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1.
Medicine (Baltimore) ; 99(10): e19124, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150053

RESUMO

Many smartphone users experience pain in the thumb/wrist. This pain can be due to certain types of hand injuries as well as inflammation of the extensor pollicis brevis and the abductor pollicis longus tendon sheaths, known as De Quervain tenosynovitis. The objective of this study was to evaluate the association between smartphone addiction and wrist/thumb pain and to determine the severity of the pain, as well as to calculate the prevalence of De Quervain tenosynovitis among medical students at King Abdulaziz University (KAU) in Jeddah.A total of 387 medical students were enrolled. The smartphone addiction scale-short version (SAS-SV) was used to divide participants into the smartphone addict group and non-addict group. Both groups completed the self-administered patient-rated wrist and hand evaluation (PRWHE) questionnaire to evaluate wrist/hand pain. The Finkelstein test was administered to those who reported pain in the thumb/wrist.Two hundred fifty-seven (66.4%) participants were smartphone addicts; 74 (19.1%) had a positive Finkelstein test. There was a significant correlation between smartphone addiction and high PRWHE scores (P = .036).Our study found the prevalence of smartphones addiction among university students to be high (66%), furthermore a correlation between heavy smartphones usage and hand pain was found which indicates that heavy usage of these devices can cause subclinical effects on the human hand.


Assuntos
Comportamento Aditivo/epidemiologia , Comportamento Aditivo/fisiopatologia , Dor/etiologia , Smartphone , Polegar/fisiopatologia , Punho/fisiopatologia , Estudos Transversais , Doença de De Quervain/epidemiologia , Doença de De Quervain/etiologia , Humanos , Dor/epidemiologia , Medição da Dor , Prevalência , Arábia Saudita/epidemiologia , Estudantes de Medicina
2.
Unfallchirurg ; 123(2): 104-113, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32016494

RESUMO

Normal function of the fingers and thumb depends on properly gliding flexor tendons and a free range of motion of the involved joints. This normal gliding function may be inhibited by adhesions due to damage of the tendon, tendon sheath and adjacent tissue. When digital function is still limited despite a long-term course of hand therapy and there are no signs of further improvement, surgical intervention should be considered. There are no absolute indications for tenoathrolysis of the flexor tendons. With respect to complications, such as secondary tendon rupture, loss of annular pulleys and scar formation, it is part of a stepwise reconstructive concept including further procedures, such as staged flexor tendon reconstruction. Important preconditions for tenoathrolysis are motivation of the patient, the possibility of readily available and frequent postoperative follow-up hand therapy, healed fractures and osteotomy, mature soft tissue, intact tendons and gliding tissue. Preoperatively, a maximum passive range of motion of the involved joints should be achieved. During the operative procedure all adhesive tissue surrounding the tendon within and outside the tendon sheath is consistently resected preserving the annular pulleys as far as possible. Therefore, extensive approaches, arthrolysis, dissolution of unfavorable scar tissue, resection of scarred lumbrical muscles and annular pulley reconstruction are frequently necessary. Salvage procedures, such as arthrodesis, amputation, ray resection or multistage flexor tendon reconstruction are recommended in failed cases and should be considered even preoperatively. In order to retain the intraoperative functional improvement hand therapy for at least 3-6 months should follow.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Traumatismos dos Tendões , Humanos , Músculo Esquelético , Traumatismos dos Tendões/cirurgia , Polegar/lesões , Polegar/cirurgia
3.
Zhonghua Yi Xue Za Zhi ; 100(1): 22-25, 2020 Jan 07.
Artigo em Chinês | MEDLINE | ID: mdl-31914553

