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The first substantial mammal fauna from the UK Paleocene-Eocene Thermal Maximum is described. It consists of 14 species and owes its collection to bulk-sampling and screen-washing techniques. The fauna belongs to European mammal zone PE II, which is recorded from only three other sites, all in northern France. The composition of the fauna is subtly different from that of slightly younger Abbey Wood (PE III), perhaps related to climatic, microhabitat or taphonomic differences. The new species Wyonycteris kingi is described, whilst Coryphodon oweni is recorded for the first time in the UK in a stratified context. A first phalanx is tentatively attributed to the plesiadapiform Platychoerops daubrei for the first time.

In the serious forms of Dupuytren disease, passive extension during surgery often results in unmasking a loss of skin substance that makes primary closure impossible. Our objective in this study was to describe and assess the therapeutic possibilities of a 3 local flaps surgical approach in serious forms of Dupuytren disease, using the lateral skin expansion because of the cord. A cadaveric study was carried out on 12 adult nonembalmed, fresh frozen hands. For each specimen, a loss of skin substance was simulated on the palmar side of the fifth finger at the level of the proximal digital flexion crease. Coverage involved an incision delineating 3 distinct local flaps: a radially based quadrangular palmar flap, triangular proximally based laterodigital flap, and a distally based triangular web space flap. For a defect reaching up to 40% of the palmar surface of the first phalanx (P1), this 3-flap combination allowed us to fill in skin loss with a tension-free closure. Then we led a clinical study among 10 patients suffering from Dupuytren contracture, Tubiana, and Michon classification stages from II to IV. For those patients who all showed perioperative inadequate skin coverage, we used the 3-flap plasty. No skin necrosis occurred. This reliable technique using a "cascade" of local flaps makes it possible, in serious forms of Dupuytren disease, to both easily access the palmar and digital portions of the cord and to achieve closure.

Objective To assess suspensory ligament extensor branch location and fracture gap reduction with simulation of standing and recumbent cortical bone screw repair of experimental incomplete parasagittal proximal phalanx (P1) fractures. Study design Controlled laboratory study. Sample population Twenty equine cadaver forelimbs. Methods Simulated fractures were repaired twice in random order. A proximal cortical bone screw was placed in lag fashion with the limb unloaded (simulated recumbent repair) and loaded to 38% of body weight (range, 375-568 kg; simulated standing repair). Changes in fracture gap width were assessed on computed tomography (CT) images and with intraplanar force-sensitive resistors measuring voltage ratios (V△ ) between loaded recumbent (R-1) and standing repair simulations (R-2). Extensor branch borders were determined relative to implant position and sagittal P1 width on transverse CT images. P ≤ .05 was considered significant. Results Standing repair simulation-associated fracture gaps were not wider than in R-1 while controlling for confounding factors (loading weight, implant position, or animal age; P > .7, repeated-measures analysis of variance). Voltage ratio data associated with R-2 were not smaller than with R-1 (mean difference, 0.002 ± 0.052; one-sided Wilcoxon signed-rank test, P = .27). More of P1 width was approachable palmar to extensor branches when limbs were loaded (0.804 ± 0.314 cm) vs unloaded (0.651 ± 0.31 cm; paired Student's t test, P Conclusion Simulated standing repair was not associated with inferior fracture reduction compared with loaded simulations of recumbent repairs. Limb loading affected extensor branch location relevant to implant positioning. Clinical significance Unloading during standing repair of incomplete parasagittal proximal P1 fractures may not be required to optimize fracture reduction.

BACKGROUND In most Dutch hospitals, because of putative peri-operative swelling of the fingers, patients must remove rings before entering the operating theatre. If this proves impossible, destructive methods for removal may be required. For some patients, this might be too radical, as the risk of wearing rings may not be in proportion to the economic and emotional damage to the patient. OBJECTIVE The objective of this study was to determine whether peri-operative swelling of fingers occurs in elective surgery patients. DESIGN A prospective observational study. SETTING University Medical Centre. PATIENTS Five groups of patients: major cardiothoracic surgery, major noncardiothoracic surgery, nonmajor surgery with a minimum of one overnight stay, nonmajor surgery without overnight stay and surgery under intrathecal anaesthesia. MAIN OUTCOME MEASURE Finger swelling, as measured by the circumference of the first phalanx of the middle and ring fingers of both hands, pre-operatively and at 3, 24 and 48 h postsurgery, using a roller tape with one winding and 20-g weights in a custom-made frame. RESULTS One hundred and forty-eight patients were enrolled. Peri-operative swelling reached statistical significance in all groups and was most prominent in major cardiothoracic and noncardiothoracic surgery (maximum increases in circumference were 10.6 and 7.3%, respectively). In all groups, maximal swelling was observed 24 h postsurgery. CONCLUSION Peri-operative swelling of fingers is a common phenomenon, which is related to the extent of the surgical procedure. TRIAL REGISTRATION Netherlands Trial Register NL8066.

International audience; Objective: Finger systolic blood pressure measurement (FSBP) has been shown helpful in the detection of distal arterial insufficiency in upper limbs. This work assesses the possibility to measure FSBP on the 2nd phalanx instead of the first one in order to improve its sensitivity and to verify this would not alter the repeatability of the measurement.Methods: In this multicenter study, FSBP was measured twice in all fingers but the thumbs in consecutive systemic sclerosis patients on the first phalanx and the second phalanx in alternate order using laser-Doppler flowmetry.Results: Thirty-seven patients were enrolled. The repeatability of FSBP was excellent and similar on the first and 2nd phalanxes with coefficients of variation respectively of 7.1% and 7.6%. While the correlation between the FSBP at the two sites was fair (Pearson coefficient 0.69; p < 0.001). The agreement was poor, with a mean difference of 14 mm Hg between the two sites. Significantly higher differences were found in fingers with digital ulcers. The ROC curves showed a better prediction of the 2nd phalanx measurements.Conclusion: FSBP has an excellent repeatability whatever the site of phalanx. However, measurements performed on the 2nd phalanx have a better sensitivity for the prediction of digital ulcers.

Subungual exostosis is a painful, benign bony outgrowth projecting from the distal phalanx of the toes. The present case consists of a 16-year-old male that presented to the primary clinic with a single circumscribed painful lesion underneath the nail of the first phalanx of the left foot that recurred after surgical extraction.

