Search

Objectives: This study aims to evaluate the clinical results and experiences in a community hospital regarding procedures for the replantation and revascularization of fingers. Patients and methods: Between June 2015 and December 2019, a total of 58 patients (51 males, 7 females; mean age: 33.4±6.3 years; range, 23 to 46 years) who were followed after total and/or subtotal amputation and replantation were retrospectively analyzed. The patients were evaluated at nine months in terms of cold intolerance, static two-point discrimination, and functional results using the range of motion (ROM) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Results: The majority of the patients presented with work-related injuries (70%), most commonly by the mechanism of guillotine (64%), and to the dominant hand (76%) and the third finger (36%) most frequently. The overall success rate of digit salvage was 72.9% (n=51). Of 19 digits with unsuccessful surgical outcomes, seven were from total and 12 were from subtotal amputations. In the long-term, cold intolerance was observed in 14 patients (24.1%) according to the cold intolerance severity scale. The mean static two- point discrimination value was 6.0±0.7 mm and the mean QuickDASH score was 22.3±5.0. The mean ROM measured at nine months after surgery in the metacarpophalangeal and interphalangeal joints of the third and fourth digits was significantly lower than that in the others (p Conclusion: The predictors of survival of a replanted digit indicated in this study can be used as a guide and decision-making aid for any attempts for replantation.

Introduction The innervation of the digital joints as well as the anatomical relationships of the articular branches is present in this anatomical work to determine the technical feasibility of a selective and efficient denervation of the digital joints. Materials and methods A study of 40 distal interphalangeal (DIP), 40 proximal interphalangeal (PIP), 50 metacarpophalangeal (MCP), 10 interphalangeal (IP) of the thumb, and 10 trapezo-metacarpophalangeal (TMC) joints was performed on ten hands. Under magnification and a proper surgical approach, we collected the course, the source origin, the number of articular nerve branches, and their caliber. Results In total, 118 nerve branches arising from the proper palmar digital nerves were found on 10 DIP of each dissected long finger (n = 40). A total of 226 nerve branches were found on 10 PIPs of each long finger (n = 40), of which 204 branches (90.3%) had a palmar origin. Dorsal innervation was found for the ring and little finger, originating from the dorso-ulnar digital nerve. 212 branches were found on 10 MCP of long fingers (n = 40), including 87 branches of palmar origin (41.1%), 107 branches of dorsal origin (50.4%), and 18 branches of the motor branch of the ulnar nerve (8.5%). 42 articular branches directed to the TMC joint (n = 10) were found. 13 branches (31%) originated from the anterior sensory branch of the radial nerve, 13 branches (31%) originated from the lateral cutaneous nerve of the forearm, 5 branches (12%) originated from the palmar cutaneous branch of the median nerve, and 11 (26%) branches originated from the thenar branch of the median nerve. The involvement of the sensory anterior branch of the radial nerve was always present for the innervation of each TMC. Discussion and conclusion Our research shows that finger joints receive their primary innervation from small branches of the digital nerves with the exception of the MCP joint and the TMC joint. To obtain an efficient and a selective digital denervation for articular pain relief, it is necessary to plan the best surgical approach and it is crucial to recognize the articular nervous branch localization and source.

We encountered a case of cutaneous squamous cell carcinoma (SCC) in a 17-year-old female koala at a zoo. A fragile, papillary, elevated mass was found on the third digit of the right hind limb. SCC was identified histopathologically: squamous cell-like polygonal tumor cells showed a nest-like growth pattern with epidermal down growth, central keratinization and necrotic foci, and invaded dermal connective tissues. Metastatic lesions were observed in various organs, including the lung and axillary lymph node: in the lung, multiple metastatic foci similar to the primary lesion, and in the axillary lymph node, individual polygonal tumor cells infiltrated the sinusoids. Immunohistochemistry revealed that the tumor cells were positive for proliferating cell nuclear antigen, which exhibited 32-33% of labeling indices in the tumor cells. To our knowledge, this is the first report of a case of SCC in a digit of a koala.

