Multicentric giant cell tumor of the upper extremities: 16 years of ongoing disease

Multicentric giant cell tumor is rare and accounts for less than 1% of all giant cell tumors of bone. We describe a case in which all the lesions occurred in the upper extremities. The 13-year-old boy's first tumor was in the left index metacarpal. Over 16 years, giant cell tumors occurred in 8 sites: right distal radius, left lunate, left middle metacarpal, left distal radius, right ring finger proximal phalanx, right radial head, left distal humerus, and left proximal humerus. Intralesional curettage of the lesions located in the hand and carpals was associated with a high incidence of local recurrence, whereas lesions in the proximal radius and in the humerus have not recurred.     

A rare case of closed isolated dislocation of the third metacarpophalangeal joint of the hand

Metacarpophalangeal joint [MCP] dislocations of the index, little and thumb are common; that of the middle finger is very rare. In all the literature consulted only five cases of isolated closed dorsal dislocation of the MCP joint of the middle finger have been reported. Hyperextension of MCP joint is the mechanism of injury. We are herewith reporting a case of isolated MCP dislocation of the middle finger.One of our medical students while driving a motorcycle fell down on the road and sustained lacerated wound over the hypothenar area of the left hand. There was prominence of the head of the third metacarpal on the volar aspect and the base of the proximal phalanx was prominent dorsally. MCP dislocation of the middle finger was our clinical diagnosis which was confirmed by the radiograph. The patient had reported within 60 min of the accident.There was no tendon injury. Wound debridement was done, wound was extended to the back of the middle finger. The volar plate which was interposed between the head of the metacarpal and the base of the proximal phalanx was repositioned and the dislocation was reduced. Reduction was stable and the patient was reviewed after 14 months. The function of the hand is satisfactory.The case is presented for its unique presentation. This is the sixth case of isolated dislocation of the MCP joint of the middle finger.     

Radiofrequency ablation in osteoid osteoma of the finger

The occurrence of osteoid osteomas of the hand is rare and their treatment usually is surgical. A 26-year-old man with an osteoid osteoma in the proximal phalanx of the right middle finger was treated with percutaneous radiofrequency ablation. Two years later he remains free of pain and finger function is normal.     

手部复合组织缺损的显微外科修复

目的 介绍吻合血管的复合组织移植或组合组织移植修复手部复合组织缺损的疗效。方法 1983年12月-2001年6月，对35例五类手部复合组织缺损进行手术治疗。采用带趾长伸肌腱的足背复合组织瓣移植修复手背皮肤缺损合并指伸肌腱缺损4例；Mu趾腓侧半复合组织瓣或第二足趾胫侧半复合组织瓣移植修复拇、手指末节半侧缺损4例；带近侧趾间关节的节段性第二趾复合组织瓣移植修复拇、手指中段部分或完全缺损8例；第二足趾与游离皮瓣组合移植为拇指缺损合并手部皮肤缺损者一期再造拇指并修复手部皮肤缺损17例；双侧第二足趾桥接组合移植再造与修复近节指骨基底水平的长手指缺损2例。结果 临床上修复组织缺损35例，成功33例。术后经半年至5年的随访，按中华医学会手外科学会上肢部分功能评定试用标准，优良率为82.9％。结论 吻合血管的复合组织移植或组合组织移植是修复手部复合组织缺损的比较理想方法。     

Digital tuberculous revealed by trauma

Tuberculous dactylitis is an uncommon condition which is particularly difficult to differentiate from other lesions, particularly tumors. Diagnosis must be confirmed by histology and/or bacteriology studies. We report the case of a 64-year-old diabetic woman who consulted for a painful tumefaction on her fourth finger of the left hand which had developed after minimal trauma. The x-ray of the hand visualized multiple bony defects involving the second phalanx of the fourth finger and a fracture. Pathology examination of a biopsy specimen revealed granulomatous osteitis with typical caseous necrosis. The clinical signs and radiographic images resolved after anti-tuberculosis treatment.     

Total replacement of a middle phalanx by free non-vascularized chondral graft, after failure of sclerotherapy for treatment of an aneurysmal bone cyst

We treated an eleven year-old boy for an aneurysmal bone cyst of the middle phalanx of the long finger. Diagnosis was established after total curettage. The tumor involved the whole phalanx and grew steadily after two attempts at sclerotherapy (with absolute alcohol and Ethibloc). After two years, en-bloc resection had to be performed, and raised the problem of reconstructing a complete finger phalanx with its proximal and distal epiphyses. A free cartilaginous graft from the non-ossified iliac crest was shaped to the exact dimensions of the phalanx and set in its place, with minimal damage to the surrounding tissues during dissection and fixation. By six months an almost normal range of motion was achieved in the PIP (10 to 90 degrees ) and DIP (5 to 30 degrees) joints and radiographs showed complete metaplasia of the chondral graft into an ossified phalanx at 20 months follow-up. The joint spaces also remodelled, and this was confirmed with MRI scanning. Reports on partial replacement of diaphysis or epiphyses in the digits are discussed, but the only valid comparison of total phalanx replacement is free toe phalanx grafting. We did not choose this solution in a normal hand because of the length discrepancy between finger and toe phalanges. This case shows that, in this particular paediatric situation, the free non-vascularised transfer of a chondral graft restored excellent function, with remodelling of the phalanx and joint spaces of the finger.     

