Fixation of Mallet Fractures Using a Modified Hook Plate Technique: A Prospective Case Series of 17 Patients / Fixação de fraturas em martelo com técnica de placa de gancho modificada: Uma série de casos prospectivos de 17 pacientes

Abstract Objective Various modalities have been suggested to manage mallet fractures; however, inappropriate treatment can lead to extension lag, a swan neck deformity, or arthritis of the distal interphalangeal joint (DIPJ). The current study aimed to evaluate the results (functional, radiological, and complications) of open reduction and internal fixation (ORIF) of mallet fractures using low-cost hook plates fabricated from low-profile titanium mini plates. Methods A prospective case series of 17 consecutive patients (average age of 32.3 years) with mallet fractures (six were Wehbe Type IB and 11 were Wehbe Type MB). Eleven (64.7%) were males. The affected hand was dominant in all patients, and the affected digit was the index in 6 (35.3%), the ring in 5 (29.4%), the small in 3 (17.65%), and the middle in 3 (17.65%) patients. The same fellowship-trained hand surgeon performed all surgeries. Results The average operative time was 37.65 minutes. After an average follow-up of 10.94 months (range 6-27), the average DIPJ motion was 50º º (range 20º-70º), the extensor lag was noted in 4 (23.5%) patients, and complications were reported in 6 (35.29%) patients. According to Crawford criteria, 6 (35.3%) patients achieved excellent results, 7 (41.2%) achieved good results, and 4 (23.5%) achieved fair results. Conclusion The modified hook plate technique for fixation of mallet fractures is a beneficiai, economical, yet demanding technique that adequately provides stable fixation to allow early DIPJ motion with acceptable functional outcomes.

Resumo Objetivo Diversas modalidades têm sido sugeridas para o tratamento de fraturas em martelo; no entanto, o tratamento inadequado pode causar retardo de extensão, deformidade em pescoço de cisne ou artrite da articulação interfalangiana distal (AIFD). Este estudo teve como objetivo avaliar os desfechos (funcionais, radiológicos e complicações) da redução aberta e fixação interna (RAFI) das fraturas em martelo com placas de gancho de baixo custo fabricadas com mini placas de titânio de baixo perfil. Métodos Série de casos prospectivos de 17 pacientes consecutivos (idade média de 32,3 anos) com fraturas em martelo (seis do tipo IB e 11 do tipo IIB de Wehbe). Onze (64,7%) pacientes eram do sexo masculino. A mão acometida era a dominante em todos os pacientes, com acometimento do dedo indicador em seis (35,3%), anelar em cinco (29,4%), mínimo em três (17,65%) e médio em três (17,65%) pacientes. O mesmo cirurgião de mão experiente realizou todas as cirurgias. Resultados O tempo operatório médio foi de 37,65 minutos. Após um acompanhamento médio de 10,94 meses (intervalo de 6 a 27), observou-se movimento médio da AIFD de 50º (intervalo de 20º a 70º), retardo de extensão em quatro (23,5%) pacientes e complicações em seis (35,29%) pacientes. De acordo com os critérios de Crawford, os desfechos foram excelentes em seis (35,3%), bons em sete (41,2%) e regulares em quatro (23,5%) pacientes. Conclusão A técnica da placa de gancho modificada para fixação de fraturas em martelo é benéfica e econômica, mas exigente; permite fixação estável e adequada para permitir a movimentação precoce da AIFD com desfechos funcionais aceitáveis.

Artroplastia interfalángica proximal de dedo de la mano con doble injerto osteocondral de costilla. Reporte de un caso y descripción de la técnica quirúrgica / Proximal interphalangeal finger arthroplasty with double osteochondral rib graft. Case report and description of the surgical technique

Se presenta el caso de un hombre de 27 años con una lesión grave articular interfalángica proximal en el dedo anular de la mano derecha, provocada por un proyectil de arma de fuego, que fue tratada con doble injerto osteocondral de costilla. Tenía una fractura expuesta y déficit de stock óseo y cartilaginoso tanto en la primera como en la segunda falange. Luego de la limpieza inicial, a las 3 semanas, se realizó una artroplastia interfalángica proximal con doble injerto osteocondral de costilla y fijador externo distractor de Suzuki. Se describe con detalle la técnica quirúrgica.A las 10 semanas posoperatorias, la flexión activa interfalángica era de 75° y la extensión activa, de -15°, con articulación estable. Alta laboral a los 3 meses de la cirugía, sin dolor y un puntaje DASH de 14,2. Las radiografías mostraron la incorporación de los injertos, sin reabsorción y con una articulación congruente.Se valora la ventaja de esta técnica en cuanto a la escasa morbilidad para la zona dadora y la versatilidad para las reconstrucciones con defectos articulares. El resultado funcional temprano subjetivo y objetivo fue satisfactorio. No se pueden descartar complicaciones futuras. Nivel de Evidencia; IV

We present the case of a 27-year-old male patient with a gunshot wound and severe proximal interphalangeal joint injury in the ring finger of the right hand, treated with a double osteochondral rib graft. He had an exposed fracture and a lack of bone and cartilage stock in both the first and second phalanx. After the initial toilette, at 3 weeks, a proximal interphalangeal arthroplasty was performed with a double osteochondral rib graft protected by a Suzuki external distractor. The surgical technique is described in detail. At 10 weeks after surgery, an active interphalangeal joint flexion of 75° and active extension of -15° were verified, without articular instability. The patient returned to work at 3 months after surgery, with no residual pain (0 VAS score) and a DASH score of 14.2. Radiographs showed incorporated grafts without resorption and a congruent joint. This technique is valued for its low morbidity on the donor site and versatility for joint defect reconstructions. The limitations of our study are mentioned. The clinical case presented obtained a satisfactory subjective and objective early functional outcome. Further complications cannot be ruled out. Level of Evidence: IV

