Search

The use of advanced imaging in diagnostic patient evaluations is increasing as well as the availability of machines for veterinary practices. The purpose of this study was to provide an atlas of synchronized normal computed tomography and cross sectional anatomy of the metacarpus and digits in the one-humped camel and Egyptian water buffalo to provide a basis for diagnosis of their diseases by the aid of CT. One cm contiguous transverse CT images and cross sectional anatomy were obtained and photographed. Clinically applicable anatomic structures were identified and labeled at each level. In both animals, the medullary cavity of the fused third and fourth metacarpal bones was divided internally by a vertical bony septum which was a complete septum in the camel, complete at the proximal and distal extremities in the buffalo and small and incomplete in main part of fused shaft of metacarpal bones in buffalo. The CT of the present study in both camel and buffalo showed the adjacent extensor tendons as transverse narrow strap with undifferentiated outlines on the dorsal aspect of fused metacarpal bones, proximal phalanges and middle phalanges and the adjacent flexor tendons as roughly rounded mass with undifferentiated outlines on the palmar aspect of fused metacarpal bones, proximal phalanges and middle phalanges. The undifferentiated outlines of the adjacent extensor or flexor tendons in CT images is equivalent to cross sectional anatomy without dissection of the intervening fascia, where the outlines didn't appear in the latter also. Therefore, the cross sectional anatomy is superior to CT only when the intervening fascia is dissected. CT images of the current study have the potential to become part of our standard diagnostic investigation for anatomic regions previously difficult to be evaluated in the camel and buffalo. [ABSTRACT FROM AUTHOR]

We recently developed continuous negative pressure therapy with irrigation (NPI) and successfully applied it to an infected digit with a narrow wound. With this technique, however, the dressing circumferentially wraps the digit or hand, and the pressure that the digit or hand receives and the influence on peripheral circulation are unclear. In this report, we evaluated the external pressure that a digit and hand received during NPI in vitro. Under circumferential NPI dressing, the skin perfusion pressure (SPP) of the peripheral portion was measured. Pressure was maintained at 1.3 mm Hg, and suction pressure ranged from -50 to -200 mm Hg. The pressure that a digit or hand receives during NPI is much lower than that at which tissue may be damaged (40-50 mm Hg). The SPP of the peripheral portion was much higher than 40 mm Hg, which is the pressure at which wound healing may be predicted. In clinical cases, NPI has been useful for wound bed preparation. [ABSTRACT FROM AUTHOR]

Abstract: Although not uncommon, dislocation of the toes, including that of the great toe, is not commonly reported in published studies. In the present report, we describe a series of 18 patients with toe dislocations managed by our department from January 2001 to December 2007. We considered the radiographic pattern of injury in our series of patients. Of the 18 patients, 10 (55.56%) had their toe dislocations treated by closed reduction with or without internal fixation. Seven patients (38.89%) with complex dislocation, defined as open dislocation or dislocation not amenable to (failed attempt) closed reduction, that required open reduction and internal fixation. One patient (5.56%) with a dislocated toe declined to undergo any form of treatment. [Copyright &y& Elsevier]

We investigate linear relations between pattern sequences in a 〈 q, r〉-numeration system, and give a basis of the module generated by pattern sequences for words of length not exceeding l. The expressions of pattern sequences using the basis are also studied. Similar results are obtained for the module generated by all pattern sequences. [ABSTRACT FROM AUTHOR]

When tendons, bones or joints are exposed in infected digits, functional and cosmetic sequelae are frequent. We propose continuous negative pressure therapy with irrigation (NPI) for an infected digit with an open wound. Continuous NPI was evaluated in vitro and subsequently applied to a clinical case. Acceptable functional and cosmetic results were obtained without any problems when continuous NPI was performed in the clinical case. Continuous NPI may be a useful alternative for treatment of an infected digit with an open wound. [ABSTRACT FROM AUTHOR]

This article examines the histological features of skeletal-extraskeletal angiomatosis in a dog. Angiomatosis is composed of multiple tumor-like lesions caused by congenital or developmental malformations of blood vessels. Clinical history recorded hemorrhagic and painful lesion in the base of the claw of the second digit of the right forelimb. The gross appearance of the amputated limb is described.

Purpose: We examined the anatomic location of recurrences of digital glomus tumors treated with surgical excision to make inferences on the causes of recurrence. Methods: We retrospectively reviewed 12 cases of glomus tumors of the hand treated surgically over an 8-year period. Two of these patients presented with recurrences after previous glomus tumor excision surgery elsewhere. The location of recurrences, duration of symptoms, gender, revision surgeries, and histological specimens were analyzed. Results: All tumors developed in the periungual and subungual area of the digits. Five of the 12 patients had recurrences, with one of these patients having a second recurrence after revision surgery. All recurrent tumors occurred in new, separate locations from the original lesions. The recurrences presented from 2 months to 5 years after the initial surgery. All surgical specimens from the index surgeries, as well as revision procedures, were examined by a pathologist and confirmed to be glomus tumors. There were no discernible differences in the histology features of the tumors that recurred compared to those that did not. Conclusions: Traditionally, recurrences of digital glomus tumors after surgical excision are thought to be rare. Inadequate resection was considered the likely cause in most cases. However, recurrent symptoms might be attributed to small, synchronous, satellite lesions not detected during the original surgery. A careful preoperative and intraoperative examination for synchronous lesions should be made, and patients should be informed of the risk of recurrent symptoms. [Copyright &y& Elsevier]