Parrot beak nail dystrophy is an excessive forward curvature of the nail plate that can affect both fingernails and toenails. Few cases have been reported since its original description in 1971; however, the incidence is estimated to be 2.5% in healthy individuals. Although the pathogenesis has not yet been established, parrot beak nail has been associated with chronic crack cocaine use, congenital bone or soft tissue abnormalities, other nail dystrophies, peripheral neuropathy, systemic sclerosis, and trauma to the nail. We describe an 86-year-old man with dementia and neuropathy who presented with an unperceived parrot beak nail of his left fourth toenail and concurrent onycholysis of his left great toenail. He had stopped visits with his podiatrist for nail care, which fostered the growth of these nail dystrophies. Our patient’s parrot beak nail was successfully treated with nail clipping and regular nail maintenance to prevent its recurrence. The associated conditions, etiologies, and treatment of parrot beak nails are discussed.

In dogs, digit squamous cell carcinoma (SCC) is uncommon. Clinical signs are frequently underestimated, leading to a diagnostic delay. The purpose of this retrospective study was to report our experience regarding the clinical presentation, diagnostic work-up, treatment and outcome of 79 client-owned dogs with SCC of the digit. The greatest majority (84.8%) of dogs was dark-coated. Schnauzers represented approximately one third of the study population, and had a poorer outcome compared with other breeds. The majority of SCCs occurred in the front limbs (61%), and bone lysis was frequently observed (92.4%). Approximately 9% of dogs had involvement of multiple digits, and this was associated with a shorter time to progression (TTP; P = 0.047). Similarly, a duration of clinical signs >90 days was associated with a shorter TTP (P = 0.02). Regional lymph node metastases were documented in 17.7% of dogs at admission and were significantly associated with tumor-related death (P < 0.001). At presentation, none of the dogs had evidence of distant metastasis. Digit amputation achieved adequate local tumor control in the majority of cases. Adjuvant chemotherapy and radiation therapy were carried out in 21.5% of cases, with uncertain benefit. Due to the relatively non-aggressive clinical behavior of digit SCC, chemotherapy should only be offered in the case of metastatic disease. Approximately one fourth of dogs developed de novo SCCs during the follow-up. Careful examination of the digits should be encouraged in breeds considered at high risk and in dogs with a previous history of digital SCC.

PICO question In Greyhounds (and Sighthounds) with recurring pedal corns, is surgical excision in comparison to corn extirpation more effective at resolving lameness? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Three case series were included, all three were retrospective, one included a prospective component. There was one opinion-based narrative review and one opinion-based article. Strength of evidence Weak Outcomes reported Extirpation allows only a short palliation of lameness and repeated treatment is required at variable intervals. Surgical excision may provide good rates of short-term resolution however, in the long-term recurrence rates are still moderate. It should also be born in mind that further corns may develop in different digits. Conclusion In Greyhounds (and Sighthounds) with recurring pedal corns, surgical excision of the corn is more likely to provide long-term resolution of lameness in comparison to extirpation. However, the current level of evidence on this topic is weak. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Background Intraosseous epidermoid cyst (IEC) is a rare, non-neoplastic, pathology in animals and humans that most commonly affects the distal phalanx. In dogs, it is important to differentiate this lesion from malignant digital tumours causing bone lysis. In previous reports, IEC has been described to affect only a single digit at the time of diagnosis which is usually based on histopathology. This is the first case report to describe immunohistochemically confirmed IECs affecting simultaneously multiple digits. Case presentation A 4-and-a-half-year-old female spayed Great Dane was presented with a 2-month history of progressive swelling of the distal phalanx (PIII) of digits IV and V of the right pelvic limb. Eleven weeks prior to presentation, the dog had a low-grade cutaneous mast cell tumour completely excised from the craniolateral base of its left pinna. A history of trauma to 1 of the nails of the same pes 4 years prior to referral was also reported. Examination of the right pelvic limb identified firm non-painful swelling of PIII of digits IV and V, with concurrent deformation of the nails. Radiographs of the right pes obtained by the primary veterinarian identified an expansile lesion of PIII of digits IV and V. Computed tomography identified large expansile lesions of PIII of digits IV and V, with associated cortical thinning and soft tissue swelling. Neoplasia was considered the most likely radiographic diagnosis. Histopathology of Jamshidi bone biopsies was consistent with intraosseous epidermoid cyst, which was confirmed with immunohistochemistry. Amputation of PIII of digits IV and V at the level of mid-PII was performed as definitive treatment. No recurrence of the lesion occurred during the 10-month follow-up period. Conclusions Intraosseous epidermoid cysts should be included in the differential diagnosis for expansile lesions affecting the canine digit. It is important to differentiate them from other digital lesions, with bone involvement, such as malignant digital tumours, which often require more extensive surgery for definitive treatment. The case herein highlights that this lesion can affect simultaneously multiple digits. Definitive diagnosis can be achieved by identification of keratin-producing epithelial cells on histopathology and confirmed by pancytokeratin labelling.

