Uninjured Finger Research Articles

Distal forearm squeeze test for the diagnosis of digital flexor tendon injuries

BackgroundThe forearm/wrist squeeze/compression test has been used to examine digital flexor tendon injuries with varied names. Furthermore, the test has not been minutely described and its mechanism remains unclear. We renamed the test the “distal forearm squeeze test”. The purpose of this study was to elaborate on the test and elucidate the mechanism.MethodsTwo patients with digital flexor tendons ruptured in zone 3 and zone 1 respectively and 50 outpatients with intact digital tendons underwent the test. Then the test was performed on 3 chickens under 4 conditions. First, when the digital flexor and extensor tendons were all intact. Second, after the flexor tendons of the third toe were transected. Third, after the flexor tendons of all toes of the foot were transected. Finally, after the flexor and extensor tendons of all toes of the foot were transected.ResultsIn the patient with digital flexor tendons ruptured in zone 3, the test showed that the injured digit was flexed slightly while the uninjured digits were flexed obviously. In the patient with digital flexor tendon ruptured in zone 1, after separate stabilization of the proximal interphalangeal (PIP) joints of the injured and uninjured fingers in extension, the test showed that the distal interphalangeal joint of the patient’s injured finger had no response, while those of the uninjured fingers were flexed. All 50 subjects showed clenched or half-clenched hands in response to the test. The test showed that all toes were flexed when the digital tendons of the chicken were intact. All toes were flexed except the third toe after the flexor tendons of the third toe were transected. All toes were extended after all the digital flexor tendons were transected. All toes had no response after all the digital flexor and extensor tendons were transected.ConclusionsThe distal forearm squeeze test is valuable in examining digital flexor tendon injuries. If only the flexor digitorum profundus tendon is examined, the PIP joint of the finger should be stabilized in extension during the test.

Comparison of Outcomes of Three Different Modalities for Treatment of Acute Fingertip Injuries

The fingertip has a crucial role in providing tactile and sensory functions to the brain. Anatomically, it refers to the region behind the extensor tendons and point of insertion of the flexor digitorum superficialis at the distal phalanx or interphalangeal joint in the case of the thumb. Objective: To compare the outcomes of three different modalities for managing acute fingertip injuries involving healing by secondary intention, primary closure, and local flap coverage. Methods: A randomized control trial was conducted, employing non-probability consecutive sampling. The inclusion criteria consisted of patients aged 20 to 40 years with fingertip injuries and tissue loss categorized as Allen II, III, or IV injuries. Cold intolerance was assessed using the Cold Intolerance Severity Symptom (CISS) questionnaire, which assigns a score ranging from 0 to 100. The sensibility of the injured and uninjured fingers was evaluated using the Semmes-Weinstein monofilament test (SWF). The chi-square test was used to examine relevant relationships. Results: Statistically significant associations were observed between smoking, comorbidities, and treatment modalities (p < 0.001). Among smokers, 81% received Group A treatment, while only 38% of smoking patients were treated with Group B and 69% with Group C. In the Group A treatment, 54.8% of patients were left-handed, 57.1% had Allen III classification, 54.8% had transverse injuries, and only 8% experienced short-term complications (infection). Conclusions: Based on the study findings, no significant differences were identified among the three treatment modalities.

Hand function 6 weeks following non-surgically treated proximal phalangeal fractures and factors associated to upper extremity disability

Purpose To describe hand function, and investigate adherence to a rehabilitation protocol and factors associated with upper extremity disability in non-surgically treated proximal phalangeal fractures. Material and methods In a prospective cohort study, 86 patients (58 women, mean age of 49 years) were assessed at cast removal and 6 weeks follow-up. Adherence was registered in a diary. Factors potentially associated with disability were assessed in a logistic regression model. Results At 6 weeks, the mean total active range of motion in the injured finger was 84% of the uninjured finger and median pain intensity levels were low (VAS <20). Mean grip strength was 66% of the uninjured hand and 28% perceived high upper extremity disability (QuickDASH score ≥30). Most patients adhered to exercise and night splint regime. The strongest associated factors with high upper extremity disability were more days in cast (Odds ratio 1.429, 95% CI 1.110–1.840) and fear of movement (Odds ratio 1.119, 95% CI 0.990–1.256) in the final regression model (Nagelkerke R Square 0.46). Conclusion Most patients regain early satisfactory hand function, but a quarter still perceives high upper extremity disability. Longer immobilisation time in particular and fear of movement are important factors that may negatively affect the early outcome.