RESUMO

Objective: To compare and analyze the correlations between thumb ossification composite index (TOCI), Risser sign and digital skeletal age (DSA) scores and to verify the possibility of TOCI as a supplementary to Risser sign in the evaluation of growth potential of adolescent idiopathic scoliosis (AIS) patients. Methods: Forty-nine AIS patients undergoing bracing treatment between May 2006 and May 2014 were selected from Nanjing Drum Tower Hospital. The follow-up interval was 4-6 months. The following data at each visit were routinely collected, including TOCI and DSA scores, as well as chronologic age and standing height. The height velocity (HV) at each visit was calculated based on the above data. All results were analyzed by Spearman correlation with TOCI and Risser sign. Results: There were strong correlations between TOCI and Risser sign and DSA scores (r=0.962, 0.813, both P<0.01). In AIS patients whose Risser sign were 0-1, the correlation between TOCI and DSA scores was more pronounced, compared with the correlation between Risser sign and DSA scores (0.918 vs 0.792, P<0.01). The HV averaged (7.1±2.1) cm/year in TOCI 5, significantly larger than these in other TOCI scores (all P<0.01). Conclusions: The TOCI 5 can be a sign of high height velocity and high growth potential in AIS patients. TOCI is a valid indicator of skeletal maturity evaluation and can be used as a helpful supplementary to Risser sign, whose predictive ability may be better than Risser sign.


Assuntos
Cifose , Escoliose , Adolescente , Humanos , Osteogênese , Polegar
4.
Dev Neurorehabil ; 23(1): 50-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30668211

RESUMO

Aim: To determine the feasibility and acceptability of parent-delivered elastic taping to the thumb and wrist in infants with cerebral palsy (CP).Design: Randomized cross-over feasibility trial.Participants: 20 infants (11 male; mean age 22 months) with CP.Intervention: Groups A and B received taping for 4 and 2 weeks, respectively.Outcomes: Primary: Recruitment and retention rates; adherence to protocol; Parent Satisfaction Questionnaire. Secondary: House Thumb score; Zancolli classification; Assisting Hand Assessment (AHA)/mini AHA. Exploratory: Duration of hand regard, thumb in palm, and open hand contact with toys during AHA/mini AHA.Results: Recruitment was feasible (95.2% uptake). Completion rates were 80% and 60% in Groups A and B. Questionnaire feedback was generally positive. Some parents reported increased awareness of the taped hand. Objective improvements were rare though one participant showed consistent improvement in thumb position.Conclusion: Taping proved feasible and acceptable; individual case benefit suggests further research is required.Trial registration: ISRCTN41918400.


Assuntos
Paralisia Cerebral/reabilitação , Reabilitação Neurológica/métodos , Polegar/patologia , Atividades Cotidianas , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Pais
5.
Harefuah ; 158(12): 799-801, 2019 Dec.
Artigo em Hebraico | MEDLINE | ID: mdl-31823534

RESUMO

INTRODUCTION: Congenital trigger thumb is found in 0.3% of all children. There is an ongoing debate whether the finding of a congenital trigger thumb is truly congenital or is developmental, although the current tendency in the literature is to see it as a developmental finding. When a toddler is found to have a thumb with the interphalangeal joint locked in flexion there are a number of differential diagnoses to be considered. Absence or aberrance of the extensor mechanism, arthrogryposis, spasticity and the clasped thumb deformity all may explain this finding. The most common diagnosis of a toddler found with his thumb locked in flexion or extension is the congenital trigger thumb. Clinical inspection will reveal, in most cases, a distinct nodule at the base of the thumb named Notta's Node, and a thumb fixed in either flexion or extension at the interphalangeal joint. A trial of conservative treatment extending for at least six months should be made, but once this fails, surgical intervention is the rule of thumb. Surgical intervention consists of ligation of the A1 pulley while preserving structures in its vicinity.


Assuntos
Dedo em Gatilho/congênito , Pré-Escolar , Diagnóstico Diferencial , Humanos , Amplitude de Movimento Articular , Polegar
6.
Medicine (Baltimore) ; 98(48): e18186, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770273

