Hand Joints Research Articles

SARS-COVID-19 TRIGGERED WERNICKE'S ENCEPHALOPATHY (CLINICAL CASE).

Patient P., born in 1956, was found by relatives in a state of confused consciousness, an act of involuntary urination and defecation, numbness and weakening of the strength of both lower limbs were recorded. He was taken by ambulance to the reception room of the Regional Clinical Center of Neurosurgery and Neurology. The following concomitant diseases are known from the life anamnesis: Atrial fibrillation, gout, hypertension and type II non-insulin-dependent diabetes mellitus. Objective status: general condition of medium severity, tophuses of small joints of hands and feet, knee and elbow joints. Pronounced deformity of hands and feet due to gouty lesions. Heart tones are weakened. Breath sounds are weakened. The abdomen is soft, not painful on palpation. Glasgow coma scale 14-15 points. Consciousness is confused, disoriented in time, space and own person. To clarify the diagnosis, clinical and laboratory and instrumental diagnostic methods were used. Neurological complications, in particular, acute encephalopathy, on the background of coronavirus infection, may develop in patients with the presence of such risk factors as advanced age, cardiovascular diseases, hypertension, diabetes, gout. Most of the neurological complications in COVID-19 are probably not related to the direct penetration of the virus into the CNS, but are a trigger for the development of the pathology. Neuroimaging in such cases does not reveal pathological changes or reflects non-specific disorders.

Functional evaluation of optimal index finger proximal interphalangeal joint fusion angle using a simulated joint arthrodesis

This study aims at qualitatively and quantitatively evaluating the effects of simulated index finger proximal interphalangeal (PIP) joint fusion angles on hand kinematic function and performance. Although arthrodesis of the index finger PIP joint is an effective medical procedure that produces a durable, pain-free, and stable joint, it permanently immobilizes the joint. Twenty healthy subjects performed basic functional hand activities with the index finger PIP joint unconstrained (UC) and constrained to selected angles under surveillance of a motion capture system. Our results indicate differences in perceived difficulty, time performance, and the functional ROM of the hand joints when the index finger PIP joint is UC and constrained to 0, 20, and 40 degrees of flexion. The mean total perceived difficulty scores for all 6 tasks were higher for the PIP at 0 degrees than for the UC condition (p < 0.001) and for the PIP at 40 degrees (p = 0.048). The functional ROM presented a smaller total number of hand joints affected by the PIP at 20 degrees (25 in total) than the PIP at 0 (31 in total) and 40 (27 in total) degrees during execution of all 6 tasks tested. Therefore, the decision on the appropriate index finger PIP angle for arthrodesis may be between 20 and 40 degrees, as globally for all 6 tasks tested, 0 degrees exhibited the worst results regarding perceived difficulty, performance time, and number of joints with affected ROM. Selecting the appropriate angle for arthrodesis should consider a more complete set of functional activities.

Dynamic Hand Gesture Recognition Using Multi-Branch Attention Based Graph and General Deep Learning Model

The dynamic hand skeleton data have become increasingly attractive to widely studied for the recognition of hand gestures that contain 3D coordinates of hand joints. Many researchers have been working to develop skeleton-based hand gesture recognition systems using various discriminative spatial-temporal attention features by calculating the dependencies between the joints. However, these methods may face difficulties in achieving high performance and generalizability due to their inefficient features. To overcome these challenges, we proposed a Multi-branch attention-based graph and a general deep-learning model to recognize hand gestures by extracting all possible types of skeleton-based features. We used two graph-based neural network channels in our multi-branch architectures and one general neural network channel. In graph-based neural network channels, one channel first uses the spatial attention module and then the temporal attention module to produce the spatial-temporal features. In contrast, we produced temporal-spatial features in the second channel using the reverse sequence of the first branch. The last branch extracts general deep learning-based features using a general deep neural network module. The final feature vector was constructed by concatenating the spatial-temporal, temporal-spatial, and general features and feeding them into the fully connected layer. We included position embedding and mask operation for both spatial and temporal attention modules to track the node’s sequence and reduce the system’s computational complexity. Our model achieved 94.12%, 92.00%, and 97.01% accuracy after evaluation with MSRA, DHG, and SHREC’17 benchmark datasets, respectively. The high-performance accuracy and low computational cost proved that the proposed method outperformed the existing state-of-the-art methods.

