Aneurysmatic bone cyst of the second metacarpal: en-block resection and bicortical iliac crest graft replacement

Hand is an unusual location for aneurysmal bone cysts. A case in whom the second metacarpal of the left hand was presented. Because of its rapidly growing nature, a radical excision was performed. The resected segment was replaced by a bicortical iliac crest graft. The graft healed without complications, and result was functional. On the follow-up at the 36th month no sign of relapse was found.     

Island bone graft from the second metacarpal to the first metacarpal

We report a case of reconstruction of the first metacarpal by using an extended vascularized bone graft taken from the distal part of the second metacarpal. Following a gunshot injury, a 57 year-old man presented with a thumb amputated at the interphalangeal joint level and an index finger amputated at the metacarpophalangeal joint level. After lengthening of the first metacarpal over a six weeks period, the bone gap was filled using a vascularized 2.4 cm-length piece of the second metacarpal. This graft was vascularized by the dorsal vascular network of the first web space. At two months, the bone fixation was removed. At five months, the bony integration was complete.     

Geometric properties of the second metacarpal

The lengths, external volumes and weights of 45 clean, dry, second metacarpals were determined. The midshaft total and medullary widths were measured on postero-anterior radiographs. The cortical volume, external volume and ash weight of a 1 cm length of the shaft of each bone were also measured. From the morphometric measurements estimators of the geometric and densitometric properties of the midshaft section and of the whole bone were computed. Some estimators of the geometric properties were derived on the assumption that the metacarpal shaft is a cylinder. The relationships between the estimators and the geometric and densitometric properties themselves were examined and the validity of the cylinder model was explored.

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Zusammenfassung Länge, äußerer Umfang und Gewicht von 45 sauberen, trockenen zweiten Metacarpalknochen wurden bestimmt. Die totale Breite und die Markhöhlenbreite des mittleren Schaftes wurden mit posterior-anterioren Röntgenaufnahmen gemessen. Corticaler und äußerer Umfang und Aschgewicht eines 1 cm langen Stückes vom Schaft jedes Knochens wurden ebenfalls gemessen. Mittels morphometrischer Messungen wurden Schätzungen der geometrischen und densitometrischen Eigenschaften der Mittelschaftregion und des ganzen Knochens berechnet. Einige Schätzungen der geometrischen Eigenschaften wurden abgeleitet unter der Annahme, daß der metacarpale Schaft ein Zylinder ist. Die Beziehungen zwischen den Schätzungen und den geometrischen und densitometrischen Eigenschaften selbst wurden untersucht, und die Gültigkeit des Zylindermodelles wurde geprüft.

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Résumé Les longueurs, les volumes extérieurs et les poids de 45 seconds métacarpes, déssèchés et nettoyés, sont déterminés. Les largeurs totales et médullaires de la diaphyse sont mesurées sur des radiographies antéro-postérieurs. le volume cortical, le volume externe et le poids de cendres de la diaphyse, d'une longueur de 1 cm, sont aussi déterminés. A partir des mesures morphométriques, les estimations des propriétés géométriques et densitométriques de la diaphyse et de l'os total sont analysées. Quelques estimations des propriétés géométriques ont pu être étudiées en estiamnt que la diaphyse du métacarpe est un cylindre. Les rapports entre les estimations et les propriétés géométriques et densitométriques sont envisagés et l'exactitude d'un modèle cylindrique est évaluée.

     

Bone volume and mineral density of iliac crest spongiosa in uremia.

Bone mass and bone mineral content were measured in non-dialyzed and dialyzed uremic patients. Bone mass, measured by micromorphometry and a gas displacement method, was higher in uremic than in age and sex matched control subjects (micromorphometry-U:25.8 +/- 8.24%; Co:15.6 +/- 4.38; gas displacement-U:211 +/- 66 mm3/cm3; Co:191 +/- 45). In hemodialyzed patients, bone mass was lower the longer the patients had been on dialysis (r = 0.38; P 0.05). Bone mineral content (specific weight) was diminished in uremia (1.82 +/- 0.095 g/ml; controls 1.854 +/- 0.0173). In hemodialyzed patients, specific weight was higher, as was Ca content of bone assessed by neutron activation analysis. It is concluded, that negative Ca balance was the major cause of bone loss and that bone loss is thus preventable.     

Malignant fibrous histiocytoma of the second metacarpal

A case of low grade malignant fibrous histiocytoma (MFH) arising from a metacarpal bone in a 21 year old African female is presented. The rarity of this disorder is emphasized with review of the relevant literature.     

