Phalanges Research Articles

Hourglass-like fascicular constriction of the median nerve: case series

Background. The anterior interosseus nerve (AIN) syndrome is a rare pathology, with cause is discussed. The findings in isolated AIN patients are in the main trunk of median nerve. It is confirmed by neuroimaging data and intraoperative picture in the form of the construction of fascicles in the nerve.Aim. To describe the clinical and instrumental characteristics of patients with isolated non-traumatic lesion of AIN.Materials and methods. The clinical, electrophysiological and neuroimaging data of 7 patients with isolated nontraumatic lesion of AIN were retrospectively analyzed, three of whom underwent surgical treatment.Results. All patients complained of neuropathic pain in the affected upper limb, with an average intensity of 8 points according to visual analog scale and a duration of 1.5 to 4 weeks. Weakness of the flexor pollicis longus from 1 to 3 points on the MRC (Medical Research Council Weakness) scale was observed in all cases, weakness of flexion of the distal phalanx of the index finger in 6 patients from 1 to 3 points, which indicated an isolated lesion of the anterior interosseous nerve.Needle electromyogram revealed denervation in c in all cases, 5 patients – in the pronator teres.The fascicular constriction from 1 or 2 sections of the median nerve were detected at the shoulder level on the affected side by ultrasound in 6 patients. An increase in the cross-sectional area of the median nerve at the shoulder level in 2 cases we observed, in one case the changes were o bilateral and asymmetric. In 2 cases, an increase in cross-sectional area of С5 root was noted on the affected side by no more than 23 % of the normal value. A change in echogenicity and size decrease of the pronator quadratus, when compared with the opposite side, was noted in all cases.Conclusion. Patients with isolated AIN syndrome needs intensive evaluation to identify the localization of the level of damage to the median nerve.

A probable case of an "Hourglass" epidermoid cyst located in the posterior fossa in an individual from Ibi, Alicante, Spain (12th-13th centuries AD).

Epidermoid bone cysts are rare, unilocular, and slow growing. They develop by the accumulation of ectodermal remnants, and they may be congenital or acquired. The most common locations for these bone cysts are the distal phalanges, followed by the skull. This paper documents an adult male from the Islamic (twelfth and thirteen centuries CE) burial site of Ibi in the Province of Alicante, southeast Spain. This individual had a cranial lesion in the form of a roughly elliptical hole in the posterior fossa (left occipital region). The lesion was examined macroscopically and using X-ray photography. Based on the shape of the lesion, the most likely diagnosis would appear to be a benign tumour, a so-called "hourglass" epidermoid cyst. No direct link between this tumour and the cause of death can be established.

Ultrasonographic Diagnosis of Finger Flexor Tendon Hypoplasia in a Child with Phalangeal Agenesis

Agenesis and hypoplasia affecting multiple flexor tendons within the same hand represent an exceedingly uncommon occurrence, with no previous studies addressing this condition. This report details a 4-year-old girl with agenesis of the right third and fourth fingers, who sought consultation due to the inability to flex her seemingly unaffected second and fifth fingers. Ultrasound examination revealed substantial thinning of the flexor tendons in the second to fifth digits, with a notable absence of attachment to the middle phalanx. In addition to flexor tendon hypoplasia, hypoplasia of the third and fourth middle phalanges was observed. Hand deformities featuring both finger agenesis and flexor tendon hypoplasia across multiple fingers were exceptionally rare. In such instances, ultrasound, in conjunction with radiography, emerges as the recommended initial imaging tool for comprehensive evaluation of both the phalangeal bones and flexor tendons.

Upper Extremity Fractures in the Emergency Department: A Database Analysis of National Trends in the United States.

Upper extremity (UE) fractures are a common reason for emergency department (ED) visits, but recent data on their epidemiology are lacking. This study aimed to describe the incidence, demographics, patient characteristics, and associated health care factors of UE fractures, hypothesizing that they would remain prevalent in the ED setting. Using the Nationwide ED Sample database, patients presenting to the ED with UE fractures in 2016 were identified, and population estimates were used to calculate incidence rates. Data on insurance status, trauma designation, cost, and teaching status were analyzed. The study identified 2 118 568 patients with UE fractures, representing 1.5% of all ED visits in 2016. Men accounted for 54.2% of UE fractures, with phalangeal fractures being most common. Distal radius and/or ulna fractures were most common in women (30.4%). The greatest proportion of UE fractures (23.2%) occurred in patients aged 5 to 14 years (1195.5 per 100 000). Nontrauma centers were the most common treating institutions (50.4%), followed by level I (19.5%), II (15.3%), and III (12.8%) centers. The greatest proportion of fractures (38.3%) occurred in the southern United States. Emergency department cost of treatment was almost 2-fold in patients with open UE fractures compared with closed. This study provides important epidemiological information on UE fractures in 2016. The incidence rate of UE fractures in the ED has remained high, with most occurring in the distal radius, phalanges, and clavicle. In addition, UE fractures were most common in younger patients, men, and those in the southern United States during the summer. These findings can be useful for health care providers and policymakers when evaluating and treating patients with UE fractures.