Introduction. Circumferential measurements (CMs) are used by hand therapists to monitor digital oedema. There are a range of tape measures available commercially to measure digital circumference, but none of them have any data to support their reliability or validity. Method. Observational measurement studies using a repeated measures design were undertaken to assess if a weighted tape measure, used with a protocol, could provide accurate and reliable CMs of swollen digits. In study 1, validity and responsiveness were determined by two raters measuring 16 steel bars of known circumferences and comparing the known measurements to those taken with the weighted tape. In study 2, intra- and inter-rater reliability was assessed by three raters measuring 12 prosthetic digits. In study 3, 27 swollen digits were measured by three raters to assess intra- and inter-rater reliability of the raters using the weighted tape in a clinical setting. The analysis of validity was based on the Bland-Altman plots. Reliability was based on the intraclass correlation coefficient (ICC). Results. There was near-perfect agreement between the measurements taken by two assessors at the start and end of the trial and the actual circumference of the steel bars (all mean differences ,1 mm). A minimum change in circumference of 2 mm could be detected with the same rater and a change of 3 mm could be detected with a different rater. On swollen digits the ICC values were significantly greater than 0.9 for both inter- and intrarater reliability. The lowest values for inter-rater reliability were ICC 0.983 (0.965-0.992) and for intrarater reliability were ICC 0.978 (0.954-0.990). Discussion. The weighted tape measure has been shown to be valid and reliable in this study when used with a protocol for measuring swollen digits. It was easy to use and may become a clinically useful tool. [ABSTRACT FROM AUTHOR]

A tremendous increase in the use of the Internet for online communication is witnessed worldwide. Yahoo! Inc., provides one such service in the form of Yahoo! Groups. Each such group is identified and accessed using a unique group identifier. This paper presents digit-wise statistics and a detailed analysis of the usage of digits based on the study of nearly 1,400 unique Yahoo group identifiers containing digits. The results show that one-fourth of the total usage of digits is contributed by the digit 0, whereas the three digits 0, 1 and 2 collectively contribute more than 50% of the total digit usage. A number of areas that influence the selection of a digit or digits by the users in the design process have also been identified. To the best of our knowledge this is the first attempt to study online user behavior based on the usage of digits for designing a unique online identifier. [ABSTRACT FROM AUTHOR]

Summary: Background: The authors present their clinical experience and surgical methods of soft-tissue coverage for the finger using a posterior interosseous free flap. Methods: Twelve posterior interosseous free flaps, including two dual-paddle flaps, were performed in 12 patients. Indications included: 1) patients with soft-tissue coverage of the dorsum of the finger (n =4), pulp (n =1), fingertip and pulp (n =5), 2) patients subsequent to release of finger and palm contracture (n =1) and 3) patients subsequent to finger separation (n =1). The posterior interosseous vessels were ligated below the level at which the motor branch to the extensor carpi ulnaris crossed the vessel superficially. The recipient vessels were the proper digital artery and palmar subcutaneous vein (n =10), deep branch of the ulnar palm artery (n =1), superficial branch of the radial palm artery (n =1) and the vena comitante. The cosmetic appearance of the donor and recipient sites, static two-point discrimination and active total range of motion of the operated finger were evaluated in a follow-up visit. Results: All flaps survived completely and all donor sites were closed directly, leaving a linear scar. De-fatting of the flap was carried out in one case in the late postoperative period; all other patients achieved a cosmetically acceptable result. Static two-point discrimination scores averaged 11mm (range: 8–15mm). Postoperatively, seven patients maintained normal flexion and extension of the joint. Two patients who had experienced a fracture and flexor injury recovered near-normal flexion and extension after flexor release; the other patients only recovered partially due to severe preoperative joint stiffness. Preoperatively, the active total range of motion of the operated fingers averaged 187 (range: 20–260). The average active total range of motion of the operated fingers at the last follow-up was 210 (range: 60–260). There was a significant difference between the preoperative and follow-up values (p =0.042). Conclusions: The posterior interosseous free flap may become one valuable option for finger re-surfacing. Avoiding the sacrifice of a main artery of the hand and shorter pedicle can reduce the morbidity and operative time associated with this procedure. In addition, separate regions can be reconstructed with a dual-paddle flap. [Copyright &y& Elsevier]

Purpose: Trauma to the digits often leaves soft tissue defects with exposed bone, joint, and/or tendon that require soft tissue replacement. The objective of this study was to evaluate the effectiveness of acellular dermal regeneration template combined with full-thickness skin grafting for soft tissue reconstruction in digital injuries with soft tissue defects. Methods: Acellular dermal regeneration template was used to reconstruct digital injuries with exposed bone, joint, tendon, and/or hardware not amenable to treatment with healing by secondary intention, rotation flaps, or primary skin grafts. Acellular dermal regeneration template was applied to 21 digits in 17 patients. Nineteen digits had exposed bone, 8 digits had exposed tendon, 6 digits had exposed joints, and 2 digits had exposed hardware. The acellular dermal regeneration template was sutured over the soft tissue defect. Over 3 weeks, a neodermis formed. The superficial silicone layer of the acellular dermal regeneration template was removed, and the digits received full-thickness epidermal autografting with cotton bolster. Results: The duration of postoperative follow-up extended to a minimum of 12 months. For the injury sites where acellular dermal regeneration template was applied, the total area of application ranged from 1 cm2 to 24 cm2, with the largest individual site measuring 12 cm2. Twenty of 21 digits demonstrated 100% incorporation of the acellular dermal regeneration template skin substitute. One digit that had sustained multilevel trauma developed necrosis requiring revision amputation. Full-thickness epidermal autografting was performed an average of 24 days after acellular dermal regeneration template skin substitute application and demonstrated a 100% take in 16 of 20 digits and partial graft loss of 15% to 25% in 4 of 20 digits that did not require further treatment. Conclusions: Acellular dermal regeneration template combined with secondary full-thickness skin grafting is an effective method of skin reconstruction in complex digital injuries with soft tissue defects involving exposed bone, tendon, and joint. The neodermis increases tissue bulk and facilitates epidermal autografting with digital injuries that otherwise would require flap coverage or skeletal shortening of the digit. Type of study/level of evidence: Therapeutic IV. [Copyright &y& Elsevier]

