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JAMA Surgery Jul 2019Optimal treatment for traumatic digit amputation is unknown.
Patient-Reported and Functional Outcomes After Revision Amputation and Replantation of Digit Amputations: The FRANCHISE Multicenter International Retrospective Cohort Study.
IMPORTANCE
Optimal treatment for traumatic digit amputation is unknown.
OBJECTIVE
To compare long-term patient-reported and functional outcomes between patients treated with revision amputation or replantation for digit amputations.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective cohort study at 19 centers in the United States and Asia. Participants were 338 individuals 18 years or older with traumatic digit amputations with at least 1 year of follow-up after treatment. Participants were enrolled from August 1, 2016, to April 12, 2018.
EXPOSURES
Revision amputation or replantation of traumatic digit amputations.
MAIN OUTCOMES AND MEASURES
The primary outcome was the Michigan Hand Outcomes Questionnaire (MHQ) score. Secondary outcomes were the 36-Item Short Form Health Survey (SF-36), Disabilities of the Arm, Shoulder, and Hand (DASH), and Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity module scores and functional outcomes.
RESULTS
Among 338 patients who met all inclusion criteria, the mean (SD) age was 48.3 (16.4) years, and 85.0% were male. Adjusted aggregate comparison of patient-reported outcomes (PROs) between patients with revision amputation and replantation revealed significantly better outcomes in the replantation cohort measured by the MHQ (5.93; 95% CI, 1.03-10.82; P = .02), DASH (-4.29; 95% CI, -8.45 to -0.12; P = .04), and PROMIS (3.44; 95% CI, 0.60 to 6.28; P = .02) scores. In subgroup analyses, DASH scores were significantly lower (6 vs 9, P = .05), indicating less disability and pain, and PROMIS scores higher (78 vs 75, P = .04) after replantation. Patients with 3 or more digits amputated (including thumb) had significantly better PROs after replantation than those managed with revision amputation (22 vs 42, P = .03 for DASH and 61 vs 36, P = .01 for PROMIS). Patients who underwent replantation after 3 or more digits amputated (excluding thumb) had higher MHQ scores, which did not reach statistical significance (69 vs 65, P = .06). Revision amputation in the subgroup with single-finger amputation distal to the proximal interphalangeal joint resulted in better 2-point discrimination (6 vs 8 mm, P = .05). Compared with revision amputation, replantation resulted in better 9-hole peg test times in the subgroup with 3 or more digits amputated (including thumb) (46 vs 81 seconds, P = .001), better Semmes-Weinstein monofilament test in the subgroup with 3 or more digits amputated (excluding thumb) (3 vs 21 g, P = .008), and better 3-point pinch test in the subgroup with 2 digits amputated (excluding thumb) (6.7 vs 5.6 kg, P = .03).
CONCLUSIONS AND RELEVANCE
When technically feasible, replantation is recommended in 3 or more digits amputated and in single-finger amputation (excluding thumb) distal to the proximal interphalangeal joint because it achieved better PROs, with long-term functional benefit. Thumb replantation is still recommended for its integral role in opposition.
Topics: Amputation, Surgical; Amputation, Traumatic; Disability Evaluation; Female; Finger Injuries; Follow-Up Studies; Humans; Male; Middle Aged; Patient Reported Outcome Measures; Recovery of Function; Reoperation; Replantation; Retrospective Studies; Treatment Outcome
PubMed: 30994871
DOI: 10.1001/jamasurg.2019.0418 -
Cureus Sep 2022Super digits are a rare hand malformation, first described by Virchel Wood. Surgical intervention to try to make two fingers out of a super digit has been discouraged....
Super digits are a rare hand malformation, first described by Virchel Wood. Surgical intervention to try to make two fingers out of a super digit has been discouraged. Here, we present a variant of a super digit type IC2 and propose a revision of the characteristics in each super digit subtype. In our view, this adjustment in Wood's original description could facilitate the identification of super digits, which are a contraindication to syndactyly release.
PubMed: 36199652
DOI: 10.7759/cureus.28678 -
Frontiers in Neuroscience 2023The aim of the present study is to evaluate the effect of vibrotactile stimulation prior to repeated complex motor imagery of finger movements using the non-dominant...
PURPOSE
The aim of the present study is to evaluate the effect of vibrotactile stimulation prior to repeated complex motor imagery of finger movements using the non-dominant hand on motor imagery (MI) performance.