Isolated finger compartment syndrome is an uncommon condition and is not well-documented. It is usually associated with pain, decreased sensation, and intra-compartmental swelling. We present the case of a finger fracture after a crush injury that developed compartment syndrome, which responded well after surgical fixation and midline skin incision for digital decompression. A 20-year-old male with a history of a 200 lb crush-injury to the left index finger 24 hours prior presented to the emergency department with decreased sensation and range of motion, deformity, increasing pallor, and severe pain. Radiographs demonstrated a middle phalanx fracture of the index finger. Digital decompression of the index finger through a radial approach, along the middle line, and open reduction internal fixation of the middle phalanx improved perfusion almost immediately. The patient continued to improve at his one-week, 12-week, and six-month follow-up appointments, with a normal neurovascular exam, a capillary refill of less than two seconds, and, ultimately, he was able to make a full composite fist. Though finger compartment syndrome is uncommon, it should be suspected in cases where the patient demonstrates hallmark clinical signs and symptoms. Compartment syndrome is a clinical diagnosis that requires urgent diagnosis and intervention and must be suspected regardless of the anatomic location of the injury.

Objectives/Interrogation: In pyogenic arthritis of the digits, when diagnosed lately, drainage sinus may occur. Because of combined osteomyelitis, soft tissue destruction, and cartilage damage, it is difficult to treat this situation. In this study, we reviewed 36 cases of chronic pyogenic arthritis[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

Objective: The study aimed to determine the efficacy and outcomes of EAVAST in the treatment of middle and proximal phalangeal fractures in comparison with surgical management. ¬ Materials and Methods: A retrospective cohort study has reviewed the outcomes of middle and proximal finger phalangeal[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

Objectives/Interrogation: Since the development of microsurgical vascular anastomoses, digital replantation has become a well-established procedure in the field of reconstructive hand surgery. Advancements in surgical techniques and peri-operative management of such patients has resulted in high[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

Objectives/Interrogation: Squamous cell carcinoma (SCC) is the commonest malignancy encountered on the hand and is generally treated by surgical resection. Here we present a case managed by primary radiotherapy, which subsequently recurred locally with deep subcutaneous dorsal to volar spread along[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

Objectives/Interrogation: The study aimed to determine the efficacy and outcomes of EAVAST in the treatment of middle and proximal phalangeal fractures in comparison with surgical management. Methods: A retrospective cohort study has reviewed the outcomes of middle and proximal finger phalangeal[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

Regeneration of mammalian limbs is restricted to amputation of the distal digit tip, the terminal phalanx (P3). The adjacent skeletal element, the middle phalanx (P2), has emerged as a model system to investigate regenerative failure and as a site to test approaches aimed at enhancing regeneration. We report that exogenous application of bone morphogenetic protein 2 (BMP2) stimulates the formation of a transient cartilaginous callus distal to the amputation plane that mediates the regeneration of the amputated P2 bone. BMP2 initiates a significant regeneration response during the periosteal‐derived cartilaginous healing phase of P2 bone repair, yet fails to induce regeneration in the absence of periosteal tissue, or after boney callus formation. We provide evidence that a temporal component exists in the induced regeneration of P2 that we define as the “regeneration window.” In this window, cells are transiently responsive to BMP2 after the amputation injury. Simple re‐injury of the healed P2 stump acts to reinitiate endogenous bone repair, complete with periosteal chondrogenesis, thus reopening the “regeneration window” and thereby recreating a regeneration‐permissive environment that is responsive to exogenous BMP2 treatment.

