Fourth Dorsal Interosseous Muscle Transfer to Treat an Abducted Little Finger.

A patient presented with an abducted little finger due to the avulsion of the third volar interosseous muscle. For treatment, we transferred the fourth dorsal interosseous muscle arising from the ulnar side of the fourth metacarpal bone to the lateral band of the little finger.

An Analysis of Profundus Tendon Repairs After Distal Phalanx Amputation in a Cadaveric Model of Little Finger Superficialis Deficiency.

PURPOSE: The flexor digitorum superficialis tendon to the little finger (FDS-5) has been observed to have a higher degree of functional and structural variation than the FDS of other digits. FDS-5-deficient individuals necessarily rely on the flexor digitorum profundus tendon to the little finger (FDP-5) for flexion in their little fingers. FDS-5 deficient patients who experience a considerable injury to their FDP-5 are therefore at a risk of losing substantial little finger flexion. The purpose of this study was to evaluate the degree of flexion of the little finger at the metacarpophalangeal and proximal interphalangeal (PIP) joints in a cadaveric model of FDS-5 deficiency following amputation of the distal phalanx. METHODS: Ten fresh-frozen cadaveric upper extremities with no prior trauma were used. Loads were applied to the FDP-5. Flexion at the PIP and metacarpophalangeal joints was measured in degrees with a goniometer. Little finger flexion testing was conducted under 5 different conditions: "baseline," "FDS-deficient," "no repair," "bone anchor" repair, and "A4 pulley" repair. RESULTS: The results were as follows: (1) no significant differences in the flexion between baseline and FDS-deficient conditions; (2) a significant decline in PIP flexion in the no repair condition after FDP-5 division compared with the FDS-deficient condition; (3) a significant restoration in PIP flexion in both surgical repair groups compared with the no repair group; and (4) no significant differences in PIP flexion between the A4 pulley and bone anchor groups. CONCLUSIONS: The bone anchor repair and the A4 pulley repair demonstrate similar abilities to restore flexion of the little finger at the PIP joint to baseline levels in this cadaveric model. CLINICAL RELEVANCE: A clinical protocol is yet to be established for the surgical treatment in FDS-5-deficient patients requiring amputation of the distal phalanx of the little finger. This study aims to address this area of uncertainty by comparing the little finger flexion after 2 different approaches to profundus tendon reattachment that may be applicable in this clinical scenario.

Mechanism Underlying the Bypass of Apurinic/Pyrimidinic Site Analogs by Sulfolobus acidocaldarius DNA Polymerase IV.

The spontaneous depurination of genomic DNA occurs frequently and generates apurinic/pyrimidinic (AP) site damage that is mutagenic or lethal to cells. Error-prone DNA polymerases are specifically responsible for the translesion synthesis (TLS) of specific DNA damage, such as AP site damage, generally with relatively low fidelity. The Y-family DNA polymerases are the main error-prone DNA polymerases, and they employ three mechanisms to perform TLS, including template-skipping, dNTP-stabilized misalignment, and misincorporation-misalignment. The bypass mechanism of the dinB homolog (Dbh), an archaeal Y-family DNA polymerase from Sulfolobus acidocaldarius, is unclear and needs to be confirmed. In this study, we show that the Dbh primarily uses template skipping accompanied by dNTP-stabilized misalignment to bypass AP site analogs, and the incorporation of the first nucleotide across the AP site is the most difficult. Furthermore, based on the reported crystal structures, we confirmed that three conserved residues (Y249, R333, and I295) in the little finger (LF) domain and residue K78 in the palm subdomain of the catalytic core domain are very important for TLS. These results deepen our understanding of how archaeal Y-family DNA polymerases deal with intracellular AP site damage and provide a biochemical basis for elucidating the intracellular function of these polymerases.

Long-term practice of isolated finger movements reduces enslaved response of tonically contracting little finger abductor to tonic index finger abduction.