IntroducciónSe realizó un estudio de cohorte prospectivo para evaluar los resultados funcionales de pacientes laborales con fracturas de falange tratadas mediante placas y establecer factores de mal pronóstico. Materiales y MétodosDesde mayo de 2012 hasta mayo de 2014, 55 pacientes laborales con fracturas de falange fueron operados consecutivamente, mediante reducción y osteosíntesis con placa y tornillos. Cuarenta y dos (39 hombres, edad promedio 30.76 años) fueron evaluados, con 68 falanges operadas (primera falange 15, segunda falange 53). El 28% de las fracturas fueron expuestas; el 38,24%, conminutas y el 11,76% tenía compromiso articular. El seguimiento promedio fue de 3.38 meses. ResultadosSe logró la consolidación ósea de todas las fracturas a los 1.8 meses. La movilidad para el pulgar (Gingrass) fue buena en dos casos y regular en uno. En los restantes dedos (Belsky), fue excelente (35%), buena (55%) y mala (9%). El puntaje DASH promedio fue de 18,53. Se observaron peores resultados en las fracturas de primera falange respecto de la segunda falange y en pacientes con más edad que en los más jóvenes, ambos con significancia estadística. No hubo relación entre el resultado y las demás variables estudiadas. Cuatro pacientes tuvieron complicaciones (9,5%). ConclusionesAl comparar nuestra serie con otras publicadas, hubo menos complicaciones y los resultados fueron similares, pero a diferencia de otros autores, no acostumbramos a retirar el material ni a realizar tenólisis ni artrólisis. Se logró la consolidación ósea en todos los casos y los resultados fueron satisfactorios en el 90% de los pacientes.

Reports of fractures in racehorses have predominantly focused on catastrophic injuries, and there is limited data identifying the location and incidence of fractures that did not result in a fatal outcome. To describe the nature and the incidence of non-catastrophic and catastrophic fractures in Thoroughbreds racing at the Hong Kong Jockey Club (HKJC) over seven racing seasons. Retrospective cohort study. Data of fractures sustained in horses while racing and of race characteristics were extracted from the HKJC Veterinary Management Information System (VMIS) and Racing Information System (RIS) respectively. The fracture event was determined from the first clinical entry for each specific injury. The incidence rates of non-catastrophic and catastrophic fractures were calculated per 1000 racing starts for racetrack, age, racing season, sex and trainer. 179 first fracture events occurred in 64,807 racing starts. The incidence rate of non-catastrophic fractures was 2.2 per 1000 racing starts and of catastrophic fractures was 0.6 per 1000 racing starts. Fractures of the proximal sesamoid bones represented 55% of all catastrophic fractures while the most common non-catastrophic fractures involved the carpus and the first phalanx. Significant associations were detected between the incidence of non-catastrophic fractures and sex, trainer and racing season. The first fracture event was used to calculate the incidence rate in this study and may have resulted in underestimation of the true incidence rate of fractures in this population. However, given the low number of recorded fracture events compared to the size of the study population, this underestimation is likely to be small. There were 3.6 times as many non-catastrophic fractures as catastrophic fractures in Thoroughbreds racing in Hong Kong between 2004 and 2011. Non-catastrophic fractures interfere with race training schedules and may predispose to catastrophic fracture. Future analytical studies on non-catastrophic racing fractures should be a priority for the racing industry. This article is protected by copyright. All rights reserved.

Emergency arthroplasty of the metacarpophalangeal joint (MCPJ) remains a valuable treatment option in patients with MCPJ destruction but may raise challenges in the event of substantial metacarpal and/or phalangeal bone defects. We report three cases of MCPJ destruction with bone defects at the proximal first phalanx treated with emergency silicone implant arthroplasty combined with bone grafting.

Objective The aim of this study was to report the technique, experience and outcome of standing arthroscopic removal of dorsal osteochondral fragmentation of the metacarpophalangeal and metatarsophalangeal joint using a 1.2-mm needle arthroscope. Study Design This was a prospective clinical study. Materials and Methods All horses referred for standing arthroscopic removal of dorsoproximal first phalanx fragments or fragments embedded in the distal aspect of the synovial plica were included. Relevant information from the cases was recorded. Follow-up was obtained by a telephone questionnaire. Results Twenty-one horses with a mean age of 4.5 years old were included. Osteochondral fragments removed were from the proximal margin of first phalanx in 18 horses (24 joints), in the synovial plica in 2 horses (2 joints) or free-floating fragment in 1 horse (1 joint). Fifteen out of twenty-one horses were unilaterally affected and 6/21 bilaterally. Fifteen out of twenty-seven affected joints were forelimbs and 12/27 hindlimbs. All articular structures within the dorsal recess of the joint were visible. The arthroscope was deemed easy to use and manoeuvre. Only minor complications occurred during the procedure. Surgery time was 15 to 20 minutes for most patients. Conclusions All fragments were successfully removed and needle arthroscopy allowed a thorough evaluation of the dorsal aspect of the joint. The technique offers an alternative for standing fetlock arthroscopy for surgeons concerned about equipment damage or portability.

A pteranodontoid pterosaur with anhanguerid affinities (MPSC R 1935) from the Romualdo Formation (Lower Cretaceous, Aptian), is described here and provides one of the few cases where the ontogenetic stage is established by comparison of skeletal fusion and detailed osteohistological analyses. The specimen comes from the Baixa Grande locality (Araripe Municipality – Ceara State) and is one of the few pterosaurs from the Araripe Basin with precise geographic and stratigraphic data. It consists of a left forelimb, comprising an incomplete humerus, metacarpal IV, pteroid and digits I, II, III, IV, including unguals. This specimen has an estimated maximized wingspan between 5.76 m and 5.84 m and a normal wingspan between 5.47 m and 5.54 m, and despite its large dimensions, is considered as an ontogenetically immature individual. Where observable, all bone elements are unfused, such as the extensor tendon process of the first phalanx and the carpal series. The absence of some microstructures such as bone resorption cavities, endosteal lamellae, an external fundamental system (EFS), and growth marks supports this interpretation. Potentially, this individual could have reached a gigantic wingspan, contributing to the hypothesis that such large flying reptiles might have been abundant during the Early Cretaceous of what is now the northeastern portion of Brazil.

This study aimed at describing anatomo-histopathological and imaging features, using computed tomography and magnetic resonance imaging on six ex vivo forelimbs of Tbourida horses, that presented a particular bone exostosis on the dorsal and proximal part of the first phalanx, diagnosed by X-ray. Gross anatomy of the bone exostosis revealed an irregular surface with poly-lobulated tissue masses showing a cauliflower shape. The diameter/depth varied from 0.5 to 5.1 cm with a mean of 3.9 ± 0.9 cm. The capsule of the metacarpophalangeal joint was hypertrophic and showed many invaginations in the inner part, in contact with the bone exostosis. Computed tomography revealed cortical and medullary continuity of the bone exostosis, with the underlying bone, and remodeling of the cortical surface of the dorsal and proximal part of the first phalanx. Magnetic resonance imaging showed an increased signal intensity of the bone exostosis on the T1- and T2*-weighted gradient fast echo. Histological examination of the bone exostosis revealed a cap of hyaline cartilage, including large foci of endochondral ossification with a base of cancellous bone surrounding marrow spaces, which confirmed the diagnosis of osteochondroma. The capsule of the metacarpophalangeal joint showed a large amount of recently formed connective tissue fibers in its inner part, interspersed with mature connective tissue. The hyperextension of the metacarpophalangeal joint during a Tbourida show, which occurs on a hard ground surface, and the use of hobbles in horse stabling are most likely responsible for the outgrowth of an osteochondroma of different shapes and sizes, and fracture complications in some cases.

