Metacarpal Bone Loss Research Articles

Iliac Crest Bone Graft With Intramedullary Headless Implant for Metacarpal Bone Loss.

Metacarpal bone loss presents a challenging reconstructive dilemma for hand surgeons. While multiple bone grafting techniques have been described, complications including nonunion, graft resorption, fixation requiring prolonged immobilization, stiffness, and the need for multiple procedures are well-documented. We present a technique for managing metacarpal bone loss utilizing a tri-cortical iliac crest graft and an intramedullary metacarpal nail for the treatment of metacarpal fractures and nonunions that is technically simple, fast, and allows for early initiation of motion to decrease postoperative complications. Level IV- Therapeutic.

Radial Half of the Second Metacarpal Bone and the First Dorsal Interosseous Muscle Composite Flap for Treating the First Metacarpal Bone Defect: A Case Report

Traumatic bone defect is a challenging problem for both patient and doctor. The goal of treatment is the restoration of hand function with acceptable appearance of an injured hand. Especially in the injury of the thumb, length and stability are very important to achieve good holding and pinching functions. We reported a 23-year-old patient with traumatic first metacarpal bone loss after a motor vehicle accident treated with vascularized radial half of the second metacarpal bone and the first dorsal interosseous muscle composite flap.

Metacarpal bone loss in patients with rheumatoid arthritis estimated by a new Digital X-ray Radiogrammetry method \u2013 initial results

BackgroundThe Digital X-ray Radiogrammetry (DXR) method measures the cortical bone thickness in the shafts of the metacarpals and has demonstrated its relevance in the assessment of hand bone loss caused by rheumatoid arthritis (RA). The aim of this study was to validate a novel approach of the DXR method in comparison with the original version considering patients with RA.MethodThe study includes 49 patients with verified RA. The new version is an extension of the BoneXpert method commonly used in pediatrics which has these characteristics: (1) It introduces a new technique to analyze the images which automatically validates the results for most images, and (2) it defines the measurement region relative to the ends of the metacarpals. The BoneXpert method measures the Metacarpal Index (MCI) at the metacarpal bone (II to IV). Additionally, the MCI is quantified by the DXR X-posure System.ResultsThe new version correctly analyzed all 49 images, and 45 were automatically validated. The standard deviation between the MCI results of the two versions was 2.9% of the mean MCI. The average Larsen score was 2.6 with a standard deviation of 1.3. The correlation of MCI to Larsen score was −0.81 in both versions, and there was no significant difference in their ability to detect erosions.ConclusionThe new DXR version (BoneXpert) validated 92% of the cases automatically, while the same good correlation to RA severity could be presented compared to the old version.

Cortical bone loss in a sample of human skeletons from the Muge Shell middens

The Muge shell middens of Cabeco da Arruda, Cabeco da Amoreira and Moita do Sebastiao (central Portugal) have been key sites of archaeological research for 150 years, possibly working as residential sites occupied by semi-sedentary communities during the final Mesolithic. The purposes of this article include the biocultural assessment of metacarpal cortical bone fragility and its associations with age at death, sex and osteoporotic fractures in the Portuguese Mesolithic, as well as a diachronic comparison of cortical bone health in Mesolithic (N = 34) and modern reference (N = 219) samples. Cortical bone at the Muge shell middens displays age and sex-specific trajectories of periosteal apposition and endosteal bone loss, most likely associated with hormonal and behavioural/cultural influences. Metacarpal endocortical bone loss seems to increase with age at death in females, with a simultaneous expansion of the diaphysis. The overall pattern of cortical bone health is similar to the pattern observed in a reference skeletal collection, but elderly women from Muge seem to lose less cortical bone than late twentieth century counterparts from Coimbra. Two older males exhibited vertebral compression fractures, but only one is possibly related with bone fragility.