The purpose of this study was to elucidate whether the long-term practice of isolated finger movements reduces the enslaved response of the little finger abductor to the index finger abduction. The right-handed participants tonically or phasically abducted the index finger, while they maintained at rest or tonic abduction of the little finger. The enslaved response of the tonically contracting little finger abductor to the tonic abduction of the index finger was greater than the response of the same muscle at rest in the nonpianists. This indicates that the tonic contraction of the little finger abductor enhances the enslaving drive from the tonically contracting index finger abductor to the little finger abductor. The enslaved response of the tonically contracting little finger abductor to the tonic abduction of the index finger in the pianists was significantly smaller than that in the nonpianists, but such a significant group difference was absent when the little finger abductor was at rest. This indicates that the inhibitory process on the enslaving drive from the tonically contracting index finger abductor to the tonically active little finger abductor is unmasked through the long-term practice.

Individual left-hand and right-hand intra-digit representations in human primary somatosensory cortex.

Individual intra-digit somatotopy of all phalanges of the middle and little finger of the right and left hand was studied by functional magnetic resonance imaging in 12 healthy subjects. Phalanges were tactilely stimulated and activation in BA 3b of the human primary somatosensory cortex could be observed for each individual phalanx. Activation peaks were further analysed using the Direction/Order (DiOr) method, which identifies somatotopy, if a significantly high number of subjects exhibit ordered distal-to-proximal phalanx representions along a similar direction. Based on DiOr, ordered and similar-direction-aligned intra-digit maps across subjects were found at the left hand for the little and middle finger and at the right hand for the little finger. In these digits the proximal phalanges were represented more medially along the course of the central sulcus than the distal phalanges. This is contrasted by the intra-digit maps for the middle finger of the right hand, which showed larger inter-subject variations of phalanx alignments without a similar within-digit representation across subjects. As all subjects were right-handed and as the middle finger of the dominant hand probably plays a more individual role in everyday tactile performance than the little finger of the right hand and all left-hand digits, the observed variation might reflect a functional somatotopy based on individual use of that particular digit at the dominant hand.

Hypothenar island flap: A safe and excellent choice for little finger defects.

Soft-tissue defects of the little finger are challenging especially when bone, tendon or vascular pedicle is exposed because of trauma. The hypothenar island flap is easy to harvest and has a good colour and texture match to the little finger pulp. We present nine clinical cases of soft tissue defects of the little finger covered using the reversed hypothenar fasciocutaneous island flap. This article intends to highlight the ease of elevation and good clinical results of the hypothenar flap which is rarely used.

Little finger carpometacarpal arthroplasty technique and result in 3 cases.

PURPOSE: To present our surgical technique and results for the treatment of posttraumatic arthritis of the little finger carpometacarpal (CMC) joint. METHODS: We performed a retrospective review of 3 patients who underwent our surgical technique. All patients had previously sustained intra-articular fractures of the base of the little finger metacarpal and presented with painful posttraumatic arthritis of the fifth metacarpal-hamate joint. Patients were treated with little finger CMC arthroplasty and extensor carpi ulnaris suspensionplasty. RESULTS: We observed the 3 patients in the office over a mean of 21 months and by telephone for a mean for 51 months postoperatively. They had improvements in wrist motion and grip strength. Finger motion remained stable. Pain and tenderness at the little finger CMC joint were eliminated. CONCLUSIONS: Our technique provided satisfactory pain relief and motion preservation for posttraumatic arthritis of the little finger CMC joint. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Interobserver variability in the treatment of little finger metacarpal neck fractures.

PURPOSE: To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck fractures with measured fracture angulation would recommend surgery as often as surgeons shown unmarked radiographs. METHODS: Members of the Science of Variation Group, an international collaboration of fully trained orthopedic and trauma surgeons, were asked to review 20 little finger metacarpal neck fracture cases, which included a vignette and 3 high-quality radiographs. Members were then randomized to review radiographs with or without measured fracture angulation on the lateral view and select operative or nonoperative management. RESULTS: Surgeons shown radiographs with measured angulation were more likely to recommend surgery, and there was less variability among these surgeons, particularly for fractures with less angular deformity. CONCLUSIONS: Measured fracture angulation has a small but significant influence on treatment recommendations for little finger metacarpal neck fractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.

Comparative evaluation of maxillary and mandibular anterior teeth width with the length of index and little finger.

