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American Journal of Veterinary Research Nov 2021To describe the technique and assess the diagnostic potential and limitations of tomosynthesis for imaging of the metacarpophalangeal joint (MCPJ) of equine cadavers;...
OBJECTIVE
To describe the technique and assess the diagnostic potential and limitations of tomosynthesis for imaging of the metacarpophalangeal joint (MCPJ) of equine cadavers; compare the tomosynthesis appearance of pathological lesions with their conventional radiographic, CT, and MRI appearances; and evaluate all imaging findings with gross lesions of a given MCPJ.
SAMPLE
Distal portions of 4 forelimbs from 4 equine cadavers.
PROCEDURES
The MCPJs underwent radiography, tomosynthesis (with a purpose-built benchtop unit), CT, and MRI; thereafter, MCPJs were disarticulated and evaluated for the presence of gross lesions. The ability to identify pathological lesions on all images was assessed, followed by semiobjective scoring for quality of the overall image and appearance of the subchondral bone, articular cartilage, periarticular margins, and adjacent trabecular bone of the third metacarpal bone, proximal phalanx, and proximal sesamoid bones of each MCPJ.
RESULTS
Some pathological lesions in the subchondral bone of the third metacarpal bone were detectable with tomosynthesis but not with radiography. Overall, tomosynthesis was comparable to radiography, but volumetric imaging modalities were superior to tomosynthesis and radiography for imaging of subchondral bone, articular cartilage, periarticular margins, and adjacent bone.
CONCLUSIONS AND CLINICAL RELEVANCE
With regard to the diagnostic characterization of equine MCPJs, tomosynthesis may be more accurate than radiography for identification of lesions within subchondral bone because, in part, of its ability to reduce superimposition of regional anatomic features. Tomosynthesis may be useful as an adjunctive imaging technique, highlighting subtle lesions within bone, compared with standard radiographic findings.
Topics: Animals; Cadaver; Horse Diseases; Horses; Joints; Magnetic Resonance Imaging; Metacarpal Bones; Metacarpophalangeal Joint; Tomography, X-Ray Computed
PubMed: 34669497
DOI: 10.2460/ajvr.82.11.872 -
Journal of Orthopaedic Case Reports Jan 2022A benign cystic lesion, the simple bone cyst (unicameral/essential bone cyst), it may be found in any long bone (most commonly found in femur and proximal humerus),...
INTRODUCTION
A benign cystic lesion, the simple bone cyst (unicameral/essential bone cyst), it may be found in any long bone (most commonly found in femur and proximal humerus), usually in immature skeletal persons. Metacarpal simple bone cyst is an exceedingly rare occurrence and few treatment options have been described for the same.
CASE REPORT
A 42-year-old manual laborer male (right hand dominant) came with history of trivial trauma to right hand thumb with hammer. He complained of mild swelling and pain since trauma. On imaging the right hand, an expansive lytic lesion was seen in the metaphyseo-diahyseal region of the first metacarpal. There was thinning of the cortex with break in cortex visible at mid diaphyseal region. There was absence of any soft-tissue involvement or periosteal reaction. Magnetic resonance imaging reported a T2 hyperintense and T1 isointense benign osteolytic lesion with pathological fracture. On aspiration, a reddish tinged fluid was found. A closed fixation was performed with the help of an intramedullary k-wire.
CONCLUSION
Simple bone cyst, although rare in metacarpal bone, is an important differential diagnosis in cases with cystic lesion. Simple bone cyst, although a benign lesion, can cause extensive involvement of the metacarpal bones and destroy the entire diaphysis. It requires adequate treatment which is simple and effective.
PubMed: 35611277
DOI: 10.13107/jocr.2022.v12.i01.2640 -
BMC Surgery Oct 2021The WALANT (wide-awake local anesthesia with no tourniquet) technique was based on local infiltration of lidocaine and epinephrine. This technique has rapidly gained...
Plate osteosynthesis of single metacarpal fracture: WALANT technique is a cost-effective approach to reduce postoperative pain and discomfort in contrast to general anesthesia and wrist block.
BACKGROUND
The WALANT (wide-awake local anesthesia with no tourniquet) technique was based on local infiltration of lidocaine and epinephrine. This technique has rapidly gained popularity in recent years and can perform most hand operations. This study aimed to investigate the time spent on anesthesia and operation and perform an economic analysis among general anesthesia, wrist block with a tourniquet, and the WALANT technique for the internal fixation of metacarpal fractures.
