A 21-year-old woman presented with a left-hand deformity that had been present since birth.She had no clear family or genetic history.Physical examination revealed absence of the left metacarpal phalanges and four sof...A 21-year-old woman presented with a left-hand deformity that had been present since birth.She had no clear family or genetic history.Physical examination revealed absence of the left metacarpal phalanges and four soft tissue bulges at the distal end of the wrist(Figure 1a).Digital radiography showed fusion of the lunate and triangular bones of the left wrist,fusion of the scaphoid with the distal row of carpal bones,and an irregular bone with an uneven distal margin.展开更多
Myofibroblastic sarcoma(MS)is a rare malignant soft tissue tumor characterized by myofibroblasts.It most commonly arises in the head and neck region,especially the tongue,with rare occurrences in the limbs.MS exhibits...Myofibroblastic sarcoma(MS)is a rare malignant soft tissue tumor characterized by myofibroblasts.It most commonly arises in the head and neck region,especially the tongue,with rare occurrences in the limbs.MS exhibits varying histopathology,ranging from low-to high-grade,with diverse subtypes showing different clinical behaviors and prognoses.This article reports the first case of high-grade MS in the hand,adding to the limited documentation of this rare condition.Here,we present the case of a 30-year-old healthy female with a year-long history of progressive shortening,mobility loss,and weakness in the first finger of the left hand.Left-hand imaging revealed a lytic,cottony tumor involving the entire first metacarpal.Following surgical resection,which included metatarsal grafting and joint reconstruction,a diagnosis of high-grade MS was confirmed based on histological manifestations and immunohistochemical staining,which was further classified as grade 2 according to the French Federation of Cancer Centers Sarcoma Group system.Postoperative radiotherapy was administered and the patient experienced a successful recovery without graft osteonecrosis.The patient regained 90%mobility and strength,without shortening,after surgical resection and radiotherapy.Six months post-surgery,the patient reported full hand functionality.MS is a rare tumor that infrequently affects bones and is often misdiagnosed owing to its controversial characteristics.The initial treatment should focus on complete resection with negative margins,followed by reconstructive surgery to preserve function.Further case studies are needed to establish standardized surgical treatment protocols.展开更多
BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a go...BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.CASE SUMMARY A 45-year-old man with a right hand injury visited the hospital.A small bone fragment was identified using plain radiography.Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal(CMC)joint.Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged.We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation.We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals.The dorsal ligament of the third CMC joint was torn.We thought it had been dislocated to the volar side and spontaneously reduced to that position.There are only few reports of volar dislocation of CMC joint fractures,particularly of the second and third metacarpals;our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.CONCLUSION Although past reports have used a palmar approach,the dorsal approach is a good option for these cases.展开更多
Objective： To explore the rules of the second metacarpal bone lateral needling in clinical application and its characteristics so as to provide the guidance to clinical practice.Methods： Taking ＂the second metacarp...Objective： To explore the rules of the second metacarpal bone lateral needling in clinical application and its characteristics so as to provide the guidance to clinical practice.Methods： Taking ＂the second metacarpal holographic acupuncture therapy＂ ＂the second metacarpal bone lateral needling＂ and ＂the second metacarpal bone＂ as the search terms, the papers on the second metacarpal bone lateral needling were retrieved from China National Knowledge Infrastructure（CNKI）and Wanfang database from January 1, 1974 to December 31, 2016 and were screened. Using the Excel2003, the database of the diseases treated by the second metacarpal bone lateral needling was set up.The indications, the acupoints selection rules and needling manipulation of this therapy were analyzed.Results： A total of 1103 papers were retrieved, of which, 446 papers were from CNKI and 657 from Wanfang database. According to the inclusion and exclusion criteria, 54 papers were included for analysis finally. It was found that the indications of the second metacarpal bone lateral needling were predominated by the soft tissue injuries, especially acute lumbar sprain, ankle sprain and knee joint injury. Regarding the acupoints selection rules of the second metacarpal bone lateral needling, the corresponding points and tender points were commonly selected. Regarding the needling manipulation, the strong stimulation was required after needle insertion and the patient was required to move the affected areas while keeping the strong needling sensation. The needles were inserted 20 mm in depth along the skin mainly.The even-needling technique was exerted and the needles were retained for 30 min mainly.Conclusion： The second metacarpal bone lateral needling is applied to the treatment of soft tissue injuries. It is applicable for some internal diseases. The strong needling sensation and the motion of the local affected area are required especially in treatment with this therapy.展开更多
BACKGROUND Intracortical chondroma of the metacarpal bone which could be painful is an extremely rare condition and previously only one case has been reported.Due to the similar physical features and appearance on cli...BACKGROUND Intracortical chondroma of the metacarpal bone which could be painful is an extremely rare condition and previously only one case has been reported.Due to the similar physical features and appearance on clinical imaging,it is difficult to differentiate between intracortical chondroma and osteoid osteoma.Therefore,pathological examination is usually required to establish a definite diagnosis,which is often carried out only after tumor removal.In this study,we describe a case of intracortical chondroma which developed in the metacarpal bone and demonstrate the utility of magnetic resonance imaging(MRI).CASE SUMMARY We present a case of a 40-year-old man with intracortical chondroma of the metacarpal bone who was strongly suspected of having a tumor,and it was confirmed using contrast-enhanced MRI and successfully treated with curettage.MRI performed before tumor removal revealed signal intensity similar to that of the nidus of an osteoid osteoma.However,no abnormal intensity was observed in the bone or soft tissues surrounding the tumor.Such abnormalities on images would indicate the presence of soft-tissue inflammation,which are characteristics of osteoid osteoma.Furthermore,contrast-enhanced imaging revealed no increased enhancement of the areas surrounding the tumor.This is the first report to describe the contrast-enhanced MRI features of intracortical chondroma.This may serve as a guide for clinicians when intracortical chondroma is suspected.CONCLUSION The contrast-enhanced MRI was useful for the differential diagnosis of intracortical chondroma.展开更多
