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Study Design Cohort cadaveric study. Introduction Ring finger metacarpal fractures are often treated with ulnar gutter orthoses incorporating the ring and small fingers. Iatrogenic pronation of the distal metacarpal fragment may occur from overzealous orthotic “molding”, resulting in a crossover deformity of the ring finger over the small finger. Purpose of the Study The goal of this cadaveric study is to determine whether including the middle finger in an ulnar gutter orthotic could lessen the chances of iatrogenic ring finger metacarpal fracture rotation. Methods Transverse ring finger metacarpal shaft fractures were created in 24 cadaver hands. The ring and small fingers were then placed into an intrinsic plus position, simulating the application of an ulnar gutter orthotic. Weights of 2.5, 5, and 10 pounds were applied to the ring and small fingers to simulate iatrogenic-induced fracture pronation. The amount of rotational displacement at the fracture was measured, and the protocol was repeated, including the middle finger in the intrinsic plus position. Mann-Whitney-Wilcoxon test was used for statistical analysis. Results There was an increase in distal fragment rotation with increasing weight. Fracture displacement was greater with the 2-finger position than the 3-finger at all weight levels; this reached statistical significance at 10 lbs (2.8 vs 1.8 mm). Conclusions Application of an ulnar gutter orthotic including only ring and small fingers can rotate the distal fragment of a ring finger metacarpal shaft fracture such that overlap could occur with the small finger. Including the middle finger in ulnar gutter splints will mitigate against the rotation of the ring finger metacarpal shaft fracture.

BACKGROUND Quantifying pediatric phalanx fracture displacement requires understanding the normal radiographic alignment of pediatric phalanges, which has never been assessed in the coronal plane, although prior studies have assumed the articular surfaces and physes to be perpendicular to the diaphyses. This study tests the hypothesis that these relationships are not uniformly perpendicular and instead vary by digit and age. METHODS Normal hand bone age radiographs were retrospectively reviewed from 40 males and 40 females 2 to 18 years old. For each finger proximal phalanx (P1) and middle phalanx (P2), 2 raters each measured twice the angle between the diaphysis and distal articular surface (D-DA), diaphysis and physis (D-P, when physis present), and diaphysis and proximal articular surface (D-PA). Intra-rater and inter-rater reliability were calculated with intraclass correlation coefficients. 95% confidence intervals were calculated for each angle for each digit, phalanx, age group, and sex to determine which angles ~90 degrees. Variability among ages and sex was assessed with analysis of variance. RESULTS Intra-rater and inter-rater intraclass correlation coefficients were >0.90, except in P2 ∠D-DA in children under 8 years old with unossified P2 condyles. Overall, only 173 (47.8%) of 362 confidence intervals included 90 degrees. Three angles of the small finger (P1 ∠D-DA, P2 ∠D-P, P2 ∠D-PA) never ~90 degrees at any age or sex, with an average 10 degrees ulnar tilt of the small finger proximal interphalangeal joint. Of the 24 angles across digits and phalanges, 10 varied significantly with age, especially in the index and middle finger P1 where initially wedge-shaped epiphyses progressively became more symmetric with age. CONCLUSIONS The coronal radiographic angles between the phalangeal diaphyses and articular surfaces or physes differ from 90 degrees more than half the time in pediatric fingers, and nearly half the angles vary by age. These findings demonstrate that the articular surfaces and physes of the pediatric finger phalanges are not uniformly perpendicular to the diaphyses, underscoring the need to consider the variability among digits, phalanges, ages and subjects. LEVEL OF EVIDENCE Level IV.

Children are one of the most vulnerable populations to burns, and hands are frequently burned anatomical structures. Restoring function in a severely burned pediatric hand is challenging. We present our experience with pediatric toe-to-thumb transfers for burn reconstruction. A retrospective review was conducted of all pediatric toe-to-thumb transfer patients between 2009 and 2014. Children younger than the age of 18 who underwent secondary reconstruction after electrical or thermal burn injuries with at least a 5-year follow-up were included. Functional outcomes were measured with the modified Kapandji score. Complications of the reconstructed hand as well as the donor foot were recorded. Four children with 10 toe-to-hand transfers (four great toes, two second toes, and two combined second–third toes) met the inclusion criteria. The average follow-up length was 104 months (range 60–144 months). Two children sustained thermal burn injuries and two sustained electrical burn injuries. Three children achieved opposition of the reconstructed toe-to-thumb transfer to the small finger (Kapandji score 5), and one child achieved opposition of the reconstructed toe-to-thumb transfer to the proximal phalanx of the middle finger, the only remaining finger (Kapandji score 3). No donor foot morbidities were noted postoperatively. Toe-to-thumb transfers should be considered the standard of care for thumb reconstruction in children with severe burn injuries of their hands to provide restoration of sensation, pinch, grasp, and opposition with minimal morbidity of the donor foot.

Punches without the use of instruments/objects are a common type of body violence and as such a frequent subject of medicolegal analyses. The assessment of the injuries occurred as well as of the potential of the assault to produce severe body harm is based on objective traces (especially the documented injuries of both parties involved) as well as the—often divergent—descriptions of the event. Quantitative data regarding the punching characteristics that could be used for the assessment are rare and originate mostly in sports science. The aim of this study was to provide physical data enabling/facilitating the assessment of various punching techniques. A total of 50 volunteers took part in our study (29 males and 21 females) and performed severe punches with the fist, with the small finger edge of the hand (karate chop), and with the open hand with both the dominant and the non-dominant hands in randomized order. The strikes were performed on a boxing pad attached to a KISTLER force plate (sampling frequency 10,000 Hz) mounted on a vertical wall. The punching velocity was defined as the hand velocity over the last 10 cm prior to the contact to the pad and ascertained by using a high-speed camera (2000 Hz). Apart from the strike velocity, the maximum force, the impulse (the integral of the force-time curve), the impact duration, and the effective mass of the punch (the ratio between the impulse and the strike velocity) were measured/calculated. The results show a various degree of dependence of the physical parameters of the strikes on the punching technique, gender, hand used, body weight, and other factors. On the other hand, a high degree of variability was observed that is likely attributable to individual punching capabilities. In a follow-up study, we plan to compare the “ordinary” persons with highly trained (boxers etc.) individuals. Even though the results must be interpreted with great caution and a direct transfer of the quantitative parameters to real-world situations is in general terms not possible, the study offers valuable insights and a solid basis for a qualified forensic medical/biomechanical assessment.

[Purpose] Isolated finger flexion associated with function of the flexor digitorum superficialis has been qualitatively assessed using standard and modified tests. The purpose of this study was to quantify isolated finger flexion in healthy participants. [Participants and Methods] We assessed 100 volunteers (mean age: 44.6 years) without upper limb dysfunction using the standard and modified flexor digitorum superficialis tests. The sum of the isolated active flexion angles of the metacarpophalangeal and proximal interphalangeal joints of the test finger was also calculated, with the other three fingers held in an extended position with our original jig. [Results] The mean isolated flexion angles were, respectively, 152.4° and 154.8° for the right and left index fingers, 161.1° and 160.4° for the middle fingers, 160.6° and 158.2° for the ring fingers, 129.4° and 134.6° for the independent flexor digitorum superficialis function, 85.8° and 74.7° for the common flexor digitorum superficialis function, and 75.8° and 71.2° for absent flexor digitorum superficialis function in the small finger. The functional variations of the flexor digitorum superficialis of the small fingers showed symmetry in 65.0% of the fingers but asymmetry in 35.0%. [Conclusion] The data obtained in this study provide normal reference values for the examination of independent movement disorders of the fingers.

