Finger Deformity Research Articles

Produced Body Customized 3D Print Finger Brace using Dicom File

We obtained a Dicom file using a CT (Computed Tomography), a diagnostic test device used in clinical practice. Dicom files and 3D programs, and finger printers with 3D printers. Because the finger brace is intended for the human body, the accuracy of the shape is very important. 3D Print has the advantage of high precision, variety of materials, and short output time. In clinic, aluminum protector or medical device manufacturer's finger protector is limited. By creating a finger brace with a 3D printer, we expect to be able to apply a precise form of a custom finger brace to the patient that can be used to treat a patient's finger trauma, illness, or deformity.

Treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with Endobutton CL BTB

Objective Purpose To introduce the treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with endobutton CL bone-tendon-bone (BTB), and discuss its clinical effects. Methods From January 2010 to August 2013, 21patients (male 15, female 6) with mallet finger deformity were retrospectively studied. The average age of patients was 31.3±5.3 years. The time from injury to surgery was 5.2±2.1 d. Extensor tendons were ruptured at the terminal insertion in all patients, and there were no avulsion fracture at the base of the distal phalanx.. the terminal extensor tendon insertion Awere surgical reconstructed with Endobutton CL BTB, via a dorsal S-shaped incision of distal interphalangeal joint. Dorsal base of the distal phalanx was drilled a hole and then the tendon suture line with Endobutton CL BTBwas inserted from the ventral finger to the dorsal base of the phalanx to suture the proximal extensor tendon. The function of the affected finger was evaluated according to the Crawford standard after operation and follow-up: the active flexion and extension range of motion of each joint of the affected finger and the contralateral healthy finger were measured, and the total active ranges of motion of the finger were recorded. Finger function was evaluated according to the total active range of motion (TAM) system of the American Association of hand Surgeons. Results All 21 cases were followed up and the follow-up period was 8 to 24 months, with an average of 18.6±5.1 months. The operation time of the patients was 20-40 min, with an average of 29.6±10.3 min. The intraoperative blood loss was 5-10ml, with an average of 7.5±2.6 ml. Mallet finger deformities were all corrected postoperatively. One case presented with limited dorsal extension with elongation of -20°. According to the Crawford evaluation standard, there were 18 excellent patients and 2 good patients, with the excellent and good rate was 95.2% (20/21). The degrees of active joint activity were: 91°±7° of the metacar-pophalangeal joint, 92°±4° of the proximal interphalangeal joint, 82°±8° of the distal interphalangeal joint, and 259°±15° of total active activity. The TAMs of the healthy side were 259°±15°, and the TAMs of the affected side were 268°±12°, the difference was statistically significant (t=2.147, P=0.038). Accorrding to TAM system assessment criteria: excellent in 18 patients, good in 2 patients, and the excellent and good rate was 95.2% (20/21). One case presented with dorsal extension limitation, one case suffered from discomfort of grip because of scar in ventral side of the finger. The postoperative dorsal extension was limited in 3 cases, and the postoperative dorsal extension function was gradually restored 6 months later. Conclusion The treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with Endobutton CL BTB was effective and easy-operating. Postoperative patients can perform early finger function exercise, satisfactory results, worthy of clinical promotion and application. Key words: Hand deformities, acquired; Tendinopathy; Reconstructive surgical procedures; Treatment outcome

The Biomechanical Basis of the Claw Finger Deformity: A Computational Simulation Study

