Search

Background: Curly/underlapping toe involves flexion, adduction, and varus deformity of the interphalangeal joints. There are no previous reports showing the relationship between physical examination and X-ray findings among patients with curly toe deformity.Methods: We investigated the clinical findings of 116 consecutive patients associated with 239 underlapping toes. We compared the age and affected toes between patients whose deformities were pointed out at a pediatric medical examination (group 1) and those referred for medical treatment (group 2). The degree of curly toe deformity was graded by a physical examination and X-ray.Results: The average age at presentation was 2.7 years. The affected toes were significantly different between groups 1 and 2 (p < .001). The morbidity of each toe differed significantly in group 2 (p < .005) but not in group 1. The correlation between the appearance grading and classification by X-ray was very strong using Spearman's rank correlation coefficient. The severity of curly toe was divided into mild in 104 toes, moderate in 105 toes, and severe in 17 toes. The methods of conservative treatment were observation only in 15 cases, manipulations in 30 cases, taping in 67 cases, and a brace in 9 cases. Surgery was performed in 8% of cases.Conclusion: Curly toe deformity of the third or fourth toes tend to be referred for medical treatment because of the abnormality. Our grading system using a physical examination and classification by X-ray was useful for assessing the severity of curly toe. [ABSTRACT FROM AUTHOR]

Stable lesions of osteochondritis dissecans (OCD) of the capitellum have been treated with activity restriction (AR), and the complete healing requires 1 or 2 years. Little is known about the effectiveness of elbow immobilization. We hypothesized that elbow immobilization would have positive effects on healing of stable OCD. The study subjects were 43 patients (mean age: 12.2 years) with 43 stable OCD lesions of the prematured elbow (mean skeletal age score: 17.1 points of 0-27 points system). The subjects were divided into 3 groups: group A, AR without elbow immobilization, 22 cases; group B, splint (mean: 8.8 weeks) followed by AR, 9 cases; and group C, cast (mean: 3.7 weeks) followed by splint (mean: 7.3 weeks) and AR, 12 cases. The mean nonoperative observation period was 17.5 months (minimum three months). On anteroposterior radiographs of the elbow at 45 degrees of flexion, 5 observers independently assessed the healing of the capitellum, and the interobserver and intraobserver reliabilities were examined. The differences in outcomes among 3 groups were also examined. The interobserver and intraobserver reliabilities of the radiographic assessment were almost perfect (Cohen kappa value: 0.82 and 0.91, respectively). There were no significant differences in age, sports played, or stage of the lesion before the treatment. The proportion of patients returning to sports and the mean period required were 77% and 8.2 months in group A, 78% and 5.7 months in group B, and 83% and 4.4 months in group C, respectively. The proportion of patients showing ossification in the central aspect of the capitellum and the mean period required were 67% and 8.2 months in group A, 63% and 4.9 months in group B, and 91% and 1.9 months in group C, respectively. The proportion of patients showing complete healing and the mean period required were 41% and 16.4 months in group A, 67% and 7.0 months in group B, and 92% and 5.5 months in group C, respectively. Compared to group A, group C showed a significantly earlier return to sports (P =.034), a significantly shorter period required for ossification (P <.001), and significantly higher proportion of patients with complete healing (P =.012) within a significantly shorter period (P =.009). Elbow immobilization had positive effects on healing and enabled both an early return to sports and complete healing. Cast immobilization is recommended as a first choice of nonoperative treatment for stable OCD lesions of the elbow before epiphyseal closure. [ABSTRACT FROM AUTHOR]

Background The present study was conducted to clarify the long-term (≥10 years) results of simple rotational osteotomy for congenital radioulnar synostosis (CRUS). Methods Twelve forearms in 9 Asian patients with CRUS who underwent simple rotational osteotomy of the radius shaft were monitored for an average of 13.6 years (range, 10-19 years) postoperatively. Before surgery, the forearm fixation averaged 51.3° of pronation (range, 30°-90°). The true position of the forearm in ankylosis was measured by a line through the styloid processes of the radius and the ulna. Palm pronation and supination angles were also measured. The osteotomy was performed at the insertion of the pronator teres to the shaft of the radius. The pronation position was then corrected manually to allow 90° of palm supination with compensatory rotation around the wrist, and a cast was applied. We evaluated activities of daily living items at a mean of 5.2 years after surgery. At the final follow-up, the 11-item version of the Disability of the Arm, Shoulder and Hand score was recorded. Results After surgery, the forearm was fixed at an average of 4.2° of supination. At the final follow-up, the palm was able to achieve an average motion arc ranging from 26° of pronation to 62° of supination. There were no neurologic or circulatory complications after surgery. Ability to perform daily activities was markedly improved, and all patients were satisfied with the results of surgery. The average score on the 11-item version of the Disability of the Arm, Shoulder, and Hand was 3.79 points at the final follow-up. Conclusion Our procedure for forearm rotation in patients with CRUS is simple, reliable, satisfactory, and safe. [ABSTRACT FROM AUTHOR]

Purpose: The amputation of digits that occurs in association with congenital constriction band syndrome (CCBS) is often described as similar to that resulting from trauma. Some previous studies have suggested that no bone hypoplasia is present in the affected limb proximal to the amputated part. The purpose of this study was to report our series of patients with metacarpal hypoplasia in amputated digits associated with CCBS. Methods: We reviewed a total of 37 hands of 24 patients diagnosed as having amputated fingers owing to CCBS and evaluated the clinical features of the metacarpal bone hypoplasia. Results: We found coexistent metacarpal hypoplasia in 11 hands in 9 patients. Three of the patients were male and 6 were female. The average age at the time of examination was 9 years (range, 4–20 y). We observed metacarpal hypoplasia in cases of amputation at the level of the proximal phalanx and not at the level of the middle phalanx. Conclusions: We found metacarpal hypoplasia in 38% of patients and in 30% of hands with amputated digits owing to CCBS. Type of study/level of evidence: Prognostic IV. [Copyright &y& Elsevier]