Accidental finger sticks with EpiPens and EpiPen Jr (epinephrine auto-injectors) are a very real hazard in those who carry them and their families. The most feared complications are digital ischemia and necrosis; however, long-term adverse effects are extremely rare. Treatment for a finger stick is controversial, ranging from intra-arterial inj­­ections of vasodilating agents to topical vasodilators to conservative management. We report a pediatric patient suffering from an EpiPen Jr accidental stick to the distal first digit who was successfully managed in a conservative fashion.

The identification of genetic variants implicated in human developmental disorders has been revolutionized by second-generation sequencing combined with international pooling of cases. Here, we describe seven individuals who have diverse yet overlapping developmental anomalies, and who all have de novo missense FBXW11 variants identified by whole exome or whole genome sequencing and not reported in the gnomAD database. Their phenotypes include striking neurodevelopmental, digital, jaw, and eye anomalies, and in one individual, features resembling Noonan syndrome, a condition caused by dysregulated RAS signaling. FBXW11 encodes an F-box protein, part of the Skp1-cullin-F-box (SCF) ubiquitin ligase complex, involved in ubiquitination and proteasomal degradation and thus fundamental to many protein regulatory processes. FBXW11 targets include β-catenin and GLI transcription factors, key mediators of Wnt and Hh signaling, respectively, critical to digital, neurological, and eye development. Structural analyses indicate affected residues cluster at the surface of the loops of the substrate-binding domain of FBXW11, and the variants are predicted to destabilize the protein and/or its interactions. In situ hybridization studies on human and zebrafish embryonic tissues demonstrate FBXW11 is expressed in the developing eye, brain, mandibular processes, and limb buds or pectoral fins. Knockdown of the zebrafish FBXW11 orthologs fbxw11a and fbxw11b resulted in embryos with smaller, misshapen, and underdeveloped eyes and abnormal jaw and pectoral fin development. Our findings support the role of FBXW11 in multiple developmental processes, including those involving the brain, eye, digits, and jaw.

Regeneration of amputated structures is severely limited in humans and mice, with complete regeneration restricted to the distal portion of the terminal phalanx (P3). Here, we investigate the dynamic tissue repair response of the second phalangeal element (P2) post amputation in the adult mouse, and show that the repair response of the amputated bone is similar to the proximal P2 bone fragment in fracture healing. The regeneration‐incompetent P2 amputation response is characterized by periosteal endochondral ossification resulting in the deposition of new trabecular bone, corresponding to a significant increase in bone volume; however, this response is not associated with bone lengthening. We show that cells of the periosteum respond to amputation and fracture by contributing both chondrocytes and osteoblasts to the endochondral ossification response. Based on our studies, we suggest that the amputation response represents an attempt at regeneration that ultimately fails due to the lack of a distal organizing influence that is present in fracture healing.

Ryckie G Wade,1,2 Claire B Paxman,3 Naomi C Tucker,3 Stephen Southern4 1Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK; 2Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK; 3Department of Hand Therapy, Pinderfields General Hospital, Wakefield, UK; 4Department of Plastic and Reconstructive Surgery, Pinderfields General Hospital, Wakefield, UK Objectives: Osteoarthritis (OA) is the most common arthropathy of the hand, and current treatments carry risks of adverse events. Supportive (kinesiology) tape may be analgesic and provide functional improvement, with a low risk of adverse outcomes. We experimented with supportive tape for OA of the proximal interphalangeal joint (PIPJ) of the finger in this pilot randomized trial. Methods: This two-group parallel randomized trial recruited adults with OA of the PIPJ of the finger. We excluded patients lacking capacity or the ability to safely apply the tape. Participants were randomized to receive kinesiology tape on the dorsum of the finger, blind to grouping. Pain was the primary outcome, which was recorded on a visual analog scale (VAS). Secondary outcomes were hand function and adverse reactions. Bootstrapped between-group analyses are reported. Results: Ten patients were included and randomized and provided complete data. There was no significant difference in pain between the groups (mean difference of 0.4 VAS units [95% confidence interval {CI} –1.6, 0.7], p=0.4). Overall, the application of kinesiology tape reduced reported pain by 6% (mean reduction of 0.6 VAS units [95% CI 0, 1.2], p=0.04). Taping did not affect hand function or digital range of motion. There were difficulties in recruiting individuals owing to the lack of dedicated research staff. Conclusion: Kinesiology taping may reduce the pain of OA in the finger; however, whether this is a true effect, placebo effect, Hawthorne phenomenon, or due to a statistical error (ie, type 1 error due to underpowering) is unclear. Hence, further trials are required. Keywords: osteoarthritis, hand, kinesiology, tape, pain, trial, pilot, randomized, PIPJ, proximal interphalangeal joint, digit