UNLABELLED: The size, color, morphology and arrangement of the anterior tooth are the various factors play an imperative role in achieving excellent esthetics in complete denture. Various modalities have been suggested for selecting the size of the anterior teeth like inter-alar distance, inter-canthal distance, bi-zygomatic width, intercanine width. There is no reliable method for selection of anterior teeth etc. To evaluate and compare the width of the maxillary and mandibular anterior teeth with the length of the index and little fingers. total of 50 people were taken for this study. They are grouped into four, Group I, 15-20 years; Group II, 20-30 years; Group III, 30-40 years; Group IV, 40-50 years. Irreversible hydrocolloid impressions of the maxilla and mandible were made and poured with dental stone. The widths of the maxillary and mandibular anterior teeth were measured with an adaptable ruler. The length of the index and little fingers were measured using a vernier caliper. There is significant correlation between the maxillary and mandibular anterior teeth with the index and little finger length. CONCLUSION: The maxillary anterior teeth width can be calculated with the formula (1.130 × index finger length - 11.972), mandibular anterior teeth width can be calculated with the formula (1.006 × little finger length - 2.231).

Double Dislocation of the Interphalangeal Joints of the Little Finger.

High-energy traumas may lead to the dislocation of joints with or without fractures. However, simultaneous double dislocation of the proximal and distal interphalangeal joints (PIP and DIP) in fingers shows up rarely. Although it can be inferred as simultaneous dislocation occurring during the same trauma, consecutive events should be taken into consideration. A 29-year-old, right-hand dominant male patient presented to the emergency room with a left little finger deformity after being hit by a ball while playing football. Despite the inability to move the little afteruent to this hyperextension injury, there was mild swelling, ecchymosis, and pain with no trace of laceration or neurovascular injury. PIP and DIP joint dislocations of the left-hand little finger with distal phalanx proximal fracture were detected on the radiograph indicating a stepladder deformity. Closed reduction was achieved by longitudinal traction and applying pressure over the base of the dislocated digit. Afterward, an aluminum finger splint was applied to the little finger in the functional position to prevent further damage. Re-evaluation radiographs revealed a successful reduction of both joints. Immobilization via an aluminum finger splint was recommended for three weeks. Subsequently, range of motion exercises and rehabilitation were started. Three-month follow-up revealed an almost full range of motion in both PIP and DIP joints without stiffness and pain. Although double dislocation seems to present with more painful and swollen fingers than single dislocations, it can also present with mild pain and swelling, as in this case. The little finger is easily exposed to traumas due to the lack of surrounding tissue. Therefore, double dislocation is mostly seen in the little finger. This case report briefly illustrates a rare incidence of double dislocation involving both the PIP and DIP joints of the little finger. Normal range of motion of both joints was reached by early reduction followed by timely rehabilitation.

Dynamic External Fixator as Treatment for Congenital Little Finger Contracture.

The surgical soft tissue release of extension contracture at metacarpophalangeal (MP) joint is technically easy; however, the preventive hand therapy after surgery is really difficult in clinical practice. Congenital MP joint contracture, especially little finger, is also difficult to spread its limited range of motion (ROM). Here, we present a patient with a congenital MP joint contracture of the little finger managed with dynamic external fixator (DEF). A 21-year-old male irritated from limited ROM associated with pain of the right little finger of more than 1 year. The symptom started after trauma on his hand while playing lacrosse. Further examination revealed that his MP joint was congenitally contracted. To address this pathology, DEF followed by orthotic therapy was done. Two years after the procedure and therapy, the MP joint ROM of the finger surpassed that of the contralateral unaffected digit without pain and recurrence. The patient was able to return to his sports of lacrosse.

Traumatic injury of the third palmar interosseous muscle in a patient with dementia: A case report.

An 81-year-old man with dementia presented with a third palmar interosseous injury. A fourth flexor digitorum superficialis tendon transfer surgery was performed the following day. The patient achieved adduction of the little finger; however, flexion contracture that began 2 months after the surgery progressed until completion because of issues related to postoperative rehabilitation and home exercise. An injury of the third palmar interosseous muscle is extremely rare and is even more uncommon in older adults. Therefore, careful consideration must be given to determine whether surgery is the best choice, especially if the patient has dementia.

Osteoid Osteoma of the Distal Phalanx of Little Finger.