Estudio comparativo entre banda de tensión y tornillo compresivo para la artrodesis interfalángica proximal y metacarpofalángica / Comparative study between tension band and compression screw fixation in metacarpophalangeal and proximal interphalangeal joint arthrodesis

Introducción: Los métodos más utilizados para la artrodesis de la articulación interfalángica proximal y metacarpofalángica son la banda de tensión y el tornillo compresivo. El objetivo de este estudio fue comparar los resultados entre pacientes tratados con estas técnicas. Materiales y Métodos: Estudio comparativo retrospectivo de 10 años. Se incluyeron pacientes esqueléticamente maduros tratados por artrosis y artritis. Se analizaron la tasa de consolidación ósea, el tiempo hasta la consolidación, la incidencia de complicaciones y la tasa de reoperaciones. En un análisis secundario, se compararon los pacientes reumáticos y no reumáticos. Resultados: Se evaluaron 56 casos en 44 pacientes (edad promedio 53 años). Grupo 1: 35 casos tratados con banda de tensión y grupo 2: 21 tratados con tornillo compresivo. Había 32 casos reumáticos y 24 no reumáticos. El seguimiento promedio fue de 24 meses. La tasa promedio de consolidación fue del 94,2% en el grupo 1 y del 85,7% en el grupo 2. La incidencia de complicaciones fue del 11,4% en el primer grupo y 23,8% en el segundo, y la tasa de reoperaciones, del 17,1% y del 0%, respectivamente. Conclusiones: Ambos métodos permiten lograr tasas altas de consolidación, pero la incidencia de seudoartrosis fue casi tres veces superior con el tornillo compresivo que con la banda de tensión. La tasa más alta de reoperaciones en el grupo con banda de tensión fue por extracción del material. El tiempo de consolidación fue más corto en los pacientes no reumáticos, independientemente de la técnica. Nivel de Evidencia: III

Introduction: Tension band wiring (TBW) and compression screw fixation are the most common methods used for proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joint arthrodesis. The aim of this study was to compare outcomes between patients treated with those methods. Materials and Methods: A 10-year retrospective comparative study. The study population included skeletally mature patients treated for osteoarthritis or arthritis. Union rates, healing times, complications, and reoperation rates were compared between TBW and compression screw fixation methods. Outcomes were also studied in terms of rheumatic and nonrheumatic patients. Results: The study sample consisted of 56 cases and 44 patients (average age, 53 years). Group 1: 35 patients treated with TBW. Group 2: 21 patients treated with compression screw fixation. There were 32 rheumatic cases and 24 nonrheumatic cases. The average follow-up was 24 months. Union rates were 94.2% (Group 1) and 85.7% (Group 2). Complication rates were 11.4% (Group 1) and 23.8% (Group 2). Reoperation rates were 17.1% (Group 1) and 0% (Group 2). Conclusions: Both methods have high union rates; however, the nonunion incidence in the compression screw group was almost three times higher than in the TBW group. The reoperation rate was higher in the TBW group, mostly due to hardware removal. Healing time was shorter in non-rheumatic patients regardless of the method. Level of Evidence; III

Osteoma osteoide de falange. Reporte de cinco casos y revisión bibliográfica / Phalanx osteoid osteoma. Five-case report and literature review

Introducción: El osteoma osteoide de falange es un cuadro infrecuente. El objetivo de este artículo es presentar cinco pacientes con diagnóstico histopatológico de osteoma osteoide de falange y resaltar los aspectos más relevantes del diagnóstico y el tratamiento. Materiales y Métodos: Estudio descriptivo, retrospectivo. Se evaluaron el dolor, según la escala analógica visual, la movilidad activa y el puntaje QuickDASH antes de la cirugía y en el control final a los 35.4 meses. Resultados: El tiempo medio desde la primera consulta hasta el diagnóstico fue de 10.6 meses (rango 5-16). El puntaje QuickDASH medio preoperatorio fue de 22,72 (rango 6,8-40,9). Luego del seguimiento medio de 35.4 meses (rango 17-63), todos los pacientes estaban satisfechos con el resultado. El puntaje medio de dolor fue 0. El puntaje QuickDASH medio fue 0. Conclusiones: El osteoma osteoide debe pensarse como diagnóstico diferencial ante un paciente que consulta por dolor digital subagudo o crónico que cede con antinflamatorios no esteroides. El tratamiento quirúrgico mediante el curetaje simple o la resección en bloque logra resultados satisfactorios. Sin embargo, como su prevalencia es baja, se suele pasar por alto y así se retrasan el diagnóstico y el tratamiento. Nivel de Evidencia; IV

