Extension Mechanism of the Proximal Interphalangeal Joint of the Human Phalanx: A Cadaveric Biomechanical Study.

Our purpose was to compare the contributions of these two systems to assess PIP joint extension in fresh cadaver models. Nine middle fingers of fresh cadavers were used. The PIP joint angle was measured while an extension load was applied on the extensor tendons. Specimens on which extension load was applied on the extrinsic extensors were classified as the extrinsic group, and those on which extension load was applied on the intrinsic extensors were classified as the intrinsic group. Linear regression analyses were performed to obtain regression equation and the extension load-PIP joint angle curve. The mean of slope of the curve was compared between the two groups using paired t-test. The same experiments were done for the metacarpophalangeal (MP) joint in 0° and 60° flexion to evaluate the effect of MP joint flexion on PIP joint extension. The mean slope of the extension load-PIP joint angle curve of the extrinsic group was significantly greater than that of the intrinsic group. With the MP joint in 0° flexion, the mean slope of the extrinsic and intrinsic groups was -0.148 and -0.117, respectively (greater absolute value means greater slope, p = 0.01). With the MP joint in 60° flexion, the mean slopes were -0.147 and -0.104, respectively (p = 0.015). The contribution of the intrinsic extensor for PIP joint extension shows decreasing trends with MP joint flexion. The extrinsic extensors have greater contribution for PIP joint extension compared with the intrinsic extensors.

Correlation between musculoskeletal structure of the hand and primate locomotion: Morphometric and mechanical analysis in prehension using the cross- and triple-ratios.

Biometric ratios of the relative length of the rays in the hand have been analyzed between primate species in the light of their hand function or phylogeny. However, how relative lengths among phalanges are mechanically linked to the grasping function of primates with different locomotor behaviors remains unclear. To clarify this, we calculated cross and triple-ratios, which are related to the torque distribution, and the torque generation mode at different joint angles using the lengths of the phalanges and metacarpal bones in 52 primates belonging to 25 species. The torque exerted on the finger joint and traction force of the flexor tendons necessary for a cylindrical grip and a suspensory hand posture were calculated using the moment arm of flexor tendons measured on magnetic resonance images, and were compared among Hylobates spp., Ateles sp., and Papio hamadryas. Finally, the torques calculated from the model were validated by a mechanical study detecting the force exerted on the phalanx by pulling the digital flexor muscles during suspension in these three species. Canonical discriminant analysis of cross and triple-ratios classified primates almost in accordance with their current classification based on locomotor behavior. The traction force was markedly reduced with flexion of the MCP joint parallel to the torque in brachiating primates; this was notably lower in the terrestrial quadrupedal primates than in the arboreal primates at mild flexion. Our mechanical study supported these features in the torque and traction force generation efficiencies. Our results suggest that suspensory or terrestrial quadrupedal primates have hand structures that can exert more torque at a suspensory posture, or palmigrade and digitigrade locomotion, respectively. Furthermore, our study suggests availability of the cross and triple-ratios as one of the indicators to estimate the hand function from the skeletal structure.

Phalangeal curvature in a chimpanzee raised like a human: Implications for inferring arboreality in fossil hominins.

Arboreal primates such as chimpanzees exhibit pronounced curvature in their hand and foot phalanges, which is assumed to develop throughout life in response to mechanical loads produced by grasping and hanging from branches. Intriguingly, ancient fossil hominins also exhibit substantial phalangeal curvature, which, too, has been interpreted as a direct result of habitual arboreality during life. Here, we describe the phalangeal curvature of a chimpanzee who was raised during the 1930s in New York City to live much like a human, including by having very few opportunities to engage in arboreal activities. We show that the degree of hand and foot phalangeal curvature in this individual is indistinguishable from that of wild chimpanzees and distinct from humans. Thus, rather than being a direct effect of mechanical loads produced by lifetime arboreal activities, phalangeal curvature appears to be shaped largely by genetic factors. An important implication of this finding is that phalangeal curvature among fossil hominins is evidently best interpreted as a primitive trait inherited from an arboreal ancestral species rather than proof of engagement in arboreal activities during life.

Insertion sites in manual proximal phalanges of African apes and modern humans.