RESUMO

RATIONALE: Most pediatric distal radius fractures are effectively treated nonoperatively; however, operative intervention is indicated in patients with open and highly unstable fractures, in those with concomitant neurovascular injuries and in patients whom soft tissue interposition between fracture fragments precludes anatomical reduction. Notably, soft tissue interposition between fracture fragments is diagnostically challenging. Surgeons must be mindful of this rare complication for early detection and prompt treatment. PATIENT CONCERNS: A 14-year-old boy presented to the emergency department with left wrist pain after falling from a bicycle. Plain radiography and computed tomography revealed a displaced Smith fracture, which was irreducible by closed reduction, necessitating open reduction and volar plate fixation. The patient reported inability to extend his thumb at his 6-week postoperative follow-up visit. DIAGNOSIS: Ultrasonography showed extensor pollicis longus (EPL) tendon entrapment near the fracture site. INTERVENTIONS: A second operation was performed 10 weeks after the first surgery, and intraoperative exploration revealed EPL tendon entrapment. The EPL tendon was torn to shreds; therefore, extensor indicis proprius tendon transfer was performed for EPL tendon reconstruction. OUTCOMES: The patient's thumb motion was completely restored after the second operation. LESSENS: EPL tendon entrapment in a pediatric Smith fracture is rare. Signs of EPL tendon entrapment include inability to perform active thumb extension, dorsal wrist pain radiating along the course of the EPL tendon, which is exacerbated by thumb flexion, a tenodesis effect elicited on thumb examination, and difficulty in anatomical fracture reduction. Surgical exploration of the EPL tendon is warranted in patients presenting with any of these signs following attempted reduction of a Smith fracture.


Assuntos
Redução Aberta , Fraturas do Rádio , Encarceramento do Tendão , Transferência Tendinosa/métodos , Traumatismos do Punho , Adolescente , Placas Ósseas , Fratura-Luxação/diagnóstico , Fratura-Luxação/cirurgia , Humanos , Masculino , Redução Aberta/efeitos adversos , Redução Aberta/instrumentação , Redução Aberta/métodos , Radiografia/métodos , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/lesões , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular , Reoperação/métodos , Encarceramento do Tendão/diagnóstico , Encarceramento do Tendão/etiologia , Encarceramento do Tendão/cirurgia , Polegar/fisiopatologia , Resultado do Tratamento , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/fisiopatologia , Traumatismos do Punho/cirurgia
7.
Acta Chir Orthop Traumatol Cech ; 86(5): 353-357, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31748111

RESUMO

PURPOSE OF THE STUDY We aimed to investigate the functional outcomes and complications of a new approach, the primary UCL repair using JuggerKnot™ Soft Anchor-1.0 mm Mini (Zimmer-Biomet). MATERIAL AND METHODS This study included a total of 12 patients with acute UCL injury who were operated with primary repair with JuggerKnot™ Soft Anchor-1.0 mm Mini between January 2012 and September 2016. All patients were operated on using the same surgical technique. The thumb pinch and grip strengths, articular range of motion, and Glickel functional score were recorded for all patients. The pinch grip strength and articular range of motion were compared with the intact side. Early and late postoperative complications were recorded. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). The grip strength and the pinch strength were 94.3% and 92.27%, respectively, of the contralateral side. Articular range of motion attained the same level as the contralatereal side in all patients at the final visit, and no patient suffered from any complication. The patients returned to work at a mean of 5.45 weeks, and the Glickel score was good in 1 patient and excellent in the remainder 11 patients. CONCLUSIONS Surgical repair using the JuggerKnot™ Soft Anchor-1.0 mm is an effective alternative treatment method for acute total ulnar collateral ligament (UCL) rupture. Key words:ulnar collateral ligament, acute total injury, thumb, soft suture anchor, JuggerKnot™.


Assuntos
Ligamento Colateral Ulnar/lesões , Ligamento Colateral Ulnar/cirurgia , Polegar/lesões , Seguimentos , Força da Mão , Humanos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Força de Pinça , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Ruptura , Âncoras de Sutura
8.
Handchir Mikrochir Plast Chir ; 51(6): 434-439, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698486