THU0123 Periarticular Demineralization as Measured by Digital X-Ray Radiogrammetry in Patients with Rheumatoid Arthritis – A Meta-Analysis

BackgroundRheumatoid arthritis (RA) is associated with periarticular bone loss. In the last decade Digital X-ray Radiogrammetry (DXR) was introduced to quantify periarticular bone loss.ObjectivesThis Meta-analysis evaluates potential factors which influence...

Potential Sources of Quantification Error When Retrospectively Assessing Metacarpal Bone Loss From Historical Radiographs by Using Digital X-ray Radiogrammetry: An Experimental Study

During the past 15 yr, digital X-ray radiogrammetry (DXR) has been used to measure metacarpal bone mineral density (BMD). BMD is often measured in existing cohorts where X-ray images were not acquired in accordance with the DXR imaging protocol (DIP). The purpose of the present study was to analyze how deviations from DIP in historical radiographs may affect the reproducibility of DXR-BMD measurements. Cadaver hand phantoms were used to conduct repeat measurements of deviations from DIP with respect to voltage, exposure, lateral displacement, supination, combination of lateral displacement and supination or rotation, extension of the wrist, and edge enhancement. Direct digital radiography (Aristos; Siemens Healthcare, Erlangen, Germany) was used for image acquisition and dxr-online (Sectra, Linköping, Sweden) for DXR-BMD measurements. The influence of the tested deviations from DIP ranged from 0 to 32.5 mg/cm2 (0–6.8%). On repetition with the same specimen, none of the deviations resulted in a within-specimen reproducibility error greater than 2 mg/cm2 (0.4%, equivalent to a T-score of 0.042). Among the tested deviations, all except tube voltage had a magnitude greater than the normal measurement noise for the technique and must therefore be considered when planning a study based on historical images.

Denosumab prevents metacarpal shaft cortical bone loss in patients with erosive rheumatoid arthritis

Osteoclast-mediated bone loss in the hand predicts future bone erosions in patients with rheumatoid arthritis (RA). Osteoclast activity depends on RANKL, which is inhibited by denosumab, an investigational fully human monoclonal antibody against RANKL. We measured metacarpal shaft cortical bone thickness using a novel computer-based technique, digital x-ray radiogrammetry (DXR), to evaluate the effects of denosumab on cortical bone in RA. Patients (n = 227) with active, erosive RA were randomized to receive subcutaneous denosumab 60 mg or 180 mg or placebo every 6 months. All patients received stable doses of methotrexate and daily calcium and vitamin D. For this blinded post hoc analysis (n = 218), cortical bone loss was determined by DXR using computer-assisted measurement of cortical thickness and shaft width at 21 midshaft levels of the second through fourth metacarpal bones of both hands. At 12 months, patients receiving denosumab had significantly less metacarpal bone loss versus placebo (denosumab 60 mg: -0.0034, denosumab 180 mg: 0.0001 gain, placebo: -0.0108; P < or = 0.01 for both denosumab doses). Twelve-month decreases from baseline greater than the smallest detectable change occurred in 2 patients in the denosumab 180 mg group, 9 patients in the denosumab 60 mg group, and 12 patients in the placebo group. Negative correlation was significant between static cortical thickness ratios and static erosion scores (6 and 12 months), and for placebo, between changes in erosion scores and changes in cortical thickness ratio. Twice-yearly injections of denosumab with ongoing methotrexate treatment significantly reduced cortical bone loss in RA patients for up to 12 months. These results add to the growing evidence supporting the clinical utility of DXR.

Pleiotropic Benefits of Moderate Salt Reduction

The report by He and colleagues provides additional support for reducing daily salt intake from the ≈9 g/d typical of UK and US populations to <6 g recommended by health authorities in both countries.1,2 In their study, moderate sodium reduction lowered clinic blood pressure −4.8/−2.2 mm Hg and daytime ambulatory blood pressure a nearly identical −4.7/−2.2 mm Hg. The blood pressure benefits of moderate sodium restriction were clinically and statistically significant in middle-aged hypertensive adults with predominantly Stage 1 disease. And, the blood pressure changes were significant not only in self-identified blacks and whites, which is consistent with previous reports,2 but also Asians, which adds new information. The mean sodium intake on slow sodium and placebo in this study were comparable to the high (target 150 mmol/d) and intermediate (100 mmol/d) intake in DASH sodium.2 …

Measuring metacarpal cortical bone by digital x-ray radiogrammetry: a step forward?

