Interphalangeal Joints Of Fingers Research Articles

Time-domain diffuse optical imaging technique for monitoring rheumatoid arthritis disease activity: experimental validation in tissue-mimicking finger phantoms

Objective. Effective treatment within 3–5 months of disease onset significantly improves rheumatoid arthritis (RA) prognosis. Nevertheless, 30% of RA patients fail their first treatment, and it takes 3–6 months to identify failure with current monitoring techniques. Time-domain diffuse optical imaging (TD-DOI) may be more sensitive to RA disease activity and could be used to detect treatment failure. In this report, we present the development of a TD-DOI hand imaging system and validate its ability to measure simulated changes in RA disease activity using tissue-mimicking finger phantoms. Approach. A TD-DOI system was built, based on a single-pixel camera architecture, and used to image solid phantoms which mimicked a proximal interphalangeal finger joint. For reference, in silico images of virtual models of the solid phantoms were also generated using Monte Carlo simulations. Spatiotemporal Fourier components were extracted from both simulated and experimental images, and their ability to distinguish between phantoms representing different RA disease activity was quantified. Main results. Many spatiotemporal Fourier components extracted from TD-DOI images could clearly distinguish between phantoms representing different states of RA disease activity. Significance. A TD-DOI system was built and validated using finger-mimicking solid phantoms. The findings suggest that the system could be used to monitor RA disease activity. This single-pixel TD-DOI system could be used to acquire longitudinal measures of RA disease activity to detect early treatment failure.

Dorso Proximal Interphalangeal Island Flap

Background: This study aimed to demonstrate the clinical application of the dorsoproximal interphalangeal island flap as an alternative approach to skin graft or cross-finger flap to repair lesions at the ventral site at the proximal interphalangeal (PIP) finger joint. Methods: Fifteen patients received flaps (11 men and four women, n = 25 flaps). The repair of volar contracture in finger sequelae after burn injuries was the main indication. Five patients underwent two or more flaps during the same surgical session. The mean patient age was 18 years (range, 7–56 years). Most patients presented with palmar finger contractures of the PIP joint. In three patients, six flaps were rotated to the lateral radial and ulnar proximal surfaces of the finger to treat syndactyly. Results: Most flaps survived and provided satisfactory functional and aesthetic improvement of palmar scar contracture in the PIP region. Postoperative donor site follow-up was normal. The color and pliability of the skin are similar to those of the surrounding area. The follow-up period ranged from 6 months to 12 years. Conclusions: Dorsoproximal interphalangeal island flaps are an option for repairing lesions that lack soft tissue and range in size from 10 × 15 to 12 × 18 mm at the volar site and around the PIP joint. The arch of rotation of this flap allows for lateral, ulnar, and radial rotations around the joint. The indication of six flaps in three patients to repair a proximal lack of tissue caused by syndactyly demonstrated its potential use in this anomaly.

P176 Ixekizumab significantly improves nail disease and adjacent joint tenderness and swelling in psoriatic arthritis