Made available in DSpace on 2018-11-12T17:27:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2018. Added 1 bitstream(s) on 2018-11-12T17:35:27Z : No. of bitstreams: 1 S1809-68912018000100309.pdf: 774965 bytes, checksum: dc7b274b75bbdebc949cc763bb2131b7 (MD5) Resumo O exame venográfico permite diagnosticar e tratar afecções da região podal. Pode ser base de estudos sobre a administração de medicação na região do casco. O objetivo do estudo foi descrever o padrão venográfico na região distal dos membros torácicos e pélvicos de ovinos e caprinos saudáveis, bem como comparar a vascularização entre eles. Foram utilizados 10 ovinos e caprinos clinicamente saudáveis, cinco machos e cinco fêmeas de raças diferentes, com idade entre 2 a 4 anos e pesando 45 a 63 kg. Os membros torácicos e pélvicos foram submetidos à venografia contrastada da região distal. Os venogramas foram coletados por um aparelho radiográfico digital e analisados no software EcoView®. As veias da região do metacarpo e metatarso; as falanges proximal, medial e distal dos membros torácicos e pélvicos dos ovinos e caprinos foram identificadas 25-30 segundos após a injeção do contraste. O erro de técnica observado durante a venografia foi o extravasamento perivascular do contraste. Os venogramas revelaram a vascularização na região distal dos membros torácicos e pélvicos e a comunicação dos vasos entre eles. A projeção lateral foi a melhor projeção radiográfica para avaliar os vasos no venograma. O padrão venoso normal da região distal dos membros torácicos e pélvicos de ovinos e caprinos pode ser observado pela venografia. Abstract The venographic examination allows diagnosing and treating foot diseases. It can be the basis of studies about the administration of medication in the hoof region. The aim of the study was to describe the venographic pattern in the distal region of the forelimb and hindlimbs of healthy sheep and goats, as well as to compare vascularization between them. Ten clinically healthy sheep and goats, five male and five female of different breeds, aged 2 to 4 years and weighing 45 to 63 kg were used. The forelimbs and hindlimbs were subjected to contrast venography of the distal region. The venograms were taken in a digital X -ray machine and analyzed in the EcoView® software. The veins of the metacarpus and metatarsus; and the proximal, middle and distal phalanges of the forelimbs and hindlimbs of sheep and goats were identified 25-30 seconds after contrast injection. The technique error observed during the venography was the contrast perivascular extravasation. The venograms showed the vascularization in the distal region of forelimbs and hindlimbs and the communication of vessels between them. The better radiographic view to evaluate the vessels was the lateral projection. The normal venous pattern of the distal region of forelimbs and hindlimbs of sheep and goats could be observed by venography. Universidade Estadual Paulista Universidade Estadual da Região Tocantina do Maranhão Universidade de Uberaba Universidade Estadual Paulista

Macrodystrophia lipomatosa is a rare congenital hamartoma presenting as a localized or generalized gigantism of a limb or digit manifesting from infancy to late adulthood. It is a progressive enlargement of the soft tissue components, especially fibrofatty tissue. The patient presents to us because of cosmetic reasons or mechanical issues secondary to degenerative joint disease, or features of neurovascular compression due to large osteophytes. Here, we present a case of this anomaly of the left second toe with complaints of difficulty in walking and wearing shoes, for which toe reduction surgery with partial amputation was done.