METHODS
Ten healthy right-handed adults (4 females and 6 males) participated in the study. The subjects performed motor imagery tasks with and without a brief vibrotactile sensory stimulation prior to performing motor imagery using either their left-hand index, middle, or thumb digits. Mu- and beta-band event-related desynchronization (ERD) at the sensorimotor cortex and an artificial neural network-based digit classification was evaluated.
RESULTS
The ERD and digit discrimination results from our study showed that ERD was significantly different between the vibration conditions for the index, middle, and thumb. It was also found that digit classification accuracy with-vibration (mean ± SD = 66.31 ± 3.79%) was significantly higher than without-vibration (mean ± SD = 62.68 ± 6.58%).
CONCLUSION
The results showed that a brief vibration was more effective at improving MI-based brain-computer interface classification of digits within a single limb through increased ERD compared to performing MI without vibrotactile stimulation.
PubMed: 37360173
DOI: 10.3389/fnins.2023.1152563 -
IUBMB Life Oct 2011During the hand plate development, the processes of cell differentiation and control of cell death are relevant to ensure a correct shape of the limb. The progenitor... (Review)
Review
During the hand plate development, the processes of cell differentiation and control of cell death are relevant to ensure a correct shape of the limb. The progenitor cell pool that later will differentiate into cartilage to form the digits arises from undifferentiated mesenchymal cells beneath the apical ectodermal ridge (AER). Once these cells abandon the area of influence of signals from AER and ectoderm, some cells are committed to chondrocyte lineage forming the digital rays. However, if the cells are not committed to chondrocyte lineage, they will form the prospective interdigits that in species with free digits will subsequently die. In this work, we provide the overview of the molecular interactions between different signaling pathways responsible for the formation of digit and interdigit regions. In addition, we briefly describe some experiments concerning the most important signals responsible for promoting cell death. Finally, on the basis that the interdigital tissue has chondrogenic potential, we discuss the hypothesis that apoptotic-promoting signals might also act as antichondrogenic factors and chondrogenic factors might operate as anti-apoptotic factors.
Topics: Animals; Apoptosis; Cell Differentiation; Chick Embryo; Gene Expression Regulation, Developmental; Mesoderm; Signal Transduction; Transforming Growth Factor beta; Upper Extremity
PubMed: 21901820
DOI: 10.1002/iub.563 -
JPRAS Open Jun 2022Polydactyly is characterized by the manifestation of supernumerary digits in the hands and feet. It can be isolated or associated with a genetic syndrome. Based on the...
Polydactyly is characterized by the manifestation of supernumerary digits in the hands and feet. It can be isolated or associated with a genetic syndrome. Based on the location of duplication, it is categorized as preaxial, postaxial, or central. The latter is a rare abnormality, comprising approximately 6% of cases. There is a paucity in the literature regarding this congenital anomaly and its overall management. Nonoperative treatment is generally unsuccessful in managing symptoms such as excessive width, abnormal digit alignment, and growth. Though surgical management addresses the individual patient's needs, general goals include preservation of digits with the greatest axial alignment, resection of symptomatic digits, alignment correction of the remaining great toe, stabilization of the soft tissues, and adequate soft tissue coverage. This study aims to delineate effective operative techniques for central foot polydactyly. Two patient cases are discussed, providing a framework for pre and postoperative care, complications, and outcomes. The techniques detailed offer a straightforward, efficacious, and safe method to reconstruct central foot polydactyly, returning form and function to the patient.
PubMed: 35330745
DOI: 10.1016/j.jpra.2022.01.006 -
Developmental Dynamics : An Official... Sep 2021Interdigits (IDs) determine digit identity in chick limbs. They are located between the digital rays and act as secondary signaling centers downstream of sonic hedgehog...
BACKGROUND
Interdigits (IDs) determine digit identity in chick limbs. They are located between the digital rays and act as secondary signaling centers downstream of sonic hedgehog to provide positional information for determining digit identity in the phalanx-forming region (PFR). We examined the dynamic developmental mechanism by which PFR cells obtain positional information from IDs to determine the identity of individual digits in the chick hindlimb.