Objective To analyze the effect of fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain on the repair of thumb tissue defect.Methods take the 100 patients with thumb tissue defec...Objective To analyze the effect of fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain on the repair of thumb tissue defect.Methods take the 100 patients with thumb tissue defects treated in our hospital from 2017.01 to 2019.01 as the research objects,and divide them into control group and observation group randomly,50 cases in each group.In the observation group,the fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain is used for repair,and in the control group,the thumb tissue is repaired with abdominal flap.Compare the DASH scores and outcomes of two groups.Results After treatment,the DASH score in the observation group is significantly lower than that in the control group,which is statistically significant(P<0.05);The operation time and intraoperative blood loss of Observation Group is significantly lower than Control Group,which is statistically significant(P<0.05).Conclusion Repairing defected thumb with the fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chaint has the advantages of simple operation and easy mastery,and has significant curative effect on patients.It is an effective way to repair partial thumb defect,and worth popularizing.展开更多
Objective: to analyze the effect of Haitongpi decoction fumigation and washing on the postoperative rehabilitation of metacarpal and phalangeal fractures. Methods: a total of 70 patients with metacarpal and phalangeal...Objective: to analyze the effect of Haitongpi decoction fumigation and washing on the postoperative rehabilitation of metacarpal and phalangeal fractures. Methods: a total of 70 patients with metacarpal and phalangeal fractures in our hospital from January 2019 to January 2020 were selected and randomly divided into two groups with 35 cases in each group. The patients in the control group were given conventional rehabilitation therapy, while the patients in the observation group were given conventional rehabilitation therapy combined with Haitongpi Decoction fumigation and washing therapy. The hospital stay, healing time of metacarpal and phalangeal fractures, pain degree before and after treatment and total effective rate and washing of the two groups were compared. Results: the hospital stay and the healing time of metacarpal and phalangeal fractures in the observation group were shorter than those in the control group. The visual analogue pain score of the patients after treatment was lower than that in the control group, and the total effective rate was higher than that in the control group (P < 0.05). Conclusion: Haitongpi Decoction is effective in postoperative rehabilitation of metacarpal and phalangeal fractures, which can reduce pain, accelerate fracture healing and shorten hospital stay.展开更多
Purpose:Flexible intramedullary nails(FIN)enable minimally invasive and immediate fracture stabilisation,while facilitating early active movement in metacarpal fractures.This systematic review aims to compare locked,n...Purpose:Flexible intramedullary nails(FIN)enable minimally invasive and immediate fracture stabilisation,while facilitating early active movement in metacarpal fractures.This systematic review aims to compare locked,non-locked,single,and double FIN and their post-operative outcomes in metacarpal fractures.Methods:A primary literature search was performed on July 15,2024.English-language studies investigating acute metacarpal fractures,treated with FIN were included.Analyses included:the 5th metacarpal neck fractures lockedvs.non-locked FIN;5th metacarpal neck fractures non-locked singlevs.dual FIN;and the 2nd-5th metacarpal fractures lockedvs.non-locked FIN.The National Institute for Health tool and the JBI tool were used to assess study quality for controlled trials and case series,respectively.Results:Thirteen studies(n=649 fractures)were eligible,with 12 low risks of bias.There was no difference in overall complication rates between locked and non-locked,and single and double non-locked FIN.Non-locked FIN demonstrated reduced metacarpophalangeal joint penetration(odds ratio(OR):3.30(95% confidence interval(CI):1.23-8.80;p=0.017 and delayed union(OR:6.95;95%CI:1.86-25.97;p=0.004),but increased tendon irritation(OR:0.19;95%CI:0.05-0.83;p=0.027vs.locked FIN.Overall operative times were lower for singlevs.double non-locked nails(mean difference:9.17;95%CI:6.12-12.22;p<0.001).Conclusions:These findings demonstrate low complication rates and excellent functional results using FIN to fix displaced metacarpal fractures.Although complication profiles are contrasting,there is no clear benefit in using locked or double nails compared to a single non-locked FIN.展开更多
Background： To avoid the irritation of tendons and soft tissues as well as hardware-related problems, we designed an intramedullary fixation with bioabsorbable rods for the treatment of the metacarpal shaft fractures...Background： To avoid the irritation of tendons and soft tissues as well as hardware-related problems, we designed an intramedullary fixation with bioabsorbable rods for the treatment of the metacarpal shaft fractures. Methods： Five patients with nine shaft fractures of the fourth and fifth metacarpi were treated with intramedullary absorbable implants and followed up with an average of 4.2 months postoperatively. Results： At final follow-up, all patients achieved fracture union with no signs of inflammatory or subcutaneous effusion. There was no shortening, angulatory, or rotatory deformity. There was almost full active extension range of motion （ROM） of the metacarpophalangeal joints while the active flexion ROM of these joints was 80.7 ± 9.6°. hand was 94.0 ± 9.6%. X-rays showed that the arch of the second Compared with the contralateral hand, the grip strength of the injured to fifth metacarpal heads was smooth. There were no intramedullary lytic changes and soft tissue swellings. Conclusion： The intramedullary absorbable implants are a safe, simple, and practical treatment for fourth and filth metacarpal fractures with good early clinical outcomes and no significant complications.展开更多
