Extension Block Pinning Vs Single Kirshner Wiring To Treat Bony Mallet Finger. A Retrospective Study.

BACKGROUND AND AIM: Bony Mallet Finger or Mallet Fracture is a common injury of the hand, which follows a forced flexion of the extended distal interphalangeal joint, that leads to a bony avulsion of the distal phalanx. Depending on fracture extension and dislocation, those lesions can either be treated conservatively or surgically. Several surgical options have been described in the literature. The aim of this study is to compare retrospectively two percutaneous pinning techniques: the extension block technique according to Ishiguro vs an original single Kirshner wiring (Umbrella technique). METHODS: Between January 1998 and December 2019, among all patients treated surgically for a Mallet Fracture with either the Ishiguro' and the Umbrella technique, 98 have been included in this study. All patients have been assessed one year after surgery using the Crawford method. RESULTS: With both techniques better results have been achieved in younger patients and for those treated early. The umbrella technique seems to have better results in patients with fracture classified as 2b or 2c (Wehbe and Schneider classification), whereas the Ishiguro technique seems more appropriate for patients with a 1b fracture. Complication rate and typology vary depending on the used technique. CONCLUSIONS: The Ishiguro' and the Umbrella technique both lead to good results for the treatment of surgical Mallet Fractures. The choice of the best type of pinning should mainly depend on fracture extension and time elapsed from trauma.

Madelung Deformity and Extensor Tendon Rupture.

Extensor tendon rupture in chronic Madelung deformity, as a result of tendon attrition on the dislocated distal ulna, is a rare occurrence. It is, however, seen more often in rheumatoid arthritis. There are few case reports in the English-language literature on this issue. We report a case of multiple tendon ruptures in a previously undiagnosed Madelung deformity.

Bilateral claw hand: an uncommon presentation of regional Guillain-Barré syndrome.

We present an uncommon case of a 38-year-old man presented with bilateral subacute weakness of intrinsic hand muscles, manifesting as bilateral claw-hand, without sensory deficits and absent tendon reflexes in upper arms. Nerve conduction studies showed findings consistent with demyelinating GBS. During the fourth day of hospitalization the patient presented symmetrical distal leg weakness and was treated with intravenous immunoglobulin.

Mucolipidosis type III in an adolescent presenting with atypical facial features and skeletal deformities.

Mucolipidosis type III (MLIII) (MIM# 252600) is an uncommon autosomal recessive disorder that results from deficiency of the multimeric enzyme, UDP-N-acetylglucosamine-1-phosphotransferase. The enzymatic defect results in deficiencies of lysosomal degradative enzymes with concomitant intracellular accumulation of both partly degraded glycosaminoglycans and sphingolipids leading to clinical manifestations such as short stature, developmental delay and other structural abnormalities. The diagnosis is challenging since musculoskeletal presentation may mimic some of the rheumatic and metabolic disorders. We herein report on a 13-year-old adolescent who was admitted to our rheumatology clinic because of progressive joint stiffness and deformities of her hands. The clinical and radiological findings led us to the diagnosis of MLIII despite negative urinary aminoglycosyaminoglycans. Therefore we decided to check for the presence of elevated activities of alpha-mannosidase and beta-hexosaminidase A+B in the plasma which was actually the case and confirmed the clinical diagnosis ofMLIII.

Primary hypertrophic osteoarthropathy (incomplete form) in young adults: a case report and review of literature.

Hypertrophic osteoarthropathy is characterised by digital clubbing and periosteal reaction of long bones. Most cases are associated with malignancy or other conditions such as congenital heart disease, liver cirrhosis, pulmonary fibrosis, biliary atresia and inflammatory bowel diseases. We report a middle-aged man found to have 15-year history of clubbing of the fingers and toes on his routine check-up for dyspepsia. Skiagram of hand joints showed periosteal apposition without any periosteal reaction of long bones. The search for a secondary cause of clubbing remained negative. The primary or idiopathic form is rare and has a good prognosis and has to be differentiated from secondary form. He was eradicated successfully with Pylori kit for his antral predominant Helicobacter-induced gastritis.

Digital ray transposition for correction of late-stage post toe-to-hand transfer forefoot deformity.

A patient with a painful, severe crossover third toe presented approximately 30 years after a second toe-to-hand transfer. He was successfully treated with multiple digital ray transposition. This procedure can realign the lesser toe, close the toe web, and eliminate the need for lifelong use of a toe filler.

