Melorheostosis of upper limb: A report of four rare cases

Melorheostosis is a rare chronic bone disease, etiology of which remains unclear. It mostly affects lower limbs and clinical features vary in each case. Radiographs show characteristic "candle wax pattern" of hyperostosis. Herein we report four cases of upper limb affection with their symptoms, radiographic findings and treatment. First case presented with gradually progressive swelling in forearm which was initially misdiagnosed as filariasis. Plain radiograph eventually demonstrated melorheostosis of ulna. Second patient had deformity of index finger and pain in hand which was diagnosed on radiograph of hand. Third case presented with progressive flexion deformity of ring and little finger. Fourth patient had ulnar involvement which was an incidental diagnosis. First three patients were managed with bisphosphonates following which there was significant improvement in pain and fourth case was kept on follow-up as he was asymptomatic.     

Positioning,Splinting and Pressure Management of the Burned Hand: A Method

A splinting procedure to avoid hand and finger deformities in deep dermal and subdermal burns of the hand is presented. The same splint may be used in the healing phase as well as in the rehabilitation period. The method is characterized by a combination of simple materials, active exercises and a teamwork involving the patient and the staff.     

Focal hand dystonia in a patient with ulnar nerve neuropathy at the elbow

We describe a patient who presented with dystonia of her small finger secondary to entrapment neuropathy of the ulnar nerve at the elbow. Pre operative electrophysiological studies suggested that the locus of entrapment was located proximal to the medial epicondyle. This was confirmed intraoperatively by the presence of a thickened and prominent arcade of Struthers. Surgical decompression resulted in a rapid and dramatic improvement of the dystonic pattern as well as an improvement in nerve conduction. A review of literature has not revealed any other reports of such a clear cut association between ulnar nerve entrapment and non task-specific focal hand dystonia.     

Using two flaps to achieve aesthetic autologous breast mound reconstruction

The authors describe a patient in whom a large arterialized venous flap was harvested from a nonreplantable part after partial hand amputation. A 9 x 6-cm segment of dorsal hand skin was transplanted acutely in an artery-vein-vein fashion to cover exposed bone, joints, and reconstructed tendons. The flap provided durable coverage, and at 1 year the patient regained 94% total active motion at the index finger and 99% total active motion at the long finger. Salvage of component parts such as a venous flap and extensor tendons avoided additional procedures for coverage and staged tendon reconstructions.     

Heterotopic replantation in mutilating hand injury

To achieve optimal hand function in the reconstruction of a mutilated hand is quite a challenge, and every salvage procedure should be tried, especially for amputated parts that cannot be replanted to their original anatomic sites. Five patients who sustained work-related mutilating hand injuries and who underwent digital heterotopic replantation are reported. Two patients had irreparably crushed, amputated thumbs. One patient (patient 1) received heterotopic replantation of the ring finger to the thumb's position; the other patient (patient 2) received heterotopic replantation of the middle finger to the thumb. Three additional patients received digital heterotopic replantation to enhance hand function. Patient 3 underwent heterotopic replantation of the middle finger to the index finger's position. Patient 4 underwent transplantation of the middle finger to the index finger's position, the ring finger to the middle finger's position, and the little finger to the ring finger's position. In patient 5, the ring finger was transplanted to the index finger's position. In all patients, satisfactory results were achieved in hand function and wound healing. In these patients, the restoration of a functional thumb was the first priority, followed by establishing at least two opposable fingers at the sites where metacarpophalangeal joints were functional.     

Immediate pollicization of an amputated index finger

A case of immediate pollicization of an amputated index finger is reported. The patient sustained accidental amputation of the entire thumb and index finger and subtotal amputation of the middle finger of her left hand. Two years following replantation of the index finger to the thumb position, the finger has limited motion but the patient has a functional replanted digit.     

Creation of an opposable small finger by muscle transfer

We present a case of a child born with metacarpal synostosis of the index, long, and ring fingers associated with a simple syndactyly of the small finger and an absent thumb. At age 7 months, a syndactyly release with skin grafting to the small finger was accomplished so that it became the new thumb. At age 4 years, one of the muscles on the radical border of the hand was transferred to the small finger to act as an opposition transfer. At follow-up, the transfer contracted well and the functional capability of the hand was improved. This operation will not often be used but should be considered for the occasional patient with congenital anomalies.     

Simultaneous double interphalangeal dislocation on a single finger

The authors report a rare case of the simultaneous double interphalangeal dislocation in the little finger of the left hand. A 35-year-old man, playing football as a goalkeeper, was injured when another player trod on his little finger. The dislocation was reduced by traction without anesthesia and the finger was immobilized on a splint. Although the patient removed the splint only a week later and failed to come for a check-up, at 1 year, his little finger showed no deformity and regained a full range of painless, active motion.     