IntroductionThe incidence of hyperuricemia (HUA) at younger ages is increasing along the coastal regions of China. This study aimed to compare the frequency of dual energy CT (DECT) urate crystal deposition between symptomatic hyperuricemic children and asymptomatic hyperuricemic children.Material and methodsFifty-six hyperuricemic children were divided into a Joint Group (n = 33) and an Asymptomatic Group (n = 23) according to whether they had a history of arthritis symptoms, which includes rapid onset monoarthritis with intense pain and swelling. We analyzed DECT scans of their feet from the Joint Group and the Asymptomatic Group and compared their clinical features.ResultsDECT urate deposits were observed in 28/33 (84.8%) children with symptomatic HUA and 14/23 (60.9%) with asymptomatic HUA. We found 60 areas of urate deposition in the Joint Group; DECT urate crystal deposition was most frequently observed in the first metatarsophalangeal (MTP) joint (30.0%), ankle joint (15.0%), and calcaneus (13.3%). 39 urate deposits were found in the Asymptomatic Group; DECT urate crystal deposition was most frequently observed in the calcaneus (25.6%), the first MTP joint (17.9%), and the first phalanx (15.4%).ConclusionsUrate deposition can occur in children with HUA, and these deposits occur more frequently in hyperuricemic children with a history of arthritis symptoms. Also, the urate deposition in the first MTP joint and calcaneus was more prevalent than in other joints. It is important to give more attention to hyperuricemic children.

Radiographic abnormalities (RAs) in the proximal interphalangeal (pastern) joint have several manifestations and can cause concern in young horses intended for racing. Our objective in this retrospective study was to describe the appearance and prevalence of pastern RAs in young Thoroughbreds and compare the racing outcomes of cases with sibling controls. All radiographic reports of young Thoroughbred racehorses born in 2003–2007 read by veterinarians in one Lexington, Kentucky, practice were searched for pastern RAs. Pastern RAs are described, and the 2- and 3-year-old racing records of affected horses are compared with siblings. Pastern RAs were detected in 1.3% of weanling and yearling Thoroughbred horses examined. Radiographic abnormalities detected included shallow (≤3 mm) indentations in joint contour, dorsal osteophytes or axial palmar and/or plantar enthesophytes (≥3 mm), osseous fragments, and subchondral lucencies (≥4 mm). Horses with fragments in the pastern joint tended to be less likely to start a race at 2 years of age. Horses with fragments and subchondral bone cysts in the distal first phalanx tended to be less likely to start a race at 2 or 3 years of age than control siblings. The importance of some pastern joint RAs to performance can be overemphasized; however, some RAs have a tendency to be associated with poorer racing outcomes than sibling controls and may be considered when reviewing the radiographs of young Thoroughbred racehorses.

The aim of this retrospective study was to document secondary wound healing and outcome in 20 cattle that had undergone digit amputation at the level of the distal metaphysis of the first phalanx between April 2009 and June 2015. The surgical technique for amputation was simple and fast, and granulation tissue covered the stump of the first phalanx 9 to 30 days postoperatively. Complications associated with wound healing were seen in 7 animals and in 3, a second surgery was required; all 20 cattle were discharged from the clinic. Epithelial closure was complete after a mean of 3 months (range, 2 to 7 months). The mean postoperative survival time was 15 months (range, 1 to 34 months), and 6 animals were still alive at the time of follow-up inquiry. Wound healing and long-term outcome did not differ between cattle that had undergone a more intensive aftercare regime than those with a less intensive postoperative treatment.Die Krankenakten von 20 Rindern, bei denen im Zeitraum zwischen April 2009 und Juni 2015 eine offene Zehenamputation im Fesselbein durchgeführt worden war, wurden hinsichtlich Wundheilung und Langzeitergebnis retrospektiv ausgewertet. Die Operation war stets einfach und schnell durchzuführen. Granulationsgewebe bedeckte den Fesselbeinstumpf nach 9 bis 30 Tagen postoperativ. Bei 7 Tieren trat eine Wundheilungsstörung auf, bei 3 war eine Nachoperation notwendig, jedoch konnten alle 20 Tiere nach Hause entlassen werden. Die Abdeckung mit Epithel benötigte durchschnittlich 3 Monate (2–7 Monate). Die postoperative Nutzungsdauer betrug durchschnittlich 15 Monate (1–34 Monate), wobei 6 Tiere zum Zeitpunkt der Befragung noch am Leben waren. In der Abheilung und im Langzeitergebnis bestanden keine Unterschiede zwischen einer aufwendigen und einer weniger aufwendigen Nachbehandlung.Les dossiers médicaux de 20 bovins ayant subi une amputation ouverte du doigt au niveau de la première phalange, entre avril 2009 et juin 2015, ont été rétrospectivement évalués du point de vue de la cicatrisation et des résultats à long terme. Toutes les opérations se sont déroulées de manière simple et rapide. Le moignon s’est recouvert de tissu de granulation après 9 à 30 jours. 7 animaux ont eu des problèmes de cicatrisation, 3 pour lesquels il a fallu ré-intervenir, cependant tous ont pu être renvoyés dans leur exploitation. L’épithélialisation a nécessité en moyenne 3 mois (de 2 à 7 mois). La durée d’utilisation après l’opération a été de 15 mois en moyenne (1–34 mois) et, au moment de l’étude, 6 bovins étaient encore en vie. Au niveau de la guérison et des résultats à long terme, aucune différence n’a été observée entre des soins post-opératoires plus ou moins intensifs.Le cartelle cliniche di 20 bovini sui cui era stata effettuata un’amputazione aperta del dito bovino a livello della prima falange, nel periodo tra aprile 2009 e giugno 2015, sono state valutate retrospettivamente per quanto riguarda la guarigione delle ferite chirurgiche e la prognosi a lungo termine. La tecnica chirurgica d’amputazione si è rivelata essere facile e veloce. Il tessuto di granulazione ricopriva il moncone della prima falange tra i 9 e i 30 giorni dopo la chirurgia. Sette animali hanno sviluppato delle complicazioni nella guarigione della ferita d‘amputazione, e in 3 animali è stato necessario un secondo intervento chirurgico. Tutti i 20 animali sono stati dimessi dall’ospedale. L’epitelizzazione della ferita richiedeva in media 3 mesi (2–7 mesi). La vita produttiva dell’animale in seguito all’amputazione era in media di 15 mesi (1–34 mesi). Sei animali erano ancora vivi al momento dell‘indagine. Non vi era alcuna differenza nella guarigione delle ferite chirurgiche e nella prognosi a lungo termine tra gli animali sottoposti a cure postoperatorie intensive rispetto a quelli con cure meno intensive.

