-
Kidney International Oct 2020The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) guideline update suggests bone mineral density testing to assess fracture risk in patients with chronic kidney...
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) guideline update suggests bone mineral density testing to assess fracture risk in patients with chronic kidney disease, but dual-energy X-ray absorptiometry is not available in most dialysis facilities. Radiographic absorptiometry is an inexpensive and quick method for evaluating bone mineral density. Therefore, we analyzed a historical cohort of 456 maintenance hemodialysis patients to determine whether metacarpal bone mineral density measured by digital image processing, a computer-assisted radiographic absorptiometry technique, predicts fracture risk. At baseline, the median metacarpal bone mineral density T-score was -2.05 (interquartile range, -3.35 to -0.99). During a mean follow-up of 5.3 years, there were 16 clinical fractures and 11 asymptomatic vertebral fractures as estimated by height loss. Metacarpal bone mineral density T-score was significantly lower in patients who sustained a clinical fracture than in those remaining event-free. Decreasing metacarpal bone mineral density T-score was significantly associated with increased risk of clinical fracture (hazard ratio, 1.41 per 1 standard deviation decrease in bone mineral density T-score [95% confidence interval, 1.09 to 1.83]; the hazard ratio for lowest versus highest tertile was 4.86 [1.03 to 22.92]. Similar associations were observed between metacarpal bone mineral density T-score and vertebral fracture or any fracture. The results were robust to different analysis strategies and were consistent across different subgroups. Thus, radiographic absorptiometry could be a useful tool for primary screening of hemodialysis patients at high risk for fracture. Additional studies are required to determine the predictive ability of radiographic absorptiometry techniques compared to dual-energy X-ray absorptiometry or other established methods.
Topics: Absorptiometry, Photon; Bone Density; Fractures, Bone; Humans; Metacarpal Bones; Renal Dialysis
PubMed: 32682522
DOI: 10.1016/j.kint.2020.02.035 -
Arthritis Research & Therapy 2009Changes 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... (Review)
Review
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.
Topics: Arthritis, Rheumatoid; Bone Density; Humans; Metacarpal Bones; Radiography
PubMed: 19833006
DOI: 10.1186/ar2788 -
The Journal of Hand Surgery... Oct 2022High energy metacarpal fracture presenting with critical bone loss requires bone graft and hardware stabilisation. Early bone grafting and rigid internal fixation allow...
High energy metacarpal fracture presenting with critical bone loss requires bone graft and hardware stabilisation. Early bone grafting and rigid internal fixation allow expedited patient recovery. Plate fixation is the most described technique when an autologous bone graft is being used. In this report, we present an alternative technique to secure bone grafts to metacarpal shafts with intra-medullary headless compression screws (HCS). In the presented patient, significant bone defects of the fourth and fifth metacarpals were bridged using iliac crest cortico-cancellous bone grafts and fixed with HCS. This method of fixation allowed controlled early active mobilisation. Bone graft incorporation and excellent active range of motion were demonstrated. Level V (Therapeutic).
Topics: Humans; Metacarpal Bones; Bone Transplantation; Bone Screws; Fractures, Bone; Fracture Fixation, Internal; Hand Injuries
PubMed: 36285758
DOI: 10.1142/S2424835522720468 -
Hand Surgery & Rehabilitation Apr 2019Gunshot wounds to the hand often produce complex injuries and large segmental bone defects. Bone reconstruction remains a challenge in this context. The induced membrane...
Gunshot wounds to the hand often produce complex injuries and large segmental bone defects. Bone reconstruction remains a challenge in this context. The induced membrane technique is a simple and effective procedure for reconstruction of segmental bone defects. The technique is straightforward but must be performed rigorously. Usually polymethylmethacrylate (PMMA) cement is required for the first stage of the surgery. We describe four cases of metacarpal bone reconstruction after gunshot wounds in a limited-resource setting. Two patients were treated using the induced membrane technique with a polypropylene syringe body instead of PMMA cement, which was unavailable in this situation. A thick membrane was observed 6 weeks after spacer implantation. Bone union was achieved in all cases.
