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Plastic and Reconstructive Surgery.... Oct 2023The deep branch of the ulnar nerve (DBUN) is a pure motor nerve. It passes through a hypothenar fibromuscular tunnel and courses radially on the interossei surface. The...
The deep branch of the ulnar nerve (DBUN) is a pure motor nerve. It passes through a hypothenar fibromuscular tunnel and courses radially on the interossei surface. The DBUN is not frequently considered during hand fracture surgery, despite the anatomical course of the nerve in close relation to the carpal and metacarpal bones, which makes it vulnerable to penetrating injury and being injured during hand surgery fixations. In this article, we describe a case of DBUN injury after percutaneous pinning of the fourth and fifth metacarpal bone fractures complicated by intrinsic muscle wasting of the hand that was treated with neuroma excision and sural nerve graft. We present the case of a 36-year-old man, who had a fracture of the base of the fourth and fifth metacarpal bones, which was treated with multiple K-wires. A few months later, the patient presented with weak abduction/adduction of the three ulnar fingers and prominent wasting in the intrinsic muscles of the hand. On hand exploration, a 2-cm neuroma was found along the course of the DBUN distal to the hypothenar fibromuscular tunnel, which was treated by neuroma excision and nerve grafting. Fractures of the fourth and fifth metacarpals and carpometacarpal dislocations are very common and are often treated surgically. To fix these fractures, awareness of the DBUN course in the hand and its proximity to the carpal and metacarpal bones is important. High caution should be taken during percutaneous pinning by inserting K-wires under radiological guidance, minimizing pining attempts and limiting pin tip protrusion to 1-2 mm.
PubMed: 37829110
DOI: 10.1097/GOX.0000000000004979 -
Scientific Reports Oct 2023Rheumatoid arthritis (RA) causes bone loss, only partly related to inflammation. The impact of RA treatments on bone metabolism and their ability to mitigate bone loss... (Observational Study)
Observational Study
Rheumatoid arthritis (RA) causes bone loss, only partly related to inflammation. The impact of RA treatments on bone metabolism and their ability to mitigate bone loss remains uncertain. The primary goal of our study was to examine the influence of abatacept on serum levels of markers and regulators involved in bone turnover. Secondary objectives included evaluating changes in bone mineral density (BMD), bone health parameters, erosions, and exploring potential correlations among these parameters. We conducted a prospective observational study on patients with active seropositive RA failure to biological disease modifying anti-rheumatic drugs initiating treatment with abatacept. We measured at baseline and after 1, 2, 3, 6, 9 and 12 months: serum bone turnover markers (CTX, P1nP, B-ALP), bone modulators (Dkk-1, sclerostin, vitamin D, PTH, OPG and RANKL), BMD and radiographic parameters (modified Sharp van der Heijde score [mSvdH], bone health index [BHI] and metacarpal index [MCI]). Disease activity and glucocorticoid intake was monitored. 33 patients were enrolled in the study. We found a significant increase in markers of bone formation (B-ALP and P1nP) from baseline to M6 and M12. PTH increased significantly at M6 but not at M12. All other bone markers and modulators did not change. We found a significant decrease in BHI and MCI from baseline to M12 (median difference - 0.17 95% CI - 0.42 to - 0.10, p 0.001 and - 0.09 95% CI - 0.23 to - 0.07, respectively). BMD at femoral neck transitorily decreased at M6 (mean difference - 0.019 g/cm 95% CI - 0.036 to - 0.001 p 0.04). BMD at total hip, lumbar spine and mSvdH score did not change significantly. P1nP delta at M12 correlated with delta mSvdH. Treatment with abatacept was associated with a significant increase in bone formation markers. The secondary and transient increase in PTH serum levels may be responsible of the transitory bone loss.
Topics: Humans; Abatacept; Antirheumatic Agents; Arthritis, Rheumatoid; Biomarkers; Bone and Bones; Bone Density; Bone Diseases, Metabolic; Bone Remodeling; Prospective Studies
PubMed: 37821541
DOI: 10.1038/s41598-023-44374-2 -
BMC Veterinary Research Oct 2023The aim of the current study was to investigate the frequency of variations of the extensor tendons of the carpus and digits in the domestic dog (Canis lupus familiaris)...
Intraspecific anatomical variations of the extensor tendons of the carpus and digits with a reexamination of their insertion sites in the domestic dog (Canis lupus familiaris): a cadaveric study.
