Distal Phalanx Of Finger Research Articles

Regional recurrence of digital papillary carcinoma in ipsilateral axillary lymph nodes 12 years after digital amputation – a case report

Digital papillary adenocarcinoma (DPA) is a rare malignant adnexal tumour that affects 0.08 per 1,000,000 people/year.1 It often presents as a solitary painless mass in the digital extremities where eccrine sweat glands are abundant. It is reported to have a recurrence rate of 50% and 14% rate of metastasis.2 Due to its rarity and vague clinical presentation, it has frequently been misdiagnosed as a benign adnexal tumour, pyogenic granuloma and ganglion cyst. We report a rare case of regional recurrence of DPA in an ipsilateral axillary node of a 66- year-old male, 12 years after a right ring finger distal phalanx amputation.

Distal phalanx intraosseous epidermoid inclusioncyst: A rare thing!

Pathological structures called epidermoid bone inclusion cysts are surrounded by a layer of stratified squamous epithelium that contains keratin debris. They go by the name epidermal bone cysts as well. Intraosseous epidermoid cysts are uncommon lesions that can develop as a result of trauma (puncture wound or pressure erosion). They typically affect the toes, phalanges, and head. The distal phalanx of the fingers is where phalangeal involvement most frequently occurs. Despite the fact that the cause of intraosseous epidermal inclusion cysts is still unknown, the majority of patients do recall a prior traumatic event, supporting the post-traumatic origin theory. Following digital trauma or surgery, it is hypothesised that surface epithelial cells are pushed into the underlying osseous compartment.Following the initiating event, symptoms may start to appear months to years later. It is challenging to distinguish intraosseous epidermoid inclusion cysts on radiographs from other radiolucent lesions, necessitating tissue diagnosis.We present a case of a 45-year-old man with right middle finger distal phalanx edoema for five months and a known history of minor blunt trauma. A well-defined expansile hypodense lytic lesion with eccentric phalanx erosion was discovered during radiological analysis. A creamy substance was found inside the lesion after surgery, and it was later determined by histology to be an epidermoid inclusion cyst.Gross examination of the surgical specimen indicated a cystic lesion with significant necrotic regions and pale, creamy material. A burst intraosseous epidermoid inclusion cyst was discovered upon microscopic inspection and was effectively removed.

Sex estimation accuracies from variables of the index and ring fingers in a Ghanaian population: Absolute lengths versus length ratios

There are variabilities in the sex and height estimation accuracies using variables of the index and ring fingers. This study sought to compare the performance of the absolute length and the length ratio variables of the index and ring fingers in sex and height estimation. The study was cross-sectional from January to June 2021 at the University for Development Studies. The participants were 216 (males=96, females=120) between 18 and 32 years. The index (IF), the ring (RF) finger lengths and their ratio (IF: RF) were obtained using computer-assisted analysis. Logistic regression (LogR) models were formulated for sex estimation while linear regression (LR) models were formulated for height estimation. Males had longer IF and RF than females (P < 0.001) but no sex differences were observed in the IF: RF ratio. The average sex estimation accuracies for all variables ranged from 54.2 % to 66.2 %. The absolute length of IF (61.6 %) and RF (63.9 %) were better than IF: RF (54.2 %) for sex estimation. The index finger distal phalanx (IFDP) was the most sexually dimorphic trait (66.2 %). Models for height estimation were significant except IF: RF in males which also had the largest standard error of estimation in females. The models for estimating height were more precise in females than males. There are substantial overlaps in variables of the index and ring fingers between males and females, such that there are less suitable for sex estimation but could be used for height estimation in a Ghanaian population.

Osteoid osteoma located in a distal phalanx of finger; two cases report

Osteoid osteoma located in a distal phalanx of finger; two cases report

The Preferred Management of a Single-Digit Distal Phalanx Amputation.

