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European Journal of Trauma and... Apr 2024Compare two simple ways for treating boxer's fractures in active adults; conservative management by ulnar gutter slab and transverse pinning in fixation of fifth... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
PURPOSE
Compare two simple ways for treating boxer's fractures in active adults; conservative management by ulnar gutter slab and transverse pinning in fixation of fifth metacarpal's neck fracture regarding union, functional outcomes, and complications.
PATIENTS AND METHODS
Ninety patients with fifth metacarpals' neck fractures with palmar angulation (30-70°) were managed either conservatively by an ulnar gutter slab or surgically by transverse pinning technique from January 2020 to December 2021. Only 84 patients completed a 1-year follow-up. Patients with old, open, or mal-rotated fractures were excluded. The block-randomization method was used to create equal groups. Patients were evaluated clinically and radiologically every 2-3 weeks until union, then at 6 and 12 months. Functional assessment at the final visit was done using the quick DASH score, total active motion (TAM), and total Active Flexion (TAF).
RESULTS
The mean radiological union time for the conservative group in this study was 7.76 weeks, while for the transverse pinning group, it was 7.38 weeks. There was no statistically significant difference between the two techniques regarding union rates and functional outcomes. All patients returned to their pre-injury jobs and level of activity.
CONCLUSION
Both conservative management in ulnar gutter slab and percutaneous transverse pinning are considered effective methods in the treatment of simple extra-articular fifth metacarpal neck fractures with angulation between 30 and 70 degrees (AO: 77 A3.1). The functional and radiological results using both methods were satisfactory and statistically comparable.
Topics: Humans; Metacarpal Bones; Male; Female; Adult; Conservative Treatment; Fractures, Bone; Fracture Fixation, Internal; Range of Motion, Articular; Bone Nails; Middle Aged; Fracture Healing; Young Adult
PubMed: 38151577
DOI: 10.1007/s00068-023-02417-3 -
Heliyon Dec 2023The Huajiying Formation (135.4-128.7 Ma) of the northern Hebei represents the early stage of the Early Cretaceous Jehol Biota in China, yielding many kinds of...
The Huajiying Formation (135.4-128.7 Ma) of the northern Hebei represents the early stage of the Early Cretaceous Jehol Biota in China, yielding many kinds of vertebrates. The only known pterosaur specimen was incomplete and assigned to the Ornithocheiroidea. Here we report a more complete pterosaur specimen, assigned to the Ctenochasmatidae. A new taxon is established on two autapomorphies: a large pneumatic foramen present on the ventral surface of the proximal end of the first wing phalanx; and coracoid lacking an expansion at its contact with the scapula, as well as the following combination of characteristics: subsquare sternal plate; coracoid having an extremely concave articulation with a posterior expansion; humerus without a tubercle on the proximal margin between the deltopectoral crest and the head; humerus slightly longer than the wing metacarpal; and the first and third wing phalanges equal in length. The relative thicknesses of bone walls are investigated among pterosaurs in three ways. The overall distribution of R/t ratios shows that most non-pterodactyloids, archaeopterodactyloids, and dsungaripterids have smaller R/t ratios than other groups. Relatively thick bone walls are not unique for the Dsungaripteridae as previously thought, and the humerus and radius of dsungaripterids have thinner walls than other bones. The feature of small R/t ratios is plesiomorphic and the thin-walled humerus and radius of dsungaripterids were evolved to meet the need of the flight, not for frequent take-off and landing as previously thought.
PubMed: 38076164
DOI: 10.1016/j.heliyon.2023.e22370 -
The Journal of Hand Surgery Mar 2024Despite modern advancements in the treatment of late stages of wrist joint degeneration, few reliable options exist for patients requiring motion-preserving...
PURPOSE
Despite modern advancements in the treatment of late stages of wrist joint degeneration, few reliable options exist for patients requiring motion-preserving reconstruction of their radiocarpal and midcarpal joints. Vascularized composite allotransplantation (VCA) could be considered an option for wrist reconstruction in the future. The goal of this study was to describe the relevant anatomy and design a potential surgical technique for wrist VCA.
