Normal Hand Research Articles

A novel technique to widen the 1st web space by using 'spare parts' of thumb polydactyly

First web space contracture causes significant morbidity and hence their release is important to make use of normal hand functions. First web space helps in improving the grasp. There are several methods of normalizing the 1st webspace. In this article we are describing a local flap that uses the spare tissue of the thumb polydactyly for recovering the defect created from the release of the first web contracture, thereby providing coverage with a tissue that has good vascularity and also giving sensation to the resurfaced part.

Surgical repair of post-traumatic finger contracture in a child

To present the experience of management of the digital flexion contractures. We present a case of 5 yrs old boy child, Patient with post-traumatic contracture of Ring finger of left hand last 3 months. Multiple continuous Z-plasty performed to correct deformity. Careful assessment and early prompt correction results in return of normal hand function. Early treatment of contractures with Z-plasty results in the improvement of finger mobility.

Case report: Syndrome of the disconnection of the callus body in a patient with extensive injury - Mellitus Diabetes and malnutrition - Marchiafava-Bignami disease / Relato de caso: Síndrome da desconexão do corpo calo num doente com lesões extensas - Diabetes Mellitus e má nutrição - doença Marchiafava-Bignami

MFL, 51 years old, female, right-handed, diabetic and previous stroke. Non alcoholic, and report of malnutrition. On neurological examination, he presented tactile anomy, visual agnosia, bucovisual apraxia, left hand agraphia, normal graphia right hand with Alexia, and bilateral crossed optical ataxia. Magnetic resonance imaging (MRI) showed extensive lesion with a swollen aspect in commissural fibers of the corpus callosum, notably in the right body and splenium, and corona radiata with hypersignal in T2 / FLAIR, suggesting demyelinating noninflammatory lesion or subacute vascular lesion.

The Aesthetics of Digit Amputation.

Background: The goal of surgery, when treating a patient with a traumatized hand, is to restore function. The importance of the aesthetics on a patient's psychological well-being should also be considered. The biomechanical ideals for creating a useful hand after digit amputation have been defined; however, ideal aesthetic levels for finger amputation have not been elucidated. The purpose of this study was to determine the general population's visual preferences for different levels of digit amputation in the hand. Methods: In all, 310 participants were surveyed to identify preferences of different levels of single digit amputations in dorsal and volar views. A normal hand was digitally manipulated to simulate various levels of digit amputation. The aesthetics of amputation at the distal interphalangeal (DIP) joint, proximal interphalangeal (PIP) joint, metacarpophalangeal (MCP) joint, and ray amputation were compared to one another via rank order. Average rank for each level of amputation for a digit was determined. Results: Amputation at the DIP was favored over all other levels; however, ray amputation was the second most aesthetic, particularly in the middle and ring fingers even when compared to amputation at the PIP level. Conclusion: When presented a choice at which level to perform a completion amputation or a primary amputation of a digit, and functionality at multiple levels of amputation is equivocal, aesthetic outcomes should be considered. Amputation at the DIP joint is preferable, but ray amputation is aesthetically more pleasing than amputation at the PIP or MCP joints in the index, middle, ring, and small fingers.

Implementation of 3D Printing Technology to Design a Posthetic Hand Based Elbow Powered for an Amputee People