BACKGROUND
The aim of the current study was to investigate the frequency of variations of the extensor tendons of the carpus and digits in the domestic dog (Canis lupus familiaris) with a reexamination of their insertions as well as the morphometric measurements of the tendons and the brachioradialis muscle. In total, we investigated 68 paired thoracic limbs of the domestic dog (16 females and 18 males) which were fixed in a 10% formalin solution.
RESULTS
The extensor carpi radialis (ECR) tendons showed striking variations in both splitting and insertion sites. In 4.4% of dissections, ECR had three tendons. Of these tendons, the extra tendon either attached independently on the fourth metacarpal bone (one right) or joined its counterpart tendon at the distal end (cross-connections) (one bilateral). It is worth mentioning that one of the ECR tendons split into two or three slips which inserted on the first, second, third, or fourth metacarpal bone in 11 (16.2%) of the specimens. In addition, we found a long tendinous slip originating from the ECR tendons to digit II or III in 7.4% of the distal limbs. The most common type of contribution to digit III was a third tendon of the extensor digiti I et II (ED III) joining the extensor digitorum lateralis (EDL III) with a frequency of 17.6%. In other types of variations, the contribution to digit III was incomplete. A part of the abductor pollicis longus (APL) deep to the superficial part of the flexor retinaculum seemed to continue up to the flexor digitorum superficialis (FDS) tendon.
CONCLUSIONS
The rare intraspecific variations of the extensor tendons of the manus described in the current research are valuable from both clinical and phylogenetic perspectives. Nonetheless, their functional importance needs more studies.
Topics: Male; Female; Dogs; Animals; Wolves; Phylogeny; Tendons; Muscle, Skeletal; Cadaver; Dog Diseases
PubMed: 37814315
DOI: 10.1186/s12917-023-03750-w -
Trauma Case Reports Dec 2023Post-traumatic osteomyelitis is a challenging complication after a fracture, requiring long-term treatment to prevent loss of function. One treatment strategy is the...
BACKGROUND
Post-traumatic osteomyelitis is a challenging complication after a fracture, requiring long-term treatment to prevent loss of function. One treatment strategy is the biphasic masquelet technique, focussing on both control of the infection and bone reconstruction. This technique is mainly used to treat defects of the long bones. Very little literature exists about the masquelet procedure for treatment of defects of smaller bones. We describe a case of post-traumatic osteomyelitis after a metacarpal fracture, treated with the 'mini-masquelet' technique.
PATIENT CASE
A 23-year old woman was treated with the masquelet procedure for osteomyelitis and bone loss following a metacarpal IV fracture of her right hand. After 29 weeks, she had full range of motion of both the hand and fingers.
CONCLUSION
The 'mini-masquelet' technique as a strategy to treat osteomyelitis and reconstruct bone loss after a metacarpal fracture, can reduce potential loss of function and loss of quality of life. This technique appears to be widely applicable for treatment of complex hand injuries and osteomyelitis of the hand.
PubMed: 37810534
DOI: 10.1016/j.tcr.2023.100945 -
Journal of Hand Surgery Global Online Sep 2023The two cases presented demonstrate the management of aneurysmal bone cysts of the metacarpal, which destroyed the normal bone architecture. Treatment of both cases...
The two cases presented demonstrate the management of aneurysmal bone cysts of the metacarpal, which destroyed the normal bone architecture. Treatment of both cases included wide resection and metacarpal reconstruction with an intercalary fibular allograft. Denosumab use contrasts these two cases and is helpful in reestablishment of a cortical rim for fixation in the absence of a 1-cm margin proximally or distally to preserve the native carpometacarpal and metacarpophalangeal joints. Surgical resection and allograft reconstruction is a viable treatment for expansile metacarpal aneurysmal bone cysts, and neoadjuvant denosumab has utility in creating an ossified margin for fixation.
PubMed: 37790824
DOI: 10.1016/j.jhsg.2023.05.004 -
Journal of Equine Science Sep 2023Surgical site infection (SSI) is one of the major complications of equine fracture surgery. The purpose of this study was to investigate the incidence of and risk...