A new method for feature extraction based on FPGA (Field Programmable Gate Arrays) implementation is proposed in this paper. The specific application is offline Farsi handwritten digit recognition. The classification is based on a simple two layer MLP (Multi Layer Perceptron). This method of feature extraction is appropriate for FPGA implementation as it can be implemented only with addition and subtraction operations. The proposed method is used to extract the features from normalized 40x40 pixel handwritten digit images from Standard Hoda database. Exprimentally results showed that the proposed system achived about 96% accuracy. Overally the system is simple, more accurate and less complex than the other similar systems. [ABSTRACT FROM AUTHOR]

In tetrapod limbs, an anteriormost digit has common traits of small, short and less-phalange morphology. In this study, we focused on three genes, Mkp3, Sef and Tsukushi (TSK), which have anterior-specific or anterior-prominent expression patterns in the developing limb bud at the autopod-forming stage. The anterior expression is not fixed in the period of limb development, but the expression domains of Mkp3, Sef and TSK change considerably from the distal domain to the anterior domain. This change in expression domains, anterior shift, of these genes involves maintenance of gene expression in the anterior side and downregulation in the posterior side. Manipulated overdose of fibroblast growth factor (FGF) in the presumptive digit 2 region of chick forelimb bud results in elongation of cartilage elements of digit 2, suggesting that attenuated FGF signaling, which Mkp3, Sef, and TSK negatively regulate, provides digit 2-specific traits of morphology. The anterior expression of Mkp3 and Sef but not TSK is conserved also in limb buds of the mouse and gecko, and the anterior shift of these genes, accumulation of their transcripts in the anterior side and appropriate regulation of strength of FGF signaling may control species-specific morphology of the anteriormost digit. [ABSTRACT FROM AUTHOR]

Summary: It is well known that percutaneous fasciotomy must not be realized at the digital level because of the risks of iatrogenic nervous injury. The purpose of this study is to verify if the percutaneous fasciotomy in the digital level is responsible or not for sensory complication by injury of the collateral nerves, thanks to the precise sensory analysis of a series of twenty five palmodigital or digital fasciotomies. Our series included 20 patients operated on between September 2006 and June 2008, as a total of 25 fingers. Only one patient presented preoperative sensory disorders. It was a multi-operated finger. The patients were operated on in one-day surgery by two senior surgeons using percutaneous fasciotomy in the palm and the digit. The analysis of the results consisted in studying at follow-up pain, DASH score, and discriminative sensibility by the static test of Weber, and the test of mono strands of Semmes Weinstein. The postoperative average follow-up was of 10 months. The pain was on average 1.8/10 and the DASH score of 19.77/100. The statistical analysis of the discriminative sensibility showed that there was no significant difference in the average of the results between the hemi-pulp of the operated finger and that of the not operated finger (test of Weber 0.1< p <0.5; test of Semmes Weinstein 0.5< p <1). A single patient had a bad result at the same time in the Weber and in the Semmes Weinstein. It was a patient operated on several times. Our study shows that the digital percutaneous fasciotomy provokes no sensory disorder. Consequently, it is possible to spread the indications of percutaneous fasciotomy to Dupuytren''s contracture in the digital region. [Copyright &y& Elsevier]

Abstract: Digit and interdigit (D/ID) development is one of the important research fields in molecular developmental biology. Interdigital cell death (ICD) is a morphogenetic event which has been considered as an essential process for D/ID formation. Although some growth factors including Bmp and Fgf signaling can modulate ICD, growth factor crosstalk regulating ICD is poorly understood. Wnt canonical pathway and Bmp signal crosstalk has been considered as the essential growth factor crosstalk in organogenesis. To elucidate the crosstalk to regulate the D/ID formation, we analyzed conditional mutant mice with limb bud ectoderm expressing constitutively activated β-catenin signaling. We showed that modulation of Wnt/β-catenin signal in the limb ectoderm including the AER regulates ID apoptosis. We also demonstrated that Wnt/β-catenin signaling in the ectoderm can positively regulate Fgf8 possibly antagonizing the epithelial derived Bmp signaling. Human birth defects for digit abnormalities have been known to be affected by multiple parameters. Elucidation of the potential mechanisms underlying such D/ID development is an urgent medical issue to be solved. This work would be one of the first studies showing essential growth factor cascades in the D/ID formation. [Copyright &y& Elsevier]

Small-eared shrews (Mammalia, Soricidae) of the New World genus Cryptotis are distributed from eastern North America to the northern Andes of South America. One well-defined clade in this genus is the Central American Cryptotis mexicana group, whose members are set off from other species in the genus by their variably broader fore feet and more elongate and broadened fore claws. Two species in the C. mexicana group, Cryptotis goodwini Jackson and Cryptotis griseoventris Jackson, inhabit highlands in Guatemala and southern Mexico and are presumed to be sister species whose primary distinguishing feature is the larger body size of C. goodwini. To better characterize these species and confirm the identification of recently-collected specimens, we obtained digital X-ray images of the manus from large series of dried skins of both species. Measurements of the metacarpals and phalanges successfully separated most specimens of C. goodwini and C. griseoventris. These measurements also show that the fore feet of C. griseoventris from Chiapas, Mexico, are morphologically distinct from those of members of the species inhabiting Guatemala. Univariate, bivariate, and multivariate analyses indicate that fore foot characters are more conservative within species of the C. mexicana group than are cranio-mandibular characters. Patterns of evolution of fore foot characters that superficially appear to be linear gradations are actually more complex, illustrating individual evolutionary trajectories. No claim to original US government works. Journal compilation © 2010 The Linnean Society of London, Biological Journal of the Linnean Society, 2010, 99, 118–134. [ABSTRACT FROM AUTHOR]

Toe syndactyly is a common congenital malformation affecting approximately 1 in 2000 people and can cause significant emotional and psychological distress for the patient. We report a case of a 41-year-old female who was concerned about the aesthetic appearance of her bilateral second and third toe with incomplete, simple syndactyly and had requested surgical correction. A number of operative techniques have been described in the orthopedic and plastic surgery data, with no one technique proving superior. We used medical tattooing to create the appearance of a complete interdigital cleft. This low-risk, and low-cost procedure resulted in a satisfactory outcome for the patient. To the best of our knowledge, this is the first reported case using this technique, which we propose as a simple alternative to surgical correction of toe syndactyly. [ABSTRACT FROM AUTHOR]

