Search

Introduction. Transmetacarpal amputation (TA) distal to the superficial palmar arch is one of the most difficult procedures in replantation surgery because it requires the reconstruction of blood vessels, muscles, tendons, bones, nerves, and s kin. We present a case of a patient with TA of the left hand and microsurgical replantation. Case report. A 23-year-old left-hand dominant male worker with a positive smoking history sustained TA from a radial saw blade and avulsion injury of the palmar side of the thumb with no other apparent injuries. The time between the amputation and replantation was 4 hrs. The patient sustained the amputation at the level of metacarpophalangeal joints. The successful replantation included: wound and intrinsic muscles debridement, microvascular anastomoses of the blood vessels, internal fixation of the metacarpal bones, neurorrhaphy, tenorrhaphy, and wound closure with local skin flap for thumb soft tissue defect. The patient was followed for seven years postoperatively. Conclusion. The replantation surgery requires a specialized department and well-educated teams of hand microsurgeons, orthopedic surgeons, and anesthesiologists. The most important factors that influenced the outcome after the replantation in the presented case included the type and level of injury, ischemia time, comorbidities, age, smoking history, and physical therapy. [ABSTRACT FROM AUTHOR]

Background: Fifth metacarpal neck fractures (FMCNFs) are common among paediatric patients. Complications include reduced metacarpophalangeal (MCP) range of motion and grip strength, which impede the hand's functional abilities. Various management options are available, but indications are not standardised. This systematic review aims to assimilate all available evidence on the management of paediatric FMCNFs to determine appropriate treatment pathways. Methods: PubMed (Medline), EMBASE, Scopus and Google Scholar were used to identify evidence pertaining to the management of these fractures. Results: Ten studies were identified, involving 237 patients with a mean age of 14.4 years (Range 9–17). Ninety percent of patients were male. Sixty-one (26%) patients, with an average fracture angulation of 27° (Range 16°–33°) and no rotational deformities, were managed with immobilisation alone. These patients returned to normal metacarpophalangeal range of motion and grip strength. Fifty-four (23%) patients, with an average fracture angulation of 42.7° (Range 33°–54°), were managed with fracture reduction and immobilisation. This technique did not yield sustained reduction of fractures with significant angulation or rotation after intervention. One hundred twenty-two (51%) patients, with an average fracture angulation of 48.3° (Range 30°–58°) and including cases of malrotation, were managed with fracture reduction and surgical fixation. These patients experienced good functional outcomes. Conclusions: This review suggests paediatric FMCNFs can be safely managed with immobilisation alone when there is an absence of rotational deformity and an angulation of < 30°. In the case of a higher fracture angulation or rotational deformity, fracture reduction and surgical fixation is an appropriate method of management. [ABSTRACT FROM AUTHOR]

Objective: Hamatometacarpal fracture-dislocations (HMFD) are rare hand injuries resulting from axial loading. This study aimed to present the clinical presentation and outcomes of HMFD, which is rare and likely to be missed in the emergency department. Methods: A retrospective analysis of 15 patients who underwent surgical intervention for HMFD between 2015 and 2023 was conducted. At the last follow-up, the presence of union, malunion, residual subluxation, and Kellgren-Lawrence grading scale were evaluated. Time to diagnosis, time to return to work (RTW), level of difficulty in working, grip strength, and disabilities of the arm, shoulder, and hand (DASH) scores were evaluated. Results: The mean patient age was 30.6 years. Most injuries (93.3%) were due to punching. Open reduction was performed in 73.3% of cases. No complications were reported during the mean of 52.3-month follow-up. Open reduction was associated with a lower DASH scores. Hand-intensive work was correlated with a longer time to RTW and higher difficulty to RTW. Delayed diagnosis was correlated with worse grip strength, but not with significantly different DASH scores. Conclusion: HMFD is a rare hand injury that presents as a diagnostic challenge. Achieving anatomical reduction is crucial for restoring hand function. Therefore, comprehensive treatment strategies should be planned individually, taking into account patients's injury patterns. [ABSTRACT FROM AUTHOR]

Simple Summary: We report a rare congenital deformity of the phalanges of the forelimbs in a 3.5-month-old mixed-breed dog, causing lameness. A unilateral ectrodactyly with hypoplastic polydactyly of the third digit was surgically treated by partial amputation of excess tissue and stabilisation of the proximal metacarpal bones with a cortical screw in compression and a K wire. Three months after the initial surgery, metal fatigue failure necessitated the removal of the implant; however, the dog achieved near physiological limb function three months thereafter. This single case report adds to the knowledge of congenital limb deformities and their treatment options. Objective: To describe a rare congenital deformity of the phalanges and the surgical details and outcome in a dog with ectrodactyly combined with polydactyly. Study design: Single case report. Animal: A 3.5-month-old male intact mixed breed dog with forelimb lameness and paw malformations. Methods: Surgery was performed on a dog with a congenital limb deformity consisting of resection of the extra bone and soft tissue structure to prevent further subluxation of the remaining metacarpals. Stabilisation consisted of a cortical screw in compression and a K wire across the proximal metacarpals. Results: Postoperative radiographs showed adequate implant positioning and good reduction of the proximal metacarpal row. At six weeks, the dog showed improvement in limb function and weight bearing. Major complications occurred at twelve weeks, and revision surgery with implant removal was required. At six months, the dog showed near normal range of motion and no lameness. Conclusions and Clinical Relevance: The decision to perform surgery on a dog with limb deformity resulted in an almost physiological gait, and the dog showed no abnormalities in daily life. This report adds to the literature on congenital limb deformities by describing the combination of ectrodactyly and polydactylism in a canine species, including the surgical approach and outcome. However, the optimal management of this heterogeneous condition is currently unclear. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Bone age is a more accurate assessment for biologic development than chronological age. The most common method for bone age estimation is using Pyle and Greulich Atlas. Today, computer-based techniques are becoming more favorable among investigators. However, the morphological features in Greulich and Pyle method are difficult to be converted into quantitative measures. During recent years, metacarpal bones and metacarpophalangeal joints dimensions were shown to be highly correlated with skeletal age.Purpose: In this study, we have evaluated the accuracy and reliability of a trained neural network for bone age estimation with quantitative and recently introduced related data, including chronological age, height, trunk height, weight, metacarpal bones, and metacarpophalangeal joints dimensions.Materials and Method: In this cross sectional retrospective study, aneural network, using MATLAB, was utilized to determine bone age by employing quantitative features for 304 subjects. To evaluate the accuracy of age estimation software, paired t-test, and inter-class correlation was used.Results: The difference between the mean bone ages determined by the radiologists and the mean bone ages assessed by the age estimation software was not significant (p Value= 0.119 in male subjects and p= 0.922 in female subjects). The results from the software and radiologists showed a strong correlation -ICC=0.990 in male subjects and ICC=0.986 in female subjects (p< 0.001).Conclusion: The results have shown an acceptable accuracy in bone age estimation with training neural network and using dimensions of bones and joints.