'Ray Pattern' of Hand Joint Involvement.

'Ray Pattern' of Hand Joint Involvement.

Effects of hand joints protection on pain, motor performance, and function in patients with hand osteoarthritis: a literature review

article: Effects of hand joints protection on pain, motor performance, and function in patients with hand osteoarthritis: a literature review - Minerva Orthopedics 2022 December;73(6):531-40 - Minerva Medica - Journals

Measurement of Hand Joint Angle Using Inertial-Based Motion Capture System

The inertial sensor motion capture system has significant advantages over the classical optical motion capture system, including its high versatility, portability, and affordability. However, its accuracy is over one order of magnitude lower than the optical system. The measurement error of the finger joint angle is mainly due to sensor drift and misalignment of sensor to finger segment. In this article, we propose a method that includes both orientation estimation and calibration for accurate joint angle estimation. Specifically, at first, the accuracy of the sensor orientation is greatly improved using the square root cubature Kalman filter (SRCKF) to fuse the magnetic and inertial measurement units (MIMUs) data. Second, the kinematic restrictions of the finger joints are used for initial and in-process calibration to achieve sensor-to-segment (StoS) calibration throughout the process. Finally, the difference between the orientation of the two adjacent segments is the joint angle. Experiments show that our proposed system improves joint measurement accuracy compared with the existing inertial sensor-based systems. Evaluation of ten participants showed that the average root mean square error (RMSE) of finger joint measurements is <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$5.5^{\circ }(\pm 4.0^{\circ })$ </tex-math></inline-formula> . Our proposed system provides accurate information in measuring hand joint angles and quantifying hand movement function in clinical practice.

Encircling Skin Structure for Covering the Dorsal and Palmar Side of Robot Hand Joints with Thick Skin

Encircling Skin Structure for Covering the Dorsal and Palmar Side of Robot Hand Joints with Thick Skin

Post hoc analysis of the results of KOLIBRI comparative observational clinical study in patients with knee and small hand joints osteoarthritis

Objective: to evaluate the effectiveness of therapy with AMBENE®Bio (AB) in comparison with the comparator drug (bioactive concentrate of small marine fish, BCSMF) in patients with osteoarthritis (OA) of large and small joints in routine clinical practice.Patients and methods. KOLIBRI multicenter, observational, non-randomized, comparative study included 233 patients with OA of the small hand joints (HJ) or knee joints (KJ) from three Russian centers (two in Moscow and one in Tula). Patients with a generalized form of OA were excluded from the analysis. The remaining patients were divided into two groups depending on the localization of OA. The first group included 174 patients with knee OA, 105 of them received AB, and 69 received the reference drug (BCSMF) according to the same regimen. The second group consisted of 21 women with HJ OA: 13 patients were prescribed AB, and 8 — the reference drug.The duration of the study averaged 330±14 days, the total number of visits was 4. The main indicator of effectiveness was the dynamics of pain during movement according to VAS (0—100 mm) 30±7 days after the start of treatment compared with the baseline value. All patients underwent radiography of the HJ and KJ, as well as ultrasound of the involved joints.Results and discussion. Both drugs provided significant clinical improvement in patients with OA, which is consistent with other studies with similar design and long follow-up. These data confirm the symptom-modifying properties of the presented group of combined drugs in the OA treatment. The Russian injectable drug AB in OA was not inferior in effectiveness to the foreign BCSMF. According to the OMERACT-OARSI criteria, 85.2% and 88.9% of patients, respectively, responded to treatment with AB and the reference drug. In both groups, half of the patients managed to stop further use of non-steroidal anti-inflammatory drugs (NSAIDs) on a regular basis.Conclusion. The use of AB was accompanied not only by a decrease in the severity of clinical symptoms of OA, but also by a decrease in the daily requirement for NSAIDs almost by 2 times.