Purpose:During fracture fixation,the size of tibial nail is a vital factor affecting the outcomes and thus preoperative estimation of tibial nail length is very important.This study aims to find out whether"olecr...Purpose:During fracture fixation,the size of tibial nail is a vital factor affecting the outcomes and thus preoperative estimation of tibial nail length is very important.This study aims to find out whether"olecranon to 5th metacarpal head"(O-MH)measurement can be used to reliably predict the tibial nail length.Methods:This was a cross sectional study involving 100 volunteers.Measurements were done and recorded by two observers on two separate occasions.Tibial nail length estimation measurement was done from highest point of tibial tuberosity to the tip of the medial malleolus(TT-MM).O-MH measurement was taken from tip of olecranon to the tip of 5th metacarpal head with wrist in neutral position and hand clenched.Statistical analysis was done to find out correlation between two measurements and influence of age,gender and body mass index on them.Results:Paired t-test showed no systematic error between the readings.Intraclass correlation coefficient showed strong agreement in inter and intra observer settings.Strong correlation was found between the TT-MM&O-MH measurements using Pearson's correlation coefficient test(r=0.966).Hierarchical regression analysis showed age,gender and BMI have no statistically significant bearings on these measurements and their correlations.Conclusion:O-MH measurement is a useful and accurate means of estimating tibial nail length preoperatively.展开更多
Aim: Fractures of metacarpals are commonly encountered in hand surgery. For adequate fixation, a thorough knowledge about the anatomy is essential. While fixing the metacarpals with plates and screws, plates are bent ...Aim: Fractures of metacarpals are commonly encountered in hand surgery. For adequate fixation, a thorough knowledge about the anatomy is essential. While fixing the metacarpals with plates and screws, plates are bent to contour the dorsal surface. However, there are no reference values in literature for the location and degree of angulation. The authors studied the dorsal surface of metacarpals in cadavers to gather data regarding the location and degree of angulation of the dorsal cortex. Methods: Cadaveric dissections of 118 metacarpals from 30 hands were performed. A true lateral view of each metacarpal was taken using fluoroscopy.These pictures were analyzed using Image J software. The dorsal cortex angle was measured in each image, and the center of rotation of angulation (CORA) was identified. The distance from the CORA to the base of metacarpal was measured and calculated as a percentage of the metacarpal length. Results: The average dorsal angle of the metacarpals was 11.5°. The average angles for each metacarpal were as follows: 2nd metacarpal = 13° (range, 6-26°;SD, 4.73), 3rd = 10° (range, 1-25°;SD, 5.28), 4th = 11° (range, 1-20°;SD, 4.45), 5th = 12°(range, 2-24°;SD, 5.11). The average location of the CORA from the base of the metacarpal as a percentage of the metacarpal length was identified as follows: 53.5% for the index finger,52.1% for the long finger, 48.3% for the ring finger and 50.3% for the small finger. Conclusion:These measurements are able to serve as reference values for plate bending while operating on a metacarpal fracture or metacarpal corrective osteotomy.展开更多
Bone age assessment(BAA)aims to determine whether a child’s growth and development are normal concerning their chronological age.To predict bone age more accurately based on radiographs,and for the left-hand X-ray im...Bone age assessment(BAA)aims to determine whether a child’s growth and development are normal concerning their chronological age.To predict bone age more accurately based on radiographs,and for the left-hand X-ray images of different races model can have better adaptability,we propose a neural network in parallel with the quantitative features from the left-hand bone measurements for BAA.In this study,a lightweight feature extractor(LFE)is designed to obtain the featuremaps fromradiographs,and amodule called attention erasermodule(AEM)is proposed to capture the fine-grained features.Meanwhile,the dimensional information of the metacarpal parts in the radiographs is measured to enhance the model’s generalization capability across images fromdifferent races.Ourmodel is trained and validated on the RSNA,RHPE,and digital hand atlas datasets,which include images from various racial groups.The model achieves a mean absolute error(MAE)of 4.42 months on the RSNA dataset and 15.98 months on the RHPE dataset.Compared to ResNet50,InceptionV3,and several state-of-the-art methods,our proposed method shows statistically significant improvements(p<0.05),with a reduction in MAE by 0.2±0.02 years across different racial datasets.Furthermore,t-tests on the features also confirm the statistical significance of our approach(p<0.05).展开更多
OBJECTIVE:To investigate the site specificity and differences of the Hegu(LI4)located on the midpoint of the second metacarpal and the point where the bases of the first and second metacarpal bones on the dorsum was h...OBJECTIVE:To investigate the site specificity and differences of the Hegu(LI4)located on the midpoint of the second metacarpal and the point where the bases of the first and second metacarpal bones on the dorsum was historically used as Hegu(LI4)in Japan,through morphological,biomechanical,and histological analyses.METHODS:We defined distally located Hegu(LI4)as Hegu(LI4)-D and proximally located Hegu(LI4)as Hegu(LI4)-P.The distance from the skin surface to the blood vessels as well as the biomechanical properties of the two Hegu(LI4)samples were measured using an ultrasound device and Myoton PRO(Myoton AS,Tallinn,Estonia),respectively,in 20 healthy adult volunteers.Sympathetic fibers under the two Hegu(LI4)samples were histologically observed using tyrosine hydroxylase(TH)immunostaining in 10 cadavers.RESULTS:Hegu(LI4)-D was classified into type 1 with blood vessels<4 mm away from the skin surface,and type 2 with blood vessels>10 mm away from the skin surface.In Hegu(LI4)-P,blood vessels were approximately 10 mm away from the surface.Further,Hegu(LI4)-P had significantly higher tone,stiffness,and elasticity than Hegu(LI4)-D(P<0.0001).TH-positive fibers were present near the artery in Hegu(LI4)-P.CONCLUSION:Hegu(LI4)-D and Hegu(LI4)-P differed in terms of hardness and the distance between the skin surface and blood vessels.Furthermore,sympathetic nerve fibers were present near the artery in Hegu(LI4)-P.Taken together,these results suggest that there is site specificity of morphological,biomechanical,and histological differences between the Hegu(LI4)-D and Hegu(LI4)-P.展开更多