Background: Repetitive microtrauma can lead to trapezoid and second metacarpal stress fractures in racket sport players. Nontraumatic trapezoid stress fractures are rare and difficult to diagnose. To our knowledge, only 3 cases had been reported as of May 2023. We report the fourth case of a nontraumatic sports-related trapezoid stress fracture and only the second case in a tennis player. Case Report: A 29-year-old professional and right hand-dominant male tennis player presented with right hand and wrist pain for 3 weeks. He complained of dorsal wrist tenderness proximal to the base of the second metacarpal that was exacerbated by extension of the index finger. Initial radiographswere normal, butmagnetic resonance imaging of thewrist showed a stress fracture of the trapezoid bone and base of the second metacarpal. The patient was treated conservatively with a wrist brace, cessation of sports activities, and modification of his training routine. The patient was asymptomatic at 1-year follow-up. Conclusion: This case highlights the relationship between trapezoid and second metacarpal stress fractures in athletes. A high index of suspicion for trapezoid stress fractures should be maintained and included in every differential diagnosis for athletes, especially racket sport players presenting with wrist pain. To avoid future injuries, clinicians should not only treat the fracture but also address the risk factors predisposing to this injury. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Bone age is a more accurate assessment for biologic development than chronological age. The most common method for bone age estimation is using Pyle and Greulich Atlas. Today, computer-based techniques are becoming more favorable among investigators. However, the morphological features in Greulich and Pyle method are difficult to be converted into quantitative measures. During recent years, metacarpal bones and metacarpophalangeal joints dimensions were shown to be highly correlated with skeletal age. Purpose: In this study, we have evaluated the accuracy and reliability of a trained neural network for bone age estimation with quantitative and recently introduced related data, including chronological age, height, trunk height, weight, metacarpal bones, and metacarpophalangeal joints dimensions. Materials and Method: In this cross sectional retrospective study, aneural network, using MATLAB, was utilized to determine bone age by employing quantitative features for 304 subjects. To evaluate the accuracy of age estimation software, paired t-test, and inter-class correlation was used. Results: The difference between the mean bone ages determined by the radiologists and the mean bone ages assessed by the age estimation software was not significant (p Value= 0.119 in male subjects and p= 0.922 in female subjects). The results from the software and radiologists showed a strong correlation -ICC=0.990 in male subjects and ICC=0.986 in female subjects (p< 0.001). Conclusion: The results have shown an acceptable accuracy in bone age estimation with training neural network and using dimensions of bones and joints. [ABSTRACT FROM AUTHOR]

Background: Fracture of the fifth metacarpal of the hand is due to trauma to the clenched fist. The non-displaced fracture can be treated by splinting and immobilization, but fracture dislocation requires individualized management to ensure the return of function. The Jahss maneuver for reduction of volar displaced metacarpal neck fractures involves flexion of the metacarpophalangeal and proximal interphalangeal joint at 90°, with the proximal phalanx used to reduce the metacarpal head. This report is of a 25-year-old male Italian pianist with a displaced fifth metacarpal neck fracture successfully treated by reduction using the Jahss maneuver and K-wire attachment of subchondral bone to the metacarpal. Case Report: A pianist presented with a trauma to his right hand due to punching a wall. Radiograph images demonstrated an angulated, displaced right fifth neck fracture. A specific approach was decided, considering the complexity of the musical movements and the patient's performance needs. After fracture's reduction by the Jahss maneuver, 2 retrograde cross-pinning K-wires were inserted at the subchondral bone of the metacarpal head. Healing under splinting was uneventful, and the K-wires were removed after 45 days. At 4 months after surgery, the patient had complete recovery of both range of motion and strength. Conclusions: Our technique avoided piercing the metacarpophalangeal joint capsule, preventing extensor tendon damage, dislocation, instability, and pain and retraction of the extensor cuff. This novel mini-invasive technique successfully achieved early metacarpophalangeal joint motion, joint stability, and complete recovery of movements in all planes. [ABSTRACT FROM AUTHOR]