Changes in metacarpal cortical bone mineral density (BMD) using digital x-ray radiogrammetry were studied in patients with early rheumatoid arthritis. After 1, 2, and 5 years, large BMD losses were found: -1.7%, -2.8%, and -5.6%, respectively. Elevated erythrocyte sedimentation rate and anti-cyclic citrullinated peptide levels were independent predictors of bone loss, indicating that the largest amount of bone loss was found in patients with severe inflammation and high production of auto-antibodies, who are known to be at the highest risk of developing radiological bone damage. Studies are needed about the spatial and time relationship between erosions and juxta-articular and metacarpal bone loss.

Nonvascularized Osteoarticular Allograft Replacement of the Proximal Interphalangeal Joint After Extensive Loss of Bone, Joint, and Extensor Tendon

Nonvascularized small-joint allografts are a potentially attractive alternative to prosthetic implantation in cases of posttraumatic destruction of the proximal interphalangeal joint combined with metaphyseal and diaphyseal metacarpal or phalangeal bone loss, as well as soft tissue tendon defects of the digital extensor mechanism. Benefits include the absence of donor site defect, the ability to simultaneously reconstruct deficiency of the extensor mechanism, restore digital length and phalangeal (and metacarpal) bone stock in the face of bone loss, and the provision of an osteoinductive platform onto which creeping substitution can occur. Difficulties include an increased potential for infection and the potential for narrowing of the joint space because of articular cartilage loss. Early results suggest that the benefit of this technique lies in its ability to restore bone stock and soft tissue integrity that would make later prosthetic joint replacement feasible.

Reverse radial artery bone flap reconstruction of segmental metacarpal losses

A vascularised bone segment of the distal radius was harvested as a distally based flap to treat segmental metacarpal bone loss in three patients. One reconstruction followed resection of a giant cell tumour excision and the other two were to replace traumatic bone loss. The bone defects were in the second metacarpal in two cases and in the second and third metacarpal in one case and included three shaft and one distal metacarpal reconstruction. The mean length of the metacarpal defects was 6 cm. All of the flaps survived and no complications occurred at the donor site. Clinical and radiological union was established in all cases after an average of 3 months.

Immediate Autologous Fillet Bone Grafting for Thumb Metacarpal Defect in a Severe Mangled Hand

Severe mutilating open injuries of hand with bone loss are challenging clinical problems for hand surgeons. Though there are many reconstructive options for these injuries, immediate and one stage bony defect restoration with anatomical reduction seem to be an ideal method. It can be accomplished with the help of autologous bone graft from other amputated part of hand. We report a case of severe open hand injury with first metacarpal bone loss. To preserve thumb as well as hand function, autologous bone graft for metacarpal and basal joint reconstruction of thumb was harvested from proximal phalanx of ipsilateral index finger which was destined for amputation due to unsalvageable of the second ray. The interposed bone graft incorporated well into first metacarpal bone and basal joint function was restored in one year follow-up. Functional results were achieved satisfactorily.

Progression of aortic calcification is associated with metacarpal bone loss during menopause: a population-based longitudinal study.