Bilateral flaps based on the dorsal branches of the proper digital artery: A reliable reconstruction in one-stage for the multiple defects in one finger

PurposeTo repair multiple skin soft tissue defects of one finger is a challenge to hand surgeons. We introduce a method which can be used to repair multiple skin soft tissue defects of one finger with bilateral flaps in parallel pattern flap based on the dorsal branches of the proper digital artery.MethodA patient suffered electric injury in her left index finger with two soft tissue defects, and the areas were 1.6 cm × 1.0 cm and 2.2 cm × 1.2 cm, respectively. And who underwent a homodigital parallel flaps based on the dorsal branches of the proper digital artery to repair in January 2018. The donor sites were covered by full-thickness skin grafting.ResultsThe flaps and the skin grafting survived uneventfully. All incisions achieved primary healing. The follow-up was 19 months, and the shape of the flaps was satisfactory with soft texture and suitable appearance. TAM of the injured finger was 210°, the level was excellent. The score of VAS was 9.ConclusionThe homodigital bilateral flaps in parallel pattern based on the dorsal branches of the proper digital artery are a potential treatment in one-stage for multiple skin soft tissue defects of one finger with reliable blood supply, satisfactory results and simple surgical procedure.     

Microvascular free on-top plasty in a mutilated hand

Amputation of the index, middle, and ring fingers leaves a poor, unstable pinch and grasp between the thumb and little finger. In this type of mutilated hand, it is necessary to reconstruct one or two fingers for firm chuck pinch and good grasp. Functionally and cosmetically, toe transfer is superior to other methods of finger reconstruction because of its mobility, sensibility, pulp size, and nail availability. However, a transfer from the foot may not always be available. In such a case, any finger stump may be considered as a possible donor finger. The authors performed a microvascular free transfer of the remaining portion of the ring finger including the metacarpophalangeal joint to the top of the remaining portion of the index finger in a mutilated hand with intact thumb and little finger because the patient declined toe transfer. Postoperatively, more effective strength and stability, provided by three converging digits, was achieved in the hand. Accordingly, it was easier for the patient to grip small and large objects. The authors describe this procedure as a microvascular free on-top plasty.     

Timing of muscle activation in a hand movement sequence

Recent studies have described muscle synergies as overlapping, multimuscle groups defined by synchronous covariation in activation intensity. A different approach regards a synergy as a fixed temporal sequence of bursts of activity across groups of motoneurons. To pursue this latter definition, the present study used a principal component (PC) analysis tailored to reveal the across-muscle temporal synergies of human hand movement. Electromyographic (EMG) activity was recorded as subjects used a manual alphabet to spell a list of words. The analysis was applied to the EMG waveforms from 27 letter-to-letter transitions of equal duration. The first PC (of 27) represented the main temporal synergy; after practice, it began to account for more of the EMG variance (up to 40%). This main synergy began with a burst in the 4-finger extensor and a silent period in the flexors. There were then progressively later and shorter bursts in the thumb abductor, thumb flexor, little finger abductor, and finally the finger flexors. The results suggest that hand movements may be generated by activity waves unfolding in time. Because finger muscles are under relatively direct cortical control, this suggests a specific form of cortical pattern generation.     

Seal finger: A case report and review of the literature

A recent case of seal finger which was misdiagnosed and hence mistreated at the patient’s first presentation is described. The patient was eventually referred to a hand specialist and after the correct treatment with tetracycline, responded well without any long-term sequelae. Seal finger is an occupational injury that occurs to those who work directly or indirectly with seals. The disease entity has been described in both Scandinavian and Canadian literature. The causative microorganism was unknown until 1991, when Mycoplasma phocacerebrale was isolated from both the finger of a patient with seal finger and from the mouth of a seal that bit the patient. Although rare, the disease is not uncommon in marine workers, biologists and veterinarians. Prompt identification based on patient history and treatment with oral tetracycline is pendant to a favourable patient outcome.     

Fingers,hands or patients? The concept of independent observations

In hand surgery trials, it is often possible to take several measurements from the same patient, because many disorders here affect bilateral or multiple structures, such as the hand itself, the finger joints or the tendons. Most conventional statistical analyses that take place on the level of hands, digit rays or joints rather than patients violate the assumption that observations should be independent. Furthermore, ignoring the multiplicity of data inflates sample size and thus may lead to spurious significance. This article describes three options to deal with such problems. First, the analysis can simply be restricted to only one measurement per patient. Second, a self-controlled design may be advantageous for conditions that usually have a bilateral pattern. Third, complex statistical modelling (involving generalized estimating equations) can be used to analyse all available measurements with adjustment for data dependency.     