Introduction: Although osteoid osteomas are relatively common lesion, sites such as distal phalanx are still rarely observed. These lesions present with characteristic nocturnal pain due to prostaglandins and may also be associated with clubbing. Diagnosis of these lesions at uncommon sites becomes tricky and 85% are misdiagnosed. Case Report: A 18-year-old patient presented with the left distal phalanx of little finger clubbing and nocturnal pain (visual analogue scale [VAS] score: 8). After clinical workup and investigation to rule out infective and other causes, the patient was posted for excision of the lesion with curettage. Post-surgery outcome showed reduced pain (2 months post-operative VAS score: 1) and good clinical results. Conclusion: Although osteoid osteoma of distal phalanx is a rare entity and difficult to diagnosed. Complete excision of lesion shows promising results both in terms of reduction of pain and functionally.

A Rare Case of Plexiform Schwannoma of the Little Finger and Its Management: A Case Report.

Schwannomas are tumors of the Schwann cells found in the myelin sheath. They cause 5% of all benign soft-tissue cancers, occur equally in males and females, and occur later in life. Since they remain asymptomatic, diagnosing and treating them becomes challenging; current guidelines recommend imaging followed by excision. Here, we present a case of a 19-year-old male who presents in an outpatient setting with a history of painless swelling of the fifth digit for the past four years. Past medical history and physicals are unremarkable. Microscopic findings from fine-needle aspiration cytology (FNAC) confirmed the schwannoma diagnosis, showing loosely arranged spindle cells with elongated nuclei with pointed ends dispersed within the myxoid stroma.

Comparison of bridge graft and end-to-side transfer for treatment of closed rupture of the flexor tendons in the little finger.

The purpose of this study was to compare the outcomes of bridge tendon grafts and end-to-side tendon transfers for treating closed ruptures of the flexor tendons in Zones 3 to 5 of the little finger. We selected the surgical procedure based on the passive distraction amplitude of the proximal part of the ruptured flexor tendon. Eleven patients comprised the bridge tendon graft group and ten patients comprised the end-to-side tendon transfer group. We found no significant between-group differences in the total active motion, percentage of total active motion, functional assessment by the Strickland and Glogovac criteria and grip strength compared with the unaffected hand. We believe that choosing the surgical procedure after determining the passive distraction amplitude of the ruptured tendon can be useful in clinical practice.Level of evidence: III.

Bilateral volleyball-related deformity of the little fingers: mallet finger and clinodactyly mimic.

A 14-year-old male high school volleyball player was seen to evaluate right- and left-hand little-finger distal interphalangeal joint deformity and pain. His symptoms began during his second season of competitive play. The distal interphalangeal (DIP) joints of the little fingers flexed 20-30°, and a 10-15° valgus deformity was seen at the same joints. Pain was relieved with rest but returned immediately after playing volleyball, so plain radiographs were obtained. The flexion and valgus deformity was obvious on plain radiographs and through a clinical examination. Thus, a bilateral little-finger distal phalanx base epiphysis injury was seen. This injury is characterized by a biplanar Salter Harris physeal injury; type 5 on anteroposterior radiographs and type 2 on lateral plain radiographs. The deformity occurred as a result of competitive volleyball play. To our knowledge, this is the first reported case of a bilateral biplanar physial injury of the base of distal phalanges of the little fingers. Flexion and valgus deformities of DIP joints are a result of repeated micro traumas around the physis. Key pointsAs a result of repeated micro traumas to the physial region, flexion and valgus deformities of the distal interphalangeal (DIP) joints should be occurred.Sports injuries to the hand often require treatment in orthopedic departments to avoid permanent deformities.Short- or long-term functional results can be gained by simple splinting procedures and abstention from play.

Reliability of anthropological measurements in determining vertical dimension of occlusion in Saudi population: A cross sectional study.