Abstract Background/Aims Nail psoriasis (PsO) is a strong predictor for the development of psoriatic arthritis (PsA) and has been reported in 63-83% of patients with PsA. Psoriatic nails are linked to arthritis in the adjacent distal interphalangeal joint (DIP) of fingers or interphalangeal joint of thumbs, and both can lead to severe functional impairment. In the SPIRIT-H2H study of adults with PsA, 354 of 566 participants had nail PsO and adjacent joint disease in at least one digit at baseline. At the group level, SPIRIT-H2H patients treated with ixekizumab (IXE) achieved significantly greater improvements in nail PsO compared to those treated with adalimumab (ADA). This analysis aimed to assess the treatment effects of IXE and ADA at the individual digit level among patients with PsA, nail PsO, and adjacent joint disease. Methods This post hoc analysis included 354 patients from SPIRIT-H2H (NCT03151551) treated with either IXE (N = 186) or ADA (N = 168) who had nail PsO (Nail Psoriasis Severity Index (NAPSI) total score >0) and adjacent joint disease (tenderness and/or swelling) in at least one digit at baseline. Treatment effects were assessed for each individual finger unit displaying nail PsO and adjacent joint disease; here, finger unit defines the nail and adjacent joint of an individual digit; adjacent joint refers to the DIP of fingers or the interphalangeal joint of thumbs. Nail PsO was measured using NAPSI in the fingers only. Joint involvement was measured by tender/swollen joint count scores (TJC68/SJC66). Patients were evaluated for both nail and joint involvement at baseline and Weeks 12, 16, 24, 32, 40, and 52. Proportions of finger units with resolution of nail PsO, and proportions of finger units with resolution of adjacent joint disease were analyzed using Chi-square tests. Non-responder imputation was used to handle missing data. Results There were 1309 (IXE=639, ADA=670) finger units affected by nail and adjacent joint disease at baseline. Resolution of psoriatic nail disease and resolution of adjacent tenderness and/or swelling of the finger unit was significantly higher with IXE vs ADA at all post-baseline assessments over 52 weeks. Joint tenderness was resolved in a significantly larger proportion of IXE-treated finger units vs ADA at all post-baseline assessments over 52 weeks. Joint swelling was resolved in a larger proportion of IXE-treated finger units vs ADA, and these differences reached statistical significance at all visits except Week 16 and Week 40. The tenderness and/or swelling of the finger unit resolved more rapidly than the adjacent nail disease. Conclusion IXE treatment showed a significant advantage over ADA in resolving nail PsO, joint tenderness, and joint swelling among the finger units with nail and adjacent joint disease of patients with PsA. Disclosure D. McGonagle: Consultancies; D. McGonagle has received consulting fees and/or honoraria and/or research grants from: AbbVie and Eli Lilly and Company. A. Kavanaugh: Consultancies; A. Kavanaugh has received consulting fees and/or honoraria from: AbbVie, Eli Lilly and Company, Janssen, Novartis, Pfizer, UCB Pharma. I. McInnes: Corporate appointments; Vice Principle & Head of College for University of Glasgow, non-executive board member of NHS Greater Glasgow & Clyde, non-executive director of Evelo, and trustee of Versus Arthritis. Consultancies; AbbVie, Amgen, Bristol Myers Squibb, Cabaletta Bio, Causeway Therapeutics, Eli Lilly and Company, Gilead Sciences, Janssen, Novartis, Pfizer, Sanofi Regeneron, and UCB Pharma. L. Kristensen: Grants/research support; AbbVie, Amgen, Biogen, Bristol Myers Squibb, Eli Lilly and Company, Gilead Sciences, Janssen, Merck Sharpe & Dohme, Novartis, Pfizer, and UCB Pharma. J. Merola: Consultancies; AbbVie, Amgen, Biogen, Bristol Myers Squibb, Dermavant, Eli Lilly and Company, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi Regeneron, Sun Pharma, and UCB Pharma. B. Strober: Corporate appointments; Editor-in-Chief for the Journal of Psoriasis and Psoriatic Arthritis and scientific co-director and investigator for CorEvitas Psoriasis Registry. Consultancies; AbbVie, Alamar Biosciences, Almirall, Alumis, Amgen, Arcutis, Arena Pharmaceuticals, Aristea Therapeutics, Asana Biosciences, Boehringer Ingelheim, Bristol Myers Squibb, Connect Biopharma, Dermavant. Shareholder/stock ownership; Connect Biopharma and Mindera. Honoraria; Eli Lilly and Company, Evelo Biosciences, Immunic Therapeutics, Incyte Corporation, Janssen, Kangpu Pharmaceuticals, LEO Pharma, Maruho, Meiji Seika Pharma, Mindera, Nimbus Therapeutics, Novartis. Grants/research support; Pfizer, Protagonist Therapeutics, Regeneron, Sanofi Genzyme, Sun Pharma, UCB Pharma, Union Therapeutics, Ventyx Biosciences, and vTv Therapeutics. R. Bolce: Shareholder/stock ownership; R. Bolce is an employee and shareholder of Eli Lilly and Company. J.R. Lisse: Shareholder/stock ownership; J. Lisse is an employee and shareholder of Eli Lilly and Company. J. Pustizzi: Shareholder/stock ownership; J. Pustizzi is an employee and shareholder of: Eli Lilly and Company. C. Sapin: Shareholder/stock ownership; C. Sapin is an employee and shareholder of: Eli Lilly and Company. C. Ritchlin: Honoraria; AbbVie, Bristol Myers Squibb, Eli Lilly and Company, Janssen, Novartis, Pfizer, and UCB Pharma.