METHODS
We retrospectively reviewed all the single metacarpal fractures managed with the same procedure, open reduction, and internal fixation with the plate between January 2015 and December 2019. They were divided into three groups according to the method of anesthesia: (1) general anesthesia (GA group), (2) wrist block with a tourniquet (WB group), and (3) WALANT technique (WALANT group). We collected and analyzed patient demographic data, perioperative or postoperative complications, number of hospital days, and postoperative functional recovery assessment.
RESULTS
A total of 63 patients met the inclusion criteria, including 24 in the GA group, 28 in the wrist block group using a tourniquet, and 11 in the WALANT group. There were no complications during the operation and follow-up in each group. The GA group had an average of 32.8 min of anesthesia time, significantly longer than the other two groups. However, there is no significant difference regarding surgical time among the presenting three groups. The discomfort of vomiting and nausea after surgery occurred in 20 patients in the GA group (38.1%). Nevertheless, there was no postoperative vomiting and nausea present in both the WB and WALANT groups. Most patients achieved full recovery of pre-injury interphalangeal and metacarpophalangeal motion at the final assessment of functional recovery.
CONCLUSIONS
The patients undergoing metacarpal fixation surgery under WALANT or WB had significantly less anesthesia time and postoperative vomiting and nausea. Moreover, there was no difference in surgical time and intraoperative complications. The time-related reduction improved the utilization of the operation room for additional cases. The reduction of the preoperative examination, anesthesia fee, postoperative recovery room observation, and hospitalization can effectively reduce medical costs. Furthermore, the WALANT group is more acceptable because of no tourniquet, which commonly causes discomfort.
Topics: Anesthesia, General; Cost-Benefit Analysis; Humans; Metacarpal Bones; Pain, Postoperative; Retrospective Studies; Wrist
PubMed: 34627230
DOI: 10.1186/s12893-021-01362-5 -
Hand (New York, N.Y.) May 2019Metacarpal lengthening by distraction osteogenesis has been well documented in pediatric patients but limited in older patients. Fewer studies have assessed the success...
BACKGROUND
Metacarpal lengthening by distraction osteogenesis has been well documented in pediatric patients but limited in older patients. Fewer studies have assessed the success of the procedure through outcome measure scores. The purpose of this study is to assess the outcomes of distraction osteogenesis in skeletally mature adults with brachymetacarpia and patients' perspectives on their satisfaction through outcome measure scores.
METHODS
Retrospective chart review of a consecutive series of metacarpal lengthenings for the treatment of brachymetacarpia was performed. Key parameters collected include starting metacarpal length, amount lengthened, range of motion of metacarpophalangeal joint, type of fixator used, distraction time, and total time in fixator. Relevant comorbidities and complications encountered were recorded as well. The Body Image Quality of Life Inventory (BIQLI) and Limb Deformity Modified Scoliosis Research Society (LD-SRS) score were given to evaluate patients' perspectives on their satisfaction of surgery.
RESULTS
Seven metacarpal lengthenings were performed in 4 adult females (average age: 22.8 years) between 2005 and 2016. The average amount lengthened was 1.5 cm (range, 1.2-2.1 cm), corresponding to a mean percent lengthening of 44.4% (range, 33.3%-57.1%). The mean distraction rate was 0.432 mm/day (range, 0.286-0.724 mm/day). The mean distraction time was 38 days (range, 28-55 days). External fixation index was 71.8 days/cm (range, 53.5-99.2 days/cm). No functional loss was observed.
CONCLUSIONS
Progressive distraction osteogenesis can obtain functionally successful results and improvement in aesthetics and body image without severe complications in skeletally mature adults with brachymetacarpia.
Topics: Adolescent; Adult; Bone Lengthening; External Fixators; Female; Hand Deformities, Congenital; Humans; Metacarpal Bones; Metacarpophalangeal Joint; Osteogenesis, Distraction; Outcome Assessment, Health Care; Patient Satisfaction; Quality of Life; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 29086650
DOI: 10.1177/1558944717736859 -
American Journal of Biological... Feb 2024Analyses of external bone shape using geometric morphometrics (GM) and cross-sectional geometry (CSG) are frequently employed to investigate bone structural variation...
OBJECTIVES
Analyses of external bone shape using geometric morphometrics (GM) and cross-sectional geometry (CSG) are frequently employed to investigate bone structural variation and reconstruct activity in the past. However, the association between these methods has not been thoroughly investigated. Here, we analyze whole bone shape and CSG variation of metacarpals 1-5 and test covariation between them.