Objective: To describe a rare congenital deformity of the phalanges and the surgical details and outcome in a dog with ectrodactyly combined with polydactyly. Study design: Single case report. Animal: A 3.5-month-old male intact mixed breed dog with forelimb lameness and paw malformations. Methods: Surgery was performed on a dog with a congenital limb deformity consisting of resection of the extra bone and soft tissue structure to prevent further subluxation of the remaining metacarpals. Stabilisation consisted of a cortical screw in compression and a K wire across the proximal metacarpals. Results: Postoperative radiographs showed adequate implant positioning and good reduction of the proximal metacarpal row. At six weeks, the dog showed improvement in limb function and weight bearing. Major complications occurred at twelve weeks, and revision surgery with implant removal was required. At six months, the dog showed near normal range of motion and no lameness. Conclusions and Clinical Relevance: The decision to perform surgery on a dog with limb deformity resulted in an almost physiological gait, and the dog showed no abnormalities in daily life. This report adds to the literature on congenital limb deformities by describing the combination of ectrodactyly and polydactylism in a canine species, including the surgical approach and outcome. However, the optimal management of this heterogeneous condition is currently unclear.

Purpose: Multiple metacarpal shaft fractures are higher-energy injuries than single metacarpal shaft injuries and are considered relatively unstable because reduction is easily lost after splinting. However, few studies have been published on operative treatment because these fractures are rare. The aim of this study was to analyze the characteristics of this rare type of fracture and report the surgical outcomes. Methods: Medical records of patients with adjacent metacarpal shaft fractures who underwent surgery were retrospectively analyzed. In total, 20 cases were included in this study. A single longitudinal incision was made at the middle of the web space of affected metacarpal bones. Fractures were fixed using a plate and screws. The clinical results were evaluated by determining the metacarpophalangeal joint range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and hand grip strength at the final follow-up. Results: Among the patients included, there were fifteen male and five female patients. Their mean age was 41.2 years. The average range of motion of metacarpophalangeal joints was 78.1°. The average DASH score was 6.5. The average hand grip strength was 92.4% compared to the unaffected side. The mean time to union was 7.5 weeks. There were no cases of complications, such as soft tissue infections, joint stiffness, or extensor tendon injuries. Conclusion: Plate fixation through a single incisional approach performed for adjacent metacarpal shaft fractures showed satisfactory results. This could be a recommendable approach for two unstable adjoining metacarpal shaft fractures. [ABSTRACT FROM AUTHOR]

Purpose: Understanding the configuration and characteristics of the comminuted fifth metacarpal neck fractures is essential for successful operative treatment, especially for antegrade intramedullary Kirchner wire (K-wire) fixation. This study aimed to investigate the characteristics and shape of comminuted fragments in fifth metacarpal neck fractures and suggest the appropriate K-wire position. Methods: Forty-one cases of fifth metacarpal neck fractures operated from January 2010 to April 2022 were enrolled in this study. The length and width of the comminuted fragments were measured, as well as the distance from the articular surface of the fifth metacarpal head to the comminuted fragment (Da-c) and the distance from the articular surface to the proximal end of the metacarpal head (Da-h). The location of the comminuted fragments was categorized in terms of four quadrants: dorsal-ulnar (DU), dorsal-radial (DR), palmar-radial, and palmar-ulnar. Results: Among 41 patients with fifth metacarpal neck fractures, comminuted fracture fragments were observed in 35 cases (85.4%). The mean length and width of the comminuted fragments were 7.5±2.3 mm and 3.2±0.8 mm, respectively. The comminuted fragments were on the dorsal aspect of the fracture in all cases; 27 (77.1%) in the DU quadrant and 8 (22.9%) in the DR quadrant. The mean Da-c and Da-h were 5.3±1.6 mm and 10.9±1.5 mm, respectively. Conclusion: To ensure stable K-wire fixation, it is essential to identify the location and characteristics of the comminuted fracture fragments before surgery and subsequently choose an appropriate K-wire position. [ABSTRACT FROM AUTHOR]

Background: Bilateral metacarpal hand injuries are extremely rare, but probably represent the most difficult reconstructive challenge in hand surgery. Methods: We discuss the various options for metacarpal hand reconstruction, including the Krukenberg procedure, bionic prostheses, multiple toe-to-hand transfers, and possibly hand transplantation, and present the long-term functional outcomes, gait analysis, and psychological evaluation after a 4-stage reconstruction of bilateral metacarpal hands in a child using 6 toe-to-hand transfers-bilateral great toe transfers to reconstruct both thumbs and bilateral combined second-third monobloc transfers to reconstruct 2 fingers in each hand. Results: Reconstruction of bilateral metacarpal hands with 6 toe transfers yielded excellent functional results and patient satisfaction. Conclusions: Bilateral metacarpal hand injuries result in a devastating functional deficit and a major psychological impact. Multiple toe transfers (4, 5, or 6) provide an excellent reconstructive outcome with acceptable donor site morbidity.

OBJECTIVES: The objectives of this study are to develop gestational age-specific growth curves for fetal third metacarpal and phalangeal lengths and to determine if fetal hand proportion is established in utero. METHODS: This prospective cross-sectional study used 2D ultrasound across gestational ages 12 to 39 weeks to evaluate the third fetal metacarpal and phalangeal measurements. Gestational age-specific reference growth curves were developed. Associations between continuous variables were assessed using Spearman correlations (rs ) and restricted cubic splines. A nonlinear biologic regression model was used to predict metacarpal and phalangeal lengths as a function of gestational age. Measurements derived from five cases of thanatophoric dysplasia were used to determine if brachydactyly could be objectified. RESULTS: Fetal metacarpal and phalangeal lengths are highly correlated across gestational age (rs  = 0.96, P