不同构制的足趾移植重建双拇指缺损

目的探讨不同构制的足趾移植重建双拇缺损的要点。方法１９８６年始，根据１１例双拇指缺损类型采用４种术式：（１）双足第二趾再造６例；（２）右足第二趾再造左拇，右示指近节背侧岛状皮瓣覆盖右拇创面１例；（３）双足甲瓣再造术２例；（４）左甲瓣＋右带末节趾骨甲瓣再造２例。１１例术后均经系统的康复治疗。结果９例全部成活，２例２个再造拇指发生血管危象，经手术探查和对症治疗后成活。术后１年随访，再造拇指感觉和运动功能恢复优良率达到９２％。结论不同构制的足趾组织移植是再造双拇缺损的首选方法。双套供血回流系统的建立是手术成功的关键。     

Ewing sarcoma of the proximal phalanx: case report

Abstract

We report a case of primary Ewing sarcoma of the proximal phalanx of the right middle finger in an 18-year-old boy. He was treated with neoadjuvant chemotherapy, followed by ray amputation. To restore maximum function, the index ray was transferred to the base of the third metacarpal bone and fixed with a plate. The function of his right hand after the operation was excellent and the cosmetic appearance acceptable. There was no evidence of local recurrence or metastasis after 20 months follow up.     

Injuries to children's hands caused by the engine belts of agricultural machines: classification and treatment

Injuries to children's hands with farm machinery, particularly tractors, are common in rural areas. We present 58 cases of hand injuries in children aged from 3 to 7 (mean 4.5), caused by the engine belts of agricultural vehicles, who were referred from the cities in Central Anatolia. The injury patterns among patients were similar. The injury generally starts from the middle phalanx of the third finger, crosses the proximal phalanx of the fourth finger and ends in the hypothenar region. The patients were categorised into five groups and treatment planned accordingly. The most commonly involved digit was the third finger and the thumb the least. Surgical treatment depended on the severity of the injury and included primary closure of the lacerations, tendon repair, fixation of fractures, grafting, and local flaps. Results of these injuries are generally poor, so prevention is more important.     

Digital artery occlusion secondary to plastic shopping bag trauma

Upper limb digital arterial occlusion is uncommon. We present the case of a 47-year-old man with an ischaemic right middle finger (dominant hand) due to trauma from carrying a heavy plastic shopping bag. Duplex scanning revealed no proximal source of emboli. An angiogram demonstrated occlusions in the medial and lateral digital arteries of the middle digit at the level of the proximal phalanx. Treatment with heparin and warfarin resulted in complete resolution of symptoms.     

Reconstruction of radial half hand by using combined transplantation of pedicled phalanx,free toe,and island flap

Combined transplantation of (1) a residual proximal phalanx flap of the thumb with a fascial pedicle, (2) a reversed island flap based on the posterior interosseous artery, and (3) a free second toe was successfully used to reconstruct the radial half of the hand in a patient who had experienced loss of the second metacarpal bone and index finger, a defect to the shaft of the third metacarpal bone, and dry gangrene of the thumb, two-thirds of the radial dorsal skin and the first web space of the left hand. The reconstructive result was satisfactory and took advantage of each tissue flap. The operation was relatively simple and was completed in one stage. We believe the procedure provided good recovery of function and appearance at an appropriate cost. © 1994 Wiley-Liss, Inc.     

Tuberculous dactylitis pseudotumor of an adult thumb: a case report

Tuberculous dactylitis is an uncommon condition which is particularly difficult to differentiate from other lesions, particularly tumors. We report the case of a 56-year-old, healthy, left-handed person who consulted for progressive painful swelling of 8-month duration in the right thumb, which had developed after direct trauma. The plain radiograph of the thumb revealed extensive destruction of the proximal phalanx associated with pathological fracture. Magnetic resonance imaging (MRI) showed replacement of the affected phalanx with prominent soft tissue mass with extension outside the bone margins. The diagnosis of tuberculous dactylitis was based on histological characteristics and positive acid fast bacilli using Ziehl-Neelsen stain. Surgical debridement and anti-tuberculous chemotherapy eradicated the infection. Seven years post treatment, the patient had good function of the thumb with no significant disability interfering with his daily activity.     

全长手指再造10例报告

目的 介绍全长手指再造的概念和3种再造的方法.方法 采用3种方法:①急诊取一侧足第二足做桥接远端部分完整的手指再造手指;②用双侧第二足趾移植再造手指;③取携带同足跖、背侧皮瓣和第一、三趾侧方皮瓣并将移植的第二跖趾关节旋转90°再造手指. 结果 临床应用10例.再造手指均一期成活,术后按中华医学会手外科学会拇、手指再造功能评定试用标准法评定,优1例.良5例,可4例. 结论 3种方法进行全长手指再造,方法可行,在一定程度上解决了手外科中长指再造的难题.     