Percutaneous, antegrade Pinning of proximal phalangeal Fractures: Comparison of Early Active Motion vs. Immobilization by Splinting

This retrospective study compares the functional outcome after early active postoperative motion with the outcome after 6 weeks of immobilization by splinting in patients with proximal phalangeal fractures treated by percutaneous, antegrade pinning. 46 out of 90 patients treated by closed reduction and percutaneous antegrade pinning of isolated fractures of the proximal phalanges were re-evaluated on average after 18.5 months. There were 17 women and 29 men with a mean age of 42.8 years. 28 patients underwent early active postoperative motion and 18 patients were immobilized by splinting for 6 weeks postoperatively. The two groups were statistically comparable with respect to age, gender, fracture localisation and morphology, mechanism of injury and operative time. Follow-up examination included measurement of active and passive range of motion (TAM; TPM) of the injured finger and the uninjured finger of the opposite side as well as grip strength of both hands. In addition, postoperative complications, the DASH-score and time interval between surgery and return to work were registered. There were no significant differences between the two groups regarding rate of complication, number or required revisions, finger motion and grip strenght. Patients with early active motion returned earlier back to work than patients treated by postoperative splinting (2.5 vs. 9.0 weeks; p = 0.035). With 1.7 the DASH-score in the group with early active motion was better than in the splinting group with 2.5 (p = .269). Patients with early active postoperative motion returned earlier back to work. There was no significant difference between both groups respecting global finger function.Compliant patients with a fracture of the proximal phalanx treated by closed reduction and percutaneous pinning can be treated with early active motion postoperatively.

The Oxford Finger Nail Appearance Score - a new scoring system for fingernail deformity following paediatric finger tip trauma

Fingernail deformity is common, yet current methods used to define cosmetic appearance following trauma are mainly descriptive. In order to quantify the cosmetic appearance of the fingernail, we developed the Oxford Fingernail Appearance Score using a three stage iterative process. The score has five cosmetic components marked as binary outcomes composed of nail shape, nail adherence, eponychial appearance, nail surface appearance and presence of a split. In the first stage, two assessors independently assessed 25 photographs of fingernails taken at a minimum of four months following paediatric nail bed repair and compared them to the corresponding contralateral uninjured finger. Following refinement in the score, ten different assessors scored a further 62 photographs of fingernails taken after paediatric nail bed repair. Assessors completed each of the five components, and the overall component score was calculated by statisticians post-hoc, taking the ideal appearance of each component as 1 ("identical to opposite" for nail shape, eponychium and surface, "complete" for adherence, "absent" for split) and all the non-ideal appearances as 0. Assessors effectively scored the photographs' integer values between 0 (least optimal appearance) and 5 (most optimal appearance). Refinements in the scoring system resulted in an improvement in a weighted kappa statistic of 0.36 (95% CI:0.09,0.68) in the initial score to 0.52 (95% CI: 0.42, 0.61). The Oxford Fingernail Appearance Score is a user-friendly and reliable scoring system which has application in a clinical trial setting.

The semi-occlusive dressing - development of the confidence of the patients in the treatment and the odour emission during the treatment period

This study aims to analyse how the confidence of patients with a fingertip injury treated with a semi-occlusive dressing develops during treatment. In addition, the development of odour emission was recorded. 17 patients with a fingertip injury were treated by use of a semi-occlusive dressing. On each appointment, before the dressing was changed, patients were interviewed about their confidence in the type of treatment and the amount of odour emission. Confidence in type of treatment and amount of odour emission were graded on a numeric analogue scale with 0 = no confidence and 10 = absolute confidence, and 0 = no odour emission and 10 = extreme odour emission, respectively. After the fingertip injury healed, pulp thickness was measured by ultrasound and compared with the uninjured finger of the opposite hand. Already at the beginning of treatment, patient confidence in the type of treatment was high (8.5 ± SD 1.1). Odour emission reached a maximum of 5.6 ± SD 2.5 at the third dressing change. As odour emission decreased, confidence in type of treatment peaked between the third and fourth dressing change. After healing of the fingertip injury, the pulp of the injured finger was measured to be 3.0 ± 0.6 mm on ultrasound; pulp thickness of the uninjured finger of the other hand was 3.4 ± 0.8 mm. The confidence that a fingertip injury will heal by use of a semi-occlusive dressing is very high from the beginning of treatment. As odour emission decreases, confidence in treatment increases further.