Surgical site infection (SSI) is one of the major complications of equine fracture surgery. The purpose of this study was to investigate the incidence of and risk factors for SSI after internal fixation of the first phalangeal bone (P1) and the third metacarpal/metatarsal bone (MC3/MT3) fractures in Thoroughbred racehorses. Between 2011 and 2020, 451 cases underwent surgery with screws or a locking compression plate (LCP) for sagittal fractures of P1 or condylar fractures of MC3/MT3. Overall, 2.9% (13/451) of the cases developed an SSI. The incidence was significantly higher in plate fixation (21.4%) than in screw fixation (2.3%). There was no significant association with other variables, such as sex, age, number of screws, experience of surgeon, or prophylactic antimicrobials. The median duration of hospitalization for screw fixation was 14 days without an SSI and 20 days with an SSI, and those for plate fixation were 26 and 25-88 days, respectively, indicating that the development of SSI prolongs the duration of hospitalization. On the other hand, there were no significant differences in discharge and race resumption rates between cases with and without an SSI. These data indicate that the incidence of SSI in this study was low and that it was higher following plate fixation than screw fixation.
PubMed: 37781565
DOI: 10.1294/jes.34.61 -
Journal of Orthopaedic Surgery and... Sep 2023This study aimed to compare the clinical efficacy of microplate trans-carpometacarpal joint fixation and non-trans-carpometacarpal joint fixation in treating fractures...
A comparative study on the clinical efficacy of microplate trans-carpometacarpal joint fixation and non-trans-carpometacarpal joint fixation in treating fractures with dislocation or subluxation of the base of the fourth and fifth metacarpal bones.
BACKGROUND
This study aimed to compare the clinical efficacy of microplate trans-carpometacarpal joint fixation and non-trans-carpometacarpal joint fixation in treating fractures and dislocation or subluxation of the base of the fourth and fifth metacarpal bones.
METHOD
From 2015 to 2021, 100 cases of metacarpal basal fractures with dislocation or subluxation were randomly divided into the trans-carpometacarpal joint fixation group (group A) and non-trans-carpometacarpal joint fixation group (group B). Group A (n = 50) comprised 44 males and 6 females, with an average age of 28.8 ± 6.1 y and an Orthopedic Trauma Association (OTA) fracture classification of type B1 (n = 29) or C1 (n = 21). Group B (n = 50) comprised 45 males and 5 females, with an average age of 28.9 ± 5.7 y and an OTA fracture classification of type B1 (n = 28) or C1 (n = 22). All patients were complicated with dislocation or subluxation. The surgery time, fracture healing time, postoperative handgrip strength, and total active motion (TAM) scores of the ring and little fingers were recorded and compared between the two groups. The clinical efficacy of patients was evaluated using scoring methods such as DASH (disabilities of the arm, shoulder and hand), visual analogue scale (VAS), and Mayo at 3, 6, and 12 months after surgery.
RESULTS
There was no significant difference in the general indexes, surgery time, or fracture healing time between the two groups (P > 0.05). There were no significant differences in handgrip strength and TAM scores of the ring and little fingers between the two groups at 3 and 12 months postoperatively (P > 0.05), but there were significant differences in these indexes 6 months postoperatively (P < 0.05). There were no significant differences in the DASH, VAS, and Mayo scores at 3 and 12 months postoperatively (P > 0.05), but there were significant differences between the two groups in the DASH and Mayo scores (P < 0.05) but not the VAS score (P > 0.05) 6 months postoperatively.
CONCLUSION
In the treatment of fourth and fifth metacarpal basal fractures with dislocation or subluxation, both microplate transarticular fixation and non-transarticular fixation could achieve fracture fixation and healing, and each method had advantages and disadvantages. The clinically appropriate fixation method should be selected according to the experience of the surgeon and the degree and type of fracture and dislocation.
Topics: Male; Female; Humans; Young Adult; Adult; Metacarpal Bones; Carpometacarpal Joints; Hand Strength; Fracture Fixation, Internal; Fractures, Bone; Joint Dislocations; Treatment Outcome; Hand Injuries
PubMed: 37770964
DOI: 10.1186/s13018-023-04225-2 -
Life (Basel, Switzerland) Sep 2023Syndactyly is the most common congenital malformation of the hand, leading to the fusion of the digits and frequently affecting the ring and middle fingers. The...