OBJECTIVES: The primary aim of this study was to describe the insertion sites of the ligaments holding the flexor digitorum profundus and superficialis muscles (flexor ridges) in proximal phalanges 2-5 of African apes and modern humans. To interpret differences in flexor ridge size based on general behavioral differences among taxa. MATERIALS AND METHODS: We analyzed 3D models of manual proximal phalanges 2-5 from 29 gorillas (Gorilla beringei and Gorilla gorilla), 30 chimpanzees (Pan troglodytes) and 36 recent modern humans. Flexor ridges (mm2) were compared within and across genera. RESULTS: Gorillas and chimpanzees had larger flexor ridges for phalanges 2-4 than humans and this difference subsists when controlling for body size. Each genus had a unique insertion size pattern across the digits, with the most heterogeneous pattern found in chimpanzees, followed by humans, and lastly gorillas. These patterns corresponded strongly to the differences in the size of the phalanges within each genus, except for phalanx 5 in humans, which had a larger flexor ridge than expected. DISCUSSION: When comparing these genera, the flexor ridges signal differences between taxa that use their hands for manipulation and locomotion (gorillas and chimpanzees) and taxa that use them exclusively for manipulation (humans). This functional signal was also apparent in the PP5 of humans, whose larger FR may be indicating the high recruitment of this digit during forceful precision grip characteristic of humans.

Treatment of proximal phalanx fractures: transarticular pinning the metacarpophalangeal joint or cross pinning from the base of the proximal phalanx-a prospective study.

INTRODUCTION: For extraarticular proximal phalanx fractures, two methods are employed, transarticular fixation in which the metacarpophalangeal joint is crossed and the extraarticular method in which the pins are introduced through the base of the proximal Phalanx. MATERIALS AND METHODS: This study was a prospective one on patients with proximal phalanx transverse or short oblique fractures. In one of the groups we used parallel pins from metacarpal head through MCP joint to proximal phalanx. In the second, we used two cross pins from proximal phalanx the base of the proximal phalanx to fix the fracture. We evaluated metacarpophalangeal, proximal and distal interphalangeal joints active range of motion and how long it took the patient to resume their daily activities and work without difficulty, as well as post-operative complications such as wound infection, malunion, and nonunion in 3 and 6 months follow-up. RESULTS: Ultimately, 61 people entered the study, 29 in the parallel pins and 31 in the cross pins group. There was no significant difference between the two groups, but the improvement in all of the joints range of motion showed a statistically significant difference (P < 0.0001) from the 3 to 6 months follow-up. The final range of motion showed an inverse correlation with age of the patient (P < 0.05). Most of the patients were in the excellent grade of range of motion class and no serious complication was observed in any of them. CONCLUSION: The results of treatment in proximal phalangeal fractures with both methods were comparable and so the surgeon may select each based on the experience and training.

Ossification of the Proximal and Middle Phalangeal Condyles: Radiographic Aid in Phalangeal Neck Fracture Reduction.

BACKGROUND: Phalangeal neck fractures are commonly dorsally displaced and angulated. Surgical treatment is often necessary to restore the retrocondylar recess. The purpose of this study was to determine whether radiographic landmarks can serve as a reference tool for assessing phalangeal neck fracture alignment based on age and sex. METHODS: In total, 1061 lateral finger radiographs that were interpreted as "normal" by pediatric radiologists in children aged 1 to 18 years were retrospectively reviewed. The proximal and middle phalanges of each digit had a line drawn along the volar cortex [termed the volar phalangeal line (VPL)] and a second perpendicular line was drawn at the level of the phalangeal condyle. A ratio of the anterior to posterior aspects of the phalangeal condyle was determined at the intersection of these lines. Sex of the patients was noted to determine whether it influenced the temporal course of ossification. A linear regression model was utilized to determine the annual coefficient of growth for the phalangeal condyles. RESULTS: There is a temporal course of ossification of the proximal and middle phalangeal condyles. As children increase in age, the VPL will intersect the phalangeal condyle more dorsally due to the eccentric ossification. In children above 9 years of age, the VPL will reliably intersect the middle one third of the phalangeal condyle. No clinically significant difference exists between the ratios of the proximal and middle phalanges. Sex was not associated with a difference in growth. The greatest growth increase was observed in the 8 to 9-year-old interval. CONCLUSIONS: The phalangeal condyles ossify in an eccentric manner and the VPL will intersect the phalangeal condyle more dorsally with increasing age. The VPL and knowledge of where it should intersect the phalangeal condyle can be used as a reference guide for evaluating the reduction of proximal and middle phalangeal neck fractures in children. LEVEL OF EVIDENCE: Level III.

A three-dimensional visco-hyperelastic FE model for simulating the mechanical dynamic response of preloaded phalanges.