RESULTS
We identified the specific region of the IDs responsible for determining digit identity and showed that PFR cells actively receive positional information only from the posteriorly, and not the anteriorly, located IDs. We also demonstrated that digits 1, 2, and 3 are interchangeable with each other, but not with digit 4. Finally, we found that both ID4 and digital ray 4 are necessary for determining digit 4 identity.
CONCLUSIONS
The digital rays are naïve during the initial stages of their development, at which time digit identity is not determined. To determine digit identity, each PFR cell shows a unidirectional response to obtain positional information specifically from the IDs located posterior to the PFR, regardless of the signal strength from the anteriorly located IDs.
Topics: Animals; Bone and Bones; Chickens; Extremities; Gene Expression Regulation, Developmental; Hedgehog Proteins; Hindlimb
PubMed: 33655599
DOI: 10.1002/dvdy.323 -
Developmental Biology Feb 2021The development of joints in the mammalian skeleton depends on the precise regulation of multiple interacting signaling pathways including the bone morphogenetic protein...
The development of joints in the mammalian skeleton depends on the precise regulation of multiple interacting signaling pathways including the bone morphogenetic protein (BMP) pathway, a key regulator of joint development, digit patterning, skeletal growth, and chondrogenesis. Mutations in the BMP receptor ACVR1 cause the rare genetic disease fibrodysplasia ossificans progressiva (FOP) in which extensive and progressive extra-skeletal bone forms in soft connective tissues after birth. These mutations, which enhance BMP-pSmad1/5 pathway activity to induce ectopic bone, also affect skeletal development. FOP can be diagnosed at birth by symmetric, characteristic malformations of the great toes (first digits) that are associated with decreased joint mobility, shortened digit length, and absent, fused, and/or malformed phalanges. To elucidate the role of ACVR1-mediated BMP signaling in digit skeletal development, we used an Acvr1;Prrx1-Cre knock-in mouse model that mimics the first digit phenotype of human FOP. We have determined that the effects of increased Acvr1-mediated signaling by the Acvr1 mutation are not limited to the first digit but alter BMP signaling, Gdf5+ joint progenitor cell localization, and joint development in a manner that differently affects individual digits during embryogenesis. The Acvr1 mutation leads to delayed and disrupted joint specification and cleavage in the digits and alters the development of cartilage and endochondral ossification at sites of joint morphogenesis. These findings demonstrate an important role for ACVR1-mediated BMP signaling in the regulation of joint and skeletal formation, show a direct link between failure to restrict BMP signaling in the digit joint interzone and failure of joint cleavage at the presumptive interzone, and implicate impaired, digit-specific joint development as the proximal cause of digit malformation in FOP.
Topics: Activin Receptors, Type I; Animals; Body Patterning; Bone Morphogenetic Proteins; Chondrogenesis; Disease Models, Animal; Forelimb; Growth Differentiation Factor 5; Growth Plate; Hindlimb; Joints; Mice; Myositis Ossificans; Osteogenesis; Signal Transduction; Smad1 Protein; Smad5 Protein; Stem Cells; Toes
PubMed: 33217406
DOI: 10.1016/j.ydbio.2020.11.004 -
Frontiers in Human Neuroscience 2022Number processing abilities are important for academic and personal development. The course of initial specialization of ventral occipito-temporal cortex (vOTC)...
Number processing abilities are important for academic and personal development. The course of initial specialization of ventral occipito-temporal cortex (vOTC) sensitivity to visual number processing is crucial for the acquisition of numeric and arithmetic skills. We examined the visual N1, the electrophysiological correlate of vOTC activation across five time points in kindergarten (T1, mean age 6.60 years), middle and end of first grade (T2, 7.38 years; T3, 7.68 years), second grade (T4, 8.28 years), and fifth grade (T5, 11.40 years). A combination of cross-sectional and longitudinal EEG data of a total of 62 children (35 female) at varying familial risk for dyslexia were available to form groups of 23, 22, 27, 27, and 42 participants for each of the five time points. The children performed a target detection task which included visual presentation of single digits (DIG), false fonts (FF), and letters (LET) to derive measures for coarse (DIG vs. FF) and fine (DIG vs. LET) digit sensitive processing across development. The N1 amplitude analyses indicated coarse and fine sensitivity characterized by a stronger N1 to digits than false fonts across all five time points, and stronger N1 to digits than letters at all but the second (T2) time point. In addition, lower arithmetic skills were associated with stronger coarse N1 digit sensitivity over the left hemisphere in second grade (T4), possibly reflecting allocation of more attentional resources or stronger reliance on the verbal system in children with poorer arithmetic skills. To summarize, our results show persistent visual N1 sensitivity to digits that is already present early on in pre-school and remains stable until fifth grade. This pattern of digit sensitivity development clearly differs from the relatively sharp rise and fall of the visual N1 sensitivity to words or letters between kindergarten and middle of elementary school and suggests unique developmental trajectories for visual processing of written characters that are relevant to numeracy and literacy.