Collodion Baby Progressing to Camisa Syndrome: Case Report and Review of Literature in Asian Population

Palmoplantar keratoderma (PPK) is a broad entity comprising wide range of hereditary and acquired disorders. Herein, we present a case of 18-year-old female who presented with complaints of palmoplantar thickening since birth and progressive constriction bands around digits for 3 years. On examination, diffuse transgradient honeycomb type of PPK was present. Fibrous constriction bands (pseudoainhum) were present circumferentially around the distal interphalangeal joint of fifth finger and metatarsophalangeal joint of fifth toe bilaterally. Punch biopsy from palms revealed hyperkeratotic, stratified squamous epithelium with vacuolar degeneration and prominent keratohyaline granules. Audiogram was normal. On the basis of history, clinical examination and investigations, a diagnosis of Camisa syndrome was made and the patient was started on oral retinoids. We also discussed case findings of Camisa Syndrome reported in Asian population.

Giant cell tumour of tendon sheath (GCTTS) – 2 Most common tumour of hand after ganglion cyst

Probably one of the most common benign neoplasm in the human hand, the Giant Cell Tumour of Tendon Sheath (GCTTS) has been studied by many authors over the years as a popular tumour. There have been studies on the etilogical factors, however, limited attention has been given to etiology, prognostic factors, and recurrence rate. Because there are several factors that predispose to recurrence, it is imperative that medical practitioners ensure complete excision of the tumour, including removal of residual satellite nodules. This study is a focus on 0.5cm swelling over dorsal part of the interphalangeal joint of middle finger of the right hand of a 55-year old female that was initially unilobulated, which eventually increased to 3cm and was bilobed over 6 months. With meticulous dissection and the use of magnification loupe to obtain a low recurrence rate, thereby emphasising the key role of surgery as the first prognostic factor of GCTTS.

Modern aspects in the treatment of intra-articular fractures and fractures of the proximal interphalangeal joints of the three-phalangeal fingers of the hand, as well as their consequences

BACKGROUND: Proximal interphalangeal joint intra-articular fractures are a prevalent problem in traumatology and orthopedics. Damage typically develops at the base of the middle phalanx due to a collision with the head of the proximal phalanx. As a result, the fingers function declines significantly, which inevitably impacts the function of the entire brush. Compared with long-standing injuries, treating patients with this pathology in the acute period of injury is more likely to result in limb function restoration. Suppose an intra-articular fracture is underestimated or missed in the early stages. In that case, the doctor may eventually encounter chronic pain syndrome, joint and/or stiffness, and more time-consuming treatment procedures. There are many methods of treatment for both acute and long-standing injuries, each with advantages and disadvantages.
 OBJECTIVE: To describe, in our opinion, the most effective modalities of therapy for patients with these injuries in the early stages (up to 4 weeks from the time of injury) and long-term periods (more than 4 weeks).
 MATERIALS AND METHODS: The Suzuki external fixation spoke device (pins and rubber traction system [PRTS]) was used to treat 26 patients with fractures and dislocations of the base of the middle phalanx of the three-phalangeal fingers of the hand in the acute period of injury. Arthroplasty of the base of the middle phalanx with a hook bone graft (hemihamate) with its modifications was used in the treatment of 23 patients with inadequately fused intra-articular fractures of the base of the middle phalanx of the three-phalangeal fingers of the hand. All patients underwent physical examinations, X-rays, and/or CT scans to diagnose and confirm or clarify the nature of the damage. All patients developed passive/active movements early in the operated section during the postoperative period.
 RESULTS: The patient estimated the VAS pain syndrome at 46 points on the scale; however, after 68 weeks, this indicator was 01 points. After 68 weeks, the amplitude of movements in the proximal interphalangeal joint of the fingers from the average of 3050 after 68 weeks, was reached the average of 1595. There was a 1520 extensor contracture in two patients.
 CONCLUSION: The treatment of patients with intra-articular fractures and fracture-dislocations in the proximal interphalangeal joint of the three-phalangeal fingers of the hand, as well as their consequences, is a complex current problem in traumatology and orthopedics with no one-word universal solution. To select treatment strategies, a comprehensive evaluation of the patient, correct verification and interpretation of the existing damage, and a thorough understanding of the anatomy of the fingers and the hand are required.