Purpose: To describe radial longitudinal deficiency with hypoplastic or absent thumb and cutaneous syndactyly between the most radial digits. In addition, to discuss the clinical relevance and unique treatment decisions involved in optimizing functional outcomes in these patients. Methods: A total of 163 extremities of 122 patients with radial longitudinal deficiencies were reviewed. We reviewed radiographs and clinical images that were available, with most radial hypoplastic digit and cutaneous syndactyly to the adjacent finger. Results: There were 7 hands with this type of deformity. Four cases had a hypoplastic thumb associated with cutaneous syndactyly between the thumb and index finger. Three cases had a deformity in which the thumb was absent and the hypoplastic index finger was syndactylized to the long finger. Proximal and distal radioulnar synostoses were associated with these deformities in 3 patients. Conclusions: Because the most radial digit is severely hypoplastic in this type of deformity, pollicization is usually indicated. However, the pollicization procedure must be modified due to associated syndactyly with different degrees of hypoplasia or absence of the intrinsic muscles. This type of deformity should be distinguished from hypoplastic thumb without syndactyly. Type of study/level of evidence: Therapeutic IV. [ABSTRACT FROM AUTHOR]

Abstract: Radium isotopes in 23 Na–Cl type groundwater sampled mainly from deep wells in Niigata Prefecture, which is the site of the largest oil- and gas-fields in Japan, were measured along with U isotopes, chemical components and hydrogen and oxygen isotope ratios to elucidate the distribution and behavior of Ra in a brackish environment underground. Also analyzed were U and Th isotopes in 38 rock samples collected from outcrops at 17 locations. Ra-226 concentrations (8.86–1637mBqkg−1) of groundwater samples roughly correlated with total dissolved solid (TDS) concentrations and other alkaline earth contents. Their 228Ra/226Ra activity ratios (0.32–5.2) were similar to or higher than the 232Th/238U activity ratios (0.6–1.7) in the rocks. The most likely transport mechanism of Ra isotopes into groundwater was due to their α-recoil from the solid phase, probably from the water–rock interface where Th isotopes had accumulated, and adsorption/desorption reaction based on the increase in 226Ra contents with TDS. [Copyright &y& Elsevier]

Central polydactyly, syndactyly, and cleft hand are categorized separately in the International Federation of Societies for Surgery of the Hand classification. However, some investigators have proposed that these malformations should be classified into a single category: abnormal induction of finger rays. In this article, we report 5 hands with central polydactyly, syndactyly, and cleft hand in 3 patients from the same family and discuss the phenotypes in each hand. [Copyright &y& Elsevier]

Abstract: A cryogenic separation method of chloromethane (CH3Cl) from methyl iodide (CH3I) for δ37Cl measurement with isotope ratio mass spectrometer is described. A cold trap with sealed 2,2,4-trimethylpentane (TMP) as the cryogen is used in this method. CH3Cl can be separated from CH3I at the TMP melting point (−107°C) based on the difference in the vapor pressure between CH3Cl (322.6Pa) and CH3I (lower than 1.3Pa) at −107°C. After two-step separation processes, the yields of CH3Cl purified from CH3Cl–CH3I mixture are 96–101%, and the difference between the δ37Cloriginal and δ37ClAfterseparation is from −0.06 to +0.06‰ (0.01±0.04‰). These results suggest that CH3Cl is completely separated from CH3I with no change of δ37Cl value. This method using the cold trap with sealed TMP is very safe and not harmful, because the liquid organic compound used as the cryogen is contained in the trap and does not evaporate during the separation procedure. This method is also simple and inexpensive relative to the method using a gas chromatograph. [Copyright &y& Elsevier]

Osteochondritis dissecans (OCD) of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes. However, its etiology remains unknown. Medical examinations using ultrasonography found that the prevalence of capitellar OCD among adolescent baseball players was approximately from 1% to 3%. A plain anteroposterior radiograph with the elbow in 45° of flexion is essential for the diagnosis of an OCD lesion. The stability of OCD lesions is evaluated on plain radiographs, computed tomography, and magnetic resonance imaging (MRI). Imaging features of the unstable lesions are an epiphyseal closure of the capitellum or a lateral epicondyle, a displaced fragment, or irregular contours of the articular surface and a high signal interface on T2-weighted MRI. A stable lesion has the potential to be healed with conservative treatment. By contrast, surgical treatment should be considered if there is no radiographic improvement within 3 months. In addition, surgery should be performed for the lesions that cause pain during daily activities, have a locking phenomenon, or which are assessed by imaging as obviously unstable. Arthroscopic debridement/loose body removal can be performed for small lesions (≤12 mm in diameter). For large lesions (>12 mm), preservation and/or reconstruction of the articular surface should be selected, such as bone-peg fixation of the lateral part of the fragment and osteochondral autograft transplantation (OAT) from the knee. In the future directions, there is no comparative study of OAT from the knee and rib. In addition, little is known about its long-term outcome, or resulting osteoarthritis. A recent meta-analysis showed that grafts harvested from the knee may lead to donor site morbidity (7.8%). Thus, a novel cartilage tissue engineering approach is anticipated. [ABSTRACT FROM AUTHOR]