A eight year old multiparous crossbred Holstein Friesian cow was presented with congenital growth in palmar aspect of distal phalanx of right forelimb, which was bleeding following trauma. The mass was firm and non-fluctuating with a wide base. The mass was excised as closely as possible and post-operatively, antibiotics and analgesics were given. Histopathology revealed that growth was lipoma. [ABSTRACT FROM AUTHOR]

The purpose of this study was defining the normal structures of the digits and hoof in Holstein dairy cattle using Magnetic Resonance Image (MRI). Transverse, Sagital and Dorsoplantar MRI images of three isolated cattle cadaver digits were obtained using Gyroscan T5-NT a magnet of 0.5 Tesla and T1 Weighted sequence. The MRI images were compared to corresponding frozen cross-sections and dissect specimens of the cadaver digits. Relevant anatomical structures were identified and labeled at each level. The MRI images provided anatomical detail of the digits and hoof in Holstein dairy cattle. Transversal images provided excellent depiction of anatomical structures when compared to corresponding frozen cross-sections. The information presented in this paper would serve as an initial reference to the evaluation of MRI images of the digits and hoof in Holstein dairy cattle, that can be used by radiologist, clinicians, surgeon or for research propose in bovine lameness. [ABSTRACT FROM AUTHOR]

Abstract: It is now recognized that geometric structures of scaffolds at several size levels have profound influences on cell adhesion, viability, proliferation and differentiation. This study aims to develop an integrated process to fabricate scaffolds with controllable geometric structures at nano-, micro- and macro-scales. A phase-separation method is used to prepare interconnected poly(l-lactide) (PLLA) nanofibrous (NF) scaffolds. The pore size of the NF scaffold at the scale of several hundred micrometers is controlled by the size of porogen, paraffin spheres. At millimeter scale and above, the overall shape of the scaffold is defined by a wax mold produced using a three-dimensional printer. The printer utilizes a stereo lithographic file generated from computed tomographic files retrieved from the National Library of Medicine''s Visual Human Project. NF PLLA scaffolds with a human digit shape are successfully prepared using this process. Osteoblast cell line MC3T3-E1 cells are then seeded and cultured in the prepared scaffolds. Cell proliferation, differentiation and biomineralization are characterized to demonstrate the suitability of the scaffolds for the digit bone tissue engineering application. [Copyright &y& Elsevier]

The reconstruction of digital pulp defects is still a challenge in hand surgery. Several reconstructive techniques are available, but in some cases, their advancement capacities are not sufficient for the flap to cover the whole defect. The Gigogne flap is a new, very simple and safe technique. It consists of harvesting two cutaneous flaps successively on the same neurovascular digital palmar bundle. The first plasty may be chosen among the well-known flaps usually applied in pulp reconstruction. The second plasty, the Gigogne flap, is an advancement VY plasty done on the main cutaneous paddle of the first proximal flap. We performed 15 Gigogne flaps in 13 patients, who suffered zone II and III digital pulp amputations. The Gigogne flap increased the advancement capacity of the proximal flap as well as restoring the physiological pulp fatty pad, thus reconstructing a functional and aesthetic fingertip. [ABSTRACT FROM AUTHOR]

Abstract: While functional imaging studies in humans have consistently reported activation of primary somatosensory cortex (SI) with painful stimuli, the specific roles of subdivisions of areas 3a, 3b, and 1 within SI during pain perception are largely unknown, particularly in the representation of mechanical evoked pain. In this study, we investigated how modality, location, and intensity of nociceptive stimuli are represented within SI by using high-spatial resolution optical imaging of intrinsic signals in Pentothal-anesthetized squirrel monkeys. Perceptually comparable mechanical nociceptive and innocuous tactile stimuli were delivered by indenting the glabrous skin of the distal finger pads with 0.2 and 2mm diameter probes, respectively. Within each of areas 3a, 3b, and 1, activations to mechanical nociceptive stimulation of individual distal finger pads were spatially distinct and somatotopically organized. We observed differential cortical activation patterns. Areas 3a, 3b, and 1 were all activated during mechanical nociceptive stimulation and were modulated by nociceptive stimulus intensity. However, with innocuous tactile stimulation, mainly areas 3b and 1 exhibited response modulation with different levels of stimulation. In summary, mechanical nociceptive inputs are area-specific and topographically represented within SI. We propose that all areas of SI are implicated in encoding the features of mechanical nociception, where areas 3a and 3b are distinctively involved in coding nociceptive and pressure sensation components of stimulation. [Copyright &y& Elsevier]

