RESUMO
Objectives: The aim of this study was to determine the relationship between the vertical mandibular ramus asymmetry and the hand measurements asymmetry in growing patients. Material and Methods: Panoramic radiographs and comparative radiographs of the right and left hands of 40 patients (14 males and 26 females) between 6 and 16 years old (mean age of 11.35±1.99 years) were evaluated. The total height of the mandibular ramus was measured, and the asymmetry index was calculated. The lengths of the proximal, middle and distal phalanges and the metacarpals of the five digits of both hands were measured and the absolute differences R-L were calculated for each one. Results: A statistically significant association between the presence of vertical mandibular ramus asymmetry and the presence of phalanges asymmetry FPII (p=0.016), FPIII (p=0.016), FPIV (p=0.033), FMIII (p=0.031) and FMIV (p=0.016) was observed. Conclusions: Mandibular asymmetry appears not to be isolated but also present in other body districts such as the phalanx bones. The total vertical asymmetry of the mandibular ramus showed an association with the asymmetry of the lengths of the FPIII, FMIII, FPIV, FMIV and FPII in growing individuals, with association between the side of mandibular asymmetry and the side of the phalanx's asymmetry. The asymmetry of this phalanges increases with increasing index of vertical mandibular ramus asymmetry.
Assuntos
Mandíbula , Humanos , Feminino , Masculino , Adolescente , Estudos Transversais , Criança , Mandíbula/diagnóstico por imagem , Mandíbula/anatomia & histologia , Mandíbula/crescimento & desenvolvimento , Mãos/diagnóstico por imagem , Mãos/anatomia & histologia , Radiografia Panorâmica , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/anatomia & histologia , Falanges dos Dedos da Mão/anormalidadesRESUMO
INTRODUCTION: Extra-articular juxtaphyseal fractures of the proximal phalanx are among the most common finger fractures in children. Immobilization of the digit for 3 to 4 weeks after reduction of the fracture is the current standard of care. The purpose of this retrospective study was to evaluate outcomes after intervention among pediatric proximal phalanx base fractures and establish radiographic criteria to guide management. METHODS: A multi-institutional retrospective review of skeletally immature patients treated for proximal phalanx juxtaphyseal fractures between 2002 and 2019 was conducted. Variables collected included Salter-Harris classification; initial, postreduction, early follow-up, and final angulation and displacement on the posterior-anterior and lateral radiographs; clinical rotational deformity at final follow-up; and method of treatment. Exclusion criteria included less than 3 weeks of follow-up; Salter-Harris III, IV, and V fractures; inadequate medical record details; and missing radiographs. RESULTS: Six hundred thirty-four fractures meeting the inclusion criteria were categorized into no reduction, closed reduction (CR), and surgical (OP) groups. Only CR and OP groups saw large decreases in angulation by 11.8° CR (95% confidence interval, 10.1 to 13.6) and 19.0° OP (95% confidence interval, 8.7 to 29.3). Closed reduction patients had a mean coronal angulation value of 6.1° at post-reduction, which was maintained with immobilization to 5.8° at final follow-up. At final follow-up, scissoring was noted, three in the no reduction and three in the CR group for an overall 0.93% rotational malalignment rate. DISCUSSION: Extra-articular proximal phalanx juxtaphyseal fractures rarely require surgical management and can typically be treated with or without CR, based on the degree of deformity, in the emergency department or clinical setting. Low rates of documented sequelae after nonsurgical management were seen in this cohort, allowing for establishment of treatment parameters that can result in clinically insignificant angular and rotational deformity. LEVEL OF EVIDENCE: Therapeutic IV.
Assuntos
Traumatismos dos Dedos , Falanges dos Dedos da Mão , Fraturas Ósseas , Criança , Humanos , Traumatismos dos Dedos/terapia , Falanges dos Dedos da Mão/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Congenital dorsal curvature of the distal phalanx has been previously described as 'reverse Kirner' or 'ski-jump' deformity. This report describes bilateral occurrence in the thumbs. A 13-year-old male presented with difficulty caring for his thumbnails and in picking up small objects. Examination showed dorsal curvature of the distal phalanges of both thumbs, with greater curvature of the right side. Radiographs showed wedge-shaped epiphyses and dorsal curvature without coronal plane deviation of the distal phalanges. There was objective and subjective decrease in function associated with lateral pinch and tripod grasp. The reported aetiopathogenesis for Kirner deformity cannot explain the observed dorsal curvature. The bilateral nature makes a secondary physeal cause unlikely and suggests an embryologic basis. Due to the noticeable deficits in function, operative intervention may be warranted. Level of Evidence: Level V (Therapeutic).