This study lays the groundwork for a multi-scale strategy that will lead to a better understanding and prediction of the effects of vibration on the digital arterial network. This is accomplished by modelling the mechanical and biological factors that could disturb the basal vasoconstriction balance in the fingertip. The first stage of this novel approach involved building and validating an original dissipative constitutive law for the fingertip soft tissue for the purpose of finite element modelling of the mechanical response of preloaded phalanges in vibration. This visco-hyperelastic constitutive law was established by means of a two-stage procedure for combining a classical pure static nonlinear law with an original dissipative model. First, the parameters of an Ogden-Hill pure static nonlinear constitutive law were identified using a constrained optimisation algorithm. Second, an original viscous dissipation model was proposed in the spectral domain. This model is based on the linearization of the nonlinear quasi-linear viscoelasticity law and the use of a viscoelastic relaxation modulus, expressed as a continuous distribution of relaxation spectra suitable for living tissues. The experimental data used to fit this model were the static and dynamic stiffnesses of preloaded fingertips acquired from a group of 20 subjects. The relative errors between the measured and simulated stiffnesses were less than 5% in the static procedure and approximately 8% using dynamic analysis. The computed mechanical pressure and maximal tangential stress within the fingertip were high in the soft tissues close to the vibration excitation and also in the bones and interphalangeal cartilages far from the vibration source. Mechanical power was only dissipated significantly in the immediate vicinity of the contact area between the probe and the finger. The main contribution of this study was to implement and identify the parameters of a new spectral dissipative law for fingertip soft tissues. This work may apply in occupational health for modifying the vibration dose assessment or for the follow-up and screening of connective tissue diseases.

Validation Study of the Thumb Ossification Composite Index (TOCI) in Idiopathic Scoliosis: A Stage-to-Stage Correlation with Classic Tanner-Whitehouse and Sanders Simplified Skeletal Maturity Systems.

BACKGROUND: The new simplified thumb ossification composite index (TOCI) based on ossification of the thumb epiphyses and adductor sesamoid has demonstrated simplicity, excellent reliability, and high accuracy for predicting skeletal maturity, comparable with the Sanders simplified skeletal maturity system (SSMS). It was our belief that, because the terminology of the SSMS system has been commonly used for skeletal maturity prediction in idiopathic scoliosis in publications over the past decade, the clinical applicability of the TOCI system would increase if the stages in the 2 systems were found to be interchangeable and highly correlated. METHODS: Hand radiographs of 125 premenarchal girls with newly diagnosed adolescent idiopathic scoliosis who had been followed longitudinally until skeletal maturity were all scored with use of the Tanner-Whitehouse III (TW3) system (stages E through I), the TOCI, and the SSMS. The scores for the epiphyses of the ulnar 4 digits were compared with those for the thumb and correlated with the timing of peak height velocity. Correlations were analyzed with the chi-square test and Cramer V and Somers delta correlations. RESULTS: Six hundred and forty-five hand radiographs (an average of 5 for each girl with idiopathic scoliosis) and 11,517 epiphyses were scored. The rate of concordance between TW3 stages F, G, and I for the thumb proximal phalangeal epiphysis and those for all of the epiphyses of the ulnar 4 digits were 72.5%, 72.5%, and 89.9%, respectively. The overall concordance rate (including all epiphyses) was 71.3%, with a very high Cramer V correlation and significance (p < 0.01). High interchangeability was demonstrated for the TOCI and SSMS stages, supported by a high Somers delta correlation (>0.8) with significance (p < 0.05). CONCLUSIONS: The TOCI is highly practical for clinical use, and its stages are highly interchangeable with those of the SSMS. CLINICAL RELEVANCE: The TOCI could serve as a simplified "marker" of skeletal maturity on hand radiographs and minimize the learning-curve problems associated with the SSMS in a busy clinical practice.

Anatomy and Biomechanics of the Finger Proximal Interphalangeal Joint.

A complete understanding of the normal anatomy and biomechanics of the proximal interphalangeal joint is critical when treating pathology of the joint as well as in the design of new reconstructive treatments. The osseous anatomy dictates the principles of motion at the proximal interphalangeal joint. Subsequently, the joint is stabilized throughout its motion by the surrounding proximal collateral ligament, accessory collateral ligament, and volar plate. The goal of this article is to review the normal anatomy and biomechanics of the proximal interphalangeal joint and its associated structures, most importantly the proper collateral ligament, accessory collateral ligament, and volar plate.

Real time relationship between individual finger force and grip exertion on distal phalanges in linear force following tasks.