Introduction: Osteoid osteomas are rarely found in the phalanges. The purpose of this study is to report 5 cases with histologic diagnosis of phalanx osteoid osteoma and highlight the most important aspects of its diagnosis and treatment. Materials and Methods: A descriptive, retrospective study was conducted. Evaluation included pain level using the visual analog scale (VAS), active range of motion, and QuickDASH score before surgery and at final follow-up (mean, 35.4 months). Results: The mean time from first consultation to diagnosis was 10.6 months (range, 5-16 months). The mean preoperative QuickDASH score was 22.72 (range, 6.8-40.9). At last follow-up (mean, 35.4 months; range, 17-63), all patients were satisfied with the outcome. The mean VAS score for pain was 0. The mean QuickDASH score was 0. Conclusions: Osteoid osteoma should be considered in the differential diagnosis when patients complain of subacute or chronic digital pain that improves with NSAIDs. Surgical treatment by simple curettage or en bloc resection shows satisfactory results. However, due to its low prevalence, osteoid osteoma is commonly underdiagnosed resulting in diagnosis and treatment delays. Level of Evidence; IV

Prevalence of the Linburg-Comstock Anomaly in a Brazilian Population Sample / Prevalência da anomalia de Linburg-Comstock em uma amostra populacional brasileira

Abstract Objective To determine the prevalence of the Linburg-Comstock anomaly in a Brazilian population sample. Methods A cross-sectional observational study was carried out between October 2017 and April 2018. We included male and female volunteers aged 18 years or older. The presence of the Linburg-Comstock anomaly was determined by performing the clinical tests described by Linburg and Comstock. The data were analyzed using the GraphPad Prism software, and we considered differences with p < 0.05. Results The study analyzed 1,008 volunteers (2,016 hands) with a mean age of 38.3 years, 531 (52.67%) of which were male, and 477 (47.33%) were female. The Linburg-Comstock anomaly was diagnosed in 564 (55.95%) individuals, and it was bilateral in 300 (53.2%) of them, right-sided in 162 (28.72%), and left-sided in 102 (18.08%). No significant differences were found when comparing the prevalence between genders. However, a the prevalence of the right-sided anomaly in the male population (n = 99; 70.21%) was higher than in the female one (n = 63; 51.21%), with p = 0.0016. In addition, the presence of pain by the maneuver described by Linburg and Comstock was more prevalent in women (n = 150; 54.94%) than in men (n = 105; 36.08%), with p = 0.0001. These results show the importance of epidemiological studies on the Linburg-Comstock anomaly, mainly in order to investigate the presence of associated conditions. Conclusion The prevalence of the Linburg-Comstock anomaly in the studied population was of 55.95%, and it was bilateral in 53.2% of the volunteers. The presence of the connection was observed more frequently in the right side and among men, but the pain symptom was more frequent among women.

Resumo Objetivo Determinar a prevalência da anomalia de Linburg-Comstock em uma amostra populacional brasileira. Métodos Estudo observacional transversal realizado no período de outubro de 2017 a abril de 2018. Foram incluídos voluntários dos gêneros feminino e masculino, com idade igual ou superior a 18 anos. A presença da anomalia de Linburg-Comstock foi determinada pela realização dos testes clínicos descritos por Linburg e Comstock. Os dados foram analisados por meio do software GraphPad Prism, sendo consideradas diferenças com valores de p < 0,05. Resultados O estudo analisou 1.008 voluntários (2.016 mãos) com idade média de 38,3 anos, dos quais 531 (52,67%) eram do gênero masculino, e 477 (47,33%) eram do gênero feminino. A anomalia de Linburg-Comstock foi diagnosticada em 564 voluntários (55,95%) da população estudada, sendo bilateral em 300 (53,2%), direita em 162 (28,72%), e esquerda em 102 (18,08%). Não foram encontradas diferenças significativas quando se comparou a prevalência entre os gêneros. Porém, foi encontrada uma maior prevalência da anomalia direita na população masculina (n = 99; 70,21%) do que na feminina (n = 63; 51,21%), com p = 0,0016. Além disso, a presença da dor pela manobra descrita por Linburg e Comstock foi mais prevalente nas mulheres (n = 150; 54,94%) do que nos homens (n = 105; 36,08%), com p = 0,0001. Estes resultados mostram a importância dos estudos epidemiológicos sobre a anomalia de Linburg-Comstock, principalmente com o intuito de investigar a presença de afecções associadas. Conclusão A prevalência da anomalia de Linburg-Comstock na população estudada foi de 55,95%, sendo bilateral em 53,2% dos voluntários. A presença da conexão foi observada com maior frequência do lado direito em homens, mas o sintoma dor foi mais frequente nas mulheres.

Hand strenght and dexterity in interphalangeal hand osteoarthritis and effects of osteophyte formations

Abstract Background: Hand osteoarthritis (HOA) is a complex disorder with various subtypes characterized with predominance of different features. It is challenging to estimate the severity of hand disability in HOA, since contribution of different disease components to clinical burden is yet to be clarified. The aim of the study is to investigate hand functions in nonerosive interphalangeal hand osteoarthritis (HOA) without inflammatory features, and search for effects of osteophyte formations detected by radiography and ultrasound on functionality. Methods: Thirty one HOA patients and 20 healthy subjects with similar age, gender, body mass index were included. Hand functions were evaluated by self-reported questionnaires and objective strength and dexterity measurements. A total of 459 interphalangeal joints were evaluated and scored by radiography and ultrasound for ostephyte formations. Results: Strength and dexterity measurements were similar between groups. Self-reported functionality was hampered in HOA group but not statistically significant. Osteophyte scores obtained by ultrasound and radiography were significantly higher in HOA group. Osteophyte scores obtained by ultrasound were higher than the scores obtained by radiography. Ultrasound scores showed no correlation with any of the parameters while osteophytes scores obtained by radiography partially showed a significant negative correlation with assembly part of dexterity testing. Conclusions: No significant difference observed in hand strength and dexterity in nonerosive interphalangeal HOA patients withouth signs of inflammation when compared to healthy subjects. Osteophyte formations prominent enough to be deteceted by radiography may have a negative effect on hand dexterity.(AU)

Triple open dislocation in the index finger of the hand without a high-energy trauma / Triple luxación abierta del segundo dedo de la mano tras traumatismo de baja energía

A simultaneous double dislocation (both proximal [PIP] and distal [DIP] interphalangeal joints) of a triphalangeal finger is a rare entity. The most common hand affected is the right hand. In the case of a closed triple dislocation (metacarpophalangeal [MCP], PIP and DIP joints); there are only two cases in the literature revised. In this case, we report an open triple dislocation in the index finger of the left-hand of a 54-year-old man treated by closed reduction and 3 weeks of immobilization followed by active mobilization with satisfactory results.