Topics: Adult; Anti-Bacterial Agents; Cancellous Bone; Cortical Bone; Foreign Bodies; Foreign-Body Reaction; Fracture Healing; Fractures, Open; Guided Tissue Regeneration; Humans; Ilium; Male; Metacarpal Bones; Polypropylenes; Surgical Flaps; Surgical Wound Infection; Tibia; Wounds, Gunshot
PubMed: 30690200
DOI: 10.1016/j.hansur.2019.01.002 -
Journal of Clinical Densitometry : the... 2020Reduction in cortical bone mineral density at diaphysis of metacarpal bones of the hand, evaluated by dual X-ray radiogrammetry, has a bad prognostic value in patients...
Reduction in cortical bone mineral density at diaphysis of metacarpal bones of the hand, evaluated by dual X-ray radiogrammetry, has a bad prognostic value in patients with early arthritis. Nevertheless, this technique is hardly accessible in clinical practice. By contrast, evaluation of cortical bone mineral density at that location has not been previously assessed by conventional dual X-ray absorptiometry. The aim of this study is to evaluate the reproducibility of bone mineral density measurements at diaphysis of metacarpal bones using conventional dual X-ray densitometry in a population of healthy volunteers and patients with early arthritis. Nondominant hand dual X-ray densitometry was performed at three consecutive times with complete hand replacement in 27 subjects: 10 early arthritis and 17 healthy volunteers. Three different evaluators analyzed the 3 measurements of second to fourth metacarpal bones. To assess the reproducibility and accuracy of the measurements, intra- and interobserver agreement degrees, intra- and interclass correlation coefficients, smallest difference detectable assessment, and Bland Altman graphs were calculated. The coefficients of variation obtained for the different metacarpal evaluations were 2.25%, 2.91%, 2.85%, and 2.07% for metacarpal-2, metacarpal-3, metacarpal-4, and mean metacarpal-second to fourth, respectively, with a smallest difference detectable of 0.028, 0.034, 0.028, and 0.03 g/cm, respectively. The mean intra- and interobserver correlation coefficients between of metacarpal second to fourth were 0.990 (95% confidence interval [CI]: 0.982-0.995) and 0.995 (95% CI: 0.991-0.997), respectively. As expected, women had lower bone mineral density at metacarpal bones, especially after menopause. The results obtained in this study show an excellent reproducibility of bone mineral density measurements at diaphysis of metacarpal bones of the hand, measured by conventional dual X-ray densitometry, in a mixed population of healthy subjects and patients with early arthritis. This is of great interest for longitudinal studies in patients with early arthritis.
Topics: Absorptiometry, Photon; Adult; Aged; Aged, 80 and over; Arthritis; Bone Density; Female; Humans; Male; Metacarpal Bones; Middle Aged; Reproducibility of Results; Young Adult
PubMed: 30910402
DOI: 10.1016/j.jocd.2019.02.006 -
The Journal of Hand Surgery, European... May 2021
Topics: Bone Transplantation; Humans; Ilium; Metacarpal Bones; Transplantation, Autologous
PubMed: 33153380
DOI: 10.1177/1753193420970162 -
Skeletal Radiology Apr 2018Extra-axial chordoma is a chordoma that occurs in non-axial locations. It is a very rare tumor, with 20 cases reported to date; 14 in bone and six in soft tissue. Of the... (Review)
Review
Extra-axial chordoma is a chordoma that occurs in non-axial locations. It is a very rare tumor, with 20 cases reported to date; 14 in bone and six in soft tissue. Of the 14 skeletal extra-axial chordomas, ten were intramedullary and four were intracortical. We report the first case of parosteal extra-axial chordoma arising in the second metacarpal bone, expressing brachyury on immunohistochemical analysis, and describe the pathologic and radiologic findings. We suggest that extra-axial chordoma can occur in parosteal bone lesions or the hand, without features of bone distribution or bone-specific sites.