METHODS
Anatomic studies were performed on 17 human upper extremities. The arterial system of each cadaver was injected with latex dye or radiographic contrast. After injecting a contrast medium visible on a computerized tomography (CT) scan, the initial three specimens were examined using microCT. This confirmed joint vascular patency and allowed for the dissection of the other specimens that were injected with latex for the study of joint vascularization and the design of the wrist VCA. We then outlined a donor and recipient surgical technique for transplant based on recipient CT scans. Customized cutting guides were designed for the transplant procedure. After the procedure, we performed angiography of the VCA to determine the vascularity of the transplant.
RESULTS
Using a combined volar and dorsal approach, we were able to perform a complete wrist VCA procedure. After the completed transplant procedure, angiographic imaging of the specimens demonstrated that the flap dissection and transplantation preserved the nutrient endosteal supply to the distal end of the radius and ulna, as well as to the carpal bones and the metacarpal bases.
CONCLUSIONS
The dissection of the donor, recipient, and the entire vascularized joint transplant procedure served to illustrate the anatomical feasibility of the cadaveric surgical technique. This establishes an anatomic basis for the possibility of future human clinical applications.
CLINICAL RELEVANCE
This study helps investigate the anatomical feasibility of a wrist VCA.
Topics: Humans; Feasibility Studies; Latex; Wrist Joint; Vascularized Composite Allotransplantation; Contrast Media; Cadaver
PubMed: 38069954
DOI: 10.1016/j.jhsa.2023.11.008 -
The Archives of Bone and Joint Surgery 2023Headless screw fixation used to treat metacarpal neck and metacarpal shaft fractures is gaining popularity. The aim of the study is to determine the proportion of the...
OBJECTIVES
Headless screw fixation used to treat metacarpal neck and metacarpal shaft fractures is gaining popularity. The aim of the study is to determine the proportion of the metacarpal head articular surface that is compromised during retrograde insertion of headless screws.
METHODS
Metacarpal screw fixation through a metacarpal head starting point was performed using fluoroscopic guidance on 14 metacarpals. Headless compression screws, with a tail diameter of 3.6mm, were used. The specimens were subsequently skeletonized and digitized using a 3-dimensional surface scanner. The articular surface defects created by the screws were then determined using computer software. Screw position in the dorsal aspect of the metacarpal head was expressed as a percentage of the total volar-to-dorsal distance.
RESULTS
The 14 metacarpals studied consisted of 2 index, 4 long, 4 ring and 4 small metacarpals, taken from 4 hands. The average total metacarpal head surface area was 284.6 mm (range, 151.0-462.2 mm); the average screw footprint in the metacarpal head was 13.3 mm (range, 10.3-17.4 mm), which compromised a mean of 5.0% (3.0-7.8%) of the total cartilaginous metacarpal head surface area. In the sagittal plane, screw placement was found to lie in the dorsal 37.4% of the metacarpal head (range, 20.7-58.6%).
CONCLUSION
The proportion of the articular surface area injured with retrograde insertion of headless compression screws into the metacarpal head is 5.0%. Screw placement is generally in the dorsal 37% of the metacarpal head.
PubMed: 38058972
DOI: 10.22038/ABJS.2023.69368.3265 -
Reumatologia Clinica Dec 2023Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by symmetric polyarthritis that can lead to joint deformity, disability, and osteoporosis. We...