A histomorphometric study of normal iliac trabecular bones. Part II: Age changes and the values of MWT and related parameters

The Mean Wall Thickness (MWT) of the trabecular packet and other related indices: number of osteocytic lacunae (N-0) and maximum number of birefringent lamellae (N-1) in the packet were measured in 142 normal Japanese subjects (male 55, female 87, mean age 44.8 yrs). MWT was obtained by the equation MWT = 2S/L, where S and L designate area and perimeter, respectively. The MWT, S, and L of the packets all decreased significantly after young adulthood. N-0 and N-1 also decreased significantly with age. In contrast, S/(N-0), which is the measure of the volume of the matrix being formed by a single osteoblast, did not change with age. Therefore, it may be concluded that BMU-leveled bone formation decreases with age probably due to the decreased number of osteoblasts which participate in forming a trabecular packet.     

A histomorphometric study of normal iliac trabecular bones. Part I: Age related changes and the values of tissue-leveled static parameters

Trans-iliac bone biopsies were performed on 142 normal Japanese subjects (55 males, 87 females, mean age: 44.8 years) and were evaluated particularly for the indices of tissue-leveled static parameters: volume and thickness of bone/osteoid, and surface measurement of formation, resorption and inert surface. The results were in general agreement with previous studies, but some discrepancies were found regarding osteoid indices: 1) The osteoid (formation) surface, especially osteoblastic osteoid surfaces, increased significantly at the ages from 50 to 60 years in females, 2) osteoid volume and relative osteoid volume were also found to have increased at this age range in females, 3) osteoid thickness decreased or had a rather constant value in females, and 4) the values of these 3 parameters decreased in males with the advance of age after young adulthood. From these results, at least at tissue level, the bone formation rate seemed to increase from the 6th to the 7th decade of life in women making a clear contrast to men in whom the formation rate appeared to decrease within the same age range.     

自体髂骨嵴移位重建掌骨头的解剖学研究

目的 :探讨髂骨嵴与掌骨头相似性,为髂骨嵴移位重建手部掌骨头提供解剖学基础。方法 :16侧上肢标本,10例骨盆标本,解剖观察第2、3、4、5掌骨头及髂骨嵴形态结构特点,测量掌骨头弧高、关节面弧长、掌背径、尺桡径和髂骨嵴弧高、弧长、内外径。将所得到的数据进行统计分析,比较各掌骨头与髂骨嵴在形态、结构特点、弧长及各径线长度相似度。结果:第2掌骨头弧长22.040(21.425,23.085)mm,掌背径(14.034±0.465)mm,弧高4.185(4.113,4.598)mm,尺桡径(12.227±0.414)mm。第3掌骨头弧长23.430(22.743,24.153)mm,掌背径(14.316±0.430)mm,弧高4.235(4.170,4.670)mm,尺桡径(12.382±0.425)mm。第4掌骨头弧长21.960(21.245,22.285)mm,掌背径(12.382±0.288)mm,弧高4.125(4.030,4.305)mm,尺桡径(11.991±0.362)mm。第5掌骨头弧长20.030(19.668,20.148)mm,掌背径(11.807±0.358)mm,弧高4.015(3.880,4.205)mm,尺桡径(11.659±0.399)mm。髂骨嵴弧长(22.930±0.701)mm,内外径14.350(13.660,14.739)mm,弧高(4.520±0.184)mm。髂骨嵴内外径与第2掌骨头掌背径差异无统计学意义(Z=-1.242,P0.05),髂骨嵴内外径与第3掌骨头掌背径差异有统计学意义(Z=-2.835,P0.05),髂骨嵴内外径与第4、5掌骨头掌背径差异有统计学意义(Z值分别为-5.094、-5.095,P0.05);髂骨嵴弧长与第2、4、5掌骨头弧长差异均有统计学意义(t值分别为1.190、-4.909、-13.791,P0.05),髂骨嵴弧长与第3掌骨头弧长差异无统计学意义(Z=-1.704,P0.05);髂骨嵴弧高与第2、3掌骨头弧高差异无统计学意义(Z值分别为-1.815、-1.386,P0.05),髂骨嵴弧高与第4、5掌骨头弧高差异有统计学意义(分别对应Z=-3.152,t=-5.639,P0.05)。结论:自体髂骨嵴与掌骨头在解剖学上有一定相似性,能够成为掌骨头移植的合适供体。     

Longitudinal study of bone loss in the second metacarpal

Summary This longitudinal study was undertaken to ascertain the rate of bone loss and to identify aging, cohort and/or time effects on bone loss in male participants of the Baltimore Longitudinal Study of Aging. Hand-wrist radiographs were obtained from 1958–1981 and were evaluated for total width, medullary width, and length of the second metacarpal. Data were analyzed using an age-time matrix with 8-year intervals for three epochs and nine age groups. The bone measurements were analyzed in three perspectives (cross-sectional, longitudinal and time-series). The results demonstrate that there is both a cross-sectional and longitudinal loss of cortical bone with age in the second metacarpal. Furthermore, the results show that males lose approximately 14% of their cortical bone, at a rate of about 2% per decade, over the adult lifespan. The majority of this loss occurs between the ages of 45 and 69 and is due primarily to aging and is not an artifact of cohort differences or secular change.     