Shape and Size Variations of Distal Phalanges in Cattle.

Studies on the structure of the distal phalanx help explain the development of laminitis. Additionally, examining the structure of the distal phalanx from a taxonomic perspective also contributes to veterinary anatomy. In this study, we examined shape variation in the medial and lateral distal phalanx of both fore- and hindlimbs using the geometric morphometry method. We investigated whether the shape of the distal phalanx differed between phalanx positions and how much of the shape variation in this bone depends on size. For this purpose, distal phalanges from 20 Holstein cattle were used, and the bones were digitized in 3D. A draft containing 176 semi-landmarks was prepared for shape analysis, and this draft was applied to all samples using automated landmarking through point cloud alignment and correspondence analysis. A principal component analysis was performed to obtain general patterns of morphological variation. The centroid size (CS) was employed as an approximation of size. Although distal phalanx groups generally showed close variations, PC1 statistically separated the hindlimb lateral distal phalanx (HL) and the forelimb medial distal phalanx (FM) from each other in shape. While PC2 separated HL from other distal phalanx groups, PC3 separated fore- and hindlimb groups. The shape (Procrustes distance) of the hindlimb medial distal phalanx (HM) is markedly less variable than the other three phalanges. The smallest distal phalanx in size was HL. For both forelimb and hindlimb, the medial distal phalanges were larger than the lateral ones. Size (CS) was found to have an effect on PC1 and PC3. In this study, a reference model of the same breeds for distal phalanx was created. These results can provide useful information, especially in terms of veterinary anatomy, zooarchaeology, and paleontology.

Study of the process of formation of a unique congenital polydactyly in mini-pigs

The formation of a unique anomaly of the structure of the distal extremities – polydactyly in mini-pigs of the selection of the Institute of Cytology and Genetics (ICiG) SB RAS was studied. The genealogy of two looked animals with polydactyly (six–toed on the fore and hind limbs) - a black boar and a white pig, demonstrated the hereditary nature of the manifestation of this anomaly, differing depending on the method of breeding in several generations, is analysed. Anatomisation of distal fragments of the limbs of these two pigs culled at the age of 15-16 months showed the formation of differentiation of trophic structures of blood supply to the accessory fingers and tendon-ligamentous apparatus, including ligaments of the finger-lift muscle. The prepared samples were processed for histological staining and microscopy, which showed the interior features of the formation of connective and bone tissues of the phalanges of additional fingers on the fore and hind limbs, characteristic of each studied animal. The results are discussed in connection with topical issues of veterinary pathogenetics of farm animals and the context of the interest of classical and modern biology in polydactyly.

A soft magnetoelectric finger for robots’ multidirectional tactile perception in non-visual recognition environments

Robotic fingers with multidirectional tactile perception are of great importance for the robotic exploration of complex unknown space, especially in environments in which visualization is not possible. Unfortunately, most existing tactile sensors for robotic fingers cannot detect multidirectional forces, which greatly limits their potential for further development in navigating complex environments. Here, we demonstrate a soft magnetoelectric finger (SMF) that can achieve self-generated-signal and multidirectional tactile sensing. The SMF is composed of two parts: a ‘finger’ covered with a skin-like flexible sheath containing five liquid metal (LM) coils and a ‘phalangeal bone’ containing a magnet. Due to the changes in magnetic flux through the LM coils caused by external forces, diverse induced voltages are generated and collected in real-time, which can be explained by Maxwell’s numerical simulation. By the analysis of the signals generated by the five LM coils, the SMF can detect forces in varied directions and distinguish 6 different common objects with varied Young’s moduli with an accuracy of 97.46%. These capabilities make the SMF suitable for complex unknown space exploration tasks, as proved by the black box exploration. The SMF can enable the development of self-generated-signal and multidirectional tactile perception for future robots.

Post-mortem feasibility of dual-energy computed tomography in the detection of bone edema-like lesions in the equine foot: a proof of concept.