Upper limb absence has an impact on both physical and mental health of a human being. Nowadays, the costs of commercial, externally powered prosthetic hands range between 25.000 € and 70.000 €. A first demonstrator of a lightweight low-cost prosthetic hand is produced with 3D-printing technology (Fused Deposition Modeling). Due to integration of single-axis solid-state joints the five fingers can be printed in one piece. Thermoplastic polyurethane is used for this purpose. The flexion of all fingers is achieved by moving cords which are positioned on the palmar side of each finger. Two twisted string actuators are integrated to allow the movement of the thumb and the remaining four fingers. These actuators consist of two polyethylene strands which are twisted along their main axis by a DC motor, providing a tensile force to bend the fingers. In order to achieve simultaneous but differential actuation of the four fingers (small finger, ring finger, middle finger and index finger), a differential mechanism is used. The thumb is driven by a separate unit. In order to open the hand, the elasticity of the joints’ material is taken advantage of. With the developed mechanics it is possible to perform precision and cylindrical grasps with an opposed thumb. Weights up to 260 g can be held according to the shape and size of an object. To increase the adaption to different sizes and weights of objects, the design should be modified. It can be concluded, that the presented device is a promising basis for a lightweight, low-cost prosthetic hand in the future.

To report the clinical and radiographic results of arthrodesis of relatively small-sized distal interphalangeal joints (DIPJs) using only K-wire fixation.Between January 2000 and December 2018 28 arthrodesis in 21 patients (9 males and 12 females with an average age of 52.1 years) with relatively small-sized DIPJs were performed using only K-wires. Data on patient's characteristics, such as age, sex, affected finger, and the number and size of the used k-wires were collected from the medical database. The narrowest diameter of the cortex and medulla of the distal phalanx was measured on preoperative plain radiographs. The time to union and the arthrodesis angle was determined using serial X-ray radiography follow-up. Preoperatively and at the latest follow-up examination, pain using the visual analogue scale (VAS) and the quick DASH score was registered. In addition, complications were investigated.Average follow-up period was 11.4 months. The small finger was mostly affected (n = 12; 42.9 %). The narrowest diameters of the distal phalanx cortex and the medulla measured on preoperative X-ray images were 2.8 mm (SD 0.5) and 1.2 mm (SD 0.4), respectively. Seven fusions were done with use of 1 K-wire, 20 with 2 (71.4 %), and 1 with 3 K-wires. The most common K-wire sizes were 1.1-inch (24 K-wires = 48 %), and 0.9 inch (21 K-wires = 42 %) The preoperative VAS score and quick DASH score improved from 6.1 (range: 0-9) and 25.8 (range: 2-38) to 0.4 (range: 0-2) and 3.4 (range: 0-10.2), respectively. 25 (89.3 %) out of 28 fingers achieved bony union in an average of 96.1 days (range: 58-114) with three non-union.Arthrodesis of small DIPJs with K-wire fixation has a high success rate. Therefore, we suggest K-wire fixation as an acceptable alternative for patients with a small phalanx which may be at risk of mismatch with bigger implants. However, concerns remain in terms of fusion delay with K-wire only fixation.ZIEL: Ziel der Untersuchung war die Evaluierung der klinischen und radiologischen Ergebnisse nach Versteifung kleiner Fingerendgelenke unter ausschließlicher Verwendung von K-Drähten.Zwischen Januar 2000 und Dezember 2018 wurden bei 21 Patienten (9 Männer und 12 Frauen mit einem mittleren Alter von 52,1 Jahren) 28 Arthrodesen kleiner Fingerendgelenke durchgeführt. Angaben bzgl. des Alters und Geschlechts der Patienten, des betroffenen Fingers sowie der Anzahl und Größe der verwendeten K-Drähte wurden den Patientenakten entnommen. Der Durchmesser der Endglieder sowie deren Markraumes wurde jeweils an der engsten Stelle auf präoperativ gefertigten Röntgenbildern ausgemessen. Die Zeit bis zur knöchernen Heilung sowie der Arthrodesenwinkel wurde anhand von postoperativen Röntgenserienaufnahmen bestimmt. Präoperativ und bei der letzten Nachuntersuchung wurden die Schmerzen mittels der visuellen Analogskala (VAS) und der Quick-DASH-Score erhoben. Des Weiteren wurden Komplikationen erfasst.Die durchschnittliche Nachbeobachtungszeit betrug 11,4 Monate. Der kleine Finger war am häufigsten betroffen (n = 12; 42,9 %). Der engste Durchmesser der distalen Phalanx betrug 2,8 mm (SD 0,5), des Markraumes 1,2 mm (SD 0,4). Bei sieben Arthrodesen wurde 1 K-Draht, bei 20 (71,4 %) 2 Drähte und einmal 3 Drähte verwand. Die meisten K-Drähte wiesen einen Durchmesser von 1,1 inches (n = 24; 48 %) bzw. 0,9 inches (n = 21; 42 %) auf. Schmerzen und Quick-DASH-Score verbesserten sich von durchschnittlich präoperativ 6,1 (0 – 9) resp. 25,8 (2–38) bis zur letzten Nachuntersuchung auf 0,4 (0–2) resp. 3,4 (0–10,2). Bei 25 (89,3 %) der 28 Endgelenke kam es zur knöchernen Heilung, 3mal entwickelte sich eine Pseudarthrose.Die Versteifung kleiner Fingerendgelenke unter ausschließlicher Verwendung von K-Drähten hat eine hohe Erfolgsrate, weshalb wir sie für Patienten mit kleinen Endgliedern empfehlen, bei denen die Gefahr besteht, dass es bei Verwendung dickerer Implantate zu Problemen kommen kann. Allerdings ist die lange Zeitdauer bis zur knöchernen Durchbauung zu bedenken.

In difficult cases of replantation following small finger avulsion injury, in which amputation occurs at the proximal interphalangeal joint, the ulnar parametacarpal island flap, rotated 180° (propeller flap), can be used as an alternative method for covering a skin defect of the proximal phalanx. This flap can prevent metacarpophalangeal joint dysfunction and additional finger shortening. We propose the use of an ulnar parametacarpal flap for this purpose and report the outcomes of two successful cases treated with this method and followed up for 12 months.

Background Traumatic digit amputations can result in significant impairment. Optimal surgical treatment is unclear for certain digits in various amputation patterns. Our aim was to compare the contribution of revision amputation vs replantation for each particular digit to functional outcomes. Materials and methods Prospective cohort study at three tertiary hospitals was conducted in China. Eligible participants were 3192 patients with traumatic digit amputations enrolled from January 1, 2014, to January 1, 2018. The primary outcome was Michigan Hand Outcomes Questionnaire (MHQ) scores 2 years after initial surgery. Secondary outcome was score on the Disabilities of the Arm, Shoulder, and Hand (DASH). Results Of 3192 enrolled patients, 2890 completed the study. Main-effect linear regression showed that participants with replantation of thumb, index, long, and ring (proximal to the proximal interphalangeal [PIP] joint) fingers had significantly better MHQ scores compared to participants with the corresponding finger revision amputation. DASH results were comparable. Finger-finger interaction analyses conducted with multifactor dimensionality reduction (MDR) revealed that the small finger and ring finger had the smallest and greatest interactions with other fingers, respectively. After stratification by amputation level of thumb, index finger, or long finger, linear regression showed that replantation of the ring finger distal to the PIP joint resulted in better MHQ and DASH when the thumb or long finger was also traumatically amputated proximal to the IP/PIP joint. Conclusions Replantation of the thumb, index, long, and ring (proximal to PIP joint) fingers is preferable to revision amputation, regardless of amputation pattern. Replantation of the ring finger amputated distal to PIP was beneficial only when the thumb or long finger was amputated proximal to IP/PIP joint. Replantation or revision amputation of the small finger was indistinguishable in terms of functional outcome. Future investigations and clinical decisions should take into account the role of finger-finger interactions.