Syndactyly is the most common congenital malformation of the hand, leading to the fusion of the digits and frequently affecting the ring and middle fingers. The incidence is 1 out of 2500 children, predominantly occurring in boys and Caucasians. Clinically, the malformation may present as a soft tissue or bony fusion, resulting in the union of the fingers characterised as complete or incomplete. This fusion may involve the phalanges but may also extend to the carpal/tarsal bones, even to the metacarpal or metatarsal level, rarely to the distal end of the forearm and lower leg. The malformation is mostly isolated but may occur together with other disorders or malformations such as synostosis, acro-syndactyly, cleft hand, clinodactyly, or polydactyly. Syndromic syndactyly can be observed in cases of Apert syndrome, Poland's syndrome, Pfeiffer syndrome, and many others. A girl born in June of 2019 was diagnosed with congenital malformation of the right hand at birth-affecting the right middle, ring, and little fingers, respectively. After X-ray imaging, the fusion of the third and fourth proximal phalanges to a common metacarpal was identified, forming a unique diagnosis of clino-syndactyly with metacarpal aplasia. Surgical intervention was advocated for, including a wedge osteotomy to correct the synchondrosis at the phalangeal base and a dorsal flap to close the interdigital space created during the correction of the III and IV. fingers. A trapezoid flap for the release of the syndactyly of the IV and V. fingers was applied. The paper aims to present this surgical correction and its results regarding an atypical case of syndactyly with clinodactyly and metacarpal aplasia.
PubMed: 37763346
DOI: 10.3390/life13091943 -
Animals : An Open Access Journal From... Sep 2023Fissure in the third metacarpal/tarsal parasagittal groove and proximal phalanx sagittal groove is a potential prodromal pathology of fracture; therefore, early...
Three-Dimensional Imaging and Histopathological Features of Third Metacarpal/Tarsal Parasagittal Groove and Proximal Phalanx Sagittal Groove Fissures in Thoroughbred Horses.
Fissure in the third metacarpal/tarsal parasagittal groove and proximal phalanx sagittal groove is a potential prodromal pathology of fracture; therefore, early identification and characterisation of fissures using non-invasive imaging could be of clinical value. Thirty-three equine cadaver limbs underwent standing cone-beam (CB) computed tomography (CT), fan-beam (FB) CT, low-field magnetic resonance imaging (MRI), and macro/histo-pathological examination. Imaging diagnoses of fissures were compared to microscopic examination. Imaging features of fissures were described. Histopathological findings were scored and compared between locations with and without fissures on CT. Microscopic examination identified 114/291 locations with fissures. The diagnostic sensitivity and specificity were 88.5% and 61.3% for CBCT, 84.1% and 72.3% for FBCT, and 43.6% and 85.2% for MRI. Four types of imaging features of fissures were characterised on CT: (1) CBCT/FBCT hypoattenuating linear defects, (2) CBCT/FBCT striated hypoattenuated lines, (3) CBCT/FBCT subchondral irregularity, and (4) CBCT striated hypoattenuating lines and FBCT subchondral irregularity. Fissures on MRI appeared as subchondral bone hypo-/hyperintense defects. Microscopic scores of subchondral bone sclerosis, microcracks, and collapse were significantly higher in locations with CT-identified fissures. All imaging modalities were able to identify fissures. Fissures identified on CT were associated with histopathology of fatigue injuries.
PubMed: 37760312
DOI: 10.3390/ani13182912 -
Scientific Reports Sep 2023Shape, size, composition, and function of the bones in the human body vary on the macro, micro and nanoscale. This can influence changes caused by taphonomy and...
Shape, size, composition, and function of the bones in the human body vary on the macro, micro and nanoscale. This can influence changes caused by taphonomy and post-mortem preservation, including DNA. Highly mineralised compact bone is less susceptible to taphonomic factors than porous trabecular bone. Some studies imply that DNA can be better preserved in trabecular bone, due to remnants of the soft tissue or bacteria better digesting organic matter while not digesting DNA. The aim of this study was to understand the differences between compact (diaphyses) and trabecular (epiphyses) bone on a molecular level and thus the reasons for the better preservation of the DNA in the trabecular bone. The powder obtained from epiphyses and diaphyses of metacarpals and metatarsals was analysed using ATR-FTIR spectroscopy and compared. Samples with poorest DNA preservation originated from diaphyses, predominantly of metatarsals. They were characterised by higher concentrations of phosphates and crystallinity, while lower collagen quality in comparison to samples with the best DNA preservation. Epiphyses presented higher concentrations of better-preserved collagen while diaphyses had higher concentrations of carbonates and phosphates and higher crystallinity. Due to better-preserved collagen in the epiphyses, the soft tissue remnants hypothesis seems more likely than the bacteria hypothesis.
Topics: Humans; Metatarsal Bones; Metacarpal Bones; Cancellous Bone; Spectroscopy, Fourier Transform Infrared; DNA; Phosphates; Ataxia Telangiectasia Mutated Proteins
PubMed: 37726341
DOI: 10.1038/s41598-023-41259-2