Replantation of a single digit at the distal phalanx level is not routinely performed since it is technically challenging with questionable cost-effectiveness. The purpose of this study was to analyze international microsurgeons' clinical decisions when faced with this common scenario. A survey of a right-middle finger distal phalanx transverse complete amputation case was conducted via online and paper questionnaires. Microsurgeons around the world were invited to provide their treatment recommendations. In total, 383 microsurgeons replied, and their responses were stratified and analyzed by geographical areas, specialties, microsurgery fellowship training, and clinical experiences. Among 383 microsurgeons, 170 (44.3%) chose replantation as their preferred management option, 137 (35.8%) chose revision amputation, 62 (16.2%) chose local flap coverage, 8 (2.1%) chose composite graft, and 6 (1.6%) favored other choices as their reconstruction method for the case study. Microsurgeons from the Asia-Pacific, Middle East/South Asia, and Central/South America regions tend to perform replantation (70.7, 68.8, and 67.4%, respectively) whereas surgeons from North America and Europe showed a lower preference toward replantation (20.5 and 26.8%, respectively p < 0.001). Having completed a microsurgery fellowship increased the attempt rate of replantation by 15.3% (p = 0.004). Clinical experience and the surgeons' specialties did not show statistical significance in clinical decision making. From the present study, the geographic preferences and microsurgery fellowship experience influence the method of reconstruction for distal phalanx amputation. Multiple factors are taken into consideration in selecting the most suitable reconstructive method for each case scenario. In addition to the technical challenges of the proposed surgery, the cost of the procedure and the type of facility needed are important variables in the decision making process.

Feasibility of Fingertip Oscillometric Blood Pressure Measurement: Model-Based Analysis and Experimental Validation.

The most commonly used oscillometric upper-arm (UA) blood pressure (BP) monitors are not convenient enough for ambulatory BP monitoring, given the large size of the arm cuff and the compression of UA during the measurement. Finger-worn oscillometric BP devices featuring miniaturized finger cuff have been developed and researched as an alternative solution to the UA-based measurement, yet the reliability of the finger-based measurement is still questioned. To investigate the feasibility of oscillometric BP measurements at the finger position, we performed model-based analysis and experimental validation to explore the underlying issues associated with extending the cuff-based oscillometric approach from UA to other alternative sites. The simulation results revealed that a larger bone-to-tissue volume ratio produced a lower pressure transmission efficiency, which can account for the inter-site measurement discrepancies of mean blood pressure (MBP). We also experimentally compared the oscillometric MBP measurements at UA, middle forearm, wrist, finger proximal phalanx, and finger distal phalanx (FD) of 20 young adults, and each position was matched with a cuff of appropriate size and kept at the same height with the heart. The experimental results demonstrated that FD could be a superior alternative position for oscillometric BP measurement, as it requires the smallest cuff size while providing the most consistent MBP with the UA. Our analysis also suggested that further study is demanded to identify the appropriate oscillometric algorithm for reliable systolic blood pressure and diastolic blood pressure measurements at FD.

Digital acrometastase as a primary manifestation of a bronchial adenocarcinoma

&lt;p&gt;Bone metastases of the hands and feet (acrometastases) are rare. Their presentation is variable and is generally confused with certain inflammatory conditions such as rheumatoid arthritis, gout, tenosynovitis, fracture or infection (panartius, osteomyelitis). The etiology of non-digital acrometastases is common to primary tumors with bone metastases (prostate, lung, kidney, breast, thyroid, and digestive tube). However, digital acrometastases are seen almost exclusively during bronchial neoplasia. We describe the case of a 43 year-old man admitted for pain and swelling of the middle finger distal phalanx of the left hand. Etiological assessement was in favor of an unusual secondary localization of bronchial adenocarcinoma. Tumoral causes must always be evoked before any inflammatory digital symptomatology, from where the interest of a good interrogation and a targeted paraclinical assessment. &lt;/p&gt;