Hand Joint Hypermobility among Dental Students—A Cross-Sectional Study

(1) Background: Joint hypermobility refers to joint movement beyond normal range. Dentistry requires fine motor skills and manual dexterity; thus, the presence of hand joint hypermobility requires early assessment and intervention. The aim of this cross-sectional study was to assess the prevalence of hand joint hypermobility among first-year dental students and investigate correlations between the severity of their hypermobility and muscular strength. (2) Methods: First-year dental students were evaluated by an occupational therapy team composed of certified hand therapists. The extension of distal interphalangeal, proximal interphalangeal, and metacarpophalangeal finger joints was assessed with bilateral testing of digit hypermobility (with a cut-off of >20° for hypermobility) and classified as high, moderate, or low risk according to number/types of joints involved. Muscular strength was assessed by comparing grip strength, lateral pinch, and three-point pinch to norm values. Right- vs. left-handed individuals, and females vs. males were compared with an independent t-test; the relationships between the variables were investigated using the Pearson correlation. (3) Results: Out of 141 dental students (24.6 ± 3.0, 70% females, 87% right-handed), 15% and 16% were classified as having a high and moderate risk of hypermobility, respectively, with no sex difference. Right-handed students scored significantly higher in the right lateral pinch than left-handed students (18.2 ± 4.8 vs. 13.2 ± 4.1, p = 0.045). A higher severity of hypermobility was associated with bilateral lower grip and pinch strength (p < 0.05). (4) Conclusions: One third of the first-year dental students exhibited moderate to severe hand joint hypermobility. Moreover, those identified as having moderate to severe hand joint hypermobility showed a decreased grip strength.

The Clinical Characteristics of Psoriatic Arthritis: A Cross-Sectional Study Based on the Psoriatic Arthritis Cohort of West China Hospital.

This study aims to describe the demographic, clinical, laboratory, and ultrasonic characteristics of patients with psoriatic arthritis (PsA) in the Psoriatic Arthritis cohort of West China Hospital. In this cross-sectional study, we included patients diagnosed with PsA according to the Classification Criteria for Psoriatic Arthritis, collected their demographic information, medical histories, and treatments, evaluated all domains (skin and nail lesions, tenderness, swelling, enthesitis, dactylitis, and axial arthritis) related to PsA, and then performed descriptive statistical analyses of all data. A total of 275 patients with PsA were included in this study. The ratio of male to female patients was 2.16:1. Skin lesions preceded arthritis in 86.5% of these patients with PsA with a mean interval of 10.1years. The metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints of fingers, and sacroiliac joints are the most commonly involved sites of tenderness, swelling, and the spine, respectively. Among all comorbidities, fatty liver has the highest incidence with 33.1%. Finally, we noted that the mean disease duration of PsA was 4.2years, suggesting a delay in the diagnosis of PsA. Our study proposes that the prevalent population of PsA are male patients with psoriasis over 40years of age who have a long disease course. For patients with PsA, MCP, PIP joints of fingers, and sacroiliac joints are the most frequently affected anatomical sites. With respect to comorbidities, the association between PsA and fatty liver and the underlying molecular mechanisms are worthy of further exploration.

