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International Journal of Surgery Case... May 2024Complex dorsal metacarpophalangeal joint (MCPJ) dislocations are uncommon injuries that mainly affect the index finger and are typically caused by a fall on an...
INTRODUCTION
Complex dorsal metacarpophalangeal joint (MCPJ) dislocations are uncommon injuries that mainly affect the index finger and are typically caused by a fall on an outstretched hand. It is exceptional for complex MCPJ dislocation to coexist with a distal fracture of the corresponding metacarpal bone.
PRESENTATION OF THE CASE
The authors report a case of a 23-year-old man presented to the emergency, with a complex dorsal metacarpophalangeal joint dislocation of the index associated with a distal metacarpal fracture confirmed by imaging. The patient had an open reduction and internal fixation of the proximal metacarpal fracture. The results were satisfying.
DISCUSSION
Dorsal MCP joint dislocations are rare, primarily affecting the index and little fingers, and are typically caused by a fall on an outstretched hand. Complex dislocations, characterized by irreducibility, involve structures forming a "noose" around the metacarpal head. Fractures associated with these dislocations are uncommon. Early diagnosis is crucial for better long-term functional outcomes. Radiographic imaging, including three different views, is necessary for accurate diagnosis. Surgery is usually required, with different approaches depending on the case. Arthroscopic techniques can be used when reduction is challenging. Timely surgical intervention yields the best results. Stiffness, osteoarthritis, osteonecrosis, and growth arrest in pediatric cases are the main complications.
CONCLUSION
Complex dorsal metacarpophalangeal joint (MCPJ) dislocations are rare. Open reduction is typically necessary for optimal outcomes. Complications such as stiffness, osteoarthritis can arise, emphasizing the importance of accurate diagnosis and appropriate management.
PubMed: 38581936
DOI: 10.1016/j.ijscr.2024.109532 -
The Veterinary Record Apr 2024Data regarding the lesion detection ability of different radiotracers are lacking in equine bone scintigraphy.
Equine skeletal scintigraphy: Comparing lesion detection ability of methylene diphosphonate and hydroxymethylene diphosphonate in the caudal cervical and proximal metacarpal/metatarsal regions.
BACKGROUND
Data regarding the lesion detection ability of different radiotracers are lacking in equine bone scintigraphy.
METHODS
In this prospective study, hydroxymethylene diphosphonate (HMDP) and methylene diphosphonate (MDP) were compared in horses with increased radiopharmaceutical uptake either in the caudal cervical region (CS group) or in the proximal metacarpal/metatarsal region (PMR group). Region of interest analysis was used to determine normal bone-to-soft tissue ratios, lesion-to-normal bone ratios and lesion-to-soft tissue ratios. Qualitative scoring and total count rates were recorded for each image.
RESULTS
A total of 213 scintigrams were included. Within the PMR group, there were significantly higher lesion-to-normal bone ratios for MDP compared with HMDP (p = 0.02). In the CS group, normal bone-to-soft tissue ratios were significantly higher for HMDP (p = 0.01). The interobserver agreement with regard to the qualitative assessment of the scintigrams was poor.
LIMITATION
Paired studies, comparing the different radiotracers in the same patient, were not feasible.
CONCLUSION
This study revealed minor differences between the two radiotracers, although these have no practical implications. Both radiopharmaceuticals are well suited for detecting lesions at the investigated sites using equine bone scintigraphy.
Topics: Animals; Horses; Technetium Tc 99m Medronate; Radionuclide Imaging; Metacarpal Bones; Metatarsal Bones; Prospective Studies; Diphosphonates; Radiopharmaceuticals
PubMed: 38578296
DOI: 10.1002/vetr.4069 -
Journal of Human Evolution May 2024Research suggests that recent modern humans have gracile skeletons in having low trabecular bone volume fraction (BV/TV) and that gracilization of the skeleton occurred...
Research suggests that recent modern humans have gracile skeletons in having low trabecular bone volume fraction (BV/TV) and that gracilization of the skeleton occurred in the last 10,000 years. This has been attributed to a reduction in physical activity in the Holocene. However, there has been no thorough sampling of BV/TV in Pleistocene humans due to limited access to high resolution images of fossil specimens. Therefore, our study investigates the gracilization of BV/TV in Late Pleistocene humans and recent (Holocene) modern humans to improve our understanding of the emergence of gracility. We used microcomputed tomography to measure BV/TV in the femora, humeri and metacarpals of a sample of Late Pleistocene humans from Dolní Věstonice (Czech Republic, ∼26 ka, n = 6) and Ohalo II (Israel, ∼19 ka, n = 1), and a sample of recent humans including farming groups (n = 39) and hunter-gatherers (n = 6). We predicted that 1) Late Pleistocene humans would exhibit greater femoral and humeral head BV/TV compared with recent humans and 2) among recent humans, metacarpal head BV/TV would be greater in hunter-gatherers compared with farmers. Late Pleistocene humans had higher BV/TV compared with recent humans in both the femur and humerus, supporting our first prediction, and consistent with previous findings that Late Pleistocene humans are robust as compared to recent humans. However, among recent humans, there was no significant difference in BV/TV in the metacarpals between the two subsistence groups. The results highlight the similarity in BV/TV in the hand of two human groups from different geographic locales and subsistence patterns and raise questions about assumptions of activity levels in archaeological populations and their relationships to trabecular BV/TV.