Finger and hand replantation. Surgical technique.

An approach to the technique of either finger, thumb, or hand replantation is presented in this article. Acceptable alternative approaches exist, but I have found those techniques described as practical and useful. Variations of these techniques will be necessary depending on any number of circumstances, but these considerations should be individualized to the specific patient and injury pattern.     

Glomus tumor associated with pacinian hyperplasia--case report

Features of the glomus tumor and the relatively recently described pacinian hyperplasia are described including signs and symptoms, differential diagnosis and treatment. The role of trauma as an etiology is proposed. A case is reported and discussed in which the patient had a glomus tumor and pacinian hyperplasia in an index finger, and a glomus tumor in the small finger of one hand. Treatment of both entities was surgical excision.     

Die florentinischen Wachsplastiken zum Urogenitaltrakt

Florentine wax sculptures of human anatomy in general and of the urogenital tract in particular constitute an iconographic speciality of the eighteenth century. In the Age of Enlightenment research and representation of the human organism also met with broad interest. To counteract the lack of preservation possibilities and the resulting time restrictions, wax was used to fabricate lifelike human models. Here, the cooperation between anatomist and wax sculptor was of essential importance. The art of anatomical wax sculpturing was cultivated especially in Bologna and Florence at the end of the seventeenth as well as in the eighteenth century. In Florence the Imperial and Royal Museum of Physics and Natural History (“La Specola”) that still exists today including a ceroplastic workshop was founded in 1775. Its macroscopically exact models of the urogenital tract – real art treasures and definitely still usable as teaching material – make an enormously authentic impression on the viewer and captivate physicians and historians alike.     

足趾移植拇指与手指再造的临床研究

目的探讨足趾移植拇指与手指再造的方法和疗效。方法采用部分坶趾移植拇指部分再造22例,躅甲瓣或带足背皮瓣船甲瓣移植拇指再造13例,第2足趾移植再造拇指4例,再造手指3例,及带足背皮瓣的第2足趾移植再造拇指7例,带足背皮瓣的第2,3足趾移植再造手指7例,带足背皮瓣的躅甲瓣或第2趾和第2,3趾组合移植再造拇手指10例,双足第2足趾移植全手缺失二指再造2例,共68例97指。结果再造拇手指和皮瓣全部成活,成活率为100％,术后经3月～10年的随访和信访,按中华医学会手外科学会拇、手指再造功能评定试用标准评定：优62指,良24指,可9指,差2指,优良率达88．66％。结论采用部棚趾、第2足趾棚甲瓣移植再造拇手指,带足背皮瓣的躅甲瓣、第2趾或第2,3趾组合移植行合并手部皮肤缺损的拇手指再造,效果满意。     

Median nerve compression, with tendon ruptures, after Colles' fracture

A rare case of rupture of the flexor pollicis longus tendon following a Colles' fracture is described. The patient also had a ruptured flexor digitorum profundus to the index finger and compression of the median nerve of the same hand. The ruptures were noted after four weeks of plaster immobilisation. Decompression of the median nerve and corrective osteotomy was performed but no tendon repair was attempted. The patient regained good function of the hand.     

Types of vascular reconstructions in replantations of distal parts of the fingers

The authors present the case of a 17-year-old patient with amputation of the distal portions of three-phalangeal fingers. During replantation of each finger a different method of revascularization of the amputate was used. In one finger the classical replantation pattern was used: anastomosis of the digital artery and dorsal vein. Inthe second finger anastomosis of the digital artery and volar vein was made, while in the third finger a method of nontraditional revascularization was used, i.e. by using an arteriovenous shunt: transposition of the second digital artery with adequate back-flow to the dorsum and anastomosis with the dorsal vein.     

A case of isolated tuberculous tenosynovitis of the flexor tendon of the third finger of the hand

A 55-year-old female patient presented with a painless swelling in the palm of the right hand, causing restriction of the third finger. Magnetic resonance imaging revealed a synovial lesion in the flexor tendon sheath of the third finger, showing heterogenous contrast. Open biopsy and histopathological studies showed a granulomatous infectious reaction of the synovial tissue. A diagnosis of tuberculosis was made, after which antituberculosis treatment was instituted. Total regression was achieved after nine months of medical treatment without further extensive surgical measures. At the end of nine months, the movements of the finger were found to be normal and painless.