Dynamic study of the finger interphalangeal joint volar plate—motion analysis with magnetic resonance cinematography and histologic comparison

ObjectiveWe aimed to further improve knowledge about volar plate (VP) motion of the finger proximal interphalangeal joint (PIP), by analyzing the dynamic VP shape during a full range of finger flexion using magnetic resonance cinematography of the fingers (MRCF), and to compare the results with anatomical cross sections from cadaver specimens.Materials and methodsThe dynamic sagittal VP shape was visualized with MRCF in a total number of 23 healthy volunteers. The length, angle, and thickness as well as the contact length of the VP to the PIP joint base were measured. Statistical analysis included t-test or rank-sum testing. Anatomical cross sections with differing degrees of PIP joint flexion were obtained from 12 cadaver specimens (fingers) for comparison.ResultsSignificant positive correlations between PIP joint flexion angle and VP area, length, depth and the VP contact length were found. This matched histologically to fiber rearrangements especially within the loose third VP layer.ConclusionOur study analyzed the full range of motion dynamic VP shape of the PIP joint using MRCF. This contributes to a more precise understanding of the complex interaction of the VP with the PIP joint and may facilitate evaluation of clinical cases such as VP avulsion or pulley rupture.

A Very Rare Case of Juvenile Dermatomyositis with Typical Cutaneous Clinical Signs

A Very Rare Case of Juvenile Dermatomyositis with Typical Cutaneous Clinical Signs

Role of Low-Level Laser Therapy as an Adjuvant in Functional Rehabilitation of Patients with Joint Stiffness in Post-Burn Contracture

Introduction Post-burn contracture is a known sequelae of burn injuries involving neck, axilla, elbow, and hand. There are many methods which are used as adjuvant in rehabilitation of post-burn contracture patients. The low-level laser therapy (LLLT) is one of the methods that can be used as an adjuvant in rehabilitation of joint stiffness following burns and but with very few data available from India. In this article we share our experience of using LLLT for functional rehabilitation of a patient with joint stiffness following postburn contracture. Materials and Methods This study was conducted in a burns centre in a tertiary care institute in South India. Informed consent and departmental ethical committee clearance were obtained prior to study. The subject was a young boy with no known co-morbidities with stiffness of metacarpophalangeal and interphalangeal joint of index and middle finger of right hand. Patient was treated with contracture release with full thickness skin graft. The patient received low-level laser therapy to induce collagenolysis and to increase the movement of the joints. Each joint received laser therapy for duration of 125-second every time for 15-minutes for 2 sessions in a span of 4-days. Result LLLT has been found to be useful in early rehabilitation of post-burn contracture patients with joint stiffness. No side effects were observed during the study. Conclusion The LLLT is an effective, safe, and non-invasive adjuvant in functional rehabilitation of our patient with joint stiffness following post-burn contracture. We suggest further study including multiple subjects and a control group for validation of the result.

Septic arthritis of the hand: From etiopathogenesis to surgical treatment.