Background:The first web space not only plays an integral role in hand functionality,but also holds an important aesthetic function for patients with cicatricial contractures,which hinders the ability to move joints,t...Background:The first web space not only plays an integral role in hand functionality,but also holds an important aesthetic function for patients with cicatricial contractures,which hinders the ability to move joints,thereby restricting the performance of everyday activities.Therefore,a wide variety of reconstruction options are available.In this study,our main aim was to have a clear surgical plan prior to surgery according to preoperative findings and the degree of thumb abduction span.Methods:This study was conducted at Kasr Al-Ainy Hospital.This cohort study included 33 patients with cicatricial first web space contractures who underwent reconstructive procedures to restore the first web space.Patients were assessed preoperatively and categorized according to the degree of contracture,and the reconstruction procedure was chosen accordingly.They were assessed using both objective and subjective methods.Results:In this study,33 cases of cicatricial contracture of the first web space due to physical or thermal trauma were included.Measurements of the change in the span of abduction were performed for all patients included in the study preoperatively and postoperatively.Skin grafting and skin substitutes had an average change in abduction span of 32.5°(±14.4°),Z-plasty release had a mean of 30.59°(±8.82°)increase in abduction span,regional flaps had an increase of 40.71°(±12.39°),while distant flaps had an increase of 35°(±3.54°).Conclusion:No single reconstruction method can be used in all cases.When viewing a patient,one must consider that each individual has a unique representation.However,if we follow a systematic method for the initial evaluation,the most efficient flap can be chosen for each case,thus reducing the need for secondary procedures.Categorizing the cases according to the abduction span into mild,moderate,or severe forms is the first building block of this algorithm.Adjacent tissue condition,patient occupation,compliance,and the need to return to work are important factors.展开更多
Introduction: Floating bone injury or bipolar dislocation is a concurrent dislocation at both ends of a long bone or a flat bone. It is an exceptional injury. We report 11 consecutives cases of floating bones. Objecti...Introduction: Floating bone injury or bipolar dislocation is a concurrent dislocation at both ends of a long bone or a flat bone. It is an exceptional injury. We report 11 consecutives cases of floating bones. Objectives: The aim of the study is to analyze the frequency, the mechanism of injury and clinical forms of floating bones, and to present the results of their management. Material and Methods: A ten years ongoing retrospective study was held in four trauma departments. Eleven cases of floating bones were identified. The floating bones characteristics such as the injured bone, the patient age and sex, the mechanism of injury, the dislocations directions, the associated complications, the treatment and the outcome were studied. Results: Nine male and two female patients, with a mean age of 37 years [19 - 65 years range] presented a concurrent bipolar dislocation of one bone or a group of bones. They sustained a road traffic accident (n = 5), a workplace accident (n = 3), a fall from height (n = 2), and a sport accident (n = 1). The clavicle (n = 3) and the first metatarsal (n = 3) were the most frequently involved. The others floating bones were the radius-ulna complex (n = 1), the radius-lunatum complex (n = 1), the first metacarpal (n = 1), the first phalanx (n = 1) and the femur (n = 1). The floating bones ends displacement occurred in the sagittal plane (the forearm, the femur, the first phalanx and the first metatarsal) and in the horizontal plane (the clavicle, the first metatarsal and the first metacarpal). We defined direction displacements as bidirectional asymmetric (n = 10) or unidirectional symmetric (n = 1). Associated complications were fractures (wrist, hip, tarso-metatarsal joints) and wounds (fingers, metatarso-phalangeal joint). Dislocations were treated conservatively (n = 5) and surgically (n = 17) with excellent results (n = 13/16 joints). Three patients were lost of view. Conclusion: Our study described the characteristics of this exceptional injury. For any joint dislocation, we promote the systematic examination of the other end of the dislocated bone.展开更多
Objective: The aim of the present study is to discriminate functions for sex determination in a subjected sample of the Egyptian population using the morphology of metacarpals and phalanges for gender comparison. Furt...Objective: The aim of the present study is to discriminate functions for sex determination in a subjected sample of the Egyptian population using the morphology of metacarpals and phalanges for gender comparison. Furthermore, the measurements discussed in this study will aid in predicting the differentiation independently and guaranteeing sex determination in the subjected population individually. Methods: Forty measurements were taken from the right metacarpals and phalangeal bones of 100 subjects, whose ages ranged from 19 to 60. Moreover, the measurements of nine metacarpals and four phalangeal bones were used for sex discrimination in each sample population. Results: Males had significantly greater mean values (P < 0.05) for the lengths of the metacarpals and the proximal phalangeal bones of all right-hand fingers than females. The cut-off value and the accuracy percentage for precise sex classification of males and females using individual and grouped bones showed that a value higher than the marking point classified an individual as male and that a lower value suggested female. Besides, the multiple stepwise discriminant functional analysis of the most predictable internal variables of the metacarpals revealed a cross-validated sex classification accuracy of 100%. In contrast, the most predictable internal variables of the phalanges showed a cross-validated sex classification accuracy of 93%. Conclusion: The results revealed a new forensic suggestion for the determination of sex based on the measurements of the metacarpals and the phalanges. Moreover, various discriminant equations were applied for the declaration of this conceivable recommendation.展开更多
文摘A 21-year-old woman presented with a left-hand deformity that had been present since birth.She had no clear family or genetic history.Physical examination revealed absence of the left metacarpal phalanges and four soft tissue bulges at the distal end of the wrist(Figure 1a).Digital radiography showed fusion of the lunate and triangular bones of the left wrist,fusion of the scaphoid with the distal row of carpal bones,and an irregular bone with an uneven distal margin.