RESUMO

BACKGROUND: After loss of a thumb, the big toe is a possible donor site for reconstruction with wrap-around free flap and trimmed-toe transfer techniques. Early reconstructions seem to reduce the risk of post-operative infections, despite several studies that show different infection rates of the recipient site in immediate toe-to-hand transfer. The authors carried out a retrospective analysis of their experience in thumb reconstruction with big toe transfer and evaluated the results achieved with both immediate and delayed reconstructions in terms of infection occurrence. PATIENTS AND METHODS: From 2000 to 2017, patients who presented cut, crush and avulsion injuries in the thumb were selected and 33 toe-to-thumb transfers were performed. Patients were divided into two groups: in group A, patients underwent immediate reconstruction, while in group B delayed reconstructions were performed. The two groups received identical antimicrobial prophylaxis. Reliability of the immediate or delayed reconstruction was compared in terms of flap survival, requirement for a secondary intention healing and, in particular, rate of infection. RESULTS: 29 male and 4 female patients were treated. Toe-to-thumb transfers were performed in both groups: in group A, 8 wrap-around free flaps and 4 trimmed toe transfers; in group B, 11 wrap-around and 10 trimmed toe transfers. No flap loss occurred in either groups. No cases of infection were detected in the transferred toes. CONCLUSION: For toe-to-thumb transfer, there are published reports of a wide range of infection rates of the recipient sites. The authors compared their results in terms of infection rate between immediate reconstruction, group A, and delayed reconstruction, group B. Immediate toe-to-thumb transfer showed equal success rates to delayed transfer. No statistically significant difference in risk of infection between the two groups was found. Results showed that the immediate reconstruction was as safe and reliable as the delayed one.


Assuntos
Amputação Traumática , Procedimentos Cirúrgicos Reconstrutivos , Polegar/cirurgia , Dedos do Pé/transplante , Amputação Traumática/cirurgia , Feminino , Traumatismos dos Dedos/cirurgia , Deformidades Adquiridas da Mão/cirurgia , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Cirurgia Plástica/métodos , Dedos do Pé/cirurgia
9.
Handchir Mikrochir Plast Chir ; 51(6): 440-443, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698491

RESUMO

BACKGROUND: Authors propose a technical innovation for the remodelling of the medial femoral condyle flap (MFCF) for reconstruction of small to medium bone defects performed after the surgical treatment of a thumb osteomyelitis. MATERIALS AND METHODS: A 45 year old male had thumb proximal phalanx osteomyelitis after a crush trauma of the dominant right hand and multiple previous unsuccessful surgical attempts in other hospitals. In our centre he underwent to a two stage surgical treatment of the infection through bone and soft tissue reconstruction with a MFCF shaped in a new three dimensional (3D) approach with multiple osteotomies. RESULTS: Bone union was achieved after 30 days with a stable thumb reconstruction and good soft tissue healing. No vascular complication occurred after surgery. There was no sign of infection recurrence. CONCLUSIONS: MFCF offers a variety of options for its 3 D shaping which make it a good solution in hand surgery reconstructions after surgical excision of small and medium size bony segments.


Assuntos
Falanges dos Dedos da Mão , Osteomielite , Procedimentos Cirúrgicos Reconstrutivos , Falanges dos Dedos da Mão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/cirurgia , Retalhos Cirúrgicos , Polegar , Resultado do Tratamento
10.
Biol Lett ; 15(10): 20190503, 2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31662063

RESUMO

A recurring theme in the evolution of tetrapods is the shift from sprawling posture with laterally orientated limbs to erect posture with the limbs extending below the body. However, in order to invade particular locomotor niches, some tetrapods secondarily evolved a sprawled posture. This includes moles, some of the most specialized digging tetrapods. Although their forelimb anatomy and posture facilitates burrowing, moles also walk long distances to forage for and transport food. Here, we use X-ray Reconstruction Of Moving Morphology (XROMM) to determine if the mole humerus rotates around its long axis during walking, as it does when moles burrow and echidnas walk, or alternatively protracts and retracts at the shoulder in the horizontal plane as seen in sprawling reptiles. Our results reject both hypotheses and demonstrate that forelimb kinematics during mole walking are unusual among those described for tetrapods. The humerus is retracted and protracted in the parasagittal plane above, rather than below the shoulder joint and the 'false thumb', a sesamoid bone (os falciforme), supports body weight during the stance phase, which is relatively short. Our findings broaden our understanding of the diversity of tetrapod limb posture and locomotor evolution, demonstrate the importance of X-ray-based techniques for revealing hidden kinematics and highlight the importance of examining locomotor function at the level of individual joint mobility.