Dupuytren’s contracture is a disease involving abnormal myofibroblast proliferation and collagen deposition leading to the formation of pathologic cords in the hand. Given that Dupuytren’s contractures rarely extend to the distal interphalangeal joint (DIP), affecting only 5% of patients, there are few cases reported in the literature. Collagenase injection is a frequently used option for minimally invasive treatment of Dupuytren’s disease with greater than a 20-degree joint contracture. Unfortunately, there is limited research on the effectiveness of these injections in isolated DIP joint deformities. We present a case of a 61-year-old right hand-dominant male with a 2-year history of isolated right small finger Dupuytren’s contracture at the DIP joint who achieved significant improvement after collagenase injection.

We describe a simple and effective method to assess the integrity of the flexor carpi ulnaris muscle and tendon. This method is called the Small Finger Abduction Test. The study also evaluates the efficacy and practicality of the test.Level of Evidence: Level II.

Demographic and clinical features of 32 patients diagnosed with dupuytren contracture and operated by partial fasciectomy were included in this study. Functional results, complications and recurrence rates were discussed with current literature. In our study male/female ratio was 7/1, mean age at onset of disease was 55.4±7.1, mean age at surgery was 60.4±8.1. There were etiological factors such as a family history in 7 patients (21.875%), smoking in 22 patients (68.75%), regular alcohol use in 6 patients (%18,75), type 2 diabetes in 10 patients (31.25%), hepatic disease in 2 patients (6.25%), long term barbiturate use for epilepsy in 1 patients (3.125%). The most often involved finger was the ring finger in 26 patients (81.25%), the small finger in 18 patients (56.25%), middle finger in 8 patients (25%) and index finger in 1 patient (3.125%). The pre-operative mean total passive extension deficit (TPEK) was 89.68o ± 30.29, the post-operative mean TPED was 6.09o ± 6.44. The post-operative mean total extension gain was 93.2%. The mean follow-up was 70±44 months, 1 patient (3.125%) had a recurrence in this period. The overall complications occured in 3 patients (9.375%), including skin necrosis in 2 patients (treated with dressings) and temporary hypoesthesia in 1 patient. The partial faciectomy is an effective and reliable method for the surgical treatment of dupuyren contracture because of improvement enough correction in the MCF and PIP joint contracture, the low rate of complication and recurrence rates.

The reconstruction of finger defects requires improved functional outcomes and acceptable esthetic outcomes, and small free flaps present a good alternative technique for repairing finger skin defects. From January 2006 to December 2018, we investigated the number and diameter of proximal digital artery perforators, medial plantar artery perforators, and peroneal proper plantar digital arteries of the hallux by dissection and then transplanted free digital arterial perforator flaps, free medial plantar flaps, and free peroneal flaps from the hallux to repair small finger skin defects. The number (SD) of perforators from the medial plantar artery was approximately 2.2 (0.5), and these perforators measured 0.53 (0.20) mm in diameter. The diameter (SD) of the first metatarsal dorsal artery was approximately 1.16 (0.30) mm. A total of 25 patients were included in this study. The transplantation times (SD) for free digital arterial perforator flaps, free medial plantar flaps, and free peroneal flaps from the hallux were 3.5 (0.5) hours, 3.2 (0.7) hours, and 2.0 (0.4) hours, respectively. The follow-up period ranged from 8 to 15 months. All flaps survived and were appropriately shaped. The donor site was either covered with a free flap or directly sutured. Among these 3 types of small flaps, the free peroneal flap from the hallux can be recommended for clinical use because of the large diameter of the contributing vessels, the short operative time, the ease of access, and the improved appearance of the donor site.

Background Within a virtual environment (VE) the control of locomotion (e.g., self-travel) is critical for creating a realistic and functional experience. Usually the direction of locomotion, while using a head-mounted display (HMD), is determined by the direction the head is pointing and the forward or backward motion is controlled with a hand held controllers. However, hand held devices can be difficult to use while the eyes are covered with a HMD. Free hand gestures, that are tracked with a camera or a hand data glove, have an advantage of eliminating the need to look at the hand controller but the design of hand or finger gestures for this purpose has not been well developed. Methods This study used a depth-sensing camera to track fingertip location (curling and straightening the fingers), which was converted to forward or backward self-travel in the VE. Fingertip position was converted to self-travel velocity using a mapping function with three parameters: a region of zero velocity (dead zone) around the relaxed hand position, a linear relationship of fingertip position to velocity (slope or/J) beginning at the edge of the dead zone, and an exponential relationship rather than a linear one mapping fingertip position to velocity (exponent). Using a HMD, participants moved forward along a virtual road and stopped at a target on the road by controlling self-travel velocity with finger flexion and extension. Each of the 3 mapping function parameters was tested at 3 levels. Outcomes measured included usability ratings, fatigue, nausea, and time to complete the tasks. Results Twenty subjects participated but five did not complete the study due to nausea. The size of the dead zone had little effect on performance or usability. Subjects preferred lower β values which were associated with better subjective ratings of control and reduced time to complete the task, especially for large targets. Exponent values of 1.0 or greater were preferred and reduced the time to complete the task, especially for small targets. Conclusions Small finger movements can be used to control velocity of self-travel in VE. The functions used for converting fingertip position to movement velocity influence usability and performance. Keywords: Human computer interaction, Virtual environment, Gesture design

Highlights • The lateral band snapping syndrome (LBSS) in the proximal interphalangeal joint (PIPJ) is the subluxation of lateral band of the extensor tendon resulting from injury of the retinacular ligament, causing finger snapping during flexion of the PIPJ. • Ultrasonography can visualize the subluxation of lateral band, facilitating diagnosis of LBSS in the PIPJ. • Patients with LBSS may benefit from prompt repair of the retinacular ligament without sequela., Background Snapping fingers resulting from flexor tendon tenosynovitis at the metacarpophalangeal (MCP) joint, is common. However lateral band snapping syndrome (LPSS) in the proximal interphalangeal joint (PIPJ) are extremely rare. Case presentation A 43-year-old female was diagnosed with LPSS in the PIPJ of fifth finger which was confirmed by dynamic evaluation upon ultrasound. Repair of retinacular ligament of the extensor tendon was performed. At the six-month follow up, the patient had regained full ROM with no discomfort, without evidence of recurrence. Discussion The diagnosis of LPSS at the PIPJ is challenging. Dynamic evaluation of the extensor tendon over PIPJ is necessary to diagnose LBSS. Ultrasound was used to assess the movement of the lateral band of the extensor tendon when the fingers flexed and to demonstrate dynamically the snapping and subluxation of the lateral band, so as to facilitate confirming the diagnosis of LBSS. Conclusion Given clinical suspicion of LBSS, we recommend ultrasonography as a feasible tool to confirm the diagnosis. Patients with LBSS may thus benefit from prompt repair of the retinacular ligament without sequela.