Topics: Biomarkers, Tumor; Bone Neoplasms; Chordoma; Contrast Media; Fetal Proteins; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Male; Meglumine; Metacarpal Bones; Organometallic Compounds; Osteotomy; T-Box Domain Proteins; Tomography, X-Ray Computed; Young Adult
PubMed: 29151144
DOI: 10.1007/s00256-017-2818-z -
European Journal of Orthopaedic Surgery... Oct 2023The treatment of irreducible or severely displaced metacarpal and phalangeal bone fractures is still much debated. The recent development of the bioabsorbable magnesium...
PURPOSE
The treatment of irreducible or severely displaced metacarpal and phalangeal bone fractures is still much debated. The recent development of the bioabsorbable magnesium K-wire is thought to allow effective treatment upon insertion via intramedullary fixation by minimizing articular cartilage injuries without discomfort until pin removal and drawbacks, such as pin track infection and metal plate removal. Therefore, this study investigated and reported the effects of intramedullary fixation with the bioabsorbable magnesium K-wire in unstable metacarpal and phalangeal bone fractures.
METHODS
This study included 19 patients admitted to our clinic for metacarpal or phalangeal bone fractures from May 2019 to July 2021. As a result, 20 cases were examined among these 19 patients.
RESULTS
Bone union was observed in all 20 cases, with a mean bone union time of 10.5 (SD 3.4) weeks. Reduction loss was observed in six cases, all showing dorsal angulation with a mean angle of 6.6° (SD 3.5°) at 4.6 weeks as compared with that noted in the unaffected side. The gas cavity upon H gas formation was first observed approximately 2 weeks postoperatively. The mean DASH score was 33.5 for instrumental activity and 9.5 for work/task performance. No patient complained of notable discomfort after surgery.
CONCLUSION
Intramedullary fixation with the bioabsorbable magnesium K-wire may be used for unstable metacarpal and phalanx bone fractures. This wire is expected to be a particularly favorable indication for shaft fractures, although care should be taken due to the possibility of complications related to rigidity and deformity.
Topics: Humans; Metacarpal Bones; Absorbable Implants; Magnesium; Fracture Fixation, Intramedullary; Fractures, Bone; Bone Wires; Fracture Fixation, Internal
PubMed: 36906666
DOI: 10.1007/s00590-023-03503-3 -
The Journal of Hand Surgery May 2019Aneurysmal bone cysts are large lytic lesions that appear most often around metaphyseal bone. The lesions are locally aggressive with high recurrence rates. Therefore,...
Aneurysmal bone cysts are large lytic lesions that appear most often around metaphyseal bone. The lesions are locally aggressive with high recurrence rates. Therefore, wide resection is commonly necessary, leading to challenging reconstruction of the defect, especially when the articular surface is involved. We present a case of an aneurysmal bone cyst of the fourth metacarpal, treated with an en bloc resection and reconstruction with a metacarpal osteoarticular allograft. At 8 years after surgery, the patient has shown no signs of recurrence, but radiographic articular reabsorption was noted. However, the patient showed an excellent outcome with a satisfactory active range of motion and grip strength. Despite potential complications, osteoarticular allograft is a feasible alternative when autologous osteoarticular reconstruction is not an option.
Topics: Allografts; Bone Cysts, Aneurysmal; Bone Plates; Humans; Male; Metacarpal Bones; Return to Work; Young Adult
PubMed: 30017650
DOI: 10.1016/j.jhsa.2018.06.003 -
Techniques in Hand & Upper Extremity... Jun 2023Metacarpal bone loss presents a challenging reconstructive dilemma for hand surgeons. While multiple bone grafting techniques have been described, complications...
ABSTRACT
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 OF EVIDENCE
Level IV- Therapeutic.
Topics: Humans; Ilium; Metacarpal Bones; Treatment Outcome; Fractures, Bone; Fracture Fixation, Internal
PubMed: 36510850
DOI: 10.1097/BTH.0000000000000421