Measuring dynamic stiffnesses of preloaded distal phalanges in vibration - Test bench validation and parameter study

An experimental vibration test bench was built for measuring the dynamic stiffnesses and dissipated power densities of preloaded distal phalanges undergoing vibration. The aim of this test bench was to analyse the effects of vibration frequency, static preloading, and vibration excitation amplitude on local biodynamic response. Prior to implementation, the test bench was validated by comparison with a tension–compression testing machine and a reference dynamic mechanical analyser. A measurement study was then conducted on a group of 20 subjects. The mean dynamic stiffness showed that the mechanical behaviour of the index finger distal phalanx is similar to that of a complex amorphous polymer: it exhibits frequency-related stiffening with a rubbery plateau, a glassy transition zone, and a glassy state. The static preloading condition considerably modifies the dynamic response of the phalanx, as well as the dissipated power, which is significantly greater when the preloading is high. An amplitude-related softening phenomenon, similar to the Payne effect for rubber, was also revealed. This can be explained by the thixotropic character of the extracellular matrix of the distal phalanx soft tissues. Relevance for industryExtensive exposure of the hand–arm system to regular vibration may lead to various disorders and injuries, due in part to changes in mechanical quantities, such as dynamic stress, strain, or dissipated power density, arising from the propagation of such vibration. Nowadays, the direct measurement of this biodynamic response inside soft tissues is still extremely challenging. A way to assess the overall mechanical effects of these local quantities on the human finger is to measure and analyse both the macroscopic stiffness and the dissipated power of fingers.

Tumeur glomique de l’index: à propos d’un cas

Glomus tumor is a benign tumor that develops from the neuromyoarterial glomus of dermo-epidermal tissue. Its typical location is the distal phalanx of the fingers. We report a case of a glomic tumour in a 42 year old patient having pain at the level of the ulnar side of the distal phalanx of the right index finger since 7 months. Pain was triggered by applying pressure to the finger and by cold exposure. Clinical examination showed a painful point at the ulnar side of the right index finger by exquisite pressure and a positive Hildeth test. Standard finger radiograph objectified a small rounded subungual notch, completed by a MRI which showed a small 2 mm lesion of the nail matrix of the right index finger, evoking a glomus tumor (A). The patient underwent biopsy excision of the tumor (B, C, D, E, F); anatomopathological results revealed the presence of a glomus tumor. Clinical outcome was favorable with disappearance of pain .

Management of peripheral injuries of the finger

The treatment of acute peripheral finger injuries is part of the daily routine of surgeons in emergency departments. This article presents the most common forms of peripheral finger injuries and the specific diagnostic and therapeutic aspects. The injuries include incision and tear injuries, injuries to the nailbed, distal extensor tendon injuries, severed flexor tendons of the distal joint, bite injuries, high-pressure injection injuries and amputation injuries of the distal phalanx of fingers. For the latter, the form, level and height of the amputation are decisive for therapy. Soft tissue defects on the extensor and flexor side of the finger are also common for emergency surgeons. The basic principles of the initial management of peripheral soft tissue injuries of the hand involve the reconstruction of tendons and nerves and soft tissue coverage. Pathogenic organisms are detectable in more than 80% of bite wounds so that prophylaxis and therapy of infections are of special importance. An adjuvant antibiotic therapy is necessary for infections as well as for high-pressure injection injuries. It is also important for the treating physician to recognize when a hand surgeon must be involved.