In this proof-of-concept study, the post-mortem feasibility of dual-energy computed tomography (DECT) in the detection of bone edema-like lesions in the equine foot is described in agreement with the gold standard imaging technique, which is magnetic resonance imaging (MRI). A total of five equine cadaver feet were studied, of which two were pathological and three were within normal limits and served as references. A low-field MRI of each foot was performed, followed by a DECT acquisition. Multiplanar reformations of DECT virtual non-calcium images were compared with MRI for the detection of bone edema-like lesions. A gross post-mortem was performed, and histopathologic samples were obtained of the navicular and/or distal phalanx of the two feet selected based on pathology and one reference foot. On DECT virtual non-calcium imaging, the two pathological feet showed diffuse increased attenuation corresponding with bone edema-like lesions, whereas the three reference feet were considered normal. These findings were in agreement with the findings on the MRI. Histopathology of the two pathologic feet showed abnormalities in line with bone edema-like lesions. Histopathology of the reference foot was normal. DECT virtual non-calcium imaging can be a valuable diagnostic tool in the diagnosis of bone edema-like lesions in the equine foot. Further examination of DECT in equine diagnostic imaging is warranted in a larger cohort, different locations, and alive animals.

Radiographic assessment of normal parameters of forelimb distal phalanx in Turkmen horses.

The Turkmen horse is one of the oldest breeds in the world with unique characteristics in agility, endurance and jump, being publicly acclaimed. Laminitis affects the limbs and decreases athletic performance. Radiographic evaluation is essential to confirm the sinking diagnosis in every breed of a horse suffering from laminitis. Since no information about distal phalanx radiographic measurements in this breed has been reported, the current study was designed and conducted. In the present study, 24 clinically sound registered Turkmen horses of both sexes (15 mares and nine stallions) were selected. Lateromedial radiographic views of both front distal phalanges were taken, focusing on the distal phalanx. After magnification correction, images were used to measure founder distances (FD) and other distal phalanx radiographic measurements using an image processing program. There was no significant difference between radiographic measurements of the left and right front feet. The FD had a significant positive correlation with weight. The horses under 3 years of age had a significantly greater U angle than the horses over the age of three. Also, palmarocortical length (PCL) in the Turkmen stallions was significantly higher than mares. In this investigation, PCL in horses under the age of three was significantly lower than horses over 3 years of age. The values determined in this study can be used as baseline data of front feet in Turkmen horses.

Bilateral Upper Limb Congenital Anomalies in a Neonate: A Case Report

Congenital anomalies are diverse in nature and can affect multiple organ systems, posing significant diagnostic and management challenges. Among these, nubbins, characterised by the absence or underdevelopment of distal terminal phalanges, present a rare clinical finding. The present case report discusses a neonate born via normal vaginal delivery who demonstrated immediate cries upon birth. The patient’s clinical presentation led to a series of diagnostic investigations. The absence of distal terminal phalanges in both hands was concerning; however, radiographs of the forearms showed normal structural findings. The detection of mild Developmental Dysplasia of the Hip (DDH) on hip Ultrasonography (USG) necessitated regular monitoring with USG and radiographs of both hips to ensure proper hip joint development. The USG of the spine revealed no anomalies, which was reassuring. The most significant finding came from the Echocardiogram (ECHO), which identified a small ostium secundum Atrial Septal Defect (ASD) with mild tricuspid regurgitation and pulmonary hypertension. The present case underscores the importance of ongoing research and collaboration in advancing our understanding and management of rare congenital anomalies.

Prolonged Union in Conservative Treatment of Symphalangeal Toe Fractures: Case Series.

Toe symphalangism is characterized by a fusion of the interphalangeal joint between the middle and distal phalanges. While typical lesser toe fractures heal well with conservative treatment, in our clinical experience, we encountered patients with symphalangeal toe fractures who experienced long-lasting pain and delayed radiographic union. Therefore, this study aimed to report radiographic outcomes following conservative treatment of symphalangeal fractures of the lesser toes. We retrospectively reviewed 14 patients with symphalangeal lesser toe fractures who were treated conservatively. We investigated the mechanism of injury and measured the time from the initial injury date to the complete radiographic union. The fracture gap distance was measured on an initial lateral radiograph. Symphalangeal fractures involved the fourth toe in 4 patients (28.5%) and the fifth toe in 10 patients (71.4%). Regarding the mechanism of injury, 6 patients (42.9%) were injured by stubbing or bumping into the door, 5 patients (35.7%) were injured by tripping, 2 patients (14.3%) were injured by heavy objects falling directly on their toes, and 1 patient (2.3%) complained of pain after wearing pointed shoes for half a day. The mean time to complete union was 9.1 months, and the median period was 5.5 months (range, 0.8-29 months). The initial gap of the fracture was 0.60 mm (range, 0.30-1.04 mm). The results of our case series may help counsel patients in the outpatient clinic that prolonged healing time may be required for the union of symphalangeal toe fractures.