Topics: Animals; Humans; Cancellous Bone; X-Ray Microtomography; Hominidae; Femur; Lower Extremity
PubMed: 38569444
DOI: 10.1016/j.jhevol.2024.103499 -
European Review For Medical and... Mar 2024Metacarpal fractures are one of the most common orthopedic injuries seen in emergency departments. Despite this, only a few data have been published about the...
OBJECTIVE
Metacarpal fractures are one of the most common orthopedic injuries seen in emergency departments. Despite this, only a few data have been published about the epidemiology of metacarpal fractures. Simple radiographs are the standard imaging modality used to diagnose boxer fractures and determine the degree of angulation. Fractures and angulations should be identified by anteroposterior and lateral radiographs. The aim of this study was to follow the healing after closed reduction of fifth metacarpal neck fractures in a pediatric population using the QuickDASH score to determine whether it results in clinically significant improvement.
SUBJECTS AND METHODS
Between 2020 and 2022, our clinical record database for all metacarpal fractures treated at our institution was searched retrospectively every month. Children aged 18 years and younger with fifth metacarpal neck fractures treated with closed reduction and immobilization in our tertiary care emergency clinic were retrospectively reviewed.
RESULTS
52 pediatric patients were included in the study. The mean age at the time of injury was 14.04 years (SD=2.10, range=10-18 years). 92.30% (n=48) of the patients were male, and 7.70% (n=4) were female.
CONCLUSIONS
Accurate diagnosis and appropriate treatment are crucial in the management of childhood fifth metacarpal fractures to ensure proper healing, prevent long-term complications, and facilitate optimal functional recovery.
Topics: Humans; Male; Female; Child; Adolescent; Metacarpal Bones; Retrospective Studies; Treatment Outcome; Fractures, Bone; Fracture Healing; Hand Injuries
PubMed: 38567594
DOI: 10.26355/eurrev_202403_35735 -
Journal of Animal Science Jan 2024Pigs from 64 commercial sites across 14 production systems in the Midwest United States were evaluated for baseline biological measurements used to determine bone...
Pigs from 64 commercial sites across 14 production systems in the Midwest United States were evaluated for baseline biological measurements used to determine bone mineralization. There were three pigs selected from each commercial site representing: 1) a clinically normal pig (healthy), 2) a pig with evidence of clinical lameness (lame), and 3) a pig from a hospital pen that was assumed to have recent low feed intake (unhealthy). Pigs ranged in age from nursery to market weight, with the three pigs sampled from each site representing the same age or phase of production. Blood, urine, metacarpal, fibula, 2nd rib, and 10th rib were collected and analyzed. Each bone was measured for density and ash (defatted and non-defatted technique). A bone × pig type interaction (P < 0.001) was observed for defatted and non-defatted bone ash and density. For defatted bone ash, there were no differences among pig types for the fibulas, 2nd rib, and 10th rib (P > 0.10), but metacarpals from healthy pigs had greater (P < 0.05) percentage bone ash compared to unhealthy pigs, with the lame pigs intermediate. For non-defatted bone ash, there were no differences among pig types for metacarpals and fibulas (P > 0.10), but unhealthy pigs had greater (P < 0.05) non-defatted percentage bone ash for 2nd and 10th ribs compared to healthy pigs, with lame pigs intermediate. Healthy and lame pigs had greater (P < 0.05) bone density than unhealthy pigs for metacarpals and fibulas, with no difference observed for ribs (P > 0.10). Healthy pigs had greater (P < 0.05) serum Ca and 25(OH)D3 compared to unhealthy pigs, with lame pigs intermediate. Healthy pigs had greater (P < 0.05) serum P compared to unhealthy and lame pigs, with no differences between the unhealthy and lame pigs. Unhealthy pigs excreted significantly more (P < 0.05) P and creatinine in the urine compared to healthy pigs with lame pigs intermediate. In summary, there are differences in serum Ca, P, and vitamin D among healthy, lame, and unhealthy pigs. Differences in bone mineralization among pig types varied depending on the analytical procedure and bone, with a considerable range in values within pig type across the 14 production systems sampled.