Cold Susceptibility of Digit Stumps Resulting from Amputation After Freezing Cold Injury in Elite Alpinists.

The aim of the study was to assess whether previous freezing cold injury in fingers and/or toes might predispose alpinists to greater risk of further freezing cold injury, primarily due to a greater vasoconstrictor response to cold, resulting in a lower perfusion, reflected in lower skin temperature. Ten elite alpinists (N = 10; 8 male and 2 female) with amputations after freezing cold injury participated in a cold-water (8°C) immersion stress test of the hands and feet. Digit skin temperatures of amputated digits, their noninjured counterparts, noninjured digits of the affected side and noninjured digits of the corresponding side were measured. The skin temperatures were compared during three consecutive phases of the cold stress test: prewarming, cold water immersion, and passive heating. Amputated toes cooled much faster compared to their uninjured counterparts (n = 26, p < 0.001), and attained lower skin temperatures during the cold exposure test (n = 26, p < 0.001). Higher cooling rate was observed in all the toes on the injured limb compared with the toes on the uninjured limb (n = 40, p < 0.001). In contrast to the toes, the fingers on the injured limb after freezing cold injury were warmer during cooling phase compared to uninjured fingers (n = 15, p < 0.001). The lower digit temperatures observed in affected toe stumps during the cold stress test compared to the nonamputated toes may indicate a heightened risk of future freezing cold injury with subsequent cold exposures, as a consequence of less perfusion, reflected in the lower skin temperature. This relationship was not confirmed in the fingers.

Hand Posturing Is a Nonverbal Indicator of Catastrophic Thinking for Finger, Hand, or Wrist Injury.

Prior research documents that greater psychologic distress (anxiety/depression) and less effective coping strategies (catastrophic thinking, kinesophobia) are associated with greater pain intensity and greater limitations. Recognition and acknowledgment of verbal and nonverbal indicators of psychologic factors might raise opportunities for improved psychologic health. There is evidence that specific patient words and phrases indicate greater catastrophic thinking. This study tested proposed nonverbal indicators (such as flexion of the wrist during attempted finger flexion or extension of uninjured fingers as the stiff and painful finger is flexed) for their association with catastrophic thinking. (1) Do patients with specific protective hand postures during physical examination have greater pain interference (limitation of activity in response to nociception), limitations, symptoms of depression, catastrophic thinking (protectiveness, preparation for the worst), and kinesophobia (fear of movement)? (2) Do greater numbers of protective hand postures correlate with worse scores on these measures? Between October 2014 and September 2016, 156 adult patients with stiff or painful fingers within 2 months after sustaining a finger, hand, or wrist injury were invited to participate in this study. Six patients chose not to participate as a result of time constraints and one patient was excluded as a result of inconsistent scoring of a possible hand posture, leaving 149 patients for analysis. We asked all patients to complete a set of questionnaires and a sociodemographic survey. We used Patient Reported Outcomes Measurement Information System (PROMIS) Depression, Upper Extremity Physical Function, and Pain Interference computer adaptive test (CAT) questionnaires. We used the Abbreviated Pain Catastrophizing Scale (PCS-4) to measure catastrophic thinking in response to nociception. Finally, we used the Tampa Scale of Kinesophobia (TSK) to assess fear of movement. The occurrence of protective hand postures during the physical examination was noted by both the physician and researcher. For uncertainty or disagreement, a video of the physical examination was recorded and a group decision was made. Patients with one or more protective hand postures did not score higher on the PROMIS Pain Interference CAT (hand posture: 59 [56-64]; no posture: 59 [54-63]; difference of medians: 0; p = 0.273), Physical Function CAT (32 ± 8 versus 34 ± 8; mean difference: 2 [confidence interval {CI}, -0.5 to 5]; p = 0.107), nor the Depression CAT (48 [41-55] versus 48 [42-53]; difference of medians: 0; p = 0.662). However, having at least one hand posture was associated with a higher degree of catastrophic thinking (PCS scores: 13 [6-26] versus 10 [3-16]; difference of medians: 3; p = 0.0104) and a higher level of kinesophobia (TSK: 40 ± 6 versus 38 ± 6; mean difference: -2 [CI, -4 to -1]; p = 0.0420). Greater catastrophic thinking was associated with a greater number of protective hand postures on average (rho: 0.20, p = 0.0138). Protective hand postures and (based on prior research) specific words and phrases are associated with catastrophic thinking and kinesophobia, less effective coping strategies that hinder recovery. Surgeons can learn to recognize these signs and begin to treat catastrophic thinking and kinesophobia starting with compassion, empathy, and patience and be prepared to add formal support (such as cognitive-behavioral therapy) to help facilitate recovery. Level III, diagnostic study.

