Little Finger Research Articles

Hypercalcemia: An Ominous sign of Malignancy

Hypercalcemia is a disorder commonly encountered by primary care physicians. The diagnosis often is made incidentally in asymptomatic patients Clinical manifestations affect the neuromuscular, gastrointestinal, renal, skeletal, and cardiovascular systems. 90% of cases of hypercalcemia are due to primary hyperparathyroidism and malignancy. This article highlights the importance of proper work-up of elevated serum calcium levels and complications that can arise from failure to do so. This is a case report of a 63-year-old female who was found to have asymptomatic hypercalcemia of 10.5 mg/dl but was lost to follow up and presented four years later to her primary care physician with complaints of pain in the neck and weakness in bilateral shoulders, arms, wrists, and numbness of 4th and 5th digits. MRI revealed lytic lesions on the cervical and thoracic spine with compression deformity likely due to metastatic breast cancer. Lab reports revealed a serum calcium level of 12.1mg/dl and the patient’s chart (mammogram/ breast US) confirmed malignant breast cancer.

Deep Learning Techniques Applied to Predict and Measure Finger Movement in Patients with Multiple Sclerosis

This research focuses on the development of a system for measuring finger joint angles based on camera image and is intended for work within the field of medicine to track the movement and limits of hand mobility in multiple sclerosis. Measuring changes in hand mobility allows the progress of the disease and its treatment process to be monitored. A static RGB camera without depth vision was used in the system developed, with the system receiving only the image from the camera and no other input data. The research focuses on the analysis of each image in the video stream independently of other images from that stream, and 12 measured hand parameters were chosen as follows: 3 joint angles for the index finger, 3 joint angles for the middle finger, 3 joint angles for the ring finger, and 3 joint angles for the pinky finger. Convolutional neural networks were used to analyze the information received from the camera, and the research considers neural networks based on different architectures and their combinations as follows: VGG16, MobileNet, MobileNetV2, InceptionV3, DenseNet, ResNet, and convolutional pose machine. The final neural network used for image analysis was a modernized neural network based on MobileNetV2, which obtained the best mean absolute error value of 4.757 degrees. Additionally, the mean square error was 67.279 and the root mean square error was 8.202 degrees. This neural network analyzed a single image from the camera without using other sensors. For its part, the input image had a resolution of 512 by 512 pixels, and was processed by the neural network in 7–15 ms by GPU Nvidia 2080ti. The resulting neural network developed can measure finger joint angle values for a hand with non-standard parameters and positions.

What's the resolutive surgery for pseudo-ainhum in Vohwinkel syndrome? A case report and review of the literature.

Vohwinkel Syndrome, also known as Keratoderma Hereditarium Mutilans, is an extremely rare dominant autosomal keratosis. It typically presents with “starfish” keratoses on the knuckles, palmoplantar keratoderma (PPK), hearing impairment and mutilating digital constriction bands (pseudoainhum) that cause strangulation, often leading to autoamputation of the affected digit. Both medical and surgical treatment haven’t shown to date consistent results, in the treatment of pseudoainhum. In this study we present the case of a woman with Vohwinkel syndrome who showed constriction bands causing ischemic changes of the 5th digit of the right hand for which she was treated with surgery. We also present a review of the literature for the management of this disease.

Congenital Right Hand Syndactyly in a child: Plain Radiographic Features and Case Report