INTRODUCTION The incidence of high-pressure injection injuries of the hand is low. Although the occurrence is rare, the precarious progression of the injury exacts prompt surgical evaluation in order to avoid complications and amputation. The current study was devised in order to make comparisons to the current data, in addition to supplementing the literature with observations regarding clinical course and management. METHODS A multisurgeon, retrospective chart review from a single institution was performed. Inclusion criteria included cases involving a high-pressure injection injury to the hand that underwent surgical management. Patient demographics, injury details, and hospital course were all reviewed and recorded. RESULTS This retrospective review identified 20 cases meeting criteria, all of which involved males. The average age at time of injury was 39.7 years (range, 21-71 years). The incidence of injection injuries over a 10-year time period was 2.1 cases per year. The nondominant hand was injured in 11 cases (63%). The most common site of injury was the index finger with 11 recorded incidents (55%). Other reported locations included the metacarpal (40%) and small finger (5%). Occupational data included 10 construction workers, 5 painters, and 2 cleaning crew members, and 3 had nonmanual occupations. Paint was the most commonly injected substance with 17 reported cases (85%). On average, the delay until surgery was observed to be 21.9 hours (n = 16). Only 1 patient underwent surgery at 6 hours after surgery. The average number of procedures performed was 1.8 (range, 1-4). Hospitalization duration was on average 3.9 days (range, 1-9 days), and the average follow-up length was 69 days (range, 7-112 days). There were no identified cases that necessitated amputation. CONCLUSIONS This form of injury most commonly affects male, middle-aged laborers. Our study found very low amputation rates when compared with the current literature, despite observing longer delays to surgery according to current recommendations. Limited comparisons can be made from data regarding clinical course and management because of the small sample size of the current study and the limited published data. This indicates a need for further exploration and collection of data involving parameters such as clinical course and management.

CASE A Salter-Harris II fracture of the small finger middle phalanx with complete extrusion of the epiphyseal fragment in a 6-year-old boy is described. Closed reduction was unsuccessful. Open reduction was performed, the epiphysis was reduced, and a single Kirschner wire was placed obliquely across the fracture and joint. CONCLUSION This is an extremely rare injury. Open reduction and pinning was successful in preserving functional range of motion. Despite eventual growth arrest, there was no clinically significant angular deformity, and the joint was preserved. Surgical technique and early hand therapy allowed the patient to return to high-level activity without pain or functional limitation thus far at the 27-month follow-up.

A 43-year-old female suffered a degloving injury of her left hand in a printing machine during her work. She was admitted to our hospital 2 h after the injury. The skin was avulsed from the distal forearm to the fingertip (Fig. 7.1). The bone, joint, tendon, nerves of the thumb and fingers, and the intrinsic muscle remained relatively intact. Complete debridement was performed under axillary block anesthesia in the emergency room. Relative intact of the degloved skin was found. The dorsal skin and palmar skin were bruised. The proper digital arteries of the index, middle, ring, and small finger were amputated at the level of the distal interphalangeal joint, and their nerves were extracted at the wrist level. The proper digital arteries of the thumb were amputated at the level of the fingertip.

Summary:. Gout can lead to the deposition of tophi and chronic arthritis, for which surgical management is indicated when tophi interfere with the function of the finger. This case report discusses the management of a 37-year-old man with a past medical history of gout who presented with triggering of his small finger from gouty infiltration of his flexor digitorum profundus (FDP) tendon. An exploratory procedure that included tenolysis and release of the A1 pulley was performed. Gouty infiltration of the FDP tendon was noted intraoperatively and biopsied, which was later confirmed by histopathological analysis as being gouty tophus. The patient regained full function of the affected finger postoperatively and has since had no recurrence. Gouty tenosynovitis is a rare cause of trigger finger and should be considered as part of the differential diagnosis. Treatment for gouty tenosynovitis consists of A1 pulley release and careful excision of gouty tophus to restore tendon glide and hand function.

Purpose There are several potential donor muscle–tendon units for a thumb opposition transfer. The extensor carpi ulnaris (ECU) is useful when the more usual donor units are not available. The technique and results of a simplified ECU opposition transfer elongated with a free tendon graft are described. Methods Ten ECU opposition transfers were performed using this modification of Henderson technique in 5 adults after complex trauma, 3 adults with median and ulnar nerve palsies, and 2 children with congenital hand differences. Results Seven patients achieved a Kapandji opposition score of 6 to the distal phalanx of the small finger, and 3 patients achieved a Kapandji score of 5 to the distal phalanx of the ring finger. None of the patients required a secondary tenolysis or developed a radial deviation imbalance of their wrist. Conclusions This modification of the Henderson technique using ECU elongated with a free tendon graft and inserted directly and only into the abductor pollicis brevis tendon is an effective method of restoring opposition to the thumb, especially when other conventional donor muscle–tendon units are not available. Type of study/level of evidence Therapeutic V.

The flexor digitorum superficialis (FDS) is the only muscle in the intermediate layer of the flexor compartment of the forearm. Its main function is flexion of the proximal interphalangeal (IP) joint. Variations of the FDS are common, and knowledge of these variations is necessary for hand surgeons because the little finger tendon of the FDS is commonly used in hand reconstruction surgery. Here we present a case of bilateral absence of the little finger tendon of the FDS in an 11-year-old Hispanic female trauma patient presenting to the Emergency Department with multiple traumatic injuries including bilateral hand lacerations sustained in a motor vehicle accident. On physical examination, flexion of the IP joint of the thumb, and metacarpal phalangeal, proximal IP, and distal IP joints of the little finger were absent bilaterally. In the operating theater, the lacerations were extended to evaluate the status of the tendons of the FDS and flexor digitorum profundus (FDP). On the right, a complete transection of the FDP tendons to the ring and little fingers were found and repaired. Upon further exploration, the FDS tendon to the ring finger was identified and repaired, whereas the little finger tendon was found to be absent. On the left, the FPL tendon was identified and repaired along with the FDP tendon to the little finger. The FDS was subsequently identified and found to be lacking the tendon to the little finger. Clinically, the absence of the FDS could lead to problems in hand reconstruction surgery and functional testing of the hand.

Comminuted intra-articular phalanx fractures are complicated injuries often treated with external fixation. The ideal external fixation system should be affordable, readily available, adaptable, and easy to use. The use of dynamic external fixation has advanced the care of these injuries but can be difficult to implement. The authors present a case example of a patient with a comminuted intra-articular phalangeal fracture of the left small finger treated using a syringe as a static uniplanar fixator that was converted to a dynamic fixator during postoperative recovery.

Metacarpal fractures account for up to 18% of all upper extremity fractures seen below the elbow. The small finger sustains the most fractures followed by the ring, long, thumb, and index fingers. Stable metacarpal fractures are traditionally treated with immobilization. There is no consensus on how to treat unstable metacarpal fractures. Ideally the fixation utilized should be stable enough to allow for mobility as early as 3 weeks to reduce the risk of stiffness. There are many treatment methods that each have their own advantages and disadvantages. This chapter presents several cases showcasing different fixation methods for various fracture patterns.

This article describes the authors' experience with, and recent advancement in, the techniques that have allowed the development of many new arthroscopic procedures in the finger joints. It also describes the role and techniques of arthroscopy in small finger joints. Because the intra-articular anatomy of the first to the fifth metacarpophalangeal (MCP) joints is similar, this article discusses the hand MCP joints without distinguishing thumb from fingers.