文摘Myofibroblastic sarcoma(MS)is a rare malignant soft tissue tumor characterized by myofibroblasts.It most commonly arises in the head and neck region,especially the tongue,with rare occurrences in the limbs.MS exhibits varying histopathology,ranging from low-to high-grade,with diverse subtypes showing different clinical behaviors and prognoses.This article reports the first case of high-grade MS in the hand,adding to the limited documentation of this rare condition.Here,we present the case of a 30-year-old healthy female with a year-long history of progressive shortening,mobility loss,and weakness in the first finger of the left hand.Left-hand imaging revealed a lytic,cottony tumor involving the entire first metacarpal.Following surgical resection,which included metatarsal grafting and joint reconstruction,a diagnosis of high-grade MS was confirmed based on histological manifestations and immunohistochemical staining,which was further classified as grade 2 according to the French Federation of Cancer Centers Sarcoma Group system.Postoperative radiotherapy was administered and the patient experienced a successful recovery without graft osteonecrosis.The patient regained 90%mobility and strength,without shortening,after surgical resection and radiotherapy.Six months post-surgery,the patient reported full hand functionality.MS is a rare tumor that infrequently affects bones and is often misdiagnosed owing to its controversial characteristics.The initial treatment should focus on complete resection with negative margins,followed by reconstructive surgery to preserve function.Further case studies are needed to establish standardized surgical treatment protocols.
文摘BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.CASE SUMMARY A 45-year-old man with a right hand injury visited the hospital.A small bone fragment was identified using plain radiography.Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal(CMC)joint.Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged.We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation.We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals.The dorsal ligament of the third CMC joint was torn.We thought it had been dislocated to the volar side and spontaneously reduced to that position.There are only few reports of volar dislocation of CMC joint fractures,particularly of the second and third metacarpals;our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.CONCLUSION Although past reports have used a palmar approach,the dorsal approach is a good option for these cases.
基金Supported by National Natural Science Foundation of China:Nos.81072883,81173342,81473773Youth Science and Research Foundation of Hebei University of Traditional Chinese Medicine:QNZ2015014~~
文摘Objective： To explore the rules of the second metacarpal bone lateral needling in clinical application and its characteristics so as to provide the guidance to clinical practice.Methods： Taking ＂the second metacarpal holographic acupuncture therapy＂ ＂the second metacarpal bone lateral needling＂ and ＂the second metacarpal bone＂ as the search terms, the papers on the second metacarpal bone lateral needling were retrieved from China National Knowledge Infrastructure（CNKI）and Wanfang database from January 1, 1974 to December 31, 2016 and were screened. Using the Excel2003, the database of the diseases treated by the second metacarpal bone lateral needling was set up.The indications, the acupoints selection rules and needling manipulation of this therapy were analyzed.Results： A total of 1103 papers were retrieved, of which, 446 papers were from CNKI and 657 from Wanfang database. According to the inclusion and exclusion criteria, 54 papers were included for analysis finally. It was found that the indications of the second metacarpal bone lateral needling were predominated by the soft tissue injuries, especially acute lumbar sprain, ankle sprain and knee joint injury. Regarding the acupoints selection rules of the second metacarpal bone lateral needling, the corresponding points and tender points were commonly selected. Regarding the needling manipulation, the strong stimulation was required after needle insertion and the patient was required to move the affected areas while keeping the strong needling sensation. The needles were inserted 20 mm in depth along the skin mainly.The even-needling technique was exerted and the needles were retained for 30 min mainly.Conclusion： The second metacarpal bone lateral needling is applied to the treatment of soft tissue injuries. It is applicable for some internal diseases. The strong needling sensation and the motion of the local affected area are required especially in treatment with this therapy.