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by symmetric polyarthritis that can lead to joint deformity, disability, and osteoporosis. We aimed to evaluate whole hand and regional BMD in RA patients compared to controls. In addition, we evaluated the BMD of dominant versus non-dominant hands in healthy subjects. We included adult female and male RA patients and control subjects matched by age, sex, and BMI. BMD (g/cm) was measured by DXA in lumbar spine (LS), whole hand, and three regions of interest: carpus, metacarpal bones, and phalanges. Results: 44 control subjects (49.5±11.8 y) and 60 with RA (52.7±12.7 y) were included. Significant lower BMD in RA patients was found in LS (-8.7%), dominant whole hand (-9.5%), carpus, metacarpal bones, and phalanges, and non-dominant whole hand (-8.7%), metacarpal bones, and phalanges compared to controls. A significant positive correlation was found between LS and whole-hand BMD (dominant r=.63, non-dominant r=.67). Finally, the whole hand, metacarpal bones, and carpus BMD measurements were significantly higher in the dominant hand compared to the non-dominant hand without differences in the phalangeal ROI. In conclusion, hand BMD was significantly lower in RA patients compared to control subjects and there was a significant correlation with LS BMD. We demonstrated that BMD measurements of the whole-hand, and different ROI (carpus, metacarpal bones, and phalanges) by DXA would be an easily reproducible technique to evaluate bone loss. In addition, the whole hand, metacarpal bones and carpus BMD measurements were significantly higher in the dominant hand compared to the non-dominant hand without differences in the phalanges.
Topics: Adult; Humans; Male; Female; Bone Density; Hand; Osteoporosis; Metacarpal Bones; Arthritis, Rheumatoid
PubMed: 38056980
DOI: 10.1016/j.reumae.2023.04.005 -
Scientific Reports Dec 2023To investigate the influence of different grasping postures on the hand's skin deformation, a handheld 3D EVA SCANNER was used to obtain 3D models of 111 women in five...
To investigate the influence of different grasping postures on the hand's skin deformation, a handheld 3D EVA SCANNER was used to obtain 3D models of 111 women in five postures, including a straight posture and grasping cylinders with various diameters (4/6/8/10 cm). Skin relaxation strain ratio ([Formula: see text]) and surface area skin relaxation strain ratio ([Formula: see text]) were used as measures of skin deformation between two landmarks and multiple landmarks, respectively. The effects of grasping posture on skin deformation in different directions were analyzed. The results revealed significant variations in skin deformation among different grasping postures, except for the width of middle finger metacarpal and the length of middle finger's proximal phalanx. The [Formula: see text] increased with decreasing grasping object diameter, ranging from 5 to 18% on the coronal axis, and from 4 to 20% on the vertical axis. The overall variation of [Formula: see text] ranged from 5 to 37.5%, following the same trend as [Formula: see text] except for the surface area of tiger's mouth, which exhibited a maximum difference of 10.9% with significant differences. These findings have potential applications in improving the design of hand equipment and understanding hand movement characteristics.
Topics: Humans; Female; Hand; Posture; Fingers; Movement; Metacarpal Bones; Hand Strength
PubMed: 38049461
DOI: 10.1038/s41598-023-48658-5 -
Bioinformation 2023The anatomical snuff box is bounded laterally by the Abductor pollicis longus (APL) and the Extensor pollicis brevis (EPB) tendons. The variation in insertion of...
The anatomical snuff box is bounded laterally by the Abductor pollicis longus (APL) and the Extensor pollicis brevis (EPB) tendons. The variation in insertion of extensor tendons at the forearm and wrist is an interesting phenomenon. Therefore, a sound knowledge of such variations in extensor tendons is essential to know the consequence of tendon injury during implementation of its repair. Hence, we studied 48 formaldehyde fixed forearms of Indian-origin cadavers with age groups ranging from 33 to 67 years from the Central Indian population at Nagpur, Maharashtra, India. Variation in the insertion of APL was checked by tracing the tendon till its insertion. APL muscle was found with single tendon in 20 forearms, double in 9, triple in 8 and quadruple in 5 and five (maximum) in 6 forearms. In 93% (n=45), the APL tendon was inserted into the first metacarpal bone and in 7% (n=03), it was inserted into the trapezium bone. No variation was noted in the EPB tendon. Data shows that there are accessory slips in the APL tendon, differing from the standard description. Thus, data provides awareness of such potential variation among operating surgeons for better management of the diseased during dissection.
PubMed: 38046520
DOI: 10.6026/973206300191111 -
BMC Musculoskeletal Disorders Dec 2023The treatment of Dubberley type B capitellar fractures, which are frequently complicated, is widely debated. This study aimed to investigate the prognostic factors and...
