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Journal of Medical Case Reports Mar 2024Synovial sarcoma is a rare soft tissue sarcoma, with incidences of 0.81/1,000,000 in children and 1.42/1,000,000 in adults. It is most commonly found in soft tissue and...
BACKGROUND
Synovial sarcoma is a rare soft tissue sarcoma, with incidences of 0.81/1,000,000 in children and 1.42/1,000,000 in adults. It is most commonly found in soft tissue and rarely in bone. It often has a slow growth pattern and a benign radiologic appearance.
CASE PRESENTATION
This study reports a case of metacarpal synovial sarcoma occurring in the hand-wrist of a 32-year-old Iranian man presented with the chief complaint of a lump on the dorsal ulnar side of his left hand and wrist. Initially, the first physician suspected the case to be a ganglion cyst. After two months of conservative treatment, the size of the lesion gradually increased. Magnetic resonance imaging (MRI) was performed and after an excisional biopsy and a postoperative histological analysis, the tumor was identified as a synovial sarcoma. The patient underwent a scheduled surgical procedure. Unfortunately, he had poor follow-ups and brought the pathologic results two months later when, the tumor had incredible growth, which makes this presentation rare.
CONCLUSIONS
Since early diagnosis can lead to higher survival rates, this report increases doctors' awareness of this extremely malignant tumor that is rarely seen.
Topics: Adult; Humans; Male; Hand; Iran; Sarcoma; Sarcoma, Synovial; Ulna
PubMed: 38486309
DOI: 10.1186/s13256-024-04469-4 -
Animals : An Open Access Journal From... Mar 2024Metacarpophalangeal joint region pain is a common cause of lameness in racehorses. Radiological abnormalities in the sagittal ridge (SR) of the third metacarpal bone...
Metacarpophalangeal joint region pain is a common cause of lameness in racehorses. Radiological abnormalities in the sagittal ridge (SR) of the third metacarpal bone have been associated with joint effusion, lameness and reduced sales prices. The aims were to describe computed tomographic (CT) appearance of the SR in racehorses, and to document the progression of these findings over three assessments. Forty yearlings were enrolled at the first examination (time 0). Re-examinations were performed twice, approximately six months apart on 31 (time 1) and 23 (time 2) horses, respectively. Computed tomographic examinations of both metacarpophalangeal regions were performed with the horses in a standing position. Computed tomographic reconstructions were analysed subjectively and objectively. The mean Hounsfield Unit values (Hus) of eight radial segments and location, size and shape of hypoattenuating lesions were recorded. Mean Hus at time 1 were higher than at time 0. There was no difference between mean HU at times 1 and 2. The mean HU values of the dorsal half were higher in the right forelimbs and in fillies. Hypoattenuation was identified in 33/80 (41.3%) limbs at time 0, in 22/62 (35.5%) limbs at time 1 and in 14/46 (30.4%) limbs at time 2. All hypoattenuations were located in the dorsodistal aspect of the SR. The most common shapes were hypoattenuating lesions elongated proximodistally and those extending towards trabecular bone. An increase in attenuation of the SR occurred in the first six months of training. Hypoattenuating lesions could decrease in size and could resolve during early training. In this population, these lesions were not associated with lameness.
PubMed: 38473196
DOI: 10.3390/ani14050812 -
International Emergency Nursing Mar 2024Background To investigate what factors contribute to a working age adult with a simple fracture seeking care in an Australian metropolitan Emergency Department (ED)...
'I just need to find out if I had broken something or not.' A qualitative descriptive study into patient decisions to present to an Emergency Department with a simple fracture.
Background To investigate what factors contribute to a working age adult with a simple fracture seeking care in an Australian metropolitan Emergency Department (ED) Methods In this Qualitative Descriptive study, we interviewed ED patients with simple fractures including 5th metacarpal, 5th metatarsal, toe, radial head and clavicle fractures. Results We interviewed 30 patients aged 18-65. Two thirds of participants were aware they might have a minor injury. Many were well informed health consumers and convenience was the most important decision-making factor. Participants focussed on organising imaging, diagnosis and immobilisation. This sequence of care was often perceived as more complex and inefficient in primary care. ED was trusted and preferred to urgent primary care with an unknown doctor. Some patients defaulted to attending ED without considering alternatives due to poor health system knowledge or from escalating anxiety. Conclusions ED is safe, free and equipped to manage simple and complex injuries. Patients would attend primary care if comprehensive fracture management was easily accessible from a trusted clinician. To effectively divert simple fracture presentations from ED, primary care requires collocated imaging, imaging interpretation, orthopaedic expertise, and fracture management resources. Services need to operate 7 days a week and must have accessible 'urgent' appointments.