offerosclerosis and osteoporosis are major causes of morbidity and mortality in postmenopausal women and have been suggested to be associated. No study has examined whether progression of atherosclerotic calcification is associated with bone loss. In the present study, we examined progression of aortic calcification, diagnosed by radiographic detection of calcified deposits in the abdominal aorta, in relation to metacarpal bone loss, as assessed by metacarpal radiogrammetry, during menopause. Initially premenopausal women (n=236), aged 45 to 57 years at baseline, were followed for 9 years. We additionally assessed the cross-sectional association between the extent of aortic calcification and metacarpal bone mass and density in 720 postmenopausal women. Twenty-five percent of women going through menopause showed progression of aortic calcification. The average loss of metacarpal bone mass among women with progression of aortic calcification was 3.2 mm(2), and their loss of metacarpal bone density was 7.2 mm(2) %, whereas in women without progression of aortic calcification, these losses were 2.0 mm(2) and 5.6 mm(2) %, respectively, adjusted for age and years of follow-up (P<0.05). Additional adjustment for age at menopause, body mass index, blood pressure, smoking, diabetes mellitus, and use of hormone replacement therapy, thiazide, and loop diuretics did not influence these results. In postmenopausal women, a graded inverse cross-sectional association between the extent of aortic calcification and metacarpal bone mass and density was found. In conclusion, our results indicate that progression of atherosclerotic calcification is associated with increased bone loss in women during menopause.

Metacarpal bone mass in systemic lupus erythematosus.

We report the prevalence of metacarpal cortical thinning in systemic lupus erythematosus (SLE). Fifty-eight ambulant female patients attending a lupus clinic (mean age 32.4 years), were found to have significant thinning of metacarpal cortices (p < 0.05) when compared with 63 normal females (mean age 34.1 years). However, metacarpal bone mass was within the normal range. Measurements were made at 6 metacarpals of the 2 hands using a computer-aided technique (digitized radiogrammetry). Femoral cortical width and Singh index at the left femur, as well as the vertebral index at L3 were also recorded. The trabecular indices were in the range of normality, but the SLE group had more patients in the immediately pre-osteopenic range. Metacarpal bone loss was not related to disease duration or corticosteroid therapy. The prevalence of osteopenia in SLE is probably underestimated and the pathogenesis is likely to be multifactorial.

Calcium Supplementation Reduces Vertebral Bone Loss in Perimenopausal Women: A Controlled Trial in 248 Women between 46 and 55 Years of Age*

To study the effect of calcium supplementation on perimenopausal bone loss, 295 women were randomized into a control group and 2 supplementation groups receiving, respectively, 1000 and 2000 mg elemental calcium/day for a period of 2 yr. We observed a significant decrease in lumbar bone loss in relation to the calcium supplementation (mean loss after 2 yr of 3.5% in the control group vs. 1.3% and 0.7% in the 1000 and 2000 mg groups, respectively), a significant increase in urinary calcium excretion, and a significant decrease in the urinary hydroxyproline/creatine ratio, serum alkaline phosphatase, osteocalcin, and 1,25-dihydroxyvitamin D. The effect of calcium supplementation on lumbar bone loss was significant in the first year of supplementation, but not in the second. However, the urinary hydroxyproline/creatinine ratio and the serum alkaline phosphatase level remained significantly decreased in the treatment groups at the end of the study; this was not the case for serum osteocalcin. Calcium supplementation did not have a significant effect on metacarpal cortical bone loss. The difference in biochemical parameters between the 2 supplementation groups was small. No significant interaction was observed between the menopausal status of the subjects and the effect of calcium supplementation. We conclude that calcium supplementation retards lumbar bone loss in the first year of calcium supplementation by reducing bone turnover. However, the effect on lumbar bone loss over a longer time span is still uncertain.

Progression of osteoarthritis of the hand and metacarpal bone loss. A twenty‐year followup of incident cases

We examined the prospective relationship between metacarpal bone mass and osteoarthritis (OA) of the hand, using incidence data from the historical cohort in the Tecumseh Community Health Study (Tecumseh, MI). Women were examined for radiographic evidence of OA and for bone mass twice, 20-23 years apart (1962-1965 and 1985; 683 subjects with an age range of 55-74 in 1985). Two measures of OA were evaluated: the highest score assigned to any of the 32 wrist/hand joints, and the sum of scores for all wrist/hand joints. After adjustment for age, women who were classified as having OA (by either measure of OA) in 1985 were more likely to have more cortical area at baseline, which indicates greater bone mass. Women who developed OA in the 23-year period were more likely to experience a significantly greater widening of the medullary cavity over time, an indicator of increased bone resorption. Women with increasing levels of OA involvement also had an increased likelihood of greater cortical area loss. We conclude that women who later developed OA were more likely to have higher baseline bone mass than women who did not develop OA, but these women also had a greater likelihood of bone loss over time.