Syndactyly is a Greek word meaning fused digits, may involve fusion of the soft tissues with or without bony fusion. It is regarded as the most common congenital defect of the hand, detected in 1 out of every 2000 live births, twice as common in males, and more among the Caucasians. This is a 10-month-old male infant that was referred for plain radiograph of the right hand on account of completely fused 2nd to 5th digits and an incompletely fused 1st digit with medial deviation since birth. The plain radiograph showed soft tissue fusion of the 2nd to 4th web spaces completely with a partially fused 1st web space. There is associated fusion of the distal phalanges of the 4th and 5th digit, foreshortening of the 3rd and 4th metacarpals with the middle phalanges of the 2nd and 5th digits. There is flexion of the interphalangeal joint and medial deviation of the 1st digit. There is also haphazard arrangement of the metacarpals and phalanges most especially the 3rd and 4th digits. Prominence of the thenar and hypothenar eminences with mild ulnar deviation of the entire right hand were also demonstrated. The contralateral left hand appears within normal limits, a complementary ultrasound showed normal abdominal organ situs. A diagnosis of congenital syndactyly most likely the complex-complicated form in a 10-month-old infant was established. The surgical repair to establish function and achieve excellent aesthetics was deferred until the child clocks about 24-months of age. We report a case of congenital syndactyly of the right hand due to its radiographic form of presentation in this 10-month-old infant.

Upper extremity injuries in the victims of intimate partner violence.

ObjectivesTo recognize most common patterns of upper extremity (UE) injuries in victims of Intimate Partner Violence (IPV).MethodsRadiological review of 308 patients who reported physical IPV at our institution from January 2013 to June 2018, identified 55 patients with 88 unique UE injuries. Demographic data and injury patterns and associations were collected from the electronic medical records.ResultsThe cohort included 49 females and 6 males (age 19–63, mean 38). At the time of injury, IPV was reported in 15/88 (17%) and IPV screening was documented for 22/88 (25%) injuries. There were 46 fractures, 8 dislocations or subluxations, and 34 isolated soft tissue injuries, most commonly involving the hand (56/88). Fractures most commonly involved the fingers (21/46, 46%) and the 5th digit (8/27, 30%). Medial UE fractures (5th digit, 4th digit) constituted 44% of hand and finger fractures (12/27) and 26% of all fractures (12/46). Comminuted and displaced fractures were rare (8/46, 17%). Head and face injuries were the most common concomitant injuries (9/22, 41%) and subsequent injuries (21/61, 35%). Of 12 patients with recurrent UE injuries, 6 had recurrent injuries of the same hand. Five of 6 non-acute fractures (83%) were of the hand.ConclusionsHand and finger injuries are the most common UE injuries in patients with IPV, with finger being the most common site and medial hand the most common region of fracture. Repeated injuries involving the same site and a combination of medial hand and head or face injuries could indicate IPV.Key Points • Upper extremity injuries in victims of intimate partner violence are most commonly seen in the hand and fingers. • Fingers are the most common site of fracture and the medial hand is the most common region of fracture in the upper extremity in victims of intimate partner violence. • In intimate partner violence victims with upper extremity injuries, concomitant injuries and subsequent injuries are most commonly seen in the head and neck region.

Analysis of finger and toe prints and their corresponding correlations in the anioma people of Nigeria

Background: A comparison of the finger and toe ridge patterns can reveal their genetic interdependence. This cross-sectional study aimed at analyzing and correlating the corresponding finger and toe ridge counts. Materials and Methods: The hands and feet of 100 subjects (50 males and 50 females) from the Anioma tribe of Nigeria were scanned with Hewlett placard G4010 photo scanner following ethical approval. Evaluation of the finger and toe prints was carried out using AutoCAD version 2010. Data were analyzed using the Statistical Package of the Social Sciences version 23 and presented using descriptive statistics. Chi-square test was used to test for association between nonparametric variables while Pearson's correlation was used to assess for the relationship between corresponding finger and toe ridge counts. P < 0.05 was considered statistically significant. Results: The predominant finger and toe ridge patterns were loops (73%, 79.7%) followed by arches (18.4%, 15.1%) and finally whorls (8.6%, 5.2%). There was a significant association between gender and the combined print patterns of all the five digits on a limb (P ≤ 0.05). A significant positive correlation existed between the mean ridge counts of some of the corresponding fingers and toes in females. This correlation was weak in the corresponding 1st right and 1st and 3rd left digits (0 < r < 0.5) (P ≤ 0.05) and strong in the corresponding 3rd to 5th right digits and 2nd, 4th, and 5th left digits (0.5 ≤ r < 1) (P ≤ 0.05). Conclusion: The study has clearly shown that sexual dimorphism is displayed only by a combination of the print patterns in all digits of a limb as against individual digits. Using correlation of digital mean ridge counts, the right 3rd to 5th and the left 2nd, 4th, and 5th digits from either the hand or the foot in females can be used to predict the corresponding digit among the Anioma people of Nigeria, hence their importance in forensic sciences.