Claw finger deformity occurs during attempted finger extension in patients whose intrinsic finger muscles are weakened or paralyzed by neural impairments. The deformity is generally not acutely present after intrinsic muscle palsy. The delayed onset, with severity progressing over time, suggests soft tissue changes that affect the passive biomechanics of the hand exacerbate and advance the deformity. Clinical interventions may be more effective if such secondary biomechanical changes are effectively addressed. Using a computational model, we simulated these altered soft tissue biomechanical properties to quantify their effects on coordinated finger extension. To evaluate the effects of maladaptive changes in soft tissue biomechanical properties on the development and progression of the claw finger deformity after intrinsic muscle palsy, we completed 45 biomechanical simulations of cyclic index finger flexion and extension, varying the muscle excitation level, clinically relevant biomechanical factors, and wrist position. We evaluated to what extent (1) increased joint laxity, (2) decreased mechanical advantage of the extensors about the proximal interphalangeal joint, and (3) shortening of the flexor muscles contributed to the development of claw finger deformity in an intrinsic-minus hand model. Of the mechanisms studied, shortening (or contracture) of the extrinsic finger flexors was the factor most associated with the development of claw finger deformity in simulation. These simulations suggest that adaptive shortening of the extrinsic finger flexors is required for the development of claw finger deformity. Increased joint laxity and decreased extensor mechanical advantage only contributed to the severity of the deformity in simulations when shortening of the flexor muscles was present. In both the acute and chronic stages of intrinsic finger paralysis, maintaining extrinsic finger flexor length should be an area of focus in rehabilitation to prevent formation of the claw finger deformity and achieve optimal outcomes after surgical interventions.

Tendon Variations of the Flexor Digitorum Superficialis of the Little Finger in Cadaveric and Physical Examination Evaluations

IntroductionFlexor digitorum superficialis (FDS) is located in the intermediate layer of the forearm muscles. Typically, it consists of four tendons that enable the movement of the index, middle, ring and little finger. The tendon to the fifth digit is known to be greatly varied in both cadaveric and physical examination assessments. It has been reported to be absent or interconnected with the FDS tendon to the fourth digit, what might have an impact upon the hand‐grip strength. Some of the researchers state that absence of the FDS to the 5th digit does not impinge the finger's movement, whilst others maintain that absence of both the palmaris longus (PL) and the FDS to the little finger results in weaker response of the latter muscle. The FDS tendon can be used during the correction of the paralysis of the intrinsic muscles of the hand, e.g. in the claw finger deformity or radial/median nerve palsies.AimThis study aimed to present the up‐to‐date pooled prevalence estimate (PPE) of the presence or absence of the FDS tendon to the little finger, as well as its laterality, functional assessment during the physical examination, coexistence of its absence with the absence of the PL and probing for sources of heterogeneity.Materials and methodsA thorough search of the major medical online databases was conducted by the authors, who further enhanced it by checking the references of the primarily identified studies. The studies that met the inclusion criteria had their data extracted and analysed in this Meta‐analysis. The AQUA tool applied whilst evaluating the quality of the included studies.ResultsA total of 31 studies (13 538 hands) were assessed in this study. The overall PPE of the presence of the FDS tendon to the fifth digit was 92.7% (95% CI: 88.5–96.0), found slightly more often in cadaveric studies (97.7%, 95% CI:95.1–99.4) than in the physical examination (90.4% 95% CI: 84.9–94.8). It was the most commonly present in reports from Europe (94.6%, 95% CI: 82.9–100.0) and slightly more common amongst the male patients (90.8%, 95% CI: 79.5–98.2). In the functional assessment, the FDS to the little finger was predominantly independent (62.5%, 95% CI: 47.0–73.6), but the common function was also frequent (29.9%, 95% CI: 17.4–42.2). Both FDS and the PL were present in 81.0% (95% CI: 62.3–89.5), but the presence of of the FDS with the absence of the PL was also quite common (11.7%, 95% CI: 2.7–23.6).ConclusionsThis study showed that the FDS to the little finger is predominantly present. Notwithstanding, the common function was also very frequent (29.9%), what facilitates the need to be vigilant whilst evaluating clinically its function and not necessarily assuming the tendon's absence when a patient has troubles with flexing the proximal interphalangeal joint without the help from the flexor digitorum profundus.Support or Funding InformationThis study was supported by “The Best of the Best! 3.0 (Najlepszy z Najlepszych! 3.0)” Grant of the Polish Ministry of Science and Higher Education.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A Study of Variations in Radial Wrist Extensors