La luxación simultánea de las articulaciones interfalángicas proximal (IFP) y distal (IFD) de un dedo de tres articulaciones es una rara entidad. La mano que es afectada con más frecuencia es la derecha. Con relación a una triple luxación cerrada (articulación metacarpofalángica [MCF], IFP e IFD), sólo hay descritos dos casos en la literatura revisada. En este caso, describimos una triple luxación abierta del segundo dedo de la mano en un varón de 54 años de edad tratada mediante reducción cerrada,e inmovilización durante 3 semanas seguida de movilización activa supervisada, con resultado final satisfactorio.

Transferencia articular vascularizada: Reporte de caso / Free vascularized joint transfer: Case report

La articulación interfalángica proximal otorga la mayor contribución al arco total de movimiento digital, por lo tanto, la pérdida de movimiento normal de la articulación tiene un impacto considerable en la función y fuerza de agarre. El único método que asegura la preservación a largo plazo de la arquitectura cartilaginosa, así como una curación ósea rápida tras destrucción articular traumática o patológica es la transferencia articular vascularizada. Es definida como un trasplante articular parcial o completo con preservación o restauración inmediata del flujo de sangre. Se presenta el caso de un masculino de 20 años, con antecedente de trauma contuso-cortante en borde cubital de 3er dedo de mano izquierda zona II a quien se realiza cierre primario. Siete meses después a presentó deformidad articular e incapacidad funcional para la flexión de articulación interfalángica proximal. Se realizó procedimiento de reconstrucción articular, mediante transferencia articular vascularizada de 2° dedo del pie derecho. Posteriormente se dio seguimiento a través de consulta externa a las 2, 4, 6 y 8 semanas, 6 meses y 12 meses. A los 6 meses fue sometido a capsulotomía, liberación de placa volar, retiro de placas de osteosíntesis y adelgazamiento de isla cutánea. Se alcanzaron rangos de movimiento pasivo de extensión de 85° y activo de 70°. En base a la experiencia de nuestro centro se demuestra que el uso de transferencia articular en 2 etapas de reconstrucción, se pueden mantener rangos de movimiento tanto activo como pasivo suficiente para una adecuada función.

The proximal interphalangeal joint provides the greatest contribution to the total arc of digital movement, therefore, the loss of normal movement of the joint has a considerable impact on function and grip strength. The only method that ensures the long-term preservation of the cartilaginous architecture, as well as a rapid recovery of traumatic or pathological joint destruction, is vascularized joint transfer. It is defined as a partial or complete partial transplant with preservation or immediate restoration of blood flow. We present the case of a 20-year-old man, with a history of contusive-cutting trauma on the ulnar border of the third finger of the left hand, area II, who underwent primary closure. Seven months after the presentation of the joint and functional disability for proximal interphalangeal joint flexion. A joint reconstruction process was performed, by means of a vascularized joint transfer of the 2nd toe of the right foot. Subsequently, follow-up was carried out through the outpatient clinic at 2, 4, 6 and 8 weeks, 6 months and 12 months. At 6 months he was subjected capsulotomy, volar plate release, osteosynthesis plates removal and cutaneous island thinning. Ranges of passive movement of extension of 85° and active of 70° were reached. Based on the experience of our center, it is shown that the use of the transfer was made in 2 stages of reconstruction, the range of both active and passive movements can be maintained for an adequate function.

Síndrome de Adams-Oliver en dos casos clínicos / Adams-Oliver Syndrom in two clinical cases

Introducción: El síndrome de Adams-Oliver es una enfermedad heterogénea, caracterizada por aplasia cutis congénita y defecto transverso terminal de extremidades, con un amplio espectro fenotípico de malformaciones asociadas. Se han descrito diferentes modos de herencia en esta enfermedad. En el contexto cubano no se ha presentado ni publicado hasta el momento, casos de pacientes afectados por este síndrome Objetivo: Aportar evidencia que demuestra la presentación de casos con síndrome de Adams-Oliver. Presentación de casos: Se exponen dos casos de pacientes neonatales con síndrome de Adams-Oliver desde el punto de vista clínico, ambos de presentación esporádica. Además de la aplasia cutis congénita y el defecto transverso terminal de extremidades, uno de los pacientes exhibía cutis marmorata telangiectásica congénita y una anomalía de Ebstein. Conclusiones: Se exponen dos neonatos con síndrome de Adams-Oliver, ambos de presentación esporádica y uno de estos con una cardiopatía congénita (anomalía de Ebstein) no informada hasta ahora en la literatura(AU)

