Test Paper 1
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
A young woman presents to the AED following a scuffle on a night out. On examination, there is a suspected fifth metacarpal fracture of her right hand. A plain radiograph is subsequently organised. This does not demonstrate a fracture, but it is noted that the patient has relatively short fourth metacarpal bones. Old chest films show bilateral inferior rib notching involving the third to sixth ribs bilaterally. What is the likely diagnosis? Noonan syndromeTurner syndromePseudohypoparathyroidismMarfan syndromeAchondroplasia
Hitch-Hiker’s Thumb
Michael E. Mulligan in 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
Tor Wo Chiu in 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.
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.
A case report of multi-compartmental lipoma of the hand
Published in Case Reports in Plastic Surgery and Hand Surgery, 2018
Maria A. Bocchiotti, Arianna B. Lovati, Loris Pegoli, Giorgio Pivato, Alessandro Pozzi
The surgery was carried out under axillary block and by tourniquet hemostasis. The mass was dorsally approached through a curved skin incision over the IV inter-metacarpal space (Figure 2(A)). The mass laid in the subfascial space, and after careful dissection from the dorsal interosseous muscles that were displaced by the tumor had been dissected from the volar compartment. The inter-metacarpal ligament between the fourth and the fifth metacarpal bones was left intact as there was enough space for the mass to be pulled dorsally and dissected (Figures 2(B,C)). No intramuscular infiltration was evident. Marginal excision of the lesion was performed and the encapsulated elliptical mass (70 mm length, 35 mm width) was removed en bloc from both the volar and dorsal compartments. It appeared as a lobular fatty mass (Figure 2(D)). Immediately after surgery, the hand was protected with a volar splint that left the metacarpal–phalangeal joint free to move. Ice was applied over the wound to prevent swelling and edema.
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.
Related Knowledge Centers
- Appendicular Skeleton
- Bone
- Hand
- Carpal Bones
- Forearm
- Joint
- Body
- Phalanx Bone
- Finger
- Wrist