Congenital erythropoietic porphyria: anesthetic implications.

Congenital erythropoietic porphyria is a rare error of heme metabolism. Derangement of heme metabolism leads to disfiguration, phototoxicity, and the precipitation of porphyric crises. This case report discusses the myriad perioperative considerations in a patient with congenital erythropoietic porphyria.

Hypocomplementemic urticarial vasculitis with Jaccoud's arthropathy and valvular heart disease: case report and review of the literature.

We describe a female Japanese patient with concomitant hypocomplementemic urticarial vasculitis, Jaccoud's arthropathy and valvular heart disease. In 1996, she developed arthritis with swelling of both proximal interphalangeal joints and urticarial vasculitis on both arms that was resolved by administration of glucocorticoid (prednisolone 30 mg/day). Tests for antineutrophil cytoplasmic antibodies, antinuclear antibody and rheumatoid factor gave negative results. The findings of a skin biopsy examination were consistent with 'leukocytoclastic vasculitis'. During 10 years of observation, the patient manifested polyarthritis leading to progressive deformity of the joints of the hands and feet (without loss of cartilage or erosion of bone), persistent urticaria exacerbated by cold and accompanied by hypocomplementemia and progressive cardiac valvular disease with mitral valve regurgitation. There are only three reports described previously documenting five patients with this rare combination of manifestations.

[Surgical treatment of hand deformities in multiple enchondromatosis: a case report]. / Multipl enkondromatoziste görülen el deformitelerinin cerrahi tedavisi: Olgu sunumu.

Multiple enchondromatosis (Ollier's disease) is a rare disease characterized by widespread enchondromas. In general, the short tubular bones of the hand are involved, with progressive lesions resulting in cosmetic problems and functional deformities. Diaphysectomy and reconstruction with structural autografts or allografts are usually recommended in the treatment of extensive enchondromas involving the fingers. Curettage and grafting and ray amputation are other surgical procedures that can be applied depending on the severity of involvement. A 25-year-old woman with enchondromatosis presented with severe swelling and deformities on her fingers in both hands. The majority of the lesions were managed by diaphysectomy and reconstruction with structural grafts; ray amputation, curettage and grafting were performed for more severe lesions. During a long-term follow-up (left hand 6 years, right hand 5.5 years) cosmetic and functional results were acceptable.

Swan-neck deformity and paresthesia following giant orf.

Orf is a zoonotic infection caused by a parapoxvirus that primarily infects sheep and goats. Human orf infection can take place when abraded skin comes into contact with infected animals. It occurs most commonly on the index finger. The characteristic lesion resembles a tumor and resolves spontaneously, usually without any complications. However, rare complications such as lymphangitis, adenitis, erythema multiforme, erysipelas, papulovesicular eruption, Pseudomonas aeruginosa infection, and bullous pemphigoid have been reported. Herein, we report a case of giant orf causing swan-neck deformity and paresthesia. These complications have not been previously reported in the literature.

La mano reumatológica: exploración y tratamiento. Revisión / The rheumatoid hand: assessment and treatment. Review

Puesto que la mano reumatológica es motivo de atención fisioterapéutica diaria, se revisarán en este artículo aquellos aspectos que puedan ser de utilidad para su valoración y posterior tratamiento. Metodología: Revisión bibliográfica en distintas bases de datos (Cochrane, PEDro, Medline y OT seeker), libros y revistas de interés. Resultados: En cuanto a la valoración no existen escalas específicas validadas en España. Las herramientas utilizadas habitualmente por el fisioterapeuta (fuerza, grado de edema, dolor, amplitud articular, destreza para las actividades de la vida diaria) son aconsejadas por algunos autores como medida de la evolución del paciente. Se discuten otros índices de valoración funcional más específicos. En cuanto al tratamiento, las revisiones sistemáticas de los métodos propuestos por la literatura clásica no son nada concluyentes. A pesar de estas limitaciones metodológicas de los trabajos analizados se concluye que los métodos que cuentan con mayor evidencia científica para su aplicación en la mano reumatológica son el láser, la electroestimulación, la electroacupuntura y los ultrasonidos. Conclusiones: Faltan estudios que den soporte a la actividad del fisioterapeuta tanto referente a las escalas de valoración como a las modalidades de tratamiento (AU)

Adult-onset idiopathic progressive acro-osteolysis with proximal symphalangism.