A variation: An extra tendon of extensor digitorum in between fourth and fifth digit in left hand

Introduction: Tendon variation of Extensor Digitorum muscle was observed in a 48yr old male formalin fixed cadaver, during the dissection at Anatomy Dissection hall. The tendons of Extensor Digitorum muscle shows anatomical variation most often and its knowledge is important to assess the diseased and traumatized hand. Incidences have shown that tendons of ED may be variably deficient but more often they are doubled or even tripled in one or more digits. The incidences of doubling are higher in index finger or in the middle finger. Very rarely a slip of tendon passes to the thumb. Methods: Regular dissection at Anatomy Dissection Hall. Result & Conclusion: In this present case in left forearm, the origin of muscle was normal but its tendon divides into five proximal to wrist which pass through a common synovial sheath deep to the Extensor Retinaculum. The extra tendon is in between 4th and 5th digit. The right forearm does not show any anatomical variation. This type of variation is rarely found. This particular variation is important for clinical perspective. This case study is useful for surgeons performing Tendon Graft Operations or Tenoplasty.

A Frameshift Variant in KIAA0825 Causes Postaxial Polydactyly

Postaxial polydactyly (PAP) is characterized by counterproductive 5th digit (pinky finger) duplication on hands and/or feet which often leads to functional complications. To date, at least 11 genes involved in causing various types of nonsyndromic polydactylies have been reported. In the present study, a consanguineous family of Sindhi origin with a segregating nonsyndromic form of PAP in an autosomal recessive manner was clinically and genetically evaluated. Genotyping, using polymorphic microsatellite markers, established linkage in the family on chromosome 5q15 harboring the KIAA0825 gene (MIM 617266). Sequence analysis of the gene revealed a novel frameshift variant leading to a premature stop codon [c.143delG, p.(Cys48Serfs*28)]. This is only the 4th novel variant in the KIAA0825 gene that leads to PAP type A10 (PAPA10) (MIM 618498). Identification of variants in the PAP causative gene will support the diagnosis of patients with limb malformations in the Pakistani population.

Hypothenar Island flap: a safe and excellent choice for little finger defects

Objective The aim was to evaluate the functional and cosmetic results of hypothenar island flap for the reconstruction of little finger defects and to assess them by follow-up. Background Reconstruction of soft-tissue defects of little finger of the hand needs a single-stage procedure that can provide well-vascularized coverage at the earliest stage to give the best functional result. Patients and methods This follow-up study that included 19 patients (13 men and six women) was carried out in the Plastic and Reconstructive Surgery Departments of Menoufia University and Helmia Military Hospital from October 2017 to October 2019, with assessment by a follow-up period of 12 months and physiotherapy. All the patients studied had the hypothenar island flap for coverage of the defects. The defects were due to postblunt trauma in three cases, post-burn in three cases, and post-sharp trauma in 13 cases. The largest flap was 20 × 15 mm2. The donor site was directly closed in all cases. Results The overall results were satisfactory regarding the function and appearance without major complications according to patient and doctor satisfaction. Regarding flap course and survival, 14 (73.7%) flaps passed uneventfully, five (26.3%) flaps suffered from venous congestion, five congested flaps survived without total loss and only partial loss and thus we had 19 (100%) survived flaps. Conclusion Hypothenar island flap is a reliable and versatile source for coverage of soft-tissue defects of little finger of the hand.