PubMed: 35959243
DOI: 10.3389/fnhum.2022.887413 -
Cortex; a Journal Devoted To the Study... Feb 2024The processing of numerals as visual objects is supported by an "Inferior Temporal Numeral Area" (ITNA) in the bilateral inferior temporal gyri (ITG). Extant findings...
The processing of numerals as visual objects is supported by an "Inferior Temporal Numeral Area" (ITNA) in the bilateral inferior temporal gyri (ITG). Extant findings suggest some degree of hemispheric asymmetry in how the bilateral ITNAs process numerals. Pollack and Price (2019) reported such a hemispheric asymmetry by which a region in the left ITG was sensitive to digits during a visual search for a digit among letters, and a homologous region in the right ITG that showed greater digit sensitivity in individuals with higher calculation skills. However, the ITG regions were localized with separate analyses without directly contrasting their digit sensitivities and relation to calculation skills. So, the extent of and reasons for these functional asymmetries remain unclear. Here we probe whether the functional and representational properties of the ITNAs are asymmetric by applying both univariate and multivariate region-of-interest analyses to Pollack and Price's (2019) data. Contrary to the implications of the original findings, digit sensitivity did not differ between ITNAs, and digit sensitivity in both left and right ITNAs was associated with calculation skills. Representational similarity analyses revealed that the overall representational geometries of digits in the ITNAs were also correlated, albeit weakly, but the representational contents of the ITNAs were largely inconclusive. Nonetheless, we found a right lateralization in engagement in alphanumeric categorization, and that the right ITNA showed greater discriminability between digits and letters. Greater right lateralization of digit sensitivity and digit discriminability in the left ITNA were also related to higher calculation skills. Our findings thus suggest that the ITNAs may not be functionally identical and should be directly contrasted in future work. Our study also highlights the importance of within-individual comparisons for understanding hemispheric asymmetries, and analyses of individual differences and multivariate features to uncover effects that would otherwise be obscured by averages.
Topics: Humans; Magnetic Resonance Imaging; Functional Laterality; Temporal Lobe; Multivariate Analysis; Individuality; Brain Mapping
PubMed: 37992508
DOI: 10.1016/j.cortex.2023.08.018 -
Zoological Studies 2020Morphology has a direct influence on animal fitness. Studies addressing the identification of patterns and variations across several guilds are fundamental in...
Morphology has a direct influence on animal fitness. Studies addressing the identification of patterns and variations across several guilds are fundamental in ecomorphological research. Wings are the core of ecological morphology in bats; nevertheless, individual bones and structures that support the wing, including metacarpals, phalanges and the length of digits, have rarely been the subject of comprehensive research when studying wing morphology. Here, I analyzed morphological variations of wing structures across 11 bat guilds and how individual bone structures are correlated to diet, foraging mode and habitat use. I obtained wing measurements from 1512 voucher specimens of 97 species. All the specimens analyzed came from the Mammalian Collection at the Museo Javeriano de Historia Natural of Pontificia Universidad Javeriana (MPUJ-MAMM) (Bogotá, Colombia). Positive correlations between size and the length of the third and fifth digit were detected. Bat guilds that capture their preys using aerial strategy in uncluttered habitats had longer third digits but short fifth digits compared to guilds that rely on gleaning strategy and forage in highly cluttered space. Although terminal phalanges were shown to be important structures for guild classification, metacarpals were strongly related to aerial foragers from uncluttered habitats because of their potential role in flight performance and ecological adaptations. Results show that habitat use, as well as foraging mode, are reflected in wing structures. Different wing traits to those evaluated in this study should be considered to better understand the ecological interactions, foraging strategy, wing adaptations, and flight performance in Neotropical bats.
PubMed: 34140977
DOI: 10.6620/ZS.2020.59-60