Distal sesamoidean ligament injury is a recognized cause of lameness but diagnosis using ultrasonography is sometimes difficult. Herein, we describe the normal appearance of the distal sesamoidean ligaments on magnetic resonance (MR) images and the changes that occur when the ligaments are injured. The appearance of the distal sesamoidean ligaments on MR images from 66 control horses and 58 horses with distal sesamoidean desmitis were described and the cross-sectional area and signal intensity of the ligaments measured. In control horses, the ligaments had a characteristic appearance and strong left–right symmetry, and the lateral oblique sesamoidean ligament was larger and had higher signal intensity than the medial ligament. Cross-sectional area and signal intensity were significantly greater in injured straight sesamoidean ligaments compared with the controls. Signal intensity increased significantly with oblique sesamoidean desmitis compared with the controls. Lesions of the distal sesamoidean ligaments were considered the sole cause of lameness in only 2 of 58 horses. Eighty percent of lesions in the distal sesamoidean ligaments were not detected using ultrasonography. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Bowen’s disease (BD), a form of squamous cell carcinoma in situ, can transform into invasive squamous cell carcinoma and should be treated aggressively. Although standard treatment for BD is electrodessication and curettage, radiotherapy (RT) can be used for those patients who are poor surgical candidates or when surgery could result in a poor cosmetic and functional outcome. Surgical treatment of BD of the digit can result in poor function and sometimes amputation. Here, we report our experience using a unique water bath technique to treat BD of the digit. Materials and methods: This retrospective review evaluates the outcomes and toxicity of nine consecutive patients with BD of the digit treated with RT between 1999 and 2004. Fourteen digit lesions were immersed in a water bath and treated with photon irradiation. The median radiation dose delivered was 50Gy (range 25–66Gy) in 2.5Gy fractions (range 2–3Gy). Results: The median age of the patients treated was 77 years (range 29–87 years). Three patients (33%) had more than one digit treated. With a median follow-up of 25 months (range 0.4–52 months), all 14 digit lesions are locally controlled. The majority of lesions demonstrated mild to moderate erythema, desquamation, or edema (grade 1–2) acutely following RT which resolved within one month of treatment. Two digits (14%) developed ulcers (grade 4) which healed following RT. The only long-term toxicity was decreased sensation and strength in one patient who had three circumferential lesions. This toxicity was limited and did not appear to influence the patient’s daily activities (grade 2). Conclusions: These preliminary results demonstrate high rates of tumor control with minimal morbidity following definitive RT in the treatment of BD of the digit, and suggest that RT may be a viable treatment alternative to surgery for selected lesions. Through a multidisciplinary assessment, treatment of BD of the digit can be individualized to optimize patient care. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]

Abstract: Myositis ossificans (MO) is a reactive zonal fibroosseous lesion in skeletal muscle of the proximal extremities and trunk of young patients. It generally matures over several weeks to form a peripheral rim of bone. Fibroosseous pseudotumor of the digits (FOPD) is a similar reactive lesion of the digits, which is reportedly less well organized. Cases up to year 1980 were previously reported from our institution. We examined new cases of FOPD since 1980 and addressed the relationship of this lesion to both myositis ossificans and other distal extremity fibroosseous lesions. Fifty-two cases coded as FOPD or MO limited to the hands and feet, from 1980 to the present, were retrieved from our files. Nine cases were excluded due to incomplete material or rediagnosis as other lesion. Materials reviewed included radiologic images and pathologic material. Forty-three cases of FOPD were included. All cases were in the fingers, except for 1 toe case, with the proximal phalanx of the index finger the most commonly affected site. Duration of lesions was radiologically estimated to range from 2 to 6 weeks. Age of patients ranged from 10 to 64 years (mean and median of 40 years). Sixty percent of cases occurred in women. Morphologically, half of these lesions had a zonal organization, with mature woven bone peripherally and immature woven bone centrally; all bone demonstrated osteoblastic rimming. Clinically, 6 patients had known antecedent trauma, yet edema and pain of the digit were noted in all. Novel findings were that patients often had occupations requiring repetitive manual labor. Cases of FOPD were diagnosed and treated by simple excision. Three patients had residual disease, subsequently resected, without any recurrences. Fibroosseous pseudotumor of the digits is a distinctive, benign, reactive myofibroblastic and osseous zonal lesion that occurs in the finger of mainly adult patients, many with occupations that require repetitive manual use. Imaging can date these lesions, determine their exact location, and help with diagnosis. These lesions are the superficial and distal counterparts of MO. It is important to understand the morphology of FOPD to distinguish this type of lesion from other benign and malignant fibroosseous lesions. [Copyright &y& Elsevier]

The authors present their technique for treating digital ischemia using a radial-to-digital artery bypass graft performed in a bloodless field under tourniquet with the use of a microscope. The outcomes in 6 patients were resolution of fingertip ulcers, avoidance of more proximal amputations, and elimination of ischemic pain. [Copyright &y& Elsevier]

Abstract: 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. [Copyright &y& Elsevier]

The specialization of the forelimb into a wing allowed bats to become the only mammals to achieve powered flight. Recent studies in developmental biology have begun to elucidate the molecular mechanisms behind elements of this important morphological transformation. Specifically, researchers have identified molecular changes contributing to: the formation of the bat wing membrane, the elongation of skeletal elements of the bat wing and the reduction of the bat ulna. The general picture emerging from this research is that small changes in the expression of genes critical to many aspects of development have driven large changes in bat wing morphology. Thus, bats can be added to the growing list of groups in which expression changes in key developmental genes have been linked to the evolution of morphological innovations (e.g. early bilaterians, cetaceans, insects). Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We quantified the extent of adaptive radiation in the evolution of the hindlimb in the bird-of-prey community on Tasmania. Assessments of the ecological capabilities of raptor species are often based on a visual inspection of their hindlimb structure, with little recourse to direct biomechanical or functional evidence. We examined the links between hindlimb structure and patterns of diet, foraging, and habitat use in raptors by analytically investigating tarsus, toe, and talon measurements. We identifed groupings on the basis of dietary preference, hunting-killing technique, and phylogeny. We found that the bird-catching specialists, which possessed relatively long digits with short talons, were consistently separable. The large-mammal and fish specialists were equipped with relatively short and robust tarsi, and short digits with long and robust talons. The hindlimbs of medium-mammal specialists were characterized by long digits and a large digit 1 talon. However, the generalist group did not possess any specializations, because their structural elements were comparable to those of other dietary groups. An association was found between the ratio of toe to talon length and the selective pressures of prey capture and ease of killing. Morphological variation in this feature was consistent with phylogeny, because the Accipitridae were characterized by a larger ratio of toe to talon length on digits 1 and 2 than the Falconidae, and the diurnal raptors possessed an interdigital pattern of larger variation in ratio of toe to talon length than the nocturnal raptors. No link was found between dietary habit and tarsus length or robustness, because these features were apparently attributed to variations in hunting style. Our analysis highlights the interrelationship between the morphology of hindlimb structure and the functional pressures associated with predatory lifestyles. [ABSTRACT FROM AUTHOR]