Chronic Ischemic Monomelic Neuropathy after Arteriovenous Fistula Creation: A Unique Presentation of Vascular Steal

We discuss a case of a 58 year old male who presented for left upper extremity steal syndrome including ischemic monomelic neuropathy (IMN) 1.5 months after arteriovenous fistula creation. He presented after three surgical attempts to salvage his fistula with rest pain, complete loss of function with contracture of the 4th and 5th digits, and loss of sensation in the ulnar distribution for more than three weeks. At our institution, he underwent surgical ligation of the distal fistula and creation of a new fistula proximally, resulting in complete resolution of his vascular steal symptoms almost immediately despite the chronicity prior to surgical presentation. Our patient provides a unique perspective regarding dialysis access salvage versus patient quality of life. The patients’ functional status and pain levels should take precedence over salvage of an arteriovenous access site, and early ligation of the access should be completed prior to chronic IMN development. However, if a patient presents late along the IMN course, we recommend strong consideration of access ligation in order to attempt to regain the full neurovascular function of the extremity as we experienced in our patient.

Not Your Ordinary Cause Of Hand Pain

HISTORY: An 18-year-old senior high school football player sustained an avulsion fracture to the left 5th digit proximal phalanx on October 2018 during practice which was treated with an ulnar gutter cast for 6 weeks. He played through the remaining football season and baseball season, after which, he presented to the clinic with what he felt was instability in his left hand. He reported no new trauma. Upon examination, there was mild tenderness in the 5th digit and tenderness localized to the head of the 4th metacarpal. The patient denied numbness, weakness, swelling, or bruising to the site of pain, but endorsed clicking of the 4th digit when making a fist and opening his had again. PHYSICAL EXAMINATION: Mild Boutonierre's deformity of 5th. Full ROM with all finger motions. Snapping sensation when going from fully flexed position in 4th digit to fully flexed position. Tenderness to palpation at 5th digit PIP and at 4th digit just proximal to MCP. Slightly more movement with anterior - posterior translation of the 4th metacarpal dorsally compared to the proximal phalanx. Sensation intact to light touch. DIFFERENTIAL DIAGNOSIS: 1. Stress fracture 2.Trigger Finger 3. Dieterich’s Disease 4. Bone Contusion 5. Improper rehab from initial splint immobilization from original injury TEST AND RESULTS: X-rays: Interval healing of nondisplaced fracture of the fifth digit proximal phalanx. Cystic lesion of the head of the fourth metacarpal not evident on the comparison study. MRI: Abnormality of the 4th metacarpal head including articular surface flattening with adjacent subcortical marrow edema bordered by linear somewhat serpiginous hypointense signal, perhaps sclerosis, and with some tiny subchondral cystic foci as well. Small amount of T2 hyperintense marrow signal in the visualized distal shaft of the 4th metacarpal as well. Small 4th MCP joint effusion. FINAL/WORKING DIAGNOSIS: Dieterich’s Disease (avascular necrosis of the metacarpal head) TREATMENT AND OUTCOMES: 1.Curettage of avascular necrosis and autogenous bone graft from distal radius, internal Fixation of metacarpal with K-wire and Ulnar gutter splint 4. Removal of K-wire at 6 weeks, application of ulnar gutter OT brace. 5. Home OT with ROM and muscle strengthening exercises. 6. Formal OT. Patient regained full function of the hand and returned to sports.

Picornaviral polymerase domain exchanges reveal a modular basis for distinct biochemical activities of viral RNA-dependent RNA polymerases