Background. The medial femoral condyle (MFC) flap is a versatile option for the reconstruction of small osseous defects; however, its use in reconstructing phalanges and metacarpal bones in the hand has not been widely reported. Patients and Methods. Between 2013 and 2020, 13 consecutive patients with osseous defects of phalanges or metacarpals reconstructed with free MFC flaps were included. Demographics, defects characteristics, flap design, and clinical course were recorded. Outcomes measured included time to bone healing, total active motion percentage (TAM%), pulp pinch power, and patient-reported outcome measures using the Michigan Hand Questionnaire (MHQ) and National Health Service (NHS) friend and family test. Results. A total of 14 MFC flaps were used to reconstruct 16 bone defects. The median age was 32 (range, 21–36) years. A total of 9 phalanges and 7 metacarpals were reconstructed. The median bone gap size was 1.5 cm (range, 1.2–2.1 cm), and most were segmental bone defects (14/16). Bone union was achieved in all the cases within a median of 7.3 (5.5–9.5) weeks. Median pulp pinch power was 71% (67–80) of contralateral side, and the median TAM% was 76% (67–76). The affected hands scored lower than the unaffected hands in MHQ total scores (p=0.109), function (p=0.002), and satisfaction (p=0.024) domains. However, all patients or patient caregivers were likely to recommend the procedure if someone would need similar care or treatment. Conclusions. In this series, the free MFC proved to be a reliable method for bone reconstruction of the hand, providing also a one-stage solution for multiple bone defects in conjunction with soft tissue loss. [ABSTRACT FROM AUTHOR]

Abstract Objeticve To compare the range of motion (ROM), return-to-work time, visual analogue score (VAS), disability of the arm, shoulder, and hand (QuickDASH), and radiographic outcomes of two methods of definitive internal fixation in active patients with boxer’s fractures, operated in the first week. Methods This was a prospective, randomized trial, in which 50 patients, with a mean age range of 18 to 40 years old, were randomized and treated to definitive intramedullary fixation using 2 headless screws (n = 20) or bouquet (2 or 3 Kirschner wires) (n = 20). The patients were assessed on return-to-work time, ROM, patient reported QuickDASH outcome, VAS, and radiographic evaluation at 6 months. Results At 6 months, there were no differences between the two groups in terms of ROM, postoperative pain (VAS), or QuickDASH score. The overall complication rate was 4.76% in the screw group, compared with 5% in the bouquet-fixation group. Conclusions In the treatment of the active patients with unstable boxer’s fractures, headless screws and bouquet fixation proved to be a safe and reliable treatment. The outcomes were similar in both groups.

Sex estimation is important in both forensic and archaeological cases and requires a variety of bones and measurements to obtain accurate estimates. Discriminant function analysis equations on postcranial elements are associated with population specificity, hence the need to generate equations for each population group. The current study examined the utility of the measurements around the nutrient foramen of the metacarpals for sex estimation from white South Africans. The study utilized 520 left metacarpals from 104 adult skeletons of white South Africans of known sex (53 males, 51 females) and age at death (range 21 to 65 years) obtained from the Raymond A. Dart Collection of Human Skeletons at the University of the Witwatersrand. Measurements that were subjected to stepwise and direct discriminant function analyses include total length, distance from proximal end to nutrient foramina, circumference, palmar-dorsal diameter, and mediolateral diameter at the level of the nutrient foramen. Combinations of breadth measurements of the first and second metacarpals produced high sex estimation scores ranging from 82% to 91% (stepwise discriminant function analysis) and 82–94% (direct discriminant function analysis) indicating that the dimensions around the nutrient foramen of the metacarpals are useful in sex estimation and can be used in fragmentary bones. [ABSTRACT FROM AUTHOR]

Introduction: Metacarpal shaft fractures (MSF) are common injuries that predominantly affect young, economically active people. However, there is limited evidence to guide their management. The aims of this study were to: evaluate the management of extra-articular MSF of the fingers; assess equipoise for surgical and nonsurgical treatments; and explore factors influencing clinician decision making to inform the design of a randomised controlled trial (RCT) comparing surgical and nonsurgical treatments., Methods: A cross-sectional, web-based survey was distributed to UK hand surgeons using membership directories of different professional networks. Practice setting, clinical experience, management strategies, willingness to participate in a RCT and factors affecting suitability for randomisation were recorded., Results: There were 108 responses eligible for analysis. Distribution of clinical experience ranged from <5 to >20 years. A variety of treatments were used for transverse, long oblique/spiral and comminuted MSF. Rotational deformity (90%), step-off deformity (5%) and angulation (5%) were the most important indications for surgical fixation. Acceptable limits of fracture angulation and shortening varied among surgeons. Over 85% expressed interest in participating in a RCT and most showed equipoise and were willing to offer operative or nonoperative treatment as part of a research study., Conclusions: This survey demonstrates that UK hand surgeons have varying views on treatments, acceptable parameters of deformity and indications for surgical fixation of displaced MSF. There is equipoise for surgical and nonsurgical treatments, variability in factors influencing clinical decision making and support for RCTs to investigate best practice.