一期再造全长指的实验研究

目的 通过实验探索一期再造全长指的手术设计和方法。方法 在6只食蟹猴上，在掌指关节处切除示指，应用带足背皮瓣和跖骨的第2足趾复合移植一期再造全长示指。结果 再造12个全长指术后全部成活，后因感染仅4个再造指存活，随访12个月，存活再造指恢复大部分功能及较好的外观。结论 利用带足背皮瓣和跖骨的第2足趾复合移植再造全长示指的方法可行，但需设法提高存活率。     

Tenosynovial haemangioma of the finger

Haemangiomas developing in the hand in relation to tendon and the tenosynovium (tendon sheath) are very rare. To our knowledge only three cases have been described arising in relation to the tenosynovium of the tendons of the hand, only one of which showed infiltration of the underlying tendon. We report the case of a 16-year-old right hand dominant student who presented to her family doctor with a swelling on her left little finger. An MRI scan was arranged which confirmed a soft tissue lesion between the flexor tendons and the proximal phalanx of the left little finger, with appearance similar to giant cell tumour of the tendon sheath. Surgical exploration demonstrated a dark red fleshy tumour that appeared to infiltrate the flexor digitorum sub-limis tendon, and extend around either side of the proximal phalanx. For complete excision of the lesion the infiltrated sublimis tendon and a part of the A2 pulley were sacrificed. There was no resultant bow-stringing of the profundus tendon. Histologically the tenosynovium was expanded by a vascular lesion consisting of dilated, thin-walled vascular channels within fibrous tissue; the appearances were consistent with those of a synovial haemangioma of the flexor tendons. Our case illustrates the pitfalls in diagnosis and the invasive potential of a synovial haemangioma. A complete surgical excision is critical to prevent recurrence.     

足趾移植再造拇,手指400例报告

总结１９６６年２月至１９９４年２月的足趾移植术４００例，以正确评估足趾移植在拇、手指再造中的作用。     

Small cell osteosarcoma of a toe phalanx: a case report and review of literature

This report describes the radiological and histological findings of a small cell osteosarcoma of a toe phalanx in a 38 year old man. This man presented with pain, swelling and redness of the left third toe. Medical history revealed an osteomyelitis of this toe eight years prior. Based on clinical findings and medical history the lesion was diagnosed as an osteomyelitis. However, peroperatively the lesion had a malignant aspect. Histological examination revealed a small cell osteosarcoma of the proximal phalanx.     

Long term follow-up of composite non-vascularized toe phalanx transfers for aphalangia

The results of 21 non-vascularized toe phalanx transfers in 13 patients were reviewed radiologically with respect to function, physeal patency, growth and donor site morbidity at a mean follow-up of 7.4 (range 2.9-13.6) years. Physeal patency was maintained in 4 of 18 surviving transfers. The length of the transferred phalanx averaged 75% of the contralateral comparable toe phalanx and 44% of the contralateral digit proximal phalanx. Most patients had good or simple use of the hand with active joint motion. There was universal shortening of the donor toe with hypoplasia of the middle and distal phalanges. This review suggests that transfer of a non-vascularized toe phalanx provides a reliable but limited means for increasing length of a digit, stabilizing soft tissue "nubbins" and improving function. Longer follow-up has shown more modest gains in growth than in some previous reports.     

一期再造正常长度手指的实验与临床应用

目的 探索一期再造全长手指的手术设计和技术。方法 手指中远节选用足趾或Mu甲再造,近节尝试不同形式再造,以复合或联合移植方式一期合成全长指,设计修复全长手指脱套伤和再造缺失全长指的术式各两种,在猴模型进行实验,每种术式实施6例次,临床应用带跖骨和足背皮瓣的Mu甲瓣修复示指全长脱套伤1例;带跖趾背皮瓣和跖骨的第二趾移植再造缺失的全长中指1例;第二趾和坟外侧皮瓣联合移植再造全长示指1例。结果 猴全长指再造近期存活率平均91.7％,无期存活率平均37.5%,猴自残和制动不当是影响存活率的最主要因素。临床再千3 全长指均完全存活,恢复良好外观和部分实用功能。结论 再造全长指方法的可行,有一定的临床应用价值,但需设法提成功率,再造指的外观仍需进一步改善。     

Adenoid cystic carcinoma of submaxillary gland metastatic to great toe.

A case of adenoid cystic carcinoma of the submaxillary gland metastatic to the left great toe in a 52-year-old man is reported. The patient survived 10 months after diagnosis of the metastasis to the hallux. The well-documented cases of four other patients, two each with pulmonary and renal-cell carcinoma metastatic to the toe, are reviewed. Metastatic carcinoma to the toe as well as the finger typically mimics an inflammatory process. An osteolytic lesion of the phalanx of a toe or finger resembling an inflammatory process without a history of injury or infection should suggest the possibility of malignancy.