La dactylite sarcoidosique est rare. Nous rapportons l'observation d'une patiente de 65 ans ayant consulte pour une tumefaction indolore du 4eme doigt de la main gauche evoluant depuis 6 ans. La radiographie de la main (A) a montre une osteolyse de la 1ere phalange du 4eme doigt avec rupture corticale sans reaction periostee. La radiographie du thorax (B) a revele des adenopathies hilaires bilaterales avec un infiltrat interstitiel. Le bilan tuberculeux etait negatif. La biopsie osseuse a montre a l'etude anatomopathologique des granulomes epithelioides et giganto-cellulaires sans necrose caseeuse. Le diagnostic de dactylite sarcoidosique etait retenu. Les principaux diagnostics differentiels regroupent les etiologies infectieuses surtout la dactylite tuberculeuse, le chondrome, la dysplasie fibreuse de l'os et le kyste osseux essentiel, la goutte et l'hyperparathyroidie primitive.

The osteometry of Neotropical camelids has drawn increasing attention over the last years given its potential to segregate species. Here we present two new osteometric standards for appendicular bones of wild camelids from the South-Central Andes (>3500 m.a.s.l.): a vicuna (Vicugna vicugna) and a guanaco (Lama guanicoe). The vicuna is from Antofagasta de la Sierra, near the margins of its present southern range. The Andean guanaco is from Sierra del Aconquija, also in NW Argentina, where this species is poorly documented. These new standards are generally consistent with other available ones. While vicunas and guanacos do not generally overlap in size, they do with their domestic counterparts: alpacas and llamas, respectively. The new measured guanaco individual is among the smallest known ones, and compares to other specimens from NW Argentina. The measured vicuna and guanaco front first phalanx, one of the most diagnostic elements, varies mainly in the breadth dimension of the articular surface and not so much in its width. The forelimb first phalanges of both camelids are about the same length, as are the rear ones and the second phalanges, unlike other studies have reported. Yet, the guanaco first phalanges are much more robust in their diaphysis. Thus, bone gracility, and not just gross maximum linear size, may be a distinctive trait in some cases. Some measures are more powerful than others to discriminate taxonomy, as has often been emphasized, although this should be used with caution until size and shape variation is further recognized. Variation recognition in wild camelid osteometry is crucial to help understand its whole range and to link it to specific conditions.

The aim of this study was to determine whether horses with a proximal palmar/plantar first phalangeal osteochondral fragment (POF) had comparable racing careers (prior to and following surgery) to horses without this fracture. A retrospective cohort study included 174 Swedish Standardbred trotters with osteochondral fragmentation in the palmar/plantar fetlock joint and 613 radiographically negative control horses presented for prepurchase examinations. Medical records and radiographs were examined for each horse. Racing data were retrieved from online Swedish Standardbred harness racing records. The effect of having a POF on race speed compared to radiographically negative control horses was examined using generalised estimating equations. Multivariable regression was used to examine differences in money earned and career longevity. The horses raced a total of 16,448 races. Horses gained speed as a function of race number. There was no difference in racing speed between horses with POF fractures that raced before surgery and control horses. Horses did not slow before, nor speed up after, surgery. There was no difference in the number of days between the last race prior to, or the first race after, the hospital visit between POF and control horses. Career earnings and lifetime starts were not significantly different between groups. The results of this study suggest the need to reevaluate the previously reported benefits of surgical intervention for POF.

Summary Reasons for performing study Proximal palmar/plantar osteochondral fragmentation of the first phalanx is a frequent radiographic finding in Standardbred horses. These lesions are routinely removed prior to the onset of a racing career with no evidence to support the timing of this surgical intervention. Objectives To determine whether horses racing before surgery slowed as they approached surgery date and whether they speeded up after surgery. To investigate the factors affecting whether a horse raced after surgery and compare the performance of horses that did and did not race before surgery. Study design A retrospective study using 193 Swedish Standardbred trotters. Methods Medical records and radiographs of each horse were examined. Racing data were retrieved from official online records. Generalising estimating equations were used to examine presurgery racing performance and determine whether this differed between horses that raced before surgery and those that had not. Multivariable regression was used to examine career earnings and number of career races. Results Horses racing before surgery neither slowed as they approached surgery, nor speeded up after surgery. Race speed of horses raced before surgery was not different from those that only raced after surgery. Racing before surgery was not associated with whether horses raced following surgery. Only horses with 3 affected legs had slower race speeds than other horses. No other horse level variables affected race speed, number of career races, career earnings or top speed. Conclusions There was no significant difference in race speed between horses that raced before surgery and those that did not. Horses did not slow down prior to surgery. Horses with 3 affected legs ran slower than those with only a single or 2 affected limbs. There was no association between timing of surgery and race speed or career longevity. The potential benefits of surgical intervention should be critically examined.

A 65-year-old male presented with rest pain for 2 weeks in the right lower extremity and he had ischemic wound in the distal part of first phalanx of right foot. He had controlled hypertension and hyperlipidemia for 10 years. There were no abnormalities in routine blood tests and hemodynamic parameters. No pulse was palpable in both lower extremities. Preoperative investigations revealed ankle-brachial index of 0.57 on the right and 0.73 on the left.

Summary Palmar/plantar osteochondral fragments (POF) in fetlock joints commonly affect and influence the athletic performance of horses. In this study, we used the Equine SNP50 BeadChip® to perform a genome-wide association study of metatarsophalangeal POF in 176 Norwegian Standardbred trotter yearlings. Putative quantitative trait loci (QTL) for medial and/or lateral POF, and medial POF only were identified on ECA1, 2, 7, 9 and 31, whereas for lateral POF, only on ECA7, 11, 27 and X. The moderate number of QTL evidences a complex inheritance and suggests various genes controlling POF development in medial and lateral locations.

In this study, the representative hand shapes for the adult Koreans were analyzed by factor analysis and cluster analyses. The analyses were conducted on the anthropometric data of 58 hand dimensions from 325 subjects having nonhomogeneous demographics. Maximum hand circumference, first phalanx length of index finger, and ratio between the two measures were the independent variables for the cluster analyses. The results of the study showed that Korean hand shapes can be divided into 2 clusters irrespective of their size for each of the male and female group. There were slight differences in component ratio of hand shapes with respect to the occupation and the age, but their differences were not statistically significant. The representative Korean hand shapes and their anthrpometric dimensions could be used to design and establish proper sizing system for various hand operating devices.