Hand bones can reflect external factors during ontogenesis and individual life history. The goal of this study was to examine age-related changes in the 2nd metacarpal in adulthood. Metacarpal bones of archaeologically excavated adult skeletons from three different medieval burial sites-Cedynia (Poland), Brno-Vídeňská Street (Czech Republic), and Dětkovice-Za zahradama (Czech Republic)-were collected, described, and scanned by means of a flatbed scanner in standardized dorsal and radial positions into two-dimensional images. On them, four measurements (one length and three widths) were taken on each view and subsequently subjected to statistical regression methods in order to quantify their relationship with age at death. These trends were compared with those in a documented sample of the Athens Human Skeletal Reference Collection of the recent Greek population. In females, no significant relationship between the length of the 2nd metacarpal and age at death (AAD) was observed. In females, mostly positive relationships between width measurements and AAD were observed, ranging typically between 3 to 7% over 30 years, with maximum of ca. 9% in midshaft width in the right hand in dorsal view. These relationships were more statistically significant for the recent than for the medieval sample which might be attributed to differences in sample size, and the nature of AAD (documented vs. estimated). In males, relationships between width measurements and AAD (i.e., an increase with age) were also prevalently positive but much lower than in females and mostly not statistically significant. The systematic increase of the width measurements in females and the differences from males of the same samples suggest certain specificities of women's life histories in adulthood that would be worth further investigation in terms of the influence of external factors. Potential methodological biases due to the cross-sectional nature of the samples and sampling selectivity are further discussed. [ABSTRACT FROM AUTHOR]

Disseminated acanthamoebiasis is a rare, often fatal, infection most commonly affecting immunocompromised patients. We report a case involving sinuses, skin, and bone in a 60-year-old woman 5 months after heart transplantation. She improved with a combination of flucytosine, fluconazole, miltefosine, and decreased immunosuppression. To our knowledge, this is the first case of successfully treated disseminated acanthamoebiasis in a heart transplant recipient and only the second successful use of miltefosine for this infection among solid organ transplant recipients. Acanthamoeba infection should be considered in transplant recipients with evidence of skin, central nervous system, and sinus infections that are unresponsive to antibiotics. Miltefosine may represent an effective component of a multidrug therapeutic regimen for the treatment of this amoebic infection.

Turner Syndrome (TS) is a chromosomal disorder, wherein the female's growth is impacted. Immature ovaries, low stature, and heart abnormalities are a range of developmental and medical issues due to TS. The condition of TS might be detected prior to birth, throughout infancy or in the early years of life. The diagnosis of TS in girls with modest symptoms and indications is sometimes deferred until they reach adolescence or become young adults. This study presents an algorithm to segment the hand digital X-ray image in children with TS. In medical image and computer vision examination, image segmentation is demanding, and very crucial. Prevailing segmentation algorithms even now suffer from common segmentation issues including under-segmentation, over-segmentation, and spurious or non-closed edges, regardless of the several years of studies. In this paper, Anchor Based Link (ABL) segmentation approach is proposed to detect TS based on fourth Metacarpal bone from left hand X-ray images. The detection of TS is demonstrated based upon the comparison of proposed approach with existing watershed segmentation and Gaussian-Mixture-Model-based Hidden-Markov-Random-Field (GMM-HMRF) method. The proposed approach attains better segmentation based on the ratio of height and width of left fourth finger that is analyzed for normal children and children having TS with the help of edge pixel present in the metacarpal bone that has been segmented. The suggested method is verified on fifty (50) sample X-ray hand images of carpal bones, providing 0.60 ± 0.02 as an average Dice coefficient. [ABSTRACT FROM AUTHOR]

Complex metacarpophalangeal (MCP) joint dislocation is an uncommon entity, which occurs following a hyperextension injury. Closed reduction is not feasible due to entrapped volar plate and/or coexisting fractures. Various approaches and techniques have been proposed for treatment of complex MCP dislocation; however, controversies exist over which one is superior. This study describes a right-handed 14-year-old boy who fell on the outstretched hand and sustained a dorsal dislocation of the left index MCP joint. The dislocation was complicated by an epiphyseal metacarpal head fracture with dorsal-ulnar displacement of the osteochondral fragment. The patient underwent open reduction through the dorsal approach, and the metacarpal head was fixed via the two-screw technique. The patient resumed left-hand function after six weeks. At the two-year follow-up, the range of motion and grip strength were normal, the patient was pain-free, and no sign of growth disturbance or joint stiffness was detected. Dorsal surgical approach with screw fixation is a feasible technique for the treatment of complex MCP dislocation, especially when it is complicated by a large epiphyseal head fracture.

Purpose: The purpose of this study was to compare the clinical and radiological results of patients with fifth metacarpal neck fractures using different sizes and numbers of Kirschner wires (K-wire). Methods: A single institutional retrospective review identified 67 patients with a fifth metacarpal neck fracture between January 2015 and July 2020. The minimum follow-up time was 6 months and they were all treated within 6.4 days of the initial injury. Either one K-wire (1.6 mm), two K-wires (1.1 mm), or three K-wires (0.9 mm) was used. We analyzed the bone union period, and K-wire removal period, duration of surgery, total active motion, intramedullary diameter, pre/postoperative shortening, and pre/postoperative angulation clinically. We used a Method of Shortening Stipulated to measure shortening and the Medullary Canal-lateral view method for angulation. The intramedullary diameter was measured in the mid-shaft of the fifth metacarpal bone in the coronal view. Total active motion was measured at the time of follow-up in our outpatient department. Results: Clinical and radiological parameters showed no statistically significant differences. Even though it did not present a statistical significance, the absolute mean duration of surgery was the shortest in a single K-wire group. Conclusion: The clinical and radiological outcomes of surgery were comparable regardless of the number of K-wires inserted. However, we could look forward to gaining potential benefit from shortened operation time in a single K-wire group. Since stable fixation can be obtained even if one K-wire is used, inserting one thick K-wire into the intramedullary canal can be an alternative according to the surgeon's preference. [ABSTRACT FROM AUTHOR]