BACKGROUND: Range of techniques have been described in traditional prosthodontics to establish Vertical dimension of occlusion (VDO). Experienced clinicians agree that there is no one single method, which is universally accepted record VDO precisely and consistently. Many facial and body landmarks have been proposed in the literature correlating to the VDO. Presence of so many methods to determine VDO further leads to confusion in the minds of clinicians. There is always a need for a research to both substantiate the findings in the literature and check reliability of such correlations in local population. Such correlation between the anthropological measurements and VDO would give clinician an evidence based approach to establish VDO during prosthetic rehabilitation. Hence this study was planned to check reliability of various anthropometric measurements in measuring VDO in a cross section of Saudi population. MATERIAL AND METHOD: Total of 500 subjects selected for the study following an inclusion and exclusion criteria. Anthropological readings such as Index finger, Little finger, Thumb finger, Distance between Inner canthus of left eye to outer canthus of right eye and Outer canthus of the right eye to corner of mouth (rima oris) were recorded using digital Vernier caliper. The data were analyzed statistically. RESULTS: Strong positive correlation was observed between VDO and anthropological landmarks selected in the study. Pearson's correlation test showed VDO in males has strong coefficient correlation with Index finger (r = 0.7341) and in females strong coefficient correlation with Little finger. (r = 0.5827). CONCLUSION: In Saudi Males, VDO could be correlated to the index finger measurements followed by Thumb finger. In Saudi females subjects, VDO correlated with little finger measurements followed by outer canthus of the eye to corner of the mouth reading. It is always appropriate to use one or more methods to approximate the measurements of VDO initially and then use the other methods to test the appropriateness of the dimensions initially established.

Finger shortening for Dupuytren's disease-induced severe PIP joint flexion contracture of the little finger: A report of two cases.

When severe proximal interphalangeal (PIP) joint flexion contracture is induced in the little finger by Dupuytren's disease, it interferes with activities of daily living. To extend the little finger, open fasciectomy is selected as a general treatment method. However, postoperative complications have been frequently reported. To solve these problems, finger shortening was undertaken. In this study, we treated two cases of Dupuytren's disease manifesting severe PIP joint flexion contracture of the little finger with finger shortening by proximodistal interphalangeal (PDIP) fusion in which the middle phalanx is resected and the residual distal and proximal phalanges are fused. For flexion contracture of the MP joint, a percutaneous aponeurotomy using an 18G needle was performed to obtain the extended position of the MP joint. Favorable outcomes with high patient satisfaction, including esthetic aspects of retaining the finger with the nail without complication, were achieved. We report this challenging treatment and its discussion.

A de novo TBX3 mutation presenting as dorsalization of the little fingers: A forme fruste phenotype of ulnar-mammary syndrome.

Ulnar-mammary syndrome (UMS) is a rare syndromic limb malformation caused by heterozygous mutations in TBX3. The name highlights the two commonly involved body parts i.e. mammary gland and ulnar ray of the upper limbs, although a more extensive systemic involvement is also known to occur. Here, we report the surprising finding of a patient with a de novo mutation in TBX3 whose clinical presentation is limited to dorsalization of both little fingers and slightly deep 4th web spaces. We review the literature to confirm that this should be considered as a forme fruste phenotype of UMS.

Management of Little Finger Metacarpal Fractures: A Meta-Analysis of the Current Evidence.

Background: The little finger metacarpal neck fracture, also known as boxer's fracture, is a commonly encountered upper limb fracture in orthopaedics. There are multiple ways of managing this fracture, ranging from immediate mobilization to rigid internal fixation. However, there is still a lack of consensus on the best management option. The aim of this study is to review all comparative studies, either randomized trial or cohort studies, on little finger metacarpal neck fracture management, meta-analyze the radiological and functional outcome between conservative and operative management. Methods: A systematic search of the literature was conducted between year 1987 to 2018 on MEDLINE and EMBASE. To be included, studies needed to have shown comparison between conservative against operative management, assessing the radiological (palmar angulation) and the patient reported functional outcomes. The data were pooled using fixed-effect method. The methodology was adapted from the Cochrane Handbook for Systematic Review of Interventions and compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO CRD42018099168). Results: 5 full papers were included in our study. Our meta-analysis showed that compared to operative management, conservative management report worse radiological palmar angulation at follow-up; but equivalent functional outcome in terms of Quick-DASH and grip strength. Conservative studies also showed fewer mean days off in comparison to operative management. Conservative management also showed equivalent Total Active Motion (TAM) and Visual Analogue Score for Pain (VAS), but some studies had insufficient data to be pooled. Conclusions: Regardless of palmar angulation, conservative treatment of little finger metacarpal neck fracture provides an equivalent functional outcome to surgical intervention with an earlier return to work and no risk of surgical complications. Larger, randomised controlled trials are required.