MATERIALS AND METHODS
We analyzed external metacarpal shape using GM and CSG of the diaphysis at three locations in metacarpals 1-5. The study sample includes three modern human groups: crew from the shipwrecked Mary Rose (n = 35 metacarpals), a Pre-industrial group (n = 50), and a Post-industrial group (n = 31). We tested group differences in metacarpal shape and CSG, as well as correlations between these two aspects of metacarpal bone structure.
RESULTS
GM analysis demonstrated metacarpus external shape variation is predominately related to changes in diaphyseal width and articular surface size. Differences in external shape were found between the non-pollical metacarpals of the Mary Rose and Pre-industrial groups and between the third metacarpals of the Pre- and Post-industrial groups. CSG results suggest the Mary Rose and Post-industrial groups have stronger metacarpals than the Pre-industrial group. Correlating CSG and external shape showed significant relationships between increasing external robusticity and biomechanical strength across non-pollical metacarpals (r: 0.815-0.535; p ≤ 0.05).
DISCUSSION
Differences in metacarpal cortical structure and external shape between human groups suggest differences in the type and frequency of manual activities. Combining these results with studies of entheses and kinematics of the hand will improve reconstructions of manual behavior in the past.
Topics: Humans; Metacarpal Bones; Metacarpus; Hand; Diaphyses; Upper Extremity
PubMed: 37929663
DOI: 10.1002/ajpa.24866 -
Anatomical Record (Hoboken, N.J. : 2007) Mar 2018Among living mammals, only the African apes and some anteaters adopt knuckle-walking as their primary locomotor behavior. That Pan and Gorilla both knuckle-walk has been...
Among living mammals, only the African apes and some anteaters adopt knuckle-walking as their primary locomotor behavior. That Pan and Gorilla both knuckle-walk has been cited as evidence of their common ancestry and a primitive condition for a combined Homo, Pan, and Gorilla clade. Recent research on forelimb ontogeny and anatomy, in addition to recently described hominin fossils, indicate that knuckle-walking was independently acquired after divergence of the Pan and Gorilla lineages. Although the large-bodied, largely suspensory orangutan shares some aspects of the African ape bauplan, it does not regularly knuckle-walk when terrestrial. While many anatomical correlates of knuckle-walking have been identified, a functional explanation of this unusual locomotor pattern has yet to be proposed. Here, we argue that it was adopted by African apes as a means of ameliorating the consequences of repetitive impact loadings on the soft and hard tissues of the forelimb by employing isometric and/or eccentric contraction of antebrachial musculature during terrestrial locomotion. Evidence of this adaptation can be found in the differential size and fiber geometry of the forearm musculature, and differences in torso shape between the knuckle-walking and non-knuckle-walking apes (including humans). We also argue that some osteological features of the carpus and metacarpus that have been identified as adaptations to knuckle-walking are consequences of cartilage remodeling during ontogeny rather than traits limiting motion in the hand and wrist. An understanding of the functional basis of knuckle-walking provides an explanation of the locomotor parallelisms in modern Pan and Gorilla. Anat Rec, 301:496-514, 2018. © 2018 Wiley Periodicals, Inc.
Topics: Adaptation, Physiological; Animals; Biological Evolution; Female; Fossils; Hand; Hominidae; Locomotion; Male; Metacarpal Bones; Walking; Wrist Joint
PubMed: 29418123
DOI: 10.1002/ar.23743 -
Journal of Biomechanics May 2023The trapeziometacarpal (TMC) joint is the one of the hand joints that is most affected by osteoarthritis (OA). The objective of this study was to determine if specific...
The trapeziometacarpal (TMC) joint is the one of the hand joints that is most affected by osteoarthritis (OA). The objective of this study was to determine if specific morphological parameters could be related to the amount of pressure endured by the joint which is one of the factors contributing to the development of this pathology. We developed 15 individualized 3D computer aided design (CAD) models of the TMC joint, each generated from the CT scan of a different participant. For each participant, we measured several crucial morphological parameters: the width and length of the trapezium bone and dorso-volar and ulno-radial curvature, of the trapezium and the metacarpal bone. Each CAD model was converted into a finite element model, of both bones and the cartilage located in between. The joint forces applied during pinch grip and power grip tasks were then applied in order to estimate the contact pressures on joint cartilage for each model. Correlations between joint contact pressures and morphology of the trapezium and the metacarpal bone were then analysed. Important variations of TMC joint pressures were observed. For both pinch and power grip tasks, the strongest correlation with joint contact pressure was with the dorso-volar curvature of the trapezium bone. Our findings indicate that dorso-volar curvature of the trapezium bone has a significant impact on mechanical loadings on the TMC joint. This contributes to understanding the prevalence of OA in certain patients.