Picornaviral RNA-dependent RNA polymerases (RdRPs) have low replication fidelity that is essential for viral fitness and evolution. Their global fold consists of the classical "cupped right hand" structure with palm, fingers, and thumb domains, and these RdRPs also possess a unique contact between the fingers and thumb domains. This interaction restricts movements of the fingers, and RdRPs use a subtle conformational change within the palm domain to close their active sites for catalysis. We have previously shown that this core RdRP structure and mechanism provide a platform for polymerases to fine-tune replication rates and fidelity to optimize virus fitness. Here, we further elucidated the structural basis for differences in replication rates and fidelity among different viruses by generating chimeric RdRPs from poliovirus and coxsackievirus B3. We designed these chimeric polymerases by exchanging the fingers, pinky finger, or thumb domains. The results of biochemical, rapid-quench, and stopped-flow assays revealed that differences in biochemical activity map to individual modular domains of this polymerase. We found that the pinky finger subdomain is a major regulator of initiation and that the palm domain is the major determinant of catalytic rate and nucleotide discrimination. We further noted that thumb domain interactions with product RNA regulate translocation and that the palm and thumb domains coordinately control elongation complex stability. Several RdRP chimeras supported the growth of infectious poliovirus, providing insights into enterovirus species-specific protein-protein interactions required for virus replication.

Hand Injury - Basketball

HISTORY: 16-year-old male presenting with left thumb injury. Patient presented due to thumb injury during basketball 5 weeks prior to presentation. He reported a basketball was thrown extremely hard and hit him on the lateral side of the thumb, pushing his thumb towards his 5th digit. Despite pain, he was able to finish the game. He had noticeable swelling when the game ended. Despite icing, he continued to have swelling in addition to pain with pinching items or texting. This led him to the urgent care 1 week prior to presentation. X-rays were obtained at the urgent care and he was sent to sports medicine clinic. PHYSICAL EXAMINATION: Examination of left hand showed noticeable deformity at MCPJ, with proximal phalanx appearing subluxed on MC. Flexible deformity on radial aspect of the thumb MCP joint. Tenderness to palpation over the radial side of the MCP joint where there is a prominence. No swelling or bruising. Full range of motion of the thumb without limitation. Strength 4/5 with thumb flexion, extension, abduction, adduction. Pain with thumb manual muscle strength testing. Stable to UCL stress at 0 and 30 degrees. RCL laxity at 0 and 30 degrees without clear endpoint. Normal thumbs up and okay sign. Normal thumb to pinky opposition. Normal grip. Neurovascularly intact. DIFFERENTIAL DIAGNOSIS: 1.Radial collateral ligament tear 2.Flexor pollicis brevis tear 3.1st proximal phalanx fracture 4. Sesamoid fracture TESTS AND RESULTS: XR Left Hand Impression: No fractures identified. Subluxation of thumb at MCP joint. MRI Left Hand Impression: Complete disruption of radial collateral ligament of the MCP joint of the thumb with ulnar subluxation of the phalanx compared to the metacarpal. Significant joint fluid. Ulnar deviation of the flexor policis longus and sesamoids. Some marrow edema of the distal metacarpal as well as subchondral bone of first phalanx. FINAL/WORKING DIAGNOSIS: Chronic radial collateral ligament rupture at metacarpal level TREATMENT AND OUTCOMES: 1.Surgical radial collateral ligament repair 2.Initially immobilized with thumb spica splint 3.Casted from 1-5 weeks post operatively 4.Out of cast at 5 weeks post op out; into OT formed hand-splint and range of motion exercises started 5.Follow up planned 9 weeks post-op. Work with OT to achieve full, painless ROM and normal strength prior to returning to basketball

MON-917 Carney Complex Due to a Contiguous Gene Deletion Syndrome (17q24.2-17q24.3)