In the first part of this methodological study eleven metacarpi of 9 skeletally normal horses were examined from 4 directions by dual energy x-ray absorptiometry (DXA). The differences between the dorsopalmar-palmarodorsal and lateromedial-mediolateral (opposite sites) bone mineral density (BMD) values were found to be nonsignificant. In the second part of the study the precision of the Norland XR-26 densitometer was tested by measuring 34 metacarpal bones and 34 proximal phalanges, each of them three times, from a single direction. The difference between the individual measurements of the first phalanges and of the metacarpal bones originating from the right or the left side of the same horse were not significant, nor did the age or breed have a significant effect on BMD or bone mineral content (BMC). However, both BMD and BMC are greater in the metacarpal bones than in the proximal phalanges and are higher in geldings than in mares or to stallions, while the BMD or BMC values of mares and stallions did not differ from each other significantly. These data point to the necessity of further BMD studies in a higher number of patients.

Category: Bunion Introduction/Purpose: Abnormal motion of the first tarsometatarsal (TMT) joint disrupts the anatomic alignment of the metatarsal head, sesamoid complex and proximal first phalanx. This anatomic disruption combined with the deforming forces of the extensor hallucis longus, adductor tendons, and extensor hallucis brevis result in a hallux valgus deformity. First TMT arthrodesis or the Lapidus procedure has been described as treatment for moderate to severe hallux valgus deformities by correcting hypermobility and restoring anatomic alignment of the first ray. The aim of this study was to evaluate the safety of a percutaneous approach to the Lapidus procedure and its relation to anatomic structures. Methods: A percutaneous, modified Lapidus procedure was performed on 19 embalmed cadaveric feet under fluoroscopic guidance. The specimens were then dissected to identify the extensor hallucis longus (EHL), extensor hallucis brevis (EHB), tibialis anterior (TA), median branch of the superficial peroneal nerve (MBSPN), intermediate branch of the superficial peroneal nerve (IBSPN), deep peroneal neurovascular bundle (DPNVB) and saphenous vein (SV). The structures were localized with reference to percutaneous burr and screw placement during the procedure. Results: The tibialis anterior and intermediate branch of the superficial peroneal nerve were a mean of 3.75 millimeters (mm) and 5.08 mm from the closest burr or screw placement. The extensor hallucis longus and extensor hallucis brevis were at greatest risk under the new approach with mean distances of .92 to 4.08 mm to nearby instrumentation. The extensor hallucis longus or extensor hallucis brevis were either directly pierced or Conclusion: The minimally invasive percutaneous Lapidus arthrodesis provides a safe alternative to the traditional, open approach for patients with moderate to severe hallux valgus deformities. This may be a beneficial alternative to conventional open Lapidus procedures by minimizing soft tissue dissection. Further clinical studies must be performed to compare deformity correction, fusion rate, and complications with the modified percutaneous Lapidus procedure.

Summary Reasons for performing study: Radiography in presale examinations of TB yearlings has become standard practice in recent years. Objectives: To describe the prevalence and distribution of radiographic changes in the fetlocks, carpi, tarsi, stifles and fore feet of Thoroughbred yearlings in central Kentucky when these joints were examined as part of routine pre- and post sale evaluations. Methods: Horses subjected to radiographs included the fore (n = 1127) and hind (n = 1102) fetlocks, carpi (n = 1130), tarsi (n = 1101), stifles (n = 660) and fore feet (n = 300). Radiographic changes were categorised by location and type of change present (e.g. lucency, fragment) for each series. Results: In the fore fetlocks 1.6% had fragmentation of the proximal dorsal first phalanx and 0.5% fragmentation of the proximal palmar aspect. In the hind fetlocks 5.9% had fragmentation at the plantar aspect and 3.3% fragmentation dorsally. Lucencies, fragments or loose bodies were detected at the dorsal aspect of the distal third metacarpus in 2.8% and, at the same location on the third metatarsus, 3.2%. Most yearlings (98%) had vascular channels in the proximal sesamoid bones and irregularvascular channels (>2 mm wide or with nonparallel sides) were more common (79%) than regular vascular channels (56%). The intermediate ridge of the distal tibia was the most common location for fragmentation in the tarsus (4.4%). Conclusions: While some radiographic changes, e.g. vascular channels in proximal sesamoid bones, are very common in Thoroughbred yearlings, others, e.g. fragmentation or subchondral lucency within joints are quite rare usually affecting less than 5% of the population. Potential relevance: Veterinarians should expect to find radiographic changes in Thoroughbreds presented for examination prior to the yearling sales. The rarity of some changes thought to affect soundness or racing performance will make further invesigation of these conditions in horses without clinical signs more difficult.

Summary Reasons for performing study: Although the radiographic examination of yearlings has become commonplace at some large Thoroughbred sales, there are few data to support the decisions facing veterinarians who are asked to evaluate future racing potential. Objectives: To identify radiographic changes in the fetlocks, proximal sesamoid bones, carpi, tarsi, stifles and fore feet of Thoroughbred yearlings associated with future racing performance during ages 2 and 3 years. Methods: Radiographs from routine pre- and post sale examinations of 1162 yearlings were used to identify individual radiographic changes in sale yearlings. Starting a race, the percent of starts placed, money earned and earnings per start were used to assess racing performance and examined for associations with the radiographic changes observed. Results: Overall 946 (81%) yearlings started at least one race during ages 2 or 3 years. Fourteen of 24 (58%) yearlings with moderate or extreme palmar supracondylar lysis of the third metacarpus, 8 of 14 (57%) of those with enthesophyte formation on the proximal sesamoid bones and 19 of 30 (63%) of those with dorsal medial intercarpal joint disease started a race. The oDs of starting a race when age 2 or 3 years were 3 times lower for yearlings with these changes (P

The purpose of this study was to examine the longevity of postoperative careers and quality of performance of 461 Thoroughbred racehorses after arthroscopic removal of dorsoproximal first phalanx (P1) osteochondral fractures. Six hundred and 59 dorsoproximal P1 chip fractures were removed arthroscopically from 574 joints in 461 horses presented for lameness or decreased performance attributed to the chip fractures. Radiological and arthroscopic examination revealed an average of 1.43 fragment sites/horse, 1.15 fragment sites/joint and 1.25 affected joints/horse. Eighty-nine percent of the horses (411/461) raced after surgery and 82% (377/461) did so at the same or higher class. Fifty horses did not race after surgery. Sixty-eight percent of the horses raced in a Stake or Allowance race postoperatively. Data, previously undocumented, establishes that the quantity and quality of performance is not diminished after arthroscopic treatment of dorsoproximal P1 fragmentation. Surgical removal of chip fractures is a means of preserving the economic value of an injured Thoroughbred, allowing a rapid and successful return to racing at the previous level of racing performance.

