weeks after her initial procedure, the patient underwent partial amputation of the small finger at the level of the DIP joint and 2-stage groin flap for soft tissue coverage. We discuss the effects of pregnancy and ulcerative colitis on thromboembolic events, and review the literature on digital blocks, digital tourniquet use and management of early digit necrosis. This case highlights the importance of delaying elective hand procedures in pregnant patients, especially if they have additional comorbidities such as pro-thrombotic diseases like inflammatory bowel disease.

Triple Open Dislocation in the Index Finger of the Hand Without a High-Energy Trauma

AbstractA simultaneous double dislocation (both proximal [PIP] and distal [DIP] interphalangeal joints) of a triphalangeal finger is a rare entity. The most common hand affected is the right hand. In the case of a closed triple dislocation (metacarpophalangeal [MCP], PIP and DIP joints); there are only two cases in the literature revised. In this case, we report an open triple dislocation in the index finger of the left-hand of a 54-year-old man treated by closed reduction and 3 weeks of immobilization followed by active mobilization with satisfactory results. Level of evidence 3