Topics: Swine; Animals; Calcification, Physiologic; Minerals; Bone Density; Ribs; Animal Feed; Diet
PubMed: 38563521
DOI: 10.1093/jas/skae090 -
Annals of Plastic Surgery Apr 2024Hand fractures are associated with significant morbidity. Current management standards often result in prolonged immobilization, stiffness, and delayed return to...
INTRODUCTION
Hand fractures are associated with significant morbidity. Current management standards often result in prolonged immobilization, stiffness, and delayed return to functional use. Intramedullary (IM) compression screws offer minimal soft tissue disruption and early postoperative active motion. In this study, we describe our outcomes after intraosseous fracture fixation using IM cannulated headless screws for a multitude of fracture patterns.
METHODS
This study is a retrospective review of patients who underwent IM screw placement for fixation of metacarpal and phalangeal fractures by a single surgeon from 2017 to 2022. Data were collected to include patient demographics, fracture details, postoperative complications, and follow-up. Time to range of motion and return to unrestricted motion was recorded.
RESULTS
There were 69 patients with 92 fractures (n = 54 metacarpal, n = 38 phalanx). The median patient age was 45 years (range, 18-89 years) with 75.4% males. Majority presented with a single fracture (n = 50, 72.5%), and 38 patients (55.1%) had open fractures. Small finger was the most affected digit (n = 35, 37.6%). The median time to allow range of motion from surgery was 8.7 days (interquartile range, 0-32) with 32 days (interquartile range, 10-62) for unrestricted use of the hand. Thirty-five patients (50.7%) were allowed controlled motion from the first postoperative day. One patient had loss of reduction requiring reintervention for hardware removal, and 1 patient had superficial skin infection managed with oral antibiotics.
CONCLUSIONS
Our findings indicate that the IM screw provides reliable fixation for a wide variety of fracture patterns with a low complication rate and offers early return to functional use.
Topics: Male; Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Female; Metacarpal Bones; Bone Screws; Fractures, Bone; Fracture Fixation, Internal; Fractures, Open; Upper Extremity; Fracture Fixation, Intramedullary
PubMed: 38556662
DOI: 10.1097/SAP.0000000000003849 -
The Journal of Veterinary Medical... May 2024Fractures occurring in the distal radius and ulna of toy breed dogs pose distinctive challenges for veterinary practitioners, requiring specialized treatment approaches...
Fractures occurring in the distal radius and ulna of toy breed dogs pose distinctive challenges for veterinary practitioners, requiring specialized treatment approaches primarily based on anatomical features. Finite Element Analysis (FEA) was applied to conduct numerical experiments to determine stress distribution across the bone. This methodology offers an alternative substitute for directly investigating these phenomena in living dog experiments, which could present ethical obstacles. A three-dimensional bone model of the metacarpal, carpal, radius, ulna, and humerus was reconstructed from Computed Tomography (CT) images of the toy poodle and dachshund forelimb. The model was designed to simulate the jumping and landing conditions from a vertical distance of 40 cm to the ground within a limited timeframe. The investigation revealed considerable variations in stress distribution patterns between the radius and ulna of toy poodles and dachshunds, indicating notably elevated stress levels in toy poodles compared to dachshunds. In static and dynamic stress analysis, toy poodles exhibit peak stress levels at the distal radius and ulna. The Von Mises stresses for toy poodles reach 90.07 MPa (static) and 1,090.75 MPa (dynamic) at the radius and 1,677.97 MPa (static) and 1,047.98 MPa (dynamic) at the ulna. Conversely, dachshunds demonstrate lower stress levels for 5.39 MPa (static) and 231.79 MPa (dynamic) at the radius and 390.56 MPa (static) and 513.28 MPa (dynamic) at the ulna. The findings offer valuable insights for modified treatment approaches in managing fractures in toy breed dogs, optimizing care and outcomes.
Topics: Animals; Dogs; Finite Element Analysis; Ulna Fractures; Radius Fractures; Biomechanical Phenomena; Forelimb; Tomography, X-Ray Computed; Stress, Mechanical
PubMed: 38556325
DOI: 10.1292/jvms.23-0520 -
Indian Journal of Surgical Oncology Mar 2024The aim of this study is to determine the treatment modalities and clinical characteristics of 12 patients diagnosed with giant cell tumor (GCT) of the hand and foot....