Septic arthritis of the hand, which is the second most common after damage of the knee joint, remains one of the leading causes of temporary disability. An inflammation can cause dysfunction of the joint, and in the most severe cases, the need for amputation of the finger may arise. The results of their treatment today, especially from a functional point of view, cannot be considered satisfactory. Urgent surgical treatment is extremely important in septic arthritis of the hand, as it helps to prevent cartilage destruction and the development of osteomyelitis. To explore the features of the course of septic arthritis of the hand as well as approaches to surgical treatment and its results, depending on the nature of the damage to the articular structures. The results of the treatment of 170 patients with septic arthritis of the hand, which were treated in the period of 2020-2021, were analyzed. Inflammation of the interphalangeal and metacarpophalangeal joints (MCP) of fingers 1, 2, and 3 was more often noted in 147 (81.6%) joints. The most common cause of arthritis was a penetrating injury as a result of household trauma (101, 59.4%), animal bite (30, 17.6%), and clenched fist injury (15, 8.8%). Septic arthritis with contiguous osteomyelitis was observed in 98 (54.4%) cases. Surgical treatment was completed with drainage and irrigation of the joint. Early mobilization was used to restore function. In patients with osteomyelitis, it was aimed at the formation of neoarthrosis. Arthrodesis was not applied. Long-term results of treatment were assessed in 142 (83.5%) patients within 1 mo to 12 mo after discharge from the hospital [the median was 7 mo (IQR: 4-9)]. The most commonly isolated organism was Staphylococcus aureus (35.3%). The median treatment delay in patients without osteomyelitis was 5 d (IQR: 4-7); for septic arthritis with contiguous osteomyelitis, it was 14 d (IQR: 5-21). Radiography for osteomyelitis within 2 wk was uninformative: 41.2% of diagnoses. A single surgical treatment was required in 138 (81.2%) patients, two treatments in 22 (12.9%), and three or more in 10 (5.9%). Total elimination of the infection was achieved in 163 (95.9%) patients. The best functional results of treatment were noted in patients without osteomyelitis. After septic arthritis, Total Active Motion (TAM) for the MCP was 96.2% (IQR: 85.1-98.0), for the proximal interphalangeal joint (PIP) 82.4% (IQR: 54.5-98.5), and for the distal interphalangeal joint (DIP) 69.4% (IQR: 65.4-74.1). In cases with osteomyelitis, it was possible to achieve the formation of neoarthrosis with TAM for MCP-64.2% (IQR: 45.3-90.1), for PIP-62.5% (IQR: 41.8-68.9), and for DIP-59.4% (IQR: 50-62.1). Additionally, the severity of pain during movements did not exceed 1 point. The delay in treatment of patients with septic arthritis of the hand was accompanied by a high incidence of osteomyelitis, especially in the presence of diabetes mellitus. Urgent surgical treatment, along with continued irrigation of the joint and antibiotic therapy, made it possible to eliminate the infection, and early rehabilitation restored the range of motion. The best results were noted in patients without osteomyelitis. With the development of osteomyelitis, a complex of early rehabilitation measures also made it possible to partially restore the range of motion due to the formation of neoarthrosis, without resorting to arthrodesis.

TU7.11 Skin Grafts Vs. Local Skin Flaps in Management of Contracted Scar Finger

Abstract Introduction In our study, we reviewed the outcome of using skin grafts and different regional flaps of the hand in order to correct flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers. In both techniques, vigorous postoperative exercises were advised for an interval of time between 3–6 months. Patients and Methods 16 patients were included. All the scar tissue was excised, and the resultant raw area was covered. In Group A consisting of 8 patients, skin grafts were used. Split thickness grafts were selected in 3 cases and full thickness grafts in 5 cases. While in group B, Z-plasty and Cross finger regional flaps were used in 4 cases per each flap. The cause of the contracture was thermal burn in 8 patients, mechanical trauma in 7 cases, and a case of contracture secondary to dupytrene's disease. The mean follow-up period was 6 months. Results The mean flexion contracture/further flexion in the joints were improved markedly at the last follow-up. More extension was gained by exercising after the operation. Near full ROM was achieved in 15 cases with strong hand grip and cosmetic satisfaction. There were no major complications. Conclusion Wise selection between different skin grafts and regional skin flaps is important, to achieve best outcome in managing finger contractures and gain satisfactory ROM. Choosing the best reconstruction method depend on the size, extent and depth of the raw area. Exposure of the deep structures is an indication to use skin flaps over grafts. Vigorous extension exerc

UPDATED PREDICTION MODEL FOR PROGRESSIVE RADIOGRAPHIC FINGER INTERPHALANGEAL JOINT OSTEOARTHRITIS

Purpose: A previously developed prediction model for radiographic finger interphalangeal joint (IPJ) osteoarthritis was developed within the Chingford 1000 Women Study. The Chingford Study is a prospective population-based cohort study of women only. Risk factors included in the original prediction model were age, occupation, base of thumb osteoarthritis, body mass index, and family history of hand osteoarthritis. The model was only weakly able to predict which participants would have IPJ osteoarthritis progression, and the model performance was poor (discrimination: 0.57, calibration: 1.38), suggesting that other risk factors might exist.