Introduction: The Adams-Oliver syndrome is a heterogenic disease characterized by aplasia cutis congenita and terminal transverse limb defects, with a wide phenotypic spectrum of associated malformations. Different kinds of inheritance of this disease have been described. In Cuba, any cases of patients suffering this syndrome have not been presented or published so far. Objective: To provide evidence demonstrating the presentation of cases with Adams-Oliver syndrome. Cases report: Two cases of neonatal patients with Adams-Oliver syndrome are presented from the clinical point of view, both of which are sporadic. In addition to the aplasia cutis congenita and the terminal transverse defect of the limbs, one of the patients presented congenital cutis marmorata telangiectatic and Ebstein anomaly. Conclusions: Two newborns cases with Adams-Oliver syndrome, both of sporadic presentation and one of these with a congenital heart disease (Ebstein anomaly) not previously reported in the literature are presented(AU)

Inicio de artritis reumatóide durante el embarazo / Onset of rheumatoid arthritis during pregnancy

RESUMEN Reportamos 2 casos de artritis reumatoide que inician durante el periodo de gestación, situación clínica muy poco frecuente y de la cual no encontramos otros casos clínicos reportados.

ABSTRACT Two cases are presented of rheumatoid arthritis that started during the gestation period, a rare clinical situation and for which no other clinical cases are reported.

An accessory extensor pollicis longus tendon: a case report of rare anatomical variant / Tendón accesorio del músculo extensor largo del pulgar: reporte de caso de una rara variación anatómica

SUMMARY: Variation in the morphology of the extensor pollicis longus muscle is very rare. The muscle is considered as one of the deep group of dorsal forearm muscles. It passes through the dorsal radiocarpal ligament in a detached compartment. It inserts at the base of the distal phalanx of the thumb. The muscle might have double tendons where they run either in one, or in separate compartments. In this study, we report an extremely rare condition for a 38-year-old male where some of the tendon fibers split at the base of the proximal phalanx and the two tendons insert at the sides of the base of the distal phalanx. We also noticed a high range of hyperextension where the action was painless and showed no sign of discomfort. We believe that the way the tendons get inserted might have a role in this wide range of extension.

RESUMEN: La variación en la morfología del músculo extensor largo del pulgar es muy rara. Es considerado perteneciente al grupo profundo de los músculos del dorso del antebrazo. Su tendón pasa a través del ligamento radiocarpiano dorsal en un compartimiento separado. Se inserta en la base de la falange distal del pulgar. El músculo puede tener tendones dobles que pasan a través de un solo compartimiento, o en compartimentos separados, del ligamento radiocarpiano dorsal. En este estudio se reporta una variación extremadamente rara en un hombre de 38 años de edad, donde algunas de las fibras del tendón se dividen en la base de la falange proximal y los dos tendones se insertaban a los lados de la base de la falange distal del pulgar. También observamos un alto grado de hiperextensión siendo la acción indolora y no mostrando ningún signo de malestar. Creemos que la forma en que los tendones se insertan podrían tener un papel en este amplio rango de extensión.

Clinical and radiographic changes of carpi, tarsi and interphalangeal joints of beef zebu bulls on semen collection regimen / Mudanças clínicas e radiográficas das articulações carpo, tarso e interfalangeana de touros de corte zebuínos em regime de colheita de sêmen

Osteoarthritis and osteochondrosis are highly correlated to reproductive failure in bulls. This study aimed to evaluate the carpal, tarsal and interphalangeal lesions in beef zebu bulls on semen collection regimen. Twenty-one beef cattle bulls, in a total of forty-one animals, were split into three age-based groups: animals from two to four years old (GI), from more than four to eight years old (GII) and above eight years old (GIII). The clinical findings were conformational changes of limbs, synovial effusion, peripheral venous engorgement of joints and prolonged decubitus. The total population showed moderate clinical manifestation and radiographic score. The GIII presented more severe joint lesions. Carpi and tarsi regions had discrete to difuse osteophytosis, subchondral cysts, cartilaginous flaps, bone incongruence and fragmentation, osteitis, and ankylosis. Interphalangeal joints presented osteophytosis, distal phalanx osteitis and enthesophytosis. The digital radiographic examination allowed full identification of articular lesions and their clinical correspondences, besides the positive correlation between age, body weight and radiographic score.(AU)

Osteoartrite e osteocondrose estão altamente correlacionados à falha reprodutiva em touros. Este estudo teve como objetivo avaliar as lesões do carpo, tarso e interfalangianas em touros zebuínos de corte em regime de coleta de sêmen. Vinte e um bovinos de corte, touros, provenientes de um total de 41 animais, foram divididos em três grupos baseados na idade, sendo eles: animais de dois a quatro anos (GI), de mais de quatro a oito anos (GII) e acima de oito anos de idade (GIII). Os sinais clínicos encontrados foram mudanças de conformação dos membros, derrame sinovial, ingurgitamento venoso periférico das articulações e decúbito prolongado. A população total avaliada apresentou manifestação clínica e escore radiográfico de grau moderado. Os touros mais velhos apresentaram maior gravidade nas lesões articulares. O GIII foi o que apresentou as lesões articulares mais severas. Identificou-se nos carpos osteofitose de discreta a difusa, cistos subcondrais, "flaps" cartilaginosos, fragmentação óssea, perda de congruência óssea, osteíte e anquilose; as lesões társicas obedeceram ao mesmo padrão. As articulações interfalangeanas apresentaram somente osteofitose, osteíte nas falanges distais e entesiofitose. O exame radiográfico digital permitiu a identificação completa das lesões articulares e suas correspondências clínicas, além da correlação positiva entre a idade, o peso corporal e o escore radiológico.(AU)