Osteoarthritis of hand joints: prevalence, risk factors, phenotypes, diagnosis, treatment

Osteoarthritis is the most common rheumatic disease, accompanied by constant pain and dysfunction of the joints, the progression of which leads to a deterioration in the quality of life and often to disability of patients. The article presents the prevalence, predictors of development and progression of osteoarthritis of the hand joints (OHJ). Clinical classification of OHJ, clinical picture depending on the localization of the process, topical features of involvement of the hand joints in different types of OHJ are given. Clinical, laboratory and instrumental methods for diagnosing of the disease, classification and diagnostic criteria are described, much attention is paid to modern principles of OHJ therapy in accordance with Russian clinical guidelines, as well as EULAR and ACR recommendations.

A hand motion capture method based on infrared thermography for measuring fine motor skills in biomedicine

Many biomedical applications require fine motor skill assessments; however, real-time and contactless fine motor skill assessments are not typically implemented. In this study, we followed the 2D-to-3D pipeline principle and proposed a transformer-based spatial–temporal network to accurately regress 3D hand joint locations by inputting infrared thermal video for eliminating need of multiple cameras or RGB-D devices. We also developed a dataset composed of infrared thermal videos and ground truth annotations for training. The label represents a set of 3D joint locations from infrared optical trackers, which is considered the gold standard for clinical applications. To demonstrate their potential, the proposed method was used to measure the finger motion angle, and we investigated its accuracy by comparing the proposal with the Azure Kinect system and Leap Motion system. On the proposed dataset, the proposed method achieved a 3D hand pose mean error of less than 14 mm and outperforms the other deep learning methods. When the error thresholds were larger than approximately 35 mm, our method first to achieved excellent performance (>80%) in terms of the fraction of good frames. For the finger motion angle calculation task, the proposed and commercial systems had comparable inter-system reliability (ICC2,1 ranging from 0.81 to 0.83) and excellent validity (Pearson’s r-values ranging from 0.82 to 0.86). We believe that the proposed approaches can capture hand motion and measure finger motion angles and can be used in different biomedicine scenarios as an effective evaluation tool for fine motor skills.

Overlap Syndrome between Systemic Sclerosis and Systemic Lupus Erythematosos: A case report.

BACKGROUND: Regarding autoimmune diseases, an overlap syndrome is defined as one that meets satisfactory inclusion criteria for two different connective tissue diseases at the same time. SLE is one of the most well-known and studied autoimmune pathologies, its overlap with other autoimmune diseases is known, being one of the least frequent its association with Systemic Sclerosis (SS). Here we present a case of SLE-SS overlap, which was diagnosed many years after the onset of symptoms. CASE REPORT: A 45-year-old female patient, diagnosed 14 years ago with Sjogren's Syndrome and Raynaud's Syndrome, without current treatment. She came to receive medical attention due to asthenia, a feeling of shortness of breath, erythema in the toes, joint pain in the distal interphalangeal joints of both hands, and lesions in the fingernails. After assessing the clinical features and with the help of complementary tests, mixed connective tissue syndrome was ruled out. The patient met the diagnostic criteria for SLE (2019 ACR/EULAR criteria) and SS (2013 ACR/EULAR criteria). EVOLUTION: After confirming the diagnosis of SLE-ES Overlap Syndrome, specific treatment with immunosuppressive drugs was started, to which the patient responded favorably, with progressive improvement of her symptoms, as well as improvement in clinical laboratory parameters. CONCLUSION: Overlapping syndromes, such as ES-SLE, are rarely poorly diseases; the diagnostic suspicion should be based on symptoms compatible with both diseases simultaneously and should be confirmed by antibody determination and supported with other complementary tests. Management will be guided by the specific clinical features of the patient and the prognosis will depend on the severity of the diseases, more than on the association of them.