BACKGROUND
The treatment of Dubberley type B capitellar fractures, which are frequently complicated, is widely debated. This study aimed to investigate the prognostic factors and clinical outcomes of Dubberley type B capitellar fractures treated with Herbert screws combined with posterior buttress plates.
METHODS
Seven men and nine women (aged 30-68 years) with Dubberley type B capitellar fractures were operated on with Herbert screws combined with posterior buttress plates. The patients were classified into Dubberley types IB (seven), IIB (four), and IIIB (five). Complications and bone union were observed, and functional outcomes were evaluated by the Mayo Elbow Performance Index (MEPI).
RESULTS
All patients were followed up for a mean period of 23.5 months (12-30 months). All fractures healed in 8-14 weeks (mean, 10.5 weeks). No cases of non-union, elbow instability, or avascular necrosis occurred. Degenerative arthritis occurred in 7 (44%) and heterotopic ossification in 11 (69%) patients. The median MEPI score was 92.5 (interquartile range, 85-100) points, with 11 reporting excellent, 3 good, and 2 fair outcomes. The MEPI scores of type IIIB fractures were significantly lower than those of types IB and IIB fractures, while the MEPI scores of type IB and IIB fractures did not differ significantly.
CONCLUSIONS
Dubberley type IIIB capitellar fractures with multiple articular fragments have a poorer prognosis than type IB and IIB fractures. However, Herbert screw fixation combined with posterior metacarpal locking plates is feasible, providing satisfactory recovery of elbow joint function.
Topics: Male; Humans; Female; Elbow Joint; Humeral Fractures; Metacarpal Bones; Treatment Outcome; Fracture Fixation, Internal; Elbow Injuries; Range of Motion, Articular; Retrospective Studies; Joint Instability; Fractures, Comminuted; Bone Plates
PubMed: 38044433
DOI: 10.1186/s12891-023-07065-7 -
JPRAS Open Dec 2023Little is known of the scale of avoidable injuries presenting to medical services on a national level in the UK. This study aimed to assess the type and incidence of...
Little is known of the scale of avoidable injuries presenting to medical services on a national level in the UK. This study aimed to assess the type and incidence of preventable wrist and hand injuries (as defined by the core research team) at a national level in the UK. 28 UK hospitals undertook a service evaluation of all hand trauma cases presenting to their units over a 2 week period in early 2021 identifying demographical and aetiological information about injuries sustained. 1909 patients were included (184 children) with a median age of 40 (IQR 25-59) years. The commonest five types of injury were fractures of the wrist; single phalangeal or metacarpal fractures; fingertip injuries; and infection, with the most common mechanisms being mechanical falls and manual labour. This is the first extensive survey of preventable hand injuries in the UK, identifying a need for further work into prevention to reduce healthcare burden and cost. 50% of injuries presenting to hand surgeons are preventable, with the most common injuries being single fractures of the wrist, phalanx and metacarpal. Few preventable injuries were related to alcohol or narcotic intoxication. Further research is needed to identify how to initiate injury prevention measures for hand injuries, particularly focussed towards hand fracture prevention.
PubMed: 38039295
DOI: 10.1016/j.jpra.2023.10.005 -
Journal of Orthopaedic Case Reports Nov 2023Traumatic bone loss at the metacarpal phalangeal joint level can be a challenging clinical situation. Not many cases have been described in the literature for this...
INTRODUCTION
Traumatic bone loss at the metacarpal phalangeal joint level can be a challenging clinical situation. Not many cases have been described in the literature for this specific articulation.
CASE REPORT
Our patient presented with a work-related accident of his hand with loss of the metacarpophalangeal joint of the index finger. After temporary external fixation and wound closure, a prosthetic joint arthroplasty was chosen to allow a reconstruction of his lost joint.
CONCLUSION
After traumatic articular bone destruction in the hand, there are several possibilities to reflect on. Taking into consideration the patient's characteristics and the degree of bone loss, implanting a prosthesis can be a safe option with acceptable results.
PubMed: 38025369
DOI: 10.13107/jocr.2023.v13.i11.4040