Abstract Background and Aim Supernumerary muscles and tendons from extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB) are sometimes encountered during hand surgery. They include accessory muscles like extensor carpi radialis intermedius (ECRI), intertendinous slips (ITS) between the two muscles, or simple birfurcated tendons. Awareness of these variations is crucial for preoperative planning for tendoplasty. This study was conducted with the aim of studying their prevalence since there is limited literature on its variations. Materials and Methods The study was carried out on 80 free upper limbs from the human cadavers, in the Anatomy Department of Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala. The radial carpal extensors were studied in detail. The length and width of the accessory muscles and tendons were measured. The percentage of different variations was also calculated. Results ITS from ECRL were seen in 20 of the limbs. ECRI was identified in 7 cases. Bifurcated tendon from ECRB was observed in two limbs. Absent ECRB was also noted in a specimen. In one specimen, ECRL and ECRB fused to form a single muscle and tendon, that later split into two for insertion into second and third metacarpal. The proximal attachment of both radial extensors was normal in all cases. Conclusion A total of 37.5% of variations was observed, among which supernumerary tendons accounted for 35%. Knowledge of these variations is essential in planning for tendon grafting and finger deformity correction surgeries.

Fowler Central Slip Tenotomy or Spiral Oblique Retinacular Ligament Reconstruction? A Cadaveric Biomechanical Study in Swan-Neck Deformity.

Background: The goal of this study is to biomechanically compare Fowler central slip tenotomy with spiral oblique retinacular ligament (SORL) reconstruction in correcting a chronic mallet deformity as part of a swan-neck deformity. Methods: We used 24 human cadaver fingers from 6 hands. Mallet finger and swan-neck deformities were created; then, Fowler tenotomy was done on one group including 3 hands with 12 fingers, and SORL reconstruction was done on the others. Results: During simulated finger extension, there was no significant difference between the 2 techniques in correcting the distal interphalangeal joint droop; however, Fowler tenotomy resulted in hyperflexion of the proximal interphalangeal (PIP) joint, whereas it remained straight after SORL reconstruction. Conclusions: This study supports the SORL reconstruction in correcting a chronic mallet deformity, especially when there is a concomitant PIP hyperextension deformity, which lowers the risk of reversing the deformity after a Fowler procedure.

Effect of Ease of Use and Fallibility of Biometric Fingerprint Technology in Criminal Identification in Kenya

The aim of this study was to assess the factors influencing the use of Biometric Fingerprint Technology in criminal identification in Kenya. The specific objectives for the study were toassess the effect of Ease of use and fallibility of biometric fingerprint technology on Criminal Identification in Kenya. The study was grounded on probability theory and technology acceptance model. The study used a census. The study targeted140 fingerprint officers working at the National Registration Bureau at the Huduma Centers, National Registration Bureau headquarters, and Langata, Kariakor, Pumwani and Makadara stations. Primary data was collected using a self-administered semi-structured questionnaire. SPSS software version 22 was used to analyze the data. Descriptive and regression analysis were used. Multiplelinear regressions were used to examine the effect of the variables on criminal identification. All the statistical tests were carried out at 5% level of significance.Correlation results revealed that Ease of useand fallibility of BFTpositively and significantly influence criminal identification. Regression results showed that Ease of use of BFT positively and significantly influencesCriminal Identification (? = 0.296, Sig = 0.000). Moreover, regression results revealed that Fallibility of biometric fingerprint technology had a positive and significant influence on Criminal Identification (? = 0.226, Sig = 0.000).The study recommends the management of National Registration Bureau to ensure that their fingerprint officers capture quality level fingerprintimpressions during the registration process using BFT in order to ensure that individuals are accurately authenticated thereby preventing and detecting criminal activities.Othermeans identification such as DNA should be incorporated as a change in environmental conditions causes fingerprints to be unrecognizable and in cases of cuts or burns or extreme weight gain or loss, higher level of deformity of fingers.