Eumycetoma infection of the hand: A case report

Mycetoma is a chronic granulomatous infection of cutaneous and subcutaneous tissues caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). The most common site of infection is the foot, followed by the hand, but sometimes other body parts may also be infected. The patients present with a painless hard and swelling subcutaneous mass, multiple sinuses, and the pathognomonic discharge of grains. A 42-year-old male patient, presented pain and swelling in his right hand and also complained of swelling in his right forearm. The swelling later involved his whole right hand and wrist joint. Physical examination revealed multiple discharging sinuses with serosanguineous exudates and black grains. Swelling and local erythema were present, lymph nodes were not palpable. The patient complained of constant mild pain which is relieved by pain medications. The serohematic discharge was witnessed with conglomerates of small and firm blackish pellets, evoking eumycetomaSaline dressing was applied overnight and next morning grains were directly collected from sinuses. Tissue and black grain samples were analyzed for bacterial and mycological evaluation. Direct microscopy was performed using Gram stain showed thicker hyphae of eumycetoma. Modified ZN stain showed no acid fast bacilli. LPCB was helpful in confirming thicker hyphae of eumycetoma. Here, on clinical diagnosis (classical triad that is, painless soft tissue swelling, draining sinuses and extrusion of grains) with microbiological investigation, we concluded it a case of “Eumycetoma”.

Macrophage Activation Syndrome in Adult Onset Still’s Disease: A Life Threatening Complication

Adult onset Still’s disease (AOSD), a multi-systemic inflammatory disorder, is a rare disorder but an important differential to be considered in patients of Pyrexia of Unknown Origin, especially if patient presents with polyarthritis. Macrophage activation syndrome (MAS), a subset of Secondary Hemophagocytic Lymphohistiocytosis (HLH), considered as the most life threatening complication of AOSD, mostly develops around the onset of disease. Hence, in a previously undiagnosed case of AOSD, recognizing MAS as a presenting feature complicating underlying AOSD is essential for increased patient survival, as in our case.&#x0D; &#x0D; &#x0D; A 39 year old diabetic female presented with high grade fever with chills and multiple joint pains symmetrically involving proximal shoulder, knees and distal joints (involving MCP, PIP and DIP joints of hand) associated with swelling and early morning stiffness, relieved on activity, since past 6 months. No history of oral ulcers, rash, jaundice, weight loss, loss of appetite, foreign travel or close animal contact.&#x0D; &#x0D; On examination, Pallor was present, Blood Pressure was 120/70 mm Hg, pulse rate was 102/min and temperature was 100 F. On per abdomen, mild hepatomegaly was present and other system examination was unremarkable.&#x0D; &#x0D; Routine laboratory findings on day of presentation have been summarised (Table 1.1). Ultrasound Abdomen revealed hepatomegaly and Chest X-ray showed signs of old infective foci. Peripheral smear for Malarial parasite, Ns1Ag and dengue serology, Widal test and Montoux test were negative. Blood cultures and urine cultures were sterile. X-Ray of joints were normal. USG of B/L Knee joints showed mild joint effusion bilaterally with no internal echoes (non tappable). Trans-thoracic echo and Trans-esophageal echo were normal. CT chest, neck and abdomen showed old tubercular changes in lung. Tests for atypical bacterial infections which was normal (RK 39, Chickungunya, Brucella, Leptospirosis and Scrub typhus). Fever did not respond to Broad Spectrum Antibiotics, Antimalarials or Antitubercular therapy and patient continued to have persistent fever spikes.&#x0D; &#x0D; Autoimmune profile showed ANA and RA Factor negative but markers of inflammation were raised: CRP- 521, ESR -148, IL-6 – 84.0, Procalcitonin-6.9 and S.Ferritin &gt;2000. During the work up for Anemia, Microcytic hypochromic anemia was found with Elevated NAP SCORE-165. Incidentally, her triglycerides were found to be elevated (356) and a reduced fibrinogen. With these results, we planned for a bone marrow aspirate and biopsy which showed increased myeloid preponderance (32:1), increased histiocytes and evidence of hemophagocytosis.&#x0D; &#x0D; The 2004 diagnostic criteria of HLH was fulfilled. After ruling out almost all infectious and malignant causes of secondary HLH, we searched for a rheumatologic cause. Thus diagnosis of AOSD (after fulfilling Yamaguchi’s criteria) with MAS (a subset of 2’ HLH) was made. Patient had dramatic improvement after receiving steroids with her fever episodes and joint pains settling completely thereafter.&#x0D; &#x0D; &#x0D; Prompt recognition of life threatening complications like MAS which pose diagnostic difficulty due to overlapping features in a patient of AOSD, should be done at the earliest to improve patient prognosis and survival. Serum Ferritin levels can be considered a useful marker to assess the disease activity and to predict MAS occurrence in such patients.