Las medidas obtenidas a partir de huesos del esqueleto apendicular de camélidos sudamericanos han sido utilizadas en los últimos años como insumo básico para interpretar distintos aspectos relacionados con su asignación especifica, manejo de rebaños y estrategias económicas, entre otros. La forma y el tamaño de los huesos han sido interpretados como el resultado de distintas fuerzas asociadas a distintos tipos de restricciones ambientales o modificaciones producto del manejo humano. Esto es de gran importancia a la hora de interpretar la historia de la relación humano-camélido, dado que el registro material obtenido en depósitos arqueológicos posee variados restos a través de los cuales se pueden reconstruir diversas situaciones ocurridas en el pasado, tanto a nivel de paleo-economías o paleoambientes. Gran parte de estas interpretaciones se han basado en escasas medidas de estándares moderno. Por ello, este trabajo tiene como objetivo presentar datos métricos obtenidos de individuos contemporáneos de camélidos sudamericanos y que han sido considerados relevantes para su uso como material comparativo. Con esto se intenta evaluar desde una mirada crítica el uso de estándares locales y no locales para la asignación específica de muestras arqueológicas. Con el fin de evaluar la variabilidad en la forma y el tamaño de las primeras falanges se aplica el Análisis de Componente Principal y de Conglomerados (UPGMA). Para ello se toman en cuenta diferencias de tamaño, forma y procedencia geográfica con el fin de observar el peso aportado por cada variable en la conformación de esta muestra. Como resultado se concluye que el uso de ambas técnicas más la procedencia geográfica de las muestras modernas permite una definición por especie de grano más fino.

Purpose To assess radiological, clinical and functional results at 3 years’ evolution of patients subjected to surgical correction of hallux valgus and hallux rigidus by means of the Regnauld technique. Materials and Methods This is a descriptive retrospective study of 131 patients and 147 cases operated through the Regnauld technique between 2003 and 2006. One hundred and one females and 30 males were reviewed; 16 cases were bilateral. Mean age was 70 years. Mean follow-up was 3 years. Additional surgical maneuvers were used in 73 cases. Before and after surgery, an assessment was made of the patients’ clinical and functional status using both the AOFAS and a subjective scale; measurements were taken of the metatarsophalangeal (MTP), intermetatarsal (IM) and distal articular set angles (DASA). Results The degrees of correction achieved were 16.6° for the MTP angle, 2° for the IM angle and 1.7° for the DASA angle. Scores on the AOFAS scale improved from 39.6 to 85.4 points. On the subjective scale, 25% of cases rated their result as excellent, 68% as good and 2% as poor. As far as complications were concerned, there were 4.7% recurrences, 2% instances of moderate pain with no cases of hallux rigidus, hallux varus or infection. There were no reoperations. Conclusions The technique makes it possible to shorten the first phalanx, correct rotations, reduce the MTP and DASA angles, preserve the joint's congruence and integrity los MTPA y DASA and regain its function.

The osteotomy of the first phalanx of the great toe has been described by Akin as early as in 1925. Since that time this technique and its modifications have been widely in clinical use and were mostly described as additional correction manoeuvre combined with standard metatarsal osteotomies like scarf or chevron osteotomies. As the so-called Akin osteotomy mostly is used as a surplus procedure scientific evaluation of this osteotomy itself can rarely be found. Different fixation techniques like k-wire-, wire, staple-thermo-staple-or screw-fixations are in use. The result are the follow up of 135 patients out of more than 200 operated patients treated with forefoot realignemant procedure because of hallux valgus with a follow up of at least 1 year.

Objective—To determine clinical and diagnostic imaging findings in young horses with osteochondral fragments involving the dorsomedial aspect of the proximal interphalangeal (PIP) joint. Design—Retrospective case series. Animals—6 horses. Procedures—Medical records were reviewed. Follow-up information was obtained through telephone conversations with owners or trainers or by examining race records. Results—Horses were between 1 and 4 years old. Three had bilateral osteochondral fragments in the forelimbs (n = 2 horses) or hind limbs (1). Radiographically, all but 1 fragment seemed to originate from the dorsomedial aspect of the distal end of the first phalanx. Fragment size ranged from 6 × 9mm to 11 × 21 mm. Three horses had lameness referable to the region of the affected joint; the other 3 horses did not have clinical signs referable to affected PIP joints. Two horses were euthanized shortly after diagnosis at the owners' request because of concerns that the horses would be unsuited for their intended athletic use. Two of the 3 horses in which fragments were incidental findings were able to race successfully, although 1 received intra-articular corticosteroid treatments; the third was retired because of unrelated orthopedic problems. Conclusions and Clinical Relevance—Results suggested that osteochondral fragments involving the dorsomedial aspect of the PIP joint may be an incidental finding in young horses. Given the absence of clinical signs in 5 of 9 affected joints and the fact that 3 of 6 horses were affected bilaterally, a developmental origin of the fragments was suspected.

Medicinal leeches are known to inject more than 100 bioactive substances in the tissue whilst sucking blood. They are being successfully used for the treatment of diseases and symptoms, especially in plastic surgery. We report the case of a 7-year old boy, who had lost the first phalanx of the middle finger of the right hand after an accident. The detached digit was replanted in the plastic surgery clinic, and treated within a period of 15 days with medicinal leeches (Hirudo medicinalis). Soon after the initiation of the hirudotherapy, the revascularisation of the re-attached phalanx, as well as the resolving of tissue oedema and pain was observed. Turkish physicians should be aware of the advantages of hirudotherapy in plastic and reconstructive surgery, especially in cases of detached digits and flaps.

The risk of fatal distal limb fractures in thoroughbreds racing in the UK was calculated and shown to vary considerably between the different types of race. Flat turf racing was associated with the lowest risk (0.4 per 1000 starts) and national hunt flat racing was associated with the highest risk (2.2 per 1000 starts). The types of fracture were classified by detailed radiographic and postmortem examinations of all the cases recorded over two years, and the distribution of the different types of fracture in the five main types of racing was examined. Overall, lateral condylar fractures of the third metacarpus were the most common, and they were also the most common in national hunt-type races (hurdle, steeplechase and national hunt flat races). In all-weather flat racing biaxial proximal sesamoid fractures were most common, and in turf flat racing fractures of the first phalanx were most common. The risk of fractures of more than one bone was greater in national hunt-type races.