Trigger finger or flexor tenosynovitis is one of the most common reasons for referral to hand surgery outpatient clinics. The lifetime risk of developing trigger finger is between 2% and 3%.1) Patients frequently present with a painful triggering or clicking during active motion of an affected digit. This is due to the loss of normal smooth gliding of the tendon beneath the pulley system, most commonly at the level of the A1 pulley. This may be as a result of a nodule in the tendon or a diffuse swelling within the sheath as a result of a tenosynovitis. In 1953, Howard2) described the technique of steroid injection into the flexor sheath as an effective treatment. It has since become an accepted initial treatment for the condition3) largely due to its ease of use within the outpatient setting, its low complication rate and the low rate of associated morbidity. This study investigated the efficacy of steroid injections at the level of the A1 pulley as a treatment for trigger digit. It also considered whether the efficacy of steroid injection is related to the severity of the condition at presentation, the presence of two common co-morbidities-diabetes and osteoarthritis-the presence of a nodule and the digit in which the tenosynovitis was present. The study is unique in that it uses Green's classification for the severity of the condition and it investigates the efficacy of the steroid injections in all the individual digits.

El uso de imagenes avanzadas en las evaluaciones diagnosticas del paciente es cada vez mayor, asi como la disponibilidad de maquinas para la practica veterinaria. El proposito de este estudio fue proporcionar un atlas de anatomia por tomografia computarizada sincronizada normal y seccion transveral del metacarpo y los dedos en el camello de una joroba y bufalos de agua Egipcios para proporcionar una base para el diagnostico de sus enfermedades con la ayuda de TC. Fueron obtenidas y fotografiadas imagenes anatomicas de TC transversales de 1 cm contiguas y de seccion transversal. Las estructuras anatomicas de aplicacion clinica fueron identificadas y etiquetadas en cada nivel. En ambos animales, la cavidad medular de los huesos metacarpianos tercero y cuarto fusionados se dividio internamente por un septo vertical de hueso, el cual era un septo completo en el camello y completo en los extremos proximal y distal en los bufalos, y pequenos e incompletos en la parte principal de eje de fusion de los huesos metacarpianos en los bufalos. La TC mostro tanto en camellos como en bufalos a los tendones extensores adyacentes como una correa transversal estrecha con los contornos indiferenciados en la cara dorsal de los metacarpianos fusionados, falanges proximales y falanges media y, los tendones flexores adyacentes como una masa mas o menos redondeada con contornos no diferenciados en la cara palmar de la fusion de los huesos metacarpianos, falanges proximales y falanges medias. Las lineas diferenciadas de los tendones extensores o flexores adyacentes en las imagenes de TC fue equivalente a la anatomia de seccion transversal sin diseccion de la fascia de intervencion, donde las lineas no aparece en el ultimo. Por lo tanto, la anatomia de seccion transversal es superior a la TC solo cuando la intervencion diseca la fascia. Las imagenes de TC del presente estudio tienen el potencial para convertirse en parte de nuestra investigacion de diagnostico estandar para las regiones anatomicas previamente dificiles de evaluar en el camello y el bufalo.

The digit tips of children and rodents are known to regenerate following amputation. The skeletal structure that regenerates is the distal region of the terminal phalangeal bone that is associated with the nail organ. The terminal phalanx forms late in gestation by endochondral ossification and continues to elongate until sexual maturity (8 weeks of age). Postnatal elongation at its distal end occurs by appositional ossification, i.e. direct ossification on the surface of the terminal phalanx, whereas proximal elongation results from an endochondral growth plate. Amputation through the middle of the terminal phalanx regenerates whereas regenerative failure is observed following amputation to remove the distal 2/3 of the bone. Regeneration is characterized by the formation of a blastema of proliferating cells that appear undifferentiated and express Bmp4. Using chondrogenic and osteogenic markers we show that redifferentiation does not occur by endochondral ossification but by the direct ossification of blastema cells that form the rudiment of the digit tip. Once formed the rudiment elongates by appositional ossification in parallel with unamputated control digits. Regenerated digits are consistently shorter than unamputated control digits. Finally, we present a case study of a child who suffered an amputation injury at a proximal level of the terminal phalanx, but failed to regenerate despite conservative treatment and the presence of the nail organ. These clinical and experimental findings expand on previously published observations and initiate a molecular assessment of a mammalian regeneration model.