ТРАВМА НОГТЕВОГО КОМПЛЕКСА: СОВРЕМЕННЫЙ ВЗГЛЯД НА ПРОБЛЕМУ ОКАЗАНИЯ МЕДИЦИНСКОЙ ПОМОЩИ

Despite the fact that the first decade of the XXI century was proclaimed by the World Health Organization as the decade of bone and joint treatment, defining the prevention and treatment of limb injuries as one of the five priority problems of musculoskeletal diseases, there is still no developed generally accepted algorithm for the management of patients with nail phalanx injuries, and the opinions of specialists are often diametrically divergent. Trauma to the distal phalanx of the fingers is one of the most common hand injuries in patients seeking emergency medical care, regardless of gender, age, or occupation. The consequences of nail phalangeal injuries worsen the aesthetic appearance of the hand, reduce the ability to work, and sometimes may even lead to a change in the patients' occupation. When nail complex trauma is combined with a distal phalanx fracture, it is necessary not only to restore the integrity of the nail bed, but also to stabilize the bone fragments. An important point in such situations is the use of a nail plate to temporarily cover the restored nail bed. Firstly, it serves as a stabilizing element for the reponated phalangeal fragments. Secondly, its use leads to a decrease in the percentage of scar formation in the nail bed. During the study, in 39 (37 patients, 80.4%) cases we found an excellent, in 7 (3 patients, 6.5%) – good and in 8 (6 patients, 13.1%) – satisfactory result of treatment. As a result of our study, we have proved that temporary covering of the nail bed with a utilized nail plate or artificial nail plate graft: a) reduces pain during the subsequent stage dressings at the outpatient stage; b) promotes normal growth of a new nail plate; c) accelerates the healing process, as traumatization of the nail bed is minimized; d) the nail plate acts as a natural splint, due to which, in most cases, no additional external fixation is required.

Changes in aspects of hoof and distal limb conformation in foals by radiographic evaluation.

This study investigated age-related radiographic changes in the distal parts of the forelimbs by radiographic evaluation and identified the radiographic changes associated with diseases specific to foals. The hoof angle (HA), distal phalanx angle (P3A), distal phalanx palmer angle (P3PA), distal interphalangeal joint angle (DIPJA), and metacarpophalangeal joint angle (MPJA) on lateromedial radiographs of forelimbs were measured on the day after birth (Day 1); at 1, 2, 4, 6, and 8 weeks of age; and then at monthly intervals until 12 months of age. HA and P3A significantly increased from 1 day to 4 weeks and 4 weeks to 3 months of age. The P3PA increased dramatically from 1 day to 1 week, 1 week to 2 weeks, and 2 weeks to 8 weeks of age, and then decreased after 3 months of age. DIPJA significantly decreased from 1 day to 2 weeks of age before increasing from 3 to 5 months of age. MPJA increased with age until 4 weeks, slightly decreased from 2 to 4 months of age, and then gradually decreased from 4 to 6 months of age. The findings indicate that foals' forelimbs typically show flexion of the fetlock and a broken backward hoof-pastern axis just after birth, an upright fetlock until 4 months of age, and a change to a mature conformation after 6 months of age. Physiological variants were correlated with the occurrence of common foal diseases during the radiographic evaluation periods.

Customizable Hyperextension Splint for Mallet Finger.

Mallet finger is a common deformity occurring due to the traumatic detachment of the extensor tendon at its insertion in the distal phalanx. Despite several different methods of splinting being available, residual extensor lag remains one of the most common complications of conservative treatment. We demonstrate a novel technique to make a hyperextension splint which can be customized as per the individual. The pictorial demonstration depicts every step in the preparation, application, and maintenance of the splint. We believe that the use of such easily accessible materials and visual demonstration of each step, with pointers along the way to verify the correct technique, will empower any medical professional, to satisfactorily treat such injuries at the primary point of contact, without necessitating the services of a hand surgeon.