Glomus tumours are lesions of the glomus body. A solitary glomus tumour is a more common, characteristically painful lesion, frequently located under the nail, whereas multiple glomus tumours are a rare clinical and genetic entity. Multiple glomus tumours are rarely subungual and do not show preference for any particular region of the body. We report a rare case of painful multidigit subungual glomus tumours in both hands.A 34-year-old male patient complained of painful fingertips (right: thumb, index finger, long finger, and ring finger; left: thumb, long finger, ring finger, small finger) on both hands for more than 5 years. Magnetic resonance imaging (MRI) detected multiple subungual glomus tumours in the fingertips (right long finger, ring finger, and left thumb, long, ring, and small finger) of both his hands, so the authors conducted tumour resection and sent biopsies for relevant fingers. We found the glomus tumour underneath the nail bed and achieved final diagnosis with histological confirmation. No remnant or newly developed lesion was detected at the 1 year outpatient clinic.Our case differed from the usual multiple glomus tumours because its characteristics were similar to those of a solitary glomus tumour, including the classic symptom triad: severe pain, localised pain, and cold hypersensitivity. In case report, we suggest the possibility that multidigit subungual glomus tumour is different from the common single subungual glomus tumour.Glomustumoren gehen vom Glomusorgan aus. Solitäre Glomustumoren kommen häufig vor, sind schmerzhaft und häufig unter dem Fingernagel lokalisiert, wohingegen multiple Glomustumoren eine seltene klinische und genetische Entität darstellen. Multiple Glomustumoren liegen selten subungual. Sie bevorzugen keine Körperregion. Wir berichten über den seltenen Fall schmerzhafter multipler Glomustumoren an beiden Händen. Ein 34jähriger Mann beklagte Schmerzen an den Fingerbeeren des rechten Daumens, Zeige-, Mittel- und Ringfingers sowie des linken Daumens, Mittel-, Ring- und Kleinfingers seit mehr als 5 Jahren. Nachdem eine Kernspinuntersuchung multiple, subungual gelegene Glomustumoren am rechten Mittel- und Ringfinger sowie am linken Daumen, Mittel-, Ring- und Kleinfinger zeigte, wurden die Tumoren entfernt. Histologisch wurde die Diagnose „multiple Glomustumoren“ bestätigt. Bei der Nachuntersuchung nach einem Jahr ergab sich kein Hinweis auf ein Rezidiv.Unser Fall unterscheidet sich von anderen Fällen mit multiplen Glomustumoren, da er die Charakteristika solitärer Glomustumoren aufwies: starke, klar lokalisierte Schmerzen, Kälteempfindlichkeit.

The ideal rehabilitation regimen of paediatric flexor tendon injuries of the hand is discussed controversially. In this study, the clinical outcome of paediatric patients with flexor tendon injuries treated with a dynamic postoperative protocol was assessed. All children with flexor tendon injuries of the hand who were treated by a dynamic postoperative protocol between 1999 and 2011 were included. Patients were invited for a follow-up examination consisting of clinical examination, the TAM and Buck-Gramcko scores, and the linear measurement system. In total, 144 patients (mean age 9.1 years, range 1-17 years) with 267 flexor tendon injuries (128 flexor digitorum superficialis (FDS), 126 flexor digitorum profundus (FDP) and 13 flexor pollicis longus (FPL)) of 191 digits were treated. Of them, 43% (n = 62; 49 male, 13 female) with 88 digits (thumb n = 4, index finger n = 17, middle finger n = 25, ring finger n = 20, small finger n = 22) with 123 injured tendons (FDS n = 62, FDP n = 57, FPL n = 4) were included in the follow-up at a mean post-operative interval of 7.2 years (range 1-13 years). Using the Total Active Motion (TAM) score, an excellent and good outcome could be achieved in 41% and 48% of the patients, respectively. The zone of injury did not influence the objective outcome measures. Subjective and objective outcomes were not statistically different between young children (≤6 years) and older children (>6 years). The present study demonstrates good to excellent outcome in a large cohort of paediatric patients with flexor tendon injuries of the hand treated with a dynamic mobilisation protocol irrespective of patient age.

Malrotation is common after oblique or spiral proximal and middle phalangeal fractures. Although a small degree of malrotation may be acceptable for many patients, greater degrees of malrotation result in functional impairment, pain due to distortion of the joints, and diminished grip strength [1]. Osteotomy is usually required, preferably through the phalanx. Recent progress in computed tomography (CT) imaging and computer technology has enabled clinicians to evaluate the 3-dimensional (3D) kinematics of joint motion and to simulate accurate 3D corrective osteotomy using CT bone models [2,3]. We developed a novel simulation system named “linkage simulation” in which each phalanx is considered a linked arm, which makes it possible to analyze multiple joint motions preoperatively. Here, we report the case of a patient with a malunited little finger proximal phalangeal fracture that was successfully treated using the linkage simulation system. This system consisted of an original 3D computer program, which was designed to reproduce preoperative 3D motion. We have not identified any previous reports of corrective osteotomy for a malunited upper extremity fracture using 3D kinematics and linkage simulation.

Background: The purpose of this cadaveric study is to evaluate the trajectory of percutaneous transverse Kirschner wire (K-wire) placement for fifth metacarpal fractures relative to the sagittal profile of the fifth metacarpal in order to develop a targeting strategy for the treatment of fifth metacarpal fractures. Methods: Using 12 unmatched fresh human upper limbs, we evaluated the trajectory of percutaneous transverse K-wire placement relative to the sagittal profile of the fifth metacarpal in order to develop a targeting strategy for treatment of fifth metacarpal fractures. The midpoint of the small and ring finger metacarpals in the sagittal plane was identified at 3 points. At each point, a K-wire was inserted from the small finger metacarpal into the midpoint of the ring finger metacarpal (“center-center” position). Results: The angle of the transverse K-wire relative to the table needed to achieve a center-center position averaged 20.8°, 18.9°, and 16.7° for the proximal diaphysis, middiaphysis, and the collateral recess, respectively. Approximately 80% of transversely placed K-wires obtained purchase in the long finger metacarpal. Conclusions: These results can serve as a guide to help surgeons in the accurate placement of percutaneous K-wires for small finger metacarpal fractures and may aid in surgeon training.

Loss of a fourth digit below the level of the proximal phalanx results in a weakened grip, loss of skilled movements, and the amputation stump is repeatedly traumatized. Transposition of an adjacent fifth digital ray can improve hand function and cosmetic appearance by closing the gap created by the missing digit. Digital ray amputation is not a commonly performed procedure. However, when performed correctly it can dramatically improve hand function and cosmesis. The aim of this study was to evaluate the functional and aesthetic results of the fifth ray radial translation and intercarpal arthrodesis in mutilating ring finger injuries. In this retrospective study, nine consecutive patients who sustained mutilating ring finger injury were managed by fourth ray amputation with fifth ray transposition between January 2008 and December 2014. There were six males and three females with a mean age of 30.2 ± 12.2 years (age range, 16–56 years) at the time of surgery who underwent delayed fourth ray amputation with fifth ray transposition (after 14 days of injury). Eight cases had undergone previous surgical interventions: three ORIF using intramedullary K-wire fixation, one failed reimplantation, four debridement and application of split thickness skin graft. Primary skin closure of the amputated finger was not considered as previous surgery (one patient). All patients were followed up for a mean period of 17.1 ± 4.1 months (range, 12–24 months). Grip strength and RAS score improved after fourth ray resection. The postoperative grip strength and RAS (score) were not compromised by the associated hand dominance. The following conclusions can be made despite the fact that this was a limited study as well as a retrospective analysis: 1-In technical terms, resection of the fourth ray with transposition of the small finger with a wedge-shaped hamate-capitate arthrodesis secured by screw fixation is easier than metacarpal osteotomy/transposition and less liable to post-operative complications. 2-The results of this study suggest that fourth ray resection and transposition of the small finger with a hamate-capitate arthrodesis restores hand function and cosmetics.