Assuntos
Falanges dos Dedos da Mão , Deformidades Congênitas da Mão , Masculino , Humanos , Adolescente , Polegar/cirurgia , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgia , Deformidades Congênitas da Mão/cirurgia , RadiografiaRESUMO
INTRODUCTION: Phalangeal fractures are the most common fractures of the hand and in particular the proximal phalanx of the long fingers is the most involved. These fractures can ben conservatively managed but, when the fracture pattern is considered unstable, surgical treatment is recommended. However, there is no consensus in literature about the proper surgical option for extra-articular proximal phalanx fractures. MATERIAL AND METHODS: We compared clinical and radiographical results after treatment of 75 cases of extra-articular proximal phalanx fractures using three different surgical techniques: closed reduction and internal fixation (CRIF) with Kirschner wires (G1 group), open reduction internal fixation (ORIF) with plates and screws or lag screws (G2 group), and closed reduction and intramedullary screw fixation (CRIMEF)(G3 group). RESULTS: We found no significant differences in term of union rate and time to fracture healing between the three groups. However, we found a significant reduction in time to return at work and in TAM at the final follow-up examination in G3 group (treated with CRIMEF) when compared with both G1 and G2. No differences in complications rate were found between three groups. DISCUSSION: The surgical variability in the management of extra-articular phalanx fractures create lacks on standard guide for treatment. CONCLUSIONS: In conclusion, our results showed good clinical and radiographical results with all the three surgical options. However, the closed reduction and internal fixation with intramedullary screws (CRIMEF) seems to be better in terms of time to return to work and TAM at the final follow-up, probably due to good primary stability and little risk of soft tissue adherence development.
Assuntos
Falanges dos Dedos da Mão , Fraturas Ósseas , Humanos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fixação Interna de Fraturas/métodos , Parafusos Ósseos , Fios Ortopédicos , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgia , MãosAssuntos
Traumatismos dos Dedos , Falanges dos Dedos da Mão , Fraturas Ósseas , Humanos , Falanges dos Dedos da Mão/lesões , Falanges dos Dedos da Mão/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Traumatismos dos Dedos/cirurgia , Traumatismos dos Dedos/diagnóstico por imagem , Masculino , Radiografia , Adulto , Fixação Interna de Fraturas/métodosRESUMO
Primary lymphoma of bone (PLB) is a rare, malignant lymphoid proliferation within bone accounting for less than 3% of all malignant bone tumors. In this case report, a 61-year-old female with past medical history of gout presented with pain and swelling in her right little finger. Initial radiographs demonstrated periostitis and soft tissue swelling about the right little finger. She returned three months later with progressive pain. Subsequent MRI and repeat radiographs demonstrated near complete destruction of the right little finger middle phalanx and periostitis with marrow infiltration at the right long finger. Given the rapid progression of disease, the differential diagnosis consisted primarily of aggressive neoplastic processes. The little finger ray was amputated through the level of the metacarpophalangeal joint and histopathology demonstrated large neoplastic cells that stained positive with CD45, CD20, and PAX5, compatible with diffuse large B-cell lymphoma. A subsequent normal bone marrow aspiration and PET-CT demonstrated no additional sites of disease, thus excluding secondary lymphoma to bone. To the best of our knowledge, this is the first case report of polyostotic PLB involving the hand. PLB of the hands may be initially misdiagnosed due to its rarity and clinical presentation mimicking rheumatological disease. Clinical vigilance in concert with close imaging follow-up is required to make the diagnosis in a timely fashion. We also review the existing PLB hand literature which consists of five cases.
Assuntos
Neoplasias Ósseas , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Diagnóstico Diferencial , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/patologia , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Imageamento por Ressonância Magnética/métodosRESUMO
The aim of this study was to establish normative values for the teardrop angle at the base of the middle phalanx. Our results showed a consistent mean teardrop angle in the range of 50°-51°, with no statistically significant difference observed between digits.Level of evidence: III.
Assuntos
Radiografia , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Valores de Referência , Falanges dos Dedos da Mão/diagnóstico por imagem , Idoso , AdolescenteRESUMO
We report a case of a 57-year-old woman who presented a rapidly progressing swelling at the base of her right 4th finger, with imaging revealing non-specific lesions suggestive of a malignant tumoral process. Following imaging, resection-biopsy revealed a non-caseating granulomatous inflammatory infiltrate suggesting sarcoidosis. Digital sarcoidosis is an uncommon presentation of the disease, especially in the early stages and without systemic symptoms. Early diagnosis and treatment are advised in order to prevent future complications.