The target for this community service program is a resident of Jl. Parikesit RT 05 RW 03 Dusun Picis, Balongdowo Village, Candi District, Sidoarjo Regency. He had a work accident in one of the industries in the city of Sidoarjo in 2010 on the left wrist up to the fingers, so the doctor suggested amputation. He is actually still in his productive age (36 years old) but because of this situation, he is unable to carry out activities in the world of work and has decreased confidence in himself and avoids socializing in society. The purpose of this community partnership program (PKM) activity is to apply 3d printing technology in the manufacture of prosthetic hands for people who have transradial amputations as an effort to improve the quality of life. The implementation methods used are: a) the measurement of several physical parameters on the amputee such as the diameter of the arm circumference, the length of the amputated part, weight and height. In addition to physical parameters, we also carry out medical measurements, including obtaining information on health conditions such as blood pressure, heart health and blood glucose levels, b) designing prosthetic hands using 3D application programs and 3D printers, c) mechanical and functional testing for perform basic movements in the form of opening and closing the palms, d) monitoring and evaluation of the use of prosthetic hands. The results obtained from this activity are that the patient can use the prosthetic hand to assist with activities in carrying out daily activities. In this PKM activity, amputees have been tested, namely the movement of holding a mineral water bottle, holding a banana, peeling a banana peel and driving a two-wheeled motorized vehicle. Monitoring shows that patients need regular exercise in using prosthetic hands so that they are able to control and condition their use. In the future, several developments can be made, including in terms of control and size of the prosthetic hand so that patients can feel the benefits of a prosthetic hand that functions like a normal hand.

Comparison of Maitland Mobilization and Mulligan Mobilization with movement on pain and hand function in patients having post Colle’s Fracture Stiffness

Background: Post-surgical rehabilitation of Colle’s fracture requires manual and exercise therapy to restore normal hand function. Aim: To compare the effectiveness of Maitland mobilization and Mulligan’s mobilization with movement on hand function and pain after Colle’s fracture. Study Design: Non randomized clinical study. Methodology: Study was conducted after ethical approval, at physiotherapy department Mayo hospital Lahore in 2019-20. Sample of 60 patients estimated by epitool, was divided into three equal groups (A, B & C). Subjects were screened on the basis of predefined eligibility criteria. All three groups received the respective therapy along with baseline treatment on alternate days for 4 weeks. Pre and post treatment and follow up assessments included VAS, patient rated wrist evaluation questionnaire and wrist ranges of motion with goniometer. Results: Mean age of participants was 45.38±6.58 years. No significant measures were found in any of the outcome measure between Maitland and Mulligan mobilization (p<0.05). Statistically significant improvement was found in all groups. Conclusion: We concluded that that the Mulligan mobilization with movement was effective to reduce pain and improve hand function in management after Colle’s fracture. Keywords: Colle’s Fracture, Post Fracture Stiffness, Radius Fracture, Mobilization and Mulligan’s Mobilization

Automated Classification of Rheumatoid Arthritis, Osteoarthritis, and Normal Hand Radiographs with Deep Learning Methods.

Rheumatoid arthritis and hand osteoarthritis are two different arthritis that causes pain, function limitation, and permanent joint damage in the hands. Plain hand radiographs are the most commonly used imaging methods for the diagnosis, differential diagnosis, and monitoring of rheumatoid arthritis and osteoarthritis. In this retrospective study, the You Only Look Once (YOLO) algorithm was used to obtain hand images from original radiographs without data loss, and classification was made by applying transfer learning with a pre-trained VGG-16 network. The data augmentation method was applied during training. The results of the study were evaluated with performance metrics such as accuracy, sensitivity, specificity, and precision calculated from the confusion matrix, and AUC (area under the ROC curve) calculated from ROC (receiver operating characteristic) curve. In the classification of rheumatoid arthritis and normal hand radiographs, 90.7%, 92.6%, 88.7%, 89.3%, and 0.97 accuracy, sensitivity, specificity, precision, and AUC results, respectively, and in the classification of osteoarthritis and normal hand radiographs, 90.8%, 91.4%, 90.2%, 91.4%, and 0.96 accuracy, sensitivity, specificity, precision, and AUC results were obtained, respectively. In the classification of rheumatoid arthritis, osteoarthritis, and normal hand radiographs, an 80.6% accuracy result was obtained. In this study, to develop an end-to-end computerized method, the YOLOv4 algorithm was used for object detection, and a pre-trained VGG-16 network was used for the classification of hand radiographs. This computer-aided diagnosis method can assist clinicians in interpreting hand radiographs, especially in rheumatoid arthritis and osteoarthritis.