Lateral Antebrachial Cutaneous Nerve as a Donor Source for Digital Nerve Grafting: A Concept Revisited.

Objective:The main objective of this study is to evaluate the availability of lateral antebrachial cutaneous nerve (LACN) autograft for acute or delayed repair of segmented digital nerve injuries.Patients and Methods:13 digital nerve defects of 11 patients; treated with interposition of LACN graft that harvested from ipsilateral extremity were included in the study. Mean follow up period was 35, 7 months. The mean time from injury to grafting is 53, 3 days. The results of the mean 2PDT and SWMT values of injured /uninjured finger at the end of follow up period were evaluated with Paired T test. The correlation between the defect length and the difference of 2PDT, SWMT values between the uninjured and injured finger at the end of follow up period; were evaluated with Pearson - correlation analysis.Results:The mean value of our 2PDT and SWMT results are ~5,923, ~3, 52, respectively in which can be interpreted between the normal and diminished light touch. The defect length and difference percentage of SWMT values is positively and significantly correlated statistically. Mean length of interposed nerve grafts was 18.5 mm. The age of the patient and the mean values of 2PDT and SWMT with the difference % of 2PDT and % of SWMT are not statistically correlated.Conclusion:Based on results regarding sensory regaining at recipient side and negligible sensory deficit at harvesting side, we suggest that lateral antebrachial cutaneous nerve might be a valuable graft option for digital nerve defects.

Why borrow from Peter when Paul can afford it? Reverse homodigital artery flap for fingertip reconstruction.

Background:Fingertip injuries that are complicated by pulp loss, bone or tendon exposure will need a flap cover. Cross finger flap is commonly used to cover such defects. However, patients are apprehensive about injuring the uninjured finger as a donor site. Reverse homodigital artery flap (RHAF) can provide reliable vascularised cover to such defects.Aims:This study aims to assess the functional and aesthetic outcomes along with the patient satisfaction of RHAFs done for fingertip defects.Materials and Methods:RHAFs done in 18 patients operated between August 2015 and October 2016 were retrospectively analysed on flap survival, sensory recovery, range of movements, hypersensitivity, cold intolerance, flexion contracture and donor site morbidity.Results:Seventeen of the 18 flaps done survived completely. One flap had partial necrosis of 3 mm that healed conservatively. Middle finger of the right hand was the most commonly injured finger. Touch, pain and pressure sensations recovered in 8–12 weeks. Two-point discrimination was 4.5 mm at 6 months. The deficit of 5° s was present at distal interphalangeal joint during active flexion at 6 months. Cold intolerance and flexion contracture were not seen and 2 instances of hypersensitivity at 2 months got cured conservatively after 4 months. Overall satisfaction of patients was 8/10.Conclusion:RHAF provides single staged well-vascularised cover for fingertip injuries with good sensory recovery without damaging the adjacent uninjured finger. Hence, it can be a reliable flap for fingertip reconstruction in selected cases.

Comparison of the Outcomes of 2 Rehabilitation Protocols After Flexor Tendon Repair of the Hand at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