Topics: Adult; Humans; Health Services Accessibility; Australia; Emergency Service, Hospital; Fractures, Bone; Qualitative Research
PubMed: 38408404
DOI: 10.1016/j.ienj.2024.101420 -
Journal of Plastic Surgery and Hand... Feb 2024This review was performed to systematically compare the effectiveness and safety of the first dorsal metacarpal artery flaps (FDMAF) and reverse homodigital dorsal flaps... (Meta-Analysis)
Meta-Analysis
PURPOSE
This review was performed to systematically compare the effectiveness and safety of the first dorsal metacarpal artery flaps (FDMAF) and reverse homodigital dorsal flaps (RHDF) for thumb reconstruction.
METHODS
All literatures, which compared FDMAF versus RHDF for thumb reconstruction, were acquired through a comprehensive search in multiple databases from inception until 31st August 2022. A meta-analysis was performed using the Cochrane Collaboration's RevMan 5.4 software.
RESULTS
A total of 19 articles were retrieved, comprising 396 patients in the FDMAF group and 423 patients in the RHDF group. The pooled estimates suggested that there were no significant differences in venous congestion, complications about flap necrosis and reduced range of motion (ROM) of thumb, static 2-point discrimination (S-2PD) between the two groups. On the other hand, patients in the RHDF group had less vascular crisis (odds ratio [OR] = 3.15, 95%CI, 1.31-7.56), complications about poor cortical reorientation (OR = 440.02, 95%CI, 91.97-2105.27) and higher satisfaction rate (OR = 0.56, 95% CI, 0.33-0.96) than those in the FDMAF group.
CONCLUSIONS
The two surgical procedures were both safe and reliable since no significant differences were found in flap necrosis between the two groups. However, the patients in the RHDF group had less complications about vascular crisis, poor cortical reorientation and higher satisfaction rate. Accordingly, we thought RHDF may be more superior for thumb reconstruction than FDMAF.
Topics: Humans; Thumb; Metacarpal Bones; Plastic Surgery Procedures; Arteries; Necrosis
PubMed: 38407389
DOI: 10.2340/jphs.v59.12435 -
Journal of Clinical Medicine Feb 2024: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This... (Review)
Review
: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This systematic review aims to describe the outcomes of bone grafting following metacarpal non-union in an attempt to establish an optimal therapeutic protocol for this complication. : A systematic review was conducted in adherence with PRISMA guidelines. Data collection and analysis were performed in duplicate and confirmed by a third investigator. Our primary outcomes focused on radiological time to bone fusion and rates of non-union. Additionally, functional outcomes and complications were analyzed as means of central tendency. : Eighteen studies were included in the systematic review, accounting for a total of 47 patients. The average follow-up time was 12.4 months. Fourteen studies analyzed radiological outcomes, with atrophic non-union representing the most common type. The time to bone fusion, assessed radiologically, following bone graft was an average of 6.9 months (n = 14), with a 100% rate of union in 42 patients. Regarding patient-reported pain improvement, 76% of patients experienced pain relief. Moreover, all patients reported a complete subjective return to baseline hand function. Adverse events, limited to hematoma and seroma, were seen in three patients, representing a complication rate of 11.8% in the examined population. : Metacarpal non-union can be treated successfully via vascularized and non-vascularized bone grafting. Based on the available evidence, bone grafts demonstrate favorable union rates, post-operative pain reduction, hand function recovery, earlier bone fusion times, and minimal complications in the context of metacarpal non-union management.
PubMed: 38398461
DOI: 10.3390/jcm13041148 -
Animals : An Open Access Journal From... Feb 2024This case report describes a novel procedure using the Isolock Intrauma implant system for treating medial instability of the carpometacarpal and tarsometatarsal joints,...
This case report describes a novel procedure using the Isolock Intrauma implant system for treating medial instability of the carpometacarpal and tarsometatarsal joints, as demonstrated in in two dogs. A 9-year-old spayed female Spanish greyhound presented with a non-weight-bearing right hindlimb following a trauma. The clinical and radiological findings confirmed medial tarsometatarsal instability consistent with valgus deviation of the tarsus and the opening of the joint line on the medial aspect from the first to the third tarsometatarsal joints. A 4-year-old female Drahthaar presented with a non-weight-bearing left forelimb, swelling of the carpus and valgus instability. Radiological examination revealed a widening of the spaces between the intermedioradial carpal bone, second carpal bone and metacarpal bone II, confirming the medial carpometacarpal instability. In both cases, the Isolock system, an implant including ultra-high-molecular-weight polyethylene suture (UHMWPE), was used to reinforce the medial joint structures. Minor short-term complications were observed, such as swelling of the tarsal surgical site and hyperextension of the carpus, but these resolved spontaneously. No lameness or major complications were reported five months postoperatively. Carpometacarpal and tarsometatarsal instabilities are rare diseases in dogs as compared to subluxations of the other joints of the carpus and tarsus. There are no previous reports regarding the use of a UHMPWE implant for the treatment of these rare joint injuries, though the present case report suggests the validity and efficacy of the Isolock Intrauma implant for restoring carpal and tarsal stability and preserving joint mobility.