Anthropometry, body composition and hand grip strength of select female athletes from Chennai, India

This was a cross-sectional study, conducted from March to December 2021. Purposive sampling was used to select 154 female athletes aged 18 to 23 years from various colleges and sports organisations. The participants were involved in athletics, ball sports, racquet sports, field sports and other sports such as boxing, fencing, kho-kho, taekwondo and swimming. Height, body weight, body mass index, waist and calf circumferences, waist to height ratio, total fat, subcutaneous fat and visceral fat percentages, muscle mass percentage, resting metabolic rate, and hand grip strength of all participants were recorded. Height (163.1 ± 8.0 cm; p<0.01) and body weight (60 ± 10 kg; p<0.05) of ball sport athletes was significantly higher compared to other participants. Highest calf circumference (34.5 ± 3.2 cm) was seen among racquet sport players. Participants involved in athletics had significantly higher muscle mass percentage (28.6 ± 2.2; p<0.01), lower total body fat percentage (24.7 ± 4.7; p<0.01) and lower subcutaneous fat percentage (21.1 ± 4.6; p<0.05). All athletes showed normal hand grip strength values. Regular assessment of these parameters is important for athletes to ensure their fitness for training, thereby improving performance and delaying the onset of fatigue during competitions.

Design of Wearable Hand Rehabilitation Glove With Bionic Fiber-Reinforced Actuator.

Background: The hand motor function is lost and activities in daily life (ADLs) are affected due to some illnesses such as stroke and hemiplegia. As a coping way, we present a wearable rehabilitation glove with the bionic actuator for restoring the hand function and the motor control ability lost by stroke patients. Methods: The soft pneumatic bionic actuator (SPBA) is developed on the basis of the research of human hand bone structure and finger joint characteristics and a series of tests are conducted. Besides, we built the rehabilitation glove system based on the proposed SPBAs to verify the availability due to typical gesture, mirror therapy (MT) and grasping experiment for irregular objects. Result: The bending angle of SPBA can reach 260°. The output force of it can reach 5.1N with 0.25 MPa air pressure input. The maximum variance of the bending angle can be concluded at 5.1° in MT. The grasping experiments of the glove worn on the hand or not shows the proposed glove is flexible, the grip force is large and achieve stable grasping of objects. Conclusion: The designed SPBA is satisfied with the requirements of rehabilitation training and the proposed glove restore the normal hand motion of patients in ADLs.

Motor Response of Mirror Therapy after Reconstruction of Extensor Mechanism Caused by Glass Cut Injury

Treatment by mirror therapy (MT) restores motion in injured limbs without invasive procedures. This process is widely accepted for rehabilitating patients with phantom limb pain, stroke victims, or patients who need therapy after nerve damage. The procedure is specifically useful in restoring motion to the hand after surgical repairs to the extensor muscle and tendons. Mirror therapy rewires the brain by making the restored limb remember hand motions by observing the motions of a normal hand. The concept of a mirror image is that the movement of the uninjured arm forms the illusion of the same movement in the affected arm. Efforts to repeat hand movements elicit the same reaction in the affected hand in what is referred to as Hebbian learning. This case study evaluated MT’s effectiveness in motion restoration after a glass injury. This case study showed restoration of normal hand motions in a patient following surgery to repair a glass cut to the arm. Surgery repaired the lacerated extensor tendon and radial nerve. The muscle belly was repaired, and a graft fixed the nerve gap. Once the arm healed, the patient underwent rehabilitation in mirror therapy to restore normal function in his hand. After conducting mirror therapy, the pain was eliminated, and the patient restored normal function of moving the hand and finger extension. In addition, the therapy could be conducted at home without needing a professional. The effectiveness of mirror therapy was seen in the functional restoration of hand and finger movement. The process is also less complicated as it can be performed at home.