Evaluation of Subclinical Hand Joint Synovitis by Ultrasonography in Patients with Psoriatic Arthritis and Cutaneous Psoriasis: A Case-Control Study.

To find the frequency of subclinical hand joint synovitis (SS) in patients with psoriatic arthritis (PsA) and cutaneous psoriasis (PsC) compared to healthy controls (HC), and correlation of SS with disease activity. PsA patients (n= 52), without any past/current history of hand joint arthritis, PsC patients (n= 48), and 45 HC were recruited. Grey-scale and power Doppler Ultrasonography of bilateral hand joints were performed. The proportions of hand joints with SS were estimated in each group. A wrist-ray score was devised. Correlations were obtained between the number of joints with SS and disease activity parameters. Higher proportion of PsA patients (55.8%) had SS than PsC (29.2%, p= 0.007), and HC (22.2%, p=0.001). Proportion of joints with SS was higher in PsA patients (5.38%) compared to PsC (2.92%, [p=0.0008]), and HC (1.11%, [p=0.0007]). Compared to HC, PsA patients had significantly higher bilateral ray 3 (p=0.002 and 0.01 for left and right ray 3, respectively), and right ray 4 involvement (p=0.037) and PsC patients had higher left ray 3 involvement (p=0.03). Wrist-ray score above 2.5 could distinguish patients of PsC with significant subclinical synovitis compared to controls (area under curve: 0.857, 95% confidence interval: 0.71-1.00). There was a significant correlation of SS with ESR in PsA group (p-value: 0.044), and with CRP in PsC group (p-value: 0.003), but not with other disease activity indices. SS was noted in approximately half of PsA and 1/3rd of PsC patients. Both PsA and PsC patients had a significantly higher number of hand joint SS than HC. Ray pattern of hand joint SS could be present in both PsA and PsC.

A Two-Stream Neural Network for Pose-Based Hand Gesture Recognition

Pose-based hand gesture recognition has been widely studied in the recent years. Compared with full body action recognition, hand gesture involves joints that are more spatially closely distributed with stronger collaboration. This nature requires a different approach from action recognition to capturing the complex spatial features. Many gesture categories, such as “Grab” and “Pinch,” have very similar motion or temporal patterns posing a challenge on temporal processing. To address these challenges, this article proposes a two-stream neural network with one stream being a self-attention-based graph convolutional network (SAGCN) extracting the short-term temporal information and hierarchical spatial information, and the other being a residual-connection-enhanced bidirectional independently recurrent neural network (IndRNN) for extracting long-term temporal information. The SAGCN has a dynamic self-attention mechanism to adaptively exploit the relationships of all hand joints in addition to the fixed topology and local feature extraction in the GCNs. The proposed method effectively takes advantage of the GCN and IndRNN to capture the temporal-spatial information. The widely used Dynamic Hand Gesture dataset (two evaluation protocols) and First-Person Hand Action dataset are used to validate its effectiveness and our method achieves state-of-the-art performance with 96.31%, 94.05%, and 90.26%, respectively, in terms of recognition accuracy.