文摘BACKGROUND Intracortical chondroma of the metacarpal bone which could be painful is an extremely rare condition and previously only one case has been reported.Due to the similar physical features and appearance on clinical imaging,it is difficult to differentiate between intracortical chondroma and osteoid osteoma.Therefore,pathological examination is usually required to establish a definite diagnosis,which is often carried out only after tumor removal.In this study,we describe a case of intracortical chondroma which developed in the metacarpal bone and demonstrate the utility of magnetic resonance imaging(MRI).CASE SUMMARY We present a case of a 40-year-old man with intracortical chondroma of the metacarpal bone who was strongly suspected of having a tumor,and it was confirmed using contrast-enhanced MRI and successfully treated with curettage.MRI performed before tumor removal revealed signal intensity similar to that of the nidus of an osteoid osteoma.However,no abnormal intensity was observed in the bone or soft tissues surrounding the tumor.Such abnormalities on images would indicate the presence of soft-tissue inflammation,which are characteristics of osteoid osteoma.Furthermore,contrast-enhanced imaging revealed no increased enhancement of the areas surrounding the tumor.This is the first report to describe the contrast-enhanced MRI features of intracortical chondroma.This may serve as a guide for clinicians when intracortical chondroma is suspected.CONCLUSION The contrast-enhanced MRI was useful for the differential diagnosis of intracortical chondroma.
文摘Objective To analyze the effect of fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain on the repair of thumb tissue defect.Methods take the 100 patients with thumb tissue defects treated in our hospital from 2017.01 to 2019.01 as the research objects,and divide them into control group and observation group randomly,50 cases in each group.In the observation group,the fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain is used for repair,and in the control group,the thumb tissue is repaired with abdominal flap.Compare the DASH scores and outcomes of two groups.Results After treatment,the DASH score in the observation group is significantly lower than that in the control group,which is statistically significant(P<0.05);The operation time and intraoperative blood loss of Observation Group is significantly lower than Control Group,which is statistically significant(P<0.05).Conclusion Repairing defected thumb with the fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chaint has the advantages of simple operation and easy mastery,and has significant curative effect on patients.It is an effective way to repair partial thumb defect,and worth popularizing.
文摘Objective: to analyze the effect of Haitongpi decoction fumigation and washing on the postoperative rehabilitation of metacarpal and phalangeal fractures. Methods: a total of 70 patients with metacarpal and phalangeal fractures in our hospital from January 2019 to January 2020 were selected and randomly divided into two groups with 35 cases in each group. The patients in the control group were given conventional rehabilitation therapy, while the patients in the observation group were given conventional rehabilitation therapy combined with Haitongpi Decoction fumigation and washing therapy. The hospital stay, healing time of metacarpal and phalangeal fractures, pain degree before and after treatment and total effective rate and washing of the two groups were compared. Results: the hospital stay and the healing time of metacarpal and phalangeal fractures in the observation group were shorter than those in the control group. The visual analogue pain score of the patients after treatment was lower than that in the control group, and the total effective rate was higher than that in the control group (P < 0.05). Conclusion: Haitongpi Decoction is effective in postoperative rehabilitation of metacarpal and phalangeal fractures, which can reduce pain, accelerate fracture healing and shorten hospital stay.
文摘Purpose:Flexible intramedullary nails(FIN)enable minimally invasive and immediate fracture stabilisation,while facilitating early active movement in metacarpal fractures.This systematic review aims to compare locked,non-locked,single,and double FIN and their post-operative outcomes in metacarpal fractures.Methods:A primary literature search was performed on July 15,2024.English-language studies investigating acute metacarpal fractures,treated with FIN were included.Analyses included:the 5th metacarpal neck fractures lockedvs.non-locked FIN;5th metacarpal neck fractures non-locked singlevs.dual FIN;and the 2nd-5th metacarpal fractures lockedvs.non-locked FIN.The National Institute for Health tool and the JBI tool were used to assess study quality for controlled trials and case series,respectively.Results:Thirteen studies(n=649 fractures)were eligible,with 12 low risks of bias.There was no difference in overall complication rates between locked and non-locked,and single and double non-locked FIN.Non-locked FIN demonstrated reduced metacarpophalangeal joint penetration(odds ratio(OR):3.30(95% confidence interval(CI):1.23-8.80;p=0.017 and delayed union(OR:6.95;95%CI:1.86-25.97;p=0.004),but increased tendon irritation(OR:0.19;95%CI:0.05-0.83;p=0.027vs.locked FIN.Overall operative times were lower for singlevs.double non-locked nails(mean difference:9.17;95%CI:6.12-12.22;p<0.001).Conclusions:These findings demonstrate low complication rates and excellent functional results using FIN to fix displaced metacarpal fractures.Although complication profiles are contrasting,there is no clear benefit in using locked or double nails compared to a single non-locked FIN.
文摘Background： To avoid the irritation of tendons and soft tissues as well as hardware-related problems, we designed an intramedullary fixation with bioabsorbable rods for the treatment of the metacarpal shaft fractures. Methods： Five patients with nine shaft fractures of the fourth and fifth metacarpi were treated with intramedullary absorbable implants and followed up with an average of 4.2 months postoperatively. Results： At final follow-up, all patients achieved fracture union with no signs of inflammatory or subcutaneous effusion. There was no shortening, angulatory, or rotatory deformity. There was almost full active extension range of motion （ROM） of the metacarpophalangeal joints while the active flexion ROM of these joints was 80.7 ± 9.6°. hand was 94.0 ± 9.6%. X-rays showed that the arch of the second Compared with the contralateral hand, the grip strength of the injured to fifth metacarpal heads was smooth. There were no intramedullary lytic changes and soft tissue swellings. Conclusion： The intramedullary absorbable implants are a safe, simple, and practical treatment for fourth and filth metacarpal fractures with good early clinical outcomes and no significant complications.