The authorship of disguised handwriting written with the unaccustomed hand: A preliminary study

Sometimes, a writer may try to disguise their normal handwriting to hide their identity. One of the most effective and less frequent modes of disguise is to write with the un-accustomed hand. In this type of disguise, due to a sudden loss of pen control, pictorial appearance of handwriting changes to such an extent that the writer assumes success and gets convinced that the disguised handwriting they have produced cannot be attributed to them by comparison with their normal writing style. In the present study, handwriting samples of several persons, both with the normal hand and the unaccustomed hand, were obtained and an attempt has been made to find out and identify those features that survive the hazards of disguise and could be helpful to accurately determine the authorship of such disguised handwriting in comparison with one’s normal handwriting samples. A detailed study of letter-forms, the connecting strokes between letters, and t-crossing written by several persons has been carried out. It has been found that, despite pictorial dissimilarities, there are certain unconscious features that are rarely disguised which could either form the basis for their association with a particular writer or indicate its probability for further investigation. The analysis, comparison, and evaluation of features unconsciously left by the writer, including the parameters selected for the present study, can be carried out by a trained forensic document examiner; and they can give whatever opinion is possible and justifiable in facts and circumstances of a case.

Phalangeal and Metacarpal Fractures of the Hand: Preventing Stiffness.

Summary:Fractures of the phalangeal or metacarpal bones of the hand are common. Many of these fractures are treated without surgery. However, both conservative and operative management of fractures of the hand can result in stiffness. Stiffness is the most common complication in the management of hand fractures. The key to preventing stiffness is early range of motion exercises. This article challenges many of the current treatment regimens offered to patients with the so-called unstable fractures. The evaluation of the patients’ function is the primary factor that should determine the course of conservation versus operative management. X-rays do not demonstrate function and therefore act as an adjunct only to the care of the patient. The goal of treating hand fractures is to restore function. Early motion may not only improve healing but may also hasten the return to normal hand function. The tenets of how to prevent stiffness are described in this review.

Design and Performance Evaluation of a Hybrid Hand Exoskeleton for Hand Opening/Closing

Abstract Finger extensor muscle weakness and flexor hypertonia are the most commonly reported issues among patients suffering from amyotrophic lateral sclerosis (ALS). Moreover, the relative hyperflexion of the wrist and fingers has limited their ability to voluntarily open the hand and interact with the external environment. In this work, a hybrid hand exoskeleton is developed to prevent the relative hyperflexion of the fingers and wrist and facilitate the users in their functional hand opening by compensating the flexor hypertonia. This exoskeleton, combining a passive device with the soft extra muscle (SEM) glove, assists users in normal hand opening/closing required for some basic activities of daily living. The paper presents kinematic and static models of passive hand exoskeleton design. Moreover, the proposed design is tested and evaluated by comparing the volunteer hand opening with the exoskeleton assistance using the flex sensors attached on the dorsal side of the middle finger, ring finger, and thumb with both healthy subjects and patients. The results show the effectiveness of using the hybrid exoskeleton in improving anatomical hand opening/closing capabilities.

Hand Prosthetic Design for Transradial Amputee by Using 3D Printing Technology to Enhance Life Quality

The target for this community service program is a resident of Jl. Parikesit RT 05 RW 03 Dusun Picis, Balongdowo Village, Candi District, Sidoarjo Regency. He had a work accident in one of the industries in the city of Sidoarjo in 2010 on the left wrist up to the fingers, so the doctor suggested amputation. He is actually still in his productive age (36 years old) but because of this situation, he is unable to carry out activities in the world of work and has decreased confidence in himself and avoids socializing in society. The purpose of this community partnership program (PKM) activity is to apply 3d printing technology in the manufacture of prosthetic hands for people who have transradial amputations as an effort to improve the quality of life. The implementation methods used are: a) the measurement of several physical parameters on the amputee such as the diameter of the arm circumference, the length of the amputated part, weight and height. In addition to physical parameters, we also carry out medical measurements, including obtaining information on health conditions such as blood pressure, heart health and blood glucose levels, b) designing prosthetic hands using 3D application programs and 3D printers, c) mechanical and functional testing for perform basic movements in the form of opening and closing the palms, d) monitoring and evaluation of the use of prosthetic hands. The results obtained from this activity are that the patient can use the prosthetic hand to assist with activities in carrying out daily activities. In this PKM activity, amputees have been tested, namely the movement of holding a mineral water bottle, holding a banana, peeling a banana peel and driving a two-wheeled motorized vehicle. Monitoring shows that patients need regular exercise in using prosthetic hands so that they are able to control and condition their use. In the future, several developments can be made, including in terms of control and size of the prosthetic hand so that patients can feel the benefits of a prosthetic hand that functions like a normal hand.