We experienced a 57-year-old female with adult-onset non-congenital idiopathic acro-osteolysis combined with proximal symphalangism. At the age of 36, she developed severe pain and swelling of the toe base of both feet and underwent Clayton surgery. However, the size of her toes diminished progressively over the 5-year period after surgery. At the age of 41, she suffered pain and swelling of the proximal interphalangeal (PIP) joints of fingers of both hands. These PIP joints became rigid and inflexible. Subsequently, she noticed shortening of the little finger of both hands, followed later by shortening of the index, middle, and ring fingers. At the age of 57, the thumbs began to shorten. Laboratory and endocrinological examinations were not abnormal. Finally, we diagnosed her with acro-osteolysis combined with proximal symphalangism by radiological examination. In this case, previously unreported mutations of the Noggin gene were identified. This is the first case report of adult-onset, non-congenital idiopathic acro-osteolysis combined with proximal symphalangism.

[Jaccoud arthropathy and pyrophosphate arthropathy: a rare association]. / Arthropathie de Jaccoud et chondrocalcinose articulaire: une association rare.

Jaccoud's arthropathy (JA) is a chronic deformity affecting hands and feet, which are voluntarily correctable by the patients. JA was usually reported in association with rheumatic fever and systemic lupus erythematosus. We describe an exceptional association between a pyrophosphate arthropathy and JA of the hands. It is a 48-year-old woman, having a 13 years history of polyarthritis involving shoulders, elbows, hips and knees, and 4 years after, a progressive unlar deviation of the fingers of the hands. Calcium pyrophosphate dihydrate crystals were identified in the synovial knee biopsy. Hands x-rays as RMI don't identify erosions and confirmed the JA.

Extensor digitorum brevis manus muscle in a patient with neurofibromatosis type 1.

The extensor digitorum brevis manus is an uncommon muscle on the dorsum of the hand and can be misdiagnosed, particularly when associated with other clinical conditions such as neurofibromatosis type 1. To our knowledge the two clinical pictures have never been described together. The aim of our report is to increase the clinician's familiarity with these combined conditions, to investigate the available diagnostic tools, and to achieve a correct diagnosis.

Tendon transfer for triple nerve paralysis of the hand in leprosy.

Paralysis of ulnar, median and radial nerves is seen in less than 1% of those affected with leprosy. This condition is a particular challenge for the surgeon, physiotherapist, and patient. A retrospective chart review was conducted at the Green Pastures Hospital and Rehabilitation Centre (GPHRC) and Anandaban Leprosy Hospital (ALH) in Nepal, and results were graded by the system outlined by Sundararaj in 1984. Thirty-one patients were identified, and 21 charts were available for review. Excellent or good results were obtained in 93% of patients for wrist extension, 85% of patients for finger extension, 90% of patients for thumb extension, 71% of patients for intrinsic reconstruction, and 63% of patients for thumb opposition reconstruction. These results are reasonable but inferior to those obtained by Sundararaj in his study. Surgical intervention offers a very significant improvement in function in these very difficult hands. Intensive physiotherapy is required both pre- and postoperatively.

The cervical spine in mutilant juvenile chronic arthritis.

OBJECTIVE: To describe inflammatory cervical spine disorders in juvenile chronic arthritis (JCA) patients with arthritis mutilans (AM) hand deformity. METHODS: The series consisted of 18 patients affected by AM hand deformity who fulfilled the European League of Associations for Rheumatology criteria for JCA. The patient records and the most recent cervical spine radiographs were evaluated for subluxations, atlantoaxial impaction (AAI) and apophyseal joint ankylosis. RESULTS: Seventeen (94%) patients had subluxation, AAI or apophyseal joint ankylosis in the cervical spine. Apophyseal joint ankylosis was noted in 12 (67%) patients and AAI in 10 (56%). Anterior atlantoaxial subluxation was detected in five (28%) patients. CONCLUSION: Almost all of the JCA patients with AM hand deformity evinced some inflammatory changes in the cervical spine. Apophyseal joint ankylosis, AAI and multiplicity of changes in cervical spine may be considered characteristic in this subset of JCA patients. Patients with JCA and AM hand deformity tend to have severe changes also in the cervical spine.