Assuntos
Falanges dos Dedos da Mão , Sarcoidose , Humanos , Feminino , Sarcoidose/diagnóstico , Sarcoidose/diagnóstico por imagem , Sarcoidose/patologia , Pessoa de Meia-Idade , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/patologia , Imageamento por Ressonância MagnéticaRESUMO
Though the Greulich and Pyle (GP) method is easy, inter-observer variability, differential maturation of hand bones influences ratings. The Tanner-Whitehouse (TW) method is more accurate, but cumbersome. A simpler method combining the above, such that it utilizes fewer bones without affecting accuracy, would be widely used and more applicable in clinical practice. OBJECTIVES: 1. Devising a simplified method utilizing three bones of the hand and wrist for bone age (BA) assessment. 2. Testing whether the 3 bone method gives comparable results to standard methods (GP,TW2,TW3) in Indian children. METHODS: Developmental stages and corresponding BA for radius, hamate, terminal phalanx (left middle finger) epiphyses combining stages from GP,TW3 atlases were described; BA were rated by two blinded observers. 3 bone method ratings were compared with the same dataset analyzed earlier using GP,TW2,TW3 (4 raters). RESULTS: Radiographs analysed:493 (Girls=226). Mean chronological age:9.4 ± 4.6 yrs, mean BA 3 bone:9.8 ± 4.8 yrs, GP:9.6 ± 4.8 yrs, TW3:9.3 ± 4.5 yrs, TW2:9.9 ± 5.0 yrs. The 3 bone method demonstrated no significant inter-observer variability (p = 0.3, mean difference = 0.02 ± 0.6 yrs); a strong positive correlation (p < 0.0001) with GP (r = 0.985), TW3 (r = 0.983) and TW2 (r = 0.982) was noted. Bland-Altman plots demonstrated good agreement; the root mean square errors between 3 bone and GP,TW3,TW2 ratings were 0.6,0.7,0.6 years; mean differences were 0.19,0.49,-0.14 years respectively. Greatest proportion of outliers (beyond ±1.96 SD of mean difference) was between 6 and 8 years age for difference in 3 bone and GP, and between 4-6 years for difference in 3 bone and TW3,TW2. CONCLUSION: The 3 bone method has multiple advantages; it is easier, tackles differential maturation of wrist and hand bones, has good reproducibility, without compromising on accuracy rendering it suitable for office practice.
Assuntos
Determinação da Idade pelo Esqueleto , Ossos da Mão , Determinação da Idade pelo Esqueleto/métodos , Humanos , Feminino , Criança , Masculino , Ossos da Mão/diagnóstico por imagem , Ossos da Mão/crescimento & desenvolvimento , Ossos da Mão/anatomia & histologia , Adolescente , Pré-Escolar , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/anatomia & histologia , Variações Dependentes do Observador , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/anatomia & histologia , Reprodutibilidade dos Testes , Punho/diagnóstico por imagem , Punho/anatomia & histologia , Desenvolvimento Ósseo/fisiologiaRESUMO
Clinodactyly can be produced by a longitudinal epiphyseal bracket that generates either a 'delta' or 'trapezoidal' phalanx. We present a case with a 15-year follow-up of bilateral clinodactyly of the little finger, to emphasize a 'wait-and-see' approach as self-remodelling of his phalanges occurred during growth.
Assuntos
Falanges dos Dedos da Mão , Deformidades Congênitas da Mão , Humanos , Seguimentos , Falanges dos Dedos da Mão/diagnóstico por imagem , Dedos , Epífises , Deformidades Congênitas da Mão/diagnóstico por imagem , Deformidades Congênitas da Mão/cirurgiaRESUMO
Phalangeal fractures are extremely common in the pediatric and adolescent populations. The incidence of phalangeal fractures peaks in children ages 10 to 14 years, corresponding to the age in which children begin contact sports. Younger children are more likely to experience crush injuries, whereas older children often sustain phalangeal fractures during sports. The physis is particularly susceptible to fracture because of the biomechanically weak nature of the physis compared with the surrounding ligaments and bone. Phalangeal fractures are identified through a thorough physical examination and are subsequently confirmed with radiographic evaluation. Management of pediatric phalangeal fractures is dependent on the age of the child, the severity of the injury, and the degree of fracture displacement. Nondisplaced fractures are often managed nonsurgically with immobilization, whereas unstable, displaced fractures may require surgery, which is often a closed rather than open reduction and percutaneous pinning.