REASONS FOR PERFORMING STUDY Understanding of the biomechanical effects of egg-bar shoes remains incomplete because kinematic studies are usually performed on hard tracks and with skin markers that do not measure the actual 3-dimensional (3D) movements of the 3 digital joints. OBJECTIVE To quantify the effects of egg-bar shoes on the 3D kinematics of the distal forelimb in horses walking on a sand track. METHODS Four healthy horses were equipped with ultrasonic markers fixed surgically to the 4 distal segments of the left forelimb. The 3D movements of these segments were recorded while the horses were walking on a sand track. Rotations of the digital joints were calculated by use of a joint coordinate system. Data obtained with egg-bar shoes were compared to those obtained with standard shoes. Mean differences were expressed in a 0.95 confidence interval. RESULTS With egg-bar shoes, the initial sinking of the heels into the ground during landing was reduced and the heels were raised by up to 5.1 degrees (3.5-6.7 degrees) compared to standard shoes at mid-stance. Concurrently, maximal flexion of the distal (DIPJ) and proximal (PIPJ) interphalangeal joints was increased by up to 3.2 degrees (2.2-4.2 degrees) and 1.8 degrees (1.1-2.5 degrees), respectively, at the beginning of the stance phase. At heel-off, extension of the DIPJ was reduced by 3.8 degrees (2.6-5.0 degrees). In extrasagittal planes of movement, egg-bar shoes prevented sinking of the medial quarter into the ground which led to a slight decrease of DIPJ medial rotation and lateromotion. CONCLUSIONS Egg-bar shoes prevent the heels and, to a lesser extent, the medial side of the hoof from sinking into the ground on a sand track. They contribute to a decrease of DIPJ maximal extension at heel-off and to hoof stabilisation in the transversal plane. POTENTIAL RELEVANCE Such quantitative results support the clinical indications of egg-bar shoes.

Proximal digital annular ligament (PDAL) desmitis occurs in horses for which PDAL desmotomy is the only reported treatment. The presented work aims to develop a technique for safely performing PDAL desmotomy in horses. Twenty hind limbs and 13 forelimbs, harvested from horses dead or euthanized for reasons unrelated to any structure in the pastern region, were used. All horses were free of disease at the level of their PDAL. Proximal digital annular ligament desmotomy was performed using a minimally invasive approach to the digital flexor tendon sheath between the palmar (plantar) annular ligament and the PDAL, using a medial or a lateral access. Limbs were immediately dissected after the procedure to assess the completeness of the PDAL desmotomy and any possible damage to surrounding structures. The PDAL was successfully transected in all limbs except one. Damage to the surrounding tissue included transection of the palmar digital nerve (n = 1), longitudinal tear of the superficial digital flexor tendon (n = 3), and transection of the ligament of the ergot (n = 21). A medial approach was found to be safer than a lateral approach. In conclusion, PDAL desmotomy can be performed in a safe, repeatable, and technically easy way. This is, to our knowledge, the first report of a standardized technique for performing a PDAL desmotomy in the horse.

Injury that occurs to a finger wearing a ring though rare can have grave consequences. It is a preventable injury which has a peculiar mode of trauma that is usually occupational. Injury ranges from simple contusion to degloving of soft tissues to traumatic amputation. We hereby report our experience of four cases of finger avulsion injuries due to a ring and discuss their variable clinical presentation and individualized management.

A case of preputial glomangioma in an 8-year-old Springer Spaniel dog is reported. The dog presented a solitary nodular mass, approximately 3.5 x 5.2 cm in diameter, located on the lateral wall of the prepuce at the base of the penis. Histologically, the excised tumour mass consisted of proliferating round epithelioid cells arranged in a cordon-like structure around small blood vessels. The neoplastic cells were positive for alpha smooth muscle actin and negative for cytokeratin, desmin, S-100 protein and neurone-specific enolase. Based on these pathologic features, the tumour was diagnosed as glomangioma, a neoplasm extremely rare in dogs. To our knowledge, this is the first report of preputial glomangioma in the dog.

FGF signalling is critical for normal embryonic development. Sulf1 has been shown to inhibit FGF activity. The role of FGF4 in Sulf1 regulation was investigated during digital development of the quail autopod. Implantation of FGF4 beads in both the interdigit and at the tip of digit III differentially up-regulated Sulf1 as also confirmed in micromass cultures. FGF4 inhibited interdigital mesodermal apoptosis in a concentration dependent manner. The FGF inhibitor, SU5402, inhibited Sulf1 expression when placed in the interdigital mesoderm. However, when placed at the digital tip, SU5402 induced an ectopic domain of Sulf1 expression and inhibited further phalange formation.