Introduction: Hand injuries metacarpal fractures are common and it accounts about 14 to 28%. Mini-plate fixation in unstable metacarpal fractures provides absolute stability and early mobilization of fingers to reduce complications. The purpose of this study is to find out the prevalence of open reduction and internal fixation with mini-plate and screws for management of unstable metacarpal fracture among hand injuries done in a tertiary care center. Methods: This was a descriptive cross-sectional study done from February 2019 and January 2021 in a tertiary care center with unstable isolated metacarpal fracture treated with mini-plate fixation and were followed up for six months duration. Ethical approval and informed written consent were taken from all patients. The outcome was assessed by the American Society for Surgery of the Hand Total Active Flexion Score. Convenient sampling method was used. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Statistical Package for Social Sciences used for analysis. Results: Out of 250 patients who underwent hand surgeries, open reduction and internal fixation with mini-plate and screws for unstable metacarpal fracture were done in 32 (12.8%) (8.66-16.94 at 95% Confidence Interval). The mean time of fracture union was 6.78±1.008 weeks. Functional outcome according to American Society for Surgery of the Hand Total Active Flexion score was excellent in 25 (78.2%), good in 6 (18.8%), and poor in 1 (3%) patient. Conclusions: Fixation of metacarpal fracture by mini-plate and screws was required in fewer patients. Mini-plate fixation provides better stability and early mobilization for unstable metacarpal fractures to achieve a good functional outcome.

Our study was carried out on a number of 200 metacarpals, each bone being determined the height and width of the middle of the diaphysis, as well as the width of its extremities (at the base and at the level of the head). The measurements were made using a radiant dicom viewer 64-bit program. Measurements were determined by sex and comparatively right/left, establishing the differences in each metacarpal between the specified dimensions. Metacarpal I we found a length in male between 33-50 mm, on the right side, and on the left side between 38-51 mm, in female the length being between 33-51 mm on both the right and left sides. The width at the level of the middle of the diaphysis, in male was between 4-13 mm on the right side and between 5-12 mm on the left side, in female, this width was between 7-12 mm on the right side and between 6-12 mm on the left side. Metacarpal II was found between 51-79 mm in male, both on the right and left sides, and in female the length was contained, both on the right and left sides, between 37-79 mm. The width in male was between 6-11 mm on the right side and 6-10 mm on the left side, and in female, this width was between 6-10 mm, both on the right and left sides. Metacarpal III was between 57-79 mm in male, both on the right and left sides, and in female the length was between 37-79 mm, both on the right and left sides. the width in male was between 6-11 mm on the right side and 6-10 mm on the left side, and in female, this width was between 6-10 mm, both on the right and left sides. Metacarpal IV we found a length in male on the right side between 49-73 mm, and on the left side between 48-73 mm, in female the length being between 46-73 mm on both the right and left sides. the width in male was between 5-10 mm on the right side and 5-11 mm on the left side, in female being between 5-9 mm, both on the right side and on the left side. Metacarpal V we found its length in male on the right side between 46-73 mm, and on the left side between 46-61 mm, and in female the length was between 43-67 mm on the right side, and between 44-67 mm on the left side. The width in male was between 5-11 mm, both on the right and left sides, and in female, this width was between 5-15 mm on the right side, and between 5-14 mm on the left side. [ABSTRACT FROM AUTHOR]

Between 2018 and 2020, 14 patients with closed metacarpal fractures requiring open reduction were operated on via a palmar approach. Reduction and fixation were done with screws or plates. We assessed range of motion, grip strength, Mayo score, possible nerve damage and cosmesis. The range of motion and grip strength were fully restored by 6 months after operation. Transient paraesthesiae in the digital nerve territory occurred in two patients and had resolved by 3 months. In selected patients the palmar approach for metacarpal shaft fractures can provide satisfactory cosmesis and function of the hand. This method can be useful in patients with history of hypertrophic scarring or in patients who would prefer to avoid a visible scar on the dorsum of the hand. Level of evidence: IV [ABSTRACT FROM AUTHOR]

There is a need for improved biomaterials for use in treating non-healing bone defects. A number of natural and synthetic biomaterials have been used for the regeneration of bone tissue with mixed results. One approach is to modify native tissue via decellularization or other treatment for use as natural scaffolding for tissue repair. In this study, our goal was to improve on our previously published alternating solution immersion (ASI) method to fabricate a robust, biocompatible, and mechanically competent biomaterial from natural demineralized bone matrix (DBM). The improved method includes an antigen removal (AR) treatment step which improves mineralization and stiffness while removing unwanted proteins. The chemistry of the mineral in the remineralized bone matrix (RBM) was consistent with dicalcium phosphate dihydrate (brushite), a material used clinically in bone healing applications. Mass spectrometry identified proteins removed from the matrix with AR treatment to include α-2 HS-glycoprotein and osteopontin, noncollagenous proteins (NCPs) and known inhibitors of biomineralization. Additionally, the RBM supported the survival, proliferation, and differentiation of human mesenchymal stromal cells (MSCs) in vitro as well or better than other widely used biomaterials including DBM and PLG scaffolds. DNA content increased more than 10-fold on RBM compared to DBM and PLG; likewise, osteogenic gene expression was significantly increased after 1 and 2 weeks. We demonstrated that ASI remineralization has the capacity to fabricate mechanically stiff and biocompatible RBM, a suitable biomaterial for cell culture applications.

Hand injury holds one of the first places among injuries of the musculoskeletal system in children. The share of fractures of metacarpal bones account for 10 to 35 % of all fractures, while for 1/5 of pediatric patients they are accompanied by injury to the growth plate. The existing classification of pediatric metacarpal fractures does not accurately reflect the nature and extent of damage to the growth plate; it underestimates or overestimates the nature of the fracture, the degree of displacement of fragments of metacarpal bones with the traditional approach to treatment, without taking into account the age-related anatomical and physiological characteristics of the traumatized child. Further scientific research on the diagnosis and treatment of traumatic injuries of metacarpal bones in children, the introduction of the results of these studies into clinical practice will contribute to improving the quality of care for patients with hand injuries and to preventing disability of the children.