FINGER STRESS FRACTURES IN YOUTH ELITE ROCK CLIMBERS

Background: With the inclusion of climbing in the 2020 Olympics, the number of adolescent competitors is on the rise. For the first time in competition history, the 2020 Olympic format requires every climber to compete in a combined format of all three disciplines: bouldering, sport climbing, and speed climbing. For speed climbing specifically, every competitor must compete on the International Federation of Sport Climbing (IFSC) speed wall. Epiphyseal stress fractures to the middle phalanx, also known as growth plate injuries, are almost exclusive to adolescent climbers, and the most common climbing injury in adolescent competitors. A2 pulley ruptures are the most common injury in skeletally mature climbers. There is a paucity of research on youth-specific climbing injuries and no previous research on perceptions of adolescent rock climbers about youth-specific climbing injuries. There is also no previous research that examines the correlation between epiphyseal stress fractures and speed climbing. Purpose: To examine the awareness, perceptions, and training practices of youth-specific climbing injuries and risk factors amongst elite, adolescent rock climbers. Methods: We surveyed elite adolescent rock climbers, ages 8-18, competing in the 2017 USA Climbing Sport and Speed National Championships. Subjects answered questions on their knowledge and awareness of the most common youth climbing injury and safe training practices. Chi Square, one-way ANOVAs, and Bonferroni post hoc tests identified misperceptions about youth climbing injuries and the safe age to start double dyno campusing, a climbing-specific training exercise. Risk ratios were used to make accuracy comparisons between adolescent competitors who self-reported as injury “informed” and “uninformed.” A Fisher’s Exact test was used to determine if training regularly on the IFSC speed wall correlated with self-reported stress fractures. Results: 267 climbers completed the survey (mean age =13.99±2.66 SD, 51.9% male, 48.1% female). The adult-specific A2 pulley injury was erroneously reported by the subjects to be the most common youth climbing injury, with an average ranking of 3.09±2.20 SD 95% confidence interval (CI) on a scale of 1 (most common) to 8 (least common). Growth plate injury to the finger ranked second most common, with an average ranking of 4.0±2.22. These rankings were significantly different (p<0.0001). Only 5.7% of climbers correctly reported the safe age to start double dyno campus board training, a risk factor for growth plate injuries. 48.9% of climbers reported they were aware of growth plate injuries to the finger; yet only 24.5% of these climbers correctly identified the injuries exclusively as stress fractures. 73.5% overall reported growth plate finger injuries to either be a type of A2 pulley injury or did not know. Growth plate injuries were significantly more common among adolescent climbers who trained regularly on the IFSC speed wall (Risk Ratio 1.34 – 13.94, p=0.02). Conclusion: Adolescent climbers are prone to characterizing skeletally immature climbing-specific injuries as A2 pulley injuries seen in skeletally mature climbers. Training regularly on the IFSC speed wall appears to be an additional risk factor for epiphyseal stress fractures. As climbing enters the 2020 Olympics, addressing misperceptions will help athletes, parents, and coaches understand the risk for stress fractures and guide adolescent climbers and parents to seek medical attention when appropriate. Educating youth, coaches, and parents about finger injuries may reduce the incidence of stress fractures and the potential for permanent finger deformity and loss of function. [Table: see text][Figure: see text][Table: see text][Figure: see text][Figure: see text]

Scar overlapping suture for treating chronic tendinous mallet finger in children

PurposeTo evaluate the effect of scar overlapping suture for treating chronic tendinous mallet finger deformity in children.MethodsSix patients younger than 18 years were investigated retrospectively. The active extensor lags of the distal interphalangeal joint (DIPJ) were all more than 40°, and the passive ranges of DIPJ motion were normal. They were all treated surgically by scar overlapping suture technique, featuring careful overlapping suture of the extensor scar and temporary transarticular Kirschner wire fixation of the DIPJ.ResultsAverage follow-up was 3.1 years (ranging from 2 to 5 years). All patients made significant improvement in DIPJ activity. Three patients achieved full active DIPJ extension, whereas one patient had a 10° extensor lag and two patients had 5° extensor lags. All patients achieved normal active flexion ranges and full passive motion ranges of DIPJ compared with their uninjured side. There was no bone dysplasia, pain, or deformity recurrence.ConclusionsScar overlapping suture for treating chronic tendinous mallet finger in children is safe and effective. According to the Crawford criteria, all patients were graded as excellent.