文摘Purpose:During fracture fixation,the size of tibial nail is a vital factor affecting the outcomes and thus preoperative estimation of tibial nail length is very important.This study aims to find out whether"olecranon to 5th metacarpal head"(O-MH)measurement can be used to reliably predict the tibial nail length.Methods:This was a cross sectional study involving 100 volunteers.Measurements were done and recorded by two observers on two separate occasions.Tibial nail length estimation measurement was done from highest point of tibial tuberosity to the tip of the medial malleolus(TT-MM).O-MH measurement was taken from tip of olecranon to the tip of 5th metacarpal head with wrist in neutral position and hand clenched.Statistical analysis was done to find out correlation between two measurements and influence of age,gender and body mass index on them.Results:Paired t-test showed no systematic error between the readings.Intraclass correlation coefficient showed strong agreement in inter and intra observer settings.Strong correlation was found between the TT-MM&O-MH measurements using Pearson's correlation coefficient test(r=0.966).Hierarchical regression analysis showed age,gender and BMI have no statistically significant bearings on these measurements and their correlations.Conclusion:O-MH measurement is a useful and accurate means of estimating tibial nail length preoperatively.
文摘Aim: Fractures of metacarpals are commonly encountered in hand surgery. For adequate fixation, a thorough knowledge about the anatomy is essential. While fixing the metacarpals with plates and screws, plates are bent to contour the dorsal surface. However, there are no reference values in literature for the location and degree of angulation. The authors studied the dorsal surface of metacarpals in cadavers to gather data regarding the location and degree of angulation of the dorsal cortex. Methods: Cadaveric dissections of 118 metacarpals from 30 hands were performed. A true lateral view of each metacarpal was taken using fluoroscopy.These pictures were analyzed using Image J software. The dorsal cortex angle was measured in each image, and the center of rotation of angulation (CORA) was identified. The distance from the CORA to the base of metacarpal was measured and calculated as a percentage of the metacarpal length. Results: The average dorsal angle of the metacarpals was 11.5°. The average angles for each metacarpal were as follows: 2nd metacarpal = 13° (range, 6-26°;SD, 4.73), 3rd = 10° (range, 1-25°;SD, 5.28), 4th = 11° (range, 1-20°;SD, 4.45), 5th = 12°(range, 2-24°;SD, 5.11). The average location of the CORA from the base of the metacarpal as a percentage of the metacarpal length was identified as follows: 53.5% for the index finger,52.1% for the long finger, 48.3% for the ring finger and 50.3% for the small finger. Conclusion:These measurements are able to serve as reference values for plate bending while operating on a metacarpal fracture or metacarpal corrective osteotomy.
基金supported by the grant from the National Natural Science Foundation of China(No.72071019)grant from the Natural Science Foundation of Chongqing(No.cstc2021jcyj-msxmX0185).
文摘Bone age assessment(BAA)aims to determine whether a child’s growth and development are normal concerning their chronological age.To predict bone age more accurately based on radiographs,and for the left-hand X-ray images of different races model can have better adaptability,we propose a neural network in parallel with the quantitative features from the left-hand bone measurements for BAA.In this study,a lightweight feature extractor(LFE)is designed to obtain the featuremaps fromradiographs,and amodule called attention erasermodule(AEM)is proposed to capture the fine-grained features.Meanwhile,the dimensional information of the metacarpal parts in the radiographs is measured to enhance the model’s generalization capability across images fromdifferent races.Ourmodel is trained and validated on the RSNA,RHPE,and digital hand atlas datasets,which include images from various racial groups.The model achieves a mean absolute error(MAE)of 4.42 months on the RSNA dataset and 15.98 months on the RHPE dataset.Compared to ResNet50,InceptionV3,and several state-of-the-art methods,our proposed method shows statistically significant improvements(p<0.05),with a reduction in MAE by 0.2±0.02 years across different racial datasets.Furthermore,t-tests on the features also confirm the statistical significance of our approach(p<0.05).
文摘OBJECTIVE:To investigate the site specificity and differences of the Hegu(LI4)located on the midpoint of the second metacarpal and the point where the bases of the first and second metacarpal bones on the dorsum was historically used as Hegu(LI4)in Japan,through morphological,biomechanical,and histological analyses.METHODS:We defined distally located Hegu(LI4)as Hegu(LI4)-D and proximally located Hegu(LI4)as Hegu(LI4)-P.The distance from the skin surface to the blood vessels as well as the biomechanical properties of the two Hegu(LI4)samples were measured using an ultrasound device and Myoton PRO(Myoton AS,Tallinn,Estonia),respectively,in 20 healthy adult volunteers.Sympathetic fibers under the two Hegu(LI4)samples were histologically observed using tyrosine hydroxylase(TH)immunostaining in 10 cadavers.RESULTS:Hegu(LI4)-D was classified into type 1 with blood vessels<4 mm away from the skin surface,and type 2 with blood vessels>10 mm away from the skin surface.In Hegu(LI4)-P,blood vessels were approximately 10 mm away from the surface.Further,Hegu(LI4)-P had significantly higher tone,stiffness,and elasticity than Hegu(LI4)-D(P<0.0001).TH-positive fibers were present near the artery in Hegu(LI4)-P.CONCLUSION:Hegu(LI4)-D and Hegu(LI4)-P differed in terms of hardness and the distance between the skin surface and blood vessels.Furthermore,sympathetic nerve fibers were present near the artery in Hegu(LI4)-P.Taken together,these results suggest that there is site specificity of morphological,biomechanical,and histological differences between the Hegu(LI4)-D and Hegu(LI4)-P.