Restoration of function in interphalangeal finger joints at injury sequelae by modified hinge-distraction device

Seventy eight patients with sequelae of interphalangeal finger joint injuries ( long-standing dislocations, fracture-dislocations, peri- and intracapsular fractures, contractures) were treated by modified hinge-distraction devices. In 1-3 years follow up outcomes were evaluated in 71 patients. Good results were achieved in 68 cases (95.8%). Use of our hinge-distraction devices excluded the superfluous mobility, provided the main axis of articular ends motion, volume constancy of the articular split as well as the possibility of active and passive movements that gave adequate conditions for the restoration of osteoarticular structures as well as surrounding soft tissues.

Intraneural glomus tumor within the digital nerve: a case report

A glomus tumor is a soft tissue tumor that arises from the glomus body, a peripheral organ responsible for regulating skin temperature. It accounts for about 1% to 5% of tumors occurring in the hand, is mainly located in the subungual region, and is less than 1 cm in size. The diagnosis is mainly based on clinical symptoms, and the main symptoms are pain at the site of the glomus tumor, pinpoint tenderness, and cold intolerance. The pain is severe and usually requires surgical resection, and the results of complete resection of the tumor are good. This case report presents a 37-year-old female patient who developed pain in the radial side around the proximal interphalangeal joint of the right second finger without any traumatic history. On physical examination and imaging, a glomus tumor of the digital nerve was diagnosed and resected. After surgery, the symptoms improved and there was no recurrence. A careful examination and accurate diagnosis and treatment are necessary for symptomatic masses.

Progressive pseudo-rheumatoid dysplasia -a rare genetic disorder: Case Report

Progressive pseudorheumatoid dysplasia (PPRD), also known as spondyloepiphyseal dysplasia tarda with progressive arthropathy (SEDT-PA), is an autosomal recessive disorder, resulting from mutations in the WNT1-inducible signaling pathway protein 3 (WISP3) gene involving the axial skeleton as well as small peripheral joints. Because of rarity here we present a case of 14-year-old boy, 1st issue of consanguineous parents who was presented with pain & gradual development of contracture in 3rd distal interphalangeal joint of right hand when he was 4-year-old, then gradual involvement of other interphalangeal joints of hands, bilateral wrists, elbows, shoulder, knees &ankles occurred over years with the development of contractures and restricted movement. For last few years, he developed difficulty in walking. Clinically spinal scoliosis and coxa vara was present. Mobility of spines and multiple joints including proximal & distal interphalangeal joints of hands, wrists, elbows, shoulders, knees, ankles were restricted with flexion contractures. The gait of the patient was limping. Radiological evaluation showed osteopenia in X-ray of pelvis with both hip joints and both knee joints. Generalized osteopenia, fusiform swelling in distal interphalangeal joint, flexion deformity in distal interphalangeal joint of middle and ring fingers of both hand was shown in X-ray of both hands. MRI of lumbosacral spine showed dorso-lumbar vertebral bodies dysplastic with anterior wedging producing bullet nose. Superior epiphyseal deformity was also noted in lower dorsal bodies suggestive of spondyloepiphyseal dysplasia of dorso-lumbar spine. Genetic study showed homozygous nonsense variation in exon 5 of the WISP3 gene suggestive pathogenic variant. Finally, he was diagnosed as a case of PPRD and treated with physiotherapy, family counseling, and anti-inflammatory medications.
 AKMMC J 2022; 13(1) : 52-55

Outcomes of Acute Operative Repair of Complete Digital Proximal Interphalangeal Joint Collateral Ligament Ruptures: A Systematic Review.