Choithram’s Modified Hanging Limb Preparation for Limb Surgeries

Abstract In an extensive lower limb burn surgery, where we need to operate circumferentially, we need to have a hanging limb preparation to have exposure to all sides of the leg. Here, we describe a modified method of limb holding described by authors from a paper published by Farroha et al. in EJPS, 2013. In our setup, we hang the lower limb using sharp towel clips, fixed to the patient’s great toe at distal phalanx (DP). These towel clips are elevated by a sterile bandage to the hook of intravenous stand, which is stabilized using weights on the other end. We are using this method for lower limb burn surgery to perform tangential excision or debridement and skin graft application/harvesting. There is no potential or residual damage to the great toe, nail, or bone of the DP. This method is very convenient, easy 360° access to operate, most impressive, needs lesser assistance and workforce and decreases chances of contamination.

ИССЛЕДОВАНИЕ МИКРОЦИРКУЛЯЦИИ КРОВИ В УСЛОВИЯХ НЕВЕСОМОСТИ С ПОМОЩЬЮ ПОРТАТИВНЫХ ЛАЗЕРНЫХ ДОПЛЕРОВСКИХ ФЛОУМЕТРОВ

The paper reports the results of blood microcirculation studies in microgravity using portable laser analyzer LAZMAPF. Two cosmonauts (C-1 and C-2) performed pre-launch and in-flight (9 days) 8-minute sessions with the use of 2 portable flowmeters symmetrically attached to the temporal skin, palmer sides of distal phalanxes III, forearm superficies and planter surfaces of toe distal phalanxes I. In C-1, mean perfusion rate in toes decreased more than in half due to blood redistribution toward the upper body on the first two days in orbit and then, by way of adaptation, regained normal mean values. In C-2, compression of the proximal regions of lower extremities to induce blood deposition caused high-amplitude NO-dependent oscillations at about 1/min. On the background of adaptation during flight days 2–3, high-amplitude endothelial vasomotions in C-1 (one oscillation every 3–4 minutes) can be associated with an endothelial hyperpolarizing factor. In whole, on flight days 2–3 adaptation of the microcirculation system, particularly pronounced in the temporal and planter tissues, was characterized by a significant reduction of perfusion and increased vascular tone. Baseline prelaunch values were regained by flight day 6. For the first time, a research technique was proposed under microgravity conditions and data were obtained on the state of blood microcirculation of astronauts during the period of acute adaptation to microgravity conditions and readaptation after flight completion.

Finger Bone by Hiroki Takahashi (review)

Finger Bone by Hiroki Takahashi (review)

Morphometrical and radiographical studies on phalangeal region bones of beetal goats

Morphometrical and radiographical studies on phalangeal region bones of beetal goats

Nail bed trauma reconstruction and artificial nail replacement - a case report.

Nail bed reconstruction is crucial after fingertip trauma, impacting both function and aesthetics. In this article, the authors describe a case of partial distal phalanx amputation of the index finger with laceration of the nail bed's remaining part. A traumatically elevated skin-fat flap covered the exposed bone on the fingertip, preserving finger length and sensitivity on the radial side. A full-thickness skin graft from the forearm closed a secondary defect on the finger pulp. Nail bed suturing prevented scarring and nail deformity, and a temporary artificial plastic nail replacement maintained the nail bed's shape. Temporary artificial nail replacements protect the regenerating fingertip bed, promote healing, and prevent nail deformities. Proper adaptation of lacerated nail bed edges, supported by either the patient's own nail or a temporary artificial nail, is crucial for optimal fingertip restoration, including proper nail shape.

Uloga šake i nastanak invalidnosti kao posledice povrede na radu

The paper describes a patient who sustained an injury while working as a bookbinder, resulting in the replantation of the second, third and fourth fingers and the re-amputation of the thumb and fifth finger of the left hand, as well as skin grafting for the distal phalanges of the third and fourth fingers of the right hand. At the time of the injury, the patient was on probation with the employer and did not have the status of an insured person with the right to compulsory social insurance based on employment (employee). Due to this, the Injury Report was not completed, and the injury was not recognized as a workplace injury, which prevented the patient from obtaining their rights under compulsory social insurance. The human hand is one of the most powerful tools for achieving the sense of touch, gesticulation, and other various demands, thus playing an extremely important role in life. Thumb injuries can impair overall hand function by 40-50%. For this reason, there has been a need to develop modern technologies for reconstructing amputations over time. In the mid-20th century, microsurgical techniques for toe-to-thumb transfers gained clinical importance and remain one of the most significant approaches to thumb reconstruction. Due to the reduction in work and life activities and to facilitate employment, the patient was referred to the Pension and Disability Insurance Fund Commission at the National Employment Service to obtain the status of a person with a disability.