Individual finger force (FF) in a grip task is a vital concern in rehabilitation engineering and precise control of manipulators because disorders in any of the fingers will affect the stability or accuracy of the grip force (GF). To understand the functions of each finger in a dynamic grip exertion task, a GF following experiment with four individual fingers without thumb was designed. This study obtained four individual FFs from the distal phalanges with a cylindrical handle in dynamic GF following tasks. Ten healthy male subjects with similar hand sizes participated in the four-finger linear GF following tasks at different submaximal voluntary contraction (SMVC) levels. The total GF, individual FF, finger force contribution, and following error were subsequently calculated and analyzed. The statistics indicated the following: 1) the accuracy and stability of GF at low %MVC were significantly higher than those at high SMVC; 2) at low SMVC, the ability of the fingers to increase the GF was better than the ability to reduce it, but it was contrary at high SMVC; 3) when the target wave (TW) was changing, all four fingers strongly participated in the force exertion, but the participation of the little finger decreased significantly when TW remained stable; 4) the index finger and ring finger had a complementary relationship and played a vital role in the adjustment and control of GF. The middle finger and little finger had a minor influence on the force control and adjustment. In conclusion, each of the fingers had different functions in a GF following task. These findings can be used in the assessment of finger injury rehabilitation and for algorithms of precise control.

Grasping primate development: Ontogeny of intrinsic hand and foot proportions in capuchin monkeys (Cebus albifrons and Sapajus apella).

Young primates have relatively large hands and feet for their body size, perhaps enhancing grasping ability. We test the hypothesis that selection for improved grasping ability is responsible for these scaling trends by examining the ontogeny of intrinsic hand and foot proportions in capuchin monkeys (Cebus albifrons and Sapajus apella). If selection for improved grasping ability is responsible for the observed patterns of hand and foot growth in primates, we predicted that fingers and toes would be longer early in life and proportionally decline with age. We measured the lengths of manual and pedal metapodials and phalanges in a mixed-longitudinal radiographic sample. Bone lengths were (a) converted into phalangeal indices (summed non-distal phalangeal length/metapodial length) to test for age-related changes in intrinsic proportions and (b) fit to Gompertz models of growth to test for differences in the dynamics of phalangeal versus metapodial growth. Manual and pedal phalangeal indices nearly universally decreased with age in capuchin monkeys. Growth curve analyses revealed that metapodials generally grew at a faster rate, and for a longer duration, than corresponding phalanges. Our findings are consistent with the hypothesis that primates are under selection for increased grasping ability early in life. Relatively long digits may be functionally adaptive for growing capuchins, permitting a more secure grasp on both caregivers and arboreal supports, as well as facilitating early foraging. Additional studies of primates and other mammals, as well as tests of grasping performance, are required to fully evaluate the adaptive significance of primate hand and foot growth.

Automated pressure map segmentation for quantifying phalangeal kinetics during cylindrical gripping.

Inverse dynamics models used to investigate musculoskeletal disorders associated with handle gripping require accurate phalangeal kinetics. Cylindrical handles wrapped with pressure film grids have been used in studies of gripping kinetics. We present a method fusing six degree-of-freedom hand kinematics and a kinematic calibration of a cylinder-wrapped pressure film. Phalanges are modeled as conic frusta and projected onto the pressure grid, automatically segmenting the pressure map into regions of interest (ROIs). To demonstrate the method, segmented pressure maps are presented from two subjects with substantially different hand length and body mass, gripping cylinders 50 and 70 mm in diameter. For each ROI, surface-normal force vectors were summed to create a reaction force vector and center of pressure location. Phalangeal force magnitudes for a data sample were similar to that reported in previous studies. To evaluate our method, a surrogate was designed for each handle such that when modeled as a phalanx it would generate a ROI around the cells under its supports; the classification F-score was above 0.95 for both handles. Both the human subject results and the surrogate evaluation suggest that the approach can be used to automatically segment the pressure map for quantifying phalangeal kinetics of the fingers during cylindrical gripping.

Distal phalanges of Eosimias and Hoanghonius.