Summary: Coverage of the dorsal aspect of the fingers is difficult, especially when the soft tissue defect is large and involves extensor apparatus and joints. Tendinous and/or articular reconstruction is not usually performed simultaneously with cutaneous repair. The aims of this study were: (1) to accurately determine the precise position of the first common dorsal metatarsal artery (FDMA) on the dorsal aspect of the foot, and (2) to enumerate the anatomical structures which could be harvested ‘en-bloc’ in order to design composite flaps. The precise position of the FDMA was studied from 22 anatomical specimens after selective injection of the arterial network. Its cutaneous area measured 75×40mm on average. The extensor apparatus of the second toe was supplied by the FDMA and its lateral branch to the second toe by 2.7 branches on average over a length of approximately 75mm. The medial dorsal digital artery was generally the main source of blood supply to the proximal interphalangeal joint (PIP), capsule, ligaments, head of proximal phalanx and base of middle phalanx. It is then possible to design composite flaps including both skin and extensor apparatus, and total or partial PIP joint, if necessary, based on the FDMA and the medial dorsal digital artery, without prejudice to the second toe. The average length of the arterial pedicle (60mm) makes its suture to the dorsal metacarpal artery, the dorsal carpal branch or the radial artery easy. The harvesting technique for such a flap is described for each anatomical type of FDMA; it has to be adapted to both the type and extent of the defect. Its use is in accordance with the modern classical principle of ‘all in one stage with early mobilisation’, thanks to adequate coverage whose blood supply does not depend on local vascularisation, and which brings its own physiological vascular supply. [Copyright &y& Elsevier]

Although ultrasonography is widely used in equine orthopedics, its use in the distal portion of the digit is still limited. The purpose of this descriptive study was to document the normal ultrasonographic appearance of the palmarodistal aspect of the digital area imaged between the bulbs of the heels. Ultrasonographic images were obtained with a 7.5 MHz microconvex transducer in 10 fresh equine cadaver forelimbs and five sound horses. Sagittal, parasagittal, and transverse images were obtained from the proximal aspect of the middle phalanx to the distal sesamoid bone. Anatomic sections were obtained from five cadaver specimens to correlate the sonographic appearance with the anatomic findings. The remaining cadaver limbs were dissected to confirm normalcy. Ultrasonographic examinations were possible on all digits but distal images were more difficult to obtain in digits with long heels. Bony structures (palmar surface of the middle phalanx and proximal border of the distal sesamoid bone) and soft tissue structures (deep digital flexor tendon, digital tendon sheath, proximal palmar recess of the distal interphalangeal joint, proximal recess of the podotrochlear bursa, collateral sesamoidean ligaments) identified on the anatomic slices were seen on the matched sonographic images. Ultrasonography provides good anatomic details of the palmarodistal aspect of the digit. The images of this study will serve as a reference for clinical studies on ultrasonography of the palmarodistal aspect of the digit. [ABSTRACT FROM AUTHOR]

Primary giant cell tumours involving digital bones of the hand are rare lesions which are generally diagnosed at an advanced stage. Accurate diagnosis requires clinical evaluation, imaging studies and histopathological assessment. Conservative treatment by digit-sparing surgery is associated with high recurrence rates. In a ten year retrospective review, this study identified only four cases. Three cases involved a phalanx and were treated by distal amputation of the involved digit. None recurred. One involved the metacarpal and recurred twice following repeated curettage and bone grafting. No further recurrence has been detected after resection and replacement with a non-vascularised fibular graft and Silastic implant replacement of the metacarpophalangeal joint. Our small series of cases supports a policy of aggressive primary surgery, including amputation or en bloc resection and reconstruction. [Copyright &y& Elsevier]

Magnetic resonance imaging has revolutionized the diagnosis of foot-related pain, defining many soft tissue injuries that had previously been poorly recognized and greatly enhancing our understanding of pathological abnormalities of the navicular bone. The concept of multiple injuries contributing to lameness has been recognized. It has become clear that lesions may predate the onset of lameness. A better understanding of pain causing lameness is required. [Copyright &y& Elsevier]

Mice are currently the species of choice for the in vivo study of injury, but few detailed anatomical descriptions have been made of rodent digits, limiting their use for the investigation of intrasynovial tendon healing. In this study a detailed microscopic and histological investigation was performed using C57/BL6 and Tie2 LacZ reporter gene transgenic mice. Serial-sectioned mouse hindpaw digits were characterized using haematoxylin and eosin, Masson's trichrome (collagen), Alcian blue (fibrocartilage), Miller's stain (elastin) and TRITC-phalloidin (cellular cytoskeleton) staining. Digital vasculature was demonstrated using FITC-labelled dextran perfusion studies supplemented with LacZ expression in Tie2 LacZ transgenic mice digits. Imaging of the digit used a combination of brightfield and confocal microscopy with three-dimensional reconstruction. Our findings demonstrated that the mouse hindpaw possesses deep and superficial flexor tendons within a synovial sheath comparable with that found in other mammalian species. The intrasynovial tendons were avascular and had regions of fibrocartilaginous specialization relating to areas of compression. Corresponding vascular networks were demonstrated around the sheath using Tie2 LacZ mice and FITC-perfused hindpaws. Furthermore, there is an area of digit where both deep and superficial tendons reside between two pulleys, similar to zone 2 in the human hand where it would be possible to study intrasynovial tendon injury and adhesion formation. In conclusion, although the dimensions of the mouse digit pose technical challenges for surgical intervention, we have identified a model for the study of flexor tendon injury that will permit future genetic manipulation studies. [ABSTRACT FROM AUTHOR]

Fingertip amputations through the distal 50% of the nail matrix usually create a finger that is best served by maintaining length. When the amputation is more proximal than this, revision with ablation of the small residual nail unit may provide greater overall patient satisfaction. When amputations in the distal 50% of the nail matrix are transverse or short oblique in orientation, a flap of some kind is needed to restore the contact surface of the pulp. Many alternative reconstructive strategies are possible but have inherent limitations that detract from the quality of the final result. Inadequate padding, lack of sensibility, excessive tension, hook nail deformity, poor durability, and donor site morbidity are but some of the considerations. Although not a panacea for all distal fingertip amputations, the antegrade-flow homodigital neurovascular pedicle flap offers a good ratio of advantages to disadvantages. As with all flaps, knowledge and execution of the details largely determine the outcome. [Copyright &y& Elsevier]