3D hand pose estimation from a single RGB image by weighting the occlusion and classification

In this paper, a new framework for 3D hand pose estimation using a single RGB image is proposed. The framework is composed of two blocks. The first block formulates the hand pose estimation as a classification problem. Since the human hand can perform numerous poses, the classification network needs a huge number of parameters. So, we propose to classify hand poses based on three different aspects, including hand gesture, hand direction, and palm direction. In this way, the number of parameters will be significantly reduced. The motivation behind the classification block is that the model deals with the image as a whole and extracts global features. Furthermore, the output of the classification model is a valid pose that does not include any unexpected angle at joints. The second block estimates the 3D coordinates of the hand joints and focuses more on the details of the image pattern. RGB-based 3D hand pose estimation is an inherently ill-posed problem due to the lack of depth information in the 2D image. We propose to use the occlusion status of the hand joints to solve this problem. The occlusion status of the joints has been labeled manually. Some joints are partially occluded, and we propose to compute the extent of the occlusion by semantic segmentation. The existing methods in this field mostly used synthetic datasets. But all the models proposed in this paper are trained on more than 50 K real images. Extensive experiments on our new dataset and two other benchmark datasets show that the proposed method can achieve good performance. We also analyze the validity of the predicted poses, and the results show that the classification block increases the validity of the poses.

Curcuma longa and Boswellia serrata extract combination for hand osteoarthritis: an open-label pre-post trial

Context Osteoarthritis (OA) of the hand is a common painful musculoskeletal disorder with no cure. There is a need for an efficient and safe treatment to relieve OA pain. Objective To investigate the effects of a Curcuma longa and Boswellia serrata food supplement in addition to standard care on hand pain. Materials and methods This open-label, non-controlled, post-observational study was based on 232 patients suffering from hand pain with or without joint deformity. Patients received a medical prescription for a three-month treatment with a food supplement containing 89 mg of C. longa dry extract, 120 mg of B. serrata resin, and 1.8 µg vitamin D. Pain was evaluated on a 10-point visual analog scale (VAS). The number of painful hand joints, patient satisfaction, nonsteroidal anti-inflammatory drugs intake, and side effects were also recorded. Results Baseline pain intensity (regression coefficient ± SE: −0.19 ± 0.01, p < 0.0001) and the number of painful joints (regression coefficient ± SE: −0.022 ± 0.0029, p < 0.0001) decreased significantly throughout the 3 months treatment period. NSAIDs intake and topical drug application were significantly decreased by 64% (p < 0.0001) and 79% (p < 0.0001) after 12 weeks, respectively. Only 3/239 (1.3%) patients reported side effects probably related to the product. 80.3% were satisfied with the treatment and 75.5% wished to continue treatment. Conclusion This is the first clinical trial showing that C. longa and B. serrata resin can relieve symptoms in patients with hand osteoarthritis. The study provides useful information for the design of a clinical trial including a broader population.