Maligne Tumoren des Nagelorgans

Because of the large number of different tissues making up the distal phalanx of fingers and toes, a large variety of malignant tumors can be found in and around the nail apparatus. Bowen disease is probably the most frequent nail malignancy. It is usually seen as a verrucous plaque of the nail fold and nail bed in persons above the age of 40 years. It slowly grows over a period of years or even decades before degenerating to an invasive squamous cell carcinoma. The latter may also occur primarily often as a weeping onycholysis. The next most frequent nail malignancy is ungual melanoma. Those arising from the matrix are usually pigmented and often start with a longitudinal melanonychia whereas those originating from the nail bed remain amelanotic, are often nodular and mistaken for an ingrown nail in an elderly person. The treatment of choice for in situ and early invasive subungual melanomas is generous extirpation of the nail apparatus whereas distal amputation is only indicated for advanced melanomas. In addition to these frequent nail malignancies, nail-specific carcinomas, malignant vascular and osseous tumors, other sarcomas, nail involvement in malignant systemic disorders and metastases may occur. In most cases, they cannot be diagnosed accurately on clinical grounds. Therefore, a high degree of suspicion is necessary in all isolated or single-digit proliferations that do not respond to conservative treatment.

Calcifying aponeurotic fibroma of the distal phalanx

Calcifying aponeurotic fibroma is a rare benign soft tissue tumor that primarily occurs on the distal portion of the extremities of children and adolescents. It appears like a firm, painless and slowly growing mass with high local recurrence rates. The lesion has characteristic histological features with areas of proliferative plumps of fibroblasts, chondrocytes and foci of calcification. We present a case of calcifying aponeurotic fibroma of the sub-ungual area of the index finger distal phalanx with bone erosion, surgically treated. A 2 year follow up showed satisfactory functional result and no evidence of recurrence.

SINGLE CLUBBED FINGER CAUSED BY AN ENCHONDROMA OF THE DISTAL PHALANX: AN UNUSUAL CLINICAL PRESENTATION

Single clubbed finger is an extremely rare condition that may show the presence of an underlying neoplasm of the distal phalanx. We describe a case of clubbing in a young adult patient with an enchondroma of the ring finger distal phalanx. The patient had a history of antecedent trauma to the left ring finger, suggesting the diagnosis of intraosseous epidermoid cyst rather than enchondroma. The lesion was successfully treated by curettage and packing of the bony defect with a synthetic bone substitute. Histologically, the tumour consisted of small, uniform chondrocytes without cytologic atypia. At the seven months follow-up, the patient had no evidence of recurrence, with a nearly normal-looking finger. We suggest that enchondroma should be considered in the differential diagnosis of clubbing in a single digit.

Desmoplastic Fibroblastoma of the Finger Tip in an Adult

Desmoplastic Fibroblastoma of the Finger Tip in an Adult

A real-time strategy for dexterous manipulation: Fingertips motion planning, force sensing and grasp stability

This paper presents a global strategy for object manipulation with the fingertips with an anthropomorphic dexterous hand: the LMS Hand of the ROBIOSS team from PPRIME Institute in Poitiers (France). Fine manipulation with the fingertips requires to compute on one hand, finger motions able to produce the desired object motion and on the other hand, it is necessary to ensure object stability with a real time scheme for the fingertip force computation. In the literature, lot of works propose to solve the stability problem, but most of these works are grasp oriented; it means that the use of the proposed methods are not easy to implement for online computation while the grasped object is moving inside the hand. Also simple real time schemes and experimental results with full-actuated mechanical hands using three fingers were not proposed or are extremely rare. Thus we wish to propose in a same strategy, a robust and simple way to solve the fingertip path planning and the fingertip force computation. First, finger path planning is based on a geometric approach, and on a contact modelling between the grasped object and the finger. And as force sensing is required for force control, a new original approach based on neural networks and on the use of tendon-driven joints is also used to evaluate the normal force acting on the finger distal phalanx. And an efficient algorithm that computes fingertip forces involved is presented in the case of three dimensional object grasps. Based on previous works, those forces are computed by using a robust optimization scheme. In order to validate this strategy, different grasps and different manipulation tasks are presented and detailed with a simulation software, SMAR, developed by the PPRIME Institute. And finally experimental results with the real hand illustrate the efficiency of the whole approach.