The aim of this study is to determine the treatment modalities and clinical characteristics of 12 patients diagnosed with giant cell tumor (GCT) of the hand and foot. The clinical findings, treatment modalities, and treatment failures of 12 patients with giant cell tumors of the hand and foot bones between 2007 and 2018 years were evaluated retrospectively. The average age at diagnosis was 29.2 ± 14.9 std. (between 16 and 62 years old), 8 males (66.6%) and 4 females (33.3%). Tumor was more frequently located in the talus, metacarpal, and metatarsal bones. The mean tumor size was 3.1 ± 1.1 cm (between 2.2 and 5.3 cm). The mean post-operative follow-up period was 76.3 ± 42.5 (between 12 and 139 months). The most of patients' (58.3%) common complaints were pain. The most commonly used surgical method was curettage + autografting (91.7%). Infection was seen in one patient after relapse surgery. Recurrence occurred in 33.3% of the patients in the first year. Only one patient was detected to have knee and lung metastases. Swelling and pain in the hand and foot should be examined for tumor lesions. When a bone lesion is detected, the giant cell tumor of the bone should be included in the differential diagnosis. Patients with giant cell tumors should be followed closely for recurrence and metastasis after treatment.
PubMed: 38545595
DOI: 10.1007/s13193-020-01153-z -
Journal of Dentistry (Shiraz, Iran) Mar 2024Bone age is a more accurate assessment for biologic development than chronological age. The most common method for bone age estimation is using Pyle and Greulich Atlas....
STATEMENT OF THE PROBLEM
Bone age is a more accurate assessment for biologic development than chronological age. The most common method for bone age estimation is using Pyle and Greulich Atlas. Today, computer-based techniques are becoming more favorable among investigators. However, the morphological features in Greulich and Pyle method are difficult to be converted into quantitative measures. During recent years, metacarpal bones and metacarpophalangeal joints dimensions were shown to be highly correlated with skeletal age.
PURPOSE
In this study, we have evaluated the accuracy and reliability of a trained neural network for bone age estimation with quantitative and recently introduced related data, including chronological age, height, trunk height, weight, metacarpal bones, and metacarpophalangeal joints dimensions.
MATERIALS AND METHOD
In this cross sectional retrospective study, aneural network, using MATLAB, was utilized to determine bone age by employing quantitative features for 304 subjects. To evaluate the accuracy of age estimation software, paired t-test, and inter-class correlation was used.
RESULTS
The difference between the mean bone ages determined by the radiologists and the mean bone ages assessed by the age estimation software was not significant ( Value= 0.119 in male subjects and = 0.922 in female subjects). The results from the software and radiologists showed a strong correlation -ICC=0.990 in male subjects and ICC=0.986 in female subjects (< 0.001).
CONCLUSION
The results have shown an acceptable accuracy in bone age estimation with training neural network and using dimensions of bones and joints.
PubMed: 38544775
DOI: 10.30476/dentjods.2023.95629.1882 -
Cureus Feb 2024Introduction Understanding the incidence and epidemiology can inform clinicians and policymakers about the population's needs. Our study reports on upper limb fractures...
Introduction Understanding the incidence and epidemiology can inform clinicians and policymakers about the population's needs. Our study reports on upper limb fractures treated at a major trauma center over 7.5 years. Methods We collected data on fracture locations, age, gender, Charlson Comorbidity index (CCI), and treatment options of all upper limb fractures treated at a Level I Trauma Centre from January 1, 2015 to June 30, 2022. Humerus, radius, and ulna fractures were each classified as proximal, diaphyseal, and distal. Results About 9,915 patients sustained 12,790 fractures, given an overall incidence of 303.2 fractures per 100,000 patients per year. The most common fracture site was the distal radius (60.1 fractures per 100,000 patients per year, whereas carpal and metacarpal bones had the lowest incidence. The mean age and CCI were 46.4 years and 1.54, respectively. 58.1% of patients were male. All bone fractures distal to the elbow were associated with an age younger than the mean (all p<0.001), with humerus fracture patients having the oldest mean age (54.6 years). Compared to the mean gender ratio, except for ulna (no association), humerus (55% female), and radius (51% female), all other locations showed significantly higher incidences of males (all p<0.001). When plotting the incidence based on the age of injury, the entire cohort, along with radius and ulna fracture subgroups, demonstrated a bi-peak distribution. This pattern revealed that younger males and older postmenopausal females had the highest incidence rates. Conclusion To our knowledge, this represents the first study of this type in the UK since 2006. We sought to elucidate relative incidence and demographic associations with fractures to highlight changing population needs and allow policymakers and services at a regional and national level to operate with up-to-date information.
PubMed: 38544581
DOI: 10.7759/cureus.54961