Reconstrução tardia na mão traumatizada com perda de múltiplos dedos / Late reconstruction of a traumatized hand with loss of multiple fingers

As lesões mutilantes de mão são um desafio para o cirurgião de mão e o paciente. O cirurgião deve tomar decisões desde o debridamento inicial, escolhendo quais dedos e articulações serão preservadas e uso apropriado das partes a serem retiradas. A reconstrução tardia é a segunda parte dessa difícil tarefa. Dificuldade que se atribui à particularidade de cada lesão, do grande número de possibilidades de tratamento e seus diversos níveis de complexidade que devem ser adequados à necessidade e motivação pessoal de cada paciente. Este relato de caso apresenta uma reconstrução tardia de mão com perda de indicador e dedo médio com transplante de articulação metacarpofalângica de indicador para função de interfalangeana proximal de dedo médio.

Mutilating hand injuries are a challenge to both the hand surgeon and the patient. The surgeon must make decisions ranging from the initial debridement to which fingers and joints will be preserved and the appropriate use of the parts to be removed. Late reconstruction constitutes the second part of this difficult task. The difficulty attributed to the characteristics of each lesion, the large number of treatment possibilities, and the different levels of complexity must be adapted to the personal needs and motivation of each patient. This case report describes a late hand reconstruction with index and middle finger loss, using metacarpophalangeal joint transplantation of the index finger to gain the proximal interphalangeal function of the middle finger.

Response of three digital anesthetic technics in horses with forelimb hoof lameness / Resposta de três técnicas anestésicas digitais em equinos com claudicação dos membros anteriores ligada ao casco

The presented study aimed to assess objectively the response of distal interphalangeal joint (DIJ), navicular bursa (NB) and deep digital flexor tendon sheath (DDFTS) anesthesia in horses with forelimb hoof lameness; and evaluate if the presence of radiographic abnormalities on navicular bone could interfere on blocks' results. Fifteen horses with lameness improvement above 70% after palmar digital nerve (PDN) block were selected for this study. Blocks were assessed separately on five consecutive trials at seven different time-points. The fifth trial was performed to evaluate the influence of exercise on preexisting lameness. Most of horses (73.33%) presented pain related to the podotrochlear apparatus based on clinical and lameness exam and blocks' responses. NB and DIJ anesthesia differed on the frequency of horses with lameness improvement above 70% only at 10min (p=0.03), and both differed from DDFTS block until 30'(p<0.05). The blocks' response was variable along the time and the highest means for NB, DIJ and DDFTS were observed at 5-10 minutes ('), 15-20' and 10-15' respectively.Exercise had low interference on lameness intensity since no improvement above 50% was observed and an increase on lameness intensity over time was identified in seven horses. Variable grades of navicular bone radiographic lesions were observed in 14 horses, although these lesions had no interference on blocks' response (p>0.05). The NB and DIJ blocks had similar responses and both were superior to DDFTS anesthesia, coincident with a major prevalence of podotroclear apparatus abnormalities in this equine population.(AU)

O presente estudo avaliou, de forma objetiva, as respostas do bloqueio da articulação interfalangeana distal (AID), da bursa do navicular (BN) e da bainha do tendão flexor digital profundo (BTFDP) em equinos com claudicação ligada ao casco nos membros torácicos; além de analisar a influência das alterações radiográficas do osso navicular no resultado dos bloqueios. Quinze cavalos, que apresentaram uma melhora da claudicação acima de 70% após o bloqueio do nervo digital palmar, foram selecionados para este estudo. Os bloqueios foram avaliados separadamente em cinco turnos consecutivos e em sete tempos diferentes. O quinto turno foi utilizado para analisar a influência do exercício sobre a claudicação preexistente. A maioria dos cavalos (73,33%) apresentou dor relacionada à porção palmar do casco, com base nos achados do exame clínico em movimento e nas respostas dos bloqueios. As anestesias da BN e da AID apresentaram diferença quanto à frequência de cavalos com melhora da claudicação acima de 70% apenas aos 10min (p=0.03), e ambos diferiram do bloqueio da BTFDP até os 30min (p<0.05). A resposta dos bloqueios foi variada ao longo do tempo, e as maiores médias de melhora da claudicação para os bloqueios BN, AID e BTFDP foram observadas aos 5-10min, 15-20min e 10-15min, respectivamente. O exercício teve pequena interferência na intensidade da claudicação, uma vez que nenhuma melhora acima de 50% foi observada e sete cavalos aumentaram a intensidade da claudicação ao longo do tempo. A presença de diferentes graus de lesão radiográfica do osso navicular foi observada em 14 cavalos, porém essas lesões não interferiram na resposta dos bloqueios (p>0,05). Os bloqueios da BN e da AID apresentaram respostas semelhantes, e ambos foram superiores ao bloqueio da BTFDP, coincidindo com uma marcada prevalência de doença do aparato podotroclear nesta população de equinos.(AU)

Hallazgos gammagráficos en manos de población adulta, sin patología osteoarticular, bajo un análisis semicuantitativo / Semi-quantitative analysis of scintigraphic findings in the hands of adults without osteoarticular disease