Metacarpal Fractures, Management Techniques, and Outcomes in Our Center.

Introduction/backgroundMetacarpal fractures comprise approximately 35.5% of cases in daily emergencies, mostly due to road traffic accidents (RTA), fall, and assault. The classification is based on the site and pattern of fracture. High-level evidence is lacking for the management of metacarpal fractures. The primary goals of treatment are to achieve acceptable alignment, stable reduction, strong bony union, and unrestricted motion. It can be managed by non-operative methods like close reduction and splintage. Operative management will be required if there is shortening, rotation, and angulation in different planes including close reduction and fixation with percutaneous intramedullary pining/k-wires and open reduction and fixation with screws, plates (compression/locking), and external fixators. This study was done to compare the efficacy of k-wire, screws, and plates in the management of metacarpal fractures and their outcomes based on their union, postoperative pain, range of movement, and grip strength in a tertiary care center, i.e., Liaquat National Hospital and Medical College.MethodsIt was a retrospective study conducted at the Department of Plastics and Reconstruction Surgery, of a tertiary care hospital. A total of 113 patients who were operated upon for metacarpal fracture were included in the study (open/close) without soft tissue loss or tendon injury, were divided into three groups according to the technique of fracture fixation, i.e., group 1 (k-wire), group 2 (screw), and group 3 (plates). The data like post-operative pain (visual analog scale, VAS) and radiological evidence of union were extracted from the registry. All the patients were called for follow-up in the outpatient department. Out of 113, 97 patients showed up for follow-up and were examined by a hand surgeon, and range of movement (goniometer) and grip strength (sphygmomanometer method) were assessed.ResultsA total of 97 patients were included in the study (male 66%, female 34%). Group 1 (K-wire) includes n = 61 (62.9%), group 2 (screw) n = 15 (15.5%), and group 3 (plate) n = 21 (21.6%). The mean follow-up time was 12 + 2 weeks after the surgery for post-operative pain and radiological evidence of union while 24 + 6 months for a range of movement and grip strength. Less post-operative pain was noted in group 1 patients while no significant difference was noted in the evidence of radiological union in all groups. Range of movement was better in group 1 patients (89.74 + 0.750) than in group 2 (80 + 0.37°) or group 3 (80.2 + 0.62°). The grip strength (compared to the normal contralateral hand) was normal in the majority of the patients in group 1, i.e., 94% while it was 80% in group 2 and 82% in group 3.ConclusionThe significance of these reported findings suggests that open reduction and internal fixation with screw or plate might be a less preferable surgical technique in comparison to k-wire fixation in the treatment of a metacarpal fracture.

Treatment of Dangling-Type Thumb Polydactyly: Suture Ligation vs. Surgical Excision.

Background: To review the cases of dangling-type thumb polydactyly treated with suture ligation vs surgical excision. Methods: Cases of dangling-type thumb polydactyly treated in 2 different hospitals from 1994 to 2014 were recruited. Group 1 includes cases treated with suture ligation in hospital 1; Group 2 includes cases treated with surgical excision in hospital 2. The demographics data, early clinical outcomes and early complications were retrieved from clinical notes. All cases were contacted for a final assessment. Results: There were 23 cases recruited in group 1 and 26 cases recruited in group 2. The mean age at the time of procedure was 15.9 days (group 1) vs. 14 months (group 2). The infection rate was comparable in both groups (4.35% vs. 3.85%). 12 cases in group 1 and 14 cases in group 2 completed a final assessment. Residual tissue is common in group 1 (58.5%) and 4 cases (33.3%) required revision surgery. No case in group 2 had residual tissue and none require revision surgery. There was no painful neuroma in both groups and all patients achieved normal thumb and hand functions. The parental satisfaction score was 7.8 (group 1) and 8.8 (group 2) with no statistical difference (p = 0.061). Conclusions: Suture ligation and surgical excision are safe and effective treatment options for dangling-type thumb polydactyly. Both methods received comparable parental satisfaction. However, residual tissue is common after suture ligation while this problem is not observed after surgical excision.