PubMed: 38396544
DOI: 10.3390/ani14040577 -
Case Reports in Plastic Surgery & Hand... 2024Dieterich's disease or avascular osteonecrosis of the metacarpal head is rare and not often described in the literature. It affects typically the middle of metacarpal...
Dieterich's disease or avascular osteonecrosis of the metacarpal head is rare and not often described in the literature. It affects typically the middle of metacarpal bones and can occur at all age groups. A case of a teenager with chronic pain of the third and fourth metacarpal head is presented.
PubMed: 38380433
DOI: 10.1080/23320885.2024.2316026 -
Veterinary Medicine and Science Mar 2024A 15-year-old Cocker Spaniel was referred to for the evaluation of left forelimb lameness. Radiographic and computed tomography examinations revealed osteolysis of the...
A 15-year-old Cocker Spaniel was referred to for the evaluation of left forelimb lameness. Radiographic and computed tomography examinations revealed osteolysis of the proximal left third, fourth and fifth metacarpal bones and pathological fractures of the proximal left fourth metacarpal bone. Histopathological examination via bone biopsy did not provide a definitive diagnosis, and the owner elected limb-sparing surgery. The fourth metacarpal bone and digits were amputated. Subsequently, autologous bone grafts were performed on the lytic area of the third and fifth metacarpal bones. The dog showed improvement in gait 7 weeks after reconstructive surgery. Chronic non-bacterial osteomyelitis (CNO) was diagnosed by exclusion. To the best of our knowledge, CNO has not been previously reported in dogs.
Topics: Dogs; Animals; Surgery, Plastic; Tomography, X-Ray Computed; Osteomyelitis; Dog Diseases
PubMed: 38379264
DOI: 10.1002/vms3.1383 -
BMC Musculoskeletal Disorders Feb 2024Low bone mineral density affects 53% of women over age 65 in the US, yet many are unaware and remain untreated. Underdiagnosis of forearm osteoporosis and related...
BACKGROUND
Low bone mineral density affects 53% of women over age 65 in the US, yet many are unaware and remain untreated. Underdiagnosis of forearm osteoporosis and related fragility fractures represent missed warning signs of more deadly, future fractures. This study aimed to determine if hand radiographs could serve as early, simple screening tools for predicting low forearm bone mineral density (BMD).
METHODS
We evaluated posterior-anterior (PA) hand radiographs (x-rays) and Dual-energy X-ray absorptiometry (DXA) scans of 43 participants. The ratio of the intramedullary cavity to total cortical diameter of the second metacarpal (second metacarpal cortical percentage (2MCP)) was used as a potential diagnostic marker. Mixed-effects linear regression was performed to determine correlation of 2MCP with BMD from various anatomic regions. Repeated measures ANOVAs were used to compare BMD across sites. An optimal 2MCP cutoff for predicting forearm osteopenia and osteoporosis was found using Receiver Operating Curves.
RESULTS
2MCP is directly correlated with BMD in the forearm. The optimal 2MCP of 48.3% had 80% sensitivity for detecting osteoporosis of the 1/3 distal forearm. An 2MCP cutoff of 50.8% had 84% sensitivity to detect osteoporosis of the most distal forearm. Both 2MCP cutoffs were more sensitive at predicting forearm osteoporosis than femoral neck T-scores.
CONCLUSIONS
These findings support the expansion of osteoporosis screening to include low-cost hand x-rays, aiming to increase diagnosis and treatment of low forearm BMD and fractures. Proposed next steps include confirming the optimal 2MCP cutoff at scale and integrating automatic 2MCP measurements into PAC systems.
Topics: Humans; Female; Aged; Bone Density; Forearm; Retrospective Studies; Prospective Studies; Bone Diseases, Metabolic; Osteoporosis; Absorptiometry, Photon; Fractures, Bone
PubMed: 38378510
DOI: 10.1186/s12891-023-07127-w