Background: In forensic anthropological identification, we usually use body remains. Accurate sex estimation from these remains is very important and needs the knowledge of specific population standards of that area. Sometimes, human remains are damaged by environmental circumstances. So, we must examine single bones for sex estimation. One of the relatively resistant bones to environmental conditions are hand bones. Specific hand phalanges and metacarpals have significantly different dimensions in two sexes depending to each population and can be a helpful tool to estimate the gender of individuals. The aim of this study was to investigate the possibility of estimating gender using phalanges and metacarpals dimensions in Iranian people. Methods: This prospective study was conducted on the X-ray images of adult people hands between the months of March and September 2017. They referred to Shafayahyaian Hospital, the educational and referral center of orthopedic disease of Iran University of Medical Sciences, in Iran. 200 adult persons (100 male and 100 female) without any background of specific disease, entered in our study. In each case, the length of D: distal phalanx, M: middle phalanx, P: proximal phalanx, MC: metacarpal, Fl: finger length, and T: total (Distal phalanx+middle phalanx+proximal phalanx+soft tissue of the finger tip) were measured in millimeter and reported in ratio. All analyses were done using SPSS software, version 20 (SPSS Inc., Chicago, IL, USA). Results: Student t-test showed that many ratios were significantly different between two genders. It is concluded that the length ratio of metacarpals and phalanges could be used for sex determination. The most valuable ratios were FL1/FL3 and MC4/MC5. Multivariate logistic regression test reported an equation by which the gender is predictable. Z= 5.856+ -3.904 X FL1/FL3+ -1.865 X MC4/MC5. Conclusion: If “Z=0”, the gender is male and if “Z=1”, it is female without any doubt. In our knowledge, this study provides the first population sex estimation formulae from the hand bones in Iranian population. However, we need further studies in larger groups to use this equation for sex determination in forensic contexts.

Metacarpals are unique bones that support the finger to aid hand function. Metacarpals are also the commonest bones to get fractured in the hand. Historically, most metacarpal fractures were managed conservatively. Due to increased patient expectations as well as advancements in diagnosis and osteosynthesis, various surgical options are now available for metacarpal fractures. The goal of operative management of metacarpal management is no longer limited to achieving clinical or radiological union. To restore hand function to a preinjury level, the surgeon must achieve adequate anatomical reduction and stable fixation with minimal soft tissue damage. Similar to tendon repair, to start early active motion should be the goal after metacarpal fracture fixation. Intraoperative consideration should also include minimizing soft tissue damage and avoiding tendon, ligament or capsular entrapment. The aim of this article is to explain the principles of surgical management, the different options available for metacarpal fractures, the techniques, pearls, advantages and disadvantages of each technique, so the surgeon can choose the ideal option to achieve the best result. [ABSTRACT FROM AUTHOR]

This study investigated cross-sectional morphological differences in the diaphysis of the third metacarpal bone (MC3) between prehistoric Jomon hunter-gatherers and modern Japanese people. Overall, 179 skeletal remains of 119 individuals (73 men and 46 women) from the Middle-to-Final Jomon period (3500 BC–500 BC) and 60 modern Japanese people (35 men and 25 women) were included in the analysis. Analyses were performed at the mid-shaft of the MC3 using linear measurement, elliptic Fourier analysis, and cross-sectional geometric properties. The standardized polar section modulus (ZpSTD) indicated sexual differences in both populations. The right MC3 was generally stronger than the left side. There was no populational difference in the ZpSTD in both sexes. In both men and women, the cross-sectional shape of the MC3 was relatively larger in the dorso-palmar direction than in the radioulnar direction in the Jomon population compared to the modern Japanese population. Sexual differences in cross-sectional shape were recognized only in the Jomon population, with the dorso-palmar elongation being greater in Jomon men than in women (particularly when comparing the left MC3). There was a significant side difference in the diaphyseal shape among Jomon women, with the right MC3 being relatively larger in the dorso-palmar direction. These findings were consistent, although skeletal remains of the Jomon population were excavated from different regions. Differences in the diaphyseal cross-sectional shape between populations suggest differences in habitual loading on MC3 associated with differences in subsistence behavior. Furthermore, differences in diaphyseal shape and strength between Jomon men and women suggest sexual division of labor, with men performing bimanual tasks and women performing unimanual tasks. [ABSTRACT FROM AUTHOR]