RESUMEN Introducción: La gammagrafia ósea es uno de los estudios más frecuentemente utilizados para el abordaje diagnóstico de la patología osteoarticular, sin embargo, no se conocen patrones claros de normalidad para algunos sitios anatómicos, llevando a tasas altas de variabilidad interobservador, como es el caso de la evaluación de las manos. No se encuentra en la literatura una descripción del patrón gammagráfico normal sobre manos, por lo cual pretendemos describir el patrón de captación más frecuente en una población adulta sin enfermedad osteoarticular. Materiales y métodos: Se hizo un análisis prospectivo de 156 gammagrafías óseas sobre manos que cumplieron el criterio de inclusión. Se delinearon regiones de interés en el carpo, metacarpo, articulaciones interfalángicas proximales y distales de los dedos índice y medio de ambas manos; se tomaron las cuentas totales, se analizaron promedios y desviación estándar, y se hizo análisis semicuantitativo de la imagen. Resultados: Se incluyeron 36 hombres (23%) y 119 mujeres (77%), la edad media fue de 44,9 ± 13,9. Los promedios de las cuentas totales disminuyeron progresivamente deproximal a distal en todos los grupos de edad y en ambos géneros, siguiendo la siguiente proporción: carpo 4,4 veces más que metacarpo; metacarpo 1,7 veces más que interfalángica proximal; interfalángica proximal 1,4 veces más que distal. Conclusiones: En manos de pacientes adultos, sin enfermedad osteoarticular, sin distinción de género y edad, encontramos un patrón gammagráfico en «degradé¼ con mayor concentración isotópica en carpo, seguida del metacarpo y de las articulaciones interfalángicas proximales y distales.

ABSTRACT Introduction: Bone and joint disease has a high incidence and impact on the population. The bone scan is a diagnostic tool that provides important metabolic and clinical information; therefore the interpretation of the images by the nuclear medicine physician must be very precise. The isotopic distribution pattern in hands has not yet been described. For this reason a description is presented of common scintigraphic findings in adults without osteoarticular disease. Materials and methods: A prospective analysis was conducted on 156 hands of patients whose bone scans met inclusion criteria. There were delineated regions of interest in the carpal, metacarpal, proximal, and distal interphalangeal joints of the second and third fingers of both hands. An analysis was made, including the total counts, means, and standard deviations. The cut-offs were selected using the normal distribution, which was defined as the cut at the 99th percentile of each variable. A semi-quantitative analysis was made of the images. Results: The study included 36 men (23%) and 119 women (77%), and the mean age was 44.9 ± 13.9. The mean total counts gradually decreased from proximal to distal in all age groups and in both genders in the following proportions: the activity in carpus was 4.4 fold more than the metacarpus; the metacarpus was 1.7 fold more than proximal interphalangeal joint; proximal interphalangeal joint was 1.4 fold more than distal one. Conclusions: A scintigraphic pattern consisting of a gradual decrease from proximal to dis-tal joints (degradation) was found in the hands of adults without bone and joint disease, regardless of gender and age.

Estudio sobre la influencia del diámetro de apertura en la fuerza ejercida por cada dedo / A study on the influence of grip span on the strength exerted by each finger

RESUMEN Objetivo Estudiar el efecto de mantener un mismo diámetro de apertura en los dedos sobre la fuerza actuante de éstos en un agarre de fuerza. Métodos Se condujo un experimento con 30 participantes (15 hombres y 15 mujeres) quienes realizaron el gesto de aprehensión en un dispositivo diseñado para mantener constante la apertura para todos los dedos en 4 diámetros diferentes. Resultados Se muestra evidencia que en un rango de accionamiento entre 0-75% de la apertura funcional, los dedos índice, corazón y anular ejercen una fuerza significativamente igual si el diámetro de apertura se mantiene constante. Conclusiones Este hallazgo permitiría reducir la exposición de los operarios de herramientas de corte a factores de riesgo de síndrome del conducto carpiano (SCC). Se sugiere que en el diseño de herramientas, la distancia de apertura para todos los dedos debe mantenerse constante durante el gesto de aprehensión.(AU)

ABSTRACT Objective To study the effect of maintaining the same grip span between the thumb and exerting fingers, on the acting force of these in a power grip. Methods We conducted an experiment with 30 participants (15 men and 15 women) who made the gesture of apprehension in a device designed to maintain constant grip span to all fingers in 4 different diameters. Results In the range between 0-75 percent of functional grip span of the fingers, the index, middle and ring finger exert a force significantly equal when the aperture diameter is maintained constant. Conclusions These findings would reduce exposure to risk factors for carpal canal syndrome (CTS) in cutting activities, by controlling risk factors like strength. We suggest that on the design of tools, the opening distance for all the fingers must remain constant during the act of apprehension.(AU)

A case of chikungunya virus disease presenting with remarkable acute arthritis of a previously damaged finger joint

Abstract: Chikungunya virus (CHIKV) is a mosquito-borne arthritogenic alphavirus that has recently been introduced to Brazil. We report the case of a 36-year-old male patient from the City of Rio de Janeiro who developed molecularly-confirmed CHIKV disease and whose clinical picture was remarkable because of acute arthritis of an interphalangeal joint that had been damaged by trauma 8 years previously. This case illustrates that acute CHIKV disease may preferentially target previously damaged joints. Careful study of individual cases may provide valuable information on the presentation and management of this emerging zoonosis in Brazil.