Assuntos
Toupeiras , Caminhada , Animais , Fenômenos Biomecânicos , Membro Anterior , Locomoção , Polegar
12.
Plast Reconstr Surg ; 144(4): 897-905, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568300

RESUMO

BACKGROUND: Health care reforms aimed at bundling payments attempt to contain costs. Uncovering variation in spending provides one strategy for decreasing expenditure. This study aims to investigate interhospital cost variation for thumb replantation. METHODS: A retrospective cross-sectional analysis of patients undergoing thumb replantation using data from the Healthcare Cost and Utilization Project National Inpatient Sample database from 2001 to 2011 was performed. Univariate and multivariable logistic regression models were used to investigate associations between patient-level and hospital-level characteristics and cost. RESULTS: A total of 778 patients were included in the study, with a mean cost for thumb replantation of $20,965. Thumb replantations performed at high-volume hospitals were significantly more expensive than those performed at low-volume hospitals (median cost, $20,395 versus $13,463; p < 0.001), with longer lengths of stay (5 days versus 4 days), despite having similar surgical complication rates (p = 0.07). Thumb replantations performed in the West were significantly more expensive than those performed in the South (median cost, $22,579 in the West versus $14,823 in the South; p < 0.001), with longer lengths of stay (5 days versus 4 days; p = 0.005) and similar surgical complications (p = 0.239). In multivariable logistic regression, hospital volume (p < 0.001), hospital region (p < 0.001), and increased length of stay (p < 0.001) were predictive of higher cost. CONCLUSIONS: High-volume hospitals and hospitals in the West are more expensive, with longer lengths of stay, despite having similar complications. Expedited discharge may be one avenue for decreasing expenditure without compromising care.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Reimplante/economia , Polegar/cirurgia , Adulto , Estudos Transversais , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
13.
Zhonghua Shao Shang Za Zhi ; 35(10): 761-763, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31658549

RESUMO

From January 2010 to December 2017, 4 patients of thumb with necrosis caused by electric burns (all male, aged from 31 to 58 years) were admitted to our hospital, with 1 patient of second degree injury of right thumb, 2 patients of third degree injury of right thumb, and 1 patient of third degree injury of left thumb. Routine debridement under general anesthesia was performed within 7 days after injury. The compound tissue flap of contralateral second toe was transplanted to reconstruct the thumb with third degree defect, and compound tissue flap of ipsilateral distal hallex was transplanted to reconstruct the thumb with second degree defect. Dorsalis pedics artery was anastomosed with radial artery, saphenous vein or dorsalis pedics vein was anastomosed with cephalic vein. The donor site was transplanted with split-thickness skin graft from autologous thigh. All the tissue flaps and skin grafts survived in 2 weeks after surgery. Within 1 year of follow-up, the reconstructed thumbs can achieve radial abduction and palmar abduction with good function. Reconstruction of thumb with free transplantation of compound tissue flap of toe is a good method to repair thumb with necrosis caused by electric burn.


Assuntos
Queimaduras por Corrente Elétrica/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos/inervação , Polegar/cirurgia , Adulto , Queimaduras por Corrente Elétrica/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Polegar/irrigação sanguínea , Polegar/inervação , Dedos do Pé , Resultado do Tratamento , Cicatrização
14.
BMC Cancer ; 19(1): 1002, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653251