Background: To describe the rate and predictors of pathologic fractures in benign neoplasms of the finger, as variables from prediction models for pathologic fractures of the long bones of the extremities are not necessarily applicable to the bones of the hand. Methods: In this retrospective chart review, 69 histologically confirmed neoplasms affecting the bones of the fingers, 49 phalanges and 20 metacarpals, were identified in patients presenting at 2 urban hospitals over a 24-year period. Different variables were studied as possible predictors of pathologic fractures. Results: Forty-nine percent of the tumors presented as a pathologic fracture. The small finger was independently associated with pathologic fractures compared to the other fingers. Tumors of the metacarpal bones were the least likely to fracture compared to other bones. Conclusions: Almost half of neoplasms affecting the bones of the fingers presented initially with a pathologic fracture, most commonly the small finger. Therefore, a lower threshold for surgical treatment of a bone neoplasm affecting the small finger may be reasonable.

Backgrounds: Syndactyly is failure of differentiation in which the fingers fail to separate into individual appendages. It is the most common congenital hand anomaly, with an incidence of 1 in 2,000 to 2,500 live births. Surgical separation of fingers as early as 6 month-old is indicated when syndactyly involves digits of unequal length (i.e., ring and little fingers). Early separation is also required in complex syndactyly and cases of acrosyndactyly. The timing of surgery of all other cases of syndactyly remains somewhat controversial; most suggest surgical correction before age of 18 months, whereas others prefer to wait until after this age.Case Presentation and Operation Technique: A 13-year old boy, presented with fusion of all fingers of the right hand at birth. Prior to his current visit, he underwent partial separation of the right fingers at the age of 6 y.o. at a local hospital. Following partial separation, the fingers did not grow normally. Current X-ray showed atrophy and deviation of middle phalanx. We performed separation of syndactyly between index and middle finger, and between fourth and small finger in our hospital. Interdigital webbings are released using local flap and the remaining raw surface is covered using full-thickness skin grafts. On follow up, the patient showed good functional and aesthetic outcome. He is able to write with his right hand with better coordination.Discussion: Complex syndactyly reconstruction is a challenging surgical problem. Common post surgical findings include rotational deformity, angular deformity, and nail deformity. We describe how we have altered our approach in these findings.Conclusion: Congenital syndactyly should be corrected early in life. Careful dissection, the use of a dorsal rectangular flap in combination with 2 volar triangular flaps, and use of full thickness skin grafts ensure a satisfactory outcome and minimize the number of operations per web

The purpose of this study was to investigate the incidence and type of metacarpal (MC) fractures in a military population, and whether these fractures are related to age, military occupational specialty, aggression, or accidental injury. A retrospective record-based review was conducted at a single military center over a 5-year period. Service members with index finger through small finger MC fracture were identified. Data were collected utilizing Armed Forces Health Longitudinal Technology Application and electronic profile (e-profile) databases. Data collected included demographic information, mechanism of injury, nature of injury, total number of visits, and estimated time on physical restriction. 400 patients met inclusion criteria. Males accounted for 94% of the study population, 75% of fractures were of the small finger MC, 54% of patients were between 20 and 24 years, 90% were sustained by junior enlisted personnel, and most occurred by punching. Men aged25 years were more likely to have intentional injuries. Total time on limited duty profile averaged 38 days and the average medically nondeployable profile was 26 days. MC fractures most commonly affect young, male, junior enlisted service members and are often self-inflicted. As a result, these injuries account for time lost at work, reduced job performance, and decreased medical readiness.

Avulsion of the flexor digitorum profundus (FDP) tendon associated to an enchondroma fracture in the distal phalanx is very rare. We report a subacute case of a type II FDP tendon avulsion of the small finger at its insertion, in combination with a fracture of the distal phalanx due to enchondroma. The bone lesion was curated and grafted using autogenous bone harvested from the ipsilateral radius. The FDP tendon was reattached to the distal phalanx using the pullout transosseous technique. Delayed protected active mobilization was used to treat the repaired tendon. According to the adjusted Strickland score, a good result was obtained and grip strength was similar between hands and PRWHE score was very low at 5 months from surgery. Early diagnosis leads to a fast surgery with good functional mobility and pain outcomes. If closely monitored by an experienced medical team, as this case demonstrates, an attempt to treat the benign tumor with a curettage, bone filling and reattachment of the tendon through the pullout technique in young motivated patients can be an alternative.

Whole-blood microsampling provides many benefits such as remote, patient-centric, and minimally invasive sampling. However, blood plasma, and not whole blood, is the prevailing matrix in clinical laboratory investigations. The challenge with plasma microsampling is to extract plasma volumes large enough to reliably detect low-concentration analytes from a small finger prick sample. Here we introduce a passive plasma filtration device that provides a high extraction yield of 65%, filtering 18 μL of plasma from 50 μL of undiluted human whole blood (hematocrit 45%) within less than 10 min. The enabling design element is a wedge-shaped connection between the blood filter and the hydrophilic bottom surface of a capillary channel. Using finger prick and venous blood samples from more than 10 healthy volunteers, we examined the filtration kinetics of the device over a hematocrit range of 35-55% and showed that 73 ± 8% of the total protein content was successfully recovered after filtration. The presented plasma filtration device tackles a major challenge toward patient-centric blood microsampling by providing high-yield plasma filtration, potentially allowing reliable detection of low-concentration analytes from a blood microsample.

Background Anal dilatation is performed after repair of anorectal malformations(ARMs) and is vital in prevention of anal stricture formation. The ideal protocol utilizes Hegar dilators. In our setup, few parents will acquire Hegar dilators for home based anal dilatation but majority will use fingers as an alternative. The basis of this study was to determine the effectiveness of digital anal dilatations in preventing anal strictures. Materials and methods This was a descriptive cross-sectional study carried out at Kenyatta National Hospital (KNH) which recruited children post ARM repair undergoing digital anal dilatation. The diameters of the digits used for anal dilatation were assessed for adequacy using the desired anal size as a reference point. The main outcome variable was the presence of anal strictures. Data were entered in a data collection sheet and analyzed by use of SPSS (V.21.0 Chicago, Illinois). Chi-square test and Fisher's exact test were used to ascertain association among variables. A P-value of less than 0.05 was considered statistically significant. Results 50 patients with ARM post repair were recruited in the study. The rate of occurrence of anal stricture was 22%. Among the participants with anal strictures, only 27% were compliant to the dilatation regimen while 73% reported noncompliance. The mean diameter(mm) of the dilating digits at the level of the middle phalanx was Index finger (15.4 ± 0.58), middle finger (15.2 ± 0.61), ring finger (14.2 ± 0.71), small finger (12.5 ± 0.91) and thumb (17.6 ± 0.78). 46% of the participants were dilated with appropriately sized digits. The remainder had dilatations done with larger (22%) or smaller digits (32%). Notably, anal strictures occurred in participants who were dilated with inappropriately sized digits (P = 0.001). Conclusion Digital anal dilatation is safe and effective as a mode of anal dilation in the setting of compliance to a strict dilatation protocol, daily frequency of dilations and use of appropriately sized digits. Owing to the variability in the finger size, we recommend that digits be calibrated and education given to the caregivers on the use of the appropriately sized digit. Level of evidence Treatment study. Level III.