Seven primate distal phalanges have been identified from two middle Eocene fossil localities (Locality 1 and Nanbaotou) in the Yuanqu Basin, China, providing the first evidence of distal phalangeal morphology in Asian Eocene adapiform and eosimiid primates. The bones are best allocated to the basal anthropoid Eosimias centennicus and to hoanghoniine adapiforms. All distal phalangeal specimens display a morphology consistent with nail-bearing fingers and toes. The hallucal distal phalanx of the basal anthropoid Eosimias is more similar to that of primitive tarsiiforms than to crown group anthropoids. The adapiform distal phalanges from Locality 1 are allocated to Hoanghonius stehlini while those from Nanbaotou are tentatively assigned to an indeterminate hoanghoniine because dental remains of adapiforms have yet to be identified from this site. The distal phalangeal anatomy of hoanghoniines differs slightly from that documented for adapines and notharctines. One distal phalanx from Locality 1 shows a second pedal digit "grooming claw" morphology as noted for notharctines by Maiolino et al. (2012) and cercamoniines by Von Koenigswald et al. (2012).

A Non-Contact Measurement System for the Range of Motion of the Hand.

An accurate and standardised tool to measure the active range of motion (ROM) of the hand is essential to any progressive assessment scenario in hand therapy practice. Goniometers are widely used in clinical settings for measuring the ROM of the hand. However, such measurements have limitations with regard to inter-rater and intra-rater reliability and involve direct physical contact with the hand, possibly increasing the risk of transmitting infections. The system proposed in this paper is the first non-contact measurement system utilising Intel Perceptual Technology and a Senz3D Camera for measuring phalangeal joint angles. To enhance the accuracy of the system, we developed a new approach to achieve the total active movement without measuring three joint angles individually. An equation between the actual spacial position and measurement value of the proximal inter-phalangeal joint was established through the measurement values of the total active movement, so that its actual position can be inferred. Verified by computer simulations, experimental results demonstrated a significant improvement in the calculation of the total active movement and successfully recovered the actual position of the proximal inter-phalangeal joint angles. A trial that was conducted to examine the clinical applicability of the system involving 40 healthy subjects confirmed the practicability and consistency in the proposed system. The time efficiency conveyed a stronger argument for this system to replace the current practice of using goniometers.

Angular stable lateral plating is a valid alternative to conventional plate fixation in the proximal phalanx. A biomechanical study.

BACKGROUND: Dorsal plating is commonly used in proximal phalanx fractures but it bears the risk of interfering with the extensor apparatus. In this study, dorsal and lateral plating fixation methods are compared to assess biomechanical differences using conventional 1.5mm non-locking plates and novel 1.3mm lateral locking plates. METHODS: Twenty-four fresh frozen human cadaveric proximal phalanges were equally divided into four groups. An osteotomy was set at the proximal metaphyseal-diaphyseal junction and fixed with either dorsal (group A) or lateral (group B) plating using a 1.5mm non-locking plate, or lateral plating with a novel 1.3mm locking plate with bicortical (group C) or unicortical (group D) screws. The specimens were loaded in axial, dorsovolar and mediolateral direction to assess fixation stiffness followed by a cyclic destructive test in dorsovolar loading direction. FINDINGS: Axial stiffness was highest in group D (mean 321.02, SEM 21.47N/mm) with a significant difference between groups D and B (P=0.033). Locking plates (groups C and D) were stiffer than non-locking plates under mediolateral loading (P=0.007), no significant differences were noted under dorsovolar loading. Furthermore, no significant differences were observed under cyclic loading to failure between any of the study groups. INTERPRETATION: No considerable biomechanical advantage of using a conventional 1.5mm dorsal non-locking plate was identified over the novel 1.3mm lateral locking plate in the treatment of proximal phalanx fractures. Since the novel low-profile plate is less disruptive to the extensor mechanism, it should be considered as a valid alternative.

Freely Chosen Index Finger Tapping Frequency Is Increased in Repeated Bouts of Tapping.

Healthy individuals (n = 40) performed index finger tapping at freely chosen frequency during repeated bouts and before and after near-maximal muscle action consisting of 3 intense flexions of the index finger metacarpal phalangeal joint. One experiment showed, unexpectedly, that a bout of tapping increased the tapping frequency in the subsequent bout. Thus, a cumulating increase of 8.2 ± 5.4% (p < .001) occurred across 4 bouts, which were all separated by 10 min rest periods. Follow-up experiments revealed that tapping frequency was still increased in consecutive bouts when rest periods were extended to 20 min. Besides, near-maximal muscle activation, followed by 5 min rest, did not affect the tapping frequency. In conclusion, freely chosen tapping frequency was increased in repeated bouts of tapping, which were separated by 10-20 min rest periods. The observed phenomenon is suggested to be termed repeated bout rate enhancement.

Correction of distal phalangeal nonunion using peg bone graft.