Assuntos
Traumatismos dos Dedos , Falanges dos Dedos da Mão , Fixação Intramedular de Fraturas , Fraturas Ósseas , Esportes , Adolescente , Criança , Humanos , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/lesões , Falanges dos Dedos da Mão/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgiaRESUMO
A comprehensive analysis of the assessment, diagnosis, and management of phalangeal fractures and fingertip injuries should emphasize the importance of achieving the right balance between undertreatment and overtreatment. Phalangeal injuries are complex, requiring an in-depth understanding of hand anatomy, fracture patterns, and treatment options to optimize patient outcomes. A thorough examination of proximal and middle phalangeal fractures and fingertip injuries, including those to the nail bed and distal phalanx, is important. A systematic approach to addressing the most prevalent injuries in this category should be implemented while highlighting the need for patient-specific approaches to treatment and a multidisciplinary perspective to ensure the best possible outcomes for patients.
Assuntos
Traumatismos dos Dedos , Falanges dos Dedos da Mão , Fraturas Ósseas , Humanos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Fixação Interna de Fraturas , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/lesõesRESUMO
SUMMARY: In the study, it was aimed to predict sex from hand measurements using machine learning algorithms (MLA). Measurements were made on MR images of 60 men and 60 women. Determined parameters; hand length (HL), palm length (PL), hand width (HW), wrist width (EBG), metacarpal I length (MIL), metacarpal I width (MIW), metacarpal II length (MIIL), metacarpal II width (MIIW), metacarpal III length (MIIL), metacarpal III width (MIIIW), metacarpal IV length (MIVL), metacarpal IV width (MIVW), metacarpal V length (MVL), metacarpal V width (MVW), phalanx I length (PILL), measured as phalanx II length (PIIL), phalanx III length (PIIL), phalanx IV length (PIVL), phalanx V length (PVL). In addition, the hand index (HI) was calculated. Logistic Regression (LR), Random Forest (RF), Linear Discriminant Analysis (LDA), K-nearest neighbour (KNN) and Naive Bayes (NB) were used as MLAs. In the study, the KNN algorithm's Accuracy, SEN, F1 and Specificity ratios were determined as 88 %. In this study using MLA, it is understood that the highest accuracy belongs to the KNN algorithm. Except for the hand's MIIW, MIIIW, MIVW, MVW, HI variables, other variables were statistically significant in terms of sex difference.
En el estudio, el objetivo era predecir el sexo a partir de mediciones manuales utilizando algoritmos de aprendizaje automático (MLA). Las mediciones se realizaron en imágenes de RM de 60 hombres y 60 mujeres. Parámetros determinados; longitud de la mano (HL), longitud de la palma (PL), ancho de la mano (HW), ancho de la muñeca (EBG), longitud del metacarpiano I (MIL), ancho del metacarpiano I (MIW), longitud del metacarpiano II (MIIL), ancho del metacarpiano II (MIIW), longitud del metacarpiano III (MIIL), ancho del metacarpiano III (MIIIW), longitud del metacarpiano IV (MIVL), ancho del metacarpiano IV (MIVW), longitud del metacarpiano V (MVL), ancho del metacarpiano V (MVW), longitud de la falange I (PILL), medido como longitud de la falange II (PIIL), longitud de la falange III (PIIL), longitud de la falange IV (PIVL), longitud de la falange V (PVL). Además, se calculó el índice de la mano (HI). Regresión logística (LR), Random Forest (RF), Análisis discriminante lineal (LDA), K-vecino más cercano (KNN) y Naive Bayes (NB) se utilizaron como MLA. En el estudio, las proporciones de precisión, SEN, F1 y especificidad del algoritmo KNN se determinaron en un 88 %. En este estudio que utiliza MLA, se entiende que la mayor precisión pertenece al algoritmo KNN. Excepto por las variables MIIW, MIIIW, MIVW, MVW, HI de la mano, otras variables fueron estadísticamente significativas en términos de diferencia de sexo.