The Importance of Recovery Treatment in Patients With Algoneurodystrophy

"Introduction: AND (Algoneurodystrophy) is a neuropathic pain disease characterized by incapacitating pain, swelling, vasomotor instability, sudomotor abnormality, and impaired motor function. The pain is disproportionate to the severity of the tissue injury and lasts longer than the expected time for tissue repair. Material and method: The current study began with the idea that, in the case of algoneurodystrophy, patients in the experiment group would benefit from a considerably faster recovery in terms of mobility and coordination joints in hand and foot if a psychokinetic program, rather than only pharmacological treatment, was implemented. The program applied includes physiotherapy, massage, light range of motion of the affected limb, strengthening exercises, stress loading of the active part, if necessary, and ensuring adequate analgesia. As a result, this type of therapy encourages AND patients to use the affected limb in daily activities. Results: The experiment group followed the recovery protocol developed by us and achieved excellent results at the end of the week; the patients felt much better and were satisfied. The control group with drug treatment did not have a high degree of pain, but the joint mobility was affected, and the coordination did not improve much compared to the experiment group. After diagnosing algoneurodystrophy, immediate psychokinetic recovery is of considerable importance on the lost function of the hand and foot. Conclusion: The combination of kinetic treatment with physiotherapy next to drug treatment has beneficial effects on the recovery process in relieving pain and inflammation. Keywords: recovery treatment, kinesiotherapy, algoneurodystrophy "

The Minimal Erosive Volume Needed for Radiographic Identification of Erosions in the Metacarpophalangeal Joints in Patients With Rheumatoid Arthritis.

To compare in images, obtained by high-resolution peripheral quantitative computed tomography (HR-pQCT) and conventional radiography (CR) of the second and third metacarpophalangeal (MCP) joints, the minimal erosive cortical break needed to differentiate between pathological and physiological cortical breaks. In this single-center cross-sectional study, patients with established rheumatoid arthritis (disease duration ≥ 5 yrs) had their second and third MCP joints of the dominant hand investigated by HR-pQCT and CR. Empirical estimation was used to find the optimal cut-off value for the number of erosions and total erosive volume, which were detectable between patients with and without erosions in the second and third MCP joints according to CR. The total erosive volume in the second and third MCP joints by HR-pQCT for CR-detected erosive disease was estimated to be 56.4 mm3 (95% CI 3.5-109.3). The sensitivity and specificity at this cutpoint were 78% and 83%, respectively, with an area under the receiver-operating characteristic curve (AUC) of 0.81. The optimal cut-off value for the number of erosions by HR-pQCT was 8.5 (95% CI 5.9-11.1) for CR-detected erosive disease in the second and third MCP joints. The sensitivity and specificity at this cutpoint were 74% and 88%, respectively, with an AUC of 0.81. Erosions by HR-pQCT were larger in patients with erosive damage in the second and third MCP joints by CR. We found that CR had poor sensitivity for detecting erosive disease when the erosive volume was < 56.4 mm3 or the number of erosions was < 8.5.

Superficial Circumflex Iliac Artery Free Flap for Coverage of Hand Injuries.

Open de-gloving hand injuries with exposed tendons and bones require coverage by a flap.Conventionally used groin or abdominal flaps are cumbersome to patients due to extensive dressing and prolonged passive positioning of the hand until pedicle division. Superficial circumflex iliac artery (SCIA) flap is evolved from a traditional groin flap, and because of its thinness, pliability, and concealed donor site, it is an ideal option for single-stage reconstruction of traumatic hand defects avoiding discomforting passive hand position, joint stiffness, and unexpected flap avulsion which were associated with traditional groin flap.All patients with exposed bones or tendons due to traumatic hand injuries who opted for free flap coverage during the year 2018 to 2020 were enrolled in our study. After initial debridement, the wound was covered with a free SCIA flap. Duration of hospital stay, days out of work, the number of dressings required, postoperative complications, and any secondary procedures for flap readjustment were noted till six months postoperatively. A total of eight patients were included in the study. The mechanism of injury was road traffic accidents in a single patient and occupational injury in eight patients. The average duration of hospital stay was six days after reconstructive surgery. The average number of dressings a patient had was 18, and only two patients required flap thinning. Only one patient had a postoperative infection which was managed with dressings and antibiotics. One patient had peripheral flap necrosis. We had zero flap re-exploration. Therefore, we conclude that hand defects coverage with SCIA flap leads to a smaller number of working days lost and rarely requires secondary procedures.