Abstract: Background: Digital nerve blocks are widely used prior to minor surgery to the digits but the injections are associated with some degree of unwanted pain and anxiety. Methods to reduce the pain associated with injection, such as cryotherapy, are therefore worthwhile. However, cryotherapy (e.g. ice) applied prior to digital injections has received little scientific evaluation. Objective: This study aimed to assess whether there was any change in pain associated with an injection into the hallux, if the site of injection was first refrigerated using ice. Method: Twenty participants each received two injections of lignocaine into the hallux (one each on the medial and lateral sides) as a standard digital nerve block. Prior to each injection, participants were randomized to receive either no-ice or a six-minute application of ice over the injection site. The primary outcomes were needle-stick pain and infiltration pain measured on a visual analogue pain scale. Results: The application of ice significantly reduced needle-stick pain, with the median scores for the no-ice and ice injections being 57 and 16mm, respectively (P <0.001). With respect to infiltration pain, however, there was no significant difference in the median scores (49 and 47mm, respectively, P =0.204). Nevertheless, 16 out of 20 participants preferred ice prior to the injection. Only four indicated no preference and none indicated a preference for no-ice. Conclusion: Icing the digit prior to injection is an effective and inexpensive method to reduce the discomfort of a local anaesthetic injection. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this study was to investigate growth patterns in human hands, digits and digit ratio (2D:4D) during the fetal period. Methods: The study is carried out on 161 human fetuses (83 males, 78 females) free from external pathology or malformation with ages ranging between 9 and 40 weeks of gestation. Following general external measurements, length and width of the hand, digit lengths separate for each hand was measured, hand index and the ratio of the lengths of the 2nd finger to the 4th finger (2D:4D index) was computed. Results: Means and standard deviations of the parameters with respect to gestational weeks, months and trimesters were calculated. There was a significant correlation between all parameters and gestational age (p <0.001). No significant differences were observed between sexes or sides for any of the parameters (p >0.05). 2D:4D ratio was significantly higher in females compared to males (p <0.05) and mean 2D:4D did not change with gestational age. Conclusion: Detailed information of hand and digit parameters related to the fetal period will reveal the extent of biological variations of hand and digit parameters to be used in future studies. We hope that data acquired in this study will facilitate other studies on hand and digit anomalies, pathologies and variations as well as diagnoses and treatments of such conditions conducted in obstetrics, perinatology, forensic medicine and fetal pathology departments. [Copyright &y& Elsevier]

Abstract: We report a series with the adipofascio cutaneous flap of the dorsal aspect of long fingers used with an anterograde or retrograde pedicle. Thirty flaps were performed in 29 patients with a mean age of 43 years, 16 cases in emergency and 13 cases secondary for the treatement of traumatic sequelae. The adipofascial pedicle was retrograde for 22 flaps and anterograde for 8 flaps. The donor site was adjacent of the cutaneous defect in 21 cases or at a distance in 9 cases. Transcient veinous congestion was observed in 2 cases. No necrosis was reported. A second surgery of plasty was performed in 1 case for a cutaneous bulk. The quality of the cutaneous coverage gave any functional discumfort and was evaluated very satisfying. These flaps have an important adaptabily of utilization depending on the localisation and the size of the cutaneous defect as well as the quality of its surrounding skin. The homodigital feature of these flaps avoids the disadvantages of the dorsal hand flaps or the heterodigital flaps. Due to their anastomotic vascularisation, these flaps are reliable and therefore can be recommended for the treatment of dorsal cutaneous defects of long fingers less than 2.5 cm. [Copyright &y& Elsevier]

Methylnitrosourea (MNU) is a multisystem teratogen that damages proliferating cells through macromolecule alkylation and generation of reactive oxygen species (ROS). Murine dams exposed to MNU midgestation produce offspring with distal limb malformations, an outcome reduced by maternal immune stimulation. Immunostimulatory effects of antioxidant therapy may in part explain this improved birth outcome. The present study hypothesizes that placental, rather than fetal, damage from excessive ROS may contribute to MNU-induced embryopathy. Fetal limbs and placentas were examined in immunotolerant CD-1 and immunosensitive C57BL/6N mice exposed to MNU, dietary antioxidant butylated hydroxytoluene (BHT), or both. MNU increased fetal resorptions and incidence of syndactyly, oligodactyly, polydactyly, and interdigital webbing, and decreased fetal size in both mouse strains. BHT reduced syndactyly and oligodactyly in both strains, and reduced polydactyly in C57BL/6N mice. Increased webbing in MNU and MNU+BHT groups likely represented maturational delay. Placentas from CD-1 and C57BL/6N MNU-exposed dams demonstrated decreased trophoblasts and increased necrosis of endothelium. Similar to distal limb defects, placental damage was reduced in mice receiving MNU+BHT. These results suggest that placental damage and fetal defects caused by MNU are in part ROS-mediated, and reduced distal limb defects following MNU+BHT may be related to improved placental integrity and function. [Copyright &y& Elsevier]