BackgroundWhile genomic rearrangements of chromosome 17 are not uncommon, deletions of chromosome band 17q24.2-q24.3 are rare, and associated features include cardiac abnormalities, characteristic facial appearance, short stature, obesity, syndactyly, intellectual disability, seizures, delayed dentition, and features of Carney Complex. It has been suggested that the involvement of KCNJ2, PRKCA, CACNG gene cluster (CACNG1, CACNG4, CACNG5), and PRKAR1A genes contribute to this phenotype. A case of a child with a 3.7 Mb deletion at chromosome band 17q24.2-q24.3, as well as a 2.1 Mb gain at chromosome 17q22, is described.Clinical CaseA now 6 year old female was born at 34 weeks gestational age with prenatal course complicated by oligohydramnios and intrauterine growth restriction. Birth weight was at the 9th percentile, and birth length was at the 92nd percentile. She was noted to have a patent ductus arteriosus (PDA), poor suck and swallow, and dysmorphic features. Chromosome microarray revealed a 3.7 Mb deletion at Chromosome 17q24.2-q24.3, involving KCNJ2, PRKCA, CACNG gene cluster (CACNG1, CACNG4, CACNG5), and PRKAR1A, as well as a 2.1 Mb gain at Chromosome 17q22, involving C17orf112 and KIP2B.At 6 years old, she continues to be small for weight (-4.5 SDs), BMI (-4.22 SDs), and height (-2.5 SDs), though with appropriate pre-pubertal linear growth velocity. She is minimally verbal and continues to receive physical, occupational and speech therapies. Examination showed dysmorphic facial features, including triangular face with pointed chin, prominent forehead with low-set ears, retro-micrognathia, almond-shaped eyes with up-slanting palpebral fissures, bulbous nose, thin lips, and irregularly-shaped teeth. She had bilateral 5th digit clinodactyly, tapering of the distal aspects of bilateral first digits of the hands, and syndactyly of bilateral 2nd/3rd digits of the feet. She had scant freckling over the nasal bridge and cheeks, as well as freckles of the left arm, left groin, and back. She had no clinical stigmata of hypercortisolism. Echocardiogram continues to show a PDA with no cardiac myxomas. Thyroid ultrasound was normal. However, she does have mild hypercalcemia, most recently 2.61 mmol/L (2.15-2.55), and mildly elevated alkaline phosphatase of 341 U/L (96-297).ConclusionThis case highlights a child with many of the previously reported findings associated with 17q24.2-q24.3 deletions. However, she also was noted to have a 2.1 Mb gain at chromosome 17q22 involving C17orf112 and KIP2B genes, which have not yet been associated with a clinical phenotype. It is therefore unclear if her phenotype is partially explained by the chromosomal gain. Clinicians should suspect a contiguous gene deletion syndrome in a patient with Carney Complex and atypical features. Patients with this condition have also been described as “Carney Complex-plus”, a term that we do not recommend be used.

GENDER ORIENTED VARIATIONS IN THE FINGER FLEXION CASCADE IN NORMAL INDIVIDUALS

Background: A normal Finger Flexion Cascade (FFC) is formed by the fingers of the hand when the hand in a relaxed position. Usually, the fingers of the hand assume a flexed position; gender may influence the normative values of the resting hand due to differences in the anatomical structure of hand and frequency of usage of joints of hand in their respective occupation and habitual activities of daily living. Hence the study aims to find the difference in the FFC between men and women in power grip and nonpower grip occupational activities.Methods: A cross-sectional study was conducted in a mixed population of five hundred active individuals aged between 25 and 40 years belonging to various occupations of industrial work and individuals working with software companies. Individuals who fulfilled the inclusion criteria participated in the study. After completing a questionnaire based on occupation, the subjects were grouped into power grip users and nonpower grip users. The range of motion of the joints of all the fingers, namely, metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of both dominant hand and nondominant hand was measured using universal finger goniometer, and the composite finger flexion was recorded using a geometric ruler. The results were analyzed, and Un-paired T-test was used to compare the FFC between the power grip and the nonpower grip group.Results: The FFC variations in both the hands of male and female subjects in power grip users (PGU) and nonpower grip users(NPGU) were recorded. In the dominant hand, it was found that the DIP joint of 5th digit in female subjects had a greater ROM values than male subjects, but greater ROM values in MCP joints of the hand in males were found. The comparison between the range of values of both groups revealed that the values in the PGU group were more than the NPGU group with a statistical significance of p&lt;0.001.Conclusion: The finger flexion cascade was found to be more closed in female subjects than males in both the dominant and nondominant hands of in the power grip users than in the nonpower grip users.