Background: Flexor tendon repair of the hand and the rehabilitation thereof are commonly discussed between hand surgeons and therapists. There are many patients in public hospitals in South Africa who require this surgery. They are regularly sent to the therapists for rehabilitation, using the early passive motion protocol. Although the early active motion protocol has yielded improved results globally, there is limited evidence on the comparison of the outcomes of these 2 protocols in the South African context. This study was implemented to compare the outcomes of these 2 protocols in a large public hospital post flexor tendon repair. Methods: Patients (n = 46) who sustained a zone II-IV flexor tendon injury were recruited for the study and equally distributed between the 2 groups (early active motion and early passive motion). Out of these participants, 11 did not return for the initial assessment at 4 weeks post surgery and were therefore excluded. There were 19 participants in the early active motion group and 16 participants in the early passive motion group. Results were collected and classified at 4, 8, and 12 weeks post surgery. The collection of data commenced in December 2014 and was completed in January 2016. Results: The results of the study included total active motion and tip to crease and tip to table measurements of the injured and uninjured fingers. At 12 weeks post surgery, the average total active motion of the injured fingers was similar between the early active and early passive motion protocols (57.46%, 61.00%, respectively). Tip to crease and tip to table measurements were also similar between the 2 groups. In terms of patient compliance, 52.17% of participants removed their splints in the initial 4-week period, and 56.52% carried out the prescribed exercises correctly. Tendon rupture occurred in 8.57% (n = 3, early active motion = 5.71%, early passive motion = 2.86%) of patients. Conclusion: There has been a global trend toward the use of an early active motion protocol post flexor tendon repair. This study found that there was no difference in outcomes between the 2 groups. Therefore, either protocol could be implemented in South African public hospitals. However, because the early active motion protocol takes less time to implement, this protocol is recommended. A larger study would be necessary to determine a significant comparison between the 2 groups; however, this is challenging due to poor patient compliance.

Finger and Toe Temperature Responses to Cold After Freezing Cold Injury in Elite Alpinists

To assess whether previous freezing cold injuries (FCI) would affect digit skin temperatures and rewarming rates during a follow-up cold stress test protocol. Nonrandomized control trial. Twenty elite alpinists participated; alpinists with previous FCI requiring digit amputations (injured, INJ: n = 10 total, n = 8 male) were compared with ability-matched, uninjured alpinists (control, CON: n = 10, all male). Digit skin temperature was measured using infrared thermography as an index of peripheral digit perfusion after a cold stress test, which consisted of 30 minutes of immersion in 8°C water. The INJ alpinists' injured toes were warmer (approximately 6%) than their uninjured toes immediately after cold immersion (95% CI, 0.01°C to 1.00°C; P = .05); there were no differences between the rates of rewarming of injured and uninjured toes (INJ, 0.5° ± 0.1°C/min; CON, 0.7° ± 0.3°C/min; P = .16). Although the INJ alpinists had colder injured fingers immediately after the 35°C warm bath compared with their own uninjured fingers (32.2° ± 2.0°C vs 34.5° ± 0.5°C; P = .02), there were no differences observed between the rates of rewarming of injured and uninjured fingers after cold exposure (INJ, 1.1° ± 0.2°C/min; CON, 1.3° ± 0.5°C/min; P = .22). Even after FCI that requires digit amputation, there is no evidence of different tissue rates of rewarming between the injured and uninjured fingers or toes of elite alpinists.

A prospective randomized controlled trial comparing night splinting with no splinting after treatment of mallet finger.

The effectiveness of night splinting after treatment of mallet finger is unknown. We tested the hypothesis that there is no difference in extensor lag between patients with mallet finger that wear a night splint for an additional month after 6 to 8weeks of continuous splinting and patients that do not wear a night splint. Fifty-one patients were enrolled in this randomized controlled trial. At enrollment, range of motion was measured for the injured and contralateral uninjured finger. The follow-up was conducted approximately 4weeks later in person (41 patients) or by phone (10 patients). Analysis was by intention to treat. There were no significant differences in final extensor lag between patients that did and did not receive a night splint. Among the 41 patients with a final in-person evaluation, the final average extensor lag was 14°, and 34% (14 of 41 patients) had a lag of 20° or greater. Final extensor lag correlated significantly with age, enrollment distal interphalangeal joint (DIP) flexion and extensor lag, and final DIP flexion, with the latter two accounting for 28% of the variation in final lag in the final multivariable model (p < 0.001). There were no differences in disability (p = 0.67) or treatment satisfaction (p = 0.48) between patients that did and did not use night splints. Supplemental night splinting does not improve the outcome of mallet finger in terms of extensor lag, disability, or satisfaction with treatment. Patients with worse initial extensor lags should expect worse final lags; residual lags of 20° or greater are commonplace.