Monostotic Fibrous Dysplasia of the Distal Phalanx: Case Report

Monostotic fibrous dysplasia in the finger is rare. We are aware of only 4 cases, none of which involved the distal phalanx. We present a case of a 16-year-old boy with a fibrous dysplasia of the left long finger distal phalanx. Treatment consisted of curettage and bone grafting.

Microscopic anatomy of nevers and blood vessels of the finger distal phanlanx and its clinical significance

Objective To provide anatomical evidence for the repair of wounds of finger distal phalanx,espe-cially for the recovery of feeling. Methods 10 samples of fresh adult hand were dissected under microscope. The course,branches,distribution and external diameter of nerves and blood vessels in finger distal phalanx and morpho-logical relationship between nerves and vessels were measured. Results Proper palmar digital nerves mostly step over digital arteries at section starts of distal finger arterial arcades and go to finger pulps and latero-backs. Their thinks di-vide into 2 branches. Transverse diameters of interior and exterior branches are 0.8 ～ 1.2 mm and 0.9 ～ 1.4 mm re-spectively at liner semilunaris levels. Distributionsof left and right branches are reciprocal chiasmas. Conclusion Finger nerve mostly ramifies to finger pulp,finger tip and finger back at the level of phalangette bottom. Its branches are lower and thinner than concomitant arteries. The suitable anatomy region for anastomosis of nerves and blood ves-sels is the middle1/3 section from the distal interphalangeal joint to the nail during replanation of amputated finger pa-ratelum. Key words: Fingers; Microdissection

Intraosseous Glomus Tumor Treated by Toe-to-Finger Transfer: Case Report

We report a case of intraosseous glomus tumor that developed in the right ring finger distal phalanx of a 19-year-old man. Clinical and radiographic findings were atypical. The tumor was excised en bloc because of the extensive involvement. The left second toe was transferred to the right ring finger to reconstruct the excised finger part. Symptom relief, function, and cosmetic outcome were satisfactory during 2-year follow-up.

Intraosseous Epidermoid Cyst of Distal Phalanx of Fingers

Intraosseous epidermoid cysts of fingers are uncommon lesions. We reported two cases with intraosseous epidermoid cysts of distal phalanx of fingers. Case 1 was a 61-year-old woman with a swelling of the left middle finger without history of trauma. Case 2 was a 47-year-old male with a crushing injury of his right thumb. On radiographic findings, a well-circumscribed osteolytic lesion in distal phalanges was noted. Unexpectedly, histological examinations showed intraosseous epidermoid cyst.

Tumor glômico subungueal: estudo epidemiológico e retrospectivo, no período de 1991 a 2003

FUNDAMENTOS: O tumor glômico subungueal é neoplasia benigna de células glômicas. É mais freqüentemente observado como lesão solitária na falange distal dos quirodáctilos, representando de um a 4,5% das neoplasias das mãos. OBJETIVO: Avaliar os aspectos epidemiológicos e clínicos, os exames complementares, bem como prognóstico e tratamento com base em exames histopatológicos e métodos de imagem. MÉTODO: Foram estudados 20 casos de tumor glômico subungueal ocorridos no período de 1991 a 2003, nos ambulatórios de Dermatologia do Hospital das Clínicas e do Hospital do Servidor Público Municipal de São Paulo. RESULTADOS: Os achados epidemiológicos deste estudo não diferiram significativamente do levantamento bibliográfico pesquisado. Confirmaram-se, na casuística analisada, preferência pelos quirodáctilos e maior acometimento em pacientes do sexo feminino. Histologicamente, os dados obtidos foram similares aos existentes na literatura. CONCLUSÕES: Os métodos de imagem não foram utilizados de maneira sistemática como auxiliares diagnósticos do tumor glômico, embora sejam de grande importância na confirmação e delimitação do tumor, especialmente a ressonância magnética de alta definição. As recidivas, consideradas raras, ocorreram em 15% dos casos, enfatizando a necessidade de acompanhamento pós-cirúrgico prolongado.