Developmental origins and evolution of bats

Through the evolution of novel wing structures, bats (Order Chiroptera) became the only mammalian group to achieve powered flight. This achievement proceeded the massive adaptive radiation of bats into diverse ecological niches. As a result, today’s bats exhibit diverse flight styles, the broadest range of dietary adaptations of any mammalian group, and comprise 20% of mammalian species. My lab is investigating the developmental mechanisms through which bats arose and then diversified. In this talk, I will discuss two of the systems we are studying in this regard: bat wings and teeth. In regard to the bat wing, we are investigating the developmental processes that underlie the evolutionary origination and diversification of two of its novel membranes: the plagiopatagium which connects the 5th digit to the body and hind limb in all bat species, and the uropatagium which connects the hind limbs in many species. Our results suggest that these structures arise through novel outgrowths of the body flank driven by increased rates of cellular proliferation. The diversification of membrane shape among bat species is driven by changes in the timing and levels of this cellular proliferation. In all bats, the cells of these novel outgrowths subsequently adhere and fuse to those of the limbs to generate the wing membranes. In regard to teeth, we are investigating the developmental processes behind the wide diversity of post‐canine dentitions among bat species. Our morphological, cellular, and computational analyses across diverse bats suggest that premolar and molar rows are established by two independent signaling mechanisms, and that the number of teeth and their size is controlled by local proliferative rates in jaw cells. Our findings support the hypothesis that an understanding of the evolution of cellular processes is a necessary prerequisite to an understanding of the developmental factors shaping evolution.

The Optimal Position for Arthrodesis of the Proximal Interphalangeal Joints of the Border Digits

This study aimed to determine the functional characteristics of various arthrodesis angles of the proximal interphalangeal (PIP) joints of the border fingers. The dominant hands of 48 volunteers were tested using custom orthoses to simulate PIP joint arthrodesis. For the index finger (IF), orthoses were made in 25°, 40°, and 55° of flexion (IF25, IF40, and IF55). For the little finger (LF), orthoses were made in 30°, 55°, and 70° of flexion (LF30, LF55, and LF70). Twenty-three volunteers performed grip and pinch (key, tripod, and pulp) strength testing with and without simulated arthrodeses and 25 volunteers performed the Jebsen Hand Function Test (JHFT) with and without simulated arthrodeses. Simulated conditions of arthrodesis were compared with the unrestricted state and with each other within the same finger. For grip and pinch strength, there were no significant differences between simulated arthrodesis angles. Compared with baseline, grip was significantly weaker for all 6 simulated arthrodesis angles. Pinch was tested with simulated IF arthrodesis only; key pinch was significantly weaker for all tested angles and tripod pinch for IF25 and IF40. For JHFT, the 3 experimental angles for the index or ring finger did not show any statistically significant differences for any subtest. Volunteers were slower at completion times for all simulated arthrodesis angles compared to baseline times. This was significant in 5 of 7 tasks for IF25, 3 of 7 tasks for IF40, and 4 of 7 tasks forIF55. Index finger angle of flexion of 40° was significantly faster than IF55 for writing and IF25 for lifting large, light objects. For the LF, LF30 was significantly slower than baseline for 6 of 7 tasks,LF55 for 3 of 7 tasks, and LF70 for 5 of 7 tasks. Index finger angle of flexion of 55° was significantly faster than LF70 for simulated feeding and IF30 for lifting large, heavy objects. No border digit PIP joint arthrodesis angle was superior for grip and pinch strength. Based on JHFT, IF40 and LF55 might be preferred arthrodesis angles. Intermediate arthrodesis angles may provide the best function for patients undergoing PIP joint arthrodesis of the IF and LF.