文摘Background:The first web space not only plays an integral role in hand functionality,but also holds an important aesthetic function for patients with cicatricial contractures,which hinders the ability to move joints,thereby restricting the performance of everyday activities.Therefore,a wide variety of reconstruction options are available.In this study,our main aim was to have a clear surgical plan prior to surgery according to preoperative findings and the degree of thumb abduction span.Methods:This study was conducted at Kasr Al-Ainy Hospital.This cohort study included 33 patients with cicatricial first web space contractures who underwent reconstructive procedures to restore the first web space.Patients were assessed preoperatively and categorized according to the degree of contracture,and the reconstruction procedure was chosen accordingly.They were assessed using both objective and subjective methods.Results:In this study,33 cases of cicatricial contracture of the first web space due to physical or thermal trauma were included.Measurements of the change in the span of abduction were performed for all patients included in the study preoperatively and postoperatively.Skin grafting and skin substitutes had an average change in abduction span of 32.5°(±14.4°),Z-plasty release had a mean of 30.59°(±8.82°)increase in abduction span,regional flaps had an increase of 40.71°(±12.39°),while distant flaps had an increase of 35°(±3.54°).Conclusion:No single reconstruction method can be used in all cases.When viewing a patient,one must consider that each individual has a unique representation.However,if we follow a systematic method for the initial evaluation,the most efficient flap can be chosen for each case,thus reducing the need for secondary procedures.Categorizing the cases according to the abduction span into mild,moderate,or severe forms is the first building block of this algorithm.Adjacent tissue condition,patient occupation,compliance,and the need to return to work are important factors.
文摘Introduction: Floating bone injury or bipolar dislocation is a concurrent dislocation at both ends of a long bone or a flat bone. It is an exceptional injury. We report 11 consecutives cases of floating bones. Objectives: The aim of the study is to analyze the frequency, the mechanism of injury and clinical forms of floating bones, and to present the results of their management. Material and Methods: A ten years ongoing retrospective study was held in four trauma departments. Eleven cases of floating bones were identified. The floating bones characteristics such as the injured bone, the patient age and sex, the mechanism of injury, the dislocations directions, the associated complications, the treatment and the outcome were studied. Results: Nine male and two female patients, with a mean age of 37 years [19 - 65 years range] presented a concurrent bipolar dislocation of one bone or a group of bones. They sustained a road traffic accident (n = 5), a workplace accident (n = 3), a fall from height (n = 2), and a sport accident (n = 1). The clavicle (n = 3) and the first metatarsal (n = 3) were the most frequently involved. The others floating bones were the radius-ulna complex (n = 1), the radius-lunatum complex (n = 1), the first metacarpal (n = 1), the first phalanx (n = 1) and the femur (n = 1). The floating bones ends displacement occurred in the sagittal plane (the forearm, the femur, the first phalanx and the first metatarsal) and in the horizontal plane (the clavicle, the first metatarsal and the first metacarpal). We defined direction displacements as bidirectional asymmetric (n = 10) or unidirectional symmetric (n = 1). Associated complications were fractures (wrist, hip, tarso-metatarsal joints) and wounds (fingers, metatarso-phalangeal joint). Dislocations were treated conservatively (n = 5) and surgically (n = 17) with excellent results (n = 13/16 joints). Three patients were lost of view. Conclusion: Our study described the characteristics of this exceptional injury. For any joint dislocation, we promote the systematic examination of the other end of the dislocated bone.
文摘Objective: The aim of the present study is to discriminate functions for sex determination in a subjected sample of the Egyptian population using the morphology of metacarpals and phalanges for gender comparison. Furthermore, the measurements discussed in this study will aid in predicting the differentiation independently and guaranteeing sex determination in the subjected population individually. Methods: Forty measurements were taken from the right metacarpals and phalangeal bones of 100 subjects, whose ages ranged from 19 to 60. Moreover, the measurements of nine metacarpals and four phalangeal bones were used for sex discrimination in each sample population. Results: Males had significantly greater mean values (P < 0.05) for the lengths of the metacarpals and the proximal phalangeal bones of all right-hand fingers than females. The cut-off value and the accuracy percentage for precise sex classification of males and females using individual and grouped bones showed that a value higher than the marking point classified an individual as male and that a lower value suggested female. Besides, the multiple stepwise discriminant functional analysis of the most predictable internal variables of the metacarpals revealed a cross-validated sex classification accuracy of 100%. In contrast, the most predictable internal variables of the phalanges showed a cross-validated sex classification accuracy of 93%. Conclusion: The results revealed a new forensic suggestion for the determination of sex based on the measurements of the metacarpals and the phalanges. Moreover, various discriminant equations were applied for the declaration of this conceivable recommendation.