AIM Popularity of resection-interposition-arthroplasty is decreasing due to more specific procedures in hallux valgus surgery. Therefore we analysed the influence of preoperative parameters and technical details to reevaluate this classic procedure. METHOD In a retrospective, clinical and radiological long-term study (mean 9.6 years) 62 operated feet were examined and the assessed parameters were analysed, with focussing on the negative results. For comparison negative and positive outcome was defined by a hallux-metatarsal-interphalangeal scale (HMIS) and a subjective rating score (SRS). RESULTS Negative outcome, 34 % according to HMIS and 24 % according to SRS, was characterised in both scoring systems by pain (visual analogue scale), functional deficit (walking distance) and negative cosmetic result (hallux-valgus-angle) (p < 0.01 each). As negative predictive factors we observed an early degenerative arthritis (p < 0.05, HMIS) and a positive metatarsal index (p < 0.05, SRS). Unsatisfactory results were related to an increased resection level of the first phalanx when compared with good results (p < 0.01 in HMIS, p < 0.05 in SRS). CONCLUSION Resection-interposition arthroplasty in symptomatic hallux valgus seems an inadequate procedure in cases with early arthritis or a positive metatarsal index. However, in accordance with these criteria good results are probable, if resection of the first phalanx does not exceed one third of length.

Background/aims: The study of patterns of fingerprints is important in anthropology and medical genetics, chiefly because of their diagnostic usefulness. In the present work, we studied the frequencies of various types of skin ridges of the first phalanx in patients with eczema, psoriasis and alopecia areata. Methods: In a double-blind case-control study, we determined the frequencies of fingerprints in 551 patients (240 cases with eczema, 164 cases with psoriasis and 147 cases with alopecia areata) as well as in general population of Hamadan City (control group: 188 males and 529 females). We compared the frequencies between various fingers, hands and sexes in all three case groups as well as between case groups and control group. Results: The frequencies of various types of fingerprints are presented in some tables. The results showed that frequencies are not statistically different according to types of fingers, hands (left or right) and sexes as well. But they are significantly different in various case groups and between case groups and control group. Conclusions: We can conclude that frequencies of various patterns of skin ridges differ in eczema, psoriasis and alopecia areata from normal population.

Objective—To evaluate a modified digital imaging technique for quantitative assessment of the grade of osteoarthritis across the proximal articular surface of the first phalanx in horses. Sample Population—6 metacarpophalangeal (fetlock) joint specimens from 6 horses with various stages of osteoarthritis. Procedure—First phalanx specimens, together with 4 gray scale reference calibration targets, were positioned in a bath with the proximal articular cartilage surface submerged in saline (0.9% NaCl) solution. Digital images were obtained from the articular surface before and after staining with Indian ink. Computer-controlled gray level analysis of the nonstained and Indian ink-stained cartilage surfaces and gray scale reference calibration targets was performed by use of the mean pixel value (based on 255-gray scale). An increase in the mean pixel value after staining was used to calculate the cartilage degeneration index (CDI). Results—The CDI of the proximal articular cartilage surface of the first phalanx specimens ranged from 9.2 ± 5.7 (early stage osteoarthritis) to 41.5 ± 3.6% (late stage osteoarthritis). The effect of repeating the measurement 6 times in nonstained (including repositioning) and stained specimens (including repositioning and restaining) was not significant. Up to 10 measurements of nonstained specimens could be made without refreshing the bath solution. In stained specimens, mean gray level increased significantly after the sixth measurement. Conclusion and Clinical Relevance—The modified digital imaging technique allowed quantitative assessment of cartilage degeneration across the articular cartilage surface. The CDI is the first quantitative measure for osteoarthritis-induced cartilage degeneration over an entire joint surface in horses. (Am J Vet Res 2003;64:83–87)

As the most conspicuous histologic feature of normal adult articular cartilage, the tidemark begs for our understanding. In their original description, Fawns and Landells likened this landmark to the irregular line of debris that is left on a sandy beach by the high point of a now-receding tide1 (Figure 1A). Such tidemarks comprise a mixture of marine flotsam, and so contain a variety of stuff from the sea. If the tidemark of cartilage is aptly named, as I believe it to be, it too should be a passive deposit of debris, but what are its constituents and where do they come from? Figure 1. A. A tidemark on the beach at Manzanita, Oregon, USA. B. Mallory aniline blue stain of the tidemark in a normal human metacarpal phalangeal (MCP) joint. Note that cell nuclei and the tidemark share orange staining not seen in the matrix. This image, as well as those that follow, was from an older subject without known rheumatic disease whose body was donated for anatomic study through the willed body program at the University of Washington. C and D. Von Gieson stains of first phalanx base and metacarpal head from 1 MCP joint. The trilaminar structure seen here was stressed by Lyons, et al 10. Its basis remains unexplained. The tidemark duplication seen in the metacarpal head is generally considered to be evidence of osteoarthritis. E. Mowat stain. Granularity of the tidemark (? apoptotic bodies) was described in the classic report of Fawns and Landells1. F. Masson trichrome stain. Again note that, as in all sections, … Address correspondence to Dr. P.A. Simkin, Division of Rheumatology, Box 356428, Department of Medicine, University of Washington, Seattle, Washington 98195, USA. E-mail: psimkin{at}uw.edu

Equine carpal and fetlock joints have been the most frequent sites for arthroscopic surgical procedures and were the initial locations where techniques were developed. The primary indication for surgical treatment of chip fragments in the equine athlete is normalization of the interior of the joint and prevention of osteoarthritis. Osteochondral chip fragments in the equine carpus are common in racehorses. The overall success rate with arthroscopic removal is 68.1% racing at a level equal to or better to preinjury in 88.6% starting at least one race. Depending on the degree of articular cartilage and bone damage, the prognosis for return to racing at a level equal to or better than preinjury ranges from 71% to 54%. Success rate with proximodorsal first phalanx chip fragments is 83.5% return to their previous use; 73.6% return to racing at the same level of performance. Other fracture fragments operated in the fetlock joint include, plantar or palmar first phalanx fragments, osteochondritis dissecans fragments from the sagittal ridge and distal dorsal metacarpus as well as apical, abaxial and basal sesamoid fragments. The success rates with these various arthroscopic surgeries are also presented.