Favorable long-term esthetic, functional, and sensory outcome and preferability of distal digital replantations

Background: To evaluate long-term esthetic, functional, and sensory outcome and preferability of distal digit replantations with respect to contralateral intact finger. Materials and Methods: A total of 63 single-or multi-digit clean cut amputations distal to distal interphalangeal joint (DIPJ) involving nail fold in 45 consecutive patients (mean 29 years, 26 males, 19 females) who underwent replantation surgery between 2010 and 2016 were included in this study. Esthetic outcome, functional, and sensory outcome were assessed in the postoperative 6 months, 1 year, and 3 years. Results: Single-digit amputation was noted in 34 patients including thumb (n = 9), index finger (n = 10), middle finger (n = 7), ring finger (n = 7), and little finger (n = 1). Multi-digit amputations were evident in 11 patients involving 2 fingers in five patients (index + middle in two patients, middle + ring in two patients, and thumb + index in one patient), 3 fingers in five patients (index + middle + ring in 4 patients and middle + ring + little in one patient), and 4 fingers in one patient (index + middle + ring + little). All patients were operated within the first 4 h of hospital admission. Postoperative 3-year outcome was excellent in 79.3% of operations, good in 14.2%, and acceptable in 6.3% of operations. None of the operations resulted in poor or very poor outcome and none of the patients had functional loss during the entire follow-up period. A very satisfactory sensory outcome with static two-point discrimination test findings of

Normal Vascular and Nerve Distribution of the Pes Region in Dogs: An Anatomical and Diagnostic Imaging

To investigate the normal anatomical distribution of the arterial blood supply, venous drainage and innervation on both the dorsal and plantar aspects of pes region including the level of tarsal joint due to its clinical importance with a little data available. Methods: Ten hind paws of five adult apparently healthy domestic dogs of both sexes; six paws injected, through blood vessels with colored latex neoprene for anatomical dissection and the other four paws injected a contrast mixture of red lead oxide and turpentine oil for the radiographic investigation of blood vessels. In addition to five live dogs used to apply the distal limb local anesthesia with the aid of Needle-Guided Ultrasonography. Results: This investigation revealed that the dorsal and plantar aspects of dog pes region supplied by superficial and deep sets of arteries, veins and nerves. The three dorsal metatarsal arteries originated from the arcuate artery. The medial tarsal vein forming characteristic venous arcades. The 3rd plantar metatarsal artery divided into two axial arteries while the 2nd and 4th continued axially without division. The plantar common digital and metatarsal nerves II, III, IV communicated to give origins of the axial and abaxial plantar proper digital nerves except the abaxials of the 2nd and 5th digits which supplied by a branch from medial plantar nerve and lateral plantar nerve respectively. Conclusion: There were little differences between dogs and other carnivores in vascularization of hind paw with the recommendation of using Needle-Guided Ultrasonography in the distal limb local anesthesia to avoid vascular puncture or damage.

Design and Dimensional Measurement of Interdigital Sensor for Blood Glucose Measurement through Non-Invasive Method

Diabetes has shown to be a chronic disease world over, mainly caused due to reduced physical activity and increased obesity. World health organization statistics show diabetes as a leading cause of disability universally. To avoid extreme medical conditions of subjects, regular monitoring of their glucose levels has been suggested. The most common method that has been in use is the pinprick method for glucose monitoring which carries the risk of contamination as well as irritation. One possible approach called noninvasive technique can be adopted to avoid this major concern. This paper presents designing Inter-Digital-Sensor (IDS) for non-invasive sensing of the glucose level. The sensor-based chip once mounted onto the upper arm or pinkie finger of diabetes subject, is able to sense different glucose levels concentration as impedance plots. A set of several simulation results has been obtained using COMSOL for getting optimized dimensions of the sensor digits. This research has presented the generation of an electric field and intensity by using electrode of known length with element spacing varying from 250μm to 600μm developed over 15mm x 20mm sensor area. An ID of 475μm width spacing with ten (10) digits producing 2.33 pF of capacitance value with impedance resonating at 13 GHz of frequency is reported in this paper.