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Upper limb
Published in David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings, McMinn’s Concise Human Anatomy, 2017
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings
A 20-year-old woman fell on her outstretched hand and immediately experienced severe wrist pain. Palpation of the anatomical snuffbox exacerbated the pain. A radiograph is most likely to reveal a fracture of which of the following?Styloid process of the ulna.Scaphoid bone.Distal radius (Colles’ fracture).Capitate bone.First metacarpal bone.
Simultaneous non-union of scaphoid and capitate: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Ryunosuke Fukushi, Kohei Kanaya, Kousuke Iba, Toshihiko Yamashita
Jethanandani et al. [5] conducted a review of surgical treatment and conservative treatment using casts and braces for capitate fractures and reported that with surgical treatment being superior, immobilisation using rigid internal fixation and autologous bone fragments are effective. In addition, retrograde screw fixation is considered ideal according to the hemodynamics of the capitate bone. In our patient, we achieved bone union of the capitate through internal fixation similarly using retrograde screws and iliac bone transplantation.
Primary hypertrophic osteoarthropathy with severe arthralgia identified by gene mutation of SLCO2A1
Published in Modern Rheumatology Case Reports, 2021
Tatsuo Ishizuka, Kei Fujioka, Ichiro Mori, Tomofumi Takeda, Masayuki Fuwa, Takahide Ikeda, Koichiro Taguchi, Hiroyuki Morita, Kazuhiko Nakabayashi, Hironori Niizeki
PDP is a rare familial disorder characterised by coarse facial features, gyrate scalps, clubbed finger and painful joint enlargement with reduced penetrance for the females [7–9]. Castori et al reviewed 204 published case from 68 families with PDP, and found that 37 families showed autosomal dominant inheritance while autosomal recessive was found in the remaining families [4]. The genetic mutations associated with PDP have been identified in HPGD and SLCO2A1, which involved in prostaglandin E2 metabolism [10,11]. The patient showed high level of urinary prostaglandin E2 levels (68 µg/g creatinine, normal level 17 µg/g creatinine) which caused severe arthralgia [12]. Identification of mutations in the prostaglandin transporter gene SLCO2A1 and its phenotype-genotype correlation in 6 Japanese patients with PDP had been investigated as follows [13]. From initial analyses of whole exome sequencing data, mutations in SLCO2A1 gene encoding prostaglandin transporter were found in 3 patients which showed 5 different SLCO2A1 mutations (c.940 + 1G > A, p.E427_p430del, p.G104*, p.Q556H) in 4 unrelated PDP patients. In addition, the splice-site mutation c.940 + 1G > A identified in 3 of 4 PDP patients was determined to be a founder mutation in the Japanese population. The combination of these SLCO2A1 mutations in PDP patients is also associated with disease severity. In this case the mutations of p. Arg288Glyfs*7 were identified. Hypertrophic osteoarthropathy and pachydermia were already diagnosed by dermatologist and severe arthralgia appeared at 38 years-old. MRI imaging in the right hand showed erosions of capitate bone, synovitis and bone marrow oedema, which were similar to the finding in image inspection of rheumatoid arthritis. Previous reports indicated non-steroidal anti-inflammatory drugs had affected on arthralgia in PDP patients [14]. However, in this case no effects of bDMARDS such as etanercept and tocilizumab with methotrexate and NSAIDs on severe arthralgia were observed, and only baricitinib slightly improved arthralgia. We indicated that patient-received outcome including visual analogue scale and general health assessment was more improved by tsDMARD compared with NSAID, DMARDS and bDMARDS in our case. Further treatments will be necessary for severe arthralgia. Moreover, past history of the patients showed ileus at 12 years old and partial gastrectomy due to gastric ulcer at 13 years old, and he was diagnosed as gastric erosion and ulcer in the rest of stomach by endoscopic examinations. Umeno et al. have been advocated that the patients of chronic non-specific multiple ulcers of the small intestine with mutations in the SLCO2A1 are named as chronic enteropathy associated with SLCO2A1 gene (CEAS) which are compatible with this case [4,5]. Above mentioned new findings, we suggested three points of view. Firstly, severe arthralgia probably associated with the mutations of SLCO2A1, c.940;1G > A. Secondly, any bDMARDS did not affect severe arthralgia. Thirdly, gastrointestinal problems also have existed. Finally analyses of accumulations of PDP patients will attain the new treatments of abnormality of prostaglandin transporter protein.