Assuntos
Humanos , Masculino , Feminino , Ossos do Carpo/diagnóstico por imagem , Falanges dos Dedos da Mão/diagnóstico por imagem , Ossos Metacarpais/diagnóstico por imagem , Determinação do Sexo pelo Esqueleto/métodos , Algoritmos , Imageamento por Ressonância Magnética , Ossos do Carpo/anatomia & histologia , Análise Discriminante , Modelos Logísticos , Falanges dos Dedos da Mão/anatomia & histologia , Ossos Metacarpais/anatomia & histologia , Aprendizado de Máquina , Algoritmo Florestas AleatóriasRESUMO
Posttraumatic malunion with combination of angular, rotational, and shortening deformity of the proximal phalanx may cause scissoring of a finger and impairment of hand function. Cosmetic disfigurement and severe dysfunction of fingers require surgical correction, most often via open corrective osteotomies and rigid fixation with a plate or screws. However, such an approach requires a longer incision, inevitably results in a scar, and has a higher potential for extensor tendon adhesion. Also, abruption of the periosteum and plating of the phalange requires longer bone healing time. Thus, we devised a technique of minimally invasive correction of phalangeal malunion using an external mini-fixator. We presented representative three cases of malunited fractures of phalanges treated with the Ilizarov mini-fixator in adolescence and review reports of similar cases. The usage of Ilizarov mini-fixator provided excellent outcomes for posttraumatic malunion of three fingers.
Assuntos
Falanges dos Dedos da Mão , Fraturas Mal-Unidas , Humanos , Adolescente , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/cirurgia , Fixação Interna de Fraturas , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgia , Osteotomia/métodos , DedosRESUMO
Hand fractures represent commonly encountered injuries in pediatric patients. However, due to modern means of mobility and product safety, the occurrence and distribution of these fractures have changed during the last decades. Therefore, it was the aim of this study to present an update of the epidemiology, pattern, and treatment of hand fractures in a large pediatric cohort. All patients aged between 0 and 17 years treated in our Department in 2019 with fractures of the phalanges, metacarpus, or carpus were included. The medical records were reviewed for age, gender, injury mechanism, fracture localization, season, and treatment. Patients were divided into three different age groups (0-5, 6-12, and 13-17 years). A total of 731 patients with 761 hand fractures were treated during the 1-year study period. The mean age was 11.1 ± 3.5 years, and the majority was male (65%). Male patients were significantly older compared to female patients (p = 0.008). Also, 78.7% of the fractures affected the phalanges, 17.6% the metacarpals, and 3.7% the carpal bones. The proximal phalanges were the most commonly fractured bones (41.5%). Patients with fractures of the carpus were significantly older compared to children sustaining fractures of the metacarpus or phalangeal bones (p < 0.001). Sixteen percent of our patients were treated surgically; these patients were significantly older compared to conservatively treated patients (p = 0.011). Conclusion: The epidemiology, mechanisms of injury, distribution, and treatment of hand fractures significantly varies among different age groups. This knowledge is of importance for educational purposes of younger colleagues entrusted with care of children and adolescents as well as development of effective prevention strategies. What is Known: ⢠Pediatric hand fractures represent the second most common fractures in children. ⢠The epidemiology of pediatric hand fractures has changed during the last decades and therefore there is a need for an update regarding distribution and epidemiology of pediatric hand fractures. What is New: ⢠In this retrospective cohort study, 761 pediatric hand fractures of 731 patients were analyzed in detail. ⢠The main mechanisms of younger patients were entrapment injuries, older children most commonly sustained their fractures due to ball sport injuries. There was an increasing rate of metacarpal and carpal fractures with increasing age, and these fractures had to be treated operatively more often than phalangeal fractures.
Assuntos
Falanges dos Dedos da Mão , Fraturas Ósseas , Traumatismos da Mão , Ossos Metacarpais , Criança , Humanos , Masculino , Adolescente , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Estudos Retrospectivos , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Ossos Metacarpais/lesões , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/lesões , Falanges dos Dedos da Mão/cirurgia , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/etiologia , Traumatismos da Mão/terapiaRESUMO
BACKGROUND: Treatment protocols for macrodactyly have not been elucidated due to its rarity and variety of clinical manifestations. This study aims to share our long-term clinical results of epiphysiodesis in children with macrodactyly. METHODS: A retrospective chart review was performed for 17 patients with isolated macrodactyly treated with epiphysiodesis over 20 years. Length and width of each phalanx in both the affected finger and the corresponding unaffected finger in the contralateral hand were measured. Results were presented in ratios of the affected to unaffected side for each phalanx. Measuring of length and width of phalanx was performed preoperatively and postoperatively at 6, 12, and 24 months, and the last follow-up session. Postoperative satisfaction scoring was done with visual analogue scale. RESULTS: The mean follow-up period was 7 years and 2 months. In the proximal phalanx, length ratio significantly decreased compared with preoperative state at after more than 24 months, in the middle phalanx after 6 months, in the distal phalanx after 12 months. When classified by the growth patterns, the progressive type showed significant decrease in length ratio at after 6 months, and the static type after 12 months. Patients were overall satisfied with the results. CONCLUSION: Epiphysiodesis effectively regulated longitudinal growth with different degree of control for different phalanges in the long-term follow-up.