1: Eye Tracking Analysis as a Means of Evaluating Aesthetic Result Following Toe to Thumb Transfers: A Pilot Study

Purpose:Exceptional functional results can be obtained with toe to thumb transfers; however objective measures to evaluate the aesthetic outcome of a toe to thumb transfers remains elusive. Aesthetic evaluation of a reconstruction when performed by external raters or the patient, may be influenced by expert knowledge, emotional antecedent, or ethnic or regional bias. In this study, we were interested in determining the observers’ instantaneous, reflexive responses to the toe to thumb transfer as determined by eye-tracking analysis.Methods:13 patients with unilateral great toe to thumb transfers were photographed using a standardized technique. None had undergone secondary procedures that changed the appearance of the transferred toe. Both hands were photographed side by side in each image. A dorsal and palmar image was taken, producing 26 photos in total. 40 observers (Average age 41.39, 14-65 yo, 18 males, 22 females), blinded to the procedure, were asked to evaluate each image for symmetry between the hands. An infrared eye-tracking camera continuously recorded their eye movements. Participants were allowed to evaluate each image for 6 seconds. Data was evaluated to determine the percent of time that was devoted to evaluating each portion of the photograph. The percent time spent in each of the lookzones was recorded.Results:i) Observers spent an average of 17.7% of their time evaluating the reconstructed thumb compared to the entire bilateral hand. This was on average 63% more time looking at the reconstructed thumb compared to the normal control thumb. (p value<0.01) ii) Observers spent 43.9% of the time looking at the reconstructed thumb compared to the entire hand of the same side. They spent 31.6% of the time looking at the normal control thumb compared to the entire hand of the same side (p value<0.01, mean 0.36 seconds on the abnormal thumb (SD 0.439)), vs. mean 0.22 seconds on normal control thumb (SD 0.305); mean 0.82 seconds on abnormal hand (SD 0.45), mean 0.69 seconds on normal contralateral hand (SD 0.423); mean 0.74 on entirely normal bilateral hand (SD 0.41)). iii) Areas of significant attention as visualized by heatmaps representing where observers focus their attention include abnormal nailbed and scar tissue at the junction between the toe and native hand skin.Conclusion:The technique described above may represent a novel and objective technique for quantifying observers’ gaze with respect to toe to thumb reconstructions and the un-altered contralateral thumb. It could be applied to other areas of hand reconstruction to help determine aesthetic outcomes. The present pilot suggests that symmetric nail size may be an area of importance for creating the sense of aesthetic success. Incorporation of this data into surgical counseling may assist the patient and medical team focus on surgical-decision making priorities.

Long-term sensibility outcomes of secondary digital nerve reconstruction with sural nerve autografts: a retrospective study

BackgroundRecovery of sensibility after digital nerve injury is crucial for restoring normal hand function. We evaluated long-term outcomes of digital nerve reconstruction with autografts.MethodsThis retrospective study included patients who underwent secondary reconstruction of digital nerves with nerve autografting. Recovery of sensibility was evaluated based on the following: patient self-assessment, two-point discrimination (2PD), and a total sensation score (sum of proprioception, temperature sensation, and sharp/dull discrimination). Mixed models regression was used to study predictors of sensibility outcomes. The predictors analyzed were age, sex, smoking status, number of fingers involved in a patient (as a measure of injury severity), time to reconstruction, and time to follow-up.ResultsIn 61 patients, 174 digital nerves in 126 fingers were reconstructed after an average of 33.1 weeks from injury. The mean follow-up was 6.4 years from reconstruction. The mean graft length was 3.6 cm. Self-rated sensibility in the affected area was very good in 13% of patients, good in 33%, satisfactory in 40%, and poor in 24%. 2PD at 6 mm was present in 17% of patients, at 10 mm in 12%, and at 15 mm in 18% (mean 2PD was 10.8). Proprioception was preserved in 107 (85%) fingers, sensation of temperature was preserved in 99 (75%) of fingers, and sharp/dull discrimination in 88 (70%) fingers. Time from injury to reconstruction was the only significant predictor of the total sensation score.ConclusionOur data indicate that earlier reconstruction is associated with a favorable outcome.