Occurrence of anti-CCP2 and RF isotypes and their relation to age and disease severity among Sudanese patients with rheumatoid arthritis

ObjectiveAnti-cyclic citrullinated peptide 2 antibodies (anti-CCP2) and rheumatoid factor (RF) in rheumatoid arthritis (RA) has been extensively assessed in industrialized countries. We investigated the diagnostic and prognostic impact of anti-CCP2 and RF isotypes in a Sudanese cross-sectional RA cohort.MethodsConsecutive RA patients (n = 281) diagnosed according to the 1987 ACR criteria were included 2008–2010. Anti-CCP2 and RF isotypes (IgA, IgM, and IgG) were measured by enzyme immunoassay in 262 patients, with reference intervals aligned to the same diagnostic specificity as for anti-CCP2 (97.6%) using national controls.ResultsIgA RF was the predominant RA-associated autoantibody (56%), followed by IgM RF and anti-CCP2 (both 52%) and IgG RF (49%). In receiver operator characteristic analysis, IgA RF also showed the largest area under the curve. Patients with IgG RF were younger and had 8 years lower median age of disease onset compared to antibody negative patients (p < 0.0001). IgG RF was the only marker associated with a high number of involved joints (p = 0.028), and together with anti-CCP2 were the strongest markers for finger deformities (p = 0.016 and p = 0.012), respectively. No statistical differences were found for disease duration, ESR and Hb levels, and occurrence of erosions/osteopenia for any of the investigated autoantibodies.ConclusionWhereas IgA RF showed the best diagnostic performance, IgG RF associated with low age of RA onset, high number of involved joints, and finger deformities. These findings indicate that RA-associated antibodies other than conventional IgM RF and anti-CCP2 might be informative in non-Caucasian RA populations.

Reducing Healthcare Costs in the Management of Pediatric Metacarpal Neck Fractures.

Background:We hypothesize that a quality improvement initiative utilizing a Velcro ulnar gutter brace over traditional casting will impart significant savings without compromising clinical outcomes in the management of small metacarpal neck fractures.Methods:Baseline data on number and treatment regimens of small metacarpal neck fractures were collected starting in October 2015. Velcro ulnar gutter braces were purchased for all orthopedic clinics in December 2016. Patients with <70 degrees of angulation and no rotational deformity of the small finger were eligible to have brace treatment without reduction of the fracture. Data were collected each month on several patients managed by Velcro ulnar gutter brace.Results:Three hundred twelve pediatric patients met nonoperative guidelines. Before the intervention, patients were casted and followed radiographically for a minimum of 2 orthopedic clinic visits—which total $916.25 in charges. From October 2015 to November 2016, we treated <1% (1/147) of patients with metacarpal neck fractures without casting. Following the implementation of interventions from December 2016 to January 2019, the percentage of patients treated without cast immobilization increased to 54.5% (90/165), with a process mean shift to >65%. These patients did not have a scheduled follow-up or further radiographic evaluation. In the first 26 months of implementation, this decreased healthcare expenditures by $261,846.Conclusions:A quality improvement initiative emphasizing Velcro ulnar gutter brace treatment for pediatric metacarpal neck fractures resulted in a shift away from cast immobilization in >65% of patients, reducing risks and expenses of cast immobilization.

Soft Tissue Reconstruction for the Finger Deformities in Patients with Rheumatoid Arthritis

Soft Tissue Reconstruction for the Finger Deformities in Patients with Rheumatoid Arthritis

Multiple Enchondromas of the Hand in Children: Long-Term Follow-Up of Mean 15.4 Years.

Multiple enchodromatosis of bone, termed Ollier's disease, or Maffucci syndrome when associated with hemangiomas, is a rare disease that can affect the pediatric hand. This condition often causes a finger mass, deformity, pain and possible pathologic fractures, and has been associated with malignant transformation to chondrosarcoma. The aim of our study is to describe the long-term sequela of multiple enchondromatosis of the hand in the pediatric population, specifically the rates of malignant transformation, tumor recurrence, rates of pathologic fracture, and phalangeal growth arrest. We examined 15 pediatric patients who were treated in our institute with a total of 127 phalanges and metacarpals lesions. Only patients with follow-up of at least 4 years were included. We retrospectively reviewed patients' chart and hand radiograph for symptoms including pathologic fractures, indications for surgery, and postoperative complications including tumor recurrence, and malignant transformation. We assessed phalangeal growth arrest with radiographs and normalized phalangeal growth charts. Mean age of diagnosis was 5.8 years and mean follow-up time was 15.4 years. Pathologic fractures were common at 46% of pediatric patients, but ceased to occur once reaching adulthood. Outcomes of pathologic fractures were excellent, regardless of treatment. Malignant transformation occurred in 1 patient and did not occur during childhood. A total of 80% of patients and 29% of lesions underwent surgical treatment of curettage and bone graft for the lesion, yet recurrence was common and affected 33% of treated patients. Phalangeal growth arrest was the most common long-term sequela and affected 11% of phalanxes and metacarpals. This sequela was significantly more prevalent in patients who had surgical excision of the tumor. Our findings reassure that malignant transformation of enchodromatosis of the hand is unlikely in the pediatric population. Pathologic fracture is common, but has excellent outcomes. When considering surgery, parents should be counseled about the possibility of phalangeal growth arrest and recurrence of the lesion. Level IV-therapeutic.