A histomorphometric determination of iliac bone structure and remodeling in obese subjects

Quantitative histomorphometric analyses of iliac crest biopsies were performed after tetracycline double labeling in 24 patients with morbid obesity and in 30 age- and sex-matched controls. The amount and structure of bone were determined from measurements of total biopsy length, fractional length of medullary space, fractional trabecular bone volume, trabecular thickness, and the intertrabecular distance. Static and dynamic variables of bone resorption and formation were determined, and the balance of the BMU level was estimated from final resorption depth and mean wall thickness of trabecular structural units. In the obese patients the total biopsy length was increased, with a normal proportion of medullary space to total biopsy length. The mean fractional trabecular bone volume was reduced due to an increased distance between trabeculae of normal mean thickness. The total biopsy length in the obese patients was found to be positively related to the intertrabecular distance and inversely related to the fractional trabecular bone volume. The remaining histomorphometric variables describing bone formation rate at tissue, BMU, and cellular levels, the amount of bone formed, the mineralization process, mineralization lag time, bone resorption, and the balance between resorption and formation were all normal in the obese group.     

Isolated dislocation of the second metacarpal at both ends

A dislocation of the second metacarpal at both ends is reported herein for the first time. Six weeks after injuring her right hand in a fall while climbing stairs, a 34-year-old woman visited our clinic with pain, swelling, and deformity of her hand. The radiographs showed a volar dislocation of the head and a dorsal dislocation of the base of the second metacarpal. The probable mechanism of injury was the hyperextension at the metacarpophalangeal joint; this force dislocated the metacarpal head toward the volar plate. Force then further continued along the second metacarpal shaft in the hyperflexed wrist, thus dislocating the base dorsally. We performed an open reduction and K-wire fixation of the second metacarpophalangeal joint and an arthrodesis of the second carpometacarpal joint. At the six-month follow-up, the patient had restricted flexion (0 to 50 degrees) at the second metacarpophalangeal joint, but full range of motion at the interphalangeal joints. The grip strength on the right side was 70% of that measured in the uninvolved hand. Key Words: Dislocation, Second metacarpal.     

Correlation between MRI and biopsies under second look ultrasound

The term “second look” lesions in MRI refers to lesions detected by MRI that were not initially seen on mammography or ultrasound. The objectives of our study were to analyse the displacement of targets between MRI and ultrasound; to define discriminating BIRADS morphological criteria to predict benign or malignant character and better establish the indications of second look ultrasound and biopsy; and to analyse the agreement between ultrasound and MRI in terms of morphological criteria. A retrospective and monocentric review was performed of the records of consecutive patients with breast abnormalities (mass or non-mass) initially detected by MRI that were not initially seen on mammography or ultrasound. All patients with abnormalities found during the performance of second look ultrasound and biopsied were included in the study. All lesions were documented using the BIRADS lexicon for MRI and ultrasound. Of 100 included patients, 108 lesions were detected by MRI, found via second look ultrasound and biopsied between January 2008 and 2010. All of the included patients were followed-up for a variable period, from 2 to 5 years. Eighty-two upon 108 biopsied lesions (76%) were benign and 26/108 lesions (24%) were malignant. This study confirmed the switch from procubitus to decubitus essentially displaces the tumour in the antero-posterior direction. It showed that the risk factors were not reliable criteria for establishing an indication for second look ultrasound. This study also showed that circumscribed contours and a progressive enhancement curve (type I) for masses on MRI had the strongest negative predictive value of greater than 0.85. In ultrasound, the round or oval shape, circumscribed contours and the parallel orientation to the skin favoured benignity with a NPV of greater than 0.85. For masses, the study showed that the agreement in interpretation of the benign versus suspicious morphological criteria between the MRI and the ultrasound was very weak for the shape (Kappa = 0.09) and weak for the contours (Kappa = 0.23). Finally, the MRI overestimated the size of the targets compared to ultrasound (Student t-test, p = 0.0001). The performance of second look ultrasound has to be performed after the detection of an abdnormality on MRI even for lesion classified BIRADS 3. The biopsy indications must be wide with insertion of a clip and a control MRI. Only this control allows to stop the investigation if the biopsied lesion is benign.     