For AR/VR systems, tapping-in-the-air is a user-friendly solution for interactions. Most prior in-air tapping schemes use customized depth-cameras and therefore have the limitations of low accuracy and high latency. In this paper, we propose a fine-grained depth-aware tapping scheme that can provide high accuracy tapping detection. Our basic idea is to use light-weight ultrasound based sensing, along with one COTS mono-camera, to enable 3D tracking of user's fingers. The mono-camera is used to track user's fingers in the 2D space and ultrasound based sensing is used to get the depth information of user's fingers in the 3D space. Using speakers and microphones that already exist on most AR/VR devices, we emit ultrasound, which is inaudible to humans, and capture the signal reflected by the finger with the microphone. From the phase changes of the ultrasound signal, we accurately measure small finger movements in the depth direction. With fast and light-weight ultrasound signal processing algorithms, our scheme can accurately track finger movements and measure the bending angle of the finger between two video frames. In our experiments on eight users, our scheme achieves a 98.4% finger tapping detection accuracy with FPR of 1.6% and FNR of 1.4%, and a detection latency of 17.69ms, which is 57.7ms less than video-only schemes. The power consumption overhead of our scheme is 48.4% more than video-only schemes.

Skin envelope degloving of fingers are rare injuries that require rapid care and surgical treatment. Mostly caused by ring finger injuries, these traumas include bone, tendon and neurovascular pedicle damage. The authors present an unusual case of finger degloving limited exclusively to the skin envelope, without skeletal, tendinous or vascular lesion. This rare case of skin envelope degloving rendered microsurgical revascularization impossible. The authors report the results at 12 months following salvage reconstruction combining a partial second toe pulp free flap for the volar side and a dermal substitute with a thin skin graft for the dorsum.

Post-traumatic arthritis is common in long-term follow-up of patients undergoing hemi-hamate arthroplasty (HHA). We hypothesize that anatomic mismatch could play a role in the development of arthritis. The purpose of this study is to establish a novel, computed tomography (CT)-based imaging technique for pre-operative assessment in HHA. With this technique, our group aims to identify digits with a high likelihood for anatomical mismatch between the donor graft and recipient interphalangeal joint. Using this technique to eliminate cases with high-likelihood of incongruent anatomy, we hypothesize the rates of arthritis could be reduced. We conducted a retrospective review of upper extremity CT scans from 2007 to 2014 at our institution. Those studies meeting our inclusion criteria were exported to a clinical radiology software suite. Subsequently, angular and linear measurements of the hamate and potential recipient proximal interphalangeal joints were collected. Angular and linear comparisons were then made between the donor hamate graft and the individual recipient sites. Using pre-established cutoff values, matches were deemed to be inconsistent or consistent. The study included 31 CT scans. The rate of anatomical consistency was low; the small finger was most often consistent (38.7 %) and the index finger was least often consistent (12.9 %). Linear inconsistency was common in all joints besides the small finger; angular inconsistency was most prevalent in the index and long fingers. This novel use of CT scans as a tool for pre-operative HHA planning is a crucial first step in trying to reduce the observed rates of arthritis after HHA.

Purpose To assess whether or not attempted closed reduction of fifth metacarpal neck fractures results in decreased fracture angulation at final follow-up. Methods Retrospective chart review of all patients aged 18 and older managed for isolated fifth metacarpal neck fractures between 2004 and 2014. Results Sixty-six patients managed for an isolated boxer fracture met inclusion criteria. Twenty-three patients underwent attempted reduction and 43 patients did not. Patients undergoing attempted reduction had a statistically significant improvement in fracture angulation following reduction compared with patients not undergoing attempted reduction. At final follow-up, there was no difference in fracture angle between the 2 groups. Conclusions Closed reduction and splint immobilization of fifth metacarpal neck fractures was not an effective means of maintaining a significant improvement in fracture alignment upon healing. Other means, such as closed reduction with pin fixation or open reduction internal fixation, should be considered when maintenance of reduction is desired. Type of study/level of evidence Therapeutic III.

An 18-year-old right-hand dominant woman presented with an enlarging right medial elbow mass which was associated with worsening paresthesias during the past 2 months, primarily affecting her ring and small fingers. She denied any weakness or loss of function. There was no family history of soft tissue tumors, neurocutaneous disorders, or neuropathy. Physical examination revealed an elongated soft tissue mass along the posteromedial aspect of her right elbow. The mass was fairly firm, did not transilluminate, and was mobile in the mediolateral plane. Although the mass was not tender to palpation, percussion of the mass reproduced her paresthesias (a positive Tinel’s sign). Moreover, light touch sensation was intact. Further evaluationof her right upper extremity revealed normal ROM, vascular status, and no atrophy of the upperextremity muscles. Small finger abduction strength was 4/5 with remaining strength testing revealing no other weakness. There was no associated lymphadenopathy. Laboratory tests, including a complete blood count with differential, a comprehensive metabolic panel, sedimentation rate, C-reactive protein, and lactate dehydrogenase levels, were normal. Imaging studies included AP and lateral radiographs of the humerus (Fig. 1) and MRI (Fig. 2). Based on the history, physical examination, laboratory studies, and imaging studies, what is the differential diagnosis at this point?

Background: The metacarpophalangeal joints exhibit range of motion that is influenced by wrist position. Synergistic motion occurs between the wrist and the metacarpophalangeal joints with different static wrist positions affecting joints’ motion capability. The aim of this study was to determine how different wrist positions influence the active range of motion of the index through small finger metacarpophalangeal joints. Methods: The active range of motion of the index through small finger metacarpophalangeal joints of 31 healthy subjects was measured in flexion/extension and radial/ulnar deviation in 5 different flexion/extension wrist positions, using biaxial electrogoniometers. Results: There was a difference in range of motion of all fingers depending on the wrist position. The minimum metacarpophalangeal joint range of motion was found in 80° wrist extension, the maximum in neutral wrist position. For the index finger, flexion/extension was 84.7° (±8.6°) to 25.9° (±10.2°) and radial/ulnar deviation was 32.1° (±11.3°) to 22.6° (±12.8°). For the middle finger, flexion/extension was 84.8° (±8.5°) to 25.9° (±10.1°) and radial/ulnar deviation 28.8° (±11.1°) to 22.1° (±8.9). The fourth finger showed a range of motion for flexion/extension of 87.2° (±11.5°) to 22.8° (±11.6°) and radial/ulnar deviation of 8.1° (±5.8°) to 32.3° (±12.4°). The highest range of motion was measured at the fifth finger with flexion/extension of 84.0° (±8.6°) to 32.1°(±16.8°) and radial/ulnar deviation of 15.1° (±12.9°) up to 54.6° (±18.7°). Conclusions: The range of motion of the index through small finger metacarpophalangeal joints was significantly influenced by wrist position. The highest metacarpophalangeal joint range of motion of all fingers was conducted in neutral wrist positions. Apart from ergonomic implications, we conclude that metacarpophalangeal joint motion should be assessed under standardized wrist positions.

Background: The extensor digiti minimi (EDM) tendon is commonly divided into a radial slip (EDM-R) and an ulnar slip (EDM-U). To our knowledge, the degree to which each EDM slip concomitantly abducts the small finger with active extension has not been formally tested. This study sought to characterize the comparative contributions of finger abduction inherent to each slip of the EDM to observe the sequelae of active small finger extension following transfer of the contralateral slip. Methods: Eighteen fresh-frozen cadaveric hands were used in this study. Starting with the hand in resting position, a controlled traction of 10 N was applied to each slip of the EDM tendon. The range of small finger abduction with respect to the fixed ring finger was recorded utilizing infrared reflective markers tracked through the range of motion using a digital video camera. Results: The mean abduction of the small finger when the radial slip of the EDM tendon was tested was 13.33° (95% confidence interval [CI]: 10.10°-16.55°), which was significantly different ( P ≤ .001) than small finger abduction produced by the ulnar slip of the EDM, with a mean of 23.72° (95% CI: 19.40°-28.04°). Conclusions: Given the fact that the ulnar slip of the EDM tendon is shown to be the major contributor of aberrant abduction with active small finger extension, as traction on this slip produces almost twice as much abduction as the radial slip, the EDM-U is the ideal donor graft with respect to tendon transfers of the EDM.