Comparison of three types of treatment modalities on the outcome of fingertip injuries

In this retrospective study, we analyzed the outcomes of different types of treatment of fingertip injuries and compared them after a mean follow-up of 4.5 years. A total of 53 patients (59 injuries) were included in this study. The fingertip injuries were classified according to Allen classification. The patients were categorized into three groups based on the treatment: reconstructive group, bone-shortening group, and conservative group. As objective assessments, strength, sensibility, and goniometry were measured; as subjective assessments, cold intolerance, nail deformation, and aesthetics were measured. The mean reduction in strength, the Semmes-Weinstein monofilament test, and the reduction in mobility for the injured fingers compared with those of the uninjured finger were not significantly different between the groups. Cold intolerance was reported in 50 (84.7%) of the 59 fingers, and in almost 90% of all the cases, there was some kind of nail distortion. For the cold intolerance and nail distortions, there was no difference between the groups. The aesthetic outcomes judged by patients and surgeon were comparable. In conclusion, the outcome of treatment of Allen II, III, and IV fingertip injuries was irrespective of the treatment chosen. In an era where the enormous variety of surgical options suggests that treatment with a flap is the best, this outcome is at least surprising. Therapeutic study, level IV.

Flap Irritation Phenomenon (FLIP): Etiology of Chronic Tenosynovitis After Finger Pulley Rupture

After a pulley rupture, most climbers regain the full function of their previously uninjured fingers. However, in some cases of pulley rupture, a persistent inflammation of the tendon sheath is observed. In this study, 16 cadaver fingers were loaded until pulley rupture and then studied for the rupturing mechanism. In addition, two patients with this pathology were investigated using ultrasound and MRI, and received surgery. In 13 fingers, a rupture of one or several pulleys occurred and almost always at the medial or lateral insertion. In one finger, a capsizing of the pulley underneath the intact tendon sheath was observed, leading to an avulsion between tendon and tendon sheath. A similar pathology was observed in the ultrasound imaging, in MRI, and during surgery in two patients with prolonged recovery after minor pulley rupture. In cases of prolonged tenosynovitis after minor pulley rupture, a capsizing of the pulley stump is probably the cause for constant friction leading to inflammation. In those cases, a surgical removal of the remaining pulley stump and sometimes a pulley repair may be necessary.

Cold-Induced Vasodilatation Following Traumatic Median or Ulnar Nerve Injury

Peripheral nerve injury of the upper extremity frequently causes changes in the thermoregulatory system of the hands and fingers and leads to reports of cold intolerance. In this study, we aimed to measure the influence of median or ulnar nerve injury on cold-induced vasodilatation (CIVD) during prolonged cooling at low temperatures. We tested 12 patients with a median (n = 6) or ulnar (n = 6) injury 4 to 76 months after nerve repair. The palmar sides of both hands were cooled continuously using a cold plate at 5°C. We measured the skin temperature of the fingers using videothermography and plotted graphs of the temperature changes of the nailbed. The presence of a CIVD reaction was defined as a minimum increase in temperature of 2.5°C starting at the distal phalanx. Furthermore, we measured self-reported symptoms of cold intolerance using the Cold Intolerance Severity Scale questionnaire. A CIVD reaction was absent in the affected digits of 4 patients (follow-up, 6-37 mo), whereas the CIVD reaction in the uninjured hand was present. The CIVD was present in 6 patients after 50 months' follow-up (range, 24-76 mo). Two patients had no CIVD reaction in the injured or uninjured fingers. All patients with a CIVD response had at least diminished protective sensation. Presence of the CIVD reaction did not exclude self-reported symptoms of cold intolerance. After peripheral nerve injury, it is possible to recover the CIVD reaction. This might be an indication of nerve recovery. However, a positive CIVD reaction does not exclude subjective symptoms of posttraumatic cold intolerance. Diagnostic III.

The Versatile Adani′s Flap for Fingertip Coverage

Heterodigital pedicle flaps have 2 possible patters of vascularization: anterograde flow (Littler) or reverse flow (Adani). The Adani's flap uses the Y-V pedicle lengthening principle. The flap is raised from the adjacent uninjured finger based on the digital artery. The common digital artery is ligated and a long pedicle is formed from the 2 converging digital arteries to supply a reverse flow flap. Four patients with severe fingertips injuries were submitted to surgical treatment with the Adani's flap. All flaps integrated and provided skin coverage. The Adani's flap has a long vascular pedicle that allows a wide arch of transposition. An easier vascular dissection in a site distant from the trauma which evolves a higher diameter digital artery and proximal interphalangeal arterial system promotes a high survival rate and good functional results. Adani's flap is a reliable technique for severe fingertip injuries.