RESUMO

BACKGROUND: Amputation is the standard of care even for early-stage subungual melanomas (SUMs), known as nail apparatus melanoma, because the nail bed and nail matrix are close to the distal phalanx. However, a recent study demonstrated that not all patients with SUMs had histologic invasion of the underlying distal phalanx. As most SUMs occur in the thumb or big toe, amputation of either the thumb or big toe substantially interferes with activities of daily living, including poor cosmesis, loss of function, and phantom pain. Non-amputative digit preservation surgery can thus be applied in such cases without compromising patient prognosis. METHODS: We are conducting a multi-institutional single-arm trial to confirm the safety and efficacy of non-amputative digit preservation surgery. We will compare our results with those reported in the Japanese Melanoma Study, in which patients underwent amputation for SUMs as a traditional standard of care. Patients aged between 20 and 80 years with stage I, II, or III without evidence of tumor invasion to the underlying distal phalanx on preoperative radiograph are included in the study. The primary endpoint is major relapse-free survival (major RFS), which does not include local recurrence as an event; secondary endpoints include overall survival, digit-preservation survival, relapse-free survival, local relapse-free survival, partial relapse-free survival, and incidence of adverse events. A total of 85 patients from 21 Japanese institutions will be recruited within 5.5 years, and the follow-up period will last at least 5 years. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in August 2017, and patient enrollment began in November 2017. Ethical approval was obtained from each institution's Institutional Review Board prior to patient enrollment. DISCUSSION: This is the first prospective trial to confirm the safety and efficacy of non-amputative digit preservation surgery for SUM without distant metastasis or bony invasion. The results of this trial could provide evidence to support this less-invasive surgery as a new standard of care to preserve adequately functioning digits. TRIAL REGISTRATION: Registry number: UMIN000029997 . Date of Registration: 16/Nov/2017. Date of First Participant Enrollment: 12/Dec/2017.


Assuntos
Melanoma/epidemiologia , Melanoma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças da Unha/epidemiologia , Doenças da Unha/cirurgia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Amputação/métodos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Estudos Prospectivos , Polegar/patologia , Polegar/cirurgia , Dedos do Pé/patologia , Dedos do Pé/cirurgia , Adulto Jovem
15.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 36(9): 890-892, 2019 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-31515783

RESUMO

OBJECTIVE: To detect potential mutation in a Chinese pedigree affected with congenital limb malformations. METHODS: Clinical data was collected. Genomic DNA was extracted from peripheral blood samples of family members. The zone of polarizing activity regulatory sequence (ZRS) were amplified by PCR and subjected to direct sequencing. RESULTS: Among the 13 individuals in this pedigree, there were 4 PPD patients, who were characterized by varying degrees of deformity. The female patients suffered triphalangeal thumb and preaxial polydactyly, while the male patients only had preaxial polydactyly. Only one patient had foot involvement. TA heterogeneous mutations was discovered in the ZRS (105C>G) in all patients, the same mutation was not detected in 2 healthy family members. CONCLUSION: The inheritance pattern of PPD was autosomal dominant inheritance. There was a significant variability of symptoms among family patients. The heterozygous mutation of the ZRS (105C>G) probably underlie the disease.


Assuntos
Deformidades Congênitas da Mão/genética , Deformidades Congênitas dos Membros/genética , Proteínas de Membrana/genética , Polidactilia/genética , Feminino , Testes Genéticos , Humanos , Masculino , Linhagem , Polegar/patologia
16.
Hand Surg Rehabil ; 38(6): 386-389, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31550552

RESUMO

Pigmented onychomatricoma (OM) is a very rare benign fibroepithelial tumor of the nail matrix. We report the case of a 23-year-old Lebanese man with 15-year history of nail plate dystrophy with longitudinal ridging, yellowish discoloration, excessive transverse curvature and late-onset melanonychia along the medial third of the right thumb nail. Excisional biopsy was performed and confirmed OM. We outline the clinical history, radiological and histopathological findings as well as the surgical and reconstructive technique of this unusual case of OM. The age group, history of crush injury, and pigmentation of the nail plate make of this rare form of ungual tumor an interesting case report.


Assuntos
Doenças da Unha/patologia , Neoplasias Fibroepiteliais/patologia , Transtornos da Pigmentação/patologia , Neoplasias Cutâneas/patologia , Lesões por Esmagamento/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Doenças da Unha/diagnóstico por imagem , Doenças da Unha/cirurgia , Unhas/lesões , Neoplasias Fibroepiteliais/diagnóstico por imagem , Neoplasias Fibroepiteliais/cirurgia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Polegar/lesões , Adulto Jovem
17.
Medicina (Kaunas) ; 55(10)2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31547029