Problem Immunostimulation reduces murine teratogen-induced birth defects. It is unclear if placental improvement contributes to this outcome. The current study examined murine placental ultrastructure and fetal limb development following maternal methylnitrosourea (MNU) exposure, ±Freund's complete adjuvant (FCA) immunostimulation. Method of study Two murine strains (CD-1, C57BL/6N) were administered MNU on gestation day 9 (GD9), FCA pre-breeding, or FCA + MNU. Fetal limb and placental development were examined on GD14. Results MNU decreased placental weight and reduced placental cellular viability; FCA reversed these effects. MNU shortened fetal limbs and increased digital defects in both strains. Placentas were less damaged in C57BL/6N versus CD-1 mice, and distal limb malformations improved only in CD-1 mice. FCA immunostimulation also increased pregnancy rate. Conclusion Improved fetal outcome from immune-stimulated mice may not be dependent on improved placental morphology. However, placental function and morphology in immune-stimulated mice may not directly correlate, thus functional improvements should be examined for possible relationship to reduced birth defects. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to develop a visualization tool for the investigation of the contact mechanics at the object-digit interface and force coordination among multiple digits during manipulation tasks. Five miniature six-component force/torque transducers, mounted on a custom-made instrumented handle, were used to record force/torque data at the tips of individual digits during five-digit manipulation tasks. A digitizing device was used to obtain three-dimensional (3-D) coordinates of anatomical landmarks of the hand for the construction of a hand geometric model. The 3D hand model and force data from transducers were transformed to a common handle csordinate frame so that force vectors were superimposed on digit-tips. One subject performed three static manipulation tasks (grasping, rotating, and lifting) with maximum voluntary contraction on the stabilized instrumented handle. The magnitude and orientation of the force vectors of individual digits were dependent on the tasks, and the subject tended to maximize task efficiency by utilizing different force coordination strategies for different tasks. The visualization methods developed in this paper could potentially provide an effective tool for the examination of object-digit interaction mechanics and interdigit force coordination. [ABSTRACT FROM AUTHOR]

Abstract: Growth/differentiation factor 5 (GDF5) is a member of the bone morphogenetic protein (BMP) family, which has been implicated in several skeletogenic events including cartilage and bone formation. To study the role of GDF5, we analyzed digit development in brachypodism (bp) mice, which carry functional null mutations of the Gdf5 gene and exhibit a reduction in the length of digit bones and loss of the middle phalanges. In situ detection of apoptosis and whole-mount detection of cell death showed abnormal apoptosis in the developing phalanges of bp mice. In situ hybridization in bp mice showed overexpression of Gdf5 mRNA in the developing phalanges where apoptotic cells were increased. In addition, bp mice exhibited excessive apoptosis in the interdigital regions. The condensed mesenchymal cells were progressively decreased in the developing phalanges and failed to form cartilage models of the middle phalanges. These findings show that excessive apoptosis in the absence of GDF5 results in developmental failure of the phalanges. We conclude that GDF5 is essential for maintenance and growth of the developing phalanges. [Copyright &y& Elsevier]

Ueo T, Kashima K, Daa T, Kashima N, Tsuji K, Hisaoka M, Yokoyama S. A case of tenosynovial chondromatosis with tophus-like deposits. APMIS 2004;112:624–8.Tenosynovial chondromatosis has not been well recognized because of its rarity, but it is clinically important because of its high rate of recurrence. We report here a case of tenosynovial chondromatosis with deposits of crystalline material that appeared to be sodium urate (gouty tophi). A 37-year-old Japanese man was admitted because of a hard mass in his left third finger. He had undergone surgery at the same anatomical site four and seven years previously. The roentgenogram revealed a soft tissue mass in the flexor aspect of the proximal phalanx. At operation, the tumor was found to have arisen in the tendon sheath. Histopathological examination showed that the tumor was composed of well-defined, multiple, cartilaginous nodules that were surrounded by tenosynovial tissue. A few of the nodules were calcified. The chondrocytes had mild atypia, and were immunopositive for S-100 protein. A diagnosis of tenosynovial chondromatosis was made. The nodules also contained crystalline deposits, which bore a histological resemblance to gouty tophi. We were unable to define the exact nature of these deposits even by transmission electron microscopy and electron roentgenographic microanalysis. Crystalline deposits in chondromas of soft tissue have been reported but not in tenosynovial chondromatosis. [ABSTRACT FROM AUTHOR]

We have analyzed the spatial and temporal patterns of B lymphocyte-induced maturation protein-1 (Blimp-1) expression during mouse embryonic development. Blimp-1 expression is induced early in the anterior definitive endoderm, mesoderm of head process, and prechordal plate. In ectoderm-derived tissues at later stages, Blimp-1 expression is found in the primitive photoreceptors of neural retina, in differentiated epithelial cells of epidermis, tongue, oral and nasal cavities, and in the precursors of internal root sheaths of hair follicles. In mesoderm-derived tissues, Blimp-1 expression is observed in splanchnopleure, a subset of somatopleure-derived cells in limb buds, and myotomes of somites. Blimp-1 is also expressed in mesenchyme of developing hand plates, digits, branchial arches, nasal processes, and external genitalia. Blimp-1 is present in mesenchyme-derived chondroblasts, supporting cells of taste buds, and papilla of teeth, hair follicles and taste buds. In endoderm-derived tissues, Blimp-1 expression in the foregut region is restricted to a subset of epithelial cells at the headfold stage while expression in the endodermal epithelium of midgut and hindgut persists from the headfold stage to birth. Finally, Blimp-1 is expressed in the migrating primordial germ cells. [Copyright &y& Elsevier]

A test procedure for evaluating vasospasm in hand digits using cold water immersion at 15°C for a period of 10 minutes is described, and the result of initial and repeat tests on 25 subjects who volunteered for a control group study are reported. Digit skin temperatures were continuously recorded and the recovery temperatures were noted while the hands were immersed and for a further 10 minutes afterwards in air. Five from their history and test results were determined to have Raynaud'sdisease or Constitutional White Finger,and a further 5 subjects with no history of cold hands or Raynaud's phenomenon had non-repeatable test results indicative of an asymptomatic sub-clinical state. A statistical analysis of the results from the 15 normal control subjects provides reference data (means and standard deviations) for the maximum skin temperature at 10 minutes immersion, and the skin recovery temperatures postcold stress at 1 minute intervals in air. This objective test is frequently used for evaluating cold induced vasospasm in hand digits, and the normative data provided will enable abnormal subjects to be identified. Additional reference data is provided for use with vibration exposed workers to permit the severity of the vasospasm to be graded in accordance with the Stockholm vascular scale for Hand-arm Vibration Syndrome (HAVS). [ABSTRACT FROM AUTHOR]