Background: No consensus exists regarding the management of complete collateral ligament injuries of the proximal interphalangeal joint (PIPJ) of fingers. Methods: We aimed to systematically review the outcomes of Acute (< 1 month) surgical repairs of these injuries. Outcomes assessed included Stability, Pain, Range-of-Motion and Return to Function. The Modified Coleman Methodology Score (MCMS) was utilised in critical appraisal. Results: 70 patients with complete collateral ligament injuries of the PIPJ were identified in 5 studies. 49 were managed operatively and 21 non-operatively. All trials were methodologically flawed with a mean MCMS of 50.4, corresponding to a "Poor" Level of evidence. Conclusions: Whilst acute surgical repair of complete collateral ligament injuries of finger PIPJs are a described viable management option with promising results, there is insufficient high-quality evidence to inform current practice. Based on the current literature, no evidence-based conclusions can be made regarding superiority of acute surgical repair over conservative management or one method of surgical repair over another. Further high level studies are required.

Treatment of Fracture-Dislocations of Proximal Interphalangeal Joint by Applying of Dynamic Mini External Fixator: Clinical and Radiographic Results.

Fracture-dislocations of the proximal interphalangeal joint of fingers are believed to be challenging injuries that usually lead to residual pain and stiffness. To date, several treatment options have been applied. Dynamic traction-external fixation is a safe and easy technique offering good results in many works of literature. The dynamic mini external fixator using K-wires and mini rods provide sufficient dynamic traction and facilitate early mobilization of the injured joint. The present study was conducted to evaluate the results of a dynamic mini external fixator for the treatment of those lesions. In total, 40 patients who suffered from proximal interphalangeal fracture-dislocations were treated at our institution between November 2017 and November 2019. Dynamic mini external fixator device was utilized for their treatment. Clinical and radiographic parameters were evaluated at 2, 4, 6, 12, and 24 weeks after surgery. This study included 30 (75%) males and 10 (25%) females with a mean age of 38.7±9.9 years. In total, 6 (15%) patients had concomitant fractures or fractures in their hands. All the fractures, including 27 (67.5%) dorsal fracture-dislocations and 13 (32.5%) Pilon fractures, were united without the occurrence of any malunion or major residual subluxation. One Pilon fracture needed to be realigned by reassembling the device at the second week of follow-up. Furthermore, 36 (90%) patients achieved full range of joint motion, and 4 (10%) patients had mild loss of motion arc. In addition, 8 (20%) patients developed mild pin site infection treated with oral antibiotics without device removal. Following six months, one (2.5%) patient mentioned minimal residual pain. The dynamic mini external fixator was found to be a safe and applicable technique to manage proximal interphalangeal fracture-dislocations. To obtain significantly accurate results, regular follow-up and accurate device care are of great necessity.

AMRTA-X: Grasp Kinematic Analysis during Myoelectric Prehension Orthosis and Body Powered Prehension Orthosis's Usage on Brachial Plexus Injury Patients

Brachial Plexus Injury (BPI) results in decreased motor function in upper extremity and leads to reduced hand grasping movement. Orthotic prehension is designed to create artificial grasp movements in paralyzed hand. This study was to compare grasp kinematic improvement between body powered and myoelectric prehension orthosis usage in patients with BPI. This study was a single group without control and post test with experimental study. The subjects of the study (n = 11) were brachial plexus injury patients with non-functional hand strength. Joint motion and angular velocity of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint of index finger were evaluated. There was an improvement in joint motion and angular velocity after both orthosis usage. Joint motion in MCP and PIP, Angular velocity in MCP were not significantly different between myoelectric and body powered and myoelectric prehension orthosis usage. PIP angular velocity improvement were better after body powered prehension orthosis usage (p= 0.03).In conclusion, body powered and myolectric prehension orthosis usage improved kinematic parameter of index finger’s MCP and PIP joint. PIP angular velocity was better after body powered prehension orthosis usage.