Introduction The most common form of acute purulent inflammation of the tissues of the fingers is periungual felon or paronychia when inflammation begins at the edge of the nail plate due to minor skin injuries. During the development process may complete defeat periungual roller and be fiber, which is accompanied by severe pain syndrome and disability of the patient. The main conventional treatment - surgery. In my clinical practice we apply the hirudotherapy (medicinal leech therapy), which effectively eliminates the inflammatory process and allows you to avoid surgery. Here is the most typical clinical example. Case description The patient, 40-year-old, of paronyhii the first phalanx of the 4th finger of the right hand developed as a result of hangnails. At the time of treatment was the third day of the disease: the patient is concerned about increasing constant severe bursting pain in the damaged finger, last night joined the growing attacks of acute pulsating pain. Objectively: state of moderate severity, the patient is partially able-bodied. Phalanx of the 4th finger of the right hand: you can clearly see the tissue with translucent purulent contents, in the form of a strip of outer inner (medial) edge of the nail plate, surrounded by a tense, hot, swollen and congested skin. Results At the session of hirudotherapy oversight of two medical leeches on the second phalanx of the finger, one on the outer and inner side. Exposure to the full saturation (24 and 55 min). After self falling away of the leeches, the bites of the superimposed hot wet cotton pads. During the inspection a day after the consoles leeches: the pain is not bothering, it is noted moderately severe arching unpleasant sensations in the region of the inner edge of the nail plate. Plot purulent inflammation eliminated, it remains moderately severe swelling and redness directly around the site of inflammation. During the inspection on the second day after the treatment with leeches - complaints patient does not show any edema and hyperemia of the skin on the former site of inflammation is not observed. Observation on the third day after treatment - inflammation eliminated, the function of the finger is fully restored. Thus, for the elimination of the inflammatory process and full recovery of the patient required one session of treatment with leeches, two leeches and two days of clinical observations.

In all surgeries with the patient standing under chemical and physical restraint, patient compliance is of the utmost importance. All fractures of the third metacarpal or metatarsal condyles and sagittal fracture of the first phalanx are not amenable to internal fixation with the horse standing, and young unhandled horses may not have a suitable disposition for standing surgical treatment of septic pedal osteitis, or implantation and removal of transphyseal screws. Previous operator experience in performing the procedure or technique under general anesthesia is beneficial. Appreciation of appropriate topographic anatomic landmarks is important, and intraoperative radiographic control is useful.

Interaction of simultaneous tactile input at two finger sites in primary (SI) and secondary somatosensory cortex (SII) was studied by whole-head magnetoencephalography. Short pressure pulses were delivered to fingers of the right and left hand at an interstimulus interval of 1.6 s. The first phalanx of the left digit 1 and four other sites were stimulated either separately or simultaneously. We compared four sites with increasing distance: the second phalanx of left digit 1, left digit 5, and digits 1 and 5 of the right hand. The temporal evolution of source activity in the contralateral SI and bilateral SII was calculated using spatiotemporal source analysis. Interaction was assessed by comparing the source activity during simultaneous stimulation with the sum of the source activities elicited by separate stimulation. Significant suppressive interaction was observed in contralateral SI only for stimuli at the same hand, decreasing with distance. In SII, all digits of the same and the opposite hand interacted significantly with left digit 1. When stimulating bilaterally, SII source waveforms closely resembled the time course of the response to separate stimulation of the opposite hand. Thus, in bilateral simultaneous stimulation, the contralateral input arriving first in SII appeared to inhibit the later ipsilateral input. Similarly, the separate response to input at two unilateral finger sites which arrived slightly earlier in SII dominated the simultaneous response. Our results confirm previous findings of considerable overlap in the cortical hand representation in SII and illustrate hemispheric specialization to contralateral input when simultaneous stimuli occur bilaterally.

To address possible differences in the resorbability of cranial and postcranial bone, slices of equine frontal bone and leg (first phalanx or third metacarpus) were seeded with embryonic chick bone cells and cultured for 20-24h. After removing the cells and drying the specimens, the areas and volumes of more than 800 resorption pits in each set were measured using a video-rate reflection confocal microscope system. Relative mineralization densities were determined by quantitative electron backscattering analysis. The mean mineralization density was greater in the leg bone, but the mean depths for resorption pits in frontal bone were smaller (median volume/area ratios, experiment 1 and experiment 2: 1.98 microm frontal and 3.79 microm leg versus 2.70 microm and 4.20 microm, respectively; P0.0001, Mann-Whitney), even though the areas were greater in the frontal (medians, 286 microm2 and 324 microm2, versus 242 microm2 and 201 microm2; P0.0001). This study has shown a difference between cranial and postcranial equine bone in the shape and size of resorption pits formed in vitro. Overall, it has shown that cranial bone may be resorbed at least as readily as postcranial bone. This result is counter to the clinical impression that cranial bone has a greater staying power than postcranial bone when used as a grafting material.

Regional anesthesia of a single finger is commonly achieved by the traditional ring block, which requires at least two painful injections in the digit. Single injection digital block techniques have been described to avoid this problem. Among these, the subcutaneous technique described by Harbison appears to be safe and to allow most procedures to be carried out with good tolerance.A prospective study was designed to evaluate the results of the subcutaneous technique in terms of patient tolerance, distribution of anesthesia and efficiency.All blocks were performed by a single investigator. A visual analog scale was used to evaluate pain associated with the injection. Prick testing was used to evaluate the quality of anesthesia at the volar and dorsal aspects of the phalanxes. Tolerance to the surgical procedure and the need for additional injections were also recorded.This technique allowed surgery to be performed without complementary injection most of the time and was very well tolerated. The dorsum of the proximal phalanx, however, was unpredictably included in the anesthetized territory.The subcutaneous single injection digital block is safe, efficient and easy to perform. It allows the treatment of all conditions on the volar aspect of the finger and on the dorsal aspect of the distal and middle phalanxes. For surgery on the dorsal aspect of the proximal phalanx, a combined single injection technique or a supplementary dorsal block should be used.L’anesthésie régionale d’un seul doigt se réalise généralement par le traditionnel bloc en bague, qui exige au moins deux injections douloureuses. Il semblerait que les techniques d’anesthésie à une seule injection résoudrait le problème. Parmi celles-ci, la technique d’injection sous-cutanée décrite par Harbison serait sûre tout en permettant à la plupart des interventions d’être bien tolérées.Étude prospective visant à évaluer les résultats de la technique d’injection sous-cutanée au regard de la tolérance, de l’étendue de l’anesthésie et de son efficacité.Toutes les anesthésies en bloc ont été effectuées par le même chercheur. L’intensité de la douleur associée à l’injection a été évaluée à l’aide d’une échelle visuelle analogue. Un test par piqûre a servi à évaluer la qualité de l’anesthésie sur les faces antérieure et postérieure des phalanges. La tolérance à l’intervention chirurgicale et le besoin d’injections supplémentaires ont également été notés.Dans la plupart des cas, l’intervention a été très bien tolérée, sans recours à une injection supplémentaire d’anesthésique. Toutefois, le dos de la phalange proximale était compris de façon imprévisible dans le territoire anesthésié.L’anesthésie du doigt par une seule injection sous-cutanée s’avère simple, sûre et efficace. Elle permet de traiter tous les troubles sur la face antérieure du doigt ou sur la face postérieure des phalanges médianes et distales. Quant aux interventions pratiquées sur la face postérieure des phalanges proximales, il faudrait recourir à une technique mixte à une seule injection ou à une anesthésie complémentaire du dos du doigt.