Assuntos
Falanges dos Dedos da Mão , Deformidades Congênitas dos Membros , Humanos , Criança , Estudos Retrospectivos , Dedos/cirurgia , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgiaRESUMO
INTRODUCTION: Osteoid osteoma (OO) is a common benign bone tumor. OO is observed most frequently in the long bones, especially in the tibia and femur. When occurring in the bones of the hand, OO can be a diagnostic and therapeutic challenge. The aim of this study was to provide a systematic review of occurrence, symptoms, diagnosis and treatment options regarding OO in hand bones. MATERIALS AND METHODS: We performed a systematic review of the literature. All studies from the online databases PubMed and SpringerLink, which reported cases of osteoid osteomas in the bones of the hand, were included. By summarizing the literature, we evaluated the localization within the hand as well as diagnostic and therapeutic options. RESULTS: We included 133 studies reporting 401 cases. OO was mostly common in the phalanges. The diagnosis was mostly made by CT (computed tomography) scan. Most of the OO were treated surgically by open curettage or en bloc resection. CONCLUSIONS: Osteoid osteomas in the bones of the hand are rare and a delayed diagnosis is common. In cases of pain combined with particular symptoms such as nail hypertrophy and swelling OO should be considered. Of the most used imaging methods, CT scans have the highest sensitivity.
Assuntos
Neoplasias Ósseas , Falanges dos Dedos da Mão , Osteoma Osteoide , Humanos , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/cirurgia , Mãos/cirurgia , Dor , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgiaRESUMO
Osteoid osteoma (OO) is a benign osteoblastic bone tumor typically involving the diaphysis or metaphysis in long tubular bones. OO in phalanges of the great toe has been rarely reported, and it is often challenging to differentiate with subacute osteomyelitis, bone abscess, or osteoblastoma. This case report describes an uncommon case of a 13-year-old female patient with subperiosteal OO in the proximal phalanx of the great toe. The atypical location of OO should be familiarized to include appropriate differential diagnosis and to ensure accurate diagnosis by radiologic evaluations. Surgical excision remains the benchmark for the treatment of OO with its advantages on direct visualization and histologic confirmation for the diagnosis.
Assuntos
Neoplasias Ósseas , Falanges dos Dedos da Mão , Hallux , Osteoma Osteoide , Osteomielite , Neoplasias de Tecidos Moles , Feminino , Humanos , Adolescente , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/cirurgia , Hallux/diagnóstico por imagem , Hallux/cirurgia , Diáfises , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgiaRESUMO
Intramedullary headless compression screw fixation of proximal phalangeal fractures permits semirigid stabilization through a minimally invasive approach with negligible tendon disturbance, allowing early mobilization and rehabilitation. Antegrade insertion is preferred for basal fractures, but various concerns and technical difficulties have been identified with both intra- and transarticular instrumentation. We describe a technical tip to facilitate easier guidewire insertion and instrumentation with a screw via an intra-articular approach.
Assuntos
Falanges dos Dedos da Mão , Fraturas Ósseas , Humanos , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Parafusos Ósseos , Fixação Interna de FraturasRESUMO
Intraosseous schwannomas are extremely rare and only a few cases involving the proximal phalanx and metacarpal of the hand have been reported. We report a patient with an intraosseous schwannoma of the distal phalanx. Radiographs showed lytic lesions in the bony cortex and enlarged soft shadows of the distal phalanx. The lesion was hyperintense to fat on T2-weighted magnetic resonance imaging (MRI) and strongly enhanced after gadolinium (Gd) administration. Surgical findings revealed that the tumour had developed from the palmar side of the distal phalanx and the medullary cavity was filled with a yellow tumour. The histological diagnosis was schwannoma. A definitive diagnosis of intraosseous schwannoma using radiography is difficult. In our case, a high signal was observed on Gd-enhanced MRI and histological findings showed areas with a high cellular area. Thus, Gd-enhanced MRI may help in the diagnosis of intraosseous schwannomas of the hand. Level of Evidence: Level V (Therapeutic).