Estudio morfológico y biométrico de los vínculos de los tendones de los músculos flexores superficial y profundo de los dedos de la mano humana / Anatomic and biometric study of the vincula of the tendons of flexor digitorum superficialis and profundus muscles of the human hand

Los vínculos son estructuras especializadas inherentes a los tendones flexores de los dedos, y tienen gran importancia en la nutrición de los mismos, además de facilitar la flexión de los dedos después de una transección distal del tendón (es), permitiendo que éste (os) actuen indirectamente a través de las articulaciones interfalángicas. El presente estudio tuvo como objetivo revisar aspectos morfofuncionales de los vínculos largos y cortos de los músculos flexores de los dedos de la mano. El trabajo fue realizado en 60 manos de cadáveres formolizados de individuos adultos, brasileños, con una edad promedio de 53,1±17,8 años. Los vínculos cortos fueron encontrados en 100 % de los casos, tanto en los músculos flexores superficiales de los dedos como en los profundos, siempre en número de uno en cada tendón y su localización siempre estuvo en la extremidad del tendón, antes de la inserción de éste en la articulación interfalángica proximal. Los vínculos largos presentaron gran variación morfológica, con una presencia promedio de 61,3 % en los tendones del músculo flexor superficial y de 77,9 % en el músculo flexor profundo. El número de vínculos por tendón varió aún más, no siendo posible identificar un patrón independientemente del músculo. En relación a la localización de los vínculos largos, en los tendones del músculo flexor superficial de los dedos, están insertos en la vaina fibrosa de la falange proximal, con un trayecto oblicuo y próximo a la articulación interfalángica proximal; los vínculos de los tendones del músculo flexor profundo estaban localizados en su mayoría (86,7 %) entre los tendones a nivel de la articulación interfalángica proximal, presentando un trayecto rectilíneo entre esos dos tendones, mientras que en 13,3 % estuvieron localizados muy próximos a la abertura del tendón del músculo flexor superficial para el paso del tendón del músculo flexor profundo. Los vínculos son estructuras escenciales en la mantención de la nutrición y de los movimientos de los dedos aún en presencia de lesiones, por lo tanto, es importante tener una comprensión clara de ellos para una correcta evaluación clínica pensando en la reparación, reconstrucción y rehabilitación de las disfunciones de la mano.

The vincula are specialized structures inherent in the flexor tendons of the fingers, and are of great importance in their nutrition. In addition they facilitate flexion of the fingers following a distal transection of this tendon, allowing it to operate indirectly across the interphalangeal joints. The aim of the present study was to describe anatomic and biometric aspects of the long and short vincula of the flexor muscles of the fingers. The work was carried out in hands of 60 adult Brazilian corpses, of both sexes, with an average age between 17.8±53.1 years. The short vincula were found in 100 % of cases of flexor digitorum superficialis tendons and flexor digitorum profundus muscles, and only one in each tendon, with its location always at the extremity of the tendon, prior to insertion in the proximal interphalangeal joint. The long vincula presented great morphological variation, with an average presence of 61.3 % in tendons of the flexor digitorum superficialis and 77.9 % in the flexor digitorum profundus muscle. Furthermore, the number of vincula per tendon changed, and it was not possible to identify a pattern independently of the muscle. With respect to the location of the long vincula, in the flexor superficial tendons they are inserted in the fibrous sheath of the proximal phalanx, with an oblique course and next to the proximal interphalangeal joint. The vincula of the tendons of the flexor digitorum profundus were located (86.7 %) between both tendons to level of the proximal interphalangeal joint, presenting a rectilinear course between these two tendons, whereas in 13.3 % they were located very close to the opening of the flexor superficialis muscle tendon for passage of the flexor digitorum profundus muscle tendon. The vincula are essential structures in nutrition and finger motion even when injuries are present. It is therefore, important to have a clear understanding of these structures forproper clinical evaluation in the repair, reconstruction and rehabilitation of hand dysfunctions.

Osteosynthesis of mallet finger using plate and screws: evaluation of 25 patients / Osteossíntese do dedo em martelo com placa e parafuso: avaliação de 25 pacientes

To evaluate the results from surgical treatment of patients with mallet finger injury using a hook plate and screw. METHODS: Twenty-five patients (19 males and six females) between the ages of 20 and 35 years were analyzed between May 2008 and December 2012. They were evaluated in accordance with Crawford's criteria and the mean follow-up was 18 months. RESULTS: The results from 10 patients (40%) were excellent and from 15 (60%), good. Twenty-one patients (84%) reported no pain, 18 months after the operation. There was no limitation to range of motion in 14 cases (56%), limitation of extension in seven (28%) and limitation of flexion in four (16%). CONCLUSION: Surgical treatment by means of open reduction and internal fixation using a hook plate and screw proved to be an excellent option for treating mallet finger fractures and was considered to be a safe and effective method.

Avaliar os resultados do tratamento cirúrgico de pacientes com lesão de dedo em martelo com o uso de placa-gancho e parafuso. MÉTODOS: Foram analisados 25 pacientes entre 20 e 35 anos, 19 do sexo masculino e seis do feminino, de maio de 2008 a dezembro de 2012. Os pacientes foram submetidos à avaliação de acordo com os critérios de Crawford e o acompanhamento médio foi de 18 meses. RESULTADOS: Os resultados obtidos foram excelentes em 10 pacientes (40%) e bons em 15 (60%); 21 pacientes (84%) não referiram dor no 18° mês de pós-operatório. Foi verificada ausência de limitação da amplitude de movimento em 14 casos (56%), limitação da extensão em sete (28%) e limitação da flexão em quatro (16%). CONCLUSÃO: O tratamento cirúrgico com redução aberta e fixação interna com placa-gancho e parafuso demonstrou ser uma ótima opção de tratamento nas fraturas em martelo e é considerado um método seguro e eficaz.