PURPOSE: To evaluate the outcome of a peg bone graft for treatment of distal phalangeal nonunion, in terms of safety and effectiveness. METHODS: We performed grafts using bone pegs in 13 patients who reported pain and instability of the fingertip as a result of distal phalanx nonunion. Surgical procedures included harvesting cancellous and cortical bone from ilium, radius, or ulna. We made a small incision in the fingertip and placed the bone pegs through the canal created for this access. In a few cases in which the bone peg did not offer mechanical stability, we used K-wires for additional support. RESULTS: All patients had successful union of the distal phalanx without serious complications in either donor or recipient areas. Range of motion improved postoperatively. An additional operation was needed in 1 case. CONCLUSIONS: The use of a peg bone graft in the treatment of distal phalanx nonunion offers easy access to the nonunion area and allows for effortless internal fixation. The bone contact area was increased, resulting in bone union and stability. Therefore, bone peg graft could be considered a potential method for the treatment of distal phalanx nonunion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Micro-finite element (µFE) modeling of the siamang (Symphalangus syndactylus) third proximal phalanx: the functional role of curvature and the flexor sheath ridge.

Phalangeal curvature is a commonly used morphological feature for the interpretation of extant and fossil primate locomotor behaviour. Here, we build on a recent biomechanical study (Richmond, 2007) in two ways: first, we use a 3D micro-FE model, which models the real internal microstructure (i.e., cortical thickness and trabecular bone structure) and, second, we model four siamang third proximal phalanges. We test identical 2D homogenized FE models and two 3D micro-FE phalanx models that are mathematically straightened to isolate the biomechanical significance of curvature. We further investigate how varying the loading configuration (e.g., boundary constraints) and modeling (e.g., 2D versus 3D) affects the biomechanical behaviour of the phalanx. Finally, we examine how intraspecific variation in external and internal bony morphology affects the biomechanical behaviour of the phalanx. Simulation results demonstrate that the general pattern of strain and displacement is similar between the 3D micro-FE and 2D homogenized FE models but the absolute values differ substantially. The biomechanical behaviour of the 3D FE models more closely match the relative strain patterns from the validation experiment than the 2D homogenized FE models, indicating the 3D microstructure model is preferable. Varying the loading configuration can have dramatic effects on the biomechanical behaviour of the phalanx depending on individual morphology, but overall a cantilevered beam model is an equally valid, if not better, configuration for modeling the phalanx as other previously-proposed models. Variation in flexor ridge morphology has a substantial effect on phalanx strain; the taller the ridge, the less strain incurred by other regions of the palmar shaft. Finally, phalangeal curvature reduces overall strain experienced by the phalanx, but does not necessarily reduce bending or increase the compression-to-tension ratio. These results confirm the adaptive role of phalangeal curvature during flexed-finger grasping postures and demonstrate that modeling variation in cortical thickness and flexor ridge morphology improves the behaviour of the FE model, which has important implications for the functional interpretation of phalanx form.

The morphology of Oreopithecus bambolii pollical distal phalanx.

Oreopithecus bambolii is a Late Miocene ape from Italy, first described in the late 19th century. Its interpretation is still highly controversial, especially in reference to its hand proportions and thumb morphology. In this study, the authors provide detailed descriptions of the available Oreopithecus pollical distal phalanx (PDP) specimens, as well as bivariate and multivariate morphometric analyses in comparison with humans, extant apes, selected anthropoid monkeys, and available Miocene PDP specimens. The multivariate results reveal two opposite poles on the hominoid PDP shape spectrum: on one side, a mediolaterally broad and dorsopalmarly short human PDP, and on the other side, the narrow and "conical" PDP of chimpanzees and orangutans. The authors contend that Oreopithecus exhibits intermediate PDP proportions that are largely primitive for hominoids because it shares morphological similarities with Proconsul. Furthermore, Oreopithecus displays a mediolaterally wide tuft for a hominoid, as well as a palmarly elevated attachment for a long tendon of a flexor muscle that is associated at its proximal edge with a proximal fossa and at its distal edge with an ungual fossa. These nonmetrical traits have been associated in humans with their capability to oppose and contact the proximal pads of the thumb and fingers, that is, pad-to-pad precision grasping. These traits reinforce previous studies that indicate a human-like thumb-to-hand length ratio compatible with pad-to-pad precision grasping in Oreopithecus. Although specific hand use is still unresolved in Oreopithecus, the results suggest enhanced manipulative skills (unrelated to stone tool-making) in this taxon relative to other (extant or fossil) hominoids.