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Digital Deformities in Rheumatoid Arthritis
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Much less common than a thumb in “Z” (7 to 20%), this deformation is explained by an initial deterioration of the trapezo-metacarpal joint and all the surrounding elements (Figure 7.5). The productive synovitis of the trapezo-metacarpal joint will distend the joint capsule and cause instability. The combined forces of traction of the abductor pollicis longus (APL) and the pressures exerted during the pollici-digital grip will gradually succeed the first metacarpal base to subdislocation in the dorsal and radial position. This results in an articular destruction (trapezo-metacarpal joint) and the permanent adduction of the first metacarpal bone. Alternatively, the adductor presents an analgesic contracture which will close the first web space. The other joints of the thumb will present deformities adaptive to this metacarpal vicious attitude, in order to maintain the function of the pollici-digital pinch: Hyperextension of the MCP joint with distension of the palmar plate and stiffness of the IP joint (Figure 7H).
Hitch-Hiker’s Thumb
Published in Michael E. Mulligan, Classic Radiologic Signs, 2020
Maurice Lamy and Pierre Maroteaux’ wrote that first 1960 article and described three patients with what they named diastrophic (twisted) dwarfism. They emphasized that the findings of club feet, a thoracic (dorsal) scoliosis and a normal skull should allow one to differentiate this new condition from the most common form of dwarfism, achondroplasia, with which it might be confused. In 1968, Angel Vazquez and Fred Lee2 (Children’s Hospital of Pittsburgh) reported two additional cases. They used the term hitch-hiker’s thumb in the radiographic description of the hand deformity of their second patient (Figure 1). ‘The first metacarpal bones are markedly hypoplastic, and the thumbs appear low set and laterally directed in a ‘hitch-hiker’s’ position.’2
Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
This is the commonest place for the metacarpal bones to fracture. These fractures usually involve axial load to a clenched fist, i.e. punching a hard object (e.g. ‘boxers’ fifth metacarpal neck fracture, actually rarely found in boxers). There is usually apex dorsal angulation (depressed knuckle and head protrudes into palm), since the intrinsics are volar and maintain a flexed MC head/MCPJ posture. The soft tissues including muscles around the metacarpal bones may help to reduce the distortion to a certain extent, but significant deformities may still result.
Salvage of Devascularized and Amputated Upper Extremity Digits with Temporary Ectopic Replantation: Our Clinical Series
Published in Journal of Investigative Surgery, 2022
Burak Sercan Erçin, Fatih Kabakaş, Burak Ergün Tatar, Musa Kemal Keleş, Ismail Bülent Özçelik, Berkan Mensa, Pedro C. Cavadas
A 61-year-old man was admitted to the emergency department with an industrial crush injury involving the radial rays of the left hand (Figure 11A). When we checked the X-ray first metacarpal bone, the mid-and distal phalanx of the index finder were intact (Figure 11B). Additionally, thenar and dorsal skin were crushed. The thumb was devascularized and useless. We planned to build one acceptable ray from two involved rays (Figure 12). At first, we wanted to transfer the mid-and distal phalanx of the index digit on top of the first metacarpal bone. However, the thenar and dorsal skin were severely injured, and it was better to wait for demarcation (Figure 12). The distal index digit was ectopically banked to the contralateral forearm (Figure 13A). Digital arteries were anastomosed to radial artery end-to-side fashion veins anastomosed to accompanying veins of the radial artery (Figure 13B).
Estimation of joint contact pressure in the index finger using a hybrid finite element musculoskeletal approach
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Barthélémy Faudot, Jean-Louis Milan, Benjamin Goislard de Monsabert, Thomas Le Corroller, Laurent Vigouroux
Joint contact pressure on cartilage surfaces and Von Mises stress distribution on bones of the index finger during a pinch grip task for one dataset of tendon forces are displayed in Figure 4. The highest stress was found on the surface of the metacarpal bone. High stress-intensity regions were visible at bone-pulley and bone-ligament interfaces because of the node coupling points (Figure 4). However, these highly localized stresses were due to numerical artefacts and considered not representative of the real bone condition. Finger joint contact areas were computed by summing all the facets bearing contact force and yielded 55.3 ± 2.9 mm2, 79.4 ± 2.2 mm2 and 105.0 ± 3.5 mm2 for DIP, PIP and MCP joints, respectively. Mean contact pressure was calculated by averaging pressure values on the contact area at each joint (Figure 4). For DIP, PIP, and MCP joints, maximal contact pressure was 32.6 ± 9.0 MPa, 34.0 ± 8.4 MPa, and 37.2 ± 7.5 MPa and mean contact pressure was 6.9 ± 2.7 MPa, 6.2 ± 1.0 MPa, and 7.2 ± 1.3 MPa, respectively, as shown in Table 5.
Closed extensor tendon rupture following neck fracture of the fifth metacarpal (Boxer’s fracture): a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Sacha Lardenoye, Pascal F. W. Hannemann, Jan A. Ten Bosch
Metacarpal neck fractures represent 40% of all hand fractures. Fifth metacarpal neck fractures (Boxer’s fractures) account for 25% of all metacarpal fractures [1,2]. A fracture at the neck of the metacarpal bone is usually the result of the energy caused by axial forces to a clenched fist. This typically results in apex dorsal deformity mainly due to forces of the interosseous muscles. The majority of fractures are closed injuries and do not require surgical treatment [2,3]. Neck fractures of the fifth metacarpal with apex dorsal angulation as high as 70°can be treated conservatively with good functional results [4]. Poor cosmetic result and malunion with shortening and with subsequent minimal extension lag are known complications. Literature shows no statistically significant differences in functional outcome between conservative and surgical treatment of displaced fractures of neck of the fifth metacarpal bone in terms of grip strength or range of motion at the metacarpophalangeal joint (MCP) [5]. In open fifth metacarpal neck fractures and other open direct clenched-fist traumas (for instance fight bites), extensor tendon injury is described [6]. However, as far as we know, no literature is available describing extensor tendon rupture following closed metacarpal neck fractures. This report describes one case of a complete rupture of the extensor tendons following a closed fifth metacarpal neck fracture.