Most fractures in the third metacarpal bone of equine athletes occur due to repeated cycles of high load magnitudes and are commonly generated during fast-training workouts. These repetitive loads may induce changes in the microstructure and mechanical properties that can develop into subchondral bone (SCB) injuries near the articular surface. In this study, we investigated the fatigue behaviour of local regions in SCB (near the articular surface i.e., 2 mm superficial SCB and the underlying 2 mm deeper SCB) under a simulated fast-training workout of an equine athlete. A fatigue test on SCB specimens was designed to simulate the fast-training workout, which comprised of repeated load cycles with varying load magnitude, representing the varying gait speed during a fast-training workout. The fatigue test was applied three times to each of the five cylindrical SCB specimens harvested from the left and right metacarpal condyles of five thoroughbred racehorses). All specimens completed at least one fatigue test. Three specimens completed all three fatigue tests with no visible cracks identified with Micro-CT scans. The other two specimens failed in the second fatigue test, and cracks were identified with Micro-CT scans in the various local regions. Using Digital Image Correlation (DIC) analysis, we found that in the local regions of all specimens, modulus decreased between load cycles corresponding to 68 and 93 MPa load magnitudes (equivalent to the fastest gallop speed). Wherein specimens that failed exhibited a greater decrease in modulus (in superficial SCB by 45.64 ± 5.66% and in deeper SCB by -36.85 ± 10.47% (n = 2)) than those not failed (in superficial SCB by -7.45 ± 14.62% and in deeper SCB by -5.67 ± 7.32% (n = 3)). This has provided evidence that the loads on SCB at galloping speeds are most likely to produce fatigue damage and that the damage induced is localised. Furthermore, one of the failed specimens exhibited a peak in the tensile strain rather than compressive strain in the superficial region with a rapid decrease in modulus. In addition, the superficial region of all specimens exhibited greater residual tensile strain than that of the deeper region., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Analyses of external bone shape using geometric morphometrics (GM) and cross-sectional geometry (CSG) are frequently employed to investigate bone structural variation and reconstruct activity in the past. However, the association between these methods has not been thoroughly investigated. Here, we analyze whole bone shape and CSG variation of metacarpals 1-5 and test covariation between them., Materials and Methods: We analyzed external metacarpal shape using GM and CSG of the diaphysis at three locations in metacarpals 1-5. The study sample includes three modern human groups: crew from the shipwrecked Mary Rose (n = 35 metacarpals), a Pre-industrial group (n = 50), and a Post-industrial group (n = 31). We tested group differences in metacarpal shape and CSG, as well as correlations between these two aspects of metacarpal bone structure., Results: GM analysis demonstrated metacarpus external shape variation is predominately related to changes in diaphyseal width and articular surface size. Differences in external shape were found between the non-pollical metacarpals of the Mary Rose and Pre-industrial groups and between the third metacarpals of the Pre- and Post-industrial groups. CSG results suggest the Mary Rose and Post-industrial groups have stronger metacarpals than the Pre-industrial group. Correlating CSG and external shape showed significant relationships between increasing external robusticity and biomechanical strength across non-pollical metacarpals (r: 0.815-0.535; p ≤ 0.05)., Discussion: Differences in metacarpal cortical structure and external shape between human groups suggest differences in the type and frequency of manual activities. Combining these results with studies of entheses and kinematics of the hand will improve reconstructions of manual behavior in the past., (© 2023 The Authors. American Journal of Biological Anthropology published by Wiley Periodicals LLC.)

Reduction in cortical bone mineral density at diaphysis of metacarpal bones of the hand, evaluated by dual X-ray radiogrammetry, has a bad prognostic value in patients with early arthritis. Nevertheless, this technique is hardly accessible in clinical practice. By contrast, evaluation of cortical bone mineral density at that location has not been previously assessed by conventional dual X-ray absorptiometry. The aim of this study is to evaluate the reproducibility of bone mineral density measurements at diaphysis of metacarpal bones using conventional dual X-ray densitometry in a population of healthy volunteers and patients with early arthritis. Nondominant hand dual X-ray densitometry was performed at three consecutive times with complete hand replacement in 27 subjects: 10 early arthritis and 17 healthy volunteers. Three different evaluators analyzed the 3 measurements of second to fourth metacarpal bones. To assess the reproducibility and accuracy of the measurements, intra- and interobserver agreement degrees, intra- and interclass correlation coefficients, smallest difference detectable assessment, and Bland Altman graphs were calculated. The coefficients of variation obtained for the different metacarpal evaluations were 2.25%, 2.91%, 2.85%, and 2.07% for metacarpal-2, metacarpal-3, metacarpal-4, and mean metacarpal-second to fourth, respectively, with a smallest difference detectable of 0.028, 0.034, 0.028, and 0.03 g/cm2, respectively. The mean intra- and interobserver correlation coefficients between of metacarpal second to fourth were 0.990 (95% confidence interval [CI]: 0.982–0.995) and 0.995 (95% CI: 0.991–0.997), respectively. As expected, women had lower bone mineral density at metacarpal bones, especially after menopause. The results obtained in this study show an excellent reproducibility of bone mineral density measurements at diaphysis of metacarpal bones of the hand, measured by conventional dual X-ray densitometry, in a mixed population of healthy subjects and patients with early arthritis. This is of great interest for longitudinal studies in patients with early arthritis. [ABSTRACT FROM AUTHOR]

• Metacarpal bone fractures represent one-fifth of upper extremity fractures. • Different technique has been described for fracture fixation with K-wires being the most described technique. • We present a new technique utilizing k-wires to reduce and fix metacarpal fractures in an easy less traumatic way aiming to optimize the clinical outcomes in regards of range of motion and stiffness with important remarks to learn from this technique. Metacarpal bone fractures represent one-fifth of upper extremity fractures. The most commonly affected bone was the fifth metacarpal also known as boxer's fracture with a range 9.7–50%. Different techniques have been described for fracture fixation with K-wires being the most described technique. In this paper, we present a new technique utilizing k-wires to reduce and fix metacarpal fractures in an easy less traumatic way aiming to optimize the clinical outcomes in regards of range of motion and stiffness. Retrospective chart review including all the patients that were managed with the new technique. 24 fractures were fixed with the new technique without violating the MCP joint with different fingers involvement and different presenting deformity. At the end of the splinting time, 80% of the cases had full ROM at the time of splint removal. The remaining 20% had some stiffness that improved with further physiotherapy. This approach is easy to teach, fast with good clinical outcomes. However, a larger sample size study comparing this technique to the existing treatment options is needed. Case Series and literature review, Level IV. [ABSTRACT FROM AUTHOR]