Reconstruction of extensor tendon insertion in situ for treatment of tendinous mallet finger deformities

Objective To explore the clinical efficacy of reconstruction of extensor tendon insertion in situ for treatment of tendinous mallet finger deformities. Methods From August 2015 to July 2017, 10 cases of tendinous mallet finger deformities were treated with the modified method. Specifically, three bone holes were drilled obliquely by 15 gauge needle at the distal phalanx dorsal base of the injured finger. The proximal of extensor tendon was fixed to the distal phalanx dorsal base with 4-0 tendon suture through the bone holes. Four weeks after the operation, external fixation was removed and moderate active flexion and extension exercises were started. After 8 weeks, the rehabilitation training could be gradually strengthened. Results All the cases were follow-up from 3 to 10 months with an average of 7 months. The wounds all achieved primary healing. The mallet finger deformities were corrected. There is no pain in the movement of the injured finger. According to the evaluation system of Crawford mallet finger evaluation system, the results were excellent in 8 cases and good in 2 cases. Conclusion It is a simple and effective surgical method to reconstruct the extensor tendon insertion by using this modified method. Key words: Surgical procedures, operative; Treatment outcome; Tendinous mallet finger; Extensor tendon insertion

Treatment of Mallet Finger Deformity with Ring Splint

Treatment of Mallet Finger Deformity with Ring Splint

3D DESIGN AND PRINTING OF CUSTOM-FIT FINGER SPLINT

Finger deformities are a major concern among the Indian population, where the increase of risk factors are higher for people suffering from Rheumatoid Arthritis. The deformities hinder the movements in the finger, affecting their day to day activities. Finger splint is a device which is used to support and correct this deformity in order to improve function. Three-dimensional modeling and 3D printing techniques are the standard measures used. The proposed methodology involves 3D modeling which was done using Solidworks 2013, along with standard measurements taken from the patients with deformities due to Rheumatoid Arthritis. The measurements were obtained using a vernier caliper. The 3D printing was done using Fused Deposition Modeling (FDM) and the materials needed for the same are Acrylonitrile Butadiene Styrene (ABS) and flex Polylactic Acid (PLA). The 3D printer used for the same is Flashforge Dreamer 3D printer. The volunteers were fitted with the custom finger splint. The finger splint is light-weight, easy to maintain and clean, with an inventive design based on the finger deformity. It is comfortable and helps support the patients during daily activities. It serves as an easy slip-on. Since it is well-ventilated, swelling of the finger does not occur. Future research will focus on the correction of the deformity, in addition to the biomechanical aspect of finger deformities.

Prosthetic Arthroplasty of Proximal Interphalangeal Joints for Treatment of Osteoarthritis and Posttraumatic Arthritis: Systematic Review and Meta-Analysis Comparing the Three Ulnar Digits With the Index Finger.