Application of resonant cavity perturbation to in vivo segmental hydration measurement

The dielectric properties of biological tissues at radio and microwave frequencies are strongly correlated with tissue water content. Localized, in vivo measurement of permittivity and conductivity should therefore provide useful clinical information in diseases involving abnormal hydration, such as lymphoedema. We have developed an open-geometry sensor for segmental hydration studies based on a flat cavity resonator operating at 300 MHz, and have demonstrated that the changes in its resonant frequency and Q-factor were significantly greater when it was applied to a swollen, oedematous finger, compared to an uninjured finger of similar size. The resonant sensor was calibrated with reference liquids in vials inserted through holes in its cavity plates, and we found that a modified resonant cavity perturbation formula, with coefficients empirically optimized by means of a genetic algorithm, yielded good agreement with literature values of complex permittivity. However, extending the length of the sample containers leads to measurement artefacts owing to antenna currents with associated radiated energy losses. A detailed simulation of the system with a full-wave solver using Method-of-Moments enabled us to estimate the current distribution and energy balance, and thus take steps towards mitigating these effects and enabling the system to make quantitative in vivo measurements of tissue dielectric properties.

Variation in Digital Rotation and Alignment in Normal Subjects

The purpose of this study is to quantify finger/digit rotation, overlap, parallelism, and convergence to the scaphoid tuberosity in normal volunteers to establish standards for comparison. We examined 240 uninjured fingers in 30 volunteers. There were 14 men and 16 women with an average age of 35 years. Rotation was determined with the palm flat and fingers extended. Digit overlap, parallelism (angular relationship between the index, ring, and small fingers with respect to the middle finger) and scaphoid convergence were determined with simultaneous flexion of metacarpophalangeal and proximal interphalangeal joints. Linear and angular measurements were performed with imaging software. Rotation, parallelism, and scaphoid convergence measurements were similar comparing left with right hands. Rotation: All digits were found to be in supination relative to the horizontal plane; the small fingers averaged 9 degrees, the ring fingers 4 degrees, the middle fingers 8 degrees, and the index fingers 12 degrees. Parallelism: Angular measurements between the middle finger and the small finger averaged 19 degrees, between the middle finger and the ring finger 9 degrees, and between the middle finger and the index finger 11 degrees. Scaphoid convergence: In no hand did all 4 fingers converge onto scaphoid tuberosity. Whereas small and ring finger trajectories averaged -0.1 to 1.2 mm from the scaphoid tubercle, the middle finger averaged 4.0 to 4.6 mm and the index finger 8.1 to 9.5 mm. Overlap: Ninety percent of individuals demonstrated digit overlap, although none covered more than 50% of the adjacent nail plate. Seventy-seven percent of these were bilateral, and 73% were asymmetric. This study establishes the normal parameters for digit rotation, overlap, parallelism, and scaphoid convergence. For digit rotation, parallelism, and scaphoid convergence, the contralateral (uninjured) hand can be used reliably for comparison. However, for digit overlap, the contralateral hand should not be used for comparison because of side-to-side asymmetry and variability. Diagnostic IV.

Mobilidade articular dos dedos não lesados pós-reparo em lesão dos tendões flexores da mão

Joint range of motion of uninjured fingers after repairs to flexor tendon injuries of the hand Objective: To assess the range of motion (ROM) in hands that underwent tendon repair in the flexor digitorum superficialis and flexor digitorum profundus muscles of the fingers, comparing the data between the fingers on the injured hand, and between the injured and uninjured hands. Method: Active goniometry was performed on 15 patients, making a total of 120 fingers (60 on injured hands and 60 on noninjured control hands). The patients were examined at the time of removing the plaster splint. Early mobilization was performed using the modified Duran method. Goniometric data were used for recording the TAM (total active motion) values of the fingers on the injured and uninjured (control) hands. To analyze the data, the functional index formula proposed by the American Society for Surgery of the Hand (ASSH) was utilized, and for statistical calculations the mixed-effect model was selected. Results: The ASSH formula for the injured fingers classified the movement as “good” in 18.33%, “fair” in 18.33% and “poor” in 63.34%. The means, in degrees, of the measurements for all the fingers were compared with each other within each group (control and injured) and between the groups. A significant difference was found between control and injured groups. There was no statistical difference between the TAM of each finger on the injured hand. Conclusion: Independent of how many fingers on one hand had suffered tendon injuries, the uninjured fingers also presented diminished active ROM during the period immediately after removal of the immobilization.