INCREASED METACARPAL BONE MASS FOLLOWING 18 MONTHS OF SLOW-ACTING ANTIRHEUMATIC DRUGS FOR RHEUMATOID ARTHRITIS

Osteoporosis in RA is mediated by numerous inflammatory substances. This study was undertaken to see if SAARD could modify the rate of metacarpal bone loss in RA. Combined cortical thickness (CCT) measured at the midshaft of the right second metacarpal was used to calculate bone mass (CA%) using a digitizer. Eighty-one subjects were studied, all of whom had at least three sets of hand X-rays, the last of which was approximately 18 months following initiation of SAARD therapy. There were 12 males and 69 females. The mean age at time of starting therapy was 51 (SD 12) years while the mean duration of disease at the time was 7.6 (SD 8) years. The mean time to referral for SAARD from the general clinic was 2.5 (SD 3) years. The percentage fall in bone mass prior to therapy was 2.51%/day compared to a gain of 0.6%/day after therapy (P less than 0.05). Forty-nine patients were aged over 50 years while 32 were 50 years or younger at the time of study. Comparison showed that in the pretreatment period, the rate of change in CCT and CA% was not significantly dependent age (P less than 0.1). During that therapy, the rate of change in CCT and CA% significantly different in the two age groups. Patients aged over 50 years continued to lose bone, but at a slower rate (P less than 0.05). Patients aged 50 years or less either stopped losing or gained metacarpal bone mass during the study period (P less than 0.005). The time to referral for SAARD and disease duration (comparable in the two age groups) did not have a significant effect on changes in CA% during therapy. Change in bone mass could be predicted by change in disease activity. We conclude that SAARD have a significant sparing effect on metacarpal osteoporosis in RA. This positive effect is masked by the overwhelming influence of age (and menopause) and could be missed. Metacarpal osteoporosis seems a pathophysiologically more useful measure of radiological change in RA than erosions or joint space narrowing.

Metacarpal bone loss in middle-aged women: “Horse racing” in a 9-year population based follow-up study

Differences in the rate of metacarpal bone loss were evaluated in a 9 year population based follow-up study among 799 women initially aged 45–64 years, using initial and follow-up radiographs of the hands. Metacarpal bone loss started around the age of 50 years and was present in more than 95% of the women. The average annual rate of loss was approximately 1 % of the initial value. The prevalence of osteopenia increased from 5% for women aged 45–49 years, up to 68% for women aged 70–76. The rate of bone loss was not similar for each individual. Regression analyses of rate of change-in-RCA on initial level of RCA indicated the presence of a consistent subgroup of fast bone losers. However, osteopenia at follow-up was more accurately predicted from initial bone density than from differences in the rate of loss.

Distraction-fixation in the primary treatment of metacarpal bone loss

Distraction-fixation in the primary treatment of metacarpal bone loss

Distraction-fixation in the primary treatment of metacarpal bone loss

Nine patients seen in civilian practice with severe open injuries of the hand, including loss of portions of some or all of the metacarpals, were treated by primary restoration of metacarpal length and alignment by distraction-fixation with the use of transverse intermetacarpal Kirschner wires. An external fixation device was added in two of the nine patients. Severe associated soft tissue injuries were present in all but one patient. Two injuries were caused by firearms, and the other seven by heavy machinery. Contractures of the joints were prevented by the use of a second set of wires to position the metacarpophalangeal joints in 70 degrees of flexion and the first metacarpal in abduction and pronation. Staged closure of wounds by local or distant flaps and secondary reconstructions by bone, nerve, and tendon grafts or transfers were necessary in all and required an average of almost 2 years until treatment was completed. All except the one child and the one most recently injured patient have returned to employment or vocational retraining. Follow-up was 24 to 78 months from injury.