Background: It is common teaching that treatment of index finger alone is a relative contraindication for arthroplasty of the proximal interphalangeal joint (PIPJ). However, limited data exist reporting the digit-specific complication of PIPJ arthroplasty for the treatment of osteoarthritis or posttraumatic arthritis. The purpose of this article is to perform a systematic review and meta-analysis of the literature to assess whether the 3 ulnar digits may bear a similar instability and complication profile. Methods: Systematic searches of the MEDLINE, EMBASE, and Cochrane computerized literature databases were performed for PIPJ arthroplasty specifying by digit. We reviewed both descriptive and quantitative data to: (1) report aggregate instability and instability-related complications after non-index digit PIPJ arthroplasty; and (2) perform statistical testing to assess relative rates by digit and compared with index digits. Results: Computerized search generated 385 original articles. Five studies reporting digit-specific instability-related outcomes of silicone, pyrocarbon, or metal surface arthroplasty on 177 digits were included in the review. Meta-analysis demonstrated a 29% instability rate for long digits (n = 65), 6% for ring digits (n = 53), and 6% for small digits (n = 17), compared with 33% for index digits (n = 42). There was no difference in the overall deformity, instability, and complication rates of long versus index fingers (P = .65). Conclusions: Instability-related deformity and complication rates of long finger PIPJ arthroplasty may not be different from that of the index finger. Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty. Future biomechanical and clinical studies are needed.

Patient satisfaction after hook plate treatment of bony avulsion fracture of the distal phalanges

BackgroundBony avulsion fractures of the distal phalanges can result in mallet finger deformity if not treated appropriately. Therefore, only minimally displaced fractures can be treated conservatively with a good outcome, as dislocation occurs very often. Several surgical treatment options have been developed during the past decades. Data concerning the recently developed hook plate are promising. So far, no data concerning the subjective satisfaction with this method have been published. Therefore, we have analyzed the outcome after hook plate implantation using a self-assessment score, which focuses also on subjective parameters and satisfaction.MethodsStandardized questionnaires (self-assessment scores and SF-36 questionnaire) were sent to each patient treated with a hook plate due to fracture of the distal phalanx, type Doyle IVb and IVc. Clinical data were evaluated according to the medical record. Scores given per question range from 0 to 10, 10 is the worst and 0 the best outcome.ResultsFrom 69 patients treated, 38 (58%) were enrolled. The whole collective (n = 38) reached a score of 39.7 ± 28.7 points, while men had slightly better results. Men (n = 24) achieved 37.3 ± 27.9 points, women (n = 14) 43.9 ± 30.7 points. Women had significantly better results when analyzed later than 12 months after surgery (52.1 ± 27.9 vs. 29.1 ± 32.8), whereas no changes could be detected in the male group (37.1 ± 29.9 vs. 37.4 ± 27.6). Overall, men were slightly more satisfied than women. Most satisfaction was found regarding pain and fine motor skills (0–0.46 points). Esthetic aspect and nail deformities (3.65 points average) led to the highest dissatisfaction. No differences in the SF 36 score could be detected.ConclusionsThe hook plate is not only a convenient method but it also results in high patient satisfaction. Nail deformities are challenging; however, with increasing experience of the surgeon they decrease. SF 36 score is not an appropriate testing tool for this problem.

On Fabrication and Mechanical Testing of a New Finger Support

Following the work done previously on design and simulation of a new finger support, this paper focuses on mechanical testing, methods of fabrication using a LaserJet 3D printer and also explores a better polymer which can be used for the support. The special composite finger support was designed for the first time to accommodate the patients with all sort of finger deformity. A new model is presented here, which is the optimum design suggested previously and is consisted of polymeric support with an inserted sheet of aluminum or carbon fiber. After presenting the results of modeling (including the calculated maximum stress and maximum deformation), the maximum stress values were compared with the yield strength values of the metals and it was noticed that the support does not undergo any plastic or permanent deformation. Furthermore, in order to validate the modeling results, the support was fabricated and mechanical tests were conducted. The steps and details of designing, simulation, mathematical confirmation using MATLAB (Mathworks©) package, fabrication, and mechanical testing are all presented. Overall the finger support is reliable and strong and can be brought to the market.

A rare case report of unusual presentation of Edward’s syndrome (trisomy 18)

Edwards syndrome, a rare genetic disorder is characterized by the extra copy of chromosome 18. About 50% babies with this syndrome do not survive one week of age and approx. 95% do not survive past the first year of life. The syndrome is usually characterized by dysmorphic facies, microcephaly, flexion finger deformity and rocker- bottom feet. There is involvement of cardiacvascular and renal system with intellectual disability. Authors report a case of Edwards syndrome presenting with failure to thrive and developmental delay in the absence of usual clinical features of Edwards syndrome.