Background: The purpose of this study was to determine whether placing the suture-button device between the long and small finger metacarpals following ring finger ray amputation may better close the intermetacarpal gap and allow early range of motion without increasing the risk of malrotation than soft tissue repair alone. Methods: We performed ray amputation of the ring finger of 14 cadaver specimens by performing an osteotomy of the base of the ring finger metacarpal and then excising the remainder of the digit. We first performed a soft tissue repair of the transverse metacarpal ligaments and then cycled the fingers in simulated active flexion and extension on a custom computer-controlled device to re-create 6 weeks of range of motion. We then placed a suture-button device across the long and small finger metacarpals and tested the specimens again, thereby using each hand as an internal control. Results: The distance between the ring and small finger metacarpals was reduced following suture-button device placement compared with the initial control; this spacing was maintained following complete cycling of the fingers. The angle between the metacarpals was divergent following soft tissue repair, and then became slightly convergent after insertion of the suture-button device. None of the hands developed clinically relevant scissoring of the digits before or after application of the suture-button device. Conclusions: The suture-button device provides stable fixation to withstand early range of motion following ring finger ray amputation and significantly closes the gap and angle between the adjacent metacarpals without causing scissoring.

The aim of the study is to introduce a new minimally invasive technique for ulnar nerve release and transposition.From January 2010 to May 2011, 51 patients with cubital tunnel syndrome were treated through a 1.5 to 2 cm incision. Limb functional recovery, scar esthetics, sensitivity of scar, numbness of the operating area, and patient satisfaction were assessed.No wound hematoma nor infection was observed in the group. The time of operation was 36 ± 17.2 minutes. At the final follow-up of 63 ± 7.3 months, 2-point discrimination of the small finger was improved from 6.3 ± 2.2 mm to 5.2 ± 2.4 mm. Grip and pinch strength of the hand were improved from 14.2 ± 7.7 kg and 3.7 ± 2.4 kg to 35.2 ± 12.7 kg and 4.1 ± 2.8 kg, respectively. The motor nerve conduction velocity was improved from 36.5 ± 11.2 to 44.6 ± 6.7 (m/sec). The Disabilities of the Shoulder, Arm, and Hand questionnaire score was improved from 37.2 ± 23.8 to 10.5 ± 9.6. No patients reported scar pain, sensitivity of scar, or numbness of the operating area. No revision surgery was needed. Michigan Hand Outcome score for aesthetics was 94.6%±5.1 and satisfaction was 92 ± 8, respectively. We obtained 33 excellent, 12 good, 5 fair, and 1 poor result.Ulnar nerve decompression with anterior transposition can be safely and effectively accomplished through the small incision. It can be an alternative technique producing good appearance.

Ultrasound imaging is widely used in clinical imaging because it is non-invasive, real-time, and inexpensive. Due to the freehand nature of clinical ultrasound, analysis of an image sequence often requires registration between the images. Of the previously developed mono-modality ultrasound registration frameworks, only few were designed to register small anatomical structures. Monitoring of small finger vessels, in particular, is essential for the treatment of vascular diseases such as Raynaud’s Disease. High frequency ultrasound (HFUS) can now image smaller anatomic details down to 30 microns within the vessels, but no work has been done to date on such small-scale ultrasound registration. Due to the complex internal finger structure and increased noise of HFUS, it is difficult to register 2D images of finger vascular tissue, especially under deformation. We studied a variety of similarity measurements with different pre-processing techniques to find which registration similarity metrics were best suited for HFUS vessel tracking. The overall best performance was obtained with a normalized correlation metric coupled with HFUS downsampling and a one-plus-one evolutionary optimizer, yielding a mean registration error of 0.05 mm. We also used HFUS to study how finger tissue deforms under an ultrasound transducer, comparing internal motion vs. transducer motion. Improving HFUS registration and tissue modeling may lead to new research and improved treatments for peripheral vascular disorders.

Background Headless compression screws have been used for arthrodesis of the distal interphalangeal joint with good clinical results. However, some distal phalanges are too small, thus precluding their use, or increasing complication rates. Methods In order to validate our digital measurements, radiographs of five cadaveric hands were obtained. The distal phalanges of these fingers were measured using our institution's digital radiograph software. The cadavers were then dissected, and the actual phalanges were measured to confirm the accuracy of the digital measurements; 200 consecutive hand radiographs were then measured to obtain average width and heights of the narrowest measurements of the distal phalanx of each finger. Subgroup analysis of each finger for age and gender was completed. Results and Conclusions Females were routinely smaller than their male counterparts. No age-related differences were seen. A substantial number of fingers were found to be too small to allow for use of headless compression screws; 42 % of small finger distal phalanges are too small to accommodate 2.8-mm threads, and that number increases to 81 % with 3.2-mm threads and 97 % with 3.5-mm threads. Few distal phalanges, regardless of which finger, are large enough to accommodate 3.5-mm-diameter threads; 22% of female ring finger distal phalanges are smaller than 2.8 mm, and 66 % of ring fingers are smaller than 3.2 mm. Based on our measurements, a surprising number of distal phalanges are smaller than the trailing thread diameter of commonly commercially available headless screws. Care must be taken in selecting implants for distal interphalangeal (DIP) fusion.

The scores used to evaluate sensibility after digital nerve reconstruction do not take the patient's age into consideration, although there is evidence that the outcome after digital nerve reconstruction is age-dependent. However, it is not clear if the normal sensibility of the hand is also age-dependent, as the existing studies have major limitations. We evaluated the normal sensibility of the hand in 232 patients using static and moving two-point discrimination (2PD) tests and the Semmes-Weinstein-monofilament test. We found the climax of sensibility in the third decade with age-dependent deterioration afterwards in all three tests. Mean 2PD values of the radial digital nerve of the index finger (N3) showed to be significantly lower than values of the ulnar digital nerve of the small finger (N10). To overcome shortcomings of classification systems that do not consider the patient's age and inter-individual differences, we suggest using the difference of the static 2PD values of the injured to the uninjured contralateral nerve (delta 2PD) for assessment of sensibility after digital nerve reconstruction.

Summary:. Finger amputations are common injuries which result in significant long-term morbidity and loss of function. In this report, we describe a creative operative solution for a 21-year-old man who was in a motorcycle crash and sustained severely comminuted open fractures of the left small and ring fingers with severe crush injury and soft tissue avulsion. Of the tissues and bones in the small finger, only the distal half of the proximal phalanx remained intact and was vascularized via the remaining ulnar neurovascular bundle. In the ring finger, the extensor mechanism and ulnar neurovascular bundle were avulsed and the distal half of the proximal phalanx was absent, but the flexor tendons were intact. A small finger ray amputation was performed. Then, using an osteocutaneous fillet flap based on the ulnar neurovascular bundle from the small finger, the bony gap and soft tissue deficits in the ring finger were reconstructed. The ring finger extensor tendon was then reconstructed. Subsequently, the patient had evidence of bony union on follow-up X-rays and he had a sensate filet flap over the ulnar aspect of the ring finger. This case demonstrates the creative use of a “spare-parts” osteocutaneous fillet flap in the reconstruction of a traumatic finger injury. This example highlights the importance of assessing all available reconstructive options to avoid the morbidity of a finger amputation.