Topics: Trapezium Bone; Metacarpal Bones; Carpometacarpal Joints; Osteoarthritis; Pressure; Humans; Male; Female; Adult; Middle Aged; Imaging, Three-Dimensional
PubMed: 37037117
DOI: 10.1016/j.jbiomech.2023.111573 -
American Journal of Veterinary Research May 2010To assess the net mechanical load on the distal end of the third metacarpal bone in horses during walking and trotting.
OBJECTIVE
To assess the net mechanical load on the distal end of the third metacarpal bone in horses during walking and trotting.
ANIMALS
3 Quarter Horses and 1 Thoroughbred.
PROCEDURES
Surface strains measured on the left third metacarpal bone of the Thorough-bred were used with a subject-specific model to calculate loading (axial compression, bending, and torsion) of the structure during walking and trotting. Forelimb kinematics and ground reaction forces measured in the 3 Quarter Horses were used with a musculoskeletal model of the distal portion of the forelimb to determine loading of the distal end of the third metacarpal bone.
RESULTS
Both methods yielded consistent data regarding mechanical loading of the distal end of the third metacarpal bone. During walking and trotting, the distal end of the third metacarpal bone was loaded primarily in axial compression as a result of the sum of forces exerted on the metacarpal condyles by the proximal phalanx and proximal sesamoid bones.
CONCLUSIONS AND CLINICAL RELEVANCE
Results of strain gauge and kinematic analyses indicated that the major structures of the distal portion of the forelimb in horses acted to load the distal end of the third metacarpal bone in axial compression throughout the stance phase of the stride.
Topics: Animals; Biomechanical Phenomena; Forelimb; Horses; Metacarpal Bones; Posture; Running; Stress, Mechanical; Walking; Weight-Bearing
PubMed: 20433375
DOI: 10.2460/ajvr.71.5.508 -
BMC Musculoskeletal Disorders Jan 2020The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this...
BACKGROUND
The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures.
METHODS
A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies.
RESULTS
Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15 to 100%, 13-98%, 55-73%, 14-73% and 75-100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26 to 55%, 13-89%, 45-76%, 41-77% and 63-75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85 to 100%, 79-100%, 49-100% and 86-97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73 to 100%, 78-100%, 70-100%, 79-100% and 70-100%, respectively.
CONCLUSIONS
Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.
Topics: Carpal Bones; Finger Phalanges; Fractures, Bone; Hand Injuries; Humans; Medical History Taking; Metacarpal Bones; Physical Examination; Predictive Value of Tests; Reproducibility of Results; Wrist Injuries
PubMed: 31910838
DOI: 10.1186/s12891-019-2988-z -
Saudi Medical Journal Jul 2019To examine the epidemiology of hand fractures including common bones affected, causes, interventions, outcomes, and complications. Methods: This retrospective...
To examine the epidemiology of hand fractures including common bones affected, causes, interventions, outcomes, and complications. Methods: This retrospective records-based study included patients who were admitted to King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, with traumatic metacarpal or phalangeal fractures between January 2016 and September 2017. Carpal fractures, wrist fractures, and all pathological fractures were excluded. Results: A total of 82 patients (90.2% of them men with an average age of 27.6±13.4 years) with 101 fractures were included. The fifth (25.5%) and first (24.5%) rays were the most commonly affected ones. The fifth finger (27.8%) and first metacarpal (28.9%) were the most commonly affected finger and metacarpal bone. Approximately 32.7% of the fractures were open fractures. The most frequent causes of hand fractures included falls (40.5%), road traffic accidents (20.3%), crushing injuries (9.5%), and machinery injuries (9.5%). Approximately 90.1% of the patients underwent operative interventions including open reduction (50.5%) and closed reduction (34.3%). The majority of fractures (79.2%) healed, and only 14.7% of fractures developed complications. Conclusion: In this study of hand fractures, patients were predominantly males and the main causes of fractures were falls and road traffic accidents.
Topics: Accidental Falls; Accidents, Traffic; Adolescent; Adult; Closed Fracture Reduction; Crush Injuries; Female; Fracture Healing; Fractures, Bone; Fractures, Open; Hand Bones; Hand Injuries; Humans; Male; Open Fracture Reduction; Retrospective Studies; Saudi Arabia; Tertiary Care Centers; Wrist Injuries; Young Adult
PubMed: 31287136
DOI: 10.15537/smj.2019.7.24286