RESUMO

BACKGROUND AND OBJECTIVES: Congenital thumb hypoplasia is a rare deformity of upper extremity. The incidence for thumb hypoplasia grade II-V is 1:10,000 newborns per year in Latvia. A technique for extensor indicis proprius (EIP) tendon transfer with subperiosteal fixation was developed and used for thumb hypoplasia grades II and IIIa. Pollicization or second-toe-to-hand transplantation with metatarsophalangeal (MTP) joint arthrodesis was used for the reconstruction of hypoplasia grade IIIb-V. The aim of this retrospective cohort study is to evaluate the outcomes for reconstruction techniques used in one surgical center during a ten-year period by one surgeon to evaluate functional and aesthetical outcomes for new techniques. MATERIALS AND METHODS: In total, 21 patients were operated on during 2007-2017, and 18 of these patients were involved in this study. Long-term follow-up was completed to evaluate the functions and aesthetics of the hands. RESULTS: disabilities of the arm, shoulder and hand (DASH) was 9.35 (8-10.7) for the second-toe-to-hand with MTP joint arthrodesis transplantation method for pollicization method 19.8 (6-26.7), and for the EIP tendon transposition, 14.54 (0.9-56.3). CONCLUSIONS: The postoperative functional parameters of congenital hand hypoplasia patients, regardless of the surgical method, are worse than the functional results of healthy patients. The use of the second-toe-to-hand with MTP joint arthrodesis transplantation method provides patients with congenital hand IIIb-V hypoplasia a stable and functional first finger formation. The functional results are comparable to the clinical results of the pollicization method while ensuring the creation of a five-digit hand.


Assuntos
Deformidades Congênitas da Mão/cirurgia , Deformidades da Mão/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Polegar/anormalidades , Dedos do Pé/transplante , Fios Ortopédicos , Criança , Pré-Escolar , Falanges dos Dedos da Mão/diagnóstico por imagem , Seguimentos , Humanos , Lactente , Radiografia , Estudos Retrospectivos , Tendões/transplante , Polegar/cirurgia
18.
J Orthop Surg Res ; 14(1): 287, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477182

RESUMO

BACKGROUND: The thumb accounts for 50% of the total hand function. This study reports the functional outcomes and complications of people with traumatic thumb amputations who underwent toe-to-thumb reconstruction. METHODS: From January 2013 to January 2018, 29 patients with second-degree thumb defect underwent thumb reconstruction with distal phalangeal braided toenail flap. The footscan foot pressure gait analysis system was used to measure the index changes of the same foot before and after 1, 3 and 6 months. The contact area, peak pressure, impulse value, contact time of each gait phase, centre of gravity coordinate and foot balance were analysed statistically. RESULTS: Twenty-nine cases of thumb reconstruction recovered well. After following up for 6-15 months, the appearance of the reconstructed thumb was close to normal, and the sensation was restored to S3+. The two-point discrimination was 6-8 mm, and the function of the thumb was good. The function of the donor foot was well restored, and no skin ulceration, pain and claudication were noted during walking. Compared with that before the operation, the biomechanical indices of the donor foot were basically restored to normal 6 months after the operation. Only the stress and impulse values of the third metatarsal head were significantly increased, forming a stress concentration area centred on the third metatarsal head. CONCLUSIONS: This study confirmed that the toenail flap with distal phalangeal bone restored the second-degree thumb defect without destroying the main functional structure of the sole. The biomechanical indices of the donor foot were basically restored to normal 6 months after the operation. Only the stress concentration area centred on the third metatarsal head, and the pain on the forefoot was induced after the operation. Discomfort, callus formation, metatarsal fasciitis, etc., can lead to fatigue fracture of the third metatarsal bone in severe cases, which requires further follow-up and observation. TRIAL REGISTRATION: Clinicaltrials.gov , NCT03879941; registered on 10 March 2019, retrospectively.


Assuntos
Amputação Traumática/cirurgia , Unhas/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/transplante , Polegar/lesões , Polegar/cirurgia , Adolescente , Adulto , Amputação Traumática/diagnóstico , Fenômenos Biomecânicos/fisiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Unhas/fisiologia , Estudos Retrospectivos , Retalhos Cirúrgicos/fisiologia , Doadores de Tecidos , Adulto Jovem
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