Is a Right Angle the Right Angle? Normal Coronal Radiographic Alignment in the Pediatric Finger Phalanges.

Quantifying pediatric phalanx fracture displacement requires understanding the normal radiographic alignment of pediatric phalanges, which has never been assessed in the coronal plane, although prior studies have assumed the articular surfaces and physes to be perpendicular to the diaphyses. This study tests the hypothesis that these relationships are not uniformly perpendicular and instead vary by digit and age. Normal hand bone age radiographs were retrospectively reviewed from 40 males and 40 females 2 to 18 years old. For each finger proximal phalanx (P1) and middle phalanx (P2), 2 raters each measured twice the angle between the diaphysis and distal articular surface (D-DA), diaphysis and physis (D-P, when physis present), and diaphysis and proximal articular surface (D-PA). Intra-rater and inter-rater reliability were calculated with intraclass correlation coefficients. 95% confidence intervals were calculated for each angle for each digit, phalanx, age group, and sex to determine which angles ~90 degrees. Variability among ages and sex was assessed with analysis of variance. Intra-rater and inter-rater intraclass correlation coefficients were >0.90, except in P2 ∠D-DA in children under 8 years old with unossified P2 condyles. Overall, only 173 (47.8%) of 362 confidence intervals included 90 degrees. Three angles of the small finger (P1 ∠D-DA, P2 ∠D-P, P2 ∠D-PA) never ~90 degrees at any age or sex, with an average 10 degrees ulnar tilt of the small finger proximal interphalangeal joint. Of the 24 angles across digits and phalanges, 10 varied significantly with age, especially in the index and middle finger P1 where initially wedge-shaped epiphyses progressively became more symmetric with age. The coronal radiographic angles between the phalangeal diaphyses and articular surfaces or physes differ from 90 degrees more than half the time in pediatric fingers, and nearly half the angles vary by age. These findings demonstrate that the articular surfaces and physes of the pediatric finger phalanges are not uniformly perpendicular to the diaphyses, underscoring the need to consider the variability among digits, phalanges, ages and subjects. Level IV.

Assessment of modified Zancolli arthroplasty for basal thumb arthritis

Background and aim The trapeziometacarpal arthritis is one of the most common joint problems affecting women after the age of 50 years. Surgery is indicated after failure of conservative treatment with continuation of pain and functional disabilities. One of the most reported and well-known surgical procedure for management of basal thumb arthritis is the ligament reconstruction and tendon interposition arthroplasty. The aim of the study was to evaluate patients who underwent modified Zancolli arthroplasty for basal thumb arthritis. Patients and methods The study included 15 patients with basal thumb arthritis (three males and 12 females). Full clinical examination and scoring of the hand was done using Quick DASH, visual analog scale, measuring range of motion, and grip strength. All patients underwent full radiological and laboratory investigations. Results Overall pain intensity was measured with a visual analog scale, which ranged from 5–10 preoperatively and ranged from 0 to 1 6 months postoperatively. Regarding the DASH score, there was improvement from a mean of 64.48±16.61 points preoperatively to a mean of 1.37±1.67 points postoperatively. The mean postoperative abduction was 75% to the normal side, opposition was 80% to the normal side, and power grip was 90% to the normal hand. Conclusion Modified Zancolli arthroplasty is an effective means of treating symptomatic patients with trapeziometacarpal arthritis who failed to improve with nonsurgical measures. This technique ensures a dynamic fixation of the apical ligament and provides better stability. The procedure is simple both technically and regarding postoperative care.