第2、4掌背动脉皮瓣的临床应用

目的：报道第2、4掌背动脉皮瓣及肌腱皮瓣修复手指软组织缺损的临床疗效。方法：对1994年5月以来25例手指软组织缺损急诊行第2掌背动脉皮瓣或第4掌背动脉皮瓣修复，其中11例为掌背动脉肌腱皮瓣修复。结果：25例皮瓣均成活，外形满意。11例肌腱皮瓣术后随访5个月～6年，肌腱功能恢复按TAM评定法：优2指、良6指、中3指。结论：第2、4掌背动脉皮瓣及肌腱皮瓣修复手指软组织缺损操作简单易行、疗效满意。     

左髂静脉受压与左下肢深静脉血栓的相关性研究

目的 用计算机断层扫描(CT)评估下肢深静脉血栓形成(deep vein thrombosis,DVT)患者和正常人群的左髂静脉(LCIV)短径和狭窄率,并探讨其与左下肢DVT的相关性.方法 回顾性分析19例右下肢DVT、60例左下肢DVT病例和218例正常人的CT影像结果,测量和计算左髂静脉受压综合征(iliac vein compression syndrome,IVCS)短径和狭窄率.采用多因素回归分析LCIV短径和狭窄率与左下肢DVT发生的相关性.结果 对照组51.8％人群LCIV受压率＞50％,24.3％LCIV受压率＞70％;女性LCIV短径[(4.7±2.7)mm]明显小于男性[(6.6±3.3)mm,P＜0.01)].左下肢DVT组LCIV短径[(2.4±1.0)mm]明显小于对照组[(5.4±3.1) mm,P＜0.01)]和右下肢DVT组[(6.2±1.8)mm,P＜0.01],其LCIV狭窄率[(78±8)％]明显高于对照组[(49±25)％,P＜0.01)]和右下肢DVT组[(38±21)％,P＜0.01)].LCIV短径每减少1 mm,左下肢DVT发生的相对危险度OR值为2.69(P＜0.001,95％ CI为1.91 ～3.77);LCIV狭窄率每增加10％,左下肢DVT发生的OR值为2.78(P＜0.001,95％ CI为1.95～3.96).当LCIV狭窄率＞75％时,左下肢DVT发生风险增加10.12倍;当LCIV短径＜2.5 mm时,左下肢DVT发生风险增加13.57倍.结论 LCIV受压是左下肢DVT发生的独立危险因素;LCIV明显受压患者,是左下肢DVT高危人群.     

Correlation between the compressive strength of iliac and vertebral trabecular bone in normal individuals

Intrabone and interbone variations and age-related changes in vertical and horizontal trabecular bone compressive strength (CS) were evaluated for loadbearing (vertebral) and nonloadbearing (iliac crest) trabecular bone from 30 normal individuals, 17 females and 13 males, aged 15-87 years. All had died suddenly. The vertebral bodies of Th6, L1, and L3 and the right and left iliac crests were frozen at -20 degrees C immediately after removal. Cylindrical bone samples in the vertical and horizontal direction were taken from the frozen bone, and load-deformation curves were recorded by a materials testing machine. For all vertebral bodies, the vertical CS was much larger than the horizontal CS (P less than 0.01), whereas no significant difference was found for the iliac crests. The anisotropy expressed as an index of vertical to horizontal CS, therefore, was higher in the vertebrae than in the iliac crest. The anisotropy index (Al) increased with age in the vertebrae but not in the iliac crest (r = 0.56, P less than 0.01). Age related, almost identical decreases in CS were observed in the vertebrae (vertical direction) (r = 0.81, P less than 0.01) and in the iliac crest (horizontal direction) (r = -0.69, P less than 0.01). In spite of the pronounced differences in the architecture between the vertebral body and iliac trabecular bone, the vertical vertebral CS could be predicted from the horizontal iliac crest CS (r = 0.88, P less than 0.01, SEE = 0.9 MPa). The vertical iliac crest CS showed a less significant correlation to the average vertical vertebral CS (r = 0.53, P less than 0.05, SEE = 1.25 MPa).     

Osteochondritis of the second metacarpal head: a case report

Osteochondritis dissecans is rare in the metacarpal head. To our knowledge, only one previous case report has been published. The initial diagnosis was ulnar collateral instability. Intraoperatively, the osteochondritis lesion was noticed and the loose cartilage flap was removed. The patient was symptom free after surgery.